Osteopathy Complete
Elmer D. Barber, D. O.
1898
  
           
DISEASES OF THE BONES AND JOINTS
 
 
SPONDYLITIS, SPINAL OSTITIS, SPINAL CARIES, OR POTT'S DISEASE
(A progressive inflammatory lesion of the vertebral bodies, or the intervertebral disks.  Chronic in character, leading to partial or complete destruction of the vertebrae, and terminates in anchylosis, with a characteristic posterior deformity.  It is considered a tuberculous disease of the spine, and may occur in the cervical, dorsal, or lumbar region.)

SYMPTOMS
    Restlessness; fatigue on slight exertion; pallor of the skin; anorexia; irritability; tendency to lean against objects.
    If in the cervical region, head frequently held to one side; pain in the pharynx, side of the neck the larynx, and the esophagus.
    If in the dorsal region, patient frequently leans forward, and in stooping does not bend the back.    Pain in the stomach or intestines or chest walls.
    If in the lumbar region, patient frequently leans forward over a chair or couch, to relieve the weight of the body from the injured vertebra; body inclined to one side, and frequently holds one limb forward.  Pain in the intestines, liver, or other abdominal viscera.
    There is usually paralysis of the lower extremities, followed by posterior angular curvature.

TREATMENT
    1.  Place the patient on the side; beginning at the upper cervicals, move the muscles upward and outward, gently but deep, the entire length of the spinal column, being exceedingly thorough in the immediate region of the diseased vertebrae.
    2.  An assistant grasping the shoulders, another the feet, give gentle extension, as the operator at the same time endeavors, by gentle pressure and manipulation, to force the vertebrae back to their normal position.  The extension should not be continued over three or four minutes each treatment; neither should sufficient strength be used to pain or exhaust the patient.
    This treatment will cure Pott's disease if taken in its early stages, and will be found very beneficial, strengthening and invigorating the patient at almost any stage of the disease.
 



 
SPINAL CURVATURE
(The curvature may be anterior, posterior, or lateral.)

CAUSE
    Curvature may be caused by long-continued, unequal compression of the intervertebral cartilages.
    Lordosis is usually found in the lumbar region, and is simply an exaggeration of the normal curve, with convexity forward, due to some deformity or diseased condition, such as rickets, congenital femoral luxation, coxalgia, etc.
    Kyphosis (humpback) is an exaggeration of the normal dorsal curve, causing convexity of the back, resulting from debility, rickets, or occupation requiring constant stooping.
    Scoliosis appears most frequently in girls between the ages of fourteen and eighteen.  There are usually two lateral curvatures. Their convexities are turned in opposite directions.

SYMPTOMS
    Pain and fatigue in the back and shoulders when sitting; projection of scapula, wing-like; undue prominence of the iliac crest of the affected side, with projection of the breast on the opposite side.

TREATMENT
    1.  Place the patient on the side; move the muscles upward and outward the entire length of the spinal column, being very thorough in the region of the curvature.  Treat the opposite side in a similar manner.
    2.  In case of lordosis, a thorough extension of the spine should be given.  Should always treat with a view of removing the primary cause.
    3.  In case of kyphosis, place the patient on the face; the operator, grasping the shoulders, draws the patient head and shoulders, over the end of the table, until the upper border of the curvature is a few inches beyond its end.  The operator now places his thumbs upon the spinous process at the upper border of the curvature; the head and shoulders of the patient will now be lowered as far as possible, the operator making strong pressure with the thumbs as the patient is raised to a level with the table.  Place the thumbs on the next lower vertebra, lower the head and shoulders as before, and repeat until the lower border of the curvature is reached.  It is always advisable, if convenient, to have a second assistant grasp the ankles of the patient, in which case the extension can be given as the head and shoulders are brought to a level with the table as the operator makes strong pressure upon the spinous process.
    4.  In ease of scoliosis, place the patient on the face; the thumbs upon the side of the first spinous process which is out of line, the operator standing at the side of the table toward the convexity, an assistant grasps the shoulders of the patient, a second passes one hand under the limbs just above the knees and draws the limbs slowly away from the operator, on a level with the table, as far as the patient can stand without too much inconvenience, the patient relaxing all muscles; as the limbs are brought back to their former position strong extension should be given.  The  operator pressing hard with the thumbs on the spinous process at the instant the body, under strong extension, arrives at its former position.  Move the thumbs down to the next spinous process, give abduction, adduction, and extension, as before, and repeat until the lower border of the curvature is reached.
    The curvature upon the opposite side should be treated in a similar manner.
    It is usually advisable in all cases of curvature of the spine to give a thorough General Treatment, to tone up and equalize the entire system.
    This treatment will occupy about twenty or thirty minutes.  An immediate change for the better will be noticed, and the treatment should be continued every other day until recovery.
 



 
RICKETS, OR RACHITIS
(A disease of early childhood, chiefly due to deficient nutrition, characterized by softening of the bones, especially of the spine, and consequent deformity.)

SYMPTOMS
    Bones are soft and yielding; muscles, flabby; child feeble, also inactive, resembling paralysis; sides of chest flattened; sternum projects; digestion impaired.

TREATMENT
    If taken in time, this disease can be cured.  After it has become fully developed, it can be materially benefited by the following treatment:
    1.  Careful and thorough manipulation of all contracted muscles.  Place the patient on the back; two assistants grasping the shoulders and feet, give careful extension, the patient cautioning them when too much strength is used; the operator now gently forces the soft, yielding bones toward their original position.
    Great care should be exercised not to overdo matters, simply endeavoring to gain a little each treatment, which should be given every, other day, occupying about ten or fifteen minutes.
    We might mention, in this connection, the case of a little girl, twelve years of age, which we treated very successfully at Cherokee, Kansas.  The disease first manifested itself eight years previous, since which time she had been almost constantly under treatment in various sanitariums of the West; gradually failing, until the pressure upon the spinal cord was so great as to cut off communication between the brain and lower extremities, thus causing paralysis of the lower limbs.  The ribs were in such position as to affect the heart and lungs.  Learning of Osteopathy, the father called us in to examine and treat the child, who was absolutely helpless and in almost a dying condition.  After four weeks of treatment the little one could walk, and in four months was able to attend school for the first time in her brief career.  The above results in such hopeless cases as this are the exception and not the rule.
 



 
CRETINISM
(Endemic disease, with deficient development of the organism.)

SYMPTOMS
    Body under-sized; head broad and shallow; eyes far apart; nose flat; hands broad; hair stiff; skin dry and rough; and intellect impaired.
    No cure in Osteopathy.
 



 
AKROMEGALIA
(Hypertrophy of the bones of hands, feet, and face.)

SYMPTOMS
    Usually spinal curvature; soft parts undergo enlargement; thyroid gland may be atrophied or hypertrophied; headache; stature may increase.
    No cure in Osteopathy.
 



 
ARTHRITIS
(Inflammation beginning in either the synovial membrane or the bone, and affecting all the structures of a joint.)

CAUSE
    Acute form may be traumatic or infective, due to pyemia, gonorrhea, etc.  Chronic form is usually diathetic, due to struma, gout, rheumatism, etc.

SYMPTOMS
    Heat, redness, and edema; crepitus, tenderness, pain; swelling, involving the entire joint; atrophy of the muscles of the affected limb; fever, when there is suppuration, and passes to the typhoid or hectic type.

TREATMENT
    In case the difficulty is in the shoulder joint:
    1.  Place the patient on the side opposite the shoulder affected; beginning at the upper cervicals, move the muscles upward and outward, gently but very deep, to the lower border of the scapula.
    2.  Place the flexed arm of the patient against the radius and ulna of the operator, whose arm should be in a flexed position (cut 7); using the arm as a lever, press the shoulder upward and outward, thus stretching and freeing the muscles beneath the scapula.
    3.  Place one hand upon the shoulder, pressing the muscles outward over the point of the acromion process; with the disengaged hand grasp the patient's arm at the elbow, which should be flexed, rotating the arm slowly, gently but as strong as possible, forward, upward, backward, and downward (cut 30).
    4.  Place the hand in the axilla, with the other grasp the patientís wrist, giving gentle but quite strong extension of the arm.
    Great care must be exercised, in giving the above treatment, to give the patient no unnecessary pain, seeking to free the circulation, and stretch the muscles a little each treatment until the desired results are obtained.
    Treatment should be given every other day.
    In case the difficulty is in any other joint of the arm, the same treatment will apply, being particularly thorough in the immediate region of the affection.
    In case the difficulty is in the hip-joint:
    l.  Place the patient on the side opposite the affected hip; beginning at the first lumbar vertebra, move the muscles upward and outward, very deep to the end of the sacrum; also manipulate carefully but very deep all the muscles in the immediate region of the affected joint.
    2.  Flex the limb slowly, gently but as strong as possible, as far as the patient can stand; giving rather strong abduction of the knee as the limb is gently extended.
    3.  Placing one hand against the sacrum, the other on the knee, draw the limb slowly backward as far as possible.
    This treatment frees the circulation, and, if given carefully every other day, will effect a speedy cure.
    In case the difficulty is in any other point of the leg, the above treatment should be given, together with careful but thorough manipulation, flexion, and extension of the joint affected.
 



 
SYNOVITIS
(Inflammation of the synovial membrane of the joint.  May be acute or chronic.)

SYMPTOMS
    In acute form, intense pain, worse at night; tenderness; muscular atrophy; inflammation, fever, with local heat and redness.
    In chronic form, symptoms of inflammation are slight or wanting; joint weak, but can be used; membrane may become thickened and indurated from venous congestion, or pass into fatty degeneration.

TREATMENT
    See Arthritis.
 



 
COXALGIA, OR HIP-JOINT DISEASE
(A strumous arthritis of the hip-joint, occurring usually in persons under fifteen years of age.
More common in boys, and may be tubercular.)

EXPLANATORY
    Coxalgia is divided into three varieties: Femoral, beginning in the upper epiphysis of the femur; Acetabular, involving the floor of the acetabulum; Arthritic, beginning as a synovitis.  It also has three stages: 1) Inflammatory, causing flexion and fixation of the joint; (2) Effusive, causing flexion, abduction, and fixation, with apparent lengthening from compensatory curvature of the spine; (3) Suppurative, causing flexion, fixation, adduction, and inversion, with apparent shortening, due to compensatory curvature of the spine in the opposite direction.

SYMPTOMS
    In the first stage, paid, usually in the knee; tenderness on jarring the femur upward, or on pressing suddenly inward on the trochanter; limping, which may wear off in the evening; fixation, detected by attempting to flex, extend, and rotate the femur.
    In the second stage, pain is more intense; tenderness, tenderness, and fixation are more marked; swelling may be apparent, also atrophy.
    In the third stage, flexion, adduction, and inversion, the affected thigh crossing the other; pelvis elevated on the diseased side; shortening, real from wasting, and apparent from spinal curvature; suppuration and abscess are common.
    The femoral form is characterized by starting pain most marked at the knee, shortening and luxation as the disease progresses.
    The acetabillar form shows marked tendency to abscess which may point front within the pelvis over the nates, or, above Poupart's ligament.
    The arthritic form approaches nearer to the type of an acute inflammation, with sharp pain in the hip-joint, swelling, etc.

TREATMENT
    1.  See Arthritis.
    2.  If attended by Spinal Curvature, see above.
 



 
HYDRARTHROSIS, OR WHITE SWELLING
(Serous effusion into a joint, usually the knee-joint; generally strumous, and occurring in children.)

SYMPTOMS
    Pain, tenderness, swelling, and lameness, at first slight, gradually increasing; knee at first flexed, but as the ligaments become softened, and yield, there is a backward displacement and outward rotation of the tibia on the femur; crepitus is marked; abscess may form, opening externally or the joint may become involved.

TREATMENT
    See Arthritis.
    If taken in its early stages, this disease is treated very successfully.
 



 
ANCHYLOSIS, OR STIFF JOINT
(True anchylosis is dependent on articular and intra-articular thickening and adhesion.  It may be complete, in which case an osseous deposit has united the articular surfaces either in part or throughout.  Rarely found except after traumatic arthritis.  It may be incomplete, motion being restricted by fibrous union between the joint surfaces.  False anchylosis is dependent on contractions and adhesions of the soft parts around the joint.)

TREATMENT
    1.  Give a very thorough manipulation of the muscles in the region of the affected joint.
    2.  Gentle but strong flexion and extension of the joint affected.
    Treatment should be given each day.  These cases are rather slow to respond, but a continuation of the treatment will usually effect a cure, provided the case is not one of complete anchylosis.
 



 
SPRAINS
(The twisting of a joint, by which the soft parts about it are stretched or torn.  Muscles, tendons, ligaments, nerves, and blood vessels may be involved.)

SYMPTOMS
    Pain and swelling due to both extravasation of blood and inflammatory effusion within and without the joint and loss of function.

TREATMENT
    1.  Thorough manipulation of the muscles, gentle but deep, in the immediate region of the sprain.
    2.  Thorough extension and gentle rotation of the joint.
    Treatment should be given every day.  Immediate relief will follow the first treatment, and a speedy cure may be expected.