{"1": {"fulltext": "", "height": "4740", "width": "3096", "jp2-path": "principlesofost00hazz_0001.jp2"}, "2": {"fulltext": "", "height": "4719", "width": "2971", "jp2-path": "principlesofost00hazz_0002.jp2"}, "3": {"fulltext": "V y o", "height": "4748", "width": "2954", "jp2-path": "principlesofost00hazz_0003.jp2"}, "4": {"fulltext": "", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0004.jp2"}, "5": {"fulltext": "", "height": "4435", "width": "2738", "jp2-path": "principlesofost00hazz_0005.jp2"}, "6": {"fulltext": "", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0006.jp2"}, "7": {"fulltext": "PRINCIPL-ES\\nOF-\\nPATHY\\nSECOND EDITION,\\nBY\\nGlias. n^^Y^^rA, Ph.T^. D. O\\nProfessor of Principles of Osteopathy in the American School of Osteo-\\npathy and Member of the Staff of Operators in the A. T. Still\\nInfirmary, Kirksville, Missouri. 1898-99.\\nKIRKSVILLE\\nJOURNAL PRINTING CO.\\nI 890.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0007.jp2"}, "8": {"fulltext": "tr\\\\\\n2fi753\\nPREFACE.\\nSince the first appearance of this work, the course of lectures of which\\nthe first edition was composed, has been increased in number to forty-four.\\nThe first edition contained discussions of theory, together with a review\\nof the human body, part by part, with indications for Osteopathic examina-\\ntion and treatment of the same. The second edition contains in addition, lec-\\ntures upon specific diseases, with descriptions of the Osteopathic method of\\nexamination and treatment of the same. A limited number of cases has been\\nthus treated, the idea being not to make this volume a Practice of Obteopath}^\\nbut to show the method employed in diagnosis and treatment of the several\\ndifferent classes of cases that the Osteopath meets in daily practice. For ex-\\nample: acute conditions, such as typhoid fever, diarrhoea, and the like, and on\\nthe other hand, chronic affections, such as spinal curvatures, constipation and\\nother complaints of a similar nature, have Vjeen dealt with.\\nTo this there have been added a few lectures upon the History of Medi-\\ncine, and a brief consideration of other systems of healing, such as Faith Cure,\\nMassage, Electricity, etc., in order that the student may know the principles\\nof such systems, and learn to point out the independence of Osteopathy from\\nthem all. Chas. Hazzard.\\nKirksville, Mo., Jan 30, 1899.\\nTWO COPIES fieceivcB.\\nMAliH]899\\nCOPYRIGHT 1898, BY CHAS. HAZZARD, D. O.", "height": "4410", "width": "3002", "jp2-path": "principlesofost00hazz_0008.jp2"}, "9": {"fulltext": "Principles of Osteopathy.\\nLECTURE I.\\nI. GKNKRAL CONSIDKRATIONS.\\nlycarn to treat understandingly; imitate no operator s motions. Emerson\\nsays, Imitation is suicide. Take for instance a case of erysipelas. Should\\nthe operator treat about the sore spots, occuring usually on one side of the face\\nnear the ear, and treat there alone, without giving attention to the general con-\\nditions of the patient, taking into account the affections of the kidneys, liver\\nand other organs, in this trouble he would certainly not meet with success. One\\nmust understand the nature of the disease which he is treating.\\nMake a correct diagnosis of the case. There are no two cases alike. You\\ncannot take it for granted that one case which you receiv^e today is like the case\\nW hich you treated yesterday. Look over the case thoroughly making an in-\\ndividual diagnosis for it; likeness and unlikeness to other cavSes are incidental\\nonly. Make no diagnosis by telephone, as I knew a physician a fellow towns-\\nman of mine did once. Remember that a young doctor s succcess often de-\\npends upon how he handles a simple case. For instance headache, which al-\\nthough not always simple, is frequently so. Should you be called first upon a\\ncase of headache and treat it successfully, granting it was a simple case, your\\nfuture success in that town in which you may be located, may depend on that.\\nI may cite here an incident told of Thoreau. It is said that, traveling on a train\\none day, he had occasion to lower the car window; soon thereafter he was ac-\\ncosted by a manufacturer traveling upon the same train, who said that he had\\nnoticed his delicate manipulation of that window and upon the strength of that\\nobservation offered him a position in his factory.\\nHave your theories but stick to facts. Remember that you cannot always\\ntreat a case according to preconceived theories that each case is peculiar to\\nitself. Huxley says, Theories do not alter facts, and the universe remains\\nunchanged, even though texts crumble.\\nII. GKNKRAI, CONSIDERATION OF THE SPINK.\\nOrigin of the Spinal Nerves (Holden): The origin of the eight cervical\\nnerves corresponds to the interval between the occiput and the 6th cervical\\nspine.\\nThe origin of the first six dorsal nerves corresponds to the interval be-\\ntween the 6th cervical and the 4th dorsal spines.\\nThe origin of the lower dorsal nerves corresponds to the interval between\\nthe 4th and nth dorsal spines.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0009.jp2"}, "10": {"fulltext": "4 THE SPINE.\\n**The origin of the five lumbar nerves corresponds to the interval between\\nthe nth and 12th dorsal spines.\\nThe origin of the five sacral nerves corresponds to the last dorsal and first\\nlumbar spines.\\nLandmarks along the spine: Holden instances a median furrow caused\\nby the prominence of the erectors spiuae, which extend along the spine as far\\nas the interval between the 5th lumbar vertebra and the sacrum. Hollows upon\\nthe surface correspond generallj to prominences of the skeleton, and vice versa.\\nThis is on account of the attachments by tendons to prominent skeletal points.\\nSharp friction will redden the spines of the veterbrae so that they can be count-\\ned and notice whether they are in line or not. The level of the 3rd dorsal spine\\nis the level of the beginning of the spine of the scapula.\\nThe level of the 7th dorsal spine corresponds to the inferior angle of the\\nscapula.\\nThe level of the 12th dorsal spine corresponds to the head of the last rib.\\nThe level of the 3rd intercostal space corresponds with the root of the spine\\nof the scapula.\\nThe level of the 3d dorsal spine corresponds with the 3d intercostal space.\\nThe level of the 3rd intercostal space corresponds with the level of the\\nright and left bronchi, the right being nearer the posterior chest wall.\\nThe following is a convenient method for ascertaining the position of the\\n1 2th dorsal spine: Have patient fold his arms and lean forward, thus bringing\\nthe spines of the vetebrse out prominently; then the lower border of the trape-\\nzius muscle can be traced to the 12th dorsal spine.\\nThe kidney is best reached by pressure below the level of the last rib at the\\nouter edge of the erector spinse.\\nThe tip of the crest of the ilium is about the level of the spine of the 4th\\nlumbar vertebra.\\nThe ilio-costal space extends from the lower border of the 12th rib to the\\ncrest of the ilium, varying in width from the width of a finger to that of a hand.\\nSo says Holden. I would caution you, however, in the former case to ascer-\\ntain carefully whether or not there be a dropping of the ribs and alteration of\\nthe chest in its antero-posterior diameter. Such a condition, a narrow ilio-costal\\nspace, is usually accompanied b} neurasthenia and kindred affections in the\\npatient.\\nIn the depression below the occiput are found the edge of the trapezius\\nmuscle and the upper end of the ligamentum nuchse.\\nThe 2nd cervical spine is forked and rather prominent. The 3d, 4th and\\n5th cervical spines are not usually made out, as they recede anteriorly from the\\nsurface. The 6th and 7th (prominens) are prominent. The spines of the dor-\\nsal vertebrae correspond with the heads of the ribs next above, e. g,, the 4th\\ndorsal spine with the head of the 3rd rib. But the nth and 12th dorsal spines\\ncorrespond with the heads of those ribs.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0010.jp2"}, "11": {"fulltext": "EXAMINATION OF THE SPINE. 5\\nIII. II.LUSTRATIONS UPON THE SPINE.\\nIn the location of the atlas, it is felt only by making out its transverse\\nprocesses, which are readily felt on each side between the mastoid process and\\nthe angle of the inferior maxillary bone; the normal position being about mid-\\nway between these points on either side. Should there be a deviation from the\\nnormal, either to one side or the other, anteriorly or posteriorly, or a twist in\\neither direction, it is readily made out by the trained touch.\\nPeculiar vertebrae are found along the spine, viz. the 2nd, 6th and yth\\ncervical, 12th dorsal and 5th lumbar. The 2nd cervical is noticeable because\\nof being slightly prominent and bifid. The 6th and yth cervical because of\\nslight prominence. The 12th dorsal because it often marks what the Osteo-\\npath calls a break, a separation of the spines of the vertebrae occurring be-\\ntween the 12 th dorsal and ist lumbar. This is a point of importance. The\\nsame is the case. with the 5th lumbar, there often being a break between its\\nspine and the superior crest of the sacrum.\\nThe ligamentum nuchse is of great importance to the Osteopath. You will\\nremember that it extends from the occipital protuberance to the yth cervical\\nspine. You must learn to recognize it by touch. Frequently it will contract\\nand is the sole means of relieving headache when stretched.\\nHOW TO EXAMINE A SPINE.\\nIn the first place, notice if at any point along the spinal column the spine\\nof any vertebra is deviated laterally. In such a case there is usually a sore\\nspot in the muscles upon the side of the spine toward which it is deviated. In\\nthe neck we do not depend upon the prominences of the spines behind, to diag-\\nnose a slip in the vertebrae, but by turning the head to one side, thus bringing\\ninto prominence the transverse processes of the vertebrae, we may ascertain\\nwhether or not one is prominent anteriorly or posteriorly; in such a case a sore\\nspot usually is found at the end of the transverse process of the vertebra.\\nSpines may be separated at any point along the column; you may find the\\nspines abnormally far apart. We occasionally find what is designated a smooth\\nspinal column, by which I mean that a spinal column may have its vertebrae\\nso protected by the thickening of the ligaments or other structures as to obvi-\\nate the ordinary feeling one experiences in running the hand down the spine.\\nFor such a condition I have somewhat arbitrarily adopted the term, a smooth\\nspinal column. The natural curves of the spine may be changed, as will\\nreadily be observed by you in practice. I do not speak here of spinal curva-\\ntures, not at all; but frequently a slight, or it may be a marked, deviation from\\nthe natural curve described by the normal spinal column, will be noticed.\\nHence, if there is a break, ligaments often cause lesions in that they may, by\\nthe displacement of the bouv parts to which they are attached, be dragged\\nacross some important structure, such as a nerve or blood vessel, thus compres-\\nsing it and abridging its function.\\nThese points upon how to examine a spine will be continued in further\\nlectures, and their significance to the Osteopath be fully considered at those\\ntimes.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0011.jp2"}, "12": {"fulltext": "LECTURE n.\\nI. CENTERS OF THK SYMPATHETIC: \u00e2\u0080\u0094These centers are of vast import-\\nance to the Osteopath. Reasoning according to centers is frequently with\\nhim going from effect back to cause, and of course from periphery back to cen-\\nter. It instances one of his modes of thought; and to acquire this habit of mind\\nand thought is frequently the basis of our professional success. There is a\\ngiven definite center for the activities of a given point or organ. For instance,\\nthere is a center for which we work to affect the kidney; or, we maj^ say, there\\nis a given definite center for each physiological process. As for instance, there\\nis a center upon which we work to affect the general circulation. In the absence\\nof a discoverable lesion, which frequently occurs, the Osteopath s work must be\\nlargely on the centers, sometimes entirely so. Even when the lesion has been\\nfound and attended to, he must give much attention to the particular center\\ngoverning the part affected. Remember, it is going back to first principles.\\nI would beg you to remember that the following points have been gathered from\\nvarious .sources; from the experience of operators, from lectures heard from oth-\\ners, from books, from conversations, from my own personal experience, and\\nthat I cannot in every case give you the authority for the center designated. I\\nspeak of the centers more in an Osteopathic than in a purely physiological sense,\\nmeaning that point along the spine which has designated itself as a center in\\nresponse to the work upon it; results justify such statements. In other cases,\\nof course, these so-called centers are the physiological centers indicated by the\\nauthorities.\\nCenters of the Sympathetic. (For the following centers I am especially in-\\ndebted to Drs. Alice Patterson and C P. McConnell.):\\nThird cervical vertebra, middle of neck. Above manipulate upward; below\\nmanipulate downward.\\nThird, fourth and fifth cervical, origin of the phrenic hiccoughs.\\nThird, fourth, fifth and sixth, vaso motors. The superior cervical gang-\\nlion is connected with the first to fourth cervical nerves. This ganglion lying\\nopposite the second and third cervical vertebrae. The middle cervical ganglion\\nconnected with the fifth and sixth cervical nerves; this ganglion lying opposite,\\nthe sixth and seventh cervical vertebrae.\\nThe point between the first and second dorsal vertebrae, the center to the\\nlungs.\\nFirst rib for heart flutter.\\nBetween second and third dorsal, ciliary center, and recti of eye ball.\\nBetween fourth and fifth dorsal on right side for the stomach center; on the\\nleft pneumogastric for the pyloric orifice.\\nFifth and sixth dorsal, vaso motors to the arm.\\nFifth, sixth, seventh and eighth dorsal, great splanchnics*\\nEighth dorsal, center for chills.\\nBetween eighth and ninth dorsal, center for liver.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0012.jp2"}, "13": {"fulltext": "SPINAL CSNITERS. 7\\nNinth, tenth and eleventh dorsal, small splanchnics.\\nTwelfth, smallest splanchnic.\\nFrom a point between the seventh cervical and first dorsal to a point be-\\ntween the eighth and ninth dorsal, the center for the anterior dorsal branches,\\nwhich convey dorsal branches to pulmonary center. The posterior pulmonary\\nplexus connects with the second, third and fourth ganglia of the sympathetic.\\nThe anterior pulmonary plexus from the pneumogastric and sympathetics.\\nVaso motors to the lungs have been found in the dog from the second to the\\nseventh dorsal. This corresponds to the centers upon which we work in man\\nto reach the lungs.\\nSecond lumbar vertebrae, center for parturition, micturition, defecation.\\nThird lumbar, coeliac axis.\\nPoint between fourth and fifth lumbar vertebrae, defecation.\\nFifth lumbar, center for hypogastric plexus.\\nFrom a point between the second and third sacral to a point between the\\nfourth and fifth sacral, center for the neck of the bladder.\\nFourth sacral, center to relax vagina.\\nFifth sacral, sphincter ani (the latter two are spinal branches.)\\nThe term cervical brain has been applied by Dr. Still to the region lying\\nbetween the first cervical vertebra and the fourth dorsal vertebra. The term\\nabdominal brain, has been applied by him to the region lying between the\\nfirst dorsal and third lumbar vertebrae. Pelvic brain, to that region lying be-\\ntween the tenth dorsal and fifth lumbar vertebrae.\\nOther centers of the sympathetic are as follows:\\nSensation, atlas to fourth dorsal.\\nMotion, fourth dorsal to sixth dorsal.\\nNutrition, sixth dorsal to coccyx.\\nThese three centers are spoken of by Dr. Still, not fully understood b} me\\nand are still food for thought.\\nCenters in the medulla as follows: Cough, sneeze, vomit, respiration, sal-\\nivation, phonation and deglutition, renal center, center for spasms.\\nVaso motor centers: Medulla, second to sixth dorsal, fifth lumbar.\\n(I remember once when sent to attend a case of Dr. Hildreth s, his words\\nto me were, Reduce the fever by desensitizing in the superior cervical gang-\\nlion, the middle donsal and lower lumbar.\\nCilio-spinal center, fifth cervical to the second or fourth dorsal.\\nTo dilate the iris and contract the pupil, from fifth cervical by the superior\\ncervical ganglion.\\nHeart center, in the corpora striata; first rib; first, second, third, fourth\\nand fifth dorsal vertebrae.\\nCervix uteri, ninth dorsal.\\nBlood supply to ovaries, eleventh dorsal.\\nUterus, second lumbar, second and third cervical vertebra, also from hypo-\\ngastric plexus by the lower dorsal and four upper lumbar nerves and through\\nthe splanchnics.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0013.jp2"}, "14": {"fulltext": "8 EXAMINATION OF THE SPINE.\\nVaso motois of the head: The eye, ear, salivary glands, tongue, brain,\\netc., are all reached at the superior cervical ganglion. Here also a general vaso-\\nmotor effect to the body is claimed. Vaso constrictors for the head are said to\\nexist at the fifth and sixth dorsal vertebrae. Stimulation of the superior cervi-\\ncal ganglion has a vaso constrictor effect upon the vessels of the retina, proba-\\nbly through its ascending branch and its connection with the fifth nerve.\\nThe lungs, second to seventh dorsal vertebrae.\\nJejunum, first to fifth dorsal vertebrae.\\nSmall intestine, above first lumbar.\\nLarge intestine, first to fourth lumbar.\\nlyiver, from the splanchnics, vagi, and inferior cervical ganglion.\\nKidneys, at the sixth dorsal, second lumbar, renal splanchnics and superior\\ncervical ganglion.\\nSpleen: splanchnics on the left side, eighth to twelfth dorsal.\\nLower limbs, second dorsal down.\\nCirculation, superficial fascia (the second dorsal for the upper part of the\\nbody, the fifth lumbar for the lower part.)\\nValves of the heart, second to fourth dorsal.\\nRhythm of the heart, third and fourth cervical.\\nThe genito-spinal center and lower hypogastric plexus and plexus to intes-\\ntinal canal, bladder and vasa deferentia, at the fourth and fifth lumbar.\\nBowels, peristalsis, ninth, tenth and especially the eleventh dorsal.\\nLarynx, first, second and third cervical.\\nIII. How TO Examine a Spine. (Continued.) Look for the lesion al-\\nways. It may be high above or much below the usual center. For instance,\\nwe may work as high as the lower dorsal for sciatica, its center being in the\\nsacral plexus. This lesion may be in the nature of a strain, congested muscle,\\na dragging of ligaments, a tightening of the ligaments, thus drawing the verte-\\nbrae together. It may be in the nature of a sprain or break. It may even be\\nabsent. But remember that your duty is not done until j^ou have thoroughly\\nlooked for the lesion. A congestion of the spinal muscles is often noticed on\\nexamination; it may be of the superficial muscles or of the deep muscles; it may\\nbe primary or secondary. By primary, I mean a congestion to the muscles set\\nup by some direct effect upon them, e. g., the effects of a draft or a blow. This\\ncongestion involves the peripheral termination of the spinal nerves, acting\\nthrough them and through their sympathetic connections to affect some inter-\\nnal viscus. By secondary, I mean the reverse, for example, the stomach may\\nbe affected, and the affects may be transmitted over the solar plexus back along\\nthe splanchnics thence to the spinal nerves with which the splanchnics are con-\\nnected, thence back over the peripheral terminations of these nerves to the skin\\nand muscles of the back. You may, in your examination of the spine, find\\nthat it is frequently rigid, not pliant; on the other hand, you may find that it\\nis quite relaxed; abnormally mobile.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0014.jp2"}, "15": {"fulltext": "CONSIDERATION OF THE SYMPATHETIC. 9\\nLECTURE III.\\nI. Further Consideration of the Sympathetic System: I have\\nalready spoken of the importance that we as Osteopaths attach to centers, espec-\\nially to those centers which I have given you along the spine. The theory of\\nour work upon them and their significance in connection with disease we shall\\ntake up later. I may in passing, however, say that they are one of the most\\nimportant things by which the Osteopath has to work. The same is true of\\nthe sympathetic system in general. The general anatomy of the sympathetic\\nsystem is doubtless already known to you, but there are points which I wish to\\nrecall to your attention and cite you their significance from our standpoint.\\nPoints FROM Quain: The sympathetics are connected with the spinal\\nnerves by white and gray rami communicantes. The white are medullated and\\npass from the spinal nerves to the sympathetic ganglia. Some white fibres pass\\nfrom the ganglion to the efferent ramus. Some end in Ihe ganglia; they may\\nascend or descend in the sympathetic cord to higher or lower ganglia, thus con-\\nnecting with several, and being in this manner widely distributed to the sym-\\npathetics. The gray rami communicantes are non-medullated, or pale. They\\npass from the sympathetic ganglia back to the spinal nerves, the reverse of the\\nwhite. They arise from cells in the sympathetic ganglia. They may, rarely\\nhowever, run in the sympathetic cord to another ganglion, and then emerge to\\ntake their course to the spinal nerves. They enter the anterior primary divis-\\nion of the spinal nerves, divide to send some fibres centrally toward the cord,\\nsome peripherally through the spinal nerves to the general system. Those\\ngray fibres of the sympathetic which pass centrally join in part a recurrent\\nbranch of the spinal nerve and with it run to supply the vertebrae, the dura\\nmater, the ligaments and blood vessels of the spinal canal. Other filaments\\npass over the bodies of the vertebra and supply the intercostal and lumbar ar-\\nteries and viens, ligaments and bones. Thus, the central distribution of the\\nsympathetic nerve is of great importance to the Osteopath in his work of build-\\ning up a weak or defective spine, and helps, in part at least, to explain the\\nwonderful results he obtains in that department of his work. Those sympa-\\nthetic fibres which pass distally in the anterior and posterior primary divisions\\nof the spinal nerves supply the blood vessels of the body walls and muscles with\\nvaso-motor fibres, and the sweat glands of the skin with secretory fibres, and\\nthe hairs with pilo-motor fibres.\\nHere again the sympathetic system becomes significant from the Osteo-\\npathic point of view, and aids in explaining the reasons for the immediate re-\\nsults attained in keeping the skin, the so-called lung, and superficial fascia in\\ngood working order. It is important in cases of blood and skin diseases and in\\nfevers. The centers of the superficial fascia, you will remember are the 2d\\ndorsal and the 5th lumbar. The Old Doctor, who in the past few months has\\nbeen making special studies upon this subject, attaches great importance to\\nsuperficial fascia. Of equal, or perhaps greater importance, finally are the vis-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0015.jp2"}, "16": {"fulltext": "ro SYMPATHE^TIC SYSTKM. LANDMARKS.}\\nceral distributions of the sympathetic nerves, there being efferent branches run-\\nning forward from the sympathetic ganglion to the great pre-vertebral plexuses,\\nthe cardiac, solar, hypogastric and pelvic plexuses, so-called primary plexuses\\nand their secondary plexuses, e. g., the phrenic, renal, spermatic, coelic, super-\\nior and inferior mesentric, aortic, hemorrhoidal, vesical, etc. Their importance\\nto the Osteopath lies in the fact that through them he may regulate the actions\\nof the internal viscera to a wonderful degree. Thus we stumble onto the para-\\ndox that a man s internal, organic life may come under the control of anotker\\nto a greater or less extent.\\nSome gray fibres pass from the ganglia out over the efferent rami. I have\\nplaced here on the board a diagram from Quain in which you note illustrated\\nthe points which I have brought out concerning the gray and white rami com-\\nmunicantes and their connections with the anterior and posterior divisions of\\nthe spinal nerves, their course toward the cord and also the efferent rami run-\\nning outward to the great prevertebral plexuses. The medullated fibres, that\\nis, those of the white rami, may be, ist, sensory, running from the poster-\\nior root of the spinal nerve; 2nd, vaso and viscero-constrictors, from the 9th, loth\\nand nth cranial nerves ending in the sympathetic ganglion, whence their action\\nis carried out through pale fibres rising from cells in the ganglia. These fibres\\nthus have become demeduUated by passing through the sympathetic ganglia;\\n3rd, vaso dilators from the anterior and posterior spinal roots, and from the 9th,\\nI oth and nth cranial nerves, pass through the sympathetic ganglia, do not\\nconnect with any nerve cells therein, and reach the organ they supply as med-\\nullated nerves.\\nII. Landmarks. A tabular plan of the parts opposite the spines of the\\nvertebrae. After Holden. Opposite 7th cervical spine, apex of lung, higher\\nin females.\\nOpposite 3rd dorsal, aorta reaches spine, apex of lower lobe of lung, angle\\nof bifurcation of trachea.\\nOpposite 4th dorsal spine, aortic ends; upper level of heart.\\n8 th lower level of heart central tendon of diaphragm.\\n9th oesophagus and vena cava perforate diaphragm;\\nupper edge of spleen.\\nOpposite loth dorsal spine, lower edge of lung; liver comes to the surface\\nposteriorly; cardiac orifice of stomach.\\nOpposite nth dorsal spine, lower edge of spleen; supra -renal capsule.\\nOpposite I2th dorsal spine, lowest part of pleura; aorta perforates diaphragm;\\npylorus.\\nOpposite I St lumbar spine, renal artery; pelvis of kidney.\\n2nd termination of spinal cord; pancreas; duodenum\\njust below; receptaculum chyli.\\nOpposite 3rd lumbar spine, umbilicus; lower border of kidney.\\n4th division of aorta; highest part of ilium.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0016.jp2"}, "17": {"fulltext": "EXAMINATION OF THE SPINE. 1 1\\nApex of lung is most liable to disease; may be examined by percussion at\\nexternal end of clavicle.\\nAngle of bifurcation of trachea is in some cases opposite the 4th dorsal\\nspine. This angle corresponds in front with the junction of the first and second\\nparts of the sternum. As to the kidney, its upper border may be as high as the\\nlevel of the space between the nth and 12th dorsal spines. Its lower border\\nmay extend as low as the 3rd lumbar spine.\\nIII. How^ To EXAMINE A Spine. (Continued.) I spoke in a previous\\nlecture of variations of curves of the spine from the normal. A few more words\\nconcerning this. There may come to your notice in your examination of a\\nspine a flattening between the shoulders; on the contrary, the tendency there\\nmay be posterior decidedly. The same condition may prevail immediately be-\\nlow the shoulders about the middle of the back. You may have a posterior\\nflattening of the lumbar region, which naturally, as you know, is curved an-\\nteriorly. But, on the other hand, you may have too pronounced a tendency\\nanteriorly in this region. Again, you may have all of the normal curves of the\\nspine lessened, leaving what we describe as a straight spine. You will readily\\nsee that in such a condition the whole equilibrium of the body is more or less\\ndisturbed. You may find the sacrum itself too prominent posteriorly, or too\\nflat, thus increasing or diminishing the antero-posterior diameter of the pelvis.\\nFinally, you may find that the coccyx has been bent to one side, in which case\\nit may be the cause of piles; it may be bent forward, as frequently you will find,\\nfrom horseback riding, etc. In such a case it may become a mechanical imped-\\niment to the passage of fecal matter, thus mechanically causing constipation.\\nRemember, please, that in calling your attention to these points in how to ex-\\namine a spine, I have left aside the subject of their significance. That subject\\nwill be fully considered in later lectures.\\nLECTURE IV.\\nHOW TO EXAMINE A SPINE (CONCLUDED.)\\nThere are a few more points regarding the abnormal curves of the spine,\\nwhich I think will be useful to you flattening between the shoulders or pos-\\nterior tendency there the posterior tendency that we frequently meet with\\nalong the lumbar region or flattening there. Then the different positions that\\nwe find upon examination that the coccyx has assumed, and the dift erent posi-\\ntions in which we find the sacrum itself. Also I may mention the fact that\\nthere may be considerable variation in the curves of the spine, so that you maj^\\nhave quite a straight spine by the time you have looked over all the points.\\nHence the natural equilibrium may be destroyed in that way.\\nThere is one other point which you will probably find, and that is that a\\nvertebra may not only be slipped from side to side, but by following the curve\\nalong the spine we may at any point come to a vertebra extending backward\\nnot only one or two, but several may be displaced backward; or you may find", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0017.jp2"}, "18": {"fulltext": "12 SIGNIFICANCE IN SPINAI. EXAMINATION.\\na single one displaced anteriorly, I was treating a case not long ago in which\\none of the dorsal vertebrae was pushed anteriorly, and it had an effect upon the\\nkidneys. It generally affects the center near where it occurs.\\nHilton says that frequently he has found that a pressure of the head\\nstraight downward on the spine, and then rotation from side to side will cause\\na sensation of pain in the cervical region, and will be evidence of disease there,\\nwhen one has not been able to find it by other diagnosis. He has found that\\nthe general symptoms justified his locating the disease in the upper cervical\\nvertebrae.\\nThere is another point that is cot of very much importance to you, but you\\nshould understand it, because 3 our patients will notice it probably, and are apt\\nto ask you to explain why it should occur. That is, as you work along the\\nspine you may hear certain noises, somewhat like popping. You will find\\nthem all along the spine, sometimes distinctly on one side, sometimes distinctly\\non the other. Also when you are workidg in the neck, moving it from side to\\nside or in any way, you may get a click. Or the patient may hear it when he\\nis turning his head from side to side. Now the reason as to why 3 OU hear\\nthese noises along the spine is explained differently in the different regions. In\\nthe dorsal region there are three things that may move. The whole vertebra\\nmaybe moved; of course there is inter-vertebral motion, but we do not get\\nmany of these noises from that cause, on account of the way they are bound\\ntogether, being connected by inter-vertebral discs, with no synoviol membrane.\\nThe second place in which you may get motion is between the head of the rib\\nand its articulation with the bodies of the vertebrae and the inter- vertebral\\nsubstances. Then in the third place, you have motion between the tubercles\\nwhere they articulate with the transverse processes of the next verte-\\nbra below. In the neck the only place you are liable to get any click is between\\nthe articular processes of the vertebrae. These noises in the spine are not of\\nmuch significance, but you will meet them and of course would like to under-\\nstand them for the patient s sake, because if they find you do not understand\\nthese things, you may lose a valuable patient.\\nII. OSTEOPATHIC SIGNIFICA.XCE OF POINTS OBSERVED IN EXAMINATION OF\\nTHE SPINE.\\nAfter understanding fully how to examine the spine, your next question\\nnaturally is, When I have found these things along the spine, what is their\\nsignificance? If we do not know what they mean they are useless to us. When\\nonce you know^ the results of certain lesions it does not take you long to find\\nthe lesion. I have therefore for the present dropped the subject of the sympa-\\nthetic nerve, and have decided to devote one or two lectures to the general con-\\nsideration of the osteopathic significance of the points which we find in our\\nexamination of the spine. Remember, please, this cannot be given to you in\\nfull by lectures, and that you will recognize the full significance only in your\\npractice. I can make it plainer later when we take up particular cases. What\\nI want to do is to show you the significance of certain points, and to get you", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0018.jp2"}, "19": {"fulltext": "METHODS OF OSTEOPATHIC REASONING 1 3\\ninto the habit of osteopathic reasoning to show you how we look at these\\nthinga, and the process of thought followed.\\nThe first point, then, is as follows: In general, a lesion along the spine,\\nwhatever its character, affects the center at which it occurs, and thus may\\naffect cerebro- spinal life or sympathetic life, either or both. The former, if it\\nis more superficial, in general, and the latter if it is deeper in general. As to\\nthe character of the lesion, it may be of any form found in the examination of\\nthe spine. As to locality, it may be either superficial or deep. You may find\\nalong between the shoulders a flattening, which may extend as low as the 8th\\ndorsal, and interfere with the centers of the stomach. If it be serious in char-\\nacter it will extend deep enough to affect the sympathetics, and thus organic\\nlife, and you will probably have stomach trouble. If it is not deep enough to\\naffect the sympathetic life, it may affect the cerebro-spinal life and you will\\nhave a lame back; or if it is in the region of the 6th or 7th dorsal, pains may\\nrun around the ribs and meet over the pit of the stomach at the abdomen.\\nThe character of the injury may be such that it affects deeper structures, or it\\nmay have a more superficial effect.\\nThe next point in osteopathic reasoning is the consideration of the amount\\nor intensity of life displayed in any given condition. This is an important\\npoint, and perhaps not clearly expressed, but I will try to make it plain to you.\\nYou may have a rigid spine, or you may have a relaxed spine. Now, in gen-\\neral, the process of reasoning which the osteopath uses is about as follows^\\nThe fact that the spine is relaxed shows a lack of nerve force, a lack of life\\nthere. On the other hand, if there is great tension along the spine, the spine\\nis closely bound down and held together by the ligaments, so that you have a\\nrigid spine with little motion, the reasoning would be, to some extent at least,,\\nthat there had been an injury to the spine or a strain that had resulted in di-\\nrecting too much nerve force to that part of the body for a shorter or longer\\nperiod of time, which resulted in throwing too much food supply there, causing\\na thickening of the ligaments binding the vertebrae together. Of course col-\\nlaterlly, when too much life and vigor was thrown to that part it was robbing\\nsome other point.\\nTake several illustrations to make this clear: You may have a tension in\\nthe spinal muscles. It may seem queer to you, or to your patients, for you to\\ntell them that a muscle is contracted, congested or drawn, and has remained\\nthat way. It is hard to believe, but such is the fact. What does such a con-\\ndition argue to your mind? Simply that there is too great an amount of nerve\\nforce there, which, reacting upon the muscles, causes them to contract. In\\nthat case your nervous force is in the nature of a violent stimulation to those\\nterminal sensory nerves. On the other hand, it may be secondary from the\\ncondition of an internal viscus. There may be some visceral disease, say\\nstomach trouble, which would be reflected from the solar plexus out along the\\nsplanchnics to the spinal nerves, and through the spinal nerves back to their\\ndestination. There may be a misdirection of nerve force or life, which life is", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0019.jp2"}, "20": {"fulltext": "14 SIGNIFICANCE IN SPINAL EXAMINATION.\\nsent to the spinal muscles, and 3^ou have too great a supply of nerve force\\nalong the spine. We reason according to the amount of nerve force or life sent\\nto these points. Again, when you make a digital examination of the rectum,\\nyou ma} find that there is some irritation which acts in the nature of a stimu-\\nlation to the nerve force which supplies that rectal sphincter, and is causing it\\nto contract. On the other hand, you will find in some examinations that there\\nis no force put forth whatever, the sphincter is relaxed, and in such cases it is\\nvery likely that the patient is suffering from incontinence of fecal matter. In\\nthe one case there is too much nerve life, in the other too little. This may also\\nresult from visceral troubles. In a case of diarrhoea the Osteopath first exam-\\nines to find some lesion along the spine at the gth, loth, or nth dorsal, caus-\\ning too much nerve force to be directed from the sympathetic sj^stem to the\\nintestine so that there is too rapid peristalsis and also too great a secretion of\\n-watery matter. There is too much nerve life there, or there could not be too\\nmuch motion. On the other hand, in constipation, either something has hap-\\npened to deaden the nerve force or to disseminate nerve force to other parts of\\nthe body so that 3 ou have too little left. You have not enough energy to pass\\nthe fecal matter along its course, and the result is a case of constipation. This\\nis not a full explanation of all these cases, but I simply use them as illustra-\\ntions. You will find this a valuable point in Osteopathic reasoning. In the\\nformer case the Osteopath adopts such measures as will disseminate the nerve\\nforce and equalize it throughout the body. In the latter case he directs his\\nattention to a rational means of renewing the nerve force which is lacking at\\nthe point affected.\\nWhen you find upon examination that the spines are separated, what is\\nyour conclusion? Simply that some lesion has caused a relaxation. There is\\ntoo little life, and hence a separation. This may impinge upon the nerve cen-\\nters and there will be trouble according to the center over which the lesion has\\noccurred. In a case of a smooth spine, where every vertebra seems to be\\ndrawn down close to its fellow, there seems to have resulted a contraction of\\nthe ligaments connecting them, affecting almost all of the centers along the\\nspine to a greater or less degree; there may result neurasthenia, a general lack\\nof nutrition, general eye troubles, nervous troubles, circulatory affections.\\nA spine twisted leads us to look at the center which is affected. This\\nbrings us to the tension on the ligaments which I have mentioned a time or\\ntwo before. When we have a case in which there is a twist of the vertebra,\\nwe reason from the position of parts as to what ligaments are affected. Sup-\\npose, for instance, that a vertebra is twisted so that a spine instead of being\\nexactly in line, is turned toward the right, then what is the condition of the\\nligaments? The anterior and posterior ligaments along the bodies of the ver-\\ntebra will be obliquely upon a tension, the supra-spinous and inter spinous\\nligaments will also be upon a strain, the ligamentum subflavium on the left\\nside will be tightened and that on the right side tightened also; the inter-\\ntransverse ligaments on each side will be tight, and extend one forward and", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0020.jp2"}, "21": {"fulltext": "SIGNIBICANCK IN SPINAIy BXAMINA^ION. 1 5.\\nthe other backward. This is the method of reasoning you should adopt, and\\nyou should reason from the symptoms as to what nerves are affected. You\\nwill find that the ligaments may draw across nerves in such a way as to affect-\\nnervous life, either spinal alone or sympathetic through the spinal.\\nI mentioned along the spine certain peculiar vertebrae. In regard to the\\nsecond cervical vertebra, if you are a young Osteopath and examining your\\nfirst patient, you will be sure to find something wrong with that vertebra.\\nPlease bear in mind that it is not like the others, but has a prominent forked\\nspine. You may make the same mistake with the 7th cervical. You should\\nacquaint yourselves with these natural conditions, so that you may judge cor-\\nrectly as to any change from the normal condition. Then bear in mind also\\nthat the 12th dorsal and the 5th lumbar are very apt to be points of mis-\\nchief, and a separation is very likely to take place at those points. Between\\nthe 5th lumbar and the sacrum is a point which is frequently affected and\\nwhich makes a great deal of trouble. The 5th lumbar may be anterior or it\\nmay be posterior, and in such a case it depends upon your other symptoms as\\nto how you will diagnose your case. This may cause trouble with the viscera\\nsupplied by the sympathetic nerve, there may uterine trouble, trouble with the\\ngenerative organs of either sex, paresis, paralysis, or sciatica.\\nIn these variations from the normal curves of the spine in general the sig-\\nnification to the Osteopath is as follows: It there is a flattening or posterior\\ntendency between the shoulders, you will generally find that the patient has\\nheart or lung trouble. You will expect to find some leision there affecting those\\norgans, which acts directly by impinging upon the nerves or by changing the\\nposition of the ribs. There may be a change in the first or second rib, causing\\nheart trouble; of the 7th rib, causing asthma. You may have heart or lung\\ntrouble there, or if it is as low as the 8th dorsal you may have stomach trouble,\\nor there may be renal trouble caused by a leison as high as the 2nd dorsal, or\\nsciatica as high as the 2nd dorsal. You must reason according to the centers\\naffected. If there is a change from the natural curve in the region of the\\nsplanchnics from below the shoulders to the first lumbar, then look for such\\ntroubles as intestinal affections, renal troubles, This same reasoning applies\\nin general to the sacrum and coccyx. The coccyx may cause either mechan-\\nical troubles, such as piles and constipation, or sympathetic trouble and affect\\nthe internal viscera in that way.\\nThe Osteopath finds the atlas of great importance to him in his work, for the\\nreason that it may impinge upon certain nerves, and may affect spinal centers;\\nor it may act in such a way as to deprive the brain of its suppl}^ of nutrition,\\nand thus lead to results which are very significant to the Osteopath. It may act\\nin such a way as to shut off the blood supply to the brain, and it may affect\\nevery center in the brain. Hence, you may commonly find that j^our patient\\nhas been unable to speak for a long time, or has been unable to hear plainly, or\\nhe may have become insane. It may also impinge so much that it presses on\\nthe cord and robs it of its nutrition, so that there may follow various spinal", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0021.jp2"}, "22": {"fulltext": ".J 6 SIGNIFICANCK IN SPINAI, EXAMINATION.\\ntroubles. It may press upon it on one side, causing hemiphlegia, the patient\\nliaving no use of one half of his body, the legs and arms being small in the\\ncase of a child where the development has been impaired. This is the Osteo-\\npathic way of looking at a case when you find that the first cervical has been\\nslipped. I had a case of this kind not long ago. The result was that the child\\ncould not speak; it could say Mamma, but everything else that it said was\\njust a peculiar sound; it could not articulate except that single word. In ad-\\ndition to that its left side was paralyzed, or there was a paresis there; the child\\nlimped, the leg was short and the arm was drawn up. The whole trouble there\\nwas really at the first cervical vertebra, which was slipped, affecting the spinal\\ncord and the brain, either through its blood supply or directly by impinge-\\nment.\\nWhat is the significance of the noises that we find along the spine? Usu-\\nally nothing whatever. You may find noises all along the spine in a man who\\nis quite healthy. But on the other hand, it may have considerable significance\\nand these the Osteopath should always take into consideration. As I have ex-\\nplained, either the heads or tubercles of the ribs may be slipped, or the position\\nof the vertebra may be changed, or the articular processes may cause a great\\ndeal of trouble in the neck. The Osteopath in thinking of these things thinks\\nof the normal anatomy of the part. He says, here is a point which may be sub-\\njected to a strain or twist, it can be extended or shortened to some extent, so\\nthat these are moveable points; and being points at which a strain may occur,\\nare points which are liable to disease. You will find this of great significance\\nin the etiology of spinal curvature. Along this line I simplj^ want to quote\\nfrom Halliburton. He says Diseases of the spine may begin in the vertebrae\\nor in the inter-vertebral substances; I think on the whole, in the intervertebral\\nsubstances where it is joined to the vertebrae. His editor. Dr. Jacobin, says\\nthat his view is supported by the fa^-t that the junction of a more with a less\\nelastic body is the weakest spot and therefore receives the full effect of the\\nstrain. He instances the case of an atheromatous artery, the weakest portion\\nis where the diseased wall joins with the more elastic substance of the healthy\\nwall, and it is at that point where the real strain comes and where an aneurism\\nis likely to occur. Hence, as explained, here arises for the Osteopath the\\nsignificance of a distorted vertebra, causing a slight irritation of the parts,\\nthrowing too much blood and nerve force and life there and setting up some\\nirritation, causing a thickening of the ligaments and perhaps a permanent injury\\nto certain parts, especially the nerves.\\nThe Osteopath realizes that the ill effects of injuries along the spine are\\nnot dependent upon their great extent. That is to say, you may have a very\\nbad curvature of the spine which is congenital, or there may be a ver}^ bad cur-\\nvature of the spine which had come on through years, without very serious\\ntrouble following. In such cases where the curvature has covered a very long\\nperiod of time, or where a child has been born so, the parts become adapted\\nto the variation from the normal, and such persons may go through life with", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0022.jp2"}, "23": {"fulltext": "SIGNIFICANT POINTS IN DIAGNOSIS. 1 7\\ngood organic life, I have seen some cases of dwarfs or hunch-backs, who had\\nvery good health; and reasoning from the Osteopathic standpoint, we some-\\ntimes wonder why it is in such pronounced curvatures of the spine, the person\\ndoes not have stomach trouble, bowel trouble, why the kidneys are not affected\\nand so on. On the other hand, you may have a man with a vSound back, but\\nwho has a little twist of one vertebra, which may make him a great deal of\\ntrouble. So the Osteopath reasons not from the great extent of the departure\\nfrom normal, but from the center affected and from antecedent conditions. Hil-\\nton says that almost all diseases of the spine are the result of some slight strain\\nor some slight accident, and that is what the Osteopath finds every week of his\\npractice. A man will come into your ofiice in trouble; you will find a spinal\\nlesion. He knows he never fell, a horse never kicked him or anything of that\\nkind, but in about three weeks he will come and tell you that he went home\\nand talked with his wife, and she reminded him of that time he fell down\\nthe court-house steps, or something of that kind. He has had some accident\\nw^hich he had overlooked, but which has caused some slight lesion of the spine,\\ntaking time to develop, but which has at last caused considerable trouble.\\nHilton also instances a very serious case in which the lesion of the spine was\\nnot discovered at all; it was only after the patient had been fourteen years a\\nparalytic and died that post mortem revealed the fact that the 5th, 6th and 7th\\ncervical vertebrae had been ankylosed. The fall which caused it was a fall of\\nforty feet upon his back and neck; upon examination of the patient he was un-\\nable to find any lesion in these parts at the time. So the lesion may not be\\ndiscoverable.\\nOnce more, Hilton says that he believes many cases of spinal diseases are\\ndue to a slight injury which has been overlooked, or to exercise persisted in\\nafter fatigue. A man falls down, says he has not been hurt, gets up and rubs\\nhimself to restore circulation, and thinks nothing more of it; but as Hilton\\nsays, very slight injury may cause very serious results, and the Osteopath has\\nto take all these things into consideration, and reason accordingly.\\nLECTURE V.\\nAt the last lecture I called your attention to how to examine the spine,\\nconcluding that subject. I also took up the Osteopathic significance of certain\\nspecial points which we had before noticed in our examination of the spine.\\nIn general, a leision affects a center over which it occurs. The Osteopath rea-\\nsons from the amount of intensit} of nerve forse display at any point. Spines\\nmay be separate or approximated. I called your attention to the special verte-\\nbrae, the 2ud and ytli cervical, and leison at the 12th dorsal and 5tli lumbar,\\nand instanced the results of such lesions. I called your attention to the dis-\\nplacement of the atlas, stating that it was of great significance to the Osteopath,\\nas it may shut off blood supply to the brain and may impinge upon the cord,", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0023.jp2"}, "24": {"fulltext": "1 8 SIGNIFIGAN.C^ OF POINTS IN DIAGNOSIS.\\ncausing serious troubles. I also called your attention, finally, to the fact that\\nthe Osteopath does not measure the injury by its vast extent, instancing the\\ncase of the hunch-back with good organic health, versus the case of a man.witjh\\na slight slip or twist of one vertebra having great trouble.\\nI wish to-day to continue this line of thought, taking up then, as the head\\nof this lecture: The further consideration of the Osteopathic significance of\\npoints in diagnosis. I failed to explain fully to you the significance of the\\nclicking in the neck. From what I said you may have gathered the impression\\nthat it has no significance, or very slight, as those noises which occur lower in\\nthe spine. Such is not the case, however; if you hear the click, the reason is\\nbecause something has shut off the blood supply, it may have been a little strain,\\na congestion of the muscles, anything that will produce a tension over the blood\\nvessles, or affect their vaso-motor fibers, causing a contraction and shutting off\\nthe blood. This may prevent the right amount of lubrication being deposited\\nin the synovial membrane between the articular processes of the vertebrae,\\nhence, you have the vertebrae too close together, and the patient in turning his\\nhead, or upon its being turned by the opeiator, elicits a click or grating, and\\nthe patient wonders what this is. To you such noises are of considerable sig-\\nnificance.\\nYou may find it useful to consider the various troubles which you will find\\nin your practice in relation to the plexuses from which they arise, and if you\\nadapt yourself to the habit of thought, and at once think, when you see trouble\\nin one part of the body, where they may have come from, what plexus is af-\\nfected, and what region in the spine, I believe it will be of considerable use to\\n3^ou. Now, there may be lesions of certain groups of nerves, the upper cer-\\nvical group of nerves, those from the first to fourth inclusive, may be affected\\nby spasms, convulsions, or by paralj^sis in general, I wish to call your atten-\\ntion to some points in relation to the distribution of nerves, and show you how\\nimportant it will be to you as Osteopaths to have a knowledge which you can\\nquickly call into use, of the distribution of the various nerves in the body. You\\nmay have a pain in the ear the person whom it affects may describe it as ear-\\nache. If this ear-ache occurs upon the anterior pendulous portion of the ear,\\nor upon the posterior aspect of the ear, you will have to refer that pain to the\\n2nd cervical nerve, which supplies those parts. If the ear-ache is in the canal\\nof the ear, or the upper anterior portion of the ear, you will have to refer that\\ntrouble to the 5th cranial nerve. Hilton states how it was that he happened\\nto find so definitely just how these nerves were distributed to the ear. The\\ncase was that in which an attempt had been made to cut a person s throat;\\nthe auricular branch of the second cervical nerve had been divided so that sensibil-\\nity had entirely departed from the posterior and lower parts of the ear. By prick-\\ning very carefully over the whole surface of the ear he found just the distribu-\\ntion of the nerves. You may have the ear-ache and tooth-ache. And why?\\nSimply because the 5th nerve supplying the auditory canal supplies also, by the\\nsuperior and inferior maxillary branches, the teeth of the upper and lower jaws", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0024.jp2"}, "25": {"fulltext": "PRINCIPLES OF OSTEOPATHIC DIAGNOSIS. I^\\nrespectively. You may have ear-ache associated with disease of the anterior\\nthird of the tongue, simply because the 5th nerve, which supplies sensation to\\nthe anterior third of the tongue also supplies the auditory canal. Pain in the\\nanterior lateral part of the scalp, over the temples, pain in the face, eyes, nose,\\ntongue, or teeth, you refer to this same 5th cranial nerve. On the other hand\\nin case the pain is in the back of the scalp, we have two areas, one supplied by\\nthe great occipital nerve, and one by the small occipital branch of the 2nd cer.\\nvical nerve. So it is that you have these areas of distribution given so that\\nyou can reason and thus refer pains in a particular part back to the origin of\\nthe nerves. Both the 5th nerve and these upper cervical nerves are readily ac-\\ncessible to the operator. You thus see what the significance of these things\\nare to the Osteopath in enabling him to make a correct diagnosis. If he is not\\nacquainted with the distribution of these nerves he is not able to trace back\\nand find the seat of the lesion. So it is by following correctly the distribution\\nof the nerves you may fit yourself to make a correct diagnosis.\\nIn general the diseases which occur from lesions in the upper cervical re-\\ngion are such troubles as torticollis, troubles with the phrenic nerve hiccough,\\nneuralgia, and troubles of that kind. Of course the Osteopath finds trouble\\nwith the phrenic nerve lower than the upper cervical group, generally arising\\nfrom the 3rd, 4th and 5th cervical. When an Osteopath meets such disease as\\ncrutch paralysis, writer s, violinist s or pianist s cramp, he refers such cases to\\nthe plexus at some point, or to a lesion affecting it centrally, I remember a\\ncase of crutch paralysis which I treated. It was simply secondary from the use\\nof a crutch, the crutch pressing upon the median nerve which comes from the\\ninner and outer cords, thus affecting that nerve and consequently the thumb\\nand first finger which are supplied by it. I^earn, then, to reason as to which\\nplexus is affected. Having known this and how to treat it, your diagnosis will\\nbe correct, and you will be able to go understandingly about what you are try-\\ning to reach.\\nHilton considers diseases of the upper cervical vertebra among the most\\nserious which may affect the spine. I quote from him as follows: No cases\\nof disease of the spine are so immediately dangerous to life as those of the upper\\npart of the cervical region, especially if situated between the first and second\\ncervical vertebrae. The reason of this is the close proximity of the bones to\\nthe spinal cord. There is danger of rupture of the ligaments about the odon-\\ntoid process of the axis, and in case this is ruptured or worn away by disease,\\nthe medulla may be impinged upon, thus affecting the centers located there, es-\\npecially the center of respiration, and so cause death. He instances a case\\nwhich I have thought would be useful to you. He had a case of a lady who\\nwas affected thus: She had pains upon the left side of her head at the back,\\npains behind the ear, and over the clavicle and shoulder, pains and muscular\\nparalysis of the left arm and deeper pain in the neck, which became apparent\\nby pressure of the head straight down upon the spine and rotation of the parts\\nthere. He found that about the ist, 2nd and 3rd cervical vertebra there was", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0025.jp2"}, "26": {"fulltext": "20 PRINCIPLES OF OSTKOPATHIC DIAGNOSIS.\\nsome tenderness slightly more marked on the left than on the right. He an-\\nticipated, that there was a history of some accident, but could find none, as the\\nlady knew of no accident that had occured. Her general health was very much\\naffected; she was unable to work; for she had very sleepless nights, and her\\nnervous system was very much affected in general. He diagnosed this case, of\\ncourse, from the tenderness in the cervical region; he diagnosed it as a disease\\naffecting the second cervical nerve, hence the pain is in the back of the head;\\nhe diagnosed it as affecting the 3rd, hence its distribution, also as affecting those\\nparts supplied by the nerves which go to make up the brachial plexus.\\nI simply bring this out to to demonstrate the need of accurac}^ in diagnosis,\\nthe need of reasoning closely along the lines of distribution of nerves. In this\\ncase Hilton found that the urine was affected, that it was ammoniacal, and\\na less skillful physician would have treated the case for bladder trouble, as in-\\ndeed often occurs. The point I wish to make is, that the Osteopath must not\\nbe carried astray by general symptoms. So where j^ou find foul urine, pain in\\nthe bladder, and things of that kind, you may be led astray; you surely wall be\\nif you are not one who knows his business. It is the dictum of one of the old\\nschools, I do not know which, to Watch the symptoms carefully and treat\\nthem as they arise. And that has seemed to be the practice followed. But\\nit does not need much reasoning to show you that should an Osteopath adopt\\nsuch a course, he would rapidl}^ become a failure in his chosen profession.\\nThere was a case here some time ago a youug man from Springfield, 111.,\\ncame here with one leg shorter than the other. He used crutches; he had a\\nsevere pain on one side of the knee of the affected limb. That man had travel-\\ned exstensively seeking help. He had been massaged and treated in almost\\nevery conceivable way; had lived in the hospitals for months. But one day he\\nsaid to the physician in charge, How does it happen that that leg is shorter;\\nWhat is the trouble with that knee? Well, he said, The bones may be\\nseparated and the tibia may have been pushed up, thus shortening that limb.\\nIf I remember correctly, that case was cured practically in one treatment. I\\ndo not say this to illustrate our quick cures. The treatment was sufficient be-\\ncause the muscles had been massaged, and were softened and ready to be work-\\ned upon. The hip was set. I became acquainted with the young man later.\\nI realized what it was to have the deformity cured. He had been treated for\\nyears for the knee, but the trouble was in the hip. This is almost a threadbare\\nillustration of what Osteopathy does; but it illustrates my point here perfectly.\\nIf you follow up the symptoms and treat them as they arise, you will land in\\nobscurity. I do not wish to criticise any system of medicine, but from our\\nstandpoint it will not do for an Osteopath to work in that way. If he does, he\\nis a poor Osteopath and does not understand what he is trying to do, and sim-\\nply makes what the Old Doctor calls an engine wiper. He goes after\\nthe seat of pain, and not the seat of the trouble, and simply becomes a masseur,\\nand, in his case, the criticism could justly be made, and that is sometimes claim-\\ned, that Osteopathy is nothing but massage.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0026.jp2"}, "27": {"fulltext": "PRINCIPI.KS OF OSTKOPATHIC DIAGNOSIS. 21\\nDr. Hildreth brought out this same point some time ago. He mentioned\\ntwo things that made up the success of the Osteopath. The first was in not\\nbeing too rough in our treatment, but the one I want to call your attention es-\\npecially to was that Osteopathy makes correct diagnoses. It goes back to the\\noriginal cause, and does not depend upon symptoms merely.\\nI wish to call your attention to the following point: That pain upon the\\nsurface of the body, not accompanied by any rise in temperature, indicates a\\ndistant origin of the trouble, and that trouble is usually in the spine.\\nHilton says that if this pain be upon the cutaneous surface then it will in-\\ndicate spinal disease in every case. I have had a drawing put here showing a\\nand b, the distribution respectively of the 6th and yth dorsal nerves. They\\nmeet over the pit of the stomach in the skin, and will refer a pain to that point.\\nThe patient thinks the trouble is there; his trouble is invariably at the spine.\\nHe, of course, will want you to treat the affected spot. There is a case on\\nrecord of pain in the pubes and over the lower part of the abdomen, the physi-\\ncian finding the trouble in the lower part of the spine, it being associated with\\nparalysis of the lower limbs, decided it was spinal trouble and rubbed an oint-\\nment on the spine. The patient thinking the symptoms should be treated,\\nrubbed the ointment over the lower part of the abdomen, being paid for his\\ninterference by a great deal of smarting. He wanted to treat the seat of the\\npain instead the seat of the lesion. It is true that these pains are not mere\\nhappen so s. They depend upon a close connection, as in this case, of the\\nnerves; this close connection may be either through the spinal nerves or it may\\nbe through the sympathetic system. You may have a pain at a part, which\\nyou may trace up through a nerve, back up through the cord to the brain or\\ncenter, down another nerve to the original cause; so that an original cause may\\nact along a nerve through a center and down through another nerve, so that\\nthat the seat of the pain is not the seat of the lesion. If such a patient comes\\nto you, do not become a masseur; do not treat the seat of his pain, but treat\\nthe seat of the lesion causing the trouble, and convert him by showing him\\ntrue Osteopathy.\\nA peculiar phenomena is often witnessed. You may come across a case\\nin which one part of the body is more sensitive than another; you may have\\nparalysis, both muscular and sensory, below an injured part, with acute hyper-\\nesthesia above. The explanation which has been given in such a case is two-\\nfold. In the first place take such a case as a fracture of the spine; of course\\nthe parts about the site of the injury are the seat of the inflammation: after the\\nfracture the parts are engorged with blood; there are exudations, both fluid\\nand cellular, about the parts, which may press upon the origins of the nerves\\njust above the seat of the fracture and may irritate for a considerable distance\\nup in the spine, thus causing considerable sensation above. Below the nerves\\nhave been injured by the trauma to the cord. The other explanation is chiefly\\nthe same except that in it the origin of the spinal nerves is taken into consid-\\neration; as you go further down the spinal coluam you will find that the roots", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0027.jp2"}, "28": {"fulltext": "22 PRINCIPLES OF OSTEOPATHIC DIAGNOSIS.\\nrun more and more obliquely in the canal, until finally the lower ones run an\\ninch and a half or an inch and three-quarters before emerging. And of course\\nwhen the impingement is upon the origin of those nerves, the pain will beat\\ntheir distribution upon the muscle and surface of the body. I had a case simi-\\nlar to this\u00e2\u0080\u0094 a man who is still in town for treatment. He has paralysis of the\\nlower limbs, almost a complete lack of muscular ability and also almost com-\\nplete lack of sensibility in the lower limbs. The lesion appears to be in the\\nlower part of the spine. I say appears to be, because there is another place\\nhigher up in the spine which may be the cause. But taking it as the lower\\none, he has a terrible itching and smarting along the spine; upon treatment,\\nhowever, he readily recovers from these symptoms. Now, the explanation\\nmay be similar to that given, and it may partake of the reasoning that I gave\\nyou the other day concerning Osteopathic matters. That is, that there\\nis too much life above, and there is too little life below; something has interfer-\\nred to cut off nerve and blood flow below, while that above is supplied with\\nits full quota already and does not need that which is misdirected to it, thus\\nthere is irritation to the parts above and the resulting symptoms. What the\\nOsteopath does is simply, as was indicated before, to try to restore the equili-\\nbrium of nerve and blood forces to the lower parts of the body which are suffer-\\ning, and then to the parts which are impinged upon above. To do this he sim-\\nply goes back to the parts affected.\\nQ. In the event of peripheral trouble, sensation, would j^ou also find the\\nsensation at the origin?\\nA. Not necessarily. You might not have any sensation there. Other-\\nwise; the patient would have himself perhaps discovered it. You may not have\\na sore spot at all; it may be such a lesion as spreading of the spines or approx-\\nimation of the spines, not necessarily any tenderness at the central, at the\\nlesion.\\nQ. Are there no exceptions to the rule that where there is pain on the\\nsurface, accompanied with rise of temperature, the trouble is of spinal origin?\\nA. I took Hilton as authority there, and he gives this example. It is\\njust as invariable as in the case of inflammation, in which the principal sign is\\nrise of temperature; you may have the sw^elling and the pain with out the inflam-\\nmation, but if you have these two and heat also it is a sign of inflammation. He\\nmakes a parallel and says it is just as invariable that if there is pain upon the\\nsurface of the body, not accompainedby rise in temperature, the cause is of spin-\\nal origin; he does not make any exception.\\nQ. I understood j^ou to say that the 5th nerve was reached through the\\nsympathetic?\\nA. The 5th cranial is reached through the superior cervical ganglion. We\\nget results which justify us in saying this; any operator will tell you that he\\ngets results from the superior cervical that influence the 5th nerve. Of course\\nhe does it by sympathetic connection, which I will explain at another time.\\nQ. In the case of that man with the pain on the inside of the knee, sup", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0028.jp2"}, "29": {"fulltext": "PRINCIPLES OF OSTKOPATHIC DIAGNOSIS. 23\\npose that he should have had localized trouble at the knee, would you have\\nrecognized the condition b}^ the lesion in the spine?\\nA. Yes, partly, and you would have to go into the history of the case.\\nYou would have to go back to your centers and determine what was the trouble.\\nThe first thin^ would be to go to the spine and thoroughly examine; if you\\nfind a lesion there, the probabilities are it is of spinal origin. You should by\\nall means whenever you have such a case, or any case, go back to the center of\\nthe nerve supply, and you may find the lesion there, above or below the center,\\nor you may not have a distinguishable lesion.\\nQ. In the event of a severe gastritis would there be a soreness in the\\nspinal region?\\nA. Very likely there would be, and in that case your soreness and con-\\ngestion of the muscles would be what I have explained as secondary.\\nQ. Which would be secondary?\\nA. The congestion of the muscles along the spine. In a case of severe\\ngastritis you would very likely find sore spots along the spine. The explana-\\ntion being that the nerve influence from the disturbed stomach travels along\\nthe sympathetic branches of the solar plexus back to the spinal connection of\\nthose nerves, and then passed through to the peripheral termination of the\\nspinal nerves in the muscles of the back.\\nQ. Is it true that you can designate which organ of the bod}^ is in trouble\\nby finding the tenderness in certain spots in the spine?\\nA. Yes, in general that is true. I thought I brought that point out in\\nmy last lecture. The sore spots may be due to either peripheral or central\\ntrouble, *and by determining whether they are primary or secondary you may\\nlocate the trouble by reasoning from the center to the periphery.\\nLECTURE VI.\\nAt the last lecture I called your attention to the further significance of the\\nthe clicking in the neck, stating that it frequently meant a lack of lubrication\\nsecreted in the synovial membranes. I began to take up the general effects of\\nlesions of plexuses along the spine, taking up the first group, the upper four\\ncervical nerves. I called your attention to the fact that pain must be referred\\nto the origin of the nerve supplying a part, instancing the anterior pendulous\\nportion of the ear and the posterior portion of the ear as being supplied by the\\nsecond cervical nerve, versus pain in the other parts of the ear indicating lesion\\nin the fifth cranial nerve. Hilton considers diseases of the upper cervical por-\\ntion of the spine among those most dangerous to life. The operator must not\\nconfuse symptoms with causes. He must not take, for instance, some symptom\\nwhich may be prominent, thinking it to be one of the first causes. If there is\\npain upon the surface of the body not accompanied by any rise in temperature, at\\nindicates disease of the spinal region. A peculiar phenomenon often witnessed", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0029.jp2"}, "30": {"fulltext": "24 principi.es of osteopathic diagnosis.\\nis that there is paralysis of sensation, or motion, or both, at a point below a\\nspinal injur}^, while there is acute hyperesthesia just above. The explanation\\nwas given that it was owing in part to the obliquitj^ of the course of the spinal\\nnerves, in part to the engorgement of the parts and the exudations, fluid and\\ncellular, which takes place around a serous lesion of the spinal cord. To-day I\\nwish to pursue this line of thought somewhat further, hoping to finish in this\\nlecture. That is, this general point of the significance of general symptoms to\\nthe Osteopath.\\nI. Further consideration of Osteopathic significance of points found in\\ndiagnosis.\\nThe lower four cervical nerves and brachial plexus constitute what is\\nknown as the second group of nerves. The brachial plexus sends short branches\\nto the shoulder and upper intercostal muscles, and long branches to the arms.\\nIn general the effects which may follow lesions to the second group of nerves\\na/e paralysis, spasms and neuralgias. Such troubles the operator must learn\\nto refer back to the center; that is, to the origin of the plexus along the spine.\\nShould you have palsy of the hand, or edema, which is neurotic in origin, such\\ncases you must refer to trouble in the brachial plexus. Of course this is speak-\\ning of these nerves as members of the cerebro-spinal system. Please remember,\\nalso, that the first Rroup of nerves is connected with the upper cervical gang-\\nlion of the sympathetic, and that the second group of nerves is connected with\\nthe second and third ganglia of the sympathetic, and that in case the lesion be\\nsevere enough to affect sympathetic life, you may in lesions in this region have\\nfar-reaching disturbances. Remember also that from the third, fourth and\\nfifth cervical nerves arises the phrenic nerve, and that injury here may cause\\ndiaphragmatic trouble; hiccoughs for instance, which we treat in that region.\\nThe third group of nerves is composed of the twelve doisal nerves. Of\\nthese the first six are connected with the first six dorsal ganglia of the sym-\\npathetic, and the last six but one are connected with the remaining six dorsal\\nganglia of the sympathetic. In their capacity as spinal nerves the members of\\nthis third group are subject, usually, to merely sensor}^ affections. Thus you\\nwill frequently come across in your practice, cases of intercostal neuralgia.\\nThis the Osteopath diagnosis, and is usually correct, as a pressure upon the\\nnerves, caused by crowding together of th2 ribs. Later, when we come to take\\nup the consideration of the thorax, 3^ou will find that we make prominent the\\npoint that the ribs are dropped together frequently or are drawn together, and\\nyou will learn to reason thus, as in the case of intercostal neuralgia, from the\\nOsteopathic point of view. Lesions here may also cause herpes zozter, com-\\nmonly called shingles, a nervous affection caused by eruptions upon the skin.\\nFrom their sympathetic connections this group of nerves may be associated\\nwith troubles of the pleura or lungs, and with sympathetic troubles of the vis-\\ncera, as 5^ou know the splanchnic nerves run from the sympathetic connections\\nof the dorsal nerves to the various viscera of the body.\\nThe fourth group of nerves is composed of the five lumbar nerves, the up-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0030.jp2"}, "31": {"fulltext": "POINTS IN OSTKOPATHIC DIAGNOSIS. 25\\nper four of these nerves, with the twelfth dorsal are connected with the upper\\nfour lumbar ganglia of the sympathetic. Diseases which may affect these\\nnerves as members of the cerebrospinal system are mainly neuralgic. Of course\\nyou may have paralysis or spasms, but you are not so liable to have them as in\\nlesions of the nerves of the cervical or sacral region. Sym^pathetic troubles of\\ncourse would occur according to the centers with which these nerves are con-\\nnected.\\nThe fifth group, finally, is that composed of the five sacral nerves. These\\nfive sacral nerves, with the fifth lumbar, are connected with the five sacral\\nganglia of the sympathetic. lycsions affecting these spinal nerves are such as\\naffect the cervical nerves in general, that is, paralysis, spasms, and neuralgias,\\nwhich may vary greatly in character. You may have tonic or clonic spasms\\nof the lower limbs; you may have neuralgia, such as sciatica; or you may have\\nparalysis of the lower limbs. Sympathetically, of course, you would refer to\\nsuch troubles as are indicated in the outline of centers given.\\nI have thus taken up the grouping of the nerves along the spine. Of course\\nit has been very general. The purpose has been to give you a general view of\\nregions affected, and to give you a general idea of how the Osteopath looks at\\ndisease; that is, he reasons from periphery back to center. My treatment of\\nthe subject has necessarily been general, leaving aside a more particular view\\nuntil such time as we shall take up these different affections which we meet,\\nmore in detail. I may in these last few lectures have been a trifle obscure; I\\nfind it a rather difficult subject to elaborate and, being so general, it may have\\nbeen indefinite. Still I trust that it may have fulfilled its object, which was,\\nbriefly as follows: In the first place, to indicate to you the necessity of keep-\\ning separate in your mind the cerebro-spinal system and the sympathetic system.\\nRemember that you cannot separate these entirely, but look for symptoms from\\nthe one and look for symptoms from the other, one is a cerebro-spinal vi ^w and\\nthe other a sympathetic. You do not really find them so separated in j^our\\npractice. Second, to impress you w ith the importance of diagnosis based ac-\\ncording to centers affected. Third, to teach you not to confound incidentals\\nwith essentials; not to mix mere symptoms with causes of disease. I thought\\nI could thus indicate to you, that Osteopathic point of view, that Osteopathic\\nhabit of mind in looking at disease.\\nHilton states that as a rule pain in disease of the lower cervical, dorsal\\nand lumbar regions is indicated by pains symmetrically upon the surface of\\nthe body. That in the upper c:rvical region being not indicated synunetrical-\\nly by pain upon the surface of the bod} The original cause for such pains\\nwe would look for, of course, in a central lesion. If the trouble be bi-lateral,\\nlocated on each side of the bod}^ we would look for a central cause, or perhaps\\nthe cause may be bi lateral, I instanced a case at the last lecture of pain over\\nthe skin a,t the pit of the stomach, being referred back along the course of the\\nnerves to the sixth and seventh dorsal vertebrce. Hilton instances a case in\\nwhich a boy had severe pain there; he went about stooping, holding his hands", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0031.jp2"}, "32": {"fulltext": "26 POINTS IN OSTEOPATHIC DIAGNOSIS.\\nover that region. Upon lying down the pain disappeared to some extent. His\\ndiagnosis of that case was that there was trouble at the sixth and seventh ver-\\ntebrse, and he found disease there of such nature that it exerted pressure upon\\nthe sixth and seventh nerves upon both sides. Another case similar, was more\\ncomplicated in that it led to vomiting. Almost any physician would have diag-\\nnosed such a case as stomach trouble, no doubt. Hilton, however, upon exam-\\nining the tongue found no indications of stomach trouble, and diagnosed that\\ncase also as disease of the sixth and seventh vertebrae, directed treatment to\\nthose points, and was successful in curing the case. Sometimes in such di-\\nseases we find a pinching feeling about the body, a feeling as if the body were\\ngirdled. Now, as to the reasons why the pains are symmetrical in these parts\\nof the body I have already indicated. But why the} do not occur so above is\\nsimply this: The difference in the nature of the vertebrse. Thus, below the\\nsecond cervical, the vertebrse articulate with each other by their bodies and ar-\\nticular processes, but above that point it is different; the atlas articulating with\\nthe occiput by just two points, and one might be affected without communica-\\nting with the other. The articulation of the atlas with the axis is by just three\\npoints; the odontoid process articulates with the anterior arch of the atlas, and\\nthe bodies by the articular surfaces. Now, any one of them may be affected,\\nand it is the rule that one of these is affected without communicating the dis-\\nease to the other. Thus you may have a symmetrical distribution of the pain.\\nA further point of importance is that if a certain organ is affected the im-\\npulse may be transmitted sympathetically from it and reflected to another or-\\ngan, and that always in such a case it is carried to that organ connected most\\nclosely by nerve strands to the organ first affected. Bryon Robinson says that\\nganglia of the sympathetic, especially the cervical ganglia and the abdominal\\nbrain, are points of reorganization of impulses sent to them, and of redistribu-\\ntion of these reorganized influences or impulses, which are sent to various vis-\\ncera, in general, to those most closely affected, those which are furnished with\\nthe greatest number of nerve filaments. I quote him as follows: It is a\\nprincipal in physiology that when a peripheral irritation is sent to the abdomi-\\nnal brain, the reorganized forces will be emitted along the lines of least resist-\\nance, so that the organ which is supplied with the greatest number of nerve\\nstrands will suffer the most. He cites here a prominent instance of uterine\\ntumor affecting the heart, and in this way, that the influence of the uterine\\ntumor upon the hypogastric plexus was reflected back through the solar plex-\\nus, where it was reorganized and sent out along the spalchnics to the superior\\ncervical ganglion and the next two below it, and was then sent out along the\\nthree cardiac branches to the heart, thus causing an irregularity of the heart,\\nleading finally to heart disease. This point is of great importance to the Os-\\nteopath. You will find it very common in your practice to find a case of\\nuterine trouble resulting in headache. Thoroughly apply any of the ordinary\\nmethods of treatment to the headache, and they will certainly be unsuccessful.\\nYou must learn to diagnose with these things in mind, and to reason according", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0032.jp2"}, "33": {"fulltext": "LANDMARKS OF THE SCAPUI.A. 27\\nto the connection of these parts through the sympathetic system. Now, in the\\ninstance given, the impulse might have been sent differently. It might have\\npassed from the hypogastric plexus to the solar plexus, being there reorgan-\\nized and then sent out to other viscera throughout the body, as is frequently\\nthe case. Or it might have run up through the sympathetic cord, reaching\\nthe medulla, then affecting the vagi nerves, resulting in stomach trouble.\\nAnother illustration I take from him. He calls to mind the fact that the kid-\\nneys, ovaries, uterus and fallopian tubes of the female are developed from the\\nWolffian bodies in the embryo. They are thus closely connected in nerve and\\nblood supply, and it is a fact that uterine trouble results often in kidney\\ntrouble, and kidney trouble may very readily result in uterine trouble. In\\nsuch a case it is difficult to diagnose the case according to the symptoms, and\\nto determine what must be the original cause. These secondary symptoms are\\nfrequently quite prominent, and treatment directed to them will not necessarily\\nhave any effect upon the original trouble.\\nII. Landmarks concerning the scapula. Holden instances the following\\npoints concerning the scapula. First, that it covers the ribs from the second\\nto the seventh inclusive on either side; that its superior angle is beneath the\\ntrapezius muscle; that its inferior angle is beneath the latissimus dorsi muscle;\\nthis latissimus dorsi binds the posterior edge of the scapula closely down\\nagainst the posterior chest-wall in a strong person. In case of consumptives\\nthe scapula is allowed to project outward at its lower angles, and this give the\\npeculiar appearance which is called, scapulae alatse. A horizontal line from\\nthe sixth dorsal spine to the inferior angle of the scapula outlines the superior\\nmargin of the latissimus dorsi muscle. A line drawn from the root of the\\nspine of the scapula down to the twelfth dorsal spine outlines the inferior bor-\\nder of the trapezius muscle. In examining a back it is convenient to have the\\npatient sit leaning forward with the hands hanging between the thighs; this\\nbrings the spine of the scapula down about the third intercostal space, on a\\nlevel with the fissure between the upper and lower lobes of the lung.\\nIII. How TO Treat a Spine: Having learned how to examine a spine,\\nhaving learned also the significance of points one finds along the spine in his ex-\\namination, the next question naturally is, how to treat these points when observ-\\ned. I am indebted to Dr. Eastman for calling my attention to the fact that often\\nthese noises which we may find in treating along the spine are of pecular sig-\\nnificance in this way: That he says he has often pushed ribs back into place\\nwhich had been slipped, simply by this pushing motion along the spine. In\\nour treatment of a spine there are two points which we may take into consid-\\neration; two objects which we may have in view. In the first place, we may\\nwish to treat the spine per se, treat the spine stself. In the second place, we\\nmay wish to reach, by treating the centers along the spine, the viscera to\\nwhich these nerves run. It is not always possible to dissociate these in your\\npractice. Indeed, this is more a separation of convenience. I have divided\\nthese points thus simply for convenience in the consideration of them. You", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0033.jp2"}, "34": {"fulltext": "28 HOW TO TREAT A SPINK.\\nwill of course, in practice not be able to separate the results upon the spine\\nitself from the result which you will get upon the centers when working along\\nthe spine, but the Osteopathy of it is the same, and I trust will be made clear\\nto you by this division.\\nNow, when you are treating a patient, one very good way to treat the\\nspine, to get everything relaxed, is simply to lay the patient on his face. The\\npatient, usually thinks he is relaxed when he may not be. I think those of you\\nwho are familiar with Delsarte methods will agree with me. Your first care is\\nto see that the patient has become fully relaxed. Now, we wish to learn how it\\nis that we ma}^ affect the central distribution of the sympathetic nerve. I spoke\\nto you the other day of the gray rami communicantes extending from the gan-\\nglia of the sympathetic back to the spinal column, supplying the blood vessels\\nof the dura mater and of the vertebrae, and the ligaments. Thus, is you wish to\\ntreat the spine itself, wish to strengthen it, of course j^ou must necessarily di-\\nrect you treatment to reaching these vaso motor nerves in order to relax and\\nallow sufficient nutriment to be sent to these parts. In order to do this you\\nmust always first loosen all the contractions of the muscles along the spine.\\nVery frequently you will find that the muscles are contracted unevenly and slip\\nunder your fingers. That is a test; a muscle may be hard, as it naturally is,\\nfrom exercise; then the hardness is homogenous. The first point, then, is to\\nloosen up the muscles, and in doing this it is well to bear in mind that you\\nmust work against the course of the muscle fibers, the deeper ones especially.\\nIt is perhaps easier in that way to get a relaxed effect, and your idea should\\nbe to work in such a way as not to hurt the patient. You may treat so hard\\nand so roughly as to damage. The motions that I may make, or the faces that\\nDr. Hildreth makes when he is treating a patient, are not any indication of\\nthe amount of force used, that is a habit, and the thing you should guard\\nagainst is too rough treatment as you may injure delicate parts. In seeking to\\nrelax a nerve you may irritate it, and thus cause the muscle to shrink. You\\nshould not manipulate with the tips of the fingers, you should turn the fingers\\nso that the cushion of the finger does the work, and in that way thoroughly re-\\nlax all the congested or contracted muscles along the spine?\\nWhat if you do not have any contracted muscles there? That, of course\\nis the condition in many cases. It is our work in such a case where the mus-\\ncles are flabby and there is a lack of tone, to stimulate all along the spine and\\nthus to tone up the parts. Do not be afraid of being thorough in this matter.\\nYou must relax all the muscles there from the occiput to the coccyx, as they\\nmay any of them produce sympathetic troubles which may be reflected over a\\nconsiderable portion of the body.\\nThere is a certain amount of hair splitting done over the terms of desensi-\\ntization and stimulation. Their significance I will take up later, but always\\nbear in mind that your first point must be to relax contracted muscles if you\\nfind them; if you do not find them your work should be directed toward reach-\\ning the deeper structures mechanically and securing an equal distribution of", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0034.jp2"}, "35": {"fulltext": "HOW TO TREAT A SPINE. 29\\nnerve force. If there are contractions, no matter what your final treatment is\\nto be, you must get rid of those contractions first. While the patient is upon\\nhis face there is an important effect which we get upon the spine itself. Of\\ncourse we cannot separate this really in our practice, that is, the work along\\nthe spine has its effect upon the body according to the centers reached. Sup-\\npostf I wish to reach the center going to supply the nutrition of these parts, I\\nspring the spines up, using the arm as a lever, and by so doing you can exert\\na grea^ deal of force. Drawing up the arms raises the ribs, and at the same\\ntime, by springing the spine I can get a considerable force all along the spine\\nThis is one way. Another way is to draw the limbs up; you will find this a\\nvery convenient method, this of course will bow the back and make prominent\\nthe spines, then you can readily reach under, and in that way you can spring\\nthe spine or any part of it; and it is always advisable for you to stretch the\\nspine in that way rather than to attempt to stretch the patient by pulling the\\nneck; that is a tensile strain upon the spinal column, and of course it resists\\nmore than it does a lateral force. You will find this useful in your practice.\\nThere is another method which we frequently use: getting one elbow down\\nagainst the upper edge of the pelvis, and the other against the prominent part\\nof the shoulder, and separating them, also reaching over the spines of the ver-\\ntebrae, you relax all along the spine. When you have done this upon one side,\\nrepeat it on the other. And why? Because when you spring the spine in this\\nway all along you have stretched the ligaments upon that side, but you have\\nnot stretched the others. You cau readily see that as I spring these spines the\\neffect must be to stretch the ligaments on the convex side, and to relax the\\nligaments on the concave side of the curve. So you must turn\\nthe patient over, treat the other side, providing you wish to\\ntreat the ligaments upon both sides of the spine. You may treat the muscles\\nalone in this way. When you have that object in view, which depends upon\\nyour case, usually you must exert considerable force, but do not dig. Do not\\nuse the end of your finger. You can develop strength so that 3 ou can keep\\nthe finders flat and work with the cushion of the fingers against the muscle,\\nand in this way you can get a very good effect upon the muscles themselves.\\nDo not be afraid, but keep at it until they are relaxed; do not treat too hard or\\nyou may stimulate, and they will contract more, but by deep work along the\\nspine you may have a soothing effect upon those nerves and thus cause them to\\nrelax. What has been the object of this work? Simpl} this, that by relax-\\nation of the contracted muscles or by stimulation of those weak, flabb\\\\ muscles,\\nyou have succeeded in drawing new life to that spinal column, and in that way\\nyou have made your first step toward reinstating the strength of that debili-\\ntated spinal column.\\nO. Is a simple manipulation there enough to relax the contracted mus-\\ncle?\\nA. Yes, simple manipulation is enough if rightly applied.\\n0. Is a dislocation of a vertebra liable to cayse giddiness?", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0035.jp2"}, "36": {"fulltext": "30 EXTERNAL MANIPULATION FOR INTERNAL RESULTS.\\nA. It may very readily. It may act in such a way as to shut off the\\nblood supply to the brain,\\nQ. More likely the cervical vertebrae?\\nA. Yes, more likely in the cervical region. Or it might act in such a way as\\nto cause retention of the blood in the head and result in dizziness.\\nQ. Did Dr. Eastman say that a rib displaced was the cause of a noise\\nalong the spine?\\nA. As he pushed the rib, and as it went back into place it made the\\nnoise.\\nQ. If you had a patient who was unable to raise his hands above the level\\nof the shoulder, and there was pain at the insertion of the deltoid muscle and\\nalso over the shoulders, where would you look for the trouble?\\nA. I would look for the trouble in the brachial plexus, the origin of the\\ncircumflex nerve, supplying the deltoid muscle.\\nLECTURE VII,\\nAt the last lecture I took up further consideration of the Osteopathic sig-\\nnificance of points found in diagnosis. I called 3^our attention to the troubles\\nwhich maj in general, affect the lower cervical group of nerves; those which\\naffect the brachial plexus, for instance, being chiefly spasms, neuralgias and\\nparah^sis. Also, I called your attention to the connection between those nerves\\nand the sympathetic ganglia; also the connection of the third group, the dorsal\\nnerves, except the twelfth, with the sympathetic dorsal ganglia; the diseases of\\nthis group being chiefl}^ sensory. I then spoke of the connection of the fourth\\ngroup, the upper four lumbar nerves and the last dorsal, being connected with\\nthe five lumber ganglia of the sympathetic; the diseases of the fourth group be-\\ning chiefly neuralgias, and not spasms or paralysis, although you might find\\nthem in that group. Spasms and paralysis, as well as neuralgia, being more\\ncommonly found in the fifth group; the five sacral nerves and the last\\nlumbar being connected with the sacral sympathetic ganglia. I also traced in\\ngeneral the connection between these plexuses and diseases which might orig-\\ninate there, stating that my object in the last two lectures had been to aid you\\nto keep separate the cerebro -spinal and sympathetic systems, to diagnose di-\\neases according to centers, and to teach you to separate non-essentials from es-\\nsentials. I instanced this rule of nerve force, that it is emitted along the path\\nof least resistance, and that, sympathetically, the organs most closely connected\\nby nerve-strands with the organ affected is most apt to suffer; that, in the send-\\ning of such impulses along the paths of the sympathetic system, certain centers\\nsuch as the abdominal brain, are centers for reorganization of those- impulses,\\nso that, being reflected to these centers, they are sent out reorganized, I then\\ndrew some illustrations to account for phenomena witnessed according to this\\nlaw. I then called your attention to landmarks concerning the scapula, and to", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0036.jp2"}, "37": {"fulltext": "STIMULATION AND INHIBITION. 31\\ntreatment of the spine. That being the question you naturally ask after having\\nlearned to examine the spine. The generel points brought out being that there\\nis a treatment upon the spine itself, and a treatment of the spine for further\\nreaching effects, chiefly through the sympathetics, upon the internal viscera.\\nAnd I showed you, by laying the patient upon his face and upon his side, what\\nwas the technique of manipulation that we employ, I shall, in the latter\\npart of this lecture coptinue that subject. I have thought that for the\\nfirst part of my lecture today it would be helpful to us to consider the Osteo-\\npathic theory of work upon centers.\\nI. How does the Osteopath by external manipulation upon the surface of\\nthe body affect internal nerve life? How can he reach centers in the spine, or\\nnerve centers in any part of the body? What does the Osteopath mean when\\nhe says that he stimulates, or desensitizes, or inhibits nerve action? Those are\\ngreat questions. It is needless for me to say to you that they lie at the\\nbasis of our science. It is not a question as to fact. The facts are already\\nproven beyond a doubt, but it is a question of finding a rational scientific expla-\\nnation of facts, of establishing theories which lie back of our work. Osteopaths\\nhave different views concerning these matters. They answer these questions\\ndifferently. I called upon the different operators in the building to give me a\\nsynopsis of what their views were. There were some w^ho said they were not\\nable to explain satisfactorily some of these things, and there was also some dis-\\nagreement in their answers. I simply wish to add my little mite, not at all\\nsupposing that it will solve the questions for all time. There are, however, cer-\\ntain facts in relation to these questions which I thmk will be profitable to call\\nto your attention, and I will also make some reference to the answers which I\\nhave received from the old operators whose experience has been wider than\\nmine. Remember, it is not a question of Do you do this? Do you accom-\\nplish such results? but granted that the results are accomplished, which is\\ntrue, how do you accomplish them? In approaching this question we must\\nclear away all misapprehension as to definitions. Do we, when we say de-\\nsensitization, etc., mean the same as the physiologists mean when they say de-\\nsensitization, stimulation, etc., and can we, in the generally accepted view,\\nhave such an effect upon the nerve as to desensitize or stimulate them? For\\nthis reason I will first define these points according to the physiological view,\\nand then according to the Osteopathic view. The physiologist uses these terms\\nin two senses. First, in the usual normal sense; a normal impulse sent from a\\ncenter along a nerve or from a periphery along the nerve, resulting in function.\\nFor instance, an impulse is sent from the brain along a nerve causing the con-\\ntraction of a muscle. Again, a sensation of pain comes from the peripherv to\\nthe center, which thus receives it, and there is a sense of pain. In this case\\nthere was a stimulation of a sensory nerve by the agency producing the pain,\\nno matter what that agency was. For instance again, the normal and contin-\\nuous inhibition of cardiac action through the vagi by the impulse sent from the\\nbrain. Now, that is the normal and usual sense in which these terms are used.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0037.jp2"}, "38": {"fulltext": "32 THEORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS.\\nThe second sense in which these terms are used by phsiologists is irritation of\\na nerve, and thus its stimulation or inhibition of function by physical agencies,\\nas heat, cold, electric current, application of pressure or tapping, or the appli-\\ncation of chemicals. That is what he means when he says he has acted upon a\\nnerve, has experimentally treated a nerve. He may, for instance, apply a\\ncaustic and elicit a sensation of pain, and state that he has stimulated the nerve.\\nHe may for instance again, apply an electric current, stimulate the nerve and\\ncause muscular contractions. Or, finally, he may by pressure or tapping upon\\nthe nerve, carried to the point of exhaustion, secure the result of paralysis,\\nthat is, inhibition of the nerve action, resulting in the loss of sensation or of\\nmotion, or of both. He then says that he has inhibited, desensitized the\\nnerve. He thus by the use of ph3^sical agencies produces such results similar\\nto the normal, for instance, the contraction of muscle, and he reasons that the\\nimpressions aroused by such agencies are similar to normal; he has really stim-\\nulated, or inhibited. For instance, he by some ageuc}^, the use of an electric\\ncurrent, so stimulates the periphery of the sciatic nerve that he gets a vaso-\\nmotor effect in the nerve. He reasons that, as he has stimulated the nerve\\n\u00c2\u00a3bres in a manner similar to normal, therefore there are sympathetic vaso- motor\\nfibres in the sciatic nerve. This was the actual method employed in determin-\\ning that vaso-motor fibers were contained in the sciatic nerve, and this was ac-\\ncepted by the authorities. I believe that I have thus correctly represented\\nthe views of the physiologists in the definition of these terms.\\nSecond \u00e2\u0080\u0094How does the Osteopath define these terms? What does he mean\\nwhen he uses them? He uses them, of course, in the the normal, physiological\\nsense, which we will leave aside. He also uses them in another sense, which\\nfor the present we will leave aside also. But the question to-day is, does he by\\na physical agency, that is, by manipulation, by pressure, by tapping, and\\nstretching, all of which he uses in effecting nerve filaments or nerve centers,\\nproduce a result similar to normal, and may he be with the physiologist, allow-\\ned to reason that therefore the impulse which he has aroused by the use of\\nsuch physical agencies is similar to the normal? A pressure on the phrenic\\nnerve controls the spasms of hiccoughs. The result of the use of such physi-\\ncal agency is similar to normal, hence the impulse must have been similar to\\n-normal. Again, by rubbing the neck in the region of the superior cervical\\nganglion, he stops bleeding from the nose, and produces an effect similar to\\nnormal, hence the vaso-motor influence generated by irritation in that region\\nmust be similar to normal. He says he inhibited the phrenic or stimulated the\\nsuperior cervical ganglion. We must allow him equally with the physiologist\\nto say that he has stimulated, or inhibited the nerve in question. ^ow, the\\nquestion at once arises, what was the manner of the application of those physi-\\ncal agencies? Does the physiologist, as well as the Osteopath apply these\\nagencies externally? Of course if there is a difference in application, then our\\nreasoning would not hold good. But my reply here is, yes, he applies them ex-\\nternally, though not always. Still, if he, the physiologist, does it only some-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0038.jp2"}, "39": {"fulltext": "THEORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS. 33\\ntimes, and obtains results which justify him in saying that he has really stim-\\nulated or inhibited, the case is proven for the Osteopath, even though the lat-\\nter works externally always, providing only that the Osteopath obtains as wide\\nrange of results as does the physiologist, who works both externally and upon\\nthe exposed nerve or center. That the Osteopath, by his means obtains results\\nin every part of the body is shown by cases upon record.\\nI wish to quote from text books to show that the physiologist does work\\nexternally upon the body to produce his results. In the first place I quote\\nfrom Dr. Lombard, Professor of Physiology in the University of Michigan, in\\nHowell s American Text Book. If pressure be brought to bear on the ulnar\\nnerve where it comes across the elbow, the region supplied by the nerve be-\\ncomes numb Now in the context he explains that everyone has occassion to\\ndemonstrate this upon himself, evidently implying that external pressure was\\nused. Dr. W. T. Porter, M. D., Assistant Professor of Physiology in Harvard\\nMedical School, in the same text book states as follows: The reflex action of\\nthe sympathetic nerve upon the heart is well shown by the experiment of F.\\nGoltz on a medium sized frog; the percardium was exposed by carefully cutting\\na small window in the chest wall. The pulsations of the heart could be seen\\nthrough the thin pericardial membrane. Goltz now began to tap upon the ab-\\ndomen at the rate of about 140 times a minute with the handle of a scalpel.\\nThe heart gradually slowed and at length stood still in diastole. Goltz now\\nceased the rain of little blows. The heart remained quiet for a time, and then\\nbegan to beat again, at first slowly and then more rapidly. Some time after\\nthe experiment, the heart beat about five strokes in the minute faster than be-\\nfore the experiment was begun. The effect cannot be obtained after section of\\nthe vagi.\\nI have thus quoted at length to show with exactness the manner of exper-\\nimentation and the external application of this physical agency which was em-\\nployed. Agai-n, the physician in applying the electric current to a living pa-\\ntient for the purpose of diagnosis or treatment, applies the same externally. I\\n\u00e2\u0096\u00a0quote from Dana. Statical electricity is applied from fifteen to twenty min-\\nutes daily or tri-weekly. For general tonic or sedative effects, sparks are drawn\\nfrom all parts of the body except the face; in paraiysis or spasms of pain, sparks\\nare applied to the affected area. Tn general electrization, whether galvanic or\\nfaradic, the indifferent electrode is placed on the sternum, feet or back and the\\nother pole is carried over the limbs, trunk, neck, and if indicated, the head.\\nIn this course of the argument I wivsh to instance what I heard Dr. Eckley say\\nonce concerning the surgical method of treating sciatica. He said that an in-\\ncision was made through the gluteal muscles down to the nerve, laying it open\\nto view; that a hook was then used, and the nerve stretched with a force of\\nabout forty pounds, that is, sufficient to raise the toe of the patient from the\\ntable, the patient lying on his face. That was the surgical method of stretch-\\ning the nerve to relieve cases of sciatica. He also went on to say that the\\nmethod used nowadays is that of flexing the thigh upon the thorax, thus giv-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0039.jp2"}, "40": {"fulltext": "34 HOW TO TREAT THE SPINE.\\ning a strong tension to the nerve, and that is the treatment used to-day by phy-\\nsicians for the cure of sciatica. You will see that that was external manipula-\\ntion, that the application of electrical current was external, the tapping upon\\nthe abdomen was external, and the pressure upon the ulnar nerve was external\\nI have simply endeavored to show that the Osteopath m treating nerves and\\ncenters emplo^-a physical agencies externally. In one case the physiolo-\\ngist is allowed to say, and it is accepted by the authorieties. that he has stimu-\\nlated a nerve, stimulated nerve action by this means, and inhibited nerve ac-\\ntions by this means, and my argument is, therefore, that in the same manner\\nthe Osteopath must be allowed to say that he has stimulated or inhibited\\nnerve force, and that we therefore use these terms in the generally accepted\\nmanner. This is my view of the subject, and I believe my conclusions are\\nreasonable and fair; that from the results accomplished, means employed, and\\nmanner of application of the physical agency by the phj^siologist and b5^ the\\nOsteopath, the latter is as much entitled as is the former to the use of the terms\\nstimulation, and inhibition in their generally accepted sense.\\nI shall follow this subject further for a lecture or two. There are many\\npoints in relation to the work upon nerve centers which are obscure, and\\nwhich I think I can with value attempt to illustrate before you.\\nII, How TO Treat a Spine. (Continued.) Whereas, the last time I\\ngave you the treatment for the spine itself, to-day I will take up the con-\\nsideration of treatment of the spine for distant effects. The point here is,\\nthat we may not only treat the spine, with the patient upon his face, for im-\\nmediate effects to the spine, but we may treat to reach viscera through the\\nsympathetic nervous system. Your first object is to relax all the structures\\nas in the other case, for the reason that tension here in the muscles may af-\\nfect a center, it may affect not only the center which relates to the spine it-\\nself, but a center, for instance, the splanchnics, controlling the stomach, or\\nthe kidneys, or the bladder, or some of the internal viscera. You will very\\ncommonly find sore spots along the spine. The indication is usually that\\nthey are the seat of lesions. We reason, then, according to the sore spots.\\nor according to the contraction of the muscles, or according to the separation\\nof the vertebrae, or whatever the lesion may be, to the centers of the sympa-\\nthetic affected. If we know where the different centers are situated along\\nthe spine, and find a lesion at a certain point, we can reason what the result\\nwould be, or vice versa, by finding a certain disease manifest in the body we\\ncan trace back from the disease to the center, and expect to find a lesion at\\nor near that center. For instance, suppose I had examined this gentleman\\nand found that he had lung trouble, I would then, according to Osteopathic\\nprocedure, go back to the centers along the spine, and I would look from the\\nsecond to the seventh dorsal for a lesion, and if I did not find a lesion, I\\nwould still stimulate in that region. I might here instance a case that I have\\ntreated, a case of congestion of the lungs associated with heart trouble, where\\nthere was great difficulty of breathing, considerable pain accompanied by", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0040.jp2"}, "41": {"fulltext": "HOW TO TREAT THK SPINK. 35\\npallor and general debility, and there was every indication that the lungs\\nwere affected. And by giving not more that a minute s work in this region,\\nfrom the second to the seventh dorsal on both sides, the patient sitting upon a\\nstool, I, standing behind, raising the ribs and stimulating the centers, got a\\ngood effect. Sometimes in such a case you have to work quickly, and in\\nsome cases you will \u00c2\u00b1ind that it will not do to have the patient lie down. If\\nI should, for instance, be treating this gentleman for stomach trouble, having\\nin my examination and in my conversation with him found that he was so\\nafflicted, I would look for some lesion along the spine in the region of the\\nsplanchnics, from the sixth dorsal down to the twelfth, especially the upper\\nsplanchnics for the stomach. And in that event, how would I go about to\\ntreat him? Simply by use of the points which I gave you in how to treat the\\nspine. I would loosen the spine, and relieve any tension in the ligaments\\nwhich I might find there, I would stimulate the muscles all along in this\\nregion, and work out any sore spots, and any contracted muscles. This con-\\ntracture, or tightening of the muscles, I shall go into deeper in the course of\\na lecture or two. Thoroughly work along the spine, not too hard, using the\\nflats of the fingers, which requires some strength in the muscles of the\\nforearm. You need not be afraid of the patient, you need not be afraid to\\napply your treatment thoroughly, but you should use your judgment\\nas to how long a treatment you should give. It is very hard to say anything\\nas to the length of time of treatment; you will have to learn that for your-\\nselves. Though in general a young Osteopath will treat a very long time, and\\nan old operator will treat a much shorter time. If I should find that there was\\ngenital trouble or trouble with the pelvic viscera I shoulid naturally look\\nalong the centers in the lumbo-sacral region, and I would very likely find a\\nlesion at the fifth lumbar, where I would find a soreness. In that case he\\nwould relax all the parts; I would bring the legs up against me and get a close\\napplication of the hand to the affected spot. Then holding in the sacro-\\niliac articulation, and, by lifting up against it allowing the weight to hang\\ndown from that point, I spring the pelvis and bring pressure upon these liga-\\nments, first on one side and then on the other, relaxing all the structures\\naround the fifth lumbar, preparatory to reducing any slip which may be\\nfound there. Suppose there was not a slip there but simply a sore spot, my\\nobject would be then to work out the sore spot and thoroughly relax all of\\nthe tension. I will take up the setting of the slip of the innominate at another\\ntime. In the examination of a spine we may find a vertebra lateral at any\\npoint. Suppose, for instance, that the twelfth dorsal is slipped laterally, to-\\nward the right, we would very probably find that the sore spot was on the\\nright side, as the sore spots in the muscles are as a rule on the side to which\\nthe spine is slipped, though it may be on the other side. I would first treat\\nhere at the twelfth dorsal, loosening the muscles about that point. How do I\\nknow when I have done enough of that? In general, when you find a more\\nrelaxed condition there. You cannot always at the first treatment relax", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0041.jp2"}, "42": {"fulltext": "36 HOW TO TREAT A SPINK.\\nall the muscles; you will find cases very stubborn. I have treated cases\\nwhere the muscles would relax under treatment but would contract again im-\\nmediately. It will depend upon the case, but work a reasonable length of\\ntime and relax all parts if possible. After I have relaxed all the muscles\\ntipon the right side about the twelfth dorsal, I pursue the same course on the\\nleft side; then go deeper than the muscles and stretch the ligaments. What\\nis the condition of those ligaments when the spine is slipped in this way? I\\nhave shown you in a previous lecture that they are probably all upon a ten-\\nsion, some forward and some backward. What we seek to do is to spring\\nthe spine up. By springing it you get the curve above and thus stretch the\\nligaments on this side, then turn the patient over and go through the same\\nprocess upon the other side. Now, you will naturall}^ want to know how\\nsoon to attempt to reduce this slip of the vertebra. Most young Osteopaths\\nwhen they find a dislocation want to put it back into place at once. You can\\nonly do that m rare cases. In a recent dislocation, if it is not very serious\\nand does not set up a great amount of inflammation, it may be reduced at\\nouce. In an old dislocation 3^ou will have to work a considerable time to re-\\nlax all these parts, throw new blood and nerve force there to endow them\\nwith new vitality which they have been lacking, and j^ou will have to learn\\nby practice to work a sufficient length of time before attempting to set a\\nvertebra. There are several methods of doing this. One of the best is to\\nfirst exaggerate the condition. I would in this case have my patient upon a\\nstool, the spine being tipped over toward the right, I bend the patient so as\\nto exaggerate the condition, and thus bring tension upon the ligaments upon\\nthat side. I have before brought tension upon the other side and relaxed\\neverything as far as possible, and by working the patient up and around holding\\nagainst the spine of the vertebra, I in that way .slip it back into place. It does\\nnot always go back with a pop as nicely as could be, but you will perhaps have\\nto pursue that method of treatment for a considerable length of time. But\\nremember, please, that in setting a misplaced vertebra, in general the method\\nis to exaggerate the condition, and that you then w^ork in just the opposite\\nway and throw the curv.e in the opposite direction.\\nQ. I do not understand the connection of the 5th nerve with the pneu-\\nmogastric.\\nA. The pneumogstric supplying the stomach is affected directly from\\nan exciting cause, the impulse passes along the pneumogastric going directly\\nto the medulla, v/hich is the center for all of. these nerves which arise from the^\\nfloor of the fourth ventrical, and then directly out over the 5thcranial nerve. It\\nhas been proved that an impulse can be sent from a nerve, through a center,\\nand out over another nerve.\\nQ. In referring to the back work we have gone over. I do not quite un-\\nderstand why a click in the neck in the cervical region should be more serious\\nthan in the rest of the spine.\\nA. Well, I so stated simply because it has been my experience that I", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0042.jp2"}, "43": {"fulltext": "THEORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS. 37\\ncould find these noises all along the spine when they mean nothing at all, the\\nsubject being perfectly healthy. While in the cervical region it seemed to me\\nthat there was always some slight break or contraction between the parts, like-\\nly enough to be serious. It showed that the blood supply had been cut off,\\nthus diminishing the supply of lubricating material in the synovial membrane.\\nI said that it was in general more serious, because my experience in practice\\nseemed to bear out that point.\\nQ. In the case of a lateral displacement of the atlas, would you exagger-\\nate the condition also?\\nA. Yes, sir, as far as possible, but to set an atlas is quite h technical\\nmatter. I will take that in detail later.\\nQ. Suppose there was a spinal curvature would you set it in the same\\nway you would a single vertebra?\\nA. In that case you would use the same general method, but you would\\nbegin at one definite point and try to set it, and then work upon the next ver-\\ntebra, and so on.\\nI^ECTURK VIII.\\nAt the last lecture I commenced to consider the osteopathic theory of work\\nupon nerve centers. That is what I have called the subject in general, al-\\nthough it includes not only nerve centers, but nerve distribution and blood\\nsupply; how the osteopath works by external manipulation upon the surface of\\nthe body, gaining results internally. I first defined the terms stimulation and\\ninhibition, and showed that while they are used in several senses, the osteo-\\npath uses them in the usual sense. Our conclusion was that the osteopath was\\njustly entitled to the use of these terms, stiniulate and inhibit nerve action, and\\nthat he works in the same manner as the physiologist when he is experimenting\\nupon these nerves. That since the physiologist, gaining results which were\\nsimilar to normal, reasons that he has therefore affected the nerves in a man-\\nner similar to normal, the osteopath should be allowed to say that, since he has\\ngained results similar to normal, he has also affected the nerves in a normal\\nmanner. As to the term desemsitize, I was not fully informed. I have\\nsince found that there is no such word, it is not in the Centur} Dictionary, and\\nI think I had better dispense with the use of it. However, we do the thing,\\nwhether we have the word the same or not. That is, taking away the sensi-\\ntiveness from a nerve, or, the excitability, or its excited condition, is realh^ an\\ninhibition of nerve force. Or it may amount to this, that we affect the con-\\nductivity of the nerve, and that is what I meant by the use of the word desens-\\nitize. Since it was simply the improper use of the word, and not any confus-\\nion of points, I do not think we have to yield any point to the authorities\\nthere. We then are privileged to say that by external manipulation we have\\nreally stimulated or inhibited a nerve. If we have worked upon nerves and\\nupon nerve centers in that way, we have produced certain results. The point", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0043.jp2"}, "44": {"fulltext": "38 THEORY OF OSTEOPATAIC WORK UPON NERVES AND CENTERS.\\nthat the physiologist works externally only sometimes, while we work outside\\naltogether, does not make any difference with the argument, from the fact that\\nwe have as broad a range of results to show for our work as he has by both\\nexternal work and work upon the exposed nerve. I think that my positio.n\\ntaken at that time was sound.\\nI. Theory OF Osteopathic Work upon Centers. (Continued.)\\nOur operators agree that we secure direct results upon nerves by mechanical\\nwork, and while they do not all fully agree in all they say, I ga ^^her from the\\ncommunications they have handed me that they all take that view of this mat-\\nter. For instance, Dr. McConnell says: We affect internal nerve action by\\nmanipulation on the external parts of the body, by a general mechanical stim-\\nulation given to the nervous system. He says further, that we stimulate or\\ninhibit sometimes but that he believes there is a general misuse of these terms,\\nand that the results which may be expressed in these terms, are not often the\\nresult of some direct inhibiting or some direct stimulating work that we put\\nupon an affected point. But we will bring that point up when I come to take\\nup the further definition of these terms according to the osteopathic point of\\nview. Dr. Harry Still says, We inhibit by pressure or by holding, thus cut\\noff nerve action, and break the force between the brain and the termination of\\nthe nerve. Dr. Harry also says that work outside upon the body, that is\\nmechanical manipulation, produces a direct effect upon the nerves through pres-\\nsure, thus affecting sympathetic life through its connection with the spinal\\nnerves or their centers. He instanced the pneumogastric. Mrs. Still s reply\\nshows that her idea is that we either directly or reflexly affect nerves or cen-\\nters by external manipultation. Dr. C. M. T. Hulett well illustrates in part\\nthe theory of our work as follows: Pressure upon a nerve fibre will cause a\\nbreak in the continuity of the semi-fluid axis cylinder; and if abnormality ex-\\nists, then the ever present tendency toward the normal will tend to restore\\nnormal conditions. I understand him to say that we may obtain that result\\nby pressure upon a nerve, by external manipulation, which is the method we\\nemplo3\\\\ Dr. Hildreth and Dr. Charles Still both have something to say about\\nthis. I could not get their communications to-day, but will bring them later.\\nThus, as you see, there is considerable unanimity upon this point. I have not\\nquoted all these parties have to say, but I shall quote from them to explain\\nfurther points when we come to them.\\nRemember, that this is not the only effect that we get upon nerve-centers\\nor nerve life, this mere stimulation or inhibition, as we may be privileged to\\ncall it, but we do it and get important results. I leave this subject to consider\\na different point there are other means at the Osteopath s command by\\nwhich he may affect blood and nerve force. These means are important, but\\nthey are not what we style the most important means at our command*\\nThey are, however, important as being external, non-medicinal methods of\\nreaching deep blood and nerve force. They are not distinctly Osteopathic,\\nthey are simply adjuncts to our work. One of these is the external application", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0044.jp2"}, "45": {"fulltext": "THEORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS. 39\\nof heat or cold. I shall take up later, possibly, the subject of Hydrotherapeut-\\nics and kindred subjects. Green in his Pathology says, It seems that vascu-\\nlar dilation of deep organs may be produced reflexly by the application of stupes\\nto the skin. They are invaluable, then, as adjuncts which the Osteopath\\nmay call to his aid if necessar}^: J may instance here that in case of inflamma-\\ntion following some injury, you may find the parts so swollen as to make it im-\\npossible for you to determine whether or not the parts are broken, or what the\\ncondition really is. You will frequently find that in such cases you must first\\nreduce the swelling before you can apply your Osteopathic work. Not to say\\nthat we do not do it Osteopathically, for I believe that we do. In the rase of\\na swollen ankle we may by manipulation of the venous flow, loosening the struc-\\ntures about the femoral vein, aid in taking down the swelling, but you will\\nfind that if such cases be of any great extent, you must bring in the application\\n\u00e2\u0080\u00a2of heat or cold.\\nYou will have to use fomentations and the application of dry heat very often\\nand it is always advisable to have a good supply of hot water near you in case\\nyou have a patient where it is likely to be necessary. For instance, if you are\\ntreating a patient for some disorder and he is continually troubled with cold\\nfeet while lying in bed, you must use the application of heat, the idea being to\\nget the patient as comfortable as possible, and to get a good distribution of\\nblood throughout the system; also to prevent collateral hyperemia on account\\nof having too little blood in one part. I think this is a good therapeutic hint\\nfor the Osteopath. You must pay attention to these details, or some such lit-\\ntle thing may hinder to a considerable extent, the results you are trying to at-\\ntain. The idea is to equalize the flow of blood throughout the body. The apt\\nplication of cold is frequently useful, though we do not use it very often. I\\nspoke of fomentations, that is a term applied to a hot, moist application. You\\nwill frequently find it useful to wring out a cloth in hot water, as hot as can be\\nborne, and a pply it to parts, repeating the operation frequently. Tliat is a fom\\nentation, while dry heat is applied by means of a hot water bag, or some such\\nthing. Please bear in mind that these things are good in our practice. You\\nmay also get a vaso-motor effect by application of cold. Speaking of renal con-\\nstriction, Howell s Text Book says: The same effect (renal constriction) is\\neasily produced by stimulating the skin, for example, by application of cold.\\nRemember, please, that we as Osteopaths do not depend upon the use of these\\nagents, but I call your attention to them as valuable, non-medicinal adjuncts to\\nour practice, and also as supporting, by quotations from the standard text\\nbooks, the contention of the Osteopath, that without medication the blood and\\nnerve forces of life may be regulated to produce health. This is, too, valuable\\nin our arguments with medical men. It all tends against the use of medication.\\nI believe that the Osteopathic position may be still further strengthened by\\nconsidering the effects produced, on the one hand, by the use of chemicals,\\ndrugs, or electric currents, and on the other hand by the Osteopath in his use\\nof mechanical agents. In the first place, drugs and chemicals introduced into\\nthe system alter normal chemical conditions in which the nerve must be in order", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0045.jp2"}, "46": {"fulltext": "40 INJURIOUS EFFKCTS OF DRUGS AND KI.ECTRICITY.\\nthat its normal irritability may be preserved. In Howell s Text Book it is\\nstated that the introduction of digitalis, ether, alcohol, water, etc., changes the\\ncondition of the irritability of the nerves. From all these results it becomes\\nevident that the normal irritability of nerves and muscles require that a certain\\nchemical constitution be maintained, and that even a slight variation from this\\nsuffices to alter, and if continued, to destroy the irritability. Now, it is the\\nphysician, and not the Osteopath, who introduces these abnormal chemical\\nconditions, thus destroying the normal irritability. I grant the force of the\\nphysician s argument when he says that he supplies these drugs for the pur-\\npose of supplying to the body some elements which are lacking, but I doubt\\nwhether that is the general method of medication. Where digitalis is given to\\nretard the action of the heart it paralyzes the nerves and in that case certainly\\nit was not given to supply the lack of some such constituent in the system. On\\nthe other hand, the Osteopath does not introduce any of these foreign sub-\\nstances. He stimulates nature, and nature supplies from the food these vari-\\nous things which are needed to keep the normal chemical conditions under\\nwhich a nerve or muscle is normally irritated. I further quote from Howell s\\nText Book to show the abnormal effects of electricity. Undoubtedl}^ chemi-\\ncal and physical alterations may occur in nerves as the result of the passage of\\nan electric current through them, and it would seem that the los^ of conductiv-\\nity which they show when subjected to strong currents is to be accounted for\\nby such means. The conductivity, like the irritabilitv of nerve and muscle\\nis greatly influenced by anything which alters chemical constitution of active\\nsubstance. Hence it must be that electricity, chemicals and drugs produce\\nabnormal changes in nerve tissues. Therefore, I maintain that the Osteopath\\nmay secure better results from his manipulation than may the physician by med-\\nication, for, whereas the latter introduces into the system those agents which\\nby their nature produce abnormal changes in nerve tissue, the Osteopath intro-\\nduces no foreign matter. Moreover, he may, through his manipulation, attain\\nresults very similar to that produced by normal physical exercise of parts of\\nthe body. I might explain here the effect upon the nerves of an athlete in\\nstooping and jumping. He may, for instance, stoop in such a way as that the\\nthorax is bent upon the thighs, the knees touching the shoulders, and the scia-\\ntica nerve is stretched, just as we stretch it in sciatica. There are normal ex-\\nercises, the results of which, if we can judge at all, are exactly similar to re-\\nsults we obtain by giving a certam motion which is in our stock of remedies,\\nwe might say. Thus we reason concerning various contractions of muscles,\\nmotions of the back, bringing pressure upon the parts and thus keeping them\\nstimulated up to the normal. I think that the similarity is readily seen between\\nnormal exercise, on the one hand, and the application of Osteopathic methods\\non the other; between the application of violent means such as the use of elec-\\ntric currents, chemicals and drugs, and the application of normal exercise to\\nthe parts by Osteopathic manipulation. In the treatment of disease, normal\\nexercise differs from Osteopathic treatment, in that the Osteopath has the pa-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0046.jp2"}, "47": {"fulltext": "HOW TO TREAT A SPINK- 41\\ntient passive in his hands and can work at will. These are not exercises upon\\nhis part, and it may be that he being ill would not be able to undergo such ex-\\nercises of his own free will.\\nRemember, please, that the points which I have brought out have been ad-\\nduced in favor of the argument that we may work externally upon the body,\\nand thus stimulate or inhibit nerve force. But we do not consider that the\\nmost important part of our work. What we consider more important than that\\nI shall take up when I come to describe what the Osteopath means in the second\\nsense ig which he defines these terms, and this is but one part of the argument.\\nI shall at the next lecture attempt to carry this line of thought a little further\\nby quoting from authorities in support of the view that we may stimulate or in-\\nhibit nerve force by external work.\\nII. How To Treat the Spine. (Continued. I showed you at the last\\nlecture how to treat a spine where a vertebra was displaced laterally. To-day I\\nwant to show 3^ou how to proceed when you find the spines separated. If by\\nexamination we find that there is a separation between the twelfth dorsal and\\nfirst lumbar, how should we go about to rectify the conditions? How should I\\nheal the breach? In such a case of course our method of reasoning is that\\nthere is a lack of tone here; there is a relaxation of the ligaments; we would\\nrather expect that, though it is not necessarily so. And in that case, we would\\nfirst go about to restore tone to all the parts here before proceeding further. I\\nneed not go over the same ground of explaining to you that you thus here\\nreach the central distribution of the sympathetics all about this part which is\\nlacking in tone, but in this case that would be the first step, and you might\\nalmost say the only step, although that is saying a little too much. The proba-\\nbilities are we would not be able to put these vertebrea back into place at once,\\nyou cannot do that often. Simply thoroughly stimulate and loosen up the\\nstructures, and patiently await results, and you will gradually see those spines\\ncoming together. So that your best method, finally, is to stimulate, first on one\\nside and then on the other, using the motions I have given you, bring about a\\nstrengthening of those parts. You need not work just between the twelfth\\ndorsal and first lumbar, work a little higher and a little lower, and get a good\\neffect all about the parts. Probably this motion of getting the elbows between\\nthe pelvis and shoulder, and spreading while you have the fingers on the oppo-\\nsite side of the spines, and springing up as you spread, will obtain good re-\\nsuits.\\nQ. If the three upper lumbar and two lower dorsal vertebrx are posterior,\\nin that case would springing it in that way tend to bring it back to the proper\\nposition in time?\\nA. Yes, in part. I shall take that up when I consider variations from\\nnormal curves; that would be a part of the method, however.\\nProbably I would have the patient sit up on a stool in case they are separ-\\nated. You can separate them a little more. Going upon the principle of exag-\\ngerating the defect, spread them a little more, thus allowing a stretch and a", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0047.jp2"}, "48": {"fulltext": "42 THKORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS.\\nrecoil, which naturally follows, and in that way throw new life to the part, and\\nthen we seek simply to push them together. You can lift up and push down\\nand get the parts approximated in that way.\\nQ. In the lecture reference is made to paralysis without loss of sensation,\\ndo we ever have loss of motion without sensation\\nA. Yes, frequently. You will find that in your practice, loss of motion\\nwithout loss of sensation.\\nQ. Do we have loss of sensation without loss of motion\\nA. Yes, sir, you may have either.\\nQ. Is epilepsy caused by displacement of the vertebrae\\nA. Very frequently caused by displacement of one of the upper cervical\\nvertebrae; we find it so in our practice.\\nQ. You were speaking of stimulating the circulation in the feet by the\\napplication of dry heat, is there any practical osteopathic treatment for cold\\nfeet?\\nA. Yes, but in case you have a severe case of cold feet it would be very\\ndifficult to at once throw enough blood to those feet to warm them in case the\\npatient were very sick. You could not adopt measures strong enough on ac-\\ncount of the general debilit}^ of the patient. But I will say this, that condition\\nyields gradually, as do a great many other things to treatment, and people I have\\nknown who had been troubled with cold feet for years would find, after a course\\nof treatment of a month or more, that they were no longer troubled in that\\nway, that the general circulation was better than it had been for years.\\nLECTURE IX.\\nAt the last lecture I considered further the theory of Osteopathic work up-\\non centers, and briefly, to recapitulate, these were the points I took up: First,\\nthat our operators agreed in the use of these terms, stimulation and inhibition\\nin general, although there is some difference in the reservations they make.\\nI also quoted from different ones of our operators to show their opinions in the\\nmatter. I then called your attention to the fact that that was not the only\\nway, nor yet the most important way in which we considered these terms; that\\nthere are other means by which the Osteopath may command deep nerve force\\nand blood flow, by the application of heat and cold, which, while not being dis-\\ntinctly Osteopathic methods, are yet at the Osteopath s command, and serve to\\nstrengthen our argument that these forces of life can be reached from the ex-\\nternal surface by proper methods, without medication. I quoted from author-\\nities to substantiate these points. In general, the application of heat is better\\nthan cold. I compared the effects produced upon the nerves by chemicals and\\nby electric currents, as producing a certain change in a nerve, producing a\\ncertain change in the chemical conditions under which a nerve must be normal-\\nly in order to be normally irritable, and so I reasoned that the Osteopath s\\npractice was the more rational, since he does not introduce these foreign things", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0048.jp2"}, "49": {"fulltext": "THEORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS, 43\\n-into the system. Further, I called your attention to the similarity of the ef-\\nfects of the Osteopathic work upon the body, and the effects on the body of\\nnormal exercise; the difference being, in part, that your patient being sick is\\nnot able to undergo these physical exercises, while in your hands he is passive,\\n:and these effects may be given without the fatigue which would accompany\\nhis own exertion. Today I continue the consideration of this subject.\\nI. Theory of Osteopathic Work Upon Nerve Centers. (Contin-\\nued.) The arguments advanced in the last lecture may be strengthened by\\nquotations from standard text books. Having shown that the Osteopath, by\\nmeans peculiar to his system of treatment, accomplishes results through stimu-\\nlation and inhibition of nerve action that are worthy of being considered nor-\\nmal results as those accomplished by physiologists through methods pursued\\nb}^ them in experimentation; having shown, further, that the Osteopath ac-\\ncomplishes such normal results in every part of the body, there being cases up-\\non record to prove that that is the fact, it therefore at once becomes apparent\\nthat the whole field of nerve-force, controlling directly or indirectly every mo-\\ntion or function of life, lies open to the Osteopath; that wherever there lies a\\nnerve of the body capable of stimulation or inhibition, it is his to command,\\nproviding only that such nerve may be reached by Osteopathic methods, either\\ndirectly, as through pressure or indirectly, as through the blood supply. For\\nstimulation is stimulation, and inhibition is inhibition. It makes no difference\\nin fact. I will grant that there may be a difference of degree of stimulation or\\nof inhibition. However, having shown that the Osteopath stimulates or inhib-\\nits just as really as does the physiologist, the question of the degree of stimula-\\ntion becomes a secondary one, and one relative only to the point in view. Re-\\nsults obtained in the cure of diseases in every part of the body, and of almost\\n-every known form of cureable disease, show conclusively that the Osteopath\\nhas really stimulated or inhibited nerve force according to the end which he\\nhas in view. It would be no argument to say to an operator that he could not\\nstimulate enough to cause a man to jump over a table. His fitting reply\\nwould be that such was not the end in view, that the end in view, perhaps,\\nwas the stimulation of a flagging circulation to restore it to its normal force\\nand activit}^ and that he very readily accomplished that result. So degree of\\nstimulation really makes but little difference to us, granted that we have gain-\\ned results. I belive that there is no nerve of the body that the Osteopath may\\nnot reach by proper manipulation, either directly or indirectly, by pressure, by\\ncorrection of lesion, by removal of obstruction, or by control of blood suppl3\\\\\\nWhat that fully means we shall see as the subject is developed.\\nNow, for further argument, in view of the above facts, it is interesting to\\nnote the following quotations from authorities as confirmation of the claims of\\nthe Osteopath, since the authorities have made use of such means as has the\\nOsteopath to produce effects upon nerve action. Speaking of an experiment\\nupon the ear of a rabbit. Kirk says: Division of the cervical sympathetic\\nproduces an increased redness of the side of the head, and looking at the ear", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0049.jp2"}, "50": {"fulltext": "44 THEORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS.\\nthe central artery with its branches is seen to dilate and become larger, and\\nmany similar branches, not previously visible, come into view. The dilatation\\nfollowing section can be demonstrated in a very simple way, by pressing the\\nnail of one finger upon the nerve where it lies by the side of the central artery\\nof the ear. So that you see that the application of the external force, in\\nKirk s opinion, is equal to section of the nerve. Again, from Green s Pathol-\\nogy; speaking of the vaso-tonic action of the sympathetics, the author says:\\nThe reflex process is generallv due to stimulation of sensory nerves, the di-\\nminuation in tonus produced being more or less accurately confined to the re-\\nregion supplied by the nerve. Fricti n and slight irritants, in the early stages\\nof their action, produce hyperemia in this way. Thus you have another il-\\nlustration of the application of an external mechanical agent, that is friction.\\nYou thus set up a reflex action. I shall consider that further when I apply\\nthis argument to work on the centers; I quote further from Howell s text\\nbook, A sudden pull, piach, twitch, or cut excites a nerve or muscle. All\\nhave experienced the effect of mechanical stimulation of a sensory nerve through\\naccidental pressure on the ulnar nerve where it passes over the elbow, the\\ncrazy bone. Speaking of their ir^itabilit3^ the same text book says: Stretch-\\ning a nerve acts in a similar wa} for this is also a form of pressure, as Valen-\\ntine says, the stretchino; causes the outer sheatli to compress the m^ clin, and\\nthis in turn to compress the axis cylinder. This is a common mode of our\\ntreatment, as we flex the limb upon the thorax strongly in order to stretch the\\nsciatic nerve, that being a part of the treatment, and there are certain move-\\nments we adopt to stretch the brachial plexus in nervous aft ections of the arm.\\nI quote further from the same source: A reflex fall in blood pressure is also\\nproduced b\\\\ a mechanical siimulation of the nerve endings in the muscle.\\nThis, then, was a mechanical means, and the fact that we can thus work on\\nnerve endings, which of course occur all over the body in the muscles, thus\\ngives to us a fruitful field for the application of external manipulation, A\\nlittle further, Howell s text book says: Both the sym.pathetic and vagus\\nnerve fibres have their influence over the heart, decreased by cold and increased\\nby heat. Now, having made these quotations, allow me to call your atten-\\ntion again to the fact that I have quoted thus fully for the purpose of showing,\\nout of the mouths of the authorities, the fact that the blood and nerve supply\\nmay be regulated b}^ external manipulation. I have quoted them for the sake\\nof the argument, not for the purpose of giving license to our practice, because\\nw^e demand license only on the results which we have obtained. Nor by the\\nabove quotations which I have made do I intend to yield a point and say that\\nthe Osteopath can obtain only such results upon nerve action as is attained by\\nphysiologists by external manipulation, because I believe that I have shown\\nthat the conclusion is fair that the Osteopath can, by his method, affect any\\nnerve in the body. Hence, I shall deem it competent to give you vaso-motor\\ncenters, etc., with the understanding that the Osteopath has a right to regard\\nall such as legitimate objects of treatment, as his facts revert to in argument.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0050.jp2"}, "51": {"fulltext": "HOW TO TREAT A SPINE. 45\\nand as his equipment for work in the eradication of disease. As I said, the\\nmore important part of how the Osteopath stimulates or inhibits is still to\\ncome, and I shall pursue this subject for a lecture or two further.\\nHow TO Treat a Spine. (Continued.) At the last lecture I attempted\\nto show you how we reason and work in case the spines were seper^ted. In\\nto-day s lecture I wish to take up the question of how we would work in case\\nthe spines were approximated. That is, how would we separate those spines?\\nIf, in passing your fingers down the spine you come to some place where the\\nspines of the vertebrae are too close together, and this is a verj^ common lesion,\\nyour reasoning in that case would be that there had been some injury, at that\\npoint, to the spine, perhaps a sudden jerk or a twist, which had resulted in ir-\\nritation; too much life in the form of nerve and blood force, had been thrown\\nthere, resulting in a thickening of these ligaments, thus contracting and bind-\\ning those parts together. When you come to study pathology you will find\\nthat an} irritation sufficient to set up an inflammation is very likely to be follow-\\nlowed by the formation of new connective tissue or the thickening of the exist-\\ning tissues. Thus, 3 ou will find that reasoning that too much force has been\\ndirected to these parts, our work is to overcome the results of such misdirection\\nof energy. We set about to do it largely by the same manipulation as we\\nwould adopt in the case of approxicnating spines, at least in the first stages.\\nWe would loosen up all the parts, very likely you would find a tension in the\\nligaments at these points as well as in the muscles. Having loosened up all\\nthe muscles, we would then spring the spines upward, getting this stretching\\nmotion that I have before described. I would work with sufficient force, ac-\\ncording to the size of the patient, to stimulate these parts and set up what\\nwould seem to be as free action as possible. You can then operate by flexing\\nthe knees up against vour own body, and get considerable purchase on such a\\npoint as that, and while it is rather a siraiued position for the operator and I\\ncannot say that it is always comfortable for the patient, it is a very good way\\nto work, because you have your patient in such a shape that you will hardly\\n\u00e2\u0080\u00a2injure him by lifting him, as I have done, fairly off of the table. By this\\nmethod you may use considerable force, but of course you must not be rough.\\nI spoke to you about a smooth spine, meaning a spinal column which\\nshowed all along it that the spines were approximated and bound down close-\\ntogether. Now, you have a variable condition there, it ma} be so bound to-\\ngether that it will be quite rigid, or it may be capable of considerable motion,\\nbut having this peculiar smooth feeling all the way, so as to lead you to sus-\\npect .some trouble. I have had a number of cases of that kind, where the whole\\nspine was in that condition, or some one particular part of it, and almost invar\\niably there was a history of some strain or jolting or twisting that had set up\\nan irritation along the spinal column, and had resulted in a tightening of the\\nligaments, which has resulted iti the approximation of the vertebrae. In such\\na case the manipulation would be largely as I have shown. I would simply\\nloosen up first the muscles along the spine, remembering to work against the", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0051.jp2"}, "52": {"fulltext": "46 TREATMENT OF THE SPINE.\\ngrain of the muscle, of course working on both sides. A good way to do that\\nby the motion I gave you with the patient on his face; you can exert consider-\\nable force, and as he is relaxed you can loosen muscles very nicely. Having\\ndone that I would proceed to spring the spine along its various parts. By flex-\\ning the knees you can spring the spine in the lumbar region, and by using the\\narm as a lever you can spring the spine in the upper region. Of course it is\\nrather difficult to spring the spines between the shoulders; one good way to\\nwork there is to get the elbow against you, and work along the spine by hold-\\ning and stretching your object, of course, being to loosen all of these ligaments\\nand to relax whatever is holding the spines together.\\nAs to the misdirection of energy in a part resulting in their being bound\\ntogether, it may of course be entirely possible that at this present time there is\\nnot a misdirection of energy, but there has been, w^hether past or present it\\ndoes not make a great deal of difference. The misdirected energy may have\\nacted for a time sufficient to thicken and perhaps to contract the ligaments, and\\nthen have been diffused to other parts of the body, so that this may be an old\\nresult without there being at present any misdirected energy or life at the point\\nof lesion.\\nI would then have the patient on his back and would stretch the lower\\npart of his spine by taking one of his limbs and my assistant the other, and\\nworkmg both limbs up toward the chest, thus getting a purchase on the lower\\npart of the spine. You are not very likely to hurt the patient but you must\\nbe careful because different people are different in that respect, and 3^ou may\\ndo considerable hurting, if not actual damage, in that way. Again, if you\\nhave such a case you want to bring traction on the spine as much as possible;\\nand it is a very good way also to take hold of the patient by the occipital pro-\\ntuberance and the inferior maxillary so as to exert traction enough there to\\npull the patient along the table. You are not likely to hurt the patient with\\nthat degree of force, unless it be a delicate lady. Remember that you have\\nalready sprung the spine by working all along on each side. One precaution\\nyou must observe when 3^ou have the neck extended in this way, remember\\nthat the neck is less supported than the other parts of the spine, and if you\\nshould twist at that time you might cause a dislocation, the articular processes\\nmight slip out of place, so it is advisable not to attempt to twist when you have\\nit extended. If you wish to twist the neck, do it when the spine is not under\\ntraction. In order to be thorough the treatment must be applied to the whole\\nlength of the spine, and when 3^ou had the patient upon his face you w^ould\\nhave loosened up the muscles along the lower regions of the spine, the sacrum\\nand coccyx. You ma}^ get considerable force by putting the knee against the\\nsacro-iliac articulation and springing the pelvis. You must relax all the liga-\\nments, you should loosen up all about it as well as further above. Remember\\nthat your work has been simply to loosen up parts which through misdirected\\nenergy have been drawn together. Of course, when you have such a condition\\nyou may haye almost any result, that is, results affecting the bodj^ through the", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0052.jp2"}, "53": {"fulltext": "TREATMENT OF THE SPINE. 47\\nnerves in almost any way. As a general rule I think you will find that the\\nresults may not be marked, but may be general, and you may have a case of\\ngeneral malnutrition, or neurasthenia, or something of that kind.\\nI would next set the patient on a stool and use the motion I showed you\\nat the last lecture, then you can get hold along the spine, generally it is better\\nto work from the bottom up, though it does not make much difference; I hold\\nthere, bend back a little and exert traction as I ascend the column. That is a\\nvery good way. You may produce the same result and I think get a little\\nbetter stretching motion by taking a turn as you work, you would be more\\nlikely then to stretch all the ligaments about the vertebrae.\\nIn case you have a spine misplaced anteriorly, you will have something\\nwhich is rather difficult to deal with. In such a case you must depend largely\\nupon the effects of the general strengthening which you give to the parts to\\nw..rk the spine out into its normal position, as you must in other cases also.\\nBut when you have the spine anterior it is very difficult to get hold of the ver-\\ntebra or to influence it. However, Mrs. Dr. Patterson makes a point of get-\\nting hold of the spine as much as possible and working at it.. In case of dislo-\\ncations of cervical vertebrae it is a good point to examine internally, and when\\nthe dislocation is considerable you may find a protrusion into the pharynx. In\\nsuch a case you would use not only the method I told you of, trying to reach\\nthe spine, but would thoroughly manipulate every point about it, and would\\nspring it each way. You might also get the patient down and go through the\\nlifting motion. There is one other method that I think would be helpful, that\\nis, your spine being anterior, and going upon the principle that we sometimes\\nadopt, of exaggerating the defect, you could bend the patient backward, and\\nby placing the knee in the back and raising the arms above the head (you must\\nbe careful with this motion) that would exaggerate the defect, it would loosen\\nthe ligaments along the anterior part of the spine which are already stretched,\\nand which you wish to stretch a little more in order to get the effect of the\\nrecoil, and then by relaxing and allowing the patient to drop forward again^\\nyou get the recoil. Then there is another point which I think will be helpful\\nto you, it is practically the same as I showed you, as you work along the spine,\\nthe idea is that you get the bodies of the vertebrae to move one upon the other.\\nMr. Bolles first spoke of this to me. You get the same result as when you\\nmove your body by working your feet along the floor. I think you may very\\nreadily get such a result by working the bodies of the vertebrae one against the\\nother.\\nIn case there is a spine posteriorly, what would you do? I take up these\\npoints in detail as I went over them in examination of the spine, although the\\nmethod of treatment is largely the same. If the spine is posterior you would\\nbend your patient forward, simply to exaggerate the defect and then you could,\\nturn him to either side and get the effect of the recoil by pushing him back-\\nward. Of course in such case you must be careful not to use too much force.-\\nand not to strain the parts beyond what they would normally stand.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0053.jp2"}, "54": {"fulltext": "48 TREATMENT OF THE SPINE.\\nIn examination of the spine I spoke to you concerning the ligamentum\\n-nuchse and the importance it sometimes bears in our treatment of the spine,\\nmentioning the fact that I have often found cases of headace which would yield\\nto treatment only when the ligamentum nuchae was relaxed. By carefully ex-\\namining along the furrow just below the occipital protuberance 3^ou may find\\nthat the ligament is tense, you ma^ find that it presents a firm\\n\u00e2\u0096\u00a0resistance to the hand; the patient can also feel it by stretching the\\nhead forward; he will feel that the ligament is tense. Naturally,\\nin projecting the head forward, one should not feel a sense as of a check rein\\nthere, but in case of cold I have frequently found it distinctly upon myself,\\nhave felt a sense of tightness along the region of the neck, and by examination\\nwith the hand there I came to the conclusion that there was no other reason\\nfor the trouble than that the ligament was tense, and I think that was really\\nthe fact. The way to stretch that ligament is ver}^ simple. I usuall}^ just\\n.flex the head directh^ upon the thorax, admonishing the patient to lie with his\\nweight down, to let his weight fall against mj^ bands, and I raise the head with\\nsufficient force to raise the shoulders off the table. That would be a good\\nmovement to adopt in stretching of the spine when the whole spine was\\n-smooth or tense. That, together with flexing of the two knees against the\\nshoulders would make a very good extension movement. In such a case of\\ntightening of the spine it is a good idea to advise your patient to hang himself,\\nnot literally, but to catch hold of his closet shelf or the top of the door jam and\\nbring the weight of his body upon his arm muscles. That would tend to relax\\nthe spine, and it is a very good way to relax the lumbar portion of the spine,\\nas it is not so much supported bj^ attachment to the shoulders as the upper\\nparts of the back, from the twelfth dorsal up. I have often heard Dr. Harry\\nStill advise some such stretching motion.\\nQ. When you have relaxed the structures along a smooth spine, would\\n\u00e2\u0080\u00a2you give the stretching treatment at the same treatment?\\nA. Yes, sir.\\n0. In the case of a vertebra being anterior, placing the knee on the\\nspine, would you put it above or below the vertebra that was anterior?\\nA. Well, generally just about that point. You of course regulate your\\nforce, and I do not think you are in any danger of pushing it forward, but the\\ngeneral idea there is not to bring pressure upon that point, so much as to give\\na fulcrum against which to work, and letting the general tendency of the for-\\nward motion of the spine do the work.\\nQ, Would stretching the ligamentum nuchae have a tendency to get pos-\\nterior curvature out between the shoulders?\\nA. Partly so, though we do not usually pursue that method for that par-\\nticular thing. It would help.\\nQ. In stretching the ligamentum nuchae forward, is there any danger of\\nacting upon the nerves that go to the stomach?\\nA. I have never found any trouble in that way; I hardly think there", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0054.jp2"}, "55": {"fulltext": "THEORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS. 49\\nwould be, unless in case of defect, as you thus stretch the whole spine, you\\ntnight get an effect upon the splanchnics.\\nQ. In case of anterior displacement of the 4th cervical, would the stretch-\\ning of the ligamentum nuchae have a tendency to draw it out?\\nA. It would not have much of a tendency to do that; it is true there are\\nslips that run down to those vertebrae, but you would hardly get enough ten-\\nsion by those slips to bring tension upon the vertebrae.\\nQ. In separation of the spines there is a weakness of the ligaments and\\nin approximation there is tenseness, and our treatment seems to be very much\\nalike, how do we know that the same treatment will cause an opposite effect?\\nA. That is a good question. Of course there is a certain lesion, in one\\ncase there is an approximation, in the other a separation; there would be no\\ntrouble in diagnosis. You must not misunderstand the use of the terms, too\\nmuch or too little life directed to a point. That is true, but there may be ex-\\nceptions, in case of a sudden wrench or jerking of the vertebrae apart, which\\nfrequently happens, there would not necessarily be a relaxation of the liga-\\nments; but that is a general method of reasoning, I have mentioned it for the\\nsake of its importance. But as to your question how we could get the different\\neffect by practically the same treatment, it simply amounts to this: that in\\neach case you are trying to stimulate parts; in one where there is a tightening\\nof the ligaments you use a stretching motion to draw them apart; in the next\\ncase where they are separated, granting there is too little life there, you wish\\nto stimulate them by stretching them, and getting the benefit of the recoil and\\nthrowing more life to the part.\\nLECTURE X.\\nAt the last lecture I brought out the point that from the preceding argu-\\nments it became apparent that the whole field of nerve force was open to the\\nOsteopath, and that the probability was that there was no nerve in the bod}^\\nwhich he could not affect either directly or indirectly, thus opening up to him\\nthe whole field of nerve life. That the question of degree of stimulation was\\nnot an important one, since the Osteopath manifesth^ could stimulate or in-\\nhibit, that is, could affect the nerve in such a way as to gain the desired end.\\nI then quoted from certain texts, one from Kirk concerning an experiment up-\\non a rabbit s ear, section of the nerve followed by vaso- dilatation of the ear,\\nhe showing that the same thing could be done by pressure of the thumb nail\\nupon the nerve; also a quotation from Greene concerning the reflex process\\nbeing generally due to stimulation, which might be applied mechanically. The\\ngeneral idea of those quotations being to show that we could from the books\\nget authority for what we have been arguing; that that did not limit us, since\\nwe have shown that we can get results in every part of the body; hence, we\\nare not limited to the same kind of experiments as the physiologist when he\\n;gains results by external experimentation, but since we can reach the whole", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0055.jp2"}, "56": {"fulltext": "50 THEORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS-\\nbody, we are privileged to say that we can stimulale the nerves in any part of\\nthe body. Today we continue the same subject.\\nI. Theory OF Osteopathic Worr Upon Centers. (Continued.)\\nThe subject grows under my pen, and I do not know but what there will be\\nseveral more lectures before we shall have concluded the subject. I have been\\ncalling 3^0ur attention to the fact that the view I gave you of mere stimulation\\nor inhibition, direct or indirect, was not the important thing that the Osteo-\\npath considers when working upon nerve centers. I have reserved that until\\nnow, calling it the second view taken by the Osteopath in regard to stimulation\\nor inhibition of nerve action. This is that by the removal of lesion, some, ob-\\nstruction which has been preventing the direct flow of the blood or nerve force,,\\nthe tendency toward the normal is left free to act. And that is the kernel of\\nour work, I believe. Not that we do not do the other things, but I wish to\\nlay stress upon the fact you must look for lesions, and having found the lesion.\\nand having removed it, you do not have to stop to consider whether it i*^ stim-\\nulation or inhibition that you must produce. After you have the lesion re-\\nmoved you have the ever present tendency toward the normal to regulate the-\\nactivity, and leave Nature to do the work. In case the lesion or obstruction,\\nhad been such as to inhibit nerve action or lessen the conductivity of the\\nnerves, and thus prevent the proper conduction of nerve impulses, and you re-\\nmove that lesion, the result would practically be stimulation. For instance,,\\nyou might have had the tightening of the spine along the region of the upper\\nsplanchnics resulting in an impingement upon the branches connecting with,\\nthe sympathetics in that region, thus interfering with the nerve force to the\\nsolar plexus and to the stomach. The result might be a case of dyspepsia.\\nThere you have an inhibition of nerve force; you have not enough life to digest\\nthe food put into the stomach. When you have removed that obstruction,\\nwhat have you done? You have taken away that obstruction, you have left\\nNature free to act, and she will go about stimulating and renewing the nerve\\nforce at that point. What you did was to correct the lesion, you did not stim-\\nulate nor inhibit, you did not care about that particular point in your treat-\\nment. On the other hand, if the lesion has been just sufficient to bring irrita-\\ntion upon the nerve and to keep it stimulated to an abnormal degree of activity,\\nthat is what you would call abnormal stimulation of the nerve, then by removal\\nof the lesion, you would obtain the result of inhibition. That is, you would\\nremove the irritation, leaving free the tendency toward the normal to act, and\\nthe result of Nature s work would be a quieting of the nerve, and thus a curev\\nYou have simply corrected the lesion. A very familiar example of snch a con-\\ndition is in female troubles; you may have a uterine tumor affecting the hypo-\\ngastric plexus, disturbing the kidneys If that tumor is taken down or re-\\nmoved the result would be stimulation, but you have simply corrected the\\nlesion. This is the most important thing that the operator does; he removes\\nlesions in the great majority of cases. The lesion may be lack of nutrition,\\nthat is, of blood-supply to the nerve; it may be a displacement of some import-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0056.jp2"}, "57": {"fulltext": "THKORY OF OSTKOPA THIC WORK UPON NERVKS AND CENTERS. 5 1\\nant part, bringing direct pressure upon the nerve. No matter what the lesion\\nbe, the Osteopath s knowledge of anatomy, and his trained sense of touch en-\\nable him to discover abnormalities in anatomy and gives him his peculiar adapt-\\nability for the treatment of disease. I do not know that it is because we are any\\nwiser than physicians, because I do not think we are, but it is because our sys--\\ntem differs from others radically; we look at disease from an entirely different\\nstandpoint. I hope later to take up that subject, the different systems and\\nschools of medicine and their modus operandi. The result of our method is\\nthat we make a correct diagnosis of the case. You remember that Dr. Hil^\\ndreth put especial emphasis upon that; stating that the strong point of Oste-\\nopathy is that we make a correct diagnosis; that we diagnose from a physical\\nstandpoint. In the great majority of cases the Osteopath diagnoses and re-\\nmoves some displacement, hence the importance of looking for the lesion in\\nevery case. To illustrate the difference between the position taken by our\\nmedical friends and our position: When I was visiting at home about a year\\nago, a young man called on me to be examined. It was the same old story of\\na dislocated hip, the leg being shorter than it ought to be by about an inch,\\nand there being a tumor upon the side of the sacrum, made of course by the\\nprotrusion of the head of the femur. Now, he told me how the doctor had ex-\\namined him, simply by setting him on the other side of the room and question-\\ning him. That illustrates the difference in our methods. You will find that in\\nyour practice, there will not be a month pass but that you will find some\\nsimilar case where the doctor has simply sat across the room and questioned\\nthe patient and has not made a thorough physical diagnosis. So if you will\\ntake the trouble and will (thoroughly acquaint yourself with texts on\\nphysical diagnosis, I think you will be amply repaid\\nBy quoting from the operators in the building I wish to show that they\\nbelieve that we reach centers and affect nerve force directly by the removal of\\nlesions. I quote first from Dr. Hildreth: In the first place, where a lesion\\nmay exist, by manipulation or rather by Osteopathic treatment you reduce the\\nlesion, you re-establish a natural circulation, and in so doing you carry away\\nany obstruction which may exist. You thus remove the obstruction to nerve\\ncenters. If there be a contracted condition of muscles, the dislocation of a\\nvertebrae, or recent injury of tissues sometimes without dislocations, all these\\nconditions may produce disease of the different nerve centers of the spine, and\\nthe effect of Osteopathic treatment in all these conditions is to help to re-estab-\\nlish a natural nerve current, thereby restoring a normal condition of circula-\\ntion, thus relieving all tensions on nerve centers. With this done thoroughly\\nhealth cannot help but follow, for a healthy condition is a natural condition.\\nThus you see that Dr. Hildreth s idea is that the Osteopath adjusts abnormal-\\nities existing in the anatomy and simply leaves Nature free to restore a condi-\\ntion of health. I wish to add this to what Dr. Hildreth has said: In some\\nfew cases you will find that all that is necassary to do is to stimulate the blood\\nsupply. The blood supply acting through a longer or shorter time removes", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0057.jp2"}, "58": {"fulltext": "52 THKORY OF OSTKOPATHIC WORK UPON NKRVKS AND CBNTE^RS.\\nthe lesion. What you have done in that case was not to remove the lesion,\\nbut you have stimulated the blood supply, which you have done through direct\\nmanipulation of the nerves controlling circulation. In that case the matter is\\nreversed, the cart before the horse. You have to do this in the case of rheu-\\nmatism, where there are deposits in articulations. That, of course, is not a\\nprimary lesion, but it is a lesion. You must stimulate the blood flow so that it\\nwill absorb those deposits. We sometimes absorb small abscesses, or thicken-\\ning of parts in that way. You first remove the primary lesion, and then the\\nsecondary result has been to remove the other lesion. Of course we cannot\\nalways bring fac:is down to fit theories. I quote further from Dr. McConnell:\\nOur Osteopathic work is largely performed in correcting lesions involving\\nnerves or nerve centers, also in correction of the lesions of the arterial, venous,\\nlymphatic, and other fluids that bear a relation to such centers. In some few\\ncases we simply correct lesions of nerves passing from or to the brain, or the\\ncord, or sympathetic chain, or to the organ affected. Thus you see that Dr.\\nMcConnell s idea is that we work upon nerve centers, but that we do it by\\naffecting either the fluids of life or the nerve forces of life. His idea being, of\\ncourse, that we remove lesions, as his words impl5^ He also says that we\\nsometimes work to restore organic activity or health by removing a lesion from\\na nerve, that is, independent of its center. That is, you may have a pressure\\nupon a nerve, and removal of that lesion may not affect the center. From Dr.\\nTurner Hulett I quote as follows: Pressure upon a nerve fiber would cause\\na break in the continuity of the semi-fluid axis cylinder and the damming back\\nof its current upon its center of supply. If any abnormality exists, then the\\never present tendency toward the normal will tend to restore normal conditions.\\nIf the previous condition was abnormal stimulation, then inhibition or desensi-\\ntization was accomplished; if it was sub-normal, then stimulation was accom-\\nplished. This expresses very nicely what I have tried to show you, that\\nwhether you stimulate or inhibit depends upon the nature of the lesion that\\nyou remove. I might quote further from other operators, but lack of space\\nforbids. I hope this subject is not growing threadbare. We hear a great deal\\nabout removal of lesions and stimulations, etc., and perhaps you get a little\\ntired of it, but I think it important to get these things correlated in some defi-\\nnite system of argument, so that we may have together the points relative to\\nOsteopathy.\\nWe have thus answered two of three questions propounded. First, what\\ndoes the Osteopath mean when he says he stimulates or inhibits? Second,\\nhow does he affect internal life by manipulation upon the outside of the body?\\nand we have partly answered the third, How does he affect centers? I have\\ntaken this up in detail because these questions are some of the most bothersome\\nto the young Osteopath, and to the older ones as well, sometimes, and if you\\nare prepared with arguments, you may retain many a patient by explaining\\nthese things to him in a logical way.\\nNow, as to how we work upon centers, I wish to carry the argument a lit-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0058.jp2"}, "59": {"fulltext": "THKORY OF OSTEOPATHIC WORK UPON NKRVK CENTERS. 53\\ntie further. From what I have quoted from Doctors Hildreth, Hulett and Mc-\\nConnell you see that they believe that we work upon centers first, by the re-\\nmoval of lesions or obstructions, and second, by direct stimulation, and I think\\nthere is no doubt but that we do affect centers. What I have quoted from\\nthem was given to me in reply to the question, How do you affect centers in\\nthe spine? I wish to call your attention to the fact that the conclusion is in-\\nevitable from what has been said that we must reach nerve centers, not simply\\nnerves alone. Certain facts which we show bear out this conclusion. Speak-\\ning of the sympathy between the area that is supplied by the 5th nerve and the\\narea which is supplied by the vagus nerve, Dr. Jacobson, Dr. Hilton s editor,\\nsays: This s^-mpathy is an example of a reflected sensation in which the\\nconnection between the nerves concerned takes place in the nervous center.\\nThus you have your effect running up one nerve through a- brain center and\\ndown another nerve. Now, if you have a lesion affecting the periphery of one\\nof these nerves and you remove that lesion, you have naturally affected the\\ncenter in ;he brain, there is no doubt whatever of that. He gives a case of\\nobstinate vomiting in a child, which was cured by simply removing from each\\near of the child a bean which had been introduced in play. There was a stim-\\nulation of the 5th nerve, the impulse must have gone through the floor of the\\n4th ventricle out over the vagus to the stomach. Of course there is a connec-\\ntion of the 5th nerve and vagus by means of the sympathetic, but it is indirect,\\nand it is probable that the brain center was the connecting link, as Dr. Jacob-\\nson says.\\nAgain, we must reach nerve centers, because by the very definition of\\nreflex action, which we know is an action caused by an impulse sent back\\nalong a nerve to a center and then out. From its very definition, if we cause\\nreflex action by manipulation, the inference is inevitable that we affect centers.\\nThat we may do this is shown in performing the experiment for tendon reflex.\\nThis is very easily done be crossing the leg at about right angles and then get-\\nting the reflex by tapping the tendon. That is a reflex action. You have sent\\nthe impulse from the nerve endings in the muscle back to the center in the cord\\nwhich governs the nerve supply of the muscles of the limb, the gluteal muscles\\nhave contracted and thrown the limb out. So you have affected the center.\\nAgain, every time we set up a vaso motor action we have probably acted upon\\na center. Howell s Text Book says that vaso-motor nerves can be excited re-\\nflexly by afferent impulses conveyed either from the blood vessels themselves,\\nor from end organs of sensory nerves in general. Of course the thing is proven\\nthe moment you show that vaso-motor actions are reflex actions. I have\\ninstanced here the bleeding of the nose, epistaxis, stopped by irritating the\\nsuperior cervical ganglion of the sympathetic; simple stimulation of the neck\\nat that point has stopped bleeding of the nose. The conclusion is that you\\nhave acted through a nerve center.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0059.jp2"}, "60": {"fulltext": "54 TREATMENT OF THE SPINE-\\nI have shown first, that we affect a nerve and its area of distribution direct-\\nly, instancing the result of pressure of the ulnar nerve where it crosses the\\ncrazy bone so-called, thus you have numbness in the hand; you have affect-\\ned that nerve in its area of distribution directly, not through a center. Second,\\nwe affect a center by removal of a lesion, the beans in the ear being the exam-\\nple cited. And third, we affect a center without removal of lesion, but by the\\neffect upon the nerve, as in the ear of the rabbit, there was no lesion removed\\nwhen we press on the nerve, we acted on the nerve back through the center\\nand got our effect. Those are at least the three different ways in which we\\nmay affect nerve action.\\nII. How TO Treat A Spine. (Continued.) I have examined this gentle-\\nman and find the curves of his spine are not normal. What I wish to do is to\\nwork inward this curve in the lumbar region, and wish to make more pro-\\nnounced this curve in the upper dorsal region, because it is flattened, while\\nthe other is drawn out a little posteriorly, thus you have a somewhat straight\\nspine. At the risk of being tiresome I bring these points up in detail as I took\\nthem up in examination of the spine. I think 3 ou know what to do here as\\nwell as I; I have shown you how to approximate or separate vertebrae, and\\nyou would treat by a combination of the methods I have shown you; the relax-\\nation treatment with the patient on his face, or springing of the spine all along\\nthe relaxation of the ligaments and muscles, and thus of the blood and nerve\\nforce to those parts By a combination of those treatments you would tend to\\nstrengthen the normal curves. You would thus remove the lesion, which\\nwould be the tightening or tension that had thrown them out of their normal\\ncurves, and would leave nature free to act. You cannot quickly replace those\\nvertebrae in their normal curves; you must strengthen gradually and build up\\nthe spine in order that it may take its normal position. This tendency toward\\nthe normal is of great use to the Osteopath.\\nYou may find th^ coccyx in almost any position, either anterior or to one\\nside. What you must do is to give a local treatment. The method of digital\\ntreatment is to first place the finger along the natural curve of the coccyx, and\\nby working from side to side free all the ligaments and tissues thereabout. In\\nthis way you loosen everything over the foramina where the nerves emerge,,\\nor any binding down which may have occured over the nerves directly. You\\nhave inserted the finger and have turned it so that you have worked every side;\\nyou must thoroughly relax before attempting to reset. This must be done not\\nonly internally, but you must thoroughly relax all the muscles externally. It\\nwill take some time, but you can at each time you treat the patient bend the\\ncoccyx toward its proper position. Of course there are lesions of the coccyx\\nwhich may be set immediately^ In general, it is recent dislocations that yield\\nthus quickly to treatment. When it is chronic, as it usually is, the man usu-\\nally did it when he was a boy riding horse back or some such way, you will\\nhave to go .slowly. Suppose the coccyx was tending to be slightly curled up.\\nas is frequently the case, you must spring it backward each time. You must", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0060.jp2"}, "61": {"fulltext": "TREATMENT OF THE SPINE. 55\\ngo according to the conditions, and must constantly spring the spine toward its\\nproper position. I think I explained the troubles which may follow this dis-\\nplacement, and I do not need to take them up now.\\nThe sacrum ma}^ be anterior or posterior. I shall consider that more in de-\\ntail when we come to the consideration of the pelvis itself. But, supposing it\\nwere posterior, we would at first, of course, loosen up all the tissues, muscles,\\nand ligaments, and then adopt the method I showed the other day get your\\nknee against the bulging portion and spring it inward, a direct application of\\nthe treatment to the displaced part. It is a good deal like putting a coccyx\\nback into place; by training it in the way it should go. Kow you may also get\\nthe same motion that I showed you and spring the sacro-iliac articulation in\\nthis way. Then have the patient lie on his back and you can get a very good\\nmotion for the sacrum in this way; Your hand is placed in this position; the\\nknuckles forming one fulcrum and the tips of the fingers the other; there are\\ntwo fixed points, you have the ends of the fingers placed against the sacro-iliac\\narticulation, and your knuckles against the table. You thus have two fixed\\npoints, and you can in this way relax, by an upward, downward and outward\\nmotion of the limb, all the muscles and ligaments. The weight of the pelvis\\nis upon those two fixed points, it gives a considerable spring there, and is a\\nvery good motion. In case the sacrum is anterior, of course it is very hard to\\napply any direct treatment to it, but use the motion I have just shown you;\\nstimulate and relax every part, and depend on the tendency toward the nor-\\nmal. You might, by getting pressure upon the side of the pelvis, spring down,\\nbut I doubt if you could do much in that way. Your tendency, however,\\nwould be to approximate the innoniinates and to cause it to bulge out.\\nLECTURE XL\\nAt the last lecture I continued the consideration of the theory of Osteo-\\npathic work OD centers, calling to your attention the second view taken by the\\noperators as to how we stimulate or inhibit nerve action, the idea being that as\\na rule we remove some lesion, and that that is our strong point in our diagnosis\\nto find some lesion which we may reduce to the normal, and thus, if the ten-\\ndency before was toward stimulation, you have removed the lesion and allowed\\nnature to tend toward inhibition, and vice versa. Thus you do not have to\\nsplit hairs over the question as to whether you employ a certain motion to\\nstimulate and a certain other motion to inhibit. That is, as far as lesion goes;\\nyou have removed the lesion. I quoted from different ones of the operators to\\nshow that that was the view generally held. I also called your attention, in\\nline with what Dr. Hildreth said, to the fact that sometimes you stimulate\\nblood-supply to remove the lesion, which although secondary is still a lesion;\\nas for instance we stimulate the blood and nerve force to remove deposits in\\nrheumatism, and to cause absorption of abcesses, and things of that kind.\\nThus I had answered two questions propounded and partly the third, as to the", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0061.jp2"}, "62": {"fulltext": "56 THEORY OF OSTEOPATHIC WORK UPON NKRVKS AND CENTERS,\\neffect we have upon nerve centers. Then I went further into the question of\\nhow we might affect centers, bringing to your attention the fact that the quota-\\ntions I made from the operators were given in response to that question, and\\none way was b}^ the removal of lesions; another way was that in any manipula-\\ntion of the nerve we must very likely affect centers, as for instance, in getting\\na reflex effect, because from the definition of reflex action we must have affect-\\ned the center, and we often produce reflex action by work upon a nerve, not a\\ncenter. I instanced a case of obstinate vomiting produced by the irritation of\\nbeans in the ears. The fact that you have removed the bean shows that you\\nreached the center; that you worked through a brain center; up one nerve and\\ndown another nerve to the periphery, to the organ supplied by the nerve. And\\nthe fact also that we can produce vaso-motor action shows that we have affected\\ncenters, since vaso-motor actions are essentially reflex. Thus I showed that\\nwe may affect a nerve by three ways: ist, we may directly affect it and its area\\nof distribution by direct work; 2nd we may affect the center by removal of les-\\nion to the nerve; 3rd we may affect a center without removal of lesion; as when\\nwe produce a reflex action. To-day I continue the same subject.\\nI. Theory OF Osteopathic Work Upon Nerve Centers, (Contin-\\nued.) In the December issue of the Journal of Osteopathy, a theory was given\\nin an article by Dr. Lawrence M. Hart, one of our recent graduates, which I\\nthink was worthy of notice. It was well received at the time, I believe, and I\\nhave thought that it contained points which would be worthy of our consider-\\nation this afternoon. His idea is that we always remove lesions. His theory,\\nin brief, is this: that contractures of muscles occur along the spine, these con-\\ntractures along the spine, he says, act in a way to mechanically shut off the\\nblood supply in the branches suppl3dng the spinal muscles themselves, collater-\\nally producing a hyperemia in the blood vessels running to the cord, and in\\nthat way stimulating she nerves, irritating them, and thus leading to inhibi-\\ntion, the final result always being an inhibition, and the lesion always being\\ncontracture. There are certain points with which I do not agree, I will call\\nthose up later, but I will go over the reasoning that he has followed, bringing\\nout his points. In the first place, he says there are two ways in which a nerve\\nmay be affected through its blood supplj^ and I think that is true. In the\\nfirst place you may have anemia of the nerve, that is, totalpack of blood supply,\\nthus robbing it of its nutrition and leading finally to a degenerated nerve, and\\nthus paralysis of the part supplied follows. In the second place, you may\\nhave hyperemia of the nerve, which he claims leads to an irritation, there being\\ntoo much blood thrown to the part, leading to abnormal activity; this leads to\\ntoo much stimulation, resulting in inhibition. Thus, in one case from anemia\\nand degeneration you have paralysis; in the other case you have practically the\\nsame, an inhibition which is liable to be more temporary, because it is produc-\\ned by an over-supply of blood and not by starvation. Thus you see that his\\nargument leads always to the one result of inhibition. He calls our atten-\\ntion to the distribution of the blood supply to the spinal cord, showing how the", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0062.jp2"}, "63": {"fulltext": "THKORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS. 57\\nbranches from the vertebral, intercostal and lumbar and other arteries in their\\nrespective regions run to supply both the cord and the spinal muscles, the same\\nbranch supplying both, that is, dividing to supply both, the posterior division\\nrunning to the spinal muscles, and the other division running to the cord and\\nits membranes. Thus he shows the close relation between the blood-supply,\\nand states the fact that from the occiput to the coccyx, all of the muscles and\\nparts of the cord are thus supplied. Now, his argument here is that in con-\\ntracture of muscles, the lumen of the vessels being thus practically closed, the\\nover supply of blood is sent through the branch which supplies the mem-\\nbranes of th3 cord, thus producing a condition of hyperemia about the cord. In\\nthe first place, this would result in throwing too much blood supply to the\\nnerves in question and the nerve centers of the cord, the re-\\nsult would be that by over blood supply there would be over stimulation, lead-\\ning finally and naturally to an inhibition of nerve force, and thus you see there\\nwould always be inhibition. Now, in relieving this condition we of course sim-\\nply take away the lesion, we, by our methods relax these old contractures, and\\nallow a return of the flow of blood through them, and thus take away the over-\\nplus which is being misdirected to the cord and, through the centers, affecting\\nother parts of the body. You see that the point is made that we remove lesions\\nand that is one reason why I bring this up, because it illustrates that fact.\\nWhatever the result, according to his theory, if I correctly understand it, we\\nhave always stimulated, but that since we remove lesions and then leave nature\\nto work, it is not an essential question to us whether we stimulate or inhibit,\\nwhich I think is another good point, because there has been a good deal of hair-\\nsplitting as to whether you should give a certain twist of the wrist to stimulate,\\nor a certain other twist of the wrist to inhibit. Now, to me, Dr. Hart s theory\\nis valuable in bringing prominently to your attention this one kind of lesion,\\ncontracted muscle, and showing the probable effect produced. That is at least\\none kind of lesion with which we have to deal. He shows the importance\\nwhich we must attach to this condition of contracted muscle, which we fre-\\nquently find along the spine. 7 doubt if there will be a day in your practice\\nin which you will not find such a condition along the spine. In the criticisms\\nI have to make, I do so not to criticise the article, but simply for the purpose\\nof bringing out the points which I think will be helpful to you. From his ar-\\ncle I do not gather that he allows of other lesions, though perhaps I am mis-\\ntaken. I do not think he makes it general enough. Now, I think there are a\\ngreat many other lesions along the spine which will affect nerve centers and\\nnerve distribution, and saying that contracture is the only cause of lesion is\\nfar from correct. So that his theory is true only when the lesion is in the na-\\nture of a contracture, and then I do not agree with the explanation, but I shall\\nspeak of that later. I wish to call your attention further to the fact that we\\nsometimes stimulate and sometimes inhibit. After 5^ou have removed the les-\\nion, you sometimes have to do your Osteopathic work upon parts affected, and\\nin those cases you must stimulate or inhibit. In the case of head-ache we fre-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0063.jp2"}, "64": {"fulltext": "58 THEORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS.\\nquently have to hold and, as we call it, inhibit the neck, while in the case of\\nepistaxis we would stimulate the superior cervical ganglion. Then again, to\\nremove the chalky deposits in rheumatism, or in absorbing an abcess, we have\\nto stimulate frequently, and in that case, of course, it is not a matter of remov-\\nal of lesions. Now, I have said that I think the explanation of the effects fol-\\nlowing contracture is only partly true, and for this reason; I believe the theory\\nis somewhat too mechanical, making this a mechanical shutting down upon\\nblood supply, and thus sending an over-plus to other parts. The theory does\\nnot, according to my mind, take into consideratien enough the mechanism of\\nnerve distribution to the vessels and to the muscles of the back and hence\\nI have gone somewhat further, and have endeavored tD explain the condi-\\ntions which would follow contractures on the basis of nerve influence. I be-\\nlieve that the generally accepted view is that not only the blood vessels of the\\nbody, but all the functions of life, are directly under the control of the nervous\\nsystem, sympathetic or cerebro-spinal. And hence, I think it would be more\\nin line with the accepted theory if we could explain these things according to\\nsome theory of nervous influence which they have produced. Now,\\nit is reasonable to suppose that there is by contracture some vaso-\\nmotor influence set up. Mechanical contracture would result in stoppage\\nof blood to the muscles along the spine, and would, of course, result in an over-\\nplus of blood to the cord and its meninges through the collateral branches.\\nThat would be inevitable, but that condition would hardly be permanent unless\\nthe vessels were dilated to accommodate it, so that we must look for some sort\\nof a nervous action to account for the blood remaining at that place, otherwise\\nI believe that the blood would be distributed about the body, and the collateral\\nequalization would be set up, and, as you had anemia along the spinal muscles,\\nyou would have that much more blood in other parts of the body, not neces-\\nsarily just along the spine. That is, in case the mechanical theory holds true.\\nBut I believe you might have in such case not only hypermia of the cord, but\\nyou might have anemia of the cord and its centers. If the muscles contracted\\nand shut off the blood supply mechanically only, you cannot have anything but\\nhyperemia; but if you regulate your theory according to nervous mechanism,\\nyou can have either. There is no question but that contractures are impor-\\ntant lesions. For instance we have heart trouble caused by lesions along the\\nback. I remember having heard Dr. Hiidreth say that in case of weakness,\\ngeneral debilit}^ and irregular heart action he always looks on the left side be-\\ntween the shoulders, for some contracture of muscles in that part, and that\\nsuch a condition would usually make the patient despondent. Dr. Hiidreth\\nalso said that when he found such a lesion on the right side of the spine it usu-\\nally makes the patient silly; has the opposite effect. Such is Dr. Hildreth s\\nexplanation of this kind of lesion along the spine, and there must be some good\\nexplanation for the results thus produced. Now, as I have said, to me it sterns\\nvery probable that the contractures act not so much mechanically, as through\\nvaso-motor centers and fibers which they involve, and not oniy that, but indir", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0064.jp2"}, "65": {"fulltext": "THEORY OF OSTEOPATHIC WORK UPON NERVKS AND CENTERS. 59\\nrectl}^ through the nervous mechanism of the muscles involved. I quote from\\nGowers on the Nervous System: **The sensory nerves of muscles have been\\nshown by Tschirjew to commence not in the muscular fibers but in the inter-\\nstitial connective tissue. Then he goes on to explain his theory of why we\\nget a myostatic reflex action, the term he has adopted for tendon- reflex. He\\nsays that in such a case the muscle is upon a tension. You remember in show-\\ning you how to produce the knee-reflex I crossed the knees, thus bringing ten-\\nsion on the muscles above the knee, then if you shock the muscle, not neces-\\nsarily the tendon itself, you get the throwing out of the foot. He bases his\\ntheory on the sensory nerve-endings between the muscle fibers being impinged\\nupon by the fibers themselves. It seems reasonable to suppose that if the mus-\\ncle is in a state of tonic contraction there would be a pressure upon the nerves;\\nand that is a fair explanation of the sore spots we find along the spine. Those\\nsore spots have been started in a contracture; it has become axiomatic that we\\nmust look for the sore spots along the spine, and you will find that they coin-\\ncide with the seat of the lesion, which is the contracture. That theory would\\naccount for the spot being sore, that is, providing it had not been of too long\\nstanding, in which case if you find it not sore you might account for it by the\\nsame theory that stimulation has gone on until it is equal to inhibition. I\\nam a good deal like Dr. Hildreth when he says, If this theory does not suit\\nyou figure one out for yourself. And while I am endeavoring to explain these\\nthings in as scientific a way as possible, if my theories are not correct, it is\\nyour privilege to do better.\\nNow, not onl}^ would we affect the terminal sensory fibers in the muscles,\\nbut we know that there is a close connection between the spinal nerves and\\nthe sympathetics and it looks very probable that an effect might be sent from\\na muscle through its sensory terminal right through to affect the sympathetic\\nnerves, and thus to affect the general sympathetic life, irrespective of an}^ ef-\\nfect you might have through the blood supply upon nerve centers in the spinal\\ncord. Thus you get the direct sympathetic effect from the irritation of sen-\\nsory nerves. You remember that I quoted from Howell s Text Book a few\\ndays since to show that nerves were frequently stimulated through their sen-\\nsory terminations in the muscles. Now, as I have said, I believe this con-\\ntracture, taking the theory that it acts through the blood supply, may thus\\nproduce either vaso-dilation or vaso-contraction, according to the centers af-\\nfected along the spine. I here quote from Kirke: The vaso-dilator nerves\\nin part accompany those first described, but are not limited to the out-flow\\nfrom the 2d thoracic to the 2d lumbar. Further: The vaso-constrictor\\nnerves for the whole body leave the spinal cord by the anterior roots of the\\nspinal nerves from the 2d thoracic to the 2d lumbar. Hence, my argument\\nis that since you have both vaso dilator and vaso-constrictor centers along the\\nspine, according to the quotation from Kirke, that acting on the center af-\\nfected you might have either a vaso-dilation or vaso-constriction; you may have\\nanaemia or hypermia of the center involved. That looks reasonable to me", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0065.jp2"}, "66": {"fulltext": "6o THEORY OF OSTEOPATHIC WORK UPON NERVES AND CENTERS.\\nfrom the theory of nervous mechanism of the blood supply. In case the lesion\\nwere such that it brought this overflow of blood upon a vaso-constrictor cen-\\nter, that center would be stimulated at first, and the first result would be to\\nshut off the blood to the parts affected by the contraction resulting from the\\nover stimulation of that vaso constrictor center. Thus you might have anae-\\nmia; the constrictor may act in such a way as to entirely shut off the blood\\nfrom a part. Byron Robinson is authority for the statement that the sympa-\\nthetics may crowd the blood from a part even unto death. However, suppose\\nthat the action has gone so far that the stimulation has resulted first in irrita-\\ntion, then in inhibition, so that there is a paralysis there, then your constric-\\nis lost; your dilators are not opposed and there would be a flooding of the part;\\na hyperemia. In line with this theor}^ I quote what Greene has to say. He\\nsays that hyperemia of a nerve center leads to, first, an excessive nervous ex-\\ncitability, together with paraesthesia of sight and hearing, and finally may even\\nlead to convulsions. On the other hand, if in the first place the vaso-dilator\\ncenter be affected, you would have the dilators over-stimulated resulting in\\nhyperemia, but when it went on, finall}^ resulting in paralysis of those dilators,\\nthen the unopposed action of the constrictors would set up an anemia, and\\nthat would be a permanent result. It would lead to death of the part para-\\nlyzed from the excessive anemia of the spinal centers and the spinal nerves.\\nThus you get an effect not only upon the spine, but upon the whole distribu-\\ntion of that nerve. Thus you can see what would be the probable effect of\\nanemia or hyperemia of the cord either from this shutting down of the con\\ntractures upon the blood supply, according to one part of the theory, the\\nother part of the theory being that this contracture might shut down directly\\nupon the nerve and through it send the effect to the part supplied by the\\nnerve. Thus you see that contractures along the spine may act as stimulators\\nor inhibitors mechanically. So in this case we remove the lesion for its\\nown sake, and not simply to stimulate.\\nSo much for that thought. I wish to take up another question in relation\\nto blood-supply, how it affects nerve life, and how, perhaps the Osteopath\\nmay thus influence nerve-life through blood supply. That is perhaps getting\\nthe cart before the horse, according to the previous argument, vStill from the\\nfacts which I wish to bring to your attention it looks as though we might ac-\\ncomplish this. This question is not proven, but I thus throw it out for the\\nsake of suggestion. It may lead to a good theory later. The quantity of\\nnatural, healthy blood in the vessels of a part act reflexly upon the mechanism,\\nthat is, the vaso-motor nervous mechanism, and thus affect the parts. There\\nwould thus be a collateral equalization of the blood throughout the body. As\\nI stated, the facts that I have to give along this line do not strictly prove the\\npoint, and I have not tried to make them, but they are valuable as hints. In\\nthe first place, if Dr. Hart s argument be true that the effect of the blood may\\nbe stimulation resulting in inhibition, or that it may be inhibition direct, then\\nthe quantity of the blood in a part, being drawn from the spinal muscles to", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0066.jp2"}, "67": {"fulltext": "THKORY OF OSTEOPATHIC WORK UPON NE^RVKS AND CENTERS 6 1\\nthe centers there, the mere quantity of blood would account for the effect uport\\nthe nervous mechanism. I use the term, pure, healthy blood, because I do\\nnot take into consideration the question of the effect of deteriorated blood,\\nwhich you know is a different thing. From Green s quotation we see that he con-\\nsiders the effect of hyperemia upon nerve centers produces paresthesia, convul-\\nsions, etc. Howell s Text-Book states There is in some degree an inverse\\nrelation between the vessels of the skin and of the deeper structures by the\\nreflex mechanism of the vaso-motor centers, If superficial parts have their\\nvessels dilated, deeper parts have them contracted, the flow of blood being reg-\\nulated in different parts of the body according to conditions. The question is,\\nwhat is the stimulation There was one of our students who conceived the\\nidea that the distribution of the fibres of the solar plexus upon the blood ves-\\nsels close to the heart, chiefly the aorta, were stimulated by the flow of blood\\nfrom the heart into the vessels that they thus acted as vaso-constrictors or di-\\nlators, and thus propelled the blood, producing the rhythmic beat of the aorta.\\nThis student wrote to Byron Robinson, who replied that he considered it a very\\nreasonable theory. Hence, you may have the quantity of blood thrown into the\\naorta acting as a stimulant. Green further notes the fact that in hyperemia\\nfollowing inflammation, that in other parts of the body there is collateral ane-^\\nmia, because there being too much blood in one place, there is too little in an-\\nother place. As I said, I quote these facts as suggestions, and not for the sake\\nof proving the theory, but if that theory can be proven, it will be important\\nto the Osteopath he may mechanically pump blood into a part, as for instance\\nby flexion of the thigh, he might repeatedly flex it and pump blood into it and\\nthus get a vaso motor effect which is mechanical. Thus, he may get a nerv-\\nous effect through the quantity of blood sent to the part. We sometimes\\nmake a practical application of such a theory by working upon the splanchnics\\nto reduce the amount of blood in the head the parts governed by the splanch-\\nnics being a sort of a reservoir for an over-plus of blood, and we can work\\nit from one part to another. These facts may may be taken for what they are\\nworth and may be suggestions for some of you.\\nII. How TO Treat a Spine. (Continued.) As to the second part of\\nmy lecture, I shall try to conclude this subject if possible. There is one point\\nI want to give you in relation to the general treatment of the spine. When\\nyou have acute hyperesthesia, an acute tenderness all along the spine, the-\\nOld Doctor treats in the neck, in the cervical enlargement, corresponding in\\ngeneral to the spines of the cervical vertebrae, and in the lumbar enlargement\\nof the cord, corresponding to the spines of the last three or four dorsal and the\\nspace between the 12th dorsal and ist lumbar.\\nThere is one treatment that I have not shown you. It is a treatment I\\nhave not seen any of the ladies use. It is a treatment in which the operator\\nsimply brings his weight to bear in this way. That is what I have denomina-\\nted as the straddling treatment.\\nI mentioned to you that we frequently get noises along the spine which are", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0067.jp2"}, "68": {"fulltext": "62 THEORY OF OSTEOPATHIC WORK Ut\u00c2\u00bbON NERVES AND CENTERS.\\ndue to motion between parts, and in some cases that that was due to a slipping of\\nparts of the ribs to their place, and when I have worked along the spine by get-\\nting direct pressure over one side only and I have not been able to produce these\\nnoises with their accompanying result, it was probably because I did not get\\nequal pressure upon both sides, but when I adopted this straddling movement\\nit brought equal pressure on both sides, then I could get that sound and the\\ngood effect following the replacement of the parts in that way.\\nI might call your attention to the technique of stretching some of these\\nscapular muscles. You will, in your treatment of the upper part of the spine,\\neither to reduce contractures, or to loosen the muscles along the spine,\\n\u00c2\u00a3nd that you must stretch these scapular muscles. It is a good plan to push\\nthe patient s arm w^ell down to the side on a level with the table, then, putting\\nthe hand beneath the scapula until the fingers are overlapping the spinal edge\\nof the scapula, the shoulder blade has been approximated to the spine, there is\\nnot much space between the spine and the edge of the scapula. By holding\\nthe muscles firmly against the edge of the scapula you can stretch so that by\\nbringing the arm across the chest you bring a tension upon the scapular mus-\\ncles. By use of the thumb on the scaleni muscles at the side of the neck,\\nbringing the arm up over the head, with your thumb over those muscles you\\ncan loosen them, this being a preparatory step to the setting of the first and\\nsecond ribs. You must have those muscles relaxed, and you get the effect in\\nthis way as well. Just hold them with one hand while you push the elbow up\\ntoward the head and around toward the body. Those are motions frequently\\nemployed in practice.\\nThere is a question now as to how to reach the psoas muscle. It is one of\\nthe flexor muscles of the thigh. It is a good plan to simply straighten the\\nlegs out and then bow the back inward at the lumbar region that gives it\\nsome little stretch and gets an effect upon the psoas muscle. The lumbar\\nplexus is formed in the substance of the psoas muscle, and if it is contracted\\nyou may have trouble wdth that plexus. I want to show you one other motion\\n-which it is sometimes necessary to use, though with great moderation. I show\\nit to you principally to warn you against its use. The patient lies on his face\\nand you lift the legs from the table and then work from side to side 3^ou can\\nthus stretch the psoas muscle often more than you did before, and by working\\nupward along the spine, one operator placing his hand on one side of the verte-\\nbra, the other on the other, you can thus bring pressure against either side of\\nthe vertebrae. This is the treatment called breaking up the spine. It is fre-\\nfrequently used with very good effect in cases of diarrhoea, flux and other\\ntroubles. The warning is that 3^ou should not raise the knees high above the\\ntable if you do that and bow the back too much you may have serious results,\\nand the Old Doctor has cautioned us against any such performance, so you must\\nbe extremely careful, though the motion is useful in reaching certain troubles.\\nYou might not only strain the spine and the anterior ligaments, but you\\natright tip the parts of the pelvis. Dr. MtConnetl spoke of a case which had", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0068.jp2"}, "69": {"fulltext": "THEORY OF OSTEOPATAIC WORK UPON UPON NERVES AND CENTERS. 65\\nbeen injured in that way, and which has been serious ever since he said he had\\nfound that the innominate bones had been slipped, and that there was an ine-\\nquality at the symphasis of the pubes.\\nLECTURE XII.\\nI wish to recapulate a little in regard to the nth lecture. At that time I\\nbrought up the theory of work upon a spine through the effect we could get\\nby removing lesions in the shape of contracture of muscles. I referred to Dr.\\nHart s theory, which was a good one; his idea being that the contracture of\\nmuscles shut off the blood supply in the muscular branches of the arteries, and\\nthe overplus is thus thrown to the cord and affects oenters and nerves, stimu-\\nlating at first, but afterwards leading to inhibition. I explained how his view\\nled up to that result. I then went further and endeavored to show that such a\\nprocess must necessarily be by affecting vaso-motor nerves, otherwise the blood\\nwould not be retained about the centers of the cord to influence them. And\\nfurther, that we might have an effect not merely upon the vasomotor nerves\\nand their centers, but we might have an effect directly through the terminal\\nsensory branches, running from the muscles, upon sympathetic and internal\\nlife. I then brought merely to [your notice, without attempting |to prove it,\\nthe point that possibly the amount of blood in a part would account for certain\\nnervous effects. Then again the theory of Byron Robinson, that the pumping\\nof the blood from the heartjinto the aorta may set up a reflex action. And finally\\nthe quotation from Green s Pathology that there was always a reflex arrange-\\nment of the circulation, that if the superficial vessels were dilated, the deep ves-\\nvSels were contracted, and vice versa; and from these and other facts it seemed\\nprobable that we, by working mechaniralh^ as for instance pumping blood into\\nthe limb, bring a certain quantity of blood to act upon nerves, we could in-\\nfluence nerves and centers. However, as I said, the theory is a little hard to\\nprove.\\nI. Theory of Osteopathic Work upon Nerve Centers. (Con-\\ntinued.) I wish to continue the same general subject to-day, going a little\\nfurther into the question of contractures; their occurence, nature and cause.\\nNow, as to the occurrence of contractures along the spine and in other parts of\\nthe body, their importance I think was fully brought out in the last lecture, in\\nshowing you how important they become when considered as lesions along the\\nspine, especially from an Osteopathic standpoint. We, as Osteopaths, find a\\ngreat deal to say about contracted muscles, and I think we are backed by the\\nauthorities when we are talking about them. When we get out in practice and\\ntell a patient that there is a muscle in his back or neck which has become con-\\ntracted and failed to let go, he is sometimes inclined not to believe it, because\\nthe popular idea is that a muscle contracts and lets go when you wish it to,\\nand that it simply cannot contract and hold on. You will also find that when\\nyou get out among the medical fraternity they will try to pick flaws in your", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0069.jp2"}, "70": {"fulltext": "64 THEORY OF OSTEOPATHIC WORK UPON NERVE CENTERS.\\nargument, and unless you are backed up by authority, you hardly feel so strong\\nin argument as you otherwise would. Hence, I have taken up this question a\\nlittle further to show that what are termed contractures are recognized by\\nthe different authorities. Howell s Text Book says: A contracture is a state\\nof continued contraction of a muscle. Gower on the Nervous system says:\\nTonic spasm, persistent and involving only a certain group of muscles, causes\\ndistortion of the parts to which they are attached, and is termed a contracture.\\nIn the Journal article which I quoted at the last lecture a quotation is made\\nfrom Dr. Allen s work on human anatomy, which is as follows: An abnor-\\nmal phase of tonicity is met with when a muscle sustains unduly prolonged\\naction of its fibers; under these circumstances a shortening of its belly takes\\nplace, which persists as long as the cause of the contraction is maintained.\\nSuch abnormal modification of contraction is termed contracture. Stretching\\nof a contractured muscle is readily accomplished and maintained, provided the\\ncause for the contracture is removed. Contracture, clinically considered, is a\\nsubject of great importance. In lateral curvature of the spine contracture of\\nmuscles will take place on the side of least curvature. Hence, you see that\\nthe authorities agree, they say that contractures are of considerable clinical im-\\nportance; they say that they cause distortion of parts to which they are attached.\\nHence, you see that others besides Osteopaths attach significance to this con-\\ngested condition of the muscle which we call contracture. But it is important\\nperhaps, in taking up this subject, to show that the Osteopath, in work upon\\ncontractures, in treating them as lesions and in removing them, is thoroughly\\n.scientific and has the weight of authority and science behind him. There is a\\nquestion as to what the nature of a contracture is. We saw from the quotation\\nabove that Gower understood it to be tonic spasms; then Howell s Text Book\\nsays that continuous contractions may be caused b3^ continuous excitation, and\\nit regards it as a tetamis. Such a condition of a muscle may be found also in\\ninvoluntary muscles. When you are in practice you will find that frequently\\nin your work upon the intestines that thej^ are drawn and hardened; you will\\nfind the stomach hardened to the touch, and this is an abnormal tonicity which\\nis regarded in the same light as contractures, although that term is not applied\\nto it. You will get so that you will recognize by touch the normal feeling of\\nthe abdomen, and hence will be able to recognize any departure from the nor-\\nmal. Kirk is authority for the following statement: Though involuntary\\nmuscle cannot be thrown into tetanus, ii has the property of entering into a\\ncondition of sustained contraction, called tonus, which is, as far as our pur-\\npose goes, practically the same thing. You will find in your work that there\\nis quite a difference between the feeling that you get from contracted muscles\\nin the back and the feeling that j^ou get when working upon the abdomen.\\nNow, the external muscles of the abdominal wall may be contracted as well as\\nthose internal muscles, and you will find often the outer covering of the abdo-\\nmen much contracted and hardened. x\\\\s I said, you will have to learn by ex-\\nperience what is the natural feeling of the muscles in the back and muscles in", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0070.jp2"}, "71": {"fulltext": "THEORY OF OSTEOPA.THIC WORK UPON NERVE CENTERS. 65\\nthe abdomen, and how they have departed from that by becoming contracted.\\nThen, again, the question comes, Is it not exercise that makes these mus-\\ncles hard, particularly in the back? Therefore, how can the Osteopath recog-\\nnize the difference between the normal hardening of a muscle due to exercise,\\nand a contraction of the muscle which is called a contracture? There are var-\\nious ways, some of which I shall give you later in the lecture, but one way is\\nthat when a muscle is hardened by proper exercise it is homogeniously harden-\\ned, the same degree of hardness all over it; while when you come to feel of a\\nmuscle which is contracted, you are apt to find it raised in welts. We shall\\nfind the reason for that presently. Of course there is contracture which, ac-\\ncording to the definition, would be called contracture, but different from what I\\nhave been describing. That is in set limbs in rheumatism, and things of that\\nkind, but you will recognize those readily by the the case itself.\\nNow, we usually find these contracted muscles not only in the back and\\nabdomen, but we find them frequently in the neck, and that is one important\\nplace that you will have to watch for hardening of muscles. The explanation\\nof the contracted muscle rising in welts on the back: When you work upon\\nthe back you will find that parts of muscle slip under your fingers, as if you\\nwere working over a whip cord or something hard; that is what is called a welt.\\nYou will, of course find muscles normally contracted to produce motion, I\\ntake the following quotation from Gower, which will explain itself. Every\\nmovement is due to a contraction of a series of fibres, which seldom corresponds\\nto the series massed together in a muscle. That is, you frequently\\nhave a contraction of different fibres, you might say a sort of a wave\\nof contraction running through different fibres of different muscles to\\nproduce complex movement, and he says that it is seldom that these\\nmovements are massed together in a muscle. Ofcourse there are\\nprominent exceptions to the rule, one being that of the biceps.\\nHe goes on to say: Fibres, not muscles, are represented in the structure of\\nthe brain, and those that cause a simple movement may be in several muscles.\\nHeDce, you see that a derangement of a certain part of the motor area in the\\ncerebrum may cause a lesion of parts of several muscles, or a lesion of different\\nnerve fibres of the muscles may cause a contraction of parts of dift erent muscles.\\nHowell s Text Book states: If the muscle be in an abnormal state the con-\\ntraction may remain localized as a swelling or welt. That is the term by\\nwhich we usually describe those contractions.\\nThe Osteopath is sure of his grounds scientifically when he says to a pa-\\ntient that the muscle has contracted and has failed to relax When he finds\\nthat such a condition is present it is a basis of work on his part, to be treated\\nas a lesion, and when he describes ii as a welt, he is in accord with the au-\\nthorities.\\nThe question naturally conies, What is the cause of these contractures?\\nThe Osteopath regards them as peculiarly significant from his standpoint. We\\nnoted, ;,in quoting from Howell s Text Book that he said constant irritation pro-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0071.jp2"}, "72": {"fulltext": "66 THEORY OF CENTERS: CONTKACTURES.-\\nduced constant contraction, so it must be some irritation which: is continually\\nacting upon the muscle itself or upon its nerve connection, causing it to act in\\nthis way. That of course would lead you to inquire if the irritation came\\nthrough the sympathetics. You will find some of the visceral diseases sending\\na continous impulse over the sympathetics through the spinal nerves to the\\nmuscles of the back. Dr. Billroth, in the article quoted from the Journal,\\nstates: Contracture of muscle, is due to disease of the muscles, to primary\\ndisease of the nervous system, to loss of antagonism, as well as to excessive use\\nof one set of muscles over another. Gowers, in speaking of nerves and mus-\\ncles says: The excitability is changed by disease, of which the change is of-\\nten an important symptom. (That is, the change in a muscle or nerve is fre-\\nquently an important S5^mptom of disease.) It indicates the state of nutrition\\nof the nerve fibres and muscles, and from this we can draw important inferences\\nregarding the condition of the centers. Gowers states that paralysis or ab-\\nnormal excitabilit}^ of a nerve refers back to the nerve center controlling it. If\\nthe abnorfnal excitability has been such as to result in contraction, it will refer\\nus back to the point from which the irritation came, it may be the distant cen-\\nter or distant periphery of some othar set of nerves reflected back sympatheti-\\ncally.\\nIn discussing before you previously to this the Osteopathic view of con-\\ntracted muscles, I said that the Osteopath regarded them in one case as primary\\nand in another case secondary. Primarily, you might say, is where a muscle\\nis directly acted upon by some external force, some blow, strain or draught of\\ncold air, causing it to contract. Your contraction then is your primary lesion.\\nIt will impinge upon the nerve fibres, as we saw a few days ago in quotations\\nfrom one of the authorities, that the terminal sensory fibres of the muscles\\nare irritated by contractures, and that constant irritation may be set up and\\ncarried into the system anywhere, according to the centers affected. This then,\\nwould be a primary lesion. A secondary lesion would be one of the kind des-\\ncribed a few minutes since, when I noted the fact that we might have stomach\\ntrouble producing secondarily a lesion of the muscle of the back producing\\nwelts; so-called contractures. When the lesion is primary, of course that indi-\\ncates at once to us where the trouble is, and you, as Osteopaths, have learned\\nby this time that you must go to the seat of the trouble; even though you\\nhave to trace it a long way back, you will finally come to it. So that when\\nyou have the contracture acting as a primary cause of disease from its nervous\\nconnections, then of course by removing the contracture, you have removed\\nthat which is irritating or inhibiting. You have restored the normal, and al-\\nlowed nature to take care of the balance. When it is secondary, it is a symp-\\ntom, as Gower says, of a diseased condition of a center; it may be, and so the\\nOsteopath treats it. In case the diseased stomach has caused a contracture in\\nthe back, we could not say that by removing that lesion that we have removed\\nthe primary cause itself. But the value of that to the Osteopath is, that he\\nthereby sees where the trouble is; it is to him a symptom, and he can trace it", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0072.jp2"}, "73": {"fulltext": "THKORY OF CKNTEJRS. CONTRACTURES. 67\\nback, and aided by other symptoms, find the original cause. Not only that\\nbut, according to what we have learned previously, the effect that the Osteo-\\npath can have by working through nerve terminals may be gotten. He can\\nwork upon these lesions, which are secondary, and remove them, and he can\\nthus affect the peripheral terminations. Now, if the cause works backward\\nover these nerves, then his work can reach forward along the same track, and\\nhe can get an effect upon the original seat of the disease. He can stimulate\\nthe stomach, in other words, by working along the back in the region of the\\nsplanchuics. Of course he would combine work upon the secondary lesion with\\nwoik upon the original cause of the disease, whatever it was, and his good\\njudgment and ability to diagnose would have to tell him when the lesion was\\nprimary or secondary. I recollect a case of chorea which we treated at one\\ntime in Evanston, which had been of seven years standing. It was the case\\nof a young lady who was some twenty years of age, and it was very bad when\\nbrought to us. She tossed about and nearly threw herself from the table, and\\nit required one to hold while another treated. The lesion in that case we found\\nmostly along the back on the left side of the spine; the muscles were in a con-\\ntracted condition all along that side of the spine. We also found that the\\nmuscles in the neck were quite stiff; we were particular to remove that con-\\ngested condition of the muscles, and the cure was complete although the case\\nhad been of seven years standing. It was quite a satisfactory case. Now,\\nthe question is, whether that was a primary lesion or a secondary, and it is\\nvery hard to say. The causes of chorea are external sometimes rheumatism\\nor exposure and in such a case the lesion may have been primary, the effect\\nof exposure or rheumatism may have hardened the muscles in the back. In\\nother cases it is due to over-work, worry and a whole list of different causes.\\nSo it may have acted indirectly, and thus have produced these contractures.\\nBy working there we remove that lesion, whether it was primary or secondary,\\nand we get our results. Of course we used general treatment with the special\\ntreatment which we gave to the lesions. My chief purpose in following this\\nline of thought was to show that the Osteopath in talking about contractures,\\nin treating them as lesions, and in working directly upon them as such, is\\nthoroughly scientific. As I showed you in previous lectures, he can work upon\\nnerve terminals in these muscles and thus gain important results. And I think\\nthat an Osteopath in an argument with a ph3^sician ought not to come out sec-\\nond best.\\nThere is one further point which I want to bring out; and that is the fact\\nthat you will find flabby muscles, and when a muscle has become flabby it is\\nusually an indication that the disease has progressed to a considerable degiee.\\nVery frequently these muscles have lost their tone, and our mode of reasoning\\nis that we must restore life to them. I wish to state what Cowers has said in\\nthis regard. He says: That when a muscle is thus flabby, it shows some\\nlesion of the nerve fibers controlling the muscle. And pathology has shown\\nthat section of a motor nerve of a nuiscle will lead to deterioration in the con-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0073.jp2"}, "74": {"fulltext": "68 EXAMINATION OF THE NBCK.\\ndition of tli\u00e2\u0082\u00ac muscle. Hence, there is close trophic coniiectioii between tihe\\nnerves and the muscle fibers, so that, reasoning from that, when you find a\\nflabb}^ condition of a muscle, you must have a diseased condition which has\\nadvanced considerabl3^\\nIn previous lectures I have considered full}^ the spine. First, how to exam-\\nine it; second, how to consider the lesions found, that is, their significance;\\nand third, how to treat your lesions when found. I know of no other points\\nwhich I should bring up in that connection. I shall, therefore, go to the neck,\\nand tell 3 ou of its indications.\\nII. Landmarks CoNCERXixG THE Neck: First, as Holden says, we\\nnote a great difierence between the skin on the back of the neck, where it is\\nvery thick, and that on the front of the neck, which is extremely thin; this is\\nthe best place in the body to note that difference. The external jugular vein\\ncorresponds with a line drawn from the angle of the inferior maxillary bone to\\na point at the middle of the clavical. We find in certain heart troubles a\\nvenous pulse can be detected in that vein, we can see it from a distance. There\\nis a case in town in which the venous pulse can be seeo in the jugular vein.\\nThere is also a venous hum in that vein in anemia.\\nThe hyoid bone is on a level with the lower jaw; the gap just below it\\ncorresponds to the apex of the epiglottis; therefore an)- deep cut at that point\\nleaves almost the whole of the glottis above the cut. The thyroid cartilege is\\nfamiliar to 3 ou all, and you can by feeling carefuU} trace out both the upper\\nand lower cornua. The lateral lobes of the thyroid gland lie on each side of\\nthe thyroid cartilage; the bridge lies across the middle, and in that region j^ou\\ncan feel the pulsation of the superior thyroid artery. The crico-thyroid mem-\\nbrane, as you know, joins the th3Toid and cricoid cartilages, and that is the\\npoint at which laryngotomy is performed. The level of the cricoid cartilage\\ncorresponds to the interval between the fifth and sixth cervical vertebrae; it is\\nalso the level of the oesophagus. Hence, if a child has attempted to swallow\\nsomething too large for it, it will probabh^ be lodged in that place. The su-\\nperior opening of the oesophagus is usually an inch and a half above the ster-\\nnum, but it may get as far as two and a fourth inches above the sternum. Nor-\\nmally about seven or eight rings of the trachea protrude above the sternum,\\nbut the3^ are not felt from the outside, being covered b} other structures. Sur-\\ngical operations are conducted in the middle line of the neck, which is called\\nthe line of safety.\\nin. How TO Examine the Neck: Of course you all know that there\\nis nothing of greater importance to the Osteopath in the body than the neck\\nDr. Harry Still is authority for the statement that almost all diseases of the\\nbody can be treated through the neck. Of course that is putting it very broad-\\nly, but it is very expressive. You can treat in the neck alone and affect the\\nstomach, heart, liver or intestines and you can treat, of course, in the neck and\\naffect the brain, or affect the vaso-motor life for the whole body.\\nIn the examination of the neck I have divided the subject into first, the", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0074.jp2"}, "75": {"fulltext": "EXAMINATION OF THE) NECK. 69\\nthroat. You all know where to find the tonsil, just beneath the angle of the in-\\nferior maxillary bone; it is very readily felt when you want to find it, in case\\nof tonsilltis it is easily found. If you cannot find it on the outside, you can\\nexamine inside the throat. So in examination of the throat you must always\\nlook for the tonsils if you suspicion tonsilitis. You must look for tender\\npoints about the throat, and where we frequently find them is, in case of catarrh,\\njust below the angle of the jaw. I will not vouch for the statement, but it is\\nmade on good autharity. Further, in examination of the throat, alwaj^s look\\nto see what is the condition of the hyoid muscles. They are of great import-\\nance to the Osteopath those above the hyoid bone and those below it; either\\nor both may be contracted, congested, or drawn, shutting off the blood supply\\nto the other parts of the head or the throat, causing very numerous troubles.\\nOf course you must always examine your patient to see that all parts are\\nnormal. You should direct your attention first to the hyoid bone, then to the\\nthyroid and cricoid cartilages, not because we find them of great Osteopathic\\nsignificance, but to see that everything is normal. Of course, in order to rec-\\nognize the abnormal you must acquaint yourselves with the normal. The thy-\\nroid gland itself has^been described. You should bear in mind that it may be\\nenlarged in disease, as in goitre, or it may be atrophied, as in myxedema. You\\nwill be able to find it very readily, and you must decide whether it is enlarged\\nor wasted, and therefore, you must know what is its normal size.\\nYou will frequently find that the lymphatics are enlarged in the neck; the\\nkernels are found along the course of the veins in the neck. The lymphatic\\nglands sometimes become enlarged, and remain so for years, showing that there\\nis some irritation or some septic process still going on. In people with chronic\\nsore throats we will frequently find that the lymphatic glands are enlarged,\\nsometimes they are left so by diphtheria, or any disease which leaves in the\\nsystem a septic product, which of course is taken up by the lymphatics. So\\nyou must look to see whether or not the lymphatics are enlarged. If they are,\\nof course the treatment is not to them, but is to remove the cause of the dis-\\nease.\\nA further point as to the anatomy of the neck in connection with Osteop-\\nathy: you will find that the glossopharyngeal, pneumogastric and spinal ac-\\ncessory nerves leave the skull through the jugular foramen. The pneumo-\\ngastric runs on down just behind the anterior border of the sterno-mastoid\\nmuscle, and we work upon it as we work along the muscles, Frequenth we\\nwork upon it high up at its exit from the skull, that is, as near as we can get\\nto it. We can usually bring pressure upon the nerves at that point. Fre-\\nquently, also, we work upon these nerves through their sympathetic connec-\\ntion with the superior cervical ganglion.\\nThe phrenic nerve, as you know, springs from the 3d, 4tli and 5tli cer-\\nvical nerves, and you reach it at the anterior border of the scaleui muscles,\\nright along the edge of the transverse processes of the vertebr.x. You can\\n.impinge upon tlie nerve by pressure between the sternal a,ud clavicular origins", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0075.jp2"}, "76": {"fulltext": "yo THEORY OF CKNTKRS. CERTAIN LESIONS.\\nof the sterno- mastoid muscle. That is where the treatment is usually given in\\ncase of hiccoughs.\\nI.ECTURK XIII.\\nAt the last lecture under the general head of theory of work upon centers,\\nI considered contractures, their occurence, nature and cause. I explained,\\naccording to the authorities, how these contractures happened, and that this\\nwas the scientific definition, the term meanining continued contraction. I quot-\\ned from Gower s, Howell s Text Book and others, to substantiate the pomt. I\\ncalled to your mind the clinical importance that is attached to these conditions,\\nespecially by the Osteopath. I called to your mind their nature, that is, that\\nthey are called a tonic spasm, being considered in the nature of a tetanus; also\\nthe fact that the continued tonicity of the involuntary muscles might exist,\\nwhich for our purpose is practically a contracture, although not called so. I\\ncalled 3^our attention to how you might recognize the difference between these\\nconditions by the touch. The chief points where these occur are in the neck,\\nback and abdomen, as well as the limbs in some cases. I called to your atten-\\ntion the fact that muscles normally contract not as a whole usually, but as sep-\\narate fibres of several muscles, according to Gowers authority, and that ac-\\ncounts for the appearance of welts; the feeling of welts under the fingers. That\\nthe cause was some constant irritation, some direct injury to the muscle, or\\nsome exposure or something of that kind. That is, that the contracture might\\nbe primary, as in the case of a blow or injury; and secondary when a muscle\\ncontracts due to a trouble which is far removed, as for instance muscles over\\nthe splanchics contracted secondarily to the affection in the stomach. I noted\\nthat muscles which felt flabby were a sign that the disease had probably pro-\\ngressed for some time? and that the centers and nerves were affected. I also\\ncalled your attention to certain landmarks in the neck. Todav I wish to con-\\nsider the same general subject further.\\nI. Theory of Osteopathic Work Upon the Nerve Centers, (Under\\nthe Special Head of Further Possible Lesions.) I have explained to you the\\nnature of some lesions, at the the last meeting the nature of a lesion when it is\\na contracture. I have also called to your mind other lesions, such as a slip of\\nthe vertebrae, a displacemeat of a part, bringing pressure upon a blood vessel or\\nupon a nerve. I believe I mentioned tumors at one lecture, but I shall carry\\nthat idea further at some time. Also I mentioned the lack of normal blood\\nsupply being anemia, or perhaps too much blood, being hyperemia. So that\\nwe have already considered certain lesions which may affect the body, may act\\nthrough the nerve and cause disease,\\nA further very important lesion which we frequently find in our\\nwork is a thickening of ligaments following a strain or some injury.\\nPathology teaches us that after having irritation we frequent-\\nly have an infiacnmation. That means that too much blood is circulated about", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0076.jp2"}, "77": {"fulltext": "THEORY OF CENTERS. CERTAIN LESIONS. 7 1\\nthe part, and in the natural process of inflammation an exudation follows,\\nfirst fluid, latter cellular, of both kinds of corpuscles. When this state of inflam-\\nmation has gone far enough you have resulting a new growth. We know that\\nthis new growth is connective tissues or scar tissues. It will be seen in a di-\\nsease called cirrhosis of the liver, usually induced, or sometimes at least, by\\nthe drinking of alcohol. The alcoholic poisoning sets up an inflammation. Fol-\\nlowing this inflammation there results a growth of new connective tissues, the\\nconnective tissues normally occuring throughout the liver are thickened. Now,\\nthis new growth of connective tissues is all right as it is new and* fresh and\\nfilled with blood vessels. But sooner or later the blood vessels begin to be\\ncontracted and absorbed and the tissue loses its blood supply and then it be-\\ngins to contract and become pale. When that process has gone far enough,\\nthe contraction has acted mechanically and shut down upon the blood supply\\npassing through the liver, thus the portal circulation is obstruced, and the blood\\nsets back and produces what is known as ascites, or dropsy of the abdomen.\\nThere you have a thickening of the connective tissues, you have resulting from\\nthat a condition of pressure, a shutting down of the thickened tissues upon the\\npart concerned. In sclerosis of the spinal cord you have a thickening of the\\nconnective tissue either at die expense of, or following, degeneration of the\\nnervous elements of the cord. When you have had a wound, say a cut with a\\nknife, you have, in the process of healing, the formation of what is known as\\ngranulation tissues, this is followed later by the appearance of blood vessels in\\nnew connective tissue, and you have your scar. So-called scar tissues occur\\nnot only after cuts and woundh, but after abcesses and various pathological pro-\\ncesses in the body. I wish to bring these things to your attention for the pur-\\npose of showing you that it is a constant and very general pathological tendency\\nin the body to produce new connective tissue, and it is the tendency of that\\nconnective tissue when produced to contract. There you have something that\\nis a very frequent source of disease, and it is of especial interest to the Osteo-\\npath, from his point of view, since it means that there may thereby be a me-\\nchanical lesion, a direct shutting down upon the parts. You have all known\\nof cases where a scab has formed upon some externel sores, catching some sen-\\nsory nerve terminals in its connective tissue, as it becomes old and commences\\nto contract, it irritates those termination of nerves, producing constant pain in\\nthe part.\\nI wish to quote from Green s Patholog}^ where he saj^s: The new con-\\nnective tissue is called inflammatory or scar tissue. The tendency to contract\\nis characteristic of this new fibrous tissues. This contraction of scar tissue\\nmay produce serious results. You will readily recognize the Osteopathic sig-\\nnificance of anything that will contract or obstruct the channels of blood or\\nnerve force. These causes are especially significant, it seems to me, in relation\\nto the spine, so I have considered that first. Now, what may the nature of\\nyour lesion be? As I have said before, it might be a vertebra displaced: it may\\nbe twisted or slipped, or in any way so placed as to bring irritation upon the", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0077.jp2"}, "78": {"fulltext": "72 THEORY OF C^NTF^RS. CERTAIN I.KSIONS.\\nparts surrounding it. It makes no practical difference for our purpose whether\\nfirst, that irritation acts upon nerves or upon blood vessels, just so it be suffic-\\nient to act upon the ligamentous parts about the vetebrae to irritate them. You\\nwill then have an inflammation. Secondary to this irritation you may not have\\ninflammation, but hyperemia. Following this inflammation you would naturally,\\naccording to the laws of disease, have a thickening of the connective tissue. I\\nwish again to quote from Green, speaking about inflammations, and under the\\nhead of injuries, slight but long continued, he says: In many cases the in-\\nflammatory^ process ends in the formation of new tissue inflammatory fibrous\\ntissue. You will notice there that the injury may only be slight, but long\\ncontinued. Such is the nature of a great many lesions that we find in the spine.\\nA man comes to the Osteopath s office for examination. He says: You have\\nhad a strain or twist here in the spine in some way. The patient says he\\nnever had any strain there. The Osteopath still thinks that he must have had\\na strain there. The reason why he did not know it was simply because it was\\nso slight as to escape observation, and has not been attended to because slight,\\nand therefore has been long continued, and finally results in some process of\\npathological growth. Further, Green says: If the hyperemia be of long du-\\nration or frequently repeated, the epithelium and connective tissue of the part\\nincrease. So an inflammation is not always necessary to produce thickening\\nof the connective tissue but it may occur from hyperemia. Too much blood\\nabout a part may, according to Green, either cause a thickening of the pitheliume\\nor of the connective tissue. So your lesion which has produced nerve irrita\\ntion and caused inflammation, may be slight, or on the other hand, may cause\\nhyperemia, which may not necessarily be known to the patient. So much,\\nthen, for the tendency of these newly formed tissues to contract and to obstruct.\\nFrom what I have already said you will see the significance of these things\\nfrom our standpoint, as I have already explained to you the effect of thicken-\\ning of tendons or hardening of muscles or ligaments.\\nYour lesion may be not only in the nature of some si ip or twist of the ver-\\ntebrae, but, secondly, it may be a strain, a pull, a cold draft, or something of\\nthat nature external violence. You are all familiar with the phenomena\\nwhich follow a sprained ankle, as we call it, and you have probably often heard\\nthe physician say that such an injury was in some cases worse than a broken\\nbone. You have, following a strain, an inflammatory process, and\\nyou have following that inflammatory process, of course, this\\nthickening of the connective tissue. Then, again, you may\\nhave a lesion in the nature of bad blood. If the blood is not pure, and if\\nall of the excretory organs of the body are not doing their duty, the bad blood\\nthen acts as an irritant and may inflame parts. Your lesion may, fourthly,\\nbe in the nature of some exposure, or cold, or rheumatism. Quain, in his dic-\\ntionary, speaking of disease of the spine, says: The ligaments here, as in\\nother parts of the body, are especially liable to a rheumatic form of inflamma-\\ntion. Inflammation means to us the formation of a new growth; a new growth", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0078.jp2"}, "79": {"fulltext": "very probably raeans the formation of an obstrttctiofi, which\\nof course acts as a continual irritation upon the part affected, with all, the con-\\ncomitant results. In view of the above facts, may not any Osteopath see the\\ntremendous [significance from his standpoint of slight, or it may be severe,\\nsprains, slips, twists, subluxations, injuries, exposures, and the like? Can he\\nfail to recognize the importance of such factors in the causation of disease, or\\ncan he disregard the therapeutic value of their removal? It seems that when\\nwe look at these things from an Osteopathic standpoint, they become fraught\\nwith great significance, and to my mind, nothing is more encouraging to an\\nOsteopath than the thought that he can go about to remedy these pathological\\nresults. I have brought this up because it seemed to me that these were Osteo-\\npathic points. Hence, you will note the importance of what we have already\\nsaid in previous lectures, that you should always and under all circumstances\\nlook for lesions. You should always, also, inquire into the history of the\\ncase.\\nThe method of questioning is one of the valuable means by which we diag-\\nagnose the case, it is the only thing that leads us into the history of the case.\\nThese lesions, such as described, are of particular importance to the Osteo-\\npath because you know that a contraction may cause, for instance, distortion of\\na part, as we frequently find in our practice. When a part has left its normal\\nposition it may very likely be obstructing some of the fluids of life, or pressing\\nupon important parts, thus producing disease. So that the result of the lesions\\nmay not only be distortions but may be obstruction of parts; further, they may\\nlead to ankylosis or ossification of the parts. Quain s Dictionary in speaking of\\nPott s disease, says: **In the majority of cases ulceration of one or more inter-\\nvertebral cartilages occurs as; a result of sub-acute inflammation; if the case\\nproceed favorably toward a curative termination, the destructive process becomes\\narrested and a healthy process is re-established, terminating in bony ankylosis\\nbetween the bodies of the vertebrae; ossification also spreads along some of the\\nligamentous structures passing between the laminae, as well as between the spin-\\nous processes. Thus, he goes on to say, the resulting posterior protusion\\nbecomes a persistent deformity, a deformity essential to the cure of the disease.\\nPott s disease, I might say, is the extreme posterior curvature of the spine, also\\ncommonly called hunch-back. Now, as to this explanation, there are several\\npoints to which I wish to invite your attention. In the first place, it empha-\\nsizes the importance of inflammation, as he says the condition may result from\\ninflammation between the bodies of the vertebrae. Further, that that inflam-\\nmation may be the result of some rheumatic process startee in the ligaments\\nabout the spine. Second, that the result may be ankylosis or ossification, if\\nthe case has gone far enough. Third, to the Osteopath it is difficult to call a\\ndeformity a cure; that is what we call disease; patients come to us with deform-\\nities to be cured. It has been a matter of some surprise that I noticed that not\\nonly Quain, but others, for instjance, Hilton, speak of cure by fixation or ossi-\\nficatiGn of parts. Now, I do not call, this to your attention to tell you that", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0079.jp2"}, "80": {"fulltext": "74 THEORY OF CENTKRS- CERTAIN I^ESIONS.\\nyou can cure every one having ossification or ank3dosis of the vertebrae. How-\\never, there is a kind of ankj^losis that may be cured bj^ the Osteopath and that\\nis the ligamentous form. When it has reached ossification it is beyond our\\npower. What the Osteopath is called upon to do in such a case, where there is\\nfixation of parts of bony growth, is to give relief or perhaps strengthen the\\ngeneral condition of the body, which he can very frequently do. The peculiar\\nwork of the Osteopath, in cases which are proceeding to such a termination, is\\nnot that he may remove the ankylosis or the ossification, but that he may pre-\\nvent its forming. I think our practice justifies the statement that he can pre-\\nvent such things. A great many cases of spinal curvature have been cured\\noutright, and there is no telling what the termination of such a case of spinal\\ncurvature may be. However, they might have gone on to ossification or anky-\\nlosis of the joints. The simple facts are that cases of deformity have been sav-\\ned from being permanent, and that people have been saved from the lives of\\ncripples time and again by Osteopathic therapeutics. And so these things are\\nsignificant to us more in a prophylactic light, that is, that we may prevent\\ntheir growth.\\nFor examples of the general cause of disease following a slip or strain\\nwhich has resulted in a thickening of ligaments, I wish to note several cases:\\nI have had cases in which, along the region of the splanchnic nerves, there was\\na tightening of all the ligaments, the parts of the spine being approximated. The\\nresult of that lesion was some form of stomach trouble. I have seen a case of\\nneurasthenia, which I would attribute to such a cause. W^hen practicing in\\nChicago we had a gentleman who was in rather a remarkable condition.\\nHis general trouble might be described as neurasthenia. His trouble was\\nlargely circulatory and nervous. He had a skin as soft as a baby s almost;\\na ruddy complexion; looked strong and healthy, and one would hardly think\\nthere was anything wrong with him. But he said he would at almost any\\ntime break out into a perspiration, when there was not any heat at all or exer-\\ntion to account for it, or perhaps he w^ould be chilly. Then, again, he would\\nflush up following any exertion. He would have trouble with his head, and\\ncould not work at times. At times he would be bothered with sleeplessness.\\nNow, those w^ere general nervous troubles and troubles of the circulation. He\\nwas a man, who on account of his disease, led practically an outdoor life. The\\nlesion in his case, according to our examination was along the spine. We\\nfound that the ligaments along the spine seemed to be tightened, and that the\\nmuscles were contracted. Now, whether or not the theory fits the facts, and\\nwhether or not all these these things are brought out properly, it seems to\\nme they explain, at least theoretically, what we do w^hen we meet similar cases\\nand go to work to remove such lesions. Such lesions then, may come, first, by\\ndirect impingement and irritation of the nerves. As, for instance, where they\\nemerge from the spine at the intervertebral foramina. Second, they may act\\nthrough the blood supply, as was shown in a lecture or two since, by causing\\nanemia or hyperemia of the centers or the nerves. This hyperemia or anemia", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0080.jp2"}, "81": {"fulltext": "LANDMARKS OF THK NECK. 75\\nmay be collateral on account of the condition of the circulation to the spinal\\nmuscles, or the anemia may exist directly by pressure at the intervertebral for-\\namina on the anterior and posterior spinal nerve branches, or perhaps pressure\\nin the same way on the vertebral branches of the arteries, and thus shutting\\noff of the blood supply to the cord.\\nII. lyANDMARKS CONCERNING THE Neck Holdcu uotcs the stcmomas-\\ntoid muscles, which he calls the surgical land-mark of the neck, and calls to\\nour attention the fact that it stands out in relief when acting to turn the head\\ntoward the opposite shoulder. Behind its inner border lies the pneumogastric\\nnerve, in the same sheath with the common caratid artery and the internal\\njugular vien. The common carotid artery runs as far as the upper level of the\\nthyroid cartilage, where it branches into the internal and external carotids; its\\ncourse corresponds to a line drawn from the sterno-clavicular articulation to a\\npoint midway between the angle of the lower jaw and the mastoid process.\\nNote the interval between the sternal and clavicular origins of the sterno-\\nmastoid muscle. Just behind this interval lies the common carotid artery in-\\nternally, the external jugular vein externally. Between them, and a little pos\\nteriorly, lies the pneumagastric nerve. The sterno-clavicular joint is important.\\nBehind it lies the commencement of the vena innominata. It is the level of the\\ndivision of the innominate artery on the right, and the level of the apex of the\\nlung. As to the apex of the lung, it may rise one and a half inches and per-\\nhaps two inches above the sterno-clavicular joint. This is the part of the lung\\nwhich is least apt to be inflated with air, and hence very apt to be the seat of\\ndisease. I have already called your attention to its examination by percussion\\nat the sternal end of the clavicle. The subclavian artery is also important. In\\nthe supraclavicular fossa, just at the outer edge of the sterno-mastoid mucle,\\nabout an inch above the clavicle you will feel the pulsation of the subclavian\\nartery at that point it crosses the first rib. Pressure slightly downward and\\ninward there will impinge upon the subclavian artery, a little pressure is suffi-\\ncient. As you know, the outer border of the sterno-mastoid muscle corres-\\nponds nearly to the outer border of the scalenus anticus muscle, and that across\\nthe scalenus anticus runs the phrenic nerve. Now, at about the point where\\nyou impinge upon the subclavian artery you will also reach the phrenic nerve.\\nIn fact, the way Dr. Harry Still often treats hiccoughs is b}^ standing behind\\nthe patient and placing bis thumb along the outer edge of the sterno-mastoid\\nmuscle and thus reaching the phrenic nerve. Deep pressure at the upper part\\nof the supraclavicular fossa will reach the transverse process of the seventh\\ncervical vertebra. In a long thin neck it is stated that just above, and nearly\\nparallel with the clavicle can be felt the posterior belly of the omo-hyoid mus-\\ncle, as it rises and falls in inspiration.\\nIII. I wish to continue the examination of the neck. There were a cou-\\nple of points that I should have noted in going over the spine, but they slipped\\nmy mind at the time. One of them is how to stretch the quadratus luniborum\\nmuscle. This muscle in various cases will become contracted and will then", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0081.jp2"}, "82": {"fulltext": "76- KxAiMEN^ATliON OF TUB M^C!^.\\ndraw d\u00c2\u00a9wn the lower rib, and may make coiasiderable trouble. I have fouad\\nthat I could treat a lame back in that way and get results ths^t I could get in\\nno other. Frequently the lameness there is between the fifth lumbar and the\\nthe sacrum. And why? Because the traction in the quadratus lumborum\\nmuscle is drawing the pelvis up and is bringing a strain at the point of\\njunction of the fifth lumbar with the sacrum, I have often removed lameness\\nthere b}^ stretching that muscle. It takes a diagonal pull to stretch the\\nquadratus lumborum properly. If I have an assistant I have him draw on the\\npelvis while I draw the arm in the other direction. I draw steadily, but do\\nnot jerk, and I put a considerable force of traction upon the part. Then I have\\nmy assistant take the arm, and I stretch in the other direction, and in that way\\nI get a pull upon every part of the quadratus lumborum muscle.\\nThe other point concerning the spine was, that you will in passing your\\nhand over the back, frequently detect changes in temperature. You will find\\na warmer spot, or, more frequently a cold streak following the distribution of\\nthe inter-costa] nerves. That is quite an important method of diagnosis. You\\nshould accustom your hand to detect differences in temperature. Of course\\nthat has to be done next to the skin. When you find that, of course it indi-\\ncates at once that the blood supply is not equally distributed, and that proba-\\nbly there is a lesion along the spine at the point where the cold streak leaves\\nit. If you find it hot it may mean the same, but we do not find that as often\\nas we do the cold streak.\\nIn the consideration of the neck I have divided it into, first, the throat,\\nwhich I considered at the last lecture; second the neck proper; which I shall\\nconsider at this time. I have alread} noted the spines and the peculiar verte-\\nbrae, and the fact that you can note the dislocated vertebra sometimes by an\\nexamination in the pharynx by means of the finger. I have called the atlas to\\nyour attention and the fact that 3^ou must turn the head from side to side in\\nattempting to examine the transverse process of the vertebrae. In a case of\\nfracture, which we may possibly find, there will be crepitus and abnormal mo-\\nbility of the parts. You should in your examination of the neck look at the\\ncondition of the superficial and deep muscles. Carefully examine to note any\\nhardening of the muscles. The hardening, of courrse, may be in the superfi-\\ncial muscles or in the deep muscles; you will have to judge as to where you\\nthink the tightening of the muscle is. Examine very carefully all about the\\nsuperficial and deep muscles. It is usually in the throat that you find the su-\\nperficial muscles contracted, and the deeper ones, in the neck further back.\\nThe sterno-mastoid muscle of course always comes prominently to your atten-\\ntion. It is contracted in cases of torticollis; or it may be hardened and produce\\npressure upon the structures beneath it. Then examine the scaleni muscles.\\nYou know how they are attached, reaching all the way from the second cervical\\ndown to the seventh, then running to the two upper ribs. Normally these mtis-\\ncles- will feel rather hard, you will become acquainted with the normal feeling\\nof tkem. They aiie significant to us irom the fact tliat they sometimes become", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0082.jp2"}, "83": {"fulltext": "KXAMINATION OP TH^ NECK. 77\\ncontracted and bring traction upon the upper two ribs. Hence it is that any dis-\\nplacement of these upper two ribs is very likely to be upwards. This will\\ncause heart trouble, or lung trouble, etc. These muscles are useful in replac-\\ning ribs which are dislocated. I have already noted the ligamentum nuchae;\\nhow you may find it and how you may treat it. The neck is about as good a\\nplace as there is for the Osteopath to find sore spots. Principally you are lia-\\nble to find them in the fossae just below the occipital bone. In fact, I have\\nbeen told that it is always naturally sore there, but I don t believe it, because\\nI find lots of cases that are not sore there at all, and I think that in the normal\\nneck there is no soreness there. Of course you may impinge at any time upon\\na nerve hard enough to hurt it, but I am speaking of examinations not of chop-\\nping wood. Why these sore spots occur is hard to say, but I think the sore-\\nness is due primarily to the condition of the great, and sub-occipital nerves which\\nyou find at that point. I do not think that it is just because you touch them,\\nbut they were sore before you touched them. Then you will often find that\\njust below the occipital protuberance there is a sore spot; and just there you\\nwill often find a tightening of the ligaments. The lesion is important because\\nif you find a sore spot there or in the fossa below the occipital bone you are led\\nto believe that there is some irritation affecting the sub and great occipital\\nnerves, and since they are in close connection to the superior cervical ganglion\\nof the sympathetic they may have an affect through it upon the distant parts\\nof the body. You should also examine in the region of the three ganglia of the\\nsympathetic. The superior cervical ganglion opposite the second and third\\nvertebrae on the rectus capitis anticus and major muscle. The second cervical\\nganglion lies opposite sixth and seventh cervical vertebrae. While the inferior\\ncervical ganglion lies just below the seventh cervical vertebra, and is frequent-\\nly coalesced with the first thoracic ganglion of the sympathetic. Quain puts it\\nthat this inferior cervical ganglion of the sympathetic lies just over the costo-\\ncentral articulation, that is, the articulation of the first rib with, the spine.\\nNow, if you should find lesions in those places they are, of course significant to\\nyou according as they may affect the sympathetic life of the individual. They\\nmay affect the brain, heart and lungs, or any distant part of the body. Also\\nremember the distinctly spinal nerves here, those of the cervical and brachial\\nplexuses. Impinge upon these nerves where they pass out between the scale-\\nnus medius and scalenus anticus muscles, and, upon deep pressure the patient\\nwill tell you he can feel pain in his shoulder and arm. You should also here\\nlook at the temperature of the parts yon are examining, and I think that no-\\nwhere else in the body we as frequently find a cold place as in the back of the\\nneck. I thought that perhaps it was because it was moie exposed, but I doubt\\nthat very much because I have treated patients who had been in the house for\\nhours; and those muscles were cold. I have treated patients in the heated per-\\niod of summer when certainly there was not any chance of there being expo-\\nsure to cold, and the temperature was abnormally low. That argues to your\\nmitwl certainly that there is some inequality in the distribution of the blood", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0083.jp2"}, "84": {"fulltext": "78 LESIONS: PRESSURE BY EXUDATES, ETC.\\nflow, it may be a tightening of the muscles upon the blood vessels, but it shows\\nyou, at any rate, that there is probably the seat of the lesion. In this exami-\\nnation you must look at the condition of the blood supply to the throat through\\nthe neck and thus to the brain, which is important, and you should be very\\nsure that the blood supply to the neck and brain are normal.\\nQ. You spoke of treating the phrenic nerve above the clavicle. Could it\\nnot also be reached from the second to to the fifth cervical?\\nA Yes sir. Dr. Harry Still frequently works right along the third, fourth\\nand fifth cervical. The phrenic nerve arises from the fourth, also partl}^ from\\nthe third, and having a connecting branch from the fift i. So we work at the\\nanterior edge of the scalenus medius and impinge upon the nerve by pressing\\nbackward against the transverse processes of the vertebrae.\\nQ. Do you use the word lesion for au}^ abnormality about the body?\\nA. I have used it for an injury. Taking it in its generic sense it means\\ninjurv. There is a difference, perhaps, in the use of that word, but we here\\nuse it in the sense of an injury. That is the use I have heard made of it ever\\nsince I have been here.\\nLECTURE XIV.\\nAt the last lecture, I considered briefly, possible lesions of centers. I\\nshall carry that idea further to-day. What I took the most time to explain\\nwas how thickening the connective tissue of parts might lead to impingement\\nupon blood vessels or upon nerves, showing that, in the first place, there\\nmight be an irritation caused by a slip of a vertebra, thus setting up inflam-\\nmation, this followed by formation of new tissue which has a tendency to con-\\ntract. I showed that the same thing could follow hyperemia. Such things,\\nthen, are significant to the Osteopath, since they act as obstructions to the\\nflow of blood and nerve force. Such lesions may, if not prevented, go much\\nfurther, resulting in bon} aukoylosis of joints or in ossification of ligaments,\\nthus setting up a permanent deformity. It is then then the function of the\\nOsteopath not so much to treat that deformity, as to prevent it. That is, in\\nsuch case his treatment is prophylactic.\\nI then called your attention to landmarks in the neck, and to certain,\\npoints in how to examine the neck.\\nI. Theory of Work Upon Centers. (Continued.) Further possible\\nlesions. You may have a pressure upon important parts bv exudates or bj^\\noedema. An exudate is in nature fluid or cellular, and it follows pathological\\nprocesses in the nature of inflammations or hyperemia. Having an inflamma-\\ntion, you have an exudation of the contents of the blood vessels, those con-\\ntents are fluid, or in the later stages of the exudation, cellular. They thus\\nmay, at any place, and do, build up a considerable thickening among the tis-\\nsues, acting as a mechanical pressure or irritant upon important parts. These\\nimportant parts may be blood vessels or nerves. Byron Robinson says The", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0084.jp2"}, "85": {"fulltext": "THEORY OF CENTERS. CERTAIN I^ESIONS. 79\\nnerves may suffer from pressure by exudates or oedema, congestion or from\\nmalnutrition. The final outcome is derangement of the nerves, exaltation of\\nsensation and motion, or debasement of sensation and motion. He was\\nspeaking there particularly of the nerves to the bowels. The Osteopath s duty\\nin relation to such things is that he must, in making his diagnosis, take into\\nconsideration the probability of there being such a lesion present. You will, of\\ncourse, in your further studies which will include pathology and other im-\\nportant things, learn how to recognize these lesions better than I can tell you\\nhere. What I propose to do is to use these things to illustrate the subject of\\nOsteopathy, but I cannot of course go into detail and explain everything in\\npathology that I come across, but they are valuable to you, and you will recog-\\nnize their importance when you come to that place in your course. In general,\\nyou will recognize or look for the process of oedema in patients with lung,\\nkidney or heart trouble, you will be very apt to find it in such cases; or in cases\\nwhere there is obstruction to the blood flow. It may be mechanical shutting\\ndown upon an artery, or it may be a narrowing of the lumen of a vessel from\\nsome disease, or something of that kind. The Osteopath must judge what\\nmay be the cause and work to remove the lesion. As to hyperemia, and its\\neffects upon the cord, I have already shown this to you in a quotation from\\nGreen some time since, where he said it caused paraesthesia of sight or hearing,\\nor perhaps even spasms. But according to Robinson, this hyperemia may act\\nmechanically to affect not centers only, but directly to affect nerves through\\npressure. Your lesion may be malnutrition, but I will notice that later.\\nOther lesions which may produce pressure upon important parts are deposits or\\ngrowths. I wish to quote from Dr. Jacobson, Dr. Hilton s editor, where he\\nsays: Sensations of sharp pains like knives around the trunk, increased by\\nmovement, and a numbed feeling about the body, may be produced b}^ gum-\\nmatous meningitis making pressure upon the posterior roots of some of the\\nspinal nerves. You note here that the pathological processis an inflammation,\\nthat secondarily there is set up a pressure as the result of that inflammation,\\nwhich is a gummatous deposit, thus it acts as a lesion producing pressure.\\nHilton instances a case, further where there was pressure upon the ulnar nerve,\\ncausing much numbness, lack of sensation, and particularly of motion, in the\\nthird and foruth fingers. They became discolored, and finally gangrenous.\\n(Gangrene is death of tissues.) Upon examination there was found an ex-\\nostosis, an outgrowth from the bone, upon the first rib, pressing upon the\\nulnar nerve and the subclavian artery, thus shutting off the nerve and blood\\nsupply partly, the nerve more fully. However, shutting oft the nerve supply,\\nalone would have been sufficient to cause degenerative changes in the part\\naffected.\\nI wish to call your attention to this structural degeneration by pressure\\nupon a nerve. Thus, you may have pressure in the form of a foreign growth\\nor in the form of some excresence upon important parts. Further, your lesion\\nmight be an aneurism, and might bring pressure upon parts. Green states", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0085.jp2"}, "86": {"fulltext": "8o THEORY OF CENTERS, CERTAIN LESIONS.\\nthat active congestion follows pressure upon the sympathetic, as for instance\\nin the neck b} an aneurism, Thus you may inhibit vaso tonic action of the\\nsvmpathetic and cause hyperemia, or vice versa.\\nAnother kind of lesion v^ hich will frequently come to your attention is\\ntumor, which you will notice also is of such a nature that it produces pressure\\nupon important parts. You might take, for instance, the case of ex-ophthal-\\nmic goitre: there you have protrusion of the eye ball due to a deposition of fat\\nbehind it. That shows an over stimulation of the trophic fibers to that part of\\nthe head. There are also cardiac symptoms, palpitation and irregularity in\\nthe beat of the heart, which shows an interference with the cardiac nerves, the\\nsympathetics receiving pressure from the goitre in the neck. And further,\\nyou have vaso motor s^^mptoms from the pressure of this goitre, because\\n3 ou frequentl} have a flushing up of the cutaneous circulation. This is a good\\nexample of what mechanical pressure maj^ do to influence nerve life. Robin-\\nson also instances the case of an abdominal tumor leading to fatty degeneration\\nof the heart. The impulse sent from the tumor up along the abdominal sj^m-\\npathetics to the solar plexus, here it is reorganized, perhaps sent to the cervi-\\ncal sympathetics, down the cardiac branches to the heart, resulting in irritation\\nof the heart, causing the heart to over feed itself, which finally results in\\nh^ pertrophv. followed by fatt^- degeneration. Thus 3 ou can learu to trace the\\ncauses. Almost any young Osteopath would treat that efi ect, heart trouble,\\nwhen really it is the tumor, far removed from the heart, which is the cause of\\nthe trouble. In speaking of abdominal tumors, Robinson says: The irritation\\nfrom the tumor is carried on the plexus of an}- contagious viscus to the abdo-\\nminal brain, where it is reorganized and emitted to the digestive tract over the\\ngastric plexus, the superior mesenteric plexus and the inferior mesenteric\\nplexus. In kny case the brunt of the forces end in the ganglia which lie just\\nbelow the mucous membrane. The ganglia constitute what is known as\\nMeissner s plexus, which rules secretion. If the irritation be of such a nature\\nas to produce excessive secretion, diarrhea may result; the excessive secretions\\nwill decompose and induce malnutrition. Thus one difiiculty leads to another.\\nYou might have constipation, indigestion and various troubles. He goes on to\\nsa3^ that small tumors on pedicles so that they may swing around, and roll\\nabout, and pound upon the abdominal structures are those which are most in-\\njurious, for obviously, if the tumor is fixed, it will not irritate much, but if it\\nrolls about and is quite movable it will keep irritating the sympathetics and\\naggravating the trouble.\\nThe lesions given above are the lesions which produce pressure in the\\nbod} pressure upon important structures, for the most part nerves. 7 have al-\\nready in m3 lectures noted certain results that 3 ou would get from pressure\\nupon nerves, for instance, irritation, stimulation, inhibition, hyperemia, anemia,\\netc. But I wish to go further today and show that the result may be more ser-\\nious than a mere inhibition or stimulation, that it ma}^ lead to degeneration of\\nthe ner\\\\ e fibers. Thus there would be processes of deterioration of the struc-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0086.jp2"}, "87": {"fulltext": "THEORY OF CENTKRS. OERtTAIN I^KSIONS. ;8l\\nture of the parts, especially the nerves affected. The process of degeneration\\nof the neives is about as follows, and is called secondary degeneration, since it\\nis -secondary to some primary lesion; it is also called Wallerian degeneration.\\nThe first process is that the myelin becomes degenerated, the sheath of\\nSchwann becomes separated into two parts, still later it becomes granulated,\\nand finally disappears from the nerve sheath, perhaps by the process of saponi-\\nfication, as has been stated by some writers. During this process the axis-\\ncylinder, which is the important part of the nerve, is segmented, broken down\\nand removed in practically the same way. Thus you finally have nothing but\\nthe nerve vsheath left. The nerve has then lost its conductivity and is useless\\nas a nerve. What I wish to show is that pressure upon nerves may be bad\\nenough to induce this degeneration, which you can readily see is a serious re-\\nsult. Gowers says: Degeneration follow^s many slight lesions of nerves,\\ncompression, over extension, and the like. He says further tjaat it is prob-\\nable that a compression for a few hours has such an effect in separating the\\nmolecules in the white substance of Schwann as to set up a secondary degener-\\nation of the same character as that resulting from division of the nerves. This\\npressure does not need to be severe; it may not extend over a period longer\\nthan a few hours to produce finally all the results which the Osteopath meets\\nin his work. Pressure of some dislocated part or pressure of some such lesion\\nas I have mentioned today upon nerves, interferes with the sense of feeling and\\nwith structure of other parts, and may have a similar effect to cutting the\\nnerve. Gowers says that after division of a nerve or degeneration of its fibers,\\nthere is a marked change in the muscles supplied by the motor nerve. This\\nis a change vv^hich is a deterioration of their structure.\\nSo much, then, for lesions which may be brought on by pressure. You\\nhave seen from what I have said what this pressure may result from. I wish\\nto call your attention to the fact that the action of muscles may in certain cases\\nbecome traumatic, wounding a nerve, and setting up serious results, often de-\\ngeneration. Gowers, speakmg of neuritis, says: Nerves are sometimes dam-\\naged by a violent contraction of muscles through which they pass. It is prob-\\nable, also, that muscular action excites neuritis in other situations, especially\\nin persons who are predisposed. Also we may notice the indirect result of\\ntraumatic lesion by action of the muscles.\\nByron Robinson, in speaking of peritonitis says: Peritonitis is due to\\ntwo causes, (of which I will name one) viz., traumatic muscular action of the\\npsaos magnus on the sigmoid, and traumatic muscular action of the lower right\\nlimb of the diaphragm on the descending colon. The w^ay by which the nerves\\nthere are involved is this: That that injury allows the migration of pathogenic\\nbacteria, which set up peritonitis, thereby crippling the nerves, and perhaps\\n-causing considerable degeneration of them. And this traumatic lesion, direct-\\nly by action of muscles upon nerves, or indirectly as in this case, is an impor-\\ntant thing to the Osteopath, and he must take it into consideration in diaguos-\\nling his^cases. You will learn later that these nerves when degenerated, may,", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0087.jp2"}, "88": {"fulltext": "82 TREATMENT OF THE NECK.\\nby appropriate treatment, of which rest and quiet is an important part, be re-\\ngenerated.\\nTo illustrate the results of pressure, take a case of which Dr. Hilton\\nspeaks; being a case of fracture of the radius. The callus, in the growing to-\\ngether of the bone, had pressed upon the ulnar nerve above the wrist, and\\nthere had resulted, not a paralysis, but an ulceration upon the skin of the\\nthumb and first and second fingers. He also notes a case which pressure of\\nthe humerus upon the brachial plexus has resulted in a wasting of the deltoid\\nmuscle by insufficient nerve supply from the circumflex nerve, which had been\\nimpinged upon. That emphasizes the importance and necessity of taking into\\nconsideratian everything which may bring pressure upon parts.\\nYour lesion, as I have stated, may be malnutrition. I have already ex-\\nplained that to some extent. Anemia may aflect not only centers in such cases\\nbut it may affect nerve fibres directly, or the malnutrition may be from a poor\\nquality of blood.\\nThe question comes to you, what can an Osteopath do in such cases? Can\\nhe remove exotosis, anuerisms, and such things as that? No, he can not. If\\nyou have a case of exostosis, it is a surgical case and you will have to send it to\\na surgeon. Aneurism has usually to be treated by surgical means. I have\\ncalled these things to your attention on account of their importance, and to\\nlead 3^ou to be on your guard. You should not take secondary symptoms and\\ntreat them. Be on 3^our guard alwa3^s in making your diagnosis. Some of\\nthese lesions you may remove of course, such as the exudates in hyperemia\\nor inflammation, or the gummatous tumor in meningitis, also the goitre press-\\ning upon the sympathetic. All these things are subject to your treatment.\\nII. How TO Treat a Neck: I have called your attention to how to ex-\\namine the neck. I wish to say to you that it is an extremely important thing\\nthat you treat the neck carefully, for the treatment of the neck, more than any\\nother part of the body, is to be done with great care by the Osteopath. As in\\nthe consideration of the examination of the neck, I first take up the throat, so\\nin the treatment I will notice that part of the subject first. In treating the\\nthroat your first duty is almost always to note whether there be a contraction\\nof the hyoid muscles, and if such be the case to relax them, as that leaves a\\nfiee field in which to work, since they may mask other troubles which you may\\nnot notice without having that removed first. You technique of manipulation\\nmust be carefull}^ noted, and the degree of force which you exert, because there\\nare important structures which you may injure by rough pressure. The best\\nway is to use the flat of the hand; the cushions of your fingers. To relax the\\nmuscles here the best way is to push the head toward the side, that is away\\nfrom you, while drawing the other hand towards you. You do not have to rub\\nyour fingers over the neck as though your fingers were a file. Draw the muscles\\nwith the fingers, do not let them slip over the surface, but hold against the\\nmuscle and draw them toward you. You can do this work as thoroughly as\\npossible without anj^ rough rubbing at all; necks are readily chafed sometimes^", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0088.jp2"}, "89": {"fulltext": "TREATMET OF THE NECK. 85\\nand if you wish to save the patient to your practice you will have to be a little\\ncareful how you handle his neck.\\nNext as to the tonsils. When you find an enlarged tonsil and wish to\\ntreat it, the first thing to do is to loosen the muscles over the blood supply to\\nthe tonsil, which is from branches from the carotid arteries. Hence, if you\\nhave relaxed all the muscles about the tonsils both internal and external, so\\nthat there is no further impingement upon the blood supply then you have re-\\nlieved the lesion. Of course if the lesion is back in the neck causing the nerves\\nto shut down on the vaso-motor supply you must attend to that. However,\\ngenerally we work directly in this way. Give it a thorough treatment, but\\nnot too hard. Work along the angles of the jaw, and then work all down\\nalong the course of the common carotid artery, down as far as where the artery\\ncomes from the thorax just behind the edge of the sterno-mastoid muscle.\\nThat should be done thoroughly; you should not be in a hurry. Further, I\\nalways put my fingers in behind the clavicle; be careful in putting your fingers\\nthere not to hurt, because it is a very tender point. I always put my fingers\\nin there and then approximating the bent arm to the face press it on above and\\nover while my fingers lie between the clavicle and the first rib. This relaxes\\neverything; then bring the arm down over the head, outward and downward;\\nthis will stretch the parts and stimulate the flow of blood through the carotid\\nartery. Perhaps the chief value of that movement is this: We frequently find\\nthat the muscles about the upper part of the thorax are drawn and are making\\nsome impingement upon or stoppage of the blood flow through the carotid ar-\\ntery, and you simply give it freer action by the motions you use there. We\\nalso frequently stretch the jaw, as we call it. I put my fingers just below the\\ninferior maxillary bone, placing the thumbs above, usually about the molar\\nprocess, then holding fairly tight spring the mouth open, rubbing downward\\nas the mouth opens to relax the muscles. That should be done three or four\\ntimes. It is not a bad idea to simply hold the jaw firmly and tell the patient\\nto open the mouth while you are holding, and that will stretch the muscles\\nabout the part. Of course, in treating any part you must watch its blood and\\nnerve supply. We have mentioned the blood suppl}- in this instance. The\\nnerve supply is from the pneumogastric, and from Meckel s Ganglion of the\\nfifth. You can stimulate the pneumogastric at its exit from the skull by deep\\npressure. You can also get an effect upon Meckel s ganglion bj^ having the\\npatient open his mouth, and thrusting the fingers into the glenoid fossa, have\\nhim close it again. It will usually hurt, but it is supposed to have an effect\\nupon Meckel s ganglion, which I will show later when I tell you how to treat\\nthe neck. The point there is the communication of the symathetic with the\\npneumogastric and with the fifth and with the blood supply about the tonsils.\\nThus you have treated both the nerve and blood supplv in treating an enlarged\\ntonsil. If your diagnosis has shown you a tender point just below the angle of\\nthe law, as is stated to be the case in catarrh, the best way to attend to it is\\nby the means already given, viz., relaxing all the parts. In that way you will\\nthrow fresh life there and take away the pain and tenderness.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0089.jp2"}, "90": {"fulltext": "84 TRKATMKNT OF THE NECK.\\nShould you find lymphatic glands enlarged it is a mistake to go at them\\nand treat them directly. If they are enlarged it is from some reason. You\\nwill sometimes find them enlarged in tonsilitis or in diphtheria, and they are\\nenlarged because the} have work to do as scavengers, and 3^ou must look to the\\noriginal cause. I do not think it admissable ever to work directly upon those\\nlymphatics, thinking that that will take down the enlargement, especially in\\nacute cases. It may possibly do in chronic cases, but in acute cases I have\\nknown of injury being done by rough treatment of enlarged l3^mphatic glands\\nwhen the trouble was somewhere else.\\nQ. In the case of tonsilitis, would you not stimulate the blood away from\\nthe tonsils?\\nA. When you have stimulated the arterial supply, you will sweep away\\nthe congestion. Whenever j^ou have attended to the nerve supply there regu-\\nlating the blood, the vaso-motors, of course then you get the same effect, it all\\ntends toward the normal and to restore the circulation as it should be.\\nQ. Increasing the arterial flow will sweep away the condition?\\nA. Yes, that is the tendency, that is how you can affect congestion\\nthrough blood supply, but do not forget to couple it with nerve supply, vaso-\\nmotor.\\nQ. I thought the way to get at it was to drain the congested part by\\nvenous withdrawal.\\nA That comes partly through 3 our vaso-motor effect, but if you can get\\nsufficient vis a tergo to sweep that all out, that is all you need, and that is\\nreadily done.\\nQ. Do you always have a local edematous condition with inflammation?\\nA. I do not know that there can be an inflammation without edema\\nwithout an exudation; that is one of the important symptoms of inflammation.\\nQ. Do you treat the sympathetics for goitre?\\nA. The cervical ganglia all three of them, I would treat, but would es-\\npecially direct my attention to loosening the anterior and posterior muscles,\\nwith the idea of relieving all parts and allowing a free flow of blood and nerve\\nforce. Of course you must do here, as you alwa^^s do, look for the lesion.\\nYou may find the clavicle is slipped, or you may find that one of the vertebrae\\nis displaced it depends upon the cause.\\nLECTURE XV.\\nAt the last lecture I considered, under the general subject of theory of\\nwork upon centers, further lesions that you might meet in your work. That\\nyou might have pressure b}^ exudates or edema; that the exudate might be fluid\\nor cellular; that the Osteopath must take into consideration the possibility of\\nsuch lesions and be on the lookout for them, thus going into the history of the\\ncase. For instance, if there is a history of inflammation, you will look for\\nsuch a possible lesion, or if a history of congestion, you will look for that lesion.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0090.jp2"}, "91": {"fulltext": "GKNERAI^ CONSIDERATIONS. 85\\nThe lesion ma}^ be a congestion bringing pressure upon parts, or it maybe mal-\\nnutrition; it may be some kind of a deposit, for instance a gummatous deposit,\\nof which I instanced a case; the pressure of the gumma upon the posterior\\nroots of the nerves, where they emerge from the spinal column. I spoke also\\nof an exostosis, or growth from a bone; the lesion may be an aneurism bring-\\ning pressure upon the sympathetics; or it may be some kind of a tumor, as in\\nthe case of exophthalmic goitre. I then quoted from Robinson to show what\\nthe effect of such lesions might be. I went further to show that the result might\\nbe more serious than mere stimulation or inhibition of nerve force, showing how\\nit might cause accual degeneration of the nerves and paralysis of the parts sup-\\nplied. I showed you how such degeneration might be accomplished by\\nthe traumatic action of contraction of muscles. That although the Osteopath\\nwas not able in every case to remove these lesions, he may prevent their form-\\ning, or he may be able to recognize the presence of such lesions and send the\\npatient to a surgeon if the case required surgical interference, without himself\\nbothering with them.\\nI. Gknkral Consider ations. There is a question that sometimes\\narises in the mind of the Osteopath, as to what the effect of stimulation or in-\\nhibition will be upon parts which he is not attempting to affect, but which are\\nconnected directly or indirectly with the parts on which he is working. In\\nother words, will he thus stimulate or inhibit other important parts of nerve\\nforce, and thus, you might say, vset up a pathological result, and his treatment\\nresult in certain pathological processes which were not intended? Every once\\nin a while a patient will say to you, such and such a thing happened after your\\nlast treatment, and do you think that your treatment could possibly have led\\nto such and such a trouble? If you are perfectly sure that the action of your\\ntreatment upon surrounding parts is not such as to produce pathological results,\\nyou will often be able to answer him strongly in the negative, when otherwise\\nhe would think you to blame for something that happened. You will frequent-\\nly meet cases of that kind. I have had a number of such questions asked me.\\nWhen considering probability, remember that the tendency is always toward\\nthe normal, and that helps you much, unexpectedly as well as expectedl}^ some-\\ntimes, not only where j^ou remove a lesion and depend upon nature to tend to-\\nward the normal to restore things as they should be, but that the manipulation\\nthat you make upon an affected part tends to restore that part to normal, while\\na manipulation that you make upon the parts associated does not tend to the\\nabnormal of those associated parts at all, but that the effect upon them is simply\\nwhat might be compared to the effect of normal exercise. So you need not\\nbe afraid of producing pathological results in that way. For instance, we have\\nto treat the pneumogastric in a case where the liver is not acting properly, and\\nthe intestines seem to be lacking in stimulating force. Part of our treat-\\nment in such a case would be directed to the pneumogastric nerve, since it has\\nto do with these viscera. Now, the question is, whether by stimulating, or in-\\nhibiting, or treating those nerves you would also have an effect upon the lungs", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0091.jp2"}, "92": {"fulltext": "86 WORKING AGAINST THE RESISTANCE.\\nand heart, which are supplied by the pneumogastric nerves, an effect which\\nwould be bad. Such has not been the experience at all, and you are not in\\ndanger, in treating the pneumogastric in such a case of having a bad effect upon\\nthe heart and lungs, supposing them to be normal, because your treatment\\ntends to restore the abnormal intestine and liver to the normal, while it tends\\nsimply to have the effect of exercise upon the other parts, and there is certain-\\nly nothing bad in that. Again, you might have a case in which the splanch-\\nnics were involved, and one who was very careful over questions of theory\\nmight want to know whether treating those nerves would have a bad effect up-\\non the kidneys. Experience shows that such would not be the case. Or, for\\ninstance, in the case of eye trouble, you frequently find that the terminal\\nbranches of the fifth nerve, emerging from the supra- orbital foramen, are very\\ntender to the touch, probably on account of a secondary lesion there, abnormal\\nimpulses coming from that nerve terminal causing the parts about the foramen\\nto contract and impinge upon the nerve, thus keeping it tender. That may be\\nthe cause of it. Now, of course in treating there you simply remove the con-\\ntraction about the parts, you stimulate the blood vessel and the nerve, and re-\\nmove the soreness. You would not he afraid of interfering with the nutrition\\nof the eye, which is innervated b}^ the fifth nerve.\\nThis will serve practically to explain the effects obtained by those who are\\nnot entitled to the right to practice Osteopathy, certain of those who have seen\\nthe pecuniary benefits of Osteopathy and gone out without proper equipflient,\\nand have become what the Old Doctor calls engine wipers, and I presume\\nothers who have had better opportunities may work in the same wa3^ That is\\nthey work all over the patient, and work pretty near half an hour, so the pa-\\ntient will think he has had a good treatment, so that if there is a place to be\\ntreated he will be ^sure to hit it. That is the way the Osteopathic quack works\\nin most instances, taking into consideration that the effect is toward the nor-\\nmal, he gives a nice stimulating treatment all over the body, and if he strikes a\\nfew lesions thej^ may be helped, as the tendenc}^ is toward the normal. That\\nwill explain how he happens to get results in some cases. Then, our work is\\nto remove the lesion, and not to be afraid that we will disturb the normal con-\\nditions.\\nFurther, concerning work upon abnormal parts, it is considered as a prin-\\nciple in our practice that we should work against the resistance we meet. That\\nis a little hard to explain, and it is not a principle which will apply as general-\\nly as some others. That is, move the part in the direction in which you will\\ncause the unnatural tension to appear. Because if by moving the part in a cer-\\ntain direction, as for instance, flexing the limb, you find that there is an un-\\nnatural tension opposing the normal movement, you then see you have a lesion\\nwith which you are dealing, and in working against the unnatural tension you\\nare working against the lesion, at least in some cases. This, then, becomes a\\nmethod of how to work to remove certain lesions. Dr. Harry says he always\\nsprings the part, as he expresses it, in the direction to cause the most pain.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0092.jp2"}, "93": {"fulltext": "STIMULATION AND INHIBITION. 87\\nFrequently you will find that the manipulation that you put upon a part will\\nbe diagnostic in part, and that it will often reveal to you certain lesions of the\\nkind I have described. Remember, that in such cases your cue is the pain\\nthat you find. For instance, I might find a contraction in the pyriformis mus-\\ncle in case of sciatica. The cause frequently of sciatica, from our standpoint^\\nis a contraction of this pyriformis muscle in such a way as to impinge upon the\\nsciatic nerve, which runs under it. So that you will then have an abnormal\\ntendency to external rotation of the head of the femur, and the movement that\\nwe adopt is of such a nature as to stretch the pyriformis muscle. The same\\nthing is seen in stretching the ligamentum nuch^, or the stretching of the\\nsterno- mastoid muscle. I have seen cases in which that muscle was stiffened\\nand contracted, in wry neck, and the treatment was to stretch the muscle.\\nThis will illustrate what I mean when I say to work against the resistance\\nwhich you will find, and that that is a cue to the lesion itself. Of course that\\nmay not be a primary lesion, it may be a secondary lesion as in the case of the\\nsterno-mastoid, the primary lesion may be something affecting the vSpinal acces-\\nsory which innervates that muscle, but at any rate it has set up a certain trou-\\nble which must be corrected. That is not, as I said, a general principle; you\\ncannot apply it everywhere; it applies especially to parts which may contract\\nand thus form obstructions. Do not be too eager in carrying out this idea, be-\\ncause you may irritate the parts. In trying to get the cue you may do harm;\\nI have seen that done.\\nIn the removal of lesions the question of stimulation or of inhibi-\\ntion becomes secondary, since the lesion being removed, nature tends\\nto the normal. Nevertheless, there come times in our practice when\\nwe must either stimulate or inhibit according to the rules laid\\ndown. As for instance, after we have removed the lesion and\\nwe have still to treat the parts to strengthen them, the question\\narises once more, what shall we do in this case, stimulate or inhibit, so that our\\nwork is not entirely confined to the removal of lesions. Sometimes the lesion is\\nnot apparent, and we simply have to go to work at the innervation of the parts\\nand get the results that we desire, either by stimulation or by inhibition. The\\ndisease may be of such a nature that this will be the rational method of treat-\\nment. Not that we should not look for lesions always, but sometimes we have\\nto get to work directly upon the nerves. For instance, in diarrhea or flux,\\ntheir abnormality must be of nerve fore?, it frequently happens that we simply\\nhave to treat that case by strongly holding the spine, that is, inhibiting the\\nsympathetic nerves, even though we mav not at that time correct some lesion\\nin the spine. I frequently simply inhibit strongly all along the lumbar region,\\nand I certainly did nothing there but inhibit nerve action. In obsteteric the\\nparturition center is stimulated at certain times to cause the contraction of the\\ncircular fibres of the uterus; we are not removing a lesion in that case, we are\\nstimulating to bring about the desired end, and are working upon the nerves\\nwhich control those muscles. In some headaches we cannot find any particu-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0093.jp2"}, "94": {"fulltext": "88 STIMULATION AND INHIBITION.\\nlar lesion; we very frequently go to the sub-occipitals and hold them and inhib-\\nit them there the sub and great occipitals; in that case we have inhibited. In\\nthe case of epistaxis we must simply stimulate in the neck; or in the case of\\nhiccoughs, which is a very good example, we often do nothing but go to the\\nphrenic nerve and inhibit it by pressure upon it. So I think the point is well\\ntaken, that we must sometime stimulate or inhibit without removing lesions,\\neither after removal of lesions, or in the absence of discoverable lesions. That\\nthen brings up the point that there must be some different movement which\\nwe employ to stimulate or inhibit. The difference in stimulation and inhibi-\\ntion is well illustrated by a simple phenomenon a very slight touch over dif-\\nferent parts of the body will cause a tickling sensation, which ma}^ become al-\\nmost unbearable; whereas a firm pressure at the same place simply removes the\\nconductivity of the nerves, or inhibits. The other was a stimulation. In gen-\\neral the movement used to inhibit is a holding or pressing motion; I will show\\nyou that later; a holding or pressing motion, having as its end in view the\\nidea of quieting the excitability of the the nerve, that is, the lessening of its\\nconductivity, which we know is done by pressure. We have seen that to be a\\nfact according to the authorities. Thus, in that pressure upon the phrenic\\nnerve we quieted the spasm of the hiccough. In general, alternation of pres-\\nsure and a relaxation of pressure, is used to stimulate, the idea being to excite,\\nto tittillate, and this is comparable to the making and breaking of an electric\\ncurrent. We use alternate pressure and relaxation, and the idea is to in that\\nway arouse nerve force. For instance, in a case of nose bleeding we have to\\nrub the superior cervisal ganglion, and thus stimulate the tonicit3 of the blood\\nvessels. In stimulating we work frequently along the spine, giving a stimula-\\nting treatment, described b}^ one as working hard and fast, making and break-\\ning. We simpl}^ keep working in that way. We do not adopt the pressing\\nmotion, what we use is a quick, stimulating motion. At least that is the Os-\\nteopathic view of how we stimulate or inhibit. That is the technique of mani-\\npulation: Perhaps I do not fully agree with all the physiologists say on the\\nsubject of stimulation or inhibition, but I think I have shown that we have a\\npretty good allowance of authority, from quotations made, and that is the way\\nwe get results. This, then, would naturally bring us to consider the question\\nof the degree of force that we should use. It is certain that you can stimulate\\nso assiduously that you can get the opposite result, and finally inhibit instead\\nof stimulate. The secret of it is that stimulation must amount to irritation,\\nwhich if performed too frequently or too hard will, after it has run its course\\nresult in the nerve refusing to respond to the usual stimulus, and finally to res-\\npond to any stimulus if the irritation is carried far enough. So that stimula-\\ntion may become irritation, and finally inhibition.\\nYou must remember in treating a jDatieut to adapt the degree of force to\\nthe end in view\\\\ This refers not only to the treating of a case, how hard to\\ntreat at the time, but the treating of a case too often. I wish you could all\\nheard what Dr. Conner said yesterday concerning the practice outside. He", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0094.jp2"}, "95": {"fulltext": "GENERAI, CONSIDERATIONS. 89\\nsaid a great many cases have to be treated too often. A patient comes into\\nyour office, and yon tell him, I want to see 3^ou not more than once a week,\\nin your case I can do you as much good in treating you once a week as I could\\ntreating you three times a week or every day. And that is a fact, but the\\npatient wants to get all he can for his money; he says, You are charging me\\ntwenty-five dollars a month, and I think I ought to get more than four or five\\ntreatments, that makes it come pretty high, and I would like at least two\\ntreatments a week. And it is almost impossible to prevent treating too fre-\\nquently, but when you do of course you are in danger of irritating. As I say,\\nyou must explain to the patient that by treating so often you irritate these\\nnerves and structures and thus keep up an abnormal irritation instead of re-\\nremoving it. You might also say that it is not you who cures, but Nature\\ncures; 3^ou simply aim to assist nature. Now, if you should treat so often, tell\\nhim you do not give Nature time enough between times to work, and that you\\ndo not think it best. You have to learn these arguments that apply to such\\ncases, as you will meet them frequently. When you say to nature that you\\nwill aid her so much that she does not have to work at all, she finally gets\\ntired of the effort and simply lays off and lets you do what you can. We\\nhad a case in Chicago of neuralgia of the fifth nerve which was treated once\\nand disappeared for quite a long time. It finally returned and was quite a\\nsevere case, as hard a case to treat as a ly that I had ever seen. We tried all\\nsorts of treatment and finally got to treating it pretty nearly every day, and it\\ndid not do much better. Finally we told the gentleman not to come back to\\nus inside of a week or two weeks, we had by this time quit taking his money,\\nbut were trying to do w^hat we could for him, so he was willing to do that.\\nThe result was improvement. We had simply stimulated until we had irritated\\nand kept up the abnormality.\\nThen, again, some lesions must be removed only gradually. If you go to\\nwork and remove the lesion instantly, you do not give nature time to accom-\\nmodate herself to the changed conditions. Nature has been for years at w^ork\\ntrying to adapt herself to the unnatural condition of things, and she has done\\nso to a greater or less extent finally, ;.nd now you, as an Osteopath, tr^^ to\\nchange all that in a second s time. It can rarely be done. I have known of\\nsome cases where a very quick change of a lesion could be made, but it is not.\\na very common occurrence. I have he.ird Dr. Harry Still state that he had\\nset a hip too soon and he had great difficulty with it until he had got it out\\nagain, because the muscles were all so contracted by being adap.ted to the ab-\\nnormal conditions. They would not relix as they would normally have done\\nwhen the hip was in place, and he had great trouble to get it out again. The\\nlesion should not be reduced too soon. In a case of asthma the Old Doctor\\nsays you should not treat oftener than once in ten days or two weeks, because\\nby frequent treatment we keep up the irritation.\\nI wish as soon as possible hereafter to take up certain centers and the\\nconsideration of the sympathetic system, that I left aside after the first few", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0095.jp2"}, "96": {"fulltext": "90 GENERAL CONSIDERATIONS.\\nlectures, as it is an important subject. There are certain things which I wish\\nto bring to your attention to-day in regard to them. Remember that stimu-\\nlating accelerator fibers accelerates and stimulating inhibitory fibers inhibits.\\nFor instance, if you were to treat the heart and wish to stimulate its action,\\nyou will recollect that there are two sets of nerves innervating the heart; one\\nthe sympathetics, and the other from the pneumogastric. That the sympa-\\nthetic keeps the heart running and tends to run it too fast, while the inhibi-\\ntory influence of the pneumogastric is to bring about an equilibrium between\\nthe forces and keep it running just righ*. If it is not running just right, not\\nfast enough, you will want to stimulate it a little, in which case you would\\nstimulate the sympathetic suppl}^ to the heart through the upper dorsal and\\nthe cervical ganglia and you would inhibit the pneumogastric so as to remove\\nthe inhibitory influence. You would thus, according to the theory, get a\\nstimulating effect upon the heart. If you wish to quiet the heart s action you\\nwould adopt just the opposite plan of treatment. That will illustrate the fact\\nthat stimulating a nerve stimulates it to its action, whether its action be that\\nof an accelerator or an inhibitor. Stimulating vaso-dilators dilates. Stimu-\\nlating vaso-constrictors constricts. This is very simple and perhaps it seems\\nunnecessary to call it to your attention except in the connection it has with\\nthese other things. There are certain things to remember in relation to the\\nvaso-motor system, and which though hard to explain are of a great deal of\\nimportance to the Osteopath.\\nThere are certain things concerning the centers and the fibers. It is said\\nthat vaso-motor fibers are present in some cranial nerves, for instance, the\\nchorda tympani of the facial nerve. _The chorda tympani is the vaso dilator of\\nthe submaxillar}^ gland. The general vaso-motor center is in the medulla. It\\nis said by Howell s Text Book, however, that that center is a constricting\\ncenter, from which a continual constrictor impulse goes to all parts of the body,\\npreserving the proper tonicity of the blood vessels, but he says it is not proven\\nthat there is any vaso-dilator center in the medulla. Simpl}^ not proven; there\\nmay be, however. The vaso-constrictor fibers, as before stated, leave the\\nspinal cord from the second dorsal to the second lumbar, while vaso-dilators\\nleave the cord all the way along, being not limited to certain places.\\nWe frequentl}^ meet with the terms, in description of the circulation, in-\\ncrease of blood pressure, and so on. Remember that stimulating vaso-con-\\nstrictors constrict the blood vessels, and thus lessens the quantity of blood in\\nthat part, but it increases the blood pressure. On the other hand, the vaso-\\ndilators loosen the tissues and allow more blood to go to the part, but decrease\\nthe amount of blood pressure. I thought I would call that to your attention\\nso you would not get those facts confused.\\nA further fact that you must take into consideration is that sometimes a\\nsingle anatomical nerve will contain more than one kind of fibers, vaso-dilator\\nand vaso-constrictor fibers. That is true in the case of the sciatic nerve, and\\nthe result you would get in stimulating the sciatic nerve would be an average", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0096.jp2"}, "97": {"fulltext": "TREATMENT OF THK NKCK. 9I\\nresult between vaso-dilator power and vasoconstrictor power. Again, some-\\ntimes stimulating a center will produce vaso-dilation and sometimes vaso-con-\\nstriction. You might have a vaso-dilator center and expect it always to pro-\\nduce vaso-dilation, hut accordii g to Howell s Text Book the center is some-\\ntimes changed in condition, and you get the opposite effect by its stimulation.\\nVaso-constrictors are less easily excited than vaso-dilators. Vaso- constrictors\\ndegenerate more rapidly when injured. The maximum effect of stimulation is\\nmore readily reached in vaso-constrictors than in vaso-dilators. Vaso-motor\\nnerves are axis cylinders of sympathetic nerve cells. The pilo-niotor and sec-\\nretory fibers we shall consider later when speaking of the structures in which\\nthey terminate. As we cannot be certain of all these things we have to de-\\npend more than ever upon the tendency toward the normal we cannot always\\nwork to get a set vaso-motor or vaso-dilator effect.\\nII. Treatment of the Neck. (Continued.) The spinal accessory,\\npneumogastric and glosso-pharyngeal nerves emerge at the jugular foramen.\\nWe frequently have to treat them, especially the pneumogastric and the spinal\\naccessory; the pneumogastric perhaps more often. We treat them in various\\nways. We can reach the pneumogastric by deep pressure over the exit from\\nthe skull deep pressure just below the mastoid process will affect the nerve-\\nSome work there. Others on the pneumogastric by stimulating all along the\\nanterior border of the sterno-mastoid muscle. Thus you get a sort of a mas-\\nsage and direct mechanical pressure upon that nerve and no doubt affect it\\nthere if our theories are correct. Another very good way to reach these three\\nnerves is through the superior servical ganglion. That is, we work on the\\nsuperior cervical ganglion to affect them. We may affect the superior ganglion\\nby working on the sub and great occipital nerves. That is rather an indirect\\nway, but it is claimed that we get an effect upon those nerves by working that\\nin place. That is the method Dr. Hildreth used to reach those nerves.\\nThere are various ways in which we reach the phrenic nerve, one way is\\nto carefully find its location opposite the transverse process of the third, fourth\\nand fifth cervical vertebrae, and get slightly in front of them and impinge back\\nupon them, thus pressing the nerve against the transverse process. That is\\none way. The way tha Dr. Harry Still treats the phrenic nerve is by thrust,\\ning the thumb between the clavicle and the first rib above; that is, thrusting it\\nabove the clavicle, between it and the first rib, then pushing the bent arm and\\nhand on back over the shoulder in this way, thrusting the thumb in deeply at\\nthe sternal end of the clavical and holding in order to impinge upon the nerve\\nand lessen its conductivity, thus inhibiting the action of that nerve. It is\\nsometimes reached, as I showed you the other day by pressure at the sternal\\nend of the clavicle. You can either press in the fouticulus gutturius, slightly\\nbackward, or between the sternal and clavicular ends of the origin of the steruo\\nmastoid muscle, backward and inward, to impinge upon the nerve. The best\\nplace to treat it is the best place that your practice tells you 3 ou can reach it.\\nDifferent ones treat in different places, and it also depends upon the patient, as\\nto how thick or how thin his neck is.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0097.jp2"}, "98": {"fulltext": "92 TREATMENT OF THE NECK.\\nNext we will consider the trearment of the sterno mastoid muscle. We\\ncan get a direct sort of a massage by working right along its course. It is\\nvery readily worked upon in this way, relaxing it and drawing it toward you\\nwithout rubbing the fingers over the neck. Another way is to follow the ob-\\nliquity of the muscle and turn the head, thus stretching the muscle on the\\nsame side. Remember that, on account of the obliquity of the muscles behind,\\nyou will at the same time stretch them, and I find that a very good plan in\\ngiving the neck a general treatment, as I will show you later. Of course you\\nmay have some trouble with the spmal accessory nerves causing a stiffening of\\nthe sterno-mastoid, in which case you must give il attention.\\nNow as to treating the neck proper, or the back of the neck. The first\\nthing is to loosen up all of the muscles. In giving this treatment I always\\nuse the flat of my hands, lay them directly on the neck, and have thus a broad\\nhold and do not run an} risk of hurting by pressure with the tips of the fins\\ngers. I usually go to work in this way and work straight backward, thus\\nloosing all of the muscles, giving a certain twist or turn as I work. You will\\nbe able to recognize by the sense of touch when you have relaxed everything.\\nIt is also good to relax the muscles by working from the side. Remember,\\nabove the third cervical to work upward and below it downward. I simply\\nrelax all the muscles that are rigid. Then when you have them thoroughly\\nrelaxed, it is a good idea to still further relax the deeper structures by a\\nstraight pull. I hold beneath the jaw^ and occipital protuberance and draw\\nthe patient toward me, that stretches the neck. I have warned you not to\\nturn it while stretching it in that way. 7 then turn the neck strongly from\\nside to side in ^^his general treatment of the neck, loosening all the deeper\\nstructures, stimulating all the parts about the vertebrae and loosening the\\nligaments. Then before finishing the neck I usually stretch the li^amentum\\nnuchae and also the other ligaments about the vertebrae, as I have already\\nshown you how to do.\\nIt is an important question how to treat the cervical ganglia of the sympa-\\nthetic. As I said, we usualh affect them by treatmg the sub- and great occip-\\nital nerves, that is. b}^ pressure in the sub-occipital fossae. The way in which\\nwe inhibit their action is by holding deeply in those fossae and then turning\\nthe head from side to side, rotating it as you go, and you thus work deep into\\nthe parts trying to get direct pressure upon the sub- and great occipital nerve-\\nThrough their connection with the cervical sympathetic you influence it. Some\\noperators treat that way almost entirely and results would indicate that they\\nwere accomplishing what the}^ were attempting. You must not be in a hurry,\\nbut turn the head slowly from side to side and hold firmly. Some treat the first\\nganglion directly by pressure opposite the second and third cervical vertebrae, a\\nlittle in front and backward, thus impinging it against the hard parts of the\\nspines beneath. In the same v/ay you can reach the second one, the third I\\nthink you cannot reach from the front of the neck, that must be reached indi-\\nrectly through sympathetic connections with the spinal nerves behind.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0098.jp2"}, "99": {"fulltext": "TRKATMKNT OF THE NKCK. 9;^\\nTo Stimulate these ganglia, pressure and relaxation are employed.\\nIn treating an atlas we use a combination of motions already shown, that\\nis, a thorough loosening up of all the parts. Then by traction, rotation and\\npressure upon the prominent part you can work it back into its place. Of\\ncourse it takes time, and frequently has to be done very slowly. That same\\nmethod can be pursued for all the cervical vertebrae. It is something you will\\nhave to learn by experience. Another way to set the atlas is with the patient\\nsitting on the chair. This is a move that Dr. Still showed us not a great\\nwhile ago. He gets his knee under the jaw and rotates the head in a direction\\nto throw out very prominantly, the part which is out of place, and then getting\\nhis thumb or fingers upon thatpartandsi mply rotates the head back again,\\nthe idea being extension and flexion in such a way as to disengage the articu-\\nlar processes and allow the part to resume its normal position.\\nIn order to work out the sore places that you will frequently find in the\\nsub-occipital fossae and just beneath the occipital protuberance you should re-\\nlax all the parts, both the ligaments and the muscles.\\nI will now show you how I usually work upon the neck; I will work just\\nas if I had come in and found this neck in a generally bad condition and wish\\nto relieve it. The treatment of the neck is a very important thing. You need\\nnot be afraid of getting down close to the shoulder and stretching all of those\\nmuscles. It is a good thing to get the head against you and push downward\\nas you turn, you can thus sometimes relax the parts and start the vertebrae\\ntoward their normal position. It takes considerable time to treat a neck\\nthoroughly and well. One thing which I did not mention is that you can\\nstretch the scaleni muscles very readily by holding the head straight and turn-\\ning it, pushing it directly to the side. If it is a case of headache I save the\\ninhibiting movement until the last, and by holding firmly in the superior cervi-\\ncal region, particularly at the sub-occipital fo.ss8e, I get good results as a rule\\non the head in that way.\\nQ. You were speaking of stretching the pyriformis muscle. Please show\\nus how that was done.\\nA. That muscle is an external rotator, and an extreme internal rotation\\nwill be all that is necessary to stretch it. Work opposite to the defect.\\nLECTURE XVI.\\nAt the last lecture I invited your attention first to the general principle of\\nour treatment, that manipulation always tends to restore parts to normal, fol-\\nlowing it out along the idea that therefore should we manipulate a part which\\nwas not diseased, we need not be in any fear that we would make in abnormal,\\nbecause the tendency would be to excite it in the way that normal exercise\\nwould excite it. But we by manipulation of the abnormal, on account of this\\ntendency, result in tending to the normal and in helping to cure the diseai^e.\\nThat is a partial explanation of why our friends, the engine wipers, who", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0099.jp2"}, "100": {"fulltext": "94 THE PHRENIC NERVE.\\nwork over nearly ail the body and work for nearly an hour, can get some re-\\nsults, when they are not Osteopaths at all. Another point was that you\\nshould take the pain as the cue, and to work the part or stretch it in the direc-\\ntion in which you get the resistance, since thereby you work against the lesion.\\nI explained about how general that should be, that you should not irritate in\\nso doing. Although the question of stimulation and inhibition is a secondary\\none to removal or lesion, that we sometimes stimulate or inhibit irrespective of\\nlesion or after removal of it. In general, we inhibit by pressure, by holding:\\nand stimulate by brisk work similar to making and breaking of an electric cur-\\nrent, and that there was a question of degree of force; that you might stimu-\\nlate hard enough to inhibit. There were certain elementary points concerning\\nnerves which I thought would be profitable to bring to your attention: That\\nstimulating an accelerator nerve accelerates, stimulating a vaso dilator dilates,\\nstimulating a vaso-constrictor constricts. I also called certain centers to your\\nmind, the fact that the center in the medulla is a vaso-constrictor center, and\\nthat a vaso- dilator center has not been found to exist, although it may be there.\\nI. The Phrenic Nerve. What I wish to-day to do is to notice, more par-\\nticularly something concerning the phrenic nerve. You all know its location\\nand treatment; how it arises from the 3d, 4th and 5th cervical nerves, espec-\\nially the fourth, having some branches from the third and a recurrent branch\\nfrom the 5th; that it is reached in different ways; being impinged against the\\ntransverse processes of the vertebrae, or being reached at the fonticulus gut-\\nturus, or Eetween the first rib and the clavicle; that it is important to us, but\\nhas been so mainly as a means of stopping hiccoughs. However, I think it\\nshould be of greater importance to the Osteopath, and while I have not heard\\nthese matters brought out that I am going to bring out this afternoon, yet I\\nmention them in the way of suggestion for further work. Perhaps I do not\\nknow all that others have done with the phrenic nerve; these points are more\\nin the manner of theories, but if what I have already said is true, certainly the\\nphrenic nerve has considerable importance to us as an adjuvant to our work.\\nThe phrenic nerve has important connections with the sympathetic system.\\nGray says that the phrenic nerve supplies the pericardium and the pleura by\\nfilaments; that in the thoracic cavity a filament is seen from the sympathetic\\njoining the phrenic nerve, and that there are also branches to the peritoneum.\\nFrom the right nerve there are branches to the phrenic ganglion, which is situ-\\nated just below the diaphragm, the terminals of course, perforating the dia-\\nphragm to reach this phrenic or diaphragmatic ganglion of the sympathetic.\\nThis ganglion of the sympathetic is, of course, connected with the solar plexus.\\nThis ganglion sends branches to the hepatic plexus, and also sends some fila-\\nments to the inferior vena-cava. Of course its function as a spinal nerve is to\\nsupply the muscle of the diaphragm. From the left nerve branches go to join\\nthe solar plexus, but there is no ganglia formed. Quain substantiates those\\npoints, and says further that branches reach the phrenic in the neck from the\\nmiddle or the lower sympathetic ganglia, some branches going to the pericard-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0100.jp2"}, "101": {"fulltext": "THE PHRENIC NERVE AND ITS SYMPATHETIC CONNECTIONS. 95\\nium. And that from the right nerve were branches going to the inferior vena\\ncava, both above and below the diaphragm, and that branches also go to the\\nright auricle of the heart. Pansina, according to Quain, has found in animals\\nthat the phrenic plexus of the diaphragm is participated in by the lower three\\nintercostal nerves. You will see that the purpose is to associate the muscles of\\nrespiration, the abdominals, intercostals and the diaphragm itself. Quain states\\nfurther, that the phrenic may have a branch from the hypoglossal nerve and\\nand from the 5th cervical nerve. Such are the facts in relation to the phrenic\\nand its distribution. When we examine those facts in the light of Osteopathy,\\nit seems certain that we find the phrenic significant to us in more ways than\\none. You see from what I have said that the phrenic is connected with the\\nsympathetics; first with the middle or lower sympathetics in the neck; next\\nthat it receives a filament from the sympathetic in the chest; next, that it per-\\nforates the diaphragm to join the nerves of visceral life, those on the right run-\\nning from the diaphragmatic ganglion, those on the left joining without the\\nintervention of a ganglion. You notice further that it has a connection with a\\ncranial nerve the hypoglossal; that it has branches connected with the brachial\\nplexus, that is, from the 5th cervical; and that it may perhaps join with the\\nlower three intercostals, but T do not know that that has ever been shown to\\nbe true in man. The conclusion is obvious, then, from what we know of the\\nconnection of nerves in different parts of the body, both sympathetic and other-\\nwise, that if any of these sympathetic, spinal or cerebral nerves were diseased,\\nthe disease might conceivably be extended to the phrenic and affect it, and\\nthat we might have phrenic symptoms arising from these other troubles. The\\nreverse of course is true, and that any of these structures which are supplied\\nby the sympathetics or these other nerves, may reflexly be affected by the\\nphrenic nerve when diseased. You have seen that it supplies the pericardium,\\npleura and peritoneum, that it supplies one of the great blood vessels, the in-\\nferior vena cava, and sends branches to the right auricle of the heart, and there\\nis no reason, according to our theory, why disease in any of these situations\\nmight not affect the phrenic nerve, and you might have symptoms of disease in\\nthe phrenic nerve. So that our theoretical rule is certainly a good one, for it\\nwnll work both ways, either affecting the phrenic nerve or the other structures\\nas the case may be. The importance of this to us liesm the fact that it would\\nbean adjuvant in the treatment already used. It is one more path by which\\nwe can influence nerve force. We have certain ways of reaching the abdominal\\nviscera through the splanchnics in the baci?:; we might have a case where we\\ncouM not get at it in that region, but if we could reach the trouble through the\\nphrenic, we would accomplish the desired result. As I have said, these facts\\nare not fully demonstrated, but it is a theory which I leave for your consider-\\nation, and which you can work on in your practice. It comes to us another\\nkey to unlock the doors of sympathetic life; another wa^ in which we can work:\\nanother tool in our hands.\\nI wish to call up what Dr. Hilton says in regard to the phrenic nerve; he sets", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0101.jp2"}, "102": {"fulltext": "96 THE PHRKNIC NKRVK. WORK UPON NERVE TERMINALS.\\nout ver}^ clearly why it is that it perforates the diaphragm and is distributed\\non its lower surface rather than upon its upper surface. He shows that were\\nit distributed to the upper surface the nerves would then be impinged upon by\\nthe lungs, and you would have constant interference with nerve force, but it is\\ndistributed on the under side of the diaphragm where it is removed from the\\ntendency of pressure of parts above, and the tendency of the force of gravita-\\ntion is to draw away the stomach, liver and spleen from the under surface of\\nthe diaphragm, so that there can be no interference with the plexus situated\\nbelow the diaphragm. Dana makes use of this tendency of gravitation in the\\n:ase of hiccoughs, but in a somewhat different way. That is, he states that it\\nhas a very effective action in hiccoughs. He places the patient on a table with\\nhis head down over the edge of the table, that would allow the thorax to arch\\nup, and the action of gravitation would allow the heavy viscera to impinge up-\\non the under surface of the diaphragm, and it would in that wa}^ be helpful in\\nstopping hiccoughs, by inhibiting the nerves of the plexus. Hilton does not\\nexplain it so. It may be that the stretching of the thorax, thus extending the\\ncontracted muscle would by its extension send an impulse back over the nerve\\nand quiet the spasm. I have not heard it explained why the drinking of cold\\nwater stops hiccoughs, but there may be an explanation here in connection\\nwi ch the sympathetics; that the action of the cold water may be such as to for\\na while inhibit the action of the sympathetics, sending an action refiexly back\\nto the phrenic from its sympathetic connections, and thus causing the spasm of\\nthe hiccoughs to be released. So that in our work upon the abdominal viscera\\nwe may avail ourselves of the advantage of work in the neck on the phrenic.\\nDana states that he treats diaphragmatic palsy by electricity applied to the\\nneck He says there is a motor area in the neck which is readily affected by\\nthe electric current. So that it no doubt corresponds with the work we do\\nwhen we bring pressure directly upon the phrenic nerve.\\nI wish to quote from Dr. Jacobson along this line as follows: Another\\nreason for the phrenic nerves traversing the diaphragm, and breaking up into\\nbranches on its under surface may be to enable them to come into communica-\\ntion with the sympathetic or visceral nerves of the abdomen. From this com-\\nmunication branches are given to the hepatic and solar plexuses, and the infer-\\nior vena cava. Everyone knows the value of active exercise when certain ab-\\n\u00e2\u0096\u00a0dominal viscera are torpid in the performance of their functions, e. g., in con-\\nstipation, biliousness, etc. The perforation of the diaphragm by the phrenic\\nand its communication with the abdominal sympathetics must bring the brain\\nand spmal cord, the diaphragm and abdominal muscles, so important in active\\nrespiration, into intimate association with the subjacent viscera. So says Dr.\\nJacobson. Hence, we see that we can go farther, and saj-, that since the brain\\nand cord are thus brought into connection through the phrenic with the sym-\\npathetics and with abdominal sympathetic life, and since it must send certain\\nimpulses along those nerves and thus affect abdominal sympathetic nerve life,\\nthere is no reason why the reverse may not be true. And why ma}^ we not af-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0102.jp2"}, "103": {"fulltext": "THK PHRENIC NERVE. WORK UPON NERVE TERMINALS. 97\\nfeet the brain and cord by working back from the sympathetics, and more par-\\nticularly when there is a lesion, because manipulation must tend toward the\\nnormal? You would manipulate the phrenics; the abnormalities would be af-\\nfected, you would affect the phrenic, and thus be more likely to affect other\\nnerves which have under control that which has become abnormal. There is\\nno reason, according to our theory, why we would not tone up the whole mech-\\nanism of respiration, especially the muscular respiration, since it is in connec-\\ntion with the phrenic nerve and with the abdominal.\\nI emphasize once more what I have said frequently before that work\\nupon nerve terminals will affect the nerve itself and will affect the center from\\nwhich it comes. I think that position taken by Osteopaths is impregnable. I\\nwish to quote from Dr. Hilton in a case of pain in the knee, where the trouble\\nwas in the hip, which the Osteopath often meets, and which shows us that\\ndoctors are not always in the dark in their diagnosis of these cases. Dr. Hilton\\nsays: Again, we find some patients with hip joint disease suffering from\\npain in the knee. Now, although the disease does not lie there, we know that\\nthe pain can be relieved by a belladonna plaster, or strong hemlock poultices,\\nor fomentations applied over the knee joint; thus acting upon the nerves of\\nthe hip joint through the medium of those which are spread over the knee-\\njoint. He has made the point previously that the nerves of a joint supply\\nalso the skin over the joint and over the insertion of the muscles which move\\nthe joint. So you have one nerve going to a joint, to its muscles and to the\\nskin over those muscles. We see that the therepeutic value of work upon\\nnerve terminals has been recognized and used long before this. Our method is\\npeculiar in this: that it works upon nerve terminals exclusively by manipu-\\nlation and its effects. Perhaps some of you have heard of certain exercises\\nfor troubles of the stomach, bowels? liver, etc. It is recommended that\\nthe patient who has torpid liver should every morning get down on all fours,\\nthat is, keeping the legs straight and walking on the hands and feet, and run\\nbriskly around the room, that if he would do that it would press the liver\\nand squeeze it like a sponge and could not help but stir up the torpid circula-\\ntion from the portal system. There is another stooping motion given in which\\nthe patient keeps the back straight, bends his knees and allows his body to\\nsink down straight, then he can bend so that the shoulders touch the\\nknees: You will notice that it is a sort of pumping motion, it will stretch the\\nspine atd knead the bowels and abdomen thoroughly. Often this may be of\\npractical use, and you might suggest it to patients with similar troubles. Now\\nwhat would be the effect in such a case? I do not think it would be simply\\nlocal in pumping the blood through the abdomen and its contents. I think\\nthat the tendency there would be to aft ect the nerve suppl3\\\\ if our work and\\nour theory go for anything, and aft ect generally the abdominal nerves, and\\nthrough them the centers, which may themselves be in an abnormal condition.\\nThe tendency continually toward the normal would tell us why work upon the\\nabdomen should affect cerebral centers and thus restore them to the normal.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0103.jp2"}, "104": {"fulltext": "98 LANDMARKS OF THK HEAD.\\nWe had quite a marked case in Chicago some time since. A lady patient told\\nDr. Sullivan that she had been treated by an Arabian doctor, who adopted a\\nqueer method. She said he had directed her to fix her mind upon the point in\\nview every day at a definite time, and he had given her particular instructions\\nas to how it should be done, and she said she was perfectlj- restored from con-\\nstipation. The explanation given was that by thus working on the mind this\\ndoctor had finally led his patient to gain control of the cerebral center which\\nhas to do with these functions.\\nI have already examined the neck before you, and shown you how to treat\\nit. I think we are ready to take up the head. I may say in passing that it is\\nmy idea to first go over the bod 3^ piece by piece, give you the examination and\\ntreatment for different pieces of the body. That is a piecemeal way to do, but\\nit will give you an analysis of the whole. After I have done that, we vShall\\nhave synthesis, and I will take up special diseases and show you how to exam-\\nine and treat the case, combining different movements and treatments accord-\\ning to circumstances.\\nII. Landmarks of the Head. Holden notes the following: That the\\nscalp is very tough and dense on account of its close connection with the apo-\\nneurosis. That its density, therefore, often obscures the growth of tumors upon\\nthe cranium. A tumor beneath the aponeurosis may very readily be confused\\nwith a growth from the scalp itself or from the the brain, and in general such\\ntumors are firm and resisting. Other tumors that are above are very readily\\nmovable, and when thev are movable I believe the point is general that they\\nare not so serious. The supra-orbital artery is felt pulsing just above the\\nnotch. You all know where the supra-orbital artery is, at the junction of the\\ninner and middle thirds of the supra-orbital arch. It runs thence up oyer the\\nforehead, and by carefully feeling you will be able to note the pulse.\\nThe temporal artery is felt an inch and a quarter behind the external angu-\\nlar process of the frontal bone. The occipital artery is felt near the middle of\\na line drawn from the occipital protuberance to the mastoid process. The pos-\\nterior auricular artery is felt pulsing near the apex of the mastoid process. I\\nthink it is a very good way to train the touch to feel for the different arteries\\nat different places.\\nIt is said that the skull cap is rarely exactly symmetrical. The promi-\\nnence of the frontal, parietal and occipital portions of the cranium is a partial\\nindication of those respective parts of the brain, and it is stated a good way to\\nmeasure their relative proportions is to pass a string from one external auditory\\nmeatus to the other, first over the frontal, then over the parietal, and then ov-\\ner the occipital eminences, and thus you can get an idea of the comparative\\nbulk of these lobes of the brain, because it is said the lobes of the brain cor-\\nrespond in general to these parts.\\nThe anterior fontelle in the infant, you are familiar with. It should be\\ncarefully noted whether the condition is a hill or a hollow. Of course normally\\nit is even. If it is a hill it will indicate too much cerebral fluid present, as in", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0104.jp2"}, "105": {"fulltext": "KXAMINATION OF THK HEAD AND FACE. 99-\\nhydrocephalus. But if there is a wasting of the fluids of the body, as in diarr-\\nhea, you may have a hollow there. Normally, the rate of the pulse beat may\\nbe counted at the fontelle of a sleeping infant. The frontal sinuses do not gain\\ntheir normal size until after puberty. The absence of them is not indicative of\\nmuch because they grow inside, or if they are very prominent it may be simply\\na heaping up of the bone and a degeneration.\\nThe mastoid process is filled with air cells, lined with mucus membrane,\\nand it may develop as other mucous membranes do, a catarrhl condition and\\nlead to suppuration. The occipital protuberance is the tickest part of the skull^\\nabout three-quarters of an inch thick. The part at the temple^is the thinnest,\\nand may be as thin as parchment, it is stated. The external auditory canal\\nruns slightly forward and inward, hence in examining^you must pull the auri-\\ncle backward and upward.\\nMarks for the face:\u00e2\u0080\u0094 The three points of the three terminations of the fifth\\nnerve are at the supra-orbital, infra-orbital and mental foramina, respectively.\\nA line passed down from the supra-orbital foramen, passing betweec the two\\nbicuspids, will pass over these three foramina. Of course nerve terminals are\\nimportant with us, and we get an important effect on the fifth nerve by work-\\ning on these terminals. The two lower foramina look toward the nose.\\nIII. Examination of The Head and Face. Of course I do not need\\nto state to you that the examination of the head and its parts, embodying as it\\ndoes, the eye, ear, nose and throat, upon any one or two of which some spend a\\nlifetime of study and work, lecture and treatment, can be encompassed by a few\\nlectures. We all recognize the importance of the subject. However, I think\\nwe can take a general view of this subject now in a few lectures and depend on\\nlater lectures and later experiences to enlarge upon our knowledge. The Os-\\nteopath has good success with troubles of the head, brain troubles, diseases of\\nthe eye, ear, nose, and throat, and diseases of the face. His treatment is very\\nsimple, being for the greater part in the neck. Troubles of the eye and ear\\nare, as you know, closely associated wath the superior cervical ganglion of the\\nsympathetic and with the various vertebrae. Dislocations of these vertebrae are\\nvery important. The atlas will affect the ear, and the atlas and upper cervical\\nwill affect the eye. So that in any examination that you make of the head and\\nits parts you must do it in connection with the neck. Please remember that\\nthe separation of these subjects has been merely for convenience, but that all\\nwork together. For instance, you may find a catarrhal condition of the head\\nwhere the cause may be entirely in the neck. You ma^- have a case of insanity\\nwhere the trouble is wholly in the neck. With these remarks I think you will\\nnote the importance of examining the neck, and of treating it in connection\\nwith head troubles.\\nIn examining a patient at any time you should note the size and shape of\\nthe head; you should look for the presence of tumors or ulcerations upon the\\nscalp or beneath it, and also carefully examine to see if the head is bald. Al-\\nways notice the face as it is a great indicator of disease; notice the countenance", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0105.jp2"}, "106": {"fulltext": "lOO EXAMINATION OF THE HEAD AND FACE.\\nthe expression. You will frequentl}^ come across in medical literature the fact\\nthat the patient has a worried expression. Your patient will sometimes wear\\nan anxious expression. Different diseases affect the countenance differently,\\nand 3^ou will often meet this anxious expression of countenance, so that is an\\nmportant indicati o n, as is also the complexion. You have all seen the eom-\\ndlexion of jaundice; stomach trouble will have its effect upon the complexion;\\ncertain diseases of the genitals will cause eruptions on the face. These things\\nyou will bear in mind. In looking at the face always note the lower jaw. It\\nis especially important from the Osteopathic point of view. It may be slipped\\nbackward or forward or it may be deviated from one side, and in being so may\\ncause a tightening of the ligaments of the jaw causing serious results. It may\\naffect the ear, or it may have something to do with neuralgia of the fifth nerve.\\nIn looking at the eye, always notice the conjunctiva, whether or not it is\\nengorged with blood, whether or .not it is yellow, whether there is any\\ngrowth upon it, or any abnormality whatever concerning it. Note whether or\\nnot the eye is brilliant; in some it is dull. All of these points should be signi-\\nficant to you. There may be growths upon the eye, e.g.. pterygium, which have\\nbeen successfully treated b} Osteopaths. You may find cataract; we have had\\nsome success in curing this also b} Osteopath}^ It is well in examining a pa-\\ntient to note whether or not the iris reflex can be obtained. Dr. Harry Still\\nalways says there is considerable hope for an eye if you can find on examina-\\ntion that the iris will readily dilate. He just taps the closed eye, putting one\\nfinger upon it, tapping three or four times gently with another; if that has\\ncaused the iris to dilate you will know that the reflex is intact. You can also\\ndetermine this by shutting off the light and then instantly turning it on, the\\nreflex being manifest in the same way. You should in your examination of\\nthe eye note what is the color of the mucous membrane. A very pale color\\nwill indicate an absence of sufficient nutriment; absence of blood supply. In\\nanemia the the mucous membranes of the whole body are pale, hence you will\\nwant to examine the eye in health to acquaint yourself with these phenomena.\\nIn examining the eye we have to turn back the lids, the under lid is very read-\\nily turned back and down, and you can examine it and notice if there is any\\nforeign body upon it. The upper lid is not quite so readily turned back. You\\ncan do it with a pencil, or you can push it right up and back. Note the meibo-\\nmian glands and note whether or not there are any granulations or any foreign\\ngrowths. It will be well for you to note whether or not the tonicity of the\\nmuscles about the eye is normal, holding the puncta lachrymala against the\\nglobe of the eye. A growth may obstruct the duct producing the same result,\\nand you want to know whether or not it it is simply a loosening of the muscles\\nor some obstruction in the duct. You may in looking at the eye discover a\\nforeign body. Sometimes 3 ou can see it, sometimes you have to look oblique-\\nly across the cornea of the eye. It may be stuck on the cornea and you will\\nhave to look at it by an oblique light, so as to see whether the surfaces are\\nclear. Looking at it obliqueh will also enable you tosee f)terygiums, although", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0106.jp2"}, "107": {"fulltext": "OSTKOPATHIC POINTS CONCERNING THE EYE. lOI\\nthese are general!} readily seen by looking at it directly. The presence of\\ndead lashes is sufficient cause of disease; you can have quite a sore eye merely\\non account of dead lashes being left in the lids. They should, I think, be reg-\\nlarl} pulled out every once in a while, and should be gently tried to see wheth-\\ner or not they will come out. It is said that if a person will keep them remov-\\ned he will not have trouble with his eyes. When they have become lifeless you\\nwill see little black points on the eye-lids. It is said a fullness under the eye is\\nindicative of dropsy, The presence or absence of a ring about the eye is also\\nindicative of the general health.\\nLECTURE XVII.\\nI spoke last time of the phrenic nerve, showing how it has connection with\\nthe sympathetic, and advancing the theory that very possibly impartant results\\nmight be obtained Osteopathically by working upon this nerve for the sake of\\ninfluencing its connections, calling to your attention the fact that it supplied\\nthe peritoneum and pericadium, send branches to the inferior vena and a branch\\nto the right auricle of the heart. That is also connected with the sympathetics\\nbelow the diaphragm and thus had very important connections with visceral\\nlife. That it also connected with a cranial nerve, the hypoglossal, and with\\nspinal nerves, viz., the 5th cervical, and that in some animals connection had\\nbeen noted between the phrenic and three lower intercostal nerves. This con-\\nnection v/ith the muscles of respiration is to cause them to work in conjunction.\\nThat is the theory supported by the quotation from Dr. Jacobson that work\\nupon, or exercises that would influence the abdominal viscera would thus have\\nan influence upon the brain. It seems likely that b}^ work upon these parts we\\ncan get an influence over the parts affected and thus perhaps reach brain cen-\\nters and gain an influence over them. I noted also the value of such exercises\\nas stooping, those which would bring a squeezing motion upon the liver, intes-\\ntines and stomach, and .showed how it might through these nervous connections\\naffect the parts which were at fault. I then explained certain points concern-\\ning landmarks about the head and face, and spoke upon the subject of how to\\nexamine the head, face and its parts. I wish to-day to continue that line of\\nthought, giving particular attention to the eye.\\nI. Osteopathic Points Concerning the Eye: We are aware that the\\nnerve supply of the eye, which is itself a nervous oro^an, is various and impor-\\ntant, and we shall see later in the lecture that we have quite a broad held upon\\nwhich to work to reach the eye. I have already given you some centers for\\nthe eye and have alread}^ spoken, in considering the neck, about the blood sup-\\npi}^ to the head and its parts, and it is also of course ver}- important to us. We\\nget our effect upon it through the nerves; the superior cervical ganglion is the\\nchief center upon which we work to affect the eye. I have seen a case of\\nblood shot eye, as we call it, cured by treating in the superior cervical re-\\ngion; simply by inhibiting the action of the sympathetics at that place. So you\\nS2e the sup2rior cervical ganglion has an important control over the nieclip.ni-in", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0107.jp2"}, "108": {"fulltext": "I02 THE THIRD NERVE IN REI.AT10N TO THE EYE.\\nof the blood supply. We probably affect it through the ascending branch to\\nthe carotid and cavernous plexuses, and no doubt also through the connection\\nwhich it has with the fifth nerve the fifth nerve having important vaso-motor\\nfibres to the eye. Quain, in his anatomy describes branches from the cavernous\\nplexus which run to the cerebral and ophthalmic arteries, forming a secondary\\nplexus about them, and from them, he says, some branches go to the eye ball\\nand form a plexus of the sympathetic in the eye-ball itself. Hence, you see,\\nwe have a very important and direct connection with the sympathetic through\\nthe superior cervical ganglion, through its ascending branches, and this termi-\\nnal sympathetic plexus in the eye-ball. The ciliary ganglion is also impor-\\ntant in relation to our work upon the eye. It has connection with the third\\nand fifth cranial nerves and the S3 mpathetics. The third and fifth nerves are\\nimportant, as you will see later when I shall take that up more in detail. Con-\\ncerning the ciliary ganglion, Quain says: The ciliary, ophthalmic or lenticu-\\nlar ganglion serves as a center for the supply of nerves, motor, sensor37 and\\nsympathetic, to the eve ball. Thus we have a center on which we may work.\\nFurther, he says, The sympathetic root is a very small nerve which emanates\\nfrom the cavernous plexus. So the ciliary ganglion gets its sympathetic sup-\\nply for the eye from the cavernous plexus. The ciliary ganglion lies at the\\nbottom of the orbit between the rectus muscle and the optic nerve.\\nThere is a treatment which we frequently give the eye, not\\ntapping, but a pressure of the eye back into its socket; and I\\nthink the effect there must be on the ciliary ganglion, and since it\\nis connected with the third and fifth nerves, we could undoubted-\\nly, if there were abnormalities, get an effect upon those nerves. Thus, work-\\ning in this way we might affect the third nerve and tone up the muscular me-\\nchanism of the eye, or working in this direction on the fifth nerve, we might\\ntone up the nutrition of the eye. Thus you see by pressure we have reached\\nnot a nerve, but a center, and the reverse is clearly true according to our theo-\\nry, that we might work upon terminals, as for instance terminals of the fifth\\nnerve which are readily reached in the face, and in that way get an effect upon\\nthis ciliary ganglion which is connected with the fifth nerve. Or, by working\\nas we do, through the superior cervical ganglion to reach the third nerve, we\\nmight have an effect upon the ciliary ganglion, of course through its sympa-\\nthetic connection. This will serve to show you how closely connected is all\\nthis nerve supply to the eye. One is quite dependent upon the other, and in\\naffecting one you affect the other, provided it is in need of treatment. Thus\\nyou see that by working on this theory you can affect not only sympathetic\\nlife, but sensation and motion of the e3 e, since these nerves send branches to\\nthe eye. A little further with regard to the third nerve and its connection\\nwith the eye ball: It innervates all the muscles of the eye ball, as you know,\\nexcept the external rectus and superior oblique. Through the ciliary ganglion\\nit also rules the sphincter of the iris. Howell s Text Book states that there\\nare fibres antagonistic to this motor occuli from the ciliary ganglion, which", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0108.jp2"}, "109": {"fulltext": "THE FIFTH NERVK IN REIvATlON TO THE EYE. I03\\nconstrict the iris and lesson the aperature of the pupil. The antagonistic fibres\\nto this motor occiili come from the third ventricle, through the bulb, the cervi-\\ncal cord, the anterior roots of the upper dorsal nerves, the upper thoracic gang-\\nlion and the cervical sympathetic cord, and thus that it joins the ophthalmic di-\\nvision of th2 fifth nerve passing through its nasal branch and its long ciliary\\nbranches to the iris. These anlaganistic fibres, of course, must be dilators.\\nThus from the more occuli you get the motor fibres to the spinchter of the iris\\nand from the region I have just explained you get the dilator fibres of the iris.\\nHence, we dilate the iris by stimulating the superior cervical ganglion or stim-\\nulating in the upper dorsal region, more particularly the latter. Quain, in\\nspeaking of fibres from the cervical ganglion, notes these centers: pupilladilat or\\nfibres arising from the ist, 2nd and 3rd dorsal nerves, then passing upward in\\nthe ascending branch of the superior cervical ganglion, reach the Gasserian\\nganglion, and the eye through the first division of the fifth nerve and the long\\nciliary nerves. He also sa s in parenthesis that it is stated by many observers\\nthat the pupilla dilator fibers are contained also in the 7th and 8th cervical\\nTierves. Motor fibres run to the involuntary muscles and orbit and the\\neye lids from the higher four or five dorsal nerves. Thus you see along\\nthe cervical region, from the sup rior cervical ganglion down as low as\\nthe 6th dorsal you may get an important effect upon the eye.\\nConcerning the fifth nerve and its connection with the eye ball, I have al-\\nready noted its connection with the ciliary mechanism; that there are dilator\\nbranches from the cervical and upper dorsal through the nasal branch of the\\nfifth, and that it has counnection with the Gasserian ganglion. The ophthalmic\\nor first division of the fifth nerve, which is sensory in function, joins with\\nbranches from the sympathetic derived from the cavernous plexus. This nerve\\nsupplies the lachrymal glands, the conjunctiva of the lids and of the e^^e ball,\\nand the skin about the lid and face of that part. The fifth nerve is also very\\nimportant in the nutrition of the eye, the face, and different parts of the head.\\nGreen s Pathology notes the fact that upon section of the fifth nerve keratitis\\nor inflammation of the cornea arises, followed by ulceration. Kirke makes the\\nsame statement, and says further that the disease may progress so far as to\\ndestroy the whole eye-ball. Kirke also states that in the case of fifth nerve,\\nthe fact that there are trophic fibres in it is proven by experiments of ^leissuer\\nand Buttner, who found that division of the innermost fibres is most potent in\\nproducing decay. Howell s Text Book states that vaso-dilator fibres for the\\nface and mouth are found in the cervical sympathetics; that they leave the\\ncord at the second to the fifth dorsal; that they connect with the fifth nerve by\\npassing from the superior cervical ganglion to the Ga.sserian ganglion. That\\n^other dilator fibres for the .skin and mucous membrane of the mouth and face\\nseem to arise in the fifth nerve itself, also some in the nerve of Wrisberg. He\\nstates further that excitation of the cervical sympathetic causes constriction;\\n\u00e2\u0096\u00a0excitation of the thoracic sympathetic, dilation of the retinal arteries. Thus\\nyou see that working from the cervical sympachetic, getting an influence along", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0109.jp2"}, "110": {"fulltext": "I04 THEORY OF OSTEOPATHIC WORK UPON THE EYE.\\nthe path of the fifth nerve, you have a vaso-motor effect upon the retina. So\\nyou have not only trophic but vaso-motor fibres in the fifth nerve, supplying\\nthe eye. Quain states further that the retinal fibres leaving the sympathetic\\nat the superior cervical ganglion pass to the ganglion of Gasser and to the eye\\nfrom the ophthalm ic branch of the fifth nerve through the gray root of the\\nophthalmic ganglion and the ciliary nerves. Almost all of the fibres of the an-\\nterior part of the eye are found in the fifth nerve, hence, you can readily see\\nthe great importance that the fifth nerve bears to Osteopathic work upon the\\neye, because there is hardlv au}^ trouble in the eye which may not be influenc-\\ned through the nutrition, and such troubles are readily within the reach of the\\nOsteopath.\\nTaking into consideration the facts, then, we note first, that the eye is\\nreadily reached by the Osteopath in two ways; through its blood supply, and\\nthrough its nerve supply. We note further that the chief points at which the\\nOsteopath works to affect the eye are the third nerve, the fifth nerve, the su-\\nperior cervical ganglion, the upper dorsal region, and also the ciliary ganglion;\\nthat, as I noted in the beginning, the superior cervical ganglion is the most\\nimportant point upon which we w^ork in treating the eye, since, as you have\\nseen, it is connected with the third and fifth nerves, and also with the ciliary\\nganglion. Also that through it you get an effect upon the iris, upon muscles,\\nand upon nutrition and sensation in general. So that the Osteopath certainly\\nis not lacking for means of reaching the eye.\\nWe note further that there is a constrictor center for the iris in the ciliary\\nganglion and in the superior cervical ganglion; that there is also a dilator cen-\\nter in the upper dorsal region and in the superior cervical ganglion. That is,\\ndilator center for the iris. That is something that might be a little confusing,\\nthat in the superior cervical ganglion you may have both a constrictor and dila-\\ntor center for the iris. However, Dr. McConnell states that we may contract\\nthe iris by working at the upper cervical region, and that we dilate it by work-\\ning down at the second and third dorsal. That has been our experience, and\\nalthough there seems to be a confusion of centers there we go according to re-\\nsults. We may work in one way upon the fifth nerve by treating the super-\\nior cervical ganglion, and we get an important effect upon the fifth nerve by\\nworking up its terminal branches. As I pointed out to you at the last lecture,\\nthe terminal branches of the fifth nerve are readily pressed upon at the supra-\\norbital and infraorbital foramina, as well as at the mental foramen, and since\\nwe have shown that working upon terminal fibres is an important part \u00c2\u00ab:f our\\nwork, and that through them we can gain important effects upon connected\\nnervous mechanism, I think it shows that we have a good opportunity to\\nreach and effect the nervous mechanisms of the eye through the fifth nerve.\\nI also noted at the last lecture, the importance of examining the neck in\\nany trouble of the eye or part of the head. If there is any dislocation of the\\natlas or of the third cervical, these points are particularly significant in regard\\nto eye troubles, or there may be an interference at the inferior maxillary artic-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0110.jp2"}, "111": {"fulltext": "LANDMARKS OF THK FACE. EXAMINATION OF THE EYE. IO5\\nulation a slip of that articulation, impinging from fibres of the inferior maxil-\\nlary division of the fifth nerve, and since in that way you may affect the whole\\nnerve, it may have an effect upon the eye.\\nByron Robinson quotes from Fox that, Irritation of the peripheral end of\\nthe cervical sympathetic will cause a protrusion of the eye ball, while section\\nwill cause a sinking of the eye ball. Dr. McConnell spates that there are\\nfibres which aid in the control of the metabolism of the retina at the fourth\\nand fifth dorsal, and the strong stimulation of the nerves of the sexual organs\\ncauses dilation of the pupils and protrusion of the eye ball.\\nII. Further Landmarks in Regard to the Parts of the Head and\\nFace. According to Holden we notice the following points: You will readi-\\nly feel the pully of the superior oblique muscle by pressing the thumb just un-\\nder the inner edge of the orbit. The seventh nerve has its exit from the cra-\\nnium at the stylo-mastoid foramen. It then passes forward and runs into the\\nparotid glands. It sends branches upward to the temple, toward the eye, the\\ncheek and jaw. The parotid duct lies on a line drawn from the bottom of the\\nlobe of the ear to midway between the nose and the mouth, and empties oppo-\\nsite the upper second molar tooth. It is accompanied by a branch of the facial\\nnerve supplying the buccinator muscle. The pulsation of the temporal artery\\nmay be felt between the root of the zygoma and the anterior part of the ear.\\nAnd it is said that that is a very convenient place to feel the pulse of a sleeping-\\npatient. The facial artery is very important in our work. It passes over the\\ninferior maxillary bone at the anterior edge of the masseter muscle and also at,\\nthe side of the nose high up as well as near the corner of the mouth close to\\nthe mucous membrane. The coronarv arteries are readily felt by placing\\nthe finger just beneath the lip against the mucous membrane; you can feel\\nthem pulsate on the inner side of the upper lip and on the inner side of the\\nlower lip. The facial vein, instead of taking a tortuous course to follow the\\nartery, runs directly from the inner angle of the eye down to the anterior bor-\\nder of the maseter muscles.\\nIII. Examination of the Eye: I took this subject up at the last lec-\\nture, but there are some points that I wish to call to your attention in examin-\\ning the eye. An unnatural luster of the eye is seen in fevers. An unnatural\\nbrilliancy is found in consumptives. A glassy eye in children shows inflam-\\nmation of the mesenteric glands, and if it is accompanied by dark, dry lips and\\ntongue and great restlessness, it showns an acute inflammation of fthe stomach.\\nIn fevers glassy eyes are a sign of great danger or of some serious change about\\nto occur. Dull eyes are noticed in febrile conditions, during the catamenia, in\\ncatarrhal and other affections. Sunken eyes are due to the absorption of the\\nfatty cushions, and indicate some loss of the vital fluid; hemorrhage or some\\nexhausting disease. Exophthalmus, that is protusion of the eye ball, when not\\ncongenital, is said to be characteristic of Basedow s or Graves disease.\\nIn your examination of the eye you should bear in mind and see what parts\\nof the eye are affected; whether it is the lid, iris or conjunctiva, whether it is a", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0111.jp2"}, "112": {"fulltext": "io3 tre:atment of the eye.\\nchange in the eye ball, whether the sight is affected, or there be a weakening of\\nthe nerves, or inflammation of the eye.\\nIV. Treatment of the Kye: As I have said, the treatment of the eye\\nOsteopathically is quite a simple matter. There are certain points that I will\\ngo over to notice how we treat the eye. In the first place, as I noted, we some-\\ntimes bring direct pressure upon the eye. We simply with one hand press gen-\\ntly upon the eye ball, or you can lay your thumbs on it and press downward.\\nIn that way, as I explained to you, you probably have an effect upon the ciliary\\nganglion, you would also, of course, mechanically excite the blood supply b}^\\npressure. You would also have an effect through this pressure upon the optic\\nnerve, since all these parts by being pressed back into the cavity would be more\\nor less impinged upon. I also noted that we sometimes gently tapped the eye,\\nlaying one finger upon the eye, and with another, tapping three or four times\\nvery gently. The idea in that is. Dr. Harry Still says, to shock the optic nerve\\nand thus stimulate it. Of course in that way also we stimulate the sympathet-\\nic, and through them the blood supply. We frequently in treatment of the\\nhead tap upon the frontal sinus, not very hard, for troubles with a branch of\\nthe fifth nerve which supplies that sinus, and from it you might have a bad ef-\\nfect upon the eye, causing some pain, which you might relieve in that way.\\nWe are frequently called upon to treat granulated eyelids. They are some-\\nthing that are readily treated by Osteopathic means, and something which are\\nvery distressing to the eye. We just wet the finger with a little water or some\\noil, sweet oil or vaseline and press it under the edge of the lid, both above and\\nbelow, and then pressing with the thumb against the outside of the lid upon\\nthe finger, work with the thumb and finger along the edge of the\\nlid, and in that way you stimulate the local blood flow; and the\\nthickening there causing the granulations is said to be due sometimes\\nto a local hypertrophy of the conjunctiva, or sometimes to a stop-\\nping of the ducts of the Meibomian glands. In thus working\\nyou would stimulate the blood flow to make that conjunctiva normal or you\\nwould take awav the stoppage of the ducts of the glands. Sometimes the se-\\ncretion gets thicii and stops up the ducts, I have often heard Dr. Hildreth\\nspeak of quite a noted case of granulated eyelids which were entirely cured.\\nHe said that Dr. Still explained that there was a stoppage of the circulation,\\nthat the blood had to make some use of the nutriment which was carried there;\\nand instead of it being directed normally it was directed abnormally on account\\nof the stoppage, and so caused these abnormal growths. What he did, was,\\nas I have .said, to free the circulation. Of course in anj^ treatment of the eye\\nwe must work over the superior cervical ganglion to get our effect upon the\\ncirculation.\\nI spoke about points at which we can reach the fifth nerve. Particularly\\nin work upon the eye we work at the supra-orbital notch or foramen, here at\\nthe junction of the inner and middle third of the arch. Be careful to free that\\nso that any contraction of the tissues about it are thoroughly relaxed. Then", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0112.jp2"}, "113": {"fulltext": "CKNTE^RS FOR PARTS OF THE HEAD. I07\\nthe same thing should be done below, at the infraorbital foramen. We also\\nget a termination of the fifth nerve at the outer angle of the eye, and I always\\nwork carefully there and stimulate that branch of the fifth nerve. There is\\nsaid to be a terminal branch just over the middle of the eye lid, and two ter-\\nminal branches at the inner canthus of the eye on the nose, where we can read-\\nily impinge upon them. A terminal branch is found also upon each side of the\\nmid-line of the forehead. According to the theory that we can work upon nerve\\nterminals, as we frequently do, to gain an important effect upon the connected\\nparts, we here have a number of terminal branches of the fifth nerve which we\\ncould certainly influence in that way to restore the normal. Of course at these\\nplaces we also get the little blood vessels, here at the inner canthus and at the\\nforamina and free them in our treatment. Another way that Dr. Harry some-\\ntimes employs almost exclusively in work upon the eye is to have a patient spring\\nthe mouth open while you hold the jaw; the idea being to free the blood supply\\nthrough the carotids, since the blood supply of the eye is deriyed entirely from\\nthe internal carotids, and it is a very important point in relation to work upon\\nthe eyes. Of course we must not forget the point I mentioned in regard to the\\nneck, and which you are familiar with; but the great and important point upon\\nwhich we work, always remember, is the superior ganglion. Thoroughly relax\\neverything and remove every pressure which may affect the blood flow. I\\nshowed you how to inhibit the action of the cervical sympathetic by holding\\nOf course stimulating would be the opposite w^orking quickly with alternate\\npressure and relaxation.\\nLECTURE XVIII.\\nAt the last lecture I took up points in regard to the eye, giving you various\\ncenters, which I need not repeat here. Also I noted the importance of the cil-\\niary ganglion in connection with the eye, the importance of the third nerve in\\nrelation with the eye; also of the fifth nerve in nutrition of the eye and parts of\\nthe head and face. Then I brought out certain points of importance to us\\nas Osteopaths. I noted certain landmarks concerning the head and face; con-\\ncluded the examination and took up the treatment of the eye. I wash to-day\\nto continue our consideration of points about the head and face.\\nI. Certain Centers FOR THE Parts OF THE Head: I have already\\nmentioned some in previous lectures. Howell s Text Book states that the cer-\\nvical sympathetic contains vaso- constrictor fibres for the face, the eye, the ear,\\nthe salivary glands, the tongue, and perhaps the brain. As to vaso- motor\\nnerves to the tongue; the lingual and glosso-pharyngeal nerves contain two\\nvaso-dilator fibres, while the hypoglossal and sympathetics contain vaso-con-\\nstrictor fibres. The chorda tympani, as already noted, is the vaso-dilator of\\nthe submaxillary gland. Quain states that the secretory fibres of the stibmax-\\nillary gland arises mainly from the second and third dorsal. Dana states that\\nherpes, fltishing, pallor, lachrymatiou and salivation indicate some disturbance\\nof the sympathetic and trophic fibres contained in the fifth nerve. Ouainstates", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0113.jp2"}, "114": {"fulltext": "I08 THE EYE. LANDMARKS.\\nfurther that the glosso-pharyngeal nerve through its small superficial petrossal\\nbranch furnishes secretory and vaso- dilator fibres to the parotid gland.\\nIn view of these facts, and of facts which I have already presented, I wish\\nto call the following points to your attention: First, that ^^ou have already been\\nshown how to reach and treat the fifth nerve, the cervical sympathetic, the\\nlingual, which is a branch of the facial, and the glossopharyngeal. I have\\nbrought up further the hypoglossal nerve, which is reached by the Osteopath\\nat its exit from the skall at the anterior condyloid foramen, and also indirectly\\nby the treatment of the superior cervical sympathetic ganglion. That the Os-\\nteopath thus controls the nerve supply of all parts of the head practically, and\\nthrough the nerve supply the blood to the head, governing as he does, b} his\\nwork upon the neck, the blood flow to all parts of the head, he must have an\\nimportant effect upcn nutrition. A further point is that the Osteopathic work\\nis very simple, and is made up largely of treatment in the neck, particularly at\\nthe superior cervical ganglion. I say very simple, because it is so in certain\\nrespects, but very complex when you come to study out the various complex\\nrelations of the nerves and the effect we may get upon them by working upon\\ncenters.\\nII. Landmarks: Holden instances the foLowing points: The opening\\nbetween the eyelids varies in size in different persons. It is this change, and\\nnot a variation in the size of the eyeball which makes us say a person has a\\nlarge or small eye, as the eyeballs are very nearl}^ of the same size in different\\nindividuals. The external angle of the lid is generally a little higher than the\\ninternal angle, ^and gives an arch expression to the face. The clos-\\ned lids fit accurately together, and are not believed, as sometimes stated, to form\\na channel with the ball of the eye for the flow of the tears. Upon shutting\\nthe eye the ball turns slightly upward and inward, and in that way cleansing\\nthe cornea uf any foreign substance which may have dropped upon it, and also\\nturning the pupil away from the light. The puncta lachrymalia are familiar ta\\nyou, they are seen at the inner angle of each lid. The lachrymal sac is found\\nb}^ drawing the eyelids outward, tensing in that way the tendo oculi, which\\ncrosses the lachrymal sac about the middle. By placing your finger upon the\\ntendo oculi you can feel, by winking the e3^e, that the orbicularis palpebrarum\\nand the muscles about the eye, keep that tendon working so that the tears are\\npumped into the lachrymal sac and passed into the nasal duct. The nasal duct\\nis from six to eight lines long, and passes from the lachrymal sac downward. It\\nopens at the top of the inferior meatus or sometimes in the outer wall. The\\nleft nostril, you will see upon examination is usually narrower thon the right,\\nowing to a division toward the left of the septum. It is important to know these\\npoints, so that you will recognize the normal conditions and not confuse them\\nwith disease. The middle and inferior spongy bones may be seen by dilating\\nthe nostril and throwing the head back. They are red in color and must be\\ncarefully distinguished from polypi.\\nThe Osteopath should also note the color of the lips, the normal vermil-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0114.jp2"}, "115": {"fulltext": "KXAM I NATION OF THE KYK. I09\\nlion color indicating health, and a departure from this indicating either the\\nstate of the circulation or condition of the blood. In looking into the mouth\\nalways bear in mind to look at the condition of the tongue, as it is a great in-\\ndicator of disease. Upon the under surface of the tongue is a median furrow\\nupon each side of which is the ranine vein. In the middle line of the floor of\\nthe mouth is the frenum linguse, upon each side of which is the opening of the\\nduct of Wharton, leading from the submaxillary glands, which you may find\\nbeneath the mucous membrane back near the angle of the jaw. The subling-\\nual glands are in the ridge of mucuos membrane each side of the middle. The\\nshape of the hard palate is sometimes significant, usually a broad arch, some\\ntimes narrower at the top like Gothic arch, and it is said that in idiots it is\\nquite sharp.\\nIn examining the throat it is a good plan, it is said, to hold the nose so\\nthat the person is obliged to breath through the mouth. That will cause a di-\\nlation of the various parts of the throat and a widening of the fauces and a\\nraising of the soft palate, so that you can then get a good view of the internal\\nparts of the throat. When you depress the tongue it should be done gently\\nwith your finger or the handle of a spoon or something of that kind; if 5 ou\\nare rough the tongue will resist the effort you are making to lower it. The\\noperator can pass his finger down into the throat past the epiglottis as far as\\nthe inferior border of the cricoid cartilage; as far as the beginning of the oeso-\\nphagus, and can make out the greater cornua of the hyoid bone and seek in\\nthe hyoid spaces on each side where any foreign body is quite apt to lodge. It\\nis important to know sometimes that behind the last molar tooth there is a\\nsmall aperature through which a little tube may be introduced through which\\nto feed a patient in spasmodic closure of the lower jaw. The pterygo maxil-\\nlary ligament is seen opposite the last molar tooth. The place where the sur-\\ngeon taps the antrum is just above the second bicuspid tooth about an inch\\nabove the margin of the gum. The aperture of the posterior nares may be\\nfelt by passing the finger carefully up behind the soft palate, and there can be\\nmade out by the touch the back of the septum and the back part of the infer-\\nior spongy bone in each nostril, also a grasping feeling from the action of the\\nsuperior constrictors of the pharynx.\\nI have already spoken concerning the tonsils. They lie at the side of the\\nthroat just behind the pillars, and in examination of the throat if you see them\\nextending beyond those pillars, it shows they are abnormal in size. The nor-\\nmal tonsil does not extend beyond the level of the pillars.\\nI have mentioned physiognomy in relation to examination of the face. It is-\\nstated that the insertion of the muscles, not only into tendons and bony parts\\nof the face, but also into the skin all over the face, leads to the formation of\\nlines. That the passage of various thoughts through the mind constantly re-\\ncurring, calls into play certain sets of muscles, and finally leaves lines upon the\\nskin at the places of contraction, thus creating a reliable method by which the\\ncountenance may be read, and which is sometimes useful to us. There are twa", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0115.jp2"}, "116": {"fulltext": "no EXAMINATION OF THK EAR.\\nof these lines which I wish to mention particularly. Fir*^t, there is the linae\\nnasalis, extending from the alse nasi out to the angle of the mouth. And it is\\nsaid in children its presence denotes some abdominal trouble, especially inflam-\\nmation of the bowels; in older persons some trouble with the stomach, or ab-\\ndominal disease, frequently of the liver. The linae labialis extends from the\\nangle of the mouth down to the side of the jaw. It is seen frequently in chil-\\ndren with inflammatory diseases of the larynx or lungs, and in older people\\nwho have laryngeal and bronchial trouble, and difficulty of breathing-. Of\\ncourse the Osteopath, as well as the physician, should become familiar with the\\nindications of the face, know its natural temperature and different things about\\nit. I cannot mention such things now, but they are interesting to stud} and\\nare very practical in directing the operator s attention to the probabilities of di-\\ndisease it is very helpful in diagnosis.\\nI wish today to examine further the parts of the head, and show 3^ou the\\ntreatment to be given.\\nIII. Examination of the Ear. The disease may be in the external, in\\nthe internal, or in the middle ear, or it may be in the brain or in the auditory\\nnerve itself. It is sometimes very difficult to say where the location of the\\ndisease is. First: As to examination of the external auditory canal. Since\\nit runs forward and inward and is slightly curved, you must draw the auricle\\nupward and backward to be able to look down into the external canal. You\\nmust have a good light. You can look directly in without the aid of any in-\\nstrument, but usually the operator should be supplied with an ear speculum,\\nwhich is a little tube, funnel .shaped, polished so as to reflect the light. Fre-\\nquently a forehead mirror is used; a little mirror that is fastened by a band\\nabout the forehead, with an aperture in the middle, through which the oper-\\nator may look. This reflects the light, and reveals the interior of the canal.\\nIn looking into the external ear you may notice that there is too much or too\\nlittle wax, indicating some general disease. You may notice that there are\\ngrowths in the ear, or foreign bodies, such as buttons in children s ears, or\\ninsects, or the wax may become hard and impacted. I had a case once in\\nwhich a person had noticed a slight deafness, continually increasing until fin-\\nally he was not able to hear his watch tick when held at his ear. I found by\\n-examination that the wax had become impacted. Of course he could hear in-\\nternally by certain methods employed to test the hearing. I just took the\\n\u00e2\u0096\u00a0curved end of a hair pin and picked out the wax, and he could hear all right.\\nIt is quite a common thing in persons who have a poor quality of blood to have\\nfuruncles, or boils, in the external auditory canal. Your examination of the\\n\u00e2\u0096\u00a0ear will reveal to you the membrani tympani, which should appear concave.\\nIt is in color a pearly gray and glistens with the reflection of the light. You\\ncan see the processus brevis of the malleus and the manubrium of the malleus,\\nand you can, sometimes, with a good light, see the processus longus of the in-\\ncus. The membrane appears concave, the most concave part at the end of the\\nmanubrium, is called the umbo; at the tip of the manubrium appears a bright", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0116.jp2"}, "117": {"fulltext": "TRtiATMENT OF THE EAR AND NOSE. Ill\\ntriangle or pyramid of light where the reflection is brighter than at other parts.\\nOf course only practice will make you familiar with the normal external parts\\nand appearance of the membrane. Further, you should always in examining\\nthe ear look for perforations, of the membrane because those frequently occur\\nin ear troubles.\\nAs to the middle ear, you may have it affected by different diseases,\\namong which are inflammations, catarrhs, etc.,. in which case pus or mucus\\nmay collect in it. In that case, if the ear were filled with pus or mucous, the\\nmembrane would be pushed outward, and would be convex instead of concave.\\nBy examining from the external ear, if inflammation were present there would\\nbe a reddish appearance of the membrane. It is said the presence of mucus\\nor pus gives a yellowish tinge to the membrane. For examination to see\\nwhether or not the Eustachian tube be closed there are different methods used.\\nOne is for the patient to close his nose and mouth and make an expiratory ef-\\nfort, eliciting a crakling sound of the membrane, due to the impact of the air.\\nThat is called Valsalra s method. Another method, called Politzer s. is prac-\\ntically the same. The patient is directed to swallow a little water, the opera-\\ntor having introduced a tube through one nostril, and closing the mouth and\\nboth nostrils except the tuhe, through this tube the operator blows, and the\\nair is forced up toward the membrane, and in case the membrane is perforated\\nthere is a whistling sound as the air escapes. Or if there is an accumulation of\\npus or fluids, they will be driven into the external ear. In case of closure of\\nthe external ear it is said that there is a magnification of the sound in the mid-\\ndle ear, or in case of closure of the Eustachian tube the same thing would ob-\\ntain, or in case there was too much secretion about the ossicles, not allowing\\nfree motion. In such cases it is against the teeth, the sound is increased in the-\\naffected side. If it is heard louder in the other ear, it indicates some trouble\\nwith the internal ear of the affected side. Your diagnosis may be made still\\ncloser by placing a watch or tuning fork against the mastoid process of the af-\\nfected ear; if there is no response you may be sure the trouble is in the internal\\near. Those are a few methods by which you may determine where is the\\ntrouble that is affecting the ear. Since the aurist makes the ear his life time\\nwork, we cannot do justice to the subject in any one or two lectures.\\nIV. Treatment of the Ear I have already shown 3 ou how to ex-\\namine the external canal of the ear; the usual methods are employed to remove\\nforeign substances, or in case of impacted wax you had better u^e some warm\\nwater; it may take several sittings to remove it entirely, and the hearing may\\nbe worse after the first treatment with the water because of the swelling of the\\nwax filling the canal. In the case of insects in the ear seme waim water or\\nsweet oil may be introduced with a syringe. In ear aft ections there is usually\\ntrouble with the atlas or in the upper cervical region. We treat then the lesion\\nif we find it, in the neck, and we treat the ear largely by regulating: the bleed\\nsupply; by springing the jaw, as already shown. The chief work in the neck\\nis on the superior cervical ganglion, and in stimulating the blood flow through", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0117.jp2"}, "118": {"fulltext": "112 TREATMENT 01! NOSS AND THROAT.\\nthe carotid arteries. Of course in affections ot the ear from catarrh or consti-\\ntutional troubles 3^ou would have to direct your treatment to the general con-\\ndition of the patient look after his general health. I had an interesting case\\nof deafness once where I did not treat the ear at all. I found the clavicle was\\nslipped; that the scaleni muscles were hard; that there was a paresis of the right\\narm. I slipped the clavicle back, treated the scaleni muscles, and the lady\\nwent up stairs and immediatel}* called dow^n that she could hear the clock tick-\\ning downstairs, something she had not done before. It must have been by\\nS3^mpathetic connection of the nerves which had been affected; the brachial\\nplexus and the nerves to the ear. I do not know of any other wa}^ to account\\nfor it. That shows you cannot always work according to rule, but you must\\nlook for the cause and treat wherever that may occur.\\nExamination and Treatment of the Nose:\u00e2\u0080\u0094 Since the aperture of\\nthe nostril is on a little lower level than the bottom of the passage of the nostril,\\n3 ou have to pull the nose up and back. You can dilate it with a speculum\\nused for the purpose, and you can use either form of reflected light. You may\\nsee the middle and inferior turbinated bones and the marks I have mentioned.\\nYou will learn to recognize the normal conditions, and to note any diseased con-\\nditions and observe whether there are any growths in the nose; the polypus is\\nthe most common. It is common to meet with fractured nasal bones. That\\nof course belongs to the surgeon, but is very readilj^ set. You can diagnose\\nthis condition by holding the ear close and you can hear a grating sound as you\\nmove the nose. I have had cases in which I would simply straighten out the\\nparts, using no splint or anything of that kind. I do not know what is the\\nusual method surgically, but with no splints the bones wall stay in position and\\nno deformity or abnormality follow. You will sometimes notice that in catarrh\\non account of the absorption of these turbinated bones, the nose is deflected to-\\none side or to the other. The usual way in which we treat the nose, aside\\nfrom the general system which is adopted in catarrh, the freeing of the blood\\nsupply in the neck and of the blood supply about the nose, is to work on the\\noutside of the nose and loosen all the tissues along the side. In that way also\\nyou free the nasal duct by loosening all the tissues. Also in case of stoppage\\nof the nose in colds and catarrh, we place the hand fiat above the frontal sin-\\nuses and press down quite hard. You can sometimes clear the nostrils in that\\nway so that the stoppage is gone and the breathing is clear through the nos-\\ntrils. There is another disease w^hich you frequentl}^ meet, a ringing in the\\near, tinnitus rurium. It is common in old people, and it is common also in\\nconstitutiotial diseases, after sunstroke, or in malnutrition, and old age. There-\\nfore, it arises sometimes from conditions of general health. The Osteopath\\nhas found that it is due, in some cases, to a stoppage of the circulation m the\\nlittle anastomosis on the ear drum, and he then works in the usual method to\\nfree up the carotid artery, and by stretching the jaw. Sometimes the trouble\\nis in an obstruction to the auditory nerv^e. It is said that we inherit the audi-\\ntory nerve by pressure in the neck opposite the third cervical, by steadily hold-\\ning there.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0118.jp2"}, "119": {"fulltext": "THE SPLANCHNIC NERVKS. II3\\nI cannot mention in such a lecture as this all the points in connection with\\nexamination of the mouth and throat. That also is a field for the specialist. I\\nhave noted that you should seethe condition of the tongue, whether it is furred,\\nwhat its teaiperature is, and its color. These are very indicative. For instance\\nit is said a tongue furred on one side is indicative of a one-sided disease, as for\\ninstance, of the liver or spleen. A furred tongue has been noticed by Hilton\\nin a case of ulceration of the teeth. The half of the tongue on the side of the\\nmouth affected by the tooth was furred, and there was stiffness of the jaw. Of\\ncourse he referred it to the fifth nerve, which supplies the muscles of the jaw\\nand supplies also a part of the tongue. As to the color of the tongue, we\\nmight mention for instance, the strawberry tongue, as it is called, in scarlet\\nfever, or the lead colored thrush-covered tongue in the dying.\\nYou wuU observe the tonsils, the uvula and the condition of the fauces.\\nFrequently in diseases of the throat the uvula is inflamed or edemetous and is\\nhanging down, obstructing the passage of the air, and keeping the patient con-\\ntinually coughing. There are certain times when we give internal treatment\\nto the mouth and throat, but not very frequently. That is, in case of catarrh,\\ntonsilitis, or something of that kind. We sometimes insert the fingers and by\\na pressure upward and outward along the pillars of the fauces, we free the\\ncirculation to those parts, and can in that way to a considerable extent allay\\nthe inflammation. That is, we frequently relax congested and contracted\\nparts. The general treatment for the throat I have shown you, by loosening\\nthe muscles and by working to free the blood suppi}^ but you must also be sure\\nthat all the muscles throughout the neck are relaxed. You can feel those in the\\nback of the neck, as I have already shown. You cannot, however feel the anterior\\nspinal muscles in the neck, you must take into consideration the probability^\\nthat^where others are contracted, they also are, and adapt 5 our different\\nmotions to the stretching of those muscles; simply b}^ stretching the head back-\\nward you can free all the branches of the nerves.\\nThere is a great deal more that might be said both in general and in parti-\\ncular concerning the eye, nose, throat, and parts of the head, but I think that\\nin three lectures that I have given you I have been able to give you the usual\\nOsteopathic treatment for the parts of the head, and to give a general idea\\nof the importance of these things. Of course we depend entirely upon the\\nnerve and blood supply. That after all is the best part of the work.\\nO. In regard to examination of the nostril, you said we should observe\\nthe turbinated bones. Is there any way by which you can remove abnormal\\ngrowths from that bone osteopathically^\\nA. That bone is very frequently softened by catarrh, sometimes tilcerated\\nand eaten away, and in so far as yoti can influence catarrh, with which we have\\ngood results, you could influence this other trouble, and by work upon the nose\\nyou might gradually work the parts back into their normal condition.\\nO. You spoke of dropping of the uvula, is that not caused largely bv\\ncatarrh?", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0119.jp2"}, "120": {"fulltext": "114 I HE SPLANCHNIC NERVES.\\nA. Yes, sir, in general. Anything which would inflame, of which\\ncatarrh is a sample.\\nLECTURE XIX.\\nAt the eighteenth lecture I considered certain Osteopathic points about the\\nhead, giving you certain centers for the head and its parts, which I need not re-\\npeat here; something concerning the vaso motors, that the Osteopath had there-\\nfore a good field upon w^hich to work in treatino: the head and all its parts, the\\nbrain included. I then instanced certain landmarks, and took up further the\\nsubject of how to examine the parts of the head, including the eye, nose, throat\\nand mouth. I wish to day to call your attention further to the thorax and its\\nparts. We have so far in our Osteopathic work seen how to examine the spine,\\nneck, head, etc., the significance of points discovered; also how to treat them.\\nIt is of great interest to us now to go to the thorax. And in going to the\\nthorax it is quite fitting that I should say something in particular about the\\nsplanchnic nerves. I have said something concerning these nerves already, but\\nthink something more in particular would be of value to you. The splanchnics,\\nas you probabl} already know, are some of the most important tools with which\\nthe Osteopath works and I will venture the asserrion that there will be hardly\\na day in your practice pass without your working upon the splanchnics. They\\nare of such far reaching connection that their importance at once becomes ap-\\nparent, hence, their constant use by the Osteopath. As to definition, you\\nknow what splanchnology is the science of the viscera. Hence, the splanch-\\nnics, refers to visceral nerves, those nerves governing the viscera, and it is in\\nthis fact that their significance lies. It is with the sympathetic splanchnic\\nnerves that we as Osteopaths have to deal, and it is because of their fair reach-\\ning control of visceral life and the wonderful results the Osteopath can get in\\nworking upon them, that he has been so successful in treatment of diseases in\\ngeneral. That is one of the reasons, I should say.\\nNow, as to what these nerves are, we know^ at once that they are the\\nsympathetics from the lateral chains of thoracic ganglia. I want to bring out\\na few points concerning these nerves by way of review, so that we will know\\nwhat we are working with. First, the great splanchnic arises from as high as\\nthe fifth or sixth, and from all of the thoracic ganglia below down to the ninth\\nor tenth. It perforates the diaphragm and joins the lower part of the semi-\\nlunar ganglion. In the chest it sometimes divides and forms a plexus with the\\nsmaller splanchnic. As to the nature of these fibers, they are white, medul-\\nlated fibers. You remember in one of the first lectures I called your attention\\nto the fact that in the sympathetic there are two kinds of fibers. And it is\\nstated by Quain that about four-fifths of the fibers of the splanchnics are made\\nup of white medullated fibers, and they come direct from the anterior roots of\\nthe spinal nerves. This greater splanchnic may arise as high as the third\\nthoracic. Gray, I believe, states it may receive branches from the upper six", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0120.jp2"}, "121": {"fulltext": "THE SPI^ANCHNIC NERVES- II5\\nthoracic. This greater splanchnic gives branches to the aorta itself and to the\\nfront of the vertebrae.\\nAs to the smaller splanchnic, it arises from the ninth and tenth, as usually-\\ndescribed, sometimes from the tenth and eleventh, thoracic ganglia. Or, it\\nmay not arise from the ganglia, it may arise from the sympathetic cord itself\\nwithout the intervention of ganglia. It also passes through the diaphragm,\\nsometimes separately, and sometimes in conjunction with the cord of the\\ngreater splanchnic. It also joins the lower part of the semi-lunar ganglion,\\nand sends branches to the renal plexus in case the renal splanchnic is wanting,\\nor in case it is small.\\nThe smallest or renal splanchnic, as you gather from the above, is some-\\ntimes wanting. It arises from the last thoracic ganglion, and passes through\\nthe diaphragm in connection with the general sympathetic cord, and goes to\\nthe renal plexus, not the semi-lunar ganglion.\\nA fourth splanchnic is sometimes described. It is stated that Wrisberg in\\neight instances out of a great many found a fourth splanchnic in the cervical\\nregion.\\nWe all understand what is meant in general when we speak of the splanch-\\nnics. That is, these three splanchnic nerves. But you will see that it is\\nsometimes used in a different sense. Gaskell, quoted by Quain, says that there\\nare visceral branches from the second, third and fourth sacral nerves, and\\nthese he calls the sacral or pelvic splanchnics. The cervicocranial rami\\nviscerales are visceral branches from the spinal accessory, pneumo^astric and\\nglosso-pharyngeal and facial nerves. So you see that visceral nerves have their\\norigin from these cranial nerves; also a branch from the ciliary ganglion from\\nthe third nerve. Byron Robinson has this to say concerning splanchnics in\\ngeneral. There are certain fine white medullated nerves, which Gaskell\\nmentioned, and which pass from the spinal cord in the white rami comniuni-\\ncantes between the second dorsal and second lumbar nerves inclusively, to sup-\\nply viscera and blood vessels. These nerves should be called, as Gaskell sug-\\ngests, splanchnics. Hence, we will have, first, the thoracic splanchnics: second,\\nthe abdominal splanchnics, and third, the pelvic splanchnics. Hence, you will\\nsee the general use to which Gaskell put the term, in the use of which the\\nother authorities have concurred. Robinson says further, that these white\\nrami communicantes extend from the second dorsal to the second lumbar, but\\nwe know that along this region and in the region above the second dorsal and\\nbelow the second lumbar, gray ones are found. In the last two named regions\\ngray exclusively. That variety he calls peripheral, supplying the parties of\\nthe body. From the foregoing, and what has been said in general concerning\\nsplanchnics, we see that the splanchnics proper of which we speak, are white\\nmedullated fibers, for the most part, and that their particular function is to\\nattend to the blood vessels and to the viscera. Flint says that the splanchnics\\nare the most important vaso-motors of the system. And further, Ouain states\\nthat the medullated fibers, that is, such as we find in the splanchnics, which", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0121.jp2"}, "122": {"fulltext": "Il6 RKGULATIVK KFFKCTS OF WORK UPON THE SPLANCHNICS.\\npass in the sympathetic system, are classed by Kolliker as (a) sensory, (by) vaso\\nand viscero-constrictors, and (c) vaso and viscero-dilators. Hence, we have\\npassing from the spinal cord along into the great prevertebral plexuses in the\\ndifferent regions these sensory, vaso-dilators and contrictors and viscero inhib-\\nitors and constrictors. He goes on further to say that the sensory are found\\nonly passing from the cranial nerves, but that these visceral and vaso-motor\\nfibers are found all the way down the cord. Hence we see at once that these\\nvisceral and vaso-motor fibers are found in the splanchnics. In line with the above\\nQuain says further, that the splanchnic nerves proper, act first, as viscero-\\ninhibitory fibers for the stomach and intestines; second, as vaso-motor fibers to\\nthe abdominal blood vessels; third as afferent fibers from the abdominal viscera.\\nThat is, fibers from the adbominal viscera back to the center. And that\\nexplains whj^ it is that we get secondary lesions, as we call them. You may\\nhave some trouble in a viscus somewhere, and knowing that 3 ou have afferent\\nfibers from the viscus back to the center, you can account for the center being\\naffected, and the impulse coming out from it to the posterior spinal nerves, for\\nexample, and causing contracture of the muscles in the back. I have already\\nsaid enough to show you the importance of the splanchnics to show you in\\ngeneral their nature and function. They become still more significant to the\\nOsteopath when he considers their connections with the other parts of the\\nsympathetic system. In the first place, they must be connected with the spinal\\ncord itself, since they arise from the anterior roots, and, through the cord, with\\ntiie brain. It is doubtful how close a connection they have with the brain\\ncenters, but they have at least a close connection with the bulbar center, the\\nvaso constrictor center of the medulla. Then it is probable that these splanch-\\nnic have a close connection also with cardiac and pulmonary fibers arising from\\nthe upper part of the spinal cord; because we have seen that the center for\\nthe lungs extends from the second to the seventh dorsal, and that we work in\\nthe upper dorsal region for the heart, and there are certain vaso motor fibers\\nfrom these regions to the heart aid lungs, so that it is almost undisputable that\\nthere is a connection between the splanchnic and what we might call other\\nsplanchnics for the heart and lungs. In ihe next place, we have seen that the\\nfirst two splanchnic nerves join the semilunar ganglion, and third the renal\\nganglion. And they are connected directly with the solar plexus, and through\\nit with the other great prevertebral plexus, the hypogastric plexus, and\\nthrough that with those little secondary plexuses, such as the superior and\\ninferior mesenteric, hemorrhoidal, portal, Auerbach s and Meissner s, and the\\nvarious plexuses throughout the pelvis and elsewhere Hence, an5^one who\\nsees the significance of osteopathic work will see the significance of this far\\nreaching connection with visceral and organic life. Then, again remember,\\nthat in the thorax the first or greater splanchnic sends branches directly to the\\naorta itself. Hence it is that the operator so frequently works upon the\\nsplanchnics; it does not make any difference what kind of trouble you may have,\\nyour general health is likel}^ to be affected, and it must be attended to; and", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0122.jp2"}, "123": {"fulltext": "RKGULATIVK KFFECT OF WORK UPON THE SPI.ANCHNICS. II7\\nwhether you are working upon the stomach, liver, portal system, upon the\\nintestines, or pelvic viscera, you will work, at least in part, upon the splanch-\\nnics.\\nThere is a second sense in which we must consider the use of these splanch-\\nnic nerves, and we may state the matter this way: That work upon the\\nsplanchnic nerve is frequently a regulative process. I might illustrate what I\\nmean by that. Here you have a set of sympathetic nerves, they are vaso-motor\\nnerves for very important parts of the body, viz: the internal viscera, which\\nreceives an exceedingly large blood supply. If the osteopathic ability to work\\nupon the nerve centers and nerve connections stands for anything, it must ecr-\\ntainl}^ stand for something^ when it goes to work upon these splanchnics Hence,\\nhe must have a large control throughout a great portion of the circulation of\\nthe body since it is so richly supplied from these nerves. Here you have a\\nquantity of blood in the body; we will say in a certain case it is unequally di-\\nvided. The Osteopath s work is sometimes to equalize the circulation through-\\nout the body. In case you have a headache, which is frequently a congestion\\nin the cranium, what do you wish to do? You wish to regulate the circulation.\\nYou must therefore employ some regulative process, and very frequently we\\nwork upon these splanchnics to throw this congestion somewhere else where it\\nwill do no harm. Another thing, the most natural place for the overplus of\\nblood to go is in the abdominal veins. Green makes the statement that the\\nabdominal veins are the most easily dilated, and while I cannot exactly quote\\nfrom him, I belie v^e he goes on to say that the overplus of blood is most read-\\nily thrown there. At any rate I can state it is my experience that we can get\\nimportant results by throwing the congested blood to the abdominal veins, and\\nwe do cause another congestion there. Not long ago I had a case of headache;\\nit came from prolapsus. The lady had vomited, and had had trouble with her\\nstomach and trouble generally. I gave the usual treatments, as I always do\\nfirst, working about the region of the stomach and liver and over the splanch-\\nnics, as it looked as if the case at first might be a case of sick headache, later\\nshe told me it was from prolapsus. I then treated all about her head, but the\\nheadache did not go until I finally pressed deeply over the region of the solar\\nplexus. By deep pressure there until you can feel the pulsation of the abdom-\\ninal aorta, you will get important results verj^ frequently. In other cases I\\nhave relieved headache by simply pressing there. Now, whether that was\\nsimply inhibition over the solar plexus, and thus to the brain, and thus quiet-\\ning the painful senses, I could not say, but it looks to me more likely that it\\nwas a regulative process which inhibited the solar splanchnic and allowed the\\nblood to couiC to the veins of the abdomen, and thus relieved the congestion in\\nother parts. There is another thing that I frequently notice in my practice,\\nthat is I get effects upon the circulation of the body by a general spinal treat-\\nment, which of course involves work upon the splanchnic region. And I can,\\nby working there, coupled with the usual treatment I give the heart, get better\\nresults in quieting the pulse than I can by other methods. It seems to me it is", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0123.jp2"}, "124": {"fulltext": "Il8 LANDMARKS FOR THE THORAX.\\nbecause I get a dilation of the vessels in general throughout the abdominal\\nviscera, hence lessening of the tension and slowing of the blood flow follows,\\nand a quieting of the pulse. A case of the same kind might be mentioned\\nwhere a congested uterus was relieved by work over the splanchnic region.\\nHow we reach and treat that region I will show you in detail in the third part\\nof the lecture.\\nIn line with what I have stated, Howell s Text Book says that vascular\\nchanges produced reflexly in the splanchnic area are of especial importance be-\\ncause of the great number of vessels innervated through these nerves, and the\\ngreat changes in blood pressure that can follow dilation or constriction on so\\nlarge a scale. Someone asked me some time ago how we worked to cure a\\ncold. I told him that was a matter of general treatment which I shall take up\\nlater. However, we give a spinal treatment, drawing the congestion from the\\npart affected, which is very frequently the head, and give relief. That is, we\\nwork upon a large amount of blood controlled by the splanchnics, and thus\\ndraw it away from the congested part. We thus see that it is a very probable,\\nand, in view of the facts it is quite likely the case, that the Osteopath can al-\\nmost at will throw large quantities of blood to the abdominal region, or away\\nfrom it, by proper treatment. I might state in passing that it is a principle of\\nwhich we might take notice, that in a case of congestion it is a good plan to\\ndivert the congestion to some other part where it will do no harm. We stated\\nthe other day when the ma ter was brought up that the way to treat it was to\\nsweep it out by freeing the arterial blood flow to the part. I am indebted to\\nDr. Conner for the suggestion that it is well to divert the congestion to a part\\nwhere it will do no harm. saw him treat a case some time ago, an old ladv\\nwith a very troublesome cold in her head, which gave her headache and caused\\nher a great deal of trouble. She had been treated for some bronchial trouble,\\nand the pain had left the upper part of the chest and she thought the conges-\\ntion had been forced into the head. Several had treated the case unsuccess-\\nfully. Dr. Connor just came in and raised the clavicle and twisted the arm a\\ntime or two and went out. I saw him later in the hall and asked him about it.\\nHe said I just lifted that clavicle and sent the congestion do^vn the arm where\\nit would do no harm. I think we very frequently use the method and throw\\nthe blood somewhere else, but when it is thrown somewhere else I do not\\nbelieve it is congestion. Howell s Text-book says further: Anemia or\\nasphyxia of the brain stimulates the cells composing the center, that is the\\nvaso-motor center, and more blood enters the cranial cavity whce it is needed.\\nDoubtless the splanchnic area plays an important part in this restoration pro-\\ncess. Hence we see from that, in the first pia-^e that the Osteopath may by\\nhis appropriate methods influence the blood in the splanchnic area by work\\nupon the vaso-motor area in the medulla And since it is a poor rule that will\\nnot work both ways, he can do the reverse. That is, he can affect blood flow\\nin the head by work upon the splanchnic direct. Our conclusions may be ex-\\npressed under two heads: First, that in work upon the splanchnics the Ostec-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0124.jp2"}, "125": {"fulltext": "I^ANDMARKS. EXAMINATION OF THK THORAX. II9\\npath works upon them for the effect that it gets upon the connected viscera\\nsupplied by those splanchnics. That he works upon them in a secondary man-\\nner frequently for regulation of blood currents to the body generally or in\\nsome particular part of the body.\\nII. Landmarks: (According to Holden:) Since the heart and lungs\\nare contained in the thorax, and since abnormalties of the parts of the thorax\\nmay cause serious troubles with these important viscera, and since the Osteo-\\npath finds so many things upon which to work about the thorax I hardly need\\nto say to you that it is important that we know the landmarks of the thorax\\nthoroughly. I have given you some in connection with the spine, but you will\\nnotice the following: As a rule the right side of the chest is a little larger\\nthan the left and you should bear that in mind in making your examination.\\nIn the female the sternum is shorter and the upper ribs are more movable, and\\nthe upper aperture of the the thorax is on a level with the second dorsal verte-\\nbra, is quite narrow, rarely exceeding two inches. Behind the first bone of\\nthe sternum there is no lung tissue. The left vena innominata crosses behind\\nthe sternum about an inch below the top. Next come the great primary\\nbranches from the aorta. You get deeper in this region the trachae bifurcation\\nat about the level of the junction of the first and second parts of the sternum:\\nand deepest of all lies the oesophagus. On the bifurcation of the trachea and\\nabout an inch below the upper margin of the sternum lies the highest part of\\nthe arch of the aorta, which curves on over the left bronchus. The course of\\nthe innominate artery corresponds to a line drawn from the middle of the junc-\\ntion of the first and second bones of the sternum to the right sterno-clavicular\\narticulation. All these are interesting to know. Here is something that is ab-\\nolutely essential to know:\\nRules for counting the ribs: In passing your fingers down the sternum in\\nfront you can readily detect where the first part ends and the second part begins.\\nHere is the junction of the cartilage of the second rib with the sternum. The\\nfirst rib is found by feeling behind the clavicle above. You can by deep pressure\\ncome to the first. The first and second ribs give a great deal of trouble, and it\\nis important to keep in mind this rule to find them. In the male the nipple is\\nusually between the third and fourth ribs, three quarters of an inch external to\\nthe line of their cartilages. It is said that the lower external border of the\\npectoralis major corresponds in direction with the fifth rib, that a horizontal\\nline drawn from the nipple right around the body will cut the sixth intercostal\\nspace at a point midway between the sternum and the spine. When the arm is\\nraised the highest visible digitation of the serratus magnus corresponds with\\nthe sixth rib, and the seventh and eighth digitations correspond with the\\nseventh and eighth ribs below. I have already noted that the scapula lies on\\nthe ribs from the second to the seventh inclusive. The eleventh and twelfth\\nribs are readily recognized, even in fleshy persons, at the outer edge of the erec-\\ntor spinae, sloping downward. The sternal end of each rib, of course, as you", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0125.jp2"}, "126": {"fulltext": "I20 EXAMINATION OF THE THORAX.\\nknow, is lower than the end which joins the spine, and it is said that if a hori-\\nzontal line w^as drawn from the middle of the third costal cartilage at its junc-\\ntion with the sternum, it would touch the body of the sixth dorsal vertebra.\\nThe end of the sternum is upon a level with the tenth dorsal vertebra, its\\nlength varying some in different individuals, more in females than in males.\\nIII. (a) How TO Treat THE SPI.ANCHINCS. (b) How to Examine the\\nThorax: There are various ways in which we may treat the splanchnics.\\nOne of the best ways to treat the splanchnics, especially the renal splanchnic,\\nis to have the patient on the back, everything being relaxed. If you are afraid\\nthat the psoas muscles will not be relaxed, you can raise the limbs, and then\\neverything will be. And then, by reaching under and raising the patient on\\nthe tips of the fingers, we get one of the most important effects upon the splanch-\\nnics, especially the renal splanchnics. Dr. Harry treats in that way almost en-\\ntirely for the kidneys. We may also treat the splanchnics by having the pa-\\ntient on the side and springing up the spine all the way along the region of the\\nsplanchnics. Also, one way you can work is by loosening up all of these mus-\\ncles, or you might have the patient upon the face and work as I have already\\nshown you, and this, restricted particularly to the splanchnic region, will stim-\\nulate the splanchnics. There is one more important way in which we reach\\nthe splanchnics, and it is something we apply usuall}^ to the treatment of the\\nliver, which of course must be done directly over the splanchnics. In treating\\nthe liver I alwaj^s end up in this way, reaching over with the left hand I get it\\nagainst the angles of the right ribs, bent in this way to make a fulcrum of the\\nhand. Then, having hold of the arm of the patient just below the elbow, I\\npush it up and back and near the head and then backward; that raises the ribs,\\nand of course it gets an effect also upon the splanchnics, that is directly; it will\\nalso act mechanicall} in freeing the ribs here and give the liver more space in\\nwhich to work. Once more as to how we can reach the splanchnics in front.\\nThis is the motion I use just here at the front; deep pressure until you can\\nfeel the abdominal aorta. It is apt to hurt some patients quite a little, you\\nwill have to be ver} careful, some it will not hurt much, and if you do it gently\\nand have quite a prolonged pressure there, you can often get the most astonish-\\ning results. It is said also that this pressure treatment here is very good to\\ncondense gas in bloating of the abdomen.\\nAs to the examination of the thorax, it is quite a long question, and I will\\nhave to let some of it go over until the next lecture, but I might call your at-\\ntention to the importance of making very careful examination of the thorax.\\nIn examining the thorax you should have the patient lying flat upon his\\nback. First, remember that the right side is usualh a little larger than the\\nleft. You should by inspection, next the skin if possible, see that both sides\\nare about the same size that one does not bulge more than the other. You\\nwill find important changes in the shape of the thorax. For instance, I saw a\\ncase of enlargement of the heart from cigarette smoking; there was a percepti-\\nble bulge in the precardial region. In another case of asthma, I saw quite a", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0126.jp2"}, "127": {"fulltext": "EXAMIRATION OF THE THORAX. 121\\nbulge Upon the right side under the region of the upper ribs. Also see that\\nwhen the patient is standing the thorax is in shape; that is, that one side is\\nnot dropped more than the other. Sometimes we will find one side of the thor-\\nax dropped. It is proper in making your examination, especially by palpita-\\ntion, to put both hands upon the part, so that you involuntarily compare the\\nparts. If I were examining this thorax upon the leftside particularly, I would\\nput my left hand upon the side opposite, so that I could compare the parts as\\nI work over it.\\nOf course to examine in front and behind. Then you put your hand over\\nthe surface of the skin to detect any departure from the normal temperature.\\nI have already noted the importance of that in examination of the liver; in\\nconditions resulting from diseased liver it is said that very frequently cold spots\\nare found upon the surface of the body. However, you will have to be a little\\ncareful on a warm summer day, a person being in a state of perspiration the\\nskin will cool very rapidly. You should observe the shape of the thorax\\nwhether the general shape be normal. In an infant yon will find it cylindrical,\\nIn asthma and emphysema you will find the characteristic barrel-shaped chest.\\nIn what is known as the paralytic chest the antero-posterior diameter is lessen-\\ned and the chest is flattened. I have -already mentioned that to you in cases of\\nneurasthenia, The rachitic chest is flattened upon the sides. Also look olOvSely\\nat the sternum. It may be abnormally protruded or retracted, or there maybe\\nmalposition at the junction of the first and second parts, and the ensiform ap-\\npendix may be deflected to one side.\\nFinally, look at the clavicle and the coracoid process. You know where\\nto find the coracoid, on the front part of the shoulder at the origin of thecoracc-\\nbrachialis muscle. It is easily found. Sometimes fibers of the deltoid get caught\\nbelow it, sometimes fibres of the brachial plexus. The clavicle ma}^ be up or\\ndown at either extremity. You will acquaint yourself with the normal feeling\\nhere at the junction of the clavicle with the scapula and will readily detect when\\nit has slipped up or down. You can also see if it has slipped down by seeing\\nwhether it is close to the coracoid process at the scapular end, you will recog-\\nnize whether it corresponds with the normal. At the upper part of the ster-\\nnum, the clavicle sets up quite prominently. It may slip down or be too high\\nup, and you must learn to look for these things carefully.\\nLECTURE XX.\\nAt the last lecture I considered especially the sp.anchnic nerves, showing\\nyou their origin, that they arise from as high as the third dorsal down to ^hc\\ntwelfth; that they were composed, largely at least, of white medullaied hoers.\\nthat they were closely connected with the cord, since they arise from the spinal\\nnerves themselves, and wnth the various viceral plexuses, also, which rule or-\\nganic life; that they were extremely important in the work of the Osteopath,\\nand that since the oreneral health was so often involved in the troubles of the", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0127.jp2"}, "128": {"fulltext": "122 LANDMARKS OF THE THORAX.\\nviscera, therefore he worked upon them very frequently; the fact that he work-\\ned usually directly for the benefit of the action he would get up on abdominal\\nlife, and that also he frequently worked in a regulative way, using the splanch-\\nnics for vaso-motor control largely, thus influencing large quantities of blood\\nand drawing them from parts of the body where a congestion may have existed.\\nI spoke in general also concerning congestion, and the way we treat it. I also\\nbrought out certain landmarks concerning the thorax and certain points in ex-\\namination of the parts of the thorax. I wish to continue that subject today.\\nI. Landmarks of the Thorax: After Holden: The interval below\\nthe clavicie is the sub-clavicular space between it and the upper margin of the\\npecloralis major and the deltoid externally, and is important as a guide to us\\nto find the coracoid process. By drawing the arm up and backward in this\\nway thus tensing those muscles we can find the subclavicle space, and at the\\nouter part near the shoulder, we can find the inner side of the coracoid\\nprocess. Also that space corresponds in direction to the direction\\nof the axillary artery,^ we can feel it pulsing there, and can compress\\nit against the second rib. The internal mammary artery runs perpendicular\\nto the cartilages of the ribs, and about half an inch external to the margin of\\nthe sternum. Its perforating branch at the the second intercostal space, is the\\nchief one. It becomes important for us Osteopaths in examination of the heart\\nto know just what its topography upon the chest wall would be. The follow-\\ning description of the outline of the heart on the chest wall is given:\\nThat the base corresponds to a horizontal line drawn from the third costal\\ncartilages, their upper border, extended a half inch to the right and an inch to\\nthe left; that the apex is found by measuring one inch internal and two inches\\nbelow the nipple, this point being between the fifth and sixth ribs; that the\\nlower margin ma^^ be outlined by drawing a line from this point of the apex;\\nbulging slightly downward to the end of the sternum, the xiphoid cartilage\\nexcepted, that line extended as far as the right edge of the sternum; that the\\nright border would therefore be indicated by a line joining a point at the right\\ninferior extremity of the sternum with a point on a level with the cartilages of\\nthe third rib, extended half an inch to the right, while on the left the border\\nwould be indicated by a line drawn from the left extremity of this line at the\\nbase, an inch from the sternum on the level with the third costal cartilage down\\nto the point which indicates the apex. In that way 3 OU would get the outline\\nof the heart upon the chest wall. It is said that a needle passed into the third,\\nfourth and fifth intercostal spaces on the right side just next to the sternum,\\nwould perforate the lung, pericardium, and the right auricle. A needle passed\\ninto the second interspace would perforate the aorta at is greatest bulge; also\\nthe part of the percardium which is reflected over the first part of the aorta.\\nAnd that a needle perforating the first intercostal space on the right of the\\nsternum would enter the superior* vena cava.\\nThis rule is given for finding the extent, or outlining in general the dull-\\nsounding space in the percardial region made by the presence of the heart; take", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0128.jp2"}, "129": {"fulltext": "EXAMINATION OF THE THORAX. 1 23\\na point midway between the nipple and the sternum, a point midway for your\\ncenter, and describe about that a circle with a diameter of two inches, and that\\nwill include practically all of this dull -sounding region over the heart.\\nThe apex of the heart, as you know, beats between the fifth and sixth ribs.\\nIts impulse is readily felt there, but that is not an invariable place to find it.\\nYou can change the position of the heart by changing your position. You\\nmay cause the heart to deviate from its usual lucus by turning from side to\\nside. In deep inspiration the heart may descend somewhat, so that when you\\nhave taken a deep breath you may feel the beating of the heart over the pit of\\nthe stomach. That is, you can get the impulse at that place.\\nAs to the valves of the heart and their location externally: The aortic\\nvalves are located behind the third intercostal space close to the left border of\\nthe sternum; the pulmonary valves at the junction of the third costal cartilage\\nwith the sternum, on the left; the tricuspid valves are on a level with the car-\\ntilage of the fourth rib just behind the middle of the sternum, and the mitral\\nvalves are at the third intercostal space, about an inch to the left of the ster-\\nnum. Since the valves are close together they are readily covered by the tip\\nof the stethoscope, or what is better for our use, by the ear. And since they\\nare covered by a small amount of lung tissue you can hear the heart better\\nby having the patient hold the breath while you listen to the beating of the\\nheart. For the resaon that these valves are so close together it is better in try-\\ning to distinguish the sound from each, to go out a little way in the direction\\nof the current from the valve. Thus, in sounding the aorta valves, you would\\ngo to the second intercostal space, just at the right edge of the sternum. For\\nsounding the pulmonary valves, you would go to the second intercostal space at\\nthe left edge of the sternum. To sound the tricuspids you would take the\\npoint at the end of the sternum just behind the middle, and to observe the\\nsound of the mitral valves you would listen at the apex of the heart. That is\\naccording to the direction that the blood takes.\\nFor finding the outline of the lungs upon the chest wall: You know that\\nthe}^ rise above the clavicle an inch and a half, or in some cases two inches:\\nthat there is very little lung tissue behind the first part of the sternum; from\\nthe sternal articulation down to about the second rib, the anterior edges of the\\nlungs converge. From the second to the fourth they are close togetner in the\\nmedian line, quite close, also about parallel. Below this point their course on\\nthe different sides is different. On the right side it follows down along the\\ncourse of the sixth costal cartilage. On the left it is notched for the heart,\\ndescending bacK: of the heart. On the left side it descends as far as the lower\\nborder of the fourth rib, which it follows. It reaches a line drawn perpendicti-\\nlarly from the nipple, at the lower edge of the sixth rib. In the axillary re-\\ngion on each side it is found at the lower edge of the eighth rib, and behind, ex-\\ntends as far down as the tenth rib. Of course in the deep inspiration it des-\\ncends still lower.\\nII. Examination of the Thorax. (Coutiutied.) I began to take up", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0129.jp2"}, "130": {"fulltext": "124 EXAMINATION OF THE THORAX,\\nthis examination at the last meeting. I wish first to give you some points\\nconcerning the divisions of the thorax, which, while they are not of so much\\nuse to us as Osteopaths, as we do not divide the thorax into such spaces in our\\npractical work, I thought it best to describe them to you for the sake of your\\nunderstanding them when you come across them in your reading, so that you\\nwill know what is meant by the mammary region, the scalpular region, etc.\\nThis division is the one adopted by Loomis. He divides the chest first into-\\nthree general regions, the anterior, lateral and posterior. The area on the an-\\nterior aspect is again divided: The supra-clavicular portion is that in general\\njust above the clavicle. The clavicular portion is that corresponding to the\\ninner three fifths of the clavicle, and is bounded by that bone. The infra-clav-\\nicular space extends from the lower border of the third rib; internally it is\\nbounded by the edge of the sternum, and externally by a perpendicular line\\ndropped from the junction of the middle and outer third of the clavicle. Next\\nbelow comes the mammary region, extending from the lower border of the\\nthird rib to the lower border of the sixth rib, extending inward as far as the\\nedge of the sternum, and outward as far as the last described. Next, as for\\nthe sternal region: There is the suprasternal region, which he describes as the\\nregion just above the sternum. The superior sternal region is that portion be-\\nhind as much of the sternum as lies above the inferior border of the third rib\\nand the inferior sternal region, that behind the rest of the sternum.\\nOn the posterior aspect we have three regions: The supra-scapular and\\nscapular, corresponding to the space from the second to the seventh ribs inclu-\\nsive, and corresponding respectively to the supraspinatus and infraspinatus\\nfossae of the scapula extending inward in this region as far as the inner or spi-\\nnal edge of the scapula and extending outward as far as the axillary region. The\\ninfrascapular region extends from the lower angle of the scapula and the sev-\\nenth dorsal vertebra down to the lower margin of the twelfth rib; extending\\ninternally in this Case to the spines of the vertebra and externally to the infer-\\nior axillary region, There is also an interscapular region, one on each side,\\ncorresponding to the space between the second and sixth ribs, and between the\\ninner or spinal edge of the scapula and the spines of the dorsal vertebrae.\\nSpeaking, by the way, of listening to the sound of the aorta, it is also heard in\\nthe posterior region of the back from the third down to the ninth dorsal ver-\\ntebra.\\nLaterally we have the axillary space, bounded above by the axilla, and be-\\nlow by a line projected from the mammary space, that is, from the inferior\\nborder of the third rib. Then we have the infra- axillary space extending from\\nthe axillary space above down to the lower margin of the i2th rib; bounded in\\nfront by the infra-mammary region and posteriorly by the infra scapular region.\\nYou know already as far as practical for our work the contents of these\\ndifferent regions, especially when studied in conjunction with the points I have\\nalready given you in these landmarks. As I said, I give these general regions\\nto you, not to detail the parts found in them, but so that y^ou will understand,.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0130.jp2"}, "131": {"fulltext": "EXAMINATION OF THE THORAX. 1 25.\\nwhen an author speaks of these general regions, what he is speaking of. You\\nare of course aware that in making a physical diagnosis, of which our method\\nlargely consists, and which our medicalfriends seem to leave out in a great\\nmany instances, we use auscultation, inspection, percussion, palpitation and\\nmensuration. In our examination we want to hear and see all that we can\\nthat is going on about the human body, especially in the way of examining and\\nmaking out things which have caused a departure from the normal. I men-\\ntioned certain points at the last lecture in relation to the chest. There is\\nanother point that I wish to speak of which is important in our practice, and,\\nthat is the movement of the chest as to whether the two sides correspond,\\nwhether one side is restricted in movement as in the case of pneumonia or\\nwhether the inferior ribs are drawn in as in some cases of asthma, where I\\nhave seen them drawn in extensively. Also note whether or not the action of\\nthe opposite side is normal or increased to compensate for lack of normal on\\nthe other side. It is taken as a very good sign of tuberculosis if there is a\\ndepression in the infra-clavicular region. A great deal more might be said\\nabout these different methods of physical diagnosis, but it is hardly the place\\nhere to go into them extensively. In considering palpation, that is the ex-\\namination on the surface with the hand, I brought up certain points last time-\\nWe should not only touch both sides of the thorax in making the examination,\\nbut we should touch with equal force and touch in the same place each time,\\nand you need not lay your hand on heavily, lightly is sufficient. Auscultation\\nand percussion are by far the most important methods in dealing with the chest,\\nespecially since il contains the heart and lungs, and to get a good idea how the\\nheart and lungs are behaving we must listen to them directly and also listen to\\nthem by percussing the region in which they lie. The authors, of course have\\ndifferent methods of bringing out these points. I have been reading Loomis\\nand he seems to have some very good points. Of course they all make this\\nstatement, that percussion is either immediate or mediate. Immediate percus-\\nsion or direct tapping upon the part is the old method and is very little used\\nnowadays. The mediate style is the one used most, in which you use a little\\nrubber tipped hammer ot some sort as you percuss, and what is known as a\\npleximeter placed between the hammer and the part sounded. This is very\\nrarely used. It is stated by some authors that we have as good instruments as\\nnecessary, the middle or index finger of the left hand being the pleximeter and\\nthe fingers of the right hand being the hammer. There are certain simple\\nrules that we may adopt in using this method of physical diagnosis. First, it\\nwill be of little value to you to find a difference in sound unless both sides of\\nthe chest or of the part of the body which is being examined are similarly dis-\\nposed, so that one is not in a higher plane than the other. You must be ex-\\ntremely careful of the position of the patient. Then, also, j^ou should have the\\nparts slightly tensed. For instance, in examing the chest the arms should drop\\ndownward and the head be thrown back. If you are percussing the axillary\\nregion have the arms lifted. If you are percussing the back have the patient", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0131.jp2"}, "132": {"fulltext": "126 EXAMINATION OF THE THORAX.\\n:Stoop over slightly so as to bring tension on the part percussed. That should\\nbe done evenly; a patient should not have one arm down and the other over the\\nhead. The condition on each side should be similar. It is well to make the\\nexamination directly upon the skin, or if that is not practicable make it upon\\nsome thin, soft cloth spread over the chest, of such a nature that it will not\\ninterfere with the sound. You should, of course, percuss equally on each side,\\nand in case of the lungs you should take it at the same stage of respiration,\\nthat is, you should not tap on one side while the patient is inhaling and on the\\nother side while the patient is exhaling You should have an equal pressure\\nwith the pleximeter finger and an equal forcibleness of the striking hand,\\nt)ecause you can make the sound different by striking harder on one side or by\\nby holding the hand more loosely against the surface you are examing The\\nbest percussing motion comes from the wrist and not from the whole arm, and\\nin general tap lightly for an examination of the superficial parts and more\\nforcible for parts more deeply located.\\nIn the practice of auscultation the same general rules will apply, you have\\nthe immediate in which you apply the ear directly to the part, or 5^ou have the\\nmediate in which you use some instruement as a stethoscope. The authors\\ndiffer a great deal as to whether a stethoscope should be used. Loomis is par-\\nticular that it should be used in examining the heart but does not care much for\\nit in examining the lungs Rane, whom I sometimes read, says he prefers in\\nall cases the use of the ear alone unless considerations of cleansiness make it\\nconvenient for the use of the stethoscope. If you are examing the chest and it is\\ncovered see that the covering is a thin soft cloth, a towel will usually do, some-\\nthing that will not interfere with the sound. See that your patient is in a\\nproper condition with both parts disposed alike, and give your full attention\\nto the sound itself. The ear should be evenly applied in each case alike, not\\nforcibly but firmly. You should listen to the corresponding parts and in\\ntouching you should touch over the corresponding parts, for instance it would\\nnot do to tap over a rib on one side and over the interspace on the other. You\\nmust examine the corresponding parts, no matter how you do it, and then,\\nx)f course, especially in respiration, it is better to examine under condition as\\nnearly normal as possible, have the patient breathing quietly and in a natural\\nway.\\nI mention these things to you more for the sake of a hint of what there is\\nin the subject and what there is for you to study, since it is quite a complex\\nsubject to go in detail oyer the different sounds that you will hear, and to do\\nso would probably confuse you more than elucidate the subject. Also it is\\nvery difficult to show these things Avithout clinic material, and you can onl}^\\nlearn them by practice. You should become perfectly familiar with the sound\\nof the normal parts both on auscultation and percussion, and then you will note\\n-any departure from the normal when you come to make examinations, and\\nalso to distinguish the different abnormal sounds one from another. However,\\ntiis is quite an important subject. I would advise you to become familiar with", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0132.jp2"}, "133": {"fulltext": "HOW TO EXAMINE FOR DISPLACED RIBS. 12 J\\nthe instruments that you are ^oing to use. I do not think it is generally\\nrecommended that the Osteopath should use a stethoscope. That is a matter of\\ntaste. The way is to get familiar with the sounds by the ear if you are going\\nto use the ear, or familiar with a certain stethescope, as the sounds vary with\\ndifferent instruments.\\nIII. How TO Examine for DispIvACEd Ribs. I examined the different\\nparts of the thorax at the last time. In the first place, I need hardly to remind\\nyou that in variations in the spine, any abnormal curve in the spine, either\\ncurvature or departure from the normal curves, will tend to alter the normal\\nposition of the ribs. So that in examining the spine if you find that the parts\\nare not in normal position, of course you will at once look for dislocations in\\nthe ribs corresponding with the affected part in the spine, to see whether or\\nnot the affection has extended that far. You may find a general alternation in\\nthe shape of the chest, as for instance the flattening in the paralytic chest in\\nits anter-posterior diameter; or flattening in lateral in rachitis, or bulging or\\nbarrel shaped chest in asthma or emphysema. Of course you will then see at\\nonce that there is a change not only in the thorax in general but in the parts\\nnecessarily, and that you will probably find that the ribs are misplaced. To\\nexamine and replace subluxated or displaced ribs is one of the most important\\nparts of our practice, not only because it occurs so frequently, but because it is\\nvery troublesome. They often cause serious trouble and are hard to locate in\\nsome in. ,tances, they will require your very careful attention. We might ex-\\nplain why it is that ribs when displaced cause so much trouble. I think the\\ntheory already advanced will explain that as far as it goes, that is, parts out of\\nthe normal, whether they be ribs or vertebrae, will bring pressure in some cases\\nupon structures such as nerves and blood vessels; in other cases they would\\ndrag ligaments across important structures. In other cases they may result in\\ncontractures and that will be followed by other results already noted. So in\\nexamining a spine and the chest particularly you should examine each rib. I\\nhave already given you the rules lor counting the ribs, and having found\\nwhere each rib is you should examine each rib in particular. It is said where\\na rib is displaced you will very likely find tender points along its course. Dr.\\nMcConnell says that usually there is a tender point at the spine where it is dis-\\nplaced, another about the middle region and another at the anterior end. You\\nwill also find cases where they are sore almost all the way along, especially the\\nanterior half.\\nThe ribs may be pressed together behind and separated in front. In\\ngeneral you will look for the soreness over the rib and over the part of the\\ninterspace which is narrowed. I have found that to be so in my experience at\\nleast. The displaced rib may be separated from one rib, which naturally\\ncauses it to be approximated to some other rib, and you will judge which it is\\nby finding the widening above and the narrowing below, for any one rib or any\\ngroup of ribs. Then your rib may be changed, not being slipped up or down,\\nbut may be twisted so that you will find that edge is more prominent, and in", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0133.jp2"}, "134": {"fulltext": "128 EXAMINATION FOR DISPIvACED RIBS-\\nthis case it is very common to find the under edge the most prominent. The\\nbest method that I have found to examine whether the ribs are separated is to\\ntake the tips of the fingers and follow down the course of the intercostal spaces.\\nYou can then learn, knowing the normal, whether or not these parts are too\\nmuch separated or too close together; you will also note whether or not they\\nare not twisted. Sometimes the cartilages will be distorted, and in that case\\nyou will find an irregularity and a tenderness along them. Thej^ may be\\ntwisted or ma}^ have been torn and grown together. I have seen several cases\\nin which the cartilage had been broken away from the tenth rib and the person\\nliad three floaters on each side instead of two. It is said to be a fact that there\\nis a little weaker attachment of the cartilages to the ends of the ribs in the case\\nof the tenth than in the case of the other ribs. In examining the ribs of the\\npatient what I have said will apply to all of the ribs, but of course we must\\napply our examination to all parts of the thorax, anterior and posterior. But\\nin examining the first and second ribs you will find thai something more of a\\nconsideration. The first and second ribs, on account of their attachment to\\nthe scaleni muscles are usually displaced upward because the tendency of these\\nmuscles when contracted is to draw the ribs upward. In the first place, how\\nwould you tell whether or not this first rib is up? To find it you feel down\\nabout the middle point of the clavicle, press down and back and you will im-\\nmediately come to the first rib. You must first know that the clavicle itself is\\nin position. If its acromial and clavicular are both in situ then you can judge\\nfrom the relative position of the first rib whether it is up or down. Of course\\nthe more it is slipped up, the more it tends to come on the level with the upper\\nridge of the clavicle, or if it is down it will widen the space between them.\\nThat is one of the best ways of determining by examination whether it be up\\nor down. The second rib is somewhat more difficult to get at. You can feel\\nit, as I noted, in the outer portion of this infra clavicular space by drawing the\\narm outward and down, tensing the muscle. You can also examine it b}^ find-\\ning the junction of the first and second parts of the sternum; follow the car-\\ntilage out, you can feel it as far as the clavicle. Note whether the points are\\nsore at the places where you can reach the rib; and by following further there\\nwill be a difference in the intercostal space, and you can tell whether the second\\nrib is up or down, but it wall require practice and I will promise you that the\\nfirst and second ribs are very hard to deal with. Just as the first two ribs are\\nusually up, the last two by some strange compensation of nature, go down.\\nAs the man said, There is compensation in everything; snow comes down in\\nwinter and ice goes up in summer. The reason why these last tw^o ribs go\\ndown, especially the last one, is that the quadratus lumborum muscle is at-\\ntached to it, and it seems to be the nature of the eleventh to follow the twelfth\\nin its course downward, I do not know just why, unless it is because it is not\\nattached by a cartilage to the others above, and is free to follow the other.\\nThe position of these ribs is very readily ascertained even in a fleshy person.\\nIt will take considerable dexterity of touch to accustom you to find them, but", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0134.jp2"}, "135": {"fulltext": "MANIPUI.ATION OF THE CLAVICLE. I 29\\nby patience you can do it. Of course any of these ribs may not only be slip-\\nped up or down, but one may overlap the other. I saw a case the other day\\nin which the tenth was overlapping the eleventh quite prominently. Then,\\n3^ou may find that these last two floating ribs instead of being down may be up,\\nand the twelfth my be pushed up under the eleventh. In that case they often\\ncause trouble, but they may sometimes be down without any trouble at all, in\\nwhich case it will not be necessary for you to bother with them.\\nI wish to tell you how to set this clavicle. I noted it in the examination\\nthe last time. Suppose, in the first place, it is down. It may be down at\\neither en-d. I believe the commonest place for it to be down is at the outer\\nend. because of the attachment of the deltoid and of the pectoralis major to it\\nat the outer end. The way the Old Doctor told me to treat that is to get\\nthe fingers against the anterior edge of the clavicle near the sternal end, draw\\nthe arm then inward, across the chest, thus relaxing the ligaments and the\\nmuscles. Then push outward upon the first point that I noted, the anterior\\nedge of the clavicle, push outward, and draw the arm up backward. Thus\\nhaving relaxed the ligaments and muscles, your push will serve, on account of\\nthe peculiar shape of the clavicle, to push it on to its proper articulation. In\\ncase it is slipped up at the acromial articulation, that sometimes happens and\\ncauses a catchhing of the fibers of the deltoid, or it impinges on the fibers of\\nthe brachial plexus, the best way is to raise the arm to relax all muscular ten-\\nsion, since it is bound to the shoulder here by the deltoid party, and some of\\nthese smaller muscles; relax them in that way, and then you can get your\\nfingers in behind the part that is slipped up, and it does not make much dif-\\nference which way you throw the arm. Dr. Harry says when a joint is out\\nalmost any way you turn it, it will want to pop back where it belongs, which\\nof course is true, that is the tendency toward the normal. In case it is down\\nat the sternal end, which you find with a fair degree of frequency, one of the\\nbest ways is to thrust the thumb of one hand under in behind the sternal end\\nof the clavicle, thrust it in deeply, and then relax the muscles bj^ drawing the\\narm up and inward. Then by drawing the arm over, down and out and thus\\ntensing the muscles, it brings a leverage upon that end of the clavicle, and will\\nforce it up. Or you do practically the same thing by bringing the arm up and\\naround and making a twist in such a way as to tense the muscles In other\\nwords, this is just a system of animal mechanics whereby you study out the\\nshape of the bones, their attachments and ligaments, and attachment of the\\nmuscles, and just how to use these ligaments, bones and muscles, as levers and\\npulleys, so as to work them back into place. Now, if the clavicle is up, the\\npoint of course would be to relax again and simply force it down from above\\nby working with the thumb in behind it. Another good way to free up the\\nspace between the clavicle and the first rib is to thrust the fingers in behind\\nthe clavicle where it is always tender, and draw the arm up over the face and\\nthen on out, thus getting a very good leverage.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0135.jp2"}, "136": {"fulltext": "130 NERVE CONNECTIONS OF THE HEART,\\nLECTURE XXI.\\nAt the last lecture I took up certain landmarks of the thorax, showin g:\\nyou, among other things, what was the outline upon the chest wall of the\\nheart, where to note its valves, and where to listen to the sounds produced by\\ntheir action; that the point at which you should listen, varies from the position:\\nof the valve in the direction of the current of blood. Also I noted the topo-\\ngraphy of the lung upon the chest wall. Then I took up certain points in the\\nexamination of the thorax, showing you how it was divided into the different\\nregions; then spoke concerning auscultation, palpitation, mensuration, percus-\\nsion, etc., the different methods that we use. Then I brought up the point of\\nhow to examine for displaced ribs. To-day I wish to take up more particular-\\nly the contents of the thorax, viz., the heart and lungs. They are, of course,\\nimportant to the Osteopath, and since they have so much to do with life, they\\nmust be carefully looked after. I think that the Osteopath has more success\\nthan other forms of healing with troubles in the heart and lungs. A great\\nmany troubles of the heart are not organic, and when not organic the oppor-\\ntunities for Osteopathic work are much better than when organic.\\nI. Some Centers and Nerve Connections for the Heart and-\\nLungs: There are certain facts that we come across in our Osteopathic work\\n^vhich lead us to reason about nerve action. In the first place, displaced ribs\\nwill very readily affect the heart. Sympathetic troubles, such as crying and\\nthe like, are caused by contractures along the left side of the back between the\\nshoulders, or by displacements in that region; displacements of the third,\\nfourth and fifth ribs particularly. From the fact that we can reach the heart\\nthrough the superior cervical ganglion and in the upper dorsal legion on the\\nleft side, and from the fact that there are certain centers given, as that in the\\nmedulla, and for the rhythm of the heart in the upper dorsal region, from the\\nsecond to the fourth, we naturally wish to know what is the nerve connection,\\nand why it is that working there we can get such an important effect upon the\\nheart. That we do get these effects, of course our practice shows, it is simply\\na question of fitting theories to these facts. In the first place, we sometimes\\nwork along the splanchnics, and thus get an effect upon the centers, which I\\nexplained at length in the lecture the other day. Then there is our work in\\nthe upper dorsal region. Those are the two places, except the neck, where we\\nget the most important effects. Now, as to this nerve connection between the\\nheart and the spine, Jacobson brings out the connection here very admirably,\\nin relation to infra-mammary pains. He shows how the viscera are connected\\nthrough the sympathetics, the great splanchnic particularly, connected with\\nthe spine as high as the fourth, fifth and sixth spinal nerves. We have learned\\nthat the great splanchnic may arise as high as the third also. These spinal\\nnerves send certain sympathetic branches to the aorta, from the fourth, fifth,\\nand sixth sympathetic ganglia branches are given off which form a plexus-\\nabout the aorta. This plexus over the aorta gives branches to the cardiac\\nplexus about the heart. Further, there are branches given off from the fourth,.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0136.jp2"}, "137": {"fulltext": "NKRVK CONNECTIONS OF THE LUNGS- 131\\nfifth and sixth, cutaneous branches, descending over the ribs and supplying\\nparts along the sixth, seventh and eighth ribs. Hence you have a direct con-\\nnection between the pain which you feel by means of these cutaneous nerves\\nof the sixth, seventh and eighth interspace which run in their distribution be-\\nneath the breast, in the infra-mammary region, a connection with the spinal\\nnerves and thus with the fourth, fifth and sixth spinal nerves, and through\\nthem out to the sympathetic plexuses about the aorta and the heart. Thus,\\nyou have an indirect connection between the viscera on the one hand, and the\\nheart s action on the other. You may have pains in the infra-mammary re-\\ngion caused by diseases of the heart. Hilton, himself, also states something\\nconcerning the sympathetic pains which we may feel on the surface of the\\nbody. That pains from diseased viscera, the liver or intestines, for instance,\\nare often reflected to the region between the shoulders or at the inferior angles\\nof the scapula. You can readily see how this connection takes place, between\\nthe sympathetics from the great splanchnics and those of these fourth, fifth\\nand sixth, and directed to the region of the scapulae and the region between\\nthem and about their angles. Thus we see how we may have pain in a distant\\npart of the body when a certain terminal is affected. I have, myself, noticed\\nin certain cases of trouble with the liver, where the liver was rather ten der,\\nthat I could get a pain under the scapula, especially on the left side.\\nTaking into consideration the connection between the heart and this upper\\ndorsal region, the fourth, fifth and sixth, you can see how the Osteopath, by\\nworking there, where he does very frequently to affect the heart, can get an\\neffect upon the heart, and thus upon the general circulation. I think I instance\\nthe point that by working along the splanchnics and by working along the\\nupper dorsal region, I could get important effects in quieting the heart. I have\\nsometimes quieted the heart as much as from ten to twenty beats per minute,\\nwhen it was running high by work iu this region. Thus you will see that\\nwork here upon the heart is directly upon nerve action, but we must not omit\\nto notice the fact that by raising the ribs we get a mechanical effect, if those\\nribs were so lowered as to narrow the cavity in which the heart acts. Any\\nlessening of that cavity has a tendency to interfere with the heart s beat, so that\\nby mechanically enlarging the cavity we also get an effects upon the heart. It\\nis probable also that the raising of the ribs frees pressure upon nerve connec-\\ntions along the spine.\\nFurther, as to connections in the upper dorsal region between the nerves\\nthere and the heart, Quain says, that accellerator fibres of the heart derived\\nfrom *he upper four or five dorsal nerves but chiefly from the second and third,\\nare sometimes found. The spinal fibres end and sympathetic fibres begin iu\\nthe middle and lower cervical, perhaps also from the first thoracic ganglion.\\nThat is, these fibres really come from the vSympathetics, the change of\\nfibres occuring in the ganglion mentioned.\\nHe says further, ttat vaso-constrictor fibres of pulmonary vessels have\\nbeen found in the dog from the second to the seventh spinal nerves, and they", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0137.jp2"}, "138": {"fulltext": "132 E^XAMINATIOTT OF TllJj HKART.\\nconneet in the stellate ganglion. In the dog and the cat it is said thai the low-\\ner cervical and upper thoracic ganglia are connected to form what is called the\\nstellate ganglion. While it has not been demonstrated in man that these fibres\\narise from the second to the seventh, these vaso-constrictors for the pulmonary\\nvessels, it looks probable that there are some such fibres existing, since that is\\nthe identical center upon which we w^ork to affect the lungs, the second to the\\nseventh dorsal. Howell s Text Book states that stimulation of the vagus in\\nthe neck constricts the pulmonary vessels, while stimulation of the sympathet-\\nics of the neck will dilate the pulmonary vessels; also that there is noted a re-\\nflex contraction of the pulmonary vessels by stimulation of some other nerve,\\nas for instance, the sciatic, intercostal nerves, abdominal pneumogastric, or ab-\\ndominal sympathetif^s. This will call to your mind instantly what I have said\\nconcerning regulative processes, in our work upon different parts of the bod3\\\\\\nI mentioned that particularly in relation to the splanchnics; you see the reflex\\neffect gained by stimulation of these nerves in different parts of the body and\\nits effect upon the lungs. You see how general that work may become.\\nIt is an interesting fact to note what Robinson says concerning the heart\\nand the aorta, which are directly connected with the circulator}^ system. He\\nsays that they have been noted at times to have periods of violent, rapid beat-\\ning, and that the heart itself and the aorta appears to be dilated and to be work-\\ning very forcibly; that feeling of the pulse in other parts of the body would not\\nindicate that the effect was general. Robinson says that this has been little\\nmade of in books, in fact, he does not know that it is mentioned except some-\\nthing abuut the aorta, and explains it b}- influence of one kind or another\\nwhich may affect the various local sympaihetic centers. And in case of the\\naorta he says he has seen, in case of a thin woman, it beating violently and\\nsimulating in every respect an aneurism. He explains it by saying that the\\ncenters in the substance or in the immediate neighborhood of the aorta, are in\\nsome way affected, though the effect may, of course, be dependent upon general\\ncorditions.\\nII. KxAMixATiON OF THE Heart. First, some general points as to the\\nheart. The Old Doctor explains some of his recent illness by a stoppage of\\nthe aorta at the point where it perforates the diaphragm. He sa^ s that fre-\\nquently some injury there may cause a constriction, especially if the injury is\\nof such a kind as to allow a relaxation of the usual vault of the diaphragm,\\ncausing a constriction about the point where the aorta passes through, and\\nthus constricting and restricting the blood flow. Thus, he says, the heart goes\\nto work pounding to force the blood through, and you have palpitation of the\\nheart. That is similar to effects we have in other parts of the body, where a\\nthickening of parts about an important structure would lead to troubles which\\nwere of peculiar significance to the Osteopath. So the Old Doctor wears a\\nbelt. He says that compresses the lower part of the thorax, allows the aorta\\nto bulge upward.\\nSecond, as to your examination. You must take into consideration that", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0138.jp2"}, "139": {"fulltext": "B:^AMrkAf ION OF THK HKART. 1 33\\nthe heart, being so closely connected with sympathetic life in every part of the\\nbody, is affected by general sympathetic disturbances. You may have trouble\\nalmost anywhere, in the neck or with the genital organs; and of course you\\nget an important effect upon the heart and circulation by dilation of the rectal\\nsphincters. Such a slight cause as a dropping of the acromial end of the\\nclavicle, or either end of the clavicle, for that matter, shutting down upon the\\ncirculation through the subclavian artery and vein, generally the vein, has\\ncaused angina pectoris. I knew of a very bad case where the woman was\\nready to die of heart trouble and looked about as bad as a person could look.\\nShe was cured by the Old Doctor by setting the clavicle. It was a typical\\ncase, with the radiating pains over the chest and all the accompanying symp-\\ntoms. That lady is one of our graduates now and enjoying a lucrative practice.\\nAlso the same kind of a slip may cause a periodic emptying of the innominate\\nvein, and thus lead to a loss of a beat of the heart occasionally, so that the\\nheart will be beating irregularly. So please consider that in looking for trouble\\nwith the heart, you will need to examine not only the region of the thorax,\\nbut everything that might affect the vessels coming from it. Do not forget\\nthe clavicle or the first and second ribs are apt to cause troubles of the heart.\\nThe reason seems to be that since they are usually displaced upward, they\\nbring pressure upon some of the blood vessels or interfere at che spine with\\nsome of the important nerves which I mentioned in the previous part of my\\nlecture. I do not know but that it should be as much a matter of pride with\\nns to observe a professional demeaner in our calling upon a patient, as it is with\\nour medical friends. I have gone with a student to see a patient where there\\nwas trouble with the heart I remember one case particularly, a case of asth-\\nma. I went in and felt the pulse the first thing, as I usually do; the heart\\nwas beating at the rate of 120 per minute, and the student had not noticed it.\\nIt will not be a bad idea to always note the pulse. It is, of course, an import-\\nant clue to the state of the circulation. It will tell you whether or not the\\nheart is intermitting, whether or not the heart is beating too strongly or too\\nweakly; whether or not the pulse is normal in every respect. The strength\\nof the beat you can tell, then, and the frequency and the regularity So I\\nfirst take the pulse, which is usually found best at the left wrist at the radial\\nartery; you all know how to find it. Also note the chest, the shape of it. In\\nenlargement of the heart there may be a bulging in the precardial region.\\nOr narrowing of the chest may interfere with the heart. Do not forget in-\\nspection of the chest in examination for troubles of the heart. Note also\\nby inspection and by palpation whether the apex beat is normal, occurring\\nat the interspace between the fifth and sixth ribs. Vou can, by knowing-\\nhow it beats normally, tell when it has departed from the normal, whether\\nit beat too strongh^ or weakly. Or it ma)- be displaced to one side or the\\nother by troubles of the other viscera, the lungs, for instance. Notice by\\ninspection and palpation where the apex beat occurs. B\\\\ palpation, not\\nonly at the apex but over the region of the heart, preferably with the pa-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0139.jp2"}, "140": {"fulltext": "134 EXAMINATION OF THE LUNGS.\\ntient sitting up, you can note the three points that you want, that is, regu-\\nlarity, frequency and strength of beat. It is not a bad point in examining\\nfor enlargement or encroachment of other solid viscera upon th e heart, to\\nuse percussion. It is as well to percuss next to the skin, or through some\\nsoft thin cloth. Tne best way to make a pleximeter of your left hand is by\\nlaying not the whole palm of your hand, but just the middle finger upon the\\nsurface to be percussed, and then striking it with the tips of the fingers of\\nthe right hand brought in line, or by the first or index finger. Of course\\nwhen you come to the heart you note its flat sound. I noted to you the\\nother day how to find that region, a circle drawn two inches about a point\\nmidway between the nipple and the end of the sternum.\\nDr. Sheehan called my attention to a point the other day: In making\\nthe percussion over the parts of the lungs which are most liable to be affect-\\ned in tuberculosis, make it light, because there is some danger of starting a\\nfresh hemorrhage if you use forcible percussion. Light percussion is as ef-\\nfective as is forcible. Of course this flat sound of the heart may vary, as for\\ninstance in emphysema it may become resonant. Or it may be increased by\\nsome effusion in the pericardium, or some effusion in the pleura or some\\nenlargement of the stomach upward, or by solidification of the lung, any-\\nthing that will make a larger area of the flat sound in the region of the\\nregion of the heart. By studying these things they will be an important aid\\nto your diagnosis.\\nWe also practice auscultation upon the heart, by placing the ear over the\\nregion of the heart. This is the best method of examining the heart. You\\nwill want to note the sounds of the heart particularly, and for doing that\\nyou would have to know the sounds for the various valves of the heart. Of\\ncourse there are various murmurs, regurgitant, restrictive, etc. There are\\nmurmurs tha c occur in several conditions of the heart. Sometimes there is\\na enous murmur, as in the jugular vein. It is said that by holding that vein,\\nand compressing it for a few minutes you can stop that hum. To differen-\\ntiate between it and the heart murmur, particularly that caused by friction of\\nthe heart against the percardium when it has been thickened by some in-\\nflammatory process, is difficult. It is also dif^cult to differentiate from other\\nmurmurs in the heart, and the only way is to find that this sound follows,\\nwhile the other accompanies the heart beat,\\nA great deal, I am aware, might be said about physical examination of\\nthe heart, about the analysis of these sounds, but should I go into that sub-\\nject extensively it would make a set of lectures as large as that I am deliver\\ning in general. It is only by study along those lines and by practice that\\nyou will learn both the normal and abnormal. But I brought them up for\\nyour notice, and leave them for the more important part, the Osteopathic\\npractice, which I shall consider here.\\nIII. Examination of the Lungs: We adopt the same methods for\\npercussing the different regions of the chest. For instance, if you were", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0140.jp2"}, "141": {"fulltext": "TREATMENT TO RAISE THE RIBS. 135\\nsounding here over the clavicle, you get a dull sound; while in the space\\nbelow we should get a resonant sound; over the larnyx, especially with the\\nmouth open, you get a higher sound called tympanitic. You must become\\naccustomed to these normal sounds. Anything which will cause a solidifi-\\ncation of the lungs about the tubes or thickening of the tubes themselves,\\nin fact, an accumulation, or any growth which aids transmission of sounds\\nwill change the character of these sounds, making them more resonant,\\nhigher; while the effusion of any liquid, such as blood in hemorrhage, or in\\nthe case of pleurisy the effusion of lymph or serum, or the accumulation of\\npus will also interfere with the sound and make it more dull. There is a\\ntympanitic sound found in the lung when there is a large cavity not com-\\nmunicating with a brochus; when the cavity communicates with a bronchus\\nwe get whal is called the cracked-pot sound. Our chief methods of ex-\\namining the lungs are by percussion and auscultation; these are two of the\\nbest methods. I am aware that this subject under my treatment is a very\\ndull subject to you. However, it will be a very important one and will mer-\\nit further study. If I had time and ability to go into the subject more fully\\nI would spend more time upon it. As it is I can best call your attention to\\nthe more important Osteopathic points in relation to the lungs by taking\\nup certain of the troubles which affect the lung. As for instance in asthma\\nyou may have trouble anywhere along the back from the second to the sev-\\nenth ribs, especially on the right side. It is said that the sixth rib upon\\neither sids may be displaced and cause this trouble, or if there is any pain\\nupon taking a deep breath probably the fifth rib is interfered with. There\\nalso may be an interference with the phrenic and pneumogastric nerves in\\nthe neck, some stoppage of the nerve force in those nerves will cause asth-\\nma. In case of bronchitis it is said the first, second and third ribs are at\\nfault, especially the first, or the clavicle may be displaced downward, or\\neither of the nerves I have mentioned in the neck may be impinged upon.\\nIn congested lungs you will find the best method is to work along the upper\\ndorsal region, raising all the ribs. I have at that point ver\\\\ quickh relieved\\nthe congestion in f he lungs, simply raising all the upper ribs; working be-\\ntween the shoulders.\\nHay fever is usually found in lesions from the third cervical down to\\nthe fifth dorsal; you may liave trouble either in the neck or of the upper\\nribs, or your clavicle may be displaced, or those nerves I ha\\\\ e mentioned\\nmay be impinged upon. Of course in working upon an\\\\- of these troubles\\nwhere there is probability of complication with general troubles you must\\ntake that into consideration; In relation to the lungs. Dr. Still has been\\nspeaking recently of the formation of gases upon the lungs, and that in fever\\nthe gases are formed but are not transformed into perspiration, and there-\\nfore the natural cooling process does not go on and\\\\ou have feser resulting.\\nIn fever his work is largel} upon the lungs, he says, to stimulate them lo\\naction to cause the proper combination of gases and the resulting perspira-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0141.jp2"}, "142": {"fulltext": "136 TRKATMKNT TO RAISK THK RIBS.\\ntion. In. the same way he explained the other night the cause of the abnor-\\nmal amount of secretion of sweat in cases of cnolera.\\nAs to how to raise the ribs: I brought out the points of examination for\\nthe ribs the last time. Dr. Charlie Still has the patient take a deep breath, and\\nthen by placing the fingers of one hand upon the spinal end of the rib, and of\\nthe other on the sternal end of the rib, he pushes the rib either up or down.\\nThat is one method which he uses. Dr. McConnell frequently works with his\\nknee in the back, as do also the other operators, and in that case the idea is to\\nget the point of the knee at the angle of the rib which is displaced, and then\\nyou can have one hand free to reach over the shoulder of the patient and get at\\nthe sternal end of the rib, while with the other hand you bring the arm up,\\nthus tensing the pectoral muscles and the latissimus dorsi, which are attached\\nto the ribs; drawing the arm toward the head, back and around in such a way\\nas to draw the ribs up. When you have gotten them up to their highest point,\\nthen relax the arm and let it drop, still holding the knee and the hand against\\nthe ends of the rib. Dr. McConnell, also sometimes works by getting the knee\\nagainst the back and by putting both hands against the front part of the rib,\\nespecially when you want to raise the front part. It does not make very much\\ndifference, anyway you can get tension of the pectoral muscles and the latissi-\\nmus dorsi. getting a leverage on the ribs, and having a fixed point against the\\nribs behind; no matter how you do that you will be able to move the rib.\\nThere is another way which is frequently used, and that is, the patient being\\nupon the table upon his side, you can place the knee in the back in the same\\nway, you can place one hand upon the arm of the patient, the other upon the\\nanterior end of the rib and draw the arm up and back in the same way; thus\\n5^ou can raise any one or all of the ribs. Also, as I showed you the other day\\nin treatment of the liver, you can reach across and beneath the patient, getting\\nyour fingers against the angles of the ribs and using the tension of the pectoral\\nmuscles in the same way to draw the ribs up. You will find all of those methods\\nquite simple, and the reason, perhaps, that there are so many different ways\\ndevised to raise the ribs is the fact that you have to work in so many dif-\\nferent positions, sometimes one will be more convenient, sometimes the other.\\nThis will serve to raise the different ribs. But when you come to the first and\\nsecond ribs it is a different matter. These displacements are usually upward\\nowing to the scaleni muscles being attached to them. Hence to treat them, we\\nmake use of these muscles. When these ribs are up, one good way is to bring\\nthe head of the patient toward the side of the rib affected, then pressing the\\nfingers down behind the middle of the clavicle, in that way you come to the\\nfirst rib. You can get firm pressure there and can bring tension upon it by\\npushing the head in the opposite direction, thus stretching the scaleni muscles\\nwhich are on a strain and which, are holding the rib up. Thus we get those\\nmuscles stretched and by working the head around and bringing pressure still\\nupon the first rib, you can press it downward. That applies to both the first\\nand second ribs. Of qourse, also, in case of the second rib you can get the", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0142.jp2"}, "143": {"fulltext": "TREATMENT TO RAISE THE RIBS. J 37\\npressure against the angle behind and raise it by working in the back, drawing\\nup with the pectoral muscles as before shown.\\nDr. Harry Still frequently works as follows upon the upper ribs;\\nin this way you can get your hands upon the first two ribs. He puts one hand\\nbeneath the angle of the rib and with the other he grasps the elbow of the pa-\\ntient and presses the arm down across the chest, thus springing the ribs out\\nand up, and can get quite a leverage in that way. This is very good for\\nthese upper ribs. In case of overlapping or twisting of the ribs the same\\nmotions that I have already shown you for raising or lowering the ribs will\\napply. In case you wish to treat the cartilages alone, which you must not\\nomit in your examination, it is well to work with the fingers against the\\ncartilages in front, drawing the arm up about the level of the shoulder and\\npushing if backward, you thus raise the ribs and free the cartilages, and you\\ncan work and twist out of them in that way, or work them up or down at the\\ntime. I have heard that method mentioned by Dr. McConnell.\\nAs to the lower ribs they may be up or down, or slipped or twisted in\\ndifferent ways. One of the best methods is to flex both knees, then, by get-\\nting your thumb against the point of the rib which is out, you can bring\\npressure there, with the fingers of the same hand back of the angle of the\\nrib, then by drawing the legs dqwn in this way you can get a stretching mo-\\ntion upon the muscles. In case the displacement has been downward by con-\\ntraction of the muscles, you will hold the rib up in that way and thus stretch\\nthe muscles. Or in case the rib has been displaced upward you must work\\nit down as you go by tension of the muscle in straightening of the knees,\\nand by pressure with the thumb. Dr. McConnell has the patient take a deep\\nbreath, he then, in case the rib is displaced downward, exaggerates it b}\\npressing it still further downward at the free end and upward at the spinal\\nend, and then when the patient lets the breath go he will simply work the\\npart up; he thus springs the part, gets a fulcrum by having the lung inflated\\nand allows the rib to take its natural position. You cannot always set a\\nrib at the first motion. It will sometimes take considerable attention and\\nconsiderable length of treatment to effect your object. There is also one\\nmore method which I saw Dr. Charlie Still use the other day for raising the\\nfloating ribs, or any of the other ribs. This is what you would call a quar-\\nter turn. He gets his arm under the legs of the patient and brings him\\naround until he is a quarter turned off of the table, then he swings the pa-\\ntient downward, upward, and backward, meanwhile he has kept his fingers\\nagainst the angles of the ribs, and thus by pressure of the hand worked them\\nback into place.\\nQ. Demonstrate to us the method of giving immediate relief in sexere\\ncases of asthma.\\nA. Any of the methods that I showed \\\\ou of raising these particular\\nribs on the right side.\\nO. In the case of the eleventh or twelth ribs being pressed right into\\nthe liver, would the motion you gave us bring it out?", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0143.jp2"}, "144": {"fulltext": "138 THE LYMPHATICS.\\nA. Yes sir, by relaxing the unnatural tension, no matter which way the\\nthe parts are. These motions were given to either raise or lower the ribs-\\nIn the first place, the motion of extending the limbs will, by the tension\\nbrought upon the quadratus lumborum, draw the limb down. You also, o^\\ncourse, push under with your thumb, and get it against the point of the rib\\nand work it outward as you go.\\nQ. If one lung is badly diseased would it affect the pulse on that side?\\nA. Not particularly on that side, it would probably affect the pulse in\\ngeneral, probably make it weaker.\\nLECTURE XXII.\\nAt the last lecture I considered the heart and lungs, taking up first\\nsome nerve centers for the heart and lungs, showing that the theory of our\\nwork was, first, that we work along the splanchnics, getting a general equal-\\nization of the circulation, general effect upon the heart and lungs, and fur-\\nther that we especially work in the upper dorsal region f\u00c2\u00a9r this effect. I\\nalso showed you the relation between intercostal and inframammary pains\\npains coming from the 6th, 7th, and 8th cutaneous nerves referred back\\nto the 4th, 5th and 6th intercostal nerves, these connecting with the plexus\\nabout the aorta, and also in that way with the heart; also that in the same\\nway a connection could be traced from the viscera to the spinal nerves, es-\\npecially the 4th, 5th and 6th; and explained the visceral pains referred to\\nthe surface of the body about the shoulders and between the scapulae. Then\\nI mentioned certain accelerator fibers for the heart and lungs, and took up\\nthe examination of the heart and lungs but had not time to go into the\\ntreatment of the heart and lungs. I also showed you the different\\nmethods of raising the ribs. Today, in the latter part of my lecture I wish\\nto consider the general treatment of the heart and lungs.\\nHaving previously taken up the spine, head, its parts, and the thorax,\\nwe have now come to the abdomen, which I wish to consider today. First,\\nhowever, some general points concerning the lymphatics. Occasionally\\nthe question arises in an Osteopath s mind, what is his duty in reference to\\nthe lymphatics? What can he do with them? Since they are important in\\nthe nutrition of the body, how can he gain control of them? Of course,\\nsince they have to do with nutrition, they are affected by general conditions\\nof the body. Anything which affects the general nutrition of the body will\\naffect the lymphatics, and ice versa. You find glands along the lymphat-\\nics, conglobate glands, as they are called, especially in the neck, although\\nevery part of the body is supplied with them. I have mentioned the fact\\nthat the l} mphatics are scavengers, and that if Ou note any enlargement\\nin the neck, it shows some trouble in the head. I have one case particularly\\nin mind, a case of measles followed by a serious trouble of the eyes, where\\nthese glands were enlarged, and had been so for quite awhile. Another case", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0144.jp2"}, "145": {"fulltext": "CONTROL OF THE LYMPHATICS. I 39\\nof measles with whooping cous^h had been followed by enlargement of the\\nglands. Another case I noted where an operation had been performed near\\nthe knee for abcess, it was on a cadaver that I saw it, the femoral glands at\\nthe groin were still enlarged, that being the set of glands in the course of\\nthe lymphatics which drained the lymph from the limb. Of course in ton-\\nsilitis, or septic processes, these glands are affected. It is well that is so,\\nfor they prevent the passage into the blood of this septic matter, which\\nwould, of course result in blood poisoning. In such cases I have called to\\nyour mind that you must not treat directly over the gland, but indirectly,\\nto remove the original cause.\\nAs to the direct treatment thai we get upon the lymphatics, you often\\nfind that the clavicle is down, and in such case it may stop up the opening\\nof the thoracic duct into the subclavian vein, so occasionally we have to\\nlook to see whether or not the clavicle is lowered. The first rib may cause\\nthe same trouble by being raised. A tightening of the tissues in these parts\\nmay cause a stoppage of the thoracic duct or of the right lymphatic duct.\\nLittle is known concerning the innervation of the lymphatic system. It is\\nknown that the lymphatic vessels are supplied in their middle and inner\\ncoats with involuntary muscular fibers. The physiologists tell us that the\\nflow is influenced in three main ways: First, the general muscular exercise\\nof the body, aided by the action of the valves in the lymphatics which pre-\\nvent a backward setting of the lymph, helps forward the flow. Another\\nmethod by which its flow is aided is the movement of the thorax in inspi-\\nration and expiration; the pumping motion of the chest. The third way is\\nthe vis a tergo, the force of the circulation behind the continual expul-\\nsion of the lymph from the blood vessels forcing the onward flow of the\\nlymph in the lymphatic s} stem. Of course the flow is more restricted b}\\nthe presence of the glands in the course of the lymphatics. However, it is\\nstated that there are certain nerves controlling all these lymphatics. That\\nthere are fibers in the upper cervical region which control the calibre of the\\nduct. That probably the thoracic duct itself, and the general lymphatic\\nsystem are under the control of the sympathetic system. And the recep-\\ntaculum chyli is probably under control of the splanchnics directly. There\\nis a point at the fourth dorsal called by the Old Doctor the center for nu-\\ntrition. He works there in cases of obesity, as well as in the upper cerxical\\nregion. In cases of obesity also there is frequently an enlarged cushion, you\\nmight call it, of flesh in the upper dorsal region; you will find that in all\\nmost every case where a person is extremely fleshy. It is said that the en-\\nlargement affects not onh the general condition of the body in that way,\\nbut the heart and the eyes as well, and I have frequently seen it so. Mrs.\\nPatterson, in describing the treatment of obesit} said that we treat in this\\nregion to reduce that cushion of flesh; work also at the 4th dorsal and in\\nthe upper cervical region, working along the transverse processes, alter-\\nnately stimulating and inhibiting nerve force, and thus getting an effect", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0145.jp2"}, "146": {"fulltext": "140 NERVE CENTERS AND CONNECTIONS OF THE ABDOMINAL CONTENTS.\\nUpon the thorcic duct. So that the Osteopath sometimes works directly to\\nremove some obstruction, as for instance, at the clavicle or the first rib, and\\nthen the effect that he may get through its possible nerve supply, added\\nalso to the effect that he gets by general manipulation of the body and the\\nstimulation of the lungs and the working of the parts, which would aid all\\nthe onward flow, And where the trouble with the lymphatic system is due\\nto the general condition of nutrition, there he would get his indirect effect\\nby working upon the lungs, heart, bowels, liver, kidneys, and all the excre-\\ntory and nutritional organs.\\nAs to the abdomen, we know that it is important to us from the fact\\nthat its contents are so often complicated with disease. It contains import-\\nant organs of nutrition. These organs are directly accessible to pressure\\nfrom the outside, hence it is the Osteopath works so frequently upon the\\nabdomen. Here I belie\\\\ e, too, we are in danger of becoming masseurs\\nsimply to knead the abdomen, as you might say, which of course is not the\\nprinciple at all, although we work upon the abdomen and frequently knead\\nit. The principle is to work for the blood and nerve control, as in other\\ncases; occasionally we do use a kneading to force onward the fecal matter\\nin the large intestine.\\nThe abdomen is important, then, since it is related to the general\\nhealth, and is readily reached by us. The fact, also, that we reach it through\\nthe splanchnic nerves along the spine, of which I have already spoken, and\\nthrough the solar plexus in front, which we can get b) deep pressure, makes\\nit an important part to us. When we work upon these ner\\\\-ous connections\\nwe have influenced the various viscera, since the\\\\ are all connected.\\nII. Some nerve centers and ner\\\\ e connections of the abdominal contents.\\nThe general facts in this connection have already been considered. I\\nhave mentioned the effect of abdominal tumors the fact that a tumor\\npressing upon the s) mpathetics may produce an effect in distant parts of\\nthe body. I call your attention again to the familiar splanchnics; yon know\\nwhere to reach them; nervous influence passes from them to the sola?\\nplexus, the solar plexus is intimately connected with the other prevertebral\\nplexuses, viz., the hypogastric and the pelvic plexuses, and these in turn are\\nconnected with the secondary plexuses the diaphragmatic, the superior\\nand the inferior mesenteric, the renal, the coeliac, prostatic, vesicle and\\nuterine, and all the secondary plexuses. So it is not strange that, as I\\nstated, there will hardly an hour pass in your practice that you will not\\nwork upon the splanchnics for something or other. Do not fall into the er-\\nror of thinking that it is only by our work upon the splanchnics and the so-\\nlar plexus that we reach the abdominal organs. Because, as you know, this\\nchain of sympathetic ganglia extend the full length of the cord; there are\\nfour lumbar and four sacral ganglia, and branches from the lumbar cord\\npass to these plexuses of the sympathetic and have to do with the life of\\nthe viscera. Sornetimes reflected jmpuls;.es are sent, as for instance, abdo-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0146.jp2"}, "147": {"fulltext": "NERVE CENTERS AND CONNECTIONS F,OR THE ABDOMINAL CONTENTS. I4I\\nminal tnmor causing hypertrophy first, and then degeneration of the heart.\\nHowever, to take a slightly different course, I wish to call your atten-\\ntion to the explanation given for a frequently observed phenomenon, that\\nis, in hysteria, frequently a pain is felt in the hip or knee, a cramping of\\nthe leg or pain on the inside of the knee. The explanation given by Hil-\\nton is as follows; that from the ovaries and uterus, which are supplied by\\nsympathetics, branches run back to the sacral sympathetic ganglia, thence\\nbranches run to connect these organs and these nerves with the great sci-\\natic and with the obturator nerve, also with the sacral plexus of nerves.\\nNow, the great sciatic, as you know, supplies the thigh, or at least sends\\nbranches to the hip joint, and the obturator also has articular branches to\\nthe knee joint. Hence, it is not strange that uterine irritation will produce\\na pain along the paths of these nerves and may affect the hip or knee-joint\\nor both, or the inner side of the knee. The same thing is noted in intestinal\\n.diseases, where the irritation in the lower bowel may send the same kind\\nof an irritation over the same nervous connections and on down the leg,\\nand you have a sciatica caused by trouble in the bowel. Cases have been\\nnoted frequently in our practice, where a pregnant uterus or the pressure of\\na large amount of fecal matter will cause a cramping of the leg; a twisted\\nilium would have the same effect. These nerve connections are all ex-\\ntremely interesting to us. However, we should not lose sight of the main\\npoints in our work upon nerve connections; when we are considering nerve\\nconnections we are apt to become too theoretical. If we can trace the\\npain up the leg to the sacral plexus and find a twisted ilium, we have done\\nthe work which is almost peculiar to the Osteopath. And so it is that we\\nmust look for the original cause whatever it may be. And remember, please\\nthat it is very frequently that the Osteopath finds a displacement of parts,\\nand the successes of our practice have been largely because we understood\\nwhere to look for and how to adjust misplaced parts.\\nIn the first few lectures I gave you certain centers which had to do\\nwith the viscera, for instance, the second lumbar, being the center for par-\\nturition, defecation and micturition. But there are other nerve fibers supply-\\ning these parts which I wish to call to your attention. I noted the fact that\\nth,e Old Doctor calls the nutrition center in general from the 6th dorsal\\ndown, and so you will see that it has to do with visceral life, and hence with\\nthe nutrition of the body very largely. Ouain, in speaking of the lumbar\\nportion of the sympathetics, says that spiral fibers decend in the cord from\\nthe lower dorsal region, and that fibers also pass from the first one or two\\nlumbar nerves to the plexuses of the sympathetics, and that the\\\\ carry aso-\\nconstrictor and secretory fibers to the lower limbs. These have been dem-\\nonstrated more particularly in animals, but there is not much doubt but\\nthat they exist iu man; also vaso-constrictor fibers to the abdominal vessels\\nare found in these nerves; and motor fibers to the circular, and inhibitory\\nfibers to the longitudinal muscles of the rectum. From the lumbar nerves-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0147.jp2"}, "148": {"fulltext": "142 LANDMARKS FOR THE ABDOMEN.\\nwe get, first, motor fibers to the bladder, they pass down to the hypogastric\\nplexus on the pelvic plexus and are then distributed to the bladder. They\\nsupply the circular muscles, including the sphincter of the bladder, and\\nprobably also some inhibitory fibers to the longitudinal fibers of the blad-\\nder. In the next place, we get motor fibers to the uterus, which follow the\\nsame course as the motor fibers to the bladder. It is a fact that there are\\nno spinal nerves from the sacral region running to the ganglia of the sym-\\npathetic. The spinal fibers which run to the sympathetic ganglia in this\\nregion come from the lumbar cord or from the lumbar nerves, and it is\\nthrough the spinal branches of the sacral nerves that we get the effect\\nthat we do by our Osteopathic work in the sacral region. Plence, the im-\\nportance of all the work the Osteopath does upon this region\\nfor the pelvic viscera. Frequently you work along the lumbar region\\nto get an effect upon the organs contained in the pelvis, and it\\nis on account of the sympathetic connections here rather than\\nwith the sacral cord, that we work here, However, we work also down\\nlower, but where we work in the sacral region we get an effect upon spinal\\nnerves. The fourth sacral nerve, spinal, having branches from the second\\nand third, and sending branches to the fifth, is called bv Gaskell one of the\\npelvic splanchnics, as it has visceral branches. Having connection with\\nthese upper sacral nerves it runs out to form a plexus with the sympathet-\\nics, and goes to the bladder and other pelvic viscera. And we frequently\\nwork over the sacral region to release tension there, set the coccyx, or set\\na slip in the innominate, or remove anything which may affect nerve force\\nthere. From these visceral branches of the sacral nerves we get the fol-\\nlowing: First, motor fibers to the longitudinal and inhibitory fibers to the\\ncircular muscles of the rectum; second, motor fibers to the bladder, prob-\\nably chiefly to the longitudinal muscles. Third, motor fibers to the uterus;\\nfourth, secretory fibers to the prostate gland. So here we have a rather\\nanom.alous condition of working directly upon the spinal nerves to get a\\ndirect effect upon the viscera. You will find that from the sacral fibers,\\nthrough the spinal nerves, we get certain fibers to the bladder and rectum,\\nAvhich are contrary in their action to the fibers to the bladder and rectum\\nderived from the lower lumbar region, for instance, the fibers to the longi-\\ntudinal muscles of the bladder are motor, while those to the circular muscles\\nof the bladder are inhibitory in the case of the sacral nerves. In case of\\nthe lumbar, they are just the opposite inhibitory to the longitudinal mus-\\ncles and motor to the circular muscles of the bladder. This applies also to\\nthose to the rectum, so that you have for the bladder and rectum in one\\ncase motor fibers, and in the other case inhibitory fibers, and thus you have\\nit under your control.\\nThe Osteopathic centers for these parts I have already given you. You\\nremember that we work there upon the 5th sacral for the sphincter ani,\\nupon the 4th to relax the vagina, and upon the 2d and 3d for the sphincter", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0148.jp2"}, "149": {"fulltext": "LANDMARKS FOR THE PELVIS. 143\\nof the bladder. In passing I might also call your attention to the import-\\nance of the fifth lumbar as a center. Important, in the first place, because\\nwe so very frequently get a displacement there, it being the point of weak-\\nness, the junction of the spinal column with the pelvis; and important, in\\nthe next place, because it is a center through which we work to reach the\\nhypogastric plexus.\\nIII. Landmarks for the Abdomen:\u00e2\u0080\u0094 There are certain points about\\nthe abdomen which may be more or less familiar to you, which I wish to\\nbring up for the sake of refreshing your memory before we proceed further.\\nThese are according to Holden as before. The Linea Alba, as you know,\\nextends from the apex of the ensiform cartilage to the symphysis of the\\npubes, and is the thinnest part of the abdominal wall. The lina semilunaris\\nextends from a point at the level of the anterior end of the seventh rib down\\nto the spine of the pubes, bulging outward; the parts between them are\\nattached to the linea alba and to the semilunaris and are sometimes filled\\nwith some extravasation of pus or fluid. The lineas transversae are usually\\nall above the umbilicus, the lower one being about on a level with the um-\\nbilicus. These lines on statuary are almost always exaggerated, making the\\nabdomen of a muscular man look like a chess board, which is not correct.\\nThese are interesting to us further from the fact that any one of these\\nsquares marked off by the transversae and linea alba may contract, or any\\none of them may become filled with pus, and stimulate some deep seated\\nabdominal tumor or other disease.\\nMarks About the Pelvis: In the erect position a line drawn between\\nthe highest points of the crests of the ilia is just about on a level with the\\npromontory of the sacrum. The umbilicus is sometimes stated to be the\\ncenter of the body. But it is a little nearer the pubes than the ensitorm\\ncartilage. It is not true that if a man should lie down on his back with his\\narm outstretched, a circle drawn with the umbilicus as its center, would just\\ninclude the extremities, because this center varies with age. It will be just\\nabove the umbilicus at birth; at two years of age it is just at the umbilicus;\\nand at thirty it is just below the pubes in man and just above in woman. Of\\ncourse it depend also on the length of the legs.\\nThe bifurcation of the aorta is just about the le\\\\ el of the promontor\\\\- of\\nthe sacrum, or you might say, level with the highest point of the crests of\\nthe ilia. The level of the umbilicus referred to the spine is about that of the\\nthird dorsal vertebra. It is said that, taking a point one inch below the\\numbilicus and slightly to the left, compression may be made upon the aorta.\\nThis point is taken because above the umbilicus there are structures which\\nmight be injured by deep pressure. By feeling here you can get the pulsa-\\ntion of the aorta. Cases are on record where the aorta has been compressed\\nhere, under chloroform, for a time sufficient to cure aneurism of the abdom-\\ninal aorta. The umbilicus, as you know, is sometimes pervious, being the\\nremains of the foetal artery it sometimes does not close. It is deeper and", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0149.jp2"}, "150": {"fulltext": "144 TREATMENT OF THE MATVIMAE, HEART AND LUNGS.\\nwider in women than in men. As it is sometimes pervious, there may be a\\nhernia here, or escape of pus, or of ovarian fluid, or of entozoa. The umbil-\\nicus is also a good fixed point from which measures are taken in case of dis-\\n\u00e2\u0096\u00a0eases where it is necessary to compare parts of the body. Measurements\\nare taken to the ensiform cartilage, to the anterior superior spines of the\\nilia, or to the symphysis. It is frequently useful in fracture to measure to\\nthe anterior superior spines to see how much the parts are displaced. In the\\nmedian line behind the linee alba as we go we have first, the liver just below\\nthe ensiform cartilage, and extending about the breadth of three fingers.\\nSecond, the stomach, which, when distended, presses the transverse colon\\ndown and occupies the space between the umbilicus and the liver. When\\nempty it recedes, leaving a slight hollow on the surface, the pit of the stom-\\nach. The transverse colon, when not displaced, the middle of it is just\\nabove the umbilicus. You will frequently want to know w^here to find the\\ntransverse colon, and you can work on it here with a sufficient degree of cer-\\ntainty. However, you must bear in mind that it is sometimes slipped out of\\nposition, as in enteroptosis. Cases are on record where it was found as low\\ndown as the floor of the pelvis. Behind and below the umbilicus are the\\nsmall intestines, when they are not displaced by a distended bladder. The\\nperitoneum, as you know, is loosel}- attached to the abdominal wall; when\\nthe bladder is not distended this peritoneum is in contact with the linea alba\\nall the way down to the pubes. But when the bladder is much distended it\\nrises, sometimes half wa} to the umbilicus, then the peritoneum is pushed\\nback by the bladder, and between the peritoneum and the abdominal wall\\nthere is a space of as much as two inches. A case is on record where in the\\nseventeenth centur}- a blacksmith cut open the bladder there and removed\\na large stone. Of course cutting the peritoneum would have been a serious\\nmatter.\\nWhen you wish to find the division of the aorta it is a safe way to find a\\npoint a little to the left of the center of a line drawn between the highest\\npoints of the crests of the ilia. And, as I said, compression can be made\\nat this point. A line bulging slightly outward from this point to where you\\nfeel the pulsation of the femoral artery will mark the course of the common\\nand external iliac arteries. The first two inches of the line belongs to the\\ncommon iliac arter}-. Of course these things vary, the aorta may be longer\\nor shorter, the bifurcation coming above or below, or the common iliac may\\nbe longer or shorter. There is one point in the examination of the thorax\\nw^hich I failed to mention, and that is w^hat is called succession. When\\nthere are fluids in the body cavities, especially in the pleura, a quick shake\\nand then the application of the ear to the chest wall v/ill give you a splash-\\ning sound, and that is called succussion.\\nAlso the Treatment of Mammae: You will find in your practice that\\nthe mammae are swollen, inflamed and perhaps caked, or something of that\\nkind, and especially at the menstrual period. In such cases it is a very good", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0150.jp2"}, "151": {"fulltext": "TREATMENT OE THE MAMMAE, HEART AND LUNGS. I45\\nplan to free the circulation by spreading the upper ribs both in front and\\nbehind. Raise them well and raise the clavicle, for there may be obstruction\\nto the internal mammary artery, especially at the second interspace, where\\nthe artery perforates and runs to the breast, you will have good success in\\ntreating such cases.\\nGeneral Treatment for the Heart and Lungs: As I havesaid, this\\nis just the indication of the general treatment. Dr. Harry Still, with whom\\nwe are all acquainted, said in an article in the last Journal that you cannot\\ngive a recipe for each parlicular treatment and it is foolish to try to do so.\\nIf you write a recipe and try to follow those directions for any one case you\\nare liable to get into trouble because cases vary. As he says, there are just\\nas many nervous systems as there are human faces, and just as many kinds\\nof paralysis as there are nervous systems. Thus it is that I can only give\\nyou the general treatment for these conditions. In treatment of the lungs,\\nI have already shown you how to examine the lungs. Your idea is to work\\nupon the upper dorsal region, you know the center is from the 2d to the 7th.\\nHowever, I might say in general concerning the heart and lungs, that they\\nare very closely related. When you have trouble with one you frequently\\nhave trouble with the other, and they are so closely related to the general\\nhealth, that if you find trouble in one place }Ou had better look also in the\\nother. In treatment of the lungs, one of the chief things to do is to raise\\nthe upper ribs, get your fingers on the angles of the upper ribs and work\\nalong, pushing the shoulder down and back. Or you can set )^our patient\\nupon a chair and place your knee in the back, or your thumb, in the same\\nway. I have relieved congestion of the lungs very readily in that way.\\nAlso in treating the lungs it is a good idf^a to get the thumb in between\\nthe clavicle and the first rib, push the arm across the chest and back over\\nthe face. That of course separated the clavicle and the first rib. I have\\nnoticed Dr. Harry Still use that method frequently, and the idea there is to\\nspread these parts, give the bloodvessels free play the subclavian, and also\\nwe get an effect upon the phrenic and the pneumogastric nerves which cross\\nthe first rib in front of the scalenus anticus. It is also important in working\\nupon the lungs to pay attention to the condition of the pneumogastric and\\nof the sympathetics. Hence it is that we work in the superior cervical region\\nand also upon the middle and inferior cervical ganglia of the s\\\\ mpathetics.\\nI have already shown you how to treat them. Now, your irritation to the\\nvagus may of course be suf^cient to produce results in the lungs. It has to\\ndo with the caliber of the bronchial tubes; it gives them motor, dilator and\\nconstrictor fibers, so that if it is irritated it may cause contraction and gi\\\\-e\\nyou a case of asthma, or something of that kind. The irritation ma\\\\ be in\\nthe stomach or in the throat, or anywhere where it may irritate the pneumo-\\ngastric nerve. If the superior laryngeal branch is irritated it ma\\\\- result in\\ncatarrhal pneumonia. So you must look carefully to the nerves and treat\\nthem in the neck at the points I have indicated. The third, fourth and fifth", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0151.jp2"}, "152": {"fulltext": "146 TREATMENT OF THE HEART AND LUNGS.\\ncervical are particularly noted because any displacement here is liable to\\naffect the sympathetics, which has to do with the involuntary movement of\\nthe lungs. Then the first and second ribs and the fifth rib are particularly\\nnoted, but all the ribs from the second to the seventh are included, and all\\nthe upper part of the spine.\\nI might tell you also how to treat the heart; it is largely a repetition of\\nwhat has been said for the lungs, because the phrenic and pneumogastric also\\nsupply the heart, and you must always look to them. We frequently work\\nupon the pneumogastric nerve here in the neck, holding against it, thus in-\\nhibiting its action, to increase the beat of the heart, because we thus cause\\nthe inhibitory fibers of the pneumogastric to cease functioning. That is\\nsimply an adjutant, as I have said before, we can get abetter effect in quiet-\\ning the heart or stimulating it by working in the region of the splanchnics\\nand along the upper dorsal region, especially on the left side. The motions\\nI have already given you any of these spreading motions to spread and\\nraise the ribs, will relieve the heart trouble. Of course, as I have said before\\nI am giving you only the general treatment. In any particular case you\\nwill probably find some one thing the matter, you might find the clavicle\\ndown and affecting the heart, you might find the first and second ribs up\\nand affecting the heart, and you might find any particular rib in the upper\\ndorsal region displaced affecting the heart.\\nQ. Suppose you were treating a case and the patient would faint on\\nyour hands, by what means would Ou bring him to?\\nA. A good way is to first get the head of the patient as low as you can\\njust let it hang over the lower end of the table; and to refer to Dr. Harry\\nagain, he says to slap them, pull their hair or anything to get the blood\\nstarted to the head; a dash of cold water to the face may be a good thing.\\nQ. In case of too much blood to the head how would you go about\\ntreating it to throw the blood away from it?\\nA. I would work first along the splanchnics.\\nO. Stimulating?\\nA. Well, yes, that is, I would loosen all the muscles, first, in the back,\\nand then I would have the patient turn over and inhibitor press deeply over\\nthe solar plexus, to get the blood from the head. You will have to find out\\nthe cause; the cause may be an impacted colon preventing the circulation\\nin the lower part of the body. Or you may stimulate the lungs and get it\\nstarted through the whole body; your idea is to equalize the blood flow.\\nQ. In case of too much heart action, what would be the quickest way\\nto reduce it?\\nA. The quickest way that I have found is simply to separate the upper\\nribs and raise them on the left side, and I have done it by the count, I have\\nlowered it as much as twenty beats, and it stayed that way until the next\\ntreatment; when the patient came back two or three days later the beat was\\nthe same. Of course that is an exceptional case; you cannot always reduce\\nit that much.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0152.jp2"}, "153": {"fulltext": "NERVE CONNECTIONS AND CENTERS OF THE STOMACH AND INTESTINES. I47\\nQ. Please give the treatment to increase the heart beat?\\nA. You should inhibit the pneumogastric, thus letting the heart run\\nfaster; and then you would take this same movement, because the object\\nwhen it is too slow is a stimulation, and by raising these upper ribs, whether\\nit is too slow, you may increase it, or if too fast you can lower it, I have\\ngotten effects either way.\\nQ. Do lymphatics remain enlarged after the septic condition has\\npassed away?\\nA. That is a very hard question to answer. I have seen them stay en-\\nlarged so very long that it looked as if they might, but I do not think they\\ndo really. They may stay enlarged a long time, but it is possible there is\\ntrouble there yet, especially if the person is in poor health,\\nO. Why are they enlarged in one place and not in another?\\nA. Because certain parts of the lymphatic system drain certain parts\\nof the body.\\nQ. The treatment you have given would be good also for irregular\\nheart action, would it not?\\nA. There are many things that would cause irregularity of the heart.\\nAs I have said, a stoppage of the subclavian vein causing a periodical empty-\\ning of it, caused by a slipping of the clavicle, would cause the heart to lose\\na beat. An irritation to the sympathetics in the dorsal region would cause\\na constriction of these vessels and thus an irregular filling of the heart, caus-\\ning it to lose a beat.\\n(Dr. Harry Still) I will tell you, doctor, when it originates from the\\nstomach, you can press upon the pneumogastric and quiet it down. Simple\\npressure, from two and a half to five pounds pressure, for a minute and a\\nhalf to two minutes.\\nO. Would not that inhibiting movement tend to stimulate the heart?\\nA. In what way?\\nO. A desensitization of the pneumogastric.\\nA. Not with a slight pressure.\\nLECTURE XXIII.\\nToday I wish to consider further the abdomen and its contents. I have\\nalready given you certain centers for the vaso motor control of these parts,\\nnecessarily so in considering the splanchnics. But there is much more that\\nmight be said, so I will mention some further fibers which go to these parts,\\nwhich teach us how we can control them.\\nFirst, as to the stomach. We know that we reach it through the solar\\nplexus and through the splanchnics, also through the vagi. We must not for-\\nget in dealing with the stomach that probabl}^ Auerbach s and Meiss:::~ ^-p^^^--\\nuses have to do with it as well as with the intestines. Robinson savs tha. :lie", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0153.jp2"}, "154": {"fulltext": "148 CKNTKRS AND NERVK CONNECTIONS OF ABDOMINAL ORGANS.\\ngastric and intestinal secretions are under the control of Meissner and Billroth s\\nplexus, aided by Auerbach s plexus. Further, note certain statements in\\nHowell s Text Book: The mesentric vessels are under the control of the\\nsplanchnics, which contain both vaso-dilators and vaso-constrictors. The vaso-\\nconstrictors for jejunum are up as high as the lifth, and extend from there\\ndown, it does not state how far. Those for the ilium a little lower,\\nand those for the rectum come off still lower along the splanchnic region.\\nThere are none, however, below the second lumbar. The vaso-dilators are\\npresent in the same nerves in these regions, and here is a chance to bring in a\\npoint of whether we inhibit or stimulate. I think w-e understand fully that\\npoint and do not think that we will split hairs over those things. However,\\nthe vaso-dilators are more abundant in the lower three dorsal and in the upper\\ntwo lumbar. The vaso-dilator and vaso constrictor fibres of the splanchnics,\\nending in the solar and renal plexuses, have the vaso motor suppl} of the liver.\\nThe splanchnics contain the vaso-dilators and vaso-constrictors for the liver\\nprobably. It is said that there are vaso-dilators also in the vagi nerves, How-\\never, this matter is not settled, and thej^ are not perfectly sure about the exis-\\ntence of these fibres. However, it makes but little difference to the Osteopath,\\nsince he can rule the flow of blood through the liver in other ways, as we shall\\nsee presently.\\nThen, as to the kidneys, there are vaso-motor fibres from the sixth dorsal\\ndown to the second lumbar. You know that we can get, more easily, perhaps,\\non the kidneys than on any other organ a vaso-motor effect reflexly bj^ the ap-\\nplication of cold to the skin. And then b}^ stimulating the sciatic nerves it\\nhas been found that one can get a vaso -motor effect upon the .kidneys. This\\nseems to be in line with what has been said concerning an equilibrium between\\nthe blood flow in different parts of the bod3\\\\ There are certain centers that\\nthe Osteopath works upon. The Old Doctor says there is a center in the\\nskin, that is, a peritoneal center about one incli each side of the umbilicus, and\\nthat work there is beneficial both upon the kidneys and upon the intestines,\\nand we often make a mere spreading motion there at the umbilicus, just press\\nin deep and spread apart, not hard, for work on the renal veins and arteries.\\nThat always seems to have a good eft ect in treating the kidneys. Of course\\nyou know the micturition center is the second lumbar but you have already\\nbeen cautioned not to go too much according to centers; look for the lesion,\\nwhich ma}^ be some place away from the center.\\nAs to the spleen, it is found that stimulation of the peripheral end of the\\nsplanchnics will cause quite a change in the size of the spleen, that is, in its\\nbulk, but it is not really known whether it is on account of vaso-motor control\\nor because of an effect upon those involuntary muscle fibres which j^ou saw\\nunder the microscope you know how the capsule and the trabeculae of the\\nspken are well supplied with involuntar}^ muscle fibres, and you remember how\\nthe oval nuclei of those fibres are easily seen. However, from the Osteopathic\\npoint of view, it makes little difference whether he can in one way or the other", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0154.jp2"}, "155": {"fulltext": "CKNTKRS AND NERVB CONNKCTlONS OF ABDOMINAL ORGANS. 1 49\\nchange the size of the spleen, so long as he does it, that is what he is after.\\nHe does not care whether it is through muscular or vaso-motor control, or\\nwhether he can work upon the splanchnics and thus reduce its size. Should\\nhe do that, of course he would thus change the flow of blood through it. There\\nis a great deal not understood about the spleen. There is a very good Osteo-\\npathic point, however, I have often heard Mrs. Patterson speak of it,\\nthat is, treatment of the spleen in connection with treatment\\nfor gall stones. She says you can treat for gall stones and\\nremove them but they will form again unless you treat the spleen on the left\\nside over the ninth, tenth and eleventh ribs. And as far as I know that is\\npart of the practice. I have not heard that statement refuted by any one.\\nAnother point as to the spleen in treating it you will sometimes find it con-\\ngested; it is like the liver in that respect, they are both liable to congestive dis-\\nturbances. You may by working deep in the left hypochondriac region reach\\nthe spleen, but when the spleen is distended with blood it is said it is very read-\\nily ruptured; and if you find the spleen enlarged and tender I would advise j^ou\\nto treat rather over the back through the spinal nerve supply than over the ab-\\ndomen. I think I might emphasize once more the importance of the Osteo-\\npathic work upon the abdomen. As I have already said, I think here we are\\nin more danger than anywhere else of becoming masseurs. Indeed, I do not\\nthink we need to learn the baker s trade before we can work on the abdomen,\\nand we ought to bear in mind that although we knead there, we work there as\\ndirectly as in other paris of the body for nerve control and for the blood flow.\\nAnd the fact that we knead the abdomen occasionally is not an}^ sign that we\\nsimply knead it as a masseur does. Of course there are times when we depend\\nupon the mere mechanical movement, as when we begin at the sigmoid and\\nwork on back to loosen up the fecal contents, but our chief work is upon the\\nnerve supply. I think I have already mentioned the point that b} work upon\\nthe abdominal peripheral terminals we can stimulate or inhibit. I merely call\\nit to your mind again, that by getting the peripheral terminals in the organs of\\nthe abdomen, which we can reach by pressure over the abdomen, and by get-\\nting these various plexuses from the solar down, we can get an effect upon\\nthese organs, and that is what we are reaching when we are working the ab-\\ndomen. For instance, we frequentl3 work along the whole length of the great\\nintestine. What are we doing? You will remember that Auerbach s and\\nMeissner s plexuses are found, the first between the muscular coats, and has to\\ndo with the motions of the intestines; and second, deeper in the submucous\\ncoat, and has to do with the secretions. Now, we ma}^ work in the region of\\nthe abdomen, and the beginning Osteopath, who does not understand, may\\nthink he is simply kneading, but such is not the fact, we are reaching termina-\\ntions of nerves. You know what the plexuses look like, with their meshes, in\\nthe internodes of which are ganglia; they (the ganglia) are centers upon which\\nyou may work directly by pressure over the abdomen. Thus it is, I think,\\nthat we get the best explanation in regard to the Osteopath s successes in treat-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0155.jp2"}, "156": {"fulltext": "I50 CENTERS AND NERVE CONNECTIONS OF ABDOMINAI, ORGANS.\\ning abdominal troubles, such as constipation, diarrhea, enteritis, and a whole\\nlist of troubles which affect man, and our success there is marked. Byron Rob-\\ninson says: Gastro-intestinal secretion appears to be carried on automatically\\nby the Meissner- Billroth aided b}^ Auerbach s plexus of nerves which are sym-\\npathetic ganglia, automatic visceral ganglia. As I have said, since they are\\nganglia they are centers, and since they are automatic, they are to a certain ex-\\ntent independent, and that by stimulating them, whether we go back to the\\nsplanchnics so much or not you get the effect, as you have an independent source\\nof nerve supply here. Indeed, Robinson in making this statement, is doing so\\nto establish his point that the sympathetic is largely independent in its action.\\nWe must, however, couple our work here with work in other places, and we\\nmust not forget also that the nerve centers chiefly are along the spine. We\\ndo our work largely here also by the blood flow. I have emphasized the nerve\\ncontrol and the blood flow. Robinson says that the movements of the intes-\\ntines is largely dependent on the amount of blood in the intestinal wall. That\\nis, on the amount of fresh blood which affects the parenchymal ganglia. We\\nhave a certain number of ganglia in these walls, they must be supplied with\\nblocd if they are to act properly; that is with good, fresh blood. And by work-\\ning over the splanchnics and b}^ this manipulation process you can throw s:reat\\nquantities of blood to the abdominal viscera, and thus supply these ganglia\\nwith an added amount of blood, and that will also help to explain how we get\\nour effect upon the nervous system there. And when you have done that you\\nrule both secretion and motion. Of course that has to do very closely with\\nconstipation, diarrhea and those things. Your peristalsis may be too rapid,\\nand thus you would have a case of diarrhea, or it may be just as rapid, but as\\nRobinson says, futile, and you will have constipation. You have to couple\\nwith that work the ruling of secretions through Meissner s and Auerbach s\\nplexuses, and if they are too abundant you have diarrhea; if deficient 3 ou would\\nhave constipation. The fact then, there, as in other cases, is that we remove\\nlesions and these secretions attend to themselves, they become normal; a change\\nin the amount of motion and a change in the quantity or quality of secretions;\\nso we w^ork toward the normal. We might repeat this for every organ in the\\nabdominal cavity. When we work for the uterus, the bladder, or in the intes-\\ntines, or ovaries, we work very largeh^ through the nerve control, as is evi-\\ndenced by the fact that in case of those organs we work generally through the\\nspine, along the lower part. It might be thought that the motions we employ\\nin our work upon the liver are exceptions to this rule, but I think not. We\\nfrequently work against the lower edge of the liver, but we cannot work much\\nof its bulk by our direct kneading motion there, and I think what we do there\\nis the same as elsewhere, we affect the nerves as well. We affect the hepatic\\nplexus of the S3mipathetics directly by manipulation there, and indirectly\\nthrough the solar plexus, also through the splanchnics, and the vagi. If you\\nwill watch Dr. Harry Still 3 ou will see that he will scarcely ever omit to treat\\nthe vagi, when treating the liver, as it contains vaso-motor fibers for this organ.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0156.jp2"}, "157": {"fulltext": "I.ANDMARKS FOR ABDOMEN. I 5I\\nSo our work in kneading is largely work upon nerve connections. There is a\\ngood point that I would like to note in speaking of the liver. I have seen a\\ncase in which there was hemorrhages from the lower bowel; whenever the\\ntrouble occurred there would be a tenderness and trouble about the liver, and\\nthe portal circulation would be stopped. There is a close connection between\\nthe portal circulation and hemorrhoidal. Here you have this great amount of\\nblood which must pass to the abdomen and through these terminal vessels, and\\nwhich must find its way back through the portal circulation and through the\\nliver to be worked upon by it. These hemorrhoidal veins connect with the\\nportal veins; so that if you have an obstruction in the liver you are very apt to\\nfind trouble in the way of hemorrhoids, piles, or something of that kind. So\\nremember, please, that there is a further object in freeing the splanchnics, as a\\nregulative process. You might say that this is true, but you might go farther\\nand say that the liver in this case is a stop cock, that it is sometimes turned\\nwhen it should not be, and is stopping the blood and you have a congestion of\\nblood at the lower bowel. You remember that the liver is particularly liable\\nto congestion, and if it is congested the blood flow is retarded and you have\\na series of abdominal troubles.\\nII. Landmarks for the Abdomen. I began this last time, and wush\\nto continue them to-day. In examining a patient, as you all know, perhaps,\\nit is best for abdominal examination and treatment to have the patient flat on\\nthe back; have the thighs flexed a little to relax the abdominal muscles; have\\nthe head and neck slightly elevated, as much as it is raised by this table, this\\nwill help to relax the recti muscles. Thus you have everything relaxed, and\\nunless the abdominal wall is unusually tense through its own condition, you\\nhave a good place to work. Then in working, I believe that beginning Osteo-\\npaths dig here perhaps as much as in any other place. That is, they use\\nthe ends of their fingers. Not only Osteopaths but surgeons make the state-\\nment that that is very wrong. Holden says to use the tips of the fingers causes\\nthe parts to contract. Thus you defeat your own object. You should lay the\\nflat of the hand on the abdomen. I have seen the worst digging over the ab-\\ndomen, and it is wrong, because you are not kneading and you cannot force\\nany condition there, and you had better not try. Dr. Hildreth always empha-\\nsizes the point that in working upon the abdomen you must work for nerve\\ninfluence; and that is .especially noted in typhoid fever, where you have an\\nulceration in Peyer s patches, and if you try to work matters along mechanic-\\nally, you are liable to perforate the ulcerated places.\\nThe central tendon of the diaphragm is about on a level with the lower\\nend of the sternum, about the level of the junction of the seventh costal carti-\\nlage with the sternum. The right half of the diaphragm will rise as high as\\nthe fifth rib when the diaphragm is extended, and to one inch below the level\\nof the nipple; rather higher than one usually expects to look for it. The posi-\\ntion of the abdominal contents is variable. There is quite a contrast, says\\nIvoomis, between the examination of the contents of the thorax and those of", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0157.jp2"}, "158": {"fulltext": "152 I^ANDMARKS FOR ABDOMEN.\\ntlie abdomen. In the first instance you have tense walls and contents which\\nmay vary but little, especially under physiological conditions. While in the\\nother you have lose walls, you have numerous organs, some of which at least,\\nvary considerably within physiological limits. So you see it is a different mat-\\nter when you go to the abdomen to examine or treat it, and you must con-\\nstantly guard against wrong diagnosis by being mistaken which organ is at\\nfault. Then, too, the action of the abdominal organs is more or less peculiar.\\nTake the stomach at different times, it changes its position when it is distended;\\nso it is with the bowels, and according to the position they assume, the others\\nare also displaced; so you must bear that in mind.\\nI wish to simply call to your attention the regions of the abdomen. You\\nknow that it is divided into three zones the epigastric, umbilical and hypo-\\ngastric. The epigastric region is bounded above by the diaphragm, below by\\na plane passing from the anterior tips of the tenth rib, and between the bodies\\nof the first and second lumbar vertebrae behind. That zone is divided into a\\nright and left hypochondriac regions, behind the false ribs, and the epigastric\\nzone, between the umbilical zone is bounded above by the epigastric and below\\nby a plane passed from the highest points of the crests of the ilia, striking a\\npoint between the first and second sacral spines behind. And the lower, or\\nhypogastric zone is the one below the umbilical, and occupies the region of the\\npelvis. These two zones are each divided into three by an almost vertical plane\\non each side, passed from the prominence at the tip of the tenth rib to the pubic\\nspine, so you have two planes. In the middle zone the regions are the right\\nand left lumbar and the umbilical, and in the h^^pogastric zone the regions are\\nthe right and left iliac and the pubic. The lower zone is bounded below by the\\nupper edge of the pubes and by the two Pouparts s ligaments, one on each side.\\nIt will not be necessary to detail the contents of these regions, I will refer to\\nthe contents as it becomes necessary later.\\nAs to the liver, it is found mainly in the right hypochondriac region and\\nextends across into the central or epigastric region, and as far toward the left\\nas the mammary line. It may extend down two or three inches, and at this\\npoint, behind the linea alba and the media linen is the best place to find the\\nliver; it protrudes half way to the umbilicus, but you will not be able to find\\nit until your hand is educated. Of course the liver may protrude lower in\\ndisease. I have seen a liver that weighed sixty pounds; the} become enor-\\nmously large at times. It may extend down, as for instance in tight lacings\\nwhen it is not diseased, and you will have to judge what the general condition\\nis. On the right side, where it goes a little higher, it may ascend as high as\\nthe diaphram, about an inch below the nipple, and below, at the lower\\nedge of the lung, or as low as the tenth dorsal spine. The liver, remember, is\\na very important organ. I do not think that with all that Dr. Harry Still says\\nabout the liver it is any to much impressed upon our minds, because it is ex-\\ntremely important to us in our practice. The gall bladder will be found just\\nbeneath the tip of the ninth rib on right side, but it is behind the liver, and", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0158.jp2"}, "159": {"fulltext": "I^ANDMARKS FOR ABDOMEN. 1 53\\nyou are not able to find it, and it is only when distended to a great degree that\\nit can be noticed; even then you do not feel it directly. But we work there to\\nget an effect upon the gall bladder and press its contents out. We work down\\nthat duct in a reversed S shape to the umbilicus, a little to the right.\\nThe stomach is one of the most variable organs of the abdomen. You all\\nknow how much it descends at times when distended with gas or over dis-\\ntended with food. At that time instead of. simply descending, it turns on its\\naxis and the greater curvature comes to the front, because the greater, curva-\\nture is not so closely attached to the lesser. When the stomach becomes thus\\ndistended it will push away those organs in front, and even may occupy all the\\nspace from the lower edge of the liver or the tip of ensiform down to the um-\\nbilicus, and in such a case you are likely to have great dyspnoea and palpita-\\ntion of the heart. I remember a case in which about three hours after a meal,\\nthe gentleman had eaten rather hearty, he had great distress in breathing, and\\nhis heart was palpitating, and he thought he would die surely. He called an\\nOsteopath for heart trouble, but the Osteopath worked the undigested food\\non through the pylorus and worked the gas off the stomach, and the man s\\nheart was all right. You will frequently meet that sort of a case, and if 3 ou\\nknow the probabilities you can be on your guard against it. The cardiac ori-\\nfice is just below the cartilage of the seventh rib where it joins the sternum,\\nand a little to the left. The stomach when empty retreats behind the liver\\nand lies flat; there is no cavity whatever in it. This reminds me of a state-\\nment made by Dr. Kckley frequently, that naturally these are but potential\\ncavities. The oesophagus when not occupied by the passage of food or drink\\nlies with its inner surface in contact, it simply collapses and occupies as little\\nroom as possible. The same is true of the stomach. The pyloric orifice of\\nthe stomach is found on the right at the edge of the sternum about the point\\nwhere the cartilage of the eighth rib joins; it is behind the liver and cannot be\\nfelt unless it is enlarged by disease.\\nThe spleen is on the left side, below the ninth, tenth and eleventh ribs,\\nsounded by percussion over the tenth and eleventh ribs, I have already given\\nyou some precautions concerning it. It may become very much enlarged,\\nthen you can readily feel its edge, but unless it is enlarged you do not feel its\\nedge. However, you can get indirect pressure on it under the edges of the\\nleft lower ribs, It is forced down sometimes in full inspiration.\\nThe pancreas is not very easily felt; it lies behind the stomach, trans-\\nversely, and crosses the aorta and the spleen at the level of about the second\\nlumbar vertebra. I mention it not because you will find it often; you can feel\\nit only when the abdomen is very thin and the stomach entirely empty; in\\nsome cases of thin individuals you might mistake it for some disease of the\\ntransverse colon.\\nThe kidneys also are not readily felt. It is said by Holden that he does\\nnot know that he has ever felt the rounded edge of the kidney, but he says it\\nis accessible to pressure as the outer edge of the erector spinas muscle between", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0159.jp2"}, "160": {"fulltext": "154 LANDMARKS FOR ABDOMKN.\\nthe lower ribs and the crest of the ilium. It is accessible to pressure because\\nyou can get indirect pressure and can know when it is tender. Of course it is\\nsometimes enlarged and can then be felt. It corresponds in position to the\\nlower two dorsal and upper two lumbar vertebrae. A point to know in rela-\\ntion to it is that it will sometimes deceive you, or you will feel masses of\\nhardened fecal matter and think they are the kidnej^, or vice versa; you must\\ndistinguish between them.\\nAs to the large intestine, you are familiar with it. The caecum and ilio-\\ncaecal valve both lie in the right iliac fossa, and in the right lumbar region and\\nover the right kidney runs the ascending colon, and across just above the um-\\nbilicus for two or three inches you find the transverse colon; the descending\\ncolon and sigmoid flexure are in the corresponding portions on the left side.\\nYou can reach all of the colon except the splenic and sigmoid flexures. How-\\never, these are sometimes prolapsed, sometimes sunken, as Robinson states.\\nDr. Tull, of our own practice, has pointed out that this is frequently the case,\\nand that prolapsus may cause constipation by acting as a mechanical hindrance\\nto the passage of fecal matter along the bowel. You all know the relations of\\nthe bowel, and except at those two points you will be able to woik upon the\\nintestine directly.\\nAs for the small intestine, the jejunum lies in the region behind the um-\\nbilicus and is the part concerned in umbilical hernia, and it is because it seems\\nto be so particularly vital that umbilical hernia is so often fatal. The point\\nconcerning the ileum is that it contains Peyer s patches, which are inflamed\\nand ulcerated in typhoid fever; they are in the lower part near the ilio caecal\\nvalve, and just at the edge of the right iliac fossa. You will have to be ex-\\ntremely careful in treating inflammatory conditions of the bowels, especially in\\ntyphoid fever and enteritis.\\nThe bladder is contained within the pelvis except when distended. It\\nmay become over distended and rise out of the pelvis as high as the umbilicus.\\nAnd as I noted at the last meeting, when it rises it pushes the peritoneum back\\naway from the wall of the abdomen, and sometimes will leave a space as great\\nas two inches between them.\\nI thought I had better finish the subject in this way today, leaving the\\npractical examination and treatment of each one of these important organs of\\nthe abdomen until next time, and I shall try to finish this subject then.\\nLECTURE XXIV.\\nAt tlie last lecture I considered the abdomen, taking first certain centers\\nand nerve connections for the contents of the abdomen the stomach, intes-\\ntines, liver, kidney, spleen, and so on, calling to your attention the fact that\\nalthough we often work mechanically upon the abdomen, our chief treatment\\nthere is nevertheless for the reaching of blood and nerve supply, taking espec-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0160.jp2"}, "161": {"fulltext": "EXAMINATION AND TREATMENT OF ABDOMEN. 1 55\\nially the case of the liver and of the bowels in constipation. I then took up\\ncertain landmarks for the abdomen. I wish to carry the subject further.\\nI. Examination and Treatment of the the Abdomen and its Contents:\\nIn this I do not include the pelvis and its contents, as I shall give a further\\nlecture, taking up the pelvis and its contents. Of course any\\none of these various organs become complicated with disease, and the manner\\nin which it is reached and treated in the various diseases might well take up a\\nlecture, but I think it best to run over the abdomen and its contents, giving\\nthe Osteopathic treatment for each different organ today, perhaps with the ex-\\nception of the kidney, which I will take up at the next time.\\nFirst, as to the examination of the external parts of the abdomen. I call-\\ned your attention at the last time to the need of having the patient raise his\\nknees, thus flexing the thighs slightly, also the fact that our tables raise the\\nhead and chest a little, thus relaxing all the parts about the abdomen, leaving\\nthe abdominal walls relaxed, so that you can readily examine them by touch.\\nYou should also take care to see that the patient is evenly disposed on each\\nside, so that there would be equal tension of the abdominal walls. Of course\\nyou see at once that it is necessary to have the parts equally disposed. We\\nuse the ordinary methods of examination of the abdomen inspection, palpation,\\nmensuration, auscultation, and percussion. We use palpation and percussion\\nprobably most frequently. The Osteopath depends upon touch largely, and\\nalso upon getting the sound by percussion from the different viscera, so these\\ntwo are the most important methods of examination that we have. We should\\nfirst inspect the abdomen, this is best done next the skin. We note its general\\nappearance; you will find in some cases enlargement due to inflation from\\ngases in the bowels. In such cases it is very likely to be even. However,\\nsome of the hollow viscera, as for instance, the stomach, may be inflated with\\ngas, in which case you would have an uneven enlargement. Further on ins-\\npection you will find whether or not any organ is enlarged. Sometimes the\\nspleen enlarges enormously and pushes farther and farther down\\nthrough the abdomen, and makes a bulging enlargement in its locality. Some-\\ntimes, as I have said, the stomach is extended with food and gases, and quite\\nenormously so. Sometimes diseases of the liver cause it to enlarge, as for in-\\nstance in sclerosis of the liver. The liver protrudes down below the ribs from\\nenlargement and makes a protrusion of the abdominal walls, as does also en-\\nlargement of the ovaries, and so on. So you should note whether or not the\\nenlargement is equally disposed, as in gases in the intestines, or is at a fixed\\npoint, in which case you will learn by other methods how to t^ll what organ is\\naffected.\\nWe should also note the temperature, whether or not parts are cold or hot.\\nIt is said that in liver troubles there are often cold spots upon the surface of the\\nbody, and we know that in cases of obstruction to the nerve supply at the spine,\\nyou can trace the cold streak on across the body.\\nInspection will reveal to you the color, which is significant. In some cases", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0161.jp2"}, "162": {"fulltext": "156 KXAMIXATION AND TREAT3IENT OF ABDOMEN.\\nthe linea alba becomes pale, or there may be splotches of 3^ellow color as in\\nsome diseases of the liver, jaundice, and in other cases. In pregnane}^ the ab-\\ndomen assumes a different color, brown, yellowish or black; it differs according\\nto the person. You can make out the outline of an}- organ and locate it by the\\nother methods of examination.\\nThe abdomen maj^ be distended or it may be retracted, as in tubercular\\ndiseases of children, where it is said the abdomen is retracted. x\\\\nd you will\\nfrequently find in your practice that in thin, emaciated people, any disease\\nthat is wasting is liable to contract the abdomen. You wnll also find that in\\nsome cases it is distended. In diseases which affect the thorax, causing pain\\nupon respiration, there is likely to be a change in the abdomen an3 thing like\\ninflammation of the pleura or pneumonia, there is restriction of motion and\\npain on the side affected, while the respirator}- motions of the abdomen are in-\\ncreased. On the other hand, in the abdomen when 5-ou have trouble which\\nwould cause pain upon motion, as for instance, in peritonitis, you have the res-\\nstriction of motion there, and increased motion in the thorax. You can also by\\nthis examination occasionalh note changes? even through the wall of the ab-\\ndomen, as in cases where the heart has been displaced by some disease in the\\nthorax. In cases of aneurism of the abdominal aorta 3 ou can find the pulsa-\\ntion of the thorax. You can feel it very frequentl} and it will sometimes be-\\ncome so marked that you can detect it on inspection. The caput medusae, or\\nlittle web of veins about the umbilicus may become enlarged and engorged with\\nblood, indicating that somewhere the blood is is interfered with; it is is usually\\nin the liver, as in case of scirrhosis of the liver, but it may be in some por;;ion\\nof the ascending vena cava.\\nPalpation, as I have said, is important to the Osteopath. You can feel\\nthe different solid viscera in the different parts of the abdomen. As I have al-\\nready mentioned, you can feel whether or not there be tumors of any kind in\\nthe abdominal wall; you can by touch differentiate between those in the wall\\nand those in the organs; 3 ou can tell whether or not the3^ are superficial or\\ndeep, fluctuating or solid. A solid tumor will give a sound such as you get\\nover the liver a flat sound; a liquid tumor will give also a flat sound, but will\\ngive in addition a fluctuation, which can be detected by palpation. When the\\nabdomen has its walls retracted it is likely to be tense, when extended the}- are\\nalso likely to be tense. In other cases 3 ou may find them very flabby, ver}\\nloose, without tone. In one case there ma3^ be too much life, in the other case\\na lack of life or nerve force, and 3-0U can ce -ect that by the feeling. You can\\nalso detect displacement of the parts; you must examine to see if the parts are\\nin their normal position. The liver, of course, ma3^ descend considerably; the\\nstomach may be displaced until it is resting upon the floor of the pelvis. The\\nspleen ma3^ be enlarged and come far down. Any of the organs may indicate\\npathological changes, or be displaced or enlarged. The transverse colon, you\\nknow^ where to find it, just across above the umbilicus. It sometimes becomes\\nloaded with fecal matter and descends, dragging with it the splenic and hepatic", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0162.jp2"}, "163": {"fulltext": "EXAMINATION AND TREATMENT OF ABDOMKN. 1 57\\nflexures, and in such case you will be able to make out those flexures You\\nwill also be able to make out fecal tumors accumulation of fecal matter in\\nthe large intestine. If there be pain in the stomach, and it increases upon\\npressure over the pit of the stomach, it is said to be inflammatory, as in ca-\\ntarrh of the stomach; if it ceases it is said to be nervous.\\nAs I have said, the method of percussion is an important one in examina-\\ntion of the abdomen. In general, percussion over parts which are distended\\nwith gas, gives a tympanitic sound of the abdomen, because there the gas is\\nrestricted within limits. Over a stomach or bowel distended you get a tym-\\npanitic sound. Over the parts contained in the abdomen you get a varying\\ncharacter of flat sounds. For instance, over the liver, you know it is best\\nreached right in the median line, below the ensiform cartilage, we get a flat\\nsound. Here, however, over the lung, you get a higher, more resonant sound.\\nYou can compare sounds in that way. Over the region of the spleen we get\\nthe same flat sound; over the region of the stomach likewise. Over the intes-\\ntine, the same, except the note is of a little higher qualify. Remember that\\nin using your left hand as a pleximeter it is best not to place the whole hand\\non the abdomen, place the middle finger oti the abdomen, and then bring the\\nfingers of the right hand into line, or take the middle finger of the right hand,\\nand tap gently for superficial structures, and for deeper structures more\\nstrongly.\\nMeasurements are used but little in our examination of the abdomen, but\\nyou can take the umbilicus as a fixed point and measure from it to the anterior\\nsuperior spines of the ilia, to the end of the ensiform cartilage, or to the sym-\\nphysis pubes.\\nAuscultation is made little of in the books. However, I think we use it\\nmore than the old profession; it is said it is of little use. Dr. Harry Still uses\\nit very frequently in cases of liver trouble. He says if he finds a gurgling\\nsound over the liver, there is trouble there. That gurgling sound indicates\\nthat there is an obstruction to the portal circulation. I have often been able\\nto hear this gurgling sound. It will be quiet for a while and then you will\\nhear a gurgling, and it will be quiet again and you will hear the gurgling\\nagain. Of course I am aware you might confuse this with the bubbling of\\ngases in the stomach, .but you will have to learn bj^ general indications what\\nthe probabilities are. However, I think auscultation in that way over the\\nliver is useful to us as Osteopaths. Auscultation is also employed to hear the\\nfetal sounds in pregnancy, we will take that up later. Please remember also\\nthat you must take into consideration the conformation of the spine, thorax\\nand pelvis, take all these parts which will in any way aft ect the abdomen into\\nconsideration in your examination.\\nIt is difficult to say just how to give a general treatment for the abdomen,\\nbecause we usually treat there for a specific object. However, as far as a gen-\\neral treatment would go in the abdomen, it would relax the walls. I would\\nsimply lay my hands on the abdomen firmly; I would not take the tips of my", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0163.jp2"}, "164": {"fulltext": "158 EXAMINATION AND TREATMENT OF ABDOMEN.\\nfingers, I would not dig, I would keep my hands straight in that way; you\\nknow the importance of that. Thus you can thoroughly relax all the surface\\nof the abdomen. We know this is a very effective movement; it is hard to ex-\\nplain. As I said at the last lecture, I believe that the movements there stimu-\\nlate the nervous mechanism in the abdomen more than anything else; and\\nmechanically of course we connot help but work the blood to the parts. It is\\nsaid to be very beneficial. It is recommended by physicians in general just to\\ntap the abdomen lightly all over. The masseur works the abdomen consider-\\nably in case of constipation, and that mechanically excites a flow of blood.\\nThat is, if it is mechanical, but it is hard to believe it is very largely in that\\nway. There is also another movement we might include in the general treat-\\nment of the abdomen, that is, a lifting up motion, you can thrust your hands\\ndown in deep in the iliac fossa, and raise everything there. You can in that\\nway raise the uterus, bladder and bowels. That is frequently an excellent\\nmethod of treatment and has been used with great success.\\nNext as to examining and treating the important organs contained within\\nthe abdomen. First, as to the stomach. It is hard to confine yourself to a\\nparticular part. The stomach, for instance, gives symptoms in all parts of the\\nbod5\\\\ We should notice the face, the expression and the complexion; there\\nmay be lack of color, a yellow or clay colored complexion. Also notice the\\neyes, the odor of the breath, the appearance of the tongue. All these things\\nare indicative in troubles of the stomach. Also, of course, vomiting, the\\nbelching of gas, and so on. But these things are so familiar to you that I need\\nbut mention them to you in the treatment of the subject in this way. How-\\never, more particularly as to the stomach locally. You have the point already\\nthat you can see by inspection whether or not it is enlarged. You can also\\nnotice by palpation whether or not it be enlarged, by percussion whether or\\nnot it be caused by solids, fluids or gases. Now, in treatment of the stomach,\\nyou know already that our chief treatment is over the splanchnics; I have\\nalready indicated to you the manner in which we treat the splanchnics. We\\nalso go to the solar plexus, treating by pressing deeply below the end of the\\nsternum, over what is called the pit of the stomach, a pressure of five, six or\\neight pounds, and thus impinging upon the solar plexus. You thus get an\\neffect on the stomach, since the plexus has control of the coeliac blood supply,\\nas well as various other blood vessels in the abdomen. Sometimes we treat\\nthe stomach mechanically by raising the ribs, as we would on the right side in\\nliver trouble. It is the usual motion of raising the ribs. Or you can set the\\npatient up, have him take a deep breath, and put the fingers in gently under\\nthe ribs and raise upward and outward, thus freeing the parts in that way.\\nOf course in any treatment we wish to reach the splanchnics, the solar plexus,\\nand it is said there is an important point in the neck. We also reace the vagus\\nalong the sides of the neck and behind the clavicle, where the vagus crosses\\nthe first rib. At the atlas, it is said a displacement to the right will interfere\\nwith the right vagus. In the case of nausea we inhibit upon the left side be-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0164.jp2"}, "165": {"fulltext": "TREATMENT OF THK STOMACH. 1 59\\ntween the fourth and fifth ribs. You know how to find these interspaces. I\\nsimply thrust my thumb into that interspace. The spine of the scapula is op-\\nposite the third, then coming down a little over an inch, you will readily be\\nable to find where the interspace is; then you must raise the arm a little, just\\nenough to relax those parts, and thrust the thumb deeply it that interspace.\\nThat is one way of treating nausea, but it depends upon the cause. I have\\nhad cases of nausea in which that would not succeed, the pressure gave no\\nrelief, but general work upon the splanchnics would give relief. That was a\\ncase where the patient was easily susceptible to congestion of the stomach, and\\nsuch treatment, coupled with treatment of the vagi in the neck would always\\ngive relief. Treat in general the back from the third or fourth dorsal down to\\nthe tenth, eleventh or twelfth. Displacement of ribs may cause the same\\ntrouble, and you may also find a contracture along the spine on either side\\nwhich will cause trouble with the stomach. I treated a case some time ago in\\nwhich the only lesion I could find was a contracture of the muscles on both\\nsides, there was a little heaviness of the stomach, which disappeared on treat-\\nment. You may find exquisite tenderness over the region of the stomach, and you\\ncan see on pressure whether or not that be nervous or inflammatory. When,\\nyou have gas in the stomach it shows there is a lack of life in such a way as to\\nallow the food not to be digested and pass on in the usual way, but to be re-\\ntained and thus to ferment and form gas. It is said to free the stomach of its\\ncontents to inhibit the pneumogastric between the fourth and fifth ribs, as I\\nhave shown you, and in that way you relax the pylorus and allow the food\\nand contents to pass off. Or you can also do the same thing by mechanical\\nwork. I thrust my hand under the left ribs in this way and work toward the\\nlarge end of the stomach; I bring pressure gradually toward the pyloric end,\\nin that way you can force onward the contents of the stomach. You w^ork\\nthus over the ribs; you can press the ribs down and you can also, in the median\\nline, work very carefully on the abdomen; you can thus work the gas or liquid\\nfrom the stomach.\\nThis deep prCvSsure over the solar plexus, as I have already shown, is said\\nto be very efficient in case of bloating with gas. In some way the stimulation\\nof the plexus allows the gases to be condensed, and that is one of the eflicient\\ntreatments in cases of gas on the stomach or bowels, The ninth and twelfth\\nribs on the left side have been found displaced in some cases. In cases of pret^-\\nnancy, menstruation or such troubles, you will frequently find a sick stomach.\\nOf course that is reflex. To treat a sick headache which is caused from the\\nstomach, you must first apply your treatment to the stomach, and thoroughlv\\nstimulate the parts there before attempting to work on the head. In case of\\nfemale troubles, you may give relief there, and it is well to do so, but of course\\nyou must work upon the local trouble at its appropriate centers to relieve it.\\nNow, as to the liver. First as to its examination; you cannot see anything\\nby mere inspection; the best way is to percuss the region of the liver. If vou\\nfind behind the linea alba that the left lobe comes down as much as three inches,.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0165.jp2"}, "166": {"fulltext": "l6o TRKATMKNT OF THK LIVKR.\\nthe liver is either prolapsed or enlarged, and you will have to determine which\\nis the case. By percussion along the lower edge of the ribs and up over the\\nribs as high as about an inch below the nipple you can make out the outline of\\nthe liver. You will also frequently find that it is quite tender, and it becomes\\nextremely so in some cases. Dr. Harry Still sa3^s that in case the liver is ex-\\ntremely tender he always looks for diarrhoea. The easiest place to find whether\\nor not the liver is tender is in the median line behind the linea alba. Of\\ncourse the liver is complicated with general troubles, as for instance, in con-\\nstipation and diarrhea; these two things indicate derangement of the liver. In\\ndiseases of the liver you will frequently notice yellow splotches upon the skin,\\noerhaps on the face, perhaps over the abdomen; j^ou will find a rushing of\\nblood to the head, double vision, or day blindness. You must learn in general\\nwhat the complications are, when the liver is deranged. I have noted already\\nthe fact that auscultation is frequently used in examination of the liver. Just\\nplace the ear very lightly over the region of the liver, at the edge of the liver\\nyou will be able to make out a gurgling if there be such there. Now, as to\\nthe treatment of the liver itself. I have already shown you how w^e treat the\\nliver the raising of the ribs as shown here; or have the patient take a deep\\ninspiration, and then raise the points of the ribs. Dr. Harry Still frequently\\nemploys that method reaching under the tips of the ribs and raising them\\nupward and outward. Of course 3^ou will have to be careful in doing that.\\nWe also work upon the liver frequently in this way: you can place one hand\\nbeneath and thus raise the side of the chest toward you, and with the other\\nhand press down with the flat of the fingers against the liver. Thus you can\\npress the ribs down, and this motion is ver3^ good.\\nI explained what I believed to be the theory of such work the other day.\\nOf course in treating the liver we must remember that there are vaso-motor\\nfibers in the pneumogastric, and we must not omit to treat it. We also treat\\nthe splanchnics, as they contain the sympathetic supply; also the solar plexus.\\nThose are the chief points for reaching the blood and nerve supply of the\\nliver. Also the point that I gave 3^ou, upon each side of the umbilicus, it is\\nsaid that pressure here applied not too deeply, a fairly firm pressure, will\\nreach those centers and influence, first, the kidneys; second, the liver: and\\nthird, the bowels; you can get an influence upon all those organs in that way.\\nAs to the gall bladder and duct, they are extremely important to us. As\\nI have said, the gall bladder is behind the liver at the point of the ninth rib on\\nthe right, but we can get indirect pressure upon it by working up under the\\npoint of the ribs, for instance, 3 OU can sometimes feel the prominence made\\nby the fundus. The first thing in working upon the gall bladder is to work\\nagainst the fundus, and we can work upon it by working up under the ends of\\nthe ribs. The duct we have already spoken of, it lies upon the right in a re-\\nversed S being just over the umbilicus, to the left, and the lower limb of\\nthe S around the umbilicus to the right where it empties into the duodenum.\\n-Since the gall bladder and its ducts are both lined with mucous membrane and", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0166.jp2"}, "167": {"fulltext": "TRKATMKNT OF THE LIVER. I 6l\\nlike mucous membranes in other parts of the body it is liable to catarrh, it fol-\\nlows that catarrhal inflammation may sometimes travel from the pharynx,\\nthrough the oesophagus, stomach and intestines and up into the gall bladder\\nYou will then have an increased secretion of mucous in the gall bladder and\\nduct, and may have a mucous plug shutting up that duct, resulting in jaun-\\ndice. Or you may have a gall stone formed, said to be a precipitation of the\\ncholesterine of the bile; these solidify and close up the duct. In treating for\\nthem we work as I have shown you, against the fundus of the bladder and\\nalong the duct, simply trying to force them out. Sometimes they are quite\\nhard, and at times they are quite soft and can be crushed in the duct; this has\\nto be done without any violence, however. It is said that in treating for gall\\nstones, you should not endyour treatment without raising the ninth, tenth and\\neleventh ribs on the left side for the spleen; that stimulation of the spleen\\nseems to prevent their formation, and results gotten there seem to prove that\\nline of argument.\\nQ. In case you were treating the vagi in the neck and the patient should\\nbe taken with a nervous chill or something of that kind, at what point would\\nyou treat to counteract that?\\nA. I would treat along the spine, a general treatment. It is said that a\\nrubbing up the spine is good for a chill, and I would work there for a chill,\\nstimulating also the heart and lungs to stimulate the circulation.\\nI.BCTURE XXV.\\nAt the last lecture I took up the examination and treatment of the abdo-\\nmen and its contents, first showing you how we treat to aifect the abdomen in\\na general way, and then I started to take up the contents of the abdomen one\\nafter another. I thought I should get as far as the intestines the last time,\\nbut failed to do so, and that will be included in today s lecture. I will also\\ntake up the consideration of the pelvis today.\\nI. Some nerve connections and centers for the intestines and pelvic con-\\ntent i. I have already mentioned some centers, in the list given, and we should\\nalways consider those conters along the spine in connection with the different\\nparts. There are certain vaso motor fibres noted in Howell s Text Book:\\nFirst, for the external genital organs there are two groups, one coming from\\nthe lumbar region, and the other from the sacral region. Tho.se of the lumbar\\nfrom the secjud, third, fourth and fifth lumbar nerves,\\nrunning forward in the white rami communicantes: thev pass\\ntbrough the pelvic plexus and pudic nerve and thus reach\\ntheir termination. You will see later that this pudic nerve is im-\\nportant to us in our treatment; you know it contains some vaso- motor fibres for\\nthe external genitals. As for the sacral group, these leave the anterior roots\\nof the nerves in the sacral region. A stimulation here causes a dilation of the", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0167.jp2"}, "168": {"fulltext": "1 62 nerve: centers and connections of PEI.VIC ORGANS.\\nvessels of the external genitals. As to the internal generative organs, vaso-\\nconstrictors for the Fallopian tubes, uterus, and vagina in the female, and for\\nthe seminal vesicles and the vasa deferentia in the male, are contained in the\\nsacral nerves. Also we get some fibres from the second, third, fourth and fifth\\nlumbar nerves, just as we had vaso-motor fibers for the external genitals. We\\nwant to know the following points: That the second, third, fourth and fifth are\\nthe same for the external and internal genitals; that we get vaso-motor fibres\\nfrom both; that we also work, as you will see later, in consideration of the pel-\\nvic contents, frequently upon the sacral region, springing the sacrum, relaxing\\nthe ligaments about it, and also stimulating the peripheral terminations of the\\nnerves in the muscles along the sacral region. It is said that the first point to\\nwhich one should go in treatment of female troubles is the fifth lumbar; that\\nthat is is the important point, not particularly an important center, but the\\nplace where it seems a displacement is likely to occur. Then, too, you know\\nthat that is the center for the hypogastric plexus. The next important point\\nis the second lumbar, which is the center for blood supply to the uterus. After\\nthat in treatment of female troubles the next important point is between the\\ntenth and eleventh dorsal vertebrae, the blood supply to the ovaries.\\nHilton makes a point that the muscular abdominal walls, the peretoneum\\nlining all of these walls, and the skin over them, are supplied by branches of\\nthe same nerves, as we have already mentioned the point he makes that a joint,\\nthe muscles moving the joint, and the skin covering the insertion of those\\nmuscles, are all supplied by branches of the same nerve. Hence, it is, he says,\\nthat retraction of the abdominal wall and great tenderness of the skin over the\\nabdomen is found in cases of peritonitis, the inflammation reaching the termi-\\nnal filament in the peritoneum, extending thus from the branches irritated,\\nthe sensory branches to the motor branches, causing the abdominal walls\\nto contract, influencing also the external cutaneous branches,\\ncausing a feeling of pain upon touching the abdomen. That\\nbrings to mind the point that has already been\\nmentioned, and which was brought up in clinics not long since. The ques-\\ntion was, can you impinge upon the sensory part of a nerve and thus affect its\\nmotor fibers. I think that such points as this answer that very clearly. Hil-\\nton also instances a case of peritonitis, in which the cause was obscure. It was\\nnot severe, but it was hard to tell at first that it was peritonitis. The patient\\nhad been having pain in the abdomen, it was bilateral, there was no heat at the\\npart; he therefore decided that the cause was either central or double, and since\\nthere was no heat there, he examined for spinal trouble. He examined thor-\\noughl}^, but could not find any evidence of disease of the spine; he then made\\nhis examination for tluid in the abdominal cavity and found that there was\\nfluid in the abdominal cavity, irritating the nerves and causing this pain upon\\nthe abdomen.\\nIn considering the pelvis, I thought it would be interesting to bring out\\nsome further points considering nerve connections there. I noted the point", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0168.jp2"}, "169": {"fulltext": ":nkrve: centers and connections of pelvic organs. 163\\nthe other day that ia trouble of the uterus, ovaries, etc., the sympathetic fila-\\nments supplying these parts carry the irritation back to the spinal nerves, and\\nthus it may go down the sciatic, or might influence the muscles at the lower\\npart of the spine, causing lameness there. A further point is noted with con-\\nsiderable interest, and it may be useful to us in many cases. Hilton noted a\\ncase in which a gentleman came to him with what he supposed to be trouble\\nof the bladder and urethra. He had pain externally in the genitals on one side\\nand he traced the pain very definitely along the peripheral branch of the pudic\\nnerve, along the ramus of the pubis and ischium to the genitals. Hilton traced\\nthe nerve carefully back and discovered at the tuberosity of the ischium on the\\nside affected a thickening of the tendons. The gentleman had been used to\\nsitting upon a hard uneven seat, and gradually there had formed a thickening\\nof the tissues which had impinged upon the nerves and caused this pain. As\\nyou know there is a bursa over the tuberosity of the ischium for its protec-\\ntion, and irritation or excessive use, or sitting upon a hard seat, or weight un-\\nevenly distributed, will cause similar troubles. It may be an Osteopath would\\ngo back to the spine, but if he did not find a lesion there the next best thing\\nwould be to go to the nerve, and 5:ee, especially at the tuberosities, if there\\nwas not some trouble.\\nII. Landmarks about the Pelvis and PsRiNtiUM: You are all famil-\\niar with the location of the anterior superior spine of the ilum. It is used by\\nsurgeons as a point from which to measure the length of the limbs, which\\nyou know is quite a hard thing to do successfully, so many things make\\nchanges in the length of the leg. Holden, however, says he finds it more re-\\nliable to take a tape line and have the patient hold it between his teeth, then\\nmeasure a fixed point on the limb somewhere, (he measures to the inner malle-\\nolus) not swinging the tape from one side to the other, but making an inde-\\npendent measurement each time. You will find that in work upon the pelvis,\\nand in examining the legs you will have to see that the patient lies perfectly\\nstraight upon the table. One good way is to ascertain whether or not a line\\ndrawn transversely between the anterior superior spines is at right angles to the\\naxis of the body; you will have to see that the patient is perfectly straight. It\\nis also helpful in making a diagnosis of hip joint disease, or disease about the\\nhip joint, to place the thumbs firmly upon the spines, one upon each, then grasp\\nbeneath the trochanters with the finger, and you will be able to examine in\\nthat way for two things; whether the two sides are alike, and at the same time\\nyou can press backward upon the spine; a tenderness behind gives evi-\\ndence of disease, frequently in the sacro-synchondrosis.\\nThe spine of the pubis is also familiar to you in its location. It is not al-\\nways easy to find; sometimes j^ou can find it by pushing the lower abdominal\\nskin backward toward the direction of the spine; if not successful then, by\\nabducting the limb slightly, causing the adductor longus to be tensed; you can\\nfeel its attachment to the spine. Frequently it is difficult to distinguish be-\\ntween two kinds of hernia, the inguinal and femoral, but is said that in case of", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0169.jp2"}, "170": {"fulltext": "1 64 LANDMARKS ABOUT THE PELVIS AND PERINEUM.\\ninguinal hernia the spine of the pubis is on the outside of the neck of the sack,\\nwhile in case of femoral hernia it is on the inside. That may be a helpful\\npoint.\\nThe perineum has a ligamentous and osseous boundary; it is bounded by\\nthe rami of of the pubes and ischia, the tuberosities of the ischia, and the great\\nsacro-sciatic ligaments and the tip of the coccyx behind. It is important in\\nour practice, I have not seen the point mentioned in the books, that we should\\nnote the shape of the perineum. In the normal, healthy perineum there is a\\nslight bowing upward to hold up the pelvic contents. In disease there may be\\na relaxation of the ligaments of the perineum and a dropping down of the con-\\ntents, causing a bulging of the perineum. Of course the bulging is slight\\nwhether it is normal or abnormal, but it is important; those things sometimes\\ncause a great deal of trouble, even though the variation from the normal posi-\\ntion may be slight. In treating such a case we go to the pubic nerve where it\\ncrosses the spine of the ischium, stimulating just where it crosses the spine,\\nand its perineal branches runnine: to the perineum cause a contraction; also by\\nstimulating the lower sacral nerves, causing a contraction of the coccygeus\\nmuscle we thus help it to raise the bow^l and the pelvic contents.\\nAlong the region of the sacrum we find the posterior superior spines of the\\nilia. They are on a line which would pass horizontally through the second sa-\\ncral spine and they also mark the middle point of the sacro-iliac synchondrosis.\\nWe can find opposite them the spines of the sacrum, down to the last, and two\\ntubercles upon the last just where it ends. The third sacral spine it is said is\\nthe limit of the extent of the membranes of the cord in the spinal canal and of\\nthe presence of the cerebro-spinal fluid in the canal.\\nThe prominence of the gluteti muscles often become significant. That is,\\nit is said that in persons of ill health these muscles become relaxed and flaccid,\\nand that wasting upon one side is an early symptom of hip jomt disease, which\\nis very difficult to diagnose. The fold of the buttock is the name given to the\\nline just below the edge of the gluteus maximus muscle, between it and the up-\\nper back part of the thigh, and it is said that in this fold is the easiest place to\\nbring pressure upon the great sciatic nerve. Taking a point between the tro-\\nchanter and the tuberosity of the ischium, and press in deeply, rather nearer\\nthe tuberosity than the trochanter, you can impinge upon the nerve. Often a\\nperson sitting sidewise will have the leg become numb because of impingement\\nupon the nerve; you may sit upon the edge of a bench and injure this nerve so\\nas to cause sciatica\\nA line drawn from the posterior superior spine of the ischium to the top\\nof the trochanter, when the thigh is rotated forward, marks at the junction of\\nthe upper with the middle two-thirds, the emergence of the gluteal artery from\\nthe great sacro sciatic notch, and it is at that point that you can determine the\\ntop of notch. The pudic nerve and artery, as you know, both cross the spine\\nof the ischium. This is located by drawing a line from the same point, the pos-\\nterior superior spine of the ischium, tb the outer side of the tuberosity of the", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0170.jp2"}, "171": {"fulltext": "EXAMINATION AND TREATMKNT OF INTESTINES. 1 65\\nischium, then taking the junction of its outer and middle third, you have where\\nthis vessel crosses the spine, and there you can impinge upon it. Of course\\nthe nerve accompanies the artery, and that is an important point to the Osteo-\\npath, for there you can stimulate that nerve and cause contraction of the peri-\\nneum. The point is mentioned that modern methods of sitting, enjoying one s\\nself in an easy chair, or upon soft cushions and the like, causes the parts to be\\nsupported more by the soft parts about the hips, so that pressure could thus be\\nbrought upon these blood vesssels, especially the pudic, and that a hard chair\\nis much more healthful. Upon the condition of these nerves depends the blood\\nsupply to the interior pelvic organs. Pressure, brought by sitting, upon these\\nvessels determines the flow of blood into the pelvis and is a fruitful source of\\nuterine and pelvic disorders.\\nIII. Examination and Treatment of Abdominai, Contents (Con-\\ntinued) As to how to diagnose troubles of the intestine, you will learn that\\nbetter in symptomatology, when you come to the special diseases. However,\\nI can show you something, pf the methods employed. It is obvious that when\\nyou have a case of constipation, diarrhoea, flux or anything of that kind, where\\nthe trouble is. The nerve supply for the intestine, as you know, is through\\nthe sympathetics from the upper dorsal down; that is, from the third dorsal\\ndown, because we get the vaso-motors to the mesenteric vessels from the\\nsplanchnics, and we reach the sympathetic connection all the way down the\\nspine. I have already shown you how to treat those parts. We also reach it\\nby working on the solar plexus, and you can get an immediate effect by work-\\ning upon the centers either side of the umbilicus. In all these ways we may.\\nreach the intestine. Stimulation of the sympathetics will inhibit the vermicu-\\nlar motion of the bowels, while stimulation of the pneumogastric will increase\\nthe motion. Of course you know that in working upon the region of the in-\\ntestines we also work upon Auerbach s and Meissuer s plexuses. There is a\\ntreatment that we use sometimes in case of constipation, trouble with the\\nbowels, that is, we begin at the left iliac fossa, and by deep pressure over the\\nline of the colon, work gradually upward along the left lumbar region where\\nthe intestine runs over the kidney, then across just above the umbilicus, and\\ndown the right lumbar region; that is, we work there largely for mechanical\\neffect; to soften the fecal matter and work it outward as we go, beginning near\\nthe orifice. Of course it is impossible not to impinge upon the nerve plexuses\\nand not to influence iVuerbach s and Meissuer s plexuses in working upon the\\nintestines there. You will very frequently, according to the season of the\\nyear, which will soon be upon us, come across cases of cramps and diarrhea.\\nIt is not, however, limited to particular seasons of the year. I have found cases\\nof bad cramps in the intestines where it was almost periodic, you might say. it\\ncame on every two or three months; after some indiscretion, as over eating or\\neating of too rich food the patient would have those attacks. The spasm, as\\nnear as I could make out, is most liable to occur in the transverse colon; it\\nstarts there first and there is an irritation, from that point the irritation will", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0171.jp2"}, "172": {"fulltext": "1 66 EXAMINATION AND TREATMENT OF INTESTINES.\\npass down through the bowel, and the next morning or the second morning\\nyou will have tenderness and pain down in the region of the right iliac fossa.\\nIt has been mj^ experience that it takes that course; and from there it will\\nspread over the bowel and you will have a case similar to an inflammation. I\\nthink it is an inflammation, from the fact that the patient usually passes\\nmucous upon convalescence. This trouble can be very readily stopped. It is\\ndone by inhibiting the splanchnics; you can have the patient sit upon a chair\\nand hold closely all along the region of the splanchnics, just by a deep pres-\\nsure, hold at each point for a minute or two and you ^vill be able in that way\\nto stop the spasm. I have seen it disappear in a very short time. The same\\nthing can of course be done by placing one knee along the splanchnics and\\ndrawing the arms up and back. Of course that brings deep pressure, and very\\nforcible, against the splanchnics, and inhibits them Particularly it is the up-\\nper splanchnics we wish to reach, but it does no harm to work on down the\\nspine. It is not a bad idea to adopt this twisting motion, because it there is a\\ntightening and irritation of those nerves, you will be able to relax them in that\\nwa}^ and I have been able, in that way, to get very good results with such\\ntrouble. There is another thing that comes to us very commonly, and that is\\nflux and diarrhea. The center for the bowels in such cases, it is said is oppo-\\nsite the lower two ribs on each side, but we work by inhibiting, by getting\\ndeep pressure, just as I have shown you. Have the patient sitting up, and\\nyou can place your knee against the eleventh and twelfth ribs and pull the arms\\nup and back, and then against the ocher side; you can thus inhibit the peris-\\ntalsis. It is undoubtedly through the sympathetic connection there, and in-\\nhibition of the sympathetics. I never omit in such cases to spring the spine,\\nand to spring it strongly; that is one of the cases where we have to give a\\nstrong treatment, so I have the patient on the side, reach under the spine and\\nspring the column up toward me strongly, all along the lumbar region. It is\\nside, very helpful also to adopt this method in such cases: with the patient upon his\\nhave the thighs bent up and get a good hold against the sacro-iliac articulation,\\nand spring enough to raise the patient from the table. I think you can see\\nfrom the motions I have given you about what you can do in such cases. Also\\nin such cases never forget to work upon the liver; I have already shown you\\nhow to reach that, and influence it, especially the flow of the bile. It does\\nnot make much difference whether the patient is constipated or whether he\\nhas flux or diarrhea, the presence of bile in the intestines in undoubtedly\\nhelpful. In cases of constipation the Old Doctor says the bile is nature s\\naperient, and that it helps to stimulate the peristalsis. In the other case the\\naction of the bile in the intestine seems to be such as to allay the irritation or\\nthe inflammation. It simply amounts to restoring the normal; in one case you\\nhave a lack of bile, and the normal action of the bowel seems to be dependent\\nupon it for stimulation. In the other case you must work to cause a flow of\\nbile also. Just why it works differently it is very hard to explain, unless, as I\\nsay, it is the normal condition of the bowel to have the bile present at certain", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0172.jp2"}, "173": {"fulltext": "TREATMENT OF INTESTINES. 1 67\\nintervals, and if that bile is lacking, you may have various effects. I had a\\nvery interesting case not long since, a gentleman who some years ago, I think\\nabout three, had a case of bowel trouble, diarrhea and considerable trouble at\\nthat time, severe trouble. Since then he had had pain after eating, about\\nthree hours after a meal, also bloody flux at stool. This had been troubling\\nhim off and on ever since he had the old trouble. Upon examination the only\\ndifficulty that I could find was tightening along the lower lumbar region, mak-\\ning a smooth place in the spine, which I have already described to you. Be-\\nsides that the eleventh and twelfth ribs on each side were approximated, forced\\ntogether, so that you could feel but very little interspace between them In\\nthe first treatment I did all I could to spring the lower part of the spine and to\\nrelax the tissues in that region, and also adopted motions already shown to\\nseparate the eleventh and twelfth ribs. After that treatment the pain after\\neating ceased and he did not have any return of it. The next treatment w^as\\ngiven about a week later, and I repeated the same process at that time. Since\\nthen, at the last information about a week ago, he had had no return of the\\ntrouble, and that was about two weeks after the treatment. Now, that was all\\nvery simple, it was merely looking to see where things had departed from the\\nnormal, and restoring them and relieving the tension upon the parts. One\\nthing that I did in that case was to relax the ligaments in this way, by spring-\\ning the lumbar region. You will learn these motions and how to apply them.\\nIt seems that in some certain kinds of trouble one motion is more efficacious\\nthan another, and you will also find that it varies with your patient. I also,\\nin that case, took what I call the quarter turn to relax the tension between\\nthose ribs. That is, I got the legs of t e patient in my arms, and turned him\\nuntil his body was about three quarters off the table, then let him slip down\\nand around back onto the table in that way, straightening the legs. I think\\nyou understand, as I showed you the motion before. I think I mentioned the\\npoint that a displaced coccyx is sometimes the cause of diarrhea. There is\\nalso another important treatment in the case of intestinal troubles. That is,\\nyou may raise the intestines almost bodily, especially in cases where there is a\\nrelaxation of the abdominal walls, where you find the transverse colon des-\\ncended below the umbilicus, and then by pushing in deeply above the pubes\\nyou can push upward and outward and thus raise the abdominal contents.\\nAnother motion is to have the patient lie on the side and then to reach deeply\\ninto the fossae and work in on the right side under the caecum, follow it up\\nand spread apart, and then work in the same way on the left to raise and spread\\nout the sigmoid flexure. That is frequently a very good way in which to\\ntreat troubles of the intestine, especially where you expect any sort of relaxa-\\ntion allowing the bowel to drop in that way, and that is in almost every case\\nwhere you have had intestinal trouble that has been going on for some time.\\nThere is almost always a relaxation of those ligaments, and prolapse of the\\nbowel. You will remember that the defecation center is at the second lumbar,\\nand the Old Doctoi has shown me a good point in how to reach the second", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0173.jp2"}, "174": {"fulltext": "1 68 TREATMENT OF INTESTINES SPI.EEN.\\nlumbar. He places the thumb of one hand just over the trochanter or just\\nabove, and then finds the second lumbar by counting carefully up from the\\nfifth lumbar, and then while he presses upward the trochanter of the patient\\nwith the hand that is on the hip, he presses inward with the other hand and\\ngives a turn to the second lumbar. Then taking the same point for one hand,\\nand reaching under and raising the patient s head and shoulders you can thus\\nvery effectually relax the second lumbar. You see that makes the second\\nlumbar a fixed point and you swing the upper part of the trunk around it, and\\nin the other place you swing it in much the same way. Robinson makes quite\\na point of the fact that what he calls the fecal reservoir, viz., the left half of\\nthe transverse colon and the descending colon and the sigmoid flexure, are all\\nsupplied by the inferior mesenteric ganglion. This inferior mesenteric gan-\\nglion is found on the inferior mesenteric artery, and you can reach it by work-\\ning a little toward the left about two inches below the umbilicus. We have\\nvery good results in cases of constipation by working there and stimulating\\nthat plexus; the inferior mesenteric ganglion of the sympathetic. In speaking\\nof the use of bile it is not only helpful in cases of diarrhea, flux and constipa-\\ntion, but that is our way of destroying entozoa, tape worms, or seat worms, or\\nparasites of any kind, it is said it is always beneficial to stimulate the flow of\\nbile iu such cases, and very frequently that is all that is necessary, thus caus-\\ning the worm or whatever it is to be acted upon by the bile. In treatment of\\nconstipation you will frequently find that the patient is simply in trouble be-\\ncause he has not drank enough water, and that is why very frequently it is\\nnecessary to prescribe so man glasses of water in a day, you can say mineral\\nwater or spring water, or something of that k;ind, so they will think you are\\nparticular about it. It is said that the explanation of why drinking of water\\nis beneficial in cases of constipation, is that when the stomach is empty (the\\nwater should be used one half hour before breakfast) that the water passes in-\\nto the intestine and is easily absorbed by the lacteals and carried to the portal\\ncirculation, and that stimulates the flow of bile and increases its quantity, and\\nthus it affects the fecal contents.\\nAs to the treatment of the spleen, I have already shown you that at the\\nlast lecture. You will find that there is a tenderness along the spine behind,\\nand in front along the region of the ninth, tenth and eleventh ribs on the left\\nside in such cases, and Dr. Harry Still tells me that in- such cases it has been\\nhis experience to find a cold, clammy perspiration, especially on the leftside of\\nthe body. What we do there I have already explained, raise the ninth, tenth\\nand eleventh ribs, and work carefully under the tips of the lower ribs in front.\\nAs I explained at the last lecture, the vaso motor supply of the spleen is not\\nunderstood, but it was seated that we changed its size by work upon the peri-\\npheral terminals of the splanchnics, but it is understood also that there is a\\ncenter in the medulla. There is also a center in the medulla for the intestines,\\nand it seems that some trouble with the atlas, or some tightening of the liga\\nments may impinge upon the sympathetics and thus get an effect either\\nthrough the medulla or directly through the sympathetic system.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0174.jp2"}, "175": {"fulltext": "tr:^atmknt of the kidneys. 169\\nIvKCTURE XXVI.\\nAt the last lecture I was following the subject of examination and treat-\\nment of the abdominal contents. I shall pursue that subject further today,\\ntaking up also the pelvis, its examination and treatment, particularly with re-\\ngard to slips or twists of the pelvis as a whole and of the innominate bones.\\nWe had gotten as far as to the kidneys. To treat the subject in a general way\\nwe can only say that in general where there is trouble with the kidneys there is\\na tenderness in the back, frequently contractures or displacements along the\\nspine. There are general symptoms which you will learn to recognize, and\\nwhich you will find by urinalysis, which you have learned elsewhere. Also such\\nthings as odor of the breath, and condition of the tongue, it is said that a fur-\\nrowed or ridged tongue indicates kidney disease. The complexion, and various\\nthings of that kind, are indications of kidney disease; also fever, especially fol-\\nlowing suppression of the urine, since then the system is poisoned. Often\\nyou have painful micturition due to bladder or kidney disease; and so on. The\\nchief thing, however, is how we, as Osteopaths, treat the kidney. The nerve\\nsupply is largely through the renal splanchnics, the last splanchnic rising oppo-\\nsite the twelfth dorsal. I have already shown you how we should work there.\\nAlso the second lumbar is the center for micturition, and the effect that we get\\nby working upon the second lumbar is probably a vaso-motor effect, since you\\nknow that vaso motors leave the spine all the way down, especiall}- from the\\nsixth dorsal to the second lumbar, having both vasodilators and vaso-constric-\\ntors within those limits. A lesion at the atlas also affects the kidneys, probably\\nby an effect upon the renal center in the medulla. Hence, we alwa3 s examine\\nto find whether or not the atlas is displaced, and if not, we are able to get an ef-\\nfect upon the renal center in the medulla by working on the superior ganglion\\nand in the sub-occipital fossa. Hence, we get a sympathetic effect. Now, a\\nlesion in the cervical region, especially at the upper part, at the atlas, may affect\\nthe kidne}^ directly through the sympathetics, and indirectly through the center\\nin the medulla.\\nOne of the best ways to treat the kidneys is the method employed b}^ Dr.\\nHarry Still; have the patient upon the back, with the knees raised, you then\\nhave all the muscles relaxed. Then by lifting along in the region of the\\nlower splanchnics, simply raising the patient upon the fingers and springing\\noutward as you go, you relax the contractions, and spring the ligaments and\\nget a general stimulating effect upon the kidneys. You will find that. I think,\\none of the best treatments. Another treatment is to press here at the linibiliciis.\\nand by pressing deeply, spxreading and stimulating probably the sympathetic\\nganglia, upon the renal ves.sel, as there the renal ganglia occur. Also the cen-\\nters which I have before mentioned, occuringone on either side of the umbilicus\\nin the skin, called perintoneal centers, have an effect upon the kidneys, and I\\ndo not doubt but that we get some sort of a mechanical eft ect also in this way,\\nby relieving any pressure which may be brought upon the renal vessels. Of", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0175.jp2"}, "176": {"fulltext": "1 70 TREATMENT OF KIDNEYS. PEI^VIS.\\ncourse there are other things that may bring mechanical pressure upon the renal\\nvessels, such as aneurism of the abdominal aorta, an enlargement of vSome one of\\nthe abdominal organs, or tumors, and in those cases you must direct your\\ntreatment to the conditions which are producing the disease. You will fre-\\nquently come across cases of renal colic, that is, stone in the kidney or in the\\nbladder, and in the passage of the stone down the ureter the pain is excruci-\\nating. Renal colic is the name given to the pain caused by the passage of the\\nstone. Of course the deposit varies, sometimes the stone is large, and it varies\\nin composition. I do not need to go into that, as that is not the purpose of\\nthis lecture; sometimes it is a crystal of uric acid about which deposits aggre-\\ngate, and in the long run there is quite a large stone. As to the proper treat-\\nment for it, when a stone is started from the pelvis of the kidney down the\\nureter it is our treatment to work along the course of the ureter and to work it\\nback, if it is possible, because you can dissolve it as well in the kidnej as you\\ncan if you press it on down to the bladder. Of course if it has started on down\\nthe ureter and cannot be worked back, it should be worked on down into the\\nbladder. You know what the course of the ureter is, from about the level of the\\numbilicus, a couple of inches on each side, down obliquely to the base of the\\nbladder. Of course I do not mean to say that you can feel the ureter by work-\\ning along its course. You can however, bring deep pressure along its course,\\nand thus work upward any stone which mav be in it. That is frequently\\ndone. In such cases our treatment would be directed to stimulating the gen-\\neral health of the kidnej^s, that is, to increase its healthy action, so that these\\nstones could not be formed. If your kidney is acting properly you will not\\nhave real calculus. Not only would we take care of the renal splanchnics, and\\nthe second lumbar, but all along the lumbar and lower dorsal region. I have\\ntried to teach you that your lesion may be at the center, but it may be above\\nor below, causing trouble with the kidneys. In general our success with kid-\\nney troubles has been very good. Of course when you come to general treat-\\nment, drinking of hot water, bathing, and exercises, are all good. There are\\nsome who believe that it is beneficial to, as they call it, flush the kidney every\\nmorning by taking a drink of water before breakfast. That acts upon the\\nkidneys as well as the bowel. It is probable that the increased excretion\\nwould tend to keep the kidneys flushed. Byron Robinson notes that fact, but\\ndoes not give it the weight of his authority\\nAs to examination and treatment of the pelvis, that is an important thing\\nin our work. The pelvis or the innominate bone may be slipped in different\\ndirections, and the correction of these slips gives the Osteopath very gratify-\\ning results indeed. The whole pelvis may be slipped forward or it may be\\ntipped backward in the first place, or the whole pelvis may be twisted from\\nside to side, and you would have tenderness on each side at the sacro-iliac\\nsynchondrosis particularly, and you will also have tenderness at the symphysis,\\nfor the reason that the sacrum is broader in front, as you see, and movement\\nof the parts then would tend to cause the wedge-shaped sacrum to act upon the", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0176.jp2"}, "177": {"fulltext": "TREATMENT OF PELVIS. I /I\\ninnominate bone and press them apart, thus you would have a strain at the\\nsymphysis, and you would have tenderness here just at the symphysis. In\\nexamining for these troubles, always pay attention to the symphysis. You\\nwould always have tenderness where the ligaments bind the back part of the\\nsacrum to the innominate bones. If it is tilted backward, your hand when it\\nhas become able by touch to detect the departure from the normal, will find\\nthat the posterior portions of the crests of the ilia are projecting farther back,\\nand when tilted forward, that the posterior portions of the crests are tilted\\nfarther forward, so that you will come to find out whether the position is cor-\\nrect when you examine by palpation, which is our general method. Now, if\\nthe pelvis is twisted from side to side you would find a tenderness on each side,\\nand at the sacro-iliac articulation as wellasa tendernessin front, at the symphy-\\nsis, and you will have to judge which is the case. Of course if the pelvis is\\ntwisted you can by examining the back get an indication of which way it is\\ntwisted. It will take v^ery close work in examination and you have to give it\\nyour careful attention. The reason why you would have tenderness on each\\nside is that in a twist of the pelvis from side to side you would have both liga-\\nments thrown on a strain, one diagonally backward, and one diagonally for-\\nward, and you would get tenderness in each case. When you have these\\nslips and twists, of course you have something then that is affecting the sacral\\nplexus of nerves, and the result may be pain down the legs, and you may have\\nsciatica in one or both limbs, and the most fruitful source of pelvic disorders,\\nespecially of female troubles, is a slip of the innominate, as you will see later.\\nSo your examination, then, would include both the symphysis in front, and\\nthe articulations behind, coupled with an examination for general disorders of\\nthe pelvis and even down into the limbs,\\nNow, as to how to treat the pelvis if it is tilted forward. One of the best\\nways that I know of is to set the patient on a chair, and then by putting the\\nknee in the sacrum behind, we can reach in front and get hold of the anterior\\nsuperior spines and pull backward; it does not take a great deal of force, and\\nat the time it is quite a good movement to pull the patient forward. If the\\npelvis is twisted, of course then the lower part of the body in respect to the\\nwaist is turned to one side or the other. One of the best ways to fix that is to\\nset the patient on a chair and get the arms up over your shoulder, you can sit\\nright down on their knees, and give a twist to one side or the other, simply\\nmaking an effort to move the whole trunk of the body upon the articulation\\nwith the pelvis, and as that is rather a moveable point, and often the point of\\ndisplacement, you can readily turn it from side to side. You can also move\\nthe whole pelvis forward by some such motion as this: have the patient lying\\nupon his side, you can make a fixed point with one hand against the back of\\nthe sacrum, and you can pull the limbs backward in this way; that would be\\nwhen the pelvis was tilted backward. Or, you can get the knee in the back,\\nand pull back on one side and then on the other with the patient lying upon\\nhis side as well as to set him in the chair. Some will prefer that method per-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0177.jp2"}, "178": {"fulltext": "172 TO SET THE INNOMINATE.\\nhaps. Then, there is another method; of course there are different ways in\\nwhich you might do this. One of the best ways which I have found to move\\nthe pelvis with the patient on his back, is to fix the hand and place it under\\nthe sacro-iliac articulation and then flex the thigh, and pull the knee down, out\\nand around quite strongly and thus relax the ligaments of the articulation.\\nThat should be done upon one side and then upon the other. Our experience\\nand practice has taught us this one thing: that ligaments are extremely impor-\\ntant; the Old Doctor sets considerable store by ligaments. You may have\\nsuch a thing as a cold, and the effect upon the ligaments will be to contract\\nthem, and you will have dislocations of the parts affected, from that simple\\nfact. You may have dislocations of the pelvis or of one of the innominate\\nbones. I had quite a remarkable case the other da}- there was almost com-\\nplete paralysis of the lower limbs, there was sensation and some motion, but\\nthere was very little motion, the patieni went about in a chair. That had all\\nbeen brought on by la grippe, and the whole body had ceased to grow, the arms\\nwere thin and small, the face and head were normal, and you got the impress-\\nion of looking at a dwarf when you examined the patient. So it is that a cold,\\nlight or severe, may act upon the ligaments and contract them and thus cause a\\ndisplacement of the parts, and there is no doubt that is frequently the cause of\\ndisplacement of the pelvis as of other parts.\\nNow, I have already stated, not only may the whole pelvis move one way\\nor the other, but one innominate bone may move one way or the other. That\\nis, the whole bone may be slipped up or down or it may be tilted backward or\\nforward. However, when the bone is tilted forward, you will see that it al-\\nmost inevitably goes somewhat upward on account of the shape of the articula-\\ntion here with the sacrum. From that fact, since when it is tilted somewLat\\nforward, and at the same time has a tendency to slip up along the back part\\nof the articulation, it will have the effect of shortening the leg. Consequently\\nwhen the innominate, not the pelvis as a whole, is slipped forward, you might\\nhave a shortening of the leg. Naturally you would suppose that a slipping\\nforward of the pelvis would lengthen the leg, but you can see from what I\\nhave said that such is not likely to be the fact. Of course that would change\\nthe normal axis of the parts. The various axes are made by junction of the\\nsacrum and ilum by means of ligaments, and when the innominate bone is mov-\\ned in one direction one point will be fixed and act as an axis, and another point\\nwill be fixed and act as an axis in another position of the innominate bone.\\nThat subject has not been thoroughly studied out, but it is a fact that when the\\ninnominate is slipped forward then you have a shortened leg, and when back-\\nward you will probably have a lengthened leg. Dr. Harry is authority for the\\nstatement that a twisted or tilted innominate may shorten a leg as much as\\nthree inches. Of course a novice looking at such a condition would think at\\nonce that the hip was dislocated, and that he had one of those wonderful things\\nthat are so much talked of, but it is not always the case, and you must be care-\\nful in your examination. One of the first things in examination is to make", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0178.jp2"}, "179": {"fulltext": "TO SET THK INNOMINATK. 1/3\\nthese motions of the thigh in and out, flexion of the knee up toward the shoul-\\nder, and so on, for the purpose of relaxing all unnatural tension about the leg,\\nso that you can tell whether or not the limbs are similar. Then gettting the\\npatient straight upon the table which you will have to do by accuracy of your\\neye, you can of course judge whether or not a line drawn between the anterior\\nsuperior spines is at right angles to the direction of the body. Then you will,\\nby taking a certain point, preferably the bottom of the heels, or just where the\\nseam runs around above the heel, note whether the legs are of the same length.\\nOf course you will have to take into consideration any variation in the thick-\\nness of the heel, some people have a thickened heel or sole put on their shoes\\nfor the very reason that their limb is a little shorter, though quite as frequent-\\nly the condition has not been discovered. When you have pain in the lumbar\\nregion of the back, pain in the hip, or in the leg, or in the sacral region, or in\\nthe external genitals, you will do well to examine to see whether or not the\\nlimbs are of the same length, and if such is not the case you may continue the\\nexamination further by looking to see whether or not the p elvis or one of the\\ninnominates is displaced. When you come to measure one leg by the other\\nyou have a variable standard, it is hard to tell whether or not one leg is longer\\nthan it ought to be, or shorter. So you have to take means of determining\\nwhich is the affected side. It is well to go to the sacral articulations, where\\nthere will be soreness on the side affected, because a greater strain has come\\nupon the ligaments there, and you will also have a soreness on the symphysis\\non the side affected. You will frequently have a tension and some tenderness,\\nvery likely from contraction of muscles, on the opposite side from the one af-\\nfected. Taking this left one as the one affected, then you might have a con-\\ntracture here and some tenderness on the right side, because when you have\\none thrown out of position, then yon have the equilibrium destroyed; there has\\nto be readjustment of the parts, and you will have tension there on that ac-\\ncount, but I think the rule given you will indicate to you which is the side af-\\nfected.\\nAs to how we may remedy the defect of one innominate being slipped,\\nthere are various waj^s; some are the same as I have shown 3 ou. As I have\\nvSaid, the motion thus employed, by flexing the thigh against the thorax, plac-\\ning the hand firmly under the pelvis, and pushing the knee outward and down,\\nthus straightening the leg again, is one of the best methods I have found. After\\nyou have done that, it is just as well to give the leg a straight pull, not a jerk,\\nand you can thus bring tension upon the ligaments, and you can in that way\\nfrequently straighten mechanically, and I think you can get a certain nervous\\neffect that will relax the spasm. It is just like putting your hand upon a con-\\ntracture and gently pulling against the contracture until you have relaxed it,\\nso it is with the limb, you can relax the spasm of the muscles, you can restore\\nthe equilibrium of nerve force, and it will return to normal. That is one way;\\nanother way is for the operator to stand in front with the patient upon the side,\\nthen, by reaching under the limb and grasping the tuberosity below and the", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0179.jp2"}, "180": {"fulltext": "174 TREATMENT OF THE BLADDER.\\nanterior superior spine above, you can move it in either way very readily; you\\ncan slip the innominate forward or backward; that is one of the best ways.\\nYou can in that way stand in front of your patient and do your work. You\\ncan get behind the patient, use the knee as a fixed point against the sacrum, and\\nthen, holding against the anterior superior spine, work it backward in that\\nway. When you stand behind, the idea is that you can work to draw the an-\\nterior spine toward 5^ou. Also you can stand behind the patient, one arm be-\\nneath the thigh of the patient, making a fixed point of your hand against the\\nsacrum, then bend the leg back until you have it back to a considerable extent,\\nvarying the degree of tension according to the patient. That is one very good\\nway to force the bone forward. Pressure upon the sacrum is very frequently\\nemployed; it is one of Dr. Hildreth s very common treatments. In a great\\nmany cases of treatment along the lower part of the spine Dr. Hildreth will\\nfinish by putting his knee against the sacrum and bringing it inward against\\nthe patient, while he draws the pelvis of the patient back towards him. The\\nidea being, as you readily see, to relax the ligaments and to take off the ten-\\nsion which is thus brought upon the branches of the sacral plexus. From\\nwhat I have said and from combinations that your own ingenuity will suggest\\nto you, you can remedy the defect when the innominate is slipped upward or\\ndownward. You might set the patient upon a chair and lift upward, at the\\nsame time having an assistant push downward upon the crest of the innomi-\\nnate affected. One point that you might notice in regard to affecting the in-\\nnominate is the fact that the quadratus lumborum has a tendency to help mat-\\nters along by its contracture, and in relaxing the tension about the innominates\\nivhen displaced, you would do well to stretch the quadratus lumborum. That\\nI have shown before; give it the diagonal stretch this way once or twice and\\n\u00e2\u0080\u00a2once or twice the other way; you can do that better with an assistant, because\\nyou can get a better tension. I think this shows the value of steady, firm work\\n\u00e2\u0080\u00a2over the body. The idea of working with jerks is bad, because as a rule, when\\nyou give a pull or prCvSsure, the idea is that you are relaxing, it is in the nature\\nof inhibition of nerve force, and if you go at it with a jerk, you are not only\\nliable to stimulate instead of inhibit, but thus set up a firmer contraction,\\nwhereas you wish to relax.\\nIn treating the pelvis, I have already noted the point that you can work\\nupon the spine of the ischium, thus impinging directly upon the pudic nerve.\\nI have indicated how you should find that point by a line drawn from the pos-\\nterior spine of the ilium to the outer side of the tuberosity, the junction of the\\nlower with the middle third of the line will be the point where you can best\\nimpinge upon the pudic nerve, and then by relaxing the glutei muscles by\\ndrawing the limb backward some, you can get deep pressure at that point, and\\nthus stimula*e or bring pressure and inhibition upon the nerve. Of course the\\neffect of that is to work upon the perineal branches, and through it to cause\\n^contraction of the perineum itself.\\nAs to the bladder, the point at which we reach the hypogastric plexus^", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0180.jp2"}, "181": {"fulltext": "TREATMENT OF THE BI^ADDER. 175\\nsupplying the fundus of the bladder, is at the fifth lumbar, as you well know.\\nAnd then along the sacral region we get some motor fibers to the bladder.\\nAlong the lumbar region, according to Quin, we get motor fibers, particularly\\nto the circular fibers of the bladder, including the sphincter. He says there^\\nare probably also to aid those fibers, inhibitors to the longitudinal fibers. Thus,\\nwork along the lumbar region would affect the bladder. An inhibitory effect\\nwould be to relax those circular fibers, and a stimulating effect would be to con-\\ntract the circular fibers. In the sacral region the Osteopath takes as his center,\\nthe third and fourth sacral, and he works there to relax the spincter of the.\\nbladder. It is stated by Howell s Text Book that in that region we get princi-\\npally the nerve fibers to the longitudinal muscular fibers. So you see there is,\\na contradiction between the Osteopath and the text book. However, it has\\nbeen our practice that by working in that region we got the effect, and of\\ncourse when theory and practice conflict we must take practice. There is a\\ndifference between the text book and what we have found in practice; we cannot\\nalways make them agree. It is stated by Howell s Text Book that in the\\nsacral region and in the lumbar region there are no vaso-motor fibers given off\\nto the blood vessels of the bladder.\\nIt is hardly worth while to tell you how to examine the bladder. Of course\\nyou know where the bladder is situated; when distended, it will rise above the.\\npubes, and you will likely find it by the tumor, and on percussion you will get\\nthe flat sound from the contained fluid, so that will be part of your examina-\\ntion, but the general symptoms which you will get, particularly in your symp-\\ntomatology and in urinalysis, will direct you in your examination of the blad-\\nder. If you have a case of ammoniacal urine you will be able to recognize the\\ncrystals under the glass, and can tell whether there is trouble with the bladder\\nin that way; you will note the presence of bacteria, setting up a decomposition\\nin the urine. Several months ago I examined a sample of urine under the\\nglass; it was freshly drawn and it was crowded with bacteria. I directed the\\noperator who brought the sample to boil the bottle and let it cool and thus have\\nit completely sterilized, and bring me a sample as fresh as possible. He did\\nso, and examination showed a great number of bacteria, and that very soon\\nafter obtaining the urine. This indicated the presence of bacteria in the blad-\\nder, setting up a decomposition of the urine. In that instance it was a case of\\nbladder instead of kidney trouble, as had been thought. That case had an en-\\nlarged prostate; the prostate had acted as a partial stricture to the passage of\\nurine, and the patient had used a catheter, had not taken any precaution to\\nkeep it antiseptic, and had thus brought about a large amount of his trouble.\\nThe operator washed out the bladder with some antiseptic solution and reduced\\nthe prostate, and the patient was out in a few days. The doctors had had him\\nready to die of kidney trouble, but the trouble was all in the bladder and pros-\\ntate. Of course in all our treatments we get particularly an effect upon the\\ncenters indicated in the spine, viz.: the fifth lumbar and the second lumbar,\\nthe centers respectively for the hypogastric plexus and micturition. The", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0181.jp2"}, "182": {"fulltext": "176 TREATMENT OF THE OVARIES.\\ntreatment there I hardly need to show you; it is the same as I have already\\nshown you in how to treat the spine. There is another treatment, though,\\nwhich I have already shown you, the treatment by raising the bladder bodily.\\nYou can do the same thing by having the patient stand in front of you, bend-\\ning forward at right angle, thus letting the abdominal contents drop down to-\\nward the symphysis, then by deep pressure inward and raising as the patient\\nstraightens up, you can raise all those parts. I have spoken already of enter-\\noptosis, the dropping down of the intestine; I shall speak presently of the pro-\\nlapsus of the uterus and all those things that allow a lengthening and a relax-\\nation of the ligaments which bind -hese abdominal contents to the walls.\\nAnything which allows a relaxation, of course brings down those structures,\\nand the Osteopath argues that there is too little life there. Now, how does he\\ngo about to replace those things? Should he simply push them into place, they\\nwould not stay they must be held there. Hence, the importance of our work\\nalong the spine, stimulating the nerve force and life to the omenta which are\\nholding these abdominal contents in place, so as to regain their tonicity.\\nNever forget that it will not do to replace a prolapsed uterus or replace intes-\\ntines which are displaced by reason of enteroptosis, unless at the same time\\nyou include the work along the spine; that we work with the idea of stimulat-\\ning the life of the ligaments and making them tense again. In fact, we should\\nalways have that in view, particularly we should be careful to stimulate or in-\\nhibit the nerve force to the part in trouble. We would also work deeply in\\nthis manner here, over the internal iliacs. That is one of the treatments for\\nthe bladder also. We thus stimulate the blood supply and direct it more par-\\nticularly to the part affected, by reason of the tendency toward the normal, and\\nthat treatment is very effective in such troubles. Of course in retention of\\nurine you wall always suspect some stricture. You may have an enlargement\\nof the prostate or some trouble of the sphincter of the bladder. You will find\\nalso that the quantity of urine varies af Ler very long reading by a person who\\nis not used to reading much, the amount of urine will be increased, and after\\nhysteria and various troubles, the amount of urine is greatly increased. There\\nis a motion employed largely by Mrs. Patterson for raising both the bladder\\nand the uterus. She has the patient flex the thighs, then, directing the pa-\\ntient to hold the knees together, you push them apart. In other words, you\\nwork against the resistance of the fiexed thighs. In that way the psoas mus-\\ncles will contract and the idea is that as you push them out the bladder will be\\nraised; having done that, you try just the opposite, tell the patient to hold the\\nknees apart and you draw them together. Mrs. Patterson employs that method\\nof treatment very frequently and has had very good success in female troubles\\nin that way. It affects both ^he bladder aud uterus.\\nWe should next direct our attention to the ovaries. They are found an\\ninch and a half in\\\\Nard from the anterior superior spines of the ilia. It is said\\nthey cannot be examined by physical means, that is, you cannot find them by\\nsimply feeling over the flesh where they should be, and it is only when tender", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0182.jp2"}, "183": {"fulltext": "EXAMINATION AND TREATMENT OF PEI.VIC VISCERA. I//\\nor when enlarged that you will be able to make out by physical examination\\nthe location of the ovaries. However, when inflamed, as they very frequently\\nare, the intense tenderness there about an inch and a half interior to the anter-\\nior superior spine would indicate their site. Also when inflamed they frequent-\\nly cause a swelling there and you will be able to find their location. The ovary\\nis also frequently the seat of a tumor, and the tumor may become very large,\\nand then not only palpation, but inspection, will reveal the seat of the trouble.\\nOur treatment for the ovaries is through the lumbar region, as you know. The\\ncenters given by Howell s Text Book for the internal genitals are along the\\nlumbar region from the second to the fifth; that is, vaso-motor fibers of both\\nkinds run to the internal genital organs. We should also examine carefully\\nthe sacro-iliao region and the lower dorsal. The center for the blood supply\\nfor the ovary is between the tenth and eleventh dorsal, and you should look all\\nthe way from the ninth to the twelfth dorsal particularly to see whether or not\\nthere is a lesion affecting the ovaries. We work upon the eleventh dorsal, re-\\nstoring it to normal when it has been misplaced, both is cases of profuse men-\\nstruation and in scant menstrual flow. That seems to be the particular center\\nsince it has control of the blood supply to the ovary. Also, as you know, the\\nspermatic artery in the male, becoming the ovarian in the female, arises about\\nopposite the second lumbar vertebra, that is, a little above the umbilicus, and\\nby working in deeply, trying to get as far as possible in under the transverse\\n\u00e2\u0096\u00a0colon and working on down in the direction of that artery, down as far as the\\novary, you wull be able to stimulate the blood-flow, and then by working back-\\nward in the same direction you stimulate the venous flow; also working over the\\nuterine blood supply, because these vessels anastomose a good deal, and you\\nthus stimulate the entire blood supply. Of course the ovaries are closely con-\\ncerned with menstruation and it wnll be worth your while to bear in mind that\\nthey act alternately, one will ovulate one month and then not again until the\\nsecond month. So if you have a trouble recurring every second month you\\nwill be able to calculate that the trouble is in one ovary or the other, and your\\nfurther examination will indicate to you which is the ovary affected. In cases\\nof obesity where the patient is extremely large, cases are on record where the\\naccumulation of fat has acted to crowd the ovary, hence the menstrual flow did\\nnot occur and the ovaries were atrophied. It may act in a mechanical way and\\n\u00e2\u0080\u00a2separate the Fallopian tube from the ovary so that the Fallopian tube cauuot\\ntake up the ovum when discharged. So that if you have a case of menstrual\\ntrouble where the person is extremely large and obese, then you will bear in\\nmind that the obese condition itself may have some effect in causing the trou-\\nhle. Of course the ovary, as it is situated in the broad ligament, is drawn down\\nin any prolapsus of the uterus and will be implicated in many troubles of that\\nkind. As for treatment, it is especially along the lumbar region and also at the\\ncenters designated, the eleventh dorsal, not forgetting the fifth hinibar. which\\nis the center for the hypogastric plexus, through which we get the pelvic plex-\\nuses which have to do with the life of the ovary.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0183.jp2"}, "184": {"fulltext": "178 EXAMINATION AND TREATMENT OF THE PEI^VIC VISCERA.\\nQ. In that case of paralysis you spoke of caused by the grippe, what was\\naffected?\\nA. The whole spinal life was affected. I have seen cases where the\\ngrippe was the only cause apparently and the whole muscular life along the\\nspine was diminished.\\nQ. Do you think that can be corrected by treatment?\\nA. Yes, sir; I think we can secure good results.\\nQ. Does that include the ligaments along the spine?\\nA. Yes, sir; that is the main trouble. The ligaments are contracted, shut-\\nting off the nerve force.\\nLECTURE XXVII.\\nAt the last lecture I spoke of the examination and treatment of the pelvic\\nviscera. I shall continue that subject today, concluding the examination and\\ntreatment of the pelvis and its contents, and taking up the Osteopathic treat-\\nment of the limbs; I shall then have gone over the whole body.\\nI. Examination and Treatment of the Pelvic iscera. Con-\\ntinued. \u00e2\u0080\u0094The next organ for us to consider is the uterus. I might say in pas-\\nsing that female diseases are among the most numerous class of cases that we\\nhandle, and are among those best handled by us. A very large percent of\\nyour cases will be various female troubles, and you will have very good success\\nwith them. The examination of the ovaries I spoke of at the last meeting.\\nNext to the ovaries the uterus is quite as frequently the seat of tumors as else-\\nwhere. These may occur in any part of the organ, and when these have en-\\nlarged the organ by their growth, you can by the ordinary methods of examin-\\nation find the trouble. In general, speaking of troubles of the uterus, pro-\\nlapsus is very common, anteversion, retroversion; also anteflexion or retro-\\nflexion, the bending of the uterus on itself. When the uterus falls, it may fall\\nforward and impinge upon the bladder, and thus one of the S5^mptoms will be\\nvery frequent micturition. It may fall backward and impinge upon the rec-\\ntum, and you will have a mechanical cause of constipation; dragging pain in.\\nthe loins and pain down the limbs. Frequently it is associated with local\\nheadache, which is generally on top of the head; it may be on the back of the\\nhead or it may run over to the forehead or to one side, but its peculiarity seems\\nto be that it becomes a local headache. There are other symptoms, since the\\nuterus becoming displaced will impinge upon other viscera and the plexuses of\\nthose viscera. You will have sympathetic troubles, such as vomiting, sick\\nstomach, and things of that kind. In case of any displacement of the uterils,\\nthe patient is likely to be very sick at the menstrual period. At such times\\nthe fact that the organ is down and is thus stopping the flow of the blood, will\\nlead to this condition. I have seen very painful cases at the period relieved\\nimmediately by replacing the uterus. However, that is not usually a good", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0184.jp2"}, "185": {"fulltext": "TREATMENT OF THE UTERUS. I 79\\nplan to pursue at the menstrual period, since the organ then is very tender, and\\nhandling is liable to irritate it and set up an inflammation or some sort of\\ngrowth, and you must always be extremely careful in local treatments of the\\nuterus. There have been some remarkable cases instanced of an enlarged uterus.\\nOf course the uterus normally enlarges within physiological limits; it enlarges\\nalso from tumor. The chief way in which tumor is differentiated from the nor-\\nmal enlargement of pregnancy, is that after a certain time you can hear the\\nuterine souffle and the the foetal heart beat. Also after the fourth month,\\nsometimes before and sometimes later, you will get the movements of the uterus.\\nDr. Smith tells quite an amusing story of a lady who came to term, she was\\nperfectly sure that she was ready to be delivered, but he found mereU^ gas in\\nthe intestines, a peculiar movement of the gas had simulated the movement of\\na foetus, which had been taken for quickening, and the gas in every respect\\nsimulated pregnancy. I only speak upon these subjects generally, because in\\ngynecology and obsteterics, w^hich you will take up later elsewhere, they will\\nbe treated fully. What I aim to tell you is how the Osteopath treats the uterus.\\nIn examining the uterus, besides these general symptoms I have given you, a\\nlocal examination will usually remove all doubt. By inserting the finger in\\nthe vagina you can feel at the upper end of the vagina, the uterus. You know\\nhow the uterus lies in relation to the passage of the vagina nearl}- at right\\nangles, perhaps not quite. The normal feeling of the cervix is described by\\nthe 01d Doctor to be about as hard as the end of the nose. On account of\\nthe transverse direction of the os pubes yon can tell whether or not the uterus\\nbe fallen or twisted. If you find the os, instead of being directed from side to\\nside, is turned at an angle, you can judge from that in which direction the\\nuterus has been twisted. The most common displacement is said to be down-\\nward and backward and to the left. Frequently you will find a sort of a turn\\nassociated with this displacement, and the uterus lies down near the left sacro-\\niliac articulation. If the uterus has fallen forward, of course you will find the\\ncervix and os projecting backward, and if it has fallen backw^ard, you will have\\nthe cervix and os projecting forward, and you will be able to judge as to its po-\\nsition. That is what the Osteopath ascertains in making examination pervag-\\ninam he looks to see whether or not the uterus is in normal position.\\nOf course you know about the eight ligaments of the uterus; the broad lig-\\naments are the most useful. They extend from each side to be attached to the\\npelvis, and when the uterus is displaced to one side you will find a tenderness\\nin the broad ligament on the opposite side, readily explained as the tension\\ncomes upon the ligament of the other side, the weight coming on it as the\\nuterus falls from it. That is one way in which we diagnose. Another point\\nin examination per vaginam is to note the condition of the vaginal walls. Of\\ncourse in prolapsus the walls have lost their tone; they have part of the duty\\nof sustaining the weight of the uterus. When they are full of tone thev will\\nhelp to hold the uterus up, but if they are prolapsed and sunken down they be-\\ncome flaccid. Frequently you can give great relief in female troubles by siui-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0185.jp2"}, "186": {"fulltext": "l8o TREATMENT OF THE UTERUS.\\npl3^ passing the finger up along each side, before and behind and at each side,\\nand smoothing out these wrinkles which have gotten into the walls of the va-\\ngina. You can also by that treatment stimulate the flow of blood and stimulate\\nthe local nerve force, and thus lead to more life in the vagina and consequently\\nto a better performance of its duty of helping to hold the uterus up.\\nYou will find such troubles as leucorrhea following the displacement of the\\nuterus, since the nutrition is partly cut off from the walls of the vagina, the\\ncirculation is impeded and the healthy tone does not exist, consequently 3^ou\\nhave a morbid secretion.\\nThe normal position of the uterns I suppose is known to you -the broad\\nligament tilts somewhat backward in the pelvis and the uterus is tilted forward\\nat the upper part of the vaginal passage, so that you have practically speaking\\na right angle between the walls of the vagina and the uterus, perhaps not quite\\na right angle. Of course the uterus normally does not rise above the brim of\\npelvis. I wish to empha.size what I said the other da} in regard to prolapsus\\nof the uterus and of the intestine, that is, the Osteopath replaces them, but\\ndoes not expect them to stay simply because he has replaced them. You must\\nalwa3 s couple local treatment with treatment along the spine. I remember a\\nca.se in point I examined a young lady in Peoria, she had a twist in the gym-\\nnasium, she had jumped to catch a cro.ss-bar and had ^iven herself a jerk and a\\ntwist. Along in the upper lumbar region there was a lesion, I do not remem-\\nber now exactly which vertebrae were displaced, it was, however, of the lum-\\nbar vertebrae, there was quite a prominence of one of them. Shortly after the ac-\\ncident the young lady was bothered with frequent micturition, and local exam-\\nination later revealed the fact that the uterus was down upon the bladder,\\nThat case was treated at the abdomen, over the iliacs, and along the spine, par-\\nticularly at the second and fifth lumbar centers, through which you can reach\\nthe uterus. The case was entirely cured within two months, and she had not\\nhad local treatment more than a half dozen times. So you see the Osteopath\\ndoes not depend upon simple reposision, he depends largely upon the work of\\nstimulating the nerve force and toning up the blood supph to give tone to these\\nligaments which have lost their tone, and thus hold the parts in place. For\\nthe purpose of the Osteopath the finger answers as well as anything for an in-\\n\u00e2\u0080\u00a2strument The first finger is usually inserted, and you can feel the cervix of\\nthe uterus The idea then is to push upward in such a way that the organ will\\ntake the pos tion of being at a right angle to the broad ligament, and it is well\\nwhile your patient is upon the table to insert the finger, reach upward to the\\nuterus, then have the patient slip around and stand up and 3 ou can then push\\nforward. One of the best ways of replacing the uterus is to have the patient\\ntake the knee-chest position kneel with the chest dowui upon the table orbed,\\nand then to push the uterus up, and thus allow the intestines to fall down be-\\nhind and over the uterus and hold it in place. The Old Doctor has invent-\\ned an instrument which is very useful also in reposition. It is a wire, curved\\nwith a handle. The. finger of the operator is slipped in with the instrument ly-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0186.jp2"}, "187": {"fulltext": "TREATMENT OF THK UTKRUS. l8l\\ning in the opening between the two wires, and then the point of the iustru-\\nmentis placed either behind or in front of the os, depending upon the position\\nof the organ, whether it has fallen forward or backward. Then with the point\\nof the instrument back and the finger in front or vice versa, you can work the\\norgan as you wish. Also you can by working upon the abdomen aid to lift the\\nparts. I have already shown you how that is done. That is, you raise it with\\nthe patient upon the back as I have shown you, or with the patient upon the\\nside, or standing bent at a right angle, and you, pushing the fingers in deeply\\nover the abdomen, raise bodily the contents. It is also a good idea to have the\\npatient practice taking the knee and chest position and simply dilating the\\npassage, the atmospheric pressure will sometimes be sufficient to cause the\\nuterus to take its place; also the motion I showed you at the last meeting, hav-\\ning the patient lie upon the back, flex the thigh, and the operator pushes\\nthe legs apart while the patient is holding them together, and drawls the legs\\ntogether while the}^ are held apara by the patient.\\nTreat especially the centers mentioned, that is, the second, which is the\\nblood supply for the uterus, and the fifth, which is the center through which\\nwe reach the hyogastric plexus, and all along the lumbar and sacral region in\\ngeneral, but do not fall into the error of thinking the trouble is always there,\\nbecause the lesion may be above or below the center at which you naturally ex-\\npect to find the trouble.\\nI have already mentioned the point that you should stimulate the cocc}\\ngeus muscle through the sacral plexus, and thus cause it to contract and aid in\\nraising the contents of the pelvis. You can also stimulate the round ligaments\\nwhich pass over the pubic arch just external to the symphysis; you can find\\nthem both by the touch and by their sensitiveness, because when you impinge\\nupon them you will always have an expression of pain. Stimulation there will\\nhelp to draw up the uterus; all these things help a good deal. Stimulation at\\nthe second lumbar is used to cause contraction of the longitudinal fibres of the\\nuterus, while stimulation of the clitoris and round ligaments is used to cause\\ncontraction of the circular fibres of the uterus. Consequently, we inhibit over\\nthe clitoris and round ligaments to cause them to relax and thus relax the\\ncircular muscular fibres of the uterus. That is one of the most important points\\nin Osteopathic obstetrics.\\nIn young females and in pregnant women it is advised never to give an in-\\nternal treatment. Mrs. Patterson says that remarkably young children are\\nsometimes suffering from prolapsus, and mentions a case in which the patient\\nwas not over two 3^ears old, but the case was entirely cured by external treat-\\nment. Should 3^ou be treating a case for other troubles in which the patient is\\npregnant, carefully avoid the ninth and eleventh dorsal and the second and fifth\\nlumbar, in fact, the whole lumbar region.\\nDr. BoUes has mentioned a point to me which is extremely interesting and\\nI think extremely important also. In a case in which there had been abortion\\nand the mother had kept wasting from the uterus, a discharge of matter and", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0187.jp2"}, "188": {"fulltext": "1 82 EXAMINATION AND TREATMENT PER RECTUM,\\nflow of blood, he directed her to rub the nipples each morning with vaseline,\\nand thus to stimulate as far as possible the normal irritation made by the suck-\\nling child. He was thus acting in accordance with nature, and the discharge\\nceased. In another case he follow^ed the same rule, where the woman was in\\ndifficulty, the pregnancy was about three months along, and the indications\\nwere that the foetus had been dead for come days. The nipples were stimula-\\nted, which caused contraction of the uterus, and the woman was delivered of a\\nstill-born child. There is a ver^^ close connection between the nerves of the\\nbreast and of the uterus. It is a very good point in flooding profuse menstu-\\nration or iu flooding after child-birsh, or in post-partum hemorrhage, which is\\na very serious thing, to give a quick jerk at the mons veneris, thus causing\\npain and causing a contraction; that will usually stop the flooding. I knew of\\na case not many months ago in which the flooding was persistent, and lasted,\\nfor some time. I sent word to the patient to try that treatment I have describ-\\ned and the flooding ceased immediately. Also in case of post-partum hemorr-\\nhage the Old Dotor says you should simply insert the fingers into the uterus\\nand press upward against the fundus. He presses up and inward to smooth\\nout any obstruction which may cause the trouble; of course there is some ob-\\nstruction there which is hindering the proper flow^ of the blood and so causing;\\nthe hemorrhage, and simph that pressing up allows the blood vessels to resume\\ntheir normal relations and the hemorrhage to be stopped Of course you un-\\nderstand when you come lo treat uterine troubles, it is a subject for the\\nspecialist, and you will get this subject fully treated in gynecology and obstet-\\nrics. I cannot do more than simply mention to you the usual treatment; this\\nwnll als^ be the case later in this lecture when I will take up the subject of dis-\\nlocations, you wall get them more fully in surgery, but I wdll give you the us-\\nual Osteopathic treatment for them.\\nIn the examination, per rectum, which is frequently resorted to bj the\\nOsteopath, in the female, if 3 ou will at the .same time insert a catheter into the\\nurethra you can feel the urethra along the anterior wall of the vagina. Here\\nis an important point which I have never heard mentioned except in connec-\\ntion with Osteopathic practice. If 3 our vaginal walls are relaxed and have\\nfallen in response to a prolapsed uterus, you may very likely get a twist or an\\nobstruction of the urethra through the prolapsus of the vaginal walls. There\\nhave been some cases of that here, and it has been readily cured by smoothing;\\nout the vaginal w^alls in the manner I have described and b} passing a catheter\\nup the urethra, simply straightening out the urethal passage. Besides that you\\nfind in digital exploradon of the rectum the grip of the external sphincter, and\\nyou will be able to judge, by practice w^hether or not it is normal. Tue nor-\\nmal grasp of the external sphincter is extremely powerful, and of course in all\\nthese internal treatments you should in.^ert the finger only after it has been\\nwell oiled with vaseline, soapsuds or something of that kind. You will have no\\ndifficulty in inserting the finger into the rectum; the palm should be turned\\ntoward the coccyx, and the finger inserted with its palm toward the coccyx,", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0188.jp2"}, "189": {"fulltext": "TREATMENT OP LIMBS: DISLOCATIONS. 183\\nand then may be turned; the patient may be on the left side, or may be stoop-\\ning, bent over the table. You will also in you practice, no doubt, come across\\ncases of prolapsed rectum, the gut may be prolapsed and be folded upon itself\\nin just the way the vagina prolapses. In Chicago I had a case in which the\\npatient came in great pain, there had been a rectal prolapsus, and there was\\ngreat tenesmus\u00e2\u0080\u0094 a feeling of wanting to go to stool continually. It was ex-\\ntremely painful and the patient was able to walk only with great difficulty. I\\nsurmised at once that there was a prolapsus, and I inserted the finger and\\ncrowded the walls of the rectum upward all the way around. I was able to re-\\nlieve the case and lie had no trouble for some time afterward. In such a case\\n3 ou must adopt the method of treating over the spine to stimulate the\\nnerve force and blood supplv to that part, and thus give permanent relief.\\nIn the male you will find, after inserting the finger for about two inches\\nand turning it forward, the prostate gland. It is said by some authorities that\\nthe prostate gland is almost universally enlarged in men over forty years of\\nage. The enlargement of the prostate is frequently the cause of stricture of the\\nurethra. You will find the lateral lobes of the gland enlarged, or the central\\nlobe may be enlarged. Should the lateral lobes be enlarged there may not be\\nmuch difficulty, but if the central lobe is enlarged you are very apt to have\\nstricture of the urethra. All of these internal treatments should be resorted to\\non y in case of necessity, you should not treat internally very frequently, not\\nmore than once a week, and sometimes not more than once in two weeks or a\\nmonth. Be very careful in treating internally, as you may irritate the internal\\nparts. When the prostate is enlarged it may set up considerable irritation, and\\ncuring that may be the only way of curing certain genital troubles in the male.\\nThe prostate is very easily reduced, you can reduce it in a half a dozen treat-\\nments, treating once a week or once in two weeks.\\nQ. Is it reduced by local treatment?\\nA. By local treatments. Of course you must couple with that treatment\\nover the internal iliacs to tone up the blood supply.\\nII. Osteopathic Treatment of the Limbs: In consideration of the\\nthe arm, the ball and socket joint is the one most likely to be dislocated. First\\nI will describe the ways in which this dislocation may occur: The dislocation\\nof the humerus may be downward in the axilla, it may be backward upon the\\nback of the scapula, or in front under the clavicle, or it may be slightly up-\\nward, called a partial dislocation, against the coracoid process. Now the treat-\\nment for an} of these is practically the same. One good way adopted by the\\npractice is to put the knee under the axilla firmly; of course you would have\\nan assistant holding against the patient to exert counter pressure. I would\\nthen press the arm .-strongly in this way, and thus spread the joint, bringing\\npressure upon the contracted muscles and upon the ligaments, and they will\\ndraw the bone down into place. Another way is when the patient is lying upon\\nthe table, simply to place the foot in the axilla in this way, and you can get a\\npowerful leverage, as you see, and can force the arm ou*^ into its sockei. I do", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0189.jp2"}, "190": {"fulltext": "1 84 DISLOCATIONS.\\nnot know just how frequent the dislocation of the shoulder is in practice, but I\\ndo know that in gymnasium practice the shoulder is very frequently dislocated\\nand set by a move on the rings, without harm. This joint is usually set with-\\nout difficulty; of course it must be set very soon after dislocation.\\nIn dislocation of the elbow, there are five different displacements. Both\\nbones may be dislocated backward, both bones may be dislocated internally or\\nexternally; the ulna maybe dislocated backward, or the radius may be disloca-\\nted forward into the hollow on the front of the humerus, or it may rarely be\\ndislocated backward. One method described is to place the knee in the bend\\nof the arm and then by having your assistant exert counter traction above the\\nelbow, you can spring the arm down strongly in this way. That will do for\\nthe first three. When you have thus exerted considerable tension, enough to\\novercome the contraction of the muscles, the bones will slip into theii places.\\nWhen the radius is dislocated forward, of course that would diaw the hand\\nback, and by turning the hand toward the supine or half supine and ex-\\nerting traction downward and outward in such a way as to pull the head of the\\nradius down into position, you wall be able to work it into place.\\nIn dislocations of the v/rist both bones may be out of place, the radius may\\nbe forward or the ulna backward, and in all those cases simple extension is re-\\nquired; 5^ou have you assistant fix the elbow and then you exert powerful trac-\\ntion upon the parts until the} have been drawm into place.\\nIn dislocation of the fingers it is said dislocation is usuall} between the\\nfirst and second phalanges, and there, also, simple extension is required, draw-\\ning straight upon the finger until the bone is slipped back into place. Dr.\\nHarr} Still says, in his own peculiar way, that if a bone is out all you have to\\ndo is to move it around enough and it will want to slip back into place.\\nAs to the usual way of treating the arm, you have seen that we frequently\\nuse it as a lever. In some cases, as for instance in articular rheumatism, we\\nwork with the idea of spreading the joint and allowing the blood and nerve\\nforce to be freed about the joint, especially allowing inflow of the blood, the\\nstimulation of the blood flow thus removing the deposit in the joint. You can\\nreadily stretch the joint by doubling the hand and putting it under the axilla\\nand then pressing the arm in against the side. That, of course will draw the\\nshoulder dowm, and I have had some very good success in relieving cases of ar-\\nticular rheumatism in that way. In spreading the joint you can also stimulate.\\nPlace your hand upon the front of the elbow and then bend the arm strongl}^\\nover the hand; that will spring the joint; and also by turning it out at a right\\nangle, you know^ how the olecranon process catches at the back of the hum-\\nerus, by bending the arm at a right angle so that they will not catch, you can\\nexert pressure to spread the joint. Also you can stmuliate the flow of blood\\ndown the arm by a certain twisting motion. That is one of Dr. Hildreth s\\nmovements. I have hold of the arm and I am moving the head of the humerus\\nin the socket. I twist it in that way without exerting much force. I might\\nspeak here of the fact that you can impinge upon the nerves of the inner side", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0190.jp2"}, "191": {"fulltext": "TRKATMKNT OF I.O\\\\VER LIMBS. 1 85\\nof the arm, the branches of the brachial plexus running down there, and the\\naxillary artery. In general if you impinge upon an artery, press it toward the\\nbone; do not press it toward the muscle. Ycu will find in your practice that\\nthese nerves become paralyzed by the use of a crutch, setting up crutch para-\\nl^^sis, and that is a point which is w^ell to take into consideration. Also we\\nhave found in our practice that something will catch here at che anterior part\\nof the shoulder; whether it is deltoid fibers under the coracoid process, or\\nwhether it is a simple binding of the ligaments drawing thehead of thehuraerus\\nout against the acromion or coracoid, it is hard to say, but we frequently find\\na catch there which w^e can reduce by drawing the arm upvv^ard and backward,\\nand then, when horizontal, draw it outward, and having the fingers in front\\nover the process you can free any obstruction in that way. I do not know^ just\\nwhat catches there, but I have seen cases of extremely lame arms which could\\nnot be raised higher than the head, and could not be put behind the back, re-\\nlieved by that treatment. Sometimes you will have such an injur}- as will\\ncause a contraction of one of the heads of the biceps muscle: you know its at-\\ntachments; by straightening the arm and drawing it backward, thus leugthen-\\nening the distance between ths attachments of that muscle, you bring tension\\nupon it. Frequently you w^ill find that muscle contracted, and all 3^ou w^U\\nneed to do is to stretch it, thus inhibiting its nerve force and thus relaxing its\\nspasm, and you get rid of the trouble.\\nIn the treatment of the legs you have all seen the various motions we all\\ngo through with, perhaps you have not all appreciated what the purpose of each\\nmovement was. When I flex the thigh above the thorax and the leg upon the\\nthigh I am stretching the quadriceps extensor muscles. You see you simply\\nstretch it and with it you free the blood supply, the femoral artery and the an-\\nterior veins and the anterior crural neive. That is the purpose of this motion\\nwhich you see so frequently employed. Sometimes, of course, we simply use\\nthis motion as a leverage, having our hands in the sacro-iliac joints; you know\\nits purpose already. You have thus stretched the anterior muscles of the thigh:\\n3 OU can stretch the muscles of the anterior part of the leg simply by pushing\\nthe toe straight down. That is a most frequent motion that the Osteopath\\nuses. You can stretch the calf muscles in just the opposite way, by pushing\\nthe toe in the direction of the knee; and you will have no difhculty in pushing-\\nit strongly enough. We can stretch the adductor muscles by holding the leg\\n.straight, standing between the legs and separating them. You can stretch the\\nexternal rotators by an internal movement in this way; it is very well to regu-\\nlate the force in this way: In making this movent turn just enough so that\\nthe patient turns on the side, it is not necessary to use a great deal of force;\\nthen turn the other way until you have turned him about the same distance.\\nWe may also stretch the muscles on the back of the thigh, you know that in\\nraising the knee, for instance against the chest, you can only do it by bending\\nthe leg; if you straighten the leg you can get it to a certain height and then\\nyou feel tension upon the hamstring muscles, consequently we frequently use", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0191.jp2"}, "192": {"fulltext": "l86 THE IvIMB AND FOOT.\\nthat in our practice. Putting the heel over the shoulder of the operator and\\nraising the limb higher than it can naturally go. you see it cannot naturally go\\nquite to a right angle, you thus lengthen the distance between the points of\\nattachment of the muscles on the back of the thigh and you stretch them. Fre-\\nquently you will find it important to stretch those muscles. I had a case just\\nthe other day of this kind, where the legs were drawn with rheumatism, the\\npatient had no use of the limbs, they were considerably draw^n, the toes were\\nturned in, the muscles set and it was with difficulty that I could handle them..\\nI simply brought deep pressure in Scarpa s triangle on the anterior crural\\nnerves, and that relaxed the anterior muscles. I had another case in which\\nwas paralysis of the lower limb, and frequently the limb would jerk when I\\nwould treat it, so I inhibited the anterior crural nerve and the limb would relax\\ndirectly. So we pay particular attention to Scarpa s triangle since there we\\ncan impinge upon the femoral artery and upon the anterior cruraljnerve. Also\\n^ve treat in the popliteal space; we very frequently knead it or work its con-\\ntents, simply bending the knee, putting the foot of the patient between your\\nthighs and working in the popliteal space; you can thus free any contraction\\nthere, and can stimulate both the popliteal nerves and the blood vessels.\\nFrequently in cases of rheumatism you will have trouble with the feet.\\nYou can straighten them down forward as I have shown, or backward. In\\ntreating the feet you will see that there are two natural arches one lengthwise\\nof the foot and one crosswise of the foot; consequently in your treatment of the\\nfeet you can break it in two ways you can spring it down toward the toes, or\\nyou can work with both hands beneath the instep and spring it toward the\\nsides. In doing that the piinciple is that you stretch the ligaments about the\\njoints. You can stretch the ligaments at the articulation of the ankle by this\\nforward and backward movement and by working it from side to side. By\\nbreaking the two arches of the foot as I have shown, you can relax all of the\\nligaments across the arch of the instep. Of course the toes can also be treated\\nin the same way. We frequently are called to treat for corns along with the\\nrest of our treatment, not that anyone pays us $25 for treating their corns, but\\nif they have something of that kind the matter with them they always want\\n370U to put that in. When 3^ou are treating a toe, you know the vessels run\\ndown the outside; simply spring it from one side to the other; that will stretch\\nthe ligaments and the blood vessels and stimulate the nerves.\\nQ. Would that treatment cure a cramp in the foot?\\nA. It would depend on the cause, if the cause were in the foot it would.\\nYou could very well cure some cases.\\nQ. Would it cure cramps on the bottom of the foot?\\nA. It would depend upon where your obstruction was; it might be higher\\nin the path very likely. You would have no trouble in curing it in the foot; I\\nhave found that in my own case, by simply stretching it. Every one naturally\\ndoes that; some people are much troubled by cramping in the feet.\\nIt frequently becomes the duty of the Osteopath to stretch the sciatic nerve", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0192.jp2"}, "193": {"fulltext": "DISLOCATIONS OF HIP, KNEE AND ANKLE 1 8/\\nthoroughly by stretching in this way, placing the heel of the patient over oper-\\nator s shoulder, and lengthening the distance along the back of the leg, and\\nthen since the branches of the nerve run on down over the planter surface of\\nthe foot simply pull down on the toe and you can stretch the sciatic nerve con-\\nsiderably, Also, in the treatment of sciatica it is one of the treatments to work\\nthe limb outward in this manner, thus to relax the muscles throughout the\\nwhole course of the sciatic nerve, or, by inward turn, the pyriformis and those\\nshort mucles, the external rotators which may impinge upon the nerve.\\nAs to dislocations. Frequently you get a dislocation of the ankle, the\\nfoot may be thrown outward, in which case 3^ou have an inward dislocation; or\\nit may be the reverse, or these bones ma} be thrown forward upon the ankle,\\nin which case you have a forward dislocation. In a few cases you have a\\nbackward dislocation. The movement is to have your patient lying down, flex\\nthe knee at a right angle, have your assistant fix the knee so that he can exert\\ncounter-extension, then you simply stretch and bend the foot in the direction\\nin which it would go. If it was thrown outward stretch it and bend it inward,\\nand vice versa. We do this in the case of the toes, simple extension is the\\nmethod employed. In the case of the knee the dislocations also are four; in-\\nward or outward, forward or backward. It is said simple extension is enough.\\nHowever, the Osteopath uses this movement: he flexes the knee at a right\\nangle, and then reaching in at the popliteal space he grasps both the internal\\nand external hamstring tendons and pulls outward with the idea of spreading\\nthem, drawing them away from the prominences at the end of the femur; and\\nthen he pulls with considerable tension and attemps to spring the joint back\\ninto place.\\nDislocation of the knee is rather serious as it is especially apt to be fol-\\nlowed by inflammation.\\nAs to the hip. There are four dislocations described for the hip. One\\nis upward and backward upon the dorsum of the ilium, in which case the leg\\nis shortened and the toes are turned inward. Another is backward into the\\nsciatic notch in which case also the limb is shortened, though not so much,\\nand the toes are turned inward. The third is forward into the obturator fora-\\nmen and is called the thyroid dislocation. It is the most difficult with which\\nwe have to deal, and when such is the case the knee is bent, the toes point to\\nthe ground and may rotate inward or outward; and in the other case the head\\nof the femur if forward upon the pubic arch and the turn of toes is invariably\\noutward. So you have two in which it is always inward, one in which it may\\nbe inward or outward, and one in which it is invariably outward. Of\\ncourse, dislocations when they are new are fairly easy to reduce, but\\nthe Osteopath gets them almost always when they are old. Your treat-\\nment must first be directed to softening all the ligaments and the muscles, re-\\nmoving the unnatural tension, and thus get the hip ready to set. These old\\ncases are almost always slow to set, though I have seen some long standing-\\ncases set in a few treatments. You always have two factors of great aid t", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0193.jp2"}, "194": {"fulltext": "1 88 DISLOCATION OF THE HIP.\\n5 ou, one is the anterior V ligament of the hip joint and the other is the\\naction of the small muscles, the pyriformis, obturator internus and externus,\\nthe two gemelli, and the quadratus femoris. They are attached in such a way\\nas to draw on the great trochanter. When it is up, they are below, conse-\\nquently the}^ are of great importance to us in setting a hip. If the hip is up\\nand back, you simply flex the thigh still more, turn it inward strongly until\\nyou get the tension of those muscles, and then throw it outward, and get the\\nhead of the femur to travel just over the edge of the ascetabulum. That looks\\nver}^ easy, but I will assure you it is not. When it is dislocated backw^ard into\\nthe sciatic notch, the idea is to flex the thigh, work the knee inward to dis-\\nengage the head of the femur from the notch, and then work it upward and\\nforward iti this way, and 3^ou get the head of the femur drawn toward the as-\\ncetabulum. When the dislocation is forward into the obturator foramen you\\nare usually in difficulty. The motion described for that is to flex the knee and\\nto rotate it inward, using the attachment of the Y ligament as a fulcrum\\nagainst which the limb works. Flex the thigh and work the head of the femur\\ninward or toward the cot^ loid notch. In the fourth dislocation, where the head\\nof the femur is over the brim of the pelvis, considerable tension is exerted\\nbackward, long enough to stretch these ligaments, and then try to lift the head\\nof the femur over and across.\\nIn diagnosing the hip dislocations you frequently find it very difficult. If\\n3^our dislocation is backward into the sciatic notch, your limb will be a little\\nshorter, the toes wiil be turned in, and when the patient sits up you have a\\nshorter limb. While if it is forward it always lengthens the limb for the pa-\\ntient to sit up. Of course, as I have said, the hips get out and stay out for a\\ngreat length of ime, and we have a great deal of trouble in getting them back,\\nand I believe of all the hard dislocations, the most difficult to treat is the one\\ninto the obturator.\\nLECTURE XXVIII.\\nThere are two or three points to which I neglected to call your attention\\nat the last time. I mentioned treating the prostate gland, but did not show\\n3^ou how to treat it. You know how to find the gland, and working down\\nacross it on each side with a fairly firm pressure, just to stimulate the flow\\nof blood through it, is the motion employed.\\nAlso as to the saphenous orening, we treat that by stretching the thigh\\nwhich has been flexed outward; that wnll enable you to stretch the muscles\\nabout that opening, then by rotating the limb inward and relaxing the muscles,\\nyou can work your fingers in at the opening, you stretch the muscles about it\\nand free the opening.\\nTenesmus in the lower bowel occurs frequently in diarrhea and in other\\ntroubles. This can be relieved by working over the sacrum, especially over", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0194.jp2"}, "195": {"fulltext": "QUESTIONS. 189-\\nthe muscles to stimulate and thus cause a contraction of the sphincter and a re-\\nlief of the feeling of tenesmus.\\nFrequently after parturition the disease known as mi?k leg, or phlegmasia\\ndolens, occurs, and is probably due to a contraction of some of the short mus-\\ncles, probably the pyriformis; it sometimes happens that the hip has been\\nthrown out in the efforts of parturition. Always after attending such a case\\nthe hip should be turned to see that it is properly In place, and see that the\\nmuscles are properly stretched. The saphenous veins should be treated also.\\nQ. How would you treat for fainting?\\nA. By the common methods employed anything to lower the head; some\\npeople, for instance, when they know they are going to faint, as some do, will\\ndrop over the back of a chair, with the head down, and that will stop it. When\\nsuch has occurred, get the head of the patient lower than the feet, you can\\n^hen have him hang his head over the end of the table at the foot; or you may\\nshock him, pull the hair, or a simple slap will draw the blood to the head w^hen\\nit is exhausted.\\nQ. I have a case in mind in which bleeding of the nose occurred and\\nlasted four or five hours before it was stopped, and the patient finally died.\\nWhat would be the treatment?\\nA. To check epistaxis or bleeding from the nose we work in the superior\\ncervical region, stimulating; that is frequentl} of use. Or you may hold the\\nfacial artery where it crosses the angle of the jaw, or hold the nasal branches\\njust here at the inner canthus of the eye. Hold them strongly. That\\nis the usual treatment, particularly the stimulation in the cervical region.\\nQ. In case of a lady whose babe is about fifteen months old; since the\\nbirth of her child she has had an extremely sore mouth, the condition of the\\nalimentary canal has been such that she could eat but a very light diet;\\ndiarrhea all the time, and a gradual wasting away of her strength and muscu-\\nlar system until she is almost a skeleton. What could be done Osteopathic-\\nally?\\nA. What we would describe as a general treatment should be given; a\\ngeneral spinal treatment to tone up the nervous system particularly, reaching\\nespecially the centers for the bowels, the splanchnics, and reaching also the\\nkidneys and the liver, toning up the secretory and excretory organs, and keep-\\ning the system in as good a condition as possible.\\nQ. It is the disease known among the medical profession as nurse s sore\\nmouth: there is also uterine trouble.\\nA. You have to look after that also. The trouble is probably of nervous\\norigin.\\nQ. In the case of a person taking a hard cold, or the disease known a.s\\nlagrippe. how would you treat?\\nA. I would give a strong stimulating treatment. That is a thing that is\\nvery important. I have already spoken of the effects of lagrippe several times,.\\nand I have found the most serious results following it after a long period of", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0195.jp2"}, "196": {"fulltext": "I90 QUESTIONS.\\ntime. Have the patient on the face for the first. This treatment will also ap-\\nply to what is called a bad cold. I have had some excellent results in treat-\\ning bad colds, and you can usually cure them. Use this general treatment.\\nYou know the purpose of the treatment to relax first all the muscles. With\\nthe condition brought about by lagrippe there is usually a painful aching in\\nthe back, especially along the lumbar region. I then have the patient on the\\nside, and having loosened the muscles as shown, I would spring the spine all\\nalong b}^ working underneath; you know the various motions. You can separ-\\nate the pelvis and the shoulder by putting your two arms between them and\\nspringing the spine. Then for this backache in the lumbar region, 1 would\\ngo particularly to the fifth lumbar, having first loosened all along the lumbar\\nregion and springing the spine in the good old Osteopathic way. The ache\\nthere is probably caused by the tension of the ligaments, and while we usually\\nuse an inhibiting motion to free one from an ache or pain, it depends upon what\\nit is caused by. If it it is caused by the contraction, as it probably is in such a\\ncase, the relaxation of the ligaments should do the work. I would then treat\\nfor the kidneys with the patient on the back; reach underneath and stimulate\\nalong the region of the lower splanchnics and upper lumbar. I would also in\\nthat case treat the liver and the bowels. Give the neck a thorough treatment;\\nI have already explained all these things in detail in going over the parts of\\nthe body. Of course the neck is a part of the spine, and you must be particu-\\nlar in watching there to see that this contracture of the deep muscles does not\\naffect important nerves, as it may very readily do. Use the motions given;\\nfirst relax all the muscles, then work deeper and spring the neck to relax the\\nligaments. Of course you can work from side to side in this way, and before\\n\u00e2\u0096\u00a0completing the operation I would give the straight pull as you see here, and\\nthe bend of the neck, enough to raise the patient s head and shoulders from\\nthe table. That motion, of course, will stretch all the spine. Then I would\\nfree all about the head and face, the points of the fifth nerve, those places at\\nwhich you know how to reach it. I would free all of the parts about the face.\\nTo free the nose press firmly upon the forehead, spring the jaw down, and\\nwork thoroughly at the styloid processes. It would not hurt to work the arms\\nand lower limbs, in fact, go all over the system to loosen any structure, either\\nmuscle or ligament, which may be contracted by the effects of lagrippe.\\nQ. What would you consider a few of the most essential points in con-\\nsideration when a patient first comes to see you?\\nA. That is a very good question, I think, because it involves the ques-\\ntion of how to start about an examination. I would first take the pulse; it is my\\nhabit to do so, I do not know that it is necessary always; others, I believe, do\\nnot do it, but the pulse is always considered an indication in diseases. I would\\nthen go to the spine and examine it thoroughly, but of course I would be\\n\u00e2\u0096\u00a0questioning them as I went concerning all the symptoms. In fact, before tak-\\ning the pulse I would ask them all about the trouble; I would get the subjec-\\ntive symptoms.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0196.jp2"}, "197": {"fulltext": "QUESTIONS. 191\\nQ. Do you think the history of the case is essential, then?\\nA. Yes, sir, it is.\\nQ. Please give the treatment for goitre.\\nA. P or goitre we would give essentially neck treatment; I will not\\nneed to show it to you. Frequenlly goitre is caused b}^ an obstruction of\\nveins, However, I think it is often caused by some impingement upon the nerves\\nsupplying the arteries and veins, consequently you have an obstruction there.\\nThe idea would be to thoroughly relax all the muscles and ligaments about the\\nneck, give the neck the straight pull and the turn from side to side, and bend\\nit backward, since there are anterior muscles in the neck which you must take\\ninto consideration. Sometimes it is those muscles which are contracted and\\nare pressing down upon the nerves and vessels. If it is a hard, encased goitre\\nwith a fibrous capsule, it is very difficult to cure. If it is an ex-ophthalmic\\ngoitre you will have difficulty in curing it, but the ordinary goitre is dealt with\\nwith considerable success, although it frequently takes considerable time. In\\ntreating for goitre I would also, besides the general treatment, work locally\\nover the thyroid gland, which you know is the gland enlarged in goitre, work\\nacross it from side to side, to free the veins there.\\nQ. How would you treat enlarged parotid, submaxillary or sublingual\\nglands, exceedingly large ones?\\nA. Do you know what caused it?\\nQ. Not unless it was scrofula.\\nA. I should give the treatment for the general system first; we must\\nget rid of what is causing it, whether it be impurities in the blood or a scrofu-\\nlous conditioD, or anything of that kind. Any case would depend upon gen-\\neral causes to some extent, and you would have to give a general treatment la\\npurify the blood. That is, attend to all the avenues of secretion and excretion\\nand of assimilation and nutrition in general. The local treatment would then\\nbe confined to loosening all the parts and freeing the blond and nerve supply to\\nthe organs affected.\\nQ. Please give the treatment for reduction of fevers.\\nA. In the first place it is said that when there is fever in the body that\\nit is made by the refuse not being cast off, and hence being burned. Nature is\\nmaking an extra effort to burn the refuse, and hence is causing fever. Whether\\nthat be true or not, you know that there is, in many cases, almost a complete\\nsuppression of urine in fever, or if not so much as that, that the urine is scanty\\nand high colored. You must go to the kidneys and free their action. Go al-\\nso to the bowels and free their action; combine the general treatment. Look\\nfor the cause; of course it would depend upon what kind of fever it was; and\\nthen having treated the particular cause, the Osteopath also goes to the super-\\nior cervical ganglion, and inhibits the action of the heart. You can inhibit\\nthe superior cervical ganglion either opposite the transverse processes or in the\\nsub-occipital fossae. Then give the treat aieut in the upper dorsal region, stim-\\nulating the action of the lungs to help them to carry oft the poisonotis matter", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0197.jp2"}, "198": {"fulltext": "192 QUESTIONS.\\nin the bod} Also treat the splanchnics. In general, go to the cause. I sup-\\npose you have heard Dr. Still s theory of fever he says that the lung is not\\nacting properly, that the gases are not properly condensed, and he treats fevers\\nthrough the lung a good deal, to get it to act properly that the poisons of the\\nbod}^ may be excreted properly.\\nQ. Would 3 ou treat the vagi in fever?\\nA. Yes, sir, we would treat them for the general effect on the liver and\\nintestines, and you could stimulate them to inhibit the pulse. Of course you\\nhave not cured the fever simply by slowing the heart, that is an adjuvant. You\\nmust go to the first cause; having done that work I should also go to the\\nsplanchnics, as I have said, and should inhibit there; having inhibited the cer-\\nvical, I would inhibit in the middle dorsal region or along the splanchnics and\\nthen I would go to the fifth lumbar, where j ou get the center for the hypogas-\\ntric plexus and through it the pelvic plexuses. Your object in doing that is to\\ndilate the vessels; inhibit the vasoconstrictors and stimulate the vaso-dilators,\\nor you tend to restore things to the normal. In other words, you free the parts\\n\u00e2\u0080\u00a2affected, and dilate the abdominal veins. In that way you equalize the circu-\\nlation. That is just part of your general work, and it depends on the kind of\\nfever; in typhoid fever you have to go to the intestines and treat them.\\nQ. How do you treat chills?\\nA. Stimulate the heart to propel the blood faster; stimulate the lungs so\\nthat the blood will be better purified and warmed.\\nQ. Where the fever follows the chill as soon as it is over, would you be-\\no-iu treatment for the fever at once?\\nA. If I supposed it would come on ri,2:ht awav; I would be on the watch\\nfor it; I do not know that I would begin to treat immediately. But having\\ntaken those general points together, I would also combine with that general\\nspinal treatment and treatment for the heart, a general stimulating treatment,\\nand in some cases it might not hurt to stretch the limbs, and do all j^ou can to\\nstimulate the flow of blood through the bod3\\\\ In chills and fever treat especi-\\nally the liver and spleen.\\nO. Just about what you would do for a cold or la grippe?\\nA. Largely so in that general treatment. Then the} say that rapid rub-\\nbing upward along the spine, hard and quickly, will cause a chill to cease. On\\none of the hot days last summer I was called to a case; it was not a regular\\nchill, but the person had become over-heated, and the blood had left the surface\\nof the body. He felt extremely faint, had difficulty in standing up, and was\\n\u00e2\u0096\u00a0covered with a cold, clammy perspiration; the surface of the body was chilly.\\nI immediately stimulated the heart and lungs, inhibited at the superior cervical,\\nand gave a general treatment to equalize the blood and keep it circulating. I\\nhad the patient keep quiet and he soon felt all right.\\nO. I would like to know what treatment you would give for vaso- dilator\\n-effect and for vaso-constrictor effect, to inhibit the flow of blood or increase it?\\nA. I do not kno^ that I would give any in that way. P or instance, go", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0198.jp2"}, "199": {"fulltext": "QUESTIONS. 193\\nto the splaiichuics, they contain both vaso-dilators and vaso-constrictors; go to\\nthe sciatics, the}^ also contain both. Now, I cannot treat the sciatic or the\\nsplanchnics and cause ttat particular set of fibers to act alone, that is, I do not\\nIcnow that I can, and frequently I employ a method which I say will inhibit\\nand frequently do that which we say will stimulate, and no doubt we do so. It\\nis very hard to say just what we do there, I tend more and more to the belief\\nthat we simply restore something that is abnormal to the normal conditions,\\nand allow nature to do the rest. I think that is the best theory by which we\\ncan explain so msny things, and there are many things we cannot explain by\\nthe theor}^ of stimulation and inhibition.\\nO- If a person faints from overheating, is not there any special treatment\\nbesides holding the head down. Dr. Charley Still seems to have had good\\nresults in that trouble?\\nA. In such a case you would also have to direct your attention to the gen-\\neral condition. In case of overheating, where there is an inward congestion,\\nvery likely the blood is prevented from flowing to the head and is congested\\nabout the lungs particularly, and about the intestines, since there the veins di-\\nlate the most readily and hold the most blood. You would have to appl)^ your\\n-stimulating treatment, and cause the blood to circulate freely.\\nQ. I would like to know why it is that nervous prostration is so much\\nmore a general complaint of ladies than gentlemen, and what treatment 3^ou\\nwould advise?\\nA. Nervous prostration is a very serious thing. Whenever I can, I ad-\\nvise against studying too hard and too long at a time, according to the patient s\\nconstitution, of course. A person can stand only a certain amount of work at\\na time. For myself I make it a rule not tc work extremely hard longer than\\ntwo or three hours at a time. I can work four hours or more at a time, but I\\ndo not do it often. In my regular work where I can regulate my hours, I will\\nhave something to break in at the end of about two hours. It is a question of\\npersonal experience and personal taste, although one may work too long and\\ntoo hard. I have seen a number of cases of nervous break down from over\\nstudy. I have seen them in college, and I do not want any in mine. It is caused\\nby lack of exercise, lack of fresh air, sedentary habits, too much stimulants, as\\ntea or coffee, and too much of a strain on the mental faculties. To prevent\\nthat, the prophylactic treatment would be to regulate the habits of the patient\\nas far as possible, get them to take plenty of exercise, etc., because when the\\ntrouble has once come on, it is in the majority of cases hard to get over, and\\nalmost always leaves its effects. And then as to our Osteopathic treatment,\\nthe treatment will have to be general, since the nervous organism is exhausted,\\nyou will have to generally tone it up, and it will take considerable time and\\ngeneral treatment.\\nO. Give us a treatment for diphtheria.\\nA. Diphtheria, of course, is a constitutional trouble. You will have to\\nprevent the membrane forming if possible, and that can be done very nicelv.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0199.jp2"}, "200": {"fulltext": "194 QUESTIONS.\\nDr. Charley Still has had the very best experience; more than any other Osteo-\\npath. He had a remarkable run of cases in Red Wing, Minnesota, and had\\nremarkable success. His treatment was vt.ry largely about the neck and\\nthroat; he would treat there to keep the blood supply open; you know how to\\ndo it, free all the muscles and ligaments, and especially keep the anterior\\nmuscles softened and loose so that there can be no tension there or stoppage of\\nthe blood so that an excretion can grow in the throat and form a membrane.\\nYou must attend to the bowels and the kidneys and the general health.\\nQ. When the membrane does form, what do you do?\\nA. Cause the patient to vomit is one way, in order to throw it out, and\\nthere are certain drinks that they use to loosen the membrane.\\nQ. How often should you treat in diphtheria?\\nA. Dr. Charley Still said that he frequently would come back to a case\\ninside of fifteen or twenty minutes. He was unprotected by the law and he\\nhad to go very carefully, or he would have had trouble.\\nQ. Did he treat for the fever?\\nA. Yes, you would have to treat for that according to the treatment out-\\nlined.\\nQ. In any acute trouble of that kind would you just treat for the symp-\\ntoms you see, unless you find some lesion?\\nA. No, sir, that is hardly our method, you should try to find a lesion, in\\nthe spine particularly, and you would probably be successful.\\nQ. Suppose you did not find a lesion?\\nA. If you didn t find a lesion you could only go according to principles\\nand word on the centers indicated, but j^ou will find lesions, contracted mus-\\ncles, or something of that kind.\\nQ. Give the treatment for granulated eyelids.\\nA. In granulated eyelids, first, of course, you must turn back the lids\\nand examine whether or not the granulations be there. Usually there is con-\\nsiderable scratching and irritation, and the eyeball is inflamed, then you will\\nsee the granulations existing as little white points all along on the inside of\\nthe lid. You may find them on both lids. Our treatment there locally is,\\nafter having wet the finger with a little soap suds or vaseline, to gently work\\nall along under the edge of both lids and to rub on the outside of the lids as\\nyon ^o along; that will crush the granulations. Some say that the granula-\\ntions are caused by the stoppage of the ducts of the Meibomian glands. The\\nOld Doctor, however, says that there is some obstruction to the veins, that\\nthe blood is brought to the eye and cannot get away, consequently it must do\\nvsomething, and it goes to work to build up some foreign growth. That seems\\nto be the most reasonable theory. If you want to know particularly about\\ngranulated eyelids, ask Dr. Hildreth; he had quite a remarkable case, which\\nthe Old Doctor cured. Having treated the granulations, treat the points of\\nthe fifth nerve over the eye here, on the forehead, at the inner and outer can-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0200.jp2"}, "201": {"fulltext": "QUESTIONS. 195\\nthus of the eye, and at the supra and infraorbital foramina, to free the blood\\nflow. Treat particularly through the upper cervical region, and look for any\\nlesion in the cervical region; give the general treatment for the neck in order\\nto keep the blood supply freely open to the eye.\\nQ. Where the upper lid is drooping, would you give the same treatment?\\nA. I would there stimulate the flow of blood and would stimulate the\\nfifth nerve, since it is the muscular trouble, and you must tone up the muscles\\nand strive to get them built up through the blood flow.\\nQ, Do you give the same treatment for cataract?\\nA. You would treat particularly through the flfth nerve for cataract, as\\nthe fifth nerve has to do with nutrition of the eye, especially its anterior part.\\nYou reach it through the superior cervical, at the inferior maxillary articula-\\ntion, and through these points that I have mentioned over the face. Also look\\nfor any lesion in the cervical region or in the upper dorsal. Give the general\\ntreatment of the neck.\\nQ. In case of the e3^eball turning inward, for instance the right one,\\nthrough weakness of either the external muscles or increased strength of the\\nother muscles, what do you do?\\nA. I do not know just what the experience has been in regard to crossed\\neyes. However, I have known of cases being treated surgically, which is\\nalways to cut a few fibers of the muscle which is opposite to the one affecting\\nthe eye most on the side pulling the most strongly; that weakens that muscle\\nand allows its antagonist to be more evenly balanced in its action. That will\\nallow^ the eye to become straight. But the trouble with that operation is that\\nafter the person has gotten well and the general health has increased, this\\nweak muscle, if the trouble was of this muscle, will strengthen and pull too\\nhard against the one which has been weakened by the operation. I have\\nheard of such cases. In speaking of such troubles once before I asked Dr.\\nSheehan if he had met such cases and he said he had, where the cure was only\\ntemporary from that surgical operation, and the trouble returned. The treat-\\nment there Osteopathically would be to strengthen the muscles. I have heard\\nof a number of cases being treated. However, in cases of young children, I\\nthink they are successful.\\nQ. This is a case of a party about middle age and it came on suddenly.\\nA. I would by all means try it in all such cases: where it comes on sud-\\ndenly that way it may be a nervous trouble, it may be a slip in the neck some-\\nwhere. I would not send the patient awa}^ and say I could not cure him, not\\nunless I was positive. It is pretty hard to be certain. In some cases the\\nOsteopath can not tell until he has tried, and if he is conscientious he nuist\\ntreat his patients awhile before he is sure.\\nQ. How would you treat for pneumonia?\\nA. In pneumonia the trouble is in the lungs, and pneumonia is usually\\nhandled very nicely. The patient will usually have fever besides the trouble\\nof the lungs. The simple Osteopathic treatment is to stimulate the lungs, as I", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0201.jp2"}, "202": {"fulltext": "196 QUESTIONS.\\nhav^ shown, in the uppei dorsal region all along on both sides. Find out\\nparticularly which one is affected by the methods which I have shown you.\\nTreat for the fever. In children and old people it often follows measles oris a\\ncomplication of them, and if you are called to a case of measles do not forget\\nthat complication; in all cases look out for p aeumonia.\\nQ. Is there any way in which severe coughing can be stopped imme-\\ndiately?\\nA. It will depend upon the cause of the trouble. If I were called to\\nsuch a case about the first thing I would do would be to examine the pneu-\\nmogastrics to see whether or not there was some irritation in the neck affect-\\ning them. Or if I could not find it I would inhibit the action of the pneumo-\\ngastrics. There are laryngeal branches supplying the larynx which may be\\nirritated, causing severe coughing. It may be some irritation of the pneu-\\nmog^stric in the stomach that is irritating the nerves and causing the\\ncoughing;.\\nQ. What would Ou do when it is caused from the lungs?\\nA. I would give a general treatment to the lungs. I would go to the\\nlungs first and treat them.\\nO. In case the heart ceases to beat for a short time, say during sleep,\\nand the person awakens and cannot breathe until he has got on his feet\\nwhat would you do?\\nA. I would raise the ribs on the left side. I would draw the arm back\\nstronglv while holding m\\\\- other hand in a shape under the angles of the\\nribs. What you describe is probably palpitation, and may be nervous in\\norigin. Perhaps the patient has lain upon the back for a certain length of\\ntime and has turned in his sleep and gotten two ribs pressed together. The\\nidea there is that ou give the heart more room mechanicall} b} raising\\nthe ribs, and that you stimulate the s} mpathetics along the spine which we\\nreach along the upper dorsal.\\n0. Give the treatment for rheumatism.\\nA. There are several kinds of rheumatism. In any case we go to the\\nkidnevs, we treat them alwa) s in the manner shown, to free the s\\\\ Stem of\\nthe acid which is present in case of rheumatism. Sometimes acute rheuma-\\ntism comes on without an\\\\- other pre\\\\-ious form, that is, it begins as articu-\\nlar rheumatism, and will strike one joint, sa\\\\ the shoulder, and next it will\\nbe ill the knee of the opposite side, the following day it will be in the fore-\\narm, then in the wrist, and it jumps about from place to place. In such a\\ncase we would stretch the joint; separate it. I would also, for this shoulder,\\nwork along the dorsal region, loosening the mscleus there; any contraction;\\nthen I would stimulate at the origin of the brachial plexus, along the scaleni\\nmuscles, between which the branches of the plexus run out to the arm; raise\\nthe clavicle, stimulate the subclavian artery, and in general, thoroughly\\nrelax everything about that arm an freed the forces of life to it. I would do\\nthat fo: .ny joint affected. In case of muscular rheumatism you must treat", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0202.jp2"}, "203": {"fulltext": "QUESTIONS. 197\\nvery gently, treat the blood and nerve supply to the part and work over the\\nmuscles affected very gently, that is, bring gentle pressure and stretch them\\nvery gently. I have known of a case of general muscular rheumatism where\\nwe simply went over the patient, gave him a gentle treatment, stretched the\\nmuscles and the ligaments, and stimulated the kidneys and the liver and the\\ngeneral excretory organs.\\nO. What is the treatment for flux?\\nA. The same as for diarrhea. I believe I showed that at one time.\\nThe chief thing which we do is to work strongly along the lumbar region,\\nspring the spine strongl} and hold against it. I have seen cases treated in\\nthat way, just as you see me doing here, the point of the knees against you\\nhere, and hold against the eleventh and twelfth ribs, inhibiting the action of\\nthe nerves there to stop the rapid peristalsis. That is the theory. You can\\ndo that by setting the patient up in a chair, get your knee against the heads\\nof the eleventh and twelfth ribs, and pull the arms up and out, and ou thus\\nget a strong pressure against this point. I would also stimulate the flow of\\nbile. I described to you not long ago a case of flux of long standing; in\\nthat case I found that the two lower ribs were too close together on each\\nside, and that there was a contraction and smoothness along the lower lum-\\nbar region. I relaxed that and staightened the ribs, and it took but two\\ntreatments to cure the case.\\nQ. Please give the treatment fur catarrh.\\nA. That is general treatment of the neck, and is what I have already\\ngiven, but I might mention a few points. They say always that there is a ten-\\nder place under the angle of the jaw. It will hardly be necessary for me to\\nshow you all these motions. The theory there is that some contraction, either\\nrecent or of long standing, is shutting off the blood supply to the membranes\\nof the throat and nose.\\nQ. Do you treat in the mouth?\\nA. We sometimes treat through the mouth. You can pat the finger back\\nand work from the top of the palate down along the pillars of the fauces on\\neach side; we sometimes do that.\\nQ. How would you treat a sprained ankle or knee?\\nA. Say it was the knee, you must be very careful, if it is a recent case\\nand there is a swelling about it you must take the swelling down. I would not\\nmove the member much at first, and the best way that I know to reduce a con-\\ngested condition from inflammation after severe strain is the use of hot water,\\nhot bandages or the hot water bottle, or something of that kind. After having\\nreduced the swelling you can see if the parts are dislocated, examine to see if\\nthey are out of place or if there is any break. Of course if vou are called at\\nonce to the case you can find that out at once. You should always do that at\\nearly as possible, find out if there are any dislocated parts, and if there are you\\nmust Dut them back as soon as possible. If there are no broken or dislocated\\nparts, after having taken down the swelling principally by the use of hot ap-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0203.jp2"}, "204": {"fulltext": "198 OrESTIONS.\\nplications, I would work gently at the popliteal space to relax the muscles and\\nstimulaie the popliteal vessels, then I would bend the thigh up aud stretch the\\nmuscles about the saphenous opening to allow the blood flow above to be prop-\\nerly opened, and give the stretching motion to the leg to relax its muscles in\\ngeneral. I should then treat along the lower part of the spine, especially\\nwhere we reach the sacral plexus, so as to stimulate the nerves to the leg.\\nQ. Those movements would be rather painful, would they not?\\nA. You will have to be very careful, perhaps you cannot do them at first:\\nI have had cases of sprain where I would not manipulate at all for several days;\\nI just used the hot applications about it, and watched 10 see that no trouble\\ntook place, but it was several days before T began to manipulate. At first you\\ncan treat the lower part of the spine without moving the leg, and I would do\\nthat. In these cases I have had good success Sometimes your strain will\\nnot be painful, and 3 ou can manipulate the leg from the start; it depends al-\\ntogether on conditions.\\nQ. Has Osteopathy come in contact with yellow fever or cholera, and if\\nso, with what success?\\nA. The Old Doctor says he ha^^ treated cholera. I do not know that\\nwe have ever had any cases of yellow fever. About all I know about the\\ntreatment for cholera is that Dr. Still says he treated the lungs, he was speak-\\ning on that the other day in relation to his theory of for .nation of gases in the-\\nlungs. He also stimulated the excretions.\\nQ. What is the treatment in Bright s disease.\\nA. In Bright s disease treat for the kidney. Bri,2:ht s disease is a gener-\\nal name. However, it refers to a disease of the parenchyma of the kidney, and\\nthere are various forms. You would have to look for any lesion affecting the\\nkidney along the lower dorsal region or at the second lumbar, and your idea\\nthere would be to work upon the nerve supply o the kidney by treating over\\nthe spine. Then you could work at the umbilicus, as I have shown you, to\\nto get these centers, or you can reach them by deep pre. ^^sure over the renal\\nganglia, which lie on the renal arteries.\\nHow do you regulate the action of the kidneys whep they are acting too\\nfrequently?\\nA. When the kidneys are acting excessively or too frequently, t\u00c2\u00b1ie idea\\nis that you must find any lesion which may cause an irritation or inhibition of\\nthe nerve force. It is frequentl3 confined to about what I have said, to lock-\\nfor the lesion and remove it, and then treat along the region of the spine where\\nwe get the nerves to the kidne^^s.\\nQ. Stimulate to increase the action, and inhibit to lesson it?\\nA. Well, that brings us back to the question of just what we do when\\nwe stimulate or inhibit. It would depend upon the condition there whether\\nI would spring the spine and work in such a wa}- as to stimulate or whether L\\nwould hold.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0204.jp2"}, "205": {"fulltext": "QUESTIONS. 199\\nQ. If there was too much secretion, you would not treat in the same way\\n-as if you wanted to increase it?\\nA. I would be very likely to. I would work along the region of the spine\\nwhich shows there is some obstruction to the nerve force and my idea would\\nbe to remove that obstruction.\\nQ. Would you pull on the neck when it is turned to one side or the other,\\nand turn it?\\nA. I would not pull it and turn it.\\nQ. I mean after it is turned?\\nA. O, yes; I would not be afraid to do that. I would have the neck\\nturned about in this way, and this straight pull is about the best way, but I\\nwould not pull it and turn it, because you are likely to cause trouble. The\\nparts are more apt to be stretched, and you may get an articular process out of\\nplace.\\nQ. In varicose veins, what would you do other than manipulate the\\nnerves and the limbs?\\nA. I would work along the lower region of the spine and stimulate\\nthe sacral nerves, and 1 would stretch the leg thoroughly to stimulate the\\nsciatic, since the sciatic contains the vaso-motor nerves for the limbs; then\\nat t!he saphenous opening, I would loosen that as I have already told you\\nhow to do, and I would work upward from the varicose veins along the\\n\u00e2\u0080\u00a2course of the veins to stimulate the flow of blood. Do everything to build\\nup the tone of the limb. The trouble may be somewhere else, but it is most\\nfrequently in the legs, from standing on the feet too much.\\nQ. How would you treat neuralgia of the heart?\\nA. I would confine myself there to the upper dorsal region. I\\nwould goto that region first and would give the heart all the room to pla}-\\nin that it needed, then I would inhibit at the superior cervical region with\\nthe idea of inhibiting the nerve force and quieting the spasm if possible.\\nYou can do anything to reach the nerve force and quiet it. It is evidently\\nexcited and there is evidently some irritation. Your idea is to find the\\ncause of the irritation and remove it if possible. It may be caused b\\\\ some\\npoison in the system, then you would have to remove the original cause b\\\\\\ngeneral treatment. Dr. McConnell says the trouble is frequently in the\\ncostal cartilages.\\nQ. How would you treat cerebral troubles?\\nA. Through the neck, it depends upon the case, of course.\\nO. In hay fever would the treatment be anything different from\\nthat for general fevers?\\nA. Yes, look for the lesion in the superior cervical region or in the\\nupper dorsal, sometimes the first rib is at fault, sometimes the clavicle, and\\nyou must look for the lesion in those places. We do not have the ordinarx\\nsymptoms of fever in hay fever, it is a catarrh.\\n^Q. How would you treat for lumbago?", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0205.jp2"}, "206": {"fulltext": "200 QUESTIONS.\\nA. I would relax everything along the spine, especially in the lower\\npart; first by working the muscles, then by flexing the knees against me,,\\nthen I would put the patient into a chair and lift up and turn as I lifted. I\\nthink the theory is that the tension of the ligaments there is affecting the\\nnerves and causing the stiffness of the muscles. I have seen several cases\\ntreated in that way and very successfully.\\nQ. How would you treat appoplexy?\\nA. It depends upon general causes and conditions generally. That\\nis, it generally occurs in elderly people, where they are not used to much\\nexercise and after they have run for a train or to a fire, the heart is excited,,\\nand the vessels being weak and the general tone of the system being relaxed,,\\nthere is a break of a small capillary in the brain and the formation of a\\nclot. Perhaps it does not extend farther than congestion of the brain.\\nSometimes it is in cases of people who ha\\\\e long been bothered with con-\\ngestion, and the blood does not circulate properly through the brain or\\nbody, and too much is thrown to the head. You would have to relieve the\\ngeneral causes, and you must in some way call the overplus of blood from\\nthe head. In that case you would treat over the superior cervical\\nregion particularly, and then to get your effect ou would have to work\\nover the solar plexus and the splanchnics to draw the blood from the head.\\nThat in general is the treatme-nt. Of course you understand these are just\\nsnapshots. I cannot say much on any of these subjects here. What I\\nhave said is simply as far as my knowledge has gone.\\nQ. What would you do in case of meningitis?\\nA. Meningitis is a germ disease affecting the spinal cord itself. I have\\ntreated chronic cases. In the case of an infant of two and one half or three\\nyears of age the symptoms were a drawing back of the feet until the body as-\\nsumed the form of a bow, a dribbling of saliva from the mouth, a lack of\\ngrowth, the lo\\\\ver part of the body being undeveloped.\\nIn an acute case the first thing to do would be to give a hot bath, evacuate\\nthe bowels; everything should be done to get the poison out of the system;\\nwhen that was done I would give the patient upon rising in the morning, spinal\\ntreatment together with treatments upon the kidneys, liver, bowels and lungs.\\nI am treating a case at present somewhat similar to this.\\nQ. What would be your method of treating the spleen when there was\\ntrouble there?\\nA. I would raise the ribs from the eigth to the twelfth on the left side,\\ncorrecting any obstruction that might exist; giving the abdominal treatment to\\nhelp remove the trouble. In malaria, where the spleen is congested, free the\\nblood supply by working from the eighth to the twelfth dorsal vertebrae.\\nQ. How would 3^ou cause vomiting by Osteopathic treatment?\\nA. This is sometimes very very hard to cause. Some people never vomit\\nno matter how sick they get, and others vomit at the slightest provocation.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0206.jp2"}, "207": {"fulltext": "QUESTIONS. 20I\\nI have known of vonjiting following manipulation of the solar plexus, and also\\nupon deep pressure in the third left intercostal space.\\nQ. Give treatment for reducing fever. Is there any way to keep the fe-\\nver from returning?\\nA. You might keep it down temporarily. I have seen cases of typhoid\\nfever where the fever was kept down, but evidently the cause was not removed.\\nAlways see to removing the cause.\\nQ. Is thtre any effective treatment for barber s itch.\\nA. I do not know. I would open the pustules with a sterilized needle,\\nsterilizing the pustules with carbolic acid.\\nQ. What is the treatment for colic?\\nA. Ordinar}^ wind colic, the kind that babies have in the night, is caused\\nby a disordered digestion. The treatment is to work the wind off the stomach,\\nthen stimulate the solar plexus, and work along the sp!anchnics.\\nQ Is neuralgia successfully treated?\\nA. Yes, the treatment for neuralgia is by inhibition. Sometimes it is\\ncaused by poisonous blood; sometimes by a pressure upon the nerves.\\nQ. In case of a paralysis of the lower limbs, where there has apparently\\nbeen no circulation for three years, and after the patient had greatly improved,\\nw^ould the appearance of rash or boils have any bearing upon the case? Is this\\nold waste matter, which has been dead for so long, carried off in this way?\\nA. take it that the appearance of rash would be a good symptom, show-\\ning that the blood supply had been renewed. I have a case of liver trouble\\nwhere the body was covered with rash; the rash disappeared and I take it as\\na sign tha. the patient is improving.\\nQ. How would you treat convulsions in a young child?\\nA. Convulsions are sometimes caused by intestinal worms; by congestion\\nat the base of the brain; sometimes by a congestion of blood vessels or some\\ndisplacements.\\nQ. Where and how treat for eczema?\\nA. I have seen cases of other troubles complicated wnth eczema and the\\nresult of treatment has been good. Usually the patient does not stay by the\\ntreatment long enough to get the desired results, as it is a slow process. The\\npoint is to build up the blood and purify it by treating all the avenues of ex-\\ncretion, and in that way remove the poison from the blood.\\nQ. Shell fish being eaten, hives appear on the skin, (^as a result of the\\nfood), and too long a time having elapsed to expel the food by vomiting, how\\ncould you treat this case to overcome the conditions where you could not expel\\nthe food at once?\\nA. If it was so that I could not cause vomiting, I would stimulate the\\nbowels by the method already indicated.\\nQ. Please explain how glasses seem to give temporary relief when taken\\noff for possibly five minutes?", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0207.jp2"}, "208": {"fulltext": "202 QUESTIONS.\\nA. I would conclude that the patient was growing away from the glasses.\\nI would consult an oculist.\\nQ. Would you suggest any other treatment for measles other than keep-\\ning the bowels open?\\nA. Stimulate the lungs, because the poison seems to take root in them.\\nQ. How do you slow the heart s action?\\nA. By inhibition in the superior cervical region, and by raising the upper\\nleft ribs.\\nQ. Please explain in detail the treatment for sea sickness.\\nA. Inhibition of the pneumogastric by thrusting the thumb into the\\nthird intercostal space on the left side. This treatment is also applied in the\\nthird and fourth intercostal spaces upon the right side, and in the fourth inter-\\ncostal space upon the left side; to this I would add inhibition of the solar plexus\\nby putting a pressure upon it, and stimulation of the pneumogastric nerves.\\nQ. What it the treatment for locomotor ataxia?\\nA. A thorough spinal treatment. This is a disease of the spinal cord.\\nStimulate the flow of blood to the cord from one end of tlie spine to the other.\\nGive attention to the local symptoms according to their nature, e. g. for diar-\\nrhoea, constipation, loss of control of bladder or bowels; give the usual indi-\\ncated treatment, with stretching of the lower limbs.\\nQ How do you treat insomnia?\\nA. Stimulate along the spine to increase the circulation; treatment in the\\nneck; thoroughly relax the muscles of the neck, reducing any dislocations or\\nslip between the vertebrae, and finally, inhibition of the superior cervical\\nganglia.\\nQ. How would you treat a child troubled with worms?\\nA. Through stimulation of the liver, causing an increased secretion of\\nbile sufficient to expell such parasites. The stomach and intestines should be\\nstimulated as well, and the child should avoid eating sweets.\\nQ. What do you inhibit in the neck for cutaneous circulation?\\nA. The inhibition of the superior cervical ganglion gets its effect upon\\nthe circulation in two ways: ist through connection with the sympathetic\\ndirectly, and second through its connection with the medulla by way of the\\nsympathetic; the treatment, therefore, in this region influences the general cir-\\nculation to the body in that it affects the vaso-motor center in the medulla.\\nQ. In what respect would a general treatment be compared in its general\\neffects to a specialized or local treatment of a lesion?\\nA. A very general question. A general treatment would be to affect the\\ngeneral circulation and the general condition of the nerves; a local treatment\\ncorrectly speaking ought to affect the circulation of the affected part under\\ntreatment. This only in the most general terms.\\nQ. Would not the tendency be to secure better results for a specialized\\ntreatment of the lesion in that a supply of blood would be drawn to that par-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0208.jp2"}, "209": {"fulltext": "QUESTIONS. 203\\nticular point alone and thus be better than the diffused state in the general\\ntreatment?\\nA. In general, I would say the more specific your treatment is, the more\\n-directed to the locus of the spinal lesion, the better. The tendency of giving a\\ngeneral treatment is far too great already. General treatments should be ju-\\ndiciously employed as an adjunct to special treatment rather than as a hit and\\nmiss plan to affect the lesions.\\nQ. How do you treat for cold feet?\\nA Stretch the limbs by flexing the knee against the thorax, and by ro-\\ntation inward and outward, thus relaxing the muscles and correcting the blood\\nsupply.\\nQ. How can the bowels be moved quickly.\\nA. I should try a strong stimulation of the liver. In obstinate cases of\\nconstipation we frequently use the anema first.\\nQ. Where you have high fever caused by absorption of poisons in the\\nblood, what should be the treatment?\\nA, Stimulate the kidneys and bowels and lungs, also cutaneous circula-\\ntion; induce copious sweats, thus throwing off the poisons from the system;\\nand work as already indicated to reduce the fever.\\nQ. What is the best plan to set lateral dislocation at the first and second\\n\u00e2\u0096\u00a0dorsal.\\nA. I work as follows: Set the patient upon a stool with his back toward\\nme, and use the head and neck as a sort of lever, so to speak, placing the\\nthumb of one hand upon the side of the spine of the vertebrae on the side to-\\nward which it has deviated; the other hand being upon the back of the head.\\nI now bend the head down away from the vertebrae in question, thus exagger-\\nating the defect, pushing strongly down to the side, meantime pressing with\\nthe thumb upon the spine of the dislocated vertebras in a direction toward that\\nfrom which it has rome. The head is next pushed around to the affected side,\\nthus relaxing the ligaments, while the vertebrae is firmly forced back into\\nplace.\\nQ. Can parasites be removed by Osteopathic treatment?\\nA. The treatment has already been indicated, in part; I would add treat-\\nment of the liver, strongly stimulating the flow of bile; this the Old Doctor\\nsays is sufficient to remove intestinal parasites.\\nQ How would you treat to relieve a very chilly feeling?\\nA. Through stimulation along the spine in the upper dorsal region to ac-\\ncelerate the action of the heart and lunp^s.\\nQ. How would you treat a case of tooth ache?\\nA. Send patient to the dentist. We have in a few cases had good re-\\nsults by inhibition! of the fifth nerve, reaching it in ways already indicated in\\nthe course of these lectures.\\nQ. Is it dangerous to reduce bacterial fever?\\nA. The theory that it requires heat to destroy them would indicate as", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0209.jp2"}, "210": {"fulltext": "204 QUESTIONS.\\nmuch. In general I would say it is our practice to reduce such fevers. While\\nperhaps the high temperature of the bod}^ might tend to render the bacteria\\nless productive of evil results, yet further treatment which we employ in such\\ncases would seem to make it safe to reduce the fever as we always do. Of\\ncourse, we never omit in such a case to strongl}^ stimulate the action of the\\nbowels, kidneys and lungs, to throw off both the bacteria or their products.\\nHere this treatment, coupled with the general spinal treatment, tends to pro-\\nmote health}^ metabolism, thus building up the tissues of the body, blood in-\\ncluded, and to render it less liable to the growth of bacteria. In other words\\nthe theory of bacterial origin is that there is a so called nidus, or nest, in\\nthe tissue in which the bacteria may grow. It is held by eminent authorities\\nthat bacteria will not grow in unhealth}^ tissue, hence if the\\nnidus exists in unhealthy tissue, the work of the Osteo-\\npath in building up the tissues does away with the nidus, the ever present ten-\\ndency being toward the normal, aiding in such a way as to cause the tissue at\\nthis particular locality to become healthy. Thus the nidus is destroyed, and\\nthe poor bacterium is left without a home. In regard to the germ theory, and\\nin its relation to Osteopathy, I might say that while the Osteopath acceots such\\ntheory in general, he, remembering the fact that unhealthy tissue only can\\nform a nidus, esteems it conclusive that there must have been a cause for the\\nprevious presence of the bacteria there, or there would not have been any nidus.\\nKe simply sees that the bacteria may become secondary causes of disease. Here\\nhis treatment is devoted to removing the primary cause, preventing the bacteria\\nfrom gaining a foot-hold in the body.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0210.jp2"}, "211": {"fulltext": "", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0211.jp2"}, "212": {"fulltext": "", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0212.jp2"}, "213": {"fulltext": "", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0213.jp2"}, "214": {"fulltext": "", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0214.jp2"}, "215": {"fulltext": "", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0215.jp2"}, "216": {"fulltext": "", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0216.jp2"}, "217": {"fulltext": "PRINCIPLES\\nOF-\\nOPATHY\\nlPJL.TtT T^SATO.\\n-BY-\\nGtias. HaKzerdI, Ph.ig. D. D.,\\nProfessor of Principles of Osteopathy in the American School of Osteo-\\npathy and Member of the Staff of Operators in the A. T. Still\\nInfirmary, Kirksville, Missouri. 1898-99.\\nKIRKSVILLE\\nJOURNAL PRINTING CO.\\n1898.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0217.jp2"}, "218": {"fulltext": "PREFACE.\\nSince the first appearance of this work, the course o-f lectures of whicbi\\nthe first edition was composed, has been increased m number to forty- four.\\nThe first edition contained discussions of theory,, together with a re view\\nof the human body, part by part, with indications for Osteopathic examin-\\nation and treatment of the same. The second edition contains in addition,,\\nlectures upon specific disease, with descriptions of the Osteopathic method of\\nexamination and treatment of the same. A limited number of cases has been\\nthus treated, the idea being not to make this vohime a Practice of Osteopathy,\\nbut to show the method employed in diagnosis and treatment of the several\\ndifferent classes of cases that the Osteopath meets in daily practice. For ex-\\nample: acute condiiions, such as typhoid fever, diarrhoea, and the like,, and on\\nthe other hand, chronic affections, such as spinal curvatures, constipation and\\nother complaints of a similar nature, have been dealt with.\\nTo this there have been added a few lectures upon the History of Medi-\\ncine, and a brief consideration of other systems of healing, such as Faith Cure^\\nMassage, Electricity, etc., in order that the student may know the principles\\nof such systems, and learn to point out the independence of Osteopathy from\\nthem all. Chas. Hazzard,\\nKirksinlle, Mo., Jan. 30, i\\nCOPYRIGHT 1898, BYCHAS. HAZZARD, D. O.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0218.jp2"}, "219": {"fulltext": "Principles of Osteopathy.\\nIvECTURK I.\\nSPINAI, CURVATURKS.\\nThe Osteopath meets with many cases of spinal curvature in his daily\\npractice, no matter where he may be located. It is a common and much\\ndreaded disease. The Osteopath gets many cases to treat because he is the bone-\\ndoctor, and people are quicker to come to him with such complaints, or, it\\nmay be, the failures of the usual modes of treatment adopted by the medical\\nprofession leave man}^ cases for the Osteopath. He is successful in a fair num-\\nber of cases, but finds many of too long standing to be cured by him, though\\nhe almost invariably benefits them. In curable cases, his success is flattering,\\npresenting the most complete cures.\\nOf these, lateral, and simple posterior curvatures are most easily cured.\\nThe importance of the spine has been noted. It might be called the foun-\\ndation of the skeleton; since it supports all the important parts of the body,\\nperhaps on the whole, more than do the limbs. It gets but little rest; e. g.\\nany one with a troublesome backache finds the spine very much in evidence;\\nat times neither sitting, standing nor lying, in any position will relieve the\\npain of the ache. Osteopaths should be careful of their own.\\nTo fulfill its functions, the spinal column must be at once strong and flex-\\nible, and the wonderful device by which this object is accomplished is worked\\nout by means of an intricate arrangement of bones, ligaments and cartilages,\\nmuscles, blood-vessels and nerves, each of which seems liable to its particular\\ndisability. The cancellous bodies of the vertebrae are liable to caries and\\nnecroses; the intervertebral discs, to ulceration, suppuration and changes of\\nform from pressure; the ligaments to strains and rheumatic aft ections, the\\nmuscles to paralysis and spasms; and the blood-vessels and nerves, in this situ-\\nation, to compression and abridgment of function. Hence it is that to the Os-\\nteopath the spine becomes the foundation in a different and very important\\nsense, and he, regards the condition of the spine, rightly, as experience proves,\\nto be the foundation of health or, disease.\\nThe fact of the compressibility of the intervertebral discs is one of great\\nimportance:\\nI. The whole spine becomes .settled down together, rigid, smooth,", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0219.jp2"}, "220": {"fulltext": "4 POTT S DISKASE.\\ninterfering with general nerve connections; causing nervous and special organic\\ndiseases, and functional troubles.\\n2. Any single or several discs may be altered in shape by pressure, e. g.\\naltering spinal equilibrium and interfering with important nerves or centers.\\n3. May be ulcerated and eaten away, leading to ankylosis and leading to\\npermanent injury of the joint.\\n4. Important part of spinal treatment is to separate vertebrae and allow\\ndiscs free blood supply and room for growth. Treatment by suspension ac-\\ncomplishes this, as does also traction of the spine, described to you as a\\nstraight pull.\\nQuestion of slight vs. extensive change in form of spine, with vast dif-\\nference in effects: i. Latter is gradual and parts become accommodated to\\nchanged shape of the spine. 2. Former more severe and accompanied by\\nacute pathological state of tissues. Question hard to answer, e. g. Hunch-\\nback and good general health vs. slight slip.\\nSeveral kinds of spinal curvature are described: i. Pott s disease (Pos-\\nterior angular curvature.) 2. Scoliosis (Lateral curvature.) 3. Kyphosis\\n(Post, round shoulders.) 4. Lordosis Ant, (Ant. in lumbar.) 5. Spastic\\n(Spasms of muscles.) 6. Hysterical.\\nPott s disease (Percival Pott), an inflammation of the spine, characterized by\\ndestruction of the cancellous bodies of the vertebrae and intervertebral discs,\\nleaving the front parts of the vertebrae to settle together and produce post,\\nangular projection, called also tuberculosis of spine, caries or osteitis of spine,\\npost, angular curvature, anter.-post. curvature, spondylitis, etc.\\nThe ulceration and destruction of the bodies and intervertebral discs may\\nbe partial or complete; the process may begin in either structure, and it usually\\nterminates in ankylosis of the affected joints. Usually the disease begins in\\nulceration of the cartilage, and the adjacent surfaces of the vertebrae suffer\\nfrom caries and necrosis. When the bodies of the vertebrae are the first to be\\nattacked, they suffer from primiary necrosis, which seems particularly liable to\\nattack cancellous bony structures. The disease spreads to involve a greater or\\nless amount of the anterior portion of the spine, destroys it, and causes the\\ncharacteristic posterior projection. This is most characteristic as angular curva-\\nture when it occurs in the middle dorsal region, the long spines causing the\\npeculiar angular appearance. But in the cervical and lumbar regions merely\\nan obtuse post, projection obtains, on account of the shorter spinous processes\\nin these regions. Kven this amount of curvature may be absent in well marked\\ncases.\\nPott s disease is most usual in children between three and ten years of age\\nand of a tubercular diathesis, but all ages and conditions are subject to it. It\\nseems to be fairly rare; one in thirteen of my cases, this one being typical.\\nThe Etiology of this disease is particularly interesting to the Osteopath\\nfor two reasons: i. It introduces the germ theory, which will be discussed\\nlater, in connection with Osteopathic treatment of spinal curvatures. 2. It", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0220.jp2"}, "221": {"fulltext": "POTT S DISEASE. 5\\nemphasizes the importance of slight mechanical causes, e. g. blows, wrenches,\\nor strains, etc., as factors, or rather, as original causes, in the production of\\ndisease.\\nThe American Text Book of Surgery states that while slight traumatism\\nis usually the cause to which the disease is ascribed, the tubercular diathesis or\\nsoil is essential to the production of the typical disease. Quain, however, lays\\nmore stress upon violence as the cause, and states that frequently cases are met\\nwith whose family history is free from scrofula, and Farnum, in a text of April\\n98, says that the microscope fails to reveal the tubercle baccilli in but a few\\ncases. Thus the doctors disagree. Cases are frequent in children after dis-\\neases such as whooping cough, measles and scarlet fever, in which the consti-\\ntution is weakened. In the adult, syphillis and rheumatism predispose to the\\ndisease, as they affect the joints.\\nThe direct cause seems to be generally some violence. Quain, speaking of\\ncases in children of good family history who had never had any sickness, says:\\nIn such cases we can hardly doubt that vSome slight accident met with in bois-\\nterous play, must have been the immediate cause of the disease: and in some\\ninstances the writer has obtained undoubted evidence of this fact. He also\\nmentions such a cause as the strain upon the spine occasioned by\\na man, in sport, catching a child by the arms, and swinging him\\naround upon his back. The violence of course may be direct and\\nsevere, as in bad falls and blows. The Osteopath continually emphasizes\\nthe importance of such injuries as causes of disease, through the effect\\nthey have upon the spine, not so often in producing curvatures, but\\nin producing unnatural conditions in the spine, which interfere with nerve\\nforce and cause various diseases. What others forget he strives to remember,\\nand frequently is sure that some old injury, either unnoticed or long forgotten\\nis the source of present ill. Frequently the patient will recall such causes.\\n^TioisOGY.- Constitutional e. g. syphillis, rheumatism, scarlet fever,\\nmeasles, whooping cough, etc., tuberculosis, scrofula, local violence, direct or\\nindirect.\\nPathology: Caries and necrocis, ulceration of discs and formation\\nof the angle have already been noted. Further consideration of the\\npathology raises additional points of significance to the Osteopath.\\nThe inflammation of the parts may effect the cord itself (myelitis)\\ncausing paralysis which varies according to the region of the cord\\naffected. Or, the inflammation may cause what is known as inflammatory\\npachymengitis, i. e. a thickening of the fibrous tissues between the dura-mater\\nand the walls of the spinal canal. Their growth may occur only along the an-\\nterior, pressing upon the anterior part of the cord and the motor nerve roots,\\ncausing motor paralysis. This is the most usual condition, but the growth of\\ntissues may affect both anterior and posterior parts of the cord, causing\\nboth motor and sensory paralysis. Sequestra are formed (^portions of\\nthe bone eaten off and surrounded by fibrous coat,) or deposits occur and bring", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0221.jp2"}, "222": {"fulltext": "6 POTT S DISKASK.\\npressure upon the cord. The same may be caused by the dislodged vertebrae^\\nof by narrowing or obliteration of the canal. These causes, of course, irritate\\nthe nervous mechanism, and pervert or suspend its operations, e. g., the irrita-\\ntion may be upon a certain center, be transmitted from cord to sympathetics\\nand affect any important organ or organs in their vital operations. These are\\nthe reasons for the great pain and distress and the very bad general health not-\\ned in a patient with Pott s disease.\\nJust so the Osteopath in any ordinary case lays great stress upon any strain\\nor injury to the spine, i. Strain followed by inflammation and thickened tis-\\nsues. 2. Hyperaemia affecting centers. 3. Slips or twists of vertebrae\\ncausing direct pressure, or act as strains. 4. Deposits irritating centers,\\netc. 5. Rheumatic affection of the joints. All affect nerve mechanism, reach\\nthe sympathetic system usually, and have far reaching results. This is shown\\nin its worst form in Pott s disease. Muscular rigidity seen iu Pott s disease is\\ndue to deep irritation of the nerves acting reflexly upon the muscles\\nSymptoms: Variable, according to part of spine alfected. The early symp-\\ntoms are ill-defined (first six to nine months making diagnosis difficult) but\\nthe patient lacks energy, is irritable, not well; poor vitality. There is pain\\nupon motion and upon percussion of affected parts of the spine. Muscular\\nstiffness and rigidity become prominent on account of irritation of nerves;\\npatient makes unconscious efforts to shield the part from. pain. The muscular\\nstiffness causes characteristic attitudes: cervical, wry-neck; upper dorsal, neck\\npushes forward, chin raised and shoulders fixed; lower dorsal, military attitude;\\nlumbar, lordosis, by contraction of the psoas muscles. Abscesses following along\\nthe psoas may contract the thigh and cause the case to resemble hip-joint\\ndisease.\\nWhile the chief deformity of Pott s disease is spinal curvature, this feature\\nmay be absent in cases where the disease develops late in life. A slight lateral\\nsweep of the curve may occur, indicating destruction, of the lateral\\nportions of the vertebrae. Secondary curves are formed, e. g: dorsal kyphosis\\nwith lumbar Lordosis. Quain notes two points at which may occur a spurious-\\nform of posterior curvature, i. e. seventh cervical and first dorsal vertebrae,\\nalso eighth and ninth dorsal vertebrae, naturally prominent points. This con-\\ndition being sometimes exaggerated; accompanied with pain. This is not real\\ncurvature. The former (seventh cervical and first dorsal vertebrae) is often\\nnoticed in hysterical girls.\\nPain is an important symptom, being both local and distant, being roused\\nlocally by percussion. Yet the patient complains but little of pain along the\\nspine, it usually being referred, e. g., in cervical disease to the throat, neck and\\narms; in dorsal disease, to the chest, intercostal and epigastric pains, coughing\\nand palpitation of the heart; in lumbar disease the pains are colicky, the blad-\\nder is irritated and pains shoot down the lower limbs. Motion increases the\\npain, e. g. turning, jumping or pressing down the head. This fact causes the\\npatient to hold the spine as quiet as possible. The pain, not usually acute.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0222.jp2"}, "223": {"fulltext": "SPINAL CURVATURES CONTINUED. 7\\nbecomes sometimes lancinating. Some few cases ran a slow course, it is said,\\nwith but little pain. Paralysis is a frequent symptom; may affect the lower\\nlimbs, or the sphincters. On an average it lasts from one to three years. Pe-\\nculiar attitudes constitute another important symptom. The patient goes\\nabout supporting himself upon some object, e. g. furniture. If the disease is\\ncervical or upper dorsal, he rests the chin upon the elbows, if lower, he rests\\nthe hands upon the hips, or walks about with body bent and hands supported\\nupon the knees, always with the effort to relieve the affected portion of the\\nspine of the superincumbent weight of the body.\\nAbscesses are frequent. They occur as retro-pharyngeal, dorsal, iliac,\\nlumbar, or psoas abscesses, being the products of suppuration following the\\nulceration and destruction of the parts. The pus gathers in the sheaths of the\\nmuscles and comes to the surface at the points named. Osteopathy, if used in\\ntime, should prevent their formation or cause them, where small, to be ab-\\nsorbed.\\nThere are with Pott s disease, general constitutional disturbances, asthma,\\nheart disease, indigestion, abnormal temperature, (99\u00c2\u00b0 to 101\u00c2\u00b0 F), fretfulness,\\nchills, loss of appetite, cold extremities, etc The disease, if left to run its\\ncourse, terminates in bony ankylosis of the affected joints, and cure, with per-\\nmanent deformity as an essential of such cure, or it ends in death from paraly-\\nsis, myelitis, and general ill health.\\nMortality in children 1-20; in adults 1-5. Thus the prognosis is more fa-\\nvorable in children than in adults, and unfavorable in proportion as the disease\\nprogresses rapidly.\\nCHAPTER II.\\nLateral Spinal Curvature: Scoliosis, This is perhaps the most\\ncommon form of spinal curvature, and is, fortunately for the patient, usu-\\nally (readil) cured by Osteopathic treatment. By far the larger per cent.\\nof the cases coming under my supervision have been lateral curves. In\\nlateral curvatures, called also Scoliosis and Rotary Lateral Curvature, the\\nspine describes two or more lateral curves, according to the American Text\\nBook of Surgery; other texts do not thus imply the invariable presence of\\nthe secondary curve. I have seen cases in which there was but one lateral\\ndeviation. The rule, however, is to have a second lateral curve with its\\nconvexity in the opposite direction, while there may be three, or even four,\\nor five curves, each compensatingthe other. I am treating a case at present\\nin which there are two; there has been a third, but that has been straight-\\nened out. That was in the lumbar region. The primars curve was in the\\ndorsal region. There was one up in the cervical region as well. Another\\ncase, which I might treat as similar, was one in which there was a very bad\\ncurve in the neck, followed by a very marked lateral cur\\\\ ature between the\\nshoulders.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0223.jp2"}, "224": {"fulltext": "8 LATERAL CURVATURE.\\nPractice of Osteopathy. Idea of Co7npe7isatio7i\\\\ Curvatures caused by tilt-\\ning of pelvis or dislocation of hip. I believe I spoke of this matter of\\ncompensation the other day. That is, nature is undertaking to restore the\\nequilibrium of the body which is lost by the formation of one lateral curve,\\nand this may be further carried out in the pelvis or in dislocation of the hip.\\nI had a case of dislocation of the hip on the left side which had been fol-\\nlowed by lateral curvature in the lumbar region toward the right, making a\\nsort of compensation in that way. Again, I had a case in which there was\\nwry-neck. The neck bent to one side and even that seemed to change the\\nequilibrium, throwing the weight on the opposite side on the sacro-iliac\\nligaments. You see how badly such a casue may affect equilibrium of the\\nspine which is so delicate, and thus cause a change in the parts to meet the\\nnew conditions.\\nLateral curvature is said to be more frequent in girls than in boys, and\\nfrequently is so slight as to be unnoticed until discovered by accident. I\\nhad a case not long ago in which there was a marked lateral curvature to\\nthe left taking in most of the spine from the cervical region down. They\\ntold me that they had not noticed the curvature coming on until it was pro-\\nnounced, and you will find that so in quite a number of cases.\\nAetiology. The causes of the disease may be local, e. g. faulty position;\\nconstitutional, e. g. ricketts; or both. The most usual cause seems to be\\nweakness, the spinal muscles giving way more on one side than on the other,\\nallowing the spine to sag. Such weakness is often apparent as the result of\\nrapid growth or of sickness. Dr. Harry Still had a case in which the patient\\nhad a very tender spine, and we found after we had been treating him for\\nsome time that he had a slight curvature. These things arise sometimes\\nwithout apparent cause. For instance, I knew a young man in splendid\\nhealth who had a marked lateral curvature. He had had no bad accident or\\napparent cause. It seemed in his case to be simply due to very rapid growth.\\nHe was over six feet tall. It seems that the system is not always able to\\nstand the strain upon it by rapid growth. I had another case exactly simi-\\nlar.\\nA habitual faulty position, e. g., sitting at a desk, e. g., holding an in-\\nfant always on one arm, will frequently cause it. Carrying a heavy weight,\\nas school books, or a heavy child, may become a cause. I knew of a young\\nlady who carried her heavy infant brother about. Without doubt tkis\\nwas the cause of her trouble.\\nObliquity of the Pelvis: I noted a case of a young girl with the left hip\\ndislocated upward, the curvature of the spine taking place with the convex-\\nity toward the right in the lumbar region as a compensation. As far as I\\nwas able to learn the curvature was caused in this way, as the mother did\\nnot know that it had occurred until I pointed it out. Unilateral muscular\\natrophy, or hypertrophy, or muscular spasms from a central cause will all\\nact as causes of lateral curvature. A ricketty condition will also weaken the", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0224.jp2"}, "225": {"fulltext": "LATERAL CURVATURES. 9\\n\u00e2\u0096\u00a0Spine and cause this curvature, as will empyema, through muscular fixation\\nof the affected side. I have known several cases in which the curvature\\n-came on without apparent cause, previous illness or anything of that kind.\\nI noted the other day a case of a young man who developed lateral curva-\\nture and had, following that, locomotor ataxia. His case came on without\\napparent cause. Quain assigns heredity as a predisposing cause.\\nAnatomical Characters: The spine does not simply yield laterally,\\nbut the bodies of the vertebrae turn so that the anterior aspect ot the body\\nof the vertebrae comes to look laterally in the center of a curvature having\\ndescribed the quadrant of circle. The transverse processes project anter-\\niorlyand posteriorly; the spinous processes, laterally. The bodies turn out-\\nward so as always to be upon the convexity of the curvature. The transverse\\nprocesses are anterior and posterior, the spinous process is laterally in the\\nopposite direction from the body of the vertebrae. You see that you have\\na great change in the condition of the spine. I cannot make it appear as it\\nnaturally would in case of curvature. The discs as well as the bones be-\\ncome eaten away. You have a condition of changed form of bone, liga-\\nments and muscles. I think that this will well illustrate to you what we\\nhave to deal with in case of lateral curvature. The relations of the ribs are\\nchanged, bulging backward at their angles or the convex side carried for-\\nward on the opposite side, and making a deep depression along the\\nconcavity of the spine. On the convex side the ribs become much\\nmore oblique than before;. on the concave side, more horizontal and wider\\napart. The bodies always deviate more than the spinous processes, and thus\\nyou see that you have a coddition that is not fully indicated by the align-\\nment of the spinous processes, so do not be misled by what you see like that.\\nQuain does not consider the deviation of the spines any sign of a curvature.\\nPatholgy: The bones, ligaments, muscles and vertebrae all undergo\\na pathological change during the course of the disease, accom-\\nmodating themselves to the new formation of the parts. The intervertebral\\ncartilages become compressed on one side by the unequal pressure, and\\nassume a wedge shape, the thin edg(i of the wedge being toward the con-\\ncave side. Pressure and absorbtion also graduall}^ alter the shape of the ver-\\ntebrae and of their articular processes. You readily see what a strain comes\\nupon these processes, and the facets gradually wear away, facing another\\n\u00e2\u0080\u00a2direction, instead of back and up. So you see how extensive the change is.\\nThe vertebrae become more or less wedge shaped, while the direction of\\nfaces of the artcular processss becomes changed. These structural changes\\nconfirm the condition of the curvature and make it more difficult to cure.\\nIf a man comes to you and wants to know how soon you can cure a lateral\\ncurvature, you will have to tell him that the case is such that ou will have\\nto alter even the shape of the bone befoi-e you can effect a cure.\\nLate authorities describe the muscles and ligaments as relaxed and\\natrophied on the convex side, and contracted and strengthened on the con-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0225.jp2"}, "226": {"fulltext": "lO LATERAL CURVATURE.\\ncave side. Ouain disagrees with this, stating thatthe muscles are simply dis-\\nplaced on the concave side, pushed together and thus apparently contracted\\nYou can readily see how this could be. The muscles and ligaments are\\nweakened on this convex side, and become atrophied because pushed out\\nof place, while these on the other side will become contracted, because it is\\na rule that if Ou approximate the points of origin and insertion of a muscle\\nit will contract to conform to the changed position. Ouain says they are\\nsimph pushed over and in that way apparenth contracted, while the later\\nauthorities, as you will see, say that there is a distinct change of condition.\\non this side.\\nAnteriorly the sternum becomes ver\\\\ oblique, and the cartilages of the\\nconca\\\\ e side bent upon themsehes. The thoracic and and abdominal,\\norgans are displaced and interfered with, often causing organic troubles.\\nThe lung on the concave side is compressed; the heart may, in some-\\ncase, be displaced to the right side; the liver and stomach and intestines\\nare forced downward; while the kidney and spleen on the convex side are\\nsaid to be usuall\\\\ smaller than on the other side. In cases of a rachitic\\ncharacter there is often deformity of the peKis.\\nSymptoms: The curvature is often so slow in development that it\\nremains unnoticed for a considerable time, being noticed first in fitting\\nclothes by a dress-maker, and sometimes the suspender slips off the shoulder\\ntoo easily, or one scapula is a little too prominent, or some slight irregular-\\nity in the patient s gait is noticed. One shoulder is higher. If on the left\\n(left de\\\\ iation), the right breast and iliac crest will be slightl} too promi-\\nnent, the curve of the waist deeper on the right, and the distance from the\\nright axilla to the hip is shorter. Ihat is one place where you may make a\\nvaluable measurement. I would advise you alwa\\\\s in these cases to make\\nmeasurements. I have a case of very marked curvature, extremely to the\\nright; on the left side the hip is up so that the ribs as high up as the sixth\\nor seventh rib fall down over the crest of the ilium That is one of the\\nmost marked cases of curvature that I have seen, and was caused by a fall\\nfrom a swing. Quain states that the diagnosis cannot be made simply upon\\nthe lateral deviation of the spine, since this often occurs in weakness or in\\nh} sterical conditions. The diagnosis must rest upon the torsion of the ver-\\ntebrae and changed direction of the transverse processes.\\nSymptoms of nervousness, palpitation of the heart, shortness of breathy\\nindigestion, etc., are often present, as are also indisposition to exercise, vague\\nfeelings of discomfort, and pain and tenderness in the back.\\nSuspension will cause the curve to disappear in mild and short time\\ncases. Those which do not thus disappear have become strongly fixed. If\\nthe curve persists until maturity, it as a rule remains throughout life. Oste-\\nopathic experience is contrary to this. I might say that cases of people\\nwell advanced in life have been rendered fairly straight, although it seems\\nthat maturity has limited our practice somewhat in that respect. It is also", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0226.jp2"}, "227": {"fulltext": "HYSTERICAL AND POSTERIOR CURVATURES. IT\\nstated that the prognosis is unfavorable in proportion to the youth of the\\nsubject when the curve begins. Here also Osteopathic experience is at vari-\\nance with the authorities. A double curvature is likely to be self limited,\\nby the arms of the S reaching equality and establishing an even balance.\\nThus you readily see here if you have a curvature occurring first in the\\nupper dorsal or in the cervical, you are liable to have a curvature on the\\nother side lower down, since nature has to restore the equilibrium. Thus a\\ncurvature is apt to be self limited, not self cured, but more curves may\\nappear as you already see. The long single curve is apt to lead to the great-\\nest deformity. The great majority of cases reach a certain stage, become\\nstationary, and pass through life with slight deformity and but little trouble\\nfrom the curvature. In some cases, however, progressive deforndtv leads to\\nimmense distortion.\\nHysterical Curvature: A form of curvature described as a lateral curva-\\nture which may be made to disappear by causing the patient to bend for-\\nward until the tips of the fingers touch the ground.\\nKyphosis or posterior curvature is a term used to describe the common\\ncondition of round shoulders, as is usually found in the upper dorsal region.\\nThe same term, however, is descriptive of ordinary posterior curvature of\\nany portion of the spine, but not of Pott s disease, commonly, though some-\\ntimes used as a synonym for that term. Its causes seem to be, in general,\\nthose which have been described for lateral curvature, viz: faulty position,\\nweakness and debility, paralysis, ricketts, etc. For example, it is found in\\ninfants who have been allowed to sit up too much; in growing girls who\\nsit in bad positions at school or at the piano; in professional men who bend\\nover desks; or in bicycle riders who assume an extreme position. Old age\\nand debility weaken the muscles of the back, and allow the spine to bend.\\nYears of hard work, e. g., as in miners, shoemakers, etc., is also a cause.\\nSometimes it is the result of positions assumed to ease pain, as in asthma,\\nmeritis and rheumatism.\\nFathology. The chief features are a relaxation of the spinal ligaments\\nat the spot affected, allowing a protrusion of the spinous processes, and a\\nseparation from each other; an approximation of the bodies anteriorly, re-\\nsulting in destruction of the edges of the intervertebral discs and of the\\nbodies of the vertebrae from pressure atrophy. In old age ossification of\\nthe joints may have occurred. The stature is diminished. It must be dis-\\ntinguished from Pott s disease by the rounded, instead of the angular curva-\\nture; by the absence of muscular rigidity, tenderness, pain and symptoms of\\ninvolvment of the cord.\\nIt is stated that infants usually recover from the disease spontaneously;\\nchildren generally recover upon exercise. If present at maturit)* it remains\\nduring life, but amounts to but small deformity in the adult. If occuring\\nlate in life it is apt to be progressive.\\nLordosis or anterior curvature is rather rare. It is usualh in the him-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0227.jp2"}, "228": {"fulltext": "12 TREATMENT OF SPINAL CURVATURES.\\nbar or in the dorso-lumbar region, often being the secondary curvature in\\nPott s disease. In this affection the hips are prominent behind, and the\\npubis is depressed, showing a tilting of the pelvis. The causes are com-\\nmonly weakness of the muscles and ligaments of the lower portion of the\\nspine, as in ricketts and paralysis, great weight of the abdomen, as in ascites\\nor pregnancy, and in persons with a naturally large or fatty abdomen, seems\\nto be the cause of the trouble. It is met in certain diseases of the hip in\\nwhich the joints are partly flexed. Structural chang^es occur in the nature\\nof relaxed and lengthened anterior muscles and ligaments, the reverse being\\ntrue of these posterior structures. Also there is a change of form in the ver-\\ntebrae and intervertebral discs. They become wedge shaped by pressure\\natrophy, with their thick edges backward. After macurity the deformity is\\napt to become permanent, but in many cases disappears in a few months.\\nLECTURE III.\\nTo-day I wish to illustrate the treatment of spinal curvatures. In treat-\\nment of spinal curvature we should consider first the theory and in the\\nsecond place the practice. The description of theory might be divided into\\nfirst, the mechanical work purely. We have to do a certain amount of\\nmechanical work upon the spine. Parts are out of place and, just as you\\nwould pile up a pile of blocks that have been knocked over, it is a mechan-\\nical matter to readjust all of the parts which are out of place. That part of\\nour work is purely and simply mechanical. You might pile up a pile of\\nlumber but if you want to be perfectly sure of its remaining so you will have\\nto put supports about it, hence we will have to do something more than\\nsimply put parts back mechanically. The muscles and ligaments must be\\nstrengthened and stimulated to hold them in place. Since the muscles, lig-\\naments and vertebrae are affected by blood and nerve supply, these parts in\\nthe normal spine are retained in position by free and unobstructed supply\\nof blood\\nWe retain these parts in place by strengthening and stimulating the\\nnerve and blood supply so that the ligaments, muscles, etc., are kept in\\nproper condition.\\nFirst, then, as to the mechanical work. Its purpose, as already indicated,\\nis to return parts to place, but we cannot separate these methods of treat-\\nment, the strengthening and stimulating must be used together. Not only\\nare the vertebrae out of place, but they are changed in form, they have be-\\ncome flattened down on one side. It is going to be a difficult matter to\\nhold them in place. You must take that into consideration in building up\\nthe spine. These parts slipped back meehanically are not going to stay,\\nthe first, second or not even the third time. You will have to keep at work\\non them and return them to place and keep strengthening the ligaments in\\norder that they may be held in place. How can you shape the material so", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0228.jp2"}, "229": {"fulltext": "TREATMENT OF SPINAL CURVATURES. 1 3.\\nthat it will stand in this delicate column? That question we have to deal\\nwith in any spinal curvature. A word as to theory. We must build up and\\nrestore lost parts. Tension or suspension as you may readily see, tends to\\nthe alignment of the vertebrae. You know how we get this effect upon the\\nspine. You can have some one holding the ankles, and you can exert a\\ngreat deal of contraction upon the spine, under ordinary circumstances,\\nwithout danger. However, I have known cases of spinal curvature where\\nthe patients were rendered bed-ridden by stretching in this way, so you\\nmust be very careful. It is a part of the treatment to see how much the\\npatient can stand. This method of traction is one of the best methods that\\nwe have, for reasons that I shall show you later as to the theory; but you\\nsee how it is accomplished, with the patient lying upon his back and with\\nthe straight pull. It can also be done in this way; you may have the\\npatient sitting (it is particularly good for small children) having the hips held\\ndown, and raising the upper part of the body by reaching over and raising\\nthe weight at various points along the spine, from below upward, thus\\nstretching the spine all the way along. There is a method frequently used\\nby surgeons in spinal curvatures. The method is simple and readily shown\\nYou have a suspensory apparatus consisting of a bow of steel with two\\nhooks on either side and with a ring on the top to hang it up by. From the\\ninner hooks are straps leading to the collar which buckles under the chin.\\nOn the ends of this bow you have straps descending vvith supports for the\\narm. There you have your patient suspended, pulled up with a pulley. His\\nfeet are free of the floor and you have the weight of the body then all hung\\nfrom the point of the greatest curvature, since upon that point comes the\\ngreatest traction. That is one of the common methods used by surgeons in\\nthe treatment of curvatures. I knew it used in one case. The operator\\nused such a method in a case of our work. It seemed to be very good.\\nThe case was a very bad lateral curvature. The stature of the patient was\\nincreased about three inches in a month, some students are trying this\\nmethod now. I, myself, have not tried it.\\nBesides that you can use this motion which I have already shown n ou.\\nHave the patient sitting with his back toward you, his hands clasped be-\\nhind his neck. You then reach under the axilla, and grasp the wrist on\\neach side, then you push the head forward against the resistance of the pa-\\ntient, and stretch the spine back in such a way as to bring tension alono-\\nthe spine. I think that is a very good movement. The tension that is ex-\\nerted in this way is one of our valuable methods of treating spinal curva-\\nture. Another way is to work from the spine, springing the spine toward\\nthe concavity. Where the spine is deviated laterally I would have the pa-\\ntient lie upon the side with the convexity upward. I can then work against\\nthe convexity, forcing the spine toward the concavity. The muscles on the\\nuppermost side of the body are almost entirely relaxed. You standing in\\nfront of the patient, reaching down upon the vertebra^ bring pressure upon", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0229.jp2"}, "230": {"fulltext": "-14 TREATEENT OF SPINAL CURVATURES.\\nthe Spine. I usually push the shoulder down toward the curvature, and\\nspring the spine. I find this method very good indeed. You can work\\nfrom above downward or below upward.\\nOur second method, then, of mechanically working the spine back into\\nplace, is to spring the spine toward the concavity. Another way is to work\\nagainst the ribs. They being attached to the transverse processes of the\\nvertebrae by ligamentous bands, may thus be used b} their connection to\\nsome extent to force the vertebra back into place. The Old Doctor one\\nday showed me, in a certain case, this motion: having the patient upon the\\nside with the convexity upward, he reached over so that the thumb of the\\nleft hand was upon the angles of the ribs on the lower side of the body, the\\nfingers of the right hand were against the angles of the ribs on the upper\\nside. He then spread the ribs as you see me doing, springing the upper\\nones, upon which he was working particularly, down and then upward;\\nhaving sprung them down to relax them from the transverse processes and\\nto spread the ligaments; and then upward. This of course helps the ribs\\nwhich are more or less displaced, also helps to draw the vertebra back into\\nplace.\\nAnother way is to have the patient sitting. This method is especially\\ngood in cases where the curvature is high up between the shoulders. Work\\nagainst the ribs in front. You can press with the knee against the anterior\\nends of the ribs and draw the arm up in such a way as to bring tension, thus\\nexerting such a pressure upon the transverse processes of the vertebrae be-\\nhind as to help bring them back into place. You should be careful and not\\npress too hard at the knee there, the ribs being joined to the sternum by\\ncartilages which may be ruptured.\\nAnother motion that I use: Have the patient sitting upon a stool, I\\nreach under the arms to the angle of the rib on either side, and then turn\\nthe patient from side to side, lifting the superincumbent weight off the ver-\\ntebrae and springing the spine back toward the original position. Not only do\\nI hold on each side against the angles of the ribs, but I may, releasing one\\nhand, and grasping the arm, reach over the spinous processes, as ou see\\nme doing, and thus twist the patient around, get a great deal of force exerted\\nagainst the spinous processes. This is a mechanical manner of springing\\nback into place that which is misplaced. Further, you may with the patient\\nsitting, stand on the side, thrusting your hand under the axilla on the op-\\nposite side, you can thus raise the weight of the patient s body to a consid-\\nerable extent. I thrust the thumb againstthe spinous processes, and working\\nwith this twisting motion, make the thumb a fixed point and spring the ver-\\ntebrae back. You can work up and down the spine in that way and tend to\\nbring the vertebrae back. You will notice a great difference in spines. Some\\nare quite mobile, while others are as stiff as iron, and it is ver}^ difficult to\\nmove them. It depends upon the nature of the case. Another point which\\nthe Old Doctor lays stress upon, is to begin at the bottom of the curvature", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0230.jp2"}, "231": {"fulltext": "TREATMENT OF SPINAL CURVATURES. I 5\\nand work upward; the idea being that the lower vertebrae are larger than\\nthose above, and you can work better than from above downward. This\\nmay not be an invariable rule. You should have a purpose in your work\\nalong the spine. If every day you attempt to replace one vertebrae you are\\nworking with a definite point in view. Do not simply work up and down\\nthe spine. Fix your attention upon a single vertebrae each day and try to\\nrestore it to position, and working from it up you will succeed better.\\nQ. If there were several vertebrae out would you only work upon one\\n-each day\\nA. I would give these general treatments described for the general\\nhelp it would be, but I would direct my attention particularly to getting\\none back into position, though I would not work on one alon.e.\\nReduce the secondary curvature first, because it is later in date, and as\\na rule less in extent. Therefore it is more amenable to your treatment and\\nmore readily restored. You will find that the secondary curvatures yield\\nfirst. Those which come first, as a rule are more difficult to restore. I\\nwould first remove any appliances which may have been put on in the shape\\nof stays, braces, etc., to allow free motion, freedom of exercise, and the free\\nflow of blood. The removal frees the patient from the irritation which\\nthese appliances bring. I do not say this simply to condemn any other\\npractice, but it is our practice to remove them to get the spine to depend\\nupon its own strength. So much then for the purely mechanical theor} of\\nour work.\\nO. By putting the lower vertebrae back into place would that have a\\ntendency to throw the one above back to some extent\\nA. Yes, sir, as far as you could within limits. The whole tendenc} is\\ntD work the one above back with the lower one. You cannot work upon\\none of the vertebrae entirely independently of the others. That is more a\\nplan of work. Work with the intention to restore first one and then the\\nother.\\nI hardly need to illustrate what I am about to say in regard to stimula-\\nting. You must thoroughly relax all of the muscles along the spine, hav-\\ning the the patient upon his face. Stretch the muscles and stimulate them.\\nI think that you you already understand that. I believe I ha\\\\ e shown \\\\-ou\\nhow to manipulate.\\nFurther as to theory You remember I have spoken of the central dis-\\ntribution of the sympathetic nerve from the ganglia, supph-ing the liga-\\nments, the vertebrae, dura mater, boneS and vessels. I mean the blood ves-\\nsels going to the muscles, cord, etc., and supplying all of these structures\\nthat we work upon. We are not simply relaxing muscles, but wearcactino-\\nupon the sensory peripheral terminals of the nerves, getting the effect\\nthrough them. The action upon the sympathetic thus influencing the s\\\\m-\\npathetic centers, we get the effect upon the spinal column. That 1 bring\\nout as a point of theory particularly concerned in our work upon the spinal", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0231.jp2"}, "232": {"fulltext": "l6 TREATMENT OF SPINAL CURVATURES.\\ncolumn. Remember that the ligaments and muscles are holding the parts\\nof the spine in place and depend for strength upon proper flow of blood to-\\nthem, consequently when you are working upon blood supply your work is\\nprimary.\\nNow a word as to the theory connected with the good of bringing\\ntraction upon vertebrae by a straight pull or in the other ways shown. Ten-\\nsion, as you know, spreads the vertebrae and allows the free ingress of the\\nblood to the discs and all of the structures concerned. These have been\\npressed out of snape. What you wish to do is to so separate that the\\nblood can be thrown to the parts. The effect that you will get is to allow\\nthe tendency toward the normal to restore parts to normal shape and con-\\ndition. So there is one important point in theory as to why we bring the-\\nstraight pull upon the vertebrae. Thus the vertebrae and the discs are tO\\nbe built up. You will not have a straight column or a strong spinal column!\\nuntil that has taken place.\\nThe process of ulceration and suppuration may be stopped in Pott s,\\ndisease, so that you may prevent the posterior angular curvature if you get\\nyour case in time, prevent the fixation of the joints. These remarks apply\\nto all the work of stimulation of blood supply along the spine. We, thus\\nby all of these means, increase blood supply, strengthen muscles and liga-\\nments, and cause them to hold the ground regained by holding replaced\\nparts in place. Of course you cannot always have parts stay where you\\nput them. It is, therefore, a process of growth. You must bear in mind\\nwhen a man comes in with spinal curvature, that to cure it will take time.\\nIt must be slow and natural. This will enable you to explain in a great\\nmany cases to patients who desire a short period of treatment and expect\\nto be cured.\\nSpring the spine both ways. Placing the patient upon the side, I spring-\\nthe spine toward me, then witli the patient upon the other side I spring\\nthe spine again. You may suppose that you should spring the\\nspine only toward the concav-ity, but the theory is this, that is\\nspringing toward the concavity, then in springing away, you get\\nthe effect of recoil. Then you must pay attention to the gen-\\neral health according to the symptoms that you encounter..\\nThere are various complications of the heart, lungs and internal viscera or\\nthere may be general symptoms, and you must direct your treatment ac-\\ncordingly. Appropriate exercises are good. If your patient has a curva-\\nture in the lower dorsal region, anywhere below the shoulders, he can hang\\nupon a horizontal bar by the arms. It is a good exercise for any one. We\\nare always shorter in the evening than when we get up in the morning. It\\nis good practice, this and other appropriate exercise, to strengthen the gen-\\neral health and strengthen the muscles of the back. This of\\ncourse is not Osteopathie practice, but it is exercise which is useful in aid-\\ning you in your treatment.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0232.jp2"}, "233": {"fulltext": "TREATMENT OF SPJNAL CURVATURES. 1/\\nI might say further that the lateral curve between the shoulders is per-\\nhaps the most difficult, and in addition to general stimulation which we give\\nthe spine in that region, by working the muscles and springing it from side\\nto side, I have a motion which I think is very good, and which I illustrate\\nin this way: The patient sittting upon the stool, and I standing at the back.\\nI have the thumb of one hand pressed against the spinous process of the\\nvertebra on the side toward the convexity, then I spring the head around\\ntoward this side, at the same time pressing the thumb upon the spinous pro-\\ncess back toward the concavity and drawing the head around in that direc-\\ntion. This method I have found to be one of the best for reducing curva-\\nture between the shoulders, as well as reducing the dislocation of a single\\nvertebra. I think that what I have said you may readily apply to the lower\\ndorsal and lumbar curvatures and secondary curvatures without my saying\\nanything more now.\\nI will speak a few minutes as to the results. In the first place, in Pott s\\ndisease, very many cases have been helped where they have taken treatment\\nin time, and in advanced cases you can do a great deal of good. In advanc-\\ned cases I have been able to relieve fever and nervous symptoms and gener-\\nal symptoms from which the patient was suffering, by ordinary work along\\nthe spine. Often the patient is very weak and you must be careful to not\\ntreat strongly. There is one patient that I treat very liitle, scarcely any at\\nat all, but I reduce the fever, and the patient is always relieved.\\nThese cases if taken in time, may be saved from deformity by pre\\\\-ent-\\ning an angular curve. Where the abscesses have not entirely formed they\\nmay be prevented, and the pus may be absorbed. I knew of one case great-\\nly deformed where the symptoms were all relieved, and the patient has\\nbeen enjoying fairly good health ever since. If you get a case earh good\\nresults generally follow.\\nKyphosis, posterior curvature, and scoliosis, lateral curvature, in fa^\u00e2\u0080\u00a2or-\\nable cases are cured. Even where we have not been able to effect a cure,\\nwe have been able to prevent further progress. We have been able to\\nchange the distorted parts to normal even after maturity, but the early\\ncases give the most gratifying results. This ma}- be accomplished in pos-\\nterior and lateral eurvatures.\\nWe must recognize our limitations. We cannot cure e\\\\erything and\\nthere are many cases that we cannot help. We are very much limited, but\\nwe have been able to cure a great number of cases. We have been able to\\ncure more cases than any other system.\\nA few words as to the methods used by surgeons. They are in spina\\ncurvatures chiefly mechanical, with prescriptions of drugs for general\\nhealth. One practice in very general use is to have the patient lie flat up-\\non the back to relieve the spine from the weight of the body. Sometimes\\na bed frame is made in this way: an ordinary iron pipe is made into a rect-\\nangular frame long enough to accommodate the patient, and a cloth is", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0233.jp2"}, "234": {"fulltext": "I8 TYPHOID FKVER.\\nspread over it and fastened, making a fixed, firm place upon which to lie,\\nand which may be readily taken up. There are various appliances which\\nare used. Plaster paris jackets are made. The patient is suspended upon\\na frame ajid bandages are applied as near the skin as possible to a perfectly\\nfitting under vest. Sometimes these jackets are cut in front and laced so\\nthe}^ may be taken off, but generally they are left on. Leather and wire\\njackets are made, and ingeniously contrived and especially elaborately\\nmade braces of great price are used. Objections: All jackets, etc., limit\\nmotion, prevent exercise, are often unsanitary; impede blood flow. Braces\\noften do not fit and are outgrown. Mechanical supports do not allow the\\nweak parts to grow strong. Such contrivances irritate nerves and often\\nperpetuate the condition they should cure. Of course the parts cannot be\\nbuilt up and strengthened, because they are dependingupon something else.\\nAs a rule we remove these things, and leave the patient to have freedom of\\nmotion.\\nSometimes they ha\\\\^e the patient assume a position that will correct the\\ncurvature. There is a seat called Volkman s seat, with the chair seat raised\\nupon one side, and the patient sitting thus, stops the curvature by overcor-\\nrection. They also have the patient lie down on a table, in such a way as\\nto bend the spine. There are various methods used. I thought I would\\nexplain them to ou as they may be useful to you sometime.\\nLECTURE IV.\\nTyphoid fever, (Enteric fever, Typhus abdominalis) is described as an\\nacu e. infectious (but not contagious) disease. I treated a case once where\\nthe lad}- next door had bottles of carbolic acid set along on the window sills.\\nA great many people are afraid of it and think it contagious. It is a long con-\\ntinued fever, characterized by certain lesions of the small intestines, which are\\nthe seat of the disease.\\nAetiology, its cause is now generally held to be a specific micro-organism,\\nthe Typhoid bacillus, or bacillus of Eberth, which invades the body and propo-\\ngates its peculiar poisons, thus infecting the patient and causing the symptoms\\nof the disease.\\nContaminated water is the chief avenue of entrance of the germ into the\\nbody. Not all bad water is thus a carrier of disease. People often use such\\nwater with impunity. Countless millions of the bacilli exist in the feces of\\nthe typhoid patients. These are frequently and criminally allowed to go with-\\nout disinfection by a good germicide. The water in the soil fiequentl}^ be-\\ncomes contaminated with sewerage which finds its waj^ into wells, or rivers,\\nand thus into the houses in the drinking water. A heavy, washing rain, in a\\ntown or village not well drained by sew^ers, will wash the germs into wells and\\ncisterns; or the same heavy rain, cleaning up the large, well drained city,\\nflushes its sewers, and carries its impurities into the river which supplies", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0234.jp2"}, "235": {"fulltext": "TYPHOID FEVKR. 1 9\\nsmaller towns below with water for all purposes. I knew of one case in par-\\nticular, in which a little girl, some five or six years of age, in going home from\\nschool, stopped at an open man -hole in a sewer and played about it for a short\\ntime, and she was very soon afterward taken with a very bad case of typhoid\\nfever, and the cause was laid to her playing about the man-hole of this sewer.\\nSuch effects may occur.\\nCold does not kill the germ. Impure ice is often the source of the infec-\\ntion, as is also adulterated milk and other articles of food. The ice which has\\nbeen used here I think has been the cause of a number of cases, although, I\\ndo not know that it is so much so at the present time.\\nTyphoid fever is not contagious. Clergymen, physicians and nurses rarely\\ncontract it. But this accident sometimes happens in houses where cleanliness\\nis not observed in the matter of bed-clothing, carpets, linen, etc. Quain states\\nthat emanations from newly opened cesspools, sewers, etc., may cause the\\ndisease, rarely however, through atmospheric contagion. This theory, I be-\\nlieve, is now held to be untenable.\\nIt becomes at once evident that great care should be taken to disinfect the\\nstools and urine, and to adopt antiseptic precautions in washing the linen.\\nTyphoid usually occurs epidemically in the Autumn (August-November),\\nbut in cities, sporadic cases are continually noted at any season.\\nSome people never take the fever, seeming to be immune. It is stated\\nthat heredity seems to predispose to an attack, it being more formidable in a\\npatient who has lost a parent by the disease. One attack does not exempt\\nfrom another. Young, robust adults are most frequently the victims, the\\ndisease seeming to avoid persons with chronic ailments. It is very rare before\\none year of age, less so between one year and fifteen years; most frequent be-\\ntween fifteen and thirty years of age. Over-work, mental depressions, shock\\nand general debility are predisposing causes. So it is that the child of a\\nparent, who has had a bad case of typhoid fever, may die from the disease.\\nThus it is that the child, or the brother, or sister who has watched at the\\nbed-side of a patient dying with the fever may have the disease. The shock of\\nthe loss of the relative weakens the system and they are taken down. Such\\ncases occur very frequently, and without doubt it is the mental shock which is\\nthe predisposing cause.\\nTyphoid fever is a disease of the small intestines, and affects chiefly Peyer s\\npatches, hence the name Ileo-typhus sometimes applied to it.\\nFour stages are marked by the condition of the mucous membrane of the\\nsmall intestines.\\n(i) In the congestive stage the whole membrane is swollen and congested,\\ncovered with a slimy exudation.\\n(2) In the case of infiltration, the swelling concentrates upon Peyer s\\npatches, disappearing in other locations. The patches swell and become of a\\ngrayish color.\\n(3) In the stage of softenings the glands burst and are covered by a", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0235.jp2"}, "236": {"fulltext": "20 TYPHOID F\u00c2\u00a3VER.\\ncrumbly crust, or burst and discharge without formation of crust.\\n(4) In the s^aa-e 0/ ulceration^ the -psLtches suppurate and form the Typhoid\\nulcer. The whole gland ma}^ now be sloughed off down to the sub-mucous\\nfibrous coat of the intestines, or the muscular coat may be eaten through, and\\nperforation of the bowels take place. Blood vessels may be eroded, resulting in\\nhemorrhage. While the ulceration as a rule affects the Peyer s glands, the\\nlatter may be wanting, or little affected, while numerous small ulcerations are\\nscattered over the intestines. The large intestine is rarely affected, the ilio-coecal\\nvalve marking the limit of the disease. The mesenteric lymphatic glands become\\ninfiltrated and enlarged. The parenchyma of the liver and kidne}^ the muscle\\nfibers of the heart, and the iuvoluntar} muscles generally may undergo granu-\\nlar degeneration. From this cause heart failure may become a complication.\\nSymptoms: The period of incubation, in which the germ grows in num-\\nbers and gains a foot hold in the tissues, is usually about two weeks, but it may\\nvary to four. The onset is usually insidious; for a few da^^s before the attack,\\nthe patient suffer\u00c2\u00ab from headache, malaise, general weakness, dizziness, nose-\\nbleed, pains in the back, loss of sleep and appetite, coated tongue, etc. The\\nattack proper is ushered in with a chill and vomiting. The chilly feeling may\\nbe slight or wanting. In typical cases, the bowels ma}- be relaxed, and diar-\\nrhoea be present, though often constipation is present. There is gurgling and\\ntenderness upon pressure in the right iliac fossa. The attack may come on\\nviolently with few prodromal symptoms.\\nAn almost unfailing sign of typhoid is the temperature variation, so char-\\nacteristic a course does its rise and fall pursue. During the first week, roughly\\nspeaking, it rises until it has reached 103 to 105 degrees F., for another week,\\nor week and a half, it remains high; then for a week to a week and a half it\\ngraduall} descends. The manner of rise is as follows: for the first four or five\\ndays the temperature increases froai two to three degrees, with a fall of one to\\none and one half degrees F. from evening until morning. After reaching its\\nlevel, it remains about the same, the morning temperature being about from\\none to one and a half degrees lower than that of the evening. During the\\nperiod of decline the morning fall exceeds the evening rise, until the normal is.\\nreached.\\nWhile the temperature is almost invariably characteristic, it has been\\nknown to vary some from the usual course.\\nAnother important diagnostic sign is the rose colored rash. This ap-\\npears about the end of the first week; frequently absent, estimated so in about\\nthirty percent of all cases. The spots are small, reddish, pale, about the size\\nof the head of a pin. The^^ appear in successive crops upon the abdomen,\\nchest and back, lasting until the end of the fever. They disappear upon pres-\\nsure. Individual spots may be observed by being marked about with ink.\\nThe spleen and liver are enlarged and tender.\\nThe symptoms, usually spoken of with regard to the week of the disease,\\nare in great variety, differing much in different patients. During the first", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0236.jp2"}, "237": {"fulltext": "TYPHOID FKVER. 21\\nweek, in addition to the weakness, dizziness, epistaxis, etc., already mentioned,\\nthe abdomen becomes tumid, the tongue is soft and shows the imprints of the\\nteeth. It is covered with a fine white fur which may become heavy, brown\\nand flaky as the disease progresses. At first the edges of the tongue are red,\\nfrequently there appears a red streak down the middle, terminating in a\\nwedge-shaped red space at the tip of the tongue. The pupils of the eye dilate.\\nDuring the second week the temperature keeps about 104 degrees F, the pulse\\nis weak, soft, often diaotic, and varies from 100 to 120 beats; the face assumes\\na stupid look, the patient is very weak, lies upon the back, slips down in bed,\\nfollowing the weight of the body. There is a dizziness, ringing in the ears, a\\ndry tongue, but the patient does not ask for water; drinks when it is given to\\nhim. He answers slowly when spoken to, shows the tongue with difficulty,\\nmutters and is delirious.\\nIn the third week the extreme weekness continues. The bowels are us-\\nually loose, owing to the catarrhal condition of the intestines, the cheeks are\\nflushed or cyanotic: the lips and teeth are covered with sordes; the abdomen is\\ninflated, and the dependent parts of the lungs solidified. The tem^perature is\\nstill high; there is a jerking of the tendons (subsultus tendinum,) the patient\\nslides further down in bed, and the stools and urine are apt to pass off involun-\\ntarily. This is the dangerous week, and the one in which the mortality is the\\ngreatest. Bed sores frequently appear at this time, and are to be carefully\\nguarded against. The patient is stupid and delirious and may pick at the bed\\nclothing. In this week the intestinal hemorrhage or the perforation of the\\nbowels may occur. The former may not be serious, but the latter is usually\\nfatal. They are often brought on by some indiscretion, such as the eating of\\nsolid food. The climax of the disease is now reached. The patient may die\\nfrom perforation, hemorrhage, weakness, or some complication. On the other\\nhand, all the symptoms may improve; the stupor becomes natural sleep; con-\\nsciousness return; pulse and respiration become normal. This continues during\\nthe fourth week, but the patient recovers very slowly.\\nRelapses are of frequent occurrence They occur about ten days after the\\nthe disappearance of the fever.\\nHemorrhages are known by passage of blood from the bowels, nose or\\nwomb. The patient nears collapse and the temperature suddenl} falls. Per-\\nforation is known usually by a sudden and intense pain in the abdoiiien, bloat-\\ning (tympanites) and collapse. The patient lies on his back with knees drawn\\nup. Peritonitis follows. The countenance is pale and wet with perspiration.\\nThe abdominal walls are motionless in respiration.\\nComplications are common, e. g. pneumonia, parotitis, pleurisy, and pul-\\nmonary gangrene. Various forms occur: e. g.. Abortive typhoid, in which the\\nsymptoms are light, remission of temperature on the eigth to ninth day; walk-\\ning or ambulatory typhoid, patient gets around,- the symptoms are slight, but\\nmay suddenly terminate in perforation or hemorrhage.\\nTreatment of typhoid fever requires great care and careful nursing.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0237.jp2"}, "238": {"fulltext": "22 TYPHOID FKVKR.\\n1 Liquid diet must be strictly enforced from the onset until from five to\\nten days after the fever has gone. Milk, meat broths, and soup are indicated.\\nThe best is milk v^ith lime water in it to prevent coagulation of the milk in the\\nstomach. Milk or beef tea should be given about every three hours. From\\ntwo to four pints of milk may be given a day.\\n2. Frequent sponging, (night and morning) with tepid water with a little\\nvinegar in it should be employed. Hands and face should be frequently wash-\\ned. Sometimes cold baths are given every three hours. The water should be\\nseventy-five to eighty-five degrees F. and the body immersed in it for a few\\nminutes, the body being well rubbed afterward ^to prevent internal conges-\\ntion.\\n3. Bed pan and urinal should be used from the first as the extra exertion\\nof sitting up is a serious drain on the patient s strength. Patient should never\\nbe allowed to get up.\\n4. Swab mouth with a wash of equal parts of glycerine and water with\\nlemon juice added.\\n5. Diarrhoea unless exceessive, more than from three to five times daily,\\nshould not be interfered with.\\nIn constipation us^ anema every day or second day.\\n6. Keep feet and hands warm by hot applications. In case of relapse\\nand sudden fall, heat up well and quickly by hot applications.\\n7. Return to solid food very slowly. Not earlier than from five to ten\\ndays after the fever has left. In all treatment avoid carbo-hydrates, (starches,\\netc.) such foods as are digested in the intestines. No fat, etc. The solid\\nfood may be ^zz, lightly boiled or poached; very soft boiled rice, curds, and\\nwhey. (There is always some one around to feed a patient boiled cabbage and\\npork.) Care should be taken as the patient always has a ravenous appetite,\\nand there is great danger of over feeding.\\n8. Plenty of water boiled\u00e2\u0080\u0094 should be given. You may give toas twater,\\nbarley water, etc.\\nThe object of medical treatment is simply palliative. Hare declaring that\\nthe course of the disease cannot be shortened. However, Dr. Goltman of Mem-\\nphis, Tenn., in the Medical Record, New York, September 17, 1898, states his\\nbelief to be that early and rigorous eliminative treatment may cause a shorter\\nor milder course by lessening toxaemia. In medical treatment as in Osteo-\\npathic treatment, great reliance is placed upon proper nursing, but the former\\nindicates a long list of drugs for the various phases of the disease.\\nOsteopathic treatment, if early and thorough, is highly successful, in most\\ncases generally shortening the course, and in most of the remainder keeping\\ndown the fever and the untoward symptoms that consume the patient s vitality.\\nDr. Connor, of much experience, states that he can usually have the fever broken\\nup within two weeks. Dr. McConnell states that by early and radical treat-\\nment the course may be shortened to five days or less.\\nQ. Would it not be injurious to take the patient out of bed to give him a\\nbath?", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0238.jp2"}, "239": {"fulltext": "TYPHOID FKVER. 23\\nA. Not necessarily so, as he could be lifted out and back.\\nQ. How soon would you reduce the fever?\\nA. As soon and as much as you can. Of course it does not stay down\\nbut we keep at it. We always make it a practice to keep it down as much as\\npossible.\\nQ. How often do you treat a patient for typhoid fever?\\nA. You should go to see your patient two or three times a day and make\\nit convenient to go several other times to see if he is getting along allright. You\\nshould give at least two treatments a day.\\nTreat7nent Procedure by Osteopathy: You will find your patient very ner-\\nvous, muscles twitching, and perhaps irritable. You can reduce the nervous-\\nness and twitching by carefully relaxing the muscles along the spine. I have\\nthe patient turned on the side, with as little effort on his part as possible, and\\nrelax all of the muscles along the spine on both sides. I do not usually put\\nhim to the trouble of being turned over to the other side. I reach over\\nmyself to the muscles on the under side. You can in this way get the effect\\non both sides, and the next time you can have him turned on the other side:\\nYou wuU find by treatment along the spine and by gentle treatment in the\\nneck you can usuallj^ quiet the patient. Treat in the neck at the superior cer-\\nvical region. The idea is to get the hand flat against these muscles which are\\ndrawn and sore, and gently turn the head to one side so that you can relax the\\ntension. That seems to relieve the tension and aid the blood flow. The spinal\\ntreatment and treatment in the neck are for these symptoms of nervousness.\\nThe theory is that we affect the posterior spinal nerves and get the effect through\\nthe terminal sensory fibres to the sympathetic nervous system, and out through\\nthem to the vaso-motor and thus equalize the circulation. I think that our\\ntheory here of work upon the superior cervical region is that we reach the sub\\nand great occipital nerves and reach the general circulation through the medulla,\\nin that way quieting the nerves. There are special points which are included\\nbetween the second dorsal and and fourth lumbar, (a.) From the second to\\nthe seventh dorsal to relieve the lungs, as you know pneumonia is one of the\\ncomplications, (b.) Work gently from the fifth to the tenth dorsal for the\\neffect upon the jejunum, (c.) From the tenth dorsal to the first lumbar for\\nthe ilium. We do the most of our work from the tenth dorsal to the first lumbar\\nbecause the small intestine is affected. You may work from the first to the\\nfourth lumbar to affect the large intestine, (d.) From the sixth dorsal to the\\nsecond lumbar to affect the kidneys. All your work along here must be very\\ngentle. Work against the mu :cles gently, about as you see me doing here,\\nparticularly from the tenth dorsal down to the fourth lumbar. I work gently\\nspringing the spine, all the way along, gently toward me as that will stimulate\\nand relieve the nerves. The spleen must be looked after in the splanchnic re-\\ngion from the eighth to the twelfth on the left side. The ribs from the eighth to\\nthe twelfth on the left side must be raised gently. I would not take up the\\narms of the patient. I would reach under him and raise in this way. Work", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0239.jp2"}, "240": {"fulltext": "24 TYPHOID FKVKR.\\nover the abdomen and under the ribs in front, not hard, as the spleen and liver\\nare likely to be congested and you must not work hard on that account. In\\ndiarrhoea, where there are more than three or four stools in a day, we inhibit\\nthe ninth, tenth and eleventh dorsal, the eleventh especially; simply by hold-\\ning against this point, the patient upon the side, and springing the spine. I\\ngo also to the lumbar region, and hold at the heads of the eleventh and\\ntwelfth ribs. The theory there is that springing the spine and gently raising\\nthe ribs releases any tension upon the spinal nerves, and through them affects\\nthe sympathetics, ruling the organs mentioned. Also treat gently the second\\ndorsal and fifth lumbar to influence the superficial fascia and thus influence the\\ngeneral circulation of the blood; the cutaneous circulation.\\nFever: I take down the fever by work here in the superior cervical region\\nas I have already shown you. I hold flat against the sub and great occipitals\\nfor a long time. Do not be in a hurry. You can hold there several minutes if\\nyou wish, and turn the head from side to side, gently. I also inhibit by spring-\\ning the arm up a little; or b}^ pressing in against the heads of the upper ribs on\\nthe left hand side, from the first to the fifth to help quiet the heart. In ex-\\ntreme cases where the heart beat is from one hundred and thirty to one hun-\\ndred and forty, Dr. Hildreth says he has had fairly good success by raising]|the\\nfifth rib on the left hand side. I would work under the angles ^behind and\\nraise both the angle and the tip. Also you will need to lower the first rib\\ngently by pressing in behind the clavicle.\\nThe abdominal treatment is one that must be given very gently. We work\\ngently in the iliac fossae on each side. I kneed gently not with the idea of\\nhelping the constipation, but of getting in deep among the intestines and re-\\nlaxing the tension upon the lower hypogastric and pelvic plexuses, simply by a\\ngentle touch to relieve the tension in this way. Now this work over the liver\\nand spleen seems to relieve the tension, takes out the soreness, and thus prob-\\nably, prevents the degeneration spoken of in the spleen, by freeing the blood\\nflow, as well as preventing ulceration in the bowel. Probably also there is de-\\ngeneration of the involuntary muscles of the heart, and as soon as you can do\\nso you should give a stimulating treatment to restore the vitality,\\nSuppose you have a hemorrhage? Osteopathic treatment there would be\\nas far as possible to inhibit the peristalsis at the ninth, tenth and eleventh dor-\\nsal vertebrae. The best thing to do is to immediately place an ice bag over\\nthe caecum to contract the blood vessels and stop the hemorrhage, while on\\nthe other hand, if 3 ou have perforation of the bowels, which is sudden, and\\nmay be noticed by the fixation of the abdominal walls, etc., hot applications\\nare used over the bowels and lower limbs, to relieve the pain. If perforation\\noccurs you are almost sure to lose your patient.\\nThe patient s room should be quiet and clean, with good ventilation, plenty\\nof fresh air, diligent nursing and frequent Osteopathic treatment, but not\\nenpugh to in any way worry the patient. Guard against relapses from\\nover eating.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0240.jp2"}, "241": {"fulltext": "MALARIA. 25\\nLECTURE V.\\nMalaria, called also Marsh Miasm, Iniermitteiit Fever, Fever and Ague, is an\\nendemic disease, dependent upon the presence, in the infected locality, of a\\nspecific poison generated by a Protozoon germ, Plasmodium Malarise, or\\nHaematozoon of Leveran.\\nThe term Malaria is commonly used in a general sense, to denote a class\\nof intermittent and remittent fevers known as the Malarial fevers or diseases.\\nThis class of fevers is characterized by enlargement of the spleen and liver,\\nparoxysmal periodicity, and the presence in the blood, either free or within the\\ncorpuscles, of various forms of the above mentioned parasite.\\nyFtiology. The cause of this disease is peculiar, and not well understood.\\nAlthough described by early writers as the Bacillus Malarise, it is now\\ngenerally admitted to belong not to the class of bacteria, but to the class of\\nprotozoa. It is generated in swampy places as the name (marsh miasm)\\nimplies, though by no means there exclusively. It occurs chiefly in tropical\\nclimates, and in places where strong heat from the direct rays of the sun,\\nmoisture, and decaying vegetable matter are present. It is often met with in\\nlocalities where the soil is rich in organic matter. When the natural drainage\\noutlets of a locality become clogged, the ground becomes waterlogged, and\\nmalaria is very apt to be developed. Malaria is also known in some dry, arid\\nregions. I^arge tracts of arable land, left without cultivation, frequently be-\\ncome malarious. Digging up of the soil, e. g. for the purpose of putting in an\\nextensive sewer system, has long been known as a cause of an epidemic of the\\nfever.\\nThe fertile strips of soil at the bases of the mountain ranges in tropical\\ncountries are seats of the miasm, e. g. base of the Himalayas, where the soil,\\nrich, well watered and covered with forest, is notably malarious. Certain\\nrocks, disintegrating, exposed to sun and air in tropical countries, are said to\\nbe productive of the poison, e. g. granite rocks, which are highly absorbent of\\nmoisture. When you come to consider that the rocks are one of the best fer-\\ntilizers known, then you have some idea how they ma}^ increase the value of\\nthe ground by fertilizing it.\\nDecaying vegetable matter m the bilge water of ships has been assigned as\\nthe cause of an outbreak of malaria.\\nCertain low lands along rivers, are known to be especially infected. Our\\nChariton river, it is said, is infested more on one side than on the other. Dr.\\nConnor used to tell us in clinics that on the west side, I think it was, the peo-\\nple were very apt to be malarious while those on the east side were not.\\nNew places, just under cultivation, and places with a damp subsoil,\\nthough the upper crust is dry, are ver}^ frequently affected.\\nCharacteristics Malaria is described by Green as being strictlyendemic, i.\\ne. limited to certain localities. The disease must be contracted, here though it", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0241.jp2"}, "242": {"fulltext": "26 MALARIA.\\nmay manifest itself elsewhere. This would seem most natural from the nature\\nof the cause. However, Epidemics of malaria are common occurences, while\\nsporadic cases are known. Rane says it is not known why epidemics and\\nsporadic cases should occur, as they have been known to occur, in localities\\nwhich have never manifested malarial infections, in individuals who had not\\nleft the locality.\\nThe disease is not contagious, it cannot be carried by one person to another.\\nOne person may be infected from another, says Green, on y be direct intraven-\\nous inoculation.\\nThe miasm seems to travel with air currents, and in certain definite plans.\\nIt may be stopped by a hedge or a wall, unless a strong breeze carries it over.\\nIt may be found only upon one side of a river, the other side being entirely\\nfree from it. A forest belt is often a barrier. Under proper conditions it may\\ntravel long distances upon air currents, provided the strength of the breeze be\\nnot sufficient ta dispel the germs. They may rise with currents of heated air\\nto considerable altitudes which are otherwise healthful. They have been\\nknown thus to ascend along ravines up mountains from five-hundred to three\\nthousand feet in height. Thus it is sometimes unsafe to place a dwelling near\\nthe edge of a ravine.\\nThe virulence of the miasm varies some with the temperature, localities\\nwhich are unhealthful in Summer and Autumn becoming safe in the winter\\nseason.\\nThere is a theory that tke system of the host may become inoculated\\nthrough the bite of insects, e. g. mosquitoes. However this theory though\\nprobable, is questioned.\\nThe Germ: As stated above, the germ of this disease is not a bacterium^\\nbut a protozoon. It is always present in the blood, in maleria, either free in\\nthe serum, or within the red corpusels. Its action upon the blood is marked,\\nit being extremely destructive of the red corpuscels. Quain states that Prof.\\nKeltch has shown that in twent3 -four hours, a man affected with maleria lost\\nmore than a million globules per cubic millimeter Thus the patient becomes\\nanemic, and this state of the blood causes murmurs about the heart, which may\\nlead to a mistaken diagnosis. The germ is seen in different forms at different\\ntimes. The form free within the liquor sanguinis is minute, globular, and\\npossessed of amoeboid movements. This seems to be the primary form. Again\\nthe germ is seen within the red blood corpuscles, amoeboid, pigmented. iVgain\\na large pigmented intracorpuscular form is seen; then an intracorpusnular\\nrosette form, with the pigment aggregated at the center; or the flagellated\\nform is seen free.\\nSome writers maintain that the above forms are different stages in the\\ngrowth of the organism. It ma} further, be crescentic in shape, or become\\nflagellated, the flagellae lashing about in the liquor sanguinis.\\nIt is stated that the severe types of malaria in tropical countries are par-\\nticularly connected with the appearance of the crescent shaped germ, and that", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0242.jp2"}, "243": {"fulltext": "MAI^ARIA. 27\\nin temperate climates the crescentic form is rarely present, the flagellated form\\nbeing produced immediately from the intracorpuscular discs I^everan first\\ndiscovered the germ.\\nPathology and Symptomatology The diagnosis of Malaria (typical) never\\nfails on account of the clock-work-like periodicity of the phases of the disease.\\nHence the name paroxysmal. There are three stages; the chill, the fever, and\\nsweat.\\nThe chilly stage lasts from a few moments to three hours. The patient s\\nappearance is marked. The features shrink; there is a chill, which may be\\nviolent; there may be vertigo, and nausea. The chill may be limited to a\\nslight chilly sensation along the spine. Ordinarily the whole surface is cold^\\nthe face is pale; the nose becomes pinched; the breathing is shallow and quick;\\nthe pulse is small and rapid; but the internal temperature rises rapidly from\\ntwo to seven degrees. Various symptoms attend this stage, such as headache,\\nbackache, cough, thirst, colic, etc.\\nThe second stage lasts a variable number of hours; from two or three to\\nten or twelve. It comes on gradually, the body recovering from the chill, the\\ntemperature continuing to rise until it reaches a height varying from 100\\ndegrees to 108 or even 109.40 degrees F. Various symptoms attend this stage.\\nThe third stage also lasts a variable number of hours. In it the fever\\ngives away to a profuse perspiration, greatly relieving the patient, the temper-\\nature declining to normal or near normal. This stage ends the paroxysm.\\nThe patient now may feel quite well, the paroxysm not returning until\\nthe next day, in which case the type is called quotidian, or the paroxysm\\nis absent until the second day. tertian type), or .finally, until the third\\nday, constituting the quartan type. Owing to this peculiarity the patient\\noften feels quite well and wants to go to his usual occupation. After he is\\nwell there is a tendency to the return of the trouble on the fifth, seventh, ninth\\nor fourteenth day. The stage between paroxysms is called the stage of Apyr-\\nexia. The fever is called intermittent on account of the intermision between\\nparoxysms. If the stage follows in the order given, the fever is ^intermittens\\ncompieta; if one stage is lacking, intermitteyis incompleta if in reverse order,\\n^Hnte?mitte7is inversa. The most usual forms are said to be the quotidian and\\nthe tertian. The paroxysms, instead of occuring at regular intervals, may\\ncome each time earlier (anticipating), or later (postponing).\\nThe fever is said to be remittent^ when between the paroxysms the tem-\\nperature is lessened, but the fever merely slackens, exacerbation recurs immedi-\\nately. The intermittent fever may vary in form, being gastric or bilious, and\\nattended with gastric derangement; typhoid, simulating that fever; or of a\\ngrave form leading to a rapid collapse. The symptoms of the latter form are\\ngreat weakness; derangement of most of the organs; icterus; bleeding of nose,\\nstomach or kidneys; dysentery, etc\\nWhen the patient has resided long in a malerial region and has gotten the\\nsystem full of the poison, a low state of vitality exists, with various symp-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0243.jp2"}, "244": {"fulltext": "--28 MALARIA.\\ntoms characteristic of the maleria, but in mild form. This is called Mala-\\nrial Cachexia.\\nDumb Ague is the name given to a variety of malaria, sometimes acute\\nbut usually chronic, in which the sequence of chill, fever and sweat does not\\noccur. The symptoms are irregular chilly sensations, flushes, pains in joints\\nand muscles, bronchial troubles, headache and neuralgia, etc.\\nEnlargement of the spleen (ague cake) and liver, with soreness of both, is\\na usual feature of all these forms, as well as a constant feature of the regular\\nform. These both and the spinal cord become pigmented, probably through\\ndestruction of the red corpuscles. The urine is often irritating during the\\nparoxysm.\\nTreatment Now as to medical treatment, quinine is the stock remedy,\\nand is said to destroy the germ.\\nThe Osteopath wants to get rid of the fever and of the poison. He stim-\\nulates as far as possible all of the avenues of excretion through the bowels,\\nkidneys, liver and the lungs in the ways already indicated. It will not be nec-\\nessary for me to indicate this to you, simple and general stimulation of the\\n\u00e2\u0096\u00a0excretory system. I think you all know the points at which you work. The\\nsecond dorsal to the seventh dorsal, and also the fascia at the second dorsal and\\n\u00c2\u00a3fth lumbar, in all stages generally treat this wa3\\\\ I also treat the liver in a\\nway wnth which you are familiar, and the spleen. Work gently, as you must\\nbear in mind that these two organs are very likely to be congested in any such\\ncases as this, and you must not run the risk of rupturing them. For chill, re-\\nlieve the internal congestion, and thus relieve the chill b3^ stimulating the heart\\nand by stimulating the superior cervical ganglion. Stimulate the lungs as\\nw^ell. b}^ raising the ribs from the second to the seventh on both sides. Give\\nalso a thorough spinal treatment. Some have said to rub up the spine in order\\nto stop the chill, but I do not see why that should be. If you stimulate the\\nspine all the way along you thus restore the circulation. When 3^ou find the\\nbody chilly, warm the patient b}^ hot applications to the spine, feet and in the\\naxilla. Also give hot drinks and hot foot baths. Hare says the action of the\\npoison at this stage of the chill has congested and engorged the thoracic and\\nabdominal organs. Work especially upon the splanchnics and solar plexus in\\nfront, and work over the abdomen in front to get rid of the congestion about\\nthe abdominal viscera; and the stimulation about the lungs already described,\\nwould get rid of the congestion about the thoracic viscera.\\nAs to the fever, you treat it as any other fever, cold sponging and cold\\ndrinks have been indicated by Hare. Besides that, Osteopathically slow the\\nheart s action by inhibiting. You raise the arm and hold back on the shoulder\\nin this wa3^ for a minute or a minute and a half, and this will slow the heart s\\naction. Inhibit the superior cervical, the splanchnics, and the lower lumbar to\\nequalize the circulation. In the stage of sweating 3^ou should let the patient\\nalone, as the perspiration removes the poison, causing the patient to feel better.\\n\u00e2\u0080\u00a2Give plenty of water to drink, and encourage the perspiration by wrapping up", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0244.jp2"}, "245": {"fulltext": "RHEUMATISM. 291\\nwarmly Give hot foot baths, also stimulate the superior ganglia and lungs\\nto help this improvement along. The constipation and diarrhoea you know\\nhow to treat, as before indicated. In the period of apyrexia, give a thorough\\ngeneral treatment for a tonic effect.\\nI might say our success is good in malaria if the case is taken in time, but\\nif the disease has been coming on for some time it is more difficult to cure,.\\nSome two or three months ago a young man came to my house on Sunday with\\nhis face flushed, and the malaria symptoms very perceptible. I treated him\\nthat day and the next. He remaied at home several days but he was out with-\\nin a few days.\\nWhere you have a malarial constitution it will probably take some time to\\nwork this poison out of the system. I have had cases where they would have-\\nchills once a week. You can stop the chills and relieve all the symptoms.\\nLECTURE VI.\\nThe various forms of rheumatism are among the most frequent cases that\\nthe Osteopath is called upon to treat. The fact that m.ost of these cases have\\nbecome long standing chronic cases, makes the average cavSe of rheumatism\\nsomewhat difficult to handle and slow to cure. Very serious cases of deformity\\nresulting from the disease present themselves for treatment. Frequently parts\\nare dislocated, e. g., hip, knee, lower jaw etc., simply in the progress of the\\ndisease. I have had several such cases. One case was of a man in this town\\nwho had been affected with rheumatism for some years, but one day he went\\nup town, and while walking his hip became dislocated. It shows you the\\ndrawing power of contraction in disease. I have seen more than one case\\nwhere the lower jaw had been dislocated from the same reason. Joints become\\nenlarged by the growth of tissues; the synovial membranes are .destroyed and\\nchalky deposits are formed in the joints. One of the most frequent phenomena\\nyou will witness in connection with rheumatism, is the enlargement of the\\njoints, for the reason that these cases, in the majority of instances, become\\nchronic and this chalky deposit is formed. Consequently it becomes one of the\\nmain points in the diagnosis of rheumatism. Hence it is not strange that the\\nOsteopath frequently finds himself confronted b}^ cases, certain features of\\nwhich are beyond his skill, while at best, they, as a whole, are slow and un-\\nsatisfactory. It is rare however, that the Osteopath cannot aft ord immediate\\nrelief from pain in any case of rheumatism, and, almost without exception,\\ncases coming under his care are greatly benefited in most particulars. He can\\nreset the dislocated joints, relax the rigid muscles, absorb to some extent the\\narticular deposits, and give new freedom to stiffened joints. In almost any case\\nof acute Rheumatism, whether muscular or articular, his success is practically\\nassured, while in chronic cases he may usually obtain good results. Hence the\\nsuccess of Osteopath}^ as a treatment for all forms of Rheumatism is marked.\\nThe fact that so many cases are of years* standing, coupled with, the fact tliat", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0245.jp2"}, "246": {"fulltext": "30 RH:eUMATlSM.\\nthe patient frequently cannot continue the treatment for a sufficient length of\\ntime to obtain the best results, makes the average of the cases coming under\\nthe treatment slow and difficult.\\nIn the special forms of this disease, such as I^umbago, Torticollis, Pleuro-\\ndynia, etc., the treatment is very successful.\\nThere are several forms of Rheumatism, commonly met with: Acute\\nRheumatism, known also as Rheumatic fever and Acute Articular Rheumatism;\\nChronic x^rticular Rheumatism, aud Muscular Rheumatism. These three forms\\nof Rheumatism are separate forms. Chronic Articular Rheumatism does not\\nnecessarily follow the Acute or Rheumatic Fever, although the latter may de-\\nvelop into the former. Sometimes the person is attacked from the beginning\\nwith this socalled Chronic form of Articular Rheumatism. They seem to be\\ndistinct from each other, though the Articular forms, both acute and chronic\\nare due to similar causes, and the latter often results from repeated attacks\\nof the former. The muscular form is often complicated with the other forms.\\nRaue makes the following general statement regarding this disease, ist\\nIt attacks either the fibrous tissues, joints, aponeuroses, the sheaths of the\\ntendons, the neurilemma, the periosteum, or the muscles and tendons. 2. It\\nis a peculiar, painful affection, caused, no doubt, by inflammation and nutritive\\ndisturbances; and, 3. It comes on independently of other acute or chronic di-\\nseases, or traumatic causes, etc\\nRheumatic Fever, (Acute Articular Rheumatism) is an acute, febrile disease,\\na constitutional disturbance, characterized by fever, sweats, and inflammation\\nof the joints and serous membrane of the body. The tendency it manifests of\\nattacking any serous membrane makes it frequently a dangerous disease.\\nAetiology. As to the causes of the disease, they are two fold; predisposing\\nand exciting. Among the former are heridity(27) per cent; previous attacks;\\noccupation, such as hard out door labor under exposure to the weather; social\\nposition, poverty being a. frequent cause; and residence in certain districts.\\nAmong the exciting causes are infection, this being considered by some a\\ndisease caused by micrococci in the system; exposure to wet and cold; strains and\\nmuscular sprains; chills from overheating; derangement of the stomach and liv-\\ner from the eating of rich food; mental effects, such as despondency and de-\\npression; exhaustion from sickness, lactation, uterine disease, etc.\\nSome authorities hold that there is accumulation of lactic acid in the sys-\\ntem, acting as a poison to the tissues. Others hold that chilling of the surface\\nof the body causes derangement of the parts of the central nervous system and\\nvaso-motor disturbances, or pain, or trophic changes. In regard to the chilling\\nof the surface of the body and this affecting the central nervous system, you\\nsee here it is given plainly in the aetiology of such a condition as rheumatism.\\nWe generallj understand a cold to be a congestion, but it has been suggested\\nthat it may be due to a nervous disturbance from chill. If your feet are wet\\nor exposed the result may be a cold in the head. It is clear in numerous res-\\npects, and I think the hypothesis of nerve causes is a very reasonable one", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0246.jp2"}, "247": {"fulltext": "RHEUMATISM. 3 1\\nSome regard a chill as affecting nutrition, causing the retention of the lactic or\\nother acid, which in turn affects the nervous system, causing affection of the\\njoints. There is a germ theory, a specific organism being suspected; and a ma-\\nlarial theory, due to miasm or poison generated outside of the body. The gen-\\neral difference between the bacterial infection and the infection of miasm is\\nthat the bacteria get a foot-hold and propogate the poisons in the system as in\\ntyphoid fever, while on the other hand in malaria, the miasm is generated on\\nthe outside of the body, and the poison formed is taken into the system by the\\nperson visiting the locality infected by the poison.\\nAll this goes to show that the nature of the disease is not well understood\\nalthough a late writer says: It is apparently becoming more and more\\nrecognized as a purely infectious disease. (Raue.)\\nPathology: Structural changes in the joints are sometimes very slight,\\nfollowing the inflammation of the synovial membrane; merely a slight exuda-\\ntion containing a few pus cells and but little fibrin is noted. There is oedema of\\ncellular tissue about the affected joint, causing a visible swelling. One of the\\nmost frequent symptoms that you will note in cases of rheumatism whether of\\nlong standing or recent, is that the joints will swell. I am treating a case now\\nin which the two fingers on the left hand will swell. Sometimes it will be in\\nthe hand, and sometimes about the various joints.\\nIn severe inflammation of the synovial membrane, considerable pus and\\nfibrin are present in the exudation, and the ends of the bones may become in-\\nfiltrated. The heart and large blood vessels contain a large amount of fibrin;\\nthe cartilages of the joints probably suffer inflammatory changes, when- there\\nhas been much fever, there is apt to be granular degeneration of the liver and\\nother solid viscera. The inflammation frequently attacks the heart, or luno-s,\\nor pleura. It may attack the peritoneum, larynx, testes or renal tubules of\\nthe kidneys. There may be congestion of the lungs, pericarditis, myocardits,\\nor endocarditis. It is this tendency of Rheumatic fever to attack the heart es-\\npecially, and the lungs, that renders it so often fatal. It is said that about\\ntwenty per cent of all cases are complicated with endocarditis; fourteen per\\ncent with pericarditis, while myocarditis is quite rare. Pleuritis, pneumonia\\nand meningitis are still less frequent.\\nSymptoms: Three prominent and constant symptoms of Rheumatic fever\\nare, fever, sweats and arthritis. The fever is variable, frequently, but often\\nfollows a tolerably regular course. It is present at the outset, and lasts as long\\nas the disease preserves its acute character. Usually the temperature does not\\n-exceed the normal more than one or two degrees. It is usually moderate if\\nthe joint symptoms are so, but may rise to 104 or 104.90 degrees F. under an\\nopposite condition of affairs. Sometimes the fever rises rapidly and becomes\\nvery high without respect to other symptoms. The fever is remittent in type,\\nrising from one fourth to one degree in the evening. The sweats are acid, and\\nthe skin is often covered by a fine red or white ash. The perspiration is pro-\\nfuse, and of an acid odor, it varies in amount and is most profuse when the", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0247.jp2"}, "248": {"fulltext": "32 RHEUMATISM.\\npain is greatest. It is said that the odor is so strong and so characteristic that\\nfrequently the diagnosis can be made from that alone. The sv/eats are not\\nweakening, but though unpleasant to the patient, afford him great relief..\\nThe arthritis, or inflammation of the joints, is marked by swelling, red-\\nness, pain and heat. Pain in a joint marks the onset of tne attack, it swells\\nand reddens and the effect may spread from one joint to another, or remain\\nlocalized at one joint. The joints of the spine and the symphysis pubes may\\nbe attacked, but the toes are rarely invaded. I had a case in which every\\njoint of the body was attacked. The person was practically immovable. Every\\narticulation of -he spine, everything but the lower jaw was attacked by the ar-\\nthritis. The kidneys were very bad, the arms w^ere drawn at the elbows, and\\nthe knees were drawn up to a right angle. There was great pain, perspiration\\nand on the whole it was very distressing. The lower jaw usually escapes, al-\\nthough I have seen several cases in which the lower jaw was attacked.\\nThe pain is excruciating; much increased upon movement. It begins as a\\nsore feeling and may become throbbing. It very gradually disappears, leaving\\na bruised feeling in the joint. The color of the swollen joint is red or pink,\\nand feels warmer than the surrounding part.\\nThe joints most affected are the knees, ankles, shoulders, wrists, and el-\\nbows, i. e., the larger joints.\\nBesides the fever, sweats and arthritis, there are various symptoms.\\nYou will notice here a similarity between Rheumatic fever and other spe-\\ncific fevers. An attack comes on much in the manner of any acute specific fe-\\nver. There is chilliness, malaise and general debility: sore throat, aching of\\nlimbs and trunk, flying pains in the joints are noted. The patient lies stretch-\\ned upon his back, careful!)^ arranged that every joint may be guarded; the com-\\nplexion is sallow, and the cheeks flushed, Thirst, lack of appetite; frequent,\\nweak pulse and slightly accelerated respiration are all present. The reaction\\nof the urine is acid; it is scanty and high colored.\\nThe joint symptoms are transient, usually, passing quickly from one joint\\nto another, those sore one day being nearly well the next, while still others\\nhave been invaded. The tongue is coated with a moist white fur. The tongue\\nis sometimes coated brown, or is dry and cracked. Dyspepsia and bowel dis-\\nturbances occur. There may be diarrhoea or constipation.\\nThe urine is scanty, high colored, strougly acid and contains a quantity of\\nurates and uric acid, which are deposited as a thick sediment upon cooling.\\nDelirium and stupor ma}^ arise, but are rare. Sleep is either prevented or much\\nbroken by the severe pain. The patient s mind is much disturbed over his con-\\ndition, particularly if he has had previous attacks. I have a case of a little\\ngirl in which the disease began with a sore throat. Both arms and both limbs\\nare affected, and the right hip has been drawn out by the disease. She has\\nbeen affected this way for five or six years. In all respects the bodily health\\nis excellent. The kidneys are in a healthy condition. The urine is frequently\\nanalyzed, and only in case of cold does the urine show a departure from the", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0248.jp2"}, "249": {"fulltext": "RHHU.AIATISM. 33\\nnormal. She is fat and has splendid general health. This shows what se-\\nvere cases of specific disease may exist in which the general health will be good.\\nThis is something that I have wondered at, and something which I think\\nyou will notice.\\nCourse, Duration and Termbiations Children and old people are rarely at-\\ntacked; the majority of cases occuring between the ages of fifteen and forty.\\nMen are more liable to it than women, probably because they are more exposed\\nto conditions of the climate. Robust persons are more frequently victims than\\nare debilitated ones. The disease is more common in the spring and winter\\nseasons, and is observed in all climates, though most trequenlly in temperate\\nones.\\nThe course does not follow a regular cycle, but is variable. The attacks\\nmay pass off in ten or twelve days, or may worry the sufferer for many weeks,\\nfinally passing into a more or less chronic form.\\nConvalescence is as a rule tedious, miay be accompanied by desquamation\\nof the hands and feet, or of the body generally, and is frequently followed, if\\nnot by more severe sequelae, by pain and weakness in the neighboring joints.\\nThe remote effects of the disease frequently persist during: the rest of the life,\\nand are sometimes considered of more consequence than the original attack.\\nSuch are chronic arthitis; heart disease, especially valvular; disease of the lungs,\\nbrain, kidneys, or vascular system.\\nComplications Various complications arise in the course of tte acute at-\\ntack; rendering it more serious and more difficult to deal with. Organic heart\\ndisease is most common, fifty per cent being the estimate. It is said that chil-\\ndren and youths seldom escape it. Its presence is more common in severe at-\\ntacks, women seeming to be more subject to it than men. If the case is neg-\\nlected, heart symptoms are more likely to appear.\\nComplications of diseases of the lungs are likely to occur, and are respon-\\nsible for death in a large proportion of the fatal cases. Such are pneumonia,\\npleuro-pneumonia, pleurisy, bronchitis, and pulmonary bronchitis. Other com-\\nplications are renaL serous intlammation, gout and scarlatina.\\nDiagnosis: The diagnosis is usually made without difficulty, but is often\\nrendered a matter of great difficulty by the tendency manifest, in the period of\\ninvasion, to resemble in its symptoms the acute specific fevers. The diagnosis\\nrests upon the family history, the history of the attack, the pain and tender-\\nness of the joints, the moving about of the joint symptoms from joint to joint,\\nand the acid sweats.\\nPrognosis: As regards death is good, only about four per cent of the cases\\nbeing lost. But as regards succeeding health, it is described as most uncertain,\\nowing to the variety of complicatious, and the uncertain course of the disease.\\nUnder Osteopathic practice the prognosis is good for Acute Articular Rheuma-\\ntism. It runs a mild cour.se in children and old persons. One must be guard-\\ned in prognosis in cases of patients who have cardiac or lung symptoms, or\\nweakness.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0249.jp2"}, "250": {"fulltext": "CHRONIC ARTICULAR RHEUMATISM.\\nLECTURE VII.\\nT wish to call 3^our attention to a couple of points which Dr. Sheehan men-\\ntioned to rae in regard to Acute Rheumatism, or Rheumatic Fever. That is.\\nthe higher the fever, and the more it shifts about from joint to joint, the more\\nliable the fever is to go to the heart. There is greater danger then of it attack-\\ning the heart. The other one is that as long as the alkalinity of the uiine is\\nretained, the heart is not so liable to be attacked.\\nThis is a painful inflammation of one or more joints, running a chronic\\ncourse. Two forms are described by Raue; one in which some single joint re-\\nmains chronically stiff and painful; the bones crepitate at the joint upon mo-\\ntion being made by the operator; the joint may be swollen, or the swelling may\\nbe lacking, or only apparent, through the atrophy of the surrounding muscles.\\nThe second form is merely repeated attacks of rheumatism. The patient\\nis very sensitive to changes in the weather, and can often foretell them by\\npains in his affected joints. This form is often complicated by rheumatic neu-\\nralgia or paralysis.\\nAetiology. The causes are mainly the same as for the acute form; hered-\\nity, exposure, mental depression, poverty and physical exhaustion. The dis-\\nease attacks mostly persons in middle life or in advanced age.\\nPathology: The ligaments and synovial membranes are thickened, enlarg-\\ning the joint; the bones have become spongiform at the cartilaginous ends, and\\nthe synovial fluid is turbid. Very commonly the joints are enlarged and de-\\nformed There is hyperaemia and effusion in the tissues about the joint.\\nWhile the disease in many cases is the result of the acute form, it may at-\\ntack one independently of previous illness. Quain states that in some instances,\\none member of a family is affected by the chronic form, while brothers and\\nsisters suffer from acute rheumatism.\\nSymptoms The most marked svmptom is pain and stiffness of certain joints,\\naggravated by bad weather, and becoming most severe at night. The affected\\njoints are dry and stiff, and crepitate upon movement. Rubbing and exposure of\\nthe joint to cold atmosphere lessen the pain, but increase of warmth aggravate\\nit.\\nThis form of Rheumatism varies much with individuals, some are affected\\nwith stiffness and pain in some single joint. The joint does not seem to have\\nundergone structural change, and the patient may have good general health,\\nleading an active and vigorous life. Other cases present more severe symp-\\ntoms. The pain in the joint is greater, anatomical changes have taken place\\nin it, and it is red, painful and swollen. There are repeated attacks of sub-\\nacute rheumatism.\\nStill other case? present more marked symptoms of pain, swelling, etc.\\nThe changes in the joint are marked, the attacks are so frequent that the pa-\\ntient is in almost constant pain. The joints are often ankylosed or dislocated.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0250.jp2"}, "251": {"fulltext": "CHRONIC ARTICULAR RHEUMATISM. 35\\nThis disease often leads to permanent disability, but deaths from the disease\\ndirectly are rare.\\nHeart disease, as in the acute form, is a frequent complication. Dyspepsia,\\nand the formation of calculi often occur.\\nThe Prognosis under Osteopathic treatment is good. In all cases relief can\\nbe given and in a certain number, entire relief from the symptoms is obtained.\\nMedical prognosis for cure is very unfavorable\\nMuscular Rheumatism \u00e2\u0080\u0094This form of Rheumatism differs considerably from\\nthe other forms described, on account of the different regions of the body in\\nwhich it settles, attacking muscles, tendons, periosteum, neurilemma, fascia, and\\nother fibrous structures, but never joints. It shows a tendency to attack cer-\\ntain groups of muscles, causing varieties of Rheumatism, to which specific\\nnames have been given, e. g. Lumbago, Pleurodynia, Cephalodyuia, etc. It\\nis frequently associated with other forms. This disease is characterized by\\npain and spasm in the part affecied, and by some fever.\\nAetiology: A rheumatic diathesis is said to be the chief predisposing cause.\\nIt attacks one at any age, and of either sex. Exposure to cold, particularly\\nto a draft upon a muscular part; strain of the muscles or ligaments, are the\\nchief causes of an attack.\\nRaue describes the pain of an attack of muscular rheumatism as, tearing,\\nshooting, stitching, screwing, burning; sometimes aggravated and sometimes\\nrelieved by motion, rest, cold or warm application, etc. Little is hnown as to\\nthe pathology of the disease. Sometimes fibrous growths are formed in the\\nmuscles, and the peripheral nerves are grown together, but usually there is no\\nchange discoverable in the muscular structures. Swelling and redness may be\\npresent or lacking.\\nSymptoms: Are slight fever, sore throat, pain in the muscles, which be-\\ncomes severe and spasmodic. The patient assumes characteristic attitudes to\\ngive ease to the parts. The tongue is furred, appetite is poor, constipation is\\npresent, also general malaise. Most of these symptoms may be wanting in any\\ngiven case.\\nThis Rheumatism is not of long duration in many cases. It may disappear\\nin a few days or weeks, or may remain as a chronic ailment, affecting the mus-\\ncles of a particular part. It readily yields to Osteopathic treatment.\\nThe chief varieties are Rheumatic Tofticollis (stiff neck); affects the mus-\\ncles, or the sterno-mastoid, drawing the head to one side, (wry neck.\\nLumbago:\u00e2\u0080\u0094 k.^^oXxw g chiefly elderly persons, coming on suddenly, the pa-\\ntient, stooping over, finds himself unable to rise. It affects the lumbo-dorsal\\nfascia, the erectors spinae, and smaller lumbar muscles. I remember one case\\nof this disease in particular. I was called early one morning to go. see a :ady\\nwho had been sitting upon a chair and bending over her trunk, and when she\\nwent to arise she could not get up. When I got there I first relaxed the mus-\\ncles ail along the lumbar region as l)est I could with her silting upon the chair.\\nShe was put in bed and I soon got the muscles all loosened. She was soon all", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0251.jp2"}, "252": {"fulltext": "36 TREATMENT OF RHEUMATISM.\\nright again, and was about that daj^ and I did not hear of her being troubled\\nafterward, although I lived in that neighborhood for some lime,\\nCephalodjmia: Attacking the frontal, occipital, temporal muscle, the galea\\ncapitis, or periosteum of the skull.\\nDorsodynia: Of the muscles of the upper part of the back and shoulders.\\nPleurolynia: Of the fibro-niuscular structures of the chest, causing pain\\nin the side, cough, restrained respiratory movements, in pectoral and intercos-\\ntal muscles.\\nTreatment: Osteopathic treatment of Rheumatism must be persistent but\\nnot severe. There is danger in Acute Rheumatism of setting up fresh inflam-\\nmation and driving the diseese to the heart, if too severe treatments are given.\\nHence m^^ great care. One should not treat too often or too long, especiall} at\\nthe beginning of treatment. Three times per week is sufficiently often. Length\\nof treatment should vary from ten to fifteen minutes, according to the case.\\nToo frequent and prolonged treatments, as well as too severe handling are\\nespecially apt to irritate and do harm in Rheumatism, because of the soreness\\nand pain that naturally accompany the complaint.\\nIn any ca^e of Rheumatism, the Osteopath must give especial attention to\\nstimulation of the kidneys. He must also thoroughly treat the liver and boivels,\\nstimulate lung action, and cutaneous circulation, all with a view of removing\\nthe acid from the system. The liver is said to be frequently enlarged in Rheu-\\nmatism.\\nDr. Harry vStill alwaj^s has good success in treating rheumatism, and his\\ntreatment upon the kidnej^s is invariabl)^ this already described to 3 OU as stim-\\nulation of the kidne3^s from the sixth dorsal to the second lumbar. Your work\\nupon the liver and bowels is for the purpose of eradicating the poison from the\\nsystem. You must also stimulate the twelfth dorsal and upper lumbar. You\\nknow how to stimulate the lungs from the second to the seventh dorsal on each\\nside, also stimulate the second dorsal and fifth lumbar, centers for the superfi-\\ncial fascia. A general spinal treatment is given, and bathing and as much ac-\\ntive exercise as the patient can take are good.\\nThe treatment then for the liver, over the ribs from the eighth to the\\ntwelfth; kidneys, sixth dorsal to the second lumbar, also the twelfth dorsal and\\nthe upper lumbar; for the lungs, second to the seventh dorsal on each side, for\\nthe fascia, second dorsal and fifth lumbar; add to that, treatment to the superior\\ncervical ganglion of the sympathetic, reaching the center for the medulla.\\nI have seen Dr. Harry Still take a case of Rheumatism and for the first\\nwork do nothing but stimulate the bowels, kidneys and liver, and he would not\\ngo anj^ further. I have often wondered w^hy he should give such short treat-\\nments, but he is very successful in treating Rheumatism. The treatments are\\nnew to the patient and this is all that he can stand. You must gradually ex-\\ntend your treatment to other parts of the body, since in the various forms of\\nRheumatism, the digestive and circulatory systems may be deranged, the heart\\nand lungs, kidneys, and blood all undergo pathological alterations, and even", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0252.jp2"}, "253": {"fulltext": "TREATMENT OF RHEUMATISM. 3|\\nhe braiu may be affected The Osteopath must keep close watch upon the\\ncondition, and by combining thorough general and spinal treatment with the\\nspecific measures he employs, keep the system and their special parts and or-\\ngans well stimulated and sustained. He may thus prevent or repair these\\npathological changes, aborting the attack, or giving grateful relief.\\nIn the articular forms, the object of treatment is to spread the Joint and\\ngive free access of blood and nerve flow. There are particular ways It is\\nw^eli to work the arm up and around. But it does not reach as well as a par-\\nticular move, taking the arm of the patient in one hand I double the other\\nhand and place it in the axilla. I then push the arm of the patient down close\\nto the side; that springs the shoulder joint, allowing the articular nerves and\\nvessels free action. If it be in the spine, this movement of traction\\nthat I have shown frequentlv is good or with the patient sitting\\nwith the hips held down, while you reach down and lift at various\\npoints along the spine, thus spreading. For the knee and ankle,\\nyou can have some one hold under the shoulder while you pull, in this way^\\nwhile spreading the joints of the knee and ankle. Another way that I\\nhave for treating the knee is to place the foot of the patient between my knees\\nand to work in the popliteal space, holding the knee in this way and spreading\\nthe hamstring muscles. Another very good way is to have the patient sitting\\nupon a chair, place your knee under that of the patient so that his popliteal\\nspace rests upon your knee and you can spread the joint by pushing the leg\\ndownward. As to the wrist and fingers, you can by holding the forearm in\\none hand, spread the wrist joint and the fingers, by traction. At the elbow I\\nhave the forearm semi-fiexed upon the arm and that releases the olecrannon\\nprocess and you can spread the joint by traction at the bent elbow. This\\nmotion will apply, I think, to all of the joints of the body, so that you will\\nhave no difficulty. When there is motion in the joint and the synovial mem-\\nbrane is not destroyed, the chances of restoring it are good. You cannot tell\\nfrom the outside how much of the joint has been destroyed. You can only tell\\nby general symptoms, by the amount of motion and the amount of pain, judg-\\ning from these that the synovial membrane has not been destroyed. Then you\\nhave a great deal better success than if the membrane has been destroyed.\\nSpreading, as I have said, renews blood and nerve supply and absorbs deposits,\\nbut it will take many months. You must have the patients treating for month\\nafter month. A great many people do not have the patience, even if they pos-\\nsess the means, to continue the treatment long enotigh to get the results. If\\npeople possessed the patience to contmue the treatment a sufficient length of\\ntime, we could do so much more good than we can under other conditions.\\nIn Actite Rheumatism great care must be taken in spreading, on account\\nof the pain. The same is true to a considerable extent in the chronic forms.\\nYou must gradually accustom the patient to the treatment so that he can btand\\na great deal more.\\nIn Muscular Rheumatism, the treatment must be directed to stretching", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0253.jp2"}, "254": {"fulltext": "^S TREATSIICNT OF RHEtrivrATISM.\\nand thoroughly kneading the affected muscle, tendon or joint. I lay special\\nstress upon stretching the muscles. If yon have, say the biceps muscles of the\\narm affected, I would adopt some such motion as this: push the arm ont\\nstraight and back, the idea being to increase the distance between the bony at-\\ntachments so as to stretch the muscles. Get the best w^ay to stretch and\\nelongate the mu cle itself. Owing to the elasticity of the muscles they may be\\nstretched, allowing free flow of blood through them. You can also knead\\n5ome, and you can prescribe baths. A salt rub is good. Massage treatment\\nwill not be a bad thing with the idea of loosening up the blood flow, taking\\naway the congested condition; but we do not depend much upon this massage,\\nthe principal treatment being to knearl the muscles and to stretch them. I\\nbelieve there is a theory that the specific poison is retained in the diseased part,\\nso that by throwing more blood to the part and by stimulating that region it\\nhelps to carry away and throw off the poison.\\nThe Osteopath must aUvays trace the nerve supply of the affected parts\\nand look for lesion to the nerve or centers. In sciatic rheumatism, in rheu-\\nmatism of the arms, I have found distant lesions along the spine. Within the\\nlast month, as I remember it now, I have had four different cases in which\\nthere was rheumatism in one or both aruis, and in each one of these cases I\\nhave found some slip of the vertebrse in the upper part of the dorsal region,\\nthis being the region that seemed to be most involved, while in the sciatica nd\\nin the lumbago you wiU often find slips or lesions along the spine. You will\\nfind that it is a part of our system, this finding of special lesions, as I under-\\nstand it, though perhaps not entirely. When you find such lesions, although\\nyou may not be able to directly connect them with he disease, you must be\\nable to trace indirectly in this way.\\nIn lumbago there is a direct lesion to the nerves of the lower spinal mus-\\ncles. I have found that the best way to treat this is with the patient sitting\\nupon a chair. This is the same treatment thnt I have shown for other things,\\nthat is for stretching the joints of the spine. I work here particularly along\\nthe lumbar region, lifting and turning as I go, with the idea of loosening these\\nmuscles and correcting any slip which may have occurred.\\nBesides the points already mentioned, heat and rest are valuable adjuncts\\nto the Osteopathic treatment.\\nAcu/e:~~ln the fevered stage of Rheumatism, the cold baths, cold pack,\\nand sponging with tepid water are beneficial\\nThe patient should be placed in bed between blankets, which absorb pers-\\npiration and prevent the chill of damp linen. Rest for the affected joint is sup-\\nplied by wrapping it in cotton, wool or other soft-, warm material. Warm fo-\\nmentations give relief when applied to the joint. As far as possible we move\\nthe joint, especially in the chronic forms. The joint is placed at rest entirely\\nin this acute form but if it is kept there too long it may become ankylosed. If\\nyou keep up motion to the greatest extent possible you will be able to get bet-\\nter results. I have not known of a case which was followed out by Osteopathic", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0254.jp2"}, "255": {"fulltext": "INFLUKNZA, CATARRH AND COI^DS. 39\\ntreatment where the joint was left stiff. It is a matter of judgment as to how\\nfar to work the joint.\\nIn chronic forms warm clothing and housing, protection, from climate,\\nrelief from toil and muscular exertion, turkish baths, warm or hot fomenta-\\ntions applied to the joints, followed by vigorous rubbing are valuable aids in\\nOsteopathic treatment.\\nIn muscular rheumatism the same general plan of treatment ma}^ be fol-\\nlowed.\\nIt should be borne in mind that these various adjuncts may not be neces-\\nsary except in severe and stubborn cases. If the simple Osteopathic treat-\\nment is sufficient you will not need to be bothered with these other things.\\nLKCTURE VIII.\\nMfluenza, Catarrh a?id Colds: These three maladies are somewhat similar\\nin pathology. They frequently are presented to the Osteopath for treatment,\\nand such treatment is, as a rule, in the highest degree successful.\\nThe treatment for inAuenza, and for the condition commonly known as\\ncold are almost identical, while that for catarrh is as far as it goes, similar.\\nHence these subjects may be conveniently considered in the same lecture. The\\nfact that all may depend upon the same agency for their production, at least to\\nsome extent, namely exposure, and the fact that in all the main pathological\\nfacts are the congestion of the blood in certain parts of the body, the tightening\\nof the muscles and ligaments, and the aberation of nerve function consequent\\nto these conditions, make them especially interesting to the Osteopath, and\\nespecially amenable to his treatment.\\nInfhieyiza, commonly known as LaGrippe, called also, Catarrhal Fever and\\nEpidemic Catarrh, is described as an acute, infectious, epidemic disease, marked\\nby febrile symptoms, and usually complicated with other serious affections,\\nbeing followed by sequelae that are frequently distressing and severe in a\\nmarked degree, such as progressive muscular, atrophy, various forms of par-\\nalysis and spinal trouble, etc. There is one patient here at present suffering\\nfrom Locomotor Ataxia and progressive muscular atrophy. He tells me that\\nhe had four or five different attacks of influenza. I think that his disease may\\nhave developed from these repeated attacks of influenza with the attending ner-\\nvous symptoms, leading to these serious results. It is not at all surprising\\nthat such serious results should follow, when 3^ou come to consider that these\\nnervous disturbances reach far enough to alter the sta^e of nerve centers to a\\nvery marked degree.\\nAs a rule this distressing malady occurs epidemically on a grand scale,\\nthough it may also occur endemicall}^, and occasionally, sporadically. Usually\\nvast areas, such as whole countries, are successively invaded by the epidemic.\\nEpidemics are recorded as early as 1729.\\nIts manifestations are varied, different epidemics seeming to possess differ-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0255.jp2"}, "256": {"fulltext": "40 INFLUKNZA, CATARRH AND COLDS.\\nent marked characteristics, but three different general forms have been\\ndescribed:\\n(i) Simple, without serious complications. (Catarrhal.) This form\\nattacks particularly the membranes of the respiratory Tract.\\n(2) Thoracic, involving the tho:aclc viscera, and complicated with such\\naffections as pneumonia, bronchitis, etc.\\n(3) Abdominal or Gastro-Iatestinal, affecting the digestive organs. I\\nwill mention one fact here, lest I forget it when speaking of colds. I have\\nknown people to have a severe attack of intestinal cramping, accompanied with\\nconstipation or diarrhoea and severe colic symptoms arise from what I believe\\nto be taking cold in the abdomen. Thf^y in some way get the abdomen ex-\\nposed perhaps b ^a change of clothing, which would cause the cold to settle in\\nthe abdomen without necessarily being felt elsewhere. This, I think, will be\\na valuable suggestion to you, although I have not read it in books but have\\nheard others speak of it.\\n(4) To these has been fittingly added, the Neural or Cerebral type,\\nattacking the nervous system, often simulating the clinical course of Typhoid\\nfever, as does sometimes the Intestinal type.\\nIt is stated that these various types may all be seen in the same family in\\nwhich several members may be suffering.\\nClinical Features: The onset is, as a rule, very sudden. The patient may\\nnote the first symptoms upon rising from bed in the morning, upon rising after\\nsitting, or when about his daily tasks, having a few moments previously felt\\nentirely well. It usually manifests itself first by a chill, followed by a fever,\\nloss of appetite, headache, lassitude, aching and soreness of the back, limbs,\\nand muscles, profound mental and physical depression, catarrhal inflammation\\nof the nasal mucous membrane, etc. This malady may affect persons of any\\nage, sex, or occupation. Pulse slow; con ^tipation; temperature irregular to\\nhigh; urine scanty and high colored or profuse and light colored.\\nCatai rhal Type- Dryt^css of the nostrils, sore throat, sneezing, watering\\nof the eyes, difficulty of swallowing and of breathing and pains in the eyeballs\\nare present. These symptoms may remit during the day, increasing at night.\\nThe tongue is moist and coated with a creamy fur, the pulse is frequent. (80-\\n100) Diarrhoea is often a symptom, ab well as inflammation of the ear.\\nThoracic Type: In this form, in addition to the usual symptoms, are seen\\npneumonia, bronchitis, pleuritis, quinzy, and infiltration of the lung. All the\\nprominent symptoms are concerned with the thoracic viscera. A peculiarity of.\\nthe Bronchitis is the general inflated condition of the lung, which, instead of\\ncollapsing upon opening the thoracic cavity, protrudes from the aperture.\\nG astro- Intestinal Type: Soreness of the abdomen, biliousness, nausea,\\nvomiting, sometimes jaundice, diarrhoea, etc., are prominent symptoms, in ad-\\ndition to the general symptoms named above.\\nCerebral Type: The nervous symptoms predominate. Headache, delirium,\\ntinnitus aurium, muscular twitching and hyperaesthesia are all noted.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0256.jp2"}, "257": {"fulltext": "INFUENZA, CATARRH AND COLDS. 4!\\nInfhienza is of variable duration in length of time of the attack. It may\\ndisappear in forty-eight hours, or it may remain acute for several weeks. Often\\nit subsides into a semi-chronic state, and keeps the suiTerer miserable for\\nmonths. It seems to attack the weak points in the system, and to develop\\nlatent morbid processes already present. It is not usually of itself fatal, but\\ncauses death in a fair average of cases through some complication or sequel.\\nThe Bronchitis of Influenza seems to be the most fatal.\\nA serious feature of this disease is the sequelae in leaves. The mental or\\nphysical depression often persist after the acute attack, hypochondria, tubercu-\\nlosis and paralysis frequently supervene. The poison left in the syslem has,\\naccording to Gowers, a peculiar liability to afiect the nervous system. Hence\\nthe nervous sequelae, both from their nature and frequency, are the mo t\\nmarked of the after effects. Mental dullness, melancholia, and delirium; the\\ngeneral paralysis of the insane; hysteria, cataleptoid and epileptic seizures;\\nneuritis and affections of nerve centers, are all amongnervous sequelae of Influ-\\nenza noied by Gowers.\\nAetiology: Little is known definitely concerning the cause of this disease.\\nSome writers have suggested an atmospheric influence, as well as the effect of\\nbad drainage and poor sanitation, as being the cause. It seems probable that\\nthe true aetiological factor is a microbe discovered by Pfeiffer, Kitasato and\\nCanon in 1892.\\nCatarrh: Catarrh, Coryza, or cold in the head, is an inflammation of the\\nnasal mucous membranes, with increased secretions from them.\\nThe term Catarrh is used in a general sense in describing the inflammation\\nof any mucous membrane in the body, Thus there is Catarrh of the stomach,\\nIntestinal Catarrh, Catarrh of the bladder, etc. The term Coryza is usually\\nemployed to designate Catarrh of the nasal membranes.\\nSymptoms mid Aetiology: Catarrh is brought on by exposure, by too sud-\\nden cooling of the body when heated, or by sudden lowering of the tempera-\\nture. It occurs sporadically, sometimes epidemically and one attack predis-\\nposes to another. It is sometimes caused by inhalation of irritating gases, such\\nas chlorine, etc. It is stated by Raue that epidemics seem to depend upon a\\npeculiar unknown condition of the atmosphere, probably deficiency or super-\\nabundance of ozone. You will also find frequently that the contraction of\\nmuscles has drawn the vertebrae out of place. This, frequently has been\\nfound to be the case by our practitioners, and there does not seem to be any\\nreason for doubting that the vertebrae may be drawn out of place, as queer as\\nit may seem, by contraction of the muscles. I have had cases of trouble in\\nthe neck where the vertebrae, one or nice, was displaced. It is often the sec-\\nond or third, I have often found when I had replaced a vertebra that the ef-\\nfect of a cold was to draw it out. I will say that such may not be the case ex-\\ncept in cases where there has been a previous accident, causing a displacement\\nof the vertebra, but I am convinced from my observation that a vertebra may\\nbe drawn out by overdue contraction of a muscle. And from the standpoint of", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0257.jp2"}, "258": {"fulltext": "42 Influenza, Catarrh and Colds.\\nOsteopathy this disease may be caused by some faulty condition in the anatomy\\nof the neck, contractions of the deep muscles, or displacement of cervical ver-\\ntebrae, usually of the second or third, which interferes with blood and nerve\\nsupply of the nasal mucous membrane by shutting down upon the jugular\\nveins, thus preventing venous return, or by affecting nerves coutrollmg the\\nblood flow, thus disarranging it. These conditions either weaken the mem-\\nbranes and leave them susceptible to the influence of th. ordinary aetiological\\nfactors, or they cause a congested and inflamed condition of these parts, at-\\ntended with ihe increased secretions characteristic of catarrh.\\nThe Syjnptoms are chilliness, headache, indisposition, sneezing, dryness of\\nthe nose and throat, etc.\\nThe inflammation extends into the frontal sinuses, into the antrums of\\nHighmore through the nasal duct to the lachrymal sac, causing conjunctivitis;\\nor into the Eustachian tubes, affecting the ears. The inflammation may also\\nextend from the mucous membrane into the skin of the nose, or down into the\\nbronchi, causing lung troubles.\\nThe catarrh is described as serous, mucous, or muco-purulent according\\nto the nature of the secretion. The first secretion is thin and watery, the\\nsecond is thick, a copious discharge of mucous; the third is composed largely\\nof leucocytes, and partakes of the nature of pus\\nThis latter discharge may, in chronic cases, decompose in the nasal cavi-\\nties or in the sinuses and become extremely offensive.\\nColds: A cold, regarded by some writers as a nervous disturbance, is\\nusually considered as a congestion of the blood in the vessels in some part or\\nparts of the body, brought on by exposure in some form. Coryza is a cold in\\nthe head.\\nAetiology. Cooled surface of the body and closed pores, drives the blood\\ninward; increases the work of the lungs, and causes it to congest at weak spots;\\nexposure to the cold or damp, e. g. getting the feet wet, sudden cooling of the\\nbody when heated; sitting or standing in a draft; living in overheated quarters;\\nsleeping undei too heavy covers, and wearing of too warm clothing, thus\\ncausing the body to become tender, are among the usual causes of catching\\ncold. I have known people who were foolish enough to suppose that by keep-\\ning in doors all the winter they would be free from colds and it is almost in-\\nvariably the case that they will have a cold much of the time. Thev stay-in\\nwarm rooms and sleep under too warm covering and the body becomes tender.\\nComing suddenly from very cold temperature into very warm, as from out\\ndoors into a super-heated room, will give a person a cold as quickly as t3 go\\nfrom a heated room out into the cold. The system is not always able to ac-\\ncommodate itself to such sudden changes of temperature.\\nSymptoms are similar to those noted in Catarrh, namely: chilly sensations,\\ndischarge from the nasal mucous membranes, headache, light hemorrhage from\\nthe nose, soreness and stiffness of the muscles, etc.\\nOne attack predisposes to another. The patient frequently falls into a", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0258.jp2"}, "259": {"fulltext": "TREATMENT OF CATARRH, COLDS AND INFLUENZA 43\\nsemi-chronic condition, continually taking more cold and seldom being without\\none. This is likely to happen on account of the deranged circulation, the\\npatient frequently breaking out into a perspiration with slight exertion, this\\nbeing followed by further chilling and fresh symptoms of a cold. A cold, if\\nsevere, may have severe complications; pneumonia, bronchitis, influenza, etc.\\nTreatjuent, {heat) The drinking of hot lemonade, hot foot baths espec-\\nially upon retiring, or wrapping up well in a dry blanket to produce copious\\nperspiration are usually enough to reduce a cold at first. It is said that if a\\ncold is treated this way vigorously within twenty-four hours you can reduce it.\\nThese things should be used at night, and additional clothing should be put on\\nnext day as the system is weakened from perspiration, and care should be taken\\nnot to take more cold. Some would prescribe dry heat instead of moist.\\nHeating of the feet before a fire is a good thing and does not open the pores in\\nthe way that hot water does, so if it is in day time when you cannot take the\\ncare you would like, this application of dry heat is perhaps a good remedy at\\nfirst.\\nInfluenza: I give the patient a thorough spinal treatment. I had a case\\nof cold to treat this morning and I gave the same treatment that I give for in-\\nfluenza. With the patient upon the face thoroughly loosen all the muscles\\nand thoroughly stimulate the whole spine. The theory you already know. If\\nI could not work enough with the patient upon his face I would turn him over\\nand thoroughly stimulate the lungs, kidneys, liver and fascia in such a way as\\nto work off the effects of the disease. That, in cold or influenza, is the partic-\\nular Osteopathic treatment. For the lungs the second to the seventh dorsal\\nvertebra; kidneys, lower splanchnics; liver, at the abdomen, from the eighth\\nto the twelfth ribs on the right side, raising the ribs, working in the right and\\nleft iliac fossae to reach the hypogastric plexuses and deep over the solar plex-\\nus. Guard against the possible settling of a cold or influenza at these points,\\nalso attend to the fascia at the second dorsal and fifth lumbar. That is, include\\nthese points in your spinal treatment.\\nShould the influenza have settled in the abdomen, give a thorough abdom-\\ninal treatment, embodying the points already given. I would also give an\\nenema in such a case to relieve the bowels of fresh congestion. I would treat\\nthe spine especially from the middle dorsal down, and all these plexuses of\\nnerves through the center to the abdomen.\\nFor Cerebral Influenza I would look particularly for any condition of con-\\ntraction of the muscles along the spine. I first look for any contractures of\\nthe muscles in the neck. It seems to me from my experience there is always\\na contraction of the muscles of the neck although the cold may be elsewhere.\\nIt may be settled in the chest or some other part of the body but there will al-\\nmost always be a contraction of the muscles of the neck. I do not know that\\nlever found a cold where there was not this marked condition of contraction of\\nthe muscles See whether or not there be any displacement of the vertebrae;\\nthe contraction of the muscles is very apt to bring on such a condition. In my", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0259.jp2"}, "260": {"fulltext": "44 TREATMENT OF CATARRH.\\nexperience in order to fiud out whether or not there is displacement of a verte-\\nbra, I stand in behind the head and turn it from side to side, getting in deep\\nto find if there be any displaced vertebra. In several cases where I knew there\\nwas trouble in the neck, I could not tell by standing at the side where the ver-\\ntebra was out. When you are w^orking on a patient in bed as you may be\\nsometime, bear this in mind, to get the patient in such a position that you can\\ngo to the top of the head. Of course when there are these cerebral symptoms,\\nand the trouble is especially in the head you must treat the spine, equalizing\\nthe circulation, and sending the blood elsewhere.\\nIn Catarrh as well as in cold we would first thoroughly loosen the muscles\\nabout the neck, especially about the sides and back of the neck, also the styloid\\nand hyoid muscles. Take the muscles which are attached to the styloid\\nprocess and thoroughly relax them. A good treatment for catarrh is to hold\\nunder the lower jaw and have the patient spring the mouth wide open, you rub\\nthe muscles w^ell on each side and thoroughly relax them. Stand at the side\\nand Dress in deeply at the styloid process wnth the idea of loosening up these\\nmu ^cles and freeing the flow of blood through the carotid artery. Dr. Harry\\nStill uses this treatment in almost every case, (and sometimes almost exclus-\\nively) of catarrh and troubles with the eyes and ears. He will have the patient\\nopen his mouth five or six times, and he assists the patient all he can by open-\\ning his own mouth at the same time. Now particularly in catarrh you wull find\\nthe second and third vertebrae are apt to be deviated to one side or the other.\\nOf course we treat here at the upper part of the neck, and reach the superior\\ncervical ganglion, thus influencing, through the sympathetic plexus, the dif-\\nferent parts of the brain, and through these nerves the sub and great occipitals,\\nthus reaching the medulla w^hich you know contains the vaso-motor center,\\nthus influence the general circulation of the body. It is important to work\\ndown along the spine to get the stimulating effect and the distribution of the\\nblood flow. Also treat all these points of the fifth nerve, at the supra-orbital,\\nthe infra orbital and the mental foramina. Have the patient open the mouth\\nwide, push the finger into the glenoid fossa, and have the patient close his\\nmouth, that will have the effect of loosening the ligaments, and, it is claimed,\\naffects the fifth nerne. We also reach the fifth nerve through its connections\\nsympathetically by working upon the sub and great occipital nerves. I also in\\naddition to thifi always thrust my finger behind the clavicles, thus raising the\\nclavicles and stimulating the flow of blood in that way. Another treatment\\nis to have the patient lie upon his back, and with the mouth open, I place the\\nfinger against ^he hard palate and work from side to side, in this way, back\\nalong the soft palate, uvulva and pillars of the fauces.\\nI am treating a case at present in which the tonsils are chronically enlarg-\\ned and the uvulva is over one half an inch in length. These internal treat-\\nments reach that condition much better than any treatments I have been able\\nto give, In this connection, you will often have a patient with a little hacking\\ncough, most frequent in children: if you will look into the throat you will find", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0260.jp2"}, "261": {"fulltext": "TREATMENT OF COI.DS. 45\\nthat the condition of the soft palate is causing just enough irritation to keep up\\nthis little cough. By this internal treatment and treatment in the neck you\\nwill be able to stop the cough. I have another case which is rather peculiar,\\nin which the mucous membrane of the throat is congested. There is an irri-\\ntation of the throat which is dry and scales off in great dry flakes, sometimes\\nblood mixed in it. It is peculiar in being so dry. I have treated a case in the\\nway indicated to you, especially the styloid and hyoid muscles, quite hard. It\\nwill not hurt usually to work hard, but that you can determine by the condi-\\ntion of your patient. I thoroughly relaxed in this way, and the lady who be-\\nfore had to have water by her bed at night and frequently during the day, is\\nvery much better. Also in a cold we treat the sides of the nose, working from\\nthe lachrymal duct down. It seems to stimulate the nerves here and the flow\\nof blood, freeing the membrane very well. We can free very nicely by work-\\ning down the nose in this way. This is on the same principle that our mothers,\\nused to grease our noses with goose grease. For a stoppage of the nostrils and\\ndifficulty in breathing here is a motion that we employ with very good success.\\nIt is best to have a pillow. Lay the palm of the hand flat, press down hard at\\nthe frontal region, and you can bring a great deal of pressure in this way. I do\\nnot know what the nerve connection is, but a great many cases of nostril stop-\\npage will be relieved in this way. Of course, work all about the eyes and loos-\\nen all about the face to relieve the congested condition.\\nNow I might explain to you my particular method of treatiiig a cold. I\\nhave bim lie upon the back, and I raise all the ribs and stimulate the lungs\\nvery briskly, on either side from the second to the seventh dorsal. I am work-\\ning from the middle dorsal above, as low as the twelfth dorsal, successively,\\nhaving my hands against the angles of the ribs, and raising them as I go very\\nbriskly and very energetically. This is a great stimulation of the lungs as\\nwell as of the circulation throughout the body. I then bend the arm, this will\\nvStretch the muscles over the chest and raise the upper ribs, then I raise these\\nupper ribs by pushing the arm up and working under the clavicle.\\nI frequentl}^ have been able, by this treatmeut, to relieve heavy colds in\\none treatment. If you can always do that you will be ver}^ fortunate. Of\\ncourse I give a brisk and thorough treatment to the neck as well, and some-\\ntimes it is the best thing you can do for the patient to thoroughly loosen the\\nneck.\\nIf in any of these troubles there is a development of any special symptoms\\nof course you must attend to these symptoms at once.\\nQ. Do you think it is necessary to remove the tonsils?\\nA. It is often done. I do not think it is necessary if we get the case in\\ntime. As to whether it is ever necessary, I presume it is. Sometimes they\\ngrow again and sometimes they do not.\\nQ. Do you give the same treatment for dry catarrh that you do for moist\\ncatarrh\\nA. Yes sir.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0261.jp2"}, "262": {"fulltext": "46 CONSTIPATION.\\nQ. What would 5^011 do in case of croup. Could you give immediate re-\\nlief?\\nA. I should work the neck through. I have been able by that treat-\\nment to give immediate relief. I would work all about the throat and neck.\\nThe trouble in giving treatment for croup is that it is generally found in little\\n.children who object to such treatment.\\n(Q. Would you use salt water?\\n-A. Yes, sir, that is very good.\\nQ. What would you do in membranous croup?\\nA. You must be very careful in cases of membranous croup. Cause the\\npatient to throw up. Thrust the finger down the throat and get the membrane\\nin that way. If the membrane is far it will take very prompt action. Thor-\\noughly treat about the throat to keep the circulation free and prevent the form-\\ning of the membrane.\\nQ. In catarrh of the throat would you give internal treatments?\\nA. Yes. sir, it is well to treat inside.\\nQ. How often would you treat catarrh?\\nA. I would treat it three times a week. That will be sufficient.\\nQ. Would you treat internally that often?\\nA. No, sir, I w^ould not treat internally oftener than once a week, or\\nonce in ten days, unless in severe cases.\\nIn regard to colds, I have had cases where the cold was chronic and the\\ncondition of the system was weakened, in which I got good results by directing\\nthe patient to take a cold bath every morning. The brisk rubbing stimulates\\nthe circulation; not only does it stimulate the circulation, but it has a good ef-\\nfect on the nervous system, stimulating and strengthening the pores of the\\nskin so that they can more readily open and close and accommodate them-\\nselves to the changes in temperature.\\nLECTURE IX.\\nCONSTIPATION.\\nConstipation is defined as infrequent or incomplete alvine evacuation,\\nleading to retention of feces. Quain.\\nWith this, one of the most annoying, as well one of the most frequent ills\\nto which mankind is heir. Osteopathy has had most unqualified success. The\\nordinary sluggishness of the bowelss that affects so many people is speedil}^ re-\\nlieved, ordinary constipation yields almost as readily, while some very marked\\nand obstinate cases of years standing have been cured. I have known\\nof a lady about thirty-five years of age constipated from birth, hav-\\ning never had a natural bowel action, to be entirely cured in six\\nmonth s treatment. I have been told by one of our students who\\nwent out practicing in the summer, that he had a case of a lady older\\nthan that, a lady eighty years of age who had never had a natural action of", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0262.jp2"}, "263": {"fulltext": "CONSTIPATION. 47\\nthe bowels, whose case yielded to Osteopathic treatment. There are others as\\nremarkable. Osteopethy seldom fails to cure constipation arising from the\\nusual causes. Paral3^sis of the bowels, as seen in some cases of spinal disease,\\nand in general paralypis, can be handled successfully only in such cases as will\\nyield in regard to the general paralytic symptoms.\\nIn the matter of bowel evacuation, each indiv^idual s habit is a law un-\\nto himself. Some people are not well without two motions daily, others in\\nperfect health, go as long as three days. Raue states that he has known women\\nin perfect health to have but one evacuation per week. As a rule, one evacu-\\nation per diem is necessary to health. But it must be borne in mind that the\\ndaily evacuation is not conclusive evidence of non-retention of fecal matter.\\nThe quantity of the motion may be insufficient. Cases have been noted in\\nwhich the w^alls and sacculi of the colon were impacted with old remnants,\\nwhile a regular daily stool, normal in consistence and color, was made, passina:\\nthus through a channel whose walls were formed of old and hardened fecal\\nmasses. You will find in the retention of the fecal matter that there is an irri-\\ntation of the bowel wall and a catarrhal condition arising from this irritation,\\nhence it is that quite often there is an alternate constipated and diarrhoeal con-\\ndition. The patient will have constipation for awdiile and diarrhoea for awhile.\\nDr. Hrrry Still tells us that he has found in his experience that if the liver is\\nexceedingly tender, and he asks the question, Are you not alternately troub-\\nled with constipation and a diarrhoea condition? the answer is usually yes.\\nSymptoms: The head is dull and the brain lacks vigor, there may be\\nheadache, dizziness, palpitation of the heart, etc, There is often too free se-\\ncretion of saliva; the appetite is increased or lessened. There is frequent bil-\\niousness, pain in the bowels and upon defecaction, coldness of the extremities,\\nbackache, pains in the lower limbs, etc. The memory is poor, the head con-\\nfused, the complexion sallow, and the breath bad. On the other hand, people\\nwith rosy complexions and every appearance of health may be chronic sufferers.\\nConstipation is a symptom in a great number of diseases.\\nAeitology: General and Local:\\nGeneral: The causes of constipation are exceedingly numerous and varied.\\nToo concentrated a diet, e g. milk, by leaving too little residue to act as an irri-\\ntant to the bowel wall, stimulating it to action, becomes a cause The same is\\ntrue of too rich foods. Laziness, late hours in bed, and neglect of the regular\\nhour are all causes. I have a patient who \\\\vill be constipated every time sh-\\noversleeps, and remains long in bed, simply because she has gone past the reg-\\nular hour. I think this is a cause with men in business who do not\\ntake time to attend to the regular calls of nature. This is one of the most ser-\\nious causes of the most obstinate cases of constipation you will meet.\\nIn hereditary cases, the factors are weak bowel muscles and nerve supply.\\nRobinson instances a case in which he says he was satisfied that the plexus of\\nnerves, the inferior mesenteric ganglion w^as not sufficiently developed, and he\\nwent to w^ork by proper exercises, horse back riding, etc., to develop the gang-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0263.jp2"}, "264": {"fulltext": "48 CONSTIPATION.\\nlion. The child had inherited weak bowel walls and a weak ganglion. Weak-\\nened muscles result from anemia, etc. lyoss of the fluids of the body, as in\\nlactation, profuse sweating, and after diarrhcea, in diabetes mellitus, etc., may\\nfrequently be causes. You must have a normal amount of fluid in the sys-\\ntem. I have found cases in which a certain amount of water had to be prescrib-\\ned daily in order for the patient to drink enough. Often the physician has to\\nprescribe some sort of table water to get enough fluid into the system. Often I\\nprescribe water to be taken in the morning before breakfast, not at breakfast\\nbut fifteen minutes or a half hour before.\\nThe use of foods leaving coarse, dry residue, e. g., corn and beans; the use\\nof strong purgative medicines, etc., and any cause lessening peristaltic action\\nof the bowels may cause constipation. People frequentl}^ take a tea spoon full\\nof salt in the morning, washing it down with a cup of water. It will do all\\nright for awhile, but it will dry the bowel, and the powerful action of the salt\\nexhausts the blood vessels supplying the bowel, so always discourage the use\\nof salt by a patient.\\nThe styptic quality of the tannin contained in tea acts as a constipator by\\nlessening their secretions. Lessen, or change in the quality of the bowel secre-\\ntions and the secretions of the liver and pancreas, cause constipation by robbing\\nthe bowel of the stimulus gained from the action of these fluids upon the\\nnerve terminals.\\nToo great muscular activity, nervousness, excessive mental application^\\nare all aetiological factors.\\nAmong the fa/ causes may be mentioned mechanical agents, e. g., a dis-\\nplaced coccyx, a tightened sphincter ani muscle, pressure of a pelvic tumor, or\\nof a gravid or misplaced uterus, impactions of the colon, stricture from peri-\\ntoneal adhesion or hernia; mechanical stoppage by the presence oi foreign bod-\\nies like grape seeds, fruit stones, etc. When you have peritoneal adhesion you\\nmay have a serious case, because that may progress enough to stop the bowel\\nentirel3^\\nOsteopathic Theory: Mechanical causes aside, the Osteopathic theory in\\nregard to constipation is that some lesion to the spine prevt^nts proper action of\\nthe innervation or of the blood flow of the bowel, leaving it weak and ready to\\nyield to any of the above mentioned general causes of constipation. Auer-\\nbach s plexus, ruling bowel motion, and Meissner s plexus, ruling bowel secre-\\ntion are intimately connected with the sympathetics of the abdomen. These\\nsympathetics may be hindered in action by some spinal obstruction of a nature\\nand in a manner previously designed. Thus either secretion, or motion, or\\nboth, may be affected and constipation result. Or, since the blood flow is un-\\nder control of the sympathetics, the lesion may readil}^ affect it and cause the\\ntrouble. Hare (^Practical Therapeutics p. 489) says experiments have shown\\nthat the circulation of the blood through the intestines greatly influence peris-\\ntalsis, and disorders in the blood supply readily bring on intestinal disorder.\\nHe also says that peristalsis is almost entirely a reflex action, dej^ending for", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0264.jp2"}, "265": {"fulltext": "CONSTIPATION. 49\\nits existence upon the integrity of the nervous plexuses in the intestinal walls,\\nnamely those of Auerbach and Meissner. Hence effects upon these plexuses\\nby lesion of their sympathetic connections might be of such a nature as to re-\\nsult in constipation.\\nIt is evident that lesion to the spine anywhere in the splanchnic area, fifth\\nto the twelfth dorsal, or below, might be the cause of constipation, but Osteo-\\npathic practice has designated certain important points in the spine at which\\nlesion is likely to be followed by constipation. Such are the second lumbar,\\nfourth and fifth lumbar and fifth sacral. The latter point is significant because\\nthe fifth sacral nerve controls the spinchter ani muscle, and lesion of it may so\\naffect the nerve as to cause undue contraction of the spincter. and thus act as\\na mechanical cause of constipation.\\nLesions of the splanchnics or solar plexus, affecting the liver and the pan-\\ncreas and their secretions, also become a cause of constipation.\\nByron Robinson has lately written (Medical Brief) very clearly upon con-\\nstipation as a neurosis of the the fecal reservoir, as he calls the left half of the\\ntransverse colon, the de.-cending colon and the sigmoid flexure. He makes a\\nvery interesting point there, that the small intestine and large intestine, (the\\nascending half of the transverse part) are subject to a quicker rythmatic action\\nfrom their innervation than is the remaining part of the bowel, which is descri-\\nbed as the fecal reservoir.\\nThis portion of the colon is under control of the inferior mesenteric gang-\\nlion situated upon the inferior mesenteric artery, and sending its branches to\\nthe intestines. Muscular atrophy of the bowel walls must be referred to the\\nnerves, since they control the lumen of the blood vessels.\\nThe abdominal brain may be abnormally small in some persons, be under\\ndeveloped and thus allow of insufficient bowel action.\\nNeurasthenia, also deficient blood supply to the parenchymal ganglia of\\nAuerbach s and Meissner s plexuses are frequent causes of constipation. In\\nthese cases of neurasthenia which you will meet, you wnll of course usually\\nfind constipation as a fa^^tor, and you will become able to recognize and ask at\\nonce if the patient has constipation. Simple observation is a great thing to\\nput you on the right track.\\nThe movements of the intestines largely depend, he says, upon the amount\\nof fresh blood sent tv these ganglia. Peristalsis, so far from being impaired in\\nconstipation, may be increased, but be in vain.\\nA checked blood flow, or a lack of blood, as in anemia, becomes a cause.\\nAn empty bowel is a still one, a full bowel an active one.\\nThe irritation which increases peristalis may also narrow the lumen of the\\nblood vessels, lessen secretions and cause constipation.\\nIn enteroptosis the w^eakened ligamentous portions of the omenta elongate\\nand allow the organs, including the intestines and stomach to sink downward\\nfrom their natural positions. This weakness of the ligaments begins from loss\\nof tone in the abdominal sympathetics and you must as Osteopaths, as a rule,", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0265.jp2"}, "266": {"fulltext": "50 TRKA.TMKNT OF CONSTIPATION.\\nrefer that to lesions along the spine. I thi^k I have thoroughly explained\\nthat before. By the gravitation of the organs downward, the nerve plexuses\\nand fibres are stretched and still further weakened. The enteroptosis allows of\\nkinking of the colon, especially at the splenic and hepatic flexures, and be-\\ncomes thus a mechanical cause of constipation. It also interferes with the\\nblood and nerve supply to the intestines, hinders muscular action, lessens se-\\ncretion and absorption and thus becomes a prolific source of constipation and of\\nother ills.\\nOsteopathy also looks upon constipation as a neurosis of the fecal reser-\\nvoir. It recognizes the importance of free blood supply to the muscles of the\\nintestines that they may not atrophy, also of free supply ot blood to the paren-\\nchymal ganglia situated within the walls of the intestines, that they may thus\\nbe stimulated to normal action. By affecting the sympathetic connections, by\\nadjusting all abnormalities that may interfere with blood and nerve flow, Os-\\nteopathy preserves the integrity of bowel action.\\nIt looks upon the weakness of the sympathetics that allows of enteroptosis\\nand of its concomitant ills, as due to some spinal lesion which either directly or\\nindirectly affects and weakens sympathetic life. I make that broad statement,\\nof course I know as well as any one else that you do not always find spinal les-\\nions in constipation, but in general that is the explanation we give and in gen-\\neral that is correct. You may have torpid liver which may in itself be a\\ncause for constipation.\\nExcepting cases of constipation caused by mechanical agents, the system\\nwould not be subject to the operation of the general causes assigned for con-\\nstipation, were spinal life perfectly adjusted and maintained.\\nTreatment It is divided into (a) upon the the spine; (b) upon the abdo-\\nmen; (d) upon the coccyx and local, and (e) adjuvants.\\nA. The purpose of the former is to remove any lesion that may be inter-\\nfering with sympathetic life or cerebro-spinal nerve life of the owel. You may\\nhave, of course, as you understand, some irritation along the spine which in-\\nterferes with nerve life, so that when I examine in case of constipation I always\\nlook for a lesion. You may find affected in constipation the splanchnic area and\\nthe region below as far down as the sacral. All of these lesions I described in\\ntreating the spine. It may be a contracted muscle, a slip of a vertebra, some-\\nthing which alters the curves of the spine, or any one of these lesions described.\\nIt may occur along the spine, so make examination in the areas mentioned. I\\ncome to the second lumbar and I often do not find it out of place. I believe I\\nhave already shown you the treatment for the second lumbar. Make the se-\\ncond lumbar a fixed point, counting up from the sacrum below, then make it\\nthe fixed point by placing the thumb and doubled finger against it and push up\\nagainst the thigh; then take the other hand at the same place and make a fixed\\npoint at the second lumbar while you raise the upper part of the body and work\\nit around this fixed point, thus effectually loosening any contracture of the lig-\\naments.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0266.jp2"}, "267": {"fulltext": "TREATMENT OF CONSTIPATION. 5I\\nThe third and fourth lumbar are particulary significant to us, and the fifth\\nlumbar as well, since lesions there rr ay affect the hypogastric plexus and we\\nwork there especially to affect the lower hypogastric and pelvic plexuses. Do\\nnot forget to attend to the splanchnic area and all of the sympathetic connec-\\ntions here with all of the nerve mechanism of the bowel. You know between\\nthe eighth and and ninth dorsal is the center given for the liver, so I always\\nwork along that region in constipation. I never stop my treatment for consti-\\npation without raising the eigth to twelfth ribs on the right side and usually it\\nis after I have treated the liver, so with the patient on his back, I reach across,\\ngrasping the right arm of the patient with my right hand, and then raise and\\nwork up and back to raise the ribs.\\nWhy do we work upon, the liver? Because we wish to keep the flow of\\nblood free. It seems that the bile is one of the best lubricants for the intes-\\ntines and has a great deal to do with the normal stimulation. At the fifth sacral\\ndesensitize if you have any reason for supposing the sphincter ani is affected. O\\ncourse you determine this by a digital examination. Note the first to fourth\\nlumbar for the large intestines. Peristalis particularly at the ninth, tenth and\\neleventh dorsal, either by raising the lower ribs or by springing the spine and\\nstrengthening that region in the ordinary w^ay.\\nB. The treatment over the abdomen. I work at the solar plexus in con-\\nstipation. It is closely associated with the bowel at a point about midway be-\\ntween the umbilicus and the ensiform appendix; by deep pressure in this region\\nyou can usually, by going slowly, bring considerable pressure upon that point.\\nIn people with bowel trouble, and in dyspeptics you will usually find it quite ten-\\nder here. Do not be rough, but you can push in deeply and stimulate these cen-\\nters. Thus you reach important connections not only with the intestines but also\\nwith the liver. Also reach the hypogastric and pelvic plexuses by working\\nalong the third, fourth and fifth lumbar, and by working through the abdomen\\nin front.\\nAlso, there is a mechanical work that we csn do along the line of the colon.\\nUsually it is best to begin at the left in the region of the sigmoid flexure and\\nwork up to the ribs, then across above the umbilicus to the corresponding re-\\ngion on the right, and on down to the right iliac fossa. You work along the\\nline of the colon and get such mechanical effect, but as I said before, that is\\nnot the only effect we get, we stimulate the bowel walls, stimulating Auerb.-iCh s\\nand Meissner s plexuses in the bowel wall, thus reaching the nerve suppl\\\\-. and\\nnot so largely through mechanical action. Also, it is important to straighten\\nthe bowel and keep it free. We reach in deeply at the iliac fossa and straight-\\nen out the sigmoid, work up against the course of the bowei and teiui to\\nstraighten it. You can sometimes obtain good results in swelling of the lower\\nlimbs by reaching in here deeply and raising the intestines, thus relieving the\\nblood vessels. Now I always work upon the liver, that of course is one of the\\nimportant points in constipation. Have the patient with the knees flexed and\\nlying evenly disposed upon the table. Taking the left hand, I reach under the", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0267.jp2"}, "268": {"fulltext": "52 TREATMENT OF CONSTIPATION.\\nedge of the right ribs against the edge of the liver. You must be careful not\\nto bruise the liver. You can also get a squeezing motion upon the liver by\\nreaching in below the right side and working on top of the ribs in front, and\\nthus quite effectually pressing the liver. Then we work along the course of\\nthe bile duct. This is upon the right as you know, curved in the shape of a\\nreversed S, so we work back along the S with the idea of freeing up. Some-\\ntimes in catarrhl conditions you will have a mucous plug formed and the duct\\nstopped.\\nAlso I stimulate the inferior Mesenteric ganglion by working the bowel a\\nlittle below and to the left of the umbilicus. This is important, since as w^e\\nsee, this ganglion controls the part of the colon described as the fecal reservoir.\\nC. The treatment in the neck. Hare says, The vagus nerve when stim-\\nulated directly or reflexly increase peristalis. Always in constipation we\\nstimulate the pneumogastric thereby increasing the peristalsis, in two ways, one\\nby working along; the sterno-mastoid muscle and the other working upon the\\nsuperior cervical ganglion which we reach at the sub-occipital fossa.\\nD. Local: Adjust the coccyx if displaced. Sometimes external man-\\nipulation is sufficient, sometimes, and usually, internal manipulation must be\\nemployed in the manner already described, but always in case of constipa-\\ntion see that the coccyx is perfectly disposed that it may not act as a me-\\nchanicalj mpediment to the passage of fecal matter. A further local treat-\\nment is dilatation of the rectum, relaxing the sphincter muscle. This treat-\\nment is applied simply b) insertion of the index finger and by a spreading\\nmotion. It should not be given oftener than once a week, once in ten days\\nor two weeks. This rectal dilatation is a great stimulation to the sympa-\\nthetic s} stem and not only for normal bowel action, but it is frequently re-\\nsorted to stimulate the lungs. In case of a patient sinking under anesthesia,\\none of the quickest and simplest ways to restore the patient is b}^ rectal dila-\\ntation.\\nE. Adju\\\\-ants: Remember that I simply give these to you as aids to\\nyour Osteopathic work, they are not osteopathy. If they were more fre-\\nquently employed, fewer would suffer from this complaint. The use of\\nwater is of great benefit. The drinking of cold or warm water fifteen or\\ntwenty minutes or half an hour before breakfast is often sufficient to cause\\na full evacuation. It should not be taken with the breakfast as it does no\\ngood then. The theory is explained that when the stomach is empty a por-\\ntion of the water, at least, is not absorbed directly from the stomach as\\nwater ordinaril}- is, but passes on into the small intestines and is there ab-\\nsorbed by the lacteals and carried into the portal circulation and greatly\\nstimulates the flow of bile. Often a good drink of water upon retiring will\\naccomplish the same purpose. We frequently use anemas of hot or cold\\nwater. It is said that a small anema of cold water is a great stimulation,\\nthough anemas are usually given of water; as hot as can be well borne. It\\nshoule be given by a fountain syringe, the patient lying upon the back or", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0268.jp2"}, "269": {"fulltext": "TRKATMKNT FOR CONSTIPATION. 53\\nupon the right side, having the syringe hung at a heighth of six feet to in-\\njure a sufficient fall. About a pint should be given and the patient should\\nimmediately void this. The operation is repeated, this time giving one\\nquart, three pints or even more of water stimulate gently by working the\\nabdomen, in order that the water may be taken up into the bowel. The\\npatient should now retain this as long as possible in order that the fecal\\nmatter may be well softened. Many make a mistake in voiding the water\\nbefore it has been held sufficient time to act as a solvanc of the fecal masses\\nwhich may have been quite hard. When he has held it as long as possible,\\nusually that will not be but a few minutes, he should void it, and ordinarily\\nthe result will be satisfactory, Sometimes your patient will\\nnot be able to pass the water, but if retained it does nothing but\\ngood, as it is acting continually as a solvent and will probably within a\\nfew hours, lead to a profuse action, but if it does not it is readily absorbed\\nand carried out through the kidneys and bladder. Drinking of carbonated\\nand sulphur waters usually develops some good conditions. Uusally in\\nsulphur water there is magnesium which has an aperient action. Graham\\nbread contains salts which stimulate the normal action of the bowels also\\nthe roughness of the reminants of the bran is of itself a good stimulation\\nof the bowel walls. Cracked wheat, oatmeal, vegetables, whole wheat\\nbread, etc., are all alike valuable foods. Now remember that one may take\\ntoo great quantities of these foods and become constipated.\\nAgain fruits are a great help. I will mention first such as are con-\\nstipating and should be avoided, such as strawberries, blackberries and rasp-\\nberries. Raspberry juice is frequently given in case of diarrhoea, where\\nyou readily note its constipating effect. But such fruits as apples, grapes\\n(no seeds), stewed prunes, figs, dates, and juicy fruits, especially before\\nbreakfast, or the first thing at breakfast, are laxative. These are all valu-\\nable, apples perhaps the most so, though different people are affected dif-\\nferently. It would seem, however, that apples, prunes and dates are to be\\ngiven the preference.\\nRegular habits should be encouraged. Defecation is found to be\\nlargely a matter of habit, acquired generations back and passed on frctm\\ngeneration to generation. A certain hour should be fixed for the stool and\\nthe patient at least go and try to produce evacuation, never howc\\\\er strain-\\ning as that may produce hemorrhoids, but by thus fixing the habit and plac-\\ning the mind on the desired end, you control the cerebral centers.\\nAside from the regular habit of going to stool, certain exercises are\\nbeneficial; remember first however that violent muscular exercise is given as\\none of the causes of constipation, and have your patient carefull\\\\- avoid fa-\\ntigue in exercise. The following exercises are recommended:\\nFirst the stooping motion, the patient bending the knees, keeping the\\nback straight, stooping down and raising, bring a pressing motion or squeez-\\ning motion upon the liver. He may, in bending downward, bend forward", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0269.jp2"}, "270": {"fulltext": "54 DIARRHOEA AND DYSENTERY.\\nuntil the shoulders touch the knees. The same effect is accomplished by\\nthe patient getting down on all fours and running about the room. This\\nsimply seems to be a natural way of massaging the liver. The patient may,\\nwhen he awakens in the morning, while lying upon the back, tap and mas-\\nsage the abdomen gently and thoroughly and thus stimulate the blood and\\nnerve force of the bowel and gain the desired end.\\nHorse back riding and ordinary enjoyable exercises are all very good.\\nLECTURE X.\\nDIARRHOEA AND DYSENTERY.\\nThe success of Osteopathic treatment in both Diarrhoea and Dysentery i.s\\nmarked. As a rule the copious evacuation of acute Diarrhoea is checked im-\\nmediately upon the fiist treatment, though frequently cases need more than\\none treatment, and sometimes become obstinate and chronic, requiring months.\\nDysentery, although a more serious condition, being essentially an inflam-\\nmation of the bowels, yields readily to our treatment. The treatment is -simi-\\nlar in both cases.\\nBoth of these conditions will illustrate, in their treatment, two points in\\nOsteopathic theory: First, the condition of th^ spine as a predisposition to dis-\\nease; second, the remarkable control gained over visceral life by manipulation\\nof the controlling nerves.\\nDiarrhoea is regarded by some writers as a symptom merely of intestinal\\nderangement, by others as a distinct disease. The word means to run through\\nand as Hare observes is loosely applied to all states of intestinal disturbance\\naccompanied by liquid stools,\\nAetiology; Hare notes four varieties of Diarrhoea: i. Catarrh of the in-\\ntestines, leading to profuse secretion and passage of mucouf. Irritatiou^set up\\nby old fecal matter may be enough to set up inflammation resulting in a dis-\\ncharge so that you may have alternation of diarrhoea and constipation. 2. Tack\\nof proper innervation of the blood vessels allows of an outpouring of liquid from\\nthem into the intestines. Right here 3^ou want to guard against an error fre-\\nquently made by some who treat Diarrhoea as if it were caused solely by too\\nrapid peristalsis. They make the same mistake as is made in considering con-\\nstipation always to be a lack of peristalsis. It should be considered simply as\\none of the classes. 3. Improper condition of the glands leads to improper pre-\\nparation of the digestive fluids, and, 4. Ulceration causes irritation and bloody\\npurging.\\nByron Robinson notes the fact that Diarrhoea may start as congestion,\\nleading to oedema, rapid exudation, and Diarrhoea. Thus, catching cold fre-\\nquently effects the bowels in this wa}^ particularly in young children. He fur-\\nther points out that. increased peristalsis mav be accompanied by too profuse", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0270.jp2"}, "271": {"fulltext": "DIARRHOEA AND DYSENTERY, 55\\nsecretion and exudation, but that on the other hand, increased peristalsis may-\\nbe accompanied by narrowing of the calibre of the blood vessels and lessened\\nsecretion. Thus the irritation that causes the increased vermicular motion\\nmay cause constipation instead of diarrhoea. Such causes as influence intesti-\\nnal peristaisis are important to the Osteopath as he finds in spinal abnormali-\\nties the frequent cause of nervous irritation leading to Diarrhoea or to consti-\\npation.\\nThe processes of vSecretion and absorption normally balancing each other,\\nmay, says Robinson, become disarranged through the irritation of the bowel\\nsegments, e. g., by cathartic medicines. Owing to the increased peristalsis,\\nnot enough time is allowed for absorption of the secretions, and they are hur-\\nried through the bowel in the form of liquid stools.\\nDisplacement of spinal parts, etc., may be the cau.se of such irritation, as\\nour practice frequentiy shows.\\nThe same author shows that catarrh of the intestinal mucous membrane\\nmay so affect intestinal secretions in quantity and character as to alternately\\ncause Diarrhoea and Constipation.\\nDr. Harry Still says that in cases w^here he finds the liver extremely tender\\nusually finds diarrhoea and constipation alternating.\\nCauses of Diarrhoea are predisposing and exciUng.\\nPredisposing causes are heredity; personal idiosyncracy; time of life, e. g.,\\nteething and the climacteric; and, from the O-^teopathic point of view, spinal\\nconditions, any obstruction or irritation of blood or nerve life of the intes-\\ntines.\\nExciting Causes are: (Quain.)\\n1. Direct irritation, as by poorly digested food upon the intestinal walls;\\nentozoa; excessive bile, or retained fecal matter.\\n2. Bad hygiene, as living in damp, badly lighted and poorly ventilated\\nquarters.\\n3. Exposure, wet feet, sudden atmospheric change, etc.\\n4. Nervous causes, e. g. depression, worry, shock, grief, reflex irritation\\nin dentition.\\n5. Altered peristalsis and secretions.\\n6. General diseases; e. g, of the heart, liver, lungs, pyaemia, peritonitis^\\nobstruction of the portal vein, measles, scarlitina, typhoid, etc. (Symptomatic\\nDiarrhoea.)\\nOsteopathic Theory. While admitting the potency of varied agencies to\\ncause Diarrhoea, the Osteopath believes that most cases can be accounted for,\\neither remotely or directly, by some abnormal condition of some part of the\\nspine, particularly of the splanchnic area and of the lower region of the spine.\\nA spinal lesion of any nature, may le of such a character as to influence the\\nnervous mechanism controlling the whole of the intestinal life and the result\\nmay be violent and rapid peristalsis; vaso dilatation of the messenteric vessels,\\nfollowed by increaj^ed exudations, abnormal glandular activity, producing per-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0271.jp2"}, "272": {"fulltext": "56 DIARRHOEA AND DYSENTERY.\\nverted or needless secretions of intestinal juices; or inflammation and catarrhal\\naffection of the mucous membranes, as pointed out above.\\nAs a predisposing cause, bad spinal condition stands pre-eminent. If the\\nexciting cause be error in diet, exposure, undue nervous excitement, unhy-\\ngienic surroundings, or a general disease, it may still be true that the bad spinal\\ncondition allows of a weakness of such a nature as to be readily developed into\\nDiarrhoea by any one of these causes acting in conjunction therewith.\\nGranted that in certain cases, e. g., when Diarrhoea is purely symptomatic,\\nno such remote causes can be found in the spine, primarily, yet because treat-\\nment at the proper spinal position will overcome the symptom, the theory still\\nholds good so far as to direct the operator to the origin of nerves governing che\\npart affected, while contractured muscles, caused secondarily by irritation sent\\noutward from the bowel through nerve connections to them, frequently indi-\\ncate to us the proper point of treatment upon the spine.\\nDysentery^ (^Bloody Flux.) This is a febrile disease characterized by intes-\\ntinal inflammation, the passage of blood, mucous, etc., and great prostration.\\nIt occurs epidemically or sporadically, and attacks males and females of all\\nagc^.\\nAetiology: The causes of Dysentery seem to operate most freel}^ in tropi-\\ncal climates, in damp or swampy localities. It is said to generally occur in re-\\ngions which are prone to malarial infection, and that malaria seems to predis-\\npose to it by abdominal congestion, engorgement of ^he liver and spleen, and\\ndigestive derangement. Hence it is to some extent a constitutional dis-\\nease. It is seen in greatest virulence in army camps and hospitals, where it\\nbest manifests its epidemic character.\\nSporadic case^ are usually caused by some indescretion in diet, by .sudden\\nchilling of the body, wet feet, etc. Impure drinking water, bad air, undiges-\\nted particles of food, and sudden changes in temperature which cause internal\\ncongestions, are all assigned as causes.\\nIt is stated that Virchow considers the epidemic form to be of a diphtheri-\\ntic nature and the sporadic form of a catarrhal nature.\\nThe epidemic form is held by some to be contagious, but this is a mooted\\nquestion.\\nPathology: This is a disease of the large intestine, but may extend be-\\nyond the ilio-caecal valve into the small intestine. The first change is a red-\\ndening and swelling of the mucous m^embrane which peels off and is passed in\\nthe stools.\\nUlceration may attack and destroy the solitary glands, spreading thence\\nto the tubular glands. From these ulcerations perforation of the bowel may\\noccur. The ilio-caecal valve is sometimes destroyed when the dysentery is\\ngangreous, and invagination follows. Ordinarilj^ the whole surface of the mu-\\ncous membrane becomes colored with a dirt}^ varicolored slime, mixed with\\nepithelial, blood and pus cells, and causing very offensive stools. Sometimes\\nthe mucous membrane decays, is sloughed off and passed.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0272.jp2"}, "273": {"fulltext": "DIARRHOEA AND DYSENTERY. 57\\nInflammation extends to the peritoneum and involves the mesenteric\\nglands. It is said that the ulcerated tissue is probably never restored, and that\\noccasionally serious contractions of the gut, or stricture, may follow the heal-\\ning of the ulcers.\\nSymptoms Are at first general constitutional and digestive disturbances,\\nchilliness, malaise, fever in the evening, dry skin, constipation or relaxation of\\nthe bowels, anxious expression, occasionally retention of urine, and offensive\\nstools are among the symptoms.\\nThe tongue is furred; there is a thirst and bad taste, evacuation is accom-\\npanied with great pain followed by tenesmus, a bearing down feeling of the\\nrectum; tormina or griping, is usually present.\\nThe stool is characteristic; described by Raue as being first liquid, with\\ntransparent, jelly-like clots of slime, like boiled sago. This matter is tinged\\nwith blood, contains little or no fecal matter, and later becomes thin, dirty\\nwhite and watery. The sto .1 may become clear blood. The decaying mem-\\nbranes and ulcers give it a particularly offensive odor. Twenty, thirty or more\\nstools are had in twenty -four hours.\\nThe attack is likely to prove fatal, and we must guard against such unfav-\\norable symptoms as hemorrhage, cold skin, great prostration, livid and blue\\ncountenance, collapsed abdominal walls, peritonitis, pneumonia, erysipelas,\\nbed sore and hepatic ulcer.\\nOsteopathic Theory: Some spinal lesions, especially at the splanchnic area\\nor at the third and fourth lumbar, disarranges blood and nerve supply to the\\nintestines, thus acting as a predisposing cause, rendering the system more sus-\\nceptible to the infiuence of poor diet, climatic change or contagion.\\nTreatment: Look for lesion along the splanchnics, and see that the\\ncoccyx is straight. There seems to be a special significance attach ^d to the\\nnth and 12th dorsal. These seem to be centers particularly for peristalsis, or\\nlesions of the nth and 12th ribs may influence these centers. The treatment\\nfor Diarrhoea is very simple. I place the patient upon the side and work along\\nthe lumbar region, springing the spine strongly. I do not hesitate to make it\\nstrong. Place the knees of the patient against you and give a very strong\\ntreatment. If the patient is a small man sometimes you can raise him off the\\ntable, and that will not be too strong a treatment. Of course you will have to\\ngauge your treatment according to the condition of the patient. I work that\\nway all along from the lower lumbar up as high as to the 6th dorsal. I hold\\nfor a minute or two then I turn the patient over onto the other side and repeat\\nthe operation. It is of course necessary to turn them over. Some operators\\nthink that by treating just on the right side they get good results. I think it\\nis simply a matter of desensitizing the spine inhibiting the nerves. Of course\\nthat sounds like the theory entirely of peristalsis, but you rule the vaso motor\\naction there and you get effect upon the liver, spleen and soLir plexus.\\nWith the patient upon the back I raise the nth and 12th ribs, or with\\nthe patient upon his side I work in at the point of the nth and 12th ribs. Put-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0273.jp2"}, "274": {"fulltext": "58 DIARRHOEA AND DYSENTERY.\\nting the thumb against the angle you can hold there strongly, with the idea of\\ninhibiting nerve action.\\nI never hesitate to have a good flow of bile to the intestines in case of\\nDiarrhoea. The theory is that we work on the bile to stimulate its flow to the\\nbowel, and 3^ou will find that it will act to allay irritation. I work on the\\ncourse of the bile duct to insure a freedom of the flow of bile to the intes-\\ntines. It will never do any harm in the case of diarrhoea or dysentery, as well\\nas in case of constipation. This then is the general treatment in cases of diar-\\nrhoea and dysentery and similar troubles. Now of course, if it is a severe case\\nof dysentery, when you work upon the abdomen you must be careful not to\\nrun any risk of perforation, which is likely to occur. I work over the bowel\\n-as in typhoid fever, simply to relax the tissues and free the flow of fluid, reach-\\ning the hypogastric plexus. In chronic cases where there is inflammation of\\nthe bowel, you wnll find the bowel contracted, and then by working gently but\\ndeeply over the site of the contracture you can relax. I am treating a case\\nnow of long standing. It seems to be chronic. There is a contraction of the\\nbowel on one side cr on the other. It may be on the right or may be on the\\nleft, varying from time to time. I work on the centers along the spine. I\\nspent considerable time one morning in giving the treatmeat in trying to relax\\nthis condition. I worked from the middle dorsal down, but none of it seemed\\nto do as m.uch good as to get directly at the seat of the contracture by working\\njn the abdomen. You may say that tends more to massage than to Osteopa-\\nthy. That is true so far as that case is concerned, but differs in having the\\norigin of the trouble in the spine.\\nWe work first upon the spine, second upon the abdomen; we also work\\nupon the 7ieck to stimulate the pneumogastric. Stimulation of the pneumo-\\ngastric will increase the peristalsis, according to Hare. You bring pressure\\nupon these nerves by working along the Mastoid muscle. You must make\\nlocal examination and satisfy yourself that the coccyx is straight. Some-\\ntimes it is displaced and is the cause of the trouble.\\nIn case of rectal troubles you must, of course, treat the sacral nerves\\nas they have to do with the rectum.\\nAlso there are certain adjuvants which we may use. Quiet and rest in\\nbed in severe cases, with proper care as to diet; meat broths, tepid (not hot)\\nwater, as hot water or hot liquid food will excite peristalsis. Use milk\\nwith lime water, also mucilaginous drinks such as white of ^g^ in water,\\nmilk, rice or barley water. Avoid fruits, except such as are constipating,\\ne. g., blackberries and strawberries. Tea is an astringent. Strong tea and\\ntoast may be given.\\nLadies and gentlemen, this is not Osteopathy. It is simply common sense\\nadjuvant methods that are used. One should not include these in Osteo-\\npathic treatment unless necessary. Ordinary cases of diarrhoea you will be\\nable to stop with the treatment.\\nAs to Dysentery, the same general treatment given above will apply", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0274.jp2"}, "275": {"fulltext": "HISTORY OF MEDICINE.\\nYou must however give a more general spinal treatment, especially for the\\nliver, spleen, stomach and intestine. Dr. McConnel has said that there is\\ninvariably a lesion at the 3d and 4th lumbar in case of dysentery. Get the\\nliver active. Frequentl)- you can relieve portal congestion and do away\\nwith danger in that direction.\\nIn Tormina I sometimes bring deep pressure over the solar plexus but\\nusually work upon the splanchnics. I have the patient upon the side upon\\na chair, and spring all along. This is the ordinary griping in the intestines.\\nFor the bearing down feeling in the rectum, strong stimulation in the\\nsacral region will be sufficient. Sometimes it is necessary to give an enema,\\nand then tepid water should be used. A mustard plaster may be good to\\nrelieve, but it should not be left on over twenty minutes, not long enough\\nto blister. I have before mentioned that the patient should not be allowed\\nto drink a quantity of liquid at once. Just a few spoonfuls of water should\\nbe given at a time to relieve thirst.\\nQuestion. In treating the Pneumogastric do you inhibit or stiinulate?\\nAnswer. The general way is to hold strongly against the Mastoid\\nmuscle. We do not depend simply upon the pneumogastric in these\\ntroubles. I have not found that I could do so.\\nQuestion. How often do you give treatments for diarrhoea?\\nAnswer. I treat such cases several times a day. It is owing to the\\nnature of the case. If it is an acute case you must keep after it. Treat\\nthree or four or a half dozen times a day; will do no hurt.\\nQuestion. Would it do to give cracked ice instead of water to quench\\nthirst?\\nAnswer. Yes, that would do in small quantities.\\nLECTURE XI.\\nTHE HISTORY OF MEDICINE.\\nThe Science of Medicine is defined as the theory of diseases and of rem-\\nedies, (Encyc. Britt.) thus broadly including all systems and manners of re-\\ngarding and of treating disea.ses. It has existed, though not ahvavs as a\\nscience, since the dawn of civilization; schools of medical thought have risen,\\nflourished and decayed, some leaving valuable contribuiions to the common\\nfund of knowledge, while others have left but an empty name or the remem-\\nbrance of a grotesque theor3^ The mission of Medicine in the world has been,\\nostensibly, the alleviation of human suffering, and the prolongation of luuuan\\nlife, but of medicine, in the sense of the application of drug remedies, truly\\nmay it be said that it is more like David than like Saul, since it has slain its\\ntens of thousands\\nThe progress of Medicine through the centuries has ever been upward;\\nvast numbers of facts have been carefully recorded; quantities of books have\\nbeen written; through diligent study and research the physician has become", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0275.jp2"}, "276": {"fulltext": "6o HISTORY OF MEDICINE.\\nthe most learned of men, and is fitly described by one of his own number as^\\nknowing almost everything except how to cure disease.\\nThe growth and evident success of a doctrine of Medicine within recent\\nyears, whose practitioners administer doses of drugs so highly attenuated that\\nit is declared that by no analysis can any trace of the original drug be recog-\\nnized, and one of whose practitioners, remarks the Encyc. Britt., claims to have-\\ndiscovered decided results from olfaction, or the smelling of medicines, but-\\nmore especially by means of medicines contained in closed vessels held in the\\nhand leaves open to serious doubt the use of any drug remedy in disease.\\nMany physicians believe of medicine what Prof. Magendie says of it, Science\\nindeed! It is nothing like Science, while the turning of the multitude for re-\\nlief to such transparent frauds as Faith Cure and Christian Science, or to the\\nmore sensible methods, such as Massage, Rest Cure, Hydrotherap}^ and Physi-\\ncal Culture, is indicative of the popular turning away from drug remedies.\\nThe old theory of disease was that disease was an entity, an idea originat-\\ning in the observation of technically described new growths, e. g cancers. Dis-\\nease, having produced such departures from the normal, and having resulted\\nin that which was without its counterpart in the healthy body, was held to\\nhave acquired an automy, or peculiar independence, hence was an entity or\\na thing apart.\\nAnother class of diseases, not marked by such abnormalities, were known\\nas physiological diseases, e. g. inflammations, rheumatism. Disease came to\\nbe regarded as a condition, which condition, or its essential nature is, in any\\ngiven case, revealed to the physician of to day by a study of the cellular pathol-\\nogy of the case. Hence the theory of disease is based, through a knowledge\\nof Pathology, upon Physiology, and a rational system of medicine, sa3^s-\\nBruntou, depends first of all upon a knowledge of the nature of the disease,\\nor pathology. It depends, secondly, upon a knowledge of the action of the\\nremedies that are to be employed in the disease, or pharmacology; and the\\nknowledge of these two subjects depends upon a knowledge of the healthy\\nstructure of the body, or Physiology. This definition the Osteo-\\npath may accept, having substituted for the word pharmacology, the word\\ntherapeutics.\\nWhereas the physician halts often in contemplation of the cellular pathol-\\nogv, assigning for such condition various causes, external or internal; the Os-\\nteopath, regarding cellular pathology as secondary, attends to the mechanical\\nregulation of all parts of of the body related to the affected part. He often\\nfinds the sole cause in disarrangement of the mechanism, or he may find causes\\nexternal or internal, as does the physician. In the latter case there may yet\\nbe mechanical causes responsible for a weakening of the tissues and the invas-\\nion by the disease. If no derangement of structure is found, as is sometimes\\nthe case, the Osteopath devotes his eSorts to controlling the condition of the\\nsystem b}^ manipulation of nerve supplies, e. g. in a germ disease.\\nBrunton divides drugs into two kinds, (i) Protoplasmic poisons, which de-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0276.jp2"}, "277": {"fulltext": "History of medicine. 6r\\nstro3^ all kinds of protoplasm, (2) Drugs which seem to have more or less affin-\\nity for variously differentiated protoplasms. Thus drugs act always upon the\\nprotoplasm, which is the physical basis of life. The Osteopath secures the in-\\ntegrity of this protoplasm by controlling the quality or the flow of blood.\\nThe History of Medicine begins with early Greek civilization, though it\\nis pointed out that savages and animals instinctively resort to such remedies\\nas rest, herbs, abstinence from food, etc. For a long period of time preceding\\nthe Greek period, Medicine existed, not as a science, but as a crude mass of:\\nknowledge, much obscured by myth and fable. To what extent the false en-\\ncumbered the true, and superstition throve upon ignorance, may be imagined\\nwhen one remembers to what degree superstition still rules the popular mind,\\nespecially in matters of healing, e. g., charming away of warts, etc.\\nIn connection with Joseph in Eygpt, about 1700 B, C, the Scriptures\\nmention physicians and embalmers, thus implying some knowledge of anatomy\\nand of the healing art. The position of the physicians then was less honorable\\nthan now, as indicated by the fact that the superstitious Egyptians would somQ^\\ntimes stone the embalmers after their work was done.\\nThe study of Anatomy probably began with the embalmers, who removed\\nthe brain through the nasal fossae, and the intestines through an opening in\\nthe left side of the abdomen. Pliny states that the Egyptian Ptolemies allowed\\ninvestigation of the bodies of the dead for the causes of disease, thus notino-\\nthe origin of pathological study.\\nOther ancient peoples had a knowledge of hygiene and medicines. The He-\\nbrews under Moses enjoyed some of the best directions concerning care of\\nhealth. In the Pentateuch, ascribed to Moses as author, rules of health, such\\nas avoidance of the flesh of the hog, circumcision, purification, relation of man\\nand wife, public hygiene, and prevention of the spread of leprosy, are pointed\\nout by Park.\\nAmong the ancient Indian races we again note the fact that the healino-\\nart was in the hands of the priests, since the Brahmins alone were allowed to\\npractice medicine. Their views are well illustrated in the following quotation:\\nThey held the human body to consist of 100,000 parts, of which 17,000 were\\nvessels, each one of which w^as composed of seven tubes, giving passage to the\\nten species of gasses, which by their conflicts engendered a number of diseases.\\nThey placed the origin of the pulse in a reservoir located behind the umbilicus.\\nThis was four fingers long by two wide and divided into 12000 canals, dis-\\ntributed to all parts of the body. Astrology, demonology, the flight of birds\\nand a casual observation of the patient s condition aided in the prognosis.\\nSome idle circumstance was of greater importance than the symptoms of the\\ndisease.\\nThe unchangeable Chinese date their system of medicine at 26S7 B. C.\\nand ascribe it to one of their emperors. This work is still their authoritative\\ntext. They examine the pnlse, noting three kinds, supreme (celestial) middle,\\nand inferior (terrestial) and used lotions, plasters, baths etc., but had practi-\\ncally no knowledge of surgery or anatomy.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0277.jp2"}, "278": {"fulltext": "62 HISTORY OF MEDICINE.\\nThe ancient Greeks were probably the wisest in medicine, and left to the\\n^vorld valuable knowledge as a foundation of science. With them mythology\\nhad its place in medicine. Hermes or Opollo, was the author of medical works,\\nand Aesculapius was worshipped as the God of Medicine. This man, it is\\nstated, is quite separate from the early practice of medicine, he was not a prac-\\ntitioner but the deity of medicine, though one writer mentions him as being\\ndesired by Castor and Pollux to become the surgeon of the Argonautic Expe-\\ndition.\\nAmong the Greeks the healiugart was at its highest state of perfection. Here\\nagain the priests succeeded in monopolizing the healing art, no one being al-\\nlowed to practice unless he became a priest. It is a notable fact that among\\nall peoples the art of healing has been closely associated in the popular mind\\nwith that of healing the soul.\\nBleeding still occasionally, though very rarely, practiced, is first ascribed\\nto Podalirius, reputed to be the son of Aesculapius, who endowed him with the\\ngift of recognizing what was not visible to the eye, and tending what could\\nnot be healed. Thus is first indicated a classification of diseases into ex-\\nternal and internal which is always taken as meaning surgery and medicine.\\nAmong the Greeks first arose the habit of recording cases, they being first\\nwritten upon the walls of the temples or upon tablets, V/here they were made\\nthe object of stud}^ by ntimbers of the profession. The following is mentioned\\nby Park: J^^i- vomited blood and appeared lost beyond recovery. The or-\\nacle ordered him to take the pine seeds from the altar, which they had three\\ndays mingled with honey; he did so and was cured. Having solemnly thanked\\nthe god, he went away. It is stated that purgatives, emetics, venesection,\\nfriction, sea -baths, and mineral v^aters were all used by the priests. All of\\nwhich sound familiar to us today. Prayer was made, and deceit was freely\\npracticed to influence the patient s mind; grotesque juggleries and extortion\\nwere common.\\nPythagoras was the founder of a school of philosophy. The Pythagorean\\nphysicians were the first to visit the homes of the sick, and were therefore\\ncalled ambulant or periodic physicians. The Pythagorean Empedocles,\\na native of Agiegentum, first noted that a periodic pestilence which visited\\nthe city always followed the sirocco. He caused a wall to be built to direct\\nthe wind and thus free the city of the fever. Likewise he quickened the\\ncurrent of a stagnant stream in Selinus to which he attributed the origin of\\nnoxious vapors, and thus freed that city of a pestilence.\\nIn the Greek gymnasia physical culture, compulsory in those days, was\\ntaught as a means of preserving health. The physical directors who were\\nphysicians, treated the sick with drug remedies, dressed wounds, applied oint-\\nments, massaged, and reduced dislocations. Here may have been the origin of\\nmassage and a further development of surgery, but certainlj^ not the origin of\\nOsteopathy, ^ince massage nor any of its methods is Osteopathy in any partic-\\nular.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0278.jp2"}, "279": {"fulltext": "HISTORY OF MEDICINE. 63\\nAt a period when mythology was waning and history was dawning, ap-\\npeared Hippocrates, known to us as The Father of Medicine, one of the\\nbrightest lights in the early history of medicine, who made observations and\\nclassifications of disease still in vogue. Hippocrates was of noble mind, free\\nfrom the follies and superstitions of his day, with an exalted conception of the\\nduties of the physician. He was of the faculty of famous school of Cos, and is\\nstated to be the founder of the medical art as we now practice it. He possessed\\ngreat skill in the use of instruments, which he imparted to his followers; he\\nrecognized disease as a condition regulated by natural laws, and with a tendency\\ntoward spontaneous recovery, which tendency alone could be successfully fol-\\nlowed by medical treatment. To Hippocrates the present age is indebted for\\nthe m.ethod of close observation and accurate interpretation of symptoms.\\nBut little was known at that time of Anatomy, Physiology and Pathology;\\nhence more dependence was placed upon mere observation of symptoms, thus\\noriginating the empiric method all too much in vogue at the present time.\\nThe Hippocratic school recognized four elements: earth, air, fire and\\nwater: and four conditions; heat, cold, dryness and moisture. Four humors of\\nthe body are described; blood, phlegm, yellow bile and black bile, (Humoral\\ntheory.) Right proportions and distribution of these meant health; wrong,\\ndisease, while the four elements must be in exact proportion in health.\\nAnother queer theory was that of Fluxions, a sort of congestion, produced\\nby either heat or cold; the tissues by action of heat or cold, became more porous\\nand the humor also became atteniiated.\\nHippocrates recognized the Vis medicatrix naturae, and taught that\\nthe physician was to aid the sick man to overcome the disease. He recognize\\ncrisis in disease, and originated the habit of prognosis. In treatment, medi-\\ncines were secondary, and exercise and diet of prime importance. But, says\\nKncyc. Britt. insensibly, the least valuable part of Hippocrates work, the\\ntheory, was made permanent; the most valuable, the practical, neglected.\\nHippocrates was a voluminous writer, among his important works are his\\nAphorisms, 70 vols., important until recent times; on Fractures; on Articula-\\ntions and Dislocations, Wounds of the head; Diseases of the Eye; on Fistula,\\non Haemorrhoids; Diseases of Women; Accouchmeut, etc., etc.\\nLECTURE Xn\\nHISTORY OF MEDICINE.\\nThe period in which Hippocrates lived is called the Philosophic period,\\n50C-320 B. C. Following this came the Anatomic Period, 320 B. C. to 200 A-\\nD., in which the most renowned names are those of Herophilus, Erasisiratus,\\nPliny, Galen.\\nFor one hundred years after Hippocrates but little advance is recorded in\\nmedical science, but under the reign of Ptolmey Soter, and his son, Ptolmev", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0279.jp2"}, "280": {"fulltext": "64 HISTORY OF MEDICINE.\\nPhiladelphus, great progress was made owing to their patronage and to their\\nallowing of human dissections before interdicted. The Alexandrian Library,\\nfounded about this time, was another mighty aid to progress, felt uo less in\\nMedicine than in other branches of learning. Herophilus and Erasistra-\\ntus both enjoyed the privileges of the library and patronage of the Ptolmeys.\\nThe former, for whom the Torcular Herophili is named, is said to be the\\nfirst to take up systmatic dissection of the human body. He was an admirer\\nand follower of Hippocrates, having studied in the school at Coz. Among his\\nwritings are some upon the eye, pulse, midwifer}^, etc., and commentaries upon\\nthe works of Hippocrates concerning the membranes, vessels and ventricles of\\nthe brain, the tunics of the eye, the intestinal canal and parts of the circulatory\\nsystem. He mentioned the thoracic duct. Thus it will be seen that under\\nhim the knowledge of anatomy was much advanced.\\nErasistratus was also a diligent anatomist but not a follower of Hippo-\\ncrates. He discovered the lymphatic vessels; declared the function of the epi-\\nglottis to be to keep the liquids from, entering the lungs; described the valves\\nof the heart more fully than had been done; wrote upon fevers, parlaysis, hy-\\ngiene, etc. He held that most diseases arose from decomposition of food in\\nthe stomach after overeating. He therefore bled and recommended fasting for\\nthis trouble which he called plethora. He depended on diet, baths, and exer-\\nercise much more than upon drugs, in his therapeutics. He elaborated a me-\\nchanical theory of digestion (trituration) and of disease.\\nThese two names are important in connection with the Alexandrian School\\nof Medicine. Each was the founder of a school. The Herophilists made great\\nprogress in Anatomy, but at last neglected it. The Erasistrateans gave much\\nattention to special symptoms of disease and to drug remedies. They opened\\nthe way for the Empiric School, which disiegaided anatomy entirely, thinking\\nit useless to seek for the cause of disease. They thus came to pay almost ex-\\nclusive attention to the observation of the phenomona of disease, and thus set\\nup pernicious habits of empiricism, treating of symptoms, which endure today.\\nThe Alexandrian schools as a whole did much to advance the knowledge\\nof Anatomy, Surgery and Obstetrics.\\nEmpiricism rejecting anatomy, and necessarily knowing but little of Phy-\\nsiology, bcame firmly entrenched in the minds of Physicians, because in the\\nmidst of confusion of theories and ideas, it rested upon a foundation of exper-\\nience and observation which seemed to give it authority. It later fell into dis-\\nrepute through the ignorance of its adherents, and Empiricism became a term\\nof anathema, until rescued later by the labors of Bacon, Locke and Condillac,\\nunder the name of the Experimental Method.\\nRoman Medicine: The earh^ Romans, it is said, possessed no distmct\\nSchool of Medicine, and when about 200 B. C. the profession first appeared\\namong them, it seemed to have come from the Greeks. One of the greatest\\nnames in Medicine belonged to a man of those times, Galen, whose name is\\nclosely connected with the development of Physiology. Galen was of the", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0280.jp2"}, "281": {"fulltext": "HISTORY OF MEDICINE. 65\\nDogmatic School founded by Hippocrates, he was very learned in all of the\\nsciences of his time, and knowing all that was to be known of Anatomy, Phy-\\nsiology, and Medicine at that period, became a unifier of the various sects\\nand theories, thus doing much to elevate the profession. He studied at Alex-\\nandria, but, while a follower of Hippocrates, yet assumed an independent place\\nas his successor. He recognized in man three principles, spirits, humors, and\\nsolids; of temperaments, resulting from the varying proportions of these three\\nprinciples, he thought eight different kinds existed between the limits of health\\no,n one hand, and disease pn the other. Tlie human soul had three parts; the\\nvegetative, found in the liver; the irascible, in the heart; the rational in the\\nbrain. He noted the difference between continued and intermittent\\nfevers, and, together with Hippocrates, held that diseases were cured by con-\\ntraries. He wrote upon the skeleton, and, as none existed at the time in Rome,\\nrecommended students to go to Alexandria, where they could see and handle\\nthe bones. He described most of the bones of the body. The term symphy-\\nsis is attributed to him. He classified the muscles as flexors and extensors\\nand showed that thej^ were necessary to voluntary motion; located arteries and\\nnerves between them. He was the first vivisector, since he exposed the mus-\\ncles of living animals in his studies. Praxagoras had believed the arteries to\\ncontain air, whence their name, but Galen showed that they contained blood,\\nand came very near being the discoverer of the circulation. Had he been a\\nmore independent observer, this prize would have been his. Park says here:\\n**A little less reverence for authority, and a little more capacity for observa-\\ntion, would have placed him in possession of the knowledge, lack of which for\\nso many centuries retarded the whole profession. He did not understand the\\nvenous system, thinking all veins originated in the liver. Whereas Aristotle\\nhad taught that the nerves originated in the heart, Galen showed that the} or-\\niginated in the brain and spinal cord, and he divided them into sensory, which\\nhe described as originating in the brain, and motor, originating in the spinal cord.\\nHe knew of glands, but supposed their secretions were excrementitious, and that\\nthey w^ere emptied into veins. He divided the body into cranial, abdomenal\\nand aortic cavities. He supposed that air entered the cranial cavit}\\nthrough the cribiform plate of the ethmoid, passing out again by the same\\nroute, carrying excretions from the brain to be discharged through the nostrils,\\nbut part of the air became mingled, in the ventricles of the brain, with the vi-\\ntal spirits of the body to form the animal spirits.\\nIt will thus be seen, that while Galen s mistakes were numerous, he did\\nmuch for the advancement of Anatomy and Physiology.\\nHe strove to place the diagnosis of diseased conditions and their treatment,\\nupon a physiological basis, the only true basis for practice, but his ideal has\\nscarcely yet been realized in any school of medicine.\\nIn the period of Roman Medicine appears the name of Asclepiadcs, from\\n\u00e2\u0080\u00a2whose theory of atoms, conies the atomic theorj of the constitution of matter,\\nheld at the present time. He held that the body was composed of minute ele-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0281.jp2"}, "282": {"fulltext": "66 HISTORY OF MKDICINK.\\ninents, eternal in existence, in constant motion, this motion resulting in the\\nvarious phenomena of the body, The atom was imperceptible except to thought\\nand was indivisible. It will thus be seen that his ideas in regard to the atomic\\nconstitution of matter are remarkably similar to those held by science today.\\nHis therapeutics w^ere based upon the idea of varying the sizes of the pores\\nof the tissues, enlarging them to give exit to disease, or contracting them to\\nkeep it out. His favorite remedy was therefore exercise.\\nA pupil of Asclepiades, Themison by name, was the celebrated founder of\\nthe school of methodists belonging to these early days. They held it to be vain\\nto attempt to understand either the cause of disease, or the organ affected by\\nit. Three conditions were found in all diseases: (i) Relaxation of the minute\\npassages of the tissues, (2) Contraction of these passages, (3) a mixture of the\\nfirst two, partial relaxation and partial contraction. Such a simple scheme of\\ndisease required but a simple system of therapeutics, namely to relax or to con-\\ntract. There were no specific diseases, and they therefore dispensed with the\\nspecific remedies. A great man of that school, Soranus, is credited with hav-\\ning used the speculum at that early date.\\nA Pneumatic school was formed in the first century A. D., whose doctrine\\nwas that the Pneuma, or universal soul, presided over pathological as well as\\nnormal activities of the body. It was seemingly an attempt to reconcile the\\ntheories of the Humoral (Hippocratic) school with those of the Solidist (Meth-\\nodic) school. Its founder was Athanaeus.\\nAt this period, also, another school of medicine was founded, the name of\\nw^hich is familiar today. The Eclectics were those of the school which strove\\nto cull from each existing school the strong points and to combine them\\nto form a new doctrine in medicine.\\nThough the period of Medicine (400 A. D.) just described, was Roman\\nMedicine, the Greeks performed most of the practice. In this period the science\\nas a w^hole retrograded. Galen was not allowed to dissect human bodies, so he\\ndissected animals, especially the hog.\\nArabian Medicine: Under the patronage of Haroun al Raschid at Bag-\\ndad, progress for the science was made. He had medical books collected from\\nall countries and translated into Arabic, he built schools and hospitals, and in-\\nvited distinguished men to reside at his court. Supremacy in Medicine soon\\npassed from Greek and Roman to Sarcen, and from the loth to the 13th cen-\\ntury is known as the most brilliant periods in Arabian Medicine. Yet but lit-\\ntle progress in the science was made during the period, and the chief service\\nrendered the cause of Medicine was to collect and keep alive the body of learn-\\ning already existing. A number of names are important in this period, but\\nonly a few can be noted in these lectures. Rhazes was the most noted of early\\nArabian physicians. He first accurately described smallpox and measles, and\\nwrote voluminous medical works. Avicenna was the author of a great work in\\nfive volumes, w^hich added -nothing to existing knowledge.\\nDuring these times the practice of Medicine was largely carried on by the", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0282.jp2"}, "283": {"fulltext": "HISTORY OF MEDICINE. 67\\nclergy since it was in the monasteries that the books were kept and the know-\\nledge preserved by study. From the loth to the 13th centuries, the Jews were\\nimportant practitioners of Medicine, although under the ban of the law, and\\nwere often called to attend prominent personages.\\nCrude medical laws to restrict the practice, were enacted even at this early\\ndate. Theodoric, a Visigoth king decreed that a physician could bleed a wom-\\nan of noble birth only with the aid of a relative or of a domestic; that if a pa-\\ntient died from a surgical operation, the unfortunate doctor was given over to\\nthe friends of the dead man to be done vdth as they wished. Other laws were\\nin keeping with these.\\nA great school in the middle ages was the school of Salurum in the Wes-\\ntern Roman Empire, at Salerno, Naples, founded b}^ Benedictine Monks. This\\nschool became a resort for sick and wounded crusaders, whose cases were sub-\\njects of study. Hippocrates and Galen were studied there, and important\\nw^orks were produced, among which may be mentioned, Antidotarium, a\\nstandard pharmacopoeia, whose system of weights and measures much resembl-\\ned ours of the present day, and the writings of Urso upon the pulse and the\\nurine.\\nIn this school women firsi became prominent in Medicine. Tortula is sup-\\nposed to have written De Mulierum Passionibus. Other women were known\\nat this time both as authors and as practitioners; they were much in demand\\nbecause of their skill, and also became professors in the schools.\\nThe influence of this school was seen in the action of Emperor Frederick\\nII, who united the variovs Medical schools of Salerno into a Medical Universi-\\nty, and enacted laws regulating the granting of licences to practice and the\\namounts of fees, etc. A physician must attend his patient twice each day and\\nmust go at night if called. Upon graduation of a student, he swore to observe\\nthe laws and to treat the poor gratis. A book was then placed in his hands,\\na ring upon his finger, a laurel crown upon his head and he was dismissed with\\na kiss.\\nCharms and relics were used in the school in treatment. Its practitioners\\nunderstood such symptoms as nausea, vomiting, bleeding at the ears in injuries\\nto the head, etc. They avoided patients suffering with trouble of the heart,\\nlungs, liver, stomach, etc., as they feared losing them. They acquired con-\\nsiderable skill in surgery, performed lithotomy, and employed splints in com-\\npound fractures.\\nMany of the Medical writings at this time were poems. Anatomy was but\\nlittle regarded; but much depended upon practical experience and the observa-\\ntion of clinic patients, thus the point is made that the Salernitan school bridges\\nthe gap between ancient and modern medicine.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0283.jp2"}, "284": {"fulltext": "67 HISTORY OF MEDICINE.\\nLECTURE XIII.\\nScholastic Period-. Arabian Medicine began to gain an influence through\\ntranslations of Arabian writings into Latin, and the Arabian teachings of\\nGreek Medicine began to predominate throughout the profession.\\nA new school was founded, now, at Montpelier [Spain] in which the\\nSpanish Jews were most active. This school grew as the Saleruian school,\\nmentioned in the last lecture, declined, and Arabian Medicine remained strong\\nin influence until the Renaissance [i6th Century.] The authoritative sources\\nof medical writings at this time were found in Arabian texts, and thus the\\nmedical writers at this period were called x\\\\rabists. But the writings at this\\ntime are said to have been mostly commentaries upon Galen, Hippocrates and\\nothers, showing how they still influenced Medical thought and Medical litera-\\nature.\\nIt is interesting to note that this period produced the first English Medi-\\ncal authors, Gilbert about 1290 wrote a Compendium Medicinal, and Bernard\\nGordon, Scotchman and professor in Montpelier, wrote a Practica or Lilium\\nMedicine. John Gaddecen, phj^sician to the king of England wrote Rosa An-\\ngilica. All of these works are spoken of as visionary, speculative and super-\\nstitious. Gilbert wrote of Leprosy, and Gaddesen may be particularly interest-\\ning to Osteopaths from the reason that he first emplo3^ed laying on of hands\\nin the treatment of scrofula.\\nSurgery, at this early date, was, as always, more progressive than Medi-\\ncine. Among the prominent names of this profession are those of Guy de\\nChauliac [1350] and John Ardern, an Englishman. Mondino [1275] was\\nanother great Anatomist; his works along with those of Galen, were read for\\n200 years. Whereas dissections had before been done upon lower animals al-\\nmost entirely, he braved public opinion and the law in making public dissec-\\ntions of the bodies of two women at Bologna. For a long time afterward no\\none dared emulate him in this matter. The objections of the clergy and the\\nbulls of the Pope rendered human dissection impossible for many years. Guy\\nde Chauliac was a most eminent and learned surgeon and author. He operated\\nfor dropsy, stone in the bladder, cataract, hernia, etc., was attacked by the\\nplague and wrote a description of his sj^mptoms and the course of the disease\\nthat became classic.\\nA curious custom of these times was the writing of scientific and medical\\nworks in poetry, and strange titles were used, e. g. Flowers and Lilies of\\nMedicine, the name of works dealing with the plague and veneral diseases.\\nThe healiug art, previously almost entirel}^ m the hands of the clergy, now\\nbegan to be taken up by others, as shown by the oft repeated term lay-surgeon.\\nPriests thought surgical operations beneath them and often left them to travel-\\ning surgeon, while the barbers espoused the profession and were known as\\nbarber-surgeons.\\nDuring the Arabian Period of Medicine the Arabian people had emerged", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0284.jp2"}, "285": {"fulltext": "HISTORY OF MEDICINE. 68\\nfrom the darknesss of ignorance and had become a polished people, only, how-\\never to be over run by the Turks from the deserts of Tartary, a people of whom\\nit has become proverbial that grass never grew where the foot of the Turk had\\ntrod.\\nThe Renaissance (i6th Century) affected Medicine as it did every other\\nbranch of learning, viz: It swept away much of the darkness of ignorance and\\nsuperstition which had obscured truth and hindered progtess, and led to renewed\\nstudy and investigation, resulting in enlightenment and advancement.\\nThe work done at that time was the origin of the present continuing\\nscientific movement. The renewed study of the works of Galen stimulated pro-\\ngress in Anatomy, while the discovery of the circulation of the blood, by Har-\\nvey, gave new life to the much neglected study of Physiology. The w^orks of\\nHippocrates, Galen and Celsus, were studied and translated from the Greek,\\nbecoming thus the foundation of this new movement, their influence being still\\nfelt in Medicine today. A complete edition of the works of Hippocrates w^as\\ntranslated into Latin. Mondinus, whom we have mentioned as dissecting the\\nbody of two women in Bologna, published a work upon Anatomy, illustrated\\nwith wood cuts.\\nThe embargo placed by the Pope upon the dissection of human bodies,\\nwas removed, dissections thereupon became general, much to the benefit of\\nscience. Jacques Dubois or Sylvius, grouped and named the muscles and de-\\ntermined their functions; he is credited with the discovery of valves in the large\\nveins, and first used colored injections in studying blood vessels. He seemed\\nto be unduly influenced by the authority of Galen.\\nVasalius (1514) was the great independent observer so much needed at this\\ntime. He dissected small animals and robbed cemeteries for human material.\\nAt the age of twenty-nine he became the author of the most complete anatomy\\nyet written. He had the boldness to deny Galen s authority and to point out\\nhis mistakes.\\nColumbus (1490) dissected many bodies, and nearly discovered the blood\\ncirculation, having noted the systole and diastole of the heart and their connec-\\ntion with the dilatation and contraction of the arteries. He found that the\\npulmonary vein contained arterial blood and was acquainted with the pulmonary\\ncirculation.\\nKustachius and Fallopius (early i6th Century) were both great Anatomists\\nand made discovery of parts^of the body bearing their names.\\nThe Arabian school of Medicine had added but few observations to the\\ncrude Pathology of Galen.\\nTwo men, Benivieni and Kustachius did much in this line. The former\\nis said to have been the first who had the habit, felt the need, and set\\nthe useful example, which he transmitted to his successors, of searching in the\\ncadaver for cause of disease. He made observations upon gall stones, the\\nlesions of heart disease, and the transmission of syphilis from the mother to\\nthe foetus.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0285.jp2"}, "286": {"fulltext": "69 HISTORY OF MEDICINE.\\nAt this time P elix Plater (1536), a Swiss, classified diseases according ta\\nthe totality of apparent symptoms. Daring the period, also, of which we\\nhave been speaking, surgery fell behind Medicine and became of small repute.\\nOwing to the social customs it had come into the hands of ignorant barbers,\\nbathers and bone-setters, simply because these classes w^ere proscribed from\\nthe trade of mechanic or artisan.\\nThe clergy, wdio practiced, were prohibited by the church from shedding\\nblood. Hence surgery fell into the hands of the low^ classes mentioned, and as\\nthey saw no need for the study of Anatomy, it sank very lov/. This condition\\nwas changed about 1515, when the school gained authorit}^ over the surgeons\\nand compelled a higher standard, i^.mbrose Pare (1510) w^as a noted surgeon\\nw^ho first ligatured blood vessels in amputations, thereby avoiding the cautery.\\nParacelsus (1493) w^as the founder of the school of Chemical Medicine. He\\ndispensed with the authorities, though he admired Hippocrates. He cut\\nloose from all autIlorit3^ denied the utility of studying Anatomy, but since he\\nregarded man as a microcosm vvhich he compared wdth the macrocosm, nature,\\na knowledge of the nature of man was to be gotten by studying external na-\\nture. He laid stress upon the curative power of nature, and gave Chemical\\nMedicines, especially Antimon3\\\\ Thus arose the school of Chemical Medicine,\\nand the use of Antimony as a Medicine wss an important thing among\\nits adherents. The value of his services to Medical Science is estimated to be\\nsmall, or entirely nil. His school did not endure, though the practice of ad-\\nministering chemical medicines did.\\nThe result ot the Renaissance upon Medicine w^as primaril}^ to renew inter\\nest in ancient Medicine. Through new study of Hippocrates and Galen, and\\nb}^ thus adhering to the old, taking Medical knowledge second hand, poorer\\nresults were obtained than w^ould have resulted from an entirely independent\\nstudy. Yet the outbreaks of epidemics of hitherto unknown diseases compelled\\ninvestigation along new and independent lines. Another advance is noted in\\nthe introduction of the clinical method of instruction, one of the most practical\\nand valuable now in vogue. This was first tried in Padua, Italj^ where the\\nsurgeon. Mcntanus, gave clinic instruction in St. Frances hospital.\\nLeonard Botal, a French surgeon, was the first to employ bleeding to con-\\nsiderable extent. He bled weak old men from tvv O to six times per annum,\\nand thought it well to bleed a robust health}^ person once in six months. He\\nhad considerable success.\\nDuring this period the profession of ph^-sicians was divorced from the\\npriesthood; surger} became m^ore closely affiliated with Medicine; schools in-\\ncreased in number, and hospitals and dispensaries w^ere founded.\\nSome peculiar customs prevailed at this tim,e. For example, the students\\nchose the ofiicers of the universities, sometimes the teachers, and took part in\\narranging the curriculum, a privilege which students of today would fain ex-\\nercise. Religious exercises were held before and after di^ssction, even though\\nthe cadavers were usually those of criminals, a custom, by the way, from", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0286.jp2"}, "287": {"fulltext": "HISTORY OF MEDICINR. 70\\nwhich we of today have far departed. Demonstrations were given by surgeons\\nbut the dissecting, an unworthy job, was the work of barbers.\\nMedicine in the \\\\yth Century: Just before the opening of the 17th Century\\nit is said the world was in a woeful state. Devasted by wars and plagues, the\\npeoples, superstitious and rude, were in poor condition for mental progress.\\nYet progress was made, be it said to the credit of the virility of the human\\nmind. The improvement began with the Renaissance, and continued until the\\n17th Century. The influence of Galen and Hippocrates in matters Medical still\\nremained supreme, though the developing sciences of Mathematics and Physics\\nled to a new independence of mind which lessened the quondam reverence for\\nauthority. This was a step in the right direction. Futhermore the formation\\nof the cell-doctrine, the discovery of the circulation, the improvement of the\\nmicroscope, together with other important discoveries furthered science and\\nMedicine remark\u00c2\u00a3bl3\\\\ In this century arose several different schools and sev-\\neral prominent individuals who claim attention.\\nNow the clinical method, begun in Italy, was introduced into Holland. It\\nis to be noted that the clinical method of studying and making prominent the\\nsymptoms of disease, led to neglect of Galen and to exaltation of Hippocrates.\\nMalpigi and Grew discovered that both plant and animal tissues were com-\\nposed of cells, and advanced the important cell^doctrine, which is. at the bottom\\nof the science of Anatomy, Physiology and Pathology today.\\nVanHelmontisoneofthegreatnam.es of the 17th Century. He was\\nreally a successor of Paracelsus, founding a grotesque theory which recognized\\nthe fall of man as the origin of disease, and regarded demons, witches and\\nghosts as a cause of disease. He used mild remedies, andintroducsd some new\\nchemical methods into pharmacy.\\nThe discovery of the circulation of the blood ho-d important and immediate ef-\\nfects, since it led to a reconstruction of the doctrines of Medicine upon a Phy-\\nsiological basis, and led to the founding of the Tatro-Physical of Medical, and\\nthe Tatro-Chemical schools. Many observers before Harvej^ had discovered\\nfacts concerning the circulation. They knew that blood was contained in the\\nveins, but finding the arteries empty after death, supposed them to be filled\\nwith spirit. The liver was supposed to be tlie origin of the veins, the blood\\nleaving it and returning to it, always through veins, propelled by undulations.\\nThis view was probably held by Erasistratus. Galen found that the arteries\\ncontained blood, that the great veins emptied into the right cavities of the\\nheart, but supposed that it passed to the left heart through perforations in the\\nseptum. Michael Servetus, Columbus and Cesalpinus were more or less fully\\ncognizant of the lesser or pulmonary circulation; valves in the vicns had been\\ndiscovered as well as the swelling below ligature.\\nWilliam Harvey was an Englishman, born in K^nt. luigiand in 157S.\\nThis advance iu truth shared the common fate and was subjected to the\\nbitter opposition of the omnipresent bigot. The new discovery was supported\\nby the phibsopher Descartes. Harvey found no lack of new facts and argu-", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0287.jp2"}, "288": {"fulltext": "71 THE HISTORY OF MEDICINK-\\nments to adduce in favor of his theory, and saw it come into general acceptance.\\nThe capillary system, without which the theory of Harvey is incomplete,\\nwas discovered by Malpigi in the lung and mesentery of the frog. Leuwen-\\nhoeck, with his improved microscope, saw the current of blood in the small ves-\\nsels in 1690. It is said that Marchetti first demonstrated the capillary connec-\\ntion of arteries and veins.\\nThe theory had beed held that the heart was an air chamber, that the air\\nconveyed by the trachea, reached the heart by anastomoses of the bronchi wnth\\nthe pulmonary veins, Harvey s discovery disproved that theory. It was\\nshown that the pulmonary veins did not conve} air, but blood alone; studies\\nwere made of the respiratory motions of the chest; the difference between ven-\\nous and arterial blood was demonstrated by Goodwin, who experimented\\nthe frog, and noted the change in blood when passed through the lungs. It is\\nsaid that an observer, Hassenfratz, filled a silk bladder full of venous blood,\\nand then placing it in an atmosphere of ox3^gen, noted the change. These ex-\\nperiments and observations opened the w^ay for studies and demonstrations of\\nrespiration, how accomplished and for what purpose.\\nLECTURE XIV.\\nIn addition to Harvey s discovery of the circulation of the blood, the dis-\\ncovery of the lymphatic system and its phj^siological action was of prime im-\\nportance. Herophilus and Erasistratus had noted the lymph vessels, but had\\nconfounded them wdth arteries. Eustachius in 1563 discovered the thoracic\\nduct in the horse. In 1622 Aselli, an Anatomist, accidentally dicovered the\\nlacteals in a dog killed during digestion by picking a vessel and seeing the\\nwhite fluid issue therefrom. Finally, Pecquet, a student at Montpelier, dis-\\ncovered the receptaculum chyli (1647) traced the thoracic duct to its ter-\\nmination in left subclavian vein. These discoveries led to widespread interest\\nin the subject, and to a working out of the blood making .system by the various\\nAnatomists of the time.\\nThe seat of vision had been located in the crystalline lens, but Kepler\\ndemonstrated its true function, and he and Scheiner found that the optic nerve,\\nterminating in the retina, was the true organ of sight.\\nThe general science of Physiology was much furthered by the discovery by\\nGlisson of the irritability of tissue, a theory worked out later by Goerter and\\nHaller.\\nTwo 17th Century schools of Medicine receive special mention.\\nThe Tatro-Physical school was an outgrowth of the study of Physiology.\\nA Neapolitan, Borelli, was its reputed founder, and the principle of the schoof\\nwas to regard the functions of the body as resting upon a purely mechanical or\\nphysical basis. Bones were levers; digestion was trituration; nutrition and se-\\ncretion depend upon mechanical tension of the vessel walls, while the heat o", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0288.jp2"}, "289": {"fulltext": "HISTORY OF MEDICINE. 72:\\nthe body was due to the friction of the blood-corpuscles against the vessel walls,\\nSantoro, a chief man of this school, constructed a thermometer, and also\\nmeasured the insensible transpiration of the body with considerable accuracy.\\nThe Tatro-Chemical School, founded by a Frenchman, Le Boe, was more\\nnearly related to the practice of Medicine. But little application of the theories\\nof the Tatro-Physical, or Physiological school, had been made to the treating\\nof disease, and it is regarded as unfortunate that the tendency thus originated\\nwas of so little real value. Physiological practice has ever been the desirable\\nthing in Medicine, but is almost as noticeably absent from the practice of the\\nschools of Medicine of today, as it was from these of the 17th Century.\\nThe Tatro-Chemical school attempted to reform Medicine upon a basis of\\nthe use of chemical Medines and the newly discovered theor}^ of circulation of\\nthe blood. P ermentation, taking place in the stomach, was an important phy-\\nsiological process. Too great acidity or alkalinity, would disturb the process\\nand result in corresponding disturbances. Willis, the great English Anato-\\nmist, was an adherent to this doctrine. He o^ave the earliest account of dia-\\nbetes, and wrote upon nervous diseases.\\nSydenham is an important name in Medicine in the 17th Century. He\\nseemed to have been unprejudiced by any of the prevailing theories, and\\nsimply studied the disease as he found it, he was thus a follower of Hippocrates\\nan empitic practitioner, though not to a fatal degree. He recognized the heal-\\ning power of nature, and held that disease was simply the result of nature s at\\ntempt to throw off the unnatural condition. He attributed much importance to\\nthe history of disease and to the influence of the weather. Sydenham was\\nreally a great medical reformer, and exerted much influence in leading men\\nback from theories to actual conditions.\\nThe 17th Century medicine, true to the spirit of the Renaissance, had been\\nprogressive, It had, however, simply opened tiie way for greater change and\\nadvances which were to follow in the i8th and 19th Centuries. The tendency\\nof the 1 8th Century seems to have been toward the perfecting of the theoretical\\nsystems.\\nTo this period belongs the names of Boerhaave, a famous professor of\\nMedicine at lycyden. He lectured at Leyden, and made the hospital there the\\ncenter of medical influence in Europe. He followed the modern method of\\nclinical instruction, and adliered to the views of Hippocrates and S5-denham.\\nHoffman attempted in his system, a synthesis of the views of spiritual and\\nmaterial schools. Stahl attempted to combat materialistic views of disease.\\nHis theory known as Auimism made the soul the chief factor in the pro-\\ncess of life.\\nHaller and Morganni represent a reaction from the theoretical speculations\\nof the teachers just mentioned and the latter with Sydenham founded methods\\nupon which modern medicine rests. The former did work in Physiology of\\nmuch influence in medicine. By defining irritability as a property of muscular\\ntissue, and distinguishing between it and the sensibility of the nerves, he did", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0289.jp2"}, "290": {"fulltext": "73\\nHISTORY OFMKDICINE.\\nmuch to discourage speculations concerning the influence of the Anima upon\\nthe body in health and disease. It is said that Physiolog}^, in the modern\\nsense, dates from Haller, while from Morgagui dates modern pathological\\nanatomy. His ante and post mortem, examinations were the basis of an im-\\nportant work, which is said to have created a new epoch in science. The study\\nof morbid Anatomy became, through him an important adjunct to medical\\nscience.\\nThe influence of the Brunonian system of John Brown, though shortlived,\\nseemed to have been considerable at the time. He believed that the processes\\nof life, disease and cure of disease rested upon excitability. External forces\\nand functions of the system w^ere exciting powers which called forth the mani-\\nfestations of life. He classes diseases as sthenic and asthenic, and treated them\\nrespectively wdth agents of depletion and of stimulation.\\nAt this time arose Homeopathy, the system of Hahnemann. His motto\\nwas Similia Similibus cii7 a7ituin [Galen s.] Hahnemann declared disease to\\nbe the totalit}^ of symptoms, and therefore regarded as useless investigation of\\nthe cause of disease. He rejected the teachings of pathology and miOrbid anat-\\nomy, as well as the Vis medicatrix 7iaticrae. He says For as far the greatest\\nnumber of diseases are of dynamic [spiritual] origin and dynamic nature, theii\\ncause is therefore not perceptible to the senses. He held that nature was a\\nbad healer, and drugs were the agents of God to cure diseases. Medicines ad-\\nministered to healthy persons caused symptoms of diseases they could cure.\\nHence the doctrine Simiiia Similibus Citratur, a motto which however, is\\nnot original with Hahnemann, since Hippocrates, Paracelsus, and oth(;rs used\\nthe phrase before him. A distinctive feature of this system, one seemingly or-\\niginal with Hahnemann, was the attenuation of medicines, styled dynamizing\\nor potentizing of the medicine. He held that dilution developed the spirit-\\nual power that lay hidden in the Medicine. He held that all diseases of a\\nchronic character are caused by either itch, sj^philis or sycosis [skin disease.]\\nHomeopaths, after a hard fight, have come to be generally recognized in\\nthis country, having been recently, during the Hispauo- American war, recogniz-\\ned by the U. S. government in the army service. Homeopathy, it is said, must\\nbe credited with drawing attention strongly to therapeutics, while it seems to\\na man up a tree that in general its success in the treatment of diseavSe is as\\ngreat as that of its enem}^ Allopathy. Possibly the case recovering with its rem-\\nedies would have gotten well anyhow, as physicians say of cases cured by\\nOsteopathy, and there still lurks the suspicion that the curative power of drugs\\nattenuated beyond the reach of chemical analysis must be about equal to the\\nhealing virtues of the colored water and chalk powders of the Allopath, and\\nthat, after all, the real explanation of the recovery would be found in the re-\\ncuperative power of nature, untampered with, and in the aid afforded by good\\nnursing. Witness the statement made by Magendie, former head physician in\\nHotel Dieu, Paris, who saj^s that he divided the 3000 or 4000 patients passing", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0290.jp2"}, "291": {"fulltext": "HISTORY OF MKDICINR. 74\\nevery year through his hands into three classes, giving to one the usual reme-\\ndies, and to the other bread pills and colored water, occasionally creating a\\nthird class to whom he gave nothing whatever. The greater mortality was\\namong those of the first class, many of the second class recovered but more of\\nthe third were restored to health. Men like Sir Ashley Cooper and Oliver\\nWendell Holmes, shake ones faith in medicines by declaring against them.\\nKeith, an P nglish Physician, in his Plea for a Simpler Life discards\\nmedicines almost entirely, and talks of success in cases of scarlet fever, apop-\\nlexy, haematuria; haemorrhage of the stomach, etc., without their use.\\nWe all know that similar statements made by the most eminent authorities,\\nmight be multiplied to a great number, that doctors give less medicine as they\\ngrow older; that prescriptions contain fewer drugs now than formerly, while\\nthe drug habit stands in ill repute.\\nTo return to the history of medicine. The i8th century produced in Italy,\\nAntonia Maria Valsalva, eminent as an observer, practitioner, and lyancisi,\\nanatomist, and author of a work upon diseases of the heart and aneurism. In\\nFrance of this period, Senac was the author of a book upon heart disease, and\\nSauvages wrote Nosolgica Methodica, a natural history classification of disease.\\nAmong English physicians, Fothergill studied Diphtheria and Tic Doul-\\noureux; Jenner introduced vaccination as a preventative measure against small-\\npox. In Germany, in this century, a Vienna physician, Leopold Arenbrugger\\ninvented the system of percussion of the chest in diseases of that region. He\\npracticed immediate, not mediate percussion, using the tips of the fingers. His\\nbook written upon the subject, was called Seventeen Novum. His discovery,\\nlike many good things before and since, w^as first ridiculed and later adopted\\nby the medical profession. It is said that this discover}^ simple as it was, did\\nmore for the real advancement of medicine than the building of the many sys-\\ntems of medicine witnessed by the centur3\\\\\\nIn the early part of the 19th century arose the modern school of medicine.\\nIt is characterized b} methods of research, giving less weight to theorizing and\\nabstract speculation than previousl5^ The growth of modern medicine was\\nmost marked in France and England, later in Germany.\\nIn France, what is knowm as the positive school of medicine, grew up.\\nBichat, an Anatomist and Physiologist, wrote an important work, General\\nAnatomy.\\nBroussais, a prominent follower of Bichat, sought to explain all diseases\\nupon an Anatomical basis, e. g. assigning all fevers to intestinal irritation or\\ninflammation. He called his method Physiological medicine, and emphasized\\nthe study of pathological school of Corvisart, Laennec and Boyle.\\nLaennec originated the method of auscultation in physical diagnosis, the\\nbasis of which was auscultation and percussion. It is said that the method of\\nLaennec revolutionized the study and knowledge of disease of the chest, and\\nwas the more valuable in that it was coupled with very careful study of the\\npathology of the organs examined.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0291.jp2"}, "292": {"fulltext": "75 HISTORY OF MEDICINE.\\nBoyle worked upon tubercles, and studied changes in the lungs and other\\nparts of the body in tuberculosis. I^ouis introduced the numerical and statisti-\\ncal method of keeping a close record of cases, thus avoiding the error of judging\\nmerits of treatment by isolated cases. Osteopathy makes a serious mistake in\\nneglecting statistics and records of its cases, laying itself liable to the charge of\\nlack of scientific method and taking to itself credit for cases accountable for by\\ncoincidence, the law of chance, etc.\\nIn England during this period the important names embrace those of Eras-\\nmus Darwin, grand father of Charles Darwin, the great scientist, and of the\\nHunters, William and his brother John. The former was a great anatomist\\nand pathologist. Richard Bright described the disease of the kidneys named\\nfor him.\\nBell and Hall did important work upon the spinal cord and its disease.\\nJohn Abercrombie published a work upon disease of the brain and spinal cord.\\nIn the German school, at this time, Karl Rokitansky did much to place\\nmorbid anatomy upon a permanent foundation.\\nOne marked feature of medicine of the present day is that, in spite of the\\nprogress made, there is a wide spread and increasing dissatisfaction with its re-\\nsults, both in the profession and outside, and a constant tendency to turn to\\nnew methods.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0292.jp2"}, "293": {"fulltext": "IVIASSAGK, SWEDISH MOVKMENT AND MAN QAE TREATMENT. 76\\nLECTURE XV.\\nMassage, Swedish Movement and Ma?i2ial Treatment: These are all forms\\nof mechanical therapeutics. All are, at least in part, manual systems,\\nthe treatment being admini tered with the hands. In each system not only\\nmanipulative proceedure is employed, but also gymnastics are used, i. e. passive,\\nresisted, or free movements on the i;art of the patient. Massage seems to con-\\nsist largely of manipulations made by the operator on the patient s body, while\\nSwedish movement, though including these manipulations, make prominent\\nthe active gymnastics of the patient and is called also Medical Gymnastics.\\nThe s^^stem of manual treatment ascribed to Ling, a Swede, seems to be a\\nmore thorough form of massage in which the manipulations predominate, but\\nincluding also certain active movements on the part of the patient.\\nIn general, these systems are but little understood, and are far more thor-\\nough as methods of healing than is generally supposed. In the hands of skill-\\nful operators, usually doctors of medicine, remarkable results have been accom-\\nplished in the cure of disease. These systems are generally employed by mas-\\nseurs without technical education, and thus have come to be generally misun-\\nderstood; being as a rule unskilifully applied, and by unsceintific operators,\\nthe results have not been such as the systems are capable of producing. How-\\never, none of these forms of treatment are Osteopathy; all differ from it radical-\\nly, yet since they arc systems of manipulative therapeutics, and since, unavoid-\\nably in any such general mode of treatment, there are certain resemblances in\\nmethod, inmanner or in results, Osteopathy has been frequently confounded\\nwith these other methods.\\nMassage is the general term used by the average man to designate all forms\\nof manual treatment, hence Osteopathy has become to him massage.\\nIn Eccles Practice of Massage five different forms of manipulation are\\ndescribed, as follows:\\n1. Effleurage, or stroking; for effects upon the skin; given in a centripetal\\ndirection to aid the flow of lymph and blood toward the heart.\\n2. Petrissage, or kneading; deeper than stroking; for effect upon skin and\\nmuscle in direction of blood flow to the heart, and for the purpose of squeezing\\nout the waste from the tissues. It stimulates lymph and blood flow.\\n3. Tapotement, or tapping, clapping or hacking. This is given with the\\ndorsal surface of the second and third phalanges, with the ulnar or radial bor-\\nder of the hand, for the purpose of affecting deeper structures, i. e., for stimu-\\nlation.\\n4. Vibration, a quick vibratory motion, variously administered, given\\nover chest, abdomen, nerve trunks, etc., for stimulation of the deeper viscera\\nor nerves\\n5. Massage, a friction, a sort of circular friction, generally employed about\\njoints to soften tissues and muscles; said to be very useful in sprains, strains\\nand rheumatism.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0293.jp2"}, "294": {"fulltext": "77 MASSAGE, SWEDISH M0VE3IHNT AND MANUAL TREATilENT.\\nThese five forms of motion, sometimes more, are described by the different\\nauthors. There is much variation in the technique. Usually a masseur, after\\na course of study, will throw aside his boois and adopt a system of motions of\\nhis own. Yet, unlike in Osteopathy, the manual of technique, or the exact\\nmode of administering the various movements, is made very important by the\\nauthors. One example will illustrate the detail with which these motions are\\ndescribed, and the careful attention that is bei^towed upon the manner of giving\\nthe treatment;\\nThe rubber, remaining upon the left side of the couch, uncovers the left\\nlower limb, and with the right hand delivers a series of rapid frictions from the\\ntoes upward over the dorsum of the foot, external surface of the ]eg, the knee,\\nand front and external surface of the thigh; then with the left hand, the knee\\nbeing semi-flexed and the thigh slightly abducted and rotated outward, the\\nsole of the foot, calf, inner side of the knee and thigh, are also lightly and\\nbriskly rubbed; then, recovering the limb; and exposing the foot and ankle\\nonl}^ the more detailed treatment of the foot is given. Supporting the sole of\\nthe foot in the palm of he left hand, the heel resting in the semi-flexed fingers,\\nfriction over the dorsum of the foot and the front and miter surface of the an-\\nkle is performed in much the same manner as that of the back of the hand,\\nThe masseur thus goes over the body in detail in general treatments.\\nThere is special massage for the limbs, the heart, the lungs, the eyes, the face,\\nthe ear, the head, the bladder, intestines, etc.\\nThe time required for treatment varies from a few moments to three quar-\\nters of an hour or an hour and a quarter.\\nIn addition to the movements described, massage includes voluntary mo-\\ntions by the patient, sometimes aided, sometimes free, sometimes resisted by\\nthe operator. These come after the passive massaging, and are for the effects\\nof exercise or to develop any special part.\\nSwedish Movemeiit is, according to Dr. J, H. Kellogg, a system of medical\\ngymnastics, a physiological mode of treatment of diNcase, As indicated by\\nthis definition, the system consists largely of active gymnastic exercise upon\\nthe part of the patient. Massage, Dr. Kellogg terms a special feature of the\\nSvvedish movement. He states the principle of Swedish movements, that mus-\\ncular movements are a powerful means of affecting physiological processes and\\nthat when gymnastics are used therapeutically, they must be employed with\\nthe same accuracy and precision with which the physician regulates the doses\\nof medicinal agents. Thus we see that the idea of gymnastics is made prom-\\ninent. Incidentally, the movement already described as massage, and other\\npassive movements are used. Such are hacking, clapping, beating, stroking,\\nkneading, fulling, sawing, etc. A great variet}^ of movements are indicated\\nand fully described, certain physiological effects being expected from a given\\ndefinite movement. Compound words are used, and the terms read something\\nas follows: (i) Sitting, chest-lifting; (2) half-lying, foot-rolling; (3) high-\\nride sitting, trunk-rolling; (4) fan sitting, arm-rolling, etc.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0294.jp2"}, "295": {"fulltext": "MASSAGE, SWEDISH MOVEMENT AND MANUAL MASSAGE. 78\\nThe above is taken from a receipt of movemeDts given for congestioil of\\nthe brain.\\nPeter Henrik Ling, the Swede, is credited with being the originator of a\\nsystem of Swedish movements. A work called Ling s System of Manual\\nTreatment gives more prominence to the manipulations of the operator, but\\ndescribes also activ*e movements to be made by the patient.\\nThe idea prevalent among us that massage does not require a knowledge\\nof anatomy is a mistake.\\nThese systems are founded upon a most thorough knowledge of Anatomy,\\nPhysiology and Physical Diagnosis. Yet it is probably true that massage and\\nthe like, as usually administered, are in the hands of persons who have but a\\nsuperficial knowledge of these sciences.\\nThese forms of treatment are given in both acute and chronic conditions\\nwith important results.\\nIn Swedish movements, motions are indicated for laxative effect, for ab-\\ndominal disease, haemorrhoids, frequent menstruation, etc. A long list of re-\\nceipts of combinations of motions is given for such conditions e. g. as Anemia\\nand Chloroses; Scrofula, Diabetes Mellitus, Hysterics, Tremors, Colic, Bright s\\nDisease, Pott s Disease, Prolapsus Uteri, Leucorrhoea, etc.\\nThe effects of manual treatment are interesting. Passive movements act\\nupon venous and lymphatic circulation, and are made in the direction of these\\ncurrents.\\nStroking stimulates the pilo motor nerves, leads to a contraction of the ar-\\nrectores-pili muscles which causes the sebacious follicles to be pressed upon,\\nthus aiding secretion.\\nBy rubbing, rolling and squeezing of the skin, the superficial circulation\\nis stimulated, the capillaries dilated, and the pulse-rate slowed.\\nFirm kneading of the muscle is followed by a slow pulse-beat, and in case\\na large muscular mass is kneaded, a fall of blood pressure in the body is noted.\\nKccles states that it is possible that pain occuring in the deeper organs may\\nbe modified by manipulation over the superficial areas corresponding to the dis-\\ntribution of the cutaneous sensory nerves derived from the same segment of\\nthe spinal cord as that from which the sensory nerves of the disturbed viscus\\nare derived. Thus effects may be gotten upon the heart and lungs by exter-\\nnal work He summarizes the effects of massage as follows:\\n1. Mechanically and directly, elimination of waste products from the tis-\\nsues under manipulation is increased, the absorption of exudations and infiltra-\\ntions is greatly favored, adhesions are attenuated, sometimes broken down,\\nand even organized thickenings may be reduced.\\n2. Nutrition of the part is improved, vascularization is increased, and me-\\ntabolism is augmented.\\n3. Indirectly, massage acts as a derivative, relieving congestion of the in-\\nternal organs by attracting the flow of blood to the surface, and muscular vi-\\nbrations are set up, stimulating the nervous system, acting through it renexly", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0295.jp2"}, "296": {"fulltext": "79 MASSAGE, SVv EDISH MOVEMENT AND MANUAL MASSAGE-\\nthus exciting secretion; while on the other hand, its sedative influence relieves\\npain and reduces over activity\\nKellRTen claims for nerve vibrations:\\n1. Raising of the nervous energy.\\n2. Diininatiju of pain [assesii in facial neuralgia an i migraine.]\\n3. Contraction of the smaller blood-vessels [heaviness of the head is\\nquickly relieved by stiniulation of the sensory nerves of the scalp.]\\n4. Stimulation of the muscles to contraction.\\n5. Increased secretions of the glands.\\n6. Diminished excretion from the skin.\\n7. Decrease of temperature [as in fevers.]\\nThese are given as examples of results claimed for manual treatment.\\nMuch more might be added.\\nOsteopathy is not Massage or Swedish Movements. While there are simi-\\nlarities, there are radical differences:\\n1. These other forms depend largely upon the general gymnastic or man-\\nipulative effect upon the body. Osteopathy does not depend upon general ef-\\nfects from general treatments, but upon specific treatment.\\n2. They emphasize the method of the motion which, to the Osteopath, is se-\\ncondary. A good masseur must be an expert manipulator in the particular\\nsense of having a knack to give certain movements.\\n3. They are much more laborious and require a much longer time per\\ntreatment than does Osteopathy. Sometimes a single motion is sufficient Os-\\nteopathic treatment, or effects a cure.\\n4. Osteopathy requires no gymnastics of the patient as a part of the treat-\\nment.\\n5. They go over the parts of the body in detail, which Osteopathy does\\nnot do except in examination.\\n6. They make no search for any lesion or abnormality about the bodily\\nmechanism, while Osteopathy finds in such lesions, e. g., a misplaced part, the\\nmost scientific cause of disease.\\n7. They do not go to nerve centers and nerve distributions in the way that\\nOsteopathy does. They work upon them in a general way and only because\\nthey are readily reached. They do not seek for and remove lesions therefrom.\\nOn the other hand, Osteopathy goes to the definite nerve centers to influence\\nthe health of the body, and often removes obstructions from such centers, al-\\nlowing normal action. The same is true of blood flow.\\nIn these last two points is seen the most radical difference between the sys-\\ntems. Upon the whole, these manual systems compare with Osteopathy as\\ndoes the shot-gun with the rifle. They produce excellent results by the shot-\\no-nn method of general manipulation, while Osteopathy works with the defi-\\nnite aim of finding the obstruction to health and removing it. It is unavoida-\\nble that, if such a comparatively hit-and-miss method as Massage can secure\\nexcellent results as a curative means, Osteopathy, with its definiteness, must\\ngenerally far exceed massage in results. It also follows that the former must\\ngenerally work more quickly and easily than the latter in such cases as the lat-\\nter could reach, and that it must succeed in a large class of cases beyond the\\npower of these manual systems, since to this class belong so many disease condi-\\ntions depending upon some removable obstruction not noticed by them.", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0296.jp2"}, "297": {"fulltext": "ii riDEx:.\\nA TI.AS 35\\nlocation of 5\\ncause of trouble 15, 99, 104\\ncase of paralysis 16\\ndisease of 26\\nlateral displacement of 36\\nto treat .93\\nin ear trouble iir\\nArm, vaso-motors to. 6\\ndislocation of 183\\nAnus, sphincter 7\\nAbdominai, Brain 7\\nAorta, location 10\\narch, position 119\\nsound is heard 124\\nbifurcation ..143\\nAbscesF, to absorb 52\\nAnemia 82\\nhow produced. 60\\nvenous hum in jug. vein 68\\nmucous membranes 100\\nAnkylosis, prevented 74\\nligamentus 74\\nAsthma, frequent treatment 89\\ncondition found in 121\\ncase rapid heart beat 132\\nAntrum of Highmore, to tap 109\\nAneurism, of aorta 143-153\\nAngina Pectoris, cause clavicle displaced 133\\nArteries, renal 10\\ncommon carotid 75\\nsub clavian 75\\ntemporal 98 105\\nsupra-orbital 98\\noccipital 98\\nposterior auricular 98\\ncoronary 105\\ninnominate 119\\naxillary 122-I84\\ninternal mammary 122\\nperforating location 122\\ngluteal .164\\npndic 164\\nspermatic 177\\novarian 177\\nfemoral 186\\nAbdomen, considerations of 138-140\\nnerve centers, connections. ..140\\ntumor, cause of 140\\nlandmarks 143-151\\nto treat I49-I57\\nregion ^52\\ncontents of ^54\\nexamination ^55\\nauscultation i57\\nmeasurements of 158\\nAbortion, stimulation of nipples 182\\nApoplexy, treatment of 200\\nAuscultation, of chest 126\\nof heart ^34\\nB\\nBronchi 4\\nirritation of ^45\\nBronchitis, caused by clavicle, i, 2, 3 ribs 135\\nBreaks, 12th dorsal 5\\n5th lumbar 5\\nBacterial fever, treatment for 203\\nBladder, center for neck 7\\nmotor fibres to ^42\\nsphincter ^42\\nperitoneum ^44\\nposition 144- 154\\nposition in over distension 154\\nsphincter, to relax and contract 175\\ntreatment 176\\nto raise ^76\\nBrain, cervical 7\\nabdominal 7-26\\npelvic 7\\nto affect S\\nblood supply affected 16\\nBack, to examine 27\\nBowels, peristalsis 8\\nto move quickly 20\\nBlood vessels, nerves to 9\\nto affect.\\n\u00e2\u0096\u00a039\\nby removing lesions .51\\nunder nerve control 58\\nBlood supply, affectiug nerve life 60\\nBright s disease, consideration of 19S\\ntreatment of 19S\\nBarber s itch, treatment 201", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0297.jp2"}, "298": {"fulltext": "85\\nINDEX.\\nc\\nCervical Nerves, upper, lesion of i8 19\\norigin 3\\nCorrespondence of vertebra and scapula. .4\\nvertebra and ribs 4\\nCenters, sympathetic 6\\ndescription of 6\\nimportant 9\\nfor superficial fasciae 9\\ntheory of work on 37-38 43 5o 53\\n56-6370-78\\ntheory by Lawrence Hart 56\\nanemia of 60\\nhyperemia of 60\\nface and head 107\\nof abdomen 140\\nperitoneal to kidney 148\\nfor lungs 6- 1 16\\ncilliary 6\\nfor stomach 6\\nfor pyloric orifice 6\\nfor chills 6\\nfor liver 6\\nfor parturition 7\\nfor micturition 7\\nfor dif ecation 7\\nfor hypogastric plexus 7\\nfor neck of bladder 7\\nto relaxvagina 7\\nof sensation 7\\nof motion, 7\\nof nutrition 7\\nfor cough 7\\nfor sneeze 7\\nfor vomit\\nfor respiration 7\\nfor salivation 7\\nfor phonation 7\\nfor deglutition 7\\nrenal 7\\nspasm 7\\nvase motor 7\\ncillio spinal 7\\nto dilate iris and contract pupil 7\\nheart 7\\nComplexion 99\\nCoeliac, axis 7\\nCervical, brain 7\\nCough, center. 7\\ntreatment for 19^\\nChest, barrel shape 121\\nrachitic 121\\ndivisions of 1 24\\nmovement of 125\\nexamination of 125\\nflattening of 127\\nrole the shape 132\\nCenter, for cervix uteri .7\\nblood supply to ovaries 7\\nfor bowel 166\\nColon transverse, position 144\\nfoccal reservoir 16S\\nflexures displaced 156\\nCenter, v? so-motor to lungs 8\\nvaso-motor to jejunum 8\\nvaso-motor to small intestine 8\\nvaso-motor to large intestine 8\\nvasomotor to liver 8\\nvaso-motor to kidneys 8\\nvaso-motor to spleen 8\\nvaso-motor to lower limbs 8\\nvaso-motor to valves of heart 8\\nyaso-motor to bowels 8\\nvaso-motor to larynx 8\\nCoccyx, cause of piles 11\\ncause of trouble 15\\ndislocation of 54\\nto set .54\\ncause of diarrhoea 167\\nConstipation, cause 14 154\\ntreatment by mind case 98\\nCurvature, cause of trouble 16\\nto set 37.54\\npost (Potts) 73\\nCervical, disease, Hilton 19-20\\nCrutch paralysis 19\\nCramp, writers.. 19\\npianists 19\\nviolinists 19\\nCold feet, 42-203\\nCold liver 121\\nChemicals, abnormal effiect 40\\nContractures, effect of 58 64\\nhow to recognize 65\\ncauses of 65 66\\nrelation to nutrition 66\\nChlorea,caseof 67\\nlesion found 67\\ncauses 67\\nCartilege, thyroid 68\\ncricoid 68\\ncostal displaced 128", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0298.jp2"}, "299": {"fulltext": "INDKX.\\n86\\nClavicle, to treat 83\\nto set 129\\ncaase of bronchitis 135\\nexamine 121\\nCatarrh, tenderness at jaw angles 69\\nto treat jaw 83\\ntreatment of 1 95 197\\nCongestion, to relieve 118\\nCoracoid process, fibers of deltoid below. 121\\nCongestion, of lungs 135\\nCramp, in intestine, how to treat 166\\nin feet 186\\nChill, treat lungs and heart 192\\nChills and fever, treat 192\\nCholera, treatment of 198\\nColic, treatment of 201\\nConvulsion, cause of 201\\nD\\nDisease, 3\\nof spine origin 16-21\\ncervical 19 20\\nDiagnosis, 3\\ndiagnosis by telephone 3\\ncorrect 20\\nosteopathic -24\\nDorsal nerves, origin of 3\\n6 and 7th cause of trouble. 21-25\\nDiseBse, Potts 73\\nGroves io5\\nDeglutition, center for 7\\nDr. Still, centers spoken of 7\\nsuperficial fasciae 9\\nengine wipers 93\\ntreatment of claricle 129\\non ligaments 172\\nDiaphragm, central tendon of 10\\ntrouble, cause 24\\nphrenic distribution on 96\\nstoppage of aorta 132\\nDiarrhoea 14\\ncause 14-167\\nto treat 87-166\\nin infants 199\\ncase cured 167\\nDyspepsia, cause of. 50\\nDislocation, hip case 2o-5o\\nhip, indications by toes 187\\nhip, obturator. 188\\nhip, dorsal 18S\\nof vertebra to reduce 36\\narm 183\\nelbow 184\\nelbow, reduction of 1S4\\nDislocation, ankle 187\\nknee 187\\nDesensilization, 28\\nosteopathic definition 32\\nDrugs, abnormal effects 40\\nDegeneration, Wallerian 8r\\nDuct, Wharton 109\\nDeafness, cause of no\\ncase cured 1 10 1 1 2\\nDiphtheria, treatment of 193-194\\nlesion in I94\\nDuodenum, location of 10\\nE\\nErysipelas 3\\nEar 3\\nto affect 8\\nnerve supply 18\\nache, cause 19\\ntrouble caused by atlas 99\\nto examine no\\nexternal no\\nmiddle m\\nappearance if inflamed m\\nto test Ill\\nto treat m\\nhow to remove m\\ninsects to remove m\\nblood supply to treat m\\ncause of trouble cured 112\\nto treat 112\\nErector Spinae. 4\\nEye, to affect S\\nan indicator of disease 100\\nto examine 100-105\\nosteopathic points loi\\nblood shot, to treat loi\\nvaso motors 102\\nto treat 102-106\\nbrilliance 105\\ndull I05\\nlids granulated 106\\nlids granulated 106\\nlandmarks concerning loS\\npuncta lacrymalia loS\\nEsophagus, perforates diaphragm 10\\nsuperior opening of bS\\nposition in thorax 119\\nElectricity, abnormal effects 40\\nEpilepsy, cause of 4-\\nEpistraxis, how cured 53 ^8\\ntreatment for 1S9", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0299.jp2"}, "300": {"fulltext": "87\\nINDEX.\\nExpression 99\\nEmphysema, condition of chest 121\\nExamination, how to proceed with 190\\nEyelids, granulations of 194\\ncause of 194\\nEczema, treatment of 201\\nF\\nFace 3 99\\na disease indicator 99\\nFacia, superficial circulation to 8\\ncenter for 9\\nFever, importance of sympathetic 9\\ntreatment for 135-191\\ntreat vagus 192\\nby poisons, treatment ..203\\nFlux, treatment for 197\\ncase cured 197\\nFomenations 39\\nFonticulas Gutheris 91\\nto reach phrenic 91\\nFontanell, anterior 98\\nsignificance 98\\nFallopian tube, crowded by obesity ijl\\nFeet, to treat 186\\ncold 42\\ncramp, to treat 186\\nFainting, treatment for 189\\nfrom overheating 193\\nG\\nGanglion, superior cervical 6-8 77-92\\nmiddle cervical 6 77-92\\n1-2-3 4 connection 7\\nsuperior cervical connection 24 25\\ninferior cervical 77 92\\nfirst thoracic 77\\nMeckel s, to treat; 83\\ncervical sympathetic 92\\ncilliary 102\\nconnection with splanchnic. .115\\nGasserian 103\\nsemi-lunar 115\\nstellate 132\\ninferior mesenteric, to reach, 168\\nGastritis, soreness found 22\\nGiddiness, cause of 30\\nGenital, trouble 35-162\\nstimulation, effect eye 105\\nexternal, nerves 161\\ninternal, nerves 162\\ninitation, reflex (case by Hilton)i63\\ninternal, center for 177\\nGlosso-pharangeal, exit from skull 69\\nfibers to parotid 108\\nGoitre, exophthalmus 80\\nto treat 84 180\\nGlands, lymphatic 69-84-139\\nmembrane 100106\\nsubmaxillary 107\\nparotid 108\\nprostate, secretory fibers 142\\nthyroid, enlarged in goitre 191\\nparotid enlarged, to treat 191\\nsubmaxillar}^ enlarged, to treat. .191\\nsublingual, enlarged, to treat. .191\\nmeibomian, cause granulated lid 194\\nGall stones, treat spleen 149\\nto remove 153\\nformation 161\\nGall bladder, location of 152\\nwork upon 160\\nGall duct, location of 160\\ncatarrh of 161\\nGrip, to treat 189\\nGranulated eyelids, treatment of 194\\ncause of 194\\nH\\nHeart, neuralgia of, treatment for 199\\naction of, to slow 202\\nflutter 6\\ncenters 7 130\\nrhythm of 8\\nupper level of 10\\ntrouble, cause 15\\ntrouble caused by ribs 77\\nto treat nerves 90-146\\nenlarged by cigarettes 120\\noutline on chest wall 122\\nvalves, location of i23\\nnerve connection i3o\\ndisplaced ribs, effect i30\\nexamination of i32\\nirregular beat i33-i96\\nHeart, percussion of 134\\nauscultation of 134\\ntreatment of 145-146\\nirregularity from stomach 147\\nHeadache 55\\nuterine, cause 26\\ntreat 87 93\\nfrom prolapsus i ii7\\nHolden 4\\nHead, vaso-motors 7\\nvaso-constrictors 8\\ncold in, how to treat 118", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0300.jp2"}, "301": {"fulltext": "INDEX.\\n88\\nHead 98\\ntumors of 98\\nHip, dislocation of, case 20-5i\\ndislocations of 187\\nHyperaesthesia, cause of 2I\\nto treat for 61\\nHart s theory 57\\ncriticised 57 58\\nHyperemia, of cord 58\\nhow produced 60\\ncaused by nerves 74\\nHyoid, bone 68\\nmuscles causing 68\\nHiccough, to treat for .70-75-88\\nHydrocephalus 98-99\\nHay Fever, cause of 135-199\\ntreatment of 199\\nHysteria 171\\nHemorrhoids, cause of 151\\nHernia, inguinal 164\\nfemoral 164\\nHip joint, disease, to examine for 164\\nHemorrhage, postpartum, treatment for 182\\nI\\nIntercostal spaces 4 131\\nlUium, crest of 4 10\\nIris, centers for 7\\nreflex to obtain 100\\nsphincter 102-103\\ndilator fibers, origin 103 104\\nconstrictor center 104\\nIntestine, troubles, cause ,15\\ncontracted 63\\nvaso motor 148\\nganglia 150\\nlarge, location of 167\\nsmall, location of 154\\nstimulation of sympathetic. .165\\nstimulation of pneumogastric.165\\ncramps in 166\\nbiliary action 166\\nparasites of 2o8\\nInjuries, cause of trouble 17\\nInflammation 71-72\\nto treat 39\\nInhibition 38-43\\neffect 85 87 88\\nInspection of chest 126\\nof abdomen 155\\nInnominates, displacement of 171-172\\ntreatment of displace-\\nments 172-173\\nInfluenza, to treat 189\\nInsomnie, how to treat 2o2\\nInhibition .31-4.3\\nJ\\nJugular vein 68\\njugular foramen 69\\nJaw, muscles to stretch 83\\ndislocation causing loo-lo4\\nin eye trouble 104\\nspasm to feed 109\\nK\\nKidneys, 1-3 4 5\\nreached. 4\\npelvis of 10\\nlocation of 11-153\\ntrouble, cause 15 169\\nvaso-motor 148-169\\nperitoneal center 148 169\\nindications of disease 169\\ntreatment of the kidneys 169\\nBright s disease of 198\\nexcessive action of 198\\nL\\nLiver, 3 10\\nlocation of 152\\nenlarged 152\\nenormous weight 152\\ncirrhosis, caput medusae ...156\\ncon.sideration of 159\\ntender in diarrhea 160\\nnerve supply 160\\nblood supply 160\\nperitoneal center 160\\ncenter for 6\\ncirrhosis, cause 71\\ntreatment of 120- loo\\npain under scapula 131\\nposition Ml\\nvaso-motor supply US\\nLumbar nerves, origin of 4\\nLandmarks along spine 4 1o\\nscapular 27\\nconcerning neck 68 75\\nconcerning head 98 lo5\\nconcerning eye loS\\nconcerning thorax 1 19-122\\nconcerning abdomen 143\\npelvis 163\\nLigamentum nuchae 4-5-48\\nin headache 48\\nto treat 4S", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0301.jp2"}, "302": {"fulltext": "89\\nINDEX.\\nLesion?, caused bj ligiments 5-8\\ncaused by vertebra. 8\\ncaused by sprain 8\\ncaused by draft 8\\noften found 15\\na ^ects what 17-18\\nupper cervical 18-19\\nof rib causing 24\\nremove result 5o\\nin brain cause contracture 65\\nas a contracture 06\\nas bad blood 72\\nsignificant in neck 77\\nby pressure 80 81\\nremove gradually 89\\nat fith lumbar, cause of genital\\ntrouble 162\\nat 2nd lumbar, cause of genital\\ntrouble 162\\nLung, center to 6-34-110130\\nvaso-motors to 7 8\\nlower lobe location lo\\npart most liable to disease H\\ntrouble cause 1 24-77\\ncase treated 34 35\\napex position 75\\noutline on chest 123\\nnerve connections 13o\\nvessels dilated 132\\nvessels constricted 132\\npercussion of 134\\ncongestion to treat 1 35\\ngasses formd 135\\ntreatment 145\\nLarynx, vaso motors to 8\\npercussion over 135\\nLigament, thickening, cause 13\\ncondition in slipped vertebra. 36\\nstretching 49\\ncontracted broad, of uterus. 181\\nround, of uterus 181\\nY shaped of hip 187\\nLaryngotomy 68\\nL5 mpathetic glands, enlarged 09\\nto treet 84\\nconsideration of 138\\nnerves of 139\\nLips, indicate lo9\\nLinae, masalis indicative erf disease llo\\nlabialis of disease llo\\nalba 143\\nsemilunaris 143\\ntransversae 143\\nLymphatic duct, stoppage of 139\\nLymph, flow influenced 139\\nLeucorrhea, I80\\nLegs, treat 1 85\\nLa grippe, to treat 189\\nLumbago, treatment for 2oo\\nLocomotor Ataxia, to treat 2o2\\nM\\nMedian furrow 4\\nMedian line 68\\nMotion, center 7\\nloss of 42\\nMuscles, spinal congested 8-13\\nprimary 8 66\\nsecondary 8 66\\ntension in 13\\nTrapezius outlined 27\\nto treat 28-35 36\\nDeltoid pain 3o\\ncontracted, result 31-34-57\\nabout coccyx to relax 54\\non right contracted 58\\non left contracted -8\\nscapular, to stretch 62\\nScaleni, to stretch 62\\npsoas, how to reach 62\\ncaution 62\\ntonus 64-67\\nwelt 65\\nflabby 67\\nof throat ..69 83\\nhyoid cause of trouble 69\\nStern o- mastoid 75 92\\nomohyoid 75\\nquadratus lumborum to stretch. 75\\nscaleni significance 76\\nscaleni to stretch 93\\npyriformis in sciatica 87 93\\npectoralis major 119\\nserratus magnus 119\\nerector spinac II9\\npsoas magnus 120\\ndeltoid 121\\nquadratus lumborum 75-137-174\\ncoccygens 164 181\\ngluttei 164\\ndeltoid fibers caught 185\\nbiceps contracted 185\\nquadriceps extensor, to stretch. 185\\nof thigh, to relax 186\\nMeasles, with whooping congh 139\\ntreatment of 2o2\\nMammae, treatment of 144", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0302.jp2"}, "303": {"fulltext": "INDEX.\\n90\\nMicturition, frequent, in prolapsus 178\\nMilk leg, cause 189\\nMenstruation, profuse, treatment for. 182\\nMeningetis, treatment of 2oo\\ncau5e of 2oo\\nMouth, nurses sore mouth 189\\nfore mouth in mother 189\\nsore mouth, treatment for 189\\nN\\nNeurasthenia 47\\ncause 74\\nNeck, to manipulate 6 82-91-92\\nto examine 68-75 76\\nto reach other organs 68\\ncare in stretching 199\\nNutrition, center 7\\nNeuralgia, intercostal, cause 24\\nlumbar 25\\n5th group of nerves. 25\\ncase of 5th nerve 89\\nof heart 199\\ntreatment 2ol\\nNose bleed, how stopped 53\\nNerves, phrenic origin of 6\\nvaso motor 6\\nsplanchnics 6-7\\nupper aurical, 1st group 18\\nlower aurical, 2d group 24\\ncervical connection 24\\n12 dorsal Sd group 24\\n5 lumbar 4th group 24\\nlumbar diseases 25\\no sacral 5th group, dieases of 25\\ndorsal 6 and 7, cause of trouble 21-25\\nall reached by O 43\\nacceleration fibers 131\\nNerve, force misdirected 13-14\\ncenters .7 8-9\\nroots, emergence of 21\\n5lh, how reached 22-99\\nimpulses reorganized 26\\nforce inhibited 34-41\\nforce stimulated 34-41\\nforce effected 38-39 44-52 54-60\\nsection result 43-44\\naction effected in three ways 54\\ntrophic connection 68\\n9th exit 69\\n10th exit 69\\n11th exit 69\\nNerve, phrenic 69 94-95 135\\nsub-occipital 77-91\\nulnar effected by rib 79\\nNerves, pressure upon 79-80 81-82\\nsheath in degeneration 81\\nof heart to treat 9o\\nterminals to reach 99\\nthird 102\\nfifth 103\\nof wrisberg 103\\noptic to shock 105\\nfacial exit\\nauditory, to inhibit 112\\nviscero dilators 116\\nconstrictors 116\\npulmonary vaso-constrictors 13\\nsciatic, stimulation of 132\\npueumogastric 135\\nconnections 14I\\nsacral distribution I42\\nsup-laryngeal irritated I45\\nsciatic to reach 164\\npudic to locate I64\\nto infringe upon 174\\nanterior crural 186\\nsciatic to stretch I87\\nNose, to examine 112\\nfractures 112\\ngrowths in 112\\ndeflection of 112\\nto clear out 112\\nto treat 112\\nbleed, to check 1S9\\nNervous prostration, treatment of 194\\nNipple, location of 119\\nstimulation of, in abortion 182\\nNausea, between 4th and 5th ribs 159\\nNurse s sore mouth ]89\\nOvary, blood supply to 7\\nlocation 176\\ntreatment 170\\ncenter for blood supply 177\\nseat of tumor 178\\nObesity, treatment for 139\\ncrowding ovary 177\\nOsteopathic reasoning. .18 14- 15-10 17 21 ol\\nin paralysis 22\\nin gastritis 23\\nhow we get results 31\\nphysiological 31-32\\ndiagnosis 24-50\\nadaptability 51\\nwork through N. terminals 67\\npoints on the eye 101\\nOcciput 99\\nPhrenic nerve 75", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0303.jp2"}, "304": {"fulltext": "91\\nINDEX.\\nPhrenic nerve 75\\norigin 6\\ntrouble in T 19\\npressure causes 32\\nto treat 91-94\\nconnections 94\\nPyloric orifice, v,enter for 6\\nPneumogastric nerve, treat in fever 192\\nLeft ....6\\nconnection with 5th nerve 86\\nsympathy in dist. of 5th and 10th. .53\\nexit from skull 69\\nto treat 69\\nlocation 76\\ntreatment of 86\\nStimulation of 1 32\\nPlexus, anterior pulmonary 7\\nposterior 7\\nhypogastric 7-8-162\\nto intestinal canal 8\\nto bladder 8\\nto vas def erentia 8\\ngreat prevertebral 90\\nprimary 9\\nsecondary 9\\nimportance of 9\\nbrochial. 24-77\\ncervical 77\\nMerisners 80-147\\nrenal 115\\nsolar, in headache 117\\nsolar 50\\nsolar, pressure condenses gas 159\\nsolar connection of 14^\\nsacral 8\\nBillroth s 147\\nAuerbach s, location of 149\\nmeissner, locati on of 149\\nhepatic 150\\nPelvic, brain. 7\\ntrouble, cause 35\\naortic 130\\ncardiac 130\\nviscera 35\\nviscera, how to treat 178\\nPhonation, center 7\\nPelvis, consolidations 143\\nhow to treat 171\\npylorus 10\\nParalysis, crutch 19 135\\ncaused by grippe. _, 178\\ncause 22\\nPleura, trouble cause 24\\nPharynx, protrusion in dislocation 47\\nPancreas, location of 10-153\\nPott s disease 73\\nPhysiognomy 109\\nProlapsus 117\\nProstate gland,] secretory fibers 142\\nenlarged 175-183\\nto reduce 183-183\\nPain, cause in face and head 19\\ndiagnosis by 21-25\\ntreat to cause 86\\nin knee, in hip trouble 97\\nin heart trouble 131\\nunder scapula 131\\nin stomach on pressure 157\\nin lumbar region 173\\nin the hip 173\\nin the leg 173\\nin the sacral region 173\\nParturation, hip dislocation in 189\\nPeritonitis, cause 81\\ncondition of 162\\nPalpation of chest 125\\nPercussion of chest 126\\nof heart 133\\nPneumonia, treatment of 195\\nParasite, intestinal, to treat 203\\nPulse, always note 133\\nPregnancy, simulated by gas 179\\nPneumogastric, cause of asthma 135\\nPiles, cause of 151\\nPerineum, boundary. 164\\nshape of 164\\nto cause contraction of 164\\nQ\\nQuotations, Emerson 3\\nHuxley 3\\nHolden 8-27-67-75\\nOuain 9 72-73 77-101-103-118 131\\nHilton 17-21-25\\nHalliburton i6\\nHilton, ear nerves to 18 79 96 97\\ncervical disease 19\\nHildreth, treatment and diagnosis 21-51\\ncontractions of spinal m 58 59\\nByron Robinson 78-81-105-115\\nAbdominal brain 26 80\\nsympathies 60\\nDr. Eastman 27\\nDr. Lombard 38\\nphysiology 33\\nDr. W. T. Porter, M. D., physiology 33\\nDana, applied eh. ctricity 33", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0304.jp2"}, "305": {"fulltext": "INDEX,\\n92\\nDr. Eckley, sciatica 33\\nDr. McConnell 38\\ncorrect lesion* 52\\nDr. Harry 38\\nDr. C. M. T. Hulett 38 52\\nHowell s Text-Book 40-44-61-64-G5-118\\nrenal constriction 39\\nnerve irritability. 40\\nKirk Physiology 45\\nvaso-motors leave cord 59\\nmuscle tonus 64\\nGreen s Patholoojy 39-44 71 72 80\\nDr Jacobson 96\\nreflex sensation 53\\ncase of child, bean in its ear 53\\nLawrence Hart, theory 56\\ncriticised 57-58\\nGower s nervous system 59-64 65 66\\nflabby muscle 67\\nDr. Allen 63\\ncontracture definition 64\\nBillroth, cause of contracture 66\\nGaskell by Quain 115\\nFlint on splanchnics 115\\nR\\nRib, last 4\\n1st may cause 6\\nlesions in causing 24\\n1st and 2d preparatory to setting. .62\\n1st and 2d may cause 76-77\\ndisplacement of 1st and 2d 128\\n1st and 2d to set 1 36-137\\nrules to count 119\\nlocation of 1 19\\nsternal ends of 120\\ndispaced to examine for 127\\ntenderness along 127\\ntwisted 127\\ncartilage displaced from 128\\n3d and 6th displaced 130\\nto raise 136\\nRenal, center 7\\nartery 10\\ntrouble, cau.se 15\\nsplanchnic to treat 120\\ncolic, treatment of 170\\nRespiration center 7\\nRetina, affected by sup. cei v. ganglion. .8\\nvaso motors 104\\nRami, communicantes 9 10 1 i5\\norigin t)\\ndistribution H\u00c2\u00bb\\nnerves to genital orgar.s 161\\nReceptaculum chyli, location of 10\\ncontrolled by splanchnics 139\\nRheumatism, to absorb deposits 52\\narticular, to treat I84\\ntreatment of 196\\nmuscular, to treat 196\\nReflex action 53\\nknee, to get 59\\nRegions, supra clavicular 124\\nclavicular. 124\\ninfra clavicular 124\\nmammary 1 24\\nsternal 124\\nsupra sternal 124\\ninferior sternal 124\\nsuperior sternal 124\\nsupra scapular 124\\nscapular 124\\ninfra scapular 124\\ninter scapular 124\\nepigastric 152\\numbilical 152\\nhypoga trie 152\\nof back 173\\nlumbar 1 73\\nsacral 175\\nRectum, nerves supply 142\\nexamination 182 183\\nprolapsed 1 83\\ns\\nSore spots 3-5 22 28-34 35-59-77-178\\nto what due 23\\nsuccess 3\\nbasis of 6\\nSpine, to treat 27 28-34 41 45 04-61\\ngeneral consideration tf 8\\nlandmarks 4 10\\nSpinal nerves, origin 3\\nSuiface.of body, follows upon 4\\nScapular spine 4\\ninf. angl 4\\nScapula, l( caiion 27\\nSpace, iutercostal 4\\nilliocostal 4\\nsub-clavicular 1 22\\n2iid intercostal 122\\naxillary 1-4\\ninfra Hxillary 1 24\\npopliteal ISti\\n8d left intercostal to protluce voni .201\\nSympathetic, centers 6\\nt\u00c2\u00abup cervical ganglion ()-24 2,\\nswslem 5", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0305.jp2"}, "306": {"fulltext": "93\\nINDEX,\\nSympathetic, connection to C. S 9-22\\ndistribution centrally 9\\nperipherally 9\\nsecretory fibers 9\\npilo-motor fibers 9\\nsignificance of 9\\nto affect distribution of 28\\nstimulation in neck 132\\nSpine, illustrations upon. 5\\nexamination of 5-8 11-12-27\\nsmooth 5,14-45-48\\ncause of 45-46\\ncondition on examination 8\\nnoises along 12-16-18-27-36-37-61\\ncurves, abnormal 15-16-54\\nresults 15\\nto sit 37-54\\ndisease of, origin 16\\nto diagnose by pain. 21\\nStomach, center 6\\ncardiac orifice opposite 10-153\\ninterference with center 13\\ntrouble, cause 15-35\\ncausing welts 66\\nexercises in 97\\nlocation 144\\nnerve supply 147\\nchanges position 152\\npain on pressure 157\\nto free of its contents 159\\nsick, reflex 159\\nSplanchnic nerves, great 6-114 130\\nsmall 7 115-120\\nsmallest 7-115\\nequalize circulation 61-117\\nmuch treated 114\\npelvic 115\\nconnections 115\\nconnections with medulla 116\\nto affect viscera 117\\nrenal to treat 120\\nSphincter, ani center for 7\\ncontraction, cause 14\\nrelaxation of 14\\nrectal dilatation...: 132\\nof bladder 142\\nof blodder, to relax and\\ncontract 175\\nSpasm, center for 7\\n5th group of nerves 25\\nSalivation, center. 7\\nSneeze 7\\nSe n Si- 1 ion, center 7\\nloss of 42\\nSalivary gland, to affect 8\\nsup. cervical ganglion, connections. .8\\nSciatica 8 15-40\\nvaso-motor 32\\ncause 87-141\\ntreatment for 187\\nSynchondrosis, sacro illiac 164\\nSweat glands, nerves to 9\\nSpines, parts opposite 10\\nseparated, cause of 14\\nresult 14\\ntwisted, 14\\nseparated, to treat 41\\napproximated to treat 45\\nposterior to treat 47\\nSpleen, upper margin of 10\\nvaso-motors of 148\\ncongested. 149\\nlocation -.153\\nenlarged 157\\ntreat for gall stones 161\\ntreatment of 168 200\\nSupra renal capsules 10\\nStimulation 38 41-43\\neffect 85-87\\nSpinal cord, termination of 10\\nScleiosis of 71\\nScar tissue 71-72\\ncause of trouble 71\\nSacrum, abnormal 11\\nant. or post 55\\nto set 55\\nSpinal, accessory nerve 68\\nSinus, frontal G9\\nSternum 119\\n2nd rib with 119\\nend of 120\\nShoulder, dislocation i 184\\ndeltoid fibers caught 185\\nSaphenous, opening 188\\nvein to treat 189\\nStrabismus, treatment of. 194\\nSprain, treatment ot 197\\nSeasickness, to treat 202\\nT\\nTheory 3\\nosteopathic 31\\nto effect internal viscera 31\\nwork on centers 43-50 53-56 63-7o 78\\nof stretching ligaments 49\\nHart s 56\\nof fever 192", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0306.jp2"}, "307": {"fulltext": "INDEX.\\n94\\nTrapez,.!.-. muscle\\noutlined 7\\nTongue, to affect 8\\nvaso dilator 1^^\\nvaso constrictor 107\\nto examine 109\\ndepressor 109\\nfurred on one side 113\\nTrachea, bifurcatonof 10-119\\nTreat, of spine. .27-28-34,41 45-46-47 54-61\\nof centers 27\\nof neck 46-82-9192\\ntime taken 35\\nof inflammation 39\\nbetween shoulders 46\\nstraddle 61\\ntoo frequent 89\\nof eye ...102-106\\nof ear 112\\nof nose 112\\nof throat 113\\nof cartilages 137\\nto raise ribs 137\\nToothache, to treat 203\\nThyroid, cartilage 68\\nthyroid gland 68-69-191\\nThroat 69\\nto treat 82-113\\nto examine lo9\\nTonsil 69\\nlocation lo9\\nsize 109\\nTemperature, changes on surface 79\\nof neck 77\\nTumor 80\\nabdominal 140\\nTympanum, appearance 110\\nappearance if inflamed Ill\\nThorax, landmarks of 119\\nsup. operature of 119\\nto examine 119-123-124\\ntreatment of 120\\nsuccussion of, 144\\nTuberculosis, signs of 125\\nThoracic duct, obstruction of 139\\nTyphoid fever, treatment of bowels 151\\nTriangle, scarpa 186\\nu\\nUterus, flexion 178\\ndisplaced, cause of headache 178\\nexamination per vaginum 179\\nligaments 179\\nmethods of replacing 180\\nUterus, blood supply 181\\nround ligament 181\\nbroad ligament 181\\nprolapsus of child 181\\ntreatment in child 180\\nexamine per rectum 182\\ncenter for cervix 7\\ncenter. 7\\nnerves to 7\\nprolapsed causing 117\\ncongested relieved 118\\nmotor fibers 140\\ncenter for blood supply 162\\nprolapse 176 178-180\\nto raise 176\\nversion 178\\nUterine tumor, causing 26 50\\ntrouble, cause and causing .27\\ndisplacem t, sympathetic troubles 178\\nsouffle in pregnancy 178\\ncervix 179\\nUmbilicus, location of 10 143\\nUrula .113\\nUrine, retention of 176\\nincreased, by reading, in hysteria.\\nUrethra, twist in 182\\nstricture of 183\\nV\\nVertebra, to line up 4\\ndorsal spines 4\\npeculiar 5\\ncaution 15\\n11 and 12 dorsal to set 41\\n1st and 3d cause eye trouble 104\\n4th and 5th dorsal, eye trouble. i05\\nVaio-motor nerve s 6\\nto arm. 6\\nto lungs 7-S\\njejunum 8\\nto small intestine S\\nto large 8\\nintestine M^\\nfor bowels. 8\\nto sciatic 31\\ncenter 7\\ncirculation 8\\neffect by cold o9\\nfor liver 8\\nfor kidnej s 8-14S\\nfor splf en 8\\nfor lower limbs 8\\nfor vulves of heart 8\\nfor larynx 8\\nof rabbit s ear V44", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0307.jp2"}, "308": {"fulltext": "95\\nliNDKX.\\nVagina, centei lO relax 7\\nexamine by rectum 182\\nVomit, center 7\\nto cause 200\\ntreatment 200-201\\nVaso, constrictor for head 8-90-91\\ndilators, origin 10-59-90 91\\nconstrictors 10-59-60\\nVein, ext. jugular corresponds 68\\npulsation 68\\nlocation 75\\nfacial location 105\\nVein, innominate 75 II9\\nabdominal dilated 117\\nsaphenous, treat after parturition 189\\nobstruction of, in goitre. 192\\nvaricose, treatment of 199\\nw\\nWater, hot 39\\ncold 39\\nWallerian degeneration 81\\nWorms, to destroy. 168\\ntreatment for 202\\nWhooping cough, measles with 139\\nThe following index with reference to the particular vertebrae and ribs is\\nadded to assist not only in diagnosis but in the treatment of any abnormal\\nconditions found. For example Should one have a case with a lesion of the\\n4th dorsal, by consulting the index under that vertebra he would at once be\\nreferred to all that has been said in the text as to effects of such a lesion. The\\nsame can be said of any one of the vertebrae. In other words, should he not\\nfind what he wanted in the regular index this special index would be useful.\\n1st Cervical. cervical brain 7\\nAtlas 5 7 rhythm of heart 8\\ncervical brain 7 5th Cervical.\\nsensation 7\\nlarynx. 8\\narticulation of 26\\neffect the ear 99\\neye 99\\ndislocation of 104\\near troubles iii\\neffect the kidney 169\\nphrenic, origin 6\\ncervical brain 7\\ncilio spinal center 7\\nankylosis. 17\\nlevel of cricoid cartilage and oesopagus ...-68\\n6th Cervical.\\norigin of nerves 3\\nprominence of 4\\n2d Cervical. .^j,\\nsup. cervieal ganglion 6 ganglion 6\\ncervical brain 7 7\\ncenter for uterus 7 ^^^osis 17\\nlarvnx 8 level of cricoid caitilage and esophagus.. ..68\\narticulation of 26\\nSd Cervical.\\nmiddle of neck 6\\nsup. cervical ganglion 6\\nphrenic, origin 6\\ncervical brain 7\\nrhjrthm of heart 8\\nlarynx _ 8\\ndislocation of 104\\ninhibit auditory nerye it2\\nin hay fever 185\\n^-oh Cervical.\\nphrenic, origin 6\\n7th Cervical-\\nprominence 4\\nmiddle cervical ganglion 6\\nant. branches to pulmonary 7\\ncervical brain 7\\napex of lung 10\\npecuiar vertebra 13\\nankylosis 17\\ntransverse process 75\\n1st Dorsal.\\ncenter to lungs. 6\\nant. branches to pulmonary 7\\ncervical brain 7", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0308.jp2"}, "309": {"fulltext": "INDKX.\\n9b\\nabdominal brain 7\\nheart center 7\\njejunum 8\\nimportance of. l5\\nhaemiplegia i6\\nlateral dislocation, to set 203\\n2d Dorsal.\\ncenter to lungs 6 8-116\\nciliary center 6\\nant. pulmonary branches 7\\ncervical brain 7\\nabdominal brain 7\\nvaso-motor center 7\\ncilio spinal center 7\\nheart center 7\\nlower limbs 8\\ncirculation to superficial fascia 8-9\\nvalves of heart 8\\nrenal trouble 15\\nsciatica 15\\nlesion 34\\nsup. cervical ganglion 77\\nupper aperature of thorax 119\\nlateral displacements to set 203\\n3d Dorsal.\\ncorresponds 4\\nciliary center 6\\nant. branches to pulmonary 7\\ncervical brain 7\\nabdominal brain 7\\nheart center 7\\naorta 10\\nlung 10\\ntrachae 10\\nsup. cervical ganglion, location of 77\\nsound of aorta is heard 1 24\\nJfth Dorsal.\\norigin of nerves 3\\ncenter for stomach 6\\npyloric orifice 6\\nant branches to pulmonary 7\\ncervical brain 7\\nabdomiual brain 7\\nsensation 7\\nmotion 7\\ncilio spinal center 7\\nheart center 7\\nvalves of heart 8\\naorta 10\\nheart 10\\ntrachea bifurcation 11\\nnutrition center 139\\n5th Dorsal.\\ncenter for stomach 6\\npyloric orifice 6\\nvaso-motors to arm 6\\nsplanchnics 6\\nant. branches to pulmonary 7\\nabdominal brain 7\\nheart center 7\\nvaso- constrictors 8\\njejunum 8\\ncirculation of superficial fascia 9\\nin hay fever 185\\n6th Dorsal.\\nvaso-motors to arm 6\\nsplanchnics 6\\nant. branches to pulmonary 7\\nabdominal brain 7\\nnutrition 7\\nvaso-motor centers 7\\nvaso constrictor 8\\nkidneys 8\\nlesion 13\\ncorresponds 120\\n7th Dorsal.\\ncorresponds 4\\nsplanchnics 6\\nant. branches to pulmonary 7\\nabdominal brain 7\\ncenter for lungs 8-1 16\\nlesion 13-34\\nlocation of mid cerv, ganglion 77\\ninf. 77\\nfinding space 124\\n8th Dorsal.\\nsplanchnics 6\\ncenter for chills 6\\nliver 6\\nant. branches to pulmonary 7\\nabdominal brain 7\\nspleen 8\\nheart 10\\ndiaphragm central tendon 10\\nstomach trouble 13\\nspleen, to treat 200\\n9th Dorsal.\\ncenter for liver 6\\nsplanchnic, small 7\\nant. branches to pulmonary 7\\nabdominal brain 7", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0309.jp2"}, "310": {"fulltext": "^1\\nINDEX\\ncervix uteri 7\\nperistalsis of bowels 8\\nspleen, upper erlge lo\\noesophagus lo\\nvena cavae lo\\nsound of aota is heard 1 24\\navoid in pregnancy 181\\nlOtU Dorsal.\\nsplanchnic, small 7\\nabdominal brain 7\\npelvic brain 7\\nperistalsis of bowels 8\\nlung, lower edge 10\\nliver 10\\nstomach cardiac orifice 10\\ncorresponds T2o\\nin female trouble. 162\\ncenter for ovary 177\\n11th Dorsal-\\norigin of nerves 3-4\\nsplanchnics, small 6\\nabdomi nal brain .7\\nblood supply to ovaries 7\\nperistalsis of bowels 8\\nspleen, lower edge 10\\nsupra renal capsule 10\\nkidney, location 11\\nin female trouble I62\\ncenter for ovary 177\\navoid in pregnancy 181\\n12th Dorsal.\\norigin of nerves 4\\ncorresponds 4\\nmethods to ascertain position of 4\\nsplanchnic, smallest 7\\nabdominal brain 7\\npleura, lowest part 10\\naorta 10\\npylorus TO\\nkidney 11\\nseparation liable 13-41\\nlateral displacement 35\\nlumbar enlargement 61\\nspleen to treat 200\\n1st Rib.\\nheart flutter 6-15\\nheart center 7\\npreparatory step to setting 62\\nsubclavian artery crosses 75\\nattachment of scaleni muscles 77\\nlocation of infra cervical ganglion 77\\nexostosis of 79\\nreach the vagus 94\\nfound 119\\ndisplaced upward 128\\ncause trouble with heart 132-146\\nin b. ^uchitis 135\\nto set 136\\nlymphatic obstruction 139\\nin lung trouble 146\\n2(1 Rib.\\nheart trouble 15\\npreparatory step to setting 62\\nattachment of scaleni muscle 76\\nfound 119\\nedges of lung 123\\nbounding spaces 124\\ndisplaced upward 128\\ncause of heart trouble I3c?-i46\\ntrouble with in asthma 135\\nin bronchitis, to set I35-136\\nin lang trouble 146\\n3d Rib.\\nbounding spaces 124\\ndisplaced 130 119\\nin bronchitis 135\\n4th Rib.\\nfourth iig-]23\\ndisplaced 130\\nnausea 158-159\\n5th Rib.\\ndisplaced 130\\nin lung trouble 146\\nnausea 159\\n6th Rib.\\nsixth corresponds 1:9-122 123\\nbounding spaces 124\\ntrouble with in asthma 135\\n7th Rib-\\nseventh rib 122\\ncause of asthma 15-135\\ncorresponds 119\\nspace boundary 124\\nlinea semilunaris 143\\ncardiac orifice of stomach 153\\n8th Rib.\\neighth corresponds 119\\npyloric orifice of stomach 153\\n9th Rib.\\nspleen for gall stones 149 153 -161\\ngall bladder 152-16O", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0310.jp2"}, "311": {"fulltext": "INDEX,\\n98\\ndisplaced in gas distension 159\\nraise gently in typhoid (Part 11) 24\\n10th Rib-\\nlower limit lung 123\\ncartilage displaced 128\\nspleen for gall stones 149-153 16 r\\nboundary of abdomi ial regions 152\\nlocation of spine 152\\nraise gently in typhoid Part II) 24\\n1 Uh Rib.\\neleventh T19\\ndown 128-129\\nspleen for gall stones I49 153-161\\ndianhea 166-167\\nflux, to treat 197\\nraise gently in typhoid (Part II) 24\\nhold at the head of in typhoid 24\\n12th Rib.\\nhead of last lib 4\\ndrawn down 76 128 129\\ntwelfth 1 1 9\\nbounding space I24\\ndiarrhea 166 i67\\nflux, to treat 197\\nFirst Lumbar.\\norigin of nerves. 4\\nabdominal brain 7\\nsmall intestine 8\\nlarge intestine 8\\nrenal artery 10\\nkidney pelvis of 10\\nseparation of 4 r\\nlumbar enlargement 6r\\nboundary regions of abdomen. 152\\nSecoixd Lumbar.\\ncenter for parturition 7\\nmicturition 7\\ndefecation 7\\nabdobinal brain 7\\nuterus, 7\\nkidneys 8\\nspinal cord 10\\npancreas 10\\nduodenum 1 ci\\nreceplaculum chyli 10\\nboundary of abdominal region i52\\nspleen 153\\neffect on bladder 1 73\\ncenter for internal genitals 177\\navoid in pregnancy 181\\nThird Lujubar.\\ncorliac axis 7\\nabdominal brain 7\\numbilicus 10\\nkidney, lower border 10- 11\\nFourth Lumbar.\\ncorresponds 4\\ncenter defecation 7\\nlarge intestine 8\\ngenito-spinal center 8\\nlower hypogastric plexus 8\\nplexus to ini estinal canal 8\\nbladder and vase deferentia 8\\naorta lO\\nillium, highest part 10\\nJtifih Lumbar.\\ncenter defecation. 7\\ncenter for hypogastric plexus 7\\npelvic brain 7\\nva.so motor center 7\\ncirculation to fascia 8\\ngenito-spinal center 8\\nlower hypogastric plexus 8\\nphxus to intestinal caral ..8\\nbladder and vaso deft rentia 8\\nseparation liable 13\\nlameness 76\\nnerve .supply to fundus of bladder i75\\neffect on bladder 175\\ncenter for internal genitals 177\\navoid in pregnancy 1 8\\ntreat for la grippe 189\\nSacrum.\\ncenter for bladder (neck 7\\ncenter to vulva and vagina 7\\ncenter to sphincter ani 7\\nlesion 13\\natiterior and posterior 55\\nlameness ~K\\\\\\nfifth sacral in constipation 49\\nCoci lix.\\nnutiition 3\\ncanst of piles 11 17\\ndii\u00c2\u00abL^cftied 34\\ncause of di.inhea i(- 7\\nClavicle.\\nto reach vrigus Q4\\nto set, \\\\2", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0311.jp2"}, "312": {"fulltext": "Ankylosis, caused by diseased discs 4\\nB\\nBarber s itch 80-81\\nbowels, keep open 81-83\\nc\\nCares of veitebra 3-4\\nCold feet 82-83\\nChilly feeling 83\\nCurvatures, (see spine).\\nColic 81\\nConvulsions 81\\nCephalodynia 36\\nCatarrh 39\\ndescription of 41\\nsymptoms of 41-42\\ncause of 41-42\\nsecretions in 42\\ntreatment 40-44\\n2d or 3d cervical deviated 44\\nColds 42\\netiology 42\\nsymptoms 42\\ncomplications 43\\ntreatment 43\\nparticular method of 45\\nCroup 45\\nmembranous, treatment of 45\\nConstipation 46\\ndefinition by Quain 46\\nsymptoms 47\\netiology 47\\nlocal causes 48\\nosteopathic theory of 48\\ntreatment 50\\n(a) splanchnic 50\\n(b) over abdomen ...51\\n(c) in neck 52\\n(d) local 52\\n(e) adjuvant 52\\nCatarrh of intestines 54\\nD\\nDisease of vertebra 3\\nof intervertebral discs 3\\nPott s, etiology of 4-5\\nDiet, in typhoid fever 22\\nDorsodynia 36\\nDiarrhea, success in treating 54\\netiology 54\\ncauses 55\\nosteopathic theory 55\\ntreatment of 58-59\\nDysentery, consideration of 54*56\\netiology 56\\npathology 56\\nsymptoms 57\\nosteopathic theory 57\\ntreatment 59\\nDrugs, division of 60\\nE\\nExercise an aid 16\\nEffleurage 76\\nEczema 81\\nF\\nFever, typhoid 18\\netiology 18 25\\nstages 19\\nsymptoms 20\\ntemperature in 20\\nperforation in 21\\nhemorrhage in 21\\ndiet in 22\\ntreatment in 23-24-28-80-83\\nmalaria 25\\ngerm 26\\npathology 26\\nsymptomatology 26\\nquotidian .27\\ntertian 27\\nquartan 27\\nFish poisoning 8 r\\nFeet, cold 82-83\\nG\\nGeneral treatment 82\\nH\\nHemorrhage, from bowels, treatment for. 24\\nHistory of medicine, definition of 59\\nHeart s action, slowed 81 82\\nI\\nIntervertebral discs, disease of 3\\nalteration in shape and size 4\\ndestruction of 4", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0312.jp2"}, "313": {"fulltext": "lOI\\nINDEX.\\nRheumatism, muscular, lumbago. 36\\ncepholodyuia 36\\ndorsodynia 36\\npleurodynia. 36\\ntreatment 36-37\\nRubbing 77\\ns\\nSpinal curvatures 3-4\\nsuccess in treating. 3\\nimportance of 3\\nligament, disease of 3\\nmuscle, disease of 3\\nblood vessels, interference with 3\\nnerves, 3\\ntreatment 4\\nSpinal curvatures, Pott s disease 4\\nscblerosis 4-7\\nKyphosis t-ii\\nlardosis 4 11\\nSpastic 4\\nhysterical 4\\ncompensation 8\\netiology of 8\\nanatomical characteristics 9\\npathology of 9\\nsymptoms of 10\\nin whom found 11\\ntreatment of 12\\nsurgically of 13\\nexercise an aid 16\\nSwedish movement 76\\nStroking 76-78\\nSpit en, treatment of 80\\nStools in typhoid 19\\nSpleen, congested in malaria 28\\nSolar piexus in constipation 51\\nSpine to spring 15\\nrigid, troubles caused by 4\\nsmooth, 4\\ntreatment of 4\\ntuberculosis of 4\\nTuberculosis of spine 4\\nTreatment\\ncatarrh 40 44\\ncolds 43-45\\nconstipation 50 52\\ndiarrhea 58-59\\ndysentery 59\\nfevers 2t; 24-28-30-83\\ninfluenza 43\\nlumbago 36\\nla grippe 43\\nmalaria 25\\nmanual y6\\nPotts disease 416\\npoisoning 81-83\\nrheumatism 36-37\\nspinal curvatures. 4-16\\nspine 4\\nspecial and general 82\\ntoothache 83\\nvomiting 80\\nworms 82\\nTheory of work in curvatures 15\\nTyphoid fever 18\\netiology iS\\nstages in 19\\nsymptoms 20\\ntemperature 20\\nperforation in 21\\nhemorrhage in 21\\ndiet in 22\\ntreatment in 23\\nTapotement -5\\nTapping 76\\nV\\nVomiting So\\nw\\nWorms", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0313.jp2"}, "314": {"fulltext": "INDEX.\\nlOO\\nInfluenza 39\\nvarieties 39-40\\nclinical features 4o\\nsymptoms of\\nf I. catarrhal type 4o\\nthoracic\\n3. gasiro-intestinal\\n4o\\n40\\n[4. cerebral type 41\\nsequelae 4i\\netiology .41\\ntreatment 43\\nInsomania 82\\nK\\nKyphosis 1 1\\npathology of 1 1\\nKneading 76\\nL\\nLigaments of vertebra, disease of 3\\nblood and nerve supply 15\\nLocomotor ataxia 82\\nLardosis 11\\nLumbago 35\\ncase f 38\\nlesion 38\\nLa Grippe 39\\nvarieties 39-40\\nclinical features 40\\nsymptoms of\\nf I. catarrhal type 4o\\nJ 2. thoracic 40\\nj 3. gastrointestinal 40\\n[4. cerebral t\\\\pe 41\\nsequelae 41\\netiology 41\\ntreatment 43\\ncerebral treatment 43\\nliver treat in constipation 51\\nM\\nMyelitis 5\\nMalaiia, consideration of 25\\netiology 25\\nthe germ 26\\npathology 26\\nsymptomatology 26\\nquotidian 27\\ntertian 27\\nquartan 27\\ntreatment 28\\nM assage 76\\nManual treatment 76\\nMeningitis 80\\nMyocarditis, caused by rheumatism 3i\\nH 23\\nMedicine, history of 61\\nRoman 64\\nArabian 66\\nscholastic period 67\\nin the 17th century 70\\ncirculation of the blood discovered 7O\\nN\\nNechrosis of vertebra 3\\nNeuralgia 81\\nP\\nPott s disease, consideration of 4\\nage in which occurs 4\\netiology of 4\\netiology, constitutional 5\\nsymptoms of 5\\npathology 5\\ncure if early treatment 16\\nPelvis, obliquity of 8\\nParasites 83\\nPleurodynia 36\\nPlexus, Auerback s ruling motion 48\\nMeissner s secretion 48\\nsolar in constipation 51\\nPetrissage 76\\nParalysis 81\\nPoisoning, treatment 81-83\\nFneumogastric, treatment of 59\\nQ\\nQuotations\u00e2\u0080\u0094 Ouain 5-46\\nMagendie 60\\nR\\nRheumatism, facute articular 30\\nchronic 30\\nmuscular 30-35\\ncauses of 30\\nrheumatic fever 30-34\\netiology 30\\npathology 31\\nsymptoms 31\\ncourse 33\\nduration 33\\ntermination..^ 38\\ncomplication 33\\ndiagnosis 33\\nprognosis 33\\netiology 35\\nsymptoms 35\\nRheumatic fever 34\\netiology 34\\npathology 34\\nsymptoms 34\\ncomplications 35\\n3 83^", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0314.jp2"}, "315": {"fulltext": "", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0315.jp2"}, "316": {"fulltext": "", "height": "4410", "width": "2858", "jp2-path": "principlesofost00hazz_0316.jp2"}, "317": {"fulltext": "", "height": "4427", "width": "2721", "jp2-path": "principlesofost00hazz_0317.jp2"}, "318": {"fulltext": "^-\u00e2\u0080\u009e.s^^", "height": "4748", "width": "2770", "jp2-path": "principlesofost00hazz_0318.jp2"}, "319": {"fulltext": "1\\nni\\nc\\nJUN83\\nN. MANCHESTER.\\nINDIANA 46962\\n\u00e2\u0096\u00a0\\\\y\\nm- j m j\u00c2\u00b0-.}^\\nO ft o .0\\ns O,\\nsV*./ O.", "height": "4748", "width": "2770", "jp2-path": "principlesofost00hazz_0319.jp2"}, "320": {"fulltext": "", "height": "4740", "width": "3096", "jp2-path": "principlesofost00hazz_0320.jp2"}}