The Practice and Applied Therapeutics of Osteopathy
Charles Hazzard, D. O.
    CASES: (1) Impaired vision in a boy of seventeen, who had been wearing glasses over three years.  Severe headache and inability to read followed removal of them.  Lesion was found as lateral luxation of the atlas and third cervical vertebra.  After three weeks treatment the glasses were removed, and at the end of two months the eves were completely cured.  The report was made six months later, the eyes still being well.
    (2) A case in which weakness of the eyes and rheumatic pains in the shoulder were caused by lesion in the form of closeness of the second and third cervical vertebrae.  After one treatment the glasses were laid aside and the pain in the shoulder was gone.  The trouble, caused by a fall in a gymnasium, affected but one eye and one side of the body, a nervous twitching of the muscles being present.
    (3) A young lady had suffered with weak eyes for two years.  The eyes would be very painful if the glasses were laid aside even for five minutes.  Lesion was of the 2nd dorsal vertebra, lateral to the left.  After five treatments the glasses were discarded.
    (4) In a lady of forty, weakness of the eyes, accompanied by great pain in the eyeballs and at the base of the brain.  Lesion existed at the atlas and third cervical vertebra.  Constipation and uterine prolapsus were present, with characteristic lesions.  After one month the eyes were almost well.  Photophobia was a feature of the case.
    (5) In a case of weak eyes, with pain in the neck, occipital headache, and a complication of troubles, lesions were found as anterior luxation of 3rd, 4th, and 5th cervical vertebras, the 5th being sore.  The whole spinal column was stiff and stooped forward.
    (6) In a case of weak eyes in a young man of twenty, of two month’s standing , the patient was unable to read, the balls were injected and painful, and the lids were inflamed.  The atlas and axis were too close.
    (7) In a lady of thirty-two, weakness of the eyes and chronic hoarseness had existed for twenty-two years.  The left cervical muscles were very sore, there was a separation between the atlas and axis, and the 5th cervical vertebrae was sore.  The right tear  duct was closed.
    (8) In a case of weakness of the eyes, coupled with indigestion, jaundice and hemorrhoids, the 7th to 11th dorsal vertebra were posterior; coccyx anterior; and innominate forward.
    (9) Extreme weakness of the eyes, together with female disease.  A few minutes use of the eyes caused violent headache.  Lesions were at the atlas and in a tilting of an innominate bone. The case was cured by removal of the lesions.
    (10) Eye trouble in a boy of thirteen, not benefited by glasses.  Patient was very nervous.  The atlas was slipped forward.  The lesion was corrected and the case was cured in six weeks.
    (11) A case of pterygium due to granulated lids of sixteen years duration.  The left pupil was covered by the growth, find the right one was nearly so.  The case was cured by the adjustment of cervical lesion.
    (12) Pterygium over each eye due to lesion of the atlas.  Under treatment gradual correction of the lesion was accompanied by gradual absorption of the growth.
    (13) Partial blindness and strabismus, associated with general paralysis, due to a forward slip of the head upon the atlas.  The case was cured in two months.
    (14) A case of blindness from optic nerve atrophy, due to a fall from a swing, resulting m lesion of the atlas and several cervical and upper dorsal vertebrae.  The disease was of twenty-three years standing.  It was cured by two years treatment.
    (15) Blindness of one eye, and almost total loss of sight in the other, of about a years duration, was cured in two weeks by correction of lesion of the atlas, which was to the right,
and of one of the first ribs, which was luxated upwards.
    (16) Partial blindness, the patient being unable to read or to recognize a person ten feet away.  The trouble was due to starvation of the optic nerve from lesion of the upper cervical vertebrae.  In four months the patient had been cured.
    (17) Blindness, almost total, in a man of sixty, due to a fall when he was a child.  Lesion was found as luxation of a cervical vertebra.  The treatment so benefited the eye that it
could see to read coarse print.
    (18) Total blindness in the left eye for more than two years, due to lesion of the atlas.  The pupil was much dilated.  After one treatment sight was partly restored, and at the end of a month of treatment the case was nearly entirely well.
    (19) Total blindness with paralysis of lower limbs, formication of upper limbs, etc.  Lesion was found in lateral luxation of the third cervical vertebra, of the 7th and 8th right ribs, and posterior protrusion of the lumbar vertebrae.  Soon vision was partly restored, but with diplopia.  Slight pressure upon the seventh cervical vertebra would at once restore perfect vision.  When pressure was removed diplopia again occurred.  Under the treatment the sight was entirely restored.  Speech had been lacking, but was restored, and the paralysis was cured.
    (20) In a young man of twenty, diplopia of two years duration had followed a severe attack of measles.  The 3rd cervical vertebra was displaced anteriorly and the tissues about it were sore.      Tenderness existed also at the 5th and 6th cervical vertebrae.  The first dorsal was posterior, the 2nd to 6th flattened  the 8th to 12th weak, with a separation between the 12th dorsal and 1st lumbar, and the 1st to 4th lumbar vertebra were posterior.  The case was cured in one month.  There had been supposed hemorrhagic retinitis.
    (21) A case of strabismus due to lesion of the 2nd dorsal vertebra was cured by correction of the lesion.   During the course of treatment, after the eyes had first become straightened, pressure upon the second dorsal vertebra would cross them again.
    (22) A case of strabismus, unilateral, convergent, due to a fall in a runaway accident.  The atlas was displaced to the right; 4th and 5th cervical vertebrae anterior.  The case was improving under treatment.
    (23) Kerito-conjunctivitis, in the left eye, of four years standing.  There was opacity of the upper two-thirds of the cornea, with marked vascularization, inflammation and granulation of the eyelids, and injection of the sclerotic.  The atlas was luxated to the left, the fifth and sixth cervical vertebrae were anterior and to the left, and the upper dorsal vertebrae were posterior. Under the treatment the case was almost cured in less than two months.
    (24) In a man of thirty-seven, glaucoma was present, and total blindness of the left eye was predicted by the oculist.  The patient was a neurasthenic, probably of the cerebral type, pain
in the head and eye being extreme.  The eye trouble was overcome and the patient's general condition much improved by three months treatment.  No special lesions were found.
    (25) Partial blindness, in which the blindness was limited to a circular portion of each eve.  Lesion found as a luxation of the atlas to the right and backwards.  The case is still under treatment.
    (26) A case in which the tear duct was closed.  It had been growing worse under the usual form of treatment for two' years.  The eye was much inflamed.  Relief was experienced at the first treatment, after the second the duct was permanently opened, and the inflammation about the eye gradually disappeared.  The case was well a year later.
    (27) Eyestrain, causing constant headache, due to a luxated atlas.  Glasses gave no relief.  The headache did not recur after the first treatment, and the eyes were well after seven treatments.  The case had been of but two or three months standing.
    (28) Astigmatism in a girl of ten.  Lesion was found at the 2nd dorsal.  Treatment was directed to correction of this lesion and to stimulation of the ocular blood and nerve supply.  The case was soon cured.
    (29) In astigmatism for which the patient had worn spectacles for nine years, lesion was found in anterior luxation of the atlas and a twist of the inferior maxillary bone.  The glasses were permanently discarded after one treatment, and the case was soon entirely cured.
    These reports illustrate very well the general lesions found in diseases of the eye.  The most important lesions occur among the vertebrae of the cervical and upper dorsal region.  Muscular lesions are often found in this region, and are of considerable importance.  The whole cervical region is frequently involved, or any one or several of the vertebrae may be luxated.  Perhaps the more important lesions are of the atlas, axis, and 3rd cervical vertebra.  The 4th and 5th are also important.
    Other bony lesions occurring in these cases, and of importance in eye troubles generally, are luxation of the inferior maxillary bone and of the first rib, sometimes also of the clavicle.
    There is a form of neck lesion that often plays a part in the production of eye disease, as well as of other forms of head and neck trouble.  It involves the whole cervical region, often causing a lateral swerve of the cervical spine.  The cervical tissues are contractured or hypertrophied upon one side more prominently than upon the other.  The condition is often evident upon simple inspection from immediately behind.  The fullness upon one side of the neck, and generally a corresponding depression in the tissues on the opposite side, are readily seen.  In some cases the condition is better appreciated upon palpation.  The fingers are readily pressed more deeply into the tissues upon one side of the posterior cervical aspect than upon the other.  Contracture of the muscles may be felt here on both sides.  If the vertebrae are traced down the midline of the back of the neck, a lateral swerve is often evident.  In other cases the bony lesions are more evident by examination of each vertebra with the patient lying upon his back.
    Dr. A. T. Still calls attention to the fact that contracture of the cervical muscles opposite the 4th vertebra are common in eye diseases, and that pressure here causes pain in the eye.  A case is reported in which pressure between the 2nd and 3rd dorsal vertebrae upon the right side revealed tenderness at that point and also caused pain in the eye.
    Without question cervical bony lesion is the most important one with which the Osteopath deals in eye diseases.
    Upper dorsal lesion may be muscular, but is usually bony.  It involves chiefly the upper four or five vertebra, but may extend as low as the 6th or 7th.  The lesions of the 1st, 2nd and 3rd dorsal vertebrae are the most important here.  A common abnormality of the anatomical parts here is a "hump" or prominent cushion of flesh covering the spinous processes of the upper two or three dorsal vertebrae.  There is often conjoined with this condition a marked prominence of the first dorsal spine from above, as if the cervical spine had been moved a little anteriorly upon the first dorsal.  This cushion is a common condition in eye troubles of various sorts, and is sometimes connected with heart trouble.
    Among lesions of this region may be mentioned lesion of the upper ribs on either side as low as the sixth, sometimes thought to have bearing upon nutritional disturbances of the eyes.
    We are perhaps not in a position as yet to point out that special kinds or locations of lesion result in specific diseases of the eye.  Cases involving deficiency somewhere in the optic tract seem to favor lesion in the upper cervical region.  In the above reports, 19 cases in which probably the intrinsic apparatus of the special sense of sight was involved, such as weakness, impaired vision, blindness, etc., show lesion chiefly in the upper cervical region.   All but 2 cases show cervical lesion, 13 of them being entirely in the cervical region; 11 at the atlas, 8 at the axis, third, or both; also the 4th, 5th and 7th were involved.  The most important lesions occurred about atlas, axis and third.
    Cases in which there is nutritional disturbances as in conjunctivitis, keratitis, glaucoma, cataract, and closure of the tear duct, also cases in which there is structural change, such as astigmatism, pterygium, etc., probably due to lack of nutrition, present atlas, general cervical, inferior maxillary, and upper dorsal lesion.  Compilations of data, by which proof of these might be made, are lacking.   Yet it seems that nutritional disturbances, involving in some way chiefly the fifth nerve, would be found tending more toward the upper dorsal region, for the anatomical reason that this nerve has important connections with the upper dorsal nerves and cord.
    Motor disturbances, such as diplopia, strabismus, eyestrain, etc., show less of high cervical lesion and more from about the third cervical down to the upper dorsal.  In this connection it is recalled that diplopia has been caused by pressure at the 7th cervical, and strabismus by pressure at the 2nd dorsal.
    This phase of the subject, inquiry how far specific lesion results in certain forms of eye disease, presents a good field for research.  It is evident that at present we cannot more than indicate probabilities.
    ANATOMIC RELATIONS: There are good anatomical reasons why lesion in the upper dorsal and cervical regions causes eye disease.  These portions of the spine are particularly rich in nerve connections with the eye.  'These lesions act by disturbing blood, nerve, or lymphatic supply of the eve.  The blood supply suffers sometimes by direct impingement, as of vertebrae upon the vertebral arteries, or by derangement of the vaso-motor control by lesion to the nerves.  The lymphatics suffer by direct impingement, as by clavicular lesion damming back the lymphatic drainage from the head.   The lesion affecting the eye does so chiefly, however, by disturbance of the numerous important nerve connections met in the upper dorsal and cervical regions.
    Experience has taught the Osteopath that body lesion in those regions causes most eye diseases and that its removal cures them.
    The superior cervical ganglion, well known to suffer by lesion of atlas, axis, or 3rd cervical, sends its ascending branch to join the carotid and cavernous plexuses, thence to help form a secondary plexus about the ophthalmic arteries and to contribute branches to the minute plexus of the sympathetic within the eyeball itself.  Thus is established a direct path of communication between the upper cervical lesion and the eye.
    The ciliary ganglion lies at the back of the orbit, between the trunk of the optic nerve and the external rectus muscle.  In this situation it is readily impinged by that treatment that presses the eyeball back into the orbit.  With this ganglion are connected the 3rd, 5th, and sympathetic nerves, it thus becoming, through the functions of these nerves, a sensory, motor, and sympathetic center for the eyeball.  Neck lesion, as will be shown, may effect either or all of these nerve connections, in this way deranging the function of the ganglion with regard to the eye.
    The third cranial nerve innervated all the voluntary muscles of the eye except the external rectus and the superior oblique.  It is, further, the nerve which contracts the pupil by supplying the sphincter function of the iris.  This function is shown by the American Textbook of Physiology to have its center in the superior cervical ganglion, where it could be affected in lesion of the upper cervical region, causing disturbance of accommodation in the eye.  Neck lesions are known to cause strabismus and diplopia (cases 19 and 21), showing disturbance by such lesion of the function of the 3rd nerve.  (Also of the 4th and 6th.)  The anatomical relations in strabismus caused by lesion at the 2nd dorsal, and in diplopia by lesion at the 7th cervical, are not well understood.  The local treatment of the cilary ganglion is important in these motor disturbances.
    Fibers antagonistic to the ciliary function of the third nerve, being dilators of the pupil, are found in the third ventricle, whence they pass through the medulla and cervical cord to the anterior roots of the upper dorsal nerves and to the first thoracic ganglion of the sympathetic.  From these points they reach the eye via the cervical sympathetic cord, ophthalmic division of the fifth, and its nasal and long ciliary branches.
    These facts indicate the importance of upper cervical, general cervical, and upper dorsal lesion in the causation of lack of accommodation, eyestrain, and similar troubles.
    The latter sympathetic connection indicates the so-called cilio-spinal center at the 4th cervical to 4th dorsal.  Quain states that these pupillo-dilator fibers pass from the 1st, 2nd and 3rd nerves, sometimes also from the 7th and 8th cervical.
    In addition to the above, motor fibbers to involuntary muscles of the orbit and eyelids pass from the upper four or five dorsal nerves.  Also retinal fibers leave the sympathetic at the
superior cervical ganglion, pass to the Gasserian ganglion of the fifth, thence through its branches to the eye.  It is shown that, acting through these fibers, stimulation of the cervical sympathetic causes constriction of the retinal arteries, while stimulation of the thoracic sympathetic causes dilatation of them.  These facts indicate the importance of cervical and upper dorsal lesion in vaso-motor disturbances in the retina, as in retinitis.
    The fact that many of these sympathetics, as pointed out, pass to the eye via the fifth nerve shows the intimate relation between the superior cervical ganglion, the cervical and upper dorsal sympathetic, and the fifth nerve, consequently the potency of cervical and upper dorsal lesion to affect the fifth nerve.  This nerve sends its sensory ophthalmic division to join with the sympathetic from the cavernous plexus.  It has trophic and vaso-motor fibers to the eyeball and its appendages.  Green states that section of the fifth nerve is followed by keratitis and ulceration.  It has charge of the nutrition of the eyeball, supplying also the lachrymal glands, conjunctiva, skin of the lids and adjacent parts of the face.  Nutritive disturbances of the eyes, such as keratitis, conjunctivitis, retinitis, cataract, glaucoma, pterygium, etc., must be referred to lesion affecting the fifth nerve.  Likewise optic nerve atrophy, and other effects due to insufficient nutrition, would result from lesion affecting the fifth.
    Slips of the inferior maxillary articulation are thought to impinge fibers of the fifth nerve, (articular branches from the auriculo-temporal nerve) and to cause certain eye troubles. (Case 33.)
    A review of these various connections shows that cervical and upper dorsal lesion may affect:
    1.  The superior cervical ganglion and its sympathetic connection with the local sympathetic plexus of the eyeball.
    2.  The various cervical nerves, and through them the ganglion and the other cervical sympathetics.
    3.  The pupillo-constrictor center in the superior cervical ganglion.
    4.  The pupillo-dilator center in the same ganglion and at the lower cervical and upper three dorsal nerves.
    5.  The motor fibers from the upper four or five dorsal nerves to the involuntary muscles of orbit and eyelids.
    6.  The fifth nerve by its connections with the superior cervical ganglion and cervical sympathetic.
    7.  Constrictors of the retinal arteries in the cervical sympathetic.
    8.  Dilators of the same in the thoracic sympathetic, and both of these at the superior cervical ganglion.
    It is noticeable that all of these eight connections, except perhaps No. 5, may be reached at the superior cervical ganglion.  This explains the special importance of lesion to atlas, axis and 3rd cervical, before pointed out as most frequent in eye diseases.  These upper cervical lesions affect this ganglion.  From the variety of functions represented in these various fibers congregated in the superior cervical ganglion we must conclude that lesion of the atlas, axis, or third, etc., affecting this ganglion, would cause a variety of diseases of the eye.
    Lesions causing stomach, kidney, and pelvic diseases may secondarily become the cause of disturbances in the eye.  The relation here is probably entirely reflex.  Perhaps also in these conditions alteration of blood pressure is a disturbing factor.
    It seems that cervical lesion causing obstruction of the tear-duct, as well as manipulation upon the nose along its course to open it, affect the mucous membrane lining it, through the distribution of the fifth nerve.
    Clavicular and first rib lesion, obstructing the lymphatic drainage of the eye by obstructing the flow from the deep cervical lymphatics into the thoracic or right lymphatic duct, may affect the metabolism of the eye.  It has been thought that lesion affecting the female breast may react upon the eye reflexly.
    The PROGNOSIS in eye diseases is, generally speaking, good.  Marked results, even to cure of blindness of many fears standing, have been acquired.  Very often surprisingly quick results have been attained.  An examination of the case reports at the opening of this chapter will show that in twenty-four of the thirty-three various cases reported a cure was affected.  Quick results, either as cure or benefit, were attained in seventeen cases.  The cases met by the Osteopath are frequently of long standing and in bad condition.  In many cases these results were gotten after specialists had failed.  All cases cannot be cured.  Many are subjects for the specialist.
    The TREATMENT of eye diseases is necessarily almost entirely upon the neck, as it has been shown that the lesions in these cases occur here.  The removal of the these various lesions is already understood from discussions in the previous pages.  The treatment looks, in general  to the establishment of perfect circulation, and the regulation of the nerve mechanism.  The general neck treatment, as applied in cases of insomnia, headache, apoplexy, etc., q, v., given with a specific object in view, would be the method employed (see also Chap.  III and IV).
    In many cases the simple removal of lesion is the only treatment required.  Often this treatment and the general neck treatment may be supplemented by local treatment upon the eye, and about it, reaching its nerve mechanism and blood circulation directly. (See Chap.  V, A and B)  This work includes treatment to the fifth nerve as the one being in charge of the nutrition and circulation of the eye.  This nerve is particularly regarded in all nutritive diseases, such as keratitis, and in all inflammatory, hyperemic or anemic conditions, such as conjunctivitis, etc.
    In conjunctivitis the local irritant, if one be present, must be removed.  Treatment should not be made upon the eye, in these cases, but about it.  The chief treatment is in the neck, especially upon the superior cervical ganglion.
    In granular conjunctivitis the same treatment is made.  The granulations must be broken down. (Chap.  V).  After this the correction of the circulation by the cervical treatment prevents their further growth.
    In keratitis treatment proceeds as in conjunctivitis.  In both conditions the fifth nerve must be especially treated.
    The removal of lesion and the correction of blood flow are the essential points in these and all similar cases.
    In pterygium especial treatment is made to cut off the "feeders" (V.  Chap.  V.)   After this operation they are absorbed by the corrected circulation by means of the neck work.  In some cases removal of neck lesion is followed by absorption of the growth, as in case 15.  Sometimes light manipulation over the closed lids aids the absorption.
    The same remarks apply to pannus.
    In diplopia, ptosis, strabismus, and other motor troubles, lesion must be sought as the cause of the muscular palsy,  etc.  Treatment is applied to the lesion and to the affected nerve.  These troubles sometimes yield to the correction of cervical lesion alone.  The muscles may be treated directly as in VI.  Chap. V.
    In cataract the treatment looks to the absorption of the cataract through increased circulation.      Cervical treatment, removal of lesion, and local treatment about the eye and upon the fifth nerve, all as before described, have successfully accomplished a cure in these cases.  In such cases, Dr. Still says that the crystalline lens is disarranged.  He holds one finger lose against one side of the eyeball, with the lid closed, and thumps this finger with the index finger of the other hand to jar the ball and straighten the lens.
    In the various optic nerve troubles, also, the treatments are, used to affect the nerve through its blood supply.  Numerous cases of blindness from optic nerve atrophy have been cured in this way.      The optic nerve may be stimulated by tapping or pressure upon the eyeball.  (II, II, Chap. V)      Retinitis likewise yields to this treatment.
    In conjugate deviation, both eyes turning strongly to one or other side, the lesion, usually cervical, affects the third and sixth nerves, supplying respectively the internal rectus and the external rectus of the eyeball.  The treatment is local and cervical.