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

    Numerous cases have been treated successfully by osteopathy.  The lesions usually found in such cases are muscular and bony lesions in the neck.  Dr. Still regards the important cause a contraction of the tissues of the throat and neck, including the scaleni muscles, drawing the first rib backward under the clavicle and thus disturbing its articulation with the first dorsal vertebra.  These contractions about the throat interfere with the venous circulation through the pharyngeal and internal jugular veins, favor a congested or catarrhal condition of the mucous membranes of the throat, and leading to diphtheria.  It is well known that catarrhal conditions predispose to the disease.
    Bony lesions and muscular contractures in the cervical region interfere with the innervation of the muscles and mucous membrane of the throat.  The sympathetic innervation is from the superior cervical ganglion.  This distribution unites with fibres from the pneumogastric, glosso-pharyngeal and external laryngeal nerves, forming the pharyngeal plexus.  Hence upper cervical lesion may, by affecting the superior cervical ganglion, derange the sympathetic vaso-motor supply of the pharyngeal mucous membranes and lead to the disease.
    The PROGNOSIS is good.  The case is usually readily cured.
    In the TREATMENT the main idea is to keep open the circulation to the throat and to thus prevent the formation of the membrane, or to prevent its further growth.  A thorough relaxation of the muscles and anterior tissues of the neck must be maintained.  The tissues at the root of the neck, and about the clavicle and first rib must also be kept free and loose.  The clavicle should be raised.  The first rib should be pressed downward and forward, working at its central articulation to correct the position of its head.  By the process of these treatments the venous and lymphatic drainage from about the throat is kept open.  This regulates the vaso-motor disturbance of the membranes, tends to loosen the membranes already formed, and, by preventing further exudation, stops the further growth of the membrane.
    The splanchnics, liver, kidneys and bowels should be treated twice daily, to keep free the excretion of poison from the system, and to aid nutrition, to keep up the strength of the system.
    Cervical bony lesion should be removed, and treatment should be given to the vagi, superior cervical ganglion, and cervical sympathetics, to correct circulation and aid in gaining vaso-motor control.
    The internal throat treatment should be given to aid in gaining the same end.  Proper precautions should be taken to protect the finger so that the child may not wound it with his teeth.  The finger is inserted and swept down over soft and hard palate, fauces and tonsils, to relieve the local inflammation by starting the circulation.
    In laryngeal diphtheria an external treatment, about the larynx and down along the trachea is good. (Chap M.  A. V.)  Laryngeal intubation should be done in case of threatened suffocation.
A general systemic treatment should be carefully given to build up the strength.  The heart and lungs should be carefully stimulated to avoid complications in them.  The case should be carefully looked after for some time, to strengthen the heart and to overcome the weakness of the throat.
    The general treatment aids in preventing paralysis, particularly apt to occur about the throat, sometimes in other parts of the body.
    The patient should be isolated and the usual antiseptic precautions should be practiced. The patient should be kept upon a liquid diet.  Milk, ice cream, broths, and the like are used.

CROUP (Spasmodic Croup, Catarrhal Croup, or Laryngismus Stridulus)

    DEFINITION: This is a disease peculiar to children and held to be chiefly of nervous origin, but it is often associated with acute catarrhal laryngitis.  It is associated with paroxysmal coughing, difficulty of breathing, and attacks of threatened suffocation.
    Numerous cases have been successfully treated by osteopathy.
    The LESIONS of greatest importance in croup involve contracturing of the muscles and tissues of the throat, irritating the pneumogastric nerves, and their recurrent and superior laryngeal branches. These contractures likewise prevent proper circulation to and from the larynx, and favor the catarrhal condition in this way.  The irritation of the pneumogastrics and their branches is accountable for the spasmodic condition of the larynx during the paroxysms.
    Dr. Still regards as important sacral and lower spinal bony lesions in croup.  He also finds a contracture of the omohyoid muscle, drawing the hyoid bone down and back upon the superior laryngeal nerve, irritating it, and causing the spasm.  In croup, as in other throat diseases, he finds that the contracture of the cervical tissues and scaleni muscles draws the first rib back under the clavicle, draws it upward, and deranges its articulation with the first dorsal vertebra.  This condition is important in shutting off venous and lymphatic drainage from the larynx, and favors the inflammation of the mucous membrane.
    Various contractures of the posterior cervical muscles, as well as those bony lesions common in laryngitis, as of atlas, axis, and 3rd cervical vertebra, are sometimes present, acting to disturb sympathetic innervation, vagi, and circulation.
    One, must, however chiefly regard those contractures and bony lesions about the throat and neck anteriorly.  Arising from exposure, cold, etc., they become the chief cause of croup.
    The PROGNOSIS is good.  Immediate relief is given by the treatment.  The spasm, stridulous breathing, and threatened suffocation are overcome at once by the treatment during the attack.
    The chief TREATMENT is to at once relax all the anterior cervical tissues, to free the circulation and to relieve the irritation to the superior and recurrent laryngeal nerves.  The treatment should begin well up beneath the inferior maxillary bone, being made especially about the hyoid bone and muscles and should be carried down along the throat and trachea.
    The hyoid bone should be grasped and manipulated laterally, forward, and upward, relaxing the omohyoid and other muscles. (Chap.  M, A, M, Chap.  IV, M.)
    The process of freeing the circulation is materially aided by working along the course of the carotid arteries and internal jugular veins, raising the clavicle, and relaxing the surrounding tissues.
    Treatment may be made close along the larynx and trachea. (Chap. M, A. V.) This is helpful during the spasm.
    Inhibition may be made upon the superior laryngeal nerve by pressure immediately below and behind the greater cornua of the hyoid bone, and upon the recurrent laryngeal at the inner side of the sterno-mastoid muscle at the level of the cricoid cartilage.  This is likewise useful during the spasm.
    Anders notes the fact that sometimes the epiglottis becomes wedged into the rima glottidis, and must be helped out by the use of the index finger.
    The spasm may be lessened by manipulation about the region of the diaphragm, relaxing it, and by treatment of the phrenic nerves in the neck. (Chap.  M, A. VM)
    Due attention must be given to the tissues and bony lesions of the posterior cervical region.
    All sources of reflex irritation, as intestinal parasites, dentition, indigestion, etc., must be looked after.  The child should not be allowed to overeat or drink.
    In spasmodic croup the attack is sometimes relieved by easing an overloaded stomach.
    Tickling the fauces with the finger will cause the vomiting.  Cold applications may be used over the throat and chest.  A warm bath is a convenient means to break up a spasm.


    DEFINITION: An acute, highly contagious diseases occurring chiefly, in children, and characterized by a catarrhal inflammation of the mucous membrane of the respiratory tract, and a peculiar spasmodic cough ending in a whooping inspiration.
    Its true nature is not known, but that theory that regards it as a lesion of the phrenic, pneumogastric, sympathetic, or recurrent laryngeal nerve, or perhaps of the medulla, best accords with the osteopathic view of the etiology.
    The PROGNOSIS is good.  The case may be aborted if taken early, but if the disease is well started but little more than alleviation can be accomplished.  The case is safely carried through, and the danger of complication is minimized.
    The LESIONS: In whooping cough, as in croup, the contraction of the omohyoid muscle, drawing the hyoid bone against the pneumogastric nerve, is important, as is also the contracting of the cervical tissues drawing the first rib back, and disturbing its central articulation.
    Cervical bony lesions are found at the upper, middle, and lower cervical vertebrae, and bony lesions are also found about the first and second dorsal vertebra the first rib and clavicle.
    The upper cervical lesion affects sympathetics and vagi in ways before pointed out.  The middle cervical lesion affects phrenics and diaphragm, sometimes important in this condition.  The contractures of throat tissues, lesion of clavicle and first rib retard venous and lymphatic drainage, and lead to catarrhal conditions, well known to be of much importance in producing the condition.    The mucous membranes are thus weakened and laid liable to the action of the specific infection.
    Lesions of the upper dorsal vertebrae and of the upper two or three ribs may derange the sympathetic connections of the laryngeal innervation.
    The TREATMENT is much the same as in croup.  The prime point is to free the circulation about the larynx and whole respiratory tract, as there is a catarrhal condition of the whole tract.  This object involves the relaxation of all the anterior cervical tissues, treatment of the hyoid bone, and relaxation of the omohyoid, raising the clavicle, etc.  All bony lesions of the cervical, upper dorsal, and upper thoracic region must be overcome, together with existing contractures, in order to remove all sources of irritation to the laryngeal innervation.  The ways in which these lesions act, and the method of their removal has before been sufficiently explained.
    For the cough, treatment should be made down along larynx and trachea, and about the angle of the jaw.
    Dr. Still mentions, also, treatment to the phrenic nerves and diaphragm to relieve the condition.
The lungs may be stimulated, and all the upper ribs be raised, to ease respiration.  The lungs, heart, kidneys, and general system must be carefully looked after and thoroughly treated to avoid the complications and sequelae that may arise in the form of broncho-pneumonia, pleurisy, pericarditis, acute nephritis.
    "Jacob Sobel gives the results of his own experience with the paroxysms of whooping cough treated by pulling the lower jaw downward and forward.  Pulling the lower jaw downward and forward controls the paroxysms of whooping cough in most instances and most of the time.  The method is usually more successful in older children than in younger ones and infants.  In cases without a whoop the expiratory spasm with its asphyxia is generally overcome, and in those with a whoop the later is prevented.  It is as successful as any single drug, or even more so. Mothers should be instructed in its use, so that attacks, especially at night, might be arrested.  The manipulation is harmless and painless. Its only contraindication is the presence of food in the mouth or esophagus Patients thus treated are less likely to suffer from complications and sequelae than those treated only medicinally.  It is advisable to try this method in other spasmodic coughs and laryngeal spasm." (N. Y. Medical Record.)
    It is probable that by drawing the jaw down and forward the suprahyoid muscles pull upon the hyoid bone, stretching all the hyoid muscles, and releasing pressure from off the superior laryngeal nerve, which passes just behind the greater cornu, thus relieving the irritation of the nerve and the consequent spasm in the muscles, especially the crico-thyroid.


    CASES: (1) Four cases in one family restored to usual health within a week.
    (2) Four cases cured in four or five treatments, no bad results following the disease.
    (3) Lagrippe, attacking the throat and complicated with a severe tonsillitis, was cured by several treatments.
    (4) A severe attack of lagrippe cured in four days by treatment directed to bowels, kidneys, and splanchnic nerves,
    (5) A list of thirty-five cases, one of which had been cured by one treatment, and the remaining cases cured by several treatments, none requiring over four.
    (6) A report of a number of cases lagrippe, all with marked symptoms.  In every case the patient was able to be up in from one to three days.  No complications nor sequelae arose.
    (7) A lady of seventy-one had been confined to her bed for two weeks with lagrippe and rheumatism.  After seven treatments she was about, the lagrippe being cured and the rheumatism much improved.
    (8) A case of lagrippe cured in four treatments.
    LESIONS: While no specific bony lesion has yet been mentioned as occurring in influenza, there is yet a specific condition of lesion doubtless closely associated with the invasion of the disease into the system.  This condition is a general contracturing of the spinal muscles, most marked in the upper dorsal and cervical regions, but affecting the whole spinal system.  This may be regarded as the specific lesion in influenza.  Dr. Still regards it as shutting down upon the whole vascular and nerve system of the body, through the constricting effect of these contractures upon the spinal nervous system through its posterior distribution.  The result is a sluggish condition of all the vital fluids, lymphatic, blood and nerve.
    While it is doubtless true that the bacillus of Pfeifer is the infecting agent, it yet remains to account for the sudden invasion of the system by this germ, since it is known that the germs of disease cannot attack healthy tissues and that a body in perfect health is immune.
    In this connection it is significant that debilitated persons fall the easiest victims to the malady.  In a majority of such individuals it is doubtless true that various osteopathic lesions already exist and so weaken the system in one way or another as to lay it liable to the invasion of the germ.
    Just so, the general muscular contracture found as the characteristic lesion in lagrippe, acts upon the vital forces of the system to debilitate them and lay the body liable to invasion.  This theory would appear entirely reasonable in the light of the fact that Pepper thinks it likely that the germ exists everywhere, but depends upon certain extraordinary atmospheric or telluric conditions for occasion to break out into virulence.  It is quite reasonable to hold that some special set of circumstances, it may even be these same extraordinary atmospheric conditions, results in these spinal contractures which, occurring coincidentally with the periods of virulence of the germ, allow of the invasion of the system.
    Lagrippe is most frequent in bad weather, and it may be that then exposure to cold may set up these contractures.  While it is true that the authorities hold the disease to be entirely independent of climate and season, it is yet true that a person may "catch cold" at any time and place, these contractures being well known to result.
    It is probable that the presence of various lesions, bony and otherwise, in the body, determines the disease to a special part of the system, resulting in the peculiar manifestation of the disease which distinguishes it as the abdominal type, the cerebral type, the thoracic type, etc.
    Probably, too, such lesions are responsible for the various complications and sequelae which constitute so marked a feature of the attack, as affections of lung,, heart, and nervous system.
    The PROGNOSIS under osteopathic treatment is particularly good, one or a few treatments being usually all necessary in uncomplicated cases.  When the case is taken in time complications do not ensue.  If present they are usually readily overcome by the treatment.  It is a well known fact that the mortality in influenza is due chiefly to its complications, consequently not the least satisfactory result of osteopathic treatment is in overcoming danger of these.  The distressing sequelae, especially affecting lungs, nervous system, and eyes and ears, do not occur.
    The TREATMENT indicated is a thorough general one, as for a bad cold, including particularly the complete relaxation of all the spinal tissues, thus restoring the equilibrium of the vascular and nervous system.  This object accomplished, a long step toward recovery has been taken.
    During this process occasion is taken to strongly stimulate heart and lungs, regulating circulation, sweeping out congestions, inducing perspiration and lessening fever, and sustaining these organs themselves against the effects the disease is likely to produce in them.  This treatment embodies raising the clavicle and ribs, work over the chest anteriorly, stimulation of the vaso-motor and accelerator innervation in the upper dorsal region, etc., all described in considering the diseases of heart and lungs.
    The liver, kidneys, bowels and fascia are likewise kept well stimulated.
    It is well, especially in the rheumatoid type, to carry the relaxing treatment over all parts of the body, flexing and rotating the thighs, working about the shoulders, upper limbs, etc.  This overcomes the distressing general aching and soreness in the muscles.
    Careful abdominal treatment is called for, particularly if the disease shows a tendency to settle in that region.  Work upon the liver, bowels, solar and hypogastric plexus, and splanchnics in the usual way will meet these requirements.
    The general spinal and cervical treatment both aids the general effect and provides against affection of the central nervous system, brain, and organs of special sense.
    The general health must be carefully guarded, the patient, must be kept from exposure, be prevented from going out too soon, and be kept upon a light nutritious diet.  This should be largely fluid in case the patient is confined any length of time to his bed.
    The fever, headache, pains in the eyeballs, and other manifestation of the disease are treated specially in the usual ways.


    Malaria is a disease which, although due to the activities of a specific germ, the hematozoon of Leveran, yet presents marked bony lesions, which account for the manifestations of the germ within the system.
    The LESIONS are mostly in the splanchnic area, disturbing the sympathetic and vaso-motor innervation of liver, spleen and kidneys.  McConnell notes lesion as a marked lateral deviation at the 9th and 11th dorsal vertebrae, and a resulting downward luxation of the 10th rib, also lesion of the 9th to 11th dorsal vertebrae or in the corresponding ribs.
    Dr. Still points out lesion at the first lumbar, at the sacrum, at the splanchnics, and in the cervical region.
    These various bony lesions must produce a marked effect upon the sympathetic system, resulting in vaso-motor disturbance.
    The PROGNOSIS is good.  Dr. Still says that he never needs to give a patient a second treatment.  Usually a few treatments overcome the difficulty, and quick results are often shown.  Yet it often happens that but slow progress is made.  Complications, however, are prohibited by the treatment.  Marked relief is at once given during the paroxysm.
    The TREATMENT is directed particularly to the splanchnic area, and to opening of the abdominal blood supply.  By the splanchnic and abdominal treatment, liver, kidneys, spleen, and bowels are kept in an active state.  This is the chief object of the treatment.
    Treatment is given at any time, during or between the paroxysms.
    The specific treatment employed by Dr. Still in cases of malaria is as follows: With the patient sitting facing him, he passes his arms beneath the axillae and grasps the spine with both hands, one on either side of the spinous process, at the fourth dorsal vertebra.  He now draws the patient's body toward him, though not moving the patient from his position on the chair, thus stretching the spine and bringing pressure upon the 4th vertebra.  He closes this maneuver by twisting or rotating the trunk slightly, first to one side and then to the other, all the time continuing the pressure at the vertebra.      This simple process is repeated at the 12th dorsal for the renal splanchnic.  In this way the splanchnic and renal splanchnics are stimulated.
    He concludes the treatment by momentarily bringing pressure with his thumbs down upon the femoral arteries.  The time of this pressure is merely long enough to allow one heart beat to elapse.    His idea is that this momentary damming back of the femoral currents upon the heart causes it to give a sudden strong beat to overcome the resistance, rousing it to activity and stimulating the system.
    A general spinal, cervical, and simulative treatment to heart and lungs may be given for the chill.  This overcomes the intense vaso-motor constriction of the surface of the body, collateral with an inward congestion, and equalizes the circulation.  The abdominal treatment aids this process.
    This general treatment likewise aids in taking down the fever.  The more specific treatment may be given as indicated, in the cervical region, upon the chief vaso-motors, and vaso-motor center of the medulla, via the superior cervical ganglion.
    No specific treatment is called for to allay the sweating, as this is itself a relief to the patient's condition.  The general method of treatment described may be properly applied during this stage or during the intermission.

     CASES: (1) A case taken in the usual way, and presenting the usual symptoms.  The fever was 103 degrees at 4 p. m., when the osteopath was called.  The next morning the fever was below 102 degrees, rising that evening to 103.5 degrees.  On the succeeding evening it was again 103.5 degrees, but this was the highest point reached.  Thereafter, instead of the temperature remaining about 104 degrees for two weeks, as is typical, the gradual decent began immediately and in two weeks the patient was well.  As early as five days after treatment began most of the symptoms had disappeared.
    (2) This case when first seen, had a pulse of 102, a temperature of 105 degrees, and all the usual symptoms marked, even delirium being present, and the stools and urine passing involuntarily.  He had been ill with the fever for two weeks.  Gradual decent of the temperature began immediately upon treatment.  It became normal seventeen days after treatment began.  The symptoms began to abate with the fever, all but the weakness having disappeared in twelve days.
    (3) A case seen on the day after it had taken to bed, with a temperature of 101 degrees. In two days the symptoms begin to abate.  On the fourth day the fever had risen to 104 degrees, falling, then rising on the seventh day to 104 degrees again.  After this there was a gradual descent, until on the evening of the twenty-fifth day the temperature was normal.  The usual period of high temperature had thus been prevented.
    (4) In a girl of nine, who had suffered from typhoid fever, the lingering effects of the disease, suffered from five years before, were very marked.  The difficulty took the form of acute attacks commencing with pain in the eyes, followed by intense headache and delirium, and a rash upon the skin.  As the rash disappeared, swelling and pain in the joints would follow.  These attacks would recur about every two weeks.  The child was emaciated and suffered from involuntary micturition.  She had been under skilled medical care, and the case had attracted such attention that it was discussed before a convention of physicians in Denver.
    Being treated osteopathically during an attack, she recovered at this time without the usual swelling and rheumatic symptoms After two months treatment the case was discharged cured.
    The only bony lesion was a lateral luxation of the third cervical vertebra, but all of the spinal muscles were intensely contractured.
    These few cases are quite typical of the many treated.
    LESIONS: Dr. Still describes, as the characteristic " typhoid spine," a posterior prominence of the lower lumbar region, caused by a backward displacement of the 3rd, 4th, and 5th lumbar vertebrate.  He holds that the result produced by these lesions is a paralysis of the lymphatic supply of the bowels, by pressure upon the spinal nerves at their exit from the intervertebral foramina.  Thus is produced the essential typhoid condition of the small intestine characteristic of the disease.
    He notes also lesions along the upper dorsal region, at which point he makes treatment upon the lungs, correcting the activities of the lymphatics system, thus, as he says, making water to put out the fire of the fever.
    In general the lesions found in typhoid fever are rib, vertebral and muscular lesions affecting the splanchnic and lumbar regions of the spine, irritating spinal nerves, and through them disturbing the sympathetic, vaso-motor, and lymphatic supply of the small intestines.
    As before pointed out in detail (see diseases of stomach and intestines), these portions of the spine suffering from lesion give origin to the visceral nerves of the intestines.  The vaso-motor supply of the abdominal vessels, according to Quain, is from the splanchnic and lumbar portion of the cord.
These include the vaso-motors of the jejunum and ileum, the seat of ulceration in the disease.
    Pathologically, the process in the first two stages of typhoid, infiltration and necrosis of the patches, is regarded as a vaso-motor disturbance.  The first stage is an intense inflammation, involving to a greater or less degree the whole mucosa.  The second stage is the result of an obstructed circulation to the parts of the intestine involved.  In view of these facts it is evident that successful therapeutic measures must gain vaso-motor control.  It is an indication to the Osteopath that he must do spinal work upon the vaso-motor area supplying the bowels, removing the lesion that is obstructing the natural play of the forces necessary to health.                                     I
    The PROGNOSIS is good, yet one must not forget to be upon his guard, constantly, against the complications and intercurrent maladies that so often carry off the typhoid patient.  Under osteopathic treatment, however, complications and sequelae are quite prevented.  Indeed, much fine osteopathic work has been done upon paralytic and various other forms of the sequelae following an attack of typhoid fever.
    If taken within a week or ten days the course can be usually aborted to a marked degree.  Often cases gotten early have had their course terminated within a few days.  Bad cases, taken under treatment after so late as the fourteenth day, commonly at once show marked improvement.
    The characteristic course of the temperature is entirely changed.  It is usual to notice, no matter in what stage the case may be when it comes under the treatment, that the temperature begins at once to gradually decline.  When the case is taken before the second week, the usual period of high temperature is prevented.
    TREATMENT: The main object of the treatment, as pointed out, is to gain vaso-motor control of the intestinal blood supply, and to restore intestinal lymphatics to normal activity.  Consequently the main treatment in these cases is spinal.  It must be devoted particularly to the correction of the malpositions of the 3rd, 4th and 5th lumbar as described above, and to the removal of any spinal, muscular, rib or vertebral lesion present.
    Most of the treatment in these cases must be done upon the spine, leaving the abdomen almost entirely free from manipulation.
    All the spinal muscles should be relaxed, this, with a careful cervical treatment, quieting the nervous system, and relieving the jerking of the subsultus tendinum.  This treatment is carefully made while the patient is lying upon one side.  The patient must not be moved into various positions any more than can be avoided.  It is important to avoid fatiguing him.
    Lungs and heart should be kept gently stimulated by work in the usual place in the upper dorsal.    This aids in keeping up the patient's strength and in preventing complicating diseases of these organs.  Treatment at the renal splanchnics should be given to keep the kidneys active.
    The main treatment being along the splanchnic and lumbar regions, these portions of the spine are treated by careful relaxation of all contractures, by gently springing the spine for the relaxation of ligaments and for the freedom of the nerves, and in removing the bony lesions mentioned.
    The correction of the lesion to 3rd, 4th and 5th lumbar controls the diarrhea.  It may be treated in the usual way.
    The spleen and liver are reached by spinal work at their innervation.
    The abdominal treatment is almost nil.  Any manipulation made here should be with extreme gentleness.  It is best to confine this treatment to the iliac regions, raising the intestines slightly, with the idea of straightening them in the iliac fossae.  (IV. Chap.  VM.)
    The fever is treated by work at the superior cervical ganglion in the usual way, thus regulating the systemic circulation by affecting the general vaso-motor center in the medulla.  The treatment to the heart and lungs aids this process by equalizing the circulation, as does also the general spinal work and the treatment given along the spine for intestinal circulation specifically.  The heart beat should be slowed by inhibition at the 2nd to 5th dorsal, on the left.
    In case of rapid beating of the heart, persisting sometimes for a long period, Dr. Hildreth finds that correction of the left 5th rib gives relief.
    The hiccough is treated in the usual way.
    In case of hemorrhage the patient should be kept perfectly quiet, have no solid food, and an icebag should be applied over the caecum.  The foot of the bed should be elevated. Inhibition of peristalsis should be done by work from the 9th dorsal down along the lumbar region.
    In case of perforation, hot applications, or the icebag, are applied to the abdomen to relieve the patient.
    The usual precautions should be taken for the hygiene of the sick room, the disinfection of the linen, the sterilizing of the stools and urine, and general cleanliness.
    The patient's body, a part at a time, should be sponged with tepid water daily.  The Brand system of baths is much used at the present day.
    In regard to diet the usual observance of a strictly liquid diet is followed.  Some are using light, easily digested food the first week or ten days, until danger of perforation has arrived.  The claim is made that the patient's strength is in this way much better preserved.  It would be safe for an Osteopath to carry a case through on such a diet providing he got it early enough to prevent the danger of perforation.
    After first taken the patient should not be allowed to get up from his bed.  A bedpan and urinal should be used.
    During convalescence the patient's condition should be carefully watched.  The return to a hearty diet should be gradual in spite of his great appetite.  After a liquid diet, the semisolid food should not be allowed until the temperature has been normal a week.

ERYSIPELAS (St.  Anthony's Fire, "The Rose")

    Erysipelas is a disease frequently treated and cured osteopathically.  The PROGNOSIS is good.
    The LESIONS are various forms of obstruction to the circulation of the part affected.  The lesion may be bony, or a contracture of muscles or other tissues.  It may directly press upon veins and lymphatic vessels, preventing the proper drainage of the part, or it may derange the vaso-motor innervation and the sympathetic innervation of the lymphatics.  For example, a case of erysipelas in a lower limb was cured by turning the head of the femur well in the socket, and in raising the abdominal viscera up from the region of the crural arch, where they  were pressing upon the blood vessels and preventing drainage from the limb through femoral vein and lymphatics.  By thus relaxing the tissues and  removing direct impingement from the vessels, the blood flow was restored and the case was cured.
    Another case in which the eruption appeared upon the face, was cured by springing the temporo-maxillary articulation with the assistance of corks placed between the molar teeth, as one would set a dislocated jaw.  In this way various tissues about the jaw may have been relaxed, or impingement of the fibers of the fifth nerve removed, restoring circulation.
    The most usual lesions in erysipelas are found preventing the circulation from the head, as the face is the part most frequently attacked.  Lesions of cervical vertebra and muscles affect the vaso-motors and sympathetics regulating the blood and lymphatic circulation of the face, and lead to inflammation by obstructing these fluids, the specific germ being present and attacking the part thus rendered liable to its action.  Clavicle and first rib lesions may directly obstruct the jugular veins and the cervical lymphatics, leading to the same result.
    McConnell notes lesion of the 2nd, 3rd, 4th and 5th dorsal vertebrae, and of corresponding ribs and surrounding muscles, causing erysipelas in the face, by disturbing sympathetic innervation.
The TREATMENT is simple, calling for removal of lesion, and re-establishment of venous and lymphatic drainage of the affected part.  This involves relaxation of muscles and other tissues, restoration of bony parts to position, freeing of nerve connections, etc., as already pointed out, according to the part affected.
    It is not necessary to manipulate the inflamed part.
    As erysipelas is a dermatitis, the need of gaining vaso-motor control is apparent.  The special treatment of the neck to affect free circulation to and from the head and face has been sufficiently discussed in the treatment of diphtheria and of the eruptive fevers.
    A general spinal treatment must be given to strengthen the general nervous system against the various nervous complications and sequelae that may arise, such as delirium, coma, subsultus tendinum, etc.  Bowels must be kept free, and liver and kidneys kept active to get rid of the poison of the disease which is deranging the constitutional condition.  The kidneys must be especially supported against albuminuria and uremia.
    Among the hygienic measures and domestic remedies recommended are isolation of the patient, drinking plenty of cold water, cold spongings of the part, or applications of iced cloths and the application of collodion over the eruption.  Carbolized vaseline may be used to anoint the affected part.
    The diet is important.  The patient should be liberally fed on a light, nutritious diet.  Anders states that liberal feeding of the patient is of greater service to the patient than any of the recognized forms of medical treatment, and the lack of attention to the diet during the primary attacks tends to increase the frequency of relapse.


    Very numerous cases have been successfully treated
    The PROGNOSIS is good.  The danger of complications and sequelae is minimized, as these cases recover quickly and thoroughly under the treatment.
    While it is held that measles, once started, must run its course, yet the period of convalescence is shortened and the child is about earlier without danger of complications.
    LESIONS: Dr. Still describes in this disease a general congestion of the lymphatic drainage of the skin becoming evident as a cutaneous rash.  This general congestion is due to spinal muscular contractures all along the spine, irritating the spinal distribution of nerves, and through them deranging sympathetic vaso-motor and lymphatic nerve supply.
    This general congestion of the spinal muscles appears as lesion in muscles.  The clavicle may be found with its sternal end displaced backward against the vagus nerve, causing the cough, and aiding to cause the catarrhal condition of the bronchi.  Upper rib lesions may be found, their correction relieving the cough.  Weakened children, especially those presenting upper spinal and thoracic rib lesions, are apt to become victims of pulmonary tuberculosis after measles.  The clavicle and first rib lesion, as well as various cervical bony lesions and muscular contractures, probably account for complications and sequelae in eye, ear, nose and throat.  These effects come largely through obstructed lymphatic drainage from the neck, a fact well illustrated by the marked enlargement of the cervical lymph glands as a complication or sequel of the disease.
    In the TREATMENT the first step, especially if the rash has not developed, is a thorough stimulation of the cutaneous system, including a general spinal treatment with particular attention to atlas and axis, for effect upon the vaso-motor center in the medulla; upon the second dorsal and fifth lumber cutaneous centers.  In tardy cases one such treatment suffices to bring out the rash abundantly, a desirable result, since upon its appearance the headache and fever disappear, and the patient feels better.
    This treatment would include a general relaxation of the spinal muscles, correcting the lymphatic obstruction.
    An important effect of the general spinal and cervical treatment, together with some special treatment to heart and lungs, is to correct the general circulation, calling away from all the viscera the abnormal amount of blood retained in them as a congestion, in this disease.  For this purpose there should be added treatment of the splanchnics, solar plexus, liver, kidneys, and abdominal circulation generally.
    The usual treatment of the throat, internal and external; of the neck; of clavicle and first rib; of the upper anterior chest, raising the ribs, and working in the anterior intercostal spaces against the costal cartilages; and of the face and nose, should be given to overcome the catarrhal condition of the respiratory tract, just as a cold and a bronchitis are treated.
    The lungs should be kept well supported by the treatment, to avoid the danger of bronchitis and pneumonia.  Likewise kidneys, eye, ear, nose, and throat should be guarded against effects in them.
The cough is relieved by relaxing the throat tissues, treatment along the larynx and trachea, correction of first rib and clavicle, and raising of the upper ribs.
    The patient should remain in bed until desquamation is well along, should be in a darkened room for the sake of the eyes, and should be kept upon a light diet of milk, bread, light soups, etc.
    The general spinal treatment, and treatment of the cutaneous system and centers will aid in allaying the itching of the skin.  For this purpose, also a daily warm bath may be given.



    To these conditions we may apply the game general remarks concerning lesions and treatment, osteopathically, as made in considering measles.
    The very mild symptoms accompanying these conditions call for but little treatment aside from the general constitutional one, pointed out in detail in measles.  These points of treatment may be applied as necessary.
    Due attention must be given to avoid exposure, the dangers of complications, etc.  In rubella the enlargement of the cervical lymphatics calls for attention in the manner pointed out.  The slight fever and catarrhal symptoms are readily overcome.  In both conditions due attention must be given to the cervical and general spinal treatment, and to the maintenance of the activities of the various viscera.    Usually the spinal muscles are contractured, and must be relaxed.  These contractures doubtless affect the general lymphatic system by way of the spinal nerves.  For example, in varicella the superficial lymph glands are sometimes visibly enlarged.
    In varicella the usual precaution of preventing the child's scratching off the scabs by putting mittens or bandages upon the hand and wrists, and of painting the seat over with collodion may be observed.


    Numerous cases have been successfully treated osteopathically.  The PROGNOSIS is good but must be guarded in cases complicated with diphtheria.  The experience is to bring these cases safely through the attack, free from complications and sequels.
    The LESIONS are, in general, the same as described for the various acute, specific fevers.      Contractured spinal and cervical muscles are noted.  One must expect various bony lesions, accounting for the weakness of the special parts attacked by complications or sequelae, as for the kidneys, throat, and general nervous system by the usual bony lesions found present in diseases of these parts.
    The TREATMENT proceeds along the lines already laid down.  In this case there is especial need of thorough constitutional treatment on account of the multiplicity of symptoms and the variety of organs sometimes affected.
    The general spinal treatment is given, relaxing muscles, stimulating the splanchnics, etc.  Particular attention must be given to lesions affecting the kidneys, and to the thorough treatment of the innervation of them, throughout the course of the disease, for the purpose of avoiding the post-scarlatinal nephritis, so common a complication.
    For a like reason one must give especial attention to the treatment of the throat to avoid diphtheria.
    The cervical treatment must be carefully carried out.  The marked enlargement of the lymphatic glands that sometimes occurs may be avoided or controlled by the usual treatment.  Relaxation of all the anterior and posterior muscles, etc., must be done.  This treatment frees the lymphatic and blood circulation through the neck, and keeps eye, ear, and throat in good condition.
    The heart must be kept well supported.  The fever is treated in the usual way.  When the patient's system is kept well supplied with moisture by allowing him a plentiful supply of cold water, daily treatment of the submaxillary salivary glands will aid in keeping the mouth and lips moist.  The irritation of the skin may be relieved by the treatment indicated f or that purpose in measles.  Daily tepid sponging and warm bathing, as well as anointing of the skin with an animal fit or cocoa butter, are useful for this purpose.
    The patient should be isolated, the scales shed in desquamation should be carefully collected and burned, and the room should be disinfected, after convalescence.  The diet should be light.  Plenty of milk and alkaline water may be used.

VARIOLA (SmallPox)

    It is at present impossible to say anything specific with regard to treatment of smallpox by osteopathic methods.  It is doubtful whether the disease, in any marked form, has ever been treated osteopathically.  Numerous light cases have been treated.  It would have to be met upon the same general plan as other fevers, with particular attention to the special clinical manifestations of the disease.  An Osteopath should follow the same precautions with regard to isolation, disinfection, and antisepsis as are followed by any other physician.  The usual osteopathic procedure would be followed in the treatment of muscular pains, vomiting, diarrhea, convulsions, etc.  The ordinary method of preventing pitting by keeping the face washed with a carbolic or mercuric-chlorid solution and covered with clean cloths saturated with warm water, and of protecting the eyes by keeping them covered by cloths wet in a boric acid solution, and by darkening the room, could probably not be improved upon by the Osteopath.  He should see that the patient is well bathed, that the diet is carefully regulated, and should meet the various  manifestations of the condition by the usual osteopathic methods.

CEREBROSPINAL FEVER (Epidemic Cerebrospinal Meningitis, Spotted Fever)
    This condition has been successfully treated osteopathically.  It should be treated upon the plan followed in the other forms of meningitis, and also in the treatment of various fevers, as described.  It is necessary to be especially persistent in the local treatment to the spine and cervical regions, on account of the marked effects of the disease upon the cord.  Continual treatment in these regions is a most valuable aid in keeping the circulation equalized and in lessening the inflammatory processes going on about the cord.  It should be mostly of a relaxing, inhibitive sort, with much direct inhibition in the superior cervical region and along the splanchnic and lumbar regions.  The spinal column should be carefully sprung, held, and relaxed.  The painful and contractured muscles along the neck and back (opisthotonos) must be continually and gently relaxed.  This spinal treatment is aided by the abdominal treatment, as before described, given for the purpose of drawing the blood to this region, away from the cord.  This whole process of treatment lessens the inflammatory process in the menages, aids in absorpting the effused serum, and the fibrino-purulent exudate, and aborts the progress of the disease.  It practically prevents the usual sequelae and complications met in this disease.
    In the course of the treatment due attention should be given to the adjustment of various spinal vertebral lesions usually present.  The heads of the ribs and the deep tissues should be carefully examined for lesion.  This part of the treatment is quite an important factor in gaining complete freedom of circulation, and complete removal of irritation.
    The remainder of the treatment is largely for the relief of the various manifestations of the condition.  One should follow the directions before given for treatment of the fever, vomiting, constipation or diarrhea, occipital headache, etc.  For the sudden violent pains one should use inhibition to various points along the spine and at the local plexuses and nerve.  Such treatment, well applied, together with the spinal treatment, would reach the convulsions if they occur.
    It is well to give particular stimulating treatment to the kidney, not only because the urine is scant and shows the usual febrile characters, but also because of the toxemia due to the disease, and because of the tendency of nephritis to appear as a complication.
    Eyes, lungs, heart, and organs of special sense must be kept well treated to avoid danger of complications or sequels affecting them.
    The PROGNOSIS must be guarded, but under osteopathic treatment the best of results may be expected.

DYSENTERY (Bloody Flux)

    DEFINITION: An infectious disease, characterized by an inflammation of the large intestine, frequent mucous and bloody stools, tormina, tenesmus, prostration and other marked symptoms.  It is due to specific spinal lesion.
    CASES: (1) Chronic dysentery of five years standing, in a man of thirty-three.  Lesions were a posterior condition from the 11th dorsal to 3rd lumbar.  The case was cured in one month of treatment.
    (2) A case of acute dysentery of two days standing.  All the symptoms were marked.  The case was much relieved by the first treatment, the bowels did not move until twenty-four hours after it.
    (3) A severe case of acute dysentery in a child.  It was treated two days and the stools became normal.
    (4) A case of chronic dysentery of a severe nature, in a patient suffering with paraplegia.  Lesions were an anterior condition of the 5th lumbar vertebra, a lateral swerve of the lower dorsal and lumbar region of the spine, and luxation of the innominate bones.  The condition was cured in four months.
    The PROGNOSIS is good.  Treatment is usually at once successful in relieving the condition.  Many cases are cured in one or a few treatments, even though they are chronic.  The worst forms of dysentery have been successfully treated after all other treatment had failed.  Generally a course of treatment is advisable in order to fully remove lesion and to restore the tissues of the bowel to their normal condition by a corrected circulation.
    The LESIONS and the TREATMENT are identical with those described for diarrhea.


    Patients suffering from the presence of the various animal parasites frequently come under treatment.  The common round worm (Ascaris Lumbricoides); the pin-, thread-, or seat-worm (Oxyuris Vermicularis); the hematozoon of malaria (Hematozoon of Leveran); and the several forms of tapeworm (Taenia Solium, T. Latum, T. Saginata) are successfully treated osteopathically.
    No particular lesion, of course, can be mentioned in this connection.  Yet commonly in these cases the various rib, vertebral, and other lesions affecting the bowels are present.  Their removal is related to the cure of the condition as a part of the treatment directed to securing good general health, and free action of liver and of bowels, all of which are quite important in the treatment of the case.
    CASES: (1) Pinworm in a child of three years, of several months standing.  No lesion was noted except a downward position of the lower ribs.  Treatment was directed to raising the lower ribs, to stimulating the innervation of intestines and liver, and to direct manipulation of these organs.  No local application at the anus, nor enema was required in this case.  The child was cured by 10 treatments, passing forty-five worms.
    (2) A case of pinworms in a child suffering with poor general health.  The case was cured in two months.
    (3) A case of tapeworm in a woman suffering from bad general health.  The liver was in bad condition.  The treatment corrected spinal lesions and restored liver function and general health.  A tapeworm was expelled.  The case was well one year later.
    (4) A case of tapeworm which had not been helped by the usual medical treatment.  The liver was inactive, and lesion was found as a lateral swerve of the spine from the 4th to the 8th dorsal vertebra.  The treatment was particularly to the liver and the spine.  The worm was passed.
    TREATMENT in these cases is directed to the removal of spinal or other lesions; the restoration of a healthy condition of the bowel and general digestive apparatus; the stimulation of hepatic activity particularly, for the purpose of increasing the flow of bile, help to be effective in expelling the worm; and the upbuilding of the general health.  This treatment applies to the general case.  The treatment for malaria has been described elsewhere.  Its success demonstrates the ability of the osteopathic treatment to clear the blood of the protozoan parasite present in it.
    In cases of pin-worms it is necessary to keep the parts thoroughly clean.  The ova are killed by anointing the anus with lard.  Injections of lard into the rectum will kill the worms.  Enemata of cold water, plain, or with a little salt or soap added, may be used to free the rectum.  The child’s finger-nails should be kept trimmed and well cleaned to avoid transfer of the ova by accumulating under them.
    The rest of the treatment is as directed above.
    In case of round or tape-worms, it is well to enforce a liquid, such as milk, diet for a day or two in order to weaken the worms and to leave them more accessible to the action of the bile.  For tape-worm, the patient should then drink quantities of pumpkin-seed infusion, or eat a gruel made of mashed pumpkin-seed, continuing several days if necessary, until the worm is passed.
    The prophylaxis includes the thorough cooking of the meat, especially of beef and pork, from which tape-worms are usually gotten.  The trichina is found in pork, usually.  The dejecta containing ova or segments of the worms should be burned.  In all cases avoidance of impure drinking water is necessary.
    In cases of trichinosis, if infection is suspected prompt and thorough treatment should be made as described, in order to get rid of the embryo young before they leave the intestine and invade the muscles.  Later a course of treatment for general health, and general muscular treatment should be given.  This will reach the muscular pains, insomnia, and weakness.