The Practice and Applied Therapeutics of Osteopathy Charles Hazzard, D. O. 1905      CHAPTER XXIV   DISEASES OF WOMEN  
 
    CASES: (1) Dysmenorrhea and irregularity of menstruation, with a complication of troubles in a young lady of twenty-five.  The lower dorsal and lumbar vertebra were anterior.  The case was cured in ten weeks, having gained 22 pounds.
    (2) Dysmenorrhea in a married woman of 38.  At each period she was confined to her bed, there being menorrhagia, headache, nausea, etc.  The condition was of 12 years standing, since childbirth.  The uterus was prolapsed and retroverted.  The right innominate was posterior.  The bone was replaced, the uterus put into correct position, and the case was discharged cured in two months.
    (3) Dysmenorrhea of 3 years standing in a young lady of twenty-one.  Lesions were: 5th lumbar to the right, and surrounding tissues much contracted; 9th, 10th and 11th dorsal vertebrae luxated and that portion of the spine rigid.  Patient's general health was much affected.  The case was cured by removal of lesion in two months.
    (4) Amenorrhea, with a complication of troubles in a woman of twenty-two, of 13 months standing.  'The greatest gynecologist in Cincinnati said the uterus was atrophied ,and she would never menstruate again.  Lesions were: 7th dorsal spine to right and whole spine rather irregular; pelvis twisted with apparent lengthening of right limb.  The case was benefited from the beginning of treatment and was cured in four months.  Menses appeared in six weeks.
    (5) Amenorrhea of 7 months standing in a case in which the period had been very irregular, often not occurring for three or four months.  The general health was much affected.  After two weeks treatment she was much better, and the menses appeared.  Under the treatment the patient gained rapidly in weight, the normal period being re-established.
    (6) Amenorrhea in a young woman, of over 8 months standing.  Lesions were: 2nd lumbar posterior; 1st, 2nd and  3rd dorsal lateral; 5th lumbar anterior.  Treatment corrected the
lesions and cured the case in three months, the patient having gained 12 pounds.
    (7) Amenorrhea of more than a years standing in a young woman.  Lesions: 4th and 5th lumbar anterior; luxation of 8th and 9th dorsal, and stricture of the os.  Lesions were corrected and the os was relaxed by spinal work.  Menstruation came on normally.
    (8) Menorrhagia and dysmenorrhea.  The menstrual flow started upon the least exercise.  The curves of the spine were straightened, and there were many slight irregularities in it.  The coccyx was lateral to the right and anterior.  The case was first treated during period, and the flow ceased at once, not returning for four months, after which it was normal.
    (9) Uterine hemorrhage suddenly appearing with abdominal pains.  The latter were intense and the hemorrhage profuse.  One treatment entirely relieved the trouble.
    (10) Uterine hemorrhage, frequent and profuse, in a married woman who had previously undergone operation for the removal of uterine fibroid tumors.  The uterus was retroverted, the left innominate anterior, and the 2nd and 3rd lumbar vertebra luxated.  The hemorrhages ceased after the second treatment.
    (11) Metrorrhagia of 2 years standing.  The right innominate was slipped upward, and its correction entirely cured the trouble.
    (12) Prolapsus of the uterus in a lady of forty, who had suffered with spinal trouble and dysmenorrhea for 26 years.  The patient had been taking local treatment for uterine displacement and other trouble twice a week for two years.  After three months of osteopathic treatment, in which time about five local treatments were given, the prolapsus, leucorrhea, etc., were cured.  Practically all the treatment was upon spinal lesion, the spine having been found swerved one and one half inches laterally.  It was corrected.
    (13) Prolapsus of the uterus, with retroversion, in a woman of forty of several years standing.  Lesion was a slight displacement of an innominate.  The case was cured by local and spinal treatment.  The lesion was corrected.
    (14) Leucorrhea in a married woman of thirty.  Lesion: slight deviation of lower dorsal and lumbar vertebrae to the left.  Upon correction of spinal lesion, in less than one month, the case was cured.
    (15) Leucorrhea, congestion of the ovaries, and painful menstruation, of three years standing.  The left innominate bone was luxated, and lesion also occurred at the 10th and 11th dorsal vertebra.  The case was cured in four months.
    (16) Vaginal cyst in a woman of forty, following subinvolution and prolapsus of the uterus after childbirth three years previously.  The cyst was about the size of a hickory nut, and had formed about four months previously to the time of examination.  Spinal lesion present was a separation between the 5th lumbar and sacrum.  Treatment consisted mainly in correction of spinal lesion.      Local treatment was given to restore tonicity to the very lax vaginal walls, and to improve venous and lymphatic drainage.  The cyst entirely disappeared by six weeks treatment.
    (17) Vaginal irritation due to lesion as a tilted ilium, which was removed and the case was cured.
    (18) Chronic hemorrhagic endometritis in a. woman of fifty-seven, who had not walked for three years, and how, for eighteen months had been unable to sit up, as the slightest exertion caused hemorrhage.  The condition was of thirty years standing.  Lesions: 3rd and 4th cervical vertebrae anterior, from ninth dorsal to sacrum decidedly posterior.  Improvement was marked after one months treatment, patient being able to walk about the house.  The case was cured in three months.  The patient was still well two years later.
    (19) Salpingitis in a married woman, multipara, who had previously suffered acute suppression of menses.  The condition became very acute, and operation was advised.  The patient was in great agony.  At this point an Osteopath was called.  With spinal and local abdominal treatment relieved the pain in half an hour, and the patient slept for six hours, the first natural sleep in a number of days.  She was awakened by fresh pain, caused by the natural discharge of about 1 pint of pus.  Two or three light treatments were given before evening of the next day, and the soreness entirely disappeared.  The patient was able to be about that day.  No return of trouble occurred.
    (20) Inflammation of the ovaries in a woman of twenty-six, of several years standing.  For four years ordinary treatment had been tried.  Operation was advised.  Lesions: muscular contractures in the middle dorsal and lower lumbar regions, the whole spine being weak.  The case was cured in two months.
    (21) Acute inflammation of the ovary in a woman of thirty-five.  Lesions: 5th lumbar posterior, sacral muscles contracted and sensitive, muscular contractions in the region of the affected ovary.  The case was treated twice daily for three days and was cured.
    (22) Ovarian colic in a case in which there had been acute attacks previously.  A cold had contractured the muscles on the left side of the lower lumbar spine.  The right innominate was displaced downward and forward.  The patient was in great pain.  Relief was immediate, and the case was cured in one treatment.
    (23) Climacteric, with dropsy and asthma, in a patient of fifty-two.  For one year the patient had suffered with all the trying symptoms of the menopause.  Lesions were found at the spinal connections of the cardiac, hepatic, renal, ovarian, uterine, and hypogastric plexuses.  Improvement was immediate.  No asthma appeared after the second treatment, the patient grew strong and was entirely cured in three months.
    (24) Phlegmasia Alba Dolens (Milkleg) in a woman of twenty-three, of three weeks standing.  There was innominate lesion, marked tenderness in the sacroiliac region, and lesions at the 6th and 7th dorsal.  The treatment was largely confined to the lesions, and the milkleg symptoms disappeared in three treatments.  The case was cured.
    When the case was taken under treatment the fever was 103, the leg was much swollen and very painful, confinement had occurred three weeks before.
 
 
LESIONS AND ANATOMICAL RELATIONS

    The lesions in cases of women's diseases are practically all found below the eighth dorsal.  Considering the multiplicity of diseases it is interesting to note that they are almost without
exception traced to actual spinal lesion at the centers controlling the pelvic viscera, or upon the closely related nerves.  Lesion is as near specific in this class of cases as in any.
    Generally speaking, lesion may be expected anywhere along the lower three or four dorsal vertebrae and corresponding ribs, among the lumbar vertebrae, at the lumbo-sacral articulation, at the innominates, sacrum and coccyx.  It is very common to find lesion at the 9th, 10th, or 11th dorsal, affecting the center of blood supply to the ovaries; at the 2nd lumbar, affecting the blood supply to the uterus; and at the 4th and 5th lumbar, at which point lesion is particularly apt to occur affecting the hypogastric plexus, and through it the pelvic viscera.  Cases have been observed in which a displaced lower rib irritated an ovary and caused disease in it.  The 5th lumbar lesion is perhaps the most frequent one, it being at the same time a weak point anatomically, therefore particularly liable to lesion, and in important relation to the hypogastric plexus.
    Innominate lesion is perhaps the next most frequent.  Its relation to the sacral nerves, which are so closely connected with the pelvic viscera, accounts for its importance.
    Such lesions as have been pointed out as the causes of enteroptosis and prolapse of the diaphragm become important causes of prolapsus of pelvic viscera by pressure from above, and by weakening the supports of these organs, also of congestive disturbances such as must follow in such a state of affairs.
    In female diseases one should look for lesion especially at the 5th lumbar, at the innominates, at the 2nd lumbar, and about the 9th, 10th, and 11th dorsal.  There is sometimes irritation of the internal pudic nerve where, it emerges from the pelvis to cross the spine of the ischium.  The ovarian vessels are frequently obstructed by enteroptosis, especially by ptosis of the transverse colon.
    In menstrual disorders lesions occur from the 10th dorsal to the 4th or 5th sacral, and among the lower ribs.  Painful menstruation is often found to be due to lesion at the 5th lumbar and at the innominates.
    The lesions as described are seen to be at points where they interfere with the nerve connections and circulation of the pelvic viscera.  There are two groups of vaso-motor nerves for the genitalia, one in the lumbar region and the other in the sacral, as pointed out in the American Textbook of Physiology.  For the external genital organs vaso-motor fibres rise from the 2nd, 3rd, 4th, and 5th lumbar nerves, run forward in the white rami communicantes, and pass through the pelvic plexus and pubic nerve to reach the organs they supply.  From the anterior roots of the sacral nerves rise vaso-motors which, when stimulated, dilate the vessels of the external genitals. Vaso-constrictors for the fallopian tubes, uterus, and vagina in the female, and for the vasa deferentia and vesicular seminales in the male are found in the sacral nerves.  The 2nd, 3rd, 4th, and 5th lumbar nerves send vaso-motor fibres to the internal, as well as to the external genitals.
    According to Quain's anatomy, it is probable that sensory nerves pass through the sympathetic, those supplying the ovary from the 10th dorsal; those supply the uterus (a) in contraction, from the 11th and 12th dorsal and 1st lumbar, (b) os uteri, 1st, 2nd, 3rd, 4th sacral, (5th lumbar rarely.)  It is seen that these points have been found as the seat of lesion in pelvic disorders.  This sensory innervation is made practical use of in pelvic disorders.  Often by preliminary inhibition along this spinal region pain is quieted.
    Quain's anatomy also notes motor fibres for the uterus passing into the sympathetic from the lower dorsal and upper one or two lumbar nerves, and reaching the uterus via the aortic plexus, the inferior mesenteric ganglion, hypogastric and pelvic plexuses.  Also motor fibres to the uterus descending from the lumbar region and terminating in the sacral ganglia.  It is at once seen that lower dorsal and upper lumbar lesion is important, as it affects this distribution via the inferior mesenteric ganglion.  The other lumber lesions are also seen to be important.
    According to Foster's physiology, stimulation of' the inferior mesenteric ganglion causes circular contractions of the uterus, with descent of the cervix and dilatation of the os.  Stimulation of the sacral nerves contracts the longitudinal fibres, shortens the cervix, and closes the os.
    These various motor effects are used by the Osteopath in both gynecology and obstetrics, for example, he stimulates the sacral nerves to contract the uterus and lessen hemorrhage, or he stimulates the upper lumbar to gain dilatation of the os.  By treatment to the lumbar and sacral regions be regulates the blood supply through the vaso-motor innervation described above.
Inhibition of the clitoris is held to relax the circular fibres of the cervix and dilate the os.  Inhibition at the 4th sacral nerve is used to relax the vagina.
    The TREATMENT of female disorders is eminently successful.  It will be seen from the above description of lesions and of anatomical relations that osteopathy can gain control of the motor, vaso-motor, and nervous mechanisms of the liver.  A knowledge of these, and proper treatment of them in a given case are all that is necessary.  A study of the facts above in regard to nerve supply, lesion, and case reports, will enable one to work out proper treatment for a given condition.
    In any case the removal of lesion as soon as possible is of the utmost importance.  Frequently this is the only treatment necessary.  Quite generally, the removal of lesion together with a little spinal and abdominal treatment are found to be sufficient for complicated cases.
    In any painful case one must first make thorough spinal inhibition from the ninth dorsal to and including the sacral nerves.  In this way all the sensory nerves noted above are reached.  Often this preliminary treatment is used to great advantage in allaying the local pain to such an extent as to allow of local or abdominal treatment which before could not be endured.
    The osteopathic method of examination and treatment of the uterus and vagina locally has been described in Part I.
    In cases of suppression of menses the treatment must look to the removal of the lesion obstructing the circulation.  This must be expected particularly along the region described above as the location of the vaso-motors for ovaries, uterus, etc., i. e., along the 5th to 12th dorsal, all the lumbar, and all the sacral region.  Examination must also be made for pressure of an abdominal organ, such as the transverse colon, upon the ovarian artery.  In any case it is well to work carefully down along the course of this vessel, beginning a little above the level of the umbilicus and proceeding downward to the pelvis.  Usually in these cases it is sufficient to give a thorough, strong, stimulating spinal treatment, from the 9th dorsal down to the sacrum.  It is not advisable to include the sacral nerves in this treatment, as their stimulation contracts the uterus and closes the os.  It is better to relax the tissues over them and to inhibit them.
    During the spinal stimulation all spinal parts and tissues should be carefully relaxed and sprung.  This treatment includes stimulation of the 11th and 12th dorsal and 1st and 2nd lumbar, by way of which effect is gotten upon the connections of the inferior mesenteric ganglion, stimulation of which aids in dilating the os.  One may also treat this ganglion directly by deep abdominal treatment over its site, it lying upon the inferior mesenteric artery a little below and externally from the umbilicus.      Further treatment may be made down over the course of the common and internal iliac vessels, stimulating their flow.  The clitoris should be inhibited, and the uterus should be replaced if prolapsed.  Inhibition may be made upon the pudic nerve where it crosses the spine of the ischium.    Sometimes dilatation of the cervix and os uteri aid the case.  The same treatment applies to scant menses.
    In many of these cases the general health suffered severely.  Particularly is one apt to find the lungs involved in cases of any length of standing.  Careful attention must be given the lungs and the general health.
    Irregular menstruation is generally corrected by such a course of treatment.
    In DYSMENORRHEA the first step is to apply the strong spinal inhibition along the area of sensory innervation described above.  Careful and moderately strong inhibition applied at successive points from the middle dorsal down, given in such a way that the spine is sprung and held at each point for two or three minutes, has the effect of relaxing the spinal tissues, relieving the irritation and gently starting the flow.  Commonly a little trying will indicate a certain point in the spine at which inhibition gives immediate relief.  This point is different in the different cases.
    Dysmenorrhea is generally relieved by a treatment which gently starts the menstrual flow.  Quite commonly these cases are due to retarded circulation.  Hence one must do gentle abdominal manipulation over the vessels and tissues concerned.  It is also often advisable to give a light spinal stimulation, as above, with this purpose in view.
    A common cause of dysmenorrhea is sudden stoppage of the flow by malposition of the uterus, leading to congestive obstruction of the circulation.  In such cases it is necessary to carefully replace the uterus.  Local treatment must, however, be avoided at time of menstruation except in cases of the most urgent necessity.  Often the treatment given, as described, gives instant relief.
    It is sometimes necessary to give a general spinal treatment to quiet the nervous system, as nervous disturbances may cause dysmenorrhea.  In cases due to cold a thorough general treatment, including stimulation of heart and lungs, may be added to the treatment outlined above.  In these cases a hot tub bath or hot vaginal douches may be the only aid required.
    In menorrhea, metrorrhagia and uterine hemorrhages often there is a specific lesion of the innominate present.  The innominates should be adjusted, at the symphasis pubes as well as at the articulation with the sacrum.  A special treatment recommended in these cases is to place the knee against the sacrum and pull backward upon both innominates.  Obviously one must have in view the removal of the cause, whatever it is, and the stanching of the hemorrhages by the contraction of the blood vessels.
    Often a quick, rather hard jerk, at the hairy covering of the mons veneris is sufficient to contract the vessels and stanch the flow.  Quick and rather forcible stimulation of the round ligaments where they cross the pubic arch, about an inch each side of the symphysis, will help.  Stimulation of the clitoris and strong stimulation of the sacral nerves contract the uterus, cervix, and os, and are important means of stopping the flow.  One should avoid stimulation of the lower dorsal and lumbar regions of the spine.  In some cases compression of the common and internal iliac arteries is helpful.  Deep pressure is to be made upon them and continued for considerable time.  In some cases good results have been gotten in this way.
    Injections of very hot or of cold water are often useful.
    The patient should be on her back with the hips elevated.  This quiets the heart and aids the venous drainage.
    Vicarious Menstruation yields to the treatment directed to the normal menstrual function.  It should at the time be treated as any hemorrhage, according to the place at which it appears.
    Prolapsus Uteri and the various displacements are considered in Part I.  In case of adhesions with prolapsus, it is the aim to gradually stretch and break them down by carefully stretching the organ away from them.  This may be generally accomplished.  It is done by local treatment.  It is probable that this process is in part an absorption of the adhesive tissues by the renewed circulation, as in case of fibroid tumors, etc.
    To strengthen the ligaments to hold the organ in place, treatment must look to the removal of lesion, the spinal and abdominal stimulation of the blood supply, and the strengthening of the perineum.  Stimulation of the pudic nerve at the spine of ischium aids the latter object.  In young girls stimulation of the round ligaments, and external abdominal treatment to the iliac blood supply, etc., is usually quite sufficient for a cure.
    In cases of Leucorrhea the object is to correct circulation and prevent the abnormal secretions.  The condition is usually due to obstruction of the vaginal circulation, and quite often occurs along the lower lumbar or sacral region.  Its removal usually soon results in cure.  Often the local circulation is impeded by a prolapsed uterus, resulting in leucorrhea.  In such cases cure, of the prolapsus is necessary.  Lumbar and sacral stimulation, and abdominal treatment about the deep pelvic vessels aid in correcting the circulation.  Cleanliness is essential.  Hot vaginal douches are useful.
    In Congestive Disturbances of the Ovary and Ovaritis, correction of the circulation is the main object.  The abdomen is apt to be quite painful in the region of the ovaries, and it is necessary first, often, to make spinal inhibition along the course of the sensory nerves.  After this careful abdominal treatment may be given, relaxing all the local abdominal tissues and thus freeing the local circulation.   The work should be carried up along the course of the ovarian vein, which accompanies the ovarian artery above described.  A certain amount of spinal stimulation is useful in the correction of circulation.
    The treatment for the fallopian tubes is local and spinal of the kind described.
    In all cases of pelvic disorders it is well to see that the lower ribs are well raised, and that no obstructions to circulation from the lower abdomen occurs at the diaphragm.  The treatments
given to raise the abdominal and pelvic viscera also helpful. (Chap.  VIII).
    For the treatment of ovarian and Uterine tumors see "Tumors."
    For the Climacteric treatment is largely symptomatic, to relieve the headache, hot flashes, nervous disturbances, etc.  A constitutional treatment is given, with special attention devoted to the spinal system, to strengthen the nervous system and to quiet nervousness.  Local treatment to the uterus is not necessary unless local trouble exists.  Care should be taken not to bring on the menstrual flow by hard treatment in the lumbar and sacral regions.
    In Phlegmasia Alba Dolens (Milkleg) the treatment consists in the removal of lesion and the correction of circulation to the limb.  The adjustment of innominate lesions or of a luxation of the hip joint, and the relaxation of the pelvic muscles may be all the treatment necessary.  These causes act as obstructions to the nerve and blood supply and cause the trouble.  The thigh should be flexed and rotated, and treatment may be given as for varicose veins, q. v., to aid in the venous return from the limb.