Elmer D. Barber, D. O.
APPENDIX - FREQUENTLY RECOMMENDED TREATMENTS
This appendix contains several patterns of treatment
that are frequently recommended throughout this text:
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
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. 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
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
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
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
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
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
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. - 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 neglectedů
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
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
2. Pull slowly on the head until the body
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
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
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
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
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
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
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.
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.