The Practice and Applied Therapeutics of Osteopathy
Charles Hazzard, D. O.
1905
  
 
CHAPTER XV
 
DISEASES OF THE NERVOUS SYSTEM
 
 
CHOREA. (St.  Vitus Dance)

    DEFINITION: A disease of the nervous system characterized by involuntary contraction of muscle groups, accompanied by weakness, and often by slight mental derangement, due to spinal lesions interfering with motor function of brain or cord.
    (1) A case in a young girl, of three or four months standing, very severe had lost all control of hands and feet, and of speech; could take only liquid food.  It was thought she could not live.  Lesions were found at the atlas and 4th dorsal vertebrae.  The case was cured.
    (2) In a boy of nine, chorea followed vaccination.  Lesion was found at the atlas and at the 2nd to 4th dorsal vertebrae.  Case cured in five weeks.
    (3) A case in a child of eleven, of nine months standing.  Very severe; no sleep for six nights; power of articulation was lost.  Six weeks of treatment showed great improvement.
    (4) A girl of ten; marked lesion of the atlas, and of the 3rd and 4th cervical vertebrae; the 2nd to 6th dorsal vertebrae were irregular and lateral; 5th lumbar posterior; cured in four months.
    (5) Case of two years standing in a boy of twelve; right hand useless and carried in a sling; lesion at 1st and 3rd dorsal.  Under treatment he became able to write well in one month.
    The case was cured.
    (6) A case of two years standing in a girl of thirteen.  She had grown continually worse under usual treatment.  The atlas was found displaced to the left, and upon its being replaced at the second treatment the jerking of the muscles bean to grow less at once.  The case was cured and the child, previously undersized, grew rapidly thereafter.
    (7) The patient was a girl of thirteen; confined to the bed; arms and limbs drawn and useless; she could not sleep or speak intelligently.  Bony lesions were found in the cervical and lower dorsal regions, and all the spinal muscles were contractured.  The case of three months standing, was cured in one month.
    (8) A case of acute chorea, in a girl of seven, a pupil in the public school.  Lesions were: 2nd dorsal lateral, 6th dorsal posterior, slight curvature to the left in the dorsal region, muscles in cervical region contractured.  Inhibition at the suboccipital region controlled the twitching of the muscles at once.  The case was cured.
    (9) A case in a girl of ten, which had been gradually coming on for six months.  Atlas and axis were luxated to the right; 1st and 8th dorsal vertebrae deviated laterally; 5th and 6th ribs drawn together.  Over study at school was the direct exciting cause.  She was cured in 2 months.
    (10) Huntingdonís Chorea.  A case of hereditary chorea is reported, which was without a doubt a true case of Huntingdonís chorea.  The father and mother had both been sufferers from chorea; the very marked affection of many muscle groups was present; the child was very dull, and had been regarded as having lost her mind.  The condition was confirmed, chronic, and hereditary.  The 2nd and 3rd dorsal vertebrae were anterior.
    The case was cured.
    LESIONS AND ANATOMICAL RELATIONS: The lesions in these cases are found in the majority in the upper dorsal and cervical regions.  Eight of the above cases described, lesion and are illustrative of the facts generally observed in such cases.  All showed lesion in the cervical or upper dorsal region, one or both.  Neck lesion is important in these cases.
    Six of the above showed cervical lesion, five of the six being atlas lesions.  The fact that atlas lesions alone may cause the disease is illustrated by case (6).  The fact that the upper dorsal lesion alone may cause it is illustrated by case (5).  But frequently, as in four of those reported, combined lesion of the cervical and upper dorsal regions occur.  The upper dorsal lesion is perhaps the most important one.  Six of the above showed lesion somewhere in the upper six dorsal vertebrae.  The spinal area from the atlas to the 6th dorsal may be regarded as the important locality for lesions producing chorea.  They may occur lower or affect the ribs as well as vertebrae.
    These lesions high up in the spine may involve the cord and brain, in a similar manner but lesser degree, as in paralytic affections of the whole body.  The frequent occurrence of high lesion explains the usual general effect of the disease upon the whole body, including the upper and lower limbs, and suggests the idea that the cord, brain, or both are involved by the lesion.
    The authors state the pathology of this condition is obscure no constant lesions being found.      Probably, as McConnell observes, this is due to the fact that spinal lesion often involve simply nerve fibers.  Some writers hold the disease to be a functional brain disturbance affecting the centers controlling the motor apparatus.  From this point of view cervical and atlas lesion have important bearing, as they may influence brain centers by interference with blood supply to the brain through direct impingement upon the vertebral arteries and by disturbance of the cervical sympathetics.  Upper dorsal lesions aid this effect by sympathetic disturbance.  From this viewpoint either atlas, other cervical, or upper dorsal lesion alone could cause the disease.
    It is worthy of note that the upper dorsal lesion (1st to 6th) falls upon a portion of the cord richer, perhaps, than any other in sympathetic centers.  The ciliospinal center, vaso-motors to face, the mouth, pupillodilator fibers, motor fibers to involuntary muscles of the orbit, vaso-motors to the lungs, accelerators to the heart, etc., all occur within this spinal area.  This disturbance to the sympathetic may have much to do in unbalancing the nervous system in such cases.  This lesion could also effect spinal fibers by impingement, or the nutrition of the cord through sympathetic disturbance of its blood supply.
    On the whole the likely pathology in this disease is that there is cord lesion or brain lesion due to mechanical irritation or to cut off nutrition.  These various lesions weaken the portions of the nerve system involved, and lay it liable to the action of such reflex causes as irritation due to parasites, eyestrain, nasal disease, sexual disorders, etc., or to such causes as over study, shock, worry, strain, etc.
    The PROGNOSIS is good.  It is rare that the treatment fails to cure or greatly relieve the case.  Cure in a short time is the rule, even in serious and long standing cases.
    The TREATMENT consists mainly in removal of lesion as the real cause.  In some cases this is the sole treatment necessary.  Ordinarily it is necessary to carry the patient through a course of treatment.  All causes of irritation or nerve strain should be removed.  Such are intestinal worms, causes of worry, etc., as noted above.  An important measure in these cases is the treatment upon the neck and spine for the general nervous system.  The neck treatment reaches the sympathetic system, the medulla, the circulation to the brain, and influences the whole nervous system.  It consists of the removal of lesion, relaxation of tissues, inhibition or stimulation of the cervical nerves and centers, etc.  The spinal treatment is upon the same plan.  It should be carried down along the spine.  These treatments quickly relieve nervous tension and quiet the nervous system.  They correct the circulation to the brain and central nervous system, increasing their nutrition, and stopping the muscular twitching characteristic of the conditions.  Inhibition of the superior cervical ganglion may also aid in stopping the twitching.  An important treatment is the removal of contracture of the muscles all along the spine, common in these cases.  Attention must be given to the patient's general health.  The heart is often very fast and should be slowed in the way already described.  'The kidneys should be stimulated and general metabolism in the body looked to increase too light specific gravity of the urine.  The bowels must be kept regular.
    A thorough general treatment should be given to the muscular system, especially to those muscle groups involved in the disease.  This includes flexion and circumduction of limbs and arms, etc.
In some cases inhibition of the cervical sympathetic will cause the muscular twitching to cease at once.  It has been accomplished by pressure between the 3rd and 4th cervical vertebrae.
    In the hygienic treatment of the case all causes of nerve strain, overwork mentally, excessive physical exertion, etc., must be removed.  Muscular exertion may lead to heart involvement, especially as cervical and upper dorsal lesion favor such conditions.  The diet should be light and nutritious.  Fruits and vegetables may be taken, but meats and highly seasoned foods should be avoided.  Sponging of the back, chest and neck with cold water is useful.
    The various CHOREIFORM AFFECTIONS, such as the spasmodic tics, habit chorea, laryngeal tic, choreic wryneck, facial tic, jumping disease, etc., also rhythmic or hysteric chorea, fibrillary chorea, athetosis, and various other forms, are met in the same way.  A number of such cases have been cured.
    Huntingdonís chorea, a hereditary disease with progressive dementia, is a very grave disease.
 



 
EPILEPSY

    DEFINITION:  A disease in which there is loss of consciousness, with or without convulsions.  From the osteopathic point of view it is caused by lesions interfering with the nutrition of cord or brain, or irritating the motor nerve strands running to the peripheral motor structures, or exciting connected nerves.
    CASES: (1) A case showing lesions at 7th and 11th dorsal vertebrae.  Under the treatment the attacks were much decreased in frequency not having appeared for a considerable period.
    (2) A case of more than one yearís standing in a girl of thirteen; three to twelve attacks daily; lesions in upper cervical spine, posterior curvature from 6th dorsal to lower lumbar, marked lesions occurring at the 6th dorsal and at the 5th lumbar; all spinal muscles very rigid.  Improvement began at once upon treatment, and the case was cured in three months.
    (3) A case of fifteen years standing in a man of thirty.  No attacks occurred after the first treatment, and the case was cured in four months.  No recurrence of attacks nineteen months later.
    (4) Daily attacks in a boy of eighteen, apparently due to a nervous stomach disease.  The latter was cured in three months, and no further attack had occurred six months afterward.
    (5) A case of fourteen years duration in a lady of eighty was cured in two treatments.  No attack occurred after the first treatment.  The report was made two and a half years after the cure, no further attack having occurred.
    (6) In a boy of twelve, monthly spells of two days duration occurred, during which he would have from three to five spasms.  The 3rd cervical vertebra was found turned far to the right.  Under a three months course of treatment he had not had the last two monthly spells.
    (7) A case of petit mal in a young man of thirty.  Lesions at the atlas, which was to the right and turned with the right transverse process backward, and at the axis, displaced to the left.  Case still under treatment.
    (8) A case of petit mal due to lesion of the atlas to the right and back, and of the 2nd cervical to the left.
    (9) A case in a woman of thirty-one.  The atlas was slipped to the left; 4th cervical much to the left, and 3rd to the right; 1st, 2nd, 6th, 7th and 8th dorsal posterior; marked separation between 5th lumbar and sacrum; left ribs considerably down.  A history of severe falls during childhood was noted.  The disease was over twenty-three yearís standing . The lesion at the 3rd cervical seemed the greatest source of irritation.  When its condition was exaggerated, it caused an attack.      Immediate benefit was given by the treatment, but the case did not remain under treatment until cured.  When first seen the patient was in a series of attacks lasting two to three days.  The attacks began at once to be less frequent and were two months or more apart when treatment ceased.
    (10) A case of six yearís standing in a woman of twenty-two, the attacks coming on first after a fall down stairs, in which the side was hurt.  Lesion was found as downward luxation of the left 12th rib, and prolapsus or contraction of the diaphragm.  The treatment was to the removal of lesion and to equalize circulation.  Benefit came by the first treatment, and the case was cured in three months.
    (11) A case of nine years standing in a woman of thirty-two.  The attacks were at first nocturnal, later coming on in the daytime. Lesion was a right lateral condition of the atlas, with marked contracture of the deep and superficial muscles along the spine.  The condition was at once benefited, and a cure was gotten in three months of treatment.  The lesion of atlas was bettered at the first treatment, giving relief.  During an attack the patient was brought out of it in five minutes by strong pressure over the solar plexus.
    (12) A case of epileptiform seizures in a woman of twenty, of three years standing.  The atlas was to the right; the spine was posterior from the 12th dorsal to sacrum; the spinal muscles and the tissues were contractured.  The uterus was anteflexed.  Under treatment the case was much benefited.  The attacks were rendered much lighter and much less frequent.
    (13) In a case of epilepsy in a boy, removal of lesion to the coccyx cured a case after all other means had failed.
    LESIONS AND ANATOMICAL RELATIONS: It seems that lesion along the neck and spine anywhere may cause epilepsy.  Dr. A. T. Still is credited with the statement that there is usually lesion between the 2nd and 3rd cervical vertebrae.  He also ascribes epilepsy to lesion causing prolapse of the diaphragm, and obstruction to the arterial and venous blood, and of the lymph, in the vessels perforating it.  In this way the products of digestion are retained and decompose, the patient suffering from autointoxication.  Lesions in the above cases occurred at the atlas, cervical region, and from the middle dorsal down to the last lumbar.  McConnell states that lesions occur often in the splanchnic area and to the ribs, especially in the spinal region between the 4th and 8th dorsal vertebrae, also that the prominent lesions occur in the neck from the 3rd to 7th vertebra.  He notes a case caused by displacement of the right 5th rib.  An attack could be caused by irritation of this lesion, or be relieved at once by replacing the rib.
    The neck lesions seem, on the whole, to be the most important.  Neck and spinal lesion may act by obstructing the blood supply to brain or cord.  They may affect the cord directly by mechanical irritation, or may affect brain, cord, or nervous system generally through the sympathetics.  In this way they may bring about those morbid conditions of the cord, brain and meninges said to cause the disease.  While the pathology of epilepsy is unknown, it yet appears that osteopathic lesion may account for many of the various conditions assigned as causes.  Such lesions, disturbing the sympathetic system, may act as does peripheral irritation from dentition, worms, cicatrices, adherent prepuce, etc.  Various of these lesions may directly irritate peripheral nerve structures.  As traumatism is assigned as a cause, osteopathic lesion, as cause or effect of traumatic conditions, may be the real cause.
    According to Gray, the best accepted modem theory of the cause of epilepsy is that it is due to direct or indirect excitation of the cortex or of nerve strands leading from the cortex to the peripheral structures; that there is a peculiar condition of the motor tract which runs from the motor convolutions to the peripheral motor structures and muscles.  He states that we are ignorant of the nature of this molecular condition; that muscles can be convulsed only by direct excitation of the muscle itself, or of the motor tract leading from the muscle up to the motor convolutions; but that some varieties of epilepsy are evidently due to an excitation that extends into this motor tract from some part of the nervous system beyond it.  It would seem clear that osteopathic lesion may irritate these motor tracts somewhere in their course, as by direct pressure of luxated spinal vertebrae, etc., or that in a multitude of ways it may produce excitation in some other part of the nervous system from which it extends to the motor tract.  As nerve irritation by lesion is the important point in osteopathic etiology generally; being well supported by numerous instances in which its removal has cured the disease, it is a reasonable conclusion that the various bony lesions found in epilepsy are causing it by excitation of the sort mentioned.  This point is likewise supported by the fact that removal of such lesion has often cured epilepsy.
    The PROGNOSIS is fair in the ordinary case, a fair number of the cases coming under osteopathic treatment being cured entirely.  A large percentage not cured are benefited. There seems to be but little difference in the prognosis in favor of petit mal.  In Jacksonian Epilepsy the prognosis is not good.
    TREATMENT: At the time of attack but little can be done for the patient.  If the patient can be reached at the aura, the attack may be prevented by pushing the patient's head strongly back against a band applying deep pressure in the suboccipital fossae.  This treatment seems to arouse reflex stimulation or to equalize blood flow to the brain by effect upon the superior cervical ganglion and medulla.
    Anders states that constriction of the limb in which the aura occurs, forcibly moving the patient's head, placing snuff to the patient's nose, applying ice to his spine, etc., will sometimes prevent the attack.  McConnell calls attention to the fact that in cases where the exciting factor seems to be in the intestine and there is reverse peristalsis of the intestines, causing a reversion of the nerve current in the vagi, thorough rapid abdominal treatment will normalize peristalsis and aid in preventing an impending attack.
    Stimulation of the solar plexus may lessen the attack by calling the blood to the intestines and thus reducing pressure in the cranium.
    At the time of the attack the patient must be prevented from having serious falls, if possible.  The clothing about the neck should be loosened that it may not restrict circulation.  Some object should be slipped between the teeth to prevent the patient biting his tongue.  Small objects that might fall into the windpipe should not be used for this purpose.
    A general course of treatment is depended upon to prevent recurrence of attacks and to cure the case.   This consists in the removal of lesion, whatever it may it may be, and all causes of reflex irritation mentioned above. It is especially important to remove lesion acting to irritate the motor fibers of the central nervous system, in view of the fact pointed out above that such excitation is probably the most efficient cause of epilepsy.  Treatment should be given to correct blood flow to and from the brain, including such treatments as opening the mouth, against resistance, treatments along the course of the carotids, elevation of the clavicles, treatment of the cervical sympathetics, etc.  Attention should be given to upbuilding the general health, and to keeping bowels and stomach in good condition.  All causes of worry or nerve strain should be avoided and the patient should lead an outdoor life.  The food should be light and easily digested, consisting of some meat, fruit, vegetables, cereals, etc.  Cold sponge baths are recommended.
 



MIGRAINE, (Hemicrania, Sick Headache) AND OTHER FORMS OF HEADACHE (Cephalagia)

    DEFINITION: Migraine is "a neurosis characterized by severe attacks of headache, often paroxysmal and more or less periodic, with or without nausea and vomiting." It is of obscure pathology; there seems to be nothing to connect it with lesion, and from an osteopathic point of view it is generally found to be due to cervical bony lesions.
    Headache is the general term used to describe pain in the head.  It may be either symptomatic or idiopathic, the latter being generally chronic and due to specific bony lesion, usually in the cervical vertebrae.  A large class of the latter come under osteopathic treatment, generally in a very bad condition after having suffered far beyond the power of drugs to cure.  These may almost be considered as suffering from a hitherto undescribed form of headache, depending upon a specific lesion, often the result of accident, and usually immediately relieved and cured upon removal of the lesion.  The form embraces many of the kinds of headache generally described under one or other of the usual classifications.
    CASES: (1) Extremely severe frontal headache in a man of thirty-two, since boyhood.  He had taken every known remedy without avail.  Lesions were found in muscular contractions on the right side of the neck; the dorsal spine was anterior in its upper half; the 11th dorsal vertebra was luxated to the left, the 2nd and 5th lumbar vertebra were prominent; the sacrum was tilted forward and the left innominate was slipped, lengthening the limb.  The lesions were corrected and the case cured.
    (2) Migraine in a man of thirty, since his sixteenth year, when he fell from a wagon.  Lesion existed at the 3rd cervical vertebra and at the atlas.  The case was relieved at once and cured.
    (3) In a boy of twelve a very severe headache was caused by a fall on his head from a bar in the gymnasium.  The atlas was found displaced laterally, and the case was cured.
    (4) In a chronic case of occipital headache persisting for years, no ordinary remedy would affect the condition.  The atlas was found slipped and the muscles about it very much contracted and tender.  Relief was given at one treatment, and the case was cured.
    (5) A man of forty-five, troubled for many years by occipital headache, mostly upon the left side.  Lesion was found at the atlas, impinging upon a cervical nerve.  Cure was accomplished in two months.
    (6) In a lady of thirty-three there was constant occipito-frontal headache.  The eyes were weak and painful; the glasses had been changed six times in one year.  The muscles of neck and shoulders were found much contracted, the atlas was luxated to the right and painful upon pressure.  But one severe headache occurred during one month's treatment, and the eyes were much improved.  In two months the glasses were laid aside and the headache was cured.
    (7) Headache, with blind ' spells, in a woman of forty-one; the 1st and 2nd cervical vertebrae were approximated and sore; the muscles of the upper cervical region very tense; headache constant; 1st to 8th dorsal vertebra were flattened anteriorly; 11th dorsal to 3rd lumbar posterior.  The patient had suffered a sunstroke, and had had two or three, attacks monthly since.
    (8) Congestive headache in a man of thirty-seven, of twelve years standing.  Violent attacks occurred daily and every known remedy had been used in vain.  The sole lesions was a depressed clavicle interfering with the venous flow from the head.  Two treatments restored the bone to place and cured the case.
    (9) Chronic headache of four years standing, by a fall upon the back of the head, which rendered the neck partly stiff.  There was contracture of the tissues over the spinous process of the axis, which was displaced to the right.  After four treatments the pain had disappeared.
    (10) A lady had for many years suffered from agonizing headache, so severe at times as to render her unconscious.  For some months the head had not ceased aching, day or night.  Lesion was found as slight luxation of the 3rd and 4th dorsal vertebrae, and there was a well marked lesion at the 11th and 12th dorsal.  The headache disappeared during one month of treatment, with no return after several months.
    (11) A case in which a woman suffered from intense headaches, there being also feeling of oppression at the base of the skull.  The axis was lateral and anterior.  The case was cured by adjustment of lesions.
    (12) A case of migraine, with chronic dysentery of five years standing, in a man of thirty-three.  Lesion was a posterior condition of spine from 11th dorsal to 3rd lumbar.  The treatment was directed to removal of lesion, curing the case.
    (13) Migraine of five years standing in a boy of sixteen.  The 3rd cervical and 4th dorsal vertebrae were lateral to the right.  Treatment was directed to removal of lesion, diet and exercise also being attended to.  The case was benefited by one treatment, and apparently cured by three treatments.      The course of treatment being continued once a week for two months.  One continually meets cases of severe chronic headache resulting from the use of drugs.
    LESIONS: Migraine, with other forms, shows the usual lesions.  Lesions found to produce it are of the atlas; 2nd and 3rd cervical, upper dorsal; 8th, 9th and 10th dorsal; 7th and 8th ribs.
    When headache is symptomatic purely, lesion depends upon the primary disease, but specific lesion is often present and determines the effect in the head.
    Atlas, axis, cervical, and, to some extent, spinal lesions are the important ones producing headache.  They result in chronic, idiopathic headaches.  Often these may develop into insanity.
    Lesions act by disturbing sympathetic relations, reflexly causing the headaches, just as may be the case in reflex headache from uterine prolapsus.  They all act by stoppage of blood flow.  This may occur in several ways.  The vertebral arteries may be occluded by pressure from the displaced cervical vertebra; the clavicle may hinder venous flow in the external and internal jugulars, the sympathetic irritation may set up vaso-motor reflexes and prevent proper circulation.  A lesion may cause headache by direct pressure of the luxated vertebra upon a nerve fiber.  A very common place for this to occur is at the atlas which impinges branches of the suboccipital nerve sent to supply the occipito-atlantal articulation.  The same thing is apt to occur at any of the upper three cervical vertebra, the corresponding nerves sending branches to supply sensation to the scalp.  Contraction of tissues over branches of the fifth nerve, or at their foramina of exit may cause headache.  Reflexes or direct irritation of the fifth nerve may cause it.
    Lesion in the splanchnic area is often responsible for migraine.
    The kinds of pain in headache aid in diagnosing the variety.  Dana notes the fact that a pulsating or throbbing pain occurs in headache due to vaso-motor disturbance, as in migraine; a dull, heavy pain in toxic or dyspeptic forms; a constrictive, squeezing, or pressing pain in neurotic or neurasthenic cases; a hot, burning, or sore pain in rheumatic or anemic headache; a sharp, boring pain in hysteric, epileptic, or neurotic forms.
    The pain is usually found to be localized in or referred to the peripheral ends of the fifth nerve, they supplying the antero-lateral parts of the scalp and the dura mater with sensation.  Hence treatment is directed to the branches of the fifth nerve upon the face and scalp.  The chief local treatment in occipital headache is made to the upper four cervical nerves, as their branches are here involved.
    The PROGNOSIS is good in all cases of headache, even in migraine.  The most long standing and severe cases yield readily to treatment, even when all other remedies have failed.
    The TREATMENT described will apply to any of the numerous kinds of headache described, though special portions of' the treatment laid down may apply to any given case as sufficient for it.  The treatment must be adapted to the case, each one needing a special study of its features to enable one to discover the cause and apply the proper treatment.  The treatment, successful in one case may not apply to another.
    The lesion must be removed, and this often constitutes the sole treatment necessary.  All causes of irritation must be removed, such as eye strain, sympathetic disturbance, uterine or stomach disease, etc.  Ordinarily the first step is the relaxation on of contractured muscles in the neck and upper dorsal region.  These muscular contractures may often be used as guides to locate bony lesion.  Sometimes one small contractured fibre will lead the examiner to the seat of bony subluxation, if carefully followed.  This relieves irritation to nerves, frees circulation and prepares for the replacing of a displaced vertebra.  Attention should be given to freeing all points of venous flow from the head.  Treatment may be made in the course of the veins across the forehead to the outer canthus of the eye and down toward the angle of the jaw, along the jugular veins, raising the clavicle and relaxing all the tissues.
    Inhibition along the back and sides of the neck in the region of the upper four vertebrae, and in the suboccipital fossae, quiets the upper four cervical nerves and aids in restoring equality of circulation through affect upon the superior cervical ganglion.
    Often pressure made as follows is sufficient: in the midline of the neck, just below the occiput; below the ears, upon and below the transverse process of the atlas; along the upper dorsal region at the upper three or four vertebra.  These treatments quiet cerebrospinal nerves and correct vaso-motion.
    Treatment should be made upon the face over the points of the fifth nerve (Chap.  V, B).  Relax tissues over the nerves and at the foramina.  Manipulation to relax the tissues all along the course of the longitudinal sinus, from nasion to occipital protuberance, and thence laterally toward the mastoid processes, over the course, of the lateral sinuses, aids in freeing the circulation in them.  As this treatment is carried over the vertex the terminals of the various sensory nerves of the scalp are affected and quieted.
    Deep pressure over the solar plexus, and inhibitive abdominal treatment, aid in relieving the headache sometimes by quieting, the reflexes and calling the blood away from the head.
    Exciting causes should be avoided.  It is well in such cases as need it to give attention to regulating the condition of stomach and bowels.  Cold applied to the forehead and temples, and heat applied to the base of the skull and the extremities, aid in relief.
 



 
LOCOMOTOR ATAXIA AND SPASTIC PARAPLEGIA

    DEFINITION: Locomotor Ataxia, or Tabes Dorsalis, is a disease characterized by sclerosis of the posterior columns of the cord, loss of coordination in trick the muscles of the limbs, absence of the patellar reflex, lightning pains in the limbs, and the Argyll Robertson pupil, which reacts to accommodation but not to light.
    CASES: (1) In a woman of thirty-two, lesions were found at the atlas and upper lumbar region.  Under treatment she regained control of the bladder and bowels, became able to walk well, and the progress of the disease had apparently been terminated.
    (2) In a man of twenty-nine, the lesion was a complex curvature of the spine.  It was lateral to the right from the 5th dorsal to the 2nd lumbar, and posterior in the lower lumbar region, being so marked that the left lower ribs came within the iliac fossa, while the right ones descended over the hip.  The whole thorax was misshapen.  The right limb was atrophied to one half its original size.  After eight months treatment the patient could walk thirty-five blocks without a cane; his general health was good and the disease was showing raid improvement.
    (3) A case in a young man of twenty, in which there was marked scoliosis of the dorsal spine, involving the thorax, some improvement in the locomotor ataxia as gained under treatment.
    (4) A case in a man of thirty-five showed spinal lesion in the dorsal spine between the shoulders, the vertebrae being irregular and posterior.  Under continued treatment his walking was much improved, visceral crises were prevented, the control of the bladder and rectum were regained, and the pains in the lower limbs were done away.
    (5) A case presented spinal lesion in the form of a too great anterior sweep of the lumbar region of the spine.
    (6) Locomotor Ataxia of a severe form, of four years duration.  The eyes had become so bad that patient could not read, and could scarcely distinguish light from dark.  Lesion was found at the 1st and 2nd cervical, 4th and 5th dorsal, posterior condition of the lower dorsal and upper lumbar spine, and lateral lesion at the 5th lumbar.  Gradual improvement took place tinder treatment, a considerable gain having been made at the time of the report.
    SPASTIC PARAPLEGIA (Spastic Spinal Paralysis) is a cord disease with loss of muscular power, exaggerated patellar reflexes, a peculiar gait, and precipitate micturition.  It is a primary sclerosis of the cord.
    CASE: A middle-aged man, after injury to the spine in a mine accident, was affected with complete motor and sensory paraplegia.  Operation for supposed fracture of the 7th dorsal vertebra removed pressure and restored sensation for the greater part.  Spastic paraplegia developed.  The lesions were found to be a posterior 7th dorsal vertebra; 8th, 9th and 10th posterior and toward the left.  Considerable improvement was made under treatment.
    LESIONS in both of these diseases are found at various places along the spine.  In spastic paraplegia they are generally in the lower dorsal, lumbar and sacral regions.
    In locomotor ataxia spinal curvature is often found as the cause.  Derangement of the thoracic vertebra in the region between the shoulders often causes it.  Atlas, cervical, and lumbar lesions are often found.  Dr. Still points out lesion of the sacrum as the cause of locomotor ataxia.
    The PROGNOSIS in neither disease is promising as to cure.  Most cases are benefited, some to a marked extent.  Locomotor ataxia is more frequently met with and, on the whole, more successfully treated.  The progress of the disease is often checked; control of bladder and rectum are established; the power of walking, even after complete loss in some cases, is restored.  These cases are generally benefited, but sometimes do not yield to treatment.  In cases of spastic paraplegia the sumtotal of results is not so great.  The walking is often improved, and precipitate micturition is bettered.
    The sclerotic changes in the cord in these diseases render them incurable, even after removal of specific lesion, yet the sclerotic process is doubtless often checked by the removal of lesion and the attendant treatment.
    A few cases of both diseases, in early stages and resulting from injury, are reported cured.
    The TREATMENT of locomotor ataxia consists in the removal of lesion and general spinal treatment.  The removal of lesion is insufficient.  The thorough spinal treatment must be made to influence spinal nerve connections, the central distribution of the sympathetics, and the blood circulation about and to the spine.  This treatment should be given especially from the middle dorsal down, as the degenerative changes in the cord and meninges begin in the lower part.  If the ataxic condition has not yet appeared in the arms, and cerebral symptoms have not developed the indications are especially for treatment to the lower spine.  Treatment to the upper spinal and cervical regions should be given, however, at any stage to limit or prevent the spread of the pathological cord changes in these regions.
    The nerve supply to the limbs, upper and lower, as well as the limbs themselves, should be treated.  Care must be taken in this latter, as the tendency of the long bones to fracture is marked in locomotor ataxia.  The arthropathies, if present, call for special treatment to the joint involved, and its nerve and blood supply.  As the knee joints are most frequently attacked, the treatment to the lower limbs will serve to lessen the danger of their occurrence.  The spinal treatment should include springing the spine, and various other methods of separating the vertebrae from each other, increasing circulation about them and keeping up their integrity, as the articular surfaces and interarticular fibro-cartilages are liable respectively to absorption and atrophy.
    Abdominal treatment should be maintained to prevent visceral crises, most common about the stomach.  Treatment should be upon the abdominal nerve plexuses and blood circulation.  The stomach and bowels may thus be kept in good condition.  Lumbar and sacral treatment, together with treatment to the internal iliac blood vessels from the abdominal aspect, aid in restoring the sphincters of bladder and rectum to good conditions.  In case of necessity the catheter should be used to empty the bladder.  To relieve the lightning pains in the limbs strong inhibition should be made upon the anterior crural nerve in Scarpa's triangle; upon the great sciatic at the back of the thigh between the tuberosity and the great trochanter, slightly nearer the latter; and upon the lumbar and sacral portions of the spine.
    The treatment of spastic paraplegia proceeds upon the same lines as the general treatment for locomotor ataxia, including removal of lesion, thorough general spinal treatment, and treatment of the lower limbs.  The spasticity in the latter sometimes hinders treatment, but may be overcome by inhibition of the anterior crural and sciatic as above.
    Other forms, such as Secondary Spastic Paralysis, in which the symptoms are not so well marked; Congenital Spastic Paraplegia, usually due to injury at birth; Ataxic paraplegia, combining spastic and ataxic features, retaining the reflexes; and the Combined System Sclerosis, Disseminated Sclerosis, etc. are approached in the same manner for discovery of lesions and treatment.
 



 
PARALYSIS AGITANS (PARKINSONíS DISEASE - SHAKING PALSY)

    DEFINITION: A chronic disease, in which there is tremor, peculiar character of speech and gait, and progressive loss of muscular power.
    The LESIONS found in this disease usually occur in the cervical and upper dorsal region, and among the upper ribs.  These lesions, being present, doubtless determine the victim of the disease.
It occurs in those whose central nervous system is thus weakened and laid liable to the action of such secondary causes its exhausting illness, mental strain, worry, traumatism, etc. 'The latter may directly result in such lesions.  The fact that the pathology of the disease is obscure, it being by many regarded as a functional disturbance, and the further fact that the causes are not well known, lends color to the theory that such lesions as are recognized by Osteopathy, being always such as are not sought for by the regular practitioner, are the real causes of the condition.  They occur high in the spine, at a point where, acting upon the central nervous system, they could produce the effect in the whole body, as noted in the tremor of both upper and lower limbs, as well as of the head sometimes.
    THE PROGNOSIS: There is a reasonable expectation of limiting the progress of the disease and bettering the patient's general condition.  'The fact that there is no pathological change in the cord, and that the disease is probably functional, leaves ground for hope that very much benefit, perhaps cure, can be attained under osteopathic treatment.  A number of cases have been cured.
The practitioner must bear in mind that it is a feature of the disease for the patient to sometimes be better, and he must not too strongly encourage the patient when such a period occurs, without reason to expect the permanence of such gain.
    The TREATMENT consists in removal of lesion; the thorough relaxation of all spinal and cervical muscles, particularly apt to be set and hardened about the neck and shoulders; and a most thorough general spinal treatment.  Particular attention should be paid to the condition of the nerve plexus supplying the upper and lower limbs.  These, and the circulation to the limbs, should be strongly stimulated.  The general health is usually good, but it is not amiss to keep bowels, kidneys and liver stimulated.
    Light exercise and baths are, good for the case.
 



 
OCCUPATION NEUROSES

    DEFINITION: A neurosis due to constant use of certain groups of muscles in occupations which necessitate delicate movements, resulting in cramp, spasm, paralysis, tremor, or neuralgia, and due to specific lesion to the nerves supplying the affected groups of muscles.
    The very numerous varieties of this disease, various forms of musician's cramp, telegrapher's, seamstress, driver's, milker's, cigar-maker's, etc., are all manifestations, more or less severe of obstruction to the nerves supplying the parts involved.  These obstructions generally act upon the nerve supply of the upper limbs, but in a few varieties, as in ballet dancers and tailors, those of the lower limbs may be involved.
    CASES: Numerous cases of telegrapher's, writer's and pianistís paralysis are known and recalled in this connection, although the data as to lesions, etc., are not now available.  These cases were generally cured.  The following cases are typical.
    (1) A marked case of telegrapher's paralysis, of three years standing.  For two years the hands had been almost useless, and the patient could not distinguish by touch between an inkstand and a pencil, sensation and motion were both much impaired.  The lesions were found in the 1st, 2nd, and 3rd right ribs being close together; the clavicle down upon the right first rib, and the cervical origin of the brachial plexus covered with much contractured muscles.  After one months treatment the patient could write his name.  In six weeks he could distinguish between coins by touch and in three months the case was cured.
    (2) Pianistís paralysis, showing lesions in the upper dorsal spine.
    (3) Pianist's paralysis, showing lesions in the cervical and upper dorsal regions of the spine, depression of both clavicles, and contracture of muscles in the posterior cervical, upper dorsal and shoulder regions.
    (4) Penman's paralysis in a man of thirty-five, of three years standing.  The 3rd cervical to the 5th dorsal region of the spine was lateral to the right.  The case was cured in two months by correction of lesion and treatment of the circulation to the arm.
    (5) Pianistís cramp in a woman of twenty-five.  There was a slip of the sternal end of the clavicle, and slight deviation of the 3rd, 4th and 5th cervical vertebrae.  The condition was of three years duration.  The case was benefited after second treatment, and was cured in one month.  This case had been diagnosed as "tuberculosis of the bone, " and amputation had been advised.
    The LESIONS in these cases are doubtless often directly due to the occupation.  Case (1) above is a good illustration of the result of an occupation requiring the elevation of the right shoulder resulting in drawing together the upper three ribs, and in approximating the clavicle and first rib in such a manner as to bring pressure upon the brachial plexus.  A faulty posture, involving bad position of the shoulder, neck and upper spine, is quite as likely to result in bony lesions in these parts as is faulty posture to result in spinal curvature.
    In a certain number of cases the lesions are likely present in the spine and other parts, and determine an early breakdown in the anatomical parts concerned in the occupation, from overuse.  Overuse of an arm, as in writing, no doubt plays its part in wearing out the nerve mechanism, but the fact that many young people suffering from an occupation neurosis are found to have these lesions, while many other persons labor assiduously for years at the same occupations without disability indicates that the lesions behind the excessive use is the real cause of the trouble.  Use of the arm is really excessive only in proportion as the parts do not recuperate after use.  The lesion to nerve supply prevents proper recuperation, and the arm wears out because of the presence of lesion.
In pianistís spinal disease is often found to be due to sitting for hours at the instrument.  It may as reasonable cause spinal lesions of a nature to result in the neurosis of the arms.  That central, i. e., spinal, lesion is present is indicated by the fact that in penman who learn to write with the left hand after an attack of paralysis in the right the disease usually soon makes its appearance in that member also.  In pianistís the trouble is generally from spinal lesion.
    Lesions may occur high in the cervical region, but such is not likely to be the case.  Lesions from the origin of the brachial plexus to the sixth dorsal vertebra are met with.  Most commonly the lesion lies between the fifth cervical and fourth dorsal, favoring a position still lower in the cervical and about the upper three or four dorsal.  Lesion of the clavicle and upper two ribs, especially upon the right side, and very common.  It is readily seen from the nature of the causes producing lesion that the ribs below the upper two may be involved.  Ribs and vertebra as low as the 5th or 6th may be luxated and cause the trouble.  Vaso-motor, secretary and trophic affections occur in the affected member.  Vaso-motors to the arms tire found as low as the first thoracic ganglion, or lower.  The connection of the intercostal nerves with the sympathetic system may explain why rib lesions this low may cause the trouble.  The first and second intercostal nerves are connected with the brachial plexus.  They are often impinged by the corresponding ribs in these troubles.  McConnell calls attention to the fact that slight luxations of shoulder and elbow joints may cause this disease.  In such case the effect would probably be through lesion to the articular branches supplied from the brachial plexus.
    While Dana states that this condition is "a neurosis having no appreciable anatomical basis," it seems from the results gotten by the removal of lesion that osteopathy discovers the real anatomical cause of the disease.
    The PROGNOSIS is good.  Even the worst cases are cured.  Cure is the rule, though some cases may be intractable.
    TREATMENT: The removal of lesion as the direct cause, as in displacement of the clavicle onto the brachial plexus, is often the only treatment necessary.  The nerve and blood supply of the affected part should be kept free by treatment upon them, and by relaxation of all contractured muscles and hardened tissues.  The arms should be stretched and treated as described in Chap.  X.   The brachial plexus may be stimulated on the inner side of the arm just below the axilla, and in the neck behind the clavicle.  Treatment should be carried up along the plexus to the spine.  The elbow and shoulder joints should be sprung and adjusted if necessary. (Chap.  X.)
    It may be necessary to have the patient rest from his occupation during the treatment, particularly at first for a few weeks.  This matter depends upon conditions.  Some cases have been cured while the customary work is continued.  In some it is well to give a general treatment to the nervous system, as nervous symptoms may appear.  Vertigo and insomnia are sometimes present, doubtless due to the upper spinal lesions affecting the blood circulation to the brain.
    Local work should be carried over the brachial artery, and over the forearm and hand.  This increases local circulation and does away with the local congestion and secretary disturbance found in the affected members.  It may be useful for the patient to develop the arms by systematic gymnastics.  The various mechanical appliances used to lessen the work upon the affected muscle groups and to call into play other and larger groups, may be useful if the patient finds it necessary to continue his occupation.  Sleeves that interfere with free motion of the hand in writing, cuffs that bind the wrist, constricting bands that may be used as sleeve supporters, and any agency limiting motion and circulation must be avoided.  Systematic gymnastics of the hand and arm are helpful in developing proper circulation, also in upbuilding neglected muscles.
    The pain frequently present in arms and shoulders may be quieted by inhibition of the plexus and its spinal origin, but generally yields to the general process of relaxing muscles, etc.
 



 
NEURASTHENIA (Nervous Prostration)

    DEFINITION: "A functional disease of the nervous system, characterized by mental and bodily weariness." It is not a psychosis.  There is functional exhaustion and irritability of the nerve centers.
    (1) In a woman of thirty-two, neurasthenia developed after confinement and sickness.  Symptoms of the disease were all very well marked.  Lesions were found in a displacement of the third cervical vertebra to the right, general depression of the ribs, separation of the 11th and 12th dorsal vertebrae, a posterior luxation of the fifth lumbar vertebra, and contracture of the lumbar muscles.  The neurasthenia was apparently reflex from uterine disease.  Two weeks daily treatment reestablished menstruation, which had been suppressed for some time.  Under one months treatment all the symptoms bad disappeared.
    (2) A case of neurasthenia in a lady of sixty, following overwork and runaway accident.  The  whole spine and body was hyperesthetic, the spinal tissues, from occiput  to sacrum were exceedingly tense.  Treatment was beneficial from the first.  One years treatment produced great improvement.
    (3) In a lady of fifty, with uterine disease, lesions were found in a posterior luxation of the atlas and depression of all the ribs, narrowing the thorax.  The patient was benefited.
    (4) Traumatic neurasthenia developed after the patient was thrown from a buggy.  Lesion was found in a slip at the fourth lumbar and marked lateral luxation of the tenth dorsal vertebra.  The spinal lesion was corrected in three weeks, but no improvement occurred in the patient's general condition until ten weeks treatment had been taken.  After two weeks further treatment the case was well.
    (5) Nervous exhaustion in a man who had been suffering from kidney disease.  The whole spine was rigid, with its muscles and ligaments all tense.  Pus and phosphates appeared in the urine.  During 3 1/2 months treatment the patient gained 12 lbs., the urine cleared, and the case was cured.
    (6) Nervous prostration of four years standing in a woman of forty-two.  Many minor lesions occurred along the spine, especially the 3rd and 4th cervical vertebrae were lateral, the 6th cervical posterior, a general posterior condition of the dorsal region, the 4th and 5th lumbar lateral, the coccyx anterior, the left innominate up and back.  There was a prolapsed uterus, dysmenorrhea, enlarged liver and spleen.. The case was cured in three months.
    The LESIONS found in neurasthenia are general spinal lesions.  Different cases present different lesions, and no typical lesion may be described for all cases.  Yet perhaps a majority of these cases show a depression of all of the ribs, narrowing the thorax and often causing enteropsis.  Floating kidney and enteroptosis are well known as causes of neurasthenia.  There is no doubt that many cases of neurasthenia apparently thus caused greatly due to bad spinal condition and flattening of the thorax through depression of all the ribs.  These extensive lesions affect cerebrospinal system directly, also the sympathetic system, thus causing the neurasthenia and the enteroptosis.
Often the lesion in these cases is such as produce disease in some organ, secondary to which neurasthenia is developed.  This is well illustrated in these lower spinal lesions producing uterine disease, from which neurasthenia is reflexly caused.  Thus a variety of lesions may be found in neurasthenia, different cases presenting different lesions.  Each case demands an individual study.  For the production of neurasthenia there is necessary merely a lesion producing an irritation upon the nerve system, reflexly or directly, allowing a leakage of nerve force, and determining the victim of neurasthenia from overwork, worry, uterine disease, naso-pharyngeal disease, the use of coffee, alcohol, etc.
    The different varieties of neurasthenia may be caused by the predominance of lesion, e. g., the cerebral type by upper dorsal and cervical lesions, the gastric by splanchnic lesions, the lithemic by lower dorsal and upper lumbar lesions, etc.  Influenza, a common cause of this disease, is a malady particularly noted by osteopathy as producing serious spinal lesions, mostly in the shape of contracted muscles and tenseness of the other tissues, but sometimes actual bony lesions by drawing parts out of place through contracture of attached tissues.  Lesion thus produced may cause neurasthenia.  It is common as the result of traumatism, such as caused by railway accidents, bony lesions thus being produced as irritants to nerves.
    The PROGNOSIS for cure is good.  Those cases that have not yielded to any of the usual modes of treatment often readily yield to osteopathic treatment.  The best of results may be expected in the worst cases.  Cases are often quickly cured if gotten in the early stages.  The average case demands a somewhat long course of treatment, varying from a few months to a year or more.
    The TREATMENT must be adapted to the case in hand after a special study of its peculiarities and requirements.  The removal of every source of reflex irritation is necessary, but these sources must be studied out in each individual case, The lesions present should be removed, but the case is not always at once benefited thereby, as a course of treatment is generally necessary to recuperate the exhausted nerve centers.  Consequently a most systematic and thorough course of treatment must be devoted to . this end.  The various spinal treatments as described for relaxation of all spinal tissues, springing the vertebrae apart for freedom of circulation and stimulation of the spinal nerve system and the circulation thereto, are given to increase nutrition of the nervous system and upbuild the exhausted centers.  This spinal treatment affects the sympathetic system markedly.  Cervical treatment is also important in this connection.  Good results are usually at once apparent in relief of nerve tension, reduction of irritability, and correction of function.
    Special manifestations of the condition, as headache, insomnia, vertigo, etc., call for cervical treatment particularly.  Bowels, kidneys, liver, etc., must be carefully looked after to relieve constipation, lithemia, anorexia and other such symptoms usually present.  A thorough general treatment of the whole body is not amiss in these cases.
    The patient must be kept free from excitement and from all causes of drain upon the nervous vitality.  The diet should be light and nutritious.  The use of cold sponge or shower baths, etc.; will aid him to preserve a cheerful state of mind.  Some cases may be treated daily with advantage, in the beginning of treatment.  Later, the treatments may be decreased in number to three or two per week.
 



HYSTERIA

    This is a condition frequently met and treated osteopathically.  One needs to be continually upon guard against its simulation of other conditions, being equally careful not to overlook other diseases because of a hurried diagnosis of hysteria. Being a functional disease of the nervous system, and a psychosis, it is frequently found to depend upon some spinal bony lesion acting as the cause disturbing the nervous equilibrium.  The lesion varies.  One cannot expect a certain kind of lesion in these cases, but generally finds some actual derangement which is, at bottom, responsible for the altered nerve conditions, making it possible for a neurotic disposition, infectious fevers, poisons of various kinds, emotional disturbances, mental or physical strain, and other causes to result in hysterical attacks.
    Dr. Still calls attention to the fact that in hysteria the lower ribs are often displaced downward, and the colon is prolapsed in the pelvis.  He raises the ribs, draws up the intestine and corrects the circulation to the genitals.
    Correction of lesion removes the primary cause of irritation to the nervous system, perhaps cures a certain disease to which the hysteria is secondary, and this is an important step in the radical cure of the condition.
    The PROGNOSIS for cure is good.  The treatment relieves nervous tension and quiets the overwrought system at once.
    In the TREATMENT considerable tact must be used.  The primary treatment embraces the removal of all lesions and causes of irritation.  A course of treatment for the general nervous system must be carried through.  The general treatment as described for upbuilding the nervous system in neurasthenia would be applicable here.
    During an hysterical attack the practitioner must use great firmness, but not violence, with the patient.  He must gain mental and moral control, and while applying a general relaxing and inhibitive spinal and cervical treatment to relieve nerve tension and to quiet the nervous system, by a strong show of authority compel the patient to cease various motions, unbend a clenched hand, stop incoherent talking. etc.  Sometimes a dash of cold water upon the face or abdomen, or pressure over the ovaries will end the attack.  All sympathetic friends must be dismissed from the room, and moral suasion, with isolation of the patient, be tried.  The practitioner must gain the patient's confidence.  Hysterical joints, hysterical pain, contractures, eye symptoms, paralysis, etc., call for no special treatment; all disappear upon regulation of the mental condition and upbuilding of the general nervous system.
    Many chronic cases, as in bedridden hysterics, must be carried through a course of education in performing simple motions and acts which they thought beyond their power.  The patient should lead a regular life, and her mind should be kept occupied by some engrossing occupation.
Judicious management of the case, authority over the patient, and a careful general treatment for the health of the body and particularly of the nervous system, will be successful in the majority of cases.
 



 
INSOMNIA

    DEFINITION: Incomplete, disturbed or lacking ,sleep.  A condition frequently idiopathic and caused by specific lesions, usually bony.  Idiopathic insomnia embraces many forms generally looked upon as symptomatic or secondary.  Many really symptomatic or secondary cases are noted, especially in nervous diseases, the primary condition itself being usually found to depend, at bottom, upon bony lesion.
    CASES: Very numerous cases are met and treated osteopathically.  The following cases illustrate various points in connection with such cases:
    (1) Insomnia, nervousness and complication of troubles.  Sleep could not be induced by the most powerful soporifics.  Lesion was found among the cervical and upper dorsal vertebra.  The case was cured in two months treatment.
    (2) Insomnia and general nervousness, pronounced incurable.  The patient had had no good nights sleep in five years and had become a nervous wreck.  Lesion was found in the shape of contractured condition of all the cervical muscles.
    (3) A case of several years standing, in which the lesion affected the atlas, which was displaced a little to the right, was cured by the correction of the lesion in six treatments.
    (4) A case of insomnia as an accompaniment of neurasthenia, in which the patient had depended upon soporifics for a number of years, slept well after the second or third treatment.  The use of artificial aid to sleep was necessary but at rare intervals thereafter.  The case was practically cured at the time of report.
    (5) A case of insomnia of some years standing, due to cervical and upper dorsal lesions, cured in six months treatment.
    (6) A case of three years standing, in which the heartbeat had become very irregular from the resulting nervousness.  Four treatments corrected the heart beat, and the case had been practically cured, at the time of report.
    (7) A case of insomnia with constipation and amenorrhea, in a woman of twenty-two, of thirteen months standing.  The atlas was to the left the posterior cervical tissues were all thick and tense, especially upon the left; the seventh dorsal spine was rather irregular.  The pelvis was twisted, with apparent lengthening of the right limb.  The treatment at once benefited the case, and it was cured in 4 months.
    (8) A case of paroxysmal sleep, or narcolepsy, presenting lesion in the form of a luxation of the second cervical vertebra toward the right.  The case was not observed under treatment.
    (9) A case of narcolepsy due to cervical lesions successfully treated.
    (10) A case of protracted sleep, in which the patient fell asleep on April 26, 1902, and slept for 3 months, with but few periods of awakening.  The lesion was found between the skull and the atlas, causing, probably, passive congestion.  Correction of the lesion cured the case, after all other means had failed.
    LESIONS AND ANATOMICAL RELATIONS: The lesions, both in insomnia and in the various other disorders of sleep are generally found in the atlas and cervical and upper dorsal regions.  All such cases, perhaps constituting a majority of all cases of these diseases, should be regarded from  the osteopathic point of view as idiopathic insomnia, dependent upon specific lesion interfering with circulation to the brain.  Lesions to the atlas and second cervical vertebra are very common causes, and lesions usually occur within the cervical region or among the upper five dorsal vertebrae.  Lesions to clavicle and to corresponding ribs may be present.  It will be observed that from the occiput to 5th dorsal all these lesions fall within an area particularly rich in sympathetic and vaso-motor centers for the head, as before pointed out.  Atlas and axis lesion acting upon the superior cervical ganglion, medulla, or cervical sympathetic, and other cervical and the upper dorsal lesions acting upon the sympathetic nerves supplying vaso-motor control to the blood vessels of neck and head, disturb circulation to the brain and cause the insomnia.  Direct pressure of the cervical vertebrae upon the vertebral arteries may contribute to, or produce, the same result.
    It is probable that in many cases of insomnia there is an anemic state of the brain caused by the interference of such lesions with the sympathetics or by direct pressure upon the arteries.  The insomnia in various diseases of the heart and arteries, in general anemia, and in Brightís disease is said to be due to an anemic condition of the brain.  On the other hand it is doubtless true that there is in many a sluggish or impeded cerebral circulation as a result of the disturbance of sympathetic vaso-motors, impeded venous return, etc., caused by these lesions.  In neurasthenic insomnia, it is said, there is loss of vaso-motor tone in the cerebral vessels.  The use of various mechanical remedies is based upon the idea of calling the blood from the head to the skin or abdominal organs, i. e., a hot foot bath, eating a light lunch, etc.
    In some cases the symptoms indicate the necessity of increasing or decreasing the amount of blood in the cerebral vessels, and these results may be readily attained by the appropriate treatment.  But, from the nature of the case, removal of lesion and the restoration of free circulation result in restoring normal quiet to the nerve mechanism and normal flow of the blood in the vessels, characteristic of the normal body which enjoys healthful sleep.  Such a result is the most rational object of the treatment.
    When insomnia is symptomatic or secondary lesions, must be sought according to the primary condition.
    In some cases of disturbed vaso-motor conditions of the brain, lesion is found in the form of much thickened, tensed, and overgrown tissues at the base of the skull, above and about the spine of the axis, extending laterally toward the mastoid process.  With this condition there frequently exists an approximation of the second cervical spine to the occiput.
    The PROGNOSIS in insomnia is good .  No class of cases present more striking results in the shape of cure of the most long-standing and intractable cases.  It is a frequent occurrence that a case of some years standing is made to sleep naturally after a
single or few treatments.
    Not all cases thus easily yield to treatment.  Often great patience and persistence are necessary to secure good results.
    The TREATMENT calls for the removal of lesion primarily, and of any cause of irritation to the nervous system.  The treatment as described in detail for headache, q. v., is applicable here.  It embraces inhibition of the superior cervical ganglion and of all the cervical vaso-motors, including the middle and inferior cervical ganglia and the upper dorsal centers, deep pressure beneath the ears and beneath the occiput.  All the cervical muscles and other tissues should be thoroughly relaxed.  A general spinal treatment, in nervous cases, at once relieves nerve tension and irritation, and materially aids in producing sleep.  It is sometimes well to add to this a general body treatment as an aid in equalizing circulation and toning up the nervous system.  All points of cervical circulation should be attended to.  The treatment begun over forehead and face may be continued down over the neck, opening the mouth against resistance, stimulating the carotid arteries and jugular veins, raising the clavicles, and even the upper few ribs, and thus entirely freeing the circulation to and from the head.
In cases of congestion of the cerebral vessels the inhibitive abdominal treatment should be used to draw the blood away from the head to the abdominal vessels.
    In anemic cases one should add treatment to liver, kidneys, stomach, bowels and spleen.  The heart and lungs should be .stimulated.  In insomnia due to autointoxication, as in lithemia, uremia, malaria, etc., one should look particularly to the excretions.  Various domestic remedies may prove useful in simple cases, such as a warm general bath, a hot foot bath, a cold douche down the spine, exercise and light massage, sleeping in cold rooms, avoidance of late meals, and the avoidance of mental work several hours before retiring.
    The various perversions of sleep such as dreams, and nightmare, sommolentia, or incomplete sleep, somnambulism, morbid drowsiness, narcolepsy, catalepsy and prolonged sleep, would all be approached and treated upon the same lines as laid down for insomnia.
 



 
PARALYSIS

    The various forms of paralysis come, with much frequency, under osteopathic treatment.  Paralysis of every part of the body and from various causes, is successfully treated.  The following ,cases are illustrative.
    CASES: (1) Paraplegia in a young lady, caused by a fall of eighteen feet.  The lower half of the body, and the lower limbs were paralyzed; control of the bladder was lost; within a certain period of five months she had passed twenty eight calculi about the size of peas, never before the accident, having bad any urinary trouble.  Lesions as follows: Marked posterior and slight lateral curvature of the spine, involving the lower and upper lumbar regions; the coccyx was bent and the right innominate bone was luxated backward.  The condition was of nine and one half months standing.  After the first treatment she was able to sleep without the customary opiate.  During the second weeks treatment she began to gain control of the bladder, and the bowels acted naturally.  The urine became normal at this time.  During the course of the treatment an ulcer upon the right foot healed.  A course of two months treatment had almost cured the patient at the time of reporting the case.
(2) Paraplegia in a man, due to an injury in a runaway accident in which he was thrown, striking the lower dorsal and lumbar regions of the spine.  After two weeks he gradually began to lose the use of his limbs, and in seven months he was confined to a chair, soon becoming unable to move a muscle of either limb.  Lesions were as follows: 9th, 10th and 11th dorsal vertebrae backward sufficiently to simulate the posterior angular projection in Pott's disease; a marked contraction of the muscles of the right side of the spine to the same side as the contracture and limited by its extent; great tension and slight lesion at the junction of the fifth lumbar vertebra with the sacrum; a binding together of all the spinal vertebra by an apparent contracture of the ligaments.  After a few treatments motion returned, and the patient was able to go about upon crutches.  The case had been almost cured after a course of five weeks treatment.
    (3) Complete paralysis of the body below the waist, and of the lower limbs, caused by spinal curvature.  The case was entirely cured, sensation, motion, and function of abdominal and pelvic organs being restored.
    (4) Lack of free use of the feet due to a paralytic stroke six years before.  A disarticulation among the tarsal bones was discovered, and its removal practically cured the case.
    (5) Paraplegia, partial, was cured by correction of lesion of the sixth dorsal vertebra.
    (6) General paralysis in a case which gradually for six years lost the use of all the voluntary muscles, the eyes were crossed and nearly blind, bowels and bladder were involved.  The case was cured by adjusting lesion between the atlas and occiput, the latter being displaced anteriorly upon the former.
    (7) Infantile paralysis involving the left lower limb.  The case was in a child two years old.  A sacroiliac lesion was found as the cause, and was treated.  The child could move the limb slightly after the first treatment, and after the sixth treatment perfect use was restored.
    (8) A case of paralysis was found presenting lesions at the occipito-atlantal and lumbo-sacral articulations, and from the sixth to the tenth dorsal vertebrae.  There was a history of exposure, alcoholism, sexual excess and great physical strain.  Correction of the lesions effect a cure in five months.
    (9)  A case of paraplegia in a man of fifty-five, due to injury in a railroad wreck.  Both innominate bones were found displaced anteriorly, and lesions were involving the whole lumbar and lower dorsal regions of the spine.  The paralysis of the limbs was total.  After three treatments the patient could walk with crutches.  After two weeks treatment the patient could walk without crutch or cane, being as well as ever, excepting some weakness of the spine.
    (10) Paraplegia, involving the bowels, in a lady of fifty-three, and of fifteen years standing.  Sensation was lacking in the limbs, and there was very little motion.  In less than one months treatment sensation and motion were both perfectly restored, and the bowels were acting naturally.
    (11) Paralysis following a stroke.  The cervical muscles were found contractured.  Their correction was accomplished in five weeks, and none of the paralytic condition remained.
    (12) Paralysis affecting the fingers and thumbs of both hands in a boy of fourteen.  The only lesion was contracture of the muscles along the lower cervical and upper dorsal regions of the spine.  There was also some atrophy of the muscles over the brachial plexus and the axillary artery.  Five months treatment restored the thumbs and the first two fingers to nearly normal condition, the condition of the other fingers was much improved and the hands could be used considerably.
    (13) Paralysis and muscular atrophy of both arms in a boy six years of age.  The condition followed an attack of malaria.  The condition spread to involve both lower limbs.  Spinal lesions were found preventing circulation to the cord.  The child began at once to improve under the treatment.  After the third treatment he could move his fingers.  In two weeks he could use his hands well enough to feed himself.  In one month he was practically cured.
    (14) Disseminated subacute cervical and lumbar myelitis in a boy of seven, following the swallowing of two pins.  Severe illness at once followed, and in the fifth week the pins were located by the x-ray on the left side about the level of the third cervical vertebra.  They were later ejected, he becoming immediately totally paralyzed.  For two weeks it was thought he could not live.  After about seven weeks the case came under osteopathic treatment.  The tissues of the entire cervical region were badly swollen and intensely painful, and this condition was found along the whole spine.  Control of the bowels and bladder was lost, and the muscles of both upper and lower limbs were atrophied.  After the first treatment the patient slept soundly for the first time in two weeks.  After about four months treatment the case was practically cured.
    (15) Monoplegia attacking the right lower limb of a girl of six, paralyzed since the age of ten as the result of spinal meningitis.  No bony lesion was found, but the treatment was directed to increasing the circulation to the cord.  The case was practically cured in three months treatment.
    (16) Paraplegia of eight months standing.  The patient was bedridden.  Lesion was found as a posterior condition of all the lumbar vertebra and a slip of the last lumbar upon the sacrum.  The case was cured in three months.
    (17) Bell's disease (facial paralysis), due to lesion at the second cervical vertebra, cured in three weeks.
    (18) Partial paralysis of the lower limbs, of four months standing, due to lesions at the sacroiliac articulation and at the 5th dorsal vertebra, cured in two months.
    (19) Partial paralysis in a lower limb in a girl of six, since infancy, accompanied by underdevelopment of the limb, was found to be due to a partial dislocation of the hip, and was cured in two months.
    (20) Paralysis, probably Progressive Spinal Muscular Atrophy, in a woman of thirty-five, of fifteen years standing.  The last two years had been spent in bed.  Lesions were found at the 7th cervical and 1st dorsal vertebrae, which were anterior.
    The case was cured in ten months.
    (21) Paralysis of the fingers, affecting the last two, and partly the middle finger of the right hand.  The patient was a lady of seventy-nine years of age.  A fall upon the hand had occurred a short time previously.  A slight lateral lesion of the first dorsal vertebra was found and corrected, curing the case in six weeks.
    (22) Hemiparesis or Hemiplegia in a lady of sixty, of six weeks standing.  The right side was affected.   Lesion was found in the 3rd cervical and 5th lumbar vertebra, the spinal muscles also being much contracted.  The patient walked after the third treatment and was cured in six weeks.
    (23) Hemiplegia, partial, of the right side, following lightning stroke.  A displacement of the atlas was found and righted at once, immediately curing the case.
    (24) Paralysis and Dysentery.  The paralysis affected the lower limbs and had been of seven years standing.  Lesion was found as great tenderness at the lumbo-sacral joint, a slip forward of the 5th lumbar, luxation of the innominates, and a lateral swerve of the lumbar and lower dorsal region of the spine A tremor of the bead was present, the cervical muscles being very tense.  After seven months treatment the lesions were about overcome and the patient was nearly well.
    (25) Paralysis affecting certain muscles of the throat, also affecting the speech.  The lesion was found in a contracture holding the hyoid bone out of place.  The patient was cured by relaxing the contracture.
    (26) Facial paralysis of more than one year standing, was cured in three weeks treatment.  The lesion was found in a displacement of the second cervical vertebral.
    (27) Facial paralysis was caused by luxation of the atlas and axis to the left.  There was also tension of the tissues at the base of the skull and on the left side of the neck.  The case, still under treatment, was improving satisfactorily.
    (28) Facial paralysis was seen on the day following its first appearance.  The lesion was marked muscular contraction at the angle of the jaw on the affected side.  Treatment gave immediate relief, and the case had almost been cured in ten treatments.
    (29) Progressive paralysis in a case, after two falls causing serious illness.  Motion in the lower limbs was lost, blindness ensued, and speech became unintelligible.  There was formication in the hands and arms, and extreme pain along the spine, occurring in agonizing paroxysms.  Lesions were found as a lateral dislocation of the third cervical vertebra, luxation of 7th and 8th right ribs, and a posterior protrusion of the lumbar vertebrae.  One treatment brought the first sleep possible in three days under treatment the spinal pain was relieved, vision was restored, and the patient had been practically cured at the time of the report.
    (30) Crutch paralysis in a man of sixty-five, causing loss of use of the left hand.  A crutch had been used on the left side.  The head of the second left rib was found displaced, and the head of the humerus was slightly dislocated anteriorly.  After eleven
treatments the patient was well.
    (31) Myotonia Congenita (Thomsen's Disease) in a man, of ten years standing.  Lesion of spinal vertebrae was removed, curing the case.
    (32) Hemiplegia in a child twenty months old, of ten months standing.  Lesion was found at the atlas, which was immediately replaced, and rapid improvement followed.  In three weeks the child could walk, and recovery was almost perfect.
    (33) Brachial Neuritis of five months standing, causing severe pain in arms and shoulders, and partial paralysis of the hands.  Lesions were found in luxation of the 2nd, 3rd and 4th right ribs, and the 2nd left rib, with irregularities of the lower cervical and upper dorsal vertebrae.  One treatment greatly relieved the pain; three treatments enabled the patient to close his hands and snap his fingers; and in three months treatment the case was entirely cured.
    (34) Partial paralysis of one hand, loss of memory, and at times inability to articulate.  Lesion was found at the 2nd cervical vertebra.  The case was cured by one months treatment.
    LESIONS: The facts of these cases are typical, and illustrate much that is seen in the practice upon this class of cases.  They point prominently to importance of anatomical lesion of the kind most regarded by osteopathy, as the cause of paralytic diseases.  The necessity of the removal of such lesion in curing the condition is obvious.  These facts clearly indicate the great potency of actual bony lesion, derangement of a bony part, in causing paralysis.  They illustrate also what experience shows to be a fact, that displacement of spinal vertebrae occurs as the real cause of a majority of the cases of paralysis.  Rib lesions sometimes occur, but do not seem to be important as causes of such disease.  The finding of a partial dislocation of a hip as the cause of paralysis in a limb is a fine point of osteopathic diagnosis.  These lesions are occasionally found and are of prime importance.  They are almost invariably overlooked in the usual line of practice.  Their reduction is the sole and immediate remedy of the monoplegia.  In a few cases both hips have been found thus luxated causing apparent paraplegia.
    Contractured muscles are no doubt generally secondary lesions.  But with some frequency they have been found as the sole discoverable cause of paralysis, and their removal has resulted in cure.
Innominate lesion is found to be of the greatest importance in causing paralysis of the lower extremities.  The coccyx lesion does not seem to be important in this connection.  The atlas lesion is perhaps the most important single lesion, notwithstanding the fact that it does not with great frequency occur as the sole cause of a paralytic condition.  Occurring at a part of the spine where the bones are small and the contained portion of the cord large, it is particularly likely to impinge upon the medulla and cause paralytic effects in the whole body below, upon one side of the body, or in the head and its parts.  As shown above, lesions of the atlas occurred in five of these cases.  It was present in two of these cases suffering paralysis of both upper and lower limbs.  In one of these cases, in which also there was blindness and crossing of the eyes, it was the sole lesion.  This circumstance is well illustrative of the importance of the atlas lesion.  In two each it was the sole lesion causing hemiplegia.  It was present with lesion of the axis in a case of facial paralysis.
    A glance at the summary of the lesions will show the very general range of these bony lesions.  Atlas, axis, cervical, upper dorsal, middle dorsal, lower dorsal, lumbar, innominate, coccyx, hip, rib and shoulder lesions were found.  It seems that any movable part along the spine, or in relation with the various nerve plexuses concerned in the various paralysis, may become misplaced and become a factor in producing a paralytic condition.  Yet there is a great deal of constancy of lesion.  It tends as much toward the specific in this class of cases as in any.  Generally in paraplegia monoplegia or paralysis of the two upper limbs the lesion is local at a place where it may affect the origin of the nerves concerned in the innervation of the parts involved.  All of these seven cases of paraplegia show this in low lesion along the spine.  All the six cases of rnonoplegia show it in local lesions to the origin of the plexuses involved.
    It often happens that in cases of paralysis involving the upper and lower limbs, one or both, there is a high lesion affecting the upper and a low lesion affecting the lower members. Yet a single lesion high up more frequently perhaps causes the trouble in the upper and lower limbs.  Lesions of the fifth lumbar and of the innominate are frequent in paralysis and in hemiparaplegias.  These are important lesions.
    An inspection of the lesions reported in seven of the above paraplegia cases show that the lower dorsal and upper lumbar region is a favorite place for lesions in such cases; that spinal curvatures may cause the condition; that fifth lumbar and innominate lesions are much in evidence.
    In case of general paralysis involving upper and lower limbs it is noted that atlas lesion alone may be the cause; that often there are both upper and lower lesions, respectively affecting upper and lower limbs; and that contractured muscles and causes obstructing circulation to the cord may be sufficient.
    The monoplegias show much constancy of lesion to the origin of the plexuses.  The hip joint, shoulder joint, and sacroiliac lesion all attract attention.  The hemiplegias seem more apt to show single high lesion, as of the atlas, but both high and low spinal lesions may be present.  Dr. Still says that in hemiplegia the atlas is often back and to the left.
    The facial paralysis shows specific bony lesions.  In three of the four cases the 2nd cervical vertebra is involved.  In one of these three the atlas is also at fault.  In a fourth case there was merely contracture of muscles occurring over the course of the trunk of the nerve where it crosses the ramus of the jaw.  In these cases, bony lesions if present, are expected to occur among the upper three cervical vertebra.
    ANATOMICAL RELATIONS: The close relation between the lesion and the disease is shown by several facts.  The early development of paralysis after accident giving origin to those lesions found upon examination to exist at important points indicates the correctness of the osteopathic idea that such lesions are the direct causes.  The further fact that recovery is dependent upon the removal of such lesions, that it actually is accomplished by their removal, also shows the close relation of lesion to paralytic disease.  Finally the Osteopath's experience directs him to expect bony lesion at certain spinal areas, according to nerve distribution from the spine to affected parts.  In all these cases we speak of lesion significant to the Osteopath only.
    The various lesions, bony and otherwise, act in several ways to cause the paralytic effect that follows their presence.  In the first place, a misplaced vertebra or bony part, or a contractured muscle, may bring direct pressure upon a nerve, a fibre, or a plexus, cutting off its function and causing paralysis in its area of distribution.  In one case pressure of the first dorsal vertebra upon the last cervical and first dorsal nerves, one or both, which make up the ulnar nerve, resulted in paralysis in the ulnar distribution in the hand, affecting the little finger, ring finger, and in part the middle finger.   The same conclusion is indicated in the case in which contracture of the hyoid muscles drew the bone against the pneumogastric nerve, causing of the laryngeal muscles, affecting deglutition and speech.    The same evidence of direct pressure upon nerves is seen in another case where the muscles contracted over the, trunk of the facial nerve; in another where the head of the humerous impinged the brachial plexus; in another where the sacroiliac lesion affected the sacral nerves.  In all of these cases quick results following the removal of pressure show that the effect of the lesion must have been directly labor). the nerves involved by pressure.
    In such cases the result is seen to be directly upon the part supplied by the impinged nerves, it is uncomplicated by results in other parts of the body, and is manifested in a circumscribed area, namely, in the muscle groups supplied by the nerve or nerves in question.  In diagnosis a practical point is to expect lesion of a kind exerting direct pressure in case presenting general features as described above.  The lesion is known at once to be located some where in the path or at the origin of the nerves involved.
    On the other hand, a certain class of lesion is found in paralytic disease by lesion to the cord.  The effect to the cord may be through direct pressure upon it, or in other ways.  An example of such conditions is seen in a case in which lesion of the 2nd cervical vertebra caused partial paralysis in one hand, loss of memory, and at times inability to articulate.  There was evident involvement of brain and cord, and the lesion was too high to affect the brachial plexus by direct pressure.  In such case there is possibility of the lesion affecting the cord either by direct pressure or by interference with the sympathetic or cord nutrition.  The supposition of direct pressure is supported by the fact that removal of the lesion cured the case in one month.  In another case, formication in the upper and paralysis in the lower limbs, blindness, unintelligible speech, and paroxysms of spinal pain, clearly indicate involvement of cord and brain.  'The lesion of the 3rd cervical vertebra was too high to affect the brachial plexus by direct pressure; the lesion to the lumbar vertebra likewise could not have pressed directly upon the nerve supply to the lower limbs.  Yet the paralytic condition in lower limbs, referable to the posterior displacement or protrusion of the lumbar vertebrae, favors the theory of direct pressure upon the cord, since such paralysis of the lower limbs is known to follow actual lesion to the lumbar segments of the spinal cord.
    In one case the hemiplegia resulted from lesion at the atlas, and was cured by its removal.  The fact that the child could walk in three weeks after treatment began, and the highness of the lesion, both favor the idea that there was pressure upon the cord.  In a case where there was paralysis of the voluntary muscles, crossed eyes, and partial blindness, the lesion was again at the atlas (occipito-atlantal) and the same reasoning would apply.  So in another case, paraplegia following lesion of the 6th vertebra.
    It must be noted that in all these cases the results are quite unlike those in the first group considered.  The results, instead of being direct upon nerve or plexus, are indirect; they are also complicated with effects in more than one part of the body, and are not circumscribed by being limited to one muscle group.  It is an indication in diagnosis to expect such cord lesions in cases showing this style of effects from lesion.
    In some cases the lesions no doubt do shut off nutrition to the cord or brain.  It is seen in cases where cervical bony lesion results in atrophy of the optic nerve, causing blindness through interference with its nutrition.  In another case lesions were described as being present and preventing circulation to the cord.  Treatment with the idea of restoring this circulation resulted in quick benefit and cure.  In another case, the lasting effects of the meningitis upon the cord were overcome by building up circulation to it.
    Quickness of results in many cases indicates functional derangement from pressure of the lesion, which being removed leads to immediate restoration of function.  On the other hand a course of treatment must look to regeneration of nerves and of ganglion cells in many cases where degeneration has taken place in these tissues because of the effect of the lesion.
    In hip cases, the underdevelopment accompanying the paralysis is often due to pressure upon blood vessels as well as upon nerves.  The pressure is from the displaced bone and the contractures of tissues.
    There is a class of cases of paralysis in which fever has been the antecedent factor, as in cases in which paralysis of a limb follows typhoid fever.  The paralysis of the vocal cords, for example, following diphtheria, is often seen.  Other diseases, febrile or not in character, in which there is much autointoxication, may be followed by similar sequelae.
    In these cases, the poison generated in the system affects nerve centers, or nerves direct, producing the paralysis.  Such sequelae are much more likely to occur in cases in which strong medication has been a feature of the treatment, since the emunctories, already occupied with all the poison they can eliminate, are called upon to handle in addition that introduced into the system in the form of drugs.
    Such sequelae are not so likely to occur in cases treated by osteopathic therapeutics.
    In the cases in which such sequelae occur, the locus of the paralysis is probably determined by lesions which are present and affecting certain centers or nerves, leaving them liable to such effects of autointoxication.  It is evident, also, that in cases in which certain of the emunctories are weakened by lesion, such lesion may become responsible for the sequelae through having lessened the function of these eliminative organs.
    This class of cases is well handled, usually, if not of too long standing.
    The PROGNOSIS in paralytic cases is very favorable.  A large percentage of the cases is entirely cured.  Few cases are neither benefited nor cured.  The apparent greatness of the lesion bears no proportionate relation to the degree of the effect.  A small or very limited lesion often causes the most serious paralysis.
    Many cases are slow and difficult.  Some cannot be cured.
    The length of standing of the case should not determine the prognosis.  Recent cases may be the most difficult to cure.  Many of the most long standing and worst cases quickly benefited and cured.  The prognosis is good, even ,after "strokes," and often where there is blood clot on the brain.
TREATMENT: The body lesion must be removed.  This is often the most necessary treatment, but most cases require a course of treatment to regenerate, through the blood supply in the nerves and centers effected.  This necessitates insuring a good quality of blood, and in many such cases the important first step consists in sufficient treatment to bowels, stomach, liver and kidneys to improve the general health and expel all impurities from the blood.
    The general spinal and cervical treatment should be applied to tone the general nervous system and to increase the circulation and nutrition of it.  This is accomplished by relaxation of all the spinal tissues, separation of the spinal vertebra, to allow free circulation, and stimulation of the central distribution of the sympathetic having control of circulation to the spine.
    In case of blood clot upon the brain the treatment is to increase cervical circulation to absorb it.  This can be accomplished in cases where the clot has not had time to become organized or encysted.  After cerebral hemorrhage, treatment should keep this object constantly in mind.  But in many old cases of hemiplegia after cerebral apoplexy, where doubtless the clot has become organized, much benefit can be given by the treatment.
    Local treatment is made upon the paralyzed limb or part to soften contractures, build up circulation, increase nutrition of the tissues, and to tone the local nerve mechanism.
    Lesions as described in this chapter will be found in most of the various diseases of brain and spinal cord.  The same principles and methods of treatment, varied to suit the case, may be applied to them.
    For example, in CEREBRAL HEMORRHAGE OR CEREBRAL APOPLEXY, strong inhibition is made at once upon  the suboccipital regions to dilate the blood vessels and to aid in reducing the congestion.  This object is aided in a most important manner by the general cervical, spinal and abdominal treatment, relaxing all tissues and calling the blood to these parts away from the head.  These treatments should be relaxing and inhibitive in nature as before described.  The head should be kept raised to aid in drawing the blood from it.  In the intervals inn treatment the ice bag may be applied to the spine.  The patient should remain quietly in bed and be fed upon a liquid diet.
    After the acute stage the treatment should be carried on to remove the blood clot from the brain and to overcome the hemiplegia.  The former is accomplished by the usual cervical treatments to increase circulation to the brain; the latter by such treatments as described in detail above for cases of paralysis.  The clot may, if taken in time, be completely removed, and the patient should be treated twice or several times daily.  Later he may be treated daily or three times a week.
    INFANTILE PARALYSIS, in children up to three or four years of age, is often caused by disorders of the digestive tract, as in teething or after catching cold or in bowel complaint.  In such cases cerebral congestion and spasms are prone to occur, and during the spasm a vessel is burst in the brain, with resulting hemorrhage and clot.
    In some of these cases the congestion, hemorrhage, clot, and inflammation occur in the cord, causing ACUTE ANTERIOR POLIOMYELITIS.  Such cases do well under treatment in these acute conditions, and the resulting Infantile Paralysis, if seen early or if not of long standing, will often yield well to a persistent course.
    In cases of HEMORRHAGE INTO THE SPINAL MEMBRANES, HEMORRHAGE INTO THE SPINAL CORD, and HEMORRHAGE INTO THE MEDULLA and PONS the treatment is upon quite the same lines as for cerebral hemorrhage.  In the first two conditions the patient should be kept lying upon his side or face, not upon his back, to favor the drainage of the blood.
    In the various forms of SPINAL MENINGITIS, often met in our practice, good prognosis is the rule.  Cases are made to recover entirely, all paralysis or lingering stiffness of the muscles being overcome.  The treatment in the acute form is the general spinal, cervical, and abdominal, to control the circulation of the cord and call the blood away from it.  The rigidity of the muscles is overcome by manipulation and by careful, inhibitive spinal treatment.  Bowels and kidneys must be kept active by treatment, to aid in removing toxic products from the system.  It may be necessary to use a catheter on account of the paralysis of the sphincter of the bladder.  In the intervals of treatment ice bags may be applied along the spine.  A course of treatment should be carried on to insure complete resorption of the inflammatory products from about the cord, and to prevent or overcome any paralytic sequel to the condition.
    The same plan of treatment will apply to CHRONIC SPINAL MENINGITIS, and to the various forms of PACHYMENINGITIS and LEPTOMENGITIS.  Further special treatment, is to be applied according to the needs of the individual case, and according to the manifestations of the disease.
    In MYELITIS the same general plan of treatment should be adopted to gain vaso-motor control and lessen the inflammatory process in the cord.  Diagnosis should be made of the portions of the cord affected, and treatment should be applied here, particularly to absorb the extravasted blood and do away with the danger of softening or degeneration of the cord following.  The patient should be kept quiet, and attention be given to any special manifestation in the case requiring alleviation.  Care must be taken in the manipulation to avoid all irritation of the skin on account of the liability to bedsores.  Rigidity and spasm in the affected muscles may be overcome by inhibitive manipulation of them, and by inhibition of the nerves.  Guard against renal and pulmonary complications by keeping the lungs and kidneys well stimulated.  A course of treatment must follow to guard against or overcome paralysis.  The prognosis is good in the acute case.  A chronic case may be cured, or much may be done for its benefit.
    In CHRONIC MYELITIS, DISSEMINATED MYELITIS, and ACUTE ANTERIOR POLIOMYELITIS, (see above) the same line of treatment is to be followed, with attention to special manifestations of the disease in each case.
    In meningitis, myelitis, apoplexy, etc., various spinal and cervical lesions occur, of the kinds pointed out in the general consideration of the subject of paralysis.
    ACUTE ASCENDING PARALYSIS, or Landry's Paralysis should be treated according to the directions given for the general treatment of paralysis.  The spinal treatment must be particularly thorough, and heart and lungs should be kept well stimulated.  The practitioner must be constantly upon his guard, as the disease runs a very quick course, and may soon terminate in death.
SYRINGOMYELIA should be treated as the ordinary case of chronic paralysis.
    PROGRESSIVE BULBAR PARALYSIS, or Labioglossopharyngeal paralysis, needs treatment mostly in the cervical and upper dorsal regions, in order to remove lesion and to stimulate the circulation to the brain to prevent the atrophy of the roots of the various cranial nerves involved in the condition.  The general health should be attended to.  The treatment should include thorough spinal work as the cord tends to be involved, and progressive muscular atrophy may appear.
CEREBRAL ANEURYSMS are to be treated as are other aneurysms, q. v.
    HYDROCEPHALUS calls for treatment to maintain the general health, and for cervical and spinal treatment to correct circulation to and from the brain.
 



CEREBRAL PALSIES OF CHILDHOOD (Infantile Paralysis)
 
    Under this head are included hemiplegis, the birth palsies, and paraplegia.  The various forms of infantile paralysis (see above) come frequently under osteopathic treatment.  Ordinarily good success is had in curing them, or in materially benefiting conditions.  Many require a long and patient course of treatment.  Some are soon cured.  In the paraplegias much is done to help out the retarded downward development of the motor pathway.  It is upon account of the necessity of developing this part of the cord that so many of these paraplegic cases are slow to be cured, yet these cases have often been cured.  In a few such cases slight luxations or dislocations of the hip joint have been found as the cause of the condition.
    In the majority of these cases of infantile paralysis, lesions of the cervical vertebrae, especially of atlas, axis, and upper vertebrae, is found.  It is doubtless due to difficult labor, the use of forceps, or rough handling in delivery.  Some cases are doubtless due to menigeal hemorrhage resulting from such causes.  Lesion may be present in the upper dorsal spine.
    The TREATMENT is practically that described for the general case of paralysis.  Correction of lesion is, of course, the indispensable part of the treatment.  Its removal frequency at once results in cure, with but little additional treatment.  The thorough general spinal and abdominal etc., treatment described for paralysis, q. v., should be applied to these cases.  A long course of such treatment is the rule.  The cervical treatment, and the treatment usually given to increase cerebral circulation should be given, both for the purpose of absorbing a possible clot upon the brain, and to help on the retarded brain development.  Some of these cases are probably due to polio-encephalitis, congenital encephalitis, or meningo-encephalitis.  They are therefore chronic cases by the time they conic under our treatment, and call for the ordinary treatment given chronic paraplegia, hemiplegia, etc.  It is seen to be absolutely necessary to devote much treatment to increasing spinal and cerebral circulation, as before described, for the purpose of repairing the tissue changes that have taken place, in the form of sclerosis, vessel changes, etc.
    Spastic cases should be treated as directed for spastic paraplegia.
    Prophylactic treatment should be given to avoid such sequelae as epilepsy, choreic affections, tremors, athetosis, etc.
    Generally speaking, these cases should receive very careful systematic training to develop and control the muscles.
    In such cases as are affected by general convulsions or spasms of certain muscle groups, one may employ, to control such manifestations, hot baths (with mustard), enemata, etc.
 

 
INFANTILE CONVULSIONS (ECLAMPSIA)

    Various kinds of convulsive attacks occur in children, sometimes soon after birth, generally later.  They may be due to much the same style of lesion as noted for multiple paralysis.  Cervical lesion is common, leading to congestive conditions of the brain, cord, and meninges, and causing the convulsions.
    A far more common cause is lesion to that portion or the spine concerned in innervation of the gastrointestinal tract.  Gastrointestinal irritation and debility result, and cause the condition.  An overloaded stomach, intestinal parasites, dentition, phimosis, and other sources of irritation may be expected.   The condition is frequently secondary to rickets, infectious diseases, etc.
    The PROGNOSIS in the ordinary case of convulsions in a child is good.  It must be guarded in many cases.
    The TREATMENT at the time of the seizure must be to relax the spasms of the muscles, and to draw the blood away from brain and cord, equalizing circulation.  Strong inhibition at the superior cervical region is the first step.  The inhibition may be carried on down along the spine.  It is usually best given the patient lying on the side, while the spine is sprung and held at various points, relaxing the tissues and inhibiting the nerves.  Sometimes the convulsion is at once relieved by continued strong, inhibition at the superior cervical, splanchnic, and lower lumbar regions.  This treatment acts by reaching, at these several places, the important vaso-motors in the spinal system.  Warm baths are effective in checking convulsions, also one may make cold applications to the head.
    Further aid is given to equalizing the circulation by the relaxing, inhibitive abdominal treatment before described.
    Attention must at once be given to the bony lesion, either adjusting it, or relaxing the bony parts and tissues about it, in order to relieve the irritation, from this source.  All sources of reflex irritation are to be sought out and removed.  Especial attention must be given to gastrointestinal affections so often present.  They are to be treated, according, to their kind; as directed in the chapter on diseases of this region.  In cases of an overloaded stomach the child should be caused to vomit.  In enteritis an enema will afford immediate relief.
    Later the general health should be attended to.  Lesions should be removed, and a thorough course of spinal treatment should be gone through.
    ANGIONEUROTIC EDEMA, or acute circumscribed edema, is a condition in which there is localized edema in the mucous membranes.  It is to be treated by removal of obstruction to the nerves supplying the part involved, and to the venous and lymphatic drainage of the part.  The heart and general circulation should be stimulated.  The condition of the nervous system must be looked after, as nervous disturbances in the patient favor the occurrence of the edema.  He should be quiet, and the general spinal and cervical treatment should be used.  Gastrointestinal disorder may be present and should be looked to.
    ERTHROMELGIA, or red neuralgia, "is a chronic disease in which a part of the body usually one or more extremities suffers with pain, flushing, and local fever, made far worse if the parts hang down." (Weir Mitchell).
    CASE: T. F., aet. Forty-seven, farmer, affected with erythromelalgia in both lower limbs.  The feet were both affected, but the trouble never progressed above the ankles.  They suffered from eruptions, fever, redness, distended veins, and great pain. The symptoms were aggravated when the patient stood, or let the limbs hang down.  Elevation of them afforded relief.  Lesion was found in posterior condition of the lumbar vertebrae, and of both innominate bones.  The case was observed for some eight months.  It had been practically cured at the time of this report.
    It is induced by exposure, rheumatism, a nervous temperament, occupations which require standing, abuse of alcohol, and traumatism.  One finds lesions affecting the origin of the nerve supply of the parts affected, or interfering with the circulation, thus weakening the parts and laying them liable to the action of the various exciting causes of the diseases.
    It should be treated as are neuralgia and sciatica, q. v.  Ice cold applications afford relief, and rest with the limb placed in the horizontal position is recommended.  Headache, dizziness, palpitation of the heart, and fainting, if present, should be treated as before directed.  Tonic treatment to the nervous system fortifies against the prominent tendency of the condition to recur.
    MENIERE'S DISEASE, or aural vertigo, is a disease of the labyrinth accompanied by vertigo, deafness, noises in the ear, vomiting, etc., usually occurring in the elderly.
    The lesions are such as are found in the great majority of ear cases, namely; of the atlas, axis, and upper cervical vertebrae particularly.  These may weaken the nerve supply to the ears, and lay the patient liable to such direct causes as exposure, gout, congestion, syphilis, irritation due to gastric disturbance, etc.
    The TREATMENT is directed to the removal of lesion, and to the direct exciting cause or disease.  The main treatment, locally, should be cervical, and of the sort described in ear diseases. (See lesions, treatment, and anatomical relations in Diseases of the Ear).
    Treatment should be directed especially to the prevention of deafness.  Cases may fully recover.  Symptoms at the time of attack may be treated as necessary.  Counter-irritation over the mastoid process is recommended.
 



DISEASES OF THE MUSCLES

    MYOTONIA CONGENITA, or Thomsenís , "is characterized by prolonged contraction of the muscles concerned in voluntary movements when brought into action."   This disease is said to be the rarest in medicine, and medical texts say that the disease cannot be cured, while practically nothing can be done by treatment.  One case has come under osteopathic treatment and was cured.  It had been examined by numerous physicians and had been under the care of a celebrated neurologist, who had made special mention of the case as a typical one of Thomsen's disease.  The case was cured merely by removal of spinal lesion, and by general spinal treatment. (See the "Journal of Osteopathy," Feb. 1899, p. 439).
    The lesions were of the 6th, 11th, and 12th dorsal vertebra and of the 1st, 2nd, 3rd, and 5th lumbar.  A report of the case 10 months after the cure showed the patient still entirely well.
    The various forms Of IDIOPATHIC MUSCULAR ATROPHY and HYPERTROPHY; pseudohypertrophic muscular paralysis, the juvenile form of progressive muscular atrophy, and the facioscapulo-humeral form, all call for general spinal and muscular treatment. The central nervous system is held to be normal, as in the case of myotonia contenita, and the disease is said to effect the muscles alone.  Yet, in myotonia congenita removal of spinal lesion and spinal treatment cured the case.  It seems at least that treatment to the spinal system of nerves, as well as spinal lesion to them has a marked effect upon these idiopathic muscular conditions.
    Flexion, extension, rotation, etc., of the limbs and parts constitutes the muscular treatment for them.
    Symptomatic treatment may be added as necessary.
 



 
NEURALGIA

CASES: (1) Severe facial neuralgia of two weeks standing, with inflammatory eruption upon the affected side, the right, and inflammation of the right eye.  The usual treatments had been tried for two weeks without avail.  The lesion was a marked displacement of the atlas to the left.  It was corrected and the case was cured in one treatment.
    (2) Facial neuralgia affecting the right side of the face and head, especially the forehead over the right eye.  The lesion was luxation of the atlas to the left.  The case was cured in one treatment.
    (3) Facial neuralgia of two years standing was greatly relieved by one treatment and was cured in six weeks, the patient gaining twenty-two pounds during that time.
    (4) Facial neuralgia and pains between the shoulders.  The lesions were contraction of cervical muscles and lateral luxation of the fourth and fifth dorsal vertebrae.  Four treatments cured the case.
    (5) Brachial neuralgia, involving the left arm and the left side as low as the fifth rib.  The pain was intense, and the case was of more than two years standing.  The arm was wasted and the pain continuous.  Lesions were a lateral luxation of the second dorsal vertebra, and contraction of the muscles of the upper spinal region as low as the sixth dorsal vertebra, drawing together the upper five ribs on the left side and causing intercostal neuralgia in this region.  In two weeks the pain was overcome and the arm began to develop).  The case was cured.
    (6) Brachial neuralgia of more than one year standing.  The pain affected the right and it almost useless.  The lesion was of the right rib, pressing upon the brachial plexus.  At the third treatment the rib was set and the pain ceased.
    (7) Cervico-brachial neuralgia in the right arm, shoulder, and chest, due to lateral luxation of the 5th cervical and third dorsal vertebra and muscular contractures of the cervical and left intercostal muscles.  The case was practically cured in four months.
    (8) Intercostal neuralgia of several years standing, cured in less than one month.  Spinal and rib lesion corrected.
    (9) Intercostal neuralgia due to heavy lifting, so severe that the patient was unable to sit erect without great pain.  Lesion was depression of the 3rd and 4th ribs on both sides.  Immediate relief followed treatment, and the case was cured in four weeks.
    (10) Intercostal neuralgia of ten years standing, causing an intense pain in the left side, extending to the abdomen.  Lesion was a luxation of the 8th left rib, and the case was cured by replacing it.
    (11) Spinal neuralgia of a number of years standing, due to lesion of the 4th dorsal vertebra.  The case was cured in two months.
    (12) Neuralgia in the head, of eight years standing, lasting continually thirty-six hours during each menstrual period.  Lesion was at the atlas, with muscular contractions in the lower dorsal and lumbar region.  The case was cured in one month.
    (13) Neuralgia of the stomach of three years standing, the attacks coming on after each meal.  At the time of examination so serious had the condition become that the patient had not taken solid food for more than two weeks.  Lesion was a lateral twist of the spine between the 6th and 7th dorsal vertebrae.  Improvement followed one treatment, and the case was cured in about one year.
    (14) Ulnar neuralgia, accompanied by swelling of the arm and of the ulnar side of forearm, hand, and third and fourth fingers.  The trouble was of two years duration, spinal lesion was found at the origin of the brachial plexus, and a contraction of the muscles in the upper dorsal region.  After four treatments there was no further pain, and the case was dismissed cured in one month.
    (15) Neuralgia in the third finger of the right hand, of several years standing.  Lesion was at the third cervical vertebra, which was corrected in a few treatments, removing the, condition.
    (16) Tic Douloureux of twelve years standing.  The pain would occur spasmodically in the infra-orbital terminals of the fifth nerve, at intervals of from three to ten minutes.  Lesion was found in a displaced atlas, which was corrected in six weeks, curing the case.
    DEFINITION: "Neuralgia is a pain in the course of a nerve unaccompanied by structural changes."  It is due to irritation, direct or indirect, of the nerve.  Often this irritation is from pressure of a displaced bony part or of contractured tissues.
    The LESIONS found causing this condition are usually bony, and these act by pressing directly upon a nerve or by affecting centers or sympathetic connections.  In case 6 above, the brachial neuralgia was due to direct pressure of the first rib upon the brachial plexus of nerves.  In case 1 or 2 it is evident that lesion of the atlas was too low to affect the nerve involved, the fifth cranial, by direct pressure.  Here the effect may have been upon the medulla, thus affecting the center in which certain roots of origin of the fifth arise, but more probably the effect was upon the nerve through its numerous sympathetic connections in the upper part of the cervical region, as pointed out in the discussion of the fifth nerve in diseases of the eye, q. v.
    In intercostal neuralgia the pressure is usually directly upon the nerve by a displaced rib, but may be due to vertebral lesion.
    The commonest bony lesion in neuralgia is a luxated vertebra, such a cause having been known to produce neuralgia in any part of the body.. (See cases 1, 5, 7, 11, 13.) It is probable that in such cases the vertebra brings direct pressure upon the nerve as it emerges from the spinal canal.
    Any bony part in the body in relation to nerves may become displaced and impinge upon the adjacent nerve, causing neuralgia. Frequently the rotation is pressure of contracted tissues upon the nerve.  This occurs at the foramina.  The tissues at and about the foramen become congested or contractured, pressing upon the nerve.  These contractures may occur along the spine, as in case 4.  Contractures of the intercostal muscles may draw the ribs together, irritate the nerves and cause the neuralgia.  Contractures are often the direct irritating cause in cases of neuralgia due to exposure, traumatism, etc.
    The lesion may be one causing a primary disease, as rheumatism, gout, or specific infectious disease, allowing of the generation of poisons in the systems, which affect the nerves by circulating in the blood.
    In TIC DOULOUREUX the lesion is usually at the atlas, but often is found among the other upper cervical vertebras.  Contracture of the cervical muscles and of the tissues about the foramina are often the causes.
    In CERVICO-OCCIPITAL neuralgia the lesions are usually among the upper four cervical vertebra.
    In INTERCOSTAL neuralgia occur lesions of vertebrae at the origin of the nerves affected, or of the ribs, and of the spinal and intercostal muscles.
    MASTODYNIA, or neuralgia of the breast, occurring generally in women, is due to similar lesions as intercostal neuralgia.  Commonly one finds rib lesion in the region affected.
    LUMBO-ABDOMINAL neuralgia, marked by pain in the lumbar region, hypogastrium, buttocks, or genitals, is caused by lesion in the lower dorsal and lumbar spine.
    CERVICO-BRACHIAL neuralgia is due to lesion of the lower cervical vertebrae.  It may be caused by vertebral lesion anywhere from the atlas to the sixth dorsal.
    Neuralgia in the LOWER LIMBS is due to lumbar, sacral or innominate lesions.  VISCERAL     NEURALGIA, as of stomach or intestines, is caused by vertebral lesion of the corresponding spinal region.  COCCYGODYNIA is caused by displacement of the coccyx, but may also be due to sacral, lumbar, or innominate lesion, leading to interference with the nerves by pressure, contracture of tissues, etc.  Neuralgia in the FEET, in addition to spinal and pelvic lesion, is often due to lesion of the small bones of the feet.  This is the case in MORTON'S PAINFUL TOE, METATARSALGIA, etc., in which subluxations among metatarsals or phalanges cause pressure on the nerve.  These conditions often occur in heavy persons who are much on the feet.  Often in such persons lithtemic, or gouty, or rheumatic diatheses are present, and contributing to the condition.  Treatment must consider the whole condition.  Sometimes the lesion is difficult of permanent and quick adjustment, owing to the weight of the person, who is more or less about.  Under such conditions a well placed pad of felt affords great relief, as a temporary measure.  It should be about 1 inch, by 2 or 3 inches, by 1/4 inch.
    FLATFEET sometimes give great trouble in the same manner, in the same class of cases, namely lithaemic, etc.  Not only may the feet be painful and troublesome, but in some cases the pain may not be in the foot, but in the ankles or shins, perhaps well up toward the knee.
    The PROGNOSIS is good in all kinds of neuralgia.  Cases of long standing often yield at once.  A few treatments, or a single treatment commonly, at once relieve the pain.  Permanent cure is usually accomplished.
    The TREATMENT is simple.  Often the removal of lesion is sufficient to entirely cure the condition.  The lesion should always be removed as soon as possible.  Likewise any cause of irritation must be removed, as an ulcerated tooth, a cicatrix, a growth in the nose, etc.  Constitutional conditions giving rise to neuralgic states must be met according to the case.
    Relaxation of all contractured muscles must be accomplished. The manipulation is carried over the course of the affected nerve, relaxing the tissues about it.  The pain of the disease does not prevent this local treatment.  Inhibition of the pain is accomplished, not by pressure, but by light =    manipulation.  The main treatment is usually upon a lesion at the origin of the affected nerve, or in its path.
    The above method of treatment is applied to any special variety of the disease.  Tic Douloureux often yields at once to light manipulation over the course of the affected branches upon the face. (Chap.  V. B.)
 



 
SCIATICA

    Sciatica is a disease in which Osteopathy has secured particularly brilliant results.  Great numbers of cases have been cured, many of them having tried previously every known means of treatment.
The prognosis is good.  Usually immediate relief is given upon the first treatment.  Often the case is soon cured, though many cases call for a patient continuance of the treatment.
    The LESIONS are almost always of such a nature as to bring irritation upon the nerve, either by direct pressure upon the nerve, or upon certain fibres contributing to it.  Derangement of its blood supply may play a part in producing the condition.
    The common lesions are bony ones along the lumbar and sacral regions.  Lesions of the 4th and 5th lumbar vertebrae, lesions of the first and second sacral nerves by contracture of the tissues about them, innominate displacement, slipping of the sacroiliac joint and derangement of its ligaments, displacement of the sacrum and derangement of the coccyx, are all important forms of lesion producing sciatica.  These lesions impinge the fibres.  Some may directly press upon the nerve.
A frequent cause of sciatica is contracture of the pyriformis muscle upon the trunk of the sciatic nerve.  The tissues about the sciatic notch may be contractured and irritate it.  It is said that lesion along the cord, anywhere from the 2nd dorsal down, may cause sciatica.  McConnell states that downward displacement of the 11th or 12th rib may cause it.
    The TREATMENT is simple.  It calls for the immediate removal of the source of pressure or irritation by correction of lesion.  A general relaxation of the tissues about the nerve and about its connections is done, due attention being given to relaxation of ligaments, as at the sacroiliac articulation.
    This relaxation of the tissues should be carried along the femoral vessels, often thus relieving the condition in an important manner.  The tissues along the course of the nerve, at the sciatic notch, at the back of the thigh, and behind the knee should be relaxed also.  Strong internal circumduction is used to relax the pyriformis muscle.
    The sciatic nerve should be well stretched by one of the methods described. (Chap.  X.)
Other forms of neuritis call for treatment upon similar lines to those followed in the treatment of sciatica.
    A LOCALIZED NEURITIS commonly shows obstructive lesion to the nerves supplying the part.  Such lesion is often the direct source of irritation causing the neuritis.  In some cases it weakens the local nerve mechanism.
    In BRACHIAL NEURITIS, a common lesion is pressure of the first rib or clavicle upon the brachial plexus.  Vertebral lesion in the cervical and upper dorsal region (4th cervical to 2nd dorsal) is often the cause.  Lesions of the upper three ribs irritating the upper two intercostal, which join the brachial plexus, may be causative factors.  One finds also slight slips at the shoulder or elbow joint, contracture of the cervical muscles and other tissues, and contracture of the tissues along the course of the plexus and the cords formed from it.
    MULTIPLE NEURITIS is almost always due to the toxic effects of alcohol.
    The TREATMENT in neuritis is especially to remove the source of irritation to the nerves.  In localized or brachial neuritis this is usually at once accomplished by removal of bony or muscular lesion.  This source of irritation must be sought from the origin of the nerves supplying the part involved out along the course of them.  Relaxation of muscles along these nerves is usually of considerable benefit.  Movements should be used to stretch the nerves affected.  In these ways the circulation to the nerve is corrected, and the inflammation is reduced.  Any toxic condition of the system should be carefully treated.  If the neuritis occurs after gout, diphtheria, influenza, etc., attention must be given to purifying the blood, and to excreting the poison from the system by way of the kidneys, liver, bowels, and skin.  These remarks apply especially to multiple neuritis.  If it be due to excessive use of alcohol, abstinence should be enforced.  In such cases treatment must be given the whole spinal system, and the general health must be looked to.
 



 
INSANITY

    CASES: (1) Farmer, injured while at work, later became insane.  Treatment by the usual methods did not avail and preparations were made to take him to an asylum.  He had been insane for some months, when the osteopathic examination was made.  Four men were required to hold the patient during the examination, so violent had he become. Lesion was found as a marked displacement of the third cervical vertebra to the right.  It was set at once, and the patient immediately fell asleep, sleeping for twelve hours and awaking rational.  In a few days the patient was well.
    (2) A young lady, violently insane for six years.  Lesion was found as a slightly misplaced atlas, which was corrected at one treatment.  The symptoms of insanity all disappeared in a few days.  There was history of a fall six years previous to the development of the insanity, and it was thought that the luxation of the atlas was caused then.
    (3) A young woman of twenty-four, insane and confined in an asylum for eight months.  Lesion existed in the form of a double lateral curvature in the lumbo-dorsal region; 5th lumbar vertebra posterior; 4th dorsal markedly posterior; 3rd and 5th dorsal anterior; 7th and 8th right ribs pressing upon the liver; innominates, one forward and the other back, one limb being 1 inch longer than the other.  Treatment directed to the correction of these lesions caused immediate benefit, and the patient was apparently well after two weeks treatment.
    (4) In a lady of twenty, insanity of two months standing.  There was a history of attacks of marked cerebral congestion.  At times she became violent.  The lesions were great tenderness and tension in the cervical region above the 4th vertebra, but no bony lesion; tenderness at the 5th lumbar vertebra and over the left ovary.  Dysmenorrhea was present.  After the first treatment she slept for eleven hours, and awoke sane for the first time in eight months.  After three weeks treatment the patient was well.
    (5) A boy acted in an insane manner after a fall upon his head from a window.  A cervical vertebra was found luxated, and one treatment sufficed to cure the case.
    (6) A lady of thirty-eight, who had been a chronic sufferer from rheumatism, had become insane ten years previously to treatment.  At the time of becoming insane the menses had ceased.  She had been in an asylum for six months, growing continually worse.  She was much excited and suffered hallucinations.  The lesions were such as pertained to the rheumatic condition; general muscular contracture, joints somewhat stiffened, tenderness over the kidneys, feeble pulse, and subnormal temperature.  One month of treatment showed great improvement; after two months the menses were reestablished and the mind was nearly normal.  Recovery was complete.
    (7) Insanity in a man followed injury in a runaway accident.  Lesion existed as anterior displacement of the atlas and a twist of the second and third vertebrae, one being turned forward and the other backward.  There was also contraction and soreness of the posterior cervical muscles.  Continued pain existed at the top of the head, there was an eruption upon the face, and a marked abnormal pulsation of the abdominal aorta.  Treatment soon cured the case.
    (8) Insanity of three weeks standing in a lady, in whose case the cause was found to be an anteversion of the uterus.  A fact that had been quite overlooked in her long course of medical treatment.  Osteopathic treatment was given this condition, and the drugs were discontinued.  In two weeks the patient became rational, and in seven weeks was entirely cured.
    The cases are illustrative of osteopathic practice in insanity, numerous cases of which come under treatment.  As a rule bony lesions are found.  Sometimes lesion exist  in the form of merely muscular contracture in the region.  The LESIONS are generally in the cervical region of the above eight cases presented such lesion.  Atlas lesion is frequent.  In some cases are general spinal lesions leading to effects on the nervous system.  Often marked lesion is found in the dorsal region.  McConnell notes the occurrence in insanity of middle dorsal, renal splanchnic, and rib lesions.  The latter occur among the middle ribs on the right side.  Case 3 above shows such lesions.
    Lesions act by interfering with cerebral circulation, probably in some cases by pressure upon the cord, and also by affecting the nervous system and setting up reflexes.  On the whole but little can be said definitely in regard to the pathology of insanity from the osteopathic point of view.  That lesions exist as the cause of such conditions, and that their removal cures, and alone can cure them, cannot be doubted from the facts.  But just how lesion is acting to cause derangement of the mental functions is not known.  It is noticeable that quick results usually follow treatment, as in the eight cases above.  Often the patient falls at once into a deep and lasting sleep.  These facts indicate some marked and immediate relief to the brain.  It seems as if some great pressure had been taken off the brain, leaving the mind free and Nature unopposed in her work of repair.  This is doubtless literally true in those cases of insanity attended by cerebral congestion, in which the impeded circulation is at once restored to normal tension by removal of that which impedes the venous flow from the head.      When the lesion is cervical it is altogether likely that its action upon the brain is by deranging the cerebral circulation, either by direct pressure upon the vertebral arteries by a displaced vertebra, by irritation to cervical sympathetics and the vaso-motor center in the medulla or by a combination of these two.  In this way may be set either hyperemia or anemia of the brain.  For example, pressure upon the vertebral arteries and irritation to the vaso-motors causing vaso-constriction might cooperate to cause marked anemia of the brain.  On the other hand, impeded venous return and increased arterial tension in this region might result from lesion and cause cerebral hyperemia.  Many cases of insanity are met in which there is hyperemia, as in cases 4 and 7.
    That hyperemia and anemia are important in relation to insanity is shown by the statement of Kellogg that "insanity from circulatory disorders of the brain arises chiefly in intense hyperemic and anemic forms."  That osteopathic lesion profoundly affects cerebral circulation is evidenced by many facts in the treatment of various diseases.  The importance of these circulatory disturbances is further indicated by Kelloggís statement that vascular degenerations deprive the brain of its customary blood supply and also prevent elimination of the waste products of cellular activity.   It is evident that the lesion shutting off the arterial supply or preventing free circulation in the brain could act as could vascular degeneration in producing the effects mentioned.  Kellogg says it is freely admitted that there is a previous link in the chain of events leading to insanity from such causes as he mentions above.      This link the Osteopath supplies by noting these important bony and other lesions, without the removal of which these cases fail to be cured.
    It is likely that the atlas lesion, so often found in insanity, acts chiefly by deranging the circulation through its close relation to the superior cervical ganglion and the medulla.  It does not seem that this and other cervical bony lesion cause direct pressure upon the cord, as in such case one would expect paralysis in the body below, yet it is not impossible that it may press directly upon the cord, getting its effect upon the brain through ascending tracts.
    The general spinal, vertebral and rib lesions mentioned may affect the general nervous system, as is known to be a fact from a study of nervous diseases, (see Paralysis) in this way leading to nervous diseases, reflex and otherwise, which are at the basis of insanity.  "All the (various influences) acting in the production of general diseases of the nervous system are those fundamentally involved in the causation of insanity." (Kellogg.) The splanchnic, right rib, and renal lesions noted by osteopathy as present in insanity cases may cause insanity through derangement of kidneys, liver and gastrointestinal tract.  The fact is noted by writers upon insanity that kidney diseases, notably Bright's disease, and gastrointestinal conditions, as gastric and intestinal catarrh, are sometimes closely associated with the causation of insanity.  Likewise liver disease is well known to be closely connected with insanity, gallstones and icterus being common in insanity.  These visceral diseases, as well as some nervous diseases, seem to be related to insanity through the vasomotor reflexes they arouse.  Kellogg says, "vasomotor disorders essentially constitute the connecting link in the causation of insanity by visceral affections and peripheral nervous diseases.  The vaso-motor center in the medulla is under the reflex control not alone of the cerebral cortex, but of the entire peripheral distribution of the sensory nervous system, so that not only emotional  stimuli, but peripheral irritations, may affect circulatory changes and variations in the blood pressure which stand in proximate relation to mental disorder.
It is a well demonstrated fact, that osteopathic lesion causes not only the visceral diseases, but likewise marked vaso-motor disorders, etc., apparently so closely related to these brain conditions.
    In view of these various facts it seems that the Osteopath has in insanity a broad field for his labors.  Nor would he be confined to that class of cases in which the traumatic effects of lesions due to violent accident and the like are the causes of insanity.  But as it is evident that the various lesions, bony and otherwise, that he finds may become fundamental to the causation of insanity through producing visceral, nervous, and vasomotor disorders, his field in insanity must be as broad as the disease.
    The PROGNOSIS is good.  The most brilliant and quickest results are often attained.  A large percentage of the cases treated are cured.  It is needless to say that many cannot be cured.
    The TREATMENT looks to the removal of lesion, and of all causes of irritation, reflex, emotional and otherwise.  The whole nervous system should be upbuilt by general spinal and cervical treatment.  One of the main objects is to correct cerebral circulation.  A congested condition is treated as in congestive headache or apoplexy, q. v.  The abdominal inhibition may be employed.      The general health is looked to, kidneys, liver, stomach, bowels, pelvic viscera, heart and lungs are all regulated in case of affection in them.  The patient should lead a quiet, regular life.