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Normally there exists perfect equilibrium of the amount and efficiency of the nerve impulses and the consequent vital energy generated by and originating within the various nerve centers contained in the brain and spinal cord. Under normal conditions there is no interference with the generation of vital energy in the nerve centers, or with the transmission of vital impulses by motor nerves, from the brain and spinal centers where they originate, outward to the various viscera or parts which these transmitting nerves ramify and supply. Vital phenomena and essential functional activity are constantly maintained, under normal physical conditions, in the various parts of the organism as a result of the efficient generation of vital energy or impulses within or by the nerve centers, and of the perfect transmission of the vital impulses by the efferent spinal nerves, to the ganglia of the sympathetic system and to the various parts of the body which they ramify. Such normal conditions will produce the fundamental requirements of perfect health and efficient auto-protection, which will maintain health during the continuation of these normal physiological conditions. Franck, in the "Dictionnaire Encyclopedique des Sciences Medicales" observes, that when one considers the normal functions of the nervous system, he finds that there exists a necessary equilibrium between the different parts of this system. This observation is true of the normal physiological condition which must be present, and continue, to maintain normal functional phenomena which constitutes perfect health. It is the existence and continuation of the equilibrium, and of perfect
co-ordination and reflex action, which maintain perfect health, and it
is the existence of some variation and loss of the perfect equilibrium
of nerve action which engenders derangement of function, and the resulting
in co-ordination or consequences, which is disease.
DISTURBANCE OF EQUILIBRIUM The existence of the normal equilibrium of nerve impulses may be disturbed, and it is always altered or destroyed in case of any temporary or continuous derangement of function, associated with disease. The abnormal functional activity or the consequent organic alterations in the different organs or parts of the body may be due to an excessive action or to a diminished function in the generation and discharge of vital impulses by the spinal centers or to derangement in the transfer of afferent impulses to efferent nerves. The derangement of function in the different organs or parts of the organism may be due to an interference with nerves causing a depression and consequent failure in transmission of the vital impulses to generate the normal amount of vital energy. A condition of over excitability of the transmitting nerves, especially if associated with an over excitable state of their centers of origin or reflex, will produce and maintain an over action, even from normal stimulation. The deviation from the normal equilibrium of function associated with
disease, in the organs or parts applied, may be due to a depressed condition,
or to an over excitability and action of the reflex centers, which will
cause an altered and ab-normal reflex phenomena, which is due to the fact
that the normal or automatic stimulus will fail to produce the normal reflex
functional response, due to the altered excitability of the reflex centers.
RESULTS OF FAILURE OF EQUILIBRIUM The prominent or excessive over action of certain centers in the spinal cord or in the brain, seem to divert, and to contribute to their own use, an excessive amount of vital energy, and in this way there is caused a diminished activity of the other spinal centers in the generation of impulses. The excessive use or waste of nerve energy, which is necessary to overcome refractive errors of the eyes, and pathological conditions of the orifices of the body, as of the rectum or genitalia, may and do materially affect the integrity of the brain and nervous system, and consequently the different viscera and parts of the body. There is generated normally within our bodies, by the nervous mechanism from the nourishment we take, sufficient vital energy to maintain the integrity of the vital phenomena in all parts of the organism and an excessive consumption of nerve energy, to overcome refractive errors of the eyes or overcome the results of orificial lesions, will rob other parts of the organism of their due portion of nerve energy and consequently the weaker portions will suffer. All the different functions of nerves may be influenced by disturbance
or alteration of the normal equilibrium of the activity of the different
nerve centers, as for example the functions of mentality, thermogenic action,
trophic supply, inhibition, excretion, secretion, and muscular action,
in short, all forms of derangement of function may ensue, and infections
and contagious disease may successfully invade, owing to deficient auto-protection
in certain zones.
FUNCTION OF NERVE CENTERS VARY The function of the nerve centers in the brain and spinal cord differ very materially in the vital phenomena which they excite, and in the functions which they, maintain in the organs and parts they supply. There are certain centers in the spinal cord which exert special or specific influences upon the different organs and parts, and there are other centers which exert counter influences, and these various centers are situated in the different portions of the spinal cord. There are centers of nerve origin which initiate nerve impulses of constriction, which are transmitted by the efferent nerves to the parts which they supply; there are centers which cause dilation; there are centers which produce inhibition or depression, and also centers which excite an acceleration and stimulation, of the vital functions in the parts which they supply. For every variety of function produced in the different nerve centers of the spinal cord and brain, there is produced a counter function in some other center thereof. We may stimulate a spinal center, and excite the impulses of contraction or constriction of a certain organ or zone, by concussion or by the application of the sinusoidal current, but we will find it necessary to apply stimulation to an entirely different center, to excite the counter reflex or impulse of dilation. From the results which we obtain, by spinal stimulation, we learn that
the different spinal centers exert different and opposing influences upon
the different organs or parts supplied, and practitioners of spinal therapy
should understand this subject.
REFLEX ACTION VARIES Owing to a deficiency of the nutritive elements, or to an interference with the circulation of the vital fluid within the spinal centers, there may be a diminished or an increased excitability and action of the spinal reflexes. The integrity of the excitability of the spinal reflexes, and of the sympathetic reflexes or automatic action, is very essential, since all the commerce of the body, as salivation of food, deglutition, digestion, peristalsis of the intestines, and all the eliminative processes are directly maintained and controlled by the automatic reflex nerve phenomena. By a general concussion and stimulation, along all or most all of the spinal column, we will stimulate impulses and also counter impulses, which may nullify each other, and for this reason we may fail to secure specific results. Spinal concussion, or stimulation of the spinal centers by any other means, should not be used by anyone who has not a competent knowledge of the specific influence of the impulses which may be excited in each spinal center upon each and every organ which they supply or in any way influence. Every practitioner of spinal concussion, or of any other method of spinal stimulation, should be competent in physical diagnosis, so that they may be able to discern what is advisable and desirable to be accomplished by the spinal stimulation, otherwise they may produce ill effects and discomfort to the patient. To stimulate the subsidiary centers of vaso-constriction, in a case where there is vaso-motor competency, would excite headache and distress, and such an unprofessional mistake is apt to be made when concussion is administered empirically. It is the object of this booklet to make the subject plain, concise and comprehensive, and to give you a competent knowledge of this subject, and to assist all who may read, understand and avail themselves of these most potent auxiliary methods of rational therapy. Those who read, understand and profit by this our humble contribution
and effort to make this matter plain and comprehensive, and those who put
these methods into intelligent use will certainly profit greatly thereby,
while those who for any reason doubt and fail to profit thereby, must bear
the misfortune of dealing with less competent methods in the treatment
of many forms of disease or functional derangement.
IMPORTANT CONSIDERATION We beg to call to the reader's attention some very important considerations in the use of spinal therapy, and some self-evident truth of material worth. No one method of treatment embraces all that is beneficial, either in the line of medical or in surgical methods, nor can any one method of treatment preempt the entire field of therapeutic art to the exclusion of all others. Spinal concussion, nerve pressure, sinusoidal stimulation and freezing over or near the spinal exit of tender nerves, are by no means the only beneficial methods of spondylotherapy. Some of the best and most efficient methods are not used by those who depend wholly upon the above mentioned methods. These measures of spinal treatment, freezing excepted, are administered
to stimulate the spinal centers of the origin of nerves, and to increase
the nerve impulses and consequently the functional phenomena produced in
the parts supplied, and to overcome any failure of the normal equilibrium
of the energy which is being generated in the spinal centers, or of the
vital function which is being produced in the different organs or parts
supplied.
WHY CONCUSSION IS NEEDED The need of this concussion stimulation and increase of function in the parts supplied, is due to a diminished functional activity of the spinal center of nerve origin, which we find it necessary to stimulate to greater activity, or to some interference with the transmission of the nerve energy from the spinal center to the zone which is supplied. This is a self-evident fact since normal, vital impulses amply generated and perfectly transmitted, will maintain normal functional activity in the organs and parts supplied. This is axiomatic. There must exist some interference with nerves, either in the generation
or transmission of vital energy, or else there would be efficient nerve
supply and a perfect equilibrium of the vital phenomena produced in the
parts supplied.
CAUSE OF NERVE INTERFERENCE Nerves are usually interfered with, by pressure upon the nerve sheaths, where they make their exit, or pass between the pedicles of the vertebrae, from the neural canal in the spinal column on their way to the zone which they ramify. The nerve sheaths, containing the spinal nerves, where they extend or pass through these spinal foramina, between the pedicles of the adjacent vertebrae, are surrounded by bone tissue, which is hard and resistant, much more so than nerve sheaths and the nerve fibers, and if any contraction of the spinal musculature occurs, causing an approximation of the vertebrae, there will occur physical, structural interference with the spinal nerve sheaths, and the nerves which they contain. These spinal nerve sheaths, extending through intervertebral foramina, contain arteries passing to spinal cord, veins which drain the neural canal, lymphatic vessels supplying nutrition to the nerve centers, besides the spinal and sympathetic nerve fibers. If the musculature of the spinal articulations contracts, and becomes permanently contractured, causing approximation of the vertebrae, the nerves become impinged or the vessels of circulation occluded, and either will interfere with the integrity of the function of the nerves or nerve centers involved, and consequently of the parts supplied. Occlusion of the arteries will cause anemia of the spinal centers which they supply, and this will retard or destroy their excitability and diminish the generation of nerve impulses, and will also derange or destroy the reflex transfer action in the spinal centers. Obstruction of the lymphatic supply, to the spinal centers, will cut off the nutrient supply to them and thus interfere with their histological or structural integrity and their functional activity. Obstruction of the veins will cause a congestion to occur in the corresponding spinal centers, and this will cause an alteration of the generative power and reflex action in the centers involved. A decided contraction of the spinal musculature will cause a closer approximation of the vertebrae, which may impinge the nerve trunk where it passes between the pedicles, and this will cause pain of a greater or less degree, according to the amount and severity of the impingement. This pain is not felt at the spinal intervertebral foramen, where it
is caused, but it is referred to the terminal endings of the nerve which
is impinged, and is felt in the organs of its terminal ramification.
A SELF-EVIDENT TRUTH We must concede that there is some interference with the integrity of the nerve supply, causing deranged conditions, before we can contend for the necessity of concussion or any other means to stimulate, to alter or increase the function of nerve centers or to correct derangement of function, or to create a balance of equilibrium of nerve impulse generated by the different nerves or spinal centers. Which is the more rational, to stimulate the action of depressed nerves, or to remove the interference which preventing their normal action? Spinal adjustment will relieve contractured conditions of the spinal musculature and overcome interference with spinal nerves. We fully believe that both methods, spinal adjustment and spinal concussion, are excellent, but that a combination of the two methods is the most rational and efficient procedure, and experience has convinced us of this fact, since many cases recover from the use of both methods, which have failed to respond to either of these methods alone. For the latest, best, and most efficient, and least painful methods of spinal adjustment, to relieve interference with nerves, the reader is referred to "Spinal Treatment, Science and Technique" (Gregory), which work is well illustrated and is clear, concise and comprehensive. We fully believe that those who advocate, exclusively, the use of the
methods of stimulation of the spinal centers to greater activity, have
failed to give the subject of spinal treatment intelligent and unprejudiced
consideration, or they could readily appreciate the rationality and necessity
of measures to remove the interference, which mitigates or in any way alters
the function of the nerves or nerve centers.
RATE AND FORCE OF CONCUSSION It has required a great amount of empirical work, and no doubt much more will be necessary, to determine the proper rate of the speed and the amount of the force of the spinal concussion blows, necessary to accomplish the most in obtaining the desired results. There is a very different result obtained by using rapid percussion blows or the rapid sine, than what is obtained by the use of the slow rate of concussion and the slow alternations or breaks of the sinusoidal current. There is a different effect produced by nerve pressure which is applied
for a brief space of time than that which is produced by continuous nerve
pressure for a considerable length of time, and it is necessary for us
to understand the rate, the force and the time of the continuation of our
treatment in order to obtain the best results by the use of stimulating
or depressing methods of spinal therapy.
IMPORTANT CONSIDERATION In this connection, there is one very important consideration or matter to which I would call the special attention of the reader, and that is the difference in the force of the concussion stroke, and amount of stimulation which is required when giving treatments after giving spinal adjustment as compared with the amount of concussion stimulation which is necessary to be administered when we do not first remove all interference with the nerves by spinal stretching or by spinal adjustment. There is a very material difference in the amount of the force of the blow and in the continuation of treatment, or in other words in the amount of stimulation, which is required in giving efficient treatment following proper spinal adjustment, compared to what is necessary when giving treatment by spinal concussion when spinal adjustment bas not been previously given. There is a very material difference in the amount of the impulses, stimulated by concussion, which are conducted by an afferent or motor nerve which is free from interference, than by one which is interfered with so that its conducting power is diminished. The reasons for all these facts are self-evident and obvious to even a casual observer or a superficial reasoner, and this question should be considered intelligently by all physicians who would use spinal concussion, sinusoidal stimulation, or nerve pressure as methods for spinal therapy. If the spinal nerves are free from any interference, and if the nerve sheaths are free from impingement and if the vessels of the circulation, supplying nourishment to the spinal centers and furnishing open channels of drainage are normal in size, then spinal concussion, or other modes of stimulation of nerve centers will not be needed or indicated, except in cases where the interference has been recently removed, and an extra amount of work is to be done, in the part supplied, by the nerves in question. If there is retention from failure of proper elimination and structural alteration occurring during the existence of the nerve interference, we may restore the normal nerve supply, by removing the spinal nerve interference, and still need more than the normal nerve supply of nerve energy to restore the normal condition. We may by spinal concussion applied to a nerve center, after that center and the nerve originating therefrom are freed from all interference, cause the veneration and transmission of double the amount of normal energy which is a most efficient and expedient healing agency. If, because of interference with the nerve in the transmission of the impulses, or if because of interference with the spinal center of origin of that nerve, we have a long continued, diminished and inefficient amount of nerve energy, to maintain health in the part supplied, then will concussion and other methods of spinal stimulation be indicated to augment or hasten recovery, and spinal treatment, to overcome the spinal interference with the nerve or of its center of origin, will be first indicated to obtain the best results. A Comparison For example, let us suppose that because of interference with a nerve or with its center of origin, only one-half of the normal amount of nerve impulses are generated and transmitted to the parts supplied. We will then have but 50 per cent of the normal vital energy and functional phenomena performed in the zone supplied. Stimulation of the center of origin of this nerve may readily double the amount of impulses which are generated by its center of origin, and this will raise the vital energy in the parts supplied to 100 per cent instead of 50 per cent. Now if we first remove interference with a nerve or with its center of origin, which has been furnishing only 50 per cent of the normal amount of energy, then it will, because of the removal of interference, furnish 100 per cent of the normal amount of energy. If we now, when the nerve is furnishing 100 per cent of vital energy, stimulate its center of origin as above we will cause it to produce 200 per cent of energy, which will be conducted to the part supplied. We will then have double the amount of the normal energy which is a most potent and efficient agency for the hasty restoration of the normal condition, and normal functional activity which is health. We can look at this matter from another angle. If we apply spinal concussion to a spinal center of nerve origin, from which the nerve is transmitting but 50 per cent of the nerve energy generated, it will require a great deal more stimulation and more vigorous concussion to increase sufficiently the nerve energy supplied to the diseased zone, than if the nerve conducted 100 per cent or all of the nerve energy, which is excited in its center of origin by the concussion or other stimulation. We obtain results by adjusting the spine and overcoming contractions, and by removing interference with nerves, because by so doing we restore their conducting power to 100 per cent or to a normal amount, and we may obtain better and quicker results by using spinal concussion also to furnish a still greater amount of energy, which will more quickly rejuvenate and reconstruct the histological or structural alterations, which have occurred as a result of long continued functional derangement. Continuation of Effects The permanency of the effects, obtained by the stimulation of any part of the nervous system, is an important item for our consideration. The natural and almost universal rule, concerning the continuation of the effects of stimulation, is that the increased action, which is excited, is transient, and that it is only manifest for a short time after the application of the stimulus, and it is generally true that a corresponding period and amount of depression follows the use of temporary stimulation. It appears to the causal observer that the effect of spinal concussion, which is excitation or stimulation, would prove but transient in effect, and of no great permanent efficiency, but this does not prove to be the case in clinical practice or has not done so in the experience of the author. We firmly believe that settling of the spine, or contraction of the musculature from direct or reflex causes, does engender the necessity of spinal stimulation by concussion and that the immediate cause of their diminished functional phenomena should be corrected in order to accomplish permanent results. We can conceive how the musculature may be affected favorably by concussion, provided the application is vigorous and severe, for then will it certainly affect the musculature and cause some relaxation which is indispensably necessary to the continuation of the result of the stimulation caused by concussion. It is also necessary for the concussion to be given with sufficient
force to adjust the musculature which is a more disagreeable method of
relaxing the spinal musculature than are methods of spinal adjustment or
spinal stretching.
RATE OF APPLICATION As a general rule the rapid sine or the rapid and interrupted concussion strokes or brief applications of nerve pressure, are more excitable or more stimulating than continuous and excessive applications, and will produce the most decided constriction or contraction of the viscera. The slow sine and the slow but interrupted concussion strokes are sedative in their influence and act as well or better than rapid treatment, when applied to spinal centers for the purpose of inducing dilation or inhibition of function or action of glandular viscera. The slow sinusoidal interruptions are more efficient in stimulating and in exercising and strengthening the muscular tissue. Nerve pressure applied for a brief space of time, consisting of about 30 seconds, acts as a decided stimulus, but long continued pressure acts as a depressant and a sedative, and inhibits the action of the nerve to which it is applied. Concussion applied interruptedly for a short time, from three to seven or ten minutes, is exciting or stimulating in its effects, while long continued concussion or concussion without interruption will soon produce a sedation and temporary paralytic condition of the center which is treated. The most effective time for applying spinal stimulation by concussion, for the purpose of excitation of the centers of nerve origin, is to apply the concussion after the spinal adjustment to remove all interference with the nerves or with their spinal centers. The most efficient manner of stimulation is to apply the rapid concussion strokes, from ten to twenty per second, for 30 seconds and then rest for 30 seconds, and then again use the concussion and periods of rest for 30 seconds each and continue in this manner for from five to ten minutes at each daily seance. If two or more different centers are to be concussed, we may them easily secure the necessary interruptions by concussing first one segment and then the other segment, and by this rotation and alteration secure the proper interruptions. If from over use, the stimulating action of concussion is exhausted,
the sinusoidal current may be substituted, and the excitation may thus
be continued and the results increased and continued.
SPINAL CENTERS Definition - A spinal center, or segment of the spinal cord, is a certain portion thereof which gives rise to a certain pair of spinal nerves, and it is the reflex center of sensory impulses and the source of origin of the central impulses of that pair of nerves. The spinal centers or segments are not clearly defined or differentiated from each other, for the reason that there is a close relation and a more or less intermingling of the grey cells of the adjacent segments or centers of the spinal cord. There are thirty-one pairs of spinal nerves which ,are given off from the spinal cord, and there are therefore thirty-one nerve centers or segments contained within the spinal cord. The different pairs of spinal nerves which are given off from the spinal cord, are given off from different regions or divisions as follows: Cervical region
8 pairs of nerves
By way of comparison, we note quite a difference in the location of the spinal centers of origin of nerves, and the spinal exit of the nerves. The center of origin or the reflex center of a pair of nerves is always situated above the point or level of the exit of the nerves, and variation in the distance in which the nerve passes downward in the neural canal, to where it makes its exit, increases from above downward. In the cervical region the nerves pass out from the neural canal but a very short distance below the location of their centers of origin. In the thoracic region there is a greater variation between the level of the site of the origin of the nerve, and of the point of its exit, which is below, and this variation increases as you pass from the upper to the lower portion of the thoracic division. There are centers of origin of the spinal nerves contained in the different divisions of the spinal column, as follows: Cervical Division
10 centers of nerve origin
We have therefore the centers of origin of all of the cervical nerves and of the upper two thoracic nerves in the neural arches of the cervical division of the spinal column. We have the origin of all of the thoracic spinal nerves except the first two, and of the lumbar and sacral nerves, situated in the neural arches of the thoracic division of the spinal column. In the lumbar region, and within the arch of the first lumbar vertebra, we have the center of origin of the coccygeal nerve. There are no centers of origin of spinal nerves situated below the neural arch of the first lumbar vertebra. For your convenience, we publish a table showing approximately the relation
of the location existing between the spinal centers of the nerve
origin, or reflex centers, and the spinous processes of the vertebrae.
GENERAL SUMMARY As a summary of the relative locations of the exits of the spinal nerves, and of their centers of origin in the spinal cord, we give you the following outline: The first four or upper pairs of cervical nerves originate in the spinal cord in that portion of the neural canal formed by the neural arches of the first and second cervical vertebrae, and just above the level of the top of the neural arch of the third cervical vertebra. The lower four cervical pairs of nerves have their origin in that portion of the spinal cord, situated within the neural arches of the third, fourth, fifth and sixth cervical vertebrae and above the upper plane or within the arch of the sixth cervical vertebra. The upper or first six pairs of thoracic nerves originate within that portion of the spinal column situated in the neural arches of the seventh cervical and the first, second, third and fourth thoracic vertebrae. The lower thoracic pairs of nerves, from the seventh to the twelfth inclusive, originate in the spinal centers or segments of the spinal cord located in the neural arches of the fifth to the eighth thoracic vertebrae, inclusive. The five lumbar pairs of nerves have their centers of origin in that portion of the spinal cord contained within the neural arches of the tenth and eleventh thoracic vertebrae. The five sacral pairs of nerves leave their centers of origin in that portion of the spinal cord located within the neural arch of the twelfth thoracic vertebra principally, the lowermost portion extends into the first lumbar neural arch. The coccygeal nerve has its spinal center of origin within the neural arch of the first lumbar vertebra and this nerve also receives fibers from the arachnoidal and myelin sheath of the spinal cord, which coverings are a continuation and an enlargement of the nerve fibers originating both in the pineal glands and the pituitary bodies, at the base of the brain. The coccygeal ganglion, which is situated within the rectal sphincters, contain the terminal endings and the commissural fibers of the downward stream of the white rami communicantes, and also the gray rami communicantes of the gangliated cords of the sympathetic system which are contained within the terminal portion and commissural union of the gangliated cords of the sympathetic system or in the coccygeal ganglion. Now that you may be able to locate easily each spinous process, and
in this way locate the different spinal centers, we will give you some
special tables of directions for locating them readily and with certainty.
SPECIAL TABLE Approximate Relation of Spinal Centers of Nerve Origin to the Spinous Processes Spinous Process Center of Nerve Origin Arch of Atlas
1st Cervical Origin
2nd Cervical Spine
3rd Cervical Origin
3rd Cervical Spine 5th Cervical Origin 4th Cervical Spine 6th Cervical Origin 5th Cervical Spine
7th Cervical Origin
6th Cervical Spine
1st Thoracic Origin
7th Cervical Spine 3rd Thoracic Origin 1st Thoracic Spine 4th Thoracic Origin 2nd Thoracic Spine 5th Thoracic Origin 3rd Thoracic Spine 6th Thoracic Origin 4th Thoracic Spine 7th Thoracic Origin 5th Thoracic Spine
8th Thoracic Origin
6th Thoracic Spine 10th Thoracic Origin 7th Thoracic Spine 11th Thoracic Origin 8th Thoracic Spine 12th Thoracic Origin 9th Thoracic Spine 1st Lumbar Origin 10th Thoracic
2nd Lumbar Origin
11th Thoracic Spine
4th Lumbar Origin
12th Thoracic Spine
1st Sacral Origin
1st Lumbar Spine
Coccygeal Segment Origin
In the above table we have, in the left-hand column, named the spinous
processes, and in the right-hand column, we have named the spinal center
that is situated directly under each spinous process.
HOW TO DETERMINE THE LOCATION OF THE SPINOUS PROCESS OF ANY VERTEBRA LANDMARKS First Cervical or Atlas The first cervical vertebra or the atlas has no spinous process. The location of the posterior arch of the atlas is approximately midway between the lower portion of the occipital bone and the first or uppermost spinous process or marked prominence, which is the spine of the axis. Second Cervical Spine The spine of the second cervical vertebra or atlas is large, thick, strong and prominent, to which are attached many important muscles. This large or prominent spine is easily recognized and located as it is the first spinous process palpated below the occipital bone. Third Cervical Spine The spine of the third cervical vertebra is difficult to palpate when the head is in the normal position. This is because this spine is covered under the large heavy prominent spine of the axis. To palpate the third cervical spine, flex the head and neck sharply by dropping the bead forward with the chin upon the breast. Fourth Cervical Spine This spinous process is the second one which is palpated below the occipital bone when the neck is in a normal position. This spine is the first one palpated below the second cervical spine except when the head is flexed forward so as to enable the palpator to detect the third cervical spine, then the fourth becomes the third cervical spine which is palpated. Fifth Cervical Spine This spine is the second spinous process below the fourth cervical spine and it is the third spinous process above the first thoracic spine or the second above the spine of the seventh cervical, when counting from below. Sixth Cervical Spine This spine is the second spinous process below the spine of the fourth cervical vertebral and it is the first one above the spine of the seventh cervical or the second spine above that of the first thoracic. It is located on a level with the upper commencement of the esophagus and opposite the cricoid cartilage. Seventh Cervical Spine (Vertebra Prominens.) This spine is distinguished by its prominence and by its length, and it serves as a guide for counting the processes which are immediately above and below it. Sometimes the sixth cervical spine is also quite prominent and may be difficult to differentiate, for this reason, from the seventh cervical spine. The seventh cervical spine is on a level with the apexes of the lungs. First Thoracic Spine This spinous process is on a level with the superior portion of the spine of the scapulae and it may be detected and located by placing the thumbs in a line with the fingers when they are placed above the spines of the scapulae on both sides. Second Thoracic Spine This spinous process may be most easily determined by first locating the first thoracic spine and then by finding the one immediately below this spine which is the second thoracic spine. Third Thoracic Spine The location of the spinous process of the third thoracic vertebra corresponds to the level of the inner edge of the spines of the scapulae and it is the second process palpated below the first thoracic spinous process. Fourth Thoracic Spine This spinous process is best located by first differentiating and then counting from the first thoracic process above, or by first locating and counting from the seventh thoracic spinous process below. Fifth Thoracic Spine The fifth thoracic spinous process is best located by first differentiating and counting from the seventh thoracic spinous process below, or it may be located by counting from the first thoracic spinous process above. Sixth Thoracic Spine The sixth thoracic spinous process is best located by first determining the location and counting from the seventh thoracic process below. Seventh Thoracic Spine The seventh thoracic spinous process is on a line with the inferior angles or points of the scapulae when the patient is standing, and this spine is a fingers breath below a straight line connecting the lower points of the scapulae when the patient lies prone upon a treatment table with the arms hanging down. This spine is easily located by placing the forefingers of the two bands immediately below and against the lower angles of the scapulae on both sides, with the thumbs on a line between and they will then fall upon the seventh thoracic spine. Eighth Thoracic Spine The spinous process of the eighth thoracic vertebra is most easily located by first determining the seventh thoracic spine. The eighth thoracic spine is directly opposite the lower level or border of the heart and of the central tendon of the diaphragm. Ninth Thoracic Spine The spinous process of the ninth thoracic vertebra is most readily determined by first locating and counting from the seventh thoracic spinous process. The ninth thoracic spine is situated on a level with the cardiac opening of the stomach. Tenth Thoracic Spine The spinous process of the tenth thoracic vertebra is about a finger's breadth below the attachments of the last two ribs, and it may be determined by the prominence of the tenth pair of ribs in the axillary line by following them to the spine. The tenth spine may be located by counting downward from the seventh thoracic spine. The tenth thoracic spine is on a level with the lower border of the lungs. Eleventh Thoracic Spine The spinous process of the Eleventh thoracic vertebra may be located by counting downward from the seventh spinous process above, or it is the spine immediately below the tenth. The eleventh spinous process marks the level of the lower border of the stomach and of the upper border of the right kidney. Twelfth Thoracic Spine The spinous process of the twelfth thoracic vertebra may be located in the same manner as the eleventh thoracic spine or it may be located by counting from the fourth lumbar below. First Lumbar Spine The spinous process of the first lumbar vertebra is most easily located by determining and counting from the fourth lumbar spinous process below. The first lumbar spine is on a level with the renal vessels and pelvis of the kidney. Second Lumbar Spine The spinous process of the second lumbar vertebra is easily and quickly located by first determining and counting from the fourth lumbar spinous process below. The second lumbar spine is situated directly opposite the third portion of the duodenum and of the receptaculum chyli. Third Lumbar Spine The spinous process of the third lumbar vertebra is best and most quickly located by counting from the fourth lumbar spinous process below. It is situated on a level with a plane just above the umbilicus. Fourth Lumbar Spine The spinous process of the fourth lumber vertebra is on a straight line between the highest points of the crest of the ilia, and this spine may be located by first palpating the sacrum and the fifth lumbar immediately below. Placing the thumbs on a straight line midway between the fingers resting upon the crests of the ilia on both sides. This fourth lumbar spine marks the level of the bifercation of the aorta and of the rest of the ilia. Fifth Lumbar Spine The spinous process of the fifth lumbar vertebra is easily determined
by palpating the sacrum below or by first determining the first lumbar
spine immediately above. This spine is on a level with the points
of spinal exit of the fifth pair of lumbar nerves.
RELATION OF SPINES AND NERVES The following directions are given to give the reader a definite idea as to the level of the spinal origin or the spinal exit of the spinal nerves from the neural canal as they pass out to the different parts, or organs which they supply. In the cervical region we have omitted any summary of the general relation of the spinal exit of the nerves to the level of the spinous process of the cervical vertebrae, for the reason that this is not so important and, for the further reason, that the spinal exit of the nerves varies but little from the same level of the location of the spinous process of the same number. This table varies very materially from that table in which we give a summary of the approximate relation of the location of the spinal centers of origin to the location of the different spines. We believe, however, that this table will be of considerable interest, especially to those who are more rational in their views and believe in relieving that interference with nerves which necessitates concussion and other stimulation and the administration of these methods of the stimulation to the spinal centers. The first thoracic or dorsal spine is on a level with a point about midway between the points of spinal exit of the first and second pairs of thoracic nerves. The second thoracic spine is nearly on a level with, but a little above, the points of exit of the third pair of thoracic nerves. The third thoracic spine is situated on a level with the spinal exits of the fourth pair of thoracic nerves. The fourth thoracic spine is situated on a level with the spinal exits of the fifth pair of thoracic nerves. The fifth thoracic spine is situated on a level with the spinal exits of the sixth pair of thoracic nerves. The sixth thoracic spine is situated on a level with the spinal exits of the seventh pair of thoracic nerves. The seventh thoracic spine is situated on a level with the spinal exits of the eighth pair of thoracic nerves. The eighth thoracic spine is situated on a level with the spinal exits of the ninth pair of thoracic nerves. The ninth thoracic spine is situated on a level with the spinal exits of the tenth pair of thoracic nerves. The tenth thoracic spine is situated on a level with, or just a little above, the spinal exits of the eleventh pair of thoracic nerves. The eleventh thoracic spine is situated on a level with a plane just between the level of the spinal exit of the eleventh and twelfth pairs of thoracic nerves. The twelfth thoracic spine is situated on a level just below the level of the spinal exits of the twelfth pair of thoracic nerves. The first lumbar spine is situated on a level with the spinal exits of the first pair of lumbar nerves. The second lumbar spine is situated on a level with the spinal exits of the second pair of lumbar nerves. The third lumbar spine is situated on a level with the spinal exits of the third pair of lumbar nerves. The fourth lumbar spine is situated on a level with the spinal exits of the fourth pair of lumbar nerves. The fifth lumbar spine is situated on a level with the spinal exits of the fifth pair of lumbar nerves. |