OSTEOPATH^^ 
 
 -ZZARD.
 
 v^i-^/ 
 
 7 
 
 l^j^ 
 
 v^/^( 
 
 U 
 
 J 
 
 L^ 
 
 / [-pL^^h^ 
 
 -^^^<^^jU
 
 \^A^, ^cLi^ /Kjl^ 
 
 S.^.O. J/^^UJ%j^oL 
 
 THK 
 
 PRACTICE '# APPLIED THERAPEUTICS 
 
 -OF- 
 
 . . O S T E O !> A T H Y . . 
 
 BY- 
 
 CHARLES HAZZARD, t»H. B. D. O.. 
 
 Professor of the Practice and of the Principles 
 
 of Osteopathy. 
 
 AMERICAX SCHOOL OF OSTEOPATHY 
 
 KIRKSVILLE, MISSOURI. 
 
 Copyright, 19OO. 
 
 by 
 Charles Hazzard.
 
 \/
 
 PART I. 
 
 GENERAL METHODS.
 
 
 PREFACE. 
 
 ) The matter contained in this volume was delivered as a course of lec- 
 
 tures. In order that the classes might have lectures in printed form as the 
 
 1 work progressed, they were printed and distributed in weekl\' lots, but in 
 />og such form that at the end of the course they could be bound and preser\'ed. 
 
 The work being printed piecemeal in this wa}' explains why there occur 
 various blank pages through the book. They will, however, be found use- 
 ful for annotations. 
 
 As the lectures were delivered in conjunction with daily quizzes in the 
 ~^ symptomatolog)' of the diseases considered, the standard texts upon Prac- 
 tice of Medicine being used, it was manifestly desirable to omit from this 
 work all the matter so easih' accessible in those writings. This plan left 
 the author free to devote these pages entirely to osteopathic considerations, 
 intending that this work should be used in conjunction with any standard 
 text of medical practice. 
 
 No special attempt has been made to follow the usual classification of 
 diseases closely, for various reasons. Likewise, no effort has been made to 
 cover every disease known. It is hoped, however, that the effort to repre- 
 sent the osteopathic view of disease and the osteopathic mode of treatment, 
 even upon this limited scale, may not have been in vain. 
 
 Charles Hazzard. 
 
 Kirksville, Mo., Jan. 15, 1901. 
 
 i
 
 
 
 ERRATA 
 
 . 
 
 
 
 10. 
 
 div. 
 
 XIV, 
 
 read 
 
 'supine" 
 
 for 
 
 "prone." 
 
 »9. 
 
 ■1 
 
 I. 
 
 II 
 
 II 
 
 " 
 
 II 
 
 20, 
 
 <i 
 
 VIII, 
 
 >i 
 
 " 
 
 II 
 
 " 
 
 20, 
 
 i< 
 
 IX (I) 
 
 >i 
 
 " 
 
 " 
 
 " 
 
 22, 
 
 " 
 
 II. 
 
 II 
 
 (1 
 
 II 
 
 11 
 
 23. 
 
 II 
 
 n, 
 
 " 
 
 II 
 
 11 
 
 It 
 
 24, 
 
 
 line 7, 
 
 " 
 
 II 
 
 II 
 
 " 
 
 27. 
 
 
 " 5. 
 
 " 
 
 II 
 
 " 
 
 •' 
 
 30. 
 
 div 
 
 VI, 
 
 " 
 
 " 
 
 II 
 
 11 
 
 30, 
 
 " 
 
 VII, 
 
 read 
 
 'prone" 
 
 " 
 
 "supine." 
 
 30, 
 
 11 
 
 VIII, 
 
 " 
 
 " 
 
 " 
 
 " 
 
 30, 
 
 II 
 
 IX, 
 
 II 1 
 
 'supine" 
 
 " 
 
 "prone." 
 
 32, 
 
 " 
 
 (4) 
 
 " 
 
 " 
 
 " 
 
 " 
 
 32, 
 
 
 last line 
 
 II 
 
 "points" 
 
 " 
 
 "portion." 
 
 35. 
 
 
 line 8. 
 
 " 
 
 "supine" 
 
 " 
 
 "prone." 
 
 36, 
 
 div. 
 
 VI 
 
 " 
 
 " 
 
 " 
 
 " 
 
 227, 
 
 " 
 
 3. 
 
 II 1 
 
 'superior" 
 
 " 
 
 "inferior."
 
 CHAPTER I. 
 Examination of the Spine. 
 
 Inspection, percussion and palpation are the methods employed by the 
 practitioner. Of these, the latter is used almost entirely. Attention must 
 be given to the position of the patient, changing it as required for the best 
 detection of the various lesions for which examination is being made. For 
 example, lateral deviations of vertebrae and departures from normal curva- 
 ture of the spine are best detected while the patient is sitting. Points of 
 separation between spinous processes, thickening of posterior spinal liga- 
 ments, rigidity of the spine, etc., are most readily made out while the 
 patient is lying upon the side. 
 
 The back must be bared in examination. For ladies, a loose ^own 
 buttoned down the front and back may be convenientl)' used. 
 
 By the methods mentioned above the examiner searches for certain 
 definite lesions, as follows: 
 
 Inspection reveals the color of the skin; rashes, which may indicate 
 disease; the presence of curvature; unequal muscular development; scars, 
 strains, and excoriations leading to inquiry regarding accident, injury, oper- 
 ation or the use of poultice. 
 
 Inspection may be made with the patient sitting. 
 
 Palpation is our most important method of examination, the trained 
 touch revealing to the Osteopath most of the lesions which he regards as 
 the causes of disease. 
 
 With the patient sitting slightl)- bent forward, the arms folded loosely 
 or the hands resting lightly on the knees, the examiner stands behind the 
 patient and passes his two index fingers, or the index and second fingers of 
 the examining hand, carefully down the opposite sides of the vertebral 
 spines, he notes: 
 
 I. Single vertebrae or groups of vertebrae which may be deviated later- 
 ally from normal position. In such case there is usuall}-. though not always, 
 tenderness in the tissues upon the side of deviation, owing to the irritation 
 by the process. 
 
 II. Lateral swerving or sagging of an)- portion of the spine. 
 
 III. Any exaggeration, deviation from or lessening of the normal curves 
 of the spine. The most common of these are a flattening of the spine anter- 
 iorly at the dorsal curve between the shoulders, a flattening of the spine pos- 
 teriorly at the lumbar curve, these two lesions together causing the so 
 called "straight spine." 
 
 IV. Sharp friction, made by passing the hand quickly down the spine, 
 reddens the tips of the spinous processes so that one may then count them 
 or note their alignment.
 
 6 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 y. The flat of the hand is passed down over the posterior aspect of 
 the sacrum and detects any flattening or bulging thereof. It is also passed 
 over the posterior superior iliac spines, noting their degree of prominence 
 and comparing them with each other relatively to the sacrum. 
 
 VI. The cushions of the examining fingers are pressed deepl)- into the 
 sacro-iliac spaces to detect any abnormal tension in the superficial or deep 
 tissues. 
 
 \TI. The index finger follows the course of the coccyx to its tip, noting 
 any lateral, anterior, or posterior deviation. 
 
 \TII. The inde.x finger is carefully passed down the spine upon the 
 spinous processes, pressure being made firml)' upon each, to detect either 
 anterior or postcyior projection of vertebra;. 
 
 IX. The tctnpcrature of the back is found h\ passing the palm of the 
 hand evenly over it. Vaso-motor disturbances, resulting in lowered or in- 
 creased temperatures of certain areas, may be thus discovered. Frequently 
 a cold area may be traced diagonally backward and upward along the course 
 of the spinal nerves toward the seat of some lesion 
 
 The patient is now placed upon his side in an easy position, the ex- 
 aminer stands at the front of the patient, and passing his hands over to the 
 spine, continues the examination. 
 
 X. The cushion of the examining finger, which is held at rigiit angles 
 to the spinal column, is carefull)- pressed deeply into the space between 
 each successive pair of spinous processes. It discovers an\ sepataiion or 
 approximation of processes, thus of vertebrae. 
 
 Points of anatomical weakness are frequentl)' found at the junction of 
 the ticclfth dorsat with the first lumbar vertebra, also at the junction of the 
 fifth luryibar \\\\.\\ the sacrum. 
 
 The fifth lumbar is often prominent posteriori)-, but is also very apt to 
 be luxated anteriorlw 
 
 XI. The examining hand is passed slowly along the spinal column to 
 note an}- general or local thickening and increased tension in the posterior 
 spinal ligaments which results is partially obliterating the space between 
 the spinous processes, and in producing the so-called "5W(7t?//^.f/!>/;^a/ r^j/z^wM." 
 
 XII. The examining fingers are pressed firmly into the spinal muscles 
 and moved transerversely to the course of their fibres for the purpose of 
 detecting an)' z}qx\oxvc\2\ hardening or coyitracticring of them. Contractures 
 generally affect certain sets of fibres rather than the muscle as a whole. 
 The)' may be situated in the superficial or in the deep muscles, and ma)' be 
 priynary or secondary according as they are produced b)' direct or indirect 
 lesion of the fibres. 
 
 Xlil. The body of the patient is braced against that of the practitioner, 
 who places the fingers of both hands upon the under side of the row of 
 spinous processes, (the patient lying on his side) and draws the spine
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 7 
 
 fo«"cibly toward him, noticing whether the spine be rigid, or too greatly ;'<?- 
 laxed. 
 
 It must be borne in mind that bony lesions are not alone important. 
 Ligamentous iesions are quite as much so, and though they are not so gen- 
 erally discernible as are the former, the student must not forget that follow- 
 ing upon and consequent to bony lesion they may bring pressure upon 
 important structures, may thus interfere with the functions of blood-vessels, 
 nerves, etc., and become a fruitful source of ill.. 
 
 Percussion, Pressure and Motion may be emplo)'ed in the examina- 
 tion of the spine, and may sometimes reveal deep tenderness or pain in the 
 tissues which has escaped notice by the other methods. 
 
 Upon motion, certain sounds are heard in various parts of the column, 
 due to the motion of parts upon each other. These seem to occur most fre- 
 quently in the neck, between the articular processes, and in the lumbar 
 region, between the bodies of the vertebrae They may occur anywhere 
 along the spine and are of diagnostic value in indicating relaxation of liga- 
 ments, interference with blood -supply, resulting in insufficient secretion of 
 synovial fiuid, or malposition of bony parts.
 
 CHAFTKR II 
 Treatment of the Sfmne. 
 
 In lliis chapter it is proposed to outline the general method of pro- 
 cedure in spinal treatment As no specific case or disease is now under 
 consideration, the student must bear in mind that the treatments described 
 are general methods of work and that, in any given case, he would find it 
 necessary to select and combine these different modes in a manner best 
 calculated to enable him individually to reach the case. 
 
 As far as practicable the specific lesions nu-ntioned in chapter I will 
 be considered, and treatments appropriate to their reduction will be given. 
 
 These treatments are all manipulative. They have as their object the 
 righting of what is mechanically wrong They are therefore mechanical of 
 necessity, and are founded upon the necessities of the human mechanism 
 when deranged. 
 
 In treatment, the practitioner may have in view either or both of two 
 objects. He works to right the spine itself, and to affect it alone, or he 
 works upon the spine to affect some other part of the body pathologically 
 connected with the part of the spine in question. 
 
 I. The patient lies upon the ventral aspect oi the body in as comfort- 
 able a position as possible. The head turns easily to one side, and the arms 
 hang down loosely at the sides of the table. The practitioner must see that 
 the patient thoroughly' relaxes the muscles of the whole body. He now, 
 standing at the side of the patient, uses the palms of the hands or the 
 cushions of the fingers to thoroughly manipulate and relax all the spinal 
 muscles. In treating the muscles upon the side toward him, he works from 
 one end of the spinal column to the other, in a direction at right angles to 
 the general direction of the muscular fibres. He treats the muscles of the 
 opposite side by spreading them away from the spinous processes. 
 
 In this wa)' all contraiturs of the muscles are released, yfa^^' muscles are 
 toned, <^/i?i7rf ««(/ wrrzr mechanisms are freed and upbuilt. Thus removing 
 of contractures is sometimes a necessary preliminary step to the diagnosis 
 of deeper lesions which ma)- have been masked b\- them 
 
 II. The patient lies upon his side, the practitioner stands a^ the side 
 of the table, in front of the patient, with one hand he grasps the upper- 
 most arm of the patient just above the elbow; with the other hand he holds 
 under the spinous processes of any portion of the spine under treatment. 
 Now, using the arm as alevet, he pushes it downward and forward, at the 
 same time springing the spine toward him. 
 
 This treatment releases tension in all deep structures, restores free-play 
 between bony parts, and removes pressure from blood-vessels and nerves. 
 It may be applied in all cases of curvature^ sagging or swerving of a portion
 
 PRACTICE AXD APPLIED THERAPEUTICS OF OSTEOPATHY. Q 
 
 oi the spine, /aferal dez'iafwns of vertebrae, in separating or approximating 
 vertebrae, etc. 
 
 III. Practicall)' the same effect may be obtained upon the lower por- 
 tion of the spine as follows; with the patient still upon the side, his thighs 
 and legs are flexed, and fixed by pressure of the abdomen of the practitioner 
 against them. Both hands are now free and spring the spine strongly up- 
 ward toward him, or manipulate the muscles; or 
 
 IV. With the patient still l>'ing upon his side, the practitioner leans 
 over him, placing his forearms, one against the iliac crest and the other 
 against the shoulder. He now with his forearms pushes these two points 
 further apart, while with both hands he springs the middle portions of the 
 spine toward him, or manipulates the muscles. 
 
 It will be observed that the treatments described under II, III and IV 
 above all may be used to thoroughly stretch any portion of the spine by 
 laterally directed force. In this way deeper stretching of all spinal struc- 
 tures may be accomplished within the limits of safety than b)' stretching 
 the spine as a whole by longetiidinal traction. 
 
 V. The latter is applied with the patient lying upon his hack; the 
 practitioner, standing at the head of the table, passes one hand beneath the 
 occiput, the other beneath the chin, and draws toward him. The required 
 degree of resistance is offorded by the weight of the patient or by an as- 
 sistant holding the ankles. 
 
 The neck must not be rotated during this forcible tension, and jerking 
 must be a\oided. 
 
 VI. The principle of exaggeration of the lesioii is one that ma)' be ap- 
 plied to the treatment of man\' bony luxations. It consists in so manipulat- 
 ing the parts as to tend to further increase their malposition, and in then 
 applying pressure to them in such a direction as to force them back toward 
 normal position at the same time as the part in question is released from its 
 condition of exaggeration. 
 
 This motion releases tension, loosens adhesion, and gains the benefit 
 of the natural recoil of the structures from their exaggerated position. 
 
 VII. With the patient prone and the practitioner kneeling tipon the 
 table at one side of the patient, or with a knee upon either side, direct pres- 
 sure ma\' be applied, from above downward, to all spinal parts. This posi- 
 tion of relaxation is favorable for forcing vertebrae or the, heads of ribs in- 
 to place and for the stretching of the deep and anterior spinal ligaments. 
 
 VIII. The patient lies across the table with the abdomen and anterior 
 chest resting upon it, the arms and head hanging loosely down upon one 
 side and the legs upon the other. The practitioner may stand at either 
 side of the table (or kneel upon it,) and work for results as in VII, with the 
 additional advantage that the arms, neck, or limbs ma)' be manipulated at 
 will in the course of the treatment. 
 
 IX. The patient sits, the practitioner stands in front, slightl)^ to one
 
 10 fKACTICE AM) AFPLIKD THERAPEUTICS OF OSTEOPATHY. 
 
 side. He passes the arm nearest the patient back ot the neck, and slips his 
 hand under the 0|)posile axilla. This bends the neck and upper spine for- 
 ward and swings the opposite side of the thorax backward, thus rotating the 
 spine. By using the free hand as a fixed point at various points along the 
 spine, its successive portions may be thoroughly rotated and all of its 
 structures loosened. 
 
 X. The patient sits; the ^)ractitioner stands behind, pushing the head 
 forward and to one side with one hand, while with the other he makes fixed 
 points along the upper spine, upon the side from which the head has been 
 forced. The head is now swung forward and to the side opposite its first 
 position while the hand brings pressure upon the fixed points, one after the 
 other. This motion makes us<t oi the neck as a lever of the first class, the 
 fulcrum being formed b)' the hand at the fixed point, with the lesion (weight) 
 below, and the power (hand applied to the head) above. It is a method of 
 "exaggeration the lesion," and is especiail)' useful for the reduction of 
 lateral luxations in the upper part of the spine. 
 
 XI. Th" patient sits and ciasps his hands around his ncck\ the practi- 
 tioner stands behind, passes his arms beneath the axillae and his palms be- 
 hind the patient's wrists, which he grasps in his hands. He now places one 
 foot upon the stool and presses the flat of the knee against the back at one 
 side of the spinous processes. As the practitioner straightens his body and 
 draws the patient back against his knee the neck and upper dorsal spine 
 are bent forward, the middle and lower portions of the spine are pressed 
 forward by the knee, the r:capulae travel back and up, and all of the ribs, 
 except the first three or four pairs which are sprung forward and downward, 
 are drawn strongly backward and upward. 
 
 This treatment thoroughly stretches most of the spinal ligaments, 
 costo-spinal ligaments, muscles of the back of the neck, scapulae, and of the 
 spine. It also brings tension upon most of the intervertebral, the costo- 
 vertebral, the costo-sternal, acromio chiricular and claviculo sternal articu- 
 lations. 
 
 XII. With the patient sitting, the practitioner, standing behind, may 
 place one icnce beneath the patient'' s axilla, thus raising and fixing the shoulder 
 and the ribs of one side of the thorax. This relieves the spine of the 
 weight of these structures and affords the practitioner two free hands with 
 which he ma\' manipulate the spine or opposite side of the thorax, using 
 the neck and other arm of the patient as levers, if desired. 
 
 XIII. The ligaments of the posterior lumbar and of the sacro iliac regions 
 may be thoroughly relaxed b>' bending the bod\' of the patient, who is sit- 
 ting far forward between his well separated knees. • 
 
 XIV. The same object is accomplished with the patient '^ tfhc , while 
 the legs and thighs are both forcibly flexed to their limit. 
 
 XV. To stretch the posterior scapular, rhomboid, and levator an^uli scap- 
 ulae muscles, the patient lies upon his back, while the practitioner slips one
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. II 
 
 hand beneath the shoulder and grasps the spinal edge of the scapula, which 
 has been approximated as closely as possible to the spinal column. The 
 other hand holds the arm of the patient just above the elbow, and the arm 
 is raised and pushes across the che.st, the patient's hand being in this way 
 forced across well into to the opposite axilla. 
 
 XVI. With the same position of the patient, the anterior scapular mus- 
 cles may be reached by thrusting the fingers of one hand deeply beneath the 
 spinal edge of the scapula, while the other hand grasps the point of the 
 shoulder. Now the whole lateral half of the shoulder-girdle may be rotated, 
 the first hand continually working deeper beneath the scapula. 
 
 XXII. A thorough ^'breaking up" of the lower dorsal and lumbar 
 regions of the spine is accomplished as follows: The patient lies prone; 
 the practitioner stands at the side and passes one arm beneath the thighs of 
 the patient, just above the knees which he raises just free of the table 
 moving them horizontally from side to side. At the same time his free 
 hand is applied to the part of the spine in question, the thumb upon one 
 side of the spinous processes, the fingers upon the other. The thumb and 
 fingers make lateral pressure upon the spine, alternating with, and in a con- 
 trary direction to, the movement of the limbs. 
 
 This treatment loosens and separates the vertebr^t, releases tension of 
 muscles and ligaments, and upbuilds nerve and blood action. 
 
 Very many more treatments might be described, but enough o-eneral 
 treatments have been given to reach all parts of the spine and to correct 
 the lesions that are likel\- to be met with in practice. These treatments 
 may be combined, or ma)' be taken for the basis of new ones which the 
 practitioner ma}' often find necessary to work out in order to reach some 
 special lesion or to treat some special case. 
 
 In this portion of the text, the treatments can of necessity be described 
 and their application be given, onl)- in a general wa)-. They are outlines of 
 methods of procedure, and the application of the principles embodied in 
 them must be made to the specific lesion met with in a given case by the 
 practitioner. 
 
 The lesions described in Chapter I, such as lateral deviation of a \er- 
 tebra or lateral swerving of a portion of the column; vertebrae separated or 
 approximated; anterior or posterior luxations of vertebr^t; the "smooth 
 spine"; the loss of normal curvature; the rigid or relaxed spine, etc., may 
 all be reduced b)' various applications of these treatments. 
 
 Generally speaking, the results attained by the use of these treatments 
 are, the relaxation of contractured muscles; the release of tension in nerve 
 muscle, ligament or other fibrous structure; the reduction of bon\- lesion- 
 the removal of obstruction from, and the renewal of, blood and nerve cur- 
 rents. 
 
 XVIII. Thejiflh lumbar vertebra, after luxation, ma)' be restored in 
 various ways. 'Y\\q. posterior displacement xs \.\i& most frequent. In this case
 
 \2 PRACTICE AND APPLIED THERAPEUTICS OE OSTEOPATHY. 
 
 one ma\- place the patient upon his side, flex the knees against the abdo- 
 men, fix the fifth hinibar b>' holding beneath it with one hand, while with 
 the other beneath the thighs the weight of the body is rotated about the 
 fixed point. Recent dislocations maybe adjusted in this way without dif- 
 ficulty. In long standing cases continued treatment is necessar\', the work 
 of relaxation of parts etc.. in preparation for its reduction, being performed 
 in part by the application of principles already described. 
 
 With the patient upon his back and the body below the fifth lumbar 
 protruding over the foot of the table, the practitioner standing between the 
 limbs and holding one under each arm, places both hands beneath the pel- 
 vis, makes a fixed joint at the fifth lumbar, and by the movement of his own 
 body, rotates the lower part of the patient's body about the fixed point. 
 
 With the patient upon his back, the practitioner standing at one side, 
 the clenched hand is placed beneaih the bod\- at one side of the fifth lum- 
 bar spine. The leg and thigh are now strongly flexed b\' the free hand, 
 external circumduction of the thigh is made, and the weight of the body is 
 thrown onto the fixed joint. In some cases this treatment is sufficient for 
 replacing the bone. 
 
 In case the vertebra be anterior the above treatments may be applied to 
 the case for the purpose loosening all the ligaments. 
 
 Also the principle of exaggerating the lesion may be applied by mak- 
 ing a fixed point of the practitioner's knee \X. the fifth lumbar, the pati nt 
 sitting. The patient's body is bent backward against the fixed po'nt and 
 then rotated forward. Also, with the patient sitting and the fifth lumbar 
 fixed with one hand, the free arm grasps the body of the patient and ro- 
 tates it about the fixed point. The bodies of the vertebra may be thus 
 warped or slightly moved upon each other, drawing the bone back to place. 
 
 Jn man)- long standing cases of bony lesion, the strengthening of the 
 surrounding muscles and ligaments must take place and be depended upon 
 to hold the ground gained as the part is gradually, during a course of 
 trea jjTTent, brought back towards its normal position. 
 
 XIX. In case the sacnim be found to be anterior or posterior from its 
 normal position, this is a matter partl\' relative to the position of the in- 
 nominate bones, luxations of which will be discussed later. 
 
 In cases of posterior protrusion, after relaxation of the sacro-iliac lig- 
 aments, pressure may be made with the keee directly upon the sacrum from 
 behind, with the patient either sitting or Ixingupon his side. At the same 
 time the pelvis and the upper parts of the body are drawn strongly back- 
 wards. 
 
 XX. In restoring the coccyx to normal position both external and rec- 
 tal treatment may be necessary. In some cases external treatment alone 
 will be sufficient. The sacro-cocc\geal articulation is generallj- quite pli- 
 able. In ^A7fr«rt/ treatment attention must be first given to the relaxation 
 of the muscles and fibrous tissues concerned. The bone may then be
 
 PRACTICE AND AI^FMED THERAPEUTICS OF OSTEOPATHY. I 3 
 
 grasped and moved or sprung from either side toward the median line, may 
 be forced anteriorl}-, or the finger may be gently inserted beneath its tip 
 and may draw it back toward its natural position. 
 
 J^eda/ ^reahnefii should not be ^iven ohener than once a week or ten 
 da)S. The patient lies upon his side or bends over a table. The index 
 finger, anointed with vaseline or other oil is inserted, palm down, into the 
 rectum. It is then turned palm up, laid along the hollow of the coccyx, 
 and swept from side to side, to free the action of blood-vessels and nerves. 
 With the finger in the rectum and the thumb outside, the bone may be 
 grasped and moved toward any position necessary. As a rule its restora- 
 tion to a normal position is only gradually accomplished.
 
 CHAPTER III. 
 Examination of the Neck. 
 
 Inspection and palpation are the two phy.sical methods used in exam- 
 ination of the neck. 
 
 Inspection reveals scars due to wounds, and suggests a history of acci- 
 dent or operation. The general conformation of the neck should be noted. 
 
 Upon the anie; tor aspeci may he seen enlargement due to increase in 
 the size of the tonsils or of the lymphatic glands; abnormal pulsations or 
 engorgement of the blood-vessels; an enlarged thyroid gland. 
 
 Upon \.\),e posterior aspect may be found enlargement of the muscles or 
 thickening of the tissues. Frequently an inequality of the tissues in and 
 below the sub-occipital fossse, due to thickening or to bony lesion, 
 occurs. 
 
 Any unnatural position in which the head may be held should be noted. 
 
 Palpation is here, as elsewhere, the important method of examination. 
 For convenience the anterior structures may be examined first. The patient 
 lies prone, relaxing the neck as much .is possible. This object may be 
 aided by the practitioner, placing one hand upon the forehead and gently 
 rolling the head from side to side, while with the other he lightly manipu- 
 lates the muscles of the neck. 
 
 A. Anterior Structures. 
 
 I. The tonsils are located by pressure of the fingers just below the 
 angles of the inferior maxillary bone. Any enlargement or tenderness of 
 the organ is to be noted. 
 
 II. Tender points, frequent in catarrhal conditions, are found by deep 
 pressure behind the angles of inferior maxillary. 
 
 III. The hyoid bone is located by pressing all the soft tissues just below 
 the jaw toward the median plane of the body. This causes a prominence 
 of the greater cornu upon the opposite side of the throat, which may be 
 easily detected by the index finger. 
 
 The finger remains upon the cornu and pushes it back toward the op- 
 posite side, thus making prominent the greater cornu of that side. With 
 the index finger and thumb upon the cornua, it may be moved about and a 
 diagnosis of its position be made. 
 
 IV. The hyoid muscles, superior and inferior, are now carefully palpated 
 to discover contracture, hypertrophy, congestion or tenderness in them. In 
 public speakers, singers, and others liable to throat disease the superior 
 hyoid muscles are often in pathological condition. 
 
 V. From the hyoid region palpation is carried down over the thyroid 
 and cricoid cartilages, noting whether their condition be normal, and is ex-
 
 I<, IKACTICK AND AfPIIKO THEKAPEUTICS OF OSTEOFATHV. 
 
 teiuicd alops the shoulder to the root of the neck. In this examination the 
 parts are graspecl between the thumb and fingers of the examining hand 
 and are moved from side to side. At the same time deep but gentle pres- 
 sure is made at either side of the lar\nx and trachea in order to note any- 
 undue U-tidinit'ss in the Ian ngcal nerves 'a^ generally revealed by an impulse 
 upon the part of the patient to cough or swallow, inunobility ox harshness of 
 sound \.\\iOv\ motion of these parts as above abnormal tension in the related 
 muscles and other tissues. 
 
 \1. Enlargement or wasting of the thyroid trland ox enlargement of the 
 drvical Ixmphatii glands must be noted. 
 
 \'1I. '\\\c stertio mastoid xx\\\%c\c is made prominent by causing the 
 patient to turn his head to the opposite side Pressure deep behind the 
 anterior border of this muscle impinges upon \.\\*t pneumogasttic nerve. Ten- 
 derness in it upon pressure ma)- accompany liver or stomach disease. 
 
 \'11I. The />///vf;/7f w^TZ'^ arises from the third, fourth, and fifth cervical 
 nerves, and may, at its points of origin, be pressed backward against the 
 bony column. It may be reached also by deep pressure with the thumb or 
 finger in the angle formed by the posterior edge of the sterno-mastoid mus- 
 cle with the upper margin of the clavicle. This pressure must be directed 
 from above diagonall\- downward and forward toward the sternum. 
 
 I X . Press H re of th e h ea d direct I;} ' doTi'nTvard upon the spinal column with 
 rotation, will sometimes discover deep pain at points of lesion. 
 
 X. The posterior structures of the neck may be tested for abnormal 
 tension by flexing the head upon the thorax, the patient prone. 
 
 XI. The palms of tne hands may be passed evenly over the surface of 
 the neck to examine for variations of temperature. Hot or cold areas may 
 be found. It is common to find an area of increased temperature at the 
 base of the skull behind. 
 
 H. rOSTEKIOK AND LaTERAI StRUCTUKES. 
 
 I. With the patient sitting, the practitioner passes the examining hand 
 down along the back of the neck. Just below the occiput is a depression 
 in which he ma)' feel the upper end of Xh^ ligament \)n niichae and the inner 
 borders of the trapezius muscles. With the head bent slightl)' forward and 
 the examining fingers pressed deeply- into this space abnormal tension of 
 these structures ma)' be noted. 
 
 JI. The second eer-cical spine is the first bony prominence felt below the 
 occiput. The spines of the third, fourth and fifth are made out with diffi- 
 culty, as they recede from the surface anteriorl)'. The next prominent 
 spine is that of the sixth, the next of the seventh. The latter is prominent, 
 but not so much so as the first dorsal, from which it must be carefully dis- 
 tinguished. 
 
 Anterior, posterior, or lateral deviations oi the cervical vertebrae ma)- be 
 diagnosed by this examination of the spinous processes.
 
 PRACTICE AND APPLIED TH ERAPFX'TICS OF OSTEOPATHY. I7 
 
 III. Anterior dislocations of the upper three cervical vertebrae may 
 be sometimes noted b)- examining for the prominence caused by the body 
 upon the posterior wall of the pharynx. This is done by passing the finger 
 over these bodies. 
 
 IV. The position of the atlas is examined as follows: The patient 
 lies upon his back and the practitioner stands at the head of the table. The 
 transverse processes are located by thrusting the palms of the examining 
 fingers deeply into the space between the angle of the inferior maxillary 
 bone and the tip of the mastoid process. A finger is placed upon each 
 transverse process which is usually prominent. Normally these processes 
 should be midway between the angle of the jaw and the tip of the mastoid 
 process. If they are too far forward, too far backward, to one side, or if 
 one be forward and the other backward, the diagnosis is readily made by 
 comparison of the position of the processes relatively to the points men- 
 tioned, and the corresponding displacement of the atlas is discovered. 
 
 V. Lateral deviations of vertebrae in the neck are best found by ex- 
 amining the articular processes. 
 
 The head, with the patient lying upon his back, is turned to one side, 
 making prominent the row of articular processes upon the opposite side. 
 The second cervical spine is now readily located by its prominence behind, 
 and the finger traces from it around to the articular processes of the second, lying 
 at about the same level, but slightly above. A finger is held upon this pro- 
 cess and the head is turned to the opposite side. The other articular pro- 
 cess of the second is then located in the same way. They are now com- 
 pared while moving the head slightly from side to side, and lateral devi- 
 ations or tenderness in the tissues are easily made out. With these two 
 points fixed, the head may be gently turned from side to side, and the ex- 
 amining fingers travel down over the successive articular processes, careful 
 examination being made of the position of each. 
 
 VI. Deep pressure may be made from the anterior surface of the neck 
 back upon the anterior aspect of the tra/tsverse processes a.nd diagnosis of an- 
 terior luxation be made. 
 
 VII. C)€pilus and abnormal mobility of bony parts indicates fracture, 
 
 VIII. The patient lies, and the practitioner stands at one side of the 
 head, turns the head slightly to one side and passes the examining hand 
 transversely to the course of the muscle fibers, noting any contractures of the 
 muscles, superficial or deep. 
 
 IX. He then stands at the head of the table and examines both sides 
 of the neck at the same time, a hand upon each stde, carefully compariiig 
 both sides with especial reference to any abnormality either of bone or of 
 other tissue. 
 
 X. Careful examination should be made for thickening of the tissues 
 of the neck just below the occuput. 
 
 XI. The scaleni tnuscles are made prominent upon one side by drawing
 
 I8 CKACTICE AND APri.IKD THERAPEUTICS OF OSTEOTATHV. 
 
 the head to the opposite side. They are normally hard to the touch, and 
 care should be taken in the diagnosis of contracture. Tenderness is often 
 found upon pressure, as in cases of rheumatism. 
 
 Their contracture often re-^ults in drawing \.\\(t first tcvo ribs upzvard out 
 
 of place. 
 
 XII. The brachial plexus o{ ner\es emerges from between the scalenus 
 unticus and the scalenus niedius muscles, below the level of the fifth cervi- 
 cal vertebra. The head is inclined to the side to relax these muscles, and 
 deep pressure is made at this point to impinge the plexus. Tenderness is 
 
 thus revealed. 
 
 XIII. 7V;/</^/' <7/vrtj are often found upon pressure in the sub-occipital 
 fossae. They are due to irritation of the ^/ra/ and .vwfl// (7f«^z7a/ 2LX\d great 
 auricular nerves. It is through manipulation of these nerves largely that 
 effects are gotten upon the superior cctvical ganglia and upon the medulla. 
 They are located at a ^^/;// about two inches from the middle of the posterior 
 margin of the mastoid process, in a line at right angles thereto extending 
 toward the median plane of the neck posteriorly. 
 
 XI\'. The superior cervical ganglion lies in front of the transverse pro- 
 cesses of the second and third cervical vertebrae, and may be reached by 
 direct pressure through the tissues. The method of locating the transverse 
 process of the second cervical has been given under V of this chapter. Deep 
 pressure from the anterior aspect of the neck may press this ganglion back 
 against these processes. 
 
 The middle cervical ganglioji,\y\w^ in front of the transverse processes of 
 the sixth and seventh cervical vertebrae, may be likewise reached. 
 
 The transverse process of the seventh cervical vertebra is readily lo- 
 cated by deep lateral pressure at the outer third of the su[)ra-cla\icular 
 
 fossa. 
 
 Lesions of the atlas and axis are b\- far the most important occurring 
 in this region of the bod\-. and account for many serious diseases of the 
 head and its parts, such as blindness, insanity, etc. The lesions of the neck 
 hold an important relation also to diseases in other parts of the bod)'. 
 
 Comparatively little treatment is given directly to the head and its 
 parts. These are treated largely through the removal of lesion in the neck- 
 Hence the importance of most thorough and careful attention to its exam- 
 ination. 
 
 The value of gently moving a part \\\\\\e under examination in order to re- 
 lax tissues, to insinuate the examining fingers more deeply into them, and 
 to develop the latent lesion through investigation of its relations to its 
 nci 'hboring parts during movement must not be overlooked.
 
 CHAPTER IV. 
 Treatment of the Neck. 
 
 Treatment of the neck, as of other parts, is, in its specific application, 
 dAvjdiys removal of lesion. The following general description of methods of 
 work in treating the neck is for the purpose of laying before the student in 
 a simple manner the general principles involved in our work. Later spe- 
 cific application of these general principles and methods will be made. 
 
 I. With the patient prpne , the guiding hand is laid upon his forehead 
 and the head is rolled gently from side to side a few times to aid in relax- 
 ing the muscles. The fingers of the operating hand are laid, palm down, 
 upon the muscles of the throat on the side opposite to the practitioner. As 
 the head is moved away from the practitioner these muscles are loosened 
 through the shortening of that side of the neck. At the same time, the 
 operating hand draws these muscles toward the median plane of the neck. 
 The head may be now moved from side to side, while the fingers upon one 
 side of the throat and the thumb upon the other manipulate the tissues. 
 All the tissues of the anterior aspect of the throat may be included in this 
 treatment, contracture and tension at any given point being thus removed. 
 The treatments must be gentle in order that sensitive necks may not be 
 irritated. 
 
 The operating hand must not be rubbed over the tissues, but they must 
 be moved by the motion of the hand. 
 
 Holding or pressing gently but continuously against a contracture 
 while the head is being slowly moved about will relieve the tension and 
 remove the lesion. 
 
 n. The ligaments of the temporo-maxillary articulations, and the 
 muscles and blood-vessels below the inferior maxillary bone may be relieve 
 of tension, and be restored to free action by springing the mouth open againstd 
 resistance. 
 
 The patient lies upon his back and the practitioner stands at the head 
 of the table, placing the palms of his thumbs upon the malar prominences 
 and the palms of the fingers beneath the jaw. The patient is now directed 
 to open the mouth widely and then to gradually close it. Resistance is 
 made by the operating hands to the first motion, and the fingers press the 
 superior hyoid muscles downward and forward toward the median plane of 
 the neck during the second motion. 
 
 The ligaments of temporo-maxillary articulations may be sprung by 
 thrusting a finger deeply into each glenoid fossa after the patient has 
 opened his mouth, nolding them there while the mouth is shut. 
 
 HI. The hyoid bone may be held between the thumb and finger and be 
 moved vertically and laterally, stretching the hyoid muscles.
 
 20 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHV. 
 
 l\ . Pressure may be in some measure applied to the pneumogastric, 
 glosso-pharyngeal and spinal-aacssory ncfves by deeply pressing the finger 
 upward and inward behind the angle of the jaw, in the direction of the jug- 
 ular foramen. 
 
 Ihc pnt'iitnogastric r\cy\c may be manipulated by deep pressure behind 
 the anterior border of the sterno-mastoid muscle. 
 
 These three nerves are also influenced by manipulation upon their 
 closely related nerves, the sub-occipital, great occipital, small occipital, and 
 great auricular, reached in the sub-occipital fosscC as above described. 
 
 V. Pressure upon the phrenic ncr-ce may be applied at the points 
 described in Chapter III. 
 
 VI. The sterno-mastoid muscle may be manipulated following the 
 method described for treatment of muscles of the throat under I of this 
 chapter. 
 
 The muscle upon one side may be stretched by turning the head toward 
 that side and slighth' upward, thus increasing the distance between the 
 mastoid process and the sterno-clavicular origin of the muscle. 
 
 VII. The lateral and posterior juuscles of the neck may all be treated in 
 a manner similar to that described under I of this chapter. 
 
 The practitioner may also stand at the head of the table, and with the 
 palms of the hands upon each side and the back of the neck, gently grasp 
 handfulls of the muscles, manipulate them thoroughly while slowly moving 
 the head in all directions. Pressure and manipulation, together with mo- 
 tion, all gentl}' and patientl>' applied, will relax the most obstinate contrac- 
 ture, loosen all deep fibrous structures, free blood-vessels and nerves, and 
 prepare the way for what is usually the real object of the treatment, the x^- 
 i}L\xz\\ov\ oi bony lesions. j i 
 
 VIII. With the patient prprae the head is pushed as far as may be 
 easily done without resistance, first to one side and then to the other, and 
 it is noticed whether it turns as/ir/ to one side as to the opposite side. Inequal- 
 it)- between the two sides indicates lesion usually upon the side toward 
 which the head turns least easily. 
 
 After relaxation of the tissues, turning the head to its limit toward 
 each side will sometimes aid in the reduction of bony lesion, especially 
 with the aid of pressure applied to force the part into its place. 
 
 IX. (i) In lesion of the atlas the patient lies prone and the practit- 
 ioner, standing at the head of the table, holds the head between the hands, 
 with a thumb or finger upon each transverse process. The head is now 
 moved in a direction to exaggerate the jesion, and with traction, rotation, 
 and pressure upon the processes, the atlas is forced toward its position. 
 
 (2) The operator may stand at the side of the head, one hand upon 
 the forehead and the other pressed firmly just below the skull, »n the region 
 of the lateral arch of the atlas. ^Exaggeration of the lesion, rotation and 
 strong pressure aid in replacing the part.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 21 
 
 (3.) The patient sits and the practitioner, standing in front, places one 
 knee beneath the chin, while the hands grasp the sides and back of the 
 head. Exaggeration of the lesion, traction, pressure, and rotation are now 
 applied as before. 
 
 (4.) The patient sits and an arm is passed about his head, the bend of 
 the elbow coming beneath the occipital protuberance and the hand beneath 
 the chin. The head is now forcibly raised with the idea of moving it upon 
 the spine in the desired direction, while the free hand makes pressure upon 
 the spine in the direction necessar)' to aid in reposition. 
 
 These various treatments may be applied to any of the usual lesions of 
 the atlas. The same principles ma}' be applied to the different malpositions 
 of any of the cervical vertebrae, generally patience and time are necessary 
 to the gradual restoration of the bones to place. Much attention must be 
 given to the thorough and gradual loosening of all parts in preparation for 
 replacement. 
 
 X. The axis is generally displaced laterally. The tissues upon its 
 transverse and articular processes are quite tender and contractures are 
 found in the muscles about it. Exaggeration of lesion, rotation and pres- 
 sure usually restore it to place. 
 
 XI. The scaleni muscles may be stretched by pressing the head down 
 toward the side in question, pressing the fingers behind the clavicle upon 
 the first rib to force and hold it down, while the head is now drawn to the 
 opposite side. 
 
 XIII. Thorough loosening of all cervical tissues may be accomplished 
 by a somewhat ''''spiral" treatment. The patient lies, the guiding hand is 
 placed upon the forehead, and the other hand is slipped beneath the neck 
 and grasps it. 
 
 The head and neck are now raised slightly, the head being rotated in 
 one direction, while, as far as possible, exactly the opposite motion is given 
 the neck. The hand travels up and down the neck, treating its different 
 portions alike.
 
 CHAPTER V. 
 Osteopathic Points Concerning the Head and its Parts. 
 
 As stated, the chief lesions affecting the head and its parts occur in the 
 neck, and have already been described. More detailed points in examnation 
 and treatment of these important structures will be considered in lectures 
 upon their specific diseases in the second part of this work. The present 
 chapter will embrace only general Osteopathic points. 
 
 Inspection and Palpation are the methods of examination. By the 
 former one notes the size and shape of the skull, the complexion, expres- 
 sion, eyes, etc. By palpation he notes the presence of tumors or other 
 growths, open fontanelles, etc. 
 
 A. The Eye. 
 
 Those lesions most frequently affecting these organs occur at the atlas 
 and axis. 
 
 I. The coiijujidiva linitig the lids may be examined. The lower lid is 
 ilrawn out and down, pressure being made at the same time below it, caus- 
 ing it to become prominent. 
 
 The upper lid is turned back by grasping the edge slightly toward the 
 outer canthus and raising the lid, while at the same time pressure is made 
 upon it from above near the mner canthus. This inverts the tarsal cartil- 
 age and exposes the membrane. 
 
 If while this lid is turned back the lower one is also treated as above, 
 both together stand out more prominently and may be observed together. 
 
 Granulations appear as minute white or pale red elevations. 
 
 II. With the patient prone, direct pressure is made, with the palms of 
 the fingers, upon the eye-balls, pressing them directl}- back into the orbits. 
 This impinges nerves, blood-vessels, muscles and all the orbital structures. 
 It presses excess of blood from the vessels, and tones the muscles, nerves 
 and the structures of the intra-ocular mechanism. 
 
 III. Tapping of the eyeball has much the same effect. It is performed 
 by placing the palms of one or two fingers over the closed eye, and 
 lightly tapping them with the index finger. Toning of the nerves, of the 
 ball and its structures, and of the optic nerve is thus accomplished. 
 
 IV. Gyanulations are crushed by squeezing them between the fingers 
 and thumb, the finger being inserted beneath the lid. 
 
 U. \x\ pterygia, \.\\e small blood-vessels formed upon and in the con- 
 junctiva as feeders, may be broken up by drawing the back portion of the 
 edge of the finger-nail across them. Care must be taken not to wound the 
 conjunctiva.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 23 
 
 VI. In st}'alns7?iHS the weakened or tensed muscle may be treated by 
 pressing the fingers into the orbit about the eye-bail. 
 
 B. The Fifth Nerve. 
 
 This nerve is reached at various points about the head, as it sends many 
 branches out over the head and face. Its treatment is especially important 
 in headaches, neuralgias, diseases of the e\-e, iiose, etc., for the reason that 
 it carries vaso-motor and trophic fibres to these parts. 
 
 I. Its supra-orbital branch may be traced from the supra-orbital fora- 
 men out over the forehead to the temple. It forms an angle of about fifty 
 degrees with the superciliary ridge. It may be felt under the skin like a 
 fine whip-cord, and it may be manipulated along its course by passing the 
 fingers transversely across it. 
 
 II. The infra-orbital 2,nA me?ital hra.nches may be manipulated at their 
 respective foramina. 
 
 By clinching the fingers beneath the malar process several branches of 
 the former may be impinged 
 
 The tissues over the foramina and along the courses of all of these dif- 
 ferent branches should be thoroughly relaxed to remove irritation. 
 
 III. A stipra trachlear hva.nch is located slightly to one side of the mid- 
 line of the forehead, a lachrymal branch about the middle of the upper eye- 
 lid, a temporal branch external to the outer canthus of the eye, an infra- 
 trachlear branch upon the nose opposite the inner canthus, and a 7iasal 
 branch at the lower third of the side of the nose. 
 
 All are subcutaneous and are readily manipulated after knowing where 
 to locate them. 
 
 With the EAR, as with the eye, lesion of the atlas, axis, or upper cervi- 
 cal region is the most usual cause of disease. 
 
 The NOSE, apart from neck treatment, is sometimes treated by local 
 mnnipuiation. 
 
 I. Manipulating and loosening ail the tissues along the sides of the 
 nose affects the blood-supply of its mucous membrane through branches of 
 the fifth nerve. It will also operate to free the channel of the nasal duct. 
 
 II. With the patient ' ^ryrrp -, the palm of the hand is placed upon the 
 forehead, the other hand is laid upon the first, and the practitioner, bending 
 over the head of the table, brings his weight upon the patient's forehead. 
 This pressure is continued several seconds and repeated a few times. It 
 
 frees the nostrils and in acute colds frequently at once restores freedom of 
 breathing through the nose. 
 
 The affect is probably gotten by the pressure affecting the branches of 
 the fifth nerve upon the forehead. 
 
 III. In colds and catarrh pain in X.\\e frontal sinus may be relieved bj' 
 lapping with the knuckles upon the frontal bone over the sinus. 
 
 The MOUTH and throat are sometimes treated internally by sweeping
 
 24 PRACTICE AND AF'PLIKD THERAPEUTICS OF OSTEOPATHY. 
 
 the palm of the index finger from the mid-line of the posterior portion of 
 the hard palate outward and downward over the 'soft palate, pillars of the 
 fauces, and tonsils. The uvula may also be touched. The nerves and 
 blood-vessels of this region are thus toned. 
 
 The Tempro-Maxillakv Articulations are examined. Inequality in 
 their action is discovered b\ standing behind the head of the patient, who 
 is lying '^^fteC'^The mouth is opened and closed, and deviation of the mid- 
 line of the chin from the median plane of the body noted. Deviation of this 
 nature indicates luxation of one of the articulations, the jaw usually deviat- 
 ing awa\" from the side of the lesion, 
 
 I. The ligaments of the articulation may first be loosened as de- 
 scribed under II of Chapter IV. Pressure upon the opposite jaw while the 
 patient is closing the mouth will bring the condyle back into place. 
 
 II. Sometimes it is n?cessary to place a small cork or piece of wood 
 between the posterior molar teeth upon the affected side. Pressure is now 
 made beneath the chin, tending to close the mouth, and the jaw is slipped 
 into place. The corks may be inserted at the same time between the mol- 
 ars of both sides in case of bilateral luxation 
 
 Treatment I, ma\' be alternatel)' applied in such case. 
 
 Opening the mouth against resistance (II, Chap. IV). manipulation of 
 the throat to free the action of the carotid arteries, and treatment of the 
 superior cervical region (XIII, Chap. Ill) are, together with removal of spe- 
 cific lesions, the chief methods of treatment in diseases of the eye, ear, nose 
 and throat. The\' produce affects by building up the blood-suppl}'.
 
 CHAPTER VI. 
 Examination of the Thorax. 
 
 From an Osteopathic point of view, and not at present considering the 
 contents of the thoracic cavit)-, the examination of the thorax consists 
 mainly in discovering, b)- palpation and inspection, whether its bony struct- 
 ures are all in position. 
 
 Ligamentous and muscular lesions, also lesions of blood-vessels, nerves 
 and centers are closely associated with bonj' lesions. 
 
 The relations of the thorax to the spine and to its contained viscera 
 cause its lesions to be among the most important ones found in the body. 
 Lesion of the spine, especially of its thoracic portion, often seriously 
 affects the thorax proper. 
 
 Inspection reveals change in ine gcrieral conformation of the thorax. It 
 is made with relation to the spine, and effects of spinal irregularities are 
 considered. Flattening ox p) ominence of the ribs, either in portions of the 
 thorax or affectmg it as a whole; restriction or increase in the movements of 
 the thorax, upon one or both sides; color of the skin, eruptions, scars, etc., 
 are all noted. 
 
 The patient ma)' sit, lie, or stand during inspection, as most convenient. 
 
 Palpation, the more important method, proceeds in conjunction with 
 further inspection, and is used in the detection of the various special lesions 
 to be described. 
 
 I. With the patient standing or sitting, the palms of the hands are 
 passed evenly over the anterior and posterior aspects of the chest <ro?;//>d!;zw^ 
 side with side\ region with region. The temperatnre is also noted. 
 
 II. The /r^fia!rflfza/ region is examined for any protrusion or retraction 
 of the thoracic wall, significant with relation to heart disease. 
 
 III. Each lateral half of the chest is examined for change or lessening 
 of its antero-posterior diameter, considering the direction of the component 
 ribs as well. Lessening of this diameter, and a tendency of the ribs to 
 greater obliquity in direction, reveals 2i flattened side ox sides of the chest. 
 This shows spinal lesion generally, also disturbed ligaments, blood-vessels, 
 nerves, etc., of all related parts. In this case the whole side is dropped 
 down and the ilio-costal space is lessened. 
 
 IV. The same lesion may affect a portion of the thorax. Often diflat- 
 tening of the ribs posteriorly beyieath the scapula is found. 
 
 Protrusions of retractions of one area of the chest generally correspond 
 with the reverse condition in the corresponding anterior or posterior area. 
 This is not true in case of slipping of the ribs downward. 
 
 V. Marked depression in the supra or infra- clavicular regions are sig- 
 nificant in the diagnosis of tuberculosis of the lungs.
 
 26 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 \'I. Wilh Xhc patient lying on his side, the pa/m 0/ //le /ia?id t's srcepf 
 along the lakml aud postcro-lakral aspects of the chest, from the shoulder down- 
 wards. Changes in the position of the ribs individually, or in the conform- 
 ation of the side of the thorax in question are thus readily made out, mainl>- 
 by detection of changes in the angles of the ribs from normal. 
 
 The Sternum must be examined. 
 
 I. \\. xv\2iy he diSdi \\'\\o\c, ptotnided or retracted, following a change in 
 the general shape of the thorax. 
 
 II. Luxation between Xhejirst and secofid pat ts, ^n\.Qr\o\\y ox \^o->\.e\\n\\y, 
 may occur. 
 
 III. lYm ensiform may be displaced laterally 
 
 The Clavicle and Cokacoid. 
 
 The latter is located as the first bony prominence at the outer end of 
 th*" infra-clavicular fossa. Its relation to the clavicle is to be noted. 
 
 The clavicle may be luxated at either its sternal or acromial articula- 
 tion. The sternal end may be upward, anteriorly or posteriorly from its 
 normal position. The acromial end may be displaced downward toward 
 the coracoid or upward upon the acromion process. Sometime.s it is tilted 
 so that one's fingers may be thrust far behinti its upper edge. 
 
 Luxation of Ribs. 
 
 One of the main objects of examination of the thorax is to locate mis- 
 placed ribs. Departures from normal conformation of spine are at once 
 indications of lesion of the several ribs. Hence, following the general ex- 
 amination as outlined above, each rib in particular must be scrutinized. 
 Landmarks for the location of the various ribs should be employed. 
 
 I. Ribs are frequently separated ox approximated beyond normal limits. 
 These conditions are discovered by placing the patient upon his side and 
 following the successive intercostal spaces with the tip or side of the ex- 
 amining finger. In the latter lesion the tissues are lender along the course 
 of the intercostal space, due to irritation of the sensor)- branches of the in- 
 tercostal nerves. 
 
 II. The same examination would reveal rotation of a rib upon its hori- 
 zontal axis. In such case the intercostal space is laiegnally widened or nar- 
 rowed. As a rule the twisting is about the head as a fixed point, and the 
 lower margin of the rib is turned out prominenth'. Then the intercostal 
 space next below is narrowed posteriorly and widened anteriorly. The an- 
 terior end is tended downward, luxating the costo-chondral and the chon- 
 dro-sternal articulations, as it deranges the costal cartilage. The reverse 
 rotation of the rib may take place, making prominent the upper edge, 
 throwing the anterior end upward, etc. 
 
 III. By various lesions of the ribs, ihe cartilages are twisted, distorted, or 
 torn loose.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 ■^1 
 
 :i 
 
 In such case tender points ire found upon pressure at the costo-chond- 
 ral or chondro-sternal articulations. The cartilage may be ^?</g;^^yf;'z<:.'a;-af 
 by protrusion of the rib, causing a prominent tender point. It may be 
 retracted, causing a slight depression. 
 
 With the patient lying pr^n^, the examining fingers may be carefully 
 passed over the successive pairs of cartilages and these lesions be noted. 
 
 The FIRST RIB is located by deep pressure behmd the middle or inner one 
 third of the clavicle. If the latter has been found in situ, comparison with it 
 may be made to determine whether the rib be up or down. By deep pres- 
 sure the rib ma)' be traced well back toward its head, which is masked by 
 the posterior cervical muscles. Pressure may be brought upon the head 
 at the level of the sexenth cervical spine, one and one-half inch laterally 
 therefrom. 
 
 The sternal e?id of the rib is located just below the claviculo-sternal ar- 
 ticulation. Its cartilage and may be traced well outward an inch or more 
 before disappearing beneath the clavicle. 
 
 Incase it may be luxated upward, the cartilage is retracted, leaving a 
 flat area or a depression at the cartilage. If downward, a protrusion of the 
 cartilage at the ttd^c of the sternum is usual. In either case the cartilage 
 and the tissues about the rib are sensitive to pressure. 
 
 The first and second intercostal spaces are wider than the others. 
 
 The SECOND RIB is located opposite the junction of the first and second 
 parts of the sternum. Prominence or depression of its cartilage, and tend- 
 erness in the tissues about it are caused in the same way as in the case of 
 the first. Its head is located and pressure brought upon its region at a 
 point one and one half inches external to the first dorsal spine. 
 
 The ELEVENTH AND TWELFTH RIBS are more frequently luxated down- 
 wards because of their anterior ends being unsupported and because of 
 traction upon the latter by the quadratus lumborum muscle. Their free 
 ends are readil}' located except when irritation from them, or other cause, 
 has irritated the overh'ing muscles, causing hypertrophy or contracture. In 
 such case they must be located from the tenth rib. 
 
 The free end of the eleventh lies well forward, thus distinguishing it 
 from the twelfth. 
 
 They may be so displaced downward as to be almost vertical; may 
 overlap the iliac crest, or may be luxated upwards, the free end of the 
 twelfth lying beneath the eleventh or that of the eleventh beneath the 
 tenth. 
 
 Frequently a luxated rib guides one to a spinal lesion. 
 
 Displaced ribs cause disease by mechanical interference with internal 
 viscera, by irritation of surrounding soft tissues, by dragging ligaments, im- 
 pinging nerves, or occluding blood-vessels.
 
 chaptp:r VII. 
 
 Treatment of Thoracic Lesions. 
 
 The thoracic portion of the spinal column is anatomically a part of the 
 thorax, but has already been discussed under another head. 
 
 Osteopathic treatment of the thorax is directed generally to the res- 
 toration of the 1 ibs and other bony portions to correct mechanical relations. 
 It includes with this, work upon ligamentous, cartilaginous, and muscular 
 lesions, which are usually secondary to bony lesion. Thus while osteopa- 
 thic treatment of the thorax consists largely in the putting of ribs into proper 
 position, this work is always done with an eye to those other lesions, and 
 effects all surrounding tissues; muscles and ligiments; nerves and vessels; 
 centers and viscera. 
 
 Thoracic is inseparable from spinal work, owing to the intimate anat- 
 omical relations of these parts. 
 
 There are various ways of setting ribs. Many of them rest upon the 
 principle that the head of the rib, being but slightly movable, is the fixed 
 point; that pressure upon the angles tends to move them about this fixed 
 point; and that this pressure may be guided and aided by elevation of the 
 arm or rotation of the shoulder, bringing traction upon the pectoral and 
 latissimus dorsi muscles, etc., which are attached to the ribs. 
 
 In some treatments, the sternal end is made the fixed point and the 
 parts are manipulated accordingly; in some, both ends of the rib are fixed, 
 etc. 
 
 Exaggeration of lesion, fixing of a fulcrum, traction upon attached tis- 
 sues, and rotation of related parts are principles applied to the work. 
 
 I. With the patient sitting upon the side of the table, the practitioner, 
 standing in front, passes an arm about the body of the patient, extending 
 his hand past the spine behind, and pressing with the fingers upon the 
 angles of the ribs of the further side. With the other hand he raises the 
 patient's arm, of the side in question, in front of the body and high over the 
 head, rotating it downward and backward. This brings traction upon the 
 pectoral muscles and soft tissues of the whole anterior aspect of the side of 
 the chest, elevates the entire side, and effects particularly the ribs upon the 
 angles of which pressure is made. 
 
 This motion may be repeated, the pressing hand traveling down the 
 back to each successive rib in need of treatment. 
 
 This treatment elevates all the ribs and tones all the connected muscles, 
 ligaments, vessels, nerves, etc. 
 
 II. The patient sits upon the stool; the practitioner stands behind, 
 and, resting one foot upon the stool, makes a fixed point of his knee at the 
 angle of the rib under treatment. One hand holds beneath the lower edge 
 of the ribs, in front, while the other ele\'ates and rotates the arm as in I.
 
 30 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 Or the first h.iiui may press clown upon the upper edge of the rib, in front, 
 while the arm is drawn from in front downwards to the side of the body, and 
 backwards. 
 
 In these ways the ribs ma\- be forced downward or upward. 
 
 111. With the patient sitting or lying upon his side, the rib is thrown 
 into action by the patient's taking a full breath. The operating hands are 
 applied, one at either end of the rib in question, and advantage is taken of 
 the relaxation of tissues and the motion of the rib which take place as the 
 patient expells the breath. The whole rib is manipulated at this time to- 
 ward its normal position. 
 
 This treatment is aided in some cases by pushing the rib still further 
 from its normal position before an attempt is made to restore it to place. 
 In this wa> the principle of exaggeration of the lesion is called into play. 
 
 I\'. Treatment II ma)' be applied with the patient lying upon his side 
 instead of sitting. Here the practitioner stands behinds, rests one foot upon 
 the table, bending his limb so as to bring the flat of his knee against the 
 angle of the rib. The treatment then proceeds as in II. The arm may be 
 rotated either forvvard and up, or downward and back, pressnre being made 
 at either margin or at the sternal end of the rib as desired. This treatment 
 allows the practitioner more latitude than does II. 
 
 Great caution must be exercised in an)- application of the knee to the 
 chest, either anteriorl)' or posteriori)-. Active work with it should be 
 avoided, use being made of it only as a fixed point. 
 
 V. A fixed point may be made of the flat of the knee at the sternal 
 end of the rib; the arm of the patient upon the same side is manipulated for 
 traction as before, while the other operating hand is passed over the 
 patient's opposite shouldtr and applied to the spinal region of the rib. This 
 treatment is applicable to luxations of the heads of ribs. The patient is 
 
 VI. With the patient -picme, the practitioner stands at one side and 
 reaches across the patient to manipulate the ribs of the opposite side. One 
 hand is slipped beneath the back and applied as a fixed point to the angles 
 of any ribs in question; with the other hand the patient's arm is rotated as 
 before tor traction. '^<''^ t 
 
 VII. With the patient lying ^pmo . the practitioner, standing at one 
 side, reaches across the bod)- and makes a fixed point of his elbow upon the 
 angles of the rib. At the same time the hand of the same arm grasps the 
 patient's forearm upon that side drawing it back and up. Thus, while the 
 rib is in action the pressure of the elbow forces the head into place. 
 
 VIII. With the patient lying s Hip i n^ y pressure with the operating 
 hands may be brought vertically downward upon heads or angles of ribs, 
 springing them into place. , ^ 
 
 IX. With the patient lying pM»*. the practitioner stands at the side 
 of the table and raises the patient's arm of the same side to a level with the
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 31 
 
 shoulder. With the arm thus horizontal, traction is made upon it, away 
 from the body, and in such a direciion as to bring longitudinal tension upon 
 the costal cartilages. The other hand manipulates the cartilage to reduce 
 any twist or anterior prominence of it. 
 
 X. With the patient sitting, the practitioner stands facing him, making 
 pressure with one hand upon the sternal end of the rib in question. The 
 other arm is passed about the patient's body, and locatfis and brings pres- 
 sure upon the head of the same rib. With both ends of the rib thus fixed, 
 the motion of the practitioner's body is used to rotate the patient's trunk 
 about these fixed points, at the same time manipulation is directed to the 
 restoration of the rib to position. 
 
 It may be said that as a rule the setting of a rib requires time and 
 patience, though in many cases this may be accomplished at once. It is 
 rarely the performance of a set motion that does this work. On the con- 
 trary, the practitioner, with his hands in position and the parts under his 
 control as described in any particular treatment, must continue his efforts, 
 with varying traction, pressure, rotation, etc. Movements of the patient's 
 whole trunk, bending, turning, raising the parts, etc., may all contribute to 
 the gradual relaxation and yielding of the parts to the persistent, well 
 directed, and carefully judged efforts of the Osteopath. 
 
 In the case of the first and second ribs many of the general princi- 
 ples and treatments, as already described, may be applied. Special methods, 
 however, are generally necessary to replace them. As already stated, these 
 ribs are usually luxated upwards, but may as well be displaced downwards. 
 
 I. Upward Displacements. 
 
 (i) The scaleni muscles are first relaxed and stretched (Chap. IV, 
 div. XI), the head is now bent toward the shoulder of the affected side, and 
 and pressure is brought directly downward upon the upper margin, the 
 sternal or spinal end of either or both ribs (Chap. VI). In this way, 
 either rib may be lowered as a whole or at either end. 
 
 (2) With the patient lying upon his back, the practitioner stands at 
 the head of the table; presses the palm of the thumb down upon the upper 
 margin of the first rib; with the other hand he raises the arm of the patient 
 upon the side in question, and pushes it across the chest at the level of the 
 shoulder, thus relaxing the tissues at side of the neck, and elevating the 
 clavicle so that the thumb may be thrust more deeply behind it. Pressure 
 may be applied anywhere along the upper margin of the rib, lowering it to 
 its normal position. 
 
 II. Downward Displacements. 
 ( i) With the patient sitting, the practitioner stands behind and brings 
 pressure with his fingers upon the inferior margin of the first or second rib 
 (see p. 27). At the same time the head is bent to the opposite side, bring- 
 ing traction upon the rib through the scaleni muscles, and rotated back-
 
 32 J'KACTICK .A.Sn APPLIED TH EKAPEUTICS OF OSTEOPATHY. 
 
 wards. This rotalion tends to bring more traction upon the anterior end 
 through the scalenus anticus (in case of the first rib). This treatment may 
 be used to elevate either rib. 
 
 (2) The treatment as described under II and IV of this chapter may 
 
 be used. 
 
 (3) With the patient sitting and the practitioner standing in front, 
 pressure may be made by the fingers below the region of the head of the 
 first or second rib, (see p. 27), while the head is bent to the opposite side 
 and rotated forward. This rotation tends to bring more traction upon the 
 posterior ends of the first and second ribs through increased traction 
 respectively of the scalenus medius and scalenus posticus muscles. 
 
 (4) In case of anterior protrusion of the cartilages (see p. 27). pres- 
 sure may be brought upon them while treatment (I) above is being given. 
 
 Or the patient's arm is raised to the level of his shoulder and drawn 
 backwards, bringing traction upon the cartilages, while pressure is applied 
 
 to them. 
 
 The first two ribs may be separated, to some extent, as follows: The 
 patient lies prone and a hand is slipped beneath his shoulder, bent to form 
 a fulcrum beneath the two ribs; the patient's arm is grasped at the elbows 
 raised, and bent strongl)- across the anterior chest at the level of the shoul- 
 der. This tends tn drive the two ribs sternum-ward, and to separate them 
 anteriorl)- owing to the intercostal space being wider at its anterior end 
 than at the other. 
 
 The Elev3n and Twelfth Rtbs. 
 
 c 
 A. Downward Displa^ments. 
 
 A 
 
 A preliminary step must be taken in the relaxation of all muscles and 
 tissues about the ribs, especiall)- of the quadrati lumborum muscles. This 
 is easily accomplished by manipulation of the tissues. A special method 
 oi sttelehing the quadrati \s :\s ioWows: The patient lies upon his side and 
 the practitioner stands in front. He grasps the arm of the patient and 
 draws it diagnonally forward, at the le\el of the shoulder, in a direction 
 awav from the pelvis. At the same time his other hand makes pressure 
 upon the anterior iliac crest in a direction diagonally backward, i. e., in a 
 direction e.xactly the opposite from that in which the arm is drawn. This 
 stretches the muscle diagonally and rotates the lumbar portion of the spine. 
 The motion is now reversed by standing in front of the pelvis, grasping the 
 crest of the ilium, and drawing it diagonally forward in a direction away 
 from the shoulder. At the 8ame time the other hand holds the bent arm 
 rigid at the side and pushes it in a direction opposite from that of the trac- 
 tion applied to the pelvis. This motion gives the opposite diagonal stretch 
 to the quadratus lumborum. and rotates the lumbar region of the spine. 
 
 The eleventh or twelfth rib itself is readil\- manipulated upwards or 
 downward by taking advantage of three portion ;( i )The head usuall>- remains
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 3 
 
 a fixed point, (2) Pressure made upon the outer aspect of the rib in the 
 region of its angle (or turn in case of the twelfth, which lacks the angle) 
 may be so directed as to move or rotate the rib upward or downward about 
 the fixed point, (3) The free end may be readily moved upward or down- 
 ward by the pressure of a finger, and this pressure, combined with pressure 
 in the opposite direction applied at the angle, readily rotates the rib about 
 its vertical axis. 
 
 One hand easily spans the rib, leaving the other hand free to manipu- 
 late the body and aid the operation. The thumb is pressed against the free 
 end of the rib and forces it upward or downward while the fingers of the 
 same hand bring pressure in the opposite direction at the angle of the rib. 
 In this way the rib is rotated about the head as a fixed point and may be 
 raised or lowered as desired. 
 
 I. With the patient lying upon his side, his knees flexed and supported 
 against the abdomen of the practitioner, the operating hand manipulates 
 the rib as above described, forcing it upward. At the same time the free 
 arm has grasped the limbs, raised them slightly to rotate the pelvis and 
 lower lumbar spine, and thrusts them downward in extension to stretch 
 the soft tissues and aid in increasing the distance between ribs and pelvis. 
 
 II. This movement may be varied, grasping the limbs in the same way 
 and drawing them and the pelvis over the side of the table, rotating them 
 downward about the edge of the table, extending the limbs and rotating them 
 upward and onto the table. The rib is manipulated as in I. This is a 
 strong treatment, and applies great force to the rib. 
 
 III. With the patient sitting, a hand is applid to each end of the rib. 
 The patient takes a full breath to throw the rib into activity; pressure is so 
 applied as to exaggerate the lesion, and the rib is finally pressed upward to 
 its normal position as the patient exhales. 
 
 IV. The patient lies upon his side; one operating hand grasps the ilio- 
 costal tissues and draws them diagonally downward and forward in the 
 direction in which the rib points. The other hand is placed upon the angle 
 of the rib and pushes it in the same direction. In this way the tissues are 
 stretched and the lesion exaggerated. The motion is finished by an upward 
 turn of the hands, the former pressing the end of the rib upward, the latter 
 forcing the shaft of the rib upwards. 
 
 B. Upward Displacements. 
 
 In these cases the anterior ends of the ribs are upward under the rib 
 above. All tissues are first relaxed as before, and the free end is located 
 by deep pressure beneath the ribs and tissues. The rib may be manipulated 
 as before described. 
 
 Treatments I, II and III may be applied equally as well to the reduc- 
 tion of upward displacements; the appropriate pressure being made to force 
 the rib downward.
 
 34 PRACTICE AND AFPLIKD THERAPEUTICS OF OSTEOPATHY. 
 
 The STERNUM, if PROTRUDED or RETRACTED as a vvhole, is restored to 
 normal through the general shaping of the thorax b\' methods already 
 described. The cnsifcrm appendix, being cartilaginous, is usually easily 
 sprung by pressure and trained toward its normal position. 
 
 In case of lu.xation between \.\\^ first and second parts of the sternum, 
 traction is brought upon the first part through the deep cervical tissues and 
 the sterno-mastoid muscle of either side by rotation of the head backward 
 and to one side. At the same time pressure is made upon the prominent 
 end of the first or second i)art, reducing it. 
 
 The CLAVICLE may be restored from any of its usual mal-posicions as 
 follows: The patient lies prone and the practitioner stands at the head of 
 the table, slightl)- to one side. The fingers of the operating hand are 
 pressed, palm up, behind the clavicle, the tissues being relaxed by slightly 
 raising the shoulder. The free hand now grasps the arm of the patient just 
 above the elbow and pushes the bent arm across the chest, up over the face, 
 above the head, and rotates it down to the side again. This motion has 
 raised the clavicle and allowed the fingers to be pressed deeply behind it. 
 They may be applied particularly to the steinal end. The elevation of the 
 shoulder has widened the anterior end of the costo-clavicular space and 
 allowed the fingers to be brought well forward toward the sternal end. As 
 the arm is now rotated outward, the increase of distance between the sternal 
 and acromial attachments of the bone draws it down hard upon the fingers 
 between it and the rib, forcing it upward from either an anterior or posterior 
 down-ward dislocation. 
 
 In case the sternal end had been dislocated npzvard on the sternum, the 
 motion would have been the same, except that during the outward rotation 
 of the arm pressure would have been made above the sternal end to force it 
 downward. 
 
 In case the acromial end had been downward or up-ward the same motion 
 would be applied, with the operating hand directed to that end of the bone. 
 During the outward rotation of the arm the bone would be grasped between 
 the fingers behind and the thumb in front and moved upward or downward 
 from its displacement. 
 
 Here, as in case of the ribs, it is less probable that the performance of 
 a single set motion would accomplish the work than that insistent, though 
 not violent, traction, pressure, rotation, etc., according to the manner of the 
 described treatment, would secure the result.
 
 CHAPTER VIII. 
 General Osteopathic Points In Regard To The Abdomen And Its 
 
 Parts. 
 
 Many of the specific lesions affecting the abdomen and its contained 
 viscera occur in the spine and thorax and are of kinds already described. 
 Much of the treatment for diseases of these parts is upon such lesions. The 
 subject of examination and treatment of the various organs will be consid- 
 ered more in detail in relation to their specific diseases. The aim of this 
 chapter is to give general methods of examination and general osteopathic 
 points concerning these parts. 
 
 Position: — The patient lies pr - o^c : the thighs are flexed and the feet 
 rest upon the table; the head and chest are slightly elevated by the in- 
 clined head of the table. In this position the abdominal muscles are re- 
 laxed. The sides of the body are disposed alike to avoid unequal tension 
 upon the tissues. 
 
 Inspection, palpation, percussion are the physical methods employed. 
 
 Inspection reveals enlargement due to gas or fluid, tumor, muscular 
 contraction, etc.; color, distended or retracted walls, restricted or increased 
 motion, pulsation or engorgement of blood vessels, etc. 
 
 Palpation reveals change in temperature; tumors, superficial or deep, 
 fluid or solid; tenseness or flabbiness of the abdominal walls; enlargements 
 and displacements of organs, etc. 
 
 Percussion reveals the limits of organs, pressure of tumors, fluids or 
 gases, etc. 
 
 Ausculation reveals the gurgling of gases, fetal sounds, lubrication of 
 the bowel, etc 
 
 I. h general treatment of ihe abdomen is sometimes necessary for 
 general relaxation of the abdominal w^alls, often as a preliminary step to- 
 ward further examination. With the patient in position as above, the prac- 
 titioner stands at the side of the table and with the palm of the hand man- 
 ipulates the tissues to relax them. Care should be taken to avoid pressure 
 with the tips of the fingers or other rude work which causes the tissues to 
 contract. The hand should be warm and the manipulation gentle but 
 thorough. 
 
 II. Direct manipulation, including pressure and various movements, 
 is often made upon the various abdominal organs. Specific directions for 
 the treatment of any given organ are reserved until specific diseases of these 
 organs are considered. But speaking in general of abdominal manipulation 
 as one of the methods in the repertoire of the Osteopath, care must be 
 taken to make clear the difference between such manipulation and massage. 
 Here the mode of motion is relatively insignificant. The manipulation is 
 not for the general effect following a thorough abdominal massage, but is
 
 36 PRACTICE AND APF'LIED THERAPEUTICS OF OSTEOPATHY. 
 
 corrective; directed to the specific end of restoring to proper mechanical 
 relations an organ or organs definitely ascertained to be in need of mechan- 
 ical adjustment. Here, as elsewhere in the body, this work removes pres- 
 sure from, or interference with, blood-vessels and nerves. For example, 
 osteopathic treatment of the colon is not made for general manipulative ef- 
 fect, but is directed to raising and straightening a sigmoid too much bent or 
 folded. Thus it removes a mechanical obstruction to bowel action, but also 
 lets free pelvic circulation and nerve action impeded by such a condition. 
 
 Or manipulation of the colon raises from its unnatural position the gut 
 which has prolapsed anti become wedged down among the peKic viscera, 
 where it has destro\ed harmony of the functions. Osteopathic manipula- 
 tion in this way is specific; corrective; bRsed upon mechanical principles, 
 and is applied b\' a practitioner who knows what causes such abdominal 
 conditions and how to correct them. 
 
 III. With the patient in position as above, or standing or sitting bent 
 well forward, the fingers are inserted deeply beneath the viscera in each il- 
 iac fossa. They are now drawn directly upward, raising all the pelvic and 
 abdominal viscera, freeing the action of the femoral and pelvic vessels and 
 nerves. 
 
 In case the patient has bent forward he straightens the body again at 
 the same time the viscera are raised. 
 
 I\'. With the patient l\ing upon the right side, the practitioner stands 
 behind the pelvis and presses llie fingers deeply into the iliac fossa upon 
 the side of the sigmoid nearest the median plane of the body. He now 
 raises the sigmoid flexure upward and slightly outward over the flaring il- 
 ium. This raises the gut from the pelvis, relieves kinking, and frees the 
 circulation of the part. 
 
 The movement may be repeated for the caecum. 
 
 V. With the patient in the dorsal position, the practitioner stands at 
 the side and places the palms of the hands over the false ribs and carti- 
 lages, one on either side, heel out and fingers directed toward the median 
 plane of the body. Pressure is now made evenly upon the sides, springing 
 the ribs and cartilages down upon the viscera beneath. As the pressure is 
 directed inward the ribs and cartilages are forced toward the mid-line and 
 pressed down upon the viscera. Repeating this motion at intervals of a 
 few seconds thoroughly tones the nerve plexuses and blood-flow of the up- 
 per abdominal viscera. 
 
 VI. Deep pressure is made upon the solar plexus as follows: The pitient 
 lies prone, the practitioner stands at the side and lays the palmar surface 
 of the distal phalanges of one hand over the pit of the stomach, at the level 
 of the tips of the seventh and eighth ribs. Pressure with the second hand 
 upon the first is gradually applied, the hand sinking deeper into the tissues 
 until very deep pressure has been made. The plexus may now be manipu- 
 lated by a slight circular movement of the hand. This treatment tones the
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 37 
 
 action of the solar plexus, etc. It should be gently and gradually applied, 
 but the pressure must be considerable. 
 
 VII. Deep pressure as above at any point will cause a purely nervous 
 pain to lessen or disappear, while it increases a pain due to inflammation. 
 
 VIII. Displaced ribs sometimes mechanicaliy depress viscera, and 
 must then be replaced by methods already described, 
 
 IX. The fundus of the gall bladder is reached by deep pressure beneath 
 the tip of the ninth rib on the right ride. Thence the course of the bile 
 duct to the duodenum is in the shape of a reversed "S," the upper limb lying 
 above and to the right of the umbilicus, the lower limb encircling the um- 
 bilicus upon the right and opening into the duodenum from one to two 
 inches below the umbilicus. Manipulation aids in empt}ing the bladder 
 and in passing gall stones along the duct. 
 
 Abdominal treatment is geneaally in conjunction with treatment upon 
 specific lesion occurring in the spine, thorax, etc. It must be given care- 
 fully, as there are many diseases, e. g., typhoid, in which rough abdominal 
 treatment might cause serious injury. It is directed to a specific end and 
 restores mechanical relations of parts, frees nerve and blood mechanisms, 
 removes muscular contracture, etc.
 
 CHAPTER IX. 
 Examination and Treatment of Lesions of the Pelvis. 
 
 Importance of pelvic lesion can scarcely be overestimated on account of its 
 relations to the spine above, to its contained viscera, and to the lower portions 
 of the body. This chapter does not deal with diseases of the pelvic organs, 
 but with bony and ligamentous lesions of the pelvis which are so significant 
 from the osteopathic standpoint, as causes of disease in the pelvic viscera in 
 the limbs, or in the body above. 
 
 A. Lesions Affecting the Pelvis as a Whole: 
 
 I. Examination. The examiner must not neglect to examine the spine 
 in relation to pelvic lesion, as malpositions of this structure are almost sure to 
 destroy spinal equilibrium and thus to effect spinal relations, sometimes to a 
 serious extent. The most common of such results is swerving or curvature of 
 the spine in respon.se to the efforts of nature to adapt the spine to a crooked 
 pelvis. 
 
 The pelvis as a whole may be tipped forward or backward; may be turned to 
 eillicr sidc\ ox mdiy ht tilted, throwing one crest up and the other downivard. 
 The.se malpositions may be combined in various ways. The g- en eral symptoms 
 of such trouble are pelvic diseases, female disorders, backache, sciatica, lame- 
 ness or paralysis of the lower limbs, etc. In case of lesion of the whole pelvis, 
 the point of movement upon the spine is usually the lumbo-sacral articulation, 
 but the fifth lumbar vertebra may be carried with the pelvis, or the yielding 
 point may include the whole lumbar region. 
 
 Inspection and Palpation aid each other in the examination. 
 
 (I.) Both superior posterior iliac spines are found equally \.oo prominent in 
 case of backward luxation of the pelvis, or 
 
 (2) They are alike found to have receded anteriorly in forward luxation, or 
 
 (3) One is prominent and the other has receded anteriorly in twisting of 
 the pelvis sidewi.se or. 
 
 (4) One stands higher than the other in case of tilting of the pelvis lat- 
 erally. In the latter case comparison shows /wr^/^a///;!' /;z the length of the 
 limbs, and tenderness is often found in the tissues upon the iliac crest of 
 the low side owing to greater tension upon them. At the same time the 7vaist 
 line is deepe7ied w^on the high side and filled out upon the low side. 
 
 Examination and comparison of the posterior superior spines is best made 
 upon the bared back, with the patient sitting sidewise upon the table. The 
 practitioner sits upon a low .stocl directly behind the patient, placing a hand 
 upon each spine, examining and comparing them carefully. Care must be 
 taken that careless posture of the patient does not cause an apparent inequal- 
 ity, or, on the other hand, that an assumed position does not mask the lesion.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. '5J9 
 
 With the patient sitting or lying on the side, careful palpation is made of 
 the superficial and deep soft tissues in the sacro-iliac and posterior sacral 
 regions. These are commonly sensitive to pressure, but are always tensed, 
 congested and strained over the sacro-iliac articulation and the posterior sacral 
 foramina. These ligamentous lesions alone cause much ill by obstructing 
 nerve action. The hand is also passed along the crests of the ilia making 
 deep pressure in the tissues, to discover tenderness in them. 
 
 Tilting of the pelvis may be ascertained also by measurements between 
 the coracoid process of the scapula and the anterior superior spine of the ilium 
 upon each side. A better method is to have the patient hold the tape between 
 his teeth in the mid-line of the body, from which point measurement is made 
 to the inner maleolus of the tibia on each side. Tilting of the pelvis cannot be 
 ascertained by measurements unless a fixed point above the pelvis is used as 
 the starting point. 
 
 II. Treatment. 
 
 In the treatment of all the lesions above described, a preliminary step may 
 usually be made with advantage by thorough relaxation of the soft tissues in 
 the sacro-iliac regions as already described. (Chap. II, divs. Ill, XIII, XIV, 
 XIX.) 
 
 All the lesions described may be treated with the patient sitting upon the 
 stool, his pelvis fixed by an'assistant, who stands in front or behind and grasps 
 the iliac crests, one with each hand. 
 
 (i) For backward tipping , the assistant stands in front and draws the pel- 
 vis forward, while the practitioner stands behind, grasps the patient beneath 
 the axillae, and raises and draws the trunk backward. His work is aided by 
 pressure of his knee against the sacrum. During this treatment, 'slight rota- 
 tion of the body from one side to the other during the lifting process helps the 
 reduction of the lesion. 
 
 (2) For tilting tipward on one side or for ttirning to either side, this same 
 treatment may be applied with variations to suit the condition. 
 
 (3) For /?)^^?«^/<?r7£'^r</, the assistant stands behind and draws the pel- 
 vis backward, while the practitioner manipulates the trunk from in front, in a 
 similar manner as before, gradually working and drawing it forward. 
 
 (4) For tipping forward, the patient may lie upon his side, the practitioner 
 stands behind the pelvis, making a fixed point with one palm against the lower 
 portions of the innominates and sacrum, He now draws backward, with the 
 other hand, upon the uppermost iliac crest and anterior superior spine. The 
 patient lies upon the other side and the motion is repeated. 
 
 (5) For tipping backward, the patient lies upon his side, the practitioner 
 stands behind and presses the flat of his knee against the upper portion of the 
 sacrum. He now grasps the uppermost limb with one hand, the uppermost 
 shoulder with the other, and draws the body backward, while forcing the pel- 
 vis carefully forward.
 
 40 I'RACTICE .AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 (6) For tiltijig upicard of the pelvis, one may adapt to the reduction of 
 this lesion the treatment described in Chap. VII, A, Downward Displace- 
 ments of Lower Ribs, for the stretching of the quadrati lumborum muscles. 
 
 (7) For turning of the pdvis to one side, one may adapt to the reduction of 
 this lesion the treatment as described in Chap. II. div. XVIII, third treatment.
 
 CHAPTP:R IX —Continued. 
 B. — Lesions Affecting Parts of the Pelvis. 
 
 We deal here chiefly with lesions of the innominate bones. They are 
 more frequent than lesions of the pelvis as a whole, and are realatively more 
 important. 
 
 The gcnoal indications of innominate lesion, which would lead one to 
 examine tor such displacement are back-ache, sciatica, pain or lameness in. 
 the limbs, limping or unequal gait, pelvic disease, female disorders, etc. 
 
 The lesions of the innominates commonly met with are: 
 
 I. The innominate di\s\^\?iC^(\ forivard or backward. 
 
 II. The innominate displaced npzvard or dotvn'iCard. 
 
 III. Combinations of tJic above, which are the rule. It is rare that the 
 simple lesion I. or II. is found. Frequently the displacement is doivmvard' 
 and backcvard at the same time, lengthening the leg. This lesion is, on the 
 whole, the most common, but the opposite \ux^i\on, forzua'd and upzvard, is 
 frequent. Generally if the lesion is backward, it is at the same time down- 
 ward; if it is forward, it is at the same time upward. In thela'cter case, the 
 leg is shortened. Yet it cannot be stated as the invariable rule that the 
 backward lesion is combined with the downward one, and that the upward 
 and forward positions alwa)-s combine. The luxation may be back and up,, 
 or vice-versa. Yet, whatever the combined lesion be, a lengthened limb in- 
 dicates a downward displacement of the innominate, while a shortened 
 limb shows the reverse. 
 
 The reason why the downward lesion usually complicates the backward 
 one is found in the beveled edge of the sacrum where it articulates with the 
 ilium. This bevel is wedge-shaped, with its broad end up. Moreover, its 
 posterior margin is longer, and rises higher than its anterior edge. Thus 
 the beveled auricular surface of the sacrum, which bone is broader in front 
 and tilts forward so that the posterior margin of its base stands higher, 
 directs the ilium either downward and backward, or upward and forward,, 
 according to the direction of the forces causing the lesion. 
 
 IV. Each innominate may suffer from lesion at the same time, which 
 may be alike upon both sides, or different. 
 
 Examination: Palpation, aided by Inspection, is used in the examina- 
 tion. 
 
 I. The length of the limbs is compared, and is one of the first and most 
 reliable methods of examining for lesion of the innominate. The patient 
 is laid upon his back; care is taken that he shall lie perfectly straight; the 
 limbs are flexed and rotated to relax muscles and ligaments, and to pre- 
 vent any unnatural tension in these structures from causing merely appar- 
 ent difference in length. The limbs are now drawn down and compared at 
 the heels. It is best to have the patient keep the shoes on, but care must
 
 42 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 be taken to notice that the heels of the shoes do not differ in thickness, and 
 that they are pushed back snugly against the patient's heel. 
 
 This examination is for confirmation only, and while it is a clear indi- 
 cation that one innominate is lu.xated, further examination is necessary to 
 determine whether one leg is too long, or the other too short. 
 
 II, Toidinicss in the sacro-iliac ligaments upon deep pressure, and 
 tenderness in the tissues along the crest of the ilium indicate that the lesion 
 is upon the side upon which such tenderness occurs. The sacroiliac liga- 
 ments are found tensed upon the side of lesion. 
 
 While this tenderness and tension will usually indicate unilateral lesion 
 it is not an in\ariable sign, as the strain thrown upon the opposite side often 
 causes like effects. 
 
 7V>fderfi(Ss at Ihc public symphysis is often present in these cases. 
 
 '\\\c posHioa of the posterior superior iliac spines is the best indication of 
 lesion, receding anteriorly, prominent posteriorly, up, or down, down 
 anti back, forward and up, etc., indicating the corresponding malposition in 
 the bone. Comparison of the spine of the luxated bone with that of the 
 normal bone is made. This examination must be made upon the bared 
 back with the patient sitting. The practitioner sits directly behind the 
 patient, palpation of both spines alike is made at the same time, one hand 
 upon each. This facilitates comparison. 
 
 I\'. The ti'rt/i/ //wi' is frequentlx changed in each case. Usually that 
 upon the side of lesion is deeper through the patient's favoring that side; 
 bending toward it. For the same reason the muscles about the hip, peh'is 
 and lower spine upon the opposite side may be hypertrophied, 
 
 \ . The spiiie adjacent to the peh'is must be examined for curvature, 
 swerving to one side, hypertroph}- or tension of tissues, etc., secondary to 
 pelvic lesion. 
 
 \T. Measurements may be made between coracoiJs and anterior super- 
 ior spines, also from the mid-line of the teeth to the inner maleolus of each 
 tibia. 
 
 Treatment: Preliminar}" relaxation of all surrounding tissues is first 
 done by methods already described. 
 
 I. Backward Luxations and their combinations: 
 
 a. Patient lies upon his back; practitioner stands at the side and places 
 the clenched hand as a fixed point beneath the posterior superior spine of 
 the luxated bone; the knee is flexed against the throax and is rotated 
 outward strongly enough to raise the weight of the patient and throw it up- 
 on the clenched hand. In this way the weight of the body is made to force 
 the bone forward. 
 
 b. Patient lies upon his side; practitioner stands in front of the pelvis, 
 slips one hand between the thighs and grasps the tuberosity of the ischium, 
 the other hand is upon the posterior crest. He now draws forward upon 
 the latter point while he pushes backward upon the tuberosity, by pulling
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 43 
 
 forward on the tuberosity and pushing backward on the crest, the anterio) 
 displacement of the bone may be set. 
 
 Commonly one alternately pushes and pulls to thoroughly loosen the bone, 
 ending by the appropriate motion to set it. 
 
 c. Patient lies upon his sound side; practitioner stands behind the pel- 
 vis .making pressure with his hand upon the upper back part of the in- 
 nominate, while at the same time he draws the uppermost thigh backward. 
 This forces the bone forward. 
 
 II. Forward Luxations and their combinations: 
 
 a. Patient lies on his side, lesion uppermost; the practitioner stands 
 behind the sacrum and places his hand or the flat surface of his knee against 
 the lower part of the sacrum, while he draws backward upon the anterior 
 spine and crest of the luxated innominate. 
 
 b. See "b" above. 
 III. Upward Lesion: 
 
 a. The patient sits upon a stool and an assistant stands in front and 
 fixes the pelvis by firm pressure downward upon the crests of the ilia. The 
 practitioner stands behind, grasps the patient's trunk beneath the axillae, 
 and lifts; turns and springs the whole trunk away from the side of lesion. 
 
 This same motion may be applied to forcing the body down toward the 
 side of lesion in downward luxations. 
 
 b. For reducing the upward lesion one may adopt the treatment de- 
 scribed in chapter VII. a. for the stretching of of the quadratus lumborum 
 muscle. 
 
 For do7u?iward luxation see "a" above. 
 
 The SACRUM and cocoyx have already been discussed. (Chap. I. divs. 
 v., VI., VII ; Chap. II. divs. XIX., XX.) Anterior or posterior, upward or 
 downward luxation of the sacrum may be overcome by combinations of the 
 treatments described for the sacrum and for the innominate. 
 
 Spinal treatment must be given in conjunction with pelvic treatment as 
 the case ma}' require. 
 
 C. — General Points Concerning the Pelvis. 
 
 The piidic nerve a?id artery may be located where they cross the spine 
 of the ischium, and be reached by deep pressure. The patient lies upon 
 his side, the practitioner stands in front and bends the uppermost thigh 
 backward to loosen the muscles and tissues. Pressure is made down upon 
 the spine at a point between the middle and lower two thirds of a line 
 drawn from the posterior superior spine of the ilium to the outer side of the 
 tuber ischii. 
 
 The gluteal arteries may be impinged in the same way by deep pressure 
 at a point between the upper and middle two thirds of a line drawn from 
 the posterior superior spine of the ilium to the outer side of the great troch- 
 anter when the thigh has been rotated forward.
 
 .^ PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 Deep manipulation may be made over the course of the ihac blood-ves- 
 sels, beginning at a point about two inches below the umbilicus and thence 
 diagonally outward to the point where the femoral vessel leaves the pelvis 
 beneath Poupart's ligament. The internal iliac artery runs diagonally 
 downward into the pelvis from about the mid-point of the line of the first 
 manipulation. 
 
 lYic speniiatii or ovarian vessels may be manipulated by deep pressure 
 alono a line beginning at the level of the umbilicus one inch external there- 
 to, and running down to enter the pelvis at a point one and one half inches 
 internal to the anterior superior spine of the ilium. 
 
 In case of these \esstls one aids the venous flow by centripetal pro- 
 gress along the lines defined. As an aid in relieving or restoring blood- 
 flow in various pelvic diseases the treatments are of value. 
 
 The Hy/>os^astrie plex2(S is reached by deep pressure at a point about two 
 inches below the umbilicus. The plexus lies between the common iliac 
 arteries, just below the bifurcation of the aorta. 
 
 The pelvie plexuses a.re reached a little lower and outward from the mid- 
 line, where they lie deep in the pelvis each side of the rectum. 
 
 D. — Osteopathic Work i-er Rectum. 
 
 The index finger is generall)' used in rectal work as its use is less inter- 
 fered with by the knuckles. Proper precautions for cleanliness and to 
 guard against infection must be employed. The patient lies upon the right 
 side or stands bent over a table. The examining finger, lubricated with 
 vaseline or soap-suds is inserted, palm down, into the rectum. It notes mal- 
 position of sacrum or coccyx; weakness, folding or prolapsing of the rectal 
 walls; whether the grasp of the external sphincter is normal; enlargement 
 of the prostate gland in the male; protrusion of the cervix or fundus of the 
 uterus against the rectum in the female; the presence of tumor or other 
 growth; haemorrhoids, protruding or internal. 
 
 The prostate gland lies below the anterior wall of the rectum and is felt 
 in that position about one and one-half inches from the anus. Either lat- 
 eral lobe, or the central lobe may be enlarged. In the latter case, stricture 
 of the urethra is threatened, as the gland surrounds its first position. 
 
 Treatment: — In prolapsed and weakened walls the finger should smooth 
 out the walls and press them upward as far as possible. This aids reposi- 
 tion, tones nerve and blood force, and helps to establish normal tone to the 
 muscular walls. 
 
 A weakened sphincter is much stimulated by the simple insertion of 
 the finger. It may be dilated by introducing two or three fingers held in 
 wedge-shape, spreading them apart upon withdrawal. 
 
 For an enlarged prostate gland, the finger makes pressure upon it and 
 is swept laterally over it to aid in freeing the blood-flow from it. Care must 
 be taken not to irritate it.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 45 
 
 In ha:?morrhoicis, all the surrounding tissues are gently manipulated for 
 relaxation and to remo\e interference with free circulation, after which pres 
 sure is made directly upon the distended vessels to empty them of blood, 
 and to gently force them back into place if external. 
 
 Rectal treatments should not usually be given oftener than once a 
 week or ten days. Great care should always be exercised to cause as little 
 irritation as may be. As a rule these treatments are but secondary to the 
 removal of pelvic or spinal lesion. 
 
 E. — Osteopathic Work per \'aginam. 
 
 This examination is made with the index finger for the same reasons as 
 in the case of rectal treatment. The same precautions as to cleanliness, etc., 
 should be obser\'ed. 
 
 As a rule local treatment is secondar}- to that done upon spinal or pel- 
 vic lesion, which is usuall\' the real cause of those conditions which require 
 local treatment. 
 
 It is proposed here to re\iew this subject onl}- in a general wa\", giving 
 the main points in connection with the examination and treatment of this 
 region as a part of the bod\', leaving detailed consideration to the portions 
 of the course dealing specially with the specific diseases of these organs. 
 
 I. Local Examination: — The patient lies on her back or on her side. 
 In the latter case the practitioner stands behind. The index finger anointed 
 with vaseline is introduced, passing from the region of the fourchette for- 
 ward. The guiding hand is placed upon the abdomen, and by deep pres- 
 sure may aid in locating the organ and in diagnosing its position. External 
 pressure over the region of the broad ligaments will sometimes re\"eal 
 tenderness in them in cases of prolapsus uteri. In case the tenderness is 
 unilateral it is usually in the ligament suffering from the most tension be- 
 cause of the organ having fallen toward the opposite side. 
 
 The examining finger should first note the condition of the vaginal zaalls, 
 which ma\' be weak and flabby, or prolapsed and contorted b)' the malpo- 
 sition of the uterus. The presence of cnlaigement or tumor of iurrounding 
 organs is to be noticed. At the upper extremity of the vaginal canal is felt 
 the cervix protruding into the canal. 
 
 The external os ute?i opens transversely at the lower end of the cervix. 
 In women who have borne children the external os inclines to be circular, 
 but by careful examination the transverse axis ma>- be distinguished. This 
 is made more certain by the shape of the cervix, which is somewhat flat- 
 tened antero-posteriorly. By these two points, the transverseness of the os 
 and the position of the cervix, the main diagnosis of the position of the 
 uterus is made. If the transverse os (or the longer transverse diameter of 
 the cervix) has assumed an oblique direction in the pelvis, it indicates a 
 corresponding turn in the position of the organ. This turning to one side
 
 46 PRACTICE AKD APPLIED THERAPEUTICS OF OSTEOHATHY, 
 
 is usually combined with the prolapsus of the ^organ in one direction or 
 another. 
 
 If the cervix points forward and upward, the fundus has gone down and 
 back, and may be against the rectum. In such case the fundus is often felt 
 through the posterior vaginal wall. Or the uterus may have turned in fall- 
 ing backward, so that the fundus lies down toward either sacro-iHac region. 
 If the cervix points backward and upward, it indicates that the cervix has 
 descended anteriorly upon the bladder. It may often be felt through the 
 anterios vaginal wall. There are all degrees^ of prolapsus, some ma) be so 
 slight that the cervix and fundus have deviated but little from normal posi- 
 tion. By noting the direction of theos, the direction of the cervix, and (if 
 possible) the position of the fundus, no difficulty is usually experienced in 
 discovering the form of prolaosus from which the patient is suffering. 
 
 The different forms of flexion are more difficult, but may be made out 
 by the relative position of the cervix and fundus. For example, if the cer- 
 vix remains near normal position while the fundus is found backward, retro- 
 flexion is diagnosed. 
 
 II. Local Treatment: — The patient ma\- lie upon the back, upon the 
 side, or kneel upon the table with the trunk inclined forward and the chest 
 touching the table. 
 
 In the first or second position, the patient may, while the operating 
 finger still supports the organ, slip off of the table and stand upon the fioor, 
 bending forward to remove the weight of the viscera above, while the finger 
 presses the organ back toward its position. In any esse, the idea of the 
 treatment is to so manipulate the cervix, by pre >sure or traction, as to cause 
 the cervix, thus the fundus, to assume its natural position. 
 
 The knee-chest position is the best for the treatment of such cases. It 
 allows the force of gravitation to act to draw the intestines from the pelvis» 
 which permits easy reposition of the organ. At the same time the vagina 
 ma\ be dilated, and atmospheric pressure aids materially in forcing the ut- 
 erus high up to its position. Moreover, when the patient has changed her 
 position first onto the side, then onto the feet, the intestines fall back around 
 the organ and help support it. 
 
 The treatment described in Chap VIII, div. Ill, may be applied to the 
 external treatment of pelvic disorders. 
 
 The /t'«;/d^//^rt/;/^«/'jr of the uterus may be located and may be stimu- 
 lated by pressure upon the upper margin of the pubic arch, about a half an 
 inch externally from the symphysis. 
 
 Inspection of the female pcrineuvi sometimes reveals a downward 
 bulging of it in place of the natural slight arch of the healthy perineum. 
 Such a condition indicates prolupsus of the pelvic viscera. 
 
 In child-birth, strain upon the perineum may be relieved by grasping 
 both tubers ischii from below with one hand, while the other hand presses 
 the tissues over the pubic crest in front down toward the perineum. The 
 first hand, meanwhile is tending to spring the tuberosities toward each 
 other.
 
 CHAPTER X. 
 The Limbs. 
 
 I. Shouldek Dislocations. The head of the humerus may be dislo- 
 cated downward into the axilla; forward beneath the clavicle; backward 
 upon the scapula; or forward beneath the coracoid process. 
 
 With the patient sitting, and the trunk fixed by an assistant, the prac- 
 titioner stands at the side, rests his foot upon the stool and places his knee 
 in the patient's axilla. Traction is now made directl)' downward upon the 
 arm, overcoming the tension of the muscles and drawing the head back into 
 the glenoid fossa. This treatment will answer for any of the dislocations. 
 
 The same object may be accomplished by placing the patient upon his 
 back, while the practitioner stands at the side, places his stockinged foot 
 in the axilla, and exerts strong traction upon the arm. 
 
 II. Elbow Dislocations. The radius and ulna may be both displaced 
 backward, externally or internally: the ulna backward; the radius forward 
 or backward. 
 
 The patient sits, and the practitioner satnds at the side with his foot 
 resting upon the stool and his knee in the bend of the elbow. The upper 
 arm is fixed and traction is made strongl)- upon the forearm. This will be 
 sufficient for the first four dislocations. When the radius is backward, 
 direct pressure upon it is sufficient to reduce it. When the radius is for- 
 ward the hand is supinated. it is bent upon the wrist away from the radius, 
 thus bringing traction upon it. while pressure is made upon the head of the 
 bone abo\ e. 
 
 III. Wrist Dislocations. The radius and ulna may both be forward, 
 backward, or outward. Simple traction will reduce them. 
 
 I\'. Radio ULNAR Dislocations. The radius is regarded as the fixed 
 bone, the ulna being displaced forward or backward. Direct pressure upon 
 it will force it to its place. 
 
 V. Carpo-Metacarpal dislocations are more frequent in case of the 
 thumb. Direct pressure will reduce them. 
 
 \T. Dislocations of carpal bones are easily reduced b\- pressure. 
 
 VII. Metacakpo Phalangeal dislocations in case of the thumb are 
 most frequent. For the backward one. continued strong hyper extension, 
 followed b\- flexion are used. If this treatment does not succeed, the meta- 
 carpal is rotated and pressure is made upon its head. In the fot~>.'ard dis- 
 placement traction and pressure are employed, or strong flexion is followed 
 by direct pressure. 
 
 In case of the fingers, simple traction and pressure are sufficient, as is 
 also the case in Phalangeal dislocations. 
 
 These remarks apply to all cases of recent dislocation as described. It 
 more often comes within the Osteopath's province to work upon old dislo- 
 cations, so frequentl)- given over as incurable. As far as possible he applies
 
 48 PRACTICE AND Alll.lED THEKAPEUTJCS OF OSTEOPATHV. 
 
 the usual mot ons for the reduction of them, but prepares the joint for re- 
 duction by a course of treatment directed to relaxing surrounding muscles 
 etc.; to restoration of free circulation about the part and the upbuilding of 
 the tissues. Often a persistent course of treatment restores a bone to posi- 
 tion when it had been given up as hopeless. These remarks apply espec- 
 ially to old dislocations of the hip joint. 
 
 General Treatment fok the Upper Limb. In treatment for various 
 conditions the arm is manipulated in special ways. 
 
 I. The shoxilder-joint ma\- be sprung to allow of free blood-flow and to 
 remove tension in the ligaments. The clenched hand is placed in the axilla, 
 care being taken not to press the knuckles against the axillary hmphatics. 
 or against the nerves and vessels on the inner side of the arm. It is best to 
 turn the hand sidewise. The patient's arm is now forced against his side, 
 springing the head of the humerus outward. 
 
 II. The clboiv may be sprung by flexing the fore arm o\er the hand 
 placed upon the arm just abo\e the bend of the elbow. Or the fore-arm 
 may be flexed to a -light angle, and the treating hands draw it away from 
 the lower end of the humerus. The\' ma)- follow along down the fore-arm, 
 working deepl)- between radius and ulna to relax the interosseous tissues. 
 
 III. The branches of the brachial plexus and the axillary artery ma>- be 
 impinged against the inner side of the humerus just below the axilla. 
 Transverse friction reaches all these nerves and may be used to tone them. 
 
 1\'. Catching of the anterior fibres of the deltoid muscle under the 
 coracoid process, and attendant slight forward luxation of the head of the hii- 
 tncrus may be remedied by grasping the arm just above the elbow and 
 drawing it directly back and up to the level of the shoulder. Now the arm 
 is carried forward at the same level, and the movement is finished with a 
 slight upward turn. 
 
 \'. The biceps muscle and its lo7is; head may be strongly stretched by 
 drawing the extended fore-arm directly backward and upward. 
 
 General Treaiment for thk Lower Li.mb. 
 
 I. Strong flexion of the thigh on the thorax and the leg upon the 
 thigh stretches the quadriceps extensor muscle. 
 
 II. H) per-extension of the thigh stretches the anterior structures, in- 
 cluding the femoral \essels and anterior crural ner\e. 
 
 III. H\per-extension of the foot stretches the anterior muscles of the 
 leg. Strong flexion of the foot stretches the calf muscles. 
 
 IV. Adductor muscles of the thigh are stretched by forced abduction. 
 The patient lies upon his back, the practitioner presses against one leg 
 which remains upon the table, at the same time keeping the other leg 
 straight and abducting it to the extreme. He ma\' stand between the legs. 
 The same object is accomplished by flexion combined with external cir- 
 cumduction.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 49 
 
 V. The muscles of external rotation for the thigh are stretched by 
 flexion combined with internal circumduction. 
 
 VI. The extensor muscles of the thi^h are stretched by raising the 
 straightened limb to or beyond right angles with the trunk. This may be 
 accomplished with the patient on his back. The limb, still straight, may 
 be supported at right angles while the foot is strongly flexed on the leg. 
 TWx'i stretches the sciatic nerve. This nerve is also stretched by motion I. 
 Motion V. stretches the pyriformis, gemeili, and obturator muscles, and aids 
 in removing irritation from the sciatic nerve. All of the motions for 
 stretching this nerve act partly through relaxation of tissues about it. 
 
 VII. Pressure at the mid-line of Scarpa's triangle, about two inches be- 
 low the middle of Poupart's ligament, impinges the femoral vessels and the 
 anterior crural nerve. 
 
 VIII. The popliteal ner\e and ves^^els are reached at the popliteal 
 space. The patient lies upon his back. The limb is drawn over the edge 
 of the table and the foot is supported between the practitioner's knees. 
 Manipulation is now made deeply just below the knee behind. 
 
 IX. Forced flexion, extension, inversion and eversion of the foot may 
 be made for the purpose of relaxing all the ligaments of the ankle. 
 
 All of the treatments described for the upper and lower limbs are 
 given in a general way. The\' ma}' be used in the treatment of specific 
 cases of disease in \arious wa) s. One should not forget that the\' are used 
 as aids in the reduction of special lesions or as secondary thereto. 
 
 X. In treatment upon \\\q feet one notes the two natural arches, the 
 transverse and the longitudual. Springing these arches by pressure upon 
 the arch above and traction at the same time upon the ends, aids in relax- 
 ing ligaments and other tissues, reducing bony luxations, removing press- 
 ure from nerves and blood-\'essels. The treatment ma}' be made more 
 effective by springing the arch both ways, i. e., first applying pressure such 
 as to increase the concavit)' of the arch, then to lessen it. 
 
 XI. In treatment for the tecs the blood-vessels, which lie upon the 
 sides, are stretched, and the tissues about them relaxed, by bending them 
 laterally. The lateral movements, combined with extension flexion, and 
 traciion, free the joint and its nerves, vessels, and tissues. 
 
 XII. The saphenous opening an inch and a half below the inner end of 
 Pouparts' ligament, is often in an occluded condition such as to seriously 
 impede the flow from the long femoral vein. The muscles and tissues about 
 it ma)' be stretched by external rotation of the flexed knee. F'oUowing 
 this movement b)- internal rotation of the extended limb relaxes the tissues 
 still further and allows of direct manipulation upon the opening. 
 
 XIII. With the patient lying upon the back one notes the angle of 
 deviation of the toes, i. e., the angle between the feet. If one foot rotates 
 outward too much or too little, it re\'eals tenseness or laxness of the rotat-
 
 50 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 tors of the thigh, and may lead one to the discox'cry of abnormal peKic or 
 hip conditions. 
 
 Concerning di'/.j/(7r«/'w/.? of the lower limbs, one must bear in mind that 
 many of the cases presented to the Osteopath are old dislocations. The 
 success of Osteopath)' in the reduction of such has been marked. Again, 
 many cases are met with in which gross dislocation is not present, but a 
 slight luxation, or "slip," of a joint has occurred and has been overlooked 
 by other practitioners. The number of cases in which such a sight displace- 
 ment in the hip-joint has caused apparent disease in the knee, sciatica, 
 lameness, etc., is remarkable. The fact that these things are commonly, or 
 at least frequently, not discoxered by others than Osteopaths indicates 
 something of the need and importance of osteopathic methods. The prac- 
 titioner must bear in mind the probability of such occurrences, and must be 
 upon his guard to disco\-er them. As a rule, in all old dislocations and 
 chronic sublu.xatious of this nature, the reall\ important osteopathic work 
 is the preparation of the parts for the restoration of normal relations. Re- 
 laxation of old contractures in muscles, softening ligaments, development 
 of atrophied parts through the upbuiltling of blood and nerve-suppl)- are 
 the preliminary steps taken by general osteopathic methods already de- 
 scribed. In case of such luxations, gross dislocations excepted, the stand- 
 point of the Osteopath in diagnosis is a new one. This teaching leads him 
 to look for such causes of disease, which are meaningless toother methods 
 of practice. 
 
 I. Dislocations OF THE Ankle. The displacement may be of both 
 leg bones forward, backward, inward or outward. In either case, the patient 
 lies upon his back; the leg is elevated to a right angle and fixed by an 
 assistant, and strong traction is made upon the foot. The muscles draw the 
 ankle into place. 
 
 II. Dislocations of the Knee. The leg may be forward, backward, 
 inward or outward. Strong traction restores it to place. 
 
 In cases of slight back vard luxation, short of dislocation, a good 
 method is to have the patient lie on his back, hang th*^ leg, btnit at the knee, 
 over the edge of the table, while the foot is supported between the practi- 
 tioner's knees and his hands work in the popliteal region. The hamstring 
 muscles are grased b}' the two' hands and stretched awa>' laterall)- from the 
 condyles of the femur, while the tibia and fibula are drawn forward. 
 
 III. Dislocations OF THE Hip. In such cases, the head of the bone 
 ma\- be displaced as follows: 
 
 (i) Up and back onto the dorsum of the ilium, shortening the limb 
 and turning the toes inward. 
 
 (2) Down and back onto or near the sciatic notch, somewhat shorten- 
 ing the limb, and turning the toes inward. 
 
 (3) P'orward and down onto or near the obturator foramen (th)roid
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 5I 
 
 dislocation), in which the knee is flexed, the toe points to the ground and 
 rotates inward or outward. 
 
 (4) Forward and up onto the pubic crest. The toe invariably turns 
 out. 
 
 In (2), as the patient sits up from a lying posture, the limb shortens; in 
 (3) and (4) it lengthens. 
 
 In the tTeahncnt of such conditions, fresh dislocations are set at once, 
 but as in our practice many old dislocations are presented, the success of 
 the treatment lies largely in knowing how to thoroughly prepare parts for 
 adjustment as above stated. Much lies in our way of regarding disease, for 
 even gross dislocations are often overlook. These, and the many luxations 
 of lesser degree found in osteopathic diagnosis, could scarcely be over- 
 look in our method of minutely scrutinizing the mechanical relations of all 
 parts in examination of acase. 
 
 In (i) the knee in flexed and rotated a little inward to disengage the 
 head of the femur, then, while pressure is made to force the head toward 
 the acetabulum, the flexed knee is rotated well outward and extended. 
 This draws the head into the acetabulum. The patient is lying on his back. 
 
 In (2) the manoeuver is the same, except that during outward rotation 
 and extension the trochanter is grasped and forced forward toward the 
 acetabulum. In the inward rotation the head has been disengaged from the 
 notch. 
 
 In (3) the flexed knee is rotated far inward, freeing the head from the 
 obturator foramen, while the "Y" ligament acts as a fulcrum. As the in- 
 ward relation is carried downward to extension the head is forced toward 
 the cotyloid notch. 
 
 In (4) the patient lies upon his sound side, the dislocated thigh is 
 h)'per-extended by being strongl}- drawn backward. This stretches all the 
 muscles about the head, which, after slight flexion of the thigh, is lifted 
 over the crest of the pubes. 
 
 In (i) and (2) the patient may sit upon a stool, the dislocated limb is 
 crossed above the other knee, the pelvis is fixed by an assistant, the tro- 
 chanter is pressed by one hand toward the acetabulum, while the other 
 hand draws the limb well across its fellow and extends it to place the foot 
 on the floor. 
 
 In (i) and (2) the patient may stand upon one foot, supporting his 
 hands upon the back of a chair ; the thigh remains straight, and the knee 
 is flexed to a right angle; the ankle is supported by the practitioner who 
 stands at the side of and behind the patient. He new places one knee upon 
 the popliteal region, allowing the weight of his body to come down upon 
 it. This forces the head downward, while a swing of the ankle outward dis- 
 engages it. Now a swing inward, while the weight is still applied, brings 
 the head into the acetabulum. 
 
 These various motions may be applied to subluxaitons as well as to 
 gross dislocations.
 
 ^^/^, '^^:>t^yKe^ (^/ChA^^^z.6-<^^ 
 
 PART II. 
 
 DISEASES. 
 
 NOTE. — // is the intention to deal here only with the osteopathic views, pHn-. 
 ciples and methods in relation to the various diseases considered. Any sta^idard 
 medical text will supply the reader with these facts, theories, etc., ivhich he may de-. 
 sire to k7iow, and which it is uniiecessary to repriiit here.
 
 ASTHMA. 
 
 Definition: Asthma is a disease of the bronchial tubes characterized 
 by dyspnea. It is spasmodic in nature, the air tubes being narrowed by 
 spasm of their muscularfibers or b> swelling of the mucous membrane from 
 hypermia. 
 
 Cause: — This disease alwa\s presents definite lesions, muscular and 
 bony, of the upper dorsal spine and of the thorax. Secondary lesions usu- 
 ally occur in the cervical region. The chief bony lesions affect the ribs from 
 ike second to the sixth on the right side. (A. T. Still.) The majority of cases 
 show lesions of this region, but the\' may occur higher up or lower down. 
 Lesion is often found in the neck. (A. G. Hildreth.) The sternal ends of 
 the ribs and the costal cartilages, as well as the spinal ends of the ribs may 
 show the lesion. Lesions of the ribs from the second to the seventh on 
 either side; of the corresponding dorsal vertebrae; of the anterior and pos- 
 terior thoracic muscles; of the atlas, axis and hyoid bone, and of the cerx'i- 
 cal muscles are all active in producing the disease. 
 
 A review of the typical cases, reported from various sources, and in 
 which cures were made by the removal of the specific lesion, shows a defi- 
 nite area in which such causes occur, (i) Luxation of first, second and 
 third left ribs. (2) Fourth, fifth and sixth dorsal vertebrae anterior; the 
 corresponding ribs lowered. Two treatments stopped the attacks, and pa- 
 tient was discharged as cured after three weeks' treatment. (3) Second 
 dorsal vertebra lateral. (4) Fifth right rib down and much tenderness of 
 tissues at the fifth dorsal vertebra. This case was of thirty years' standing, 
 and is reported cured by two weeks' treatment. (5) The scaleni, mas- 
 toid and anterior and posterior thoracic muscles very tense. (6) Right 
 fourth and fifth ribs, and left fifth and sixth ribs luxated. This case was 
 also of thirt)' years' standing. One month's treatment cured it. 
 
 (7) The axis luxated to the right, cervical muscles contractured, all 
 the ribs depressed. A case of twenty years' standing, cured in one month. 
 (8) The left fifth and sixth ribs downward. (9) The first to the eighth 
 ribs on both sides down; spinal muscles of the same region contractured; 
 luxation of the atlas and axis; depression of the h)'oid bone. (10) The 
 second dorsal vertebra luxated laterally, involving the corresponding ribs; 
 several ribs below down, (ii) All the upper dorsal vertebrae anterior, 
 carrying the ribs forward; closeness of the first rib to the clavicle. 
 
 One can but note how all of these lesions occur in those regions it which 
 it is claimed the cause of asthma occurs. No other school of practice no- 
 tices such causes of this disease. Their theories are various, man}' exciting 
 causes are agreed upon, but Anders makes the statement in regard to the 
 real and original causes that they are of an unknown nature. 
 
 The spinal area of motion is given by Dr. Still as extending from the 
 fourth to the sixth dorsal vertebra. These lesions affect this area. They
 
 56 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 cause abnormal motor effects both in arousing spasmodic conditions of the 
 muscles of the bronchial walls, and in the vaso-motor activity that produces 
 the hyperemia of the mucous membranes. 
 
 There are good anatomical reasons why lesions in these regions affect 
 the lungs. The American Text Book of Phjsiology states that stimulation 
 of the vagus in the neck produces constriction of the pulmonary vessels, 
 while stimulation of the sympathetics in the neck causes dilatation of them. 
 Ouain's anatomy says that the pneumogastrics conve)- motor fibers to tlie 
 unstriped muscle fibers of the trachea, bronchi, and their subdivisions in- 
 the lungs. Vasoconstrictors for the lungs exist, in some animals, in the 
 second to the seventh spinal nerves. (Quain.) The anterior pulmonary 
 plexus is composed of the pneumogastrics and the sympathetics; the pos- 
 terior, of the pnemogastrics and branches from the second, third, and fourth 
 'thoracic sympathetic ganglia. These regions of the spine, with their im- 
 portant nerxe connections with the lungs, are naturall}' investigated by the 
 Osteopath in relation to asthma. It is reasonable that obstruction to the 
 nerves here should cause the disease. Anders gives a-nong exciting causes 
 "irritating lesions of the medulla." The Osteopath finds in lesions of atlas, 
 axis and cervical tissues sufficient cause of such irritation of the medulla as 
 well as of the pneumogastric, through their s\mpathetic and spinal nerve 
 connections. In these ways, lesions to the cervical, dorsal and upper thor- 
 acic structures act as obstructors of these nerve mechanisms concerned in 
 asthma, the pneumogastric ner\e, pulmonary plexuses, sympathetic and 
 vaso-motors, and cause the disease. 
 
 Exciting Causes of the paroxN'sm, such as bronchitis; the inhalation of 
 irritants, such as dust, fog, smoke, chemical vapors, pollen of plants, odors 
 of animals; reflex irritation from nose or stomach; the results of other dis- 
 eases, etc., would not act to cause asthma did these anatomical lesions not 
 exist 1 hev"are the real CTuse of the condition; existing in an individual,, 
 they obstruct the vital forces of the bronchi and deteriorate the vitality of 
 their tissues, perhaps gradually during a term of years, and make it pos- 
 sible for these various exciting causes to act. 
 
 The PROGNOSIS is good under osteopathic treatment, though under med- 
 ical treatment^com;)aratively few cases recover. Very many cases, a large 
 number of them apparently helpress, have been cured. The fact that most 
 of these cases coming under osteopathic treatment are of long standing and 
 have usuall)' tried every known remed)' seems to make little difference in^ 
 gaining results upon them. Some cases the most severe and longest stand- 
 ing yield quickest. 
 
 Examination and^Treatment are carried out according to the meth- 
 ods describedjin Part I, (Chapters I. II, III, IV, \T, VII.) Any of the les- 
 ions that may affect the bon\- parts in the regions mentioned may produce 
 the disease. Displacements of ribs, vertebrae, etc., need not take place in 
 a particular direction. Rib and thoracic vertebral lesions are more likely to^
 
 PRACTICE AND APPLIED THERAPBUTICS OF OSTEOPATHY. 5^ 
 
 act as causes. Lesions in the neck alone seem quite unlikely to cause it. 
 Those of the fourth and fifth ribs upon the right side are most frequently 
 the cause. It is unnecessary to name the various probable causes of the an- 
 atomical derangements or lesions named, as that subject has been fully 
 dealt with elsewhere, as well as the theory of the exact waj- in which such 
 lesions as the Osteopath finds act to cause disease. 
 
 Treatment must always depend for its success upon removing the 
 causative lesion, but treatment durins; the attack must look more particularly 
 to immediate relief of the patient, for as a rule these lesions can be removed 
 only by a course of treatment. At this time great relief is given and the 
 spasm usually quieted by thorough relaxation of the spinal muscles (Chap. 
 II, div. I. p. 8), followed by raising of all the ribs (Chap. VII) and clavicles 
 to allow free thoracic and lung action, and by relaxation of the muscles and 
 other soft tissues of the neck. Loosen the clothing about the neck. 
 
 The best time to treat for removal of the lesion is between attacks, it 
 being located and treated, according to its kind, b}' methods alread}' de- 
 scribed. Attention should be given the sternal ends and cartilages of the 
 ribs, and to the intercostal tissues, as well as to the heads of the ribs and 
 the vertebrae. The scapular muscles should be relaxed (pp. ID, li), the 
 clavicles raised (p 34), the tissues of the neck thoroughly relaxed (p 20), 
 the spinal column relaxed (p. 8, II; p. 9, III, IV, V), and the ribs raised at 
 their angles. If the patient finds it difficult to take a full breath raising or 
 correcting the fifth rib will sometimes give relief. Pressure upon the phre- 
 nic ner\e aids the work by relaxing the diaphragm, which is sometimes ele- 
 vated (p. 16, VIII.) 
 
 Treatment once a week or ten days is often enough in most cases. Fre- 
 quent treatment may undo the results accomplished and keep up constant 
 irritation. Many severe cases have been cured by a few treatments at long 
 intervals, or by a single treatment. 
 
 Under this course of treatment the patient usually feels relief at once. 
 As a rule the spasms and the various attendant symptoms terminate 
 abruptly. 
 
 Care of patient should include the wearing of loose clothing, living out 
 of doors in pure air if possible, or in large, well ventilated rooms. The di- 
 et should be light and easily digested to avoid danger of stomach reflexes, 
 and the patient should avoid dust and other exciting causes.
 
 PRACTICE AND APPLTED THERAPEUTICS OF OSTEOPATHY. 59 
 
 BRONCHITIS. 
 
 Definition: Bronchitis is an acute or chronic inflammation of the 
 mucous membrane of the large and middle sized air tubes. It is attended 
 by increased secretions and cough, and is caused by a vaso-motor disturb- 
 ance of the vessels ot those membranes due to specific lesions in the upper 
 spinal, anterior and posterior thoracic, and cervical regions. These lesions 
 may be bon)' displacements, muscular contractures, ligamentous derange- 
 ment, etc. 
 
 Cause: These various specific lesions cause the condition by obstruct- 
 ing peripheral nerves or centers connecting with the vaso-motor innervation 
 of the bronchi. They usually occur high up in the thorax, and in the neck, 
 in close relation to the vaso-motor areas for the bronchi. 
 
 Lesions found causing bronchitis are as follows: (i) Luxation of 
 atlas and axis, depression of hyoid bone, lowering of upper eight ribs, con- 
 gestion of spinal muscles. (2) Third cervical vertebra anterior, muscular 
 tension from the second to the sixth dorsal vertebra, second left rib much 
 depressed. (3) Fourth dorsal vertebra lateral. (4) Luxation of clavicle 
 and first rib anterior!}'. (5) Anterior and posterior intercostal spaces as 
 low as the fourth or fifth either changed by misplacement of rib or the seat 
 of irritation to the intercostal structures by contracture. (6) Lesion to the 
 vagus nerve by cervical luxation and contracture, also luxation of the four 
 upper dorsal vertebrae. (7) Luxation of the first, second and third ribs. 
 (8) Displacement of the anterior ends of the first, second and third ribs, and 
 derangement of these cartilages. (9) Bilateral contracture of cervical and 
 spinal muscles as low as the sixth dorsal. (10) Second to fourth dorsal 
 vertebrae lateral, (ii) Luxation between manubrium and gladiolus of the 
 sternum. 
 
 The anatomical relations between these lesions and the seat of the dis- 
 ease are clear. While generall}- located higher than in the case of asthma, 
 they still fall within the vasomotor area to the lungs. As to lesion of the 
 atlas, axis, and other cervical tissues, in relation to the vagus and cervical 
 sympathetics, as well as of the upper dorsal vertebrae, ribs, and muscles to 
 the \aso-motor innervation of the bronchi, the same remarks apply as in 
 case of asthma, q. v. Noting from the above lesions that they, being higher, 
 are more concentrated upon the vaso-motor centers of the bronchi, (2nd, 3rd, 
 4th dorsal), may explain in part the reason for a more intense vaso-motor 
 effect necessary to produce the inflammation of the membranes. Luxations 
 of the clavicle and first rib anteriorly are anatomically related to the dis- 
 ease as causing contracture of the anterior deep cervical tissu&s and thus 
 obstructing both phrenic and pneumogastric nerves, concerned in innerva- 
 tion of the lungs, retarding the circulation in the cervical vessels, and 
 collaterally obstructing circulation in the lungs. The general dilatation of
 
 60 PKACTICK Av:i) APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 the air tubes, often seen in chronic cases, is likely caused by those lesions 
 especially affecting the vagus, which innervates the involuntary muscles 
 regulating the calibre of the bronchi. Lessened action of the nerve allows 
 a dilatation of the tubes through loss of tonicity of those muscle fibres. The 
 same explanation probably accounts for local thinning and dilatation of the 
 walls of the tubes. 
 
 Osier's statement that the cause of the disease is probably microbic is 
 a confession that the real cause is not known. We hold the true cause to 
 be anatomical lesions as described. The fact that the disease is often a 
 sequel of catching cold is suggestive from an osteopathic view point. The 
 contraction of muscles and tissues from exposure ma)- be sufficient lesion, 
 or may produce actual bony luxations b)' drawing parts out of place. The 
 further fact that the subjects of spinal curvature are prone to the disease is 
 a confirmation of the osteopathic idea of making bon)- lesions the cause. 
 
 The PROGNOSIS is good for both acute and chronic cases. Many of the 
 latter are cured in a comparatively short time, varying usually from one 
 month or less to three months. In the former the first treatment gives 
 great relief, and, if the case is seen early enough, may abort the attack. A 
 few treatments usually start the patient well on the way to recovery, and as 
 a rule he is well in about one half of the time these cases usually run, which 
 is stated to be two or two and a half weeks. 
 
 In the TREATMENT of the case the specific lesions should be at once 
 sought and treated. Often relief can be given only in this way. A thor- 
 ough treatment should be given the spine, thorax and neck to relax all con- 
 tracted tissues. Easing of the tension in this way gives-great relief, as the 
 constriction of the chest and neck causes much of thcAComfort from which 
 the patient suffers. This is aided by raising all the ii ■". T-^ tnient of the 
 neck corrects the vagus and aids in dispelling the inflammation by its par- 
 ticipation in the vaso-motor control. In the same way relaxation of all the 
 tissues of the dorsal region about the second, third, and fourth vertebrae 
 particularly, also correction of these vertebrae themselves, tends to the 
 same end. The clavicle should be raised and the first rib lowered to free 
 irritation to the phrenic, vagus, and cervical vessels. Thorough treatment 
 of the spine from the second to the seventh dorsal \ertebra (vaso-motor 
 area) aids in ecjualizing bronchial circulation, the work on the left side as 
 low as the sixth aiding this resuit b)' strengthening the pulse beat. This 
 initial portion of the treatment should ^be brisk and energetic enough to 
 arouse good reaction. It relieves the patient at once of the constriction, 
 langor, and aching pain in the back. It frees the lungs and starts perspira- 
 tion. 
 
 The patient should be laid on his back and the upper anterior ribs, 
 cartilages and intercostal structures thoroughl)- treated. Strong manipula- 
 tion of the tissues upon the anterior chest and along the sternum reddens 
 them and acts as a mustard plaster would. These treatments, together
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY, 6l 
 
 with treatment directly along the trachea in the neck will relieve the cough 
 The pain along the sternum is relieved by raising the ribs and by the above 
 treatments along the anterior chest. The fever is taken down by the equal- 
 ization of circulation wrought by the general treatment, and by pressure in 
 the superior cervical region. The blood flow may be diverted from the 
 bronchi to the abdomen by a slow, deep, inhibitive treatment over it, in- 
 cluding pressure over the solar and hypgastric plexuses. By the process 
 of raising the ribs and treating the spine the engorged azygos major vein is 
 emptied. The restoration of free thoracic play by these treatments is an 
 important consideration in the eqalizing of the circulation throughout the 
 lungs. 
 
 An acute case should be treated daily at least once, and oftener in case 
 of need. One thorough general treatment daily may be sufficient of the 
 kind. Some special treatment being given for cough or fever at other 
 times. In chronic cases the treatment should be given two or three times 
 a week. In case of local or general dilatation of the bronchi, and in the 
 thinning of the walls, close attention to the vagus nerve should be given for 
 reasons already explained. 
 
 Good care should be taken of the paient, particularly as to guarding 
 against exposure which may lead to complications. Treatment should be 
 given bowels and kidnej's to keep them active. 
 
 HAY-FEVER. 
 
 Definition:-— Hay-Fever or Autumnal Catarrh, is a disease of the up- 
 per respiratory tract, styled by some writers a form of asthma. It is caused 
 by specific lesions in the upper dorsal, thoracic and cervical regions, which 
 deteriorate the vitality of the membranes of this tract and lay them liable 
 to the effect of certain irritants, such as the pollen of various plants, lead- 
 ing to an inflammatory or catarrhal condition. 
 
 Lesions: — The anatomical causes for this condition are, from the oste- 
 opathic point of view, held to be derangements, in the regions mentioned, 
 of bones or other tissues, which act as lesions upon the motor, vaso-motor 
 and sensory innervation, also upon the blood-vessels of the upper respira- 
 tory tract. 
 
 In one case, complicated with asthma and bronchitis, the scaleni, ster- 
 no-mastoid, and anterior and posterior thoracic muscles were contractured. 
 In another, lesions were found affecting the inferior cervical and upper 
 thoracic regions. 
 
 In other cases lesions were found as follows: Right fifth rib; contract- 
 ure of muscles from the ist to lOth dorsal vertebra, with ribs in this region 
 drawn down; second cervical vertebra to the right and posterior; second 
 cervical vertebra right, cervical muscles contractured, upper three or four
 
 62 PRACTICE AND ATTLIED THERAPEUTICS OF OSTEOPATHY. 
 
 dorsal vertebra to the rij^ht. In addition to these, lesions of the atlas, of 
 the phrenic nerve, of the clavicles and upper three ribs (especiall)- the first) 
 and of the dorsal vertebrae as far as the fifth are all found. 
 
 The fact that this disease is often found complicated with asthma and 
 bronchitis is readil)' explained b)- noting that lesions for all of these con- 
 ditions occur at the same area of the spine. In all, as well, vaso-motor 
 lesion seems a more potent cause than motor lesion. In the case of hay- 
 fever, as with the other two, upper cervical lesion is less important than 
 lower cervical lesion. The latter kind, with those affecting the first few 
 dorsal vertebrae, the clavicle, and the first and second ribs, are always ex- 
 pected in cases of hay-fever. Purely muscular lesions are relati\ely less 
 important than other kinds, as the)' are mere likeh' to be secondary lesions. 
 The anatomical rdation of lesion to disease in this case seems clear. 
 The lesions mentioned affect the vagus, cervical sympathetic, and \aso- 
 motor ner\es as already explained. They also affect the fifth cranial nerve 
 through the cervical S)nipathetic, including the superior cervical ganglion. 
 This is the nerve which causes tne swollen and painful face, the running 
 eyes and nose, and the sneezing, all of which are so noticeable in hay-fever. 
 The fifth nerve and the vagus are intimately related in function, both 
 of the respiratory and of the digestive tract, and are closel)- connected by 
 the floor of the fourth \entrical, the superior cervical ganglia, and the cervi- 
 cal sympathetic. Lesions to the vagusin the region of the clavicle and first 
 rib, to the ssmpathetic in the cervical region, and in the upper thoracic 
 region of the spine, may affect one or both of these nerves. According to 
 Howell's American Text Book of Ph)-siology, vaso-dilator fibres for the 
 face and mouth leave the cord at the 2d to 5th dorsal, pass up the cervical 
 sympathetic to the superior cervical ganglion, thence to the Gasserian gang- 
 lion of the fifth and to the regions mentioned. Thus a low lesion, affecting 
 nerves which ascend to suppl)' the parts, may be the sufficient cause of hay- 
 fever. At the same time the close association of this disease with asthma 
 is shown, since the vaso-motors to the lungs occupy this same region of the 
 upper thoracic spine- 
 While the common form of irritant producing the attack is supposed to 
 be dust or pollen in the atmosphere, the fact that emotional excitement, a 
 deflected nasal septum, the presence of a nasal polypus, hypertrophied mu- 
 cous membranes, etc., ma\- produce attacks, shows that there are other 
 causes, some of them anatomical, accounting for an irritable nasal mucous 
 membrane or acting as an irritant upon it. It is as reasonable for an Osteo- 
 path to maintain that lesions acting as obstructions to natural nerve and 
 blood supply to these membranes, weakens them and lays them liable to 
 the action of various irritants, thus being the real cause of the disease. 
 Immunit)- from attack in certain climates or altitudes is but alleviation. The 
 patient has gone away from the special irritant which produces the attack 
 in him. The real causes of the disease still exist, and it generally returns
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 63 
 
 upon his again exposing himself to the same irritant. Although a patient 
 is more liable to attacks in rural districts, more cit}' people contract the 
 disease, showing that a locality in which much pollen occurs has nothing to 
 do. ^^;- 5^, with the matter. Osier states that three elements are necessary 
 to the production of the disease; "a nervous constitution, an irritable nasal 
 mucosa, and the stimulus." Yet nervous people, with colds or catarrhal in-, 
 flammation of the nasal membranes, may be with impunity in districts filled 
 with the common irritants which excite attacks in ha)'-fe\-er subjects. Evi- 
 dently some further etiological factor is necessary, and is found in the speci- 
 fic anatomical abnormality pointed out by the Osteopath, the removal 
 of which has, in great numbers of cases, cured the disease. The most se- 
 vere cases yield quickh', often, upon the removal of the specific lesion. The 
 length of standing of the case seems to ha\e but little relation to the length 
 of time necessary to cure. A case of fourteen years' standing was cured in 
 three weeks; one of twenty-four years, in three months; one of five years in 
 one and one half months. This rehersal might detail great numbers of 
 cases, but the few mentioned illustrate the whole matter. In view of these 
 facts it seems incontrovertible that the specific lesions found by the Osteo- 
 path, and held b)' him to be the cause of disease, are the actual causes of the 
 disease. 
 
 The diagnosis of this condition is easily made according to the mani- 
 festations of the disease described in standard medical texts. 
 
 The PROGNOSIS, under osteopathic treatment, is good. A large per- 
 centage of the cases are cured. The most severe and oldest cases may be 
 safely encouraged to take the treatment. Of medical prognosis in hay- 
 fever, i\nders says that permanent cure is a rare event. 
 
 The Examination AND Treatment, made by methods already given, 
 (See Part I) consist in the location and removal of the particular anatomi- 
 cal derangement that is causing the condition. The removal of lesion is 
 the first consideration. It may, occurring in the fegion described, be any 
 one of the mal-adjustments of tissue considered in the general chapters rela- 
 tive to the examination and treatment of the parts. An immediate effort 
 should be made for its removal. In addition special treatment is given to 
 alleviate the condition. K\\ the upper spinal, thoracic and neck muscles, and 
 deep tissues should be thoroughl\- relaxed for freedom of circulation and to 
 release tension upon nerves. The ribs and clavicles, apart from correction 
 of displacement, should be raised. Attention should be given to releasing 
 and toning the vagus nerve, and the vaso-motor nerves from the 2d to the 
 7th dorsal. For the lachrymation, itching of the eyes, swelling and pain in 
 the face, and rhinorrhoea, special treatment should be given the fifth nerve. 
 This may be aided by deep manipulation and pressure in the sub-occipital 
 fossae for the superior cervical ganglion, but is done especially b\' relax- 
 ation and quiet, deep inhibitive treatment to the facial branches of the fifth 
 nerve (p. 23). Treatment is given along the sides of the nose (p. 23) to free
 
 64 PRACTICE AND AITLIED THERAPEUTICS OF OSTEOPATHY. 
 
 its blood-vessels, nerves, and to reduce the swelling and irritation in the 
 mucous membranes. Strong pressure is made with the palm upon the 
 forehead (p. 23) to open the nostrils. Cervical treatment, inhibition at the 
 superior cervical region, and opening the mouth against resistance (II, 
 Chap I\'), all relieve the congested circulation about the head and face and 
 give much relief. 
 
 For the sneezing one may make inhibition of the phrenic nerve (p 16, 
 VIII), may press upon the palatine branches of the fifth nerve where they 
 run over the hard palate, or may grasp the head as in (4) p. 21, and raise it 
 from the spine. 
 
 Treatment is ordinarily given three times per week. The patient 
 should be kept from exposure to the particular initant that excites his at- 
 tacks. 
 
 PNEUMONIA. 
 
 Definition: Lobar Pneumonia, or Lung Fever is an acute inflamma- 
 tion of the parenchyma of the lungs caused by specific lesions; bony, mus- 
 cular, or ligamentous, in the upper spinal, thoracic, and cervical regions. 
 In other forms of pneumonia the same lesions are found. Lobular or 
 Catarrhal Pneumonia is an inflammation of the capillar)- air tubes, which ex- 
 tends also to the lung tissue proper. Chronic Interstitial Pneumonia is 
 characterized b)' increase of the interstitial connecti\e tissues. 
 
 Causes: Anatomical lesion in the form of displaced bon}- parts, liga- 
 ments, etc., and of contractured or tensed muscles and other soft tissues 
 are found affecting the spine as low as the eighth or ninth dorsal; the ribs 
 in the corresponding region, but more generall\- the i.st, 2d, 3d, 4th and 
 5th; the intercostal tissues, including nerves and vessels; the cervical ver- 
 tebrae and tissues, the clavicle and first rib. More specifically, lesions have 
 been found affecting the 2d to 5th dorsal vertebrae; contracture of inter- 
 costal, cervical and spinal muscles; thoracic muscles; 4th and 5th ribs; 8th 
 and 9th ribs; the vaso-motor area, the 2d to 7th dorsal; neck lesions to the 
 vagi; the recurrent laryngeal nerves at the 1st and 2d ribs. 
 
 The anatomical fclatio7is of such lesions to the lungs have been explained. 
 It is to be noted that the neck lesions assume greater importance in these 
 cases than in asthama or bronchitis, though there is considerable concen- 
 tration of lesion about the portion of the spine in which is located the most 
 important vasomotor area for the lungs, the region as low as the fourth 
 dorsal. In regard to neck lesion, important considerations are pointed out 
 b>- IMcConnell in regard to the vagi and the recurrent laryngeal nerves. 
 Such obstructions to the vagi, which are motor nerves to the lung, cause loss 
 of motor power in them and favor the stasis and engorgement present. 
 Obstruction to the recurrent laryngeal nerves by luxation of the 1st and 2d 
 rib, or by engorgement of the aorta or sub-clavian artery where they are in
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 65 
 
 relation to them, causes catarrhal inflammation of the air tubes. Lesions 
 of the 8th and 9th ribs, affecting fibres to the lower lobes of the lungs, are 
 more usual in cases in which the disease occurs in the lower lung. 
 
 The fact that more men than women are attacked by the disease; that 
 a debilitated system is more susceptible; that exposure, winter season, and 
 trauma are exciting causes, favors the theory that such anatomical lesions 
 cause the disease. The result may be caused directly by them, or they may 
 make the anatomical weak points that lead to deterioration of the lung tis- 
 sues and lay them liable to invasion. The specific microbes found in such 
 cases could not live and grow in tissues whose vitality had not been weak- 
 ened by such causes. 
 
 If the case be seen before it has* passed the stage of engorgement, the 
 fever may be gotten under control at once, and a few treatments ma}' abort 
 the case. This is the experience of our practitioners, although Osier says 
 that the disease can neither be aborted nor cut short by an}- means (medical) 
 at command. The means at the Osteopath's command to control vaso- 
 motor action are sufficient to relieve the engorgement. In the stages of 
 red and gray hepatization it is natural that slower results must be expected 
 as the treatment has more work to accomplish. Yet vaso-motor correction 
 must lessen' the inflammatory process, allow of less solidification, and 
 hasten the process of resolution. 
 
 In the first stage there is better opportunit}' to correct the specific les- 
 ion, as the patient's strength will allow of such treatment. The work is also 
 aided by the fact that the alveoli are still open, and lung action, stimulated 
 by treatment, ma}- become a valuable aid in dispelling the engorgement. In 
 view of these facts, and as experience shows, every symptom of the case 
 can be lessened because the pathological processes are modified. Less 
 poison is generated and the patient's general condition remains better. In 
 one case the treatment was applied in the first stage; the fever was under 
 control from the first and the temperature became normal in three 
 days. In another it disappeared in four days; in another in five days. A 
 case in which the temperature was 104^2 degrees when first seen showed 
 three degrees less fever the next morning. It had been treated in the even- 
 ing. In a case in which the temperature was 103 degrees, the temperature, 
 pulse, and respiration became normal in five days. It is true that cases 
 vary naturally, yet in view of the fact that Osier states that the fever per- 
 sists for from five to ten days, and that after its fastigium is reached (usu- 
 ally within a few hours) it remains remarkably constant, it is evident that 
 osteopathic work is successful to a marked degree in bettering the case. 
 
 The diag7iosis is made according to directions given in standard texts, 
 and by the location of specific lesions. 
 
 TViep}og7iosis is good under osteopathic treatment. 
 
 Examination and Treatment for the location and removal of lesion are 
 made according to methods considered in Part I. In beginning the treat-
 
 66 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 ment, as the patient finds it easy to lie on the sound side, the muscles and 
 deep tissues are gently but thoroughly relaxed along the length of the spine, 
 particularl\' upon the affected side. This starts vaso- motion and brings a 
 sense of relief from the constriction that so distresses the patient. During 
 this treatment upon the side, treatment is gi\en the centers for bowels, 
 kidneys, and superficial fascia (2d dorsal and 5th lumbar) to rouse them to 
 action and to aid in the elimination of poison from the s\stem. 
 
 This initial treatment has thus prepared for the more specific treatment 
 for the fever, itself being part of the process. The next step consists in 
 turning the patient gently upon his back and thoroughly relaxing the cervi- 
 cal tissues, the tissues behind the clavicle and first rib, raising the cla\icle 
 and depressing the first rib, after relaxation of the scaleni muscles. Treat- 
 ment should also be applied to the course of the vagi, and to the recurrent 
 laryngeal nerves at the lower inner parts of the sterno-mastoid muscles. In 
 these ways motor power to the lungs is increased, and vaso-motion is cor- 
 rected. The treatment for fever is now completed by stead)' pressure in 
 the sub-occipital fossae in the usual way. The fever is not likely to go 
 down at once, but is gradually reduced after the treatment, for some hours. 
 This is because of the freedom given to the vaso-motors in the course of the 
 treatment, and to the gradual change now being wrought in the patient's 
 system by the recuperated forces. 
 
 The treatment for fever ma}' be aided b)- the deep inhibiti\e treatment 
 to the abdomen, before described, to dilate the immense abdominal veins 
 and aid in calling away the blood from the engorged lung. 
 
 F'urther treatment is given the lungs, with the patient on the back, by 
 gentl)' elevating the ribs from the second to the seventh on both sides. This 
 stimulates the vaso-motor centers to the lungs. Elevation of all the ribs 
 gives much relief from tension, and is the specific method of relieving the 
 pain in the side. 
 
 Stimulation of the accelerators of the heart, second to fifth dorsal on 
 the left side, aids in circulation through the lungs, and stimulates the heart 
 against failure. 
 
 For the cough, the treatment should be close and deep along the 
 trachea from the larn\'x to the root of the neck, also relaxation of the an- 
 terior tissues of the chest, including the upper intercostal tissues. The 
 middle and inferior cervical regions should be treated for the lymphatics 
 to the lungs. (McConnell.) 
 
 The amount and strength of the treatment must be regulated by the 
 patient's condition. Strong treatments are not allowed on account of 
 weakness. The general treatment should be given, thoroughl\' but gently, 
 once a da\' at least. The patient should be seen three or four times per day, 
 but the whole treatment outlined need not be given each time. A little 
 treatment for the fever, to release tension over the lungs, to relie\e pain in 
 the side, etc , ma}- be enough at a time. 
 
 Hygienic precautions, the use of hot applications, foot baths, rectal in- 
 jections, etc., maybe employed according to direction of the standard texts, 
 as necessary. The patient should have plenty of water to drink, and should 
 be kept upon a liquid diet.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 67 
 
 ACUTE NASAL CATARRH, OR CORYZA, AND COLDS. 
 
 Definition: — Acute Nasal Catarrh is an inflammation of the nasal mu- 
 cous membranes, accompanied by an increased secretion of mucous and by 
 various general symptoms, and is caused by specific lesions, in the cervical 
 region chiefly, which may be secondary to contractures of muscles and 
 soft tissues by exposure. After repeated attacks the disease becomes 
 chronic^ upon account of the confirmed condition of the lesions. 
 
 A "cold in the head" is an acute attack of this disease. Yet "colds'' 
 may settle in an)- part of the body, as a rule, in "the weakest part," and then 
 probabl)' assumes the form of congestion instead of inflammation as in the 
 case of cor}'za. Its manifestations are various, one of the chief ones being 
 the disturbed vaso-motor reflexes of the body. These weak places liable to 
 such congestion are commouly due to lesion of the part, which acts to de- 
 teriorate its vitality and lessen its resistance power. 
 
 Causes: — The specific lesions causing such disease are, as a rule, high 
 up in the cervical region, effecting especially the 1st to 3d cervical verte- 
 brae, but they may occur as low as the sixth dorsal. One of the chief 
 forms of lesion is that of contracture of the cer\'ical muscles and deep soft 
 tissues. These contractures, due primaril)' to exposure, gradually act to 
 warp, or draw, the cervical vertebrae and intervertebral discs out of shape 
 and out of their normal anatomical relations. The result is obstruction to 
 blood and nerve supply, causing chronic catarrh. The deeper anatomical 
 lesions due to contracture, and to other causes as well, produce catarrh, and 
 not some other disease, because of affecting certain areas of nerve connec- 
 tions and certain centers. Thus lesion of the upper three cervical vertebrae 
 act upon the superior cervical ganglion, in ways already discussed, and dis- 
 turb the fifth nerve through its very intimate connections with the ganglion 
 in question. In the same way, lesion to the inferior cervical or upper dor- 
 sal bony parts may affect those sympathetic fibers (or the area of the cord 
 giving origin to them) which ascend in the cervical s}'mpathetic chain, fin- 
 ally to reach the fifth nerve, which thus supplies secretory fibers to the 
 parts in question. The very numerous vaso motor, secretory and trophic 
 fibers for all parts of the head and face; for salivary glands, eye, ear, tongue, 
 face, mouth, etc., etc., passing to their points of distribution through vari- 
 ous of the cranial nerves, quite generally arise in the upper dorsal and cerv- 
 ical cord, having also numerous connections with the cervical sympathetics. 
 This matter has been fully discussed in another place.* This explains the 
 importanee of cervical and upper dorsal lesions. Thus lesions low down 
 act upon the ascending fibers of nerve suppl}' and affect a part much above, 
 as in the case of dorsal lesion here. 
 
 The fifth nerve bears special mention in these cases as the one con- 
 cerned in the headache, lachrjmation, sneezing, secretion of mucous, and 
 inflammation of membranes. This nerve is also in part concerned in the
 
 68 PRACTICE AND APPLIKD THERAPEUTICS OF OSTEOPATHY. 
 
 loss or alteration of the functions of taste and smell, caused by pressure of 
 the injected membranes upon the fine nerve terminals. 
 
 The Prognosis is good for all forms of the disease. In acute cases it is 
 particularly so, as one or a few treatments usuall}' end the sjmptoms. In 
 chronic catarrh good results are generally easil\- attained, and many times 
 a cure is effected. Unfavorable climates do much to prevent cure as the 
 patient is constantly e.xposed. 
 
 The Examination and Treatment for the spccijic lesion is made accord- 
 ing to directions in Chaps. I to VII. The specific lesion should be treated, 
 and removed at once if possible. This applies to both acute and chronic 
 cases. In acute cases one of the first steps is to relax all the upper dorsal 
 and cervical tissues. A thorough spinal treatment tones all the vaso-con- 
 strictors (2d dorsal to 2d lumbar), and all the vaso-dilators (all along the 
 spine), thus aiding to equalize circulation, and reduce congestion of parts 
 concerned. 
 
 This effect is aided in an important ua\' by raising all the ribs, and par- 
 ticularl)- treating all the 2d to 7-h dorsal region on both sides, in this way 
 increasing the activities of heart and lungs. The anterior thoracic region is 
 treated to relax tissues and replace ribs; the clavicle is raised, and sepa- 
 rated from the first rib to rela.x the deep anterior cervical tissues, free cir- 
 culation through the carotid arteries and juglar veins, and to free the pneu- 
 mogastric nerves. All the cervical muscles are thoroughly relaxed, the 
 ligaments released by deep treatments, and the vertebrae of the whole 
 region manipulated. This frees the connections of the sj'mpathetics, the 
 venous flow from the head, and tones vaso-motion in the affected parts. It 
 is an important step in remedying the congestion of the parts of the head. 
 Inhibitive treatment should be given the superior cer\-ical ganglion to di- 
 late blood-vessels and allow the congestion to be swept out. The superior 
 and inferior h)oid muscles are relaxed, and the work is carried down along 
 the trachea to the root of the neck. The mouth is opened against resist- 
 ance; the tissues beneath the angles of the jaws are relaxed. This releases 
 the internal jugular veins, stimulates circulation through the carotid arter- 
 ies, and corrects circulation . 
 
 Particular attention is devoted to the treatment of the fifth nerve for 
 reasons already given. It is reached at points upon the face already de- 
 scribed, and all the tissues o\erthem are relaxed. Treatment of this nerve 
 thus directly is a most important adjunct to that given its sympathetic con- 
 nections. It is most important as a means of relieving the inflammation, se- 
 cretion, lachrymation, and stopping of the nostrils. Man'pulation along 
 the sides of the nose frees the nasal ducts and relieves the congestion; 
 strong pressure upon the root of the nose and upon the forehead frees the 
 nostrils; tapping o\er the frontal sinus relieves congestion and pain in it. 
 The headache is relieved b}' the treatment in the general cer\ical, superior 
 cervical, and frontal regions; the cough is relieved by the treatment along
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPAVHY. 69 
 
 the trachea; the chill}' feeling by the brisk spinal treatment. The soft pal- 
 ate may be treated b)' placing the finger gently upon it and sweeping it lat- 
 erally across. This treatment may be carried well up toward the opening 
 of the eWstachian tube. The congestion of these parts is thus relieved. 
 
 The lungs must be kept well treated to prevent the cold from settling 
 upon them. The bowels and kidneys are treated to keep their action free. 
 The treatment about the lower jaw and to the carotid arteries is efficient in 
 reaching the eustachian tube, and in loosening the secretions that some- 
 times occlude it. 
 
 In chronic cases the treatment is devoted more particularly to the re- 
 moval of the specific lesion, and the building up of the blood supply to the 
 nasal membranes. As these are often atrophied or hypertrophied a long 
 course of treatment is generally necessary to their rehabliation. The prin- 
 cipal treatment is directed to the cervical tissues, where chronic contract- 
 ure of the muscles exists 
 
 Daily treatments in severe acute cases, and three per week in chronic 
 cases, are usually sufficient. 
 
 The patient should take care not to expose himself, but, on the other 
 hand, should not keep the body tender and susceptible by dressing too 
 warmly, sleeping under too many covers, or living in overheated quarters. 
 One may contract a cold by going suddenly from an extremely hot to a very 
 cold atmosphere, or vice versa. 
 
 *See "Principles of Osteopathy" Lectures XYI-XVIII. 
 
 EPISTAXIS. 
 
 Definition: — Epistaxis is the term used to designate hemorrhage from 
 the nose. It is found in serious form in some people. It ma)' be 
 caused by accident, as in fracture of the skull, or by local irritation, such as 
 picking at the nose. Cer\ical lesion, involving the atlas and the muscles, 
 has been noted. Other forms of cervical lesion, affecting the superior 
 cervical ganglion or the cervical s}'mpathetic may aid in causing it. 
 
 Treatment:— Holding of the facial artery where it crosses the inferior 
 maxillary bone, and the nasal arter)- at the inner canthus, also pressure ap- 
 plied to the carotid arteries, slow the blood current and favor the formation 
 of a clot. In some cases, friction over the superior cervical region has been 
 sufficient to arouse sufficient vasoconstriction to stop the flow. The case 
 may be helped by raising the arms high above the head. It is frequently 
 difficult to stop the hemorrhage at the time, but the treatment applied to 
 the correction of the lesion and to the freedom of circulation through the 
 neck will stop the recurrence of the hemorrhages. In severe cases it may 
 be necessary to resort to plugging of the posterior iiares. The application 
 of ice or cold water to the superior cervical region, and the use of hot or 
 cold injections into the nostrils are efficient domesiic remedies for the con- 
 dition.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 PLEURISY. 
 
 Definition: An acute inflammation of a part or the whole of one or 
 both pleurae, attended b}' cough and pain in the side, and caused by lesions 
 affecting ribs, thoracic vertebrae intercostal and spinal muscles, nerves, etc. 
 
 Causes: The important lesions in these cases affect the ribs; 
 cases are rare in which lesions of this kind are not the actual cause 
 of the disease. Other lesions are consequent or subsidiary to rib lesions. 
 They ma\- affect the ribs of either side, as low as the lOth on the left and 
 the 9th on the right, marking the lower limits of the pleurae. Secondary 
 lesions in the cervical region, affecting pneumogastric, phrenic, or s)mpa- 
 thetic nerves, concerned in the innervation of the pleurae, may occur. Le- 
 sion of the clavicle and first rib, impeding circulation through the sub- 
 clavian and internal mammary arteries, are important. The cervical lesions 
 mentioned, with lesions of the spinal muscles and dorsal vertebrae, affect 
 the innervation, composed of branches from the pneumogastrics, phrenics, 
 sympathetics, and pulmonary plexuses. Important derangement of circu- 
 lation are thus caused by lesion to vaso-motors, aiding the process of inflam- 
 mation, which is the active morbid process in the case. The drawing of 
 spinal muscles, luxations of vertebrae, and the interference with spinal 
 nerves also aid the causation of rib lesions. The latter sort is by far the 
 most efficient one in causing pleurisy because of its relation to the inter- 
 costal vessels and nerves. These nerses and \essels all together total a 
 vast area of blood and nerve supply to the pleurae, especially to the par- 
 ietal portions. The nerves carry vaso-motor and secretorj- fibres to the 
 parts supplied by them, hence to the pleurae. Hilton points out that the 
 nerves innervating the linings of the body cavities supply also the skin and 
 muscles of the walls of these cavities. This is well instanced in the case of 
 the parietal pleurae, which are supplied by the intercostal nerves, the}- also 
 supplying the intercostal muscles and the overlying skin. Such being the 
 case, lesion by displacement of ribs, irritating intercostal nerves, disturbs 
 the vaso-motor and secretory processes in the pleurae supplied by the same 
 nerves. Hilton has also pointed out that a joint, the muscles moving the 
 joint, and the skin overlying these muscles, are all supplied by branches of 
 the same nerxes. Hence vertebral lesion and lesions affecting the relations 
 of the heads of the ribs may affect the nerves through their articular 
 branches. In this way spinal lesion might be the origin of such disease. 
 But further, since each intercostal nerve is connected by the rami commu- 
 nicantes with the sympathetic system, lesion of these nerves affects the sym- 
 pathetics. These sympathetics in the dorsal region contain both vaso-di- 
 lator and vaso-constrictor fibres; the)- enter into the formation of the 
 pulmonary plexus, which in part innervates the pleura. Hence intercostal 
 lesion affects vaso-motor control of the parietal pleura directl)', and of the 
 visceral pleura indirectly. In another way does intercostal lesion act to set
 
 PRACTICE AND APPLIED THERAPEUTICS OE OSTEOPATHY. 71 
 
 up the inflammatory process of pleurisy. Lesions of the clavicle, derang- 
 ing circulation through the sub-clavian and internal mammary vessels, and 
 of the other ribs, directly obstructing the intercostal vessels, and indirectly 
 deranging the circulation through related vessels to the 'visceral pleurae, 
 (bronchial, mediastinal, and diaphragmatic vessels) disturb the entire cir- 
 culation to these parts. 
 
 In these ways may all the various lesions described work together to 
 produce inflammation. The affected area is larger or smaller according to 
 the nature and extent of the lesions. Lesion of a single rib has frec^uently 
 been found responsible for an acute attack of pleuris)', either circumscribed 
 and limited in extent, or spreading to involve cons'derable areas. The 
 same sort of lesion may produce all the various kinds of pleuris)' described 
 in medical texts. 
 
 According to osteopathic theor}% the bacteria present in this disease 
 and ascribed by some writers as its cause, could not live and propogate their 
 poisons in healthy tissues. The presence of the lesions described may 
 weaken the tissues and allow the microbes to gain a foothold. It is signi- 
 ficant that exposure to cold and wet, and mechanical injuries cause the dis- 
 ease, as the Osteopath looks for such causes to produce the displacements 
 and other lesions to which he traces the disease 
 
 The diagnosis is made according to the symptoms and physical signs 
 described in standard medical texts. 
 
 The PROGNOSIS is good. Cases generally recover without difficulty. 
 Often all the pain and other manifestations disappear at once upon remo\-al 
 of lesion; the setting of a rib. 
 
 The Examination and Treatment for the specific lesion are carried 
 on according to directions given for the examination and treatment of those 
 regions. This lesion should be removed as soon as possible, and at once if 
 the condition of the patient will allow. Treatment should be directed to 
 the relaxation of all spinal, intercostal, and cervical tissues, and to the rais- 
 ing of the ribs, for the purpose of removing obstruction from and toning 
 the circulation and innervation of the pleurae. The raising of the ribs and 
 clavicle, including the repair of the particular luxation of ribs that is caus- 
 ing the trouble, are the most important steps. If the case is seen before 
 the inflammation and exudation has progressed far, the process may be 
 more eisily stopped, as the necessary point is to gain control of circulation, 
 which may be readily accomplished through nerves and x'essels as already 
 explained. In the stage of exudation, where quantities of the exudate occur 
 in the pleural cax'ities, attention must be given to releasing the tension in 
 parts due to contractures of muscles, etc., to raising the ribs to allow more 
 free play of the lungs, and to the relief of the pain iu the side, and the dis- 
 tressing cough by carefully raising the ribs and manipulating the tissues at 
 the seat of the pain. But the main point at this stage is, by the treatment 
 to the circulation, to hasten the resorption of inflammatory products. This
 
 72 PRACTICE AND APPLIKD THERAPEUTICS OF OSTEOPATHY. 
 
 may be done to a considerable extent. Great care must be taken in hand- 
 ling the patient on account of the great pain, l^y stimulating the process 
 of absorption, and by keeping the parts free from tension in the tissues, 
 also by keeping up, carefully, free motion of the ribs and parts, the adhes- 
 ions of the pleurae, and the retraction of parts likely to occur as a result of 
 the intlammation, may be avoided. This is during the con\alescence of the 
 patient, when his condition must be carefully watched. The point ma)' be 
 reached in some cases where tapping might be necessary, but if the case is 
 seen in time the the process ma)- be so controlled as to obviate this diffi- 
 cult)-. In cases of adhesions between the pleurae, if painful they should 
 be gradually broken up. This is done in a course of treatment, carefully 
 gi\ing the parts concerned the extremes of motion of which they are capa- 
 ble. The process is aided by developing the circulation to in part absorb . 
 the adhesi\e tissues. This must frequently be done in the chronic case. 
 The treatment of such cases consists mainly in restoration of lesion, and in 
 maintaining free circulation for the absorption of pus, if present. 
 
 In treatment of pleurisy, stimulation of heart and lungs, of bowels, 
 kidneys and superficial fascia, for the removal of poisonous waste, and 
 attention to the general health of the patient are necessary. Acute cases 
 should be kept upon a light, easily digested diet. Exposure must be pre- 
 vented. One thorough treatment daily, with more treatment at times dur- 
 ing the day for the relief of pain, etc., will usually be sufficient. Chronic 
 cases should be treated three times per week.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHV. 75 
 
 PULMONARY CONSUMPTION. 
 
 Definition: Pulmonary Consumption, or Tuberculosis of the Luno-s, 
 is a destructive disease of the tissues of the lungs, characterized by the 
 presence of the ba/cillus tuberculosis, and caused by specific lesions in the 
 upper dorsal and thoracic regions. 
 
 Causes: "'Ca^^^; (i) In a case of "quick consumption," Acute Pneu- 
 monic Phthisis, the upper dorsal spine was swerved to the right; the 2nd 
 dorsal vertebra was lateral; the 8th and gth dorsal vertebrae lateral; the ribs 
 down, narrowing the thoracic cavity. Reported cured in three months' 
 treatment. (2) Second and third ribs luxated; marked lesion between the 
 corresponding vertebrae and the tissues about them very tender. Three 
 months' treatment so benefited the patient that recovery followed, (3) 
 First, second and third left ribs down and in. Reported cured. (4) Left 
 clavicle down; 1st to 8th dorsal vertebrae flat; 8th dorsal to ist lumbar ver- 
 tebrae posterior; 2nd right rib tilted; the spine and thorax flat. (5) The 
 4th dorsal v^ertebra sore; 3rd to 5th lumbar vertebrae tight and irregular; 
 fifth and sixth left ribs close together; first rib on right luxated; all ribs 
 down and irregular. Case benefited. 
 
 Lesions are often found of the 2nd, 3rd, and 4th ribs; of the 5th, 6th, 7th 
 and 8th ribs (A. T. Still); 2nd and 3rd cervical vertebrae usually lateral, and 
 lesions to the middle and inferior cervical sympathetic ganglia affecting the 
 iymphatics of the lungs (McConnell); of the clavicle. 
 
 Anatomical ielations. In these cases the neck lesion is not generally of 
 prime importance, the dorsal lesion being the particular one, and of this 
 variet}', that more especially affecting the upper several ribs. Lesion of 
 the spine, muscles, ligaments, or ribs, as low as the loth may become the 
 cause of the disease. In very many cases the lesion will be found to in- 
 volve the second dorsal vertebra or the second rib. 
 
 There are important reasons why lesions of ribs lead to pulmonary tuber- 
 culosis, and why the flattened thorax, characteristic of the disease, is so closely 
 related to the condition, either as primary lesion causing it, or as a lesion 
 secondary to it. According to the American Text Book of Physiology, 
 stimulation of intercostal nerves causes reflex constriction of pulmonary 
 vessels. The intercostal nerves are all connected directly with the S}'mpa- 
 thetic system by rami communicantes, and the sympathetic vaso-dilator and 
 vaso-constrictor fibres of the system are situated all along the thoracic 
 spinal region. Luxations of ribs and a flattened thorax (dropped ribs) set 
 up irritation in the intercostal nerves, leading to constriction of the pul- 
 monary vessels, A vast area may be affected through the wide distribution 
 of intercostal nerves. Very general, or localized, anemia of lung tissues fol- 
 lows upon pulmonary vascular constriction caused by this over stimulation 
 of the intercostal nerves. This dexitalizes the tissues of the lung, and gives
 
 76 PRACTICK A.Vn APPLIED TMKRAPEUTICS OF Oi^TEOPATHV. 
 
 a foot-hold to the pathogenic bacteria, held by medical authorities to be the 
 sole cause of tuberculosis. 
 
 With regard to the microbic origin of this disease, the Osteopath does 
 not deny the presence of such bacteria in the lung, nor their activit)- in 
 destruction of lung tissue. He holds that there is necessary a lesion to the 
 lung, in the form of an impediment to proper nerve and blood supply to the 
 lung tissues, weakening them to an e.xtent that allows the bacteria, which 
 cannot grow in healthy tissues, to produce their kind and to form their 
 toxins. 
 
 It has already been pointed out that the vaso-motor spinal area for the 
 lungs (2nd to 7th dorsal), and particularl}' the region of the 2nd, 3rd, and 
 4th thoracic sympathetic ganglia, is most apt to suffer from lesion in dis- 
 eases of the lungs. Rib, vertebral, intercostal or spinal muscular lesion, 
 etc., is more likely to cause lung disease in this area than elsewhere. It is 
 a well known fact that the apices of the lungs are most generally the seat of 
 the disease. This fact is readily explained by the fact that upper rib and 
 spinal lesions, most frequent in consumption of the lungs, affect this region 
 of the lung generally, centering upon this important vaso-motor area. The 
 further fact that the apex of the lung is not usually so well developed on 
 account of lazy habits of breathing, makes lesion in this region more im- 
 portant. Anders states that special investigation has shown that the dis- 
 ease does not begin at the tip of the apex, but about one and one-half 
 inches below, near the postero-external border. Posteriorly the first signs 
 are discovered over the lower part of the supra spinous fossa; anteriorly, 
 immediately below the middle of the cla\icle, along a line about ly^ inches 
 from the inner ends of the second and third intercostal spaces. The start- 
 ing point may also be located at the first and second intercostal spaces below 
 the outer third of the clavicle. These points of origin of this disease in the 
 lung are thus in close relation with those upper ribs apparently most often 
 luxated in this disease. In this way the osteopathic view that such lesion 
 causes the disease is supported by the facts. 
 
 Prognosis; Except in late and serious stages of the disease, the 
 chances of limiting its progress are good. Some cases may be cured. 
 The prognosis as to recovery, however, must be guarded. In many cases 
 much may be done for the benefit of the patient's general health. 
 
 Treatment: The first consideration is the removal of the specific les- 
 ion causing the trouble. This is accomplished by methods already given. 
 The removal of lesion has frequently been followed by recovery. On the 
 whole a considerable number of cases have been cured. Thorough spinal 
 treatment should be given for the correction and upbuilding of the vaso- 
 motor activities. The spinal muscles and deep tissues should be relaxed, 
 and the ribs should be raised to allow the greatest area of expansion possi- 
 ble. The vaso-motor area for the lungs should receive especial treatment. 
 In all these ways the blood-supply to the lungs is upbuilt. This, next to
 
 PRACTICK AND APPLIED THERAPEUTICS OE OSTEOPATHY. 77 
 
 the removal of lesion, is the main consideration in the treatment of the case. 
 Phagocjtic activit}' is said to constitute the natural power of resistance of 
 of the system to the ba^cilli. By increasing blood supply to the tissues 
 phagoc)'tic activity is increased, the tissues are strengthened, and the en- 
 croachments of the bacteria are limited. As they cannot live and pop4gate 
 in healthy tissues, and as pure blood is a germicide, the progress of the dis- 
 ease is checked as soon as pure blood and healthy tissue are opposed to 
 to them in equal ratio. Thorough stimulation of the functions of heart and 
 lungs materially aids this process. The very important nerve connections of 
 the lungs, already pointed out in detail, afford the Osteopath the surest 
 means of reaching this result. His is the natural method. Strong lungs 
 remain immure to this disease because healthy tissues will not harbor the 
 microbe. Consumptives have been cured by judicious exercise, fresh air, 
 and careful regimen. In this way the tissues of the lung have been built 
 up, the circulation to it has been increased, and the bacteria have been 
 crowded out by the gain over them of the natural healthy processes thus 
 aroused. Osteopathy removes the impediment to normal activities of the 
 blood and ner\e forces that make strong lung tissue. Its method does that 
 which Nature unaided could not do, and further aids Nature to recover from 
 the weakness caused by the disease. No other method would seem more 
 sure of chances of success than this. 
 
 The clavicles should be raised, and the pneumogastric, phrenic, and 
 cer\ical sympathetic nerves, should be freed and toned for reasons already 
 explained. Fresh air, judicious exercise, and nutritious diet are indispensa- 
 ble factors in the treatment. Antiseptic precautions in regard to the pa- 
 tient's sputum, linen, etc, should be observed as directed in medical texts. 
 Bowels, kid neys, and skin should be stimulated to full activity. General 
 circulation must be increased. 
 
 The night sweats generally soon yield to the spinal treatment. The 
 coicgh may be relieved by treatment along the trachea and anterior thorax, 
 but it, as well as 'ihe expectoratio)i, fever, and hemorrhages^ are relieved and 
 checked by the favorable progress of the case. The greatest care must be 
 taken for the patient's general condition and nutrition. 
 
 Treatment is given in the ordinary chronic case three times per week. 
 In the acute form it should be given daily. 
 
 CONGESTION OF THE LUNGS. 
 
 Defixition: — A vaso-motor disturbance to the lungs, resulting in en- 
 gorgement of the blood-vessels, and caused by lesions in the upper dorsal, 
 thoracic, and cervical regions. 
 
 Causes: — The lesions producing this disease may be any of the lesions 
 interfering with the innervation, especially vaso-motor, and with the blood
 
 ^8 PRACTICE AND APPLIED THERAPEUTICS OK OSTEOPATHV. 
 
 suppl)' to the lungs. These have been described in the discussion of the 
 different diseases of the lungs already considered, q. v. With these lesions 
 present and weakening the circulatory energy in the lungs, some direct ex- 
 citing cause, such as exposure, over-exertion, and the like, may bring on the 
 attack. In the passive forms of congestion, secondary to enfeebled heart 
 action or to valvular disease, or coming on through stasis of blood due to a 
 long continued dorsal position of the patient, also in the active form of 
 pulmonarj' congestion, when the trouble ma)- be symptomatic of pneumonia, 
 pleurisy, etc., the lesion must be investigated with regard to the actual dis- 
 ease, and may be but in part responsible directly for this condition. 
 
 The Prognosis is good. 
 
 The Treatment must be directed at once to the removal of the speci- 
 fic lesion if possible. The main object of the treatment is to give vaso- 
 motor control. As soon as the impeded circulation is released, and activ- 
 ity restored to the innervation of the vessels, further progress of the dis- 
 ease is prevented. As in the first stage of pneumonia the disease wasaborted 
 by gaining vaso-motor control of the parts, so here the whole matter rests 
 upon the correction of the circulation. The accelerators of the heart, 2d to 
 cth dorsal on the left, and the vaso-motors of the lungs, 2d to the 7th dor- 
 sal, should be stimulated at once, and the treatment gives immediate relief 
 from the dyspnea. Often ihe patient is sitting up in the effort to get air, 
 and the practitioner may easil}- stand behind and thoroughl)- treat the up- 
 per dorsal region, releasing contractured muscles, stimulating the centers 
 mentioned, and raising the ribs. Pressure with the knee upon the back, 
 while the arms are both raised high above the head, expands the chest, 
 draws the air into the lungs, and aids in restoring circulation. This work 
 also aids the process b>' increasing activit)- in intercostal vessels and ner\es. 
 The latter should be thoroughly treated along the spine, intercostal spaces, 
 and over the chest anteriorly, as stimulation of the intercostal nerves has 
 been shown to cause reflex constriction of the pulmonary vessels. Treat- 
 ment should be given the pneumogastric nerves, and any cervical lesion to 
 them removed, on account of their participation in the pulmonar)- plexus. 
 Treatment at the superior cervical region for general vaso-motor effect, 
 and in the abdominal region to call the blood away from the lungs, will aid 
 the case. In cases of hypostatic congestion the patient's position in bed 
 must be changed so as to drain the blood from the parts affected, usually 
 the postero-inferior. 
 
 Patients are usualh' relieved immediately upon treatment. The dys- 
 pnea being most easily relieved. The cough and blood)- expectoration 
 gradually subside with the betterment of the case, which quickly \ields to 
 treatment.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 79 
 
 LARYNGITIS. 
 
 Definition-. — An acute inflammation of the mucous membrane lining 
 
 . the larynx. In acute and chronic catarrhal forms the inflammation is a 
 
 catarrhal condition. In the spasmodic form (laryngismus stridulus), the 
 
 condition is a nervous one. In the edematous form the inflammation is 
 
 accompanied hy exudation and infiltration ot the tissues. 
 
 Causes:— Lesions to the innervation and blood-supply of the larynx 
 are present. The chief ones are to the pneumogastrics and cervical sympa- 
 thetics, and occur at the atlas, axis and third cervical vertebra, where they 
 affect the superior cervical ganglion, and through it the nerves in question. 
 Cervical lesion may also affect the other cervical sympathetics concerned 
 in the innervation of the larynx- These lesions affect circulation of the 
 larynx through the innervation. Direct lesion to the blood vessels may 
 occur at the clavicle and first rib, at the deep anterior cervical tissues, and 
 in the muscles along the neck anteriorl\- and about the throat. They may 
 obstruct the circulation in the carotid arteries and the thyroid axis, or ma\' 
 impede the venous return through the small veins and the innominates and 
 internal jugulars. Local weakness of the glottis, or of the laryngeal mus- 
 cles, may occur primarily or secondary to other lesion The edematous 
 form is especiall)- likel\- to be caused by obstruction to the internal jugular 
 veins. Traumatism ma)- be the sole cause, or cold, exposure, and irritation, 
 etc , ma)' act secondarily to cervical lesion to cause the disease. 
 
 The Prognosis is good. Immediate relief is obtained from the treat- 
 ment, and reco\ery soon follows. 
 
 In dangerous cases of edematous laryngitis great care must be taken. 
 Tracheotomy may become necessary in some cases, but ordinarily this can 
 be avoided by the treatment if the case be seen in time. 
 
 The Treatment must be directed as far as possible to the immediate 
 removal of the specific lesion. This releases circulation and nerve supplv 
 as shown above. The tissues of the neck, particularly of the throat, must 
 be thoroughly relaxed; the clavicle is raised, and the deep anterior mujcles 
 and tissues of the root of the neck are treated. These treatments free the 
 circulation in the vessels as "^hovvn abo\'e. The circulation in the carotids 
 is further aided by opening the mouth against resistance. The vagi are 
 treated along the course of the sterno-mastoid muscle, and at the superior 
 cervical region. Its superior laryngeal branch is treated behind the superior 
 cornua of the thyroid cartilage. Its recurrent laryngeal branch is reachc d 
 at the inner side of the lower portion of the sterno-mastoid muscle at about 
 the level of the cricoid cartilage. 
 
 Deep treatment is made along the course of the lar\nx and trachea, 
 from the hyoid bone and muscles to the root of the neck. Care must be 
 taken to apply the fingers of the operating hand close along the sides of
 
 8o PRACTICE AM) Al'I'LIKD TIIEK APF.UTICS OF OSTEOPATHY. 
 
 the trachea. This is excellent treatment for the huskiness and the spasm. 
 The latter, however, is apt to depend upon some special lesion. In spas- 
 modic larynj^itis the epiglottis is sometimes caught in the rima, and must 
 be released by introducing the index finger into the throat. Treatment of 
 the phrenics and the diaphragm aid in lessening the spasm by quieting the 
 action of the diaphragm. A warm bath is recommended to break up the 
 spasm. 
 
 The vagi and cervical sympathetics are treated at the superior cervical 
 region and along the posterior region. 
 
 Cases of aphonia, due to the changes in the vocal cords, or to weakness 
 of the epiglottis, may be cured by this treatment. 
 
 TONSILLITIS. 
 
 Definition: — Tonsillitis is an inflammation of the tonsils, accompanied 
 by enlargement of the gland, fever and various constitutional symptoms. 
 It is caused by lesions in the cervical region. 
 
 Causes: — The lesion in the case may affect the general cervical region, 
 but usually occurs high up. affecting the atlas, axis, or third vertebra. The 
 lower vertebrae are often found luxated, and contracture of the posterior 
 and lateral cervical tissues often acts as the primary lesion. Contracture of 
 the upper hyoid muscles is always present, frequently as secondary lesion. 
 Luxation of the clavicle and first rib, and tension in the deep anterior cerv- 
 ical tissues about them are sometimes found. 
 
 Lesions of the atlas, axis, and third vertebra probabl)' act through af- 
 fecting the fifth nerve through its connections with the superior cervical 
 ganglion. Lesions of the lower cervical vertebrae, and or the posterior 
 muscles of the throat, of the deep anterior cervical tissues, and of the first 
 rib and clavicle have an important effect by obstructing the circulation 
 through the carotid arteries and the external jugular vein. 
 
 In persons subject to tonsillitis through the presence of these specific 
 lesions, acute attacks are frequently aroused by exposure to cold and wet, 
 by bad h)genic surroundings, and by various nervous disturbances. 
 
 The I'kognnsis is good in the acute follicular and acute suppurative 
 forms and in ordinary chronic enlargement of the glands. One or a few 
 treatments may cure the case in the acute forms. Great relief is almost in- 
 \ariably given immediately b)' the treatment. The chronic enlargement 
 requires long continued treatment. In the chronic form, described also as 
 naso-pharyngeal obstruction, or mouth breathing, the prognosis for cure is 
 not good. Much relief can be given, and long continued treatment aids the 
 retarded mental and bodily development. 
 
 In the Treatment of acute tonsillitis, due attention must be gi\en the 
 general constitutional condition. Liver, bowels, kidneys and skin must be
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 8l 
 
 kept active. Thorough spinal treatment should be given for tonic effect. 
 The treatment should be directed at once to the reduction of the spinal 
 lesion. Treatment is given the upper three cervical vertebrae to affect the 
 superior cergical ganglion. All the muscles and tissues of the neck are 
 gently but thoroughly relaxed. Careful treatment is made over the supra- 
 hyoid muscles and over the region of the tonsils. The extreme tenderness 
 will allow of but gentle treatment, but by exercising care in appUing the 
 treatment at first, a deep and thorough treatment may be given after pre- 
 liminary relaxation of the tissues. All the cervical vertebrae and posterior 
 tissues should be thoroughly treated for the sympathetic connections of 
 the fifth, (XIII, p. 21.) The treatment over the throat as described is to 
 relieve the inflammation by freeing the circulation in the substance of the 
 gland and in the carotid and external jugular veins. As the large arterial 
 supply is from branches of the external carotids, particular treatment is 
 made along them by relaxing the muscles and tissues o\er them and by open- 
 ing the mouth against resistance as already described. This work over 
 the throat is carried well down to the root of the neck over the carotid 
 arteries and external jugular veins. 
 
 Manipulation over the tonsil aids the flow of the blood through the 
 tonsillar plexus of veins into the external jugular. This vein is freed bv 
 raising the clavicle and relaxing the anterior cervical tissues about it and 
 the first rib. In the same way the carotid artery is stimulated in action. 
 Circulation in the substance of the gland is aided by internal treatment in 
 the throat, made by sweeping and pressing the index finger o\"er the gland, 
 fauces and surrounding tissues. This treatment gives much relief. All the 
 treatment directed to the throat and anterior cervical region is the most 
 important part of the treatment. The large blood suppl\' of the gland, and 
 our ability to reach it directly more than through the innervation, make 
 this part of the treatment important. It is readily efificient. Ireatment to 
 the first rib and over the upper anterior chest aids circulation. 
 
 The tonsils should be kept free from accumulations of secretion'-, which 
 persist in chronic cases. The fever is treated in the usual way, being af- 
 fected by the superior cervical and spinal work. The spinal and general 
 treatment relieves the chilly feelings, aches, etc. The neck and throat 
 treatments relieve the sore throat. Careful treatment will prevent suppura- 
 tion in the suppurative form. The general tonic treatment must be persist- 
 ent in these cases because of the severe general symptoms. 
 
 Acute cases should be treated daily one or more times as necessary. A 
 few treatments are generall)' sufTfi<:ient. The chronic enlargements (hyper- 
 trophy) and the chronic naso-phar)ngeal obstruction should be treated 
 three times per week. In the latter local treatment upon the gland from 
 within the throat is \er\' helpful. Long continued treatment should be 
 urged in all chronic cases to prevent, or to aitl, retarded mental and 
 physical development.
 
 82 TKACTICE AND Ari'LIEO TH KKAF'EL'TICS OF OSTEOPATHY. 
 
 PAROTITIS. 
 
 Deitmtion:- Parotitis or, mumps is an acute inflammation of the par- 
 otid glands. 
 
 Causes: — The lesions in such cases affect the upper cervical region, 
 mainly the atlas, axis antl third vertebra. Other cervical vertebrae may be 
 luxated, and the cervical muscles are contractured. The deep anterior 
 cervical tissues may be tensed, and the clavicle luxated. Secondary con- 
 tracture occurs in the muscles and tissues over the region of the gland. 
 
 Lesions of the upper three cervical vertebrae and to the tissues affect 
 the superior cervical ganglion, and thus the carotid plexus through its 
 ascending branch; the fifth nerve through this ganglion and through its 
 s>mpathetic connections, and thus its auriculo-temporal branch; the second 
 cervical nerve, and thus its auricular branch; while lesions to the muscles in 
 this region may affect the facial nerve directly, and these and other lesions 
 affect it through the sympathetic connections- Contraction of the tissues 
 over the course of the external carotid arteries and the external jugular 
 veins affect the flow of the blood to and from the gland. Luxation of the 
 clavicle and its tissues affects the external jugular vein. 
 
 The Prognosis is good. Treatment Is rapidly effective and the course 
 of the disease is shortened from the usual course, seven to ten days, to 
 three or four days. Some cases may become obstinate and require longer 
 treatment. 
 
 The Treatment is in most particulars identical with that given for ton- 
 sillitis, q. v., the lesions to vertebrae, tissues, and clavicle, etc., being 
 practically the same. 
 
 The tissues over and about the gland may be more readily relaxed as 
 the condition is less painful. The swelling is more persistent, and requires 
 more treatment. The fever is treated as before, and a thorough spinal and 
 general treatment is given for the constitutional symptoms. This should 
 include treatment to the blood and nerve supply of the breasts, ovaries, and 
 testacies to prevent metastasis. This point must not be neglected, as the 
 inflammation may be driven by the treatment to these parts. By thor- 
 ougii treatment of them the danger of metastasis is much lessened. 
 Thorough general treatment prevents the serious sequelae that sometimes 
 follow parotitis. Careful nursing and care of the patient are necessary to 
 prevent relapse. The patient should remain in bed during the acute attack 
 
 ACUTE AND CHRONIC GASTRITIS. 
 
 Definition: — The acute form is an acute catarrhal inflammation of the 
 mucosa of the stomach; acute indigestion. The chronic form, chronic dys- 
 pepsia, is associated with structural changes m the mucosa, and with change 
 in the secretions and muscular activity of the stomach.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 83 
 
 Causes: — Lesions have been noted in various cases as follows: (i) 2d 
 to 6th cervical vertebrae to the right; 2d cervical anterior; 8th to lOth dor- 
 sal vertebrae separated; break at the fifth lumbar. (2) Luxation of the 8th 
 rib; tenderness at the Sth dorsal vertebrae. (3) cer\ical and dorsal curva- 
 tures of spine, and luxation of the ribs. Lesions at the atlas, axis and third 
 cervical affect the vagus nerve through its connection with the superior cer- 
 vical ganglion. It may be obstructed along its course in the neck. Lesions 
 to the cervical region and to the pneuniogastric nerves in the neck are of 
 secondary importance in causing stomach disease. The main lesions occur 
 in the spine, affecting the splanchnic area, and may be of the ribs and 
 their cartilages, of the vertebrae, or of the spinal and intercostal muscles 
 and other tissues mentioned. Lesions to these structures occur mainly be- 
 tween the fourth and tenth dorsal region, but may occur either a little above 
 or below these limits The pneumogastrics and the splanchnics both con- 
 tribute to the solar plexus, which has charge of the functional activities of 
 the organ. The wide area of origin of the splanchnics along the spine, and 
 their importance in the innervation of the stomach, accounts for the fact 
 lesions to this area are most potent in producing derangement. At the 
 same time this region is so readilx' accessible to the Osteopath's work that 
 results are general!)' easily attained in the treatment of such troubles. 
 
 Lesions to ribs and cartilages act in part through interference iwth the 
 intercostal nerves, which are in direct s\ mpathetic connection with the 
 solar plexus through the splanchnics. Luxation of the ribs may also inter- 
 fere with spinal nerves by derangement of the tissues about the head of the 
 rib. Lesions of spinal muscles, ligaments, and vertebrae act mainly through 
 interference with the spinal nerves and thus upon the connected splanch- 
 nics. Muscular lesion may often be secondary to stomach disease, but in 
 such case indicates the point of treatment, and may point to other spinal 
 lesion at that place. The vagi nerves carry sensory, motor and secretory 
 fibers to the stomach. The splanchnics contain vaso-motor and vaso-inhib- 
 ititory fibers for the stomach. But as the influence of the abdominal brain 
 is, according to Robinson, supreme over visceral circulation, and controls 
 as well visceral secretion and nutrition, the results of our treatment upon 
 the pneumogastrics and the splanchnics must affect the stomach mainl}' 
 through the solar plexus. As the splanchnics contain these vaso-motors 
 for the stomach, the main treatment for gastritis, a vasomotor disturb- 
 turbance, must be through them. Lesions to the splanchnic area are likely 
 to cause gastritis upon account of their being the vaso-motors. 
 
 McConnell states that lesion of the eighth and ninth costal cartilages 
 may cause gastritis. 
 
 The mechanical irritation of coarse, poorl}- masticated food, the fermen- 
 tation of over-ripe fruit in the stomach, and the effects of constant over- 
 loading of the stomach and of indiscretion in diet, may irritate the mucosa 
 and cause gastritis in the absence of specific lesion. But in such cases sec-
 
 84 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 otidary lesions are generally produced by the trouble. In the ordinary 
 case of gastritis some causes beyond these must be sought, as the disease so 
 frequently occurs without such indiscretions. 
 
 The Prognosis for recovery is good in both acute and chronic cases. 
 The ordinary acute case is relieved immediately by a treatment. More than 
 one treatment may not be necessary. In chronic cases, even when severe 
 and of very long standing, relief is soon given, and a cure can usually be 
 
 made. 
 
 The Treatment must be directed to the specific lesion, generally of 
 the splanchnic area, that is causing the trouble. Its main object must be to 
 correct the circulation, and thus ts take down the inflamed condition of the 
 mucosa and restore normal secretion. The ?planchnics and solar plexus, 
 having charge of the circulation and secretion, afford a m.ost convenient 
 means of doing this. The correction of lesion here, and the treatment 
 given the splanchnics and solar plexus in conjunction with the removal of 
 lesion constitute the main treatment in such cases. 
 
 With the patient lying upon his side or upon his face, the muscles and 
 deep tissues of the splanchnic area are thoroughly treated and relaxed. The 
 patient now lies upon his side, or sits up, and treatment is given the spinal 
 vertebrae and ribs of this region. The former are thoroughly treated and 
 sprung, to relax all their related tissues and remove obstructions to the 
 nerves. The latter are raised, and adjusted in case of lesion, to aid in this 
 process. Vaso-motor activity is thus aroused and corrected. This import- 
 ant process is aided by by deep treatment of the solar plexus from the 
 abdominal aspect. (VI. p 36) As this plexus has the main control of visceral 
 circulation and secretion, treatment of it rouses and normalizes its functions. 
 Mechanical pressure of displaced ribs upon the stomach may be found. 
 The upper abdominal treatment aids circulation in the stomach. (V, p 36). 
 Attention is given the upper cervical region for lesions affecting the vagus. 
 It may be treated in the neck as a means of aiding the general treatment. 
 Inhibition by pressure upon the left vagus relaxes the pylorus. This press- 
 ure may be made in the neck directly upon the nerve, or may be made at 
 the third or fourth intercostal space near the spine. This latter treatment 
 is much used to relieve nausea and vomiting. Its effect is probabl\- through 
 the sympathetic connections with the vagus. In some cases pressure at 
 this intercostal space has caused vomiting. In some cases abdominal 
 manipulation induces vomiting. This should be encouraged to relieve the 
 stomach of its irritating contents. Excessive vomiting should be checked 
 A thorough treatment along the spine (splanchnic area) will aid in this. 
 After inhibition qf the left vagus to relax the pjlorus, the patient may be 
 placed upon his right side and deep pressure Le made over or beneath the 
 left hypochondrium, from the cardiac toward the pyloric end, to aid in the 
 passage of the stomach contents into the intestine. 
 
 McConnell states that inhibition at the 8th and 9th dorsal relaxes the 
 pylorus; inhibition at the 6th and 7th dorsal relaxes the cardiac orifice. He 
 has found that correction of lesion in the lower left ribs aids in the absorp- 
 tion of gas. Deep pressure over the solar plexus also aids this process. 
 
 Liver, bowels, and kidneys must be kept in active condition b\' treat- 
 ment. The patient should be absteminous in diet. It should be light and 
 easily digested, and ma}- be according to prescribed dietaries. 
 
 Acute cases should be treated frequently, chronic cases three times per 
 week.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 85 
 
 DISEASES OF THE STOMACH (Continued.) 
 
 Cases. — (i) Strain from heav)- lifting, followed by se\-ere lameness 
 at the time, which gradually disappeared. In a few months severe stom- 
 ach disease followed; no food could be retained, and rectal feeding was re- 
 sorted to. He came under treatment too weak to walk or talk. Muscular 
 contractures under the right shoulder and a slightly displaced rib were the 
 lesions found. They were corrected and the case was cured. 
 
 (2) Ulceration of the stomach and a complication of troubles, due to 
 spinal curvature. Correction of curxature gave great relief. 
 
 (3) Ascidity of the stomach and diarrhoea, caused by abnormal ten- 
 sion in the spinal tissues. Cured. 
 
 (4) Gastralgia; attacks so severe that they induced spasm in abdominal 
 and neck muscles at the same time. The spasm was always stopped at 
 once by inhibition of the solar plexus and of the posterior cervical nerves. 
 Attacks grew less frequent under treatment. 
 
 (5) Gastralgia; agonizing pain followed taking even small quantities 
 of food as long as it remained in the stomach. 6th, 7th, and 8th right ribs 
 were down. These being replaced at the second treatment the trouble 
 disappeared. 
 
 (6) Gastralgia of several years' duration. Lesions at 5th and 6th dor- 
 sal and 2d lumbar \'ertebrae. Luxation of the 8th right rib. Case cured by 
 four months' treatment. 
 
 (7) Tenderness over the stomach (hyperaesthesia) ; 8th dorsal verte- 
 bra very tender and 8th rib luxated; cured by two weeks' treatment. 
 
 (8) Gastralgia; three years' standing; attacks after nearly every meal. 
 Lesion, a lateral twist of the 6th dorsal vertebra. Cured in one \-ears' treat- 
 ment. 
 
 (9) Gastralgia; incessant pain in left side, stomach, and bowels; 4th 
 and 5th right and left ribs drawn together; 8th left rib under 7th; spinal 
 muscles tense. Great relief was given b)' one months' treatment. 
 
 (10) Dilatation of the stomach and a complication of diseases. The 
 spine was straight and flat; thorax flat; 2d and 3d cervical vertebrae lateral; 
 left cervical muscles tense; siiyht lateral curvature to left between the 5th 
 dorsal and 3d lumbar; spinal muscles tense. 
 
 (11) Gastralgia. Seventh dorsal vertebra right; great tension at the 
 I2th dorsal. 
 
 (12) Gastralgia. Lesions at atlas and 4th dorsal. 
 
 (13) Gastralgia. Luxation of the nth rib. 
 
 Lesions: In all the above cases the splanchnic area was affected; neck 
 lesion was rare, and apparently of secondar)- importance; lesions to the spine, 
 including vertebrae and muscles were important, occurring in ten of the 
 cases; rib lesions were the most important and specific, occurring in seven
 
 86 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 of the cases. Lesions of the 5th to 8th ribs (area of greater splanchnic) oc- 
 cur most frequently. 
 
 Lesions to the splanchnic area, through rib or spinal lesion, apparently 
 occur in all cases of stomach disease. We are not yet able to specialize as 
 to lesion, and saj- that one particular style of lesion, or lesion of some ind- 
 ixidual rib or vertebra causes a certain kind of stomach disease. 
 
 It is probable that in the future compilation of lesions niay show con- 
 siderable specilization of them in the etiology of stomach disease. But it 
 is also likely that such tabulation will indicate the probabilities onl\-,.for it 
 is a matter of experience that a given lesion will produce in one patient one 
 form of stomach disease, and in another a different form, depending upon 
 individual peculiarities, and upon various attendant conditions. Hence one 
 must be upon the lookout for an)- various lesion in the splanchnic area in all 
 stomach diseases. The\- ma\' cause a predominance of sensory, motor, se- 
 cretory, or motor derangements, and complications thereof, and according 
 to the pre Jominating difficulty it may be that special lesion will be sus- 
 pecteti, or that special areas will be treated in conjunction with the removal 
 of specific lesion in the case. 
 
 The practitioner's simple duty in stomach disease is mostly thorough 
 examination of the splanchnic region of the spine, justabo\e and just be- 
 low, and of the thoracic parts in relation thereto. When he has done this 
 he has located the trouljle, almost invariabl)-, and his treatment of this, 
 region, removing the lesion, ahnost as generall)' cures or benefits the case. 
 Lesion outside of this area is of minor importance, and treatment directed 
 elsewhere (abdomen and neck) is either secondary or for alleviation merel}'. 
 
 Special lesions ha\e been noted as fallows: in ascidit)-. the lesser 
 splanchnics and the 4th and 5th dorsal (A. T Still); in gastralgia, frequent 
 luxation of the 8th and 9th ribs anteriorl\- ( McConnell), also of the 5th, 6th 
 and 7th dorsal; for gas on the stomach, the lesser splanchnics and the i ith 
 and 12th dorsal; for gastric ulcer, frequent lesion of the 8th and 9th ribs an- 
 teriorly, and of the 5th to Sih ribs posteriorly (McConnell.) 
 
 Secondary lesion in the form of contracturing of spinal muscles, par- 
 ticularly along ths splanchnic area, is of very frequent occurrence in stom- 
 ach disease. Although in this case the result, and not the cause, of stomach 
 disease, it is of much importance osteopathically. (i) It indicates the 
 point of treatment, for it is an indication upon the surface of the body of 
 what special nerve fibers or areas are suffering derangement by the particu- 
 lar form of disease present. There is a direct path between the diseased 
 stomach and the contractured muscle, over which the abnormal impulses, 
 generated in the stomach, pass out. It is Nature's landmark of a special 
 diseased condition, or of a phase thereof. Experience shows that in the 
 absence of an}- other lesion whatsoever, treatment at the point of contract- 
 ure may cure the condition. It is evident that the nerve era thus indicated 
 was the one needing treatment.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 87 
 
 (2) These contractures do not always occur at the same location, nor 
 always affect the spinal muscles over the splanchnic area generally. They 
 may occur upon the one side of the spine only, high up in the splanchnic 
 area or above it. They must therefore indicate lesion in different nerve 
 areas or fibers, according to some condition present and determining which 
 fibres shall thus suffer and produce contracture. It is possible that they in- 
 dicate seat of lesion in the spine not otherwise discoverable. In such case 
 this weak point would be the determining condition in the location of the 
 situation of the contracture. Thorough treatment at this point may restore 
 conditions and thus correct lesion which is important in the causation of 
 the stomach disease. Contracture and soreness in the cervical or lumbar 
 regions may follow stomach disease, and possibly indicate important rela- 
 tions, by lesion or otherwise, between these parts. 
 
 Anatoviical Relations: Robinson states that the solar plexus is supreme 
 over visceral circulation, that it controls also secretion and nutrition. The 
 important lesions noted in stomach trouble affect its spinal connections, 
 the splanchnics, and may therefore cause circulator)-, secretory, or nutri- 
 tional disturbances in its connected organs. Likewise they may cause 
 sensor)' and motor troubles, as the same authority states that this plexus 
 recei\'es sensation and sends out motion. According to Ouain, the terminal 
 branches of the pneumogastric unite with the gastric plexus of the sympa- 
 thetic, and carry motor and sensor)^ fibers to the stomach. Flint shows, 
 that the pneumogastrics have much to do with gastric secretions, as -^ k^f^ ^ 
 dioa-of them leads to almost complete cessation of stomach secretions. It 
 is considered probable by investigatosr that its motor function in the 
 stomach is deri\-ed from its sympathetic connections. Osteopathic work 
 seems to influence it more largely through its sympathetic connections. It 
 is treated also in the neck directl)'. It is important in sensory and motor 
 diseases. The splanchnics contain vaso and viscero-i h^oro f'TtbTe's. '^ Stimu- 
 latiotL-oi the splanchnics lessens peristalsis; of the pneunioorastricsj^ncreases 
 it. Thus important control is gained in various conditions. Quain 
 states that sensory nerves for the stomach pass from the dorsal nerves from 
 the 6th to the 9th; the 6th and 7th supplying the cardia, the 8tb and 9th to 
 the pyloric end. 
 
 The Prognosis in stomach diseases as a class is extremely good. Many 
 severe cases of long standing have been cured. As a rule relief is immedi- 
 ately given, and cure follows. 
 
 The Treatment of stomach diseases as a class is very simple. It con- 
 sists mainl)' in corrective treatment in the splanchnic area, together with a 
 certain amount of neck and abdominal work. This is supplemented b)- 
 certain special treatments for various purposes in the treatment of special 
 diseases. Through the pneumogastrics and the s)-mpathetic connections, 
 the solar plexus and the splanchnics, control is had, to a marked degree, 
 over the processes regulated by them; sensation, motion, nutrition, secre-
 
 88 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY, 
 
 tion, circulation. Few diseases can remain after correction of these func- 
 tions by removal of the lesion disarranging them. 
 
 The treatment of the solar plexus, the spine (splanchnics), the pneu- 
 mogastrics, and the removal of the various lesions likely to occur in these 
 regions have already been discussed. 
 
 The various motor, secretory, and sensory neuroses,- described under 
 
 the general name of nervous dvspcpsia, are treated by the removal or special 
 
 lesion and by the work for the control of various functions as discussed, Iji 
 
 / cases of supermotjlity, peristaltic unrest, and nexvous eructation^ special 
 
 \ treatment may be given to stimulate j^he splanchnics and solar plexus to 
 
 I lessen peristalsis. In nervous vomiting, the work should be directed to the 
 
 Icerebral centers, by treatment in the superior cervical region, and to the 
 
 solar plexus. 
 
 In spasm of the cardia, inhibition should be made at the end of the 6th 
 and /th dorsal for fibers controlling it, while in spasm of the pylorus the in- 
 hibition should be upon the 8th and gth dorsal and upon the left vagus 
 (p. 84). Inaton)' of the stomach, thorough stimulation should be given the 
 vagi, splanchnics and solar plexus, to increase muscular tone and to devel- 
 op circulation. Local manipulation over the region of the stomach would 
 aid in toning the muscular walls (p. 84). In insufficienc)' of the cardia 
 stimulation should be gi\'en the 6th and 7th dorsal, while in p}'loric insuf- 
 ficiency the 8th and gth dorsal and the left vagus must be looked to. Local 
 stimulation, by brisk work over the abdomen, aids the operation. 
 
 In secretor)' disturbances, hyper-ascidit)-, super-secretion, and sub- 
 ascidit)-, work upon the vagus and solar plexus, through the splanchnics, 
 corrects circulation and rights secretion. Stimulation of the lesser splanch- 
 nics and of the 4th and 5th dorsal is important. 
 
 In sensory disorder attention must be given the sensory innervation. 
 Hvperaesthesia needs a general stimulation. Gastralgia needs deep inhi- 
 bition at the solar plexus, splanchrics, and vagi. Special inhibition should 
 be made from the 6th to gth dorsal, 8th and gth ribs anteriorly, and the 5th, 
 6th, and 7th dorsal vertebrae. All of which points seem concerned in the 
 sensory innervation of the stomach. For the abnormal sensations of 
 hunger, lack of appetite, etc., general correction of secretions and sensation 
 will be efficient. 
 
 For dilatatio7i of the stomach, rapid cutaneous stimulation over the 
 region of the stomach aids in contracting its muscular fibers. Treatment 
 should be given for the stimulation of the vagi, and accumulated food must 
 be kept worked out of the stomach, (p, 84.) 
 
 \\\ peptic tdce> attention should be given to perfect freedom of circula- 
 tion. The condition of the 8th and gth ribs anteriorly, and of the 5th to 8th 
 ribs posteriorly must be looked to. 
 
 In hemorrhage from the stomach, inhibit the splanchnics, and the solar 
 plexus carefully, to lessen the blood pressure by vaso-dilatation. Also in-
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 89 
 
 hibit the superior cervical region for the general vaso-motor center, and 
 make deep inhibitive treatment of the abdomen to dilate the great abdom- 
 inal veins and call the blood away from the stomach. 
 
 In ca7icei' oi the stomach general corrective work and particular atten- 
 tion to freedom of circulation must be relied upon. 
 
 Look for lesion to an)' of the special points mentioned in relation to 
 the various diseases. The bowels, kidne}s and liver must be kept in free 
 action. The diet should in all cases be limited and easil)- digested. 
 
 CONSTIPATION. 
 
 Definition: "Infrequent or incomplete alvine evacuation, leading to 
 retention of feces" (Quain). "A neurosisof the fecal reservoir" (Byron 
 Robinson). Osteopathicall)- it is regarded as a neurosis due to obstructed 
 action of the nerves supplying the bowel with secretion, motion, and circu- 
 lation. It may be symptomatic of other disease, or a complication. It is 
 very frequently idiopathic, due to specific lesion to bowel innervation. 
 
 Cases have presented vd^rxous lesions; {\) Contraction of the sigmoid 
 flexure. (2) Spinal lesions, mostly in the lumbar, causing spinal cord dis- 
 ease and partial paral}'sis of limbs and bowel (3) A posterior prominence 
 of the whole lumbar region. (3) Lesion at 5th and 6th dorsal, 2nd lumbar, 
 and 8th right rib. (5) At 3rd and 4th dorsal, 9th dorsal, 5th lumbar. (6) 
 Intense contraction of the external sphincter ani. (7) Slight parting of 1st 
 and 2nd lumbar. (8) Prolopsus of the sigmoid. (9) Retroversion of the 
 uterus against the rectum. (10) Right curve of spinal column ; 3rd to 6th 
 dorsal vertebrae posterior; 7th to loth dorsal vertebrae anterior and flat; 
 nth and 12th dorsal and ist lumbar posterior; 12th dorsal and 1st lumbar 
 the seat of pain; 12th rib down; 2nd and 3rd lumbar close; 5th lumbar sore 
 and anterior, (ii) 2nd and 3rd dorsal separated, 3rd and 4th together, 
 3rd to 5th flat, 6th to the left, nth dorsal to 2nd lumbar posterior. (12) 6th 
 and 7th dorsal posterior, 9th to 12th flat, ribs irregular and prominent on 
 the left. (13) Cocc)-x badly bent, lesion of 5th lumbar. (14) Separation 
 between \-ertebrae from 8th to lOlh dorsal, and between 5th lumbar and 
 sacrum. (15) 2nd to 5th dorsal approximated and to the right, separations 
 between \ertebrae from 8th dorsal to 3rd lumbar, the right innominate up 
 and back. 
 
 An examination of cases shows a wide distribution of lesion, ranging 
 from the upper dorsal to the coccyx, and affecting ribs, vertebrae, spinal 
 muscles and other tissues, innominates, coccyx, etc. The most important 
 lesions in these cases appear in the region of the lower two or thfee dorsal, 
 and in the lumbar region. It is in this portion of the spine that origin is 
 given to the sympathetic nerves supplying the bowel. Particular attention 
 should be given the nth and 12th dorsal and the 1st and 2nd lumbar, as the
 
 QO PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 sympathetic branches from these points supply the inferior mesenteric 
 ganglion and the rectum with motor fibres, and the abdominal vessels with 
 constrictor fibres. Sympathetic distribution for the small intestine is from 
 just above the first lumbar; for the large intestine from the ist to 4th lum- 
 bar. Hence the importance of the lower dorsal and lumbar lesion in con- 
 stipation, as it may interfere with the functions of motion, secretion, and 
 circulation by obstructing the spinal connections of these importani sym- 
 pathetics. 
 
 Lesions of the lower two ribs are important causes of constipation, not 
 only by spinal interference with the sympathetics mentioned, but by direct 
 mechanical pressure upon the bowel, sometimes. In )'ct another important 
 manner they ma)- cause bowel trouble b)- lesion to the diaphragm as already 
 mentioned. The whole subject of change in the diaphragm is an important 
 one in relation tu bowel disease. It is reasonable to consider that certain 
 spinal and rib lesions affect the diaphragm. They may cause it as a whole 
 to weaken and sag, may cause contracture of the whole muscular structure, 
 or may contracture or strain certain portions of it. Thus. impingement is 
 brought upon the important structure passing through the diaphragm, and 
 having much to do with abdominal activities. The aorta, ascending cava, 
 thoracic duct, pneumogastrics, phrenics, and splanchnics — may be inter- 
 fered with. Or the sagging of the diaphragm may set up ptosis of the 
 abdominal organs, thus causing constipation mechanically or otherwise. 
 This subject has been discussed at length elsewhere. 
 
 Lesion to the fourth sacral nerve may cause contracture of the external 
 sphincter, which it innervates. Lesio n to the lower dorsal and the lu mba r 
 nerves may lead to loss of energy of the muscles of the abdominal 
 walls, as ma)' other causes, and lead to constipation. Robinson states that 
 such a condition favors constipation by allowing congestion of blood and 
 secretions. Lesions to the liver and pancreas, usually from the 8th to i2th 
 dorsal, or through the splanchnics or solar plexus, aid constipation by less- 
 ening the secretions of these organs, necessary to stimulation'bf peristalsis. 
 McConnell states that contractured muscles are generall)' found in consti- 
 pation on the right side of the spine over the region of the liver. Dr. Still 
 makes lesion of the 5th dorsal important in these cases. 
 
 The cocc)'x may be so misplaced as to act as a mechanical obstruction 
 to the passage of the stool. Lesion at this point may cause contracture of 
 the sacral tissues and interfere with the fourth sacral, or it may interfere in 
 a similar manner with the sympathetic distribution to the rectum and cause 
 atony or contracture of its walls. A prolapsed uterus, hernia, adhesions, or 
 the presence of foreign bodies, fruit stones, etc., may mechanically obstruct 
 the bowel. 
 
 \'arious lesions, as of the diaphragm, the weight of a loaded colon, of 
 the spinal regions, etc., producing ptosis of the abdominal organs, or of the 
 colon itself, cause a kinking of the flexures by their dragging upon their
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 91 
 
 ligaments at those points. The same causes allow of a sinking of the 
 caecum and sigmoid into their respective iliac fossae, allowing also the sig- 
 moid to fold upon itself. In these ways obstruction to the passage of fecal 
 matter along the bowel is caused. In enteroptosis the pressure of organs upon 
 each other limits motion, peristalsis, and circulation. The elongated omenta 
 and ligaments, in which the blood vessels and nerves run to the bowels, 
 stretch these structures and abridge their function. These become import- 
 ant causes of constipation. 
 
 The anatomical relations have been described in detail in considering 
 diarrhoea, q. \'. 
 
 Various lesions, acting to weaken circulation and nutrition, lead to 
 atony of the bowel muscles, and lead to constipation. Any lessening of 
 circulation acts to cause it, as the circulation of blood about the nerve 
 terminals in the bowel wall is necessary to their activity. 
 
 The Prognosis is good. Most cases are cured in a reasonable length 
 of time. The ordinary acute form, occasional constipation, is cured in one 
 or a few treatments. Very quick results are often obtained. Cases which 
 have been most obstinate, and those that have been from birth, ha\^e been 
 readily cured. Many cases are obstinate under treatment, and require time 
 and patience to effect a cure. 
 
 The Treatment for constipation, from the nature of the case, must look 
 to the correction of the lesion that is obstructing circulation, peristalsis, or 
 secretion in the bowel, or to the removal of the mechanical stoppage that 
 sometimes causes the disease. Some one or more of the special lesions 
 described is found, and may be removed by the appropriate methods. The 
 main t reatment i_s for nerve supply, as practicall)' all of the lesions, except 
 mechanical causes, act in one way or another through the innervation. The 
 main treatment upon the spine is in the lower dorsal and lumbar regions, 
 the seat of the chief lesions. The removal of the lesion is often all the 
 treatment necessary, but various points must be considered. The treatment 
 must, by the remox^al of lesion or otherwise, tone the splanchnics, spinal 
 sympathetics, and solar plexus, as well as Auerbach and Meissner's plex- 
 uses, controlling the motor, secretory, and other functions of the bowels. 
 Special attention must be given to lesion at the points mentioned as liable 
 to them in this trouble. 
 
 Abdominal treatment should be a deep, slow, relaxing treatment 
 carried along the course of the bowel. It relaxes all the tissues, and frees 
 local circulation, affecting also the local nerve distribution. It dwells par- 
 ticularly upon those portions in which are felt the aggregations of fecal 
 matter, releasing the tissues about them, softening and passing them along. 
 This is the special method of removing obstruction by foreign bodies, such 
 as fruit stones, etc. This treatment should be given especially to the caecal 
 and sigmoid portions, as they are generally full. Attention must be given 
 to raising and straightening them when necessary. This may be done in
 
 Q2 PRACTICE AXD APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 the treatments described in III and IV, p. 36. Likewise the colon as a 
 whole should be raised and straightened to relieve kinking at its flexures 
 and the e\il results to ner\es and blood vessels accuring from the stretch- 
 ing of its omenta in ptosis. Spinal work and the correction of lesion tones 
 these omenta to hold in position the replaced organs. 
 
 The liver should be thoroughly treated to stimulate the flow of bile. 
 By the rcmo\al of lesion, by treatment to its spinal connections through 
 the splanchnics. and b\- raising the 8th to I2th right ribs, this is in part 
 accomplished. It is treated at the abdomen, as are the gall bladder and 
 bile duct. {V. p. 36, IX. p. 37). 
 
 The inferior mesenteric ganglion is the center for the fecal reservoir, 
 and should be treated at the location already described. The vagi ma)' be 
 treated in the neck to aid in the general process. The coccyx should be 
 straightened as the case requires. (XX, p. 13.) A contractured sphincter 
 should be dilated, (p. 44). Or it may be released b)' strong inhibition over 
 the fourth sacral nerves. They may be located at the fourth sacral for- 
 amina, just to the side of and below the bony prominences that mark the 
 termination of the sacral canal, and which may be easily felt beneath the 
 skin. 
 
 Peritoneal adhesions ma)' be broken up gradually by deep and careful 
 work upon the bowel at their site. In the absence of pain, or as it disap- 
 pears, the treatment ma)' be made strong, care being taken not to set up in- 
 flammation. 
 
 Obstruction from volvulus may be sometimes oxercome by manipula- 
 tion at the seat of the obstruction directed to the straightening the bowel. 
 This requires long treatment at a time, and much care and patience. 
 
 Symptomatic cases must de treated in conjunction with the primary 
 disease. 
 
 The use of cold and hot drinks before breakfast, rectal injections, cereal 
 foods, fruits, regularity in habit, and exercise are all helpful. 
 
 CARARRHAL ENTERITIS; DIARRHOEA. 
 
 Definitiom: — An acute inflammation of the intestinal mucous mem- 
 brane due to specific spinal lesions. Diarrhoea is often sxmptomatic of 
 other diseases . 
 
 Cases: — Lesions were found as follows: ( i) Tension of the spinal tissues 
 from the 3rd to lOth dorsal. (2) Lateral lesion of the 7th, 8th and 9th 
 dorsal vertebrae. (3) 9th to nth right ribs depressed. (4) Right nth rib 
 down onto the 12th; 4th and 5th lumbar anterior; spine weak. 
 
 Lesions may occur an)- where along the splanchnic area and along the 
 spine as low as the coccyx. The most important lesions effect the region of 
 the lower two dorsal and the lumbar vertebrae. The nth and 12th ribs on
 
 PRACTICE AXD APPLIED THERAPEUTICS OF OSTEOPATHY, 93 
 
 each side are sometimes found luxated, most often downwards. Lesion 
 may occur at the 2d lumbar, the 5th lumbar, to the innervation of the 
 small intestine above the first lumbar, to the innervation of the large intes- 
 tine from the ist to 4th lumbar, to the cocc\x, or to the innonimates. Lesions 
 from the 8th to 12th dorsal and ribs ma\' affect liver and pancreas to aid 
 the diseased condition. 
 
 Anatomical relations: — In intestinal diseases as in stomach diseases, the 
 importance of the splanchnics and solar plexus must be borne in mind. 
 The former contain vaso and viscero-motors to the intestines, these vaso- 
 motors being, according to Fliut, among the most important in the body, 
 innervating the immense area of abdominal vessels, which, when fully dilat- 
 ed, are said to be able to accomodate one-third of the total quantit)' of blood 
 in the body They contribute to the solar plexus, which rules sensation, 
 motion, secretion, nutrition, and circulation in all these viscera. Our cor- 
 rection of circulation in these cases is an important consideration. Robinson 
 shows that movements of the intestines are largely dependent upon the 
 amount of blood circulating in the intestinal walls. For these reasons lesions 
 anywhere along the splanchnic region may produce important disturbances 
 of intestinal secretions, circulation, or motion, all of which ma}' be disturbed 
 in diarrhoea. 
 
 The whole abdominal sj-mpathetic is important in these diseases. 
 Stimulation of it lessens peristalsis; stimulation of the pueumogastric in- 
 creases peristalsis. We work not to directly stimulate or inhibit either of 
 these for the purpose of controlling peristalsis, but to remove lesion from 
 them as it produces through them abnormalities of motion. 
 
 Auerbach and Meissner's plexuses of ner\"es have to carr}- on gastro- 
 intestinal secretion. Auerbach's is a motor plexus. The)' lie in the intest- 
 inal walls, and may be directly influencel by work upon the abdomen, but 
 are corrected by us through the remo\-al of lesions affecting them through 
 their sj'mpathetic and spina! connections. Lesions to them, disturbing both 
 secretion and motion, are important causes of diarrhoea. Robinson states 
 that the inferior mesenteric ganglion, upon the inferior mesenteric artery, 
 located from externally a little below and to the left of the umbilicus, in- 
 nervate the muscular -vvalls of the fecal reservoir, i. e., the left half of the 
 transverse colon, the descending colon, and the sigmoid. Spinal lesion to 
 it, through its connected nerves, is acti\-e in production of diarrhoea. 
 
 The fact that afferent sympathetic fibres pass from the abdominal 
 \'iscera to the thoracic sympathetic cord may explain the occurence of 
 secondary lesions in the form of contractured muscles along the thoracic 
 spine. The presumption is that the)- are sensory in function, and if so, sen- 
 sor)- fibres for the abdominal viscera may be associated with them. Ouain 
 states that among the meduUated fibres passing into the sympathetic system, 
 some derived from spinal nerves are sensory fibres. This ma)' be the ex-
 
 94 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 planation why inhibition of the splanchnic area will Stop pain in thestomich 
 or intestines. 
 
 All these various facts indicate the importance in diarrhoea, of spinal 
 or lower rib lesion, from the 6lh dorsal to the coccyx, which may interfere 
 with the spinal connections of all these abdominal sympathetics and derange 
 their functions. 
 
 Our most important treatment is given from the lOth dorsal down, in 
 these cases. Lesions in this lower spinal region are of prime importance 
 in causing diarrhoea. The importance of the lesion to iith and 12th ribs 
 and vertebrae, and to the upper two lumbar, is found in the fact that nerve 
 branches from the lower dorsal and upper two lumbar pass to the inferior 
 mesenteric ganglion, shown above to innervate the fecal reservoir. These 
 branches are motor fibres for the circular, and inhibitor)' fibres for the longi- 
 tudinal, muscle fibres of the rectum. At the same time these lower dorsal 
 and upper two lumbar nerves send branches to the sympathetics and supply 
 \aso-constrictor fibres to the abdominal \essels. The motor fibres to the 
 longitudinal, and inhibitory fibres to the circular, muscle fibres of the rectum 
 are sent from the sacral nerves. This explains why the lesion of the in- 
 nominate or cocc) X may cause a part of the trouble in diarrhoea, also why 
 strong stimulatfon to the sacral nerves relieves tensmus. 
 
 Branches from the four lumbar ganglia go to the plexus upon the aorta, 
 and to the hypogastric plexus. Lesion in the lumbar region may in this 
 way further interfere with the bowel. 
 
 The various forms of enteritis and diarrhoea seem to have as their basis 
 derangement of nerve or blood supply in the form of infl immation (catarrh) ; 
 lack of proper vaso-inner\ation, leading to congestion and exudation; im- 
 proper preparation of digestive fluids, due to deranged glandular activity; 
 or increased peristalsis, accompanied b)- increased secretion and exudation. 
 
 The remo\al of lesion obstructing ner\e and blood suppl)' corrects 
 the«e manifestations of such derangement. 
 
 The Prognosis is good. Most cases of diarrhoea are checked at once 
 by a single treatment, man}' needing no further treatment. Cases of years' 
 standing ha\e been in many instances cured in a short time. The ordinary 
 acute diarrhoea needs but one or a few treatments. Acute enteritis needs 
 careful treatment for several da)-s while the acute pocess lasts. 
 
 Teatment for diarrhoea consists in the removal of lesion as found, af- 
 fecting any of the special points named above as subject to lesion in this 
 disease. The main treatment aside from this is very simple, and is often 
 given as the sole measure of relief. It consists of very strong inhibition of 
 the spine from the lower dorsal to the sacrum. It may be given with the 
 patient on his side, as described in III, p. 9. The "breaking up" spinal 
 treatment may be used for the same purpose. (XXII, p. 11). The former 
 seems preferable. It may be applied to either side or to both sides of the 
 spine.
 
 PRACTICE AND APPLIPJD THERAPEUTICS OF OSTEOPATHY. 95 
 
 Inhibition may be made at the nth and i2th dorsal region by sitting 
 the patient upon a stool, pressing the knee against the spine, first on one 
 side then upon the other, and grasping the arms of the patient, raising them 
 above his head, and bending the body backwards against the knee. This 
 not only inhibits these nerves, but stretches all the anterior spinal parts and 
 related tissues in the lower dorsal and upper lumbar regions. This result is 
 more important than the mere inhibition. The nth and 12th ribs are often 
 displaced downward, and may then drag portions of the diaphragm in such 
 a manner as to prevent free circulation of blood and lymph in the vessels 
 perforating it. This result alone might cause diarrhoea. 
 
 Muscular contractures along the spine should be removed. Deep but 
 careful manipulation should be made upon the abdomen over the intestines 
 for the purpose of relaxing all their tissues, freeing circulation and correct- 
 ing the activities of the Auerbach and Meissner's plexuses. One may treat 
 to tone the solar plexus, splanchnics, and general abdominal circulation. 
 The liver should be thoroughly treated, lesion to it be removed, and the 
 secretion of bile corrected. Its presence in abnormal quantities may cause 
 biarrhoea through increasing peristalsis. In other cases its presence in the 
 bowel does not hinder the cast,. And it is said to allay irritition of the 
 mucosa. Lesion of the 8th to 12th dorsal and ribs may derange either liver 
 or pancreas, In fatty diarrhoea the latter must be looked to. 
 
 For tormina or griping, inhibition of the splanchnics is done. For 
 tenesmus, or bearing down pains in the bowel, strong stimulation of the 
 sacral nerves is made by thorough manipulation of the tissues over the 
 sacrum. 
 
 It is said that in such cases the abdominal fascia is contracted and 
 causes congestion mechanically. (Chas. Still) When contracted it should be 
 relaxed by abdominal manipulation. 
 
 The vomiting and purging should not be checked if they are the evid- 
 ent means of getting rid of the irritating contents of the bowel. The or- 
 dinary case is seen after plenty of opportunity has been afforded nature to 
 remove the irritant by these means, and calls for immediate checking. 
 
 In acute enteritis the case must be seen several times daily. Gentle re- 
 laxing treatment should be made over the abdomen. The liver is to be 
 lightly treated; spinal muscles relaxed; the spine gently sprung to release 
 tension in its tissues. The lower ribs may be raised a little and the neck 
 treated for relief of the head. Careful attention must be given to the diet 
 of the patient It should be light and restricted, Meat broths, mucilaginous 
 drinks, etc., may be given according to prescribed dietaries. Warm baths 
 and rectual injections may be employed. 
 
 Cases of acute diarrhoea and enteritis should remain quietly in bed. 
 The various measures described may be employed as necessary. Spinal in- 
 hibition alone may be sufficient. When diarrhoea is s\'mptomatic of other 
 disease it may be relieved by these treatments. Its cure depends upon the 
 cure of the disease present.
 
 96 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 AN OSTEOPATHIC STUDY OF THE DIAPHRAGM, ITS RE- 
 LATION TO ABDOMINAL DISEASE 
 
 (Prepared for "The American Osteopath," Dec. '99.) 
 '•The diaphram. next to the heart," says McClellan, "is the most extra- 
 ordinary muscular arrangement in the body." Standing as a partition wall, 
 or barrier between the thoracic and abdominal cavities of the body; being 
 practically an involuntary muscle, and, like the heart, in constant motion 
 throughout life ; assisting in many important functions of life, such as 
 breathing, laughing, coughing, sneezing, vomiting, defecation and parturi- 
 tion, yet at the same time being a subsidiary, and not always an indispensi- 
 ble agent m the performance of these functions, it takes its place at once as 
 somewhat of a physiological anomaly among the organs of the body. 
 ^Arising by fleshy digitations from th^ cnsiform cartilage, from the inner 
 surfaces of the lower six ribs on either side, from the ligamenta arcuata 
 externa et interna, and by its crura from the bodies of the upper four lum- 
 bar \ertebra ; sweeping upward as a broad arch to its insertion, by its inter- 
 I lacing fibres, its own club-shaped central tendon, it forms a musculo mem- 
 braneous sheet without counterpart in the body, and which further bears 
 out the claim of this remarkable structure to be an anomal\', anatomical as 
 well as phjsilogical. 
 
 To the Osteopath, since Dr. Still's declaration that downward luxa\ 
 
 Itions or dislocations of any of the lower ribs might cause such an altera-1 
 tion in the arch of the diaphragm as to allow of a binding of its substance 
 upon the aorta at its passage between the crura, thus obstructing the blood 
 current and leading to irregular heart-action, the diaphragm has become an 
 important object. Astudyof the diaphragm, therefore, in the light of 
 Osteopathic experience with the musculature of the body, and its innerva- 
 tion and blood-supply, and an application of well-known Osteopathic prin- 
 ciples to the subject, would seem tp be in place. 
 
 In other parts of the body the Osteopath makes much of muscular 
 contractures or ajftony, of their interference with blood vessels and nerves, 
 of mechanical derangements or dislocations of organs and tissues. May 
 he not, then, apply such reasoning to the diaphragm, which occupies an im- 
 portant position, aids in carr\ ing on important functions, and is related me- 
 chanically to organs, vessels, and nerves whose functions are concerned 
 with the most vital operations of the body? The importance of this sub- 
 ject becomes at once apparent when it is recalled that upon one hand the 
 diaphragm is contiguous to the heart and lungs, that upon the other it is 
 related to the liver, stomach, pancreas, kidneys, spleen and intestines, 
 while it transmits to and from the abdomen, such important structures as 
 the aorta, inferior \ena cava, oesophagus, thoracic duct, vena az)gos major, 
 \ena azygos minor, pneumogastric nerves, phrenic nerves, splanchnic nerves,
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 97 
 
 and small blood and lymphatic vessels. To all of these structures it bears,, 
 direct!)' or indirectly, a mechanical relation. 
 
 Byron Robinson is authority for the statement that "traumatic muscu- 
 lar action of the psoas magnus on the sigmoid, and traumatic muscular ac- 
 tion lower right limb of the diaphragm on the descending colon, which 
 muscular action induces emigration of pathogenic microbes to the serosa" 
 may cause peritonitis. Gowe rs is authority for the statement that violent 
 contractions of muscles may have a traumatic action upon nerves passing 
 through ^heir s ubstance or beneath or around them. If these things be 
 true, it is reasonable to suppose that the diaphragm might, when abnormal 
 in action, unfavorably affect the structures to which it is so closely related. 
 If it be possible for the psoas magnus and the right crus to so act as to irri- 
 tare or wound a contiguous structure so freel\' mobile and so well lubrica- 
 ted as is the sigmoid or the descending colon, it would also seem possible 
 that conditions could arise under which the diaphragm would wound or 
 irritate the thoracic duct, one of the azygos veins, the oesophagus, or the 
 aorta, all of which are more closel)' related to the diaphragm than is the 
 sigmoid to the psoas magnus, or the descending colon to the crus, as they 
 are less mobile and lack lubrication. If, as Gowers says, it be possible for 
 violent muscular action to wound nerves impinged upon b}' muscles, it 
 would also seem possible that the diaphram, when in violent action, as in 
 hiccough, might irritate the pneumogastrics phrenics, or the splanchnics. 
 It is a well-known fact one of much significance to the Osteopath, that 
 the voluntary muscles of the body are capable of entering into a state of 
 continued contraction tech'o^call)' known as tetanus, and that, as Kirke 
 states, while this term is not applied to involuntary muscles, they likewise 
 are often thrown into a condition pi unduly protracted contraction, known 
 as tonus. The causes of such conditions are \'arious, the different authori- 
 ties pointing out that the)' may arise as the results of, (a) constant irrita- 
 tion, affecting either nerve or center, (b) traumatism, the result of direct 
 force upon the muscle, as a blow, strain, etc., (c) disease of the muscle, (d) 
 loss of antagonism, or excess use. The Osteopath la)'s great stress upon 
 the potency of such conditions to act as mechanical interferences and to 
 cause disease of various kinds. Such reasoning applies as well to the dia-^ 
 phragm as to an)- other muscle. The motor nerves of the diaphragm are 
 
 fthe phrenics and, according to McClellan, branches from the lower five or 
 six intercostal nerves, which are reinforced by S) mpathetic fibres from the 
 neighboring supra-renal plexuses. The phrenics or intercostals, as our~ 
 daily experience shows, may be irritated by spinal lesion at their origins, 
 such lesion acting upon the nerve either directly or indirectly, through its 
 connected nerves, its blood-supply, or its center. The intercostals may alsa 
 
 ^e irritated by crowding together of the ribs, and just as such irritatibn 
 may cause intercostal neuralgia, when affecting the sensor)' function of the
 
 98 PRACTICE AND AF'PLIED THERAPEUTICS OF OSTEOPATHY. 
 
 nerve; it may produce contracture of the diaphragm and other musclca 
 when affecting the motor function. 
 
 Such a condition might be set up in the diaphragm, as in other muscles, 
 by traumatism, or the result of force directed upon the diaphragm. As a 
 blow or strain ma)- contracture spinal muscles, so the direct traumatic effect 
 of an enlarged liver or spleen, or of a distended stomach, or of an accumula- 
 tion of pus or other fluid in the pleural cavit)' may so irritate the muscle 
 direct]) as to result in tonus. 
 
 Loss of antagonism, too, would seem as potent in this situation as in 
 any other, to cause contracture of the muscle. Just as a dislocated hip is 
 
 "Hield out of place through contracture of muscles, the normal antagonism 
 to which has been destrosed by the displacement, so may tonus or contrac- 
 ture of the diaphragm follow loss of antagonism. Those muscles which 
 
 'raise and spread the ribs in inspiration, and maintain the full form of the! 
 
 ' thora.x, particularly the levatores costarum and the intercostales, are thej 
 natural antagonists of the diaphragm. We are all familiar with the antero- 
 posterior flattening of the chest in the paralytic or the neurasthenic, with 
 the lateral flattening of the thorax in rachitis, and with the multitudes of 
 cases in which all the ribs, or many of them, are dropped down and drawn 
 close together. When for an\- reason this change in the position of the 
 ribs and in the diameters of the thorax has taken place, then the agents 
 which have held the ribs apart and raised them, thus keeping well separat- 
 ed the points of attachment of the diapragm, have ceased, in greater or less 
 measure, to operate, perfect antagonism to the action of the diaphragm no 
 longer exists, and, following the rule that a muscle whose points of attach- 
 ment have been approximated contracts to accommodate itself to the 
 changed conditions, the diaphragm, it would seem, contracts to adjust itself 
 to the limits set for it by the narrowed thorax, and is thus allowed to as- 
 sume an unnatural condition of tonus which bodes ill to the free play of 
 the many important structures passing through it. 
 
 If it be reasoned that the nature and function of the diadjragm would 
 not admit of the existence of such a condition of its muscular substance, it 
 being an involuntar}- muscle performing rhythmic motion continually which 
 is well nigh indispensable as an aid to vital functions, and that these func- 
 tions seem to be carried on without apparent embarrassment even when all 
 the untoward conditions pointed out abo\e seem to exist, let it be remem- 
 bered that in other parts of the body we ha\e important involuntary mus- 
 cular organs, also in rhythmic action almost continually, and more indis- 
 pensible than is the diaphragm to certain vital operations, which are well 
 known to become the seat of tonus or contracture, even while still perform- 
 ing their functions. I refer to the intestines. Ever)- Osteopath's experi- 
 ence with abdominal work will teach him that at times there are in the in- 
 testines more or less extensive areas of tonus, in which the walls of the 
 bowel become so drawn as to be clearl)- perceptible to the touch. Such a
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATH\^ 99 
 
 spasmodic action of the muscles takes place in an acute form in colic. The 
 functions of the intestines may still be carried on under such conditions, 
 though it be with pain and dif^culty. 
 
 [ In gross displacement of the ribs, as best seen in the enormous change^, 
 ;in position that may affect the eleventh and twelfth rib>, it is likely that \ 
 there is a dragging upon special fibres or portions of the diapragm. The | 
 .central tendou is held in place by the attachment to the pericardium, and ' 
 jby the lateral bands extended downward from the deep cervical fascia. If, 
 nows one or several lower ribs be displaced dowoward, the portions of the 
 (diaphragm attached thereto would be carried downward, causing traction 
 upon them, and perhaps drawing them across an important structure, it 
 jmight be the aorta, impeding its blood current, or the splanchnics, interfer- 
 Cing with their function. 
 
 If these views are correct, it is apparent at a glance what harm might 
 be caused b)- such interference with the structures passing through the dia- 
 phragm. In such case it seems that the inferior vena cava and the struc- 
 tures passing through the oesphageal opening would suffer least through 
 impingement, since the former passes through a fibrous portion, which is 
 naturally less yielding, and the shape of the aperture is maintained by at- 
 tachment of the wall of the inferior vena cava to the central tendon, while 
 the oesophagus and^pneumogastric nerves, though surrounded b\' the upper 
 part of the eight-sj^aped arrangment of the muscular crura, are protected 
 by the yielding character of the oesophagus, which, when not occupied by 
 the passage of food or drink, is merely a potential cavity, its walls lying in 
 apposition. 
 
 The aorta, however, surrounded by the crura 'of the diaphragm upon 
 both sides and anteriorly, and by the bony spinal column behind, would, to- 
 gether with the vena azygos major and the thoracic duct, be subject to serious 
 pressure from contracture. This is on account of the muscular nature of 
 the crura, the unyielding spine behind the aorta, and the fact that the aorta, 
 to fulfil its function, must have walls resistent enough to maintain its form. 
 Moreo\er, the walls of the aorta are supplied b}' delicate sympathetic 
 nerve fibres which are very susceptible to irritation. The sympathetic and 
 splanchnic nerves, and the vena az)'gos minor, transmitted by the crura, 
 and the phrenic nerves, which perforate the substance of the diaphragm, 
 would all likewise suffer from pressure and irritation through contracture 
 or dragging of its fibres. 
 
 In the consideration of the pathology of the diaphragm there is another 
 matter which invites our attention, namel}': atony of its muscular fibers. If 
 the diaphragm is like other muscular organs there can be no doubt that 
 such a condition might occur. We are acquainted with the condition known 
 as aton)' of the bowel, or of the stomach, and with the serious consequences 
 of such a pathological change. i 
 
 It is a well-known fact that section of a motor nerve is followed by loss
 
 100 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 of nutrition in the muscles supplied b)' such nerve. We are also familiar 
 with the fact that pressure upon a motor nerve leads to wasting of the mus- 
 cles supplied by that nerve. Hilton reports a case in which pressure upon 
 the circumflex nerve by the head of a dislocated humerus caused atrophy 
 of the deltoid muscle. Gowers says that a muscle remains small after lesion 
 of its nerve. Such occurences are common enough in our practice. Now 
 it is a reasonable supposition that the lower six ribs might be so crowded 
 together as to impinge the intercostal nerves supplying the diaphragm, that 
 pressure upon these ner\es would be followed b)- wasting of the muscles 
 supplied b)' them, and that lack of tone in the diaphragm would follow. It 
 is also quite possible that derangement of cervical vertebrae would so inter- 
 fere with the third, fourth and fifth cer\ ical nerves, from which the phrenic 
 ner\'es arise, as to contribute to, or produce, the same result. Add to these 
 facts the possibilities of various interferences with the lower intercostal, in- 
 ternal mammary, and phrenic arteries, which suopl)' blood to the diaphragm, 
 and there would seem to be sufficient grounds for supposing that this mus- 
 cle can not be immune to the \arious causes that would lead to atony of its 
 muscular fibres. 
 
 Here is fruitful soil for evil. \'er}- possibl\' hese is the origin of erT^ 
 teroptosis, the evil consequences of which have been so well portrajed by 
 Byron Robinson. Enteroptosis is a neurotic disease; the neurasthenic is 
 flat-chested; the lowered ribs in the flat-chested allow of an atonic 
 diaphragm. To the under surface of the diaphragm, by the various- omenta, 
 are attached the liver, the stomach, the spleen, and the splenic flexure of/ 
 the colon. Following atony of the diaphragm, these organs sink downward 
 in the abdomen. They crowd the other organs, weight them, and cause 
 them to gravitate downward. The colon kinks at its splenic and hepatic! 
 flexures, and the passage of its contents is impeded. The dragging of the 
 various organs upon their omenta and ligaments causes them to elongate, 
 and thus stretches the blood-vessels and nerves conveyed in them to thq 
 abdominal viscera, in short, the whole blood and nerve mechanism of the 
 abdomen is deranged, and discord reigns in the family of abdominal organs^y 
 
 Another ill result would arise from an atonic diaphragm. The ordinary 
 quiet, abdominal breathing that carries on respiration generally, would suf- 
 fer from lazy action of a weakened diaphram, leading to poor ox)genation 
 of the blood and an accumulation of waste material in the system. The 
 aspiration of the venous blood through the li\er and other abdominal or- 
 gans, which is effected by free diaphragmatic action would be weakened or 
 lost, leading to sluggishness of these currents, and to abdominal conges- 
 tion. 
 
 It would be well for the Osteopath, in all cases in which there is altered 
 chest form, luxated lower ribs, irregular heart action, general nervousness, 
 digestive disturbance, biliousness, constipation, and other abdominal troub- 
 les, etc., to consider well whether or not the diaphragm might be in such a 
 condition as to cause or aggravate the symptoms.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. lOl 
 
 The method of treating the diaphragm in such contingencies is simple 
 enough, since it depends upon the application of the same principles as are 
 used in our work upon any muscle or organ similarly affected; to stmiulate 
 or inhibit, or to remove the special lesion which is causing the mischief. 
 There are, generally speaking, two methods of relaxing or stimulating mus- 
 cles; (a) through affecting their nerve connections, (b) through affecting 
 the muscle directly. Either or both of these ways may be brought into 
 play by removal of lesion. An example of the former, in relation to the 
 diaphragm is seen in pressure made in the neck upon the phrenic nerve, re- 
 leasing the spasm of hiccough. An example of the latter is seen in a meth- 
 od employed by one of my friends; in a case of hiccougs, after trying the 
 usual method of stopping the spasm, he inserted the fingers beneath the 
 lower ribs on either side, and by spreading them away from the median 
 plane of the body, brought traction directly upon the diaphragm by sepa- 
 rating its points of attachment, thus relaxing it and stopping the spasm. 
 Ihe same principle is involved in Dana's method of stopping hiccough. He 
 lays the patient upon a table with the upper half of the body hanging over 
 the edge. This arches the thorax, spreads the ribs and brings tension upon 
 the diaphragm, inhibiting the spasm. 
 
 But, aside from hiccough, there are important considerations for the 
 Osteopath in treatment of the diaphragm in conditions of contracture or 
 atony as pointed out in this paper. This whole question was suggested to 
 my mind by the remark of a friend that my lower costal treatment first 
 stimulated the diaphragm, leading to clonicity, which was soon followed by 
 fatigue of its muscular fibres, allowing of a complete relaxation and a con- 
 sequent freedom of all structures passing through it. Of the correctness of 
 this view there seems to be no doubt. Naturally, we propose to repair 
 atony, contracture, or distortion of the diaphragm by removal of the lesion 
 causing it. By correcting cervical or spinal lesion, by shaping a narrowed 
 thorax, by raising and replacing dislocated or luxated ribs, and by separat- 
 ing rips when crowded together, we are to remove the active and original 
 cause of such conditions. But, aside from these considerations, in cases in 
 which it is desirable to affect the diaphragm either as adjurant to the re- 
 moval of lesion or independently of it, in such cases as seem to need extra 
 stimulation or relaxation of the diaphragm, there are important considera- 
 tions for its treatment. There is no doubt that much abdominal and lower 
 costal treatment goes much further that the operator supposes in effecting 
 the body. The proposition may be stated as follows: Lower costal and 
 abdominal treatment profoundly affects the diaphragm, (a) It stimulates 
 and strengthens it when lacking energy, adding to it that force and tension 
 so necessary to a perfect performance of its function. At the same time 
 pneumogastrics and sympathetics, thoracic duct, and blood vessels are 
 stimulated in their action, (b) It sets up clonicity of its muscular fibres, 
 this leads to fatigue and relaxation of its fibres, relaxes the contractured con-
 
 102 PKACTICK AND APPLIED THKRAPEUTICS OF OSTEOPATHY. 
 
 tlition of the whole organ and allows of perfect freedom in the action of all 
 structures passing through it. Which one of these affects follows depends 
 upon the condition of the diaphragm to begin with, and upon the method 
 of treatment adopted by the operator. 
 
 If these views are correct, it does not need much penetration to see 
 that such treatment must necessarily have a marked effect upon the health 
 
 of the whole bod\'. 
 
 To the examination of this proposition let us again appl\- well known 
 principles used by us upon other parts of the body. Atony: In an atonic 
 or lifeless condition of the bowels, allowing of sluggish performance, or 
 non-performance, of duty, resulting in lessened, or lost, peristalsis, leading 
 to constipation, etc., the most important part of our work (aside from re- 
 moval of lesion, which is also left aside for the present, in the consideration 
 of the diaphragm), is direct manipulations upon the intestines, stimulating 
 their substance, and the blood vessels and ner\es contained in their walls 
 and about them. Increased vigor, peristalsis, follows. Contracture: In 
 tormina and in all kinds of contracturing or drawing of the intestinal walls, 
 our mo.-^t important effects in relaxing the muscular walls are attained by 
 direct inhibiting treatment upon the intestines (removal of lesion aside). 
 The same principles apply to diaphragmatic treatment. With us it is an 
 aphorism that muscles and nerves may be stimulated mechanically. Wit- 
 ness the production of the patellar reflex, or our abdominal treatment to in- 
 crease peristalsis. This point must be supported by quotations at length 
 from authorities, but I take it to be unnecessary to prove this point again to 
 Osteopaths. Suffice it to quote from Howell's Text Book, "'A sudden blow, 
 pinch, twitch, or cut excites a nerve or muscle." Neuro-muscular contrac- 
 tion follows excitation of motor nerves. Idlo-muscular contraction follows 
 excitation of a muscle directly. Moreover, Gowers states that slow tonic 
 contractions of a muscle occur when its points of attachment are suddenly 
 approximated. 
 
 Now all of these conditions can be easily applied in treatment of the 
 diaphragm. Both idio-muscular and neuro-muscular contractions may be set 
 up in it. It ma\- be directh' stimulated mechanically by quick abdominal 
 manipulations which thrust the liver, stomach, spleen and intestines up against 
 itscuraand vault. It may be stimulated through its intercostal nerves by the 
 excitation given them in the lower costal treatment, which squeezes the ribs 
 too-cther and separates them, this motion as well slimulatmg these nerves 
 through their spinal connections through the spring given to the ribs at 
 their spinal ends by such manipulations. In addition to this, the costal and 
 abdominal treatments, by approximating the ribs, narrowing the lower 
 thorax, and raising the abdominal viscera, result in suddenly approximat- 
 ing all the points of attachment of the diaphragm, which must, in accord- 
 ance v.ith the law enunciated by Gowers. enter into slow tonic contractions. 
 
 Add to this, now, the fact that by removal of lesion the injured nerves
 
 PRACTICE AKD APPLIED THERAPEUTICS OF OSTEOPATHY. 103 
 
 may be restored, resulting in the muscle regaining its nutrition. Consider- 
 ing the above points, we have all that is necessary to affect the repair of 
 the diaphragm in aton\', or its stimulation in all cases where desirable. 
 
 We must now consider the removal of contracture in diaphragmatic 
 treatment. As we remove abnormal tonicity in the intestinal walls by deep 
 pressure and inhibition, directly applied, so we may remove it in the dia- 
 phragm by direct inhibition of its substance. This may be accomplished 
 in several ways. It has already been pointed out that spreading of the 
 ribs from the median plane of the body brings inhibition upon the fibers of 
 the diaphragm. Here, also, deep pressure and inhibition may be di- 
 rectly applied by firm pressure of the abdominal contents upward against 
 the diaphragm. 
 
 The law of muscular action and fatigue affords us another means of ef- 
 fecting this result. If we consider the nature of muscular action, we learn 
 from Howell's Text Book that all normal physiological contractions of 
 muscles are regarded as tetani. This means that the contraction of a mus- 
 cle as a whole is not due to a single contraction of its substance, but to 
 many succeeding contractions of its elements. Repeated excitations lead 
 to a gradually increasing state of contraction, the "stair-case contractions" 
 as shown by Bowditch upon the ventricle of frog's heart. Howell's Text 
 Book shows that stimulations of a muscle once in about e\ erv two seconds 
 leads to an incomplete tetanus of the muscle, while eight to thirteen exci- 
 tations per second can cause voluntary tetani. But it also shows that, 
 "rapidly repeated stimuli, though at first fa\-orable to activity of a muscle, 
 soon exert an unfavorable influence by causing the lessened irritability 
 whi5(h is associated with fatigue." "Mechanical applications to nerxe and 
 muscle first increase and later lessen and destroy the irritability. Thus 
 pressure, gradually applied, first increases and later reduces the power to 
 respond to stimulants." Hence it seems that the Osteopath would be able 
 to apply to the diaphragm mechanical stimulation frequently enough and 
 continuously enough to first excite and contract it, and later fatigue it, lead- 
 ing to its relaxation and the consequent freedom of all structures penetrat- 
 ing it. 
 
 Careful attention to the condition of the diaphragm, both in diagnosis 
 and in treatment, would well repa\' the Osteopath. 
 
 /
 
 
 
 |/H:fc. S-^r^jOr A-W ....M-wU^ . ^^^^ ^A^or^..-^-^.^ ^ 
 
 
 ^^^^^^" 'S^SrtSr^^
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 10$ 
 
 APPENDICITIS, 
 
 Definition. — An inflammation of the vermiform appendix, acute or 
 chronic, caused by traumatisin, or by specific rib or spinal lesions, These 
 lesions obstruct bowel action, limit its motion, deplete its nerve and blood- 
 supply, leaving a weakened condition, allowing of aggregation of fecal 
 matter, foreign bodies, etc. The vigor to pass these onward is lacking, and 
 they are pressed into the appenpix, which itself is suffering from a weaken- 
 ed state due to these causes. Or direct irritation of lesion may affect nerve 
 and blood mechanism, derange vaso-motion, and set up the inflammation. 
 Or the direct mechanical irritation of a displaced lower rib may set up the 
 inflammation. 
 
 Cases:-— (i) Three attacks had occured, another one was threatening. 
 Operation had been advised, but osteopathic treatment relieved at once and 
 cured the condition in two weeks. (2) In a case in which operation had 
 been advised, one month's treatment cured the condition and chronic con- 
 stipation as well. (3) Case showed a histor}' of constipation; cured by the 
 treatment. (4) Lesions; 2 I lumbar lateral, with heat and pain about it; 
 nth right rib luxated. Treatment relieved at once, and the patient was 
 cured in two weeks. Surgeon had been ready to operate. (5) 12th right 
 rib down and inside of the crest of the ilium. Setting the rib cured the case 
 in a few days (6) Recurring appendicitis; spine posterior in lower dorsal 
 and upper lumbar; lateral curve at 6th to 9th dorsal; constipation chronic; 
 cured by ten weeks' treatment. (7) Tenderness upon right side of spine 
 from 6th dorsal to 2d lumber, especially at the 6th to loth dorsal and ist 
 and 2d lumbar. (8) Acute attack cured by the treatment, (9) Lesion at 
 lower dorsal and upper lumbar; loth and nth ribs overlapping 12th, due to 
 a fall. Operation had been atlvist d, but two months' treatment cured the 
 case. 
 
 Lesions a)id causes: — (i)There is usually a histor\- of constipation in these 
 cases. In some it follows diarrhoea. There can be no doubt that the lesions 
 causing these diseases, q. v., are the real causes of appendicitis in many cases. 
 Many apparently robust men suffer from this disease, but experience shows 
 that many such have unhealthy bowels to begin with. Many show the 
 specific spinal lesion. The ordinary case caused by a foreign body, seeds, 
 shot, enteroliths, etc., would probaby not become victims of appendicitis 
 but for weakened bowel condition due to such lesions as cause constipation. 
 The fact that very often the body is a fecal concretion supports this view. 
 The inflammation is a vaso-motor disturbance. Such disturbances, due to 
 lesion, have been seen to be the causes of constipation, etc. The appendix 
 must suffer with the rest of the bowel from these causes, and thus being 
 weakened cannot further resist special causes of vaso-motor disturbance. 
 
 (2) Displacement, or dragging of the colon at the hepatic flexure pre-
 
 106 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 vents the passage of fecal matter and forces the introduction of fecal masses 
 into the appendix. 
 
 (3) The most important bony lesions seem to be displacements of the 
 lower two ribs on the right side. They may add mechanical obstruction or 
 irritation to deranged nerve connections at the spine. 
 
 (4) Lesions of the dorsal and lumbar regions are very important on ac- 
 count of the nerve connections with the bowel. From the 9th, loth, nth 
 and 1 2th dorsal region sensory nerves pass through the sympathetics to 
 supply the intestines down to the upper part of the rectum. For this rea- 
 son strong inhibition to this portion of the spine is useful in controlling the 
 pain in appendicitis. The s)mpathetic vaso-constrictor fibres for the ab- 
 dominal vessels pass from the lower dorsal and upper two lumbar nerves, 
 whiel branches from the lumbar ganglia pass to the plexus upon the aorta 
 and to the hypogastric plexus. Thus lower dorsal and lumbar lesion has 
 an important effect in disturbing the vaso-motor innervation necessary to 
 the production of this inflammation. 
 
 The anatomical relations given for lesion in diarrhoea apply to those 
 in appendicits. 
 
 The appendix has the same structure as the caecum, practically; is nour- 
 ished b)' a branch of the ileo-colic arter)', possesses innervation (Auerbach 
 and Meissner's plexus?) causing in it peristalsis and secretion of abundant 
 tough mucous from its numerous mucous glands. In health the free secre- 
 tion of this mucous fills the caviy of the structure to the exclusion of foreign 
 bodies, but upon lesion to the blood or nerve supply such as mentioned 
 above, lessened secretian allows of room for the entrance of foreign bodies. 
 Anemia may become a cause of the inflammation in it. 
 
 The Prognosis is favorable for recovery in nearly all cases. The ex- 
 perience with cases, even the most dangerous acute ones, has been very sat- 
 isfactory. Man\- such are upon record, restored to health after operation 
 had been advised as the last resort. If seen in time, very few cases need 
 ever come to the knife. The point of surgical interference may, however, 
 be reached. Osteopathic treatment prevents the case falling into the chronic 
 forms so commonl)- met, and in which operation, to prevent an acute at- 
 tack, is £0 often resorted to. The acute case is usually aborted by prompt 
 treatment. 
 
 Treatment: — The first consideration is the removal of the lesion if pos- 
 ible in the patient's condition. This applies particularly to displacements 
 of the nth and 12th ribs. Here gentle manipulation and slight elevation 
 may be sufficient to remove the irritation. Immediate attention should also 
 be given to the relief of the constipation commonly present. If not soon 
 affected by the treatment, rectal injection should be employed. This 
 measure materially aids conditions b)' removing the pressure of bowel con- 
 tents from tender points, b}' giving freedom of circulation in the bowel, and 
 by aiding to remove foreign bodies.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHV. 10/ 
 
 An essential part of the treatment is local treatment of the tissues at or 
 above the site of the inflammation. By care, little difficulty will be experi- 
 enced in applying such treatment even in very painful cases. The relaxa- 
 tion of the tissues thus accomplished gives immediate relief to the patient. 
 Not only the abdominal walls, but the deep tissues and circulation about the 
 appendix are thus treated. The treatment must slow, deep, and inhibitive 
 and given with great care, In the intervals of treatment, it may be neces- 
 sary to apply the ice bag or hot fomentations at the seat of the inflamma- 
 tion. 
 
 It is not likel)' that in this contingency spinal work to increase perista- 
 lsis would be at all successful in removing the foreign body from the ap- 
 pendix. Local manipulation must be depended upon for this. The pain 
 is relieved by spinal inhibition from the gth to the 1 2th dorsal particularl)'. 
 Nausea, vomiting, fever, and hiccough, aside from being relieved by the 
 general trertment of the case, may be relieved by the usual methods before 
 described. 
 
 The patient should go to bed at once upon the attack threatening. A 
 restricted fluid diet, taken a little at a time, should be enforced. Attention 
 should be given the kidneys and general condition. The patient should be 
 seen several times daily until out of danger. Continued treatment should 
 be given for a while after recovery to prevent recurrence or relapse. 
 
 The chronic case, possessing various degrees of'chronic pain, tenderness 
 of tissues, and inflammation in the right iliac fossa is a familiar object. The 
 object of the work is to remove lesion, to restore perfect freedom of circula- 
 tion, and by local treatment of the tissues to remove tenseness and pain. 
 Thorough spinal and abdominal treatment, and attention to the general 
 condition of the bowel are necessary. The disapperance of tenderness in 
 the right iliac fossa does not remove the danger of acute attack, as extensive 
 morphological changes have usually taken place in the tissues of the ap- 
 pendix which call for a course of treatment to so restore circulation as to 
 enable it to repair them. 
 
 IN TESTINAL^OBSTRUCTION. 
 
 Definition: — The occlusion of the bowel ma\' be but partial, persist- 
 ing as a chronic condition. In acute cases it ma)' be wholly or partiall}' ob- 
 structed. 
 
 Cases: (i) Fecal impaction. Severe radiating abdominal pains, 
 griping, and some dj'sentery had been present for twenty-four hours. The 
 impaction was located at the hepatic^flexure. Treatment relieved the pain 
 at once, and the manipulation removed the obstruction. Complete recov- 
 ery followed. 
 
 (2) Volvulus was diagnosed, located near the ilio-caecal valve. The
 
 I08 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 surgeon was ready to operate. Persistent treatment straightened the bowel 
 and a movement of the bowels was had. The recovery was complete. 
 
 (3) Impaction of the ileo-caecal valve. The attack came on violently 
 at night. The family physician, after eighteen hours' work over the patient 
 advised operation. Osteopathic treatment reduced pain and inflammation 
 at once, and allowed a further examination. The impaction was located at 
 the ileo-caecal valve, and manipulation removed it within a short time. Tlie 
 patient was asleep in thirty minutes. 
 
 Lesions and Causes: Only in rare cases would it be likely that some 
 specific lesion would lead directly to this trouble, but in most of them it is 
 probable that lesions would be present accounting for the bad condition of 
 the bowel that resulted in some form of obstruction. In general one would 
 expect such lesions as have alread>- been described as interfering with the ab- 
 dominal organs. Intussusception is sometimes due to irregular, limited, 
 sudden, or severe peristalsis. In such cases special lesion to the splanch- 
 nics, or to the sympathetic connections of Auerbach's plexus.'might result 
 direcll)- in the abnormal paristalsis producing the invagination. In such 
 cases the outer la\er, or receiving portion of the bowel involved, draws up 
 by contraction of its longitudinal fibers. Such abnormal activity of these 
 fibers might also be due to some special lesion to motor inner\'ation. 
 
 In some cases McConnell suggests that special spinal lesion could 
 cause paresis or paralysis of a bowel segment. Such a condition could al- 
 low of a pouching of the affected portion, and of accumulation of feces or 
 foreign bodies. Specific lesion might also cause stricture by contraction of 
 a segment. 
 
 The fact that obstructions often follow constipation or diarrhoea shows 
 the importance of lesions producing a bad bowel condition. Volvulus is es- 
 pecially frequent at the sigmoid and at the caecum, enteroptosis being often 
 the cause, through allowing the parts to prolapse and turn. The frequency 
 of spinal lesions causing the weakened omental supports that allow of the 
 ptosis shows the importance of spinal lesion as a factor in causing obstruc- 
 tions. Spinal or rib lesion may be looked to as the original cause of a 
 large number of the various forms of obstruction. It may produce the 
 tumor whose pressure obstructs the bowel; the peritonitis, following which 
 adhesions cause strangulation; the ulceration in the bowel which gives place 
 to cicatrization and stricture; or the inactive condition of bowel motion and 
 secretion that allows of accumulation of old fecal matters, foreign bodies,. 
 etc. A healthy bowel, perfectly free from the effect of lesion of any kind, 
 coul.l only under rare conditions become the seat of one of the various 
 forms of obstruction. 
 
 The importance of lesion producing unhealthy abdominal or internal 
 conditions must be acknowledged in the etiology of most of these cases. 
 
 The anatomical relations of these \arious lesions have already been 
 pointed out in the consideration of various intestinal diseases.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. IGQ 
 
 The Prognosis must be guarded. Very many cases die, and surgical 
 measures have generall)- been considered necessary after the third day of 
 obstructfon. Yet osteopathic treatment has been successful in a number of 
 cases after the necessity for operation had been urged. Probably, as in the 
 case of appendicitis, many lives could be saved by osteopathic means be- 
 fore surger)' is resorted to. 
 
 In chronic cases the prognosis for recovery is very favorable. Most 
 cases could be prevented from coming to the point of absolute obstruction. 
 If they could be foreseen, most acute cases could no doubt be prevented by 
 osteopathic treatment. 
 
 Treatment: In such cases as seem to depend upon a special lesion it 
 should be removed. Generally the first consideration is the alleviation of 
 the patient's condition. Strong inhibition of the splanchnic area, especially 
 from the gth to I2th dorsal, and of the lumbar region, aids in lessening the 
 pain. This step ma)- be necessary before abdominal manipulation can be 
 borne. This solar plexus should now be inhibited. A slow, deep, but 
 gentle inhibitive treatment should next be given over the bowel to relax the 
 tissues, decrease the inflammation, and lessen the pain. This treatment 
 may be used also to quiet abnormal peristalsis if present. After this pre- 
 liminary treatment the practitioner may proceed b\' careful palpation to lo- 
 cate the seat of the obstruction if possible. This is often impossible, and 
 in such cases one must work over the bowel generally. In some cases the 
 obstruction is felt, or the seat of the pain is an indication of its position. 
 
 The main work must be done by abdominal manipulation. The parts 
 of the intestine must be so managed as to be raised, straightened, and 
 drawn away from each other. The caecum and sigmoid may be raised and 
 straightened, (Chap VIII, divs. II, III, IV.) Deep treatment may be made 
 in the right and left hypochondriac regions to free the hepatic and splenic 
 plexuses. In intussusception the parts should be raised and drawn from 
 each other toward the extremities of the c)'lindrical tumor, if it can be made 
 out. In volvulus, raising and straightening the involved portions is relied 
 upon. 
 
 The stricture and adhesions may be manipulated with the purpose of 
 softening, relaxing, and breaking them down. Foreign bodies and fecal 
 aggregations must be gradually loosened and worked along the bowel. 
 They are more readily handled than other forms. It may be necessary to 
 manipulate them after rectal injection, to aid in moving them. Copious 
 injections sometimes aid in overcoming intussusception, voK'ulus, etc. 
 During the abdominal treatment it is well for the patient to be placed in 
 various positions; upon the back, sides, upon the abomen, etc., to get the 
 aid of gravity in righting the parts. Some writers recommend thorough 
 shaking of the patient. He is held by four men by the arms and legs, first 
 with the abdomen upward, then downward, while the shaking is done. 
 
 There should be much persistence in the treatment. The practitioner
 
 no PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY 
 
 should remain continuously with the case, and treat it as much as practi- 
 cable, until relieved. In the intervals, hot applications over the seat of 
 the pain may made. 
 
 In chronic cases the treatment may be carried on as usual, upon the plan 
 given above for the treatment of acute cases. After removal of obstruction, 
 a thorough course of general treatment should be undertaken for the re- 
 moval of lesions that have originally impaired the bowel or have produced 
 abnormal abdominal conditions. 
 
 ENTEROPTOSIS. 
 
 Enteroptosis is a disease in which various of the abdominal and pelvic 
 viscera leave there natural positions, slipping downward into the abdominal 
 and pelvic cavities. It is a common and distressing complaint, frequently 
 overlooked or not recognized. It is sometimes regarded as a symptom 
 group, but ma\', from the osteopathic point of \ie\v, be regarded as an 
 idiopathic condition, due to specific lesion. 
 
 These cases are often treated for some one feature, as for nervous d)s- 
 pepsia, constipation, operation for floating kidne)', etc. It is a common 
 error to overlook the essential condition of the disease. The Osteopath 
 who gives close attention to a class of neurasthenic, flat-chested, consti- 
 pated patients, who complain of lack of bodily and mental vigor, many and 
 various indefinite nervous symptoms, abdominal pulsation, vaso-motor dis- 
 turbance, etc., will find most interesting material. The multitude of symp- 
 toms may vary greatl)' in different cases, but the presence of neurasthenic 
 conditions, altered thorax and spine, and unnatural abdominal condition, 
 either of walls, viscera, or both, will usually afford an unmistakable sign of 
 the disease. After a little experience with such cases one learns to recog- 
 nize them at a glance when presented for examination. Once seen these 
 cases can hardl)* be mistaken, and a few moments examination reveals a 
 story of disease beginning imperceptibh', the growing conviction through 
 many months or some years that something was the matter, the attempt to 
 seem well because no decided disease seemed present, or a long course of 
 treatment for various ills, none of which reached the true condition. This 
 most common disease is still but seldom clearly recognized or intelligently 
 handled. 
 
 Lesions and Causes: The common description of its aetiology is un- 
 satisfactorw Tight lacing, traumatism, muscular strain, and repeated peg- 
 nancies are mentioned. The condition of relaxed abdominal walls and 
 prominent viscera due to repeated pegnancies ma)- probably be rightly 
 regarded as a separate condition. It is due to a ph)siological act, and does 
 not present those specific lesions nor the resulting symptoms found in neu- 
 rasthenic enteroptosis. Tight lacing, traumatism, and muscular stran may
 
 PRACTICE AXD APPLIED THERAPEUTICS OF OSTEOPATHY. Ill 
 
 produce those lesions found to be the causes of such conditions. 
 
 These cases commonly present spinal, rib, diaphragmmatic and abdom- 
 inal lesions. Spinal lesions may be of any of the kinds found the spine 
 ordinarily, and may occur anywhere along the splanchnic or lumbar region. 
 Rib lesions may occur in any or all of the lower six ribs on either side. " 
 
 Mobility of the tenth rib is regarded by a German physician. Dr. B. 
 Stiller, (Phila. Med. Journal, Jan. 13. 1900,) as the pathognomonic cause of 
 enteroptosis.* Undoubtedly it could interfere with the sympathetic con- 
 nections of the abdominal viscera and become a factor in causing this con- 
 dition. But, from an osteopathic view-point, lesions of other ribs, and of 
 spinal vertebrae, etc., may be as potent in producing the "basal neuropathy" 
 concerned in this disease as its fundamental pathological condition. Further, 
 rib lesions may cause a condition of the diaphragm in which its normal 
 tone is lost, and prolapse in it causes ptosis in the abdominal organs which 
 it aids in supporting, (p. loo.) Spinal lesions may participate in causing 
 the atonic condition of the diaphragm. 
 
 Spinal and rib lesion, aside from derangement of the diaphragm, acts to 
 produce enteroptosis by interfering with the spinal sympathetic connections 
 of the viscera and of their omental supports. Impeded circulation and 
 nerve-supply, vaso-motor, motor, secretory, trophic and sensor\-, produces 
 at the same time derangement of function in the organs and weakness in 
 their mesenteric supports. These conditions work together to bring about 
 the disordered function and the displacement of these organs. The dis- 
 placement of itself furthers the present bad conditions by mechanically in- 
 terfering with the activities of organs, stretching nerve-fibres and blood-ves- 
 sels which are carried in the now elongated omenta, kinking the colon at 
 various points, etc. The viscera, having sunk down into the abdominal 
 cavity, cause prominence of the lower abdomen, leaving a hollow in the 
 ui)per abdomen, thus giving to it the peculiar boat-shaped appearance 
 described as "scaphoid abdomen." 
 
 Lower dorsal and lumbar lesion may interfere with the spinal innerva- 
 tion of the abdominal walls, cause them to loose their tone and to dilate. 
 Intra-abdominal pressure is thus lessened and the organs are allowed to 
 prolapse. 
 
 According to Byron Robinson, enteroptosis begins with a weakening 
 of the abdominal sympathetic, which looses its normal power over circula- 
 tion, secretion, assimilation and rhythm. That this weakness of the abdom- 
 inal sympathetic and its consequent loss of function originates in spinal 
 lesion to its origin in the splanchnic nerves has already been pointed out 
 and fully discussed in considering the diseases of the stomach and intes- 
 tines q. v. T\\^ anatomical relations oi such le>ions to parts affected was 
 pointed out. 
 
 The Prognosis in these cases is very favorable, but the progress of the 
 
 Boston Osteopath, Jan. 14, 19'J0.
 
 112 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 cure is likely to be slow, Generall\- improvement begins immediatel)' upon 
 treatment and maj' progress to a cure in a few months. Other cases yield 
 more slowly, though relief if soon given, and require an extended course of 
 treatment to effect a cure. 
 
 The Treatment must be both constitutional and local. The latter con- 
 sists in the removal of lesion and in abdominal treatment. Lesions any- 
 where to the splanchnic and lumbar regins, to the ribs, thorax and dia- 
 phragm, must be treated after their kind, according to directions given in 
 Part I. With spine, ribs, and diaphragm restored to normal conditions, the 
 underlying causes of the enteroptosis have been removed. Corrected nerve 
 and blood-suppl)- to the organs and their supports, aids in correcting their 
 function and strengthens the supporting tissues to hold them in place when 
 restored by abdominal manipulations. 
 
 Correction of spinal lesion also aids in restoring nutrition and tone to 
 the relaxed and atrophied abdominal walls. This process is furthered by a 
 thorough treatment upon the abdominal walls. This renders the use of the 
 favorite abdominal bandage unnecessary, and it is gradually laid aside. 
 Throughout the course of the case the restored abdominal walls act as the 
 mechanical bandage has done to hold the organs to their places as replaced 
 by the treatment. With corrected spine, free blood and nerve-suppl}' to 
 all the \isceral supports, and a strengthened abdominal wall, no difficulty 
 is found in getting the parts to gradually be retained in their normal posi- 
 tions. Thorough spinal stimulation over the splanchnic and lumbar areas 
 is kept up for the purpose of increasing the blood and nerve-suppl)' to the 
 parts in question. 
 
 Abdominal work, aside from treatment of the walls, is directed to rais- 
 ing and replacing the viscera. This is readily accomplished by various 
 treatments. (II, III. IV, Chap. VIII). This releases and renews circula- 
 tion and nerve-supply at the same time, removes pressure of organs upon 
 each other, gives freedom of motion, and aids in strengthening the omenta 
 to hold the parts in place. 
 
 The diaphragm has been restored to normal position and tone b\- cor- 
 rection of those lesions originally deranging it. 
 
 The constitutional treatment must be thorough and general to restore 
 the patient from the nervous, circulatory, nutritional, and other effects of 
 the disease. A most thorough general spinal treatment must be given. 
 Thorough stimulation or heart and lungs, treatment of the cervical sympa- 
 thetic, and attention to kidneys, liver and skin accomplishes the desired 
 object. The auto-intoxication usually present is overcome by this treat- 
 ment of the excretory organs. The constipation, dyspepsia, and other 
 functional disorder is corrected by the restoration of the organs concerned. 
 
 The patient should be much out of doors, free from worry, and care- 
 ful not to become fatigued. Deep breathing exercises are beneficial.
 
 ^ 
 
 PRACTICE AXD APPLIED THERAPEUTICS OF OSTEOPATHV". II3 
 
 NEUROSES OF THE INTESTINE. 
 
 The various lesions producing derangement of the intestinal innerva- 
 tion, sensory, circulatory, motor, secretory and trophic, have been describ- 
 ed. Their anatomical relations to intestinal diseases have been fully dis- 
 cussed. Various of these lesions may occur and produce intestinal derange- 
 ments by special interference with certain functional activities of the in- 
 testines, through acting as lesions to the particular portion of the innervation 
 having those functions in charge. Thus the lesion may so act upon the 
 sensory innervation as to cause sensory disease. Or the predominating 
 disorder ma}' affect particularly the secretory or the motor functions. Sen- 
 sory, secretor}', and motor neuroses of the intestine are common. The 
 lesions producing them are not different in nature from the ordinary lesions ' 
 found as the causes of gastro-intestinal disorders. For some reason, not 
 well understood, certain of these lesions may produce, in a given case, cer- 
 tain special kinds of disturbance of function. In the diseases described be- 
 low no special lesion has been as }'et described as the special cause of each 
 condition. One finds lesions already described producing them. As a rule, 
 howe\er, these special sensory, secretory, or motor neuroses are noted in 
 cases of bad intestinal health, and frequently seem to be specialized patho- 
 logical manifestations of this general bad condition. The sensory, secre- 
 tory, or motor disturbance has gained the upper hand. In some cases the 
 "■neuroses is itself the sole manifestation of the results of the lesion. 
 
 J 
 
 SECRETORY NEUROSES. 
 
 Membraneoics Enteritis, or Mucous Colitis, is often met, frequently occur- 
 ing in subjects of intestinal disease. The special lesions present and dis- 
 turbing bowel innervation act particularl\- upon the secretory fibres. The 
 result is over-action in the mucous secreting glands. The mucous mem- 
 brane is not pathologically altered, and catarrh if present at all, is a second- 
 ary effect. It is a purely nervous manifestation. Special lesion is com- 
 monly found to be the active cause of irritation to the centers or fibres con- 
 trolling this funcnion. Its results are apparent in the copious secretion of 
 intestinal mucous, which passes away from the patient in conglomerate 
 masses forming the whole or a separate part of the stool, in long ribbon- 
 like strips, or in a complete cast of the intestinal canal of some inches in 
 length. 
 
 It is not a serious condition, and removal of lesion, with thorough 
 spinal and abdominal treatment, will at once begin to correct the over-act- 
 ion of the glands. Its cure may depend upon the restoration of a general 
 healthy bowel condition. Relief is generally obtained at once from the 
 treatment, but considerable treatment may be necessa.iy to eradicate the 
 chronic condition. Tenesmus, when present, is relieved by strong sacral
 
 I 14 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 Stimulation, Colic is relieved b\' stion<T spinal inhibition and by local in- 
 hibitive treatment at the seat of the pain in the abdomen. 
 
 SENSORY NEUROSES. 
 
 These disturbances are due to irritation to the sensory nerves supplied 
 by the splanchnics to the intestines. 
 
 Enteralgia, Colic, ox Intestinal Neuralgia, is met with in neurotic and 
 anemic subjects, and attacks are induced by exposure, gout, and local irri- 
 tation to the sensory nerves of the intestine by inflamation, enteroliths, etc. 
 Excepting mechanical irritants, lead poisoning, and like agencies, the actu- 
 al cause that weakens the intestines and lays them liable to the action of 
 such exciting causes, is spinal lesion irritating or weaking the sensor)' cen- 
 ters or fibres. Many cases occur spontaneousl)- from spinal lesion. This 
 spinal lesion may act b\" causing increased activity in the muscularis, lead- 
 ing to the ring-like contractions of the intestine present in colic. In many 
 of these cases intestinal cramps cause localized contractions in portions of 
 the intestines, which may be readily seen or felt through the intestinal 
 walls. Here the most ef^cient treatment is b}- local manipulation over the 
 seat of the contraction. Deep inhibitive treatment here quiets the nerves 
 and releases the spasm. Such local work must be supplemented by cor- 
 rective work upon the spine, which prevents further attacks. Strong spinal 
 inhibition may be used to quiet the pain. Some one point is generally 
 found along the splanchnic area at which inhibition is effective. This is 
 often high up in the splanchnic region, but \'aries with the case, and is 
 found by trial. Special lesion is to be removed, and stoppage of the pain 
 may depend upon that. 
 
 Dimiyiished Sensibility of the intestines is a common neuroses. It may 
 be both sensor}- and motor, and leads to diminished peristalis, constipation 
 and accumulation of the feces in a portion of the intestine, often in the 
 rectum. It is likely to occur in diseases of the brain and cord in which the 
 centers are effected. Special spinal lesion is often the direct cause, or 
 causes the cord disease. Cure of this condition in such cases depends up- 
 on cure of the primary disease. In other cases, removal of lesion, and res- 
 toration of activity to the local nerve mechanism overcomes the paresis. 
 Spinal and abdominal treatment, directed especiall)' to the course of the in- 
 testine, to affect Auerbach's plexus, and to the solar plexus, will aid a cure. 
 Specific lesion may cause a paretic condition of a bowel segment and be re- 
 sponsible for the trouble. A general weak condition of the nervous sys- 
 tem, on account of which nervous shocks and other disturbances cause this 
 condition, must be remedied by upbuilding it. 
 
 MOTOR NEUROSES. 
 
 Ne}~'ous Diarrhoea is a condition in which increased contractility of 
 the muscularis of the bowel is aroused by purely nervous causes. It is an 
 overaction of the bowel, not presenting the usual aspects of diarrhoea. The
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 1 1 5 
 
 Stools are softer than normal, and frequent, occuring two, three, four, or 
 more times in twenty-four hours. The subject is as a rule a neurotic, be- 
 ing hysterical, neurasthenic, or of a very nervous temperament, but the 
 characteristic lesions found in diarrhoea, q. v., are present and so act upon 
 the nerve-mechanism of the bowel as to lessen its motor stability. Thus 
 its abnormal activity made possible by the lesion becomes the special mani- 
 festation of the nervous condition. There must be some sufficient reason 
 why the general nervous condition should be able to so center itself upon 
 the bowel. The presence of such lesions as anat^ically weaken the bowel 
 affords a reasonable explanation of this phenomenon. These lesions, usu- 
 ally of the lower dorsal and lumbar regions, probably affect, through its 
 connections with the nth and 12th dorsal and the 1st and 2nd lumbar 
 nerves, the inferior mesenteric ganglion ruling motor activity in the fecal 
 reservoir. 
 
 The treatment commonly enplo}'ed for diarrhoea is efficient in checking 
 this form. At the same time, thorough general spinal and neck treatment 
 must be gi\en to strengthen the nervous system. Spinal causes of the ner- 
 vous condition must be sought and overcome. The case yields rapidly to 
 treatment, but is ver)' prone to setbacks due to nervous disturbance. For 
 this reason the patient must be kept as free from exciting influences as 
 possible. The condition is apt to recur until the nervousness has been 
 lessened. Fortunately this latter condition yields readily to treatment. 
 
 Enteropasm is a neurosis of the intestine in which a spasmodic condi- 
 tion of portions of the intestinal walls occurs. It may result in temporary 
 obstruction, but its most usual manifestation is to cause the stools to be 
 passed in separate, rounded masses, or in ribbon-shape. The latter is most 
 frequent. While often a nervous phenomenon, special lesion is necessary 
 to account for this peculiar manifestation of nervousness. Special lesion 
 may affect the inferior mesenteric ganglion through its spinal connections^ 
 or the motor fibres of the circular muscles of the rectum, originating 
 from the lower dorsal and upper one or two lumbar nerves, and passing 
 thence through the inferior mesenteric ganglion to the rectum. 
 
 CHOLERA MORBUS. 
 
 Definition: Cholera morbus is an acute catarrhal inflammation of the 
 stomach and intestines, characterized by severe abdominal pain, colic, vom- 
 iting, purging, and muscular cramps. 
 
 Cases: (i) A young man in intense pain; had vomited blood several 
 times, and continuous severe vomiting and purging were present, had a 
 chill; severe griping in the epigastric and umbilical regions. Inhibition at 
 the 4th and 5th dorsal vertebrae, on the right, stopped the vomiting. Inhi- 
 tion of the splanchnics stopped the purging. Cracked ice was allowed the
 
 Il6 PRACTICE AND APPLIKD THERAPEUTICS OF OSTEOPATHY. 
 
 patient, and a hot enema was administered After the first treatment no 
 vomiting or purging occured, and rapid recovery followed. In his prexioiis 
 attacks he had usually remained in bed for three days, being incapacitated 
 for a week. Morphine was usually necessary to stop the pain. 
 
 (2) Severe nausea, vomiting and cramps disappeared at once under the 
 treatment. 
 
 Lesions: Such lesions as described for enteritis, q. v., are present in 
 these cases, weakening tiie bowel and rendering it susceptible to the agen- 
 cies usually described as the exciting causes. The irritation of bad food, 
 etc., may affect a healthy bowel in this manner, but there is often no such 
 factor in the case. Simple chilling of the bod)' may cause the attack, or 
 slight indiscretion in diet may bring it on. 
 
 The Prognosis is good. Treatment relieves the case at once, stopping 
 the pain, vomiting, cramps, etc. The patient rapidly recovers. 
 
 Treatment: Correction of lesion protects the patient against further 
 attacks. The severe abdominal pain and colic are removed by strong inhi- 
 bition of the spine, especially over the splanchnic area, and from the 9th to 
 the I2th dorsal. This quiets the sensory nerves of the viscera. Deep inhib- 
 itive treatment upon the abdomen, over the seat of the pain and about it, 
 aids in relieving it. The vomiting is checked as before described, (p. 84), 
 as is the diarrhoea. The cramps in the calves are relieved by strong in- 
 hibition over the sacrum and upon the popliteal nerve in the popliteal 
 space. The system should be strengthened against collapse b)' stimulation 
 of heart and lungs and by spinal and neck treatment for the general system. 
 
 HEMORRHOIDS. 
 
 Definition: Varicose enlargements of the inferior hemorrhoidal veins 
 or of the hemorrhoidal plexus. 
 
 Cases: (i) Protruding piles of fourteen years' standing cured in two 
 months. 
 
 (2) Hemorrhoids of four years' duration cured in four treatments. 
 
 (3) Protruding piles of many years' standing, accompanied by consti- 
 pation, cured in two months. 
 
 (4) Hemorrhoids and constipation. Lesion at 5th lumbar, coccyx badly 
 bent. (5) 7th to nth dorsal vertebrae posterior, coccyx anterior, innomi- 
 nate forward. Hemorrhoids were accompanied by indigestion and jaun- 
 dice. (6) Internal hemorrhoids and constipation, no natural bowel mo- 
 tion for several years; cured in one month. (7) Protruding piles of several 
 years' standing, constipation, prolapsed rectal walls. Lesion caused by 
 strain from heav}- lifting. A weakened lumbar region. Cured in one month. 
 
 (8) Constipation and piles of many )'ears' standing caused by a bent 
 coccyx. Four treatments gave great relief; case still under treatment.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. II7 
 
 Lesions AND Causes: The common bony lesion jjresent is a bent or 
 dislocated coccyx, which acts as a local irritant and mechanical impediment 
 of the venous return from the hemorrhoidal veins. Luxated coccyx, by lo- 
 cal irritation and interference with the fourth sacral nerve, may cause ob- 
 stinate contracture of the external sphincter, leading to constipation or 
 straining at stool. Possibly coccygeal and innominate or sacral lesion, by 
 direct interference or by dragging of tissues, derange the sacral nerves sup- 
 plying motor fibers to the longitudinal muscle fibers of the rectal walls, 
 weakening them. This result would probably be aided by the interference 
 of these same lesions with the sympathetic (sacral) nerve-suppl}' to the cir- 
 culation through branches contributed to the lower hypogastric and hem- 
 orrhoidal plexuses. That of the coccyx seems to be the most important 
 lesion in hemorrhoids. 
 
 Lumbar and lower dorsal lesion may be present and interfering with 
 the innervation of the abdominal walls, relaxing them, lessening intra-ab- 
 dominal pressure, and allowing of congestion of the abdominal circulation. 
 B)' direct effect or b)' causing constipation, this condition may cause hem- 
 orrhoids. Lower dorsal and upper lumbar lesion to the nerve fibers which 
 pass by way of the inferior mesenteric ganglion to suppl)' motor fibers to 
 the circular muscles of the rectal walls may become a factor b)' weakening 
 the wall, relaxing its tone, and -allowing of a congestion in its vessels. 
 Lesion to the splanchnic and lumbar areas, affecting the sympathetic sup- 
 ply which, through the splanchnics, solar plexus, and other sympathetic 
 vaso and viscero-motors originating along these areas, rules circulation and 
 muscular tonus in the abdominal and pelvic viscera, may contribute in an 
 important way to causation of hemorrhoids. Likewise those lesions to the 
 spine and lower ribs, well known as causes of liver-derangement, become 
 causes of hemorrhoids by producing obstructed portal circulation and con- 
 stipation. The chief drainage of the hemorrhoidal plexus of veins is 
 through the portal circulation by way of the superior hemorrhoidal vein. 
 Lesions causing disease of heart and lungs, q. v., may secondarily become 
 the causes of hemorrhoids through the impeded systemic circulation re- 
 sulting. Lesions causing atomic diaphragm (p. 100), and other causes of 
 enteroptosis, q. v., produce hemorrhoids b}- the mechanical obstruction of 
 circulation, and by deranged nerve suppl>', etc. 
 
 The a?iafojn/cal re/ah'o)is are pointed out above. The American Text 
 Book of Surgery calls attention to the fact that these veins are unsupplied 
 with valves and also that they tend to become congested by the natural up- 
 right position of the body. These facts aid in explaining the potency of 
 the above lesions, and of any obstructive condition (pregnancy, over-eating, 
 etc.) in causing this condition. 
 
 The EXAMINATION must be made by both inspection and palpation, the 
 use of a proper speculum aiding a thorough inspect'on of the rectum. 
 
 The Prognosis is very favorable. The usual medical treatment is pal-
 
 I iS PRACTICE AND APPLIED THERAPEUTICS OF OSTKOPATHV. 
 
 liativc, or surgery is resorted to. The latter may often become necessary, 
 but the success of osteopathic treatment prevents many operations. 
 
 Even the most severe cases have been successfully treated. The treat- 
 ment generally begins to succeed immediately. Long standing cases are 
 often cured in a few months. Some cases are slow and obstinate. 
 
 The Treatment is local, abdominal, spina! and constitutional. 
 
 Local treatment is first directed to correcting the coccyx if necessary. 
 (XX, Chap. II.) The external sphincter should be well dilated. This may 
 be accomplished by inserting two, or even three, fingers, well vaselined, and 
 held together at the tips in wedge-shape. After being well inserted, they 
 are spread apart and withdrawn carefully. The dilatation must be thorough. 
 The rectal speculum maybe used for this purpose. All the surrounding 
 tissues, both externally and internally, are to be thoroughly but gently re- 
 laxed. Internally this operation should be carried as far up along the rec- 
 tal walls as the index finger is able to work. Pressure is made upon the 
 injected veins to empty them of blood and to stimulate their local nerve 
 and muscle substance to proper tonus. In case of thrombi in strangulated 
 \-eins, the manipulation about and upon them must be gently applied with 
 the purpose of stimulating the circulation to a gradual absorption of them. 
 They must not be broken up or detached, as there is danger of their being 
 swept into the circulation as emboli. 
 
 After dilatation of the spliricter and relaxation of the tissues, protrud- 
 ing piles, first emptied if possible, must be gently pressetl back beyond the 
 sphincter. If the rectal walls are prolapsed, as is often the case in protrud- 
 ino' piles, they must be replaced by the index finger directed to straighten- 
 ing out and pushing them up on all sides. 
 
 This local work removes irritation of the cocc)x, frees the whole 
 local circulation, tones the local musculature and other tissues, and stimu- 
 lates the local sympathetics. It may be the sole and suf^cient treatment 
 in many bad cases. It should be given but once per week or ten da}s. 
 
 Abdcminal treatment is for the purpose of increasing freedom of circu- 
 lation and to aid in the venous return. The solar and h\-pogastric plexuses 
 are stimulated and manipulation is made over the course of the inferior 
 mesenteric and common and internal iliac arteries. Portal circulation is 
 helped by deep abdominal work from the lower abdominal region upward 
 to the liver. Lesions to the latter organ are removed, and thorough treat- 
 ment given to the liver as in the treatment for constipation, q. v., which must 
 be relieved, it being usually present. (V. Chap. VIII.) 
 
 The viscera are raised, and treatment is made deep in the iliac fossae to 
 stimulate the pelvic sympathetic pexuses and to aid venous return from the 
 hemorrhoidal, vescical, uterine, and other related flexuses of veins. (II, III, 
 I\\ Chap. VIII). If the patient is placed in the knee-chest position while 
 abdominal treatment is performed with the ideas explained above, the force 
 of CTravitatation is made to assist in venous drainage of the parts.
 
 PRACTICE AND APPUKD THERAPEUTICS OF OSTEOPATHY. II9 
 
 Enteroptosis and diaphragmmatic lesion are repaired as before ex- 
 plained. 
 
 Thorough spinal treatment is given from the sixth dorsal down, stimu- 
 lating splanchnics and other sympathetics, with all their contained vasoand 
 viscero-motor, circulatory, and trophic fibres. This treatment is to strengthen 
 circulation and to maintain its freedom. It is supplementary to the abdom- 
 inal work. It also aids in restoring tone to the vessel walls, as well as to 
 prolapsed rectal walls, and thus to maintain them in correct condition. 
 Anatomical relations between the spinal work and abdominal and pelvic 
 viscera have before been fully explained. 
 
 Correction of spinal, rib, or innominate lesion is made if necessary. In 
 this way, and by work along the lower dorsal and upper lumbar regions, 
 coupled with the local treatment upon the abdominal walls, the latter are 
 built up and restored to normal tonus if relaxed. 
 
 The r^^/5/'///^//(?;m/ treitment consists in the general spinal treatment 
 and in special treatment for heart and lung disease if present and causing 
 the hemorrhoids. 
 
 Light out-door exercise and absolute personal cleanliness should be en- 
 joined upon the patient. 
 
 INTESTINAL TUMORS. 
 
 Intestinal Tumors of various kinds, both benign and malignant have 
 been frequently treated osteopathically with sucsess. Medical treatment is 
 but palliative, and the onl)- means of remo\'al has been b\' surgical opera- 
 tion. The fact that in numerous instances these cancers and tumors have 
 been entirely removed by osteopathic treatment is '.n itself remarkable, and 
 helps to sustain the claim often made, that the use of the knife is often ob- 
 viated in the treatment of such conditions. 
 
 The Treatment is simple, and consists in the removal of spinal lesion 
 which may be of any of the kinds discribed as producing gastro-intestinal 
 disease. At bottom the real cause of these growths is some obstruction or 
 irritation to local blood and nerv^-supply. It has alread)' been shown how 
 special lesion causes this obstruction, or lays the foundation of the condi- 
 tion which directly or indirectly producss the irritation. The treatment is 
 therefore the removaj of lesion and the restoration of normal nerve and 
 blood supply. Spinal treatment, aided by abdominal work accomplishes 
 this object. The latter is done, not upon the tumor itself, but upon the 
 surrounding parts. It relaxes tensed tissues, opens arterial blood-suppl)- 
 and venous and lymphatic drainage, and restores normal condition. In 
 this way the progress of the morbid process is stopped, healthy tissue is 
 built, and the tumor disappears, probably by absorption. At least one case 
 is upon record in which the tumor, a fibroid, was loosened by the treatment 
 and passed per rectum. (Cosmopolitan Osteopath, Feby., igoo, p. 30.) 
 
 Attendant conditions, such as cotstipation, fecal impaction, colic, etc., 
 are treateed as described elsewhere.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 121 
 
 PERITONITIS. 
 
 Definition: An acute or chronic inflammation of the peritoneum, 
 localized or general. 
 
 Cases: (i) A case diagnosed as septic peritonitis, probably caused by- 
 appendicitis, under the care of celebrated Chicago physicians grew steadily 
 worse until death was expected in a few hours. No hopes of recovery were 
 entertained, and it was evident that the best medical treatment was of no 
 avail. As a last resort an Osteopath was finally called, all medical treat- 
 ment was discontinued, and the treatment began. Immediatel}', under the 
 treatment, the great pain that had been present for hours at a time, was 
 controlled, and during the next four weeks not two hours' pain in all was 
 experienced. The other symptoms were also controlled, and the outcome 
 was a cure. Spinal lesions were discovered upon examination, and led to 
 inqiury concerning accident,which brought out the fact that the bo\- had had a 
 serious fall a few weeks before. Ihese were held to be the primary cause 
 of the peritonitis, and treatment directed to them was the cardinal treat- 
 ment. The fact that the child's life was saved at such a juncture, in dis- 
 ease of such a nature, by the removal of spinal lesion, is a convincing dem- 
 onstration of the correctness of osteopathic theory and practice. 
 
 (2) A second case presenting the ordinary severe symptoms of the 
 disease, and in a state of collapse when seen by the Osteopath, was cured in 
 five days by the treatment. 
 
 The Lesions expected in such cases are to the lower ribs, the lower 
 dorsal and lumbar spine, and sometimes the pelvis. In such cases as are 
 secondary to other disease, such as inflammation in the various abdominal 
 organs, typhoid or diphtheritic ulcer, appendicitis, volvulus, etc., the active 
 lesion in the case must be sought for as the cause of the primary disease. 
 Such lesions may be various. 
 
 Anatomical Relations: The nerve-supply to the parietal peritoneum 
 is from the lower intercostal and upper lumbar nerves, which suppl}' also 
 the muscles of the abdominal walls. The abdominal sympathetics also 
 supply the peritoneum, being chiefly vaso-motors for the blood-\'essels in 
 the mesentery, but also having certain branches distributed directly to the 
 substance of the peritoneum. 
 
 The blood-supply is from the coeliac axis through the hepatic and 
 splenic arteries, and from the blood-supply of the parts with which the vari- 
 ous portions of the mesentery are in relation. 
 
 The fact that the chief sympathetic supply to the peritoneum is to the 
 blood-vessels in it is a significant one. 
 
 The inflammation of peritonitis is a vaso-motor disturbance. It has 
 been before explained how spinal lesion deranges spinal sympathetic con- 
 nections of the abdominal sympathetics and produces disease. Thus cer-
 
 122 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 tain lesions among the lower ribs, and along the lower spine, result in 
 derangement of the sympathetic, which, when affecting the peritoneum, 
 becomes a chiefly vaso-motor disturbance because of these peritoneal sym- 
 pathetics being mostly vaso-motors, and the inflammation results. 
 
 In another way, these lesions, affecting the lower intercostal and upper 
 lumbar spinal nerves, may become the active cause of peritonitis. Hilton 
 shows that these nerves, supplying the skin and muscles of the abdominal 
 walls, as well as the parietal peritoneum, probably also supply the visceral 
 peritoneum and send sensory branches through the sympathetic to the 
 intestinal walls. Quain's anatomy shows that from the 9th, loth, nth and 
 1 2th dorsal nerxes, sensory nerves pass through the sympathetic to the 
 abdominal viscera. It also shows that from the thoracic sympathetic and 
 from the lumbar s\mpathetic cord, vaso-motor fibres of the abdominal blood- 
 vessels take origin. The intimate relation between the spinal and sjmpa- 
 thetic nerves is well known. Hilton uses the facts he points out in regard 
 to this connected nerve mechanism to explain why the abdominal walls be- 
 come painful and contracted from the inward irritation of the inflammation. 
 The connection of this nerve mecharnsm for all these related parts also ex- 
 plains how lower rib, lower dorsal, and upper lumbar spinal lesions may so 
 interfere with the vaso-motor supply to the peritoneal vessels as to cause 
 peritonitis. This immense abdominal nerve supply, both superficial and 
 internal, spinal ind sympathetic, offers the Osteopath, both through its sur- 
 face distribution, its spinal connections, and its internal distribution, a vast 
 and most readily accessible field for his »work by superficial and deep 
 abdominal and spinal treatment. This fact well explains his good results, 
 even in desperate cases, in gaining control of the \aso-motor mechanism 
 which is deranged in this inflammation. 
 
 Through the connection of this local vaso-motor mechanism with the 
 vaso-motor system of the whole body, reflex irritation is set up which leads 
 to a general vaso-constriction of the \essels of the whole body surface. 
 Robison thus explains why the whole skin is waxy, pale and cold, saying 
 that thri patient, on this account, dies from circumference to center. 
 
 Robinson also shows that traumatic action of the left end of the dia- 
 phragmmatic muscle upon the gut wall, of the psoas niagnus upon the sig- 
 moid, and abrasion of the bowel mucosa at the splenic and sigmoid flex- 
 ures, very frequently become the causes of peritonitis by allowing the mi- 
 gration and foot-hold of pathogenic bacteria. Spinal, or other specific 
 osteopathic lesion, b)' causing bad bowel conditions which allow of the pos- 
 sibilit}- of such traumatism may be present, and must be removed in the 
 treatment for, or the prophylaxis of, this disease. 
 
 The Prognosis in these cases is fair. Considering that peritonitis pa- 
 tients usuall}' die under medical treatment, in the acute form of the disease, 
 and that operation must frequently be resorted to, the success Osteopathy 
 has had with serious cases is marked.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. I23 
 
 The Treatment must aim at gaining vaso-motor control and thus re- 
 ducing the inflammation. Lesion must be corrected as soon as possible. 
 The treatment must be both spinal and abdominal. The first step should 
 be thorough but careful relaxation of all spinal tissues. If the patient can- 
 not be turned upon his side, he may continue to lie upon his back, and the 
 operating hand may be slipped under him to work along the spine. Inhibi- 
 tion should be made along the splanchnic and upper lumbar regions, espec- 
 ially from the gth to 12th dorsal, to quiet the pain through inhibition of the 
 sensory fibres. After spinal relaxation and inhibition, the abdominal treat- 
 ment will be better borne. Through this spinal treatment effect upon vaso- 
 motor activities is gained by way of the sympathetic connections explained 
 above. This aids in freeing the circulation. During the progress of the 
 treatment of the case the inhibitive spinal treatment may be alternated with 
 a thorough stimulation of the sympathetic connections of the parts involved, 
 to check peristalsis. As soon as possible, thorough general spinal and neck 
 treatment should be given to equalize the general circulation, and to over- 
 come the intense vaso-constriction of all the superficial vessels, so notice- 
 able a feature of the case. Heart and lungs should be stimulated, and in- 
 hibition of the superior cervical region be made. 
 
 • After spinal inhibition very light abdominal treatment is given. The 
 walls are tense and painful, and much care is required in treating them. 
 The treatment should be gentle, relaxing, and inhibitive, thus relaxing the 
 contractured muscles, aiding general circulation, and decreasing pain. On 
 account of the relation between the nerves of the abdominal walls and those 
 of the inward parts involved, as pointed out above, work upon the abdomi- 
 nal walls has an important corrective effect upon the morbid conditions 
 present internally. The theory that work upon nerve terminals affects 
 parts supplied by connected nerves is well supported by fact. Thus restor- 
 ation of a relaxed and natural condition of the abdominal walls it an im- 
 portant aid in restoring natural conditions in the parts supplied by these 
 connected nerves. Gradually, deeper work may be done, affecting the 
 abdominal sympathetic locally, increasing circulation and stimulating 
 absorption of the inflammatory effusions and other products. Care must 
 be taken in the treatment o\'er the intestines, as their' walls are intensely 
 gorged with blood, and arc friable. 
 
 The obstinate constipation present is due to pressure from congestion 
 of the bowel walls, and by edema into them, checking peristalsis. As the 
 circulation is restored this condition is corrected, and bowel action can be 
 stimulated by the usual means. The liver, kidneys, and skin should lie 
 stimulated to aid in carrying off the effusions and the effete products of the 
 disease. The hiccough is relieved by inhibition of the phrenic nerve (VIII, 
 Chap. III). Treatment for the fever (p. 66), and for the vomiting and 
 tympanites (p. 84) is applied as before directed. The treatment prevents 
 the formation of adhesions, and takes down the thickening of the periton-
 
 124 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 eum. The patient should be kept quiet in bed, no food should be allowed 
 as long the vomiting occurs. Later a restricted liquid diet is used in small 
 amounts at a lime. Cracked ice may be used to allay the thirst. Rectal 
 injections may be necessary to relieve the constipation at first. 
 
 The treatment of the chronic case is directed to the gradual breaking 
 down of adhesions; the restoration of circulation to absorb pus or effusion^ 
 and to remove the chronic inflammation, and to the relaxation of the 
 abdominal tissues. Correction of the spinal lesion must not be neglected. 
 
 Cases of acute peritonitis secondary to other diseases must be treated 
 in conjunction with them. Cases resulting from gunshot wounds and other 
 traumatism are surgical cases. In the acute case the patient should be seen 
 two or three times per day as long as the severe acute symptoms predomi- 
 nate. 
 
 JAUNDICE. 
 
 Definition: — A condition in which bile is absorbed into the circula- 
 tion and colors the tissues of the body and the secretions. 
 
 Cases: (i) Lesion from overexertion in the form of a "twist" between 
 the 6th and 7th dorsal vertebrae. Jaundice followed immediately after its 
 occurence. (2) 9th and loth dorsal \ertebrae anterior; intense congestion 
 of the deep muscles of the right cervical region; looseness of the 7th cervi- 
 cal vertebra. (3) Catarrhal jaundice following difficult childbirth; extreme 
 tenderness of the spine from the loth dorsal to the is'c lumbar. 
 
 Lesions afid causes: — Sp'\na\ \es\on anywhere along the splanchnic area 
 has been known to produce the disease. Lesion of the lower right ribs is 
 common. Prolapsus of the transverse colon, due to various lesions (see In- 
 testinal Obstruction and Enteroptbsis), may obstruct the duct by compres- 
 sion. Various mechanical causes; stricture, gall-stones, parasites, tumors, 
 etc., are well known as causes of obstructed bile-flow, leading to jaundice. 
 The relation of lesion to these causes, osteopathicall)', is found in the agency 
 of various lesions, whose nature and action are well undersood from discus- 
 sions in the previous pages, in producing diseased conditions of the gastro- 
 intestinal tract leading to the presence of such obstructive agents. 
 
 Anatomical Relations: — The relation between spinal and other lesion 
 and abnormal liver conditions have been discussed (see Cirrhosis and Gall- 
 stones). In catarrhal jaundice, the usual form presented for treatment as 
 jaundice, lesion has occurred in the splanchnic area and is interfering with 
 vaso-motor activity of the gastro-intestinal tract, producing, or allowing 
 other causes to produce, an inflamed condition of the mucous membrane of 
 the gastro-duodenal mucosa and of the mucous lining of the ductus com- 
 munis. 
 
 The immediate appearance of jaundice after spinal lesion, as in case i 
 cited above, as well as the presence of spinal lesion in other cases of jaun-
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHS. I25 
 
 dice, favors the probability of direct interference of such lesion with the in- 
 nervation of the gall-bladder and duct. The presence in the sympathetic 
 supply of the liver (hepatic and cystic plexuses. See Gall-Stones) of spinal 
 fibres which, upon stimulation or inhibition of the spianchnics, cause con- 
 striction or dilatation of the bladder and ducts; also the fact that stimula- 
 tion of the pneumogastrics constricts the bladder while relaxing the sphinct- 
 er of the opening of the common duct into the duodenum, make it probable 
 that certain lesion to the splanchnic area or to the pneumogastric, directly 
 or indirectly through its sympathetic connections, might so pervert the 
 normal workings of this mechanism as to lead to retention of bile, i. e., a 
 form of obstructive jaundice. 
 
 The Prognosis is good. The acute case yields immediately to treat- 
 ment. The usual course (two to eight weeks) is materially shortened. In 
 tht. chronic case, clearing of the tissues from the pigmentation is rather a 
 slow process. 
 
 The Treatment must look at once to the removal as such active lesion 
 as described above. Mechanical obstructions must be located if possible, 
 and removed by work upon the duct, proceeding upon the lines laid down 
 for the manipulative removal of gall stones and of intestinal obstructions, 
 q. V, Prolapsus of the intestines and pressure from surrounding organs 
 must be relieved (see Enteroptosis). 
 
 In catarrhal jaundice the first step must be to gain vaso-motor control 
 and relieve the inflammation. A peliminary inhibition of the splanchnic 
 area of the spine may be necessary to relieve pain and to gain a degree of 
 relaxation of abdominal tissues before local work is attempted. Next, slow, 
 deep, inhibitive or relaxing treatment is directed to the upper intestinal 
 region and ductus communis. This relieves the inflammation, aids in tak- 
 ing down the swelling of the mucous membrane, and frees the secretion of 
 mucous which miy be obstructing the duct. At the same time, treatment of 
 the splanchnics aids in correcting circulation in the parts. 
 
 After treatment for the inflammation and relaxation of the duct, the 
 next step is the emptying of the gall-bladder and hepatic ducts. This is 
 done by local manipulation which acts mechanically and by stimulation of 
 the hepatic and cystic plexuses. The patient lies upon his back and the 
 operator stands at the left side; he places the palm of the right hand be- 
 neath the postero-lateral aspect of the lower four right ribs and, while rais- 
 ing them, presses down upon their anterior portions with the right forearm. 
 At the same time the left hand makes careful but deep pressure beneath 
 the tip of ninth rib, against the fundus of the gall-bladder. This mechanic- 
 ally empties the liver and ducts. It also stimulates the local cystic plexus 
 to cause constriction of the bladder and ducts. 
 
 This same treatment, and the lower costal treatment (V. Chap. VIII). 
 carefully applied, are given to regulate the circulation through the liver 
 and to free it of accumulated bile. The splanchnics should also be thor-
 
 126 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 o-ughly treated for the circulation. By these treatments the flow of bile is 
 increased, and the system is cleared of it. Thorough stimulation of the 
 kidneys and skin (2d dorsal, 5th lumbar) aids in freeing the blood of the 
 bile acids. This allays the itching. The superior cervical region (medulla) 
 should be inhibited to correct general vaso-motor action. This is for the 
 itching and localized sweating. The bowels and stomach must be treated 
 to relieve the constipation or diarrhoea, and the dyspepsia, as before direct- 
 ed. Other symptoms may be allayed by appropriate treatment. 
 
 The diet should be plain, avoiding pastry, starchy, fatty, and saccharine 
 foods. Plenty of water should be drunk; lemonade and alkaline drinks are 
 allowed, 
 
 CONGESTION OF THE LIVER. 
 
 Definition: — An excess of blood in the vessels of the liver. In active 
 congestion, or acute byperemia, an excess of arterial blood is circulating 
 through it. In passive congestion the liver is engorged by retention of 
 blood in its portal circulation. 
 
 The /t'^w/.? alread)' discussed in connection with liver diseases, i. e., 
 these of the splanchnic area and of the lower ribs, interfering with the vaso- 
 motor control of the organ, lead to the congestion, Heart and liverdiseases 
 are said to be almost always the causes of passive congestion. The lesions 
 here must be sought according to the case, and treatment made as thus in- 
 dicated. 
 
 The Prognosis is good. These cases are usually readily cured. 
 
 The Treatment is merely one to gain vaso-motor control. Thorough 
 stimulation of the splanchnic area, and solar and hepatic plexuses are im- 
 portant means of accomplishing this. The lower costal and direct liver 
 treatment indicated for jaundice, q. v., are used. Besidesjdirectly stimulat- 
 ing the local ner\ e-mechanism, these treatments, by squeezing the liverand 
 mechanically forcing the blood into and out of it, cause the mechanical 
 action of the blood upon the vessel walls to still further arouse vaso-motor 
 activity. Local treatment should be made upon the liver to stimulate the 
 flow of bile and prevent jaundice. A general spinal, neck, and abdominal 
 treatment aids in correcting general circulation. Treatment for the abdom- 
 inal vessels aids the work. Inhibiting the splanchnics, solar plexus, and 
 abdominal vessels quiets active congestion by dilating the abdominal vessels 
 and drawing the blood to them. 
 
 CIRRHOSIS OF THE LIVER. 
 
 Definition: A chronic disease, characterized by an increase of con- 
 nective tissue in or about the liver. 
 
 Cases: (i) Atrophic cirrhosis; a case brought on by social drinking^
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 12/ 
 
 diagnosed and treated by ph^'sicians as such. The first tapping of the ab- 
 domen brought eight and one-half quarts of fluid. The case now came un- 
 der osteopathic treatment and it succeeded so well that a second tapping 
 was delayed some days beyond the expected time. Later a third tapping 
 beceme necessary, but after that none was required. Under the treatment 
 the patient was apparently restored to perfect health. 
 
 (2) Diagnosis of cirrhosis; 6th and 7th dorsal vertebrae posterior, 9th 
 to I2th flat; ribs irregular and prominent on left. 
 
 (3) Malarial cirrhosis; entire lumbar region bad. nth rib on each 
 side down. 
 
 (4) Lesions and Causes: The lesions commonly found in these cases 
 affect the splanchnic area, the lower ribs on each side, or the lower right 
 ribs. The latter may cause mechanical pressure and irritation upon the 
 liver. The various lesions weaken the vaso-motor sjmpathetic supply and 
 lay it liable to the action of special causes of the disease. 
 
 In those forms of cirrhosis in which ascites develops, the contraction 
 of the connective tissue causes pressure upon the soft walls of the branches 
 of the portal vein. Upon this account, and because of the low pressure of 
 the blood in the portal system, obstruction soon follows, and ascites results. 
 
 The Prognosis must be guarded in all cases. Various cases ha\e been 
 cured, among them even atrophic cirrhosis. In the latter case the prog- 
 nosis is very unfavorable. It is probnble that other forms of the disease 
 can be much benefitted or cured under the treatment in many instances. 
 
 The Treatment aims at gaining vaso-motor control and thus taking 
 down the inflammatory or congestive process that is allowing of the in- 
 crease in connective tissue. In those forms complicated with ascites as the 
 main symptom, special attention mCist be given to it as being mosi immedi- 
 ately dangerous to the patienf's life. (See Ascites.) It is doubtful if con- 
 nective tissue, once formed, could be absorbed by the renewed blood-sup- 
 ply. But the process of its formation could be stopped, the liver substance 
 could be kept softened by thorough work locally over the organ, thus pre- 
 venting hardening and contraction of it, and maintaining freedom of circu- 
 lation through it. In this way danger of ascites could be avoided. 
 
 Vaso-motor control is gained by removal of lesion, by thorough stimu- 
 lation of the splanchnic area of the spine, and by local abdominal work 
 over the liver and over the course of the portal vein. 
 
 Local work may be done as described in V, Chap. VIII, workieg be- 
 neath the right ribs, directly upon the liver, while the pressure from above 
 upon the ribs, pressing them down upon the liver, alternating with that 
 applied directly to the liver, is an efficient mode of stimulating the 
 organ directly. 
 
 In atrophic cirrhosis attention must be given to relieving the conges- 
 tion of the spleen, stomach and intestines present. This is done through 
 treatment of the organs as described in considering diseases of them. In
 
 128 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 case of the spleen only slight treatment should be made over it locally on 
 account of danger of rupture. Stimulation of the lower splanchnic area 
 and raising the lower four left ribs, together with work upon the solar 
 plexus and the abdominal circulation are sufficient for it. The constipa- 
 tion, gastric catarrh, nausea, vomiting, edema of the lower extremities, etc., 
 are treated as before described. 
 
 In biliary cirrhosis, the chief object of treatment is to remove the ob- 
 struction to the duct and to empty the gall bladder. (IX, Chap. VIII.) 
 The general corrective treatment for the liver as described is relied upon 
 to soften the new tissue about the small ducts and to prevent its further 
 formation. 
 
 In congestive and malarial cirrhosis the chief point is to remove and 
 prevent the congestion. Otherwise the treatment is as indicated for the 
 general case. 
 
 In all cases the general treatment outlined, with attention to the special 
 symptoms manifested, should be applied. 
 
 In acute cases the patient should be seen daily. 
 
 GALL-STONES. 
 
 Definition': Concretions in the gall bladder, chiefly of cholesterin 
 due to a pathological process usually caused by spinal lesion to sympathet- 
 ic nerves in charge of liver functions. 
 
 Cases: Very numerous cases of gall-stones, some of them noted, have 
 been successfully treated. It is one of the most common things treated, 
 and in no class of cases have more uniformly good, even striking, results 
 been attained. 
 
 The Lesions found in these cases are usually low down in the splanch- 
 nic area, affecting the lower four ribs upon either side, ver\- frequently upon 
 the left, for the spleen. Lesions of the nth and I2th vertebrae may not be 
 too low to cause it. However, any of those lesions to the ribs and splanch- 
 nic area, characteristic of bad gastro-intestinal conditions may, from the 
 nature of the case, affect the liver to produce gall-stones. The liver is in- 
 nervated from the same nerve supply, gastro-intestinal diseases are usually 
 complicated with deranged liver function, and it is reasonable to find in the 
 usual lesions deranging the activities of the former a sufficient cause for dis- 
 ease in the latter, which, owing to some particular form, degree, or concen- 
 tration of lesion, results in cholelithiasis. 
 
 Anatomical Relations of lesion to disease: The liver is supplied by 
 the splanchnics through the solar plexus, the secondary plexus, the hepatic, 
 in the formation of which the left pneumogastric nerve participates, having 
 special charge of the liver activities. Its branches ramify throughout the 
 liver upon the branches of the portal vein and the hepatic artery, the chief 
 supply being to the latter. The blood-supply from both of these sources is
 
 PRACTICE AND APPI.IRD THERAPBUTICS OF OSTEOPATHY. 1 29 
 
 thought to be essential to the activities of the liver cells. The nutrien* 
 blood-supply (hepatic) is chiefly supplied by branches of the sympathetic. 
 A cystic plexus of the sympathetic supply is spread upon the gall-bladder 
 and bile-ducts. The American Text Book of Physiology states that special 
 investigation has shown that these nerves are similar in function to vaso- 
 constrictor and vaso dilator nerves, and that stimulation of the peripheral 
 end of the cut splanchnics causes a contraction of the bile-ducts and gall- 
 bladder, while stimulation of the cut end of the same nerve causes reflex di- 
 latation. According to the same investigator, stimulation of the central 
 end of the vagus nerve causes contraction of the gall-bladder and at the 
 same time an inhibition of the sphincter muscle closing the opening of the 
 common bile-duct into the duodenum. 
 
 These interesting and instructive facts cannot but be of much signifi 
 cance to the Osteopath. Doubtless he could not avail himself of these de 
 tailed facts to manipulate at will the activities of the biliary apparatus, but 
 spinal and other lesions affecting the sympathetic connections of the organs 
 must be efficient causes in producing abnormal function. 
 
 Osier states that any cause, such as tight-lacing, bending forward at a 
 desk, enteroptosis, etc., which produce stagnation of bile favors cholelithia- 
 sis. From an osteopathic standpoint, and in view of the above facts, it is a 
 reasonable conclusion that certain spinal lesion, acting through this nerve- 
 mechanism above described, may cause a stimulated, irritated, or over-ac- 
 tive condition of the dilator fibers of the ducts and gall-bladder, thus 
 maintaining a permanent dilated or sluggish condition of the apparatus, 
 favoring stagnation of the bile and the formation of gall-stones. Likewise 
 one must concede the possibility of lesion to the central end of the vagus 
 nerve, cutting off the normal impulses through the nerve which contract 
 the gall-bladder and relax the sphincter of the common duct, thus allowing 
 of a lack of normal contraction of the bladder and opening of the duct; in 
 other words, favoring a sluggish condition of the biliary apparatus leading 
 to retention and stagnation of bile, thus to cholelithiasis. If any osteo- 
 pathic spinal lesion can interfere with sympathetic viscereal supply, a point 
 placed beyond controversy by demonstrated facts, it is a reasonable con- 
 clusion that spinal lesion to the sympathetic supply to the liver can become 
 the cause of gall-stones in this way. 
 
 According to the catarrhal theory of the formation of gall-stones, litho- 
 genous catarrh of the mucosa of the bladder and duct modifies the chemical 
 constitution of bile and favors the deposition of cholesterin about some nu- 
 cleus, such as epithelial debris. Cholesterin and lime salts are produced by 
 the inflamed mucous membrane to form the calculus. As shown above, 
 both the hepatic and portal blood-supply is under control of the hepatic 
 plexus, i. e., of the solar plexus and the splanchnics. According to the 
 American Text-Book of Physiology, stimulation or inhibition (section) of 
 the splanchnics produces at once vaso-constriction or vaso-dilatation of the
 
 130 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHV. 
 
 blood-vessels of the liver. Here, as in the case gastric or intestinal catarrh, 
 spinal lesion to the splanchnics could disturb vaso-motor equilibrium in the 
 liver and cause catarrh of the mucous membrane. 
 
 It is the practice of Osteopaths to give close attention to the condition 
 of the spleen in case of gall-stones. Important lesions to this organ are 
 often found in such cases (8th to 12th left ribs, A. T. Still) Removal of 
 this lesion seems to prevent further formation of the calculi. What influ- 
 ence the spleen naturally exerts upon the liver is not known. The splenic 
 and superior mesenteric veins unite to form the portal vein. The abundant 
 venous flow from the spleen is carried directly to the liver in the portal 
 circulation. The American Text-Book shows that there is little doubt that 
 the materials actually utilized by the liver cells in forming their secretions 
 are brought to them mainly b}- the portal vem. The blood which has cir- 
 culated through the spleen must compose an important part of the blood 
 brought by the portal vein to the liver. It may be that certain products of 
 splenic activity are useful in maintaining the fluidity of the cholesterin and 
 in preventing the formation of gall-stones. The spleen is enlarged and 
 tender in this case. 
 
 Sensory nerves pass through the sympathetic from the (6th?) 7th, 8th, 
 9th and lOth spinal nerves (Quain) This fact may explain the radiation of 
 the pain in hepatic colic to the spine and right shoulder, and forms a good 
 anatomical reason why inhibition over this spinal region will aid in stopping 
 the pain. 
 
 The Prognosis is good, even in serious cases in which operation has 
 seemed advisable. The case is frequently presented to the Osteopath as 
 the last resort before operation, and results have been almost uniformly 
 good. 
 
 Treatment: The success of the treatment seems to rest mainl)- upon 
 the mechanical effect and upon the relaxation of all tissues concerned, 
 gall-ducts included, gained by the use of osteopathic methods. The main 
 treatment in these cases is locall)- about the region of the liver; as much of 
 the relaxing and inhibitive treatment, and the main work of removing the 
 stone are done here. Spinal work is important, as here inhibition for the 
 pain of the colic is made, lesion is corrected, and circulation is stimulated. 
 Nervous control is an important factor in the treatment. It is gained by 
 both spinal and abdominal work, perhaps alone by the removal of lesion. 
 
 The objects of the treatment are: (i) To remove the stone. (2) To 
 restore normal liver function and prevent further formation of stones. 
 
 The former is palliative treatment; the latter is the real curs. 
 
 In the acute case, \i colic is present the first step is to make strong in- 
 hibition over the 7th to loth spinal nerves. (Some say upon the right side.) 
 This will lessen or stop the pain and allow of work upon the abdomen. 
 This is deep, relaxing, inhibitive work upon the tensed abdominal walls, 
 over the epigastric and lower anterior thoracic regions, and over the course
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. I3I 
 
 of the duct (IX, Chap. VIII.) The pain is usually relieved in a few min- 
 utes. 
 
 The stone is removed by working it along the duct after the'preliminary 
 relaxing treatment. The patient should He upon his back with knees flexed 
 and shoulders slightly raised. The lower ribs are raised by inserting the 
 fingers beneath their anterior edges, and manipulation is made deeply over 
 the site of the fundus of the gall-bladder (tip of gth rib) and down along 
 the course of the duct. The latter may vary from its course on account of 
 sagging of the intestines sometimes found. This treatment must be thor- 
 ough and persistent. It should be firmly and deeply, but most carefully 
 applied. Sometimes a few minute's work will pass the stone, but often con- 
 tinued treatment for three-quarters of an hour or an hour must be devoted 
 to it. Only careful manipulation could be borne by the patient for this 
 length of time. As long as the stone remains in the duct and causes the 
 colic the attempt to remove it should be continued, though it may not be 
 advisable to treat continuously all of the time. The stone may or may not 
 be large enough to be felt in the duct. Stones are often passed without 
 pain. Some stones are soft and may be carefully broken down by the 
 treatment. 
 
 The spleen is treated by careful abdominal work over and beneath the 
 lower left rib, anteriorly. It is chiefly affected by treatment to the splanch- 
 nics, raising the lower right ribs (8th to 12th), and removal of lower spinal 
 and rib lesion. 
 
 T\\^ jaundice, if intense, indicates impaction of the stone in the com- 
 mon duct. Its cure depends upon the removal of the stone. The kidneys 
 should be kept active. 
 
 Fever, if present is alla)'ed in the usual manner. Fatal syncope some- 
 times occurs. If imminent the patient should be fortified against it by thor- 
 ough stimulation of the heart. Yox obstniction of bowelhy calculi, see In- 
 testinal Obstruction. 
 
 A dilaled gall-bladder and duct are treated locally by manipulation to 
 remove the obstruction as for removal of the stone. Thorough treatment 
 must be given the liver locally and thorough spinal treatment must be kept 
 up for the purpose of circulation, etc. 
 
 According to Dr. A. T. Still the lesion of the 6th to lO left ribs found in 
 cases of gall-stones is obstructing pancreatic secretions. These, he says, 
 dissolve gall-stones. 
 
 ASCITES. 
 
 ■ Definition: — A dropsical condition of the abdomen, due to an accumu- 
 lation of serous fluid in the peritoneal sac. 
 
 The Lesions in these diseases are various, as it is commonly a condition 
 secondary to some other disease, as of the heart, lungs, kidneys, liver, etc.
 
 132 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY 
 
 Lesions must be expected according to the nature of the primary disease. 
 If i»: be due to a local condition, such as obstructed portal circulation (see 
 Cirrhosis of the Liver), peritonitis, q. v., or abdominal tumor, the lesions 
 expected are the ones usually found in these conditions. Lesions in the 
 splanchnic area, the upper lumbar region, and among the lower ribs occur 
 often in these cases as underlying causes, determining the local manifesta- 
 tion of the disease through interference with the sympathetic innervation 
 of the abdominal vessels, as before explained. 
 
 The vast area and capacity of the abdominal veins, the ease with which 
 they are dilated, and the relation of the portal circulation to the liver, to- 
 gether with the frequent presence of lesions in the splanchnic and upper 
 lumbar regions of the spine, weakening vaso-motor control of these vessels 
 are no doubt important anatomical factors in determining the drops)- to the 
 abdominal region. 
 
 The Prognosis in these cases depend upon that for the condition produc- 
 ing the trouble. Generally speaking, it is good except in cases of atrophic 
 cirrhosis of the liver, 
 
 The Treatment for ascites consists chiefly in the treatment of the dis- 
 ease to which it is secondarj'. Special lesion as found must be removed. 
 Obstructed circulation must be opened, general abdoininal circulation stimu- 
 lated, and the collateral circulation through the superficial abdominal veins 
 developed. This is accomplished by spinal correction and stimulation of 
 the splanchnic and lumbar vaso-motor areas. The solar and other abdomi- 
 nal plexuses are stimulated, and deep abdominal manipulation is made from 
 below upward along the course of the vena-cava and azygos veins, the portal 
 vein, and the superficial abdominal veins. Thorough stimulation of the 
 liver and portal circulation is the most important factor in the treatment of 
 this condition. (See Cirrhosis of the Liver.) Treatment over the course 
 of the superficial abdominal veins results, in the course of a few treatments, 
 in considerable enlargement of them. As circulation is corrected the drop- 
 sical process is checked, and absorbption of fluid already effused begins to 
 take place. Stimulation of kidnej's, bowels, and skin aid the process. The 
 distention of the abdomen may considerably hinder the treatment. By 
 laying the patient upon his side, so that the fluid gravitates away from the 
 uppermost side, the latter may be treated by deep manipulation. The pati- 
 ent may then be laid on the other side, and the process be repeated. On 
 account of the accumulation of fluid paracentesis may have to be perform- 
 ed, but ordinarily under osteopathic treatment tapping does not become 
 necessar}-, except in cases of atrophic cirrhosis of the liver. The lower 
 limbs should be treated to increase circulation in them and to empty their 
 ■dilated veins. 
 
 The patient should be treated daily.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY, I33 
 
 DISEASES OF THE LIVER. Continued. 
 
 Cases: (i) Heptic abscess, complicated with gastric ulcer. Lesions 
 at the 3rd cervical, and at the 4th, 5th, and 8th dorsal; rigid spinal muscles; 
 7th to lOth right ribs overlapped. The case was in a very serious condition^ 
 but began to improve after two weeks, and was finally cured by the treat- 
 ment. (2) A case of hypertrophy of the liver; the organ was restored to 
 normal size and function in one month's treatment. (3) Torpid liver, with 
 chronic gastritis; marked lesion at 4th and 5th dorsal; slight lesion at the 
 9th dorsal cured. 
 
 For Hepatic Abscess the prognosis must be guarded and unfavorable. 
 While limited quantities of pus may be effectually and safely absorbed 
 through increased circulation, any large quantity could probably not be 
 thus disposed of. Some cases have been cured by osteopathic treatment, 
 and there are some chances of curing the ordinary case presented for treat- 
 ment. The fact that the disease has and can be cured warrants thorough 
 trial. 
 
 The Treatment must be to absorb the pus and heal the ulcer through 
 increased circulation of the blood. Removal of lesion is naturally the im- 
 portant step in this process, as it is obstructing proper circulation and in- 
 nervation. The usual lesions in liver diseases must be expected. Full 
 directions have been given for treatment of circulation to the liver. Great 
 care must be taken in local treatment over the liver because of danger of 
 rupturing the abscess. Pain, if present, is quieted as before. Attention 
 must be given to the gastro-intestinal disorders; constipation and diarrhoea. 
 As abscess is frequently secondary to some other disease, treatment must 
 be made accordingly in such cases. A bronchial cough, frequently present, 
 may be guarded against by stimulation of the vaso-motors to the lungs. 
 
 Hyhertrophy of the Liver is frequently presented for treatment, and 
 as a rule good results are gotten. Many cases are cured. Many cases can- 
 not, from their nature, be cured. Complete.restoration of size and function 
 often results from the treatment. In many other cases, while the size can- 
 not be reduced to normal limits, function is restored. The general prog- 
 nosis is favorable. In true hypertrophy due to increase of connective tissue 
 the new tissue can probably not be absorbed, but the further increase of it 
 may be checked and the function usually restored. 
 
 In true hypertrophy due to increase in size or number of the parenchy- 
 matous cells, the treatment may reduce their size or number, and normal 
 size and function of the liver is restored. As the chief causes of true hyper- 
 trophy are active and passive congestion (lesion to the vaso-motors), good 
 results follow corrected circulation. 
 
 In false hypertrophy due to cancer or abscess, little is expected in the 
 way of reduction. When due to fatty infiltration, the renewed circulation
 
 134 PRACTICE \ND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 removes the accumulated fatty particles and restores normal size and func- 
 tion. The treatment in these cases consists in the removal of lesion and 
 correction and stimulation of circulation. When secondary, the primary 
 disease is treated. 
 
 In fatty degeneration of the liver good results may be expected from 
 the treatment. Recorded facts are lacking, as they are also in regard to 
 amyloid degeneration, cancer, and acute yellow atrophy, of the liver. 
 
 SPLENITIS. 
 
 Definition: Acute or chronic proliferative inflammation of the spleen. 
 Suppuration may occur. 
 
 Case: Lady, fifty years of age, suffering from chronic inflammation of 
 the spleen. Spleen was much enlarged, and she was unable to wear corsets. 
 Lesion was found in the form of a misplaced rib pressing upon the spleen. 
 Its replacement caused the pain to disappear, and the waist measured two 
 inches less the next morning. The case was cured in one month. 
 
 Lesions occur in downward and forward luxations of the 6th to 12th 
 left ribs. , (A. T. Still). Diaphragmmatic lesion thus caused may interfere 
 with position, circulation, or innervation of the organ. Direct pressure of 
 a misplaced rib may irritate the organ, or Iherib may, by interference with 
 spinal innervation, cause the trouble. 
 
 Anatomical Relations: Stimulation of the peripheral end of the 
 splanchnics causes sudden and large diminution of the volume of the spleen. 
 It is probable that this diminution is due to contraction of its trabeculae 
 and capsule, which are plentifully supplied with involuntary muscle fibres. 
 *'The organ is richly supplied with nerve-fibres which, when stimulated 
 directly or reflexly, cause the organ to diminish in volume" (American Text 
 Book of Physiology). According to Schafer, these fibres are contained in 
 the splanchnics, which carry also inhibitory fibres whose stimulation causes 
 dilatation of the spleen. 
 
 In view of these facts it seerfis that treatment over the splanchnic area 
 of the spine and locally over the spleen may produce changes in its volume 
 (^through thus directly or indirectly stimulating these nerve-connections) 
 which is most useful "n correcting circulation through it. In addition to 
 this, the same work would affect the vaso-motor mechanism of the organ. 
 The splenic plexus, ramifying upon the splenic artery and upon its branches 
 throughout the spleen, is composed of sympathetic fibres from the solar 
 plexus and of branches from the right pneumogastric. Local or spinal 
 treatment affects these. It is readily apparent, in view of the whole mech- 
 anism described above, that spinal and rib lesion may seriously affect the 
 organ by disturbance of these nerve-connections, producing inflammatory 
 or congestive conditions.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 135 
 
 Anders states that splenitis is prohably never primary, but in the case 
 cited above it seems that the disease must have originated primarily in the 
 spleen by action of the disturbance caused by the displaced rib. 
 
 Treatment: As splenitis and congestion are frequently secondary to 
 some other disease (malaria, typhoid, etc), such disease must be treated 
 primarily. Removal of lesion, as in the above case, may be the only treat- 
 ment necessary. Stimulation or inhibition of the splanchnics at the spine, 
 and of the capsule and local plexuses by work' directly upon the organ, 
 is made. Care must be taken in the latter process to avoid danger of rupture 
 of the organ. 
 
 Inhibitive work upon the splanchnics, the solar plexus, and the abdo- 
 men will dilate the abdominal vessels and draw the blood to them, away 
 from the spleen. 
 
 Splenic Hyperaemia, active or passive, is readily reduced. Chronic 
 cases may yield at once or may require a patient course of treatment. Con- 
 traction of the tissues about the splenic vein has been known to cause great 
 enlargement of the organ by passive congestion. Upon removal of the 
 obstruction the organ quickly returned to its normal limits. The lesions and 
 lreatme?it dixe. the same as indicated for splenitis.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY, 137 
 
 DISEASES OF THE URINARY SYSTEM. 
 
 Cases: (i) Lithuria in [a young girl after typho-malaria. Lesion, a 
 faulty condition of the lower dorsal and lumbar regions. Such quantities 
 of uric acid "sand" appeared as to be easily seen by the naked eye. Dr. 
 A. T. Still found a "hot spot" at the 4th lumbar which was slipped. Also 
 found the loth right rib off its articulation at its head, interfering with the 
 function of the adrenal bodies. In less than two hours after his treatment 
 normal urine was passed. The previous passage, one half-hour before the 
 treatment, had been cloudy, dark, and contained a heavy precipitate. 
 
 (2) Abscess of the kidney and catarrh of the bladder, of three }'ears' 
 standing, in a man. He was obliged to urinate every five or ten minutes, 
 always with great pain. The urine was about one-half sediment and blood, 
 and only about one-half the normal amonnt. After six weeks' treatment 
 the case was almost well, no pain upon urination; retains urine one hour; 
 practically no sediment; normal amount of urine. 
 
 (3) Bright's disease in a mantwenty-nine )'ears of age; diagnosis con- 
 firmed by several physicians; great dropsical swelling of feet, limbs and 
 body up to the I2th dorsal vertebra. After five weeks' treatment he was 
 able to go to work at an occupation that kept him constantly upon his feet. 
 After the fourth treatment there had been rapid improvement; in six weeks 
 the urine was almost normal, and the dropsy had disappeared. 
 
 (4) Retention of urine from enlarged prostate, and uric acid poisoning, 
 in a man of seventy-three years of age. He was about to be operated up- 
 on for "abdommal tumor." The Osteopath used a catheter at once, and 
 drew about a gallon of decomposing urine. The next morning about one 
 quart of urine was drawn, containing much blood and stringy mucous. In 
 three months' treatment the prostate was reduced, and the urination was 
 about normal. 
 
 (5) Uremic poisoning (kidne)' and bladder disease), in which the pa- 
 tient was m a critical condition; had not slept for two days on account of 
 severe pain. In fifteen minutes the pain was relieved by the treatment. 
 Spinal lesion was found at the centers for bladder and kidneys. Great im- 
 provement attended one month's treatment. 
 
 (6) Chronic Bright's disease after lagrippe. The patient was in a 
 very bad condition, being confined to his room. After five treatments he 
 was able to go out, and was much improved in one month. 
 
 (7) Renal calculi, in which operation had been advised. The patient 
 was kept in bed by the great pain of the colic. After two treatments the 
 patient was able to go to the of^ce for treatment, and after a third treat- 
 ment had no further trouble. 
 
 (8) Enuresis. The 5th lumbar vertebra was lateral. The case was 
 entirely cured in six weeks by the removal of this lesion.
 
 138 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY 
 
 (9) Chronic Nephritis (probably) diagnosed as floating kidney. The 
 patient, a ladv of fifty-five, was in a very bad general condition; heavy sed- 
 iment in the urine; painful micturition. Lesions: Upper cervical lateral; 
 posterior curvature from $th dorsal to 5th lumbar; marked lesion at loth, nth 
 and I2th dorsal, and 2d lumbar. The nth and 12th ribs were subluxated, 
 giving the appearance of tumor, diagnosed as floating kidney. The case 
 began to improve upon the first treatment, and was practicallx' cured in two 
 
 months. 
 
 (10) Kidney disease due to double scoliosis, 6th to loth dorsal left; 
 ist to 5th lumbar posterior. Treatment of the curvature improved the kid- 
 neys. 
 
 (n) Enuresis in a bo)- of seventeen, of seven years' standing. Occip- 
 ital pains present. Tissues about 2d cervical tense; about 3d and 4th cerv- 
 ical sore; 7th and 8th dorsal vertebrae anterior and sore. The boy had 
 been thrown from a horse at ten years of age, and the trouble had persisted 
 ever since. 
 
 (12) Enuresis in a boy of five, had been present all his life. For four 
 years he had been constantly under medical care. He had no warning of 
 the passage of urine, even in the day time. After eleven treatments but 
 two involuntary passages occurred in eight months. After a recurrence 
 due to an attack of the mumps, two weeks' treatment cured the case. The 
 treatment was given over the sacral and lumbar regions. 
 
 (13) Enuresis in a boy of nine. He had been so troubled for eight 
 years during sleep. The usual methods of treatment had been without 
 avail. Great tenderness and a slight lesion occurred at the 2d lumbar, re- 
 moval of which cured the case. 
 
 (14) Eneuresis in a boy of twelve who had always had poor health. 
 For eight years nocturnal urination had been constantly present. In the 
 day time the urine passed involuntarih'. Lesions were found in the cervi- 
 cal region; pronounced posterior position of the lower dorsal spine; lesions 
 from the 2d to 5th lumbar. Steady improvement took place under treat- 
 ment, and the case was cured in three months. 
 
 (m) Enuresis in a girl of eight cured in five weeks' treatment. 
 
 (16) F'requent mictuiition, varicocele and weak e)es being [Mesent, 
 The lesions were at the 3d cervical, lateral spinal curvature, and lesion at 
 the 2d and 4th lumbar. 
 
 (17) Acute Nephritis in a man of forty. Lesion was found irritating 
 the renal splanchnics. The treatment was at the nth and I2lh dorsal, and 
 raising of the I ith and I2ih ribs. 
 
 (18) Acute Hright's Disease, so diagnosed by two physicians. Large 
 quantities of albumen appeared in the urine The I2th dorsal vertebra was 
 found anterior. One treatment relieved the pain and the patient slept. 
 Good progress was reported. 
 
 ^19) Acute Bright's Disease. Spinal lesion was found. After severe
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. I 39 
 
 weeks' treatment no further sxmptoins remained. For five weeks a ph)'si- 
 cian examined the urine daily findin<^ no further evidence of the trouble at 
 the end of that time. He said he had never seen a case do so well. 
 
 (20) Bright's Disease and Paraplegia; lesion was found as a separation 
 between the iith and 12th dorsal. There was a history of the patient's 
 having jumped from moving trains for )'ears. 
 
 (21) Uremic Poisoning cured by thorough stimulation of the kidneys. 
 
 (22) Uremic Poisoning; the case was sleepless, vomiting, and near con- 
 vulsions. Treatment relieved the case at once. 
 
 (23) Enuresis in a boy of five. The lumbar region was very weak, 
 and iiad a posterior tendency. Treatment here relieved the case. 
 
 (24) Renal Calculi. Severe attacks of colic had caused great pain 
 and sleeplessness for three days. Medical treatment for two days was with- 
 out avail. In the evening of the third day osteopathic treatment was given 
 and the relief was immediate; The patient was out of bed the next morn- 
 ing, and was cured in a few treatments. 
 
 (25) Inflammation of the urinary meatus. Constipation was preseet. 
 There had been congestion of the kidneys one year before. The vertebrae 
 from the 2d to the 5th dorsal were approximated and to the right; those 
 from the 8th dorsal to 3d lumbar were separated. The right innominate was 
 displaced upward and backward, shortening the limb. 
 
 (26) Suppression of urine, the patient having not urinated in fifteen 
 hours, Vv'as relieved at once by treatment at the renal splanchnics and upper 
 lumbar. 
 
 (27) Renal Calculus. Lesion was found at the nth dorsal. Inhibit- 
 ing treatment upon the renal splanchnics lessened pain. The calculus was 
 worked along the course of the ureter into the bladder and passed later. 
 
 lyESiONs: The centers of importance osteopathically in urinarj- diseases 
 are generally stated as follows: ^6th dorsal for kidneys; 12th dorsal for 
 renal splanchnics; 2d lumbar for micturition; 3d and 4th sacral for neck 
 and bladder; medulla (sup. cervical, atlas) renal center; 2d to 5th lumbar / 
 (Am. Text Bk. Physiol ) urino-genital (or genito-spinal) center for bladder; 
 peritoneal sympathetic centers, each side of the umbilicus for the renal 
 plexus; the umbilicus as a landmark for the renal vessels and their sympa- 
 thetic supply (two inches above.) 
 
 The lesions usually found in renal diseases are as follows: {^\) At the 
 atlas or upper cervical, affecting the superior cervical ganglion and the ren- 
 al center in the medulla. (2) At the lOth, nth and i2th dorsal, and the 
 1st lumbar, the main lesions affecting the kidneys directly. (3) From the 
 2d lumbar to the 4th sacral for disease in the bladder and urethra. (4) In 
 the female patient it may occur that uterine polapsus, wrinkling the anterior 
 vaginal walls, may twist and obstruct the urethra. (4) In the male patient , 
 and enlargement of the prostate gland, especially of its middle lobe, is with
 
 140 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 considerable frequency found to be the cause, easily overlooked, of stricture 
 of the urethra. 
 
 A careful analysis of the lesions in the twenty-seven cases presented 
 above brings out facts representatix'e of this class of cases (urinary diseases.) 
 These facts well illustrate what is usually found in such cases. The lesions 
 are mostl\' spinal, few being rib lesions; but three of the tvvent)'-seven men- 
 tion rib lesion. As a matter of fact, spinal lesions are the important causes 
 of urinarv troubles. The vast nerve-suppl\' of the kidneys and bladder is 
 delicately balanced. Most of the lesions in renal diseases being spinal, 
 th<: conclusion is that spinal derangement of this nerve-supply is the most 
 potent and frecjuent cause of such disease. The kidneys are, at bottom, 
 generally deranged by lesions affecting the nerve-supply, including vaso- 
 mptor, i. c blood-sypply, ^Isp. 
 
 Of these lesions, practically all are low down in the spine, including 
 also the sacral region. Excepting cervical lesion, but one of the above 
 cases mentioned lesion above the 5th dorsal. (This occurred at the 2d 
 dorsal, and was unimportant because of other, lower lesions.) Hut five 
 showed lesion above the lOth dorsal, and while lesions of some importance 
 occur about the 7th and 8th dorsal, the important lesions all occur lower 
 down. 
 
 Eleven of the twent)'-seven showed lesion about the lOth, nth, and 12th 
 dorsal; twenty showed lesion below and including the loth dorsal; ten 
 showed lesion below the i2th dorsal, i. e , in the lumbar and sacral regions. 
 '.These latter occur chiefly in bladder and urethral diseases. This is seen in 
 the fact that of the seven cases of enuresis reported, six presented lumbar 
 and sacral lesions. The fact that twenty showed lesion below the loth dor- 
 sal, eleven of them being about the lOth, nth and I2lh dorsal, must be re- 
 marked in considering distinctively kidney diseases. In the cases of Bright's 
 Disease mentioned, all in which the lesion was described showed lesion in 
 the lower dorsal and lumbar regions, practically all of these concentrating 
 about the lOth to 12th dorsal. In nine of these cases the micturition center 
 at the 2d lumbar was affected, participating in both kidney and bladder af- 
 fections. Its anatomical relations make it most important in the latter 
 class, and experience shows that it is more likely to affect bladder than 
 kidneys. 
 
 Xeck lesion is not important. Only three of the cases showed them, 
 but the)" occurred at the 2d to 4th \ertebrae, where they could all affect the 
 superior cervical ganglion, and through it the n-)edulla. This location of 
 the lesion is mainl)- im[)ortant as a secondary or adjuvant lesion in renal 
 diseases. 
 
 Without exception, the lesions in these cases fall within areas in which 
 they may affect the sympathetic inncr\-ation of the urinary apparatus. It 
 is noticeable, therefore, that only through this nerve-supply could they 
 become the causes of renal disease, even though they should be mainl)- up-
 
 PRACTICK AND APPLIED THERAPEUTICS OF OSTEOPATHY. T4I 
 
 on the blood-suppi)'. The \aso-motor function in relation to disease thus 
 has its importance eimphasized. 
 
 Anatomical Relations: Sensory nerves are distributed through the 
 sympathetic, from the spinal nerves, as follows: To the kidneys from the 
 loth, nth and I2th dorsal; to the upper part of the ureter, from the roth 
 dorsal; at the lower end of the ureter supply from the 1st lumbar tends to 
 appear; to the mucous membrane and neck of the bladder, from the (ist) 
 2d, 3d and 4th sacral; for sensation of over-distention and ineffectual contract- 
 ion, from the nth and I2th dorsal and ist lumbar (Ouain.) This sensory 
 distribution is made use of in relieving spinal pain in kiduey and bladder- 
 disease. Disturbed sensations in these parts is usually found associated 
 with lesion in the spinal areas named, generally in connection with more 
 serious trouble. 
 
 Vaso-motor fibres for the renal vessel are found in the splanchnics, and 
 somewhat below, occuring from the 6th dorsal to the 2d lumbar nerve. As 
 shown by the American Text Book of Physiology, stimulation of the central 
 endings, not only of the splanchnics, but also of the sciatic, causes constric- 
 tion of the renal vessels. Thus work upon the spine over the origin of the 
 great sciatic nerve, at the 4th and 5th lumbar, and 1st, 2d and 3d sacral, 
 is useful in controlling the circulation of the kidneys. Actual cases of kid- 
 ney diseases show spinal lesion as high as the 5th or 6th dorsal, and as low 
 as the 3d or 4th sacral. The continual action of lesion in these situations 
 upon the vaso-motors of the kidneys has most important pathological re- 
 sults through modification of the renal blood-supply. As a rule these les- 
 ions are concentrated about the 10th dorsal to 2d lumbar. The main vaso- 
 motor suppl)', originating as above described, passes from the aortico-renal 
 ganglion, solar and aortic plexuses to the renal plexus. Important branches 
 come from the renal splanchnics, sometimes also from the lesser splanchnic 
 and /rom the first lumbar ganglion. The branches of this plexus lies upon 
 the renal vessels, and accompany them in their ramifications in the kidne\'s. 
 Osteopathic work upon this important vaso-motor supply of the kidne\'s 
 via fhe splanchnic area of the spine (by remo\'al of lesion) and the renal 
 plexus, which is reached by abdominal u'ork at the level of the umbilicus, 
 gains marked results upon the circulation, and through it upon the whole 
 metabolism of the kidneys. 
 
 The blood-vessels and the muscular coat of the bladder are supplied 
 b\' the vescical plexus. It consists of numerous nerves from the lower end 
 of the pelvic plexus to the side and lower part of the bladder. The supply 
 to the fundus of the bladder is from the hypogastric plexus. The Ameri- 
 can Text Book points out that stimulation of the 2nd, 3rd and 4th sacral 
 nerves causes reflex contraction of the bladder. The chief motor fibres of 
 the bladder, probabl\' suppl\ing the longitudinal muscle fibres, pass to the 
 bladder from the sacral nerx'es. At the same time some of the motor fibres 
 passing to the bladder in the \escical plexus rise in the lumbar nerves and
 
 142 PRACTICE AND APPLrEU TH KRAPEUTICS OF OSTEOPATHY. 
 
 reach their destination via the aortic plexus, inferior mesenteric ganglion 
 and hypogastric and pelvic plexuses. They supply the circular muscle fibres 
 of the bladder and its sphtncttr. 
 
 These facts explain vvh)- lower spinal lesion is so often found by the 
 Osteopath to be the cause of motor derangement of the bladtler. A good 
 illustration of this is seen in the lack of motor control \n enuresis, due as a 
 rule to low lesions. Reference to the case reports above will show that six 
 of the seven cases of enuresis presented lumbar and sacral lesion. 
 
 These anatomical facts underlie osteopathic theor)' of renal diseases. 
 They form a foundation of truth for osteopathic procedure. Lesion to these- 
 various important nerve-supplies at their origin along the spine must pro- 
 duce renal disturbance in kind, and this disturbance can be righted only by 
 correction of the anatoiuical deranrrement responsible for them. 
 
 ACUTE NEPHRITIS. (Acute Frights Disease.) 
 
 Dei-imtion: An acute intlammation of the kidneys, mild or severe, at- 
 tended b)' structural changes iir the organ.. 
 
 The Lesfons and Anatomical Relations have been drsctissed. Le.s- 
 ions occur preferabl)- from the rOth dorsal to the upper lumbar, but may be 
 either higher or lower. Cervical lesions, as low as the jrd or 4tb vertebra, 
 may occur. 
 
 The Prognosis is, on the whole, good, stfll bearing inmind the necessity 
 of guarded prognosis in all renal diseases as above indicated. Considering^ 
 the seriousness of the disease, it is a matter of rem-ark how many cases of 
 Acute Bright''s disease have been apparently entircl)' cured. Good results 
 are quickly evident under the treatment. The ordinary course of a few 
 days to six weeks is generally shortened. 
 
 According to Anders the restoration of the destro}'ed eDrthelium and 
 of the glomerular function may occur. The chances of accomplishing the 
 result by the natural method of restored and corrected circulation as brought 
 about by osteopothic treatment v/ould seem of the best. The same author 
 states that \n cases due to exposure to cold and wet, irrespective of alcoholic 
 indulgence, it may be presumed with reason that there is some inherent or 
 acquired weakness or a susceptibility of the kidneys rendering them the 
 weak links in the visceral or systemic chain. It is the osteopathic idea tha£ 
 these cases, as a rule, present lesions of the spine of such a nature as to 
 interfere with the vital forces distributed to the kidneys. This, we reason, 
 is the "inherent or acquired weakness or susceptibility of the kidneys that 
 renders their weak links in the visceral chain," and that is the real cause 
 why they fall victims to the various causes ascribed as the active agents in 
 producing the disease. This explains why the poison of acute infectious; 
 diseases, as in scarlet fever, producing nephritis in certain cases, has been
 
 PRACTICE AND APPLIKD THERAPKUTICS OF OSTEOPATHY. I43 
 
 able to unbalance the already weakned urinary mechanism. The same ex- 
 planation holds good for all the ordinary active causes of the disease. It 
 seems to be the sufficient reason \vh\- one person (presumably with spinal 
 lesion) suffers from the disease while similar circumstances have failed to 
 cause it in another. 
 
 Treatment: The general treatment for nephritis, acute and chronic, 
 have been given with that for congestion of the kidneys, q. v., as stated at 
 that place. Its object, as stated, is primarily to gain vaso-motor control, 
 and thus allay inflamation, relieve vascular tension, and, through restored 
 and corrected circulation, to clear away the debris from the tubules, absorb 
 the exudates, check degenerative on new growths, and rebuild as far as pos- 
 sible the destroyed or compromised renal epithelium, 
 
 Repeated and careful analysis of the urine must be made in all cases of 
 nephritis for signs of the processes in the kidneys as directed in standard 
 medical texts. 
 
 In Acute. N^pfn-itis, aside from the main treatment already discussed, 
 . the practitioner must direct his work to the alleviatian of many of the mani- 
 I J festations of the disease. The general treatment will allay many of the 
 sK symptoms at once; others may call for special attention. Uremic symptoms, 
 . such as nausea, vomiting, headache, and pain in the back are treated as be- 
 ^y^'fore directed. For the latter, relaxation of the spinal muscles and inhibi- 
 I ^ tion 01 the sensory nerves (lOth to 12th dorsal.) Convulsions are quieted by 
 VKj inhibitive spinal treatment and by inhibition of the centers or local nerve- 
 ^ suppl)' for the affected part. The dropsy is relieved by the stimulation of 
 A the general circulation brought about by the general treatment. It is aided 
 ■^ by local treatment of the venous flow from the part affected, e. g., treatment 
 of the long and short saphenous veins, relaxation of the tissues about the 
 saphenous opening, and raising the intestines from the femoral veins, in 
 edema of the lower extremities. Suppression, if it occur, yields at once 
 generally, to thorough stimulation of the kidne}'. The lungs ifiust be stimu- 
 lated against the occurrence of bronchitis or pneumonia. Perspiration mav 
 be excited by thorough stimulation of the spinal system., heart, and lungs. 
 It is a necessary measure for the relief of the system from the accumulated 
 poisons. As a rule, it is readil}' accomplished b\- this treatment. Failino- 
 of this, recourse should be had to the hot baths, applications, packs, and the 
 use of vapor, as described in medical texts, 
 
 The A)'^/6'«6' a;i(f rt'/d'/ of nephritis patients is a most important matter. 
 These should be carefull)- looked after according to directions laid down in 
 standard works. 
 
 The patient with acute nephritis should be treated once or twice daih'. 
 More treatment, or less, may be given as the practitioner's judgment dictates. 
 In Chronic Exudativc Nephritis and Chronic Non-Exudative Ne- 
 phritis the practitioner must be constantly upon his guard. A fair number 
 ■of cases of chronic nephritis have been cured or greatl}- benefited. In the 
 
 ^
 
 144 PRACTICE VND APPI.IKD Til ERAPEUTICS OF OSTEOPATHY. 
 
 fomer, \.ht progtiosis, while guarded, is fair. The patient may be cured, or 
 be helped to enjoy a prolonged and comfortable life, In these cases the 
 practitioner may be thrown off his guard by the fact that the disease may 
 have arisen insidiousl)- without having presented n>arked sjmptoms. 
 
 In the non-exudative form the prognosis must be unfavorable, owing 
 to the very serious pathologidal changes that have taken place in the organ. 
 I'erhaps much can be done for the cop.^fort of the patient. The slow pro- 
 gress of the case renders thorough treatment useful. The patient may be 
 helped to a long and comfortable life. 
 
 Concerning /es/a?is and ircatment, little need be added to what has al- 
 reatly been said. Special manifestations of either forni may call for special 
 treatment. One must sustain the entire system, and be continuall)- upoiD 
 his guard against a suddembad turn in the case, or intercurrent maladies or 
 complications. The retinitis ntay call for some treatment of the eye local- 
 ly and through the cervical sympathetic and blood-supply. 
 
 Concerning hygiene and diet, the same remark applies as for acute ne- 
 phritis. 
 
 Chronic cases should be treated daily or three times* per week, accord- 
 ing to the needs of the individual. 
 
 CONGESTION OF THE KIDNEYS. 
 
 In both acute or arterial hyperemia and chronic or ver>ous hyperemia a 
 good PROGNOSIS can, generally speaking, be expected. This must, however^ 
 \>Q guarded \x\ ^\\ cases, especially in the chronic venous congestion second- 
 ary to heart and lung diseases. As both of these conditions of congestion) 
 of the kidney are secondary to other diseases, and as each may precede in- 
 tlammation (acute or chronic) of the kidney, much care must be taken m 
 prognosis ancrtreacment. When the condition is secondary the prognosis 
 must depend upon that for the primary disease. Yet, even though a favor- 
 able prognosis is limited by such circumstances, good results are generally 
 gotten upon the kidneys. They are very responsive to- treatment- it is 
 usually readily effective m producing fTOod effects. "While keeping in mind 
 the difficulties presented by renal cases as a class, we can yet expect im- 
 provement under the treatment. Yet, the prognosis for cure is always to be 
 guarded. 
 
 The Lesions for kidrrey diseases have beerr discussed above. In cases 
 of congestion specific lesion is expected in the vasomotor irea, 6th dorsaE 
 to 2nd lumbar. In cases secondary to other disease the lesion is that pro- 
 ducing such disease, though auxiliary lesion to the kidney is often present 
 and has weakened the organ preliminarily to its being thus affected. Though 
 cold and exposure, the toxic products of various acute diseases, and other 
 causes ma)* produce congestion directly, it is still necessary in most cases
 
 PRACTICE AND APPLl ED 'J'HERAPEUTICS OF OSTEOPATHV. I45 
 
 to account for such agents e.speciall)' attacking tlie kidnc\'s, to account for 
 the disease settling upon them. There can be no doubt that in very many 
 cases it is the presence of spinal lesion which determines the disease to the 
 kidne)'s. This hypothesis not onl\' accounts fjr tlie frequency with which 
 spinal lesions are found in such cases, but aho explains wh)' one person 
 may become the victim of Icidney disease while another under a similar set 
 of circumstances escapes. These general remarks apply with ec^uul force 
 to the subject of nephritis ne.xt considered 
 
 The Treatment has lOr its object the correction of the waso-molor 
 disturbance evident as congestion of the Icidnej's. It gains vaso-motor con- 
 trol both directly, by treatment to the kidne\'s, and indirectly, if necessary, 
 by the tre.itment of the disease to which the congestion is secondar)'. In 
 the latter case the main treatment must Ije (iirccted to the j^rimary disease. 
 The spinal lesio- to the kidne\s must alwa\ s be removed. 
 
 Treatment to gain vaso-motor control is made tlirectly upon the vaso- 
 motor innervation of the ]<idneys. This consists (in addition to the re- 
 moval of the lesion obstructing them) of spinal stimulation from the 6th 
 dorsal to the 2nd lumbar, for the vaso- motor fibres to the kidneys originat- 
 ing in this spinal area. This includes the whole splanchnic area. As stimu- 
 lation over the central ends of the splanchnics and of the great sciatic is 
 known to cause renal constriction, it is well to carry this spina! stimulation 
 down over the origin of the sciatic nerve, including the 4th and 5th lumbar 
 and the upper three sacral. 
 
 This treatment for the circulation is aidea b)- direct work over the re- 
 gion of the kidney. Deep pressure, with a spreading motion, applied at 
 the umbilicus and about rwo inches above it, stimulates tlie peritoneal nerve- 
 centers said to exist at each side of the umbilicus, it also reaches the renal 
 and supra-renal plexuses and aortico-renal ganglion, lying upon the aorta 
 and renal vessels, the plexus ramifying the kidney upon thejolood-vessels. 
 This treatment further affects the renal vessels mechanically, and relieves 
 it of tension in the surrounding tissues. 
 
 The spinal treatment should be applied especially to the region of the 
 lesser and renal splanchnic. In these various ways the kidney circulation 
 is equalized and the inflammation or congestion is reduced. 
 
 To aid in calling the blood from the kidneys and in equalizing the 
 general body circulation, general deep inhibitive work is made over the 
 abdomen to call the blood to its vessels; a general spinal and neck treat- 
 ment, particularly directed to stimulation of heart and lungs and to the in- 
 hibition of the superior cervical ganglion, tones the general circulation and 
 relieves blood-tension (through the superior cervical). 
 
 A valuable spinal treatment for stimulation of the kidneys is perform- 
 ed with the patient lying on his back. The practitioner's hands are slipped 
 palm up beneath the back, one on each side, in the region of the innerva- 
 tion of the kidneys. Now as the fingers are bent at the metacarpo-phalan-
 
 146 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 geal knuckles, making a fulcrum of the latter upon the table, the cushions 
 of the finj^ers are pressed deeply into the spinal tissues, the weight of the 
 patient is raised by the fingers thus applied, and the tissues are drawn later- 
 ally away from the spine. Quick repetetion of this movement a number 
 of times thoroughly manipulates the tissues and stimulates the nerve-con- 
 nections of the kidne\s. 
 
 The bowels and skin should be kept free and acti\e by treatment as be- 
 fore described. 
 
 The treatment thus described applies not only to congestion of the 
 kidneys, but to nephritis, next to be discussed. 
 
 In both forms of congestion of the kidneys the case must be carefully 
 looked after to obviate the danger of its passing into inflammation, acute 
 hyperemia tending to acute nephritis, the passive congestion tending to be- 
 come chronic nephritis. 
 
 The patient should be kept quiet, resting in bed, and upon a liquid diet, 
 in active hyperemia. In venous congestion a light diet must be followed. 
 The patient should drink plenty of pure water. Hot baths and hot applica- 
 tions over the kidneys, may, if necessary, be used with advantage. In the 
 acute form the patient should be seen daily; more than one treatment per 
 diem may be necessary. In the venous form daily treatment should be 
 eiven.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 147 
 
 RENAL CALCULI. 
 
 Definition: Fine or coarse concretions in the substance of the kidney 
 or in the renal pelvis resulting from precipitation of the solid constituents of 
 the urine. It is due to spinal lesion which disturbs the normal secretorj' 
 activities of the kidney and leads to the deposition of certain substances. 
 
 The Lesions and Anatomical Relations have been discussed under the 
 general consideration of renal diseases. Lesions from the loth dorsal to the 
 ist lumbar, including those of the lower two ribs, are the most frequent in these 
 cases. No pathognomonic lesion has been located for this condition. From 
 the nature of the case, any lesion interfering with the proper innervation and 
 circulation of the kidney might so interfere with normal secretions as to render 
 them disproportionate or excessive as to certain constituents. Whether the 
 stone be of uric acid or urates, of calcuim oxalate, phosphates, o*- some other 
 substance, it is clear that some cause is operating which prevents the natural 
 proportions of the renal constituents from being msintained. While, as Anders 
 states, the causes are not well known, the osteopathic view is that the real 
 cause is found in spinal lesion which deranges the vital forces underlying kid- 
 ney activity. It is as reasonable that spinal lesion should unbalance the deli- 
 cate sympathetic nerve-mechanism controlling these organs, leading to dispro- 
 portionate or excessive secretion of the urinary constituents and the precipita- 
 tion of the stone, as that spinal lesion should in a similar way disturb intestinal 
 secretion and lead to diarahoea. 
 
 The Prognosis is good, both for the removal of the stone and for the pre- 
 vention of its further formation. Immediate relief is usually given in the case 
 of renal colic, and the case is entirely cured under the treatment. The treat- 
 ment of these cases is uniformly successful. 
 
 The Treatment has as its object the removal the stone and the correction 
 of the metabolism of the kidney to prevent stones being formed again. The 
 stone may be removed in one of two ways. Correction of the activities of the 
 organ will lead to disintegration of the stone. Renal secretions dissolve kidney 
 stones. (A. T. Still.) Stones too large to pass, formed by the precipitation 
 of insoluble substances, necessitate operation. This corrective work embraces 
 the removal of lesion, and general stimulation of controlling nerves and circu- 
 lation. This is accomplished by both spinal and local abdominal treatment as 
 before described in the treatment of the kidney. Under this restorative pro- 
 cess normal urine is secreted and the stone is dis.solved. 
 
 This same procedure would prevent the formation of more calculi. It 
 would be efficient in all cases, and should be administered to cases passing renal 
 sand or gravel without pain as a prophylactic against worse conditions, and to 
 cure the case. It corrects those conditions favoring precipitation; lessens the 
 ascidity of the urine, dispels the uric acid, increases the salines, etc.
 
 I4S PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY 
 
 The stone may also be removed by manipulation of it along the ureter and 
 into the bladder. The practitioner is generally called to these cases during an 
 attack of renal colic. Under these conditions the finst step is to allay the usually 
 extreme pain. First, spinal inhibition is to be made. As the sensory innerva- 
 tion is through the sympathetic, from the loth dorsal for the upper part of the 
 ureter, while at the lower end the 1st lumbar probably supplies the structure, 
 strong inhibition (as in diarrhoea) must be made. As the pain spreads, and is 
 very likely to extend down the spine to the testacle or inner side of the thigh, 
 it is well to carry the inhibitation from the middle dorsal down over the sacrum. 
 After this treatment obdominal work is better borne. This is a very deep, firm, 
 but not rough, treatment over the course of the ureters. It is slow, inhibitive 
 and relaxative, thus helping to quiet the pain and relaxing the ureter for the 
 passage of the stone. This relaxation may be aided by inhibition of the in- 
 ferior mesenteric, spermatic, and pelvic (lower hypogastric) plexuses. This 
 treatment aids the ureter to pass the stone by mechanically working along. 
 It should be begun at a point about two inches above and two inches external- 
 ly from the umbilicus and progress diagonally downward and inward to the 
 promontory of the sacrum and as far below it as possible This treatment 
 reachei: the ureter by deep pressure of the overlying tissues down upon the 
 ureter. It must be very dee]), but slow and with the careful avoidance of any 
 violence. Usually the stone is readily parsed under the Ireatment, but some 
 cases require nearly continuous treatmen'. for a con-siderable time, three-quarters 
 of an ho'jr or more. If possible, treatment should not be stopped until the 
 stone is passed. Treatment afterwards over the sore parts may be necessary. 
 The patieni's system should be stimulated against syncope or collapse by treat- 
 ment of the heart, lungs, and cervical region. 
 
 The ])aiient should be directed to avoid red meats and those articles of 
 drink and diet favoring uric acid. He should lead a temperate life, taking 
 moderate exercise. The drinking of lemonade, soda-water, and plenty of pure 
 water is a valuable aid and in keeping the kiJneys flushed and free. 
 
 PvKLiTis, if present, must be treated (aside from the removal of the stone 
 from the pelvi^) as the inflammatory conditions of the kidney before di.scussed. 
 
 Movable Kidney (Nephroptosis, Dislocated Kidney,) may be successful- 
 ly treated by osteopathic means if it has not that extreme degree of mobility 
 known as "floating kidney." Movable kidney is the term designating ihe con- 
 dition in which the upper end of the organ may be pushed down to the level of 
 the umbilicus. The /csio?is, so far as this condition may be traced to them, are 
 of the sort producing enteroptosis, q. v. There is usually present a slight 
 curvature ofthe dorsj-lumbirspine (McCjnnell). A bid spiaal condition, or a 
 definite single lesion, compromises blood and nerve-supply of the organ and 
 its related tissues, weakens the tissues and vessels supporting it in place, and 
 allows of a prolapsus of the organ directly or by allowing other causes to oper- 
 ate. Thus it occurs as a part of enteroptosis, or from falls, heavy lifting, strain- 
 ing at stool, etc. Spinal lesions causing relaxed abdominal walls, also repeat-
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. I49 
 
 ed pregnaucies producing the same result, favor mobility of the kidney. Lesions 
 and diseases leading to extreme emaciation and consequent wasting of the 
 fatty tissues of the capsule of the kidney may cause this condition, as may also 
 tight lacing. 
 
 .Treatment: From the nature of these causes it may be seen that one's 
 chances of curing a moderate degree of movable kidney are good, the causes 
 being removable. Much the same treatment would be given as for enteroptosis. 
 The removal of spinal lesion, spinal treatment to restore tone to the support- 
 ing tissues, local treatment at the kidney to mechanically replace it and to re- 
 move the tenderness and swelling in it due to twisting of the renal vessels, and 
 abdominal treatment to restore tone in the surrounding and supporting tissues 
 would all be useful. In cases suffering from extreme emaciation attention 
 should be given to the general health and to incrersing the nutrition of the 
 body. Abdominal supporters and pads should be gradually laid aside, the 
 abdominal muscles being toned to act in their stead. The neurasthenia and 
 general nervous symptoms, indigestion, palpitation, irritable bladder, etc., call 
 for general treatment of the nervous system coupled with special treatment 
 for any particular troublesome manifestation. 
 
 The patient should have plenty of rest lying down, and should avoid over- 
 exertion, overeating, ^training at stool, etc. 
 
 CYSTITIS. 
 
 Definition: An acute or chronic inflammation of the mucous membrane 
 of the bladder. 
 
 Lesions and Anatomical Relations: Lumbar and sacral lesions pre- 
 dominate in bladder troubles. The urino-genital center occurs in the spine 
 from the 2nd to 5th lumbar, while the sensory nerve-supply to the mucous 
 membrane and neck, of the bladder, is derived from the (ist) 2nd, 3rd and 4th 
 sacral. The vescical plexus is derived from the lower end of the pelvic plexus 
 and supplies vaso-motor fibres to the blood-vessels of the bladder. Through 
 the pelvic plexus it is in connection with both lumbar sympathetic and sacral 
 nerves, hence may be subject to the effect of lumbar or sacral lesion, acting to 
 derange the blood-supply of the bladder. Such lesion weakens this circulation 
 and renders the bladder liable to the action of various causes to produce the 
 cystitis. In this way cold or exposure could cause the condition. Through 
 lesion to the motor nerves of the bladder (see Enuresis) a paresis of the bladder 
 walls may be caused, leading to cystitis. An enlarged prostate may cause 
 pressure upon the bladder and retention of urine, leading to the disease. 
 Traumatism, such as the careless use of catheter or sound, irritation of fecal 
 matter or, of a stone in the bladder, or from a pregnant uterus, may be a suf- 
 ficient cause. This is also true of septic causes of cystitis; the introduction of
 
 150 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 an unclean catheter, the poisonous products of febrile diseases, of gonorrhoea, 
 etc., becoming direct causes of the condition. Yet in many of such cases the 
 weakness of parts due to spinal lesfon precedes and predisposes to the trouble. 
 Also lesion is often the direct cause of the condition leading to cystitis, as in 
 inflammation of the surrounding organs; vaginitis, urethritis, etc. 
 
 The Treatment is to restore normal circulation. It is upon that part of 
 the spine pointed out above as related directly to the vaso-motor innervation 
 of the bladder. Lesion in these areas must be removed. Such treatment is 
 often followed by great relief at once. Local abdominal treatment over the 
 course of the internal iliac venis aids in reducing the inflammation. The ab- 
 dominal treatment must be carefully applied. It may be made over the hypo- 
 gastric plexus to aid in controlling the circulation. It should be inhibitive. 
 Inhibitive and relaxing treatment aids in quieting the pain and vescical irri- 
 tability. It also calls the blood to the abdominal vessels, away from the bladd- 
 er. An enlarged prostate must be reduced, (Chap. IX. D) and mechanical 
 irritants must be removed if possible. 
 
 For the pain and irritation of the bladder, strong inhibition should be 
 made from the ist lumbar down, especially over che 2nd, 3rd and 4th sacral 
 nerves. For the vescical and rectal tenesmus, stimulation of the lumbar, and 
 especially of the sacral region should be made after the pain is allayed. 
 
 The patient should remain lying down, as it is said that then the intra- 
 vescical pressure is but one-third as great as in the erect position. The diet 
 should be simple, avoiding highly seasoned foods and alcohol. In the early 
 stages a milk diet is recommended. The patient should drink freely of water 
 for internal irrigation of the bladder. Treatment should be given to keep 
 active the cutaneous circulation (2nd dorsal, 5th lumbar, superior cervical). 
 This is aided by general spinal treatment, by friction of the skin, and by bath- 
 ing. The bowels must be kept open and the kidneys free. The usual treat- 
 ments should be given for this purpose. Hot sitz baths aLd hot applications 
 may be employed to relieve the pain in the intervals between treatments, if 
 necessary. 
 
 The patient should be treated once or twice daily. 
 
 In the chronic case the prognosis is fair, but guarded. Treatment should 
 proceed along the lines laid down above. In this form, and in septic cystitis, 
 washing out the bladder is a valuable aid to the treatment. For the chronic 
 case boiled water, sterile normal salt solution (4060 gr. to a pint), or a weak 
 solution of mercuric cblorid (i: 50,000 or 100,000 ) are recommended. For 
 septic cases, a Saturated solution of boric acid may be used. 
 
 ENURESIS, (Incontinence of Urine). 
 
 Definition: Inability to retain the urine, A neurosis due to sacral or 
 lumbar lesion which so affects the motor nerve mechanism of the bladder as to 
 result in lack of control.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 151 
 
 Lesions and Anatomical Relations: The lesions usually occur in the 
 lower lumbar and sacral regions. They have been discussed in the beginning 
 of the chapter on renal diseases (see ante). Frequently some single lesion, as 
 of the 2nd or 5th lumbar, is found, the removal of which cures the case at 
 once. A common lesion is weakness and posterior position of the whole lum- 
 bar spine. Quite often lower dorsal lesion is found. 
 
 As the vescical plexus supplies the muscular coats of the bladder, and as 
 it is in connection, through the pelvic plexuses, with both the lumbar and 
 sacral nerves, lesions of these portions of the spine may readily affect the 
 motor activities of the bladder. This becomes more evident in the light of the 
 fact that the motor fibres of the circular muscles and sphincter of the bladder 
 are derived from the lumbar portion of the sympathetic, by way of the aortic 
 plexus, the inferior mesenteric ganglion, the hypogastric and pelvic plexuses. 
 On the other hand, the sacral nerves furnish the chief motor supply to the 
 longitudinal muscle fibres of the bladder. (Qnain.) The American Text Book 
 of Physiology states that stimulation of the sacral nerves (ist, 2nd, 3rd and 
 4th) causes a reflex contraction of the bladder. It is evident that lumbar and 
 spinal lesion may directly affect this nerve-supply. The lesion involving the 
 sphincteric center of the bladder; the paralytic incontinence; the imperfect 
 vescical innervation and paresis of the walls from over distention; the spas- 
 modic incontinence due to over action of the compressor muscle of the bladder, 
 may all arise from spinal lesion as described occuring at certain or various 
 points in the lumbar and sacral regions. This lesion ma}' cause a stoppage of 
 nerve-supply, resulting in a paralytic condition, or an irritation of the bladder. 
 The anatomical relation between lesion and disease is clear in this case. 
 
 The Prognosis is good. Very many cases have been successfully treated. 
 Generally quick results are attained. In some cases a few treatments cause 
 immediate lessening of the trouble. 
 
 Treatment: The relation of lesion to disease is .so close in this disease 
 that the first step is to remove the lesion. This may be all the treatment 
 necessary. A thorough stimulation of the lumbar and ^acral region affects 
 the nerve-connections explained above and tones the n otor mechanism of the 
 bladder. Spasmodic conditions call for thorough inhibition of thee regions. 
 Corrective spinal work restores normal conditions and allows Nature to attend 
 to the result. Abdominal treatment over the hj'pogastric plexus and over the 
 internal iliac vessels aids the case. When the condition is due to a postrating 
 disease the treatment must be directed as well to the upbuilding of the system. 
 A prolapsed uterus must be replaced, and other irritating causes removed. 
 Among the latter may be intestional worms, an elongated prepuce, etc Cir- 
 cumcision is advisable in the latter case. In neurotic children treatment must 
 be given to the general nervous system. 
 
 Note: — A case of kidney trouble is reported in which insuflSciency of urine 
 was overcome solely by stimulation of the superior cervical ganglion. A renal 
 center exists in the medulla. The treatment trebeled the amount of the urine.
 
 152 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 No Other treatment was given. Probably the general systemic vaso-constric- 
 tion set up by stimulation of the general vaso-motor center in the medulla, 
 through the treatment of the superior cervical ganglion, supplied tte increased 
 blood-pressure and arterial tension in the kidneys necessary, under the circum- 
 stances, to the activity of the organ. 
 
 DISEASES OF THE HEART' AND CIRCULATORY SYSTEM. 
 
 As in considering the disease of the urinary system, a number of cases are 
 here noted for their value in showing various facts in regard to the practice 
 upon cases of this cla.ss. They show either important lesion, the removal of 
 which cured the disease; quickness of results gained by osteopathic treatment 
 in serious or long standing cases, unrelieved by other methods of treatment; 
 and something of the variety and range of the practice in these cases. These 
 reports, as far as they go, are typical of the practice. They are not, however, 
 presented as model case reports, nor as representing the whole field of prac- 
 tice in diseases of this class. 
 
 Cases: (i) Impeded heart-action, resulting from a fall caTising spinal 
 injury and nervous shock. The marked lesion was found at the atlas. 
 
 (2) Fatty degeneration of the heart. The patient was too weak to walk; 
 the action of the heart was very weak; arrhythmia was present; great dropsy 
 of the lower limbs prevailed. The patient could sleep only by kneeling over a 
 couch with the chest supported by pillows. This position relieved irritation 
 from the lesion. Lesion was marked; there was great contracture of the mus- 
 cles from the atlas to the 6th dorsal, especially marked in the upper dorsal 
 region. The patient was very round-shouldered. These causes caused a 
 drawing together of the sternal ends of the ribs, and lessened the cavity of the 
 chest, allowing of less room for the heart's action. For two weeks the patient 
 was treated daily, and could then lie down to sleep. After one month he could 
 walk a quarter of a mile to the oflBce for treatment and return unaided. At 
 the end of a three month course of treatment he returned home to work, and 
 was well two years later. 
 
 (3) A case of extreme palpitation was relieved in fifteen minutes. 
 
 (4) Great palpitation of the heart, due to marked spinal curvature in the 
 upper dorsal and cervical regions, came upon the patient frequently. Such 
 an attack was usually treated medically with digitalis and kept the patient in 
 bed for several days. Osteopathic treatment always relieved the patient of 
 such an attack in a few minutes and the patient could go about her usual 
 duties. It was a common occurence in this case to slow the heart-beat as much 
 as twenty beats per minute, this effect not being transient, but lasting for sev- 
 eral days. 
 
 1^5) Arrhythmia and a general bad condition of the health; lesion of the
 
 PRACTICK AND APPLIED THERAPEUTICS OF OSTEOPATHY. I53 
 
 4th left rib; slight lateral lesion of the fifth lumbar vertebra. The latter was 
 probably responsible for uterine trouble present, which may have influenced 
 the heart. After two months' treatment the heart-beat was almost normal. 
 
 (6) Palpitation; a smothering sensation had occurred for many years 
 when the patient lay down. This was accompanied by pain in the heart. The 
 case so improved in three weeks under treatment that the patient could with 
 impunity drink coffee and smoke tobacco, whereas these articles had been 
 quite interdicted to him by his previous condition. 
 
 (7) A case variously diagnosed as valvular lesion, hypertrophy, angina, 
 pectoris, etc., was cured in one month by osteopathic methods. 
 
 (8) Marked arrhythmia, with nervousness and insomnia, was so bene- 
 fitted in four treatments that the heart action became normal. WithDut 
 further treatment its normal action still continued two months later. 
 
 (9) Arrhythmia, in which the patjent was very weak. The left 5th rib 
 was down upon the 6th and slightly inward. The cervical and upper thoracic 
 spinal muscles were very much contracted. The treatment was directed to 
 raising the riband relaxing the contractured muscles, and resulted in regulat- 
 ing the heart-beat in six weeks. 
 
 (10) A case of chronic endocarditis, given up by medical practice, was 
 cured in six weeks under osteopathic treatment. 
 
 (ri) Bad palpitation, of several years' standing, was cured in three 
 months. 
 
 (12) Palpitation and a complication of diseases; lesion found at the atlas 
 and in the upper dorsal spine. No palpitation occurred after the third treat- 
 ment. 
 
 (13) A case of valvular weakness reported cured in three months. 
 
 (14) Enlargement of tlie heart, mitral and aortic incompetence, and re- 
 gurgitation showed lesion in forward displacement of the ajLias, lesion of the 
 left cl avicle and upper tivo or three left ribs. Three trnatments produced much 
 improvement, one months treatment corrected the arrhythmia, and constant 
 improvement went on under treatment. 
 
 (15) A case of palpitation of the heart, with goitre, uterine disease, etc., 
 presented contracture of the spinal muscles. The clavicles were both down 
 and backward at the sternal end; there was lesion of the ist right rib and of 
 the 2d left rib; also a general dropping of the ribs which narrowed the chest 
 cavity. Lesion affected the 1st and 2d lumbar, and the pelvis was tilted. In 
 six months all lesions were corrected, and the case showed marked improve- 
 ment. 
 
 (16) Palpitation of one years' standing, attending a physical or mental 
 exertion. Sub luxation of the fiTth^rib was discovered. It was removed in 
 one treatment, and the patient suffered no further trouble. 
 
 (17) Angina pectoris after lagrippe; spinal muscles contractured; the 3d 
 to5tb ribs displaced downward. The case was cured in one month. 
 
 (18) Angina pectoris showing lesion of the 2d to 5th left ribs. The left
 
 154 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 arm could not be raised above the head without extreme paiu. Under treat- 
 ment the pains became gradually less severe, until they had practically ceased 
 at the end of two months. 
 
 (19) Pericarditis cured by correction of rib lesions. 
 
 (20) Angina pectoris, caused by 'downward displacement of the left 
 clavicle, and cured by its correction. 
 
 (21) Functional weakness; sinking spells occurred upon any exertion, 
 as in climbing stains. The left thorax was found depres.sed; the left clavicle 
 ■was displaced downward at its sternal end, while it was up and for^^ard at its 
 acromial end. All the ribs were crovi'ded together- Relief followed the first 
 treatment, and the case was cured in five weeks. 
 
 ■(22) Cardiac dilatation. In one treatment the pulse was reduced from 
 140 to no, and at the end of one month it was 80. Fainting spells, frequent 
 before, did not occur after the first treatment. 
 
 (23) Varicose veins and milk leg of fifteen years standing. The tissues 
 surrounding Hunter's canal and the saphenous opening were tense, and the 
 lumbar vertebrae were anterior. An operation had been advised, but the case 
 had been practically cured under osteopathic treatment at the time of the re- 
 port. 
 
 (24) \'aricose veins of eight years' standing. Three varicose ulcers 
 were discharging; when treatment began. Innominate lesion was discovered. 
 The case was cured in five weeks. 
 
 (25) Varicose veins, for which operation had been made without suc- 
 cess. The patient was compelled to sit with the limb elevated, and had been 
 thus for five months. The physicians found they could do nothing more, and 
 recommended continued elevation. One month of osteopathic treatment cured 
 the case. 
 
 (26 ) Weakness of the heart of three years' standing. The i)atient was 
 unable to climb stairs, and had to be assisted to the office for the fiist treat* 
 ment. The usual treatment, raisins^ the ribs, gave immediate relief. The pa- 
 tient came alone for the second treatment, and was cured in two weeks. 
 
 ( 27) Varicose veins of two years' standing. Severe and continuous pain 
 in the limb prevented sleep. The muscles over the sacrum and the lower 
 lumbar vertebrae were rigid. In one month of treatment the case showed 
 great improvement. 
 
 (28) Disturbed circulation, in which the superficial capillaries of one 
 side of the i>ody were flushed, reddening the skin, while the other half of the 
 body was pale. The line of demarkation between the halves of the body was 
 very prominent. This trouble had come upon the patient as the direct result 
 of a hard bicycle ride- Lesion was found at the fifth lumbar, and its correc- 
 cured the case. 
 
 (29) Disturbed circulation. The patient had accidentally received a hard 
 blow upon the head, and intense pain developed upon one side of the head. 
 She was unable to turn her head without turning the whole body. If she lay
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. I5J 
 
 upon the injured side great pain followed. This condition was of five years* 
 standing. Examination showed a strong contraction of the deep muscles of 
 the neck, which set up irritation of the local sympathetic, affecting the vaso- 
 constrictor fibres of the side of the head in question, causing over-contraction 
 of the vessels, setting up the pain. Treatment was directed entirely to the 
 contractured muscles and in fiv'e weeks' lime overcame the trouble entirely. 
 
 IvESiONs: In seeking the lesion and in giving the treatment in cardiac 
 diseases, certain centers, prominently connected with the normal, activities and 
 pathological manifestations of the heart, must be specially examined for lesion. 
 These centers, given below, do not always relate to specific anatomical or phys- 
 iological centers of the texts, but in some cases refer to bony points become 
 prominent in osteopathic work as locations of lesion or of places where treat- 
 ment produces special results. These are: the first rib (heart flutter); cor- 
 pora striata; 1st, 2d, 3d, 4th, 5th dorsal vertebrae; 2d to 4th dorsal (valves of 
 the heart); 3d and 4th cervical (rhythm of the heart); superior cervical gang- 
 lion (a sympathetic center); upper four or five dorsal nerves, especially the 
 2d and 3d (accelerator center); medulla (general circulatory.) 
 
 General vaso-motor centers which, with the special vaso-motor innerva- 
 tion of a given viscus; suffer from lesion in circulatory disturbances; superior 
 cervical ganglion; 2d dorsal, 5th lumbar, for general superficial capillary circu- 
 lation. 
 
 The lesions usually present in cardiac disease are: (i) of the atlas and 
 axis; (2) the cervical region generally, both muscular and bony lesion. Les- 
 ions ot the atlas, axis and cervical region affect the superior cervical gang- 
 lion and the other sympathetic supply of the heart. (3) Lesions of the clav- 
 icle are found, as are those, (4) of the 1st rib, (5) of the 2d rib, (6) of the 
 upper six ribs, especially on the left side, (7) of the upper five dorsal verte- 
 brae, (8) as a change in the general shape of the thorax, (9) of the fifth left 
 rib in particular. (10) of the diaphragm, i. e., of the lower six ribs, any or all 
 of them, and of certain portions of the spine, (p. 96 ) 
 
 Lesions were reported in twenty of the above twenty-nine ctses. This 
 number of case reports is too meagre to be used as the basis of conclusive 
 proof as to lesions in the disease, yet an analysis of the cases presents facts 
 typical of those pertaining to general practice in this line. From this stand- 
 point they are instructive. 
 
 Five of these twenty cases reporting lesion were not cardiac disease. In 
 thirteen of the fifteen cardiac cases reporting lesion, rib lesion was present. 
 These lesions are of prime importance in such diseases. They seem to be rel- 
 atively more frequent than other sorts, perhaps for the reason that they affect 
 the heart often mechanically, through alteration of the chest cavity, as well as by 
 interference with its nerve connections. A s to kind, the rib lesion is as import- 
 ant as any other lesion, while as to frequency it is of greater importance. Eight 
 of the thirteen rib lesions were of the 4th and 5th ribs, either or both, and usu- 
 ally of the left side. As a matter of fact lesions of these two are the most im-
 
 1 56 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 portant of the rib lesions. They may affect both nerve-counections and me- 
 chanical relations of the heart. The fact that the apex beat (falling at the 
 fifth interspace) may be interfered with, easily deranging the whole delicate 
 rhythm of the organ, may account in part for the frequency with which such 
 lesion causes cardiac disease. In six of the thirteen the ist and 2d rib pre- 
 sented lesion, usually on the left side. While these lesions are not so generally 
 the cause of heart disease, they are frequent and important lesions in these 
 cases. Their main effect is through disturbance of the nerve connections. The 
 first rib may derange circulation through the sub-clavian vessels, as may the 
 clavicle. In four of the fifteen cases lesion of the clavicle occurred. While 
 not frequent, these lesions may be the cause of serious trouble. 
 
 Spinal lesions, including both muscular and bony, are of the greatest im- 
 portance when it is considered that rib lesion contributes to them by distubance 
 of the spinal nerve-connections. They occur in seven of the above fifteen 
 cases. They 'act by producing derangement of the important nerve-connec- 
 tions in the upper dorsal region. From this point of view bony and muscular 
 lesions in the cervical region become significant, while not so frequently the 
 sole cau.se of heart disease, they yet often occur and derange the important 
 sympathetic nerve connections of the heart and this region. Lesions of the 
 atlas, axis, or of any of the first three or four cervical vertebral, also of the 
 rectus capitis anticus major muscle, may affect the superior cervical ganglion 
 as well as other cervical sympathetics In si.K of the fifteen cas^s cervical lesion 
 occurred, three of the six being ^ielooation of the athas. 
 
 It may be noted that practically all of the above lesions affect the heart, 
 in whole or in part, through its nerve-connections. This seems to be the most 
 important avenue over which abnormal influences travel from lesion to heart. 
 B}' working directly upon nerve distribution to the heart, irrespective of lesion, 
 important changes are readily made in its activities. Physiologically this 
 organ is markedly affected by nervous influences. It seems that a viscus 
 whose nervous equilibrium is so readily disturbed or influenced, should be 
 peculiarly susceptible to the influence of lesions to its regulative mechanism. 
 Such lesions as osteopathy considers, affecting this mechanism directly as it 
 does, must be the true cause of many pathological states. Their removal is 
 therefore a rational means of cure. 
 
 The diaphragmmatic lesion is of some importance in heart diseases, as 
 mentioned above. In four of the fifteen cases such lesion was rjresent as may 
 have affected the diaphragm. 
 
 In the cases of varicose veins reported the importance of lumbar, sacral 
 and innominate lesion becomes apparent, also of the stoppage of venous re- 
 turn. The two cases of vascular disturbance showed lesion of the cervical re- 
 gion and of the 5th lumbar vertebra, it being noticable that each came at a 
 place at which it could effect the center for superficial circulation, (Superior 
 cervical and .5th lumbar.) 
 
 In seventeen of the twenty cases benefit or cure was made in a short time,
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHV. I 5/ 
 
 considering the case. In periods varying from one or a few treatments to three 
 months results were attained in long standing or serious cases that well dem- 
 onstrated the superiority of osteopathic therapeutics. In one case the pulse 
 was reduced from 140 to no at the first treBtment, and was kept down and 
 constantly improved thereafter. In case 4 it is pointed out that the pulse could 
 be slowed as much as twenty beats per minute. Considering the fact that a 
 cardiac medicine that reduces the heart beat one per minute is a successful 
 one, it is readily seen that osteopathic control of the heart is most successful. 
 
 The Anatomical Relations between the lesion and the heart-disease 
 are made clear by the following facts : In view of them it seems that the sci- 
 ence of Osteopathy, by its methods of diagnosis, arrives at the real cause of 
 the disease. This is true also with reference to diseases in general. 
 
 The pneumogastric nerves and the sympathetics are the cardiac nerves. 
 The pneumogastric is the heart inhibitor, and its center has been definitely 
 located in the medulla. It is a well-known osteopathic fact that lesion in the 
 superior cervical region, acting through the superior cervical ganglion, may 
 disturb the centers contained in the medulla. In such case the heart may be 
 affected by disturbance of the center of cardiac inhibition. 
 
 Special details of the action of the vagus in inhibiting the heart have 
 been observed. Strong stimulation of the nerve lengthens both systole and 
 diastole, i. e. slows the beat. It also lessens the force of contraction, and 
 causes the heart to beat not only more slowly, but more weakly. At the same 
 time this stimulation results in the heart handling less blood, as the output 
 and the input of the ventricle are both diminished. The ventricular tonus is 
 diminished, and the heart dilates furher by vagus stimulation, while at the 
 same time the walls of the ventricle have been found to be softer. 
 
 Osteopathic lesion to the vagi is a demonstrated fact. In view of the 
 above functions of these nerves, it becomes at once apparent that lesion to 
 them might cause serious disturbance. An irritative lesion, keeping up stim- 
 ulation of the nerve, would permanently slow the beat, lessen cardiac force, 
 retard circulation, and possibly lead to dilated and flaccid heart. On the other 
 hand, should the lesion be of a nature to cut off or to inhibit to a degree the 
 vagal impulse normally retarding the heart within limits, the accelerator sym- 
 pathetics would be left free to run the heart too fast. In either case the re- 
 moval of the lesion to the pneumogastric would be of prime importance in 
 curing the condition. Aside from removal of lesion, osteopathic treatment of 
 the vagi has been demonstrated to influence heart action. The after effect of 
 vagus stimulation Gaskell notes to be increased force of cardiac contraction. 
 This is>an indication that upon removal of lesion Nature would make special 
 effort to repair the former deficiency of function. As it is known that section 
 of the vagus is followed by atrophy of the cardiac muscle, it would be possible 
 that serious lesion might approximate such a result. 
 
 The vagus supplies the heart by its upper and lower cervical and thoracic 
 cardiac branches, which join with the sympathetic and go to the cardiac
 
 158 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 plexus. It also has connection with the superior cervical ganglion. As this 
 nerve is known to be amenable to osteopathic treatment at many points, like- 
 wise susceptible of lesion at various places, as at the at^as, axis, and upper 
 dorsal via its sympathetic connections, along the sterno-mastoid muscle and at 
 the clavicle, its importance in relation to the cause and cure of heart disease 
 is apparent. 
 
 The cardiac depressor nerve, whose presence has been demonstrated in 
 man, as well as in various other mammals, retards heart action in a manner 
 diflerent from that of the vagus. Its stimulative impulses come from the 
 heart and act upon its sympathetic connections with the splanchnics to pro- 
 duce a reflex vaso-dilatation in the abdominal vessels. They dilate and receive 
 a large amount of blood from the general system, the general blood pressure is 
 lessened, arterial tension falls, and the heart is thus quieted. 
 
 An important avenue to the heart is through • the cervical sympathetic 
 ganglia, each of which sends a cardiac branch to the cardiac plexus. Between 
 these branches, the branches of the vagus, and the thoracic sympathetic, there 
 are numerous points of communication. Each ganglion is so situated and so 
 connected with the spinal nerves that it is susceptible to lesion. The upper 
 ganglion lies in front of the second and third cervical vertebrae and communi- 
 cates with the upper four cervical nerves. It may suffer from lesion of the 
 upper three vertebrae. Its branches of communication with the third and 4th 
 cervical nerves of ten pierce the rectus capitis auticus major muscle, on the 
 sheath of which the ganglion lies. Contracture of this muscle may act as 
 lesion to them. The middle ganglion lies in front of 6th and 7th cervical ver- 
 tebrae and connects with the 5th and 6th cervical nerves. The lower gang- 
 lion lies in front of the ist costo-vertebral articulation, and connects with the 
 7th and 8th cervical nerves. They are susceptible to lesion respectively of the 
 5th and 6th cervical vertebrae and of the 7th cervical vertebrae and the 6rst rib. 
 All three are liable to muscular lesion. Hence the importance of neck lesion 
 in cardiac disease. 
 
 The accelerator or augmentor nerves of the heart are sympathetic- They 
 are antagonistic to the vagi. That they are likely to suffer from spinal lesion 
 is at once apparent from their anatomical relations. They are derived from 
 the upper four or five dorsal nerves, especially from the 2nd and 3rd. They 
 join the sympathetic at the middle and lower cervical, perhaps also first 
 thoracic, ganglia. (Quain) The most important treatments for cardiac stimu- 
 lation or inhibition are made in the upper dorsal region, at ihe origins of these 
 nerves, by stimulation or inhibition of them. Important heart lesions occur 
 in the upper dorsal region (spine or rib) and ptobably affect the heart through 
 these conections. The connection of these glanglia with the middle and in- 
 ferior cervical ganglia lends the latter added importance in these matters. 
 
 When these accelerators are stimulated they increase ihe frequency of 
 the heart-beat from 7 to 70 per cent, but a long stimulation produces no greater 
 acceleration than a short one. This marked increase in the pulse is quickly
 
 PRACTICE AND APPLIKD THERAPEUTICS OF OSTEOPATHY. I 59 
 
 apparent under osteopathic stimulation of the accelerators. Further results 
 of stimulating them are an increased force of the ventricular beat, the ventri- 
 cles are more completely fi'led by the auricles and thei^ volume is increased. 
 The strength and volume of the auricular contractions are also increased. 
 Hence our treatment both quickens and invigorates the heat muscle. 
 
 Lesions of the lower cervical, upper dorsal, or upper thoracic (rib) region 
 might be of such a nature as to maintain continual stimulation of the accelera- 
 tors, lead to permanently quickened and strengthened heart-beat, and produce 
 such an affect as hypertrophy of the heart. Or the lesion might cut ofif or 
 lessen the accelerator impulse, leading to abnormally slow heart-beat, lack of 
 strength of heart action, etc. Hence the importance of correcting lesion in 
 these regions. 
 
 Jacobson (in Hilton's "Rest and Pain") points out that the cardiac plexus, 
 through the aortic plexus, is connected with the 4th, 5th, and 6th spinal nerves. 
 This fact may in part explain the importance of lesion of the 4th and 5th ribs 
 in heart disease. The ist, 2nd and 3rd spinal nerves, through the sympathetic, 
 supply sensory fibers to the heart. (Quain) The above facts explain why 
 secondary lesion as contractured muscles may occur along the upper dorsal 
 spine as far as the 6th in cardiac disease.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 163 
 
 ANATOMICAL RELATIONS. Continued. 
 
 The cardiac plexus is made up of the cardiac branches of the vagus 
 and from the cervical ganglia, whose functions and relations to cardiac 
 disease were pointed out above. This plexus suffers from lesion of those 
 nerves, and is the medium through which such lesion acts upon the heart. 
 The right and left coronarj' plexuses derived from the cardiac, supply the 
 coronary arteries. Lesion to them, through the cardiac, would influence 
 nutrition and circulation in the heart substance. 
 
 The intercostal nerves may become important paths of transmission of 
 the effects of lesion to the heart. It is well known that rib lesions are 
 among the most frequent causes of heart-disease. Possibl)- much of their 
 influence is by irritation to the intercostal nerves. These nerves are the 
 anterior primary branches of the spinal nerves, and the ramus communicans 
 from each thoracic sympathetic ganglion passes directly to the intercostal, 
 nerve corresponding. As shown above, the heart is in connection with the 
 upper six dorsal nerves through its sympathetic supply. The upper four 
 or five give origin to the accelerators. The ist, 2nd, and 3rd contribute 
 sensory branches to the heart. The 4th, 5th, and 6th connect with the 
 cardiac plexus through the aortic. Hence, on account of this direct con- 
 nection between heart and the anterior primary divisions of the upper six 
 dorsal nerves the immediate effect of lesion in this portion of the thorax 
 might be upon the heart. Hence the importance of luxateil ribs, sore 
 and contractured intercostal muscles, a narrowed chest and changed shape 
 of the thorax. These facts emphasize the importance of the maintainence 
 of free thoracic play in the maintainence of the health of the thoracic 
 \iscera. 
 
 A general changed shape of the thorax ma)' have its bearing upon the 
 etiology of cardiac trouble in other ways. The total intercostal circulation 
 represents a considerable portion of the general circulation. If this whole 
 circulation be obstructed, as may occur in those conditions in which a gen- 
 eral alteration in the shape of the thorax has produced narrowing of the 
 intercostal spaces, the heart must be put to greater exertion to force the 
 blood through this area of obstructed vessels. Furthermore, such a con- 
 dition of narrowed thorax is just the one pointed out as the cause of lesion 
 to the diaphragm which obstructs the flow of blood through the aorta and 
 still further embarrases the heart, Take these obstructions to intercostal 
 and aortic circulation in conjunction with rib lesions to intercostal nerves^ 
 a frequent occurance. and it could hardly result otherwise than that cardiac 
 derangement must follow. 
 
 The phrenic nerve innervates both heart and diaphragm. Lesion to it 
 may affect this organ, or treatment of it may aid in cardiac cases. It is 
 joined by branches from the middle or lower cervical sympathetic ganglia
 
 164 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 and from the ihoracic sympathetic, both of which are connected with the 
 heart innervation. It perforates the diaphragm and joins the abdominal 
 sympathetic. It supplies the right pericardium, the right auricle, and the 
 inferior vena cava. Perhaps it, a motor nerve, coordinates the activities of 
 of heart and diaphragm, so closely related in function. Its inhibition is 
 our common method of relaxing the diaphragm in hiccough. 
 
 Its inhibition would be important in securing a lax or quiet diaphragm» 
 so desirable in the treatment of certain forms of cardiac diseases, the more 
 so as it ma\' likely be suffering from the irritation of the disease affecting 
 the heart or its coverings. 
 
 Clavicular lesion ma\' affect the subclavian vessels, dam back the flow 
 of blootl through the artery, or b) preventing the return flow through the 
 vein cause the pciodic loss of a heart-beat through insufificient filling of 
 the organ. 
 
 The intimate relations between the cardiac nerves and the general ner- 
 vous s\stem is seen in the fact that stimulation of the sciatic increases the 
 force ai?d freciuenc)' of the heart-beat, while stimulation of the abdominal 
 s\mpathetics inhibits heart-action. These facts are of \alue in treatment 
 for the general circulation. 
 
 PERICARDITIS. 
 
 Under osteopethic treatment ihepro^>ios/s iov cure is good in the dry or 
 plastic form and in that with serous effusion. In the purulent form, and in 
 chronic adhesive pericarditis the prognosis must be unfavorable, though 
 much might be done to benefit the patient's condition. 
 
 The Lesions affect the blood-supply b)' derangement of the spinal 
 s)mpathetics. Irritative nb lesions, bringing pressure directly upon the 
 heart, cause the disease by mechanical irritation of the pericardium. This 
 is especially likel)- to occur in lesion to the fourth and fifth left ribs, they 
 occuring at the site of apex beat where the greater range of motion is more 
 likely to be interfered with by narrowing of the thoracic cavit)- or by in- 
 ward displacement of tliese ribs. Lesions to the subclavian vein at the first 
 rib or clavicle, and to the anterior intercostal vessels, preventing venous 
 drainage of the pericardium, may predispose to the condition. A natrowed 
 thoracic cavity and a deranged diaphragm may, by pressure or traction up- 
 on the pericardium, allow special causes to set up irritation and inflamma- 
 tion in the structure. These various 1 .-sions may la\- the foundation for the 
 disease, some special acti\e acause producing it directlw Thus spinal and 
 other lesion to the cardiac nerves weakens the tissues and lajs them liable 
 to the effect of such diseases as rheumatism, gout, scarlatina, influenza, 
 etc., secondaril)' to which pericarditis occurs. In such cases also attention 
 must be given 'o the lesion accountable for the primar\- disease.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 165 
 
 In the TREATMENT the patient must be kept at rest in the recumbens posi- 
 tion to aid in slowing the beat of the heart. This object is directly accom- 
 plished by stimulation of the vagi and inhibition of the accelerators. The 
 former is treated by manipulation along its course behind the sterno-mastoid 
 mnscle. Inhibition of the accelerators is applied along the spine from the 
 6th cervical to the 5th dorsal. With the patient lying upon his back the 
 left arm is raised and held well above and behind the head, while steady 
 pressure is applied along the upper dorsal region as far down as the fifth 
 vertebra. 
 
 The lesion must be removed. The ribs may be carefully raised to free 
 the venous circulation through the internal mammary veins, which drain 
 the anterior intercostal veins. This aids in allaying the inflammation, as 
 does all the] inhibitive abdominal treatment by drawing the blood to the 
 abdomen. The latter operation is assisted by inhibition along the splan- 
 chnics at the spine. Calling the blood to the abdomen not only aids in 
 allaying the inflammation, but may very likely slow the heart by decreas- 
 ing arterial tension. As this reflex dilatation of the abdominal veins is a 
 result the same as that produced by the heart depressor nerve in function- 
 ing to quiet the heart, it is supposable that treatment given to dilate these 
 vessels produces a result similar to that resulting from depressor nerve 
 action. 
 
 As all the ribs are carefully raised to expand the thorax and give free- 
 dom to the heart, the various intercostal muscles should be gently mani- 
 fested and relaxed. On account of the close connection pointed out above 
 between the intercostal ner\'es and the sympathetics connected with the 
 heart, it is probable that reflex sensations are transmitted from the diseased 
 cardiac apparatus to the intercostal nerves, leading to a contractured con- 
 dition of the intercostal muscles generally. 
 
 The phrenic nerves should be inhibited to relax the diaphragm, (and 
 pericardium (?) which it supplies.) This treatment is the more important 
 in pericarditis, as the diaphragm is probably irritated by the inflammation in 
 the pericardium directly contiguous to it. Irritation would mean contrac- 
 ture. This relaxation of the diaphragm would aid in quieting the heart 
 and in relieving the whole local condition. The desirabilit)- of securing a 
 lax state of diaphragm and pericardium in the treatment of pericarditis is 
 suggested b}- Hilton. 
 
 The pain about the heart is lessened by the whole treatment. Direct 
 treatment may be made for it by inhibition of the ist, 2nd, and 3rd dorsal 
 nerves (sensory to the heart), and the 4th, 5th, and 6sh dorsal nerves, which 
 apparently convey sensory impressions from the heart. 
 
 The dyspnea is relieved by the allaying of the inflammation, quieting the 
 heart, and raising of all the ribs. Effusion is prevented or resorbed by 
 keeping up free circulation, especially after the acute stage for the latter 
 object. If necessary, the ice-bag may be applied to the precordial region
 
 l66 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 to allay the inflammation. Its use may become necessary in the intervals 
 between treatment. The diet should be of milk and broths during the acute 
 stage. Later it should be light. 
 
 Treatment should be given dail\'. More than one treatment/^;- diem 
 may be necessary, especially attention to various phases. 
 
 PALPITATION. 
 
 Definition: A paroxysmal rapidit)- of heart-action, perceptible to 
 the patient, and usually accompanied by increased force, disturbed rhythm, 
 precordial distress, anxiety, and dyspnea. This condition is caused by 
 special lesion, usually a bon\- one, that interferes with the nerve-mechanism 
 or with the heart mechanically. This, and the so-called neuroses of the 
 heart, are, from the osteopathic standpoint, neuroses mainly because of 
 their being caused by disturbed nerve-mechanism of the organ. This is no 
 more nor less true in such diseases than in the general diseases of the heart. 
 
 Lesions and Anatomical Relations have been discussed in a general 
 way above. An examination of the several cases of palpitation reported at 
 the beginning of the chapter shows a wide range of lesion, namely from the 
 atlas to the last rib, when considering as a lesion producing this condition 
 these changes in the shape of the thorax and those lesions of the lower six 
 ribs responsible for lesion of the diaphragm embarrasing the heaj-t. These 
 lesions may act by disturbing the nerve-connections of the heart, by occlud- 
 ing certain vascular areas or single vessels, or by direct mechanical pressure 
 upon the heart. Lesions of the clavicle and first rib are frequent, and they 
 by damming back the blood in the sub-clavian artery, may cause periods of 
 labored beat of the heart to force it through. Or by lessening venous flow 
 from the sub-clavian vein such lesion may cause a paroxysm of rapid beat- 
 ing of the heart in the endeavor to fill itself. Cervical and upper dorsal 
 lesions, curvatures of the upper spine, lesions of the upper five ribs, and 
 general contracture of the spinal muscles could all act as irritants upon the 
 accelerator sympatbetics noted as rising from the upper four or fi\e dorsal 
 nerves and passing to the middle and lower cervical sympathetic ganglia. 
 Stimulation of these accelerators thus caused could produce the rapid beat- 
 ing of the heart found in palpitation. This class of lesion i^- most frequent 
 in these cases. 
 
 Atlas lesion may affect the heart through the superior cervical ganglion 
 and its upper cardiac branch. But through this ganglion such lesion is able 
 to affect the inhibitory center in the medulla, or it may'affect the vagus it- 
 self by way of its sympathetic connections with the ganglion mentioned. 
 The result is over-activity of the inhibitor function of the vagus and the 
 rapid beat thus allowed as the result of unapposed activity of the accelera- 
 tor. This style of lesion is not a frequent cause of palpitation.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHS. 167 
 
 It may be argued that as bony lesions are by nature continuous, the 
 paroxysmal rapidit)- of the heart in palpitation could not be thus ciused, 
 that the effect of this continuous lesion must itself be continuous as oppos- 
 ed to paroxysmal. Such is not the case, however. The lesion may not be 
 so excessive in degree as to keep up continual irritation. Its irritation may 
 become active only in certain motions or postures of the affected parts. It 
 may be th:?neuropathic bass weakening the nerve tissues and leaving the heart 
 liable to the effects of special emotions, stimulants, etc. The lesion might 
 t.\cn per se be of a nature to cause continuous irritation and yet its effects 
 not be continually apparent as rapid heart-beat on account of the natural 
 variation in the activity of the accelerator centers and in the condition of 
 the nervous S}'stem. 
 
 Luxation of the fifth left rib mechanically irritates the heart and causes 
 palpitation. Occuring as it does at the site of the apex-beat, it is just as 
 likel}' a cause of palpitation as is the pressure from a stomach dilated with 
 gas. Displacement of this rib and of the 4th is a common cause of palpita- 
 tion. Rib lesions in general are quite apt to be found in cases in which pal- 
 pitation is brought on by slight muscular exertion. The movable rib, be- 
 ing luxated, is readily thrown into an exaggerated condition of lesion upon 
 muscular effort. Cases are continuall\' met in which some special form of 
 muscular activity, perhaps necessitated b)- the patient's occupation, has first 
 caused the displacement and has then bcome the repeatedly-acting cause 
 of the various attacks of palpitation which have folio ved. 
 
 A frequent and serious cause of heart disease in general, as well as of 
 palpitation in particular, is found in a general downward luxation 01 the 
 ribs resulting in a narrowed thorax. Such a condition becomes a three-fold 
 lesion. Looked at as the cause of palpitation it acts: (1) By partially oc- 
 cluding the calibre of the arteries in the total intercostal area, aggregating 
 a considerable vascular total. (2) By causing lesion to the diaphragm of a 
 nature allowing it to constrict the aorta. As a result of all this arterial ob- 
 struction the heart labors (palpitation) to force the blood along its accustom- 
 ed channels. (3) B\' irritation to the intercostal nerves in the narrowed in- 
 tercostal spaces. The upper six of these nerves, as above explained, are in 
 direct sympathetic connection with the heart and convey to it the irritation 
 engendered in the intercostal spaces, causing it to palpitate. 
 
 It will be noted that chronic heart sufferers are very often the posses- 
 sors of flat chests and narrowed thora.xes. 
 
 Dyspepsia, flatulence and diseased abdominal organs often reflcxly set 
 up palpitation. It may be that both effects are the results of a common le- 
 sion, i. e., one to the splanchnic nerves (abdominall)' or spinall)')- It has 
 been explained that the depressor nerve of the heart acts reflexly through 
 the splanchnics to produce vaso-dilatation in the great abdominal vascular 
 area, "bleeding the patient into his own veins," and cause a fall of blood-pres- 
 sure with a quieting of the heart. On the other hand, splanchnic lesion
 
 l68 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 may set up intense vaso-constriction in this area, oppose the circulation of 
 the blood in this way, and cause the labored beat or palpitation of the heart 
 to force the blood through. 
 
 The common cause assigned for palpitation, such as a strong emotion, 
 the use of tea, coffee, tobacco, and alcohol; reflex disturbances from the 
 ovaries, uterus, and other pelvic organs, etc., seem to be but incidental. 
 There must be some cause determining the effects of these agents upon the 
 heart. Otherwise it is hard to explain why these things effect one patient's 
 heart and not that of another. The real cause weakening the heart and al- 
 lowing these incidental causes to disturb it lies in the anatomical weak point 
 affecting the organ or its connections. A multitude of cases cured by re- 
 placement of a displaced rib, or the like, leads to the conclusion that these 
 so-called causes had little to do with the real cause; cf case 6 above, in which 
 three week's treatment cured palpitation of many year's standing, and 
 rendered the patient immune to the effects of coffee and tobacco, which be- 
 fore he could not use. 
 
 In cases where the palpitation is purel)' secondary, as in anemia, from 
 the changed state of the blood, and in acute infections diseases, from the 
 irritation of toxic substances circulating in the blood, the lesions belong to 
 the primar)' disease. 
 
 The Prognosis is good. The most marked and long standing cases 
 have yielded readily to treatment. The case is generally relieved at once 
 and soon cured. 
 
 The Treatment at the time of attack must look at once to quieting the 
 the nerve irritation that is causing the trouble, (i) Often the immediate 
 removal of the lesion is practicable and is the sole treatment necessary. 
 
 (2) Inhibition of the accelerators in the manner described in detail in 
 the previous pages is the most efficient method of at once relieving the pal- 
 pitation. Considerable pressure may be applied to the accelerator area of 
 the spine, the left arm meanwhile being strongly held above the head (see 
 Pericarditis). Steady pressure at each point along these nerves for several 
 minutes is necessary. During this treatment one hand is slipped beneath the 
 patient, the arm may be held down above the head against the table by the 
 pressure of the practitioner's trunk against it, while with his free hand 
 relaxes the intercostal tissues all about the precordial region. This is to 
 release contractions in the intercostal muscles set up by the irritation carri- 
 ed from the cardiac plexus to the upper intercostal nerves, with which it is 
 closely connected. 
 
 (3) Stimulation of the pneumogastric nerves in the neck aids in inhibit 
 the heart action (IV, Chap. IV). 
 
 (4) Stimulalion of the abdominal sj'mpathetics, by a quick treatment, 
 will aid in inhibiting the heart bert. A better method, however, is to dilate 
 the vast abdominal vascular system by the deep, inhibitive abdominal treat- 
 ment. This drains the blood into the abdomen, decreases general arterial
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 169 
 
 tension, and quiets the heart. It is the exact orocess b}' which the depressor 
 nerve quiets the heart, and may possibly cause it to function, Strong in- 
 hibition of the spinal splanchnics aids this process. 
 
 (5) All the ribs should be carefully elevated to allow free play to re- 
 spiration and heart. The dyspnea is a reflex from the disturbed heart. It 
 is relieved by this treatment, and by the relieving of the heart. 
 
 (6) Other sources of irritation, as anemia, pelvic disease, etc., call for 
 special treatment. 
 
 (7) Upon the attack the patient should be laid upon his back at once, 
 and the clothing about the chest and neck should be loosened. Treatment 
 (2) should be at once applied. In case of necessity during the practitioner's 
 absence an ice-bag applied to the precordial region is a good domestic rem- 
 edy. The patient may swallow bits of ice or drink plentifully of cold 
 water. Hot and somewhat stimulating drinks are recommended. 
 
 If the attacks are frequent or persistent the treatment must be often 
 given. In treatment to prevent the recurrence of attacks a course of treat- 
 ment may be carried out aiong the lines laid down. Special attention would 
 naturally be given the lesion. Heart action and circulation would be built 
 np, etc. 
 
 TACHYCARDIA, BRACHYCARDIAANDARRHYTHMIA. 
 
 The first is a rapid beating of the heart in paroxysms of variable 
 duration, unaccompanied by any marked subjective sensations. The sec- 
 ond is an abnormal slowness of the heart, temporary or permanent. The 
 third is irregular beating of the heart, the irregularity being manifest in 
 volume and force only, in time only, or in both in various combinations, 
 presenting various peculiarities. 
 
 The lesion and its mode of causing disease described for palpitation 
 are essentially the same for these three manifestations of disturbance to 
 the cardiac mechanism. The treatment, also, would proceed along the 
 same general lines there laid down, being varied to suit the requirements of 
 the disease and of the individual case. As a matter of fact the lesions 
 found as the actual causes of these different diseases are practically the 
 same in kind, affect the same areas, nerve connections, and vascular rela- 
 tions, but differ in degree, in concentration upon a particular region, e. g., 
 chiefly upon the accelerators in the upper dorsal region to produce tachy- 
 cardia, and therefore in the particular manifestation or results of their pres- 
 ence. 
 
 It is natural that these lesions producing palpitation should be greater 
 in degree and more continuous and severe in action, thus producing tachy- 
 cardia; that upper dorsal lesion should so excessively affect the accelerators 
 as to permanently inhibit their activity to a degree great enough to cause
 
 i;0 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY 
 
 • 
 
 brachycardia, or that the periodic or irregular manifestations of such lesion 
 should produce arrhythmia. The latter is generally a feature of ordinary 
 palpitation. In the same way arterial, venous, or other nerve lesion might 
 become the cause of either disease. In other words, a purely osteopathic 
 classification of diseases would regard these conditions as essentially the 
 same, both as to lesion and as to general manner of treatment. 
 
 The fact that tachycardia is looked upon as being a manifestation of 
 paral\sis of the pneumogastric or stimulation of the s}-mpathetic is signifi- 
 cant from the osteopathic view point. 
 
 The />/v^;/(?jv.y for these conditions is ordinaril)- good. The results at- 
 tained are ver}' satisfactory and cases are often readily cured. The fact 
 that they are frequently symptomatic of other disease, or secondary thereto, 
 makes the prognosis and treatment depend upon the primary condition. 
 When, as is often the case, they are found to depend upon specific remov- 
 able lesion the prognosis is good. It is not good when organic heart dis- 
 ease is present. 
 
 The treatment for these conditions must be primarily the removal of 
 lesion or irritating cause, or the treatment of the primary disease to which 
 either ma\' be secondary or symptomatic. That for tachycardia and arrhy- 
 thmia is practically that for palpitation. The treatment for brachycardia 
 is mainly stimulation of the accelerators. In the treatment of brachycardia 
 or the tachycardia following acute infectious disease, e. g., typhoid fever, 
 the excretory organs must be stimulated to free the system of poison, and 
 the centers controlling the activities of the heart must be built up, as they 
 have been invaded by the poison of the disease. In brachjxardia the heart 
 and lungs must be kept stimulated against the occurrence of syncope or 
 physical prostration. Treatment in the intervals ma)' be directed to up- 
 building the general health, mechanical correction of the body, etc. 
 
 ANGINA PECTORIS. 
 
 Definition: Paroxisms of \iolent pain in the pecordial region, ex- 
 tending to the neck, back and arms, and accompanied b>' a sense of impend- 
 ing death. It is said to be largel)' symptomatic. 
 
 The lesions piesented in the above cases were main!)' to the left ribs 
 over the heart. One case showed lesion to the left clavicle, affecting the 
 subclavian circulation. Another case is reported with the lesion as a spread- 
 ing of the sixth and seventh left ribs anteriorly. Lesions to the ribs over 
 the heart are very common in this disease. The upper dorsal spine is often 
 affected. The nature of the pain of angina pectoris is not well understood. 
 Upper dorsal lesion ma)- irritate the sensory nerves of the heart, (ist, 2d, 
 and 3d dorsal.) The irritation of the lesion upon the heart may result in a 
 neurosis of the sensory branches of the vagi. Other lesion to the vagi
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. I71 
 
 through their sympathetic connections may cause it. Some writers ad- 
 vance the theory that an aortitis is present and causes it. A deranged 
 nerve-mechanism as the result of spinal, rib and other lesion, seems suffi- 
 cient, from an osteopathic point of view, to cause this disturbance. The 
 fact that it is usually associated with some form of organic heart lesion, ar- 
 terio-sclerosis, etc., is not contrary to the idea that bony lesion is at bottom 
 the cause of the whole bad condition. 
 
 The. prognosis must be guarded because of the frequent presence of or- 
 ganic heart disease m cases manifesting angina pectoris. The prognosis 
 for relief is good, and cases are often entirely cured. 
 
 The treatment consists mainly in relieving the pain. This may be best 
 accomplished by raising the left lower ribs in the region of the heart, es- 
 pecially incase of lesion here, by adopting the motion described for inhi- 
 bition of the accelerators, bringing pressure over the upper three spinal 
 nerves (cardiac sensor)-) at the same time, and also relaxing the tissues of 
 the pecordial region, with additional inhibition of the pneumogastric nerves. 
 
 Spinal inhibition ma\'be carried down along the spine as low as the 6th 
 dorsal ner\'e. Inhibition should be made upon the local nerves of the parts 
 to which the pain has radiated, as to the brachial plexus, the cervical and 
 spinal nerves, etc. 
 
 A general course of treatment, should be giqen to strengthen the pa- 
 tient's general health, to correct heart-action, and to remove all lesions. In 
 this way much may be done to prevent the recurrence of the attacks, The 
 patient should lead a quiet life free from physical, mental and emotional 
 extremes. In case of emergency the use of the ice bag, or of hot appli- 
 cations over the heart ma\' be useful. 
 
 ENDOCARDITIS AND MYOCARDITIS. 
 
 These are inflammations of the endocardium and of the heart muscle, 
 attended b)' various pathological and degenerative changes in the part at- 
 tacked. The extent to which the pathological changes go in most of these 
 cases renders a cure hopeless. All forms of these diseases are apt to pro- 
 duce serious valvular lesions. Aside from simple acute endocarditis, death 
 is immanent in most of these cases, yet much may be done in individual 
 cases to alleviate conditions and to prolong life. 
 
 The Lesions and Anatomical Relations as pointed out at the open- 
 ing of the chapter apply here. It is seldom that mj'ocarditis or an)- of the 
 several forms of endocarditis seems to occur idiopathically. How far the 
 actual causes of these diseases may be shown, from the accumulation of 
 osteopathic data, to be specific osteopathic lesions to the heart remains to 
 the future to decide. The accepted cause of these conditions generally is 
 the irritation of the organ by the poisonous products of disease. Acute
 
 172 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 articular rheumatism is made accountable for 40 per cent of simple acute 
 endocarditis. Rheumatism, malaria, scarlet fever, pulmonary tuberculosis, 
 syphilis, gout, lead poisoning, etc., are looked upon as the primary diseases 
 in which poisonous products are generated and cause endocarditis or myo- 
 carditis as a secondary condition. Various other causes are assigned. 
 
 While poison in the system is admitted by the Osteopath to be suf^- 
 cient cause of disease, it seems likely that specific lesion to the cardiac ap- 
 paratus has much to do in weakening the heart and laying it liable to the 
 invasion of these diseases. Circulation to the substance of the heart is un- 
 der control of the coronary plexuses, derived from the cardiac plexus. 
 Lesion to the latter through its spinal connections may affect the former 
 and disturb the nutrition of the organ. The same result maybe produced 
 by lesion to the pneumogastries, said to contain vaso-motor fibers to the 
 heart and to have charge of trophic condition. It is obvious that the usual 
 cardiac lesions may predispose the heart to these diseases. The direct irri- 
 tation of the left ribs upon the heart, when they are displaced, may directly 
 cause pericarditis and myocarditis. As medical etiolog)' lays most of these 
 cases to the action of bacteria, it is reasonable to conclude that some direct 
 lesion to the heart deteriorates the vitality of its tissues and allows them 
 to gain a footholdj 
 
 This conclusion is strengthened by the fact that endocarditis some- 
 times follows chronic wasting diseases, such as diabetes and gleetj 
 The fact that chronic endocarditis may be due to mechanicel influ- 
 ences, may be caused by heavy muscular effort, straining, etc , and the 
 further fact that myocarditis is ascribed by Anders to injuries of the antero- 
 lateral thoracic region emphasizes the idea that mechanical lesions regarded 
 as important by the Osteopath may directl)- cause these conditions. 
 
 The Prognosis for simple acute endocarditis is good. It depends 
 some upon the primar)- disease. The prognosis for chronic and ulcerative 
 endocarditis and for myocarditis is grave. If specific lesion is found and 
 may be removed, perhaps much may be done for the case — generally speak- 
 ing, much may be done in all of these cases to limit the disease and to pro- 
 long life. Chronic endocarditis has been cured. 
 
 The Treatment is practicall)' that described for pericarditis, q. v. 
 Knowledge of the nerve and blood-supply and of lesions gives one the ke\' 
 to the situation. The lesion and all cause of irritation must be removed, 
 and the patient, in the acute stages, is kept in bed to keep the heart quiet. In- 
 hibition of the accelerators and stimulation of the vagi is done as directed. 
 The ribs are raised to give the best freedom, and the abdominal treatment 
 may be applied to draw the blood away from the heart and aid in keeping it 
 quiet. 
 
 Strict attention must be given the primary disease. In those generat- 
 ing toxins in the system the bowels, kidne)S and liver are stimulated to ex- 
 crete the poisons. In the chronic forms the heart and its connected nerves
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY, I 73 
 
 may be carefully stimulated to increase its tone and nutrition. The vege- 
 tation in acute endocarditus may be absorbed. 
 
 Prophylactic treatment in rheumatism aud in those diseases leading to 
 these conditions consists in keeping the heart well stimulated, and in main- 
 taining free action of kidneys and bowels to excrete the poison. 
 
 VALVULAR DISEASES. 
 
 The prog?iosis in cases oi this kind is not generally favorable. Asa 
 rule, valvular disease is incurable. Yet some cases may be cured, and a 
 fair number have been cured by osteopathic treatment. In cases not cura- 
 ble much may be done to better the patient's condition. Cases caused by 
 simple dilatation or diminished contractile power may be cured. Also 
 when occuring in simple acute endocarditis the prognosis for cure is good. 
 
 Lesions: In many cases of valvular lesion, in the left heart especially, 
 the lesions present would be as described for endocarditis, to which disease 
 these may be secondary, In tricuspid insufficiency due to obstructed pul- 
 monary circuit lesion to the lung, as described in the chapter on lung dis- 
 eases, may cause the valvular trouble. 
 
 In aortic stenosis from increased tension in the aorta the condition may 
 be due to lesion to the diaphragm as explained impeding circulation through 
 the aorta. The same result may follow extensive arterial obstruction, as of 
 all the intercostals, the sub-clavians, the abdominals, etc., as explained 
 under Anatomical Relations at the opening of this chapter, r\ortic valvular 
 lesions due to heavy muscular strains, etc., may be due to the presence of 
 some one of the various lesions described as affecting the heart, which 
 forms a predisposing cause. Lesions to the vagus and to the sympathetic 
 supply of the heart may lead to lack of tone and diminished contractile 
 power (See gen. anatomical relations) which sometimes causes valvular dis- 
 ease. General lesions to the cardiac mechanism, as of upper vertebrae, ribs, 
 diaphragm, vagi and sympathetics, doubtless weaken the heart and act as 
 predisposing causes to the valvular lesion which so frequently follows other 
 disease. 
 
 The Treatment in ordinary cases would be to sustain the heart and to 
 maintain compensation. It should look to the removal of an)' lesion, or of 
 any obstruction to the blood-current, especially in tricuspid insufficiency 
 caused by obstructed pulmonary circulation, and in aortic stenosis due to 
 increased tension in the aorta. Diaphrammatic lesion or important arterial 
 obstruction may be present. In the obstructed pulmonary circulation the 
 lungs should be kept stimulated and any lesion to the lung should be re- 
 moved. In cases in athletes or due to heavy muscular strains one should 
 suspect the presence of definite spinal or rib lesion due to such activities.
 
 1/4 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 The primary disease which may be causing the trouble calls for treatment 
 according to its kind. In diminished contractile power or dilatation of the 
 left ventricle causing mitral insufficiency the accelerators, should be stimu- 
 lated, as this increases cardiac tonus and strenghth of beat, and contracts 
 the heart. In such cases lesion should be suspected to the vagus, as lesion 
 to bhis nerve may diminish ventricular tonus, dilate the heart, and weaken 
 its walls. 
 
 In all such cases the patient should lead a quiet life, free from excite- 
 ment or great exertion. He should be much out of doors, and live upon 
 a light nutritious diet. He should avoid straining at stool, exposure, the 
 use of alcohol, tobacco, etc. Bathing is recommended with exception of 
 Turkish baths. 
 
 HYPERTROPHY OF THE HEART. 
 
 In these conditions the prognosis is fair. Much may be done to main- 
 tain the patient in a state of comfortable health, preventing dilatation. 
 Cases may sometimes be cured by osteopathic theropeutics. The prognosis 
 depends upon that for the condtion producing the hypertroph\-. In such 
 forms of valvulaf diseases as are curable it ma\' be cured. In cases due to 
 exophthalmic goitre it ma}' be curable. 
 
 Such LESIONS as before described in cardiac disease may affect the 
 nerve connections, etc., of the cardiac mechanism, and cause or predispose 
 to the condition. A common cause is obstruction to the circulation through 
 the small arteries. In the light of such fact, lesions before pointed out 
 causing obstructed pulmonary circulation, obstructed aorta, intercostals, 
 subclavians, abdominals, etc., are important. As the heart hypertrophies 
 in valvular disease frequently-, lesions would ha\e to be sought according 
 to primary conditions. 
 
 Lesion to the sympathetics, as in exophthalmic goitre, causing hyper- 
 trophy are important. Lesion to vagi and accelerators, resulting in over- 
 activity of the heart ma)- cause hypertrophy. When such simple causes as 
 the use of alcohol, coffee, tobacco, etc., and lead poisoning, etc., are alleg- 
 ed, one is bound to suspect one of the ordinary lesions present as the real 
 cause allowing the heart to be affected by such agents. 
 
 The Treatmen'j" looks to be removal lesion, obstruction to the blood 
 flow, etc. It is directed to the primar\- disease when the hypertrophy, as 
 is the rule, is a secondary condition. The circulation through the lungs 
 should be kept free. The patient should remain quiet. Attention should 
 be given the ss-mpathetics to slow the beat as much as possible. 
 
 The patient should lead a quiet life, free from excitement. His diet 
 should be chosen with care, and he should particularly a\oid overeating, 
 alcohol, coffee, etc.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. I75. 
 
 DILATATION OF THE HEART. 
 
 Definition: There may be simple dilatation of a cavity, causing in- 
 crease in its size and thinning of its walls. The dilatation ma)- be accom- 
 panied with hypertrophy, in which there is both increase in the size of the 
 cavity and in the thickness of the muscular wall. 
 
 As to CAUSES, the lesions as discussed would be sufficient. No specific 
 lesion has been pointed out for this condition. Lesions to the cardiac 
 mechanism weaken the heart and thus are especially apt to predispose to 
 dilatation. Under such conditions o\'er-exertion and great physical strain 
 would be more likely to cause dilatation of the right ventricle. As the 
 vagus nerve has been shown to have a trophic influence upon the heart 
 walls, also upon their dilatation, lack of tone, and a softened condition of 
 them, lesion to it would have an important part in the production of dilata- 
 tion. Obstructed circulation, and any cause producing increased intra- car- 
 diac pressure may result in dilatation. This is seen in mitral diseases. Os- 
 teopathic lesion causing obstruction or the aorta by the diaphragm, obstruc- 
 tion to the intercostals, abdominals, pulmonar)' circulation, etc., as before 
 discussed, may become the direct cause of dilatation of the heart. 
 
 The Prognosis is not good. It depends upon that for the primary con- 
 dition often, as in valvular diseases where the prognosis is bad. When due to 
 specific removable lesion the prognosis ma)' become favorable. 
 
 The TREATMENT consists in righting of mechancal relations and re- 
 mo\'al of lesion. Obstruction to the circulation must be relieved, and heart 
 and lungs must be kept well stimulated to empt)' the chambers of the heart 
 of the clotted blood that is retained in them. Stimulation of the accelera- 
 tors aids the process by steadying and strengthening the heart beat, con- 
 tracting it and adding tone. 
 
 When secondary to acute infectious disease, vah'ular disease, etc., the 
 primar)- condition must be treated. The dropsy and dyspepsia j)resent de- 
 pend upon the bad circulation and are treated in the usual wa\-s. Stimula- 
 tion of the lungs and raising the ribs relieve the dyspnea. Stimulation to 
 the kidneys increases the flow of urine, which has been lessened, and aids 
 in overcoming the dropsy. 
 
 In the acute form the patient should rest in bed. In the chronic form 
 he should avoid fatigue' Genaral directions for the care of the patient are 
 as before gi\'en.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHi^. I79 
 
 DISEASES OF THE NERVOUS SYSTEM. 
 
 CHOREA. (St. Vitus Dance.) 
 
 Definition: A disease of the nervous system characterized by in- 
 voluntary contraction of muscle groups, accompanied by weakness, and 
 often by slight mental derangement, due to spinal lesions interfering with 
 motor function of brain or cord. 
 
 Cases: (i) A case in a young girl, of three or four months standing; 
 very severe; had lost all control of hands and feet, and of speech; could 
 lake only liquid food. It was thought she could not live. Lesions were 
 found at the atlas and 4th dorsal uertebrae. The case was cured. 
 
 (2) In a boy of nine, chorea followed vaccination. Lesion was found 
 at the atlas and at the 2d to 4th dorsal vertebrae. Case cured in five weeks. 
 
 (3) A case in a child of eleven, of nine months standing. Very se- 
 vere; no sleep for six nights; power of articulation was lost. Six weeks of 
 treatment showed great improvement. 
 
 (4) A girl of ten; marked lesion of the atlas, and of the 3d and 4th 
 cervical vertebrae; the 2d to 6th dorsal vertebrae were irregular and lateral; 
 5th lumbar posterior; cured in four manths. 
 
 (5) Case of two years' standing in a bo}' of twelve; right hand useless 
 and carried in a sling; lesion at ist to 3d dorsal. Under treatment he be- 
 came able to write well in one month. The case was cured. 
 
 (6) A case of two years' standing in a girl of thirteen. She had grown 
 continually worse under usual treatment. The atlas was found displaced 
 to the left, and upon its being replaced at the second treatment the jerk- 
 ing of the muscles began to grow less at once. The case was cured in one 
 month, and the child, previously undersized, grew rapidly thereafter. 
 
 (7) The patient was a girl of thirteen; confined to the bed; arms and 
 limbs drawn and useless; she could not sleep or speak intelligently. Bony 
 lesions were found in the cervical and lower dorsal regions, and all the 
 spinal muscles were contractured. The case, of three months' standing, 
 was cured in one month. 
 
 Lesions and Anatomical Relations: The lesions in these cases 
 are found in the majority of cases in the upper dorsal and cervical regions. 
 Six of the above seven cases described lesion and are illustrative of the 
 facts generally observed in such cases. All showed lesion in the cervical 
 or upper dorsal region, one or both. Neck lesion is important in these 
 cases. 
 
 Five of the above showed cervical lesion, four of the five being atlas 
 lesions. The fact that atlas lesions alone may cause the disease is illus- 
 trated by case (6) The fact that the upper dorsal lesion alone may cause 
 it is illustrated by case (5). But frequently, as in three of those reported, 
 combined lesion of the cervical and upper dorsal regions occur. The up-
 
 I So PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 per dorsal lesion is perhaps the most important one. Four of the above 
 six showed lesion somewhere in the upper six dorsal vertebrae. The spinal 
 area from the atlas to the 6th dorsal may be regarded as the important 
 locality for lesions producinor chorea. They may occur lower or affect the 
 ribs as well as vertebrae. 
 
 These lesions high up in the spine ma}' involve the cord and brain, in 
 a similar manner but lesser degree, as in paralytic affections of the whole 
 body. The frequent occurrence of high lesion explains the usual general 
 effect of the disease upon the whole body, including the upper and lower 
 limbs and suggests the idea that the cord, brain, or both are involved by 
 the lesion. 
 
 The authors state that the pathology of this condition is obscure, no 
 constant lesions being found. Probably, as McConnell observes, this is due 
 to the fact that spinal lesion may often involve simply nerve-fibers. Some 
 writers hold the disease to be a functional brain disturbance affecting the 
 centers controlling the motor apparatus. From this point of view cer\ical 
 and atlas lesion have an important bearing, as they may influence brain 
 centers by interference with blood-supply to the brain through direct im- 
 pingement upon the vertebral arteries and by disturbance of the cervical 
 sympathetics. Upper dorsal lesion may aid this effect by sympathetic dis- 
 turbance. From this view either atlas, other cervical, or upper dorsal les- 
 ion alone could cause the disease. 
 
 It is worthy of note that the upper dorsal lesion (ist to 6th) falls upon 
 a portion of the cord richer, perhaps, than any other in sympathetic cen- 
 ters. The cilio-spinal center, vaso-motors to face and mouth, pupillo-di- 
 lator fibers, motor fibers to involuntary muscles of the orbit, vaso-motors to 
 the lungs, accelerators to the heart, etc., all occur within this spinal area. 
 This disturbance to the sympathetic may have much to do in unbalancing 
 the nervous system in such cases. This lesion could also effect spinal fibers 
 by impingement or the nutrition of the cord through sympathetic disturb- 
 ance of its blood-supply. 
 
 On the whole the likely patholog)' in this disease is that there is cord 
 lesion or brain lesion due to mechanical irritation or to cut off nutrition. 
 These various lesions weaken the portions of the nerve-system involved, 
 and lay it liable to the action of such reflex causes as irritation due to para- 
 sites, eye-strain, nasal disease, sexual disorders, etc., or to such causes as 
 over-study, shock, worry, strain, etc. 
 
 The Prognosis is good. It is rare that the treatment fails to cure or 
 greatly relieve the case. Cure in a short time is the rule, even in serious 
 and long-standing cases. 
 
 The Treatment consists mainly in removal of lesion as the real cause. 
 In some cases this is the sole treatment necessary. Ordinarily it is 
 necessary to carry the patient through a course of treatment. All causes 
 of irritation or nerve-strain should be removed. Such are intestinal worms,
 
 PRACTICE AMD APPLIED THERAPEUTICS OF OSTEOPATHY. l8l 
 
 causes of worry, etc., as noted above. An important measure in these 
 cases is the treatment upon the neck and spine for the general nervous 
 system. The neck treatment reaches the sympathetic system, the medulla, 
 the circulation to the brain, and influences the whole nervous system. It 
 consists of the removal of lesion, relaxation of tissues, inhibition or stimu- 
 lation of the cervical nerves and centers, etc. The spinal treatment is upon 
 the same plan. It should be carried down along the spine. These treat- 
 ments quickly relieve nervous tension and quiet the nervous system. They 
 correct the circulation to the brain and central nervous system, increasing 
 their nutrition, and stopping the muscular twitching characteristic of these 
 conditions. An important treatment is the removal of contracture of the 
 muscles all along the spine, common in these cases. Attention must be 
 given to the patient's general health. The heart is often very fast and 
 should be slowed in the way already described. The kidneys should be 
 stimulated and general metabolism in the body looked to, to increase the 
 too light specific gravity of the urine. The bowels must be kept regular. 
 
 A thorough general treatment should be given to the muscular system, 
 especially to those muscle groups involved in the disease. This includes 
 flexion and circumduction of limbs and arms, etc. 
 
 In some cases inhibition of the cervical sympathetic will cause the 
 muscular twitching to cease at once. It has been accomplisned by pressure 
 between the 3d and 4th cervical vertebrae. 
 
 In the hygienic treatment of the case all causes of ner\e-strain, over- 
 work mentally, excessive physical exertion, etc., must be removed. Mus- 
 cular exertion may lead to heart involvement, especially as cervical and 
 upper dorsal lesion favor such conditions. The diet should be light and 
 nutritious. Fruits and vegetables may be taken, but meats and highly 
 seasoned foods should be avoided. Sponging of the back, chest and neck 
 with cold vv^ater is useful. 
 
 The various Choreiform Affections, such as the spasmodic ties, habit 
 chorea, laryngeal tic, choreic wry-neck, facial tic, jumping disease, etc., also 
 rhythmic or hysteric chorea, fibrillar)' chorea, athetosis, and varions other 
 forms, are met in the same way. 
 
 Huntingdon's chorea; a hereditary disease with progressive dementia, 
 is a very grave disease. There is no record of its ever having been 
 treated osteopathically. 
 
 EPILEPSY. 
 
 Definition: A disease in which there is loss of consciousness, with or 
 without convulsions. From the osteopathic point of view it is caused by 
 lesions interfering with the nutrition of cord or brain, or irritating the motor 
 nerve strands running to the peripheral motor structures, or exciting con- 
 nected nerves.
 
 l82 PRACTICE AND AI'PLIED THERAPEUTICS OF OSTEOPATHY. 
 
 Cases: (i) A case showing lesions at 7th and nth dorsal vertebrae. 
 Under the treatment the attacks were much decreased in frequenc)-, not 
 having appeared for a considerable period. 
 
 (2) A case of more than one year's standing in a girl of thirteen; three 
 to twelve attacks daily; lesions in upper cervical spine, posterior curvature 
 from 6th dorsal to lower lumbar, marked lesions occuring at the 6th dorsal 
 and at the 5th lumbar; all spinal muscles very rigid. Improvement began 
 at once upon treatment, and the case was cured in three months. 
 
 (3) A case of fifteen years' standing in a man of thirty. No attacks oc- 
 cured after the first treatment, and the case was cured in four months. No 
 recurrence of attacks nineteen months later. 
 
 (4) A case of twelve )'ears' standing in a bo)' of twelve cured by the 
 treatment. 
 
 (5) Daily attacks in a bo\' of eighteen, apparently due to a nervous 
 stomach disease. The latter was cured in three months, and no further at- 
 tack had occured six months afterward. 
 
 (6) A case of fourteen years' duration in a lady of eighty was cured in 
 two treatments. No attack occured after the first treatment. The report 
 was made two and a half )-ears after the cure, no further attack having oc- 
 cured. 
 
 (7) In a boy of twelve, monthly spells of two days' duration occured, 
 during which he would have from three to fi\'e spasms. The 3rd cervical 
 vertebra was found turned far to the right. Under a three months' course 
 of treatment he had not had the last two monthly spells. 
 
 (8) A case of petit mal in ajoung man of thirty. Lesions at the atlas, 
 which was to the right and turned with the right transverse process back- 
 ward, and at the axis, displaced to the left. Case still under treatment. 
 
 Lesions and Anatomical Relations: It seems that lesion along the 
 neck and spine anywhere may cause epilepsy — Dr. A. T. Still is credited 
 with the statement that there is usually lesion between the 2nd and 3rd 
 cervical vertebrae. Lesions in the above cases occured at the atlas, cervical 
 region, and from the middle dorsal down to the last lumbar. McConnell 
 states that lesions occur often in the splanchnic area and to the ribs, especi- 
 ally in the spinal region between the 4th and 8th dorsal vertebrae, also that 
 the prominent lesions occur in the neck from the 3rd to 7th \ertebra. He 
 notes a case caused by displacement of the right 5th rib. An attack could 
 be caused by irritation of this lesion, or be relieved at once by replacing 
 the rib. 
 
 The neck lesion seems, on the whole, to be the most important. Neck 
 and spinal lesion may act b>' obstructing the blood-supply to brain or cord. 
 They may affect the cord directly by mechanical irritation, or may affect 
 brain, cord, or nervous-system generally through the sympathetics. In 
 this way they may bring about these morbid conditions of cord, brain and 
 and meninges said to cause the disease. While the pathology of epilepsy
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 1 83 
 
 is unknown, it yet appears that osteopa thic lesion may account from any of 
 the various conditions assigned as causes. Such lesions, disturbing the 
 sympathetic system, may act as does peripheral irritation from dentition, 
 worms, cicatrices, adherent prepuce, etc. Various of these lesions may 
 directly irritate peripheral ner\'e structures. As traumatism is assigned as 
 a cause, osteopathic lesion as cause or effect of traumatic conditions may 
 be the real cause. 
 
 According to Gray the best accepted modern theory of the cause of 
 epilepsy is that it is due to direct or indirect excitation of the cortex or of 
 the nerve- strands leading fj-om the cortex to the peripheral ctncctures; that there 
 is 3. peculiar violecnlar condition of the motor tract ivhich runs from the motoi con- 
 volutions to the peripheial motor structures and muscles. He states that we are 
 ignorant of the nature of this molecular condition; that muscles can be 
 convulsed only by direct excitation of the muscle itself, or of the motor 
 tract leading from the muscle up to the motor convolutions; but that same 
 varieties of epilepsy are evidenly due to an excitation that extcnde into this 
 motor tract from some part of the nervous system beyond it. It would seem clear 
 that osteopathic lesion may irritate these motor tracts somewhere in their 
 course, as by direct pressure of luxated spinal vertebrae, etc., or that in a 
 multitude of wa)'s it may produce excitation in some other part of the 
 nervous system from which it extends to the motor tract. As nerve irrita- 
 tion by lesion is the important point in osteopathic etiolog)' generally, be- 
 ing well supported by numerous instances in which its removal has cured 
 the disease, it is a reasonable conclusion that the various bony lesions found 
 in epilepsy are causing it by excitation of the sort mentioned. This point 
 is likewise supported by the fact that removal of such lesion has often 
 cured epilepsy. 
 
 The Prognosis is fair in the ordinary case, a fair number of the cases 
 coming under osteopathic treatment being cured entirel}'. A large per- 
 centage not cured are benefitted. There seems to be but little difference in 
 the prognosis in favor of petit mal. In Jacksonian Epilepsy the prognosis 
 is not good. 
 
 Treatment: At the time of attacks but little can be done for the 
 patient. If the patient can be reached at the aura the attack may be pre- 
 vented by pushing the patient's head strongly back against a hand apply- 
 ing deep pressure in the sub-occipital fossae. This treatment seems to 
 arouse reflex stimulation or to equalize blood-flow to the brain by affect 
 upon the superior cerxical ganglion and medulla. 
 
 Anders states that constriction of the limb in which the aura occurs, 
 forcibly moving the patient's head, placing snuff to the patient's nose, ap- 
 plying ice to his spine, etc,, will sometimes prevent the attack. McConnell 
 calls attention to the fact that in cases where ;he exciting factor seems to 
 be in the intestine and there is reversed peristalsis of the intestines, causing 
 a reversion of the nerve current in the vagi, thorough rapid abdominal
 
 l84 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 treatment will normalize peristalsis and aid in preventing an impending at- 
 tack. Stimulation of the solar plexus may lesson the attack by calling the 
 blood to the intestines and thus reducing pressure in the cranium. 
 
 At the time of the attack the patient must be prevented from having 
 serious falls, if possible. The clothing about the neck should be loosened 
 so that it may not restrict circulation. Some object should be slipped be- 
 tween the tecih to prevent the patient's biting his tongue. .Small objects 
 that may fall into the wind-pipe should not be used for this purpose. 
 
 A general course of treatment is depended upon to prevent recurrence 
 of attacks and to cure the case. This consists in the removal of lesion, 
 whatever it be, and of all causes of reflex irritation mentioned above. It is 
 especiall)' important to remove lesion acting to irritate the motor fibers of 
 the central nervous system, in view of the fact pointed out above that such 
 excitation is probably the most efficient cause of epilepsy. Treatment 
 should be given to correct blood-flow to and from the brain, including such 
 treatments as opening the mouth against resistance, treatments above the 
 course of the carotids, elevation of the clavicles, treatment of the cervical 
 sympathetics, etc. Attention should be given to upbuilding the general 
 health, and to keeping towels and stomach in good condition. All causes 
 of worry or nerve-strain should be avoided and the patient should lead an 
 out-door life. The food should be light and easily digested, consisting of 
 some meat, fruit, vegetables, cereals, etc. Cold sponge baths are recom- 
 mend eti. 
 
 MIGRAINE. (Hemicrania, Sick Headache) and OTHER FORMS OF 
 HEADACHE (Cephalalgia). 
 
 Definition : Migraine is "a neurosis characterized by severe attacks 
 of headache, often paroxysmal and more or less periodic, with or without 
 nausea and vomiting." It is of obscure pathology; there seems to be noth- 
 ing to connect it with stomach lesion, and from an osteopathic point of 
 view it is generally found to be due to cervical bony lesions. 
 
 Headache is the general term used to describe pain in the head. It 
 may be either symptomatic or idiopathic, the latter being generally chronic 
 and due to specific bony lesion, usually in the cervical vertebrae. A large 
 class of the latter come under osteopathic treatment, generally in very bad 
 condition after having suffered far beyond the power of drugs to cure. 
 These may almost be considered as suffering from a hitherto undescribed 
 form of headache, depending upon specific lesion, often the result of acci- 
 dent, and usually immediately relieved and cured upon removal of the 
 lesion. The form embraces many of the kinds of heahache generally de- 
 scribed under one or other of the usual classifications.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. I85 
 
 Cases : (i) Extremely severe frontal headache in a man of thirty- 
 two, since boyhood. He had taken e\ery known remedy without avail. 
 Lesions were found in muscular contractions on the right side of the neck; 
 the dorsal spine was anterior in its upper half; the nth dorsal vertebra 
 was luxated to the left ; the 2d and 5th lumbar vcrtcbiae were prominent ; 
 the sacrum was tilted forward and the left innominate was slipped, length- 
 ening the limb. The lesions were corrected and the case cured. 
 
 (2) Nervous headache of years' standing in a lady was cured in three 
 months. 
 
 (3) Chronic headache of twenty years' standing cured in six weeks. 
 
 (4) Acute headache, very severe; pulse 128, temperature 1033-5°; 
 relieved in one treatment and soon cured. 
 
 (5) Migraine in a man of thirty, since his sixteenth year, when he 
 fell from a wagon. Lesion existed at the 3d cervical vertebra and at the 
 atlas. The case was relieved at once and cured. 
 
 (6) In a boy of twelve a very severe headache was caused by a fall 
 on his head from a bar in the gymnasium. The atlas was found displaced 
 laterally, and the case was cured in two treatments. 
 
 (7) Li a chronic case of occipital headache persistmg for years, no or- 
 dinary remedy would affect the condition. The atlas was found slipped and 
 the muscles about it very much contracted and tender. Relief was given 
 at one treatment, and the case was practically cured in one month. 
 
 (8) Migraine, with constipation, stomach disease, temporar)' blind- 
 ness, etc., was cured in nine months. 
 
 (9) A man of forty-five, troubled for many years by occipital head- 
 ache, mostly upon the left side. Lesion was found at the atlas, impinging 
 upon a cervical ner\ e. Cure was accomplished in two months. 
 
 (10) In a lady of thirty there was constant occipito-frontal headache. 
 The eyes were weak and painful; the glasses had been changed six 
 
 times in one year. The muscles of neck and shoulder were found much 
 contracted, the atlas was luxated to the right and painful upon pressure. 
 But one severe headache occurred during one month's treatment, and the 
 e}'es were much improved. In two months the glasses were laid aside and 
 the headache was cured. 
 
 (11) Headache, with blind spells, in a woman of forty-one; the ist 
 and 2d cervical vertebrae were approximated and sore; the muscles of the 
 upper cervical region very tense; headache constant; ist to 8th dorsal ver- 
 tebrae were flattened anteriorly; nth dorsal to 3d lumbar posterior. The 
 patient had suffered a sunstroke, and had had two or three attacks month- 
 ly since. 
 
 (12) Congestive headache in a man of thirty-seven, of twelve years' 
 standing. Violent attacks occurred daily, and ever)' known remedy had 
 been used in vain. The sole lesion was a depressed clavical interfering
 
 l86 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 with the venous flow from the head. Two treatments restored the bone to 
 place ann cured the case. 
 
 (13) Catamenial headache (migraine) occurred each month, lasting 
 two or three days. It was of six years' standing. A cure was made in two 
 month's treatment, no headache occurring after the first treatment. 
 
 (14) Chronic headache of four years' standing, caused by a fall upon 
 the back of the head, which rendered the neck partly stiff. There was con- 
 tracture of the tissues over the spinous process of the axis, which was dis- 
 placed to the right. After four treatments the pain had disappeared. 
 
 Lfsions : Migraine, with other forms shows the usual lesions. Le- 
 sions found to produce it are of the atlas : 1st, 2nd and 3d cervical; upper 
 dorsal; 8th, gth and loth dorsal; 7th and 8th ribs. 
 
 When headache is symptomatic purely, lesion depends upon the pri- 
 mary diseae, but specific lesion is often present and determines the effect 
 in the head. 
 
 Nine of the above fifteen cases report les'on, Kic^ht of the nine were 
 cervical lesions; one was clavicular; six of the eight cervical were of the 
 atlas. Atlas, axis, cervical, and, to some extent, spinal lesions are the 
 important ones producing headache. They result in chronic, idiopathic 
 headaches. Often these may develop into insanity. 
 
 Lesions act by disturbing sympathetic relations, reflexl\- causing the 
 headaches, just as may be the case in reflex headache from uterine prolapsus. 
 They all act by stoppage of blood-flow. This may occur in several ways. 
 The vertebral arteries may be occluded by pressure from the displaced cer- 
 vical vertebra; the clavicle may hinder venous flow in the external and in- 
 ternal jugulars, the sympathetic irritation nia\' set up vaso-motor reflexes 
 prevent proper circulation. A lesion may cause headache by direct press- 
 ure of the luxated vertebra upon a nerve-fibre. A very common place 
 for this to occur is at the atlas which impinges branches of the of the sub- 
 occipital nerve sent to supply the occipito-atlantal articulation. The same 
 thing is apt to occur at any of the upper three cervical vertebrae, the corres- 
 ponding nerves sending branches to supply sensation to the scalp. Con- 
 traction of tissues over branches of the fifth nerve, or at their fo- 
 ramia of exit may cause headache. Reflex or direct irritation of the 
 fifth nerve ma)- cause it. 
 
 The kinds of pain in headache aid in diagnosing the variety. Dana 
 notes the fact that a pulsating or throbbing pain occurs in headache due to 
 vaso-motor disturbance, as in migraine, a dull. hea\\' pain in toxic or dys- 
 peptic forms; a constrictive, squeezing, or pressing pain in neurotic or neu- 
 rasthenic cases; a hot, burning, or sore pain in rheumatic or anemic head- 
 ache; a sharp, boring pain in hysteric, epileptic, or neurotic forms. 
 
 The pain is usually found to be localized in or referred to the peri- 
 pheral ends of the fifth nerve, they supplying the antero-lateral parts of the 
 scalp and the dura mater with sensation. Hence treatment is directed to
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 187 
 
 .^ 
 
 the branches of the fifth nerve upon the face and scalp. The chief local 
 treatment in occipital headache is made to the upper four cervical nerves, 
 as their branches are here involved. 
 
 The Prognosis is good in all forms of headache, even in migraine. The 
 most long standing and severe cases yield readily to treatment, even when 
 all other remedies have failed. 
 
 The Treatment described will apply to any of the numerous kinds of 
 headache described, though special postions of the treatment laid down 
 may apply to an}' given case as sufficient for it. The treatment must be 
 adapted to the case, each one needing a special study of its features to 
 enable one to discover the cause and apply the proper treatment. The 
 treatment successful in one case ma)' not apply to another. 
 
 The lesion must be removed, and this often constitutes the sole treat- 
 ment necessary. All causes of irritation must be removed, such as eye 
 strain, sympathetic disturbance, uterine or stomach disease, etc. Ordinarily 
 the first step is the relaxation of contractured muscles in the neck and 
 upper dorsal region. This relives irritation to nerv es, frees circulation 
 and prepares for the replacing of a displaced vertebra. Attention should 
 be given to freeing all points of venous flow from the head. Treatment 
 may be made in the course of the veins across the forehead to the outer 
 canthus of the eye and down toward the angle of the jaw, along the jugular 
 veins, raising the clavicle and relaxing all the tissues. 
 
 Inhibition along the back and sides of the neck in the region of the 
 upper four vertebrae, and in the sub-occipital fossae quiets the upper four 
 cervical nerves and aids in restoring equality of circulation through affect 
 upon the superior cervical ganglion. 
 
 Often pressure made as follows is efficient: in the mid-line of the neck, 
 just below the occiput; below the ears, upon and below the transverse pro- 
 cesses of the atlas; along the upper dorsal region at the upper three or four 
 vertebrae. These treatments quiet cerebro-spinal nerves and correct vaso- 
 motion. 
 
 Treatment should be made upon the face over the points of the fifth 
 nerve (Chap. V. B). Relax tissues over the nerves and at the foramina. 
 Manipulation to relax the tissues all along the course of the longitudinal, 
 sinus, from nasion to occipital protuberance, and thence laterally toward the 
 mastoid processes, over the course of the lateral sinuses, aids in freeing the 
 circulation in them. As this treatment is carried over the vertex the ter- 
 minals of the various sensory nerves of the scalp are affected and quieted. 
 
 Deep pressure over the solar plexus and inhibitive abdominal treat- 
 ment aid in relieving the headache some times by quieting the reflexes and 
 calling the blood awa\- from the head. 
 
 Exciting causes should be avoided. It is well in such cases as need it 
 to give attention to regulating the condition of stomach and bowels. Cold 
 applied to the forehead and temples, and heat applied to the base of the 
 skull and the extremities aid in relief.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHV. I89 
 
 LOCOMOTOR ATAXIA AND SPASTIC PARAPLEGIA. 
 
 Definition: Locomotor Ataxia, or Tabes Dorsalis, is a disease charac- 
 terized by sclerosis of the posterior columns of the cord, loss of co-ordina- 
 tion in the muscles of the limbs, absence of the patellar reflex, lightning 
 pains in the limbs, and the Argyll-Robertson pupil, which reacts to ac- 
 comodation but not to light. 
 
 Cases: (i) In a woman of thirty-two, lesions were found at the atlas 
 and upper lumbar region. Under treatment she regained control of bladder 
 and bowels, became able to walk well, and the progress of the disease had 
 apparently been terminated. 
 
 (2) In a man of twenty-nine, the lesion was a complex curvature of 
 the spine. It was lateral to the right from the 5th dorsal to 2nd lumbar, 
 and posterior in the lower lumbar region, being so marked that the left 
 lower ribs came within the iliac fossa, while the right ones descended over 
 the hip. The whole thorax was misshaped. The right limb was atrophied 
 to one-half its original size. After eight months' treatment the patient 
 could walk thirty-five blocks without a cane; his general health was good, 
 and 'he disease was showing rapid improvement. 
 
 (3) A case in a }'oung man of twenty, in which there was marked 
 scoliosis of the dorsal spine, involving the thorax, some improvement in 
 the locomotor ataxia was gained under treatment. 
 
 (4) A case in a man of thirty-five showed spinal lesion in the dorsaF 
 spine between the shoulders, the vertebrae being irregular and posterior. 
 Under continued treatment his walking was much improved, visceral crises 
 were prevented, the control of bladder and rectum were regained, and the 
 pains in the lower, limbs were done away. 
 
 (5) A case which could not rise from his chair nor walk, could do 
 both after three weeks' treatment. 
 
 (6) A case of eleven years' standing in a man. In several weeks 
 treatment the pain was stopped and the case showed marked improvement. 
 
 (7) A case presented spinal lesion in the form of a too great anterior 
 sweep of the lumbar region of the spine. 
 
 Spastic Paraplegia (Spastic Spinal Paralysis) is a cord disease with 
 loss of muscular power, exaggerated patellar reflexes, a peculiar gait, a:nd 
 precipitate micturition, It is a primary lateral sclerosis of the cord. 
 
 Case: A middle-aged man, after injury to the spine in a mine ac- 
 cident, was affected with complete motor and sensory paraplegia. Opera- 
 tion for supposed fracture of the 7th dorsal vertebra removed pressure and 
 restored sensation for the greater part. Spastic paraplegia developed. The 
 lesions were found to be a posterior 7th dorsal vertebra; 8th, 9th a«d l€^h 
 posterior and toward the left. Considerable improvement was made uftd«r 
 treatment.
 
 190 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 Lesioxs in both of these diseases are found at various places along the 
 spine. In spastic paraplegia they are generally in the lower dorsal, lumbar 
 and sacral regions. 
 
 In iocomotor ataxia spinal curx'aiure is often found as the cause. De- 
 rangement of the thoracic vertebrae in the region between the shoulders 
 often causes it. Atlas. cer\-ical and lumbar lesions are often found. 
 
 The Progxosis in neither disease is promising as to cure. Most cases 
 are benefitted, some to a marked extent. Locomotor ataxia is more fre- 
 ' quently met with and. on the whole, more successfully treated. The pro- 
 gress of the disease is often checked: the lightning pains and visceral crises 
 are prevented or checked; control of bladder and rectum are established; 
 the power of walking. e%-en afier complete loss in some cases, is restored. 
 These cases are generally benefitted, but sometimes do not yield to treat- 
 ment. In cases of spastic paraplegia the sum-total of results is not so 
 great. The walking is often improved, and precipitate micturition is bet- 
 tered. 
 
 The sclerotic changes in the cord in these diseases renders them in- 
 curable, even after removal of specific lesion, yet the sclerotic process is 
 doubtless often checked by the removal of lesion and the attendant treat- 
 ment. 
 
 A few cases of both diseases, in early stages and resulting from injur}*, 
 are reported cured. 
 
 The TRE.ATMENT of locomotor ataxia consists in the removal of lesion 
 and general spinal treatment. The removal of lesion alone is insufficient. 
 The thorough spinal treatment must be made to influence spinal ner\'e con- 
 nections.the central distrubution of the sympathetics.and the blood -circula- 
 tion about and to the spine. This treatment should be given esi>ecially 
 from the middle dorsal down, as the degenerative changes in cord and 
 meninges begin in the lower part. If the ataxic condition has not yet ap- 
 peared in the arms, and cerebral symptoms have not developed the indica- 
 tions is especially for treatment to the lower spine. Treatment to the 
 upper spinal and cervical regions should be given, however, at any stage, to 
 limit or prevent the spread of the pathological cord changes in these re- 
 gions. 
 
 The nerve-supply to the limbs, upper and lower, as well as the limbs 
 tacmselves. should be treated. Care must be taken in this matter, as the 
 tendency of the long bones to fracture is marked in locomotor ata.xia. The 
 arthropathies, if present, call for special trealmeat to the joint involved, 
 , aad its nerve and blood-supply. As the knee-joints are most frequently at- 
 I tacked, the treatment tu the lower limbs will ser\'e to lessen the danger of 
 r t|ieir opcurance. The spinal treatment should include springing the spine, 
 . and various other methods of separating the vertebrae from each other, in- 
 creasing circulation about them and keeping up their nutritive integrity, as 
 the articular surfaces and interarticular fibro-cartilages are liable respective- 
 ly to absorption and atrophy.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. I91 
 
 Abdominal treatment should be maintained to j)revent visceral crises, 
 most common about the stomach. Treatment should be upon the abdom- 
 inal nerve-plexuses and blood-circulation. The stomach and bowels may 
 thus be kept in good condition. Lumbar and sacral treatment, together 
 with treatment to the internal iliac blood-vessels from the abdominal aspect, 
 aid in restoring the spincters of bladder and rectum to good conditions. In 
 case of necessity a catheter should be used to empty the bladder. To re- 
 lieve the lightning pains in the limbs strong inhibition should be made up- 
 on the anterior crural nerve in Scarpa's triangle; upon the great sciatic at 
 the back of the thigh between the tuberosity and the great trochanter, 
 slightly nearer the latter; and upon the lumbar and sacral portions of the 
 spine. 
 
 The treatment of spastic paraplegia proceeds upon the same lines as 
 the general treatment for locomotor ataxia, including removal of lesion, 
 thorough general spinal treatment, and treatment of the lower limbs. The 
 spasticity in the latter sometimes hinders treatment, but may be overcome 
 by inhibition of the anterior crural and sciatic as above. 
 
 Other forms, such as Secondary Spastic Parahsis, in which the sym- 
 ptoms are not so well marked; Congenital Spastic Paraplegia, usually due 
 to injury at birth; Ataxic Paraplegia, con::bining spastic and ataxic features 
 retaining the reflexes; and the Combined S\'stem Scleroses, etc., arc ap- 
 proached in the same manner for discovery of lesions and treatment. 
 
 PARALYSIS AGITANS. 
 (Parkinson's Disease. Shaking Palsy,) 
 
 Definition: — A chronic disease, in which there is tremor, peculiar 
 character of speech and gait, and progressive loss of muscular power. 
 
 The Lesions found in this disease usually occur in the cervical and up- 
 per dorsal regions, and among the upper ribs. These lesions, being pres- 
 ent, doubtless determine the victim of the disease. 
 
 It occurs in those whose central nervous system is thus weakened and 
 laid liable to the action of such secondary causes as exhausting ilness, men- 
 tal strain, worry, traumatism, etc. The latter may directly result in such 
 lesions. The fact that the pathology of the disease is obscure, it being by 
 many regarded as a functional disturbance, and the further fact that the 
 causes are not well known, lends color to the theory that such lesions as 
 are recognized by Osteopathy, being alwa)'s such as are not sought for by 
 the regular practitioner, are the real causes of the condition. They occur 
 high in the spine, at a point where, acting upon the central nervous sys- 
 tem, they could produce the effect in the whole body, as noted in the 
 tremor of both upper and lower limbs, as well as of the head sometimes.
 
 192 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 The Prognosis: — There is a reasonable expectation of limiting the 
 progress of the disease and bettering the patient's general condition. The 
 fact that there is no pathological change in the cord, and that the disease 
 is probably functional, leaves ground for hope that very much benefit, per- 
 haps cure, can be attained under osteopathic treatment. A number of cases 
 have been cured. 
 
 The practitioner must bear in mind that it is a feature of the disease 
 for the patient to sometimes be better, and he must not too stronglj- encour- 
 age the patient when such a period occurs, without reason to expect the 
 permanence of such gain. 
 
 The Treatment consists in removal of lesion; the thorough relaxation 
 of all spinal and cervical muscles, particular!}- apt to be set and hardened 
 about the neck and shoulders; and a most thorough general spinal treat- 
 ment. Particular attention should be paid to the condition of the nerve- 
 plexuses supplying the upper and lower limbs- These, and the circulation 
 to the limbs, should be strongly stimulated. The general health is usually 
 good, but it is not amiss to keep bowels, kidneys and liver well stimulated. 
 
 Light exercise and baths are good for the case. 
 
 OCCUPATION NEUROSES. 
 
 Definiiion:— A neurosis due to constant use of certain groups of mus- 
 cles in occupations which necessitate delicate movements, resulting in 
 cramp, spasm, paralysis, tremor or neuralgia, and due to specific lesion to 
 the nerves supplying the affected groups of muscles. 
 
 The very numerous varieties of this disease, various forms of musician's 
 cramp, telegrapher's, seamstress', driver's, milker's, cigar-makers, etc., are 
 all manifestations, more or less severe, of obstruction to the nerves supply- 
 ing the parts involved. These obstructions generall)' act upon the nerve- 
 supply of the upper limbs, but in a few varieties, as in ballet-dancers and 
 tailors, those of the lower limbs may be involved. 
 
 Cases: — Numerous cases of telegrapher's, writer's and piansit's paral- 
 ysis are known and recalled in this connection, although the data as to les- 
 ions, etc., are not now available. These cases were generally cured. The 
 following cases are typical. 
 
 (i) A marked case of telegVapher's paralysis, of three years' standing. 
 
 For two years the hands had been almost useless, and the patient could 
 not distinguish by touch between an ink-stand and a pencil, sensation and 
 motion were both much impaired. The lesions were found in the 1st, 2d, and 
 3d right ribs being close together; the clavicle down upon the right first rib 
 and the cervical origin of the brachial plexus covered with much contrac- 
 ured muscles. After one month's treatment the patient could write his 
 name. In six weeks he could distinguish between coins by touch, and in 
 three months the case was cured.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. I93 
 
 (2) A case of telegrapher's paralysis of three months' standing. The 
 patient had stopped work to go to a hospital, but took osteopathic treat- 
 ment instead. In three days he was able to return to work, and was cured 
 in five weeks. 
 
 (3) Pianist's paralysis, showing lesions in the upper dorsal spine. 
 
 (4) Pianist's paralysis showing lesions in the cervical and upper dorsal 
 regions of the spine, depression of both clavicles, and contracture of mus- 
 cles in the posterior cervical, upper dorsal, and shoulder regions. 
 
 The Lesions in these cases are doubtless often directly due to the oc- 
 cupation. Case ( I ) above is a good illustration of the result of an occupa- 
 tion requiring the elevation of the right shoulder, resulted in drawing to- 
 gether the upper three ribs, and in approximating the clavicle and first rib 
 in such a manner as to bring pressure upon the brachial plexus. A faulty 
 posture, involving bad position of the shoulder, neck and upper spine, is 
 quite as likely to result in bony lesions in these parts as is faulty posture 
 to result in spinal curvature. 
 
 In a certain number of cases the lesions are likely present in the spine 
 and other parts, and determine an early breakdown in the anatomical parts 
 concerned in the occupation, from over-use. Over use of an arm, as in 
 writing, no doubt plays its part in wearing out the nerve-mechanism, but the 
 fact that many young people suffering from an occupation neurosis are 
 found to have these lesions while many other persons labor assiduously for 
 years at the same occupations without disability, indicates that the lesions 
 behind the excessive use is the real cause of the trouble. Use of the arm 
 is really excessive only in proportion as the parts do not recuperate after 
 use. The lesion to nerve-supply prevents proper recuperation and the arm 
 wears out because of the presence of lesion. 
 
 In pianists spinal disease is often found to be due to sitting for hours 
 at the instrument. It may as reasonably cause spinal lesions of a nature to 
 result in the neurosis of the arms. That central, i. e. spinal, lesion is pres- 
 ent is indicated by the fact that in penmen who learn to write with the left 
 hand after an attack of paralysis in the right the disease usually soon makes 
 its appearance in that member also. In pianists the trouble is generally 
 bilateral from spinal lesion. 
 
 Lesions may occur high in the cervical region, but such is not likely to 
 be the case. Lesions from the origin of the brachial plexus to the sixth 
 dorsal vertebra are met with. Most commonly the lesion lies between the 
 5th cervical and fourth dorsal, favoring a position still lower in the cervical 
 and about the upper three or four dorsal. Lesion of the clavicle and upper 
 two ribs, especially upon the right side, are very common. It is readily seen 
 from the nature of the causes producing lesion that the ribs below the up- 
 per two may be involved. Ribs and vertebrae as low as the 5th or 6th may 
 be luxated and cause the trouble. Vaso-motor, secretory and trophic af- 
 fections occur in the affected member. Vaso-motors to the arms are found
 
 194 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 as low as the first thoracic ganglion, or lower. The connection of the inter- 
 costal nerves with the sNmpathetic s}stem may explain wh)- rib lesions this 
 low may cause the trouble. The first and second intercostal ner\es are con- 
 nected with the brachial plexus. They are often impinged by~ the corres- 
 ponding ribs in these troubles. McConnell calls attention to the fact that 
 slight luxations of shoulder and elbow-joints may cause this disease. In 
 such case the affect would probably be through lesion to the articular 
 branches supplied from the brachial plexus. 
 
 While Dana states that this condition is "a neurosis having no appre- 
 ciable anatomical basis," it seems from the results gotten b\- the removal of 
 lesion that Osteopath)- discovers the real anatomical cause of disease. 
 
 The Prognosis is good. Even the worst cases are cured. Cure is the 
 rule, though some cases may be intractable. 
 
 Treatment: — The removal of lesion as the direct cause, as in displace- 
 ment of the clavicle onto the brachial plexus, is often the only treatment 
 necessar)'. The nerve aud blood-supply of the affected part shouldjbe kept 
 free by treatment upon them and by relaxation of all contractured muscles 
 and hardened tissues. The arms should be stretched and treated as de- 
 scribed in Chap. X. The brachial plexus may be stimulated on the inner 
 side of the arm just below the axilla, and in the neck behind the clavicle. 
 Treatment should be carried up along the plexus to the spine. The elbow 
 and shoulder joints should be sprung and adjusted if necessar)'. (Chap. X.) 
 
 It ma)- be necessary to have the patient rest from his occupation dur- 
 ing the treatment, particularly at first for a few weeks. This matter depends 
 upon conditions. Some cases have been cured while the customary work 
 is continued. In some cases it is well to give a general treatment to the 
 nervous system, as nervous symptoms may appear. \'ertigo and insomnia 
 are sometimes present, doubtless due to the upper spinal lesions affecting 
 the blood-circulation to the brain. 
 
 Local work should be carried over the brachial artery, and over the 
 fore-arm and hand. This increases local circulation and does away with 
 the local congestion and secretory disturbance found in the affected mem- 
 bers. It may be useful for the patient to develop the arms by systematic 
 gymnastics. The various mechanical appliances used to lessen the work 
 upon the affected muscle groups and to call into play other and larger 
 groups, may be useful if the patient finds it necessary to continue his occu- 
 pation. Sleeves that interfere with free motion of the hand in writing, cuffs 
 that bind the wrist, constricting bands that ma)- be used as sleeve support- 
 ers, and any agency limiting motion and circulation must be avoided. 
 
 The pain frequentl)- present in arms and shoulders may be quieted by 
 inhibition of the plexus and its spinal origin, but generally yields to the 
 general process of relaxing muscles, etc.
 
 PRACTICE AND APPLIKD THERAPEUTICS OF OSTEOPATHY. I95 
 
 NEURASTHENIA. 
 
 (nervous PROSTRATION.) 
 
 Definition : "A functional disease of the nervous system, character- 
 ized by mental and bodily weakness." It is not a psychosis. There is 
 functional exhaustion and irritablity of the nerve centers. 
 
 Cases : (i) Well marked neurasthenia in a child of five, a neurotic. 
 It had never walked, and had never slept in the daytime. In one month it 
 became able to walk under the treatment. 
 
 (2) In a lady a case of three years' standing, with attendant consti- 
 pation, was cured in two months. 
 
 (3) In a woman of thirty-two, neurasthenia developed after confine- 
 ment and sickness. Sjmptoms of the disease were all very well marked. 
 Lesions were found in a displacement of the third cervical vertebra to the 
 right, general depression of the ribs, separation of the nth and 12th dorsal 
 vertebrae, a posterior luxation of the fifth lumbar vertebra, and contracture 
 of the lumbar muscles. The neurasthenia was apparently reflex from uter- 
 ine disease. Two weeks' daily treatment re-established menstruation, 
 which had been suppressed for some time. Under one month's treatment 
 all the s)'mptoms had disappeared. 
 
 (4) A case of neurasthenia in a lady of sixty, following overwork and 
 runaway accident. The whole spine and body was hyperesthetic, the spinal 
 tissues, from occiput to sacrum, were exceedingly tense. Treatment was 
 beneficial from the first. One year's treatment produced great improve- 
 ment. 
 
 (5) In a lady of fifty, with uterine disease, lesions were found in a 
 posterior luxation of the atlas and depression of all the ribs, narrowing the 
 thorax. The patient was benefitted. 
 
 (6) Neurasthenia in a lady of thirty-five, complicated with constipa- 
 tion, ovarian disease, and many other symptoms, was almost cured in one 
 month's treatment. 
 
 (7) In neurasthenia of eight year's standing, due to cigarette smoking, 
 six weeks' treatment cured the cigarette habit and materiall)- bettered the 
 general condition. 
 
 (8) Neurasthenia and exophthalmic goitre of one month's standing. 
 The goitre was cured in two week's treatment. In one month's treatment 
 the neurasthenia was cured and the patient had gained twent\- pounds. 
 
 (9) Traumatic neurasthenia developed after the patient was thrown 
 from a buggy. Lesion was found in a slip at the fourth lumbar and marked 
 lateral luxation of the tenth dorsal vertebra. The spinal lesion was cor- 
 rected in three weeks, but no improvement occurred in the patient's gener- 
 al condition until ten weeks' treatment had been taken. After two weeks' 
 further treatment the case was well.
 
 196 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 (10) In a man of thirt\- neurasthenia of three jear's standing was 
 cured in two months. 
 
 (11) In a young lady a case of several month's standing"was cured in 
 four months. 
 
 The Lesio.ns found in neurasthenia are general spinal lesions. Differ- 
 ent cases present different lesions, and no typical lesion may be described 
 for all cases. \'et perhaps a majority of these cases show a depression of 
 all of the ribs, narrowing the thora.x and often causing enteropsis. Float- 
 ing kidney and enteroptosis are well known as causes of neurasthenia. 
 There is no doubt that many cases of neurasthenia apparentl)' thus caused 
 are really due to bad spinal condition and flattening of the thorax through 
 depresssion of all the ribs. These extensive lesions effect the cerebro spi- 
 nal SNstem directly, also the s)'mpathetic system, thus causing the neuras- 
 thenia and the enteroptosis, (p. 98.) 
 
 Often the lesion in these cases is such as produce disease in some 
 organ, secondary to which neurasthenia is developed. This is well illustra- 
 ted in these lower spinal lesions producing uterine disease, from which 
 neurasthenia is reflexl\- caused. Thus a varietN' of lesions may be found in 
 neurasthenia, different cases presenting different lesions. Each case de- 
 mands an individual study. For the production of neurasthenia there is 
 necessary merely a lesion producing an irritation upon the nerve system, 
 reflexl)- or directly, allowing a leakage of nerve-force, and determining the 
 victim of neurasthenia from overwork, worry, uterine disease, naso-pharyn- 
 geal disease, the use of coffee, alcohol, etc. 
 
 The different varieties of neurrasthenia ma)' be caused by the predom- 
 inance of lesion, e. g., the cerebral t> pe by upper dorsal and cer\ical le- 
 sions, the gastric by splanchnic lesions, the lithemic by lower dorsal and 
 upper lumbar lesions, etc. lefluenza, a common cause of this disease, is a 
 malad\- pariicularl)- noted by osteopathy as producing serious spinal lesions, 
 mostly in the shape of contractured muscles and tenseness of the other 
 tissues, but sometimes actual bony lesions by drawing parts out of place 
 through contracture of attached tissues. Lesions thus produced may 
 cause neurasthenia. Neurasthenia is common as the result of traumatism, 
 such as caused by railway accidents, bon)' lesions thus being produced as 
 irritants to nerves. 
 
 The Prognosis for cure is good. Those cases that have not \ ielded to 
 an)' of the usual modes of treatment often readily yield to osteopathic 
 treatment. The best of results may be expected in the worst cases. Cases 
 are often quickly cured f gotten in the early stages. The average case 
 demands a somewhat long course of treatment, varying from a few months 
 to a year or more. 
 
 The Treatment must be adapted to the case in hand after a special 
 study of its peculiarities and requirements. The removal of every source 
 of reflex irritation is necessary, but these sources must be studied out in
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. I97 
 
 «ach individual case. The lesions present should be removed, but the case 
 is not always at once benefitted thereby, as a course of treatment is gener- 
 ally necessary to recuperate the exhausted nerve-centers. Consequently a 
 most systematic and thorough course of treatment be devoted to this end. 
 The various spinal treatments as described, for relaxation of all spinal 
 tissues, springing the vertebrae apart for freedom of circulation and stimu- 
 lation of the spinal nerve-system and the circulation thereto, is given to 
 increase nutrition of the nervous system and upbuild the exhausted centers. 
 This spinal treatment affects the sympathetic system markedly. Cervical 
 treatment is also important in this connection. Good results are usually 
 at once apparent in relief of nerve-tension, reduction of irritabilit}-, and 
 correction of function. 
 
 Special manifestations of the condition, as headache, insomnia, vertigo, 
 etc., call for cervical treatment particularly. Bowels, kidneys, liver, etc., 
 must be carefully looked after to relieve the constipation, lithemia, anorexia 
 and other such symptoms usually present. A thorough general treatment 
 •of the whole body is not amiss in these cases. 
 
 The patient must be kept free from excitement and from all causes ot 
 drain upon nervous vitality. The diet should be light and nutritious. The 
 use of cold sponge or shower baths may be helpful. Advising the patient 
 to take gentle exercise, baths, etc,, will aid him to preserve a cheerful state 
 of mind. Some cases may be treated daily with advantage, in the begin- 
 ning of the treatment. Later, the treatments may be decreased in number 
 to three or two per week. 
 
 HYSTERIA. 
 
 This is a condition frequently met and treated osteopathically. One 
 needs to be continually upon guard against its simulation of other condi- 
 tions, being equally careful not to overlook other diseases because of a hur- 
 ried diagnosis of hysteria. Being a functional disease of the nervous sys- 
 tem, and a psxxhosis, it is frequently found to depend upon some spinal 
 bony lesion acting as the cause disturbing the nervous equilibrium. The 
 lesion varies. One cannot expect a certain kind of lesion in these cases, 
 but generally finds some actual derangement which is at bottom, responsible 
 for the altered nerve-conditions making it possible for a neurotic disposi- 
 tion, infectious fevers, poisons of various kinds, emotional disturbances, 
 mental or physical strain, and other causes to result in hysterical attacks. 
 
 Correction of lesion removes the primary cause of irritation to the 
 nervous system, perhaps cures a certain disease to which the hysteria is 
 secondary, and is an important step in the radical cure of the condition. 
 
 The Prognosis for cure is good. The treatment relieves nervous ten- 
 sion and quiets the overwrought system at once.
 
 198 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 In the 7>rrt/;//d';// considerable tact must be used. The primary treat- 
 ment embraces the removal of all lesions and causes of irritation. A 
 course of treatment for the general nervous system must be carried through. 
 The general treatment as described for upbuilding the nervous system in 
 neurasthenia would be applicable here. 
 
 During an hysterical attack the practitioner must use great firmness, 
 but not violence, with the patient. He must gain mental and moral con- 
 trol, and while appljing a general relaxing and inhibitive spinal and cervi- 
 cal treatment to relieve nerve-tension and to quiet the nervous s>'stem, b)- a 
 strong show of authorit)- compel the patient to cease various motions, un- 
 bend a clinched hand, stop incoherent talking, etc Sometimes a dash of 
 cold water upon the face or abdomen, or pressure over the ovaries will end 
 the attack. All sympathetic friends must be dismissed from the room, and 
 moral suasion, with isolation of the patient, be tried. The practitioner 
 must gain the patient's confidence. Hysterical joints, h)'sterical pains, 
 contractures, eye-symptoms, paralyses, etc., call for no special treatment; 
 all disappear upon regulation of the mental condition and upbuilding of 
 the general nervous system. 
 
 Many chronic cases, as in bed-ridden hysterics, must be carried through 
 a course of education in performing simple motions and acts which they 
 thought beyond their power. The patient should lead a regular lite, and 
 her mind should be kept occupied by some engrossing occupation. 
 
 Judicious management of the case, authority over the patient, and a 
 careful general course of treatment for the health of the body and partic- 
 ularly of the nervous s\'stem, will be successful in the majority of cases. 
 
 INSOMNIA. 
 
 Definition: Incomplete, disturbed, or lacking sleep. A condition 
 frequently idiopathic and caused by specific lesions, usually bonj-. Idiopa- 
 thic insomnia embraces man}- forms generally looked upon as s)'mptomatic 
 or secondary. Many reall}- symptomatic or secondary cases are noted, es- 
 pecially in nervous diseases, the primary condition itself being usually 
 found to depend, at bottom, upon bon\- lesion. 
 
 Cases: Ver)- numerous cases are met and treated osteopathically. The 
 following cases illustrate various points in connection with such cases: 
 
 (i) Insomnia, nervousness, and a complication of troubles. Sleep 
 could not be induced by the most powerful soporifics. Lesion was found 
 among the cervical and upper dorsal vertebrae. The case was cured in two 
 months' treatment. 
 
 (2) Insomnia and general nervousness, pronounced incurable. The 
 patient had had no good nights' sleep in five years, and had become a
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. I99 
 
 nervous wreck. Lesion was found in the shape of contractured condition of 
 all the cervical muscles. The case was cured in one month. 
 
 (3) A case of several years' standing, in which the lesion affected the 
 atlas, which was displaced a little to the right, was cured by the correction 
 of the lesion in six treatments. 
 
 (4) A case of insomnia as an accompaniment of neurasthenia, in which 
 the patient had depended upon soporifics for a number of years, slept welt 
 after the second or third treatment. The use of artificial aid to sleep was 
 necessary but at rare intervals thereafter. The case was practically cured 
 at the time of report. 
 
 (5) A case of insomnia of some years' standing, due to cervical and 
 upper dorsal lesions, cured in six months' treatment. 
 
 (6) A case of three years' standing, in which the heart-beat had be- 
 come very irregular from the resulting nervousness. Four treatments cor- 
 rected the heart-beat, and the case had been practically cured, at the time 
 of report, by two months' treatment. 
 
 (7) A case of paroxysmal sleep, or narcolepsy, presenting lesion in the 
 form of a luxation of the second cervical vertebra toward the right. The 
 case was not observed under treatment. 
 
 (8) A case of narcolepsy due to cervical lesions successfully treated. 
 Lesions and Anatomical Relations: The lesions, both in insomnia 
 
 and in the various other disorders of sleep, are generally found in the atlas 
 and cervical and upper dorsal regions. All such cases, perhaps constitut- 
 ing a majority of all cases of these diseases, should be regarded from the 
 osteopathic point of view as idiopathic insomnia, dependent upon speci- 
 fic lesion interfering with circulation to the brain. Lesions to the atlas and 
 second cervical vertebra are very common causes, and lesions usually occur 
 within the cervical region or among the upper five dorsal vertebrae. Le- 
 sions to clavicle and to corresponding ribs may be present. It will be ob- 
 served that from the occipui^t to 5th dorsal all these lesions fall within a 
 area particularly rich in sympathetic and vaso-motor centers for the head, 
 as before pointed out. Atlas and axis lesion acting upon the superior cer- 
 vical ganglion, medulla, or curvical sympathetic, and other cervical and the 
 upper dorsal lesions acting upon the sympathetic nerves supplying vaso- 
 motor control to the blood vessels of neck and head, disturb circulation to 
 the brain and cause the insomnia. Direct pressure of the cervical vertebrae 
 upon the vertebral arteries may contribute^to ,or produce, the same result. 
 
 It is probable that in many cases of insomnia there is an anemic state 
 of the brain caused by the interference of such lesions with the sympathet- 
 ics or by direct pressure upon the arteries. The insomnia in various dis- 
 eases of the heart and arteries, in general anemia, and in Bright's disease, is 
 said to be due to an anemic condition of the brain. On the other hand it 
 is doubtless true that there is in many cases a sluggish or impeded cere- 
 bral circulation as a result of the disturbance of sympathetic vaso-motors,,
 
 200 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY 
 
 impeded venous return, etc., caused by these lesions. In neurasthenic in- 
 somnia, it is said, there is loss of vaso-motor tone in the cerebral vessels. 
 The use of various mechanical remedies is based upon the idea of calling 
 the blood from the head to the skin or abdominal organs, e. g., a hot foot- 
 bath, eating a light lunch, etc. 
 
 In some cases the symptoms indicate the necessity of increasing or de- 
 creasing the amount of blood in the cerebral vessels, and these results may 
 be readily attained by the appropriate treatment. But, from the nature of 
 the case, removal of lesion and the restoration of free circulation result in 
 restoring normal quiet to the nerve mechanism and normal flow of the 
 blood in the vessels, characteristic of the normal bod)' which enjoys health- 
 ful sleep. .Such a result is the most rational object of the treatment. 
 
 When insomnia is symptomatic or secondary, lesions must be sought 
 according to the primary condition. 
 
 In some cases of disturbed vaso-motor conditions of the brain, lesion is 
 found in the form of much thickened, tensed, and overgrown tissues at the 
 base of the skull, above and about the spine of the axis, extending laterall}' 
 toward the mastoid process. With this condition there frequentl)' exists 
 an approximation of the second cervical spine to the occiput. 
 
 The Prognosis in insomnia is good. No class of cases presents more 
 striking results in the shape of cure of the most long-standing and intract- 
 able cases. It is a frequent occurrence that a case of some year's standing 
 is made to sleep natural!)- after a single or few treatments. 
 
 Not all cases thus easily yield to treatment. Often great patience and 
 persistence are necessar)' to secure good results. 
 
 The Treatment calls for the removal of lesion primarily, and of any 
 cause of irritation to the nervous system. The treatment as described in 
 detail for headache, q. v., is applicable here. It embraces inhibition of the 
 superior cervical ganglion and of all the cervical vaso-motors, including the 
 middle and inferior cervica;l ganglion and the upper dorsal centers, deep 
 pressure beneath the ears and beneath the occiput (p. 187.) All the cervi- 
 cal muscles and other tissues should be thoroughly relaxed. A general 
 spinal treatment, in nervous cases, at once relieves nerve-tension and irrita- 
 tion, and materiall)- aids in producing sleep. It is sometimes well to add 
 to this a general body treatment as an aid in equalizing circulation and 
 toning up the nervous s)-stem. All points of cervical circulation [should be 
 attended to. The treatment begun over forehead and face may be contin- 
 ued down over the neck, opening the mouth against resistance, stimulating 
 the carotid arteries and jugular veins, raising the clavicles, and even the 
 upper few ribs, and thus entirely freeing the circulation to and from the 
 head. 
 
 In cases of congestion of the cerebral vessels the inhibitive abdominal 
 treatment should be used to draw the blood away from the head to the ab- 
 dominal vessels.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 201 
 
 In anemic cases one should add treatnneni to liver, kidneys, stomach, 
 bowels and spleen. The heart and lungs should be stimulated. In insom- 
 nia due to auto-intoxication, as in lithemia, uremia, malaria, etc., one 
 should look particularly to the excretions. Various domestic remedies 
 may prove useful in simple cases, such as a warm general bath, a hot foot- 
 bath, a cold douche down the spine, exercise and light massage, sleeping in 
 cold rooms, avoidance of late meals, and the avoidance of mental work 
 several hours before retiring. 
 
 The various perversions of sleep, such as dreams and nightmare, som- 
 molentia, or incomplete sleep, sommambulism, morbid drowsiness, narco- 
 lepsy, catalepsy and prolonged sleep, would all be approached and treated 
 upon the same lines as laid down for insomnia.
 
 PRACTICE ANDAPPLIED THERAPEUTICS OF OSTEOPATHS. 2O5 
 
 PARALYSIS, 
 
 The various forms of paralysis come, with much frequency, under oste- 
 opathic treatment. Paralysis of every part of the body, and from various 
 causes, is successfully treated. The following cases are illustrative. 
 
 Cases:— (r) Paraplegia in a young lady, caused by fall of eighteen feet. 
 The lower half of the body, aud the lower limbs were paralyzed; control of 
 the bladder was lost; within a certain period of five months she had passed 
 twenty-eight calculi about the size of peas, never before the accident hav- 
 ing had any urinary trouble. Lesions as follows: Marked posterior and 
 slight lateral curvature of the spine, involving the lov\er and upper lumbar 
 regions; the coccyx was bent and twisted; the right innominate bone was 
 luxated backward. The condition was of nine and one-haif months stand- 
 ing. After the first treatment she was able to sleep without the customary 
 opiate. During the second week's treatment she began to gain control of 
 the bladder; and the bowels acted naturally. The urine became normal at 
 this time. Durmg the course of the treatment an ulcer upon the right 
 foot healed. A course of two month's treatment had almost cuied the pa- 
 tient at the time of reporting the case. 
 
 (2) Paraplegia in a man, due to an injury in a runaway accident in 
 which he was thrown, striking the lower dorsal and lumbar regions of the 
 spine. After two weeks he gradually began to lose the use of his limbs, 
 and in seven months he was confined to a chair, soon becoming unable to 
 move a muscle of either limb. Lesions were as follows: gth, loth and i ith 
 dorsal vertebrae displaced backward sufficientl)' to simulate the posterior 
 angular projection in Potts' disease; a marked contraction of the muscles of 
 the right side of the spine from the ninth dorsal down; slight swerving of 
 the spine to the same side as the contracture and limited by its extent; 
 great tension and slight lesion at the junction of the fifth lumbar vertebra 
 with the sacrum; a binding together of all the spinal vertebrae by an appar- 
 ent contracture of the ligaments. After a few treatments motion returned, 
 and the patient was able to go about upon crutches. The case had been 
 almost cured after a course of five weeks' treatment, 
 
 (3) Complete paralysis of the body below the waist, and of the lower 
 limbs, caused by spinal curvature. The case was entirely cured, sensa tion, 
 motion, and function of a'odominal and pelvic organs being restored, 
 
 (4) Lack of free use of the feet due to a paralytic stroke six years be- 
 fore. A disarticulation among the tarsal bones was discovered, and its re- 
 moval practically cured the case. 
 
 (5) Monoplegia, partial in one lower limb, of a number of years' stand- 
 ing was cured by the treatment. 
 
 (6) Paraplegia, partial, was cured by correction of lesion of the sixth 
 dorsal vertebrae.
 
 206 PRACTICE AND Ari'LIED THERAPEUTICS OF OSTEOPATHY. 
 
 (7) General paralysis in a casr which gradually for six )ears lost the 
 use of all the voluntar)' muscles, the eyes were crossed and nearly blind, 
 bowels and bladder were involved. The case was cured by adjusting lesion 
 between the atlas and occuput, the latter being displaced anteriorly upon the 
 former. 
 
 (S) Infantile paralysis invohing the left lower limb. The case was 
 in a child two }ears old. A sacro-iliac lesion was found as the cause, 
 and was treated. The child could move the limb slightl)' after the first 
 treatment, and after the si.xth treatment perfect use was restored. 
 
 (9) A case of paralysis was found presenting lesions at the occipito- 
 athintal and lunibo-sacral articulations, and from the sixth to the tenth 
 dorsal vertebrae. There was a history of exposure, alcoholism, sexual ex- 
 cess and great physical strain. Correction of the lesions effected a cure in 
 five months. 
 
 (10) A case of paraplegia in a man of fifty-fi\e, due to injury in a rail- 
 road wreck. Both innominate bones were found displaced anteriorl)', and 
 lesions were found involving the whole lumbar and lower dorsal regions of 
 the spine. The paralysis of the limbs was total. After three treatments 
 the patient could walk with crutches. After two weeks treatment the pa- 
 tient could walk without crutch or cane, being as well as ever, excepting 
 some weakness of the spine. 
 
 (11) Paraplegia, involving the bowels, in a lad\- of fift)--three, and of 
 fifteen years' standing. Sensation was lacking in the limbs, and there was 
 very little motion. In less than one month's treatment sensation and mo- 
 tion were both perfectl}' restored and the bowels were acting naturally. 
 
 (12) Hemiplegia of the left side following two strokes, one fifteen 
 years previously, one four )ears. The j)atient was cured in one month. 
 
 (13) Taralwsis following a stroJ<e. The cervical muscles u'ere found 
 contractured. Their correction was accomplished in five weeks, and none 
 of the paral\tic condition remained. 
 
 (14) Paralysis affecting the fingers and thumbs of both hands in a boy 
 of fourteen. The only lesion was contracture of the muscles along the 
 lower cervical and upper dorsal regions of the spine. There was also some 
 atiophyofthe muscles over the brachial plexus and the axillarv- artery. 
 Five months' treatment restored the thumbs and first two fingers to nearly 
 normal condition, the condition of the other fingers was much improved, 
 and the hands could be used considerably. 
 
 (15) ParalNsis and muscular atroph)- of both arms in a boy six years 
 of age. The condition followed an attack of malaria. The condition spread 
 to involve both lower limbs. Spinal lesions were found preventing circu- 
 lation to the cord. The child began at once to improve under the treat- 
 ment. After the third treatment he could move his fingers. In two weeks 
 he could use his hands well enough to feed himself. In one month he was 
 practically cured.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY, 20/ 
 
 (i6) Disseminated subacute cer\'ical and lumbar m)-elitis in a boy of 
 seven, following the swallowing of two pins. Severe illness at once fol- 
 lowed, and in the fifth week the pins were located by the X-ray on the left 
 side about the level of the third cervical vertebra. They were later 
 ejected, he becoming immediately totall)' paraljv.ed. For two weeks it was 
 thought he could not live. After about seven weeks the case came under 
 osteopathic treatment. The tissues of the entire cervical region were badly 
 swollen and intensely painful, and this condition was found along the whole 
 spine. Control of the bowels and bladder was lost, and the muscles of 
 both upper and lower limbs atrophied. After the first treatment the pa- 
 tient slept soundl)' for the first time in two weeks. After about four 
 months' treatment the case was practicall}- cured. ^ 
 
 (17) Monoplegia attacking the right lower limb of a girl of six^'para- 
 lyzed since the age of ten as the result of spinal meningitis. No bony le- 
 sion was found, but the treatment was directed to increasing the circulation 
 to the cord. The case was practically cured in three months' treatment. 
 
 (18) Paraplegia in a girl of four, which had been gradually develop- 
 ing for one )'car, showed improvement after the first treatment and was 
 cured in less than one month. 
 
 (ig) Paraplegia of eight months' standing. The patient was bedridden. 
 Lesion was found as a posterior condition of all the lumbar vertebrae and a 
 slip of the last lumbar upon the sacrum. The case was cured in three 
 months. 
 
 (20) Bell's disease (facial paralysis), due to lesion at the second cervi- 
 cal vertt ora, cured in three weeks. 
 
 (2t) Partial paral)^sis of the lower limbs of four months' standing, due 
 to lesions at the sacro-iliac articulation and at the 5th dorsal vertebra, cured 
 in two months. 
 
 (22) Partial paral)-sis in a lower limb in a girl of six, since infanc}', 
 accompanied by under-developement of the limb, was found to be due to a 
 partial dislocation of the hip, and was cured in two months. 
 
 (23) Paralysis, probably Progressive Spinal Muscular Atroph\-, in a 
 woman of thirty-flve, of fifteen years' standing. The last two years had 
 been spent in bed. Lesions were found at the /t'h curvical and 1st dorsal 
 vertebrae, which were anterior. The case was cured in ten months'. 
 
 (24) Paralysis of the fingers, affecting the last two, and partly the 
 middle finger of the right hand. The patient was a lady of seventy-nine 
 years of age. A fall upon the hand had occured a short time previously. 
 A slight lateral lesion of the first dorsal vertebra was found and corrected, 
 curing the case in six weeks. 
 
 (25) Hemiparcsis or Hemiplegia in a lady of sixty, of six weeks' stand- 
 ing. The right side was affected. Lesion was found in the 3rd cervical 
 and 5th lumbar vertebrae, the spinal muscles also being much contracted. 
 The patient walked after the third treatment and was cured in six weeks.
 
 2o8 PRACTICE AND APPLIED THEKAPEUTJCS OF OSTEOPATH V. 
 
 (26) Hemiplegia, alternate or crossed, following a stroke a year be- 
 fore, affected the left side of the face and the right arm and lower limb. 
 Case was practically cured in three and one-half months' treatment. 
 
 {2/) Hemiplegia, partial, of the right side, folloving lightning-stroke. 
 A displacement of the atlas was found and righted at once, immediately 
 curing the case. 
 
 (28) Paralysis and Dysentery. The paral)sis affected the lower 
 limbs, and had been of seven years' standing. Leaion was found as great 
 tenderness at the lumbo sacral joint, a slip forward of the 5th lumbar, luxa- 
 tion of the innominate?, and a lateral swerxe of the lumbar and lower dorsal 
 region of the spine- A tremor of the head was present, the cervical mus- 
 cles being very tense. After seven months' treatment the lesion were about 
 o\'crcome and the patient was nearly well. 
 
 (29) Paralysis affecting certain muscles of the throat, also affecting 
 the speech. The lesion was found in a contracture holding the hyoid bone 
 out of place. The patient was cured by relaxing the contracture. 
 
 (30) Facial paral)si> of more than one years' standing, was cured in 
 three weeks' treatment. The lesion was found in a displacement of the 
 second cervical vertebra. 
 
 (31) Facial paralysis caused by luxation of the atlas and axis to the 
 left. There was also tension of the tissues at the base of the skull and on 
 the left side of ihe neck. The case, still under treatment, was improving 
 satisfactorily. 
 
 (32) Facial paralysis was seen on the day following its first appear- 
 ance. The lesion was marked muscular contraction at the angle of the jaw 
 on the affected side Treatment gave immediate relief, and the case had 
 almost been cured in ten treatments. 
 
 (33) Progressive paralysis in a case after two falls causing serious ill- 
 ness. Motion in the lower limbs was lost, blindness ensued, and speech be- 
 came unintelligible. There was formication in the hands and arms, and ex- 
 treme pain along the spine, occuring in agonizing paroxysms. Lesions 
 were found as a lateral dislocation of the third cervical vertebra, luxation 
 of /th and 8th right ribs, and a posterior piotrusion of the lumbar vertebrae 
 One treatment brought the first sleep possible in three days. Under treat- 
 me It the spinal pain was relieved, vision was restored, and the patient had 
 been practicall\- cured at the time of the report. 
 
 (34) Crutch paralysis in a man of sixt}-five, causing loss of use of the 
 left hand. A crutch had been used on the left side. The head of the 
 second left rib was found displaced, and the head of the humerus was 
 slightly dislocated anteriorly. After eleven treatments the patient was 
 well. 
 
 (35) Myotonia Congenita (Thomsen'sDisease) in a man, of ten years' 
 standing. Lesion of a lumbar vertebra was removed, curing the case. 
 
 (36) Hemiplegia in a child twenty months old, of ten months stand-
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 209 
 
 ing. Lesion was found at the atlas, which was immediately replaced, and 
 rapid improvement followed. In three weeks the child could walk, and re- 
 co\'ery was almost perfect. 
 
 (37) Brachial Neuritis of five months' standing, causing severe pain in 
 amrs and shoulders, and partial paralysis of the hands. Lesions were found 
 in luxation of the 2nd, 3rd and 4th right ribs, and the 2nd left rib, with ir- 
 regularities of the lower cervical and upper dorsal \'ertebrae. One treat- 
 ment greatly relieved the pain; three treatments enabled the patient to 
 close his hands and snap his finders; and in three months' treatment the 
 case was entirely cured. 
 
 (38) Partial paral)'sis of one hand, loss of memory, and at times in- 
 ability to articulate. Lesion was found at the 2nd cervical \-ertebra. The 
 case was cured by one month's treatment. 
 
 Lesions: Thirty-two of the abo\e cases reported lesion. Twenty- 
 se\'en of the thirt)'two were bony lesions, while five of the lesions were con- 
 tractures as the sole apparent anatomical derangements. Twent)'-one of 
 the bony lesions were vertebral; three were rib lesions; one was a hip lesion ; 
 five were of the innominates; one of the cocc\x; five of the atlas. In but 
 seven was there serious accident as the obvious circumstance resulting in 
 such injur}' as to cause the paralysis. Minor accidents were doubtless the 
 causes of many of these lesions. Thirty-five of the thirt\'eight cases re- 
 ported were reported as cured. In twenty-eight of these cases cured, quick 
 results were gotten by the treatment, either in the form of immediate better- 
 ment or of cure. 
 
 These facts are typical, and illustrate much that is seen in the practice 
 upon this class of cases. They point prominently to importance of anatom- 
 ical lesion, of the kind most regarded by osteopathy, as the cause of para- 
 lytic diseases. The necessity of the removal of such lesion in curing the 
 condition is obvious. These facts clearl)' indicate the great potency of 
 actual bony lesion, derangement of a bony part, in causing paralysis. They 
 illustrate also what experience shows to be a fact, that displacement of 
 spinal vertebrae occurs as the real cause of a majorit)- of the cases of para- 
 lysis. Rib lesions sometimes occur, but do not seem to be important as 
 causes of such disease. The finding of a partial dislocation of a hip as the 
 cause of paralysis in a limb is a fine point of osteopathic diagnosis. These 
 lesions are occasionally found and are of prime importance. The)' are 
 almost invariably overlooked in the usual line of practice. Their reduction 
 is the sole and immediate remedy of the monoplegia. In a few cases both 
 hips have been found thus luxated causing apparent paraplegia. 
 
 Contractured muscles are no doubt generally secondary lesions. But 
 with some frequency the\' have been found as the sole discoxerable cause 
 of paral}'sis, and their removal has resulted in cure, 
 
 Innominate lesion if found to be of the greatest importance in causing 
 paralysis of the lower extremities. The coccyx lesion does not seem to be
 
 210 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 important in this connection. The atlas lesion is perhaps the most import- 
 ant single lesion, notwithstanding the fact that it does not with great fre- 
 quency occur as the sole cause of a paralytic condition. Occuring at a part 
 of the spine where the bones are small and the contained portion of the 
 cord large, it is particularly likely to impinge upon the medulla and cause 
 paral)-tic effects in the whole body below, upon one side of the body, or in 
 the head and its parts. As shown above, lesions of the atlas occured in five 
 of these cases. It was present in two of these cases suffering paralysis of 
 both upper and lower limbs. In one of these cases, in which also there was 
 blindness and crossing of the eyes, it was the sole lesion. Thiscircumstance 
 is well illustrative of the importance of the atlas lesion. In two cases it was 
 the sole lesion causing hemiplegia. It was present with lesion of the axis 
 in a case of facial paralysis. 
 
 A glance at the summary of the lesions will show the very general 
 range of these bony lesions. Atlas, axis, cervical, upper dorsal, middle dor- 
 sal, lower dorsal, lumbar, innominate, cocc)x, hip, rib, and shoulder lesions 
 were found. It seems that an)' movable part along the spine, or in relation 
 with the various nerve-plexuses concerned in the various paralysis, may be- 
 come mib'placed and become a factor in producing a paralytic condition. 
 Yet there is a great deal of constanc}' of lesion. It tends as much toward 
 the specific in this class of cases as in any. Generally in paraplegia, mono- 
 plegia or paralysis of the two upper limbs the lesion is local at a place where 
 it may affect the origin of the nerves concerned in the innervation of the 
 parts involved. All of the seven cases of paraplegia show this in low lesion 
 along the spine. All the six cases of monoplegia show it in lo:al lesions to 
 the origins of the plexuses involved. 
 
 It often happens that in cases of paralysis involving the upper and 
 lower limbs, one or both, there is a high lesion affecting the upper and a 
 low lesion affecting the lower members. Yet a single lesion high up more 
 frequently perhaps causes the trouble in upper and lower limbs. Lesions 
 of the fifth lumbar and of the innominates are frequent in paralysis and in 
 hemiparaplegias. These are important lesions. 
 
 An inspection of the lesions reported in seven of the above paraplegia 
 cases shows that the lower dorsal and upper lumbar region is a favorite 
 place for lesions in such cases; that spinal curvatures may cause the condi- 
 tion; that fifth lumbar and innominate lesions are much in evidence. 
 
 In case of general paralysis invohing upper and lower limbs it is noted 
 that atlas lesion alone may be the cause; that often there are both upper 
 and lower lesions, respectively affecting upper and lower limbs; and that 
 conlractured muscles and causes obstructing circulation to the cord maybe 
 sufficient. 
 
 The monoplegias show much constancy of lesion to the origin of the 
 plexuses. The hip-joint, shoulder-joint, and sacro-iliac lesion all attract
 
 PRACTICE AND APPLIRD THERAPEUTICS OF OSTEOPATHY. 211 
 
 attention. The hemiplegias seem more apt to show single high lesion, as of 
 the atlas, but both high and low spinal lesions may be present. 
 
 The facial paralysis shows almost specific bony lesions. In three of the 
 four cases the 2nd cervical vertebra is involved. In one of these three the 
 atlas is also at fault. In a fourth case there was merely contracture of mus- 
 cles occuring over the course of the trunk of the nerve were it crosses the 
 ramus of the jaw. In these cases, bony lesions if present, are. expected to 
 occur among the upper three cervical vertebra. 
 
 Anatomical Relations: The close relation between the lesion and 
 the disease is shown by several facts. The early development of paralysis 
 after accident giving origin to those lesions found upon examination to ex- 
 ist at important points indicates the correctness of the osteopathic idea that 
 such lesions are the direct causes. The further fact that recovery is depend- 
 ent upon the removal of such lesions, that it actually is accomplished b)' 
 their removal, also shows the close relation of lesion to paralytic disease. 
 Finall)' the Osteopath's experience directs him to expect bony lesion at 
 certain spinal areas, according to nerve-distribution from the spine to 
 affected parts. In all these cases we speak of lesion significant to the Os- 
 teopath only. 
 
 The various lesions, bony and otherwise, aetin s^A^^ral was to cause the 
 paralytic effect thai follows their presence In the first place, a misplaced 
 vertebra or bony part, or a contractured muscle, may bring direct pressure 
 upon a nerve, a fibre, or a plexus, cutting off its function and causing para- 
 lysis in its area of distribution. This fact is well shown in case 24. Here 
 pressure of the first dorsal xertebra upon the last cervical and first dorsal 
 nerves, one or both, which make up the ulnar nerve, resulted in paralysis 
 in the ulnar distribution in the hand, affecting the little finger, ring-finger, 
 and in part the middle finger. The same conclusion is indicated b)' the 
 facts in case 29. Contracture o'f the hyoid muscles drew the bone against 
 the pneumogastric nerve, causing paralysis of the laryngeal muscles, affect- 
 ing deglutition and speech. The same evidence of direct pressure upon 
 nerves is seen in case 32, where the muscles contracted over the trunk of 
 the facial nerve; in case 34, where the head of the humerus impinged the 
 brachial plexus; in case 8, where the sacro-iliac lesion affected the sacral 
 ner\-es. In all of these cases quick results following the removal of press- 
 ure show that the effect of the lesion must have been directl)' upon the 
 nerves inxohed by pressure. 
 
 In such cases the result is seen to be directly upon the part supplied by 
 the impinged nerves, it is uncomplicated b)' results in other parts of the 
 bod)-, and is manifested in a circumscribed area, namely, in the muscle 
 groups supplied by the nerve or nerves in question. In diagnosis a practi- 
 cal point is to expect lesion of a kind exerting direct pressure in cases pre- 
 senting general features as described above. The lesion is known at once 
 to be located some where in the path or at the origin of the ner\es involved.
 
 212 PRACTICE AND AFM'LIED THERAPEUTICS OF OSTEOPATHY. 
 
 On the other hand, a certain class of lesions is found causing paralytic 
 disease by lesion to the cord. The effect to the cord ma)- be through di- 
 rect pressure upon it, or in other ways. An example of such conditions is seen 
 in case 38. Here lesion of the 2nd cervical vertebra caused partial paralysis 
 in one hand, loss of memor)-, and at times inability to articulate. There 
 was evident involvement of brain and cord, and the lesion was too high to 
 affect the brachial plexus by direct pressure. In such case there is possi- 
 bility of the lesion affecting the cord either by direct pressure or by inter- 
 ference with the s)mpathetic or with cord-nutrition. The supposition of direct 
 pressure is supported by the fact that removal of the lesion cured the case 
 in one month. In case 33, formication in the upper, and paralysis in the 
 lower limbs, blindness, unintelligible speech, and paroxysms of spinal pain, 
 clearl)- indicate involvement of cord and brain. The lesion of the 3rd cer- 
 \ ical vertebra was too high to affect the brachial plexus by direct pressure; 
 the lesion to the lumbar \ertebra likewise could not have pressed directly 
 u[)on the nerve-suppl)- to the lower limbs. Vet the paralytic condition in 
 lower limbs, referable to the posterior displacement or protrusion of the 
 liuubar vertebrae, favors the theory of direct pressure upon the cord, since 
 such paralysis of the lower limbs is known to follow actual lesion to the 
 lumbar segments of the spinal cord. 
 
 In case 36, the hemiplegia resulted from lesion at the atlas, and was 
 cured by its removal. The fact that the child could walk in three weeks 
 after treatment began, ami the highness of the lesion, both favor the idea 
 that there was pressure upon the cord. In case 7, where there was paralysis 
 of the voluntary muscles, crossed e}es, and partial blindness, the lesion was 
 again at the atlas (occipitoa'-tlantal) and the same reasoning would applw 
 So in case 6, paraplegia following lesion of the 6th dorsal vertebra 
 
 It must be noted that in all these cases the results are quite unlike those 
 in the first group considered. The results, instead of being direct upon 
 nerve or ple.xus, are indirect; the}' are also complicated with effects in more 
 than one part of the body, and are not circumscribed by being limited to 
 one muscle group. It is an indication in diagnosis to expect such cord 
 lesions in cases showing this stvle of effects from lesion. 
 
 In some cases the lesions no doubt do shut off nutrition to the cord or 
 brain. It is seen in cases where cervical bony lesion results in atrophy of 
 the optic ner\e, causing blindness through interference with its nutrition, 
 (case 33; case 7. ) In case 15, lesions were described as being present and 
 preventing circulation to the cord. Treatment with the idea of restoring 
 this circulation resulted in quick benefit and cure. In case 17, the lasting 
 effects of the meningitis upon the cord were overcome b)- building up cir- 
 culation to it. 
 
 Quickness of results in many cases indicates functional derangement 
 from pressure of the lesion, which being removed leads to immediate restor- 
 ation of function. On the other hand a course of treatment must look to
 
 PRACTICE AND APPLIED THERAPEUTICS^OF OSTEOPATHY. 2I3 
 
 regeneration of nerves and of ganglion cells in many cases where degenera- 
 tion has taken place in these tissues because of the effect of the lesion. 
 
 In hip cases, as in case 22, the underdevelopement accompanjing the 
 paralysis is often due to pressure upon blood-vessels as well as upon nerves. 
 The pressure is from the displaced bone and the contractures of tissues. 
 
 The Prognosis in paralytic cases is very favorable. A large percentage 
 ■of the cases is entirely cured. Fiew cases are neither benefitted nor cured. 
 The apparent greatness of the lesion bears no proportionate relation to the 
 degree of the effect. A small or very limited lesion often causes the most 
 serious paralysis. 
 
 Many cases are slow and difficult. Some cannot be cured. 
 
 The length of standing of the case should not determine the prognosis. 
 Recent cases may be the most difficult to cure. Many of the mo(»t long- 
 standing and worst cases are quickly benefitted and cured. The prognosis 
 is good, even after "strokes," and often in cases where there is blood-clot 
 on the brain. 
 
 Treatment: The bony lesion must be removed. This is often the 
 only necessary treatment. But most cases require a course of treatment to 
 regenerate, through the blood-supply, the nerves and centers effected. This 
 necessitates insuring a good qualit}' of blood, and in many such cases the 
 important first step consists in sufficient treatment to bowels, stomach, liver 
 and kidnej-s to improxe the general health and expell all impurities from 
 the blood. 
 
 The general spinal and cervical treatment should be applied to tone the 
 general nervous system and to increase the circulation and nutrition of it. 
 This is accomplished b\' relaxation of all the spinal tissues, separation of 
 the spinal vertebrae to allow free circulation, and stimulation of the central 
 distribution of the sympathetic having control of circulation to the spine. 
 
 In case of blood-clot upon the brain the treatment is to increase cervi- 
 cal circulation to absorb it. This can be accomplished in cases where the 
 clot has not had time to become organized or encx'sted. After cerebral 
 hemorrhage, treatment should keep this object constantly in mind. But in 
 many old cases of hemiplegia after cerebral apoplexy, where doubtless 
 the clot has become organized, much benefit can be gi\-en b)- the treatment. 
 
 Local treatment is made upon the paralyzed limb or part to soften 
 contractures, build up circulation, increase nutrition of the tissues, and to 
 tone the local ner\-e-mechanism. 
 
 Lesions as described in this chapter will be found in most of the vari- 
 ous diseases of brain and spinal cord. The same principles and methods 
 of treatment, varied to suit the case, may be applied to them. 
 
 For example, in Cerebral Hemorrhage, or Cerebral Apoplexy^ 
 strong inhibition is made at once upon the sub-occipital regions to dilate 
 the blood-vessels and to aid in reducing the congestion. This object is 
 aided in a most important manner b)' the general cervical, spinal and ab-
 
 214 PRACTICE AND ArrLIED THERAPEUTICS OF OSTEOPATHY. 
 
 dominnl treatment, relaxing all tissues and calling the blood to these parts 
 
 away from the head. These treatments should be rela.xing and inhibitive 
 
 in nature as before described. The head should be kept raised to aid in 
 
 drawing the blood from it. In the intervals of treatment the ice-bag 
 
 ma)- be applied to the head, hot ap|)lications to the feet, and counterirritants 
 
 to the spine. The patient should remain cjuietly in bed and be fed upon a 
 
 liquid diet. 
 
 After the acute stage the treatment should be carried on to remove the 
 
 blood-clot from the brain and to overcome the hemiplegia. The former is 
 
 accomplished b\- the usual cervical treatments to increase circulation to the 
 
 brain; the latter by such treatment as described in detail above for cases of 
 
 paralysis. The clot ma\-. if taken in time, be completely removed, and the 
 
 patient may be completely cured of all paralysis. During the acute stages 
 
 the patient should be seen twice or several times daily. Later he ma}- be 
 
 treated daily or three times a week. 
 
 In the various forms of Spinal Me.vingitis, often met in our practice, 
 good prognosis is the rule. Cases are made to recover entirely, all paralysis 
 or lingering stiffness of the muscles being overcome. The treatment in the 
 acute form is the general spinal, cervical, and abdominal, to control the cir- 
 culation of the cord and call the blood away from it. Tne rigidity of the 
 muscles is overcome by manipulation and by careful, inhibitive spinal treat- 
 ment. Bowels and kidneys must be kept active b)' treatment, to aid in re- 
 moving toxic products from the s)'stem. It may be necessary to use a 
 catheter on account of the paralysis of the sphincter of the bladder. In the 
 intervals of treatment ice-bags may be applied along the spine. A course 
 of treatment should be carried on to insure complete resorption of the in- 
 flammatory products from about the cord, and to prevent or overcome any 
 parah tic sequel to the condition. 
 
 In Myelitis the same general plan of treatment should be adopted to 
 gain vaso-motor control and lessen the inflammatory process in the cord. 
 Diagnosis should be made of the jiortions of the cord affected, and treat- 
 ment should be applied here particularly to absorb the extravasated blood 
 and do away with the danger of softening or degeneration of the cord fol- 
 lowing. The patient should be keep quiet, and attention be given to any 
 special manifestation in the case requiring alleviation. Care must be taken 
 in the manipulation to avoid all irritation of the skin on account of the 
 liability to bed-sores. Rigidit)- and spasm in the affected muscles may be 
 overcome by inhibitixe manipulation of them, and by inhibition of the 
 nerves. Guard against renal and pulmonary co;iiplications b)- keeping the 
 lungs and kidneys well stimulated. A course of treatment must follow to 
 guard against or overcome paral)sis. The prognosis is good in the acute 
 case. A chronic case maj- be cured, or much may be done for its benefit. 
 
 In meningitis, myelitis, apolexy, etc., various spinal and cervical 
 lesions occur, of the kinds pointed out in the general consideration of the 
 subject of paralysis.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 21 J 
 
 INSANITY. 
 
 Cases: (i) Farmer, injured while at work, later became insane. 
 Treatment by the usual methods did not avail and preparations were made 
 to take him to an asylum. He had been insane for some months, when the 
 osteopathic examination was made. Four men were required to hold the 
 patient during the examination, so violent had he became. Lesion was 
 found as a marked displacement of the third cervical vertebra to the right. 
 It was set at once, and the patient immediatel)' fell asleep, sleeping for 
 twelve hours and awaking rational. In a few da)'s the patient was well. 
 
 (2) A young lady, violentl\' insane for six }'ears. Lesion was found 
 as a slightly misplaced atlas, which was corrected at one treatment. The 
 symptoms of insanity all disappeared in a few days. There was history of 
 a fall six )ears previous to the development of the insanit>% and it was 
 thought that the luxation of the atlas was caused then. 
 
 (3) A young woman of twenty-four, insane and confined in an asylum 
 for eight months. Lesion existed in the form of a double lateral curvature 
 in the lumbo-dorsal region; 5th lumbar \ertebra posterior; 4th dorsal mark- 
 edly posterior; 3rd and 5th dorsal anterior; 7th and Sth right ribs pressing 
 upon the liver; innominates, one forward and the other back, one limb being 
 I inch longer than than the other. Treatment directed to the correction of 
 these lesions caused immediate benefit, and the patient was apparentl)' vvell 
 after two weeks' treatment. 
 
 (4) In a lady of twent}', insanit)' of two months' standing. There was 
 a history of attacks of marked cerebral congestion. At times she became 
 violent.' The lesions were great tenderness and tension in the cervical re- 
 gion abo\-e the 4th vertebra, but no bony lesion; tenderness at the 5th lum- 
 bar vertebra and over the left ovary. Dysmenorrhoea was present. After 
 the first treatment she slept tor eleven hours, and awoke sane for the first 
 time in eight months. After three weeks' treatment the patient was well. 
 
 (5) A boy acted in an insane manner after a fall upon his head from 
 a window. A cervical vertebra was found luxated, and one treatment suf- 
 ficed to cure the case. 
 
 (6) A lady of thirt)--eight, who had been a chronic sufferer from rheu- 
 matism, had become insane ten years previonsly to treatment. At the time 
 of becoming insane the menses had ceased. She had been in an asylum for 
 six months, growing continually worse. She was much excited and suffer- 
 ed hallucinations. The lesions were such as pertained to the rheumatic 
 condition; general muscular contracture, joints somewhat stiffened, tender- 
 ness over the kidne}-s, feeble pulse, and subnormal temperature. One 
 month of treatment showed great improvement; after two months the 
 menses were reestablished and the mind was nearly normal. Recovery was 
 complete.
 
 2l6 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHV 
 
 (/) Insanit)- in a man followed injury in a runawa)' accident. Lesion 
 existed as anterior displacement of the atlas and a twist of the second and 
 third vertebrae, one being; turned forward and the other backward. There 
 was also contraction and soreness of the posterior cer\ical muscles. Con- 
 tinued pain existed at the top of the head, there was an eruption upon the 
 face, and a marked abnormal pulsation of the abdominal aorta. Treatment 
 soon cured the case. 
 
 The cases are illustrative of osteopathic practice in insanit)', numerous 
 cases of which come under treatment. As a rule bony lesions are found. 
 Sometimes lesion exists in the form of merely muscular contracture in the 
 cervical region. The lesions are generally in the cervical region. Fi\e of 
 the above seven cases presented such lesion. Atlas lesion is frequent. In 
 some cases are general spinal lesions leading to effects upon the nervous 
 system. Often marked lesion is found in the dorsal region. McConnell 
 notes the occurrence in insanity of middle dorsal, renal splanchnic, and rib 
 lesions. The latter occur among the middle ribs on the right side. Case 
 3 above shows such lesions. 
 
 Lesions act by interfering with cerebral circulation, probably in some 
 cases by pressure upon the cord, and also by affecting the nervous system 
 and setting up reflexes. On the whole but little can be said definitel)- in 
 regard to the pathology of insanity from the osteopathic point of view. 
 That lesions exist as the cause of such conditions, and that their removal 
 cures, and alone can cure, them, cannot be doubted from the facts. But 
 just how lesion is acting to cause derangement of the mental functions is 
 not known. It is noticable that quick results usually follow treatment, as 
 in the seven cases above. Often the patient falls at once into a deep and 
 lasting sleep, These facts indicate some marked and immediate relief to 
 the brain. It seems as if some great pressure had been taken off the brain, 
 leaving the mind free and Nature unopposed in her work of repair. This is 
 doubtless literally true in those cases of insanity attended b}' cerebral con- 
 gestion, in which the impeded circulation is at once restored to normal ten- 
 sion b\' removal of that which impedes the venous flow from the head. 
 When the lesion is cervical it is altogether likely that its action upon the 
 brain is b}- deranging the cerebral circulation, either by direct pressure upon 
 the vertebral arteries by a displaced vertebra, by irritation to cervical sym- 
 pathetics and the vaso-motor center in the medulla, or by a combination of 
 these two. In this way may be set up either hyperemia or anemia of the 
 brain. For example, pressure upgn the vertebral arteries and irritation to 
 the vaso-motors causing vaso-constriction might co-operate to cause marked 
 anemia of the brain. On the other hand, impeded \enous return and in- 
 creased arterial tension in this region might result from lesion and cause 
 cerebral hyperemia. Many cases of insanit)- are met in which there is 
 hyperemia, as in cases 4 and 7. 
 
 That h)peremia and anemia are important in relation to insanity is
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 217- 
 
 shown by the statement of Kellogg that "insanity from circulatory disord- 
 ers of the brain arises chiefly in intense hyperemic and anemic forms." 
 That osteopathic lesion profoundly affects cerebral circulation is e\idenced 
 by many facts in the treatment of various diseases. The importance of 
 these circulatory disturbances is further indicated by Kellogg's statement 
 that vascular degenerations deprive the brain of its customary blood-supply 
 and also prevent elimination of the waste products of cellular activity. It 
 is evident that the lesion shutting off the arterial supply or preventing free 
 circulation in the brain could act as could vascular degenerations in produc- 
 ing the effects mentioned. Kellogg says it is freely admitted that then is a 
 pre\ious link in the chain of events leading to insanity from such causes as 
 he mentions above. This link the Osteopath supplies by noting these im- 
 portant bony and other lesions, without the removal of which these cases 
 fail to be cured. 
 
 It is likely that the atlas lesion, so often found in insanity, acts chiefly 
 by deranging the circulation through its close relations to the superior 
 cervical ganglion and the medulla. It does not seem that this and other 
 cervical bon)' lesion cause direct pressure upon the cord, as in such case one 
 would expect paralysis in the body below, yet it is not impossible that it 
 may press directl}' upon the cord, getting its effect upon the brain through 
 ascending tracts. 
 
 The general spinal, vertebral and rib lesions mentioned may affect the 
 general nervous system, as is known to be a fact from a study of nervous 
 diseases, (see Paralysis) in this way leading to nervovs diseases, reflex and 
 otherwise, which are at the basis of insanity "All the (various influences) 
 acting in the production of general diseases of the nervous system are those 
 fundamentall)' in\'olved in the causation of insanity," (Kellogg). The 
 splanchnic, right rib, and renal lesions noted by osteopathy as present in in- 
 sanity cases may cause insanit)^ through derangement of kidneys, liver and 
 gastro-intestinal tract. The fact is noted by writers upon insanity that 
 kidne)' diseases, notably Bright's disease, and gastrointestinal conditions, 
 as gastric and intestinal catarrh, are sometimes closely associated with the 
 causation of insanity. Likewise liver disease is well known to be closely 
 connected with insanit)', gall-stones and icterus being common in insanity. 
 These visceral diseases, as well as some nervous diseases seem to be related 
 to insanity through the vaso-motor reflexes they arouse. Kellogg says, 
 ''vaso-motor disorders essentially constitute the connecting link in the 
 causation of insanit)' by visceral affections and peripheral nervous diseases. 
 The \'aso motor center in the medulla is under the reflex control not alone 
 of the cerebral cortex, but of the entire peripheral distribution of the sen- 
 sor)- nervous s)stem, so that not onl)' emotional stimuli, but peripheral ir- 
 ritations, ma)' affect circulatory changes and variations in the blood-pres- 
 sure which stand in poximate relation to mental disorder." 
 
 It is a well demonstrated fact that osteopathic lesion causes not only
 
 2l8 
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY 
 
 the visceral diseases, but likewise marked vaso-motor disorders, 'etc., ap- 
 parently so closely related to these brain conditions. 
 
 In view of these various facts it seems that the Osteopath has in in- 
 sanity a broad field for his labors. Nor would he be confined to that class of 
 cases in which the traumatic effects of lesions due to violent accidents and 
 the like are the causes of insanity. But as it is evident that the various le- 
 sions, bony and otherwise, that he finds may become fundamental to the 
 causation of insanity through producing visceral, nervous, and vaso-motor 
 disorders, his field in insanitv must be as broad as the disease. 
 
 The Pro(;nosis is good. The most brilliant and quickest results are 
 often attained, A large percentage of the cases treated are cured. It is 
 needless to say that many cannot be cured. 
 
 The Treatment looks to the removal of lesion, and of all causes of 
 irritation, reflex, emotional and otherwise. The whole nervous system 
 should be upbuilt by general spinal and cervical treatment. One of the 
 main objects is to correct cerebral circulation. A congested condition is 
 treated as in congestive headache or apoplexy, q. v. The abdominal in- 
 hibition may be employed. The general health is looked tD, kidneys, liver, 
 stomach, bowels, pelvic viscera, heart and lungs are all regulated in case of 
 affection in them. The patient should lead a quiet, regular life. 
 
 
 ^ T^jlJuj:^^ 
 
 i- 
 
 9u I 
 
 1 
 
 C't'-^ r-^-^ 
 
 cLchr^jJ^ 
 
 
 ^l 
 
 ,^-Lsl^ 
 

 
 yt-,^.^^ Lj-^ ^ ^''' "^^"-^-""^^ 
 
 (PoJc^ji^ yJ^^jL l^^^^ ^>— ^w^...-.^ W/^-:^. 
 
 -^J!^ ^^ iH^ ^v-^^-Xa^ 
 
 vT' — ^ — ^^ ' 
 
 0^ C^th^'^-j^ J^.j^.^guXZe-~r^ 6- 
 
 U>pf^<^ 
 
 yHx^'^-*C/ft^ 
 
 ^^w.<„i.''-^ 
 
 
 '^-Hy.A^y^.yUL 
 
 
 
 *L cy A-T-v^t^v^ >v~»T 
 
 r 
 
 
 <---&-><-*» ; ^ '**^
 
 
 ^ Y^x>^ &^ ic:^^ -fer-^/V. v>l^^— ^ ^^ Y: ^^ ^^-^-->^ '"'^"^'^ 
 
 ry^AA-^ 
 
 6^1. 
 
 
 \(y >^-^^-^.L^ J- 
 
 0<-p<^ "^^-QJ^-U^ ; 
 
 ^ /kJa^ oA- ^0 ^h)i 
 
 A V — 'i ' 1* I / I L . i 
 
 ^J^" "^T^ Hfe '^^^'^ -vv.^^ (v^feu,,afcd~feoJ-- :i 
 •v^^^Jl^ .V v-rtu^-t^:.^.^ ^UMr-n^t-r^^ -C^uJ,-Wt,>.A - I
 
 PRACTICE AND APPLIRD THERAPEUTICS OF OSTEOPATHY. 221 
 
 DISEASES OF THE EYE. 
 
 Cases: (i) Impaired vision in a boy of seventeen, who had been 
 wearing glasses over three years. Severe hsadache and inability to read 
 followed removal of them. Lesion was found as lateral luxation of the 
 atlas and third cervical vertebra. After'three weeks' treatment the glasses 
 were removed, and at the end of two months the eyes were completely 
 cured. The report was made six months later, the eyes still being well. 
 
 (2) In a case of weak eyes the glasses were laid aside permanently 
 after one month's treatment. 
 
 (3) Weak eyes, which for two years, had required the use of spectacles, 
 were cured at the second treatment by adjustment of cervical bony lesion. 
 The glasses were at once laid aside. 
 
 (4) A young man of eighteen had, for twelve years, been forced to 
 wear spectacles, in spite of which the eyes continued to grow weaker. He 
 had to give up school work. Under osteopathic treatment he laid aside the 
 glasses after three treatments. No further treatment was required. Five 
 months later the eyes were still well. 
 
 (5) A case in which weakness of the eyes and rheumatic pains in the 
 shoulder were caused lesion in the form of closeness of the second and third 
 cervical vertebrae. After one treatment the glasses werelaid aside and the 
 pain in the shoulder was gone. The trouble, caused by a fall in a gymnas- 
 ium, affected but one eye and one side of the body, a nervous twitching of 
 the muscles being present. 
 
 (6) A young lady had suffered with weak eyes for two years. The 
 eyes would be very painful if the glasses were laid aside even for five min- 
 utes. Lesion was of the 2nd dorsal vertebra, lateral to the left. After five 
 treatments the glasses were discarded. 
 
 (7) In a lady of forty, weakness of the eyes, accompanied by great 
 pain in the eyeballs and at the base of the brain. Lesion existed at the 
 atlas and third cervical vertebra. Constipation and uterine prolapsus were 
 present, with characteristic lesions. After one month the eyes were almost 
 well. Photophobia was a feature of the case. 
 
 (8) In a cases of weak eyes, with pain in the neck, occipital headache, 
 and a complication, ot troubles lesions were found as anterior luxation of 
 3rd, 4th, and 5th cervical vertebrae, the 5th being sore. The whole spinal 
 column was stiff and stooped forward. 
 
 (9) In a case of weak eyes in a young man of twenty, of two month's 
 standing, the patient was unable to read, the balls were injected and pain- 
 ful, and the lids were inflamed. The atlas and axis were too close. 
 
 (10) In a lady of thirty-two, weakness of the eye and chronic hoarse- 
 ness had existed for twenty-two years. The left cervical muscles were very 
 sore, there was a separation between the atlas and axis, and the 5th cervical 
 vertebra was sore. The right tear duct was closed.
 
 222 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 (I i) In a case o( weakness of the eyes, coupled with indigestion, j lun- 
 dice and hemorrhoids, the 7th to i»th dorsal vertebrae were posterior; 
 coccyx anterior; an innominate forward. 
 
 (12) Extreme weakness of the eyes, together with female disease. A 
 few minutes' use of the eyes caused violent headache. L-^sions were at the 
 atlas and in a tilting of an innominate bone. The case was cured by re- 
 moval of the lesions. 
 
 (13) Eye trouble in a boy of thirteen, not benefitted by glasses. Pa- 
 tient was very nervous. The atlas was slipped forward. The lesion was 
 corrected and the case cured in six weeks. 
 
 (14) A case of pterygium due to granulated lids of sixteen years' 
 duration. The left pupil was covered by the growth, and the right one was 
 nearly so. The case was cured by the adjustment of cervical lesion. 
 
 (15) Pterygium o\er each eye due to lesion of the atlas. Under treat- 
 ment gradual correction of the lesion was accompanied by gradual absorp- 
 tion of the growth. 
 
 (16) Partial blindness and strabismus, associated with general paraly- 
 sis, due to a forward slip of the head upon the atlas. The case was cured in 
 two months. 
 
 (17) A case 01 blindness from optic-nerve-atrophy, due to a fall from 
 a swing, resulting in lesion of the atlas and several cer\ ical and upper dor- 
 sal vertebrae. The disease was of twenty-three years' standing It was 
 cured by two years' treatment. 
 
 (18) Blindness of one eye, and almost total loss of sight in the other 
 of about a ) ears' duration, was cured in two weeks by correction of lesion of 
 the atlas, which was displaced to the right, and of one of the first ribs,w^hicb 
 was luxated upwards. 
 
 (19) Partial blindness, the patient being unable to read or to recog- 
 nize a person ten feet away. The trouble was due to starvation of the optic 
 rerve from lesion of the upper cervical vertebrae. In four months the pa- 
 tient had been cured. 
 
 (20) Blindness, almost total, in a min of sixty, due to a fall when he 
 was a child. Lesion was found as luxation of a cervical vertebra. The 
 treatment so benefitted the eye that it could see to read coarse print. 
 
 (21) A case of cataract reported cured, the patient's oculist verifying 
 the report. 
 
 (22) Total blindness in the left eye for more than two years, due to 
 lesion of the atlas. The pupil was much dilated. After one treatment 
 sight was partly restored, and at the end of a month of treatment the case 
 was nearly entirely well. 
 
 (23) Total blindness with paralysis of lower limbs, formication of 
 upper limbs, etc. Lesion was found in lateral luxation of the third cervical 
 vertebra, of the 7th and 8th right ribs, and posterior protrusion of the lum- 
 
 ar vertebrae. Soon vision was partly restored, but with diplopia. Slight
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 223 
 
 pressure upon the seventh cervical vertebra would at once restore perfect 
 vision. When pressure was removed diplopia again occured. Under fhe 
 treatment the sight was entirely restored. Speech had been lacking, but was 
 restored, and the paralysis was cured. 
 
 (24) In a young man of twenty, diplopia of two years' duration had 
 followed a severe attack of measles. The 3rd cervical vertebra was dis- 
 placed anteriorly and the tissues about it were sore. Tenderness existed 
 also at the 5th and 6th cervical vertebrae. The first dorsal was posterior, 
 the 2nd to 6th flattened, the 8th to 12th weak, with a separation between the 
 I2th dorsal and ist lumbar, and the ist to 4th lumbar vertebrae were poster- 
 ior, The case was cured in one month. There had been sugposed hem- 
 orrhagic retinitis. 
 
 (25) A case of strabismus due to lesion of the 2nd dorsal vertebra was 
 cured by correction of the lesion. During the course of treatment, after the 
 eyes had first become straightened pressure upon the second dorsal vertebra 
 would cross them again. 
 
 (26) A case of strabismus, unilateral, convergent, due to a fall in a run- 
 away accident. The atlas was displaced to the right; 4th and 5th cervical 
 vertebrae anterior. The case was improving under treatment. 
 
 (27) Kerito-conjunctivitis, in the left eye, of four years' standing. 
 There was opacity of the upper two-thirds of the cornea, with marked vas- 
 cularization, inflammation and granulation of the eyelids, and injection of 
 the sclerotic. The atlas was luxated to the left, the fifth and sixth cervical 
 vertebrae were anterior and to the left, and the upper dorsal vertebrae were 
 posterior. Under the treatment the case was almost cured in less than two 
 months. 
 
 (28) In a man of thirty-seven, glaucoma was present, and total blind- 
 ness of the left e\e was predicted by the oculist. The patient was a neuras- 
 thenic probably of the cerebral type, pain in the head and eye being ex- 
 treme. The eye trouble was overcome and the patient's general condition 
 much improved by three months' treatmeut. No especial lesions were found. 
 
 (29) Partial blindness, in which the blindness was limited to a circular 
 portion of each e\e. Lesion was found as a luxation of the atlas to the 
 light and backwards. The case is still under treatment. 
 
 (30) A case in which the tear-duct was closed. It had been growing 
 worse under the usual form of treatment for two years. The eye was much 
 inflamed. Relief was experienced at the first treatment, after the second 
 the duct was permanently opened, and the inflammation about the eye grad- 
 ually disappeared. The case was well a }'ear later. 
 
 (31) Eye-strain, causing constant headache, due to a luxated atlas. 
 Glasses gave no relief. The headache did not recur after the first treatment, 
 and the eyes were well after seven treatmeats. The case had been of but 
 two or three months' standing. 
 
 (32) Astigmatism in a girl of ten. Lesion was found at the 2nd dor-
 
 224 FKACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHV. 
 
 sal. Treatment was directed to correction of this lesion uid to stimulation 
 of the ocular blood and nerve-supply. The case was soon cured. 
 
 (33) In astigmatism for which the patient had worn spectacles for nine 
 years, lesion was found in anterior luxation of the atlas and a twist of the 
 inferior ma.xillary bone. The glasses were permanently discarded after one 
 treatment, and the case was soon entirely cured. 
 
 Lesions: Of the 33 cases above, 27 report lesion, and in each case bony 
 lesions were present. Contracture was also noted in one case. Of these 
 "•T lesion?. 21 were cer\ ical bonv lesions and two were muscular contrac- 
 lures. Preponderance of atlas lesion was seen in the cervical region, 16 of 
 the 27 being such. Numerous lesions occured. Among the other cervical 
 vertebrae were lesions as follows: Axis, 3; 3rd cervical, 6; 4th cervical, 2; 
 5th cervical, 5; 6th cervical, 2. 
 
 Upper dorsal lesions were present in 8 cases, 7 being bony lesions. 
 These lesions extended as low as the 6th dorsal vertebra, as follows: ist 
 dorsal, 2; 2nd dorsal, 5; 3rd dorsal, 2; 4th dorsal, 2; 5th and 6th dorsal each 
 one. 
 
 Oth r bon)- lesions occuring in these caser, and of importance in eye 
 troubles generall)-, are luxation of the inferior maxillar)- bone and of the 
 first rib, sometimes also of the clavicle. 
 
 These reports illustrate very well the general lesions fcund in diseases •f 
 the eye. The most important lesions occur among the vertebrae of the 
 cervical and upper dorsal region. Muscular lesions are often found in this 
 region, and are of considerable importance. The whole cer.vical region is 
 frequently involved, or any one or several of the \-ertebrae may be luxated. 
 Perhaps the more important lesions are of the atlas, axis, and 3rd cervical 
 vertebra. The 4th and 5th are also important. 
 
 There is a form of neck lesion thar often plays a part in the production 
 of eye disease, as well as of other forms of head and neck trouble. It in- 
 volves the whole cervical region, often causing a lateral swerve of the cervi- 
 cal spine. The cervical tissues are contractured or hypertrophiel upon one 
 side more prominentl)- than upon the other. The condition is often evident 
 upon simple in spection from immediately behind. The fullness upon 
 one side of the neck, and generally a corresponding depression in the tissues 
 on the opposite side, are readily seen. In some cases the condition is better 
 appreciated upon palpation. The fingers ar<: readily pressed more deeply 
 into the tissues upon one side of the posterior cervical aspect than upon the 
 other. Contracture of the muscles may be felt here on both sides. If the 
 vertebrae are traced down the mid-line of the back of the neck, a lateral 
 swerve is often evident. In other cases the bony lesions are more evident 
 by examination of each verteba with the patient I)'ing upon his back. 
 
 Dr. A. T. Still calls attention to the fact that contracture of the cervical 
 muscles opposite the 4th vertebra are common in eye-diseases, and that 
 pressure here causes pain in the e)e. A case is reported in which pressure
 
 v>RACTlCE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 22$ 
 
 between the 2nd and 3rd dorsal v^ertebrae upon th€ right side revealed ten- 
 derness at that point and also caused pain in the e)e. 
 
 Without question cervical bony lesion is the most important one with 
 which the Osteopath deals in eye-diseases. 
 
 Upper dorsal lesion may be muscular, but is usually lx>ny. It involves 
 chiefly the upper four or five vertebrae, but may extend as low as the 6th or 
 seventh. The lesions of the ist, 2nd and 3rd dorsal vertebrae are the most 
 important here. A common abnormality of the anatomical parts here is a 
 "'hump" or prominent cushion of flesh covering the spinous processes of the 
 upper two or three dorsal vertebrae. There is often conjoined with this con- 
 "d it ion a marked prominence of the first dorsal spine from above, as if the cer- 
 vical spine had been moved a little anteriorly upon the first dorsal. This cush- 
 ion is a common condition in eye troubles of various sorts, and is sometimes 
 connected with heart- trouble. 
 
 Among lesions of this region may be mentioned lesiou of the upper ribs 
 on either side as low as tlie sixth, sometinies thought to have as bearing upon 
 nutritional disturbances of the eyes. 
 
 We are perhaps not in a pcsition or yet to point out that special kinds or 
 locations of lesion result in specific di.sea.ses of the eye. Cases involving defi- 
 ciency somewhere in the optic tract seem to favor lesion in the upper cervical 
 region. In the above reports, 19 cases in which probably the intrinsic apparatus 
 of the special sense of sight, was involved such as weakness, impaired vision, blind- 
 ness, etc., show lesion chiefly in the upper cervical region. All but two cases show 
 cervical lesion, 13 of them being entirely in the cervical region; 1 1 at the atlas; 
 8 at the axis, third, or both; also the 4th, 5th and 7th were involved. The 
 most important lesions occured about atlas, axis, and third. 
 
 Cases in which there is nutritional disturbance, as in conjunctivitis, kera- 
 titis, glaucoma, cataract, and closure of the tear-duct, also cases in which there 
 is structural change, such a-^ astigmatism, pterygium, etc., probably due 10 
 lack of nutrition, present atlas, general cervical, inferious maxillary, and upper 
 dorsal lesiou. Compilations of data, by which proof of these matters might 
 be made, are lacking. Yet it seems that nutritional disturbances, involving in 
 some way chiefly the fifth nerve, would be found tending more toward the 
 upper dorsal region, for the anatomical reason that this nerve has important 
 connections with the upper dorsal nerves and cord. 
 
 Motor disturbances, such as diplopia, strabismus, eye strain, etc., show 
 less of high cervical le.sion and more from about the third cervical down to the 
 upper dorsal. In this connection it is recalled that diplopia has been caused b}' 
 pressure at the 7th cervical, and strabismus by pressure at the 2nd dorsal. 
 
 This phase of the subject, inquiry how far specific lesion results in a cer- 
 tain form of eye disease, presents a good field for research. It is evident that 
 at present we cannot more than indicate probabilities. 
 
 Anatomical Relations: There are good anatomical reasons why lesion 
 n the upper dorsal and cervical regions causes eye disease. These portions of
 
 226 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATKY. 
 
 the spiue are particularly rich in nerve conneclions with the eye. These lesions 
 act by disturbing blood nerve, or lyiiipaihic-supply of the eye. The blood- 
 supply suffers sometimes by direct inipingenieni, as of vertebrae upon the ver- 
 tebral arteries, or by derangement of the vasomotor control by lesion to the 
 nerves. The lymphatics suffer by direct impingement, as by clavicular lesioD 
 damming back the Ivmpliaiic drainage from the head. The lesion affecting 
 the eye does so chiefly, hovTever, by distbrbance of the numerous important 
 nerve-connections met in the upper do-sal and cervical regions. 
 
 Experience has taught the Osteopath that bony lesion in those regions 
 causes most eye-diseases and that its removal cures them. 
 
 The superior cervical ganglion, well known to suffer b\' lesion of atlas, 
 axis, or 3d cervical, sends its ascending branch to join the carotid and cav- 
 ernous plexuses, thence to help form a secondary plexus about the opthal- 
 mic arteries and to contribute branches to the minute plexus of the sympa- 
 thetic within the eyeball itself. Thus is established a direct path of com- 
 munication between the upper cervical lesion and the eye. 
 
 The ciliary ganglion lies at the back of the 01 bit, between the trunk of 
 the optic nerve and the external rectus muscle. In this situation it is read- 
 ily impinged by that treatment that presses the e) eball back into the orbit. 
 With this ganglion are connected the 3d, 5th and sympathetic nerves, it 
 thus becoming, through the functions of these neives, a sensory motor, and 
 sympathetic center for the eye-ball. Neck lesion, as will be shown, may 
 effect either or all of these nerve-connections, in this wa)' deranging the 
 function of the ganglion with regard to the eye. 
 
 The third cranial nerve inner\ates all the voluntary muscles of the eye 
 except the external rectus and the superior oblique. It is further the nerve 
 which contracts the pupil b}- supplying the sphincter function of the iris. 
 This function is shown by the American Text-Book of Ph} siology to have 
 its center in the superior cervical ganglion, where it could be affected in 
 lesion of the upper cervical region, causing disturbance of accommodation 
 in the eye. Neck lesions are known to cause strabismus and diplopia 
 (cases 23 and 25), showing disturbance b)- such lesion of the function of the 
 3d nerve. (Also of the 4th and 6th ) The anatomical relations in 
 strabismus caused by lesion at the 2i dorsal, and diplopia by lesion at the 
 7th cervical is not well understood. The local treatment of the ciliary 
 ganglion is important in these motor disturbances. 
 
 Fibers antagonistic to the ciliary function of the third nerve, being di- 
 lators ot the pupil, are found rising in the third ventricle, whence they pass 
 through the medulla and cervical cord to the anterior roots of upper dorsal 
 nerves and to the first thoracic ganglion of the sympathetic. From these 
 points the)- reach the eye zva the cervical s\mpathetic cord, ophthalmic di- 
 vision of the fifth, and its nasal and long ciliary branches. 
 
 These facts indicate the importance of upper cervical, general cervical,
 
 PRACTICK AND APPLIED THERAPEUTICS OF OSTEOPATHY, 227 
 
 and upper dorsal lesion in the causation of lack of accommodation, eje- 
 strain. and similar troubles. 
 
 The latter sympathetic connection indicates the so called cilio-spinal 
 center at the 4th cervical to 4th dorsal. Ouain states that these pupillo- 
 dilator fibers pass from the 1st, 2d, and 3d dorsal nerves, sometimes also 
 from the 7th and 8ih cervical. 
 
 In addition to the above, motor fibers to the involuntary muscles of 
 the orbit and eye-lids pass from the upper four or fiv^e dorsal nerves. Also 
 retinal fibers leave the sympathetic at the superior cervical ganglion, pass 
 to the Gasserian g.inglioi of the fifth, thence through its branches to the 
 eye. ItisshoA^n that, acting through these fibers, stimulation of the cervi- 
 cal sympathetic causes constriction of the retinal arteries, while stimulation 
 of the thoracic sympathetic causes dilatation of them. These facts indicate 
 the importance of cervical and upper dorsal lesion in vaso-motor disturb- 
 ances in the retina, as in retinitis. 
 
 The fact that many of these sympathetics, as pointed out, pass to the 
 eye via the fifth nerve shows the intimate relation between the superior 
 cervical ganglion, the cervical and upper dorsal sympathetic, and the fifth 
 nerve, consequently the potency of cervical and upper dorsal lesion to af- 
 fect the fifth nerve. This nerve sends its sensory ophthalmic division to 
 join with the sympathetic from the cavernous plexus. It has trophic and 
 vaso-motor fibers to the eyeball and its appendages. Green states that sec- 
 tion of the fifth nerve is followed by keratitis and ulceration. It has charge 
 of the nutrition of the eye-ball, supplying also the lachrymal glands, con- 
 junctiva, skin of the lids and adjacent parts of the face. ^Nutritive dis- 
 turbances of the eyes, such as keratitis, conjunctivitis, retinitis, cataract, 
 glaucoma, pteryguim, etc., must be referred to lesion affecting the fifth 
 nerve. Likewise optic-nerve-atrophy, and other effects due to insufficient 
 nutrition would result from lesion affecting the fifth. 
 
 Slips of the inferior maxillary articulation are thought to impinge fibers 
 of the fifth nerve, (articular brancnes from the auriculo-temporal nerve) 
 and to cause certain eye troubles (case 33.) 
 
 A review of these various connections shows that cervical and upper 
 dorsal lesion may affect: 
 
 I. The superior cervical ganglion and its sympathetic connection with 
 the local sympathetic plexus of the eye-ball. 
 
 2. The various cervical nerves and through them the ganglion and 
 the other cervical sympathetics. 
 
 3. The pupillo constrictor center in the inferior cervical ganglion. 
 
 4. The pupillo-dilator center in the same ganglion and at the lower 
 cervical and upper three dorsal nerves. 
 
 5. The motor fibers from the upper four or five dorsal nerves to the 
 involuntary muscles of orbit and eyelids. 
 
 *For important functions o£ the fifth nerve see "Principles of Osteopathy."
 
 228 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 6. The fifth nerve by its connections with the superior cervical gang- 
 lion and cervical sympathetic. 
 
 7. Constrictors of the retinal arteries in the cervical s\mpathetic. 
 
 8. Dilators of the same in the thoracia symp.ithetic, and 
 Both of these at the superior cervical ginglion 
 
 It is noticable that all of these eight connection-;, except perhaps No. 
 5, may be reached at the superior cervical ganglion. This explains the 
 special importance of lesion to atlas, axis and 3rd cerxical, before pointed 
 out as most frequent in eye-diseases. These upper cervical lesions affect 
 this ganglion. From the variety of functions represented in these various 
 fibres congregated in the superior cervical ganglion we must conclude that 
 lesion of the atlas, axis, or third, etc , affecting thi? ganglion, would cause 
 a \ariet}' of diseases of the eye. 
 
 Lesions causing stomach, kidne)', and pelvic di.seases m ly secondarily 
 become the cause of disturbances in the e\'e. The relation here is probably 
 entirely reflex Perhaps also in these conditions alteration of blood-pres- 
 sure is a disturbing factor. 
 
 It seems that cervical lesion causing obstruction of the tear-duct, as well 
 as manipulation upon the nose along its course to open it, affect the mucous 
 membrane lining it through the distribution of the fifth nerve. 
 
 Clavicular and first rib lesion, obstructing the lymphatic drainage of 
 the eye by obstructing the flow from the deep cer\ical l\mphatics into the 
 thoracic or right Ixmphatic duct, may affect the metaljolism of the eye. It. 
 has been thought that lesion affecting the female breast nia\- react upon the 
 eye reflexly. 
 
 The Prognosis in eye-diseases is, generally speaking, goo 1. M. irked 
 results, even to cure of blindness of many yerrs' standing, have been acquir- 
 ed. Very often surpri<ingl\' quick results have been attained. An examina- 
 tion of the case reports at the opt.-ning of this chapter will show that in 
 twenty-four of the thirtx-three various cases reported a cure was affected. 
 Quick results, either as cure or benefit, were att. lined in seventeen cases 
 The cises met by the Osteopath are frequently of long standing and in bad 
 condition. In many cases these results were gotten after specialists had 
 failed. AH cases cannot be cured. Many are subjects for the specialist. 
 
 The Treatmenj" of eye-diseases is necessarily almost entirel)- upon the 
 neck, as it has been shown that the lesions in these cases occur here. The 
 removal of these various lesions is already understood from discussions in 
 the previous pages. The treatment looks, in general, to the establishment 
 of perfect circulation, and the regulation of the nerve-mechanism. The 
 general neck treitment, as applied is cases of insomnii, headache, apoplex}-, 
 etc., q v., given with a specific object in view, would be the method em- 
 ployed (see also Chap. Ill and IV). 
 
 In many cases the simple removal of lesion is the ouly treatment required 
 Of.eu this treatment, and th^ general neck treatment may be supplemented by
 
 PRACTICE AMD APPLIED THERAPEUTICS OF OSTEOPATHY. 229 
 
 local treatment upon the eye, and about it, reaching its nerve-mechanism and 
 blood circulation diiectly. ( See Chap. V. A and B.) This work includes 
 treatment to the fifth nerve as the one being in charge of the nutrition and 
 circulation of the eye. This nerve is particularly regarded in all nutritive dis- 
 eases, such as keratitis, and in all inflammatory, hyperemic or anemic condi- 
 tions, such as conjunctivitis, etc. 
 
 In conjunctivitis the local irritant, if one be present, must be removed 
 Treatment should not be made upon the eye in these cases, but about it. The 
 chief treatment is in the neck, especially upon the superior cervical ganglion 
 
 In granular conjunctivities the same treatment is made. The granula- 
 tions must be broken down. (Chap. V.) After this the correction of the 
 circulation by by the cervical treatment prevents their further growth. 
 
 In keratitis treatment proceeds as in conjunctivitis. In both conditions 
 the fifth nerve must be especially treated. 
 
 The removal of lesion and the correction of blood-flow are the essential 
 points in these and all similar cases. 
 
 In pterygium especial treatment is made to cut off the "feeders." (V 
 Chap. V.) After this operation they are absorbed by the corrected circulation 
 by means of the neck work. In some cases removal of neck lesion is followed 
 by absorption of the growth, as in case 15. Sometimes light manipulation 
 over the closed lid aids the absorption. 
 
 The same remarks apply to pannus. 
 
 In diplopia, ptosis, strabismus and other motor troubles, lesion must be 
 sought as the cause of the muscular palsy, tension, etc. Treatment is applied 
 to the lesion and to the affected nerve. These troubles sometimes yield to the 
 correction of cervical lesion alone. The muscles may be treated direcly as in 
 VI. Chap. V. 
 
 In cataract the treatment looks to the absorption of the cataract through 
 increased circulation. Cervical treatment, removal of lesion, and local treat- 
 ment about the eye and upon the fifth nerve, all as before described, have suc- 
 cessfully accomplished a cure in these cases. 
 
 In the various optic nerve troubles, also, the treatments are used to aflfect 
 the nerve through its blood-supply. Numerous cases of blindness from optic- 
 nerve-atrophy have been cured in this way. The optic nerve may be stimu- 
 lated by tapping or pressure upon the eyeball. (II, III, Chap. V.) Retinitis 
 likewise yields to this treatment. 
 
 In conjugate deviation, both eyes turning strongly to ons or other side 
 the lesion, usually cervical, affects the the third and sixth nerves, supplying 
 respectively the internal ructus and the external ructus of the eyeballs. The 
 treatment is local and cervical.
 
 230 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY 
 
 DISEASES OF THE EAR. 
 
 Cases: (i) Deafness of two \ears' duration in a lady of foit)-t\vo, 
 caused by displacement of atlas to the rifjht, tightening muscles and liga- 
 ments around the ear and lower jaw. Tenderness was extreme in the cervi- 
 cial region. Dry catarrh was present. There was lesion of the 2iid cervi- 
 cal vertebra. The patient had been injured in a railroad wreck, being 
 confined to the bed. She could not hear a clocl; strike in the room, nor 
 the playing of a piano. After three treatments the patient could hear the 
 clock strike. After five weeks' treatment the hearing was complete!)- re- 
 stored. 
 
 (2) A case of deafness, pronounced by specialists incurable, was 
 treated four weeks osteopathically and again examined b)- a specialist, who 
 pronounced the case cured. 
 
 (3) Deafness in a young bow due to lesion of the atlas. The deafness 
 was complete in one ear, and almost so in the other. After one month's 
 treatment he could hear con\'ersation spoken in an ordinary tone. 
 
 (4) Total deafness of several years' standing much benefitted by ihree 
 weeks' treatment, the patient being able to hear the street cars pass the 
 house. 
 
 (5) In a bo}' of fourteen, a continuous discharge from the right ear, 
 of ten years' standing. Lesion of the atlas and axis, luxated to the right, 
 and contraction of the tissues. The case was cured in nine treatments. 
 
 (6) In a boy of eleven, partial deafness in, and continual discharge 
 from one ear. The lesion was a slip of the atlas. The cast^ was cured in 
 one month's treatment. 
 
 (7) In a young lady, an abscess in one ear had been discharging for 
 several months. After one treatment there was no further discharge, and 
 after four treatments the trouble had disappeared. 
 
 The Lesion in ear diseases, as illustrated b\- the above cases, are al- 
 most as a rule in the atlas and axis. The 3rd ccr\ ical and other cervicals 
 may be affected, but in the vast majority of cases the atlas and axis, one 
 or both, are affected. It is more often at the atlas than elsewhere. A 
 lu.xation of the temporo-maxillary articulation, impinging probably the 
 articular fibres of the auriculo-temporal branch of the inferior-maxillary 
 division of the fifth nerve, and contractured tissues abjat th; upper cervical 
 region and the angle of the jaw may act as lesions in tliese diseases. 
 
 The fifth nerve supplies the external auditory canal by its auriculo- 
 temporal branches, the upper one of which sen Js a branch to the tympanum. 
 Also the vidian of the fifth sends nasal branches to the membrane of the 
 end of the Eustachian tube. The internal throat treatment given to affect 
 this tube, does so b>' stimulating these fibres, thus freeing the secretions in 
 this portion of the Eustachian tube. Reasoning by analogy, doubtless the
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 231 
 
 secretor)', trophic, and \aso-motor functions of the fifth ner\'e with relation 
 to the e)e and other parts of the head and face are extended to the ear 
 secretion of cerumen and circulation about the ear being to some extent 
 under control of the fifth. Experience connects lesions of this nerve with 
 ear-diseases. It has been shown above that the nerve suffers from lesion 
 of the upper cervical region, such as occur in ear troubles (see Diseases of 
 the Eye). The treatment of this nerve, so important in nasal catarrh and 
 oiher inflimmatoi y affections of the eye, nose, and parts of the head, is im- 
 portant likewise in these catarrhal, inflammatory, and other circulatiory 
 troubles, so commonly complicated with the diseases of the ear. 
 
 Vdso-constrictor fibres for the ear are contained in the cervical sympa- 
 thetic. They constitute another pathway for the effect of cervical lesion to 
 reach the ear. Likewise the atlas and axis lesion may affect the blood- 
 supply of the ear through the medulla, which suffers from these lesions. It 
 is possible that vaso-motors for the head exist in the upper dorsal nerves 
 though upper dorsal lesion is rare in ear trouble. It is likely that much of 
 the effect of cervical lesion upon the ears is gotten through the vaso-motors 
 and other sympathetics. 
 
 The claim is made that the auditor)- nerve may be inhibited bv deep 
 pressure opposite and behind the third cervical vertebra. 
 
 The pneumogastric nerve has an auricular branch, and is in close con- 
 nection with the fifth in relation to the ear, as well as with the cervical 
 sympathetic. The petrosal ganglion of the glosso-pharyngeal is related to 
 upper cervical lesion by sending a branch to the superior cervical ganglion. 
 Its tympanic branch passes from this ganglion and contributes fibres to the 
 mucous lining of the middle ear, and to the mastoid cells. It sends branches 
 to unite with the sympathetic and form a plexus on the carotid artery in 
 the carotid canal- Thus is this nerve connected both with neck lesions and 
 with the blood-supply to the ear. The facial nerve, well known to be in- 
 fluenced by lesions of the atlas and axis, as seen in facial paralysis, has 
 direct communication with the auditory nerve and with the auricular branch 
 of the pneumogastric. 
 
 The various simple methods described in the texts on this subject will ai d 
 one to determine the location of the trouble in the external, middle or in- 
 ternal ear. The disease may be seated in the auditory nerve or in the brain, 
 in such case being as directly connected with cervical lesion, before shown 
 to affect the brain and cranial nerves. 
 
 Treatment: An ear syringe may be used in the ordinary ways to 
 cleans the ear of secretions, discharges, foreign objects, etc. 
 
 The removal of bony lesion and the cervical treatment as before describ- 
 ed are the main osteopathic treatments applied in ear diseases. The pre- 
 sence of the original cause of these diseases in the form of neck lesion ne- 
 cessitates practically the whole treatments being cervical. There is no iocal
 
 232 PRACTICE AND APPLIED THERAPEUTICS OF OSTKOPATHV. 
 
 ear treatment, except as in the common methods in \ogue in use of springe, 
 etc. 
 
 Outside of removal of lesion, an almost specific treatment for eye and 
 ear is that of opening the mouth against resistance (Chap. IV, Div. I, II. 
 \'II).andthe neck treatment, with the object of increasing circulation 
 through the carotid arteries. Due attention is given to the cervical sjmpa- 
 thetics and vaso-motors in this connection. 
 
 The internal throat treatment (p. 24) may be used, the finger being 
 directed about the opening of the Eustachian tube to stimulate the local 
 points of the fifth nerve, the mucous membranes, and thus the secretions. 
 This aids in freeing the tube, an object that is well accomplished b\- the aid 
 of the external throat treatment upon the carotids, etc.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 233 
 
 GOITRE 
 
 Cases: (i) In a lad}- of twenty-five, a bilateral, vascular goitre of 
 about three months' standing, growing rapidly, causing considerable dys- 
 pnea and discomfort. The treatment consisted merely of stretching the 
 muscles and ligaments attached to the sternal end of the clavicle, raising 
 it, and depressing the first rib. Marked improvement followed the treat- 
 ment at once. Two months later the enlargement and other symptoms had 
 disappeared. 
 
 (2) Exophthalmic goitre and nervous prostration of one months' 
 standing. The trouble followed nervous strain and over-work. The goitre 
 was as large as a hen's-egg, and the usual symptoms of exophthalmic goitre 
 were present. The case yielded rapidly to treatment and at the end of two 
 weeks the goitre had disappeared and the eyes were normal. In one month 
 she had recovered from the goitre and nervous prostration, and had gained 
 twenty pounds in weight. 
 
 (3) In a boy of fourteen, a goitre of two > ears' standing. Lesion ex- 
 isted as a lowering of the right clavicle and muscular contracture in the 
 lower cervical and upper dorsal region. One treatment a week for twelve 
 weeks cured the case. 
 
 (4) A case of goitre treated by raising the clavicles, relaxing the tis- 
 sues surrounding the gland, and opening circulation to and from the gland. 
 After one month there was no perceptible change; after two months the 
 growth had begun to get smaller, and after three months the condition was 
 cured. 
 
 (5) In a lady of thirt\-four, a large exophthalmic goitre with all the 
 usual symptoms marked The general system was in bad condition. Lesion 
 was luxation of the fourth cervical vertebra; the spine was irregular. The 
 case was cured in six months. 
 
 (6) Exophthalmic goitre and eczema of the face and neck in a young 
 lady of twenty-six cured in six weeks' treatment. 
 
 (7) In a lady, a goitre of one year's standing. No bony lesions were 
 found. After one month's treatment the diameter of the neck had been 
 decreased one and one-half inches. 
 
 Definition: — Goitre is defined as "a chronic hx'pertrophy or hyper- 
 plasia of a portion or the whole of the thyroid gland. It is of obscure ori- 
 gin, involving one or more of the structural tissues, and is subject to various 
 degenerative changes." 
 
 This so called simple goitre is met in various forms; simple hypertro- 
 phic, follicular, fibrous, vascular, cystic, degenerative, etc. They are most 
 frequenth- met and treated osteopathically. 
 
 Exophthalmic goitre (Grave's or Basedow's disease) is quite a differ- 
 ent condition. It is defined as, "a chronic neurasthenic neurosis character-
 
 234 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATKY. 
 
 ized by rapid heart-beat, enlarged thyroid, protrusion of the eye balls, and 
 various neurasthenic or vasomotor symptoms." 
 
 Osteopathy simply regards goitre as an enlargement of the thyroid 
 gland due to a specific, usually bony, lesion which interferes with the proper 
 blood and lymph circulation of that body. This leads to congestion, en- 
 gorgement, and hypertrophy. In some cases, especially in exophthalmic 
 goitre, the lesion may act chiefly upon the innervation of the gland, pro- 
 ducing the various phenomena marking the disease. 
 
 The Lesions bear, in conformity with the above view, a close anatomi- 
 cal relation to the disease. They are generally bony lesions of the cervi- 
 cal and upper thoracic regions, consisting in displacements of middle and 
 lower cervical vertebrae, of the clavicle, or of the first rib. Yet various 
 muscular, and other tissue, contractures are often found as the lesions in the 
 case. These commonh- occur together with bony lesion, but may be inde- 
 pendent of such. The\- occur mostly in the anterior region of the neck, in- 
 volving the infrahyoid muscles and the soft tissues down to the root of the 
 neck. The scaleni muscles are often involved. The posterior cervical and 
 upper dorsal muscles are sometimes found contractured and acting as 
 lesion. 
 
 The chief bony lesions in simple goitre are of the clavicle and first rib, 
 while in exophthalmic goitre lesions of the cervical vertebrae are more fre- 
 quent. Vet either form of lesion ma\- occur in either case. The clavicle 
 and rib lesion, and the contracturing of the anterior cervical tissues act 
 specifically b\' obstructing arterial, venous, and lymphatic currents to and 
 from the gland. The inferior thyroid artery arises from the thyroid axis, 
 which, lying behind the clavicle and scalenus anticus muscle ma)' suffer 
 pressure from them when abnormal in position. The superior tb)roid artery 
 is related to the infra-h\oid muscles, and ma\- suffer from their contracture. 
 Hut the interferences of these lesions with the lymphatic and venous drain- 
 age of the gland are doubtless most potent in causing goitre. The l)'m- 
 phatics of the gland are large and numerous, emptying upon the right into 
 the lymphatic duct, upon the left into the thoracic duct, both avenues of 
 lymphatic drainage, therefore, lying where derangement of clavicle or of 
 first rib may obstruct them. 
 
 Just as clavicular and first rib lesion has been known to obstruct lym- 
 phatic drainage of the breast and result in so-called cancer, the same kind 
 of lesion ma\' prevent lymphatic drainage and cause goitrous enlargement 
 of the thyroid. 
 
 In a like manner the venous return becomes abridged. The superior 
 and middle thyroid veins are in relation to the inferior hyoid muscles, and 
 suffer pressure from their contracture. They both empty into the internal 
 jugular vein which ma\' be obstructed by clavicular lesion. The chief 
 venous flow is through the three or four large inferior thyroid veins, and it 
 may be impinged by clavicular and anterior cervical lesion. This view of
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHV. 235 
 
 lesion is well supoorted \)y the fact that simple goitres often rapidly disap 
 pear after treatment, restoring cla\'icle and first rib to position, relaxing an- 
 terior cer\ical tissues, and reestablishing perfect circulation of all fluids to 
 and from the thyroid. This has been observed in some cases, probably of 
 vascular goitre, by Dr. Still, in which the facts strikingl}- illustrate the cor- 
 rectness of the osteopathic etiology. In these cases he saw, in a few hours, 
 a great reduction in the volume of the gland follow removal of such ob- 
 structions to the vessels. The gland seemed to have been rapiJly emptied 
 and the goitre drained away by the the renewed drainage. 
 
 The nerve-supply of the th)'roid gland is from the middle and inferior 
 cervical ganglia of the sympathetic. Consequently various vf-rtebral lesions 
 are found, especially in exophthalmic goitre. Such lesions have been found 
 from the 2nd to the 7th cervical vertebra. In discussing diseases of the eye 
 and of the heart the connections of the cervical sjmpathetic mechanism 
 with both of these organs has been pointed out. The lesions occuring thus 
 to the innervation of the thyroid, cervical lesions, are likewise closely re- 
 lated anatomically to the innervation of eye and heart, accounting in part 
 for the related disturbance of these organs in exophthalmic goitre. 
 
 This disease has been regarded by medical writers as due to disturbed 
 innervation of the gland, or to an affection of the sympathetic nerves. It 
 has been sometimes thought that the seat of the disease is in the medulla, 
 and that the disturbance of the thyroid function causes the gland to throw 
 into the blood substances that irritate the nerves and cause the various 
 neurasthemic s\mptoms accompying the condition. It is readily seen that 
 cervical lesion may disturb the innervation of the organ, set up the smypa- 
 thetic disturbance, and derange the function of the thyroid. This disturb- 
 ance of the s)'mpathetic innervation is further evident in the \'ascular con- 
 dition of the gland, its arteries being dilated, and in the paralysis of the 
 orbital vessels, which become distended with blood and cause the exoph- 
 thalmos. Dana explains all symptoms upon the theory of vaso-motor and 
 cardio-motor paresis, a result that may readily be due to the operation of 
 cervical lesion upon the sympathetic. 
 
 The Prognosis is good in all cases. It is to be noted that aecording 
 to Anders the prognosis in goitre (simple) is but guardedly favorable as to 
 life, but unfavorable as to cure, while but few cases of exophthalmic goitre are 
 expected to be cured. Yet under osteopathic treatment very numerous 
 cases of both kinds have been cured. A cure is often effected, even in long 
 standing cases which have tried all the known remedies. 
 
 The prognosis is most favorable in \ounger and shorter cases, and in 
 those in which the gland is soft. Under treatment, signs of softening in a 
 part of the gland are indications of progress. In the vascular and paren- 
 chymatous forms the progress is good. The former promise the most for 
 quick results. In the hard, fibrous forms, and in those in which degenera- 
 tion of the tissues, or calcareous infiltration has taken place, the prognosis 
 is not favorable.
 
 236 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 Some cases of goitre yield quickly; some are very slow. From one to 
 three months' treatment is usually necessary. 
 
 The Treatment looks at once to the removal ot lesion, and to the free 
 opening of Ismpathtic and venous drainage. All the cervical muscles must 
 be relaxed. This direction applies especially to the deep anterior cervical 
 and the h\oid muscles, as well as to the tissues about the gland. 
 
 Pressure is made downwards over th« goitre, out about its edges, and 
 along the course of the \eins draining it. All the tissues about the root of 
 the neck auteriorl)-, and about clavicles and first ribs, must be relaxed. The 
 ribs and clavicles should be separated, elevating the latter and depressing 
 the former. 
 
 Close attention should be given to all the cervical vertebral articula- 
 tions, seeing that they are perfectly adjusted. 
 
 In exophthalmic goitre one must look particular!)- to the cervical sym- 
 pathetics, toning them to overcome the vaso motor paresis. Inhibitory 
 cardiac and local eye treatment may be applied as before directed. A mod- 
 erate pressure of the eye-ball back into its orbit aids in emptying the blood 
 from the distended vessels. For a similar reason pressure upon the gland, 
 in exophthal,mic and in vascular forms of goitre, is a good measure. In the 
 form-r kind one should look well to the constitutional condition and to that 
 of the general nervous S)stem. 
 
 i 
 
 NEURALGIA. 
 
 Cases: (i) Severe facial neuralgia of two weeks' standing, with in- 
 flammatory eruption upon the affected side, the right, and inflammation of J£ 
 the right e\e. The usual treatments had been tried for two weeks without 3 
 avail. The lesion was a marked displacement of the atlas to the left. It 
 was corrected and the case cured ir one treatment. 
 
 (2) Facial neuralgia affecting the right side of the face and head, es- 
 pecially the forehead over the right eye. The lesion was luxation of the 
 atlas to the left. The case was cured in one treatment. 
 
 (3) Facial neuralgia of two years' standing was grealty relieved by 
 one treatment and was cured in six weeks, the patient gaining twenty-two 
 pounds during that time. 
 
 (4) Facial neuralgia and pains between the shoulders. The lesions 
 were contraction of cervical muscles and lateral luxation of the fourth and 
 fifth dorsal vertebrae. Four treatments cured the case. 
 
 (5) Brachial neuralgia, involving the left arm and the left side as low 
 as the fifth rib. The pain was intense, and the case was of more than one 
 years' standing. The arm was wasted and the pain continuous. Lesions 
 were a lateral luxation of the second dorsal vertebra, and contraction of the 
 muscles of the whole upper spinal region as low as the sixth dorsal vertebra,
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 237 
 
 drawing together the upper five ribs on the left side and causing intercostal 
 neuralgia in this region. In two weeks the pain was overcome and the arm 
 began to develope. The case was cured. 
 
 (6) Brachial neuralgia of more than one year's standing. The pain 
 affected the right arm and rendered it almost useless. The lesion was of 
 the right first rib, pressing upon the brachial plexus. At the third treat- 
 ment the rib was set and the pain ceased. 
 
 (7) Cervico-brachial neuralgia in the right arm, shoulder, and chest, 
 due to lateral luxation of the 5th cervical and third dorsal vertebrae and 
 muscular contractures of the cervical and left intercostal muscles. The 
 case was practically cured in four months. 
 
 (8) Intercostal neuralgia of several years' standing, cured in less than 
 one month. 
 
 (9) Intercostal neuralgia due to heavy lifting, so severe that the pa- 
 tient was unable to sit erect without great pain. Lesion was depression of 
 3rd and 4th ribs on both sides. Immediaie relief followed treatment, and 
 the case was cured in four weeks. 
 
 (10) Intercostal neuralgia often years' standing, causing an intense 
 pain in the leftside, extending to the abdomen. Lesion was a luxation of 
 the 8th left rib, and the case was cured by replacing it. 
 
 (11) Spinal neuralgia of a number of years' standing, due to lesion of 
 the 4th dorsal vertebra. The case was cured in two months. 
 
 (12) Neuralgia in the head, of eight years' standing, lasting continu- 
 ally thirty-six hours during each menstrual period. Lesion was at the 
 atlas, with muscular contractions in the lower dorsal and lumbar region. 
 The case was cured in one month. 
 
 (13) Neuralgia of the stomach of three years' standing, the attacks 
 coming on after each meal. At the time of examination so serious had the 
 condition become that the patient had not taken solid food for more than 
 two weeks. Lesion was a lateral twist of the spine between the sixth and 
 seventh dorsal vertebrae Improvement followed one treatment, and the 
 case was cured in about one year. 
 
 (14) Ulnar neuralgia, accompanied by swelling of the arm and of the 
 ulnar side of forearm, hand, and third and fourth fingers. The trouble was 
 of two years' duration, spinal lesion was found at the origin of the brachial 
 plexus, and a contraction of the muscles in the upper dorsal region. After 
 four treatments there was no further pain, and the case was dismissed cured 
 in one month, 
 
 (15) Neuralgia in the third finger of the right hand, of several years' 
 standing. Lesion was at the third cervical vertebra, which was corrected 
 in a few treatments, removing the condition. 
 
 (16) Tic Douloureux of twelve years' standing. The pain would oc- 
 cur spasmodically in the infra-orbital terminals of the fifth nerve, at inter- 
 vals of from three to ten minutes. Lesion was found in a displaced atlas, 
 which was corected in six weeks, curing tne case.
 
 238 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY 
 
 Definition; "Neuralgia is a pain in the course of a nerve, unaccom- 
 panied by structural charges. It is clue to irritation, direct or indirect, of 
 the nerve." Often this irritation is from pressure of a displaced bony part 
 or of contractured tissues. 
 
 The Lesions found causing this condition are usually bons'. and these 
 act by pressing directl)' upon a nerve, or by affecting centers or s\'mpathe- 
 tic connections. In case 6 above, the brachial neuralgia was due to direct 
 pressure of the first rib upon the brachial plexus, of nerves. In case I or 2 
 it is evident that lesion of the atlas was too low to affect the nerve involv- 
 ed, the fifth cranial, by direct pressure. Here the effect may have been 
 upon the medulla, thus affecting the center in which certain roots of origin 
 of the fifth arise, but more probably the effect was upon the nerve through 
 its numerous sympathetic coimections in the upper part of the cervical re- 
 gion, as pointed out in the discussion of the fifth nerve in diseases of the 
 eye, q. v. 
 
 In intercostal neuralgia the pressure is usually directly upon the nerve 
 by a displaced rib. but may be due to vertebral lesion. 
 
 The commonest bory lesion in neuralgia is a luxated vertebra, such a 
 cause having been known to produce neuralgia in any part of the body. 
 (See cases i, 5, 7, li, 13.) It is probable that in such cases the vertebra 
 brings direct pressure upon the nerve as it emerges from the spinal canal. 
 
 Any bony part in the body in relation to nerves may become displaced 
 and impinge upon the adjacent nerve, causing neuralgia. Frequently the 
 cause of irritation is pressure of contractured tissues upon the nerve. This 
 occurs at the foramina of exit of the various branches of the fifth nerve up- 
 on the face. The tissues at and about the foramen become congested or 
 contractured, pressing upon the nerve. These contractures may occur 
 along the spine, as in case 4. Contracture of the intercostal muscles may 
 draw the ribs together, irritate the nerves and cause the n.euralgia. Con- 
 tractures are often the direct irritating cause in cases of nenralgia due to 
 exposure, tranmatism, etc. 
 
 The lesion may be one causing a primary disease, as rheumatism, gout, 
 or specific infectious disease, allowing of the generation of poisons in the 
 s)'stem, which affect the nerves by circulating in the blood. 
 
 In Tic Douloureux the lesion is usually at the atlas, but often is found 
 among the other upper cervicil vertebrae. Contracture of the cervical 
 muscles and of the tissues about the foramina are often the causes. 
 
 In Cervico-occipital neuralgia the lesions are usually among the 
 upper four cervical vertebrae. 
 
 In Intercostal neuralgia occur lesions of vertebrae at the origin of 
 the nerves affected, of the ribs, and of the spinal and intercostal muscles. 
 
 Mastodvnia, or neuralgia of the breast, occuring generally in women, 
 is due to similar lesions as intercostal neuralgia. Commonly one finds rib 
 lesion in the region affected.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 239 
 
 LuMBO-ABDOMiNAL neuralgia, marked by pain in the lumbar region, 
 hyphogastiium, buttocks, or genitals, is caused by lesion in the lower dorsal 
 and lumbar spine. 
 
 Cervico-brachial neuralgia is due to lesion of the lower cervical ver- 
 tebrae, of the first rib, clavicle, and of the upper dorsal vertebrae. It may 
 be caused by vertebral lesion anywhere from the atlas th the sixth dorsal. 
 
 Neuralgia in the lower limbs is due to lumbar, sacral, or innominate 
 lesions. Visceral ueuraliga, as of stomach or intestines, is caused by 
 vertebral lesion of the corresponding spinal region. Coccygodynia is 
 caused by displacement of the coccyx. 
 
 The Prognoses is good in all kinds of neuralgia. Cases of long stand- 
 ing, often )'ield at once. A few treatments, or a single treatrnent, common- 
 1)', at once relieve the poin. Permanent cure is usually accomplished. 
 
 The Treatment is simple. Often the removal of lesion is at once suf- 
 ficient to entirely cure the condition. The lesion should always be re- 
 moved as soon as possible. Likewise any causes of irritation must be re- 
 moved, as an ulcerated tooth, a cicatrix, a growth in the nose, etc. Con- 
 stitutional conditions giving rise to neuralgic states must be met according 
 to the case. 
 
 Relax-^tion of all contractured tissues must be accomplished. The 
 manipulatiou is carried over the course of the affected nerve, relaxing the 
 tissues about it. The pain of the disease does not prevent this local treat- 
 ment. Inhibition of the pain is accomplished, not by pressure, but by light 
 manipulation. The main treatment is usually upon a lesion at the origin of 
 the affected nerve, or in its path. 
 
 The above method of treatment is appliecd to any special variety of 
 the disease. Tic Douloureux often j'ields at once to light manipulation 
 over the course of the affected branches upon the face. (Chap. V. B.) 
 
 RHEUMATISM. 
 
 Cases, (i) Inflammatory rheumatism, off and on, for sixteen years. 
 The effect was general, but the body below the waist was worse, hip and 
 lower limbs being very bad. Lesion occured at the 4th lumbar vertebra. 
 The inflammation began to subside with the first treatment. The patient, 
 confined to the bed, was able to sit up in one week, and was cured in five 
 weeks. 
 
 (2) Inflammatory rheumatism of three years' standing, cured in two 
 months. 
 
 (3) Inflammatory rheumatism of one month's standing, the patient 
 being confined to the bed. The hands, feet, elbows, and knees were affect- 
 ed and very painful. Under the first treatment the pain and swelling were 
 much relieved; the second day the patient was out of bed, and in a short 
 time he was cured.
 
 240 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 (4) Rheumatic fever of twelve weeks' standing cured in three weeks. 
 
 (5) Muscular rheumatism of three years* standing in a man of seventy. 
 The left lower limb was affected. The case was cured in three weeks. 
 
 (6) Muscular rheumatism and swelling of the lower limbs in a woman 
 of seventy-four. The case was cured in five treatments. 
 
 (7) Muscular rheumatism, in the form of torticollis, following malar- 
 ial fever. The condition was of one month's standing. It improved from 
 the first treatment, and was cured in three weeks. 
 
 (8) Muscular rheumatism in the shoulder, the patient having been un- 
 able to raise her hand to her head for seven months. The first rib was 
 found party dislocated at its head. The arm could be raised to the head 
 after one treatment, and the case was cured in one month. 
 
 (9) Acute articular rheumatism in a lady of eighty-three, of three 
 months' standing. Lesions occured in the upper dorsal and lumbar regions 
 of the spine. The hips and knees were affected. One month's treatment 
 had greatly improved the case. 
 
 (10) Acute articular rheumatism in a lady of eighty-two, who had suf- 
 fered with attacks of this disease most ot her lite. Both knees were much 
 swollen, and the patient had been in bed for two weeks. Improvement fol- 
 lowed the first treatment, and in ten days she could get about very well. 
 The case was cured in several weeks. 
 
 (11) Articular rheumatism affecting the foot, of six years' standing, 
 and due to an upward dislocation of the tarsal end of the first metatarsal 
 bone. The case was cured by reducing the d'slocation. 
 
 (12) Chronic rheumatism of three years' standing, occuring in the 
 spring and fall. The whole body was affected. Three months' treatment 
 had greatly benefited the case. 
 
 (13) Chronic rheumatism of eight months' standing. The patient was 
 unable to raise his hand to his head or to dress himself. After one treat- 
 ment he could do both, and the case was pratically cured by four treatments. 
 Lesions were found at the third cervical vertebra, 1st to 4th dorsal, and 4th 
 lumbar. 
 
 (14) Lumbago, in occasional attacks, one of which had been brought 
 on b)' bic)cling. Lesion was found in a lateral luxation of the 4th lumbar 
 vertebra. The case was relieved by one treatment, and was cured in three 
 treatments. 
 
 (15) Lumbago, brought on by a muscular strain, showed lesions at the 
 lumbosacral and sacro-iliac articulations. The case was cured in a few 
 treatments. 
 
 Lesions: In the three forms; Acute Articular Rheumatism, or Rheu 
 matic Fever, or Inflammatory Rheumatism, Chronic, or Chronic Articular 
 Rheumatism, and Muscular Rheumatism, various bony and muscular lesions 
 are found. 
 
 In Rheumatic Fever special bony lesions may be lacking. Often
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 24I 
 
 spinal lesions affecting liver and kidneys are found, and muscular contract- 
 ures may be present at lesion. Bony lesions are apt to occur at the origin 
 of the nerves supplying the affected points. Contractured tissues due to 
 climatic effects are common. 
 
 In Muscular and Chronic Rheumatism specific lesion is much more 
 definite than in Rheumatic Fever. Local bony lesions play an important 
 part in the production of muscular rheumatism, as do also muscular con- 
 tractures. Both ma}' be due to physical strains. Contractures may like- 
 wise be due to exposure to inclement weather, etc. 
 
 It is common in muscular rheumatism of shoulders and arms to find 
 luxation of the lower cervical and upper dorsal vertebrae, one or several, 
 together with contractures in the fibres of the trapezius muscles in these 
 regions. So in rheumatism of special muscle groups bony lesion is quite 
 general!)' found at the on'gin of the nerves supplying them. This is equally 
 true for chronic articular rheumatism. For example, in these very numerous 
 cases in which the joints of the lower limbs are affected, it is almost the 
 rule to find lumbar or innominate lesions obstructing the nerve-supply to 
 the limbs. 
 
 In rheumatic affections of special localities as, for example, the wrist, 
 ankle, etc., it is common to find a local bony part out of place, as carpal, 
 tarsal, or metatarsal bone. In lumbago there is almost invariably luxation 
 of lumbar vertebrae, irritatingthe nerve fibres supplying the muscle-bundles 
 of the erectors spine. 
 
 The contracturing of tissues as the result of chronic rheumatism is 
 often sufficient to draw a joint out of place, as in case of the hip-joint. 
 
 Lesions in rheumatism act by deranging blood and nerve supply, 
 locally or generally. In inflammatory rheumatism the effect is a constitu- 
 tional one, acting upon the system through lesions which derange the 
 functions of liver and kidneys, also of the central nervous system. Yet this 
 condition is often a good deal like "catching cold," and presents, therefore, 
 no constant lesion. 
 
 In the other forms of rheumatism , local derangement of ner\'e and 
 blood-supply is the result of the lesion. This lesion may be present at the 
 exact locality of the effect, or in the course or at the origin of the nerves 
 suppl) ing the part. In the case of muscular rheumatism particularly, the 
 fact that the pathology is indefinite, that no structural changes occur in the 
 muscles, and that many authors regard it as nuralgia, well supports the os- 
 teopathic theory that it is due to bony or muscular lesions irritating the 
 nerve-supply of the muscles affected. This effect is especially well shown 
 in that form of muscular rheumatism known asLumbago, in which vertebral 
 ksion, irritating the local nerve-fibres, is regarded as the cause, osteopathic- 
 ally. As a matter of fact one meets numerous cases diagnosed as either 
 rheumatism or neuralgia, or to which these terms are applied interchang- 
 ably. From an osteopathic point of view it makes but little difference
 
 242 PRACTICE AND APPLIED THERAPEUTICS OF OSTKOPATHV. 
 
 which \ie\v of the case is taken. The essential fact is lesion irritating ner\e- 
 supply, its remo\al being the necessary- therapeutic measure. 
 
 The Prognosis, in all forms of rheumatism, is good. Even the so- 
 called incurable chronic rheumatism is often cured. The prognosis is es- 
 pecially good in inflammator)- and muscular rheumatism. In such cases 
 one expects to give relief at one treatment. Quick cures are often made in 
 them. In chronic cases the progress is siow because of the deformity, the 
 deposit in the joint, and the thickening of the local tissues. Many of these 
 cases are incurable but may be benefitted. Up to a certain point the de- 
 posits may be absorbed, the deformity overcome, and the joint be put in 
 good condition. It is the rule, however, that the enlargement ordeformit}' 
 of the joint cannot be much relieved, though the progress of the disease 
 may be stajed. 
 
 The Treatment of these cases must be persistent, but not severe. In 
 inflammator}- rheumatism the extreme pain, which cannot tolerate the slight- 
 est jarring of the floor, or movement of the bed-clothes, must be considered. 
 Vet it does not prevent treatment of the case. Delicacy of manipulation 
 enables one to soon overcome the patient's fear and to manipulate the joints 
 at will. The beneficial effect of this treatment becomes at once apparent 
 in reduction of the pain and inflammation. Cases should not be treated too 
 often or too long at a time. 
 
 In these cases, especially in rheumatic fever, special attention must be 
 given to stimulating the activities of kidneys, li\er, digestive system, and 
 skin, to remove poisons from the system and to improve the condition of 
 the blood. Often the treatment is at first confined to these parts, so ini- 
 portant is it to gain control of their functions. 
 
 A general spinal treatment is necessary in rheumatic fever, for consti- 
 tutional effects. A close watch must be kept upon the general health, and 
 lungs and heart must be kept well stimulated. Careful stimulation of the 
 heart will prevent the disease reaching that part. It is particularly neces- 
 sary to provide against the heart being affected. 
 
 The circulation to the joint, muscle, or part affected, must be kept free. 
 This is accomplished by work along its vessels, by removal of bony lesion 
 and muscular contracture, but especially by springing the bones of the joint 
 so as to separate them and allow of free circulation of the blood to the 
 membran2s. It is in this waj' that the deposits are removed and the mem- 
 branes restored to normal condition. 
 
 In acute inflammation of a joint, also, its blood-supply must be kept 
 free and itself be lightl)' manipulated, to take down the inflammation. 
 
 In muscular rheumatism the muscles should be stretched and manipu- 
 lated gently to stimulate the metabolism of the local tissues, aiding th'-m to 
 throw off the poisonous substances supposed to collect in them. 
 
 In any case the nerve-supply of the part must be treated from its origin, 
 and the lesion be removed.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 243 
 
 In Lumbago the affected muscles must be relaxed, and the lesion be 
 reduced. It is readily affected. The patient may sit upon a stool, while the 
 practitioner stands in front and passes his arms about the body, clasping 
 either side of the spine well down toward the sacrum. He now raises and 
 slightly rotates the trunk, first to one side, then to the other, relaxing the 
 muscles, separating the vertebrae, and relaxing rhe nerve-fibres from im - 
 pingement. 
 
 In inflammatory rheumatism one should look after the hyo-fene of the 
 sick chamber. Cold baths and sponging with tepid water are allowable for 
 the fever, but are not usually necessary under the osteopathic treatment 
 The patient should be between blankets, which absorb the perspiration and 
 prevent chill. The joint should be well protected by being wrapped in 
 some soft, warm material, such as cotton. The diet should be light and nu- 
 tritious. Chronic cases should be protected from toil, exposure, etc. 
 
 4.Ujue-^jL^- V. ^ ''>— tr^' (P^'^r- "^ '' ^ ' 
 
 
 
 ^^^ 
 
 
 H 
 
 r 
 
 /r;::*^ '"-^ 
 
 
 O'J^^Jt 

 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHS. 245 
 
 DIABETES MELLITUS AND DIABETES INSIPIDUS. 
 
 Cases: (i) Diabetes Mellitus in a man of thirty four. The disease 
 was well established by urinal)si3 and the characterictic symptoms. The 
 patient was a great sufferer from pain in the lower dorsal and lumbar re- 
 gions, and showed bony lesions at the 1 2th dorsal, second and fifth lumbar 
 vertebrae. He was discharged cured after eight months' treatment, and 
 has since passed the medical examination for life insurance, being pronounc- 
 ed a good risk. 
 
 (2) Diabetes Mellitus in a 3 oung man of nineteen, who had been given 
 up to die. He was passing nine pints per day of urine of a sp. gr. of 1054. 
 In one week it was reduced to 1043, 3""^ four pints per day. He gained 
 strength daily, and was practicall)' cured at the time of report. 
 
 (3) Diabetes Mellitus in a lady of fifty-six. The patient had lost 
 eighty pounds in six months., and her]symptoms were very marked. The 
 
 .case was expected to die. Lesions were found in the upper cervical ver- 
 tebra, also of the 2nd and 3rd dorsal, and lower dorsal and upper lumbar 
 vertebrae. The sp. gr. of the urine was 1043, sugar 4 per cent, and quantity 
 from 10 to 18 "^Inis per diem. Improvement was continuous from the first, 
 and in fi\e months the case was cured. 
 
 (4) A case of Diabetes Mellitus showed, under treatment, continual 
 diminution of 'the quantity of urine, and a complete disappearance of the 
 sugar in a few weeks. Some months later the patient was still in good 
 health. 
 
 (5) Diabetes Mellitus in a lad>' of fifty-six. She passed about 200 
 ounces of urine each day, containing a large percentage of sugar. A de- 
 pression of the right ribs over the region of the liver. The case showed 
 marked improvement under the treatment. In four months the general 
 symptoms were much improved, and the quantity of sugar was less than 
 half as much as at first, 
 
 (6) Diabetes Mellitus, in which lesions were found in the lower dorsal 
 and lumbar region. Also in the cervical region and at the atlas. Marked 
 improvement took place under treatment, but the treatment was discon- 
 tinued before a cure was affected. 
 
 (7) Diabetes Mellitus showing lesion in the lower dorsal and lumbar 
 regions. The treatment was continued for four months, and the case was 
 completely cured, the patient passing a medical examination for life in- 
 surance. 
 
 (8) Diabetes Mellitjs in a girl of sixteen. The case was in an advanc- 
 ed stage, shokving a large percentage of sugar. The case was cured in five 
 months. 
 
 (9) Diabetes Mellitus in a man fift}'one years of age* Lesion was a 
 posterior condition of the spine from the sixth dorsal to the second lumbar
 
 246 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY 
 
 vertebra. At the lime of report, one month's treatment had been taken, 
 and improvement was made. 
 
 (10) Diabetes Mellitus showing lesion in thecervical and lower dorsal 
 regions. The urine contained two percent of sugar. Complete cure was 
 made. 
 
 Lesions causing diabetes are usually bony lesions along the spine from 
 the middle dorsal to the lower lumbar region. McConnell notes the fact 
 that in a number of cases there was a posterior swerve of the spine form the 
 middle dorsal to the upper lumbar region. 
 
 Sacral lesion has been noted in these cases, some showing a slip of the 
 ilium, some lesion of the fifth lumbar. Cervical lesion, chiefly in the upper 
 cervical region is sometimes found in diabetes mellitus. Sometimes a rib 
 lesion, as in case 5, occurs in the region of the liver or of the splanchnics. 
 
 Lesions of the dorsal and upper lumbar region inxolve the innervation 
 of these organs, derangement of which is thought to be most closely as- 
 sociated with diabetes. Through their effects upon the splanchnics and 
 solar-plexus, they derange the functions of the liver, pancreas, and intes- 
 tines, all thought to be implicated in this condition. It is well established 
 that pancreatic disease is usually closely associated with diabetes, that a 
 glycolytic ferment secreted by this gland is necessarj' to normal metabol- 
 ism. This being disturbed results in sugar in the urine. Such a result is 
 doubtless affected by such lesions as above, interfering with the innerva- 
 tion of the organ by way of the solar and splenic plexuses. 
 
 It has already been shown how closely are such lesion associated with 
 derangement of the liver innervation, the glycogenic function of the organ 
 being disturbed in diabetes. 
 
 It may be that these lesions likewise aid the condition b}' deranging 
 the activities of the intestinal villi. According to Pavy's view of diabetes a 
 disturbance in the functions of the cells of the intestinal villi is the essential 
 feature in the causation of diabetes. Lesion to the vaso-motor innervation 
 of the portal vessels, arising from the 5th to 9th dorsal may have something 
 to do with such a disturbance. Lesion to the upper region maj- aid this 
 effect. 
 
 The influence of the general nervous s)stem in diabetes is v\ell known, 
 but not well understood. It is shown that lesions to the medulla, cord and 
 sympathetic system cause diabetes. The various spinal and cervical bony 
 lesions dobutless could do the mischief resulting in diabetes, as it has been 
 shown frequently that these lesions may injure cord, medulla, or sympathe- 
 tic system, as in paralysis, etc. In this connection one sees the importance 
 of upper cervical lesions, which may affect the medulla. Here, in the floor 
 of the fourth ventricle, lies the so-called diabetic center. It is a point, 
 puncture at which results in diabetes. The effect is doubtless gotten through 
 the vagi nerves, whose origin is from this point. With regard to this fact, 
 also to the well known participation of the vagi in liver functions, it seems
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 247 
 
 that cervical and spinal lesion, affecting the vagi through their sympathetic 
 cervical connections, or through their connections with the solar plexus, 
 may in this way produce a part of the effect of lesion in diabetes. 
 
 Prognosis. Although diabetes mellitus is a grave, and, by ordinary 
 methods, an incurable disease, the outcome under osteopathic treatment is 
 usually more encouraging. A fair percentage of cures has been shown, Ihere 
 being no room for doubting the facts in such cases. In accounts of twenty- 
 six cases gathered by Dr. C. W. Proctor, thirteen improved continually 
 under the treatment; seven were entirely cured; others were yet under 
 treatment. 
 
 It may be well said that in such cases our prognosis for recovery is 
 fair, and for benefit is good. 
 
 The Treatment is mainl)'. as far as the specific treatment is concerned, 
 upon that portion of the spine most affected with lesion, namely along the 
 splanchnic and lumbar regions. It is of course necessary to remove the 
 lesion as soon as possible. Treatment at the above mentioned regions is 
 particularly for restoring to normal the functions of pancreas, liver and 
 small intestine. 
 
 As the heart, kidneys, lungs and spleen undergo pathological changes, 
 it is necessory to give special attention to their condition, according to 
 methods before given. The skin and general excretory system must be 
 stimulated to aid in excreting the sugar from the blood. The bowels must 
 be treated for the constipation which is usually present. 
 
 A thorough general systemic treatment is given for the purpose of af- 
 fecting the various organs involved in the disease, stimulating and increas- 
 ing the general nutrition of the body, which is much affected, and of up- 
 building the general nervous system. 
 
 It is necessary to give close attention to the diet and regimen of the 
 patient. Carbohydrates must be excluded from the diet as thoroughly as 
 passible, no sugars nor starches being allowed in any form. Meats, fish, 
 poultry, eggs and green vegetables which do not contain starch(string-beans, 
 lettuce, water cress, spinach, young onions, tomatoes, olives, celery,) are 
 allowed. So, likewise, are milk, cream, butter and cheese. The patient 
 should drink plenty of water, especially such alkaline mineral waters as 
 Vichy, Carlsbad, etc. 
 
 He should take light exercise, but should avoid fatigue, particularly 
 inimical to his weakened condition. For the same reason, while warm and 
 steam baths are recommended, they should not be prolonged for fear of a 
 weakening effect. 
 
 In Diabetes Insipidus the lesions are usually found in the lower 
 splanchnic area, affecting the kidneys. Some cases show lesion of the 
 superior cervical vertebrae. In the latter case the effect may be upon the 
 medulla, or upon the sympathetic system. There is a point in the floor 
 of the fourth ventricle, panccure at which causes diabetes insipidus.
 
 248 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATKY. / 
 
 A 
 
 These various bony lesions miy cause it l:)y affcctintj the cord, since is 
 is known that injuries to the cerebro-spinal axis result in the disease. 
 Anders regards the condition as a vaso-motor neurosis, usually of oennal, 
 sometimes of reflex origin. It is also thought to be due to a \aso»motor 
 relaxation of the kidneys. It is rcadil)- seen that spinal lesion to the renal 
 splanchnic could result .in this vaso-motor neurosis and give rise to the 
 disease. 
 
 The Prognosis is good under osteopathic treatment, although the C( n- 
 dilion is regarded as incurable. A fair number of cases are cured. 
 
 The Treafment is mainly local for the kidne\s, b\' removal of lesion 
 at the splanchnic areas and by the various special vvaj-s of affecting the 
 kidne}s as pointed out in considering diseases of the kidne}S. 
 
 Some general treatment for the nervous sj'stem may be necessary. 
 
 DIPHTHERIA. 
 
 Numerous cases have been treated successfull\' b)- o teopathy. 
 
 The Lesions usually found in such cases are muscular and bony lesions 
 in the neck. Dr. Still regards the important cause a contraction of the tis- 
 sues of the throat and neck, including the scaleni muscles, drawing the first 
 rib backward under the clavicle and thus disturbing its articulation with the 
 first dorsal vertebra. These contractures about the throat interfere with 
 the venous circulation through the pharyngeal and internal jugular veins. 
 fa\oring a congested or a catarrhal condition of the mucous membranes of 
 the throat, and leading io diphtheiia. It is well known that catarrhil con- 
 ditions preispose to the disease. 
 
 Bony lesions and muscular contractures in the cer\ ical region interfere 
 with the innervation of the muscles and mucous membrane of the throat. 
 The S) iiipathetic innervation is from the superior cervical ganglion. This 
 distribution unites with fibres from the pneumogastric, glosso phalangeal, 
 and external larjngeal nerves, forming the phar> ngeal plexus. Hence 
 upper cervical lesion may, by affecting the superior cerxical ganglion, de- 
 range the sjmpathetic vaso-motor suppl\' of the phar)ngeal mucous mem- 
 branes and lead to the disease. 
 
 The Prognosis is good The case is usually readily cured. 
 
 In the Treatment the main idea is to keep open the circulation about 
 the throat and to thus prevent the formation of the membrane, or to pre- 
 vent its further growth. A thorough relaxation of the muscles and anterior 
 tissues of the neck must be maintained. The tissues at the root of the neck, 
 and about the clavicle and first rib must abso be kept free and loose. The 
 clavicle should be raised. The first rib should be pressed downward and 
 forward, working at its central articulation to correct the position of its 
 head. By the process of these treatments the venous and lymphatic drain-
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 249 
 
 age from about the throat is kept open. This regulates the vasomotor dis- 
 turbance of the membranes, tends to loosen the membrane already formed, 
 and, by preventing further exudation, stops the further growth of the mem- 
 brane. 
 
 The splanchnics, liver, kidneys and bowels should be treated twice 
 daily, to keep free the excretion of poisons from the system, and to aid 
 nutrition, to keep up the strength of the system. 
 
 Cervical bony lesion shoujd be removed, and treatment should be given 
 to the vagi, superior cervical ganglion, and cervical sympathetics to correct 
 circulation and aid in gaining vaso-motor control. 
 
 The internal throat treatment should be given to aid in gaining the 
 same end. Proper precautions should be taken to protect the finger so that 
 the child may not wound it with his teeth. The finger is inserted and swept 
 down over soft and hard palate, fauces and tonsils, to relieve the local in- 
 flammation by starting the circulation. 
 
 In laryngeal diphtheria an external treatment about the larynx and 
 down along the trachea is good. (Chap. Ill, A. V.) 
 
 A general systemic treatment should be carefully given to build up the 
 strength. The heart and lungs should be kept carefully stimulated to avoid 
 complications in them. The case should be carefully looked after for some 
 time, to strengthen the heart and to overcome the weakness of the throat. 
 
 The general treatment aids in preventing paralysis, particularly apt to 
 occur about the throat, sometimes in other parts of the body. 
 
 The patient should be isolated and the usual antiseptic pecautions 
 should be practiced. The patient should be kept upon a liquid diet. Milk 
 ice cream, broths, and the like are used. 
 
 CROUR 
 
 (Spasmodic Croup, Catarrhal Croup, or Laryngismus Stridulus.) 
 
 Definition: This is a disease peculiar to children and held to be chief- 
 ly of nervous origin, but it is often associated with acute catarrhal laryngitis. 
 It is associated with paroxysmal coughing, difficulty of breathing,and at- 
 tacks of threatened suffocation. 
 
 Numerous cases have been successfully treated by Osteopathy. 
 
 The Lesions of greatest importance in croup involve contracturing of 
 the muscles and tissues of the throat, irritating the pneumogastric nerves, 
 and their recurrent and superior laryngeal branches. These contractures 
 likewise prevent proper circulation to and from the larynx, and favor the 
 catarrhal condition in this way. The irritation of the pneumogastrics and 
 their branches is accountable for the spasmodic condition of the larynx dur- 
 ing the paroxysms. 
 
 Dr. Still ragards as important sacral and lower spinal bony lesions in
 
 250 PRACTICE AND AIM'LIED THERAPEUTICS OF OSTEOPATHY. 
 
 croup. He also finds a contracture of the omohyoid muscle, drawing the 
 hyoid bone down and back ui)on the superior laryngeal nerve, irritating it, 
 and causing the spasm In croup, as in other throat diseases, he finds that 
 the contracture of the cervical tissues and scaleni muscles draws the first 
 rib back under the clavicle, draws it upward, and deranges its articulation 
 with the first dorsal vertebra. This condition is important in shutting off 
 venous and 1\ mphalic drainage from the larynx, and favors the inflamma- 
 tion of the mucous membrane. 
 
 \'arious contractures of the posterior cervical muscles, as well a> those 
 bony lesions common in laryngitis, as of atlas, axis, and 3rd 'cervical verte- 
 bra, are sometimes present, acting to disturb sympathetic innervation, vagi, 
 and circui ition. 
 
 One must, however, chiefly regarti those contractures and bon\' lesions 
 about the throat and neck anteriorly. Ari!>ing from exposure, cold, etc., 
 they become the chief cause of croup 
 
 The Prognosis is good. Inrmediate relief is given by the treatment. 
 The spasm, stridulous breathing, and threatened suffocation are o\ ercome 
 at once by the treatment during the attack. 
 
 The chief Treatment is to at once relax all the anterior cervical tissues, 
 to free the circulation and to relieve the irritation to the superior and re- 
 current laryngeal nerves. The treatment should begin well up beneath the 
 inferior maxillary bone, being made especially about the hyoid bone and 
 muscles, and should be carried down along the throat and trachea. 
 
 The h}'oid bone should be grasped and manipulated laterally, forward, 
 and upward, relaxing the omo-h)oid and other muscles. (Chap III, A. 
 III. Chap. IV, III.) 
 
 The process of treeing the circulation is materially aided b\- working 
 along the course of the carotid arteries and internal jugular veins, raising 
 the clavicle, and relaxing the surrounding tissues. 
 
 Treatment may be made close along the lar\nx and trachea, (Chap. 
 Ill, A. V). This is helpful during the spasm. 
 
 Inhibition ma)' be made upon the superior laryngeal nerve by pressure 
 immediately below and behind the greater cornua of the hyoid bone, and 
 upon the recurrent lar\ ngeal at the inner side of the sterno-mastoid muscle 
 at the level of the cricoij cartilage. This is likewise useful during the 
 spasm. 
 
 Anders notes the fact that sometimes the epiglottis becomes wedged 
 into the rima glottidis, and must be helped out b>- the use of the index fin- 
 ger. 
 
 The spasm may be lessened by manipulation about the region of the 
 diaphragm, relaxing it, and by treatment of the phrenic nerves in the neck. 
 (Chap. Ill, A. VIII.) 
 
 Due attention must be given to the tissues and bony lesions of the 
 posterior cer\ ical region.
 
 PRACTICK AND APPLIED THERAPEUTICS OF OSTEOPATHY. 25I 
 
 All sources of reflex irritation, as intestinal parasites, dentition, indi- 
 gestion, etc., must be looked after. The child should not be allowed to 
 over-eat or drink. 
 
 In spasmodic croup the attack is sometimes relieved by easing an over- 
 loaded stomach. Tickling the fauces with the finger will cause the vomit- 
 i.ig. Cold applications may be used over the throat and chest. A warm 
 bath is a convenient means to employ to break up a spasm. 
 
 • WHOOPING-COUGH. 
 
 (pertussis). 
 
 Definition: An acute, highly contagious disease, occuring chiefly in 
 children, and characterized by a catarrhal infl.^mmation of the mucous mem- 
 brane of the respirator)' tract, and by a peculiar spasmodic cough ending in 
 a whooping inspiration. 
 
 Its true, nature is not known, but that theor)' that regards it as a lesion 
 of the phrenic, pneumogastric, sympathetic, or recurrent laryngeal nerve, 
 or perhaps of the medulla, best accords with the osteopathic view of the 
 etiology. 
 
 The Prognosis is good. The course may be aborted if taken earl>', but 
 if the disease is well started but little more than alleviation can be accom- 
 plished. The case is safely carried through, and the danger of complica- 
 tions is minimized. 
 
 The Lesions In whooping-cough, as in croup, the contraction of the 
 omo hyoid muscle drawing the hyoid bone against the pneumogastric nerve 
 is important, as is also the contracturing of the cervical tissues drawing the 
 first rib back, and disturbing its central articulation. 
 
 Cervical bony lesions are found at the upper, middle, and lower cervi- 
 cal vertebrae, and bony lesions are also found about the first and second 
 dorsal vertebrae, the first rib and clavicle. 
 
 The upper cervical lesion affects sympathetics and vagi in ways before 
 pointed out. The middle cervical lesion affects phrenics and diaphragm, 
 sometimes important in this condition. The contractures of throat tissue?, 
 lesion of clavicle and first rib retard venous and lymphatic drainage, and 
 lead to catarrhal conditions, well known to be of much importance in j)ro- 
 ducing the condition. The mucous membranes are thus weakened and laid 
 liable to the action of the specific infection. 
 
 Lesiors of the upper dorsal vertebrae and of the upper two or three 
 ribs maj' derange the sympathetic connections of the laryngeal innervation- 
 
 The Treatment is much the same as in croup. The prime point is to free 
 Ihe circulation about the larynx and whole respiratory tract, as there is a 
 catarrhal condition of the whole tract. This object involves the relaxation 
 of all the anterior cervical tissues, treatment of the h3oid bone and relaxa-
 
 252 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 tion of the omo-hyoid, raising the clavicle, etc. All bony lesions of the 
 cervical, upper dorsal, and upper thoracic region must be overcome, together 
 with existing contractures, in order to remove all sources of irritation to the 
 laryngeal innervation. The ways in which these lesions act, and the method 
 of their removal has before been sufficiently explained. 
 
 For the cough, treatment should be made down along larynx and 
 trachea, and about the angle of the jaw. 
 
 Dr. Still mentions, also, treatment to the phrenic nerves and diaphragm 
 to relieve the condition. 
 
 The lungs may be stimulated, and all the upper ribj be raised, to ease 
 respiration. The lungs, heart, kidneys, and general sjstem must be care- 
 fully looked after and thoroughly treated to avoid the complications and 
 sequelae that ma\- arise in the form of broncho-pneumonia, pleurisy, per- 
 icarditis, acute nephritis, etc. 
 
 INFLUENZA 
 
 (La Grippe — Epidemic Catarrhal Fever.) 
 
 Cases : (i) Four cases in one family restored to usual health within 
 a week. 
 
 (2) Four cases cured in four or fi\»; treatments, no bad results follow- 
 ing the disease. 
 
 (3) La Grippe, attacking the throat and complicated with a severe 
 tonsilitis, was cured by several treatments. 
 
 (4) A severe attack of la grippe cured in four days by treatment di- 
 rected to bowels, kidneys, and splanchnic nerves. 
 
 (5) A list of thirty-five cases, one of which bad been cured by one 
 Ireacment, and the remaining cases cured by several treatments, none re- 
 quiring over four. 
 
 (6) A report of a number of cases of la grippe, all with mared symp- 
 toms. In every case the patient was able to be up in from one to three days 
 No complications nor sequelae arose. 
 
 (7) A lady of seventy-one had been confined to her bed for two 
 weeks with la grippe and rheumatism. After seven treatments she was 
 about, the la grippe being cured and the rheumatism much improved. 
 
 (8) A case of la grippe cured in four treatments. 
 
 Lesions : While no specific bony lesion has yet been mentioned as 
 occurring in Influenza, there ia yet a specific condition of lesion doubtless 
 closely associated with the invasion of the disease into the system. This 
 oondition is a general contracturing of the spinal muscles, most marked in 
 the upper dorsal and cervical regions, but affecting the whole spinal sys- 
 tem. This may be regarded as the specific lesion in Influenza. Dr. Stil.
 
 PRACTICE AMD APPLIED THERAPEUTICS OF OSTEOPATHY, 
 
 regards it as shutting down upon the whole vascular and nerve systems of 
 the body, through the constricting affect of these contractures upon the 
 spinal nervous system through its posterior distribution. The result is a 
 sluggish condition of all the vital fluids, lymphatic, blood, and nerve. 
 
 While it is doubtless true that the bacillus of Pfeifer is the infecting 
 agent, it yet remains to account for the sudden invasion of the system by 
 this germ, since it is known that the germs of disease cannot attack healthy 
 tissues and that a body in perfect health is immune. 
 
 In this connection it is significant that debilitated persons fall the easiest 
 victims to the malady. In a majority of such individuals it is doubtless true 
 that various osteopathic lesions already exist and so weaken the system in 
 one way or another as to lay it liable to the invasion of the the germ. 
 
 Just so, the general muscular contracture found as the characteristic 
 lesion in la grippe, acts upon the vital forces of the system to debilitate 
 them and lay the body liable to invasion. Tnis theory would appear en- 
 tirely reasonable in the light of the fact that Pepper thinks it likely that the 
 germs exists everywhere, but depends upon certain extraordinary atmos- 
 pheric or telluric conditions for occasion to break out into virulence. It is 
 quite reasonable to hold that some special set of circumstances, it may even 
 be these same extraordinary atmospheric conditions, results in these spinal 
 contractures which, occurring coincidentally with the periods of virulence 
 of the germ, allow of the invasion of the system. 
 
 La grippe is most frequent in bad weather, and it may be that then 
 exposure to cold may set up these contractures. While it is true that 
 the authorities hold the disease to be entirely independent of climate and 
 season, it is yet true that a person may "catch cold" at any time and place, 
 these contractures being well known to result. 
 
 It is probable that the presence of various lesions, bony and otherwise, 
 in the body, determines the disease to a special part of the system, result- 
 ing in the peculiar manifestation of the disease which disguishes it as the 
 abdominal type, the cerebral type, the thoracic type, etc. 
 
 Probably, too, such lesions are responsible for the various complica- 
 tions and sequelae which constitute so marked a feature of the attack, as 
 affections of lungs, heart and nervous system. 
 
 The Prognosis under osteopathic treatment is particularly good. One, 
 or a few treatments being usually all that are necessar)' in uncomplicated 
 cases. When the case is taken in time complications do not ensue. If 
 present they are usually readily overcome by the treatment. It is a well 
 known fact that the mortality is influenza is due chiefly to its complications, 
 consequently not the least satisfactory result of osteopathic treatment is in 
 overcoming danger of these. The distressing sequelae, especially affecting 
 lungs, nervous system, and eyes and ears, do not occur. 
 
 The Treatment indicated is a thorough general one, as for a bad cold, 
 including particularly the complete relaxation of all the spinal tissues, thus
 
 254 rRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 restoring the equilibrium of the vascular and nervous systems. This ob- 
 ject accomplished, a long step toward recovery has been taken. 
 
 During this process occasion is taken to strongly stimulate heart and 
 lungs, regulating circulation, sweeping out congestions, inducing perspiia- 
 tion and lessening fever, and sustaining these organs themselves against 
 the effects the disease is likely to produce in them. This treatment em- 
 bodies raising the clavicle and ribs, work over the chest anteriorl)', stimula- 
 tion of the vaso-motor and accelerator innervation in the upper dorsal re- 
 gion, etc., all described in considering the diseases of heart and lungs. 
 
 The liver, kidneys, bowels and fascia are likewise kept well stimulated. 
 
 It is well, especially in the rheumatoid type, to carry the relaxing treat- 
 ment over all parts of the bod\', flexing and rotating the thighs, working 
 about shoulders, upper limbs, neck, etc. This o\ercomes the distressing 
 general aching and soreness in the muscles. 
 
 Careful abdominal treatment is called for, particularly if the disease 
 shows a tendenc}- to settle in that region. Work upon the liver, bowels, 
 solar and hypogastric plexuses, and splanchnics in the usual way will meet 
 these requirements. 
 
 The general spinal and cervical treatment both aids the general affect 
 and pro\"ides against affection of the central nervous system, brain, and 
 organs of special sense. 
 
 The general health must be carefully guarded, the patient must be 
 kept from exposure, be prevented from going uut too soon, and be kept 
 upon a light, nutritious diet. This should be largely fluid in case the 
 patient confined any length of time to his bed. 
 
 The fever, headache, pains in the e)e-balls, and other manifestations 
 of the disease are treated speciall)' in the usual wa)s.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHS. 255 
 
 SCIATICA. 
 
 Sciatica is a disease in which Osteopathy has secured particularly bril- 
 liant results. Great numbers of cases have been cured, many of them hav- 
 ing tried previously every known means of treatment. 
 
 The Prognosis is good. Usually immediate relief is given upon the 
 first treatment. Often the case is soon cured, though many cases call for a 
 patient continuance of the treatment. 
 
 The Lesions are almost always of such a nature as to bring irritation 
 upon the nerve, either by direct pressure upon the nerve, or upon certain 
 fibres contributing to it. Derangement of its blood-supply may play a part 
 in producing the condition. 
 
 The common lesions are bony ones along the lumbar and sacral regions. 
 Lesions of the 4th and 5tb lumbar vertebrae, lesions of the first and second 
 A sacral nerves by contracture of the tissues about them, innominate displace- 
 "^ ment, slipping of the sacro ilac joint and derangement of its ligaments, dis- 
 '^ placement of the sacrum, and derangement of the coccyx, are all important 
 forms of lesion producing sciatica. These lesions impinge the fibres con- 
 tributing to or connecting with the sacral plexus. Some may directly press 
 upon the nerve. 
 
 A frequent cause of sciatica is contracture of the pyriformis mnscle 
 
 • upon the trunk of the sciatic nerve. The tissues about the sciatic notch 
 
 may be contractured and irritate it. It is said that lesion along the cord, 
 
 anywhere from the 2nd dorsal down, may cause sciatica. McConnell states 
 
 that downward displacement of the nth or 12th rib may cause it. 
 
 The Treatment is simple. It calls for the immediath removal of the 
 source of pressure or irritation by correction of lesion, A general relaxa- 
 tion of tissues about the nerve and about its connections is done, due at- 
 tention being given to relaxation of ligaments, as at the sacro-iliac articula- 
 tion. 
 
 This relaxation of the tissues should be carried along the femoral ves- 
 sels, often thus relieving the condition in an imi)ortant manner. The tissues 
 along the course of the nerve, at the sciatic notch, at the back of the thigh, 
 and behind the knee should be relaxed also. Strong internal circumduc- 
 tion is used to relax the pyriformis muscle. 
 
 The sciatic nerve should be well stretched by one of the meihods de- 
 scribed. (VI, p. 49.) 
 
 MALARIA. 
 
 Malaria is a disease which, although due to the activities of a specific 
 germ, the Hematozooan of Leveran, yet presents marked bony lesions, 
 which account for the manifestations of the germ within the system.
 
 256 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 The Lesions are mostly in the splanchnic area, disturbing the sym- 
 pathetic and vaso-motor innervation of liver, spleen and kidneys. Mc- 
 Connell notes lesion as a marked lateral deviation at thegth and loth dorsal 
 vertebrae, and a resulting downward luxation of the lOth rib, also lesion of 
 thegth to lith dorsal vertebrae or in the corresponding ribs. 
 
 Dr. Still points out lesion at the first lumbar, at the sacrum, at the 
 splanchnics, and in the cervical region. 
 
 These various bony lesions must produce a marked affect upon the sym- 
 pathetic system, resulting in vaso-motor disturbance. 
 
 The Prognosis is good. Dr. Still says that he never needs to give a 
 patient a second treatment. Usually a few treatments overcome the dif- 
 ficulty, and quick results are often shown. Yet it often happens that but 
 slow progress is made. Complications, however, are prohibited by the 
 treatment. Marked relief is at once given during the paroxysm. 
 
 The Tre.\tment is directed particularly to the splanchnic area, and to 
 opening of the abdominal blood-supply. By the splanchnic and abdominal 
 treatment liver, kidneys, spleen, and bowels are kept in an active state. 
 This is the chief object of the treatment. 
 
 Treatment is given at any time, during or between the paroxysms. 
 
 The specific treatment employed by Dr. Still in cases of malaria is as 
 follows: With the patient sitting facing him, he passes his arms beneath 
 the axillae and grasps the spine with both hands, one on either side of the 
 spinous process, at the fourth dorsal vertebra. He now draws the patient's 
 body toward him, though not moving the patient from his position on the 
 chair, thus stretching the spine and bringing pressure upon the 4th vertebra. 
 He closes this manoeuvret by twisting or rotating the trunk slightly, first to 
 one side and then to the other, all the time continuing the pressure at the 
 vertebra. This simple process is repeated at the 12th dorsal for the renal 
 splanchnic. In this way the splanchnics and renal splanchnics are stim- 
 ulated. 
 
 He concludes the treatment by momentaril}- bringing pressure with his 
 thumbs down upon the femeral arteries. The time of this pressure is merely 
 long enough to allow one heart-beat to elapse. His idea is that this mo- 
 nlentary damming back of the femeral currents upon the heart causes it to 
 give a sudden strong beat to overcome the resistance, rousing it to activity 
 and stimulating the system. 
 
 A general spinal, cervical, and stimulative treatment to heart and lungs 
 may be given for the chill. This overcomes the intense vaso-motor con- 
 striction of the surface of the body, collateral with an inward congestion, 
 and equalizes th'' circulation. The abdominal treatment aids this process. 
 
 This general treatment likewise aids in taking down the fever. The 
 more specific treatment may be given as indicated, in the cervical region, 
 upon the chief vaso-motors, and vaso-motor center of the medulla, via the 
 superior cervical ganglion.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 257 
 
 No specific treatment is called for to allay the sweating, as this is it- 
 self a relief to the patient's condition. The general method of treatment 
 described may be properly applied during this stage or during the inter- 
 mission. 
 
 TYPHOID FEVER. 
 
 Cases: (i) A case taken in the usual way, and presenting the usual 
 symptoms. The fever was 103° at 4 p. m. when the Osteopath was called. 
 The next morning the fever was below 102°, rising that evening to 103.5°. 
 On the succeeding evening it was again 103.5°, but this was the highest 
 point reached, Thereafter, instead of the temperature remaining about 
 104° for two weeks, as is typical, the gradual decent began immedeately, 
 and in two weeks the patient was well. As early as five days after treat- 
 ment began most of the symptoms had disappeared. Fourteen days after 
 treatment began the evening temperature was normal. Five days later the 
 patient was out upon the street. 
 
 (2) This case, when first seen, had a pulse of 102, a temperature of 
 105°, and all the usual symptoms marked, even deleruim being present, and 
 the stools and urine passing involuntarily. He had been ill with the fever 
 for two weeks. Gradual descent of the temperature began immediately up- 
 on treatment. It became normal seventeen ^days after treatment began. 
 The symptoms began to abate with the fever, all but the weakness having 
 disappeared in twelve days. 
 
 (3) A case seen on the day after it had taken to bed, with a tempera- 
 ture of 101°. In two days the symptoms began to abate. On the fourth 
 day the fever had risen to 104°, falling, then rising on the seventh day to 
 104° again. After this there was a gradual descent, until on the evening of 
 the twenty-fifth day the temperature was normal. The usual period of high 
 temperature had thus been prevented. 
 
 (4) A case of typho-malarial fever which had been ill fonrteen daj's 
 when the Osteopath was called. The temperature was 103°. After six 
 treatments the case was discharged cured. 
 
 (5) Typhoid Fever and Pueumonia, showing a temperature of 105°, 
 having been ill thirteen days when the Osteopath was called. But one 
 treatment was given in this case. It recovered entirely. 
 
 (6) In a girl of nine, who had suffered from typhoid fever, the linger- 
 ing effects of the disease, suffered from five j-ears before, were very mark- 
 ed. The difficulty took the form of acute attacks commencing with pain 
 in the eyes, followed by intense headache and delerium, and a rash upon 
 the skin. As this rash disappeared, swelling and pain in the joints would 
 follow. These attacks would recur about every two weeks. The child was 
 emaciated and suffered from involuutarv micturition. She had been under
 
 258 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 skilled medical care, and the case had attracted such attention that it was 
 discussed before a convention of physicians in Denver. 
 
 Being treated osteopathically during an attack, she recovered this time 
 without the usual swelling and rheumatic symptoms. After two months' 
 trtatment the case was discharged cured. 
 
 The only bony lesion was a lateral lu.xation of the third cervical ver- 
 tebra, but all of the spinal muscles were intensely contractured. 
 
 These few cases are quite typical of the many treated. 
 
 Lesions: Dr. Still describes, as the characteristic "typhoid spine," a 
 posterior prominence of the lower lumbar region, caused b>- backward dis- 
 placement of the 3rd, 4th and 5th lumbar \erthbrae. He holds that the re- 
 sults produced by these lesions is a paralysis of the lymphatic supply of the 
 bowels, by pressure upon the spinal nerves at their exit from the interver- 
 tebral foramina. Thus is produced the essential typhoid condition of the 
 small intestine characteristic of the disease. 
 
 He notes also lesions along the upp; r dorsal region, at which point he 
 makes treatment upon the lungs, correcting the activities of the 1) mphatic 
 system, thus, as he sa>'s, makmg water to put out the fire of the fever. 
 
 In general, the lesions found in t)phoid fever are rib, vertebral, and 
 muscular lesions affecting the splanchnic and lumbar regions of the spine, 
 irritating spinal nerves, and through them disturbing the sympathetic, vaso- 
 motor, and lymphatic supply of the sniall intestines. 
 
 As before pointed out in detail (see diseases of stomach and intestines), 
 these portions of the spine suffering from lesion give origin to the visceral 
 nerves of the intestines. The vaso-motor supply of the abdominal vessels, 
 according to Quain, is from the splanchnic and lumbar portion of the cord. 
 These include the vaso-motors of the jejUuum and ileum, the seat of ulcera- 
 tion in the disease. 
 
 Pathologicalls', the process in the first two stajes of tj'phoid, infiltera- 
 tion and necrosis of the patches, is regarded as a vaso-motor disturbance. 
 The first stage is an intense inflammation, involving to a greater or less de- 
 gree the whole mucosa. The second stage is the result of an obstructed 
 circulation to the parts of the intestine involved In view of these facts it 
 is evident that sucessful therapeutic measures must gain \aso-motor control. 
 It is an indication to the Osteopath that he must do spinal work upon the 
 vaso-motor area suppl)ing the bowels, removing the lesion that is obstruct- 
 ing the natural play of forces necessary to health. 
 
 The Prognosis is good, yet one must not forget to be upon his guard, 
 constantly, against the complications and intercurrent maladies that so 
 often carry off the typhoid patient. Under osteopathic treatment, however, 
 complications and sequelae are quite prevented. Indeed, much'fine osteo- 
 pathic work has been done upon paralytic and various other forms of the 
 sequelae following a former attack of t\ phoid fever. 
 
 If taken within a week or ten da\s the course can be usually aborted
 
 i'l^ACTTCE AXB APPLIED THEKAPEUTICS OF OSTEOPATHS. 259 
 
 -:o a marked degree. Often cases gotten early have had their course term- 
 inated within a few days. Bad case.s, taken under the treatment after so 
 Tate as the fourteenth day, commonly at once show marked improvement. 
 
 The characteristic course of the temperature is entirely changed. It is 
 usual to notice, no matter in what stage the cas-e may be when it comes 
 under the treatment, that the temperature begins at once to gradually de- 
 cline. When the case is taken before the second week, the usual period of 
 high temperature is prevented. 
 
 Treatment: The main object of the treatment, as pointed out, is to 
 gain vaso-motor control of the intestinal blood-supply, and to restore the 
 intestinal lymphatics to normal activity. Consequently the main treat- 
 ment in these cases is spinal. It must be devoted particularly to the cor- 
 rection of the malpositions of the 3d, 4th and 5th lumbar as described 
 above, and to the removal of any spinal, muscular, rib, or vertebral lesion 
 present. 
 
 Most of the treatment in these cases must be done upon the spine, 
 leaving the abdomen almost entirely free from manipulation. 
 
 All the spinal muscles should be relaxed, this, with a careful cervical 
 treatment, quieting the nervous system, and relieving the jerking of the 
 ^ubsxdhis tendlnuvi. This treatment is carefully made while the patient is 
 l\ing upon one side. The patient must not be moved into various posi- 
 tions anymore than can be avoided. It is important to avoid fatiguing him. 
 
 Lungs and heart should be kept gently stimulated by work in the usual 
 place in the upper dorsal. This aids in keeping up the patient's strength 
 andjin preventing complicating diseases of these organs. Treatment at the 
 renal splanchnics should be given to keep the kiduej's active. 
 
 The main treatment being along the splanchnic and lumbar regions, 
 these portions of the spine are treated by careful relaxation of all contrac- 
 tures, by gently springing the spine for the relaxation of ligaments and for 
 the freedom of the nerves, and in removing the bon)' lesions mentioned. 
 
 The correction of the lesion to 3d, 4th, and 5th lumbar controls the di- 
 arrhoea. It may be treated in the usual wa\'. 
 
 The spleen and liver are reached b}' spinal work at their innervation. 
 
 The abdominal treatment is almost nil. Any manipulation made here 
 should be with extreme gentleness It is best to confine this treatment to 
 the iliac regions, raising the intestines slightly, with the idea of straighten- 
 ing them in the iliac fossae. (IV. Chap. VIII.) 
 
 The fever is treated b}' work at the superior cervical ganglion in the 
 usual way, thus regulating the systemic circulation by affecting the general 
 vasomotor center in the medulla. The treatment to the heart and luno-s 
 aids this process by equalizing the circulation, as does also the general 
 spinal work and the treatment given along the spine for intestinal circula- 
 tion specifically. The heart beat should be slowed b\' inhibition at the 2d 
 to 5th dorsal, on the left.
 
 260 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATKT. 
 
 In case of rapid beating of the heart, persisting sometimes for a long' 
 period, Dr. Hildreth finds that correction of the left 5th rib gives relief. 
 
 The hiccough is treated in the usual way. 
 
 In case of hemorrhage the patient should be kept perfectly quiet, have 
 no solid food, and an ice-bag should be applied over the caecum. The foot 
 of the bed should be elevated. Inhibition of peristalsis should be done by 
 work from the c>th dorsal down along the lumbar region. 
 
 In case of perforation, hot applications, or the ice-bag, are applied tO' 
 the abdomen to relieve the patient. 
 
 The usual precautions should be taken for the hygiene of the sick room, 
 the disinfection of the linen, the sterilizing ot the stools, and urine and gen- 
 eral cleanliness. 
 
 The patient's bod)', a part at a time, should be sponged with teprd water 
 daily. The Brand system of baths is much used at the present day. 
 
 In regard to diet the usual observance of a strictl\' liquid dret is fol- 
 lowed. Some are using light, easil)' digested food the first week or ten 
 days, until danger of perforation has arrived. The claim is made that the 
 patient's strength is in this wa\- much l>etter preserved. It would be safe 
 for an Osteopath to carr)' a case through on such a diet providing he got it 
 early enough to prevent the danger of perforation. 
 
 After first taken the patient should not be allowed to get up from his 
 bed. A bed-pan and urinal should be used. 
 
 During convalescence the patient's condition should be carefully 
 watched. The return to a hearty diet should be gradual in spite of his 
 great appetite. After a liquid diet the semi-solid food should not be allowed 
 until the temperature has been normal a week. 
 
 ERYSIPEAS. 
 
 (ST. ANTHONY'S FIRE. "THE ROSE.") 
 
 Erysipelas is a disease frequently treated and cured osteopathically. 
 The Prognosis is good. 
 
 The Lesions are various forms of obstruction to the circulation of the 
 part affected. The lesion may be bon)-, or a contracture of muscles or 
 other tissues. It ma}' directly press upon veins and ]\ mphatic vessels, pre- 
 \enting the proper drainage of the part, or it may derange the vaso-motor 
 innervation and the S)mpathetic innervation of the lymphatics. For ex- 
 ample a case of erysipelas in a lower limb was cured by turning the head of 
 the femur well in the socket, and in raising tne abdominal viscera up from 
 the region of the crural arch, where they were pressing upon the blood ves- 
 sels and preventing drainage from the limb through the femoral vein and 
 lymphatics. By thus relaxing the tissues and removing direct impinge- 
 ment from the vessels, the blood flow was restored and the case was cured.
 
 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 26l 
 
 Another case in which the eruption appeared upon the face, was cured 
 by springing the temporol-maxillary articulation with the assistance of 
 corks placed between the molar teeth, as one would set a dislocated jaw. 
 In this way various tissues about the jaw may have been relaxed, or impinge- 
 ment of the fibers of the fifth nerve removed, restoring circulation. 
 
 The most usual lesions in er)-sipelas are found prevent'ng the circula- 
 tion from the head, as the face is the part most frequently attacked. Lesions 
 of cervical vertebrae and muscles affect the vaso-motors and sympathetics 
 regulating the blood and lymphatic circulation of the face, and lead to in- 
 flammation by obstructing these fluids, the specific germ being present and 
 attacking the part thus rendered liable to its action. Clavicle and first rib 
 lesion may directly obstruct the jugular veins and the cervical lymphatics, 
 leading to same result. 
 
 McConnell notes lesion of the 2d, 3d, 4th and 5th dorsal vertebrae, and 
 of corresponding ribs and surrounding muscles, causing erysipelas in the 
 face, by disturbing sjmpathetic innervation. 
 
 The Treatment is simple, calling for removal of lesion and re-estab- 
 lishment of venous and lymphatic drainage of the affected part. This in- 
 volves relaxation Df muscles and other tissues, restoration of bony parts to 
 position, freeing of nerve connections, etc., as already pointed out, accord- 
 ing to the part affected. 
 
 It is not necessary to manipulate the inflamed part. 
 
 As erysipelas is a dermatitis the need of gaining vaso-motor control is 
 apparent. The special treatment of the neck to affect free circulation to 
 and from the head and face has been sufificiently discussed in the treatment 
 of diphtheria and of the eruptive fevers. 
 
 A general spinal treatment must be given to strengthen the general 
 nervous system against the various nervous complications and sequelae that 
 may arise, such as delerium, coma, subsultus tendinum, etc. Bowels must 
 be kept free, and liver and kidneys kept active to get rid of the poison of 
 the disease which is deranging the constitutional condition. The kidneys 
 must be especially supported against albuminuria and uremia. 
 
 Among the hygienic measures and domestic remedies recommended, 
 are isolation of the patient, drinking of plenty of cold water, cold spong- 
 ings of the part, or applications of iced cloths, and the application of col- 
 lodion over the eruption. Carbolized vaseline may be used to anoint the 
 affected part. 
 
 The diet is important. The patient should be liberally fed on a light, 
 nutritious diet. Anders states that liberal feeding of the patient is of 
 greater service to the patient than any of the recognized forms of medicinal 
 treatment, and that lack of attention to the diet during the primary attack 
 tends to increase the frequency of relapse
 
 262 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY. 
 
 MEASLES. 
 
 (morbilii, rubeola ) 
 
 Ver)- numerous cases have been successful!)' treated. 
 
 The Prognosis is good. The danger of complications and sequelae is 
 minimized, as these cases recover quickly and thoroughl)- under the treat- 
 ment. 
 
 While it is held that measles, once started, must run its course, yet the 
 period of convalescence is shortened and the child is about earlier without 
 danger of complications. 
 
 Lesions: Dr. Still describes in this disease a general congestion of 
 the lymphatics and of the superficial fascia, insufficient lymphatic drainage 
 of the skin becoming evident as a cutaneous rash. This general congestion 
 is due to spinal muscular contractures all along the spine, irritating the 
 spinal distribution of nerves, and through them deranging sympathetic 
 vaso-motor and lymphatic nerve-supply. 
 
 This general congestion of the spinal muscles appears as lesion in 
 measles. The clavicle max be found with its sternal end displaced back- 
 ward against the vagus nerve, causing the cough, and aiding to cause the 
 catarrhal condition of the bronchi. Upper rib lesions may be found, their 
 correction relieving the cough. Weakened children, especially those pre- 
 senting upper spinal and thoracic rib lesions, are apt to become \ictims of 
 pulmonary tuberculosis after measles. The clavicle and first rib lesion, as 
 well as various cervical bony lesions and muscular contractures, probably 
 account for complications and sequelae in e\e, ear, nose and throat. These 
 effects come largely through obstructed lymphatic drainage from the neck, 
 a fact well illustrated by the marked enlargement of the cervical 1} mph 
 glands as a complication or sequel of the disease. 
 
 In the Treatment the first step, especiallx- if the rash has not devel- 
 oped, is a thorough stimulation of the cutaneous system, including a gen- 
 eral spinal treatmennt, with particular attention to atlas ancf axis, for effect 
 upon the vaso-motor center in the medulla; upoii the second dorsal and fifth 
 lumbar, cutaneous centers. In tardy cases one such treatment suffices to 
 bring out the rash abundantly, a desirable result, since upon its appearance 
 the headache and fever disappear, and the patient feels better. 
 
 This treatment would include a general relaxation of the spinal mus- 
 cles, correcting the Ijmphatic obstruction. 
 
 An important effect of the general spinal and cervical treatment, to- 
 gether with some special treatment to heart and lungs, is to correct the gen- 
 eral circulation, calling away from all the viscera the abnormal amount of 
 blood retained in them as a congestion, in this disease. For this purpose 
 these should be added treatment of the splanchnics, solar plexus, liver, kid- 
 ne)s, and abdominal circulation general!;'.
 
 PRACTICE AKD APPLIED THERAFEUIICS OF OSTEOPATHY. 263 
 
 The usual treatment of the throat, internal and external; of the neck; of 
 -clavicle and tirst rib; of the upper anterior chest, raising the ribs, and work- 
 •ing in the anterior intercostal spaces against the costal cartilages; and of 
 the face and nose, should be given to overcome the catarrhal condition of 
 the respirator}- tract, just as a cold and a bronchitis are treated. 
 
 The lungs should be kept well supported by the treatment, to avoid the 
 danger of bronchitis and pneumonia. Likewise kidneys, eye, ear, nose, and 
 throat should be guarded against effects in them. 
 
 The cough is relieved by relaxing the throat tissues, treatm-ent alono- 
 the larynx and trachea, correction of first rib and clavicle, and raising of 
 the upper ribs. 
 
 The patient should remain in bed until desquamation is well along, 
 should be in a darkened room for the sake of the e)""s, and should be kept 
 <upon a light diet of milk, bread., light soups, etc. 
 
 The general spinal treatment, and treatment of the cutaneous system 
 and centers, vv'll aid in allaying the itching of the skin. For this purpose, 
 also, a daily warm bath may be given. 
 
 RUBELLA. 
 
 (FRENCH OR GERMAN MEASLES.) 
 
 VARICELLA. 
 
 (CHICKENPOX.) 
 
 To these conditions we may apply the same general remarks concern- 
 lesions and treatment, osteopathicall}-, as made in considering measles. 
 
 The very mild symptoms accompan)ing these conditions call for but 
 little treatment aside from the general constitutional one, pointed out in de- 
 tail in measles. These points of treatment may be applied as necessary. 
 
 Due attention must be given to avoid exposure, the dangers of compli- 
 cation, etc. In rubella the enlargement of the cervical !)mphatics calls for 
 attention in the manner pointed out. The slight fever and catarrhal symp- 
 toms are readily overcome. In both conditions due attention must be given 
 to the cervical and general spinal treatment, and to the maintenance of the 
 activities of the \arious viscera. Usuall)' the spinal muscles are contract- 
 ured, and must be relaxed. These contractures doubtless effect the general 
 lymphatic system b)- wa.y of the spinal nerves. For example, in varicella 
 the superficial, lymph glands are sometimes visibly enlarged. 
 
 In varicella the usual precaution of preventing the child's scratching 
 off the scabs by putting mittens or bandages upon the hand and wrists, and 
 of painting the scab over with collodion may be observed. 
 
 SCARLET FEVER. 
 
 (scarlatina.) 
 Numerous cases have been successfully treated osteopathically. The 
 Prognosis is good, but must be guarded in cases complicated with diph-
 
 264 PRACTICE AND APPLIED THERAPEUTICS OF OSTEOPATFTY. 
 
 theria. The experience is to bring these cases safely through the attack.. 
 free from connplications and sequelae. 
 
 The Lesions are, in general, the same as described for the various- 
 acute, specific fevers. Contractured spinal and cervical- muscles are noted. 
 One must e.xpcct various bony lesions, accounting for the weakness of the 
 special parts attacked by complications or sequelae, as for the kidneys^ 
 throat, and general nervous system by the usual bony lesions found present 
 in diseases of these parts. 
 
 The Treatment proceeds along the lines already laid down. In this 
 case there is especial need of thorough constitutional treatment on account of 
 the multiplicity of symptoms and the variety of organs sometimes affected. 
 
 The general spinal treatment is given, relaxing muscles,.stimulaling the 
 splanchnics, etc. Particular attention must be given to lesions affecting 
 the kidneys, and to the thorough treatment of the innervation of them^ 
 throughout the course of the disease, for the purpose of avoiding the post- 
 scarlatinal nephritis, so common a complication. 
 
 For a like reason one must give especial attention to the treatment of 
 the throat to avoid diphtheria. 
 
 The cervical treatment must be carefully carried out. The marked en- 
 largement of the lymphatic glands that sometimes occurs ma)- be avoided 
 or controlled by the usual treatment. Relaxation of all the anterior and 
 posterior muscles and tissues, treatment along larynx and trachea, raising 
 the clavicles, etc., must be done. This treatment frees the l)mphatic and 
 blood-circulation through the neck, and keeps eye, ear, and throat in good 
 condition. 
 
 The heart must be kept well supported The fe\er is treated in the 
 usual way. When tiie patient's system is kept well supplied with moisture 
 by allowing him a plentiful suppl)' of cold water, daily treatment of the sub- 
 maxillar)' salivary glands will aid in keeping the mouth and lips moist. 
 
 The irritation of the skin may be relieved by the treatment indicated 
 for that purpose in measles. Daily tepid sponging and warm bathing, as 
 well as anointing of the skin with an animal fat or with cocoa butter, are 
 useful for this purpose. 
 
 The patient should be isolated, the scales shed in desquamation should 
 be carefully collected and burned, and the room should be disinfected after 
 convalescence. The diet should be light. Plenty of milk and alkaline 
 water may be used. 
 
 TUMORS. 
 
 Cases: (1) Ovarian tumor, upon which operation was advised, cured 
 by two months' treatment. 
 
 (2) Uterine fibroid tumor, the patient having for si.xteen jears suffer- 
 ed intensely at period. Surgeons were about to operate upon the case,
 
 PTIACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHY, 26$ 
 
 wTien it was decided to tr\' Osteopathy. After four treatments the period 
 "vas pissed without an)- discomfort. After three months' treatment the 
 tumor had disappeared. 
 
 (3) Intestinal fibroid tumor. There was a history of constipation, and 
 •colick)' pains for a number of weeks, constantly increasing in severit\' and 
 -and frequenc\\ and leading finallj' to spasms. 
 
 The abdomen was much distendad with fec€s and gas; the lOth. iith, 
 and I2th left ribs were displaced downward. The tumor could be deeply 
 palpated in the left side of the abdomen, at the level of the crest of the 
 i 1 i u m . 
 
 The colon was cleared with repeated enemas of water and oil. As the 
 tumor still remained an operation was decided upon. But, before the day 
 set, the tumor loosened under osteopathic treatment, and was passed from 
 the rectum. It was in size i% by i^{ inches. It was examined by leading 
 physicians who pronounced it fibroid tumor. 
 
 {4) A tumor upon the back of the neck, due to a much enlarged 
 sebaceous gland, had been growing for ten years. Treatment was directed 
 to softening the contents of the gland until able to pass through the duct, 
 the passage being facilitated by removal of the hair into the follicle of 
 which the gland emptied. Under the treatment the tumor had been much 
 reduced at the time of report. 
 
 (5^ A case in which an abdominal tumor in the region of the stomach, 
 and an epithelial cancer upon the nose were nearly removed by the treat- 
 ment. 
 
 (6) A tumor of the brain, so called, was a condition found to be due 
 to a displacement of the atlas and a great contraction of the cervical mus- 
 cles. The head was drawn backward, and giddiness, insomnia, and ocular 
 disturbance were present. The condition seemed likely to lead to insanit}', 
 and leading ph3'sicians diagnosed it as tumor upon the brain. Correction 
 of the lesions cured the case, and the diagnosis of cerebral tumor was 
 shown to be wrong. 
 
 (7) An abdominal tumor in a lady, the waist measuring 46'.; inches, 
 and increasing at the rate of i in. per week. Lesion was found at the 5th 
 dorsal, also at the nth, and the left ribs were luxated. The tumor appeared 
 to be as large as a cocoanut. At the end of one months' treatment the 
 growth had been stopped and the waist measurement was reduced i in.; at 
 the end of 2 months, 13^ in., and had reached nearly her normal size. The 
 treatment was continued for three months longer, and the case was dis- 
 charged cured. 
 
 (8) A tumor of the breast, about the size of a walnut, very hard and 
 involving the center and deep portion of the gland.. Sharp pains radiated 
 in all directions from the tumor, but mostly toward the axillaryregion. 
 
 The condition was found to be an engorgement due to obstructed 
 3)mph vessels, with which the gland is richly supplied. The lesion was a
 
 266 I'RACTICE AND APPLIED THERAPEUTICS OF OSTEOPATHr. 
 
 twiit of the clavicle, narrowing the space between the clavicle and first rib^ 
 and caused by using a crutch for a lame leg upan the same side as the lesion. 
 Thus was caused an obstruction to the lymphatic drainage of the breast^ 
 and the growth resulled. As a preliminary measure the limb was cured and 
 the use of the crutch was dispensed with. The cla\icle was righted and the 
 growth began to be absorbed. The case was cured in seven weeks. 
 
 (9) A case thought by the ph>sicians a cancerous nodolein the breast,. 
 and lor which operation was advised, was cured by the treatment. 
 
 (10) A tumor just external to the \aginal orifice, of four month's 
 standing. There was a fluid contained in fhe tumor, and it varied in size,, 
 becoming smaller after the patient had remained in a recumbent position 
 for a few days. There was prolapsus of the uterus and lesion among the 
 lumbar vertebrae. The case was cured in two mouths. 
 
 (11) An ovarian tumor in a patient, from whom, two years previousl), 
 the left ovary and a tumor weighing twenty-five pounds had been removed. 
 A few months later a tumor appeared upon the right oxary, and operation 
 was advised. After a month and a half of treatment the tun)or had disap- 
 peared. 
 
 (12) P'ibroid tumors of the uterus in a patient who had, four years 
 previousl}', been injured in the left side by a viscious cow. The patient was 
 suffering from heart and bowel troubles, and female diseases. Various 
 spinal lesions were found. By four treatments the tumors were loosened 
 and passed, there being several of them, varying in size from that of a hen's- 
 egg to that of a walnut, 
 
 The Trognosis, generally speaking, to benefit or cure various tumors 
 by osteopathic treatment is good. Numerous cases ha\e been saved b\' this 
 means from the surgeon's knife. While man)- tumors cannot be cured, the 
 treatment merits a trial in every case before operation be submitted to. 
 
 The Lesions are various bony, muscular, and other obstructions to 
 blood and hmph flow, or to nerve-supply. Some lesions cause tumorous 
 growths by direet irritation of the tissues. A frequent cause of ti m jrs is 
 found in lesion to the lymphatic drainage of a part, through direct pressure 
 upon its l\mphatic vessels or b\' constrictor effect upon them by lesion to 
 the vaso-motor and sympathetic ner\e supph'. Tumors of the breast are 
 very often due tu such a cause, (cases 8 and 9). 
 
 The common lesions in tumor of the breast are found at the clavicle, 
 first rib, among the upper five or si.x ribs, or among the corresponding ver- 
 tebrae. Abdominal tumors are commonly caused by lower rib and 
 lower vertebral lesions, uterine tumors by sacral or lumbar lesions, etc. 
 
 The simple Treatment is to remove lesion, correct l)mphatic and 
 blood drainage, or remove any source of direct irritation upon the tissues. 
 Correcting anatomical relations is the main point, and commonly no man- 
 ipulation directly upon the tumor is required, yet such a measure is some- 
 times employed to soften a fatty tumor and aid in its absorption, or to 
 loosen a fibroid growth, several such having thus been loosened and dis- 
 charged /)<?r rrr//^;;/ ox per vaginat:t. One instance is recorded in which ex- 
 ternal treatment upon the nose loosened and caused the discharge of a 
 cancer in the upper nasal passage. 
 
 It is a point worthy of note that in many instances fibroids, according to 
 all evidences, have been absorbed by the renewed blood currents. It indi- 
 cates that new fibrous tissues, once formed, ma}- be absorbed under the 
 treatment.
 
 1XU>KX. 
 
 Abdomen, examination 
 
 treatment 
 
 Angina Pectoris 
 
 definitions 
 
 Lesions 
 
 prognosis 
 
 treatment 
 
 Ankle, dislocation 
 
 Appendicitis. 
 
 recurring 
 
 treatment 
 
 Ascites 
 
 prognosis 
 
 treatment 
 
 Asthma 
 
 Atlas 1 
 
 B 
 
 Brachial Plexus 
 
 Bright's Disease, see Nephritis 
 
 Bronchitis 
 
 C 
 
 Carpal Dislocations 
 
 Cataract, treatment 
 
 Cholera Morbus 
 
 Chorea 
 
 Clavicle, displacements 
 
 treatment 
 
 Cirrhosis of the Liver 
 
 Coccyx, treatment 
 
 Colds, see Cory za 
 
 Colic 
 
 Congestion of the Lungs 
 
 Constipation 
 
 Coryza 
 
 Croup 
 
 Cystitis 
 
 D 
 Diabetes Insipidus 
 
 " Mellitus 
 
 Diaphragm 
 
 Diarrhoea, nervous 
 
 Dilatation of the Heart » 
 
 Diphtheria 
 
 Diseases of the Ear 
 
 " Eye 
 
 " " Heart and Circulation. 
 
 •' *' Intestine 
 
 Diseases of the Liver. . . 
 
 " " Nervous System 
 
 " " Urinary System 
 
 Dislocations of 
 
 Ankle 
 
 Carpus 
 
 35 
 
 35 
 170 
 170 
 170 
 171 
 175 
 
 50 
 105 
 105 
 106 
 131 
 132 
 132 
 
 55 
 :,20 
 
 16 
 
 59 
 
 47 
 
 229 
 
 115 
 
 179 
 
 26 
 
 34 
 
 126 
 
 12 
 
 114 
 
 67 
 249 
 149 
 
 245 
 245 
 96 
 114 
 175 
 248 
 230 
 221 
 152 
 105 
 133 
 179 
 137 
 
 50 
 47 
 
 elbow 48 
 
 hip 50 
 
 knee 50 
 
 metacarpo phalangeal 47 
 
 radio ulnar 47 
 
 shoulder 48 
 
 E 
 
 Endocarditis 171 
 
 Enteralgia 114 
 
 Enteritis, catarrhal ifS 
 
 Enteropasm* 115 
 
 Enteroptosis 110 
 
 Enuresis 150 
 
 Epilepsy 181 
 
 Epistaxis 69 
 
 Erysipelas 260 
 
 Eye, conjunctiva 22 
 
 diseases of 221 
 
 granulations 22 
 
 pterygia , 22 
 
 strabismus 23 
 
 tapping 23 
 
 F 
 
 Fecal Impaction 107 
 
 Fifth nerve, branches 23 
 
 Fifth Lumbar Displacement 11 
 
 G 
 
 Gallstones 128 
 
 Gastralgia 85 
 
 Gastritis, acute and chronic 82 
 
 Glossopharyngeal nerve 20 
 
 Goitre , , 235 
 
 H 
 
 Hay Fever 61 
 
 Head, examination and treatment.... 22 
 
 Heart and Circulatory Diseases... . 152 
 
 Hemorrhoids 116 
 
 Hepatic abscess 133 
 
 Hip, dislocations 50 
 
 Hyoid Bone and Muscles 15, 19 
 
 Hypertrophy of the Heart 174 
 
 Liver 133 
 
 Hypogastric Plexus 44 
 
 Hysteria 197 
 
 I 
 
 Influenza. .... 252 
 
 Ilio Caecal Impaction 108 
 
 Innominate Lesions 41 , 42, 43 
 
 Insanity 216 
 
 Insomnia 198 
 
 Intussusception 108 
 
 Intestinal Neuralgia 114 
 
 Intestinal Obstruction 107 
 
 Intestinal Tumors 119
 
 IXJ3KX. 
 
 Jaundice 124 
 
 K 
 
 Keratitis, treatment. 
 Kidney congestion. . . 
 
 movable 
 
 Knee Dislocations . . 
 
 La Grippe, see Influenza 
 
 Laryngitis 
 
 Limbs, examination and treatment. 
 
 Liver, congestion 
 
 T^ocoraotor Ataxia 
 
 r^umbago 
 
 M 
 
 Malaria 
 
 Measles 
 
 Membranous Enteritis 
 
 Metacarpal Dislocations 
 
 Middle Cervical Ganglion 
 
 Migraine 
 
 Mucus Colitis 
 
 Mumps, see Parotitis 
 
 Myelitis 
 
 Myocarditis 
 
 N 
 Neck, examination 
 
 lesions 
 
 treatment 
 
 Nephritis, acute 
 
 Neuralgia 
 
 Neurasthenia 
 
 Neurosis of the Intestine 
 
 diminished sensibility 
 
 Motor , 
 
 secretory 
 
 sensorv 
 
 O 
 Occupation neurosis 
 
 P 
 
 I "aralysis 
 
 Paralysis Agitans 
 
 Palpitation 
 
 I'arotitis 
 
 Pelvis, examination and treatment... 
 
 Pelvic Plexus 
 
 Pericarditis 
 
 Peritonitis 
 
 Pertussis, see Whooping Cough 
 
 l^hrenic nerve J 6, 20 
 
 Piles, see Hemorrhoids 
 
 Pleurisy 
 
 229 
 
 144 
 
 148 
 
 50 
 
 79 
 
 47 
 
 126 
 
 189 
 
 240 
 
 255 
 262 
 113 
 47 
 18 
 184 
 113 
 
 214 
 171 
 
 15 
 16 
 19 
 142 
 236 
 195 
 113 
 114 
 114 
 113 
 114 
 
 192 
 
 205 
 
 191 
 
 166 
 
 82 
 
 38 
 
 44 
 
 164 
 
 121 
 
 70 
 
 Pneumogastric nerve 16, 20 
 
 Pneumonia 64 
 
 Pterygium, treatment 229 
 
 Pulmonary consumption 75 
 
 Pyelitis 148 
 
 R 
 
 Radio Ulnar Dislocation 47 
 
 Rectal treatment 13,44 
 
 Renal Calculi 147 
 
 Rheumatism 2.39 
 
 Rib Luxations 26 
 
 Rib treatments . 31 
 
 Rubella 263 
 
 S 
 
 Sacrum displacements 12 
 
 Scarlet Fever 263 
 
 Sjiatica 255 
 
 Shoulder dislocation ... 47 
 
 Spastic Paraplegia 189 
 
 Spinal Accessory Nerve 20 
 
 Spinal Meningitis 214 
 
 Spine examination 5 
 
 lesion * 6 
 
 treatment 8 
 
 Spleen 131 
 
 Splenic Hyperaemia 1.35 
 
 Splenitis 134 
 
 Sternum di placements 26 
 
 Stomach diseases 85 
 
 Superior Cervical Ganglion. . . 18 
 
 T 
 Thorax, examination and treatment.. 26 
 
 Tonsillitis 80 
 
 Tonsil 15 
 
 Tuberculosis, see P. Consumption 
 
 Tumors 264 
 
 Typhoid Fever 257 
 
 U. 
 
 Ulceration of the Stomach 85 
 
 Urinary System Diseases 137 
 
 V 
 
 Vagina, examination and treatment ...115 
 
 Valvular Diseases 173 
 
 Varicella 263 
 
 Volvulus 107 
 
 Whooping Cough ... 251
 
 ' ' iiuJ.*^ W-t7fe c^^^XCc^ c^^,zt^:iM^-^ 
 
 
 
 
 ^ tl^->^ t-C^-^M^^^ 
 
 wOc^I 'fi^Tu-t.^A-L^ i^-Cti-tJi^r-e.^ A-«-e.*-v-v*'i-15~~^5^ i^
 
 
 
 '^i 
 
 /7 ^ ^••//^>._. ^^V./_ 
 
 ,25r^'. 
 
 
 >v 
 
 r^
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 PRINTED IN U.S.A. CAT NO 24 161 ^ 
 
 
 UC SOUTHERN REGIONAL LIBRARY FACILITY 
 
 D 000 224 676 7 
 
 WB9U0 
 
 Hli31p 
 
 1900 
 Hazzard, Charles 
 
 Practice and applied therapeutics c 
 osteoj athy 
 
 MEDICAL SCIENCES LIBRARY 
 
 UNIVERSITY OF CALIFORNIA, IRVINE 
 
 IRVINE, CALIFORNIA 92664