The Practice and Applied
Therapeutics of Osteopathy
Charles Hazzard, D. O.
OSTEOPATHIC POINTS CONCERNING THE HEAD AND ITS PARTS
As stated, the chief lesions affecting the head
and its parts occur in the neck, and have already been described.
More detailed points in examination and treatment of these important structures
will be considered in lectures upon their specific diseases in the second
part of this work. The present chapter will embrace only general
INSPECTION AND PALPATION are the methods of examination.
By the former one notes the size and shape of the skull, the complexion,
expression, eyes, etc. By palpation he notes the presence of tumors
or other growths, open fontanelles, etc.
A. THE EYE
Those lesions most frequently affecting these organs
occur at the atlas and axis, and along the cervical and upper dorsal regions
as low as the fifth dorsal vertebra.
I. The conjunctiva lining the lids may be examined.
The lower lid is drawn out and down, pressure being made at the same time
below it, causing it to become prominent.
The upper lid is turned back by grasping the edge
slightly toward the outer canthus and raising the lid, while at the same
time pressure is made upon it from above near the inner canthus.
This inverts the tarsal cartilage and exposes the membrane.
If while this lid is turned back the lower one is
also treated as above, both together stand out more prominently and may
be observed together.
Granulations appear as minute white or pale red
II. With the patient supine, direct pressure
is made, with the palms of the fingers, upon the eye-balls, pressing them
directly back into the orbits. This impinges nerves, blood-vessels,
muscles and all the orbital structures. It presses excess of blood
from the vessels, and tones the muscles, nerves and the structures of the
III. Tapping upon the eyeball has much the
same effect. It is performed by placing the palms of one or two fingers
over the closed eye, and lightly tapping them with the index finger.
Toning of the nerves, of the ball and its structures, and of the optic
nerve is thus accomplished.
IV. Granulations are crushed by squeezing
them between the finger and thumb, the finger being inserted beneath the
V. In pterygia, the small blood-vessels formed
upon and in the corneal conjunctiva as feeders, may be broken up by draining
the back portion of the edge of the finger-nail across them. Care
must be taken not to wound the conjunctiva.
VI. In strabismus the weakened or tensed muscle
may be treated by pressing the fingers into the orbit about the eyeball.
B. THE FIFTH NERVE
This nerve is reached at various points about the
head, as it sends many branches out over the head and face. Its treatment
is especially important in headaches, neuralgias, diseases of the eye,
nose, etc., for the reason that it carries vaso-motor and trophic fibres
to these parts.
I. Its supra-orbital branch may be traced
from the supra-orbital foramen out over the forehead to the temple.
It forms an angle of about fifty degrees with the superciliary ridge.
It may be felt under the skin like a fine whip-cord, and it may be manipulated
along its course by passing the fingers transversely across it. Often
one nerve is more plainly felt and often one is more tender, than its fellow.
Though not invariably so, it is often noticed that the nerve which is seemingly
slightly enlarged and more plainly felt is the one in abnormal condition.
II. The infra-orbital and mental branches
may be manipulated at their respective foramina.
By clinching the fingers beneath the malar process several branches
of the former may be impinged.
The tissues over the foramina and along the courses of all of these
different branches should be thoroughly relaxed to remove irritation.
III. A supra-trachlear branch is located slightly
to the outer side of the midline of the forehead, a lachrymal branch about
the middle of the upper eyelid, a temporal branch external to the outer
canthus of the eye, an infra-trochlear branch upon the nose opposite the
inner canthus, and a nasal branch at the lower third of the side of the
All are subcutaneous and are readily manipulated
after knowing where to locate them.
C. THE EAR
With the ear, as with the eye, lesion of the atlas,
axis, or upper cervical region is the most usual cause of disease.
The auricle should be drawn up and back in order
that the external canal may be inspected for the presence of growths, boils,
foreign objects, discharges, etc.
Attention should be given to the condition of the
cerumen. It is sometimes seen to be dry and flaky, indicating poor
circulation and imperfect secretion. Or it may be abundant, forming
a plug, which gathers in the deeper part of the canal and obscures the
drum, generally, but not always, impairing or quite obstructing the hearing
in that ear. If it presses upon the drum it is apt to cause vertigo,
or a sense of congestion in the head.
In some cases the cerumen will be found to be entirely
or almost, lacking, in one or both ears. This commonly indicates
greatly impaired, local circulation, due to cervical lesions, poor general
health, or both. In many cases treatment has restored the normal
secretion of wax.
Itching and extreme tenderness of the canal are sometimes noted.
The head-mirror and ear-speculum should be employed
in the examination of the deeper parts of the canal, and of the tympanum.
Sometimes a plug of cerumen can be detected by this means only.
By the use of these instruments the student should become familiar
with the appearance of the normal drum. A good textbook, with its
illustrated plates, showing the appearance of the various abnormal conditions
of the drum, is a valuable aid to this study.
The patient should be instructed to close the mouth,
hold the nostrils shut, and blow. This will reveal whether or not
the Eustachian tubes are open, by the presence, or lack, of the crackling
sound and sensation of fullness in the ears as the air is forced against
the inside of the drum.
When this act is performed, a perforation of the
drum is betrayed by the whistling of the air through the aperture, or by
the gushing through it of secretions or pus from the middle ear.
Impaired hearing may be due to fault in the outer,
middle or inner ear, auditory nerve, or brain center. A watch is
a very handy and delicate instrument to employ in testing the hearing.
This should be done in a quiet room. First the watch should be held
quite close to the ear, and gradually removed from it, to test the distance
at which the ear may catch the ticking. Both cars should be tested
in this way. The less acute power of one ear is often thus discovered.
Sometimes the watch may not be heard to tick unless pressed close against
the auricle. The ear which stands this simple test is sound, as to
its hearing power, throughout the auditory mechanism.
If the ear fails to hear the ticking when the watch
is held near or against the auricle, the watch should then be held rather
firmly against the upper part of the mastoid process, just behind the auricle.
If now the hearing fails, the trouble lies, probably, in the inner ear,
but may be located in either the auditory nerve or in the brain center.
As a matter of fact, the causes of deafness lie, for the most part in the
middle, or inner ear, or in the Eustachian tube, being rarely referable
to the auditory nerve proper or to the center. Deafness due to causes
affecting nerve or center may be distinguished from strictly aural deafness
in a simple way. In the former case the ticking can be heard only
faintly or not at all whether the watch be held away from the ear or be
brought near to it or pressed against the auricle or the mastoid.
But in the latter the watch may be heard more distinctly when it is held
against the mastoid, since by bone conduction the sound is carried to the
Sometimes the test is applied by having the watch
held between the teeth. If the Eustachian tube is occluded the sound
is heard less distinctly upon the affected side. But if the obstruction
is in the middle ear, as from thickening of the tissues and rigidity of
the ossicles, the sound may be heard more distinctly upon the affected
side (through conduction). Sometimes, also, this occurs when there
are impactions of cerumen against the membrane tympani.
Tinnitus Aurium, or "ringing of the ears," consists
of a variety of subjective sounds due to nervous disease, anemia, catarrhal
conditions, and various other causes. Generally speaking, the dull,
throbbing or buzzing noises are due to obstructed circulation in the ear,
especially in the fine capillary network spread upon the drum. This
commonly results from colds and catarrhal affections. This class
can often be bettered.
On the other hand, ringing, screeching, or whistling
noises commonly denote some affection the nerves of the auditory apparatus,
as is sometimes seen resulting from lagrippe. These cases are usually
difficult to help much.
Of the discharges from the ear, pus and blood are
the most significant, and their source should be carefully sought.
Treatment of the ear is discussed under the heading
of Diseases of the Ear.
D. THE NOSE
In the examination of the nose its external aspect should
be noted. Deformities from operation, violence, or disease are common.
The nose often indicates chronic catarrh by being bent somewhat to one side,
following ulceration of bones or cartilages, or surgery.
A peculiar "club-shaped" nose, with a large, rounded end
is sometimes seen in the scrofulous.
A red, or livid nose, with enlarged and injected vessels,
is a common indication of bibulous habits, and this member sometimes becomes
grossly hvpertrophied and deformed by excessive indulgence in alcoholic beverages.
Redness of the nose very often results from congestion due to chronic valvular
heart-disease, from congestion of the liver, or from tight-lacing in women.
The internal examination should be made by use of a convenient
dilator, head-mirror and speculum. The examiner should note the condition
of' the mucous membrane for redness or inflammation or for paleness and atrophy
as in chronic catarrh.
The character of the secretions and discharges should be
noted, and, if abnormal, their source or cause carefully sought. Very
offensive mucous discharges and pus indicate advanced catarrhal conditions,
and may result from ulceration in the tissues of the nose or from abscess or
ulceration in the frontal sinus or antrum.
Bleeding is usually from the membrane and due to local irritation,
or from congestion of the vessels of the head, causing rupture of small vessels.
After violence one should consider the probability of fracture of the base of
the skull as a source of bleeding.
Foreign bodies; growths, such as polypi and adenoids; "spurs"
of bone, due to hypertrophy resulting from catarrh; enlargement of the middle
or inferior turbinated bones; or a deflected septum may be found.
The NOSE, apart from neck treatment, is sometimes treated
by local manipulation.
I. Manipulating and loosening all the tissues along
the sides of the nose affects the blood-supply of its mucous membrane through
branches of the fifth nerve. It will also operate to free the channel
of the nasal duct.
II. With the patient supine, the palm of the hand is
placed upon the forehead, the other hand is laid upon the first, and the practitioner,
bending over the head of the table, brings his weight upon the patient's forehead.
This pressure is continued for several seconds and repeated a few times.
It frees the nostrils and in acute colds frequently at once restores freedom
of breathing through the nose.
The affect is probably gotten by the pressure affecting the branches of the
fifth nerve upon the forehead. It is greatly increased by first applying
momentary pressure, with the thumbs, to the internal jugular veins, which are
thus dilated back to the capillaries by the pent-up blood, after which they
carry away more blood, relieving the congested head and mucous membrane of the
III. In colds and catarrh, pain in the frontal sinus
may be relieved by tapping with the knuckles upon the frontal bone over the
The MOUTH and THROAT are sometimes treated internally by
sweeping the palm of the index finger from the, midline of the posterior portion
of the hard palate outward and downward over the soft palate, pillars of the
fauces, and tonsils. The uvula may also be touched. The nerves and
blood-vessels of this region are thus toned.
The Uvula, being thus treated by digital application, elongations
of it are overcome through restoring tone to its muscles and vessels.
It is usually elongated by conditions which congest it and the surrounding tissues,
and the elongation is due to the loss of tone thus induced in the azygos uvulae
muscles. This condition is often the cause of a little hacking cough in
The TEMPORO-MAXILLARY ARTICULATIONS are examined. Inequality
in their action is discovered by standing behind the head of the patient, who
is lying supine. The mouth is opened and closed, and deviation of the
midline of the chin from the median plane of the body noted. Deviation
of this nature indicates luxation of one of the articulations, the jaw usually
deviating away from the side of the lesion, though often toward it, by reason
of tightened condition of the articulation on the affected side.
I. The ligaments of the articulation may first be loosened
as described under II of Chapter IV. Pressure
upon the opposite jaw while the patient is closing the mouth will bring the
condyle back into place.
II. Sometimes it is necessary to place a small cork
or piece of wood between the posterior molar teeth upon the affected side.
Pressure is now made beneath the chin, tending to close the mouth, and the jaw
is slipped into place. The corks may be inserted at the same time between
the molars of both sides in case of bilateral luxation.
Treatment I, may be alternately applied in such case.
Opening the mouth against resistance (II,
Chap. IV), manipulation of the throat to free the action of the carotid
arteries, and treatment of the superior cervical region (XIII,
Chap. III) are, together with removal of specific lesions, the chief methods
of treatment in diseases of the eve, ear, nose and throat. They produce
affects by building up the blood-supply.
Treatment along the midline of the skull, from the nasion
to the occipital protuberance, thence outward along the sides of the head, affects
the circulation in the longitudinal and lateral sinuses through connected nerves
and veins. It also affects the sensory nerves of the scalp, they congregating
about the vertex.