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Full text of "Practice and applied therapeutics of osteopathy"

Presented in honor of 

lliam R. Laughlin, D. 0. 

by 
'lliamR. Laughlin 




COLLEGE OF OSTEOPATHIC PHYSICIANS 
AND SURGEONS LOS ANGELES, CALIFORNIA 



WILLIAM ROSS LAUGHLIN 

M.S. - D.O. 
Los ANGELES. CALIFORNIA 



The ^Praftice and Applied 
Therapeutics of 

OSTEOPATHY 



By 
HAZ 



CHARLES HAZZARD, Ph. B., D. O. 

Author of "Principles of Osteopathy," Former Profes- 
sor of the Principles of Osteopathy and of the 
Practice of^Osteopathy, Superintendent of 
Clinics, American School of Oste- 
opathy, Kirksville, Missouri. 



(Third Revised Edition.) 



KIRKSVILLE 

JOURNAL PRINTING CO. 
1905. 






\A>JJ 7V V 



Copyright 

by 

CHARLES HAZZARD 
1905. 



PRACTICE OF OSTEOPATHY. 



Preface to the Third Edition. 



Since the publication of the second edition of this work, the 
growth and progress of Osteopathy have been marked, and it 
has been the aim of the author to have these pages reflect those 
virile characteristics of the Science. He has made an earnest 
endeavor to add to his previous work as much as possible that 
would be of value to the profession. The work has been rewritten 
in many parts, and much new matter has been added throughout, 
considerably enlarging the volume. 

The same considerations that before led to the omission from 
these pages of the facts of pathology, symptomatology, etc., 
which the student finds useful in his studies, but which are so 
available from other sources, were still deemed sufficient. But 
the continued demand for a compact work upon this subject, of 
moderate price, and devoted exclusively to osteopathic considera- 
tions seems to warrant the bringing out of this further edition. 

CHARLES HAZZARD, 

New York City, Nov 18, 1905 

"Go little book, 

"Bearing an honored name, 
" 'Till everywhere that you have went, 

"They're glad that you have came." 

(BILL NYE OR SHAKESPEARE.) 



PRACTICE OF OSTEOPATHY. 



Preface to the Second Edition. 



In preparing the second edition for press, much care has 
been taken to make the work a complete text-book upon the 
subject of Practice of Osteopathy, and to make it thoroughly 
osteopathic throughout. 

It is obviously unnecessary to include- in such a work ma- 
terial so easily available in the many standard texts of medical 
practice. It is better that the student should, so far as neces- 
sary, refer to them for the symptomatology, pathology, etc., of 
the diseases he studies, rather than to fill these pages with a repeti- 
tion of what has been so well written elsewhere. Thus the author 
is left free to devote these pages exclusively to the osteopathic 
aspects of disease. Collaterally with this work one may use any 
standard medical practice, as was done in the American School 
in the course in which the matter presented in this volume was 
delivered as a course of lectures. 

The second edition is thoroughly revised and much en- 
larged. To Part I have been added various points of use in 
examination and diagnosis from an osteopathic point of view. 
To Part II have been added several hundred new case reports. 
These reports have been added to the subjects which were con- 
sidered in the first edition, and have likewise been added to the 
work in the consideration of the many diseases not discussed in 
the first edition. 

By the use of these many CASE REPORTS there is established 
a foundation of actual fact and experience for this work. Theory 
is of value, and is assigned its proper place here, but the facts 
shown in the case-reports have been demonstrated by the actual 
work of Osteopaths in all parts of the field, whence these reports 
are drawn. They give to the practitioner the value of others' 
experience. Much care has been given to the analysis of LESIONS 
presented by reports, and to the pointing out of the lesions which 
may be expected as the CAUSES of disease. 



6 PRACTICE OF OSTEOPATHY. 

Under the head of ANATOMICAL RELATIONS are considered 
the anatomical and physiological reasons why various given 
lesions may derange function and cause disease. These points 
have involved much careful research, and the author feels that 
they will be found of value to student and practitioner alike. 

The TREATMENT of each disease is discussed at some length. 
Much thought must be devoted by the successful practitioner 
to his method of handling his case. In each case the various 
points of treatment applicable are pointed out. Part I is re- 
ferred to in these sections as a key to Part II. In this way specific 
treatments are indicated. 

CHARLES HAZZARD. 

Kirksville, Mo., June 1, 1901. 



PRACTICE OF OSTEOPATHY. 



PART I GENERAL METHODS. 

CHAPTER I. 

EXAMINATION OF THE SPINE. 

Inspection, percussion and palpation are the physical meth- 
ods employed by the examiner. Of these the latter is most 
important. Attention must be given to the position of the pa- 
tient, 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 cur- 
vature of the spine are best detected while the patient is sitting. 
Points of separation between spinous processes, thickening of 
posterior spinal ligaments, 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 gown buttoned down the front and back may be convenient- 
ly used. 

By the methods mentioned above the examiner searches 
for certain definite legions, as follows: 

INSPECTION reveals the color of the skin; rashes, which may 
indicate disease; the presence of curvature or other deformity; 
unequal muscular development, or change of contour from what- 
ever cause; scars, wounds, stains, and excoriations, leading to 
inquiry regarding accident, injury, operation, or the use of poul- 
tice; injected blood-vessels; tumors, enlargement of parts, etc. 

Inspection may be made with the patient sitting. 

In any examination, care must be taken not to so place the 
patient as to cause his position to mask the lesion. An un- 
natural posture may be to him natural by reason of his condit- 
ion. If now an attempt be made to cause him to assume the 
usually natural position, the result may be to obscure that which 
would be a clew to his disability. 

Close inspection should be made of a patient's habitual 
posture, gait, etc., as a preliminary step. One often gains thus 
valuable clews to his condition. 



8 PRACTICE OF OSTEOPATHY. 

Inspection often reveals inequalities of waist-lines and hips. 
A waist-line deeper cut on one side, usually accompanied by a 
higher or larger contour of the corresponding hip, is a frequent 
indication of a swerved spine. 

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 slightly bent forward, the arms 
folded loosely or the hands resting lightly on the knees, the ex- 
aminer stands behind the patient and passes his two index fingers, 
or the index and second fingers of the examining hand, care- 
fully down the opposite sides of the vertebral spines. He notes: 

I. Single vertebra or groups of vertebrae which may be 
deviated laterally from normal position. In such case there is 
usually, though not always, tenderness in the tissues upon the 
side of deviation, owing to the irritation by the process. 

In order not to mistake a bent spinous process for a lateral 
lesion of the vertebra, all such apparent lesions should be further 
tested by feeling out the transverse processes of the vertebra in 
question. Dr. Still uses these more than the spinous processes 
in identifying lateral lesions. If the spinous process is merely 
bent the transverse processes have not changed their relations 
to the surrounding tissues. 

Lateral deviation of one or more vertebrae causes the trans- 
verse processes to rotate slightly backward on one side and for- 
ward on the other. This alters the depth of the furrow running 
along the spine on either side of the spinous processes. Pressure 
of the examining finger carefully into those furrows at the point 
of lesion will show that the furrow on one side is deeper, and on 
the other side shallower, than normal. 

Such observation of transverse processes and furrows will 
obviate error over bent spinous processes. 

II. Lateral swerving or sagging of any 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 anteriorly at the dorsal curve between 
the shoulders, and a flattening of the spine posteriorly at the 



PRACTICE OF OSTEOPATHY. 9 

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. 

V. 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 deeply 
into the sacro-iliac spaces to detect any abnormal tension or 
tenderness in the superficial or deep tissues. 

VII. The index finger follows the course of the coccyx to 
its tip, noting any lateral, anterior, or posterior deviation. 

VIII. The index finger is carefully passed down the spine 
upon the spinous processes, pressure being made firmly upon each, 
to detect either anterior or posterior projection of vertebrae. 

IX. The temperature of the back is found by passing the 
palm of the hand evenly over it. Vaso-motor disturbances, 
resulting in lowered or increased temperature 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 lesion. 

The patient is now placed upon his side in an easy posit- 
ion. The examiner stands at the front of the patient and con- 
tinues the examination. 

X. The cushion of the examining finger, which is held at 
right angles to the spinal column, is carefully pressed deeply 
into the space between each successive pair of spinous processes. 
It discovers any separation or approximation of processes, thus 
of vertebrae. 

Students often have difficulty in distinguishing a separa- 
tion of processes from an anterior displacement, the former be- 
ing often diagnosed as the latter condition. One may avoid 
such errors by remembering that the separation is rarely so great 
as the space left by a marked anterior displacement of a ver- 
tebrae. The latter condition is rare. In case of doubt count 



10 PRACTICE OF OSTEOPATHY. 

the next two spinous processes above or below the point in quest- 
ion, and compare the space they occupy with the space occupied 
by the lesion and the spinous process next above or below it. 
The comparison will at once aid in determining the point. 

Points of anatomical weakness are frequently found at 
the junction of the twelfth dorsal with the first lumbar verte- 
bra, also at the junction of the fifth lumbar with the sacrum. 

The fifth lumbar is often prominent posteriorly, but is also- 
very apt to be luxated anteriorly or laterally. 

Separations occurring between the fifth and the sacrum 
are often mistakenly treated as anterior displacements of the 
fifth. Separations at this point are common. Marked tender- 
ness is usually present. 

XI. The examining hand is passed slowly along the spinaL 
column to note any general or local thickening and increased 
tension in the posterior spinal ligaments which results in par- 
tially obliterating the spaces between the spinous processes, 
and in producing the so-called "smooth spinal column." 

XII. The examining fingers are pressed firmly into the 
spinal muscles and moved transversely to the course of their 
fibres for the purpose of detecting any abnormal hardening or 
contracturlng of them. Contractures generally affect certain 
sets of fibres rather than the muscle as a whole. They may 
be situated in the superficial or in the deep muscles, and may 
be primary or secondary according as they are produced by di- 
rect or indirect lesion of the fibres. 

XIII. 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 forcibly toward him, noticing whether 
the spine be rigid, or too greatly relaxed. 

It must be borne in mind that bony lesions are not alone 
important. Ligamentous lesions are quite as much so, and 
though they are not so generally discernible as are the former, 
the student must not forget that following upon and conse- 
quent 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. 



PRACTICE OF OSTEOPATHY. 11. 

PERCUSSION, PRESSURE AND MOTION may be employed in 
the examination 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 frequently in the neck, between 
the articular processes, and in the lumbar region, between the 
bodies of the vertebrae, and between the articular processes. 
Motion between the heads of the ribs and the bodies of the ver- 
tebra? , and between the tubercles of the ribs and the transverse 
processes is frequent. 

They may occur anywhere along the spine and are of diag- 
nostic value in indicating relaxation of ligaments, interference 
with blood-supply, resulting in insufficient secretion of synovial 
fluid, or malposition of bony parts. 

A motion which tends to separate the members of a joint 
may produce a suction sound therein. A sharp, cracking or 
snapping sound may accompany the normal play of tendons. 

The "examiner should not overlook the results of lesions 
which in any way alter the equilibrium of the spinal column. 
When this occurs, the weight of the trunk no longer rests squarely 
upon the pelvis, but drives upon it at an angle, unequally con- 
tracting lumbar muscles and ligaments, tilting the pelvis, shorten- 
ing a limb, etc. Lumbago and sciatica often result from such 
conditions, as do, likewise, various neck lesions, and even spinal 
curvatures. 

CHAPTER II. 
TREATMENT OF THE SPINE. 

In this chapter it is proposed to outline the general method 
of procedure in spinal treatment. As no specific case or dis- 
ease is now under consideration, the student must bear in mind 
that the treatments described are general methods 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 
individuallv to reach the case. 



12 PRACTICE OF OSTEOPATHY. 

As far as practicable the specific lesions mentioned in Chapter 
I will be considered, and treatments appropriate to their re- 
duction 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 of the body in 
as comfortable 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 thorqughly 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 way all contractures of the muscles are released, 
flabby muscles are toned, blood and nerve mechanisms are freed 
and upbuilt. This removing ' of contractures is sometimes a 
necessary preliminary step to the diagnosis of deeper lesions 
which may have been masked by them. 

II. The patient lies upon his side, the practitioner stands 
at the side of the table, in front of the patient; with one hand 
he grasps the uppermost 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 
a lever, he pushes it downward and forward, at the same time 
springing the spine toward him. 

This treatment releases tension in all deep structures, re- 
stores free-play between bony parts, and removes pressure from 



PRACTICE OF OSTEOPATHY. 13 

blood-vessels and nerves. It may be applied in all cases of 
curvature, sagging or swerving of a portion of the spine, lateral 
deviations of vertebra?, in separating or approximating verte- 
brae, etc. 

III. Practically the same effect may be obtained upon the 
lower portion 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 upward toward him, or 
to manipulate the muscles; or, 

IV. With the patient still lying upon his side, the practi- 
tioner 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 treatment 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 structures may be accomplished 
within the limits of safety than by stretching the spine as a whole 
by longitudinal traction. 

V. The latter is applied with the patient lying upon his 
back; 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 afforded 
by the weight of the patient or by an assistant holding the ankles. 

The neck must not be rotated during this forcible tension, 
and jerking must be avoided. 

VI. The principle of exaggeration of the lesion is one that 
may be applied to the treatment of many bony luxations. It 
consists in so manipulating the parts as to tend to further in- 
crease 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 con- 
dition of exaggeration. 

This motion releases tension, loosens adhesions, and gains 



14 PRACTICE OF OSTEOPATHY. 

the benefit of the natural recoil of the structures from their ex- 
aggerated position. 

VII. With the patient prone and the practitioner kneeling 
upon the table at one side of the patient, or with a knee upon 
either side, direct pressure may be applied, from above down- 
ward, to all spinal parts. This position of relaxtion is favor- 
able for forcing vertebrae or the heads of ribs into 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 may be manipulated at will in the 
course of the treatment. 

IX. The patient sits, the practitioner stands in front, slightly 
to one side facing backward from the patient. He passes the 
arm nearest the patient back of the neck, and slips his hand 
under the opposite axilla from in front. This bends the neck 
and upper spine forward 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 suc- 
cessive portions may be thoroughly rotated and all of its struc- 
tures loosened. 

X. The patient sits; the practitioner stands behind, push- 
ing 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 use of the neck as a lever of the first 
class, the fulcrum being formed by 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 of the lesion," 
and is especially useful for the reduction of lateral luxations in 
the upper part of the spine. 

X. (a) A variation from the above applies the same prin- 
ciples to lesions lower down in the spine. The patient sits; the 



PRACTICE OF OSTEOPATHY. 15 

practitioner stands at one side and passes one arm in front of 
him, grasping his body securely, and rotating his trunk about 
fixed points made at any desired place along the spine by the 
application of the free hand to it. The cushion of the thumb 
of this hand is pressed firmly against one side of the spines of the 
vertebrae suffering from lesion, while the bent index finger is 
pressed against the other. 

XI. The patient sits and clasps his hands behind his neck; 
the practitioner stands close behind, passes his arms beneath the 
axillae and his palms behind the patient's wrists, which he' grasps 
in his hands. As the practitioner straightens his body and 
draws the patient back against his abdomen the neck and upper 
dorsal spine are bent forward, the scapulae 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, scapula?, and of the spine. It also brings tension upon 
most of the intervertebral, the costo-vertebral, the costo-sternal, 
acromio-clavicular and claviculo-sternal articulations. 

XII. With the patient sitting, the practitioner, standing 
behind, may place one knee 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 struc- 
tures and affords the practitioner two free hands with which 
he may 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-illac regions may be thoroughly relaxed by bending the 
body of the patient, who is sitting, far forward between his well- 
separated knees. 

XIV. The same object is accomplished with the patient 
supine, while the legs and thighs are both forcibly flexed to their 
limit. 

XV. To stretch the posterior scapular, rhomboid, and levator 
anguli scapulae muscles, the patient lies upon his back while 
the practitioner slips one hand beneath the shoulder and grasps 



16 PRACTICE OF OSTEOPATHY. 

% 

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 pushed across the chest, the patient's hand being 
in this way forced across well into the opposite axilla. 

XVI. With the same position of the patient, the anterior 
scapular muscles 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. 

XVII. 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 contrary direction to, the movement of the limbs. 

This treatment loosens and separates the vertebrae, releases 
tension of muscles and ligaments, and upbuilds nerve and blood- 
action. 

XVIII. Dr. Still, in case of lateral spinal lesion, stands 
in front of the patient, who is sitting. He passes both arms 
around the body and clasps his hands over the point of lesion; 
"sinks" the spine down upon this point, bends the patient to- 
ward the side of deviation of the vertebra, then with the hand 
makes pressure upon the vertebra to force it back to place while 
he rotates the body toward the opposite side. 

Very many more treatments might be described, but enough 
general treatments have been given to reach all parts of the 
spine and to correct the lesions that are likely to be met with 
in practice. These treatments may be combined or may be 
taken as the basis of new ones which the practitioner may often 
find necessary to work out in order to reach some special lesion 
or to treat some special case. 



PRACTICE OF OSTEOPATHY. 17 

In this portion of the text, the treatments can of necessity 
be described, and their application be given, only in a general 
way. They are outlines of methods of procedure, and the ap- 
plication 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 vertebra or lateral swerving of a portion of the column; 
vertebrae separated or approximated; anterior or posterior lux- 
ations of vertebrae; the "smooth spine"; the loss of normal curva- 
ture; the rigid or relaxed spine, etc., may all be reduced by vari- 
ous applications of these treatments. 

Generally speaking, the results attained by the use of these 
treatments are, the relaxation of contractured muscles; the re- 
lease of tension in nerve, muscle, ligament or other fibrous struc- 
ture; the reduction of bony lesion; the removal of obstruction 
from, and the renewal of, blood and nerve-currents. 

XIX. The fifth lumbar vertebra, after luxation, may be 
restored in various ways. The posterior- displacement is the most 
frequent. In this case one may place the patient upon his 
side, flex the knees against one's abdomen, fix the fifth lumbar 
by holding beneath it with one hand, while the other, slipped 
beneath the thighs, rotates the weight of the lower part of the 
body about the fixed point. Recent dislocations may be ad- 
justed in this way without difficulty. In long standing cases, 
continued treatment is necessary, 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 practit- 
ioner, standing between the limbs and holding one under each 
arm, places both hands beneath the pelvis, makes a fixed point 
at the fifth lumbar, and by th* 1 movement of his own body ro- 
tates the lower half 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 beneath the body at 
one side of the fifth lumbar spine. The leg and thigh are now 
strongly flexed by the free hand, external circumduction of the 
thigh is made, and the weight of the body is thrown onto the 



18 PRACTICE OF OSTEOPATHY. 

fixed point. In some cases this treatment is sufficient for re- 
placing the bone. 

In case the vertebra be anterior the above treatments may 
be applied for the purpose of loosening all the ligaments. 

Also the principle of exaggerating the lesion may be ap- 
plied by making a fixed point of the practitioner's knee at the 
fifth lumbar, the patient sitting. The patient's body is bent 
backward against the fixed point 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 vertebrae may 
be thus warped or slightly moved upon each other, drawing the 
bone back to place. 

In many long-standing cases of bony lesion, the strength- 
ening 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 treatment, brought back toward 
its normal position. 

XX. In case the. sacrum be found to be anterior or posterior 
from its normal position, this is a matter partly relative to the 
position of the innominate bones, luxations of which will be 
discussed later. 

In cases of posterior protrusion, after relaxation of the sacro- 
iliac ligaments, pressure may be made with the knee directly 
upon the sacrum from behind, with the patient either sitting or 
lying upon his side. At the same time the pelvis and the upper 
parts of the body are drawn strongly backward. 

XXI. In restoring the coccyx to normal position both ex- 
ternal and rectal treatment may be necessary. In some cases 
external treatment alone will be sufficient. The sacro-coccy- 
geal articulation is generally quite pliable. In external treatment, 
attention must be first given to the relaxation of the mucles 
and fibrous tissues concerned. The bone may then be grasped 
and moved or sprung from either side toward the median line, 
may be forced anteriorly, or the finger may be gently inserted 
beneath its tip and may draw it back toward its natural posi- 
tion. 

Rectal treatment should not be given oftener than once a 



PRACTICE OF OSTEOPATHY. 19 

week or ten days. The patient lies upon his side or bends, face 
downward, over a table. The index finger, anointed with vase- 
line or 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 restoration to a normal position is only gradually 
accomplished. 



CHAPTER III. 
EXAMINATION OF THE NECK. 

INSPECTION and PALPATION are the two physical methods 
used in examination of the neck. 

INSPECTION reveals scars due to wounds, and suggests a 
history of accident or operation. The general conformation of 
the neck should be noted. 

Upon the anterior aspect may be 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 the posterior aspect may be found enlargement of the 
muscles or thickening of the tissues. Frequently an inequal- 
ity of the tissues in and below the sub-occipital fossae, due to 
thickening or to bony lesion, occurs. 

This inequality often indicates the existence of a typical 
cervical condition of much importance to the Osteopath. So 
frequently does one meet this sort of a neck in practice, and of 
such importance are the various lesions present, that its ready 
recognition becomes necessary. Upon inspection, inequality 
is seen in the postero-lateral aspects of the neck. One side will 
be somewhat hollowed, and the other side full. In general ex- 
amination of the spine one takes such condition as an indication 
of slight curvature. Further examination show such to be the 
case in the neck. The tissues are usually found, upon palpation, 
to be tense and contract ured upon the full side. They are as a 



20 PRACTICE OF OSTEOPATHY. 

rule tender. The tissues upon the hollow side may be in a sim- 
ilar condition, not usually so marked. Palpation further shows 
a swerving of the cervical vertebrae, convexity to the full side. 
All or several of the vertebrae are involved, thus causing an ex- 
tensive cervical lesion, capable of producing the various ills due 
to bony lesion of this region. 

This cervical condition is often found associated -with, and 
may sometimes be due to. a swerve in the spine below or an in- 
nominate lesion, changing the equilibrium of the spine and giving 
a one-sided tendency. 

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 upon his back, relaxing the 
neck as much as 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 
manipulates the muscjes of the neck. 

A. ANTERIOR STRUCTURES. 

I. The tonsil is located by pressure of the fingers just below 
the angle of the inferior maxillary bone. Any enlargement or 
tenderness of the organ is to be noted. This examination should 
be supplemented by inspection of the throat internally. 

In palpation of the tonsil externally one often feels an en- 
larged lymphatic gland below the angle of the jaw, accompanying 
the enlargement of the tonsil, for which it should not be mistaken. 

II. Tender points, . frequent in catarrhal conditions, are 
found by deep pressure behind the angles of the inferior max- 
illary bones. 

III. The hyoid bone is located by pressing all the soft tis- 
sues 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 to- 
ward the first side, thus making prominent the greater cornu of 



PRACTICE OF OSTEOPATHY. 21 

that side. With the index finger and thumb upon the cornua, 
the bone may be moved about and a diagnosis of its position be 
made. Contracted tissues may draw the bone upward, down- 
ward, or to^one side. 

IV. The hyoid musdes, superior and inferior, are now 
carefully palpated to discover contracture, hypertrophy, con- 
gestion 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 condi- 
tion be normal, arid is extended along the throat structures to 
the root of the neck. In this examination the parts are grasped 
between the thumb and fingers of the examining hand and are 
moved from side to side. At the same time, deep but gentle 
pressure is made at either side of the larynx and trachea in order 
to note any undue tenderness in the laryngeal nerves, as gener- 
ally revealed Jby an impulse upon the part of the patient to cough 
or swallow. Immobility or harshness of sound upon motion of 
these parts as above indicates abnormal tension in the related 
muscles and other tissues. 

VI. Enlargement or wasting of the thyroid gland or enlarge- 
ment of the cervical lymphatic glands must be noted. 

VII. The stern o-mastoid muscle is made prominent by 
causing the patient to turn his head to the opposite side. Pres- 
sure deep behind the anterior border of this muscle impinges 
upon the pneumogastric nerve. Tenderness in it upon pressure 
may accompany liver or stomach disease. 

Its superior laryngeal branch is located by pressure behind 
the greater cornu of the hyoid bone. Note whether the hyoid 
muscles are contractured in such a way as to draw this bone 
back upon the nerve. 

Its recurrent laryngeal branch may be impinged by pres- 
sure near the anterior border of the sterno-mastoid muscle at 
the level of the cricoid cartilage. This pressure irritates the 
larynx and causes the patient to cough when the nerve is ten- 
der, as in various throat affections. Note the condition of irrita- 
bility of the nerve. 



22 PRACTICE OF OSTEOPATHY. 

VIII. The phrenic nerve 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 muscle with the upper 
margin of the clavicle. This pressure must be directed from 
above diagonally downward and forward toward the sternum. 

IX. Pressure of the head directly downward upon the spinal 
column with rotation, will sometimes discover deep pain at 
points of lesion. 

X. With the patient lying on his back, turn h'.s head well to 
one side and to the other, noting any inequality in the degree to 
which it readily turns. Contracted muscles, luxated vertebrae, 
etc., often prevent its turning so far to one side as to the other. 

Occasionally motion is so restricted (e. g., in chronic mus- 
cular or articular rheumatism) that the head can be turned 
scarcely a fraction of an inch. 

XI. The posterior structures of the neck may be tested 
for abnormal tension by flexing the head upon the thorax, the 
patient upon his back. 

The examining finger should follow the ligamentum nuchse 
carefully up to its insertion at the skull, where deep soreness 
and contracture are sometimes found associated with headaches. 

XII. The palms of the hands may be passed evenly over 
the surface of the neck to examine for variations of tempera- 
ture. Hot or cold areas may be found. It is common to find 
an area of increased temperature at the base of the skull behind- 

XIII. The state of the blood-vessels should be noted. A 
strongly pulsating carotid artery is seen in aortic regurgitation 
and in some nervous diseases. A venous pulse in the jugular 
veins may accompany marked tricuspid regurgitation. Con- 
gested veins of neck, chest, and face, especially if unilateral, 
may indicate pressure of a thoracic aneurysm or tumor. Often 
one sees one external jugular vein much fuller than its fellow, 
due to narrowing of the space between clavicle and first rib. 
Hard, incompressible, or rigid, carotid arteries indicate arterio- 
sclerosis. They are commonly accompanied by rigidity and 



PRACTICE OF OSTEOPATHY. 23 

tortuosity of the temporal arteries, and by cardiac hypertrophy 
and valvular lesion. 

B. POSTERIOR AND LATERAL STRUCTURES. 

I. With the patient sitting, the practitioner passes the ex- 
amining hand down along the back of the neck. Just below 
the occiput is a depression in which he may feel the upper end 
of the ligamentum nuchse and the inner borders of the trape- 
zius muscles. With the head bent slightly forward and the ex- 
amining fingers pressed deeply into this space abnormal tension 
of these structures may be noted. 

II. The second cervical spine is the first bony prominence 
felt below the occiput. The spines of the third, fourth and fifth 
are made out with difficulty, as they recede from the surface 
anteriorly. The next palpable 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 distin- 
guished. 

There are two ways to distinguish between them. The 
sixth cervical spine is first located. While not at all promi- 
nent it may easily be felt as a small point snugly resting upon 
the upper surface of the seventh. Commonly a careful exam- 
ination locates the sixth without difficulty, thus the seventh is 
known to be the next below, and is distinguished from the first 
dorsal. 

Anterior, posterior, or lateral deviations of the cervical verte- 
brae may be diagnosed by this examination of the spinous pro- 
cesses. 

III. Anterior dislocations of the upper three cervical ver- 
tebrae may be sometimes noted by examining for the. promi- 
nence 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 



24 PRACTICE OF OSTEOPATHY. 

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 back- 
ward, 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 mentioned, and the cor- 
responding displacement of the atlas is discovered. 

Occasionally the posterior tubercle of the atlas may be felt 
in the space between the second cervical spine and the skull. 

In palpating the transverse processes of the atlas, care should 
be taken to feel out their shape and contour fully. They vary ex- 
ceedingly in size within normal limits, being sometimes so large 
as to extend below and behind the mastoid processes. 

If the relations of the atlas with the axis be unchanged, 
while those of the atlas with the skull are altered, we must re- 
gard the head as being displaced upon the atlas. 

V. Lateral deviations of vertebrae in the neck are best found 
by examining 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 process 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 artic- 
ular process of the second is then located in the samp way. They 
are now compared while moving the head slightly from side to 
side, and lateral deviations 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 examining 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 transverse pro- 
cesses and diagnosis of anterior luxation be made. 

VII. Crepitus and abnormal mobility of bony parts indi- 
cate fracture. 

VIII. The patient lies on his back, and the practitioner 



PRACTICE OF OSTEOPATHY. 25 

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 side, 
carefully comparing 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. Sometimes these 
tissues may be felt like a thick transverse band across the back 
of the neck just below the skull. Such a lesion is usually an in- 
indication of intense congestive headaches. 

XI. The scaleni muscles are made prominent upon one side 
by drawing 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 results in drawing the first two ribs 
upward out of place. 

XII. The brachial plexus of nerves emerges from between the 
scalenus anticus and the scalenus medius muscles, below the 
level of the fifth cervical 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. This 
plexus may be readily traced downard behind the clavicle, and 
along the inner side of the arm. 

XIII. Tender areas are often found upon pressure in the 
sub-occipital fossae. They are due to irritation of the great and 
small occipital and great auricular nerves. It is through manip- 
ulation of these nerves largely that effects are gotten upon the 
superior cervical ganglia and upon the medulla. They are lo- 
cated at a point about two inches from the middle of the post- 
erior margin of the mastoid process, in a line at right angles 
thereto extending toward the median plane of the neck pos- 
teriorly. These nerves, when firmly pressed, carry a sensation 
of pain to the top of the head and over it to the brow. 

XIV. The superior cervical ganglion lies in front of the 



26 PRACTICE OF OSTEOPATHY. 

transverse processes 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. This ganglion lies in front of the 
rectus capitis anticus muscle, which is penetrated by its branches 
connecting it with the first four cervical nerves. 

The middle cervical ganglion, lying in front of the trans- 
verse processes of the sixth and seventh cervical vertebrae, may 
be likewise reached. This ganglion has branches connecting it 
with the fifth and sixth cervical nerves 

The lower cervical ganglion lies in front of the first costo- 
vertebral articulation, and is connected with the seventh and 
eighth cervical nerves. 

The transverse process of the seventh cervical vertebra is 
readily located by deep lateral pressure at the outer third of the 
supra-clavicular fossa. 

Lesions of the atlas and axis are by far the most important 
occurring in this region of the body, and account for many ser- 
ious 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 body. 

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 examination. 

The value of gently moving a part while under examination 
in order to relax tissues, to insinuate the examining fingers more 
deeply into them, and to develop the latent lesion through in- 
vestigation of its relations to its neighboring parts during move- 
ment must not be overlooked. 

CHAPTER TV. 
TREATMENT OF THE NECK. 

Treatment of the neck, as of other parts is, in its specific 
application, always removal of lesion. The following general 



PRACTICE OF OSTEOPATHY. 27 

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 specific appli- 
cation of these general principles and methods will be made. 

I. With the patient upon his back, the guiding hand is 
laid upon his forehead and the head is rolled gently from side to 
side a few times to aid in relaxing 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, Avhile 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 con- 
tracture, while the head is being slowly moved about, will re- 
lieve the tension and remove the lesion. 

II. The ligaments of the temporo-maxillary articulations, 
and the muscles and blood-vessels below the inferior maxillary 
bone may be relieved of tension, and be restored to free action, 
by springing the mouth open against 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 operat- 
ing 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 the temporo-maxillary articulations may 
be sprung by thrusting a finger deeply into each glenoid fossa 



28 PRACTICE OP OSTEOPATHY. 

after the patient has opened his mouth, holding them there while 
the mouth is shut. It is necessary to avoid hard pressure here. 

III. The hyoid bone may be held between the thurhb and 
finger and be moved vertically and laterally, stretching the 
hyoid muscles. 

IV. Pressure may be in some measure applied to the pneu- 
mogastric, glosso-pharyngeal and spinal-accessory nerves by 
deeply pressing the finger upward and inward behind the angle 
of the jaw, in the direction of the jugular foramen. 

The pneumogastric nerve may be manipulated by deep pres- 
sure behind the anterior border of the stern o-mastoid muscle. 

These three nerves are also influenced by manipulation 
upon their closely related nerves, the sub-occipital, great occipi- 
tal, small occipital, and great auricular, reached in the sub- 
occipital fossae as above described. 

V. Pressure upon the phrenic nerve may be applied at the 
points described in Capter III. 

VI. The sterno-mastoid muscle may be manipulated, fol- 
lowing 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 slightly upward, thus increasing the 
distance between the mastoid process and the sterno-clavicular 
origin of the muscle. 

VII. The lateral and posterior muscles 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 handsfull of the muscles, manipu- 
lating them thoroughly while slowly moving the head in all 
directions. Pressure and manipulation, together with motion, 
all gently and patiently applied, will relax the most obstinate 
contracture, loosen all deep fibrous structures, free blood-ves- 
sels and nerves, and prepare the way for what is usually the 
real object of the treatment, the reduction of bony lesions. 

VIII. With the patient supine, the head is pushed as far 
as may be easily done without resistance, first to one side and 



PRACTICE OF OSTEOPATHY. 29 

then to the other, and it is noticed whether it turns as far to one 
side as to the opposite side. Inequality 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. (1) In lesion of the atlas the patient lies supine and 
the practitioner, 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 lesion, 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, in the region of the lateral arch of the atlas, on the 
opposite side. Exaggeration of the lesion, rotation, .and strong 
pressure aid in replacing the part. 

(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, and the fingers are firmly pressed upon 
the lateral arch of the atlas upon each side. Exaggeration of 
the lesion, traction, pressure, and rotation are now applied as 
before. The chin is slightly raised and drawn forward by motion 
of the knee beneath it. The head is rocked upon the atlas gently, 
the requisite pressure being made upon the lateral arches to press 
the bone back to its position. 

(4) The patient sits and an arm is passed about his head, 
the bend of the elbow coming beneath the occipital protuber- 
ance and the hand beneath the chin. The head is now forci- 
bly raised with the idea of moving it upon the spine in the de- 
sired direction, while the free hand makes pressure upon the 
spine or neck in the direction necessary to aid in reposition. 

(5) Dr. Still uses the following movement in setting the 
atlas. He stands in front of the patient, who is sitting, and 
clasps his hands behind the neck, just below the skull, pressing 
the pisiform bones firmly 'against the lateral arches of the atlas. 



30 PRACTICE OF OSTEOPATHY. 

Now the proper movement is made to rotate the head to the 
affected side, "sinking" it down upon the spine, and to press the 
atlas into place. 

(6) With the patient lying upon his back, the practitioner 
stands at the head of the table, holds the head between his hands, 
presses his fingers against the lateral arches of the atlas, while 
the head is slightly raised from the table and supported by 
pressure from his own body, pressing it down upon the spine. 
Now the proper movement is made to exaggerate the defect, 
rotate the head, and press the atlas into place. 

These various treatments may be applied to any of the 
usual lesions of the atlas. The same principles may be applied 
to the different malpositions of any of the cervical vertebrae. 
Generally patience and time are necessary to the gradual res- 
toration 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 pressure 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 be- 
hind the clavicle upon the first rib to force and hold it down, 
while the head is now drawn to the opposite side. 

XII. Thorough loosening of all cervical tissues may be 
accomplished by a somewhat "spiral" treatment. The patient 
lies on his back, 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 ro- 
tated in one direction, while, as far as possible, exactly the op- 
posite motion is given the neck. The hand travels up and down 
the neck treating its different portions alike. 

XIII. Flexing the head strongly upon the thorax stretches 
the ligamentum nuchse and posterior tissues of the neck. 



PRACTICE OF OSTEOPATHY. 31 

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 examination and treatment of these important 
structures will be considered in lectures upon their specific dis- 
eases in the second part of this work. The present chapter will 
embrace only general osteopathic points. 

INSPECTION AND PALPATION are the methods of examina- 
tion. By the former one notes the size and shape of the skull, 
the complexion, expression, 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, and along the cervical and upper dorsal 
regions as low as the fifth dorsal vertebra. 

I. The conjunctiva lining the lids may be examined. The 
lower lid is drawn out and down, pressure being made at the 
same time below it, causing 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 inner canthus. 
This inverts the tarsal cartilage 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 supine, direct pressure is made, with 
the palms of the fingers, upon the eye-balls, pressing them di- 
rectly 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 struc- 
tures of the intra-ocular mechanism. 

III. Tapping upon 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. 



32 PRACTICE OF OSTEOPATHY. 

Toning of the nerves, of the ball and its structures, and of the 
optic nerve is thus accomplished. 

IV. Granulations are crushed by squeezing them beween 
the finger and thumb, the finger being inserted beneath the lid. 

V. In pterygia, the small blood-vessels formed upon and^ 
in the corneal conjunctiva as feeders, may be broken up by draw- 
ing the back portion of the edge of the finger-nail across them. 
Care must be taken not to wound the conjunctiva. 

VI. In strabismus the weakened or tensed muscle may be 
treated by pressing the fingers into the orbit about the eyeball. 

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 treat- 
ment is especially important in headaches, neuralgias, diseases 
of the eye, nose, 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 foramen 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. Often one nerve is more plainly felt, and often one is 
more tender, than its fellow. Though not invariably so, it is 
often noticed that the nerve which is seemingly slightly enlarged 
and more plainly felt is the one in abnormal condition. 

II. The infra-orbital and mental branches may be manip- 
ulated 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 different branches should be thoroughly relaxed to re- 
move irritation. 

III. A supra-trachlear branch is located slightly to the outer 
side of the mid-line of the forehead, a lachrymal branch about the 
middle of the upper eyelid, a temporal branch external to the 
outer canthus of the eye, an infra-trochlear branch upon the nose 
opposite the inner canthus, and a nasal branch at the lower third 
of the side of the nose. 



PRACTICE OF OSTEOPATHY. 33 

All are subcutaneous and are readily manipulated after 
knowing where to locate them. 

THE EAR. 

With the EAR, as with the eye, lesion of the atlas, axis, or 
upper cervical region is the most usual cause of disease. 

The auricle should be drawn up and back in order that the 
external canal may be inspected for the presence of growths, 
boils, foreign objects, discharges, etc. 

Attention should be given to the condition of the cerumen. 
It is sometimes seen to be dry and flaky, indicating poor circu- 
lation and imperfect secretion. Or it may be abundant, forming 
a plug, which gathers in the deeper part of the canal and obscures 
the drum, generally, but not always, impairing or quite obstruct- 
ing the hearing in that ear. If it presses upon the drum it is apt 
to cause vertigo, or a sense of congestion in the head. 

In some cases the cerumen will be found to be entirely or 
almost, lacking, in one or both ears. This commonly indicates 
greatly impaired local circulation, due to cervical lesions, poor 
general health, or both. In many cases treatment has restored 
the normal secretion of wax. 

Itching and extreme tenderness of the canal are sometimes 
noted. 

The head-mirror and ear-speculum should be employed in 
the examination of the deeper parts of the canal, and of the tym- 
panum. Sometimes a plug of cerumen can be detected by this 
means only. 

By the use of these instruments the student should become 
familiar with the appearance of the normal drum. A good text- 
book, with its illustrated plates, showing the appearance of- the 
various abnormal conditions of the drum, is a valuable aid to 
this study. 

The patient should be instructed to close the mouth, hold 
the nostrils shut, and blow. This will reveal whether or not the 
Eustachian tubes are open, by the presence, or lack, of the crack- 
ling sound and sensation of fulness in the ears as the air is forced 
against the inside of the drum. 

When this act is performed, a perforation of the drum is 



34 PRACTICE OF OSTEOPATHY. 

betrayed by the whistling of the air through the aperture, or by 
the gushing through it of secretions or pus from the middle ear. 

Impaired hearing may be due to fault in the outer, middle or 
inner ear, auditory nerve, or brain center. A watch is a very 
handy and delicate instrument to employ in testing the hearing. 
This should be done in a quiet room. First the watch should be 
held quite close to the ear, and gradually removed from it, to 
test the distance at which the ear may catch the ticking. Both 
ears should be tested in this way. The less acute power of one 
ear is often thus discovered. Sometimes the watch may not be 
heard to tick unless pressed close against the auricle. The ear 
which stands this simple test is sound, as to its hearing power, 
throughout the auditory mechanism. 

If the ear fails to hear the ticking when the watch is held 
near or against the auricle, the watch should then be held rather 
firmly against the upper part of the mastoid process, just behind 
the auricle. If now the hearing fails, the trouble lies, probably, 
in the inner ear, but may be located in either the auditory nerve 
or in the brain center. As a matter of fact, the causes of deafness 
lie, for the most part in the middle or inner ear, or in the Eus- 
tachian tube, being rarely referable to the auditory nerve proper 
or to the center. Deafness due to causes affecting nerve or 
center may be distinguished from strictly aural deafness in a 
simple way. In the former case the ticking can be heard only 
faintly or not at all whether the watch be held away from the 
ear or be brought near to it or pressed against the auricle or the 
mastoid. But in the latter the watch may be heard more dis- 
tinctly when it is held against the mastoid, since' by bone con- 
duction the sound is carried to the nerve. 

Sometimes the test is applied by having the watch held be- 
tween the teeth. If the Eustachian tube is occluded the sound 
is heard less distinctly upon the affected side. But if the ob- 
struction is in the middle ear, as from thickening of the tissues 
and rigidity of the ossicles, the sound may be heard more dis- 
tinctly upon the affected side (through conduction). Some- 
times, also, this occurs when there are impactions of cerumen 
against the membrana tympani. 

Tinnitus Aurium, or "ringing of the ears," consists of a 



PRACTICE OF OSTEOPATHY. 35 

variety of subjective sounds due to nervous disease, anemia, 
catarrhal conditions, and various other causes. Generally speak- 
ing, the dull, throbbing or buzzing noises are due to obstructed 
circulation in the ear, especially in the fine capillary network 
spread upon the drum. This commonly results from colds and 
catarrhal affections. This class can often be bettered. 

On the other hand, ringing, screeching, or whistling Aoises 
commonly denote some affection of the nerves of the auditory 
apparatus, as is sometimes seen resulting from lagrippe. These 
cases are usually difficult to help much. 

Of the discharges from the ear, pus and blood are the most 
significant, and their source should be carefully sought. 

Treatment of the ear is discussed under the heading of Dis- 
eases of the Ear. 

THE NOSE. 

In the examination of the nose its external aspect should be 
noted. Deformities from operation, violence, or disease are 
common. The nose often indicates chronic catarrh by being 
bent somewhat to one side, following ulceration of bones or 
cartilages, or surgery. 

A peculiar "club-shaped" nose, with a large, rounded end 
is sometimes seen in the scrofulous. 

A red, or livid nose, with enlarged and injected vessels, is 
a common indication of bibulous habits, and this member some- 
times becomes grossly hypertrophied and deformed by excessive 
indulgence in alcoholic beverages. Redness of the nose very 
often results from congestion due to chronic valvular heart-dis- 
ease, from congestion of the liver, or from tight-lacing in women. 

The internal examination should be made by use of a con- 
venient dilator, head-mirror and speculum. The examiner 
should note the condition of the mucous membrane for redness 
or inflammation or for paleness and atrophy as in chronic catarrh. 

The character of the secretions and discharges should be noted, 
and, if abnormal, their source or cause carefully sought. Very 
offensive mucous discharges and pus indicate advanced catarrhal 
conditions, and may result from ulceration in the tissues of the 
nose or from abscess or ulceration in the frontal sinus or antrum. 



36 PRACTICE OF OSTEOPATHY. 

Bleeding is usually from the membrane and due to local 
irritation, or from congestion of the vessels of the head, causing 
rupture of small vessels. After violence one should consider 
the probability of fracture of the base of the skull as a source of 
bleeding. 

Foreign bodies ; growths, such as polypi and adenoids; "spurs" 
of bone, due to hypertrophy resulting from catarrh; enlargement 
of the middle or inferior turbinated bones ; or a deflected septum 
may be found. 

The NOSE, apart from neck treatment, is sometimes treated 
by local manipulation. 

I. Manipulating and loosening all the tissues along the 
sides of the nose affects the blood-supply of its mucous mem- 
brane through branches of the fifth nerve. It will also operate 
to free the channel of the nasal duct. 

II. With the patient supine, 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.lt is greatly in- 
creased by first applying momentary pressure, with the thumbs, 
to the internal jugular veins, which are thus dilated back to the 
capillaries by the pent-up blood, after which they carry away 
more blood, relieving the congested head and mucous membrane 
of the nose. 

III. In colds and catarrh, pain in the frontal sinus may be 
relieved by tapping with the knuckles upon the frontal bone 
over the sinus. 

The MOUTH and THROAT are sometimes treated internally 
by sweeping 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. 



PRACTICE OF OSTEOPATHY. 37 

The Uvula, being thus treated by digital application, elonga- 
ations of it are overcome through restoring tone to its muscles 
and vessels. It is usually elongated by conditions which con- 
gest it and the surrounding tissues, and the elongation is due to 
the loss of tone thus induced in the azygos uvulae muscles. This 
condition is often the cause of a little hacking cough in children. 

THE TEMPORO-MAXILLARY ARTICULATIONS are examined. 
Inequality in their action is discovered by standing behind the 
head of the patient, who is lying supine. 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 in- 
dicates luxation of one of the articulations, the jaw usually de- 
viating away from the side of the lesion, though often toward it, 
by reason of tightened condition of the articulation on the affected 
side. 

I. The ligaments of the articulation may first be loosened 
as described under II of Chapter IV. Pressure upon the op- 
posite jaw while the patient is closing the mouth will bring the 
condyle back into place, 

II. Sometimes it is necessary 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 in- 
serted at the same time between the molars of both sides in case 
of bilateral luxation. 

Treatment I, may be alternately applied in such case. 

Opening the mouth against resistance (II, Chap. IV), man- 
ipulation 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 specific lesions, the chief metkods 
of treatment in diseases of the eye, ear, nose and throat. They 
produce affects by building up the blood-supply. 

Treatment along the mid-line of the skull, from the nasion 
to the occipital protuberance, thence outward along the sides 
of the head, affects the circulation in the longitudinal and lat- 
eral sinuses through connected nerves and veins. It also affects 
the sensory nerves of the scalp, they congregating about the 
vertex. 



38 PRACTICE OF OSTEOPATHY. 

CHAPTER VI. 
EXAMINATION OF THE THORAX. 

From an Osteopathic point of view, and not at present 
considering the contents of the thoracic cavity, the examina- 
tion of the thorax consists mainly in discovering, by palpa- 
tion and inspection, whether its bony structures are all in posit- 
ion. 

Ligamentous and muscular lesions, also lesions of blood- 
vessels, nerves, and centers are closely associated with bony 
lesions. 

The relations of the thorax to the spine as a whole and to its 
own 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 the general conformation of 
the thorax. It is made with relation to the spine, and effects 
of spinal irregularities are considered. Flattening or promi- 
nence of the ribs, either in portions of the thorax or affecting 
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. 

Change in the general conformation of the thorax is sig- 
nificant of the presence of many lesions. Often a single glance 
assures the examiner of the presence of many lesions which are 
closely related, and which, as experience teaches, are all in a 
train of abnormalities, so that he is practically sure from the be- 
ginning that he will find present certain various lesions. A 
weakened condition of the spine, allowing of lateral swerving of 
its vertebrae or of changes in its normal curves is apt to be 
found causing a weakness of the costo-vertebral ligaments. The 
ribs are therefore not held in their proper relation to the spine, 
the whole thorax is weakened, and the ribs sag downward, narrow- 
ing the antero-posterior diameter of the chest, or otherwise dis- 
torting it. The foundation is thus laid for the various diseases 
of heart, lungs, etc. The angles of the ribs are approximated 
and become prominent along the postero-lateral aspects of the 



PRACTICE OF OSTEOPATHY. 39 

chest, or "stand out in rings under the shoulders," as Dr. Still 
says. This narrows the thorax so that a lateral view of it shows 
the axillary and infra-axillary regions narrowed, and the examining 
hand swept down along the angles finds the lateral span of the 
chest much decreased. The two sides may differ. The ilio- 
costal spaces are narrowed, sometimes to the extent of oblitera- 
tion. 

In case of a lateral swerve of the spine the ribs upon the 
convex side are found to be more oblique, and their inter-spaces 
are narrowed or obliterated. At the same time the whole thorax 
may be altered in shape as above described. 

The patient may sit, lie, or stand during inspection, as most 
convenient. 

PALPATION, the more important method, proceeds in con- 
junction 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, comparing side with side; region with region. The 
temperature is also noted. 

II. The precordial 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 di- 
ameter, and a tendency of the ribs to greater obliquity in direction, 
reveals a flattened side or 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. 

People with such lesions are always poor breathers because 
of the extra effort required of weakened muscles to raise the dis- 
arranged ribs. They therefore suffer, in addition to the results 
of specific lesion, from the various evils of congestion and im- 
perfect oxygenation consequent upon poor rib, chest, and lung 
action. 

IV. The same lesion may affect a portion of the thorax. 



40 PRACTICE OF OSTEOPATHY. 

Often a flattening of the ribs posteriorly beneath the scapula is 

found. 

Protrusions or retractions of one area of the chest generally 
correspond with the reverse condition in the corresponding an- 
terior or posterior area. This is not true in case of slipping of 
the ribs downward. 

V. Marked depressions in the supra or infra-clavicular re- 
gions are significant in the diagnosis of tuberculosis of the lungs. 

VI. With the patient lying on his side, the palm of the hand 
is swept along the lateral and postero-lateral aspects of the chest, 
from the shoulder downwards. Changes in the position of the 
ribs individually, or in the conformation of the side of the thorax 
in question are thus readily made out, mainly by detection of 
changes in the angles of the ribs from normal. 

The STERNUM must be examined. 

I. It may be as a whole, protruded or retracted, following 
a change in the general shape of the thorax. 

II. Luxation between the first and second parts, anteriorly 
or posteriorly, may occur. 

III. The ensiform may be displaced laterally. 

THE CLAVICLE AND CORACOID. 

The latter is located as the first bony prominence at the outer 
end of the infra-clavicular fossa. Its relation to the clavicle is 
to be noted, also the condition of the tissues attaching to it. 

The clavicle may be luxated at either its sternal or acro- 
mial articulation. 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. Sometimes the bone is tilted so that one's 
fingers may be thrust for behind its upper edge. These lesions 
are generally easily detected by inspection and palpation. The 
examination of the sternal end is often facilitated by having the 
patient lie flat upon his back, then pressing the tip of the examin- 
ing finger down deeply upon the sterno-clavicular junction, at 
the same time comparing it with its fellow, which should be felt 
out by the other hand. Very slight depressions or elevations 
may be thus detected, as may also tenderness. 



PRACTICE OF OSTEOPATHY. 41 

Dr. Still points out that in diseases of the throat the ster- 
nal end of the clavicle is often found displaced backwards against 
the pneumogastric nerve, irritating it and causing the disease. 

LUXATION OF RIBS. 

One of the main objects of examination of the thorax is 
to locate misplaced ribs. Departures from normal conforma- 
tion of spine are at once indications of lesion of the several ribs. 
Hence, following the general examination 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 or 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 examining finger. In the latter 
lesion the tissues are tender along the course of the intercostal 
space, due to irritation of the sensory branches of the intercostal 
nerves. 

II. The same examination would reveal rotation of a rib 
upon its horizontal axis. In such case the intercostal space is 
unequally widened or narrowed. As a rule the twisting is about 
the head as a fixed point, and the lower margin of the rib is turned 
out prominently. Then the intercostal space next below is 
narrowed anteriorly and widened posteriorly. The anterior end 
is tended downward, luxating the costo-chondral and the chondro- 
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, the cartilages are twisted, 
distorted or torn loose. 

In such case tender points are found upon pressure at the 
costo-chondal or chondro-sternal articulations. The cartilage 
may be bulged forward by protrusion of the rib, causing a prom- 
inent tender point. It may be retracted, causing a slight de- 
pression. 

With the patient lying supine, the examining fingers may 
be carefully passed over the successive pairs of cartilages and 
these lesions be noted. 



42 PRACTICE OF OSTEOPATHY. 

IV. The heads of ribs are often luxated, and may sometimes 
be easily felt near the transverse process of the adjacent vertebra. 
This lesion is most readily found by carefully feeling along the 
shaft of the rib upward toward its head, using deep pressure. It 
may be impossible to trace the shaft by touch where it is covered 
by the thick erector spinae muscles. In such case it is easy to 
follow the direction of the rib up to the spine. Deep palpation 
may reveal the head to be prominent, depressed, or sore. 

The FIRST RIB is located by deep pressure behind the mid- 
dle 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 pressure the rib may be traced 
well back toward its head, which is masked by the lateral cervical 
muscles. Pressure may be brought upon the head at the level of 
the seventh cervical spine, one and one-half inch laterally there- 
from. 

This pressure is deeply in the tissues over the region of 
the head of the rib. The latter is, not always easily felt by touch, 
but may often be definitely felt out. Sometimes the head of 
the first rib is separated from and drawn outward away from its 
spinal articulation, when it may be easily felt. This sometimes 
occurs in cases of exophthalmic goitre. Dr. A. T. Still points 
out that lesions of the first rib often cause goitre. 

A more reliable method for definitely locating the head of 
the first rib is as follows: Find the tip of the transverse process 
of the seventh cervical vertebra, (XIV, Chap. 3) and make firm 
downward pressure just in front of it. As the head of the first 
rib lies anterior to the transverse process of the first dorsal ver- 
tebra, the first bony part felt under this pressure is the first rib 
in the region of its head. 

The sternal end of the rib is located just below the clavi- 
culo-sternal articulation. Its cartilage and shaft may be traced well 
outward an inch or more before disappearing beneath the clavicle. 

In case it 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 edge of the sternum is usual. 
In either case the cartilage and the tissues about the rib are sen- 
sitive to pressure. 



PRACTICE OF OSTEOPATHY. 4cf 

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 tenderness 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, upon a level with the 
superior angle of the scapula. 

THE ELEVENTH AND TWELFTH RIBS are more frequently 
luxated downwards because of their anterior ends being un- 
supported and because of traction upon the latter by the quad- 
ratus lumborum muscle. Their free ends are readily located 
except when irritation from them, or other cause, has irritated 
the overlying 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 distin- 
guishing it from the twelfth. 

They may be so displaced downward as to be almost ver- 
tical; 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 surroundirg soft tissues, 
by dragging ligaments, impinging nerves, or occluding blood- 
vessels. One must remember that in probably most cases of 
displacement of a rib there is lesion at its head affecting the re- 
lated spinal nerves. 



CHAPTER 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 an- 
other head. 

Osteopathic treatment of the chorax is directed generally 



44 PRACTICE OF OSTEOPATHY. 

to the restoration of the ribs and other bony portions to cor- 
rect mechanical relations. It includes with this, work upon 
ligamentous, cartilaginous, and muscular lesions, which are 
usually secondary to bony lesion. Thus while osteopathic treat- 
ment 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 
ligaments; nerves and vessels; centers and viscera. 

Thoracic is inseparable from spinal work, owing to the in- 
timate anatomical 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 tissues, 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 fur- 
ther 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 par- 
ticularly the ribs upon the angles of which pressure is made. Care 
must be taken to maintain this pressure until the end of the move- 
ment of the arm. 

This motion may be repeated, the pressing hand traveling 
down the back to each successive rib in need of treatment. 



PRACTICE OF OSTEOPATHY. 45 

This treatment elevates all the ribs and tones all 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 
elevates and rotates the arm as in I, or the first hand may press 
down 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 may be forced downward or upward. 

III. 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 expels the 
breath. The whole rib is manipulated at this time toward 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 way the principle of exaggeration 
of the lesion is called into play. 

IV. Treatment II may be applied with the patient lying 
upon his side instead of sitting. Here the practitioner stands 
behind, 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 forward and up, or downward and back, pressure 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 any application of the 
knee to the chest, either anteriorly or posteriorly. 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 shoulder and applied 



46 PRACTICE OF OSTEOPATHY. 

to the spinal region of the rib. This treatment is applicable to 
luxations of the heads of ribs. The patient is sitting. 

VI. With the patient supine, 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 ap- 
plied as a fixed point to the angles of any ribs in question; with 
the other hand the patient's arm is rotated as before for traction. 

VII. With the patient lying prone, the practitioner, stand- 
ing at one side, reaches across the body and makes a fixed poin't 
of his elbow upon the angle 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 prone, pressure with the oper- 
ating hands may be brought vertically downward upon heads or 
angles of ribs, springing them into place. 

IX. With the patient lying supine, the practitioner stands 
a,t the side of the table and raises the patient's arm of the same 
side to a level with the shoulder. With the arm thus horizontal, 
traction is made upon it, away from the body, and in such a 
direction as to bring longitudinal tension upon the costal cartil- 
ages. The other hand manipulates the cartilage to reduce an}' 
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 the hand locates and brings pressure upon the head 
of the same rib. With both ends of the rib thus fixed, the mo- 
tion 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 accom- 
plished at once. It is rarely the performance of a set motion 
that does this work. On the contrary, the practitioner, with 
his hands in position and the parts under his control as described 
in any particular treatment, must continue his efforts, with vary- 
ing traction, pressure, rotation, etc. Movements of the pa- 



PRACTICE OF OSTEOPATHY. 47 

tient'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 gen- 
eral principles and treatments, as already described, may be 
applied. Special methods, however, are generally necessary 
to replace them. As already stated, these ribs are usually lux- 
ated upwards, but may, as well, be displaced downwards. 

I. UPWARD DISPLACEMENTS. 

(1) 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 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 re- 
laxing the tissues at the side of the neck, and elevating the clavicle 
so that the thumb may be thrust more deeply behind it. Pres- 
sure may be applied anywhere along the upper margin of the rib, 
lowering it to its normal position. 

(3) A most effective treatment is shown by Dr. Still. For 
example if the lesion be to the right rib, the patient is to sit side- 
wise upon the table. The practitioner sits beside him, at his 
left, passing his right arm under the left axilla and placing his 
right fingers on the upper aspect of the rib. His left hand is 
pressed against the patient's head. First the patient's head is. 
drawn toward the practitioner while his body is pushed slightly 
away. This swerves the spinal column and throws the luxated 
rib up higher, exaggerating the lesion. Now the head is pushed 
well away from the practitioner, while the body is drawn to him, 
with accompanying strong pressure of the right hand downward 
upon the shaft of the first rib, which is thus replaced. 



48 PRACTICE OF OSTEOPATHY. 

II. DOWNWARD DISPLACEMENTS. 

(1) With the patient sitting, the practitioner stands be- 
hind and brings pressure with his fingers upon the inferior mar- 
gin of the first or second rib. At the same time the head is bent 
to the opposite side, bringing traction upon the rib through the 
scaleni muscles, and rotated backward. This rotation tends to 
bring more traction upon the anterior end through the scalenus 
anticus (in case of the first rib.) The 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 heads of the first and second rib, (see Cap. VI), 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 
Chap. VI), pressure 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, as follows: The pa- 
tient lies supine 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 elbow, raised, and bent strongly across the 
anterior chest at the level of the shoulder. This tends to drive 
the two ribs sternum-ward, and to separate them anteriorly 
owing to the intercostal space being wider at its anterior end 
than at the other. 

THE ELEVENTH AND TWELFTH RIBS. 
A. DOWNWARD DISPLACEMENTS. 

A preliminary step must be taken in the relaxation of all 
muscles and tissues about the ribs, especially of the quadrati 



PRACTICE OF OSTEOPATHY. 49 

lumborum muscles. This is easily accomplished by manipu- 
lation of the tissues. A special method of stretching the quad- 
rati is as follows: The patient lies upon his side and the prac- 
titioner stands in front. He grasps the arm of the patient and 
draws it diagonally forward, at the level of the shoulder, in a 
direction away from the pelvis. At the same time his other 
hand makes pressure upon the anterior iliac crest in a direc- 
tion diagonally backward, i. e., in a direction exactly the op- 
posite from that in which the arm is drawn. This stretches 
the muscles 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 same 
time the other hand holds the bent arm rigid at the side and 
pushes it in a direction opposite from that of the traction 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 readily manipulated 
upward or downward by taking advantage of three points; (1) 
The head usually remains 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, readi- 
ly rotates the rib about its horizontal axis. 

One hand easily spans the rib, leaving the other hand free 
to manipulate 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 



50 PRACTICE OF OSTEOPATHY. 

it upward. At the same time the free arm has grasped the 
semi-flexed 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 be- 
tween 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 applied 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 down- 
ward 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 upward. 

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 reduction of upward displacements; the appropriate pres- 
sure being made to force the rib downward. 

The STERNUM, if PROTRUDED or RETRACTED as a whole, is 
restored to normal through the general shaping of the thorax 
l&y methods already described. The ensiform appendix, being 
cartilaginous, is usually easily sprung by pressure and trained 
toward its normal position. 



PRACTICE OF OSTEOPATHY. 51 

In case of luxation between the 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 part, reducing it. 

The CLAVICLE may be restored from any of its usual mal- 
positions as follows: The patient lies supine and the practi- 
tioner stands at the head of the table, slightly 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 
sternal 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 downward dislocation. 

In case the sternal end has been dislocated upward 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 upward the 
same motion would be applied, with the operating hand di- 
rected 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 per- 
formance 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. 



52 PRACTICE OF OSTEOPATHY. 

The posterior margin of the clavicle may be tipped up- 
ward, so that the space between its outer end and the scapula 
is widened. The tissues at this point are then tender. The 
condition may be remedied by the proper application of the 
above treatment for reduction of displacement of the acromial 
end. 



CHAPTER VIII. 

GENERAL OSTEOPATHIC POINTS IN REGARD TO THE ABDOMEN 
AND ITS PARTS. 

Many of the specific lesions affecting thfe 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 considered more in de- 
tail 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 supine; the thighs are flexed 
and the feet rest upon the table; the head and chest are slightly 
elevated by the inclined head of the table. In this position the 
abdominal muscles are relaxed. The sides of the body are dis- 
posed alike to avoid unequal tension upon the tissues. 

Inspection, palpation, percussion and auscultation 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, super- 
ficial or deep, fluid or solid; tenseness or flabbiness of the ab- 
dominal walls; enlargements and displacements of organs, etc. 
Pulsations, also, are to be noted. A marked pulsation of the 
abdominal aorta is common in nervous people, but generally 
indicates liver, stomach, or intestinal congestions. 



PRACTICE OF OSTEOPATHY. 53 

Deep palpation of the abdomen in thin persons readily reaches 
the bodies of the lumbar vertebrse, rising quite prominently 
under the touch. They should not be mistaken for tumor. 

The examiner should grasp the abdominal walls in the fingers 
and raise them up away from the abdominal viscera, thus en- 
abling him to tell whether tender places, growths, etc., lie in or 
beneath these walls. 

PERCUSSION reveals the limits of organs, presence of tu- 
mors, fluids or gases, etc. 

AUSCULTATION reveals the gurgling of gases, fetal sounds, 
lubrication of the bowel, etc. 

I. A general treatment of the abdomen is sometimes nec- 
essary for general relaxation of the abdominal walls, often as 
a preliminary step toward further examination. With the pa- 
tient in position as above, the practitioner stands at the side of 
the table and with the palm of the hand manipulates 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 re- 
served until diseases of these organs are considered. But, speak- 
ing 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 manip- 
ulation is not for the general effect following a thorough abdominal 
massage, but is corrective ; directed to the specific end of restoring 
to proper mechanical relations an organ or organs definitely 
ascertained to be in need of mechanical adjustment. Here, as 
elsewhere in the body, this work removes pressure from, or in- 
terference with, blood-vessels and nerves. For example, osteo- 
pathic treatment of the colon is not made for general manipula- 
tive effect, but is directed to raising and straightening a sigmoid 
too much bent or folded. Thus it removes a mechanical ob- 



54 PRACTICE OF OSTEOPATHY. 

struction 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 po- 
sition the gut which has prolapsed and become wedged down 
among the pelvic viscera, where it has destroyed harmony of 
the functions. Osteopathic manipulation in this way is specific 
and corrective, based upon mechanical principles, and is applied 
by a practitioner who knows what causes such abdominal condi- 
tions 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 be- 
neath the viscera in each iliac fossa. They are now drawn di- 
rectly 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 time the viscera are raised. 

IV. With the patient lying upon the right side, the prac- 
titioner stands behind the pelvis and presses the 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 inner surface of the ilium. 
This raises the gut from the pelvis, relieves kinking, and frees 
the circulation of the part. 

The movement may be repeated for the caecum. 

The knee-chest position is very important and effective in 
all conditions requiring the elevation of pelvic and abdominal 
viscera. The patient gets upon his knees, and, turning his head 
to one side, lays the upper part of the chest upon the table (still 
remaining on his knees.) While he is in this position manipula- 
tions are made to draw abdominal and pelvic contents down 
away from the pelvis. Gravitation aids this process. 

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 cartilages, one on either side, heel out and fingers 
directed toward toward the median plane of the body. Pres- 
sure 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 are forced toward the mid-line and pressed 



PRACTICE OF OSTEOPATHY. 55 

down u'pon the viscera. Repeating this motion at intervals of 
a few seconds thoroughly tones the nerve-plexuses and blood- 
flow of the upper abdominal viscera. 

VI. Deep pressure is made upon the solar plexus as follows: 
The patient lies supine, 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 manipulated by a slight circular movement of the hand. 
This treatment tones the 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 mechanically depress vis- 
cera, 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 side. Thence 
the course of the bile duct to the duodenum is somewhat in the 
shape of a reversed "S," opening into the duodenum from one 
to two inches below the umbilicus. Manipulation aids in empty- 
ing the bladder and in passing gall-stones along the duct. 

Abdominal treatment is generally in conjunction with 
treatment upon the specific lesion occurring in the spine, thorax, 
etc. It must be given carefully, as there are many diseases, e. g., 
typhoid, in which rough abdominal treatment might cause seri- 
ous injury. It is directed to a specific end and restores mechani- 
cal relations of parts, frees nerve and blood-mechanisms, removes 
muscular contracture, etc. 



56 PRACTICE OF OSTEOPATHY. 

CHAPTER IX. 

EXAMINATION AND TREATMENT OF LESIONS OF THE PELVIS. 

The 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 ex- 
amine the spine in relation to pelvic lesion, as malpositions of 
this structure are almost sure to destroy spinal equilibrium 
and thus to affect spinal relations, sometimes to a serious extent 
The most common of such results is swerving or curvature of the 
spine in response 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 either side ; or may be tilted, throwing one crest 
up and the other downward. These malpositions may be com- 
bined in various ways. The general symptoms of such trouble 
are pelvic diseases, female disorders, backache, neck lesion, 
sciatica, lameness 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 examina- 
tion. 

(1) Both superior posterior iliac spines are found equally 
too prominent in case of backward luxation of the pelvis, or 

(2) They are alike found to have receded anteriorly in for- 
ward luxation, or 

(3) One is prominent and the other has receded anteriorly in 
twisting of the pelvis sidewise, or 

(4) One stands higher than the other in case of tilting of 



PRACTICE OF OSTEOPATHY. 57 

the pelvis laterally. In the latter case, comparision shows in- 
equality in 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 waist line is deepened 
upon 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 sit- 
ting sidewise upon the table. The practitioner sits upon a low 
stool 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 
inequality, or, on the other hand, that an assumed position does 
not mask the lesion. 

With the patient sitting or lying on the side, careful pal- 
pation 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 by having the pa- 
tient hold the tape between his teeth in the mid-line of the body, 
from which point measurement is made to the inner malleolus 
of the tibia on each side. Tilting of the pelvis cannot be ascer- 
tained 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 pre- 
liminary step may usually be made with advantage by thor- 
ough 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. 

(1) For backward tipping, the assistant stands in front and 



58 PRACTICE OF OSTEOPATHY. 

draws the pelvis forward, while the practitioner stands behind r 
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 rotation of 
the body from one side to the other during the lifting process 
helps the reduction of the lesion. 

(2) For tilting upward on one side or for turning to either side, 
this same treatment may be applied -with variations to suit the 
condition. 

(3) For tipping forward, the assistant stands behind and 
draws the pelvis backward, while the practitioner manipulates 
the trunk from in front, in a similar manner as before, grad- 
ually 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 pelvis 
carefully forward. 

(6) For tilting upward of the pelvis, one may adapt to the 
reduction of this lesion the treatment described in Chap. VII, 
A, Downward Displacements of Lower Ribs, for the stretching 
of the quadrati lumborum muscles. 

(7) For turning of the pelvis to one side, one may adapt to 
the reduction of this lesion the treatment as described in Chap. 
II, div. XVIII, third treatment. 

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 relatively more important. 

The general indications of innominate lesion, which would 
lead one to examine for such displacement, are back-ache, sciatica, . 



PRACTICE OF OSTEOPATHY. 59 

pain or lameness in the limbs, limping or unequal gait, pelvic 
disease, female disorders, etc. 

The lesions of the innominate commonly met with are: 

I. The innominate displaced forward or backward. 

II. The innominate displaced upward or downward. 

III. Combinations of the above, which are the rule. It is 
rare that the simple lesion I or II is found. Frequently the 
displacement is downward and backward at the same time, lentgh- 
ening the leg. This lesion is, on the whole, the most common 
but the opposite luxation, forward and upward, 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 the 
latter 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 always 
combine. The luxation may be back and up, or vice-versa. 
Yet, whatever the combined lesion be, a lengthened limb indi- 
cates a downward displacement of the innominate, while a short- 
ejied limb shows the reverse. 

There are numerous points upon the lateral articular surface 
of the sacrum, any one of which may act as the fixed point about 
which ,the innominate bone may rotate. This fixed point may 
be termed the axis of rotation, and its location determines how 
the innominate rotates, and whether the leg be lengthened or 
shortened as a result of the lesion. Thus, if the axis of rotation 
be located upon the upper and anterior part of the auricular sur- 
face of the sacrum, the innominate may rotate forward, while 
at the same time the posterior superior spine is thrown upward 
and the leg is lengthened. 

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 auri- 
cular 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 



60 PRACTICE OF OSTEOPATHY. 

forward, according to the direction of the forces causing the 
lesion 

IV. Each innominate may suffer from lesion at the same 
time, which ma}- be alike upon both sides, or different. 

EXAMINATION: PALPATION, aided by INSPECTION, is used 
in the examination. 

I. The length of the limbs is compared, and is one of the first 
and most reliable methods of examining for lesion of the innom- 
inate. 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 prevent any unnatural 
tension in these structures from causing merely apparent differ- 
ence 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 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 indication, that one innominate is luxated, further ex- 
amination is necessary to determine whether one leg is too long, 
or the other too short, or both. 

II. Tenderness in the sacro-iliac ligaments upon deep pres- 
sure, and tenderness in the tissues along the crest of the ilium indi- 
cate that the lesion is upon the side upon which such tenderness 
occurs. The sacro-iliac ligaments are found tensed upon the 
side of lesion. 

While this tenderness and tension will usually indicate uni- 
lateral lesion, it is not an invariable sign, as the strain thrown 
upon the opposite side often causes like effects. 

Tenderness at the pubic symphysis is often present in these 
cases. 

III. The position of the posterior superior iliac spines is the 
best indication of lesion, receding anteriorly, prominent poster- 
iorly, up, or down, down and back, forward and up. etc., indi- 
cating 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 



PRACTICE OF OSTEOPATHY. 61 

i 

the patient, palpation of both spines alike is made at the same 
time, one hand upon each. This facilitates comparison. 

IV. The waist-line is frequently changed in each case. 
Usually that upon the side of lesion is deeper through the pa- 
tient's favoring that side; bending toward it. For the same 
reason the muscles about the hip, pelvis and lower spine upon 
the opposite side may be hypertrophied. 

V. The spine adjacent to the pelvis must be examined for 
curvature, swerving to one side, hypertrophy or tension of 
tissues, etc., secondary to pelvic lesion. 

VI. Measurements may be made from the mid-line of the 
teeth to the inner malleolus of each tibia. 

TREATMENT: Preliminary relaxation of all surrounding 
tissues is first done by methods already described. 

I. BACKWARD LUXATIONS and their combinations: 

a. Patient lies upon his back; the 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 thorax and is rotated outward strongly enough to 
raise the weight of the patient and throw it upon the clenched 
hand. In this way the weight of the body is made to force the 
bone forward. 

b. The patient lies upon his side; the 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 pos- 
terior crest. He now draws forward upon the latter point while 
he pushes backward upon the tuberosity. By pulling forward 
on the tuberosity and pushing backward on the crest, the an- 
terior 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; the practitioner stands 
behind the pelvis, making pressure with his hand upon the upper 
back part of the innominate, while at the same time he draws 
the uppermost thigh backward. This forces the bone forward. 

II. FORWARD LUXATIONS and their combinations. 

a. The patient lies on his side, lesion uppermost; the practi- 
tioner stands behind the sacrum and places his hand or the flat 



62 PRACTICE OF OSTEOPATHY. 

surface of his knee against the lower part of the sacrum, while 
he draws backward upon the anterior spine and crest of the lux- 
ated 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 treat- 
ment described in chapter VII, A, for the stretching of the quad- 
ratus lumborum muscle. 

For downward luxation see "a" above. 

The SACRUM and COCCYX 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 may require. 

C. GENERAL POINTS CONCERNING THE PELVIS. 

The pudic nerve and 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 third 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 thirds 
of a line drawn from the posterior superior spine of the ilium to 
the outer side of the great trochanter when the thigh has been 
rotated forward. 



PRACTICE OF OSTEOPATHY. 63 

Deep manipulation may be made over the course of the 
iliac blood-vessels, 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 manipu- 
lation. 

The spermatic or ovarian vessels may be manipulated by 
deep pressure along a line beginning at the level of the umbil- 
icus, one inch external thereto, 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 vessels one aids the venous flow by cen- 
tripetal progress along the lines defined. As an aid in relieving 
or restoring blood-flow in various pelvic diseases the treatments 
are of value. 

The hypogastric plexus 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 pelvic plexuses are 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 PER RECTUM. 

The index finger is generally used in rectal work as its use 
is less interfered 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 nor- 
mal; 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 rec- 



64 PRACTICE OF OSTEOPATHY. 

turn and is felt in that position about one one-half inches from 
the anus. Either lateral lobe, or the central lobe may be enlarged. 
In the latter case, stricture of the urethra is threatened, as the 
gland surrounds its first part. 

TREATMENT: In prolapsed and weakened walls the finger 
should smooth out the walls and press them upward as far as 
possible. This aids reposition, tones nerves and blood-force, 
and helps to establish normal tone in 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. Its surround- 
ing tissues should be well relaxed. 

In haemorrhoids, all the surrounding tissues are gently 
manipulated for relaxation and to remove interference with 
free circulation, after which pressure is made directly upon the 
distended vessels to empty them of blood, and to gently force 
them back into place if external. (See " Haemorrhoids. ") 

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 VAGINAM. 

The examination is made with the index finger for the 
same reasons as in the case of rectal treatment. The same pre- 
cautions as to cleanliness, etc., should be observed. 

As a rule local treatment is secondary to that done upon 
spinal or pelvic lesion, which is usually the real cause of those 
conditions which require local treatment. 

It is proposed here to review this subject only in a gen- 
eral way, giving the main points in connection with the exam- 
ination and treatment of this region as a part of the body, leaving 
detailed consideration to the portions of the course dealing with 
the specific diseases of these organs. 



PRACTICE OF OSTEOPATHY. 65 

I. LOCAL EXAMINATION: The patient on her back or on 
her side, preferably in the Sims position. * In the latter case 
the practitioner stands behind. The index finger anointed with 
vaseline is introduced, passing from the region of the fourchette 
forward. The guiding hand is placed upon the abdomen (bi- 
manual palpation) and by deep pressure may aid in locating 
the organ and in diagnosing its position. External pressure 
over the region of the broad ligaments will sometimes reveal 
tenderness in them in cases of prolapsus uteri. In case the ten- 
derness is unilateral it is usually in the ligament suffering from 
the most tension because of the organ having fallen toward the 
opposite side. 

The examining finger should first note the condition of the 
vaginal walls, which may be weak and flabby, or prolapsed and 
contorted by the malposition of the uterus. The presence of 
enlargement or tumor of surrounding organs is to be noticed. 
At the upper extremity of the vaginal canal is felt the cervix 
protruding into the canal. 

The external os uteri 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 trans- 
verse axis may be distinguished. This is made more certain by 
the shape of the cervix, which is somewhat flattened antero- 
posteriorly. By these two points, the transverseness of the os 
and the position of the cervix, the diagnosis of the position of 
the uterus is greatly aided. If the transverse os (or the longer 
transverse diameter of the cervix) has assumed an oblique di- 
rection in the pelvis, it indicates a corresponding turn in the 
position of the organ. This turning to one side is usually com- 
bined with the prolapsus or version 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 falling backward, so that the 
fundus lies down toward either sacro-iliac region. If the cervix 
points backward and upward, it indicates that the fundus has 
descended anteriorly upon the bladder. It may often be felt 



66 PRACTICE OF OSTEOPATHY. 

through the anterior vaginal wall. There are all degrees of 
prolapsus, and malposition. Some may be so slight that the 
cervix and fundus have deviated but little from normal position. 
By noting the direction of the os, the direction of the cervix, and 
(if possible) the position of the fundus, no difficulty is usually 
experienced in discovering the form of malposition 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 cervix remains near normal position while 
the fundus is found backward, retroflexion is diagnosed. 

In these cases, retroflexion, anteflexion, etc., the uterus is 
bent over on itself. The examining finger detects the bend hi 
the organ by finding itself in the space between fundus and cervix. 

Adhesions are noted by the fixity of the uterus in malposi- 
tion; its resistance to pressure directed toward its normal posi- 
tion, or to positions assumed by the patient to aid in replacing it . 

II. LOCAL TREATMENT: The patient may lie upon the 
back, upon the sid<e, or kneel upon the table with the trunk in- 
clined 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 the table and 
stand upon the floor, bending forward to remove the weight of 
the viscera above, while the finger presses the organ toward its 
position. In any case, the idea of the treatment is to so manipu- 
late the cervix, by pressure 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 may be dilated, and 
atmospheric pressure aids materially in forcing the uterus 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 round ligaments of the uterus may be located and may 



PRACTICE OF OSTEOPATHY. 67 

be stimulated by pressure upon the upper margin of the pub- 
ic arch, about a half an inch externally from the symphysis. 

Inspection of the female perineum sometimes reveals a 
downward bulging of it in place of the natural slight arch of 
the healthy perineum. Such a condition indicates prolapsus 
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 
dow r n toward the perineum. The first hand, meanwhile is tend- 
ing to spring the tuberosities toward each other. 



CHAPTER X. 
THE LIMBS. 

I. SHOULDER DISLOCATIONS. The head of the humerus 
may be dislocated 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 assist- 
ant, the practitioner stands at the side, rests his foot upon the 
stool and places his knee in the patient's axilla. Traction is 
now made directly 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 pa- 
tient 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, backward, or outward. 

The patient sits, and the practitioner stands 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 
strongly upon the forearm. This will be sufficient for the first four 
dislocations. When the radius is backward, direct pressure 



68 PRACTICE OF OSTEOPATHY. 

upon it is sufficient to reduce it. When the radius is forward 
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 above. The outward dislocation of 
the radius is often accompanied by rupture of the orbicular liga- 
ment. It is reduced by traction and pressure. 

III. WRIST DISLOCATIONS. The radius and ulna may both 
be forward, backward, or outward. Simple traction will reduce 
them. 

IV. RADIO-ULNAR DISLOCATIONS. The radius is regard- 
ed as the fixed bone, the ulna being displaced forward or back- 
ward. 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. 

VI. Dislocations of CARPAL bones are easily reduced by 
pressure. 

VII. METACARPO-PHALANGEAL dislocations in case of the 
thumb are : most frequent. For the backward one, continued 
strong hyper-extension, followed by flexion is used. If this 
treatment does not succeed, the metacarpal is rotated and pres- 
sure is made upon its head. In the forward displacement trac- 
tion and pressure are employed, or strong flexion is followed by 
direct pressure. 

In case of the fingers, simple traction and pressure are suf- 
ficient, 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 dislocations, so frequently given over as in- 
curable. As far as possible he applies the usual motions for the 
reduction of them, but prepares the joint for reduction by ;i 
course of treatment directed to relaxing surrounding muscles, 
etc. ; to restoration of free circulation about the part and the up- 
building of the tissues. Often a persistent course of treatment 
restores a bone to position when it had been given up as hopeless. 
These remarks apply especially to old dislocations of the hip- 
joint. 

GENERAL TREATMENT FOR THE UPPER LIMB. In treatment 
for various conditions the arm is manipulated in special ways. 



PRACTICE OF OSTEOPATHY. 69 

I. The shoulder- joint may 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 lymphatics, 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 elbow may be sprung by flexing the forearm over 
the hand placed upon the arm just above the bend of the elbow. 
Or the fore-arm may be flexed to a right angle, and the treating 
hands draw it away from the lower end of the humerus. They 
may follow along down the fore-arm, working deeply between 
radius and ulna to relax the interosseous tissues. 

III. The branches of the brachial plexus and the axillary 
artery may 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. 

IV. Contracture of the anterior fibres of the deltoid muscle 
and attendant slight forward luxation of the head of the humerus, 
may be remedid 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 move- 
ment is finished with a slight upward turn. 

V. The biceps muscle and its long head may be strongly 
stretched by drawing the extended fore-arm directly backward 
and upward. 

VI. The tendon of the long head of the biceps may be dis- 
placed from its groove, usually inward causing serious trouble 
in the arm. It is then felt upon the anterior surface of the hu- 
merus and is very sensitive. It may be stretched as in V,. after 
which the arm is flexed and the tendon is pressed back into its 
groove. 

In such cases Dr. Still flexes the fore-arm to a right angle 
with the arm and, with a quick motion, swings it around against 
the front of the body, suddenly then raising the flexed arm out- 
ward laterally from the body up to a horizontal position. The 
effect of this motion is to turn the groove on the humerus in to- 
ward the displaced tendon, which lodges against the caracoid 



70 - PRACTICE OF OSTEOPATHY. 

process of the scapula. The latter thus, so to speak, is used to 
push the tendon into the groove, where it is secured by the sud- 
den tension put upon it by raising the arm to the horizontal 
position. 

GENERAL TREATMENT FOR THE LOWER LIMB. 

I. Strong flexion of the thigh on the thorax and the leg 
upon the thigh stretches the quadriceps extensor muscle, but 
particularly the posterior portions of the gluteal muscles, and 
the gluteal portion of the sciatic nerve. (See also VI below.) 

II. Hyper-extension of the thigh stretches the anterior 
structures, including the femoral vessels and anterior crural 
nerve. 

III. Hyper-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 cither leg straight and abducting it to the ex- 
treme. He may stand between the legs. The same object is 
accomplished by flexion combined with external circumduction. 

V. The muscles of external rotation of the thigh are stretched 
by flexion combined with internal circumduction. 

VI. The extensor muscles of the thigh 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. This stretches the 
sciatic nerve. This nerve is also stretched by motion I. Motion 
V stretches the pyriformis, gemelli, 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 midline of Scarpa's triangle, about two 
inches below the middle of Poupart's ligament, impinges the 
femoral vessels and the anterior crural nerve. 

VIII. The popliteal nerve and vessels are reached at the 



PRACTICE OF OSTEOPATHY. 71 

popliteal space. The patient lies upon his back. The limb is 
drawn over the edge of the table and the foot is supported be- 
tween 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 liga- 
ments of the ankle. 

All of the treatments described for the upper and lower 
limbs are given in a general way. They may be used in the 
treatment of specific cases in various ways. One should not 
forget that they are used as aids in the reduction of special le- 
sions, or as secondary thereto. 

X. In treatment upon the feet one notes the two natural 
arches, the transverse and the longitudinal. Springing these 
arches by pressure upon the arch above and traction at the same 
time upon the ends, aids in relaxing ligaments and other tissues, 
reducing bony luxations, removing pressure from nerves and 
blood-vessels. The treatment may be made more effective by 
springing the arch both ways, i. e., first applying pressure such 
as to increase the concavity of the arch, then to lessen it. 

XI. In treatment for the toes the blood-vessels, which lie 
upon the sides, are stretched, and the tissues about them re- 
laxed, by bending them laterally. The lateral movements, 
combined with extension, flexion, and traction, free the joint 
and its nerves, vessels and tissues. 

XII. The saphenous opening, an inch and a half below the 
inner end of Poupart's ligament, is often in an occluded condit- 
ion such as to seriously impede the flow from the long femoral 
vein. The muscles and tissues about it may be stretched by ex- 
ternal rotation of the flexed knee. Following this movement by 
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 reveals 
tenseness or laxness of the rotators or ligaments of the thigh, and 
may lead one to the discovery of abnormal pelvic or hip con- 
ditions. 



72 PRACTICE OF OSTEOPATHY. 

Concerning DISLOCATIONS of the lower limbs, one must bear 
in mind that many of the cases presented to the Osteopath are. 
old dislocations. The success of Osteopathy 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 slight dis- 
placement 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 discovered 
by others than Osteopaths indicates something of the need and 
importance of osteopathic methods. The practitioner must 
bear in mind the probability of such occurrences, and must be 
upon his guard to discover them. As a rule, in all old disloca- 
tions and chronic subluxations of this nature, the really im- 
portant osteopathic work is the preparation of the parts for the 
restoration of normal relations. Relaxation of old contractures 
in muscles, softening ligaments, development of atrophied parts 
through the upbuilding of blood and nerve-supply are the pre- 
liminary steps taken by general osteopathic methods already 
described. In case of such luxations, gross dislocations ex- 
cepted, 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 to other methods of practice. 

I. DISLOCATIONS OF THE ANKLE: The displacement may 
be both leg bones forward, inward or outward. In either case, 
the patient lies upon his back, the knee is flexed, the leg is ele- 
vated to a right angle with the thigh 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, outward, or twisted. Strong traction re- 
stores it to place. 

In cases of slight backward luxation, short of dislocation, 
a good method is to have the patient lie on his back, hang the 
leg, bent at the knee, over the edge of the table, while the foot 
is supported between the practitioner's knees and his hands 
work in the popliteal region. The hamstring muscles are grasped 



PRACTICE OF OSTEOPATHY. 73 

by the two hands and stretched away laterally from the con- 
dyles of the femur, while the tibia and fibula are drawn forward. 
III. DISLOCATIONS OF THE HIP: In such cases, the head 
of the bone may be displaced as follows: 

(1) 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, some- 
what shortening the limb, and turning the toes inward. 

(3) Forward and downward onto or near the obturator fora- 
men (thyroid dislocation), in which the knee is flexed, the toe 
points to the ground and rotates inward and or outward. 

(4) Forward and up onto the pubic crest. The toe invari- 
ably turns out. 

In (2), as the patient sits up from a lying posture, the limb 
shortens; in (3) and (4) it lengthens. 

In the treatment of such conditions, fresh dislocations are 
set at once, but as in our practice many old dislocations are pre- 
sented, the success of the treatment lies largely in knowing how 
to thoroughly prepare parts for adjustment. Much lies in our 
way of regarding disease, for even gross dislocations are often 
overlooked. These, and the many luxations of lesser degree 
found in osteopathic diagnosis, could scarcely be overlooked in 
our method of minutely scrutinizing the mechanical relations of 
all parts in examination of a case. 

In (1) the knee is flexed and rotated a little inward to dis- 
engage 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. It is of great importance to note 
that during the outward circumduction and extension of the limb 
in this manoeuvre the foot must be held with the toes pointing 
inward, toward the body. This directs the head of the femur 
toward the acetabulum. This draws the head into the aceta- 
bulum. The patient is lying on his back. 

In (2) the manoeuver is the same, except that during out- 
ward 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 



<4 PRACTICE OF OSTEOPATHY. 

head from the obturator foramen, while the "Y" ligament acts 
as a fulcrum. As the inward rotation 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 hyper-extended by being strongly 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 (1) and (2) the patient may sit upon a stool, the dislo- 
cated limb is crossed above the other knee, the pelvis is fixed 
by an assistant, the trochanter 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 (1) and (2) the patient may stand upon one foot, sup- 
porting his hands upon the back of a chair; the thigh remains 
straight, and the knee is flexed to a right angle; the ankle is sup- 
ported by the practitioner who stands at the side of and behind 
the patient. He now 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 
disengages it. Now a swing inward, while the weight is still 
applied, brings the head into the acetabulum. 

These various motions may be applied to subluxations as- 
well as to gross dislocations. 



PRACTICE OF OSTEOPATHY. 75 



PART II. DISEASES. 



NOTE. It is the intention to deal here only with the osteopathic views,, 
principles, and methods in relation to the various diseases considered. Any 
standard medical text will supply the reader with those facts, theories, etc.,. 
which he may desire to know, and which it is unnecessary to reprint here. 



DISEASES OF THE RESPIRATORY TRACT. 

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 muscular fibers or by 
swelling of the mucous membrane from hypermia. 

CAUSE: This disease always presents definite lesions, mus- 
cular and bony, of the upper dorsal spine and of the thorax. 
Secondary lesions usually occur in the cervical region. The 
chief bony lesions affect the ribs from the second to the sixth on 
the right side. (Dr. A. T. Still.) The majority of cases show- 
lesions of this region, but they may occur higher up or lower 
down. Lesion is often found in the neck. The sternal ends of 
the ribs and the costal cartilages, as well as the spinal ends of 
the ribs may show the lesions. Lesions of the ribs from the sec- 
ond to the seventh on either side; of the corresponding dorsal 
vertebrae; of the anterior and posterior thoracic muscles; of the 
atlas, axis, and hyoid bone, and of the cervical muscles are all 
active in producing the disease. A case is reported in which- the 
bony lesion was in the lumbar spine, constipation also being a 
feature of the case. No treatment was given above the lumbar 
region, but the asthma was cured. It was regarded as being 
reflex from the lumbar lesion. (See case 13). 

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 definite area in which such causes occur. 



76 PRACTICE OF OSTEOPATHY. 

(1) Luxation of first, second and third left ribs. 

(2) Fourth, fifth and sixth dorsal vertebra anterior: the 
corresponding ribs lowered. Two treatments stopped the at- 
tacks, and patient 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. 

(5) The scaleni, mastoid and anterior and posterior thoracic 
muscles very tense. 

(6) Right fourth and fifth ribs, and left fifth and sixth ribs 
luxated. 

(7) The axis luxated to the right, cervical muscles contrac- 
tured, all the ribs depressed. 

(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 hyoid bone. 

(10) The second dorsal vertebra luxated laterally, involv- 
ing the corresponding ribs; several ribs down. 

(11) All the upper dorsal vertebrae anterior, carrying the 
ribs forward: closeness of the first rib to the clavicle. 

(12) Third, fifth, and seventh right ribs luxated down- 
ward at their anterior ends; their heads were also luxated; atlas 
and axis to the right. The patient had previously been a suf- 
ferer from bronchitis, with upper dorsal and rib lesions. Ac- 
cidental slipping of the third rib caused asthma at once. Irri- 
tation from the fifth rib always caused expectoration of quan- 
tities of sputum, but if the third rib were kept in place the asthma 
disappeared at once. 

(13) Female: age 22; single; book-keeper. Lumbar region 
much posterior; constipation and dysmenorrho?a accompanied 
the asthma, which was of two years' standing. Xo neck, rib, 
or thoracic spinal lesion appeared. The heart was irregular, 
dropping one beat in four. No treatment was given above the 
12th dorsal, and as soon as the constipation was cured (3 mos.) 
the asthma and dysmenorrhoea disappeared. The patient had 
not had a night's sleep in more than a year without the use of a 



PRACTICE OP OSTEOPATHY. 77 

powder which she burned, inhaling the fumes. The bony lesion 
was removed, and cure resulted. The asthma was reflex from 
the lumbar condition and diseases present. 

(14) A fourth rib displaced, causing asthma, accompanied 
by bronchitis and pleurisy. The whole spine was stiff. After 
two treatments the patient was free from asthma, and was dis- 
charged cured after six treatments. 

(15) Asthma and Hay Fever. Male, aged 38; grocer. One 
clavicle was depressed. Raising it gave immediate relief. The 
upper spinal muscles were contractured. These were relaxed 
and the ribs, from the 1st to 5th on the left side, were raised. 

(16) Female, aged 23. A fall in childhood caused a lateral 
curvature from the lower dorsal to the sacral region, the lumbar 
reigon being also anterior. The right limb was much smaller 
and shorter than the left; the ankle stiff; the flesh always cold; 
menstrual flow every two weeks. After two weeks treatment 
the asthma disappeared. Under further treatment constant 
improvement was taking place in the general condition. 

(17) Male, aged 43; married; overseer of land and oil wells. 
3d, 4th, 5th, and 6th dorsal vertebrae posterior, especially the 3d. 
The cervical muscles were badly contractured, due to the atlas 
being displaced to the right. 

Relief was given at once in treatment by pressing the dorsal 
vertebra? forward, throwing the upper ribs and clavicles for- 
ward. The condition was complicated with hay-fever, which 
was also cured. 

One can but note how all of these lesions occur in those 
reigons in which it is claimed the cause of asthma occurs. No 
other school of practice notices such causes of this disease. 
Their theories are various, many exciting causes are agreed upon, 
but Anders makes the statement in regard to the real and orig- 
inal causes that they are of an unknown nature. 

These lesions 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 membrane. 

There are good ANATOMICAL REASONS why lesions in these 
regions affect the lungs. The American Text Book of Physi- 



78 PRACTICE OF OSTEOPATHY. 

ology 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. Quain's 
anatomy says that the pneumogastrics convey motor fibers to 
the unstriped muscle fibres of the trachea, bronchi, and their 
subdivisions in the lungs. Vaso-constrictors for the lungs ex- 
ist, 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 posterior, of the pneu- 
mogastrics and branches from the second, third, and fourth 
thoracic sympathetic ganglia. These regions of the spine, with 
their important nerve connections with the lungs, are naturally 
investigated by the Osteopath in relation to asthma. It is rea- 
sonable that obstruction to the nerves here should cause the dis- 
ease. Anders gives among 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 medul- 
la as well as of the prieumogastric, through their sympathetic 
and spinal nerve connections. In these ways, lesion to the cer- 
vical, dorsal and upper thoracic structures act as obstructors of 
these nerve mechanisms concerned in asthma, the pneumogastric 
nerves, pulmonary plexuses, sympathetic and vaso-motors, and 
cause the disease. 

Exciting Causes of the paroxysm, 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 diseases, etc., would not act to 
cause asthma did these anatomical lesions not exist. They are 
the real cause of the condition. Existing in an individual, they 
obstruct the vital forces of the bronchi and deteriorate the vital- 
ity of their tissues, perhaps gradually during a term of years, 
and make it possible for these various exciting causes to act. 

The PROGNOSIS is good under osteopathic treatment, though 
under medical treatment comparatively few cases recover. Very 
many cases, a large number of them apparently helpless, have 
been cured. The fact that most of these cases coming under 
osteopathic treatment are of long standing and have usually 
tried every known remedy seems to make little difference in 



PRACTICE OP OSTEOPATHY. 79 

gaining results upon them. Some cases the most severe and 
longest standing yield quickest. 

EXAMINATION AND TREATMENT are carried out according to 
the methods described in Part I, (Chapters I, II, III, IV, VI, 
VII.) Any of the lesions that may affect the bony parts in the 
regions mentioned may produce the disease. Displacements 
of ribs, vertebrae, etc., need not take place in a particular direc- 
tion. Rib and thoracic vertebral lesions are more likely to 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 anatomical derangements or le- 
sions named, as that subject has been fully dealt with elsewhere, 
as well as the theory of the exact way in which such lesions as 
the Osteopath finds act to cause disease. 

TREATMENT must always depend for its success upon re- 
moving the causative lesion, but treatment during 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 
treatments. At this time great relief is given and the spasm 
usually quieted by thorough relaxation of the spinal muscles 
(Chap. II, div. I), followed by raising of all the ribs (Chap. VII) 
and clavicles to allow free thoracic and lung action, and by re- 
laxation 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, by 
methods already described. 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 (Chap. II, div. XV.) 
the clavicles raised (Chap. XII); the tissues of the neck thor- 
oughly relaxed, the spinal column relaxed (Chap. II, div. II, 
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, or all of the ribs, will sometimes give relief. Pressure 
upon the phrenic nerve aids the work by relaxing the diaphragm, 
which is sometimes elevated (Chap. Ill, div. VIII.) 



80 PRACTICE OF OSTEOPATHY. 

Treatment once a week or ten days is often enough in most 
cases. Frequent 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 treat- 
ment. 

Under this course of treatment the patient usually feels 
relief at once. As a rule the spasms and the various attend- 
ant 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 ven- 
tilated rooms. The diet should be light and easily digested to 
avoid danger of stomach reflexes, and the patient should avoid 
dust and other exciting causes. 

BRONCHITIS. 

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 
disturbance of the vessels of those membranes, due to specific 
lesions in the upper, spinal, anterior and posterior thoracic, and 
cervical, regions. These lesions may be bony displacements, ' 
muscular contractures, ligamentous derangement, etc. 

CAUSE: These specific lesions cause the condition by ob- 
structing 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 typified by the fol- 
lowing cases: (1) Luxation of atlas and axis, depression of 
hyoid bone, lowering of upper eight ribs, congestion 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 anteriorly. (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 



PRACTICE OF OSTEOPATHY. 81 

dorsal vertebrae. (7) Luxation of the first, second and third 
ribs. (8) Displacement of the anterior ends of the first, second 
arid third ribs, and derangement of these cartilages. (9) Bi- 
lateral contracture of the cervical and spinal muscles as low as the 
sixth dorsal. (10) Second to fourth dorsal vertebrae lateral. 

(11) Luxation between manubrium and gladiolus of the sternum. 

(12) A case accompanied by torticollis and a weak heart in a 
female, age 24, teacher by occupation. Upper four cervical 
vertebrae to the right and ankylosed ; a lateral swerve of the spine 
from the 4th to 9th dorsal. 

The ANATOMICAL RELATIONS between these lesions and the 
seat of the disease are clear. While generally located higher 
than in the case of asthma, they still fall within the vaso-motor 
area to the lungs. As to lesion of atlas,' axis, and other cervi- 
cal tissues, in relation to the vagus and cervical sympathetics, 
as well as of the upper dorsal vertebras, ribs, and muscles to the 
vaso-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 pro- 
duce the inflammation of the membranes. Luxations of the 
clavicle and first rib anteriorly are anatomically related to the 
disease as causing contracture of the anterior deep cervical tissues, 
thus obstructing both phrenic and pneumogastric nerves, con- 
cerned in innervation of the lungs, retarding the circulation of 
the cervical vessels, and collaterally obstructing circulation in 
ihe lungs. The general dilatation of 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 those muscle fibers. The 
same explanation probably accounts for local thinning and di- 
latation 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 bften the sequel of catching cold is sug- 



82 PRACTICE OF OSTEOPATHY. 

gestive from an osteopathic point of view. The contraction of 
muscles and tissues from exposure may be sufficient lesion, or 
may produce actual bony luxations by 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 bony lesions the cause. Also, it is significant to note 
that the obese are particularly subject to bronchitis because the 
weight of the flesh aggregated about the chest walls acts as a 
mechanical impediment to free rib-action free breathing, thus 
favoring sluggish circulation and weak tissues which are prone to 
congestions and inflammations. 

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 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 thorough treatment should be given the spine, 
thorax and neck to relax all contracted tissues. Easing of the 
tension in this way gives great relief, as the constriction of the 
chest and neck causes much of the discomfort from which the 
patient suffers. This is aided by raising all the ribs. Treatment 
of the neck corrects the action of the vagus and aids in dispelling 
the inflammation by its participation 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 irrita- 
tion to the phrenic, vagus, and cervical vessels. Thorough treat- 
ment of the spine from the second to the seventh dorsal vertebra 
(vaso-motor area) aids in equalizing bronchial circulation, the 
work on the left side as low as the sixth aiding this result by 
strengthening the pulse beat. This initial portion of the treat- 
ment should be brisk and energetic enough to arouse good re- 



PRACTICE OF OSTEOPATHY. 83 

action. It relieves the patient at once of the constriction, languor, 
and aching pain in the back. It frees the lungs and starts per- 
spiration. 

The patient should be laid on his back and the upper an- 
terior ribs, cartilages and intercostal structures be thoroughly 
treated. Strong manipulation of the tissues upon the anterior 
chest and along the sternum reddens them and acts as a mus- 
tard plaster would. These treatments, together with treat- 
ment 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 equalization of circulation wrought by the 
general treatment, and by pressure in the superior cervical re- 
gion, affecting the superior cervical ganglion via the upper cervical 
nerves. 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 hypogastric plexuses. By 
the process of raising the ribs and treating the spine, the en- 
gorged azygos major vein is emptied. The restoration of free 
thoracic play by these treatments is an important consideration 
in the equalizing of the circulation throughout the lungs. 

A hot mustard plaster over the anterior chest, or a hot full 
bath, are efficient aids. 

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 additional 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 thin- 
ning of the walls, close attention to the vagus nerve should be 
given for reasons already explained. 

Good care should be taken of the patient, particularly as 
to guarding against exposure, which may lead to complications. 
Treatment should be given bowels and kidneys to keep them 
active. The obese should be taught the habit of deep respiration 
as should all persons subject to attacks of the disease. This 
measure, together with the daily cold sponge or shower bath, is 
a great aid in overcoming the chronic tendency. 



84 PRACTICE OF OSTEOPATHY. 

BRONCHIECTASIS is successfully treated. The condition 
frequently comes under treatment as a complication in chronic 
bronchitis, asthma, etc., being benefited or perhaps practically 
cured along with the primary condition. As this condition is gen- 
erally a result of chronic bronchial catarrh, and is frequently 
associated with emphysema, chronic bronchitis, and asthma, 
the lesions found causing it are similar to those found in these 
diseases. One would expect such lesions as have been pointed 
out as the cause of vaso-motor derangement in the bronchi, 
leading to the chronic, catarrhal condition which so often causes 
it. These lesions occur mostly in the upper dorsal region, be- 
tween the 2d and 7th. One notes that in bronchitis the dilata- 
tion of the air-tubes is probably due to lesion to the vagus nerve, 
whose fibers innervate the muscles controlling the calibre of the 
tubes. Hence cervical lesion to the vagus might be the cause 
of the disease. The lesion may be entirely those of the primary 
condition, followed by bronchiectasis, as in cases in which the 
tumors, aneurysms, enlarged glands, cicatricial contractions in 
interstitial pneumonia, etc., cause mechanical obstruction of the 
bronchi and lead to their dilatation. 

The TREATMENT of this condition would give much relief, 
but it is questionable whether the majority of cases could be 
cured entirely. They are frequently much helped by the treat- 
ment of a case of asthma, chronic bronchitis, etc. Some cases 
have been cured. 

The removal of a foreign body or other obstructing cause 
as pointed out above; the removal of lesion from blood and 
nerve-supply of the bronchi: thorough stimulation of the vagi 
to give renewed tone to the muscles in the bronchial walls and 
to aid their contraction; treatment of the bronchial vaso-motor 
center (2nd to 7th dorsal) to aid in strengthening the bronchial 
walls and in overcoming the chronic catarrhal condition of their 
lining membranes, are all necessary. In this way the case could 
be much improved. The purulent and fetid expectorations 
would be remedied as the renewed blood-flow began to restore the 
secretions to their normal quality. To some extent the structural 
changes in the bronchi could be repaired and their further pro- 
gress prevented. 



PRACTICE OF OSTEOPATHY. 85 

i 

HAY-FEVER. 

DEFINITION: Hay-fever, or Autumnal Catarrh, is a dis- 
ease of the upper respiratory tract, styled by some writers a 
form of asthma. It is caused by specific lesions in the upper 
dorsal, thoracic and (especially) 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, 
leading to an inflammatory or catarrhal condition. 

LESIONS: The anatomical causes for this condition are, 
from the osteopathic 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 upoji the blood-vessels of the upper respiratory tract. 

CASES: (1) In one case, complicated with asthma and 
bronchitis, the scaleni, stern o-mastoid, and anterior and pos- 
terior thoracic muscles were contractured. (2) In another, 
lesions were found affecting the inferior cervical and upper thoracic 
regions. 

In other cases lesions were found as follows: (3) Right 
fifth rib; (4) contracture of the muscles from the 1st to 10th 
dorsal vertebra, with ribs in this region drawn down; (5) sec- 
ond cervical vertebra to the right and posterior ; (6) second cervi- 
cal vertebra right, cervical muscles contractured, upper three 
or four dorsal vertebrae to the right. (7) See "Asthma," case 
15; (8) see "Asthma," case 17. In addition to these, lesions of 
the atlas, of the phrenic nerve, of the clavicles and upper three 
ribs (especially 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 readily explained by noting that lesions 
for all of these conditions 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 verte- 
brae, the clavicle and the first and second ribs, are always ex- 
pected in case of hay-fever. Purely muscular lesions are. rela- 



86 PRACTICE OF OSTEOPATHY. 

lively less important than other kinds as they are more likely 
to be secondary lesions. 

The ANATOMICAL RELATION of lesion to disease in this case 
seems clear. The lesions mentioned affect the vagus, cervical 
sympathetic, and vaso-motor nerves as already explained. They 
also affect the fifth cranial nerve through the cervical sympathetic, 
including the superior cervical ganglion. This is the nerve which 
causes the 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 closely connected by the floor of the fourth ventricle, 
the superior ganglia, and the cervical sympathetic. Lesions to 
the vagus in the region of the clavicle and first rib, and to the 
sympathetic in the cervical region and in the upper thoracic 
region of the spine, may affect one or both of these nerves. Ac- 
cording to Ho well's American Text Book of Physiology, vaso- 
dilator fibers for the face and mouth leave the cord at the 2d to 
5th dorsal, pass up the cervical sympathetic to the superior cer- 
vical ganglion, thence to the Gasserian ganglion of the fifth and 
to the regions mentioned. Thus a low lesion, affecting nerves 
which ascend to supply these parts, may be 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. 

"Modern Medicine" describes Hay-Fever as "A vasomotor 
paralysis." 

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 mucous membranes, etc., 
may produce attacks, shows that there are other causes, some of 
them mechanical, accounting for an irritable nasal mucous mem- 
brane or acting as an irritant upon it. It is reasonable for an 
Osteopath to maintain that lesions act as obstructions to natural 
nerve and blood-supply to these membranes, weaken them and 
lay them liable to the action of various irritants, thus being the 
real cause of the disease. Immunity from attack in certain cli- 



PRACTICE OF OSTEOPATHY. 87 

mates or altitudes is but alleviation, or possibly cure, by allowing 
Nature a chance. 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 upon his again ex- 
posing himself to the same irritant. Although a patient is more 
liable to attacks in rural districts, more city people contract the 
disease, showing that a locality in which much pollen occurs has 
nothing to do, per se, with the matter. Osier says that McKenzie 
induced attacks by offering the patient an artificial rose to smell. 
Osier states that three elements are necessary to the production 
of the disease; "a nervous constitution, an irritable nasal muscosa, 
and the stimulus." Yet nervous people, with colds or catarrhal 
inflammation of the nasal membranes, may be with impunity 
in districts filled with the common irritants which excite attacks 
in hay -fever subjects. Evidently some further etiological fac- 
tor is necessary, and is found in the specific anatomical abnormality 
pointed out by the Osteopath, the removal of which has, in great 
numbers of cases, cured the disease. The most severe cases 
yield quickly, often, upon the removal of the specific lesion. 
The length of standing of the case seems to have but little rela- 
tion to the length of the 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 rehearsal 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 Osteopath, and held by him to be the cause of disease, are 
the actual causes of this disease. 

The PROGNOSIS, under osteopathic treatment, is good. Many 
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, Anders says that permanent cure is a rare event. 

THE EXAMINATION AND TREATMENT. The removal of le- 
sion is the first consideration. It may, occuring in the region 
described, be any one of the mal-adjustments of tissue considered 
in the general chapters relative to the examination and treat- 
ment of the parts. An immediate effort should be made for its 
removal. In addition special treatment is given to alleviate the 



88 PRACTICE OF OSTEOPATHY. 

condition. All the upper spinal, thoracic and neck muscles, and 
deep tissues should be thoroughly relaxed for freedom of circula- 
tion and to release tension upon nerves. The ribs and clavicles, 
apart from correction of displacement, should- be raised. At- 
tention should be given to releasing and toning the vagus nerve, 
and the vaso-motor nerves from the 2nd to the 8th dorsal. For 
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 fossa? for the superior cervical ganglion, but is done es- 
pecially by relaxation and quiet, deep, inhibitive treatment to 
the facial branches of the fifth nerve (Chap. V. B.) Treatment 
is given along the sides of the nose (Chap. V.) to free 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 (Chap. V. B. II) to open the nostrils. Cer- 
vical treatment, inhibition at the superior cervical region, and 
opening the mouth against resistance (II, Chap. IV), all relieve 
the congested circulation about the head and face, and give much 
relief. Momentary pressure upon both external jugular veins 
causes the blood in them to set back and dilate the veins back to 
the capillaries, after which, being dilated, they carry off more 
blood, relieving the congestion. 

For the sneezing one may make inhibition of the phrenic 
nerve (Chap. Ill, 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 Chap. V, div. IX, 4, and raise it from the 
spine. The latter is a particularly good treatment. 

Treatment is ordinarily given three times per week. The 
patient should be kept from exposure to the particular irritant 
that excites his attacks. 

PNEUMONIA. 

DEFINITION: Lobar Pneumonia, or Lung Fever, is an acute 
inflammation of the parenchyma of the lungs caused by specific 
lesions, bony, muscular, 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 



THE PRACTICE OF OSTEOPATHY. 89 

inflammation of the capillary air tubes, which extends also to 
the lung tissue proper. Chronic Interstitial Pneumonia is charac- 
terized by increase of the interstitial connective tissues. 

CASES: (1) In this case, acute lobar pneumonia, lesion 
existed at the 2nd to 5th dorsal vertebrae; the intercostal, cer- 
vical, and spinal muscles were contractured. 

(2) Marked contracture of the spinal muscles about the lung 
center (2nd to 7th dorsal). 

(3) Acute lobar pneumonia in a woman, aged 38. Temper- 
ature, 102 5-10; pulse, 100; respiration, 38. Cervical and dorsal 
spinal muscles, as well as the intercostals, were rigid; vertebral 
lesion from the 2nd to 5th dorsal inclusive. The crisis was reached 
upon the second day of treatment, after which time no serious 
symptoms existed. On the fifth day temperature, pulse, and 
respiration were found normal and so remained. 

(4) A case in which the temperature was found at 105. 
The cough could be well relieved each time by steady pressure 
at the 2nd, 3rd and 4th dorsal; the pain in the side was relieved 
by raising the ribs and pressing on the left side from the 6th to 
8th ribs. The crisis was reached in seven days and the patient 
was out upon the 12th day. 

CAUSES: Anatomical lesion in the form of displaced bony 
parts, ligaments, 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 generally the 1st, 2nd and 3rd, 4th and 5th; the intercostal 
tissues, including nerves and vessels; the cervical vertebrae and 
tissues; the clavicle and first rib. More specifically, lesions have 
been found affecting the 2nd to 5th dorsal vertebrae; contracture 
of intercostal, cervical and spinal muscles; thoracic muscles; 
4th and 5th ribs; 8th and 9th ribs; the vaso-motor area, the 2nd 
to 7th dorsal; neck lesions to the vagi; to the recurrent laryngeal 
nerves at the 1st and 2nd ribs. 

Dr. Still says that in pneumonia the ribs below the 4th are 
twisted and the lower ribs are down. He lays some stress in 
these cases upon sacral lesion, acting by effect through the sympa- 
thetic system to constrict the blood-vessels of the superficial 
fascia, and to thus throw congestion onto the lungs. 



90 PRACTICE OF OSTEOPATHY. 

The ANATOMICAL RELATIONS of such lesions to the lungs 
have been explained. It is to be noted that the neck lesions as- 
sume greater importance in these cases than in asthma or bron- 
chitis, though there is considerable concentration of lesion about 
the portion of the spine in which is located the most important 
vaso-motor area for the lungs, the region as low as the fourth 
dorsal. In regard to neck lesion, important consideration are 
pointed out by McConnell 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 recur- 
rent laryngeal nerves by luxations of the 1st and 2nd rib, or by 
engorgement of aorta or sub-clavian artery where they are in 
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 ex- 
posure, winter season, and trauma are exciting causes, favors 
the theory that such anatomical lesions cause the disease, for the 
reason that t such conditions are fruitful sources of mechanical 
lesions. The result may be caused directly by them, or they 
may make the anatomical weak points that lead to deterioration 
of the lung tissues 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 weakened by such causes. It is 
of interest, in this connection, to note the remark of Strumpell ; 
that the diplococcus pneumonise exists in the mouths of healthy 
persons. 

If the case be seen before it has passed the stage of en- 
gorgement, the fever may be gotten under control at once, and 
a few treatments may abort the disease. 

This is the experience of our practitioners, although Osier 
says that the disease can neither be aborted nor cut short 
by any means (medical) at command. The means at the Osteo- 
path's command to control vaso-motor action are sufficient to 
relieve the engorgement. In the stages of red and gray hepatiza- 



PRACTICE OF OSTEOPATHY. 91 

tion it is natural that slower results must be expected, as the 
treatment has more work to accomplish. Yet vaso-motor cor- 
rection must lessen the inflammatory process, allow of less solidi- 
fication, and hasten the process of resolution. 

In the first stage there is better opportunity to correct the 
specific lesion, as the patient's strength will allow of such treat- 
ment. The work is also aided by the fact that the alveoli are 
still open, and lung action, stimulated by treatment, may 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 re- 
mains better. In one case the treatment was applied in the first 
stage ; the fever was under control from the first, and the temper- 
ature became normal in three days. In another it disappeared 
in four days; in another in five days. A case in which the tem- 
perature was 104V2 degrees when first seen showed three degrees 
less fever the next morning. It had been treated in the evening. 
In a case in which the temperature was 103 degrees, the tempera- 
ture, 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 persists for from five to ten days, and that 
after its fastigium is reached (usually within a few hours) it re- 
mains remarkably constant, it is evident that osteopathic work 
is successful to a marked degree in bettering the case. 

The PROGNOSIS 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 treatment, as the patient finds it easy to lie on 
the sound side, the muscles and deep tissues are gently but thor- 
oughly relaxed along the length of the spine, particularly 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 given the 
centers for bowels, kidneys, and superficial fascia (2nd dorsal 
and oth lumbar), to rouse them to action and to aid in the elimi- 
nation of poison from the system. 

This initial treatment has thus prepared for the more specific 



92 PRACTICE OF OSTEOPATHY. 

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 cervical tissues, the tissues behind 
the clavicle and first rib, raising the clavicle and depressing the 
first rib, after relaxation of the scaleni muscles. Treatment 
should also be applied to the course of the vagi, and to the re- 
current 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 corrected. The treatment for 
fever is now completed by steady 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 the gradual change now being 
wrought in the patient's system by the recuperated forces. 

The treatment ,for fever may be aided by the deep inhibi- 
tive treatment to the abdomen, before described, to dilate the 
immense abdominal veins and aid in calling away the blood from 
the engorged lung. 

Further treatment is given the lungs, with the patient on 
the back, by gently 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. "In consolidation, the 
right ventricle is subjected to a strain and there is danger of heart 
failure. " (Stevens.) 

For the cough, the treatment should be close and deep along 
the trachea from the larynx to the root of the neck, also relaxa- 
tion of the anterior tissues of the chest, including the upper in- 
tercostal tissues. The middle and inferior cervical regions should 
be treated for the lymphatics to the lungs. 

The amount and strength of the treatment must be regu- 
lated by the patient's condition. Strong treatments are not 
allowed on account of weakness. The general treatment should 



PRACTICE OF OSTEOPATHY. 93 

be given, thoroughly but gently, once a day at least. The pa- 
tient should be seen three or four times per day, but the whole 
treatment outlined need not be given each time. A little treat- 
ment for the fever, to release tension over the lungs, to relieve 
pain in the side, etc., may be enough at a time. 

Hygienic precautions, the use of hot applications, foot baths, 
rectal injections, etc., may be employed, if necessary. The pa- 
tient should have plenty of water to drink, and should be kept 
upon a liquid or semi-liquid diet. 

PULMONARY CONSUMPTION. 

DEFINITION: Pulmonary Consumption, or Tuberculosis of 
the Lungs, is a destructive disease of the tissues of the lungs, 
characterized by the presence of the bascillus tuberculosis, and 
caused by specific lesions in the upper dorsal and thoracic regions. 

CAUSES: Cases: (1) In a case of "quick consumption," 
acute pneumonic phthisis, the' upper spine was swerved to the 
the right; the 2nd dorsal vertebra was lateral; the 8th and 9th 
dorsal vertebra lateral; the ribs down, narrowing the thoracic 
cavity. 

,(2) Second and third ribs luxated; marked lesion between 
the corresponding vertebrae, and the tissues about them very 
tender. (3) First, second and third left ribs down and in. (4) 
Left clavicle down; 1st to 8th dorsal vertebrae flat; 8th dorsal to 
1st lumbar vertebras posterior; 2nd right rib tilted; the spine and 
thorax flat. (5) The 4th dorsal vertebra sore; 3rd to 5th lumbar 
vertebrae tight and irregular; fifth and sixth left ribs close to- 
gether; first rib on right luxated; all ribs down and irregular. 
(6) First to fifth right ribs lowered, decreasing the capacity of 
the chest and interfering with the vaso-motors of the lungs 
through their spinal connections. 

(7) A lateral lesion from the 2nd to 5th dorsal, and a drop- 
ping downward of the ribs. 

(8) A lateral curvature of the upper dorsal spine, the 2nd 
and 3rd ribs were down, and the muscles of the neck much con- 
tractured. 

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 



94 PRACTICE OF OSTEOPATHY. 

vertebrae usually lateral, and lesions, to the middle and inferior 
cervical sympathetic ganglia affecting the lymphatics of the lungs 
(McConnell); of the clavicle. 

ANATOMICAL RELATIONS: In these cases the neck lesion is 
not generally of prime importance, the dorsal lesion being the par- 
ticular one, and of this variety, that more especially affecting 
the upper several ribs. Lesion of the spine, muscles, ligaments, 
or ribs, as low as the 10th may become the cause of the disease. 
In very many cases the lesion will be found to involve the second 
dorsal vertebra or the second rib. 

There are important reasons why lesions of ribs lead to 
pulmonary tuberculosis, and why the flattened thorax, charac- 
teristic of the disease, is so closely related to the condition either 
as primary lesion causing it, or as a lesion secondary to it. Ac- 
cording 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 sympathetic system by rami communicant es, and the sympa- 
thetic 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 inter- 
costal nerves, leading to a constriction of the pulmonary ves- 
sels. A vast area may be affected through the wide distribution 
of intercostal nerves. Very general, or localized, anemia of lung 
tissues follows upon pulmonary vascular constriction caused by 
this over-stimulation of the intercostal nerves. This devitalizes 
the tissues of the lung, and gives a foot-hold to the pathogenic 
bacteria, held by medical authorities to be the sole cause of tuber- 
culosis. 

With regard to the microbic origin of this disease, the Osteo- 
path does not deny the presence of such bacteria in the lung, nor 
their activity 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 extent 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 particularly the re- 



PRACTICE OF OSTEOPATHY. . 95 

gion of the 2nd, 3rd, and 4th thoracic sympathetic ganglia, is 
most apt to suffer from lesion in diseases 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 consump- 
tion of the lungs, affects this region of the lung generally, center- 
ing 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 
important. Anders states that special investigation has shown 
that the disease 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 fossae; anteriorly, immediately below the middle 
of the clavicle, along a line about one and one-half inches from 
the inner ends of the second and third intercostal spaces. The 
starting point may also be located at the first and second inter- 
costal spaces below the outer third of the clavicle. These points 
of origin of this disease in the lung are thus in the 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 dis- 
ease, 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 lesion causing the trouble. This is accomplished by 
methods already given. The removal of lesion has been followed 
by recovery. 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 possible. 
The vaso-motor area for the lungs should receive especial treat- 
ment. In all these ways the blood-supply to the lungs is upbuilt. 



96 PRACTICE OF OSTEOPATHY. 

This, next to the removal of lesion, is the main consideration in 
the treatment of the case. Phagocytici activity is said to con- 
stitute the natural power of resistance of the system to the bas- 
cilli. By increasing blood-supply to the tissues, phagocytic 
activity is increased, the tissues are strengthened, and the en- 
croachments of the bacteria are limited. As they cannot live and 
propagate in healthy tissues, and as pure blood is a germicide, 
the progress of the disease is checked as soon as pure blood and 
healthy tissue are opposed 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 immune 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 circula- 
tion 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 activ- 
ities of the blood and nerve-forces that make strong lung tissue. 
Its method does that which Nature unaided could not do, and 
further aids Nature to recover from weakness caused by the 
disease. No other method would seem more sure of success than 
this. 

The clavicles should be raised, and the pneumogastric, 
phrenic, and cervical sympathetic nerves should be freed and 
toned for reasons already explained. Fresh air, judicious ex- 
ercise, and nutritious diet are indispensable factors in the treat- 
ment. Antiseptic precautions in regard to the patient's sputum, 
linen, etc., should be observed. Bowels, kidneys, and skin should 
be stimulated to full activity. General circulation must be in- 
creased. 

The night sweats generally soon yield to the spinal treat- 
ment. The cough may be relieved by treatment along the 
trachea and anterior thorax, but it, as well as the expectoration, 
fever, and hemorrhages, are relieved and checked by the favor- 
able progress of the case. The greatest care must be taken for 



PRACTICE OF OSTEOPATHY. 97 

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. 

The modern method of having the patient live entirely, or 
practically so, in the open air is a most valuable means of fighting 
the disease. 

CONGESTION OF THE LUNGS. 

DEFINITION: A vaso-motor disturbance of the lungs, re- 
sulting in engorgement of the blood-vessels, and caused by 
lesions in the upper dorsal, thoracic, and cervical regions. 

The lesions producing this disease may be any of the lesions 
interfering with the innervation, especially vaso-motor, and with 
the blood-supply to the lungs. These have been described in 
the discussion of the different diseases of the lungs already con- 
sidered, q. v. With these lesions present and weakening the cir- 
culatory energy in the lungs, some direct exciting 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 pulmonary congestion, when the trouble 
may be symptomatic of pneumonia, pleurisy, etc., the lesion 
must be investigated with regard to the actual disease, and may 
be but in part responsible directly for this condition. 

The PROGNOSIS is good, numerous cases are treated with 
marked success. 

The TREATMENT must be directed at once to the removal 
of the specific lesion if possible. The main object of the treat- 
ment is to gain vaso-motor control. As soon as the impeded 
circulation is released, and activity restored to the innervation 
of the vessels, further progress of the disease is prevented. As 
in the first stage of pneumonia the disease was aborted by gain- 
ing vaso-motor control of the parts, so here the whole matter 
rests upon the correction of the circulation. The accelerators 
of the heart, 2nd to 5th dorsal on the left, and the vaso-motors 
of the lungs, 2nd to the 7th dorsal, should be stimulated at once, 
and the treatment gives immediate relief from the dyspnea. 
Often the patient is sitting up in the effort to get air, and the 



98 PRACTICE OF OSTEOPATHY. 

practitioner may easily stand behind and thoroughly treat the 
upper 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 
by increasing activity in intercostal vessels and nerves. The 
latter should be thoroughly treated along the spine, intercostal 
spaces, and over the chest anteriorly, as stimulation of the in- 
tercostal nerves has been shown to cause reflex constriction of 
the pulmonary vessels. Treatment should be given the pneumo- 
gastric nerves, and any cervical lesion to them be removed, on 
account of their participation in the pulmonary plexus. Treat- 
ment at the superior cervical region for general vaso-motor effect, 
and in the abdominal region to call tbe blood away from the 
lungs, will aid in the case. Turpentine stupes applied to the 
chest over the affected areas are a great aid. In cases of hypo- 
static congestion the patient's position in bed must be changed 
so as to drain the blood from the parts affected, usually the pos- 
tero-inferior. 

Patients are usually relieved immediately upon treatment, 
The dyspnea being most easily relieved. The cough and bloody 
expectoration gradually subside with the betterment of the 
case, which quickly yields to treatment. One or a few treat- 
ments ordinarily correct the condition. 

EDEMA OF THE LUNGS. 

DEFINITION : A condition in which there is transudation 
of the serum of the blood from the vessels into the aveoli, bronchi, 
and sometimes into the interstitial tissues of the lungs. 

Cases are commonly met as complications of other diseases, 
as of heart, lungs, etc. 

LESIONS AND ANATOMICAL RELATIONS: As this condition 
is generally secondary to lung, heart, kidney, or other disease, 
the lesions would be those responsible for the primary disease. 

Local lesion may be the cause of the condition. As it is 
pointed out that generalized edema of the lungs may be due to 
any of the causes producing active or passive congestion of the 
lungs, those lesions already described as interfering with vaso- 



PRACTICE OF OSTEOPATHY. 99 

motor and motor activities of the lungs would be sufficient to 
cause it. The general lesions, and their anatomical relations, 
which interfere with the pulmonary innervation and circulation 
have been fully discussed. Circumscribed edema may result 
from localized disturbance of the blood-supply, due to the effects 
of a certain localized lesion. "Obstruction to the aorta may 
cause it" (Anders.) 

It must be borne in mind that lesion to the vagus nerve 
interferes with muscular motion in the lungs and favors con- 
gestive, and inflammatory conditions, and may lead to edema. 
Lesions in the vaso-motor area (2nd to 7th dorsal,) and the vari- 
ous rib, clavicular, and other lesions affecting the lungs may 
cause this trouble. Eichhorst shows that disturbances of the 
innervation of the pulmonary vessels may cause it, and it is 
probable that the increased permeability of the vessel walls 
which allows of the transudation of serum is directly due to the 
lesions to the vaso-motors. Anders describes the condition as a 
"disturbance of cardio-pulmonic innervation." Such disturb- 
ances are well known to be the result of various bony lesions. 

The PROGNOSIS must be guarded, especially in those acute 
cases complicating other diseases, as in cardiac and renal dropsy. 
In the chronic and recurring forms the prognosis is more favor- 
able. The prognosis must usually depend upon that for the pri- 
mary disease. ) 

It is often symptomatic of approaching death. 

TREATMENT includes that for the primary disease, accord- 
ing to its kind. In any case the main object is to remove all 
obstruction to free circulation throughout the lungs. To this 
end the heart and the vaso-motor area for the lungs should be 
kept well stimulated. 

Any lesion present must be removed as soon as possible. 

With renewed activity of the circulation and increased 
tone of the vessels the further progress of the trouble is limited, 
' and the absorption of the exudate is favored. Now the kidneys, 
bowels, and skin should be kept active by thorough treatment. 
It has been shown in dropsical cases that the kidneys may be 
aroused, by the treatment, to enormous activity. 

The spinal and intercostal muscles should be relaxed and 



100 PRACTICE OF OSTEOPATHY. 

the ribs should be well raised to relieve the dyspnea. The ex- 
pectoration, due to the accumulation of fluid in the alveoli and 
bronchi, is relieved by the general process of the treatment, and 
by the increased circulation particularly. 

A general spinal and cervical treatment, with flexion of 
the thighs, abdominal stimulation, etc., should be given to keep 
the general circulation active and thus to call away the congested 
blood from the lungs. For the same purpose treatment should 
be given over the sternum and ribs anteriorly. 

In severe acute stages one must be continually on guard 
against an emergency. In urgent situations it is necessary to 
take quick and vigorous measures. In such situations the regu- 
lar osteopathic measures are greatly aided by the use of cafe noir, 
or by the application of hot sponges or hot mustard-plasters to 
the chest. 

PULMONARY- HEMORRHAGE. 

I. BRONCHO-PULMONARY HEMORRHAGE; HEMOPTYSIS. 

II. PULMONARY APOPLEXY; HEMORRHAGIC INFARCT. 

CASES: (1) A young married woman, five months preg- 
nant; daily hemorrhage from the lungs for nearly a week. Had 
had similar attacks 5 months before. They were due to con- 
gestion of the lung tissue. Lesions were found in the form of a 
sensitive upper dorsal spine, with contracture of the scapular, 
cervical, and intercostal muscles. Treatment of the lesions 
caused rapid improvement. 

(2) Hemoptysis in a case of bronchial disease; lesion as a 
lateral curvature of the spine, and lesion at the 3rd dorsal ver- 
tebra. The case was treated successfully. Cases of hemoptysis 
as a complication of pulmonary tuberculosis, its commonest 
cause, are frequently treated with success. 

DEFINITION: Broncho-Pulmonary Hemorrhage, or Hem- 
optysis, is a condition due to bleeding into the bronchus, whence 
the blood is coughed up and expectorated. 

Pulmonary Apoplexy, or Hemorrhagic Infarct is a condi- 
tion in which the bleeding takes place into the air-cells and lung- 
tissue. It may be diffuse (rare) or circumscribed. The former 



PRACTICE OF OSTEOPATHY. 101 

is more copious. The latter is usually due to embolism, and is a 
true hemorrhagic infarct. 

LESIONS: There are commonly present lesions of spine, 
-ribs, cervical tissues, spinal tissues, etc., affecting the area of 
innervation of the lung. These occur largely between the 2nd 
and 7th dorsal, at the clavicle, among the upper ribs, or in the 
cervical region upon the vagus nerves, weakening the lung and 
laying it liable to the action of the numerous causes that may 
result in pulmonary hemorrhage. The various lesions that may 
affect the circulation and innervation of the lungs, and the ana- 
tomical relations of such lesions to the lungs, have been pointed 
out. Almost any of these various lesions may result in deranging 
the vaso-motor state of the lungs, either by directly affecting 
-the vaso-motor nerves, or indirectly, by weakening the lung- 
function and impairing the nutrition of the tissues and vessels. 

Consumption, q. v. offers a good illustration of the effects 
of lesion to the lungs resulting in a disturbed vaso-motor con- 
.dition which results in hemorrhage. Here, in the early stages, 
the hemorrhage is due to a congestion of the membrane lining 
the small bronchi. So any lesion weakening the vessels and 
leading to congestion of the lungs may result in hemorrhage. 

In cases in which the hemorrhage is secondary, as in heart- 
disease, pneumonia, bronchitis, ulcers, etc., the lesion must be 
looked for as causing the primary disease. 

The PROGNOSIS must be guarded. Hemorrhage from the 
lungs is commonly a grave occurrence. In some cases it is of 
but little consequence. A fair number of cases are handled suc- 
cessfully by Osteopathy. The prognosis is favorable in cases 
due to consumption in its first stages, pulmonary congestion, 
pneumonia, fibrinous bronchitis, some forms of heart-disease, 
anemia, etc. It is grave in the later stages of pulmonary tuber- 
culosis, in rupture of an aneurism, in some forms of heart-dis- 
ease, etc. 

TREATMENT : 

I. IN HEMOPTYSIS: Here the first indication is to keep 
the patient quiet, bodily and mentally. He should remain in 
bed. In cases due to a congestive condition of the bronchial 



102 PRACTICE OF OSTEOPATHY. 

mucous membrane, the main thing is to keep the patient quiet 
in this way. 

A valuable osteopathic treatment in all such cases is inhi- 
bition of the heart. This is accomplished by continuous inhi- 
bitive pressure from the 2nd to 5th dorsal. It meets the important 
requirement of decreasing the power of the heart's contractions. 

This inhibition may be carried down over the lung area and 
over the splanchnics, thus decreasing the vascular tonus in the 
lungs, and in the vessels of the splanchnic area. This object is 
aided by deep, inhibitive abdominal work, dilating the abdom- 
inal veins, and calling the blood away from the lungs. The 
general vaso-motor center in the medulla should be inhibited, 
by pressure in the sub-occipital fossae. In all these ways one 
quiets the circulation, slows the blood-flow, and favors the for- 
mation of clots to stop the hemorrhage. This line of treatment 
likewise meets the important requirement of confining the blood 
to the systemic circulation. 

One should avoid percussion, as it may increase the hem- 
orrhage. The fever should be treated in the usual way, but it 
is not a troublesome symptom usually. All the upper spinal 
muscles and tissues, as well as those of the cervical region, and 
the intercostal muscles, should be carefully relaxed in order to 
remove any irritating tension from the lungs. This treatment 
will aid in relieving the cough, but it must be carried out very 
gently, in order not to move the chest or ribs, as thereby the clots 
might be broken and the hemorrhage increased. 

Any lesion present may usually be left for treatment until 
after the hemorrhage is fully controlled, as the handling of the 
patient in repairing it would be likely to start the hemorrhage. 
Later a thorough course of treatment should be devoted to them. 

The patient may eat ice and use iced drinks, but hot drinks 
and alcoholics must be avoided. The diet should be light and 
non-stimulating. In congestive conditions hot foot baths are 
useful. Cold applications to the chest may be used. "A firm 
ligature about one or both legs retards the flow of venous blood 
and aids in stopping the hemorrhage." (Stevens.) In severe 
cases no salt or fluids should be allowed. It is sometimes neces- 
sary to withhold food entirely for a time. 



PRACTICE OF OSTEOPATHY. 103 

After the emergency due to the hemorrhage has been safely 
met, and the patient has recovered sufficiently to undergo a 
course of treatment, attention should be given to the underlying 
condition of the system responsible for the hemorrhage. The 
gout, suppressed menstruation, heart affection, anemia, etc., 
must be treated as the circumstances require. Of course many 
cases, in which the hemorrhage does not become severe enough 
to be considered an emergency, fall at once into this category. 

II. In pulmonary apoplexy one may follow the same .line 
of treatment largely, especially at the time of hemorrhage. The 
patient must have absolute rest, etc., as described above. 

In the diffuse pneumorrhagia, where the hemorrhage is 
usually copious, the case is generally hopeless,and rest is the 
only measure necessary. The cases are, fortunately, rare. 

In the circumscribed form (pulmonary infarction) the in- 
dications at the time of the hemorrhage are the same as above. 
The syncope, dyspnea, pain in the side, cough, and convulsions 
will be relieved by these measures. 

Later indications are to repair lesion, build up the strength 
of the lung, keep the local circulation active and absorb the clot. 
This will prevent the formation of abscess or gangrene, at the 
point of infarction. 

EMPHYSEMA. 

DEFINITION: Alveolar Emphysema is a condition in which 
air is retained in the aveoli, distending them, leading to atrophy 
of the elastic tissue in their walls, and to destruction of the septa 
between the alveoli. It may be localized, unilateral or bilateral. 
It is conpensatory when occuring from overwork of one lung, 
or a portion of it, by disability of the rest, and may then be re- 
garded as an hypertrophy; it is essential when involving most 
of both lungs. SENILE EMPHYSEMA is a variety, occurring in old 
people, in which atrophy and destruction of the alveolar walls 
allows of the formation of large aii-sacs by the coalesced air-cells. 

Interstitial Emphysema is a form in which air escapes into 
the interalveolar and interlobular connective tissue. 

The LESIONS AND ANATOMICAL RELATIONS before observed 
in lung-diseases may be recalled here. 



104 PRACTICE OF OSTEOPATHY. 

Various rib and vertebral bony lesions, contractures of 
spinal muscles, etc., as well as lesions in the cervical region, 
interfere with the sympathetic vaso-motor and trophic inner- 
vation of the lung, weaken its tissues, derange its blood-supply, 
or interfere with its motor apparatus in such a way as to lay it 
liable, (a) to diseases which result in emphysema, or (b) to dis- 
tention of tissues from weakness, due to bad trophic conditions, 
upon the occasion of sudden strain put upon them by coughing 
or other strong effort. 

Thus, in the one class of cases the lesion would pertain 
more particularly to the primary disease. The bony lesion causing 
bronchial asthma by irritating the vagus nerve and causing 
spasmodic contraction of the bronchioles, or that causing a 
vaso-motor derangement resulting in catarrhal swelling of the 
mucous membrane of the bronchioles, thus obstructing the exit 
.of the air from the alveoli, is the underlying cause of the emphy- 
sema. 

In the other class the lesion is more directly responsible for 
the condition. 

These cases frequently come under our treatment, most 
commonly as a complication of asthma or bronchitis. 

The PROGNOSIS is favorable in that the patient's life may 
be made comfortable and be prolonged. The conditions re- 
sulting from emphysema may be modified or prevented. 

The condition is incurable because it is impossible to re- 
store the elasticity of the lung tissue or the destroyed septa. 

Great improvement in the patient's condition is accom- 
plished by the treatment. 

In the interstitial form absorption of the air in the tissues 
may take place, the case thus recovering. In cases of acute in- 
flation the prognosis is good. 

The TREATMENT looks at once to the removal of the lesions 
present, and to the relief of the primary disease, whatever it 
is. The vaso-motor area (2nd to 7th dorsal) should be kept 
well stimulated to increase the circulation. This is especially 
necessary because of the compression or destruction of the cap- 
illary networks about the alveoli in the affected portions. It 
also aids in restoring strength to the tissues, and in correcting 



PRACTICE OF OSTEOPATHY. 105 

the catarrhal condition of the bronchi so likelyto result from this 
disease. Stimulation of the vagi is important for the purpose 
of increasing the motor power in the lungs. The ribs should 
all be raised to give the lungs free-play, and likewise the spinal 
and intercostal muscles should be relaxed, the clavicles raised, 
and the sternum and cartilages be well treated. 

It is important to keep the heart well stimulated to guard 
against venous stasis and its results, which are the most to be 
feared. Eichhorst mentions rhythmic compression of the thorax 
in these cases. Treatment to raise the ribs in inspiration and 
to compress them in expiration may be used with profit. 

In these ways danger of death from stasis or suffocation 
is minimized. The patient's general health should be built up. 
In these cases hypertrophy of the right heart usually results. 
The patient must avoid dust, bad air, and exertion. In emergen- 
cies mustard plasters to the chest and hot foot-baths are good. 
The patient must be continually guarded against heart failure, 
which is likely to result from acute dilatation of the right ven- 
tricle. 

ACUTE NASAL CATARRH, OR CORYZA, AND COLDS. 
CHRONIC NASAL CATARRH. 

RHINITIS, ACUTE AND CHRONIC. 

DEFINITION: Acute Nasal Catarrh is an inflammation of 
the nasal mucous membranes, accompanied by an increased 
secretion of mucus and by various general symptons, 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 any part of the body, as a rule, in 
f 'the weakest part," and then probably assume the form of 
congestion instead of inflammation as in the case of coryza. 
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 commonly due to lesion of the part, 



106 PRACTICE OF OSTEOPATHY. 

which acts to deteriorate its vitality and lessen its resistance 
power. 

CASES: (1) A very severe and distressing cold, to sudden 
attacks of which the patient was subject. They came on sud- 
denly, lasted nearly a week, and then gradually disappeared. 
Marked coryza, lachrymation, and sneezing continually, were 
features of the case. It stimulated hay-fever very closely. 
Upon treatment the sneezing stopped almost immediately. 
Treatment was to the vaso-motor control of general circulation, 
to the pulmonary circulation, to relaxation of contractured 
muscles of cervical and upper dorsal regions, and to the circula- 
tion to the head. 

(2) Sneezing and coryza, with all the common symptoms 
of " catching cold" were relieved at once by a treatment. Marked 
lesion was present at the 2nd cervical vertebra. 

(3) Intense nasal catarrh in a debilitated system suffering 
from a complication of diseases yielded at once to the treatment. 
After six week's treatment a cold contracted from exposure was 
well withstood. 

(4) A case of nasal catarrh in a debilitated system showing 
various spinal lesions was greatly relieved by three treatments, 
and was progressing satisfactorily under treatment. 

Very numerous cases, many of them in an aggravated con- 
dition come constantly under treatment. The author has treated 
several individuals who were subject to very severe colds, in 
whom one treatment invariably broke up the most severe attack. 

One case of chronic catarrh would, soon after a treatment, 
begin to spit out catarrhal concretions which had formed in the 
Eustachian tubes. 

CAUSES: The specific lesions causing such disease are, as 
a rule, high up in the cervical region, effecting especially the 
1st to 3rd cervical vertebrae, but they may occur as low as the 
sixth dorsal. One of the chief forms of lesion is that of contrac- 
ture of the cervical muscles and deep, soft tissues. These con- 
tractures, due primarily 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 ob- 
struction to blood and nerve-supply, causing chronic catarrh. 



PRACTICE OF OSTEOPATHY. 107 

The deeper anatomical lesions due to contracture and to other 
causes as well, produce catarrh, and not some other disease, be- 
cause of affecting certain areas of nerve-connections and certain 
centers. Thus lesions of the upper three cervical vertebrae act 
upon the superior cervical ganglion, in ways already discussed, 
and disturb the fifth nerve through its very intimate connec- 
tions with the ganglion in question. In the same way, lesion to 
the inferior cervical or upper dorsal bony parts may affect 
those sympathetic fibers (or the area of the cord giving origin to 
them) which ascend in the cervical sympathetic chain, finally 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 oT the head and face ; for salivary 
glands, eye, ear, tongue, face, mouth, etc., etc., passing to their 
points of distribution through various of the cranial nerves, quite 
generally arise in the upper dorsal and cervical cord, having also 
numerous connections with the cervical sympathetics. This mat- 
ter has been fully discussed in another place.* This explains the 
importance of cervical and upper dorsal lesions. Thus lesions low 
down act upon the ascending fibers of nerve-supply 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 concerned in the headache, lachrymation, sneezing, secretion 
of mucous, and inflammation of membranes. This nerve is also 
in part concerned in the 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 usually 
end the symptoms. In chronic catarrh good results are generally 
easily attained, and many times a cure is effected. Unfavorable 
climates do much to prevent cure as the patient is constantly 
exposed, hence the best results are attained in the favorable 
seasons of the year. 

The EXAMINATION AND TREATMENT for the specific lesion is 
made according 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 



108 PRACTICE OF OSTEOPATHY. 

ihe first steps is to relax all the upper dorsal and cervical tissues. 
A thorough spinal treatment tones all the vaso-constrictors 
(2nd dorsal to 2nd lumbar), and all the vaso-dilators (all along 
the spine), thus aiding to equalize circulation, and reduce con- 
gestion of parts concerned. 

This effect is aided in an important way by raising all the 
Tibs, and particularly by treating all the 2nd to 7th 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 separated from the 
first rib to relax the deep anterior cervical tissues, to free circu- 
lation through the carotid arteries and jugular veins, and to free 
the pneumogastric nerves. All the cervical muscles are thor- 
oughly relaxed, the ligaments released by deep treatments, and 
the vertebrae of the whole region manipulated. This frees the 
connections of the sympathetics, the venous flow from the head, 
/and tone? vaso-motion in the affected parts. It is an important 
-step in remedying the congestion of the parts of the head. In- 
hibitive treatment should be given the superior cervical ganglion 
to dilate blood-vessels and allow the congestion to be swept out. 
The superior and inferior hyoid muscles are relaxed, and the work 
is carried down along the trachea to the root of the neck. The 
mouth is opened against resistance ; the tissues beneath the angles 
of the jaws are relaxed. This releases the internal jugular veins, 
stimulates circulation through the carotid arteries, and corrects 
-circulation. One of the most efficient measures for curing the 
-congestion of the head, and to relieve the stoppage of the nos- 
trils is the momentary pressure upon both internal jugular veins, 
before described, followed by heavy pressure with the palms of 
the hands upon the forehead. 

Particular attention is devoted to the treatment of the fifth 
nerve for reasons already given. It is reached at points upon 
the face already described, and all the tissues over them are 
relaxed. Treatment of this nerve thus directly is a most im- 
portant adjunct to that given its sympathetic connections. It 
is most important as a means of relieving the inflammation, 
-secretion, lachrymation, and stopping of the nostrils. Manip- 
ulation along the sides of the nose frees the nasal ducts and re- 



PRACTICE OF OSTEOPATHY. 109' 

lieves the congestion; strong pressure upon the root of the nose 
and upon the forehead frees the nostrils; tapping over the frontal 
sinus relieves congestion and pain in it. The headache is relieved 
by the treatment in the general cervical, superior cervical, and 
frontal regions; the cough is relieved by the treatment along the 
trachea; the chilly feeling by the brisk spinal treatment. The 
soft palate may be treated by placing the finger gently upon it 
and sweeping it laterally across. This treatment may be carried 
well up toward the opening of the Eusta'chian tube. The con- 
gestion of these parts is thus relieved. 

The lungs must be kept well treated to prevent the cold 
from settling upon them. Precautions must be taken against 
the marked tendency of these congestions to move from part to 
part. This is done by keeping all well stimulated by the treat- 
ment. 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 loosen- 
ing the secretions that sometimes occlude it. Deep treatment 
under the angles of the jaws is good in all forms of catarrh. 

In chronic cases the treatment is devoted more particularly 
to the removal of the specific lesion, and the building up of the 
blood-supply to the nasal membranes. As these are often 
atrophied or hypertrophied. (Atrophic or Hypertrophic Rhin- 
itis, Ozena.) A long course of treatment is generally necessary 
to their rehabilitation. The principal treatment is directed to- 
the cervical tissues, where chronic contracture 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 sus- 
ceptible 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. In all of these conditions it is important that the 
patient should not go out too soon after the treatment, as the- 
system is relaxed and more cold may be contracted. 

*See "Principles of Osteopathy" Lectures XVI-XVIII. 



110 PRACTICE OF OSTEOPATHY. 

EPISTAXIS. 

DEFINITION: Epistaxis is the term used to designate 
hemorrhage from the nose. It is found in serious form in some 
people. It may be caused by accident, as in fracture of the 
skull, or by local irritation, such as picking at the nose. It is 
often an incident in some other disease, as in typhoid or influ- 
enza, or in anemia, hemophilia, plethora, etc. In all cases a 
careful search should be made for its causes . For example, it 
may be due simply to rarefaction of air; or to affections of the 
nasal mucosa, such as ulcers, polypi, hyperemia, or to contracted 
kidneys or valvular heart lesions. Or it may be brought on by 
over exertion, by vigorous blowing of the nose, or by overeating. 

When the cause is found the case must be treated accordingly. 
Specific lesions present often act as determining factors, and their 
removal is an important measure in preventing recurrence of 
such hemorrhages. Cervical lesion, involving the atlas and the 
muscles, has been noted. Other forms of cervical lesion, affect- 
ing the superior cervical ganglion or the cervical sympathetic 
may aid in causing 'it. 

CASES: (1) A lady of 53 years of age, suffering for three 
years with epistaxis, the hemorrhage coming generally after 
fatigue. It was often profuse. Lesion existed as contractures 
of the muscles of the right side of the neck, leading down to a 
tender area upon the point of the right shoulder. The lady had 
been injured here just before the trouble came on her. The 
condition was cured in ten treatments. 

TREATMENT: Holding of the facial artery where it crosses 
the inferior maxillary bone, and the nasal artery at the inner 
canthus of the eye, also pressure applied 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 
enough to arouse sufficient vaso-constriction 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 neces- 



PRACTICE OF OSTEOPATHY. Ill 

sary to resort to plugging of the posterior nares. The applica- 
tion of ice or cold water to the superior cervical region, and the 
use of hot or cold injections into the nostrils are efficient domestic 
remedies for the condition. The patient should rest quietly, 
and avoid blowing and wiping of the nose. Holding the nostrils 
shut may facilitate the formation of the clot. Injections of cold 
water and vinegar into the nostrils are useful. A tampon of ab- 
sorbent cotton in the nostril may be sufficient. 

PLEURISY. 

DEFINITION: An acute or chronic inflammation of a part or 
the whole of one or both pleurae, attended by cough and pain in 
the side, and caused by lesions affecting ribs, thoracic vertebrae, 
intercostal and spinal muscles, nerves, etc. 

CASES: (1) A case of pleurisy due to a displacement of 
the 8th rib. 

(2) In a dentist, a case of pleurisy was developed by the 
irritation by the eighth and ninth left ribs, which were luxated by 
continued bending over at his work. Correction of the lesion 
cured the case. 

(3) A case presented lesions in the form of the upper four 
ribs drawn together and (4) another case showed merely vertebral 
lesions. 

CAUSES: The important lesions in these cases affect the 
ribs; cases are rare in which lesions of this kind are not present. 
Other lesions are consequent or subsidiary to rib lesions. They 
may affect the ribs of either side, as low as the 10th 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 sympathetic nerves, concerned in the innervation of 
the pleurae, may occur. Lesions of the clavicle and first rib, 
impeding circulation through the sub-clavian and internal mam- 
mary 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 
derangements of circulation are thus caused by lesion to vaso- 
motors, aiding the process of inflammation, which is the active 



112 PRACTICE OF OSTEOPATHY. 

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 in causing pleurisy because of its relation to 
the intercostal vessels and nerves. These nerves and vessels all 
together total a vast area of blood and nerve-supply to the pleu- 
rae, especially to the parietal portions. The nerves carry vaso- 
motor and secretory 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, they also supplying the intercostal and abdominal muscles 
and the overlying skin. Such being the case, lesion by displace- 
ment 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 nerves. 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 fur- 
ther, since each intercostal nerve is connected by the rami com- 
municantes with the sympathetic system, lesion of these nerves 
affects the sympathetics. These sympathetics in the dorsal 
region contain both vaso-dilator and vaso-constrictor fibres; 
they 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 directly, and of the 
visceral pleura indirectly. In another way does intercostal le- 
sion act to set up the inflammatory process of pleurisy. Lesions 
of the clavicle, deranging circulation through the sub-clavian and 
internal mammary vessels, and of the other ribs, directly ob- 
structing the intercostal vessels, and indirectly deranging the 
circulation, through related vessels to the visceral pleurae, (bron- 
chial, mediastinal, and diaphragmatic vessels) disturb the en- 
tire circulation to these parts. 

In these ways may all the various lesions described work 



PRACTICE OF- OSTEOPATHY. 113 

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 frequently been found responsible for 
an acute attack of pleurisy, either circumscribed and limited in 
extent, or spreading to involve considerable areas. The same 
sort of lesion may produce all the various kinds of pleurisy de- 
scribed in medical texts. 

According to osteopathic theory, 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 pres- 
ence of the lesions described may weaken the tissues and allow 
the microbes to gain a foothold. It is significant that exposure 
to cold and wet, and mechanical injuries cause the disease, as 
the osteopath looks for such causes to produce the displacements 
and other legions to which he traces the disease. 

The PROGNOSIS is good. Cases generally recover without 
difficulty. Often all the pain and other manifestations disap- 
pear at once upon removal of lesion; the setting of a rib. 

THE EXAMINATION AND TREATMENT: 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 relax- 
ation of spinal, intercostal, and cervical tissues, and to the rais- 
ing of the ribs, for the purpose of removing obstruction from 
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 causing the trouble, are the 
most important steps. If the case is seen before the inflamma- 
tion and exudation has progressed far, the process may be more 
easily stopped, as the necessary point is to gain control of circu- 
lation, which may be readily accomplished through nerves and 
vessels as already explained. In the stage of exudation, where 
quantities of the exudate occur in the pleural cavities, attention 
must be given to releasing the tension in parts due to contrac- 
tures of muscles, etc., to raising the ribs to allow more free-play 
of the lungs; and to the relief of the pain in the side, and the 
distressing 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 re- 



114 PRACTICE OF OSTEOPATHY. 

sorption of inflammatory products. This may be done to a con- 
siderable extent. Great care must be taken in handling the pa- 
tient on account of the great pain. By 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 adhesions of the pleura, and the retraction of parts 
likely to occur as a result of the inflammation, may be avoided. 
This is during the convalescence of the patient, when his condi- 
tion must be carefully watched. The point may be reached in 
some cases where tapping might be necessary, but if the case is 
seen in time the process may be so controlled as to obviate this 
difficulty. In cases of adhesions between the pleurae, if painful 
they should be gradually broken up. This is done in a course of 
treatment, carefully giving the parts concerned the extremes of 
motion of which they are capable. The process it aided by develop- 
ing the circulation to in part absorb the adhesive tissues. This 
must frequently be done in the chronic case. The treatment of 
such cases consists mainly in correction of lesion, and in main- 
taining free circulation for the absorption of pus, if present. 

In treatment of -pleurisy, stimulation of heart and lung:-;. 
of bowels, kidneys and superficial fascia, for the removal of 
poisonous waste; and attention to the general health of the pa- 
tient, are necessary. Acute cases should be kept upon a light, 
easily digested diet. Exposure must be prevented. One thor- 
ough treatment daily, with more treatment at times during the day 
for the relief of pain, etc., will usually be sufficient. Chronic 
cases should be treated three times per week. 

PNEUMOTHORAX (Hydropneumothorax. Pyopneumothorax). 
HYDROTHORAX (Dropsy of the Pleura) and HEMOTHORAX. 

In all of these conditions the situation which confronts 
the Osteopath is much the same. Xo particular LESION can 
be mentioned for the causation of these diseases directly. They 
are all usually secondary to other diseased conditions, and the 
lesion of the primary disease is the one responsible for the trouble. 
Pneumothorax and hemothorax may occur from violence, no 
ordinary lesion, of course, having anything to do with such a 
result. The lesion is otherwise the one producing the disease 



PRACTICE OF OSTEOPATHY. 115 

of heart, lungs, kidneys, or of the general system, to which these 
conditions are secondary, and must be sought and treated ac- 
cordingly. Naturally such lesions may have much to do with 
weakening the lung tissues, vessels, and other structures, pre- 
liminarily to one of these diseases. 

The PROGNOSIS in these conditions is, generally speaking, 
fair. Much may be done for the relief of the patient. The 
prognosis for cure depends upon that for the original disease. 

In the TREATMENT the practitioner has in view three main 
objects: (1) to relieve the painful or troublesome symptoms, 

(2) To treat the original disease, or remove the active cause, 

(3) To absorb the gas or fluid from the pleura! cavity. 

In cases of pneumothorax the treatment is in most respects 
like that for pleurisy. Spinal inhibition, relaxation of spinal 
and intercostal tissues, and careful elevation of the ribs quiets 
the pain, gives more freedom to the lungs, and reileves the dysp- 
nea. A general spinal treatment should be given to equalize 
the systemic circulation. For the absorption of the gas and 
fluid one should proceed as in pleurisy, q. v. If much pus be 
present it should be drained. 

In hydrothorax the treatment would be practically the 
same. As these cases are usually due to chronic heart, lung, 
or kidney diseases, particular attention must be given to the 
treatment of the diseased part. Any obstruction to free cir- 
culation must be removed. In anemic and cachetic states at- 
tention must be given to the general system to build up the health. 
As there is no inflammatory process, the absorption of the transu- 
date is accomplished as is that of the pleuritic effusion after the 
inflammation has been controlled. The heart and lungs must 
be kept well stimulated to increase the vigor of the heart, render 
the general circulation active, and thus decrease the pressure in 
the venous system. If the accumulation of fluid threatens suf- 
focation, paracentesis must be performed. 

In hemothorax the primal y step is to insure absolute rest 
of the patient and to control the hemorrhage. This may be 
done much as in pulmonary hemorrhage, q. v. All stimula- 
tion must be avoided. After the clot is formed absorption 
will proceed naturally. Later one may give such treatment 



116 PRACTICE OF OSTEOPATHY. 

as will insure complete absorption, and restore entire freedom 
to the activity of the lungs. (See Pleurisy.) 

LARYNGITIS. 

' DEFINITION: An acute inflammation of the mucous mem- 
brane 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. 
(See Croup.) In the edematous /form the inflammation is ac- 
companied by exudation and infiltration of the tissues. This 
form is also known as Edema of the Larynx. 

CASES: (1) A case of chronic laryngitis due to lesions 
as follows: left cervical muscles sore; 1st cervical vertebra up; 
2nd, down; 5th cervical vertebra posterior. The right eye was 
weak and the tear-duct was closed. Aphonia would occur fre- 
quently for several weeks. 

(2) An acute attack of laryngitis in a singer w r as overcome 
by a single treatment upon several occasions, enabling him to 
sing in public. 

(3) A case in which a few minutes treatment of the hyoids, 
etc., enabled a singer to readily run the scale to a high note, 
previously beyond her reach. 

(4) A case in which chronic laryngeal disease had destroyed 
a finely cultivated voice, in which, after the failure of treatment 
by specialists, an Osteopath found weakness of the epiglottis. 
Treatment strengthened it, restored it to free action, and re- 
covered the voice. 

(5) A case of aphonia frequently fully relieved by a few 
minutes treatment. 

(6) A case of aphonia, due to spinal injury, cured in two 
months. 

CAUSES: Lesions to the innervation and blood-supply of 
the larynx are present. The chief ones are to the pneumogas- 
trics and cervical sympathetics, 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 larvnx. These lesions affect circulation of the 



PRACTICE OF OSTEOPATHY. 117 

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 anteriorly, 
and about the throat. They may obstruct the circulation in the 
carotid arteries and the thyroid axis, or may 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 secondarily to other lesion. The 
edematous form is especially likely to be caused by obstruction 
to the internal jugular veins. Traumatism may be the sole cause, 
or cold, -exposure, and irritation, etc., may act secondarily to cer- 
vical lesion to cause the disease. 

The PROGNOSIS is good. Immediate relief is obtained from 
the treatment, and recovery 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 circula- 
tion and nerve-supply as shown above. The tissues of the neck, 
particularly of the throat, must be thoroughly relaxed ; the clavicle 
is raised, and the deep anterior muscles and tissues of the root of 
the neck are treated. These treatments free the circulation in 
the vessels as shown above. The circulation in the carotids is 
further aided by opening the mouth against resistance. The 
vagus is 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 cartil- 
age. Its recurrent laryngeal branch is reached 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 larynx 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 the trachea. This is excellent treatment 
for the huskiness and the spasm. The latter, however, is apt to 
depend upon some special lesion. In spasmodic laryngitis the 



118 PRACTICE OF OSTEOPATHY. 

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 diaplaragm aid in lessening the spasm by 
quieting the action of the diaphragm. A warm bath is recom- 
mended to break up the spasm. In a child with an overloaded 
stomach, to cause vomiting affords relief. 

The vagi and cervical sympatheics are treated at the superior 
cervical region and along the posterior region. 

In acute cases inhalations of steam are helpful. If there be 
much swelling and pain, the patient may be relieved by sucking 
ice. In case of stenosis, apply a mustard plaster or cold compress 
to the front of the neck. 

Chronic cases must avoid exposure, and irritation of the 
throat, as from overuse, also smoking and alcohol. 

Cases of aphonia, due to the changes in the vocal cords, or 
to weakness of the epiglottis, may be cured by this treatment. 

In edema of the larynx due to a dropsy from kidney, heart, 
or lung disease, attention must be given to the general dropsical 
condition and its cause. In dangerous cases of edema an opera- 
tion becomes necessary to prevent suffocation. Short of this, 
hot foot-baths, hot drinks, milk, or seltzer-water give relief. 

DISEASES OF THE DIGESTIVE TRACT. 

STOMATITIS AND GLOSSITIS. 

DEFINITION: Stomatitis is an inflammation of the mucous 
membrane lining of the mouth. It may be catarrhal (simple 
or acute stomatitis) ; ulcerative (putrid sore mouth) ; aphthous 
(aphthae, vesicular stomatitis); parasitic (thrush, muguet); 
mercurial (ptyalism) ; or gangrenous (noma, cancrum oris). 

To the Osteopath these various forms present, in each case, 
practically the same aspects, so far as lesion and method of pro- 
cedure are concerned. 

Glossitis is an acute or chronic parenchymatous inflammation 
of the tongue. 

Stomatitis and glossitis may be discussed together. The 
latter condition commonly complicates the former; both are 
forms of a vaso-motor disturbance referable to practically the 



PRACTICE OF OSTEOPATHY. 119 

same nerve and blood-mechanism; both present the same bony 
lesions and are treated in the same manner. 

CASES: (1) Glossitis; the tongue raw and fissured for 
weeks; irritation was extending to the stomach. Lesion was 
present as a contracture of the supra-hyoid muscles, drawing 
the hyoid bone back against the pneumogastric nerve, and ob- 
structing the blood-drainage via the throat. After the tissues 
were relaxed and the bone restored to its normal position the 
patient recovered. 

(2) Glossitis, in a patient with a diseased gastro-intestinal 
tract, due to poisoning of the system by a patent medicine. 
Quickly relieved by treatment to throat, neck, and emunctories. 

(3) Case of glossitis, and stomatitis (ulcerative) , due to 
bony neck lesions. 

(4) Stomatitis associated with pharyngitis; medicines were 
used to no purpose. The patient was unable to eat for 16 days. 
After two days osteopathic treatment he could eat, and the con- 
dition was cured in one week. 

LESIONS AND ANATOMICAL RELATIONS. 

In these cases there is generally lesion to the bony or other 
tissues in the cervical region (sometimes also in the upper dor- 
sal,) which deranges vaso-motor control of the tissues of the 
mouth and tongue, obstructs venous return, weakens the tissues, 
and lays them liable to the effects of some particular irritant, 
local or in the system, but there is, generally, lesion affecting the 
gastro-intestinal tract which is the real underlying cause of the 
trouble. Naturally there are many cases due to the irritation of 
a poisonous drug, of a decayed tooth, etc., which suffer from no 
specific lesion. Yet the ordinary case shows cervical or upper 
dorsal lesion of some kind. Lesions to the atlas, axis, lower cer- 
vical, or upper dorsal vertebrae; sometimes of the upper few ribs; 
of the clavicle; of the cervical muscles, especially those of the 
throat ; of the hyoid bone; of the lower jaw, may be present. 

These lesions derange the nerve and blood-supply of the 
mouth and tongue. Contractured throat muscles may shut 
down upon the arterial and venous circulation (carotid, jug- 
ular), mechanically deranging it. Lesion of the clavicle, first 



120 PRACTICE OF OSTEOPATHY. 

rib, and deep anterior cervical tissues may cause the same re- 
sults. Contractured muscles in the cervical region, displaced 
vertebrae and ribs, may all disturb the spinal and sympathetic 
nerve-connections having control of these tissues. Inferior 
maxillary lesion may disturb the 5th nerve by impinging its 
articular branches. 

The vaso-motor supply of tongue and lining membranes 
of the mouth are mainly from the fifth cranial nerve. Accord- 
ing to the American Text-book of Physiology, the vaso-dilator 
fibers for the face and mouth are found in the cervical sympa- 
thetics; they emerge from the spinal cord by way of the 2nd 
to 5th spinal nerves, and connect with the fifth cranial nerve 
by passing from the superior cervical ganglion to the Gaserian 
ganglion. Other dilator fibers for the mucous membrane of the 
mouth seem to arise in the fifth nerve itself. 

The same authority shows that the cervical sympathetic 
contains vaso-constrictor fibers for the tongue. The hypo- 
glossal nerve also contains vaso-constrictor fibers for the tongue. 
The lingual (a branch of the fifth) and the glosso-pharyngeal 
nerves contain vase-dilators for the tongue. 

In view of these facts it becomes at once apparent that atlas 
and axis, lower cervical and upper dorsal vertebral lesion, as well 
as upper rib lesion could affect these sympathetic connections of 
the fifth nerve, along this portion of the spine, and lead to a de- 
rangement of the vaso-motor state of the tissues of tongue and 
mouth. (See also the anatomical discussion under Catarrh.) 
Upper cervical lesion could likewise affect the glosso-pharyngeal 
and hypoglossal nerves, since both are connected with the super- 
ior cervical ganglion. The glosso-pharyngeal is also connected 
with the fifth, and could suffer with it from lesion. The hypo- 
glossal is connected with both the fifth and the facial nerves. 

In these diseases, secondary lesions resulting in constitu- 
tional conditions favoring them will be found. 

The PROGNOSIS in stomatitis and glossitis is good. The 
case usually quickly recovers under the treatment. One or a 
few treatments give relief, and a short course of treatment is 
usually all that the case requires. In gangrenous stomatitis. 



PRACTICE OF OSTEOPATHY. 121 

however, the prognosis must be guarded. It is usually a surgical 
case. 

The TREATMENT must be directed particularly to the re- 
moval of the lesion. Frequently the removal of this irritation 
results at once in a rapid recovery. Thorough cervical treat- 
ment must be carefully given. Following corrective work upon 
the lesion, all the cervical tissues must be entirely relaxed. Es- 
pecially all the tissues about the throat and angles of the jaws 
should be relaxed, but the treatment in these places must be gentle 
to avoid irritation. The deep anterior cervical tissues low down 
should be thoroughly relaxed, and the clavicles should be raised 
to aid in free venous drainage from the affected parts. The lower 
jaw should be carefully opened against resistance. One should 
.see that the adjustment of the temporo-maxillary articulations 
is correct. 

In all forms of stomatitis, proper attention must be given 
to cleanliness of the mouth, It should be kept well washed out. 
A mild alkaline wash is recommended. Proper attention must be 
given to the general health. Bowels and stomach should be kept 
active and in good condition. In aphthous stomatitis, especial 
care must be taken to correct disturbed digestion, and the mouth 
should be washed before food is given. In parasitic stomatitis 
the child's tongue should be wiped off with a soft cloth/ It is 
recommended to soak the cloth in boric acid solution. 

Gangrenous stomatitis usually becomes a surgical case unless 
successfully handled early. 

In catarrhal stomatitis and in acute glossitis ice may be 
applied to the tongue and to the angles of the jaws. Antiseptic 
mouth washes are good in glossitis. In chronic glossitis the food 
should be plain. All stimulating or irritating articles, such as 
-alcohol and tobacco should be avoided. The teeth should be 
kept in good repair, and bowels and stomach must be kept active. 

In mercurial stomatitis stop all mercury and use a mouth- 
wash of listerine. 

DISEASES OF THE SALIVARY GLANDS. 

HYPERSECRETION, XEROSTOMA. 
In Hypersecretion (Ptyalism) and Xerostoma (Dry Mouth) 



122 PRACTICE OF OSTEOPATHY. 

one must expect much the same style of lesion as in glossitis and 
stomatitis, as the fifth nerve and the cervical sympathetics are 
again the ones chiefly involved in the disease. 

Quain's anatomy states that secretory fibres for the sub- 
maxillary glands arise mainly from the second and third dor- 
sal spinal nerves. They ascend through the cervical sympa- 
thetic. The fifth nerve, according to Dana, is the nerve pre- 
siding over salivation. The American Text-Book of Physi- 
ology points out .that vaso-constrictor fibres for the salivary 
glands are contained in the cervical sympathetics. The chorda- 
tympani branch of the facial nerve is the vaso-dilator of the sub- 
maxillary gland. The glosso-pharyngeal nerve furnishes secre- 
tory and vaso-dilator fibres to the parotid gland. The glosso- 
pharyngeal and facial nerves are closely connected with the fifth, 
and may suffer with it from lesion. 

From the foregoing facts it is easily seen that lesions in the 
upper dorsal and cervical regions," etc., as pointed out for stom- 
atitis, may, any of them, under the proper conditions, derange 
the vaso-motor and secretory conditions of these glands and lead 
to hypersecretion or dryness. 

Hypersecretion is sometimes of reflex origin from diseases 
of the teeth and mouth, digestive organs, sexual organs, etc. 
In such cases it is still probable that the lesion has an affect in 
determining the disease to these glands. No lesion may be pres- 
ent when ptyalism is due to the use of a drug, such as mercury, 
gold, copper, etc. Xerostoma is thought to be due to an affec- 
tion of the nerve-supply of all the glands of the mouth. 

PROGNOSIS: Ordinarily good success is had in correcting 
these conditions. The prognosis must depend upon that for the 
disease to which these are commonly secondary. 

The TREATMENT must be directed to the removal of the 
lesion, as well as of the disease upon which the condition may 
depend. A thorough neck and upper dorsal treatment should 
be carried out upon the lines laid down for the treatment of 
stomatitis. Removal of lesion and treatment of nerve and 
blood-supply does much to correct the secretions. 

Local work over the region of the glands externally, relax- 
ing the tissues and stimulating the gland directly is much used 



PRACTICE OF OSTEOPATHY. 123 

in dryriess of the mouth in fevers. It is quite successful. 

Care for the general health is an important measure in the 
treatment of these conditions. It is fully as important as is the 
specific treatment. The secretions of the body cannot be re- 
stored to normal unless the general health be repaired, inasmuch 
as most of these conditions depend, fundamentally, upon sys- 
temic conditions. The frequent use of small amounts of water, 
or of a little oil in the mouth, is a measure of relief. 

INFLAMMATIONS OF THE SALIVARY GLANDS. 

For Specific Parotitis see "Parotitis." Parotid Bubo and 
Chronic Parotitis would be regarded, osteopathically, from 
much the same standpoint as parotitis, as far as specific lesion 
and mode of treatment are concerned. 

As parotid bubo is not a primary affection, particular at- 
tention must be given to the condition which it complicates. 
As most of the cases are septic a special effort must be made to 
free the system of poison by active work upon bowels, kidneys 
and skin. Thorough treatment must be given to the gland to 
guard against suppuration. 

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. 

CASES: (1) A case showing a right curvature of the spine; 
2nd and 4th cervical vertebrae were sore; the cervical muscles 
upon each side were contractured ; the 3rd to 6th dorsal vertebrae 
posterior. Vertigo was also present. 

(2) A case showing a straight spine, with many vertebral 
luxations, and emaciation of the upper dorsal muscles. 

(3) An acute case cured by two treatments thirty minutes 
apart. 

(4) A case in which the tonsils were ulcerated. After four 
treatments the swelling and inflammation were reduced, and the 
ulcers healed in a few days. 

(5) A case sick for five days, the usual medical treatment 



124 PRACTICE OF OSTEOPATHY. 

affording no relief. The fever was high. After one treatment 
the size of the tonsils was reduced and the patient slept for the 
first time in two days. Upon .the third day of treatment the 
patient was out. 

(6) A case in a boy three years old, in which, after unsuc- 
cessful medical treatment for two months, removal of the tonsils 
was advised. They were so enlarged as to almost close the 
throat. They were soon restored to normal size by treatment 
directed to the upper cervical region, and to the glands, exter- 
nally and internally. 

(7) A case of acute tonsillitis in a boy of four years, whose 
tonsils were chronically enlarged. The attacks were frequent 
and severe, lasting four or five days, and confining the child to his 
bed. During an attack, one treatment reduced the fever, and 
four more treatments overcame all inflammation. The lesions 
were; contracture of upper cervical ligaments and muscles, and 
slight luxation of the atlas to the right. The lesions were cor- 
rected in less than two months, the chronic enlargement was 
overcome, and in the nine subsequent months but one slight acute 
attack occurred. ' 

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 lux- 
ated, 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. Lux- 
ation of the clavicle and first rib. and tension in the deep anterior 
cervical tissues about them are sometimes found. Systemic 
conditions are often very prone to induce attacks. Often these 
begin as biliousness and constipation, or as a nervous upset, or 
as a feature of a cold. It is probable that many of the more 
particular lesions found are secondary. Attention must be given 
to the system, and the general causes must be sought in its con- 
dition. 

Lesions of the atlas, axis, and third vertebra probably act 
by affecting the fifth nerve through its connections with the 
superior cervical ganglion. Lesions of the throat, of the deep 
anterior cervical tissues, and of the first rib and clavicle, have 



PRACTICE OF OSTEOPATHY. 125 

an important effect by obstructing the circulation through the 
carotid arteries and the internal 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 hygienic surroundings, and 
by various nervous disturbances. 

The PROGNOSIS 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 invariably given immediately by 
the treatment. The chronic enlargement requires long contin- 
ued treatment. In the chronic form described as naso-pharyn- 
geal obstruction, or mouth breathing, the prognosis for cure is 
not good. Much relief can be given, and long continued treat- 
ment aids the retarded mental and bodily development. 

Although Salinger and Kalteyer's ''Modern Medicine" states 
that acute follicular tonsillitis cannot be aborted, it is the com- 
mon experience with Osteopathy to abort the disease. 

In the TREATMENT of acute tonsillitis, due attention must 
be given general constitutional condition. Liver, bowels, kid- 
neys and skin must be kept active. Thorough spinal treatment 
should be given for tonic effect. The treatment should be di- 
rected at once to the reduction of the spinal lesion. Treatment 
is given the upper three cervical vertebne to affect the superior 
cervical ganglion. All the muscles and tissues of the neck are 
gently but thoroughly relaxed. Careful treatment is made over 
the suprahyoid muscless and over the region of the tonsils. The 
extreme tenderness will allow of but gentle treatment, but by 
exercising care in applying the treatment at first, a deep and 
thorough treatment may be given after preliminary relaxation 
of the tissues. All the cervical vertebrae and posterior tissues 
should be thoroughly treated for the sympathetic connections of 
the fifth. (Chap. IV.) The treatment over the throat as de- 
scribed is to relieve the inflammation by freeing the circulation 
in the substance of the gland and in the carotid and internal jugu- 
lar 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 over them and by opening the 



126 PRACTICE OF OSTEOPATHY. 

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 internal jugular veins. 

Manipulation over the tonsil aids the flow of the blood through 
the tonsillar plexus of veins into the internal jugular. This 
vein is freed by raising the clavicle and relaxing the anterior 
cervical tissues about it and the first rib. Momentary pressure 
should be made upon these veins, one at a time, followed by 
downward stroking from over the gland and down the vein. If 
this be repeated, and kept up for a few minutes, the acute en- 
largement can be quite reduced for the time. 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 over the 
gland, fauces and surrounding tissues. This gives much relief. 
All the treatment directed to the throat and inferior cervical 
region is the most important part of the treatment. The large 
blood-supply of the gland, and our ability to reach it directly 
more than through the innervation, make this part of the treat- 
ment important. 'It is readily efficient. Treatment to the first 
rib and over the upper anterior chest aids circulation. The cold 
pack to the throat, or hot applications give relief. The diet 
should be liquid, bland and nourishing, such as milk and broth. 

The tonsils should be kept free from accumulation of secre- 
tions, which persist in chronic cases. The fever is treated in the 
same way, being affected 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 suppuration 
in the suppurative form (Quinsy). The general tonic treat- 
ment must be persistent 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 generally sufficient. The 
chronic enlargements (hypertrophy) and the chronic naso-pharyn- 
geal obstruction should be treated three times per week. In the 
latter, local treatment upon the gland from within the throat is 
very helpful. Many of these cases are, in fact, tubercular, and 



PRACTICE OF OSTEOPATHY. 127 

the practitioner must be observant of such condition. Long 
continued treatment should be urged in all chronic cases to pre- 
vent, or to overcome, retarded mental and physical development. 

PAROTITIS. 

DEFINITION: Parotitis or mumps is an acute inflammation 
of the parotid glands. 

CAUSES: The lesions in such cases affect the upper cer- 
vical region, mainly the atlas, axis and third vertebra. Other 
cervical vertebrae may be luxated, and the cervical muscles are 
contractured. The deep anterior cervical tissues may be tensed, 
and clavicle luxated. Secondary contracture 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 sympathetic 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 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 tonsillitis, q. v., the lesions to vertebrae, tissues," and 
clavicle, etc., being practically the same. 

The tissues over and about the gland may be more read- 
ily 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, 



128 PRACTICE OF OSTEOPATHY. 

and testacles to prevent metastasis, which is probably usually 
due, in part, to lesions affecting these parts, and rendering them 
liable to this invasion. Such should be looked to. This point 
must not be neglected, as the inflammation may be driven by 
the treatment to these parts. By thorough treatment of them 
the danger of metastasis is much lessened. Thorough general 
treatment prevents the serious sequelae that sometimes follow 
parotitis, such as disorders of the eye, ear, optic nerve, album- 
inuria, arthritis, facial paralysis, hemiplegia, etc. Careful nursing 
and care of the patient are necessary to prevent relapse. The 
patient should remain in bed during the acute attack. Hot or 
cold applications to the gland, and support with cotton and a 
bandage, afford relief. 

PHARYNGITIS, (Sore Throat.) 

DEFINITION: Acute Pharyngitis is an acute catarrhal in- 
flammation of the mucous membrane lining the pharynx. 

Chronic Pharyngitis is a chronic catarrhal condition of the 
membrane, with hypertrophy or atrophy of the follicles. It 
may be a chronic naso-pharyngeal catarrh, chronic hypertrophic 
pharyngitis (pharyngitis sicca), or follicular or granular pharyn- 
gitis. 

CASES: (1) Chronic pharyngitis in a professional singer. 
The voice was impaired, the patient being hardly able to speak 
above a whisper. Lesion of one of the middle cervical vertebra 
was found. Treatment to it cured the case. 

(2) Acute pharyngitis and stomatitis. The throat was 
ulcerated. The usual medical treatment, tried for a number 
of days, was unsuccessful. The patient could not eat for sixteen 
days. He was enabled to eat by two osteopathic treatments, 
and the case was cured. 

(3) A case of chronic pharyngitis, showing lesion as marked 
tension and rigidity of the ligaments along the entire cervical 
region, with tenderness at the 2d and 3d vertebrae. Chronically 
enlarged tonsils were present. Both conditions were cured by 
restoring normal anatomical conditions in the cervical region. 

(4) Pharyngitis, chronic, caused by reflex irritation by 
lesion at the fourth right rib, which was twisted at its'articula- 



PRACTICE OF OSTEOPATHY. 129 

tion. The rib was replaced and the trouble disappeared, not 
having returned at a time six years later. 

LESIONS AND ANATOMICAL RELATIONS: These conditions 
are at once seen to be catarrhs.. They are closely associated 
with nasal catarrh, and with tonsillitis. Largely the same nerve 
and blood-supply suffers in pharyngitis as in these conditions, 
hence the remarks made concerning lesions and anatomical re- 
lations in considering them will apply with equal force to this 
disease. 

The nerve-supply to the mucous membrane of the pharynx 
is from the pharyngeal plexus, composed of branches from the 
glosso-pharyngeal, pneumogastric, spinal accessory, and cer- 
vical sympathetic. The sympathetic supply is from the superior 
cervical ganglion. It has already been discussed how cervical 
ajid upper dorsal lesion affects this nerve mechanism. Under 
certain conditions it is readily seen that the vaso-motor equili- 
brium of the pharyngeal mucous membrane would be upset, the 
lesion directly causing the inflamed condition, or weakening it 
and laying it liable to the effects of cold, exposure, tobacco, a 
depraved constitution, gout, scrofula, overuse, etc., commonly 
regarded as the active cause of the condition. 

It is significant from the osteopathic point of view that ex- 
posure causes the condition, and that the neck is stiff and sore. 

The hyoid bone is sometimes drawn back against the pneu- 
mogastric nerve by contraction of the hyoid muscles, irritating 
this nerve, and through it causing pharyngitis. This is a very 
common condition in people using the voice to excess, such as 
public speakers and singers. Almost without exception these 
cases show marked contracture of the upper hyoid muscles es- 
pecially. It is common, in these cases, to notice marked improve- 
ment after a few minutes treatment directed to the relaxation of 
these muscles. In some cases lesions of the cervical vertebrae 
cause spasmodic contractions in these throat muscles, resulting 
in pharyngitis in this way. 

Upper rib and clavicle lesion is sometimes present, derang- 
ing sympathetic connections and impeding circulation from the 
throat. The clavicle may be back against the pneumogastric 
nerve. Dr. Still holds this to be one of the commonest causes of 



130 PRACTICE OF OSTEOPATHY. 

irritation in the throat. He also points out in these cases lesions 
of the first rib, sometimes at its sternal end. but especially at its 
head. 

Atlas, axis, and upper cervical lesions are the most frequent, 
but lesion may be found anywhere in the cervical region. The 
former act chiefly by affecting the superior cervical ganglion. 

As pharyngitis is frequently associated with digestive dis- 
turbances one sometimes meets lesion in the splanchnic area 
causing pharyngitis indirectly in this way. In some cases various 
kinds of lesions, causing depraved constitutional conditions, 
may be the ones present. It is interesting in this connection, to 
note that many persons who have suffered from la grippe, etc., can 
be made to cough by spinal manipulation between the shoulders, 
which affects the vagus nerve through spinal sympathetic con- 
nections. Lesions are usually present here. 

One case of aphonia was cured by reduction of lesion between 
first and second parts of the sternum. 

The PROGNOSIS is favorable, good results being almost 
uniformly gained. The acute case is at once greatly relieved, 
and is cured in a few treatments. Chronic cases are often en- 
tirely cured. They are more frequently presented for treatment 
than are the acute. Relief is at once apparent under the treat- 
ment. 

The TREATMENT is mainly that pointed out in detail for 
Catarrh and Tonsillitis, q. v. Thorough correction of lesion, 
freeing of the circulation, and relaxation of the tissues is to be 
accomplished. Removal of specific lesion is often able at once 
to cure the case. One must make a special point of keeping re- 
laxed the tissues of the throat from the angles of the jaws to the 
clavicle. This frees the circulation. Likewise the clavicle should 
be raised. The circulation in the pharyngeal plexus is also much 
relieved by the inward mouth treatment. It is well to extend 
this well up to the openings of the Eustachian tubes, as in this 
way one may prevent the inflammation spreading to affect the 
ears. The work beneath the angles of the jaws' externally, and 
opening the mouth against resistance are particularly good treat- 
ments in this condition. Sore throat and cough are often much 
relieved by grasping the larynx between thumb and fingers and 



PRACTICE OF OSTEOPATHY. 131 

applying a rapid shaking movement to it, extending the treat- 
ment down along the trachea as far as the sternum. 

In the acute case the patient may suck ice for relief. A hot 
foot-bath is good. The diet should be liquid or semisolid. 

Daily sponge baths should be used, with first tepid and then 
cool water, to harden the skin. 

In all cases the active source of irritation must be removed. 
This is often bony lesion. If it be smoking, the use of alcohol, 
etc., it must be dispensed with. 

The chronic case usually calls for a thorough course of treat- 
ment to enable one to overcome the chronic inflamed, hyper- 
trophied or atrophied condition of the membrane. 

The corrected blood-supply loosens and dispels the muco- 
purulent secretions, "and normalizes the secretory function. 
It heals the ulcerations, builds up the atrophied membrane, or 
absorbs the hypertrophied follicles. 

Constitutional treatment is often necessary. 

ESOPHAGITIS. 

DEFINITION: An acute inflammation of the mucous lining 
or the submucous coat of the esophagus. 

CASES: (1) A case in which the inflammation of stomatitis 
extended downward into the esophagus. There was contracture 
of the supra-hyoid muscles, drawing the bone back against the 
pneumogastric nerve. 

(2) A case in which irritation the length of the esophagus, 
and a distressed feeling of the stomach, were due to a posterior 
condition of the upper 4 or 5 dorsal vertebrae. Correction of this 
lesion removed the irritation and relieved the stomach. 

LESIONS AND ANATOMICAL RELATIONS: The lesions are 
often the same as those for stomatitis and pharyngitis, as this 
condition is often due to extension of inflammation downward 
from above. Thus lesion to the hyoid bone, to the muscles of 
the throat, to the clavicle and upper ribs are all likely to occur. 
Lesion to the clavicle and 1st rib may interfere with the circula- 
tion to the esophagus via the subclavian and thyroid axis. The 
various cervical lesions already discussed as capable of deranging 
the activities of the pneumogastric and sympathetic, both of 



132 PRACTICE OF OSTEOPATHY. 

which unite in forming the esophageal plexus, may react upon the 
esophagus. 

The esophageal plexus is in connection with the pulmonary 
plexus and thoracic sympathetic. Thus is seen the close con- 
nection between upper spinal lesion, common in derangement 
of the esophagus, and its sympathetic innervation, having charge 
of its circulation. Spinal lesion in this way affects the circula- 
tion from the aorta to the esophagus. 

The cause is frequently traumatic, and no special lesion is 
present. 

The PROGNOSIS is good. Cases usually recover in a few 
days; often spontaneously. Generally one or two treatments 
are all that are required. In the suppurative form, perforation, 
gangrene, or late stricture is apt to end in death. 

The TREATMENT is simple. Any cause of irritation, me- 
chanical, thermal, or chemical must be removed. The circu- 
lation is corrected and the inflammation reduced by correction 
of lesion, treatment of the upper dorsal region, elevating the upper 
ribs and clavicle, and freeing the circulation through the neck 
and about the throat.' 

If due to catarrh, infectious fevers, etc., treatment must 
be made accordingly. 

A bland diet, especially of milk, is recommended. In seri- 
ous cases rectal alimentation may be necessary. Small pieces 
of ice may be swollowed. Warm demulcent drinks are good. 

In chronic cases the treatment must be more persistent. 
Any source of continued irritation must be removed. This form 
is often due to passive congestion from chronic heart or kidney 
diseases, and attention must be then given to the primary con- 
dition. 

SPASM AND STRICTURE OF THE ESOPHAGUS. 

CASES: (1) A man, aged fifty, suffered from a constriction 
of the esophagus, which occurred while eating. The physician 
allayed the intense pain by injection of morphine, but was un- 
able to overcome the obstruction. The case became serious. 
An Osteopath was called and after several hours effort relieved 



PRACTICE OF OSTEOPATHY. 133 

the condition. The case was treated for two weeks and all effects 
of the trouble disappeared. 

(2) A case of constriction of the esophagus cured by treat- 
ment to the pneumogastric nerves and in the upper dorsal region. 

The LESIONS in these cases are usually upper rib and upper 
thoracic vertebral ones. 

There are many of the cases which present no special bony 
lesion, but are due to other causes, as when spasm depends en- 
tirely upon a nervous reflex, e. g., from the uterus, etc., or when 
stricture is due to congenital narrowing or to constrictive growth 
after burning with a corrosive fluid. 

Yet it is evident that a reflex irritation from a rib or- ver- 
tebral lesion upon the direct nerve-connections of the esophagus 
could be quite as effectual as a reflex irritation from the uterus 
in causing spasm of the esophagus. Specific bony lesion may 
be the determining cause of the spasm in cases of hysteria, chorea, 
epiliepsy, etc. 

In case of stricture the bony lesion may be the ultimate 
cause of the epithelioma, polypus, or ulcers and cicatrix finally 
resulting in stricture. 

The PROGNOSIS for spasm is good. It is commonly easily 
overcome by the treatment. The prognosis for stricture is not 
favorable. It is a surgical case, and usually can be relieved only 
by passing a bougie. 

The TREATMENT depends upon the cause. In cases of spasm, 
if a nervous disease be present it must be carefully treated. All 
cause of irritation must be removed. Rib and vertebral lesion 
must be adjusted. Thorough treatment in the upper dorsal, 
lower cervical, and upper thoracic region is quite successful. 

In cases of stricture the diet should be semi-solid or fluid, 
and concentrated. Rectal feeding may become necessary. 
Osteopathic treatment as above may be applied, but it is likely 
that the bougie will have to be used. 

ACUTE AND CHRONIC GASTRITIS. 

DEFINITION: The acute form is an acute catarrhal inflam- 
mation of the mucosa of the stomach; acute indigestion. The 
chronic form, chronic dyspepsia, is associated with structural 



134 PRACTICE OF OSTEOPATHY. 

changes in the mucosa, and with change in the secretions and 
muscular activity of the stomach. 

CAUSES: Lesions have been noted in various cases as fol- 
lows: (1) 2d to 6th cervical vertebrae to the right; 2nd cervical 
anterior; 8th to 10th dorsal vertebrae separated; break at the 
fifth lumbar. (2) Luxation of the 8th rib; tenderness at the 8th 
dorsal vertebrae. (3) Cervical and dorsal curvatures of spine, 
and luxation of the ribs. 

(4) A case of catarrhal gastritis in a man sixty-four years 
of age, of twenty years standing. The patient was unable to 
take nourishment. Lesion was of the 4th and 5th right ribs, 
which were slipped at their vertebral articulations. The pa- 
tient was able to get up on the fifth day of treatment and re- 
turned to work in three weeks. The ribs were entirely corrected 
in two months. 

(5) Chronic gastritis due to a downward displacement of 
the right fifth rib. The lesion was corrected and the case cured. 

These cases, almost without exception, show lesion in the 
upper splanchnic region, between the shoulders, including the 
spinal area from the second to the seventh dorsal. A common 
form is flatness or anterior position of this region. Its tissues are 
often sore or sensitive under pressure. The soreness may appear 
only coincidentally with more acute manifestations of the stomach 
disorder, or it may be better and worse according to the condi- 
tion of that organ. 

Lesions at the atlas, axis and third cervical affect the vagus 
nerve through its connection with the superior cervical ganglion. 
It may be obstructed along its course in the neck. Lesions to 
the cervical region and to the pneumogastric 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 between the fourth and 
tenth dorsal region, but may occur either a little above or below 
these limits. The pneumogastrics and the splanchnics both 
contribute to the solar plexus, which has charge of the functional 
activities of the organ. The wide area of origin of the splanchincs 



PRACTICE OF OSTEOPATHY. 135 

along the spine, and their importance in the innervation of the 
stomach, accounts for the fact that lesions to this area are most 
potent in producing derangement. At the -same time this is so 
readily accessible to the Osteopath's work that results are gen- 
erally easily attained in the treatment of such troubles. 

Lesions to ribs and cartilages act in part through inter- 
ference with the intercostal nerves, which are in direct sympa- 
thetic connection with the solar plexus through the splanchnics. 
Luxation of the ribs may also interfere 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 
splanchnics. Muscular lesion may often be secondary to stomach 
disease, but in such case indicates the point of treatment, and 
may point to spinal lesion at that place. The vagi nerves carry 
sensory, motor and secretory fibers to the stomach. The splanch- 
nics contain vaso-motor and viscero inhibitory fibers for the 
stomach. But as the influence of the abdominal brain is, accord- 
ing to Robinson, supreme over visceral circulation, and controls 
as well visceral secretion and nutrition, the results of our treat- 
ment upon the pneumogastrics and the splanchnics must affect 
the stomach mainly through the solar plexus. As the splanch- 
nics contain these vaso-motors for the stomach, the main treat- 
ment for gastritis, a vaso-motor disturbance, must be through 
them. Lesions to the splanchnic area are likely to cause gas- 
tritis upon account of their being the vaso-motors. 

McConnell states that lesion of the eighth and ninth cos- 
tal cartilages may cause gastritis. 

The mechanical irritation of coarse, poorly masticated food, 
the fermentation of over-ripe fruit in the stomach, and the effects 
of constant overloading 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 secondary lesions are gen- 
erally produced by the trouble. In the ordinary case of gastritis 
some causes beyond these must be sought, as the disease so fre- 
quently occurs without such indiscretions. 

The PROGNOSIS for recovery is good in both acute and 
chronic cases. The ordinary acute case is relieved immediately 



136 PRACTICE OF OSTEOPATHY. 

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 to 
take down the inflamed condition of the mucosa and restore 
normal secretion. The splanchnics and solar plexus, having 
charge of the circulation and secretion, afford a most convenient 
means of doing this. The correction of lesion here, and the treat- 
ment 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 important process is aided by deep treatment of the solar 
plexus from the abdominal aspect. (VI. Chap. VIII). 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. 
Chap. VIII). 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 pressure 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 probably through the sympathetic connections with 
the vagus. In some cases pressure at this intercostal space has 
caused vomiting. In some cases abdominal manipulation in- 
duces vomiting. This should be encouraged to relieve the stomach 
of its irritating contents. Excessive vomiting should be checked. 



PRACTICE OF OSTEOPATHY. 137 

Thorough treatment along the spine (splanchnic area) will aid 
in this. After inhibition of the left vagus to relax the pylorus, 
the patient may be placed upon his right side and deep pressure 
be made over or beneath the left hypochondrium, from the cardiac 
toward the pyloric end, to aid in the passage of t'he stomach con- 
tents into the intestine. 

McConnell states that inhibition at the Sth 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 absorption of gas. Deep pressure 
over the solar plexus also aids this process. 

Liver, bowels, and kidneys must be kept in active condi- 
tion by treatment. The patient should be absteminous in diet. 
It should be light and easily digested, and may be according to 
prescribed dietaries. The patient should masticate thoroughly 
He must avoid fats, alcohol, and sweets. In severe cases he 
should be put upon a milk diet. 

Acute cases should be treated frequently, chronic cases 
three times per week. 

DISEASES OF THE STOMACH (Continued.) 
CASES' (1) Strain from heavy lifting, followed by severe 
lameness at the time, which gradually disappeared. In a few 
months severe stomach disease followed; no food could be re- 
tained, and rectal feeding was resorted to. Patient 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 are corrected and the case was cured. 

(2) Ulceration of the stomach and complication of troubles, 
due to spinal curvature. Correction of curvature gave great 
relief. 

(3) Ascidity of the stomach and diarrhoea, caused by ab- 
normal tension 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 



138 PRACTICE OF OSTEOPATHY. 

quantities of food as long as it remained in the stomach. 6th, 
7th, and 8th right ribs were down. These being replaced the 
trouble disappeared. 

(6) Gastralgia of several years duration. Lesions at 5th 
and 6th dorsal and 2d lumbar vertebrae. Luxation of the 8th 
right rib. Case cured by four month's treatment. 

(7) Gastralgia; three years standing; attacks after nearly 
every meal. Lesion, a lateral twist of the 6th dorsal vertebra. 
Cured in one year's treatment. 

(8) Gastralgia; incessant pain in left side, stomach, and 
bowels; 4th and 5th right and left ribs drawn together; 8th left 
under 7th; spinal muscles tense. Great relief was given by one 
month's treatment. 

(9) Gastralgia. Seventh dorsal vertebra right ; great ten- 
sion at the 12th dorsal. 

(10) Gastralgia. Lesions at atlas and 4th dorsal. 

(11) Gastralgia. Luxation of the llth rib. 

(12) Tenderness over the stomach (hypenethesia) : 8th 
dorsal vertebra very tender and 8th rib luxated; cured by two 
weeks treatment. 

(13) Dilatation of the stomach and a complication of dis- 
eases. The spine was straight and flat ; thorax flat ; 2d and 3rd 
cervical vertebrae lateral; left cervical muscles tense; slight lateral 
curvature to left between the 5th dorsal and 3rd lumbar; spinal 
muscles tense. 

(14) A case of chronic dilatation of the stomach of some 
years standing, with constipation and gastric pain. The ap- 
petite was ravenous at times, at times, but taking food aggravated 
the pain. The case was cured in 5 months, the weight having 
increased from 104 to 158 pounds. 

(15) Chronic nervous dyspepsia of twenty years standing 
in a man of 42. The stomach was dilated, and pain was present 
two hours after eating. Lesion was posterior condition of 6th 
and 7th cervical; lower dorsal and upper lumbar markedly pos- 
terior; compensatory anterior swerve of the upper dorsal region. 
The case was cured in eight months. 

(16) A severe acute attack of pain in the stomach with 
nausea and constant vomiting for 48 hours. Medicine gave 



PRACTICE OF OSTEOPATHY. ISO 

no relief. One treatment greatly relieved the case, and in three 
days the patient was at work. 

(17) Gastric colic in a man of forty, resulting from injuries 
received six years previously, in which the spine was injured, 
and the lower right ribs were pressed inward. The first attack 
The first attack of pain occurred 2 months after the accident, 
marked by severe pain and cramping in the right side above the 
crest of the ilium, radiating upward. Attacks every 10 days, 
and accompanied by extreme nausea and vomiting. The pa- 
tient was confined to bed three of four days at each attack. At 
times the cramping was so severe as to extend to all the mus- 
cles of the body. 

Lesion was present as anterior condition of the fourth dor- 
sal vertebra. The lumbar portion of the spine was prominently 
posterior. The condition of the ribs was as above noted. Kid- 
neys and liver were involved. 

After the 3d treatment the patient was benefited. The 
attacks grew less severe and less frequent. The case was prac- 
tically cured at the time of the report, three months having 
elapsed since the last attack. 

LESIONS: In all the above cases the splanchnic area was 
affected; neck lesion was rare, and apparently of secondary im- 
portance; 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 of the cases. 
Lesions of the 5th to 8th ribs (area of greater splanchnic) occur 
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 say that one particular 
style of lesion, or lesion of some individual rib or vertebra causes 
a certain kind of stomach disease. 

It is probable that in the future compilation of lesions may 
show considerable specialization of them in the etiology of stomach 
disease. But it is also likely that such tabulation will indicate 
the probabilities only, 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 indivi- 



140 PRACTICE OF OSTEOPATHY. 

dual peculiarities, and upon various attendant conditions. Hence 
one must be upon the lookout for any various lesions in the splanch- 
nic area in all stomach diseases. They may cause a predomi- 
nance of sensory, motor, secretory, or vaso-motor derangements, 
and complications thereof, and according to the predominating 
difficulty it may be that special lesion will be suspected, 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 most 
thorough examination of the splanchnic region of the spine, 
just above and just below, and of the thoracic parts in relation 
thereto. When he has done this he has located the trouble, 
almost invariably, and his treatment of this region, removing 
the lesion, almost as generally cures or benefits the case. Le- 
sion outside of this area is of minor importance, and treatment 
directed elsewhere (abdomen and neck) is either secondary or 
for alleviation merely. 

Special lesions have been noted as follows: in ascidity, 
the lesser splanchnics and the 4th and 5th dorsal (A. T. Still) ; 
in gastralgia, frequent luxation of the 8th and 9th ribs anteriorly 
(McConnell) , also of the 5th, 6th and 7th dorsal; for gastric ulcer, 
frequent lesion of the 8th and 9th ribs anteriorly, and of the 5th 
to 8th ribs posteriorly (McConnell.) 

Secondary lesion in the form of contracturing of spinal 
muscles, particularly along the splanchnic area, is of very fre- 
quent occurrence in stomach disease. Although in this case the 
result, and not the cause, of stomach disease, it is of much im- 
portance osteopathically. (1) It indicates the point of treat- 
ment, for it is an indication upon the surface of the body of what 
special nerve fibers or areas are suffering derangement by the 
particular form of disease present. There is a direct path be- 
tween 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 
any other lesion whatsoever, treatment at the point of contrac- 
ture may cure the condition. It is evident that the nerve area 
thus indicated was the one needing treatment. 



PRACTICE OF OSTEOPATHY. 141 

(2) These contractures do not always occur at the same 
location, nor always affect the spinal muscles over the splanch- 
nic 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 fibers 
shall thus suffer and produce contracture. It is possible that 
they indicate seat of lesion in the spine not otherwise discover- 
able. In such case this weak point would be the determining con- 
dition in the location of the situation of the contracture. Thor- 
ough 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 im- 
portant relations, by lesion or otherwise, between these parts. 

ANATOMICAL 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 circulatory, secretory, or nutritional disturb- 
ances in its connected organs. Likewise they may cause sensory 
and motor troubles, as the same authority, and the American 
Text-Book of Physiloogy, as well, states that this plexus receives 
sensation and sends out motion. According to Quain, the termi- 
nal branches of the pneumogastric unite with the gastric plexus 
of the sympathetic, and carry motor and sensory fibers to the 
stomach. Flint shows that the pneumogastric has much to do 
with gastric secretions, as section of it leads to almost complete 
cessation of stomach secretions. It is considered probable by 
investigators that its motor function in the stomach is derived 
from its sympathetic connections. Osteopathic work seems. 10 in- 
fluence it more largely through its sympathetic connections. 
It is treated also in the neck directly. It is important in sensory 
and motor diseases. The splanchnics contain vaso-and viscero- 
motor fibers. Stimulation of the planchnics lessens peristalsis; 
of the pneumogastrics increases 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 



142 PRACTICE OF OSTEOPATHY. 

9th; the 6th and 7th supplying the cardia, the 8th and 9th 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 immediately given, and cure follows. 

The TREATMENT of stomach diseases as a class is very simple. 
It consists mainly in corrective treatment in the splanchnic area, 
together with a certain amount of neck and abdominal work. 
This is supplemented by certain special treatments for various 
purposes in the treatment of special diseases. Through the 
pneumogastrics and the sympathetic connections, the solar 
plexus and the splanchnics, control is had, to a marked degree, 
over the processes regulated by them; sensation, motion, nutri- 
tion, secretion, circulation. Few diseases can remain after 
correction of these functions by removal of the lesion disarrang- 
ing them. 

The treatment of the solar plexus, the spine (splanchnics), 
the pneumogastrics, and the removal of the various lesions likely 
to occur in these regions have already been discussed. 

The various motor, secretory, and sensory neuroses, de- 
scribed under the general name of nervous dyspepsia, are treated 
by removal of special lesion and by the work for the control 
of various functions as discussed. In cases of supermotility, 
peristaltic unrest, and nervous eructation, special treatment 
may be given to stimulate the splanchnics and solar plexus to 
lessen peristalsis. In nervojis vomiting, the work should be 
directed to the cerebral centers, by treatment in the superior 
cervical region, and to the solar plexus. Strong inhibition to 
the left pneumogastric in the neck will relax the pylorus and 
aid in passing the stomach contents into the duodenum. Deep 
pressure at the 3rd and 4th left intercostal space near the spine 
will relieve nausea and stop the vomiting. 

In spasm of the cardia, inhibition should be made at the 
6th and 7th dorsal for fibers controling it. while in spasm of 
the pylorus the inhibition should be upon the 8th and 9th dor- 
sal and upon the left vagus. In atony of the stomach, thorough 
stimulation should be given the vagi, splanchnics and solar plexus, 
to increase muscular tone and to develop circulation. Local 



PRACTICE OF OSTEOPATHY. 143 

manipulation over the region of the stomach would aid in toning 
the muscular walls (see treatment of Gastritis.) In insufficiency 
of the cardia stimulation should be given the 6th and 7th dorsal, 
while in pyloric insufficiency the 8th and 9th dorsal and the left 
vagus must be looked to. Local stimulation, by brisk work 
over the abdomen, aids the operation. 

In secretory disturbances, hyper-ascidity, super-secretion, 
and sub-ascidity, work upon the vagus and solar plexus, through 
the splanchnics, corrects circulation and rights secretion. Stim- 
ulation of the lesser splanchnics and of the 4th and 5th dorsal 
is important. 

In sensory disorder attention must be given the sensory 
innervation. Hyperaesthesia needs a general stimulation. Gas- 
tralgia needs deep inhibition at the solar plexus, splanchnics, 
and vagi. Special inhibition should be made from the 6th to 
9th dorsal, 8th and 9th ribs anteriorly, and the 5th, 6th and 7th 
dorsal vertebrae, all of which points seem concerned in the sen- 
sory innervation of the stomach. For the abnormal sensations 
of hunger, lack of appetite, etc., general correction of secretions 
and sensation will be efficient. 

For dilatation 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. 
All causes of obstruction of the pylorus should be removed. 
This obstruction may be of such a nature as to demand surgical 
attention. In case the cause be overgrowth of tissue, cancer, 
cicatrix of an ulcer, etc., an attempt may be made to relax the 
pylorus by inhibition of the vagus (vide supra), and to pass the 
food on through the stomach by manipulation as before described. 
In case the obstruction of the pylorus be not total one may suc- 
ceed in keeping the contents of the stomach passed until the 
course of treatment can reduce the cause of obstruction. 

Much the same plan must be followed in cases in which the 
obstruction is due to external compression, or from growths, 
displaced kidney, gall-stones, etc. One may sometimes easily 
remove the cause of obstruction. 

In all cases not due to pyloric stenosis, as from over-strain 



144 PRACTICE OF OSTEOPATHY. 

of the muscular coats by repletion; chronic gastric catarrh, 
weakening the muscle; fatty, and other forms of degeneration; 
congenital weakness; impaired innervation, etc., one may apply 
the treatment first mentioned above for dilatation, always with 
due attention to the cause and to the lesions present. 

Careful attention to the diet is necessary. It should be 
small in amount at a time, and fluid or semi-fluid or semi-solid. 
In this way the food is soon passed through, and has no tend- 
ency to dilate the organ further or to interfere with its repair. 

A thorough abdominal treatment should be given to tone 
local circulation. Strengthen the abdominal walls, and stim- 
ulate the walls of the stomach itself. (See treatment of gas- 
tritis.) 

For gastroptosis one should apply treatment as described for 
enteroptosis, q. v. 

In peptic ulcer attention should be given to perfect free- 
dom of circulation. The condition of the 8th and 9th ribs an- 
teriorly, and of the 5th to 8th ribs posteriorly, must be looked 
to. Absolute rest is necessary. The patient should remain 
abed, and rectal feeding be resorted to in part, for alimentation. 
The diet must be carefully regulated, and of a sort mostly digested 
in the stomach. Skimmed milk, butter-milk, and pancreatized 
milk gruel are recommended. The latter is used also for rectal 
injection. A diet of ice-cream is reported as having cured a 
number of cases. 

The vomiting, hematemesis and pain may be controlled 
according to directions given for those conditions. 

The removal of lesion and maintenance of a free circula- 
tion are measures greatest importance, as thereby the ulcer 
is healed. As a derangement of the secretions, such as hyper- 
ascidity, predisposes to ulcer, it is seen that correction of circula- 
tion guards against it. The same is true of the point that gas- 
tritis causes ulcer. 

A general course of treatment should be given to build up 
the health of the body and to improve the quality of the blood 
in such conditions as anemia, chlorosis, and amenorrhoea. which 
favor the development of ulcers. 

In hemorrhage from the stomach (Hematemesis) ; inhibit the 



PRACTICE OF OSTEOPATHY. 145 

splanchnics, and the solar plexus carefully, to lessen the blood- 
pressure for the general vaso-motor center, and make deep in- 
hibitive treatment of the abdomen to dilate the great abdominal 
veins and call the blood away from the stomach. One should 
proceed as in other internal hemorrhage. (See Pulmonary Hem- 
orrhage). One must treat the condition according to its cause. 
If it be from local disease, such as ulcer, the first measure is to 
stop the hemorrhage as above directed. The same remark ap- 
plies to hemorrhage from traumatic causes. If the cause be a 
mechanical impedment to the portal vein, this should be removed; 
if vicarious menstruation, the local hemorrhage of the stomach 
must be first controlled, while later treatment looks to the re- 
establishment of menstruation. 

In the treatment of hemorrhage from the stomach, the or- 
gan must be given absolute rest. Rectal feeding may be re- 
sorted to for this purpose. Cold applications may be made over 
the region of the stomach. The patient must remain quietly 
upon his back. No stimulants should be administered. 

In cancer of the stomach, general corrective work and par- 
ticular attention to freedom of circulation must be relied upon. 
(See treatment of "Tumors.") 

Look for lesion to any of the special points mentioned in 
relation to the various diseases. The bowels, kidneys and liver 
must be kept in free action. The diet should in all cases be lim- 
ited and easily digested. 

CONSTIPATION. 

DEFINITION: "Infrequent or incomplete alvine evacua- 
tion, leading to retention of feces" (Quain). "A neurosis of 
the fecal reservoir" (Bryon Robinson). Osteopathically it is 
regarded as a neurosis due to obstructed action of the nerves 
supplying the bowel with secretion, motion, and circulation. 
It may be symptomatic of other disease, or a complication. 
It is very frequent idiopathic, due to specific lesion to bowel 
innervation. 

CASES have presented various lesions; (1) Contraction of 
the sigmoid flexure, (2) Spinal lesions, mostly in the lumbar, 
causing spinal cord disease and partial paralysis of limbs and 
bowel, (3) A posterior prominence of the whole lumbar region, 

10 



146 PRACTICE OF OSTEOPATHY. 

(4) 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) Prolapsus of the sigmoid, (9) Retro- 
version of the uterus against the rectum, (10) Right curve of 
spinal column; 3rd to 6th dorsal vertebra? posterior; 7th to 10th 
dorsal vertebrae anterior and flat; llth and 12th dorsal and 1st 
lumbar posterior; 12th dorsal and 1st lumbar the seat of pain; 
12th rib down; 2nd and 3rd lumbar close; 5th lumbar sore and 
anterior. (11) 2nd and 3rd dorsal separated, 3rd and 4th to- 
gether, 3rd to 5th flat, 6th to the left, llth dorsal to 2nd 
lumbar posterior, (12) 6th and 7th dorsal posterior, 9th to 
12th flat, ribs irregular and prominent on the left, (13) Coccyx 
badly bent, lesion of 5th lumbar, (14) Separation between verte- 
brae from 8th to 10th dorsal, and between 5th lumbar and 
sacrum, (15) 2nd to 5th dorsal approximated and to the right, 
separations between vertebrae from 8th dorsal to 3rd lumbar, 
the right innominate up and back, (16) Spine rigid; atla.s to the 
left; 2d, 3d, and 4th cervical vertebrae to the right; 12th dorsal 
posterior; llth rib overlapping the 9th and 10th, (17) 6th dorsal 
anterior; 4th and 5th lumbar to the right; spine stiff from 6th 
dorsal to 4th lumbar; right innominate posterior; 12th rib dis- 
placed upward, at its anterior end, under the 12th, (18) Lateral 
lesion of 10th dorsal vertebra, with marked rigidity of muscles 
and ligaments in the lower dorsal and lumbar regions. 

An examination of cases shows a wide distribution of le- 
sion, ranging from the 1 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 three 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 atten- 
tion should be given the llth and 12th dorsal and the 1st and 
2nd lumbar, as the sympathetic branches from these points sup- 
ply the inferior mesenteric ganglion and the rectum with motor 
fibers, and the abdominal vessels with constrictor fibers. Sym- 
pathetic distribution for the small intestine is from just above 
the first lumbar; for the large intestine from the 1st to 4th him- 



PRACTICE OF OSTEOPATHY. 147 

bar. Hence the importance of the lower dorsal and lumbar les- 
ion in constipation, as it may interfere with the functions of 
motion, secretion and circulation by obstructing the spinal con- 
nections of these important sympathetics. 

Lesions of the lower two ribs are important causes of con- 
stipation, not only by spinal interference with the sympathetics 
mentioned, but by direct mechanical pressure upon the bowel, 
sometimes. In yet another important manner they may cause 
bowel trouble by lesion to the diaphragm as already mentioned. 
The whole subject of change in the diaphragm is an important 
one in relation to 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 cer- 
tain portions of it. Thus impingement is brought upon the im- 
portant structures passing through the diaphragm, and having 
much to do with abdominal activities. The aorta, ascending 
cava, thoracic duct, pneumogastric, phrenics, and splanchnics 
may be interfered with. Or the sagging of the diaphragm may 
set up ptosis of the abdominal oigans, 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. Lesion to the 
lower dorsal and the lumbar nerves may lead to loss of energy of 
the muscles of the abdominal walls, as may other causes, and lead 
to constipation. Robinson states that such a condition favors 
constipation by allowing congestion of blood and secretions, and 
by lessening intra-abdominal pressure. Lesions to the liver and 
pancreas, usually from the 8th to 12th dorsal, or through the 
splanchnics or solar plexus, aid constipation by lessening the 
secretions of these organs, necessary to stimulation of peristalsis. 
McConnell states that contractured muscles are generally found 
in constipation on the right side of the spine over the region of 
the liver. Dr. Still makes lesion of the 5th dorsal important in 
tlu'se cases. 

The coccyx may be so misplaced as to act as a mechani- 
cal obstruction to the passage of the stool. Lesion at this point 
mav cause contracture of the sacral tissues and interfere with 



148 PRACTICE OF OSTEOPATHY. 

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 mechanic- 
ally obstruct the bowel. 

Various 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 ligaments at those points. The same 
causes allow of a sinking of the caecum and sigmoid into their 
respective iliac fossae, allowing also the sigmoid to fold upon it- 
self. In these ways obstruction to the passage of fecal matter 
along the bowel is caused. In enteroptosis the pressure of or- 
gans 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 important causes of constipation. 

The anatomical relations have been described in detail in 
considering diarrhoea, q. v. 

Various lesions, 'acting to weaken circulation and nutrition, 
lead to atony of the bowel muscles, and to constipation. Any 
lessening of circulation acts to cause it, as the circulation of the 
blood about the nerve terminals in the bowel wall is necessary 
to their activity. 

The PROGNOSIS is good. Most cases are cured in a reason- 
able length of time. The ordinary acute form, occasional con- 
stipation, is cured in one or a few treatments. Very quick re- 
sults are often obtained. Cases which have been most obstinate, 
and those that have been from birth, have 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 obstruct- 
ing 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 are 
found, and may be removed by the appropriate methods. The 
main treatment is for nerve-supply, as practically all of the le- 



PRACTICE OP OSTEOPATHY. 149 

sions, 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 removal of lesion or otherwise, tone the splanchnics, spinal 
sympathetics, and solar plexus, as well as Auerbach and Meissner's 
plexuses, 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 treat- 
ment carried along the course of the bowel. A very successful 
treatment is to spread both hands upon the abdomen, and w r ork 
deeply, first with the fingers pressing upon the ascending colon, 
then with the thumbs upon the descending colon, thus alternating 
the pressure from side to side of the abdomen. This treatment 
should begin lov/ in the iliac fossae, and ascend gradually. It 
relaxes all the tissues, and frees local circulation, affecting also 
the local nerve distribution. It dwells particularly upon those 
portions in which are felt the aggregations of fecal matter, re- 
leasing the tissues about them y 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 csecal and sigmoid portions, as they are generally 
full. Attention must be given to raising and straightening them 
when necessary. This may be done in the treatments described 
in III and IV, Chap. VIII. Likewise the colon as a whole should 
be raised and straightened to relieve kinking at its flexures and 
the evil results to nerves and blood-vessels accruing from the 
stretching of its omenta in ptosis. The patient should be placed 
in the Sims position, or, better, in the knee-chest position, and 
the bowels should be thoroughly pulled up out of the pelvis. 
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 removal of lesion, by treatment to its spinal 
connections through the splanchnics, and by raising the 8th to 
12th right ribs, this is in part accomplished. It is treated at the 



150 PRACTICE OF OSTEOPATHY. 

abdomen, as are the gall-bladder and bile-duct. (V, IX, Chap. VIII.) 

The inferior mesenteric ganglion is the center for the fecal 
reservoir, and should be treated at the location already described. 
The vagi may be treated in the neck to aid in the general process. 
The coccyx should be straightened as the case requires. (XX, 
Chap. II.) A contractured sphincter should be dilated. (Chap. 
IX, D.) Or it may be released by strong inhibition over the 
fourth sacral nerves. They may be located at the fourth sacral 
formania, 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 may be broken up gradually by deep 
and careful work upon the bowel at their site. In the absence 
of pain, or as it disappears, the treatment may be made strong, 
care being taken not to set up inflammation. 

Obstruction from volvulus may be sometimes overcome by 
manipulation at the seat of the obstruction directed to the straight- 
ening the bowel. This requires long treatment at a time, and 
much care and patience. 

Symptomatic cases must be treated in conjunction with 
the primary disease. 

The use of cold and hot drinks before breakfast, rectal in- 
jections, cereal foods, fruits, regularity in habit, and exercise 
are all helpful. The water should be drunk neither too soon nor 
too long before breakfast. About fifteen to twenty minutes 
generally gives the best' results. 

CATARRHAL ENTERITIS; DIARRHOEA. 

DEFINITION: An acute inflammation of the. intestinal mu- 
cous membrane due to specific spinal lesions. Diarrhoea is often 
symptomatic of other diseases. 

CASES: Lesions were found as follows: (1) Tension of 
the spinal tissues from the 3rd to llth dorsal, (2) Lateral lesion 
of the 7th, 8th and 9th dorsal vertebrae, (3) 9th to llth right 
ribs depressed, (4) Right llth rib down onto the 12th; 4th and 
5th lumbar anterior; spine weak, (5) 6th to llth dorsal vertebrse 
lateral to the left; 12th dorsal, 1st and 2nd lumbar posterior; ex- 
treme weakness and irritability of the muscles along the affected 
area, especially opposite the 2nd lumbar: ribs over the liver 



PRACTICE OF OSTEOPATHY. 151 

down, (6) 5th lumbar anterior; 6th and 7th dorsal posterior; 
luxation of lower four right ribs. 

Lesions may occur anywhere 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 verte- 
brae. According to Dr. Still, in all cases of diarrhoea, and dysen- 
tery there is lesion of the 5th lumbar, which, through the con- 
nected sympathetic innervation, paralyzes the lymphatics of the 
bowels, causing the exudations and the stools. The llth and 
12th ribs on each side are sometimes found luxated, most often 
downwards. Lesion may occur at the 2d lumbar, the 5th lum- 
bar, to the innervation of the small intestine above the first 
lumbar, to the innervation of the large intestine from the 1st to 
4th lumbar, to the coccyx, or to the innominates. Lesions from 
the 8th to 12th dorsal and ribs may 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, ac- 
cording to Flint, among the most important in the body, in- 
nervating the immense area of abdominal vessels, which, when 
fully dilated, are said to be able to accommodate one-third of 
the total quantity of blood in the body. They contribute to the 
solar plexus, which rules sensation, motion, secretion, nutrition, 
and circulation in all these viscera. Our correction of circula- 
tion 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 may be disturbed in diarrhoea. 

The whole abdominal sympathetic is important in these 
diseases. Stimulation of it lessens peristalsis; stimulation of 
the pneumogastric increases peristalsis. We work not to di- 
rectly stimulate or inhibit either of these for the purpose of con- 
trolling peristalsis, but to remove lesion from them as it pro- 
duces through them abnormalities of motion. 



152 PRACTICE OF OSTEOPATHY. 

Auerbach and Meissner's plexus of nerves have to carry 
on gastro-intestinal secretion. Auerbach 's is a motor plexus. 
They lie in the intestinal walls, and may be directly influenced 
by work upon the abdomen, but are corrected by us through 
the removal of lesions affecting them through their sympathetic 
and spinal connections. Lesions to them, disturbing both se- 
cretion and motion, are important causes of diarrho?a. Robin- 
son states that the inferior mesenteric artery, located, externally, 
a little below and to the left of the umbilicus, innervates the 
muscular walls 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 active in production 
of diarrhoea. 

The fact that afferent sympathetic fibers pass from the 
abdominal viscera to the thoracic sympathetic cord may ex- 
plain the occurrence of secondary lesions in the form of con- 
tractured muscles along the thoracic spine. The presumption 
is that they are sensory in function, and if so, sensory fibers for 
the abdominal viscera may be associated with them. Quain 
states that among the medullated fibers passing into the sym- 
pathetic system, some derived from spinal nerves are sensory 
fibers. This may be the explanation why inhibition of the 
splanchnic area will stop pain in the stomach or intestines. 

All these various facts indicate the importance in diar- 
rhoea of spinal or lower rib lesion, from the 6th 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 10th dor- 
sal down, in these cases. Lesions in this lower spinal region are 
of prime importance in causing diarrhoea. The importance of 
the lesion to llth 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 mesen- 
teric ganglion, shown above to innervate the fecal reservoir. 
These branches are motor fibres for the circular, and inhibitory 
fibers for the longitudinal, muscle fibers of the rectum. At the 
same time these lower dorsal and upper two lumbar nerves send 
branches to the sympathetics and supply vasoconstrictor fibres 



PRACTICE OF OSTEOPATHY. 153 

to the abdominal vessels. The motor fibers 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 innominate or coccyx may cause a part of the trouble in diar- 
rhoea, also why strong stimulation to the sacral nerves relieves 
tenesmus. 

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 inflammation (catarrh); lack of proper vaso-innervation, 
leading to congestion and exudation; improper preparation of 
digestive fluids, due to deranged glandular activity; or increased 
secretion and exudation. 

The removal of lesion obstructing nerve and blood-supply 
corrects these manifestations of such derangement. 

The PROGNOSIS is good. Most cases of diarrhoea are checked 
at once by a single treatment, many needing no further treat- 
ment. Cases of years standing have been in many instances 
cured in a short time. The ordinary acute diarrhoea needs but 
one or a few treatments. Acute enteritis needs careful treat- 
ment for several days while the acute process lasts. Even long 
standing cases that had their origin in army dysentery have 
been cured. 

TREATMENT for diarrhoea consists in the removal of lesion 
as found, affecting 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 pa- 
tient on his side, as described in III, Chap. II. The "breaking 
up" spinal treatment may be used for the same purpose. (XXII, 
Chap. II.) The former seems preferable. It may be applied 
to either side or to both sides of the spine. 

Inhibition may be made at the llth and 12th dorsal region 
by setting the patient upon a stool, pressing the knee against the 
spine, first on one side then upon the other, and grasping the 



154 PRACTICE OF OSTEOPATHY. 

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 re- 
lated tissues in the lower dorsal and upper lumbar regions. This 
result is more important than the mere inhibition. The llth 
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 perforting it. This 
result alone might cause diarrho?a. 

Muscular contractions along the spine should be removed. 
Deep but careful manipulation should be made upon the abdo- 
men over the intestines for the purpose of relaxing all their tis- 
sues, freeing circulation and correcting 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 diarrhoea through increasing peristalis. 
In other cases its presence in the bowel does not hinder the case, 

and it is said to allav irritation 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 manipula- 
tion of the tissues over the sacrum. 

It is said that in such cases the abdominal facia is contracted 
and causes congestion mechanically. (Chas. Still.) When con- 
tracted it should be relaxed by abdominal manipulation. 

The vomiting and purging should not be checked if they 
are the evident means of getting rid of the irritating contents 
of the bowel and stomach. The ordinary 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 relaxing 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 



PRACTICE OF OSTEOPATHY. 155 

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 pa- 
tient. It should be light and restricted. Meat broths, mucilag- 
inous drinks, etc., may be given according to prescribed dietaries. 
Warm baths and rectal 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 inhibition alone may be sufficient. When 
diarrhoea is symptomatic of other disease it may be relieved by 
these treatments. Its cure depends upon the cure of the dis- 
ease present. 

The various diarrhoeas of children; summer diarrhoea, gas- 
tro-enteritis, cholera infantum, etc., are all treated along the 
same lines, with special attention to conditions present. There 
is quite commonly an acute dyspeptic condition present. Hy- 
gienic and dietetic measures must supplement the osteopathic 
treatment. Fresh air and cleanliness are essential. Cool bathing 
is recommended. Cracked ice may be given to allay the thirst, 
or small quantities of water at a time. Thin broths, egg-albu- 
men, etc., may be fed to the child. 

These cases are frequently serious, but the success of osteo- 
pathic treatment has been very marked. 

Croupous or diphtheritic enteritis calls for no special dis- 
cussion. It should be treated as indicated for catarrhal enteritis,, 
with special attention to the particular causes. 

INTESTINAL ULCERS. 

The various forms of intestinal ulcers are successfully treated 
osteopathically. They are generally due to other intestinal 
disease, and are assignable to those lesions so common as the 
causes of derangement of intestinal function. These .general 
lesions have been described under "constipation," and "catarrhal 
enteritis." 

DUODENAL ULCER. 

DEFINITION: This is a small, round, perforating ulcer 
which attacks the walls of the duodenum. It is the homologue 
of the gastric ulcer, q. v., and probably originates in the same 



156 PRACTICE OF OSTEOPATHY. 

way. Such lesions as interfere with intestinal circulation and 
secretions are the causes. An obstructed area of circulation in 
the tissues becomes devitalized as a consequence of the spinal 
lesion interfering with the nerves controlling blood-flow. These 
devitalized tissues are acted upon by the acid gastric juices, 
and the beginning of the ulcer is made. These ulcers are asso- 
ciated with such conditions as cause gall-stones and B right's 
disease, and are referable to the same lesions. 

The TREATMENT is practically the same as that for gastric 
ulcer before described. Lesion must be removed and circula- 
tion be kept free to correct secretions and functions of the in- 
testine, and to heal the ulcer. Continued thorough treatment 
should be directed to the seat of the ulcer to keep the tissues soft 
and prevent the occurrence of cicatricial contraction, which may 
result in obstruction. 

INTESTINAL HEMORRHAGE (ENTERORRHAGIA). 

Hemorrhage is one of the most constant symptoms of du- 
odenal ulcer, and may occur in other forms of intestinal ulcer, 
as well as from other causes. The treatment of it must be upon 
the same plan as described for peptic ulcer, q. v., for pulmonary 
hemorrhage, q. v., and for hemorrhage in typhoid fever, q. v. 

Absolute rest must be enjoyed, and no food must be allowed, 
with but a little ice to suck for thirst. Ice-bags should be ap- 
plied to the abdomen, and the foot of the bed should be elevated 
about six inches. If the bleeding comes from low down, small 
injections of ice-water are good. All active handling of the pa- 
tient must be avoided, but a little quiet inhibition may be made 
along the spine to quiet heart and peristalsis. 

FOLLICULAR ULCERS. 

These are due to necrosis of the apices of the solitary glands 
in enteritis. They have the same etiology and pathology as has 
catarrhal enteritis. The lesions and treatment described for 
that disease apply exactly to this condition. 

STERCOREAL ULCERS'. 

These ulcers are due to mechanical irritation of hard fecal 
5cybala or enteroliths, and are referable to such lesions as cause 



PRACTICE OF OSTEOPATHY. 157 

constipation. Their treatment is a most thorough one for bowel 
evacuation, as in constipation. Rectal injections may be used 
to soften fecal accumulations. The course of treatment removes 
lesion arid builds up the circulation, which cures the ulcer. The 
diarrhoea, tenesmus, and colicky pains are treated as before di- 
rected. 

SIMPLE ULCERATIVE COLITIS. 

This condition is usually the result of chronic intestinal 
catarrh, and is due to such lesions and conditions as produce it. 
The ulceration may involve considerable areas of the mucous 
lining of the bowel, showing an extensive disturbance of the 
intestinal circulation. The treatment must be thorough and 
continued long enough to overcome the marked tendency of the 
condition to become chronic. The diarrhoea, in the stools of 
which pus and blood are constant, must be treated as before. 
Constipation may alternate with it. Constitutional treatment 
must be given, as the disease is a drain upon the system, and the 
patient may become weak and emaciated. One must exercise 
much care with these cases, especially in the aged. The diet 
should be fluid or semi-solid. 

NEUROSES OF THE INTESTINE. 

The various lesions producing derangement of the intestinal 
innervation, sensory, circulatory, motor, secretory and trophic, 
have been described. Their anatomical relations to intestinal 
diseases have been fully discussed. Various of these lesions may 
occur and produce intestinal derangements by special interfer- 
ence with certain functional activities of the intestines, through 
acting as lesions to the particular portion of the innervation hav- 
ing those functions in charge. Thus the lesion may so act upon 
the sensory innervation as to cause sensory disease. Or the pre- 
dominating disorder may affect particularly the secretory or the 
motor functions. Sensory, secretory, and motor neuroses of 
the intestine are common. The lesions producing them are not 
different in natuie from the ordinary lesions found as the causes 
of gastro-intestinal disorders. For some reason, not well under- 
stood, certain of these lesions may produce, in a given case, cer- 



158 PRACTICE OF OSTEOPATHY. 

tain special kinds of disturbance of function. In the diseases de- 
scribed below no special lesion has been yet described as the 
special cause of each condition. One finds lesions already de- 
scribed producing them. As a rule, however, these special 
sensory, secretory, or motor neuroses are noted in cases of bad 
intestinal health, and frequently seem to be specialized path- 
ological manifestations of this general bad condition. The sen- 
sory, secretory, or motor disturbance has gained the upper hand. 
In some cases the neuroses is itself the sole manifestation of the 
results of the lesion. 

SECRETORY NEUROSES. 

Membranous Enteritis, 3Iueous Enteritis, or Mucous Colitis, 

is often met, frequently occurring in subjects of intestinal dis- 
ease. The special lesions present and disturbing bowel innerva- 
tion act particularly upon the secretory fibers. The result is 
over-action in the mucous secreting Igarids. The mucous mem- 
brane is not pathologically altered, and catarrh if present at all. 
is a secondary effect. It is a purely nervous manifestation. 
Special lesion is commonly found to be the active cause of irrita- 
tion to the centers or fibers controlling this function. Its re- 
sults are apparent in the copious secretion of the intestinal mu- 
cous, 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-action of the glands. Its cure may depend 
upon the restoratipn of a general healthy bowel condition. Re- 
lief is generally obtained at once from the treatment, but con- 
siderable treatment may be necessary to eradicate the chronic 
condition. Tenesmus. when present, is relieved by strong sacral 
stimulation. Colic is relieved by strong spinal inhibition and 
by the local inhibitive treatment at the seat of the pain in the 
abdomen. 



PRACTICE OF OSTEOPATHY. 159 

SENSORY NEUROSES. 

These disturbances are due to irritation to the sensory 
nerves supplied by the splanchnics to the intestines. 

Enteralgia, Colic, or Intestinal Neuralgia, is met with in neu- 
rotic and anemic subjects, and attacks are induced by exposure, 
gout and local irritation to the sensory nerves of the intestine 
by inflammation, enteroliths, etc. Excepting mechanical irri- 
tants, lead poisoning and like agencies, the actual cause that 
weakens the intestines and lays them liable to the action of such 
exciting causes, is spinal lesion irritating or weakening the 
sensory centers or fibers. Many cases occur spontaneously 
from spinal lesion. This spinal lesion may act by causing in- 
creased .activity in the muscularis, leading to the ring-like con- 
tractions 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 
testinal walls. Here the most efficient treatment is by 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 corrective 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 varies with the case, 
and is found by trial. Special lesion is to be removed, and stop- 
page of the pain may depend upon that. 

Diminished Sensibility of the the intestines is a common neu- 
rosis. It may be both sensory and motor, and leads to dimin- 
ished peristalsis, 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 
upon cure of the primary disease. In other cases, removal of 
lesion and restoration of activity to the local nerve-mechanism 
overcomes the paresis. Spinal and abdominal treatment, di- 
rected especially to the course of the intestine, to affect Auer- 



160 PRACTICE OF OSTEOPATHY. 

bach's plexus, and to the solar plexus, will aid a cure. Specific 
lesions may cause a paretic condition of a bowel segment and be 
responsible for the trouble. A general weak condition of the 
nervous system, on account of which nervous shocks and other 
disturbances cause this condition, must be remedied by upbuild- 
ing it. 

MOTOR NEUROSES. 

Nervous Diarrhoea is a condition in which increased con- 
tractility of the muscularis of the bowel is aroused by purely 
nervous causes. It is an over-action of the bowel, not present- 
ing the usual aspects of diarrhoea. The stools are softer than 
normal, and frequent, occurring two, three, four, or five times in 
twenty-four hours. The subject is as a rule neurotic, being 
hysterical, neurasthenic, or of a very nervous temperament, 
but the characteristic lesions found in diarrhoea, q. v., are pres- 
ent and so act upon the nervous mechanism of the bowel as to 
lessen its motor stability. Thus its abnormal activity, made 
possible by the lesions, becomes the special manifestation 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 anatomically 
weaken the bowel affords a reasonable explanation of this phen- 
omenon. These lesions usually of the lower dorsal and lumbar 
regions, probably affect, through its connections with the llth 
and 12th dorsal and the 1st and 2nd lumbar nerves, the inferior 
mesenteric ganglion ruling motor activity in the fecal reservoir. 

A case of nervous diarrhoea showed lesions of the llth and 
12th ribs, and of the lumbar spine. It readily yielded to the 
usual treatment for diarrhoea, coupled with tonic treatment to 
the general system. 

The treatment commonly employed for diarrhoea is effi- 
cient in checking this form. At the same time, thorough general 
spinal and neck treatment must be given to strengthen the 
nervous system. Spinal causes of the nervous condition must 
be sought and overcome. The case yields rapidly to treatment, 
but is very prone to setbacks due to nervous disturbance. For 
this reason the patient must be kept as free from exciting in- 



PRACTICE OF OSTEOPATHY. 161 

fluences as possible. The condition is apt to recur until the 
nervousness has been lessened. Fortunately this latter condi- 
tion yields to treatment. 

Enterospasm is a neurosis of the intestine in which a spas- 
modic condition of portions of the intestinal walls occurs. It 
may result in temporary obstruction, but its most usual man- 
ifestation 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 pheonomenon, special lesion is necessary to ac- 
count for this peculiar manifestation of nervousness. Special 
lesion may affect the inferior mesenteric ganglion through its 
spinal connections, or the motor fibers 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; CHOLERA INFANTUM. 

DEFINITION: Cholera morbus is an acute catarrhal inflam- 
mation of the stomach and intestines, characterized by severe 
abdominal pain, colic, vomiting, purging and muscular cramps. 
This condition, when present in children under two years of age, 
is called cholera infantum. 

CASES: (1) A young man in intense pain; had vomited 
blood several times, and continuous severe vomiting and purg- 
ing 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. Inhibition of the 
splanchnics stopped the purging. Cracked ice was allowed the 
patient, and a hot enema was administered. After the first 
treatment no vomiting or purging occurred, and rapid recovery 
followed. In his previous attacks he had usually remained in 
bed for three days, being incapacitated for a week. Morphine 
was usually necessary to stop the pain. 

LESIONS: Such lesions as described for enteritis, q. v., 
are present in these cases, weakening the bowel and rendering 
it susceptible to the agencies 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 body may cause the attack, or slight 
indiscretion in diet may bring it on. 

11 



162 PRACTICE OF OSTEOPATHY. 

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 inhibition of the spine, especially over the 
splanchnic area, and from the 9th to the 12th dorsal. This 
quiets the sensory nerves of the viscera. Deep inhibitive treat- 
ment upon the abdomen, over the seat of the pain and about it, 
aids in relieving it. The vomiting is checked as before described, 
as is the diarrhoea. The cramps in the calves are relieved by 
strong inhibition over the sacrum and upon the popliteal nerve 
in the popliteal space. The system should be strengthened 
against collapse by stimulation of heart and lungs and by spinal 
and neck treatment for the general system. 

The patient should rest, in bed, and no food should be 
allowed at first, but a little ice is to be used to relieve thirst. 
Later a rigorously restricted diet is enforced. Hot injections are 
a valuable measure, aiding in the removal of the irritant ma- 
terial from the bowel. A mustard plaster over the abdomen 
relieves pain. 

HEMORRHOIDS. 

DEFINITION: Varicose enlargements of the inferior hem- 
orrhoidal veins or of the hemorrhoidal plexus. 

(1) Hemorrhoids and constipation. Lesion at 5th lumbar, 
coccyx badly bent. (2) 7th to llth dorsal vertebrae posterior, 
coccyx anterior,' innominate forward. Hemorrhoids were ac- 
companied by indigestion and jaundice. (3) Protruding piles 
of several years standing, constipation, prolapsed rectal walls. 
Lesion caused by strain from heavy lifting; a weakened lumbar 
region. Cured in one month. 

(4) Constipation and piles of many years standing caused 
by a bent coccyx. Four treatments gave great relief; case still 
under treatment. 

LESIONS AND CAUSES: The common bony lesion present 
is a bent or dislocated coccyx, which acts as a local irritant and 
mechanical impediment of the venous return from hemorrhoidal 



PRACTICE OF OSTEOPATHY. 163 

veins. Luxated coccyx, by local irritation and interference with 
the fourth sacral nerve, may cause obstinate contracture of the 
external sphincter, leading to constipation or straining at stool. 
Possibly coccygeal and innominate or sacral lesion, by direct in- 
terference or by dragging of tissues, derange the sacral nerves 
supplying 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 sympa- 
thetic (sacral) nerve-supply to the circulation through branches 
contributed to the lower hypogastric and hemorrhoidal plexuses. 
That of the coccyx seems to the most important lesion in hem- 
orrhoids. 

Lumbar and lower dorsal lesion may be present and inter- 
fering with the innervation of the abdominal walls, relaxing them, 
lessening intra-abdominal pressure, and allowing of conges- 
tion of the abdominal circulation. By direct effect or by causing 
constipation, this condition may cause hemorrhoids. Lower 
dorsal and upper lumbar lesion to the nerve fibers which pass by 
way of the inferior mesenteric ganglion to supply motor fibers 
to the circular muscles of the rectal walls may become a factor 
by weakening the wall, relaxing its tone, allowing of a conges- 
tion in its vessels. Lesion to the splanchnic and lumbar areas, 
affecting the sympathetic supply which, through the splanch- 
nics, solar plexus, and other sympathetic vaso-and viscero- 
inotors originating along these same areas, rules circulation and 
muscular tonus in the abdominal and pelvic viscera, may con- 
tribute in an important way to causation of hemorrhoids. Like- 
wise 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 constipation. 
The chief drainage by the hemorrhoidal plexus of veins is through 
the portal circulation by way of the superior hemorrhoidal vein. 
Lesions causing disease of the heart and lungs, q. v., may second- 
arily become the causes of hemorrhoids through the systemic 
circulation. Lesions causing atonic diaphragm and other 
causes of enteroptosis, q. v., produce hemorrhoids by the me- 
chanical obstruction of circulation, and by deranged nerve- 
supply, etc. 



164 PRACTICE OF OSTEOPATHY. 

The ANATOMICAL RELATIONS 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 upright 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 in- 
spection of the rectum. 

The PROGNOSIS is very favorable. The usual medical 
treatment is palliative, 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 treatment 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, spinal and constitu- 
tional. 

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 thor- 
ough. The rectal speculum may be used for this purpose. All 
the surrounding tissues, both externally and internally, are to be 
thoroughly but gently relaxed. Internally this operation should 
be carried as far up along the rectal 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 
veins, the manipulation about and upon them must be gently 
applied with the purpose of stimulating the circulation to a grad- 
ual absorption of them. They must not be broken up or de- 
tached, as there is danger of their being swept into the circula- 
tion as emboli. 



PRACTICE OF OSTEOPATHY. 165 

After dilatation of the sphincter and relaxation of the tis- 
sues, protruding piles, first emptied if possible, must be gently 
pressed back beyond the sphincter. If the rectal walls are 
prolapsed, as is often the case in protruding piles, they must 
be replaced by the index finger directed to straightening out and 
pushing them up on all sides. 

This local work removes irritation of the coccyx, frees the 
whole local circulation, tones the local musculature and other 
tissues, and stimulates the local sympathetics. It may be the 
sole and sufficient treatment in many, bad cases. It should be 
given but once per week or ten days. 

Abdominal- treatment is for the purpose of increasing free- 
dom of circulation and to aid in the venous return. The solar 
and hypogastric 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 
treatment 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 plexuses and 
to aid venous return from the hemorrhoidal, vescical, uterine, 
and other related plexuses of veins. (II, III, IV, Chap. VIII). 
If the patient is placed in the knee-chest position while abdom- 
inal treatment is performed with the ideas explained above, the 
force of gravitation is made to assist in venous drainage of the 
parts. This is an important treatment, and should not be omitted 
in these cases. 

Enteroptosis and diaphragmatic lesion are repaired as be- 
fore explained. 

Thorough spinal treatment is given from the sixth dorsal 
down, stimulating splanchnics and other sympathetics, with 
all their contained vaso and viscero-motor, circulatory, and 
trophic fibers. This treatment is to strengthen circulation and 
to maintain its freedom. It is supplementary to the abdominal 
work. It also aids in restoring tone to the vessel walls, as well 



166 PRACTICE OF OSTEOPATHY. 

as to prolapsed rectal walls, and thus to maintain them in cor- 
rect condition. Anatomical relations between the spinal work 
and the effect gotten at the seat of the disease have been ex- 
plained. 

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 constitutional treatment consists in the general spinal 
treatment, and in special treatment for heart and lung diseases 
if present and causing the hemorrhoids. 

Light out-door exercise and absolute personal cleanliness 
should be enjoined upon the patient. 

INTESTINAL TUMORS. 

Intestinal Tumors of various, kinds, both benign and malig- 
nant have been frequently treated osteopathically with success. 
Medical treatment is but palliative, and the only means of re- 
moval has been by surgical operation. The fact that in numer- 
ous instances these tumors have been entirely removed by 
osteopathic treatment is in itself remarkable, and helps to sus- 
tain the claim often made, that the use of the knife is often 
obviated 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 described as 
producing gastro-intestinal disease. At bottom the real cause 
of these growths is some obstruction or irritation to local 
blood and nerve-supply, It has already been shown how special 
lesion causes this obstruction, or lays the foundation of the con- 
dition which directly or indirectly produces the irritation. The 
treatment is therefore the removal 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-supply 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, by absorption. At least one 
case is upon record in which the tumor, a fibroid, was loosened 



PRACTICE OF OSTEOPATHY. 167 

by the treatment and passed per rectum. (Cosmopolitan Osteo- 
path, Feby., 1900, p. 30.) The diet should be light, and of a sort 
easily digested. Rectal feeding has sometimes to be resorted to 
in cases where the tumor causes obstruction. 

Attendant conditions, such as constipation, fecal impac- 
tion, colic, etc., are treated as described elsewhere. See also 
section upon "Tumors." 

APPENDICITIS. 

DEFINITION: An inflammation of the vermiform appen- 
dix, acute or chronic, caused by traumatism, or by specific rib 
or spinal lesions. These lesions obstruct bowel-action, limit 
its motion, deplete its nerve and blood-supply, leaving a weak- 
ened condition, allowing of aggregation of fecal matter, foreign 
bodies, etc. The vigor to pass these onward is lacking, and they 
are pressed into the appendix, which itself is suffering from a 
weakened state due to these causes. Or direct irritation of le- 
sion may affect nerve and blood mechanism, derange vaso-mo- 
tion, and set up the inflammation. Or the direct mechanical 
irritation of a displaced lower rib may set up the inflammation. 

CASES: (1) Lesions; 2d lumbar lateral, with heat and pain 
about it; llth right rib luxated. Treatment relieved at once, 
and the patient was cured in two weeks. Surgeon had been 
ready to operate. (2) 12th right rib down and inside of the 
crest of the ilium. Setting the rib cured the case in a few days. 
(3) Recurring appendicitis; spine posterior in lower dorsal and 
upper lumbar; lateral curve at 6th to 9th dorsal; constipation 
chronic; cured by ten weeks treatment. (4) Tenderness upon 
right side of spine from 6th dorsal to 2d lumbar, especially at 
the 6th to 10th dorsal and 1st and 2d lumbar. (5) Lesion at 
lower dorsal and upper lumbar; 10th and llth ribs overlapping 
12th, due to a fall. Operation had been advised, but two months 
treatment cured the case. (6) Appendicitis in a boy of twelve, 
for which operation had been advised. Examination showed 
downward displacement of llth and 12th ribs, a posterior con- 
dition of the 5th lumbar vertebra. Incontinence of urine was 
also a feature of the case. The case was cured by correction of 
the lesions. (7) A severe acute case, in which operation was 



168 PRACTICE OF OSTEOPATHY. 

about to be performed. The patient was in great agony when 
the treatment was begun. Treatment gave immediate relief, 
and the case was cured. Lesion was found at the 5th lumbar. 
(8) A chronic appendicitis of five months standing, in a young 
man of twenty-five. Lesion was present as a lateral displace- 
ment of the 9th to 12th dorsal vertebrae to the left. This same 
spinal area was anterior. The bladder would not empty. By 
twenty-two treatments the case was cured, within three months. 
Pain at McBurney's point was relieved at. the second treatment 
and did not recur. 

LESIONS AND CAUSES: (1) There is usually a history 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 ap- 
parently 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 cases caused by a 
foreign body, seeds, shot, enteroliths, etc., would probably 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 inflam- 
mation 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 prevents the passage of fecal matter and forces the intro- 
duction of fecal masses into the appendix. It also obstructs 
circulation, causing congestion and favoring inflammation. 

(3) The most important bony lesions seem to be displace- 
ments of the lower two ribs on the right side. They may add 
mechanical obstruction or irritation to deranged nerve-connec- 
tions at the spine. 

(4) Lesions of the dorsal and lumbar regions are very im- 
portant on account of the nerve connections with the bowel. 
From the 9th, 10th, llth and 12th dorsal region sensory nerves 
pass through the sympathetics to supply the intestines down to 



PRACTICE OF OSTEOPATHY. 169 

the upper part of the rectum. For this reason strong inhibition 
to this portion of the spine is useful in controlling the pain in 
appendicitis. The sympatheic vaso-constrictor fibers for the 
abdominal vessels pass from the lower dorsal and upper two 
lumbar nerves, while 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 produc- 
tion of this inflammation. 

(5) Direct traumatism to the region of the appendix, the 
presence of foreign bodies in the bowel, or extended inflamma- 
tion from contiguous structures, may all be causative factors. 

The anatomical relations given for lesion in diarrhoea apply 
to those in appendicitis. 

The appendix has the same structure as the caecum, prac- 
tically; is nourished by a branch of the ileo-colic artery, 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 secretion of this 
mucous fills the cavity of the structure to the exclusion of foreign 
bodies, but upon lesion to the blood or nerve-supply such as 
mentioned above, lessened secretion allows of room for the en- 
trance of foreign bodies. Byron Robinson says that active oc- 
cupations in men, contracting the abdominal walls, favor thus 
the forcing of matter into the appendix, causing appendicitis. 
But it is very likely that some lesion, of the kinds above described, 
first weakens the tissues of the appendix and lessens its normal 
condition and secretions, laying it liable to such accident. 

Anemia may become a cause of the inflammation in it. 

The PROGNOSIS is favorable for recovery in nearly all cases. 
The experience with cases, even the most dangerous acute ones, 
has been very satisfaot ory. Many 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 is, however, often reached. Osteo- 
pathic treatment prevents the case falling into the chronic form 
so commonly met, and in which operation, to prevent an acute 
attack, is so often resorted to. The acute case is usually aborted 
by prompt treatment. 



170 PRACTICE OF OSTEOPATHY. 

TREATMENT: The first consideration is the removal of the 
lesion if possible in the patient's condition. This applies par- 
ticularly to displacements of the llth 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 by removing the pressure of 
bowel contents from tender points, by giving freedom of circu- 
lation in the bowel, and by aiding to remove foreign bodies. 

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 experienced in applying such treatment even 
in very painful cases. The relaxation of the tissues thus ac- 
complished 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 be slow, deep, 
inhibitive and given with great care. In the intervals of treat- 
ment, it may be necessary to apply the ice-bag or hot fomenta- 
tions at the seat of the inflammation. 

It is not likely that in this contingency spinal work to in- 
crease peristalsis would be at all successful in removing the for- 
eign body from the appendix. Local manipulation must be 
depended upon for this. The pain is relieved by spinal inhibi- 
tion from the 9th to the 12th dorsal particularly. Xausea, 
vomiting, fever, and hiccough, aside from being relieved by the 
general treatment of the case, may be relieved by the usual meth- 
ods before described. 

The patient should go to bed at once upon the attack threat- 
ening. 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 purpose of the work is to remove 
lesion, to restore perfect freedom of circulation, and by local 



PRACTICE OF OSTEOPATHY. 171 

treatment of the tissues to remove tenseness and pain. Thor- 
ough spinal and abdominal treatment, and attention to the gen- 
eral condition of the bowel are necessary. The disappearance 
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 appendix, which call for a course 
of treatment to so restore circulation as to enable it to repair 
them. 

RECURRENT APPENDICITIS frequently comes under treat- 
ment, and presents the same lesions as have been above described. 
No special mention need be made regarding its treatment, in ad- 
dition to what has been in regard to the treatment of chronic 
and acute cases. 

INTESTINAL OBSTRUCTION. 

DEFINITION: The occlusion of the bowel may be but par- 
tial, persisting as a chronic condition. In acute cases it may 
be wholly or partially obstructed. It may be due to strangu- 
lation; to twists and knots, called volvulus; to strictures and 
tumors; or to intussusception. 

CASES: (1) Fecal impaction. Severe radiating abdominal 
pains, griping, and some dysentery had been present for twenty- 
four hours. The impaction was located at the hepatic flexure. 
Treatment relieved the pain at once, and the manipulation re- 
moved the obstruction. Complete recovery followed. 

(2^ Volvulus was diagnosed, located near the ileo-csecal 
valve. The surgeon was ready to operate. Persistent treat- 
ment 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. 
The patient was asleep in thirty minutes. 

(4) Intestinal obstruction from fecal impaction, in a boy. 
Three physicians had given the patient up. The abdomen was 



172 PRACTICE OF OSTEOPATHY. 

much swollen and intensely painful, and the seat of the obstruc- 
tion could not be located. Tension was found in the tissues of 
the spine at the 10th dorsal. Inhibitive treatment was made 
here, while the pneumogastric were stimulated. This treatment 
was kept up throughout the night. An enema was given. Early 
in the morning the bowels were gotten to move successfully, and 
in a few weeks the boy was quite well. 

(5) Intestinal obstruction in a child of 7 months of age. 
Physicians gave up the case, and were ready to resort to sur- 
gery as the last hope. By one treatment the baby's howels 
were moved, and the case was entirely cured. 

(6) In a case of fecal impaction in the splenic flexure of 
the colon, ten minutes treatment relieved the intense pain and 
opened the bowels. The patient had been about to undergo 
operation for appendicitis, as the condition had been wrongly 
diagnosed. 

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 ac- 
counting for the bad condition of the bowel that resulted in some 
form of obstruction. In general one would expect such lesions 
as have already been described as interfering with the abdominal 
organs. Intussusception is sometimes due to irregular, limited, 
sudden, or severe peristalsis. In such cases special lesion to the 
splanchnics, or to the sympathetic connections of Auerbach's plex- 
us, might result directly in the abnormal peristalsis producing the 
invagination. In such cases the outer layer, or receiving portion 
of the bowel involved, draws up by contraction of its longitu- 
dinal fibers. Such abnormal activity of these fibers might also 
be due to some special lesion to motor innervation. 

In some cases McConnell suggests that special spinal lesion 
could cause paresis or paralysis of a bowel segment. Such a con- 
dition could allow 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 especially frequent at the sigmoid and 



PRACTICE OF OSTEOPATHY. 173 

at the caecum, enteroptosis being the cause, through allowing 
the parts to prolapse and turn. Volvulus may be caused by a 
long or relaxed mesentery. 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 ob- 
structions. 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 bow^el motion and secre- 
tion that allows of accumulation of fecal matters, foreign bodies, 
etc. A healthy bowel, perfectly free from the effect of lesion of 
any kind, could 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 
these cases. 

The ANATOMICAL' RELATIONS of these various lesions have 
already been pointed out in the consideration of various intes- 
tinal diseases. 

The PROGNOSIS must be guarded. Very many cases die, 
and surgical measures have generally been considered necessary 
after the third day of obstruction. Yet osteopathic treatment 
has been successful in a number of cases after the necessity for 
operation had been urjred. Probably, as in the case of appendi- 
citis, many lives could be saved by osteopathic means before 
surgery is resorted to. 

In chronic cases the prognosis for recovery is very favor- 
able. 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 depend upon a special le- 
sion 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 9th to 12th dorsal, and 
of the lumbar region, aids in lessening the pain. This step may 
be necessary before abdominal manipulation can be borne. The 



174 PRACTICE OF OSTEOPATHY. 

solar plexus should now be inhibited. A slow, deep, but gentle 
inhibitive treatment should next be given over the bowel to re- 
lax the tissues, decrease the inflammation, and lessen the pain 
This treatment may be used to quiet abnormal peristalsis if pres- 
ent. After this preliminary treatment the practitioner may pro- 
ceed by careful palpation to locate the seat of obstruction if pos- 
sible. 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 flexures. 
In intussusception the parts should be raised and drawn from each 
other toward the extremities of the cylindrical 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. For- 
eign 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 injec- 
tions sometimes aid in overcoming intussusception, volvulus, 
etc. Injections of Sedlitz powder solutions, injected separately, 
have been successfully used. During the abdominal treatment it 
is well for the patient to be placed in various positions ; upon the 
back, sides, upon the abdomen, in the knee-chest position, 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 should remain continuously with the case, and treat 
it as much as practicable, until relieved. In the intervals, hot 
applications over the seat of the pain may made. 



PRACTICE OF OSTEOPATHY. 175 

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 treat- 
ment should be undertaken for the removal of lesions that have 
originally impaired the bowel or have produced abnormal ab- 
dominal conditions. 

ENTEROPTOSIS. 

Enteroptosis is a disease in which various of the abdomi- 
nal and pelvic viscera leave their natural positions, slipping 
downward into the abdominal and pelvic cavities. It is a com- 
mon and distressing complaint, frequently overlooked or not 
recognized. It is sometimes regarded as a symptom group, 
but may, from the osteopathic point of view, be regarded as an 
idiopathic condition, due to specific lesion. 

These cases are often treated for some one feature, as for 
nervous dyspepsia, constipation, operation for floating kidney, 
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, constipated patients, who complain 
of lack of bodily and mental vigor, many and various indefinite 
nervous symptoms, abdominal pulsation, vaso-motor disturbance, 
etc., will find most interesting material. The multitude of symp- 
toms may vary greatly 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 experi- 
ence with such cases one learns to recognize them at a glance when 
presented for examination. Once seen these cases can hardly 
be mistaken, and a few moments examination reveals a story of 
disease beginning imperceptibly, the growing conviction through 
many months or some years that something was wrong, the at- 
tempt to seem well because no decided disease seemed present, 
or a long course of treatment for various ills, none of which reach- 
ed the true condition. This most common disease it still but sel- 
dom clearly recognized or intelligently handled. 

LESIONS AND CAUSES: The common description of its 
etiology is unsatisfactory. Tight lacing, traumatism, muscu- 



176 PRACTICE OF OSTEOPATHY. 

lar strain, and repeated pegnancies are mentioned. The con- 
dition of relaxed abdominal walls and prominent viscera due to 
repeated pegnancies may probably be rightly regarded as a sep- 
arate condition. It is due to a physiological act, and does not 
present those specific lesions nor the resulting symptoms found 
in neurasthenic enteroptosis. Tight lacing, traumatism, and 
muscular strain may produce those lesions found to be the cause 
of such conditions. 

These cases commonly present spinal, rib, diaphragmatic 
and abdominal lesions. Spinal lesions may be of any of the kinds 
found in 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 4 of the tenth rib is regarded by a German physi- 
cian, Dr. B. Stiller, (Phil. Med. Journal, Jan. 13, 1900,) as a path- 
ognomonic cause of enteroptosis.* Undoubtedly it could in- 
terfere with the sympathetic connections of the abdominal vis- 
cera and become a factor in causing this condition. But, from 
an osteopathic view-point, lesions of other ribs, and of spinal 
vertebrae, etc., may be as potent in producing the "basal neuro- 
pathy" concerned in this disease as its fundamental pathologi- 
cal 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 support- 
ing. Spinal lesions may participate in causing the atonic con- 
condition of the diaphragm. 

Spinal and rib lesions, aside from derangement of the dia- 
phragm, 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 sensory, 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 or- 
gans. The displacement of itself furthers the present bad con- 
ditions by mechanically interfering with the activities of organs, 
stretching nerve-fibers and blood-vessels which are carried in the 

*"Boston Osteopath," Jan. 14, 1900. 



PRACTICE OF OSTEOPATHY. 177 

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 
upper abdomen, thus giving to it the peculiar boat-shaped ap- 
pearance described as "scaphoid abdomen." 

Lower dorsal and lumbar lesion may interfere with the 
spinal innervation of the abdominal walls, cause them to lose 
their tone and to dilate. Intra-abdominal pressure is thus less- 
ened and the organs are allowed to prolapse. 

According to Byron Robinson, enteroptosis begins with a 
weakening of the abdominal sympathetic, which loses its nor- 
mal power over circulation, secretion, assimilation and rhythm. 
That this weakness of the abdominal sympathetic and its conse- 
quent 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. The anatomical relation of such lesions to parts 
affected was pointed out. 

The PROGNOSIS in these cases is very favorable, but the 
progress of the cure is likely to be slow. Generally improve- 
ment begins immediately upon treatment and may progress to 
a cure in a few months. Other cases yield more slowly, though 
relief is soon given, and require an extended course of treatment 
to effect a cure. 

The TREATMENT must be both constitutional and local. 
The latter consists in the removal of lesion and in abdominal 
treatment. Lesions anywhere to the .splanchnic and lumbar 
regions, to the ribs, thorax and diaphragm, must be treated 
after their kind, according to directions given in Part I. With 
spine, ribs, and diaphragm restored to normal condition, the 
underlying causes of the enteroptosis have been removed. Cor- 
rected nerve and blood-supply 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 manip- 
ulations. 

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 abdom- 

12 



178 PRACTICE OF OSTEOPATHY. 

inal walls. This renders the use of the favorite abdominal band- 
age unnecessary, and it is gradually laid aside. Throughout the 
course of the case the restored abdominal walls act as the band- 
age has done to hold the organs to their places as replaced by the 
treatment. With corrected spine, free blood and nerve supply 
to all the visceral supports, and a strengthened abdominal wall, 
no difficulty is found in getting the parts to gradually be retained 
in their normal positions. Thorough spinal stimulation over the 
splanchnic and lumbar areas is kept up for the purpose of increas- 
ing the blood and nerve-supply to the parts in question. 

Abdominal work, aside from treatment of the walls, is di- 
rected to raising and replacing the viscera. This is readily ac- 
complished by various treatments. (II, III, IV, Chap. VIII.) 
This releases and renews circulation 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 by correction 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 of heart and 
lungs, treatment of the cervical sympathetic, and attention to 
kidneys, liver and skin accomplishes the desired object. The 
auto-intoxication usually present is overcome by this treatment 
of the excretory organs. The constipation, dyspepsia, and other 
functional disorders are corrected by the restoration of the or- 
gans concerned. 

The patient should be much out of doors, free from worry, 
and careful not to become fatigued. Deep breathing exercises 
are beneficial. 

PERITONITIS. 

DEFINITION: An acute or chronic inflammation of the peri- 
toneum, localized or general. 

CASES: (1) A case diagnosed as septic peritonitis, prob- 
ably caused by appendicitis, under the care of celebrated Chicago 



PRACTICE OF OSTEOPATHY. 179 

physicians grew steadily worse until death was expected in a few 
hours. No hopes of recovery were entertained, and it was evi- 
dent that the best medical treatment was of no avail. As a last 
resort an Osteopath was finally called, all medical treatment was 
discontinued, and the treatment began. Immediately, 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 discovered upon examination, and led to inquiry concerning 
accident, which brought out the fact that the boy had had a ser- 
ious fall a few weeks before. The resulting lesions were held to 
be the primary cause of the peritonitis, and treatment directed 
to them was the cardinal treatment. The fact that the child's 
life was saved at such a juncture, in disease of such a nature, 
by the removal of spinal lesion, is a convincing demonstration 
of the correctness of osteopathic theory and practice. 

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 inflam- 
mation 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 supply also the muscles of the abdominal walls. 
The abdominal sympathetics also supply the peritoneum, being 
chiefly vaso-motors for the blood-vessels in the mesentery, but 
also having certain branches distributed directly to the substance 
of the peritoneum. 

The blood-supply is from the cceliac axis through the- hepatic 
and splenic arteries, and from the blood-supply of the parts with 
which the various portions of the mesentery are in relation. 

The fact that the chief sympathetic supply to the perito- 
neum is to the blood-vessels in it is a significant one. 

The inflammation of peritonitis is a vaso-motor disturb- 
ance. It has been before explained how spinal lenon deranges 
spinal sympathetic connections of the abdominal sympathetic 



180 PRACTICE OF OSTEOPATHY. 

and produces disease. Thus certain lesions among the lower 
ribs, and along the lower spine, result in derangement of the sym- 
pathetic, which, when affecting the peritoneum, becomes a chiefly 
vaso-motor disturbance because of the peritoneal sympathetics 
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, 10th, llth 
and 12th dorsal nerves, sensory nerves pass through the sym- 
pathetic to the abdominal viscera. It also shows that from thor- 
acic sympathetic and from the lumbar sympathetic cord, vaso- 
motor fibres of the abdominal vessels take origin. The intimate 
relation between the spinal and sympathetic nerves is well known. 
Hilton uses the facts he points out in regard to this connected 
nerve mechanism to explain why the abdominal walls become 
painful and contracted from the inward irritation of the inflam- 
mation. The connection of this nerve mechanism for all these 
related parts also explains how lower rib, lower dorsal, and upper 
lumbar spinal lesions may so interfere with vaso-motor supply to 
the peritoneal vessels as to cause peritonitis. This immense 
abdominal nerve-supply, both superficial and internal, spinal 
and sympathetic, offers the Osteopath, both through its sur- 
face distribution, its spinal connections, arid its internal distrib- 
ution, 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 bad cases, in gaining 
control of the vaso-motor mechanism which is deranged in this 
inflammation. 

Through the connection of this local vaso-motor mechan- 
ism with the vaso-motor system of the whole body, reflex irrita- 
tion is set up which leads to a general vaso-constriction of the 
vessels of the whole body surface. Robinson thus explains why 
the whole skin is waxy pale and cold, saying that the j atirnt. 
on this account, dies from circumference to center. 



PRACTICE OF OSTEOPATHY. 181 

Robinson also shows that traumatic action of the left end 
of the diaphragmatic muscle upon the gut wall, of the psoas 
magnus upon the sigmoid, and abrasion of the bowel mucosa 
at the splenic and sigmoid flexures, very frequently become the 
causes of peritonitis by allowing the migration and foot-hold of 
pathogenic bacteria. Spinal, or other specific osteopathic le- 
sion, by causing bad bowel conditions which allow of the possi- 
bility 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 patients often 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. 

The TREATMENT must aim at gaining vaso-motor control 
and thus reducing 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 re- 
laxation of all spinal tissues. If the patient cannot 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. Inhibition should be made along the splanchnic and 
upper lumbar regions, especially from the 9th to 12th dorsal, to 
quiet the pain through inhibition of the sensory fibres. After 
spinal relaxation and inhibition, the abdominal treatment will 
be better borne. Through this spinal treatment effect upon 
vaso-motor activities is gained by way of the sympathetic con- 
nections 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 
treatment should be given to equalize the general circulation, 
and to overcome the intense vaso-constriction of all the super- 
ficial vessels, so noticeable a feature of the case. Heart and 
lungs should be stimulated, and inhibition of the superior cer- 
vical region be made. 

After spinal inhibition very light abdominal treatment is 



182 PRACTICE OF OSTEOPATHY. 

given. The walls are tense and painful, and much care is re- 
quired in treating them. The treatment should be gentle, re- 
laxing, 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 abdominal walls has an important corrective effect 
upon the morbid conditions present internally. The theory 
that work upon nerve terminals affects parts supplied by con- 
nected nerves is well supported by fact. Thus restoration of a 
relaxed and natural condition of the abdominal walls is 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 treat- 
ment over the intestines, as their walls are intensely gorged with 
blood, and are friable. 

The obstinate constipation present is due to pressure from 
congestion of the bowel walls, and by edema into them, check- 
ing 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 be stimulated to aid in carry- 
ing 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 and for the vomiting and 
tympanites, is applied as before directed. The treatment pre- 
vents the formation of adhesions, and takes down the thickening 
of the peritoneum. 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 time. Crack- 
ed 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. 



PRACTICE OF OSTEOPATHY. 183 

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 predominate. 

ASCITES, (HYDROPERITONEUM.) 

DEFINITION: A dropsical condition of the abdomen, due 
to an accumulation of serous fluid in the peritoneal sac. 

CASES: (1) Ascites following malarial fever, and of more 
than one years standing. The condition was so pronounced that 
the patient could walk but little. Lesion was present as a down- 
ward displacement of each llth rib, and the whole lumbar re- 
gion of the spine \vas affected. The pulse was 156. Under 
treatment rapid improvement took place. The pulse was re- 
duced to 82, and the patient was able to go to work. 

(2) A case of ascites which had suffered from the condition 
two times previously, at one time for fourteen years, at another 
for one year. Recovery was made from these attacks, but the 
disease again developed after an attack of the grippe, and was 
not relieved by the means which had before been successful. 
It was of three years standing when it came under osteopathic 
care. After the seventh treatment the dropsical fluid began to 
be absorbed into the circulation and thrown off by the kidneys. 
Ten pounds of fluid were excreted every twenty-four hours, and 
the patient's weight was rapidly reduced from 190 to 153 pounds. 

(3) See Cirrhosis of the Liver, case (1). 

The LESIONS in this disease are various, as it is commonly 
a condition secondary to some other disease, as of the heart, 
lungs, kidneys, liver, etc. Lesions must be expected - accord- 
ing to the nature of the primary disease. If it 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 fonnd 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, determin- 
ing the local manifestation of the disease through interference 
with the sympathetic innervation of the abdominal vessels, as 
before explained. 



184 PRACTICE OF OSTEOPATHY. 

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, together 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 dropsy 
to the abdominal region. 

The PROGNOSIS in these cases depends upon that for the 
condition producing 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 disease to which it is secondary. Special lesion as found 
must be removed. Obstructed circulation must be opened, 
general abdominal circulation stimulated, 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 
abdominal plexuses are stimulated, and deep abdominal manip- 
ulation is made from below upward along the course of the vena- 
cava and azygos veins, the portal vein, and the superficial ab- 
dominal 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 dropsical process is checked, and ab- 
sorption of fluid already effused begins to take place. Stimula- 
tion of kidneys, bowels, and skin aid the process. The disten- 
tion 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 patient 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 performed, but ordinarily 
under osteopathic treatment tapping does not become necessary, 
except in cases of atrophic cirhosis of the liver. The lower limbs 
should be treated to increase circulation in them and to -empty 
their dilated vens. 

The patient should be treated daily. 



PRACTICE OF OSTEOPATHY. 185 

JAUNDICE. 

DEFINITION: A condition in which bile is absorbed into 
the circulation and colors the tissues of the body and the secre- 
tions. 

CASES: (1) Lesion from overexertion, in the form' of a 
"twist" between the 6th and 7th dorsal vertebrge. Jaundice 
followed immediately after its occurrence. (2) 9th and 10th 
dorsal vertebrae anterior; intense congestion of the deep mus- 
cles of the right cervical region; looseness of the 7th cervical 
vertebra. (3) Catarrhal jaundice following difficult child-birth; 
extreme tenderness of the spine from the 10th dorsal to the 1st 
lumbar. (4) Jaundice and constipation in a lady of 23. The 
jaundice was of several months standing. There was a lateral 
lesion of the 10th dorsal vertebra, with marked rigidity of mus- 
cles and ligaments in the lower dorsal and lumbar regions. The 
case was practically cured in one month. (5) Jaundice of four 
years standing. There was external tenderness in the legion of 
the hepatic flexure of the colon; luxation of the 10th right rib: 
posterior condition of the 9th to llth dorsal. Correction of le- 
sions, with occasional abdominal treatment, cured the case in 4 
months. 

LESIONS AND CAUSES: Spinal lesion 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 Intestinal Obstruct ion and En- 
teroptosis), may obstruct the duct by compression. Various 
mechanical causes; stricture, gall-stones, parasites, tumors, etc., 
are well known as causes of obstructed bile-flow, leading to ob- 
structive jaundice. The relation of lesion to these causes, "osteo- 
pathically, is found in the agency of various lesions, whose na- 
ture and action are well understood from discussions in the pre- 
vious pages, in producing diseased conditions of the gastro-in- 
testinal tract leading to the presence of such obstructive agents. 

ANATOMICAL RELATIONS: The relation between spinal and 
other lesion and abnormal liver conditions will be discussed (see 
Cirrhosis and Gall-stones). In catarrhal jaundice, the usual form 
presented for treatment as jaundice, lesion has occurred in the 



186 PRACTICE OF OSTEOPATHY. 

splanchnic area and is interfering with vaso-motor activing 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 
communis. 

The immediate appearance of jaundice after spinal lesion, 
as in case 1 cited above, as well as the presence of spinal lesion 
in other cases of jaundice, favors the probability of direct inter- 
ference of such lesions with the innervation of the gall-bladder 
and duct. The presence in the sympathetic supply of the liver 
(hepatic and cystic plexuses, see Gall-Stones) of spinal fibers 
which, upon stimulation or inhibition of the splanchnics, cause 
constriction or dilatation of the bladder and ducts; also the fact 
that stimulation of the pneumogastrics constricts the bladder, 
while relaxing the sphincter 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 nor- 
mal w r orkings 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 immedi- 
ately to treatment. The usual course (two to eight weeks) is 
materially shortened. In the chronic case, clearing of the tis- 
sues from the pigmentation is rather a slow process. 

The TREATMENT must look at once to the removal of such 
active lesion as described above. Mechanical obstruction must 
be located if possible and removed by work upon 'the duct, pro- 
ceeding 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 preliminary 
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, inhi- 
bitive or relaxing treatment is directed to the upper intestinal 
egion and ductus communis. This relieves the inflammation, 



PRACTICE OF OSTEOPATHY. 187 

aids in taking down the swelling of the mucous membrane, and 
frees the secretion of mucous which may 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 mechanic- 
ally 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 beneath the postero- 
lateral aspect of the lower four right ribs and, while raising them, 
presses down upon their anterior portions with the right fore- 
arm. At the same time the left hand makes careful but deep 
pressure beneath the tip of the ninth rib, against the fundus of 
the gall-bladder. This mechanically 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 circu- 
lation through the liver and to free it of accumulated bile. The 
splanchnics should also be thoroughly treated for the circula- 
tion. 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 re- 
gion (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 directed. Other symp- 
toms 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. Skimmed milk and butter- 
milk, lean meat, soups, bread, and green vegetables may be 
used. Frequent bathing is good to aid elimination and to clear 
the skin and restore its healthy condition. 

In toxemic jaundice the main object of treatment must be 
the removal from the system of the poison that is causing the 



188 PRACTICE OF OSTEOPATHY. 

trouble. If due to a toxic disease, the treatment must be to it. 
In any such case all the avenues of excretion must be kept active 
to cleanse the system. The usual liver treatments etc., may be 
also applied. 

CONGESTION OF THE LIVER. 

DEFINITION: An excess of blood in the vessels of the liver. 
In active congestion, or acute hyperemia, an excess of arterial 
blood is circulating through it. In passive congestion the liver 
is engorged by retention of blood in its portal circulation. 

CASES: (1) A case of active congestion, which was in a 
dangerous condition. Lesion was present as a severe contrac- 
tion of the muscles on the right side of the spine, from the 6th to 
12th vertebra. The intercostal muscles over the liver were also 
contracted. (2) Active congestion in a woman of 45, of two 
weeks standing. There was muscular lesion in the region of the 
splanchnics. 

The LESIONS already discussed in connection with liver dis- 
eases, i. e., these of the splanchnic area and of the lower ribs, in- 
terfering with the -vase-motor control of the organ, lead to the 
congestion. Heart and lung diseases are said to be almost always 
the causes of passive congestion, but the ordinary congested liver, 
found in dyspepsia, biliousness, constipation, etc., is due, not to 
heart or lung disease, but to lesions in the splanchnic area. The 
lesions here must be sought according to the case, and treat- 
ment made as thus indicated. 

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 is an important means of accomplishing this. 
The lower costal and direct liver treatment indicated for jaun- 
dice, q. v., are used. Besides directly stimulating the local 
nerve mechanism, these treatments, by squeezing the liver and 
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 



PRACTICE OF OSTEOPATHY. 189 

jaundice. A general spinal, neck, and abdominal treatment aids 
in correcting general circulation. Treatment for the abdominal 
vessels quiets active congestion by dilating the abdominal ves- 
sels and drawing the blood to them. 

In active hyperemia correct errors in diet, and avoid the 
use of highly seasoned food and alcohol. A milk diet is good. 
Keep the bowels active. 

In passive hyperemia look well to the condition of the heart. 
Keeping it stimulated. Due attention should also be given to 
the lesser circulation. 

CIRRHOSIS OF THE LIVER, (SCLEROSIS OF THE LIVER.) 

DEFINITION: A chronic disease, characterized by an in- 
crease of connective tissue in or about the liver. 

CASES: (1) Atrophic cirrhosis; a case brought on by social 
drinking, diagnosed and treated by physicians as such. The 
first tapping of the abdoment brought eight and one-half quarts 
of fluid. The case now came under osteopathic treatment, and 
it succeeded so well that a second tapping was delayed some 
time beyond the expected time. Later a third tapping became 
necessary, after that none was required. Under the treatment 
the patient was retsored to perfect health. 

(2) Diagnosis of cirrhosis; 6th and 7th dorsal vertebrae pos- 
terior, 9th to 12th flat; ribs irregular and prominent on left. 

(3) Malarial cirrhosis; entire lumbar region bad; llth rib 
on each side down. 

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 sympathetic 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 



190 * PRACTICE OF OSTEOPATHY. 

have been cured, among them even atrophic cirrhosis. In the 
latter case the prognosis is very unfavorable. It is probable 
that other forms of the disease can be much benefited 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 increase in connective tissue. In those forms 
complicated with ascites as the main symptom, special atten- 
tion must be given to it as being most immediately dangerous 
to the patient's life. (See Ascites.) It is doubtful if connective 
tissue, once formed, could be absorbed by the renewed blood- 
supply. But the process of its formation could be stopped, the 
liver substance could be kept softened by thorough work locally 
over the organ, thus preventing hardening and contractions of 
it, and maintaining freedom of circulation through it. In this 
way danger of ascites could be avoided. 

Vaso-motor control is gained by removal of lesion, by thor- 
ough stimulation 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, 
working beneath the right ribs, directly upon the liver, while 
the pressure from above upon the ribs, pressing them down upon 
the liver, alternating with what 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 congestion of the spleen, stomach and intestines present. 
This is done through treatment of the organs as described in 
considering diseases of them. In 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 consti- 
pation, 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 rt 
move the obstruction to the duct and to empty the gall-bladder 
(IX, Chap. VIII.) The general corrective treatment for the 



PRACTICE OF OSTEOPATHY. 191 

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 re- 
move and prevent the congestion. Otherwise the treatment is 
as indicated for the general case. 

In hypertrophic cirrhosis the main indication is to prevent 
the formation of new connective tissue, or to limit its forma- 
tion. This connective tissue does not usually show a tendency 
to contract, as in atrophic cirhosis. Possibly much might be 
done by renewed and stimulated circulation to absorb this tis- 
sue, since fibroid tumors have been removed by like means. The 
kidneys must be kept well stimulated, as the amount of urine is 
decreased. Careful treatment must be done about the spleen 
and abdomen, as the former is enlarged and tender, and there 
may arise perisplenitis and peritonitis. Such complications 
may be avoided by proper attention to the circulation, etc. The 
heart and general circulation must be looked after, to prevent 
cardiac complications and hemorrhages. 

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 sympathetic 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 uni- 
formly good, even striking, results been attained. 

(1) In a case of gall-stones, with chronic constipation and 
dysmenorrhoea, the muscles of the lower dorsal region were much 
contracted, and there was lesion between the llth and 12th dor- 
sal vertebrse. The case was cured. 

(2) A case of gall-stones after typhoid fever, in which oper- 
ation had been advised. The stones were passed under osteo- 
pathic treatment. 

(3) A serious case of gall-stones and catarrh of the stomach, 



192 PRACTICE OF OSTEOPATHY. 

V 

in which every medical means of cure had been tried without 
avail. The patient grew continually worse. After a few osteo- 
pathic treatments the stones began to pass, and a large number of 
them, a large sized teacupful were gotten rid of. After this a 
copious passage of mucus, amounting to several pints, took place. 
Much of the mucous membrane lining of the intestines, gall- 
bladder, duct and stomach was cast. The stones continued to 
pass, and two as large as a man's thumb were among them. At 
the passage of the last large stone the patient's limbs and lips 
were paralyzed, and her condition became critical. The crisis 
was safely passed under treatment, however, and entire recovery 
followed. 

(4) In man of 45, who had been troubled for years with 
gall-stones, the common bile-duct became impacted, and the 
ordinary methods of treatment were of no avail. Hypodermic 
injections of morphine gave no relief from the pain, and an oper- 
ation was advised. The intense pain was relieved at the first 
treatment, which opened the duct. After the second treatment 
thirty stones passed from the bowel. The case was entirely cured. 

(5) A case of gall-stones of 18 years standing, lesion was 
found as a depression of the 10th right rib, infringing the 10th 
intercostal nerve, which was sensitvie along its entire course. 
The treatment was directed to the lesion, and to the gall-bladder 
and duct. By two treatments, the colic and pain were overcome, 
and the case entirely recovered under further treatment. 

The LESIONS found in these cases are usually low down in 
the splanchnic area, affecting the lower four ribs upon either 
side, frequently upon the left, for the spleen. Lesions of the 
llth and 12th vertebrae may not be too low to cause it. How- 

* 

ever, any of those lesions to the ribs and splanchnic area, charac- 
teric of bad gastro-intestinal conditions may, from the nature of 
the case, affect the liver to produce gall-stones. The liver is 
innervated from the same nerve-supply, gastro-intestinal dis- 
eases are usually complicated with deranged liver function, and 
it is reasonable to find in the usual lesions producing the latter 
a sufficient cause for disease in the former, which, owing to some 
particular form, degree, or concentration of lesion, results in 
cholelithiasis. 



PRACTICE OF OSTEOPATHY. 193 

ANATOMICAL RELATIONS of lesion to disease: The liver 
is supplied by the splanchnics through the solar plexus, the sec- 
ondary 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 thought to be essential to the activities of the 
liver cells. The nutrient blood-sulpy (hepatic) is chiefly gov- 
erned 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 dilatation. Ac- 
cording 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 significance to the Osteopath. Doubtless he could not 
avail himself of these detailed 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 produces stagnation 
of bile favors cholelithiasis. 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-active con- 
dition 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 le- 
sion to the central end of the vagus nerve, cutting off the normal 

13 



194 PRACTICE OF OSTEOPATHY. 

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 ap- 
paratus leading to retention and stagnation of bile, thus to chole- 
lithiasis. If any osteopathic spinal lesion can interfere with 
sympathetic visceral supply, a point placed beyond controversy 
by demonstrated facts, it is a reasonable conclusion 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, lithogenous catarrh of the mucosa of the bladder and duct 
modifies the chemical constitution of bile and favors the deposit- 
ion of cholesterin about some nucleus, 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 hepati- 
plexus, i. e., of the solar plexus and the splanchnics. According 
to the American Text-book of Physiology, stimulation or inhibi- 
tion (section) of tfye splanchnics produces at once vaso-constric- 
tion or vaso-dilatation of the blood-vessels of the liver. Here, 
as in the case of 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 influence 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 by the portal vein. The blood which has circulated 
through the spleen must compose an important part of the blood 
brought by the portal vein to the liver. It may bo that certain 



PRACTICE OF OSTEOPATHY. 195 

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 10th 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 in- 
hibition over this spinal region will aid in stopping the pain. 

The PROGNOSIS is good, even in serious cases in which opera- 
tion 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 
mainly 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 
locally 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: (1) To remove the stone, 
(2) To restore normal liver function and prevent further forma- 
tion of stones. 

The former is palliative treatment; the latter is the real cure. 

In the acute case, if colic is present the first step is to make 
strong inhibition over the 7th to 10th 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 inhi- 
bitive work upon the tensed abdominal walls, over the epigastric 
and lower anterior thoracic regions, and over the course of the 
duct (IX, Chap. VIII). The pain, which is due to inflammation 
of the mucosa of the duct and to the rotary motion of the stone, 
which is given this motion by the spiral arrangement of the 
Heisterian valve within the duct, is usually relieved in a few 
minutes. 



196 PRACTICE OF OSTEOPATHY. 

The stone is removed by working it along the duct after the 
preliminary relaxing treatment. The patient should lie upon 
his back with knees flexed and shoulders slightly raised. The 
lower ribs are raised by inserting the fingers beneath their an- 
terior edges, and manipulation is made deeply over the site of the 
fundus of the gall-bladder (tip of 9th rib) and down along the 
course of the duct. The latter may vary from its course on ac- 
count of sagging of the intestines sometimes found. This treat- 
ment must be thorough and persistent. It should be firmly and 
deeply, but most carefully applied. Sometimes a few minutes 
work will pass the stone, but often continued treatment for three- 
quarters of an hour or an hour 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 ribs, anteriorly. It is chiefly affected by 
treatment to the splanchnics, raising the lower left ribs (8th to 
12th), and removal of lower spinal and rib lesion. 

The jaundice, if intense, indicates impaction of the stone 
in the common duct. Its cure depends upon the removal of 
the stone. The kidneys should be kept active. 

Fever, if present, is allayed in the usual manner. Fatal 
syncope sometimes occurs. If imminent, the patient should be 
fortified against it by thorough stimulation of the heart. For 
obstruction of bowel by calculi, see Intestinal Obstruction. 

A dilated gall-bladder and duct are treated locally by manip- 
ulation to remove the obstruction as for removal of the stone. 
Thorough treatment must be given the liver locally, and thor- 
ough spinal treatment must be kept up for the puqiose of in- 
creasing circulation, etc. 

According to Dr. A. T. Still the lesion of the 6th to 10th left 
ribs, found in cases of gall-stones, is obstructing pancreatic se- 
cretions. These, he says, dissolve gall-stones. They are ab- 



PRACTICE OF OSTEOPATHY. 197 

sorbed from the intestines by the lacteals and carried by them 
into the portal circulation, and thus to the liver as portal blood, 
where they may influence the secretion of bile, and, mingling 
with the latter as a constituent of the bile, act upon stones already 
formed. The patient should drink plenty of alkaline waters. 

SUPPURATIVE CHOLANGITIS. 

This is a suppurative process in the mucous membrane 
lining the duct, and is commonly the result of gall-stones. It 
may be due to parasites, or may arise after typhoid fever, dysen- 
tery, or other acute disease. 

The treatment is upon the lines laid down for the treatment 
of the liver, gall-stones, etc. The local circulation must be kept 
free to overcome the suppuration and to repair the membranes. 
This, with treatment along the course of the duct opens it, and 
lets free the flow of bile. 

DISEASES OF THE LIVER CONTINUED. 

CASES: (1) Hepatic abscess, complicated with gastric ulcer. 
Lesions at the 3rd cervical, and at the 4th, 5th, and 8th dorsal; 
rigid spinal muscles; 7th to 10th right ribs over-lapped. The 
case was in a very serious condition, but began to improve after 
two weeks, and was finally cured by the treatment. (2) Torpid 
liver, with chronic gastritis; marked lesion at 4th and 5th dorsal; 
slight lesion at the 9th dorsal , 

For HEPATIC AIJSCESS 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 treatment. 
The fact that the disease has and can be cured warrants thor- 
ough 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 important step in this process, as it is ob- 
structing proper circulation and innervation. The usual lesions 
in liver diseases must be expected. Full directions have been 
given for treatment of circulation to the liver. Great care must 



198 PRACTICE OF OSTEOPATHY. 

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, con- 
stipation 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. 

HYPERTROPHY OF THE LIVER is frequently presented for 
treatment, and as a rule good results are gotten. Many cases 
are cured. Complete restoration of size and function often re- 
sults from the treatment. In many other cases, while the size 
cannot be reduced to normal limits, functions is restored. The 
general prognosis is favorable. In true hypertrophy due to in- 
crease of connective tissue the new tissue can probably not be 
absorbed, but the further increase of it may be checked and the 
function is usually restored. 

In true hypertrophy due to increase in size or number of the 
parenchymatous cells, the treatment may reduce their size or 
number, and normal size and function of the liver is restored. As 
the chief causes of hypertrophy are active and passive conges- 
tion (lesion to the 4 vaso-motors,) good results follow corrected 
circulation. 

In false hypertrophy due to cancer or abscess little is ex- 
pected in the way of reudction. When due to fatty infiltration, 
the renewed circulation removes the accumulated fatty particles 
and restores normal size and function. In these cases diet is 
very important. Avoid fats, starches, and wheat bread. Use 
gluten or bran bread, also fish, lean meat, vegetables and fruit, 
but no alcohol. Exercise and baths should be employed. The 
treatment in these cases consists in the removal of lesion and cor- 
rection and stimulation of circulation. The prognosis is good. 
The size of the liver can be reduced to normal. When secondary, 
the primary disease is treated. 

In fatty degeneration of the liver good results may be expected 
from the treatment. It consists simply in the removal of lesion 
and in the active stimulation of the circulation, with due atten- 
tion to the primary condition upon which the degeneration de- 
pends. Diet, exercise and baths should be used as in the treat- 



PRACTICE OF OSTEOPATHY. 199 

rnent of fatty infiltration. Recorded facts are lacking in regard 
to cancer and acute yellow atrophy, of the liver. The latter two 
are rare conditions, yellow atrophy exceedingly so. Treatment 
for these diseases could be worked out according to the fates 
and principles given in relation to the various diseases of the 
liver already discussed. 

In AMYLOID INFILTRATION of the liver the starch-like de- 
posit occurring in the connective tissues of the liver must be 
absorbed in the renewed blood-supply. But the condition of 
the blood is an impoitant factor, apparently, as it is thought that 
in suppurative processes in the body, to which the disease is fre- 
quently due, the alkalinity of the fluids of the body has been 
decreased. The general health must be built up, the excretion 
stimulated, and the blood purified. The primary disease, such 
as tuberculosis, rickets, etc., must be attended to. Any local 
lesions must be repaired, and the circulation be kept stimulated. 
A thorough general course of treatment is necessary. The diet 
should be carefully attended to, It should consist of nitrogenous 
or animal food. Starches and fats should be avoided. Lean 
meats and green vegetables, etc., are allowed. Exercise and 
bathing should be encouraged. 

SPLENITIS. 

DEFINITION: Acute or chronic proliferative inflammation 
of the spleen. Suppuration may occur. 

CASES: (1) 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. (2) Splenitis; the case showing lesion as 
depression of the 9th, 10th, and llth left ribs, and a posterior 
swerve of the lower dorsal and lumbar region. 

LESIONS occur in downward and forward luxations of the 
6th to 12th left ribs. (A. T. Still). Diaphragmatic lesion thus 
caused may interfere with position, circulation, or innervation 
of the organ. Direct pressure of a misplaced rib, or lower splanch- 
nic lesion causing interference with spinal innervation, may 
cause the trouble. 



200 PRACTICE OF OSTEOPATHY. 

ANATOMICAL RELATIONS: Stimulation of the peripheral 
end of the splanchnic 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 fibers. "The organ is richly 
supplied with nerve, fibers which, when stimulated directly or 
reflexly, cause the organ to diminish in volume" (American Text- 
Book of Physiology). According to Schafer, these are contained 
in the splanchnics, which carry also inhibitor}' fibers whose stim- 
ulation causes dilatation of the spleen. 

In view of these facts it seems that treatment over the splanch- 
nic area of the spine and locally over the spleen may produce 
change in its volume (through thus directly or indirectly stim- 
ulating these nerve connections) which is most useful in correct- 
ing 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, is composed 
of sympathetic fibers from the solar plexus and of branches 
from the right pneumogastric. Local or spinal treatment affect 
these. It is readily 'apparant, in view of the whole mechanism 
described above, that spinal and rib lesion may seriously affect 
the organ by disturbance of these nerve connections, producing 
inflammatory or congestive conditions. 

Anders states that splenitis is probably never primary, but 
in case (1) cited above it seems that the disease must have origi- 
nated 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 
diseases must be treated primarily. Removal of lesion, as in 
the above case, may be the only treatment necessary. Stim- 
ulation 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 abdomen will dilate the abdominal vessels and draw 
the blood to them, away from the spleen. 



PRACTICE OF OSTEOPATHY. 201 

SPLENIC HYPER.EMIA, active or passive, is readily reduced. 
Chronic cases may yield at once or may require a patient course 
of treatment. Contraction of the tissues about the splenic vein 
has been known to cause great enlargement of the organ by pas- 
sive congestion. Upon removal of the obstruction the organ 
quickly returned to its normal limits. The lesions and treat- 
ment are the same as indicated for splenitis. 

DISEASES OF THE PANCREAS. 

The lesions commonly found affecting the pancreas are 
those occurring at the lower ribs and to the lower dorsal verte- 
brse. Generally the diseases of this organ are complications of, 
or secondary to, other diseases, most frequently those of the 
Castro-intestinal tract. As the blood and nerve-sulppy of these 
parts are closely related, it is not strange that the lesions affect- 
Ing this tract should also often be the cause of derangement of 
the pancreas. The blood and nerve-supply are especially closely 
related to that of the liver, stomach and spleen. The nerves are 
from the splenic plexus, which is derived from the right and left 
semilunar ganglia and from the right pneumogastric. The pan- 
creatic plexus thus formed is closely connected with the hepatic 
plexus and with the left gastro-epiploic plexus. These are all 
offsets of the coeliac plexus. The arterial supply is from the 
superior mesenteric, and from the coeliac axis by way of the hepatic 
and splenic arteries. The venous drainage is into the splenic and 
superior mesenteric veins, thus directly into the portal system. 

Thus it may be seen at a glance how the inter-relation of 
these anatomical parts lays the pancreas liable to the action of 
those lower dorsal lesions that cause disease in the stomach, 
liver, intestines, spleen, etc. 

Treatment to the spinal nerve-connections in the region 
mentioned, and to these plexuses directly by work in the ab- 
dominal region over them, affects the pancreas. Local or direct 
treatment is given it by deep manipulation in the median plane 
of the abdomen, midway between the ensiform and the umbilicus. 
Abdominal treatment may also mechanically affect its blood- 
vessels; and may remove obstruction from them, from the duct, 
or from the organ itself, when caused by growths in the abdomen, 



202 PRACTICE OF OSTEOPATHY. 

malposition of the contiguous organs, etc. Local treatment over 
the pancreas should be done when the stomach is empty. 

ACUTE PANCREATITIS, hemorrhagic, suppurative, or gan- 
grenous, is generally due to gastro-intestinal disorders, such as 
dyspepsia, glycosuria, gall-stones, catarrhal inflammation etc. 
Doubtless the lesion responsible for the primary disease is di- 
rectly accountable for the effect upon the pancreas, the same 
lesion deranging the nerve and blood-supply of, each diseased 
part. 

Traumatism may directly affect the substance of the gland, 
or it may cause various lesions to nerves and vessels, and pro- 
duce either form of pancreatitis. The disease is often secondary 
to tuberculosis, specific fevers, etc. 

The treatment must depend to some extent upon the cause. 
In any case it is necessary to remove the lesion, and to take 
down the inflammation by removing all sources of irritation or 
obstruction to the circulation. Treatment may be made along 
the course of the venous drainage as above pointed out. The 
left lower ribs should be elevated, and the lower dorsal spine re- 
laxed. Local treatment over the organ must be carefully ap- 
plied. The pain should be treated by strong spinal inhibition 
and by relaxation of the upper abdominal tissues. The nausea, 
vomiting, hiccough, constipation, diarrhoea, etc., may all be 
treated as before directed. 

Every effort should be made to alleviate the patient's suf- 
fering. 

Mild cases of hemorrhagic pancreatitis may recover; the other 
forms are fatal. 

Chronic pancreatitis is to be treated upon the same plan. 

Treatment for for otherms of pancreatic disease could be 
worked out according to general points given above. 

DISEASES OF THE URINARY SYSTEM. 

CASES: (1) Lithuria in a young girl after typho-malaria. 
Lesion, a faulty condition of the lower dorsal and lumbar re- 
gions. 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 10th right 



PRACTICE OF OSTEOPATHY. 203 

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, (chronic 
cystitis) of three years standing, in a man. He was obliged to 
urinate ever five or ten minutes, always with great pain. The 
urine was about one-half sediment and blood, and only about one- 
half the normal amount. 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) B right's disease in a man twenty-nine years of age* 
diagnosis confirmed by several physicians; great dropsical swell- 
ing of feet, limbs and body up to the 12th 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 treat- 
ment there had been rapid improvement; in six weeks the urine 
was almost normal, and the dropsy had disappeared. 

(4) Acute nephritis in a married woman of 65, of 4 weeks 
standing. She had suffered from previous attacks. The in- 
flammation had extended to ureters and bladder (cystits). 10th, 
llth, and 12th dorsal were posterior and lateral. The case was 
cured in 3 weeks. It was free of pain after the second day. 

(5) Acute Nephritis in a man of forty. Lesion was found 
irritating the renal splanchnics. The treatment was at the llth 
and 12th dorsal, and raising of the llth and 12th ribs. 

(6) Acute Bright 's disease. Large quantities of albumen 
appeared in the urine. The 12th dorsal vertebra was found an- 
terior. One treatment relieved the pain and the patient slept. 
Good progress was reported. 

(7) Acute Bright 's disease. Spinal lesion was found. After 
seven weeks treatment no further symptoms remained. For five 
weeks a physician examined the urine daily finding no further 
evidence of the trouble at the end of that time. He said he had 
never seen a case do so well. 

(8) Bright 's disease and paraplegia; lesion was found as a 
separation between the llth and 12th dorsal. There was a his- 



204 PRACTICE OF OSTEOPATHY. 

tory of the patient's having jumped from moving trains for years. 

(9) Chronic Nephritis (probably) diagnosed as floating 
kidney. The patient, a lady of twenty-five, was in a very bad 
condition; heavy sediment in the urine; painful micturition. 
Lesions: Upper cervical lateral; posterior curvature from 5th 
dorsal to 5th lumbar; marked lesion at 10th, llth, and 12th dor- 
sal, and 2nd lumbar. The llth 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 
practically cured in two months. 

(10) Enuresis in a boy of seventeen, of seven years standing. 
Occipital pains present. Tissues about 2nd cervical tense; 
about 3rd and 4th cervical sore; 7th and 8th dorsal vertebrae an- 
terior and sore. The boy had been thrown from a horse at ten 
years of age, and the trouble had persisted ever since. 

(11) Enuresis. The 5th lumbar vertebra was lateral. The 
<?ase was entirely cured in six weeks by the removal of this lesion. 

(12) Enuresis in a boy of five. The lumbar region was very 
weak, and had a posterior tendency. Treatment here relieved 
the case. 

(13) 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. 

(14) 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 2nd lumbar, removal of which cured the case. 

(15) Enuresis 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 involuntarily. Le- 
sions were found in the cervical region; pronounced posterior 
position of the lower dorsal spine; lesions from the 2nd to 5th 
lumbar. Steady improvement took place under treatment, 
and the case was cured in three months. 



PRACTICE OF OSTEOPATHY. 205 

(10) In a man of 21, enuresis and chronic^eystitis, of five 
years standing. Voiding of urnie was usually followed by the 
passage of pus and blood. There were accompanying pains 
through penis and bladder. The 8th dorsal to 2nd lumbar ver- 
tebrae were posterior, the left innominate was forward and down- 
ward, the pros.tate gland was enlarged. The case was improving 
under treatment. 

(17) Renal Calculus. Lesion was found in the llth dorsal. 
Inhibiting treatment upon the renal splanchnic lessened pain. 
The calculus was worked along the course of the ureter ftito the 
bladder and passed later. 

(18) 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 office for treat- 
ment, and after a third treatment had no further trouble. 

(19) Renal Calculi. There was great pain due to the colic, 
which was lessened by inhibition of the renal splanchnics. Le- 
sion was found at the llth dorsal. The stone was manipulated 
down along the ureter, the pain moving downward with it. Twelve 
hours later the calculus passed from the bladder. 

(20) Uremic Poisoning; the case was sleepless, vomiting, 
and near convulsions. Treatment relieved the case at once. 

(21) Uremic poisoning (kidney and bladder disease) in 
which the patient was in a critical condition; had not slept for 
two days on account of severe pain. The pain was relieved by 
the treatment. Spinal lesion was found at the centers for bladder 
and kidneys. Great improvement attended one months treat- 
ment. 

(22) 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 upon for "abdominal tumor." The Osteo- 
path used a catheter at once, and drew about a gallon- of decom- 
posing 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. 

(23) Inflammation of the urinary meatus. Constipation 
was present. There had been congestion of the kidneys one year 



206 PRACTICE OF OSTEOPATHY. 

before. The vertebrae from the 2nd to the 5th dorsal were ap- 
proximated and to the right; those from the 8th dorsal to 3rd 
lumbar were separated. The right innominate was -displaced 
upward and backward, shortening the limb. 

(24) A kidney trouble of five years standing, complicated 
with heart disease, due to lesions as follows: A. luxated atlas, 
causing the heart difficulty, which was cured by righting the 
atlas; 9th dorsal vertebras posterior; 2nd lumbar lateral; 5th lum- 
bar anterior. The case was cured in three months. 

(25) Kidney disease due to double scoliosis, 6th to 10th 
dorsal left; 1st to 5th lumbar posterior. Treatment of the curva- 
ture improved the kidneys. 

(26) Frequent micturition, varicocele and weak eyes being 
present. The lesions were at the 3rd cervical, lateral spinal cur- 
vature, and lesion at the 2nd and 4th lumbar. 

(27) Pyuria. See case (16). 

(28) Hematuria. See case (16) 

(29) A case of kidney disease is reported in which insuffici- 
ency of urine was overcome solely by stimulation of the superior 
cervical ganglion. A renal center exists in the medulla, and was 
thus affected. The quantity of urine was trebled by the treat- 
ment. No other treatment was given. Probably the general 
vaso-motor center in the medulla, through the treatment of the 
superior cervical ganglion, supplied the increased blood-pressure 
and the arterial tension in the kidneys necessary, under the cir- 
cumstances, to activity of the organ. 

LESIONS: The centers of importance, osteopathically, in 
urinary diseases are generally stated as follows: 6th dorsal for 
kidneys; 12th dorsal for renal splanchnics; 2nd lumbar for mic- 
turition; 3rd and 4th sacral for neck of bladder; medulla (sup. 
cervical, atlas) renal center; 2nd to 5th lumbar '(Am. Text-Book 
Physiology) 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 ves- 
sels and their sympathetic supply, (two inches above.) 

The lesions usually found in renal diseases are as follows: 
(1) At the atlas or upper cervical, affecting the superior cervical 
ganglion and the renal center in the medulla. (2) At the 10th, 



PRACTICE OF OSTEOPATHY. 207 

llth and 12th dorsal, and the 1st lumbar, the main lesion affect- 
ing the kidneys directly. (3) From the 2nd lumbar to the 4th 
sacral for disease in the bladder and urethra. (4) In the female 
patient it may occur that uterine prolapsus, wrinkling the an- 
terior vaginal walls, may twist and obstruct the urethra. (5) In 
the male patient an enlargement of the prostate gland, especially 
of its middle lobe, is with considerable frequency found to be the 
cause, easily overlooked, of stricture of the urethra. 

A careful analysis of the lesions in the cases presented above 
brings out facts representative of the class of cases, (urinary dis- 
eases). These facts well illustrate what is usually found in such 
cases. The lesions are mostly spinal, few being rib lesions. As 
a matter of fact, spinal lesions are the important causes of urinary 
troubles. The vast nerve-supply of the kidneys and bladder is 
delicately balanced. Most of the lesions in renal diseases being 
spinal, the conclusion is that spinal derangement of this nerve- 
supply is the most potent and frequent cause of such disease. 
The kidneys are, at bottom, generally deranged by lesions affect- 
ing the nerve-supply, including vaso-motor, i. e., blood-supply, 
also. 

Of these lesions, practically all are low down in the spine, 
including also the sacral region. Dr. Still points out sacral 
lesion in kidney diseases. 

A great number of cases show lesion about the 10th, llth 
and 12th dorsal. Many show lesion in the lumbar and sacral 
regions. These latter occur cheifly in bladder and urethral dis- 
eases. This is seen in the fact that of the cases of enuresis re- 
ported, most of them presented lumbar and sacral lesions. The 
fact that many of the above cases showed lesion below the 10th 
dorsal, especially about the 10th, llth and 12th dorsal, must be 
remarked 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 10th and 12th 
dorsal. In most of these cases the micturition center at the 2nd 
lumbar was affected, participating in both kidney and bladder 
affections. Its anatomical relations make it most important in 
the latter class, and experience shows that it is more likely to 
affect bladder than kidneys. 



208 PRACTICE OF OSTEOPATHY. 

Neck lesions are not important. Few of the caseg show them, 
but they occurred at the 2nd to 4th vertebrae, where they could 
all affect the superior cervical ganglion, and through it the me- 
dulla. This location of the lesion is mainly important as a sec- 
ondary or adjuvant lesion in renal diseases. 

Without exception, the lesions in these cases fall within 
areas in which they may affect the sympathetic innervation 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 affect mainly the blood-supply. 
The vaso-motor function in relation to disease thus has its im- 
portance emphasized. 

ANATOMICAL RELATIONS: Sensory nerves are distributed 
through the sympathetic, from the spinal nerves, as follows: 
To the kidneys from the 10th, llth and 12th dorsal; to the upper 
part of the ureter, from the 10th 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 (1st), 2nd, 3rd and 
4th sacral; for sensation of over-distention and ineffectual con- 
traction, from the llth and 12th dorsal and 1st lumbar (Quain). 
This sensory distribution is made use of in relieving spinal pain 
in kidney and bladder-disease. Disturbed sensation 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 splanch- 
nics. and somewhat below, occurring from the 6th dorsal to the 
2nd 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 constriction 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, and 3rd 
sacral, is useful in controlling the circulation of the kidneys. 
Actual cases of kidney diseases show spinal lesion as high as the 
5th or 6th dorsal, and as low as the 3rd or 4th sacral. The con- 
tinual action of lesion in these situations upon the vaso-motors 
of the kidneys has most important pathological results through 
modification of the renal blood-supply. As a rule these lesions 
are concentrated about the 10th dorsal to 2nd lumbar. The 



PRACTICE OF OSTEOPATHY. 209 

main vaso-motor supply, originating as above described, passes 
from the aortico- renal ganglion, solar and aortic plexuses to the 
renal plexus. Important branches come from the renal splanch- 
nics, sometimes also from the lesser splanchnic and from the first 
lumbar ganglion. The branches of this plexus lie upon the renl 
vessels, and accompany them in their ramifications in the kidneys. 
Osteopathic work upon this importantvaso-motor supply of the 
kidneys, via the splanchnic area of the spine(by removal of 
lesion) and the renal plexus, which is reached by abdominal work 
at the level of the umbilicus, gains marked results upon the cir- 
culation, and through it upon the whole metabolism of the kid- 
neys. 

The blood-vessels and the muscular coat of the bladder are 
supplied by the vesical 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 American Text-Book points out 
that stimulation of the 2nd, 3rd and 4th sacral nerves causes re- 
flex contraction of the bladder. The chief motor fibres of the 
bladder, probably supplying the longitudinal muscle fibres, pass 
to the bladder from the sacral nerves, At the same time some 
of the motor fibres passing to the bladder in the vesical plexus 
rise in the lumbar nerves and reach their destination via the aortic 
plexus, inferior mesenteric ganglion and hypogastric and pelvic 
plexuses. They supply the circular muscle of the bladder and its 
sphincter. 

These facts explain why lower spinal lesion is so often found 
by the Osteopath to be the cause of motor derangement of the 
bladder. A good illustration of this is seen in the lack of motor 
control in 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 theory of renal 
diseases. They form a foundation of truth for osteopathic pro- 
cedure. Lesion to these various important nerve-supplies at 
their origin along the spine must produce renal disturbance in 
kind, and this disturbance can be righted only by correction of 
the anatomical derangement responsible for them. 



210 PRACTICE OF OSTEOPATHY. 

ACUTE NEPHRITIS. (Acute Bright 's Disease). 

DEFINITION: An acute inflammation of the kidneys, mild 
or severe, attended by structural changes in the organ. 

The LESIONS AND ANATOMICAL RELATIONS have been dis- 
cussed. Lesions occur preferably from the 10th dorsal to the 
upper lumbar, but may be either higher or lower. Cervical 
lesions, as low as the 3rd or 4th vertebra, may occur. 

The PROGNOSIS is, on the whole, good, still bearing in mind 
the necessity of guarded prognosis in all renal diseases as above 
indicated. Considering the seriousness of the disease, it is a 
matter of remark how many cases of acute Bright 's Disease have 
been entirely 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 destroyed epithe- 
lium 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 osteopathic treatment 
would seem of the .best. The same author states that in cases 
due to exposure to cold and wet, irrespective of alcoholic indul- 
gence, it may be presumed with reason that there is some inher- 
ent or acquired weakness or a susceptibility of the kidneys, ren- 
dering them the weak links in the visceral or systemic chain. 
It is the osteopathic idea that these cases, as a rule, present le- 
sions of the spine of such a nature as to interfere with the vital 
forces distributed to the kidneys. This, we reason, is the "in- 
herent or acquired weakness or susceptibility of the kidneys that 
renders them 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, pro- 
ducing nephritis in certain cases, has been able to unbalance the 
already weakened urinary mechanism. The same explanation 
holds good for all the ordinary active causes of the disease. It 
seems to be the sufficient reason why one person (presumably 
with spinal lesion) suffers from the disease while similar circum- 
stances have failed to cause it in another. 



PRACTICE OF OSTEOPATHY. 211 

TREATMENT: The general treatment for nephritis, acute 
and chronic, is given with that for congestion of the kidneys, 
q. v. Its object, as stated, is primarily to gain vaso-motor con- 
trol, and thus allay inflammation, relieve vascular tension, and, 
through restored and corrected circulation, to clear away the 
debris from the tubules, absorb the exudates, check degenerative 
or new growths, and rebuild as far as possible 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 Nephritis, aside from the main treatment already 
discussed, the practitioner must direct his work to the allevia- 
tion of many of the manifestations of the disease. The general 
treatment will allay many of the symptoms at once; others may 
call for special attention. Uremic symptoms such as nausea, 
vomiting, headache, and pain in the back are treated as before 
directed. For the latter, relaxation of the spinal muscles and 
inhibition of the sensory nerves, (10th to 12th dorsal). Convul- 
sions are quieted by inhibitive spinal treatment and by 
inhibition of the centers or local nerve-supply for the affected 
part. The dropsy is relieved by the stimulation of the general 
circulation brought about by the general treatment. It is 
aided by local treatment of he 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 femoral veins, in edema of the lower extrem- 
ities. Suppression, if it occur, yields at once, generally, to thor- 
ough stimulation of the kidney. The lungs must be stimulated 
against the occurrence of bronchitis or pneumonia. ,Ferspria- 
tion may be excited by thorough stimulation of the spinal sys- 
tem, heart, and lungs. It is a necessary measure for the relief 
of the system from the accumulated poisons. As a rule, it is 
readily accomplished by this treatment. Failing of this, re- 
course should be had to the hot baths, applications, packs, and 
the use of vapor. The vapor should be generated at the bedside, 
and be conducted under the cradled-up bed clothes. 

A hot pack is applied as follows: The patient is stripped 



212 PRACTICE OF OSTEOPATHY. 

and wrapped in a blanket well wrung out of hot water. Over 
this is wrapped a dry blanket, and over this a rubber-cloth or 
oil-cloth cover. These are kept on until the patient has sweat 
copiously for one or two hours. 

- Children with post-scarlatinal nephritis may be placed in a 
hot bath for twenty, thirty, or forty minutes. 

The patient should live upon a bland liquid diet. The 
skimmed milk diet is best. Milk taken hot is very good. Butter- 
milk is also advised, and the thin broth of meat. The patient 
should drink plenty of water and lemonade. 

"Diuretics, other than simple diluent drinks, have little use 
in acute nephritis" (Anders). 

The patient must carefully avoid exposure during conva- 
lescence, and must afterward use great care in the matters of 
dress, diet, and exercise. 

During the attack he should be in a warm bed, in a warm 
room, and be dressed in woolen underwear and covered with 
blankets. 

Upon convalescence he must not return too suddenly to 
solids, especially meat. He may have vegetables, fruits, cereals 
and milk. 

The hygiene and diet of nephritis patients is a most impor- 
tant matter. These should be carefully looked after according 
to directions laid down in standard works. 

The patient with acute nephritis should be treated once or 
twice daily, more treatment, or less, may be given as the prac- 
titioner's judgment dictates. 

In CHRONIC EXUDATIVE NEPHRITIS, (CHRONIC PARENCHY- 
MATOUS NEPHRITIS) AND CHRONIC NON-EXUDATIVE NEPHRITIS, 
(CHRONIC INTERSTITIAL NEPHRITIS), the practitioner must be 
constantly upon his guard. A fair number of cases of chronic 
nephritis have been cured or greatly benefited. In the former, 
the prognosis, 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 insidiously without having 
presented marked symptoms. 

In the non-exudative form the prognosis must be unfavor- 



PRACTICE OF OSTEOPATHY. 213 

able, owing to the very serious pathological changes that have 
taken place in the organ. Perhaps much can be done for the 
comfort of the patient. The slow progress of the case renders 
thorough treatment useful. The patient may be helped to a 
long and comfortable life. 

Concerning lesions and treatment, little need be added to 
what has already been said. Special manifestations of either 
form may call for special treatment. One must sustain the 
entire system, and be continually upon his guard against a sud- 
den bad turn in the case, or intercurrent maladies or complica- 
tions. The retinitis may call for some treatment of the eye 
locally and through the cervical sympathetic and blood-supply. 

Concerning hygiene and diet, the same remark applies as 
for acute nephritis. 

In all chronic cases very much depends upon the way in 
which the patient lives., and he must be directed accordingly. 
Thorough general treatment along the lines indicated for acute 
nephritis tends to correct the chronic changes, congestions, 
fatty degenerations, destruction of epithelium, exudations, etc., 
characteristic of these conditions. The growth of new connec- 
tive tissue may be limited. 

The general circulation and excretions should be kept stim- 
ulated, and the condition of all the organs must be Ipoked to. 

The diet should be much as in the acute case. Skimmed 
milk and butter-milk are useful. Dried bread and crackers 
should be used during dropsy. When the dropsy is light the 
diet may be more solid. Light meats, vegetables, rice and 
fruits may be had. 

The patient should live in a warm dry climate, wear woolens, 
and lead an out of doors life, but should avoid over-exercise. 

"Hygienic and dietetic treatment are more important than 
medicines. ' ' (Thompson) . 

One must not forget that in these cases death may occur 
at any time, from dropsy, heart-failure, or edema of the larynx. 

Chronic cases should be treated daily or three times per 
week, according to the needs of the individual. 



214 PRACTICE OF OSTEOPATHY. 

AMYLOID DISEASE OF THE KIDNEY. 

This condition is commonly associated with chronic par- 
enchymatous or interstitial nephritis, and with cachetic con- 
ditions of the system, consequently it is quite as important to 
treat the nephritis or the other disease present as to treat for 
the amyloid degeneration. It is especially necessary' to be on 
one's guard against suppurative processes in the system, as 
they particularly dispose to this condition. It is quite likely 
to be associated with amyloid changes in spleen, liver, intes- 
tines, etc. 

The lesions are those described for kidney diseases, espec- 
ially those of nephritis. The treatment would be practically 
that for nephritis, in so far as direct treatment to the kidney, 
is concerned. See also the remarks concerning the treatment 
of amyloid disease of the liver. A general course of treatment 
must be directed to upbuilding the health and to overcoming 
the weakness. Dyspnea must be treated as before directed. 
The liver and spleen must be looked after, as they are enlarged 
and tender. Correction of the kidney circulation tends to reg- 
ulate the quantity of urine, which is usually in excess, and to 
free it of albumen and casts. This treatment, together with 
treatment to the heart and general circulation, reaches the drop- 
sical condition. 

The diet should be carefully regulated, and the patient 
should take plenty of light, out-o-door exercise, as directed for 
other kidney diseases. 

FATTY DEGENERATION of the kidney is very frequent in 
chronic parenchymatous nephritis. The epithelium of the glom- 
eruli and tubules is effected. The treatment of the nephritis, 
correcting the circulation in the organ, must be relied upon to 
prevent this change, and to renew the epithelial cells if thus 
destroyed. Thorough general treatment, including bowels, liver, 
spleen, etc., prevents fatty degeneration by preventing the 
anemia to which it is often due. Fatty degeneration is less 
likely to take place under osteopathic treatment, as it is often 
caused by the administration of certain drugs, such as phos- 
phorous, arsenic, cantharides, chloroform, iodoform, etc. 



PRACTICE OF OSTEOPATHY. 215 

PERINEPHRITIC ABSCESS must be treated practically as are 
pyelitis and pyelonephritis, q. v. Careful search should be made 
for suppurative disease in surrounding tissues, as of the spine, 
bowel, veriform appendix, liver, etc. Marked cases require 
surgical treatment, as it is not probable that large quantities of 
pus could be safely absorbed into the circulation. The fever, 
lumbar pain, etc., should be treated as before directed. 

CONGESTION OF THE KIDNEYS. 

In both acute or arterial hyperemia and chronic or venous 
hyperemia a good PROGNOSIS can, generally speaking, be expected. 
This must, however, be guarded in all cases, especially in the 
chronic venous congestion, secondary to heart and lung diseases. 
As both of these conditions of congestion of the kidney are sec- 
ondary to other diseases, and as each may precede inflammation 
(acute or chronic) of the kidney, much care must be taken in 
prognosis and treatment. When the condition is secondary the 
prognosis must depend upon that for the primary disease. Yet, 
even though a favorable prognosis is limited by such circum- 
stances, good results are generally gotten upon the kidneys. 
They are very responsive to treatment; it is usually readily ef- 
fective in producing good effects. While keeping in mind the 
difficulties presented by renal cases as a class, we can yet expect 
improvement under the treatment. Yet, the prognosis for cure 
is always to be guarded. 

The LESIONS for kidney diseases have been discussed above. 
In cases of congestion specific lesion is expected in the vaso-motor 
area, 6th dorsal to 2nd lumbar. In cases secondary to other 
disease the lesion is that producing 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 ex- 
posure, the toxic products of various acute diseases, and other 
causes may produce congestion directly, it is still necessary in 
most cases to account for such agents especially attacking the 
kidneys; 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 kidneys. This hypoth- 
esis not only accounts for the frequency with which spinal 



216 PRACTICE OF OSTEOPATHY. 

lesions are found in such cases, but also explains why one person 
may become the victim of kidney disease, while another under 
a similar set of circumstances escapes. These general remarks 
apply with equal force to the subject of nephritis before consid- 
ered, as do those upon treatment. 

The TREATMENT has for its object the correction of the 
vaso-motor disturbance evident as congestion of the kidneys. 
It gains vaso-motor control both directly, by treatment to the 
kidneys, and indirectly, if necessary, by the treatment of the 
disease to which the congestion is secondary. In the latter 
case the main treatment must be directed to the primary dis- 
ease. The spinal lesion to the kidneys must always be removed. 

Treatment to gain vaso-motor control is made directly upon 
the vaso-motor innervation of the kidneys. This consists (in 
addition to the removal of the lesion obstructing them) of spinal 
stimulation from the 6th dorsal to the 2nd lumbar, for the vaso- 
motor fibres to the kidneys originating in this spinal area. This 
includes the whole splanchnic area. As stimulation over the 
central ends of the splanchnics and of the great sciatic is known 
to cause renal constriction, it is well to carry this spinal stim- 
ulation 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 aided by direct work 
over the region of the kidney. Deep pressure, with a spread- 
ing motion, applied at the umbilicus and about two inches above 
it, stimulates the 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 the blood- 
vessels. This treatment further affects the renal vessels 
mechanically, and relieves them 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 con- 
gestion is reduced. 

To aid in calling the blood from the kidneys and in equal- 
izing the general body circulation, general deep inhibitive work 



PRACTICE OF OSTEOPATHY. 217 

is made over the abdomen to call the blood to its vessels; a gen- 
eral spinal and neck treatment, particularly directed to stim- 
ulation of heart and lungs and to the inhibition 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 performed with the patient lying on his back. The practi- 
tioner's hands are slipped, palm up, beneath the back, one on 
each side, in the region of the innervation of the kidneys. Now 
as the fingers are bent at the metacarpo-phalangeal knuckles, 
making a fulcrum of the latter upon the table, the cushions of 
the fingers are pressed deeply into the spinal tissues, the weight 
of the patient is raised by the fingers thus applied, and the tis- 
sues are drawn laterally away from the spine. Quick repetetion 
of this movement a number of times thoroughly manipulates the 
tissues and stimulates the nerve-connections of the kidneys. 

The bowels and skin should be kept free and active by treat- 
ment as before described. 

The treatment thus described applies not only to conges- 
tion of the kidneys, but to nephritis. 

In both forms of congestion of the kidneys the case must 
Tse carefully looked after to obviate the danger of its passing 
into inflammation; acute hyperemia tending to acute nephritis, 
the passive congestion tending to become 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 applications 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 given. 

HYDRONEPHROSIS. 

DEFINITION: A condition in which obstruction to ureters, 
bladder, or urethra causes accumulation of urine in the pelvis 
.and calyces of the kidney. 

LESION may or may not be concerned in the causation. 



218 PRACTICE OF OSTEOPATHY. 

It is said that about 20 to 35 per cent of the cases are duo to 
congenital obstruction. Prostatitis, causing urethral stricture 
may be the cause, itself dependent upon a bony lesion. The 
same is true of displaced uterus -pressing upon the ureter; of a 
tumor or growth in the contiguous tissues pressing upon the 
ureter: of an inflammation of the urethra, leading to obstruction; 
disease of the bladder involving the urethral orifice; of a floating 
or movable kidney, causing a twist in the ureter. Parasites, or 
calculi may obstruct the tube. 

The TREATMENT must be directed to the relief of the pa- 
tient, but chiefly to the removal of the obstructing cause. This 
may not always be feasible, but is often possible. A careful 
study must be made of the history of the case to determine the 
probable nature of the obstruction. A movable kidney must 
be carefully raised, straightening out the ureter, manipulation 
being directed particularly to this end. All manual operations 
in such cases must be conducted with extreme care to avoid 
rupture. A movable kidney may be held in place by strengthen- 
ing its omental supports and the abdominal walls (see movable 
kidney). Reducing an enlarged postate, replacing a prolapsed 
uterus, or dilating the ureter and working the calculus or para- 
sites down out of it, ma}- be all the treatment necessary. (See 
Chap. TX D., Renal Calculi. Uterine Diseases). 

The bony lesion must be removed. A continued course 
of treatment should be carried on to overcome the atrophy of 
the renal epithelium and the growth of connective tissue that 
has likely taken place. 

TUMORS OF THE KIDNEY of the benign variety, such as fibro- 
ma, lymphadenoma, angiomia, lipoma, may be amenable to the 
treatment. The malignant tumors, sarcoma and carcinoma, 
probably would not be. The latter is almost invariably fatal 
and removal by surgery seems to be only resort. The treat- 
ment and lesions in these conditions are as described in the chap- 
ter on tumors, q. v. An obstructed venous or lymphatic cur- 
rent is probably most potent in causing them. 

CYSTIC KIDNEY. OR RENAL CYST, is a condition that is usually 
remediable only by surgery. The treatment would be palliative, 
and of the kind described for nephritis, to the chronic interstitial 



PRACTICE OF OSTEOPATHY. 219 

variety of which the cysts are often due. The kidney excretions 
should be kept free by plenty of stimulative treatment to the 
organs, to -guard against the sudden occurrence of uremia in the 
patient. The heart is often hypertrophied, and should be treated 
as directed for that condition. In retention cysts due to chronic 
interstitial nephritis, much might be accomplished in the measure 
that the nephritis is benefited, which is often considerable. The 
patient's life may be rendered safe and be much prolonged by 
the treatment. Just what would be accomplished in these cases 
is still an open question. 

RENAL CALCULI, (Nephrolithiasis). 

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 secretory activities of the kidney 
and leads to the deposition of certain substances. 

The LESIONS AND ANATOMICAL RELATIONS have been dis- 
cussed under the general consideration of renal diseases. Les- 
ions from the 10th dorsal to the 1st 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, or some other sub- 
stance, it is clear that some cause is operating which prevents 
the natural proportions of the renal constitutents from being 
maintained. While, as Anders states, the causes are not well 
known, the osteopathic view is that the real cause is fouud in 
spinal lesion which deranges the vital forces underlying kidney 
activity. It is as reasonable that spinal lesion should unbalance 
the delicate sympathetic nerve-mechanism controlling these 
o grans, leading to disproportionate or excessive secretion of the 
urinary constituents and the precipitation of the stone, as that 
spinal lesion should in a similar way disturb intestinal secretion 
and lead to diarrhoea. Dr. Still points to the fact that the supra- 



PRACTICE OF OSTEOPATHY. 

renal bodies have a rich arterial supply, and believes that theii 
secretions have to do with preventing renal calculi. They 
should be stimulated at the level of the 10th rib in such cases. 
Lesion to them may be one of the causes of renal calculi. 

The PROGNOSIS is good, both for the removal of the stone 
and for the prevention 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 treatment of these 
cases is almost uniformly successful. 

The TREATMENT has as its object the removal of the stone 
and the correction of the metabolism of the kidney to pievent 
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 stim- 
ulation of controlling nerves and circulation. This is accom- 
plished by both spinal and local abdominal treatment as before 
described in the treatment of the kidney. Under this restorative 
process normal urine is secreted and the stone is dissolved. 

This same procedure would prevent the formation of more 
calculi. It would be efficient in all cases, and should be ad- 
ministered 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. 

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 first 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 10th 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. This inhibitive treatment for the pain probably 
also aids in dilating the ureter for the passage of the stone. Quiet- 
ing the colic must itself be in the nature of a relaxation of the 



PRACTICE OF OSTEOPATHY. 221 

tissues of the ureter. This treatment is a step preliminary to 
the abdominal treatment along the course of the ureter, which 
has for 'its object the inhibition of pain, relaxation'of the ureter, 
and the manipulation of the stone downward along the duct. 
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 
inhibition from the middle dorsal down over the sacrum. After 
this treatment abdominal 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 inferior mesenteric, 
spermatic, and pelvic (lower hypogastric) plexuses. This treat- 
ment aids the ureter to pass the stone by mechanically working 
it along. It should be begun at a point two inches above and 
two inches externally from the umbilicus and progress diagonally 
downward and inward to the promontory of the sacrum and as 
far below it as possible. This treatment reaches the ureter by 
deep pressure of the overlying tissues down upon it. It must be 
very deep, but slow and with the careful avoidance of any vio- 
lence. Usually the stone is readily passed under the treatment, 
but some cases require nearly a continuous treatment for a con- 
siderable time, three quarters of an hour or more. If possible, 
treatment should not be stopped until the stone is passed. Treat- 
ment afterwards over the sore parts may be necessary. The 
patient's system should be stimulated against syncope or col- 
lapse by treatment of the heart, lungs, and cervical region. 

The patient 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 lemon- 
ade, soda water, and plenty of pure water is a valuable aid in 
keeping the kidneys flushed and free. Hot baths, and the applica- 
tion of hot fomentations or poultices to the loins, afford relief 
in the acute attack. 

PYELITIS, if present, must be treated (aside from the removal 
of the stone from the pelvis) as the inflammatory condition of the 
kidneys before discussed. 

PYELONEPHRITIS results from an extension of the inflam- 



222 PRACTICE OF OSTEOPATHY. 

mation inward to involve the substance of the kidney. Both 
of these conditions are to be regarded in the light in which nephri- 
tis is looked at, and call for practically the same treatment (See 
nephrtis.) Careful attention must be given the conditions causing 
the disease. Irritant calculi may sometimes be absorbed from 
the pelvis of the kidney, or may have to be removed by surgical 
operation. A cystitis, the inflammation from which extends up- 
ward to involve the pelvis and kidney, must be carefully looked 
after. (See cystitis). 

In a similar way infectious diseases, irritant drugs, cold and 
exposures, etc., acting as the cause of the pyelitis and pylone- 
phritis, must be attended to. Bony lesion must be removed. 

The inflammation is sometimes simply catarrhal in nature 
and is easily overcome by the corrected circulation. Ulceration 
may occur in the pelvis from the continued irritation of calculi, 
and tissue changes occur. In such cases a longer course of treat- 
ment will be necessary to overcome these conditions. 

From severe irritation, and in the course of infectious dis- 
eases, a purulent process may be set up. This exudate, and 
strictures, may obstruct the kidney, and ABSCESS OF THE KID- 
NEY, or PYONEPHROSIS occurs. In such cases the treatment is 
upon the same plan, but the prognosis is not so favorable. The 
process may be limited and the case be cured by the treatment. 
Surgical treatment may become necessary. In all of these cases, 
especially in those with purulent features, constitutional treat- 
ment must be given. 

MOVABLE KIDNEY (Nephroptosis, Displaced Kidney) may 
be successfully treated by osteopathic means if it has not that 
extreme degree of mobility known as "floating kidney." Mov- 
able kidney is the term designating the condition in which the 
upper end of the organ may be pushed down to the level of the 
umbilicus. The lesions, 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 of the dorso-lumbar spine 
(McConnell). A bad spinal 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 



PRACTICE OF OSTEOPATHY. 223 

other causes to operate. Thus it occurs as a part of enteroptosis, 
or from falls, heavy lifting, straining at stool, etc. Spinal lesions 
causing relaxed abdominal walls also repeated pregnancies pro- 
ducing the same result, favor mobility of the kidneys. Lesions 
and diseases leading to extreme emaciation and consequent 
wasting of the fatty tissues of the capsule o 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 movabl 
kidney are good, the causes being removable. Much the same 
treatment would be given as for enteroptosis. q. v. The re- 
moval of spinal lesion, spinal treatment to restore tone to the 
supporting tissues, local treatment at the kidney to mechanically 
replace it and to remove the tenderness and swelling in it due to 
twisting of the renal vessels, and abdominal treatment to re- 
store 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 increasing the nutri- 
tion 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, over-eating, straining at stool, etc. 

SPECIAL PATHOLOGICAL STATES OF THE URINE, such as 
Hematuria, Albuminuria, Lithuria, Oxaluria, and various other 
conditions, hardly call for special discussion. They depend 
upon pathological states of the kidney, and are adequately treated 
along with the various kidney diseases with which they occur, 
as symptoms or complications. 

UREMIA. 

DEFINITION: An acute or chronic condition due to acute 
or chronic kidney disease, and resulting from toxemia caused by 
the retention in the blood of renal poisons. 

Uremia is symptomatic, therefore no separate lesions are 



224 PRACTICE OF OSTEOPATHY. 

expected for it. They are those causing the primary disease 
from which the patient is suffering, most frequently Bright 's 
disease, but quite often also such diseases as gout, scarlet fever, 
typhoid fever, cholera, etc.; conditions in which the blood and 
kidneys are affected. 

The PROGNOSIS, while guarded, is fair. In the acute form 
rapid work must be done to obviate the danger of a fatal termina- 
tion. The treatment quickly relieves, however, and usually 
the kidneys can soon be gotten to acting freely. 

In the chronic case one must be continually upon his guard 
against a bad turn. The chances in these cases are better than 
in the acute, to overcome the condition. 

The prognosis must always depend upon that for the pri- 
mary disease. 

The TREATMENT, especiahV in the acute case must be prompt- 
ly efficient. The first object is to arouse the kidneys to activ- 
ity, and to excrete from the system the poison that is causing the 
trouble. 

Thorough stimulation at the renal region of the spine for- 
tunately soon accomplishes this object. Cases that have not 
urinated in many hours will often respond promptly to this treat- 
ment. Reference to cases reported above will give an indication 
of what may be done. The accomplishment of this ob- 
ject is furthered by the local treatment to the kidneys, renal 
vessels, and associated nerve plexuses, given upon the abdomen 
at and above the umbilicus. For this abdominal treatment, and 
a special treatment for these cases, see the treatment of congest- 
ion of the kidneys. Catheterization should be employed when 
necessary. 

Sweating should be induced in order to help free the blood 
of the poisons. Thorough spinal treatment, and stimulation of 
heart and lungs will cause perspiration. A hot pack may be used 
for this purpose if necessary. The stimulation of the heart over- 
comes the feeble and labored beating of the heart, while the 
stimulation of the lungs, raising of the ribs, etc., relieves the 
dyspnea. (Cheyne-Stokes breathing is often present). 

For the convulsions general relaxation of the spinal and 
cervical tissues should first be done, followed by strong inhibi- 



PRACTICE OF OSTEOPATHY. 225 

tion in the superior cervical region, affecting the vaso-motor 
center in the medulla. This treatment, together with the stim- 
ulation of the heart, corrects the circulation to the brain. The 
spasms are supposed to be due to localized or general anemia of 
the brain and cerebral anemia. 

The eye and ear symptoms, such as dimness of vision, blind- 
ness, tinnitus aurium, deafness, etc., are of centric origin, and are 
remedied by restoring the circulation to the brain. They do not 
commonly last more than a few days in the course of the disease. 

Fever may be present and should be treated as before di- 
rected. Bowels and skin should be kept active. The bowels 
may be made to respond to treatment, or may be emptied by 
an enema. Subnormal temperature is normalized by the heart 
and lung treatment. The coma is reached by the spinal and 
cervical, and heart and lung treatment as described. 

The vomiting, nausea, diarrhoea, stomatitis, etc., should be 
treated as before directed for those conditions. They depend 
upon the irritation of the mucosa. 

CYSTITIS. 

DEFINITION: An acute or chronic inflammation of the 
mucous membrane of the bladder. 

LESIONS AND ANATOMICAL RELATIONS: Lumbar and sacral 
lesions predominate 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 (1st), 2nd, 3rd and 4th sacraL 
The vesical 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 pro- 
duce 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 

15 



226 PRACTICE OF OSTEOPATHY. 

upon the bladder and retention of urine, leading to the disease. 
Traumatism, such as the careless use of catheter or sound, irrita- 
tion of fecal matter, or of a stone in the bladder, or from a preg- 
nant uterus, may be a sufficient cause. This is also true of septic 
causes of cystitis; the introduction of an unclean catheter, the 
poisonous products of febrile diseases, of gonorrhrea, etc., becom- 
ing direct causes of the condition. Yet, in many of such cases, 
the weakness of parts due to spinal lesion precedes and predis- 
poses to the trouble. Also lesion is often the direct cause of 
the condition leading to cystitis, as in inflammation of the sur- 
rounding 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 veins aids in reducing the inflammation. The 
abdominal treatment must be carefully applied. It may be made 
over the hypogastric plexus to aid in controlling the circulation. 
It should be inhibiti,ve. Inhibitive and relaxing treatment aids 
in quieting the pain and vescical irritability. It also calls the 
blood to the abdominal vessels away from the bladder. An en- 
larged 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 1st lumbar down, especially over the 
2nd, 3rd and 4th sacral nerves. For the vescical and rectal tenes- 
mus, stimulation of the lumbar, and especially of the sacral 
region should be made after the pain is allayed. For all of these 
pains a good treatment is to have the patient lie upon his back, 
and strong pressure is made upon the pubic arch; or better, have 
him lie upon his chest, and the practitioner brings the heavy 
pressure upon the sacrum. 

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 sea- 
soned foods and alcohol. In the early stages a milk diet is rec- 
ommended. The patient should drink freely of water for internal 



PRACTICE OF OSTEOPATHY. 227 

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 bathing. The bowels must be kept open and 
the kidneys free. The usual treatments should be given for this 
purpose. Hot sitz baths and hot applications may be employed 
to relieve the pain in the intervals between treatments, if neces- 
sary. 

The patient should be treated once or twice daily. 

In the chronic case the prognosis is fair, but guarded. Treat- 
ment should proceed along the lines laid down above. In this 
form, and in septic cystitis, washing out the bladder is a val- 
uable aid to the treatment. For the chronic case boiled water, 
sterile normal salt solution (40-<>0 gr. to a pint), or a weak solu- 
tion of mercuric chlorid (1:50,000 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. 

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 lum- 
bar, is found, the removal of which cures the case at once. A 
common lesion is weakness and posterior position of the whole 
lumbar spine. Quite often lower dorsal lesion is found. An- 
terior lesion of the 5th lumbar is a frequent cause. 

As the vesical 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 por- 
tions 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 
namely, from the llth and 12th dorsal and the 1st and 2nd lum- 
bar spinal nerves connecting with the sympathetic by way of 



228 PRACTICE OF OSTEOPATHY. 

the aortic plexus, the inferior mesenteric ganglion, the hypogas- 
tric and pelvic plexuses. On the other hand, the 2nd, 3rd, and 
4th sacral nerves furnish the chief motor supply to the longitu- 
dinal muscle fibres of the bladder. (Quain). The American 
Text-Book of Physiology states that stimulation of the sacral 
nerves (1st, 2nd, 3rd and 4th) causes a reflex contraction of the 
bladder. It is evident that lumbar and spinal lesion may di- 
rectly affect this nerve-supply. The lesion involving the sphinc- 
teric center of the bladder; the paralytic incontinence; the 
imperfect vesical innervation and paresis of the walls from over 
distention; the spasmodic incontinence due to over action of the 
compressor muscle of the bladder, may all arise from spinal les- 
ion as described occurring at certain or various points in the 
lumbar and sacral regions. This lesion may cause a stoppage 
of nerve-supply, resulting in a paralytic condition, or in an irri- 
tation of the bladder. The anatomical relation between lesion 
and disease is clear in this case. 

The PROGNOSIS is good. Very many cases have been suc- 
cessfully treated. Generally quick results are attained. Treat- 
ment causes immediate lessening of the trouble. Cure is the 
rule. 

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 sacral region affects the nerve-connections 
explained above and tones the motor mechanism of the bladder. 
Spasmodic conditions call for thorough inhibition of these re- 
gions. Corrective spinal work restores normal conditions and 
allows Nature to attend to the result. Abdominal treatment 
over the hypogastric plexus and over the internal liiac vessels 
aids the case. When the condition is due to a prostrating dis- 
ease 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 intestinal 
worms, an elongated prepuce, etc. Circumcision is advisable 
in the latter case. In neurotic children treatment must be given 
to the general nervous syste. Enjoin regularity of habits in 
children, and regulate diet and drink, especially for the latter 



PRACTICE OP OSTEOPATHY. 229 

part of the day. Avoid late play; all worry, and excitement. 
The child should sleep in a cool room, under light covers. The 
hips may be elevated a little. Keep the rectum empty. 

RENAL DROPSY. 

DEFINITION: This is "an abnormal accumulation of watery 
fluid transuded from the blood-vessels into the cellular tissues 
and lymph-spaces." "A toxemic edema" (Butler). It is a 
common occurrence in acute and chronic nephritis and in other 
form of kidney diseas3. 

The lesions are those causing the primary disease of the 
kidneys. 

The prognosis is good, the condition yielding quickly to 
treatment. The kidneys become very active under treatment 
and throw off the accumulated fluid from the system. In case 
3, under "Diseases of the Urinary System," great dropsical swell- 
ing of the body from feet to middle of the back was quickly over- 
come by treatment. Under the subject "Ascites" is reported 
a case in which enormous quantities of the fluid were passed 
from the system by the kidneys which were kept well stimulated. 

The TREATMENT is for the removal of lesion and the cure of 
the primary disease of the kidneys. The organs must, them- 
selves, be kept thoroughly stimulated by treatments described 
in "Congestion of the Kidneys," q. v. The heart should be kept 
thoroughly stimulated to overcome its weakness, a feature quite 
important in these cases. This treatment aids in overcoming 
the venous stasis present in the whole system. Any special dis- 
ease of the heart present should be given due attention. It is 
apt to be dilated as well as weak. Any lesion affecting the heart 
should be removed. An important effect is gotten upon the 
heart by the thorough treatment to the kidneys, thus' lessening 
the vascular tension in the system due to the kidney disease. 
(See Dilatation of the Heart, for treatment). 

It is thought that the accumulation of fluid in the tissues 
is due to the relaxation and loss of elasticity in them. This 
prevents the forcing of the lymph into circulation, and allows the 
fluid to infiltrate the tissues. For this condition a thorough gen- 
eral spinal and muscular treatment is necessary to increase the 
activity of the circulation, and to add tone to vessels and tissues. 



230 PRACTICE OF OSTEOPATHY. 

DISEASES OF THE HEART AND CIRCULATORY SYSTEM. 

As in considering the diseases of the urinary system, a num- 
ber of cases are here noted for their value in showing various facts 
in regard to the practice upon cases of this class. The}- 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 treat- 
ment; 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 re- 
ports, nor as representing the whole field of practice in diseases 
of this class. 

(1) Fatty degeneration of the heart. 'The patient was 
too weak to walk ; the action of the heart was very weak ; arrhyth- 
mia 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 
muscles from the atlas to the 6th dorsal, especially marked in 
the upper dorsal region. The patient was very round shouldered. 
These causes brought about 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 office 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. 

(2) 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 first right rib and of the second left rib; also a 
general dropping of the ribs which narrowed the chest cavity. 
Lesion affected the 1st and 2nd lumbar, and the pelvis was tilted. 
In six months all lesions were corrected, and the case showed 
marked improvement. 

(3) Palpitation of one years standing, attending physical 
or mental exertion. Subluxation of the fifth rib was discovered. 



PRACTICE OF OSTEOPATHY. 231 

It was removed in one treatment, and the patient suffered no 
further trouble. 

(4) Palpitation and a complication of diseases; lesion found 
at the atlas and in the upper dorsal spine. No palpitation oc- 
curred after the third treatment. 

(5) 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 occurrence in this case to 
slow the heart-beat as much as twenty beats per minute, this 
effect not being transient, but lasting for several days. 

(6) Arrhythmia and a general bad condition of the health; 
lesion of the 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. 

(7) Arrhythmia, in which the patient was very weak. The 
left 5th w r as down upon the 6th and slightly inward. The cer- 
vical and upper thoracic spinal muscles were very much con- 
tracted. The treatment was directed to raising the rib and re- 
laxing the contractured muscles, and resulted in regulating the 
heart-beat in six weeks. 

(8) Functional weakness; sinking spells occurred upon 
any exertion, as in climbing stairs. The left thorax was found 
depressed; the left clavicle was displaced downward at its sternal 
end, while it was up and forward at its acromial end. All the 
ribs were crowded together. Relief followed the first treatment, 
and the case was cured in five weeks. 

(9) Functional weakness of the heart, due to a downward 
displacement of the right fifth rib affecting the intercostal nerve. 
The case was cured in two months. 

(10) Impeded heart-action, resulting from a fall causing 
spinal injury and nervous shock. The marked lesion was found 
at the atlas. 

(11) Valvular disease of 12 years standing in a lady aged 40. 



232 PRACTICE OF OSTEOPATHY. 

Marked edema of limbs and abdomen were present. She was suf- 
fering also from bronchial asthma. Lesions were contracture 
of lower cervical and upper dorsal muscles; the upper ribs were 
all drawn tight tgoether, under treatment the asthma and dropsy 
were cured, and the whole general health was made better than 
for years. 

(12) Valvular lesion following acute rheumatism, in a young 
man of 23. There was a twist in the spine at the 2nd dorsal and 
at the 5th dorsal. Great benefit was gotten under the treatment. 

(13) Enlargement of the heart, mitral and aortic incom- 
petence, and regurgitation ; showed lesion in forward displacement 
of the atlas, lesion of the left clavicle and upper two or three left 
ribs. Three treatments produced much improvement, one months 
treatment corrected the arrhythmia, and constant improvement 
went on under treatment. 

(14) Angina pectoris after lagrippe; spinal muscles con- 
tractured; the 3rd to 5th ribs displaced downward. 

(15) Angina pectoris showing lesion of the 2nd to 5th left 
ribs. The left arm could not be raised above the head without 
extreme pain. Under treatment the pains became gradually 
less severe, until they had practically ceased at the end of two 
months. 

(16) Angina pectoris, caused by downward displacement 
of the left clavicle, and cured by its correction. 

(17) Varicose veins and milk leg of fifteen years standing. 
The tissues surrounding Hunter's canal and the saphenous open- 
ing 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 report. 

(18) Varicose veins of eight years standing. Three varicose 
ulcers were discharging when treatment began. Innominate 
lesion was discovered. The case was cured in five weeks. 

(19) Varicose veins, for which operation had been made 
without success. 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. 

(20) Varicose veins of two years standing. Severe and 



PRACTICE OF OSTEOPATHY. 233 

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. 

(21) Varicose ulcers of ten years standing in a man of 55. 
The ulcers extended from the middle of each leg down upon the 
foot. The case was cured in three months by opening the venous 
return from the limb. 

(22) Disturbed circulation, in which the superficial cap- 
illaries of one side of the body 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 cor- 
rection cured the case. 

(23) 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 upon the injured 
side great pain followed. This condition was of five years stand- 
ing. Examination showed a strong contraction of the deep 
muscles of the neck, which set up irritation of the local sympa- 
thetic, 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 five weeks time overcame the trouble entirely. 

(24) Circumscribed ecchymosis upon the left wrist, about 
the diameter of a five cent piece, due to no bruise or injury to 
the tissues directly. The spot was drak, nearly black, and was 
allompanied by slight numbness in the forearm. The lesion was 
a slight elevation of the first left rib. The condition seemed to be 
a vaso-motor effect from pressure upon the brachial plexus or by 
interference with the spinal sympathetic connections. Reduc- 
tion of the lesion was accomplished at one treatment and had an 
immediate effect upon the ecchymosis. The area began at once 
to grow lighter in color, and in ten minutes had materially changed. 
In six hours it had disappeared. 

(25) General Dropsy, ascites being quite marked, in a lady 
of 38, and of 2^ years standing. Lesions occurred' as a pos- 



234 PRACTICE OF OSTEOPATHY. 

terior condition of the third dorsal, and a separation between the 
fifth lumbar and the sacrum. The spinal muscles were all very 
tender. The case was cured. The treatment was almost en- 
tirely upon the lesions, with some general spinal, cervical and 
thoracic treatment combined. 

LESIONS: 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 be- 
low, do not always relate to specific anatomical or physiological 
centers of the texts, but in some cases refer to bony points be- 
come prominent in osteopathic work as locations of lesion or of 
places where treatment produces special results. These are: 
the first rib (heart failure); corpora striata; 1st, 2nd, 3rd, 4th, 5th. 
dorsal vertebrae ; 2nd to 4th dorsal (valves of the heart) ; 3rd and 
4th cervical (rhythm of the heart); superior cervical ganglion 
(a sympathetic center) ; upper four or five dorsal nerves, especially 
the 2nd and 3rd (accelerator center); medulla (general circula- 
tory). 

General vaso-motor centers which, with the special vaso- 
motor innervation of a given viscus, suffer from lesion in circu- 
latory disturbances: superior cervical ganglion; 2nd dorsal, 5th 
lumbar, for general superficial capillary circulation. 

The lesions usually present in cardiac diseases are: (1) of 
the atlas and axis; (2) the cervical region generally, both mus- 
cular and bony lesion. Lesions of the atlas, axis and cervical 
region affect the superior cervical ganglion and the other sympa- 
thetic supply of the heart. (3) Lesions of the clavicle are found, 
as are those, (4) of the 1st rib, (5) of the 2nd rib, (6) of the upper 
six ribs, especially on the left side, (7) of the upper five dorsal 
vertebrae, (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. 

Rib lesions are of prime importance in such diseases. They 
seem to be relatively 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. 



PRACTICE OP OSTEOPATHY. 235 

nerve-connections. As to kind, the rib lesion is as important as 
any other lesion, while as to frequency it is of greater importance 
Many of the rib lesions are of the 4th and 5th ribs, either or both, 
and usually of the left side. Lesions of the 6th rib, significant 
with relation to the apex, also occur. As a matter of fact, le- 
sions of these two are the most important of the rib lesions. They 
may affect both nerve-connections and mechanical relations of the 
heart. The fact that the apex beat (falling at the fifth inter- 
space) may be interfered with, easily deranging the whole rhythm 
of the organ, may account in part for the frequency with which such 
lesion causes cardiac disease. In numerous cases the 1st and 2nd 
rib present 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 some cases lesion of the clavicle occurs. While not frequent, 
these lesions may be the cause of serious trouble. 

Spinal lesions, including both muscular and bony, are of the 
greatest importance when it is considered that rib lesion con- 
tributes to them by disturbance of the spinal nerve-connections. 
They act by producing derangement of the important nerve- 
connections in the upper dorsal region. From this point of view, 
bony and muscular lesions in the cervical region become signif- 
icant. While not so frequently the sole cause of heart disease, 
they yet often occur and derange the important sympathetic 
connections of the heart and this region. Lesions of the atlas, 
axis, or of any of the first three or four cervical vertebrae, also of 
the rectus capitis anticus major muscle, may affect the superior 
cervical ganglion as well as other cervical sympathetics. 

It may be noted that practically all of the above lesions 
affect the heart, in w r hole or in part, through its nerve-connec- 
tions. This seems to be the most important avenue over w-hich 
abnormal influences travel from lesion to heart. By working 
directly upon nerve distribution to the heart, irrespective of le- 
sion, important changes are readily made in its activities. Physi- 
ologically this organ is markedly affected by nervous influences. 
It seems that a viscus whose nervous equilibrium is so readily 



236 PRACTICE OF OSTEOPATHY. 

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 
they do, must be the true cause of many pathological states. 
Their removal is therefore a rational means of cure. 

The diaphragmatic lesion is of some importance in heart 
diseases, as mentioned above. It is frequently associated with 
a narrowed thorax, by reason of increased obliquity of the ribs, 
as well as of various other lesions of them. These lesions prevent 
free rib action, meaning also, practically, free thoracic play, free 
diaphragmmatic play, and free circulation. The various lesions 
which impede the free play of these parts must unfavorably 
affect circulation. 

In the cases of varicose veins reported, the importance of 
lumbar, sacral, and innominate lesion becomes apparent, also 
of the stoppage of venous return. Lesions of the tissues about 
the saphenous opening, and along Hunter's canal, are important 
in this connection. Two cases of vascular disturbance showed 
lesion of the cervical region and of the 5th lumbar vertebra, it 
being noticeable that each came at a place at which it could af- 
fect the center for superficial circulation. (Superior cervical 
and 5th lumbar). 

In periods from one or a few treatments to three months 
results are attained in long standing or serious cases that well 
demonstrate the superiority of osteopathic therapeutics. In one 
case the pulse was reduced from 140 to 110 at the first treatment, 
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 success- 
ful 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 science 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 



PRACTICE OF OSTEOPATHY. 237 

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 dis- 
turb 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 stim- 
ulation 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 further by vagus stim- 
ulation, 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 stimulation of the nerve, would per- 
manently 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 sympathetics would be left free to run the 
heart too fast. In either case the removal of the lesion to the 
pneumogastric would be of prime importance in curing the con- 
dition. 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 re- 
moval 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 



238 PRACTICE OF OSTEOPATHY. 

and go to the cardiac plexus. It also has connection with the 
superior cervical ganglion. As this nerve is known to be amenable 
to osteopathic treatment at many points, likewise susceptible 
of lesion at various places, as at the atlas, 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 dem- 
onstrated in man, as well as in various other mammals, retards 
heart action in a manner different from that of the vagus. Its 
stimulative impulses come from the heart and act upon its sym- 
pathetic connections with the splanchnics to produce a reflex 
vaso-dilatation in the abdominal vessels. They dilate and re- 
ceive a large amount of blood from the general system, the gen- 
eral blood pressure is lessened, arterial tension falls, and the 
heart is thus quieted. 

It is thus apparent that a bony lesion in the splanchnic 
area might affect the spinal connections of the splanchnics, pro- 
ducing an inhibitor effect that would likewise dilate the abdom- 
inal vessels, and slow the heart by a process similar to that by 
which the heart depressor nerves function. 

On the other hand, lesion in the splanchnic area might be 
of a nature to irritate or over-stimulate the sympathetic connec- 
tions, thus causing a constriction of the abdominal vessels, and 
combating the normal dilator tendency of the depressor nerve, 
thus preventing the heart from being retarded in its beat to a 
normal degree. 

Hence splanchnic lesion may result in abnormal slowness or 
rapidity of the heart, and this condition may lead to other cardiac 
disease. These facts may explain Avhy we so frequently meet 
digestive disturbances and the like in heart disease. 

A further fact becomes evident. The practical Osteopath 
makes much use of the splanchnic and abdominal areas in his 
work upon cardiac and circulatory disturbances. By inhibiting 
the splanchnics, and by an inhibitive or relaxing treatment over 
the abdomen, he dilates the vast area of abdominal vessels and 
calls the blood from other parts of the body. Reflexly the gen- 
eral blood-pressure is lessened, arterial tension is decreased and 



PRACTICE OF OSTEOPATHY. 239 

the heart is quieted. On the other hand, stimulative treatment 
to splanchnics and abdomen will, by the opposite effect, increase 
arterial tension and strengthen cardiac action. 

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 lesions. 
The upper ganglion lies in front of the second and third cervical 
vertebrae and communicates with the upper four cervical nerves. 
It may suffer from lesion of the upper three vertebrae. Its branch- 
es of communication with the 3rd and 4th cervical nerves often 
pierce the rectus capitis anticus 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 the 6th and 
7th cervical vertebras and connects with the 5th and 6th cervical 
nerves. The lower ganglion lies in front of the 1st costo-verte- 
bral articulation, and connects with the 7th and 8th cervical 
nerves. They are susceptible to lesion respectively of the 5th, 
6th, and 7th cervical vertebrae and the 1st rib. All three are 
liable to muscular lesion in cardiac disease. 

The accelerator or augmentor nerves of the heart are sym- 
pathetic. They are antagonistic to the vagi. That they are 
liable 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 treat- 
ments for cardiac stimulation or inhibition are made in the upper 
dorsal region, at the origin of these nerves, by stimulation or 
inhibition of them. Important heart lesions occur in the upper 
dorsal region (spine or rib) and probably affect the heart through 
these connections. The connection of these ganglia with the 
middle and inferior cervical ganglia lends the latter added im- 
portance in these matters. 

When these accelerators are stimulated, they increase the 
frequency of the heart-beat from 7 to 70 per cent, but a long 



240 PRACTICE OF OSTEOPATHY. 

stimulation produces no greater acceleration than a short one. 
This marked increase in the pulse is quickly apparent under os- 
teopathic stimulation of the accelerators. Further results of 
stimulating them are an increased force of the ventricular beat, 
the ventricles are more completely filled by the auricles and their 
volume is increased. The strength and volume of the auricular 
contractions are also increased. Hence our treatment both 
quickens and invigorates the heart muscle, and the organ conse- 
quently handles more blood at a beat. 

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 accelerators, lead to permanently quickened 
and strengthened heart-beat, and produce such an affect as hyper_ 
trophy of the heart. Or the lesion might cut off or lessen the 
accelerator impulse, leading to abnormally slow heart-beat, lack 
of strength of heart action, etc. Hence the importance of cor- 
recting 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 ex- 
plain the importance of lesion of the 4th and 5th ribs in heart 
disease. The 1st, 2nd and 3id spinal nerves, through the sym- 
pathetic, supply sensory fibres 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. 

The cardiac plexus is made up of the cardiac branches of the 
vagus and from the cervical ganglia, whose functions and rela- 
tions to cardiac disease were pointed out above. This plexus 
suffers from lesion of those nerves, and is the medium through 
which lesion acts upon the heart. The right and left coronary 
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. Possibly much of their influence is by irritation to the 



PRACTICE OF OSTEOPATHY. 241 

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 connec- 
tion with the upper six dorsal nerves through its sympathetic 
sppply. The upper four or five give origin to the accelerators. 
The 1st, 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 connection 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 luxated ribs, 
sore and contractured intercostal muscles, a narrowed chest and 
changed shape of the thorax. These facts emphasize the im- 
portance of free thoracic play in the maintenance of the health 
of the thoracic viscera. 

A general changed shape of the thorax may have its bear- 
ing 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 general alteration 
in the shape of the thorax has produced narrowing of the inter- 
costal spaces, the heart must be put to greater exertion to force 
the blood through this area of obstructed vessels. Furthermore, 
such a condition 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 embarrasses the heart. 
Take these obstructions to intercostal and aortic circulation in 
conjunction with rib lesions to intercostal nerves, a frequent^oc- 
currence, 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 and from the thoracic sym- 
pathetic, both of which are connected with the heart innerva- 
tion. It perforates the diaphragm and joins the abdominal sym- 
pathetic. It supplies the right pericardium, the right auricle, 

16 



242 PRACTICE OF OSTEOPATHY. 

and the inferior vena cava. Perhaps it, a motor nerve, co-ordi- 
nates the activities 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 may likely be suffering from 
the irritation of the disease affecting the heart or its coverings. 

Clavicular lesion may affect the subclavian vessels, dam 
back the flow of blood through the artery, or, by preventing the 
return flow through the vein, cause the periodic loss of a heart- 
beat through insufficient filling of the organ. 

The intimate relations between the cardiac nerves and the 
general nervous system is seen in the fact that stimulation of the 
sciatic increases the force and frequency of the heart-beat. These 
facts are of value hi treatment for the general circulation. 

PERICARDITIS. 

Under osteopathic treatment the prognosis for 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 prog- 
nosis must be unfavorable, though much might be done to bene- 
fit the patient's condition. 

The LESIONS affect the blood-supply by derangement of 
the spinal sympathetics. Irritative rib lesions, bringing pressure 
directly upon the heart, cause the disease by mechanical irrita- 
tion of the pericardium. This is especially likely to occur in 
lesion to the fourth and fifth left ribs, they occurring at the site 
of apex beat, where the greater range of motion is more likely 
to be interfered with by narrowing of the thoracic cavity or by 
inward displacement of these 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 narrowed thorax and a deranged 
diaphragm may, by pressure or traction upon the pericardium, 
allow special causes to set up irritation and inflammation in the 
structure. These various lesions may lay the foundation for the 
disease, some special active cause producing it directly. Thus 



PRACTICE OF OSTEOPATHY. 243 

spinal and other lesion to the cardiac nerves weakens the tissues 
and lays them liable to the effect of such disorders as rheumatism, 
gout, scarlatina, influenza, etc., secondarily to which pericarditis 
occurs. In such cases also attention must be given to the lesion 
accountable for the primary disease. 

In the TREATMENT the patient must be kept at rest in the 
recumbent position to aid in slowing the beat of the heart. This 
object is directly accomplished by stimulation of the vagus and 
inhibition of the accelerators. The former is treated by manip- 
ulation along its course behind the sterno-mastoid muscle. In- 
hibition 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 mam- 
mary veins, which drain the anterior intercostal veins. This 
aids in allaying the inflammation, as does also the inhibitive 
abdominal treatment by drawing the blood to the abdomen. 
The latter operation is assisted by inhibition along the splanch- 
nics at the spine. Calling the blood to the abdomen not only 
aids in allaying the inflammation, but may' slow the heart by 
decreasing arterial tension. As this reflex dilatation of the ab- 
dominal veins is a result the same as that produced by the heart 
depressor nerve in functioning 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 freedom to the heart, the various intercostal . muscles 
should be gently manipulated and relaxed. On account of the 
close connection pointed out above between the intercostal 
nerves and the sympathetics connected with the heart, it is 
probable that reflex sensations are transmitted from the dis- 
eased cardiac apparatus to the intercostal nerves, leading to a 
contractured condition of the intercostal muscles generally. 

The phrenic nerves should be inhibited to relax the dia- 
phragm (and pericardium (?) which it supplies). This treat- 



244 PRACTICE OF OSTEOPATHY. 

ment 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 contracture. 
This relaxation of the diaphragm would aid in quieting the heart 
and in relieving the whole local condition. The desirability of 
securing a lax state of diaphragm and pericardium in the treat- 
ment of pericarditis is suggested by Hilton. 

The pain about the heart is lessened by the whole treat- 
ment. Direct treatment may be made for it by inhibition of 
the 1st, 2nd, and 3rd dorsal nerves (sensory to the heart), and 
the 4th, 5th, and 6th 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 pre- 
vented 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 to allay the inflam- 
mation. 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 daily. More than one treatment 
per diem may be necessary, especially attention to various phases. 

Treatment for the various forms of pericarditis would be 
upon the same plan, with due attention to the manifestations 
of each condition. In the chronic form it would be proper to 
keep the heart well stimulated, to increase its nutrition. The 
patient should take plenty of rest lying down to avoid hyper- 
trophy of the heart. For the plastic form and for that with 
serous effusion,' the treatment is as above described. In the 
latter, during the stage of effusion one must carefully watch the 
heart to prevent collapse. When the pulse becomes weak, and 
cyanosis is present, the heart and lungs should both be stimu- 
lated. In the purulent form the treatment should be applied 
as above, but this condition calls for surgical treatment. The 
pericardial sac should be drained. 

HYDROPERICARDIUM is a condition in which a serous fluid 
transudate occupies the pericardial sac. but no inflammatory 
condition is present. It is commonly associated with renal or 



PRACTICE OF OSTEOPATHY. 245 

cardiac dropsy, and its treatment is that indicated for them, q. v. 
PNEUMOPERICARDIUM calls for palliative treatment similar 
to that described for pericarditis with effusion. The heart should 
be kept stimulated against collapse. The case calls for surgical 
treatment. 

PALPITATION. 

DEFINITION: A paroxysmal rapidity of heart-action, per- 
ceptible 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 bony 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 those 
changes in the shape of the thorax and those lesions of the lower 
six ribs responsible for lesion of the diaphragm embarrassing the 
heart. These lesions may act by disturbing the nerve-connec- 
tions of the heart, by occluding certain vascular areas or single 
vessels, or by direct mechanical pressure upon the heart. Le- 
sions of the clavicle and first rib are frequent, and they, by dam- 
ming 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 ma"y cause 
a paroxysm of rapid beating 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 may all act as irritant upon the accelerator 
sympathetics, noted as rising from the upper four or five dorsal 
nerves and passing to the middle and lower cervical sympathetic 
ganglia. Stimulation of these accelerators thus caused could 



246 PRACTICE OF OSTEOPATHY. 

produce the rapid beating of the heart found in palpitation. This 
class of lesion is most frequent in these cases. 

Atlas lesion may affect the heart through the superior cer- 
vical 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 itself 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 accelerator. 
This style of lesion is not a frequent cause of palpitation. 

It may be argued that as bony lesions are by nature con- 
tinuous, the paroxysmal rapidity of the heart in palpitation could 
not be thus caused, that the effect of this continuous lesion must 
itself be continuous as opposed 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 the neuropathic basis weakening the nerve tissues and 
laying the heart liable to the effects of special emotions, stimu- 
lants, .etc. The lesion might even, per se, be of a nature to cause 
continuous irritation and yet its effects not be continually ap- 
parent as rapid heart-beat on account of the natural variation in 
the activity of the accelerator centers and in the condition of the 
nervous system. 

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 likely 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 palpitation. Rib lesions 
in general are quite apt to be found in cases in which palpitation 
is brought on by slight muscular exertion. The movable rib, 
being luxated, is readily thrown into an exaggerated condition 
of lesion upon muscular effort. Cases are continually met in 
which some special form of muscular activity, perhaps necessitated 
by the patient's occupation, has first caused the displacement 
and has then become the repeatedly-acting cause of the various 
attacks of palpitation which have followed. 

A frequent and serious cause of heart disease in general, 



PRACTICE OF OSTEOPATHY. 247 

at? well as of palpitation in particular, is found in a general down- 
ward luxation of 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 occluding 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 obstruction the heart labors (palpitation) to force the 
blood along its accustomed channels. (3) By irritation to the 
intercostal nerves in the narrowed intercostal spaces. The upper 
six of these nerves, as above explained, are in direct sympathetic 
connection w r ith the heart and convey to it the irritation engen- 
dered in the intercostal spaces, causing it to palpitate. 

It will be noted that chronic heart sufferers are very often 
the possessors of flat chests and narrowed thoraxes. 

Dyspepsia, flatulence and diseased abdominal organs often 
reflexly set up palpitation. It may be that both effects are the 
results of a common lesion, i. e., one to the splanchnic nerves 
(abdominally or spmally). It has been explained that the de- 
pressor 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 venis," and to cause a fall 
of blood-pressure, with a quieting of the heart. On the other 
hand, splanchnic lesion 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 dis- 
turbances 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 allow- 
ing these incidental causes to disturb it lies in the anatomical 
weak point affecting the organ or its connections. A multitude 
of cases cured by replacement of a displaced rib, or the like, leads 
to the conclusion that these so-called causes had little to do with 



248 PRACTICE OF OSTEOPATHY. 

the real cause ; as of case 6 above, in which three weeks treatment 
cured palpitation of many years standing, and rendered the patient 
immune to the effects of coffee and tobacco, which before he could 
not use. 

In cases where the palpitation is purely secondary, as in 
anemia, from the changed state of the blood, and in acute infectious 
diseases, from the irritation of toxic substances circulating in 
the blood, the lesions belong to the primary disease. 

The PROGNOSIS is good. The most marked and long stand- 
ing cases have yielded readily to treatment. The case is gen- 
erally relieved at once and soon cured. 

The TREATMENT of the time of attack must look at once to 
quieting the nerve irritation that is causing the trouble. (1) 
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 palpitation. Considerable pressure may be 
applied to the accelerator area of the spine, the left arm mean- 
while being strongly held above the head (see Pericarditis). 
Steady pressure at each point along these nerves for several min- 
utes 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 hand he relaxes the intercostal tissues all about 
the precordial region. This is to release contractions in the in- 
tercostal muscles set up by the irritation carried 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 inhibition of the heart-action (IV, Chap. IV). "Pressure 
upon the vagus in the neck, or pressure upon special points in 
the abdominal parieties, (the ovarian region in particular) some- 
times arrests the attack promptly" (Anders). 

(4) Stimulation of the abdominal sympathetics, by a quick 
treatment, will aid in inhibiting the heart beat. A better method, 
however, is to dilate the vast abdominal vascular system by the 
deep, inhibitive abdominal treatment. This drains the blood 



\ 

PHACTICE OF OSTEOPATHY. 249 

into the abdomen, decreases general arterial tension, and quiets 
the heart. It is the exact process by which the depressor nerve 
quiets the heart, and may possibly cause it to function. Strong 
inhibition of the spinal splanchnics aids- this process. 

(5) All the ribs should be carefully elevated to allow free 
play to respiration and heart. The dyspnea is a reflex from the 
disturbed heart. It is relieved by this treatment, and by the re- 
lieving 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 neck and chest 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 remedy. 
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 at- 
tacks a course of treatment may be carried out along the lines 
laid down. Special attention would naturally be given the le- 
gion. t Heart action and circulation would be built up, etc. At- 
tention should be given to the diet, as certain articles of diet may 
cause palpitation. An overloaded stomach should be relieved by 
vomiting. 

TACHYCARDIA, BRACHYCARDIA AND ARRHYTHMIA. 

The first is a rapid beating of the heart in paroxysms of 
variable duration, unaccompanied by any marked subjective 
sensations. The second is an abnormal slowness of the heart, 
temporary or permanent. The third is irregular beating of the 
heart, the irregularity being manifest in volume, force or time, 
.alone, or in various combinations, presenting various peculiarities. 

The lesion and its mode of causing disease, described for 
palpitation, are essentially the same for these three manifesta- 
tions 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 



250 PRACTICE OF OSTEOPATHY. 

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 
relations, but differ in degree, in concentration upon a particular 
region, e. g., chiefly upon the accelerators in the upper region to 
produce tachycardia, and therefore in the particular manifesta- 
tion or results of their presence. 

It is natural that those lesions producing palpitation should 
be greater in degree and more continuous and severe in action, 
thus producing tachycardia; that upper dorsal lesion should so 
excessively affect the accelerators as to permanently inhibit 
their activity to a degree great enough to cause brachycardia, 
or that the periodic or irregular manifestations of the effects 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. 

One must bear ip. mind the fact that these conditions are 
frequently simply symptomatic, as, for example, the arrhythmia 
resulting fiom reflexes from kidneys, lungs, liver or stomach, or 
from the toxic effects of tea, coffee, tobacco, alcohol, or drugs. 
But they may also be due to cardiac changes in the ganglia, or 
in the walls, such as simple dilatation, fatty degeneration, or 
sclerosis. 

The fact that tachycardia is looked upon as being a mani- 
festation of paralysis of the pneumogastric or stimulation of the 
sympathetic is significant from the osteopathic viewpoint. 

The prognosis for these conditions is ordinarily good. The 
results attained are very satisfactory and cases are often readily 
cured. The fact that they are frequently symptomatic of other 
disease, or secondary thereto, makes the prognosis and treat- 
ment depend upon the primary condition. When, as is often the 
case, they are found to depend upon specific removable lesion 
the progress is good. It is not good when organic heart disease 
is present. 

The treatment for these conditions must be primarily the 



PRACTICE OF OSTEOPATHY. 251 

removal of lesion or irritating cause, or the treatment of the pri- 
mary disease to which either may be secondary or symptomatic. 
All causes of reflex irritation, and the abuse of tea, coffee, and 
alcohol, etc., must be looked to. That for tachycardia and 
arrhythmia 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 diseases, e. g., typhoid fever, the excertory 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 brachy- 
cardia the heart and lungs must be kept stimulated against the 
occurrence of syncope or physical prostration. Treatment in 
the intervals may be directed to upbuliding the general health , 
mechanical correction of the body, etc. Proper physical train-' 
ing to strengthen the heart muscle is valuable in all cases, and is 
practically all that is necessary in some cases. 

IRRITABLE HEART is another neurosis, and is to be regarded 
in the same light as the above conditions. It will be found to 
depend upon practically the same lesions, and readily yields to 
the treatment. Thorough general treatment for the nervous 
system should be added to that given the heart. The digestive 
disturbances, constipation, etc., yield readily to the treatment 
for those conditions. The cardiac uneasiness is overcome by 
keeping the ribs raised, and by inhibition of the heart's action. 
The patient should avoid stimulants and overexertion. 

ANGINA PECTORIS. 

DEFINITION: Paroxysms of violent pain in the pecordial 
region, extending to the neck, back and arms, and accompanied 
by a sense of impending death. It is said to be largely symp- 
tomatic. 

The lesions presented in the above cases were mainly 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 spreading 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. 



252 PRACTICE OF OSTEOPATHY. 

The nature of the pain of angina pectoris is not well understood. 
Upper dorsal lesion may irritate the sensory nerves of the heart. 
(1st, 2nd, and 3rd 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 through their sympathetic connections 
may cause it. Some writers advance the theory that an aortitis 
is present and causes it. A deranged nerve-mechanism as the 
result of spinal, rib and other lesion, seems sufficient,from an osteo- 
pathic point of view, to cause this disturbance. The fact that 
it is usually associated with some form of organic heart lesion, 
arterio-sclerosis, etc., is not contrary to the idea that bony le- 
sion is at bottom the cause of the whole bad condition. 

The prognosis must be guarded because of the frequent 
presence of organic heart disease in 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, especially in case of lesion here, by adopting 
the motion described for inhibition of the accelerators, bringing 
pressure over the upper three spinal nerves (cardiac sensory) at 
the same time, and also relaxing the tissues of the pecordial region, 
with additional inhibition of the pneumogastric nerves. 

Spinal inhibition may be carried down along the spine as 
low as the 6th dorsal nerve. 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 given to strengthen 
the patient's general health, to correct heart action, and to re- 
move 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. Rest of mind 
and of body, and a good diet, are helpful. In case of emergency 
use of the ice-bag, or of hot applications over the heart may be 
useful. 

ENDOCARDITIS AND MYOCARDITIS. 
These are inflammations of the endocardium and of the 



PRACTICE OF OSTEOPATHY. 253 

heart muscle, attended by various pathological and degenera- 
tive changes in the part attacked. The extent to which the path- 
ological changes go in most of these cases renders a cure hope- 
less. All forms of these diseases are apt to produce serious val- 
vular lesions. Aside from simple acute endocarditis, death is 
imminent in most of these cases, yet much may be done in in- 
dividual cases to alleviate conditions and to prolong life. 

The LESIONS AND ANATOMICAL RELATIONS as pointed out 
at the opening of the chapter apply here. It is seldom that 
myocarditis or any 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 articular rheumatism is made accountable 
for 40 per cent of simple acute endocarditis. Rheumatism, ma- 
laria, scarlet fever, pulmonary tuberculosis, syphilis, gout, poison- 
ing, etc., are looked upon as the primary diseases in which poison- 
ous products are generated and cause endocarditis or myocardi- 
tis as a secondary condition. Various other causes are assigned. 

While poison in the system is admitted by the Osteopath 
to be sufficient cause of disease, it seems likely that specific le- 
sion to the cardiac apparatus has much to do in weakening the 
heart and laying it liable to the invasion of these diseases. Cir- 
culation to the substance of the heart is under control of the 
coronary plexus, 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 may be 
produced by lesion to the pneumogastrics, said to contain vaso- 
motor fibres 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 irritation of the left ribs upon 
the heart, when they are displaced, may directly cause pericarditis 
and myocarditis. As medical etiology lays most of these cases 
to the action of bacteria, it is reasonable to conclude that direct 
lesion to the heart deteriorates the vitality of its tissues and 
allows them to gain a foothold. 



254 PRACTICE OF OSTEOPATHY. 

This conclusion is strengthened by the fact that endocarditis 
sometimes follows chronic wasting diseases, such as diabetes and 
gleet. The fact that chronic endocarditis may be due to mechan- 
ical influences, may be caused by heavy muscular effort, strain- 
ing, 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 directly cause these conditions. 

The PROGNOSIS for simple acute endocarditis is good. It de- 
pends some upon the primary 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 speaking, much may be done in all 
of these cases to limit the disease and to prolong life. Chronic 
endocarditis has been cured. 

The TREATMENT is practically that described for pericard- 
itis, q. v. Knowledge of the nerve and blood-supply and of 
lesions gives one the key 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. Inhibition 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 generating toxins in the system the bowels, kidneys and 
liver are stimulated to excrete the poisons. In the chronic forms 
the heart and its connected nerves may be carefully stimulated 
to increase its tone and nutrition. The vegetation in acute 
endocarditis may be absorbed. 

Prophylactic treatment in rheumatism and in those dis- 
eases leading to these conditions consists in keeping the heart 
well stimulated, and in maintaining free action of kidneys and 
bowels to excrete the poison. 

In acute endocarditis the precordial pain and dyspnea, if 
present, are relieved by carefully elevating the ribs in the 
region of the heart by elevating the arm and holding it up behind 
the head. While the arm is held in this position the intercostal 



PRACTICE OF OSTEOPATHY. 255 

tissues about this region should be manipulated and relaxed' 
The upper dorsal spinal region should be inhibited, from the 1st to 
the 6th dorsal. This treatment would likewise quiet palpitation. 

The heart should be carefully sustained and kept gently 
stimulated, especially if it show indications of failing. 

In ulcerative endocarditis the whole progress of the case 
must be carefully watched. If it accompany a septic disease, 
especial attention must be given that condition, and the chief 
indication is to keep the poison freely excreted from the sys- 
tem. Local symptoms of this form of endocarditis, if present, 
are similar to those for which the treatment has been described 
in the acute form. Gastro-intestinal disturbance, vomiting 
and diarrhoea, calls for such treatment as has been described 
for these conditions. The local circulation to eyes and kidneys 
should be kept active to prevent retinal and renal hemorrhages, 
evident as hematuria and dimness of vision. Kidneys must 
be stimulated to increase the urine, which may become scanty 
and contain albumen. A general spinal and cervical treatment 
is necessary to quiet the general nervous system and to relieve 
headache, delerium, somnolence or coma, which may appear. 

Chronic endocarditis necessitates such treatment as is de- 
scribed for valvular lesions, q. v. 

Myocarditis should be treated as are endocarditis and per- 
icarditis, conditions which it frequently accompanies as a com- 
plication. It is necessary to keep the heart quiet. Enforce ab- 
solute rest, and attend to the general nutrition. 

FATTY DEGENERATION OF THE HEART. 



DEFINITION: A condition in which the fitoes of the cardiac 
muscle are converted into fat. 

LESIONS such as have been pointed out affecting the heart 
may be present. The fact that this condition is often second- 
ary to cardiac hypertrophy, q. v., would lead one to work for 
such lesions as cause it. These lesions act in various ways to 
cause the heart to overwork and hypertrophy, either by over- 
stimulation of the accelerators, obstruction to the arterial cir- 
culation, by causing valvular lesion, etc. After hypertrophy 



256 PRACTICE OF OSTEOPATHY. 

when the centers and parts concerned become exhausted, fatty 
degeneration occurs. 

It is pointed out by Anders that lesions to the coronary arteries 
are the most significant causes of fatty degeneration. Narrow- 
ing of the lumen of those vessels must result in defective nutri- 
tion of the cardiac muscle, and fatty degeneration follows. It 
was pointed out above, in considering the general anatomical 
relations of lesion to heart disease, that these coronary arteries 
are regulated in their calibre and activities by the coronary plex- 
uses, right and left, which are derived from the cardiac plexus. 
Hence it is seen that lesions to the vagus and to the sympathetic 
nerves of the heart, acting through the cardiac and coronary 
plexus, could so influence these vessels as to narrow their lumen, 
and cause mal-nutrition of the heart leading to degeneration. 

Where the condition is due to a cachetic condition of the 
system, as in phthysical and anemic conditions, and when it is 
secondary to some severe acute disease, lesion must be expected 
according to the primary disease. 

The PROGNOSIS must be guarded. Sudden death may en- 
sue. Yet, on the other hand, much may be done to strengthen 
the heart and build up its substance. 

The TREATMENT must be according to the requirements of 
the individual case. In each case the special cause of the condi- 
dition should be found out and treated. The lesion must be cor- 
rected. Special attention should be given the dilatation. It may 
be treated as described for that condition. The heart should be 
continuously but judiciously stimulated, because of the weak- 
ness of the heart. This should be by stimulation to the accelera- 
tors in the uppe* dorsal region, and to the sympathetics in the 
neck. This increases the strength of the beat and the tone of the 
heart muscle. By the same process, and by removal of lesion, 
the functions of the coronary plexuses are corrected, free circu- 
lation to the heart muscle is brought about, and it is better nour- 
ished. 

The palpitation, dyspnea, small and irregular pulse, and 
cool extremities are due to the cardiac dilatation, and are bene- 
fited by treatment of that condition. Raising the ribs and stim- 
ulating the heart will be helpful for these symptoms. 



PRACTICE OP OSTEOPATHY. 257 

Pseudo-apoplectic attacks may occur, and should be promptly 
met. The patient should be placed upon his back with the head 
a little raised. The heart should be well stimulated, and this 
treatment should be extended the whole length of the spine. 
The cervical tissues should be relaxed, and strong inhibition should 
be made in the sub-occipital fossae for several minutes. Next 
the splanchnics should be inhibited as well as the solar plexus, 
and the treatment should be given, as described before, to call 
the blood to the abdominal vessels. By this procedure systemic 
circulation is rendered active, the blood is called from the head, 
and is distributed throughout the vascular system. 

For cardiac asthma treat as in ordinary asthma. The ribs 
should be occasionally elevated, and the lungs should be kept 
well stimulated, to overcome breathlessness and the Cheyne- 
Stokes breathing which tends to appear. Agina pectoris may be 
treated as directed for that condition. 

In anemic and cachetic conditions responsible for the fatty 
degeneration, the oxygen-carrying power of the blood should be 
increased by a thorough course of general treatment devoted to 
the upbuilding of the general health. The spleen, bowels, kid- 
neys, liver and gastro-intestinal tract should receive special 
stimulating treatment. 

The patient should be kept upon a carefully regulated diet. 
Light exercise invigorates the heart. 

FATTY OVERGROWTH, or fatty infiltration, is a condition in 
which an abnormal amount of fat is deposited in the auriculo- 
ventricular groove, beneath the visceral layer of the pericardium 
and even between the muscle fibers of the heart. The disease is 
apt to occur in the obese, and in those who over-eat, or who 
lead sedentary lives. 

Such LESIONS as before mentioned may be present, inter- 
fering with the nerve mechanism of the heart and disposing it 
to this condition, or causing the primary disease to which this is 
secondary. 

The PROGNOIS is good for cure. 

The TREATMENT consists in removal of lesion and in due at- 
tention to the primary disease. The heart should be kept well 
stimulated as it may suffer weakness by reason of atrophy of its 



258 PRACTICE OF OSTEOPATHY. 

fibers and the liver. It tends to be dilated, and may then be 
treated as described for dilatation of the heart. This treatment 
overcomes the resultant vertigo, syncope, dyspnea, cyanosis, 
palpitation, each gf which may be especially treated as before 
indicated, as may also the asthma and bronchitis which are apt 
to occur. In obese persons it is well to keep the pancreas and the 
liver stimulated. (See Obesity). This will aid in preventing the 
deposition of fat. Also one should administer thorough general 
treatment, with the same object in view. Careful and contin- 
uous stimulation of the heart ni creases the tone of its muscle and 
the strength of its beat. Exercise helps this. 

In these conditions much may be accomplished by diet and 
exercise. A special method is followed. It consists in, (1) lim- 
iting the supply of fluids allowed the patient, (2) enforcing a 
proteid diet, (3) taking as much exercise of a special kind as will 
l>e tolerated by the condition of the heart. The fluids are limited 
to 36 oz. in twenty-four hours. The diet consists of coffee, tea, 
or water; a little bread; game, veal, or beef; salad, vegetables, 
fruit and eggs. The exercise is walking up graduated inclines, to 
invigorate the heart muscle. This is well accomplished by walk- 
ing up hills, varying, from mild inclines, gradually, to steeper ones. 

VALVULAR DISEASES. 

The prognosis in cases of this kind is not generally favor- 
able. As a rule, valvular disease is incurable. Yet some cases 
may be cured, and a fair number have been cured by osteopathic 
treatment. In cases not curable, much may be done to better 
the patient's condition, and prolong his life, Cases caused by 
simple dilatation or diminished contractile power may be cured. 
Also when occurring 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 endo- 
carditis, to which disease these may be secondary. In tricuspid 
insufficiency due to obstructed pulmonary circuit, lesion to the 
lung, as ascribed in the chapter on lung diseases, may cause the 
valvular trouble. 

In aortic stenosis from increased tension in the aorta, the 



PRACTICE OF OSTEOPATHY. 259. 

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 An- 
atomical Relations at the opening of this chapter. Aortic valvu- 
lar lesions following heavy muscular strains, etc., may be due to 
the presence of some one of the various lesions described as affect- 
ing 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 general anatomi- 
cal relations) which sometimes causes valvular disease. 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 any lesion, or of any obstruction to the blood-current, 
especially in tricuspid insufficiency caused by obstructed pul- 
monary circulation, and in aortic stenosis due to increased tension 
in the aorta. Diaphragmatic lesion or important arterial ob- 
struction may be present. In the obstructed pulmonary circu- 
lation the lungs should be kept stimulated and any lesion to the 
lung should be removed. In all cases the whole general circula- 
tion must be kept free and well stimulated, in order to aid the 
heart to carry out its work, thus relieving it of much labor. In 
cases in athletes, or due to heavy muscular strain, one should 
suspect the presence of definite spinal or rib lesion due to such 
activities. The primary disease which may be causing the trouble 
calls for treatment according to its kind. In diminished con- 
tractile power or dilatation of the left ventricle causing mitral 
insufficiency, the accelerators, should be stimulated, as this in- 
creases cardiac tonus and strength of beat, and contracts the 
heart. In such cases lesion should be suspected to the vagus, 
as lesion to this 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 excitement or exertion. He should be much out of doors, 



260 PRACTICE OF OSTEOPATHY. 

and live upon a light nutritious diet. He should avoid straining 
at stool, 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 maintain the patient in a state of comfortable health, 
preventing dilatation. Cases may sometimes be cured by os- 
teopathic therapeutics. The prognosis depends upon that for 
the condition producing the hypertrophy. In such forms of 
valvular diseases as are curable it may be cured. In cases due 
to exopthalmic goitre it may 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 ob- 
structed pulmonary circulation, obstructed aorta, intercostals, 
subclavians, abdominals, etc., are important. As the heart 
hypertrophies in valvular disease frequently, lesions would have 
to be sought according to primary conditions. 

Lesion to the sympathetics, as in exophthalmic goitre, 
causing hypertrophy are important. Lesion to vagi and ac- 
celerators, resulting in over-activity of the heart, may cause hyper- 
trophy. When such simple causes as the use of alcohol, coffee, 
tobacco, etc., and lead poisoning, etc., are alleged, one is bound to 
suspect one of the ordinary lesions present as the real cause allow- 
ing the heart to be affected by such agents. 

The TREATMENT looks to the lesion, obstruction to the blood- 
flow, etc. It is directed to the primary disease when the hyper- 
trophy, as is the rule, is a secondary condition. The circula- 
tion through the lungs should be kept free. The patient should 
remain quiet. Attention should be given the sympathetics 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 
avoid overeating, alcohol, coffee, etc. 



PRACTICE OF OSTEOPATHY. 261 

DILATATION OF THE HEART. 

DEFINITION: There may be simple dilatation of a cavity, 
causing increase in its size and thinning of its walls. The dilata- 
tion may be accompanied with hypertrophy, in which there is 
increase in both 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. Le- 
sions to the cardiac mechanism weaken the heart and thus are 
especially apt to predispose to dilatation. Under such conditions 
over-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 an influence upon their dilatation, lack of tone, and a softened 
condition of them, lesion to it would have an important part in 
the production of dilatation. Obstructed circulation, and any 
cause producing increased intra-cardiac pressure may result in 
dilatation. This is seen in mitral diseases. Osteopathic lesion 
causing obstruction to the intercostals, abdominals, pulmonary 
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 condition often, as in valvular diseases where the prog- 
nosis is bad. When due to specific removable lesion the prog- 
nosis may become favorable. 

The TREATMENT consists in righting of mechanical relations 
and removal of lesion. Ostruction to the circulation must be 
relieved, and heart and lungs must be kept well stimulated to 
empty the chambers of the heart of the clotted blood that is 
retained in them. Stimulation of the accelerators aids the pro- 
cess by steadying and strengthening the heart beat, contracting 
it and adding tone. 

When secondary to acute infectious disease, valvular dis- 
ease, etc., the primary condition must be treated. The dropsy 
and dyspepsia present depend upon the bad circulation and are 
treated in the usual ways. Stimulation of the lungs and raising 
the ribs relieve the dyspnea. Stimulation to the kidneys in- 



262 PRACTICE OF OSTEOPATHY. 

creases 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. General directions for 
the care of the patient are as before given. 

CARDIAC DROPSY should be treated upon the same plan as 
renal dropsy, q. v. The kidneys should be kept thoroughly stim- 
ulated to quicken their excretory action and to thus relieve vascu- 
lar tension. The heart and general circulation should be kept 
gently stimulated in order to lessen venous stasis, to help out 
cardiac compensation, and to force the lymph into the circulation. 

ARTERIO-SCLEROSIS calls chiefly for a general palliative 
course of treatment, equalizing and aiding general circulation, 
and attending to the special disease or cause that is responsible 
for the condition. As the lack of elasticity in the blood vessels 
interferes with the propulsion of blood through them, the heart 
should be kept well stimulated, and general circulation should 
be aided by a general spinal and muscu-lar treatment. To this 
may be added the abdominal treatment, and the treatment which 
regularly elevates and depresses the ribs, thus aspirating the ven- 
ous blood and toning general circulation. This treatment also 
meets the important indication of increasing the blood-supply 
to the viscera, as it has been lessened. Keeping the heart well 
stimulated maintains the balance of the cardio-vascular forces, 
and this, with the aid given the general circulation by the above 
treatment, renders less necessary the hypertrophy of the left 
ventricle, that is, limits the progress of such hypertrophy. 

By this plan of procedure, myocardial degenerations and 
dilatation of the left ventricle, common in the latter stages, as 
well as the dilatation of the aorta often present, are rendered less 
probable. 

Palpitation, dyspnea, angina, and precordial constriction 
are treated as before directed. 

The cerebral type calls for cervical treatment to lemove 
any obstruction to the circulation, and to aid the blood-flow to 
the brain. Raising the clavicles, opening the mouth against 
resistance, working along the course of the carotids, etc., may all 
be useful. The special effects in this type, such as tinnitus, 



PRACTICE OF OSTEOPATHY. 263 

syncope, headache, vertigo and the like, are remedied by cor- 
rected circulation. They may be treated in the usual ways. 

Likewise lungs and kidneys should be vigorously treated to 
prevent their involvement, and the circulation to the extremities 
should be kept active to prevent starvation of the tissues and 
resulting gangrene. 

Much may be done to retard the progress of the disease by 
correcting any habit that favors the disease, such as the use of 
alcohol, excessive eating and drinking, muscular over-strain, etc. 
The diet should be light and non-stimulating. 

Rheumatism, gout, syphilis, Bright 's disease, mitral dis- 
ease, emphysema, and other diseases which predispose to arterio- 
sclerosis, should be carefully looked after. 

ANEURYSMS. 

The treatment of arieurysms must be largely palliative. 
Under favorable conditions the danger to life from the aneu- 
rysm may be greatly lessened, and the contents of the sac may be 
clotted, practically curing the case. 

The treatment must be with great care. Any considerable 
handling of the patient, in the way of strong treatments, must 
be avoided on account of the danger of rupture of the aneurysm. 

It is probable that various lesions, affecting vaso-motor 
and trophic nerves, weaken the vessels, and lay them liable to 
aneurysm by action of various causes, such as sudden great strain 
from physical exertion, arterio-sclerosis, etc. It is likely that 
spinal and rib lesions, acting upon the innervation of the thoracic 
aorta, and often combined with lesion to the diaphrgam which 
allows it to obstruct the aorta, may be the causesof weakness and 
strain upon this vessel that result in aneurysm. 

With the Osteopath, as with other physicians, the object 
of treatment must be to decrease arterial tension, produce clotting 
of the blood in the sac, and favor contraction of the walls of the 
sac. 

It is necessary for the patient to remain entirely quiet upon 
his back, thus diminishing the number of heart beats, as well as 
their strength, and at the same time the pressure of the blood in 
the sac. A most valuable aid in this process is a large amount of 



264 PRACTICE OF OSTEOPATHY. 

inhibiting treatment applied to the accelerator innervation of the 
heart. (2nd to 5th dorsal and lower cervical). As the patient 
lies upon his back, the operating hand may be slipped beneath 
the shoulder and inhibition be applied. The free hand may press 
the shoulder down upon the inhibiting fingers. If the left arm 
be raised above the head to aid in this treatment, it should be 
done slowly and cautiously. This treatment diminishes force 
and frequency of the heart beat. 

It is also of the greatest importance to decrease arterial 
tension by further inhibitive treatment applied to the superior 
cervical region to affect the general vaso-motor center in the 
medulla. To this should be added the treatment for dilating 
the abdominal vessels and calling the blood to them.by inhibition 
of the splanchnic area of the spine and by the inhibitive, relaxing 
treatment to solar plexus and abdomen, as before described. 
This treatment locally upon the abdomen cannot be applied in 
.case of abdominal aneurysm, but the remainder of the treatment 
may be safely used. 

Any lesion or source of obstruction to the vessels, partic- 
ularly to the aorta*, should be removed. The diaphragm, if 
prolapsed, should be raised, and it should be sustained by a belt 
about the lower costal region. The palpitation of the heart may 
be quieted by the inhibition applied to the accelerators; the dysp- 
nea by very cautious and gentle elevation of the ribs; the pain by 
inhibition of the local nerve-supply of the part affected; other 
symptoms, according to their kind, may be met by the usual 
osteopathic procedures. While most of these symptoms are due 
to pressure from the aneurysm, the treatment is employed to 
relieve and to make the patient comfortable. 

The methods employed to reduce blood-pressure, etc., also 
favor contraction of the sac. 

Tufnell's treatment by absolute rest in the recumbent po- 
sition, and a restricted, dry diet is highly recommended. The 
dietary consists of 2 oz. of bread and butter and 2 oz. of milk 
for breakfast; 2 or 3 oz. of meat and 3 or 4 oz. of milk or claret 
for dinner; 2 oz. of bread and 2 oz. of milk for supper. This 
regimen must be persisted in for several months, in order to bring 
about sufficient diminution of the blood-volume. 



PRACTICE, OF OSTEOPATHY. 265 

/ ' 

Surgical methods are often necessary for the reduction of 
aneurysm. 

The patient should avoid stimulating diet and drink, and 
should avoid excitement. 

VARICOSE VEINS, (ANEURYSM OF VEINS). 

DEFINITION: This is a condition in which the veins be- 
come enlarged, elongated, tortuous, and distended with blood 
It may occur in various parts of the body, and is, generally speak- 
ing, due to obstruction to the blood-flow from the veins, by le- 
sions of various kinds. The term "varicose veins" is applied 
especially to this condition in the lower extremities, in which the 
internal saphenous suffers most often. 

The LESIONS are bony, muscular, tendinous, etc., or pressure 
from adjacent organs or growths, obstructing the venous flow. 
The course of the vessel, its surrounding anatomical parts, and 
sources of its innervation, must be carefully examined for sources 
of obstruction, the simple removal of which constitutes the effic- 
ient treatment in these cases. 

In the case of the internal saphenous vein there are numer- 
ous lesions which may act to obstruct the flow of blood. One 
of the most common of these is tension or thickening of the tis- 
sues about the saphenous opening, impeding the out-flow from 
the vein. Sometimes relaxed abdominal walls, or ptosis of the 
abdominal viscera, may cause pressure upon the femoral vein 
where is passes beneath Poupart's ligament. A displaced or 
pregnant uterus, or a loaded caecum or sigmoid, may bring pres- 
sure upon the iliac veins, and cause varicoses in the ex- 
tremities. It is also possible for a prolapsed diaphragm, com- 
pressing the azygos veins and obstructing the ascending vena 
cava to produce a like result. 

The vaso-motor innervation to the lower limbs is from the 
lower dorsal, lumbar, and sacral sympathetic ganglia, and lesion 
to lower dorsal vertebrae, lower ribs, lumbar vertebrae, innomi- 
nate bones, sacrum, or pelvis may act through the connected 
nerves to weaken the vaso-motor state of the arteries of the 
lower limbs, cause weakness of the circulation, and allow such 
causes as excessive standing to cause varicoses. Dislocations of 



266 PRACTICE OF OSTEOPATHY. 

the hip, partial or total, tense the tissues and muscles, obstruct- 
ing venous return, and causing this condition. 

When the condition is due to pressure from tumors in the 
abdomen or pelvis, heart or lung disease, ascites, etc., the lesion 
must be sought according to such primary condition. 

The PROGNOSIS is good. Very severe and long standing 
cases can be cured. Osteopathic treatment has cured very many 
cases in which the enlarged veins had reached a large size. Ulcers 
and eczema resulting from varicose veins heal up after the cir- 
culation is restored. 

The TREATMENT is directed at once to the removal of the 
obstruction. In case of obstruction at the saphenous opening 
one may employ such a treatment as described in Chap. X. 
The intestines should be raised from the femoral vein (III, IV, 
Chap. VIII); the prolapsed uterus should be replaced ( Chap. 
IX, E) ; the abdominal walls should be strengthened by local 
treatment and by treatment to the spine; and in like manner 
tumors, a constipate^ bowel, ascites, diseases of heart or lungs, 
etc., should be treated as necessary according to directions given 
for those various conditions. Tight garters should not be worn. 
Lesion to lower ribs, spine, pelvis, etc., should be corrected. 
Special treatment is given in these cases to stimulate the vaso- 
motor innervation of the limbs to aid in keeping the circulation 
active. Likewise, a muscular treatment of the limbs, with 
flexion, circumduction, etc., and thorough abdominal treatment, 
reaching the iliac veins, the ascending cava. the portal circula- 
tion, etc., would be found helpful. The liver should be kept 
free, and the bowels as well. 

Care must be taken in the treatment that the thinned walls 
of the veins do not rupture and cause serious hemorrhage. In 
case of varicose ulcers, and of eczema, the part should be kept 
clean, and a healing dressing may be applied, but the parts must 
not be kept irritated by too frequent washing. Ulcers and 
eczema heal when the circulation is made free. 

Thrombi may form in the varicosed veins, and care must 
be taken to absorb them, not to break them down, on account of 
the danger of embolism. 

Bandages, silk stockings, etc.. are gradually removed, and 



PRACTICE OF OSTEOPATHY, 267 

the vessels and circulation are strengthened to take care of them- 
selves. Elevation of the limb and recumbency help. 



DISEASES OF THE NERVOUS SYSTEM. 

CHOREA. (St. Vitus Dance). 

DEFINITION: A disease of the nervous system character- 
ized by involuntary 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: (1) A case in a young girl, of three or four months 
standing; very severe; had lost all control of hands and feet r 
and of speech; could take only liquid food. It was thought she 
could not live. Lesions were found at the atlas and 4th dorsal 
vertebrae. The case was cured. 

(2) In a boy of nine, chorea followed vaccination. Le- 
sion was found at the atlas and at the 2nd to 4th dorsal verte- 
brae. Case cured in five weeks. 

(3) A case in a child of eleven, of nine months standing. 
Very severe; 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 3rd 
and 4th cervical vertebra?; the 2nd to 6th dorsal vertebrae were 
irregular and lateral; 5th lumbar posterior; cured in four rnonths. 

(5) Case of two years standing in a boy of twelve; right 
hand useless and carried in a sling; lesion at 1st and 3rd dorsal. 
Under treatment he became 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 jerking of the muscles began to grow less 
at once. The case was cured and the child, previously under- 
sized, 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 cerivcal and lower 



268 PRACTICE OF OSTEOPATHY. 

dorsal regions, and all the spinal muscles were contractured. 
The case, of three months standing, was cured in one month. 

(8) A case of acute chorea, in a girl of 7, a pupil in the pub- 
lic school. Lesions were: 2nd dorsal lateral, 6th dorsal pos- 
terior, slight curvature to the left in the dorsal region, muscles 
in cervical region contractured. Inhibition at the sub-occipital 
region controlled the twitching of the muscles at once. The 
case was cured. 

(9) A case in a girl of 10, which had been gradually coming 
on for six months. Atlas and axis were luxated to the right; 
1st and 8th dorsal vertebra deviaed laterally; 5th and 6th ribs 
drawn together. Overstudy at school was the direct exciting 
cause. She was cured in 2^ months. 

(10) Huntingdon's Chorea. A case of hereditary chorea 
is reported, which was without a doubt a true case of Hunting- 
don's chorea. The father and mother had both been sufferers 
from chorea; the very marked affection of many muscle groups 
was present; the child was very dull, and had been regarded as 
having lost her mind. The condition was confirmed, chronic, 
and hereditary. The I 2nd and 3rd dorsal vertebrae were anterior. 
The case was cured. 

LESIONS AND ANATOMICAL RELATIONS: The lesions in these 
cases are found in the majority in the upper dorsal and cervical 
regions. Eight of the above 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. 

Six of the above showed cervical lesion, five of the six being 
atlas lesions. The fact that atlas lesions alone may cause the 
disease is illustrated by case (6) . The fact that the upper dorsal 
lesion alone may cause it is illustrated by case (5). But fre- 
quently, as in four of those reported, combined lesion of the 
cervical and upper dorsal regions occur. The upper dorsal 
lesion is perhaps the most important one. Six of the above 
showed lesion somewhere in the upper six dorsal vertebras. The 
spinal area from the atlas to the 6th dorsal may be regarded as 
the important locality for lesions producing chorea. They may 
occur lower or affect the ribs as well as vertebrae. 



PRACTICE OF OSTEOPATHY. 269 

These lesions high" up in the spine may 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 the pathology of this condition is obscure 
no constant lesions being found. Probably, as McConnell ob- 
serves, this is due to the fact that spinal lesion may often involve 
simply nerve-fibers. Some writers hold the disease to be a func- 
tional brain disturbance affecting the centers controlling the 
motor apparatus. From this point of view cervical and atlas 
lesion have important bearing, as they may influence brain cen- 
ters by interference with blood-supply to the brain through direct 
impingement upon the vertebral arteries and by disturbance of 
the cervical sympathetics. Upper dorsal lesions aid this effect 
by sympathetic disturbance. From this viewpoint either atlas, 
other cervical, or upper dorsal lesion alone could cause the dis- 
ease. 

It is worthy of note that the upper dorsal lesion (1st to 6th) 
falls upon a portion of the cord richer, perhaps, than any other 
in sympathetic centers. The cilio-spinal center, vaso-motors 
to face and mouth, pupillo-dilator fibers, motor fibers to involun- 
tary muscles of the orbit, vaso-motors to the lungs, accelerators 
to the heart, etc., all occur within this spinal area. This dis- 
turbance to the sympathetic may have much to do in unbalanc- 
ing the nervous system in such cases. This lesion could a]so 
effect spinal fibers by impingement, or the nutrition of the cord 
through sympathetic disturbance of its blood-supply. 

On the whole the likely pathology 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 parasites, 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 



270 PRACTICE OF OSTEOPATHY. 

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, 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 sys- 
tem. 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 stimulation of the cervical nerves and 
centers, etc. The spinal treatment is upon the same plan. It 
should be carried down along the spine. These treatments 
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. Inhibition of the 
superior cervical ganglion may also aid in stopping the twitch- 
ing. An important treatment is the removal of contracture of 
the muscles all along the spine, common in these cases. At- 
tention 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 meta- 
bolism in the body looked to, to increase too light specific gravity 
of the urine. The bowels must be kept regular. 

A thorough general treatment should be given to the mus- 
cular 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 
accomplished by pressure between the 3rd and 4th cervical ver- 
tebrae. 

In the hygienic treatment of the case all causes of nerve- 
strain, over-work mentally, excessive physical exertion, etc., 
must be removed. Muscular exertion may lead to heart involve- 
ment, especially as cervical and upper dorsal lesion favor such 



PRACTICE OF OSTEOPATHY. 271 

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 water is useful. 

The various CHOREIFORM AFFECTIONS, such as the spasmodic 
tics, habit chorea, laryngeal tic, choreic wry-neck, facial tic, 
jumping disease, etc., also rhythmic or hysteric chorea, fibrillary 
chorea, athetosis, and various other forms, are met in the same 
way. A number of such cases have been cured. 

Huntingdon's chorea, a hereditary disease with progressive 
dementia, is a very grave disease. 

EPILEPSY. 

DEFINITION: A disease in which there is loss of conscious- 
ness, 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 connected nerves. 

CASES: (1) A case showing lesions at 7th and llth dorsal 
vertebrae. Under the treatment the attacks were much decreased 
in frequency 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 occurring 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 occurred after the first treatment, and the case was cured 
in four months. No recurrence of attacks nineteen months 
later. 

(4) Daily attacks in a boy of eighteen, apparently due to a 
nervous stomach disease. The latter was cured in three months, 
and no further attack had occurred six months afterward. 

(5) A case of fourteen years duration in a lady of eighty 
was cured in two treatments. No attack occurred after the first 
treatment. The report was made two and a half years after the 
cure, no further attack having occurred. 



272 PRACTICE OF OSTEOPATHY. 

(6) In a boy of twelve, monthly spells of two days dura- 
tion occurred, during which he would have from three to five 
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. 

(7) A case of petit mal in a young man of thirty. Lesions 
at the atlas, which was to the right and turned with the right 
transverse process backward, and at the axis, displaced to the 
left. Case still under treatment. 

(8) A case of petit mal due to lesion of the atlas to the right 
and back, and of the 2nd cervical to the left. 

(9) A case in a woman of 31. The atlas was slipped to the 
left; 4th cervical much to the left, and 3rd to the right; 1st, 2nd, 
6th, 7th and 8th dorsal posterior; marked separation between 
5th lumbar and sacrum; left ribs considerably down. A his- 
tory of severe falls during childhood was noted. The disease was 
over 23 years standing. The lesion at the 3rd cervical seemed the 
greatest source of irritation. When its condition was exaggerated 
it caused an attack. Immediate benefit was given by the treat- 
ment, but the case did not remain under treatment until. cured. 
When first seen the patient was in a series of attacks lasting two 
to three days. The attacks began at once to be less frequent and 
were two months or more apart when treatment ceased. 

(10) A case of six years standing in a woman of 22, the at- 
tacks coming on first after a fall down stairs, in which the side 
was hurt. Lesion was found as downward luxation of the left 
12th rib, and prolapsus or contraction of the diaphragm. The 
treatment was to the removal of lesion and to equalize circula- 
tion. Benefit came by the first treatment, and the case was cured 
in three months. 

(11) A case of nine years standing in a woman of 32. The 
attacks were at first nocturnal, later coming on in the daytime. 
Lesion was a right lateral condition of the atlas, with marked 
contracture of the deep and superficial muscles along the spine. 
The condition was at once benefited, and a cure was gotten in 
three months of treatment. The lesion of atlas was bettered at 
the first treatment, giving relief. During an attack the patient 



PRACTICE OF OSTEOPATHY. 273 

was brought out of it in five minutes by strong pressure over the 
solar plexus. 

(12) A case of epileptiform seizures in a woman of 20, of 
three years standing. The atlas was to the right; the spine was 
posterior from the 12th dorsal to sacrum; the spinal muscles and 
the tissues were contractured. The uterus was anteflexed. 
Under treatment the case was much benefited. The attacks 
were rendered much lighter and much less frequent. 

(13) In a case of epilepsy in a boy, removal of lesion to the 
coccyx cured a case after all other means had failed. 

LESIONS AND ANATOMICAL RELATIONS: It seems that le- 
sion 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. He also 
ascribes epilepsy to lesion causing prolapse of the diaphragm, and 
obstruction to the arterial and venous blood, and of the lymph, 
in the vessels perforating it. In this way the products of digest- 
ion are retained and decompose, the patient suffering from auto- 
intoxication. 

Lesions in the above cases occurred 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, especially 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 vertebra. 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 lesions seem, on the whole, to be the most im- 
portant. Neck and spinal lesion may act by obstructing the 
blood-supply to brain or cord. They may affect the cord di- 
rectly by mechanical irritation, or may affect brain, cord, or 
nervous system generally through the sympathetics. In this 
way they may bring about those morbid conditions of the cord, 
brain and meninges said to cause the disease. While the path- 
ology of epilepsy is unknown, it yet appears that osteopathic 
lesion may account for many of the various conditions assigned 
as causes. Such lesions, disturbing the sympathetic system > 



274 PRACTICE OF OSTEOPATHY. 

may act as does peripheral irritation from dentition, worms, 
cicatrices, adherent prepuce, etc. Various of these lesions may 
directly irritate peripheral nerve structures. As traumatism is 
assigned as a cause, osteopathic lesion, as cause or effect of trau- 
matic 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 nerve-strands leading from the cortex to the 
the perpheral structures; that there is a peculiar condition of the 
motor tract which runs from the motor convolutions to the peripheral 
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 convolu- 
tions; but that some varieties of epilepsy are evidently due to an 
excitation that extends into this motor tract from some part of 
the nervous system beyond it. It would seem clear that osteo- 
pathic 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 ways it may produce excitation in some 
other part of the nervous system from which it extends to the 
motor tract. As nerve irritation by lesion is the important point 
in osteopathic etiology generally, being well supported by num- 
erous 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 le- 
sion has often cured epilepsy. 

The PROGNOSIS is fair in the ordinary case, a fair number 
of the cases coming under osteopathic treatment being cured 
entirely. A large percentage not cured are benefited. 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 attack but little can be done 
for the patient. If the patient can be reached at the aura the 
attack may be prevented by pushing the patient's head strongly 
back against a hand applying deep pressure in the sub-occipital 
fossse. This treatment seems to arouse reflex stimulation or to 



PRACTICE OF OSTEOPATHY. 275 

equalize blood-flow to the brain by effect upon the superior cer- 
vical 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, applying ice to his spine, etc., will sometimes 
prevent the attack. McConnell calls attention to the fact that 
in cases where the exciting factor seems to be in the intestine 
and there is reverse peristalsis of the intestines, causing a re- 
version of the nerve current in the vagi, thorough rapid abdom- 
inal treatment will normalize peristalsis and aid in preventing 
an impending attack. 

Stimulation of the solar plexus may lessen 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 between the teeth to prevent the 
patient biting his tongue. Small objects that may fall into the 
windpipe 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 may be, and all causes of reflex 
irritation mentioned above. It is especially important to re- 
move 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. Treat- 
ment should be given to correct blood-flow to and from the brain, 
including such treatments as opening the mouth, against resist- 
ance, treatments along the course of the carotids, elevation of 
the clavicles, treatment of the cervical sympathetics, etc. At- 
tention should be given to upbuilding the general health, and to 
keeping bowels 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 di- 
gested, consisting of some meat, fruit, vegetables, cereals, etc. 
Cold sponge baths are recommended. 



276 PRACTICE OF OSTEOPATHY. 

MIGRAINE, (Hemicrania, Sick Headache) AND OTHER 
FORMS OF HEADACHE (Cephalagia). 

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 ob- 
scure pathology; there seems to be nothing to connect it with 
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 a very bad condition after 
having suffered far beyond the power of drugs to cure. These 
may almost be considered as suffering from a hitherto undes- 
cribed form of headache, depending upon a specific lesion, often 
the result of accident, and usually immediately relieved and 
cured upon removal of the lesion. The form embraces many 
of the kinds of headache generally described under one or other 
of the usual classifications. 

CASES: (1) Extremely severe frontal headache in a man 
of thirty-two, since boyhood. He had taken every 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 llth dorsal vertebra was luxated to the left, the 
2nd and 5th lumbar vertebrae were prominent; the sacrum was 
tilted forward and the left innominate was slipped, lengthening 
the limb. The lesions were corrected and the case cured. 

(2) Migraine in a man of thirty, since his sixteenth year. 
when he fell from a wagon. Lesion existed at the 3rd cervical 
vertebra and at the atlas. The case was relieved at once and 
cured. 

(3) 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. 

(4) In a chronic case of occipital headache persisting for 
years, no ordinary remedy would affect the condition. The 



PRACTICE OF OSTEOPATHY. 277 

atlas was found slipped and the muscles about it very much 
contracted and tender. Relief was given at one treatment, and 
the case was cured. 

(5) A man of forty-five, troubled for many years by occipital 
headache, mostly upon the left side. Lesion was found at the 
atlas, impinging upon a cervical nerve. Cure was accomplished 
in two months. 

(6) 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 shoulders 
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 eyes were much improved. 
In two months the glasses were laid aside and the headache was 
cured. 

(7) Headache, with blind spells, in a woman of forty-one; 
the 1st and 2nd cervical vertebra? were approximated and sore; 
the muscles of the upper cervical region very tense; headache 
constant; 1st to 8th dorsal vertebra were flattened anteriorly; 
llth dorsal to 3rd lumbar posterior. The patient had suffered 
a sunstroke, and had had two or three attacks monthly since. 

(8) Congestive headache in a man of thirty-seven, of twelve 
years standing. Violent attacks occurred daily, and every known 
remedy had been used in vain. The sole lesion was a depressed 
clavicle interfering with the venous flow from the head. Two 
treatments restored the bone to place and cured the case. 

(9) Chronic headache of four years standing, caused by a 
fall upon the back of the head, which rendered the neck partly 
stiff. There was contracture of the tissues over the spinous 
process of the axis, which was displaced to the right. After four 
treatments the pain had disappeared. 

(10) A lady had for many years suffered from agonizing 
headache, so severe at times as to render her unconscious. For 
some months the head had not ceased aching, day or night. 
Lesion was found as slight luxation of the 3rd and 4th dorsal 
vertebrae, and there was a well marked lesion at the llth and 
12th dorsal. The headache disappeared during one month of 
treatment, with no return after several months. 



278 PRACTICE OF OSTEOPATHY. 

(11) A case in which a woman suffered from intense head- 
aches, there being also feeling of oppression at the base of the 
skull. The axis was lateral and anterior. The case was cured 
by adjustment of lesions. 

(12) A case of migraine, with chronic dysentery of five 
years standing, in a man of 33. Lesion was a posterior condi- 
tion of spine from llth dorsal to 3rd lumbar. The treatment 
was directed to removal of lesion, curing the case. 

(13) Migraine of five years standing in a boy of 16. The 
3rd cervical and 4th dorsal vertebras were lateral to the right. 
Treatment was directed to removal of lesion, diet and exercise 
also being attended to. The case was benefited by one treat- 
ment, and apparently cured by three treatments. The course 
of treatment being continued once a week for two months. 
One continually meets cases of severe chronic headache re- 
sulting from the use of drugs. 

LESIONS: Migraine, with other forms, shows the usual 
lesions. Lesions found to produce it are of the atlas; 2nd and 
and 3rd cervical, upper dorsal; 8th, 9th and 10th dorsal; 7th and 
8th ribs. 

When headache is symptomatic purely, lesion depends upon 
the primary disease, but specific lesion is often present and de- 
termines the effect in the head. 

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, reflexly 
causing the headaches, just as may be the case in reflex head- 
ache 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 cervical vertebra ; 
the clavicle may hinder venous flow in the external and internal 
jugulars, the sympathetic irritation may set up vaso-motor 
reflexes and prevent proper circulation. A lesion may cause 
headache by direct pressure 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 suboccipital nerve sent to supply 
the occipito-atlantal articulation. The same thing is apt to 



PRACTICE OF OSTEOPATHY. 279 

occur at any of the upper three cervical vertebrae, the correspond- 
ing nerves sending branches to supply sensation to the scalp. 
Contraction of tissues over branches of the fifth nerve, or at their 
foramia of exit may cause headache. Reflex or direct irritation 
of the fifth nerve may cause it. 

Lesion in the splanchnic area is often responsible for mi- 
graine. 

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, heavy pain in toxic or dyspeptic forms; a constrictive, 
squeezing, or pressing pain in neurotic or neurasthenic cases; 
a hot, burning, or sore pain in rheumatic or anemic headache; 
a sharp, boring pain in hysteric, epileptic, or neurotic forms. 

The pain is usually found to be localized in or referred to 
the peripheral ends of the fifth nerve, they supplying the antero- 
lateral parts of the scalp and the dura mater with sentation. 
Hence treatment is directed to 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 numer- 
ous kinds of headache described, though special portions of the 
treatment laid down may apply to any 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 suc- 
cessful in one case may not apply to another. 

The lesion must be removed, and this often constitutes 
the sole treatment 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 relax- 
ation of contractured muscles in the neck and upper .dorsal re- 
gion. These muscular contractures may often be used as guides 
to locate bony lesion. Sometimes one small contractured fibre 



280 PRACTICE OF OSTEOPATHY. 

will lead the examiner to the seat of bony subluxation, if care- 
fully followed. This relieves irritation to nerves, frees circula- 
tion and prepares for the replacing of a displaced vertebra. At- 
tention 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 re- 
gion of the upper four vertebrae, and in the sub-occipital fossae, 
quiets the upper four cervical nerves and aids in restoring equal- 
ity of circulation through affect upon the superior cervical gang- 
lion. 

Often pressure made as follows is sufficient: in the mid- 
line of the neck, just below the occiput ; below the ears, upon and 
below the transverse processes of the atlas; along the upper dor- 
sal region at the upper three or four vertebrae. These treat- 
ments 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 pro- 
tuberance, and thence laterally toward the mastoid processes, 
over the course of the lateral sinuses, aids in freeing the circula- 
tion in them. As this treatment is carried over the vertex the 
terminals of the various sensory nerves of the scalp are affected 
and quieted. 

Deep pressure over the solar plexus, and inhibitive abdom- 
inal treatment, aid in relieving the headache sometimes by quiet- 
ing the reflexes and calling the blood away 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. 

LOCOMOTOR ATAXIA AND SPASTIC PARAPLEGIA. 

DEFINITION: Locomotor Ataxia, or Tabes Dorsalis. is a 
disease characterized by sclerosis of the posterior columns of 



PRACTICE OF OSTEOPATHY. 281 

the cord, loss of cooidination in the muscles of the limbs, absence 
of the patellar reflex, lightning pains in the limbs, and the Argyll 
Robertson pupil, which reacts to accommodation but not to 
light. 

CASES: (1) In a woman of thirty-two, lesions were found 
at the atlas and upper lumbar region. Under treatment she 
regained control of the bladder and bowels, became able to walk 
well, and the progress of the disease had apparently been termi- 
nated. 

(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 the 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 the disease was showing raid improvement. 

(3) A case in a young man of twenty, in which there was 
marked scoliosis of the dorsal spine, involving the thorax, some 
improvement in the locomotor ataxia was gained urider treat- 
ment. 

(4) A case in a man of thirty-five showed spinal lesion in 
the dorsal spine between the shoulders, the vertebrae being irreg- 
ular and posterior. Under continued treatment his walking was 
much improved, visceral crises were prevented, the control of 
the bladder and rectum were regained, and the pains in the lower 
limbs were done away. 

(5) A case presented spinal lesion in the form of a too great 
anterior sweep of the lumbar region of the spine. 

(6) Locomotor Ataxia of a severe form, of four years dura- 
tion. The eyes had become so bad that patient could not read, 
and could scarcely distinguish light from dark. Lesion was found 
at the 1st and 2nd cervical, 4th and 5th dorsal, posterior condi- 
tion of the lower dorsal and upper lumbar spine, and lateral les- 
ion at the 5th lumbar. Gradual improvement took place under 
treatment, a considerable gain having been made at the time of 
the report. 



282 PRACTICE OF OSTEOPATHY. 

SPASTIC PARAPLEGIA (Spastic Spinal Paralysis) is a cord 
disease with loss of muscular power, exaggerated patellar re- 
flexes, a peculiar gait, and precipitate micturition. It is a pri- 
mary sclerosis of the cord. 

CASE: A middle-aged man, after injury to the spine in a 
mine accident, was affected with complete motor and sensory 
paraplegia. Operation 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 and 10th posterior 
and toward the left. Considerable improvement was made under 
treatment. 

LESIONS 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 locomotor ataxia spinal curvature is often found as the 
cause. Derangement of the thoracic vertebrae in the region be- 
tween the shoulders often causes it. Atlas, cervical, and lum- 
bar lesions are often found. Dr. Still points out lesion of the 
sacrum as the cause 'of locomotor ataxia. 

The PROGNOSIS in neither disease is promising as to cure. 
Most cases are benefited, some to a marked extent. Locomotor 
ataxia is more frequently met with and, on the whole, more suc- 
cessfully treated. The progress of the disease is often checked; 
control of bladder and rectum are established ; the power of walk- 
ing, even after complete loss in some cases, is restored. These 
These cases are generally benefited, but sometimes do not yield 
to treatment. In cases of spastic paraplegia the sum-total of 
results is not so great. The walking is often improved, and pre- 
cipitate micturition is bettered. 

The sclerotic changes in the cord in these diseases render 
them incurable, even after removal of specific lesion, yet the 
sclerotic process is doubtless often checked by the removal of 
lesion and the attendant treatment. 

A few cases of both diseases, in early stages and resulting 
from injury, are reported cured. 

The TREATMENT of locomotor ataxia consists in the removal 
of lesion and general spinal treatment. The removal of lesion 



PRACTICE OF OSTEOPATHY. 283 

is insufficient. The thorough spinal treatment must be made 
to influence spinal nerve connections, the central distribution of 
the sympathetics, and the blood-circulation about and to the 
spine. This treatment should be given especially from the mid- 
dle dorsal down, as the degenerative changes in the cord and 
meninges begin in the lower part. If the ataxic condition has 
not yet appeared in the arms, and cerebral symptoms have not 
developed the indications are 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 regions. 

The nerve-supply to the limbs, upper and lower, as well 
as the limbs themselves, should be treated. Care must be taken 
in this matter, as the tendency of the long bones to fracture is 
marked in locomotor ataxia. The arthropathies, if present, call 
for special treatment to the joint involved, and its nerve and blood- 
supply. As the knee-joints are most frequently attacked, the 
treatment to the lower limbs wll serve to lessen the danger of 
their occurrence. The spinal treatment should include spring- 
ing the spine, and various other methods of separating the verte- 
brae from each other, increasing circulation about them and 
keeping up their nutritive integrity, as the articular surfaces and 
interarticular fibro-cartilages are liable respectively to absorption 
and atrophy. 

Abdominal treatment should be maintained to prevent 
visceral crises, most common about the stomach. Treatment 
should be upon the abdominal nerve-plexuses and blood-circu- 
lation. The stomach and bowels may thus be kept in good con- 
dition. Lumbar and sacral treatment, together with treatment 
to the internal iliac blood-vessels from the abdominal aspect, 
aid in restoring the sphincters of bladder and rectum to good con- 
ditions. In case of necessity the cathseter should be used to 
empty the bladder. To relieve the lightning pains in the limbs 
strong inhibition should be made upon 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. 



284 PRACTICE OF OSTEOPATHY. 

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 treat- 
ment 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 Paralysis, in which 
the symptoms are not so well marked; Congenital Spastic Par- 
aplegia, usually due to injury at birth; Ataxic paraplegia, com- 
bining spastic and ataxic features, retaining the reflexes; and the 
Combined System Sclerosis, Disseminated Sclerosis, etc. are 
approached in the same manner for discovery of lesions and treat- 
ment. 

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 cer- 
vical and upper dorsal region, and among the upper ribs. These 
lesions, being present, doubtless determine the victim of the dis- 
ease. 

It occurs in those whose central nervous system is thus 
weakened and laid liable to the action of such secondary causes 
as exhausting illness, mental 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 always such as are not sought 
for by the regular practitioner, are the real causes of the condi- 
tion. They occur high in the spine, at a point where, acting upon 
the central nervous system, 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. 

The PROGNOSIS : There is a reasonable expectation of limiting 
the progress of the disease and bettering the patient's general condi- 



PRACTICE OF OSTEOPATHY. 285 

tion. 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, perhaps 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 strongly encourage the patient when such a period oc- 
curs, without reason to expect the permanence of such gain. 

The TREATMENT consists in removal of lesion; the thor- 
ough relaxation of all spinal and cervical muscles, particularly 
apt to be set and hardened about the neck and shoulders; and a 
most thorough general spinal treatment. 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 stimulated. 

Light exercise and baths are good for the case. 

OCCUPATION NEUROSES. 

DEFINITION: A neurosis due to constant use of certain 
groups of muscles 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-maker's, etc., are all manifestations, more or less severe r 
of obstruction to the nerves supplying the parts involved. These 
obstructions generally 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 
pianist's paralysis are known and recalled in this connection, 
although the data as to lesions, etc., are not now available. 
These cases were generally cured. The following cases are typical. 

(1) A marked case of telegrapher's paralysis, of three years 
standing. For two years the hands had been almost useless, 



"286 PRACTICE OF OSTEOPATHY. 

and the patient could not distinguish by touch between an ink- 
stand and a pencil, sensation and motion were both much im- 
paired. The lesions were found in the 1st, 2nd, and 3rd right 
ribs being close together; the clavicle down upon the right first 
rib, and the cervical origin of the brachial plexus covered with 
much contractured muscles. After one months 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. 

(2) Pianist's paralysis, showing lesions in the upper dorsal 
spine. 

(3) Pianist's paralysis, showing lesions in the cervical and 
upper dorsal regions of the spine, depression of both clavicles, 
and contracture of muscles in the posterior cervical, upper dor- 
sal and shoulder regions. 

(4) Penman's paralysis in a man of 35, of three years stand- 
ing. The 3rd cervical to the 5th dorsal region of the spine was 
lateral to the right. The case was cured in two months by cor- 
rection of lesion and treatment of the circulation to the arm. 

(5) Pianist's cramp in a woman of 25. There was a slip 
of the sternal end of the clavjcle, and slight deviation of the 3rd, 
4th. and 5th cervical vertebrae. The condition was of three 
years duration. The case was benefited after second treatment, 
and was cured in one month. This case had been diagnosed as 
"tuberculosis of the bone, " and amputation had been advised. 

The LESIONS in these cases are doubtless often directly due 
to the occupation. Case (1) above is a good illustration of the 
result of an occupation requiring the elevation of the right shoulder 
resulting in drawing together, the upper three ribs, and in approx- 
imating 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 break-down 
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 



PRACTICE OF OSTEOPATHY. 287 

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-sup- 
ply prevents proper recuperation, and the arm wears out because 
of the presence of lesion. 

In pianist's spinal disease is often found to be due to sit- 
ting 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 present is indicated by the 
fact that in penman 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 pianist's the trouble is 
generally 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 com- 
monly the lesion lies between the fifth 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 upper 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 affections occur in the affected 
member. Vaso-motors to the arms are found as low as the first 
thoracic ganglion, or lower. The connection of the intercostal 
nerves with the sympathetic system may explain why rib lesions 
this low may cause the trouble. The first and second intercostal 
nerves are connected with the brachial plexus. They are often 
impinged by the corresponding 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 sup- 
plied from the brachial plexus. 

While Dana states that this condition is "a neurosis having 



288 PRACTICE OF OSTEOPATHY. 

no appreciable anatomical basis," it seems from the results gotten 
by the removal of lesion that Osteopathy discovers the real 
anatomical cause of the 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 displacement of the clavicle onto the brachial plexus, is 
often the only treatment necessary. The nerve and blood-sup- 
ply of the affected part should be kept free by treatment upon 
them, and by relaxation of all contractured muscles and hardened 
tissues. The arms should be stretched and treated as described 
in Chap. X. The brachial plexus may be stimulated on the 
inner side of the arm just below the axilla, and in the neck be- 
hind the clavicle. Treatment should be carried up along the 
plexus to the spine. The elbow and shoulder joints should be 
sprung and adjusted if necessary. (Chap. X.) 

It may be necessary to have the patient rest from his occu- 
pation during the treatment, particularlyi 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. Vertigo and insomnia are some- 
times present, doubtless due to the upper spinal lesions affect- 
ing 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 disturb- 
ance found in the affected members. 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 occupation. Sleeves that interfere with free motion of the 
hand in writing, cuffs that bind the wrist, constricting bands that 
may be used as sleeve supporters, and any agency limiting mo- 
tion and circulation must be avoided. Systematic gymnastics 
of the hand and arm are helpful in developing proper circulation, 
also in upbuilding neglected muscles. 



PRACTICE OP OSTEOPATHY. 289 

The pain frequently present in arms and shoulders may be 
quieted by inhibition of the plexus arid its spinal origin, but gen- 
erally yields to the general process of relaxing muscles, etc. 

NEURASTHENIA. 

(Nervous Prostration.) 

DEFINITION: "A functional disease of the nervous system, 
characterized by mental and bodily weakness." It is not a 
psychosis. There is functional exhaustion and irritatability of 
the nerve centers. 

(1) In a woman of thirty-two, neurasthenia developed after 
confinement and sickness. Symptoms 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 llth and 12th dorsal yertebrae, a posterior 
luxation of the fifth lumbar vertebra, and contracture of the 
lumbar muscles. The neurasthenia was apparently reflex from 
uterine disease. Two weeks daily treatment re-established men- 
struation, which had been suppressed for some time. Under 
one months treatment all the symptoms had disappeared. 

(2) A case of neurasthenia in a lady of sixty, following over- 
work 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 years treatment produced great improvement. 

(3) 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 benefited. 

(4) 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 corrected in three weeks, but 
no improvement occurred in the patient's general condition until 
ten weeks treatment had been taken. After two weeks further 
treatment the case was well. 

(5) Nervous exhaustion in a man who had been suffering 
from kidney disease. The whole spine was rigid, with its muscles 
and ligaments all tense. Pus and phosphates appeared in the 



290 PRACTICE OF OSTEOPATHY. 

urine. During 3^ months treatment the patient gained 12 lbs v 
the urine cleared, and the case was cured. 

(6) Nervous prostration of four years standing in a woman 
of 42. Many minor lesions occurred along the spine, especially 
the 3rd and 4th cervical vertebrae were lateral, the 6th cervical 
posterior, a general posterior condition of the dorsal region, the 
4th and 5th lumbar lateral, the coccyx anterior, the left innom- 
inate up and back. There was a prolapsed uterus, dysmenorrhoea, 
enlarged liver and spleen. The case was cured in three months. 

The LESIONS found in neurasthenia are general spinal le- 
sions. Different cases present different lesions, and no typical 
lesion may be described for all cases. Yet perhaps a majority 
of these cases show a depression of all of the ribs, narrowing the 
thorax and often causing enteropsis. Floating kidney and en- 
teroptosis are well known as causes of neurasthenia. There is 
no doubt that many cases of neurasthenia apparently thus caused 
are really due to bad spinal condition and flattening of the thorax 
through depression of all the ribs. These extensive lesions affect 
cerebro-spinal system directly, also the sympathetic system, thus 
causing the neurasthenia and the enteroptosis. 

Often the lesion in these cases is such as produce disease 
in some organ, secondary to which neurasthenia is developed. 
This is well illustrated in these lower spinal lesions producing 
uterine disease, from which neurasthenia is reflexly caused. 
Thus a variety of lesions may be found in neurasthenia, dif- 
ferent cases presenting different lesions. Each case demands an 
individual study. For the production of neurasthenia there is 
necessary merely a lesion producing an irritation upon the nerve 
system, reflexly or directly, allowing a leakage of nerve-force, 
and determining the victim of neurasthenia from overwork, worry, 
uterine disease, naso-pharyngeal disease, the use of coffee, aico- 
hol, etc. 

The different varieties of neurasthenia may be caused by 
the predominance of lesion, e. g., the cerebral type by upper dorsal 
and cervical lesions, the gastric by splanchnic lesions, the lithemic 
by lower dorsal and upper lumbar lesions, etc. Influenza, a 
common cause of this disease, is a malady particularly noted by 
osteopathy as producing serious spinal lesions, mostly in the 



PRACTICE OF OSTEOPATHY. 291 

shape of contracted muscles and tenseness of the other tissues, 
but sometimes actual bony lesions by drawing parts out of place 
through contracture of attached tissues. Lesion thus produced 
may cause neurasthenia. It is common as the result of trauma- 
tism, such as caused by railway accidents, bony lesions thus being 
produced as irritants to nerves. 

The PROGNOSIS for cure is good. Those cases that have 
not yielded to any of the usual modes of treatment often readily 
yield to osteopathic treatment. The best of results may be ex- 
pected in the worst cases. Cases are often quickly cured if 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 re- 
moval of every source of reflex irritation is neccessary, but these 
sources must be studied out in each individual case, The le- 
sions present should be removed, but the case is not always at 
once benefited thereby, as a course qf treatment is generally neces- 
sary to recuperate the exhausted nerve-centers. Consequently 
a most systematic and thorough course of treatment must 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 stimulation of the spinal nerve- 
system and the circulation thereto, are -given to increase nutri- 
tion 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 irritability, and correction of function. 

Special manifestations of the condition, as heada'che, in- 
somnia, vertigo, etc., call for cervical treatment particularly. 
Bowels, kidneys, liver, etc., must be carefully looked after to re- 
lieve 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 of drain upon the nervous vitality. The diet should 



292 PRACTICE OF OSTEOPATHY. 

be light and nutritious. The use of cold sponge or shower baths ; 
etc.. will aid him to preserve a cheerful state of mind. Some 
cases may be treated daily with advantage, in the beginning of 
treatment. Later, the treatments may be decreased in number 
to three or two per week. 

HYSTERIA. 

This is a condition frequently met and treated osteopath- 
ically. One needs to be continually upon guard against its sim- 
ulation of other conditions, being equally careful not to over- 
look other diseases because of a hurried diagnosis of hysteria. 
Being a functional disease of the nervous system, and a psychosis, 
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 disposition, infectious fevers, poisons 
of various kinds, emotional disturbances, mental or physical 
strain, and other causes to result in hysterical attacks. 

Dr. Still calls attention to the fact that in hysteria the lower 
ribs are often displaced downward, and the colon is prolapsed in the 
pelvis. He raises the ribs, draws up the intestine and corrects 
the circulation to the genitals. 

Correction of lesion removes the primary cause of irrita- 
tion to the nervous system, perhaps cures a certain disease to 
which the hysteria is secondary, and this is an important step 
in the radical cure of the condition. 

The PROGNOSIS for cure is good. The treatment relieves 
nervous tension and quiets the overwrought system at once. 

In the TREATMENT considerable tact must be used. The 
primary treatment embraces the removal of all lesions and 
causes of irritation. A course of treatment for the general ner- 
vous 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 



PRACTICE OF OSTEOPATHY. 293 

mental and moral control, and while applying a general relax- 
ing and inhibitive spinal and cervical treatment to relieve nerve- 
tension and to quiet the nervous system, by a strong show of 
authority compel the patient to cease various motions, unbend 
a clenched 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, hysterical pains, contractures, 
eye-symptoms, paralysis, 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 mo- 
tions and acts which they thought beyond their power. The 
patient should lead a regular life, and her mind should be kept 
occupied by some engrossing occupation. 

Judicious management of the case, authority over the pa- 
tient, and a careful general treatment for the health of the body 
and particularly of the nervous system, 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 bony. Idiapathic insomnia embraces many forms gen- 
erally looked upon as symptomatic or secondary. Many really 
symptomatic or secondary cases are noted, especially in nervous 
diseases, the primary condition itself being usually found to de- 
pend, at bottom, upon bony lesion. 

CASES: Very numerous cases are met and treated osteo- 
pathically. The following cases illustratrate various points in 
connection with such cases: 

(1) Insomnia, nervousness and complication of troubles. 
Sleep could not be induced by the most powerful soporifics. Le- 
sion was found among the cervical and upper dorsal vertebrae. 
The case was cured in two months treatment. 



294 PKACTICE OF OSTEOPATHY. 

(2) Insomnia and general nervousness, pronounced in- 
curable. The patient had had no good nights sleep in fiveyears> 
and had become a nervous wreck. Lesion was found in the shape 
of contractured condition of all the cervical muscles. 

(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 neuras- 
thenia, in which the patient had depended upon soporifics for 
a number of years, slept well after the second or third treatment. 
The use of artificial aid to sleep was necessary but at rare inter- 
vals thereafter. The case was practically cured at the time of 
report. 

(5) A case of insomnia of some years standing, due to cer- 
vical and upper dorsal lesions, cured in six months treatment. 

(6) A case of three years standing, in which the heart-beat 
had become very irregular from the resulting nervousness. Four 
treatments corrected the heart beat, and the case had been prac- 
tically cured, at the, time of report. 

(7) A case of insomnia with constipation and amenorrhcea. 
in a woman of 22, of thirteen months standing. The atlas was 
to the left; the posterior cervical tissues were all thick and tense, 
especially upon the left ; the seventh dorsal spine was rather irreg- 
ular. The pelvis was twisted, with apparent lengthening of the 
right limb. The treatment at once benefited the case, and it 
was cured in 4 months. 

(8) 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. 

(9) A case of narcolepsy due to cervical lesions successfully 
treated. 

(10) A case of protracted sleep, in which the patient fell 
asleep on April 26, 1902, and slept for 3 months, with but few 
periods of awakening. The lesion was found between the skull 
and the atlas, causing, probably, passive congestion. Correc- 
tion of the lesion cured the case, after all other means had failed. 

LESIONS AND ANATOMICAL RELATIONS: The lesions, both 
in insomnia and in the various other disorders of sleep are gen- 



PRACTICE OF OSTEOPATHY. 295 

erally found in the atlas and cervical and upper dorsal regions. 
All such cases, perhaps constituting a majority of all cases of 
these diseases, should be regarded from the osteopathic point 
of view as idiopathic insomnia, dependent upon specific lesion 
interfering with circulation to the brain. Lesions to the atlas 
and second cervical vertebra are very common causes, and le- 
sions usually occur within the cervical region or among the upper 
five dorsal vertebrae. Lesions to clavicle and to corresponding 
ribs may be present. It will be observed that from the occiput 
to 5th dorsal all these lesions fall within an area particularly rich 
in sympathetic and vaso-motor centers for the head, as before 
pointed out. Atlas and axis lesion acting upon the superior 
cervical ganglion, medulla, or cervical 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 le- 
sions with the sympathetics or by direct pressure upon the arteries. 
The insomnia in various diseases 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 cerebral 
circulation as a result of the disturbance of sympathetic vaso- 
motors, impeded venous return, etc., caused by these lesions. 
In neurasthenic insomnia, it is said, there is loss of vaso-motor 
tone in the cerebral vessels. The use of various mechanical rem- 
edies is based upon the idea of calling the blood from the head 
to the skin or abdominal organs, i. -e., a hot foot-bath, eating a 
light lunch, etc. 

In some cases the symptoms indicate the necessity of in- 
creasing or decreasing the amount of blood in the cerebral ves- 
sels, 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 



296 PRACTICE OF OSTEOPATHY. 

the vessels, characteristic of the normal body which enjoys health- 
ful sleep. Such a result is the most rational object of the treat- 
ment. 

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 laterally toward the mastoid process. 
With this condition there frequently exists an approximation of 
the second cervical spine to the occiput. 

The PROGNOSIS in insomnia is good. No class of cases pre- 
sent more striking results in the shape of cure of the most long- 
standing and intractable cases. It is a frequent occurrence that 
a case of some years standing is made to sleep naturally after a 
single or few treatments. 

Not all cases thus easily yield to treatment. Often great 
patience and persistence are necessary to secure good results. 

The TREATMENT calls for the removal of lesion primarily, 
and of any cause of irritation to the nervous system. The treat- 
ment 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 
cervical ganglia and the upper dorsal centers, deep pressure be- 
neath the ears and beneath the occiput. All the cervical muscles 
and other tissues should be thoroughly relaxed. A general spinal 
treatment, in nervous cases, at once relieves nerve-tension and 
irritation, and materially aids in producing sleep. It is some- 
times well to add to this a general body treatment as an aid in 
equalizing circulation and toning up the nervous system. All 
points of cervical circulation should be attended to. The treat- 
ment begun over forehead and face may be continued 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 



PRACTICE OF OSTEOPATHY. 297 

abdominal treatment should be used to draw the blood away 
from the head to the abdominal vessels. 

In anemic cases one should add treatment to liver, kidneys, 
stomach, bowels and spleen. The heart and lungs should be 
stimulated. In insomnia due to auto-intoxication, as in lithemia, 
uremia, malaria, etc., one should look particularly to the excre- 
tions. 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 sev- 
eral hours before retiring. 

The various perversions of sleep, such as dreams, and night- 
mare, sommolentia, or incomplete sleep, somnambulism, morbid 
drowsiness, narcolepsy, catalepsy and prolonged sleep, would 
all be approached and treated upon the same lines as laid down 
for insomnia. 

PARALYSIS. 

The various formes of paralysis come, with much frequency, 
under osteopathic treatment. Paralysis of every part of the body 
and from various causes, is successfully treated. The following 
cases are illustrative. 

CASES: (1) Paraplegia in a young lady, caused by a fall 
of eighteen feet. The lower half of the body, and 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 having 
had any urinary trouble. Lesions as follows: Marked pos- 
terior and slight lateral curvature of the spine, involving the lower 
and upper lumbar regions.; the coccyx was bent and twisted; the 
right innominate bone was luxated backward. The condition 
was of nine and one-half months standing. After the first treat- 
ment she was able to sleep without the customary opiate. During 
the second weeks treatment she began to gain control of the blad- 
der, and the bowels acted naturally. The urine became normal 
at this time. During the course of the treatment an ulcer upon 
the right foot healed. A course of two months treatment had 
almost cured the patient at the time of reporting the case. 



298 PRACTICE OF OSTEOPATHY. 

(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 be- 
gan to lose the use of his limbs, and in seven months he was con- 
fined to a chair, soon becoming unable to move a muscle of either 
limb. Lesions were as follows: 9th, 10th and llth dorsal ver- 
tebrae backward sufficiently to simulate the posterior angular 
projection in Pott's disease; a marked contraction of the mus- 
cles of the right side of the spine to the same side as the contrac- 
ture and limited by its extent; great tension and slight lesion at 
the junction of the fifth lumbar vertebra with the sacrum ; a bind- 
ing together of all the spinal vertebras by an apparant contrac- 
ture of the ligaments. After a few r 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 en- 
tirely cured, sensation, motion, and function of abdominal and 
pelvic organs being restored. 

(4) Lack of free use of the feet due to a paralytic stroke six 
years before. A disarticulation among the tarsal bones w r as 
discovered, and its removal practically cured the case. 

(5) Paraplegia, paitial, was cured by correction of lesion 
of the sixth dorsal vertebra. 

(6) General paralysis in a case which gradually for six years 
lost the use of all the voluntary muscles, the eyes were crossed 
and nearly blind, bowels and bladder were involved. The case 
was cured by adjusting lesion between the atlas and occiput, the 
latter being displaced anteriorly upon the former. 

(7) Infantile paralysis involving the left lower limb. The 
case was in a child two years old. A sacro-iliac lesion was found 
as the cause, and was treated. The child could move the limb 
slightly after the first treatment, and after the sixth treatment 
perfect use was restored. 

(8) A case of paralysis was found presenting lesions at the 
occipito-atlantal and lumbo-sacral articulations, and from the 
sixth to the tenth dorsal vertebrae. There was a history of ex- 
posure, alcoholism, sexual excess and great physical strain. 



PRACTICE OF OSTEOPATHY. 299 

Correction of the lesions effected a cure in five months. 

(9) A case of paraplegia in a man of fifty-five, due to injury 
in a railroad wreck. Both innominate bones were found dis- 
placed anteriorly, and lesions were 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 patient could walk 
without crutch or cane, being as well as ever, excepting some 
weakness of the spine. 

(10) Paraplegia, involving the bowels, in a lady of fifty- 
three, and of fifteen years standing. Sensation was lacking in 
the limbs, and there was very little motion. In less than one 
months treatment sensation and motion were both perfectly 
restored, and the bowels were acting naturally. 

(11) Paralysis following a stroke. The cervical muscles 
were found contractured. Their correction was accomplished 
in five weeks, and none of the paralytic condition remained. 

(12) 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 atrophy of the muscles over 
the brachial plexus and the axillary artery. Five months treat- 
ment 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. 

(13) Paralysis and muscular atrophy 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 le- 
sions were found preventing circulation to the cord. The child 
began at once to improve under the treatment. After the third treat- 
ment he could move his fingers. In two weeks he could use his 
hands well enough to feed himself. In one month he was prac- 
tically cured. 

(14) Disseminated subacute cervical and lumbar myelitis 
in a boy of seven, following the swallowing of two pins. Severe 
illness at once followed, and in the fifth week the pins were lo- 
cated by the X-ray on the left side about the level of the third 
cervical vertebra. They were later ejected, he becoming imme- 



300 PRACTICE OF OSTEOPATHY. 

diately totally paralyzed. For two weeks it was thought he could 
not live. After about seven weeks the case came under osteo- 
pathic 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 were atrophied. 
After the first treatment the patient slep soundly for the first 
time in two weeks. After about four months treatment the case 
was practically cured. 

(15) Monoplegia attacking the right lower limb of a girl 
of six, paralyzed since the age of ten as the result of spinal men- 
ingitis. No bony lesion was found, but the treatment was di- 
rected to increasing the circulation to the cord. The case was 
practically cured in three months treatment. 

(16) 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. 

(17) Bell's disease (facial paralysis), due to lesion at the 
second cervical vertebra, cured in three weeks. 

(18) Partial paralysis 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. 

(19) Partial paralysis in a lower limb in a girl of six, since 
infancy, accompanied by under-development of the limb, was 
found to be due to a partial dislocation of the hip, and was cured 
in two months. 

(20) Paralysis, probably Progressive Spinal Muscular Atro- 
phy, in a woman of thirty-five, of fifteen years standing. The 
last two years had been spent in bed. Lesions were found at 
the 7th cervical and 1st dorsal vertebrae, which were anterior. 
The case was cured in ten months. 

(21) 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 
occurred a short time previously. A slight lateral lesion of the 
first dorsal vertebra was found and corrected, curing the case 
in six weeks. 



PRACTICE OF OSTEOPATHY. 301 

(22) Hemiparesis or Hemiplegia in a lady of sixty, of six 
weeks standing. 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. 

(23) Hemiplegia, partial, of the right side, following light- 
ning-stroke. A displacement of the atlas was found and righted 
at once, immediately curing the case. 

(24) Paralysis and Dysentery. The paralysis affected the 
lower limbs, and had been of seven years standing. Lesion was 
found as great tenderness at the lumbo-sacral joint, a slip for- 
ward of the 5th lumbar, luxation of the innominates, and a lateral 
swerve of the lumbar and lower dorsal region of the spine. A 
tremor of the head was present, the cervical muscles being very 
tense. After seven months treatment the lesions were about 
overcome and the patient was nearly well. 

(25) 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. 

(26) Facial paralysis of more than one year standing, was 
cured in three weeks treatment. The lesion was found in a dis- 
placement of the second cervi-cal vertebra. 

(27) 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 the neck. The case, still 
under treatment, was improving satisfactorily. 

(28) Facial paralysis was seen on the day following its first 
appearance. The lesion was marked muscular contraction at 
the angle of the jaw on the affected side. Treatment gave im- 
mediate relief, and the case had almost been cured in "ten treat- 
ments. 

(29) Progressive paralysis in a case, after two' falls causing 
serious illness. Motion in the lower limbs was lost, blindness 
ensued, and speech became unintelligible. There was formication 
in the hands and arms,and extreme pain along the spine,occurring 
in agonizing paroxysms. Lesions were found as a lateral dis- 
location of the third cervical vertebra, luxation of 7th and 8th 



302 PRACTICE OF OSTEOPATHY. 

right ribs, and a posterior protrusion of the lumbar vertebrae. 
One treatment brought the first sleep possible in three days. 
Under treatment the spinal pain was relieved, vision was restored, 
and the patient had been practically cured at the time of the report. 

(30) Crutch paralysis in a man of sixty-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. 

(31) Myotonia Congenita (Thomsen's Disease) in a man, 
of ten years standing. Lesion of spinal vertebrae was removed, 
curing the case. 

(32) Hemiplegia in a child twenty months old, of ten months 
standing. Lesion was found at the atlas, which was immediately 
replaced, and rapid improvement followed. In three weeks the 
child could walk, and recovery was almost perfect. 

(33) Brachial Neuritis of five months standing, causing 
severe pain in arms and shoulders, and partial paralysis of the 
hands. Lesions were found in luxation of the 2nd, 3rd and4th 
right ribs, and the 2nd left rib, with irregularities of the lower 
cervical and upper dorsal vertebrae. One treatment greatly 
relieved the pain; three treatments enabled the patient to close 
his hands and snap his fingers; and in three months treatment 
the case was entirely cured. 

(34) Partial paralysis of one hand, loss of memory, and 
at times inability to articulate. Lesion was found at the 2nd 
cervical vertebra. The case was cured by one months treat- 
ment. 

LESIONS: The facts of these cases are typical, and illustrate 
much that is seen in the practice upon this class of cases. They 
point prominently to importance of anatomical lesion of the 
kind most regarded by osteopathy, as the cause of paralytic dis- 
eases. The necessity of the removal of such lesion in curing the 
condition is obvious. These facts clearly indicate the great po- 
tency of actual bony lesion, derangement of a bony part, in caus- 
ing paralysis. They illustrate also what experience shows to 
be a fact, that displacement of spinal vertebrae occurs as the 
real cause of a majority of the cases of paralysis. Rib lesions 



PRACTICE OF OSTEOPATHY. 303 

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. 
They are almost invariably overlooked in the usual line of prac- 
tice. 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 they have been found as the 
sole discoverable cause of paralysis, and their removal has re- 
sulted in cure. 

Innominate lesion is found to be of the greatest importance 
in causing paralysis of the lower extremities. The coccyx le- 
sion does not seem to be important in this connection. The atlas 
lesion is perhaps the most important single lesion, notwithstand- 
ing the fact that it does not with great frequency occur as the 
sole cause of a paralytic condition. Occurring 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 paralytic effects in the whole body below, upon one side 
of the body, or in the head and its parts. As shown above, le- 
sions of the atlas occurred 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. This circum- 
stance 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 dorsal, lower dorsal, lumbar, innominate, coccyx, 
hip, rib and shoulder lesions' were found. It seems that any 
movable part along the spine, or in relation with the various nerve- 
plexuses concerned in the various paralysis, may become mis- 
placed and become a factor in producing a paralytic condition. 
Yet there is a great deal of constancy of lesion. It tends as much 
toward the specific in this class of cases as in any. Generally 



304 PRACTICE OF OSTEOPATHY. 

in paraplegia, monoplegia 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 these seven cases of paraplegia show this in low lesion along 
the spine. All the six cases of monoplegia show it in local le- 
sions to the origin 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 affect- 
ing the upper and a low lesion affecting the lower members. Yet 
a single lesion high up more frequently perhaps causes the trouble 
in the 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 show that the lower dorsal and upper lumbar 
region is a favorite place for lesions in such cases; that spinal 
curvatures may cause the condition; that fifth lumbar and in- 
nominate lesions are much in evidence. 

In case of general paralysis involving upper and lower limbs 
it is noted that atlas 1 lesion alone may be the cause; that often 
there are both upper and lower lesions, respectively affecting 
upper and lower limbs; and t-hat contractured muscles and causes 
obstructing circulation to the cord may be 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 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. Dr. Still says that in hem- 
iplegia the atlas is often back and to the left. 

The facial paralysis shows 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 muscles occurring over the course of 
the trunk of the nerve where it crosses the ramus of the jaw. In 
these cases, bony lesions if present, are expected to occur among 
the upper three cervical vertebrae. 

ANATOMICAL RELATION'S: The close relation between the 
esion and the disease is shown by several facts. The early de- 



PRACTICE OF OSTEOPATHY. 305 

velopment of paralysis after accident giving origin to those le- 
sions found upon examination to exist at important points in- 
dicates 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 accom- 
plished by their removal, also shows the close relation of lesion 
to paralytic disease. Finally 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 Osteopath only. 

The various lesions, bony and otherwise, act in several ways 
to cause the paralytic effect that follows their presence. In the 
first place, a misplaced vertebra or bony part, or a contractured 
muscle, may brine direct pressure upon a nerve, a fibre, or a plexus, 
cutting off its function and causing paralysis in its area of dis- 
tribution. In one case pressure of the first dorsal vertebra 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 in the case 
in which contracture of the hyoid muscles drew the bone against 
the pneumogastric nerve, causing paralysis of the laryngeal 
muscles, affecting deglutition and speech. The same evidence 
of direct pressure upon nerves is seen in another case where the 
muscles contracted over the trunk of the facial nerve; in another 
where the head of the humerus impinged the brachial plexus; in 
another where the sacro-iliac lesion affected the sacral nerves. 
In all of these cases quick results following the removal of pressure 
show that the effect of the lesion must have been directly upon 
the nerves involved by pressure. 

In such cases the result is seen to be directly upon the pan 
supplied by the impinged nerves, it is uncomplicated by results 
in other parts of the body, and is manifested in a circumscribed 
area, namely, in the muscle groups supplied by the nerve or 
nerves in question. In diagnosis a practical point is to expect 
lesion of a kind exerting direct pressure in case presenting gen- 
eral features as described above. The lesion is known at once 

20 



306 PRACTICE OF OSTEOPATHY. 

to be located some where in the path or at the origin of the nerves 
involved. 

On the other hand, a certain class of lesion is found in par- 
alytic disease by lesion to the cord. The effect to the cord may 
be through direct pressure upon it, or in- other ways. An example 
of such conditions is seen in a case in which lesion of the 2nd cer- 
vical vertebra caused partial paralysis in one hand, loss of mem- 
ory, 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 possibility of the lesion affecting the cord either by direct 
pressure or by interference with the sympathetic or cord-nutri- 
tion. The supposition of direct pressure is supported by the 
fact that removal of the lesion cured the case in one month. 
In another case, formication in the upper and paralysis in the 
lower limbs, blindness, unintelligible speech, and paroxysms of 
spinal pain, clearly indicate involvement of cord and brain. 
The lesion of the 3rd cervical vertebra was too high to affect the 
brachial plexus by direct pressure; the lesion to the lumbar ver- 
tebra likewise could not have pressed directly upon the nerve- 
supply to the lower limbs. Yet the paralytic condition in lower 
limbs, referable to the posterior displacement or protrusion of the 
lumbar vertebrge, 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 one case 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, and the highness of 
the lesion, both favor the idea that there was pressure upon the 
cord. In a case where there was paralysis of the voluntary mus- 
cles, crossed eyes, and partial blindness, the lesion was again at 
the atlas (occipito-atlantal) and the same reasoning would ap- 
ply. So in another case, paraplegia following lesion of the 6th 
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 plexus, are indirect; they are also 
complicated with effects in more than one part of the body, and 



PRACTICE OF OSTEOPATHY. 307 

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 style 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 nerve, causing blindness through 
interference with its nutrition. In another case 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 another case, the lasting effects of 
the meningitis upon the cord were overcome by 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 restoration of function. On the other hand 
a course of treatment must look to regeneration of nerves and of 
ganglion cells in many cases where degeneration has taken place 
in these tissues because of the effect of the lesion. 

In hip cases, the under-development accompanying 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. 

There is a class of cases of paralysis in which fever has been 
the antecedent factor, as in cases in which paralysis of a limb 
follows typhoid fever. The paralysis of the vocal-cords, for ex- 
ample, following diphtheria, is often seen. Other diseases, 
febrile or not in character, in which there is much auto-intoxica- 
tion, may be followed by similar sequelae. 

In these cases, the poison generated in the system affects 
nerve-centers, or nerves direct, producing the paralysis.- Such 
sequelae are much more likely to occur in cases in which strong 
medication has been a feature of the treatment, since the emunc- 
tories, already occupied with all the poison they can eliminate, 
are called upon to handle in addition that introduced into the 
system in the form of drugs. 

Such sequelae are not so likely to occur in cases treated by 
osteopathic therapeutics. 

In the cases in which such sequelae occur, the locus of the 



308 PRACTICE OF OSTEOPATHY. 

paralysis is probably determined by lesions which are present and 
affecting certain centers or nerves, laying them liable to such 
effects of autointoxication. It is evident, also, that in cases in 
which certain of the emunctories are weakened by lesion, such 
lesion may become responsible for the sequelae through having 
lessened the function of these eliminative organs. 

This class of cases is well handled, usually, if not of too long 
standing. 

The PROGNOSIS in paralytic cases is very favorable. A 
large percentage of the cases is entirely cured. Few cases are 
neither benefited 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 par- 
alysis. 

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 most long standing and worst cas2s aro quickly ben- 
efited and cured. The prognosis is good, even after "strokes," 
and often where there is blood-clot on thj brain. 

TREATMENT: The bony lesion must ba 1*3 moved. This 
is often the most 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 quality of blood, and in many such cases the important 
first step consists in sufficient treatment to bowels, stomach, 
liver and kidneys to improve the general health and expel all 
impurities from the blood. 

The general spinal and cervical treatment should be ap- 
plied to tone the general nervous system and to increase the 
circulation and nutrition of it. This is accomplished by relax- 
ation of all the spinal tissues, separation of the spinal vertebra? 
to allow free circulation, and stimulation of the central distribu- 
tion of the sympathetic having control of circulation to the spine. 

In case of blood-clot upon the brain the treatment is to 
increase cervical circulation to absorb it. This can be accom- 
plished in cases where the clot has not had time to become or- 
ganized or encysted. After cerebral hemorrhage, treatment 



PRACTICE OF OSTEOPATHY. 309 

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 given by 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 nerve-mechanism. 

Lesions as described in this chapter will be found in most 
of the various diseases of brain and spinal cord. The same prin- 
ciples 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-oc- 
cipital regions to dilate the blood-vessels and to aid in reducing 
the congestion. This object is aided in a most important manner 
by the general cervical, spinal and abdominal treatment, re- 
laxing all tissues and calling the blood to these parts away from 
the head. These treatments should be relaxing and inhibitive 
in nature as before described. The head should be kept raised 
to aid in drawing the blood from it. In the intervals in treat- 
ment the ice-bag may be applied to the spine. The patient should 
remain quietly 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 by the usual cervical 
treatments to increase circulation to the brain; the latter by 
such treatments as described in detail above for cases of paralysis. 
The clot may, if taken in time, be completely removed, and the 
patient should be treated twice or several times daily. Later 
he may be treated daily or three times a week. 

INFANTILE PARALYSIS, in children up to three or four years 
of age, is often caused by disorders of the digestive tract, as in 
teething or after catching cold or in bowel complaint. In such 
cases cerebral congestion and spasms are prone to occur, and 
during the spasm a vessel is burst in the brain, with resulting 
hemorrhage and clot. 

In some of these cases the congestion, hemorrhage, clot, and 
inflammation occur in the cord, causing ACUTE ANTERIOR POLIO- 



310 PRACTICE OF OSTEOPATHY. 

MYELITIS. Such cases do well under treatment in these acute 
conditions, and the resulting Infantile Paralysis, if seen early, 
or if not of long standing, will often yield well to a persistent 
course. 

In cases of HEMORRHAGE INTO THE .SPINAL MEMBRANES, 
HEMORRHAGE INTO THE SPINAL CORD, and HEMORRHAGE INTO 
THE MEDULLA and PONS the treatment is upon quite the same 
lines as for cerebral hemorrhage. In the first two conditions 
the patient should be kept lying upon his side or face, not upon 
his back, to favor the drainage of the blood. 

In the various forms of SPINAL MENINGITIS, often met in 
our practice, good prognosis is the rule. Cases are made to re- 
cover 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 circulation of the 
cord and call the blood away from it. The rigidity of the muscles 
is overcome by manipulation and by careful, inhibitive spinal 
treatment. Bowels and kidneys must be kept active by treat- 
ment, to aid in removing toxic products from the system. 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 paralytic sequel to the condition. 

The same plan of treatment will apply to CHRONIC SPINAL 
MENINGITIS, and to the various forms of PACHYMENINGITIS and 
LEPTOMENGITIS. Further special treatment is to be applied 
according to the needs of the individual case, and according to 
the manifestations of the disease. 

In MYELITIS the same general plan of treatment should be 
adopted to gain vaso-motor control and lessen the inflamma- 
tory process in the cord. Diagnosis should be made of the por- 
tions of the cord affected, and treatment should be applied here 
particularly to absorb the extra vasted blood and do away with 
the danger of softening or degeneration of the cord following. 
The patient should be kept quiet, and attention be given to any 
special manifestation in the case requiring alleviation. Care 



PRACTICE OF OSTEOPATHY. 311 

must be taken in the manipulation to avoid all irritation of the 
skin on account of the liability to bed-sores. Rigidity and spasm 
in the affected muscles may be overcome by inhibitive manipu- 
lation of them, and by inhibition of the nerves. Guard against 
renal and pulmonary complications by keeping the lungs and 
kidneys well stimulated. A course of treatment must follow to 
guard against or overcome paralysis. The prognosis is good in 
the acute case. A chronic case may be cured, or much may be 
done for its benefit. 

In CHRONIC MYELITIS, DISSEMINATED MYELITIS, and ACUTE 
ANTERIOR POLIO-MYELITIS, (see above) the same line of treat- 
ment is to be followed, with attention to special manifestations of 
the disease in each case. 

In meningitis, myelitis, apoplexy, etc., various spinal and 
cervical lesions occur, of the kinds pointed out in the general 
consideration of the subject of paralysis. 

ACUTE ASCENDING PARALYSIS, or Landry's Paralysis should 
be treated according to the directions given for the general treat- 
ment of paralysis. The spinal treatment must be particularly 
thorough, and heart and lungs should be kept well stimulated. 
The practitioner must be constantly upon his guard, as the dis- 
ease runs a very quick course, and may soon terminate in death. 

SYRINGOMYELIA should be treated as the ordinary case of 
chronic paralysis. 

PROGRESSIVE BULBAR PARALYSIS, or Labioglossopharyn- 
geal paralysis, needs treatment mostly in the cervical and upper 
dorsal regions, in order to remove lesion and to stimulate the 
circulation to the brain to prevent the atrophy of the roots of the 
various cranial nerves involved in the condition. The general 
health should be attended to. The treatment should^ include 
thorough spinal work as the cord tends to be involved, and pro- 
gressive muscular atrophy may appear. 

CEREBRAL ANEURYSMS are to be treated as are other 
aneurysms, q. v. 

HYDROCEPHALUS calls for treatment to maintain the gen- 
eral health, and for cervical and spinal treatment to correct cir- 
culation to and from the brain. 



312 PRACTICE OF OSTEOPATHY. 

CEREBRAL PALSIES OF CHILDHOOD. 

(Infantile Paralysis.) 

Under this head are included hemiplegia, the birth palsies, 
and paraplegia. The various forms of infantile paralysis (see 
above) come frequently under osteopathic treatment. Ordi- 
narily good success is had in curing them, or in materially bene- 
fiting conditions. Many require a long and patient course of 
treatment. Some are soon cured. In the paraplegias much 
is done to help out the retarded downward development of the 
motor pathway. It is upon account of the necessity of develop- 
ing this part of the cord that so many of these paraplegic cases 
are slow to be cured, yet these cases have often been cured. In 
a few such cases slight luxations or dislocations of the hip- joint 
have been found as the cause of the condition. 

In the majority of these cases of infantile paralysis, lesions 
of the cervical vertebrae, especially of atlas, axis, and upper ver- 
tebrae, is found. It" is doubtless due to difficult labor, the use 
of forceps, or rough handling in delivery. Some cases are doubt- 
less due to menigeal hemorrhage resulting from such causes. 
Lesion may be present in the upper dorsal spine, 

The TREATMENT is practically that described for the gen- 
eral case of paralysis. Correction of lesion is, of course, the 
indispensable part of the treatment. Its removal frequently 
at once results in cure, with but little additional treatment. 
The thorough general spinal and abdominal etc., treatment 
described for paralysis, q. v., should be applied to these cases. 
A long course of such treatment is the rule. The cervical treat- 
ment, and the treatment usually given to increase cerebral cir- 
culation should be given, both for the purpose of absorbing a 
possible clot upon the brain, and to help on the retarded brain- 
development. Some of these cases are probably due to polio- 
encephalitis, congenital encephalitis, or meningo-encephalitis. 
They are therefore chronic cases by the time they come under 
our treatment, and call for the ordinary treatment given chronic 
paraplegia, hemiplegia, etc. It is seen to be absolutely necessary 



PRACTICE OF OSTEOPATHY. 313 

to devote much treatment to increasing spinal and cerebral cir- 
culation, as before described, for the purpose of repairing the 
tissue changes that have taken place, in the form of sclerosis, 
vessel changes, etc. 

Spastic cases should be treated as directed for spastic par- 
aplegia. 

Prophylactic treatment should be given to avoid such se- 
quelae as epilepsy, choreic affections, tremors, athetosis, etc. 

Generally speaking, these cases should receive very careful 
systematic training to develop and control the muscles. 

In such cases as are affected by general convulsions or spasms 
of certain muscle groups, one may employ, to control such man- 
ifestations, hot baths (with mustard), enemata, etc. 

INFANTILE CONVULSIONS. 

(ECLAMPSIA.) 

Various kinds of convulsive attacks occur in children, some- 
times soon after birth, generally later. They may be due to 
much the same style of lesion as noted for infantile paralysis. 
Cervical lesion is common, leading to congestive conditions of 
the brain, cord, and meninges, and causing the convulsions. 

A far more common cause is lesion to that portion of the 
spine concerned in innervation of the gastro-intestinal tract. 
Gastro-intestinal irritation and debility result, and cause the 
condition. An overloaded stomach, intestinal parasites, denti- 
tion, phimosis, and other sources of irritation may be expected. 
The condition is frequently secondary to rickets, infectious dis- 
eases, etc. 

The PROGNOSIS in the ordinary case of convulsions in a 
child is good. It must be guarded in many cases. 

The TREATMENT at the time of the seizure must be to re- 
lax the spasms of the muscles, and to draw the blood away from 
brain and cord, equalizing circulation. Strong inhibition at the 
superior cervical region is the first step. The inhibition may be 
carried on down along the spine. It is usually best given with 
the patient lying on the side, while the spine is sprung and held 
at various points, relaxing the tissues and inhibiting the nerves. 
Sometimes the convulsion is at once relieved by continued strong 



314 PRACTICE OF OSTEOPATHY. 

inhibition at the superior cervical, splanchnic, and lower lumbar 
regions. This treatment acts by reaching, at these several places, 
the important vaso-motors in the spinal system. Warm baths 
are effective in checking convulsions, also one may make cold 
applications to the head. 

Further aid is given to equalizing the circulation by the re- 
laxing, inhibitive abdominal treatment before described. 

Attention must at once be given to the bony lesion, either 
re-adjusting it or relaxing the bony parts and tissues about it, 
in order to relieve the irritation from this source. All sources 
of reflex irritation are to be sought out and removed. Especial 
attention must be given to gastro-intestinal affections so often 
present. They are to be treated, according to their kind, as 
directed in the chapter on diseases of this region, In cases of an 
overloaded stomach the child should be caused to vomit. In 
enteritis an enema will afford immediate relief. 

Later the general health should be attended to. Lesions 
should be removed, and a thorough course of spinal treatment 
should be gone through. 

ANGIONEUROTIC ' EDEMA, or acute circumscribed edema, 
is a condition in which there is localized' edema in the skin or 
mucous membranes. It is to be treated by removal of obstruc- 
tion to the nerves supplying the part involved, and to the venous 
and lymphatic drainage of the part. The heart and general 
circulation should be stimulated. The condition of the nervous 
system must be looked after, as nervous disturbances in the pa- 
tient favor the occurrence of the edema. He should be quiet, 
and the general spinal and cervical treatment should be used. 
Gastro-intestinal disorder may be present and should be looked to. 

ERYTHROMELGIA, or red neuralgia, "is a chronic disease 
in which a part of the body usually one or more extremities 
suffers with pain, flushing, and local fever, made far worse if 
the parts hang down. 5 ' (Weir Mitchell). 

CASE: T. F., aet. 47, farmer, affected with erythromelalgia 
in both lower limbs. The feet were both affected, but the trouble 
never progressed above the ankles. They suffered from erupt- 
ions, fever, redness, distended veins, and great pain. The symp- 
toms were aggravated when the patient stood, or let the limbs 



PRACTICE OF OSTEOPATHY. 315 

hang down. Elevation of them afforded relief. Lesion was 
found in posterior condition of the lumbar vertebra, and of both 
innominate bones. The case was observed for some eight months. 
It had been practically cured at the time of this report. 

It is induced by exposure, rheumatism, a nervous temper- 
ament, occupations which require standing, abuse of alcohol, 
and traumatism. One finds lesions affecting the origin of the 
nerve-supply of the parts affected, or interfering with the cir- 
culation, thus weakening the parts and laying them liable to the 
action of the various exciting causes of the diseases. 

It should be treated as are neuralgia and sciatica, q. v. 
Ice cold applications afford relief, and rest with the limb placed 
in the horizontal position is recommended. Headache, dizzi- 
ness, palpitation of the heart, and fainting, if present, should be 
treated as before directed. Tonic treatment to the nervous 
system fortifies against the prominent tendency of the condition 
to recur. 

MENIERE'S DISEASE, or aural vertigo, is a disease of the 
labyrinth accompanied by vertigo, deafness, noises in the ear r 
vomiting, etc., usually occurring in the elderly. 

The lesions are such as are found in the great majority of 
ear cases, namely ; of the atlas, axis, and upper cervical vertebrae 
particularly. These may weaken the nerve-supply and circu- 
lation to the ears, and lay the patient liable to such direct ex- 
citing causes as exposure, gout, congestion, syphilis, irritation 
due to gastric disturbance, etc. 

The TREATMENT is directed to the removal of lesion, and 
to the direct exciting cause or disease. The main treatment, 
locally, should be cervical, and of the sort described in ear dis- 
eases. (See lesions, treatment, and anatomical relations in Dis- 
eases of the Ear). 

Treatment should be directed especially to the prevention 
of deafness. Cases may fully recover. Symptoms at the time 
of attack may be treated as necessary. Counter-irritation over 
the mastoid process is recommended. 



316 PRACTICE OF OSTEOPATHY. 

DISEASES OF THE MUSCLES. 

MYOTONIA CONGENITA, or Thomson's disease, "is character- 
ized by prolonged contraction of the muscles concerned in vol- 
untary movements when brought into action." This disease 
is said to be the rarest in medicine, and medical texts say that the 
disease cannot be cured, while practically nothing can be done 
by treatment. One case has come under osteopathic treatment, 
and was cured. It had been examined by numerous physicians 
and had been under the care of a celebrated neurologist, who 
had made special mention of the case as a typical one of Thorn- 
sen's disease. The case was cured merely by removal of spinal 
lesion, and by general spinal treatment. (See the "Journal of 
Osteopathy," Feby. 1899, p. 439). 

The lesions were of the 6th, llth, and 12th dorsal vertebrae 
.and of the 1st, 2nd, 3rd, and 5th lumbar. A report of the case 
10 months after the cure showed the patient still entirely well. 

The various forms of IDIOPATHIC MUSCULAR ATROPHY and 
HYPERTROPHY; pseudohypertrophic muscular paralysis, the ju- 
venile form of progressive muscular atrophy, and the facioscapulo- 
humeral form, all call for general spinal and muscular treatment. 
The central nervous sytem is held to be normal, as in the case of 
myotonia congenita, and the disease is said to effect the muscles 
alone. Yet, in myotonia congenita removal of spinal lesion and 
spinal treatment cured the case. It seems at least that treatment 
to the spinal system of nerves, as well as spinal lesion to them 
has a marked effect upon these idiopathic muscular conditions. 

Flexion, extension, rotation, etc., of the lirnbs and parts 
constitutes the muscular treatment for them. 

Symptomatic treatment may be added as necessary. 

NEURALGIA. 

CASES: (1) Severe facial neuralgia of two weeks standing, 
with inflammatory eruption upon the affected side, the right, 
and inflammation of the right eye. The usual treatments had 
been tried for two weeks without avail. The lesion was a marked 
displacement of the atlas to the left. It was corrected and the 
case was cured in one treatment. 



PRACTICE OF OSTEOPATHY. 317 

(2) Facial neuralgia affecting the right side of the face and 
head, especially the forehead over the right eye. The lesion was 
luxation of the atlas to the left. The case was cured in one treat- 
ment. 

(3) Facial neuralgia of two years standing was greatly re- 
lieved 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 lux- 
ation 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 two 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 
upper spinal region as low as the sixth dorsal vertebra, drawing 
together the upper five ribs on the left side and causing inter- 
costal neuralgia in this region. In two weeks the pain was over- 
come and the arm began to develop. The case was cured. 

(6) Brachial neuralgia of more than one years 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 treatment 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. Spinal and rib lesion corrected. 

(9) Intercostal neuralgia due to heavy lifting, so severe 
that the patient was unable to sit erect without great pain. Le- ' 
sion was depression of the 3rd and 4th ribs on both sides. Im- 
mediate relief followed treatment, and the case was cured in four 
weeks. 

(10) Intercostal neuralgia of ten years standing, causing 



318 PRACTICE OF OSTEOPATHY. 

an intense pain in the left side, extending to the abdomen. Le- 
sion 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 
continually thirty-six hours during each' menstrual period. Le- 
sion 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 exami- 
nation 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 6th and 7th dorsal verte- 
brae. Improvement followed one treatment, and the case was 
cured in about one year. i 

(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 sev- 
eral years standing. Lesion was at the third cervical vertebra, 
which was corrected in a few treatments, removing the condit- 
ion. 

(16) Tic Douloureux of twelve years standing. The pain 
would occur spasmodically in the infar-orbital terminals of the 
fifth nerve, at intervals of from three to ten minutes. Lesion 
was found in a displaced atlas, which was corrected in six weeks, 
curing the case. 

DEFINITION: "Neuralgia is a pain in the course of a nerve 
unaccompanied by structural changes." It is due 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 ?.re usually bony, 



PRACTICE OF OSTEOPATHY. 319 

and these act by pressing directly upon a nerve or by affecting 
centers or sympathetic 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 1 or 2 it is evident that le- 
sion of the atlas was too low to affect the nerve involved, 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 conec- 
tions in the upper part of the cervical region, 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 bony lesion in neuralgia is a luxated ver- 
tebra, such a cause having been known to produce neuralgia in 
any part of the body. (See cases 1, 5, 7, 11, 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 be- 
come displaced and impinge upon the adjacent nerve, causing 
neuralgia. Frequently the cause of irritation is pressure of con- 
tractured tissues upon the nerve. This occurs at the foramina. 
The tissues at and about the foramen become congested or con- 
tractured, pressing upon the nerve. These contractures may 
occur along the spine, as in case 4. Contractures of the inter- 
costal muscles may draw the ribs together, irritate the nerves and 
cause the neuralgia. Contractures are often the direct irritating 
cause in cases of neuralgia due to exposure, traumatism, etc. 

The lesion may be one causing a primary disease, as rheu- 
matism, gout, or specific infectious disease, allowing of the gen- 
eration of poisons in the systems, which affect the nerves by cir- 
culating in the blood. 

In Tic DOULOUREUX the lesion is usually at the atlas, but 
often is found among the other upper cervical vertebrae. Con- 
tracture 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. 



320 PRACTICE OF OSTEOPATHY. 

In INTERCOSTAL neuralgia occur lesions of vertebrae at the 
origin of the nerves affected, or of the ribs, and of the spinal and 
intercostal muscles. 

MASTODYNIA, or neuralgia of the breast, occurring generally 
in women, is due to similar lesions as intercostal neuralgia. Com- 
monly one finds rib lesion in the region affected. 

LUMBO-ABDOMINAL neuralgia, marked by pain in the lum- 
bar region, hypogastrium, 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 vertebrae, of the first rib, clavicle, and of the upper dor- 
sal vertebrae. It may be caused by vertebral lesion anywhere 
from the atlas to the sixth dorsal. 

Neuralgia in the LOWER LIMBS is due to lumbar, sacral or 
innominate lesions. VISCERAL NEURALGIA, as of stomach or 
intestines, is caused by vertebral lesion of the corresponding 
spinal region. COCCYGODYNIA is caused by displacement of the 
coccyx, but may also be due to sacral, lumbar, or innominate 
lesion, leading to interference with the nerves by pressure, con- 
tracture of tissues, etc. Neuralgia in the FEET, in addition to 
spinal and pelvic lesion, is often due to lesion of the small bones 
of the feet. This is the case in MORTON'S PAINFUL TOE, META- 
TAESALGIA, etc., in which subluxaticns among metatarsals or 
phalanges cause pressure on the nerve. These conditions often 
occur in heavy persons who arc much on the feet. Often in such 
persons lithaemic, or gouty, or rheumatic diatheses are present, 
and contributing to the condition. Treatment must consider the 
whole condition. Sometimes the lesion is difficult of permanent 
and quick adjustment, owing to the weight of the person, who is 
more or less about. Under such conditions a well-placed pad of 
felt affords great relief, as a temporary measure. It should be 
about 1 inch, by 2 or 3 inches, by ^4 inch. 

FLAT-FEET sometimes give great trouble in the same manner, 
in the same class of cases, namely lithaemic, etc. Not only may 
the feet be painful and troublesome, but in some cases the pain 
may not be in the foot, but in the ankles or shins, perhaps well 
up toward the knee. 

The PROGNOSIS is good in all kinds of neuralgia. Cases of 



PRACTICE OF OSTEOPATHY. 321 

long standing often yield at once. A few treatments, or a single 
treatment commonly, at once relieve the pain. Permanent cure 
is usually accomplished. 

The TREATMENT is simple. Often the removal of lesion is 
sufficient to. entirely cure the condition. The lesion should 
always be removed as soon as possible. Likewise any cause of 
irritation must be removed, as an ulcerated tooth, a cicatrix, a 
growth in the nose, etc. Constitutional conditions giving rise 
to neuralgic states must be met according to the case. 

Relaxation of all contractured muscles must be accom- 
plished. The manipulation is carried over the course of the af- 
fected nerve, relaxing the tissues about it. The pain of the 
disease does not prevent this local treatment. 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 applied to any special 
variety of the disease. Tic Douloureux often yields at once to 
light manipulation over the course of the affected branches upon' 
the face. (Chap. V. B.) 

SCIATICA. 

Sciatica is a disease in which Osteopathy has secured par- 
ticularly brilliant results. Great numbers of cases have been 
cured, many of them having 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 5th lumbar vertebrae, 
lesions of the first and second sacral nerves by contracture of 
the tissues about them, innominate displacement, slipping of the 
sacro-iliac joint and derangement of its ligaments, displacement 

21 



322 PRACTICE OF OSTEOPATHY. 

of the sacrum, and derangement of the coccyx, are all important 
forms of lesion producing sciatica. These lesions impinge the 
fibres. Some may directly press upon the nerve. 

A frequent cause of sciatica is contracture of the pyriformis 
muscle 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 displace- 
ment of the llth or 12th rib may cause it. 

The TREATMENT is simple. It calls for the immediate re- 
moval of the source of pressure or irritation by correction of 
lesion. A general relaxation of the tissues about the nerve and 
about its connections is done, due attention being given to re- 
laxation of ligaments, as at the sacro-iliac articulation. 

This relaxation of the tissues should be carried along the 
femoral vessels, often thus relieving the condition in an im- 
portant 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 circumduction is used 
to relax the pyriformis muscle. 

The sciatic nerve should be well stretched by one of the 
methods described. (Chap. X.) 

Other forms of neuritis call for treatment upon similar lines 
to those followed in the treatment of sciatica. 

A LOCALIZED NEURITIS commonly shows obstructive le- 
sion to the nerves supplying the part. Such lesion is often the 
direct source of irritation causing the neuritis. In some cases it 
weakens the local nerve mechanism. 

In BRACHIAL NEURITIS, a common lesion is pressure of 
the first rib or clavicle upon the brachial plexus. Vertebral 
lesion in the cervical and upper dorsal region (4th cervical to 
2nd dorsal) is often the cause. Lesions of the upper three ribs. 
irritating the upper two intercostal, which join the brachial 
plexus, may be causative factors. One finds also slight slips at 
the shoulder or elbow joint, contracture of the cervical muscles 
and other tissues, and contracture of the tissues along the course 
of the plexus and the cords formed from it. 



PRACTICE OF OSTEOPATHY. 323 

MULTIPLE NEURITIS is almost always due to the toxic ef- 
fects of alcohol. 

The TREATMENT in neuritis is especially to remove the 
source of irritation to the nerves. In localized or brachial neur- 
itis this is usually at once accomplished by removal of bony or 
muscular lesion. This source of irritation must be sought from 
the origin of the nerves supplying the part involved out along 
the course of them. Relaxation of muscles along these nerves 
is usually of considerable benefit. Movements should be used 
to stretch the nerves affected. In these ways the circulation to 
the nerve is corrected, and the inflammation is reduced. Any 
toxic condition of the system should be carefully treated. If 
the neuritis occurs after gout, diphtheria, influenza, etc., atten- 
tion must be given to purifying the blood, and to excreting the 
poison from the system by way of the kidneys, liver, bowels, and 
skin. These remarks apply especially to multiple neuritis. If 
it be due to excessive use of alcoh'ol, abstinence should be en- 
forced. In such cases treatment must be given the whole spinal 
system, and the general health must be looked to. 

INSANITY. 

CASES: (1) 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 become. Lesion was found as a 
marked displacement of the third cervical vertebra to the right. 
It was set at once, and the patient immediately fell asleep, sleep- 
ing for twelve hours and awaking rational. In a few days the 
patient was well. 

(2) A young lady, violently insane for six years. 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 years previous to the 
development of the insanity, and it was thought that the luxa- 
tion of the atlas was 'caused then. 

(3) A young woman of twenty-four, insane and confined 



324 PRACTICE OF OSTEOPATHY. 

in an asylum for eight months. Lesion existed in the form of 
a double lateral curvature in the lumbo-dorsal region; 5th lum- 
bar vertebra posterior;. 4th dorsal markedly posterior; 3rd and 
5th dorsal anterior; 7th and 8th right ribs pressing upon the liver; 
innominates, one forward and the other back, one limb being 
1 inch longer than the other. Treatment directed to the cor- 
rection of these lesions caused immediate benefit, and the pa- 
tient was apparently well after two weeks treatment. 

(4) In a lady of twenty, insanity of two months standing. 
There was a history of attacks of marked cerebral congestion. 
At times she became violent. The lesions were great tender- 
ness and tension in the cervical region above the 4th vertebra, 
but no bony lesion; tenderness at the 5th lumbar vertebra and 
over the left ovary. Dysmenorrhoea was present. After the 
first treatment she slept for 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 sufficed to cure the case. 

(6) A lady of thirty-eight, who had been a chronic sufferer 
from rheumatism, had become insane ten years previously 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 suffered hal- 
lucinations. The lesions were such as pertained to the rheumatic 
condition; general muscular contracture, joints somewhat stiff- 
ened, tenderness over the kidneys, feeble pulse, and subnormal 
temperature. One month of treatment showed great improve- 
ment; after two months the menses were re-established and the 
mind was nearly normal. Recovery was complete. 

(7) Insanity in a man followed injury in a runaway 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 cervical muscles. Continued pain existed at the 
top of the head, there was an eruption upon the face, and a 



PRACTICE OF OSTEOPATHY. 325 

marked abnormal pulsation of the abdominal aorta. Treatment 
soon cured the case. 

(8) Insanity of three weeks standing in a lady, in whose case 
the cause was found to be an anteversion of the uterus. A fact 
that had been quite overlooked in her long course of medical 
treatment. Osteopathic treatment was given this condition, and 
the drugs were discontinued. In two weeks the patient became 
rational, and in seven weeks was entirely cured. 

The cases are illustrative of osteopathic practice in insanity, 
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. Five of the above eight cases 
presented such lesion. Atlas lesion is frequent. In some cases 
are general spinal lesions leading to effects upon the nervous sys- 
tem. Often marked lesion is found in the dorsal region. Mc- 
Connell 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 w r ith cerebral circulation, prob- 
ably in some cases by pressure upon the cord, and also by affect- 
ing the nervous system and setting up reflexes. On the whole 
but little can be said definitely in regard to the pathology of in- 
sanity 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 noticeable that quick results usually 
follow treatment, as in the eight 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 by 
cerebral congestion, in which the impeded circulation is at once 
restored to normal tension by 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 by deranging 



326 PRACTICE OF OSTEOPATHY. 

the cerebral circulation, either by direct pressure upon the ver- 
tebral arteries by a displaced vertebra, by irritation to cervical 
sympathetics 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 upon 
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 venous return and in- 
creased arterial tension in this region might result from lesion 
and cause cerebral hyperemia. Many cases of insanity are met in 
which there is hyperemia, as in cases 4 and 7. 

That hyperemia and anemia are important in relation to 
insanity is shown by the statement of Kellogg that "insanity 
from circulatory disorders of the brain arises chiefly in intense 
hyperemic and anemic forms." That osteopathic lesion pro- 
foundly affects cerebral circulation is evidenced by many facts 
in the treatment of various diseases. The importance of these 
circulatory disturbances is further indicated by Kellogg 's state- 
ment that vascular degenerations deprive the brain of its cus- 
tomary blood-supply and also prevent elimination of the waste 
products of cellular activity. It is evident that the lesion shut- 
ting off the arterial supply or preventing free circulation in the 
brain cquld act as could vascular degeneration in producing the 
effects mentioned. Kellogg says it is freely admitted that there 
is a previous link in the chain of events leading to insanity from 
such causes as he mentions above. This link the Osteopath sup- 
plies by noting these important 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 rela- 
tions to the superior cervical ganglion and the medulla. It does 
not seem that this and other cervical bony lesion cause direct 
pressure upon the cord, as in such case one would expect par- 
alysis in the body below, yet it is not impossible that it may 
press directly 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 



PRACTICE OF OSTEOPATHY. 327 

from a study of nervous diseases, (see Paralysis) in this way 
leading to nervous 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 fundamentally involved in the causation of insanity." 
(Kellogg.) The splanchnic, right rib, and renal lesions noted 
by osteopathy as present in insanity cases may cause insanity 
through derangement of kidneys, liver and gastro-intestinal 
tract. The fact is noted by writers upon insanity that kidney 
diseases, notably Bright's disease, and gastro-intestinal condi- 
tions, as gastric and intestinal catarrh, are sometimes closely 
associated with the causation of insanity. Likewise liver dis- 
ease is well known to be closely connected with insanity, 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 insanity by visceral affections and periph- 
eral nervous diseases. The vaso-motor center in the medulla 
is under the reflex control not alone of the cerebral cortex, but 
of the entire peripheral distribution of the sensory nervous sys^ 
tern, so that not only emotional stimuli, but peripheral irritations, 
may affect circulatory changes and variations in the blood-pres- 
sure which stand in proximate relation to mental disorder. ' ' 

It is a well demonstrated fact that osteopathic lesion causes 
not only the visceral diseases, but likewise marked vaso-motor 
disorders, etc., apparently so closely related to these brain con- 
ditions. 

In view of these various facts it seems that the Osteopath 
has in insanity 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 accident and the like are the causes of in- 
sanity. But as it is evident that the various lesions, bony and 
otherwise, that he finds may become fundamental to the causa- 
tion of insanity through producing visceral, nervous, and vaso- 
motor disorders, his field in insanity must be as broad as the disease. 

The PROGNOSIS is good. The most brilliant and quickest 
results are often attained. A large percentage of the cases treated 



328 PRACTICE OF OSTEOPATHY. 

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 circu- 
lation. A congested condition is treated as in congestive head- 
ache or apoplexy, q. v. The abdominal inhibition may be em- 
ployed. The general health is looked to, 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. 

DISEASES OF THE EYE. 

CASES: (1) Impaired vision in a boy of seventeen, who 
had been wearing glasses over three years. Severe headache 
and inability to read followed removal of them. Lesion was 
found as lateral luxation of the atlas and third ceivical verte- 
bra. 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) A case in which weakness of the eyes and rheumatic 
pains in the shoulder were caused by lesion in the form of close- 
ness of the second and third cervical vertebrse. After one treat- 
ment the glasses were laid aside and the pain in the shoulder 
was gone. The trouble, caused by a fall in a gymnasium, affect- 
ed but one eye and one side of the body, a nervous twitching of 
the muscles being present. 

(3) 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 minutes. Lesion was of the 2nd dorsal vertebra, 
lateral to the left. After five treatments the glasses were dis- 
carded. 

(4) In a lady of forty, weakness of the eyes, accompanied 
by great pain in the eye-balls and at the base of the brain. Le- 
sion existed at the atlas and third cervical vertebra. Constipa- 
tion and uterine prolapsus were present, with characteristic le- 
sions. After one month the eyes were almost well. Photopho- 
bia was a feature of the case. 



PRACTICE OF OSTEOPATHY. 329 

I 

(5) In a case of weak eyes, with pain in the neck, occipital 
headache, and a complication of 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 for- 
ward. 

(6) In a case of weak eyes in a young man of twenty, of two 
months standing, the patient was unable to read, the balls were 
injected and painful, and the lids were inflamed. The atlas and 
:axis were too close. 

(7) In a lady of thirty-two, weakness of the eyes and chronic 
hoarseness 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. 

(8) In a case of weakness of the eyes, coupled with indi- 
gestion, jaundice and hemorrhoids, the 7th to llth dorsal verte- 
bra were posterior; coccyx anterior; and innominate forward. 

(9) Extreme weakness of the eyes, together with female 
disease. A few minutes use of the eyes caused violent head- 
.ache. Lesions were at the atlas and in a tilting of an innominate 
bone. The case was cured by removal of the lesions. 

(10) Eye trouble in a boy of thirteen, not benefited by 
glasses. Patient was very nervous. The atlas was slipped for- 
ward. The lesion was corrected and the case was cured in six 
weeks. 

(11) 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 adjust- 
ment of cervical lesion. 

(12) Pterygium over each eye due to lesion of -the atlas. 
Under treatment gradual correction of the lesion was accompanied 
by gradual absorption of the growth. 

(13) Partial blindness and strabismus, associated with 
general paralysis, due to a forward slip of the head upon the atlas. 
'The case was cured in two months. 

(14) A case of blindness from optic-nerve atrophy, due to 
.a fall from a swing, resulting in lesion of the atlas and several 



330 PRACTICE OF OSTEOPATHY. 

cervical and upper dorsal vertebrae. The disease was of twenty- 
three years standing. It was cured by two years treatment. 

(15) Blindness of one eye, and almost total loss of sight in the 
other, of about a years duration, was cured in two weeks by cor- 
rection of lesion of the atlas, which was displaced to the right, 
and of one of the first ribs, which was luxated upwards. 

(16) Partial blindness, the patient being unable to read or 
to recognize a person ten feet away. The trouble was due to 
starvation of the optic nerve from lesion of the upper cervical 
vertebra. In four months the patient had been cured. 

(17) Blindness, almost total, in a man of sixty, due to a 
fall when he was a child. Lesion was found as luxation of a 
cervical vertebra. The treatment so benefited the eye that it 
could see to read coarse print. 

(18) 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. 

(19) Total blindness with paralysis of lower limbs, formica- 
tion 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 lumbar vertebrae. Soon vision was 
partly restored, but with diplopia. Slight pressure upon the 
seventh cervical vertebra would at once restore perfect vision. 
When pressure was removed diplopia again occurred. L r nder 
the treatment the sight was entirely restored. Speech had been 
lacking, but was restored, and the paralysis was cured. 

(20) In a young man of twenty, diplopia of two years dura- 
tion had followed a severe attack of measles. The 3rd cervical 
vertebra was displaced anteriorly and the tissues about it were 
sore. Tenderness existed also at the 5th and 6th cervical verte- 
brae. The first dorsal was posterior, the 2nd to 6th flattened, 
the 8th to 12th weak, with a separation between the 12th dorsal 
and 1st lumbar, and the 1st to 4th lumbar vertebras were pos- 
terior. The case was cured in one month. There had been 
supposed hemorrhagic retinitis. 

(21) A case of strabismus due to lesion of the 2nd dorsal 
vertebra was cured by correction of the lesion. During the 



PRACTICE OF OSTEOPATHY. 331 

course of treatment, after the eyes had first become straight- 
ened, pressure upon the second dorsal vertebra would cross them 
again. 

(22) A case of strabismus, unilateral, convergent, due to a 
fall in a runaway accident. The atlas was displaced to the right; 
4th and 5th cervical vertebrae anterior. The case was improving 
under treatment. 

(23) Kerito-conjunctivitis, in the left eye, of four years 
standing. There was opacity of the upper two-thirds of the 
cornea, with marked vascularization, inflammation and granula- 
tion 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 pos- 
terior. Under the treatment the case was almost cured in less 
than two months. 

(24) In a man of thirty-seven, glaucoma was present, and 
total blindness of the left eye was predicted by the oculist. The 
patient was a neurasthenic, probably of the cerebral type, pain 
in the head and eye being extreme. The eye-trouble was over- 
come and the patient's general condition much improved by 
three months treatment. No special lesions were found. 

(25) Partial blindness, in which the blindness was limited 
to a circular portion of each eye. Lesion was found as a luxa- 
tion of the atlas to the right and backwards. The case is still 
under treatment. 

(26) 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 gradually disap- 
peared. The case was well a year later. 

(27) Eye-strairi, 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 
treatments. The case had been of but two or three months 
standing. 

(28) Astigmatism in a girl of ten. Lesion was found at 
the 2nd dorsal. Treatment was directed to correction of this 



332 PRACTICE OF OSTEOPATHY. 

lesion and to stimulation of the ocular blood and nerve-supply. 
The case was soon cured. 

(29) In astigmatism for which the patient had worn spec- 
tacles for nine years, lesion was found in anterior luxation of the 
atlas and a twist of the inferior maxillary bone. The glasses were 
permanently discarded after one treatment, and the case was 
soon entirely cured. 

These reports illustrate very well the general lesions found 
in diseases of 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 cervical region is frequently involved, 
or any one or several of the vertebra may be luxated. Perhaps 
the more important lesions are of the atlas, axis, and 3rd cervical 
vertebra. The 4th and 5th are also important. 

Other bony lesions occurring in these cases, and of import- 
ance in eye troubles generally, are luxation of the inferior max- 
illary bone and of the first rib, sometimes also of the clavicle. 

There is a form, of neck lesion that often plays a part in the 
production of eye disease, as well as of other forms of head and 
neck trouble. It involves the whole cervical region, often causing 
a lateral swerve of the cervical spine. The cervical tissues are 
contractured or hypertrophied upon one side more prominently 
than upon the other. The condition is often evident upon simple 
inspection 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 
are readily pressed more deeply into the tissues upon one side 
of the posterior cervical aspect than upon the other. Contrac- 
ture of the muscles may be felt here on both sides. If the verte- 
brae 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 vertebra with the patient 
lying 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 eye. 



PRACTICE OF OSTEOPATHY. 333 

A case is reported in which pressure between the 2nd and 3rd 
dorsal vertebrae upon the right side revealed tenderness at that 
point and also caused pain in the eye. 

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 bony. 
It involves chiefly the upper four or five vertebrae, but may ex- 
extend as low as the 6th or 7th. The lesions of the 1st, 2nd and 
3rd dorsal vertebras are the most important here. A common 
abnormality of the anatomical parts here is a "hump" or prom- 
inent cushion of flesh covering the spinous processes of the upper 
two or three dorsal vertebrae. There is often conjoined with this 
condition a marked prominence of the first dorsal spine from 
above, as if the cervical spine had been moved a little anteriorly 
upon the first dorsal. This cushion 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 lesion of 
the upper ribs on either side as low as the sixth, sometimes 
thought to have bearing upon nutritional disturbances of the 
eyes. 

We are perhaps not in a position as yet to point out that 
special kinds or locations of lesion result in specific diseases of 
the eye. Cases involving deficiency 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 appara- 
tus of the special sense of sight was involved, such as weakness, 
impaired vision, blindness, etc., show lesion chiefly in the upper 
cervical region. All but 2 cases show cervical lesion, 13 of them 
being entirely in the cervical region; 11 at the atlas; 8 at the 
axis, third, or both; also the 4th, 5th and 7th were involved. The 
most important lesions occurred about atlas, axis and third. 

Cases in which there is nutritional disturbance, as in con- 
junctivitis, keratitis, glaucoma, cataract, and closure of the 
tear-duct, also cases in which there is structural change, such as 
astigmatism, pterygium, etc., probably due to lack of nutrition, 
present atlas, general cervical, inferior maxillary, and upper 
dorsal lesion. Compilations of data, by which proof of these 



334 . PRACTICE OF OSTEOPATHY. 

might be made, are lacking. Yet it seems that nutritional dis- 
turbances, 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 lesion and more from about 
the third cervical down to the upper dorsal. In this connection 
it is recalled that diplopia has been caused by pressure at the 7th 
cervical, and strabismus by pressure at the 2nd dorsal. 

This phase of the subject, inquiry how far specific lesion re- 
sults in certain forms 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 rea- 
sons why lesion in the upper dorsal and cervical regions causes 
eye disease. These portions of the spine are particularly rich 
in nerve connections with the eye. These lesions act by dis- 
turbing blood, nerve, or lymphatic-supply of the eye. The blood- 
supply suffers sometimes by direct impingement, as of vertebrae 
upon the vertebral arteries, or by derangement of the vaso-motor 
control by lesion to the nerves. The lymphatics suffer by direct 
impingement, as by clavicular lesion damming back the lymphatic- 
drainage from the head. The lesion affecting the eye does so 
chiefly, however, by disturbance of the numerous important nerve- 
connections met in the upper dorsal 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 by 
lesion of atlas, axis, or 3rd cervical, sends its ascending branch 
to join the carotid and cavernous plexuses, thence to help form 
a secondary plexus about the ophthalmic arteries and to con- 
tribute branches to the minute plexus of the sympathetic within 
the eye-ball 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 orbit, between 
the trunk of the optic nerve and the external rectus muscle. 



PRACTICE OF OSTEOPATHY. 

In this situation it is readily impinged by that treatment that 
presses the eyeball back into the orbit. With this ganglion are 
connected the 3rd, 5th, and sympathetic nerves, it thus becom- 
ing, through the functions of these nerves, 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 
way deranging the function of the ganglion with regard to the eye. 

The third cranial nerve innervates all the voluntary mus- 
cles of the -eye except the external rectus and the superior ob- 
lique. It is, further, the nerve which contracts the pupil by sup- 
plying the sphincter function of the iris. This function is shown 
by the American Text-Book of Physiology to have its center in 
the superior cervical ganglion, where it could be affected in le- 
sion of the upper cervical region, causing disturbance of accom- 
modation in the eye. Neck lesions are know r n to cause strabis- 
mus and diplopia (cases 19 and 21), showing disturbance by such 
lesion of the function of the 3rd nerve. (Also of the 4th and 6th). 
The anatomical relations in strabismus caused by lesion at the 
2nd dorsal, and in diplopia by lesion at the 7th cervical, are 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 dilators of the pupil, are found rising in the third ventricle, 
whence they pass through the medulla and cervical cord to the 
anterior roots of the upper dorsal nerves and to the first thoracic 
ganglion of the sympathetic. From these points they reach the 
eye via the cervical sympathetic cord, ophthalmic division of the 
fifth, and its nasal and long ciliary branches. 

These facts indicate the importance of upper cervical, gen- 
eral cervical, and upper dorsal lesion in the causation of lack of 
accommodation, eye-strain, and similar troubles. 

The latter sympathetic connection indicates the so-called 
cilio-spinal center at the 4th cervical to 4th dorsal. Quain states 
that these pupillo-dilator fibers pass from the 1st, 2nd and 3rd 
nerves, sometimes also from the^Tth and 8th cervical. 

In addition to the above, motor fibers to involuntary mus- 
cles of the orbit and eye-lids pass from the upper four or five 
dorsal nerves. Also retinal fibers leave the sympathetic at the 



336 PRACTICE OF OSTEOPATHY. 

superior cervical ganglion, pass to the Gasserian ganglion of the 
fifth, thence through its branches to the eye. It is shown that, 
acting through these fibers, stimulation of the cervical sympa- 
thetic causes constriction of the retinal arteries, while stimula- 
tion of the thoracic sympathetic causes dilatation of them. These 
facts indicate the importance of cervical and upper dorsal lesion 
in vaso-motor disturbances 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 dor- 
sal sympathetic, and the fifth nerve, consequently the potency of 
cervical and upper dorsal lesion to affect 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 section of the fifth nerve is followed by keratitis and ulcera- 
tion. It has charge of the nutrition of the eye-ball, supplying 
also the lachrymal glands, conjunctiva, skin of the lids and ad- 
jacent parts of the face. *Nutritive disturbances of the eyes, 
such as keratitis, conjunctivitis, retinitis, cataract, glaucoma, 
pterygium, 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 branches 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: 

1. The superior cervical ganglion and its sympathetic con- 
nection with the local sympathetic plexus of the eye-ball. 

2. The various cervical nerves, and through them the gang- 
lion and the other cervical sympathetics. 

3. The pupillo-constrictor center in the superior cervical 
ganglion. 

4. The pupillo-dilator center in the same ganglion and at 
at the lower cervical and upper three dorsal nerves. 

5. The motor fibers from the upper four or five dorsal nerves 



PRACTICE OF OSTEOPATHY. ' 337 

to the involuntary muscles of orbit and eyelids. 

6. The fifth nerve by its connections with the superior cer- 
vical ganglion and cervical sympathetic. 

7. Constrictors of the retinal arteries in the cervical sym- 
pathic. 

8. Dilators of the same in the thoracic sympathetic, and 
both of these at the superior cervical ganglion. 

It is noticeable that all of these eight connections, except 
perhaps No. 5, may be reached at the superior cervical ganglion. 
This explains the special importance of lesion to atlas, axis and 
3rd cervical, 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 fibers congrega- 
ted in the superior cervical ganglion we must conclude that 
lesion of the atlas, axis, or third, ' etc., affecting this ganglion, 
would cause a variety of diseases of the eye. 

Lesions causing stomach, kidney, and pelvic diseases may 
secondarily become the cause of disturbances in the eye. The 
relation here is probably entirely reflex. Perhaps also in these 
conditions alteration of blood-pressure 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- 
vical lymphatics into the thoracic or right lymphatic duct, may 
affect the metabolism of the eye. It has been thought that le- 
sion affecting the female breast may react, upon the eye reflexly. 

The PROGNOSIS in eye-diseases is, generally speaking, good. 
Marked results, even to cure of blindness of many years stand- 
ing, have been acquired. Very often suprisingly quick results 
have been attained. An examination of the case reports at the 
opening of this chapter will show that in twenty-four of the 
thirty-three various cases reported a cure was affected. Quick 
results, either as cure or benefit, were attained in seventeen cases. 
The 'cases met by the Osteopath are frequently of long standing 

*For important functions of the fifth nerve see "Principles of Osteopathy." 1 

o., . , 



338 PRACTICE OF OSTEOPATHY. 

and in bad condition. In many cases these results were gotten 
after specialists had failed. All cases cannot be cured. Many 
are subjects for the specialist. 

The TREATMENT of eye-diseases is necessarily almost en- 
tirely upon the neck, as it has been shown that the lesions in 
these cases occur here. The removal of the these various lesions 
is already understood from discussions in the previous pages. 
The treatment looks, in general, to the establishment of per- 
fect circulation, and the regulation of the nerve-mechanism. 
The general neck treatment, as applied in cases of insomnia, 
headache, apoplexy, etc., q. v., given with a specific object in 
view, would be the method employed (see also Chap. Ill and IV). 

In many cases the simple removal of lesion is the only treat- 
ment required. Often this treatment and the general neck treat- 
ment may be supplemented by local treatment upon the eye, 
and about it, reaching its nerve-mechanism and blood circula- 
tion directly. (See Chap. V, A. and B) This work includes 
treatment to the fifth nerve as the one being in charge of the nutri- 
tion and circulation of the eye. This nerve is particularly re- 
garded in all nutritive diseases, such as keratitis, and in all in- 
flammatory, hyperemic or anemic conditions, such as conjunc- 
tivitis, 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 conjunctivitis the same treatment is made. 
The granulations must be broken down. (Chap. V). After 
this the correction of the circulation 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 



PRACTICE OF OSTEOPATHY. 339 

growth, as in case 15. Sometimes light manipulation over the 
closed lids 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 le- 
sion alone. The muscles may be treated directly 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 treatment about the eye and upon 
the fifth nerve, all as before described, have successfully accomp- 
lished a cure in these cases. In such cases, Dr. Still says that 
the crystalline lens is disarranged. He holds one fingerc lose 
against one side of the eye-ball, with the lid closed, and thumps 
this finger with the index finger of the other hand, to jar the ball 
and straighten the lens. 

In the various optic nerve troubles, also, the treatments 
"are used to affect the nerve through its blood-supply. Nu- 
merous cases of blindness from optic-nerve atrophy have been 
cured in this way. The optic nerve be may stimulated by tap- 
ping or pressure upon the eye-ball. (II, III, Chap. V.) Ret- 
initis likewise yields to this treatment. 

In conjugate deviation, both eyes turning strongly to one 
or other side, the lesion, usually cervical, affects the third and 
sixth nerves, supplying respectively the internal rectus and the 
external rectus of the eye-ball. The treatment is local and 
cervical. 



DISEASES OF THE EAR. 

CASES: (1) Deafness of two years duration in a lady of 
forty-two, caused by displacement of atlas to the right, tighten- 
ing muscles and ligaments around the ear and lower jaw. Ten- 
derness was extreme in the cervical region. Dry catarrh was 
present. There was lesion of the 2nd cervical vertebra. The 
patient had been injured in a railroad wreck, being confined to 



240 PRACTICE OF OSTEOPATHY. 

bed. She could not hear a clock 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 completely restored. 

(2) Deafness in a young boy, due to lesion of the atlas. 
The deafness was complete in one ear, and almost so in the other. 
After one months treatment he could hear conversation spoken 
in an ordinary tone. 

(3) In a boy 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. 

(4) In a boy of eleven, partial deafness in, and continual 
discharge from, one ear. The lesion was a slip of the atlas. 
The case was cured in one months treatment. 

(5) In a young lady, an abscess in one ear had been dis- 
charging for several months. After one treatment there was no 
further discharge, and after four treatments the trouble had 
disappeared. 

(6) In a young lady, partial deafness of some years stand- 
ing, continually growing worse. Several members of her family 
are afflicted in the same way. An ear specialist had pronounced 
her case hopeless. Lesions were luxation of the 2nd and 3rd 
cervical vertebrae; thickened tissues at the base of the skull; 
irregularity of the upper dorsal vertebrae. The entire treatment 
was directed to the head, neck, and upper dorsal region, with the 
result that after one months treatment the patient could hear a 
watch tick at double the distance that she could upon beginning 
treatment. 

(7) A case of growing deafness, of some years standing, in 
a gentleman who had given up his profession upon this account. 
Lesion was found at the atlas, which was turned backward and 
to the left. Upon its adjustment the hearing was much im- 
proved. 

(8) Complete deafness in the left ear, and partial deafi 

in the right ear, complicated with facial neuralgia, of about 20 
years standing. The atlas was posterior and to the left. In 
two months treatment great improvement was made. 



PRACTICE OF OSTEOPATHY. 341 

(9) A case of intense earache of years standing. The atlas 
was displaced slightly to the right. This was adjusted at the 
first treatment, and no earache appeared after that. 

The LESION in ear diseases, as illustrated by the above cases, 
is almost as a rule in the atlas and axis. The 3rd cervical 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 luxation of the temporo-max- 
illary articulation, impinging probably the articular fibres of the 
auriculo-temporal branch of the inferior-maxillary division ^of 
the fifth nerve, and contractured tissues about the upper cer- 
vical region and the angle of the jaw, may act as lesions in these 
diseases. 

The fifth nerve supplies the external auditory canal by its 
auriculo-temporal branches, the upper one of which sends a 
branch to the tympanum. Also the vidian of the fifth sends 
nasal branches to the membranes of the end of the Eustachian 
tube. The internal throat treatment, given to affect this tube, 
does so by stimulating these fibres, thus freeing the secretions 
in this portion of the Eustachian tube. Reasoning by analogy, 
doubtless the secretory, trophic, and vaso-motor functions of 
the fifth nerve with relation to the eye and other parts of the head 
and face are extended to the ear, secretion of cerumen and cir- 
culation about the ear being to some extent under control of the 
fifth. Experience connects lesions of this nerve with ear-dis- 
eases. It has been shown that the nerve suffers from lesion of 
the upper cervical region, such as occur in ear-troubles (see Dis- 
eases of the Eye). The treatment of this nerve, so important 
in nasal catarrh and other inflammatory affections of the eye, 
nose, and parts of the head, is important likewise in these catarrhal, 
inflammatory, and other circulatory troubles, so commonly com- 
plicated with the diseases of the ear. 

Vaso-constrictor fibers for the ear are contained in the cer- 
vical sympathetic. 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 
iiH'd'ulla, \vhich suffers from these lesions. It is possible that 
vaso-motors for the head exist in the upper dorsal nerves, though 



342 PRACTICE OF OSTEOPATHY. 

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 pneumogastric nerve has an auricular branch, and is 
in close connection 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 fibers 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 influenced by lesions of the 
atlas and axis, as seen in facial paralysis, has direct communica- 
tion with the auditory nerve and with the auricular branch of 
the pneumogastric. 

The various simple methods described in the texts on this 
subject will aid one to determine the location of the trouble in 
the external, middle, or internal ear. The disease may be seated 
in the auditory nerve or in the brain, in such case being as di- 
rectly connected with cervical lesion, before shown to affect the 
brain and cranial nerves. Examination of the ear is given in 
detail in Part I. 

TREATMENT: An ear syringe may be used in the ordinary 
ways to cleanse the ear of secretions, discharges, foreign objects, 
insects, etc. Care must be used with the syringe. It should 
have an olivary tip to prevent introducing it so far as to touch 
the drum. If a piston syringe be employed, care must be taken 
not to press the piston in too quickly, as it may inject the fluid 
with sufficient force to injure or perforate the drum. It is best 
to use an ordinary fountain syringe, with an appropriate tip. 
and hung up not more than a foot or eighteen inches above the 
level of the patient's head, in order to have a gentle flow. 

For antisepsis, to insure cleanliness when there are discharges 
from the ear, one may use a warm solution of boracic acid, sat- 
urated, or containing from one to two teaspoonfulls of the powder 
to a pint of water. 



PRACTICE OF OSTEOPATHY. 343 

When there is a firm plug of cerumen in the canal, it is well 
to first soften it by dropping a few drops of sweet oil into the 
canal, and allowing it to remain over night after having plugged 
the meatus with a little absorbent cotton. After the softening 
process, a good deal of the wax may be carefully removed with 
a spatula, but it is not always advisable to attempt to remove it 
all in this way, as the canal may be sensitive or the drum may be 
irritated. The remnants may always be safely and easily re- 
moved by gentle syringing. Considerable water may be used if 
necessary. 

When insects get into the ear they should be first drowned 
with a little water or sweet-oil, then removed by syringing. 

The removal of bony lesion and the cervical treatment as 
before described are the main osteopathic treatments applied 
in ear diseases. The presence of the original cause of these dis- 
eases in the form of neck lesion necessitates practically the whole 
treatment being cervical. There is no local ear treatment, ex- 
cept as in common methods in vogue in use of syringe, 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, VII), and the neck treatment, with the 
object of increasing circulation through the carotid arteries. 
Due attention is given to the cervical sympathetics and vaso- 
motors in this connection. 

A valuable local treatment of the ear in cases where the 
drum, or local circulation, or normal secretions, etc., are affected, 
is as follows: 

The tragus is pressed rather firmly into the external meatus, 
and then quickly released, the operation being repeated about 
once per second. Or the finger may be moistened and introduced 
into the meatus, being worked in and out like a piston". These 
treatments create a local suction and pressure which stimulates 
circulation and all the local tissues, stretches and massages the 
drum, and helps to soften and relax it in cases of retraction due 
to catarrhal processes, etc. In cases of retraction of the drum 
it is sometimes helpful to frequently introduce a little sweet 
oil- into the canal to aid in softening it. Such treatments also 
aid in loosening the ossicles in catarrhal deafness, thus rendering 



344 PRACTICE OF OSTEOPATHY. 

them more susceptible to vibrations of sound. These treatments 
will materially aid in improving the hearing in some cases. 

A similar effect is gotten, also, by inflating the ear drum in 
the familar manner of holding nostrils and mouth closed and 
blowing. This should be judiciously practiced by the patient 
in all cases of retraction of the drum in catarrhal deafness, in order 
to keep the drum and ossicles relaxed and able to vibrate, but this 
must not be done to excess for fear of eventually leading to hyper- 
trophy of the drum. A few inflations, once or twice per day, are 
enough. 

The drum may also be inflated by the practitioner, who 
spreads a clean handkerchief over the ear and applies his lips 
close over the meatus and blows. It is probable that by these 
means, and more especially by the latter, subluxations of the 
ossicles may be reduced, restoring or aiding the hearing. There 
are on record some cases in which a few such inflations have 
greatly increased the power of hearing, probably because thereby 
luxated ossicles have been articulated. 

The throbbing, buzzing or humming sounds that occur in 
the ear with catarrha"! affections, etc., can sometimes be stopped 
by use of the above measures. 

Perforations of the drum generally readily heal up, as do 
incisions by the knife, but not always. These perforations may 
not be in* the drum proper, but at the notch of Rivinius, which 
is covered with skin and will quickly heal. 

The internal throat treatment may be used, the finger be- 
ing directed about the opening of the Eustachian tube to stim- 
ulate the local points of the fifth nerve, the mucous membranes, 
and thus the secretions. This aids in freeing the tube, an ob- 
ject that is well accomplished by the aid of the external throat 
treatment upon the carotids, etc. 

In catarrhal affections of the ear the treatment is as described 
for nasal catarrh. 

In earache the treatment embraces the repair of lesion, 
inhibition of the upper cervical nerves, and inhibition about the 
mastoid process, below the ear, in front of the ear, etc. 



PRACTICE OF OSTEOPATHY. 345 

DISEASES OF THE BLOOD AND DUCTLESS GLANDS. 

GOITRE; EXOPHTHALMIC GOITRE. 

CASES: (1) In a lady of twenty-five, a bilateral, vascular goitre 
of about three months standing, growing rapidly, causing con- 
siderable dyspnea 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 treatment at once. Two 
months later the enlargement and .other symptoms had disap- 
peared. 

(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 the patient 
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 years standing. 
Lesion existed as 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, relax- 
ing the tissues surrounding the gland. After one month there 
was a 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 thirty-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) In a lady, a goitre of one years standing. No bony 
lesions were found. After one months treatment the diameter 
of the neck had been decreased one and one-half inches. 

(7) Exophthalmic goitre of eight months standing in a 
woman of 26. Lesions were: 3rd and 4th cervical vertebrae 
posterior, 7th cervical lateral to the left; 3rd, 4th and 5th dorsal 



346 PRACTICE OF OSTEOPATHY. 

posterior; subluxation of 4th rib on the left side. Benefit was 
noted after the 2nd treatment, and the case was cured in four 
months. 

(8) Dr. Still mentions a case of vassular goitre in which he 
raised the clavicles and caused the goitre to entirely drain away 
in 45 minutes. 

DEFINITION: Goitre is denned as "chronic hypertrophy 
or hyperplasia of a portion or the whole of the thyroid gland. 
It is of obscure origin, involving one or more of the structural 
tissues, and is subject to various degenerative changes." 

The so-called simple goitre is met in various forms: simple 
hypertrophic, follicular, fibrous, vascular, cystic, degenerative, 
etc. The}- are frequently met and treated osteopathically. 

Exophthalmic goitre (Graves' or Basedow's disease) is quite 
a different condition. It is defined as, "a chronic neurasthenic 
neurosis characterized by rapid heart-beat, enlarged thyroid. 
protrusion of the eye-balls, and various neurasthenic or vas<>- 
motor 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, engorgement, and hypertrophy. 
In some cases, especially in exophthalmic goitre, the lesion may 
act chiefly upon the innervation of the gland, producing the 
various phenomena marking the disease. 

The LESIONS bear, in conformity with the above view, a 
close anatomical relation to the disease. They are generally 
bony lesions of the cervical and upper thoracic regions, consist-' 
ing 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 commonly occur together with bony lesion, but may be 
independent of such. They occur mostly in the anterior region 
of the neck, involving the infra-hyoid muscles and the soft tissues 
down to the root of the neck. The scaleni muscles are often in- 
volved. 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 



PRACTICE OF OSTEOPATHY'. 347 

and first rib, while in exophthalmic goitre lesions of the cervical 
vertebrae are more frequent. Dr. Still points out that in goitre 
the heads of the first ribs will often be found to be displaced up- 
ward and outward, away from the spinal column. Yet either 
form of lesion may occur in either case. The clavicle and rib 
lesion, and the contracturing of the anterior cervical tissues act 
specifically by obstructing arterial, venous, and lymphatic cur- 
rents to and from the gland. The inferior thyroid artery arises 
from the thyroid axis, which, lying behind the clavicle and 
scalenus anticus muscle may suffer pressure from them when 
abnormal in position. The superior thyroid artery is related to 
the infra-hyoid muscles, and may suffer from their contracture. 
But the interferences of these lesions with the lymphatic and 
venous drainage of the gland are doubtless most potent in causing 
goitre. The lymphatics 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 lymphatic drainage of the breast and result in so-called 
cancer, the same kind of lesion may 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 in- 
ferior hyoid muscles, and suffer pressure from their contracture. 
They both empty into the internal jugular vein which may be 
obstructed by clavicular lesion. The chief venous flow is through 
the three or four large inferior thyroid veins, and it may be im- 
pinged by clavicular and anterior cervical lesion. This view of 
lesion is well supported by the fact that simple goitres often 
rapidly disappear, after treatment restoring clavicle and first 
rib to position, relaxing anterior cervical tissues, and re-estab- 
lishing 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 strikingly illustrate the correctness 
of the osteopathic etiology. In these cases he saw, in a few r hours, 
a great reduction in the volume of the gland follow removal of 



348 PRACTICE OF OSTEOPATHY. 

such obstructions to the vessels. The glands seemed to have 
been rapidly emptied and the goitre drained away by the re- 
newed drainage. 

The nerve-supply of the thyroid gland is from the middle 
and inferior cervical ganglia of the sympathetic. Consequently 
various vertebral 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 sympathetic mechanism 
with both of these organs has been pointed out. The lesions oc- 
curring thus to the innervation of the thyroid, cervical lesions, 
are likewise closely related 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 neuras- 
thenic symptoms accompanying the condition. It is readily seen 
that cervical lesion may disturb the innervation of the organ, 
set up the sympathetic disturbance, and derange the function 
of the thyroid. This disturbance of the sympathetic innervation 
is further evident in the vascular condition of the gland, its 
arteries being dilated, and in the paralysis of the orbital vessels, 
whicll become distended with blood and cause the exophthalmos. 
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 
according to Anders the prognosis in goitre (simple) is but guard- 
edly 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 younger and shorter 



PRACTICE OF OSTEOPATHY. 349 

cases, and in those in which the gland is soft. Under treatment, 
signs of softening in a part of the gland are indications of pro- 
gress. In the vascular and parenchymatous forms the progress 
is good. The former promise the most for quick results. In 
the hard, fibrous forms, and in those in which degeneration of the 
tissues, or calcareous infiltration has taken place, the prognosis 
is not favorable. 

Some cases of goitre yield quickly; some are very slow. 
From one to three months treatment, or much longer, is usually 
necessary. 

The TREATMENT looks at once to the removal of lesion, 
and to the free opening of lymphatic and venous drainage. All 
the cervical muscles must be relaxed. This direction applies 
to the deep anterior cervical and the hyoid muscles, as well as 
to the tissues about the gland. 

Pressure is made downward over the goitre, out about its 
edges, and along the course of the veins draining it. All the 
tissues about the root of the neck anteriorly, 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 verte- 
bral articulations, seeing that they are perfectly adjusted. 

In exophthalmic goitre one must look particularly to the 
cervical sympathetics, toning them to overcome the vaso-motor 
paresis. Inhibitory cardiac and local eye treatment may be 
applied as before directed. A moderate 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 ex- 
ophthalmic and in vascular forms of goitre, is good measure. In 
the former kind one should look well to the constitutional condit- 
ion and to that of the general nervous system. 

ANEMIA. 

DEFINITION: A condition in which there is a diminution 
either in the quantity of blood or in one of its constituents. 

The Anemias are divided into: I. Primary (simple, chloro- 
tic, and pernicious) ; II. Secondary (symptomatic) ; III. Leu- 
cocytosis; IV. Leucocythemia. 



PRACTICE OF OSTEOPATHY. 

The lesions noted in anemia are merely of the general spinal 
form. Cases of primary and secondary anemia come, with fair 
frequency, under our treatment. They are almost without ex- 
ception successfully treated. 

The TREATMENT in all the anemias is practically the same, 
varying in different cases according to the manifestations and 
needs of the case. In all forms the general plan of treatment 
is to remove such lesions as may be found present and to give 
special attention to the renovation of the general health by 
thorough general spinal treatments, designed to increase heart- 
action, tone the circulation, increase nutrition, and thus to im- 
prove the quality of the blood. 

In SIMPLE OR BENIGN ANEMIA (Primary), the treatment 
embraces removal of lesion and the thorough general treatment 
above described. Special treatment should be given the spleen. 
The liver, kidneys, skin and bowels should be kept active. In 
this way the quality of the blood is improved, and nutrition of 
the tissues is increased. 

The heart should be kept well stimulated in order to over- 
come palpitation. This treatment also aids in overcoming the 
dyspnea, which should be further treated by lower costal treat- 
ment to stimulate the diaphragm and by raising the ribs and 
stimulating the lung area of the spine (2nd to 7th dorsal) . Head- 
a,che should be treated in the usual way. It is quite necessary 
to look after the hygienic conditions under which the patient 
lives. Diet, drink, and manner of life need attention. 

In CHLOROSIS or "green sickness" one must follow the general 
plan of treatment outlined above. This condition is character- 
ized especially by a deficiency of hemoglobin in the red corpuscles, 
and iron is the specific drug remedy employed. There is a ques- 
tion whether the iron thus administered is absorbed by the blood. 
The osteopathic idea is to normalize the organic functions of the 
body and to build good blood by increasing glandular activity 
in the body. This excretes impurities and enables the blood to 
secure from the food the elements, especially iron, that are lack- 
ing in it. 

The heart must be kept well stimulated, as the cardiac mus- 
cle is often softened, and the organ may be dilated. Special 



PRACTICE OF OSTEOPATHY. 351 

attention must be given to disorders of menstruation. The dis- 
ease often dates from a period of scanty menstruation, and while 
amenorrhoea is said not to be a cause of the condition, it is quite 
necessary to overcome it, if present, in the process of restoring 
health. 

The treatment must also be directed to a regulation of the 
bowels, as toxemia due to the absorption of poison from retained 
fecal matter has much to do in causing chlorosis, it is held by some. 

Attention should be given to hygienic conditions. Pure 
air, plenty of nutritious food, good sleep, etc., are necessary. 
Moderate exercise and hot baths are recommended. 

Nervous, circulatory, gastro-intestinal, and general symp- 
toms may be met according to the needs of the case. 

PROGRESSIVE PERNICIOUS ANEMIA requires much care in 
treatment, as it is considered a dangerous condition. However, 
under osteopathic treatment it seems to be readily cured. A 
thorough general spinal, muscular and abdominal treatment is 
necessary to overcome the anemic condition of most of the or- 
gans and tissues. The general treatment above described should 
be assiduously applied. In the course of it heart, liver, kidneys, 
and gastro-intestinal tract should be well treated, as they show a 
tendency to fatty degeneration. Increase of general circulation 
overcomes the tendency to ecchymosis in skin and mucous mem- 
branes. 

Particular attention must be given to the spinal treatment, 
spinal circulation should be kept active to guard against sclerosis 
of the posterior and lateral colums of the cord, to which are due 
the various paralytic symptoms which are likely to occur. 

SECONDARY ANEMIAS are purely symptomatic. They in- 
dicate some disease or abnormal process in the body, and may 
at the same time be complicated with one of the primary anemias. 
They occur; (1) after hemorrhage, as from bursting of an aneurysm 
epistaxis, piles, menorrhagia, etc. ; (2) in inanition, as from esoph- 
ageal carcinoma, chronic gastritis, etc.; (3) from excessive 
a I hum in ions discharges, as in B right's disease, lactation, exten- 
sive suppuration, dysentery, etc.; (4) from the action of toxic 
agents, as in poisoning from lead, mercury, arsenic, phosphorus, 
or in acute or chronic infectious diseases. 



352 PRACTICE OF OSTEOPATHY. 

The prognosis depends upon that for the primary condition. 

The TREATMENT must be according to the cause. After 
hemorrhage, rest and nutritious diet are required. The primary 
disease in each case must be treated. Hygienic treatment, plenty 
of fresh air, good food, sunshine, rest, and later, light exercise, 
necessary. In toxic cases the excretories must be kept stimu- 
lated to eliminate the poisons from the system. 

LEUCOCYTOSIS is "a temporary increase in the number of 
polymorphoneuclear leucocytes in the blood, though rarely in 
the mononeuclear elements." It may be continuous. 

It is often a physiologic condition, as soon after birth, during 
pregnancy, after meals, after exercise, after massage and baths, 
etc. 

It is frequently a pathologic condition, being secondary to 
disease, as acute inflammations and acute infectious febrile dis- 
eases. 

Being reparative and protective in nature, a natural pro- 
cess, it calls for no treatment. Treatment should be directed 
to the primary disease. 

LEUCOCYTHE.MIA, or leukemia, is a blood disease in which 
there is marked and persistent increase of the number of leu- 
cocytes in the blood. It is said to be due to lesion to the spleen, 
bone-marrow, and lymphatic glands. The spleen and lymphatic 
glands are enlarged. 

The prognosis is not favorable. 

The TREATMENT should be upon the general lines before 
laid down. The gastro-intestinal symptoms; shortness of breath; 
edema of ankles, face and hands, etc., occur as in the anemias. 
Treatment should include the liver, which is found to be enlarged, 
and the kidneys should be kept stimulated, as the leucocytes 
collect in them, as in the liver. 

MYXEDEMA. 

This is a condition in which there is a peculiar disorder rf 
the general nutrition of the system, due to atrophy and loss of 
function of the thyroid gland. There is a myxomatous change 
of the sub-cutaneous tissues, and a cretinoid cachexia. 



PRACTICE OF OSTEOPATHY. 353 

The condition appears as, (1) True Myxedema, (2) Spo- 
radic Cretinism, or (3) Operative Myxedema. 

But few cases have been treated Osteopathically. Re- 
sults are not satisfactory. McConnell states that serious lesions 
of the cervical vertebrae have been found in these cases. 

The TREATMENT must necessarily be a general one to in- 
crease general nutrition, and to thus aid in overcoming the con- 
dition of malnutrition of the system. The disease is regarded 
as being of tropho-neurotic origin. It is supposed that the in- 
ternal secretion of the active thyroid gland aids in maintaining 
the normal metabolism of the body, consequently it is of great 
importance in these cases to remove lesion to the gland, restore 
nerve and blood-supply to it, arid thus regenerate its activities. 

In case of congenital absence or removal of the gland it is 
obvious that nothing could be done except to maintain the gen- 
eral health by the treatment, and overcome in that way, if pos- 
sible, the effects of the lack of thyroidin. It seems that in these 
cases thyroid feeding, a treatment regarded as specific, would be 
necessary. 

In case of atrophy of the gland an attempt should be made 
to upbuild it by local work on circulation and nerve-supply. 
Cervical treatment should be added, to increase circulation to 
the brain, and the kidneys should be kept active to overcome the 
tendency for sugar and albumin to appear in the urine. 

The local treatment should be upon and about the gland, 
coupled with a cervical and upper thoracic treatment, as de- 
scribed for goitre, q. v. 

CONSTITUTIONAL DISEASES. 

RHEUMATISM. 

CASES: (1) *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. Le- 
sion occurred at the 4th lumbar vertebra. The inflammation 
began to subside with the first treatment. The patient, con- 
fined to the bed, was able to sit up in one week, and was cured. 

*-For convenience Acute Rheumatic Fever is considered here instead of with the 
Infectious Diseases. 
23 



354 PRACTICE OF OSTEOPATHY. 

(2) Muscular rheumatism, in the form of torticollis, follow- 
ing malarial fever. The condition was of one months standing. 
It improved from the first treatment, and was cured in three 
weeks. 

(3) Muscular rheumatism in the shoulder, the patient hav- 
ing been unable to raise her hand to her head for seven months. 
The first rib was found partly dislocated at its head. The arm 
could be raised to the head after one treatment, and the case 
was cured in one month. 

(4) Acute articular rheumatism in a lady of eighty-three, 
of three months standing. Lesions occurred in the upper dorsal 
and lumbar regions of the spine. The hips and khees were af- 
fected. One months treatment had greatly improved the case. 

(5) 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 
dislocation. 

(6) Chronic rheumatism of eight months standing. The 
patient was unable to raise his hand to his head or to dress him- 
self. After one treatment he could do both, and the case was 
practically cured by four treatments. Lesions were found at 
the third cervical vertebra, 1st to 4th dorsal, and 4th lumbar. 

(7) Lumbago, in occasional attacks, one of which had been 
brought on by bicycling. Lesion was found in a lateral luxa- 
tion of the 4th lumbar vertebra. The case was relieved by one 
treatment, and was cured in three treatments. 

(8) Lumbago, brought on by a muscular strain, showed 
lesions at the lumbo-sacral and sacro-iliac articulations. The 
ease was cured in a few treatments. 

LESIONS: In the three forms, Acute Articular Rheuma- 
tism, or Rheumatic Fever, or Inflammatory RehumatismjChronic, 
or Chronic Articular Rheumatism; and Muscular Rheumatism, 
various bony and muscular lesions are found. In rheumatic 
fever special bony lesions may be lacking. Often spinal le- 
sions affecting liver and kidneys are found, and muscular 
contractures may be present' as 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. 



PRACTICE OF OSTEOPATHY. 

In practically all forms of rheumatism, lithsemia, uric acid, 
gout, and the allied conditions, the real foundation of the 
trouble lies in lesions which interfere with metabolism. The 
commonest of these are found in the splanchnic area of the 
spine, interfering chiefly with the functions of the digestive 
tract and of the liver. Probably the great majority of these 
cases originate in this way.' Often some other particular lesion 
determines the point at which the disease makes its chief at- 
tack. 

In Muscular and Chronic Rheumatism specific lesion is 
much more definite than in Rheumatic Fever. Local bony le- 
sions play an important part in the production of muscular rheu- 
matism, as do also muscular contractures. Both may be due 
to physical strains. Contractures may likewise be due to ex- 
posure 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 generally found at 
the origin of the nerves supplying them. This is equally true 
for chronic articular rheumatism. For example, in those very 
numerous cases in which the joints of- the lower limbs are affected, 
it is almost the rule to find lumbar or innominate lesions obstruct- 
ing the nerve-supply to the limbs. 

In rheumatic affections .of special localities as, for ex- 
ample, the wrist, ankle, etc., it is common to find a local bony 
part out of place, as carpal, tarsal, or metatarsal bone. In lum- 
bago there is almost invariably luxation of lumbar vertebrae, 
irritating the nerve-fibres supplying the muscle-bundles of the 
erectors spinae. 

The contracturing of tissues as the result of chronic rheu- 
matism 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 constitutional one, acting upon the system through 
lesions which derange the functions of liver and kidneys; also 



356 PRACTICE OF OSTEOPATHY. 

of the central nervous system. Yet this condition is often a 
good deal like "catching cold," and presents, therefore, no con- 
stant lesion. 

In the other forms of rheumatism, such as Rheumatic Tor- 
ticollis, affecting the sterno-mastoid and other muscles; Lum- 
bago, affecting the lumbo-dorsal fascia, erectors spinse and 
smaller lumbar muscles; Cephalodynia, attacking the occipito- 
frontalis and temporal muscles, and the galea capitis; Dorso- 
dyiiia, of the muscles of the upper part of the back and shoulders; 
and Pleurodynia, of the nbro-muscular structures of the chest, 
local derangement of nerve 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 supplying 
the part. In the case of muscular rheumatism particularly, 
the fact that the pathology in indefinite, that no structural 
changes occur in the muscles, and that many authors regard it 
as neuralgia, well supports the osteopathic 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 as Lumbago, in which ver- 
tebral lesion, irritating the local nerve-fibres, is regarded as the 
cause, osteopathically, As a matter of fact, one meets numer- 
ous cases diagnosed as either rheumatism or neuralgia, or to 
which these terms are applied interchangeably. From an osteo- 
pathic point of view it makes but little difference which view of 
the case is taken. The essential fact is lesion irritating nerve- 
supply, its removal 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 especially good in inflammatory and muscular rheu- 
matism. In such cases one expects to give relief at one treat- 
ment. Quick cures are often made in them. In chronic cases 
the progress is slow 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 benefited. Up to a certain point 
the deposits may be absorbed, the deformity overcome, and the 
joint be put in good condition. It is the rule, however, that the 
enlargement or deformity of the joint cannot be much relieved, 



PRACTICE OF OSTEOPATHY. 357 

though the progress of the disease may be stayed. 

The TREATMENT of these cases must be persistent, but not 
severe. In inflammatory rheumatism the extreme pain, which 
cannot tolerate the slightest jarring of the floor, or movement 
of the bed-clothes, must be considered. Yet 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 at- 
tention must be given to stimulating the activities of kidneys, 
liver, 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 important is it 
to gain control of their functions. 

A general spinal treatment is necessary in rheumatic fever, 
for constitutional effects. A close watch must be kept upon the 
general health, and lungs and heart must be kept well stimu- 
lated. Careful stimulation of the heart will prevent the disease 
reaching that part. It is particularly necessary 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 membranes. It is 
in this way that the deposits are removed and the membranes 
restored to normal condition. 

In acute inflammation of a joint, also, its blood-supply must 
be kept free and itself be lightly manipulated, to take down the 
inflammation. 

In muscular rheumatism the muscles, should be stretched 
and manipulated gently to stimulate the metabolism of the local 
tissues, aiding them to throw off the poisonous substances sup- 
posed to collect in them. 

In any case the nerve-supply of the part must be treated 
from its origin, and the lesion be removed. 



358 PRACTICE OF OSTEOPATHY. 

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 
the arm 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 mus- 
cles, separating the vertebra 1 , and releasing the nerve-fibers from 
impingement. By these means, in most cases, a subluxated lower 
dorsal or lumbar vertebra, the most usual cause of the trouble, 
is set back into place, and the cause is removed. 

In Inflammatory rheumatism one should look after the hy- 
giene 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 be- 
tween 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 nutritious. Chronic cases should be protected from toil, 
exposure, etc. 

The treatment for the special forms of rheumatism men- 
tioned is upon the same lines. 

GONORRHEAL ARTHRITIS, while not properly regarded as a 
rheumatism, may yet be considered in the same category of treat- 
ment. Specific bony lesion is commonly found at the affected 
joint or at the origin of its nerve-supply, weakening the joint, 
and laying it liable to invasion by the poison of the disease. 
Knee and ankle joints are most frequently affected. 

The PROGNOSIS, while guarded, is favorable for a cure. 

There is not the destruction of the joint as in chronic articular 

rheumatism, and to a certain extent the condition is more sure 

of entire recovery. Yet the progress of the case is apt to be slow, 

and one must be upon his guard against relapses. 

The TREATMENT of the joint is practically the same as that 
described for articular rheumatism, combining with it treatment 
for the primary disease, looking particularly to the excretion of 
the poison from the system via bowels, liver, kidneys, and skin. 



PRACTICE OF OSTEOPATHY. 359 

ARTHRITIS DEFORMANS (Rheumatoid Arthritis.) 

DEFINITION: A chronic disease of the joints, in which 
destructive and proliferative changes occur in the tissues of the 
joint. While not a rheumatism, it is regarded osteopathically 
from much the same point of view as are the various forms of 
this disease. The lesions found are of the same style as those for 
articular rheumatism, occurring at the spinal origin, or in the 
course, of the nerves supplying the affected joints. The small 
joints of the hands or feet, sometimes the large joints, are affected. 
Every joint in the body may finally become involved. 

The PROGNOSIS is fair, but the case will require a long course 
of treatment. The progress of the disease can be entirely stopped, 
the function of the joints can be almost entirely restored, and 
they can be much reduced in size, pain can be stopped, and the 
general health can be kept good. The deformities that have 
taken place in the joints cannot be removed. 

Most satisfactory results have been attained under osteo- 
pathic treatment. 

The TREATMENT is practically that outlined for articular 
rheumatism. It must be persistent in order to repair the marked 
changes that have taken place in the tissues of the joint. It is 
of prime importance to increase the suffering nutrition of the 
joint, and to this end lesion must be removed from blood and 
nerve-supply, and they must be kept actively stimulated. The 
bones of the joint should be spread apart as in rheumatism, to 
enable the blood to circulate freely throughout the joint. A 
certain amount of local treatment about the joint is necessary 
to aid this process, as well as to affect the muscles and other ap- 
pendages of the joint, which are suffering atrophy. Treatment 
should begin at the spinal origin of the nerves of the part affected. 
A thorough course of muscular treatment for the limb involved 
should be carried out. 

Hygiene and diet should be considered. Plenty of meat 
and vegetables are allowed. Exposure to wet and cold must 
be avoided, and bathing is recommended. 



360 PRACTICE OF OSTEOPATHY. 

GOUT (Podagra.) 

DEFINITION: A constitutional disease, in which there is 
arthritis of the small joints, and deposits of urates of soda about 
them. 

LESIONS, as commonly found, affect the joint locally, its 
innervation, or the kidneys. One or more such lesions may 
be present in any case. It is common to find a slight derange- 
ment of one of the joints of the great toe, or of the part affected. 
McConnell notes lesion of the astragalus. These cases generally 
present the characteristic lesions of the kidney areas, weakening 
the organs, and laying the system liable to an accumulation of 
urates by means of sedentary habit, overeating, abuse of alco- 
hol, etc. 

The PROGNOSIS is good. Immediate relief is given during 
the attack. The pain is quieted. Recovery will be complete 
if the treatment is followed long enough. 

The TREATMENT looks at once to the removal of bony le- 
sion above described. It is quite necessary to adjust the bones 
of the joint involved. This may be carefully undertaken even 
during an acute attack. The intense pain may be relieved by 
careful manipulation of the joint itself and by opening the cir- 
culation about it. This takes down the inflammation. In this 
stage, treatment should begin at the spinal origin of the nerves 
of the part involved and be carried down the limb to the joint. 
The limb should receive a general muscular treatment. The 
joint should be carefully stretched. In case of the great toe, it 
may be submitted to tension and to slight motion from side to 
side. In urgent cases hot applications to the affected joint may 
be made. It may be wrapped in cotton woop and be kept ele- 
vated during the intervals of treatment. During the acute stage 
the patient should be kept upon a diet of milk, farinaceous food, 
and plenty of water. Fever if persent, should be treated as 
described for fevers. The bowels should be kept well opened. 

It is necessary to give most thorough treatment to the 
kidneys to eliminate the urates from the system. The blood- 
supply to the joint should be kept under treatment to cause ab- 
sorption of the deposits of urates in and about it. 



PRACTICE OF OSTEOPATHY. 361 

The joint should be well protected from the cold, and the 
patient should be guarded against exposure, while at the same 
time the heart, stomach, brain, etc., and the general spinal sys- 
tem, should be kept well stimulated in order to avoid the grave 
complication known as retrocedent gout, in which the arthritic 
symptoms are transferred to an internal organ. 

The diet of the gouty patient is a matter of considerable 
importance. It should be restricted in quantity, and should 
be taken at regular hours. Succulent vegetables (cabbage, 
salads, string-beans;) farinacea (rice, hominy, etc.); fruits, ex- 
cept bananas, tomatoes and strawberries; fats, in the form of 
butter; and stale bread may be used. Meats are to be restricted; 
oysters, fish, and fowl may be taken. All alcoholic beverages 
must be refused. Plenty of water and alkaline mineral waters 
.are good. Bathing and exercise should be regularly employed. 

LITHEMIA (Irregular gout; American gout) is a condition 
the pathology of which is much like that of gout, but the joints 
.are not very much involved. There is an excess of urates in 
the blood. The kidneys are involved, suffering from lesion, and 
.are unable to keep the blood free of these poisons 

The PROGNOSIS is good. The condition yields readily to 
treatment. Cases may be entirely cured. 

The TREATMENT is a most thorough and corrective one for 
the kidneys. They must be kept active in order to free the 
system of the urates. A general spinal treatment, with atten- 
tion to bowels, liver, stomach, etc., is necessary to increase the 
nutrition of the body, and to cause it to take up more of the 
excess of nutriment. On the other hand, the diet must be strictly 
limited. A diet of cereals and fruit is particularly good, meat 
being entirely omitted. Alcohol, tea, coffee, and tobacco are 
best not taken. Sweets, fats, butter and cheese are hot to be 
taken. The patient should drink plenty of water. 

The liver should be kept well treated to avoid hemorrhoids 
and biliousness. The general spinal and special treatment for 
nervous and digestive systems aid in keeping the patient free 
from many annoying symptoms. Further symptomatic treat- 
ment may be given as necessary. 



362 PRACTICE OF OSTEOPATHY. 

OBESITY. (Polysarcia, Lipomatosis Universalis.) 

DEFINITION: A condition due to an increase of fat in the 
tissues of the body, sufficiently great to impair functions, and 
showing lesion to the lymphatic system, liver, pancreas, etc. 

CASES: (1) A case of obesity in which there was marked 
pathological condition of liver and kidneys. Treatment was 
directed particularly to these organs,and a strict diet was enforced. 
In ten days the patient began to improve, and at the end of two 
weeks found that he had lost ten pounds. After one month 
the treatment was discontinued, as the patient left the city tem- 
porarily. Returning later he reported a loss of twenty-five 
pounds and the enjoyment of better health than for a long time, 

(2) A second case, treated upon the same plan, lost 37 
pounds in two months, and the health improved. 

(3) A case of obesity reduced 23 pounds in five months 
treatment. 

Numerous cases have been successfully treated. 

The LESIONS in these cases are largely spinal vertebral ones 
affecting the innervation of the lymphatic system, of the liver, 
and of the pancreas Dr. Still points out spinal lesion to the 
full length of the thoracic duct, acting through the various spinal 
sympathetic connections, splanchnics, etc. He mentions es- 
pecially lesion at the 4th dorsal, which he calls a center for nutri- 
tion, and at the 7th cervical, opposite which the duct ends. He 
has called attention to lesion in the upper dorsal region, just 
below the cervical, giving rise to the growth of a fleshy cushion, 
a condition of affairs that seems to influence the lymphatic sys- 
tem and cause a deposition of fat. He also works high in the 
cervical region, opposite the transverse processes of the vertebrae, 
for nerves controlling the calibre of the duct. 

Lesion at the 1st and 2nd ribs, and at the clavicle, are found 
in some cases. They may cause pressure upon, and obstruction 
of, the thoracic and right lymphatic ducts where they empty 
into the innominate veins. 

Obstructive lesions to the nerves controlling the lymphatics 
or to the lymphatics directly, prevent the proper flow of the 
lymphatic fluid containing the saponified and emulsified fat ah- 



PRACTICE OF OSTEOPATHY. 363 

sorbed by the lacteals. Thus the fat is not freely enough poured 
into the circulation and passed to the lungs to be oxidized, there 
and in the arterial blood, and as a result the fat is deposited in 
the tissues of the body. Lack of oxidization of the fats is a well 
known cause of obesity. 

Splanchnic spinal lesion is also a factor in such conditions. 
It acts probably in more than one way. In the first place it 
may aid in disturbing the nerve-control of the thoracic duct 
and receptaculum. But it probably also affects the activities 
of pancreas and liver. Lower rib lesion could do the same 
thing. 

*The pancreatic fluid and the bile, chiefly the former, emul- 
sify and saponify the fats, preparing them for absorption into 
the lymph capillary of the lacteal, whence they are carried into 
the thoracic duct, and to the circulation to the lungs for oxidiza- 
tion. Deficiency of these secretions would thus prevent the 
proper preparation of the fats for absorption and further elabor- 
tion. The American Text Book of Physiology states that the 
bile acids stimulate the epithelial cells to a greater activity in 
the absorption of fats. As the fats are not properly prepared 
by the action of the pancreatic and liver secretions, it seems 
probable that they are absorbed into the circulation directly 
from the intestine, and, not being in a state for oxidization, are 
carried through the portal circulation and deposited in the tis- 
sues. Of course much of the fat is passed from the intestine with 
the fecal matter. 

Thus excess of fats and starches in the diet is deposited as 
adipose tissue. 

The PROGNOSIS is fair in cases of obesity. If the fat is solid 
and healthy, and the general health good it is difficult, to reduce 
the fat except by careful dieting and exercise. But if the fat 
is soft and flabby, it may be greatly reduced by proper treatment. 
Many cases have been treated successfully osteopathically. 

The TREATMENT must be directed to the correction of the 
lesions described. It is essential to keep normal the functions of 
liver and pancreas. They should be treated by local abdominal 
work, and by the removal of lesion. If the cushion of flesh ap- 

*Phila. Jour. Osteopathy, Nov. '99. p. 6. 



364 PRACTICE OF OSTEOPATHY. 

pears in the upper dorsal region it should be treated by direct 
manipulation, causing it to be gradually absorbed. All sources 
of obstruction to the lymphatics and to their irmervation must 
be removed. 

The heart should be kept stimulated, on account of its ten- 
dency to weakness and fatty degeneration. The breathlessness 
often present should be treated by raising the ribs as in asthma. 
Kidneys must be kept active, and be stimulated against nephritis, 
which is apt to come on late in the disease. 

A thorough general spinal and muscular treatment, includ- 
ing limbs, abdomen, chest, etc., aids in the oxidization of the 
fat in the tissues. A course of exercise may be prescribed with 
the same object. It should not be too severe in patients with 
weak hearts and vascular systems. 

Lungs and stomach should be kept treated. The latter is 
apt to be dilated, and to suffer from gastritis. The lungs are 
likely to suffer enlargement and fatty infiltration. 

A strict diet should be enforced in these cases. This is an 
essential part of the treatment of them. The amount of food 
should be small. Starches, fats, and sweets are to be excluded. 
The amount, of water allowed is small, and alcoholic drinks are 
forbidden. It is well to follow some prescribed dietary such as 
Oertel's, Ebstein's, or Banting's. 

Severe exercises must not be prescribed in cases in which 
heart and vessels are not perfectly sound. 

RICKETS (Rachitis). 

DEFINITION: A constitutional disease of children, in which 
there is marked nutritive change in bones and cartilages, result- 
ing in defoimities. 

It is a general nutritive disturbance, and there are no con- 
stant bony lesions. Improper hygiene and nutrition are the 
causal factors. 

Osteopathic treatment has been successful in the handling 
of these cases. The progress of the disease may be limited, 
further deformity is prevented, but deformities once confirmed 
cannot be corrected. Beginning deformities may be corrected. 

The TREATMENT is mainly such a change in the diet as to 



PRACTICE OF OSTEOPATHY. 365 

supply the elements lacking in the nutrition of the body. In 
case the babe cannot be properly nourished by the mother's 
milk, cow's milk diluted is found to be the most satisfactory sub- 
stitute. Barley water is also recommended. The feeding should 
not be too frequent nor excessive in amount. Older children are 
allowed light meats % vegetables and fruit. 

The hygienic treatment is quite as important. Plenty of 
fresh air and sunshine, and daily bathing are very helpful. The 
child should not be allowed to lie much in one position. This 
should be frequently changed. It should be kept from walking 
until danger of deformity is past. 

With this treatment the value of proper osteopathic treat- 
ment cannot be overestimated. Its effects in increasing gen- 
eral nutrition of the body are well demonstrated. A thorough, 
but careful, general spinal treatment should be given. This 
reaches the general nervous system and affects function through- 
out the body. It also aids in overcoming the nervous symptoms 
manifest in the case. The liver, spleen, and kidneys should be 
treated, as they may be involved. The bowels should be kept 
free. 

A general muscular, abdominal and cervical treatment 
should be added to the general spinal treatment. Impaired 
nutrition of certain muscles may lead to a semblance of paralysis. 
These muscles should be well treated to build them up. 

If the bony parts are yet soft much may be done to restore 
shape of the parts. A curvature of the spine may be entirely 
cured. Treatment should be directed to shaping of the parts 
undergoing deformity. 

DIABETES MELLITUS AND DIABETES INSIPIDUS. 

CASES: (1) Diabetes Mellitus in a man of thirty-four. 
The disease was well established by urinalysis and the charac- 
teristic symptoms. The patient was a great sufferer from pain 
in the lower dorsal and lumbar regions, and showed bony lesions 
at the 12th dorsal, second and fifth lumbar vertebrae. He was 
discharged cured after months treatment, and has since passed 
the medical examination for life insurance, being pronounced a 
good risk. 



366 PRACTICE OF OSTEOPATHY. 

(2) Diabetes Mellitus in a young 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 1048, 
and four pints per day. He gained strength daily, and was 
practically 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 vertebrae, also of the 2nd and 3rd 
dorsal, and lower dorsal and upper lumbar veitebrse. The sp. 
gr. of the urine was 1043, sugar 4 per cent, and quantity from 10 
to 18 pints per diem. Improvement was continuous from the 
first, and in five months the case was cured. 

(4) Diabetes Mellitus in a lady of fifty-six. She passed 
about 200 ounces of urine each day, containing a large percentage 
of sugar. Lesion: A depression 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. 

(5) 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 discontinued before a cure was affected. 

(6) 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 insurance. 

(7) Diabetes Mellitus in a man fifty-one years of age. Le- 
sions was a posterior condition of the spine from the sixth dorsal 
to the second lumbar vertebra. At the time of report one months 
treatment had been taken, and improvement was made. 

(8) Diabetes Mellitus showing lesion in the cervical and 
lower dorsal regions. The urine contained two per cent 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 



PRACTICE OF OSTEOPATHY. H67 

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 4, occurs 
in the region of the liver or of the splanchnics. 

Lesions of the dorsal and upper lumbar region involve the 
in nervation of these organs, derangement of which is thought to 
be most closely associated with diabetes. Through their effects 
upon the splanchnics and solar plexus, they derange the func- 
tions of the liver, pancreas, and intestines, all thought to be im- 
plicated in this condition. It is well established that pancreatic 
disease is usually closely associated with diabetes; that a gly- 
colytic ferment secreted by this gland is necessary to normal 
metabolism. This being disturbed results in sugar in the urine. 
Such a result is doubtless affected by such lesions as above, in- 
terfering with the innervation of the organ by way of the solar 
and splenic plexuses. 

It has already been shown how closely are such lesions as- 
sociated with derangement of the liver innervation, the glyco- 
genic function of the organ being disturbed in diabetes. 

It may be that these lesions likewise aid the condition by 
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 may 
aid this effect. 

The influence of the general nervous system in diabetes is 
well 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 doubtless could do 
the mischief resulting in diabetes, as it has been shown frequently 
that these lesions may injure cord, medulla, or sympathetic 
system, as in paralysis, etc. In this connection one sees the 
importance of upper cervical lesions, which affect the medulla. 



368 PRACTICE OF OSTEOPATHY. 

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 
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, there being no room for 
doubting the facts in such cases. In accounts of twenty-six 
cases gathered by Dr. C. W. Proctor, thirteen improved con- 
tinually under the treatment; seven were entirely cured; others 
were yet under treatment. 

It may be well said that in such cases our prognosis for re- 
covery is fair, and for benefit is good. 

The TREATMENT ,is mainly, 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 the normal functions of pancreas, liver and small in- 
testine. 

As the heart, kidneys, lungs and spleen undergo patholog- 
ical changes, it is necessary 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 affecting the various organs involved in the disease, 
stimulating and increasing the general nutrition of the body 
which is much affected, and upbuilding the general nervous 
system. 

It is necessary to give close attention to the diet and reg- 



PRACTICE OF OSTEOPATHY. 369 

imen of the patient. Carbohydrates must be excluded from 
the diet as thoroughly as possible, no sugars nor starches being 
allowed in any form. Meats, fish, poultry, eggs, and green veg- 
etables 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 sys- 
tem. There is a point in the floor of the fourth ventricle, punc- 
ture at which causes diabetes insipidus. 

These various bony lesions may cause it by affecting the 
cord, since it is known that injuries to the cerebro-spinal axis 
result in the disease. Anders regards the condition as a vaso- 
motor neurosis, usually of central, sometimes of reflex origin. 
It is also thought to be due to a vaso-motor relaxation of the kid- 
neys. It is readily seen that spinal lesion to the renal splanchnic 
could result in this vaso-motor neurosis and give rise to the dis- 
ease. 

The PROGNOSIS is good under osteopathic treatment, al- 
though the condition is regarded as incurable. A fair number 
of cases are cured. 

The TREATMENT is mainly local for the kidneys, by removal 
of lesion at the splanchnic areas arid by the various special ways 
of affecting the kidneys as pointed out in considering diseases 
of the kidneys. 

Some general treatment for the nervous system may be 
necessary. 



370 PRACTICE OF OSTEOPATHY. 

INFECTIOUS DISEASES. 

DIPHTHERIA. 

Numerous cases have been treated successfully by osteo- 
pathy. 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 tissues of the throat and neck, includ- 
ing the scaleni muscles, drawing the first rib backward under 
the clavicle and thus disturbing its articulation with the first 
dorsal vertebra. These contractions about the throat interfere 
\rith the venous circulation through the pharyngeal and internal 
jugular veins, favoring a congested or eatarrhal condition of the 
mucous membranes of the throat, and leading to diphtheria. 
It is well known that catarrhal conditions predispose to the 



Bony lesions and muscular contractures in the cervical 
region interfere with the innervation of the muscles and mucous 
membrane of the throat. The sympathetic innervation is from 
the superior cervical ganglion. This distribution unites with 
fibres from the pneuinogastrie. glosso-pharyngeal and external 
laryngeal nerves, forming the pharvngeal plexus. Hence upper 
cervical lesion may. by affecting the superior cervical ganglion, 
derange the sympathetic vaso-motor supply of the pharvngeal 
mucous membranes and lead to the dise.-i- 

The PROGNOSIS is good. The case is usually readily cured. 

In the TRRATMKNT the main idea is to keep open the circu- 
lation to the throat and to thus prevent the formation of the 
membrane, or to prevent its further growth. A thorough re- 
laxation 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 also l>e kept free and loose. The 
clavicle should be raised. The first rib should be pressed down- 
ward and forward, working at its central articulation to correct 
the position of its head. By the process of these treatments the 
venous and lymphatic drainage from about the throat is 
open. This regulates the vaso-motor disturbance of the mem- 
branes, tends to loosen the membranes already formed, and. by 



PRACTICE OF OSTEOPATHY. 371 

preventing further exudation, stops the further growth of the 
membrane. 

The splanchnics, liver, kidneys and bowels should be treated 
twice daily, to keep free the excretion of poison from the system, 
and to aid nutrition, to keep up the strength of the system. 

Cervical bony lesion should be removed, and treatment 
should be given to the vagi, superior cervical ganglion, and cer- 
vical sympathetic^, 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 inflammation 
by starting the circulation. 

In laryngeal diphtheria an external treatment about the 
larynx and down along the trachea is good. (Chap. III. A. V.) 
Laryngeal intubation should be done in case of threatened suf- 
focation. 

A general systemic treatment should be carefully given 
to build up the strength. The heart and lungs should be care- 
fully 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, par- 
ticularly apt to occur about the throat, sometimes in other parts 
of the body. 

The patient should be isolated and the usual antiseptic 
precautions should be practiced. The patient should be kept 
upon a liquid diet. Milk, ice cream, broths, and the like are 
used. 

CROUP. 

(Spasmodic Croup, Catarrhal Croup, or Laryngi.smus Strid- 
utafl.) 

Jn.ii \rno.N : This is a disease peculiar to children and 
h-ld to be chiefly of nervous origin, but it is often a.--o<-iat<-d 
with acute catarrhal laryngitis. It is associated with paroxys- 



372 PRACTICE OF OSTEOPATHY. 

mal coughing, difficulty of breathing, and attacks of threatened 
suffocation. 

Numerous cases have been successfully treated by osteo- 
pathy. 

The LESIONS of greatest importance in croup involve con- 
tracturing of the muscles and tissues of the throat, irritating the 
pneumogastric nerves, and their recurrent and superior laryngeal 
branches. These contractures likewise prevent proper circu- 
lation 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 
during the paroxysms. 

Dr. Still regards as important sacral and lower spinal bony 
lesions in croup. He a,lso finds a contracture of the omohyoid 
muscle, drawing the hybid bone down and back upon 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 lymphatic drainage from the larynx, and favors 
the inflammation of the mucous membrane. 

Various contractures of the posterior cervical muscles, as 
well as those bony lesions common in laryngitis, as of atlas, axis, 
and 3rd cervical vertebra, are sometimes present, acting to dis- 
turb sympathetic innervation, vagi, and circulation. 

One, must, however, chiefly regard those contractures and 
bony lesions about the throat and neck anteriorly. Arising from 
exposure, cold, etc., they become the chief cause of croup. 

The PROGNOSIS is good. Immediate relief is given by the 
treatment. The spasm, stridulous breathing, and threatened 
suffocation are overcome 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 irrita- 
tion to the superior and recurrent laryngeal nerves. The treat- 
ment should begin well up beneath the inferior maxillary bone. 
being made especially about the hyoid bone and muscles and 



PRACTICE OF OSTEOPATHY. 373 

should be carried down along the throat and trachea. 

The hyoid bone should be grasped and manipulated laterally, 
forward, and upward, relaxing the omohyoid and other muscles. 
(Chap. Ill, A, III, Chap. IV, III.) 

The process of freeing the circulation is materially aided 
by 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 larynx and trachea. 
.(Chap. Ill, A. V.) This is helpful during the spasm. 

Inhibition may be made upon the superior laryngeal nerve 
by pressure immediately below and behind the greater cornua 
of the hyoid bone, and upon the recurrent laryngeal at the inner 
side of the sterno-mastoid muscle at the level of the cricoid car- 
tilage. 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 by the 
use of the index finger. 

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 cervical region. 

All sources of reflex irritation, as intestinal parasites, den- 
tition, indigestion, 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 overloaded stomach. Tickling the fauces with the 
finger will cause the vomiting. Cold applications may be used 
over the throat and chest. A warm bath is a convenient means 
to break up a spasm. 

WHOOPING-COUGH. 

(PERTUSSIS.) 

DEFINITION: An acute, highly contagious disease, occurring 
chiefly in children, and characterized by a catarrhal inflammation 
of the mucous membrane of the respiratory tract, and by a pecu- 
liar spasmodic cough ending in a whooping inspiration. 



374 PRACTICE OF OSTEOPATHY. 

Its true nature is not known, but that theory that regards 
it as a lesion of the phrenic, pneumogastric, sympathetic, or 
recurrent laryngeal nerve, or perhaps of the medulla, best ac- 
cords with the osteopathic view of the etiology. 

The PROGNOSIS is good. The case may be aborted if taken 
early, but if the disease is well started but little more than allevia- 
tion can be accomplished. The case is safely carried through, 
and the danger of complication is minimized. 

The LESIONS: In whooping-cough, as in croup, the con- 
traction of the omohyoid muscle, drawing the hyoid bone against 
the pneumogastric nerve, is important, as is also the contrac- 
turing of the cervical tissues drawing the first rib back, and dis- 
turbing its central articulation. 

Cervical bony lesions are found at the upper, middle, and 
lower cervical vertebra?, 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 tissues, lesion of clavicle and first 
rib retard venous and lymphatic drainage, and lead to catarrhal 
conditions, well known to be of much importance in producing 
the condition. The mucous membranes are thus weakened and 
laid liable to the action of the specific infection. 

Lesions of the upper dorsal vertebrae and of the upper two 
or three ribs may derange the sympathetic connections of the 
laryngeal innervation. 

The TREATMENT is much the same as in croup. The prime 
point is to free the circulation about the larynx and whole re- 
spiratory 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 hyoid bone, and relaxation of 
the omo-hyoid, raising the clavicle, etc. All bony lesions of the 
cervical, upper dorsal, and upper thoracic region must be over- 
come, 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. 



PRACTICE OF OSTEOPATHY. 375 

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 ribs be 
raised, to ease respiration. The lungs, heart, kidneys, and gen- 
eral system must be carefully looked after and thoroughly treated 
to avoid the complications and sequelae that may arise in the 
form of broncho-pneumonia, pleurisy, pericarditis, acute nephritis. 

"Jacob Sobel gives the results of his own experience with 
the paroxysms of whooping cough treated by pulling the lower 
jaw downward and forward. Pulling the lower jaw downward 
and forward controls the paroxysms of whooping cough in most 
instances and most of the time. The method is usually more 
successful in older children than in younger ones and infants. 
In cases without a whoop the expiratory spasm with its asphyxia 
is generally overcome, and in those with a whoop the later is 
prevented. It is as successful as any single drug, or even more 
so. Mothers should be instructed in its use, so that attacks, 
especially at night, might be arrested. The manipulation is 
harmless and painless. Its only centra-indication is the presence 
of food in the mouth or oesophagus. Patients thus treated are 
less likely to suffer from complications and sequelae than those 
treated only medicinally. It is advisable to try this method in 
other spasmodic coughs and laryngeal spasms." (N. Y. Med- 
ical Record.) 

It is probable that by drawing the jaw down and forward 
the suprahyoid muscles pull upon the hyoid bone, stretching all 
the hyoid muscles, and releasing pressure from off the superior 
laryngeal nerve, which passes just behind the greater oornu, 
thus relieving the irritation of the nerve and the consequent 
spasm in the muscles, especially the crico-thyroid. 

IXFLUEN7A. 

(LAGRIPPE EPIDEMIC CATARRHAL FEVER.) 
CASES: (1) Four cases in one family restored to usual 
health within a week. 

(2) Four cases cured in four or five treatments, no bad re- 
sults following the disease. 



376 PRACTICE OF OSTEOPATHY. 

(3) Lagrippe, attacking the throat and complicated with 
a severe tonsillitis, was cured by several treatments. 

(4) A severe attack of lagrippe cured in four days by treat- 
ment directed to bowels, kidneys, and splanchnic nerves. 

(5) A list of thirty-five cases, one of which had been cured 
by one treatment, and the remaining cases cured by several 
treatments, none requiring over four. 

(6) A report of a number of cases of lagrippe, all with marked 
symptoms. 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 lagrippe and rheumatism. After seven treat- 
ments she was about, the lagrippe being cured and the rheuma- 
tism much improved. 

(8) A case of lagrippe cured in four treatments. 

LESIONS: While no specific bony lesion has yet been men- 
tioned as occurring in Influenza, there is yet a specific condition 
of lesion doubtless closely associated with the invasion of the 
disease into the system. This condition is a general contrac- 
turing of the spinal muscles, most marked in the upper dorsal 
and cervical regions, but affecting the whole spinal system. 
This may be regarded as the specific lesion in influenza. Dr. 
Still regards it as shutting down upon the whole vascular and 
nerve system of the body, through the constricting effect of these 
contractures upon the spinal nervous system through its pos- 
terior 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 germ. 

Just so, the general muscular contracture found as the char- 



PRACTICE OF OSTEOPATHY. 377 

.acteristic lesion in lagrippe, acts upon the vital forces of the sys- 
tem to debilitate them and lay the body liable to invasion. This 
theory would appear entirely reasonable in the light of the fact 
that Pepper thinks it likely that the germ exists everywhere, but 
depends upon certain extraordinary atmospheric 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, re- 
:sults in these spinal contractures which, occurring coincidentally 
with the periods of virulence of the germ, allow of the invasion 
of the system. 

Lagrippe 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 in- 
dependent 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, resulting in the peculiar manifestation of the 
disease which distinguishes it as the abdominal type, the cere- 
bral type, the thoracic type, etc. 

Probably, too, such lesions are responsible for the various 
complications 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 particu- 
larly good, one or a few treatments being usually all necessary 
in uncomplicated cases. When the case is taken in time com- 
plications do not ensue. If present they are usually readily 
overcome by the treatment. It is a well known fact that 
the mortality in 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 restoring the equilibrium of the 



378 PRACTICE OF OSTEOPATHY. 

vascular and nervous system. This object 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 perspiration and lessening fever, and sustaining these 
organs themselves against the effects the disease is likely to pro- 
duce in them. This treatment embodies raising the clavicle and 
ribs, work over the chest anteriorly, stimulation of the vaso- 
motor and accelerator innervation in the upper dorsal region, 
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 iheumatoid type, to carry the 
relaxing treatment over all parts of the body, flexing and rotating 
the thighs, working about the shoulders, upper limbs, neck. etc. 
This overcomes the distressing general aching and soreness in 
the muscles. 

Careful abdominal treatment is called for, particularly if 
the disease shows a tendency 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 effect and provides 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 out too 
soon, and be kept upon a light nutritious diet. This should be 
largely fluid in case the patient is confined any length of time to 
his bed. 

The fe^ffcr, headache, pains in the eye-balls, and other man- 
ifestations of the disease are treated specially in the usual ways. 

MALARIA. 

Malaria is a disease which, although due to the activities 
of a specific germ, the hematozoon of Leveran, yet presents 
marked bony lesions, which account for the manifestations of 
the germ within the system. 

The LESIONS are mostly in the splanchnic area, disturbing 



PRACTICE OF OSTEOPATHY. 379 

the sympathetic and vaso-motor innervation of liver, spleen and 
kidneys. McConnell notes lesion as a marked lateral deviation 
at the 9th and 1th dorsal vertebrae, and a resulting downward 
luxation of the 10th rib, also lesion of the 9th to llth dorsal ver- 
tebrse 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 effect 
upon the sympathetic system, resulting in vaso-motor disturb- 
ance. 

The PROGNOSIS is good. Dr. Still says that he never needs 
to give a patient a second treatment. Usually a few treatments 
overcome the difficulty, and quick results are often shown. Yet 
it often happens that but slow progress is made. Complica- 
tions, however, are prohibited by the treatment. Marked re- 
lief is at once given during the paroxysm. 

The TREATMENT 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 par- 
oxysms. 

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 to- 
ward 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 manoeuver by twisting or ro- 
tating 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 splanchnic and renal splanchnics are stimulated. 

He concludes the treatment by momentarily bringing pres- 
sure with his thumbs down upon the femoral arteries. The 
time of this pressure is merely long enough to allow one heart- 



380 PRACTICE OF OSTEOPATHY. 

teat to elapse. His idea is that this momentary damming back 
of the femoral 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 constriction of the surface of the body, 
collateral with an inward congestion, and equalizes the circula- 
tion. 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. 

No specific treatment is called for to allay the sweating, 
.as this is itself a relief to the patient's condition. The general 
method of treatment described may be properly applied during 
this stage or during the intermission. 

TYPHOID FEVER. 

CASES: (1) A 'case taken in the usual way" and presenting 
the usual symptoms. The fever was 103 degrees at 4 p. m., 
when the osteopath was called. The next morning the fever 
was below 102 degrees, rising that evening to 103.5 degrees. On 
the succeeding evening it was again 103.5 degrees, but 
this was the highest point reached. Thereafter, instead of the 
temperature remaining about 104 degrees for two w r eeks, as is 
typical, the gradual decent began immediately and in two weeks 
the patient was well. As early as five days after treatment began 
most of the symptoms had disappeared. 

(2) This case when first seen, had a pulse of 102, a tem- 
perature of 105 degrees, and all the usual symptoms marked, 
even delirium being present, and the stools and urine passing 
involuntarily. He had been ill with the fever for two weeks. 
Gradual decent of the temperature began immediately upon 
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 



PRACTICE OF OSTEOPATHY. 381 

a temperature of 101 degrees. In two days the symptoms began 
to abate. On the fourtli day the fever had risen to 104 degrees, 
falling, then rising on the seventh day to 104 degrees again. 
After this there was a gradual descent, until on the evening of the 
twenty-fifth day the temperature was normal. The usual per- 
iod of high temperature had thus been prevented. 

(4) In a girl of nine, who had suffered from typhoid fever, 
the lingering effects of the disease, suffered from five years before, 
were very marked. The difficulty took the form of acute at- 
tacks commencing with pain in the eyes, followed by intense 
headache and delirium, and a rash upon the skin. As the 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 involuntary micturition. She had 
been under 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 
at this time without the usual swelling and rheumatic symptoms. 
After two months treatment the case was discharged cured. 

The only bony lesion was a lateral luxation of the third 
cervical vertebra, 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 charactesistic "ty- 
phoid spine," a posterior prominence of the lower lumbar region, 
caused by a backward displacement of the 3rd, 4th, and 5th 
lumbar vertebrae. He holds that the result 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 interverte- 
bral foramina. Thus is produced the essential typhoid- condi- 
tion of the small intestine characteristic of the disease. 

He notes also lesions along the upper dorsal region, at which 
point he makes treatment upon the lungs, correcting the activ- 
ities of the lymphatics system, thus, as he says, making water 
to put out the fire of the fever. 

In general the lesions found in typhoid fever are rib, ver- 
tebral and muscular lesions affecting the splanchnic and him- 



382 PRACTICE OF OSTEOPATHY. 

bar regions of the spine, irritating spinal nerves, and through 
them disturbing the sympathetic, vaso-motor, and lymphatic 
supply of the small 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 jejunum and ileum, 
the seat of ulceration in the disease. 

Pathologically, the process in the first two stages of typhoid, 
infiltration 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 degree 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 successful therapeutic measures must gain vaso-niotor 
control. It is an indication to the Osteopath that he must do 
spinal work upon the vaso-motor area supplying the bowels, re- 
moving the lesion 'that is obstructing the natural play of the 
forces necessary to health. 

The PROGNOSIS is good, yet one must not forget to be upon 
his guard, constantly, against the complicatiQns and intercurrent 
maladies that so often carry off the typhoid patient. Under 
osteopathic treatment, however, complications and sequelse are 
quite prevented. Indeed, much fine osteopathic work has been 
done upon paralytic and various other forms of the sequelse fol- 
lowing an attack of typhoid fever. 

If taken within a week or ten days the course can be usually 
aborted to a marked degree. Often cases gotten early have had 
their course terminated within a few days. Bad cases, taken 
under treatment after so late 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 case 
may be when it comes under the treatment, that the temperature 
begins at once to gradually decline. When the case is taken 



PRACTICE OF OSTEOPATHY. 383 

before the second week, the usual period of high temperature i? 
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 intestinal lymphatics to normal activity. Con- 
sequently the main treatment in these cases is spinal. It must 
be devoted particularly to the correction of the mal-positions 
of the 3rd, 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 manipula- 
tion. 

All the spinal muscles should be relaxed, this, with a careful 
cervical treatment, quieting the nervous system, and relieving 
the jerking of the subsultus tendinum. This treatment is care- 
fully made while the patient is lying upon one side. The patient 
must not be moved into various positions any more 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 and in preventing complicating diseases 
of these organs. Treatment at the renal splanchnics should be 
given to keep the kidneys active. 

The main treatment being along the splanchnic and lumbar 
regions, these portions of the spine are treated by careful relax- 
ation of all contractures, by gently springing the spine for the 
relaxation of ligaments and for the freedom of the nerves, and in 
removing the bony lesions mentioned. 

The correction of the lesion to 3rd, 4th and 5th lumbar 
controls the diarrhoea. It may be treated in the usual way. 

The spleen and liver are reached by spinal work at their in- 
nervation. 

The abdominal treatment is almost nil. Any manipula- 
tion made here should be with extreme gentleness. It is best 
to confine this treatment to the iliac regions, raising the intes- 
tines slightly, with the idea of straightening them in the iliac 
fossse. (IV. Chap. VIII.) 

The fever is treated by work at the superior cervical ganglion 



384 PRACTICE OF OSTEOPATHY. 

in the usual way, thus regulating the systemic circulation by 
affecting the general vaso-motor center in the medulla. The 
treatment to the heart and lungs aids this process by equalizing 
the circulation, as does also the general spinal work and the 
treatment given along the spine for intestinal circulation specific- 
ally. The heart beat should be slowed by inhibition at the 2nd 
to 5th dorsal, on the left. 

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 9th 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 of the 
stools and urine, and general cleanliness. 

The patient's body, a part at a time, should be sponged 
with tepid water daily. The Brand system of baths is much 
usejl at the present day. 

In regard to diet the usual observance of "a strictly liquid 
diet is followed. Some are using light, easily 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 way much 
better preserved. It would be safe for an Osteopath to carry 
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 grad- 
ual 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. 



PRACTICE OF OSTEOPATHY. 385 

ERYSIPELAS. 

(St. Anthony's Fire, "The Rose.") 

Erysipelas is a disease frequently treated and cured osteo- 
pathically. The PROGNOSIS is good. 

The LESIONS are various forms of obstruction to the cir- 
culation of the part affected. The lesion may be bony, or a 
contracture of muscles or other tissues. It may directly press 
upon veins and lymphatic vessels, preventing the proper drain- 
age of the part, or it may derange the vaso-motor innervation 
and the sympathetic 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 the ab- 
dominal viscera up from the region of the crural arch, where they 
were pressing upon the blood-vessels and preventing drainage 
from the limb through femoral vein and lymphatics. By thus 
relaxing the tissues and removing direct impingement from the 
vessels, the blood-flow was restored and the case was cured. 

Another case in which the eruption appeared upon the face, 
was cured by springing the temporo-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 impingement, of the fibers of 
the fifth nerve removed, restoring circulation. 

The most usual lesions in erysipelas are found preventing 
the circulation from the head, as the face is the part most fre- 
quently 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 inflammation 
by obstructing these fluids, the specific germ being present and 
attacking the part thus rendered liable to its action. Clavicle 
and first rib lesions may directly obstruct the jugular veins and 
the cervical lymphatics, leading to the same result. 

McConnell notes lesion of the 2nd, 3rd, 4th and 5th dorsal 
vertebrae, and of corresponding ribs and surrounding muscles, 
causing erysipelas in the face, by disturbing sympathetic inner- 
vation. 

The TREATMENT is simple, calling for removal of lesion and 

25 



386 PRACTICE OF OSTEOPATHY. 

re-establishment of venous and lymphatic drainage of the affected 
part. This involves relaxation of muscles and other tissues, 
restoration of bony parts to position, freeing of nerve connec- 
tions, etc., as already pointed out, according 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 sufficiently 
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 com- 
plications and sequelae that may arise, such as delirium, 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 rec- 
ommended are isolation of the patient, drinking plenty of cold 
water, cold spongings of the part, or applications of iced cloths, 
and the application of collodion 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 the lack of atten- 
tion to the diet during the primary attacks tends to increase the 
frequency of relapse. 

MEASLES. 
(MORBILLI, RUBEOLA). 

Very numerous cases have been successfully treated 
The PROGNOSIS is good. The danger of complications and 
sequlee is minimized, as these cases recover quickly and thor- 
oughly under the treatment. 

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. 



PRACTICE OP OSTEOPATHY. 387 

LESIONS: Dr. Still describes in this disease a general ."con- 
gestion of the 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 muscles. The clavicle may be found with its sternal 
end displaced backward 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 presenting upper 
spinal arid thoracic rib lesions, are apt to become victims of pul- 
monary tuberculosis after measles. The clavicle and first rib 
lesion, as well as various cervical bony lesions and muscular con- 
tractures, probably account for complications and sequela in 
eye, ear, nose and throat. These effects come largely through 
obstructed lymphatic drainage from the neck, a fact well illus- 
trated by the marked enlargement of the cervical lymph glands 
as a complication or sequel of the disease. 

In the TREATMENT the first step, especially if the rash has 
not developed, is a thorough stimulation of the cutaneous sys- 
tem, including a general spinal treatment, with particular at- 
tention to atlas and axis, for effect upon the vaso-motor center 
in the medulla; upon the second dorsal and fifth lumbar, cutan- 
eous centers. In tardy cases one such treatment suffices to bring 
out the rash abundantly, a desirable result, since upon its ap- 
pearance the headache and fever disappear, and the patient feels 
better. 

This treatment would include a general relaxation of the 
spinal muscles, correcting the lymphatic obstruction. 

An important effect of the general spinal and cervical treat- 
ment, together with some special treatment to heart and lungs, 
is to correct the general circulation, calling away from all the 
viscera the abnormal amount of blood retained in them as a con- 
gestion, in this disease. For this purpose there should be added 
treatment of the splanchnics, solar plexus," liver, kidneys, and 
abdominal circulation generally. 



388 PRACTICE OF OSTEOPATHY. 

The usual treatment of the throat, internal and external; 
of the neck; of clavicle and first rib; of the upper anterior chest, 
raising the ribs, and working 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 respiratory 
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, treat- 
ment along the larvnx 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 
eyes, and should be kept upon a light diet of milk, bread, light 
soups, etc. 

The general spinal treatment, and treatment of the cutane- 
ous system and centers, will 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 
concerning lesions and treatment, osteopathically, as made in 
considering measles. 

The very mild symptoms accompanying these conditions 
call for but little treatment aside from the general constitutional 
one, pointed out in detail in measles. These points of treatment 
may be applied as necessary. 

Due attention must be given to avoid exposure, the clan- 
gers of complications, etc. In rubella the enlargement of the 
cervical lymphatics calls for attention in the manner pointed out. 
The slight fever and catarrhal symptoms are readily overcome. 
In both conditions due attention must be given to the cervical 



PRACTICE OF OSTEOPATHY. 389 

and general spinal treatment, and to the maintenance of the 
activities of the various viscera. Usually the spinal muscles are 
contractured, and must be relaxed. These contractures doubt- 
less affect the general lymphatic system by way 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 collo- 
dion may be observed. 

SCARLET FEVER. 

(SCARLATINA.) 

Numerous cases have been successfully treated osteopath- 
ically. The PROGNOSIS is good, but must be guarded in cases com- 
plicated with diphtheria. The experience is to bring these cases 
safely through the attack, free from complications and sequelae. 

The LESIONS are, in general, the same as described for the 
various acute, specific fevers. Contractured spinal and cer- 
vical muscles are noted. One must expect 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 dis- 
eases 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, 
stimulating 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 enlargement of the lymphatic glands that sometimes 



390 PRACTICE OF OSTEOPATHY. 

occurs may be avoided or controlled by the usual treatment. 
Relaxation of all the anterior and posterior muscles, etc., must 
be done. This treatment frees the lymphatic and blood-circu- 
lation through the neck, and keeps eye, ear, and throat in good 
condition. 

The heart must be kept well supported. The fever is treated 
in the usual way. When the patient's system is kept well sup- 
plied with moisture by allowing him a plentiful supply of cold 
water, daily treatment of the sub-maxillary 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 cocoa butter, are useful for this purpose. 

The patient should be isolated, the scales shed in desqua- 
mation 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. 

VARIOLA (Small-Pox.) 

It is at present impossible to say anything specific with 
regard to treatment of small-pox by osteopathic methods. It 
is doubtful whether the disease, in any marked form, has ever 
been treated osteopathically. Numerous light cases have 
been treated. It would have to be met upon the same 
general plan as other fevers, with particular attention to 
the special clinical manifestations of the disease. An Osteo- 
path should follow the same precautions with regard to isola- 
tion, disinfection, and antisepsis as are followed by any other 
physician. The usual osteopathic procedure would be followed 
in the treatment of muscular pains, vomiting, diarrhoea, convul- 
sions, etc. The ordinary method of preventing pitting by keep- 
ing the face washed with a carbolic or mercuric-chlorid solution 
and covered with clean cloths saturated with warm water, and 
of protecting the eyes by keeping them covered by cloths wet in 
a boric acid solution, and by darkening the room, could probably 
not be improved upon by the Osteopath. He should see that the 
patient is well bathed, that the diet is carefully regulated, and 



PRACTICE OF OSTEOPATHY. 391 

should meet the various manifestations of the condition by the 
usual osteopathic methods. 

CEREBRO-SPINAL FEVER. 

(Epidemic Cerebro-Spinal Meningitis, Spotted Fever.) 

This condition has been successfully treated osteopathic- 
ally. It should be treated upon the plan followed in the other 
forms of meningitis, and also in the treatment of various fevers, 
as described. It is necessary to be especially persistent in the 
local treatment to the spine and cervical regions, on account of 
the marked effects of the disease upon the cord. Continual treat- 
ment in these regions is a most valuable aid in keeping the cir- 
culation equalized and in lessening the inflammatory processes 
going on about the cord. It should be mostly of a relaxing, 
inhibitive sort, with much direct inhibition in the superior cer- 
vical region and along the splanchnic and lumbar regions. The 
spinal column should be carefully sprung, held, and relaxed. 
The painful and contractured muscles along the neck and back 
(opisthotonos) must be continually and gently relaxed. This 
spinal treatment is aided by the abdominal treatment, as before 
described, given for the purpose of drawing the blood to this 
region, away from the cord. This whole process of treatment 
lessens the inflammatory process in the meninges, aids in absorb- 
ing the effused serum, and the fibrino-purulent exudate, and 
aborts the progress of the disease. It practically prevents the 
usual sequelse and complications met in this disease. 

In the course of the treatment due attention should be 
given to the adjustment of various spinal vertebral lesions usually 
present. The heads of the ribs and the deep tissues should be 
carefully examined for lesion. This part of the treatment is 
quite an important factor in gaining complete freedom of circu- 
lation, and complete removal of irritation. 

The remainder of the treatment is largely for the relief of 
the various manifestations of the condition. One should follow 
the directions before given for treatment of the fever, vomiting, 
constipation or diarrhoea, occipital headache, etc. For the sud- 
den violent pains one should use inhibition at various points 
along the spine and at the local plexuses and nerves. Sueh 



392 PRACTICE OF OSTEOPATHY. 

treatment, well applied, together with the spinal treatment,, 
would reach the convulsions if they occur. 

It is well to give particular stimulating treatment to the 
kidneys, not only because the urine is scant and shows the usual 
febrile characters, but also because of the toxaemia due to the 
disease, and because of the tendency of nephritis to appear as a 
complication. 

Eyes, lungs, heart, and organs of special sense must be kept 
well treated to avoid danger of complications or sequels affect- 
ing them. 

The PROGNOSIS must be guarded, but under osteopathic 
treatment the best of results may be expected. 

DYSENTERY (Bloody Flux.) 

DEFINITION: An infectious disease, characterized by an 
inflammation of the large intestine, frequent mucous and bloody 
stools, tormina, tenesmus, prostration and other marked symp- 
tioms. It is due to specific spinal lesion. 

CASES: (1) Chronic dysentery of five years standing, in 
a man of thirty-thre'e. Lesions were a posterior condition from 
the llth dorsal to 3rd lumbar. The case was cured in one month 
of treatment. 

(2) A case of acute dysentery of two days standing. Ail 
the symptoms were marked. The case was much relieved by 
the first treatment, the bowels did not move until twenty-four 
hours after it. 

(3) A severe case of acute dysentery in a child. It was 
treated two days and the stools became normal. 

(4) A case of chronic dysentery of a severe nature, in a 
patient suffering with paraplegia. Lesions were an anterior 
condition of the 5th lumbar vertebra, a lateral swerve of the 
lower dorsal and lumbar region of the spine, and luxation of the 
innominate bones. The condition was cured in four months. 

The PROGNOSIS is good. Treatment is usually at once 
successful in relieving the condition. Many cases are cured in 
one or a few treatments, even though they are chronic. The 
worst forms of dysentery have been successfully treated after 
all other treatment had failed. Generally a course of treatment 



PRACTICE OF OSTEOPATHY. 393 

is advisable in order to fully remove lesion and to restore the tis- 
sues of the bowel to their normal condition by a corrected circu- 
lation. 

The LESIONS and the TREATMENT are identical with those 
described for diarrhoaa. 

PARASITES. 

Patients suffering from the presence of the various animal 
parasites frequently come under treatment. The common round 
worm (Ascaris Lumbricoides) ; the pin-,thread-, or seat-worm 
(Oxyuris Vermicularis) ; the hematozoon of malaria (Hemato- 
aoon of Leveran) ; and the several forms of tape-worm (Tsenia 
Solium, T. Latum, T. Saginata) are successfully treated osteo- 
pathically. 

No particular lesion, of course, can be mentioned in this 
connection. Yet commonly in these cases the various rib, ver- 
tebral, and other lesions affecting the bowels are present. Their 
removal is related to the cure of the condition as a part of the 
treatment directed to securing good general health, and free 
action of liver and of bowels, all of which are quite important in 
the treatment of the case. 

CASES: (1) Pin- worm in a child of three years, of several 
months standing. No lesion was noted except a downward 
position of the lower ribs. Treatment was directed to raising 
the lower ribs, to stimulating the innervation of intestines and 
liver, and to direct manipulation of these organs. No local 
application at the anus, nor enema was required in this case. 
The child was cured by 10 treatments, passing forty-five worms. 

(2) A case of pin- worms in a child suffering with poor gen- 
eral health. The case was cured in two months. 

(3) A case of tape-worm in a woman suffering from bad 
general health. The liver was in bad condition. The treatment 
corrected spinal lesions and restored liver function and general 
health. A tape-worm was expelled. The case was well one 
year later. 

(4) A case of tape-worm which had not been helped by 
the usual medical treatment. The liver was inactive, and le- 
sion was found as a lateral swerve of the spine from the 4th to 



3!)4 PRACTICE OF OSTEOPATHY. 

the 8th dorsal vertebra. The treatment was particularly to the 
liver and the spine. The worm was passed. 

TREATMENT in these cases is directed to the removal of 
spinal or other lesion; the restoration of a healthy condition of 
the bowel and general digestive apparatus; the stimulation of 
hepatic activity particularly, for the purpose of increasing the 
flow of bile, held to be effective in expelling the worm; and the 
upbuilding of the general health. This treatment applies to the 
general case. The treatment for malaria has been described 
elsewhere. Its success demonstrates the ability of osteopathic 
treatment to clear the blood of the protozoan parasite present 
in it. 

In cases of pin-worms it is necessary to keep the parts thor- 
oughly clean. The ova are killed by anointing the anus with 
lard. Injections of lard into the rectum will kill the worms. 
Enemata of cold water, plain, or with a little salt or soap added, 
may be used to free the rectum. The child's finger-nails should 
be kept trimmed and well cleaned to avoid transfer of the ova 
by accumulating under them. 

The rest of the treatment is as directed above. 

In case of round or tape-worms, it is w r ell to enforce a liquid, 
such as milk, diet for a day or two in order to weaken the worms 
and to leave them more accessible to the action of the bile. For 
tape-worm, the patient should then drink quantities of pumpkin- 
seed infusion, or eat a gruel made of mashed pumpkin-seed, con- 
tinuing several days if necessary, until the worm is passed. 

The prophylaxis includes the thorough cooking of the meat, 
especially of beef and pork, from which tape-worms are usually 
gotten. The trichina is found in pork, usually. The dejecta 
containing ova or segments of the worms should be burned. In 
all cases avoidance of impure drinking water is necessary. 

In cases of trichiniasis, if infection is suspected prompt and 
thorough treatment should be made as described, in order to 
get rid of the embryo young before they leave the intestine and 
invade the muscles. Later a course of treatment for the general 
health, and general muscular treatment should be given. This 
will reach the muscular pains, insomnia, and weakness. 



PRACTICE OF OSTEOPATHY. 



THE INTOXICATIONS. 

Various chronic cases of alcoholism, and opium, morphine, 
or cigarette habit have been cured under osteopathic treatment. 

CASES: (1) A young man of 35 came under treatment for 
"nervous prostration" due to chronic alcoholism. He was a 
nervous wreck; could not sleep nor digest his food; had palpita- 
tion of the heart; the lungs and kidneys were affected, and he 
suffered from frequent attacks of sick headache and constipa- 
tion. His left leg was varicosed. He suffered much from melan- 
cholia, and had unbearable craving for opium or whisky. He 
had taken the Keeley cure once, another cure twice, and another 
five times. After a course of treatment his general health was 
very much improved, and he had no desire whatever for an in- 
toxicant. 

(2) Chronic alcoholism in a man of 31. The patient had 
taken the Keeley cure three times, and had taken besides several 
other cures. He had become insane from the use of a drug, the 
use of which he had learned while under treatment of one of these 
cures. He had had delirium tremens eight times in three years. 
During all this time he had never lost the desire for whisky. 
He was a nervous wreck, ate but little, and could sleep only under 
the influence of drugs. At the time of beginning treatment he 
was using three quarts of whiskey a day. At the end of three 
weeks treatment he was using no stimulant, and his appetite for 
it was under control. At the end of the second month he was 
eating and sleeping naturally, and all desire for drink was gone. 
Four months later he was still well. 

(3) A woman addicted to the use of opium came under 
the treatment. Upon leaving off the drug she was attacked 
with great pain, which was relieved by the treatment. These 
pains were successfully relieved whenever they appeared, and 
continually grew less severe. Gradually the system was built 
up and the desire for the drug ceased. 

(4) In a case addicted to the cigarette habit for 12 years,, 
all desire for the article was removed by the treatment. 

(5) A man of about 33. who had long been a cigarette smoker. 



396 PRACTICE .OF OSTEOPATHY. 

and whose nervous system had been wrecked by the habit, was 
cured by a course of osteopathic treatment. 

The TREATMENT in these conditions is practically the same. 
In opium, morphine, and cigarette habit the effects are the same, 
as the harm is done by the opium. 

From the use of either alcohol or opium the nervous sys- 
tem becomes undermined and comes to depend upon the stim- 
ulant. Gradually the nervous system is wrecked. In either 
case it is the object of the treatment to build up and restore 
tone to the nervous system, and to enable it to do without the 
accustomed stimulation of the drug. The style of treatment is 
& thorough general spinal and cervical one, which corrects the 
circulation to the brain and cord. In addition treatment is de- 
voted to buliding up the general health, and special treatment 
is given to the various symptoms and manifestations as neces- 
sary. In this way the system is strengthened and the nature! 
functions are restored. As strength is gained there is constantly 
less desire for the accustomed drug. The desire for it is quite 
taken away. 

In case of opium habit the principal anatomical changes in 
the tissues are due simply to malnutrition, consequently a gen- 
eral treatment to the circulation, nervous system, bowels, stomach, 
liver, etc., is the rational method of repairing the effects of the 
drug. The muscular cramps are treated by local and spinal 
inhibition; the insomnia is treated as before described. Pal- 
pitation, weakness, dyspnea, etc., are readily affected by keep- 
ing the heart stimulated, the ribs raised, etc. 

In the case of alcoholism the tissues are fat-infiltrated, de- 
generated, cirrhotic. congested or inflamed. Liver, kidneys, 
heart, lungs and stomach are quite likely to be affected by these 
processes. These effects in the various organs may be treated 
in ways described in considering the various diseases of them. 
It is obvious that a thorough and persistent course of treatment 
is necessary to correct local circulation and restore these tissues 
to normal. 

Delirium tremens should be treated as described for con- 
vulsions. A spinal and cervical treatment would be particularly 



PRACTICE OF OSTEOPATHY. 397 

indicated. The insomnia yields to the treatment usually made 
for that condition. 

SUNSTROKE (Heat-Stroke; Insolation; Thermic Fever) and 
HEAT EXHAUSTION. 

These two conditions are due to exposure to high temper- 
ature. The former is brought on by exposure to the direct rays 
of the sun. The latter is contracted by persons working in close, 
confined places in high temperature. 

The state of the patient in one of these conditions is quite 
different from that in the other. 

In sunstroke there is very high temperature, 106 to 115 
F., marked dyspnea, red or livid skin over the entire body, lack 
of perspiration generally, a full pulse, unconsciousness and coma. 

In heat exhaustion there is cold, clammy, and pallid sur- 
face of body; the temperature is normal or subnormal, occasion- 
ally slightly feverish; the pulse is full and small; consciousness 
is rarely lost. 

The TREATMENT differs some in these two conditions. 

Sunstroke is much the more serious condition. It must 
be treated promptly. The patient should be laid in the shade, 
the clothing should be loosened, and the applications of cold 
water to head, spine and surface of the body are made. Ice 
may be rubbed over the surface of the body, or the patient may 
be put in an ice-bath (ice in the water.) Ice water enemata 
may be used. After the temperature has been reduced the pa- 
tient should be given much the same treatment as described for 
apoplexy. It is especially important to relax all the cervical 
muscles, which are found to be much contracted. The spinal 
muscles should also be relaxed, and the abdominal treatment 
may be given to draw the blood away from the brain and cord. 
The patient should be kept quiet, and the heart should be inhi- 
bited. Cervical relaxation and inhibition should be continu- 
ously applied. 

Heat exhaustion calls for less treatment. Usually the 
patient soon recovers if removed to a shady spot, with the clothing 
loosened, and sprayed with cool water. The muscles of neck 
and spine should be first relaxed, and the whole spinal system, 



398 PRACTICE OF OSTEOPATHY. 

heart, and lungs, should be thoroughly stimulated. In case 
the temperature be subnormal the patient should be placed in a 
warm bath. 

After-treatment for the spine, neck and general system 
prevents the sequelae that are so frequently the results of sun 
or heat-stroke, such as headaches, brain affections, intolerance 
of heat, etc. 

LIGHTNING STROKE. 

Several cases have been treated osteopathically of persons 
suffering from the effects of lightning-stroke. Paralytic affects 
are usually found. The case must be treated upon general 
principles, usually as a case of paralysis. As a rule marked ver- 
tebral lesions and contractions of cervical and spinal muscles 
are found resulting from the stroke. Good results are gained by 
treatment. 



DISLOCATIONS, DEFORMITIES, JOINT-AFFECTIONS, ETC. 

This class of troubles furnishes the Osteopath with very 
numerous cases. The marked success of osteopathy in curing 
spinal curvature; setting old dislocations; overcoming chronic 
pain, stiffness, etc., in joints; overcoming the various effects of 
injuries to any part of the body; curing synovitis, ankylosis, 
etc., makes this line of practice a very satisfactory one. 

The curing of spinal curvature without the use of braces 
or mechanical appliances; the removal' of plaster casts, jackets, 
splints, bandages, and all things of that kind, causing the natural 
resources of the parts to be depended on, is a novel and success- 
ful feature of Osteopathy. 

The setting of old dislocations is not much attempted by 
other lines of practice. Great success is met in this line. It 
is evident by a glance at the case reports that egregious blunders 
are repeatedly made by the most skilled physicians in many 
cases of this and similar sorts. "Tubercular joints, " "ruptured 
ligaments," "fractured bones," and various other serious con- 
ditions are often found by the Osteopath to be partial or complete 
dislocations, slips, strains, etc., which are curable. 



PRACTICE OF OSTEOPATHY. 399 

CASES: A few typical cases of deformity, etc., in each of 
the various parts of the body subject to these conditions are here 
presented. Great numbers of these cases are upon record, but 
it will be sufficient to confine this list to a few examples. 

(1) A pronounced double lateral curvature, in a young 
lady, involving the whole dorsal region, with single vertebral 
lesions at 10th and llth dorsal, and 4th and 5th lumbar. The 
spine was very sensitive, but this condition was overcome by 
three or four treatments. After twelve treatments the patient, 
considerably benefited, went away upon a visit, remaining 
several months. Upon her return it was found that the curva- 
ture and spinal condition were materially improved. Seven 
more treatments cured the condition entirely. 

(2) Double lateral curvature of five years standing in a 
girl of twelve. The curvature was to the right from 3rd to 8th 
dorsal; to the left from the 9th dorsal to 3rd lumbar. The case 
was cured by four months treatment. 

(3) A posterior curvature in the dorsal region, in a young 
boy, general health was poor. After two weeks treatment the 
spinal brace was removed, and after two months treatment the 
curvature had entirely disappeared. 

(4) Pott's disease of eighteen years standing, in a young 
lady of twenty-eight It came on gradually after a fall at the 
age of eight, having developed to completeness in two years. 
Casts were worn for two and a half years, during which time 
two abscesses discharged, one just below the anterior superior 
spine on the left, the other hi the right limb just below the groin. 
For years the abscesses would alternately heal and break. The 
posterior angular projection involved the vertebrae from the 4th 
dorsal to the sacrum, the apex being at the 10th dorsal. She 
came under treatment at the age of twenty-eight. Both ab- 
scesses were discharging freely; after three months treatment 
a third abscess appeared, and the patient appeared to grow worse. 
After this she began to improve and the curvature began to yield. 
Two abscesses healed. Gradually the curvature was reduced 
until scarcely noticeable, and the 3rd abscess was nearly healed. 
The general health was perfect. The patient's height had been 
increased two and a half inches. 



400 PRACTICE OF OSTEOPATHY. 

(5) A thyroid dislocation of the hip set in one treatment. 

(6) A dislocation of the hip of three years standing; the 
patient had been upon crutches ever since the accident pro- 
ducing the injury. The hip was set in three treatments, and 
the patient had no use for crutches thereafter. 

(7) A dislocation of the hip of four years standing in a case 
which had been thrown from a buggy. The femur had been 
fractured at the same time. The hip was set in three months 
treatment. 

(8) Tuberculosis of the hip and spine, so-called, in a girl 
of sixteen, of four years standing. The best physicians had pro- 
nounced it tuberculosis of the hip. The hip was found to be 
slightly dislocated downward and forward, and there was ver- 
tebral lesion of the 3rd and 4th lumbar. The hip was set and 
the case entirely cured hi four months. 

(9) A case diagnosed by the physician as hip-joint disease. 
The patient had been confined to his cot for ten months. A 
partial dislocation of the hip was found and set in three months 
treatment, curing the case. 

(10) Partial dislocation of hip and knee-joints. The pa- 
tient had worn a laced leather stocking from the ankle half-way 
to the thigh for eleven months. He walked with a crutch. The 
case had been diagnosed as "rupture of the internal lateral lig- 
ament of the knee" by two prominent Chicago physicians. The 
dislocations were set in nine treatments. 

(11) A case which had been diagnosed as a "complicated 
fracture of the neck of the femur," of five years standing. Spec- 
ialists had confirmed this diagnosis. The injured limb was three 
inches shorter than the other. Osteopathically the case was 
diagnosed as a dislocation and was cured. 

(12) Tuberculosis of the knee, so-called, in a boy. The 
joint was put in a cast. There was constant pain in it. A slip 
of the hip-joint was found, and its adjustment cured the case. 

(13) Torticollis due to contraction of the sterno-mastoid 
muscles. By four treatments the muscle was relaxed, and the 
condition was cured. 

(14) Torticollis of many years standing, caused by injury 
to the neck. The muscles were extremely rigid, and the cervical 



PRACTICE OF OSTEOPATHY. 401 

vertebrse were badly curved and twisted. There was constant 
pain in head, neck, and eyes. The case was greatly relieved 
permanently by the treatment. 

(15) Injury of the knee and shoulder- joints in a bicycle 
accident. The knee condition had been diagnosed as rupture 
of the ligaments. By three weeks treatments the shoulder and 
knee were entirely cured. 

(16) Tubercular knee in a boy six years old. The knee 
was swollen, and the temperature was 103 F. The case was 
much benefited by three weeks treatment, and was well on the 
way to recovery. The 10th and llth dorsal, 1st, 2nd, 3rd, and 
4th lumbar vertebrse were posterior. 

(17) A long standing pain in the shoulder, which had been 
examined and treated by eminent physicians both in Europe 
and America without relief. Lesion was found in crowding to- 
gether of the 2nd and 3rd dorsal vertebrae. After one treatment 
the patient suffered no further pain. 

(18) Partial dislocation of the head of the humerus, of 
some months standing, causing a painful condition which had 
been treated as rheumatism. The case was cured by setting 
the bone. 

(19) Fibrous ankylosis of the elbow-joint in a boy of five, 
due to being kept in splints too long after fracture of the humerus. 
The condition was of eight weeks standing. By the treatment 
use of joint was gradually perfectly restored. 

(20) Broken down arches of the feet in a man of twenty- 
eight, due to rheumatism which had settled in the ankles. The 
astragalus was markedly dislocated to the inner side. For two 
years the patient had worn braces to support the arch of the 
instep. By the treatment the bones were replaced and the 
arches were rebuilt into their natural condition. The case was 
cured in six weeks. 

TREATMENT OF DISLOCATIONS, DEFORMITIES, AND 
JOINT-AFFECTIONS. 

While the treatment of each of these conditions will be dis- 
cussed separately, some general remarks apply to them collec- 
tively. The marked success of Osteopathy in cases of this kind 



402 PRACTICE OF OSTEOPATHY. 

is largely due, at bottom to an intimate knowledge of nerve 
and blood-supply of the affected part, patience and skill in manip- 
ulation, and the ability to relax, strengthen, or build up tissues, 
open a joint and direct the circulation to it, and in all respects 
to thoroughly prepare parts concerned to be returned to the 
normal state. In the recent case this preparatory treatment 
does not take long. In the chronic one, which represents a con- 
siderable majority of this class, this preparation may necessarily 
extend over many months. It is here that patience and skill 
play an important part. Often the preliminary work done in 
getting all parts ready to be restored to normal is the most im- 
portant and most distinctively osteopathic part of the process. 
When parts are once prepared, as for example in the setting of a 
hip, the final manceuver used to replace the bone in position is 
practically the same as a surgeon would use for the purpose. 

These remarks apply with almost equal force to both disloca- 
tions and deformities. Yet in the latter case the correction of 
position of bony parts is continually going on, pari passu with 
the process of the treatment. In case of joint-affections this 
process of treatment constitutes the whole course of procedure, 
yet it not infrequently occurs that the replacing of a slipped 
bony part is a portion or the whole of the treatment of a joint- 
affection. 

TREATMENT OF SPINAL CURVATURES AND OF POTT'S DIS- 
EASE: The treatment of the various forms of spinal curvature 
and of Pott's disease are upon much the same lines. In all, 
the preliminary work as described is of the utmost importance. 
It constitutes much of the course of treatment, but bony parts 
are drawn and pressed back into place all the while. 

Spinal curvatures are rarely painful, but when they are the 
first step in the treatment is to carefully relax all spinal tissues, 
deep and superficial; to increase or correct circulation in tluMn; 
and in these ways to gradually work out the soreness and to 
strengthen them. 

In any case of curvature this sort of treatment constitutes 
the first step in the procedure. To this end one may use any or 
all of the treatments described under I, II, III, IV, and V, in 
Chap. II. In this way the spine is gradually strengthened through- 



PRACTICE OP OSTEOPATHY. 403 

out ; the muscles and ligaments are given greater strength to hold 
the ground gradually gained, now and later, in the form of the 
slow restoration of bony parts toward the normal position. 

Likewise, during this process of treatment, the interverte- 
bral discs, which have been altered in shape by pressure atrophy, 
are gradually freed of unequal pressure and are rebuilt into proper 
shape by properly distributed pressure and by the renewed blood- 
circulation. 

After a short preliminary treatment, or at once if the case 
allows, attention is directed to the replacement of bony parts. 
It is a good rule in spinal curvatures to begin at the lowest ver- 
tebra involved and make an attempt at each treatment to set 
it back into place. When this has been accomplished, and while 
it is going on. the next vertebra, then the next, and the next, 
and so on, is attempted. Much may be gained in this way. 

Suspension of the patient in the osteopathic swing, or in 
the special apparatus devised for the suspension of curvature 
patients, is a great help to the practitioner in the treatment. 
By this device the weight of the patient's body is used to help 
draw the bony parts back into place during the various special 
treatments employed for that purpose. In this way very rapid 
gain^ have been made in straightening the curve. 

Various special movements may be successfully applied 
to the reduction of the bony parts. The treatments described 
under VI. VII. VIII. IX. X. 'x(a). XI. XII. XVII. and XVIII, 
in Chap. II. may be used and combined as desired. This style 
of treatment should be combined all the time with that described 
as the first step in the process of treatment. The treatment 
must be most persistently and assiduously applied, the practi- 
tioner using a considerable degree of force to put parts back into 
place. But violence must be avoided. 

During the course of the treatment all spinal braces, jackets, 
casts, and artificial supports or corrective mechanisms of even- 
sort are laid aside, either gradually or at once as the patient may 
be able to do without them. In this way one gets rid of their 
irritating local effects and of their detrimental influence upon 
the general health, while at the same time the parts are taught 
to depend upon their own strength, a matter essential to a cure. 



404 PRACTICE OF OSTEOPATHY. 

Due attention must be given to complications and to the 
general health. 

The practitioner must bear in mind the changed relations 
assumed by the ribs both with respect to each other and with 
respect to the vertebrae. Treatment must be^ applied during 
the^. course of treatment, to the adjusting of these ribs. The 
various special methods described in Chap. VII may be used. 

This method of treatment applies to SCOLIOSIS, LORDOSIS. 
KYPHOSIS, and their combinations. 

In case of POTT'S DISEASE the same general plan of treat- 
ment is followed. In case the destructive process in the bones 
and discs has ceased, and cure by deformity has followed by bony 
ankylosis of the vertebrae, one cannot straighten the spine, but 
much may be done to correct the general health. Yet, as in 
the case reported above (see case reports), it often happens that 
after years of deformity the spine has been materially straightened. 

In this disease the 'destructive processes can be quite stopped 
often, or greatly limited; general health is bettered, and pain is 
relieved. 

In these cases thorough attention to the general health is 
necessary. Also bowels, kidneys, liver, and skin must be kept 
well stimulated to aid in carrying off the septic products of the 
disease. In case of the appearance of abscess, it must be drained 
when it has come to a head. Such quantities of pus cannot be 
absorbed, and the abscess should not be allowed to break. After 
drainage the abscess may be entirely healed by the treatment. 

Various swerves in the spine, or departures from the nor- 
mal curves, are frequently met with. They are often called 
curvatures, but are not properly so regarded. Yet they may 
predispose to curvatures. They may be readily righted by the 
treatments given above. 

Pott's disease requires a long and patient course of treat- 
ment. This is often true of the ordinary curvatures, but very 
frequently a single month, or a few months, of treatment will 
show surprising results. 

The TREATMENT OF DEFORMITIES proceeds upon much the 
same general plan of treatment as described for curvatures. 
All the surrounding parts must be relaxed, strengthened and 



PRACTICE OF OSTEOPATHY. 40t5 

prepared by a course of treatment directed to the complete restor- 
ation of circulation to the parts and tissues involved. When 
the preparation is completed the practitioner proceeds by ex- 
aggeration of lesions, traction, pressure, rotation, etc.. applied 
to the bony part to force it back into place. 

It often happens that in apparent deformity of a bony part, 
as of a joint, while pain and abnormal position and condition of 
the tissues is apparent at the joint, the real cause may be an ob- 
struction in the nerve and blood-supply of the joint somewhere 
above or at the spine. Thus apparent deformity of a knee has 
with much frequently been found to be due to a luxation of the 
hip-joint or of spinal vertebra-. 

A deformity, as an enlargement of a joint, may be not real 
but apparent by reason of atrophy of the surrounding tissues. 
Then the cause must be sought elsewhere for the wasting of the 
tissues. But the surrounding tissues often waste in cases of 
joint disease or deformity. 

It sometimes happens, as in the case of "hysterical joints" 
that there is no real diseased condition of the kind suspected. 

.Muscular and ligamentous deformities are often the results 
of some preceding or existing disease. In such cases treatment 
must be made accordingly. Locally one must direct treatment 
to the affected tissues te relax and restore them. 

On the other hand these muscular and soft tissue deform- 
ities are surprisingly often found to be due to a vertebral lesion, 
or other lesion, at the origin or in the course of the nerves supply- 
ing the part. In such case the treatment must embrace the re- 
moval of lesion as the real cause, and corrective work upon the 
deformed tissues. It sometimes happens in the treatment of 
these cases that the spinal lesion is treated to the exclusion of 
the local treatment upon the affected part, or that treatment is 
mistakenly directed to a spinal lesion not responsible for the con- 
dition. One will learn that he must judge of the relative import- 
ance of treatment directed to one situation or the other. 

Sometimes a minute luxation of a joint itself is the cause 
of the trouble. 

In cases of deformity due to deposits in and about joints, as 
in chronic rheumatism, the circulation is built up and kept stim- 



406 PRACTICE OF OSTEOPATHY. 

ulated to absorb the deposit. In such cases it is necessary to 
adapt some motion to thoroughly stretching or spreading the 
joint in order that the renewed blood-supply may freely circu- 
late in the joint. 

Various special treatments applicable to the treatment of 
deformities will be found described in the general treatments 
for the upper and lower limbs. 

The TREATMENT OF DISLOCATIONS is fully described in 
Chap. X. 

Concerning the TREATMENT OF JOINT AFFECTIONS little 
need be added to what has been said in describing the treatment 
of deformities (see also the treatment of rheumatism.) Pain in 
a joint is often to be due to a spinal lesion or to a lesion in a re- 
lated joint. A very common occurrence is to discover the cause 
of a so-called tubercular knee, or of a swelling or synovitis of the 
knee-joint, in a luxation of the hip-joint. 

In all cases of joint affections one must look closely for 
lesion to nerves or vessels supplying the joint from the origin 
down, and remove it as the cause of the trouble. To this must 
be added local manipulation of the joint and its parts in order 
to correct proper circulation. 

Plaster casts and bandages are at once removed to aid in 
securing freedom of blood circulation. 

One must not forget that apparently very serious disease 
has often been found by osteopaths to depend upon a slight slip 
of the bones or cartilages of the joint affected. Treatment upon 
the principles laid down will usually suffice to slip these back into 
place. 

In strains, sprains, and inflammations of a joint one must 
free the local and the connected circulation to take down the 
inflammation. If applications are used, hot are better than cold. 

In chronic affections it is usually necessary to treat from 
the spine out to the joint in question, besides removing all bony 
lesions, adjusting all tissues, etc. 

Moderate use of a joint is usually advised, at discretion. 
The use builds up a natural condition. 

Cases of bony ankylosis are incurable without breaking. 
Llgamentous ankylosis may be cured. If any motion at all ex- 



PRACTICE OF OSTEOPATHY. 407 

ists in a joint there is good reason for belief that it may be in- 
rrr;isod, possibly fully restored. 



DISEASES OF WOMEN. 

CASES: (1) Dysmenorrhcea and irregularity of menstrua- 
tion, with a complication of troubles in a young lady of t \vcnty- 
five. The lower dorsal and lumbar vertebrae were anterior. 
The case was cured in ten weeks, having gained 22 pounds. 

(2) Dysmenorrhoea in a married woman of 38. At each 
period she was confined to her bed, there being menorrhagia, 
headache, nausea, etc. The condition was of 12 years standing, 
since childbirth. The uterus was prolapsed and retroverted. 
The right innominate was posterior. The bone was replaced, 
the uterus put into correct position, and the case w r as discharged 
cured in two months. 

(3) Dysmenorrhoea of 3 years standing in a young lady 
of 21. Lesions were: 5th lumbar to the right, and surrounding 
tissues much contracted; 9th, 10th and llth dorsal vertebrae 
luxated and that portion of the spine rigid. Patient's general 
health was much affected. The case was cured by removal of 
lesion in two months. 

(4) Amenorrhcea. with a complication of troubles, in a 
woman of 22, of 13 months standing. The greatest gynecolo- 
gist in Cincinnati said the uterus was atrophied and she would 
never menstruate again. Lesions were: 7th dorsal spine to 
right and whole spine rather irregular; pelvis twisted with ap- 
parent lengthening of right limb. The case was benefited from 
the beginning of treatment and was cured in four months. Menses 
appeared in six weeks. 

(5) Amenorrho?a of 7 months standing in a case in which 
the period had been very irregular, often not occurring for three 
or four months. The general health was much affected. After 
two weeks treatment she was much better, and the menses ap- 
peared. Under the treatment the patient gainted rapidly in 
weight, the normal, period being re-established. 

(6) Amenorrhcea in a young woman, of over 8 months 
standing. Lesions were: 2nd lumbar posterior; 1st, 2nd and 3rd 



408 PRACTICE OF OSTEOPATHY. 

dorsal lateral; 5th lumbar anterior. Treatment corrected the 
lesions and cured the case in three months, the patient having 
gained 12 pounds. 

(7) Amenorrhcea of more than a years standing in a young 
woman. Lesions: 4th and 5th lumbar anterior; luxation of 8th 
and 9th dorsal, and stricture of the os. Lesions were corrected 
and the os was relaxed by spinal work. Menstruation came on 
normally. 

(8) Menorrhagia and dysmenorrhoea. The menstrual flow 
started upon the least exercise. The curves of the spine were 
straightened, and there were many slight irregularities in it. 
The coccyx was lateral to the right and anterior. The case was 
first treated during period, and the flow ceased at once, not re- 
turning for four months, after which it was normal. 

(9) Uterine hemorrhage suddenly appearing with abdominal 
pains. The latter were intense and the hemorrhage profuse. 
One treatment entirely relieved the trouble. 

(10) Uterine hemorrhage, frequent and profuse, in a married 
woman who had previously undergone operation for the removal 
of uterine fibroid- tumors. The uterus was retroverted, the left 
innominate anterior, and the 2nd and 3rd lumbar vertebrae lux- 
ated. The hemorrhages ceased after the second treatment. 

(11) Metrorrhagia of 2 years standing. The right innom- 
inate was slipped upward, and its correction entirely cured the 
trouble. 

(12) Prolapsus of the uterus in a lady of 40, who had suffered 
with spinal trouble and dysmenorrhrea for 26 years. The pa- 
tient had been taking local treatment for uterine displacement 
and other trouble twice a week for two years. After three months 
of osteopathic treatment, in which time about five local treat- 
ments were given, the prolapsus, leucofrhcea, etc., were cured. 
Practically all the treatment was upon spinal lesion, the spine 
having been found swerved one and one-half inches laterally. 
It was corrected. 

(13) Prolapsus of the uterus, with retroversion, hi a woman 
of forty of sveral years standing. Lesion was a slight displace- 
ment of an innominate. The case was cured by local and spinal 
treatment. The lesion was corrected. 



PRACTICE OF OSTEOPATHY. 409 

(14) Leucorrhcea in a married woman of thirty. Lesion: 
slight deviation of lower dorsal and lumbar vertebrae to the left. 
Upon correction of spinal lesion, in less than one month, the case 
was cured. 

(15) Leucorrhcea, congestion of the ovaries, and painful 
menstruation, of three years standing. The left innominate 
bone was luxated, and lesion also occurred at the 10th and llth 
dorsal vertebrae. The case was cured in four months. 

(16) Vaginal cyst in a woman of forty, following subin- 
volution and prolapsus of the uterus after child-birth three years 
previously. The cyst was about the size of a hickory nut, and 
had formed about four months previously to the time of exami- 
nation. Spinal lesion present was a separation between the nth 
lumbar and sacrum. Treatment consisted mainly in correction 
of spinal lesion. Local treatment was given to restore tonicity 
to the very lax vaginal walls, and to improve venous and lymphatic 
drainage. The cyst entirely disappeared by six weeks treatment. 

(17) Vaginal irritation due to lesion as a tilted ilium, which 
\vas removed and the case was cured. 

(18) Chronic hemorrhagic endometritis in a woman of 
fifty-seven, who had not walked for three years, and who, for 
eighteen months had been unable to sit up, as the slightest ex- 
ertion caused hemorrhage. The condition was of thirty years 
standing. Lesions: 3rd and 4th cervical vertebrae anterior, 
from ninth dorsal to sacrum decidedly posterior. Improvement 
Mas marked after one months* treatment, patient being able to 
walk about the house. The case was cured in three months. 
The patient was still well two years later. 

(19) Salpingitis in a married woman, multipara, who had 
previously suffered acute suppression of menses. The condi- 
tion became very acute, and operation was advised. The pa- 
tient was in great agony. At this point an Osteopath was called. 
Light spinal and local abdominal treatment relieved the pain in 
half an hour, and the patient slept for six hours, the first natural 
sleep in a number of days. She was awakened by fresh pain, 
caused by the natural discharge of about 1 pint of pus. Two 
or three light treatments were given before evening of the next 
day, and the soreness entirely disappeared. The patient was 



410 PRACTICE OF OSTEOPATHY. 

able to be about that day. No return of trouble occurred. 

(20) Inflammation of the ovaries in a woman of twenty- 
six, of several years standing. For four years ordinary treat- 
ment had been tried. Operation was advised. Lesions: mus- 
cular contractures in the middle dorsal and lower lumbar regions, 
the whole spine being weak. The case was cured in two months. 

(21) Acute inflammation of the ovary in a woman of thirty- 
five. Lesions: 5th lumbar posterior, sacral muscles contracted 
and sensitive, muscular contractions in the region of the affected 
ovary. The case was treated twice daily for three days and was 
cured. 

(22) Ovarian colic in a case in which there had been acute 
attacks previously. A cold had contractured the muscles on 
the left side of the lower lumbar spine. The right innominate 
was displaced doward and forward. The patient was in great 
pain. Relief was immediate, and the case was cured in one treat- 
ment. 

(23) Climacteric, with dropsy and asthma, in a patient of 
fifty-two. For one year the patient had suffered with all the 
trying symptoms of the menopause. Lesions were found at the 
spinal connections of the cardiac, hepatic, renal, ovarian, uterine, 
and hypogastric plexuses. Improvement was immediate. No 
asthma appeared after the second treatment, the patient grew 
strong and was entirely cured in three months. 

(24) Phlegmasia Alba Dolens (Milk-leg) in a woman of 
twenty-three, of three weeks standing. There was innominate 
lesion, marked tenderness in the sacro-iliac region, and lesions 
at the 6th and 7th dorsal. The treatment was largely confined 
to the lesions, and the milk-leg symptoms disappeared in three 
treatments. The case was cured. 

When the case was taken under treatment the fever was 
103, the leg was much swollen and very painful, confinement 
had occurred three weeks before. 

LESIONS AND ANATOMICAL RELATIONS. 

The lesions in cases of women's diseases are practically all 
found below the eighth dorsal. Considering the multiplicity of 
diseases it is interesting to note that they are almost without. 



PRACTICE OF OSTEOPATHY. 411 

exception traced to actual spinal lesion at the centers controll- 
ing the pelvic viscera, or upon the closely related nerves. Le- 
sion is as near specific in this class of cases as in any. 

(Jenerally speaking, lesion may be expected anywhere among 
the lower three or four dorsal vertebra? and corresponding ribs, 
among the lumbar vertebra^, at the lumbo-sacral articulation, at 
the innominates, sacrum and coccyx. It is very common to 
find lesion at the 9th, 10th, or llth dorsal, affecting the center 
of blood-supply to the ovaries; at the 2nd lumbar, affecting the 
blood-supply to the uterus; and at the 4th and oth lumbar, at 
which point lesion is particularly apt to occur affecting the hypo- 
gastric plexus, and through it the pelvic viscera. Cases have 
been observed in which a displaced lower rib irritated an ovary 
and caused disease in it. The oth lumbar lesion is perhaps the 
most frequent one, it Ix ing at the same time a weak point ana- 
tomically, therefore particularly liable to lesion, and in important 
relation to the hypogastric plexus. 

Innominate lesion is perhaps the next most frequent. Its 
relation to the sacral nerves, which are so closely connected with 
the pelvic viscera, accounts for its importance. 

Such lesions as have been pointed out as the causes of enter- 
optosis and prolapse of the diaphragm become important causes 
of prolapsus of pelvic viscera by pressure from above, and by 
weakening the supports of these organs, also of congestive dis- 
turbances such as must follow in such a state of affairs. 

In female diseases one should look for lesion especially at 
the 5th lumbar, at the innominates, at the 2nd lumbar, and 
about the 9th, 10th. and llth dorsal. There is sometimes irri- 
tation of the internal pudic nerve where it emerges from the 
pelvis to cross the spine of the ischium. The ovarian vessels are 
frequently obstructed by enteroptosis, especially by ptosis of 
the transverse colon. 

In menstrual disorders lesions occur from the 10th dorsal 
to the 4th or oth sacral, and among the lower ribs. Painful 
menstruation is often found to be due to lesion at the 5th lumbar 
and at the innominates. 

The lesions as described are seen to be at points where they 
interfere with the nerve-connections and circulation of the pelvic 



412 PRACTICE OF OSTEOPATHY. 

viscera. There are two groups of vaso-motor nerves for the 
genitalia, one in the lumbar region and the other in the sacral, 
as pointed out in the American Text-Book of Physiology. For 
the external genital organs vaso-motor fibres rise from the 2nd, 
3rd, 4th, and 5th lumbar nerves, run forward in the white rami 
communicantes, and pass through the pelvic plexus and pudic 
nerve to reach the organs they supply. From the anterior roots 
of the sacral nerves rise vaso-motors which, when stimulated. 
dilate the vessels of the external genitals. Vaso-constrictors for 
the fallopian tubes, uterus, and vagina in the female, and for the 
vasa deferentia and vesiculae seminales in the male, are found in 
the sacral nerves. The 2nd, 3rd, 4th, and oth lumbar nerves send 
vaso-motor fibres to the internal, as well as to the external gen- 
itals. 

According to Quain's anatomy, it is probable that sensory 
nerves pass through the sympathetic, those supplying the ovary 
from the 10th dorsal; those supply the uterus (a) in contraction, 
from the llth and 12th dorsal and 1st lumbar, (b) os uteri, (1st), 
2nd, 3rd, 4th sacral , (5th lumbar rarely.) It is seen that these 
points have been found as the seat of lesion in pelvic disorders. 
This sensory innervation is made practical use of in pelvic dis- 
orders. Often by preliminary inhibition along this spinal re- 
gion pain is quieted. 

Quain's' anatomy also notes motor fibres for the uterus 
passing into the sympathetic from the lower dorsal and upper 
one or two lumbar nerves, and reaching the. uterus via the aortic 
plexus, the inferior mesenteric ganglion, hypogastric and pelvic 
plexuses. Also motor fibres to the uterus descending from the 
lumbar region and terminating in the sacral ganglia. It is at 
once seen that lower dorsal and upper lumbar lesion is important, 
as it affects this distribution via the inferior mesenteric ganglion. 
The other lumbar lesions are also seen to be important. 

According to Foster's physiology, stimulation of the in- 
ferior mesenteric ganglion causes circular contractions of the 
uterus, with descent of the cervix and dilatation of the os. Stim- 
ulation of the sacral nerves contracts the longitudinal fibres, 
shortens the cervix, and closes the os. 

These various motor effects are used by the Osteopath in 



PRACTICE OF OSTEOPATHY. 413 

both gynecology and obstetrics, for example, he stimulates the 
sacral nerves to contract the uterus and lessen hemorrhage, or 
he stimulates the upper lumbar to gain dilatation of the os. By 
treatment to the lumbar and sacral regions he regulates the 
blood-supply through the vaso-motor innervation described 
above. 

Inhibition of the clitoris is held to relax the circular fibres 
of the cervix and dilate the os. Inhibition at the 4th sacral 
nerve is used to relax the vagina. 

The TREATMENT of female disorders is eminently successful. 
It will be seen from the above description of lesions and of ana- 
tomical relations that osteopathy can gain control of the motor, 
vaso-motor, and nervous mechanisms of the liver. A knowl- 
edge of these, and proper treatment of them in a given case are 
all that is necessary. A study of the facts above in regard to 
nerve-supply, lesion, and case reports, will enable one to work 
out proper treatment for a given condition. 

In any case the removal of lesion as soon as possible is of 
the utmost importance. Frequently this is the only treatment 
necessary. Quite generally, the removal of lesion, together 
with a little spinal and abdominal treatment are found to be 
sufficient for complicated cases. 

In any painful case one must first make thorough spinal 
inhibition from the ninth dorsal to and including the sacral 
nerves. In this way all the sensory nerves noted above are 
reached. Often this preliminary treatment is used to great ad- 
vantage in allaying the local pain to such an extent as to allow 
of local or abdominal treatment which before could not be en- 
dured. 

The osteopathic method of examination and treatment of 
the uterus and vagina locally has been described in Part I. 

In cases of suppression of menses the treatment must look to 
the removal of the lesion obstructing the circulation. This 
must be expected particularly along the region described above 
as the location of the vaso-motors for ovaries, uterus, etc., i. e. r 
along the 5th to 12th dorsal, all the lumbar, and all the sacral 
region. Examination must also be made for pressure of an ab- 
dominal organ, such as the transverse colon, upon the ovarian 



414 PRACTICE OF OSTEOPATHY. 

artery. In any case it is well to work carefully down along the 
course of this vessel, beginning a little above the level of the 
umbilicus and proceeding downward to the pelvis. Usually in 
these cases it is sufficient to give a thorough, strong, stimulating 
spinal treatment, from the 9th dorsal down to the sacrum. It is 
not advisable to include the sacral nerves in this treatment, as 
their stimulation contracts the uterus and closes the os. It is 
better to relax the tissues over them and to inhibit them. 

During the spinal stimulation all spinal parts and tissues 
should be carefully relaxed and sprung. This treatment in- 
cludes stimulation of the llth and 12th dorsal and 1st and 2nd 
lumbar, by way of which effect is gotten upon the connections 
of the inferior mesenteric ganglion, stimulation of which aids in 
dilating the os. One may also treat this ganglion directly by 
deep abdominal treatment over its site, it lying upon the inferior 
mesenteric artery a little below and externally from the umbilicus. 
Further treatment may be made down over the course of the 
common and internal iliac vessels, stimulating their flow. The 
clitoris should be inhibited, and the uterus should be replaced if 
prolapsed. Inhibition may be made upon the pudic nerve where 
it crosses the spine of the ischium. Sometimes dilatation of the 
cervix and os uteri aid the case. The same treatment applies 
to scant menses. 

In many of these cases the general health suffered severely. 
Particularly is one apt to find the lungs involved in cases of any 
length of standing. Careful attention must be given the lungs 
and the general health. 

Irregular menstruation is generally corrected by such a 
co'urse of treatment. 

In DYSMENORRHCEA the first step is to apply the strong 
spinal inhibition along the area of sensory innervation described 
above. Careful and moderately strong inhibition applied at 
successive points from the middle dorsal down, given in such 
a way that the spine is sprung and held at each point for two or 
three minutes, has the effect of relaxing the spinal tissues, re- 
lieving the irritation and gently starting the flow. Commonly 
a little trying will indicate a certain point in the spine at which 



PRACTICE OF OSTEOPATHY. 415 

inhibition gives immediate relief. This point is different in the 
different cases. 

Dysmenorrhoea is generally relieved by a treatment which 
gently starts the menstrual flow. Quite commonly these cases 
are due to retarded circulation. Hence one must do gentle ab- 
dominal manipulation over the vessels and tissues concerned. 
It is also often advisable to give a light spinal stimulation, as 
above, with this purpose in view. 

A common cause of dysmenorrhoea is sudden stoppage of 
the flow by malposition of the uterus, leading to congestive ob- 
struction of the circulation. In such cases it is necessary to 
carefully replace the uterus. Local treatment must, however, 
be avoided at time of menstruation except in cases of the most 
urgent necessity. Often the treatment given, as described, gives 
instant relief. 

It is sometimes necessary to give a general spinal treatment 
to quiet the nervous system, as nervous disturbances may cause 
dysmenorrhoea. In cases due to cold a thorough general treat- 
ment, including stimulation of heart and lungs, may be added 
to the treatment outlined above. In these cases a hot tub bath 
or hot vaginal douches may be the only aid required. 

In menorrlwa, metrorrhagia and uterine hemorrhages often 
there is a specific lesion of the innominate present. The innom- 
inates should be adjusted, at the symphysis pubes as well as at 
the articulation with the sacrum. A special treatment 
recommended in these cases is to place the knee against the 
sacrum and pull backward upon both innominates. Obviously 
one must have in view the removal of the cause, whatever it is, 
and the stanching of the hemorrhages by the contraction of the 
blood-vessels. 

Often a quick, rather hard jerk, at the hairy covering of the 
mons veneris is sufficient to contract the vessels and stanch the 
flow. Quick and rather forcible stimulation of the round lig- 
aments where they cross the pubic arch, about an inch each side 
of the symphysis. will help. Stimulation of the clitoris and 
strong stimulation of the sacral nerves contract the uterus, cervix, 
and os, and are important means of stopping the flow. One 
should avoid stimulation of the lower dorsal and lumbar regions 



416 PRACTICE OF OSTEOPATHY. 

of the spine. In some cases compression of the common and in- 
ternal iliac arteries is helpful. Deep pressure is to be made upon 
them and continued for considerable time. In some cases good 
results have been gotten in this way. 

Injections of very hot or of cold water are often useful. 

The patient should be on her back with the hips elevated. 
This quiets the heart and aids the venous drainage. 

Vicarious Menstruation yields to the treatment directed to 
re-establishing the normal menstrual function. It should at 
the time be treated as any hemorrhage, according to the place 
at which it appears. 

Prolapsus Uteri and the various displacements are consid- 
ered in Part I. In case of adhesions with prolapsus, it is the aim 
to gradually stretch and break them down by carefully stretch- 
ing the organ away from them. This may be generally accom- 
plished. It is done by local treatment. It is probable that this 
process is in part an absorption of the adhesive tissues by the 
renewed circulation, as in case of fibroid tumors, etc. 

To strengthen the ligaments to hold the organ in place, 
treatment must look to the removal of lesion, the spinal and ab- 
dominal stimulation of the blood-supply, and the strengthening 
of the perineum. Stimulation of the pudic nerve at the spine of 
ischium aids the latter object. In young girls stimulation of the 
round ligaments and external abdominal treatment to the iliac 
blood-supply, etc., is usually quite sufficient for a cure. 

In cases of Leucorrhoea the object is to correct circulation 
and prevent the abnormal secretions. The condition is usually 
due to obstruction of the vaginal circulation, and quite often 
occurs along the lower lumbar or sacral region. Its removal 
usually soon results in cure. Often the local circulation is im- 
peded by a prolapsed uterus, resulting in leucorrhcea. In such 
cases cure of the prolapsus is necessary. Lumbar and sacral 
stimulation, and abdominal treatment about the deep pelvic 
vessels aid in correcting the circulation. Cleanliness is essential. 
Hot vaginal douches are useful. 

In Congestive Disturbances of the Ovary and Ovaritis, correc- 
tion of the circulation is the main object. The abdomen is apt 
to be quite painful in the region of the ovaries, and it is necessary 



PRACTICE OF OSTEOPATHY. 417 

first, often, to make spinal inhibition along the course of the sen- 
sory nerves. After this careful abdominal treatment may be 
given, relaxing all the local abdominal tissues and thus freeing 
the local circulation. The work should be carried up along the 
course of the ovarian vein, which accompanies the ovarian artery 
above described. A certain amount of spinal stimulation is 
useful in the correction of circulation. 

The treatment for the fallopian tubes is local and spinal of 
the kind described. 

In all cases of pelvic disorders it is well to see that the lower 
ribs are well raised, and that no obstruction to circulation from 
the lower abdomen occurs at the diaphragm. The treatments 
given to raise the abdominal' and pelvic viscera are also helpful. 
(Chap. VIII). 

For the treatment of ovarian and uterine tumors see "Tu- 
mors. ' ' 

For the Climacteric treatment is largely symptomatic, to 
relieve the headache, hot flashes, nervous disturbances, etc. A 
constitutional treatment is given, with special attention devoted 
to the spinal system, to strengthen the nervous system and to 
quiet nervousness. Local treatment to the uterus is not nec- 
essary unless local trouble exists. Care should be taken not to 
bring on the menstrual flow by hard treatment in the lumbar 
and sacral regions. 

In Phlegmasia Alba Dolens (Milk-leg) the treatment con- 
sists in the removal of lesion and the correction of circulation 
to the limb. The adjustment of innominate lesion, or of a lux- 
ation of the hip-joint, and the relaxation of the pelvic muscles 
may be all the treatment necessary. These causes act as ob- 
structions to the nerve and blood-supply and cause the trouble. 
The thigh should be flexed and rotated, and treatment may be 
given as for varicose veins, q. v., to aid in the venous return 
from the limb. 

OBSTETRICS. 

It is not the object here to deal with the conduct of a case 
of child-birth. That is left to special works upon the subject. 
It is sufficient, within the scope of this \vork, to give the special 



418 PRACTICE OP OSTEOPATHY. 

osteopathic points in connection with obstetrical work. 

It is the common practice, during the early stage of labor, 
after the true pains have commenced, to hasten labor, if desir- 
able, by stimulation at the parturition center at the 2nd lum- 
bar. This increases circular contractions in the uterus, causes 
descent of the cervix, and dilatation of the os. It is usually best 
to rely upon the natural process of labor and very often this 
treatment is not used. 

Later one may aid the further dilatation of the os by inhi- 
bition of the clitoris. This is accomplished by pressure over 
the lower part of the pubic symphysis, between the labia. In- 
hibition of the round ligaments is also used for this purpose. 

For severe pains in the back, desensitize about the 5th lum- 
bar and relax the neighboring spinal tissues. 

If the bearing down pains do not come regularly and hard 
enough, one should give occasional firm stimulation in the re- 
gion of the second lumbar. 

As the head is descending the finger should be used to press 
back the edges of the os all around the head. Also, in case of 
folds in the vaginal walls, they should be kept smoothed out, 
and the walls should be pressed well up and outward all around. 
If these folds occur they cause great pain an-i headache. 

To prevent laceration of the perineum, both hands should 
be applied to the pelvis. One presses the tissues down over the 
pubic arch and inhibits the clitoris, while the other grasps the 
two tubers ischii and springs them toward each other, at the 
same time supporting the perineum. As the head is born the 
hand makes pressure against it, as required, to prevent its coming 
with too great force. 

When the afterbirth is ready for delivering, slight stimula- 
tion at the upper lumbar will aid it if necessary. If necessary, 
a quick pull at the mons veneris will aid in expelling it. A 
cough will sometimes be sufficient to start it. 

After it is born the hand should be placed upon the abdom- 
inal wall and support the uterus until it is well contracted and 
hard. 

Desensitize the clitoris to stop after pains. 



PRACTICE OF OSTEOPATHY. 419 

It is well to flex and circumduct the limbs carefully, be- 
fore leaving a case, to see that there are no slips at the hip- joints 
or excessive contractures of muscles, which may lead to milk-leg. 



DISEASES OF THE MALE GENERATIVE ORGAXS. 

CASES: (1) Orchitis, in a young man, following muscular 
strain. Lesions: 4th lumbar posterior, 5th lumbar anterior, 
left iliac very painful. The left testacle was affected. The 
treatment at once gave relief. The lesion was corrected and the 
case was cured. 

(2) Orchitis due to lesion at the 10th and llth dorsal ver- 
tebrae. The patient was in intense pain and the testacle was 
greatly swollen. Relief was immediate, and cure as well, upon 
removal of lesion. 

(3) Edematous swelling of the prepuce in a boy. following 
accident in which the innominate bone was luxated. Its cor- 
rection cured the case. 

(4) Impotence; lack of power to secure erection in a man 
suffering from marked contracture and soreness of the lumbar 
muscles, due to being on the feet too much. One treatment re- 
laxed the muscles and overcame the difficulty. 

(5) Impotence and splenitis. Lesions: Oth. 10th, and llth 
left ribs depressed; posterior curvature in the dorso-lumbar 
region, prostate gland atrophied. The case was cured in four 
months. 

(6) Impotence in a man of fifty-one, of three to four months 
standing. Lesions: 4th and 5th lumbar turned to the right. 
1st lumbar to the left. 4th dorsal vertebra to the right. The 
patient had tried medicine, electricity, and hydrotherapy with- 
out avail. He was cured by six weeks treatment. 

(7) Varicocele in a case which had tried medical treatment 
without success, and in which operation was recommended. It 
was entirely cured by osteopathy in five weeks. 

(8) Enlarged prostate gland in a man of seventy-eight, 
causing retention of urine and cystitis, for which he had been 
unsuccessfully treated for many years. Treatment reduced the 
gland, and the case entirely recovered. 



420 PRACTICE OF OSTEOPATHY. 

(9) Enlarged prostate in a man of sixty-eight, who for 
several months had suffered with some retention of the urine. 
The prostate was reduced by a few treatments and the case was 
cured. 

(10) Prostatitis and stricture of the urethra in a man of 
forty. He had had an operation for the stricture, but it w r as 
unsuccessful. There was great pain upon urination, and Avrnk- 
ened sexual power. The case was entirely cured in two months. 

(11) Gonorrheal prostatitis in a young man. Operation 
had been unsuccessful. The prostate was enlarged and hard. 
It was reduced by treatment and the case was cured. 

LESIONS AND ANATOMICAL RELATIONS in diseases in the 
male generative organs occur in positions corresponding to le- 
sions pointed out in female pelvic diseases. These lesions occur 
from the 8th or 9th dorsal down, including the lumbar, lumbo- 
sacral, and innominate lesion. The lower lesions seem to be the 
more important ones. 

It is to be noted that vaso-motors for both external and 
internal genitals occur in the male in the same regions as de- 
scribed in female diseases, at the 2nd, 3rd, 4th and 5th lumbar 
and at the sacral nerves. The sympathetics convey to the 
prostate sensory fibres derived from the 10th, llth, (12th) dor- 
sal; 1st, 2nd, 3rd sacral, and 5th lumbar; and to the prostate 
from the 10th dorsal. (Quain). For the epididymis sensory 
fibres are derived from the llth and 12th dorsal and 1st lumbar. 

It is readily seen that the lesions usually found in male gen- 
erative diseases fall within these areas of innervation. 

TREATMENT: In all these cases it is necessary to bear in 
mind the anatomical relations of lesion to disease, and to see that 
such lesion is removed. In a good many of these conditions the 
removal of lesion is all that is required. After removal of the 
irritating cause, spinal and abdominal treatment of the kind 
described for female diseases is usually helpful. 

The treatment for the prostate has been described in Part I. 
In cases of prostatitis the treatment must be carefully applied 
locally, and it should be directed particularly to freeing the tis- 
sues about the gland. Great case is necessary not to irritate 
the structure. Abdominal and spinal treatment may be added. 



PRACTICE OF OSTEOPATHY. 421 

For Orchitis the treatment is mainly in removal of lesion. 
This immediately relieves and usually cures the case. Spinal 
and abdominal treatment may be directed to the relaxation of 
tissues, relief of tension, and correction of circulation. The 
tissues about the inguinal canal should be kepi relaxed to main- 
tain free drainage from the testacle. Treatment should be carried 
well up along the spermatic vein, terminating on the left in the 
renal vein and on the right in the inferior vena cava at about 
the same level. The abdominal viscera may be raised to aid 
free circulation. The patient should remain quiet. If the case 
is severe he may lie upon his ba-ck with hips elevated. The 
irritating pressure of clothing, etc.. should be avoided. 

In case of Varieoeele the object of the treatment is to empty 
the over-distended veins, to strengthen the vessels, and to re- 
move the causes which obstruct the circulation. Lesion in the 
lower lumbar and sacral region is usually present and weakens 
the vaso-nv.)tor innervation of the parts. Allowing of sluggish 
circulation and venous engorgement. The lesion must be re- 
moved, and spinal treatment is made to strengthen the v a so- 
motor supply. The veins are stripped to empty them, and the 
manipulation is carried up over the spermatic vein to its con- 
nection with the renal vein. Care must be taken to see that the 
tissues about the inguinal canal do not obstruct the veins, also 
that pressure from the abdominal viscera i> entirely removed. 
To this end the bowels must be kept free and the abdominal 
contents should be raised as before directed. 

In some cases surgical interference may be necessary, yet 
on the other hand cases have been saved from operation by the 
treatment. 

Impotence and Spermatorrhoea have been very successfully 
treated. In some cases thorough relaxation and stimulation 
of the spinal musculature and nerves from the middle dorsal 
region down is the only treatment necessary. In other cases 
the removal of innominate lesion and the stimulation of the 
sacral nerves has been successful. It is well to have the patient 
lie on the side and then strong pressure is made with the knee 
in the sacro-iliac articulations, springing them freely. 

In these cases lesion at the region of the genito-spinal center 



422 PRACTICE OF OSTEOPATHY. 

in the cord (1st and 2nd lumbar) is sometimes present and re- 
sponsible for the trouble. 

A good point of treatment is to stimulate the perineal nerve 
where it crosses the spine of the ischium. This strengthens the 
erector muscle of the penis. Enlargement of the prostate gland 
is sometimes closely associated with these conditions, and it 
should be reduced according to directions given above. 

All causes of reflex irritation, as from an elongated prepuce, 
constipation, nervousness, etc., must be removed. It is quite 
necessary in most cases to direct general treatment to the quiet- 
ing and strengthening of the nervous system. In these nervous 
cases it is well to place the patient upon a simple diet, with the 
avoidance of stimulants and excitement. Cold baths, exercise, 
and outdoor life are helpful. 

GONORRHCEA AND SYPHILIS. 

Some cases of syphilis and a number of cases of gonorrhoea 
have been treated osteopathically. Some success has been ap- 
parent in the treatment of syphilis, the patient at the time being 
considerably bettered or gaining, entire relief from the symptoms 
with which he was suffering. Extended observation of these 
cases, however, has not as yet become a matter of record. 

Gonorrhrea is usually readily cured without the usual se- 
quelse. The special treatment is to the blood-supply upon the 
lines laid down, with the idea of controlling the circulation and 
reducing the inflammation. Constitutional treatment is given, 
and liver, kidneys, and bowels are kept active to aid in getting 
rid of the poisons. 

TUMORS. 

CASES: (1) Ovarian tumor, upon which operation was 
advised, cured by two months treatment. 

(2) Uterine fibroid tumor, the patient having for sixteen 
years suffered intensely at period. Surgeons were about to 
operate upon the case, when it was decided to try osteopathy. 
After four treatments the period was passed without any dis- 
comfort. After three months treatment the tumor had disap- 
peared. 



PRACTICE OF OSTEOPATHY. 423 

(3) Intestinal fibroid tumor. There was a history of con- 
stipation, and colicky pains for a number of weeks, constantly 
increasing in severity and frequency, and leading finally to spasms. 

The abdomen was much distended with feces and gas; the 
10th, llth and 12th 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 ilium. 

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 
lH by 1 ] 4 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 en- 
larged sebaceous gland, had been growing for ten years. Treat- 
ment was directed to softening the contents of the gland until 
able to pass it 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 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 muscles. The head was drawn backward, the 
giddiness, insomnia, and ocular disturbances were present. The 
condition seemed likely to lead to insanity, and leading physicians 
diagnosed it as a tumor upon the brain. Correction of the le- 
sion cured the case, and the diagnosis of cerebral tumor was 
shown to be wrong. 

(6) An abdominal tumor in a lady, the waist measuring 46^ 
inches, and increasing at the rate of one inch per week. Le- 
sion was found at the oth dorsal, also at the llth, and the left 
ribs were luxated. The tumor appeared to be as large as a cocoa- 
nut. At the end of one months treatment the growth had been 
stopped and the waist measurement was reduced one inch; at 
the end of 2 months, the waist was 31 ] ^ inches, and had reached 
nearly normal size. The treatment Avas continued for three 
months longer, and the case was discharged cured. 

(7) A tumor of the breat. about the size of a walnut, very 



424 PRACTICE OF OSTEOPATHY. 

hard and involving the center and deep portion of the gland. 
Sharp pains radiated in all directions from the tumor, but mostly 
toward the axillary region. 

The condition was found to be an engorgement due to ob- 
structed vessels, with which the gland is richly supplied. The 
lesion was a twist of a clavicle, narrowing the space between the 
clavicle and first rib, and caused by using a crutch for a lame leg 
upon the same side as the lesion. Thus was caused an obstruc- 
tion to the lymphatic drainage of the breast, and the growth 
resulted. As a preliminary measure the limb was cured and the 
use of the crutch was dispensed with. The clavicle was righted 
and the growth began to be absorbed. The case was cured in 
seven weeks. 

(8) A tumor just external to the vaginal orifice, of four 
months standing. There was a fluid contained in the tumor, 
and it varied in size, becoming smaller after the patient had re- 
mained in a recumbent position for a few days. There was pro- 
lapsus of the uterus and lesion among the lumbar vertebrae. 
The case was cured in two months. 

(9) An ovarian tumor in a patient, from whom, two years 
previously, the left ovary and a tumor weighing twenty-five 
pounds had been removed. A few months later a tumor ap- 
peared upon the right ovary, and operation was advised. After 
a month and a half of treatment the tumor had disappeared. 

(10) Fibroid tumors of the uterus in a patient who had, 
four years previously, been injured in the left side by a vicious 
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 PROGNOSIS, generally speaking, to benefit or cure various 
tumors by osteopathic treatment is good. Numerous cases have 
been saved by this means from the surgeon's knife. While many 
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 ob- 
structions to blood and lymph flow, or to nerve-supply. Some 



PRACTICE OF OSTEOPATHY. 425 

lesions cause tumorous growths by direct irritation of the tis- 
sues. A frequent cfause of tumors is found in lesion to the lym- 
phatic drainage of a part, through direct pressure upon its lym- 
phatic vessels or by constrictor effect upon them by lesion to 
the vaso-motor and sympathetic nerve-supply. Tumors of the 
breast are very often due to such a cause. 

The common lesions in tumor of the breast are found at the 
clavicle, first rib, among the upper five or six ribs, or among the 
corresponding vertebrae. 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 lym- 
phatic and blood drainage, or remove any source of direct irri- 
tation upon the tissues. Correcting anatomical relation is the 
main point, and commonly no manipulation directly upon the 
tumor is required, yet such a measure is sometimes 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 per rectum or per vaginam. One instance is recorded 
in which external 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 indicates that new fibrous tissues, once 
formed, mav be absorbed under the treatment. 



426 PRACTICE OF OSTEOPATHY. 



Index. 



PAGE 

Abdominal aorta ...................................... 52 

Abdomen, general treatment of .......................... 53 

Abdomen, osteopathic points of .......................... 52 

Abscess, of kidneys .................................... 222 

of liver ......................................... 197 

Acidity of stomach .................................... 143 

Acute yellow atrophy of liver ........................... 199 

Acute nasal catarrh .................................... 105 

Adhesions, uterine .................................. 66, 416 

Alba dolens .......................................... 417 

Albuminuria .......................................... 223 ; 

Alcoholism ........................................... 395 

Alveolar emphysema ................................... 1 03 

Amyloid degeneration of kidney ......................... 214 

degeneration of liver ............................. 119 

Angina pectoris ....................................... 251 

Aneurysm ............................................ 263 

cerebral ........................... . ............ 311 

Ankle, dislocation of ................................... 72 

Ankylosis, bony and ligamentous .................... 406, 407 

Apoplexy .............................................. 308 

Appendicitis .......................................... 167 

Arrythmia ............................................ 249 

Arterio-sclerosis ..................................... . . 262 

Articulation, tempero-maxillary ......................... 27 

Ascaris lumbricoides ................................... 393 

Ascending paralysis, acute .............................. 311 

Ascites ............................................... 183 

Anemia .............................................. 349 

Arthritis deformans ................................... 359 

Asthma .............................................. 75 

Ataxia, locomotor ........................ j ............ 280 

Ataxic paraplegia ...................................... 



PRACTICE OF OSTEOPATHY. 427 

Atlas examination of 23 

treatment of 2& 

Atony of stomach 143 

Autumnal catarrh (See Hay Fever) 85 

Axis 24 

B 

Bell's paralysis -. 300 

Bladder, inflammation of 22."> 

Bleeding from nose 36 

Blood disease 345 

Bloody flux 392 

Brachycardia 249 

Brachial plexus 25 

Bright's disease, acute 210 

chronic 212 

Bronchiectasis 84 

Bronchitis 80 

Bony ankylosis 406 

'' Breaking up" treatment 311 

Bulbar paralysis 16 

C 

C'alculi, renal 219 

Cancer of liver 119 

Cancer of stomach 144 

Cardia, spasm of 1 42 

Cartilages, palpation of 21 

Carpo-metacarpal dislocations 6& 

( 'ataract 

C'atarrh, nasal 105 

Catarrh, ear 35 

Catarrh, autumnal 85 

Catarrhal croup 371 

Catarrhal Enteritis 158 

fever, epidemic 375 

pneumonia 97 

Cerebro-spinal fever 391 

Cephalodynia 27<> 

Cerebro-spinal meningitis 391 



428 PRACTICE OF OSTEOPATHY. 

Cerebral hemorrhage 308 

aneurysms 263 

apoplexy 308 

Cervical vertebra 23 

Cerumen of ear 33 

Children, diarrhreas of 160 

Chickenpox , 388 

Cigarette habit 395 

Cholera morbus 161 

infantum 161 

Cholangitis 195 

Chorea 267 

Circulatory system 230 

Cirrhosis of the liver 189 

atrophic 190 

billiary 190 

malarial 191 

hypertrophic 7 191 

Clitoris, inhibition of 413 

Clavicle treatment of ."> 1 

Climacteric 417 

Coccyx, treatment of 18 

Coccygodnia 320 

Colds 105 

Colic 1 59 

Colitis mucous 161 

simple ulcerative 157 

Colon 149 

Comparison of limbs 60 

Comparison of size of thorax 38 

Congestion of kidney 215 

Constipation 145 

Congestion of liver 188 

lungs 97 

ovaries 416 

Contractures of spinal muscles 10 

Conjunctiva 31 

Consumption, pulmonary 93 



PRACTICE OF OSTEOPATHY. 429 

Constitutional diseases 353 

Convulsions, infantile 213 

ursemic 224 

Crepitus of vertebra 24 

Cricoid cartilage 21 

Croup 371 

Croupous enteritis 158 

Curvatures of spine 8 

Cystitis 225 

D 

Deafness 34, 342 

Deformities 40, 398 

Delirium tremens 396 

Deviation of spine 8 

Deformities of sternum 40 

Diabetes mellitus and diabetes insipudus 365 

Discharges from ear 35 

nose 105 

Diarrhoea 150 

of children 160 

nervous 150 

Diphtheria 370 

Displacements of spine 9 

Diseases, infectious 370 

Disease, Pott's 402 

Dilatation of stomach 142 

of heart 261 

Dislocations of ankle 72 

carpo-metacarpal 68 

carpal 68 

of elbow 67 

of hip 73 

of knee 72 

metacarpal-phalangeal 68 

phalangeal 68 

radio-ulnar 68 

of shoulder 69 

of vertebra 16 



430 PRACTICE OF OSTEOPATHY. 

of wrist 68 

Duodenal ulcer 155 

Dyspepsia 142 

Dysentery 392 

Dysmenorrhoea 414 

E 

Ear, -discharges from 35 

drum of 33 

cerumen of 33 

examination of 33 

itching and tenderness 33 

Ear diseases 339-44 

Edema of lungs 98 

Elbow, dislocations of 67 

Emphysema 103 

Endocarditis 252 

Enteritis 150 

Entorrhagia 156 

Enterospasm 161 

Enteroptosis 175 

Enuresis 227 

Epilepsy 271 

Epistaxis 110 

Esophagus, spasm of 132 

stricture of 132 

Esophagitis 131 

Equilibrium of spine 20 

Erysipelas 385 

Eustachian tubes 33 

Exaggeration of lesions 13 

Examination, general 8 

of atlas 23 

of innominates 58 

of larynx 21 

of limbs 67 

of neck 19 

of plevis 36 

of rectum . . 63 



PRACTICE OF OSTEOPATHY. 431 

Examination of spine 7 

of thorax 38 

of trachea 

of vagina 64 

Exhaustion, heart 397 

Exudative nephritis 212 

Eye, treatment 31 

foreign bodies in 31 

diseases of 328 

F 

Fallopian Tubes 412 

Fatty degeneration of heart 255 

of kidney 214 

of liver 198 

Female disorders 407 

Fever, cerebro-spinal 391 

epidemic catarrhal 375 

scarlet 389 

spotted 391 

thermic 397 

typhoid 380 

Fifth lumbar vertebra, treatment of 17 

Fifth nerve, branches 32 

treatment of 32 

Flatfoot 320 

Flux, Bloody 392 

Folicular ulcer 156 

Foreign bodies in nose 36 

in eye 31 

French measles 388 

G 

Gallstones 191 

( lastralgia 138 

Gastritis, acute 133 

chronic 133 

Gastroptosis 1 44 

Generative organs, male 418 

Genitalia. vaso-motors of. . 412 



432 PRACTICE OF OSTEOPATHY. 

German measles 388 

Glands, thyroid 21 

cervical lymphatic 21 

Gout 360 

Gonorrheal arthritis 358 

Glossitis 118 

Gluteal arteries 62 

Gonorrhoea 422 

Granulation of Eye 32 

Growths of nose 36 

Gynecology 407, 413 

H 

Hardening of Spinal Muscles 10 

Hay fever 85 

Head...' 

palpation of 28 

position of 20 

rotation of 22 

temperature 22 

Head mirror, use of 33 

Hearing, impaired 34 

test for 34 

Heart, diseases of 230 

Heat stroke 397 

Hematurea 

Hematozoon of Leveran 393 

Hemorrhage, cerebral 309 

intestinal 156 

of lungs .' 100 

of spinal cord 310 

of stomach 144 

uterine 415 

Hemorrhagic infarct 100 

Hemothorax 114 

Hip, dislocation of 73 

Hydrocephalus 311 

Hydroperitoneum 183 

Hvdrothorax . . 114 



PRACTICE OF OSTEOPATHY. 433 

Hyoid bone 20 

treatment of 28 

muscles, treatment of 21 

Hyperacidity of stomach 143 

Hypertrophy of liver 198 

Hypertrophy of heart 260 

Hypogastric plexus 63 

I 

Iliac blood vessels 63 

Impotence 421 

Infantile convulsions 313 

paralysis 309 

Infectious diseases 370 

Influenza 375 

Innominate bone, treatment 58 

Insanity 323 

Insomnia 293 

Insolation 397 

Inspection of spine 7 

of tonsils 20 

Interstitial nephritis 212 

Intestinal neuroses 157 

obstruction 171 

parasites 393 

tumors 166 

ulcer 156 

Intussuseption 

Intoxications, The , 395 

J 

Jaundice 185 

Joint affections 398 

K 

Kidney, abscess of 222 

amyloid 214 

congestion of 215 

fatty degeneration of 214 

movable 222 

Knee-chest position 54 

28 



434 PRACTICE OF OSTEOPATHY. 

Knee, dislocation of 72 

L 

Lagrippe 375 

Laryngeal tenderness 21 

diphtheria . 371 

Laryngitis 116 

Lateral deviation of spine 8 

Ligaments, lesions of 10 

tenderness of 60 

Ligamentous ankylosis 406 

Lateral structures of neck 23 

treatment 28 

Leg, milk 417 

Leveran, Hematozoon of 393 

Leucorrhoea . 416 

Limbs, comparison of length 60 

Lightning stroke 398 

Lithemia 223 

Liver, abscess of , 197 

acute yellow atrophy of 199 

amyloid, infiltration of 199 

cancer of 199 

cirrhosis of 189 

fatty degeneration 198 

hypertrophy of 198 

sclerosis of 189 

Locomotor ataxia 280 

Longitudinal traction of spine 13 

Lumbricoides, ascaris 393 

Lungs, congestion of 97 

Lumbago 358 

Lungs, edema of 98 

hemorrhage from 100 

tuberculosis of 93 

Luxations of ribs, treatment 47 

of sternum 40 

M 

Male generative organs 419 



PRACTICE OF OSTEOPATHY. 435 

Malaria 378 

Manipulation of coccyx 18 

of hyoid bone 28 

of spine 12 

Maxillary, inferior, in whooping cough 375 

Mastodynia 320 

Measles, French, German 386-378 

Metacarpal phalangeal dislocations 68 

Menses irregular, suppressed 413-414 

Men, diseases of 418 

Meningitis, cerebro-spinal 391 

Menstrual disorders 411-414 

Menstruation vicarious 416 

Middle cervical ganglion 26 

Migraine 276 

Milk leg 417 

Motor neuroses 160 

Mucus enteritis 158 

Mumps ' 127 

Morphine habit 395 

Muscles, diseases of 316 

stretching of 15 

of spine 10 

Myotonia congenita 316 

Myocarditis 250 

Myxedema 352 

N 

Neck anterior 19 

lateral structure of 23 

palpation of : 20 

posterior structures of 23 

posterior aspect of 19 

treatment of 28 

thickening of tissues 25 

Nephritis acute 210 

chronic 212 

Nephroptosis 222 

Nephrolithiasis 21 



436 PRACTICE OF OSTEOPATHY. 

Nerves, auricular 25 

brachial 25 

fifth 32 

laryngeal 21 

middle cervical 26 

occipital 25 

phreni c '2'2 

pneumogastric 21 

recurrent laryngeal 21 

superior laryngeal 21 

superior cervical ganglion 25 

Nervous dyspepsia 142 

Neuralgia 316 

Neurasthenia 289 

Neuritis localized 322 

brachial 322 

multiple 323 

Neuroses, intestinal 157 

motor 160 

occupation 285 

secretory 158 

sensory 159 

Nose, bleeding from 36 

examination of 35 

foreign bodies in 36 

growths in 36 

secretions 35 

treatment 36 

O 

Occupation Neuroses . 285 

Obesity 362 

Obstetrics 407, 413, 418 

Opium Habit 395 

Orchitis 421 

Ovaries 411,416 

Ovaritis 416 

Osteopathic points of abdomen 52 

head . . 7 



PRACTICE OF OSTEOPATHY. 437 

Osteopathic work per rectum t> :> > 

vagina 04 

Oxyuris vermicularis :'>'.):> 

P 

Paralysis 297 

ascending 311 

agitans 284 

Imlbar 311 

infantile 312 

penman's 280 

of cartilages 21 

neck 20 

spine 8 

Parasites 393 

Pancreatitis, acute 201 

chronic 127 

Paratitis 8 

Patient, general examination of 

Pelvic plexus 03 

Pelvis, examination of 55 

Peritonitis 178 

Perforation of ear drum 33 

Perineum 07 

Pert ussis 373 

Phrenic nerve 22 

Phlegmasia alba dolens 417 

Pharyngitis : . . . 228 

Phalangeal dislocation 08 

Pianist's paralysis 280 

Pin worms 393 

Pleurisy Ill 

Pneumonia 93 

Pneumo thorax 114 

Points of spinal weakness ~ . 10 

Position of waist line 01 

of head - 20 

Posterior iliac spine GO 

Pott's disease . . 402 



438 PRACTICE OF OSTEOPATHY. 

Posterior structure of neck 23 

aspect of neck .- 19 

Prolapsus uteri 416 

Ptyalism 121 

Pubic symphysis, tenderness of 60 

Pudic nerve 62 

artery 62 

Pulmonary hemorrhage 100 

tuberculosis 93 

Pulsation of abdominal aorta 52 

Pyelitis 221 

Pyelonephritis 221 

Pyonephrosis 221 

Q 

Quadratus lumborum muscles, to stretch 49 

Quinsy . / 126 

B 

Radial ulnar dislocations 68 

Rectum, examination of 63 

treatment of 64 

Reduction of dislocations 68 

Still's method 16 

Relaxed spine 10 

Relaxing ligaments 15 

Relief of tension 12 

Renal calculi 219 

dropsy 229 

Ribs, abnormalities of 38 

treatment of 43 

Rickets 364 

Rigid spine 10 

Rheumatism 354 

Rubella 388 

Rubeola 386 

S 

Sacrum, treatment of luxations 18 

Salivary glands 121 

Scaleni muscles 25 



PRACTICE OF OSTEOPATHY. 439 

Scarlet fever 389 

Sclerosis of liver 189 

Sciatica 321 

Separation of spinal processes 9 

Seat worms 393 

Secretory neuroses 158 

Secretions of nose 35 

Sensory disorders 143 

Skull.' 37 

Smallpox 390 

Sore throat 128 

Spiral treatment of 30 

Solar plexus . . 55 

Spermatic vessels 63 

Spermatorrhoea 421 

Spastic paraplegia 280 

Spasmodic croup 371 

Spinal curvatures 402 

Splenitis 199 

"Spine, typhoid 381 

Stomach disease 137 

Stomach supersecretions 143 

Stomach ulcer of 144 

cancer of 144 

Strains 406 

St. Vitus' dance 267 

St. Anthony's Fire 385 

Sternum, deformities of 40 

Sternum, luxations of 40 

treatment 50 

Stroke, lightning 398 

heat 398 

Stomatitis 118 

Sub-acidity 143 

Sunstroke 397 

Strabismus, treatment of 30 

Spine, rotation of 14 

Syringomyelia 31 



440 PRACTICE OF OSTEOPATHY. 

Superior laryngeal nerves 21 

Superior cervical ganglion 25 

Superior laryngeal 21 

Suppressed menses . . . '. 413 

Spinal cord hemorrhage 310 

Sounds of spine 11 

Stercoreal ulcer 156 

Suppurative cholangitis 197 

Strangulation of bowel 171 

Syphilis 422 

T 

Trenia latum 393 

saginata 393 

sodium 393 

Tape worm - 393 

Temperature of spine 9 

Thermic fever 397 

Treatment of spine 11-18 

Temperature of head 22 

Tests for hearing 34 

Tenderness of symphises 60 

Thread worms 393 

Treatment of axis ' ~ 29 

of neck 28 

of spine ' 30 

of clavicle 50 

of coracoid 21 

of thorax 43 

of abdomen 53 

of eye 31 

of rectum 64 

Thorax, temperature of 39 

examination of 38 

comparison of sides 39 

Tonsils, treatment of 21 

Tuberculosis of lungs 93 

Tonsillitis 123 

Treatment of vagina 66 



PRACTICE OF OSTEOPATHY. 441 

Tubes, fallopian 407-412 

Tumors 422 

Typhoid fever 380 

spine 381 

U 

Uvula 37 

Ulcer of stomach 144 

follicular 156 

Urinary diseases 203 

Uremia 223 

Uterus 66 

Uterus, adhesions of 416 

hemorrhage of 415 

motors of : 412 

prolapsus of 416 

sympathetic supply of 412 

vaso-motors of 412 

V 

Vagina, adhesions 66 

examination 64 

treatment 66 

relaxation of 413 

vaso-motors of 412 

Valvular heart disease 258 

Varicose veins 265 

Varicella 388 

Variola 390 

Varicocele 421 

Vaso-motors of genitalia 412 

Vertebra, reduction of 16 

fifth lumbar, treatment 17 

cervical, deviation of 23 

crepitus of 24 

Vicarious menstruation 416 

W 

Women, diseases of 407-64 

Worms 393 

pin 393 



442 PRACTICE OF OSTEOPATHY. 

Worms, round 393 

seat 393 

thread 393 

tape 393 

Wrist, dislocation of 68 

Whooping cough 373 

X 

Xerostoma 121 



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