The Practice and Applied
Therapeutics of Osteopathy
Charles Hazzard, D. O.
1905
CHAPTER XX
INFECTIOUS DISEASES
DIPHTHERIA
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.
WHOOPlNG COUGH (PERTUSSIS)
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.
INFLUENZA
(LAGRIPPE - EPIDEMIC CATARRHAL FEVER)
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
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.
TYPHOID FEVER
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.
MEASLES (MORBILLI, RUBEOLA)
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.
RUBELLA (FRENCH OR
GERMAN MEASLES)
VARICELLA (CHICKENPOX)
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.
SCARLET FEVER (SCARLATINA)
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.
PARASITES
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.
