Principles of osteopathy

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rnan ,3irtmtt J

Bruce S. Collins, D.O.

COLLEGE OF OSTEOPATHIC PHYSICIANS
AND SURGEONS • LOS ANGELES, CALIFORNIA

FIG. 1. Radiograph of a lesion of the second dorsal vertebra. Note the
approximation of the left transverse processes of the first and second
dorsal vertebrae. Case of exophthalmic goitre following traumatic
strain in this spinal area. Recovery.

By DAIN L. TASKER, D. O.

MEMBER OF THE FACULTY OF THE PACIFIC

COLLEGE OF OSTEOPATHY

1898-1907

FELLOW OF THE SOUTHERN CALIFORNIA
ACADEMY OF SCIENCES

PRESIDENT OF THE CALIFORNIA STATE

BOARD OF OSTEOPATHIC EXAMINERS

1901-1902

PRESIDENT OF THE CALIFORNIA STATE

BOARD OF MEDICAL EXAMINERS

1910-1911

MEMBER OF THE AMERICAN OSTEOPATHIC
ASSOCIATION

Fourth TLdition — Illustrated

PUBLISHED BY

BIRELEY & ELSON PRINTING CO.
LOS ANGELES, CAL.

COPYRIGHTED 1916 BY THE AUTHOR,

DAIN L. TASKER, D.O.

LOS ANGELES, CALIFORNIA.

PREFACE.

This book on the Principles of Osteopathy is intended
as a manual for the use of students and practitioners.
There has been no effort on the part of the author to do
more than give a short, terse exposition of the essential
facts underlying osteopathy. Realizing fully the great
effort required to keep pace with the rapid progress of
medicine in general, we have tried to include in our chap-
ters only that which will be solid food for our readers. We
have long since learned that the hurried student and busy
practitioner have no time to read long dissertations on
any subject. Time is an essential factor in covering the
necessary studies of an osteopathic curriculum.

In order that the student may read these chapters
intelligently he must have concluded at least ten months
study of Biology, Histology, Anatomy and Physiology.
These subjects form the basis of the science of osteopathy.

The author has kept in touch with the growth of osteo-
pathy from year to year through careful perusal of its pub-
lished books and periodicals.

The contents of this book are the condensed results
of the author's study of recognized medical text books on
Anatomy, Physiology, Histology, Pathology, Bacteriology
and Diagnosis, of the works of the founder of Osteopathy,
Dr. A. T. Still, Hazzard, Riggs, Henry and McConnell ; of
six years' experience in the clinics of the Pacific School of
Osteopathy, and the Infirmary in connection with this
college, and six years of continuous teaching, two of which
were devoted to Anatomy and Physiology and the remain-

8 PREFACE

ing four to Theory and Practice of Osteopathy and Physi-
cal Diagnosis.

To enumerate the books from whose pages facts have
been gleaned for corroborative testimony concerning the
Principles of Osteopathy is impossible. Books have been
read and laid aside and what is here written may be the
result of something which caught the author's attention
for a moment only and then became a maverick.

The illustrations to elucidate the text have been fur-
nished principally by the laboratories and clinics of the
Pacific School of Osteopathy. Without the hearty and
efficient aid of my associates on the faculty of this college
much of the concise detail of this book would have been
impossible. I am indebted to several osteopathic physi-
cians for drawings of histological tissues which they had
prepared during their college work. They are given credit
under their drawings.

The large number of excellent photographs of micro-
scopic structures, patients and movements is the result
of the skill of J. O. Hunt, D. O. A few of the photographs
were made by M. E. Sperry, D. O., who also took great
care to see that we had the best of photographic lenses
with which to work. I am also greatly indebted to C. H.
Phinney, D. O., and J. E. Stuart, D. O., for their accurate
demonstration of osteopathic movements.

My thanks are extended to Miss Louisa Burns, B. S.,
for reading the manuscript and suggesting corrections
therein, also to Miss Gertrude Smith for preparing the
manuscript for the publisher.

DAIN L. TASKER, D. O.

PREFACE 9

PREFACE TO THIRD EDITION.

A long. time has elapsed since the second edition of
this book was sold out. The present edition is, in reality,
a new book instead of what is ordinarily understood as a
revision. The material which was developed for the first
and second editions was entirely destroyed by the dyna-
mite explosion and fire which wrecked the great estab-
lishment of the Los Angeles Times and killed more than a
score of its employees.

The demand for this book having grown steadily
more insistent and the more important fact that, during
the time since the publication of the second edition, there
has been a great development in every phase of osteopathic
teaching and practice, has led us to attempt to produce
an edition of Principles of Osteopathy which will be even
more useful to students and practitioners than our former
editions.

The experimental work done in the laboratories of
our colleges and of private investigators, as well as the
recorded experiences of our practitioners, tend more and
more to substantiate the Principles of Osteopathy as set
forth in our previous editions. The feeling that this book
will furnish genuine assistance in the teaching and prac-
tice of osteopathy leads the author to send it forth, with
the belief that its imperfections will be kindly excused by
its readers, in view of the spirit of generous helpfulness
toward all schools of medicine which has been made the
reason for its existence.

Nearly every chapter is in some degree changed or
completely rewritten. Several new chapters, of practical
value, have been added. Much of the material in early
chapters of the former editions, relating to histology, has
been eliminated.

The writer wishes to express his gratitude to John
Comstock for his valuable assistance in illustrating this
edition.

TABLE OF CONTENTS

CHAPTER I— Causes of Disease

Normal and Abnormal — The Ideal Normal — Variations in
Structure and Function — -Adaptation — Normal Health — Comfort
and Efficiency — Variation of the Normal — Distress and Ineffi-
ciency— Difference in Belief as to Causes — Interpretation of
Phenomena of Disease — Favorable Reaction to Environment —
Known Causes of Disease — The Tenacity of Life — Lesion-
Disease Association — Remove the Cause of Disease — Preven-
tative Medicine — Symptoms — A Normal Stimulus — A Change
of Resistance — Cause and Effect — Cell Relations — Excessive
Stimulation — Structural Defects — Cell Life Dependent on Cir-
culation— Intercellular Tension — Scientific Therapeutics — The
Problem as a Whole — Natural Recovery — Extrinsic Causes of
Disease — Inherent Recuperative Power — Disturbed Tissue Re-
lations— The Biological Relation of Function and Structure —
The True Art of Healing.

CHAPTER II — The Lesion as a Cause 40

Definition — Characteristics of a Lesion — Classes of Lesions —
Causes of Lesions — Secondary Lesions — Effect of Violence or
Fatigue — Failure of Adaptation — Chemical Causes of Spinal
Lesions — The Reason for the Persistance of a Lesion — The
Sequence of Lesion Phenomena — Variations in Development —
Palpation of a Lesion — Description — Find the Lesion — Inspec-
tion of the Back — Palpation of Vertebral Structures — History
of Accident — Traumatic Lesion — Weight Carrying and Balanc-
ing Function Disturbed — Lack of Physiological Rest — Influence
on Circulation and Innervation — Segmental Co-ordination —
Example of Fatigue — Loss of Muscular Tone — Experimental
Lesions — Loss of Motion — Necessity for Study of Structure.

CHAPTER III— The Lesion as an Effect 55

Analysis of the Causes of Lesions — The Attractiveness of the
Traumatic Lesion Theory — Classification of Lesions — Examples
of Secondary Lesions — The Spinal Lesion, an Objective Symp-
tom— Visceral Reflexes — -Pleurisy — Cardiac Lesion Patterns —
Unity of the Body.

CHAPTER IV — Spinal Hyperaesthesia and Muscular Tension 59

Subjective Symptoms — Irritation of the Spinal Nerves — Spinal
Treatment — Control of the Body by the Nervous System — A
Concept of the Nervous System — Neuralgia — Visceral Disturb-
ance Due to Disturbed Nerve Control — Co-existence of Spinal

TABLE OF CONTENTS 11

Tenderness — Symptoms of Spinal Irritation — Duration of Affec-
tions Due to Spinal Irritation — Affection of the Upper Cervical
Region — Irritation of the Lower Cervical Region — Irritation of
the Upper Dorsal Region — Irritation of the Lower Dorsal
Region — Irritation of the Lumbar and Sacral Regions — The
Effect of Recumbency — Irritation of Spinal Marrow Not Neces-
sarily Dependent on Disease of Vertebrae — lateral Curvature
— Treatment — Ganglia of the Sympathetic Nerves — Symptoms
of Irritation of Sympathetic Ganglia — Middle and Lower Tho-
racic Sympathetic Ganglia — Spinal Treatment, Hyperaemia —
Muscular Tension — Digital Examination of the Spinal Area —
The Use of Spinal Muscular Tension in Diagnosis — Cause or
Effect.

CHAPTER V — The Segmentation of the Body 76

The Lesion as a Guide in Diagnosis — The Spinal Segment —
Injury of a Single Nerve — A Unilateral Cervical Spinal Lesion
— Treatment — Involvement of the Central Nerve Cells — Cervical
Muscles — Embryology — Segmentation — Widespread Influence
of a Spinal Lesion — Association of Muscles Innervated by the
Same Segment — Effect of Sectioning Single Spinal Nerve —
Developmental Changes in Muscles.

CHAPTER VI— The Nervous System 97

The Medium of Communication — The Attributes of Nerve Tis-
sue— Nerve and Muscle Irritability — Conductivity — Trophicity
— Unity of the Nervous System — Other Systems of Integration
— Mechanical Irritation — Effect on Conductivity — Afferent and
Efferent Fibres — Organization of the Nerve Bundle — Intra-
spinal Fibers — Segmentation of the Spinal Cord — Segmental In-
tegration— Ceaseless Play of Reflexes — The Simple Reflex — The
Sensory Side of the Reflex Arc — Protective Reactions — Exam-
ple— Comparative Segmentation — Efferent Impulses — Efferent
Fibers to the Sympathetic Ganglia — Ganglionic Control — Three
Fields for Reception of Sensory Impressions — Proprio-ceptive
Field — Segmental Co-ordination — Plurisegmental Control —
Clinical Evidence, Group Lesions — Differentiation of Spinal
Lesions — Lesions Due to Functional Fatigue.

CHAPTER VII— The Nervous System (Continued) 114

Alignment, Tone, Reflexes — Clinical Illustration — Inspection —
Patellar Tendon Reflex — Gastric Spinal Reflex — Sensation —
Visceral Sensation — Dependence on Objective Symptoms —
Depth and Extent of Lesions — Lesion Picture in Autotoxemia
— Lesions Independent of Segmental Reflexes — The Lesion as
an Expression of Some Form of Integration — Circulatory Inte-
gration Lesion — Protective Reactions — Pains Incident to Chill
and Fever — The Practical Use of Knowledge.

CHAPTER VIII— The Sympathetic Nervous System 125

Unity of the Nervous System — Origin — Lateral Ganglia — Four
Prevertebral Plexuses — Visceral Ganglia — Communicating
Fibers — White Rami-communicantes — Distribution — Function —

12 TABLE OF CONTENTS

Gray Rami-communicantes — Distribution — Functions of the
Sympathetic System — Independent or Dependent — Ganglia —
Cervical Ganglia of Importance to Osteopaths — Superior Cervi-
cal Ganglion — Connections — Vaso-constriction — Distribution —
Headache — Middle Cervical Ganglion — Distribution — Function
— Manipulation — Recapitulation — The Thoracic Ganglia — Rami-
efferentes — Upper Five Thoracic Ganglia — Nerve Distribution
— The Interscapular Region — A Case Illustrating the Ciliospinal
Center — Effects of Treatment, First to Seventh Dorsal — Great
Splanchnic — Lesser Splanchnic — Least Splanchnic — Functions
— Theory — Lumbar Ganglia — Sacral Ganglia — Distribution —
Function — Cardiac Plexus — Position and Formation — Pulmo-
nary Plexus — Physiology — Functions — Treatment — Results —
Argument — Solar Plexus — Location and Formation — Distribu-
tion— Function — Centers — Hypogastric Plexus — Location and
Formation — Pelvic Plexus — Distribution — Subsidiary Plexuses
— Function — Summary — Automatic Visceral Ganglia — Conclu-

CHAPTER IX— Circulatory Tissue 149

Functions — Lymph — Distribution of the Blood — The Circulatory
Apparatus — The Heart — Regulation of Contraction — Co-ordi-
nating Centers — The Pneumogastric Nerve — Accelerator Cen-
ter— Stimulation of the Heart — Inhibition of the Heart — Vaso-
motor Control of the Coronary Arteries — Angina Pectoris —
Action of the Heart Centers — Vaso-motor Nerves — Vaso-con-
striction— Vaso-dilation — Summary — Sensory Nerves — Capillary
Circulation — Recapitulation — Vaso-motor Centers — Conclusions
— Hyperaemia — Therapeutics — Case Illustrations.

CHAPTER X— Hilton's Law 181

The Law Stated — Methods of Studying Anatomy — Example of
Hilton's Law — The Knee — Object of such a Distribution — Uni-
formity of the Law — Precision of Nerve Distribution to Muscles
— Indications for the Use of Therapeutics — The Use of Hil-
ton's Law in Physical Diagnosis — Comparison of Methods —
Herpes Zoster — The Distribution of an Intercostal Nerve —
Some of the Evil Effects of Rest — Head's Law — Application of
the Law — The Viscera — Nerves of Conscious Sensation.

CHAPTER XI— Osteopathic Centers 194

Diagnosis — First Four Cervical Nerves — Example of Hilton's
Law — The Pneumogastric Nerve — The Hypoglossal Nerve —
Superior Cervical Ganglion — Suboccipital Triangles — Cervical
Plexus — Intensity of Reflexes — The Spinal Accessory — The
Phrenic Nerve, Hiccoughs — The Trapezius and Splenius Capitis
et Colli Muscles — Vaso-motion, Head, Face and Neck — Affec-
tions of the Cervical Nerves — Brachial Plexus — Affections of the
Brachial Nerves — A Case of Hemiparesis below the Fifth Cer-
vical Vertebra — Subluxation of the Scapula — The Nerve of
Wrisberg — The Interscapular Region — The Lung Center — Cilio-
spinal Center — Heart Center — Stomach Center — Liver and
Spleen Center — Large Intestine — Small Intestine — Center for
Chills — The Language of Pain — Osteopathic view of Pathology

TABLE OF CONTENTS 13

— Center for the Gall-bladder — Intestines — Uterus — Ovaries and
Testes — Kidney — Second Lumbar — Paraplegia — Lumbar and
Sacral Plexuses — The Bladder — Sphincter Vaginae — Conclu-
sions.

CHAPTER XII— The Back 239

The Spinal Column — The Spinal Ligaments — Flexibility — Nor-
mal Spinal Curves — Limitation of Flexibility — Articular Pro-
cesses— Cervical Region — Dorsal Region — Lumbar Region —
Flexion and Extension — Side Bending Rotation — Best Position
for Freest Movement — Rotation in the Dorsal Region — Char-
acteristic Movement in the Lumbar Region — Rotation Toward
Concavity of a Curve — Adaptability of Position to Body Weight.

CHAPTER XIII— The Pelvis 263

The Fifth Lumbar — Loss vs. Exaggeration of Normal Curves
— Motion in Lumbo-sacral Articulation — Adaptation in Lumbo-
sacral Articulation — Stability of the Lumbo-sacral Articulation
— Decompensation of the Lumbro-sacral Articulation — Part of
the Pelvis — Characteristics of the Sacro-iliac Articulation — Phys-
iological Relaxation — The Male Pelvis — Loss of Stability — -
Analysis of Sacro-iliac Articulations — Relation of Sex to Sacro-
iliac Lesions — Inherent Weakness in the Character of the Struc-
ture— Causes of Subluxations — Rotation — Compensatory Pelvic
Tilt — Classes of Cases — Symptoms — Plan of Treatment.

CHAPTER XIV— Subluxations 283

Definition — Characteristics of Subluxations — Primary or Sec-
ondary Lesions — The Characteristic Structure of Joints — The
Atlas — Occipito-atlantal Articulation — The Causes of Subluxa-
tions— Normal Relations of the Atlas — Abnormal Positions of
the Atlas — The Effect of Muscle Contraction — The Effect on
Circulation — Effect on Superior Cervical Ganglion — Atlo-axial
Articulation — Unequal Development — Caries — Dislocation —
Spontaneous Reduction — Cervical Vertebrae — Disproportion
between Cause and Effect — Example — Unequal Development of
Spinous Processes of Cervical Vertebrae — Palpation of Dorsal
Spinous Processes — Normal Dorsal Movements — False Lesions
— Lateral Subluxation — Muscular Contraction — Comparison of
Effects of Muscular Contraction — Separation of Spinous Pro-
cesses— Approximation of Spinous Processes — Primary Sub-
luxations — Secondary Subluxations — Limited Area for Lateral
Subluxations — Lower Dorsal Vertebrae — Dorso-lumbar Articu-
lation— Kyphosis, Lower Dorsal — Lumbar Region — Examina-
tion of the Ribs — Costo-central Articulations — Costo-transverse
Articulations — Co-ordination — Inco-ordination — Nervous Con-
trol of Respiration— Costal Subluxations — First Rib — Tenth Rib
— Eleventh and Twelfth Ribs — Effect of Position of Vertebrae
on Position of Ribs — The Clavicles — Summary.

CHAPTER XV— The Diagnostic Value of Backache 311

Elasticity — A Field for Study — Objective and Subjective Symp-
toms— Pain — Poise — Structural Defects — Statics — General De-
bility— Sacro-iliac Subluxation— Spinal Rotation — Spinal Cur-

14 TABLE OF CONTENTS

vature — Caries — Rigidity — Arthropathies — Spondylitis Deform-
ans — Rachitis — Malignant Growths — Typhoid Spine — Lumbago
— Posture — Toxemia — Trauma — Crick in the Back — Involvement
of the Spinal Cord — Infectious Fevers — Referred Visceral Pains
— Inflammation of Serous Membranes — Colicy Pain — Summary
— Plurisegmental Control of Viscera — Reflex Subluxations — In-
tensity of Reaction — Location of Reflexes — Reflex Patterns.

CHAPTER XVI— Adaptation and Compensation 332

Definition — The Spinal Column — Compensatory Curvature —
The Thorax — The Heart — Skin and Kidneys — Power of En-
cysting— The Extremities — Law — The Attitude of Rest.

CHAPTER XVII— Inhibition 354

Acceleration, Inhibition — Muscular Contraction — Secretion —
Acceleration and Inhibition as Attributes of Nerve Tissue — In-
hibition a Normal Attribute of the Central Nervous System —
History — Arrest of Activity — Shock — Fatigue — Location of In-
hibition— Muscular Activity — Three Characteristics of the Nerv-
ous System — Development of Inhibition — Neurotic Diathesis,
Chorea — Paralysis Agitans — Developing Inhibition by Training
— Inhibitory Effect of Pressure — Dosage — Impairment of
Function — Physiological Activity is the Result of Stimulation —
Hilton's Law — Inhibition, Therapeutic — How Vaso-motor Cen-
ters Act — Over-stimulation Equals Inhibition — The Guide for
the Use of Inhibition — Pathological Changes Which Accom-
pany Over-stimulation — Rational Treatment — Hyperaesthesia
of Sensory Areas, Diagnosis — Results of Inhibition — The
Phrase "Remove Lesions" — The Human Body is a Vital
Mechanism — Osteopathic Meaning of Inhibition — The Scientific
Use of Inhibition — Inhibition as a Local Anaesthetic — Inhibi-
tion to Remove Lesions — Inhibition as a Preparatory Treat-
ment.

CHAPTER XVIII— Sounds Produced in Joints 371

Normal Sounds — Abnormal Sounds — Pathology of Joints Pro-
ducing Abnormal Sounds — Synovial Adhesions — Non-use of a
Slightly Sprained Joint — Rheumatic Joints — Semilunar Carti-
lages of the Knee — Bone Setting — Historical Reference — Tar-
sal and Carpal Subluxations — Enarthrodial and Arthrodial
Joints — Slow vs. Quick Reduction of a Subluxation — Bone-
Setter's Phrases — Differences of Opinion — "Affections of the
Spine," Dr. Hood — "Crick in the Back" — Manipulation of the
Neck — Manipulation of the Back — Treatment of Upper Dorsal
— Comment — Differential Diagnosis — Size of the Vertebral
Canal — Conservative vs. Radical Treatment.

CHAPTER XIX— Position for Examination 384

Observation — Testing Alignment and Flexibility — Sense of
Touch — Inspection — Palpation of the Ribs — Palpation of the
Spine — Extrinsic and Intrinsic Muscles of the Back — Test
Muscular Tension — Thoracic Flexibility — Examination of the
Abdomen — Elevation or Depression of the Ribs — Examination

TABLE OF CONTENTS 15

of the Rectum and Prostate Gland — Examination of the Neck —
The History of Lesions — The Extremities — Subjective Symp-
toms.

CHAPTER XX— Manipulation 402

Methods of Procedure — Relaxation of the Latissimus Dorsi —
Relaxation of the Trapezius — Relaxation of the Rhomboids —
The Pectoralis Major and Serratus Magnus — Quadratus Lum-
borum — Erector Spinae — Treatment of Simple Kyphosis — Lor-
dosis, Upper Dorsal — The Possible Variety of Movements
which Will Secure the Same Results — The Head and Neck as a
Lever — Lordosis or Kyphosis May Affect a Function Similarly
— Splenius Capitis et Colli — Kyphosis, Upper Dorsal — Kypho-
sis, Dorso-lumbar — Other Movements — New Schools — Various
Applications of a Principle — The Use of a Fulcrum — Co-ordi-
nation of Corrective Movements — Dorsal Rotation — Lateral
Curvature — Know How to Apply Principles — Do Not Copy
Movements.

CHAPTER XXI— Reduction of Subluxations 443

Lateral Subluxations — Luxations of the Innominate Bones —
Anterior Rotation of the Ilium — Posterior Rotation of the
Ilium.

CHAPTER XXII— Treatment of the Cervical Region 471

To Raise the Clavicle — Subluxation of the Clavicle — Preparatory
Treatment of the Neck, Trapezius — Sterno-cleido-mastoid —
Scaleni — Splenius Capitis et Colli — Extension — Rotation — The
Hyoid Bone — Mylo-hyoid and Hyoglossus — Sterno-thyroid and
Sterno-hyoid — Intrinsic Muscles of the Larynx — The Atlas —
Sixth Cervical — General Principle Underlying Corrective Move-
ments— The Simplest Form of Correction— Torsion and Coun-
ter Pressure — Rigidity — The Favorable Position for Corrective
Movements.

CHAPTER XXIII— Extremities 493

Diagnosis — Causes of Stiff Joints — Ankylosis — The Scapulo-
humeral Articulation — Examination of the Brachial Plexus —
Reduction of Dislocations by Traction — Reduction of Disloca-
tions by Leverage — Elbow Dislocations — The Radius — Old Dis-
locations— Muscles of the Lower Extremity — Quadriceps Ex-
tensor— The Adductor Group — Dislocation of the Femur —
Stretching the Sciatic Nerve — The Calf Muscles — Scientific
Manipulation — Saphenous Opening — Semilunar Cartilages of
the Knee — Paralysis of External Popliteal Nerve — "Glucokinesis
and Mobilisation" — Pain in the Legs and Feet — Varicose Veins.

CHAPTER XXIV— Manipulation for Vaso-motor Nerve Effects 522
The Fifth Cranial Nerve — Inhibition of Suboccipital.

INTRODUCTION.

Great strides have been made during the past twenty-
five years in the practice of medicine. The relative posi-
tions formerly held by drug therapy and surgery have
been completely reversed. The concoctions of the pharmo-
copoeia, with their vague and uncertain effects upon human
tissues and functions, no longer entice the earnest seeker
after medical truths to spend a lifetime experimenting
with substances which are absolutely foreign to the human
body.

There was a time, not far away, when that person
who treated human diseases by manipulation, water, diet
and general hygiene was considered to be the chief of
impostors. Go a little farther back in the history of medi-
cine and we see surgery dishonored because it was me-
chanical, not mystical enough for the ponderous minds
whose fort it was to deal with strange substances of the
animal, vegetable and mineral kingdoms.

During all the years in which drug-therapy flourished
there were a few real scientists who devoted time and
talents to the structure of our bodies and the function of
each part. Discoveries came slowly along these lines be-
cause the majority of medical men were concentrating
their energies on ferreting out the effects of drugs. Facts
in anatomy and physiology which are so patent to us at
this time remained obscure for centuries, simply because
there was no thought of studying the form and action of
tissues, while all nature outside of our own bodies seemed
to be a grand laboratory of specifics for human ailments.

If osteopathy had been born fifty years ago, it would
have died because the popular and scientific minds were
not in a condition to receive it. Even the time at which

18 INTRODUCTION

it was born, scarcely thirty-five years ago, was hardly ripe
for this new departure in medicine. Twenty years easily
cover the period of its active history.

A Scientific Growth. — There is one distinctive point
about osteopathy which should be especially emphasized:
It is not an empirical system ; nothing is done on the cut
and dry plan. It has been developed in a purely scien-
tific way. We might observe the action of the human
body in health and disease indefinitely without securing
any exact data to pass on to the next generation of ob-
servers if we fail to know the structure of the body. A
physician may learn many things in an empirical way
which are very poor assets for science.

The strange part of medical history, to the modern
investigator, is the fact that discoveries in anatomy and
physiology, which are of such vital importance to the suc-
cessful treatment of human diseases, were left stored away
between the covers of books, not deemed of any value
except to whet the mind of the dilletante in medicine.

Osteopathy as a distinct system of medicine has
grown to its present proportions at a time when the older
schools of medicine are making radical changes in their
therapeutical procedures, e. g., serum-therapy. In spite
of all these so-called scientific advances in drug-therapy,
osteopathy has made steady advance into public favor,
thereby showing that it is fully able to compete with the
older systems of practice.

The Founder of Osteopathy.— Dr. A. T. Still, of Kirks-
ville, Mo., is the honored founder of this system of thera-
peutics. His work was in studying the structure of our
bodies directly, and thus gaining an accurate knowledge of
how bones, ligaments and muscles, blood-vessels, glands
and nerves are placed. Then he sought that department
of knowledge which we call physiology, and learned how
these tissues act in health. Having had previous train-
ing in treating diseases by the drug method, he was slow
to discard the old method for one which had never been

INTRODUCTION 19

tried, even though it had good scientific reasons back of
it. But the substitution did take place by degrees until his
system of therapeutics no longer depended on the use of
drugs.

It seems to be a popular idea that it is necessary for
the founder of a system to have a creed or statement of
belief. We do not doubt but that it is good for us at times
to try to put our beliefs in writing, not to form a fixed
position, but just as the architect draws many plans to
gradually develop his mental pictures. These statements
usually contain the truth about our work so far as we
know it. We can thus see how far we have advanced
and realize that we have much to learn.

Dr. Still has, from time to time, expressed the result
of his studies, that is, the observed facts upon which he
has built his system of therapeutics. In 1874, Dr. Still
stated his observations as follows : "A disturbed artery
marks the period to an hour, and minute, when disease
begins to sow its seeds of destruction in the human body.
That in no case could it be done without a broken or sus-
pended current of arterial blood which, by nature, is in-
tended to supply and nourish all nerves, ligaments, mus-
cles, skin, bones and the artery itself. * * * The
rule of the artery must be absolute, universal, and unob-
structed, or disease will be the result. * * * All
nerves depend wholly upon the arterial system for their
qualities, such as sensation, nutrition and motion, even
though by the law of reciprocity they furnish force, nu-
trition and sensation to the artery itself."

Definitions. — Many definitions have been formulated
and published to the world. Each one tends to limit
one's conception of osteopathy in some particular. A
definition always limits the thing defined, therefore, no
definition of osteopathy can be complete, because we are
dealing with a principle, the universality of which no one
knows. Whereas, less than seven years ago, it was thought
that osteopathy was an excellent method of treating

20 INTRODUCTION

chronic ailments, we now find osteopaths working day
and night at the bedside of the acutely sick. Thus does it
spread and become thoroughly recognized as a system
applicable to all diseases.

In order to bring before the student as full and com-
prehensive an idea of the scope of osteopathy as possible,
a series of definitions are quoted. These definitions h ive
been taken from current osteopathic literature and are
credited to their respective authors.

One of the short paragraphs in Dr. Still's auto-
biography is sufficient to give a clear understanding of his
idea of the human body. "The human body is a machine
run by the unseen force called life, and that it may be run
harmoniously, it is necessary that there be liberty of blood,
nerves and arteries from the generating point to des-
tination."

The following definition is one which has been used
in the American School publications for a long time : "Os-
teopathy is that science which consists of such exact, ex-
haustive and verifiable knowledge of the structures and
functions of the human mechanism, anatomical, physio-
logical and psychological, including the chemistry and
physics of its known elements as has made discoverable
certain organic laws and remedial resources, within the
body itself, by which nature, under the scientific treatment
peculiar to osteopathic practice, apart from all ordinary
methods of extraneous, artificial, or medicinal stimulation,
and in harmonious accord with its own mechanical prin-
ciples, molecular activities, and metabolic processes, may
recover from displacements, disorganizations, derange-
ments, and consequent disease, and regain its normal equi-
librium of form and function in health and strength."
Mason W. Pressly, A. B., Ph. D., D. U.

"Osteopathy is that science of healing which empha-
sizes, (a) the diagnosis of disease by physical methods
with a view to discovering not the symptoms but the causes
of diseases, in connection with misplacements of tissue,

INTRODUCTION 21

obstruction of the fluids and interference with the forces
of the organism ; (b) the treatment of diseases by scientific
manipulations in connection with which the operating
physician mechanically uses and applies the inherent re-
sources of the organism to overcome disease and establish
health, either by removing or correcting mechanical dis-
orders, and thus permitting nature to recuperate the dis-
eased part, or by producing and establishing antitoxic and
antiseptic conditions to counteract toxic and septic con-
ditions of the organism or its parts; (c) the application
of mechanical and operative surgery in setting fractured
or dislocated bones, repairing lacerations and removing
abnormal tissue growths or tissue elements when these
become dangerous to the organic life." J. Martin Little-
John, LL. D., M. D., D. O.

"Osteopathy is a school of mechanical therapeutics
based on several theories. 1. Anatomical order of the
bones and other structures of the body is productive of
physiological order, i. e., ease or health in contradistinc-
tion to disease or disorder which is usually due, directly
or indirectly, to anatomical disorder. 2. Sluggish organs
may be stimulated mechanically by way of appropriate
nerves (frequently by utilizing reflexes) or nerve centers.
3. Inhibition of over-active organs may be effected by
steady pressure substituted for the mechanical stimulation
mentioned above. 4. Removal of causes of faulty action
of any part or organ is the keynote of the science." C. M.
Case, M. D., D. O.

"Osteopathy is that school of medicine whose dis-
tinctive method consists in (1) a physical examination to
determine the condition of the mechanism and functions
of all parts of the human body, and (2) a specific manipu-
lation to restore the normal mechanism and re-establish
the normal functions. This definition lays stress (1) upon
correct diagnosis. The osteopath must know the normal
and recognize any departure from it as a possible factor
in disease. There is not one fact known to the anatomist

22 INTRODUCTION

or physiologist that may not be of vital importance to
the scientific osteopath. Hence a correct diagnosis based
upon such knowledge is half the battle. Without it scien-
tific osteopathy is impossible and the practice is neces-
sarily haphazard or merely routine movements. The defi-
nition lays stress upon (2) removal of the cause of disease.
A deranged mechanism must be corrected by mechanical
means specifically applied as the most natural and only
direct method of procedure. This work is not done by
any of the methods of other schools. After the mechanism
has been corrected little remains to be done to restore
function, but stimulation or inhibition of certain nerve
centers may give temporary relief and aid nature. The
adjuvants used by other schools, such as water, diet, exer-
cise, surgery, etc., are the common heritage of our profes-
sion and should be resorted to by the osteopath if they are
indicated." E. R. Booth, Ph. D., D. O., Ex-President
A. O. A.

"Osteopathy is that science or system of healing which,
using every means of diagnosis, with a view to discover-
ing, not only the symptoms, but the causes of diseases,
seeks, by scientific manipulations of the human body, and
other physical means, the correcting and removing of all
abnormalities in the physical relations of the cells, tissues
and organs of the body, particularly the correcting of mis-
placements of organs or parts, the relaxing of contracted
tissues, the removing of obstructions to the movements
of fluids, the removing of interferences with the trans-
mission of nerve impulses, the neutralizing and removing
of septic or foreign substances from the body; thereby re-
storing normal physiological processes, through the re-
establishment of normal chemical and vital relations of
the cells, tissues and organs of the body, and resulting in
restoration of health, through the automatic stimulation
and free operation of the inherent resistant and remedial
forces within the body itself." C. M. Turner Hulett, D. O.

INTRODUCTION 23

"Osteopathy is that science which reasons on the
human system from a mechanical as well as a chemical
standpoint, taking into consideration in its diagnosis,
heredity, the habits of the patient, past and present; the
history of the trouble, including symptoms, falls, strains,
injuries, toxic and septic conditions, and especially in every
case a physical examination by inspection, palpation, per-
cussion, ausculation, etc., to determine all abnormal physi-
cal conditions ; the treatment emphasizing scientific manip-
ulation to correct mechanical lesions, to stimulate or in-
hibit and regulate nerve force and circulatory fluids for
the recuperation of any diseased part, using the vital forces
within the body; also the habits of the patient are regu-
lated as to hygiene, air, food, water, rest, exercises, climate
and baths; such means as hydropathy, electricity, massage,
antidotes and antiseptics, and suggestion sometimes being
used as adjuncts." Chas. C. Reid, D. O.

The above definitions have nearly all been taken from
the Journal of the American Osteopathic Association.

Osteopathic Diagnosis. — Physical diagnosis is and al-
ways will be the leading factor in the success of osteo-
pathic practitioners. This ability to take hold of an ailing
human being and detect the disturbing factor in it is the
highest attainment of the physician. Osteopathy has de-
veloped the art of palpation to a wonderful degree. Bas-
ing this art on a definite knowledge of structure and
function makes it the chief reliance in diagnosis. Every
physical diagnosis begins with palpation and proceeds with
ausculation and percussion, and not failing to use chemical
and microscopical methods when necessary. The student
must learn to use his sense of touch continually, in fact,
learn to see with his fingers. Add to this development of
touch a training in chemical and microscopical analysis of
secretions and excretions of the body, and we have a
practitioner thoroughly equipped to make an accurate
scientific diagnosis.

24 INTRODUCTION

Osteopathic Therapeutics. — Osteopathic treatment is
based on this kind of physical diagnosis which we have
just described. It takes into account the fact that the
organism is a self-recuperating mechanism and requires
proper food, proper surroundings, and perfect activity of
every tissue, especially the blood. Thus we divide treat-
ment into three divisions, (1) manipulation for the pur-
pose of correcting the mal-position of any tissue, whether
that tissue be bone or blood; (2) proper feeding, i. e.,
dietetics; and (3) proper surroundings, i. e., hygiene.

If the condition of the body is such that none of the
three methods just mentioned will right the difficulty, i. e.,
if there are broken bones, ruptured muscles and connec-
tive tissues or false growths, we can then use surgical
means. Surgery is a part of the Osteopathic system, just
as it is of all systems of medicine. The chief assurance
lies in the fact that the Osteopathic system is very con-
servative as regards the use of the knife.

Osteopathy includes all those qualities which make
up a successful system ; its diagnosis is accurate and its
treatment is comprehensive, including scientific manipula-
tions, scientific dietetics, hygiene and surgery.

In a recent article in the American Monthly Review
ol Reviews, the following sentences appear: "With but
few exceptions, the entire vegetable and mineral kingdoms
have given us little of specific value ; but still, up to the
present day, the bulk of our books on materia medica is
made up of a description of many valueless drugs and
preparations. Is it not to be deplored that valuable time
should be wasted in our student days by cramming into
our heads a lot of therapeutic ballast."

This is probably the most recent statement of this
kind in the public prints. It substantiates the position
taken by the Osteopathic colleges. We feel justified in
claiming that osteopathy today occupies a position which
every other system of medicine must come to sooner or
later. It is broad enough and liberal enough to accept

INTRODUCTION 25

truth wherever demonstrated. Its foundations being laid
in the basic sciences, and its treatment never departing
from the facts of these sciences, make it a system of lasting
worth and capable of adding an entirely new conception
of the phenomena of life to medical literature.

The formation of the name osteopathy (from osteon,
bone, and pathos, suffering) seems to be as perfect a de-
scriptive name as it is possible to form which would cover
the basic principle of the science. The bones are the
foundation upon which all the soft tissues are laid, and
the osteopath makes all his examinations, using them as
fixed points from which to explore for faulty arrange-
ment. The name does not mean bone disease, but since
the osteopath finds many diseases resulting from irritation
due to slightly displaced bone, the name is used in the
sense of disease caused by bone. We do not consider that
all diseases are caused by displaced bone, but it is a cause
which has heretofore been overlooked. We recognize that
there are many causes of disease, and do not wish to be
understood as trying to fit fact to theory, but as a result
of observing certain facts, this basic principle of osteo-
pathy has been made clear.

We believe that health is the natural state, and that
this condition is bound to be maintained so long as every
cell has an uninterrupted blood supply, and its controlling
nerve is undisturbed. Therefore, the first effort of the
osteopath is to remove all obstructions to blood and nerve
supply, feeling certain that when these obstructions are
removed, health will follow. Hilton in his lectures on
"Rest and Pain," which are considered medical classics,
has expressed himself forcibly on this subject, as follows:
"It would be well, I think, if the surgeon would fix upon
his memory, as the first professional thought which should
accompany him in the course of his daily occupation, this
physiological truth — that nature has a constant tendency
to repair the injuries to which her structures may have
been subjected, whether those injuries be the result of

26 INTRODUCTION

fatigue or exhaustion, of inflammation or accident. Also,
that this reparative power becomes at once most con-
spicuous when the disturbing cause has been removed;
thus presenting to the consideration of the physician and
surgeon a constantly recurring and sound principle for his
guidance in his professional practice."

Every system of curing human ills which is based on
the known facts of anatomy and physiology will last,
because it is true. When systems of drug medication are
known only as history, osteopathy will be ministering to
the human race, because it knows no other path than that
which leads to greater truths in physiology and anatomy.

PRINCIPLES OF OSTEOPATHY 27

CHAPTER I.

CAUSES OF DISEASE.

Normal and Abnormal. — In order to use the word ab-
normal, with reference to the structure and function of living
tissues, we must have knowledge of the normal. Normal is
a word having, apparently, as many interpretations as the
word "beauty," i. e. standards to which these words are
applied differ, even as the individuals who use them. In
order that we make clear what we conceive as normal and
abnormal conditions, it is necessary to call attention to
variations in structure and function, which should be recog-
nized as not being far enough removed from typical condi-
tions to indicate the existence of a need for corrective
interference.

The Ideal Normal. — Our first steps in the acquirement
of a medical education are practically all concerned with
study of the normal. We dissect bodies which have been
changed by disease and therefore we come in contact with
abnormality. To counteract this we study descriptive anat-
omy and idealize our real knowledge which was obtained by
dissection. Ofttimes our ideal has such attributes of perfec-
tion that nothing ever comes up to standard and hence ap-
pears to us to be defective. This hypercritical attitude leads
to exaggeration of the interpretation put upon symptoms
and hence leads to misdirected efforts at correction.

Variations in Structure and Function. — We need there-
fore, first of all, a fairly good knowledge of the variations in
structure and function which may be recognized as consid-
erable departures from type, but still not abnormal in the
sense we use that term when speaking of disease. No tissue

28 PRINCIPLES OF OSTEOPATHY

in the body is unyielding and hence will adapt itself to even
a very moderate force, if that force is long continued. This
is well illustrated by the great changes which can be pro-
duced in the alignment of the teeth under corrective bracing.

Adaptation. — The changes in structure, which are fre-
quently recognized, may be evidence of adaptation, i. e. they
are the final result of the body's effort to maintain its exis-
tence at the highest point of efficiency of which it is capable.
With this thought ever in our minds we may safely observe
the character of structures and draw more just conclusions
as to the existence of normal or abnormal conditions.

Normal Health. — People usually seek the services of a
physician because they suffer some degree of discomfort.
True it is that some seek a cosmetic effect, but this may
hardly be seriously considered. Normal health means a con-
dition wherein we are unconscious of bodily distress and are
able to do what is ordinarily counted as our share of work.
This state of bodily comfort, under the ordinary stress of
labor, is not necessarily based upon symmetry of structural
development, i. e. absolute conformity to our ideal of struc-
tural perfection.

Comfort and Efficiency. — Normality from the cradle to
the grave seems to be a personal equation, i. e. bodily com-
fort under the stress of moderate physical and mental exer-
tion. Increase of physical or mental exertion either, through
adaptation, produces increased capacity, or, through failure
of adaptation, produces destructive changes. Comfort and
efficiency are the real attributes of normality. If these are
present in average degree there is little likelihood of a physi-
cian being consulted.

Variation of the Normal. — The normal of any individual
varies at different periods of life and following accidents or
severe illnesses. The physician is frequently consulted with
the hope that the normal of later years might be raised to
the degree consciously possessed at a former time, or in the
hope of being restored to the normal which existed previous
to an accident or severe illness. The new normals which

PRINCIPLES OF OSTEOPATHY 29

constitute the result of repair after injury and illness do not
measure up to the previous standard in most cases. Con-
sciousness of a decrease in efficiency leads many people to
the hope of securing an increase by some specific means.

Distress and Inefficiency. — The physician is constantly
dealing with two classes of patients, those who suffer bodily
distress, and those who are conscious of bodily inefficiency,
in some degree, and hence suffer mental distress. It is allur-
ing to sufferers of either class to think there is a specific re-
movable cause of their distresses, hence any form of treat-
ment, aiming to specifically attack the cause, has a captivat-
ing character.

Difference in Belief as to Causes. — All forms of treat-
ment are, at least in fancy, based on the desire to remove
the cause of the ailment. The reason there is such wide dis-
crepancy in methods is because of differences in belief as to
causes. In other words, if all forms of disease were thor-
oughly understood, i. e. as to cause as well as manifestations,
there would very quickly develop an agreed form of treat-
ment. It appears so, but there is another factor to consider.
The same disease, due to the same cause, does not manifest
itself the same in every individual, therefore the same means
used to remove the cause does not bring the same reaction
in every individual. This has led to a multiplicity of meth-
ods even where the cause is known. It is certainly a great
gain to have but one unknown quantity, the vitality of the
patient, instead of the two that previously existed, i. e. the
cause of the illness and the vitality of the patient. This de-
sire to have but one unknown quantity has frequently led to
the development of medical dogmas based on a belief in the
existence of certain causes of disease. The germ theory and
the lesion theory are good present day examples. Both the
germs and the lesions are so universally found that both
form convenient foundations for dogmatizing.

Interpretation of Phenomena of Disease. — Although
these studies are directly concerned with the phenomena of
lesions there is no desire on our part to exalt any group of

30 PRINCIPLES OF OSTEOPATHY

phenomena out of its comparative value with any other
group. It is hoped that by presenting, as well as we are able,
the lesion theory of disease, we may be able to show paths of
convergence leading to a better interpretation of disease
phenomena and thus the truths which underlie the lesion
theory will not become distorted into fantastic vagaries.
We do not wish to be understood as claiming for osteopathy
the discovery of the cause of disease. There are many
causes, widely divergent in character. Osteopathy brings to
your attention a cause, frequently found and of sufficient
definiteness to warrant concentrated attention.

Favorable Reaction to Environment. — Since we are
mechanisms of living tissues, our survival depends .upon re-
acting favorably to environment. We find the elements, air,
light, heat and cold all affect us adversely at times. They
become destroyers of bodily comfort and efficiency when
intensified. Changes in atmospheric pressure, intensifica-
tion of light, increased heat or cold, affect us seriously.

Known Causes of Disease. — Chemical poisons, such as
lead, arsenic, mercury, phosphorus, carbon monoxide and
other gases, are causes of profound injury. The organic
poisons, alcohol, opium, morphine, cocaine, food poisons,
snake venoms, autointoxications, play no small part in caus-
ing bodily discomfort and inefficiency. The vegetable or-
ganisms, fungi and bacteria claim abundant recognition as
causes of disease. Protozoa are properly listed as causes,
for have we not the wonderful discoveries concerning ma-
larial fever, sleeping sickness, amoebic dysentery and yellow
fever; sufficient scientific achievements to startle the world.
The fluke, cestode and round worm infections have long
been recognized causes of disease. Add to the foregoing all
those adverse conditions imposed by the nature of our
crowded existence in cities, noise and unrest, surfeit and
poverty, fatigue and worry, it is little to be wondered at that
we find ourselves searching almost hysterically for some
thing to aid us to survive it all.

PRINCIPLES OF OSTEOPATHY 31

The Tenacity of Life. — It is marvelous how our bodies
adapt themselves to all the vicissitudes of environment, sur-
vive the effects of inorganic and organic poisons, invasions
of bacteria or protozoa, maintain existence in spite of defi-
cient food and rest. The tenacity of life in human tissues,
the adaptations and compensations that are developed, are
worthy the pen of some scientific genius who has the literary
ability to make the layman have faith in natural law.

Lesion-Disease Association. — With all these causes of
disease we may well ask ourselves what relation the spinal
or other joint lesion has. It would be difficult to find any
disease process that does not exhibit a spinal or other joint
lesion, in the sense we osteopaths recognize. This coin-
cidence of disease and spinal, or other, joint lesion does not
necessarily indicate a sequence of events starting in the le-
sion. As scientists, rather than special pleaders for a theory,
we want to know the significance of this association. It is
our aim to devote the pages following to an analysis of this
lesion-disease association. We aim to write helpfully, ana-
lyzing our failures that we may know our weaknesses, an-
alyzing our successes so that we may make our solid prin-
ciples more widely recognized.

Remove the Cause of Disease. — No great amount of
analysis of the various causes of disease is required before
we realize that to "remove the cause" we must do something
more than treat individual members of society. There is a
phase of medical practice which requires us to view the good
of the community rather than any portion of it. Some lives
are sacrificed because we have no cure for the individual.
We cure the community, the race, by sacrificing the individ-
ual. Public health requires what seems to be cruelty toward
the individual from whose disease we must be protected.

Preventive Medicine. — As fast as causes of certain dis-
eases have been demonstrated, plans for prevention take
precedence over treatment of the individuals who suffer from
those diseases. Thus a new class of physicians is developed,
i. e. those trained to cope with the problems of preventive

32 PRINCIPLES OF OSTEOPATHY

medicine rather than meet the exigencies of treating in-
dividual patients. It is the necessarily aggressive advance
of preventive medicine which arouses antagonism and social
discord. No one could successfully contend that all preven-
tive methods, thus far enforced, are satisfactory. Then, too,
it is not possible to demonstrate quickly to all the members
of a community the necessity for certain procedures. Sacri-
fice of the individual, be it ever so slight, for the good of the
whole, is not agreeable to the victim or his friends. Altho
we are developing methods primarily applicable to the in-
dividual rather than serving the aggressive purposes of pre-
ventive medicine, that which makes the individual an effi-
cient member of society subserves public health.

Symptoms. — Diseases manifest themselves by certain
phenomena which are designated as symptoms. Symptoms
are abnormal degrees of normal reaction. This is made evi-
dent by the fact that some symptoms represent sub- and
others supernormal functioning. The supernormal function-
ing represents a reaction, on the whole favorable to recovery,
whereas the subnormal reaction is not favorable. Since the
symptoms represent phases of reaction or non-reaction in
tissues, the effort put forth by the body, as a whole, to re-
cover, is in proportion to the energy contained in its cells.
In a restricted sense the cause of disease is in the cells of the
body. They contain the stored energy, i. e ., po-
tential energy. When this potential energy is re-
leased by some force, or stimulus, we have kinetic energy.
Potential energy does not transfer itself spontaneously into
kinetic energy without first being affected by some other
force, which may be called a stimulus. The amount of po-
tential energy converted into kinetic is not proportional to
the amount of the stimulus used to initiate the process. All
stored energy, i. e., potential energy, requires a certain
strength of stimulus to start the process of conversion into
kinetic. When this strength of stimulus is known, it is called
the normal. There are usually several kinds of stimuli, each
one having a varying degree of intensity. For example, the

PRINCIPLES OF OSTEOPATHY 33

potential energy in a muscle fiber will be converted into ki-
netic energy as a result of mechanical, thermal, chemical or
electrical stimuli. Certain amounts of each of these stimuli
are required to initiate the change in the form of energy.

A Normal Stimulus. — The potential energy in a muscle
fiber has a certain degree of resistance to stimuli. A definite
amount of any one of the four forms of stimuli named is
necessary to cause the muscle fiber to contract. This defi-
nite amount, which is capable of stimulating the muscle to
an average contraction, is called the normal stimulus, and
the action of the muscle is called the normal contraction. If
the muscle should contract more vigorously than usual in
response to this normal stimulus, the resistance of the po-
tential energy of the muscle fiber is below normal. The
strength of stimulus and discharge of energy may vary
greatly in their proportions within normal limits, but there
are well marked lines above or below which resistance is
spoken of as above or below normal.

A Change of Resistance. — When the resistance of the
potential energy is below normal, a normal stimulus causes
too great an effect, that is, too much potential energy is
transferred into kinetic energy. When the resistance of the
potential energy is normal, and the stimulus above normal,
there also results an excessive discharge of potential energy.
Therefore, excessive discharge results from lowered resis-
tance, or increase of stimulus. Resistance is a quality of the
cell protoplasm. The stimulus is an external force. The
cell depends on proper surroundings in order to maintain its
resistance to external stimuli, such as bacteria. The strength
of bacteria may also be increased or decreased by the nature
of their surroundings.

Cause and Effect. — After potential energy has been
changed into kinetic energy, this latter may generate more
potential energy, and this also may be converted into kinetic.
Thus cause is converted into effect and effect into cause.
This is an endless chain. When such a process is beyond the
normal, as in the body when varying symptoms present

34 PRINCIPLES OF OSTEOPATHY

themselves, therapeutic efforts must be concentrated on
some particular reflex in order to break the chain.

Cell Relations. — The relations of a cell with its fellows,
that is, its structural relations, are the basis upon which its
resistance, in large measure, depends. Therefore, anything
which disarranges its normal relations will, in all proba-
bility, change its resistance to stimuli. All therapeutic
methods which aim at lessening the too rapid conversion of
potential into kinetic energy, that is, increasing cell resist-
ance, must see that correct structure is attained.

Excessive Stimulation. — In cases where almost com-
plete exhaustion of potential energy has resulted from low-
ered resistance and we find that even increased strength of
stimulus fails to evoke a response, the same structural fault
may exist. We know that stimulation, when excessive,
passes into inhibition. Perhaps it is truer to state that over-
activity of a cell leads to exhaustion of its potential energy.
The stage of exhaustion, in this sense, is consonant with in-
hibition. As an example: In case of structural changes in
the lower dorsal region, there may result a change in re-
sistance in the secretory and contractile cells of the intes-
tines, due to changed blood supply. Diarrhoea results for a
time, followed by constipation. At the beginning of the
.rapid conversion of potential into kinetic energy the muscles
feel tense. After the constipation, or period of exhaustion,
sets in, they are flabby.

Structural Defects. — Structural defects may result in
lowered resistance in groups of cells. They also act as stim-
uli to set free the potential energy in these cells. In many
cases we note only a predisposition to yield to weak stimuli.
This is the condition in individuals who are "fairly well,"
but cannot endure any of the normal stimuli in average
amount. They cannot exercise freely without a bad reac-
tion. A slightly heavier meal than usual, the excitement due
to the presence of many people, arouses "symptoms." Their
physiological processes are easily perverted by normal stim-
uli because a structural defect, either directly or indirectly,

PRINCIPLES OF OSTEOPATHY 35

has decreased cell resistance. Cases of lowered resistance,
supposed to be due to heredity, should be carefully exam-
ined for structural defects. It is not improbable that many
an ancestor is wrongly accused of transmitting a "predispo-
sition." While cell resistance remains below normal, all ex-
ternal stimuli, such as atmospheric changes and the presence
of bacteria, even if in only normal amounts, may call forth
"symptoms of disease."

Cell Life Dependent on Circulation. — The individual
cells of the body depend on the supply of nourishment
brought to them by the circulating fluids of the body. The
protoplasm of the cells is a complex, chemical substance
made up of an enormous number of complex molecules.
These molecules, on account of the looseness of combina-
tion of their atoms, require sufficient crude material brought
to them to maintain the proper atomic tension. Upon this
tension is based the resistance to normal or abnormal stimuli.
The necessary food for cell protoplasm is brought to the
cells by blood and lymph. Since cell protoplasm is entirely
dependent upon the circulating media, any disturbance of
these media changes the metabolism of the cell, and hence
a change in resistance results. This resistance may be varied
by failure on either the arterial or venous side of the general
circulation, resulting in changed lymph circulation. The
constant removal of katabolic products is of as much im-
portance as the constant renewal of material for anabolism.

Intracellular Tension. — Intracellular tension, i. e., the
cohesiveness of the atoms of each molecule, is dependent on
lymphatic circulation ; this upon arterial and venous circula-
tion. If there is abnormal variation in any of these circula-
tory fluids, there results a change in resistance of the cells.
Therefore, a normal stimulus may provoke too great a trans-
ference of potential into kinetic energy and thus initiate a
chain of such transferences of one form of energy into an-
other. As a rule, the kinetic energy which results from the
release of potential energy, in excessive amounts, acts as a
stimulus to release still more potential energy and so on to

36 PRINCIPLES OF OSTEOPATHY

the point of exhaustion of the supply of such stored energy.
This change is exemplified in the series of symptoms which
appear in many diseases. Each liberation of a new supply
of energy gives rise to a new system. If the potential en-
ergy resides in a gland, excessive secretion results; if in mus-
cle, excessive contraction, etc. The way in which the kinetic
energy is manifested depends upon the manner in which its
cause, i. e., potential energy, is stored. The secretion or the
contraction may act as a stimulus to liberate still more po-
tential energy.

Scientific Therapeutics. — Therapeutic methods become
scientific just in proportion as they are based on the known
structure and function of the tissues and the exact cause of
the disturbed condition of the tissues, i. e., the disease. The
effort to develop scientific therapeutics has led to various
ways of looking at the problem. We have mentioned the
fact that each case of illness is a problem with two unknown
quantities, i. e., the cause of the illness and the reaction pow-
er, i. e., the resistance of the individual. The cause, in many
instances, may be sufficiently well known to govern the
method of treatment, at least the treatment appears scien-
tific if we think only of the cause. The possible weak point
in the plan of treatment is the fact that no consideration has
been paid to the existence of the second unknown quantity,
i. e., the resistance of the tissues to the disease as well as to
the treatment. The treatment of typhoid fever by intestinal
antiseptics appears scientific because it appears to bring the
cause of typhoid and the means of destroying it in proper
relation. The treatment has not proven successful because
of the second unknown quantity and because that which is
destructive to the cause is likewise destructive to the tissues.

The Problem as a Whole. — The development of scien-
tific therapeutics is evidently not easily accomplished, even
when we know the cause of disease. There are those who
treat diseases and those who treat individuals, i. e., those
who attack causes, with little regard for the reactions of the

PRINCIPLES OF OSTEOPATHY 37

individual, and those who aim to support the reactions of the
individual without any direct attack on the cause. It is evi-
dent that neither method is altogether right, hence scientific
medicine is ever striving to evolve a treatment suited to the
problem as a whole. Take for example the problem of rid-
ding the body of an intestinal parasite, such as a tape worm.
Methods of treatment differ, altho based on a known cause
and a known condition for elimination of the parasite. There
are many ways of making the parasite sick enough to loose
its hold on the walls of the intestine. The question is :
Which way will be least disturbing to the host? The prac-
tice of osteopathy is full of such problems, the majority of
them nowhere near as simple as the one used as an illustra-
tion. The human body is disturbed by many specific causes,
varying in destructive power, which bring forth series of
symptoms, which, taken together, give us a picture of a cer-
tain disease. To these causes all human beings react in ap-
proximately the same way. The symptoms pass through
varying degrees of intensity, run a characteristic course and
disappear. We recognize that the reaction power of the
body has triumphed over the cause of the disease. The fact
that the majority of sick people get well under all sorts of
treatment naturally leads us to believe that the body is able,
in a majority of instances, to conquer the cause of the dis-
ease. Recognition of the healing power of Nature leads to
the development of two views as to how disease should be
met. There are those who distrust and decry all therapeutic
methods. Such are fond of pointing to past therapeutic
failures and are, in fact, therapeutic nihilists.

Natural Recovery. — It is not enough to recognize the
fact of recovery. We want to know how natural recovery
takes place, then we may be able to assist, at least not hin-
der, the forces acting for recovery. The study of structure
and function of human tissues is the foundation for under-
standing how Nature cures. We believe that osteopathy
has brought, and is now bringing, very valuable additions
to the sum of human knowledge as to how Nature cures. It

38 PRINCIPLES OF OSTEOPATHY

is building its portion of scientific therapeutics based upon
a knowledge of causes and reactions.

Extrinsic Causes of Disease. — The causes of disease
previously mentioned, i. e., environmental conditions, poi-
sons, parasites, etc., are all external influences, in the sense
that they are not a part of normal tissue structures. The
causes noted especially in osteopathic diagnosis are a part
of the structure of the body. The structural relations are
sufficiently altered to compel the body to react on its own
structural imbalance.

Inherent Recuperative Power. — Since it has inherent re-
cuperative power to overcome the effects of external causes
of disease, there is no doubt but that it usually survives lo-
calized structural lesions of this inherent character. It adapts
itself as well to internal structural conditions as to diseases
produced by other causes. We have noted the necessity of
a normal molecular intracellular tension in order to main-
tain the efficiency of the cell, also the necessity for proper
relations between the cells and the circulating fluids. Any
structural fault which interferes with this relationship com-
pels the body to react to this fault either in a way to correct
it, or, if it threatens the life of the whole body, get rid of it.
We see in these reactions just such phenomena as we ex-
hibit in our social relations, i. e., a sick member of the com-
munity causes no great reaction in the body politic until his
illness menaces the whole people.

Disturbed Tissue Relations. — Osteopathy emphasizes
the disturbances in tissue relations. It sees in these both
predisposing and exciting causes of disease; predisposing, in
that tissue resistance to outside influences is weakened; ex-
citing, in that, in many instances, the reactions take on the
character of acute diseases. Injuries are so very frequent
that there is scarcely an individual who has not put the struc-
tural tissues to a severe test. These strains, usually of suffi-
cient severity to produce local distress and healing reactions,
leave their influences, and if a long time for healing was re-
quired, perhaps influenced the general statics of the body.

PRINCIPLES OF OSTEOPATHY 39

The Biological Relation of Function and Structure. —

The author does not look upon the so called osteopathic le-
sion as being an evidence that structure determines function,
biologically considered. The structural lesion is an inter-
ruption of the biological concept that function fashions the
structure. This interruption disturbs function, but the bio-
logical law is sure to assert itself in the recuperative process.
Since "biology has no statics," living tissues are always be-
ing rebuilt to serve the function which brought them into
being. This ability to repair an injured tissue and make it
serve the special function for which it was intended, is the
foundation for adaptation and compensation, those phe-
nomena which we see exhibited by the body in so many
forms in its struggle to survive.

The True Art of Healing. — If we can study these phe-
nomena, understand what Nature is trying to do, assist ac-
cordingly, then we are indeed physicians. "In no case can
anything appear in the form of disease which was not pre-
viously present in the body as a predisposition ; external
forces are able merely to make this predisposition apparent.
When the physician, by thorough observation and investi-
gation, knows the conditions that influence a given predis-
position in a definite way, when he is scientifically trained
and has a true conception of hygiene, and is at once physi-
cian and naturalist, then he is able to cure disease by use of
the very same forces which serve to create or alter the hu-
man constitution. In this simple sense there is a true art of
healing."

40 PRINCIPLES OF OSTEOPATHY

CHAPTER II.

THE LESION AS A CAUSE.

Definition. — The principles of osteopathy take their nat-
ural beginning in the consideration of "the lesion." The
word "lesion" is used by osteopaths to designate something
more than "an injury, hurt or wound in any part of the body"
(Gould). Any structural change which affects the func-
tional activity of any tissue is called a lesion. There may be
structural changes, abnormal development, which are very
evident to palpation but do not affect functional activity and,
therefore, are not lesions. A lesion is not only a structural
change, but such a change as influences function detri-
mentally. Fig. 112 illustrates a structural change without
detrimental influence on function, while Fig. 113 illustrates a
true lesion. The relation of these structural lesions to the
media of communication and exchange, nerves and blood
vessels, is believed to be the chief element active in pro-
ducing and maintaining functional disorders. This is the
central principle of osteopathic practice.

Characteristics of a Lesion. — Lesions may be present in
any tissue, but their existence is most easily recognized in
bone, ligament and muscle. Dislocations and subluxations
of bones, thickened ligaments and contracted muscles con-
stitute the usual varieties of lesions. A true lesion is usually
palpable ; the functional disturbance is related anatomically
and physiologically; there is hyperaesthesia at the palpable
area. These three conditions constitute the characteristics
of the lesion as it is designated by the osteopath. Its palpa-
bility may vary between very wide limits ; the location of the
structural change and functional derangement rnay be direct

PRINCIPLES OF OSTEOPATHY 41

or indirect, the hyperaesthesia distinct or indistinct; still,
the diagnostician is justified in centering attention upon the
lesion if a reasonable amount of association can be detected.

Classes of Lesions. — Lesions, according to osteopathic
theory, may be of two classes, i. e., first, change in size of
tissues ; second, change in position. Generally speaking, a
change in size is far more difficult to overcome than a change
in position, because the former is a result of more profound
changes. Tissues may increase in size as the result of ef-
forts to repair injury, e. g., the formation of callous in bone,
or thickening of ligaments following a sprain.

Causes of Lesions. — The causes of lesions fall under two
general divisions: First, violence; second, failure to react to
environment. In the first division all the lesions are primary
in character, i. e., the violence immediately changes the rela-
tions of structure, and this change becomes an obstruction
to vital activity of the body fluids. If the lesion is not cor-
rected by the recuperative power of the body itself or by out-
side efforts, the change in position is very apt to become
complicated by a change in size. The injury results in thick-
ening of the ligaments or other fibrous tissues.

Secondary Lesions. — The second division of lesions is a
very large one. These lesions develop as an evidence of the
failure of the organism to become perfectly adapted to its
food, clothing, labor or general environment. They are,
therefore, secondary in character and must be recognized as
objective symptoms of one functional derangement, while
at the same time they operate primarily to cause functional
derangement elsewhere. Thus they may be removed by
manipulation and cease to act as an active cause of func-
tional change, but will return again so long as environ-
mental forces are overwhelming.

Effect of Violence or Fatigue. — The first division or pri-
mary lesion may result from sudden violence or from a force
comparatively weak but long continued. In other words, a
lesion may be developed immediately, under great force, or

42 PRINCIPLES OF OSTEOPATHY

slowly as the result of great fatigue. An example of a lesion
developing under fatigue is noted in the faulty positions as-
sumed by the body following prolonged effort or in perform-
ing certain tasks.

Failure of Adaptation. — The second division or sec-
ondary lesions may result from failure to react properly to
changes of temperature. The temperature of the surround-
ing air may be the same at various times, but the character
of the clothing may necessitate a greater effort at adaptation.
There must be suddenness in the change of temperature or
clothing in order to produce the lesion, i. e., the responsive-
ness of the tissues must be overtaxed. The first effect of
failure of adaptation is the contraction of muscle and ac-
companying sensitiveness. The distortion of the bony struc-
ture is consequent on the contraction. Ordinarily, if the
shock is not too great, the adaptive forces of the organism
will exert sufficient power to correct the condition, but
when the environment is not suitable the lesion may be-
come permanent. Humidity or electrical conditions of the
atmosphere may operate to produce these lesions.

Chemical Causes of Spinal Lesions. — We have noted
that these lesions have been discovered coincident with vis-
ceral disorder. We may, therefore, safely assume that food
which is too difficult of digestion or the usual food taken
during fatigue, may act chemically to produce spinal lesions.
In this instance they are certainly objective symptoms of
visceral disease, but as stated before they must be primary
causes of other disorders. To remove such a lesion by man-
ipulation is helpful to the organism, but the patient must
know that dietetic indiscretions or eating when fatigued was
the real starting point of the disease. Here is where dietetic
and hygienic knowledge must be a portion of the physician's
therapeutics. If the pointing out of structural changes as a
result of functional disturbance due to indiscretions in eat-
ing and other appetites will lead patients to simpler living,
the physician may feel that he has performed a duty more
valuable to the patient than the removal of his secondary

PRINCIPLES OF OSTEOPATHY 43

lesions. There can be no doubt but that the removal of a
primary lesion due to violence is absolutely essential, but
when we maintain that all lesions must be removed before
function can right itself, we become absurd. Furthermore,
if we contend that a structural lesion antedates all func-
tional disturbances we make of life a series of accidents, in-
stead of a force governed by fixed laws.

The Reason for the Persistence of a Lesion. — The ques-
tion arises, why does the muscular contraction persist after
the proper changes in habits have been made? This ques-
tion can not be answered at present. Scarcely one of us will
voluntarily make the change in habits until forced to do so
by failure of the body to respond to our demands. Many
things of a sociological character are at work to compel peo-
ple to labor after fatigue is evident, to eat, sleep and dress
unhygienically. Viewed from this standpoint, the practice
of medicine is a problem in sociology. The original irrita-
tion which causes the tension probably causes more or less
congestion of blood. The congestion results in over-growth
of tissue, which becomes a fixed condition maintaining the
lesion, i. e., it is a portion of the lesion.

The Sequence of Lesion Phenomena. — We have con-
sidered three points concerning lesions — hyperaesthesia,
muscular contraction, and subluxation. They have been
considered in this order merely on account of historical ref-
erence. In osteopathic practice, they are reversed. We note
first the structure, then the tension which accompanies the
change in structure, then the hyperaesthesia.

Variations in Development. — It is not uncommon to find
changes from the usual forms of the bones. Sometimes these
changes may be very deceptive, but when analyzed with
reference to the existence of functional disorder in the area
of their normal influence and the presence of hyperaesthesia,
they will be recognized as morphological changes due to
natural causes. Lesions which might have been active at a
former time are sometimes nonactive on account of laws of
accommodation which are always active in the body. If the

44 PRINCIPLES OF OSTEOPATHY

body has succeeded in recuperating from the effect of these
lesions, it is unwise to disturb them. As an example of an
accommodated lesion, we may mention the formation of a
new socket for the head of the femur, following dislocation.
There are variations in development all through the body,
and each physician should strive to become acquainted with
them.

Palpation of a Lesion. — The first sign of a lesion is
noted by palpation, i. e., the change in structure is felt. Ac-
cording to what we have just said, this is not sufficient evi-
dence of the existence of an active lesion. It must be ac-
companied by other signs. First, try to eliminate the ap-
parent existence of the lesion by having the patient "assume
different positions." Second, note whether the bony land-
marks in that area vary from the normal. Third, note
whether the lesion causes the patient to assume any special
attitude. Fourth, test the amplitude of movement in the
articulation to determine the changes in its extent. If there
is perfect flexibility it is scarcely probable that a lesion ex-
ists, for an active lesion is quite inconceivable without ten-
sion. Fifth, feel of the soft parts of the joint, muscles and
connective tissues. Note any swelling or change in tempera-
ture. Sixth, inspect the surface as to color and texture.
Seventh, test sensibility by pressure. Ordinarily an exam-
ination of the body for lesions consists in comprehensive
palpation, which notes synchronously the existence of posi-
tional change, tension, temperature, swelling and sensitive-
ness. The existence of tension is sufficient evidence of de-
crease of flexibility. When violence is the cause of the le-
sion, it is necessary to correct structure directly. When the
osseous lesion is the result of muscular tension due to reflex
stimulation, methods differ according to the viewpoint of the
physician. Some manipulate for direct reduction, others re-
lax muscles and thus remove the cause of the osseous lesion.
The really comprehensive plan should take into account the
cause of the tension which occasions the osseous lesion.
Having done this, the physician may manipulate the lesion

PRINCIPLES OF OSTEOPATHY 45

to secure direct reduction with the feeling that the problem
has been undertaken wisely.

Description. — Theories of the causation of disease are
capable of being spun out to the point where concrete use-
fulness is very doubtful. In order that we may not wander
too far in theoretical speculation, we will seek to keep the
phenomena, which we are trying to describe, of such a tan-
gible character that the reader will not have to draw on the
imagination.

Find the Lesion. — Osteopathy has developed as a school
of medicine exploiting "the lesion" as a caus*e of disease
and its correction as the efficient cure of disease. This
theory has been so enthusiastically adhered to that many
have been more than willing to attribute failure to cure a
given case as due to the practitioner's inability to find or cor-
rect the lesion. The desire to maintain the adequacy of a
theory is thus apparent. This book is written to present the
usefulness of osteopathy but not the extremes of theoretical
speculation.

Inspection of the Back. — In order that we may quickly
have before us characteristic lesion phenomena for discus-
sion and elucidation, let us observe some well recognized pe-
culiarities noted in the inspection of the dorsum of the body.
A mature male patient, stripped for inspection, will present,
as a general rule, some peculiarities which the trained diag-
nostician will recognize as adaptation due to labor or mode
of life. Closer inspection of the spine, as to its curves, will
show adaptation of even more significance, i. e., to body
weight, general vitality and visceral conditions. As a rule
the diagnostician is trained to note these latter conditions
from other points of view. The point is here emphasized
that the spinal column is a good recorder of all these things.

Palpation of Vertebral Structures. — Digital palpation of
the vertebral and paravertebral structures will, in most cases,
show some degree of localized unilateral deviation in verte-
bral alignment or muscular tension. These apparent changes
from what we conceive as the ideal normal are present in

46 PRINCIPLES OF OSTEOPATHY

practically all people, sick or well. It remains, therefore,
necessary that we add to these physical changes something
of a determining character in order to recognize an active
lesion. Tenderness to pressure is the determining sign.
Having located a lesion, i. e., an osseous deviation with mus-
cular tension and tenderness in the same spinal segments,
we can now proceed to analyze it with reference to its ex-
istence as cause or effect. The spinal vertebral lesion just
noted may involve two or more vertebrae with their at-
tached tissues. Some observers claim that a lesion of a
single vertebra is rare. Since osteopathy has fostered the
view that structure affects function in preference to the re-
verse, the author feels justified, solely by historical consider-
ations, in beginning all analyses of lesions from that view-
point. It is candidly understood that in doing this the
author is not holding a brief for either side of any contro-
versy which circles about the question whether the egg pre-
ceded the chicken or the reverse.

History of Accident. — In any case under examination
the diagnostician desires to uncover the history of the lesion,
hence the most direct question possible is asked, i. e., "Is
there any history of accident?" If a history of accident is
given having direct bearing on the lesion under considera-
tion then we are quite justified in believing it to be the pri-
mary cause of disturbed function. For example, a patient
when attempting to alight from a street car just before it
stopped, found his footing insecure and hence clung to the
handrail of the car with one hand in an effort to protect
himself. The forward motion of the car rotated him and
wrenched his back. He was able to go to his home without
feeling more than a sense of weakness and pain in the area
of the dorso-lumbar articulation. The next morning he was
quite unable to rise. Examination showed great muscular
tension in the muscles controlling the movement of the
twelfth dorsal and first lumbar. Pressure on the spinous
processes of these vertebrae caused intense pain. The bowels
became constipated and the cutaneous areas supplied by the

PRINCIPLES OF OSTEOPATHY 47

twelfth dorsal and first lumbar pairs of spinal nerves gave
some subjective symptoms of being disturbed. This case
recovered in a few weeks under the influence of hot packs to
the injured area, rest in bed, and after acute soreness abated,
passive motion. This case, for many years, has had attacks
of "lumbago." These attacks usually follow changes in the
weather and some exertion beyond the ordinary. The lesion
always exhibits its old characteristics, viz., tenderness, mus-
cular rigidity and loss of motion in the arthrodial joints be-
tween the twelfth dorsal and first lumbar. Usually an osteo-
pathic treatment to establish relaxation and movement is
sufficient to secure rapid recovery.

Traumatic Lesion. — We have in this case a condition
similar to the results of a sprained wrist or ankle. This is a
case of such evident traumatic origin that no one would
think of it from any other standpoint. The lesion is a char-
acteristic one, derived in a characteristic manner and fulfills
our classical picture of localized spinal injury. It is fairly
mild in its disturbance of function of the nerves from the in-
jured area. It was recovered from to such an extent that the
patient has considered himself well except at such times as
the formerly injured tissue failed to function properly under
somewhat unusual conditions. There has never been com-
plete recovery of function in the articulation. This is evi-
denced by partial loss of flexion and extension, hence "the
lesion" is always apparent to the trained sense of touch.
This lesion presents the same characteristics so commonly
noted in peripheral joints which have been sprained and re-
covered from with partial loss of motion. It is usually many
months before the point of attachment of a strained liga-
ment is free from sensitiveness to pressure or tension.

Weight Carrying and Balancing Function Disturbed. —
With an injury of this character located where it has a
weight carrying and balancing function to perform, forming
part of the protective covering of the spinal cord and its
membranes, as well as being a part of the wall of a visceral
cavity, there are many far-reaching influences which may be

48 PRINCIPLES OF OSTEOPATHY

attributed to it. The rigidity which nature manifests first
as a protective reaction, i. e., to prevent motion in the in-
jured part, will be maintained as a constant factor in any
case of joint injury which heals with a partial return of mo-
tion. By this is meant that before the motion of the joint
reaches its limit the muscles assume the function of liga-
ments, so as to protect the weakened ligaments. This ac-
tion of the muscles we note as a protective rigidity which
under the influence of passive motion may be absent but re-
appears when the joint is put through its voluntary func-
tional tests. Thus the fact that the lesion under discussion
involves structures forming a part of the weight carrying
and balancing mechanism of the body makes it more diffi-
cult of recovery. In order to protect it from movement
rigidity exists in segments just above and below it. A lesion
at the point mentioned will tend to produce a straight spinal
column because it is situated at the junction of two curves,
the dorsal posterior and the lumbar anterior. Any exaggera-
tion of these curves necessitates greater movement in this
joint. Therefore, if this joint be injured and its movement
limited there is greater rigidity in both curves in order to
protect the injured joint through which their compensating
movements operate. The tension of the posterior spinal
muscles is met by counter-balancing contraction of the psoas
magnus, the diaphragm and the abdominal muscles. The
tension of the diaphragm results in lessened respiration. The
tension of the abdominal muscles subtracts one factor in the
maintenance of bowel action. Lessened oxygenation and
elimination are thus possible results on a purely mechanical
basis. To compensate for these decreases the whole body
metabolizes at a slower rate and, without the sympathetic
nervous system is vigorous, the decrease in visceral activity
soon makes itself so apparent that the patient may be con-
sidered constitutionally ill. Thus it appears that a spinal
lesion may influence body metabolism adversely as a result
of the natural healing reaction as manifested in rigidity. The
decrease of rhythmical movement in the walls of the abdo-

PRINCIPLES OF OSTEOPATHY 49

men and thorax is the immediate consequence of spinal rig-
idity. These functions are less interfered with when the
weight carrying function of the spine is least called upon,
hence the horizontal position is naturally assumed to lessen
pain and get rid of the demand for compensatory tensions.

Lack of Physiological Rest. — While these injuries are
acute we note easily the compensatory reactions just de-
scribed, but no doubt the majority of such cases feel the
press of economic necessity and hence try to adapt them-
selves to labor through hours more than sufficient to pro-
duce a fatigue akin to sickness. The lesion develops a chro-
nicity, or rather has never had a chance to heal under the
benign influence of physiological rest. This chronic lesion
necessitates permanent compensatory changes such as we
have noted. This patient develops periodical digestive weak-
ness, synchronous with his times of fatigue. He visits a doc-
tor and from then on "suffers many things of many physi-
cians." Through time and the compensatory changes in
this patient's body the original lesion and its significance are
lost to view. The effort made to correct or palliate the di-
gestive disturbance probably has no reference to anything
but the prominent symptoms. It is such cases as these,
suffering from chronic illness, whose history of traumatic
lesion is discovered by the osteopathic examination, which
have given prestige to osteopathic therapeutics. The treat-
ment given by the osteopath to this old lesion reestablishes
movement in the joint and, therefore, the compensatory ten-
sions in the back, abdomen and chest are lessened.

Influence on Circulation and Innervation. — Having thus
followed the mechanical influence of this traumatic lesion
through some of its compensations we can with profit turn
our attention to the far more subtle influences upon circula-
tion and innervation. The trauma under consideration has
been sufficient, in some degree, to rupture tissue continuity
and therefore requires increase of circulation for repair.
The swelling, occasioned by the congestion of the circula-
tion, being under the spinal apponeurosis, does not evidence

50 PRINCIPLES OF OSTEOPATHY

its presence by a localized tumefaction. Some fibers of an
intrinsic spinal muscle, i. e., one of the fifth layer, according
to Gray's grouping, has been injured, hence our repair in-
flammation is deep seated. The deeper seated the lesion,
the more pressure will be exerted on the branches of nerve
trunks emerging from the intervertebral canal and the more
likelihood will there be that the patient will complain of
some symptoms of a character which might be interpreted
as of central origin, especially if bilateral. The subjective
symptoms, pain and paraesthesia, in the area of cutaneous
distribution of the twelfth dorsal nerve are usually unilat-
eral, hence showing that the lesion causes a peripheral neu-
ritis or, at least, a pressure on the nerve sufficient to cause
the brain to register as though the peripheral distribution
of this nerve was irritated.

Segmental Coordination. — A segment of the spinal cord
coordinates the impulses reaching it over its afferent fibers,
hence, in the case of our lesion, the bombardment of this
segment with impulses from the injured tissue as well as
from the nerves subjected to pressure as a result of the re-
pair inflammation will cause efferent impulses to be sent to
somatic and splanchnic areas supplied from this segment.
These outgoing impulses are influencing motion, secretion,
nutrition which are probably disturbed if the sensory nerve
impulse which calls forth the reaction is a disturbed one.
It is hardly probable that reactions of the kind here men-
tioned tend to remain active within one spinal segment.
The nerve centers involved are vertical, i. e.. extend through
one or more segments and hence our reactions tend to
spread. As soon as visceral activity is disturbed by vas-
omoter changes a train of reflexes of a compensatory char-
acter are initiated and without we hold firmly in mind the
character and location of the lesion and realize the probable,
as well as possible, compensatory reactions of a mechanical,
circulatory and nervous character dependent upon it, we are
quite apt to be led astray by the boldness with which some
obscurely related symptom crowds its way into the fore-

LLE'

PRINCIPLES OF OSTEOPATHY 51

ground of our attention. The persistence with which many
of the older osteopaths have worked upon the lesion and re-
fused to be led away, in fruitless efforts to palliate symp-
toms, has contributed much to the success of their school.

Example of Fatigue. — Another phase of the lesion as a
tenable cause of disease is found in those cases whose struc-
ture suffers on account of fatigue or effort to become
adapted to position. We will take two lesions commonly
associated, i. e., muscular tension with a variable amount of
distortion over the splanchnic area, and muscular tension
centered over one or all of the upper three cervical verta-
brae. A bookkeeper fatigues his back muscles by his posi-
tion. The effort to see clearly, especially if there is any in-
trinsic defect of vision or of the coordinating power of the
occular muscles requires compensatory action of the cervical
muscles to maintain the head in the most favorable position
for seeing. The fatigue resulting from many hours of this
compensatory effort, supplemented by other events of daily
life, produces a so-called "bony lesion," usually about the
second or third cervical or even as low as the fourth dorsal.
By carrying the weight of the head forward of the center of
the body the strain on the extensor cervical muscles is eased
somewhat by rounding the shoulders, depressing the thorax,
shortening the distance between the end of the sternum,
costal arches and the pelvic brim, thus relaxing the abdom-
inal muscles and permitting gastro and enteroptosis. This
sagging of the stomach and bowel must be checked if pos-
sible, hence the extensor muscles over the splanchnic area
contract to maintain the normal erect attitude, but fail even-
tually because the body is not planned to sustain the weight
of the head in a position constantly off the center of the
body. This illustrates the gradual development of lesions
due to efforts of adaptation.

Loss of Muscular Tone. — Loss of tone in muscles will
allow those tissues to which they are attached to yield to
the force of gravity and, hence, lesions will be produced. As
example, one of my surgical cases complained bitterly, on

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52 PRINCIPLES OF OSTEOPATHY

the third day after a hysterectomy of pain in the back and
at the lower end of the abdominal wound. Inspection of the
wound showed nothing unusual. The course of the pain
was examined and it was found to follow the course of the
twelfth dorsal nerve. The feebleness of the patient allowed
all her tissues to sag, with the result that the right twelfth
rib lay against the transverse process of the first lumbar ver-
tebrae. A pressure thus exerted on the twelfth dorsal nerve
produced pain in the area of its distribution. A small pad
of gauze and cotton, sufficient to keep the rib away from the
transverse process for a few days until general body nutri-
tion reasserted its tonic effect, was sufficient for relief.

As heretofore stated, it isn't the acute lesion, so easily
recognized, that has contributed so much prestige to oste-
opathy. It is the lesion having been overlooked or mis-
treated and considered a negligible quantity as a causative
factor.

Experimental Lesions. — As a foundation for better clin-
ical observation and understanding, experiments have been
conducted, notably by Dr. Louisa Burns, in the Physiologi-
cal Laboratory of the Pacific College of Osteopathy, Los
Angeles, and by Dr. Carl M. McConnell of Chicago. These
experiments consisted in producing artificial lesions on small
animals, usually dogs, and noting the immediate and remote
effects, then killing the animals and making a careful path-
ological study of the changes in the lesioned tissues. Dr.
McConnell's description of the manner in which he produced
experimental lesions is as follows : "The production of the
lesion is a simple but still very important matter. It can-
not be performed successfully in a haphazard manner. Strict
attention to the thorough relaxation of tissues about the
field of operation and definite application of mechanical prin-
ciples are demanded. After selecting a healthy animal (a
small or medium size dog is best), surgical anesthesia is
instituted. Complete relaxation under anasthesia is neces-
sary. Following this, further relaxation of the area of in-
tended operation by traction is essential for ease of lesion

PRINCIPLES OF OSTEOPATHY 53

production. Next, having determined the character of osteo-
pathic lesion desired, that is, right or left rotation, or hyper-
extension, or hyperflexion, or combination of these, the
second essential is to apply definite mechanical principles.
Bringing the fulcrum to bear at just the desired point when
the tissues are thoroughly relaxed is as necessary in pro-
ducing a lesion as in adjusting one. Much strength can be
wasted if the leverage is not right ; otherwise comparatively
few pounds exertion will accomplish the result. A simple
way is to place the animal flat upon its belly, completely un-
der surgical anesthesia, then while an assistant bears down
with his thumbs upon the selected vertebra the operator
grasps the animal by the rear legs and exerts traction in line
with the spinal column until the spinal muscles thoroughly
relax and stretch, then immediately, while still maintaining
the traction, hyperextend and rotate the spine until the de-
sired point is felt to give and slip. It is simply a question
of applying the indicated mechanics. Various leverages
may be utilized. Frequently we place a small block trans-
versely under the animal, especially in producing rib lesions,
in order to help separate the ribs, as well as to secure a sta-
ble fulcrum.

"The traumatism is not carried to a point where tis-
sues are torn or lacerated. The object is to obtain a slight
slipping or maladjustment of the articular surfaces. If done
correctly, that is, specifically, little force is required. The
immediate noticeable results are malalignment of the verte-
brae, malposition of the ribs corresponding to the deranged
vertebrae, if the lesion is a dorsal one, and contraction of
the spinal muscles of the same segments. These changes
are readily palpated. After recovery from the anesthesia
and during the ensuing time the above characteristics are
evident with the added ones of tenderness and rigidity.
Muscular contraction usually subsides, but not always, un-
til only the deep spinal muscles are palpably contracted and
these corresponding to the local lesion. In some cases the
animal exhibits upon movement that the back is stiff and

54 PRINCIPLES OF OSTEOPATHY

tender; others do not and shortly show no apparent ill ef-
fects. Later on, a number present more or less systemic dis-
turbances, depending upon the locality of the lesion. The
periods of observation have ranged from three to eighty
days, that is, the time from production of the lesion to
autopsy."

Loss of Motion. — The moveable vertebral and costo-
vertebral articulations are arthodial, i. e., gliding, hence any
change in one of these articulations, short of dislocation, is
in a normal direction. In other words, the lesions which
we recognize are partial fixations, hence it isn't the position
which constitutes the lesion so much as it is the loss of mo-
tion, i. e., the loss of function and the exaggerated muscu-
lar contraction which maintains the fixation and the charac-
ter of the injury which is the cause of these changes.

Necessity for Study of Structure. — Based on this idea
of what the lesion is we must study the normal structure
and function of every vertebral and costo-vertebral articula-
tion, so that we may recognize not only the compensatory
changes on the immediate group affected, but also those
widespread compensations of a mechanical, circulatory and
nervous character which are part of every reparative and
adaptive effort of the body. Since pathology is the study
of the perversions of the normal we can not understand
what the body is trying to do in any given case without
taking into account the successes and failures of compensa-
tion as are made evident by this division of medical science.

PRINCIPLES OF OSTEOPATHY 55

CHAPTER III.

THE LESION AS AN EFFECT.

Analysis of the Causes of Lesions. — As previously
noted, the inspection of the vertebral and paravertebral tis-
sues in almost all cases of illness involving the trunk of the
body will show physical signs of compensatory reactions.
These physical signs we call "lesions." They seem to be
identical in character with those which we noted as trau-
matic lesions, i. e., there is deviation in osseous alignment,
muscular contraction and hyperaesthesia. It may be impos-
sible to secure from the patient any history of trauma as the
foundation of this lesion, therefore two explanations are
open to us ; either we must wilfully hold to the hypothesis
that a trauma did occur of so light immediate effect as to
escape the notice of the patient, or use the facts of anatomy
and physiology to build up a rational theory of normal reac-
tions. It is much easier to declare trauma as the cause than
analyze the protective reactions of the body. This fact has
led the exponents of the various forms of spinal adjustment
to explain every lesion by claiming an obscure trauma as the
cause. Since no one ever goes through life without many
slips, falls and other strains which can be called to mind, it
is easy for the patient to be convinced that some remote ex-
perience of this kind is in fact the foundation for all the
trouble.

The Attractiveness of the Traumatic Lesion Theory. —
The theory that an obscure trauma in the spinal tissues is
the essential and adequate cause of bodily disorders is cap-
tivating both to the physician and the patient. It has so
many definite elements which are evident both to the mind

56 PRINCIPLES OF OSTEOPATHY

of the physician and of the patient. The physician's palpat-
ing finger feels the change in osseous alignment and muscu-
lar tone. The patient recognizes the difference in sensitive-
ness between this lesion area and those outside the lesion
influence. Specific manipulation having for its aim the cor-
rection of alignment in the lesioned area gives so frequently
almost instant sense of relief that it is no wonder physician
and patient become convinced that the hypothesis of trauma
is correct. Under the influence of such a theory as this our
osteopathic literature is well spiced with statements tending
to belittle the influence of all other causes of disease. The
writer wishes to emphasize the fact that lesions can be di-
vided into two great classes, i. e., primary and secondary.
The first class is made up of those of traumatic origin and
are undoubtedly causes of disorder in their areas of influ-
ences. The second class is made up of those lesions which
are physical sign of the body's efforts at adaptation and
compensation.

Classification of Lesions. — A given lesion can be
classed as primary or secondary only after careful study of
all those factors which constitute the history and symptom-
otology of the case. Visceral lesions cause muscular con-
tractions in the spinal area from which they receive their
cerebro-spinal nerve communications. They also cause pain
in areas of higher sensibility, cutaneous areas, with which
they are associated by innervation from the same segment
of the spinal cord. These referred pains and contractions of
spinal muscles are beginning to be recognized by specialists
in pulmonary, digestive and renal diseases. There has been
no well ordered effort to coordinate the facts which lie at the
foundation of these phenomena. It is hoped that we may
make for our students a beginning in this work by what
is to follow.

Examples of Secondary Lesions. — As examples of var-
ious secondary lesions we will call attention to the lesion
phenomena found usually to be synchronous with envolv-
ments of some of the organs of the body. Rather than rush

PRINCIPLES OF OSTEOPATHY 57

into an analysis of lesions, we deem it more to the student's
interest to have a clear picture of the phenomena we desire
to analyze later on. Our practitioners who are devoting
much time in treating the eye recognize that in diseases of
the eye and orbital tissues there are points in the neck which
are rarely free from tenderness. Along with the tenderness
are found muscular contraction and malalignment, these
completing our trinity of localized lesion phenomena. Such
lesions may be located as low as the second dorsal.

The Spinal Lesion an Objective Symptom. — Disturb-
ance of circulation in the tonsil is associated with spinal le-
sions. These lesions vary in number and extent according
to whether the disease process is simple and decidedly local,
or is of enough severity to produce constitutional symptoms
such as chill, fever, etc. The spinal lesions multiply and in-
tensify in proportion to the extent and severity of the dis-
turbance of the body. This is the case no matter in what
organ or tissue our original disturbance made its appear-
ance. Just as the symptom complex varies according to the
severity of a disease, so the spinal lesions proportion them-
selves in like manner. Therefore, in this sense, spinal lesions
are physical signs: objective and subjective evidence of dis-
turbance in tissues innervated by branches of nerves from
the same segment of the spinal cord.

Visceral Reflexes. — Each viscus, or localized tissue,
such as glands, mucous or serous membranes, tend to es-
tablish reflex lesions in the spinal area tissues which are
supplied with nerves from the same spinal cord segment as
they themselves are supplied. In proportion to the amount
of compensatory assistance required by any organ or tissue
from those parts of the body ordinarily called upon for such
assistance, our spinal lesion increases in extent and inten-
sity. As a common example of the foregoing, the stomach
may fail to do its work thoroughly and thus throw added
work on the small intestine and its related glands, liver and
pancreas. If these are somewhat overtaxed by their com-
pensatory efforts, our spinal lesion which represented the

58 PRINCIPLES OF OSTEOPATHY

stomach, extends further down over the spinal areas from
which the liver and pancreas receive a portion of their in-
nervation. Such examples as this can be recognized in a
majority of cases.

Pleurisy. — Disease processes in the lungs produce
spinal lesions of various kinds, according to their intensity
and destructiveness. Pleurisy produces so great contrac-
tion in respiratory muscles, which act particularly on the
ribs lying over the inflamed area, that friction of the pleural
surfaces at this point is reduced to a minimum. Physicians,
taking their plan from this natural compensatory contrac-
tion, frequently reinforce natural efforts by strapping over
the contracted area with adhesive. The thorax adapts itself
to the state of its contents, hence when a portion of the lung
is destroyed the antero-posterior diameter of the chest is les-
sened in proportion. The vertebral and costo-vertebral ar-
ticulations enter into this adaptive process and hence ex-
hibit decided lesion phenomena.

Cardiac Lesion Patterns. — In case of heart lesions the
body is called upon to make extensive compensatory reac-
tions and hence our spinal lesion phenomena may be limited
to the area of the heart's innervation, or extend in propor-
tion as the heart's condition involves the pulmonary circu-
lation, the portal circulation or the kidney.

Unity of the Body. — Disease processes in the pelvic vis-
cera produce their characteristic spinal lesion phenomena
just as the thoracic and abdominal organs. The point we
desire to emphasize is that the unity of the body is exempli-
fied by the spinal lesion phenomena. No organ or tissue
can or does suffer injury without other tissues being drafted
to compensate for its condition so as to maintain not only
existence but the most satisfactory life of which the organ-
ism is capable. If the spinal lesion is viewed not only as a
possible cause but, also, as a quite probable effect of tissue
disturbance elsewhere, we will appreciate more fully the
manner in which the body strives to live up to its best.

PRINCIPLES OF OSTEOPATHY 59

CHAPTER IV.

SPINAL HYPERAESTHESIA AND MUSCULAR
TENSION.

Osteopaths are not the first or only physicians who
have used the spine as a means of diagnosis as well as an
area upon which to concentrate therapeutic methods. It is
interesting and instructive to note the steps in the develop-
ment of the knowledge of spinal conditions and of the indica-
tions of remote functional disturbances which are registered
there.

Subjective Symptoms. — Subjective symptoms precede
any attempt to discover objective evidences of disease. It
was early noted by physicians that patients could not be re-
lied upon to interpret their own symptoms. This led to ef-
forts to discover symptoms which were independent of the
patient's imperfect perceptions. Palpation would naturally
be used at the areas complained of by the patient. Since
the brain takes cognizance of only the peripheral areas of
distribution of sensory nerves, instead of the whole course
of the nerve fibers, the physician might still be misled in ap-
plying palpation, because he would be largely governed by
the patient's sensory impressions. Palpation made with ref-
erence to a realizing sense of the distribution and function of
the nervous system, becomes a more satisfactory means of
diagnosis. As the knowledge of the nervous system in-
creased, attention was called more and more to the spinal
column, on account of its relations to the great nervous mass
within it. Palpation of the spinal column demonstrated
the existence of sensitive areas, -associated with visceral or
other disorders ; therefore, hyperaesthetic areas are the first

60 PRINCIPLES OF OSTEOPATHY

diagnostic points mentioned in medical literature, in regard
to the spinal lesion. Such hyperaesthetic areas were con-
sidered as evidence of spinal irritation ; that is, irritation of
the spinal cord.

Irritation of the Spinal Nerves. — The first reference
to spinal irritation which I have found is contained in a
monograph entitled "A Treatise on Neuralgic Diseases
Dependent on Irritation of the Spinal Marrow and Ganglia
of the Sympathetic Nerve," by Thomas Pridgin Teale, 1834.
He quotes a letter from Mr. R. P. Player to the editor of
the Quarterly Journal of Science "On Irritation of the
Spinal Nerves," dated December 10, 1821, as follows: "I
take the liberty to submit to your notice a pathological
fact which has not, to the best of my knowledge, been
generally remarked and attention to which, so far as my
own experience goes, promises some diminution of those
difficulties with which the healing art has to contend.
Most medical practitioners who have attended to the sub-
ject of spinal disease, must have observed that its symp-
toms frequently resemble various and dissimilar maladies
and that commonly every function of every organ is im-
paired whose nerves originate near the seat of the disorder.
The occurrence of pain in distant parts forcibly attracted
my attention and induced frequent examinations of the
spinal column ; and after some years' attention, I considered
myself enabled to state that in a great number of diseases
morbid symptoms may be discovered about the origins of the
nerves which proceed to the affected parts, or of the spinal
branches which unite; and that if the spine be examined,
more or less pain will commonly be felt by the patient on
the application of pressure about or between those verte-
brae from which such nerves emerge.

Spinal Treatment. — "This spinal affection may, per-
haps, be considered as the consequence of diseases, but of
its existence at their commencement any one may satisfy
himself; and this circumstance, combined with the success
which has attended the employment of topical applications

61

to the tender parts about the vertebrae, appears to indicate
that the cause may exist there. Prejudice sometimes oper-
ates against ideas of connection so remote ; but in many
instances patients are surprised at the discovery of tender-
ness in a part, of whose implication and disease they had
not the least suspicion."

Control of the Body by the Nervous System. — Dr.
Teale brings to his aid in the exposition of his subject, some
interesting corroboratory observations made by others and
recorded in the medical literature of that period. He quotes
Dr. Darwell in an interesting paragraph which is a faint
distant undercurrent of Dr. A. T. Still's oft-repeated state-
ment concerning the interaction of nerves and the blood
stream. The passage is as follows : "If, however, the nerv-
ous system is more or less connected with every function
of the animal body; if the circulation of the blood, the phe-
nomena of the respiration and the operation of intellect,
cannot be carried on without its intervention, the manner
in which it is disregarded can not but be a most important
defect. It has perhaps in great measure arisen from always
contemplating the brain as acted upon by the circulation
and never reversing the order of review."

A Concept of the Nervous System. — One of the best
expressed concepts of the nervous system I have read, is
Dr. Teale's introduction to his monograph. It is the con-
cept which is being more clearly taught in osteopathic col-
leges than in those of other schools of medicine : "The
term Neuralgia which was originally employed to designate
certain affections of nerves attended with severe pain has
of late with great propriety been extended from its original
and literal signification, to many other morbid affections
of nerves, which are not characterized by pain, but by some
other perverted state of their functions."

Neuralgia. — "Neuralgia includes within its range a great
variety of diseases, presenting an endless diversity both in
their symptoms and in the parts where they are seated."
That such variety should exist, ceases to excite surprise,

62 PRINCIPLES OF OSTEOPATHY

when we consider how varied are the functions of the dif-
ferent nerves and how diversified the tissues and organs to
which they are distributed.

"To the attentive observer of diseases, neuralgic affec-
tions, under the more extended signification, must repeat-
edly present themselves. The skin, for instance, may be
the seat of every degree of exalted or diminished sensi-
bility, from the slightest uneasiness to the most acute suf-
fering and from the most trivial diminution of sensibility
to the complete obliteration of feeling, — symptoms not de-
pendent upon disease affecting the different tissues of the
part but solely referable to a morbid condition of the sen-
tient nerves. The voluntary muscles may in like manner
indicate in a variety of ways a morbid condition of the
nerves with which they are supplied. They may be affected
with weakness, spasms, tremors, or a variety of other dis-
ordered states included within the two extremes of con-
vulsion and paralysis. The involuntary muscles may have
the harmony of their actions interrupted from a morbid
condition of their nerves; the heart may be affected with
palpitation; the vermicular motion of the stomach or the
peristaltic action of the intestines may be subject to irreg-
ularity. The sensibility of the internal organs may like-
wise be affected, the heart, the stomach, the intestines,
being the seat of pain, referable to their nerves, and inde-
pendent of inflammation, or any alteration of structure.
The secretions may also undergo alterations, both in quan-
tity and quality, from a perverted agency of the nerves
upon which they depend. Such is a -very imperfect recital
of the various morbid affections which may be included
under the term Neuralgia, and so frequent is their occur-
rence that they must be familiar to every practitioner. They
are, however, often perplexing in their treatment and not
unfrequently exhaust the patience of the afflicted sufferer,
and also of the medical attendant.

"The difficulty and embarrassment which have attended
the diagnosis and treatment of these affections, I am in-

PRINCIPLES OF OSTEOPATHY 63

clined to believe, has principally arisen from mistaken views
of their pathology. They have too often been regarded as
actual diseases of those nervous filaments which are the
immediate seat of the neuralgia instead, of being consid-
ered as symptomatic of disease in the larger nervous masses
from which those filaments are derived ; hence the treat-
ment has too frequently been ineffectually applied to the
seat of neuralgia ; instead of being directed to the more
remote and less obvious seat of disease.

"It is now pretty generally admitted as a pathological
axiom, that disease of the larger nervous masses, as the
brain and spinal marrow, is not so much evinced by phe-
nomena in the immediate seat of disease, as in those more
remote parts to which the nerves arising from the diseased
portion are distributed. In the more severe forms of dis-
ease, this principle is readily admitted and recognized.
When for instance one-half of the body shall have lost its
sensibility and the corresponding muscles their power of
action, the skin and the muscles are not regarded as the
seat of disease, but the brain is immediately referred to.
In the slightest forms of disease of the brain and spinal
marrow, such as do not completely obliterate but merely
impair or pervert the functions of the nerves — such as do
not paralyze the sentient and muscular powers of the part
but produce weakness, tremors, spasms, etc., in the mus-
cular system, and numbness and prickings, pains and other
morbid feelings in the nerves of sensation, this important
principle, which as strictly obtains as in the former instance,
is too often entirely overlooked; and a numerous class of
complaints of very frequent occurrence, are regarded as
nervous or spasmodic diseases of the part affected, instead
of being considered as actual diseases of that portion of
the brain and spinal marrow from which the nerves of the
part are derived.

Visceral Disturbance Due to Disturbed Nerve Control.
— "The same pathological principle is, I believe, equally
applicable to the sympathetic system of nerves; although

64 PRINCIPLES OF OSTEOPATHY

it may be difficult to establish this opinion by actual ex-
periment, yet I think it may be rested upon a well grounded
analogy, which will justify us in regarding the nervous
masses of the ganglionic system as bearing the same rela-
tion to the nerves derived from them, as the large nervous
masses of the cerebro-spinal system bear to their respective
nerves. Hence many nervous affections of the viscera ought
not be considered as diseases of the viscera themselves but
as symptomatic of disease in those particular ganglia
whence their nerves are derived.

Co-existence of Spinal Tenderness. — "Influenced by
such considerations, I have for a few years been in the
habit of treating many of these nervous affections as dis-
eases of some portion of the spinal marrow or ganglia; and
have been still further confirmed in my opinion by the
frequent and almost uniform co-existence of tenderness
on pressing some portion of the vertebral column and the
circumstances of the tender portion of the spine being in a
particular situation where the nerves of the affected part
originate.

Symptoms of Spinal Irritation. — "The symptoms of
spinal irritation consist in an infinite variety of morbid
functions of the nerves of sensation and volition which
have their origin in the spinal marrow, and the parts in
which these morbid functions are exhibited, of course, bear
reference to the distribution of the spinal nerves.

"The morbid states of sensation include every variety,
from the slightest deviation from the healthy sensibility of
any part, to the most painful neuralgic affections on the
one hand, and to complete numbness or loss of feeling on
the other; including pains which may be fixed or fugitive
or darting in the direction of the nerve, pricking and ting-
ling sensations, a sense of creeping in the skin, of cold
water trickling over it, and numerous other states of per-
verted sensation of which words are inadequate to convey
a description. In the muscular system we find weakness

PRINCIPLES OF OSTEOPATHY 65

or loss of power, tremors, spasms or cramps and sometimes
a tendency to rigidity.

"These symptoms sometimes exist in so slight a degree
that the patient considers them unworthy of notice, and
only admits their existence when particular inquiry is made
respecting them ; the only complaint which he makes be-
ing of an unaccountable sense of weakness and inability
of exertion. In other cases the tremors have excited alarm ;
sometimes the neuralgic pains in the scalp or the fixed
pain in the muscles, particularly when it occurs in the in-
tercostal muscles, have suggested the idea of serious disease
in the brain or in the lungs; and when the pain is seated
in the muscles of the abdomen, a fear that some organic
disease of the abdominal viscera has taken place harasses
the mind of the patient. The muscular weakness in some
cases tending to paralysis often suggests the fear of apoplexy
or paralysis from cerebral disease.

Duration of Affections Due to Spinal Irritation. — "The
affection is often of very protracted duration, undergoing
alternate variations from the sanative powers of the con-
stitution and the different existing causes of disease. There
are many individuals in whom the complaint has existed,
in varying degrees of intensity for a series of years, with-
out its real nature having been suspected ; the patients and
their medical attendants having regarded it throughout as
a rheumatic or a nervous affection.

"In this complaint tenderness in the 'portion of the
vertebral column which corresponds to the origin of the
affected nerves, is generally in a striking and unequivocal
manner evinced by pressure. In some instances the ten-
derness is so great that even slight pressure can scarcely
be borne, and will often cause pain to strike from the spine
to the seat of spasm or neuralgia.

"This affection of the spinal marrow occasionally exists
throughout its whole extent; more frequently, however, it
is confined to some particular portion, and occasionally is
seated in different and remote portions at the same time;

66 PRINCIPLES OF OSTEOPATHY

the particular symptoms and tenderness on pressure indi-
cating the affected part.

"The symptoms of course vary considerably, according
to the particular part of the spine which is affected, and
bear reference to the distribution of the different spinal
nerves.

Affections of the Upper Cervical Region. — "When the
upper cervical portion of the spinal marrow is diseased, we
frequently find neuralgic affections of the scalp ; the pain
strikes in various directions over the posterior and lateral
parts of the head ; sometimes the twigs in the neighborhood
of the ear, sometimes those which ascend over the occiput
to the superior part of the scalp, are more particularly the
seat of the complaint; the nervous twigs distributed to the
integuments of the neck are occasionally affected, the pain
darting across the neck to the edge of the lower jaw, and
sometimes encroaching a little upon the face. These neu-
ralgic diseases frequently assume an intermittent form, the
paroxysms generally occurring in the evening. A stiff neck
or impaired action of the muscles moving the head fre-
quently attend the affection of the upper cervical portion
of the spinal marrow; and occasionally the voice is com-
pletely lost, or suffers alteration, and the act of speaking is
attended with pain or difficulty.

Irritation of the Lower Cervical Region. — "Irritation
of the lower cervical portion of the spinal marrow gives rise
to a morbid state of the nerves of the upper extremities,
shoulders, and integuments at the upper part of the thorax.
Pains are felt in various parts of the arm, shoulder, and
breast; sometimes the pain takes the course of the anterior
thoracic branches of the brachial plexus, occasionally the
pain is fixed at some point near the clavicle, scapula or
shoulder joint at the insertion of the deltoid, or near
the elbow or shoots along the course of some of the cutan-
eous nerves. Frequently one or both of the mammae be-
come exquisitely sensible and painful on pressure, and
some degree of swelling occasionally takes place in the

PRINCIPLES OF OSTEOPATHY 67

breast, attended with a knotty and irregular feeling, when
the neuralgic pains have existed a considerable time in
that part, prickling and numbness, tingling and creeping
sensations are often felt in the upper extremities; and
also a sensation of cold water trickling over the surface.
On rubbing the hands over the part affected a soreness is
frequently felt, which is described as not merely situated
in the integuments but also in the more deep seated parts.
In the muscular system are observed most frequently a
weakness of the upper extremities sometimes referred par-
ticularly to the wrists, tremors and unsteadiness of the
hands; also cramps and spasms of various degrees of in-
tensity. Occasionally there is an inability to perform com-
plete extension of the elbows, the arm appearing restrained
by the tendon of the biceps; and tightness being produced
in this part when extension is attempted beyond a certain
point. As far as I have observed, the pain and other mor-
bid feelings in the upper extremities and chest are felt
more frequently and more severely on the left than on the
right side.

"Females of sedentary habits appear particularly sub-
ject to these affections of the upper extremities, and it is
not uncommon for them to complain of being scarcely able
to feel the needle when it is held in their ringers, and that
their needles and work frequently drop from their hands.

Irritation in the Upper Dorsal Region. — "When the
upper dorsal portion is affected, in addition to various mor-
bid sensations similar to those in the extremities, there is
often a fixed pain in some part of the intercostal muscles,
to which the name pleurodynia has been assigned ; and when
this pain has existed a long time, there is tenderness on
pressing the part.

Irritation in the Lower Dorsal Region. — "When the
lower dorsal half of the spinal marrow is the seat of irri-
tation, or subacute inflammation, the pleurodynia, when it
exists, is felt in the lower intercostal muscles; frequently
there is also a sensation of a cord tied round the waist; and

68 PRINCIPLES OF OSTEOPATHY

oppressive sense of tightness across the epigastrium and
lower sternal region ; and soreness along the cartilages of
the lower ribs or in the course of insertion of the diaphragm.
Various pains, fixed and fugitive, are also felt in the par-
ietes of the abdomen, throughout any part of the abdom-
inal and lumbar muscles ; the pain is frequently fixed in
some portion of the rectus muscle and not infrequently in
the oblique muscle or transversalis, a little above the crest
of the ilium, particularly when the origin of two or three
of the lowest dorsal nerves is diseased.

Irritation in the Lumbar and Sacral Regions. — "The
affection of the lumbar and sacral portion of the spinal cord
often produces a sensation of soreness in the scrotum and
neighboring integuments; and the lower extremities be-
come the seat of various morbid sensations, spasms, tremors,
etc., for the most part resembling those which have been
described as occurring in the upper limbs. The patients
also complain of a sense of insecurity or instability in
walking; their knees totter, and feel scarcely able to sup-
port the weight of the body.

The Effect of Recumbency. — "In some cases very con-
siderable relief is found from recumbency, the pain fre-
quently being diminished as soon as the patient retires to
bed, independently of any paroxysmal remission.

Irritation of Spinal Marrow Not Necessarily Dependent
on Disease of Vertebrae. — "This irritation or subacute in-
flammatory state of the spinal marrow is not necessarily
connected with any deformity of the spine, or disease in
the vertebrae. It may co-exist with these as well as with
any other diseases, but it so repeatedly occurs without them
that they can not be regarded as dependent upon each
other. Where, however, inflammation and ulceration of
the vertebrae or intervertebral cartilages exist, it is prob-
able they may predispose to, and in some instances, act
as an exciting cause of an inflammatory state of the nervous
structures which they contain ; for we not frequently find
inflammatory affections of the vertebrae in conjunction with

PRINCIPLES OF OSTEOPATHY 69

symptoms of irritation of the spinal marrow. But these two
affections, although co-existing, bear no regular relations
to each other; and during the progress of the vertebral
disease the affection of the nervous structures is subject to
great changes and fluctuations. The local remedies em-
ployed for arresting the disease in the bone often alleviate
the affection of the spinal marrow at the very commence-
ment of the treatment, long before the vertebral disease
is suspended ; but as the neighboring inflammation in the
bones appears to predispose or excite the nervous mass
which they contain to disease, relapses of the nervous af-
fections are repeatedly occurring during the whole course
of the complaint.

Lateral Curvature. — "The affections of the spine,
termed lateral curvature and excurvation, appear to have
no necessary connection with the disease which I have
been describing; and the proportion of cases in which they
are found united is so small that lateral curvature can
scarcely be considered even as predisposing to this disease.
The most extreme degrees of deformity are frequently ob-
served without any affection of the nerves; and when
lateral curvature does occasionally co-exist, local antiflo-
gistic treatment will often speedily remove the nervous
symptoms while the curvature remains unrelieved. Hence
there is an impropriety in considering these nervous symp-
toms as a result of the deformity and in explaining them
upon the mechanical principle of pressure and stretching,
to which the nerves are supposed to be subjected as they
issue from the intervertebral foramina. If the pressure
and stretching produced by the curvature were the cause
of the nervous symptoms, they ought to continue as long
as the deformity remains.'

Treatment. — "When the different neuralgic symptoms
which have been enumerated can be traced to this morbid
state of some portion of the spinal marrow, the treatment
that ought to be pursued is readily decided upon. Local
depletion by leeches or cuping, and counter irritation by

70 PRINCIPLES OF OSTEOPATHY

blisters to the affected portion of the spine, are the prin-
cipal remedies. A great number of the cases will fre-
quently yield to the single application of any of these
means. Some cases which have even existed several months
I have seen perfectly relieved by the single application of
a blister to the spine, although the local pains have been
ineffectually treated by a variety of remedies for a great
length of time. A repetition of the local depletion and
blistering is, however, often necessary after the lapse of a
few days, and sometimes is required at intervals for a con-
siderable length of time. In a few very obstinate cases
issues or setons have been thought necessary; and where
the disease has been very unyielding, a mild mercurial
course has appeared beneficial.

"When my attention was first directed to this subject,
I considered recumbency a necessary part of the treatment;
it is, for a moderate length of time, undoubtedly beneficial
and frequently very much accelerates recovery, but sub-
sequent observation has convinced me that it is by no
means essential. I have seen several instances of the most
severe forms of those complaints occurring in the poorer
classes of society, where continued recumbency was im-
practicable, which have, nevertheless, yielded without dif-
ficulty to the other means of the treatment, whilst the indi-
viduals were pursuing their laborious avocations.

"These observations, howefver, are not intended to
apply to those cases in which there is actual disease of the
vertebrae.

"When there exists a tendency to relapse, I have
thought it advantageous to continue the use of some stim-
ulating liniment to the spine for a few weeks after the
other means of treatment have been discontinued. A lini-
ment consisting of one part spirits of turpentine and two
of olive oil is what has generally been employed.

Ganglia of the Sympathetic Nerves. — "The ganglia of
the sympathetic nerves appear subject to a state of disease

PRINCIPLES OF OSTEOPATHY 71

similar to that which has been described in the preceding
chapter, as occurring in the spinal marrow.

"As the disease may be confined to one part of the
spinal marrow, or exist simultaneously in different por-
tions, or may even pervade its whole extent, so the af-
fection of ganglia may be confined to one of these nervous
masses, may exist in several which are contiguous, or in
ganglia remote from each other; and as there is reason to
believe the whole chain may occasionally be affected.

"The disease of the ganglia is seldom found, except in
conjunction with that of the corresponding portion of the
spinal marrow, whereas the spinal marrow is often affected
without the neighboring ganglia being under the influence
of disease. Thus we frequently find symptoms of disease
in a portion of the spinal marrow without any evidence
of its existence in the corresponding ganglia, frequently the
symptoms of both combined, and occasionally, but rarely,
symptoms referable to the ganglia without the spinal mar-
row being implicated.

Symptoms of Irritation of Sympathetic Ganglia. — "The
principal symptoms resulting from irritation of the ganglia
of the sympathetic are to be found in those organs which
derive their nerves from this source. They consist of per-
verted functions of these organs, and are exemplified by a
variety of phenomena. The involuntary muscles, deriving
their power from the sympathetic, have their action altered
as is evinced by spasms and irregularity in their contrac-
tions. The heart is seized with palpitations, the large ves-
sels with inordinate pulsations; the muscular fibers con-
necting with the bronchial apparatus are thrown into
spasms, constituting a genuine asthma independent of
bronchial inflammation. The muscular fibers of the stom-
ach and intestines become the seat of spasms and various
other deviations from their natural operation. The sensi-
bility of the organs, which derive their sentient power ffom
the great sympathetic, is variously perverted, the nervous
filaments being the seat of pain. The heart and lungs, for

72 PRINCIPLES OF OSTEOPATHY

instance, are subject to morbid sensations bearing great
analogy to those which have been designated 'tic doulou-
reaux' when occurring in the spinal nerves. The stomach
and intestines are liable to similar neuralgia, to which the
names gastrodynia and enterodynia have been applied. The
kidneys, the bladder, and the uterus are liable to the same
perverted state of their sensibility. The secretions also
undergo alterations, products being formed, which in health
have no existence. This is exemplified by the enormous
secretions of air which sometimes occur in the stomach.
Large quantities of clear transparent liquid are also secreted
by this organ, constituting what is called pyrosis. The
secretions of the stomach undergo variation in their quan-
tities, rendering them unfit for digestive process. It is
probable that the secretion of the liver also experiences
some alteration in these complaints. The urine is some-
times influenced, and I am inclined to suspect that some
forms of diabetes partake of neuralgic character. Leu-
corrhoea is frequently a concomitant of these diseases, and
ceases on their removal; but I am not prepared to say that
it is ever symptomatic of them. Irregularities in the cata-
menia are often observed, the discharge often being gen-
erally in excess.

Middle and Lower Thoracic Sympathetic Ganglia. —
"The ganglia most liable to the disease are the middle and
lower thoracic, from which the splanchnic nerves are de-
rived, giving rise to various disorders of the stomach and
digestive organs, which will hereafter be more fully dis-
cussed. Next in frequency is the affection of the cervical
ganglia, producing painful and spasmodic states of the
heart. The symptoms denoting disease of other ganglia, al-
though occasionally met with, are less frequent in their
occurrence. Irritability of temper and depression of spirits
often attend these complaints, particularly when the stom-
ach is the part which suffers.

"The disease of the ganglia, like that of the spinal
marrow, is not necessarily connected with disease of the

PRINCIPLES OF OSTEOPATHY 73

vertebrae or distortion of the spine. It may co-exist with
these complaints, and, when it does so, the symptoms
proper to the ganglionic disease are often erroneously sup-
posed to be produced by distortion or by disease of the
vertebrae ; they are, however, frequently relieved by treat-
ment, whilst the disease of the bones remains uninfluenced
by it, and the most extreme distortion of the spine or de-
struction of the vertebrae from inflammation may exist
without there being any symptoms attributable to neuralgia
of the sympathetic nerves.

"In conjunction with the symptoms denoting disease
of the ganglia, tenderness to a greater or less degree may
generally be found on pressing some part of the spine, and
the tender portion invariably corresponds with the symp-
toms; or rather, the seat of tenderness is near the part
occupied by the particular ganglia from which the nerves
of the disordered organ are derived ; for example, when the
heart is affected the tenderness is found in some of the
cervical vertebrae, and when the stomach is the seat of
complaint, it is in some of the middle or lower dorsal ver-
tebrae.

Spinal Treatment. Hyperaemia. — "With respect to the
treatment, I have but little to add to what has been said
in the preceding chapter respecting the treatment of irrita-
tion of the spinal marrow. Leeches, cuping, blisters, etc.,
to the neighborhood of the affected ganglia constitute the
essential part."

Muscular Tension. — Following the observation of spinal
tenderness came the noting of muscular tension accompany-
ing it. As near as I can determine from perusing medical
literature, muscular tension was not recognized until after
the advent of Osteopathy. Since the attention of medical
writers was called to the conditions of the spinal column
called "lesions" there are frequent passages descriptive of
these in medical literature. One of the best of these ref-
erences is found in Boardmen Reed's work on "Diseases
of the Stomach and Intestines," and is as follows :

74 PRINCIPLES OF OSTEOPATHY

"Dr. John P. Arnold has recently called attention to
a novel objective sign which may be recognized upon pal-
pation over the sensitive .regions along side of the spinal'
vertebrae, and sometimes in such regions which are not
sensitive to pressure, though in all cases he maintains that
the part of the body supplied by the vaso motor nerve
fibres immerging in the corresponding intervertebral space
will be found to present some abnormal condition. The
peculiarity described by him is, in such cases, a somewhat
doughy, and in chronic ones, a gristly tense, cord-like feel-
ing of the band of longitudinal muscular fibres which run
up and down on either side of the spine. This abnormality
is supposed by Arnold to be due to a congested or infiltrated
condition of the muscle while the cord itself is anaemic,
probably in chronic cases. Hammond believed the spinal
cord to be anaemic in such cases. The findings obtained by
a careful palpation over the spine should thus assist in di-
recting our attention to the organ or part of the body which
may be suspected of being diseased.

Digital Examination of the Spinal Area. — "You should
make it a rule to examine carefully the spines of all chronic
invalids by pressing deeply with the finger tips (or with
the thumbs, as Flint advised) close to the vertebrae and
then exert gentle traction in a lateral direction outward
from the spine on either side. The patient should be lying
upon his right side while you palpate along the left side of
the vertebrae, and should then change to his left side in
order that you may palpate upon the right side of the
latter so that the tissues may be in the utmost condition
of relaxation practicable. In both cases you will find it
best to stand in front of the patient and reach over his
upper side to make palpation along the .region of the upper
side of the spinal column.

"In numerous patients, especially those suffering from
digestive derangements, you will be likely while palpating
in the way described to recognize in the longitudinal muscles
running parallel and close to the spine the tense, cord-like

PRINCIPLES OF OSTEOPATHY 75

sensation above mentioned. If, simultaneously with your
recognition of such a condition the patient complains of
sensitiveness in the same regions, the accuracy of your
finding will be at once confirmed."

The Use of Spinal Muscular Tension in Diagnosis. —
The use of these tense cord-like muscles as diagnostic evi-
dences of disease has been a constant practice of Osteo-
paths from the beginning of Dr. Still's work. Judging from
the quotation the true significance of these contractions has
not been apprehended by the medical profession in general.
It is very evident that a contracted muscle is shorter and
thicker than when relaxed, also that when contracted it
exerts force to draw its extremities together. The ends of
the muscle being attached to bones forming portions of
a movable articulation, a change in the relation of the
bones must follow. This change is called a subluxation
and is described more in detail in another chapter.

Cause or Effect? — Having noted that sensitiveness and
muscular contraction are well recognized conditions found
along the spinal column, the question arises, are these
merely objective symptoms of disease or are they to a
large extent causative factors in the origin and maintenance
of diseased conditions of the areas of peripheral distribu-
tion of spinal nerves? Are they causes or effects?

They have been noted almost exclusively as efficient
causes of disease. Furthermore, osteopathic therapeutics
have been administered from that standpoint with marked
success. This change in position and size of tissues is
recognized as an obstruction to the movements of fluids,
and therefore is a condition operating in the system to
cause disease.

76 PRINCIPLES OF OSTEOPATHY

CHAPTER V.

THE SEGMENTATION OF THE BODY.

The Lesion as a Guide in Diagnosis. — Since the spinal
lesion may be either cause or effect, i. e., a trauma or an ex-
pression of the body's protective reaction, we need certain
fundamental facts upon which to base judgment. No mat-
ter whether the lesion is cause or effect the physician must
recognize it as a guide for the unravelling of a series of phe-
nomena which are quite sure to be present in any case. It is
a well recognized fact that effects become causes and thus a
cycle of reflexes become established making it difficult to
recognize where the series began. Any diagnosis worthy
the name must be based on structure and function. Much of
the phenomena we are called upon to interpret is difficult to
understand, unless we know not only normal structure but
the development processes whereby this present structural
formation was achieved.

The Spinal Segment. — The far reaching influence of a
cervical lesion can readily be understood when we study the
embryological development of cervical structures. To men-
tion a nerve to a diagnostician should instantly bring to his
mind all the structural associations of that nerve, its origin
and distribution. The thought of its origin and distribution
would naturally bring to mind an association of all the tis-
sues depending on it for innervation. We would thus have
a picture of a localized community of interests. Considering
the similar distribution on the opposite side of the body we
have pictured a sort of transverse division of the body.
Every pair of spinal nerves, with the tissues directly under
their influence, should form in our minds an entity, a mech-

PRINCIPLES OF OSTEOPATHY

77

anism in which reactions tend to take place independent of
all other segments. Although we may think of a segment as
a unit, the development of the body has coalesced its various
structures in such a way as to locate the nervous control of
any one structure, such as a muscle, in more than one seg-
ment of the spinal cord, hence the controlling nerve to a
muscle usually contains fibers from more than one segment.

Ixisi persisting
cephalic myotomes

First three

cephalk

rriyotomcs

Ceroicol
m^otomes

Caudal myotomcs

Lumbar
niyo tomes

Sacrol myotomes

PIG. 2. Scheme to illustrate the disposition of the myotomes in the
embryo in relation to the head, trunk and limbs. Drawn by John
Coms'tock (after Cunningham).

78

PRINCIPLES OF OSTEOPATHY

It is readily seen that there is an element of protection in
this fact. A slight central lesion, i. e., an injury to the spinal
cord, its membranes; or a pressure lesion due to disease of
the bone, as in Pott's disease, might not produce complete
loss of function in any single muscle because the governing
nerve to that muscle is made up of fibers from two or more
cord segments.

Injury of a Single Nerve. Example : Posterior Thoracic.
— Complete paralysis of a single muscle is indicative of
serious injury to its governing nerve at some point exterior

Dorsal musciilatur

IVirsnl division— -f-
uf a >[>inul /
nerve

Vjiluni ln'tiiT'Tii ilor.Mil tmcl

vi>iilnil trunk musculature.

FIG. 3. Diagram of a segment of the body and limb. Drawn by John
Comstock (after Kollmann).

to the central nervous system; in fact, beyond the point of
coalescence of the fibers which form it. As an example of in-
jury of a single nerve we may take a case of paralysis of the
Serratus Magnus. This large muscle which acts to hold the
posterior border of the scapula close to the thorax, when one
is pushing with the hand or when taking a deep inspiration,
is innervated by the posterior thoracic nerve which is made
up of fibers from the upper portion of the brachial plexus,

PRINCIPLES OF OSTEOPATHY

79

fifth, sixth and seventh cervicals. Evidently an injury capa-
ble of involving all the fibers of the posterior thoracic nerve
and no others must be peripheral to the point of junction of
its fibers from the fifth, sixth and seventh cervicals.

A patient came to me in 1901 complaining of a peculiar
loss of power of the right arm. He was a large, powerfully

FIG. 4. Paralysis of right serratus magnus. Shows the promi-
nence of the scapula, when it is the foundation for a move-
ment such as extension of the arm to the side.

built young man whose occupation, as a lumber shover, un-
loading lumber on the San Pedro docks, was lost as a result
of his condition. He gave a history of perfect health at all
times. Said that two days previous, on Sunday, he had
erected a tent for himself and as he was tightening the guy
ropes he felt a sharp pain under his right shoulder blade,

80 PRINCIPLES OF OSTEOPATHY

which was immediately followed by inability to push with
the right arm. The pain was of short duration. He de-
scribed his position as a somewhat awkward one, i. e., he
was kneeling on his right knee facing one of the tent guy
rope pegs. With his right hand grasping the wooden clamp

FIG. 5. Paralysis of right serratus magnus. Shows loss of
power to rotate the scapula on the thorax.

on the guy rope, he attempted to draw the guy rope taut.
His great strength enabled him to do this, even though his
right hand was considerably behind him. Figs. 4 and 5
show the effects of the paralysis of the Serratus Magnus in
this case.

A second case presenting exactly the same symptoms
was seen in the clinic of the Pacific College of Osteopathy

PRINCIPLES OF OSTEOPATHY

81

a short time later. A telephone lineman, while engaged in
stringing wire from pole to pole, made a vigorous awkward
pull with the right hand some distance back of his hip. His
legs were entwined about the crosspieces of the pole. At
the time of greatest effort he felt a severe pain under the

FIG. 6. Paralysis of right serratus
magnus. Shows the "winged"
condition of right scapula when
arm is extended forward.

right shoulder, followed by a profound sense of weakness in
the shoulder and arm. The scapula immediately took a
wing position and the patient could not shove with the right
arm.

These cases serve to give us a picture of the influence
of position and motion of the shoulder as governed by one

82

PRINCIPLES OF OSTEOPATHY

nerve taking origin from three cervical segments. The
lesion was not a spinal one, i. e., such as we have before de-
scribed, neither was it one involving the cells of origin of
this nerve in the spinal cord. The awkward position of the
patients and their naturally great strength operated to in-

FIG. 7. Paralysis of right serratus
magnus. Shows outline of the
vertebral borders of the scapulae
when arms are extended forward.

jure them in much the same way as the various nerve holds
practiced by the jiu-jitsu wrestler. The pressure where the
nerve crossed the ribs became too great and, hence, caused
a severe trauma of the nerve.

A Unilateral Cervical Spinal Lesion. — The foregoing
cases present the classical first symptoms of a severed motor

PRINCIPLES OF OSTEOPATHY 83

nerve. In order to present the symptoms accompanying a
cervical lesion of the spinal lesion type we will describe a
case which has been under observation for a long time. A
woman, 41 years of age, has been under my professional
care for three years. At the time of my first examination

FIG. 8. Shows digitations of the FIG. 9. Paralysis of the right ser-
serratus magnus and normal po- ratus magnus. No digitations are

sition of the scapula. apparent. The scapula takes an

extreme "wing" position.

she appeared to be constitutionally ill, but careful examina-
tion failed to discover any organic disease. Functional
rhythm seemed discordant everywhere, hence our first ef-
forts were to see that environment was fairly normal. Rest,
nutritious diet and an optimistic atmosphere served to elim-
inate many of the irritating symptoms.

84 PRINCIPLES OF OSTEOPATHY

The first examination of the spinal area discovered a
lesion between the sixth and seventh cervical vertebrae.
There was muscular ankylosis controlling this articulation
and any attempted movement of the whole cervical area,
sufficient to make demand on this joint, caused pain of a
sharp neuralgic character to radiate into the left shoulder
and arm. This pain could be produced most easily by either
voluntary or passive rotation of the head to the left. A per-
sistent effort to rotate the head in this direction caused the
hand and arm to become numb. The hand would become
bloodless, cold and moist; power to pick up a book or cup
was greatly lessened. These symptoms would wear off in
twenty-four to thirty-six hours, but the pain would leave her
in almost a state of collapse. Massage of the arm and hand
would bring no reaction ; heat also failed to stimulate cir-
culation.

These attacks had been brought on by any sort of house-
work, at first only sweeping or such work as required arm
leverage. Later it seemed as though the attacks came with-
out any mechanical reason. They were accompanied by se-
vere headache, tachycardia, meteorism, cold extremities
and subnormal temperature. As might be expected in such
a case the spinal lesion picture was a mixed one and it
seemed, in view of so many symptoms of auto-intoxication,
as though the mid-dorsal lesions were more nearly primary
than the others. The sensitiveness of this spinal column
was so great and so many compensations were in evidence
that it was deemed best to attempt at first merely to simplify
the symptom complex as much as possible by giving the
spinal column physiological rest. The patient was kept in
bed, thus reducing the demand on the weight carrying func-
tion of the spine. This, and the psychological influence of
trying a new plan under optimistic circumstances, served to
reduce the number and complexity of symptoms, but in no
wise changed the character, or viciousness, of the reactions
arising from any disturbance of the articulation between the
sixth and seventh cervical vertebrae.

PRINCIPLES OF OSTEOPATHY 85

Treatment. — Direct extension, slow and gentle, was at-
tempted with marked success. Great care had to be exer-
cised when releasing the extension, else the closure of the
cervical articulations acted as though a nerve had been
caught by direct pressure. Gradually the muscular tension
around this joint was decreased and a slight degree of rota-
tion toward the lesion, i. e., in this case the left side, could
be accomplished without arousing severe pain. Digital pres-
sure made against the left side of the sixth cervical spine
would always cause a severe reaction. It was not possible
to use any quick leverage or thrusting movements in this
case for correction of the lesion until about eighteen months
after we gave our initial treatment. A fairjy wide range of
movement is now possible. The patient can voluntarily
rotate the head to the left, but the sensitiveness on the left
side of the cervical spine has never entirely disappeared.
She lives a normal existence as a busy housewife. She has
gained thirty pounds in weight.

In this case the lesion is nearer center, i. e., closer to
the spinal cord. The symptoms it presents are nearer in
character to those of true central origin, except that they
are unilateral. The local symptoms, pain, muscular tension,
anaesthesia and vaso-constriction, are manifested in the area
of distribution of the brachial plexus. Although the spinal
muscles, whose tension constituted an ankylosis of the artic-
ulation between the sixth and seventh cervical vertebrae, are
innervated by branches of the posterior division of the lower
cervical nerves, the reflexes, through the cells of origin of
the lower cervical nerve trunks in the spinal cord, were
manifested in all divisions of the brachial plexus, not only in
the plexus but overflowed into the sympathetics, as shown
by the vaso-motor disturbance and rapid heart action.

There is a history of accident in this case which classes
this lesion as traumatic. We have its effects shown in the
reaction of the cerebro-spinal and sympathetic systems. In
other words, the somatic and splanchnic structures, inner-
vated by nerves from the lower cervical group, act and react

86

PRINCIPLES OF OSTEOPATHY

upon each other in an effort to adapt themselves to this
lesion. As time went on the whole body was engaged in a
losing effort at adaptation, simply because the lesion area
was never given physiological rest, i. e., eliminating all de-
mand on the weight carrying and balancing functions of the
joint. The manipulation of this spinal joint was also in the
nature of physiological rest because it reduced the hyper-
tension and gradually reestablished normal functional move-
ments.

I i"

FIG. 10. Paralysis of the trapezius
and clavicular division of the
sterno-cleido-mastoid due to death
of some of the central cells of
the spinal accessory nerve.

Involvment of the Central Nerve Cells. — The next step
in severity in lesions is the involvment of the contents of the
spinal canal, either through direct invasion of the tissues of
the cord, or by pressure due to destruction of sections of the
spinal column. The point we wish to illustrate is that the
diagnostician must, in order to do scientific work, make a
diagnosis based on the facts of anatomy as interpreted by
embryology. If symptoms were noted and interpreted with
the same precision with which the trouble man on a tele-
phone system works out his problems we would not find so

PRINCIPLES OF OSTEOPATHY

87

many fantastic medical theories. It is, in large measure, the
failure to teach the fundamentals of anatomy, physiology
and pathology in a thorough manner that is responsible for
the vagaries in medical practice. We are not forgetting the

FIG. 11. Atrophy of right trapezius.

fact that the public is not educated to this view and, there-
fore, the one who attempts to act irrespective of the public's
state of education has a hard row to hoe.

Cervical Muscles. — In the first case described, wherein
the Serratus Magnus was paralyzed, we noted that it re-
ceives its innervation from the cervical region. This makes
it a cervical muscle. In this same sense the trapezius and
latissimus dorsi are cervical muscles and will necessarily
enter into any reactions involving the segments of the spinal
cord which give origin to their nerves. In order to bring
to your attention some of these peculiar changes which have

88

PRINCIPLES OF OSTEOPATHY

taken place in the development of the body, we will review
a few of the most notable which will aid us in the interpre-
tation of the effects of lesions.

Embryology. — Embryology is the "histology of very
young beings." We may question here what contribution

FIG. 12. Shows atrophy of right
trapezius.

the study of embryology has made which has practical sig-
nificance in the diagnostic and therapeutic work of our prac-
titioners. Since we have a "division of labor," as evidenced
by a variety of tissues having special functions, and since
self-preservation for purposes of perpetuating organisms of
a similar character is a prime requisite of life, groups of tis-
sues are associated into mechanisms. Comparative embry-
ology has helped us to recognize, in part, these mechanisms.
The recognition of the segmental arrangement of the body
is one of the great contributions of embryologists.

PRINCIPLES OF OSTEOPATHY

89

Segmentation. — Early in the development of the em-
bryo the mesodermic cells on either side -of the longitudinal
groove show transverse divisions which form a series of seg-
ments called protovertebrae or mesodermic somites. With-

PIG. 13. Paralysis of right trapezius and portion of the sterno-
cleido-mastoid.

out our going into a lengthy description of the arrangement
of the mesodermic cells to form the spinal column and its
muscles, we want this early series of divisions kept in mind.
"The appearance of the mesodermic somites is an im-
portant phenomenon in the development of the embryo,
since it influences fundamentally the future structure of the
organism. If each pair of mesodermic somites be regarded
as an element and termed a metamere or segment, then it
may be said that the body is composed of a series of meta-
meres, each more or less resembling its fellows, and succeed-
ing one another at regular intervals. Each somite differen-
tiates, as has been stated, into a scleratome and a myotome,
and, accordingly, there will primarily be as many ver-
tebrae and muscle segments as there are mesodermic

90 PRINCIPLES OF OSTEOPATHY

somites, or, in other words, the axial skeleton and the
voluntary muscles of the trunk are primarily metameric.
Nor is this all. Since each metamere is a distinct unit, it
must possess its own supply of nutrition, and hence the pri-
mary arrangement of the blood-vessels is also metameric, a
branch passing off on either side from the main longitudinal
arteries and veins to each metamere. And, further, each pair
of muscle segments receives its own nerves, so that the ar-
rangement of the nerves, again, is distinctly metameric.

"This metamerism is most distinct in the neck and trunk
regions, and at first only in the dorsal portions of these re-
gions, the ventral portions showing metamerism only after
the extension into them of the myotomes. But there is clear
evidence that the arrangement extends also into the head
and that this, like the rest of the body, is to be regarded as
composed of metameres. There is reason, therefore, for be-
fieving that the fundamental arrangement of all parts of the
body is metameric, but though this arrangement is clearly
defined in early embryos, it loses distinctness in latter
periods of development. But even in the adult the primary
metamerism is clearly indicated in the arrangement of the
nerves and of parts of the axial skeleton, and careful study
frequently reveals indications of it in highly modified mus-
cles and blood-vessels

"Although the dermal mesenchyme is unsegmental in
character, yet the nerves which send branches to it are seg-
mental, and it might be expected that indications of this con-
dition would be retained by the cutaneous nerves, even in
the adult. A study of the cutaneous nerve-supply in the
adult realizes to a very considerable extent this expectation,
the areas supplied by the various nerves forming more or
less distinct zones and being, therefore, segmental. But a
considerable commingling of adjacent areas has also oc-
curred. Thus, while the distribution of the cutaneous
branches of the fourth thoracic nerve, as determined experi-
mentally in the monkey (Macacus), is distinctly zonal or
segmental, the nipple lying practically in the' middle line of

PRINCIPLES OF OSTEOPATHY

91

the zone; the upper half of its area is also supplied or over-
lapped by fibers of the third nerve and the lower half by
fibers of the fifth, Fig. 14, so that any area of skin in the
zone is innervated by fibers coming from at least two seg-

m Dorsol

YDorsol

3S"Dorsol

FIG. 14. Showing overlapping of segmental sensory nerves Drawn by
John Comstock (after Sherrington).

mental nerves (Sherrington). And furthermore, the dis-
tribution of each nerve crosses the mid-ventral line of the
body, forming a more or less extensive crossed overlap.

"And not only is there a confusion of adjacent areas,
but an area may shift its position relatively to the deeper
structures supplied by the same nerve, so that the skin over
a certain muscle is not necessarily supplied by fibers from
the nerve which supplies the muscle. Thus, in the lower
half of the abdomen, the skin at any point will be supplied
by fibers from higher nerves than those supplying the un-
derlying muscles (Sherrington), and the skin of the limbs
may receive twigs from nerves which are not represented at
all in the muscle-supply (second and third thoracic and third
sacral)."

Widespread Influence of a Spinal Lesion. — No skin
area (or individual muscle) is supplied wholly by fibers from
one segment of the spinal cord, but, in fact, is innervated by
a nerve made up of fibers from two or more segments. A

92 PRINCIPLES OF OSTEOPATHY

spinal lesion of traumatic origin, granting that only one ar-
ticulation is involved, will influence, in some cases, widely
separated structures. For example: A lesion between the
fourth and fifth cervical vertebrae might influence the dia-
phragm, latissimus dorsi and trapezius, and through the
spinal accessory the muscles of the larynx. Such apparent-
ly widely separated structures must be kept in mind when
considering a lesion at the location under discussion. Xor
is this enough, because skin areas must be reckoned with.

To learn these tissue associations, through the study
of anatomy, is quite possible, but embryology furnishes an
interpretation which tends to keep them in one's mind.
When we know that the diaphragm^ trapezius and latissimus
dorsi are essentially cervical muscles which have migrated
but remain under the control of cervical nerves, we cease to
think of one as the dividing wall between thorax and abdo-
men, a great muscle of respiration; the others as constitut-
ing the first layer of dorsal muscles.

Association of Muscles Innervated by the Same Seg-
ment.— Such structures, as we have just mentioned, have
migrated far from their original segments and have taken
on functions and are concerned in reactions which are no
longer segmental but have for their aim the preservation of
the whole body, hence any injury to one, or all, of them
would tend to produce a reflex localized in the segment from
which they received their innervation. Compare with these
migrated structures a segmental muscle of primitive charac-
ter like the intertransversalis or interspinalis. The influence
of these primitive muscles is wholly on the one articulation,
but they are part of the mechanism supplied from the same
segment as the migrated muscles. These small muscles,
which are the intrinsic muscles of the spinal arthrodial
joints, are important prime movers in the effort to maintain
the erect position, i. e., they enter into the weight carrying
and balancing functions of the spinal column. In case of
their injury, a spinal lesion, the lost motion in the joint
causes widespread influences, as heretofore mentioned. The

PRINCIPLES OF OSTEOPATHY 93

fifth layer of dorsal muscles, according to Gray, consists of
a network of small muscles, the deepest of which extend
between portions of two adjoining vertebrae; more super-
ficially placed layers extend greater distances so as to influ-
ence the movements between more than two vertebrae. The
next layer of muscles, consisting of the erector spinae and its
continuations, influence a greater number of vertebrae and
bring rib positions under the influence of cervical nerves.
The splenius capitis et colli, of the third layer, and the rhom-
boids, of the second layer, are likewise supplied by cervical
nerves. Thus we find the nerve which takes its exit between
the fifth and sixth cervical vertebrae supplies a series of over-
lapping muscles, the first one supplied, intertransversalis,
being wholly intrinsic to the spine and the one on the sur-
face of the body, the latissimus dorsi, having a very wide-
spread influence.

Effect of Sectioning Single Spinal Nerve. — To cut the
fifth cervical nerve at its exit from the intervertebral fora-
men would not paralyze any but the intrinsic spinal muscles
between the fifth and sixth cervical vertebrae. All muscles
beyond that point would be weakened in proportion to the
number of fibers their governing nerves received from that
cut trunk. In other words, it appears probable that the sev-
ering of the pair of nerves, the fifth cervical, could weaken
the gross movements made by muscles innervated by them,
but since only the intrinsic spinal muscles of one interverte-
bral articulation are wholly supplied by them there would
be no complete muscular paralysis apparent. The sixth cer-
vical nerves innervate about twenty-eight pairs of muscles
in the neck, chest, shoulders and upper extremities and back,
and the diaphragm.

Developmental Changes in Muscles. — This gives us
some idea of the great changes that have been consummated
in the development of the body. The many changes in posi-
tion and direction of fibers are recognized through the fact
that they remain under the nerve control of the one seg-
ment. The various changes in the development of muscles

94 PRINCIPLES OF OSTEOPATHY

are thus described by McMurrich : "It may be seen that the
changes which occur in the myotomes may be referred to
one or more of the following processes :

"1. A longitudinal splitting into two or more portions,
a process well illustrated by the trapezius and sternomas-
toid, which have differentiated by the longitudinal splitting
of a single sheet and contain, therefore, portions of the same
myotomes. The sterno-hyoid has also differentiated by the
same process, and indeed, it is of frequent occurrence.

"2. A tangential splitting into two or more layers.
Examples of this are also abundant and are afforded by the
muscles of the fourth, fifth and sixth layers of the back, as
recognized in English textbooks of anatomy, by the two
oblique and transverse layers of the abdominal walls, and
by the intercostal muscles and the transversus of the thorax.

"3. A fusion of portions of successive myotomes to
form a single muscle, again a process of frequent occur-
rence, and well illustrated by the rectus abdominis (which
is formed by the fusion of the ventral portions of the last six
or seven thoracic myotomes) and by the superficial portions
of the erector spinae.

"4. A migration of parts of one or more myotomes over
others. An example of this process is to be found in the
latissimis dorsi whose history has already been referred to,
and it is also beautifully shown by the serratus anterior and
the trapezius, both of which have extended far beyond the
limits of the segments from which they are derived.

"5. A degeneration of portions or the whole of a myo-
tome. This process has played a very considerable part in
the evolution of the muscular system in the vertebrates.
When a muscle normally degenerates, it becomes converted
into connective tissue, and many of the strong aponeurotic
sheets which occur in the body owe their origin to this pro-
cess. Thus, for example, the aponeurosis, connecting the
occipital and frontal portions of the occipito-frontalis is due
to this process and is muscular in such forms as the lower
monkeys, and a good example is also to be found in the apo-

PRINCIPLES OF OSTEPOATHY 95

neurosis which occupies the interval between the superior
and inferior serrati postici, these two muscles being contin-
uous in lower forms. The strong lumbar aponeurosis of the
oblique and transverse muscles of the abdomen are also good
examples.

"Indeed, in comparing one of the mammals with a mem-
ber of one of the lower classes of vertebrates, the greater
amount of connective tissue compared with the amount of
muscular tissue in the former is very striking, the inference
being that these connective-tissue structures (fasciae, apo-
neurosis, ligaments) represent portions of the muscular tis-
sue of the lower form (Bardeleben). Many of the accessory
ligaments occurring in connection with diarthrodial joints,
apparently owe their origin to a degeneration of muscle tis-
sue, the fibular lateral ligament of the knee joint, for in-
stance, being probably a degenerated portion of the per-
oneous longus, while the sacro-tuburous ligament appears
to stand in a similar relation to the long head of the biceps
femoris (Sutton).

"Finally, there may be associated with any of the first
four processes a change in the direction of the muscle-fibers.
The original antero-posterior direction of the fibers is re-
tained in comparatively few of the adult muscles and excel-
lent examples of the process here referred to are to be found
in the intercostal muscles, and the muscles of the abdominal
walls. In the musculature associated with the branchial
arches the alteration in the direction of the fibers occurs
even in the fishes, in which the original direction of the
muscle-fibers is very perfectly retained in other myotomes,
the branchial muscles, however, being arranged parallel
with the branchial cartilages or even passing dorso-ven-
trally between the upper and lower portions of an arch, and
so forming what may be regarded as a constrictor of the
arch. This alteration of direction dates back so far that
the constrictor arrangement may well be taken as the pri-
mary conditions in studying the changes which the branchial
musculature has undergone in the mammalia."

96 PRINCIPLES OF OSTEOPATHY

Please note that, "since the relation between a nerve
and the myotome belonging to the same is established at a
very early period of development and persists throughout
life, no matter what changes of fusion, splitting or migra-
tion the myotome may undergo, it is possible to trace out
more or less completely the history of the various myotomes
by determining their segmental innervation." In view of this
the clinician ought to be well versed in the knowledge of an-
atomy, i. e., the gross structures innervated from the same
segment of the cord. Much of the physical diagnostic work
of the osteopath is based on the fundamental facts of em-
bryology and anatomy, i. e., metamerism.

PRINCIPLES OF OSTEOPATHY 97

CHAPTER VI.

THE NERVOUS SYSTEM.

The Medium of Communication. — A masterful knowl-
edge of nerve tissue and its arrangement in the body to form
the nervous system is an absolute prerequisite for success
in osteopathic practice. Every vital phenomenon calls for
interpretation by the skillful physician. Interpretation can-
not be attempted without a definite knowledge of structure
and function of that tissue which acts as a medium of com-
munication between all other elements of the body.

The name of our system, Osteopathy, calls attention
primarily to osseous structure, but it is only in connection
with its effects on the tissues of communication and ex-
change, vital phenomena, we are actually interested.

The Attributes of Nerve Tissue. — All physiological
phenomena are characterized by the manifestation of at-
tributes of nerve tissue, irritability, conductivity and tro-
phicity. Motion, sensation and nutrition are the vital phe-
nomena whose perversion constitutes disease. Therefore,
whatever the pathological condition may be, we are called
upon to note a change in some one or all of these attributes
of nerve tissue.

Nerve and Muscle Irritability. — Scarcely any thought
of muscle is ever complete without the nerve impulse which
controls the muscle is also considered. For convenience sake
we may separate nerve and muscle when teaching their spe-
cial attributes, but for all practical purposes they are never
separated. Muscle and nerve are both irritable, but we pay
no attention to the irritability of muscle because under nor-
mal conditions we do not see any evidences of specific mus-

98 PRINCIPLES OF OSTEOPATHY

cular irritability. We view muscular irritability as the re-
sult of nerve irritability. Therefore nerve tissue is the chief
irritable tissue. Irritability is an attribute of cell proto-
plasm whereby chemical and physical phenomena are en-
acted in response to irritants. Irritants may be mechanical,
chemical, thermal and electrical. Practically all that physi-
ologists know of the reactions of nerve tissue to irritants has
been derived through experimentation by means of the elec-
trical current. Osteopathists are bringing to light many
facts concerning mechanical stimulation. Hydrotherapists
have demonstrated the utility of thermal stimuli. Drug
therapy makes use of the chemical form of stimulation.

Conductivity. — Nerve tissue is not only irritable but
possesses the ability to transmit its irritability to other tis-
sues and cause certain activities to be initiated there. Con-
ductivity, the second vital attribute of nerve tissue, is the
power to carry impulses from the point of irritation to other
points in the nervous system. Irritability would be of small
moment if conductivity were not present to transmit the
message to the center and arouse response. The nerve cell
and its axis-cylinder are a continuous mass of protoplasm
and as long as the continuity is maintained conductivity will
be maintained.

Trophicity. — The third attribute of nerve tissue, tro-
phicity, is very imperfectly understood. We do not use this
term here to represent so much the nutritional influences of
the cell-body over its axis-cylinder as the influence exerted
by nerve tissue over other body tissues, causing them to
grow and prosper. This nutritional influence over other
tissues is an attribute which we are compelled to note quite
frequently in practice. There are individuals in whom motion
and sensation are normal but nutrition fails, hence we note
that in some cases mechanical lesions may cause only a
slight change in the nerve tissue upon which they impinge,
and this change is manifested by variation in nutrition of
the part controlled by the irritated nerve. It is probably
this attribute of nerve tissue which is perverted or lost when

PRINCIPLES OF OSTEOPATHY 99

the tissues refuse to take up certain chemical elements which
are ordinarily normal to them ; for example, iron. In osteo-
pathic practice we consider nutritional, disorders as being
the result of perverted trophic influence of nerves. Of course
in cases where it is known that the ingested food does not
contain the required element or elements we must regulate
the diet. But there are many cases where all conditions ap-
pear normal, except that the tissues do not take up nourish-
ment as they should. In these cases we search for lesions
in the same way we would if motion or sensation showed
perversion or loss. This phase of our subject can best be
considered at another time.

Unity of the Nervous System. — The unity of the nervous
system is a physiological fact, and this brings deep and
superficial areas in close relation. Every portion of the body
is able through the medium of the nervous system to work
in harmony with every other part. Physiologists divide the
nervous system into central and peripheral portions, but
for practical purposes this division is of little use to us when
attempting to make use of the irritability and conductivity
of the nervous system for therapeutic purposes. Since all
portions of the nervous system are connected there must be
some place where impressions made upon terminal nerve
filaments may be assembled, co-ordinated and responded to
harmoniously. Wherever large numbers of nerve cells are
assembled we expect to find such duties performed.

Other Systems of Integration. — Any influence which we
have upon the body through therapeutic methods must be
based on the unity of the body. That the body is a unit
must be constantly borne in mind, not only a unit because
of the nervous system but also a mechanical unit, formed by
its fibrous tissues and a chemical unit through its circulating
media. The nervous system is so preeminently the master
tissue that, when we think of any integrative reaction, we
attribute it to this tissue, which not only takes note of im-
pressions secured by contact but reaches out into surround-
ing space and causes the body to react to things at a distance.

100 PRINCIPLES OF OSTEOPATHY

Mechanical Irritation. — The particular therapeutic pro-
cedures with which we are here dealing are aimed to affect
by contact and hence we are most interested in those re-
flexes originating through stimuli applied to skin, visceral
and somatic tissues. Structural displacements in the human
body act as mechanical irritants to nerve tissue, changing
the chemical and physical condition of the protoplasm and
thus altering its irritability, either plus or minus according
to the intensity of the stimulation. The displaced structures
may have other detrimental influences on nerve tissue, for
instance the pressure brought to bear on the nourishing
liquids surrounding the nerve, i. e., the blood and lymph,
may cause sufficient chemical change in these liquids to
materially affect irritability of the protoplasm of the nerves
which they are expected to nourish.

Effect on Conductivity. — Conductivity is not destroyed
by these slight mechanical pressures. If the protoplasm of
the cell and axis-cylinder were unable to conduct impulses
and project them in such manner as to reach other cell
bodies of the nervous system our work would be very lim-
ited. Conductivity depends on the continuity of protoplasm.
The mechanical irritations we deal with in osteopathic prac-
tice seldom destroy conductivity. If they did so they would
cease to become irritants the moment conductivity was lost.
Other irritants may act for a time on the severed portions of
protoplasm, but the original lesion* would have destroyed
the continuity of the protoplasm.

Afferent and Efferent Fibers. — The fibers composing a
nerve bundle may be efferent or afferent so far as direction
of impulse is concerned. Efferent fibers may be further dif-
ferentiated by the names, motor, vaso-motor, secretory, ac-
cording to the structures in which they end. Afferent fibers
are usually termed sensory to denote their function of carry-
ing impulses to the central nervous system. Nerve trunks
contain all of these various fibers, therefore, pressure will
irritate all of the fibers and conductivity of individual fibers
.will transmit the impulses in the direction of the normal

-I »-. I, I- I- , (J (-

CGU.EG-E GF OS

PRINCIPLES OF OSTEOPATHY 101

nerve impulse, thus causing contraction in the voluntary or
involuntary muscles or activity of secretory tissues; sensory
impulses will be transmitted to the central nervous system
and will purport to come from the terminal distribution of
the sensory nerve. If the afferent impulse is such a one as
will reach the patient's consciousness, we find that the cen-
tral cells are misled as to the location of the stimulus and
hence manifest a response in the supposed area. It is not
necessary for the patient to be conscious of any irritation in
order to bring about this result.

Organization of the Nerve Bundle. — The organization
of the nerve bundle complicates our ideas of irritability and
conductivity in the protoplasm of the cell and axis-cylinder
of a nervous unit. Complexity of action and reaction in-
creases as we near the central nervous system. We have
considered that all impulses generated in the protoplasm of
a nerve cell and axis-cylinder have been transmitted to all
parts of that unit of nerve tissue, but have not in any way
influenced any other unit. We have not considered the rela-
tions of cell bodies in the central system. It is sufficient for
our present purpose to note that the afferent fibers enter the
spinal cord as the posterior roots and that their cells are in
the ganglia of these posterior roots.

Intraspinal Fibers. — The efferent fibers leave the cord
as its anterior roots and their bodies are located in the an-
terior cornua of the gray matter of the cord. Upon careful
study of the spinal cord there are found other cells and axis-
cylinders which do not leave the cord but serve to connect
the afferent and efferent elements and distribute impulses
within the cord. These latter are found in enormous num-
bers in all portions of the central nervous system.

Segmentation of the Spinal Cord. — The first fact of
great interest to us, osteopathically, is the segmentation of
the spinal cord. This is only relative in character, but yet
is apparent, not only histologically but pathologically. We
note that according to distribution of afferent fibers in the

T/V}Q3T20 3

102

303JJ0

1 •"»

PRINCIPLES OF OSTEOPATHY

- N.to rcctus lateral;!

— .M . „ antic, minor.
.-— Anastomosis uii' '

-Anastomosis uwth pneumogastnc.
-N. to rectus antic. major.
— N. to mastoid region

Qreat auricular N.

-Transvene cervical N.

r---H. to trapezius, Ang. scop, and
Ehomboki
-.-Supra clavicular N.

Supra acroimai H.

-Phrentc
r-N.to tevatgr ana. scop.

ti.io rnomboias

— Subicapular N.

•aubclavvcular N.
N.to pectoralis major.

-Circiunfle* N.

MusaUo cuwuvtl
Median. W.
•Radial N.

-Dinar N.
•Internal cutaneous N.
internal cutaneous N.

Ilio-hypogastrtc N.
-— Uto-vnguvnal N.

Ext. cutaneous N.

-Qenito-crural N.

Anterior crural (kmora^N.
Obturator N.

•'Superior gluteal N.

•N.to pyriforrms .
N to gemellui superior

M to gemeilui inferior.

\ 14 t.0 Quadratui

Small sciatic N

3ciatvc.N

FIG. 15. Diagram of spinal segmentation, showing relation between the
points of origin of the spinal nerves and their points of emergence
from the spinal column; also their distribution to the muscles.
Drawn by John Comstock (after Dejerine et Thomas, modified by
Starr).

PRINCIPLES OF OSTEOPATHY

103

spinal cord impulses are diffused both above and below the
point of entrance. The cell bodies of the anterior roots are
also somewhat diffused, but in practice we note that afferent
and efferent impulses seem to be correlated within compara-
tively narrow limits in the spinal cord. How the impulses
set up in the protoplasm of an afferent fiber are transmitted
from it to the protoplasm of other cells located in the spinal
cord and thence transmitted to the protoplasm of efferent
cells is not known, nor is it necessary for us to thoroughly
understand the method in this instance so long as we recog-

Pifeterior
root

FIG. 16. Diagram showing two segments of the spinal cord.

nize the results. Our specific knowledge must comprehend
the exact point of entrance to and exit from the spinal cord
of each nerve bundle and the peripheral distribution of the
same. Having a knowledge of the structure, the function
comes naturally as a result.

Segmental Integration. — A segment of the spinal cord,
i. e., that portion giving rise to a pair of spinal nerves may
be conceived to act independently of other segments. Of
course it would be difficult to demonstrate this, but for pur-
poses of analysis we may be permitted to segregate the
various divisions and nervous elements so as to better un-
derstand the structures with which we are dealing. The

104

PRINCIPLES OF OSTEOPATHY

central nervous system is constantly receiving impulses
from afferent fibers and co-ordinating them. We are almost
entirely dependent on reflex action for the effects we secure
on deep tissues. Our manipulations affect sensory nerves in

Muscle

PIG. 17. Diagrammatic representation of a single spinal segment and a
simple reflex arc. Drawn by John Comstock.

skin, muscle and synovial membranes. These impulses are
carried to the central nervous system and transformed into
efferent impulses.

Ceaseless Play of Reflexes. — During life there is no
period when the body is not dependent on external stimuli.
These ordinary mechanical and thermal stimuli keep a con-
stant stream of impulses entering the central system to be
translated into stimuli of muscle and gland. This ceaseless

PRINCIPLES OF OSTEOPATHY 105

play of reflexes may vary in intensity, but so long as life
lasts they are demonstrable. We expect the reflex to be
initiated by the sensory side of the reflex arc, therefore the
intensity of muscular contraction and glandular secretion is
governed by the intensity of the initiatory impulse.

The Simple Reflex. — The simplest reaction in the ner-
vous system may be conceived as a sensory impulse trans-
mitted to the spinal cord over a sensory nerve and from the
cord over a motor nerve. The tissue in which the motor or
efferent nerve ends will express reaction to the stimuli com-
ing over the sensory or afferent side of this reflex arc.

The Sensory Side of the Reflex Arc. — The sensory side
of the reflex arc is the one upon which we must depend to
initiate reactions. The segment coordinates the sensory im-
pulses reaching it over the afferent roots of its nerve trunks.
By following the distribution of its nerves we can determine
what cells its afferent fibers arise in and what cells its effer-
ent fibers innervate. Taking a mid-dorsal segment we find
its pair of nerve trunks dividing and branching so as to sup-
ply skin, muscle and viscera. All of these parts must have
sensory and motor fibers and since our spinal nerves are
mixed nerves, i. e., have afferent and efferent fibers, we know
that a segment receives sensory impulses from skin, muscle
and viscera and the segment integrates these impulses and
sends out efferent impulses coordinated for the best good of
itself and the tissues it innervates.

Protective Reactions. — A reflex is primarily a protec-
tive reaction. It is an effort on the part of the structures
entering into the reaction to protect that of which they are
a part. It seems that the sole object of a reflex is self de-
fense. Therefore a study of reflexes will tend to make symp-
tomatology far more interesting. The integration expressed
in the reactions of a spinal segment mirror the manifold re-
lations existing between the cells which constitute the ac-
tive elements in a metamere or body segment. The seg-
mental structure of the cord and the reflex action manifested
therein show that, on the whole, a definite muscle group and

106 PRINCIPLES OF OSTEOPATHY

a definite cutaneous area are innervated from a limited por-
tion of the central system. Therefore we may count on the
stimuli originated in the cutaneous area being reflexed to
the definite muscular area.

Example. — An example in practice is as follows : Pa-
tient's head is drawn slightly to the left side. Complains of
pain shooting to the left shoulder and over the left clavicle
whenever movement is attempted. History of exposure to
draught of cold air. Physical examination discloses con-
traction of left trapezius, levator anguli scapulae and sca-
leni. Pressure upon these muscles causes pain. When in-
structed to take a full inspiration, patient says he cannot on
account of pain, which is sharp and darting in character and
radiates over the intraclavicular portion of the left chest.
When we consider the muscles involved and the area of
painful sensations, our attention is immediately called to a
definite segment of the cord, in this case the point of origin
of the third and fourth cervical nerves. The cold air striking
the skin intensified the normal stimuli and the efferent im-
pulses from that segment of the cord were intensified as the
direct result of the cutaneous irritation. The point of irrita-
tion, the cutaneous area, governed the location of the reflex.
So long as the original stimulus was only moderately inten-
sified all the reflexes emanated from one segment of the cord,
but if they had been more intense or continued longer, we
might have found a greater area reflexly affected. The stim-
uli which would have reached the cord would have been
more widely diffused above and below the point of entrance.

Comparative Segmentation. — Since we know that the
highly organized spinal cord of man is not to be compared
with the same structure in lower forms of animal life and
that segmentation in it is illy defined, the practical question
arises as to how much dependence we can put upon reflexes
in the human nervous system. Will the reflexes guide us to
definite segments of the spinal cord? Experience teaches us
that a thorough knowledge of the distribution of afferent
and efferent nerves in man will interpret reflexes with suffi-

PRINCIPLES OF OSTEOPATHY 107

cient exactness and invariably lead the investigator to a
spinal segment which is itself affected or is coordinating im-
pulses from a known sensory area.

Efferent Impulses. — When we follow the efferent im-
pulses to their points of distribution our work is greatly
complicated. To reason from contracted voluntary muscle
to cutaneous sensory area is a comparatively simple pro-
cedure, but to start with the sensory impulse and trace it
through the central system and thence along efferent path-
ways, to estimate its final effects, as mechanical work done
by muscle and gland in many combinations, requires a con-
siderable knowledge of structure and function of all parts of
the human system.

Efferent Fibers to the Sympathetic Ganglia. — Many of
the efferent fibers of the cerebro-spinal system take their
course through the sympathetic ganglia and are distributed
in that system to plain muscle and secretory cells of the
body. It has been ascertained by various careful observers
that these efferent fibers, after entering the sympathetic
system, either end in the ganglia nearest their point of emer-
gence from the cord or pass up or down to ganglia above or
below the one originally entered. Some fibers pass through
these ganglia and end in the more peripherally placed
plexuses.

Ganglionic Control. — Wherever nerve cells are accumu-
lated a certain amount of independent action is probably
carried on. Terminal filaments of efferent fibers in sympa-
thetic spinal ganglia are in relation with a large number of
cells and the number of fibers leaving the ganglia is greater
than those entering. Therefore diffusion of impulses from
these ganglia must be very great. The accumulation of
sensory impulses in these ganglia may be equally as great.
Each ganglion must have a dominant influence over a cer-
tain visceral area, and this influence is subsidiary to the
control exercised by the segment of spinal cord to and from
which the larger number of fibers proceed.

108

PRINCIPLES OF OSTEOPATHY

Gland

MU5d€.

Vessel

PIG. 18. Diagram of sensory and motor fields co-ordinated in a spinal
segment; and the inhibitory influence of the brain.

PRINCIPLES OF OSTEOPATHY 109

Three Fields for Reception of Sensory Impressions. —

The three original layers of the embryo, epiblast, endoblast
and mesoblast, forming skin, mucous membrane and the
intervening tissues, are represented by sensory fibers which
connect them with the central nervous system. The outer
surface of the body is supplied with extero-ceptive, the in-
ternal surface with intero-ceptive and the intercellular sur-
faces with proprio-ceptive fibers. The coordination of these
various receptive fields is the duty of the segment. We have
reactions in this segment which represent the effort of the
segment to adapt itself to external conditions. The external
surface registers in the segment the conditions of the out-
side world, so far as the special endings of its sensory nerves
are capable. The internal surface takes cognizance of the
presence of material in contact with it which in most cases
may serve as food. Not all spinal segments have this vis-
ceral division represented in them.

Proprio-ceptive Field. — The surface of the individual
cells, which compose the bulk of the body, are represented
in the segment by a large number of sensory fibers which
register their conditions and needs. This proprio-ceptive
field is an exceedingly large one and is usually little thought
of when considering the reactions of the nervous system.
It is the proprio-ceptive nerves which are affected in any
trauma of joints or other deep structures. The sense of po-
sition, muscular tension and weight are to a large extent de-
pendent on these fibers.

Segmental Coordination. — The segment of the spina!
cord governing a metamere receives sensory stimuli from
three different receptor fields, the external and internal sur-
faces and the bulk of the tissue between these surfaces. The
harmonious functioning of the whole segment is the result
of the coordination of all the impulses from these three re-
ceptor fields, expressed in effector tissues, muscle and gland.
These reactions represent the segment's effort to meet the
conditions of its environment, plus its own inter-cellular

110 PRINCIPLES OF OSTEOPATHY

condition, to the best advantage. In other words, its reac-
tions represent its effort to maintain its existence.

Plurisegmental Control. — Just as no skin area, or mus-
cle, other than a distinctly segmental one. as mentioned in
Chapter V, no viscus is wholly under the influence of one
segment. Therefore one segment is merely a contributor of
a partial influence over skin, muscle and internal organ. One
segment may furnish the majority of fibers to a certain per-
ipheral nerve, but complete control is divided between two
or more segments. This seems to indicate that physiologi-
cal centers in the spinal cord consist of series of cells, placed
vertically, whose fibers thus emerge at various levels. With
this fact in view we recognize that any reaction to stimuli,
arising in any one of the three receptor fields, will be ex-
pressed in effector tissues belonging to at least two or more
metameres. Therefore any protective reaction in spinal
areas will involve more than one spinal articulation.

Clinical Evidence, Group Lesions. — This agrees with
the clinical findings. Take spinal tenderness for example :
A point is usually found which shows considerable tender-
ness and this tenderness shades off through a metamere
above and below the most sensitive point. Contraction of a
spinal muscle, i. e., of a portion of the erector spinae, extends
over two or more metameres. Osseous lesions are usually
of the group character. The approximation or separation of
two spinous processes represents the involvement of at least
four vertebrae, i. e., one above and one below the center of
the lesion. Likewise, the lateral deviation of a spinous pro-
cess means the involvement of three vertebrae. Thus we see
that all reactions are practically pluri-segmental instead of
segmental. The vertical arrangement of the governing cells
in the spinal cord is the foundation for this. Just as we
noted the migration of muscles for purposes of better guard-
ing of the body, so also we note that segments have divided
their influence with adjoining ones.

Differentiation of Spinal Lesions. — In view of these
facts it is hard, in fact impossible, to differentiate spinal le-

PRINCIPLES OF OSTEOPATHY

111

i.e.

MOTOR

Stevno-mastoid

3 ^ Trapezium

4 } Diaphragm

5 \5erratu5]

J '5houVder

Arm

Hand .
(Ulnar loiueit)

Intercostal
muscles

Abdominal
tnusciu

$ 1 \ Fkxon> , Hvp.

3 E>*

J J jAdductow(z) hip

y I [Adductors.

^-•^on.Knce.
>Muids> of U<
moving foot

) Pcrineal
^nnd anal
I muiclej

3EN30BY

| Neck and scalp
> NecK and shoulder

Shoulder

Arm-

Hand

Front of thorax.
I Xiphoid area

• Abdomen
(Umbilicus, 10 th)

[Buttock,
I upper part

l(3roin and scrotum
(front)
'outer side

Thigh-

front
vnncr side

Leg, inner side
Buttock.
loujer part

Back of IhigH

L«9l except
and-f inner part
footj

jPmnccum and
anus

•5km from coccyx
to anus

REFLEX

Scapular

^Epigastric

. Abdominal

Cretnaaterc

>Kn£t joint

uluteul

Foot v.tonu.-
r"l<mtQt

FIG. 19. Diagram and table showing the approximate relation to the
spinal nerves of the various motor, sensory and reflex functions of
the spinal cord. (Cowers.)

112 PRINCIPLES OF OSTEOPATHY

sions as primary or secondary, i. e., traumatic or reflex,
based on palpation of the tissues. The characteristics are
quite similar because the protective reactions of the body,
whether in response to stimuli from the extero-, intero-, or
proprio-ceptive fields, will be manifested in the effector tis-
sues, muscle and gland, of the pluri-segments belonging to
the receptor fields receiving the stimuli. For example : Irri-
tation of the skin of the back supplied by nerves from the
segments of the cord which have rami-communicantes con-
necting with the renal splanchnics, may produce reactions in
all the tissues governed by that pluri-segmental center. A
stream of cold air blown on this skin wh«n it is wet would
produce a pronounced reaction. Likewise, a counter-irritant
would produce a reaction. In the case of the reaction to cold
the muscles under this skin area would contract. There
would be lost motion in the vertebral articulations of these
metameres due to the hypertension of the muscles. Sensi-
tiveness to pressure and a feeling of lameness would de-
velop. The probabilities are that the kidneys would show
marked change in function. We have kept our reactions
thus far in the metameres whose cutaneous surfaces are af-
fected, but, clinically, we know such a condition as this is
serious and hence the whole fighting power of the body is
called upon to protect it from this high tension in a series
of important metameres.

Lesions Due to Functional Fatigue. — Let us reverse the
picture and start with a functional disturbance of the kid-
neys due to too great demands on them in eliminating nitrog-
enous waste material. This functional fatigue might pro-
duce muscular contraction, pain or tenderness in the spinal
areas associated by innervation, i. e., the pluri-segmental
areas, and thus duplicate all the phenomena mentioned in
our previous description. The field of proprio-ceptive im-
pressions, that is the structural tissues in this particular
pluri-segmental field, may likewise be the point at which all
these reactions are initiated. Injury, or functional fatigue,
as is seen in street car men whose backs suffer from the con-

PRINCIPLES OF OSTEOPATHY 113

stant vibration of the cars, will set up reactions which, so
far as palpation is concerned, show physical signs similar to
the two preceding. After noting the physical signs, of a
pluri-segmental character, it is evidently necessary to go
much farther into symptomatology in order to differentiate
the primary from the secondary lesion. Since the body func-
tions as a whole no limited pluri-segmental reactions con-
tinue without other portions of the body enter the contest
for the preservation of the whole. In the example just given
the contraction of somatic muscles, tension in skin and kid-
ney consequent on the influence of the cold air, is a condition
prejudicial to the life of the body because elimination is
greatly decreased and hence, unless compensatory elimina-
tion can be established, autointoxication of a fatal type will
supervene. We may conceive of an elimination center in
the nervous system represented by a column of cells extend-
ing throughout the cord, controlling in all metameres the
sweat function of the skin and in those metameres asso-
ciated with the bowels and kidneys, the special functions of
these organs. We know all these means of elimination are
coordinated and, in case of need, strongly compensatory.
The bowels must be urged to compensate for the failure of
skin and kidney elimination. Elimination may fail so quick-
ly and completely that the consequent autointoxication and
high arterial tension strain the heart. A new group lesion
representing this organ becomes apparent, and, to the phy-
sician who studies the case for the first time, at this stage
offers difficulties of analysis almost insurmountable. The
spinal lesions mirror the compensatory reactions of the
body. They are guides to an understanding of the symp-
tom complex presented in any case of disease and if studied
coordinately with the symptoms often lead the mind of
the physician logically to the origin of the disease reactions.

114 PRINCIPLES OF OSTEOPATHY

CHAPTER VII.

THE NERVOUS SYSTEM (Continued).

Alignment, Tone, Reflexes. — Osteopaths have, to some
extent, discarded subjective symptoms, believing that they
are of very doubtful value in the large proportion of patients.
Having discarded subjective symptoms, they have developed
a method which gives equal or better results. It has three
phases, two of which are structural and one which is partial-
ly subjective. First in order comes skeletal alignment; sec-
ond, muscular tone; third, condition of reflexes. These
three divisions all come under the general head of palpation.

Clinical Illustration. — As an illustration of the value of
objective in preference to subjective symptoms, the follow-
ing case is of considerable value. The gentleman whose
physical condition is practically illustrated in Figs. 20 and 21
was examined in the clinic of the Pacific College of Osteo-
pathy. He has been operated on surgically for a peculiar
enlargement just above and external to the right knee . The
line of the incision is shown in Fig. 20. He stated that he
had suffered pain at this point during more than a year, and
his physician had decided that there was a tuberculous con-
dition of the bone. The operation did not confirm this diag-
nosis. No unhealthy tissue was found.

Inspection. — We noted his peculiar handling of the leg
when walking, compared both limbs from toe to hip and
discovered a marked difference in size, as is indicated in the
photograph. By following the course of the nerves to the
spinal column, we discovered that the muscles on the right
side of the spine were atrophied in proportion to those of
the extremity. Fig. 21 shows the fact that the atrophied

PRINCIPLES OF OSTEOPATHY

FIG. 20. Case illustrating atrophy of the muscles of the right
leg due to faulty trophic influence of the nerve cells in the
spinal cord. The scar, just above the right patella, is su-
perficial to a hypertrophic condition of the bone.

116

PRINCIPLES OF OSTEOPATHY

FIG. 21. General view of case illustrated in the
preceding figure. The spinal curvature is
clearly indicated. Patellar tendon reflex ab-
sent on right side but present on the left.

PRINCIPLES OF OSTEOPATHY 117

condition extends into the interscapular region, and the
spinal column is bent.

Patellar Tendon Reflex. — The patellar tendon reflex was
lost on the right side, but present on the left. The right leg
was ataxic, .but the left leg was normal, thus presenting
what might be called a unilateral locomotor ataxia. If this
man's surgeon had taken the care to examine him from an
objective structural standpoint rather than to depend on the
subjective symptoms, it is highly probable that no opera-
tion would have been performed. Our examination demon-
strated that this man's structural condition was at fault and
that the trophic influence of a part of his nervous system
was being gradually lost. Both the motor and sensory
nerves were acting feebly.

Gastric-spinal Reflex. — It might be asked, "How could
one secure a spinal reflex from the stomach?" In what way
would the finding of such a reflex surpass ordinary methods
of examination? The neurologist, when making examina-
tion of a patient suffering with some condition of the sen-
sory or motor portion of the nervous system, must possess
a definite knowledge of the origin, course and distribution of
nerve trunks in order to locate accurately the position of the
lesion. The osteopath pursues the same method of exam-
ination, but follows it farther. His investigation takes into
consideration the dispersion of efferent fibers in the sympa-
thetic system and the sensory impulses received by the
spinal cord from that system.

Sensation. — Edinger quotes Exner as follows : "One
must not suppose that all the impulses reaching the spinal
cord by the sensory roots are identical with what is ordi-
narily called 'sensation.' In order that an impression be
perceived, it is not sufficient that it be conducted to the
spinal cord, but it must be farther carried up, from the place
where the peripheral part ends to the cerebral cortex. There
is, however, no doubt at all that all these higher connections
are few in number, and that contrasted with the multitude of
fibers in the posterior roots, the number of such cranial con-

118 PRINCIPLES OF OSTEOPATHY

nections is quite small. This alone makes the conclusion
possible that there are, indeed, many sensory impressions
which arrive at the spinal cord, but that we are aware of but
few of them at the time. All the viscera of the body, as the
staining method has distinctly shown, are traversed by an
altogether unexpectedly large number of nerves and their
arrangement and course, their relations to blood vessels and
glands, and to muscle fibers, bones and enamel, makes it
more than probable that there is, in this connection, a large
system which serves essentially to regulate impressions and
reflex action."

Visceral Sensation. — It is the reflexes mentioned in this
quotation in which we are interested. Sensation and per-
ception are dissimilar. Sensations from the viscera are co-
ordinated in fairly well marked areas of the spinal cord and
when these sensory impressions are intense the efferent-
fibers of the spinal cord manifest the condition existing in a
visceral area by causing an abnormal condition of muscular
tone in the intrinsic muscles of the back. This contractured
condition of the muscles is not the only evidence of the vis-
ceral reflex. Pressure on the contracted muscle causes pain.
The intensity of the aesthesia is usually in proportion to the
visceral irritation. Even though the patient does not say
in so many words that there is pain on slight pressure, the
examiner, if his palpation is good, can detect the reflex in the
action of the muscle.

Dependence on Objective Symptoms. — A patient comes
to an osteopath desiring to be examined. He does not vouch-
safe any information as to his condition, merely saying:
"I want you to examine me and find out what is the matter
with me." This is a challenge to the skill of the examiner
and calls for something besides a long-distance catechising
as to subjective feelings. The osteopath proceeds with ab-
solute precision to determine the condition of his patient's
structural formation — (1) skeletal alignment, (2) muscu-
lar tone, and (3) segmental spinal reflex. Each yields valu-
able information. The examiner's fingers may develop a re-

PRINCIPLES OF OSTEOPATHY 119

flex around the sixth dorsal spine. This is noted as a reflex
from the gastric area. Testing the segments above and be-
low, this will show how great a section of the cord is irri-
tated and will be an indication of the extent of the internal
irritation, i. e., whether other portions of the digestive tract
are affected. The reflex might extend as far as the fourth
dorsal and still indicate the gastric area. Finding the reflex
at the sixth dorsal spine has directed the attention of the
examiner to the gastric area and has located a point from
which further examination is to proceed. Percussion over
the stomach would reveal other facts, and then the examina-
tion would be pursued along general lines of physical diag-
nosis to determine the character of the gastric disorder. The
moment the examiner centers his examination on the stom-
ach, the confidence of the patient is assured. Is not this
confidence greatly to be desired in every case? Is it not a
force which compels the patient to follow the directions of
his physician in matters of diet and hygiene? In this exam-
ple we have illustrated the attributes of nerve tissue, (1)
irritability, (2) conductivity. Other conditions which make
this illustration possible are (1) muscular contraction in re-
sponse to nerve stimulation, (2) segmentation of the spinal
cord, (3) reflex action.

Depth and Extent of Lesions. — From the clinical stand-
point lesions may be classified somewhat according to depth
and extent; for example, the lesions which are due to trauma
of somatic tissues, involving one spinal articulation, would
be deep and as soon as the patient is placed in a position of
rest, the extent of the muscular contraction would greatly
decrease. This is not the case when the lesion is due to a
visceral irritation. The viscus has a pluri-segmental con-
nection with the nervous system and hence the contraction
of muscles in the spinal area is usually of greater extent.
The position of rest, i. e., reclining, does not usually cause
the muscles to relax. This shows that the contraction is not
a normal effort to maintain the upright position but a hyper-
tension due to visceral disturbance.

120 PRINCIPLES OF OSTEOPATHY

Lesion Picture in Autotoxemia. — As soon as we have an
autotoxemia to deal with our lesion picture is greatly en-
larged. This is well illustrated in the various manifestations
of indigestion. In such cases, not only lesions in the areas
segmentally associated, but also above and below, will be
found. Some cases will complain of the whole length of the
spine while the autointoxication is at its height. As the in-
tensity of the autointoxication decreases the lesion areas
become restricted to the physiologically associated spinal
areas. This is true in the infections as well. The backache
in tonsilitis, la grippe, smallpox, etc., are well known and
evidently not located in physiologically associated areas.
The phenomena of spinal hypertension and hyperaesthesia
are very prominent in these cases. Nothing seems to palliate
this spinal condition due to toxemia to the same extent as
manipulation. We say palliate because the toxemia which
causes the tension is not overcome by relieving the spinal
tension.

Lesions Independent of Segmental Reflexes. — As soon
as we find lesions that seem to have arisen independently of
what we can readily recognize as segmental reflexes, they
must be explained on the basis of some integration of the
body other than nervous. This is the case in the toxemias.
The circulating media are the integrating factors which ex-
plain the backache as well as many other aches in those
cases where there is no visceral involvement which may
reasonably be associated with them. Increasing elimination
will usually correct these spinal lesions due to toxemia.

The Lesion as an Expression of Some Form of Integra-
tion.— Any spinal lesion may be analyzed from several
standpoints, because it may be a partial expression of one or
more integrating factors of the body, i. e., the structural,
circulatory or nervous. The traumatic lesion shows itself
subject to position, i. e., can be rested and lessened by a
position which mechanically lessens the strain. The lesion
due to nervous integration is not so quickly relieved by the
means which relieve the traumatic lesion. The fact that it

PRINCIPLES OF OSTEOPATHY 121

is a reflex presupposes an adequate point of irritation else-
where. This point must be located before the lesion is ade-
quately relieved. This is well illustrated in the reflexes in
the mid-dorsal area due to fermenting food in the stomach.
Emptying the stomach relieves the lesion.

Circulatory Integration Lesion. — The lesion due to cir-
culatory integration is hard to recognize because one nat-
urally thinks of the other forms of integration and attempts
to square his findings with these forces. Then also the cir-
culatory integration is largely under the direct influence of
the nervous system. It is a good plan to analyze lesions first
on a basis of structural integration, then nervous and finally
circulatory. This evolutionary method of following a nat-
ural plan helps to keep ones mind working in a logical
manner.

Protective Reactions. — The protective reactions of the
body are not all segmental nor even within small groups of
segments. So long as they are purely segmental we are
reasonably certain that the condition is not constitutional
because a constitutional ailment involves the whole fighting
power of the body to such an extent that the clinician readily
recognizes the seriousness of the situation. Take for in-
stance the progressive involvement of lung tissue in tuber-
culosis. The early stages of the disease may show very lit-
tle or no constitutional symptoms such as chill, fever, sweat
and loss of flesh. At this time somewhere in the interscap-
ular area will appear a lesion, muscular contraction and
tenderness to digital pressure. This lesion is not distinctive
of pulmonary tuberculosis any more than of any other ir-
ritation in its associated visceral area. It merely indicates
the segment or segments involved in the circulatory dis-
turbance characterized by the congestion in the infected
area. As the pulmonary lesion envolves larger areas the
spinal lesion grows proportionately. This is probably true
except when the pleura is inflamed. Then we have a pro-
tective rigidity of a vastly more pronounced character.
As soon as effusion takes place the intensity of the rigidity

122 • PRINCIPLES OF OSTEOPATHY

lessens because pain is lessened. As soon as the tubercu-
lar process shows constitutional symptoms the spinal lesion
picture varies from morning to night, that is, fluctuates
with the varying intensity of the disease reactions. The
positive and negative phases of the body's reactions are
reflexly evidenced in the spinal areas. As the disease pro-
gresses and areas of pulmonary tissues are lost or fibrous
tissue formed, with consequent lessening in antero-pos-
terior diameter of the chest and decreased amplitude of
the respiratory movements, lesions of a structural char-
acter appear in the spinal area, such as flattening of the
dorsal curve and elevation of the angles of the ribs caused
by the rotation downward of the anterior extremities of
the ribs in the flattening of the chest. The change in the
chest causes a change in the tension of the scaleni muscles
in the neck and in case only one pulmonary apex is in-
volved there is unequal tension in the scaleni of the two
sides of the neck, thus causing the extensors of the neck
to exert a compensatory action. The change in cervical
vertebral alignment and muscular tension constitutes in
this instance a spinal lesion which is properly compensa-
tory and therefore not helped by corrective movements.
Many such lesions, profoundly compensatory in character,
should receive no direct corrective manipulation. Since
they are dependent upon tissue involvement elsewhere we
must make our diagnosis from cause to effect in order to
get our therapeutics in -right sequence.

Pains Incident to Chill and Fever. — The headache,
neckache, backache and legache of chill and fever are sub-
jective symptoms prominent in a host of cases. These
symptoms are of varying intensity but even when not com-
plained of, a tenderness in the neck and back is readily
elicited by digital pressure. As the fever subsides these
areas of sensitiveness to pressure grow less and less, show-
ing that their great extent in the beginning is a constitu-
tional condition. It is readily recognized that our spinal
lesion in pulmonary tuberculosis has changed with each

PRINCIPLES OF OSTEOPATHY 123

phase of the disease. This is probably true of all diseases,
hence there is no fixed lesion associated with any visceral
or somatic disease. A slightly varying set of reactions
accompanies each disease process. These reactions are
usually true to type but not capable of classification ex-
cept in a general way. The organs of the body are inner-
vated from fairly definite areas of the cord and we speak
of these as nerve centers, but as before stated these cen-
trs consist of cells placed vertically and extending through
several segments. The spinal lesions found in visceral
disease are hence pleuri-segmental and, if there is toxemia,
there is a set of lesions expressive of this condition super-
imposed on the first, then, in case of destruction of tissue,
compensatory changes in structure are noticeable. The
three major forms of integration are involved in any severe
illness and hence the diagnostician must try to separate
the various evidences of the body's protective reactions.
The greater variation will be in those symptoms due to
circulatory integration. This is evidenced by the rapid
changes in cases of autointoxication. The lesion which is
characterized by its persistence will be located in that seg-
ment or segments most closely allied with the center of
visceral disturbance. The lesion of still more permanence
will be the primarily traumatic or secondarily compensa-
tory.

The Practical Use of Knowledge. — We have added
nothing new to the world's knowledge of nerve tissue, but
we have applied general knowledge of this tissue to specific
uses. We have taken the results of laboratory experiments
and made them practical methods in the detection and
alleviation of disease. It appears to us that sufficient re-
search work has been done on the nervous system by med-
ical men and sufficient general conclusions drawn from
their investigations to justify all branches of the profession
in making more extensive use of such data. The correla-
tion of laboratory data with the results of clinical experi-
ence make the foundation of osteopathic diagnosis at the

124 PRINCIPLES OF OSTEOPATHY

present time. By this bold application of knowledge,
which by the medical profession at large has been regarded
as speculative and at least impracticable, osteopathy has
gained an impregnable position in the healing arts.

Laboratories make scientists, not physicians; hence
physicians have not always grasped the full significance
of the scientific discoveries in physiology and applied them
to therapeutics.

Whatever osteopathy may at present possess or gain
in the future, is due solely to a close adherence to the facts
of anatomy and physiology; and the application of these
fundamental facts to scientific therapeutics.

PRINCIPLES OF OSTEOPATHY 125

CHAPTER VIII.

THE SYMPATHETIC NERVOUS SYSTEM.

Unity of the Nervous System. — It gives a wrong im-
pression to speak of the cerebro-spinal nervous system and
the sympathetic nervous system as though they are inde-
pendent of each other. They are parts of a single system.
They make all parts of the body intercommunicative, and
make it possible for a slight stimulus to cause a widespread
response. They convey all impulses of a sensory character
to the central nerve cells and cause internal activity and re-
sponse to external stimuli. In fact, the harmonious action
of the tissues in our body depends on every cell knowing the
condition of every other cell. Each cell is capable of perfect
life only so long as it is able to communicate with the cen-
tral nervous system, ready to give and to receive, thus ful-
filling the law of reciprocity.

For convenience of description, the nervous system is
divided into the cerebro-spinal and the sympathetic. We
have already said that these are parts of one whole. They
are continuous anatomically and physiologically. In the at-
tempt to write of them separately, we desire you to bear
constantly in mind their interdependence.

"The dependence and independence of the cerebro-
spinal and sympathetic systems of nerves may be compared
to the State and Federal Governments, or the Municipal and
State Governments. The former run in harmony, when
friction does not arise, yet the State lives quite a distinct,
individual life — quite independent of the Federal Govern-
ment. And the life of each is dependent, however, on the
other. The internal life of each (as of the sympathetic)

126

PRINCIPLES OF OSTEOPATHY

Pharynx.

Hcort.

Ss

Storruich.
Liver.
Spleen.
Pancreas.

all Intestine
' itestinc

Hypo^astric
Plexus

FIG. 22. Schematic representation of the connections between
the sympathetic and cerebro-spinal nervous systems.

PRINCIPLES OF OSTEOPATHY 127

maintains itself." — Byron Robinson in the "Abdominal
Brain," page 55.

Origin. — The sympathetic appears to originate from the
ganglia on the posterior roots of the spinal nerves.

(1) Lateral Ganglia. — The substance of the sympthetic
is conveniently divided into four portions: (1) The lateral
chains of ganglia, placed one on each side of the vertebral
column. The chains are connected above by the Ganglion of
Ribes (French, 1800-1864), situated on the anterior com-
municating artery, and joined below by the Ganglion Im-
par situated on the anterior surface of the coccyx. These
chains of ganglia are connected with the cerebro-spinal
nerves by well marked cords.

(2) Four Prevertebral Plexuses. — The next prominent
aggregations of nerve tissue are the great prevertebral plex-
uses situated ventral to the bodies of the vertebrae. The
first, or Pharyngeal, is situated around the larynx. The
second, or Cardio-Pulmonary Plexus, lies in the thorax.
The third, or Solar Plexus, encircles the Coeliac Axis and
superior mesenteric artery. The fourth is the Pelvic Plexus,
which governs the generative organs and rectum.

(3) Visceral Ganglia. — The third part of the sympa-
thetic tissue is composed of those ganglia placed between
the coats of viscera, and called the peripheral apparatus or
"Automatic Visceral Ganglia." (Robinson.)

(4) Communicating Fibers. — All of these ganglia and
plexuses are intimately connected with each other by nu-
merous nerve fibers. These four parts constitute what is
commonly known as the sympathetic nervous system. The
nerve fibers in the sympathetic system consist of both the
medullated and non-mednllated varieties, i. e., white and
gray. It is commonly believed that the white are cerebro-
spinal and the gray are sympathetic fibers, though whether
they belong to the one or the other system cannot be told by
appearance alone. Function must also be considered. The
fibers in the sympathetic system are principally of the non-

128 PRINCIPLES OF OSTEOPATHY

medullated variety; hence, gray fibers are called sympa-
thetic.

White Rami-communicantes.-L— The chains of the lateral
ganglia are connected with the spinal nerves serially by two
distinct nerve bundles to each ganglion. These bundles are
called rami-communicantes, and are composed of: (1) A
bundle of white or cerebro-spinal fibers passing from the
anterior and posterior roots of the spinal nerves to the gan-
glion, in which a few fibers may end; but the majority pass
on to be distributed to the prevertebral plexuses, thereby
giving direct communication between viscera and the spinal
cord. These white fibers consist of both motor and sensory
fibers. The white rami-communicantes leave the spinal
cord between the second dorsal and second lumbar verte-
brae only. Many of the fibers are demedullated in the lat-
eral ganglia; others retain their sheaths as far as the pre-
vertebral plexuses, where they also become demedullated.
The cervical region has no white rami-communicantes.

Distribution. — The nerves in the sacral region which
correspond to white rami-communicantes, pass to the viscera
without entering the sympathetic ganglia. We may sum-
marize what we have written concerning the endings of the
white rami-communicantes as follows: (1) End in the lat-
eral ganglia. (2) Pass through lateral ganglia and end in
prevertebral plexuses. (3) Split up before entering lateral
ganglia and send some fibers to the ganglia, others to gan-
glia above and below, after passing into its own ganglia.

Function. — The white rami-communicantes have many
functions, and these can be determined by a close study of
distribution and physiological action. The functions may
be tabulated approximately as follows : First, it has been
demonstrated that vaso-constrictors pass out of the cord be-
tween the second dorsal and second lumbar vertebrae; sec-
ond, cardiac augmentors, ending in the lower cervical gan-
glia and first thoracic ganglion ; third, motor fibers to the
plain muscles of the intestines; fourth, motor fibers to the
sphincter of the iris leave the cord at the third dorsal and

PRINCIPLES OF OSTEOPATHY 129

ascend in the chain of sympathetic ganglia; fifth, inhibitory
fibers to the viscera; sixth, sensory fibers from viscera.

In other words, it may be tabulated as follows : The ab-
dominal splanchnics contain viscero-motor and viscero-in-
hibitory, vaso-constrictor, vaso-dilator and sensory fibers,
which are white rami-communicantes. Since no white rami-
communicantes leave the cord above the second dorsal or
below the second lumbar, the cardiac augmentors and the
constrictors to the sphincter of the iris probably leave the
cord as white rami-communicantes in the dorsal region.

We have thus far considered only those fibers which
are supposed to originate in the cerebro-spinal system ; at
least, they are medullated nerves, and hence are considered
cerebro-spinal in character.

As we have previously stated, the bond of union be-
tween the sympathetic and cerebro-spinal systems consists
of a white and gray bundle.

Gray Rami-Communicantes. — These gray fibers are
non-medullated and originate in the lateral ganglia, being
axis cylinder processes of nerve cells in those ganglia, pass-
ing thence to the spinal nerves and spinal cord.

Distribution. — They pass first to the anterior primary
divisions of the spinal nerves and continue with them to
their distributive area ; or they may pass to the distribution
area of the posterior division, to the distribution area of the
recurrent branch of the spinal nerve, and to the structures
(dura) surrounding the posterior root of the spinal nerve
and to the spinal cord.

Function. — Since the function of the sympathetic sys-
tem is to control the caliber of blood vessels, the plain mus-
cle fibers, and the action of the secretory and excretory
glands, we may state the function of these gray rami-com-
municantes to be as follows: (1) Vaso-motor to the blood
vessels of the skin and skeletal muscles in the area of dis-
tribution of spinal nerves ; also secretory to the sweat glands
and motor to the plain muscle controlling the hairs; (2)
vaso-motor to the blood vessels in the spinal cord and its

130 PRINCIPLES OF OSTEOPATHY

membranes. The nerves passing from the lateral ganglia to
the prevertebral plexuses, therefore, contain white and gray
fibers having the functions of the sympathetic and cerebro-
spinal systems, and from these prevertebral plexuses fibers
pass to the distal ganglia in the walls of the viscera. Thus
we see that all the ganglia of the sympathetic are closely
connected with the cerebro-spinal. These ganglia demedul-
late the spinal nerves which enter them, and more fibers
leave the ganglia than enter them. These ganglia have a
trophic influence over the nerves which pass from them to
the periphery. They are reflex centers.

Functions of the Sympathetic System. — "In general it
may be said that the sympathetic presides over involuntary
movements, nutrition and secretion, holds an important in-
fluence over temperature and vaso-motor action, and is en-
dowed with a dull sensibility." (Robinson's "Abdominal
Brain.")

Independent or Dependent. — Whether the action of the
sympathetic is independent or dependent is no longer sub-
ject for experiment and discussion. You have seen the
heart beat after extirpation from the body; also the ver-
micular motion of the intestines. These are offered as evi-
' deuces of independent action, but it must be borne in mind
that under normal conditions the cerebro-spinal nerves can
influence these activities, either repressing or augmenting
them.

Ganglia. — The ganglia of the sympathetic contain (a)
nerve cells, (b) afferent fibers, (c) efferent fibers — and are
therefore governing centers. They are able to receive sen-
sation and transform this into motor impulses, and hence
are, in a measure, independent.

Cervical Ganglia of Importance to Osteopaths. — The
cervical portion of the gangliated cord contains three gan-
glia which are designated as superior, middle and inferior,
according to position. These ganglia are important to the

PRINCIPLES OF OSTEOPATHY 131

osteopath, because they are in a measure affected by direct
manipulation, i. e., pressure can be transmitted to them
through the soft tissues over them.

Superior Cervical Ganglion. — The superior cervical
ganglion lies on the rectus capitis anticus major muscle and
sends branches upward which form a plexus around the in-
ternal carotid artery (carotid plexus). The cavernous
plexus is a continuation of this. From these plexuses many
communicating branches pass to unite with the cranial
nerves of the cerebro-spinal system.

Connections. — This ganglion is connected with the first
four spinal nerves and the ninth, tenth and twelfth cranial.
Its branches are distributed on all the blood vessels of the
head and face.

Vaso-constriction. — Physiological experiment has dem-
onstrated that this ganglion exercises a vaso-constrictor in-
fluence over the blood vessels of the head and face.

Distribution. — "The terminal filaments from the caro-
tid and cavernous plexuses are prolonged along the internal
carotid artery, forming plexuses which entwine around the
cerebral and ophthalmic arteries ; along the former vessels
they may be traced into the pia mater ; along the latter, into
the orbit, where they accompany each of the subdivisions of
the vessel, a separate plexus passing with the arteria cen-
tralis retinae, into the interior of the eye-ball. The fila-
ments prolonged on to the anterior communicating artery
form a small ganglion, the Ganglion of Ribes, which serves,
as mentioned above, to connect the sympathetic nerve of the
right and left side." (Gray's Anatomy, page 871.)

Reasoning from the position of the ganglion, in the
neck, its distribution to blood vessels of the head and face,
and its vaso-constrictor functions to the vessels, we can
readily understand why mechanical lesions in the upper
cervical region can be the cause of grave pathological condi-
tions in the tissues of the head and face. Anything which

132 PRINCIPLES OF OSTEOPATHY

disturbs the normal circulation in a definite area will neces-
sarily affect the nutrition of the tissues in that area; there-
fore, nutritional disorders of the eye are found to be caused
by subluxation of vertebrae, or contraction of muscles in re-
lation to the superior cervical ganglion.

Headache. — Since sympathetic branches are distributed
to the blood vessels of the pia mater, we may reasonably
expect to affect the caliber of these vessels in the case of
congestive headache, by removing all obstructions, — e. g.,
contracted muscles causing dilatation — to the active func-
tioning of the superior cervical ganglion. The distribution
of these sympathetic nerves to the orbit, nose, pharynx,
tonsils, palate and sinuses, explains the possibility — yes,
probability — of a mechanical lesion in the upper cervical
region in these cases.

Middle Cervical Ganglion. — The middle cervical gan-
glion is the smallest of the three. "It is placed opposite the
sixth cervical vertebra, usually upon or close to the superior
thyroid artery; hence the name of 'Thyroid Ganglion' as-
signed to it by Haller." It sends branches to the fifth and
sixth spinal nerves.

Distribution. — It sends branches to accompany the in-
ferior thyroid artery to the thyroid gland, where they com-
municate with the superior and recurrent laryngeal nerves.
These branches regulate the caliber of the inferior thyroid
artery and its branches. The chief nerve trunk passing from
this ganglion is the middle cardiac nerve. The cardiac aug-
mentors leave the spinal cord as 'white rami-communicantes
to the second, third and fourth dorsal ganglia, then pass up-
ward to the middle cervical ganglion. This ganglion is
connected with the superior cervical ganglion.

Function. — The functions of this ganglion are (a) vaso-
constrictor (through connection with the superior cervical
ganglion) to the blood vessels of the head and face ; (b)
vaso-constrictor to the vessels of the thyroid gland ; (c)
augmentor influence to the heart.

PRINCIPLES OF OSTEOPATHY 133

Manipulation. — Therefore, inhibition (pressure) will
lessen those influences, and stimulation (make-and-break
pressure) will increase them. Since sympathetic centers
(ganglia) control vaso-motion and secretion, we may con-
sider that this ganglion controls vaso-motion and perspira-
tion in the area of distribution of the fifth and sixth cervical
spinal nerves.

Inferior Cervical Ganglion. — "The inferior cervical gan-
glion is situated between the base of the transverse process
of the last cervical vertebra and the neck of the first rib, on
the inner side of the superior intercostal artery."

Distribution. — It connects with the ganglion above,
and the fibers which connect it with the first thoracic
ganglion pass both in front of and behind the subclavian
artery. Its chief branch is the inferior cardiac nerve, which
communicates with the middle cardiac nerve and the recur-
rent laryngeal nerve. It sends gray rami-communicantes
to the seventh and eighth cervical nerves ; also some
branches which pass upward to the vertebral artery. The
fibers which encircle the subclavian artery are called the
Annulus of Vieussens, and some fibers to the cardiac nerve
are given off from it.

Function. — From this distribution we may draw the fol-
lowing conclusions as to the function of the inferior cervical
ganglion : (a) It is vaso-motor to the area of distribution of
the seventh and eighth cervical nerves; (b) it controls per-
spiration in this same area; (c) it is vaso-motor to the ver-
tebral artery and its branches in the posterior fossa of the
skull ; (d) vaso-motor to the internal mammary, inferior thy-
roid, and nervi comes phrenici arteries ; (e) augmentor in-
fluences to the heart.

Manipulation. — Treatment on this ganglion would les-
sen its vaso-constrictor influence over the arteries named,
and they would then carry more blood at a slower rate. The
stimulation of this ganglion would raise blood pressure in
the area it controls, and augment the force of the heart.

134 PRINCIPLES OF OSTEOPATHY

Recapitulation. — It has been mentioned that the cervical
ganglia receive no white rami-communicantes from the cer-
vical nerves, and that vaso-constrictor fibers pass from cere-
bro-spinal to the sympathetic system in the white rami-com-
municantes between second dorsal and second lumbar ver-
tebrae ; therefore, the constrictor influence manifested by
the cervical sympathetics is derived from the second, third
and fourth dorsal. They derive fibers also from the upper
thoracic region, as follows : (a) Augmentor fibers to the
heart from the second, third and fourth dorsal; (b) secre-
tory fibers to the salivary glands, second and third dorsal;
(c) pupilo-dilator and motor fibers to the involuntary mus-
cles of the eye and orbit from second and third dorsal ; (d)
afferent fibers whose stimulation causes activity of the vaso-
motor center in the medulla.

Thoracic Ganglia. — "The thoracic portion of the gan-
gliated cord consists of a series of ganglia which usually
correspond in number to that of the vertebrae, but from the
occasional coalescence of two, their number is uncertain.
These ganglia are placed on each side of the spine, resting
against the head of the rib and covered by the pleura cos-
talis; the last two are, however, anterior to the rest, being
placed on the sides of the bodies of the eleventh and twelfth
dorsal vertebrae. The ganglia are small in size, and of a
gray color. The first, larger than the rest, is of elongated
form, and frequently blended with the last cervical. They
are connected together by cord-like prolongations of their
substance. In the thoracic region the ganglia are connected
with the spinal nerves by both white and gray rami-com-
municantes."— (Gray's Anatomy, page 804 in 1901 Edition.)

Rami-efferentes.— The rami-efferentes or branches of
distribution are divided into an internal and external set.
The external branches are smaller, being distributed to the
bodies of the vertebrae and their ligaments. The internal
branches may properly be divided into an upper and lower
group, which are distributed to the viscera of the thorax and
abdomen.

PRINCIPLES OF OSTEOPATHY 135

Upper Five Thoracic Ganglia. — The upper five thoracic
ganglia send branches which are distributed around the up-
per portion of the descending aorta. From the second, third
and fourth ganglia are given branches to the posterior pul-
monary plexus, which control the tissues of the lungs. You
will remember that the pneumogastric nerves are the motor,
sensory and trophic nerves to the air passages. The sympa-
thetic, second to seventh dorsal, are vaso-motor and trophic
to the blood vessels of the tissues of the lungs. We have
now laid a foundation of anatomical and physiological facts
upon which we may base our principles of treatment. The
upper thoracic region is an important one, because in it we
find not only those white rami-communicantes which are
distributed to the aorta and lungs, joining with the pneumo-
gastric nerve to complete the plexuses which control lung
action, but also those white rami-communicantes which as-
cend to the cervical ganglia, and are distributed as follows :'

Nerve Distribution. — "(1) Pupilo-dilator fibers pass by
rami-communicantes from the first, second and third tho-
racic nerves, ascend in the sympathetic cord to the superior
cervical ganglion to form arborizations around the cells.
These gray fibers pass to the Gasserian Ganglion and reach
the eye ball by the ophthalmic division of the fifth and long
ciliary nerves; (2) motor fibers to the involuntary muscles
of the orbit and eyelids, from the fourth and fifth thoracic
nerves, following a similar course; (3) vaso-motor fibers to
the head, secretory fibers to the submaxillary glands, and
pilo-motor fibers to the head and neck, are derived from the
upper thoracic nerve, and reach their area of distribution,
after similar interruption, in the superior cervical ganglion;
(4) the accelerator fibers to the heart are derived from the
upper thoracic nerves, and end similarly in the middle and
lower cervical ganglia, gray fibers in the cervical cardiac
nerve completing the connection." — (Gerrish's Anatomy,
page 18.)

Interscapular Region. — Therefore, we have an area ex-
tending from the second to the seventh dorsal, in which we

136

PRINCIPLES OF OSTEOPATHY

must make careful examination for lesions affecting vaso-
motor, trophic and secretory activity in the thoracic vis-
cera, upper extremities, and structures of the head, face and
neck. This explains to you why a treatment in the inter-
scapular region has such far-reaching effects.

A Case Illustrating the Cilio-spinal Center. — As an il-
lustration of the nerve connection between the cilio-spinal
center, first, second and third dorsal and the eye, I wish to
call your attention to a patient now in the clinic. There
was extensive inflammation of the conjunctiva of the right
eye, sight in that eye was almost gone on account of the
opacity caused by the inflammation of the conjunctiva over

Spil>ol
co*d

I

Internal ctiroi
artery

Superior ceivicol ^

donglion

2nd dorsol <4oru5lvorv
y y

FIG. 23. Diagram showing cilio-spinal center and the course of the
nerves governing accommodation of the eye to light and distance.
Drawn by John Comstock (after Schultz).

the cornea. This condition was present for five years. The
inflammation had traveled to the nasal duct, and as a result
it was closed. The duct had been opened by the surgeon's
knife long before we saw the case. A close examination of
the center likely to be irritated in such a condition disclosed
the fact that the area between the first and third dorsal
vertebrae was exceedingly sensitive, and, most interesting
of all, pressure on this area caused intense pain in the in-
flamed eye, and caused the pupil to dilate. The muscles in

PRINCIPLES OF OSTEOPATHY 137

the interscapular area were very much contracted. Treat-
ment was given, and in proportion to the amount of relaxa-
tion gained in the interscapular area, the inflammation in
the conjunctiva subsided. After one month's treatment, the
patient could see to thread a needle, using only the formerly
diseased eye. Pressure at the third dorsal spine still causes
the patient to speak of a sense of pressure or swelling in the
eye. (Two years have passed since this was written. The
patient has continued to have perfect use of the eye.)

The following extract from "The Osteopath" in regard
to this case is of interest to us while considering the sympa-
thetic nervous system : "It is not surprising that diseases of
the eye should affect the sympathetic nerve, and that by that
path the center known as the 'cilio-spinal.' But by what
sensory path would the influence of pressure be carried to
the eye? We know of none. From the first two dorsal
nerves, which are identical with the cilio-spinal center,
sympathetic fibers are distributed to the dilating muscle
fibers of the iris, and when stimulated cause dilatation of the
pupils. From the third dorsal nerve fibers are distributed
which regulate the caliber of the blood vessels of the eye.
Under the pressure, either set of these fibers may be af-
fected. The first may be stimulated, dilating the muscles of
the iris so as to press upon filaments of sensitive nerves;
or, the pressure may inhibit the vaso-constrictor function of
the other nerve, and by dilating the arterioles cause pressure
upon the sensitive nerve; or, both causes may operate and
thus induce the pain. The abundant supply of sensory
nerves to the ciliary muscle, iris and cornea, from the nasal
branch of the ophthalmic division of the fifth nerve and the
short ciliary branches from the ciliary (lenticular or ophthal-
mic) ganglion makes it conceivable that any change of ar-
terial pressure might affect these nerves to the extent of
causing pain. It seems reasonable to conclude that there
was no inflammation, but congestion, and partial paralysis
of the vaso-constrictor nerve." — (A. E. Brotherhood, D. O.,
D. Sc. O., in "The Osteopath," Vol. V., No. III.)

138 PRINCIPLES OF OSTEOPATHY

Effects of Treatment, First to Seventh Dorsal. — Treat-
ment in the interscapular region, first to seventh vertebrae,
may reasonably be expected to affect the heart beat, the nu-
tritional circulation in the lungs, and the circulation in the
upper extremities, head, neck and face.

The remainder of the dorsal area constitutes what is
called the splanchnic region. Three splanchnic nerves are
given off from this region to be distributed to the preverte-
bral plexuses in the abdominal cavity.

The Great Splanchnics. — The first is called the Great
Splanchnic and takes origin from the sixth to the tenth dor-
sal nerves, and probably receives many filaments from the
upper dorsal nerves. It is a large nerve trunk and contains
many medullated nerves from the cerebro-spinal system.
Its course is downward and inward, perforates the crus of
the diaphragm and ends in the semilunar ganglion. Some
fibers end in the renal and suprarenal plexuses.

Lesser Splanchnic. — The Lesser Splanchnic arises from
the tenth and eleventh ganglia and their connecting cord.
It also takes a downward and inward course, piercing the
<;rus of the diaphragm, and ends in the Coeliac Plexus. It
communicates with the Great Splanchnic, and sometimes
sends fibers to the renal plexus.

Least Splanchnic. — The Least, or Renal Splanchnic,
arises from the last thoracic ganglion and ends in the renal
plexus. It sometimes communicates with the lesser splanch-
nic.

Functions. — First, vaso-constriction ; second, viscero-
inhibition. I mention merely those functions which have
been well demonstrated by physiological experiments and
osteopathic practice.

Theory. — The osteopath reasons as follows concerning
this Splanchnic area : Since the Great Splanchnic ends in
the semilunar ganglion, from this ganglion and plexuses
around it fibers are distributed to the blood vessels of the
stomach, liver, spleen and intestines ; therefore, we operate
in the area between the fifth and tenth dorsal spines for

PRINCIPLES OF OSTEOPATHY 139

vaso-motor effects on the above-mentioned viscera. Again,
the Great Splanchnic sends viscero-inhibitory fibers to the
muscular layers of the stomach and intestines; hence, we
control excessive muscular activity in these viscera by re-
moving obstructions to the normal inhibitory influence of
these nerves. The Lesser Splanchnic has the same func-
tions, but exercises its functions chiefly on that portion of
the intestinal muscular layer comprised in the area supplied
by the superior mesenteric artery; therefore, the tenth and
eleventh dorsal area is a vaso-motor and motor-inhibitory
center for a segment of the intestines. The renal splanch-
nics exert a vaso-constrictor influence on the blood vessels
of the kidneys, and the osteopath secures vaso-motor effects
on the blood vessels of the kidneys, and hence effects secre-
tion by removing obstructions to the normal influence of
this nerve.

The twelfth dorsal spine marks a renal center. These
nerves contain sensory fibers which carry sensation from
the prevertebral plexus in the abdomen to the spinal cord.
Therefore, a disturbance in the viscera can reflex its painful
sensations to the area of greater sensibility which is in close
central connection with the seat of disturbance.

It should be borne in mind that the power of movement
resides in the muscular wall of the intestine and is initiated
by the Automatic Ganglia in its walls, which are excited by
the pressure of food. We may state that the intestines pos-
sess an intrinsic nerve apparatus which initiates peristalsis,
but the control of the movement after it is initiated is exer-
cised by cerebro-spinal nerves. The pneumogastric nerve
exercises a decided motor influence over the intestines.
As previously stated, the great and lesser splanchnics are
inhibitory nerves to the musculature of the intestines.

Lumbar Ganglia. — Four small ganglia, connected above
and below by intercommunicating fibers, constitute the
lumbar portion of the sympathetic ganglia. These ganglia
are connected with the cerebro-spinal lumbar nerves by
rami-communicantes. The first and second ganglia are the

140 PRINCIPLES OF OSTEOPATHY

only ones in this region receiving white rami-communi-
cantes. The functions which we found were exercised in
the lower dorsal area are continued into the lumbar ganglia
as far as the second. These ganglia send fibers to the aortic
plexus, the hypogastric plexus, and thence to the pelvic
plexus. They also send branches, as in other regions, to the
blood vessels supplying the bones and ligaments of the
spinal column.

Since vaso-constrictor fibers do not enter the sympa-
thetic ganglia below the second lumbar, we may reasonably
expect to influence the circulation of the lower extremities
by manipulations in this area.

The descending colon and rectum are supplied with vis-
cero-inhibitory fibers from this area. Vaso-constrictor fibers
are supplied to the blood vessels in the lower portion of the
abdomen. The influence exerted by the lumbar sympa-
thetics may be tabulated as follows :

1st: Viscero-inhibitory to descending colon and rectum.

2nd : Vaso-constrictor to lower abdominal blood vessels.

3rd : Vaso-constrictor to the blood vessels of the penis.

4th : Vaso-motor fibers to the blood vessels of the blad-
der.

5th : Vaso-motor fibers to the blood vessels of the
uterus.

6th : Vaso-constrictor to the blood vessels of the pelvic
viscera.

7th: Motor to vas deferens (male), round ligament
(female).

8th : Vaso-constrictor to the blood vessels of the lower
extremities.

Sacral Ganglia. — The pelvic portion of the sympathetic
chain usually consists of four ganglia situated along the
inner side of the sacral foramina, and communicates with
the four upper sacral nerves. These ganglia are connected
with each other, as in other regions. The two chains con-
nect by the Ganglion Impar on the anterior surface of the
coccyx.

PRINCIPLES OF OSTEOPATHY 141

Distribution. — The rami-efferentes are distributed to
the pelvic plexus; or a plexus on the middle sacral artery,
and to vertebrae and ligaments in the sacral region.

"Through the pelvic plexus, the pelvic viscera are sup-
plied with motor, vaso-motor and secretory fibers." (Ger-
rish's Anatomy, page 648.)

The rami-communicantes in the sacral region are gray,
hence, the influence of the cerebro-spinal system is carried
down from the upper lumbar ganglia.

"Below the second lumbar vertebra they are also of the
gray peripheral variety." ("Abdominal Brain," page 31.)

In the sacral region the spinal nerves are distributed
directly to the pelvic viscera; some fibers pass into the
pelvic plexus, thence to the viscera.

The sacral region offers an area in which the osteo-
path can secure an influence on pelvic viscera without the
extensive sympathetic connections encountered in other
regions of the spine.

Function. — These sacral nerves are :

1st: Vaso-dilator to the vessels of the penis and vulva.

2nd : Motor fibers to the rectum.

3rd : Motor fibers to the bladder.

4th : Motor fibers to the uterus.

Cardiac Plexus. — The three great prevertebral plex-
uses must now engage our attention. The first one, the car-
diac plexus, is situated at the base of the heart, and in the
concavity of the arch of the aorta; this portion is called su-
perficial, while the deep portion lies between the trachea and
the aorta.

Position and Formation. — The cardiac plexus is formed
by fibers from the pneumogastric and cervical cardiac sym-
pathetics. "It is very common to find upper cervical cardiac
branches of the vagus and sympathetic united to form a
common trunk. In other cases, the nerves branch and com-
municate with each other in a plexiform manner." (Mor-
ris's Anatomy.)

142 PRINCIPLES OF OSTEOPATHY

The cardiac nerves form the cervical sympathetic chain ;
all enter the cardiac plexus, but their distribution is varia-
ble. The superficial plexus receives the "left superior car-
diac nerve of the sympathetic and the left inferior cervical
cardiac branch of the pneumogastric." — (Morris's Anat-
omy.)

The deep cardiac plexus "receives all the other cardiac
nerves." From the superficial cardiac plexus branches pass
to the plexus around the right coronary artery and pass to
the left lung to join the anterior pulmonary plexus.

From the deep cardiac plexus branches are distributed
to the anterior pulmonary plexus of both sides, the left coro-
nary plexus, right auricle, superficial cardiac plexus, and
right coronary plexus.

Pulmonary Plexus. — The anterior pulmonary plexus is
formed by a branch of the pneumogastric and the sympa-
thetic. It is situated on the anterior surface of the bronchi
and the branches enter the lung on the bronchus.

The posterior pulmonary plexus is formed by the pneu-
mogastric and fibers from the second, third and fourth tho-
racic ganglia of the sympathetic. Its branches enter the
lung on the posterior aspect of the bronchus.

Physiology. — Physiological experiments have demon-
strated that the pneumogastric is motor to the muscles of
the bronchioles, sensory and trophic, while the sympathetics
are vaso-motor and trophic. Therefore, the function of the
lungs and heart can be affected by operating on the inter-
scapular region.

Functions. — The functions of the thoracic plexus are :

1st: Cardiac augmentors, per sympathetics.

2nd : Cardiac inhibitor, per pneumogastric.

3rd : Vaso-constrictor to coronary arteries, per pneumo-
gastric.

4th : Vaso-constrictor to bronchial arteries, per sympa-
thetic, first to fifth dorsal.

PRINCIPLES OF OSTEOPATHY 143

5th: Sensory fibers to the pleura and lungs, peV sympa-
thetic, first to fifth dorsal.

6th : Sensory fibers to heart and pericardium, per sym-
pathetic, second to fifth dorsal.

7th : Broncho-constrictor, per pneumogastric.

8th : Broncho-dilator, per pneumogastric.

9th : Sensory fibers to mucous lining of air passages,
per pneumogastric.

Treatment. — A true inhibitory treatment would pro-
duce greatest effect on the heart, if administered over the
middle and inferior cervical ganglia. The heart would be
slowed. Such a treatment is rarely given, because nearly
every case presents some physical lesion which, if removed,
allows normal impulses to meet in the cardiac plexus and
be re-organized for proper distribution.

Always bear in mind that a plexus is a re-organizing
center for nervous impulses, and we can hope only to regu-
late the function of an organ by attempting to equalize the
impulses reaching its controlling plexus. This equalizing
process is not ordinarily secured by the administration of
inhibition to a definite nerve trunk which ends in the plexus,
but by removing a lesion, — usually bony or muscular —
which is affecting the nerve fiber in the direction of increase
or decrease of function.

The region between the scapulae is in close central
connection with the lungs, pleura, heart and pericardium ;
hence, painful sensations originating in these organs may be
referred to this area. The muscles in this area will contract
reflexly from irritation of these organs, or from exposure of
the skin over them to a change of temperature. Hence, in
the first instance the contraction is a secondary lesion; in
the latter, a primary one.

Pressure in this area practically causes relaxation of
muscles, removes a lesion ; but the patient experiences a
cessation of pain, freer respiration, and less rapid action of
the heart.

144 PRINCIPLES OF OSTEOPATHY

Restilts. — After administering inhibitory pressure, the
osteopath realizes that the muscles under his fingers are
softer than formerly; then he knows that he has actually
changed the physiological condition of an important tissue.

Argument. — Coincident with the softening of the mus-
cles, the heart beats slower; therefore, he has removed an
irritant to the augmentor fibers of the heart ; the respiration
is deeper, therefore a change has been secured in the ac-
tivity of the walls of the thorax, and in the circulation of
blood in the bronchial and pulmonary blood vessels ; the
pain has decreased, therefore the sensory nerves in the lung
tissue are no longer irritated by hyperaemic pressure or
toxic substances in the blood. This illustrates to you why
the osteopath studies and treats the interscapular region so
carefully.

Solar Plexus. — In the abdominal cavity we find the so-
lar plexus, which on account of its great size and wonderful
distribution, Byron Robinson calls the "Abdominal Brain."

Location and Formation. — It is placed in front of the
aorta at its entrance into the abdomen, and surrounds the
Coeliac Axis. It consists of two semilunar ganglia, which
are placed on each side of the coeliac axis, and are connected
by a large number of fibers which pass above and below the
coeliac axis. From this circle of ganglia and nerves, fibers
are given off which are joined by branches of the right pneu-
mogastric, and by both small splanchnics. The great
splanchnic ends in the semilunar ganglion.

Distribution. — The branches of distribution from the
solar plexus are prolonged on the branches of the abdominal
aorta as subsidiary plexuses, taking their names from the
arteries they accompany, as splenic, gastric, hepatic, dia-
phragmatic, suprarenal and renal, superior mesenteric, in-
ferior mesenteric, aortic and spermatic. The ultimate dis-
tribution of the branches of the solar plexus is to the mus-
cular and secretory tissues of all the abdominal viscera, and

PRINCIPLES OF OSTEOPATHY 145

to the muscular coat of the arteries supplying these viscera.
This great plexus is the vaso-motor center for the ab-
dominal viscera. "It is connected with almost every organ
in the body, with a supremacy over visceral circulation,
with a control over visceral secretion and nutrition, with a
reflex influence over the heart that often leads to fainting,
and may even lead to fatality." — "Abdominal Brain," page
76.

Function. — We find that the great and the small
splanchnics and right pneumogastric are the chief contribu-
tors to the solar plexus, and in order to get a clear idea of
the functions of this plexus, we may tabulate them as fol-
lows:

1st: Viscero-motor to stomach, small intestines, as far
as sigmoid flexure, per pneumogastric.

2nd : Sensory to stomach and small intestines, per
pneumogastric.

"If the pneumogastric nerve be divided during full di-
gestion in a living animal, in which a gastric fistula has
been established, so that the interior of the stomach can be
examined, the muscular contractions will be observed to
cease instantly; the mucous membrane to become pale and
flaccid; the secretion of the gastric juice to be arrested, and
the organ to have become insensible. There can be no
doubt, also, that stimulation of the pneumogastric nerves
causes the stomach to contract, and that digestion may, to a
certain extent, at least, be re-established by stimulation of
the peripheral extremities of the divided nerves."' — (Chap-
man's Phys., page 680.)

3rd : Viscero-inhibitory, per splanchnics.

4th : Vaso-motor, per splanchnics.

5th : Sensory, per splanchnics.

6th : Sensory, per pneumogastric and splanchnics.

The fibers of the great and small splanchnics come
from the sympathetic ganglia in the dorsal region, sixth to
eleventh.

146 PRINCIPLES OF OSTEOPATHY

These ganglia may receive fibers from some of the up-
per dorsal.

Centers. — The facts just stated give us a foundation
for osteopathic treatment to influence motion, sensation, se-
cretion, and vaso-motion in the abdominal viscera. The
area in the vertebral column which we may consider as con-
taining centers for these various functions lies between the
sixth and eleventh dorsal spines. The fibers from this region
have a segmental distribution to the abdominal viscera;
therefore, the stomach, liver, gall bladder, spleen and in-
testines each have a limited portion of this area which is
their special center; at least, painful sensations are reflexed
from them to a definite point in the vertebral column be-
tween the sixth and eleventh dorsal spines. The enormous
regulative influence which can be excited by an osteopathic
treatment in this area is being demonstrated daily.

We have already mentioned the fact that the intestines
will contract after being separated from the body, thereby
proving that the intrinsic power to cause movement lies in
the nervous mechanism in the gut walls. Keep constantly
in mind the regulative character of the impulses which
enter the "abdominal brain" over the pneumogastric and
splanchnic nerves.

The vaso-motor phenomena in this area have been dis-
cussed in another chapter.

Hypogastric Plexus — Location and Formation. — The
great re-organizing center for the pelvic viscera is called
the hypogastric plexus, which lies anterior to the fifth lum-
bar vertebra. It is formed by a continuation of fibers from
the aortic plexus which are joined by fibers from the lum-
bar sympathetic ganglia. In front of the sacrum the plexus
divides into two portions, which join the pelvic plexuses
lying on each side of the rectum and bladder, in the male,
and of the rectum, vagina and bladder in the female.

Pelvic Plexus. — These pelvic plexuses contain many
small ganglia, and are joined by fibers from the upper sacral

PRINCIPLES OF OSTEOPATHY 147

sympathetic ganglia, and by direct branches of the second,
third and fourth sacral cerebro-spinal nerves.

Distribution. — The branches of these plexuses are dis-
tributed on the coats of the arteries to the pelvic viscera,
and frequently enter the substance of the organ.

Subsidiary Plexuses. — According to the artery fol-
lowed, we have subsidiary plexuses, called hemorrhoidal,
visceral, prostatic, vaginal and uterine.

Functions. — The functions of the pelvic plexus are as
follows :

(1) Vaso-constrictor, (2) vaso-motor, (3) sensory, (4)
viscero-inhibitor, per hypogastric plexus.

(5) Motor to rectum, vagina and bladder, (6) sensory
to rectum, vagina and bladder, (7) vaso-dilator to sexual
organs, erectile tissue, (8) viscero-constrictor to neck of
uterus, per second, third and fourth sacral.

Summary. — With the arrangement and functions of
these nerves well in mind, we recognize two paths over
which we can influence the pelvic viscera :

(1) Sensory influences may be reflexed through the
hypogastric plexus, and thence to the second lumbar; or,
they may pass over sacral nerves to the same point, second
lumbar. In connection with disturbance of the pelvic vis-
cera, pain may be reflexed on to the back of the sacrum,
or to an area around the second lumbar. Disturbance of
function in the uterus causes reflex sensitiveness at fourth
and fifth lumbar.

(2) Vaso-constrictor influences come through hypo-
gastric plexus from spinal nerves about second lumbar.

(3) Vaso-dilator influences come directly to the pelvic
plexuses from second and third sacral nerves; nervi
erigentes.

(4) Viscero-motor influences chiefly from second, third
and fourth sacral.

(5) Viscero-inhibitory influences, chiefly through hypo-
gastric plexus, probably from upper lumbar spinal nerves.

148 PRINCIPLES OF OSTEOPATHY

We have therefore a vaso-constrictor center for pelvic
viscera at second lumbar; a vaso-dilator and motor center
at second and third sacral.

Automatic Visceral Ganglia. — The last portion of the
sympathetic is but little known, and physiologists have
refrained from speculating on it until more definite knowl-
edge is obtained.

Byron Robinson mentions a number of "automatic
visceral ganglia" situated in the walls of the hollow viscera.
The fact that the heart, intestines, uterus, bladder and
fallopian tubes will contract rhythmically in response to
mechanical stimulation after all nerve connections are
severed, seems to prove the existence of ganglia in the walls
of these viscera which are capable of receiving sensation
and sending out motor impulses.

Conclusions. — We will therefore conclude that the
sympathetic system can act independently of the cerebro-
spinal; that it receives sensation, and initiates motion;
gives tone to the arteries, and controls secretion. We in-
fluence the functions of the sympathetic through its con-
nection with the cerebro-spinal system.

PRINCIPLES OF OSTEOPATHY 149

CHAPTER IX.

CIRCULATORY TISSUE.

From the histological standpoint, blood conforms to
the general definition of a tissue, being composed of a
cellular and intercellular substance. The intercellular sub-
stance, being liquid, differentiates it greatly from other
tissues. It contains cellular elements which differ from
each other in form and function. Then, too, it is a moving
tissue enclosed in a system of closed tubes.

Functions. — The blood performs many functions.
These may be stated in general terms as follows :

1. To convey nutrition to all other tissues.

2. To remove waste products from the tissues.

3. To convey oxygen for tissue respiration.

4. To distribute heat.

5. To repel invasion of bacteria.

Lymph. — Lymph is another liquid tissue, less rich in
corpuscular elements, but greater in total bulk than the
blood. The lymph comes in direct contact with the ele-
ments of the tissues. Stewart states the relationship
tersely when he says, "The blood feeds the lymph and the
lymph feeds the cell."

Since we think of individual tissues as possessing some
one well developed attribute or function, it is well to call
blood and its congener, lymph, the media of exchange.
This expression covers at least four of the functions pre-
viously mentioned.

With this comprehensive but short statement of the
relation of these liquid tissues to the structural, contractile,
irritable and secretory tissues, it seems hardly necessary

150 PRINCIPLES OF OSTEOPATHY

to discuss so self-evident a proposition as that health pri-
marily depends on a perfect circulation. It is not even
necessary to add to this the fact that the blood should be
pure, because under ordinary circumstances if the blood
circulates properly it will become purified.

All schools of medicine have a therapeutic principle
around which their practice is built. From its earliest iri-
ception the osteopathic idea has been that a perfect circu-
lation is the foundation for perfect health.

The proportion of blood to body weight is about one-
twelfth of the whole, i. e., twelve pounds of blood in a
body weighing 150 pounds. This amount of blood is dis-
tributed approximately as follows : One-fourth to the
heart, lungs and great blood vessels; one-fourth to the liver;
one-fourth to the resting muscles; one-fourth to the re-
maining organs. There is not blood enough in the body
to maintain all of its activities at the maximum at the
same time. Therefore it is difficult to do the best physical
or mental labor just after digestion has begun. The
splanchnic blood vessels are capable of containing so large
a proportion of the whole amount of blood that death may
result from lack of sufficient blood returning to the heart
to cause it to beat.

Distribution of the Blood. — Granting that the blood
possesses all these functions, the question still confronts
us, how can we affect its distribution? This question leads
us to a consideration of the physiological distribution of
the blood. It is believed by the writer that nothing be-
sides the use of water has so great an effect on the circu-
lation of the blood as manipulation according to osteopathic
methods. These methods do not depend on a mere physi-
cal assistance of the venous flow by means of centripetal
stroking, such as is employed by a masseur. Effects on
circulation are obtained in nearly all cases by knowing
where definite nerves which control the action of the heart
and blood vessels are placed and what their action in re-
sponse to irritation may be. All manipulations are given

LIEfclE GF

PRINCIPLES OF OSTEOPATHY 151

with a definite knowledge of the location of blood vessels
and the nerve centers which control their variation in
caliber. The response secured is a new coordination of
the whole circulation brought about under the control of
the nerve centers.

It has been stated that the blood is contained in a
closed system of tubes. A short resume of the most im-
portant points in the anatomy and physiology of the cir-
culation may prepare us for a clearer insight of the modus
operandi of osteopathic methods.

The Circulatory Apparatus. — The circulatory appa-
ratus consists of the heart, arteries, capillaries, veins and
lymphatics; some writers include the spleen.

Muscular tissue is found in the heart, small arteries
and veins. The heart is practically all muscle, and its con-
tractions are governed by two sets of nerve fibers from the
cerebro-spinal system; the first set is called accelerator;
second, inhibitory.

Likewise, the small arteries and veins have two sets
of fibers which increase and decrease the intensity of the
contraction of their muscular fibers, and thus change the
caliber of the vessels.

The capillaries are short, narrow tubes, having a thin
wall composed of nucleated cells which possess the power
of contraction. So far as known, the capillaries expand
and contract in response to the degree of physical pressure
exerted by the blood current coming from the arterioles.
Thus the change in the caliber of the capillaries is pas-
sive. The lymphatics begin in small irregular spaces in
the cellular tissue outside of the blood vessels. They are
found in direct relation with the cells of perivascular tis-
sues, thus bringing the lymph to each cell. These open-
ings lead to small lymphatic vessels which convey the
lymph to the lymphatic glands which are situated so as
to filter out the impurities, after which it is emptied into
the venous circulation by the lymphatic ducts. The lym-

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152 PRINCIPLES OF OSTEOPATHY

phatic vessels possess power of contraction. The lymph
equals about one-third of the body weight.

The blood is a passively moving tissue. It is kept in
constant circulation within a closed system of tubes by a
combination of forces. The propulsion of the blood is al-
most entirely accomplished by the contraction of the heart.
This initial force is supplemented by the aspiration of the
chest during respiration, and the contraction of the skele-
tal muscles of the entire body. It is a debatable question
whether or not the muscular coat of the arterioles and
venules assist in the direct propulsion of the blood passing
through them.

It is the function of the heart to maintain a compara-
tively uniform tension of the blood in the large arteries.
The arterioles and capillaries are concerned in maintain-
ing resistance to the passage of the blood. The degree of
resistance in the capillaries, in large measure, determines
the amount of nourishment received by the tissues. The
relation between capillary resistance to the passage of
the blood and the metabolism carried on in perivascular
tissues is a point of great importance. The current of
blood ordinarily passes through the capillaries very slowly,
at a rate of one inch in two minutes, and under low ten-
sion, thus giving ample opportunity for the escape of nour-
ishing material for the surrounding tissues.

Tension in the arteries is maintained by three factors :
(1) The initial force of the heart beat; (2) friction in the
vessels; (3) elasticity of the vessel walls. The first and
third of these factors are under nerve control which act
according to a large number of stimuli.

The capillaries being passive in action, the tension of
the blood stream in them is mainly dependent on the ten-
sion in the arterioles. It may be profitably noted that
after the initial impulse is given to the blood stream by
the heart, the distribution of this blood depends solely on
the arteries, arterioles and capillaries. This peripheral
distributive mechanism is therefore responsible for the

153

nutrition of the tissues, and its resistance offered to the
passage of the blood regulates the amount of force ex-
erted by the heart.

Manipulatory treatments, according to the best authori-
ties writing on massage and Swedish movements, have
for their object the acceleration of the blood flow on the
venous side of the general circulation. Osteopathic man-
ipulations are essentially directed to the active instead of
the passive side of the circulation.

The osteopath makes use daily of the v-aso-motor
nerves in order to control the circulation of the blood in
local areas; therefore, it is necessary to make a detailed
study of this wonderful mechanism in order to achieve
the best results in practice.

The more we know of structure and function, the more
rational ought our methods of treatment to be, because
we will then have no excuse for using methods which do
not have a scientific basis to recommend them.

The Heart. — In order to affect the active side of the
circulation our manipulations must affect the heart beat.
There are two sets of nerve fibers arising in the cerebro-
spinal system which exert a regulating influence on the
beat of the heart. Heart muscle possesses an inherent
power of rhythmical contraction. It will beat rhythmical-
ly for hours if the muscle be kept moist with a one per
cent salt solution.

Contraction begins in the auricles and ends in the ven-
tricles; hence, it is thought that the auricular rhythm is
transmitted to the ventricle. Any influence which changes
the auricular rhythm also changes the ventricular rhythm.

Regulation of Contraction. — Since the heart possesses
inherent power of rhythmic contraction, the nervous sys-
tem acts as a regulator of the rate of contraction. The
two centers of cardiac control act in a manner to increase
or decrease the rate. The speed of the blood current is
dependent on the rate and strength of the cardiac con-
tractions. The pressure of the blood is dependent on the

154 PRINCIPLES OF OSTEOPATHY

rate and strength of the cardiac contractions, together
with the resistance offered by the arterioles and capillaries.
Considering the arterioles and capillaries as possessing
fixed diameters, an increase in the number and strength
of the heart beats would increase the speed and pressure
of the blood current. A lessened cardiac activity would
have the opposite effect. The speed and pressure of the
blood stream may vary within wide limits and still main-
tain a fair degree of health.

Coordinating Centers. — The nerve impulses reaching
the heart are coordinated in two governing centers in the
cerebro-spinal system. These centers are located in the
bulb. The inhibitory center is connected with cells in the
walls of the heart by fibers which form a part of the pneu-
mogastric nerve. Section of the pneumogastric nerve re-
moves the inhibitory influence over the heart's action.
Stimulation of this nerve slows the heart. The relaxation
period is lengthened which results in greater filling of the
heart and the pressure in the veins is increased while ar-
terial pressure decreases. These results have been noted
by many physiologists.

The Pneumogastric Nerve. — The pneumogastric is one
of the nerve trunks which can be reached by direct pres-
sure made through the skin and muscles of the neck. Its
inhibitory action can be aroused by pinching the sterno-
cleidomastoid muscle between the thumb and forefinger,
taking care to work deeply under the internal margin of
the muscle.

It is no uncommon phenomenon to have a patient
faint as a result of this manipulation. Individuals differ
greatly as to their response to this stimulation. The stim-
ulation should be a gentle pressure of a constantly vary-
ing intensity.

A pulse tracing is appended, Fig. 24, which shows the
results of stimulating the pneumogastric in the manner
just described. The gentleman upon whom the experi-

PRINCIPLES OF OSTEOPATHY

155

ment was made was in excellent health, and possessed a
quiet, well-balanced temperament. The tracing shows
that the number and force of the beats was lessened and
the arterial pressure decreased. This tracing is probably

' / /

/ / y y /

FIG. 24. Stimulation of the pneumogastric by pinching the nerve trunk
in the neck.

typical of the change, in a well person, in response to stim-
ulation of the pneumogastric. No sensation of faintness
or other disagreeable feeling was noted.

The inhibitory action of the pneumogastric seems
to be most active in individuals who suffer from some dis-
order of the digestive tract. In such patients the constant
irritation of the sensory fibers of the pneumogastric, which
arise in the mucosa of the digestive viscera, seems to in-
crease the irritability of the whole nerve trunk to such a
delicate point that the slightest stimulation made at any
point along the course of the nerve will excite its inhibitory
action. Many osteopaths, just starting in practice, have
had their self-possession severely tried by a patient faint-
ing during manipulation of the neck. I have never heard
of any fatal results from manipulation of the pneumogas-
tric. Why stimulation of the pneumogastric should result
in cardiac inhibition rather than in phenomena connected
with its other branches seems incapable of explanation.

156 PRINCIPLES OF OSTEOPATHY

Sometimes spasm of the laryngeal muscles will accompany
cardiac inhibition.

The intensity of action of the pneumogastrics is so
well known to experienced osteopaths that they are careful
to test its irritableness in cases before undertaking any
extensive manipulations along its course.

The inhibitory center is continually active and acts
according to the blood pressure within the arteries. A rise
in peripheral resistance causes a decrease in number and
strength of the heart beats.

Accelerator Center. — The accelerator center is con-
nected with the heart by fibers which descend in the cord
to the upper portion of the dorsal region ; here connection
is made with the cells whose fibers pass to the sympathetic
spinal ganglia, first, second and third dorsal, and end there
around other cells whose fibers convey their impulses to
the heart.

FIG. 25. Sphygmograms illustrating the effect of inhibition, first, second
and third dorsal.

The action of the accelerator center is not so readily
demonstrated as is the case with the inhibitory center. It
causes the heart to beat faster and stronger, thus bringing
about a rise in arterial blood pressure and a fall in venous
pressure. This center acts in response to lowered per-
ipheral resistance. The products of metabolism brought
about by physical exercise also excite it. Deep, steady
pressure made on the muscles lying on each side of the
first, second and third dorsal spines causes a decrease in the
rapidity of the heart's action.

PRINCIPLES OF OSTEOPATHY

157

FIG. 26. Vaso-constrictor area, second dorsal to second lumbar.

158 PRINCIPLES OF OSTEOPATHY

Stimulation of the Heart. — A make and break pressure
made at the edge of the sternum in the first and second
intercostal spaces will usually stimulate the heart. Some-
times the first effect is inhibition, but it quickly passes to
stimulation. The manipulation made anteriorly increases
the number and intensity of the stimuli reaching the seg-
ment of the cord from which the accelerator nerves pass
out. All centers act according to the sum of the stimuli
reaching them from all sources.

Inhibition of the Heart. — In cases of rapid heart beat
with high tension pulse the best effects are secured by
digital pressure at first, second and third dorsal spines. The
pneumogastrics have too many branches to important vis-
cera and act frequently with unexpected intensity. The
accelerators act more slowly with less intensity and the
action is sustained longer, that is, as a result of man-
ipulation.

Vaso-motor Control of the Coronary Arteries. — A fur-
ther factor in relation to the regulation of the heart's action
is the blood supply for the nourishment of the heart. All
organs act with greater force when their blood supply is
abundant. The heart beats stronger when its coronary
arteries are dilated than when constricted, therefore the
power of the heart depends on the vaso-motor control of
its own arteries.. The vaso-motor nerves to the coronary
arteries leave the cerebro-spinal system between the third
and fifth dorsal spines. In cases of angina pectoris, this
area will be sensitive. Steady pressure here will dilate the
coronary arteries and ease the pain. A sharp stroke with
the hypothenar eminence on the fourth dorsal spine will
nearly always start an attack with such patients.

Angina Pectoris. — Physiologists name the pneumogas-
tric nerve as the vaso-motor nerve to the coronary arteries.
I mention the area, third to fifth dorsal, as a vaso-motor
center for the coronary arteries because clinical experience
seems to demonstrate it. Other osteopaths have noted
the frequency of lesions in this area in connection with

PRINCIPLES OF OSTEOPATHY 159

heart difficulties. The lesions are contracted muscles, lat-
eral subluxations of the vertebrae or in some instances
subluxations of the fourth and fifth ribs. With any of
these lesions there is intense sensitiveness.

Dr. George Keith of Scotland mentions digital pres-
sure in the second left intercostal space as a means of in-
hibiting an attack of angina pectoris, and suggests the
nerve connection of the pneumogastric as being the nerve
path over which the inhibitory impulse travels.

Persons suffering with angina pectoris will press their
hands, with all the force they possess, against the left
chest. I have used heavy digital pressure on the left side
of the fourth and fifth dorsal spines while the patient was
in a paroxysm of pain. The pressure never failed to be
grateful to the patient. A further experiment with this
center was made by extending the patient in a recumbent
position. While extension was maintained the angles of
the ribs could be raised, the left arm could be extended
over the head, a full inspiration could be taken, but as
soon as the vertebrae were allowed to approximate as a
result of cessation of extension, these things could not
be done.

Heat, digital pressure and counter irritation are capa-
ble of causing vaso-constrictor paralysis, i. e., vaso-dilation,
and hence increase the power of the heart in such cases.

Action of the Heart Centers. — The governing centers
of the heart act principally according to the peripheral
resistance maintained by the blood vessels. The heart pos-
sesses a nerve called the depressor nerve. Its endings are
in the walls of the heart and are affected by the pressure
of the blood within the heart. A rise in arterial pressure
is followed by a rise in pressure within the heart. The
depressor nerve notes this fact and carries an inhibitory
impulse to the vaso-dilator center in the medulla, thus
bringing about a fall in arterial pressure. In this way the
heart is protected from over-exertion as a result of too
high pressure.

160 PRINCIPLES OF OSTEOPATHY

In cases having rapid, weak heart action, inhibit the
accelerators to slow the heart, also inhibit in the area of
vaso-motor control of the coronary arteries to increase
the amount of blood for nourishment to the heart muscle,
thus increasing the strength of the beat.

In cases of rapid, high tension pulse, inhibit the
splanchnics and in the suboccipital fossae to lessen peri-
pheral resistance, also inhibit the accelerators or stimulate
the pneumogastrics.

Vaso-motor Nerves. — In 1840 Henle discovered and
demonstrated the muscular coat of the arteries, and as a
result of this step forward we have our present knowledge
of the vaso-motor nerves. Associated with the demonstra-
tion of these nerves we have the names of Brown-Sequard,
Bernard, Waller and Schiff.

It has been proven that two sets of fibers innervate
the muscles of the arteries ; a vaso-constrictor set, which
causes a decrease in the caliber; and a vaso-dilator set
which causes an increase in caliber. The constrictors
were demonstrated first.

Henle said "the movement of the blood depends on the
heart, but its distribution depends on the vessels." We
have followed the phenomena in connection with the first
part of this quotation, hence it remains for us to study the
part played by the vessels in the distribution of the blood.

In order to carry our thoughts along in a proper man-
ner, we will commence at the center and work toward the
periphery.

The chief vaso-motor center is in the medulla. De-
struction of this center causes an immediate fall of blood
pressure all over the body. Stimulation of this center
causes a general rise of blood pressure.

There are subsidiary centers situated at various levels
in the spinal cord.

After the spinal cord is severed, that portion which is
no longer connected with the chief vaso-motor center will
exercise a vaso-constrictor influence over the blood vessels

PRINCIPLES OF OSTEOPATHY 161

in its area of normal control. "It is probable that they are
normally subordinate to the bulbar nerve cells."

After all connection between the cerebro-spinal sys-
tem and sympathetic spinal ganglia is cut off, the tone of
the blood vessels is maintained, after a short interval, by
the sympathetic ganglia.

By commencing at the center and destroying- it, then
the centers in the spinal cord assume control ; destruction
of these leaves the sympathetic spinal ganglia active; hence
by this process of exclusion we find that the true vaso-
motor cells are sympathetic and lie in the spinal ganglia.
From these cells in the spinal ganglia-axis cylinder pro-
cesses pass as gray fibers to blood vessels. These ganglia
cells are controlled by fibers from the chief vaso-motor
center in the medulla which end around the subsidiary cells
in the spinal cord, the neuraxons of these latter terminat-
ing by filaments which surround the true vaso-motor cells
in the sympathetic spinal ganglia.

FIG. 27. Arterial tension is manifested in a sphygmogram by the rela-
tive height of the aortic notch. The upper tracing shows the aortic
notch on a straight line drawn from the top of one percussion wave
to the bottom of the next. The middle tracing shows this notch
very low.

Since gray rami-communicantes pass from the spinal
sympathetic ganglia to the spinal nerves and are distributed
with them to the skin and blood vessels, we can influence
the distribution of the blood generally and locally by in-
creasing or decreasing the nurnber of sensory impulses,
originating in the skin and muscle, which may reach the
vaso-motor centers.

162 PRINCIPLES OF OSTEOPATHY

"The vaso-motor apparatus consists, then, of three
classes of nerve cells. The cell bodies of the first class lie
in sympathetic ganglia, their neuraxons passing directly
to the smooth muscle in the walls of the vessels; the second
are stimulated at different levels in the cerebro-spinal axis,
their neuraxons passing hence to the sympathetic ganglia
by way of spinal and cranial nerves ; and the third are
placed in the bulb and control the second through intra-
spinal and intracranial paths. The nerve cell of the first
class lies wholly without the cerebro-spinal axis, the third
wholly within it, while the second is partly within and part-
ly without, and binds together the remaining two." Am.
Text-book of Physiology.

FIG. 28. The signification of a sphygmogram. The space S is the period
of ventricular systole when the aortic valves are open; the space D
the period of ventricular diastole; t, the tidal wave due to the ven-
tricular systole; p, the percussion wave due to instrumental defect;
a is the aortic notch which marks the closure of the aortic valves;
d, the dicrotic wave.

Vaso-constriction. — The vaso-constrictor nerves which
pass from the bulbar and spinal centers of control leave the
cord as white rami-communicantes from the anterior roots
of the second dorsal to the second lumbar nerves and enter
the sympathetic ganglia to be distributed as has been de-
scribed before. It is believed that all of these vaso-con-
strictor fibers end in the ganglia, thus exerting their influ-
ence on the true vaso-motor cells in the ganglia which
alone send fibers to the blood vessels. All these constric-
tor nerves are gray.

Vaso-dilation. — The vaso-dilator fibers are not re-
stricted to any one portion of the cord or brain, but pass
out with both cranial and spinal nerves, and do not lose
their sheaths until they reach their destination. They

PRINCIPLES OF OSTEOPATHY 163

are best demonstrated in those regions of the cerebro-spinal
system from which vaso-constrictors do not arise. The
vaso-dilators from the head, face, salivary glands, etc., pass
to their destination with the cranial nerves supplying these
parts. They do not end in the sympathetics. They proba-
bly leave the cord in the anterior roots of the spinal nerves
and pass to the periphery without interruption. The vaso-
dilators, leaving the cord in the same region as the vaso-
constrictors to be distributed to the visceral blood vessels
probably pass out by the ventral roots and reach their
destination without losing their sheaths in the sympathetic
ganglia.

FIG. 29. Sphygmograms illustrating Tachycardia and Brachycardia. Up-
per tracing — radial pulse of a woman exhibiting great nervousness, a
small goitre but no exophthalmos. Lower tracing — radial pulse of a
young man whose power of recalling past events of his life was
suddenly lost. Result of mental shock.

No distinct centers for vaso-dilator fibers have been
demonstrated. They probably arise from segments of the
brain and spinal cord and their influence is carried along
the paths of motor nerves and is exerted in a local area.

Summary. — 1. The vaso-dilator nerves are cerebro-
spinal ; (a) and are not demedullated in the sympathetic
ganglia, (b) They are distributed principally to the ar-
teries of the muscles, (c) and leave the cerebro-spinal axis
with the motor nerves from all portions, (d) Their influ-
ence is local.

2. The vaso-constrictors are essentially neuraxons of
sympathetic cells in the spinal ganglia; (a) are gray fibers;

(b) are distributed to viscera and cutaneous blood vessels;

(c) and are probably continuous in action to maintain the

164 PRINCIPLES OF OSTEOPATHY

tone of the vascular system, (d) The vaso-motor cells in
the sympathetic ganglia can act independently, (e) but are
normally under the control of the cells in the spinal cord
whose neuraxons end in the spinal ganglia, (f) These
cells in the spinal cord are under the influence of neuraxons
of cells in the medulla which constitute the chief vaso-
motor center, (g) Therefore, the vaso-constrictor influ-
ence is both local and general, (h) The controlling fibers
leave the cord in the ventral roots of the second dorsal to
the second lumbar nerves only.

Sensory Nerves. — We have now considered in detail
only one side of the vaso-motor mechanism, the motor.
We have yet to note the sensory side, that which calls forth
the motor response. If there were no chief or spinal vaso-
motor centers to transfer sensory impulses to the vaso-con-
strictor cells in the spinal ganglia, the blood vessels in the
viscera and skin could not contract or relax according to
the necessity for greater or lesser amounts of heat in the
-deep or superficial areas.

The vaso-motor centers in the brain and cord send
out impulses in response to sensory stimulation; this sen-
sory stimulation is usually of a thermal or mechanical
character.

It is difficult to realize the extent of the distribution
of sensory nerves. "They are located not only in those
places usually known to be sensitive, but also in all other
tissues and organs. Whether one examine the liver or the
kidney, lung or the wall of a blood vessel, one always finds
delicate nerve arborizations in unsuspected numbers. A
large portion of them end probably in the peripherally
placed end cells belonging to the reflex arc of the sympa-
thetic ; another portion may very probably be traced to
the spinal ganglia, and even to the spinal cord itself, es-
pecially the investigations of the past two years, making
use of the silver and methyl blue stains, have not only dis-
closed the wealth of nerves in the different organs, but
have also shown that we have regarded the sensory in-

PRINCIPLES OF OSTEOPATHY 165

nervation of the sensitive surfaces, as the skin and the
gustatory-mucous membrane as much less fully explained
than they really are. One finds there numerous plexuses
of nerve fibers beneath and between the epithelial cells,
and they send one, often many, fine fibrils to each cell."
"In the liver, too, and the bladder, and many
other places, one can find numerous examples of the abun-
dant peripheral innervation. We have always given too
great importance to the single end apparatus, overlooking
the fact that really the major portion of the body tissues is
supplied with nerves for every cell. One can hardly over-
estimate the wealth of nerve fibers in the end organs them-
selves, as the taste papillae and the tactile papillae. Good
staining discloses with each of them plexuses of unexpected
density of arborization."

"For what services may such an abundant sensory
innervation be provided? It occurs immediately to one
that there are a great number of reflexes, very necessary to
the preservation of the individual, even though he be un-
aware of them. The regulation of the secretions, the blood
supply to the skin in relation to the caloric body economy
of the organism, the adjustment to varying illumination,
the tension of the muscles and tendons through the re-
spective tendon reflexes, the different response by such
varying tensions according to the intensity of the volun-
tary impulse, and many other phenomena could be cited.
To all of them is necessary, besides the motor part of the
reflex arc, a sensory part. Indeed, Exner, to whom we are
indebted for indicating the importance of these short re-
flex arcs and the roles they play in the organism, has
pointed out how, in general, for the production of any
movement the sensory innervation must be intact."

"By 'sensory innervation,' however, one must not think
only those processes are meant which enter into our con-
sciousness, but rather all those by which from any place
in the body impressions are conducted to the nearest gan-
glion, or to the central axis. Whether they be conducted

166 PRINCIPLES OF OSTEOPATHY

farther still, or whether they be recognized by the in-
dividual as they occur does not affect their nature. Sen-
sation and perception are not the same thing." — Anatomy
of the Central Nervous System in Man and in Vertebrates
in General. — Edinger.

Thus we find that there are abundant sensory nerves
in superficial and deep tissue to receive the mechanical
stimuli which the osteopath may project upon them.

Recent investigations prove that many conditions
which have previously been called inflammation are, in
reality, congestions due to vaso-constrictor paralysis, and
can be corrected by stimulation of the vaso-constrictor
center governing the congested area; the stimulation of
such center being secured by mechanical stimuli applied to
the sensory nerves ending in the center.

The vaso-motor mechanism responds quickly to osteo-
pathic manipulation, and is our means of correcting any
disturbance of circulation, both local and general.

Since the blood carries the nourishment for the tis-
sues, and the vaso-motors control the distribution of the
blood, the vaso-motor nerves are trophic nerves. In the
same sense they are secretory nerves.

Capillary Circulation. — The capillary circulation is de-
pendent on the state of the arterioles. Their walls are
formed by endothelial cells which are elastic, and hence
respond to the force of the blood which enters them. If
the vaso-constrictors are active in a local area the re-
sistance offered to the passage of the blood current by the
arterioles is increased, and therefore the pressure exerted
on the capillary walls is lessened, allowing the capillaries
to contract. If the vaso-constrictor influence over the
arterioles be lessened, the blood current is allowed to exert
its pressure on the capillary walls, thus increasing the
caliber of the capillary.

If, in a large area of the body, vaso-constrictors are
active, the influence of this resistance is felt by the heart,
which immediately beats harder to overcome the resistance

PRINCIPLES OF OSTEOPATHY 167

to the passage of the blood through the constricted arteries.
The heart is usually relieved by compensatory dilatation
of the arteries in some other area. The visceral and cu-
taneous arteries usually counter-balance each other in this
way. This counter-balancing effect is probably brought
about through the sensory impressions sent out from an
overworked heart to the vaso-motor center, thus causing
a lessened constrictor effect in some portions of the body.

The relaxation of all the arteries of the body would
cause death, because the blood would gravitate to the most
dependent part, and there is not blood enough to fill all
the arteries when relaxed. A slight relaxation of general
blood pressure causes the heart to beat more rapidly for
a short time. Relaxation of the peripheral blood vessels
is noted by the increased warmth and redness of the area
in which relaxation takes place.

Recapitulation. — To recapitulate: (1) Capillary circu-
lation is passive. (2) Vaso-constriction of the arterioles
causes a decrease in the lumen of the capillary. (3) Vaso-
dilation of the arterioles causes increase in the lumen of
the capillary. (4) General vaso-constriction of the cu-
taneous blood vessels slows the heart and causes it to work
against higher pressure, but the heart is relieved by relaxa-
tion of blood vessels in visceral areas, chiefly the splanch-
nics. (5) Decrease of constrictor effect on superficial ves-
sels causes a more rapid heart beat, which is quickly con-
trolled by constriction in the splanchnic area. (6-) The
vaso-motor center in the medulla acts according to the
sum of the sensory influences reaching it from all parts of
the body. (7) The spinal vaso-motor centers act according
to the influences sent to them by the chief center and the
sensory impulses which enter their segment of the cord.

Vaso-motor Centers. — The vaso-motor centers for the
various viscera, organs and members are as follows :

HEAD: The superior cervical ganglion.

EYE : The superior cervical ganglion through the fifth
nerve.

168 PRINCIPLES OF OSTEOPATHY

NOSE, THROAT, TONSILS, TONGUE and GUMS:
By the same path. Dilator fibers for the tongue per the
lingual branch of the fifth cranial nerve.

BRAIN: "Sherrington and others have demonstrated
the presence of vaso-motor nerves in the vessels of the
brain. It is probable that the cerebral circulation is wholly
dependent upon the general blood pressure, and, inasmuch
as the general blood pressure is very markedly regulated
by the capacious splanchnic area, it is obvious that the
cerebral circulation may be better controlled by modifying
the blood supply of the splanchnic area than by any at-
tempts at the modification of the cerebral circulation itself."

Sympathetic fibers to the anterior and middle fossae
come from the superior cervical ganglion per the carotid
plexus. Sympathetic fibers are distributed to the vessels
in the posterior fossa from the vertebral plexus which is
formed by fibers from the inferior cervical ganglion.

THYROID GLAND: Middle and inferior cervical
ganglion.

The vaso-constrictors for the blood vessels of the head,
face and neck with their contained organs leave the spinal
cord in the upper dorsal, second to fifth, and pass thence
through the cervical ganglion.

LUNGS : Second to the sixth dorsal.

INTESTINES: The vaso-constrictors for the mesen-
teric blood vessels are found in the splanchnic nerves. Com-
mencing at the fifth dorsal, there is a segmental distribution
to the various portions of the intestines. The lowest con-
strictor influence comes from the second lumbar. Vaso-
dilator fibers are also found in the splanchnics.

LIVER : Sixth to tenth dorsal, right side.

KIDNEY : Tenth to twelfth dorsal.

SPLEEN : Ninth, tenth and eleventh dorsal, left side.
The vagus is a motor nerve to the muscular fibers in the
trabeculae of the spleen.

PORTAL SYSTEM : Fifth to ninth dorsal.

PRINCIPLES OF OSTEOPATHY 169

EXTERNAL GENERATIVE ORGANS: First and
second lumbar, through the lumbar sympathetic ganglia,
second to the fifth, to the hypogastric plexus, thence
through the pelvic plexuses and pudic nerves to the gen-
erative organs. Function, vaso-constriction. First, second
and third sacral nerves are vaso-dilators to the same organs.

INTERNAL GENERATIVE ORGANS: Vaso-con-
strictor influence at first and second lumbar.

ARTERIES TO THE SKIN OF THE BACK: Vaso-
constrictor influence from sympathetic ganglion of the cor-
responding segment.

UPPER EXTREMITY: Vaso-constrictor influence to
the skin, from second to the seventh dorsal.

LOWER EXTREMITY : Sixth dorsal to second lum-
bar.

MUSCLES : Dilator influence to the arteries of the
muscles per motor nerves to the muscles.

Conclusions. — Vaso-motor nerves are of two classes,
viz : Vaso-constrictor and vaso-dilator. These nerves act
according to the sum of the stimuli reaching their govern-
ing center over sensory nerves of skin, muscle and gland.
Therefore the osteopath depends on increasing or decreas-
ing the stimuli reaching the spinal centers.

The heart is innervated by two sets of nerves which
control it. These nerves arise from centers in the cerebro-
spinal system and govern the action of the heart according
to the sum of stimuli reaching their centers over sensory
nerves of skin, muscle and gland, and in harmony with
the resistance maintained by the peripheral blood vessels.

Since perivascular tissues are dependent on the trans-
fusion of nutriment from the blood, through the walls of
the capillaries into the lymph, and this process of trans-
fusion is dependent on the tension and speed of the cur-
rent of blood in the capillaries, any condition which
markedly increases or decreases this speed and tension
will affect the nourishment of the tissues.

170 PRINCIPLES OF OSTEOPATHY

Hyperaemia. — A study of hyperaemia is, in reality, a
study of the vaso-motor mechanism. We have noted the
fact of vaso-motor nerves controlling the caliber of blood
vessels. These nerves are branches of the cerebro-spinal
system. Most of them leave the spinal nerves and pass to
the sympathetic spinal ganglia as rami-communicantes and
then pass up and down to other ganglia of the sympathetic
system. Some fibers return from the sympathetic to the
spinal nerves and are distributed to blood vessels of skin,
muscle and bone in the area of distribution of the spinal
nerves. A few vaso-motor nerves do not enter the sympa-
thetic system but pass directly tc their destination with
the spinal nerves. Thus two paths exist by which vaso-
motor impulses reach the blood vessels, a direct route with
the spinal nerves and an indirect one through the sympa-
thetics.

Experimenters have long noted the return of vascular
tone in an area whose vaso-constrictor nerves have been
cut. This return of vascular tonicity is supposed to be
due to the presence of a perivascular mechanism which
is capable of acting feebly after all other constrictor in-
fluences have been paralyzed.

So far as methods of treatment are concerned, we have
paid very little attention to the presence of vaso-dilator
nerves, but physiologists seem to prove that there are fibers
leaving the cord with the posterior roots of the nerve trunks
which act as dilators when irritated. The vaso-constric-
tor nerves are considered as constantly in action.

Irritation of the dilator nerves or paralysis of the con-
strictors will result in dilatation of the arterioles, so that
the capillaries will be dilated to their fullest extent. Such
a condition is called an "active hyperaemia." When the
exit of the blood through the veins is obstructed and con-
gestion results it is denoted "passive hyperaemia."

The same irritants, mechanical, thermal and chemical,
which are capable of stimulating muscles to unusual or un-
equal contractions so as to produce marked evidences of

PRINCIPLES OF OSTEOPATHY 171

changed bony alignment, also cause such decided changes
in the caliber of blood vessels as to cause tissues to be-
come hyperaemic or ischaemic.

If any hyperaemia exists in the mucosa of the stomach,
palpation around the sixth dorsal spine will disclose ten-
derness. This spinal tenderness is probably due either to
the irritation of the dilator fibers which accompany the
posterior division of the fifth dorsal nerve or to paralysis
of the vaso-constrictors of that area. The resulting dila-
tation impinges on sensory nerves and causes tenderness.
The irritation of sensory nerves in the mucosa of the
stomach causes dilatation of blood vessels in that area
and in the spinal area from which its sensory nerves arise.
The irritation might have originated centrally and then in-
volved the stomach, thus reversing the course of the irrita-
tion. These reflex hyperaemias are continually noted in
practice, and it is through the reflexes that relief is ob-
tained. One of the classical experiments to prove the re-
flex action of vaso-.motor nerves is to immerse one hand
in cold water, the temperature of the other hand will be
lowered also.

It is quite generally conceded that the small arteries
and arterioles in all parts of the body are supplied with
vaso-motor nerves. Their presence in the blood vessels of
the brain has been recently proven by G. C. Huber. His
demonstration of vaso-motor nerves in the cerebral blood
vessels explains many of the circulatory phenomena result-
ing from osteopathic manipulations.

Irritation of sensory nerves in any part of the body
causes vascular dilatation in the irritated area. Physi-
ological experiments seem to prove that vaso-dilator fibers
accompany the sensory nerves, or that irritation of sensory
nerves causes paralysis of vaso-constrictor nerves. Irrita-
tion of the nerves of one side of the body by pricking with
a pin causes a rise of temperature on that side and a de-
crease on the unirritated side, thus demonstrating that
vaso-dilation follows sensory irritation.

172 PRINCIPLES OF OSTEOPATHY

Experiments to note the effects of direct mechanical
irritation of the stomach mucosa demonstrate that dilata-
tion of gastric blood vessels follows mechanical irritation.
The physiological hyperaema thus produced is for purposes
of increased secretion. It is well known that when this
physiological congestion is continued without cessation, as
in the case when meals are frequent and full, the con-
gestion becomes pathological, and the secretion of mucus
is rapid. The liver and intestines become chronically con-
gested from similar causes. This hyperaemia leads to ex-
udates and hyperplasia which further irritates sensory
nerve endings and continues the dilatation of the arterioles.
Thus a vicious cycle of reflexes is established which tends
to ever increasing destructiveness.

When the sensory nerve terminals in the stomach are
irritated and hyperaemia of the gastric vessels results, the
influence of the irritation does not end with gastric con-
gestion, i. e., if the hyperaemia be excessive, but causes
dilatation of arteries in the spinal cord around the roots of
sensory nerves distributed in other parts of the body which
are supplied by branches of the same nerve trunk. The
brain does not always note the real location of the irrita-
tion. It may refer the pain to any point supplied by a
branch of the nerve trunk, one of whose branches is irri-
tated. Thus in the presence of chronic congestion of the
gastric mucosa, as in gastric catarrh, the irritation may
not be intense enough to impress the brain with a painful
sensation, but a slight increase of capillary pressure around
the trunk of the sixth dorsal nerve such as would be brought
about by digital pressure made upon the muscles around
the sixth dorsal spine, would cause instant recognition of
hyperaesthesia by the patient. Continued pressure made
around the spine drives the blood out and lessens the sen-
sitiveness. If hyperaemia has been intense enough to
cause exudates, pressure increases the pain the longer it is
continued, because the exudates have affected the venous
circulation and there is no open path for exit of the blood.

PRINCIPLES OF OSTEOPATHY 173

From personal experience I should judge that it is
quite probable that hyperaemia occurs along the whole
course of the nerve and the nervi nervorum are rendered
more sensitive thereby. In case of absolute neuritis, man-
ipulation relieves the condition temporarily, but the pain
increases shortly after the treatment is given. This shows
that a condition exists which is much more difficult to
change than a reflex hyperaemia.

Continued hyperaemic conditions cause increased nu-
trition, i. e., hyperplasia of connective tissue. Connective
tissue seems to be more readily formed than any of the
higher grades of tissue. This may explain the rapid stif-
fening of the spine in cases of visceral hyperaemia.

The digital pressure test is an excellent method of
differentiating the intensity of an hyperaemia. Even in
cases of conscious pain in the gastric or intestinal areas, it
is possible to use this test. In colic, deep pressure made
gradually will give relief, but in cases of gastric ulcer or
other inflammatory conditions, pressure aggravates the
pain.

Therapeutics. — We now have before us an array of
physiological facts and it remains for us to indicate how
we shall use them.

The osteopath treats the vaso-motor nerves as though
there were no dilator fibers to be reckoned with. Practically,
we consider that the vaso-constrictors are continually act-
ing to maintain the "tone" of the blood vessels. There-
fore, having only this one force with which to reckon, we
consider all dilatation as vaso-constrictor paralysis.

We noted the fact that the cutaneuos and visceral
blood vessels were supplied with vaso-constrictors and
that vaso-constriction in the superficial area was compen-
sated for by dilatation in the deep area.

A large number of sensory impressions reaching the
vaso-motor centers over the sensory nerves of the skin
usually result in vaso-constriction of cutaneous blood ves-

174 PRINCIPLES OF OSTEOPATHY

sels, hence internal congestion. Irritation of the sensory
nerves in the skin may cause muscle under the skin to con-
tract, thus obstructing the circulation in the skin. There-
fore, our manipulations for vaso-motor effects naturally
divide themselves into two classes. First, those which in-
hibit cutaneous reflexes ; second, those which relax muscle
in order to remove obstructions. This division is purely
arbitrary on our part, but it serves to explain our work.
We purposely leave out of this discussion the thought that
we may have an osseous lesion causing our vaso-motor
disturbance. We divide the spine into areas according
to the predominating influence which issues from it; thus,
the sub-occipital fossa is the first important area. It has
long been known that pressure applied to this area in a
case of congestive headache gives great relief. The good
effects are not lost when the pressure is removed. This
proves that the effect of the pressure is on the nerves of
that area, and that they are in close central connection
with the vaso-motor center in the medulla. This center
regulates the caliber of the arteries all over the body. It
has been stated that pressure at the basi-occiput retards
the blood flow to the brain, the pressure being on the ver-
tebral arteries. We believe a careful examination of the
atlas will convince one that in the average skeleton the
groove for the vertebral artery is so deep and well pro-
tected that pressure on the surface of the neck cannot af-
fect the artery. If our pressure effect is mechanical, why
does the effect last so long? The blood stream is as swift
as an ocean greyhound, and would rush into the partly
filled vessel with its previous force just the moment the
pressure is removed. We can only explain the result by
noting the fact that a change has been made in the entire
circulation. Downward pressure on the carotids is also
recommended to retard the blood flow to the head. This
seems impracticable since the pressure cannot help af-
fecting the venous return as well as the carotid stream.
The best and most lasting effects are always vaso-motor.

PRINCIPLES OF OSTEOPATHY 175

It is a well recognized fact in the osteopathic profes-
sion that pressure in the suboccipital triangles causes a
lessened blood pressure all over the body. This fact is
made use of daily to lower the temperature of the body
in cases of fever. If pressure had a mechanical rather
than a nervous effect on the circulation, we could hope
for no general effect, such as we do secure. This procedure
is called inhibiting the vaso-motor center. Why does it
inhibit? A "vascular tone" is normal in the body in order
to keep the blood equally distributed. This "vascular
tone" is easily disturbed since it acts according to the sum
of the sensory impulses reaching the center in the med-
ulla. Pressure in the suboccipital triangles affects not only
the sum of the stimuli reaching the center, but, most im-
portant of all, affects the capillary circulation in this area
which is in close nervous and circulatory connection with
the medulla. Any external application, such as hot or cold
water, local anaesthetics or counter-irritants must secure
whatever internal change may be manifested, by the ef-
fect these therapeutic procedures may have on cutaneous
nerves.

Pressure in the suboccipital triangles will relax the
structures forming those triangles, thus lessening the sen-
sory impulses entering the center from that source. The
relaxed structures will hold more blood, hence they will
in a slight degree relieve congestion of the center.

These triangles are the bilateral surface centers in
which we operate to cause dilatation of vessels in the skin
of the trunk and extremities. We inhibit vaso-constricton
of surface arteries.

The next great constrictor area is the splanchnic, sixth
to eleventh dorsal. This and the preceding area are the two
points of vantage for the osteopath. Since the splanchnic
nerves control a system of blood vessels whose combined
capacity is equal to the entire amount of the blood in the
body, we can quickly realize what it means to the general
circulation to affect this area. In all cases of congestive

176 PRINCIPLES OF OSTEOPATHY

headaches, fever, hyperaemia of visceral organs, etc., we
"inhibit the splanchnics." Why? The reflexes between
the skin of the back and the muscles of the back are so
intense that they cause vascular constriction of the cu-
taneous arteries and contraction of the deep muscles of
the back, thus adding a mechanical obstruction to the cir-
culation of the blood in an already constricted area. Is
it not possible, yes, probable, that this state of the surface
tissue causes a congestion of the vaso-motor centers in
the dorsal area of the cord, thus nullifying their control
of the splanchnic area? Such a condition might be brought
about by cold. The eating of indigestible food which re-
mains a long time in the digestive tract may also be a
cause.

The facts are as we have stated them, we inhibit over
the splanchnic area to lessen the intensity of the reflexes
in that area, thereby allowing the centers to regain their
control. Remember that inhibition lessens the sensory
impressions reaching a center and relaxes muscle both
directly and indirectly.

Case Illustrations. — An illustration of osteopathic
methods applied to hyperaemia is afforded by the following
case : A gentleman about fifty years of age was inspecting
mines in the vicinity of Yuma, Arizona. He was of ple-
thoric habit and hence the heat of that locality affected
him quickly. About eight p. m., while in his tent pre-
paring to bathe in order to get some relief from the in-
tense heat, he felt a wave of weakness pass up his left side
and almost instantly power of motion on that side was
lost. Paralysis did not extend to the face. The gentle-
man was brought to Los Angeles and came under the best
of medical treatment. Electricity and massage were tried
with fair success, but the left arm and hand remained
helpless and were carried in a sling. The hand was badly
swollen and would pit under pressure, thus showing a
marked degree of vaso-constrictor paralysis. The hand
and arm had been thoroughly massaged for two months

PRINCIPLES OF OSTEOPATHY 177

before osteopathic treatment was given. One hour's seance
with the masseur would make a wonderful change in the
hand, but the oedematous condition returned in a few
hours. The ringers were bent into the palm, showing a
marked tendency to a spastic condition.

From the medical standpoint it was considered suf-
ficient for this case to have the local massage of the arm
and hand, with administration of strychnine.

The osteopathic examination was made at the end of
two months of the treatment just outlined. Slight signs
of paralysis were noted at the angle of the mouth on the
hemiplegic side. Examination of the neck showed marked
contraction of the deep cervical muscles on the left side,
extending from the occiput to the fourth cervical vertebra.
Moderate digital pressure over these contracted muscles
caused pain. There was also some tenderness as low as
the sixth dorsal spine. The intense contraction and tender-
ness in the upper cervical region was noted as a secondary
lesion existing as a result of a blood clot. It was reasoned
that if these contracted muscles could be relaxed cerebral
circulation would be equalized and more rapid absorp-
tion of the clot made possible. The spinal tenderness was
brought about by the same law of irritation of sensory
nerves we have previously stated. There was a dilated
condition of the arterioles around the roots of the sensory
nerves in the cord similar in character to that which existed
at the peripheral distribution of these nerves, especially in
the hand. There was decided wrist and elbow reflex, show-
ing that the subsidiary nerve cells in the cord were intact,
but that either the cerebral motor areas or some part of
their connecting paths were injured. The vascular tone
of blood vessels in all other parts of the body was good,
showing that the chief vaso-motor center in the medulla
was acting. Here was a case showing a perfect reflex in
the arm but loss of ability to will a motion ; perfect sensa-
tion and vaso-motor paralysis.

178 PRINCIPLES OF OSTEOPATHY

Treatment was directed to securing relaxation of the
contracted cervical muscles and to breaking up adhesiions in
the shoulder joint which had been allowed to stiffen. No
treatment was given to the hand or arm. The patient was
instructed to straighten the bent fingers with the well hand
many times per day to overcome the spastic condition.
Vaso-motor tone returned to the blood vessels of the hand
in proportion to the amount of cervical relaxation ac-
complished. At the end of one month the hand was al-
lowed to hang naturally, and scarcely any oedema was
noticeable. Muscular control and power have steadily
increased.

Another illustration is afforded by the following case :
A gentleman suffering with inflammatory rheumatism in
the second toe of the right foot sought relief by means of
osteopathic treatment. He had used the salicylates in his
previous attacks, but his stomach had become intolerant of
them. The toe was red and angry looking, throbbing with
pain and swollen to the size of the great toe.

Examination of the spine revealed tenderness between
the fifth lumbar and third sacral spines, also between the
second and third lumbar spines. Why should tenderness
exist at these points? The answer according to anatomy
and physiology is that these spinal areas mark the point of
emergence from the spinal column of the anterior crural
and great sciatic nerves which are distributed to equal
parts of the affected toe; the sensory nerves being ir-
ritated by the deposit of faulty katabolic products in the
tissues of the toe as the result of a slow blood stream.
In this case the patient was caught out in the rain and
got his feet wet. The peripheral irritation of the sensory
nerves caused dilatation of the arterioles and capillaries.
The blood vessels around the roots of other sensory
nerves which were branches of the same nerve trunks also
dilated in response to this irritation, i. e., hyperaemia in
the spinal cord was brought about at the point of origin

PRINCIPLES OF OSTEOPATHY 179

of the. anterior crural and great sciatic nerves, hence the
sensory nerves to the skin and muscles of the back which
are innervated from the same area of the cord as these
great nerve trunks will also be tender to increased tension
such as that secured by the digital pressure.

In a case such as this we do not desire to have the
deposit in the toe taken up until the eliminating organs
of the body are acting freely. To force it into the circula-
tion before such time as it can be eliminated may result in
inflaming another part. It is quite necessary that the
throbbing pain be subdued so that sleep may be had. The
patient soon learns to take advantage of venous circula-
tion by elevating the foot. If pressure upon, and a gentle
relaxing movement of the muscles in the spinal area is
made, there will quickly be noted a decrease in spinal
sensitiveness followed by lessened conscious pain in the
toe. It is quite probable that pain in the toe is due to
hyperaemia; sensitiveness in the spinal area is due to the
same sort of condition, the difference being in degree. It
is impossible to prove the presence of these transitory
hyperaemias by any direct observations any more than it
is possible to prove by post mortem examination that hy-
peraemia or anaemia of the brain is present as a fixed
pathological lesion in faulty functioning of the brain.

Pressure and relaxation in the spinal area draws the
blood away from its position around the nerve trunk roots
and thus stops many of the impulses which would originate
centrally as a result of the irritation of the sensory roots of
the nerve trunk.

We usually think of these reflex sensitive areas of the
spine as being evidence of the ability of all the branches of
a nerve trunk to express some degree of the irritation be-
ing brought to bear on any one of the branches. It seems
to me that in the light of what is known to happen in the
area of an irritated nerve, hyperaemia, that the same
change in circulation may occur around the roots of its

180 PRINCIPLES OF OSTEOPATHY

parent nerve trunk and be the sole reason for what we de-
nominate a reflex pain.

By giving the heavy movement required to replace a
subluxated vertebra or even to relax tense muscles around
an otherwise normal articulation, it is quite probable that
inexplicable changes are wrought in the circulation at
these points which immediately change the character of
the nerve impulses originating or reflexing from this por-
tion of the spinal cord.

PRINCIPLES OF OSTEOPATHY 181

CHAPTER X.

HILTON'S LAW.

In the years 1860-61-62 a seres of lectures was delivered
by John Hilton, F. R. S., F. R. C. S., "On the Influence of
Mechanical and Physiological Rest in the Treatment of
Accidents and Surgical Diseases, and the Diagnostic Value
of Pain." These lectures were afterward published in book
form under the title of "Rest and Pain." This book is a
medical classic and worthy of careful perusal by all stu-
dents of medicine.

The careful observations and reasonings therefrom
which are reported in "Rest and Pain" explain many of the
phenomena noted in osteopathic practice. We desire to
give all due honor to this man who was so far in advance
of his time.

We will quote a few paragraphs from "Rest and Pain"
which have a direct bearing on osteopathic methods of
diagnosis and therapeutics.

The Law Stated. — After careful study of the distribu-
tion of nerves throughout the body, Hilton sums up his ob-
servations in a terse sentence which we choose to call a
law : "The_same trunks of nerves whose branches supply
the groujrjs jrf muscles moving^ a joint, furnish also a_djs^
tribution of nerves to the skin over the insertion of theu
same muscles, and the interior of the joint receives its
nerves from the same source."

Hilton further states that "Every fascia of the body
has a muscle attached to it, and that every fascia through.-
<>ut the body must be considered as a muscle/'

182

PRINCIPLES OF OSTEOPATHY

a Spinal Cord

t> posterior pnmo.ru

t Internal branch. (

d External bronchi t( mu.scu.tar)

€. bymjoathedc f)anc)U(m

, LaCeval cu-C<xntou&
. T^ecu.rrenf branch

Verva Cai/o, lt«fertor.

S\or<Ca,

5ymipathet«.C branch

a tKe wtcU ran^e anxi trvtlmate retatton.5

J)tsl?i()tttloiv and Connections.

FIG. 30. Drawn by Dr. J. E. Stuart.

PRINCIPLES OF OSTEOPATHY 183

Methods of Studying Anatomy. — These statements
lead us to a closer study of each joint and its controlling
muscles and governing nerve or nerves. We may study
anatomy under artificial divisions such as Osteology, Syn-
desmology, Myology, etc., and still, after securing an
accurate technical knowledge of details, we have nothing
of practical value. It is in the correlation of these tissues
with their interdependence quite fully understood that we
have a working knowledge. With this thought of the in-
fluence of one tissue on another and the harmonious ac-
tion secured by the comparatively varied distribution of
the nerve trunks, we find a new and vital interest in
anatomy.

This law is based upon the facts of anatomy and physi-
ology, and makes our concrete knowledge of these sub-
jects of constant practical value in both diagnosis and
therapeutics. This law shows us the "why" of certain vital
and mechanical manifestations, and teaches us practical
methods of treatment.

Example of Hilton's Law. — -An example of Hilton's
law is the distribution of the sciatic nerve to the ankle.
The muscles moving the joint, the synovial membrane and
most of the skin over the joint are all innervated by it.

The Knee. — The knee has three nerves. Each one has
a motor and sensory control. The extensor muscles and
the skin over them is innervated by the anterior crural.
The flexor muscles and the skin over them is innervated
by the sciatic. The obturator, in addition to these nerves,
furnishes sensory filaments to the synovial membrane. All
the joints of the body may be examined in the light of this
law. The same segment of the central nervous system
which gives off a purely motor nerve trunk, gives off also
a sensory nerve whose filaments are distributed over the
same area. Thus it is sometimes necessary to go to the
central nervous system to discover this association of
motor and sensory distribution. In practice we always do

184 PRINCIPLES OF OSTEOPATHY

this, because it is easier to work from the center of the
areas of distribution.

The Object of Such a Distribution. — Hilton says : "The
object of such a distribution of nerves to the muscular and
articular structures of the joints, in accurate association, is
to insure mechanical and physiological consent between
the external muscular, or moving force, and the vital en-
durance of the parts moved, namely, of the joints, thus
securing in health a true balance -of force and friction until
deterioration occurs."

"Without this nervous association in the muscular
and articular structures, there could be no intimation by
the internal parts of their exhausted condition." "Again,
through the medium of the muscular and cutaneous nervous
association great security is given to the joint itself by
those muscles being made aware of the point of contact
of any extraneous force or violence. Their involuntary
contraction instinctively makes the surrounding structures
tense and rigid, and thus brings about an improved de-
fence for the subjacent structures."

The Uniformity of the Law. — "This articular, muscu-
lar and cutaneous distribution of the nerves is, in my
opinion, a uniform arrangement in every joint in the body.
We may find numerous illustrations of the same method
of distribution in other parts of the body, which have the
same definite relations to each other, and in this respect
present the same physiological and mechanical arrange-
ment observable in joints. * * * This same prin-
ciple of arrangement, anatomically, physiologically and
pathologically considered, is to be observed with an equal
degree of accuracy in the serous and in the mucous mem-
brane. Thus considered, it presents a principle which, if
it has any application in practice, must be one certainly
of large extent."

Precision of Nervous Distribution to Muscles. — "The
great precision with which muscles are supplied by their
nerves is worthy of remark; and is such that if we have

PRINCIPLES OF OSTEOPATHY 185

before us a contracted muscle, we may be sure of the
nerve which must be the medium, or the direct cause of it."

"In studying the supply of nerves to muscles over
every part of the body, we find a great degree of precision,
which marks one difference between their distribution
and that of the arteries."

Indications for Use of Therapeutics. — "I should say in
aid of other means, employ this cutaneous distribution of
nerves as a road or means toward relieving pain and irrita-
tion in the joint. You thus quiet the muscles, prevent ex-
treme friction, and reduce muscular pressure and spasm.
Therapeutics may certainly reach the interior of this joint
and its muscles through the medium of the nerves upon
the surface of the skin, and so induce physiological rest to
all the parts concerned in moving the joint. * * *
The advantage to be derived arises in this way: Sensibility
of the filaments supplying the skin being reduced, that
influence is propagated through the sensitive nerves to the
interior of the joint and to the muscles moving a joint.
This diminution of sensibility tends to give quietude or
perfect rest to the interior of the joint, which is one of the
most important elements towards the successful issue of
the treatment of cases of this kind."

The Use of Hilton's Law in Physical Diagnosis. — Hil-
ton's law is applicable in physical diagnosis. The osteo-
path makes constant use of the superficial expressions of
nerve activity. After having learned the whole course, dis-
tribution and central connections of the nerve, we can
judge rightly as to the structures involved by noting the
physiological conditions of all the structures innervated
by a definite nerve trunk. Hilton applied his law entirely
from the physiological side, i. e., he observed changes in
the relations of joint structures, but considered the de-
formity as due to excessive physiological action of the
muscles in their effort to secure rest for the joint surfaces.
This is largely true, but he did not question how the pro-
cess was initiated. The osteopath seeks a point of stimu-

186 PRINCIPLES OF OSTEOPATHY

lus to the nerves controlling a joint or other structure,
believing that it is of little value to anaesthetize nerve
endings and give rest so long as this stimulus is allowed
to arouse impulses in the nerve fibers.

Comparison of Methods. — To compare methods of us-
ing Hilton's Law, we will note one of his cases, and a sim-
ilar one treated osteopathically. In Chapter VIII of "Rest
and Pain" he describes a case of inflammation of the shoul-
der joint, and mentions that the joint is fixed in a position
of rest as a result of the association of nerves to the syno-
vial membrane, the muscles of the joint and the skin over
the joint. Anaesthesia releases the fixedness of the joint,
because the muscles do not contract after the sensory im-
pulses are deadened by the anaesthetic. He says, "Thera-
peutics may certainly reach the interior of this joint and
its muscles through the medium of the nerves upon the
surface of the skin, and so induce physiological rest to all
parts concerned in moving the joint. I mean to say that
these nerves upon the surface of the skin being in direct
association with the interior of the joint itself, we may
reduce the muscular spasm as well as the sensibility of
the interior portion of the joint, by applying our anaes-
thetics with accuracy and with sufficient intensity upon
the exterior of the deltoid muscle, over the distribution of
these sensitive filaments. The thought will occur to you
at once that there is nothing very remarkable in this opin-
ion, and that is quite true. The embrocations, however,
which would ordinarily be suggested for this purpose, are
not of a character sufficiently potent to alleviate the pain
of the patient, and are, I believe, seldom employed with a
definite idea in the mind of the prescriber. I would sug-
gest that we should employ our fomentations strongly
medicated with belladonna, with opium or with hemlock,
instead of using mere fomentation of hot water. Some will
say, 'Oh, hot water is quite as good;' but I can assure you
practically that it is not so."

PRINCIPLES OF OSTEOPATHY 187

You will note that he makes use of the cutaneous re-
flexes to affect the interior of the joint.

A recent case, corresponding we believe, was treated
osteopathically with marked success. The inflammation
in the shoulder joint was not traumatic in origin nor did
it appear to be rheumatic in character. Hot fomentations
would give great relief, but did not give sufficient rest to
the joint to permit of a cure. The fear was entertained
that longer rest of the articulation would result in adhe-
sion and loss of function in the joint. Since the circum-
flex nerve appeared to be the one involved, a careful ex-
amination was made of the articulations between the sixth
and seventh cervical vertebrae. The circumflex nerve is
made up largely of fibers from the sixth cervical nerve
trunk. Tension and tenderness, together with slight ro-
tation of the sixth cervical were noted at this point. The
osteopath, instead of working over the area of distribution
of the circumflex, centered his work upon this articulation
to bring about right relations between the sixth and sev-
enth cervical vertebrae. Tension and irritation were re-
moved. The circumflex nerve ceased to manifest any un-
due irritation. The osteopath almost invariably works
from the center to periphery instead of the reverse.

Herpes Zoster. — An example of the osteopath's use, or
rather recognition of Hilton's law : A case of Herpes Zoster
located along the course of the left fifth intercostal nerve
was given a grave prognosis by a homeopathic physician.
The patient visited an osteopath immediately, hoping that
some relief might be found for the intolerable pain. The
eruption extended from the spine to the median line in
front, forming a band about one inch wide. The fifth rib
was found rotated downward, thus lessening the fifth inter-
costal space and pressing on the nerve at some point in
its course. This rib was raised, even though the osteo-
path's fingers rested directly upon the eruption, in order
to force the rib upward. The result was most gratifying.
Pain decreased almost immediately, and there was a rapid

188

PRINCIPLES OF OSTEOPATHY

CIY

SI

PIG. 31. Sensory dermatomes on anterior surface
of the body. Drawn by John Comstock (after
Head).

PRINCIPLES OF OSTEOPATHY 189

change in the appearance of the eruption, the firey red
giving place to a paler color. Those papules which were
just forming subsided, and those which had formed vesi-
cles began immediately to scab.

The patient could not stand erect, lifting the arm
caused increase of pain, likewise inspiration was lessened
because it caused pain. Hilton would say that these move-
ments were curtailed to give physiological rest. From
the osteopathic standpoint, they are reflexes which are not
reparative in character, hence must be eliminated. Every
movement which tended to separate the fifth and sixth ribs
caused pain, hence the patient refrained from making them.
The osteopath separated these ribs, even though the pro-
cess of doing so caused pain. The structural defect caus-
ing the irritation was removed. In view of the fact that
Herpes Zoster is associated with posterior ganglionitis, it
may be that the subluxation of a rib is a secondary lesion
and hence only a secondary cause of pain. Clinical exper-
ience teaches us that relief is obtained in these cases by
separating the ribs which are approximated by the mus-
cular tension.

The Distribution of an Intercostal Nerve. — The distri-
bution of an intercostal nerve is to the pleura, intercostal
muscles and skin over these muscles, thus corresponding
to the distribution of nerve trunks to the synovial mem-
brane of a joint, the muscles moving the joint and the skin
covering the joint.

Some of the Evil Results of Rest. — If we give rest to
all structures in which pain is located, we will help to fill
the world with stiff joints and serous adhesions, to say
nothing of the far reaching after affects of these structural
defects upon the functional activity of the nervous system.
A differential diagnosis is required in all cases of painful
joints in order to determine whether it is wise to disturb
the physiologically protective reaction.

Hilton's law may be called an anatomical law; there do
not appear to be any exceptions to it, especially when sup-

190

PRINCIPLES OF OSTEOPATHY

S i

FIG. 32. Sensory dermatomes on posterior surface
of the body. Drawn by John Comstock (after
Head).

PRINCIPLES OF OSTEOPATHY 191

plemented by his statement that "every fascia of the body
has a muscle attached to it, and every fascia throughout
the body must be considered as the insertion of a muscle."
This carries the influence of motor nerves to points covered
by their sensory companions.

Head's Law. — Another law, or in this case a compre-
hensive statement, has been made by Head in his writings
in "Brain." This is a statement of physiological transference
of pain from its point of origin to a point of conscious
sensation. This physiological law is stated as follows :
"When a pamfuJL stimulus is applied to a part of low sen-
sibility in close central connection with a part_of much
higher sensibility, the pain produced is felt in_ the part of
higher sensibility rather than in the part of lower sensibil-
ity to which the stimulus was applied/'

Application of the Law. — This physiological law can
be applied in two ways. First, we may consider the rela-
tive sensibility of different portions of a nerve trunk. If a
stimulus is applied to a nerve trunk at some point in its
course between its origin and distribution, the pain caused
by the stimulus will be felt in the area of distribution of
the fibers of this nerve trunk rather than at the point where
the stimulus is applied. The skin, mucous or serous mem-
brane and muscle. in which sensory nerves end are areas of
high sensibility compared with the trunk of the nerve.
The brain is conscious of only the areas of distribution of
the sensory nerves, hence stimuli applied at the points of
low sensibility are referred to the areas of high sensibility.
Thus all lesions causing pressure upon nerve trunks cause
pain, contraction, or perversion of secretion in the areas
of distribution. The patient is not thoroughly conscious
of any location but the area of distribution which is an
area of high sensibility.

The cases described under Hilton's law are applicable
here. In the case of inflamed shoulder joint the patient
was not conscious of the irritation at the spinal column —

\

192 PRINCIPLES OF OSTEOPATHY

the rotated vertebra — this was an area of low sensibility
in the course of the nerve trunk. The brain attributed all
the trouble to the terminations of the nerves in the tissues
of the joint. All of the reflexes acted accordingly.

The second application of this law is to the relative in-
tensity of areas of high sensibility. The areas in which
sensory nerves end are all areas of high sensibility, but
some are higher than others. We note in practice that
sometimes a nerve trunk which supplies several structures
will manifest pain in a portion of its area of distribution
which is not the part in which the irritation is located.
For example, the sensory portion of the obturator nerve
is distributed to the hip joint and skin on the inner side
of the knee. The skin seems to be an area of higher sen-
sibility than the interior of the hip joint, because in disease
of the hip joint the patient frequently complains of pain
in the cutaneous area rather than in the joint where the
actual disease is located.

The Viscera. — The viscera are normally non-sensitive,
i. e., we are not conscious of possessing viscera. The pres-
sure of food in the stomach and the beat of the heart make
no impression on our consciousness; and so it is with all
parts of the body governed by sympathetic nerves. The
viscera are areas of low sensibility, not low irritability,
for they are richly supplied with sensory nerves, upon
the stimulation of which active functioning depends. The
response to stimuli of sensory nerves in viscera is rapid,
but normally this response takes place entirely outside of
our consciousness, the impression is not recognized as com-
ing from the viscera, but from a remote area of high sen-
sibility in close central connection with the less sensitive
area. As an example, pain is felt in the right shoulder, as
a result of hyperaemia of the liver. The pressure upon
sensory nerves in the liver does not cause pain in the liver,
but refers it to a more sensitive area — the skin and muscles
of the right shoulder.

PRINCIPLES OF OSTEOPATHY 193

Chronic inflammation of the stomach may cause no
consciousness of pain in that organ, but may cause intense
aching in the mid-dorsal region.

Nerves of Conscious Sensation. — Cerebro-spinal nerves
are nerves of consciousness, and seem to have the duty of
registering on the sensorium of our brains not only their
own impressions, but the impressions derived from that
part of the sympathetic system in closest central connec-
tion with them.

A close study of the segmental distribution of spinal
nerves and their connection with the sympathetic system
by the rami-communicantes will make Head's law of prac-
tical value in osteopathic diagnosis and therapeutics.

194 PRINCIPLES OF OSTEOPATHY

CHAPTER XL

OSTEOPATHIC CENTERS.

Certain points on the surface of the body are spoken
of as "Centers." This word has become a part of the osteo-
path's technical vocabulary. It does not convey to the
mind of the osteopath the same meaning which attaches
to it when used in physiological text-books.

A physiological functional center in the central nervous
system is that point where the action of a certain viscus or
other structure is governed.

An osteopathic center is that point on the surface of
the body which has been demonstrated to be in closest
central connection with a physiological center, or over the
course of a governing nerve bundle.

In Chapter III, under the sub-heading Segmentation,
reference is made to the division of the central nervous
system into sections which may, to a moderate degree,
functionate independently. No portion of the nervous sys-
tem ever functionates absolutely independently. The ac-
tion of every portion affects all other portions, but certain
areas in the brain and spinal cord seem to be somewhat
set apart to govern or coordinate the physiological activity
of certain organs. Physiology has demonstrated a large
number of these centers.

"Physiology shows how not only the individual gan-
glia which lie in the intestines function with relative in-
dependence, but how even structures like the spinal gan-
glia frequently reckoned in with the central system still
enjoy relative independence from it functionally."

"What we know of the anatomical structure and of

PRINCIPLES OF OSTEOPATHY 195

the functions of the central nervous system of vertebrates
forces us more and more to the conclusions (1) that even
individual parts of the central system are themselves in a
position to function to a certain extent independently, and
(2) that even the brain and spinal cord of vertebrates are
composed of a series of centers. Whether the one or the
other of these is more highly developed, whether they
are in connection with deeper centers, whether they have
connections among themselves and with higher centers,
determine the measure of the higher or lower development
of the central system. We will find later, that in the course
of the development of a class, individual centers connected
with the central nervous system have reached a high de-
velopment, while others have arrived at a certain stage
(or reached a certain type) where they remain stationary,
and throughout all subsequent posterity remain everywhere
alike.

"One can conceive that in its essentials every nervous
system is composed of afferent tracts and efferent tracts,
and of tracts which form the connection of the elements
among themselves."

Anatomy and Physiology demonstrate that from a
certain segment of the spinal cord nerve fibers are dis-
tributed to skin, skeletal muscles, involuntary muscles and
mucous membrane of viscera, and to the muscular coats
of the arteries supplying all these structures.

Physiology and Pathology demonstrate that impres-
sions made upon sensory elements in skin, mucous mem-
brane, muscle, or other structures, are carried to a center
in the central nervous system. These impressions are co-
ordinated in this center, and affect the physiological action
of all structures innervated from the same center. When
we speak of two or more structures being in close central
connection, we mean that they are innervated from the same
segment of the central nervous system.

Diagnosis.- — In diagnosis these segments serve the pur-
pose of calling the osteopath's attention to the condition

196

PRINCIPLES OF OSTEOPATHY

FIG. 33. Surface marking of the brachial plexus.

PRINCIPLES OF OSTEOPATHY 197

of several correlated structures. For example : A hyper-
aesthesia at any point along the spinal column fixes the
attention of the osteopath upon all the structures of the
body which are innervated from the segment of the central
nervous system which furnishes nerves for this over-
sensitive area. Examination of all the structures thus
supplied will probably discover the point chiefly affected.

In order to give the student a clear insight into the
principles underlying osteopathic diagnosis, we will ex-
amine the osteopathic centers serially, commencing at the
atlas.

First Four Cervical Nerves. — We will first divide the
spinal column into sections according to the location of
certain groups of nerves. Remember that these divisions
are made with reference to the points of exit of the spinal
nerves from the spinal column.

The first section contains the first four cervical nerves.
The first cervical nerve leaves the spinal canal between the
occipital bone and the atlas. A study of its distribution
will inform us what structures are governed by it. Its
anterior division forms a part of the cervical plexus. This
division communicates with the sympathetic nerves on the
vertebral artery, the pneumogastric, the hypoglossal, and
superior cervical sympathetic ganglion. It innervates the
Rectus Lateralis and Anterior Recti.

The posterior division of the first cervical nerve is
called the suboccipital. It supplies motor fibers to the
posterior Recti muscles of the head, the Superior and In-
ferior Oblique, and the Complexus. Sensory fibers from
the scalp form part of this nerve.

Example of Hilton's Law. — With this outline of dis-
tribution before us, we can note some of the results of
stimulation of this nerve. Since the anterior division sup-
plies a few fibers to the occipito-atlantal articulation, we
have an example of Hilton's law of distribution of a nerve
trunk. The synovial membrane of the occipito-atlantal

198

PRINCIPLES. OF OSTEOPATHY

articulation, the muscles which govern movements of the
joint, and the skin over the joint are all innervated by this
first cervical nerve.

The muscles moving the occipito-atlantal articulation
act according to impulses reaching the point of origin of

FIG. 34. Front view of partial paralysis of the
brachial plexus.

the first cervical nerve over sensory fibers ending in the
skin covering the back of the head and this articulation,
also from those ending in the synovial membrane of the
joint. These impulses are coordinated in higher centers

PRINCIPLES OF OSTEOPATHY

199

of the brain which govern equilibration. The muscles of
this joint act also according to our will.

The Pneumogastric Nerve. — Furthermore, the anterior
division of this nerve communicates with the pneumogas-
tric, hypoglossal, and the superior sympathetic ganglion.

FIG. 35. Side view of same case as Fig. 34.

The pneumogastric has such a wide distribution that we
cannot afford to follow all of its paths of influence at this
time. The student is referred to any extended work on
anatomy for the details. The muscles and mucous mem-
branes of the larynx are innervated by the pneumogastric,
hence any irritation of the larynx may reflex impulses to
the center of origin of the first cervical nerve and cause
undue contraction of the muscles innervated by it. This

200

PRINCIPLES .OF OSTEOPATHY

muscular contraction can result in changing the relation
of the bones forming the occipito-atlantal articulation until
a condition exists which we call a subluxation of the atlas.
Having followed the impulses from the larynx to the
center of coordination and out again to the muscles of

FIG. 36. Rear view of same case as Fig. 34.

the occipito-atlantal articulation with consequent subluxa-
tion, we may profitably note the fact that sudden temper-
ature changes may affect the skin over these muscles,
arousing impulses which are carried to the center of co-
ordination, thence to the muscles, causing them to con-
tract with resulting subluxation. Some of the reflex im-

COLLEG

PRINCIPLES OF OSTEOPATHY

201

FIG. 37. Topographical outline of the lungs.

30 nO 323JJOO
VsllMOlC-M-iS

202 PRINCIPLES OF OSTEOPATHY

FIG. 38. Posterior surface marking of the lungs.

PRINCIPLES OF OSTEOPATHY 203

pulses may find their way to the larynx and cause con-
gestion of its mucosa. The atlas may be subluxated by
violence, then the sensory impulses originate in the syno-
vial membrane of the joint and in the muscles moving the
joint. These impulses may be reflected in such manner as
to affect the larynx, pharynx and other structures inner-
vated by the pneumogastric. The reflex influences exist-
ing between the first cervical nerves and the pneumogas-
tric are chiefly confined to the larynx and the pharynx,
because spinal nerves usually receive sympathetic reflexes
from the segment of the body which they cover. If we
should follow all of the divisions of the pneumogastrics,
we would find a wonderful diversity of distribution. We
do not expect that reflexes from the heart, lungs, stomach,
etc., are going to be subject to coordination in the area
of origin of the first cervical nerve, just because there is
communication between the pneumogastric and this nerve.
The pharynx and larynx are, in part, structures governed
involuntarily, and hence they are in large part removed
from the influence of nerves carrying voluntary impulses,
i. e., spinal nerves. The pneumogastric is essentially sym-
pathetic in character. The tissues of the larynx and phar-
ynx are practically under the influence of the first cervi-
cal nerve. Your attention is called to Hilton's law as he
has stated it in relation to mucous and serous surfaces.
"This same principle of arrangement, anatomically, physio-
logically and pathologically considered, is to be observed,
with an equal degree of accuracy in the serous and mu-
cous membranes. Thus considered, it presents a prin-
ciple which, if it has any application in practice, must be
one certainly of large extent."

Since the spinal accessory forms part of the pneumo-
gastric above the point of communication between that
nerve and the first cervical, we can perceive the reason
for the great influence which temperature changes, affect-
ing the skin over the sterno-cleido-mastoid and trapezius
muscles, have on the action of the muscles forming the

204

PRINCIPLES OF OSTEOPATHY

FIG. 39. The lung center.

PRINCIPLES OF OSTEOPATHY 205

suboccipital triangles. The spinal accessory innervates the
sterno-cleido-mastoid and trapezius. These muscles will
contract reflexly when the sensory nerves in the skin over
them are affected by temperature changes. The action of
these muscles affects the position of the head chiefly by
causing movement in the occipito-atlantal articulation
whose accurate adjustment depends on the muscles inner-
vated by the first cervical nerves.

The point of origin of the first two cervical nerves is
probably a bilateral center. In order to secure coordinated
movements, both sides of this bilateral center must act
reciprocally, but if the impulses coming into the center
from one side are much greater in number and intensity
than those entering on the opposite side, this reciprocity
of action may be interfered with and subluxation result.

The Hypoglossal Nerve. — The hypoglossal nerve is
the motor nerve to the muscles of the tongue, and to the
muscles moving the larynx and hyoid bone. It commu-
nicates with the first cervical nerve. Movement in the
occipito-atlantal articulation affects the relations of the
points of origin and insertion of the muscles innervated
by the hypoglossal ; therefore, impulses passing over both
nerves are coordinated at about the same area.

Superior Cervical Ganglion. — Probably the greatest
cause for disturbance along the course of the first cervi-
cal nerve is the communication with the superior cervical
ganglion and the sympathetic plexus on the vertebral artery.
This communication subjects all the structures innervated
by the first cervical to reflexes initiated in various areas of
the head, neck and brain.

The superior cervical sympathetic ganglion has a vaso-
constrictor influence over the blood vessels of the head,
neck and brain. It is a well known clinical fact that ice
applied to the surface of the neck over the occipito-atlantal
articulation will cause constriction of the blood vessels of

206

PRINCIPLES OF OSTEOPATHY

FIG. 40. Cilio-spinal and heart centers.

PRINCIPLES OF OSTEOPATHY

207

FIG. 41. Surface outline of the heart.

208

PRINCIPLE'S OF OSTEOPATHY

FIG. 42. Surface outline of the stomach.

PRINCIPLES OF OSTEOPATHY 209

the brain. This constriction is a reflex effect due to the
communication of the first cervical nerve with the superior
cervical sympathetic ganglion.

Suboccipital Triangles. — When the first cervical nerve

is sensitive to moderate pressure over the suboccipital tri-
angles, we may be sure that it is evidence of disturbance
of circulation in some part of the head, neck or face. We
look for this disturbance in the structures which are
subjected to the greatest amount of work, i. e., the eye,
pharynx or larynx. The brain last, because it is not easily
fatigued. Sensitiveness is nearly always associated with
a subluxated atlas, i. e., one is indicative of the other.

Whether the subluxation is primary or secondary, it
is a source of irritation and must be reduced; therefore,
in practice, our treatment is applied primarily to this
changed structure. The results of practice prove this to
be the best method.

Patients rarely complain of sharp neuralgic pain in
the area of the suboccipital triangles. A dull ache or ten-
sion is the usual subjective symptom.

We have described the characteristics of this center
with considerable detail in order that the student may
understand how thoroughly an accurate knowledge of
anatomy and physiology enters into the work of the osteo-
path. Every center must be understood in this same man-
ner. We do not deem it necessary to go into such detail
in describing all of the remaining centers in order that
the student can understand their significance.

In order to make the characteristics of the first cervical
nerve stand out prominently, we have described it as
though it were individual in its action and reaction. This
is not strictly true. Analysis compels us to note ill-defined
separations in the nervous system. In order to get a right
conception, we must view the first cervical nerve as only
one of a group of four cervical nerves which act in harmony.

210 PRINCIPLES OF OSTEOPATHY

FIG. 43. The stomach center.

PRINCIPLES OF OSTEOPATHY 211

Cervical Plexus. — The first four cervical nerves are in-
terwoven to form a plexus. Each distributive branch
from this plexus probably contains some communicating
fibers from the four primary nerve trunks. Viewing the
plexus as a whole, we find that its branches are distributed
according to Hilton's law. They innervate the skin of
the neck as low as the fifth cervical spine posteriorly, then
obliquely forward as low as the sterno-clavicular articula-
tion anteriorly, and the acromio-clavicular articulation
laterally. The skin of the posterior surface of the cranium
and the ear receives sensory fibers from this plexus. These
are the gross points to be remembered concerning cutan-
eous sensory distribution from this plexus. The muscles
under this cutaneous area all receive motor fibers from the
first four cervical nerves.

Anatomists divide the cervical nerves into anterior
and posterior 'divisions, then desdribe these separately.
This is an artificial division which does not serve any use-
ful purpose for us. It multiplies detail without giving
an adequate conception of the real character of the w«hole
nerve. When you study the ultimate distribution of the
anterior division of a nerve forming the cervical plexus,
do not fail to remember that the ultimate distribution of
the posterior division is a part of the same nerve. If the
anterior division communicates with a sympathetic gan-
glion, the posterior division receives impulses from and
sends impulses to this ganglion. If the anterior division
communicates with the vagus and hypoglossal nerves, the
posterior division is a party to this communication, and
in all ways benefits or suffers by it according to the num-
ber and intensity of the stimuli applied at any point along
the course of either nerve.

This upper portion of the neck is the most flexible
part of the whole spinal column. It is subjected to more
changes of temperature and more strains or twists than
other portions of the spine. The constant effort to save
the head from injury puts a severe tax upon the activity

212

PRINCIPLES OF OSTEOPATHY

FIG. 44. The splanchnic area.

PRINCIPLES OF OSTEOPATHY 213

of the muscles moving this portion of the spinal column.
Subluxations of the atlas and third cervical are quite fre-
quent. Muscular lesions, contractions, are found here in
connection with functional disorders of many kinds lo-
cated in the brain, eyes, ears, nose, mouth or throat. Al-
most invariably a relaxation of these contractions will be
a necessary step in relieving disorders in the areas named.

Intensity of Reflexes. — Individuals differ greatly in
the intensity of their reflexes. Anatomically considered,
•the connections between the sympathetic and cerebro-
spinal systems are alike in all individuals, but physiolog-
ically considered, there is a vast difference in the degree
of independent functioning of these systems. Patients
will be found whose symptoms and lesions do not show
any marked tendency toward reflexing impulses from one
system to the other. The sympathetic nerve cells may
be so vigorous that severe lesions affecting cerebro-spinal
nerves do not in the least disturb the rhythm of the sympa-
thetic system. Likewise, severe functional disturbances
may exist in the area of the sympathetic control without
causing very definite conscious sensations.

The Spinal Accessory. — The sterno-cleido-mastoid and
trapezius muscles are innervated by the spinal accessory.
This nerve arises from the spinal cord as low as the sixth
cervical, therefore its impulses are coordinated with the
cervical plexus in the area of its normal control.

The Phrenic Nerve — Hiccough. — The phrenic nerve is
the motor nerve from the cervical plexus. It innervates
the diaphragm. It is formed by branches of the third,
fourth and fifth cervical nerves. The position of this nerve
in its course along the anterior surface of the scalenus
anticus, makes it convenient to apply direct inhibitory
pressure over the nerve trunk. This pressure has a re-
straining influence over the impulses traveling to the dia-
phragm ; therefore, we inhibit to stop hiccough. We have
treated cases in which inhibition was of no avail. In such
cases a strong movement of the head and first three cervi-

214

PRINCIPLES OF OSTEOPATHY

FIG. 45. Posterior surface outline of the liver and spleen with their
centers indicated.

PRINCIPLES OF OSTEOPATHY 215

cal vertebrae, as a solid lever, to secure rotation and re-
laxation between the third and fourth cervical vertebrae
may give good results. Since hiccough is a reflex due to
stimulation of sensory nerves, especially the pnetimogas-
tric, it should not be expected that inhibition of the motor
nerve, phrenic, would entirely stop hiccoughs while the
sensory stimulation is continued. Clinically, we find that
inhibition of the phrenic nerve is sufficient to stop the
ordinary case of hiccoughs. Therefore, we call the area
over the course of the phrenic nerve, as it crosses the sca-
lenus anticus muscle opposite the fifth cervical transverse
process, the "center for hiccoughs." See Fig. 266.

The Trapezius and Splenius Capitis et Colli Muscles.
— The cervical plexus communicates with the brachial
plexus; therefore we expect that those large muscles, such
as the trapezius and splenius, which are innervated by
nerves from segments of the spinal cord, at various levels,
will transmit by their action the influence reflexed to them
at the point of their serial innervation. The spinal acces-
sory innervates a large part of the cervical fibers of the
trapezius. The third and fourth cervical nerves send
branches to this muscle. Therefore any disturbance along
the course of these nerves, or along the course of other
nerves in close central connection with them which may
cause abnormal contraction of the trapezius, will influence,
more or less, all the points of attachment of that muscle.
The trapezius is seldom abnormally contracted. Any les-
sening in the normal range of its action is quickly noted
by the patient. The contractured condition is easily re-
moved by a willed action. We use the trapezius muscle
as a means of transmitting power to various portions of
the spinal column, i. e., in our efforts to move one or more
vertebrae.

Vaso-motion, Head, Face and Neck. — The superior
cervical ganglion communicates with the first four cervical
nerves, therefore the area over the spines of the first four

216 PRINCIPLES OF OSTEOPATHY

FIG. 46. Anterior surface outline of the liver and large intestine.

PRINCIPLES OF OSTEOPATHY 217

cervical vertebrae is called a vaso-motor center for the
head, face and neck.

Affections of the Cervical Nerves. — These upper cer-
vical nerves are seldom paralyzed. Paralysis in this region
would stop the action of the diaphragm. Neuralgia may
affect the nerves of this group. Spasmodic contraction of
the muscles innervated from this area is not uncommon.

Brachial Plexus. — The four lower cervical nerves arise
from the cervical enlargement of the cord and form the
brachial plexus with their anterior divisions, while their
posterior divisions supply motor fibers to muscles on the
sides and back of the neck, and sensory fibers to the skin
over these muscles. The anterior division of the first dor-
sal nerve forms a part of the brachial plexus.

Fig. 33 illustrates the superficial area in which the
reflexes from the skin and muscles of the arm are mani-
fested. Subluxations or muscular contractions, in this
area may affect one or more branches of this plexus.

Affections of the Brachial Nerves. — Neuralgia, paraly-
sis or spasm may affect the area innervated by this group.
Cervico-brachial neuralgia is quite common. A lesion will
usually be found affecting the painful nerve at its point of
exit from the spinal column. Paralysis rarely affects this
plexus independently of the nerves leaving the cord at a
lower level. Spasm is represented by such a condition as
writer's cramp.

Lesions causing cramp or neuralgia may be located
at the point of exit of the nerve from the spinal column,
but the clot or other pressure causing paralysis is usually
located in the brain. Paralysis of the brachial plexus is a
part of a hemiplegia; it does not occur independently of
the more general condition. Paralysis of certain groups of
muscles of the arm, forearm or hand can usually be traced
to the direct injury of individual nerve trunks in the arm.

Hemiparesis Below Fifth Cervical Vertebra.— Figures
34, 35 and 36 illustrate the results of pressure upon the
spinal cord at a point between the fourth and fifth cervical

218

PRINCIPLES OF OSTEOPATHY

FIG. 47. Center for large intestine. The arrow marks point of
close connection of cerebro-spinal nerves with the hypogastric
plexus.

PRINCIPLES OF OSTEOPATHY 219

vertebrae. The child was not very strong at the time of
the injury. A slight fall, while playing, subluxated the
fifth cervical. No notice was taken of this slight fall. The
next day, while bathing the child, the mother noted a pe-
culiarity in the position of the shoulder. The arm could
not be raised above the head. The author examined this
case the day the mother discovered the change in the
shoulder. At first glance from the side, it appeared to be
a sub-spinous dislocation of the humerus, but palpation
disproved this. Careful examination showed a hemipare-
sis of the whole left side below the fourth cervical nerve.
None of the normal movements were lost, but it required
the utmost effort of the patient to make them. Now and
then the left toe would strike the floor too soon and slight-
ly trip her. Palpation of the fifth cervical vertebra
showed a lateral subluxation. The slightest pressure at
this point caused the patient to cry out with pain.

After our examination (these photographs were taken
at that time) the child was taken to a surgeon, who pre-
scribed a surgical operation to stitch the latissimus dorsi
to its proper position on the lower angle of the scapula.
He did not recognize the paretic condition of the whole
left side. After a short time, the child was brought to us
for treatment. Our sole effort \vas to reduce the subluxa-
tion of the fifth cervical vertebra. The tenderness was so
great that this was manifestly out of the range of possi-
bilities with a delicate child. After two weeks of relaxing
around this articulation a direct movement was made to
reduce the subluxation. The alignment was perfected,
but no immediate good results were noted. A continued
increase in nerve power has gradually, in large measure,
overcome the deformity.

Subluxation of the Scapula. — The deformity is the ef-
fect of uneven contraction of muscles. The latissimus
dorsi, rhomboids and serratus magnus are weakened while
the levator anguli scapuli and cervical fibers of the trape-
zius are contracting with their customary power. The

220 PRINCIPLES OF OSTEOPATHY

muscles innervated by nerves from above the lesion are
acting normally, but their action is not resisted. This
results in subluxation of the scapula.

The Nerve of Wrisberg. — A division of the first dorsal
nerve forms the first intercostal nerve. The inner side
and back of the arm receive cutaneous branches from the
first dorsal nerve. There is communication between the
cutaneous nerves to this area and the second intercostal
nerve by means of the nerve of Wrisberg, hence pain is
frequently felt along the inner surface of the arm in cases
of heart trouble, intercostal neuralgia in the second space,
or pleurisy.

The Interscapular Region. — The division of the spinal
column between the first and seventh dorsal vertebrae is
commonly called the interscapular region. It is an ex-
ceedingly important one. It is sometimes called the pul-
monary region, because it is the area from which the lungs
derive many nerves. Sensory impulses from the lungs are
coordinated in this area.

Figure 37 illustrates the anterior surface outline of
the lungs, while Fig. 38 shows the outline on the posterior
surface of the thorax. These markings were made on the
surface according to physical methods of diagnosis. They
represent the average position of the lungs in a healthy
man.

Lung Center. — Figure 39 illustrates the lung center
within which sensory impulses from the lungs are co-
ordinated. A large proportion of cases of bronchitis,
pulmonitis or pleuritis of either the simple or bacterial
types, are accompanied by great sensitiveness in this area.
This sensitiveness is in the contracted muscles, or,
when the shape of the thorax is greatly changed, at the
angles of the ribs. Subluxations of ribs or vertebrae in
this area are sometimes found in connection with the in-
flammations above named. Whether they are the cause
or the effect of the inflammation can only be told by the

PRINCIPLES OF OSTEOPATHY

22i

history. Because the two conditions, that is, inflamma-
tion in the thoracic viscera and osseous subluxation, exist
at the same time is no reason for saying- that the subluxa-
tion is necessarily the cause of the inflammation. That is
a mere dogmatic assertion which lacks scientific proof.

FIG. 48. Center for chills.

222

PRINCIPLES OF OSTEOPATHY

The condition might be just the opposite. We do not de-
sire to confuse our readers in the least, but it should be
remembered that before making a dogmatic statement
such as "disease is the result of anatomical abnormalities
followed by physiological discord," we should be certain

FIG. 49. Center for the gall bladder.

PRINCIPLES OF OSTEOPATHY 223

that our statement is not based on a series of selected co-
incidences. The old saw : "It's a poor rule that does not
work both ways," is decidedly applicable to nerve reflexes.

Cilio-Spinal Center. — Tenderness in this area is riot
necessarily indicative of physiological disturbance in any
thoracic viscus. Fig. 40 indicates two centers. The one
between the second and third dorsal is called the cilio-
spinal center. Detail concerning this center will be found
in the chapter on the Sympathetic Nervous System.

The fact that the vaso-constrictor fibers to the cervical
sympathetic ganglia leave the spinal cord below the second
dorsal vertebra shows that some reflexes from the head,
face and neck may be coordinated in the interscapnlar
region.

Heart Center. — The point between the fourth and fifth
dorsal spines is noted as a heart center. We have not found
any text-book authority for this statement. Clinical ex-
perience leads the author to locate a heart center at this
point. What the absolute influence of this center is we do
not know. From observation of cases of angina pectoris
it appears to be a sensory and vaso-motor center for the
heart. Stimulation of this center by a quick percussion
stroke of the fingers will bring on an immediate attack of
pain in the heart, blueness of lips and finger tips. Heavy
digital pressure at this point relieves the pain. Steady ex-
tension of the whole spinal column does not stimulate such
cases, but as the pull is reduced and the vertebrae are drawn
closer together, this point is frequently stimulated. In or-
der to avoid an attack after extension, it is necessary to
lessen the force of the pull very gradually and evenly.

Fig. 41 illustrates the surface markings of the heart.
This organ has three centers. (1) The pneumogastric nerve
exerts an inhibitory influence. This nerve can be stimu-
lated in the neck. See Fig. 257. (2) The accelerator cen-
ter includes second, third and fourth dorsal. See Chapter
VI on the Sympathetic Nervous System. (3) Vaso-motor
and sensory center is found between fourth and fifth dorsal.

224

PRINCIPLES OF OSTEOPATHY

FIG. 50. Center for the ovaries. Reflexes from the ovaries may
follow the ovarian plexus to the aortic and reach the cerebro-
spinal system at this point. This is true for the testes also.

PRINCIPLES OF OSTEOPATHY 225

Stomach Center. — The surface outline of the stomach
is given in Fig. 42, while its reflex surface center on the
back is indicated in Fig. 43. This center lies wholly
within the pulmonary area, therefore it will be readily
noted that there is opportunity for much careful reasoning
in order to determine whether a lesion between the first and
seventh dorsal vertebrae is connected with disturbance of
the lungs, pleura, heart, eyes or stomach. Clinically, we
distinguish somewhat as follows : A lesion covering a
large part of this area is probably pulmonary. A lesion in
the lower half and extending below the seventh spine is
probably gastric in character. When the lesion is at the
third or fourth and decidedly limited, i. e., the tenderness
is sharply circumscribed in this area, it is impossible to
tell, except by further examination of the heart, bronchi
and eyes, to which it belongs. The experienced diagnos-
tician can frequently estimate the probable relation of a
lesion by his power of reading the signs of disease as evi-
denced by expression, posture and general indications.

The splanchnic area is a large and important one. It is
indicated in Fig. 44. We have noted in this photograph
the upper connections of the splanchnic nerves in the pul-
monary area. This explains the high position occupied by
some reflexes from the first part of the gastro-intestinal
tract. Wonderful influences can be secured in this area,
over circulation in the abdominal viscera.

Liver and Spleen Center. — The liver and spleen re-
ceive their sensory and vaso-motor innervation from the
eighth, ninth and tenth dorsal nerves. The surface mark-
ings and center are indicated by Fig. 45. The liver fre-
quently reflexes its disturbed sensory influences to the
right shoulder. We have noted cases of gastric disorder
or enlarged spleen which reflexed sensory impressions to
the left shoulder.

Large Intestine. — Fig. 46 pictures the surface mark-
ings of the liver and large intestine. These average nor-
mal outlines should be thoroughly remembered and used

226

PRINCIPLES OF OSTEOPATHY

FIG. 51. Posterior surface outline of the kidneys.

PRINCIPLES OF OSTEOPATHY 227

when making a physical examination. The spinal center
of the large intestine is indicated by Fig. 47.

Small Intestine. — The first portion of the small intes-
tine, duodenum, is innervated from about the same area
as the liver. Fig. 45. It must be borne in mind that the
splanchnic area is a large one and comprehends these
smaller centers. Many of these points indicated as cen-
ters are the areas which clinical experience has noted in
connection with visceral disturbance. The repeated ex-
perience of many cases gives them value for diagnostic
and therapeutic purposes.

Center for Chills. — Within the area indicated by Fig.
48, there is a center usually described as the eighth dor-
sal, which has received the name of "the center for chills."
Our first observation of the action of this center was in
connection with a case of malarial fever. Heavy inhibi-
tion of this area lessened the severity of the chill. We
have observed the effects of inhibition of this center in
many cases of chill due to nervousness, onset of La
Grippe or other infectious diseases, and to abscess forma-
tion. In all cases the treatment was distinctly helpful
to the patient.

The Language of Pain. — Homeopathic medical prac-
tice notes variations in the character of pain, and uses
these characteristics as indications for the administra-
tion of special drugs, as though a nerve fiber expressed a
language of pain. To the osteopathic physician, it is suf-
ficient that a nerve express a disturbance at some point
of its course. This cry of the nerves calls for just one
thing, remove the cause. Search is made for this cause
along its entire course, and the course of its connections.

Osteopathic View of Pathology. — Another particular
in which the osteopathic pathology differs from other
schools of medicine is in the way we view varying condi-
tions of a viscus. To the medical practitioner, simple

228

PRINCIPLES' OF OSTEOPATHY

FIG. 52. End of the spinal cord. Physiological center for parturition,
defecation and micturition.

PRINCIPLES OF OSTEOPATHY 229

gastritis is a vastly different condition from gastric ulcer.
To the mind of the osteopath, these conditions differ in
degree, not in kind. The same organ, the same blood
supply, the same nerves are involved in both conditions,
therefore we treat these structures. Our dietetic treat-
ment takes account of the differing activity of the
stomach, but our manipulative treatment does not.

We apply this same method to all organs. Our man-
ipulative therapeutics are based on structure more than
on function.

Center for Gall Bladder. — The gall bladder lies under
the anterior extremity of the tenth rib. In cases of gall
stone the area of the tenth dorsal spine has been found
to be sensitive. All of the structural and functional
changes connected with gall stones have seemed to center
at this area, and along the tenth rib. Fig. 49 indicates
the center for the gall bladder at the spine.

Intestines. — The small intestines are governed from
the lower part of the splanchnic area, ninth, tenth, elev-
enth and twelfth dorsal. The large intestine is controlled
by nerves from the lumbar region. There is a segmental
distribution of these nerves to the large and small intes-
tines. This segmental arrangement is exemplified in
cases of diarrhoea. If the large intestine is the part af-
fected, our manipulation is devoted to the lumbar region.
Reflexes from the bowels may be found at any point be-
tween the ninth dorsal and the fourth sacral.

In five consecutive cases of appendicitis, the reflex
was located at the third and fourth lumbar spines. Fig.
47 indicates the area concerned in reflexes from the large
intestine.

Uterus. — The position of the arrow in Fig. 47 indi-
cates the point of apparently close connection between
the hypogastric plexus and the cerebro-spinal system.
This point is frequently the seat of great tenderness which
is entirely reflex in character. All of the pelvic viscera

230

PRINCIPLES OF OSTEOPATHY

FIG. 53. Areas of the lumbar and sacral plexuses.

PRINCIPLES OF OSTEOPATHY 231

at times send reflexes here. The uterus more than any
other pelvic organ manifests its disturbed condition by
tenderness at this point.

The uterus is such a changeable organ that it is the
chief disturber of sympathetic rhythm in a woman's body.
A change in its position causes a change in its blood sup-
ply, followed by congestion of its mucosa. This con-
gested condition sets up a series of impulses in the sympa-
thetic system which may never reach the cerebro-spinal
system. They spend their force on the various organs
governed by the sympathetic nervous system, the heart,
stomach, bowels, etc. Fig. 55 illustrates the difference
in the heart's rhythm in the same patient. The first
sphygmogram was taken while the patient had considera-
ble difficulty in moving about on account of the heart's
very irregular action. The uterus is prolapsed. Patient
has worn a stem pessary for years. When the patient
takes the genu-pectoral position and inhales strongly,
while pulling upward on the abdominal muscles there is
great relief, but when the heart becomes as irregular as
this sphygmogram indicates, she is afraid to take this po-
sition. After twenty-four to seventy-two hours of ir-
regular action, the heart regains its rhythm. The ^position
of the uterus becomes changed by the moving of the pa-
tient in bed. The perineum is badly torn and the uterine
ligaments are greatly lengthened, hence the organ cannot
be kept in one position. She has refused operation.

Many different points are named as centers for the
uterus, but they all rest on the fact that after the organ
has initiated a large number of impulses in the sympa-
thetic system, they may be passed to the cerebro-spinal
system at any point of union of the two systems. *"

Ovary and Testes. — These organs receive their sym-
pathetic innervation from the plexus which lies on their
arteries. The ovarian plexus is given off from the aortic
plexus which receives fibers from as high as the eleventh
and twelfth dorsal ganglia. Therefore a lesion in the

232

PRINCIPLES' OF OSTEOPATHY

FIG. 54. Center for the bladder.

PRINCIPLES OF OSTEOPATHY 233

area of the eleventh and twelfth spinal nerves is frequent-
ly in connection with the ovaries or testes. Fig. 50 indi-
cates the height of the influence of the aortic plexus
through its direct connection with the cerebro-spinal
system.

Kidneys. — Fig. 51 indicates the surface marking of
the kidneys and the junction of the last dorsal and first
lumbar vertebrae. Lesions of either the eleventh or
twelfth dorsal may affect the kidneys.

The reflexes of this organ may reach the cerebro-
spinal system over the renal splanchnic. The articulation
of the last dorsal and first lumbar allows considerable
movement. It is probably the weakest part of the back.
The area of the twelfth dorsal nerve is usually sensitive
when the kidneys are affected. This sensitiveness may
extend a short way upward, as far as the tenth dorsal.

In patients whose abdomen is moderately thin, it is
possible to affect the renal sympathetic plexus by deep
manipulation above the umbilicus. The kidneys lie above
the level of the umbilicus. Have the patient lie in the
dorsal position with flexed thighs so as to relax the ab-
dominal muscles. The balls of the fingers of both hands
should be pressed deeply into the abdomen about two
inches above the umbilicus, then move the fingers lateral-
ly toward the kidneys. Pressure is thus brought to bear
upon the renal artery. The mechanical stimulation of the
renal plexus usually results in vaso-constriction of renal
arteries.

Second Lumbar. — The lumbar enlargement of the
spinal cord is the physiological center for several func-
tions performed in the pelvis. Defecation, micturition,
and parturition, are all reflexly controlled at this point,
second lumbar. The spinal cord ends at the lower border
of the first lumbar vertebra. The second lumbar verte-
bra is indicated in osteopathic literature as a center for
the three functions named above. We understand by this
that an injury at this point may involve the functional ac-

234 PRINCIPLES OF OSTEOPATHY

tivity of the rectum, bladder, or uterus. Disturbances in
these viscera are not necessarily manifested to the osteo-
path by tenderness around the second lumbar vertebra.
Any point along the spinal column below the second
lumbar may be sensitive as a result of disturbance in the
pelvic viscera. Fig. 52.

During parturition there is conscious aching along
the whole lumbar area, thus demonstrating that the sen-
sory nerves of the uterus can reflex their irritation to all
the lumbar nerves. Injury of the spinal column at the
junction of the dorsal and lumbar portions may affect mo-
tion, sensation and nutrition of all the structures inner-
vated by the cauda equina. An injury below the second
lumbar vertebra will not have as far-reaching effect as
an injury of the same character above that point.

Paraplegia. — When the back is broken at the dorso-
lumbar articulation, paraplegia results. It is not necessary
to actually break the back in order to cause paraplegia.
A severe strain caused by a fall may induce such an
exudate around this articulation that pressure is exerted
on the lumbar enlargement of the cord. Many of the so-
called broken backs, which are spoken of as causative of
paraplegia, are not broken at all, but the ligaments are
badly sprained. The same condition exists here as in
other sprained joints. There may be marked kyphosis,
but this does not necessarily indicate dislocation. The
paraplegic condition may be perpetuated by the pressure
of connective tissue formed in the repair of the injury.
This is especially liable to follow if some form of manipu-
lative treatment is not persisted in for from one to three
years. The author has fortunately been able to observe
the slow regeneration of nerve tissue following complete
paraplegia as a result of injury of the dorso-lumbar ar-
ticulation. This case has been observed by us during
nearly four years. During all of this time, she has re-
ceived osteopathic treatment. This method of treatment
was not begun until ten months after the accident, there-

PRINCIPLES OF OSTEOPATHY

235

fore, synovial adhesions had formed to such an extent in
the joints of the limbs that much painful manipulation
of these joints has been necessary.

Following the accident, there was motor and sensory
paralysis of the extremities, bladder and rectum. Control
of the bladder and rectum returned after two months of
osteopathic treatment. Sensation and motion have re-
turned to the extremities. There is deformity as a result

FIG. 55. Sphygmograms illustrating the effect of uterine reflexes on the
heart.

of the adhesions formed during the ten months previous
to the first osteopathic manipulation. The patient had
been massaged during the ten months mentioned.

Lumbar and Sacral Plexuses. — From the nerves of the
cauda equina are formed two large plexuses, the lumbar
and sacral, indicated in Fig. 53. The branches of these
plexuses innervate the muscles of the lower extremities.
The spinal area from which these plexuses receive their
fibers should be carefully examined whenever any diffi-
culty of movement or sensation in the lower extremities
is presented.

The student should learn the sensory and motor dis-
tribution of each branch of these plexuses, so that per-
ipheral disturbance can be immediately associated with
the point of emergence from the spinal column of the
affected nerve or nerves.

The Bladder. — Fig. 54 indicates the superficial area
in which reflexes from the bladder are most frequently

236

PRINCIPLES OF OSTEOPATHY

FIG. 56. Surface marking of the pudic nerve.

PRINCIPLES OF OSTEOPATHY 237

found. The sensory fibers to the bladder are found in
the first, second, third and fourth sacral nerves. The
first to third give the strongest evidence of sensory dis-
turbance. When the mucous lining of the bladder is con-
gested, these sensory nerves are stimulated. Motor fibers
to the bladder are found in the second and third sacral
nerves. The stimulation of the sensory nerves results in
/•eflex stimulation of the motor nerves, which cause con-
traction of the muscular tissue of the bladder. Inflamma-
tion of the bladder is accompanied by almost continuous
desire to micturate.

The sacral spinal nerves take a more direct and un-
interrupted course to the pelvic viscera than do nerves
from other portions of the spinal column to their respec-
tive areas of distribution.

Inhibitory pressure over the sacral foramina has a
very marked effect on the sensory nerves of the bladder.
This pressure does not directly affect the anterior divi-
sions of the sacral nerves, nevertheless the effect is the
same as though the anterior divisions were subjected to
the inhibitory pressure. This is evidence of the close
harmony between the two divisions of a spinal nerve.
The inhibitory pressure not only lessens conscious pain
in the bladder, but also changes the vaso-motor condi-
tions. In this respect it much resembles the action of
heat applied to the surface.

Sphincter Vaginae. — The sphincters of the vagina and
rectum are controlled from the area of the third and
fourth sacral nerves. When the vulva, vagina or rectum
are highly sensitive, we usually find a hyperaesthetic area
at the third and fourth sacral spines. When this area is
sensitive, the point where the pudic nerve crosses the
ischiatic spine is also decidedly sensitive to pressure.
Fig. 56 indicates the superficial relation of the pudic
nerve. This nerve is sensory and motor to the skin and
muscles of the perineum. This point will be found sen-

238 PRINCIPLES OF OSTEOPATHY

sitive when the prostate is enlarged ; in fact, almost any
disorder of the male sexual organism is accompanied by
this sensitive condition.

Inhibitory movements over the back of the sacrum
and ischiatic spine will result in relaxation of the perineal
muscles. It affects spasmodic stricture of the urethra in
a wonderful manner. The local anaesthetic effect of in-
hibition is not so easily demonstrated in any other por-
tion of the body as in this sacral area.

When the uterus is turned either backward or for-
ward or prolapsed, there are impulses aroused in sensory
nerve fibers in the rectum or bladder. These impulses
are reflexed to the sacral area, while those aroused in the
uterus pass to higher points in the spinal column. In-
hibition of this sacral area will have a temporary effect.
The, only treatment worth while is the correcting of the
position of the uterus.

Conclusions. — There are many more so-called "cen-
ters" mentioned by osteopathic writers. We have not
attempted to even recapitulate those other centers which
seem to us to be quite too fanciful for practical use. The
centers mentioned in this chapter are those which can
be demonstrated in daily practice, and hence are used
continually, both as guides for diagnosis and as indica-
tions for the application of manipulative therapeutics. No
sympathetic spinal centers for "sensation," "motion" or
"nutrition" can be demonstrated. These are characteris-
tics of nerve fibers in general, and it is entirely mislead-
ing to limit these characteristics to any one portion of
the spinal column. Every osteopathic center should be
capable of demonstration anatomically, physiologically
and clinically. Only those which can pass this test satis-
factorily are worthy of our consideration.

PRINCIPLES OF OSTEOPATHY 239

CHAPTER XII.

THE BACK.

The Spinal Column. — The back is characterized by tru
spinal column, which constitutes the long axis of the body.
This column consists of twenty-four movable vertebrae,
the sacrum and coccyx. The movable bony segments are
separated from each other by fibro-cartilaginous discs.
Each vertebra is characterized by a body and an arch which
extends from the posterior lateral portions of the body.
The body serves to give strength, stability and weight-
carrying capacity to the column. The arches serve tc
form an incomplete bony canal for the protection of the
spinal cord and its membranes. Although these arche*
form a fairly complete protection to the contents of the
canal in the upper dorsal region, the approximation of the
laminae is not nearly so perfect in the lumbar region. It is
through the gaps between the laminae in the lumbar region
that puncture can most easily be made.

Spinal Ligaments. — The discs of fibre-cartilage are
very strongly attached to the bodies of the vertebrae and
the fibrous tissue of these discs interweaves with the fibers
of the common ligaments which extend from end to end of
the spinal column on the anterior and posterior surfaces
of the bodies. After cutting the neural arches, at their
junction with the bodies, we have left a strong column of
bony segments, separated by fibro-cartilaginous discs which
are strongly adherent. Both bones and cartilages are very
strongly bound together by the anterior and posterior com-
mon ligaments.

240

PRINCIPLES OF OSTEOPATHY

-Axis of rotation
located in
concavity of
the curues in
Cervical,

Dorsal,

V

I

Lumbar.

FIG. 57. Drawn by John Comstock.

PRINCIPLES OF OSTEOPATHY

241

Nucleus
pulposus

Ligciiuenium
fTlovwn. ot*
subflovum

Li^amentum
int«r*pinule

Ligciroentum
suprospmale

Spinous
process

FIG. 58. Mesial section through a portion of the lumbar part of the
spine. Drawn by John Comstock (after Cunningham).

Pedicte of
vertebra
divided-
Posterior
common
ligament

Intervcrtebral
disc.

FIG 59. The posterior common ligament of the
vertebral column. Drawn by John Com-
stock (after Cunningham).

242 PRINCIPLES OF OSTEOPATHY

Flexibility. — This column is characterized by moder-
ate flexibility and certain curves. The elasticity is due to
the structure of the fibre-cartilaginous discs. The center
of the discs is a very soft mass of fibro-cartilage, thicker
than the margins and containing the remains of the chorda
dorsalis of the embryo.

FIG. 60. Curves of the vertebral
column (Fick). A, with inter-
vertebral discs; B, without inter-
vertebral discs.

Normal Spinal Curves. — The curves are due to the un-
equal thickness of the anterior and posterior portions of
the discs. The discs are thicker anteriorly in the cervical
and lumbar regions, thicker posteriorly in the dorsal region,
thus producing anterior curves in the cervical and lumbar/
and a posterior curve in the dorsal. The bodies of the ver-
tebrae also vary slightly in thickness anteriorly and pos-
teriorly, i. e., the anterior depth of the bodies is less than
the posterior so that without the discs the whole column
presents a posterior curve with a loss of the anterior curves
in the cervical and lumbar regions. These curves and the
characteristics of the centers of the inter-vertebral discs

PRINCIPLES OF OSTEOPATHY 243

give the column its resilience. In bending this column to
the side, rotation of the vertebral bodies is inevitable.

Limitation of Flexibility. — The anterior and posterior
common ligaments of this column of vertebral bodies and
inter-vertebral discs tend, by their inelastic fibrous tissue,
to limit flexibility. By adding the neural arches with their
ligaments the flexibility of the column is still further lim-
ited. Besides the common ligaments binding the bodies
there is one other ligament which extends the whole length
of the column, i. e., the supraspinal ligament, consisting of
inelastic fibrous tissue extending over the spinous pro-
cesses from the sacrum to the seventh cervical, where its
structure changes to yellow elastic fiber and is known as
the ligamentum nuchae through its continuation to the
cervical spinous processes and the occipital bone. This
ligament limits flexibility in the dorsal and lumbar regions.
The remainder of the spinal ligaments are intervertebral,
i. e., extend between two vertebrae. They are inelastic
with one exception, the ligamenta subflava connecting the
laminae of the neural arches. There are many other things
which are factors in limiting the inherent flexibility of the
spinal column, viz., the articulation with the ribs to form
the thorax, the articulation with pelvic bones, the contents
of abdomen and thorax and the bulk of the soft tissues
which round out the body.

Articular Processes. — - Although the spinal ligaments
and other structures limit the flexibility of the spinal
column, the character of its evident flexibility is largely
governed in the various regions by the shape and position
of articular processes, which form a series of gliding joints
between the neural arches. The articular processes are
located at the junctions of the pedicles and laminae. They
consist of two superior and two inferior for each vertebra.

Cervical Region. — In the cervical region the articular
processes are placed very obliquely. The surfaces of the
superior look upward and backward and are somewhat

244

PRINCIPLES OF OSTEOPATHY

FIG. 61. Radiograph of the cervical region in position for balancing the
head erect.

PRINCIPLES OF OSTEOPATHY

245

FIG. 62. Radiograph of the cervical region in extension.

246 PRINCIPLES OF OSTEOPATHY

arched to fit the slight concavity of the inferior which look
downward and forward. This arrangement permits flexion,
extension and side bending accompanied by slight rotation.
These are recognized as the physiological movements for
this region of the column. The highly specialized articu-
lations between the occipital bone and atlas, the axis and

FIG. 63. Radiograph illustrating normal flexion in the cervical region.

PRINCIPLES OF OSTEOPATHY

247

FIG. 64. Radiograph of the cervical region in rotation.

248

PRINCIPLES OF OSTEOPATHY

atlas are worthy of more detailed consideration. (See
Chap. XIV.)

Dorsal Region. — The surfaces of the dorsal articular
processes are vertical, the superior facing backward, the
inferior forward. The surfaces are slightly curved from
side to side thus forming parts of the surface of a theo-
retical cylinder having its axis located in front of the body.
The movements permitted by this structural arrangement
are the physiological ones known as flexion, extension and
side bending rotation. Rotation is the most characteristic
of the movements in this region. It is greatest in the upper
dorsal articulations and decreases as the articular processes
begin to take on lumbar characteristics. The eleventh,
sometimes the tenth, dorsal verterbra marks the limit of
this characteristic dorsal movement. All movements are
limited in the dorsal region, not only by the inherent form
of the vertebral articulations but also by the attachment
of the ribs. The typical costovertebral articulation is char-
acterized by the head of the rib articulating with the bodies
of two vertebrae while the tubercle of the rib unites
with the articular facet on the transverse process of the
lower of these two vertebrae. The first, eleventh and

4 tli cervical,
left lateral view*

—Centre of
rotation

FIG. 65. Drawn by John Comstock.

PRINCIPLES OF OSTEOPATHY

249

twelfth costovertebral articulations are exceptions. The
junction of the upper ribs with the sternum serves still
further to give stability to the thorax and limit movement
in the upper portion of the dorsal division of the column.

Lumbar Region. — The articular processes in the lum-
bar region are vertical. The surfaces of the superior and
inferior face almost directly inward and outward, respect-
ively. These surfaces are curved in the opposite direction
from those in the dorsal region, so that they would form
parts of a theoretical cylinder having its axis posterior to
the spinous process.

4th cervical, superior surface.

FIG. 66 Drawn by John Comstock.

250

PRINCIPLES OF OSTEOPATHY

Flexion and Extension. — Since the arrangement of the
articular processes is an index to the character of move-
ment normally permitted between the vertebrae in the
various regions of the spinal column, it is advisable that
we call attention to a few points concerning them. It is
readily seen that flexion is a fairly free movement in all
portions of the column, with the exception of that portion
of the dorsal which articulates with the seven true ribs.
Extension is likewise free in these same sections, i. e.,
where flexion is free it is met by fairly free extension.

Side Bending Rotation. — Side bending, of a column
having antero-posterior curves, is characterized by rota-

7 th dorsal T lateral view

of
rotation

FIG. 67. Drawn by John Comstock.

UEP/:RY OF
F K v s f c f /: H 5 j£'^r: ( j R £ E

PRINCIPLES OF OSTEOPATHY 251

tion. This inherent rotation of the segments of the spinal
column will naturally take place with a center of rotation
theoretically located on a line extending directly from end
to end. This line would pass on the concave side of the
curves, i. e., be posterior to the bodies in the cervical region,
anterior to the bodies in the dorsal and posterior to the
bodies in the lumbar. A study of the articular processes
will show how this action is favored by the facing of their
articular surfaces. Lines drawn perpendicular to the sur-
faces of the superior articular processes of a typical cerv-
ical, i. e., the fourth or fifth cervical, will meet at a point
behind the spinous processes and about three inches above

1th dorsal, superior surface.

Centra of
rotation:

\

FIG. 68. Drawn by John Comstock.

su

H23JJQO

252

PRINCIPLES OF OSTEOPATHY

Costocmtrol
articulation

FIG. 69. Drawn by John Comstock (after Toldt).

3rd lumbar, lateral vieiu.

FIG. 70.

PRINCIPLES OF OSTEOPATHY

253

the level of the body of the vertebra. These lines incline
backward, upward and inward.

Best Position for Freest Movement. — The range of
movement in any joint is favored by relaxation of its liga-
ments, therefore any characteristic movement will be greater
when the relation of the joint surfaces to each other is
least limited by the ligaments. This position will be prac-
tically attained when the surfaces are in their normal posi-
tion for weight-carrying, i. e., balance. The weight of the
head upon the neck is balanced by the muscles governing
the movement in the arthrodial articulations so that there
is no sense of strain. This erect position favors rotation.
The extent of rotation diminishes as the neck is flexed. It

3rd lumbar, superior surface.

centre »f /
rotation/

/

/

FIG. 71.

254

PRINCIPLES OF OSTEOPATHY

also diminishes as the neck is extended. In either flexion
or extension, a series of ligaments becomes tense and hence
limits the extent of another movement, which requires free-
dom of this tense ligament. The erect position of the neck

FIG. 72. Left dorsal — right lumbar
curvature, progressive in type
and therefore painful. Bodies or
the dorsal vertebrae rotated to
the left. Bodies of the lumbar
vertebrae rotated to the right.

FIG. 73. Bodies of the lumbar ver-
tebrae are rotated into proper
alignment by elevating right but-
tock.

signifies ligamentous relaxation and is therefore the posi-
tion of election for reducing subluxations in the cervical
region. The seventh cervical marks the change in direction
of the facing of the articular processes. Its superior sur-

PRINCIPLES OF OSTEOPATHY 255

faces adhere to cervical characteristics while its inferior
become more vertical and lines perpendicular to them meet
at a point in front of the column. There is frequently a
gradual change in the facing of the cervical articular pro-

FIG. 74. Shows greatest right lat- FIG. 75. Shows greatest left lat-

eral flexion in concavity of the eral flexion in concavity of the

dorsal curve. lumbar curve.

cesses which begins at the sixth cervical. The inferior
processes of the sixth may face so as to bring their per-
pendicular lines together in front of and below the body.

Rotation in the Dorsal Region. — The articular pro-
cesses in the dorsal are characteristically vertical and theo-
retically move in line with the surface of a cylinder having
its axis anterior to the bodies of the vertebrae. Thus ro-
tation in the dorsal appears to move on a fixed point, just
anterior to the bodies of the vertebrae and hence the spinous

256

PRINCIPLES OF OSTEOPATHY

processes make an actually as well as apparently greater
excursion to right or left. The same rule with relation to
freedom of movement being greatest in the normal poised
position, applies here. Rotation is greater in the upper

FIG. 76. Illustrates the degree of
rotation of the bodies of the
lumbar vertebrae in this case of
left dorsal-right lumbar lateral
curvature.

FIG. 77. Illustrates the degree of
rotation of the bodies of the dor-
sal vertebrae in this case of left
dorsal-right lumbar lateral curv-
ature.

dorsal and decreases downward, disappearing at the vari-
able point where lumbar characteristics begin to influence
the form of the articular processes. This variable point is
found from the ninth to eleventh dorsal. Rotation with
the axis of movement anterior to the vertebral body usu-
ally ceases at the articulation between the eighth and ninth
dorsal. The lateral flexion between the ninth and tenth,
tenth and eleventh and eleventh and twelfth, is character-
ized by very little rotation of either the dorsal or lumbar

257

type. In this short region of the dorsal we have an almost
pure lateral flexion. Rotation in the upper dorsal is de-
creased in the flexed or extended position, for the same rea-
sons given for the cervical. All movements in the upper
dorsal are lessened by the costovertebral articulations. Since
the head of a rib articulates with the bodies of two vertebrae

FIG. 78. Structural lateral curva-
ture in the upper dorsal region,
due to partial paralysis of the
left rhomboideus major and
minor. Compensatory rotation
has taken place in the lumbar
region, as shown by the relative
outline of the body.

258

PRINCIPLES OF OSTEOPATHY

and their interovertebral disc, it is apparent that this would
tend to block the movement of one vertebra on the other
and hence greatly limit rotation. Although a study of the
mechanics of this portion of the column seems to show a

FIG. 79. Flexion to the left, in case
shown in preceding illustration.
The point of greatest flexion is
located in the concavity of the
right lumbar curve.

FIG. 80. Flexion to the right, in
case shown in the preceding il-
lustration. The point of great-
est flexion to the right is about
the ninth dorsal, i. e., about the
center of the concavity of the
left lateral part of the curvature.

very solid and unyielding construction, the fact exists that
we have a considerable amount of movement in the upper
dorsal articulations. Rotation is probably the most pro-
nounced of the upper dorsal movements and it is in this
region of the column lateral subluxations are found.
Flexion and extension are readily demonstrated from first
to fourth and from eighth to twelfth dorsal, i. e., in these
regions they are more pronounced than in the mid-dorsal.

PRINCIPLES OF OSTEOPATHY

259

Characteristic Movement in the Lumbar Region. — The

lumbar articular processes are vertical and face so that
they move in line with the surface of a theoretical cylinder
having its axis running in the tips of the spinous processes.

FIG. 81. Slight lateral curvature
of the structural type, as is evi-
denced by rotation of the bodies
of the lower dorsal vertebrae to
the left, the bodies of the lumbar
to the right.

There is much variation in the form of the lumbar articu-
lar surfaces. Since they have much greater weight for their
bearing surfaces to support they are heavily developed.
Exaggeration of the normal lumbar curve during the de-

260 PRINCIPLES OF OSTEOPATHY

veloping period causes them to take on a greater weight
carrying function than normal and hence changes the bear-
ing movable surface so as to decrease the range of move-
ment. The more nearly the bodies of the vertebrae tend

FIG. 82. Lateral flexion to the FIG. 83. Lateral flexion to the left,

right, is greatest in concavity of in this case, is greatest in con-

the dorsal curvature. cavity of the lumbar curve.

to support the superincumbent weight the greater freedom
of movement will naturally exist in the arthrodials between
the articular processes. The characteristic form of the
lumbar articular surfaces is not conducive to rotation, as
a well defined movement, such as we find in the upper
dorsal and cervical, but nevertheless, side bending in this
region is characterized by rotation having its center in a
line drawn vertically through the spinous processes. Thus
we note that rotation in the three regions of the column

PRINCIPLES OF OSTEOPATHY 261

places the center of movement on the concave side of the
curve. Any corrective movements made with reference to
any portion, or the column as a whole, must be made with
reference to these points of normal rotation. As in the

FIG. 84. Illustrating the presence
of rotation in the lumbar region,
coexistent with lateral curvature.

other regions of the column, rotation in the lumbar is less-
ened proportionally by flexion or extension. Flexion is
a greater check in this region than extension.

Rotation Toward Concavity of a Curve. — It is readily
noted that, in each region of the column, movement toward
the concavity of the curve is less of a check on rotation

262

PRINCIPLES OF OSTEOPATHY

than the reverse. Movement in the opposite direction com-
presses the intervertebral disks and hence lessens their resi-
lience.

Adaptability of Position to Body Weight. — Flexion and
extension in the lumbar are normally quite free, hence there

FIG. 85. Illustrating the presence
of rotation in the dorsal region,
coexistent with lateral curvature.

is great adaptability to the position of the body weight.
A decided deviation of a single spinous process is seldom
found in this region. The direction of the articular sur-
faces tends to prevent such deviation.

PRINCIPLES OF OSTEOPATHY

263

CHAPTER XIII.

THE PELVIS.

The Fifth Lumbar. — The fifth lumbar vertebra pre-
sents some points of importance. Its massiveness is an
evidence of its weight-carrying capacity. The depth of its
anterior margin is markedly greater than that of the pos-
terior portion of its body. The intervertebral disc between
the fifth and the sacrum still further accentuates, by the
relatively great thickness of its anterior margin, the angle
formed by the articulation of the fifth with the sacrum. The
inferior articular processes are wider apart than those of

FIG. 86. Drawing of pelvis, showing sacro-vertebral angle.
Drawn by John Comstock (after Holden).

264 PRINCIPLES -OF OSTEOPATHY

other lumbars. The transverse processes are usually
heavily developed, but the spinous process is apt to be
smaller than those of the other lumbars. This vertebra
joins the sacrum at a rather abrupt angle forming a de-
cided projection, the sacro- vertebral angle. A line drawn
through the intervertebral disc between the fifth lumbar
and the sacrum would form an angle with the horizontal
of about 30 degrees. It is evident that the inferior articu-
lar processes of this vertebra have a considerable function
of weight carrying. If it were not for the bracing action
of these processes, the superincumbent weight would tend
to slide the body of the fifth forward on the base of the
sacrum.

Loss vs. Exaggeration of Normal Curves. — As a gen-
eral proposition, it may be stated that, the loss of a normal
curve in the spinal column is apt to cause more discomfort
than would the exaggeration of a normal curve. There is
probably no better example of this, than the effects noted
in changes of the lumbo-sacral articulation. It is mani-
fest that extension in the arthrodial articulations, between
the articular processes of these two bones, serves to hold
them more firmly together and make the sacro-vertebral
angle more prominent. This serves to make the lower ab-
domen more prominent and makes the line of division be-
tween abdomen and pelvis more marked.

Motion in Lumbo-Sacral Articulation. — Flexion, of the
fifth on the sacrum, compresses the thick anterior margin
of the intervertebral disc and slides its articular processes
upward on those of the sacrum, thus tending to greatly de-
crease the sacro-vertebral angle and make the spinous pro-
cess of the fifth become more prominent. It is conceiv-
able that forced flexion in this articulation could cause a
complete dislocation of the articular surfaces. Flexion
and extension are so free in this articulation that much of
the movement, ascribed to the lumbar region as a whole,
is contributed by it. Loss of motion here, as in lumbago,

PRINCIPLES OF OSTEOPATHY

265

Last lumbar spine -

\

FIG. 87. Showing sacro-vertebral angle of the average female pelvis.
Drawn by John Comstock (after Crossen)

266

PRINCIPLES OF OSTEOPATHY

is characterized by a rigidity which causes the stride in
walking to be greatly shortened.

Adaptation in Lumbo-Sacral Articulation. — In cases of
unequal length of legs as a result of injury, flat-foot, slight
bend of an inflamed knee or hip, there is a tilting of the
fifth, on the base of the sacrum, in order to balance the
weight of the body. There is unequal movement in the

FIG 88. Normal poise of the body.
Drawn by John Comstock (after
Holden)

arthrodials formed by the articular processes, i. e., the joint
on the side of the shorter leg extends, while the opposite
one flexes, thus producing a tendency to rotate. This rock-
ing action permits a great range of adaptation in this joint,
an action which is absolutely essential to the maintenance
of balance in the upright position.

Stability of the Lumbo-Sacral Articulation. — The an-
terior common ligament is so placed as to lend support to

PRINCIPLES OF OSTEOPATHY

267

FIG. 89. Plantar impression of a case that sought relief for a sacro-
iliac subluxation. The use of an arch support corrected the supposed
lesion. The effort at adaptation in the lumbo-sacral articulation
caused a fatigue pain.

268 PRINCIPLES OF OSTEOPATHY

this articulation in the extended position. Ligaments or-
dinarily limit motion but are extensible tissues when under
continuous strain, hence the weight of the body tends
always to be transmitted from bone to bone. To change
this arrangement and thus put the strain continuously on
ligamentous tissue, leads to relaxation in the joint. There
are many joints in the body which, so far as the adapta-
tion of the articulating surfaces of the bones which form
them are concerned, furnish no stability. The knee joint
is a good example of this. It has sixteen ligaments which
serve to furnish it a stability not warranted by the form
of the articulating surfaces of tibia and femur. The lumbo-
sacral articulation has a stability in its normal angle due to
the locking of its articular processes. The more these pro-
cesses are locked, as in hyperextension, the greater the ten-
dency to transmit weight through them. This is unnat-
ural and hence produces fatigue, both by continuous pres-
sure on the articular surfaces and by stretching of the an-
terior common ligament. This is the condition caused by
a pendulous abdomen.

Decompensation of the Lumbo-Sacral Articulation. —
Flexion of the lumbo-sacral articulation causes a straight-
ening of the lumbar thus bringing the weight of the body
more completely on the column of bodies and changing
the lumbo-sacral angle, so that the axis of the pelvic cavity
is brought more nearly in line with that of the abdomen.
The obliteration of the normal lumbar curve produces a
general curve, i. e., coincides with the dorsal and thus be-
comes part of a general posterior curve. This puts a great
strain on the posterior spinal ligaments. This is a state of
decompensation of the normal spinal curves, which necessi-
tates a decided effort to balance the body.

Part of the Pelvis. — Obstetricians count the fifth lum-
bar as a part of the pelvis, since it is bound to the innomi-
nates by ilio-lumbar ligaments, which extend from the tips
of its transverse processes to the crests of the ilia. These
ilio-lumbar ligaments tend to compel the fifth lumbar verte-

PRINCIPLES OF OSTEOPATHY

269

bra to act somewhat as though it were a portion of the
solid pelvis.

Characteristics of the Sacro-Iliac Articulations. — The
articulations between the sacrum and innominates are nor-
mally immovable. They may become physiologically mov-
able, in the pregnant woman, in order to facilitate the birth
of the child, i. e., they exhibit functional adaptation. Fol-
lowing the act of parturition they normally become immo-
bile, i. e., exhibit functional adaptation to weight carrying.
Failure of either of these forms of adaptation is an abnor-
mality. In case the articulations do not relax in the par-
turient woman, the whole process of adapting the birth
canal and its contents, is exhibited by the head of the child.
Normally the bony birth canal and the child's head mutu-
ally undergo adaptive changes. In case these articulations

Section through
Socro -iliac Joint

FIG. 90. Drawn by John Comstock.

270

PRINCIPLES OF OSTEOPATHY

do not regain comparative immobility, following parturi-
tion, a condition of instability will exist, which will express
itself in a disturbance of the statics of the body. Balancing
and weight-carrying functions will be injured.

Physiological Relaxation. — The menstrual periods in
many women are characterized by relaxation of the pelvic
ligaments, with consequent disturbance of the weight-carry-
ing power of the sacro-iliac articulations.

The Male Pelvis. — The male pelvis never exhibits any
form of normal relaxation of ligaments, therefore the ex-
istence of any instability in the sacro-iliac articulations is
pathological, i. e., due to debility or trauma. The trauma
may be direct and forceful enough to strain the ligaments
suddenly, or it may consist in a form of fatigue, which
eventually allows the ligaments, engaged in the weight-
carrying functions of these joints, to become strained.

FIG. 91. Drawing of posterior aspect of pelvis, showing relation of
second sacral to the posterior superior iliac spines. Drawn by John
Comstock.

PRINCIPLES OF OSTEOPATHY 271

Loss of Stability. — It is axiomatic that loss of sta-
bility, in the pelvic girdle, will weaken its weight-carrying
capacity and hence disturb the normal static condition of
the whole body. In view of this fact, we must make a
rather careful study of the structure of these joints and
note any evidences of inherent weakness, i. e., observe at
what points unusual force might most easily produce a
lesion.

FIG. 92. Normal relations of sacrum and ilium.

Analysis of Sacro-Iliac Articulations. — Dissection of
these joints discloses the existence of the same structures
found in other joints, i. e., bone, cartilage, synovial mem-
brane and ligaments. The fact that these structures do
exist in the sacro-iliac articulations, naturally classifies
these joints as having possible mobility. These joints
serve to absorb shocks transmitted through the legs to the
pelvic girdle. The slight movement, normally possible in
them, subjects them to much the same conditions which
serve to injure other joints.

272 PRINCIPLES OF OSTEOPATHY

FIG. 93. Ilium forced upward and forward.

FIG. 94. Ilium forced upward and backward.

PRINCIPLES OF OSTEOPATHY

273

Relation of Sex to Sacro-Iliac Lesions. — Clinically we
have found disturbances of these joints in both men and
women, hence we are forced to believe that sex does not
control the character of the lesions. They are much more
frequent in women than in men. This is undoubtedly due
to the necessarily greater functional adaptability of the fe-
male pelvis.

Inherent Weakness in the Character of the Structure.
— The sacro-iliac articulations are inherently weak, so far
as any bony interlocking is concerned. Their stability is
a matter of ligamentous strength. The sacrum is wedge-
shaped from above downward and from anterior to posterior.
The anterior surface, being broader than its posterior, does
not serve well to offer resistance to the superincumbent
weight of the spine. The sacrum articulates by its auricular
surfaces with those of the ilia. The articulating surfaces
of both bones are covered with cartilage. The joints are
surrounded by capsular ligaments and contain synovial

PIG. 95. Posterior superior spine of the ilium is too prominent.

PRINCIPLES OF OSTEOPATHY

FIG. 96. Normal surface markings of the relations of the sacrum and
ilia.

275

sacs. The apposing auricular surfaces are reciprocally,
slightly, uneven but not enough so to sustain any weight
without ligaments. The illustration, Fig. 90, shows
clearly the relation of the form of the sacrum to the direc-
tion of the weight it sustains. The structure of the sacro-
iliac synchondroses indicates that movement is possible
and, in fact, probable. The primary object of the move-
ment is to produce elasticity in the pelvic girdle and inter-
rupt shocks which would be transmitted from the legs to
the trunk. A further object would be, in the female, adapta-
tion of the birth canal to its contents.

Causes of Subluxations. — Clinically we recognize the
existence of disturbances in these joints as due to relaxa-
tion of ligaments due to pregnancy, menstruation, general
debility, or trauma. Functional adaptability in the female
pelvis makes women easily subject to changes in these
joints, and likewise permits easier correction. The male
pelvis is practically never disturbed except as result of
debility or trauma, and is therefore more difficult to correct.

Rotation. — The motion in these joints is described by
various authors. Judging from clinical experience the mo-
tion seems to be in the nature of rotation. This rotation
takes place on an axis which passes through the articulat-
ing surfaces of the sacrum and ilia on a level with the pos-
terior superior spines of the ilia and the second sacral
spine. This makes the second sacral spine and the pos-
terior superior spines of the ilia the bony landmarks indi-
cating the position of the joint surfaces. Rotation of the
ilium forward would make the posterior superior spine less
prominent and slightly higher, so that a line drawn across
the sacrum through its second spinous process would pass
through the lower border of the posterior superior spine,
instead of its apex. Rotation of the crest of the ilium back-
ward makes the posterior superior spine more prominent
and slightly lower than normal. All the positions described
by various authors can be reduced by analysis to the two

276

PRINCIPLES OF OSTEOPATHY

FIG. 97. Rotation of the ilium, forward.

PRINCIPLES OF OSTEOPATHY

FIG. 98. Posterior superior spine of the ilium is prominent, ana
slightly below the second sacral spine.

278

PRINCIPLES OF OSTEOPATHY

rotations just described. Since these rotations are unilat-
eral, the pelvic distortion results in a slight apparent dif-
ference in the length of the legs so that when the patient
lies on the back, on a hard surface, with the legs stretched
out as evenly as possible, the heels will be found not to be
equal. In order to compensate for this apparent inequality
in length, the pelvis will be found to be tilted, with relation
to the spinal column. This compensatory tilt is the same
phenomenon that is present in every case having unequal

FIG. 99. A case of posterior right
iliac which was characterized by
persistent pain in the right sacro-
iiiac and the sacro-vertebral ar-
ticulations.

PRINCIPLES OF OSTEOPATHY 279

length of leg support. In order to make sure which joint
is the one at fault, one must use those bony landmarks
which are a part of the pelvis, i. e., posterior superior iliac
spines and the second sacral spine. An apparent difference
in the length of the legs might be due to a lumbar condi-
tion, irrespective of any change in the relation of the bones
of the pelvis.

Compensatory Pelvic Tilt. — It should be remembered
that no change in a sacro-iliac synchondrosis is ever unac-
companied by a compensatory effort of the body to trans-
mit the body weight through the normal half of the pelvis.
This produces a slight spinal curvature, which is part of
the compensatory tilt of the pelvis, to avoid transmitting
body weight through the weakened joint of the pelvic girdle.

Classes of Cases. — Two classes of cases complain of
pain which may be traced to disturbance in these -joints.
The first group comprises those of both sexes, who are
debilitated, and hence do not have normal tone in muscles
and ligaments. These cases either are bed-fast or inclined
to assume the recumbent position. Cases compelled to lie
on the back for a long period following surgical operations
are apt to suffer distress in these joints. The second group
comprises those who are over-weighted in the abdomen,
and hence tend to lordosis in the lumbar region. Both of
these classes are greatly helped by corrective manipula-
tion and bandages.

The debilitated individual is toned by corrective man-
ipulation, and the weakened ligaments reinforced by some
simple form of girdle which helps to hold the pelvis firm.
The individual with the over-weighted abdomen is physio-
logically rested by corrective manipulation and the use of
a support which will assist the back in carrying the ex-
cessive weight which lies anterior to its normal weight-
carrying structure.

The really difficult sacro-iliac lesion to correct is the
traumatic. Such a lesion has all the elements which make
perfect recuperation problematical in any joint.

280

PRINCIPLES OF OSTEOPATHY

FIG. 100. Elevation of the foot in
a case of posterior rotation of
the right ilium. This is not suf-
ficient, in such cases, to correct
the compensatory changes in the
lumbar articulations.

PRINCIPLES OF OSTEOPATHY

281

Symptoms. — The symptoms of sacro-iliac lesions are
usually pains located in the lumbar, gluteal and thigh re-
gions. The pains are described by patients as being usu-
ally a dull heavy ache whenever the weight of the body
is transmitted through these joints. Close analysis will be
required to determine whether a given case is in reality a
sacro-iliac lesion. The only physical test worth trusting is
the alignment of the posterior superior iliac spines and the
second sacral spine, when the patient is standing. The pains
may be due to many different strains. The hyperesthetic
points about the sacro-iliac joints may accompany other
conditions. Flat-foot will, in some instances, produce all
the sore spots in the lumbar and sacral region which may
be present with a sacro-iliac lesion. The backache, due to
tilting of the pelvis, to compensate for a sacro-iliac lesion, is
practically similar to that due to the effort to compensate
for a change in statics due to flat-foot.

Plan of Treatment. — A sacro-iliac subluxation is due
to relaxation of ligaments, or trauma. To correct such

PIG. 101. Showing the average amount of inequality in the length
of the legs in a case of posterior rotation of the right ilium.

282 PRINCIPLES OF OSTEOPATHY

subluxations, the cause is the controlling factor as to the
means to be employed, i. e., debility must be controlled
by general means, so that local reinforcement of weakened
ligaments will not be continuously necessary. It is usu-
ally easy to make a specific correction of the lesion in a
debilitated case, but not easy to maintain the correction.
It is difficult to correct a traumatic lesion, but when once
corrected, the vitality of the tissues tends to make the cor-
rection permanent. In all debilitated cases voluntary exer-
cise must form an important part of the treatment. Climb-
ing on rough ground is the best aid in such cases, because
no two steps are alike, and hence the tissues are not
fatigued by repetitions of similar movements.

PRINCIPLES OF OSTEOPATHY 283

CHAPTER XIV.

SUB LUXATIONS.

Definition. — The word subluxation was so new, to the
general medical profession, that much ridicule was heaped
upon the osteopaths because they advocated such a ridicu-
lous theory as that "all diseases are caused by dislocation of
bone." We are not so sure but that this ridicule was, to a
large extent, well merited by the osteopaths. The loose way
in which the words luxation, dislocation and subluxation are
used in some of our literature shows that they do not always
cover a definite idea in the mind of the writer. They can
not be used interchangeably. The word subluxation should
be used to denote a definite condition. Subluxation is de-
fined as a partial dislocation in which the normal relations
of the articulating surfaces are but slightly changed.

Da Costa describes subluxation of the shoulder, also of
the head of the radius. For the latter condition he has col-
lected eight different explanations. We have not been able
to find the term used in reference to any other articulations.
The osteopath uses the term to define certain inequalities in
the arrangement of vertebrae and ribs, sacro-iliac and other
articulations. Perhaps we hear the term used in connection
with the atlas more than with any other bone.

Characteristics of Subluxations. — Subluxations allow
considerable movement in the articulation, but to the trained
hand there are evidences of malposition. Pain is developed
when the complete normal movement is attempted by the
operator. Digital pressure around the joint causes deep
pain. There is usually a history of accident, exposure or
visceral disorder.

PRINCIPLES OF OSTEOPATHY

FIG. 102. Normal surface marking of the transverse process of the
Atlas.

PRINCIPLES OF OSTEOPATHY 285

Primary or Secondary Lesions. — From experience we
know the frequency of very evident malpositions of verte-
brae, commonly spoken of as subluxations, and as being true
or primary lesions causing disordered function in the area
of peripheral distribution of the nerves from that segment
of the spinal cord.

The Characteristic Structure of Joints. — In order to get
at a true understanding of what subluxation is, we must
make a careful study of the structures which form a joint
and their vital manifestations. The bones of the skeleton are
bound together by ligaments and muscles. The opposing
surfaces of bones forming movable joints are covered with
cartilage. The muscles execute and the ligaments, or soft
parts around a joint, limit the motions of the articulation.
All movable articulations have their bony parts maintained
in their normal relations either by the form of the bones and
cartilages attached to them or by the equal tension of all the
controlling muscles. Enarthrodial joints have freest move-
ments and yet are the least dependent on muscles for reten-
tion of their normal position. Air pressure and the form of
the bones are responsible for the integrity of these joints.
These joints are less frequently subluxated than those pos-
sessing more limited motion. Arthrodial joints depend upon
the equal tension of their governing muscles to keep the
opposed surfaces in their proper relations. Coordination of
the muscular tension is usually so perfect that the joint sur-
faces are perfectly opposed to each other. The disturbance
of this nicely balanced muscular tension results in the draw-
ing of one or both bony surfaces away from their true rela-
tions ; not entirely, but sufficiently to make it possible for
the physician's fingers to note the change.

The Atlas. — The atlas is placed not only first in the ver-
tebral column, but also first in importance to the osteopath
on account of the great possibilities for slight displacement
between it and the occiput. All the conditions are present
which make a very movable joint and close at hand are im-

286

PRINCIPLES OF OSTEOPATHY

portant nerves and blood vessels whose slightest maladjust-
ment causes instant disturbance at the very fountains of
fife. No physical examination is considered complete with-
out noting accurately the position of the atlas. There being
no spinous process all reckoning must be made from the
transverse processes.

Occipito-Atlantal Articulation. — According to Gray's
Anatomy: "The movements permitted in this joint are
flexion and extension, which give rise to the ordinary for-

FIG. 103. Abnormal surface markings of the transverse process of
the Atlas.

PRINCIPLES OF OSTEOPATHY 287

ward and backward nodding of the head, besides slight lat-
eral motion to one or the other side. * * The
Recti Laterales are mainly concerned in the slight lateral
movement. According to Cruveilhier there is a slight mo-
tion of rotation in the joint." According to Gerrish : * *

FIG. 104. Normal relations between the atlas and
occipital bone.

"Some lateral gilding is also allowed, by which the
outer edge of the condyle on the one side is depressed and
on the other is elevated in relation to its socket. Or the
movement may be obliquely lateral, one condyle advancing
slightly at the same time that it is depressed toward the
median line, while the opposite condyle takes the reverse po-
sition. This is the position of greatest stability, and is as-
sumed in the most easy and natural attitudes. Lateral move-
ments are restrained by the check ligaments and the lateral
parts of the capsules. No true rotation is allowed."

288

PRINCIPLES OF OSTEOPATHY

FIG. 105. Normal relations be-
tween the atlas and occipital
bone.

FIG. 106. Right transverse pro-
cess of the atlas too far posterior.

PRINCIPLES OF OSTEOPATHY

289

FIG. 107. Right transverse process
of the atlas too far posterior.

FIG. 108. Twisted atlas-rotation.

290

PRINCIPLES' OF OSTEOPATHY

The capsular ligaments are very loose, hence the
strength of the joint lies in the anterior, posterior and lat-
eral ligaments. There is no cartilaginous disk between the
atlas and occiput, hence motion is limited only by the liga-
ments named.

FIG. 109. Twisted atlas-rotation.

If one should judge of the prevalence of dislocations of
the atlas by the number of times such a condition is men-
tioned in osteopathic literature, we would draw the conclu-
sion that everyone's atlas is dislocated. The term disloca-
tion is a strong one and ought not to be used in connection
with the atlas. Its dislocation would cause death instantly.
Subluxation is the proper term to use. Subluxations can be
readily diagnosed; the fact that they exist can not be
doubted ; all positions between the normal relations and
complete dislocation are possible. The complete dislocation
of this bone from the occiput means death ; intermediate po-
sitions, subluxations, mean irritation of nerves direct

PRINCIPLES OF OSTEOPATHS 291

and both direct and indirect disturbances of circulation ; di-
rect disturbance by pressure exerted on arteries and veins,
indirect disturbance by excitation of vaso motor nervta.

The Causes of Subluxations. — It is difficult to account
for these subluxations of the atlas without bringing in the
contraction of muscles. This seems to us to be the most
prevalent cause of misplacement of the atlas. Even though
we recognize the numberless jars, twists and strains of this
articulation, still the resultant bad effects are maintained by
the unequal contraction of opposing groups of muscles
which is brought on by these accidents. Take, for instance,
the various twists of the atlas found by osteopathic methods
of physical diagnosis. Gray says : "The Recti Laterales are
mainly concerned in the slight lateral movements." This is
the movement concerned in a lateral subluxation. The po-
sition in which we usually find the atlas is an oblique one,
having the right transverse process hugging the angle of
the jaw while the left is too close to the mastoid process.
Gerrish describes this position as the "obliquely lateral," a
normal movement. We also consider it normal if it pos-
sesses the ability to slip back into a position having similar
relations on both sides. It is a subluxation when it can not
get out of that position without assistance. If there is free
movement in the occipito-atlantal articulation, every change
of the position of the head will change the relations in this
joint. Our bodies are constructed so that when the bones,
forming a joint, are moved to their fullest extent, pressure
is usually exerted on the soft tissues around the joint. This
is normal, but when these normal relations are retained too
long and the bones do not resume their easy resting position
the condition becomes abnormal ; it is then a subluxated
joint.

There is no articulation in the body whose bony parts
are abnormally related when the extreme movement in the
joint is made. (We will except the sacro-iliac articulation,
because it is not ordinarily considered a movable joint.)
The subluxation consists in the relation of the bony sur-

292 PRINCIPLES "OF OSTEOPATHY

faces in a position other than that which they should hold
during relaxation or equal tension of all the muscles. The
normal position of the transverse processes of the atlas is
pictured in Fig. 102. The subluxations are pictured in Fig.
103.

Normal Relations of the Atlas. — The normal relations
of the atlas are illustrated by photographs of the skull and
first vertebra in Fig. 104. Fig. 105 shows an oblique side
view. In Fig. 106 the atlas is slightly twisted, so that the
right transverse process is posterior. This rear view shows
the distance between the left mastoid and left transverse
process increased. The right transverse process is promi-
nent. The same relations viewed from below are shown in
Fig. 107. The right transverse process is slightly posterior
to the mastoid.

Abnormal Positions of the Atlas. — Fig. 108 and Fig. 109
show side and lateral views of a twisted atlas. In preparing
these bones for photographing, it has been borne in mind
that the articulating surfaces must be kept in close apposi-
tion. The relations illustrated are normal to the articula-
tion, but abnormal when retained in these positions after re-
laxation of opposing muscles.

The Effect of Muscle Contraction. — If, as Cruveilhier
says, there is a slight rotation in this joint — and osteopathic
practice proves Cruveilhier's statement true — , then what
muscle could by its persistent contraction cause this rota-
tion to be maintained? The Rectus Capitis Anticus Minor is
so placed as to cause this movement. It arises from the an-
terior surface of the lateral mass and root of transverse pro-
cess of the atlas and passes obliquely upward and inward.
It is inserted into the basilar process of the occipital bone.
This muscle has as its external relation the superior cervi-
cal ganglion of the sympathetic, and as a contracted mus-
cle is thicker than an uncontracted one, pressure may be
exerted on this ganglion which may also be irritated by the
transverse process of the atlas being pulled toward it, there-
by lessening its normal space in more than one direction.

PRINCIPLES OF OSTEOPATHY 293

The reflexes originated by this irritation of the superior
cervical ganglion, or its connections, may initiate changes
in the caliber of the blood vessels of the brain, eyes or any
other circulatory area under control of the ganglion.

The Effect on Circulation. — The influence exerted di-
rectly on circulation by the subluxation of the atlas is proba-
bly most active where the vertebral arteries pass through
the foramena in the transverse processes. It might be argued
against this view that nature has not failed to provide a
certain amount of elasticity in the artery and surrounding
structures to meet just such a condition. Nature has cer-
tainly done this, but not with the idea in view that any such
exaggerated condition is to be maintained for any great
length of time.

Effect on Superior Cervical Ganglion. — Subluxations of
the atlas are found in connection with a great number of
disturbed areas, but the condition in each is the same. For
example, there is no difference between a hyperaemia in the
nasal, pharyngeal or laryngeal mucosa and a congestion of
the retina, except in location. We must not view the phe-
nomena of retinitis as especially different from those of lar-
yngitis. If we should do so, we fix our attention on symp-
toms and see a picture which conceals causes. When the
superior cervical ganglion has its function of vaso-constric-
tion inhibited by continued irritation, the work of main-
taining vascular tone is passed along to peripherally placed
ganglia. If the eyes are strained by overwork, the resistance
of their nerves is decreased. This, added to the weakened
vaso-con stricter action of the superior cervical ganglia, al-
lows congestion, a retinitis. Wearing high collars weakens
the resistance of nerve endings in the skin of the neck. This,
added to low power in the ganglionic station, leads to con-
gestion in the pharynx or larynx. Treatment must be ap-
plied to the structures around the ganglion, and peripheral
nerve power increased by gradually exposing the skin to
the atmosphere.

294 PRINCIPLES OF OSTEOPATHY

Atlo-axial Articulation. — The articulation between the
atlas and axis is the most intricate in the whole spinal col-
umn, consisting of four distinct joints. Rotation takes place
between these bones, but this motion is limited by the check
ligaments. Dislocation of the odontoid process causes in-
stant death by pressure on the lower part of the medulla
oblongata. The articulations between the articular pro-
cesses of these bones are arthrodial. The articulation be-
tween the odontoid process of the axis and anterior arch of
the atlas holds the bones firmly together. Most of the rota-
tion in the cervical region is in this joint. Although there
is so much movement allowed by these articulations, we sel-
dom find the axis subluxated.

Unequal Development. — Deviation of the spine of the
axis from the median line is a frequent condition, but in the
majority of cases is its normal relation on account of un-
even development.

Caries. — Hilton describes cases of disease of the articula-
tion between the atlas and axis, showing how destruction of
the transverse ligaments allows the head to tip forward,
thereby causing the odontoid process to impale the medulla.

Dislocation. — We may safely say that dislocation of the
atlo-axial articulations is probably the rarest condition we
will ever meet. Various degrees of rotation may be met
with which are in the nature of subluxations due to muscular
contractions.

Spontaneous Reduction. — Since the above paragraph
was written, an article in the Medical Record, March 3,
1900, has come under my observation. The article is en-
titled "Spinal Fracture — Paraplegia." The author, Dr. Rob-
ert Abbe, exhibits a radiograph illustrating a case of dislo-
cation of the neck. The dislocation is between the articular
processes of the atlas and axis. The most interesting feature
of the case is the spontaneous reduction of the dislocation
while the patient was asleep. The author thinks that the
relaxation of sleep and the restlessness of the patient com-
bined to reduce it.

PRINCIPLES OF OSTEOPATHY

295

Cervical Vertebrae. — The remaining cervical vertebrae
are occasionally forced from their proper relations by vio-
lence. Quite a number of cases are on record which show
how great the disturbance is in such conditions. Those
cases recorded in medical literature are complete disloca-

FIG. 110. Normal rela-
tions of the cervical
vertebrae.

FIG. 111. Third cervical
vertebra subluxated to
the right. The superior
articular process of the
fourth cervical is vis-
ible.

tions, and hence can not be classed with subluxations such
as are met with in osteopathic practice. In order for com-
plete dislocation to take place, i. e., so that the articular pro-
cesses are both locked, the intervertebral disks would have
to be torn and would probably bring great pressure on the
cord.

All grades of subluxation are found between cervical
vertebrae. Where the violence has not been sufficient to
cause locking of the articular processes, it has exaggerated
the normal movement sufficiently to injure the ligaments
or muscles, which therefore maintain the subluxated posi-
tion.

Disproportion Between Cause and Effect. — We cannot
estimate the extent of the systemic effects of a lesion in the

296 PRINCIPLES OF OSTEOPATHY

spine. What might appear to us to be a very slight lesion
might be the cause of a very profound nervous disorder.
The position of the lesion is the chief means of estimating
results.

Example. — To illustrate this point, we may mention the
case of Mr. Norton Russell. A lesion of the sixth cervical
vertebra was found. The vertebra was slightly twisted.
Mr. Russell had not slept during one hundred nights and
days without the use of sulphonol or morphine. The fiist
osteopathic treatment applied to the sixth cervical vertebra
made it difficult for him to keep awake until he reached his
home and then he fell into a profound sleep. There was a
history of severe accident. Muscular contraction was very
evident.

Unequal Development of Spinous Processes in Cervical
Vertebrae. — Fig. 110 illustrates the appearance of the poster-
ior surfaces of the cervical vertebrae, second to the seventh,
when all the vertebrae are in normal position, i. e., articular
surfaces evenly opposed to each other. The changing char-
acter of the spinous processes is readily noted. Nearly all
of these processes are unevenly developed, showing that pal-
pation of these prominent points can not help being unsatis-
factory. The tubercles on the back and outer surfaces of the
inferior articular processes present a much more uniform
development and they can be easily palpated after one has
become accustomed to the feel of the cervical muscles. Fig.
Ill shows the third cervical subluxated to the right. The tu-
bercle on the left inferior articular process is made more
prominent. The muscles over this point will be found con-
tracted.

Palpation of Dorsal Spinous Processes. — When the
spines of the dorsal vertebrae are palpated, the trained
fingers may find individual spines which are not in line with
those above and below, or that the spacings between the
spines are not equal. The deviations from the normal are
indicative of changed relations between the vertebrae.

PRINCIPLES OF OSTEOPATHY

297

Normal Dorsal Movements. — The normal movements
in the dorsal region are flexion, extension and rotation. The
lesions in this region correspond with these movements.

False Lesions. — We must guard against being misled by
the deviations which we find, especially lateral ones. Fig.
112 illustrates a decided lateral inclination of the third dorsal

FIG. 112. Abnormal development
of the spinous process of the
third dorsal vertebra. A false
lesion.

FIG. 113. Lateral sub-
luxation of a dorsal
vertebra.

FIG. 114. Flexion In the
dorsal region showing
spinous processes sepa-
rated and superior ar-
ticular processes par-
tially uncovered.

FIG. 115. Lateral view of same
condition as Fig. 114.

298

PRINCIPLES OF OSTEOPATHY

spinous process. Such a deflection from the median line
would be noted by the unskilled touch of a layman. This
deflection has no diagnostic significance, unless there is pro-
nounced sensitiveness around it, and then it is the hyperaes-
thesia and not the osseous formation that must be noted. A

FIG. 116. Extension in the
ciorsai region showing ap-
proximation of the spinous
processes.

very skillful osteopathic diagnostician might be misled by
this lesion. There does not appear to be any way to pro-
tect against a wrong interpretation in a case like this except
the experience of the physician in weighing all the evidence.

Lateral Subluxation. — Fig. 113 illustrates a genuine lat-
eral subluxation of a dorsal vertebra. The arrangement of
the Rotatores Spinae account for such a lesion as this. They
arise from the upper surfaces of the transverse processes and
insert into the laminae above. The subluxated vertebra in
this group is the fifth. The digitation of the Rotatores
Spinae between the right transverse process of the sixth and
lamina of the fifth must contract in order to produce this
condition. This digitation may respond to a severe visceral
reflex and cause a subluxation of this character. Direct
violence may cause it, also a cutaneous reflex initiated by
temperature change in the atmosphere.

PRINCIPLES OF OSTEOPATHY 299

Muscular Contraction. — Muscles contract as a result of
excessive straining or wrenching, or exposure to cold and
of reflex irritation. If opposing muscles under all condi-
tions of temperature, mechanical and reflex irritation would
continue to exert equal influence on a joint, then nothing
but a complete dislocation would be possible. A movable
joint is enclosed in a synovial membrane which facilitates
the rapid return to a normal position. All the mechanical
conditions in and around a joint are conducive to the quick
return to normal. It is the vital and not the mechanical
principle which keeps up a condition of maladjustment. No
intermediate position is possible, there being no unevenness
of surface to become locked, unless we take into considera-
tion the vital activity as manifested in a contracted muscle.

Comparison of Effects of Muscular Contraction. — J. E.
Stuart, D. O., has made an apt comparison between the pull
of the muscles of the back on the individual vertebrae and
the well recognized insufficiencies of the ocular muscles. All
physicians recognize the serious effects of long continued
insufficiency of an ocular muscle, but few, indeed, have given
any thought to the possibility of a similar condition affect-
ing structures less movable, or less sensitive, than the eye-
ball. The relation of a vertebra with its fellows is of great
importance to the delicate nervous tissue which it sur-
rounds. It is not necessary for a vertebra to press upon the
spinal cord, or nerve fibers coming from or going to it, in
order to produce irritation. There is a nerve strain in con-
nection with these lesions which is not the result of direct
pressure but of the efforts of the central nervous system to
balance and coordinate the contraction of the muscles pull-
ing on the vertebra. It is not necessary for divergent or
convergent squint to be so marked that the expression of
the eyes is instantly noted by all observers before any symp-
toms of eye strain are felt by the patient. Neither is it neces-
sary for a vertebra to be dislocated in order to create a dis-
turbance. It is conceivable that a completely dislocated
vertebra might, after a time, cause as little irritation as an

300 PRINCIPLES OF OSTEOPATHY

eyeball which is so divergent that no effort is made to use
binocular vision. The body becomes accommodated to the
change.

Separation of Spinous Processes. — Figs. 114 and 115 give
two views of the fifth, sixth and seventh vertebrae, illustrat-
ing the separation of the spines, as in extreme flexion. Note
that the superior articular facets are uncovered by the move-
ment. The vertebrae assume this position in kyphosis. We
frequently find that there is a gap between two spines while
the spacing above and below is quite even. Either the space
directly above or that below this gap is lessened. Fig. 116
shows the spine of the fifth, sixth and seventh dorsal verte-
brae in the position of extreme extension. The spines crowd
hard upon each other. These illustrations all show normal
positions, but they are the ones which our fingers discover
as lesions of the vertebrae.

Approximation of Spinous Processes. — When two spines
are closely approximated, as in Fig. 116, there is neces-
sarily a widening of the next space above or below, depend-
ing upon which vertebra is affected. The contracted space
will usually be sensitive to digital pressure. There is a con-
tractured condition of the muscles causing this extreme
movement of extension. This contracture disturbs the
rhythm of nerve impulses from that section of the spinal
cord in closest relation with the disturbed vertebra. There
is lack of coordination of movement in the affected joints.
When several vertebrae are tightly bound together a
straight, non-flexible spinal column is the result. The mus-
cles are tightly contracted and more or less sensitive to digi-
tal pressure.

Primary Subluxations. — These conditions, as here illus-
trated, are what osteopaths usually designate as spinal sub-
luxations which are causative factors in disease. They are
sources of irritation to the spinal nerves in direct central
relation with them, and these nerves convey disturbed or
arythmical impulses to the viscera and blood vessels, thus

LfBFAFY GF ,.
LLEGE OF OS TEG FA

PRINCIPLES OF OSTEOPATHY

301

causing the various perversions of function which are recog-
nized as symptoms of disease.

Secondary Subluxations. — These lesions must also be
recognized as structural changes resulting from excessive
irritation to the peripheral end of sensory nerves, either
those ending in skin and subject to the temperature changes
or those ending in the visceral muscosa and subject to irrita-
tion from the presence of food of an indigestible character,
products of fermentation, etc. We must recognize the fact
that sensory nerves are subject to excessive stimulation in
cases of gluttony or masturbation. Both of these bad habits
may result from the stimulation of a spinal lesion, but ex-
perience with humanity teaches the physician that mankind
in general delights in gratifying the senses. We do not wish
to place spinal lesions at the bottom of man's moral weak-
nesses.

Limited Area for Lateral Subluxations. — Lateral sub-
luxations may exist as low as the tenth dorsal spine. The
articular processes of the eleventh and twelfth dorsal

FIG. 117. — Posterior view of five
lower dorsal vertebrae, nor-
mal relations.

FIG. 118. Side view of five
lower dorsal vertebrae,
normal relations.

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302 PRINCIPLES OF OSTEOPATHY

vertebrae take on the character of the lumbar, hence rota-
tion is practically impossible. There is a digitation of the
Rotatores Spinae between the eleventh and twelfth dorsal
vertebrae.

Lower Dorsal Vertebrae. — Figs. 117 and 118 give a pos-
terior and lateral view of the five lower dorsal vertebrae.
The changing characteristics of the spinous processes of
these vertebrae should be carefully noted, so that the stu-
dent may not be misled as to the significance of that which
his palpation may discover. The eleventh dorsal spine takes
a horizontal direction, and in some cases this makes either
a very narrow space between it and the tenth or a very wide
space between it and the twelfth.

Dorso-Lumbar Articulation. — The junction of the dor-
sal and lumbar regions is very flexible. A large portion of
flexion and extension of the spinal column is made in this
articulation. The most common condition noticeable in the
lower dorsal region is increased prominence of the spines,
and incipient kyphosis. This condition frequently affects
the junction of the dorsal and lumbar regions.

Kyphosis — Lower Dorsal. — A slight kyphosis in the
lower dorsal region is indicative of loss of tone in the exten-
sor muscles governing the articular surfaces. The spines
are separated farther than normal and the inferior articulat-
ing surfaces are partly uncovered by the superior ones.
This weakened condition of the back may be brought on
by injury, or reflexes from the bowels or kidneys. Contin-
ual vibration of the spinal column, as in cases of street car
men, weaken the back and then functional disturbances of
the kidneys are noted.

Lumbar Region.- — Figs. 119 and 120 illustrate the lateral
and posterior appearance of the normal lumbar vertebrae.
The spinous processes are easily palpated in this region.
Their development varies enormously in different individ-
uals. The formation of the articular processes prevents

PRINCIPLES OF OSTEOPATHY

303

any rotation, hence we do not find any lateral subluxations
in this region. The position of individual vertebrae is rare-
ly affected. "Breaks," that is, separations of the spines,
are sometimes noted, but not often. Violence is the chief
cause of these separations. The muscles in this region are

FIG. 120. Lumbar region,
rear view — normal.

FIG. 119. — Lumbar region.
— normal.

Side view

thick and powerful, hence their influence is not exerted so
much on individual vertebrae as upon the whole series of
vertebrae. Therefore we find curves instead of subluxations
in this region. Exaggeration of the normal movements is
responsible for kyphosis, lordosis or scoliosis. Extreme
weariness, as a result of maintaining a sitting or standing
position, leads the individual to shift the weight of the body
so as to take some advantage of the ligaments which limit a
movement. The strength and flexibility of the lumbar
region is frequently a very good criterion of the patient's
bodily vigor. It is easier to affect this portion of the spinal
column, by leverage movements, than any other region.

304 PRINCIPLES OF OSTEOPATHY

Examination of the Ribs. — The position of the ribs is al-
ways noted by the osteopathic physician. It is noted, in
medical text-books on diagnosis, that the general conforma-
tion of the thorax is indicative, to a variable degree, of either
the past medical history of the individual or is evidence of
the present existence of predisposition to certain diseases.
A full, round, nonflexible chest denotes asthma or emphy-
sema ; flat chest denotes tendency to tuberculosis, etc. These
statements are generalizations based on long observation,
and are usually very near the truth. The respiratory move-
ments should be noted, whether full and free, compared
with the capacity of the thorax. The osteopathic physician
goes farther than these excellent generalizations in his diag-
nosis. The relation and position of each individual rib are
extremely important. The condition of the whole thorax
and its contents is dependent on the relations of the bones
which form it. With this idea in mind, a careful examina-
tion of each rib is made.

The ribs are, normally, quite movable. Their spinal
articulations are so arranged that an easy rise and fall of the
shaft of the rib is permitted. The rise and fall is the result
of rotation of the rib on an axis passing through the costo-
central and costo-transverse articulations.

Costo-central Articulations. — The costo-central articu-
lations of the first, tenth, eleventh and twelfth ribs have no
interarticular ligament. The movement of the heads of these
ribs is limited by the capsular ligaments. The heads of all
the other ribs are held in place by interarticular ligaments
attached to ridges on the heads of the ribs and to the inter-
vertebral disks.

Costo-transverse Articulations. — The tubercles of the
ribs articulate with the transverse processes of the verte-
brae forming arthrodial joints. The superior costo-trans-
verse ligaments prevent the dropping down of the costo-
transverse articulation. There is very limited gliding move-
ment in this articulation. As before stated, the movement
in the costo-central and costo-transverse articulations is ro-

PRINCIPLES OF OSTEOPATHY

305

tary. The shaft of the rib lies obliquely downward, there-
fore the rotation of the rib during inspiration turns the an-
terior extremity upward and outward. The axis of the rota-
tion through the costo-vertebral articulations is obliquely
downward, therefore the lateral position of the shaft of the
rib is elevated during inspiration and the lower border is
turned outward.

FIG. 121. Normal relations of the
fifth and sixth ribs.

FIG. 122. Approximation of the fifth
and sixth ribs.

306 PRINCIPLES OF OSTEOPATHY

Coordination. — Fig. 121 illustrates the normal obliquity
of the fifth and sixth ribs. When the contraction of all the
muscles of respiration is properly coordinated, the inter-
costal spaces are all equal in width. The respiratory rhythm
should be equal in all parts of the thorax.

FIG. 123. Separation of the fifth and
sixth ribs.

Incoordination. — When through some nervous reflex
inspiration is made difficult, the inspiratory muscles expand
the thorax to its fullest extent and retain the expansion.
Then the diameters of the thorax are increased. This posi-
tion of extreme inspiration is typical of the asthmatic chest.
There may be lack of coordination of the muscles in any
intercostal space. This incoordination may be manifested
by too much contraction or relaxation. The result is a
change in the normal width of an intercostal space.

Nervous Control of Respiration. — Respiration is car-
ried on by a complicated mechanism. Its chief center of nor-
mal control is in the medulla, but subsidiary centers, in lin-
ear series, exist in the spinal cord. Each spinal nerve which
innervates intercostal muscles, or other muscles of inspira-
tion, arises from a subsidiary respiratory center. One of
these subsidiary centers may become too active or passive
as a result of local irritation, due to circulatory changes.

j

PRINCIPLES OF OSTEOPATHY 307

The muscles governed by this disturbed center will not act
harmoniously, hence the rhythmical movement of all the
ribs is interfered with.

We have noted that spinal muscles contract unevenly
as a result of direct spinal injury, exposure of the skin over
them to cold, or from visceral reflexes. The respiratory
muscles are subjected to the same conditions. A lateral sub-
luxation in the dorsal region carries its articulated rib with
it. Palpation will discover their changed relations. A ky-
phosis in the dorsal region causes the ribs to rotate upwards,
thus increasing the diameters of the thorax. Lordosis in
this region has the opposite effect.

Costal Subluxations. — Figs. 122 and 123 illustrate the
changes in spacing of the ribs due to incoordination of mus-
cular contraction. These positions of the ribs are spoken of
as costal subluxation. In Fig. 122 the upper rib is rotated
downward as a result of a contraction of the intercostal
muscles in the space below it, or the relaxation of those
above it. Palpation elicits sensitiveness at the lower border
of this fifth rib. The sensitiveness is usually found where
there is compression due to the dropping of the rib and the
contraction of the muscles. This rib might have become
displaced as a result of violence, or the patient might have
been exposed to cold air while sweaty, or some disease of
another part of the body might have caused sufficient weak-
ness to allow this rib to drop as a result of pressure occa-
sioned by the position in bed or otherwise.

Whatever the cause of these subluxations, they certain-
ly become sources of great irritation to the nervous system.
Sometimes the body becomes accommodated to these sub-
luxations, but the fact that cases of asthma have been cured
after years of suffering, by reducing these malpositions, is
prima facie evidence that accommodation is something that
can not always be depended on.

The heads of the second to ninth ribs cannot be dislo-
cated without rupture of the interarticular ligaments. Con-

308 PRINCIPLES 'OF OSTEOPATHY

siderable change in the position of the shaft of the rib occa-
sions very little change in the position of the head of the
rib.

First Rib. — The first rib does not move in the same
manner as those below. The attachment of the scalenus an-
ticus keeps the shaft always raised. No matter how flat the
remainder of the thorax may be, the first rib stands out
prominently. The chief change in its position is due to the
contraction of the scalenus anticus, therefore it needs to be
depressed rather than elevated.

Tenth Rib. — The head of the tenth rib is articulated
with the body of the tenth vertebra ; there is no interarticu-
lar ligament. This allows freer movement. Its anterior
extremity is insecurely articulated to the cartilage of the
ninth rib. This connection is frequently broken, thus mak-
ing an added floating rib.

Eleventh and Twelfth Ribs.— The eleventh and twelfth
ribs are very loosely articulated to the vertebrae. They
have no costo-transverse ligaments, hence depend on the ac-
tion of muscles to hold them in place. They are frequently
found rotated upward or downward.

We have endeavored to show that the normal move-
ments of the ribs, as a whole, may become very abnormal
when made individually, or out of rhythm with each other.
The depressions or elevations of individual ribs have not dis-
located their articulations ; they have merely carried and re-
tained them in positions out of harmnoy with the remainder
of the ribs. They have become discordant members of a
harmonious body, and unless made to cooperate for the gen-
eral welfare, they will rapidly make other members inhar-
monious.

Effect of Position of Vertebrae on Position of Ribs. —
Lack of symmetry in the dorsal vertebrae causes a change in
the position of the ribs. Both conditions can be corrected
by reduction of the vertebral subluxations.

PRINCIPLES OF OSTEOPATHY

309

FIG. 124. Traumatic lesion of
right sterno- clavicular articula-
tion, followed by enlargement of
right lobe of the thyroid gland.

The Clavicles. — The clavicles may be elevated or de-
pressed by muscular contraction. Their depression affects
the vessels crossing the first rib and from the upper ex-
tremity. The subclavius is responsible for the depression
of the clavicle.

Summary. — Every individual has his or her particular
development. When examining patients this must be taken
into consideration. All subluxations must be judged accord-
ing to the condition of the reflexes along the nerve tracts
which they might influence.

A subluxation is evidence of unequal activity of oppos-
ing muscles, caused by twist, strain, fall, thermal change or
reflex irritation from viscera. It is an evidence of vital ac-
tivity unevenly manifested. The mechanical condition

310 PRINCIPLES OF OSTEOPATHY

which we call a lesion, may be only evidence of a lesion
which lies in the excessively active muscle or at some other
point in close nervous connection.

A subluxation may be called a primary lesion when it
results from accident. It is secondary when due to reflex
action. It is not always possible to determine whether a
lesion is primary or secondary, but in general it is best to
reduce them wherever found, if any disturbance can be
traced to them.

In rare instances one treatment has been found suffi-
cient to reduce a subluxation. The fact that the majority of
cases must be treated two or three months proves that they
are not easily kept reduced.

PRINCIPLES OF OSTEOPATHY 311

CHAPTER XV.

THE DIAGNOSTIC VALUE OF BACKACHE.

Elasticity. — It is frequently said that "a man is as old
as his arteries." It may with equal significance be said that
a man is as old as his spinal column. In either case a loss of
elasticity lessens one's youthfulness out of all proportion to
one's actual years.

A Field for Study. — The use of the back and the spinal
column as a field for initiating an effort to diagnose the
physical condition of human beings, has many advantages,
both for eliciting objective and subjective information.
Probably few physicians realize how much of physical dis-
tress is mirrored in symptoms consciously or unconsciously
referred to the back.

Objective and Subjective Symptoms. — In order that we
may have something for reference we will pass a few facts
in review. As diagnosticians we are always desirous of
knowing whether the structure of the back is normal and
whether there is any distress, i. e., pain of any character, in
the tissues of the back. Here we have the old division of
objective and subjective symptoms.

Pain. — Pain is the symptom which usually leads a pa-
tient to seek relief or advice, hence we are interested in seek-
ing the cause of the pain. The simplest possible cause of
the pain should naturally be the first thing considered. Since
many localized peripheral and visceral pains either are
caused by conditions in the structures of the back, or at least
reflexly produce areas of associated hyperaesthesia there, we
seek to discover what structural fault or referred sensitive-
ness may exist.

312 PRINCIPLES OF OSTEOPATHY

Poise. — The first observation should be addressed to de-
termining the poise of the body, i. e., statics. It is very im-
portant to note the poise of the body. There are many dev-
iations from normal which are only slightly apparent but
nevertheless give rise to bodily distress. Postural faults in
adults lead to distress due to fatigue of the tissues and, as
the bones are not plastic, pain is felt. The child's bones are
plastic, hence the same force that produces distress in ma-
ture persons causes structural distortion in children, i. e.,
the static conditions which in children produce spinal de-
formity produce in mature persons spinal distress.

Structural Defects. — Pain in the back is of such fre-
quent occurrence that it is advisable for us to consider some
of the general and special conditions which may be more or
less characterized by backache. Since we are exponents of
a system of corrective manipulation we naturally look first
for possible structural defects. The simplest structural de-
fect would be a bad posture with its consequent imbalance
in the muscle groups which maintain the body erect.

Statics. — 1. Statics. Under this head we must consider
backache as a possible result of any change in structural sup-
port. The muscles of the back must compensate, by altered
tension, for any change in the length of a leg, such as that
present in flat-foot, slightly flexed knee, knock-knee, or a sa-
cro-iliac lesion. The pain due to flat-foot is one of the most
common complaints. Many cases of so-called "innominate
lesions" are nothing more than backache caused by the ef-
fort to compensate for a weak arch. Manipulation of the
muscles of the back gives relief but does not remove the
cause. The longer such a condition exists, i. e., flat-foot, the
more widespread will be the back pains. Segments above
the lumbar are gradually involved until it is hard to recog-
nize where the vicious cycle began. Backache due to dis-
turbed statics is a fatigue pain, i. e., is evidence of tired mus-
cles or strained ligaments. All such backaches are relieved
by manipulation. They disappear under the influence of
tonic exercise, such as mountain climbing, because the un-

PRINCIPLES OF OSTEOPATHY

313

FIG. 125. Right dorsal-left lumbar
lateral curvature. Note the out-
line of the body.

314

PRINCIPLES OF OSTEOPATHY

evenness of the ground necessitates constant variation in
muscular tension. Walking on pavement rapidly produces
fatigue, because each movement is a replica of the preceding
one.

General Debility. — General debility may lead to static
errors with consequent distress. Many static errors make
their appearance during a slow convalescence and then per-

FIG. 126. Position which shows, by
the outlines of the vertebral bor-
ders of the scapulae, that rota-
tion of the vertebral bodies ex-
ists as high as the sixth dorsal.

PRINCIPLES OF OSTEOPATHY

315

FIG. 127. Correction of the lum-
bar curve by raising the left
buttock.

316

PRINCIPLES OF OSTEOPATHY

sist in spite of improved muscle tone; in fact are never rec-
ognized until such time as they force special attention be-
cause of the distress they cause.

Sacro-iliac Subluxation. — Since backache is one of the
most prominent symptoms in cases of sacro-iliac subluxa-

PIG. 128. The effect of rotation of
the bodies of the vertebrae, in
spinal curvature, on the location
and extent of side bending.

FIG. 129. Same case bending to
the left.

tion, no examination would be complete without taking the
possibility of such a lesion under consideration.

Spinal Rotation. — Practically all static conditions of
long standing are characterized by slight spinal rotation.
This is the natural result of the body's effort to transmit its
weight through its strongest side. This compensatory rota-
tion can not be corrected without taking into consideration
that condition for which the rotation is itself a correction.

PRINCIPLES OF OSTEOPATHY

317

FIG. 130. This picture shows that
the lumbar curve is primary and
due to faulty development of the
left lower extremity.

FIG. 131. Correction of the lateral
lumbar curve bv lengthening the
left leg.

318

PRINCIPLES OF OSTEOPATHY

Spinal Curvature. — Curvature of the spinal column is
not always characterized by local or general backache. As
a general rule structural scolioses are not painful. This is
probably because the shape of the bones has become adapted
to the weight of the body in the new position. Pain is apt

PIG. 132. Great irregularity of the
spinal column, in a case of te-
dious convalescence, after typhoid
fever. Shows the effect of re-
maining almost constantly on
the right side.

FIG. 133. Corrective effect of ex-
tension of left arm so as to in-
fluence the irregularity of the
spinal column due to weakness.

to be associated with a functional curve, because such a
curve puts muscles and ligaments on a stretch. As the bones
and intervertebral discs gradually yield to the unequal pres-
sure of a functional curve, rotation takes place, according to

PRINCIPLES OF OSTEOPATHY 319

the laws which govern rotation in the dorsal and lumbar
regions, and a compensatory condition results, which we rec-
ognize as a right dorsal left lumbar scoliosis, or the reverse.

Caries. — 2. Actual disease of vertebrae may be the
cause of backache. Such a condition is usually a localized

FIG. 134. Structural lateral curva-
ture and kyphosis, great rigidity,
no pain or discomfort.

caries due to tuberculosis. Caries is characterized by angu-
lar deformity, great sensitiveness to digital pressure arid
especially to vertical pressure ; i. e., any addition to the
weight of the body above the involved vertebrae. Localized
backache associated with a prominent spinous process and

320 PRINCIPLES OF OSTEOPATHY

sensitiveness to vertical pressure should be sufficient to
cause any physician to suspicion the existence of caries.

Rigidity. — Even these conditions without apparent de-
formity should make one hesitate before using any leverage
through that area. One of the characteristics of localized
backache in disease of the structure of the spinal column
is rigidity, i. e., the body protects itself by muscular ten-
sion sufficient to limit or prevent movement in the in-
flamed area. Whenever this protective phenomenon is
observed it should be a warning against interference, until
one is convinced that more is to be gained than lost by
interfering with nature's protective mechanism.

Arthropathies. — Cases of paresis and tabes dorsalis are
subject to arthropathies and hence heavy manipulation, of a
leverage or thrusting type, should be avoided. There is dan-
ger that an arthropathy may exist, and as such conditions
are not characterized by pain, the normal protective mechan-
ism does not assert itself. Fig. 135 shows an angular de-
formity in a case of paresis. The deformity was caused by
severe manipulation by one who had no knowledge of path-
ology or, in fact, any of the basic medical sciences. This
woman had a comparatively straight spinal column which
exhibited some stiffness and sensitiveness, eighth to twelfth
dorsal. The woman was placed on her back, knees doubled
under her chin, then rolled on to her shoulders and a heavy
downward thrust given so as to strongly flex the lower dor-
sal. The sharp kyphosis was instantly produced, with re-
sulting pressure on the spinal cord.

Spondylitis Deformans. — A general posterior curve with
ankylosis, or diminished flexibility, thickened spinous pro-
cesses, tenderness to digital pressure, localized pains, not
markedly sensitive to vertical pressure, is recognized as
spondylitis deformans. Other joints of the body are usually
similarly affected.

Rachitis. — The changes due to malnutrition, rachitis,
are frequently recognized. The fact that changes elsewhere

PRINCIPLES OF OSTEOPATHY

321

FIG. 135. An angular kyphosis produced in a
case of paresis by severe flexion and com-
pression, by an ignorant pretender.

322 PRINCIPLES OF OSTEOPATHY

are apt to more positively indicate the previous existence of
rachitis makes diagnosis comparatively easy.

Malignant Growths. — When localized backache is com-
plained of and no deformity is evident, thorough tests should
be made to determine the effects of positions and move-
ments. The protective contraction of the muscles should
be carefully analyzed, so as to judge whether the pain is due
to any inflammatory process involving the vertebrae, or any
of their joints. Nearly all pains in the lumbar region are
called "lumbago," but one must always be on guard lest a
persistent lumbago-like pain be not given its true value.
Pains of a sharp, lancinating character which persistently
appear in a definite spinal area or along nerve trunks orig-
inating from that area, usually have a sinister significance.
A definite diagnosis is practically impossible, but the per-
sistence of the pains, in spite of all efforts to relieve with
heat, positions of rest, or manipulations, is pretty good evi-
dence that some malignant process is at work which involves
these spinal tissues. If no fever exists, or other constitu-
tional sign, it may be that the pain is due to involvement of
the spinal column by a growth within the body. As exam-
ple, a man, 44 years old, complained bitterly of sharp lan-
cinating pains in the lumbar region and extending down
branches of the lumbar and sacral plexuses. All efforts at
relief were unavailing. There was no deformity of the
spinal column, but the patient held himself rigid. Many
attempts were made by many physicians to make a diag-
nosis. One of them used heavy manipulation of a leverage
character. In order to test the effect of vertical pressure he
used a concussing blow on the top of the head and then on
the heels. This latter produced agonizing pain which was
followed rapidly by paraplegia. The case ran a tedious
course of many months. Autopsy showed cancer involving
left kidney and the spinal area under it. The progress of
the disease was exceedingly slow and hence his body was
able to bring many compensatory mechanisms into action,

PRINCIPLES OF OSTEOPATHY 323

which made it difficult for even the most skillful to recog-
nize the true condition.

Typhoid Spine. — The so-called "typhoid spine" is an-
other form of spinal trouble, without deformity, which may
be a spondylitis but probably is a pure neurosis.

Lumbago. 3. Under this head we may collect a va-
riety of conditions which are characterized by pain which
is particularly aggravated by voluntary movement. It is
ofttimes difficult to determine what the structural change
is which gives rise to this pain. Each case will show peculi-
arities as to the exact location of the pain and the amount
of possible voluntary movement. There may be involv-
ment of muscle, ligament, fascia, or periosteum. The cause
of the trouble may be fatigue as result of posture, strain
from lifting, or may be due to a toxemia.

Posture. — Backache, due to posture, is commonly pro-
duced in any one who attempts to do work which com-
pels bending of the back forward. Until such time as
the individual develops adaptation to this position there
will be sensitiveness at those points in the spinal column
which endure the greatest strain. The strain thus pro-
duced may affect the extensor muscles of the back, or in
case the posture is such as puts strain on ligaments, there
will be hyperesthetic points directly on the vertebral spinous
processes where the supraspinous ligaments attach. Back-
ache due to strain is not characterized by fever. The re-
cumbent position gives relief.

Toxemia. — Backache due to toxemia is nearly always
of sudden appearance. The fact that the patient first be-
comes conscious of its existence when some movement is
made such as quickly sitting up in bed, or bending for-
ward to pick up something, or putting on clothing, always
leads to the belief that the pain is due to strain. Nearly
all such cases show a coated tongue, bad breath, constipa-
tion, headache, and general physical depression. The pain

324

PRINCIPLES OF OSTEOPATHY

FIG. 136. A swelling under the sheath of the
left erector spinae muscle, which was coin-
cident with an attack of "lumbago," follow-
ing a heavy strain.

PRINCIPLES OF OSTEOPATHY 325

is not necessarily located in the erector spinae muscles. It
is frequently localized around the fifth lumbar spinous
process, which is exceedingly sensitive to digital pressure.
There may be some fever in the cases for twenty-four hours.
Thorough catharsis is indicated and usually is followed
by rapid decrease in pain. The pain in most of these cases
is only present during voluntary movement. The physician
can usually give quite extensive passive movement with-
out causing severe pain.

Trauma. — A genuine trauma of the extensor muscles
or ligaments of the back usually has enough of positive
history to classify it with sprains of other joints. Rest,
heat and gentle manipulation are indicated. In these cases
the protective mechanism heretofore mentioned, that is,
muscular tension to prevent movement, is very apparent.
Relief from pain is usually quickly attained by a position
of rest which makes no demand on the strained tissues.
There may be localized swelling under the aponeurosis cov-
ering the erector spinae. Fig. 136 shows such a swelling
caused by a severe lift. The patient was a lumber shover.
He was assisting in handling a heavy timber when the
greater portion of the weight came suddenly upon him.
Another case, whose back had a swelling of similar char-
acter and history of repeated attacks of "lumbago," but no
history of trauma, proved to be sarcoma involving both
muscle and bone in this area.

"Crick in the Back." — The so-called "crick in the back"
is characterized by a sudden onset and excruciating pain.
It appears to be due to some sudden movement which or-
dinarily puts no strain upon any tissue. They are not lim-
ited to any particular area of the back, but are as apt to
appear in the neck or interscapular area as in the lumbar
area. All such attacks are rather severe during the first
day but usually subside under heat and manipulation.
These attacks seem to be associated with a constitutional
state and hence tend to recur at certain seasons or under

326 PRINCIPLES OF OSTEOPATHY

certain conditions of the atmosphere, especially cold, dry,
electrical winds. Although these cases show some signs
of indigestion they do not seem to be of the same char-
acter as those we have previously mentioned.

Involvement of the Spinal Cord. 4. Pain in the back
may be due to some involvement of the spinal cord or its
membranes. As a general rule there are enough other
symptoms such as motor or sensory phenomena to direct
one's attention to the real seat of disease. The pain in
these cases is likely to be symmetrical or at least definitely
located with respect to certain spinal nerve trunks. Fur-
thermore, pain due to involvement of the cord, or its men-
inges, does not call forth the protective reflexes which are
so evident when any structural tissue of the spinal column
is involved. There is no necessity for rigidity to protect
supporting tissues. (We are not including spinal menin-
gitis in this group.) When the nerve roots are involved
the pain is intense and definitely located. When the root
ganglia are involved we have the well known condition
called herpes zoster.

Infectious Fevers. 5. Many of the acute infectious
fevers are characterized, in part, by severe backache. In-
fluenza, tonsilitis, smallpox, typhoid, diphtheria and dengue
all have severe backaches as an incident in their course. It
is not known what produces the pain in these fevers.

Referred Visceral Pains. 6. Probably the great pro-
portion of backaches are referred pains due to involvement
of thoracic, a-bdominal or pelvic viscera. Attention has
already been called to Head's law of referred pain,
and to the existence of the receptor fields for sensory
impressions for certain segments of the spinal cord. The
intero-ceptive field is an area of low sensibility, so far as
our conscious recognition of this field is concerned. Not
all segments of the spinal cord receive sensory fibers from
this field, hence visceral reflexes are found only in those
portions of the. back associated with those segments having

PRINCIPLES OF OSTEOPATHY

327

FIG. 137. An occupation curve with flattening in
the upper dorsal. Telegrapher. Patient com-
plained of pain and tenderness, second to
fourth dorsal on the left side. Died sixty days
after the photo was made, angina pectoris.

328 PRINCIPLES OF OSTEOPATHY

intero-ceptive sensory communication. Disturbances in
hollow viscera such as the stomach and intestines are due
to overloading the digestive apparatus. Fatigue and con-
sequent failure of digestion leads to distention with gas,
absorption of toxins, faulty elimination. Distention causes
pressure on nerve endings in the walls of the viscera and
thus initiates reflex backache. Exaggeration of physio-
logical activity of the liver, or spleen, causes tension on the
capsules of those organs arid hence irritation of their sensory
nerves with reflex back pains. The same is true of the kid-
ney. Disturbances in the blood supply to any organ, such
as occurs in arterio-sclerosis, or as result of aneurism, usu-
ally cause referred pains. The referred pains that are due
to functional fatigue are usually of a somewhat different
character from those due to inflammation in visceral or-
gans. Acute inflammatory states in the viscera give rise
in many instances, to cutaneous hypersensitiveness in their
segmentally associated areas. These cutaneous areas are
hypersensitive to a slight touch but not especially so to
pressure. States of functional strain and fatigue, whether
acute or chronic, are more apt to produce a reflex, in the
spinal area, which is characterized by tenderness to pres-
sure over the extensor muscles at some point between the
spinous processes of the vertebrae and the angles of the
ribs. Cutaneous and deep tissue hypersensibility may be
associated in the same case. The deep hypersensibility
is the more constant form discovered by palpation.

Inflammation of Serous Membranes. — Wherever the
necessity for friction of one organ, or structure, on another
is necessary, we find serous tissue in the form of a bursa,
tendon, sheath, synovial membrane, tunica vaginalis testis,
pleura, pericardium or peritoneum. Inflammation of a
serous membrane is accompanied by muscular fixation of
the structures which depend on that membrane for free
movement. This is a protective action required to prevent
friction of the inflamed surfaces. Inflammation of a pleural
surface calls forth a protective contraction of all the muscles

PRINCIPLES OF OSTEOPATHY 329

which are concerned in producing movements which re-
quire the co-operation of that pleural surface. If pleural
effusion occurs there is still an increased muscular tension,
although not so spasmodic as when no effusion exists.

Colicy Pain. — Gall stone colic, intestinal colic, renal
colic and appendicitis all cause severe reflexes, deep mus-
cular as well as cutaneous, in the areas innervated from
the same segments of the cord. These reflexes are found
in areas of greater extent than those properly associated
with these visceral structures. The severity of these colicy
pains undoubtedly excites an overflow of stimuli into seg-
ments above and below those which directly innervate these
structures.

Summary. — For the purpose of bringing some of the
various causes of reflex pain into orderly arrangement we
may classify them as follows :

1. Due to functional strain of viscera, e. g., diges-
tion of a very rich meal.

2. Due to distension of a hollow viscus, or stretch-
ing of the fibrous capsule of an organ.

3. Due to inflammation of the serous investment of a
viscus.

4. Due to disturbance of circulation in visceral blood
vessels caused by disturbed mental condition, or on account
of a pathological change in the walls of the arteries, arterio-
sclerosis.

5. Due to excessive. effort to overcome obstruction of
the lumen of hollow organs as in spasms of the 'muscular
coats of the intestines, common bile duct, ureter or fallopian
tube.

Pluri-Segmental Control of Viscera. — It should be re-
membered that, as a general rule, the reflexes due to these
causes are not definitely limited in extent, either as to skin
areas, or groups of extensor spinal muscles. Just as no
skin area, or single muscle, other than a rudimentary one

330 PRINCIPLES OF OSTEOPATHY

of the fifth layer of the back, is completely innervated from
a single segment of the cord, we find also that no viscus
is wholly controlled by fibers from one segment.

Reflex Subluxations. — The continuous action of a re-
flex, such as that due to inflammation of a serous surface,
or to long continued functional strain, or to continued cir-
culatory disturbance, usually results in a change in the
character of the back, i. e., a certain degree of static altera-
tion takes place as a compensatory adaptation to varying
degrees of muscular ankylosis. This muscular ankylosis
is the expression of the visceral reflex. It produces changes
in bony alignment which we recognize as subluxations
when only three or four vertebrae are affected ; or as curva-
tures, when greater numbers are involved.

Intensity of Reaction. — The extent and complexity, or
intensity, of a reflex, or co-ordinated series of reflexes, is
not a criterion by which to estimate the extent of patho-
logical change in a viscus or viscera. Very serious patho-
logical changes may be present in a viscus without pro-
ducing intense or even determinable spinal reflexes. These
changes may have progressed so slowly and involved such
small areas that no intense protective reaction was called
forth.

Location of Reflexes. — Based upon clinical and experi-
mental observations, a considerable amount of data has been
secured bearing upon the location of reflexes in connection
with various visceral diseases. The data with respect to
the location of cutaneous hyperaesthesia has been well
mapped out, but until osteopaths began to plan their manip-
ulative treatment according to the structural changes in
spinal alignment, due to muscular hypertension, there was
practically no attention paid to the phenomenon of reflex
hypertension. The referred visceral pains and the hyper-
tension of the spinal muscles are expressions of a disturbed
segment or segments of the spinal cord.

PRINCIPLES OF OSTEOPATHY 331

Reflex Patterns. — Based on clinical and experimental
data, it is possible to outline a series of reflex patterns which
are characteristic of certain visceral involvments. The
complexity of the patterns depends largely on how great
an effort is required by the body to overcome the disease.
Some diseases have a spinal reflex pattern apparently out
of all proportion to the gravity of the illness. This is espe-
cially marked when autotoxemia is a characteristic of the
illness. Under such circumstances muscular tension and
tenderness extend far outside the limits of the normal seg-
mental innervation.

332 PRINCIPLES OF OSTEOPATHY

CHAPTER XVI.

ADAPTATION AND COMPENSATION.

Examination of patients frequently reveals the results
of accidents or disease which do not appear to have any
present deleterious influence on their health. It is always
necessary for the physician to estimate the relations which
these changes have, in the past, borne to the general
health, or may, at present, be liable to exert under known
conditions of climate, diet and environment.

Definition. — In speaking of structural and functional
changes, we use the words adaptation or compensation.
Adaptation means, in biology, favorable organic modifica-
tions suiting a plant or animal to its environment. Com-
pensation means, "to make up for," "to counterbalance,"
"that which makes good the lack or variation of some-
thing else." The examples of adaptation and compensa-
tion are very numerous and it is necessary for the physi-
cian to be able to recognize the cases in which the body
has exercised, or may, with proper assistance, exercise
this power to a great degree. It is sometimes said that
disease is an effort of the body to accommodate itself to
new conditions, that is, changes in the quantity and
quality of stimuli occasioned by variations in climate, diet,
environment or accident.

Osteopathy apparently originated from the fact that
structure affects function. With this as a basis, all exam-
inations are made from the structural standpoint and
therefore, if we follow this method too literally, we are
apt to overlook the fact that the cells of our bodies have
the power of adapting themselves to very pronounced

PRINCIPLES OF OSTEOPATHY 333

changes in all those things which are considered essen-
tial to perfect functioning. Function in these affected
cells may not be perfect, measured by their former ac-
tivity, and yet apparently answer all the demands made
upon them by the conscious or sympathetic life of the
individual. There may be other cells, somewhat similar in
character, whose increased activity can compensate, that
is, "make good the lack of" activity in the affected cells.

The Spinal Column. — The examination of the spine
frequently reveals the irregularities in its structure. Dis-
turbed function in some viscus or other group of tissues
is sometimes attributed to this structural variation, even
when no direct nerve influence over the affected tissues
can be directly traced to the spinal area. Mere change
in structure, cannot warrant us in considering it primary
to a functional disturbance, which does not exist in a lo-
cation whose control can be traced to it. The effort on
our part to always connect structure with function, hav-
ing the relations of cause and effect, sometimes leads to
very far-fetched reasoning. It is necessary for us to de-
cide, in a given case, whether or not the present condi-
tion of the individual is as good as it can be made. Our
decision will manifest to the keen observer whether we
have recognized the extent of possible adaptation and
compensation.

Curvatures of the spine present many phases which
must be considered before treatment is begun. The cur-
vature of an old case of Pott's disease seldom affects sym-
pathetic life to the extent that we would expect. The
very gradual progress of this disease seems to give ample
opportunity for the structures, in close relation to the
diseased area, to accommodate themselves to the changed
conditions. It is hardly conceivable that anyone would
fail to recognize the accommodation manifested in these
cases, and yet we have heard of those who advocated
forcible straightening of the spine. The question to be
decided is whether it is better to risk life by forcible

334

PRINCIPLES OF OSTEOPATHY

FIG. 138. Adaptation of the body to the state of its
contents. Enlargement of the spleen which causes
a bulging of the ribs and a coincident spinal lesion.

PRINCIPLES OF OSTEOPATHY 335

straightening of the spine or endure deformity with fair
health. Deformity is always a wound in the self-esteem
of the individual. Many would risk life time and again
to be rid of it. It is this which gives the experimenting
physician or surgeon ample opportunity to try his skill
or his ignorance. It is all one to the patient, a chance
to be rid of deformity.

Compensatory Curvature. — A lateral curvature of the
spine usually has two parts, the primary and the compen-
satory curve. The compensatory curve is the effort to
maintain the erect position, that is, keep the weight of
the body properly balanced. The physician must determine
which curve is primary and which is compensatory.

When the hip is dislocated, or any condition exists
which shortens one leg, the spinal column is curved to
compensate for this reduced length. It would be useless
to treat a compensatory spinal curvature, without length-
ening the leg by reducing a hip dislocation or putting
an extension on the shoe. When the femur is dislocated,
all the thigh and hip muscles accommodate themselves
to a new position, then the spinal column curves because
the pelvis tilts enough to compensate for the lack of
length in the extremity. The longer the dislocation has
existed the more perfect is the adaptation and compensa-
tion. To reduce the dislocation we must undo the work
of adaptation, that is, lengthen the muscles and force the
head of the femur into the acetabulum. .

All individual spinal lesions must be judged careful-
ly as to their relations to functional disturbance. The
fact that spines develop unevenly, in many cases, makes it
hard to define their exact condition. A lateral subluxa-
tion may exist to which the body has become accommo-
dated. To reduce this subluxation might again subject
the individual to disturbed function.

The Thorax. — Drooping of the ribs lessens the an-
tero-posterior diameter, but increases the vertical diam-
eter. The full round chest of large capacity is usually

336 PRINCIPLES OF OSTEOPATHY

less flexible and active than the small chest. The ques-
tion in each case is whether the thorax is doing the
amount of work necessary for the body. The chest may
show evidence of a period of malnutrition, during child-
hood, that is, "rickets." There may be evidences of the
effects of occupation. In any case of deformed thorax

FIG. 139. Posterior view of a case of leukemia, showing
spinal area involved in adaptation of the body wall to
its contents.

PRINCIPLES OF OSTEOPATHY 337

the question uppermost in our minds should be : "What is
its functional capacity?"

The Heart. — Compensation by the heart, for some
mechanical defect in it, is the most interesting subject
studied by the physician. As a result of contraction of
the orifices of the heart, or faulty action of its valves, there

FIG. 140. Anterior view of case of leukemia, showing outline of
the enlarged spleen.

338 PRINCIPLES OF OSTEOPATHY

is an increase in the size of one or more of its chambers.
This increase is at the expense of the thickness of its
walls, thus resulting in disproportion between the size of
the cavity of the ventricle or auricle, and the amount of
muscular tissue required to empty them of their contents.
When the proportion between the cavity and its walls
is so far restored that the heart is able to overcome the
stasis of the blood in that portion of the circulatory ap-
paratus behind the lesion, we say that compensation ex-
ists. The ability to recognize the status of a heart lesion
is of great value to a physician.

Skin and Kidneys. — A spinal lesion might cause a dis-
turbance in the functioning of the kidneys, decrease of
activity, which in turn is compensated for by increased
activity of the skin, which in time is compensated for by
increased activity of the bowels. The diarrhoea in this
case would be compensatory, and yet it is very difficult
for the physician to note this fact. If therapeutic means
were used to stop the diarrhoea, and the kidneys or skin
did not immediately take up the work of elimination, the
body would call upon the serous membranes and areolar
tissue, to take care of the surplus liquid in the circulation.
As a result there would be edema of the extremities, as-
cites, pleuritic effusion.

The compensating action which may take place be-
tween the kidneys, skin, mucous and serous membranes, is
'one which is more frequently recognized and made use
of by physicians than any other example of the same pow-
er manifested in the body. The fact that the skin and kid-
neys respond to each other's needs, forms the basis for
many therapeutic procedures. Mucous membranes be-
come active when the skin -fails. Perspiration reduces
activity of the mucous membranes. Serous membranes
cease their excessive activity when mucous membranes
eliminate freely. The oedema of areolar tissue gives way
to activity of mucous membranes. The physician must

PRINCIPLES OF OSTEOPATHY

339

recognize which is the diseased tissue, and which is the
compensating one. The failure of the kidney to excrete
might not be the fault of its own structure, but result
from the vis a tergo given the circulation by a diseased
heart.

Power of Encysting. — In this western country, Cali-
fornia, we have ample opportunity to witness the ability

FIG. 141. Side view of case of leukemia, showing re-
suit of adaptation of the spinal column and ribs
to the contents of the body.

340 PRINCIPLE'S OF OSTEOPATHY

PIG. 142. Plantar impression of almost com-
plete letting down of the longitudinal arch.

PRINCIPLES OF OSTEOPATHY 341

of individuals to do hard, tedious work, after a considera-
ble portion of the lung has been destroyed by disease.
The healing which takes place under favorable climatic
conditions, seems to leave the remainder of the lung in
perfect functional condition. We have examined two
cases, in which the whole right lung was destroyed, and
the heart had been drawn into the right half of the thorax.
Both of these individuals were able to compete with their
more perfect fellows for a living, by doing hard manual
labor. One of these patients had a discharging abscess
in the axillary line, between the ninth and tenth ribs. This
abscess had discharged continuously for four years. The
patient did not complain of a single symptom of ill health.
He earned his living as a miner. This shows how thor-
oughly the system may become accommodated to very
marked changes in the condition of its tissues. This ab-
scess was in the man, but apparently not affecting his
functions. Probably the abscess was walled off from the
active body tissues by a protective membrane.

The history of the lodgment of bullets in various por-
tions of the body, demonstrates that what cannot be thrown
off by ordinary means, may become encysted, and thus
not interfere with the activity of the tissues.

The Extremities. — Adaptation and compensation can
be noted very quickly in many cases of injury of the
extremities. A fixed scapulo-humeral articulation is par-
tially compensated for by increased mobility of the scapula
on the thorax. When the anterior tibal group of muscles
is paralyzed, the patient compensates for inability to raise
the toe, by flexing the thigh. When the hip joint is fixed
in the extended position, the lumbar portion of the spinal
column becomes very flexible.

Law. — All living things strive to preserve themselves.
This means they do the best they can under all conditions.
In order to do this they must adapt themselves to changes
in the character of their environment and compensate for

342 PRINCIPLES OF OSTEOPATHY

FIG. 143. Plantar impression of case of absolute flat
foot. The longitudinal arch is completely broken
down.

PRINCIPLES OF OSTEOPATHY

343

FIG. 144. Plantar impression of loss of trans-
verse arch, and consequent Increase of pres-
sure on the head of the second, third and
fourth metatarsal bones, as evidenced by
the callous.

344 PRINCIPLES OF OSTEOPATHY

injuries to, or losses of their own structure. Adaptation
to external conditions calls for the operation of compen-
sating or balancing devices within the organism, there-
fore the logical study of this subject would naturally group
the phenomena under three heads. First, the study of
structure, with a view to determining the existence of
balancing devices in the arrangement of bones, ligaments,
muscles, blood vessels, viscera and nerves. These com-
pensatory mechanisms must be considered in every effort
at adaptation. This first division deals with internal
structural conditions, and their functions, i. e., anatomy
and physiology. Second, the study of conditions under
which living structures are existing. This division deals
with all those things which constitute environment, such
as food, temperature, atmospheric pressure; relation to
other living things, such as insects, protozoa and bac-
teria ; animal and vegetable poisons. Third, a logical out-
growth of the first and second divisions, i. e., a study of
the artificial conditions used by physicians to influence
the natural conditions of the first and second divisions.

Since man's position is upright, it appears that all
parts of his body are constructed with the end in view
of making that position easy to maintain. A bewilder-
ing series of compensating devices serve to balance the
body in the upright position. Any deviation of any part,
as the result of accident or necessity, is immediately met
by an opposing counterbalancing effort of its natural
compensatory opposing structure. If this compensatory
effort is not present, there is loss of balance between re-
ciprocating parts, resulting in strain and discomfort. As
a general proposition the foregoing is recognized by all,
but to actually recognize the failure of compensation,
the presence of strain, imbalance, requires knowledge of
the structure of reciprocating parts.

The feet present some interesting mechanisms for
responding to the needs of the body in balancing in the
upright position. Every change in shoe last calls for a

PRINCIPLES OF OSTEOPATHY 345

compensatory change in the relation of tarsal, metatarsal
and phalangeal joints, with the consequent changes in
muscular tension, to meet the demands of maintaining the
equilibrium of the body. The bursae which lie under the
skin areas, which are subject to pressure, vary considera-
bly. Their compensatory character is well illustrated
in the different forms of club-foot. A bursa is usually
located in such deformities wherever needed to protect
the bony points from friction. Figs. 89, 142, 143 and 144
show plantar impressions of feet with varying degrees
of weakness in the longitudinal or transverse arches.
Two of these cases had been treated for backache and in-
nominate'lesions, without success. The reason for the
failure is well illustrated by these plantar impressions.

The adaptive and compensative changes, which are
so readily observed in the human foot, present very many
phenomena which should be patent to all students of
medicine. The fact remains that physicians fail with as-
tonishing frequency to take account of these phenomena,
therefore we feel warranted in giving attention to this
subject.

The case which is here described and illustrated was
sent to me by Dr. Geo. F. Martin, of Tucson, Ariz. Mr.
C., age about 28, interested in mining enterprises, applied
for relief from pain in the right foot and leg. Examina-
tion revealed a high, swollen instep, and measurement of
the length of the foot showed it to be one-half inch
shorter than the left. The ankle did not appear to be in-
volved. The top of the instep felt bony, instead of pulpy,
as might be expected from the appearance. Palpation of
the inner side of the longitudinal arch showed that some
decided change had taken place in the astragalo-scaphoid
articulation. Just posterior to the scaphoid tubercle, in-
stead of feeling the astragalus, a depression was noted and
this depression was continuous with a sort of groove
which passed across the instep, from internal to external
maleollus. Fig. 145. When the patient stood on the foot

346

PRINCIPLES OF OSTEOPATHY

FIG. 145. Anterior view of old fracture
of the scaphoid.

FIG. 146. Side view of old fracture of
the scaphoid.

this groove was decidedly apparent. Fig. 146. Palpation,
while the weight was on the arch, seemed to indicate that
the tibia and fibula held a relation to the astragalas sim-
ilar to that which is normal when the foot is extended
on the leg, i. e., the posterior portion of the superior sur-
face of the astragalus was bearing the weight. The short-
ening of the foot, height of the instep, inability to pal-
pate perfect continuity of the internal side of the longi-
tudinal arch and existence of groove just in front of the
ankle joint, together with slight swelling but no edema,
dilated veins and dull pain in the arch and leg, but no
loss of function, (i. e., mobility existed in all tarsal and
metatarsal articulations) were indicative of some decided
structural changes. The principal point noted about the

PRINCIPLES OF OSTEOPATHY

347

FIG. 147. Radiograph of an old fracture of the -scaphoid and consequent
displacement of the astragalus.

movements was that inversion and eversion of the foot
took place with the foot in the normal relation to the leg,
as though it was extended, thus demonstrating that the
astragalus was in fact in a position of extension, even
though the foot appeared not to be so.

The condition of this foot is exceedingly interesting,
when the history is considered. Mr. C. says his foot was
injured by a large rock, which a fellow workman acci-
dentally dropped. This accident took place four years
ago, while he was working in a mine. The foot swelled
slightly, i. e., to about its present size and was painful,
but did not incapacitate him for work. Claims he never

348 PRINCIPLES OF OSTEOPATHY

lost a day on its account, and it was not examined by a
physician. The swelling gradually subsided and the foot
gave him no inconvenience for three years, except in the
matter of fitting a shoe. Recently swelling and pain have
developed.

FIG. 148. Radiograph of an old fracture of the
scaphoid, showing compensatory rotation of
the foot on to its outer margin, to avoid trans-
mitting the body weight through the longi-
tudinal arch.

PRINCIPLES OF OSTEOPATHY

349

My first suggestion, based on the insufficiency of the
arch, was the use of an instep supporter, but this proved
a failure, as it caused his foot to turn on the outer border.
The support prevented the inner side of the arch from
lengthening when weight was put on it, and the astraga-
lus could not have free movement, hence the foot inclined
toward the outer side, and strained the ankle.

Several skiagraphs were made which were very sat-
isfactory in aiding diagnosis. The first one was made
to show the relation of the tarsal bones on their superior-
external aspect. Fig. 147. This shows the head of the
astragalus downward, out of , relation to the scaphoid.
Fig. 148 shows a view directly from above the dorsnm of
the arch, and demonstrates clearly the dislocation of the
head of the astragalus. The innei side of the longitu-
dinal arch is not complete, and what there is of it — sca-

FIG. 149. Radiograph of an old fracture of the scaphoid, showing rela-
tion of the head of the astragalus to the fractured scaphoid.

350 PRINCIPLES OF OSTEOPATHY

phoid, internal cuneiform and first metatarsal — is badly
distorted. The relations of the metatarsals, as shown in
this illustration, indicate the tendency to throw the
weight on the outer edge of the foot. The side view,
shown in Fig. 149 demonstrates again the dislocation of
the head of the astragalus downward to a position under
the scaphoid. The scaphoid shows an irregular outline,

FIG. 150. Plantar impression show-
ing effect of ol'd fracture of
scaphoid and consequent downward
movement of the head of the as-
tragalus.

CGLLE , ', TEGF£T

PH

PRINCIPLES OF OSTEOPATHY 351

as though having been fractured and repaired, leaving ir-
regular masses of callous.

An impression of the plantar surface of the foot was
taken. Fig. 150. This shows the great increase in con-
tact surface, especially under the head of the astragalus.
Another interesting thing demonstrated by this impres-
sion is the change that has taken place in the second meta-
tarsal, and second toe. Both have been elevated so that
they no longer bear much direct weight. The third and
fourth metatarsals are bearing the direct application of
the weight of the body.

In order to more clearly analyze this case, we will
consider some general fundamental ideas concerning the
structure and function of the foot. The foot acts, pri-
marily, as a passive support of the body weight; secon-
darily, as an active lever to move this weight, as in run-
ning. In order to perform these functions, it must have
strength, elasticity and adaptability, thus permitting it
to assume various attitudes necessary to protect it from
injury. Since the primary function of the foot is to act
as a support, the integrity of the ligaments is essential.
When the foot is passive under weight, the arches settle
slightly. The arch as a whole is elastic, but the ligaments
are not. The elasticity of the arch is the result of the
movement of the bones into a position where the liga-
ments receive the weight. Muscles, ligaments and the
plantar fascia all serve to support the foot, but when
passively bearing the weight of the body, the ligaments
bear the strain. Loss of elasticity in the foot causes in-
creased pressure on points of contact on the sole of the
foot, also on the toes. The skin thickens over these bony
contact points in an effort to compensate for loss of elas-
ticity, thus corns and callouses are evidences, in many
cases, of compensation and should indicate the necessity
for a careful examination of the structure of the foot.

In the attitude of rest the astragalus rotates slightly
inward and downward on the os calcis, thus making the

3S3JJOG

352 PRINCIPLES OF OSTEOPATHY

head of the astragalus somewhat prominent on the inner
side of the foot. This movement is checked by liga-
ments, and this position of fixation removes all strain from
the muscles. In the case we are studying, the calcaneo-
scaphoid ligament was torn, hence the rotation of the
astragalus is limited only by compressing the soft tissues
of the sole against the floor, as is evidenced by the im-
pression along the inner border of the foot in Fig. 150.
The position of the head of the astragalus under the
scaphoid raises the inner border of the foot and throws
the weight on the outer border, a natural compensatory
position. From the foregoing we judge that this foot is
a poor passive support. Although it has done good
service for nearly four years, it has never been called upon,
until within the present year, to act for long periods of
time as a passive support. Heretofore this foot has
adapted itself to uneven surfaces, producing constant
variation of pressure. Now that contact with smooth
hard pavement gives no opportunity for shifting of weight
and alternating contraction of muscles, it fails as a sup-
porting mechanism. Steady pressure of the head of the
astragalus on the soft tissues of the plantar surface inter-
feres with circulation, causes edema and pain.

The secondary function of the foot is as a lever, in
actively raising and propelling the body. We divide these
functions into primary and secondary, because a foot that
might serve as a good passive support, might possess none
of the active elements required in running. A wooden
foot would serve as a support, but not as an active lever.
The heads of the metatarsal bones act as a fulcrum, the
calf muscles furnish the power, the weight rests on the
astragalus. When the foot is used normally, the line of
weight passes downward through the center of the knee
and ankle joints, hence forward along the line of the
second toe. The fact that the inner side of the foot is
longer than the outer, causes the strain resulting from
lifting the weight of the body over the fulcrum, to be car-

PRINCIPLES OF OSTEOPATHY 353

ried toward the outer side of the foot. This gives an ap-
pearance of turning the foot inward — "pigeon-toe." The
toe does not turn in, but points directly ahead. This is
the normal action when walking. In standing, the feet
point outward, so as to give a greater base of support. In
walking properly the feet should move parallel to each
other, so that the strain falls through the center of the foot.

The movements accomplished by the case we are
studying were quite normal, thus demonstrating that all
the muscles were active, and that there was very little
ankylosis in any of the joints. It is interesting to note
that the astragalus has no muscles attached to it, hence
its change of position is purely accommodative. All the
other bones of the tarsus have muscles attached to them,
hence they respond to muscular contraction, and take po-
sitions to which the astragalus accommodates itself when
weight is put upon it.

An interesting problem is presented in this case, which
is associated with fractures in general. We have been
taught that fixation is the basic principle in the treat-
ment of fractures, and this is so firmly believed by the
public, that any other treatment, which might be used by
a physician, resulting in deformity or some loss of func-
tion, would subject the physician to probable loss, in a
mal-practice suit. This foot never had the benefits of rest,
adjustment of the bony structure, or fixation. It passed
through the successive repair stages, subject to at least a
moderate degree of functional demands. How much bet-
ter it might have been under ordinary routine treatment,
is conjectural. The point we are interested in at this time,
is the adaptation, which has resulted in a fairly useful
foot as an active lever under conditions of rough ground,
but has failed when the primary function of passive sup-
port on a hard level surface is required.

354 PRINCIPLES OF OSTEOPATHY

CHAPTER XVII.

INHIBITION.

Acceleration — Inhibition. — We have noted in a former
chapter that the attributes of nervous tissue are irritability,
conductivity and trophicity. We may add to these ac-
celeration and inhibition. We do not use the terms stimu-
lation and inhibition as denoting opposite conditions, be-
cause stimulation applies to the initiation of an impulse.
This impulse may be acceleratory or inhibitory in charac-
ter. We may stimulate a nerve whose chief function is
inhibition. An impulse, whether accleratory or inhibitory
in character, is the result of stimulation.

All bodily functions require stimulation, in the sense
we have used the term, i. e., something must initiate an
impulse which is designed to excite activity. After this
activity is started, it must be governed. It is the means
of governing these activities, we are interested in studying.

Muscular Contraction. — Muscle may be s imulated to
contraction. This contraction may be increased or de-
creased, thus showing that after initiatory impulse starts
on its way to the point of conversion into work done by
the muscle, it is accelerated, increased, or inhibited, re-
strained by certain influences which we cannot easily
analyze. The contraction and relaxation phenomena of
muscle are equally important. Vaso-constriction and vaso-
dilation are examples of these phenomena.

Secretion. — The activity of secretory tissues is regu-
lated by some arrangement similar to that controlling mus-
cular action. After a cell becomes active, it is still under

PRINCIPLES OF OSTEOPATHY 355

the control of a governing center, which accelerates or
inhibits, according to the necessities of the case.

Acceleration and Inhibition as Attributes of Nerve
Tissue. — Cells are full of potential energy, which needs a
stimulus to start its conversion into kinetic energy. We
may ask ourselves the question ; Why isn't all of the po-
tential energy converted into kinetic at one time, or in
response to a single stimulus? If the explosive material
in a magazine is ignited, it all explodes — there is complete
conversion of potential into kinetic energy. There is no
restraining or accelerating in this case. The element,
nitrogen, whose liberation in this case causes such dire
results, is the same element in the cells whose liberation
is noted as "work" done by muscle or gland. Why isn't
all the nitrogen in the cells liberated by a single stimulus,
as in the magazine? We can think of no explanation ex-
cept that impulses passing over nerves are qualified by
other impulses passing over other nerves, the two stimuli
of opposite character thus modifying each other, or in
some cases, adding their forces when of like character.

Inhibition as an attribute of the nervous system, does
not seem to be exercised in short reflex arcs, neither does
it appear to be exercised by centers in the spinal cord.
It may be that a certain amount of inhibitory influence
is exerted in these subsidiary centers, but thus far in-
vestigations demonstrate this attribute to be possessed by
the brain cells.

Inhibition a Normal Attribute of the Central Nervous
System. — Inhibition is a normal restraining influence pos-
sessed by the central nervous system. When the osteo-
pathic physician speaks of inhibition, he means a thera-
peutic procedure which exercises a restraining influence
over some function, this restraining influence being inde-
pendent of that inhibition which is an attribute of the
central nervous system.

Anything which decreases the number or strength of
sensory impulses reaching a reflex center, is inhibitory in

356 PRINCIPLES OF OSTEOPATHY

character. The medical profession has made use of a large
number of agents for this purpose, opium, for example.

History. — Inhibition is a word found in literature
bearing on the phenomena of the nervous system. It is
well for us to investigate the history of this word, and
the phenomenon which it indicates. The phenomenon
which occasioned the use of this word was first observed
by the brothers Weber (1845) and many investigators
have since confirmed it. They noted that excitation of
fibers of the pneumogastric nerve occasioned slowing or
stoppage of the contractions of the heart. This new phe-
nomenon must have a designative term, hence the word
"stoppage" was used, meaning the arrest of activity of
an organ, by arousing activity in a nerve supplying it. The
word "inhibition" was proposed later by Brown-Sequard
and has remained in use, to the exclusion of the earlier
terms.

After observing the phenomenon of nerve arrest in
the heart, other phenomena of a somewhat similar charac-
ter were grouped under the same head. Thus we find the
term inhibition confused with such phenomena as the
paralysis of motor nerves by curare, loss of sensation fol-
lowing the inhalation of chloroform, shock and fatigue.
We can thus realize the great confusion of meanings
attached to this term. Later investigators realized the
essential differences in these phenomena, and drew atten-
tion to the fact that paralysis, shock and fatigue were not
. comparable to the phenomenon of arrest of cardiac con-
traction following stimulation of the pneumogastric.
Morot says, "In order to prevent this confusion, it is neces-
sary to return to the experimental datum which lies at the
foundation of the conception of inhibition. This appella-
tion will be given to every phenomenon reproducing the
characters and the essential conditions of stoppage of the
heart by the stimulation of the vagus nerves."

Arrest of Activity. — Paralysis, shock, fatigue and in-
hibition all signify arrest of activity, but are not synony-

PRINCIPLES OF OSTEOPATHY 357

mous, as may be noted by examining into the pathology
of the conditions thus described. Paralysis ordinarily
means arrest of activity, due to a destructive process in-
volving nerve elements.

Shock. — Shock is a phenomenon more closely allied to
inhibition than the others. It signifies arrest of activity
of the whole nervous system, due to excessive stimula-
tion of a part, as, for example, the making of a wound.
The stimulation produced by the wound reacts on the cen-
tral nervous system, and produces arrest of activity. This
phenomenon fulfills the definition of inhibition, as it is
given in physiology : "An activity which prevents the
manifestation of other activities."

Fatigue. — Fatigue is the arrest of activity due to over
stimulation, and therefore involves the idea of destruction
in a less degree than is signified by paralysis.

Location of Inhibition. — In the consideration of re-
flexes, we presuppose the existence of a mechanism con-
sisting of two nerve elements, motor and sensory. The
stimulation of the latter is transmitted to the former, and
is manifested by work done by the terminal tissue which
received it. This simple mechanism presupposes the ap-
proximation of the motor and sensory elements at some
central point. To explain inhibition, we must add a third
element to this reflex arc, interposing it at the point of
contact of the motor and sensory elements. Since the
point of terminal contact of motor and sensory elements
is in the gray matter, wherever it occurs, this inhibitory
phenomenon evidently resides in the same location.

Muscular Activity. — It is axiomatic that muscular ac-
tivity is the evidence of the nervous elements which con-
trol it. Likewise, it has been considered that non-activity
of muscle implied quiescence of the nervous elements.
The phenomenon of inhibition would seem to im;)ly a
form of activity of nervous elements just as important as

358 PRINCIPLES OF OSTEOPATHY

that which calls forth contraction. Muscular repose is the
result of nerve activity. This is the important point, in the
practical consideration of inhibition.

Three Characteristics of the Nervous System. — The
nervous system during its developing period, shows three
special characteristics, i. e., it either appropriates or pro-
duces energy — it is undetermined how the energy is se-
cured— transmits energy, and lastly retains the discharge
of energy. The last characteristic is inhibition.

Development of Inhibition. — When watching the move-
ments of a young babe, we are amused by the incoordinate
activity of its extremities. At this stage in its develop-
ment, inhibition is not an accomplished function of its
nervous system. The bladder and bowels act reflexly. If
inhibition develops normally, the child soon controls de-
fecation and micturition ; if not, a case of enuresis exists,
until such time as the inhibitory function is developed in
the central nervous system.

Neurotic Diathesis, Chorea. — The well recognized fact
that many children are easily precipitated into the con-
vulsive state, is an evidence of the poorly developed condi-
tion of this third attribute of nervous tissues. The so-
called neurotic diathesis seems to mean little more than
faulty development of inhibition. Inhibition may develop
in a fairly normal manner, but on account of nutritional
conditions, environment or accident, be in part impaired.
An example of this is exhibited by the well known un-
controlled movements in chorea. Impairment of the in-
hibitory function of the central nervous system would
seem to be sufficient cause for chorea.

Paralysis Agitans. — To carry our theory into later life
we may take paralysis agitans as an example of the im-
pairment of the inhibitory function of the central nervous
system. This functional neuronic disease presents no lesion
of the nervous tissue, which has been detected up to the

PRINCIPLES OF OSTEOPATHY 359

present time. It may be that future study of nerve tissue
will discover a delicate mechanism, whose )ur >ose is in
hibition.

Developing Inhibition by Training. — The functional
activity of nerve tissue is augmented by use, just as muscu-
lar power is enhanced by proper training. Knowing this
fact is evidenced everywhere in the field of educational
endeavor, we feel that inhibition, as an important function
of the nervous system (in fact, we may call it a protec-
tive function) should be recognized and cultivated early
in life. The well-trained child is the one possessing a
well balanced nervous system. Such a child does not have
spasms, because appetite and desire have been trained, and
these virtues of self control manifest themselves in nerve
power and control. Thus do we find the consideration of
a purely scientific aspect of the development of the nervous
system leads us into thoughts concerning moral develop-
ment of the units of human society. Through such studies
as this, the physician becomes an important factor in the
development of a proper and healthful social life.

Inhibitory Effect of Pressure. — Now, to return to an-
other view of our subject, we call your attention to a few
of the recognized phenomena constantly presented to us,
by our efforts to alleviate disease conditions. We know
by many experiences that by pressure on the surface of
the body, over the course of a nerve bundle, a restraining
influence is often exercised over the function of the tissue
receiving the terminals of that nerve bundle. Even more
interesting is the observed fact that a restraining influence
is often exerted on tissues remote from the point of pres-
sure, which do not receive any of the terminals of the
nerve which is pressed upon, but receive terminals of
other nerves from the same segment of the central nervous
system. We may even go farther and say that it is not
an unobserved phenomenon to have functional activity
restrained in very remote tissues, which do not seem

360 PRINCIPLES OF OSTEOPATHY

ordinarily to be immediately connected with the segment
of nerve tissue directly affected. This diffusion of re-
straining influences, following external pressure, would
seem to point to the probability that the pressure acts as
a stimulus to an inhibitory mechanism in the central
nervous system. If this were not so, we could not expect
any reflex restraining effects, such as we are constantly
seeking. As examples of pressure effects, let us call at-
tention to pressure of the suboccipital nerves in cases of
headache. These nerves are in position to be compressed
against bone. The effect of compression seems to be
manifested peripherally by a decrease in pain. Pain in
the abdominal viscera can frequently be lessened, to a
very appreciable extent, by external pressure made over
the proper associated spinal area. In this we have a good
example of the reflex effect of pressure, which seems to
uphold the idea that pressure is really stimulation of a
function residing in the central nervous tissues. Pres-
sure over the sacral nerves in a woman passing through
the menopause, and troubled by irregular heart action, has
been known to be almost immediately followed by reg-
ular heart rhythm. Since the cardiac irregularity was a
reflex, occasioned by disturbance of the sacral plexus, there
must have been a re-adjustment of nervous activity, due to
some form of stimulation. It seems very probable that a
movement, which we name inhibition, may in reality be
a form of stimulation which calls forth a function of the
central nervous system, the resultant action of the cen-
tral nervous system being merely evidence of the fact that
re-adjustment takes place as a self preservative activity,
i. e., a manifestation toward the normal.

Dosage. — We are likely to be misled into the fatuous
belief that if we give just enough stimulation, or inhibi-
tion, in a given case, i. e., if our dosage is just right, we
will get perfect results. This is the old stumbling block
of homeopathy and allopathy. Devotees of these systems
beguile themselves with the idea that specificity of dosage

PRINCIPLES OF OSTEOPATHY 361

is the needful thing. If we observe closely, we are very
cognizant of the fact that we can not exactly estimate
the quantity of nerve force resident in the patient we
are treating. This being so, there is no possibility of
exact dosage, hence stimulation and inhibition, as thera-
peutic measures, other than simply palliative procedures,
are of little avail. We are continually impressed with
one of the fundamental ideas in osteopathic practice, that
the only measurable guiding quantity in giving an osteo-
pathic treatment is the palpable tissue change, the lesion.
Any case not presenting a palpable lesion, can only be
treated on general principles underlying natural therapeu-
tics, i. e., the tonic effect of change, re-adjustment. These
changes range all the way from slight variations in diet,
habits, surroundings and thoughts, up to genuine shock.
Inhibition as a form of movement has a place in our prac-
tice, but it is well for us to have a realizing sense of its
limitations.

Impairment of Function. — Inhibition, as a function of
the central nervous system, must necessarily impress us
with a host of new ideas in connection with the mani-
festation of lack of restraint of functional activity in
various tissues. Enuresis in the babe is normal, but we
look with suspicion on its presence in the four year old;
there is retardation of development. Chorea is an evi-
dence of impairment of this function, after it has appar-
ently been normally developed. Paralysis agitans is an
evidence of impairment of this function late in life.

Physiological Activity Is the Result of Stimulation. —

All the functions of our body are initiated by stimuli. It
must not be inferred from this statement that the author
is satisfied that life consists of nothing but reflexes. So far
as we can note the phenomena of muscle and gland, we are
compelled to recognize the fact that most of them are re-
flexes. Work done by muscle and gland is initiated prin-
cipally by sensory stimuli. Excessive sensory stimuli excite

362 PRINCIPLES OF OSTEOPATHY

increased work in muscle and gland, sometimes to the point
of exhaustion. To decrease the amount of work, we must
decrease the number of stimuli. The stimuli originate at the
periphery of sensory nerves. Sensory nerves are most
numerous in the skin, mucous membrane and muscle. Inhib-
itory influences must be applied to one or more of these
structures. Skin is the surface tissue, richly supplied by
sensory nerves, and under it are muscles, also well sup-
plied by sensory nerves.

Hilton's Law. — Hilton, by showing that the skin, mus-
cles and synovial membrane of a joint, or the skin, mus-
cles of the abdomen and contents covered by peritoneum,
are innervated from the same segment of the cord, laid a
foundation for the rational use of inhibition, in osteopathic
practice.

Inhibition — Therapeutic. — Inhibition, as a terapeutic
procedure, consists in a steady digital pressure made over
some nerve trunk, or over an area which is closely con-
nected with a spinal segment from which nerves pass to
an internal viscus, which we desire to affect.

In order to explain the necessity for this movement
and its beneficial effects, we must note the phenomena of
vaso-motion.

How Vaso-motor Centers Act. — Vaso-motor centers
act according to the sum of the stimuli reaching them
from skin, muscle, glands, etc. If the sensory nerves of
one lateral half of the body are stimulated, as by pricking
with needles, the temperature of that half of the body
will be higher than the other, thus demonstrating that
excessive stimulation of sensory nerves ends in vaso-
dilation, i. e., loss of tone of the muscular coat of the blood
vessels. Since excessive, i. e., over-stimulation of sensory
nerves in this experiment causes inhibition of vascular
tone and hyperaemia results, we argue that any procedure,
which lessens the excessive amount of stimulation pass-
ing to a vaso-motor center, will favor the return of the
vascular tone. Therefore, since it is easily demonstrated

PRINCIPLES OF OSTEOPATHY 363

that digital pressure lessens pain and sensitiveness in the
area pressed upon, we know that the registering power of
these peripheral nerves is decreased, and there results a
better vascular tone in that area.

Over-stimulation Equals Inhibition. — If over-stimula-
tion results in inhibition of vascular tone, as the above ex-
periment seems to demonstrate, then it appears rational to
decrease the stimulation to a point where vascular tone
is not disturbed. Digital pressure does decrease the ir-
ritability; therefore we may express ourselves as follows:
Inhibition of sensory nerves, in skin and muscle, which
are over-stimulated, will favor the return of vascular tone
in all areas which are supplied with nerves from the same
segment of the cord.

Over-stimulation of sensory nerves causes vascular
dilatation. Inhibition lessens the irritability of sensory
nerves and hence decreases the number of stimuli reach-
ing the vaso-motor centers, thus allowing a return of vas-
cular tone.

The Guide for the Use of Inhibition. — Knowing the
complete distribution of any nerve trunk, we may judge
the condition of the internal structures, supplied by one
of its branches, by the physiological activity of surface
tissues, supplied by others of its branches. In this way
we are guided as to our use of inhibition.

Pathological Changes Which Accompany Over-stimu-
lation.— If an individual eats a hearty meal, and before it is
digested eats another, and continues the process, the stimu-
lation of the sensory nerves in the mucosa of his digestive
viscera results in a physiological hyperaemia which, under
the ceaseless stimulation of the presence of food, finally
becomes chronic. The liver becomes hyperaemic, and its
sensory nerves are stimulated by the increased amount of
blood present in the capillaries. These sensory nerves
do not register their impressions on the sensorium of the
brain, but do excite that area of the spinal cord with which
they are connected by means of the rami-communicantes.

364 PRINCIPLES OF OSTEOPATHY

This area of the spinal cord lies between the sixth and
tenth dorsal spines. From this area, nerves pass to the
deep muscles of the back. These muscles are excited to
undue contraction, and their sensory nerves are thereby
made sensitive. The capillary circulation in these muscles
is poor, thereby increasing the muscular sensitiveness.
This muscular sensitiveness, or rather increased stimula-
tion of the sensory endings in the muscles, sends a new
set of impulses to the same area of the spinal cord, sixth
to the tenth dorsal, and the cord reflexes them back to the
sympathetic system. Thus a figure 8 is formed with the
union of the circles representing the spinal cord. With
impulses entering the cord from both loops, sympathetic
and cerebro-spinal, the cord itself becomes hyperaemic.
The constant interchange of reflexes which were originated
by excessive demands on the physiological activity of the
tissues involved, either ends in a spasmodic effort of na-
ture to rid itself of the intolerable condition, by means of
a "bilious spell," or the hyperaemia causes excessive secre-
tion of mucous, hypertrophy of connective tissue, and
atrophy of parenchymatous tissue. The bilious spell is
nature's safety valve.

Rational Treatment. — After such a condition as we
have described is well established, dieting merely lessens
the reflexes in the sympathetic portion of our figure 8.
The reflexes in the cerebro-spinal portion are still active,
because the deep muscles of the back have become chron-
ically contracted, and continue to over-stimulate the sen-
sory nerves. These cerebro-spinal reflexes still help to
maintain the hyperaemia of the spinal cord, which con-
tinues to disturb the rhythm of the sympathetic. Mani-
festly, the treatment must consider both portions of the
figure 8. Dietetics will lessen to some extent the hyper-
activity of the sympathetic loop. Digital pressure, inhibi-
tion, will relax the spinal muscles, and lessen the hyper-
activity of the cerebro-spinal loop. The two lines of treat-
ment will decrease the number of stimuli entering the

PRINCIPLES OF OSTEOPATHY 365

segment of the spinal cord, sixth to tenth dorsal, hence
there will cease to go out from that segment a series of
impulses which have tended to pervert the secretion in
the digestive viscera.

The contraction of the spinal muscles may have sub-
luxated a vertebra which then becomes a source of irrita-
tion. In such a case, a movement to replace the vertebra
in its true relation acts in the nature of inhibition, i. e.,
it ceases to cause excessive stimuli to enter the spinal cord.

Digital pressure on contracted dorsal muscles causes
sensitiveness, i. e., consciousness of the fact that the nerves
in that region are abnormally irritable. The sensitive
area along the spine will be in direct central connection
with an internal viscus which is equally if not more
sensitive.

Hyperaesthesia of Sensory Areas — Diagnosis. — The

hyperaesthesia of sensory areas along the spine is of prac-
tical value for diagnostic and therapeutic purposes when
we know their nerve connections. By inhibiting a hyper-
sensitive spinal area, we set up a change in an area of low
sensibility, i. e., a visceral area. The inhibitory pressure
does not merely deceive consciousness by lessening the
power of its informing nerves, which alone have power to
stir up those reflexes which will tend to assist the dis-
eased part to return to normal.

Results of Inhibition. — We know that inhibition les-
sens pain in the area of conscious sensation. The result
of daily practice teaches us this.

Inhibition of painful areas does more than lessen
pain ; it aborts those impulses which are the result of pain,
and sends a counter impulse into the center which, in a
measure, negatives the original impulse. If this were
not so, we could not stop vomiting, intestinal peristalsis
or uterine colic. We know that inhibition of a sensory
area of the spine not only stops pain in that area, but
also pain, if there is any, in the viscus which is in central

366 PRINCIPLES OF OSTEOPATHY

connection with it. Therefore, if we affect the tonus of
both skeletal and involuntary muscles, sensation in the
cerebro-spinal and sympathetic systems, we certainly af-
fect the caliber of blood vessels and the activity of secre-
tory and excretory glands.

It is not too much to say that inhibition does not de-
ceive consciousness by lessening the power of registering
nerves, but does stop a storm of reflexes which have no
reparative tendency, and that it does affect the area of low-
sensibility, as is evidenced by a change in the condition
of its musculature, blood supply and secretory activity.

There are many osteopaths who contend that the key-
note of all manipulative work, according to osteopathic
principles, is the discovery and removal of a "lesion,"
osseous in character. With this idea carried to extreme,
the author has no sympathy. In connection with this
idea the student is referred to the chapter on Subluxation,
page 283.

The Phrase "Remove Lesions." — The phrase "Remove
Lesions" is a good one, and yet it is inexact in many
cases. It is an elastic phrase, and capable of many and
varied interpretations. Each year of active practice adds
to the osteopathic idea of what lesions are. Our litera-
ture contains many references to lesions which are not
mentioned in Dr. Still's writings, and yet Dr. Still's basic
work has made the later conception possible. Osseous
lesions have always been paramount in our work and
thought, but muscular lesions now hold an equal place,
and bid fair to lead, when we see more clearly into the
subject.

The Human Body Is a Vital Mechanism. — We say
-that "when the anatomical is absolutely correct, the physi-
ological potentiates." This conception is based on the
statement that the human body is a machine. The human
body is vastly more than a machine. It is a vital mech-
anism, and the fact that it is vital, renders it susceptible
to other influences besides mechanical, such as falls, twists,

PRINCIPLES OF OSTEOPATHY 367

strains, etc. We may truthfully say that when the
physiological is over-active, the anatomical alignment is
disarranged. The principles of osteopathy, as they were
first promulgated, declared that a structural defect is at
the bottom of every physiological defect. Structure al-
ways affects function. A sufficient number of cases were
found to give a foundation of fact to this statement.
Hasty reasoning tried to make this an all-embracing prin-
ciple, applicable to every case of disease. Other schools
of medicine have made similar mistakes. The allopathic
school promulgated the "law of contraries." The homeo-
pathic school holds aloft the "law of similars." Neither
of these are laws. A law is absolute, no exceptions are
tolerated. If there are any exceptions to a so-called law,
it ceases to be a law.

Osteopathic Meaning of Inhibition. — By the term in-
hibition, we do not attempt to convey any other meaning
than that of pressure, applied at some particular point on
the surface of the body, for the purpose of lessening the
hyperactivity, or hyperaesthesia, of the immediate, or some
distant part of the body. The inhibition itself does in some
cases remove what we may choose to call a lesion, in other
cases it may make the removal of a lesion possible, but
in the majority of cases, its effect is purely on the nerves,
thereby acting on both the motor and sensory1 portions
of the reflex arc, lessening muscular contraction and pain.

The Scientific Use of Inhibition. — It has been proven
many times that the osteopath is capable of checking ex-
cessive functional activity in viscera by the simple means
of inhibition. Some would quibble as to the cause of this
activity. The original stimulus may have disappeared,
but the reflexes which it initiated may be perpetuating
the condition. Many cases have been treated in which no
definite cause or osseous lesion could be discovered. Some
of these cases came under the heading Indiscretions; others
under purely mental conditions. These cases were treated

368 PRINCIPLES OF OSTEOPATHY

by inhibition, based on a knowledge of the anatomy and
physiology of the parts involved. The treatment was
successful. We are sure that such successes are just as
gratifying, just as scientific, as are those in which the find-
ing and reducing of a subluxation brings the glow of tri-
umph to the eye of patient and physician alike.

Inhibition as a Local Anaesthetic. — Inhibition is a local
anaesthetic, and as such, is being used universally in the
osteopathic profession today. True, it is not a treatment
which will secure results in a minute. We can not in-
hibit for five minutes at the eighth dorsal spine, in a case
of malarial fever, and expect to check the chill. The chill
can sometimes be controlled as long as the inhibition is
maintained. The influence thus gained over the muscular
contractions seems to increase the patient's resistance.
The onset of the next chill usually shows a decrease in
the intensity of muscular contraction, and the duration
is shortened. No one would say that we remove a physical
lesion by this treatment, or the cause of the chill. Mus-
cular contraction of the deep dorsal muscles comes on
with the chill, but does not cause it. Surely inhibition in
this case works a nervous change of a pronounced char-
acter.

An example of the good results of inhibition is af-
forded by one of the author's cases. Woman, fifty years
of age, suffered from diarrhoea, two years' duration. Five
to seven bowel movements daily. No formed feces.
Usually the stools were typhoid in character. Uterine
fibroid removed prior to development of diarrhoea. His-
tory of continuous drug treatment. Osteopathic examina-
tion did not reveal any osseous lesion. There seemed to
be nothing to lay the blame upon, except the once existent
fibroid, or the result of the operation. Since no definite
lesion existed, the treatment was planned as a test of in-
hibition without any other method. At the end of three
months the patient had but one movement daily, and the

PRINCIPLES OF OSTEOPATHY 369

feces were well formed. Pressure, and gentle stretching
of the muscles extending over the area between the eighth
dorsal and fifth lumbar spines, constituted the methods
used. From fifteen to twenty minutes was the duration of
the treatment, three times per week for two months, and
twice per week thereafter.

In cholelithiasis the intense pain can be modified by
inhibition at ninth and tenth dorsal spines, right side. In-
hibition at this point also lessens the contraction of the
abdominal muscles, and thus makes direct manipulative
treatment possible. The same is true in cases of appen-
dicitis. We could not give direct manipulative treatment
in such cases, if it were not for the power of inhibition to
lessen pain in the affected area, and the consequent mus-
cular contraction. How much more influence is exerted
over the nerves of the appendix and surrounding region, it
is hard to say. It may be that the inhibition arouses other
forces of a stimulatory character to be brought into action
to empty the appendix. Direct manipulation in these cases
is frequently out of the question.

Inhibition to Remove Lesions. — Inhibition is a large
and necessary part of many treatments given for the pur-
pose of removing a definite lesion, for if inhibition were
not first used, the true lesion could not be touched. This
is the case in intestinal obstructions. The intestinal irrita-
tion causes such bowel contractions, cramps, and con-
traction of the abdominal muscles, that the physician's
fingers cannot palpate the disturbed area. Inhibition over
the spinal area from which the nerves to the disturbed
area pass out, will cause relaxation of the muscles.

In a case of pleurisy which came under the author's
care, an opportunity was afforded to test inhibition un-
hampered by any other method. The patient could not
bear to have the right arm moved; respiration was exceed-
ingly shallow, and the physical strength was very low.
Hot fomentations had been used, but to lift the arm caused

370 PRINCIPLES OF OSTEOPATHY

excruciating pain in the side. It was a case of dry pleu-
risy. Steady inhibition was given for fifteen minutes, be-
tween the transverse processes on the right side, in the
area between the third and the seventh dorsal vertebrae.
After this length of time the patient could raise the right
arm above the head and take much better inspiration. As
a result of this treatment given twice per day, the patient
made a good recovery, though all the metabolic processes
were carried on in a very unsatisfactory way.

Inhibition as a Preparatory Treatment. — There is still
another time when inhibition is of incalculable value : In
making examination of the vagina or rectum, especially
the former. Several times, in the author's practice, exam-
ination of the vagina seemed impossible, without great dis-
tress to the patient. The irritability of the mucous mem-
brane of the vagina caused intense spasmodic contraction
of the sphincter, but steady inhibition over the third and
fourth sacral foramina for about five minutes, caused com-
plete relaxation, and the examination could then be made
without any trouble. Cases have been reported to the
author by many osteopaths, describing the good results of
inhibition in gynecological cases. These cases have ranged
from simple nervous vaginismus to curettement. Since
the sacral nerves are so near the surface, and are not in-
terrupted in their course to the pelvic viscera, they afford
excellent opportunity for the good effects of inhibition to
be demonstrated.

PRINCIPLES OF OSTEOPATHY 371

CHAPTER XVIII.

SOUNDS PRODUCED IN JOINTS BY MANIPULA-
TION.

Normal Sounds. — It is not uncommon to hear peculiar
sounds accompanying the normal movement of joints. These
sounds are indicated by popular terms, such as "cracking,"
"snapping" and "popping." They are so common that every
one has heard them, either in their own bodies, or those of
friends. Pulling the fingers is the best known method. It is
commonly supposed that such a method, if persisted in, will
enlarge the joints. It is doubtful whether there is any proof
of this. Doubtless the fear of it originated as an effort to
frighten some one in whom the phenomenon was easily pro-
duced. Loose jointed people are able to produce sounds in
many joints by carrying normal movements to the limit.
Scarcely any movable joint, in which the ligaments and
muscles are normally relaxed, is free from the possibility of
producing sound, when the opposing muscles are contracted
unevenly, i. e., either the flexors or extensors predominating.
The joint surfaces will slip upon each other suddenly, thus
producing the sound. After it has been once made, it is
rarely repeated without there has been an interval of rest,
during which the muscles change their tension. The crack-
ing in the tempero-maxillary articulation can be repeated
until the structures ache, because it is occasioned by the slid-
ing of the interarticular cartilage on to the eminentia articu-
laris. The wrist and shoulder are capable of producing fre-
quent sounds, on account of their free movement, and the
many directions in which the force is applied.

372 PRINCIPLES OF OSTEOPATHY

Abnormal Sounds. — A large number of sounds which
originate in joints are abnormal; i. e., the joints are not
normal, or else these particular sounds would not be pro-
duced. Some of these sounds are familiar to all physicians.
They result from forced motion, actively or passively made,
in a joint having limited movement as a result of injury; or
intracapsular deposits, due to disease. Another class of
sounds is produced by forced movement, passive, in joints
having lost some of the normal relations of their surfaces.

Pathology of Joints Producing Abnormal Sounds. — It
may be well to recount systematically the conditions in
which passive. movement of joints produces sounds. In this
way we can note the difference between the characters of
sounds usually recognized by physicians, and those especial-
ly peculiar to manipulative treatment of subluxations.

Synovial Adhesions. — The breaking of adhesions be-
tween articular surfaces produces a sound comparable to
that occasioned by the breaking of a green stick, in which
the fibers break individually as the force becomes greater
and greater. Synovial adhesions are due to many causes,
the simplest of which are slight injury and non-use of a
joint. An injury sufficient to cause slight efforts at repair,
when accompanied by rest, will result in a few adhesions.
Voluntary movement of the joint is arrested by these adhe-
sions. Such conditions frequently follow a sprain, or the
splinting of a joint just above or below a fracture. The joint
may be quite well, but by keeping it perfectly fixed during
the repair of the fracture, the periarticular structures lose
their elasticity, and a few adhesions may form within.

Non-use of a Slightly Sprained Joint. — Sometimes a
timid person may be so fearful of moving a slightly sprained
joint that adhesions form, and control of the joint is lost. I
was recently called to examine a foot, which was very pain-
ful and useless. Seven months previously the ankle was
sprained. The foot had not been used since that injury. I
found the foot stiff, cold and resting on a pillow. Examina-
tion revealed slight motion which seemed to be limited by

PRINCIPLES OF OSTEOPATHY 37*

elastic bands. There was no inflammation in the foot. Sud-
den force, applied first in direction of flexion, then extension,
caused a series of cracking sounds, which indicated the ru )-
turing of adhesions. The range of motion instantly in-
creased. If these adhesions had been broken six months be-
fore, much of the muscular atrophy of the leg and thigh
would have been avoided.

A patient with broken femur, having been kept in bed
twelve weeks, was unable to move the knee, on account of
adhesions formed during period of non-action due to splint-
ing. Forcible flexion of the knee a little each day gradually
broke the adhesions, until movement was nearly normal.

These are the cases with which all physicians are fa-
miliar. The sounds produced are not repeated at any time
following the first forcible movements. Such adhesions as
these, are due to rest, not without some slight injury, involv-
ing the joint structures. I do not believe that non-use alone
is capable of causing adhesions.

Rheumatic Joints. — Rheumatic joints sometimes mani-
fest conditions similar to sprain. Adhesions form during
the period of inflammation and persist after its subsidence.
Rupturing these by sudden force frequently restores normal
movement.

All the foregoing conditions are the result of some de-
gree of inflammation. Forced movement breaks the adhe-
sion, which makes a sound as it breaks. There is no repeti-
tion of the sound in succeeding movements.

Semilunar Cartilages of the Knee. — The semilunar
cartilages of the knee joint may become displaced and cause
great pain, with loss of motion. A case recently under treat-
ment gave history of frequent accidents of this kind, while
riding a bicycle. When extending the leg to push the pedal
down, the force was exerted with the knee somewhat
everted. Excruciating pain came on suddenly, and the leg
could not be extended. Examination revealed a very sen-
sitive spot at the outer and anterior surface of the joint. The
semilunar cartilage slipped forward and blocked the exten-

374 PRINCIPLES OF OSTEOPATHY

sion of the joint. By taking the leg between my knees and
making thumb pressure on the painful prominent spot, then
gently flexing and slightly rotating the tibia on the condyles
of the femur, followed by quick extension, a distinct sound
was elicited, and the action of the joint was restored. The
sound indicated replacement of the cartilage.

"Bone Setting." — It has been supposed that much of
the work of osteopaths consisted in breaking adhesions,
which were simple enough, but happened not to have been
strictly attended to by the surgeons. There is much chance
to misinterpret the work of the osteopaths in reducing sub-
luxations. Medical men of established schools of medicine
have failed to closely analyze the structural condition of
joints before and after manipulation, hence they have jumped
to the conclusion that all of our work was of that kind called
"bone setting" for want of a better descriptive term. This
appellation, "bone setting," is a popular one, first used in
England to describe the work of individuals, usually un-
educated, who treated patients by manipulation of joints,
which they said were out. Quick forceful movements in the
direction of normal joint actions usually resulted in a "pop-
ping" sound. When this occurred the "bone setter" consid-
ered his work accomplished.

Historical Reference. — Aside from adhesions the condi-
tions which we find limiting the movements of joints are
subluxations. Wharton P. Hood, M.D., M.R.C.S., furnished
the Lancet a description of what was commonly called
"bone setting." His articles were published in that journal
March and April, 1871. The articles were published in book
form the same year, entitled "On Bone Setting (So Called)
and Its Relation to the Treatment of Joints Crippled by In-
jury, Rheumatism, Inflammation, Etc." Dr. Hood made
close observations of the work of a "bone setter" — Mr. Hut-
ton. This gentleman sought to teach Dr. Hood his art, as a
matter of gratitude for professional attention given him by
Dr. Peter Hood. In the pages of this book I find a clear,
concise exposition of the bone setter's art, together with a

PRINCIPLES OF OSTEOPATHY 375

record of the observations of the author, who has the advan-
tage of excellent training in the medical arts. There is no
doubt in my mind as to the similarity existing between the
conditions which were recognized by so-called "bone setters"
and those who have formed the basis for the successful ad-
vancement of osteopathy. The difference lies principally in
the educational qualifications. Dr. Hood notes that the man-
ipulations were made without any knowledge of anatomy and
physiology, but were nevertheless astonishingly successful,
and he calls attention to the fact that much greater success,
with less probability of injury, ought to result from these
manipulations, when the true pathology of the joint is under-
stood; i. e., when the operator is in fact a trained surgeon,
thoroughly versed in the details of anatomy. Dr. Hood evi-
dently did not understand the conditions which we recog-
nize as subluxations of the ribs and vertebrae, although he
came very near to it, as you will observe hereafter. His at-
tention was principally fixed on the conditions following
greater or lesser degrees of joint inflammation, resulting in
intra-articular adhesions or extra-articular contractions. In
the case of adhesions, breaking them causes a sound which
can not be repeated, but subluxations may occur repeatedly
in the same joint, each reduction causing a sound.

Tarsal and Carpal Subluxations. — In Dr. Hood's chap-
ter on pathology, I find the following: "Subluxations of tar-
sal and carpal bones must occur, I think, in a considerable
number of instances. I mean by subluxations, some dis-
turbance of the proper relations of a bone without absolute
displacement, and I believe that such disturbance may be
produced either by the traction of a band of adhesion about
the joints, or by a twist or other direct violence." Grant the
possibility of subluxation in the arthrodial joints of the car-
pus and tarsus, it is not improbable to conceive of them in
any other joint. As a pure example of "bone setting," one
of my recent cases is apropos. A lady stepped on some small
hard object, the point of contact being just under the instep.
Sharp pain, localized on top of the instep, began at once, and

376 PRINCIPLES OF OSTEOPATHY

was not relieved by heat or other antiphlogistic measures.
Forty-eight hours after the onset of pain, I was called to
examine the foot. Found some swelling over the instep,
but palpation localized the pain in the articulation between
the scaphoid and internal cuneiform. Any attempt at local
movement of this joint caused sharp pain. The patient could
not stand on the foot, on account of the pain, which was in-
creased thereby. Extension of the foot, with firm pressure
on the upper side of the articulation, caused a very loud
sound, the prominence of the scaphoid was not so apparent,
and the patient could put her weight on the foot immediate-
ly. This was a case of tarsal subluxation. If the same de-
gree of displacement had existed in a vertebral articulation,
the effect on circulation in the nerve centers of the cord
might have caused very widespread symptoms.

The subluxations treated by "bone setters" have usual-
ly been those which occasioned pain in the joint. The osteo-
path does not depend upon pain as a symptom of subluxa-
tion, but makes palpation the true guide.

Enarthrodial and Arthrodial Joints. — When the head
of the femur is forced out of the ascetabulum, there is more
or less tearing of ligaments, with consequent inflammation.
Replacement of the head is not accomplished without a dis-
tinct sound. The sound is considered as audible evidence of
successful operation. The same is true of the shoulder joint.
The great range of movement in these joints necessarily re-
quires lax ligaments, therefore great separation of the joint
surfaces is possible. The arthrodial joints, in all parts of
the body, are constructed on a different principle. The range
of movement is not great in them, and their ligaments are
comparatively short. The form of the body surfaces of the
arthrodial joints does not limit motion, as in the case of en-
arthrodial joints.

Replacement of the head of the femur or humerus re-
quires it to move over a ridge of bone or cartilage, and when
it sinks suddenly into its proper place, a sound is heard.
Probably the sound which accompanies the reduction of a

PRINCIPLES OF OSTEOPATHY 377

subluxation arthrodial joint, can be explained by the sudden
readjustment of joint surfaces, even though there is no ridge
of bone or cartilage to glide over. It is hardly probable
that a subluxated joint has its surfaces smoothly, though in
a limited area, opposed to each other. Forcing a greater
area of contact corrects the unevenly opposed surfaces.

Slow vs. Quick Reduction of a Subluxation. — A sub-
luxation may be reduced slowly, and in such an instance no
sound is heard. Quick, sharp force is required to overcome
the periarticular tension which will result in sudden replace-
ment with sound.

Bone Setters' phrases. — The use of the statement by
some osteopaths that a "joint is out" or a "bone is out" is
merely the direct appropriation of the "bone setter's" pet
phrase. The use of the phrase "There, it's in," or some sim-
ilar one, when the sound of the reduction is heard, is also an
appropriation from the same source. These phrases are un-
scientific, and should not be used by any one who pretends to
understand the true pathology of the condition he is treat-
ing. In the case of sound due to the breaking of adhesions,
we could not truly say a "bone is out," nor in the case of
subluxation is it right to describe it thus. If it is adhesion,
call it so, and if a subluxation, describe it carefully. In this
way definite knowledge of joint conditions will be gathered.

Differences of Opinion. — There is some difference of
opinion between osteopaths as to whether a subluxation
must give forth a sound when properly reduced. Discus-
sions of the subject thus far have not settled it. It seems
that the statement made previously in this chapter, that slow
reduction of a subluxation by relaxing movements will not
cause a sound, but forceful and sudden relaxation will do
so, about covers the facts. We know that subluxations are
reduced by both methods, with satisfactory results.

Elsewhere we have called attention to the treatment of
subluxations. For comparative purposes, and that the stu-
dent may know what was understood concerning the manip-
ulative treatment of the spinal column previous to the ad-

378 PRINCIPLES OF OSTEOPATHY

vent of osteopathy, we quote a portion of Dr. Hood's chap-
ter on "Affections of the Spine."

"Affections of the Spine," Dr. Hood.— "I fear it must
be admitted that the great importance of the spinal cord,
and the gravity of its diseases, have rather tended to make
professional men overlook the osseous and ligamentous case
by which it is enclosed, and which is liable to all the mala-
dies that befall bones and ligaments elsewhere. The quack,
on the other hand, who probably never heard of the spinal
cord, recognizes the presence of structures with which he is
familiar, and deals with them as he does in other situations.
The result is much the same as in the hip joint. The quack
every now and then cures conditions which the authorized
practitioner had regarded with a sort of reverence because
they were "spinal"; and he every now and then kills a pa-
tient because this reverence did not exist for his protection.
.If the profession generally would so study the diseases of the
spinal cord as to rescue them from specialists, the first step
would be taken towards rescuing the disease of the vertebral
column from quacks.

"Crick in the Back." — "However, the matter may be ex-
plained, it is quite certain that many people now resort to
bone setters, complaining of a "crick" or pain or weakness
in the back, usually consequent upon some injury or undue
exertion, and that these applicants are cured by movements
of flexion and extension, coupled with pressure upon any
painful spot.

Manipulation of the Neck. — "In a few cases, Mr. Hut-
ton was consulted on account of stiffness about the neck or
cervical vertebrae, and he then was accustomed to straighten
them. * * * His left forearm would be placed un-
der the lowered chin of the patient, with the hand coming
round to the base of the occipital bone. The right thumb
would then be placed on any painful spot on the cervical
spine, and the chin suddenly elevated as much as seemed
to be required. As far as my observation extends, the in-
stances of this kind were not bona fide examples of adhe-

PRINCIPLES OF OSTEOPATHY

379

FIG. 151. Illustration from "On Bone Setting" by Whar-
ton P. Hood, 1871.

sions, but generally such as might be attributed to slight
muscular rigidity, or even to some form of imaginary mal-
ady. The benefit gained was probably rather due to the
pain of the operation and the effect produced by it upon the
mind of the patient than to any actual change in the physi-
cal condition concerned.

Manipulation of the Back. — "For the lower regions of
the spine he had two methods of treatment differing in de-
tail but not in principle. In the first, when the painful spot
was found the patient was made to get out of bed and to
stand facing its side, with the front of the legs or perhaps
the knees — according to the height of the patient and the
bedstead — pressed against it. She was then told to bend
forward until the bed was touched by the elbows. His left
arm was then placed across the chest, and the thumb of
the right hand upon the painful spot. Firm pressure was
then made with the thumb, and as soon as he felt that he
had settled himself into such a position that he could obtain

380 PRINCIPLES OF OSTEOPATHY

the full power of the left arm, the patient was told to assume
the erect posture with as much rapidity and vigor as she
could command. This movement was facilitated and ex-
pedited by the throwing up of his left arm and the opposing
force of the right thumb. As a rule there seemed to be two
painful spots, answering to the upper and lower border of
the affected vertebrae, so that the manoeuvre would require
to be repeated.

"In the second method the patient was seated in a chair
placed a short distance from the wall, so that the feet could
be firmly pressed against it. She was told to bend forward
and place her arms between her legs, with the elbows rest-
ing against the inner side of the knee; to sit firmly on the
chair, and at a given signal to throw herself upright. The
operator passed his left arm under the chest, placed his right
thumb on the painful spot, and, in order to obtain firm and
resisting pressure, rested his elbow against the back of the
chair. The signal being given, the operator, keeping his fist
clenched so as to support his thumbs and the elbow being
held firm in its position, when the patient throws herself
upright, resists the approach of her back to the chair and
bends her head and shoulders as far backwards as possible,
the position of the feet preventing any forward movement.

Treatment of Upper Dorsal. — "These two methods are
used for cases in which pain is present in the dorsal verte-
brae below the eighth, or in any of the lumbar. The treat-
ment used for the upper dorsal and lower cervical vertebrae
was to place the operator's knee against the painful spot
and, with the hands placed upon the shoulders, to draw the
upper part of the body as far back as possible.

"In cases when pain was complained of in the dorsal
and lumbar region and the backward movements did not
afford the required relief, the patient was made to bend side-
ways, and a similar process was gone through as in the
other manipulations.

Comment. — "As a commentary on all this, there is
manifestly little to say, except that the size of the vertebral

PRINCIPLES OF OSTEOPATHY 381

column is such as to admit of considerable diminution with-
out injury to the cord, and that the bones and ligaments of
the column as already observed are liable to the same results
of injury and to the same diseases that befall bones and
ligaments elsewhere.

Differential Diagnosis. — "The surgeon who is consulted
about a case of spinal malady should first of all make sure
that he is not frightened by a bugbear, and should then pro-
ceed to determine by scientific methods of examination
whether or not he is in the presence of disease of the nervous
centers, or of caries, abscess or other destructive change in
the vertebral column. On such points as these no man who
possesses a thermometer, a microscope and a test tube has
any excuse for remaining long in doubt; and if he is able to
exclude the possibility of such conditions, he may then re-
gard the spine simply as a portion of the skeleton and may
deal with it accordingly. Here, as elsewhere, injury and rest,
or rest and counter irritation, may produce adhesions that
painfully limit movement and that may at once be broken by
resolute flexion and extension. Here, as elsewhere, partial
displacement may occur and may be rectified by pressure
and motion. In the lower cervical, the dorsal and the lum-
bar portions of the spine the change of position of any single
vertebra can only be slight — enough to produce pain and
stiffness, but not enough to produce visible deformity. In
the highest region, however, partial dislocations are some-
times more manifest. The following case is quoted from the
hospital report of the Medical Times and Gazette of August

5th, 1865 : 'John S , aged 21, laborer, of St. Mary's Cray,

was admitted on May 26th, 1865, under Mr. Hilton. States
that he has been ailing foi the last three months ; loss of ap-
petite and general debility; has, however, followed employ-
ment. On Sunday, May 14, he was stooping down to black
his boots as they were on his feet, when suddenly he "felt a
snap" in the upper and back part of his neck; he felt as if
someone had struck him there. About a quarter of an hour
after he became insensible and continued so about half an

382 PRINCIPLES OF OSTEOPATHY

hour; then he felt a stiffness and numbness at the sides and
back of his head and the back of his neck, with a fullness in
the throat and difficulty of swallowing. At first he. had no
loss of power over his limbs, only slight pain down his right
arm ; some days after admission, however, he had partial
loss of power in the right arm, which shortly recovered
itself. On admission he carries his head fixed, and has pain
on slightest attempt to rotate, flex or extend the head; his
jaw is partially fixed, and he cannot open his mouth wide
enough to admit of a finger being passed to the back of the
pharynx ; his voice is thick and guttural ; deglutition not at-
tended by any great uneasiness. Complains of all symptoms
before enumerated. Externally, over the spine of the second
cervical vertebra, there is a tumor hard and resisting, but
tender on pressure; this is evidently formed by the undue
prominence of the spine of the axis itself; the tenderness
is not general, but circumscribed; the parts all around are
numb. He was put on his back on a hard bed, his head
was slightly elevated 'and a small sand bag was placed
beneath the projecting spine, and the whole head main-
tained in a fixed position by larger sand bags. He was
ordered pulv. Dov. gr. V; hydr. c. creta; gr. iij., bis die.
This was continued for about ten days, when his gums
became affected slightly, and it was then omitted. Marked
improvement has taken place in his general appearance
and more particularly in his special symptoms. He con-
tinued until July 3, gradually and steadily improving. He
then had acute rheumatic inflammation of the right knee
and elbow joint, followed in a day or two by a similar
state in the left knee joint. There was no evidence of a
pyaemic state. The joints were blistered; he has been
treated with pot. nitr. and lemon juice and is now fast re-
covering. The tenderness and all the symptoms have disap-
peared, the projection still remaining, and he expresses him-
self much relieved by the continued rest in bed.'

Size of the Vertebral Canal. — "Mr. Hilton, in remark-
ing on this case, observed that it had been demonstrated that

PRINCIPLES OF OSTEOPATHY 383

the area of the vertebral canal might be diminished by one-
third, provided that the diminution was slowly effected,
without giving rise to any alarming or indeed marked symp-
toms of compression of the cord.

Conservative vs. Radical Treatment. — "Now, there can
be no doubt that most surgeons would agree that Mr. Hilton
exercised a sound discretion in simply placing this man in
conditions favorable to recovery, or in keeping him at rest
until the axis was fixed in its new position and the spinal
cord accustomed to the change in its relations. There can
be little doubt that Mr. Hutton would have made thumb
pressure on the prominent spine while he sharply raised
the head. The probability is that he would by this manoeu-
vre have cured his patient; the possibility is that he might
have killed him. This sort of 'make a spoon or spoil a horn'
practice we may contentedly leave to quacks, and without
risking reputation in doubtful cases. I think we may find
a considerable number which are not doubtful, in which
skilled observation may exclude all elements of danger,
and in which the rectification of displacement or the rup-
ture of adhesions will be certainly followed by the most
favorable results. For the discovery of these cases no set-
tled rules can be laid down, since they can only be known
by negations — by the absence of the symptoms that would
give warning of danger. The diagnosis must be made in
each instance for itself, and in each must depend upon the
sagacity and skill of the practitioner."

384 PRINCIPLES OF OSTEOPATHY

CHAPTER XIX.

POSITIONS FOR EXAMINATION.

Observation. — The method of examination should be
somewhat affected by one's getting a sense of the individu-
ality of the patient. There are many things which one
should be trained to observe quickly, such as the pose and
movement of the patient, nutrition, character of the skin,
etc. All of these things give a sense of direction to the
examination, i. e., odd poses, compensatory movements, or
cachexias lead one to try to determine the causes of these
very apparent abnormalities. Minor phases of these things
may escape our cursory glance, but it is unwise to com-
mence any examination without first determining the
probable region or regions especially requiring examina-
tion. This does not mean being particularly guided by
the patient's own statement, but rather seeking to exer-
cise one's powers of observation and deduction.

We wish it distinctly understood that we are striv-
ing here to explain a special form of examination which
is only a part of general diagnostic work. An examina-
tion which comprehends merely the use of palpation would
give a limited understanding of a patient's ailment, but
since this book is concerned with elucidating groups of
phenomena which can quite clearly be recognized by pal-
pation, we will not use time or space to describe other
coordinate methods which are ably taught in other texts.

In order to be systematic in the examination of
patients, it is well to adopt the use of a certain routine of
positions which will best show the details of osseous struc-
ture.

PRINCIPLES OF OSTEOPATHY 385

Testing Alignment and Flexibility. — The first position,
as illustrated in Fig. 152, flexes the spinal column and
makes the spinous processes prominent. This position is
valuable in examining even very fleshy people. Approxi-
mation or separation of the spines can be noted, also

FIG. 152. Flexion of the spine in the vertical position to make the
spinous processes prominent.

386 PRINCIPLES OF OSTEOPATHY

lateral deviation. If the amount of flesh over the spines,
as in fat people, precludes the use of the sense of sight,
you can ascertain the relation by the sense of touch.

Sense of Touch. — We wish to emphasize the necessity
of the student's acquiring the habit of depending on the
sense of touch, rather than of sight. In all osteopathic
examinations, the sense of touch should be used to obtain
those data concerning structure which form the basis of all
diagnosis. Remember that you can not see bone, muscles
and glands, but you can feel them.

Inspection. — While the patient is sitting erec% ascer-
tain the flexibility of the spinal column. Note the position
of the scapulae, whether near or far from the spinal col-
umn, whether unevenly placed. Note the development
of the trapezius, latissimus dorsi, and erector spinae, i. e.,
observe their surface markings. If the patient does not
voluntarily relax while in the erect position, ask him to
assume his normal posture. This will illustrate the points
of greatest spinal stress and show how the spinal column
acts in its normal weight carrying capacity.

Palpation of the Ribs. — Fig. 153 illustrates a method
of bringing the ribs prominently into view, or in case of
fleshy persons, making it easy to palpate them. By pull-
ing the arm up and across the chest, the latissimus dorsi
is stretched which brings the four lower ribs into a good
position for examination. The movement of the scapula
away from the vertebrae makes it easier for the examiner
to feel the angles of the fourth and fifth ribs. It is not well
to depend on this position for evidence of rib subluxations,
because the tension of the latissimus dorsi brings at least
the four lower ribs into proper alignment. The spacing
of these ribs will then be equal.

The chief value of this position is to give the exam-
iner better opportunity to palpate the angles of the ribs
above the ninth and to note the changed relations which

PRINCIPLES OF OSTEOPATHY

387

FIG. 153. Position to accentuate the prominence of the ribs.

may take place at the anterior end of the ninth, tenth,
eleventh and twelfth ribs.

Palpation of the Spine. — After gathering as much in-
formation as possible by observing the form of the back,
position of the scapulae and contour of the muscles, ex-
amine the spine by means of your sense of touch. To do
this, have the patient sit erect, being careful not to exag-
gerate the normal posture, i. e., bend the spine far for-
ward or backward in the lumbar region. A marked ten-

388

PRINCIPLES OF OSTEOPATHY

FIG. 154. Palpation of the spine in the vertical position.

dency to either position is indicative of weak muscles.
Use the index and middle finger of either hand to care-
fully note the relations of the individual vertebrae, as in
Fig. 154. Begin at the first dorsal and work downward
to the sacrum. Lateral subluxations are easily noted with
the patient in this position. Gentle digital pressure may
be made at the prominent side of any subluxated vertebra
to determine the degree of sensitiveness. This informa-

PRINCIPLES OF OSTEOPATHY

389

tion is best secured when the patient is reclining, because
the muscles are relaxed. While the patient is sitting there
is usually too much contraction of both intrinsic and ex-
trinsic muscles of the back to allow much examination,
outside of mere study of alignment and normal or ab-
normal curves.

PIG. 155. Palpation of the dorsal muscles, horizontal position.

Now have the patient recline on the right or left side,
which is most convenient, as in Fig. 155. Examine the con-
dition of the spinal muscles by using the ball of the ringers
of one or both hands. Be careful not to use the ends of
the fingers. Commence your examination at the first
dorsal by noting the amount of sensitiveness directly on
or between the spinous processes all the way to the coccyx.
To elicit this sensitiveness use a moderate pressure, equal
to about six pounds. With this much pressure the patient

390

PRINCIPLES OF OSTEOPATHY

FIG. 156. Diagram of dorsal muscles, first, second, third and fifth
layers.

PRINCIPLES OF OSTEOPATHY

391

FIG. 157. Diagram of dorsal muscles — fourth layer. Adapted
from a diagram in Cunningham's Anatomy.

392 PRINCIPLES OF OSTEOPATHY

will be able to distinguish easily between the sense of
mere pressure and a painful or hyper-sensitive feeling.

Begin once more at the first dorsal and examine along
the sides of the spines and about three inches from them.
This space brings the internal and middle groups of in-
trinsic muscles under your fingers.

Extrinsic and Intrinsic Muscles of the Back. — In
speaking of extrinsic and intrinsic muscles of the back,
we desire you to bear in mind the different groups as they
are noted in Gray's Anatomy. Gray divides them into
five layers. The first three layers are extrinsic, i. e., arise
from vertebrae and insert into the humerus, scapulae, or
ribs. They depend upon the intrinsic muscles of the
fourth and fifth layers to fix the spine so that operating
from the spinal column as a fixed point, they can move
the upper extremities and ribs.

While palpating a back which is moderately well mus-
cled, you will be able to feel through the upper three
layers and distinguish the condition of the muscles of the
fourth layer. It is important that the student should learn
to feel through the soft tissues to harder ones below. Skill
in detecting varying degrees of density and hardness is an
absolutely essential qualification of the diagnostician.

A careful dissection of the fourth layer will disclose
the fact that there are three parallel groups of muscles.
The first is the spinalis dorsi which lies on the side of the
spines. The second group lies more on the transverse
processes. The longissimus dorsi and its continuations
make up this group. The sacro-lumbalis and continuations
make up the third group which lies on the angles of the
ribs. Careful palpation will distinguish these divisions.

The Diagnostic Value of Hyperaesthesia. — Different
points, along the line of the first group, which are hyper-
sensitive, may be evidence of direct strain of a single ver-
tebral articulation, or the result of a visceral reflex, or even
in sympathy with a rib subluxation which affects sensory

PRINCIPLES OF OSTEOPATHY 393

nerves reaching the same segment of the cord from which
its nerves arise. Hyperaesthesia directly upon the spines
is usually found in connection with depression or eleva-
tion of the spines, not lateral subluxation.

Hyperaesthesia at points in the second group of mus-
cles, i. e., the longissimus dorsi and continuations over
the transverse processes, may result from vertebral or
costal subluxation, or muscular contraction caused by
visceral reflex.

When this excessive sensitiveness is found at the
angles of the ribs, in the short muscular divisions of the
sacro-lumbalis and continuations, it nearly always signi-
fies an irritation from a costal subluxation.

The examination of the ribs should be made while the
patient is in this reclining position. The fingers should
follow the angles of the ribs, noting the spacing, special
prominence or depression of an angle, then noting the
compensatory changes at the chondro-costal articulations.
In this way the relation of the ribs to each other can be
determined.

When pain exists at any one of the points named, or the
digital pressure arouses a painful reflex, all of the sensory
points along the course of the spinal nerve should be tested
in order to determine the extent of the nerve irritation.
Take for example, the point on the spinal column between
the fifth and sixth dorsal. After examining these two spines
and finding them well placed, our digital pressure at the
sides might cause a painful reflex, i. e., the patient might
complain of our pressure. Then we test the point over the
transverse processes and angles of the ribs, and even the
junction of the ribs and costal cartilages. If hyperaesthesia
is present at all points in the distribution of the fifth spinal
nerve, we understand that the original irritation may be
slight, but long continued, or strong and of short duration.
If no osseous displacement is discoverable, which has a rela-
tionship with a hypersensitive nerve, we must look for evi-
dence of disturbed functioning by the viscus most nearly

394 PRINCIPLES OF OSTEOPATHY

related. The original irritation might have been an exces-
sive demand on the ability of the viscus, as in the case of
the stomach being overloaded.

In any case, the discovery of what appears to be an
osseous lesion, leads us to test the condition of its related
nerves. If they do not show undue excitability, the lesion
is doubtful as a causative factor. A careful examination of
vertebral spinous processes may show many deviations from
symmetrical development, and the diagnostician should
guard against the false evidence of these distorted spines.
If a spine has been distorted by unequal development, there
should be no sensitiveness around it except as the result
of a visceral reflex. In case of such visceral reflex, the ex-
aminer can not help being misled as to the value of the ap-
parent osseous malformation. His ringers can not inform
him that what he considers an osseous lesion is in reality
bad development. The only way he can escape from mak-
ing a mistake is by continuing his examination without hold-
ing a positive idea that he has found the cause. The history
and development of the case may arouse strong doubts as
to the value of his discovered spinal lesion.

Your attention is called to this possible mistake in val-
uation of a lesion, so that you may not become wedded to
the idea that, when you have found what appears to be a
misplacement, you are free to end your examination and
pronounce a competent judgment.

Test Muscular Tension. — While the patient is on his
side, examine carefully the amount of tension in these three
groups constituting the fourth layer. After considerable
education of the sense of touch, it will be possible for you
to determine that the points under your ringers are probably
too sensitive. When these muscles feel hard and unyield-
ing, they are usually sore to pressure. The contractured
condition of the muscle has affected the sensory nerve fila-
ments in two ways : First, by direct pressure between the
contracted muscle bundles; second, by retention of meta-
bolic waste products which result in chemical poisoning.

PRINCIPLES OF OSTEOPATHY

395

FIG. 158. Testing the pliability of tht> interscapular portion of
the spinal column.

Thoracic Flexibility. — Fig. 158 illustrates a method of
ascertaining the elasticity of the dorsal spine and thorax.
This procedure assists in estimating the general condition
of the body. If the thorax is fixed, inelastic, respiration
can not be carried on properly. Oxygenation of the blood
will be imperfect. If desired we may palpate the spinous
processes and the musculature while the patient is in this
prone position.

Examination of the Abdomen. — Fig. 159 shows the
proper position of the patient for examination of the abdo-
men. The knees being drawn up allows relaxation of ab-
dominal muscles. Where the abdomen is very sensitive to
the touch, either because of pain or ticklishness, use the
whole hand until the patient becomes somewhat accustomed
to the touch. Sometimes it is necessary for the physician

396

PRINCIPLES OF OSTEOPATHY

FIG. 159. Palpation of the abdomen.

to lift the feet from the table and flex the knees quite close
to the abdomen. A steady, even pressure of the hand on
the abdomen will soon become non-irritating to the patient,
and deeper palpation can be made.

If the examination is a general one, commence your
work, with the patient in this position, by palpating the
thorax. Note form and flexibility, especially the flexibility
of the five lower ribs. The free movement of these ribs is
essential to many functions, chiefly respiration, but it also
affords a sort of rhythmical massage to the liver and
stomach.

Such observations of form and flexibility are very gen-
eral, but they lead invariably to some clue of especial value
in the search for effects and their causes.

Elevation or Depression of Ribs. — Note the spacing of
the ribs to determine whether any rib is elevated or de-

PRINCIPLES OF OSTEOPATHY

397

pressed. Palpate the chondro-costal articulations for mis-
placements, especially note the articulations of the tenth ribs,
they are frequently broken loose and form additional float-
ing ribs. They are usually depressed slightly under the
ninth.

After palpation of the chest, use percussion, then auscul-
tation, according to the methods outlined in the best text-

FIG. 160. Position for examination of the prostate gland.

398

PRINCIPLES OF OSTEOPATHY

books on diagnosis. By the use of all these physical meth-
ods it is possible to arrive at a very definite conclusion of
the state of the thoracic viscera.

The abdomen should be palpated, then percussed.
These two methods should make evident any organic change
in the abdominal viscera.

Examination of the Rectum and Prostate Gland. — Fig.
160 illustrates a position for examining the rectum and pos-
tate gland. Fig. 161 is the well-known Simm's position
which may be used for the same purpose as the preceding.

Other positions used by the osteopath for examination
and treatment are the well-known gynecological positions,
genu-pectoral and Trendelenburg.

Examination of the Neck. — For easy examination of
the neck, the patient should be recumbent, as in Fig. 159.
The muscles of the neck must have all tension removed
so that the examiner's fingers can feel the processes of the
cervical vertebrae.

A flat table instead of the model shown in the illus-
tration is better. A hard small pillow may be used to sup-
port the head.

PIG. 161. Simms' position.

PRINCIPLES OF OSTEOPATHY 399

Since the spinous processes in the cervical region are
short and bifid, and oftentimes developed unevenly and
are covered with several layers of muscles and ligaments,
it is not satisfactory to use them as landmarks for relations
of cervical vertebrae.

The tubercles on the transverse processes are easily
palpated, hence these serve as guides in the detection of
slight misplacements of cervical vertebrae.

The transverse processes of the atlas are usually large
and sufficiently prominent to enable the examiner to ascer-
tain accurately its position. When the atlas is in its true
position, its transverse processes will be found about mid-
way between the mastoid processes of the temporal bones
and the angles of the jaw. This relationship may appear
untrue when the mastoid processes are quite large or small,
or the angles of the jaw are more or less obtuse. It is
necessary to study the relative development and positions
in every case, on both sides, in order to discover whether
a subluxation exists. The fact that nearly all subluxations
of the atlas are twists instead of direct forward or backward
displacements, makes it comparatively easy to detect the
inequalities and understand the faulty position. Sensitive-
ness will be found in the tissues on the side whose trans-
verse process is posterior. In case there is marked sensi-
tiveness on both sides, that is, on the posterior surfaces of
both . transverse processes, the atlas is probably drawn
slightly posterior on both sides by the severe contraction
of its attached muscles.

The third cervical vertebra seems to be easily sublux-
ated. It is usually twisted, not sufficiently to lock its ar-
ticular processes, but just enough to make the dorsal sur-
face of its inferior articular process easily palpable through
the muscles which lie over it. This prominent point will
be sensitive because the muscles over it are always tense.

Sometimes the sixth cervical vertebra is twisted. When
this condition exists, there is marked disturbance of circu-
lation in the head. The patient is usually wakeful and

400 PRINCIPLES OF OSTEOPATHY

excitable on account of the congested condition of the cere-
bral blood vessels, caused by the pressure on the vertebral
veins.

Note the tone of all the cervical muscles, the flexibility
of the neck, the temperature of the skin on different parts
of the neck. Palpate the chains of lymphatic glands, the
thyroid and the submaxillary salivary glands.

After a thorough palpation of the neck, look carefully
for any evidences of disturbed circulation in the head as
may be evidenced by the appearance of the skin, mucous
membrane of the mouth, the tonsils, conjunctiva or the
wearing of glasses. Your knowledge of optics should en-
able you to judge the general condition of the eyes by in-
spection of the glasses worn.

Such an examination of the head and neck as herein
outlined should give the examiner a good understanding
of the structural and functional condition existing at the
time of examination, and even guide him to what other
parts of the body may need special attention.

The History of Lesions. — All facts as to structure and
function, determined by your examination are historical,
that is, they have dates and circumstances which give them
much or little value. The experienced diagnostician de-
lights in filling in the life history of the patient to fit the
structural and functional changes. Herein lies the oppor-
tunity for the physician to bring to his aid all his resource
of experience and education in judging how these lesions
have been brought about and how they are now influencing
other tissues.

The Extremities. — While the patient is in the recum-
bent dorsal position, Fig. 159, the lower extremities can be
examined. Note the comparative length of the legs, but
be careful to eliminate all possibility of mistake by observ-
ing whether the patient is lying evenly on the back, ilia
same height, and muscles of both legs equally relaxed. A
measurement from the anterior superior iliac spine to the
internal malleolus determines the length of the leg.

p jj Y j^ f c f /i f '£-/' ^ U P P F G f
PRINCIPLES OF OSTEOPATHY 401

Palpate the great trochanter. Note its relation to Ne-
laton's liner These general directions for examination will
determine the weak, disordered or diseased part of the body
which requires your further careful examination.

Subjective Symptoms. — You will observe that thus far
nothing whatever has been said about asking the patient
concerning his or her subjective symptoms. It is a general
principle underlying osteopathic diagnosis that objective
symptoms are the only true facts upon which the diagnos-
tician dares base his judgment and final verdict. The near-
est approach to a subjective symptom thus far mentioned
is hyperaesthesia. This may frequently be judged by the
feeling of the muscle when pressed upon by the fingers.
The muscular reaction to the painful sensory impressions
occasioned by the pressure can be felt. Usually we depend
upon the patient to indicate or corroborate our sense of
touch.

In actual practice this process is not carried out in its
entirety. Time is a factor in the physician's life as well as
in the life of the business man. He cannot afford to go
about his work in this detective-like manner. It requires
too much time. We hear a great deal of objection to the
physician's question to his patient: "What is your trouble?"
But the answer to it enables him to get quickly to work
on the seat of disease or at least leads him quickly to it.
The physician who is a good questioner saves much time.
He does not accept the subjective symptoms, merely goes
to work to prove or disprove their verity by the standards
of physical diagnosis.

saa.-Uea

"' IT S
402 PRINCIPLES OF OSTEOPATHY

CHAPTER XX.

MANIPULATION.

There has been a very rapid evolutionary develop-
ment of manipulation as a therapeutic method. It has
been found to be a wonderfully adaptable means of al-
leviating human suffering. Undoubtedly the principles
underlying any method of manipulation contribute some-
thing to all other so-called systems of movement cures.
Manipulation is hand practice in the surgical sense. It
is applicable in a tremendously wide range of disorders,
for example the treatment of fractures, sprains, breaking
adhesions, reducing dislocations, assisting venous circula-
tion, stimulating peristalsis, reducing congestions, quiet-
ing reflexes, stimulating nerve centers, and many other
things of a helpful character.

The form of manipulation most generally understood
is massage. This term is used by some to mean any
method of manual manipulation. Massage is a method of
manipulation which has been extensively practiced and
written about, hence there is no excuse for the prevailing
slovenly use of the terriv to cover all forms of hand
manipulation. The characteristic movements of massage
are friction and kneading. They have proven wonderfully
satisfactory as adjuvants in overcoming venous stasis and
toning the neuro-muscular mechanism of the body. No
one who is at all conversant with the phenomena of nat-
ural recovery fails to recognize the great assistance which
even the crudest usfe of massage furnishes.

The next step of a scientific character in the devel-
opment of manipulative methods was Swedish move-

PRINCIPLES OF OSTEOPATHY 403

ments. These introduced leverage and voluntary resistance
as new factors in increasing the tone of the neuro-mus-
cular apparatus. A very limited field was accorded to
massage and Swedish movements. Both these methods
were practically never used except as prescribed by a
physician. Practically no diagnostic ability or initiative
is credited to those who apply the methods. Surgery was
"Formerly that branch of medicine concerned with man-
ual operations under the direction of the physician." If
the evolution of surgery can be used as a criterion for
judging the future of manual manipulation, there can be
no doubt as to the commanding position that will be at-
tained.

Osteopathy has introduced a new factor in manipu-
lative therapeutics, i. e., the adjustment of joint luxations
and subluxations. It is interesting to note that the art
of manipulation applicable to this corrective work was
developed independently of massage and Swedish move-
ments. Osteopathic movements could not have evolved
naturally from massage and Swedish movements, because
osteopathic technique is the direct result of the theory,
sturdily asserted and defended by Dr. A. T. Still, that
"structure governs function." His recognition and treat-
ment of joint lesions, "subluxations", led to the develop-
ment of a system of movements primarily surgical in
character. No matter how much any osteopathic physi-
cian may take issue with him in matters of theory, the
fact exists that not one of them believes that he has ever
been approached in skill in the art of corrective manipu-
lation.

Present day osteopathic physicians are beneficiaries
of all the successes credited to massage, Swedish move-
ments. Dr. A. T. Still's original work, special operations
devised by orthopaedists all over the world, and the
brilliant work of Professor Lucas Champoniere in the
treatment of fractures by "gluco-kinesis" and mobilisa-
tion. We are beneficiaries of all these because Dr. Still

404 PRINCIPLES OF OSTEOPATHY

believed in fundamental medical education and the es-
tablshment of a school of medicine and surgery primarily
devoted to the scientific development of manipulative
therapeutics. Since at the time of his most active work
in practice and teaching, the abuse of drugs and surgery
was at its height, it is no wonder that he desired to estab-
lish a system of practice which would not be burdened
by inheritance of the foibles and failures of drug-therapy.

As a result of the success of osteopathic theory and
practice, there has been the inevitable plagiarizing of its
literature and methods by those who find it profitable to
impose on an ignorant public. This plagiarizing has been
done under several names, but especially under that of
chiropractic. The history of this attempt to appropriate
the principles and methods, of 'osteopathy, without re-
quiring any creditable educational work to make them
safe means of treating ailing human beings, is a sad trav-
esty on the standards of medical education in this coun-
try. Under our present laws new schools of medicine
may be started as short cuts to avoid the moderately
severe requirements of established schools. So long as
this is possible, there will continue to appear "new schools"
exploiting some phase of established methods under new
names.

Methods of Procedure. — Osteopathic physicians fre-
quently differ as to methods of procedure, but they all
work according to the same principle. For instance, a
subluxation of a vertebra might be discovered by two
osteopaths. The first one might undertake to reduce the
subluxation without any preliminary work on the mus-
cles, believing that it is best to go right to the seat of
trouble and remove it. His treatment would be severe
because much strength would be required to overcome
the resistance of the muscles governing the articulation.
The second one might spend considerable time on the
preliminary work of relaxing the muscles of the articula-
tion, increasing flexibility, reducing sensitiveness, etc.,

PRINCIPLES OF OSTEOPATHY

405

before attempting any specific reduction of the lesion. The
ultimate result of both methods would be alike. The
question of which method is best lies wholly with the in-
dividual osteopath. Some like to put forth a severe effort
for a short time, others a moderate effort for a longer time.
Outside of the special choice of the osteopath, lies the
business one of satisfying the patient. Severe work at
the outset frightens some patients, furthermore, it actual-
ly bruises some of them. The ultimate result of the treat-
ment may be excellent, but the patient does not quickly
forget the methods used. There is a parallel between the
immediate after-results of a severe osteopathic treatment
and surgical shock. This shock should be avoided as
much as possible.

FIG. 162. Relaxation of the latissimus dorsi.

406 PRINCIPLES OF OSTEOPATHY

The movements hereafter pictured and described are
all made with reference to structure rather than function.
Few references are made concerning their applicability to
special diseases. We do not care what the name of the
disease is. The groups of symptoms which make up the
pictures described in symptomatology have very little
significance to the osteopath. His movements are not
made with reference to a named disease, but to a faulty
structural condition. The structural condition may be
the basis for the physiological. Function does affect struct-
ure. We are not to lose sight of this fact. Function
may be perverted by bad 'habits, hence our therapeutics
must comprehend the hygienic and dietetic side of life as
well as structural.

Every movement herein outlined secures a definite
effect on a muscle, or is used to affect the relation of bony
parts.

The movements made to affect the muscles of the
back and spinal column are based upon the attachment of
the muscles and the leverage they exert on the spinal
column.

Relaxation of the Latissimus Dorsi.— The arrange-
ment of the back muscles has been noted in the chapter
on Positions for Examination. In order to relax these
muscles in their natural relations, i. e., from superficial
to deep groups, we begin with such a movement as will
separate the extremities of the most superficial muscles
to their fullest extent. Fig. 162 illustrates the method of
relaxing the latissimus dorsi. One hand extends the arm
to its fullest extent, the other hand anchors the ilium. It
will be noted that the lower dorsal and lumbar portions
of the spinal column are lifted by the pull of this muscle,
Also the four lower ribs are raised. The intrinsic effect
of this stretching movement is to take most of the ten-
sion out of the muscle itself and increase the amount of
metabolic change taking place within it. But that is not
what is primarily intended. The intrinsic effects are mere

PRINCIPLES OF OSTEOPATHY

407

FIG. 163. Relaxation of the trapezius.

incidents in the physiological life of the muscle, and as
such are found following all kinds of muscular movements.
The extrinsic effects are what concern us most; the effect
upon the vertebrae and ribs, the change in the form of
the chest.

There are three uses for this movement. First, as
preparatory to work upon muscles lying beneath it, i. e.,
purely relaxing. Second, in case of overlapping by any
one of the four lower ribs. It is a common condition to
find the twelfth rib under the eleventh, or tenth under
eleventh. The pull of the latissimus dorsi is exerted on
all alike, hence the individual ribs are brought into their
proper relations. Relaxation usually allows a return of
the faulty position, but if the ribs are held at their ex-
tremities by the operator for a few seconds after relaxa-
tion, the intercostal muscles and quadratus lumborum will

408

PRINCIPLES OF OSTEOPATHY

FIG. 164. Relaxation of the rhomboideus major and minor.

be filled with arterial blood which tones them. The
patient should be directed to hang by the hands several
times per day so as to get a good effect on the position of
the lower ribs. Third, to affect lateral curvature of the
spine in the lumbar or lower dorsal portion.

Relaxation of the Trapezius. — The trapezius is an-
other of the superficial group of back muscles. Its fibers
are so variously attached that several movements are re-
quired to relax all its divisions. Fig. 163 illustrates the
method of grasping and holding the scapula while relax-
ing the trapezius. The scapula is rotated on the thorax
as far as possible toward the head so as to stretch those
fibers extending from the spine of the scapula to the sixth

PRINCIPLES OF OSTEOPATHY 409

and twelfth dorsal spines; then away from the head to
affect the cervical fibers, then away from the spinal column
to relax the short fibers between the upper dorsal spines
and scapula. There is a vast difference in the way the
scapula can be moved about in different cases. Those
having any tendency to asthmatic trouble will present a
very fixed scapula. The more marked the asthmatic con-
dition is, the more difficult it is to move the scapula.
Pleurisy and lung troubles, especially when coughing is
frequent, tend to hold the scapula fixed. Lifting the
patient's body above the table by the scapula gives instant
relief in many cases of pleuritic pain, intercostal neuralgia
or angina pectoris. This result is explained by the re-
moval of the pressure exerted by the scapula when it is
held too close to the thorax by contracted muscles which
are acting reflexly. A subluxated rib is usually respon-
sible for the pains mentioned, but the muscles of the
scapula are partially respiratory, hence act in connection
with disturbances of normal rhythm of intercostal mus-
cles. The pressure of the scapula helps to fix the whole
chest in an unyielding condition. That which was at first
purely helpful in character becomes in itself an added
irritant. This movement or series of movements affects
the tone of the muscle fibers, then the whole respiratory
process.

Relaxation of the Rhomboids. — In the second group
of back muscles we find the rhomboids, major and minor,
accessory muscles of inspiration. Fig. 164 illustrates a
method of stretching these muscles. The patient's elbow
is placed against the physician's abdomen. Pressure
against the elbow forces the scapula back, and makes its
vertebral border prominent. The physician's fingers grasp
this border securely, and then lift steadily upward. This
movement is excellent for the purpose intended. That
which has been written concerning the trapezius is ap-
plicable to the rhomboids. Outside of the intrinsic effects
on the muscle and on respiration, a- slight effect may be

410

PRINCIPLES OF OSTEOPATHY

FIG. 165. Relaxation of the pectoralis major and serratus magnus.

exerted on a lateral curve in the interscapular region. It
is generally used as preparatory to work on deeper struc-
tures.

The Pectoralis Major and Serratus Magnus. — Follow-
ing these movements, where general thoracic and spinal
relaxation are desired, the movement illustrated in Fig.
165 may be used. It affects the Pectoralis Major and
Serratus Magnus. By pushing the patient's elbow as far
back as possible, the scapula is approximated to the spinal
column, hence the serratus magnus is put upon a ten-
sion which lifts the eight upper ribs. The pectoralis
major also affects the upper ribs. The physician's hand
on the angle of the ribs accentuates the expansion of the

PRINCIPLES OF OSTEOPATHY

411

FIG. 166. Relaxation of the serratus magnus ana some floret, of the
fourth layer of dorsal muscles.

chest. This is a general movement, but one which has far-
reaching effects upon respiration and circulation. It is
adaptable to many specific structural defects of the ribs.
In Fig. 166 the physician again uses the humerus and
scapula as means by which to affect the spinal column.
The left hand exerts traction on the muscles above the
spine, while the right hand and arm forces the patient's
scapula toward the head and spine. The movement is
made to enable the physician to relax the serratus mag-
nus and some of the fibers of the fourth layer of the back.
Slight torsion of the dorsal spinal column is also secured.

Quadratus Lumborum. — The relaxation of the quad-
ratus lumborum is secured according to Fig. 167. In all
displacements of the twelfth rib, it is necessary to secure
a free circulation in the muscles attached to that rib. The
fact that it is a floating rib makes its position dependent

412

PRINCIPLES OF OSTEOPATHY

FIG. 167. Relaxation of the quadratus lumtaorum.

on the tone of the muscles attached to it. It is frequent-
ly slipped under the eleventh. This movement separates
them.

Fig. 168 is in some respects similar to the movement
illustrated in Fig. 166, except that the scapula is forced
downward, and the left hand is able to work through the
relaxed superficial muscles. After the use of the move-
ments already illustrated, it is astonishing how easily one
can work upon the fourth layer or examine the condition
of deep structures.

Erector Spinae. — The work upon the fourth layer
should be done according to Fig. 155. The fingers are
placed between the muscles and the spines of the verte-

PRINCIPLES OF OSTEOPATHY

413

FIG. 168. Relaxation of the lower fibres of the trapezius.

brae and then drawn away from the spines in such a. man-
ner as to stretch the muscles. The fingers should never
be allowed to slip over the muscles. Work steadily and
deeply. Do not move the fingers over the skin. When
you place your fingers, compel all soft tissues beneath
them to move with them. In this way you secure relaxa-
tion of the erector spinae and continuations, take out sore-
ness of the muscles, and prepare for specific work upon
the ribs or vertebrae.

The erector spinae is rarely contracted throughout
its whole length. Your work should be centered on that
portion which your examination has demonstrated to be
contracted, either as a result of visceral disturbance, os-
seous subluxation, strain or cutaneous reflex from cold.

Having now prepared our patient for specific manipu-
lation, we will note the results to be obtained on the gen-
eral contour of the spinal column.

Treatment of Simple Kyphosis. — Fig. 169 illustrates
one of the simplest methods of springing a spine which is

414 PRINCIPLES OF OSTEOPATHY

PIG. 169. Springing a dorso-lumbar kyphosia.

FIG. 170. A method of springing a lumbar kyphosis.

415

FIG. 171. Springing an upper dorsal lordpsis

kyphosed at the junction of the dorsal and lumbar. The
physician's forearms are placed against the patient's
shoulder and ilium while the fingers rest over the ky-
phosed portion of the spinal column. The hands draw for-
ward while the forearms push away. Considerable force
can be exerted in this way on slender patients.

Great force can be exerted on a posterior curve of the
lower dorsal and lumbar portions by the movement shown
in Fig. 170. This movement is also used for purposes other
than corrective of structural defects. Since the leverage
is so great, it is quite easy for the physician to carry it
too far. The result is an active congestion of the lower
portion of the spinal cord, followed by excessive activity
of the nerve centers located there. In giving this move-
ment to women, ascertain whether pregnancy exists. If

416 PRINCIPLES OF OSTEOPATHY

so, do not under any consideration use it. The center for
parturition might be excited by it, even though the move-
ment made is slight.

There is practically no danger in this movement when
intelligently used, except in the case of pregnancy. A
slow, steady lift made while the physician is watching
carefully the amount of resistance offered by the back
will usually inhibit the excitement of the centers located
in the lumbar enlargement of the spinal cord. The slow-
ness and steadiness of the movement relaxes the muscles
of the fifth layer and secures better drainage for blood in
the spinal canal. No active congestion is brought on,
hence a sedative effect is gained. Quick, intense execu-
tion of this movement has frequently a reverse effect, be-
cause the sharp strain put upon the muscles results in
added contraction, active congestion and obstruction to
good drainage of the spinal canal. These conditions re-
sult in functional activity of those organs governed by
the nerve cells in the lumbar enlargement. Active con-
gestion of a center results in increased function of the
organ governed by that center.

As a general rule, this movement is contra-indicated
for any purpose but that of correcting a structural defect.
The reaction of many patients is an uncertain quantity,
hence it is not wise to use this treatment for purely func-
tional effects.

As a result of the ignorant use of this movement by
those who are palming themselves off as osteopaths, the
author knows of several cases where dangerous conditions
were brought on.

Lordosis — Upper Dorsal. — An anterior curve, or
straightened condition of the spine in the interscapular
region, is rather difficult to treat on account of inability
of the physician to use the extremities as levers. Fig. 171
illustrates a method of applying leverage by means of the
cervical vertebrae. The position of the knee on the spinal

PRINCIPLES OF OSTEOPATHY

417

FIG. 172. Springing an upper dorsal lordosis. The leverage
is so great in this movement that the operator must
exercise great discretion in its use. As applied by a
skillful operator it is exceedingly satisfactory.

418 PRINCIPLES OF OSTEOPATHY

column regulates the extent of the force of the movement.
The knee is the weight to be lifted, the spinal column is
a flexible lever. The physician's forearms are the fulcrum,
while his hands apply the force to lift the weight (the
knee) which bends the lever at the point governed by
the position of the weight and fulcrum. The position of
the physician's hands is important, because the cervical
is not the portion of the spinal column we desire to bend.
If the hands are allowed to rest close to the head, the
force exerted is nearly all spent on the neck; the most
flexible part of the spinal column is affected — a result not
desired. Place the hands as nearly over the cervical and
first dorsal spines as possible. Since the junction of the
dorsal and lumbar segments is a very flexible point, the
knee should be located higher.

Fig. 172 illustrates another method of producing
flexion in the upper dorsal region. The leverage in this
position is so great that the operator must exercise cau-
tion in its use. The operator should never aim to over-
come the patient's resistance by exerting a greater force.
The patient will usually relax under the influence of a
tetering movement, i. e., short, gentle application of the
leverage.

The Possible Variety of Movements Which Will Se-
cure the Same Results. — All of the effects described may
be secured by movements differing from those outlined.
The author desires to illustrate the application of osteo-
pathic principles. It is believed by him that the series of
movements illustrated have the virtue of directly and
forcibly affecting the part desired without using up too
much of the physician's strength in their application.
Where much work is done by a physician, it becomes a
vital problem with him how to conserve his own strength.
By the selection of those movements which give the great-
est leverage, he saves himself.

PRINCIPLES OF OSTEOPATHY 419

The Head and Neck as a Lever. — If the anterior or
straightened condition of the spine is very marked in the
upper dorsal, it is possible for the physician to use the
head and neck in securing his leverage. When the posi-
tion of the spine is as described, the spinal muscles in that
area will be very contracted. The vertebrae will be held
tightly together, thus lessening the flexibility. Loss of
flexibility of the spinal column results in poor circulation
in the spinal cord with consequent perversion of the ac-
tivity of the physiological nerve centers located there.
Congestion, passive type, usually exists around these cen-
ters when drainage is interfered with by these contracted
muscles.

Lordosis or Kyphosis May Affect a Function Similarly.
— A change in the contour of the spine, either anterior or
posterior, may result in the same disturbances in the
peripheral distribution of the nerves from the dis-
torted section. The anterior curve in the interscapular
region usually causes the ribs to droop, which occasions
a flat chest. The thoracic cavity is lessened, hence respira-

FIG. 173. Voluntary treatment of an upper dorsal lordosis.

420 PRINCIPLES OF OSTEOPATHY

tion is feeble. People with flat chests may develop won-
derful breathing capacity by persistent exercise. The
respiratory muscles lift the ribs. Exercise of these mus-
cles will increase the antero-posterior diameter of the
chest.

When directing a patient about the details of exercise
to increase the breathing capacity, do not fail to impress
the fact that a full round chest without flexibility is just
as bad a condition as an abnormally flat chest. Flexibility
is the keynote of health. Those exercises which merely
increase the contracting power of muscles, without at the
same time increasing their relaxing power are not health-
ful.

Examination shows that whether we have anterior or
posterior conditions in the interscapular region, the spinal
muscles are contracted. The patient's power to relax them
is lost. The patient may feel tired and weak, but these
muscles will not cease their contraction. The rigidity has
passed beyond the patient's control.

The patient can do something toward restoring flexi-
bility to an anteriorly curved or straight spinal column
in the upper dorsal region. Fig. 173 illustrates the effect
of flexing the neck forcibly by pulling down with the
hands. These spines are greatly separated, and hence the
muscles of the fourth and fifth layers are relaxed.

Fig. 174 illustrates how the physician can use the dor-
sal and cervical vertebrae as a flexible lever, and by shift-
ing the position of the hand upon the spine apply the
movement specifically to any particular vertebra. No
movement which uses the arms as levers will affect the
position of these vertebrae, because the first and second
layers of muscles which are affected by arm movements
do not control the intrinsic mobility of this portion of the
spinal column. The fourth and fifth layers of back mus-
cles are the groups which cause the mal-position of verte-
brae in this region.

PRINCIPLES OF OSTEOPATHY

421

FIG. 174. Use of the head and neck as a flexible
lever 10 aftect the upper dorsal region.

Splenius Capitis et Colli. — The Splenius Capitis et
Colli, a muscle of the third group, extends as low as the
sixth dorsal spine. As its name indicates, it is a bandage
muscle, and binds down the muscles under it. Its long
attachment in the dorsal region gives it a considerable in-
fluence there, when its superior attachments to the head
and neck are forced anteriorly by flexion of the neck. It is
the influence of this muscle which makes the movements
described so effective. These movements are for a gen-
eral corrective effect on a section of the spinal column.

422

PRINCIPLES OF OSTEOPATHY

FIG. 175. A method of affecting kyphosis in the upper dorsal

region.

They are not well adapted to treatment of an individual
vertebra.

Kyphosis — Upper Dorsal. — A posterior curve in the
upper dorsal region can be treated by the method illus-
trated in Fig. 175. The physician's right arm is placed
above the patient's right shoulder and under the chest, so
that the hand can be placed in the patient's left axilla.
The patient's head should be turned away from the physi-
cian, so that the upward pressure of his arm will not inter-
fere with the trachea. The physician's left hand may be
moved from place to place along the spinal column. The
farther the hands are separated, the more leverage is
gained. Considerable force can be exerted in this move-
ment without any danger to the patient, in fact, to be of
any value it must be made forcefully. The primary use
of this procedure is to reduce the excess of posterior curve.

PRINCIPLES OF OSTEOPATHY

423

That which has been written concerning the nerve
centers in the interscapular region, when straightening or
anterior curvature of the spine exists, applies equally to
the posterior curvature.

FIG. 176. A method of affecting kyphosis in the tlorso-lumbar

region.

424

PRINCIPLES OF OSTEOPATHY

Posterior curvature is accompanied by increased an-
tero-posterior diameter of the chest, and loss of flexibil-
ity. This movement increases flexibility. It can easily be
adapted to the treatment of the fifth or sixth ribs.

FIG. 177. A method of affecting kyphosis in the lower dorsal
region.

PRINCIPLES OF OSTEOPATHY

425

Kyphosis — Dorso-lumbar. — When the kyphosis is at
the junction of the dorsal and lumbar regions, it is easy
to secure enormous leverage. The arms can be used as
levers while the physician's knee rests against the kypho-
sis as in Fig. 176. If the patient's buttocks are held to the
stool, the whole force of the leverage is spent on the back
under the physician's knee. This movement should not
be carried too far. It, like all other movements in which
the physician has tremendous leverage, is liable to pro-
duce more than the desired effect. It stretches the thorax
and abdomen very decidedly.

Centra-indications. — The author expects that all who
use this and other high power movements, have examined
their patients carefully before administering them. The
presence in the abdomen of an aneurism, ovarian cyst, or

. FIG. 178. A method of affecting kyphosis in the lumbar region.

426

PRINCIPLES OF OSTEOPATHY

gravid uterus, centra-indicate the use of any movement
which compresses the abdominal contents, and also in the
case of a gravid uterus any movement which is liable to
cause active congestion of the lumbar enlargement of the
spinal cord.

Other Movements. — Fig. 177 illustrates another meth-
od of exerting pressure on the prominent part of a kypho-
sis. The leverage is not so great as in the preceding
method, but where the kyphosis is slight, it is the better
movement.

Still another simple method of springing the lumbar
portion of the spinal column is shown in Fig. 178. The
patient's knees are held against the physician's abdomen,
while the physician's hands make counter pressure over
the apex of the kyphosis. The buttocks are forced back-
ward by the pressure on the patient's knees. Some osteo-
paths object to this movement or any other which neces-

FIG. 179. A method of affecting either kyphosis or lordosis in the
lumbar region.

PRINCIPLES OF OSTEOPATHY 427

sitates pressure of the patient's knees or elbows against
the abdomen. There is an element of danger to the
osteopath.

This position, Fig. 178, is used frequently where
strong inhibitory pressure in the lumbar region is required.
For example, in cases of diarrhoea or cramps. Any hyper-
activity of structures governed by cells in the lumbar en-
largement may be inhibited in this region.

When lordosis of the lumbar region exists, it is neces-
sary to flex that region in order to counteract it. Fig. 179
illustrates an easy method of accomplishing this result.

This same movement with the physician's right hand
under the spine can be made to do duty in correcting a
posterior curve. When the hand is placed directly under
the kyphosis, the back is lifted; then if the buttocks be
forced to the table, the spine will be sprung in the direc-
tion desired.

Functional Kyphosis. — A large proportion of patients
whose spinal columns exhibit a tendency to kyphosis, in
the splanchnic area, suffer from either visceral reflexes or
a hypotonic condition of the erector spinae muscles. There
is scarcely a case of visceral ptosis that does not present
a hypotonic condition of these extensor muscles. The
functional kyphosis so frequently apparent in this region
is tremendously benefited by rather forceful leverage
movements which are accompanied by counter pressure at
the apex of the kyphosis. If this counter pressure is ap-
plied suddenly, but not severely, it usually produces a
sound in the arthrodial articulations of the spinal column
under the point of counter pressure. This popping sound
can be produced by a variety of methods, many of which
are illustrated in this chapter. The patient practically
always feels an increase of muscle tone after the popping
sound is elicited. This is evidenced by a feeling of greater
ability to hold the body erect. There is a genuine feeling
of increased power, aside from any psychological effect

428

PRINCIPLES OF OSTEOPATHY

FIG. 180. A method of securing general dorsal rotation.

that may accompany the phenomenon. As a simple ex-
periment, one may voluntarily extend one's fingers in
opening the hand to its fullest extent, after having had it
flexed for a considerable time. There is a feeling of lim-
itation of the extensor movement which is done away with
if we passively extend the fingers with the other hand.
After this passive extension by manipulation we are able
to voluntarily extend the fingers with greater power and
to a greater extent than before. This equalizing of the
forces of extension and flexion is probably what takes
place, when we hear the sound, incidental to movements
which produce sudden passive extension, in a joint which
is in a state of imbalance on account of a static error, or
visceral reflex.

PRINCIPLES OF OSTEOPATHY

429

Wherever we find the muscles which are prime movers
of a joint in a state of imbalance, we are apt to produce a
sound in the joint when we exaggerate the movement so
as to suddenly stretch the dominant muscle or muscle
group. This produces a readjustment of the joint sur-
faces. Since the spinal arthrodial joints are apt to be in
a state permitting spinal flexion, due to static conditions,
fatigue, or visceral ptosis, we are able more frequenlty to
produce sounds in these joints than in most others,
when sudden correction is made by counter pressure. This
phenomenon of sound in a joint, incidental to a quick re-
adjustment of its joint surfaces, when muscular tension
controlling the joint is equalized, has led to the inven-
tion of many ingenious methods for producing it. Tables
have been devised of various heights, having adjustable
pads and separable sections so as to allow the patient to
lie prone across openings in the surface of the table, thus
greatly increasing the advantage of the operator in mak-
ing sudden downward pressure on a selected point in the
spinal column. No apparatus is necessary to enable one
to do efficient adjusting work if the conditions necessary
for the production of the popping sound are understood.

FIG. 181. To correct rotation in lower dorsal and lumbar region
and secure free movement of the lower ribs.

430

PRINCIPLES OF OSTEOPATHY

The effort to produce such a sound in all so-called sub-
luxations will surely result in strain of the peri-articular
tissues. The operator must have a trained sense of tissue
resistance and be governed accordingly. Leverage and
counter pressure should never be used in the treatment
of any joint which exhibits symptoms of inflammation.
In case of inflammation in a joint, its position is probably
self-protective and hence should not be roughly treated.
The lack of ability to diagnose the true condition of a
joint leads to frequent misuse of manipulative methods.

New Schools. — It is astonishing how varied a class
of patients is benefited by rather heavy counter pressure
movements. This fact has led to the rapid exploiting of so-
called "new schools" which claim their methods are differ-
ent from and far superior to osteopathic methods. It is an
interesting fact, testified to by many patients who have been
treated by many osteopathic physicians, that no two of
their physicians operated alike. This is characteristic, in
that the osteopathic colleges have not concentrated so
much on a particular method as on teaching principles
which are capable of many methods of application.

FIG. 182. Simplest form of movement to overcome a functional
kyphosis in the dorsal region.

PRINCIPLES OF OSTEOPATHY

431

Various Applications of a Principle. — If a patient with
a functional kyphosis, in the splanchnic area, lies prone on
the floor or any other unyielding surface, as in Figs. 182
and 183, it often suffices to merely make sudden down-
ward pressure on the apex of the kyphosed area with the
palm of the hand. One, or several, popping sounds will be
heard if the patient relaxes and the force of the sudden
pressure is properly proportioned to the passive resistance
of the spinal tissues. It may be necessary to concentrate
the point of pressure, i. e., use a thumb or heel of the hand,
reinforced with the opposite hand. The reason some op-
erators use low tables is merely to allow them to use
their own weight to the best advantage in using down-
ward pressure. According to the extent of the "lesioned
area," i. e., the kyphosis, and according to the voluntary
power of relaxation characteristic of the patient, the op-
erator can use a large or small contact area, i. e., the heel
of the hand, hypothenar eminence, or the thumb. The
amount of pressure must be proportioned to the passive
resistance of the tissues. No effort should be made to

FIG. 183. To overcome a functional kyphosis in the upper dorsal
we may use a towel as a sort of fulcrum while making sudden
downward pressure over the transverse processes of the verte-
brae with the thumbs. This movement usually causes a snap-
ping sound in the articulations most affected by the thumb
pressure.

432

PRINCIPLES OF OSTEOPATHY

overcome any active resistance on the part of the patient.
The operator must contrive to use the pressure before the
patient can bring his muscles into active contraction.
Herein lies the necessity for the exercise of considerable
discretion as to when the advantage of the patient's off
guard moment should be taken.

The Use of a Fulcrum. — Advantage over a patient's
natural spinal resistance is gained by using a fulcrum at
some chosen point on the anterior surface of the body. A
very simple use of this principle is illustrated by Fig. 184,
wherein the operator's forearm serves the purpose of a ful-
crum.

Figs. 185 and 186 illustrate the application of the
same principle with the patient sitting. This is probably
the easiest position for the operator to use counter pressure.
His knees serve as a fulcrum. His hands, grasping the pa-
tient's elbows, have a secure hold, so that a sudden pull
backward serves to force the weight of the upper portion
of the patient's body over the fulcrum and thus fulfill the
conditions of extension and counter pressure required for
correction of the kyphosis. By varying the position of the

FIG. 184. To correct a functional kyphosis in the dorsal region.
Operator using his right forearm as a fulcrum. Sudden down-
ward pressure is made with the opposite hand, reinforced by
the pressure of the operator's chest.

PRINCIPLES OF OSTEOPATHY

433

FIG. 185. To correct a functional Kyphosis in the dorsal
region. Patient, must be relaxed. Operator makes a
sudden but very moderate pull against his knees.

434 PRINCIPLES OF OSTEOPATHY

operator's knees and interlocking his fingers over the pa-
tient's chest, as in Fig. 185, the movement can be made
very specific as to a single spinal segment.

A movement of great adaptability is illustrated by
Fig. 187. The patient places his hands on opposite shoul-
ders and then allows his weight to rest on the operator's
forearm. In this manner the operator may use his left
or right hand, according to convenience, as a fulcrum to
be applied at any selected point in the dorsal or lumbar
area. By lifting the patient's body against the fulcrum,
either suddenly or gradually, the operator is able to con-
centrate corrective leverage and pressure at any desired
point. Rotation of the spinal column can be secured by
this movement and hence it serves as one of the most
adaptable movements for all sorts of corrective work. The
operator does not actually carry much of the patient's
weight on his arm.

The first four dorsal vertebrae are rather difficult to
manipulate. The position illustrated by Fig. 230 shows
how the hypothenar eminence of the operator's left hand
serves as a fulcrum, while the rest of the hand reinforces
the neck, so that the head and neck thus reinforced can
be used as a lever, which is forced backward by the right
hand on the patient's chin. Fig. 189 shows how more pow-
erful leverage may be applied, by one who has a keen sense
of tissue resistance. Any movement, embodying great
leverage, must be used with extreme caution.

Coordination of Corrective Movements. — The success
of any of these movements depends entirely on the oper-
ator's ability to coordinate his movements so as to affect
the special point in the spinal tissues requiring adjust-
ment. Just as one's eyes coordinate to produce binocular
vision, one's hands must work harmoniously to secure good
results. The skillful operator causes practically no pain
by his movements. They are timed and graduated to suit
the needs of his case.

Fig. 191 illustrates a method of exerting leverage
and pressure to correct a lateral subluxation in the upper

PRINCIPLES OF OSTEOPATHY

435

FIG. 186. To correct a functional kyphosis in the dorsal
region. Practically the same movement as in preceding
illustration. By transmitting the pull through the pa-
tient's arms, the patient's pectoral and serratus magnus
muscles lift the anterior extremities of the ribs. This
is an exceedingly efficient movement when executed by
a skillful operator.

436

PRINCIPLES OF OSTEOPATHY

FIG. 187. An excellent movement by which to exert leverage
and counter pressure in the dorsal and lumbar regions.

PRINCIPLES OF OSTEOPATHY

437

FIG. 188. An application of leverage and counter pressure to
secure corrective rotation in the dorsal region. By con-
centrating the counter pressure tne rotation can De ac-
centuated in a single articulation.

438

PRINCIPLES OF OSTEOPATHY

FIG. 189. Using the head and neck as a lever while the
hypothenar eminence of the right nand is used as a
fulcrum in the upper dorsal region or by using the thumb
and forefinger as the fulcrum the force of the move-
ment may be exerted to correct a cervical lesion.

PRINCIPLES OF OSTEOPATHY

439

FIG. 190. A variation of the movement pictured in the pre-
ceding illustration.

440 PRINCIPLES OF OSTEOPATHY

dorsal. The operator's right hand serves to force the head
and neck in a direction to bend the column over the thumb
of the left hand, as a fulcrum. The patient's face is inclined
toward the lesion side, so as to accentuate rotation, which
is the actual corrective part of the movement.

Dorsal Rotation. — Fig. 181 is a simple method of se-
curing flexibility in the lower dorsal portion of the back.
Rotation is possible in the dorsal but not in the lumbar
region, hence, by holding the shoulders down and lifting
one hip, rotation is secured in the dorsal region. This
movement forces the normal action between individual ver-
tebrae of the lower dorsal region. If any particular articu-
lation is at fault, it will not yield to such a general move-
ment as this. The only gain made by it, in that case, is to
prepare the surrounding tissues for more specific work.

Lateral Curvature. — This kind of deformity is fre-
quently found and a large proportion of such cases are ben-
efited by osteopathic manipulation. A weakened con-
dition of the whole body predisposes to the formation of
a lateral curve. Fig. 192 illustrates an uncompensated
lateral curve, that is, the curvature is all in one direction.
In such a case the muscles on the convex side are not doing
their full duty. The patient is allowing the weight of the
upper portion of the trunk to be held by the ligaments in-
stead of the muscles. This simple curvature can be readily
overcome by exercises which will develop the weak spinal
muscles.

Fig. 134 illustrates a compensated curve, that is, a
letter S curve. The primary curve is in the interscapular
region and is compensated for by a curve in the opposite
direction in the lumbar region.

Know How to Apply Principles. — The osteopath
should know how to apply his principles so thoroughly that
the position of his patient, whether lying, sitting or stand-
ing, will not confuse him. Some osteopaths desire to give
their manipulations to the patient sitting, others like the
reclining position better. On the whole, it seems best to
select the position suited to the special work required.

PRINCIPLES OF OSTEOPATHY

441

FIG. 191. Using the head and neck as a lever, reinforced by
the operator's right nano. ana arm, while the operator's
left thumb is used as a fulcrum to accentuate the force
of an effort to correct a rotated upper dorsal vertebra,
or a group lesion.

442

PRINCIPLES OF OSTEOPATHY

Do Not Copy Movements. — Do not copy anybody's
movements. Learn the principles, then apply them in the
manner most satisfactory to yourself and helpful to the
patient. To understand the principles and apply them
intelligently, one cannot know too much concerning all
the subjects which are the basis of a broad medical edu-
cation.

FIG. 192. A case of uncompensated lateral
curvature, due to debility.

PRINCIPLES OF OSTEOPATHY 443

CHAPTER XXI.

REDUCTION OF SUBLUXATIONS.

Having noted a few movements which have a general
beneficial effect on groups of structures, we will now ex-
amine a few of the movements which are applicable to
specific subluxations.

In the chapter on Subluxation in the theoretical sec-
tion of this volume, we called attention to the fact that "A
subluxation is a slight abnormal relation between bony
surfaces, maintained by uneven contraction in opposing
groups of muscles which control the articulation. The
causes of the contraction are violence, temperature changes
and reflex irritation. A reduction is secured by equalizing
vital activity." With this statement in mind, we will study
first the lateral subluxations in the dorsal region.

Lateral Subluxation. — A lateral subluxation is possible
only in those portions of the spinal column where the
formation of the articular facets allow rotation. The cer-
vical and dorsal are the regions in which this occurs. Lat-
eral subluxation is most common in the articulations of
the atlas, third cervical, and anywhere in the dorsal with
the exception of the twelfth. The inferior articular facets
of the twelfth are lumbar in character, hence allow only
flexion, extension and circumduction.

It makes no difference what the cause of the lateral
subluxation may be, the uneven contraction of muscles
is the final result, hence all are treated in the same manner.

When the vertebral spine is discovered out of line with
those above and below and tenderness noted on its prom-
inent side, we are disposed to consider it a true lesion, an
irritant to the nervous system. Whether it is the result of

444

PRINCIPLES OF OSTEOPATHY

FIG. 193. Surface indication of a lateral subluxation.

accident, cold or reflexes does not need to be seriously
considered. While it exists, it is a continual source of ir-
ritation to the nervous system, hence should be removed
without delay. If it is the result of reflexes, its reduction
will at least remove one disturbing factor from the case.

The prominent side of the spine is the one on which
the muscles are contracted. The contracted muscles must
be those which are holding the bone in its mal-position.
In order to exert this influence, they must be attached in
such a way as to move the bone in this direction when
they act normally. Their present condition is one of hyper-
activity. With this line of reasoning, any articulation can
be examined, the pull of its muscles determined and move-

PRINCIPLES OF OSTEOPATHY

445

FIG. 194. "Exaggeration" of a lateral subluxation.

ments made in accordance with the normal action of these
muscles.

In Fig-. 193 we observe the subluxation to the left of a
mid-dorsal vertebra. Intrinsic rotation of the dorsal spines
is the result of the contraction of the rotatores spinae, one
of the fifth group. In order for this vertebra to remain
subluxated, i. e., more rotated than any of its fellows, the
particular digitation of the rotatores spinae attached to it
must remain contracted, after the other digitations have
become relaxed. The work laid out for us is relaxation of
this one digitation. The digitation which is acting is work-
ing from below, i. e., arises from the transverse process
of the vertebra below the one which is subluxated.

The first movement consists in "exaggerating the le-
sion." The patient's body is flexed laterally away from the

446

PRINCIPLES OF OSTEOPATHY

FIG. 1S5. "Flexion" of a lateral subluxation.

prominent side of the lesion as in Fig. 194. This procedure
stretches the contracted rotatores spinae and also sep-
arates the three vertebrae, i. e., the subluxated one and
the superior and inferior ones, thus making it easier to
push the subluxated vertebra into its true position.

The second movement is an anterior flexion to permit
of greater freedom of movement between the articular pro-
cesses. By forcing the body first into the position of lateral
flexion, then anterior flexion, all the muscles of the fifth
group which affect the subluxated vertebra are relaxed.
During this anterior flexion, a "click" is sometimes heard
which is evidence of relaxation sufficient to allow approxi-
mation of the subluxated surfaces. During all the time of

PRINCIPLES OF OSTEOPATHY

447

FIG. 196. Extension ana counter pressure to re-
duce a lateral subluxatlon.

making these flexions, the physician's right thumb should
make steady pressure against the prominent side of the
spine, thus taking advantage of the relaxation gained by
each flexion. The anterior flexion is illustrated in Fig. 195.

The final movement is lateral flexion toward the lesion
while lifting the patient from the stool in such a way that
the weight of the body below the lesion exerts its influence
to separate the vertebrae. Fig. 196. Counter pressure with
the thumb is made vigorously during 'iis final movement.

The successful reduction of this subluxation may be
accomplished without any "click" or other evidence of
movement of the surfaces. The vertebra usually moves
into its true position without any audible sign. The physi-

448

PRINCIPLES OF OSTEOPATHY

cian's fingers can determine the success or failure of the
movement. If the subluxation was caused by accident or
cold, its reduction is all that is needed, but if it is the re-
sult of reflex irritation, originating in a viscus, the physi-
cian must direct such a mode of living that rest may be
secured for the stimulated viscus. Habits of life must be
looked into.

Fig. 197 illustrates another method of reducing a slight
lateral subluxation. The physician's left arm passes under
the patient's left axilla, then the hand is placed firmly on
the base of the neck posteriorly. This gives the physician
great leverage. The physician's knee, right or left, is
placed against the spinal column at a point four or five

FIG. 197. Leverage applied to a lateral subluxation in the mid-
dorsal region.

PRINCIPLES OF OSTEOPATHY

449

inches below the subluxation. This compels the flexible
spinal column to yield to the force applied at the neck, in
such a way as to relax the deep muscles controlling the
subluxation. Counter pressure applied to the prominent
spine by the physician's right thumb completes the move-
ment. By this movement about the same result is ob-

FIG. 198. Leverage applied to a lateral subluxation in the lower
dorsal region.

,450 PRINCIPLES OF OSTEOPATHY

tained as when counter extension is given by two men
pulling at the head and feet of the patient, while a third
one devotes his attention to forcing the vertebral spine
into place. When the patient is short and heavily muscled,
it is impossible to execute this movement satisfactorily.

Lateral Subluxation — Lower Dorsal. — A lateral lesion
of the ninth, tenth or eleventh dorsal is more easily han-
dled than those higher up, because the physician can
grasp the patient in a much more satisfactory manner.
Fig. 198 illustrates the method.

The series of movements is always the same as al-
ready described, that is, lateral flexion or "exaggeration,"
anterior flexion, then lateral flexion toward the lesion, as
illustrated by the cut.

With this same position, other forms of subluxation in
the lower dorsal and lumbar regions can be corrected.

A Depressed Spine.— Slight depression of a dorsal
spine with sensitiveness over it, that is, between its apex
and the spine below, indicates that the muscles in that
situation are sufficiently contracted to draw the spine of
the upper vertebra downward. The depressed spine indi-
cates that the body of the vertebra is slightly tipped back-
ward and downward. See chapter on Subluxations.

To reduce this lesion, a flexion of the spinal column
as far as the vertebra below the lesion is made anteriorly.
If the depressed spine is any one of the upper six dorsal,
use the pull of the splenius capitis et colli, i. e., flex the
head and neck as in Fig. 174. The physician's right hand
is placed on the spine of the vertebra below the subluxa-
tion, thus allowing all the force of the movement to ter-
minate in a pull on the muscles between this vertebra and
the depressed spine. This same principle can be applied
to all portions of the spinal column.

When individual spines are prominent and sensitive-
ness is found above the process instead of below, we have
a condition the reverse of that just described. Its treat-
ment is similar to that of the preceding, except that by

LLEGE OF

PRINCIPLES OF OSTEOPATHY

451

changing the position of the right hand to rest upon the
prominent spine, our leverage affects the contracted mus-
cles above the spine.

Kyphosis — Pott's Disease. — Whenever a "knuckle" is
found in the spine, inquire carefully as to the possibility
of direct injury, predisposition to tuberculosis, etc. Pott's

Fig. 199. Spreading the lower ribs and stretching the diaphragm.

^ o YH ^H 8 1 J,

r.ASO-r :UJoo

1 1 c Y H 4

452 PRINCIPLES OF OSTEOPATHY

disease of the spinal column may cause prominence of a
single vertebral spine. As other vertebrae are affected, a
kyphosis is developed.

Rib Subluxations. — Rib subluxations present many
difficulties to the osteopath. The methods used in their
reduction are as varied as can well be imagined. A few
of the most useful and direct are given here.

In Fig. 199 the physician is applying a method of
spreading the lower ribs. When the tenth rib sinks under
the ninth and there is a general jamming of the four lower
ribs together, the physician stands behind the patient who
raises his hands above his head to spread the lower ribs
by means of the latissimus dorsi. While the hands are
elevated, the physician grasps the anterior extremities of
the ribs and holds them up while the patient lowers his
hands to his thighs. Such a movement as this will replace
the ribs in their right relations, but a flexion of the patient's
body will undo the work. Continual well directed treat-
ment and voluntary exercise are needed to bring them to
place and hold them there.

The four lower ribs can be separated and the antero-
posterior diameter of the thorax increased by the method
illustrated in Fig. 200.

The left hand lifts on the angles of the depressed ribs
while the patient's arm is extended beyond his head, thus
making use of the leverage gained through the attachment
of the latissimus dorsi. This movement increases the right
and left hypochondriacal spaces.

The position of an individual rib is affected by the
contraction of the intercostal muscles above and below it.
The spacing determines whether the rib is elevated or de-
pressed. The width of an intercostal space will not be the
same between the angles and anterior extremities. This
is caused by the fact that the head of the rib is fixed so
that it cannot move up or down. The movement which
takes place between the head of the rib and the vertebra

PRINCIPLES OF OSTEOPATHY

453

FIG. 200. Spreading the lower ribs by using the latissimus dorsi.

is a slight rotation. The costo-transverse articulation al-
lows a slight gliding of the articular facet of the rib upon
that of the transverse processes. As an example, take the
fifth rib, when the space between it and the fourth rib is
lessened by the contraction of the fourth intercostals. The
lower margin of the rib becomes prominent because the
rib is twisted when raised. The anterior extremity is de-
pressed, making the fourth intercostal space wider anter-
iorly. Palpation of this rib in this condition will show a
prominent angle with corresponding depression of the an-
terior extremity. When the rib is depressed at the angle,
its anterior extremity will be prominent.

Palpation is the only method of discovering these sub-
luxations. To reduce them, the same principle we applied
to reduction of vertebral subluxations must be applied
here, i. e., the relaxation of the contracted muscles.

454

PRINCIPLES OF OSTEOPATHY

The tendency in asthmatic and bronchitic patients is
to cause elevation of the ribs, thus developing a barrel-
shaped chest. When all the intercostal muscles act equal-
ly, the ribs are equally spaced, but in a case of bronchitis,
some local portion of the bronchial tubing is especially

FIG. 201. First position to reduce a subluxated fifth rib.

PRINCIPLES OF OSTEOPATHY

455

irritated. From this area, irritant impulses reach the spinal
center with which it is most closely associated. The inter-
costal muscles in direct relation with this center receive
a greater number of impulses, hence, contract more vigor-
ously. A strain or blow might cause the same result.

FIG. 202. Second position to reduce a subluxated fifth rib.

456 PRINCIPLES OF OSTEOPATHY

To bring this fifth rib down to its proper position, the
physician may stand behind his patient, as is illustrated
by Fig. 201. His left hand grasps the patient's right elbow
and pushes it above the shoulder, thus causing the mus-
cles to lift the ribs. This movement will pull on all the
ribs of the right side, and tend to equalize the spacing.
The physician places his left knee directly over the angle
of the fifth rib, his right hand on the anterior extremities
of the fifth, sixth and seventh ribs, the middle finger of
this hand being applied against the lower margin of the
fifth rib. The rib being now in right relation with its fel-
lows, the critical period of the movement is when relaxa-
tion is allowed by lowering the arm. The knee above and
over the angle, pressing forward and downward, while
the middle finger of the right hand prevents depression
of the anterior extremity. This leverage forces the rib
to retain right relations with its fellow in relaxation of
the chest. The termination of the movement is illustrated
by Fig. 202.

A general depression of all the angles of the ribs
causes their superior margins to be prominent. A flat chest
is the result. This condition frequently follows pneumo-
nia or some disease which causes the patient to lie on the
back during a long period of weakness.

When a single depressed rib is found, it usually has
been caused by a strain which has weakened the inter-
costal muscles in the space above it. Treat it while stand-
ing in front of the patient. Place the middle finger of the
left hand under the angle. The patient's right elbow
may rest against the physician's abdomen. Pressure made
on the elbow forces the scapula back and brings into ac-
tion the serratus magnus which lifts the ribs. Ask the
patient to inspire and this will raise all the ribs. When
relaxation comes with expiration, lift the angle of the rib
forcefully, and it will regain its proper position. Fig. 203
illustrates this movement. Some osteopaths grasp the

PRINCIPLES OF OSTEOPATHY

457

FIG. 203. The position of the fingers below the angle of a de-
pressed rib.

patient's right wrist and extend the arm first forward,
then above the head, and back to the side, instead of placing
the patient's elbow against the abdomen.

It will be noted that all these movements are based
on the effects of muscular contraction and relaxation with
resulting changes of the position of the structures to which
they are attached.

458

PRINCIPLES OF OSTEOPATHY

PIG. 204. First position in lifting- a series of depressed lower ribs.

Figs. 204, 205 and 206 illustrate the method of raising
and spreading the lower ribs. With the patient in this
position, the physician can make extensive passive move-
ments without much resistance. These movements are
similar to that illustrated by Fig. 199.

When the ribs "droop" to a marked degree, there is a
decided change in the shape of the diaphragm. The extent
of the thoracic floor is lessened, and it may be that the
structures passing through the diaphragm are detrimental-
ly affected by it. The movement pictured in Fig. 199 is
well calculated to spread the lower ribs and thereby in-
crease respiratory capacity.

PRINCIPLES OF OSTEOPATHY

459

The first rib is so strongly held by the scalenus anti-
cus that it practically never is depressed. It is, however,
frequently elevated to such an extent that it infringes on
structures around the first thoracic sympathetic ganglion,
thus affecting heart action.

To depress the first rib to its proper position, it is
necessary to take the extra contraction out of the scalenus

FIG.. 205. Second position in lifting a series of depressed lower

ribs.

460 PRINCIPLES OF OSTEOPATHY

anticus. Th?s is done by making the first rib a fixed in-
stead of a movable attachment. Fig. 218 illustrates the
method of relaxing the scalenus anticus. The physician's
thumb holds the first rib down while the muscle is stretched
by forcing the patient's head directly to the opposite side.
The scaleni muscles can be easily detected by placing
one's fingers on the side of the neck near the base. They
will be felt hardening during inspiration.

FIG. 206. The third position in lifting a series of depressed lower ribs.

PRINCIPLES OF OSTEOPATHY 461

Luxations of the Innominate Bones. — Examination of
the innominate bones requires very close observation of
all the factors concerned in tilting the pelvis and varying
the length of the lower extremities.

The only way to determine the condition of the in-
nominates is by palpation and mensuration. Have the
patient stripped and sitting in a perfectly upright position
on a level surface. Determine the condition of the lum-
bar portion of the spinal column. Have the patient's shoul-
ders level. While the patient is in this position the rela-
tive prominence of the posterior superior iliac spines can
be noted by palpation. Find the second sacral spine and
note the relations of the iliac spines to it. They should
all be on a level. See Fig. 91 in Chapter XIII. Palpate
for sensitiveness around the iliac spines, crests of the ilia
and crests of pubes. Measure from the anterior superior
iliac spines to the adductor tubercles on the internal con-
dyles of the femur, when the patient rests evenly in the
dorsal position. This measurement is not entirely satis-
factory, because any change in the thigh muscles or hip
rotators may easily vary the measurements. The only
fixed structures from which a reckoning can be made are
the second sacral and posterior superior iliac spines. The
relations between the sacrum and ilium are never greatly
changed, therefore it requires the examiner to exclude
practically all measurements which might be varied by
muscular tension.

The posterior superior iliac spine may be less prom-
inent than its fellow on the opposite side, or vice versa.
There may not be enough upward or downward displace-
ment to make a well recognized change in horizontal re-
lations with the second sacral spine. This being the case,
it is decidedly difficult to determine which side is normal
and which is abnormal. Hyperaesthesia will have to be
depended on to determine this point. The related sub-
jective symptoms of the patient will decide which is the
affected side.

462

PRINCIPLES OF OSTEOPATHY

FIG. 207. Position for treatment of an upward and forward dis-
location of the ilium.

The shock which is transmitted to this articulation in
an accident usually strikes the tuber ischii from below, or
posteriorly, or strikes the knee and the force is exerted
against the ascetabulum. When, the force is against the
tuber ischii from below, or posteriorly, we have an upward
displacement, or a twist, causing the posterior superior
iliac spine to become more prominent. When the force
strikes the ascetabulum by means of the femur, the twist
is in the opposite direction, and the spine is less prominent.

Have the patient give details, if possible, concerning
his position with reference to the direction of the force at
the time of the accident, or if the condition appears to be
due to other causes, strive to find out what they are.

Having determined the direction of the twist, the force
of our manipulation must be made counter to that applied
at the time of the accident. Since the hip joint is very
movable, we cannot use the thigh as a stiff lever, there-
fore, our force must be applied to either the anterior or pos-
terior surface of the tuber ischii and to the anterior or

PRINCIPLES OF OSTEOPATHY 463

posterior superior spine of the ilium, i. e., push and pull,
such as turning a wheel on its axle. This movement is
illustrated in Fig. 207. The original force which this move-
ment is trying to overcome was transmitted from the knee
by the femur to the acetabulum, and resulted in a twist
of the ilium which made the posterior superior spine less
prominent than its fellow of the opposite side. In order
to make this movement effectual, an assistant must make
steady, even pressure over the articulation of the sacrum
and fifth lumbar vertebra, i. e., overcome the tendency of
the twisting movement to merely affect the movable sacro-
vertebral, instead of the immovable sacro-iliac articulation.

By flexing the patient's thigh on to his abdomen, suf-
ficient opportunity is given the physician to make pres-
sure on the anterior surface of the tuber ischii, and pull
forward on the posterior superior iliac spine, thus revers-
ing the movement illustrated by Fig. 207.

Fig. 208 illustrates an effort to use the thigh as a lever
to affect the sacro-iliac articulation when the posterior
superior spine is prominent. This is a dangerous move-
ment, and should not be used. The force transmitted by
the thigh as a lever will not reach the joint desired, and
will only result in straining the ilio-femoral ligament.

A sacro-iliac subluxation is difficult to correct, because
the joint is practically without normal movement. The
pelvis tends always to resist any appreciable movement in
its joints, therefore the physician must devise ways of
securing leverage to directly affect these joints without
transmitting his corrective leverage through the very
movable sacro-vertebral joint above or the hip joint below.
This is a difficult condition to fulfill.

Anterior Rotation of the Ilium. — When the ilium is
rotated forward, the posterior superior spinous process is
less prominent than its fellow of the opposite side. This
condition can be met by having the patient prone on an
unyielding surface, slightly padded so as not to bruise
the anterior superior spine of the ilium. Since the twist

464

PRINCIPLES OF OSTEOPATHY

FIG. 208. A dangerous method of applying force to the sacro-
iliac articulation.

PIG. 209. To correct anterior rotation of the ilium. Hard pad-
ding Bunder the anterior superior spine of the ilium. Sudden,
heavy, downward pressure on tne sacrum between its first
spinous process and the iliac spine, on the lesion side.

PRINCIPLES OF OSTEOPATHY

465

may be considered as an ilium rotated forward or the sac-
rum rotated backward, we may meet the conditions neces-
sary for correction by making sudden pressure on the
sacrum at a point between the first sacral spine and the
crest of the ilium. This point lies sufficiently above the
axis of rotation in the sacro-iliac articulation to give the
operator some leverage to assist in securing reduction of
the subluxation. The operator should use the hypothenar
eminence of one hand, reinforced by the other hand, to
make contact with the proper area on the back of the
sacrum. The pressure must be exerted in a direction par-
allel with the iliac crest. After contact has been made with
the hand the operator 'should prepare to deliver a sudden
forceful pressure, as though he was trying to compress a
very stiff spring which would not show any compression
without throwing his weight on it. It may be necessary
to increase the operator's advantage by putting a special
pad under the anterior superior spine of the ilium so as
to eliminate any support by the soft tissues of the ab-
domen. A further advantage may be gained by allowing

FIG. 210. To correct anterior rotation of the ilium. Flex thigh,
on the lesion side, onto the abdomen. Use padded edge of
operating table to support the sacrum at point between first
sacral spine and spine of the ilium, while a sudden, heavy
downward rotating pressure is made on the thigh and lesioned
ilium.

466 PRINCIPLES OF OSTEOPATHY

the patient's leg, on the side of the lesion, to hang off the
table so as to be at a right angle to the spinal column.
This tends to tilt the pelvis backward and thus permit a
greater downward movement in response to the sudden
pressure. Sometimes it is advisable to use several par-
tial applications of the pressure before the final corrective
effort, without removing the contact hand. This tends
to permit the patient to relax by taking away the feeling
that protective resistance must be made. The operator
must create and recognize the psychological moment for
the application of the corrective movement.

The principle underlying the operation just described
can be applied if the patient lies on his back. The leg
on the lesion side should be flexed on the thigh and the
thigh on the abdomen, thus tilting the pelvis backward.
By placing the pelvis so that the ilium on the lesion side
is just off the padded edge of the table, the operator can
place his chest against the flexed leg and thigh while his
hands rest on the opposite anterior superior spines of the
ilia. A sudden downward pressure, coordinated with an
attempt to spread the ilia apart, will be met by the re-
sistance of the padded edge of the table against the side
of the sacrum, between its first spinous process and the
iliac crest. These movements have the advantage of ap-
plying corrective force without having any of that force
dissipated by passing it through a movable joint before
reaching the intended point of application. This is a very
important factor if the patient is anaesthetized.

Posterior Rotation of the Ilium. — When the posterior
superior spine of one of the ilia is apparently too prom-
inent, care should be taken to note whether the apparent
prominence is not due to a rotation and tilting of the pel-
vis in its relation to the spinal column. Since the flexion
of the trunk on the pelvis is characteristic, in the sitting
posture, and all people tend to rest themselves while stand-
ing by transmitting the weight of the body through one
leg, continued maintenance of these positions changes the

PRINCIPLES OF OSTEOPATHY 467

relation of the pelvis to the spinal column, i. e., causes a
unilateral lumbo-sacral subluxation. Static errors are
characterized by a compensatory tilt of the pelvis, hence
all the factors that might produce such a condition must
be taken into consideration. As previously noted, the one
test of whether a subluxation exists is a comparison of the
relative positions of the posterior superior spines with
relation to the second sacral spine.

To correct a posterior rotation we use practically the
same position and leverage required to correct a tilt of
the pelvis on the spinal column. The patient should re-
cline on the normal side, thus presenting the subluxation
area to the operator. Force must be applied on the crest
and side of the ilium close to the posterior superior spine,
so as to rotate the ilium forward. The body must be ro-
tated backward, thus tending to hold the sacrum from ro-
tating idly with the ilium. These conditions can be ful-
filled if the operator takes the position illustrated in Fig.
211, i. e., grasps the patient's elbow with his hand and
presses his own elbow against the patient's shoulder, thus

FIG. 211. To correct posterior rotation of the ilium. Balance pa-
tient's body in the lateral recumbent position so that, by push-
ing the patient's shoulder backward the operator can make
efficient pressure against the prominent iliac spine with his
opposite forearm and thus secure a combination extension and
torsion movement, concentrated in the sacro-iliac joint.

468

PRINCIPLES OF OSTEOPATHY

securing an advantageous hold for forcing the patient's
body to rotate backward. The operator places his other
forearm solidly against the crest of the ilium and gluteal
tissues just above and external to the posterior iliac spine.
By rocking the pelvis forward and the body backward a
few times the patient will yield to the movement and the
operator should select the moment of the patient's greatest
relaxation to suddenly accentuate these opposing rota-
tions. No attempt should be made to make more than a
moderate rotation until it is felt that the patient is per-
mitting the movement to be made without interposing any
strong protective muscle tension. It is quite impossible
to correct a subluxated ilium if the patient exerts any pro-
tective contraction of his muscles. The force of the rota-
tion movement must go through the muscles without re-
sistance, so as to reach the ligaments and other deep struc-
tures around the joint. The art of getting successfully
by the muscular tension of the patient without exerting
a force capable of producing trauma requires no small
degree of skill. No great amount of force seems ever to
be required if one has a fine sense of tissue resistance.

FIG. 212. Leverage and counter pressure to reduce a posterior
iliac subluxation. Operator's left forearm makes pressure
against posterior superior il:ac spine. Same leverage as in
Fig. 218, therefore dangerous.

PRINCIPLES OF OSTEOPATHY 469

By working skillfully in applying corrective force one
learns to recognize a psychological moment when, by in-
tensifying the force suddenly, the deep structures which
are the object of our operation can receive the full benefit
of our effort without interference from muscular contrac-
tion. The operation, at the climax of the application of
the corrective force, is characterized by a popping sound.

The position here described serves in an almost iden-
tical manner for treating unilateral subluxations in the
lumbar arthrodials or the lumbo-sacral articulation. The
only change required is the shifting of the forearm from
the ilium to some selected point higher on the crest and
lumbar region. Since the lumbar arthrodials face nearly
directly inward and outward, the forcing of the shoulders
and pelvis in opposite directions tends to take out tension
in the muscles controlling these joints and the force is evi-
dently applied with the same angle of incidence to the sur-
faces of the lumbar arthrodials as we secure in the dor-
sal area of the spinal column by a sudden counter pressure
and extension.

After a successful correction has been made of a case
of subluxated innominate it is advisable to reinforce the
pelvic ligaments by strapping the pelvis with surgeon's
adhesive plaster. Plaster three inches wide serves very
well. Apply the first strip so that its upper edge just
reaches the posterior superior spine of the ilium. Pass the
strip forward so that it comes just above the crease at the
junction of the thigh and the abdomen, the upper margin
of the strip covering the anterior superior spine of the
ilium. The pubic hair must be shaved so that the ends
of the adhesive strip may lap over the pubes. The second
and third strips are brought around the body on lines sim-
ilar to the first and overlapping each other about an inch.
The strips should be put on tightly so as to bind the pelvis
and give the patient a sense of security and comfort. The
strips may be left on for ten days, then a series of treat-
ments of a tonic character which will serve to strengthen

470 PRINCIPLES OF OSTEOPATHY

the tissues is advisable. It may be necessary to repeat
the corrective movements many times if the case is one of
low vitality or has a static area which does not permit the
pelvis to hold its normal relation to the spinal column.

FIG. 213. Three strips of two and one-half-inch adhesive
applied to reinforce the pelvic ligaments so as to retain
a subluxated ilium in position after correction.

PRINCIPLES OF OSTEOPATHY 471

CHAPTER XXII.

TREATMENT OF THE CERVICAL REGION.

The treatment of the clavicle must be considered here,
because its position so frequently interferes with the
drainage of the tissues of the neck. When it is held down
too closely to the first rib, by shortening of the subclavius
muscle, it is quite sure to affect venous circulation in the
head and neck.

To Raise the Clavicle. — To raise it place the right
thumb on the first rib as illustrated by Fig. 214, then carry
the patient's left forearm across his face above the head
as in Fig. 215. Then as far outward as the physician's
arm. This movement causes the clavicle to press down
on the physician's thumb, where it rests on the first rib,
and thus stretches the subclavius.

Subluxation of the Clavicle. — Articulations, such as
the sterno-clavicular and acromio-clavicular, which depend
entirely on their ligaments to keep them together and to
limit their motion, cannot be retained in place if their liga-
ments have been injured. If the ligaments of the sterno-
clavicular joint become relaxed, the pull of the sterno-
cleido-mastoid lifts it upward. Slight irritation of the
pneumogastric nerve may be occasioned by this change of
position.

Preparatory Treatment of the Neck — Trapezius. — The

preparatory treatment of the neck consists in movements
to relax the various groups of muscles. Fig. 216 illustrates
the method of relaxing the cervical portion of the trape-
zius. One hand on the shoulder holds it firmly down, while

472

PRINCIPLES OF OSTEOPATHY

FIG. 214. First position to raise the clavicle.

the other hand forces the head as far as possible in the
opposite direction. Relax the opposite muscle in a similar
manner.

Sterno-cleido-mastoid. — Next, relax the sterno-cleido-
mastoid by separating its attachments as far as possible,
as in Fig. 217, also by direct manipulation. Observe
whether both muscles will relax equally. These large mus-
cles are frequently found unevenly contracted. Since the
spinal accessory nerves control these muscles, any con-
traction should lead the physician to examine all parts
in connection with them. A reflex from the laryngeal
branches as well as pneumogastric branches might ac-
count for it.

PRINCIPLES OF OSTEOPATHY

473

FIG. 215. Second position to raise the clavicle.

Scaleni. — The scaleni muscles should be treated as al-
ready mentioned in Chap. XXI. See Fig. 218.

Splenius Capitis et Colli. — Fig. 219 illustrates a meth-
od of stretching the ligamentum nuchae, as well as all the
extensor muscles on the back of the neck. This may be
modified by forcing the chin backward with one hand,
while the other flexes the head as sharply as possible. This
stretches the muscles and ligaments on the posterior por-
tion of the occipital-atlantal and axial articulations. The
retraction of the chin governs the amount of stretching
exerted by the flexion.

474

PRINCIPLES OF OSTEOPATHY

FIG. 216. Relaxation of the cervical fibres of the trapezius.

Extension. — Direct extension of the neck makes an
equal pull on all the vertebrae. When the patient's feet
are anchored, the force of the pull is felt in the weakest
portions of the spinal column. The average patient requir-
ing this treatment enjoys a delicious stimulation after re-
laxation of the extension. A few who are extremely ner-
vous may give a bad reaction. The influx of blood in the
spinal cord is highly beneficial to those who have suffi-
cient vaso-motor tone to hold it there, but those who lack
this tone will feel faint or even absolutely lose conscious-
ness. Simply allowing them to rest on the table until the
vascular system reacts, will enable them to reap the full
benefit of the treatment. The extension should be made
with absolute steadiness. The relaxation period is usually
the one in which any vaso-motor phenomena are noted.

PRINCIPLES OF OSTEOPATHY

475

FIG. 217. Relaxation of the sterno-cleido-mastoid.

The tension should be lessened very slowly in all cases.
Fig. 220 shows the position of the physician's hand.

Rotation.- — The following movement is one for which
long practice is required, in order to get anything like a
successful result from its use. It consists in grasping the
patient's neck with the left hand as in Fig. 221. The pa-
tient's head rests against and slightly to the right of the
physician's forearm. The right hand grasps the chin while
the forearm rests firmly against the patient's head. The
object is to hold the neck and head rigid above the point
grasped by the thumb and fingers of the left hand. While
holding the head and neck rigid, they are moved so as to
force circumduction in the joint below the grasp of the
left hand. After each circumduction the left hand is shifted
the depth of one vertebra nearer the head. Thus all the in-
tervertebral articulations in the cervical region are relaxed

476

PRINCIPLES OF OSTEOPATHY

FIG. 218. Relaxation of the scaleni by depressing the first rib.

and specific work on a definite articulation can be done
more easily.

The Hyoid Bone. — Work on the anterior portion of
the neck consists in affecting- the condition of groups of
muscles forming the floor of the mouth and extrinsic mus-
cles of the larynx.

The Hyoid bone is the movable part which can be
grasped by the physician's fingers. Drawing it downward
and to the right, as in Fig. 222, relaxes the stylo-hyoid and
posterior belly of the digastric. A contractured condition
of these muscles may affect the pneumogastric nerve.

Mylo-hyoid and Hyoglossus. — The mylo-hyoid and
hyoglossus forming the floor of the mouth may be treated
as in Fig. 223. When the maxillary glands are congested,

PRINCIPLES OF OSTEOPATHY

477

FIG. 219. Relaxation of the splenius capitis et colli.

it is necessary to relax these muscles. The physician's
right hand grasps the hyoid bone, being careful to provide
enough loose skin above the bone so that the force will
not be exerted on the cutaneous tissues instead of the
muscles underneath. After the hyoid bone is pulled down-
ward, the tension of the mylo-hyoid is increased by using
the pressure of the fingers of the left hand.

Sterno-thyroid and Sterno-hyoid. — The depressor mus-
cles of the larynx and hyoid may be stretched by forcing
these structures toward the angle of the jaw, while the
free hand makes direct manipulation of the muscles. In
all cases of congestion of the glands, mucous membranes
or cellular tissues of the mouth, pharynx or larynx, these
muscles should be relaxed if the position of the atlas has
been corrected.

478

PRINCIPLES OF OSTEOPATHY

FIG. 220. Extension of the neck.

Intrinsic Muscles of the Larynx. — The intrinsic mus-
cles of the larynx sometimes need attention. The crico-
thyroid is the tuning muscle of the larynx. This may be
demonstrated by grasping the thyroid cartilage with the
thumb and forefinger of one hand, while the thumb and
forefinger of the other hand grasps lightly the cricoid
cartilage, as in Fig. 224. If the cartilages are slightly sep-
arated while the patient makes a vowel sound, the pitch
of the voice will be perceptibly lowered. This is occa-
sioned by relaxation of the vocal cords by separating the
cartilages, which stretches the crico-thyroid. This mus-
cle is innervated by the external branch of the superior
laryngeal branch of the pneumogastric. The motor fibers
of the superior laryngeal come from the spinal accessory,
hence we find lesions in the cervical articulations, which
are primary causes of laryngeal disorders.

PRINCIPLES OF OSTEOPATHY

479

FIG. 221. Circumduction of the neck to relax the muscles of the
flfth layer.

The Atlas. — The atlas, on account of its position, free-
dom of movement, numerous muscular attachments, etc.,
is subject to frequent subluxation. Fig. 102 shows the
normal relations of the mastoid process, transverse pro-
cess of the atlas, and the angle of the jaw. Fig. 103 shows
the abnormal relations of these various prominent points
as they are frequently found by the osteopath. When
the right transverse process is near the mastoid, the left
is too close to the angle of the jaw, and vice versa.

In reducing this twist of the atlas, the physician
should work on the side which shows the transverse pro-
cess to be posterior. The same principle is applied in re-
ducing this subluxation as was described in connection
with the dorsal lateral subluxations. Fig. 225 illustrates
"exaggeration." Fig. 226 shows lateral flexion to the left,
while the physician's fingers make firm pressure back of
the prominent transverse process, thus steadily taking

480

PRINCIPLES OF OSTEOPATHY

FIG. 222. Relaxation of the stylo-hyoid and posterior belly of the

digastric.

advantage of all the relaxation gained in each portion of
the movement. The termination of the movement is il-
lustrated in Fig. 227. Sometimes the atlas slips into place
with an audible "click," but more often the physician feels
a "gritting" sensation as the articular surfaces rub over
each other. When the subluxation of the atlas is reduced
by this movement, it will hold its true position more firmly
than will any other vertebral articulation which has been
affected in a like manner. This is because the condyles
of the occiput fit more deeply into the superior articulat-
ing surfaces of the atlas than is the case between articulat-
ing surfaces of pairs of vertebrae. Fig. 229 illustrates a

PRINCIPLES OF OSTEOPATHY

481

FIG. 223. Relaxation of the mylo-hyoid and hyo-glossus.

method of relaxing the muscular tension in the muscles
which move the atlas. This method is used to force the
atlas forward. It will be readily noted that by over-ex-
tending the head on the neck and using counter pressure
on the posterior surface of the atlas the mechanical re-
quirements for forcing the atlas forward are fulfilled. By
moving the head up and down and from side to side, mus-
cular tension will be sufficiently reduced to permit reduc-
tion of the snbluxation.

Sixth Cervical. — The sixth cervical vertebra is especial-
ly difficult to treat. When the cervical muscles are well
developed, it is obscured to the touch posteriorly, but the
carotid tubercles anteriorly can be felt. It is not wise to

482

PRINCIPLES OF OSTEOPATHY

FIG. 224. Relaxation of the crico-thyroid.

exert much pressure upon bony structures from the an-
terior surface of the neck. There are so many glands,
nerves, arteries, etc., lying over the transverse processes,
that direct pressure is liable to injure them.

Fig. 228 illustrates a method of reducing a subluxation
of the sixth cervical vertebra. The patient's chin rests in
the physician's hands, which are placed on each side of the
neck and near enough to the chin to support it by the
little finger. The thumbs are used to affect the spine
directly. The compression of the head and neck above
the lesion, by both hands, keeps them rigid and all are
moved together, first to exaggerate the lesion of the sixth,
then anterior flexion is forced in the articulation affected,
then lateral flexion with counter pressure by the thumb
on the prominent side of the spine.

PRINCIPLES OF OSTEOPATHY

i

483

FIG. 225. Reduction of subluxation of the atlas, right trans-
verse process too far posterior — exaggeration movement.

This movement can be applied to subluxations of the
first and second dorsal.

General Principles Underlying Corrective Movements.
—The same general principle, governing the correction of
subluxations in other portions of the spinal column, is
applicable in the cervical region, i. e., the movement, or
series of movements, must be made so as to overcome the
influence of a dominant muscle group. As we have pre-

484

PRINCIPLES OF OSTEOPATHY

FIG. 226. Reduction of subluxation of the atlas, lateral flexion.

viously noted, the position of an arthrodial joint is expres-
sive of the relative tension of the muscles which activate it.
The Simplest Form of Correction. — The simplest form
of corrective movement is extension, i. e., a direct pull in
the long axis of the spinal column. This tends to put

PRINCIPLES OF OSTEOPATHY

485

FIG. 227. Reduction of subluxation of the atlas, extension and
counter pressure.

equal stress on all the joints, but, in reality, it will be felt
most in any lesioned articulation. The lesioned articula-
tion is the "weakest link" and therefore is most sensitive
to the effect of the extension. Extension of this kind is
grateful to most patients and when made by one who has
a keen sense of tissue resistance, is practically without
danger.

486

PRINCIPLES OF OSTEOPATHY

FIG. 228. Manner of holding the head and neck in order to reduce a
subluxated sixth cervical vertebra.

Torsion and Counter Pressure. — Since the cervical
region is normally very flexible, considerable skill is re-
quired, if an operator makes use of rotation and counter
pressure for correction of joint lesions. The results se-
cured by these means are very gratifying, but there is a
larger element of danger than in the use of extension. The
skillful operator must have a good knowledge of the anat-
omy of the region and a sense of tissue resistance. A tor-
sion movement is a powerful lever and should be used
very carefully. Although it is possible to describe the
relative positions of the operator's hands and the general
direction of the movements, it is not possible to convey to
the reader an idea of the amount of force used, or the rela-
tive amount of resistance to be overcome. It is this var-
iable element which makes the difference between success
and failure in operative work. Normal muscle tone is
equal to about six pounds' pull, hence if a patient volun-
tarily relaxes, or is placed in a position which does not

PRINCIPLES OF OSTEOPATHY

487

FIG. 229. Position for loosening structures around the atlas
and forcing it forward.

488

PRINCIPLES OF OSTEOPATHY

PIG. 230. Movement to secure correction of a cervico-
dorsal kyphosis. Many variations of this leverage may
be used. The effectiveness of the movement depends on
the fulcrum being properly applied.

PRINCIPLES OF OSTEOPATHY 489

require any exertion to overcome gravity, it is very evi-
dent that no great amount of force will be required to
change the position of an arthrodial joint. If the operator
will always bear in mind that great force is not required,
there will be no accidents.

Rigidity. — When the patient holds his neck stiff and
rigid, it is necessary to determine why it is so held before
we attempt any movements to alter the condition. Disease
of the vertebrae, or inflammation in the joints, is charac-
terized by bilateral muscular tension, which is necessary
to protect the structures from the strain occasioned by
movement. No attempt should be made to relax this ten-
sion by manipulation. The usual case of "stiff neck" is
unilateral. It consists of a unilateral muscular contrac-
tion. Usually the patient cannot turn the head toward
the lesion, but can turn it in the opposite direction. This
is the differential diagnostic point between a muscular and
a ligamentous lesion. The ligamentous lesion does not
permit rotation away from the lesion because such action
stretches the ligament.

The Favorable Position for Corrective Movements. —

As stated in a previous chapter, the position of election,
for the use of rotation as a corrective movement, is exten-
sion. Some operators prefer to have the patient sitting
and thus have the head balance its weight on the vertical
vertebral column. It is then very easy to use the weight
of the head as an assisting factor in securing the leverage
necessary to correct slight rotation lesions. By allowing
the patient's chin to rest in the operator's right or left
hand, while the opposite hand supports the suboccipital
region, Fig. 230, the head may be rotated and flexed, or
extended, in such manner as desired by the operator, to
correct a cervical subluxation. The hand, which supports
the suboccipital region, is made to do double duty by act-
ing through its lower border, as a fulcrum, over which
the spinal column is bent, so as to accentuate the force

490 PRINCIPLES OF OSTEOPATHY

of the corrective movement in a certain joint. The correc-
tive rotation movement is always associated with a little
flexion or extension, according to the character of the

FIG. 231. The use of rotation to secure correction of cervical lesions.

PRINCIPLES OF OSTEOPATHY 491

lesion. The head is rocked gently in the direction required
for the correction and when the rotation reaches a point
where the resistance in the lesion is felt, Fig. 231, the op-

FIG. 232, Leverage and counter pressure applied to a reclining patient. Rotation

is secured in the upper dorsal or any point in the cervical

according to the location of the fulcrum.

492 PRINCIPLES OF OSTEOPATHY

erator strives to create a condition of relaxation by ad-
monishing his patient not to resist, so that by a sudden
but very slight increase in rotation the lesion will receive
the full effect of the movement and yield to it. The yield-
ing is usually accompanied by a clicking sound in the
joint and a feeling of comfort. The range of voluntary
movement in the articulation is increased and the patient
usually experiences a feeling of added power.

The position of the fulcrum individualizes the charac-
ter of a movement, therefore the shift of the depth of one
vertebra either makes or mars the success of one's effort
at correction. In order to use the fulcrum hand with more
specificity, or force, the operator may rest the patient's
chin in the bend of his elbow and then, by anchoring
the head with his body, forearm and hand, Fig. 189, ex-
tend the patient's neck by a gentle lift. This extension
frequently overcomes enough of the muscular tension to
permit a slight additional rotation movement, with coun-
ter pressure, to correct the lesion.

Several illustrations are presented herewith, to show
the manner of applying the osteopathic principle of cor-
recting cervical subluxations by extension and torsion.
The position of the patient, either lying or sitting, is pure-
ly arbitrary with the operator. The principles involved in
the operation are the same in either position. Fig. 232
shows how torsion and counter pressure may be used wrhen
the patient is recumbent. The position of the right hand
illustrates how the influence of the leverage may be car-
ried into the upper dorsal region. Fig. 191 illustrates the
application of the same principle when the patient is sit-
ting. As we have previously stated, the position of the
fulcrum is the part of any corrective movement, of this
character, which localizes the effect. Since we are aiming
to change the relations of the bony elements in a flexible
lever, the spinal column, at a certain point, the fulcrum
must be used with reference to the kind of movement
characteristic at that point.

PRINCIPLES OF OSTEOPATHY 493

CHAPTER XXIII.

EXTREMITIES.

Treatment of the shoulder for synovial adhesions. liga-
mentous or muscular contractions, consists of movements
made in the normal direction, but carried farther than the
patient can do so voluntarily.

Diagnosis. — Test the extent of the movements, normal
to the articulation, to ascertain whether the loss of move-
ment is general in all directions or results from impair-
ment of some, special muscle or ligament.

Causes of Stiff Joints. — The history of the case will
usually give an insight into its cause, progress, etc. The
shoulder articulation is frequently stiffened by a sprain,
dislocation, muscular and articular rheumatism. The
simplest cases are those resulting from rest, necessitated
by a broken clavicle or humerus.

The necessary rest after a dislocation gives the
strained ligaments an opportunity to shorten and thicken.
Movements should be frequently forced in such cases to
prevent any synovial adhesions. The differentiation of cases
of ankylosis is an important one. It is disheartening to
physician and patient alike to find that after weeks of
earnest effort no satisfactory results are obtained.

An article on "Ankylosis" by J. S. White, D. O., of
Pasadena, Cal., published in Vol. V., No. IV., of The
Osteopath, page 211, deserves quotation here because it
notes so clearly the important points which the student
ought to know. With his permission, it is quoted in full.

"Ankylosis. — When, from an injury, disease or other
cause, a joint loses its function and becomes stiff, it is said

494

PRINCIPLES OF OSTEOPATHY

to be ankylosed. This condition may be termed bony
(complete) or fibrous (incomplete), true (intra-articular)
or false (extra-articular) ankylosis."

"These are the terms used by Da Costa to define
ankylosis, yet some claim that joint-stiffness caused by
extra-articular contraction, or obstruction, is not ankylosis
in the correct sense ; but on looking at the derivation of the
word (an(g)kulos — crooked or bent), it seems that the
term ankylosis would be correct when applied to any form
of restricted joint movement."

"The causes of ankylosis are many. First, let us con-
sider those which result in complete and incomplete an-
kylosis. Inflammations in or around the joint, from what-
ever cause, if continued long enough for new tissue forma-
tion, will cause ankylosis. After aseptic inflammations we

FIG. 233.

Manner of applying leverage to stretch the structures
forming the scapulo-humeral articulation.

PRINCIPLES OF OSTEOPATHY

495

will most likely find fibrous, but when there is infection,
bony ankylosis is more probable."

"This fibrous formation is the result of inflammation,
for wherever there is inflammation there is an increase of
tissue. Suppose a case of dislocation, with considerable

FIG. 234. A position for easy manipulation or the scapulo-hu-
meral articulation.

496 PRINCIPLES OF OSTEOPATHY

contusion of the tissues around the joint, inflammation re-
sults, and embryonic tissue begins to form as a reparative
process; the embryonic tissue sends out small processes,
which start from new centers and spread through the
gelatinous mass, in and around the joint, until a very ir-
regular network is spread all around the joint surface,
when the contraction process begins, the new tissue is
formed into fibrous tissue, which unites the bones closely
together; by cicatricial contraction the bones may be drawn
so closely together that movement is almost impossible."

"Bony union of the joint surface follows fibrous anky-
losis; it occurs when the bone itself is injured or diseased,
and the surface of the bone eroded or broken. Ossification
begins chiefly in those layers of fibrous tissue lying next
to the bone."

"False or extra-articular ankylosis is caused by the
contraction of tissues around the joint. These contrac-
tions, external to the joint, may be the result of many
remote and obscure causes."

FIG. 235. Relaxation of the quadriceps extensor.

PRINCIPLES OF OSTEOPATHY

497

"First. Chronic contraction, which may be due to dis-
ease or obstruction to the nerve, at the center, or in its
course to the muscles. As the normal action of muscles
is dependent on normal nerve stimulus, a muscle may be
affected in various ways by the stimulus of an over-irri-
tated or inhibited nerve ; excess of nerve stimulation will
cause a pathological contraction, or there may be suspen-
sion of nerve stimulus and paralysis of muscles, allowing
the opposing muscles to pull and hold the joint in a fixed
position."

"Second. Contractions sufficient to cause permanent
fixations may follow the healing of wounds, ulcers or ab-
scesses. Active contraction, from any cause, if kept in that
state any length of time, can cause the muscle to undergo
a state of fibroid degeneration; tissue waste is replaced by
fat and fibrous material. There is good evidence that,
after a time, tissues which have not fulfilled their function
lose the ability to do so, and the nutritive changes ac-
companying vital activity do not take place ; the contiguous
fibers and cells become adherent, agglutinated and united

FIG. 236. Relaxation of the quadriceps extensor, sacro-vertebral
articulation allowed to remain movable.

498

PRINCIPLES OF OSTEOPATHY

by exuded serum and waste material not carried away by
the circulation, sluggish through inactivity of the muscles."

"The tendons and ligaments around the joint are
thickened and hardened to the length the limb was held
by the active contraction, but after the manner of all new-
ly formed tissue, it continues to retract and draw the limb
more out of its normal position."

"Third. Contractions may be the result of certain
diseases (as rheumatism, gout, tuberculosis, syphilis, or
any disease causing non-use of the joint or mal-nutrition
of the controlling muscles."

"In examining an ankylosed joint, we must distinguish
between bony and fibrous ankylosis and extra-articular con-
traction. A joint may be immovable, and yet not so be-
cause of bony ankylosis."

"Da Costa says that a joint immovable from fibrous
ankylosis is distinguished from a joint immovable from
bony ankylosis by the fact that, in the former, attempts
at motion are productive of pain and subsequently of in-
flammation ; therefore, pain on attempted motion excludes

FIG. 237. Relaxation of the adductor muscles of the thigh.

PRINCIPLES OF OSTEOPATHY 499

bony ankylosis from our diagnosis. An approximate idea
of the extent of the stiffness may be obtained from a his-
tory of the case as to whether the disease has been severe
in character and long in duration. The nerves of the joint
should be examined at their point of exit from the spine
and throughout their course to the joint."

"The same conditions, in general, which cause pain in
a joint may cause ankylosis, whether that pain be due to
local injury or referred from some other part. A contracted
psoas muscle by irritation to the branches of the obturator
nerve can cause pain, contraction and consequent stiffness
of the knee joint."

"What can osteopathy do for this condition? For
bony ankylosis nothing should be attempted, for the treat-
ment would only result in discouragement and disappoint-
ment to both physician and patient; but if the joint is in an
almost useless position, excision or osteotomy may be tried
with good results. If the joint has become ankylosed
through septic inflammation, it should not be forcibly
broken up, because of the danger of re-infection of the

FIG. 238. Method of stretching the sciatic nerve.

500 PRINCIPLES OF OSTEOPATHY

whole joint, or other parts of the body, through the cir-
culation."

"In cases of fibrous and extra-articular ankylosis osteo-
pathy can refer to the most encouraging records, and is un-
doubtedly ahead of any other method of treatment. The
main point in the treatment consists principally in making
active the retarded circulation, gradually breaking up the
adhesions, thoroughly relaxing all the muscles, and a
stimulating treatment to the nerves."

"For extra-articular ankylosis the treatment is varied
according to the cause. Osteopathy has a great mission
to fill in finding and removing the primary cause of many
cases of ankylosis. Hilton speaks of a case of diseased
(tubercular) knee joint cured by ankylosis. True! the
rest and ankylosis was nature's way of reducing the in-
flammation and disease when it had progressed so far.
But the work of the osteopath is to look for the causes
which made the knee joint "a point of least resistance" for
the tubercle bacilli to multiply in. Examine the spine
thoroughly, the sacro-iliac articulation and the hip for dis-
locations, which cause pain in the knee joint through irri-
tation of the obturator nerve. But does pain alone in the
joints lead to the condition known as a 'point of least re-
sistance?' Pain prevents much movement in the joint,
and remembering that continued non-use of muscles causes
mal-nutrition, sluggish circulation and degeneration of the
muscle, we may see how the joint may become a place for
germs to multiply."

"Is it too long a course from simple pain to disease?
Remember that pain is usually accompanied by contraction
of muscle. Our treatment must be both preventive and
curative."

"Following is a case of fibrous ankylosis and paralysis
illustrating the efficiency of osteopathy to treat this class
of sufferers. Vincent Pete, five years of age, had an anky-
losed elbow as a result of a dislocation and break. The
joint was attended to immediately after the accident by a

PRINCIPLES OF OSTEOPATHY 501

regular physician, but was kept in the splints too long,
which caused the fibrous ankylosis. The humerus was
broken just above the condyles, and a small spicula of bone
had protruded so that it interfered with those fibers of
the median nerve which supply the flexor muscles of the
thumb and forefinger to such a degree that the thumb
and forefinger were completely paralyzed, as far as the
flexor movements were concerned. The forearm was
ankylosed almost at a right angle with the arm, and a very
little movement could be made, and that with great pain;
the muscles in the cervical region of the spine were sore
and contracted. This was the condition of the patient
when he came for treatment eight weeks after the accident.
The improvement began with the first treatment, and in
on month the arm was perfectly straight and movable in
any direction, and he began to have power of movement
in his finger and thumb; at the end of two months' treat-
ment, his arm had returned to almost its usual strength
and flexibility. I saw him a month later and the arm and

FIG. 239. Method of stretching the pyriformis muscle.

502

PRINCIPLES OF OSTEOPATHY

hand were perfectly normal. Contrast this case with one
treated by mechanical rest, resulting in a fixed elbow joint,
or perhaps a moderately useful joint following forcible
breaking of adhesion under anaesthesia, which is a dan-
gerous treatment, with very doubtful results, as the opera-
tion may have to be done over and over again before a use-
ful joint is gained."

The Scapulo-humeral Articulation. — Fig. 233 illus-
trates a method of prying the head of the humerus out of
the glenoid fossa, i. e.. separating the articular surfaces.
This movement can be used in cases of muscular rheuma-
tism when complete abduction of the arm is impossible. It
also allows an influx of fresh arterial blood.

When abducting the arm, the scapula must be held by
the physician's hands. Place the fingers on the vertebral
border of the scapula, while the axillary border is com-
pressed by the thumb. By holding the scapula securely,
the physician is sure that all the movement he forces is in
the shoulder articulation, and not the gliding of the scapula
on the thorax. The muscles of the arm may be relaxed by
direct manipulation. The insertion of the deltoid is fre-
quently tender. Any wasting of the muscles of the ex-
tremity should be carefully noted, so that the course of its

FIG. 240. Stretching the deep and superficial muscles on the
back of the leg.

PRINCIPLES OF OSTEOPATHY 503

governing nerve may be searched for a point of com-
pression.

Examination of the Brachial Plexus. — The principal
motor divisions of the brachial plexus may be tested by
simple movements made by the patient. The patient's
gripping power is an index to the condition of the median
nerve, and the muscles it innervates. Extension of the
forearm, wrist and fingers made against resistance is an
index of power in the musculo-spiral nerve tract. Abduc-
tion and adduction of the fingers are controlled by the ulnar
nerve. Flexion of the forearm by the musculo-cutaneous.

Observe the condition of the first posterior interos-
seous muscle which forms the little muscular swelling when
the thumb is adducted to the second metacarpal bone. If
it is wasted there is evidence of nerve cell degeneration.
This muscle should be well developed in thin hands, as
well as in fat ones. If the wasting is unilateral, look for
impingement on the ulnar nerve at some point in its course.
If it is bilateral the cells in the spinal cord are probably
at fault.

The deltoid is frequently painful as a result of pressure
on the circumflex nerve. The pressure is usually at the
point of exit from the vertebral canal. Relaxation of the
structures around its point of exit usually gives relief.

Reduction of Dislocations by Traction. — The general
method applied to dislocations of all joints of the extremi-
ties is direct traction. This is sometimes aided by pres-
sure on the prominent point of the dislocated bone to aid
it in slipping to its place. All of the dislocations of the
humerus, subcoracoid, subclavicular, subglenoid and sub-
spinous, can be reduced by using traction to stretch the
muscles and ligaments of the joint to the extent that the
head of the humerus will slip over the rim of the glenoid
fossa. This traction may be made with the patient sitting,
as in Fig. 234. The knee in the axilla springs the head
of the humerus outward. The same treatment may be ap-
plied with the patient reclining. The physician should

504

PRINCIPLES OF OSTEOPATHY

place a ball of woolen yarn in the axilla, then place his
stockinged foot upon it, and make traction on the arm.

It is possible to apply the traction method in a simpler
way. An ordinary canvas cot, with a hole cut in it, so that
the arm can be put through while the patient rests easily on
his side, should be elevated far enough from the floor to al-
low a six-pound weight to be attached to the wrist. This
steady weight quickly relaxes the muscles and reduces the
subluxation.

Traction always strains the muscles and causes some
heat and swelling, therefore, care should be taken to pre-
vent exudates and adhesions.

Reduction of Dislocations by Leverage. — Those who
are expert in reducing shoulder dislocations, usually make
use of a series of movements which exaggerate the lesion,
i. e., make the head of the dislocated bone more prominent.
In subcoracoid dislocations of the humerus, abduction of
the arm causes exaggeration. The physician stands at
the side of the patient, who is reclining on a hard surface.
As abduction is made, the physician's free hand rests upon

FIG. 241. Position for easy manipulation of the saphenous opening.

PRINCIPLES OF OSTEOPATHY

505

the head of the humerus. From the position of abduction
the arm is carried inward and forward on a level with the
shoulder, at the same time being rotated internally so
that the external condyle will be in front of the patient's
nose; then carry the arm downward to the side with a
quick, vigorous movement, at the same time exerting pres-
sure on the head of the bone as before mentioned. This
series of movements must be made quickly, and the pres-
sure on the head of the bone be most intense while the in-
ternal rotation and adduction are at the maximum

This series of movements may be employed to break
up synovial adhesions.

Elbow Dislocations. — Elbow dislocations are infre-
quent compared to those of ball and socket joints. The
possible dislocations of the ulna are lateral and posterior.
The former require traction, the latter is reduced by placing
the bend of the patient's elbow over the physician's knee.
Traction with one hand on the patient's wrist, while the
other hand makes pressure on the olecranon, will force

FIG. 242. Position for easy manipulation of the popliteal space.

506 PRINCIPLES OF OSTEOPATHY

the ulna into place. This dislocation is usually compli-
cated with fracture of the coronoid process.

The Radius. — The radius may be dislocated posteriorly
or anteriorly. Lateral dislocations of either radius or ulna
carry both bones together. A posterior dislocation of the
radius can be reduced by flexion of the forearm, then ex-
tension with counter pressure on the prominent point of
the head of the radius posteriorly. A forward dislocation
requires supination of the arm and adduction of the hand,
together with pressure on the anterior surface of the head
of the radius.

Dislocations of the bones of the wrist or hand are re-
duced by traction or pressure.

Old Dislocations. — All dislocations, twenty-four hours
old, require considerable relaxing treatment. The older
they are, the harder they are to reduce. Nature begins
to adapt herself to new conditions almost immediately.
All the slack of muscles and ligaments is swiftly taken up.
Those tissues most compressed by the new position of the
bone are impoverished by the lack of nourishment. Thick-
enings and adhesions quickly form, so that old dislocations
are not easily handled. Old dislocations are treated in
the same manner as fresh ones, except that much relaxing
and restoring of vitality is necessary.

Muscles of the Lower Extremity. — The muscles of the
lower extremity may be relaxed, either by direct manipu-
lation or by taking advantage of the movement of various
joints to put them on a stretch. Direct manipulation is
laborious and requires considerable time.

The muscles of the hip joint frequently contract suf-
ficiently to make walking difficult. They contract as a re-
sult of strain, bruise, disease of the joint, subluxation of
lumbar vertebrae, or luxation of the iliac bones. The sub-
luxations irritate the nerves which innervate the muscles
controlling the joint.

The movements hereafter outlined may be used for
many different purposes, but they are applied here to spe-

PRINCIPLES OF OSTEOPATHY

507

cific groups of muscles. All the movements we have thus
far outlined have been described according to the way they
affect structure, not function.

FIG. 243. Position for reduction of subiuxation of external
semilunar cartilage of the knee.

508

PRINCIPLES OF OSTEOPATHY

FIG. 244. Showing position for producing free movement
in the arthrodial articulation between upper ends of the
fibula and tibia. External popliteal nerve lies behind
the head ot the fibula.

PRINCIPLES OF OSTEOPATHY 509

Quadriceps Extensor. — The quadriceps extensor of
the thigh is innervated by the anterior crural nerve. In
order to stretch this muscle the patient should lie face
downward. The physician grasps the patient's ankle with
the left hand, as in Fig. 235. The right hand holds the
pelvis to the table. Lifting with the left hand puts the
muscle on a tension which can be easily increased by flex-
ing the knee. This movement stretches the fascia over
Poupart's ligament and the saphenous opening.

Fig. 236 illustrates a movement similar to the pre-
ceding, but it is not so powerful. When the patient lies
on the side, his back bends to the force of the movement
of the leg. If the physician grips the ankle instead of the
knee there is a great increase in the effect of the move-
ment.

The Adductor Group. — The adductor group of thigh
muscles, innervated by the obturator nerve, can be
stretched as in Fig. 237. If there is any inflammation in
the acetabulum, this movement will cause the patient
great distress, because it stretches the teres ligament.

Dislocation of the Femur. — Dislocations of the hip
joint are usually caused by the forcible spreading of the
legs. The head of the femur is thus forced over the edge
of the acetabulum at its dependent and weakest part, the
cotyloid notch. It passes into the thyroid foramen, and
if it remains there all the muscles are stretched very tight-
ly, and no voluntary movement is possible. The direction
the head takes is dependent on the direction of the force.
If the knee points anteriorly at the time of the forced ex-
treme abduction, the head, after entering the thyroid fora-
men, passes out of it posteriorly and takes a position over
the spine of the ischium, great sciatic foramen or outer sur-
face of the ilium, all owing to the vigorous pulling of the
muscles. If the knee points posteriorly, the head of the
femur travels to a position under the anterior inferior spine
of the ilium.

510

PRINCIPLES OF OSTEOPATHY

FIG. 245. Radiograph of fractured oiecranor, process and exudate
after removal of splints. Movement recovered after many weeks
of gentle manipulation to promote absorption and break ad-
hesions.

PRINCIPLES OF OSTEOPATHY 511

The movements made to reduce these subluxations
take into consideration the fact that the head of the femur
must be made to retrace its route in order to regain its
proper position. For example, a dislocation posteriorly on-
to the spine of the ischium causes the toe to turn inward,
and there is slight shortening of the leg. The physician
takes a position as in Fig. 239 and carries the knee upward
and inward. He forces the knee as far as possible across
the median line, then flexes the thigh hard on the abdo-
men. This turns the head of the femur downward and
inward. Remember that the head points always in the
same direction as the internal condyle. Now, forcibly ab-
duct and extend the thigh with a quick external rotation.
These movements cannot be made successfully without a
long course of preliminary relaxing treatments, that is, if
the dislocation is an old one.

Direct traction may be used for all dislocations of the
femur, just as for the shoulder, but the muscles are so
strong that it is no small matter to overcome them, hence
movements which take advantage of leverage are much
more satisfactory.

The formula for any dislocation of the hip may be
worked out by noting the position of the head of the femur
and then carrying the internal condyle so as to make the
head retrace its course. When shortening or lengthening
of the leg is noted, make sure that the iliac bones are even.
A half-inch difference in the length of the legs may easily
be accounted for by the action of the hip muscles.

The pyriformis muscle may contract and compress the
sciatic nerve in its course through the great sciatic foramen.
Fig. 239 illustrates the movement to stretch the pyrifor-
mis. The physician holds the pelvis to the table by press-
ing on the anterior superior spine of the ilium. The thigh
is then strongly adducted.

Stretching the Sciatic Nerves. — Sciatica is frequently
successfully treated by relaxing the pyriformis, but the
majority of cases require a stretching of the sciatic nerve,

512

PRINCIPLES OF OSTEOPATHY

FIG. 246. Position for reducing tarsal subluxations.

PRINCIPLES OF OSTEOPATHY 513

which is performed as in Fig. 238. The physician has
great leverage in this movement. It stretches all the
flexor group on the back of the thigh.

The Calf Muscles. — The calf muscles sometimes con-
tract and make it difficult for the patient to get the heel
to the floor. Fig. 240 illustrates the method of applying
leverage to the case.

Scientific Manipulation. — Every group of muscles in
the body can be relaxed by stretching them, hence if the
student will study their attachments and the effects of
their normal contraction, a series of movements can be
devised to suit the condition. Learn anatomy in a prac-
tical manner and a system of osteopathic movements will
spring forth from the understanding mind of the student.
The author has tried the plan of not demonstrating move-
ments to students, but putting the whole attention to un-
derstanding the conditions in the patient which require
treatment. A study of the mechanical difficulties pre-
sented and the comparison of these with the normal rela-
tions, leads the student to apply anatomical knowledge in
treatment. If the student understands the case, that is,
realizes the significance of the points found by the physical
diagnosis, he can be depended upon to apply a rational
method of treatment. As soon as the student makes a
movement in a certain manner in order to copy his in-
structor, instead of basing it on his own understanding
of the condition treated, he degenerates to mere empirical
methods.

Saphenous Opening. — The circulation in the lower ex-
tremity is frequently affected on the venous side by tension
at the saphenous opening. Enlargement of the superficial
veins of the leg, above a point three or four inches above the
ankle, denotes obstruction to free blood flow in the long
saphenous vein. Abduction and tension of the thigh will
stretch the fascia forming the saphenous opening, then
place the thigh in a semi-flexed position, as in Fig. 241, to
facilitate direct manipulation of the tissues forming this

514

PRINCIPLES OF OSTEOPATHY

FIG. 247. Distension of veins due to tricuspid insuf-
ficiency. Varicose ulcers on both shins ana under
maiieoli of both ankles were healed by strapping
over the ulcers with strips of adhesive plaster.

PRINCIPLES OF OSTEOPATHY 515

opening. The deep and superficial veins of the leg have
little or no communication above a point about the junction
of the lower and middle third of the leg. This applies
especially to the long saphenous vein. Varicose veins on
the feet or ankles may be drained by both superficial and
deep veins, therefore, their existence in these locations
may be due to visceral causes, even when there is no ob-
struction to the saphenous opening.

Popliteal Space. — The popliteal space sometimes needs
relaxation. This is performed by direct manipulation, as
illustrated in Fig. 242. The position of the physician's
hands in this illustration affect the upper portion of the
popliteal space. By facing the patient the lower portion
can be easily affected.

The Semilunar Cartilages of the Knee. — These carti-
lages, which serve to form cup-like depressions for the
condyles of the femur to rest in, on the superior articular
surface of the tibia, may become slightly displaced and
hence act as wedges to limit motion in the joint. Since
they normally move with the condyles, it is probable that
some slight ligamentous strain is primarily the cause of the
change in position of a semilunar cartilage. The external
semilune is the one most frequently affected. The reason
for this probably is due to the fact that the internal con-
dyle of the femur is longer than the external, hence in a
movement, such as pedaling a bicycle, the extension of
the joint is made with the knees rather wide apart. This
tends to strain the external lateral ligament. The cartilage
slips slightly forward and prevents either flexion or exten-
sion. The joint remains in a semi-flexed position and is
exquisitely painful. Some of these cases can be quickly
relieved by having the patient sit, so that the operator can
grasp the knee with both hands, as in Fig. 243. The op-
erator's thumb makes careful pressure on the painful spot
where the external semilune causes a little transverse
ridge. By gently rotating the tibia and using a slight ef-
fort to slide the tibia on the condyles, without producing

516

PRINCIPLES OF OSTEOPATHY

FIG. 248. Same case as the preceding illustration. No
caput medusae present, thus showing that portal cir-
culation is not seriously obstructed.

517

either flexion or extension, the semilune will tend to yield
to the thumb pressure and resume its normal relations to
the condyle. Since some swelling accompanies such an
accident, it should not be expected that complete flexion,
or extension, would be possible immediately after replace-
ment of the semilune. Any trauma of a ligament is ac-
companied by the swelling incident to normal repair.

Paralysis of External Popliteal Nerve. — One of the
most frequent forms of peripheral paralysis involves the
Peroneal or External Popliteal nerve. Its position, with re-
lation to the fibula, subjects it to possible pressure, when
one knee is crossed over the other. It is also subject to in-
jury when traction is made on the leg, for a considerable
time, as is frequently done in cases of hip joint injury or
fracture of the femur. Surgeons realize the danger of mak-
ing traction below the knee joint, but there are still enough
of these peripheral paralyses, due to this cause, to make it
evident that not all physicians realize the danger. This form
of peripheral paralysis is characterized by ankle drop. In
cases of Peroneal paralysis due to pressure, recovery is
nearly complete in a few weeks. This seems to show

FIG. 249. Illustration of typical varicose veins.

518

PRINCIPLES OF OSTEOPATHY

PIG. 250. Method of strapping with adhesive plaster to
support varicose ulcer on the shin.

PRINCIPLES OF OSTEOPATHY 519

that a slight edema exists in the sheath of the nerve at the
point which suffered the traumatic pressure. In those
cases due to extension of the leg, recovery is always
problematical, because the traumatic pressure may have
been produced by a fold of fascia. This is especially the
case when the anterior tibial nerve is the only branch of
the Peroneal, paralyzed. These cases need to be treated
by semi-flexing the knee, so that deep digital manipulation,
of all the soft tissues of the knee, will hasten absorption
of the edema. Judging by some of the cases we have seen,
the patients would have been in more capable condition
with bony deformities, due to fractures, than with the
paralyses, resulting from the efforts to maintain reduction
of the fractures. These paralyses are, however, unavoida-
ble in some cases, but recovery would be more rapid and
certain if intelligent manipulation was used almost from
the beginning of the cases.

"Glucokinesis and Mobilisation." — Many efforts have
been made to develop a method of treating fractures, that
will not only insure a reasonably perfect union but will
avoid the serious sequelae incident to the use of casts,
splints and extension apparatus. No single method of
treatment is applicable to all forms of fractures, but there
are certain principles, underlying the art of manipulation,
which are applicable in the treatment of certain forms of
fractures. The use of a form of massage, by Dr. Just
Lucas-Championniere, in the treatment of fractures, is a
new development in the art of manipulation. He calls
his method "glucokinesis," painless massage. It is so dif-
ferent from massage, as generally understood by masseurs,
that none but physicians, who understand the phenomena
in tissues involved in fracture, can use it intelligently. It
consists in stroking the injured part very gently, in the
direction of venous circulation and the muscle fibers. This
stroking is rhythmical and continuous for about fifteen or
twenty minutes. The stroking is so gentle as to seem
quite ineffective. The first principle is : "Never be afraid

520 PRINCIPLES OF OSTEOPATHY

of rubbing too gently, or of giving too small a dose of
mobilisation ; always fear that the massage is too heavy
and the movement too great." The result of this stroking
is the relief of pain in the injured part and a coincident
relaxation of the muscles involved in the fracture. This
relaxation of muscles allows replacement of the fragments.
Mobilisation consists of minute "doses" of passive move-
ment in all of the joints above and below a fracture. The
"dose" should cause no pain in the limb. The applica-
tion of Prof. Lucas-Championniere's methods has been
excellently described by Dr. James B. Mennell in his work
on The Treatment of Fractures by Mobilisation and Mas-
sage, MacMillan and Co.

Pain in the Legs and Feet. — Many cases complain of
pain of variable character in the legs and feet. It is good
practice to test the plantar arches in all such cases. Weak-
ness of the longitudinal arch may not be evident except
when the leg muscles are fatigued, therefore a plantar
impression may not show any sagging. If no structural
defect is apparent, it is safe to assume that weakness
exists. The application of strips of adhesive, to parallel
the suspected tendons, will give enough support to demon-
strate whether the diagnosis is reasonably correct.

Tarsal ligaments may be strained, or a tarsal bone
become subluxated. The pain, incident to these conditions,
is very acute. Subluxations are usually reduced by pas-
sive movements, which merely tend to produce mobility
in the tarsus as a whole. If this does not produce reduc-
tion, it will be necessary to use thumb pressure over the
prominent painful spot and then flex and extend the tar-
sus with the other hand, so as to allow the pressure to be-
come e'ffective. In any case of weak arch, or subluxated
tarsal bone, it is advisable to use some means of passive
support until the acute phases are past. Some cases will
recover completely under the influence of voluntary exer-
cises, while others cannot get along without support.

PRINCIPLES OF OSTEOPATHY 521

Varicose Veins. — The pain incident to varicose veins
may be very severe. The first thing to determine is
whether the varicosity is due to local or general condi-
tions, i. e., whether there is involvment of one group of
veins in a single extremity, or a general back pressure
in all the veins of the body, due to a lesion in the right
auriculo-ventricular valves, or muscular insufficiency. The
varicosity due to pregnancy is in a class of its own. The
veins on the shin lie so close to the surface that a very
slight abrasion causes a varicose ulcer. The weight of the
column of blood, in the long saphenous vein, serves to
break down the granulations by which healing tends to
take place. In such cases, whether due to local or systemic
conditions, it is best to furnish the vein an artificial sup-
port by strapping with strips of adhesive plaster directly
over the ulcer and for a space of three inches on all sides
of it. These strips should be about one inch wide and
lapped on to each other about one-quarter inch, .as in Fig.
250. This artificial support should be left in place three
days, then be stripped off, the ulcer cleansed and fresh
adhesive applied. The amount of exudate will decrease
rapidly under this treatment. Previous to the first dress-
ing, there should be no application of irritating antisep-
tics. The mechanical principle of supporting the wall of
the vein is all that is necessary. The moisture of the ulcer
will keep the adhesive from breaking the granulations as
it is pulled off. As soon as the discharge from the ulcer
ceases there is no necessity for removing the adhesive for
many days. In the meantime such general help, as may
be possible, should be given to overcome the conditions
which predispose to a recurrence of the ulcer.

522 PRINCIPLES OF OSTEOPATHY

CHAPTER XXIV.

MANIPULATION FOR VASO-MOTOR NERVE
EFFECTS.

There are times when the physician desires to affect
the amount of blood in the tissues of the head. There may
be congestion of the nasal, pharyngeal and laryngeal mu-
cosa, as during a hard "cold." After manipulating to re-
lax the muscles of the neck and overcome any effects these
may have had on the position of the cervical vertebrae, it
is well to try to cause vaso-constrictor action by stimulat-
ing nerve endings. Fig. 251 illustrates a method of stimu-
lating deeply under the zygoma in the sigmoid notch of
the inferior maxillary bone. When the patient opens his
mouth, the physician places his finger over the depression
below the zygoma and presses inward, at the same time
making a vibratory movement of the finger. This affects
the branches of Meckel's Ganglion and, through it, the
nasal mucosa. It is a painful treatment, but the blood
will often surge from the mucous tissues to the skin as a
result of it.

About the same effect is secured by using the move-
ment illustrated in Fig. 252. While the patient's mouth
is open, the physician places his thumbs on the bridge
of the nose, and his fingers at the angles of the jaw. The
tips of the little and ring fingers are pressed into the de-
pression caused by the forward movement of the condyle
of the jaw on the eminentia articularis. The physician
forces the mouth shut while the patient opposes. The
position of the tips of the little and ring fingers prevents
the easy slipping of the condyles into the glenoid fossa.

PRINCIPLES OF OSTEOPATHY

523

The sensory fibers around the condyle are intensely stim-
ulated and frequently manifest it by spreading a flood of
color over the face in front of the ear. This is also a pain-
ful stimulation. It is highly probable that all movements
of this character which are painful secure results by caus-
ing activity of the dilator nerves to blood vessels in super-
ficial tissues, thus depleting the blood in the congested
area. A sharp pain may cause a sudden blanching, but it
is followed by vaso-dilation.

If it is difficult for the patient to breathe through the
nostrils, press on the nasal bones, first on the right side,
then left, then make a heavy pressure over the junction of
the nasal and frontal bone with one thumb above the other.
This movement is very pleasant to the patient, ordinarily.

To carry off the venous blood, make a stroke from

FIG. 251. Stimulation between the zygoma and the sigmoid notch
of the inferior maxilla.

524

PRINCIPLES OF OSTEOPATHY

the inner canthus of the eye downward over the junction
of the masseter muscle with the lower jaw, thence to the
supraclavicular fossae.

The Fifth Cranial Nerve. — The fifth cranial nerve can
be treated at its points of exit through the bones of the
face. Fig. 253 illustrates the position of these points. A
vibratory pressure over these points causes a dull but in-
creasing pain. If the movement is made quickly and vig-
orously, there will be evidence of a reaction in a flushed
appearance.

Inhibition of Suboccipital. — When there is a high
blood pressure in the head and the patient is suffering
with headache it is possible to give great relief by steadily
inhibiting in the suboccipital fossae and temples, as illus-

FIG. 252. Stimulation by forcible closure of the mouth against
resistance.

PRINCIPLES OF OSTEOPATHY

525

trated by Fig. 254. All nervous conditions are greatly
reduced by this movement. The inhibition reduces the
number of sensory impressions, and lessens the tension of
blood vessels all over the body. This inhibitory move-
ment should be used in cases of epilepsy and delirium tre-
mens during the excitable stages. Have an assistant in-
hibit in the splanchnic area, thus causing a general reduc-
tion of blood pressure in the superficial and deep tissues
of the body and extremities. The blood is thus drawn
away from the head, and the patient becomes quiet.

To inhibit the transmission of impulses to the dia-
phragm by the phrenic nerves, pressure should be made
as in Fig. 255. The physician's fingers compress the phrenic
nerve against the scalenus anticus.

FIG. 253. Points of exit of divisions of the fifth cranial nerve.

526

PRINCIPLES OF OSTEOPATHY

The phrenic, pudic and pneumogastric are the only
nerve trunks distributed in the body which can be easily
compressed through soft tissue. Fig. 256 illustrates stim-
ulation of the pneumogastric. The physician's fingers roll
over the nerve trunk where it lies along the inner edge
of the sterno-cleido-mastoid.

The general tendency of an osteopathic treatment,
which aims to relax the extensor muscles of the neck and
trunk, is to reduce blood pressure. Cases which are char-
acterized by high blood pressure are greatly benefited by
relaxation of muscle tension, by means of gentle leverage.
The use of heavy pressure movements is contraindicated,
because they might occasion involuntary resistance by the
patient and thus suddenly raise blood pressure to a dan-
gerous degree.

It is very probable that the extension and counter
pressure movements we use to reduce subluxations, act also

FIG. 254. Inhibition in the suboccipital fossa.

PRINCIPLES OF OSTEOPATHY 527

as factors in changing blood pressure in localized visceral
areas.

Vaso-motor effects can be secured by various forms
of stimulation applied to spinal areas. Counter irritation,
cupping, heat or cold, concussion, or sudden pressure to

FIG. 255. Inhibition of the phrenic nerves. Center for hiccough.

528 PRINCIPLES OF OSTEOPATHY

the point of producing a "click" in an arthrodial joint, all
produce vaso-motor effects of various degrees. They all
serve a useful purpose and tend to reinforce each other in
some cases.

FIG. 256. Stimulation of the pneumogastric nerves.

PRINCIPLES OF OSTEOPATHY 529

BIBLIOGRAPHY

On Bone Setting Wharton P. Hood

Theory of Osteopathy „ Riggs

Physiology of Bodily Exercise La Grange

Principles of Osteopathy Hulett

Principles of Osteopathy Hazzard

Practice of Osteopathy _ Hazzard

Practice of Osteopathy McConnell and Teall

Lateral Curvature of the Spine and Round Shoulders

Lovett

The Development of the Human Body McMurrich

Technique Rigsby

Autobiography _ A. T. Still

Philosophy of Osteopathy A. T. Still

Philosophy and Mechanical Principles of Osteopathy

A. T. Still

Osteopathy, Research and Practice A. T. Still

Pain Schmidt

Pulmonary Tuberculosis Pottinger

«

Orthopedic Surgery Whitman

Studies in the Osteopathic Sciences. Vols. I, II, III

Burns

The Integrative Action of the Nervous System...Sherrington

Diagnosis and Treatment of Diseases of Women Crossen

Immunity _ Citron

Applied Anatomy Bardeleben

530 PRINCIPLES OF OSTEOPATHY

Physiology of the Nervous System „ _Morot

Text Book of Physiology Howell

Treatment of Fractures by Mobilisation and Massage

~ - Mennell

Spondylotherapy „ _ Abrams

Hand Atlas of Human Anatomy Spalteholz

Eye Strain in Health and Disease Ranney

Abdominal Pain _ ; Maylard

The Abdominal and Pelvic Brain .*.....Robinson

Diseases of the Nervous System Resulting from Acci-
dent and Injury Bailey

Modernized Chiropractic Smith, Langworthy, Paxson

Surgical Anatomy _ Campbell

Clinical Anatomy _ :. Eisendrath

A Manual of Medicine Allchin

Manual of Physiology Stewart

Kirke's Handbook of Physiology .'. Kirke

Diseases of the Nervous System Mettler

Biology, General and Medical McFarland

Applied Anatomy Clarke

Normal Histology Piersol

Comparative Physiology and Morphology of Animals

_ „ Le Conte

Neurotic Disorders of Childhood Rachford

Anatomy of the Central Nervous System in Man and

in Vertebrates in General Edinger and Hall

Bier's Hyperaemic Treatment Meyer, Schmieden

Physiologic and Pathologic Chemistry Bunge

Origin of Life _ „ Le Dantec

Manual of Osteopathic Gynecology Woodall

PRINCIPLES OF OSTEOPATHY 531

Deformities including Diseases of the Bones and

Joints Tubby

The Treatment of Fractures Scudder

Principles of Surgery Nancrede

Lectures on Rest and Pain .Hilton

ARTICLES

Rotary Lateral Curvature. No. 7, Vol. II of J. of A.

O. A H. W. Forbes

The Nature of a Subluxation. No. 5, Vol. I, J. of

A. O. A Tasker

How the Heart is Affected by Osteopathic Manipula-
tions. No. 11, Vol. II, J. of A,. O. A Tasker

Vertebral Articular Lesions. (Series begun in 1908)

J. of A. O. A Forbes

Auto-Protective and Recuperative Mechanism of the

Body. No. 4, Vol. XI, J. of A. O. A E. S. Willard

The Osteopathic Lesion. No. 8, Vol. IX, J. of A. O.

A McConnell

The Immediate Effects of Bony Lesions. No. 11, Vol.

IX, J. of A. O. A Burns

Examples of Functional Lesions. No. 9, Vol. X, T-

of A. O. A H. F. Goetz

Adaptation and Compensation. No. 3, Vol. Ill, West-
ern Osteopath Tasker

Backache. California State Journal of Medicine, June

and July, 1909 C. M. Cooper

A Consideration of the Pelvic Articulations from an
Anatomical, Pathological and Clinical Standpoint.
Boston Medical and Surgical Journal, May 18 and
June 1, 1905 Goldthwait and Osgood

INDEX

NOTE — Main chapter subjects are referred to in dark faced numerals.

Page

Abdomen 395

Acceleration 354

Adaptation 28, 332

Adaptation, Failure of 42

Adhesions, Synovial 372

Alignment and flexibility 385

Anaesthetic, inhibition 368

Anatomy 183

Angina pectoris 158

Ankylosis 493

Articulation, Atlo-axial 294

Costo-central 304

Costo-transverse 304

Dorso-lumbar 302

Lumbo-sacral 264, 266, 268

Occipito-atlantal 286

Sacro-iliac 269

Scapulo-humeral 502

Articulations, Ankylosis of 493

Arthrodial, enarthrodial 376

Sounds produced in 371

Structure of 285

Tarsal 520

Atlas, The 285, 479

B

Back 239, 325, 379

Back, Inspection of the 45

Backache 311, 378

Blood 149

Bone-setting 374

Cardiac plexus 141

Caries 294, 319

Carpal subluxations ....375

Cartilages, Semilunar of knee 373

Cause and effect 33

Causes of disease 27

Causes of disease, Difference in

belief as to 29

Cell life dependent on circula-
tion 35

Cell relations 34

^Center, Bladder 235

-Cardiac 154, 156, 158

Chills 227

vCilio-spinal 136, 223

Defecation 233

-'Gall bladder 229

x Heart 223

-Intestines 225, 227, 229

" Kidneys 233

^Liver 225

Lung 220

^Micturition 233

' Osteopathic 194

• Ovary 231

^Parturition 233

^Spleen 225

• Stomach 225

• Testes 231

• Uterus 229

Vaso-motor 167

Cervical region, Affections of.... 66

Extension 474

Rotation 475

Chorea 358

Circulation 149

Circulation apparatus 151

Capillary 166

Cell life dependent on 35

Influence on 49

Clavicles 309, 471

Compensation 332

INDEX

Page

Compensation curvature 335

Conductivity 98

Contraction, Muscular 354

Control, Plurisegmental 1 10

Co-ordination, Segmental 50

Curvature, Compensatory 335

Lateral . 69, 408, 440

Development, Variations in 43

Diagnosis 195, 381, 386, 392, 493

Diagnosis, Backache 311

Extremities 493

Osteopathic 23

Physical 23, 185

Digastric 476

Disease, Causes of 27

Interpretation of phenomena

of 29

Known causes of 30

symptoms 32

Dislocations 503

Dislocations, Elbow 505

Femur 509

of radius 506

Old 506

Dorsal region, Irritation in..67, 380

E

Efficiency 28

Elbow, Dislocations 505

Embryology 88

Encysting, Power of 339

Environment, Favorable reac-
tion to 30

Erector spinae 412

Examination, Position for 384

Extension 474

Extension, Spinal 250

Extremities 341, 400, 493

F

Page

Fatigue, Effect of 41, 357

Feet 342

Feet, Pain in 520

Femur, Dislocation of 509

Fever 122

Fever, Infectious 326

Flexion, Spinal 250

Fracture, Mobilisation 353, 519

Fulcrum, The use of 432

Function, Impairment of 361

and structure 39

Variations in ... . 27

Ganglia, Automatic visceral 148

Sympathetic 127

Ganglion, Meckel's 522

Superior cervical 205, 293

Gluco-kinesis and mobilisation..5l9

H

Headache 132

Head's law 191

Healing, The true art of 39

Health 25

Health, Normal 28

Heart 153, 337

Herpes Zoster 187

Hiccough 213

Hilton's law 181

Hyoglossus 476

Hyoid bone 476

Hyperaemia 73, 170

Hyperaesthesia, Spinal. .59, 365, 392
Hypogastric plexus 146

Inefficiency 29

Inflammation, Serous mem-
branes .328

Inhibition ... ....354

INDEX

Page
Inhibition, Dosage 360

Therapeutic 362

Innervation, Influence on 49

Inspection 114, 386

Integration, Segmental 103

Systems of 99

Irritability 97

Irritation, Mechanical 100

K

Kidneys 338

Knee 183, 515

Kyphosis

413, 419, 422, 425, 427, 450, 451

Kyphosis, Lower dorsal 302

Larynx, Intrinsic muscles of 478

Latissimus dorsi, Manipulation

of 406

Law of compensation 341

Head's 191

Hilton's 181, 362

Legs, Pain in 520

Lesion an objective symptom.... 57

as a cause 40

Causes of 41, 75

Characteristics of 40

Classes of 41, 56

Disease association 31

in diagnosis 76

integration 120

palpation 44

patterns 58

Persistence of 43

Secondary 41, 56

Sequence of 43

Spinal 82, 91, 450

Traumatic 47

Twelfth rib 407

Lesions, Autotoxemia in 120

Chemical causes of.... ... 42

Page

Depth and extent of 119

Experimental 52

False 297

Functional fatigue : 112

Group 110

History of '. 400

Leverage 419, 448

Life, Tenacity of 31

Lordosis 416, 419

Lumbago 323

Lumbar region, Irritation in 68

Lumbo-sacral articulation

264, 266, 268

Lymph 149

M

Malignant growths 322

Manipulation 133, 402

Manipulation, Back 379

Chiropractic 404

Conservative vs. radical 383

Corrective 434, 484

Dislocation 503

Dislocation of elbow 505

Dislocation, Old 506

Dorsal 380

Extension 478

External popliteal nerve 517

Fifth cranial nerve 524

General principles 483

Gluco-kinesis 403

Gluco-kinesis and mobilisation5l9

Head and neck 378, 419

Kyphosis 413, 422, 425, 427

Lordosis 416

Methods of procedure 404

Mobilisation 403

of adductor muscles of thigh. .509

of ankylosis 493

of atlas 479

of cervical region 471

of clavicle 471

of digastric 476

INDEX

Page
Manipulation —

of erector spinae 412

of extremities 493

of femur dislocation 509

of hyoglossus 476

of larynx 478

of latissimus dorsi 406

of mylo-hyoid 476

of pectoralis major 410

of phrenic nerve 525

of popliteal space 515

of pyriformis muscle 511

of quadratus lumborum..407, 411

of quadriceps extensor 509

of rhomboids 409

of rib subluxations 452

of sacro-iliac subluxations 461

of scaleni 473

of scapulo-humeral articula-
tion 502

of serratus magnus 410

of splenius capitis et colli

421, 473

of sterno-cleido mastoid 472

of sterno-hyoid 477

of sterno-thyroid 477

of stylo-hyoid 476

of subluxations 443

Position for 489

Rigidity, cervical region 489

Rotation, cervical region 475

Saphenous opening 513

Scientific 513

Semilunar cartilages, knee 515

Stretching sciatic nerve 511

Suboccipital nerve 524

Swedish 402

Tarsal ligaments 520

Torsion and counter pressure..486

Traction 503

Varicose veins 521

Vaso-motor effects 522

Massage ....402

Page

Meckel's ganglion 522

Medicine, Practice of 17

Preventive 31

Schools of 430

Membranes, Inflammation of
serous 328

Mobilisation and gluco-kinesis..5l9

Motion, Loss of 54

Muscle, Crico-thyroid 478

Digastric 476

Erector spinae 412

Hyoglossus 476

Irritability of 97

Latissimus dorsi, Manipula-
tion of 406

Mylo-hyoid 476

Pectoralis major 410

Pyriformis 51 1

Quadratus lumborum 407, 411

Quadriceps extensor 509

Rectus capitis anticus minor....292

Rectus lateralis 291

Rhomboids 409

Scaleni 473

Serratus magnus 410

Sphincter vaginae 237

Splenius capitis et colli. ...215, 421

Sterno-hyoid 477

Sterno-thyroid 477

Stylo-hyoid 476

Trapezius 215, 408

Muscles, Adductor of the thigh..509

Association of 92

Cervical 87

Developmental changes in 93

Nervous distribution to 184

of lower extremity 506

of the back 392

M-uscular contraction 299, 354

tension 59, 73, 75, 394

tone, Loss of 51

Mylo-hyoid 476

INDEX

N

Page

Neck, Examination of 398

Manipulation of 378

Nerve bundle 101

cells, Central 86

fibres, Afferent and efferent.... 100

fibres, Intraspinal 101

Hypoglossal 205

Intercostal 189

Phrenic 213, 525

Pneumogastric....l54, 199, 472, 526

Posterior thoracic 78

Spinal accessory 213, 472

Splanchnic 138

tissue, Attributes of 355, 358

of Wrisburg 220

Nerves, B rachial 217

Cervical 197, 217

External popliteal 517

Fifth cranial 524

Pudic 526

Sciatic 51 1

Sensory 164

Suboccipital 524

Vaso-motor . 160

Nervous system 61, 97

Sympathetic 125

Neuralgia 61

Neurotic diathesis 358

Normal and abnormal 27

Variation of.... .. 28

Osteopathy 403

Osteopathy, Definition of 19

Founder of 18

Growth of 17

Name 25

Scope of 24

Pain

Page
.122, 311, 520

Pain, Colicy 329

Referred visceral 326

Palpation 23, 74, 296, 386, 453

Palpation of vertebral struc-
tures 45

Paralysis agitans 358

Paraplegia 234, 322

Patterns, Reflex 331

Pectoralis major 410

Pelvic plexus 146

Pelvis 263

Pleurisy 58, 409

Plexus, Brachial 217, 503

Cardiac 141

Cervical 21 1

Hypogastric 146

Lumbar 235

Pelvic 146

Pulmonary 142

Sacral 235

Solar 144

Subsidiary 147

Poise 312

Popliteal space 515

Position for examination 384

Posture 323

Pott's disease 451

Pressure, Inhibitory effect of 359

Tenderness to 46

Principles, Application of.. ..431, 440

Corrective movements 483

Prostate gland 398

Pulmonary plexus 142

Pyriformis 511

Quadratus lumborum, Manipu-
lation of 407, 411

Quadricep extensor 509

INDEX

Page

Rachitis 320

Radius, Dislocation of 506

Reactions, Intensity of 330

Protective 105, 121

Recovery, Natural 37

Rectum, Examination of 398

Recumbency, Effect of 68

Recuperative power, Inherent.... 38

Reflex patterns 331

subluxations 330

Reflexes 105, 114

Reflexes, Intensity of 213

Location of 330

Visceral 57

Region, Cervical 243, 471, 489

Cervical extension 474

Cervical rigidity 489

Dorsal 248, 255

Interscapular 135, 220

Lumbar 249, 259, 302

Resistence, A change of 33

Respiration, Nervous control of..306

Rest 189

Rest, Physiological 49

Rhomboids 409

Ribs, Examination of 304, 396

Rigidity 489

Rotation, Cervical region 474

Dorsal 440

Spinal , 250, 261

Sacral region, Irritation in 68

Sacro-iliac articulation 269

Saphenous opening 513

Scaleni 473

Scapula 219, 408

Sciatic nerve, Stretching 511

Secretion ....354

Segmental co-ordination 109

Segmentation 106

Page

Segmentation of the body 76

of the spinal cord 101

Semilunar cartilages of knee 515

Sensation 117

Sensation, Reception of 109

Sensory nerves 164

Serous membranes, Inflamma-
tion in 328

Serratus magnus 410

Shock '. 357

Skin 338

Solar plexus '. 144

Spinal alignment and flexibility..385

arthropathies 320

column 239, 333

cord 326

curvature 318

curves 264

curves, Normal 242

extension 250

flexion 242

hyperaesthesia ..59, 64, 378

irritation, Symptoms of 64

ligaments 239

nerves, Irritation of 60

rigidity 320

rotation 250, 316

treatment 60

Splanchnic nerves 138

Spondylitis deformans 320

Splenius capitis et colli 421, 473

Statics 312

Sterno-cleido-mastoid 472

Sterno-hyoid 477

Sterno-thyroid 477

Structure, Necessity for study

of 54

Variations in 27

Stylo-hyoid 476

Subluxation, Atlas, 479

Carpal 375

Clavicle 471

Lateral 298, 443, 450

INDEX

Page
Subluxation —

Reduction of 443

Sacro-iliac 269, 316, 461

Tarsal 375, 520

Subluxations 283

Costal 307, 452

Innominate bones 461

Reflex 330

Suboccipital triangles 209

Subsidiary plexus 147

Surgery 24

Sympathetic, Ganglia of 70

nervous system 125

Symptoms, Objective 118

Subjective 59, 401

Page

Trapezius 408, 471

Trauma 325

Treatment 85

Triangles, Suboccipital 209

Trophicity 98

Tumor 322

Typhoid spine 323

U

Ulcer, Varicose 521

Unity, of the body 58

of the nervous system 99, 125

Tarsal subluxations 375

Tension, Arterial 152

Intracellular 35

Muscular 59

Testing alignment and flexibility 384

Therapeutics 173, 185

Osteopathic 24

Scientific 36

Thorax 335, 395

Tissue relations, Disturbed 38

Torsion 486

Toxemia 323

Traction, Femur dislocation 509

Vaso-motion 215

Vaso-motor nerves 160, 362, 522

Veins, Varicose 521

Vertebra, Fifth lumbar 263

Sixth cervical 481

Vertebrae, Cervical 295

Lower dorsal 302

Violence, Effect of 41

Viscera 192

Viscera, Plurisegmental control

of 329

Visceral disturbance 63

ganglia 148

pain, Referred 326

Date Due

CAT. NO. 23 233 PRINTED IN U.S.A.

T198p
1916
Tasker.

Principles of osteopathy

UCI CCM LIBRARY