The Practice and Applied Therapeutics of Osteopathy
Charles Hazzard, D. O.

    DEFINITION: Asthma is a disease of the bronchial tubes characterized by dyspnea.  It is spasmodic in nature, the air tubes being narrowed by spasm of their muscular fibers or by swelling of the mucous membrane from hyperemia.
    CAUSE: This disease always presents definite lesions, muscular and bony, of the upper dorsal spine and of the thorax.  Secondary lesions usually occur in the cervical region.  The chief bony lesions affect the ribs from the second to the sixth on the right side. (Dr.  A. T. Still.) The majority of cases show lesions of this region, but they may occur higher up or lower down.  Lesion is often found in the neck.  The sternal ends of the ribs and the costal cartilages, as well as the spinal ends of the ribs may show the lesions.  Lesions of the ribs from the second to the seventh on either side; of the corresponding dorsal vertebra; of the anterior and posterior thoracic muscles; of the atlas, axis, and hyoid bone, and of the cervical muscles are all active in producing the disease.  A case is reported in which the bony lesion was in the lumbar spine, constipation also being a feature of the case.  No treatment was given above the lumbar region, but the asthma was cured.  It was regarded as being reflex from the lumbar lesion. (See case 13).
    A review of the typical cases, reported from various sources, and in which cures were made by the removal of the specific lesion, shows a definite area in which such causes occur.
    (1) Luxation of first, second and third left ribs.
    (2) Fourth, fifth and sixth dorsal vertebra anterior; the corresponding ribs lowered.  Two treatments stopped the attacks, and patient was discharged as cured after three weeks' treatment.
    (3) Second dorsal vertebra lateral.
    (4) Fifth right rib down and much tenderness of tissues at the fifth dorsal vertebra.
    (5) The scaleni, mastoid and anterior and posterior thoracic muscles very tense.
    (6) Right fourth and fifth ribs, and left fifth and sixth ribs luxated.
    (7) The axis luxated to the right, cervical muscles contractured, all the ribs depressed.
    (8) The left fifth and sixth ribs downward.
    (9)  The first to the eighth ribs on both sides down; spinal of the same region contractured luxation of the atlas and axis; depression of the hyoid bone.
    (10) The second dorsal vertebra luxated laterally, involving the corresponding ribs; several ribs down.
    (11) All the upper dorsal vertebrae anterior, carrying the ribs forward; closeness of the first rib to the clavicle.
    (12) Third, fifth, and seventh right ribs luxated downward at their anterior ends; their heads were also luxated; atlas and axis to the right.  The patient had previously been a sufferer from bronchitis, with upper dorsal and rib lesions.  Accidental slipping of the third rib caused asthma at once.  Irritation from the fifth rib always caused expectoration of quantities of sputum, but if the third rib were kept in place the asthma disappeared at once.
  (13) Female; age 22; single; book-keeper.  Lumbar region much posterior constipation and dysmenorrhea accompanied the asthma which was of two years' standing.  No neck, rib, or thoracic spinal lesion appeared.  The heart was irregular, ,dropping one beat in four.  No treatment was given above the 12th dorsal, and as soon as the constipation was cured (3 mos.) the asthma and dysmenorrhea disappeared.  The patient had not had a night's sleep in more than a year, without the use of a powder which she burned, inhaling the fumes.  The bony lesion was removed, and cure resulted.  The asthma was reflex from the lumbar condition and diseases present.
    (14) A fourth rib displaced, causing asthma, accompanied by bronchitis and pleurisy.  The whole spine was stiff.  After two treatments the patient was free from asthma and was discharged cured after six treatments.
  (15) Asthma and Hay Fever.  Male, aged 38; grocer.  One clavicle was depressed.  Raising it gave immediate relief.  The upper spinal muscles were contractured.  These were relaxed and the ribs, from the 1st to 5th on the left side, were raised.
    (16) Female, aged 23. A fall in childhood caused a lateral curvature from the lower dorsal to the sacral region, the lumbar region being also anterior.  The right limb was much smaller and shorter than the left; the ankle stiff; the flesh always cold; menstrual flow every two weeks.  After two weeks treatment the asthma disappeared.  Under further treatment constant improvement was taking place in the general condition.
  (17) Male, aged 43; married; overseer of land and oil wells. 3d, 4th, 5th, and 6th dorsal vertebrae posterior, especially the 3d.  The cervical muscles were badly contractured, due to the atlas being displaced to the right.
    Relief was given at once in treatment by pressing the dorsal vertebrae forward, throwing the upper ribs and clavicles forward.  The condition was complicated with hay-fever, which was also cured.
One can but note how all of these lesions occur in those regions in which it is claimed the cause of asthma occurs.  No other school of practice notices such causes of this disease.  Their theories are various, many exciting causes are agreed upon, but Anders makes the statement in regard to the real and original causes that they are of an unknown nature.
    These lesions cause abnormal motor effects both in arousing spasmodic conditions of the muscles of the bronchial walls, and in the vaso-motor activity that produces the hyperemia of the mucous membrane.
    There are good ANATOMICAL REASONS why lesions in these regions affect the lungs.  The American Text Book of Physiology states that stimulation of the vagus in the neck produces constriction of the pulmonary vessels, while stimulation of the sympathetics in the neck causes dilatation of them.  Quain's anatomy says that the pneumogastrics convey motor fibers to the unstriped muscle fibres of the trachea, bronchi, and their subdivisions in the lungs.  Vaso-constrictors for the lungs exist, in some animals, in the second to the seventh spinal nerves. (Quain.) The anterior pulmonary plexus is composed of the pneumogastrics and the sympathetics; the posterior, of the pneumogastrics and branches from the second, third, and fourth thoracic sympathetic ganglia.  These regions of the spine, with their important nerve connections with the lungs, are naturally investigated by the Osteopath in relation to asthma.  It is reasonable that obstruction to the nerves here should cause the disease.  Anders gives among exciting causes "irritating lesions of the medulla." The Osteopath finds in lesions of atlas, axis and cervical issues sufficient cause of such irritation of the medulla as well as of the pneumogastric, through their sympathetic and spinal nerve connections.  In these ways, lesion to the cervical, dorsal and upper thoracic structures act as obstructors of these nerve mechanisms concerned in asthma, the pneumogastric nerves, pulmonary plexuses, sympathetic and vaso-motors, and cause the disease.
    Exciting Causes of the paroxysm, such as bronchitis; the inhalation of irritants, such as dust, fog, smoke, chemical vapors, pollen of plants, odors of animals; reflex irritation from nose or stomach; the results of other diseases, etc., would not act to cause asthma did these anatomical lesions not exist.  They are the real cause of the condition.  Existing in an individual, they obstruct the vital forces of the bronchi and deteriorate the vitality of their tissues, perhaps gradually during a term of years, and make it possible for these various exciting causes to act.
    The PROGNOSIS is good under osteopathic treatment, though under medical treatment comparatively few cases recover.  Very many cases, a large number of them apparently helpless, have been cured.  The fact that most of these cases coming under osteopathic treatment are of long standing and have usually tried every known remedy seems to make little difference in gaining results upon them.  Some cases the most severe and longest standing yield quickest.
    EXAMINATION AND TREATMENT are carried out according to the methods described in Part I, (Chapters I, II, III, IV, VI, VII.) Any of the lesions that may affect the bony parts in the regions mentioned may produce the disease.  Displacements of ribs, vertebrae, etc., need not take place in a particular direction.  Rib and thoracic vertebral lesions are more likely to act as causes.     Lesions in the neck alone seem quite unlikely to cause it.  Those of the fourth and fifth ribs upon the right side are most frequently the cause.  It is unnecessary to name the various probable causes of the anatomical derangements or lesions named, as that subject has been fully dealt with elsewhere, as well as the theory of the exact way in which such lesions as the Osteopath finds act to cause disease.
TREATMENT must always depend for its success upon removing the causative lesion, but treatment during the attack must look more particularly to immediate relief of the patient, for as a rule these lesions can be removed only by a course of treatments.  At this time great relief is given and the spasm usually quieted by thorough relaxation of the spinal muscles (Chap. II, div. I), followed by raising of all the ribs (Chap. VII) and clavicles to allow free thoracic and lung action, and by relaxation of the muscles and other soft tissues of the neck.  Loosen the clothing about the neck.
The best time to treat for removal of the lesion is between attacks, it being located and treated, according to its kind, by methods already described.  Attention should be given the sternal ends and cartilages of the ribs, and to the intercostal tissues, as well as to the heads of the ribs and the vertebrae.  The scapular muscles should be relaxed (Chap. II, div.  XV.) the clavicles raised (Chap.  XII); the tissues of the neck thoroughly relaxed, the spinal column relaxed (Chap. II, div. II, III, IV, V.) and the ribs raised at their angles.  If the patient finds it difficult to take a full breath, raising or correcting the fifth rib, or all of the ribs, will sometimes give relief.  Pressure upon the phrenic nerve aids the work by relaxing the diaphragm, which is sometimes elevated (Chap. III, div. VIII.)
    Treatment once a week or ten days is often enough in most cases.  Frequent treatment may undo the results accomplished and keep up constant irritation.  Many severe cases have been cured by a few treatments at long intervals or by a single treatment.
    Under this course of treatment the patient usually feels relief at once.  As a rule the spasms and the various attendant symptoms terminate abruptly.
    CARE OF PATIENT should include the wearing of loose clothing, living out of doors in pure air if possible, or in large, well ventilated rooms.  The diet should be light and easily digested to avoid danger of stomach reflexes, and the patient should avoid dust and other exciting causes.


    Bronchitis is an acute or chronic inflammation of the mucous large membrane of the middle sized air tubes.  It is attended by increased secretions and cough, and is caused by a vaso-motor disturbance of the vessels of those membranes, due to specific lesions in the upper spinal, anterior and posterior thoracic, and cervical, regions.  These lesions may be bony displacements, muscular contractures, ligamentous derangement, etc.
    CAUSE: These specific lesions cause the condition by obstructing peripheral nerves or centers connecting with the vaso-motor innervation of the bronchi.  They usually occur high up in the thorax, and in the neck, in close relation to the vaso-motor areas for the bronchi.
    LESIONS found causing bronchitis are typified by the following cases: (1) Luxation of atlas and axis, depression of hyoid-bone, lowering of upper eight ribs, congestion of spinal muscles. (2) Third cervical vertebra anterior, muscular tension from the second to the sixth dorsal vertebra, second left rib much depressed. (3) Fourth dorsal vertebra lateral. (4) Luxation of clavicle and first rib anteriorly. (5) Anterior and posterior intercostal spaces as low as the fourth or fifth either chanced by misplacement of rib, or the seat of irritation to the intercostal structures by contracture. (6) Lesion to the vagus nerve by cervical luxation and contracture, also luxation of the four upper dorsal vertebrae. (7) Luxation of the first, second and third ribs. (8) Displacement of' the anterior ends of the first, second and third ribs, and derangement of these cartilages. (9) Bilateral contracture of the cervical and spinal muscles as low as the sixth dorsal. (10) Second to fourth dorsal vertebrae lateral.  (11) Luxation between manubrium and gladiolus of the sternum.  (12) A case accompanied by torticollis and a weak heart in a female, age 24, teacher by occupation.  Upper four cervical vertebrae to the right and ankylosed; a lateral swerve of the spine from the 4th to 9th dorsal.
    The ANATOMICAL RELATIONS between these lesions and the seat of the disease are clear. While generally located higher than in the case of asthma, they still fall within the vaso-motor area to the lungs.  As to lesion of atlas, axis, and other cervical tissues, in relation to the vagus and cervical sympathetics, as well as of the upper dorsal vertebrae, ribs, and muscles to the vaso-motor innervation of the bronchi, the same remarks apply as in case of asthma, q. v. Noting from the above lesions that they, being higher, are more concentrated upon the vaso-motor centers of the bronchi (2nd, 3rd, 4th dorsal) may explain in part the reason for a more intense vaso-motor effect, necessary to produce the inflammation of the membranes.  Luxations of the clavicle and first rib anteriorly are anatomically related to the disease as causing contracture of the anterior deep cervical tissues, thus obstructing both phrenic and pneumogastric nerves, concerned in innervation of the lungs, retarding the circulation of the cervical vessels, and collaterally obstructing circulation in the lungs.  The general dilatation of the air tubes, often seen in chronic cases, is likely caused by those lesions especially affecting the vagus, which innervates the involuntary muscles regulating the calibre of the bronchi.  Lessened action of the nerve allows a dilatation of the tubes through loss of those muscle fibers.  The same explanation probably accounts for local thinning and dilatation of the walls of the tubes.
    Osler's statement that the cause of the disease is probably microbic is a confession that the real cause is not known.  We hold the true cause to be anatomical lesions as described.  The fact that the disease is often the sequel of catching cold is suggestive from an osteopathic point of view.  The contraction of muscles and tissues from exposure may be sufficient lesion, or may produce actual bony luxations by drawing parts out of place.  The further fact that the subjects of spinal curvature are prone to the disease is a confirmation of the osteopathic idea of making bony lesions the cause.  Also, it is significant to note that the obese are particularly subject to bronchitis because the weight of the flesh aggregated about the chest walls acts as a mechanical impediment to free rib-action -- free breathing, thus favoring sluggish circulation and weak tissues which are prone to congestions and inflammations.
    The PROGNOSIS is good for both acute and chronic cases.   Many of the latter are cured in a comparatively short time varying usually from one month or less to three months.  In the former the first treatment gives great relief, and, if the case is seen early enough, may abort the attack.  A few treatments usually start the patient well on the way to recovery, and as a rule he is well in about half of the time these cases usually run, which is stated to be two or two and a half weeks.
    In the TREATMENT of the case the specific lesions should be at once sought and treated.  Often relief can be given only in this way.  A thorough treatment should be given the spine, thorax and neck to relax all contracted tissues.  Easing of the tension in this way gives great relief, as the constriction of the chest and neck causes much of the discomfort from which the patient suffers.  This is aided by raising all the ribs.  Treatment of the neck corrects the action of the vagus and aids in dispelling the inflammation by its participation in the vaso-motor control.  In the same way relaxation of all the tissues of the dorsal region about the second, third, and fourth vertebrae, particularly, also correction of these vertebrae themselves, tends to the same end.  The clavicle should be raised and the first rib lowered to free irritation to the phrenic, vagus, and cervical vessels.  Thorough treatment of the spine from the second to the seventh dorsal vertebra (vaso-motor area) aids in equalizing bronchial circulation, the work on the left side as low as the sixth aiding this result by strengthening the pulse beat.  This initial portion of the treatment should be brisk and energetic enough to arouse good reaction.  It relieves the patient at once of the constriction, languor, and aching pain in the back.  It frees the lungs and starts perspiration.
    The patient should be laid on his back and the upper anterior ribs, cartilages and intercostal structures be thoroughly treated.  Strong manipulation of the tissues upon the anterior chest and along the sternum reddens them and acts as a mustard plaster would.  These treatments, together with treatment directly along the trachea in the neck will relieve the cough.  The pain along the sternum is relieved by raising the ribs and by the above treatments along the anterior chest.  The fever is taken down by the equalization of circulation wrought by the general treatment, and by pressure in the superior cervical region, affecting the superior cervical ganglion via the upper cervical nerves.  The blood-flow may be diverted from the bronchi to the abdomen by a slow, deep, inhibitive treatment over it, including pressure over the solar and hypogastric plexuses.  By the process of raising the ribs and treating the spine, the engorged azygos major vein is emptied.  The restoration of free thoracic play by these treatments is an important consideration in the equalizing of the circulation throughout the lungs.
    A hot mustard plaster over the anterior chest, or a hot full bath, are efficient aids.
    An acute case should be treated daily at least once, and oftener in case of need.  One thorough general treatment daily may be sufficient of the kind, some additional special treatment being given for cough or fever at other times.  In chronic cases the treatment should be given two or three times a week.  In cases of local or general dilatation of the bronchi, and in the thinning of the walls, close attention to the vagus nerve should be given for reasons already explained.
    Good care should be taken of the patient, particularly as to guarding against exposure, which may lead to complications.  Treatment should be given bowels and kidneys to keep them active.  The obese should be taught the habit of deep respiration, as should all persons subject to attacks of the disease.  This measure, together with the daily cold sponge or shower bath, is a great aid in overcoming the chronic tendency.
    BRONCHIECTASIS is successfully treated.  The condition frequently comes under treatment as a complication in chronic bronchitis, asthma, etc., being benefited or perhaps practically cured along with the primary condition.  As this condition is generally a result of chronic bronchial catarrh, and is frequently associated with emphysema, chronic bronchitis, and asthma, the lesions found causing it are similar to those found in these diseases.  One would expect such lesions as have been pointed out as the cause of vaso-motor derangement in the bronchi, leading to the chronic catarrhal condition which so often causes it. These lesions occur mostly in the upper dorsal region, between the 2d and 7th.  One notes that in bronchitis the dilatation of the air-tubes is probably due to lesion to the vagus nerve, whose fibers innervate the muscles controlling the calibre of the tubes.  Hence cervical lesion to the vagus might be the cause of the disease.  The lesion may be entirely those of the primary condition, followed by  bronchiectasis, as in cases in which the tumors, aneurysms, enlarged glands, cicatricial contractions in interstitial pneumonia, etc., cause mechanical obstruction of the bronchi and lead to their dilatation.
    The TREATMENT of this condition would give much relief, but it is questionable whether the majority of cases could be cured entirely.  They are frequently much helped by the treatment of a case of asthma, chronic bronchitis, etc.  Some cases have been cured.
    The removal of a foreign body or other obstructing cause as pointed out above; the removal of lesion from blood and nerve-supply of the bronchi: thorough stimulation of the vagi to give renewed tone to the muscles in the bronchial walls and to aid their contraction; treatment of the bronchial vaso-motor center (2nd to 7th dorsal) to aid in strengthening the bronchial walls and in overcoming the chronic catarrhal condition of their lining membranes, are all necessary.  In this way the case could be much improved.  The purulent and fetid expectorations would be remedied as the renewed blood-flow began to restore the secretions to their normal quality.  To some extent the structural changes in the bronchi could be repaired and their further progress prevented.


    DEFINITION: Hay-fever, or Autumnal Catarrh, is a disease of the upper respiratory tract, styled by some writers a form of asthma.  It is caused by specific lesions in the upper dorsal, thoracic and (especially) cervical regions, which deteriorate the vitality of the membranes of this tract and lay them liable to the effect of certain irritants, such as the pollen of various plants, leading to an inflammatory or catarrhal condition.
    LESIONS: The anatomical causes for this condition are, from the osteopathic point of view, held to be derangements, in the regions mentioned, of bones or other tissues, which act as lesions upon the motor, vaso-motor and sensory innervation, also upon the blood-vessels of the upper respiratory tract.
    CASES: (1) In one case, complicated with asthma and bronchitis, the scaleni, sterno-mastoid, and anterior and posterior thoracic muscles were contractured. (2) In another, lesions were found affecting the inferior cervical and upper thoracic regions.
    In other cases, lesions were found as follows: (3) Right fifth rib; (4) contracture of the muscles from the first to 10th dorsal vertebra, with ribs in this region drawn down; (5) second cervical vertebra to the right and posterior; (6) second cervical vertebra right, cervical muscles contractured, upper three or four dorsal vertebra, to the right. (7) See "Asthma,  case 15; (8) see "Asthma," case 17.  In addition to these, lesions of the atlas, of the phrenic nerve, of the clavicles and upper three ribs (especially the first) and of the dorsal vertebrae as far as the fifth are all found.
    The fact that this disease is often found complicated with asthma and bronchitis is readily explained by noting that lesions for all of these conditions occur at the same area of the spine.  In all, as well, vaso-motor lesion seems a more potent cause than motor lesion.  In the case of hay-fever, as with the other two, upper cervical lesion is less important than lower cervical lesion.  The latter kind, with those affecting the first few dorsal vertebrae, the clavicle and the first and second ribs, are always expected in case of hay-fever.  Purely muscular lesions are relatively less important than other kinds as they are more likely to be secondary lesions.
    The ANATOMICAL RELATION of lesion to disease in this case seems clear.  The lesions mentioned affect the vagus, cervical sympathetic, and vaso-motor nerves as already explained. They also affect the fifth cranial nerve through the cervical sympathetic, including the superior cervical ganglion.  This is the nerve which causes the swollen and painful face, the running eyes and nose, and the sneezing, all of which are so noticeable in hay-fever.
    The fifth nerve and the vagus are intimately related in function, both of the respiratory and of the digestive tract, and are closely connected by the floor of the fourth ventricle, the superior ganglia, and the cervical sympathetic.  Lesions to the vagus in the region of the clavicle and first rib, and to the sympathetic in the cervical region and in the upper thoracic region of the spine, may affect one or both of these nerves.  According to Howell's American Text Book of Physiology, vaso-dilator fibers for the face and mouth leave the cord at the 2d to 5th dorsal, pass up the cervical sympathetic to the superior cervical ganglion, thence to the Gasserian ganglion of the fifth and to the regions mentioned.  Thus a low lesion, affecting nerves which ascend to supply these parts, may be sufficient cause of hay-fever. At the same time the close association of this disease with asthma is shown, since the vaso-motors to the lungs occupy this same region of the upper thoracic spine.
    "Modern Medicine" describes Hay-Fever as "A vasomotor paralysis."
    While the common form of irritant producing the attack is supposed to be dust or pollen in the atmosphere, the fact that emotional excitement, a deflected nasal septum, the presence of a nasal polypus, hypertrophied mucous membranes, etc., may produce attacks, shows that there are other causes, some of them mechanical, accounting for an irritable nasal mucous membrane or acting as an irritant upon it.  It is reasonable for an Osteopath to maintain that lesions act as obstructions to natural nerve and blood-supply to these membranes, weaken them and lay them liable to the action of various irritants, thus being the real cause of the disease.  Immunity from attack in certain climates or altitudes is but alleviation, or possibly cure, by allowing Nature a chance.  The patient has gone away from the special irritant which produces the attack in him.  The real causes of the disease still exist, and it generally returns upon his again exposing himself to the same irritant.  Although a patient is more liable to attacks in rural districts, more city people contract the disease, showing that a locality in which much pollen occurs has nothing to do, per se, with the matter.  Osler says that McKenzie induced attacks by offering the patient an artificial rose to smell.  Osier states that three elements are necessary to the production of the disease;  "a nervous constitution, an irritable nasal muscosa, and the stimulus."  Yet, nervous people, with colds or catarrhal inflammation of the nasal membranes, may be with impunity in districts filled with the common irritants which excite attacks in hay-fever subjects.  Evidently some further etiological factor is necessary, and is found in the specific anatomical abnormality pointed out by the Osteopath, the removal of which has, in great numbers of cases, cured the disease.  The most severe cases yield quickly, often, upon the removal of the specific lesion.  The length of standing of the case seems to have but little relation to the length of the time necessary to cure.  A case of fourteen years' standing was cured in three weeks; one of twenty-four years, in three months, one of five years, in one and one-half months.  This rehearsal might detail great numbers of cases, but the few mentioned illustrate the whole matter.  In view of these facts it seems incontrovertible that the specific lesions found by the Osteopath, and held by him to be the cause of disease, are the actual causes of this disease.
    The PROGNOSIS, under osteopathic treatment, is good.  Many of the cases are cured.  The most severe and oldest cases may be safely encouraged to take the treatment.  Of medical prognosis in hay-fever, Anders says that permanent cure is a rare event.
    THE EXAMINATION AND TREATMENT. The removal of lesion is the first consideration. It may, occurring in the region described, be any one of the maladjustments of tissue considered in the general chapters relative to the examination and treatment of the parts.  An immediate effort should be made for its removal.  In addition special treatment is given to alleviate the condition.  All the upper spinal, thoracic and   neck   muscles,  and   deep   tissues   should  be thoroughly relaxed for freedom of circulation and to release tension upon nerves.  The ribs and clavicles, apart from correction of displacement, should be raised.  Attention should be given to releasing and toning the vagus nerve, and the vaso-motor nerves from the 2nd to the 8th dorsal.  For lachrymation, itching of the eyes, swelling and pain in the face, and rhinorrhea, special treatment should be given the fifth nerve.  This may be aided by deep manipulation and pressure in the suboccipital fossa for the superior cervical ganglion, but is done especially by relaxation and quiet, deep, inhibitive treatment to the facial branches of the fifth nerve (Chap.  V.  B.) Treatment is given along the sides of the nose (Chap.  V.  D.) to free its blood vessels, nerves, and, to reduce the swelling and irritation in the mucous membranes.  Strong pressure is made with the palm upon the forehead (Chap. V. B. II) to open the nostrils.  Cervical treatment, inhibition at the superior cervical region, and opening the mouth against resistance (Chap.  IV, II), all relieve the congested circulation about the head and face, and give much relief.  Momentary pressure upon both external jugular veins causes the blood in them to set back and dilate the veins back to the capillaries, after which, being dilated, they carry off more blood, relieving the congestion.
    For the sneezing one may make inhibition of the phrenic nerve (Chap.  III, VIII), may press upon the palatine branches of the fifth nerve where they run over the hard palate, or may grasp the head as in Chap. V, div.  IX, 4, and raise it from the spine.  The latter is a particularly good treatment.
    Treatment is ordinarily given three times per week.  The patient should be kept from exposure to the particular irritant that excites his attacks.


    DEFINITION: Lobar Pneumonia, or Lung Fever, is an acute inflammation of the parenchyma of the lungs caused by specific lesions, bony, muscular, or ligamentous, in the upper spinal, thoracic, and cervical regions.  In other forms of pneumonia the same lesions are found.  Lobular or Catarrhal Pneumonia is an inflammation of the capillary air tubes, which extends also to the lung tissue proper.  Chronic Interstitial Pneumonia is characterized by increase of the interstitial connective tissues.
CASES: (1) In this case, acute lobar pneumonia, lesion ,existed at the 2nd to 5th dorsal vertebrae; the intercostal, cervical, and spinal muscles were contractured.
    (2) Marked contracture of the spinal muscles about the lung center (2nd to 7th dorsal).
    (3) Acute lobar pneumonia in a woman, aged 38.  Temperature, 102 5-10; pulse, 100; respiration, 38.  Cervical and dorsal spinal muscles, as well as the intercostals, were rigid; vertebral lesion from the 2nd to 5th dorsal inclusive.  The crisis was reached upon the second day of treatment, after which time no serious symptoms existed.  On the fifth day temperature, pulse, and respiration were found normal and so remained.
    (4) A case in which the temperature was found at 105.  The cough could be well relieved each time by steady pressure at the 2nd, 3rd and 4th dorsal; the pain in the side was relieved by raising the ribs and pressing on the left side from the 6th to 8th ribs.  The crisis was reached in seven days and the patient was out upon the 12th day.
    CAUSES: Anatomical lesion in the form of displaced bony parts, ligaments, etc., and of contractured or tensed muscles and other soft tissues are found affecting the spine as low as the eighth or ninth dorsal; the ribs in the corresponding region, but more generally, the 1st, 2nd and 3rd, 4th and 5th; the intercostal tissues, including nerves and vessels; the cervical vertebra and tissues; the clavicle and first rib.  More specifically, lesions have been found affecting the 2nd to 5th dorsal vertebra; contracture of intercostal, cervical and spinal muscles; thoracic muscles; 4th and 5th ribs; 8th and 9th ribs; the vaso-motor area, the 2nd to 7th dorsal; neck lesions to the vagi; to the recurrent laryngeal nerves at the 1st and 2nd ribs.
    Dr. Still says that in pneumonia the ribs below the 4th are twisted and the lower ribs are down. He lays some stress in these cases upon sacral lesion, acting by effect through the sympathetic system to constrict the blood-vessels of the superficial fascia, and to thus throw congestion onto the lungs.
    The ANATOMICAL RELATIONS of such lesions to the lungs have been explained.  It is to be noted that the neck lesions assume greater importance in these cases than in asthma or bronchitis, though there is considerable concentration of lesion about the portion of the spine in which is located the most important vaso-motor area for the lungs, the region as low as the fourth dorsal.  In regard to neck lesion, important consideration are pointed out by McConnell in regard to the vagi and the recurrent laryngeal nerves.  Such obstructions to the vagi, which are motor nerves to the lungs, cause loss of motor power in them and favor the stasis and engorgement present.  Obstruction to the recurrent laryngeal nerves by luxations of the 1st and 2nd rib, or by engorgement of aorta or subclavian artery where they are in relation to them, causes catarrhal inflammation of the air tubes.  The lesions of the 8th and 9th ribs, affecting fibres to the lower lobes of the lungs, are more usual in cases in which the disease occurs in the lower lung.
    The fact that more men than women are attacked by the disease; that a debilitated system is more susceptible; that exposure, winter season, and trauma are exciting causes, favors the theory that such anatomical lesions cause the disease, for the reason that such conditions are fruitful sources of mechanical lesions.  The result may be caused directly by them, or they may make the anatomical weak points that lead to deterioration of the lung tissues and lay them liable to invasion.  The specific microbes found in such cases could not live and grow in tissues whose vitality had not been weakened by such causes.  It is of interest, in this connection, to note the remark of Strumpell; that the diplococcus pneumonia exists in the mouths of healthy persons.
    If the case be seen before it has passed the stage of engorgement, the fever may be gotten under control at once, and a few treatments may abort the disease.
    This is the experience of our practitioners, although Osler says that the disease can neither be aborted nor cut short by any means (medical) at command.  The means at the Osteopath's command to control vaso-motor action are sufficient to relieve the engorgement.  In the stages of red and gray hepatization it is natural that slower results must be expected, as the treatment has more work to accomplish. Yet vaso-motor correction must lessen the inflammatory process, allow of less solidification, and hasten the process of resolution.
    In the first stage there is better opportunity to correct the specific lesion, as the patient's strength will allow of such treatment.  The work is also aided by the fact that the alveoli are .still open, and lung action, stimulated by treatment, may become a valuable aid in dispelling the engorgement.  In view of these facts, and as experience shows, every symptom of the case can be lessened because the pathological processes are modified.  Less poison is generated and the patient's general condition remains better.  In one case the treatment was applied in the first stage; the fever was under control from the first, and the temperature became normal in three days.  In another it disappeared in four days; in another in five days.  A case in which the temperature was 1O4 1/2 degrees when first seen showed three degrees less fever the next morning.  It had been treated in the evening.  In a case in which the temperature was 103 degrees, the temperature, pulse, and respiration became normal in five days.  It is true that cases vary naturally, yet in view of the fact that Osler states that the fever persists for from five to ten days, and that after its fastigium is reached (usually within a few hours) it remains remarkably constant, it is evident that osteopathic work is successful to a marked degree in bettering the case.
    The PROGNOSIS is good under osteopathic treatment.
    EXAMINATION AND TREATMENT for the location and removal of lesion are made according to methods considered in Part I.  In beginning the treatment, as the patient finds it easy to lie on the sound side, the muscles and deep tissues are gently but thoroughly relaxed along the length of the spine, particularly upon the affected side.  This starts vaso-motion and brings a sense of relief from the constriction that so distresses the patient.  During this treatment upon the side, treatment is given the centers for bowels, kidneys, and superficial fascia (2nd dorsal and 5th lumbar), to rouse them to action and to aid in the elimination of poison from the system.
    This initial treatment has thus prepared for the more specific treatment for the fever, itself being part of the process.  The next step consists in turning the patient gently upon the back and thoroughly relaxing the cervical tissues, the tissues behind the clavicle and first rib, raising the clavicle and depressing the first rib, after relaxation of the scaleni muscles.  Treatment should also be applied to the course of the vagi, and to the recurrent laryngeal nerves at the lower, inner parts of the sternomastoid muscles.  In these ways motor power to the lungs is increased, and vaso-motion is corrected.  The treatment for fever is now completed by steady pressure in the sub-occipital fossae in the usual way.  The fever is not likely to go down at once, but is gradually reduced after the treatment, for some hours.  This is because of the freedom given to the vaso-motors in the course of the treatment, and the gradual change now being brought in the patient's system by the recuperated forces.
    The treatment for fever may be aided by the deep inhibitive treatment to the abdomen, before described, to dilate the immense abdominal veins and aid in calling away the blood from the engorged lung.
    Further treatment is given the lungs, with the patient on the back, by gently elevating the ribs from the second to the seventh on both sides.  This stimulates the vaso-motor centers to the lungs.  Elevation of all the ribs gives much relief from tension, and is the specific method of relieving the pain in the side.
    Simulation of the accelerators of the heart, second to fifth dorsal on the, left side, aids in circulation through the lungs, and stimulates the heart against failure.  "In consolidation, the right ventricle is subjected to a strain and there is danger of heart failure."- (Stevens.)
    For the cough, the treatment should be close and deep along the trachea from the larynx to the root of the neck, also relaxation of the anterior tissues of the chest, including the upper intercostal tissues.  The middle and inferior cervical regions should be treated for the lymphatics to the lungs.
The amount and strength of the treatment must be regulated by the patient's condition.  Strong treatments are not allowed on account of weakness.  The general treatment should be given, thoroughly but gently, once a day at least.  The patient should be seen three or four times per day, but the whole treatment outlined need not be given each time.  A little treatment for the fever, to release tension over the lungs, to relieve pain in the side, etc., may be enough at a time.
Hygienic precautions, the use of hot applications, foot baths, rectal injections, etc., may be employed, if necessary.  The patient should have plenty of water to drink, and should be kept upon a liquid or semi-liquid diet.


    DEFINITION: Pulmonary Consumption, or Tuberculosis of the Lungs, is a destructive disease of the tissues of the lungs, characterized by the presence of the bascillus tuberculosis, and caused by specific lesions in the upper dorsal and thoracic regions.
    CAUSES: Cases: (1) In a case of "quick consumption," acute pneumonic phthisis, the upper spine was swerved to the right; the 2nd dorsal vertebra was lateral; the 8th and 9th dorsal vertebrae lateral; the ribs down, narrowing the thoracic cavity.
    (2) Second and third ribs luxated; marked lesion between the corresponding vertebra, and the tissues about them very tender. (3) First, second and third left ribs down and in.  (4) Left clavicle down; 1st to 8th dorsal vertebrae flat; 8th dorsal to 1st lumbar vertebrae posterior; 2nd right rib tilted; the spine and thorax flat. (5) The 4th dorsal vertebra sore; 3rd to 5th lumbar vertebrae tight and irregular; fifth and sixth left ribs close together; first rib on right luxated; all ribs down and irregular.  (6) First to fifth right ribs lowered, decreasing the capacity of the chest and interfering with the vaso-motors of the lungs through their spinal connections.
    (7) A lateral lesion from the 2nd to 5th dorsal, and a dropping downward of the ribs.
    (8) A lateral curvature of the upper dorsal spine, the 2nd and 3rd ribs were down, and the muscles of the neck much contractured.
    Lesions are often found of the 2nd, 3rd and 4th ribs; of the 5th, 6th, 7th and 8th ribs (A.  T. Still); 2nd and 3rd cervical vertebra, usually lateral, and lesions, to the middle and inferior cervical sympathetic ganglia affecting the lymphatics of the lungs (McConnell); of the clavicle.
    ANATOMICAL RELATIONS: In these cases the neck lesion is not generally of prime importance, the dorsal lesion being the particular one, and of this variety, that more especially affecting the upper several ribs.  Lesion of the spine, muscles, ligaments, or ribs, as low as the 10th may become the cause of the disease.  In very many cases the lesion will be found to involve the second dorsal vertebra or the second rib.
    There are important reasons why lesions of ribs lead to pulmonary tuberculosis, and why the flattened thorax, characteristic of the disease, is so closely related to the condition either as primary lesion causing it, or as a lesion secondary to it.  According to the American Text-book of Physiology, stimulation of intercostal nerves causes reflex constriction of pulmonary vessels.  The intercostal nerves are all connected directly with the sympathetic system by rami communicates, and the sympathetic vaso-dilator and vaso-constrictor fibres of the system are situated all along the thoracic spinal region.  Luxation of ribs and a flattened thorax (dropped ribs) set up irritation in the intercostal nerves, leading to a constriction of the pulmonary vessels.  A vast area may be affected through the wide distribution of intercostal nerves.  Very general, or localized, anemia of lung tissues follows upon pulmonary vascular constriction caused by this over-stimulation of the intercostal nerves.  This devitalizes the tissues of the lung, and gives a foot-hold to the pathogenic bacteria, held by medical authorities to be the sole cause of tuberculosis.
    With regard to the microbic origin of this disease, the Osteopath does not deny the presence of such bacteria in the lung, nor their activity in destruction of lung tissue.  He holds that there is necessary a lesion to the lung, in the form of an impediment to proper nerve and blood-supply to the lung tissues, weakening them to an extent that allows the bacteria, which cannot grow in healthy tissues, to produce their kind and to form their toxins.
    It has already been pointed out that the vaso-motor spinal area for the lungs (2nd to 7th dorsal), and particularly the region of the 2nd, 3rd, and 4th thoracic sympathetic ganglia, is most apt to suffer from lesion in diseases of the lungs.  Rib, vertebral, intercostal or spinal muscular lesion, etc., is more likely to cause lung disease in this area than elsewhere.  It is a well known fact that the apices of the lungs are most generally the seat of the disease.  This fact is readily explained by the fact that upper rib and spinal lesions, most frequent in consumption of the lungs, affects this region of the lung generally, centering upon this important vaso-motor area.  The further fact that the apex of the lung is not usually so well developed on account of lazy habits of breathing, makes lesion in this region more, important.  Anders states that special investigation has shown that the disease does not begin at the tip of the apex, but about one and one-half inches below, near the postero-external border.  Posteriorly the first signs are discovered over the lower part of the supra-spinous fossae; anteriorly, immediately below the middle of the clavicle, along a line about one and one-half inches from the inner ends of the second and third intercostal spaces.  The starting point may also be located at the first and second intercostal spaces below the outer third of the clavicle.  These points of origin of this disease in the lung are thus in the close relation with those upper ribs apparently most often luxated in this disease.  In this way the osteopathic view that such lesion causes the disease is supported by the facts.
    PROGNOSIS: Except in late and serious stages of the disease, the chances of limiting its progress are good.  Some cases may be cured.  The prognosis as to recovery, however, must be guarded.  In many cases much may be done for the benefit of the patient's general health.
    TREATMENT: The first consideration is the removal of the specific lesion causing the trouble.  This is accomplished by methods already given.  The removal of lesion has been followed by recovery.  Thorough spinal treatment should be given for the correction and upbuilding of the vaso-motor activities.  The spinal muscles and deep tissues should be relaxed, and the ribs should be raised to allow the greatest area of expansion possible.  The vaso-motor area for the lungs should receive especial treatment.  In all these ways the blood-supply to the lungs is upbuilt.  This, next to the removal of lesion, is the main consideration in the treatment of the case.  Phagocytic activity is said to constitute the natural power of resistance of the system to the bascilli.  By increasing blood-supply to the tissues, phagocytic activity is increased, the tissues are strengthened, and the encroachments of the bacteria are limited.  As they cannot live and propagate in healthy tissues, and as pure blood is a germicide, the progress of the disease is checked as soon as pure blood and healthy tissue are opposed to them in equal ratio.  Thorough stimulation of the functions of heart and lungs materially aids this process.  The very important nerve connections of the lungs, already pointed out in detail, afford the Osteopath the surest means of reaching this result.  His is the natural method.  Strong lungs remain immune to this disease because healthy tissues will not harbor the microbe.  Consumptives have been cured by judicious exercise, fresh air, and careful regimen.  In this way the tissues of the lung have been built up, the circulation to it has been increased, and the bacteria have been crowded out by the gain over them of the natural healthy processes thus aroused.  Osteopathy removes the impediment to normal activities of the blood and nerve-forces that make strong lung tissue.  Its method does that which Nature unaided could not do, and further aids Nature to recover from weakness caused by the disease.  No other method would seem more sure of success than this.
The clavicles should be raised, and the pneumogastric, phrenic, and cervical sympathetic nerves should be freed and toned for reasons already explained.  Fresh air, judicious exercise, and nutritious diet are indispensable factors in the treatment.  Antiseptic precautions in regard to the patient's sputum, linen, etc., should be observed.  Bowels, kidneys, and skin should be stimulated to full activity.  General circulation must be increased.
    The night sweats generally soon yield to the spinal treatment.  The cough may be relieved by treatment along the trachea and anterior thorax, but it, as well as the expectoration, fever, and hemorrhages, are relieved and checked by the favorable progress of the case.  The greatest care must be taken for the patient's general condition and nutrition.
    Treatment is given in the ordinary chronic case three times per week.  In the acute form it should be given daily.
    The modern method of having the patient live entirely, or practically so, in the open air is a most valuable means of fighting the disease.


    DEFINITION: A vaso-motor disturbance of the lungs, resulting in engorgement of the blood-vessels, and caused by lesions in the upper dorsal, thoracic, and cervical regions.
    The lesions producing this disease may be any of the lesions interfering with the innervation, especially vaso-motor, and with the blood-supply to the lungs.  These have been described in the discussion of the different diseases of the lungs already considered, q. v.  With these lesions present and weakening the circulatory energy in the lungs, some direct exciting cause, such as exposure, over-exertion, and the like, may bring on the attack.  In the passive forms of congestion, secondary to enfeebled heart action or to valvular disease, or coming on through stasis of blood due to a long continued dorsal position of the patient, also in the active form of pulmonary congestion, when the trouble may be symptomatic of pneumonia, pleurisy, etc., the lesion must be investigated with regard to the actual disease, and may be but in part responsible directly for this condition.
    The PROGNOSIS is good, numerous cases are treated with marked success.
    The TREATMENT must be directed at once to the removal of the specific lesion if possible.  The main object of the treatment is to gain vaso-motor control.  As soon as the impeded circulation is released, and activity restored to the innervation of the vessels, further progress of the disease is prevented.  As in the first stage of pneumonia the disease was aborted by gaining vaso-motor control of the parts, so here the whole matter rests upon the correction of the circulation.  The accelerators of the heart, 2nd to 5th dorsal on the left, and the vaso-motors of the lungs, 2nd to the 7th dorsal, should be stimulated at once, and the treatment gives immediate relief from the dyspnea.  Often the patient is sitting up in the effort to get air, and the practitioner may easily stand behind and thoroughly treat the upper dorsal region, releasing contractured muscles, stimulating the centers mentioned, and raising the ribs.  Pressure with the knee upon the back, while the arms are both raised high above the head, expands the chest, draws the air into the lungs, and aids in restoring circulation.  This work also aids the process by increasing activity in intercostal vessels and nerves.  The latter should be thoroughly treated along the spine, intercostal spaces, and over the chest anteriorly, as stimulation of the intercostal nerves has been shown to cause reflex constriction of the pulmonary vessels.          Treatment should be given the pneumogastric nerves, and any cervical lesion to them be removed, on account of their participation in the pulmonary plexus.  Treatment at the superior cervical region for general vaso-motor effect, and in the abdominal region to call the blood away from the lungs, will aid in the case.  Turpentine stupes applied to the chest over the affected areas are a great aid.  In cases of hypostatic congestion the patient's position in bed must be changed so as to drain the blood from the parts affected, usually the postero-inferior.
    Patients are usually relieved immediately upon treatment, The dyspnea being most easily relieved.   The cough and bloody expectoration gradually subside with the betterment of the case, which quickly yields to treatment.  One or a few treatments ordinarily correct the condition.


    DEFINITION: A condition in which there is transudation of the serum of the blood from the vessels into the aveoli, bronchi, and sometimes into the interstitial tissues of the lungs.
Cases are commonly met as complications of other diseases, as of heart, lungs, etc.
    LESIONS AND ANATOMICAL RELATIONS: As this condition is generally secondary to lung, heart, kidney, or other disease, the lesions would be those responsible for the primary disease.
Local lesion may be the cause of the condition.  As it is pointed out that generalized edema of the lungs may be due to any of the causes producing active or passive congestion of the lungs, those lesions already described as interfering with vaso-motor and motor activities of the lungs would be sufficient to cause it.  The general lesions, and their anatomical relations, which interfere with the pulmonary innervation and circulation have been fully discussed.
    Circumscribed edema may result from localized disturbance of the blood supply, due to the effects of a certain localized lesion.  "Obstruction to the aorta may cause it" (Anders.)
    It must be borne in mind that lesion to the vagus nerve interferes with muscular motion in the lungs and favors congestive, and inflammatory conditions, and it may lead to edema.  Lesions in the vaso-motor area (2nd to 7th dorsal,) and the various rib, clavicular, and other lesions affecting the lungs may cause this trouble.  Eichhorst shows that disturbances of the innervation of the pulmonary vessels may cause it, and it is probable that the increased permeability of the vessel walls which allows of the transudation of serum is directly due to the lesions to the vaso-motors.  Anders describes the condition as a "disturbance of cardio-pulmonic innervation." Such disturbances are well known to be the result of various bony lesions.
    The PROGNOSIS must be guarded, especially in those acute cases complicating other diseases, as in cardiac and renal dropsy.  In the chronic and recurring forms the prognosis is more favorable.  The prognosis must usually (depend upon that for the primary disease.
    It is often symptomatic of approaching death.
    TREATMENT includes that for the primary disease, according to its kind.  In any case the main object is to remove all obstruction to free circulation throughout the lungs.  To this end the heart and the vaso-motor area for the lungs should be kept well stimulated.
    Any lesion present must be removed as soon as possible.
    With renewed activity of the circulation and increased tone of the vessels the further progress of the trouble is limited, and the absorption of the exudate is favored.  Now the kidneys, bowels, and skin should be kept active by thorough treatment.  It has been shown in dropsical cases that the kidneys may be aroused, by the treatment, to enormous activity.
    The spinal and intercostal muscles should be relaxed and the ribs should be well raised to relieve the dyspnea.  The expectoration, due to the accumulation of fluid in the alveoli and bronchi, is relieved by the general process of the treatment, and by the increased circulation particularly.
A general spinal and cervical treatment, with flexion of the thighs, abdominal stimulation, etc., should be given to keep the general circulation active and thus to call away the congested blood from the lungs.  For the same purpose treatment should be given over the sternum and ribs anteriorly.
In severe acute stages one must be continually on guard against an emergency.  In urgent situations it is necessary to take quick and vigorous measures.  In such situations the regular osteopathic measures are greatly aided by the use of cafe noir, or by the application of hot sponges or hot mustard-plasters to the chest.


    CASES: (1) A young married woman, five months pregnant; daily hemorrhage from the lungs for nearly a week.  Had had similar attacks 5 months before.  They were due to congestion of the lung tissue.  Lesions were found in the form of a sensitive upper dorsal spine, with contracture of the scapular, cervical, and intercostal muscles.  Treatment of the lesions caused rapid improvement.
(2) Hemoptysis in a case of bronchial disease; lesion as a lateral curvature of the spine, and lesion at the 3rd dorsal vertebra.  The case was treated successfully.  Cases of hemoptysis as a complication of pulmonary tuberculosis, its commonest cause, are frequently treated with success.
    DEFINITION: Broncho-Pulmonary Hemorrhage, or Hemoptysis, is a condition due to bleeding into the bronchus, whence the blood is coughed up and expectorated.
    Pulmonary Apoplexy, or Hemorrhagic Infarct is a condition in which the bleeding takes place into the air-cells and lung tissue.  It may be diffuse (rare) or circumscribed.  The former is more copious.  The latter is usually due to embolism, and is a true hemorrhagic infarct.
    LESIONS: There are commonly present lesions of spine, ribs, cervical tissues, spinal tissues, etc., affecting the area of innervation of the lung.  These occur largely between the 2nd and 7th dorsal, at the clavicle, among the upper ribs, or in the cervical region upon the vagus nerves, weakening the lung and laying it liable to the action of the numerous causes that may result in pulmonary hemorrhage.  The various, lesions that may affect the circulation and innervation of the lung and the anatomical relations of such lesions to the lungs, have been pointed out.  Almost any of these various lesions may result in deranging the vaso-motor state of the lungs either by directly affecting the vaso-motor nerves, or indirectly, by weakening the lung function and impairing the nutrition of the tissues and vessels.
    Consumption, q. v. offers a good illustration of the effects of lesion to the lungs resulting in a disturbed vaso-motor condition which results in hemorrhage.  Here, in the early stages, the hemorrhage is due to a congestion of the membrane lining the small bronchi.  So any lesion weakening the vessels and leading to congestion of the lungs may result in hemorrhage.
    In cases in which the hemorrhages is secondary, as in heart disease, pneumonia, bronchitis, ulcers, etc., the lesion must be looked for as causing the primary disease.
    The PROGNOSIS must be guarded.  Hemorrhage from the lungs is commonly a grave occurrence.  In some cases it is of but little consequence.  A fair number of cases are handled successfully by Osteopathy.  The prognosis is favorable in cases due to consumption in its first stages, pulmonary congestion, pneumonia, fibrinous bronchitis, some forms of heart-disease, anemia, etc.  It is grave in the later stages of pulmonary tuberculosis, in rupture of an aneurism, in some forms of heart-disease, etc.
    I.  IN HEMOPTYSIS: Here the first indication is to keep the patient quiet, bodily and mentally.  He should remain in bed.  In cases due to a congestive condition of the bronchial
mucous membrane, the main thing is to keep the patient quiet in this way.
    A valuable osteopathic treatment in all such cases is inhibition of the heart.  This is accomplished by continuous inhibitive pressure from the 2nd to 5th dorsal.  It meets the important requirement of decreasing the power of the heart's contractions.
    This inhibition may be carried down over the lung area and over the splanchnics, thus decreasing the vascular tonus in the lungs, and in the vessels of the splanchnic area.  This object is aided by deep, inhibitive abdominal work, dilating the abdominal veins, and calling the blood away from the lungs.  The general vaso-motor center in the medulla should be inhibited, by pressure in the sub-occipital fossae.  In all these ways one quiets the circulation, slows the blood-flow, and favors the formation of clots to stop the hemorrhage.  This line of treatment likewise meets the important requirement of confining the blood to the systemic circulation.
    One should avoid percussion, as it may increase the hemorrhage.  The fever should be treated in the usual way, but it is not a troublesome symptom usually.  All the upper spinal muscles and tissues, as well as those of the cervical region, and the intercostal muscles, should be carefully relaxed in order to remove any irritating tension from the lungs.  This treatment will aid in relieving the cough, but it must be carried out very gently, in order not to move the chest or ribs, as thereby the clots might be broken and the hemorrhage increased.
    Any lesion present may usually be left for treatment until after the hemorrhage is fully controlled, as the handling of the patient in repairing it would be likely to start the hemorrhage.. Later a thorough course of treatment should be devoted to them.
    The patient may eat ice and use iced drinks, but hot drinks and alcoholics must be avoided.  The diet should be light and non-stimulating.  In congestive conditions hot foot baths are useful.  Cold applications to the chest may be used. "A firm ligature about one or both legs retards the flow of venous blood and aids in stopping the hemorrhage." - (Stevens.)   In severe cases no salt or fluids should be allowed.  It is sometimes necessary to withhold food entirely for a time.
    After the emergency due to the hemorrhage has been safely met, and the patient has recovered sufficiently, to undergo a course of treatment, attention should be given to the underlying condition of the system responsible for the hemorrhage.  The gout, suppressed menstruation, heart affection, anemia, etc., must be treated as the circumstances require.  Of course many cases, in which the hemorrhage does not become severe enough to be considered an emergency, fall at once into this category.
    II.  In pulmonary apoplexy one may follow the same line of treatment largely, especially at the time of hemorrhage.  The patient must have absolute rest, etc., as described above.
    In the diffuse pneumorrhagia, where the hemorrhage is usually copious, the case is generally hopeless, and rest is the only measure necessary.  The cases are, fortunately, rare.
    In the circumscribed form (pulmonary infarction) the indications at the time of the hemorrhage are the same as above.  The syncope, dyspnea, pain in the side, cough, and convulsions will be relieved by these measures.
    Later indications are to repair lesion, build up the strength of the lung, keep the local circulation active and absorb the clot.  This will prevent the formation of abscess or gangrene, at the point of infarction.


    DEFINITION: Alveolar Emphysema is a condition in which air is retained in the aveoli, distending them, leading to atrophy of the elastic tissue in their walls, and to destruction of the septa between the alveoli.  It may be localized, unilateral or bilateral.  It is compensatory when occurring from overwork of one lung, or a portion of it, by disability of the rest, and may then be regarded as an hypertrophy; it is essential when involving most of both lungs.  SENILE EMPHYSEMA is a variety, occurring in old people, in which atrophy and destruction of the alveolar walls allows of the formation of large air-sacs by the coalesced air-cells.
    Interstitial Emphysema is a form in which air escapes into the interalveolar and interlobular connective tissue.
    The LESIONS AND ANATOMICAL RELATIONS before observed in lung-diseases may be recalled here.
    Various rib and vertebral bony lesions, contractures of spinal muscles, etc., as well as lesions in the cervical region, interfere with the sympathetic vaso-motor and trophic innervation of the lung, weaken its tissues, derange its blood-supply, or interfere with its motor apparatus in such a way as to lay it liable, (a) to diseases which result in emphysema, or (b) to distention of tissues from weakness, due to bad trophic conditions, upon the occasion of sudden strain put upon them by coughing or other strong effort.
    Thus, in the one class of cases the lesion would pertain more particularly to the primary disease.  The bony lesion causing bronchial asthma by irritating the vagus nerve and causing spasmodic contraction of the bronchioles, or that causing a vaso-motor derangement resulting in catarrhal swelling of the mucous membrane of the bronchioles, thus obstructing the exit of the air from the alveoli, is the underlying cause of the emphysema.
    In the other class the lesion is more directly responsible for the condition.
    These cases frequently come under our treatment, most commonly as a complication of  asthma or bronchitis.
    The PROGNOSIS is favorable in that the patient's life may be made comfortable and be prolonged.  The conditions resulting from emphysema may be modified or prevented.
    The condition is incurable because it is impossible to restore the elasticity of the lung tissue or the destroyed septa.
    Great improvement in the patient's condition is accomplished by the treatment.
    In the interstitial form absorption of the air in the tissues may take place, the case thus recovering.  In cases of acute inflation the prognosis is good.
    The TREATMENT looks at once to the removal of the lesions present, and to the relief of the primary disease, whatever it is. The vaso-motor area (2nd to 7th dorsal) should be kept well stimulated to increase the circulation.  This is especially necessary because of the compression or destruction of the capillary networks about the alveoli in the affected portions.  It also aids in restoring strength to the tissues, and in correcting the catarrhal condition of the bronchi so likely to result from this disease.  Stimulation of the vagi is important for the purpose of increasing the motor power in the lungs.  The ribs should all be raised to give the lungs free-play, and likewise the spinal and intercostal muscles should be relaxed, the clavicles raised, and the sternum and cartilages be well treated.
    It is important to keep the heart well stimulated to guard against venous stasis and its results, which are the most to be feared.  Eichhorst mentions rhythmic compression of the thorax in these cases.  Treatment to raise the ribs in inspiration and to compress them in expiration may be used with profit.
    In these ways danger of death from stasis or suffocation is minimized.  The patient's general health should be built up.  In these cases hypertrophy of the right heart usually results.  The patient must avoid dust, bad air, and exertion.  In emergencies mustard plasters to the chest and hot foot-baths are good.  The patient must be continually guarded against heart failure, which is likely to result from acute dilatation of the right ventricle.


    DEFINITION: Acute Nasal Catarrh is an inflammation of the nasal mucous membranes, accompanied by an increased secretion of mucous and by various general symptoms, and is caused by specific lesions, in the cervical region chiefly, which may be secondary to contractures of muscles and soft tissues by exposure.  After repeated attacks the disease becomes chronic, upon account of the confirmed condition of the lesions.
    A "cold in the head" is an acute attack of this disease.  Yet "colds" may settle in any part of the body, as a rule, in "the weakest part," and then probably assume the form of congestion instead of inflammation as in the case of coryza.  Its manifestations are various, one of the chief ones being the disturbed vaso-motor reflex of the body.  These weak places liable to such congestion are commonly due to lesion of the part, which acts to deteriorate its vitality and lessen its resistance power.
    CASES: (1) A very severe and distressing cold, to sudden attacks of which the patient was subject.  They came on suddenly, lasted nearly a week, and then gradually disappeared.  Marked coryza, lachrymation, and sneezing continually, were features of the case.  It stimulated hay-fever very closely.  Upon treatment the sneezing stopped almost immediately.   Treatment was to the vaso-motor control of general circulation, to the pulmonary circulation, to relaxation of contractured muscles of cervical and upper dorsal regions, and to the circulation to the head.
    (2)  Sneezing and coryza, with all the common symptoms of  "catching cold" were relieved at once by a treatment.  Marked lesion was present at the 2nd cervical vertebra.
    (3) Intense nasal catarrh in a debilitated system suffering from a complication of diseases yielded at once to the treatment.  After six week's treatment a cold contracted from exposure was well withstood.
    (4) A case of nasal catarrh in a debilitated system showing various spinal lesions was greatly relieved by three treatments, and was progressing satisfactorily under treatment.
    Very numerous cases, many of them in an aggravated condition come constantly under treatment.  The author has treated several individuals who were subject to very severe colds, in whom one treatment invariably broke up the most severe attack.
    One case of chronic catarrh would, soon after a treatment, begin to spit out catarrhal concretions which had formed in the Eustachian tubes.
    CAUSES: The specific lesions causing such disease are, as a rule, high up in the cervical region, effecting especially the 1st to 3rd cervical vertebrae, but they may occur as low as the sixth dorsal.  One of the chief forms of lesion is that of contracture of the cervical muscles and deep, soft tissues.  These contractures, due primarily to exposure, gradually act to warp, or draw, the cervical vertebrae and intervertebral discs out of shape and out of their normal anatomical relations.  The result is obstruction to blood and nerve-supply, causing chronic catarrh.  The deeper anatomical lesions due to contracture and to other causes as well, produce catarrh, and not some other disease, because of affecting certain areas of nerve connections and certain centers.  Thus lesions of the upper three cervical vertebrae act upon the superior cervical ganglion, in ways already discussed, and distort the fifth nerve through its very intimate connections with the ganglion in question.  In the same way, lesion to the inferior cervical upper dorsal bony parts may affect those sympathetic fibers (or the area of the cord giving origin to them) which ascend in the cervical sympathetic chain, finally to reach the fifth nerve, which thus supplies secretary fibers to the parts in question.  The very numerous vaso-motor, secretory and trophic fibers for all parts of the head and face; for salivary glands, eye, car, tongue, face, mouth, etc., etc., passing to particular points of distribution through various of the cranial nerves, quite generally arise in the upper dorsal and cervical cord, having also numerous connections with the cervical sympathetics. This matter has been fully discussed in another place.  (*See "Principles of Osteopathy" Lectures XVI-XVIII. [Publisher's Note: Not included in this database.])  This explains the importance of cervical and upper dorsal lesions.  Thus lesions low down act upon the amending fibers of nerve-supply and affect a part much above, as in the case of dorsal lesion here.
    The fifth nerve bears special mention in these cases as the one concerned in the headache, lachrymation, sneezing, secretion of mucous, and inflammation of membranes.  This nerve is also, in part concerned in the loss or alteration of the functions of taste and smell, caused by pressure of the injected membranes upon the fine nerve terminals.
    The PROGNOSIS is good for all forms of the disease.  In acute cases it is particularly so, as one or a few treatments usually end the symptoms.  In chronic catarrh good results are generally easily attained , and many times a cure is effected.  In favorable climates do much to prevent cure as the patient is constantly exposed, hence the best results are attained in the favorable seasons of the year.
    The EXAMINATION AND TREATMENT for the specific lesion is made according to directions in Chaps. I to VII.  The specific lesion should be treated, and removed at once if possible.  This applies to both acute and chronic cases.  In acute cases one of the first steps is to relax all the upper dorsal and cervical tissues.  A thorough spinal treatment tones all the vaso-constrictors (2nd dorsal to 2nd lumbar), and all the vaso-dilators (all along the spine), thus aiding to equalize circulation, and reduce congestion of parts concerned.
    This effect is aided in an important way by raising all the ribs, and particularly by treating all the 2nd to 7th dorsal region on both sides, in this way increasing the activities of heart and lungs. The anterior thoracic region is treated to relax tissues and replace ribs; the clavicle is raised, and separated from the first rib to relax the deep anterior cervical tissues, to free circulation through the carotid arteries and jugular veins, and to free the pneumogastric nerves.  All the cervical muscles are thoroughly relaxed, the ligaments released by deep treatments, and the vertebrae of the whole region manipulated.  This frees the connections of the sympathetics, the venous flow from the head, and tones vaso-motion in the affected parts.  It is an important step in remedying the congestion of the parts of the head.  Inhibitive treatment should be given the superior cervical ganglion to dilate blood-vessels and allow the congestion to be swept out.  The superior and inferior hyoid muscles are relaxed, and the work is carried down along the trachea to the root of the neck.  The mouth is opened against resistance; the tissues beneath the angles of the jaws are relaxed.  This releases the internal jugular veins, stimulates circulation through the carotid arteries, and corrects circulation.  One of the most efficient measures for curing the congestion of the head, and to relieve the stoppage of the nostrils is the momentary pressure upon both internal jugular veins, before described, followed by heavy pressure with the palms of the hands upon the forehead.
    Particular attention is devoted to the treatment of the fifth nerve for reasons already given.  It is reached at points upon the face already described, and all the tissues over them are relaxed.      Treatment of this nerve thus directly is a most important adjunct to that given its sympathetic connections.  It is most important as a means of relieving the inflammation, secretion, lachrymation, and stopping of the nostrils.  Manipulation along the sides of the nose frees the nasal ducts and relieves the congestion; strong pressure upon the root of the nose and upon the forehead frees the nostrils; tipping over the frontal sinus relieves congestion and pain in it.  The headache is relieved by the treatment in the general cervical, superior cervical, and frontal regions; the cough is relieved by the treatment along the trachea; the chilly feeling by the brisk spinal treatment.  The soft palate may be treated by placing the finger gently upon it and sweeping it laterally across.  This treatment may be carried well up toward the opening of the Eustachian tube.  The congestion of these parts is thus relieved.
    The lungs must be kept well treated to prevent the cold from settling upon them.  Precautions must be taken against the marked tendency of these congestions to move from part to part.  This is done by keeping all well stimulated by the treatment.  The bowels and kidneys are treated to keep their action free.  The treatment about the lower jaw and to the carotid arteries is efficient in reaching the Eustachian tube, and in loosening the secretions that sometimes occlude it.  Deep treatment under the angles of the jaws is good in ill forms of catarrh.
    In chronic cases the treatment is devoted more particularly to the removal of the specific lesion, and the building up of the blood-supply to the nasal membranes.   As these are often atrophied or hypertrophied.   (Atrophic or Hypertrophic Rhinitis, Ozena.)   A long course of treatment is generally necessary to their rehabilitation.  The principal treatment is directed to the cervical tissues, where chronic contracture of the muscles exists.
    Daily treatments in severe acute cases, and three per week in chronic cases, are usually sufficient.
The patient should take care not to expose himself, but, on the other hand, should not keep the body tender and susceptible by dressing too warmly, sleeping under too many covers, or living in overheated quarters.  One may contract a cold by going suddenly from an extremely hot to a very cold atmosphere, or vice versa.  In all of these conditions it is important that the patient should not go out too soon after the treatment, as the  system is relaxed and more cold may be contracted


    DEFINITION: Epistaxis is the term used to designate hemorrhage from the nose.  It is found in serious form in some people.  It may be caused by accident, as in fracture of the skull, or by local irritation, such as picking at the nose.  It is often an incident in some other disease, as in typhoid or influenza, or in anemia, hemophilia, plethora, etc.  In all cases a careful search should be made for its causes.  For example, it may be due simply to rarefaction of air, or to affections of the nasal mucosa, such as ulcers, polypi, hyperemia, or to contracted kidneys or valvular heart lesions.  Or it may be brought on by over exertion, by vigorous blowing of the nose, or by overeating.
    When the cause is found the case must be treated accordingly.  Specific lesions present often act as determining factors, and their removal is an important measure in preventing recurrence of such hemorrhages.  Cervical lesion, involving the atlas and the muscles, has been noted.  Other forms of cervical lesion, affecting the superior cervical ganglion or the cervical sympathetic may aid in causing it.
    CASES: (1) A lady of 53 years of age, suffering for three years with epistaxis, the hemorrhage coming generally after fatigue.  It was often profuse.  Lesion existed as contractures of the muscles of the right side of the neck, leading down to a tender area upon the point of the right shoulder.  The lady had been injured here just before the trouble came on her.  The condition was cured in ten treatments.
    TREATMENT: Holding of the facial artery where it crosses the inferior maxillary bone, and the nasal artery at the inner canthus of the eye, also pressure applied to the carotid arteries slow the blood-current and favor the formation of a clot.  In some cases, friction over the superior cervical region has been enough to arouse sufficient vaso-constriction to stop the flow.  The case may be helped by raising the arms high above the head.  It is frequently difficult to stop the hemorrhage at the time, but the treatment applied to the correction of the lesion and to the freedom of circulation through the neck will stop the recurrence of the hemorrhages.  In severe cases it may be necessary to resort to plugging of the posterior nares.  The application of ice or cold water to the superior cervical region, and the use of hot or cold injections into the nostrils are efficient domestic remedies for the condition.  The patient should rest quietly, and avoid blowing and wiping of the nose.  Holding the nostrils shut may facilitate the formation of the clot.  Injections of cold ,water and vinegar into the nostrils are useful.  A tampon of absorbent cotton in the nostril may be sufficient.


    DEFINITION: An acute or chronic inflammation of a part or the whole of one or both pleurae, attended by cough and pain in the side, and caused by lesions affecting ribs, thoracic vertebrae, intercostal and spinal muscles, nerves, etc.
    CASES: (1) A case of pleurisy due to a displacement of the 8th rib.
    (2) In a dentist, a case of pleurisy was developed by the irritation by the eighth and ninth left ribs, which were luxated by continued bending over at his work.  Correction of the lesion
cured the case.
    (3) A case presented lesions in the form of the, upper four ribs drawn together and (4) another ease showed merely vertebral; lesions.
    CAUSES: The important lesions in these cases affect the ribs; cases are rare in which lesions of this kind are not present.  Other lesions are consequent or subsidiary to rib lesions.  They may affect the ribs of either side, as low as the 10th on the left and the 9th on the right, marking the lower limits of the pleurae.  Secondary lesions in the cervical region, affecting the pneumogastric, phrenic, sympathetic nerves, concerned in the innervation of the pleurae, may occur.  Lesions of the clavicle and first rib, impeding circulation through the sub-clavicle and internal mammary arteries, are important.  The cervical lesions mentioned, with lesions of the spinal muscles and dorsal vertebrae, affect the innervation, composed of branches from the pneumogastric, phrenics, sympathetics, and pulmonary plexuses.  Important derangements of circulation are thus caused by  lesion to vaso-motors, aiding the process of inflammation, which is the active morbid process in the case.  The drawing of spinal muscles, luxations of vertebrae, and the interference with spinal nerves also aid the causation of rib lesions.  The latter sort is by far the most efficient in causing pleurisy because of its relation to the intercostal vessels and nerves.  These nerves and vessels all together total a vast area of blood and nerve supply to the pleurae, especially to the parietal portions.  The nerves carry vasomotor and secretory fibres to the parts supplied by them, hence to the pleura.  Hilton points out that the nerves innervating the linings of the body cavities supply also the skin and muscles of the walls of these cavities.  This is well instanced in the case of the parietal pleurae, which are supplied by the intercostal nerves, they also supplying the intercostal and abdominal muscles and the overlying skin.  Such being the case, lesion by displacement of ribs, irritating intercostal nerves, disturbs the vaso-motor and secretary processes in the pleura supplied by the same nerves.  Hilton has also pointed out that a joint, the muscles moving the joint, and the skin overlying these muscles, are all supplied by branches of the same nerves.  Hence vertebral lesion and lesions affecting the relations of the heads of the ribs may affect the nerves through their articular branches.  In this way spinal lesion might be the origin of such disease.  But further, since each intercostal nerve is connected by the rami communicantes with the sympathetic system, lesion of these nerves affects the sympathetics.  These sympathetics in the dorsal region contain both vaso-dilator and vaso-constrictor fibres; they enter into the formation of the pulmonary plexus, which in part innervates the pleura.  Hence intercostal lesion affects vaso-motor control of the parietal pleura directly, and of the visceral pleura indirectly.  In another way does intercostal lesion act to set up the inflammatory process of pleurisy.  Lesions of the clavicle, deranging circulation through the sub-clavian and internal mammary vessels, and of the other ribs, directly obstructing the intercostal vessels, and indirectly deranging the circulation, through related vessels to the visceral pleura!, (bronchial, mediastinal, and diaphragmatic vessels) disturb the entire circulation to these parts.
    In these ways may all the various lesions described work together to produce inflammation. The affected area is larger or smaller according to the nature and extent of the lesions.  Lesion of a single rib has frequently been found responsible for an acute attack of pleurisy, either circumscribed and limited in extent, or spreading to involve considerable areas.  The same sort of lesion may produce all the various kinds of pleurisy described in medical texts.
    According to osteopathic theory, the bacteria present in this disease and ascribed by some writers as its cause, could not live and propogate their poisons in healthy tissues.  The presence of the lesions described may weaken the tissues and allow the microbes to gain a foothold.  It is significant that exposure to cold and wet, and mechanical injuries cause the disease, as the osteopath looks for such causes to produce the displacements and other legions to which he traces the disease.
    The PROGNOSIS is good.  Cases generally recover without difficulty.  Often all the pain and other manifestations disappear at once upon removal of lesion; the setting of a rib.
    THE EXAMINATION AND TREATMENT: This lesion should be removed as soon as possible, and at once if the condition of the patient will allow.  Treatment should be directed to the relaxation of spinal, intercostal, and cervical tissues , and to the raising of the ribs, for the purpose of removing obstruction from and toning the circulation and innervation of the pleura.  The raising of the ribs and clavicle, including the repair of the particular luxation of ribs that is causing the trouble, are the most important steps.  If the case is seen before the inflammation and exudation has progressed far, the process may be more easily stopped, as the necessary point is to gain control of circulation, which may be readily accomplished through nerves and vessels as already explained.  In the stage of exudation, where quantities of the exudate occur in the pleural cavities, attention must be given to releasing the tension in parts due to contractures of muscles, etc., to raising the ribs to allow more free-play of the lungs; and to the relief of the pain in the side, and the distressing cough, by carefully raising the ribs and manipulating the tissues at the seat of the pain.  But the main point at this stage is, by the treatment to the circulation, to hasten the resorption of inflammatory products.  This may be done to a considerable extent.  Great care must be taken in handling the patient on account of the great pain.  By stimulating the process of absorption, and by keeping the parts free from tension in the tissues, also by keeping up, carefully, free motion of the ribs and parts, the adhesions of the pleurae, and the retraction of parts likely to occur as a result of the inflammation, may be avoided.  This is during the convalescence of the patient, while his condition must be carefully watched.  The point may be reached in some cases where tapping might be necessary, but if the ease is seen in time the process may be so controlled as to obviate this difficulty.  In cases of adhesions between the pleurae if painful, they should be gradually broken up.  This is done in a course of treatment, carefully giving the parts concerned the extremes of motion of which they are capable.  The process is aided by developing the circulation to, in part, absorb the adhesive tissues.  This must frequently be done in the chronic case.  The treatment of such cases consists mainly in correction of lesion, and in maintaining free circulation for the absorption of pus, if present.
    In treatment of pleurisy, stimulation of heart and lungs, of bowels, kidneys and superficial fascia, for the removal of poisonous waste; and attention to the general health of the patient, are necessary.  Acute cases should be kept upon a light, easily digested diet.  Exposure must be prevented.  One thorough treatment daily, with more treatment at times during the day for the relief of pain, etc., will usually be sufficient.  Chronic cases should be treated three times per week.

PNEUMOTHORAX (Hydropneumothorax, Pyopneumothorax)

HYDROTHORAX (Dropsy of the Pleura) and HEMOTHORAX

    In all of these conditions the situation which confronts the Osteopath is much the same.  No particular LESION can be mentioned for the causation of these diseases directly.  They are all usually secondary to other diseased conditions, and the lesion of the primary disease is the one responsible for the trouble.  Pneumothorax and hemothorax may occur from violence, no ordinary lesion, of course, having anything to do with such a result.  The lesion is otherwise the one producing the disease of heart, lungs; kidneys, or of the general system, to which these conditions are secondary, and must be sought and treated accordingly.  Naturally such lesions may have much to do with weakening the lung tissues, vessels, and other structures, preliminarily to one of these diseases.
    The PROGNOSIS in these conditions is, generally speaking, fair.  Much may be done for the relief of the patient.  The prognosis for cure depends upon that for the original disease.
    In the TREATMENT the practitioner has in view three main objects: (1) to relieve the painful, or troublesome symptoms, (2) To treat the original; disease, or remove the active cause,  (3) To absorb the gas or fluid from the pleural cavity.
    In cases of pneumo-thorax the treatment is in most respects like that for pleurisy.  Spinal inhibition, relaxation of spinal and intercostal tissues, and careful elevation of the ribs quiets the pain, gives more freedom to the lungs, and relieves the dyspnea.  A general spinal treatment should be given to equalize the systemic circulation.  For the absorption of the gas and fluid one should proceed as in pleurisy, q. v. If much pus be present it should be drained.
    In hydrothorax the treatment would be practically the same.  As these cases are usually due to chronic heart, lung,, or kidney diseases, particular attention must be given to the treatment of the diseased part.  Any obstruction to free circulation must be removed.  In anemic and cachetic states attention must be given to the general system to build up the health.  As there is no inflammatory process, the absorption of the transudate is accomplished as in that of the pleuritic, effusion after the inflammation has been controlled.  The heart and lungs must be kept well stimulated to increase the vigor of the heart, render the general circulation active, and thus decrease the pressure in the venous system.  If the accumulation of fluid threatens suffocation, paracentesis must be performed.
In hemothorax the primary step is to insure absolute rest of the patient and to control the hemorrhage.  This may be done much as in pulmonary hemorrhage, q.  v.   All stimulation must be avoided.  After the clot is formed absorption will proceed naturally.  Later one may give such treatment as will insure complete absorption, and restore entire freedom to the activity of the lungs. (See Pleurisy.)


    DEFINITION: An acute inflammation of the mucous membrane lining the larynx.  In acute and chronic catarrhal forms the inflammation is a catarrhal condition.  In the spasmodic form (laryngismus stridulus), the condition is a nervous one. (See Croup.) In the edematous form the inflammation is accompanied by exudation arid infiltration of the tissues.  This form is also known as Edema of the Larynx.
    CASES: (1) A case of chronic laryngitis due to lesions as follows: left cervical muscles sore; 1st cervical vertebra up; 2nd, down; 5th cervical vertebra posterior.  The right eye was weak and the tear-duct was closed.  Aphonia would occur frequently for several weeks.
    (2) An acute attack of laryngitis in a singer was overcome by a single treatment upon several occasions, enabling him to sing in public.
    (3) A case in which a few minutes treatment of the hyoids, etc., enabled a singer to readily run the scale to a high note, previously beyond her reach.
    (4) A case in which chronic laryngeal disease had destroyed a finely cultivated voice, in which, after the failure of treatment by specialists, an Osteopath found weakness of the epiglottis. Treatment strengthened it, restored it to free action, and recovered the voice.
    (5) A case of aphonia frequently fully relieved by a few minutes treatment.
    (6) A case of aphonia, due to spinal injury, cured in two months.
    CAUSES: Lesions to the innervation and blood-supply of the larynx are present.  The chief ones are to the pneumogastrics and cervical sympathetics, and occur at the atlas, axis and third cervical vertebra, where they affect the superior cervical ganglion, and through it the nerves in question.  Cervical lesion may also affect the other cervical sympathetics concerned in the innervation of the larynx.  These lesions affect circulation of the larynx through the innervation.  Direct lesion to the blood-vessels may occur at the clavicle and first rib, at the deep anterior cervical tissues, and in the muscles along the neck anteriorly, and about the throat.  They may obstruct the circulation in the carotid arteries and thyroid axis, or may impede the venous return through the small veins and the innominates and internal jugulars.  Local weakness of the glottis, or the laryngeal muscles, may occur primarily or secondarily to other lesion.  The edematous form is especially likely to be caused by obstruction to the internal jugular veins.  Traumatism may be the sole cause, and irritation, etc., may act secondarily to cervical lesion to cause the disease.
    The PROGNOSIS is good.  Immediate relief is obtained from the treatment, and recovery soon follows.
    In dangerous cases of edematous laryngitis great care must be taken.  Tracheotomy may become necessary in some cases, but ordinarily this can be avoided by the treatment if the case can be seen in time.
    The TREATMENT must be directed as far as possible to the immediate removal of the specific lesion.  This releases circulation and nerve-supply as shown above.  The tissues of the neck, particularly the throat must be thoroughly relaxed; the clavicle is raised, and the deep anterior muscles and tissues of the root of the neck are treated.  These treatments free the circulation in the vessels as shown above.  The circulation in the carotids is further aided by opening the mouth against resistance.  The vagus is treated along the course of the sterno-mastoid muscle, and at the superior cervical region.  Its superior laryngeal branch is treated behind the superior cornua of the thyroid cartilage.  Its recurrent laryngeal branch is reached at the inner side of the lower portion of the sterno-mastoid muscle at about the level of the cricoid cartilage.
    Deep treatment is made along the course of the larynx and trachea, from the hyoid bone and muscles to the root of the neck.  Care must be taken to apply the fingers of the operating  hand, close  along the sides of the trachea.  This is excellent treatment for the huskiness and the spasm.  The latter, however, is apt to depend upon some special lesion.  In spasmodic laryngitis the epiglottis is sometimes caught in the rima, and must be released by introducing the index finger into the throat.  Treatment of the phrenics and the diaphragm aid in lessening the spasm by quieting the action of the diaphragm.  A warm bath is recommended to break up the spasm.  In a child with an overloaded stomach, to cause vomiting affords relief.
    The vagi and cervical sympathetics are treated at the superior cervical region and along the posterior region.
    In acute cases inhalations of steam are helpful.  If there be much swelling and pain, the patient may be relieved by sucking ice.  In case of stenosis, apply a mustard plaster or cold compress to the front of the neck.
    Chronic cases must avoid exposure, and irritation of the throat, as from overuse, also smoking and alcohol.
    Cases of aphonia, due to the changes in the vocal cords, or to weakness of the epiglottis, may be cured by this treatment.
    In edema of the larynx due to a dropsy from kidney, heart, or lung disease, attention must be given to the general dropsical condition and its cause.  In dangerous cases of edema an operation becomes necessary to prevent suffocation.  Short of this, hot foot-baths, hot drinks, milk, or seltzer-water give relief.