Osteopathy Complete
Elmer D. Barber, D. O.
1898
  
             
DISEASES OF THE BRONCHI, LUNGS, AND PLEURAE
 
 
ASTHMA
(Paroxymal dyspnea, with oppression)

SYMPTOMS
    Recurrent and temporary difficulty in breathing, accompanied by a wheezing sound and a sense of constriction in the throat, with couch and expectoration.  Authors distinguish two varieties: dry convulsive or nervous. and humid or common.  In the first variety the attacks are sudden and violent and of short duration, the sense of constriction is hard, dry, and spasmodic, the cough slight, and expectoration scanty and only appearing toward the end of the paroxysm.  In the second variety the paroxysm is gradual and protracted, the constriction heavy, laborious, and humid, the cough violent, and expectoration commences early, and is at first scanty and viscid, but afterward copious, affording great relief.  In many cases the attack is in the night, and most frequently an hour or two after midnight.

CAUSE
    Asthma, pronounced incurable by the medical fraternity, can be relieved, and in most cases cured, by an application of the principles laid down in the following pages.
    The thorax is a bony cage formed by the ribs, dorsal vertebrae, and sternum, containing and protecting the principal organs of circulation and respiration.  The ribs are not only very elastic, but, being connected with the sternum by costo-cartilage and with the dorsal vertebrae by ligaments, have limited motion.  Thus it will be seen that they are easily affected by accident or contraction of the muscles.  In most cases of asthma a slight depression will be noticed over the second, third, and fourth ribs on the left side, about two inches to the left of the median line, while the cartilaginous portion of the corresponding ribs on the right side will be found elevated; occasionally this will be reversed, but in either case it is proof positive that the framework which is supposed to protect the vital machinery of life is out of gear.
    The great Creator, in His infinite wisdom, has arranged for just such an emergency as this by preparing a system of levers, one of which we will now use in raising the ribs, stretching the intercostal muscles, and expanding the chest.
    The pectoralis major, a large muscle which covers the entire front of the chest, attaching to the sternal half of the clavicle (collar-bone), the six or seven upper ribs, and the cartilages of all the true ribs, is inserted by a flat tendon into the external bicipital ridge of the humerus about two or three inches below the shoulder-joint.  If you will raise your arm high above the head, you will feel all the upper ribs move, thus proving that our theory is correct.

TREATMENT
    1.  Place the patient on the back with a pillow under the head.  Two assistants at the head of the table; one places his right, the other his left hand under the patient's shoulders on the angle of the second rib, half way between the scapula (shoulder-blade) and spine and one inch above the scapula.  With the disengaged hands take the patient's wrists, and, slowly drawing the arms upward high above the head (see cut 4), pull steadily and strongly for a moment; at the same time with the fingers press steadily on the angle of the ribs.  Lower the arms slowly, the elbows passing below and to the sides of the table.  Move the fingers down the spine one inch, to the angle of the next rib, and draw up the arms as before; repeat until you have raised the four or five upper ribs.  It will be also observed that this operation stretches the intercostal muscles.
    2.  The patient will now be seated upon a stool.  The operator places his knee between the shoulders, grasps the patient's wrists and raises the arms slowly but strongly high above the head, pressing hard with the knee and lowering the arms with a backward motion (see cut 5).
Each time as the arms are drawn upward the patient should inhale, filling the lungs to their utmost capacity, exhaling as the arms reach their normal position.
    3.  Standing beside the patient, with one hand upon each side of thorax, press the ribs forward and upward, holding them in this position while the patient fills the lungs with air.
    4.  Place the patient upon the back; and, with the fingers of one hand pressing upon the angle of the first rib which is depressed, with the other hand pressing outward and downward upon the cartilages of the ribs that are thrown forward towards the sternum, have an assistant draw the arm upon the side where the depression has been discovered, high and strong, above the head, the patient filling the lungs to their utmost capacity.  Lower the arm with a backward motion, the elbow passing below the edge of the table, at the same instant pressing hard with the fingers upon the angle of the rib, and with the other hand upon the cartilage which is thrown toward the sternum (cut 6).
    5.  Place the hand lightly upon the thorax, and vibrate gently for two minutes over that portion of the lungs or bronchi which seems to be affected.  See Vibration.
    It is very important in all cases of lung trouble that vibration should be given, as it assists in starting, stimulating, and equalizing the circulation through the lungs and bronchial tubes, and very materially aids in the recovery of the patient.  We might mention in this connection one case, of a lady, who had been unable to lie down without having a paroxysm for over four years, and after two weeks' regular treatment showed no signs of improvement.  After the first vibration a marked change was noticed for the better, and in four weeks a complete cure was effected.  Instant relief is often experienced after the first treatment, and a continuation of the treatment seldom fails to effect a cure.
    Coughs, colds on the lungs, short difficult breathing, and pleurisy never fail to respond quickly to our Asthma treatment.  Of the numerous cases treated by us in this manner, 90 per cent have been cured and all benefited.
    This entire treatment should occupy about fifteen minutes, and be given in acute or stubborn cases each day; in milder forms, every other day is sufficient.
 



 
VIBRATION

    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.
 



 
PULMONARY TUBERCULOSIS, OR CONSUMPTION
(Atrophy of the lungs, characterized by tubercle bacillus.)

SYMPTOMS
    The special symptoms are a short and tickling cough; the pain in the chest is slight, and there is either a sense of tenderness or weight experienced at the upper part of the lungs; the breathing is habitually short, and a full inspiration is impracticable, the attempt increasing the sense of weight and soreness or aggravating the cough; the expectorations are generally scanty and small in quantity in the early stages, and in many cases are very trifling throughout; the matter expectorated is watery and whey-like, sometimes tinged with blood, and as the disease progresses thick, tenacious, curdy, or cheesy particles are excreted.  As the functional powers of the lungs become impaired the pulse becomes frequent and feeble, the breathing grows shorter; irregular chills come on, succeeded by some degree of feverish heat, and in the last stages night-sweats, diarrhea, swelling of the limbs, etc., denote the rapidly approaching fatal termination.  The local condition of the part diseased is one of engorgement, and its secretions are changed from a healthy to a morbid condition.

CAUSE
    It is a well-known fact that cold will contract not only iron and steel, but the muscles of the human body.  To prove our theory is correct, allow a cold draught of air to strike the neck for a short time, and possibly the next morning you have a stiff neck; the head does not turn freely on its axis: the muscles that were exposed have contracted and are a little too short.  Acting on these principles, we trace consumption to the contracted muscles of the chest, which are forcing the elastic ribs down upon the pleura and lungs.  The old idea is that as the lungs decay the ribs settle.  How absurd to imagine that the soft, spongy lungs support the chest!  As well say that a house full of sponges would hold up the roof.
    We have established the fact, beyond the shadow of a doubt, that it is the steady pressure of the contracting muscles that causes this dread disease, and experience has taught us that until tuberculosis sets in it can be cured.

TREATMENT
    1. Place the patient on the right side, facing the operator, his left arm flexed, the elbow resting on the right arm of the operator, pressing against the humerus, thus making a lever of the patient's arm to stretch the muscles of the shoulder and scapula.  The patient must allow his muscles to relax as much as possible.  The operator will now place his hands in the position shown in cut 7. With the finger ends close to the spine, pressing quite hard, using the arm as a lever, with a circular motion move the muscles under the hand toward the head.
    Do not let the hands slip on the spine, as that would be simply rubbing.  Our object is to loosen and stretch the muscles, thus freeing the vital forces of life from any obstruction and equalizing the circulation.  After each upward motion, move the hands down one inch, keeping close to the .spine and working deep the entire length of the spinal column.  The left side will now be treated in a like manner.
    2.  Place the patient on the back; one operator placing the right hand, the other the left, under the patient's shoulders, the fingers pressing hard upon the angles of the first rib, with the disengaged hands grasp the patient's wrists; as the patient fills the lungs with air, draw the arms slowly and very strongly high above the head (cut 4); lower the arms with a backward motion, pressing hard upon the angles of the ribs, the elbows passing below the sides of the table.  Repeat this operation with each successive rib, as low as the lower border of the scapula It will be observed that this treatment expands the thorax thereby increasing the breathing capacity of the lungs and also freeing the circulation.
    3.  Place the hand lightly upon the chest, and vibrate gently over the diseased lung for two minutes.  See Vibration.
    4.  Place the patient upon a stool; the operator places his knees between the shoulders, grasps the wrists, and raises the arms slowly but strongly high above the head; pressing hard with the knee as he lowers the arms with a backward motion.  Patient should always be instructed to inhale when the arms are raised.  All manipulations must be slow, careful, and strong; particular care should be taken in treating thoroughly through the upper dorsal region, as it is here, in these diseases, that we usually find contracted muscles pressing upon nerve-centers which control the lungs, thereby causing or aggravating the condition.
    The patient can usually be relied upon to caution the operator if too much strength is being used.
    A thorough treatment every other day is usually enough to produce the best results, as Nature must be given a chance to do her part.  Light cases of lung trouble can be cured in two weeks by this treatment, and the most stubborn, provided tuberculosis has not set in, in from eight weeks to three months.
    5.  We have recently discovered that stimulation of the spleen by vibration will increase the corpuscular richness of the blood, thereby aiding in the removal of morbid elements from the system.
    This entire treatment should not occupy over fifteen or twenty minutes.
 



 
ACUTE BRONCHITIS
(Inflammation of the bronchial tubes.)

SYMPTOMS
    Light fever; pain in chest; tickling in the throat; soreness under the sternum; sense of oppression in the chest; soreness, due to straining the muscles when coughing; expectoration, at first viscid, subsequently muco-purulent.

TREATMENT
    1.  Place the patient upon a stool; and, with the knee between the scapulae, raise the arms high above the head, the patient inhaling as the arms are raised; press hard with the knee, lowering the arms with a backward motion (cut 5).  Repeat three or four times, as this movement expands the chest and frees the circulation to the lungs and bronchi.
    2.  Place the patient upon the back; with one hand under the chin, the other under the occipital bone (cut 8), give thorough extension, being careful not to rotate the head.
    3.  Pulling gently upon the chin, rotate the head as far as possible from side to side, thus stretching the muscles of the neck, and thereby freeing the circulation to the head, also freeing the pneumogastric nerve which sends filaments to the bronchi and lungs; also manipulate the muscles and trachea very thoroughly as low as the sternum, moving the trachea upward as much as possible, as this movement materially assists in freeing the circulation.
    The treatment, while thorough and deep, should be so very gentle as to give no unnecessary pain.
    4.  Standing in front of patient, place the hands upon each side of the neck, the fingers almost meeting over the spines of the upper cervicals; tip the head backward and press gently for two or three minutes to reduce the fever (cut 35).
    It is at this point that we can reach the vaso-motor nerve-center, a steady pressure upon which will reduce almost any fever.  See Vaso-motor.
    5.  Vibrate gently over the affected part.  See Vibration.
    This entire treatment should not occupy over fifteen minutes.  Immediate relief is usually experienced; and a few treatments, given one each day, will effect a speedy cure.
 



 
CHRONIC BRONCHITIS
(Results from repeated attacks of the acute form.)

SYMPTOMS
    It usually first makes its appearance as a winter cough, becoming continuous subsequently; the breath is short; muco-purulent expectoration.

TREATMENT
    The treatment for chronic bronchitis is the same as in the acute form, with the exception that treatments need not be given oftener than every other day.  While we may look for the same results, it will take from two to three months to effect a cure.
 



 
CAPILLARY BRONCHITIS
(Inflammation of the smallest bronchia, and usually secondary.)

SYMPTOMS
    This disease is most common in children and old people; the respiration is hurried, and, in addition to other symptoms, the cough is severe; expectoration scanty; the pulse rapid, with moderate fever.

TREATMENT
    1.  Place the patient upon the back; and, with the right hand beneath the left shoulder, the fingers pressing upon the angle of the first rib, with the left hand grasp the patient's left wrist, and draw the arm high above the head (cut 9); press hard upon the angle of the rib as the arm is lowered with a backward motion, the elbow passing below the edge of the table.  Work in this manner as low as the eighth rib, the patient inhaling each time as the arm is raised.  Treat the opposite side in a similar manner.  This treatment moves the ribs, stretches the intercostal muscles, expands the chest, and frees the entire circulation to the bronchial an obstruction of which causes inflammation of the smallest bronchia.
    2.  See 2, 3, 4, and 5, Acute Bronchitis.
 



 
FIBRINOUS BRONCHITIS
(Usually chronic, and is characterized by expectoration of fibrinous casts.)

SYMPTOMS
    Paroxysmal cough; a decided cyanosis - a diseased condition of the circulation, causing a livid, bluish color in the skin; - dyspnea - labored and difficult breathing; - there may be bleeding from the nose.  This disease is more common in males.

TREATMENT
    By expanding the chest, vibration, or any manipulation which will free the circulation, we can hope for good results.  But a very small per cent of these cases are cured.  See Chronic Bronchitis.
 



 
PUTRID BRONCHITIS
(May accompany other bronchial affections, and is characterized by inflammation and ulceration of the bronchial mucous membrane.)

SYMPTOMS
    Irregular fever; occasional chills; cough; breath and sputa highly offensive.

TREATMENT
    This disease is seldom cured by Osteopathy, but is sometimes greatly benefited.  For treatment, see Chronic Bronchitis.
 



 
BRONCRIECTASIS
(Dilatation of the bronchi.)

SYMPTOMS
    Usually complicated with other bronchial troubles; difficult breathing; paroxysmal cough; mucus, pus, and casts of tubules in the sputa; more common in males.

TREATMENT
    This disease is sometimes benefited by osteopathic treatment.  See Chronic Bronchitis.
 



 
CATARRHAL PNEUMONIA OR BRONCHO-PNEUMONITIS
(Inflammation of the lungs, beginning with the bronchi.)

SYMPTOMS
    Harsh breathing; shallow respiration; temperature elevated; muco-purulent expectoration; and cough.

TREATMENT
    1.  Place the patient on the side; beginning at the upper cervicals, with the finger-tips close to the spine, move the muscles upward and outward with a circular motion, gently but deep, the entire length of the spinal column.  Treat the opposite side in a similar manner.  Tender spots will be found about the third or fourth dorsal, upon which a pressure will cause the patient to cough; manipulate very thoroughly over these nerves.
    2.  Place the patient on the back; the hand resting lightly upon the thorax immediately over the right lung, vibrate gently one minute.  Treat the opposite lung in a similar manner.  See Vibration.
    3.  Place the right hand under patient's left shoulder, the fingers pressing upon the angles of the second rib; with the left hand draw patient's left arm high and strong above the head as the patient inhales.  Press hard upon the angle of the rib as the arm is lowered with a backward motion (cut 9).   Work in this manner as low as the eighth dorsal.  Treat the opposite side in a similar manner.  Great caution must be exercised not to fatigue or exhaust the patient.
    4.  Place the left hand under the chin, drawing the head gently backward and to the right, at the same instant manipulating the muscles upon the left side of the neck with the right hand.  Treat the opposite side and front of the neck in a similar manner.  This treatment frees the circulation to the head, also frees and stimulates the pneumogastric nerve, filaments of which assist in controlling the lungs.
    5.  Place the hands upon each side of the neck, the finger-tips almost meeting over the spines of the upper cervicals; press gently with the fingers three or four minutes upon the vaso-motor to control the fever.  See Vaso-motor.  The treatment should be given each day, and should not occupy over fifteen or twenty minutes.
 



 
ACUTE MILIARY TUBERCULOSIS
(Disseminating tuberculosis.  May involve several organs.)

SYMPTOMS
    Very similar to those of acute bronchitis; rapid pulse; high fever; delirium; profuse perspiration; prostration; and symptoms of intoxication.
    No cure in Osteopathy.
 



 
INTERSTITIAL PNEUMONITIS
(Induration of the lungs, by interstitial over-growth of fibrous tissue.  Due to inhaling particles of dust, steel or cotton.)

SYMPTOMS
    Curvature of the spinal column; shoulders drawn down; chest retracted; ribs drawn together; heart displaced towards the affected side.
    No cure in Osteopathy.
 



 
PULMONARY EMPHYSEMA
(Dilatation - produced by the infiltration of air of the air-cells of the lungs.)

SYMPTOMS
    Very distressing cough; difficult breathing; scanty expectoration; enlarged chest; ribs fixed in position of full inspiration; expectoration is attended with a succession of puffs.  More common in males.
    No cure in Osteopathy.
 



 
PULMONARY CONGESTION
(Excessive amount of blood in the lungs, which diminishes the air-space.)

SYMPTOMS
    Cough; difficult breathing; increased fremitus,  vibration or thrils; and bloody expectoration.

TREATMENT
    In the treatment of this disease it is very necessary to use our utmost endeavor to free the circulation to and from the lungs, if we hope to relieve their congested condition.
    1.  Place patient upon the side; beginning at the last cervical vertebra, the fingertips barely touching the spine, move the muscles upward and outward with a circular motion, gently but deep, the entire length of the dorsal region.  The spine will usually be found in a very sensitive condition, particularly between the third and the sixth dorsal, where a pressure of the hand will instantly produce a paroxysm of coughing.  Treatment in this region should be very thorough.  Treat the opposite side in a similar manner.
    2.  Place the patient upon the back;  one operator placing the left, the other the right hand, beneath the shoulders, the fingers pressing upon the angles of the second ribs; with the disengaged hands grasp the patientís wrists, drawing the arms gently but strongly above the head, the patient filling the lungs with air; press hard with the fingers upon the angles of the ribs as the arms are lowered with a backward motion.  Move the fingers to the next ribs below, and repeat the operation until the sixth rib is reached.  This treatment expands the chest, and usually gives immediate relief.
    3.  Place the hand lightly upon the thorax, over the right-lung, and vibrate gently for one minute.  See Vibration.
    4.  Treat the other lung in a similar manner.  This treatment tends to equalize and free the circulation in the congested lung.
    Care must be exercised, in giving this treatment, not to unduly fatigue or exhaust the patient; on the contrary, if the treatment is given in a correct manner, the patient will feel refreshed and invigorated.
    It is always well after each treatment to place the hand upon the sides of the neck, finger-tips almost meeting over the upper cervicals, and press gently for three or four minutes upon the vaso-motor to reduce the fever and quiet the patient.  See Vaso-motor.
 



 
PULMONARY EDEMA
(Serous exudation into the air-cells of the lungs.)

SYMPTOMS
    Similar to congestion but in a more aggravated form; large quantities of sero-mucoid fluid is expectorated; moist rales, - sounds additional to that of respiration, heard on auscultation of the chest, are detected.  Often occurs with heart disease, or may be associated with dropsical conditions.

TREATMENT
    This disease is very seldom cured, but is sometimes benefited by osteopathic treatment.  See Pulmonary Congestion.
 



 
PULMONARY ABSCESS
(Abscess of the lungs.  Always secondary, and must be considered in connection with its cause.)

SYMPTOMS
    Sputum is copious, purulent, and often offensive, and contains elastic fibers.

TREATMENT
    This disease is often benefited and sometimes cured by the Pulmonary Congestion treatment, being very particular to give thorough vibration immediately over the abscess.
 



 
PULMONARY THROMBOSIS AND EMBOLISM
(Plugging of the pulmonary artery or its branches by coagulation in the right heart or veins.)

SYMPTOMS
    Pain in the chest; rapid breathing; craving for air; an intense dyspnea; heart's action irregular; temperature may be below normal, but may rise later.
    No cure in Osteopathy.
 



 
PULMONARY GANGRENE
(Mortification of the lungs.  Frequently results from pneumonia.  Is always secondary, and due to obstruction.)

SYMPTOMS
    A brownish purulent expectoration, having a gangrenous odor, and containing fragments of lung tissue; fever.
    No cure in Osteopathy.
 



 
CROUPOUS PNEUMONIA, OR LUNG FEVER
(Inflammation of the lung tissue.  Characteristically accompanied by fever reaching its height about the ninth day, local pain, cough, expectoration, and dyspnea.  Frequently complicated with other diseases.)

SYMPTOMS
    Croupous pneumonia generally comes on insidiously, with restlessness and feverish disturbance, and sometimes has made great progress before the true character of the disease has been discovered.  There is a deep-seated, dull pain beneath the breastbone or shoulder-blade; a great feeling of illness; frequent short cough, with expectoration of viscid matter of a green, yellow, or pale color, sometimes tinged with blood, which forms such tenacious masses that inversion of the vessel containing them will not detach them.  Profuse green expectoration is a serious symptom.  The breathing is hurried and difficult, the skin hot, especially in the regions of the armpits and ribs; there is no moisture in the nostrils, and there exists great thirst.  If the disease is unchecked, the face often exhibits patches of redness and lividity and the blood-vessels of the neck become swollen and turgid.  The patient may sink either from exhaustion or obstruction of the lungs.
    There is shortness and jerkiness of breath, breathing forty or fifty times a minute; red spot on the cheek of the side affected; low or whispering voice; chills; fever; full, rapid pulse; sharp pain in the chest; cough dry, then in two days the expectoration becomes rusty and bloody.

TREATMENT
    1.  Place the patient on the side; beginning at the upper cervicals, move the muscles upward and outward the entire length of the spinal column, gently but deep.  Treat the opposite side in a similar manner.
    2.  Place the patient on the back; with one hand under the chin, the other under the occipital bone, give gently extension and rotation of the neck.  Also manipulate all muscles of the neck, carefully but very thorough and deep.
    3.  Place the left hand under the right shoulder, fingers resting upon the angle of the second rib; draw the right arm very gently, but strong, above the head as the patient inhales; lower the arm with a backward motion, pressing hard upon the angle of the rib at the same instant.
    Treat the third, fourth, and fifth ribs in a similar manner, and repeat the operation on the opposite side.
    4.  Place the hand lightly over the right lung and vibrate gently two minutes.  Treat the opposite lung in a similar manner.
    5.  Place the hands upon the sides of the neck, the fingers almost meeting over the spines of the upper cervicals; tip the head backward, pressing hard upon the vaso-motor center for five minutes, to reduce the fever.
    This treatment, if the case is taken in any reasonable time, will give immediate relief, and a continuation of the treatment a speedy cure.
    Treatment will occupy about fifteen or twenty minutes, and should be given each day.
 



 
PNEUMOTHORAX
(Air in the pleural cavity.)

SYMPTOMS
    Shallow, hurried breathing; pain in the chest; metallic tinkling may be heard; chest distended on the affected side.

TREATMENT
    This disease is very difficult to manage, but is sometimes benefited by our Asthma treatment.
 



 
ACUTE PLEURISY
(Inflammation of the pleura.)

SYMPTOMS
    Sharp and stabbing pain in the side; difficult breathing; fever; cough; the pain generally on a level with the nipple, usually anteriorly to the axilla.

TREATMENT
    1.  Trace the rib or ribs under which the pain is located to their angle near the spine; place the thumb of the right hand, should the seat of pain be located in the left side, upon the angle of the first rib above the seat of pain; with the left hand draw patient's left arm high and very strong above the head (cut 10) as the patient fills the lungs to their utmost capacity; press hard with the thumb as the arm is lowered with a backward motion.  Apply the same treatment to the next two lower ribs.
    This treatment seldom fails to give instant relief; and two or three treatments usually effect a cure.
    2.  Should the case prove stubborn and fail to respond to the above treatment, stand behind the patient, who should be seated upon a stool, and place the thumbs on each side of the spine upon the angles of the third ribs; the assistant standing in front and grasps the patient's wrists, raising the arms slowly with great strength high above the head (cut 11), the patient inhaling, and relaxing all muscles. This treatment stretches the intercostal muscles and expands the chest, thereby freeing the blood-supply to the pleura, an obstruction of which has caused its congested condition.  Always press hard upon the angles of the ribs as the arms are lowered with a backward motion, the patient permitting the elbows to bend.  Place the thumbs upon the angles of the fourth ribs, while the assistant raises the arms as before.  This operation should be repeated until we are below the seat of pain.
    This treatment usually gives immediate relief, and always effects a cure in a very short time.  Treatment should be given once each day, until a cure is effected.  All manipulations, while strong, should be slow and gentle, great care being exercised to give no unnecessary pain.
 



 
CHRONIC PLEURISY
(Results from acute attacks.)

SYMPTOMS
    Curvature of the spine; chest contracted; heart displaced; scapula dislocated, and shoulder deformed; chills; sweats; and accelerated pulse.
 
TREATMENT
    Chronic cases of pleurisy which have not reached what might reasonably be considered an incurable stage can be relieved, and a very large per cent cured, by a continuation of the treatment as laid down for Acute Pleurisy.
    Treatment should be given every other day, and should occupy not over ten minutes.  We may expect a cure, according to the nature of the case, in from one to three months.
 



 
EMPYEMA
(Effusion of pus into the pleural cavity.)

SYMPTOMS
    If the effusion is on the right side, the diaphragm and liver are depressed; if on the left, the heart is displaced and the apex beat is found in the epigastrium; palpable vibrations of the chest walls absent; heart action rapid, and pulse feeble.

TREATMENT
    This disease, although sometimes benefited, is seldom cured by Osteopathy.
    1.  A light treatment as in Pleurisy, should be given.
    2.  Place the patient on the back; the hand resting lightly over the diseased portion of the pleura, vibrate gently for three or four minutes.  See Vibration.
 



 
HYDROTHORAX
(Dropsy of the chest.  Usually occurs in the course of debilitating disease.)

SYMPTOMS
    General symptoms of effusion; difficult breathing, relieved only by an upright position; no symptoms of inflammation.
    No cure in Osteopathy.
 



 
HEMOTHORAX
(Effusion of blood into the pleural cavity.  May result from rupture of an aneurism, or may be in connection with a serous effusion; if the latter, it likely indicates carcinoma, or tuberculous disease.)

SYMPTOMS
    General symptoms of effusion, such as no pain or frictional sound; enlargement of the affected side; displacement of the organs; diminution of movement.
    No cure in Osteopathy.
 



 
INTERCOSTAL NEURALGIA, OR PLEURODYNIA
(Pain in the intercostal muscles.)

SYMPTOMS
    A constant aching or burning pain, aggravated by turning, twisting, or breathing; the side is also sensitive to touch; it often leaves one side and attacks the other.

TREATMENT
    This disease can usually be quickly relieved, and while somewhat slow, can be nearly always cured by our Acute Pleurisy Treatment.
 



 
DIAPHRAGMATIC PLEURISY
(Inflammation of the pleura involving the diaphragm.)

SYMPTOMS
    Greater elevation of temperature than in ordinary pleurisy; pain in the epigastrium; hiccough; vomiting; nausea; intense dyspnea; peritonitis may occur at any time.

TREATMENT
    1.  See Acute Pleurisy.
    2.  Standing behind the patient, place the fingers upon the transverse processes of the third, fourth, and fifth cervical vertebrae; press the muscles forward and slip the fingers down in front of the transverse processes, where a pressure can be exerted upon the phrenic nerve, near its origin (cut 12).  This nerve controls the diaphragm, and a pressure at this point breaks the nerve-wave to this muscle, and consequently slows its action, as is fully explained under the head of Hiccoughs.  The phrenic nerve should be held about two minutes.
    3.  Place the hand lightly over the pit of the stomach and vibrate gently two minutes.
    4.  Press gently upon the stomach, slowly increasing the pressure, until as much strength is exerted as patient can endure without too much inconvenience.
    Standing beside the patient, place one hand upon each side of the neck, the first fingers resting against the occipital bone, the index fingers meeting over the spine of the upper cervicals; tip the head slightly backward, press gently with the fingers for three or four minutes upon the vaso-motor center (cut 13), thus reducing the fever.  See Vaso-motor.
    Treatment should be given every day, occupying about fifteen minutes.