Essentials of Osteopathy
Isabel M. Davenport, M.D., D.O.
NATURE'S AID IN TREATMENT.
Hence you will see and understand how it is that
the Osteopath is able to affect the inner life or the internal organs by
manipulating the body externally, and yet the point is made one for much
ridicule by physicians who have condemned Osteopathy as perfectly foolish
because they either did not understand the theory upon which the Osteopath
works or they did not thoroughly know their Anatomy and Physiology.
Remember that the tendency of Nature is to the normal
or natural, and if given a little help she will readjust things to their
normal course; and so in your work you will always have the assistance
of Mother Nature if you do not work against her, and for this reason it
is possible often to correct lesions and remove obstructions by stimulating
the blood supply or by increasing the flow of blood through the body.
By throwing open the vaso-motors and flushing the capillaries you increase
elimination. The blood makes its circuit through the lungs more often
and is purified, and the muscles and all tissues become strengthened and
adjust themselves to their normal positions and conditions. The old
theory of keeping an injured part quiet is fast becoming nil. It
was one of the hardest things for me to get away from, but after I had
seen and experienced the perfect rationalism of keeping the blood moving
and not allowing venous congestion to take place or to remain I no longer
hesitated to begin gently manipulating the sorest part (even to a bad sprain
of my own ankle) at once, and by stimulating the surrounding vessels to
aid them in carrying away the products of injury and inflammation, thus
relieving pain and pressure, and to bring new blood to the injured vessels
and tissues, and thus to rebuild and strengthen them on to resolution and
complete health in a much shorter period of time than by the old method
of bandages, casts and "perfect quiet." You will have some difficulty in
inducing patients to walk on a sore limb or use a sick part when it is
painful to do so, and there is a limit even to this method, for you must
remember that you have an injured and weakened lot of vessels in the sick
part and they will not be able to empty themselves of blood brought to
them as readily as if they were normal, hence by over-treating or over-stimulating
circulation you may keep too much blood moving in a given part and produce
inflammation. As an example, I had a patient who was suffering from
synovitis of the knee joint due to an injury. Her physician, a regular
of high standing and of broad mind, referred her to me for treatment.
I visited her at her home because she was confined to her bed. The
knee and whole limb was badly swollen and excruciatingly painful.
I began by treating the back from the lower dorsal on down to the foot,
treating both sides and gradually worked around to the sore knee.
The patient was so much relieved by the first treatment that, against my
advice she insisted upon a treatment every day, and after the fourth day
the limb was so much inflamed I was compelled to desist and allow the part
to rest, when I resumed treatment, giving three a week and allowing the
vessels to gradually empty and refill in the interim. Under this
procedure my patient was able to come to my office, although only by aid
of crutches. However, in two months' time she was able to appear
upon the stage as the leading contralto in a concert, but if I had not
understood the theory upon which I worked I could have done the patient,
myself and Osteopathy irreparable damage. Don't for the sake of a
double fee treat patients too often. It will not pay in the end.
Of course, if you have a pale, poorly nourished, anaemic patient who is
warmed and improved by daily treatments give them by all means. What
I wish to impress upon you is that Osteopathy cannot be taken ad libitum
or with irregularity any more than any other therapeutic measure.
Dose your patients as they need it and as best suits their case.
Don't be an egotist or faddist. Remember that while Osteopathy is
an excellent and most successful method of curing disease and ailments
there are many things which aid and assist it. No treatment will
prove satisfactory if the patient is constantly making errors in his daily
living, and so when you take a case in hand look well to his diet.
For instance, if a patient suffers from indigestion and a congested liver
the case will not yield to treatment if he keeps up the trouble by drinking
coffee and eating large quantities of starch food. Without going
into the subject fully here your Physiology will teach you the foods which
are cared for by the stomach and intestines, and also the changes which
take place in the liver. Neither will your patient be benefited by
the increased circulation which your treatment will make possible if he
is shut up in an atmosphere of poisoned and vitiated air. Or, again,
if he does not bathe and keep the skin free from the accumulations of elimination.
Again, there are many ...
[sorry, missing page 33]
... body freely with pure water. Drink it copiously, thus flushing
the alimentary tract and the kidneys. The vaginal douche has been
much overdone and yet it is a comforting, cleanly measure, but should never
be absolutely cold, neither extremely hot, simply comfortably warm --such
heat as one can hold the hand in without wincing is a good guide in the
absence of a thermometer, when 100 - 1100 F. is about correct.
VARIATIONS FROM THE NORMAL CURVES OF THE SPINE.
In examining the spine you will often find an increase
or accentuation in the natural curves of the spine. Sometimes this
means simply an unusual thickening of the spinous processes or of the tissues
covering them, but more often they are due to an actual change in the curves
of the spine. As a general rule the center in the location of the
lesion is affected, either the cerebro-spinal or sympathetic, or both.
If only the superficial muscles are at fault the cerebro-spinal system
only may be affected, but, of course, this may later be transmitted through
the sympathetics to an internal organ. On the other hand, if the
lesion is deep, the sympathetics will be affected and the parts which they
supply. You may find a flattening between the shoulders or an increased
curve, and the centers for the stomach are affected to the eighth dorsal;
or you may get an increase in the curve in the lumbar region, when the
bowels and pelvic organs will suffer, etc. This is not the actual
spinal curvature, which I shall take up later, but merely a deviation from
the normal curve, but enough to cause considerable trouble.
The coccyx is often displaced because of the
fact that it is the end bone of the spine and movable. The most common
abnormal position of this bone is an extreme anterior displacement which
encroaches upon the rectum and is a common cause of constipation, hemorrhoids
and uterine congestion, to say nothing of the reflex troubles which it
is possible to cause. Again, the coccyx may be deflected to one side
or the other, and here the sciatic nerves may be affected through connecting
branches, or directly or by interference with the sympathetic centers.
The uterus and nutrition are involved, as well as the blood supply to the
bowels and pelvis. I have had two cases where the coccyx was completely
displaced in a backward position and was extremely painful because constantly
irritated and injured by pressure from the patient's clothing and movements,
making it painful for the patient to lean back against a chair or anything
hard. One of these cases I was able to correct because recent, but
the chronic case was only relieved by treatment and by wearing a small
soft rubber ring applied by adhesive plaster straps about the coccyx for
In the neck the atlas may impinge upon nerves
affecting the superior cervical ganglion and by its connection with the
fifth nerve, the retina of the eye. Again, the atlas may be displaced
in such a manner as to act upon the cord or as to shut off circulation
to the brain, causing paralysis, insanity, hysteria, etc. In fact,
any abnormality of the structures in the neck is probably most serious.
The position of the first and second ribs is of great importance,
also, to the Osteopath, because by pressure of the first rib or structures
about it there is interference with the cardiac ganglion and the heart
is affected thereby. If the second rib is involved we have difficulty
in breathing, and pressure from this rib is the most common cause of asthma.
But more of this when I take up examination of the thorax.
It sometimes happens that the back in found to be
very stiff and rigid, either in one locality or the whole length of the
spine. This condition is due to a constant contraction of the multifidious
spinae, interspinales and intertransversalis which are the small muscles
attaching one vertebra to another, etc. These contractions bring
the vertebrae so close together that motion between them is inhibited and
is one cause of the little clicking or cracking sounds which you will often
get in examining a patient, and is due to the snapping or grating of the
tendons or the moving of surfaces one upon the other, rather than to dislocations,
which the new operator will be led to take them for unless he keeps this
fact in mind. Of course these noises may be due to displacements,
but you must know how to diagnose between them. Rigidity is most
common in the neck, probably because of exposure to cold draughts.
However, I find it often the case that patients say, "Why, doctor, I did
not realize until since taking treatment that I have not been turning my
neck, but if I wished to look around I turned my whole body."
The lumbar region is the next which is most
commonly rigid, but often it is the whole spine, and you will be able to
feel the deeper layers of muscles hard and cordy through the superficial
ones under your fingers upon deep pressure. The treatment is a thorough
kneading of the whole muscular system, with attention to the vaso-constrictor
centers, relaxing them and relieving the congestion in the muscles, and
after relaxation is established then movements. The danger of this
condition is serious, because the pressure and friction of one vertebra
upon another may set up an inflammatory condition which can be carried
to the meninges or membranes covering the spinal cord, to say nothing of
the impingement of nerves and blood vessels, and the least dangerous but
nevertheless painful condition of the sore muscles of the back and neck.
Spinal Relaxation. - On the other hand you
may have an abnormal relaxation of the spine due to flabby tendons and
muscles, and this is not necessarily the case in an anaemic patient, but
is often found in an apparently fairly well nourished and full-blooded
person in whom the blood supply to this one part is insufficient.
In this case you will find a stoop or if the patient is straight it is
through great effort. On examination you may find separation of the
vertebrae, one or several, with great sensitiveness at the point of separation
-- not soreness, but light pressure causes the patient to jump and show
irritability. The whole skin is very sensitive in these patients
also, probably because the cord is less protected at these points.
This condition is commonly found, especially in children;
the lateral curvature more often than any other and the posterior next,
but the anterior is most difficult to treat when present. In true
spinal curvature there is generally a compensatory curve. These little
blocks of bone piled one upon the other begin to topple because the attachments
on one side are contracted, while those of the other are either normal
or too relaxed. At least one side pulls harder than the other and
to offset this another set of muscles on the opposite side and lower down
or higher up begin to contract, and so the vertebrae are pulled and pushed
out of line there. If I find curvature of long standing in an adult
I never expect to fully correct it, but in children it yields readily to
treatment, and some of the most brilliant and gratifying results I have
had were in this class of cases. My experience shows me that it is
a mistake to put braces on a patient with view to correcting and displacement
or deformity, inasmuch as the pressure made upon the muscles causes them
to atrophy and become flabby, thus making them too weak to hold the parts
in place when the brace is removed, and so I give a thorough muscular treatment
followed by an adjustment of the bony parts every other day and the results
are very satisfactory, both to the patient and physician.
EXAMINATION OF THE THORAX.
In making an examination of the thorax strip your
patient to the waist, seat him on a stool and then observe carefully the
appearance. Normally the right side is a little larger than the left
--bulges more, as it were. You may also find a flattened condition
of the anterior surface. Note whether there is a sinking above the
clavicle or between the ribs whether the soft parts sink in below the ribs,
all of which denotes difficult breathing and cause must be found.
On the other hand, you may find a bulging of the entire anterior wall (pigeon
breast). Note the ensiform cartilage. I have found it hard
and sticking out in front; also in other cases depressed and pointing inward.
Note the attachment of the ribs, or their cartilages, to the sternum, often
I have found them very irregular and the end of the rib either too much
depressed or drawn up too close to its neighbor, engaging the intercostal
nerves, causing neuralgia and pain. Note the clavicle, sometimes
you will find either end flattened or depressed or down too far, in or
out. Learn the structures under these articulations and their functions,
then you will know what the result ought to be by interference with them.
Because of a tightening of all the muscles of the thorax or of the intercostal
muscles the chest walls are rigid and all of the ribs are drawn too closely
together; in such cases you will generally find intercostal pain and soreness
along the course of the ribs and sometimes the nerves of the arm are involved.
Not all of the irregularity which you may find on the surface of the thorax
is due to displacements, for you may have here or in the vertebrae one
rib heavier and thicker than its mate, and of course it will make an irregularity.
But find the articular ends and note their approximation to the other articular
surfaces. Hazzard gives the following rules for counting the ribs:
RULES FOR COUNTING THE RIBS.
"In passing your fingers down the sternum in front
you can readily detect where the first part ends and the second part begins.
Here is the junction of the cartilage of the second rib with the sternum.
The first rib is found by feeling behind the clavicle above, at about the
junction of the middle and inner thirds. You can by deep pressure
come to the first rib. The first and second ribs give a great deal
of trouble, and it is important to keep in mind this rule to find them.
In the male the nipple is usually between the third and fourth ribs, three-quarters
of an inch external to the line of the cartilages. It is said that
the lower border of the pectoralis major corresponds in direction with
the fifth rib; that a horizontal line drawn from the nipple around the
body will cut the sixth intercostal space at a point midway between the
sternum and the spine.
"When the arm is raised the highest visible digitation
of the serratus magnus corresponds with the sixth rib, and the seventh
and eighth digitations correspond with the seventh and eighth ribs
below. I have already noted that the scapula lies on the ribs from
the second to the seventh inclusive. The eleventh and twelfth ribs
are readily recognized, even in fleshy persons, at the outer edge of the
erector spine, sloping downward. The sternal end of each rib is lower
than the end which joins the spine, and it is said that if a horizontal
line were drawn from the middle of the third costal cartilage at its junction
with the sternum, it would touch the body of the sixth dorsal vertebra.
The end of the sternum is upon a level with the tenth dorsal vertebra,
varying some in different individuals, more in females than in males."
Along the posterior surface of the thorax you may field the ribs too widely
separated or the ends dislocated from the vertebrae -- not torn away, but
slipped or twisted in any direction. The first and second ribs are
usually drawn upward. That is the most common abnormal position for
them, and it is just as common a rule that the last two are drawn down,
probably because in the upper ones the scalene muscles are attached in
such a manner that when contracted they draw the ribs up, while in the
lower ones the Quadratus Lumborum is attached to the last and draws both
it and the eleventh one downwards. The position of the first and
second ribs is of great importance because by pressure upon the sympathetic
ganglion and all the important nerve and blood supply in that locality
the heart and lungs are very much affected, and often serious symptoms
may be relieved by reducing pressure, either from these ribs, the clavicle,
or from vertebrae, and it may be all three structures in this region.
It is such cases as this which have been diagnosed as organic heart trouble,
which the Osteopath cures miraculously, so it appears to those who do not
understand the theory of Osteopathy. To make a diagnosis of malposition
in these ribs first find whether the clavicle is in its normal position,
then feel down about the middle of the clavicle, press down and back, and
you will find the first rib. If it is slipped up it will come to
or near the upper margin of the clavicle. If it is down the distance
between them will be greater. Hazzard says, "A depression at the
junction of the end of the first rib with the sternum usually indicates
that this rib is raised and thus drawn away from the articulation.
A prominence at the same place indicates the reverse. Such points
are usually tender to the touch and the tenderness may extend along the
rib as far as the clavicle."
The second rib is more difficult to treat, but the
articulation in front is at the juction of the manubrium or upper bone
of the sternum with the second bone or gladiolas in the back. A dislocation
of this rib may be determined by a soreness over the attachment with the
first dorsal. You can make deep pressure upon the head of this rib
by measuring one inch outward from the posterior spinous process of the
first dorsal vertebra. Of course the head of this rib cannot be well
distinguished because of the thick muscles at this point, but you can detect
soreness and work about the head is such a manner as to relieve its pressure
upon other structures.
The floating ribs often overlap one another at the
loose ends. Sometimes this gives no inconvenience, when of course
you let them alone, but again they are often responsible for pain in the
side or limb, and may even and indeed often do press in upon the liver,
spleen or intestines, causing congestion, pain and inhibition of these
organs. The position of all the lower ribs is rather easy to determine
because of the softer walls about them and because by raising the limbs
of the patient you may relax the muscles of the abdomen and feel through
them the hard rib.
THE CLAVICLE AND ARM.
Displacement of the clavicle is of great importance
because it is a landmark for the first and second ribs and because of so
many important attachments to it, and more than all else because of the
important nerve and blood supply under and about it.
The clavicle may be displaced in any direction, at
one end or at both. The most common displacement is downward at the
outer end because of the attachment of the deltoid and Pectorals major
muscles. Dr. Still's manner of correcting this is to place his fingers
against the anterior edge of the sternal end of the clavicle, then with
his other hand to draw the patient's arm inwards across and close to the
chest, thus relaxing the muscles; then, while pushing upward upon the anterior
edge of the clavicle, to draw the arm up and backward. If the clavicle
is slipped up at the acromial end it will probably impinge on the fibers
of the brachial plexus, causing pain, or catch some fibers of the deltoid
muscle and the patient comes to you complaining of rheumatism of the shoulder,
neck and arm. Here Dr. Still raises the arm to relax the muscles
over the shoulder, and placing his fingers behind the part that is slipped
up moves the arm in different directions until the end slips back to its
normal place. At the sternal end you treat in much the same way,
bringing the arm forward, first to relax the muscles and give room for
the fingers of your other hand, there move the the arm to relax the muscles
over the shoulder, and arm forward, downward and backward, thus tensing
the muscles and making them draw the bone back while you push it.
The forward or backward positions are not as frequent, though perhaps that
is an error, for in asthma I almost invariably find the clavicle drawn
back and downward, making great pressure upon the blood supply and trachea.
In asthma there is a general spasm of muscular tissue, and the muscles
about the neck and chest are in a state of contraction all the time, which
accounts for this malposition, and by manipulating the muscles, relaxing
them, removing the clavicle and perhaps the first and second ribs from
their false positions, and finally by making gentle pressure over the recurrent
laryngeal and phrenic nerves I have relieved many asthmatic patients who
were suffering intensely because of difficult breathing. In these
cases I free the clavicle by placing the fingers of one hand above and
behind it while I raise the arm up and bring it across the patient's face
and over the head and back and then downward.
Of course while you are examining the clavicle the
head of the humerus must be looked to, for much of the pain in the axilla,
chest, shoulder or back, swelling of the lymphatics and pain in the arm
or hand may be due to pressure from the head of the humerus. One
very common displacement is a slipping of the head of the humerus out against
the acromion or coracoid process. Probably it is more often drawn
into this position by the contracted muscle, causing the tendons to bind
or hold it here, or there may be some of the deltoid fibers under the coracoid
process. At any rate we often find patients who complain of a catch
there and of inhibition in movements of the arm upwards or backwards, and
by drawing the arm slowly upward and backward, then manipulating over the
process and drawing the arm out and downward, you may relieve the difficulty.
Or you may find the biceps contracted and by straightening the arm and
drawing it backward you bring tension upon it and inhibit its nerve force,
thus relaxing the spasm and relieving the pain.
Going on down the arm you may find soreness the whole
length upon deep pressure, especially along the course of the median nerve,
which shows pressure at some point upon this nerve; usually from the muscles,
which you may find hard in small areas. These sore spots in the muscles
are probably due to a congested area which retains the poisonous gases
or ptomaines from the venous blood, but when you find soreness the full
length of the arm you may expect to find the median nerve engaged some
At the elbow you may find different dislocations.
The ulna and radius may both be drawn backward or internally or externally.
The ulna may be displaced backward and the radius forward. The olecranon
process of the ulna and the condyles of the humerus are your guides as
to normal positions of the articulation at the elbow. After injury
you may have simply a stiffness of this joint, due most commonly to contracted
muscles and tendons, and sometimes to inflammatory exudate, or, if of long
standing, ankylosis. A systematic manipulation of the muscles, not
alone of the arm but of the shoulder and back, gradually relaxing and stretching
them with movements of the joint to favor circulation and carry away inflammatory
products, relieving stiffness of the joint, has always given me a most
At the wrist you most often have both bones
dislocated either backward or forward, though it may be only one of the
long bones; but the small bones of the wrist may be shoved or pulled about
in many ways, and the sore points will show this at once. The fingers
are easily dislocated and easily readjusted. Always treat the muscles
about a dislocation first, thus relaxing them, then pull gently and gradually
out upon the displaced bone before moving it in the direction in which
it needs to go. The tendency to the normal will help greatly in correcting
I have said little so far about the scapula
which is bound down so securely by muscles that the only trouble from it
will be contraction of these muscles which draw it too closely down or
a relaxed condition which with a bulging of the chest walls gives the scapula
the wing-like appearance which we sometimes see. We often stretch
these muscles and raise the scapula when
there is too much pressure upon the nerve and blood supply beneath.
THE NECK, FACE AND HEAD.
Examination of the neck, face and head. As
I have told you the neck is a most important point to the Osteopath and
much more important to the patient. The structures here are very
superficial and through them and their connections the operator may influence
the entire body directly and indirectly.
LANDMARKS OF THE NECK
The median line of the neck is called by surgeons
the line of safety because in this locality there are no important nerves
or blood vessels and the trachea is very superficial, making it possible
to operate here for membranous croup or for other cause with comparative
safety. Beginning from above just under and well up on either side
of the angle of the lower maxilla are the tonsils which may be readily
felt externally and are easily treated here, next is the hyoid bone,
on a level with and just beneath the middle of the lower jaw. The
gap just below it corresponds to the apex of the epiglottis. The
thyroid cartilage is easily traced, especially the upper and lower
cornuae. The lateral lobes of the thyroid gland lie on each
side of the thyroid cartilage, and is important because of the common enlargement
of the gland known as goiter. The superior thyroid artery
lies across the center between these lobes and you may feel the pulsation
by the finger. The circo-thyroid membrane is next in line
and is the usual point for the operation of laryngotomy. The cricoid
cartilage, which is next, corresponds to the junction of the fifth and
sixth cervical vertebrae and is the level of the oesophagus. The
superior opening of the oesophagus is about an inch and a half above the
superior border of the sternum. The trachea arises above the sternum
for the length of 7 to 8 rings, but cannot be felt because covered by muscles
and is deeper than the structures above it.
At the sides of the neck the sternomastoid muscle
is the most prominent and is attached to the mastoid process of the temporal
bone above and to the sternum and clavicle below. The carotid artery
and pneumogastric nerve pass down under the anterior margin of this muscle
and under the rectus capitis anticus muscle. The external jugular
vein corresponds to a line drawn from the angle of the lower jaw or inferior
maxillary bone to a point at the middle of the clavicle. In the suboccipital
fossae or hollows of the neck, between and under the mastoid process and
the attachment of the trapezium muscle, you get the great and suboccipital
nerves, and in this region you often find soreness, especially in patients
who suffer from stomach trouble, indigestion, etc., probably because of
the proximity of the pneumogastric nerve and also the spinal accessory,
which with the glossopharangeal makes its exit through the same foramina
(the jugular) with the pneumogastric. The phrenic nerve arises from
the third, fourth and fifth cervical nerves, and may be reached at the
anterior border of the scalini muscles in front of the transverse processes
of the vertebrae. You may also reach this nerve at the inner side
of the sternoclavicular articulation, and this is the usual point for treatment
of this nerve. By making pressure upon the nerve at this point you
rarely fail to stop hiccoughs, no matter how persistent. Of course
you will note the position of the vertebrae and the greater thickness of
the skin in the back of the neck, also the ligamentum nuchae deeper in
and extending from the occipital protuberance to the spinous process of
all the cervical vertebrae.
The lymphatic glands may be and often are enlarged
in the neck and along the spine, and the latter are especially irritating
to the nerves by the friction which they make in slipping over them with
the patient's movements.
LANDMARKS OF THE FACE.
The most important points here are the three terminal
branches of the fifth nerve, which make their exits from the supraorbital,
infraorbital and mental foramina. Hazzard says "a line passed from
the supraorbital foramina (which is at the inner and upper borders of the
orbital arch, or just at the inner edge of the eyebrow) between the two
bicuspids will pass over the remaining two foramina." He also says,
"The supraorbital branches of the fifth nerve run from the supraorbital
notch back over the temple, forming an angle of about forty degrees with
the line of the superciliary ridges. They may be easily felt beneath
the tissues and can be traced back over the temples." The supraorbital
branch is usually found to be very sore at the place of exit., i. e., the
supraorbital notch, in headache and neuralgia, and friction or pressure
over this point, with a thorough loosening of all tissues of the neck,
head and face, relieves both these symptoms.
The superior and inferior dental nerve runs along
the upper border of the superior maxillary and the inferior maxillary bones
respectively. The seventh nerve may be reached at the middle of the
outer edge of the ramus of the inferior maxillary bone just in front of
the lobe of the ear.
LANDMARKS OF THE HEAD.
At the junction of the inner and middle thirds of
the supraorbital arch you will be able to feel the pulsating supraorbital
artery as it passes up over the forehead.
The temporal artery may be an inch and a quarter
behind the external angular process of the frontal bone.
The bony prominences of the head are the occipital
protuberance, which is the thick prominence at the back of the head, just
above the hollow of the neck.
The parietal eminences are on either side of the
head above the ears, and the temples, as you know, are the thinnest portion
of the skull.
The occipital artery is felt near the middle of a
line drawn from the occipital protuberance to the mastoid process, which
is the prominence just back of and below the ear.
The posterior auricular artery may be felt near the
apex of the mastoid process. The scalp is thick and should be easily
moved over the cranium, but is often found tight and immovable. You
may find small tumors of the scalp, which are usually benign and only enlargements
of the sebaceous glands. A tumor of the skull will be immovable,
while these move about under the examining finger. The scalp is usually
tight and contracted in headache cases, and in treating for this disorder
always treat well over the head, moving the scalp in all directions.
The anterior fontanelle in the infant is a diagnostic point. Normally
it should be level but if there is an abnormal accumulation of cerebral
fluid it will rise above the level, while if the child is suffering from
any depleting disease, such as diarrhoea for instance, you may find the
The eye, ear, nose and throat come under consideration
in examining the head. I never meddle with the ear. Let a specialist
treat this delicate and difficult organ, but much may be done by treating
the eye osteopathically. The superior cervical ganglion is the chief
point from which to treat the eye through the ascending branch to the carotid
and cavernous plexuses and through the connection which it has with the
fifth nerve. The ciliary ganglion also connects with the superior
cervical ganglion, and hence by freeing the muscles in the neck and face
and stimulating or inhibiting the superior cervical ganglion we may relieve
congestion and inflammation, and by treating the end nerves through the
eye itself we may affect the nervous organism. I have found that
many of my patients who wear glasses are able to leave them off and do
without them after being treated osteopathically. The muscles of
the eye may be strengthened and the glands and superficial blood vessels
emptied. One of my most successful methods of treating conjunctivitis
is to slip my forefinger up under the upper lid and gently roll the lid
between the finger and thumb. It relieves the swollen blood vessels
and the roughness and scratching which they cause to the cornea.
The tear ducts, which, you know, begin at the inner canthus of the eye,
may be occluded and swollen. They may be relieved by treating all
around them and making pressure over the infraorbital artery. The
nose, mouth and throat may show hyperaemia or growths, such as polypi in
the nose, or hypertrophied turbinated bones. In the pharynx and throat
you may find an inflamed, reddened mucous membrane, with enlarged tonsils
and uvula, and besides the thorough treatment about the neck I treat inside
the throat, over the hard palate, to the tonsils and uvula.
So far we have had in a superficial manner the landmarks
and examination of the spine, thorax, arm, neck, face and head. I
have given them in this order because it is my manner of examining a patient.
My next move always is to make a thorough examination of the heart and
lungs before leaving the thorax and upper part of the body.