The Practice and Applied Therapeutics of Osteopathy
Charles Hazzard, D. O.
    Many of the specific lesions affecting the abdomen and its contained viscera occur in the spine and thorax and are of kinds already described.  Much of the treatment for diseases of these parts is upon such lesions.  The subject of examination and treatment of the various organs will be considered more in detail in relation to their specific diseases.  The aim of this chapter is to give general methods of examination and general osteopathic points concerning these parts.
    POSITION: he patient lies supine; the thighs are flexed and the feet rest upon the table; the head and chest are slightly elevated by the inclined head of the table.  In this position the abdominal muscles are relaxed.  The sides of the body are disposed alike to avoid unequal tension upon the tissues.
    Inspection, palpation, percussion and auscultation are the physical methods employed.
    INSPECTION reveals enlargement due to gas or fluid, tumor, muscular contraction, etc.; color; distended or retracted walls; restricted or increased motion; pulsation or engorgement of blood-vessels, etc.
    PALPATION reveals change in temperature; tumors, superficial or deep, fluid or solid; tenseness or flabbiness of the abdominal walls; enlargements and displacements of organs, etc.  Pulsations, also, are to be noted.  A marked pulsation of the abdominal aorta is common in nervous people, but generally indicates liver, stomach, or intestinal congestions.
    Deep palpation of the abdomen in thin persons readily reaches the bodies of the lumbar vertebrae rising quite prominently under the touch.  They should not be mistaken for tumor.
    The examiner should grasp the abdominal walls in the fingers and raise them up away from the abdominal viscera, thus enabling him to tell whether tender places, growths, etc., lie in or beneath these walls.
    PERCUSSION reveals the limits of organs, presence of tumors, fluids or gases, etc.
    AUSCULTATION reveals the gurgling of gases, fetal sounds, lubrication of the bowel, etc.
    I.  A general treatment of the abdomen is sometimes necessary for general relaxation of the abdominal walls, often as a preliminary step toward further examination.  With the patient in position as above, the practitioner stands at the side of the table and with the palm of the hand manipulates the tissues to relax them.  Care should be taken to avoid pressure with the tips of the fingers or other rude work which causes the tissues to contract.  The hand should be warm and the manipulation gentle but thorough.
    II.  Direct manipulation, including pressure and various movements, is often made upon the various abdominal organs.  Specific directions for the treatment of any given organ are reserved until diseases of these organs are considered.  But, speaking in general of abdominal manipulation as one of the methods in the repertoire of the Osteopath, care must be taken to make clear the difference between such manipulation and massage.  Here the mode of motion is relatively insignificant.  The manipulation is not for the general effect following a thorough abdominal massage, but is corrective; directed to the specific end of restoring to proper mechanical relations an organ or organs definitely ascertained to be in need of mechanical adjustment.  Here, as elsewhere in the body, this work removes pressure from, or interference with, blood-vessels and nerves.  For example, osteopathic treatment of the colon is not made for general manipulative effect, but is directed to raising and straightening a sigmoid too much bent or folded.  Thus it removes a mechanical obstruction to bowel action, but also lets free pelvic circulation and nerve-action impeded by such a condition.
    Or, manipulation of the colon raises from its unnatural position the gut which has prolapsed and become wedged down among the pelvic viscera, where it has destroyed harmony of the functions.  Osteopathic manipulation in this way is specific and corrective, based upon mechanical principles, and is applied by a practitioner who knows what causes such abdominal conditions and how to correct them.
  III.  With the patient in position as above, or standing or sitting bent well forward, the fingers are inserted deeply beneath the viscera in each iliac fossa.  They are now drawn directly upward, raising all the pelvic and abdominal viscera, freeing the action off the femoral and pelvic vessels and nerves.
In case the patient has bent forward he straightens the body again at the time the viscera are raised.
    IV.  With the patient lying upon the right side, the practitioner stands behind the pelvis and presses the fingers deeply into the iliac fossa upon the side of the sigmoid nearest the median plane of the body.  He now raises the sigmoid flexure upward and slightly outward over the flaring inner surface of the ilium.  This raises the gut from the pelvis, relieves kinking, and frees the circulation of the part.
    The movement may be repeated for the caecum.
    The knee-chest position is very important and effective in all conditions requiring the elevation of pelvic and abdominal viscera.  The patient gets upon his knees, and, turning his head to one side, lays the upper part of the chest upon the table (still remaining on his knees.)  While he is in this position manipulations are made to draw abdominal and pelvic contents down away from the pelvis.  Gravitation aids this process.
    V.  With the patient in the dorsal position, the practitioner stands at the side and places the palms of the hands over the false ribs and cartilages, one on either side, heel out and fingers directed toward the median plane of the body.  Pressure is now made evenly upon the sides, springing the ribs and cartilages down upon the viscera beneath.  As the pressure is directed inward the ribs are forced toward the mid-line and pressed down upon the viscera.  Repeating this motion at intervals of a few seconds thoroughly tones the nerve-plexuses and blood flow of the upper abdominal viscera.
    VI.  Deep pressure is made upon the solar plexus as follows: The patient lies supine, the practitioner stands at the side and lays the palmar surface of the distal phalanges of one hand over the pit of the stomach, at the level of the tips of the seventh and eighth ribs.  Pressure with the second hand upon the first is gradually applied, the hand sinking deeper into the tissues until very deep pressure has been made.  The plexus may now be manipulated by a slight circular movement of the hand.  This treatment tones the action of the solar plexus, etc.  It should be gently and gradually applied, but the pressure must be considerable
    VII.  Deep pressure as above at any point will cause a purely nervous pain to lessen or disappear, while it increases a pain due to inflammation.
    VIII.  Displaced ribs sometimes mechanically depress viscera, and must then be replaced by methods already described.
    IX.  The fundus of the gallbladder is reached by deep pressure beneath the tip of the ninth rib on the right side.  Thence the course of the bile duct to the duodenum is somewhat in the shape of a reversed "S," opening into the duodenum from one to two inches below the umbilicus.  Manipulation aids in emptying the bladder and in passing gall-stones along the duct.
    Abdominal treatment is generally in conjunction with treatment upon the specific lesion occurring in the spine, thorax, etc.  It must be given carefully, as there are many diseases, e. g., typhoid, in which rough abdominal treatment might cause serious injury.  It is directed to a specific end and restores mechanical relations of parts, frees nerve and blood-mechanisms, removes muscular contracture, etc.