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