Osteopathy Complete
Elmer D. Barber, D. O.
1898
  
 
 APPENDIX - FREQUENTLY RECOMMENDED TREATMENTS
 
 
    This appendix contains several patterns of treatment that are frequently recommended throughout this text:   

 
GENERAL TREATMENT 

    1.  Place the patient on the side; beginning at the upper cervicals, move the muscles upward and outward) gently but very deep, the entire length of the spinal column, being very particular in all regions which appear tender to the touch, have an abnormal temperature, or where the muscles seem to be in a knotty, cord-like, or contracted condition.  Treat the opposite side in a similar manner. 
    2.  With the patient on the back, place the hand lightly over the following organs, vibrating each two minutes, respectively: lungs, stomach, liver, pancreas, and kidneys. 
    3.  Flex the lower limbs, one at a time, against the abdomen, abducting the knee, and adducting the foot, strongly as the limb is extended with a light jerk. 
    4.  Grasping the limb around the thigh with both hands (cut 29), move the muscles very deeply from side to side the entire length of the limb.  Treat the opposite limb in a similar manner. 
    5.  Place one hand upon patient's shoulder, pressing the muscles down toward the point of the acromion process; with the disengaged hand grasp the patient's elbow, rotating the arm around the head (cut 30). 
    6.  Holding the arm firmly with one hand, with the other rotate the muscles very deep the entire length of the arm, also grasp the hand, placing the disengaged hand under the axilla, and give strong, extension.  Treat the opposite arm in a similar manner. 
    7.  Place one hand under the chin, the other under the occipital, and give gentle but strong extension (cut 8). 
    8.  Place one hand under the chin, drawing the head backward and to the side; with the disengaged hand manipulate the muscles which are thrown upon a strain.  Treat the opposite side in a similar manner.  Also manipulate, thoroughly and deep, the muscles in front of the neck. 
    9.  Place the patient upon a stool; the operator placing the thumbs upon the angles of the second ribs, an assistant raising the arms slowly but strongly above the head as the patient inhales; press hard with the thumbs as the arms are lowered with a backward motion, patient relaxing all muscles and permitting elbows to bend; move the thumbs down to the next lower ribs; raise the arms as before; and repeat, until the fifth pair of ribs have been treated in a similar manner. 
    10.  In all cases of fever hold the vaso-motor center (cut 13) . 
    11.  In cases of diarrhea place the patient face down while pressing hard upon the first lumbar vertebra, raise the limbs slowly but strongly as far as patient can stand; press also upon the second, third, and fourth lumbar, raising the limbs in a similar manner.  In severe cases of diarrhea it is also well to vibrate the bowels two minutes. 
    12.  In cases of constipation No. 11 should be omitted, and the Constipation Treatment be substituted. 
 


 
TREATMENT TO EQUALIZE THE CIRCULATION 
 
    1.  Place the patient on the side; using the arm as a lever (cut 7), with the fingers pressing rather hard close to the spine, beginning at the first cervical vertebra, move the muscles upward and outward gently but deep, the entire length of the spinal column.  Treat the opposite side in a similar manner. 
    In giving this treatment the operator should endeavor to avoid as much as possible using the ends of the fingers, but should place the hands flat, using the fingers as far back as the second phalanges, which will give the patient no pain, while the ends of the fingers are apt to go too deep, thus causing the patient unnecessary discomfort. 
    Tender spots upon the spine are very apt to be discovered; in which case a little additional treatment should be given in this immediate region, which will assist in relieving the congested condition, possibly immediately over some nerve-center, which may control some distant part of the anatomy, and hence could not be expected to do its work correctly with such a condition existing at its origin. 
    2.  Flex the limbs against the chest, the patient lying on the back; rotate the leg from side to side quite strongly two or three times, extending the limb with a light jerk (cuts 32 and 36).  Flex the limbs strongly against the chest, abducting the knee and adducting the foot as the limb is extended.  This treatment stretches the adductor muscles of the thigh, thereby freeing the femoral artery and vein and the long saphenous vein, and should never be omitted in any case where the patient is troubled with cold extremities. 
    3.  Grasp the thigh firmly, with one hand on each side, the fingers meeting; beginning close to the body, move the flesh to the bone, if possible, from side to side (cut 29). 
    This treatment is beneficial in all cases of impaired circulation of the limbs. 
    4.  Place the left hand under patient's right shoulder, the fingers on the angle of the second rib; with the right hand grasp the patient's right wrist', drawing the arm slowly, with some strength, above the head as the patient inhales; press hard with the fingers upon the angle of the rib as the arm is lowered with a backward motion.  Treat the third, fourth, and fifth ribs in a similar manner.  This operation should be repeated on the opposite side. 
    It is remarkable what a relief the patient will experience in almost all cases of heart disease if this treatment, which expands the chest and equalizes the circulation, is given in a correct and scientific manner. 
    5.  Place one hand under the chin, the other under the back of the head, and give gentle extension (cut 8), rotating the head from side to side.  In all cases where the action of the heart is too rapid, place one hand on each side of the of the four neck, the fingers almost meeting over the spines or five upper cervicals; press gently with the fingers for three or four minutes upon the vaso-motor center (see cut 13).  A pressure at this point causes the arteries to relax, thus increasing their caliber and slowing the action of the heart. 
    In all cases of heart disease or diseases of the blood, in addition to this treatment, such other treatment should be given as the condition for accompanying complications would indicate. 
    In applying osteopathic treatment, the operator must determine with the utmost nicety just how strong or light a treatment will produce the best results.  Always begin with a very light treatment, which should increase in strength with each succeeding treatment until a point is reached beyond which we can go no further without unduly fatiguing the patient.  If the treatment is correctly given, the patient should feel refreshed and relieved after each treatment 
    This treatment will require from fifteen to twenty minutes, and in acute cases should be given each day; in chronic diseases every other day is sufficient. 
    Of the numerous cases cured by this treatment, we will mention that of an old gentleman of Galena, Kansas.  He could not climb the steps to our office.  We treated him on the counter in a grocery store near by.  His pulse, which was hardly perceptible, was down to 38.  When he came for his second treatment, two days later, his pulse was strong and had increased to 58.  He could hear better, and recognized people on the street for the first time in months. 
 

 
VIBRATION 

    Vibration. - We have recently discovered that vibration administered by the hand quickens, stimulates, strengthens, and assists very materially in reducing congestion and inflammation, and is very beneficial in many cases, in addition to the regular osteopathic treatment; in fact, we have cured cases of stammering, asthma, and various other troubles in which we failed to get results by the regular osteopathic manipulations.  Vibration should be applied with a loose wrist-joint, the whole or a part of the palmar surface of the hand or fingers being used.  The movements in the wrist-joint are abduction and adduction, while the movements of the elbow are flexion and extension; the hand lies immovable upon the part of the body on which it rests.  Through a quick succession of individual movements, with a perfectly loose wrist-joint the vibrations are produced.  Flexion and extension of the wrist must be carefully guarded against, as this would produce pressure, which would be injurious in many localities.  In fact, vibration correctly applied is such a wonderful. instrument in relieving pain that we cannot impress this one point too forcibly upon the minds of our readers:     Always vibrate with a loose wrist-joint, using no greater pressure than the weight of the hand, as the entire benefit to be derived from the treatment is lost if this point is neglected… 
    Vibrations might be compared to fine shaking movements, in which the whole or part of the palmar surface of the fingers or hand is used.  The benefit to be derived from this treatment depends so largely upon the manner in which it is administered, and the treatment is so applicable in such a variety of cases, that we cannot be too particular in educating ourselves to vibrate correctly.  Place the hand lightly upon the patient, using no pressure.  The movements at the elbow are flexion and extension, while those of the wrist are adduction and abduction.  The vibrations are produced through a succession of quick individual movements.  There should be no straining of the muscles in the operator's arm, or strong contractions of the muscles of the hand, arm, or shoulder.  When given correctly, with the hand on the anterior surface of the thorax, the vibrations can be easily felt by the other hand placed upon the back of the patient while with a stiff hand and arm no motion can be distinguished upon the back.  To further give an idea of how delicately the movements should be made, place a tumbler of water upon a table, and the vibrations are given absolutely correct upon the same, the water will not move from side to side, but simply quicken in the center.  The table should be fairly large to make a fair test. 
 


 
GENERAL TREATMENT OF THE NECK 

    1.  Place the patient on the back; with one hand under the chin and the other under the back of the head, pull gently, rotating the head in all directions, slowly but strongly, endeavoring to stretch all muscles of the neck (see cut 8). 
    2.  Pull slowly on the head until the body moves. 
    3.  Place the left hand on the top of patient's head, the right hand and arm beneath the head and neck, two fingers upon each side of the fourth dorsal vertebra, the ends of the fingers pressing hard, moving the muscles upward, at the same time press rather hard with the left hand, rotating the head from side to side, the fingers of the right hand working gradually upward, until the occipital is reached (cut 46). 
    4.  Standing at patient's head, place the hands upon the sides of the neck, the fingers just back of the transverse processes of the upper cervicals; give gentle extension, rotating the head to the right, with the left hand moving the muscles forward and over the transverse processes upon the. left side; rotate the head in the opposite direction, with the right hand moving the muscles forward and over the transverse processes upon the right side; move the hands down. ward to the next lower cervicals; rotate the head as before, and repeat until the last cervical is reached (cut 47). 
    5.  Manipulate the muscles thoroughly and deep, in the front of the neck; place the hand under the chin, drawing the head backward, thus giving these muscles extension; work as deeply as possible under the inferior maxillary. 
 


 
THE VASO-MOTOR CENTER 

    The chief or general center, supplying all the non-striped muscles of the arterial system with motor fibers, lies in the medulla oblongata at a spot which contains many ganglionic cells. 
    The nerves which pass to the blood vessels contain vasomotor fibers, and are known as vaso-motor nerves.  The chief center reaches from the upper part of the floor of the medulla oblongata to within four to five m.m. of the calamus scriptorius (but in the higher animals other centers are distributed throughout the spinal cord which are able to take the place of the great primary center). 
    Each half of the body has its own center in that part of the medulla oblongata which represents the upper continuation of the lateral column of the spinal cord. 
    Stimulation of this central area causes contraction of all the arteries and in consequence there is great increase of the arterial blood pressure, resulting in swelling of the veins and heart. 
    Paralysis of this center causes relaxation and dilatation of all the arteries, and consequently there is an enormous fall of the blood pressure. 
    Under ordinary circumstances the vaso-motor center is in a condition of moderate tonic excitement. 
    Just as in the case of the cardiac and respiratory centers, the vaso-motor center may be excited directly or reflexly. 
    From the vaso-motor center fibers proceed directly through some of the cranial nerves to their area of distribution; through the trigeminus partly to the interior of the eye, through the lingual and hvpoglossal to the tongue, and to the intestines by the splanchnics. 
    All the other vaso-motor fibers descend in the lateral column of the spinal cord; hence stimulation of the lower cut end of the spinal cord causes contraction of the blood vessels supplied by the nerves below the point of section. 
    The cervical portion of the sympathetic supplies the great majority of the blood-vessels of the head. 
    The vaso-motor fibers to the upper extremities pass through the anterior roots of the middle dorsal nerves into the thoracic sympathetic and upward to the first thoracic ganglion, and from thence through the rami communicates to the brachial plexus. 
    The skin of the trunk receives its vaso-motor fibers through the dorsal and lumbar nerves. 
    The lungs are supplied from the dorsal spinal cord through the first thoracic ganglion. 
    The vaso-motor fibers to the lower extremities pass through the nerves of the lumbar and sacral plexuses into the sympathetic, and from thence to the lower limbs. 
    The splanchnic is the greatest vaso-motor nerve in the body, and supplies the abdominal viscera. 
    In referring to the above, from Landois, it will be observed (1) that the chief vaso-motor nerve-center is situated in the medulla oblongata; (2) that the majority of and all the most important vaso-motor nerves descend in the lateral column of the spinal cord; and (3) that stimulation of the vaso-motor causes contraction of all the arteries, and a consequent enormous increase of the arterial blood-pressure  resulting in swelling of the veins and heart; while paralysis of the same center causes relaxation and dilatation of all the arteries, and a consequent immense fall in the general blood pressure. 
    It is impossible for the osteopath to reach directly the center in the medulla oblongata.  The same results are attained, however, through so-called "reflex action," by a pressure upon the upper cervicals - where is situated the most important subsidiary center - at the same instant tipping the head backward, thus bringing the neck into such a position as to throw a pressure upon the nerves over the cervical vaso-motor center.  A steady pressure at this point for a few moments - reduces the general blood pressure, slows the action of the heart, and will reduce the temperature of the body in one-half the time required by any other known method. 
    Place the fingers upon the sides of the neck, the tips ,almost meeting over the spines of the upper cervicals; tip the head backward, and press gently with the fingers four or five minutes, to reduce a fever. 
 


 
CONSTIPATION TREATMENT 
 
    1.  Place the patient on the side, and proceed to free all the muscles of the spine on each side as low as the twelfth dorsal vertebra.  Let the arm of the patient rest on that of the operator, the patient's elbow pressing against the humerus, forming a lever with which the muscles of the scapula can be manipulated.  With the fingers between the spine and scapula, pressing hard, move the scapula and muscles under the fingers upward (see cut 7), being particular not to let the hand slip over the muscles, but to move them.  After each upward motion, move the fingers down an inch, until the last dorsal vertebra is reached, taking care not to work lower than the last rib. 
    2.  With the patient lying on the back, grasp the right wrist with the right hand, drawing the arm slowly but with some strength high above the head, at the same time placing the left hand between the shoulder-blades on the right side of the spine, about two inches. below the upper part of the shoulder-blades, pressing hard as the arm comes up; lower the arm, the elbow passing below and at the side of the table.  Repeat, moving the hand down the spine one inch every time, until you have reached the tenth dorsal vertebra, which will be found one inch below the inferior angle of the scapula.  This excites and stimulates the splanchnic nerve. 
    3.  Knead the bowels (cut 17),  beginning on the right side and at the lower portion of the abdomen, close to the bone, and immediately over the ileo-cecal valve.  Work lightly at first, gradually using more strength, following the ascending colon upward from its commencement at the cecum to the under surface of the liver on the right side of the gall-bladder, where it bends abruptly to the left, forming, the hepatic flexure; it now becomes the transverse colon, and passes transversely across the abdomen from right to left, where it curves downward beneath the lower end of the spleen, forming the splenic flexure.  The descending colon passes almost vertically downward to the upper part of the left iliac fossa, where it terminates in the sigmoid flexure.  The sigmoid flexure is the narrowest part of the colon.  It is situated in the left iliac fossa, commencing at the termination of the descending colon at the margin of the crest of the ileum, and ending in the rectum opposite the left sacro-iliac syphysis.  Work across the abdomen, following the transverse colon and down the descending and sigmoid portions to the rectum.  Next knead the small intestine, which is contained in the central longer part of the abdominal cavity, surrounded above and at the sides by the colon or large intestine. 
    4.  Place the patient upon the back; with one hand upon the ribs, over the liver, press them down several times quite strongly, holding them a moment in this position before slowly removing the pressure, thus starting the circulation in and through the liver.  Work as deeply as possible with the fingers over the liver, under the ribs, raising them gently.  Also carefully knead and manipulate the gallbladder, endeavoring empty its contents into the duodenum. 
    5.  Place the hand lightly over the liver, vibrating gently for two minutes.  See Vibration. 
    6.   Place the patient upon the back; and with the hand under the chin, pull the head backward to the right and left, thus stretching the muscles, and freeing as much as possible the pneumogastric nerve, which so largely controls the digestive organs.  It is also well to manipulate, thorough and deep, the muscles on the front and sides of the neck, the object being to remove all obstructions, and equalize as much as possible the nerve-wave between the brain and solar plexus. 
    This treatment should be given every other day, and can be administered in fifteen minutes.  It will cure the most stubborn cases of constipation or torpid liver.  Care should be taken to work as deep and as far under the ribs as possible.  Children and young people are often cured in a single treatment, but the average time required for a cure is from two to six weeks.  In very stubborn cases it is well to flush the bowels once or twice, until Nature begins to act.  This treatment, if applied as directed, will be found infallible. 
 

 
CHRONIC DIARRHEA TREATMENT 
 
    1.  Place the patient on the side; beginning at the upper dorsal, move the muscles upward and outward very deeply, the entire length of the dorsal region.  Treat the opposite side in a similar manner. 
    2.  Place the patient on a stool; the operator placing the knee against the back of the patient, just below the last dorsal, draw the patient backward, slowly but strongly, as far as the patient can stand without too much inconvenience; hold in this position a moment and repeat. 
    3.  Place the hand lightly over the bowels, with the patient lying on the back; vibrate gently two minutes. 
    4.  Place the hand under the chin, drawing the head backward, rotating it gently from side to side, with the disengaged hand manipulating the muscles immediately over the pneumogastric. 
    This treatment should be applied each day; will require about fifteen minutes; and, if correctly given, will cure any case of chronic diarrhea.