Endo-Nasal, Aural and Allied Techniques
Thomas T. Lake, N.D., D.C.
1949 (Sixth Edition)

In this chapter we will deal with what are called specific conditions that are given diagnostic connotation according to locality. However, we do not or must not lose sight of the constitutional unity of the whole body. Only he who has a true comprehension of the whole and who regards nature as a grand indivisible unity is in a position to rightly interpret the phenomena of symptoms of disease that are manifested here and there in the body. Nature exhibits the same material in various and dissimilar forms. Water is a unit, but is seen in the forms of fluid, mist, steam and cloud changed by variations in temperature. The body is a unit, but changed by variations from normal, by the habits of sleeping, eating, drinking, working, and thinking, and sometimes the emphasis of change manifests itself in one locality of the body.

There are many physical aids that may implement these Endo-nasal, Aural and Allied Techniques, such as electrical apparatus, dietetics, hydrotherapy, and other forms of treatment.

Diseases of the External and Middle Ear.

Eczema of Auricle and Auditory Canal. - This condition is quite common. The symptoms are those of eczema on any other part of the body. The firm, red surface of the auricle and canal may be covered with scales, or vesicles, and traversed by fissures. There is more or less itching.

Treatment. - There is a constitutional cause for this condition. Irritation by any habit of the patient should be eliminated by instruction and manipulative treatment. Give General Techniques Nos. 1, 2 and 4 until acute condition subsides, then give No. 5.

Aids. - Cleanliness is important. After thoroughly cleaning the part, apply a 50-50 solution of lemon juice and water by absorbent cotton. Water cooled ultraviolet lamp is also recommended. The patient should be warned about scratching lest he cause abrasions and create more serious complications.

Otalgia, Earache without any Impairment o f Hearing. - The importance of quick attention to any distress in the ear cannot be emphasized too strongly. It may be the beginning of an abscess in the middle ear, which if promptly examined and treated may avoid more serious complications. Unless there is a deeper constitutional cause, most of the earaches come from swimming, or picking the ears with instruments that scratch the membrane or come in contact with the drum too forcefully. Too strong currents of air may strike the ears and set up a temporary irritation; mild reflex irritations from congestions in nose, throat, and the pharyngeal cavity may cause some symptoms of pain, or muscular rheumatic diathesis may be present. Every ear distress has a possibility of  serious complications.

Treatment. - Radiant light heat and infra-red have been found to produce splendid results. Positive galvanism, which has been successful, is given by placing an electrode in the ear or a pad electrode behind the affected ear, with the negative pad on the opposite side of the neck. Heat of some nature is necessary. After all the pain has been relieved, all of the General Endo-nasal, Aural and Allied Techniques would be of great benefit.

Otitis Media Non-suppurative. - Otalgia of this nature is usually of catarrhal origin, created by anoxia of the middle ear. The middle ear, in health, consumes great quantities of air and oxygen. This air is supplied through the eustachian tube. If the nose and the pharyngeal cavity and the cavity of Rosenmuller have obstructions by mucus, ptosis, adenoids, or adhesions, the entrance of air and oxygen to the eustachian tube is shut off, and the air in the middle ear is rarefied. This causes engorgement of the blood vessels and in time a serious exudate is poured out which fills the tympanic cavity, causing the tympanum to bulge, giving pain on pressure. This exudate becomes purulent and infected by bacteria because of the lack of cooling by the germ-destroying elements of air and oxygen. The amount of pressure against the drum will vary according to the amount of interference with air passing through the eustachian tube. If the interference is slight, there may be a low degree of congestion, which may pass off in a day or two. When the pain is exceptionally severe, the interference by congestion or ptosis of the eustachian tube is very great. If the congestion is not released, then the otitis will go on to rupture or paracentesis of the drum membrane. 

The Endo-nasalist has before him three tasks: First, to relieve the pain; second, to create drainage, and third, to remove all obstructions to the intake of air into the middle ear. We are convinced that if rupture and paracentesis can be avoided by establishment of the above three healing processes, the patient will in future years be better off if afterward an occasional Endo-nasal treatment is given.

Physical Signs. - The signs of this disease are pain and throbbing with certain degrees in loss of hearing. Some have tinnitus, redness, and a bulging outward of the drum tympani with disappearance of all signs of the malleus except the handle.

Extraneous points of examination for possible infiltration of toxemic substances and obstructions are the teeth, tonsils, hose, pharyngeal cavity, carotid sinus block, the liver and intestines through congestion and constipation.

Treatment. - The first step as we have noted before is the relief of pain. Methods suggested for otalgia are all useful.

Radiant light heat has been advocated as the ideal treatment for otitis media. It is claimed it will lessen the earache immediately, and in most cases the membrane and canal will clear up in two or three days, the exudate will be absorbed, and the bulging of the drum disappear, paracentesis avoided and infection controlled. While we can see how the pain would be lessened by the heat, yet we fail to understand how the obstructions of a static nature can be removed by the radiant heat. This, as we see it, can be done only by finger or instrumental surgery. This brings us to the second desired result; namely, removal of obstructions and drainage. After all pain has subsided, every General Technique should be given, with special emphasis on the external and posterior nares, eustachian tube, and tonsils. Treatments for at least six to eight weeks, twice each week, should follow an acute attack, with diets and vitamins to suit each particular case.

Acute and Chronic Purulent Otitis Media. - Otitis is a discharging ear with small or large perforation or with complete obliteration of the membrane tympani. Barring accidents and paracentesis, it is otherwise a sequence of acute catarrhal otitis media with rupture. In some cases the discharge may last only a few days or weeks and then cease. In others, it will continue intermittently or almost continuously for a long time, even through life.

The symptoms are easily recognized; the discharge and odor. The odor of discharge is not as offensive in some cases as in others, but so far as we have been able to judge the odor has no special significance in evaluating the effect of treatments or of the virulence of the disease. Both the non-offensive and offensive seem to respond alike in a given time. Some never respond except by surgery, and few patients care to submit to the operation because of the risk of total deafness in the affected ear. Many patients and others who have discharging ears can hear rather well without aids of any kind if the discharge does not block the ear entirely. It often happens that after the ear is blocked for a day or two, the pressure of pus forces the block out and there is an overflowing rush of fluid for a few seconds. It is known that people have lived for a half century and more with this condition, and gotten along very well except for some annoyance from the odor. Surgical interference, of course, should be suggested only as the last resort.

Treatment. - The damage having been done to the tympanum by rupture or paracentesis, and to the contents of the tympanic cavity by pus and other exudates, the effort of the Endo-nasalist must be directed toward saving as much of the hearing as possible, and to the removal of the causes of the discharge. The causes can be stated briefly as anoxia of the middle ear and imperfect drainage. There also may be anoxemia, created by the anemia or ischemia of tuberculosis, syphilis, or diabetes. These latter complications make such cases almost hopeless, but the physician should try at least to bring about some relief.

Since this condition is generally a sequence of otitis media, it follows then that after the acute attack, sufficient drainage and aerifying did not take place and there was a prevention of the recession into the lymphatics or open cavities of the catarrhal substances. Draining must now be established. To overcome the blocking and anoxia, give the full General Endo-nasal, Aural and Allied Techniques, with specific techniques on tonsils, the pharyngeal cavity, and the eustachian tube cavity on the side of the affected ear. All sorts of remedies have been offered for discharging ears, but none of them will amount to much unless the obstructions to the intake of air and oxygen are removed.

Aids. - To keep the ear clean, a light wash of two ounces of warm water with ten drops of lemon juice has been found very suitable. The patient lies on the opposite side to that of the affected ear. The solution is put in by a dropper. After a few seconds the patient turns over and floods it out. This is repeated until the solution is used up. Ultraviolet light from a water cooled lamp is of some value, but should not be employed until obstructions have been removed in the nose, pharynx and the cavity of Rosenmuller.

Zinc ionization has been reported to bring about very favorable results, both alone and as an aid to Endo-nasal Therapy. This technique and its contra-indications should be studied thoroughly before the operation is performed. Efforts should be made by diets and exercises, especially of walking, to build up the patient's resistance.

Impacted Cerumen. - By the removal of a plug of wax or some other substance from the external auditory canal, countless numbers of people throughout the world have been relieved of deafness.

Cerumen is a light yellow semi-fluid which secretes outward. Its functions are to lubricate the meatus, preserve the elasticity of the lining membrane, and by its stickiness prevent insects and atmospheric bodies from entering the middle ear. Sometimes this cerumen will harden and block the whole canal and cause deafness. The first symptoms noticed by the patient are a fullness and itching and a sudden loss in acuteness of hearing. If at this time the average person would see a physician for examination and treatment, instead of probing the ear with matches, hairpins, and other instruments, he would save himself from serious complications. Hardening of the wax is associated with some constitutional irritations that need to be removed as well as the wax. These instruments which the patient may use to cleanse the canal, push and pack the wax with some epithelial cells deeper into the ear.

Treatment. - General Techniques Nos. 1, 2, 4 and 5 (6 if necessary) should be used. Twenty-four hours before removing the wax, put in the ear four drops of warm camphorated oil, or some other oil if preferred, but we have found camphorated oil more penetrating and soothing. On the second visit, after twenty-four hours have passed, create heat in ears with vibrations in all directions. Then with a medium size syringe, rubber or metal, aimed at the top of the wax, force the warm water strongly at first, then slowly. If all wax is not removed after two or three syringefuls, have patient return in twenty-four hours, repeating the treatment described above. If any pain has been caused, some form of heat will give immediate relief.

Another method is the instillation of about five drops of hydrogen peroxide followed by irrigation. Some favor the method of putting the oils in to soften the mass, then the instillation of hydrogen peroxide to bubble out the mass. The patient can be instructed in the performance of the last method. The writer, however, prefers to do these operations rather than let the patient run the possibility of doing himself more harm than good. (See Fig. 30.)

Otosclerosis. - This is a condition that is baffling to say the least. In a class room, our professor once remarked that otosclerosis is a condition about which the doctor is in the dark, can see nothing, and the poor patient can hear almost nothing, if not absolutely deaf. For a definition of this condition, we have searched the literature available, and all definitions are practically the same with some slight deviation in the use of words. The substance of them all is that otosclerosis is a spongification of the bony capsule of the labyrinth and fixation of the stapes, due to ankylosis of the oval window, the membrana tympani are normal and the eustachian tubes are of normal patency. It is easy to accept the first part of this definition relative to spongification, ankylosis and fixation, but difficult to accept the last part, in view of our experience. Most of these patients, on close examination, show some variations in color and contour of the tympanum, and a bulging of the carotid sinus area, which denotes a ptosis of the eustachian tube.

Again, if the patency of the eustachian tubes were true, it is extremely doubtful if spongification could have taken place. It may be true that the ear can be inflated and the sound can be considered to be that of the air going through the tube by force. However, if there had not been an anoxia, thereby causing a rarefication of the air in the first place, no engorgement or spongification could have taken place. It is reasonable then to suppose that preceding the otosclerosis, there were toxemic infiltrations, stasis, exudates, and hardening due to a lack of free exercise of the eustachian tube functions, and the assumption that the eustachian tube is not fulfilling all its functions remains even after the disease has fully developed. The assumption also remains that the origin of the cause of auditory sclerosis is the same as sclerosis or arthritis anywhere else in the body. It is our practice in all cases of this nature to study thoroughly all signs of physical disturbances in the whole body. Intoxications from the intestinal tract, rheumatoid arthritis from excessive calcium, use of drugs, tobacco and alcohol are all studied carefully. Anemia, local ischemia tuberculosis, and other symptoms which can produce anoxia and anoxemia are investigated.

Those who were not afflicted by heredity usually have a rather long history of congestions and colds affecting the nose, the pharyngeal cavities in particular. Extension of the congestion through the eustachian tube to the middle ear diminishes the amount of air that normally should pass through the tube. Because of this diminished amount of air, the congestion begins to dry, a process which eventually affects the bones producing a hyperostosis with spongification and fixation of the ossicles.

Symptoms. - There is a gradual loss of hearing, but sometimes this varies, the hearing being better some days than others, especially if the weather is dry and clear, but the trend is toward greater deafness. The membrane tympani is usually showing its normal luster, but careful examination will reveal some signs of congestion of the inner wall. Patients say they can hear better in noisy places; others say they hear the sound of the voice but cannot quickly distinguish the words spoken. This slow apprehension is due to the weight of the congestion on the inner wall of the tensor tympani. While in a noisy place, the weight of the external vibrations forces the congestion back of the tympanum to recede enough to allow the vibrations to go through. Noise and voice vibrations are blended, but by some inherent or developed faculty they are able to differentiate the sounds and interpret them one from the other. The patient will hear his own voice at a pitch higher than others, and if of a nervous temperament, he will be afraid of it and speak very low. It disturbs him to speak loudly because of the pitch in bone conduction and also from the fear he is yelling at people. Some overcome the fear and go to the other extreme, and they really do yell in conversation. Tinnitus is present in more or less degree and is worse at night than in the day time. Tinnitus, we have found, varies much in tensity according to the general physical condition and the temperament of the patient.

Treatment. - This is a condition that involves the whole upper respiratory and auditory apparatuses. Therefore, all General Techniques should be given at least twice a week. Emphasis should be placed on external nasal, tonsil, and post nares drainage, with a thorough clearing away of adhesions, adenoids and toxic matters from the whole pharyngeal space, and an effort to get the finger in the fossa of Rosenmuller to massage and clear the auditory orifice. (See specific techniques on breaking adhesions and raising the eustachian tube.) In addition to the above, every effort should be made to get more freedom in all the processes of respiration. Diathermy has proved itself of great value from reports we have received. The idea is that since diathermy is very useful in treating any conditions of fibrous connective tissue formations, or fixations of joints, it is reasonable to assume that it should act on the same principle in the middle ear. The purpose, then, of applying diathermy is similar to that of treating a joint. Absorption of calcified deposits may be affected to such a degree that function is at least partially restored. Diathermy increases the arterial flow in the part treated and augments the return circulation; intercellular tension is thus altered and cellular activity stimulated. Furthermore, it is fairly well accepted that sedative diathermy aids in the absorption of effusions, the softening of exudates and fibrous tissues, and in relaxation of muscle spasms. By giving the general endo-nasal treatments and the few specific techniques as mentioned above, we believe we have the best approach to this problem, because of attention to the constitution as a whole. No. 1 and No. 2 diets, alternated day by day, for a period of a month or so, with supplemental vitamin therapy, and some clear-cut instructions to the patient on their habits of life, can be of assistance. Total deafness may be delayed, or hearing gradually restored to such a degree that the patient will not need to resort to lip reading or mechanical devices. It is wise to instruct the patient in living the positive life, or forming the habit in conversation of insisting on hearing distinctly what is being said before replying. This will in time rehabituate the functional faculties of reception and interpretation of sound waves. These are like any other portions of the body; if not exercised, they atrophy.

Temporary Fixation of Membrana Tympani and the Ossicles. - Very often patients will complain of a fullness in the ear with some sound as of wind coming out or going in. They complain of being dull of apprehension and also lack of alertness. Nothing seems to be wrong. However, a careful examination of the membrana tympani may reveal some slight deformities or variations in position.

Now, examine Fig. 31 and then look into the ear of a normal hearing person who has not complained of any ear troubles worthy of note for some years. You will notice that the cone or membrana tensor is pearl gray and of transparent appearance: It is like a light in a cavern. The whole drum is oblique in appearance. Notice now the short process of the malleus located in the upper portion of the drum. In health, it is yellowish white. Then look at the long process of the malleus terminating in the lower middle of the "U" of the membrane at what is known as the umbo, or the funnel-shaped area of the drum membrane. Look carefully into the ears of several people of good hearing and you will notice some slight variations in color and light reflex; however, the variations are very slight, but all variations are of significance when a patient complains of pain. However, if there is a fullness felt and a slight lack of acuteness then we can regard it as a temporary fixation of the tympani itself and possibly a temporary fixation of the ossicles.

Treatment. - A little heat applied in any form and then the General Endo-nasal, Aural and Allied Techniques with emphasis. on No. 4 and No. 5.

Colds and Congestion in Head. - This condition is purely constitutional and requires a full constitutional treatment. In the vast majority of cases one treatment is required to cause the elimination processes to become so active that a return visit is not necessary.

Treatment. - Give the whole lymphatic treatment thoroughly with special emphasis on the liver squeeze, and the Lake Head Recoil Adjustment. Put finger up into the posterior nares as far as possible and start a side-to-side movement, pulling the finger downward and outward slowly. Tell patient to go home and drink one glass of water with the juice of half a lemon every four hours, and if weather is bad to stay at home. If a second visit is necessary, give a rectal dilation in addition to the above to release gases, and also give small finger treatment of the external nasal canal to aid drainage from the sinuses.

Rhinitis. - This can be described as a filling up of the head and respiratory apparatus. It is the product of numerous colds aggravated by climate, drafts, drugs of suppressive nature, and many substances inhaled. Originally, however, it started by anoxia and anoxemia, and is perpetuated by a continued existence of those two conditions. The disease is usually in three stages. The first stage, the dryness of the mucous membrane, is so pronounced that even the head and body aches from nerve reflexes. There is sneezing, lacrimation, and itching. There may be some fever. The second stage is when the healing crisis of the natural processes of the body are set in motion by fever to bring about the third state when the discharge becomes quite free and is sometimes streaked with blood. For a time there is relief, but unless the obstacles to normal respiration are removed, recurrence will take place, and since this is a condition of the mucous membrane that extends to all of the sinuses, the ears, pharyngeal space and tonsils, serious complications can result.

Treatment. - Give the Lymphatic Drainage Technique, the Lake Head Recoil Adjustment, the Enlarging of the External Nares, and the Pharyngeal Dilation Technique.

Patient should be instructed to maintain an erect posture and to breathe through the nose consciously for a time, so as to establish the habit. Most sufferers of rhinitis are mouth breathers.

Aids. - Apply heat of any nature as long as it does not reach the point of coagulating the blood. Vitamin therapy and the drinking of several glasses of water a day with the juice of half a lemon aid in the solution of the solids and relaxing the mucous membrane. After the discharge has been established, all the techniques are advisable for several weeks.

Tinnitus. - Nerve-wracking noises in the head or ears are the condition known as tinnitus. It is a joy to see the light of gratitude in the faces of those who have been even temporarily relieved of this condition. The writer knew for years the distress of lying awake at night with head throbbing and noises of many kinds and tensity going through the head. Not much attention was paid to a variety of sounds and pitches, but when only one sound was vibrating at one pitch, it was at times almost unbearable. It is too much to hope that some day a method of relief, regardless of the causative factors, will be found for all causes. Up to now, however, and probably for years to come, the only method of giving relief and the possible eradication of this condition is the process of eliminating causative factors one by one.

Some have been relieved by accident. Four years ago a lady of fifty, who had our treatments for weeks with no relief at all, was suddenly entirely relieved while undergoing a treatment. While she was getting the gland raising treatment of the neck, the operator's hand accidentally struck a slight blow on the lower ridge of the occiput. slight headache resulted. Two days later the patient returned and said the headache had passed off quickly and she had heard no noises. Up to this time, she has experienced no return of tinnitus.

We have another case on file in which a gentleman told us of the noises in his head stopping when he experienced an accident to his foot. These, of course, are extreme and rare cases, but they do illustrate the far reaching and various elements that enter into this complex problem of tinnitus.

At a recent seminar, we asked a noted specialist what success he had in the relief of tinnitus. He replied, "Very little; it is too big a problem to hold the patient long enough for a final solution." This is the biggest problem, holding the patient until every cause of the condition is explored and treated. The outline of related causes of this troublesome condition is long. We will attempt to make it as brief as possible. Some noise may come from deformities in the hearing apparatus itself, fixation of the tympani and the ossicles, and from the air pressure being too much lower on one side of the tympanum than on the other. There are sounds that come from low blood pressure that create local vacuums with squeezes on surrounding tissues and those from high blood pressure, slurgging hissing sounds accompanied by throbbing and vertigo; sounds from nerve deafness or reflexed from nerve irritations anywhere in the body or brain. The brain sounds may be due to tumors or other neoplasms. Tinnitus is, then, a symptom which occurs as a part of the majority of ear diseases, but also it is in many cases reflexed from systemic disorders apart from ear disturbances. In the ear it is usually associated with suppurative otitis media, otitis media from catarrhal colds, ptosed, strictured and air tight eustachian tubes, from nasal obstructions and impacted cerumen disturbances of the semilunar canals and cochlea.

If vertigo is present it can be taken for granted there is a constitutional toxemia present, or the patient is smoking too much. Lately we were told by a gentleman that he heard noises and felt dizzy only after smoking. This leads us to remark that when treating for tinnitus with vertigo, tobacco and liquors in any form should not be used, at least while taking treatments.

Treatment. - Many have but a single attack of tinnitus which may be reflexed from some abdominal organ or organs, particularly the liver, and may recover completely in a short time. Others may have it for years, or a lifetime, unless the cause is found and removed. While giving the full General Techniques, diligent search should be made for the cause; urinalysis, and hemoglobin and blood count tests should be made in every case. High acidosis, sugar, albumen and chlorides to an appreciable amount may be evidence of anoxemia, diabetes, and nephritis. These present serious implications in connection with tinnitus and vertigo. The color and blood count test will help establish the presence of anemia or leukemia. These diseases mentioned with uremia, gout, arteriosclerosis and migraine are sometimes accompanied by tinnitus. Look at the toe nail, denoting an anemia of the spinal nerves. Give all the General Endo-nasal, Aural and Allied Techniques and specific techniques according to the findings.

Aids. - Fasts of one or two days, with a follow through of Diet No. I and No. 2 alternately for a month, have been of great benefit to those who show toxemic tendencies.  Negative galvanism is recommended and diathermy, through the finger tips of the doctor held in the patient's ear, also endocrine therapy off the adrenal and thyroid types. Thorough elimination should be established and we have known of cases where colonic irrigations accomplished splendid results. Zone therapy has its merits if the patient will persist in its performance. Pressure on the internal and external carotid artery on one side for about five minutes, when the tinnitus is extremely annoying, has produced temporary relief; also pressure on the roof of the mouth underneath the noise area. Concussion of the seventh cervical has helped some, also vibration on the whole head area. If all of these fail, and the patient is in a state of nervous exhaustion, plugging for five minute periods about five times a day will help. A small rubber tube completely incased in absorbent cotton, so made that it will slip easily into the ear, is inserted in the ear as far as possible without force. If there is a perforation in the drums, it can be placed just over it. If the cotton tube is placed in the appropriate place, there is nearly always an immediate diminishing of the sounds in all patients. The location is not uniform. The patient, after being shown, can be instructed to do this at home. For the first few days it should be removed after five minutes. After this treatment, dry heat of some nature is very helpful.

Vertigo. - Vertigo is a very distressful affliction and may come from many causes. Chronic anoxia or anoxemia produces symptoms resembling drunkenness, without the stimulation of drunkenness. It produces, instead, a very depressed and fatigued feeling before and after the attacks.

It may accompany tinnitus and usually does. The semicircular canals of the ear have not been mentioned before because we do not believe they have anything to do with the perception of sound or the locating of sound waves, but rather with the coordination of the movements of the body balance. Here in the semicircular canals is the source of vertigo caused by reflexes from obstructions in the respiratory system, or reflexes from tumor in the cranium, irritations of gastric or uterine disturbances, pharyngeal congestion, certain drugs, tobacco, alcohol, auto-intoxication, high and low blood pressure, and many more conditions apart from the ear itself. Any abnormal condition of the ear can produce vertigo in a more or less degree, but should it be so severe that the person reels or falls, there is a reflex combination of ear disturbances, and hepatic, systemic or cranial disturbances.

Treatment. - Give all of the General Techniques. Place patient on a milk fast, consisting of one glass of milk every two hours, for a day at least. Careful search should be made for the one cause or the combination of causes and they should be removed if at all possible. Every part of the auditory and respiratory apparatus should be explored for possible clues. Emphasis should be placed on the liver and spleen techniques. Rectal dilation for expulsion of gases is often of great value, also colonic irrigations.

The Eustachian Tube Deformities. - Here is the greatest source and cause of deafness. The average person has more or less an accumulation of catarrhal waste matter in the pharyngeal cavity at all times, so that when it reaches the stage of a cold or healing crisis a free outlet is required. If, however, the resiliency of the soft palate is impaired or is adhered to the pharyngeal wall, and if the lymphatics are inactive, proper drainage cannot take place, and by extension, the toxic waste matter goes along this membranous tube or blocks it at the entrance. If there is sufficient inflammation and anoxia, there may be a destruction of the whole hearing apparatus. Apart from the catarrhal condition, the eustachian tube may fall or bend slightly, in which case there is a shut-off of pressure as when a hose is bent. This position lends itself to the development of hypertrophy with hardening of deposits in a portion of the tube, or atrophy of a portion or even the whole tube.

Our task, then, is to attempt to get air in the tube. However, before we can do this, it may be necessary to attempt to raise up the whole bony structure in the neighborhood of the eustachian tube. Here we run into great difficulty in trying to present the image or location of the eustachian tube orifice. If you have practiced the strategy of approach to the whole pharyngeal cavity and mastered it, you are now ready to explore the Rosenmuller cavity in which is located the eustachian tube orifice. Let us see if we can make some kind of a picture of it. Briefly, the eustachian tubes are two tubes about 1/2 inches long, passing downward, forward and inward from the middle ear to the nasopharynx. They consist of one-third bone and two-thirds fibrocartilage. They are lined by ciliated epithelium. The eustachian orifice is situated at the upper lateral portion of the pharyngeal cavity behind the posterior part of the inferior meatus just above the nasal floor underneath the curve of the plica salpingo and palatina pharyngea cartilage. The large pad on the curve of this cartilage, which is covered with tissue, is sometimes called the bulbous mass. It curves over the fossa of Rosenmuller, in which is found the slit of the tube.

All the written descriptions, drawings and pictures in the world will not do very much in the way of making an image. The pharyngeal mirror with a good light will, with some practice, reveal the slit of its opening, but practice with the finger in the pharyngeal space will do more to train you than any other method. Find that bulbous mass or tubal cartilage, then slip your finger down about an eighth of an inch and you are in the orifice of the eustachian tube. (See Fig. 32.)

Treatment. - Before attempting to treat the eustachian tubes, the whole pharyngeal cavity must be cleansed of all foreign matter. In the pharyngeal cavity, there are normally only the following contents, which are prominent: the tubal fold, of the plica salpingo palatina and, at its curve, the pharyngea; the septum and the membrane; above can be felt the turbinates. Anything else is of foreign substance. These foreign substances can be adenoids, adhesions, polypi, masses of mucus with the consistency of jelly, or lumps of mucus that have solidified. All of these are treated under separate headings.   

The purpose of these treatments is to get air and oxygen passing through the tubes into the middle ear. Give General Techniques Nos. 1, 2, 3, 4 and 5, then note if pharyngeal cavity has been made free of any foreign substances. After this make a test of the patency of the tube to see if air is going through. If not, give the following specific technique.

Have patient sit on stool. With the nurse holding head, stand on left side of patient. Put thumb of left hand on soft tissue one inch back of the angle of the jaw bone just behind the auricle of the ear. Put middle finger of right hand in the fossa of Rosenmuller as snugly as possible. Give easy upward jerks with the left thumb, at the same time giving light pumping movements with the finger of the right hand inserted in the mouth of the tube. Do not say it is impossible before trying it. After this technique, make tests with the Politzer air bag. It may be necessary for the patient to help at home by putting something between the teeth on the affected side to aid in. pushing the ptosed tissues up a little. Fifteen minutes a day of holding a small wad of cotton or rubber between the teeth will be sufficient.

Adhesions. - Adhesions are the abnormal jointing of parts to each other and may be found in any part of the body. They are like strings of tissue, and in the pharyngeal cavity may be single or multiple in number, and go in one direction or different directions.

In the pharyngeal cavity and the fossa of Rosenmuller, only one finger can be used.

Treatment. - It is taken for granted that now you have mastered the strategy of approach to the pharyngeal cavity. Now feel for these strings of tissue. If they are horizontal, hook the finger up around them, then pull the finger out. If they are vertical, then move the finger from side to side. If they are broken, there will be some bleeding. Caution the patient not to blow the nose for at least ten minutes. Have patient gargle with glass of cold water.

Loss of Sense of Smell and Taste. - The cause of this condition, barring injury, is due to frequent colds, chronic rhinitis, dryness of the membrane or hard mucus paralyzing the olfactory nerve, shutting off all its sensitivity. This, again, is a constitutional condition and must be treated as such complemented by Endo-nasal Therapy.

Treatment. - Give General Techniques No. 1, with emphasis on the cervical glands ; No. 2, Lake Head Recoil Adjustment; No. 4, Opening and Massaging the Pharyngeal Cavity, No. 6, Nasal Dilation and Drainage. After a few treatments, make tests with some strong but pleasant odor. Do not pour odor substance in orifices. Note. In a case of impotency in man or woman, it would be well to examine the sense of smell. The nose has a strong sexual character as can be seen in all animals.

Mastoiditis. - This is an inflammation with pus filling up the porous portion of the mastoid bone. This bone actually is a sinus acting as a sounding board for the ear. It must be remembered that the middle ear consists of a series of communicating pneumatic spaces, beginning with the pharyngeal end of the eustachian tube in the lateral wall of the nasopharynx and terminating in the pneumatic spaces of the mastoid processes that in health are filled with air.

Treatment. - Two things must be borne in mind (1) the future of the patient relative to prevention of poor hearing and tinnitus aurium, and (2) the safety of the patient, if conservative treatment is instituted, then general supportive measures and establishing free drainage are recommended. There has been much discussion as to whether hot or cold applications are best. Both sides have a fair argument. We usually see which gives the most comfort to the patient for awhile, and then apply the cold packs if temperature remains high. The pus is thus slowly taken up by the blood stream for elimination. Infra red light has been found useful, applied for five minute periods at intervals of every hour. Diet: Fast on fruit juices while acute condition lasts. With all this remember that the quicker the air gets in the better. Then, as soon as possible without giving too much pain, open the pharyngeal and Rosenmuller cavities. After inflammation has subsided, give all General Techniques for a few weeks, testing to see if eustachian tube is patent.

Sinus Troubles. - “Sinus” means a “hollow” or “cavity.” There are eight groups of cavities in the bone of the skull, four on each side. There is an antrum or maxillary sinus in each cheekbone. The frontal sinuses are above the eyes. Along the inner wall of each eye are the ethmoid and deep within the skull lie the two sphenoid sinuses.

The function of these cavities is to give lightness and balance to the head and to act as a sounding board to the voice; in health they are filled with air and a normal residual oxygen content. When deprived of air, they cause distress and a certain amount of unbalance and loss of resonant tone. There are three principal reasons why the sinuses become oxygen starved: (1) Lack of proper elimination, blocking up the head with excessive waste matters; (2) Injuries to the tubes that carry the oxygen to them; (3) Irritating them by smoking and improper habits of posture and breathing.

Treatment. - Give General Technique Nos. 1, 2, 4 and 6. These sometimes suffice, but if there are calcareous deposits, heat will have to be employed. Infra red light and diathermy are very useful. Hot or cold compresses will relieve pain to some extent. Should all of these treatments fail, then X-rays should be taken. We have found some patients with a complete absence of one or the other of the sinuses; or one or the other with so much solidified calcareous deposits that major surgery was the only solution.

Lupus. - This is a nodular enlargement of the nasal mucous membrane and cutaneous structures of the nose. It is characterized by the formation of nodules of varying size which have a tendency to break down and ulcerate. One or both nasal cavities may be involved. The most pronounced symptom is nasal obstruction. There is usually a slight discharge and some pain.

Treatment. - This condition is purely systemic and therefore the treatment is largely constitutional, tending to build up resistance. Swabs of an alkaline solution may be used. Give all the General Techniques and these lumps will disappear.

Mucous Polypi. - These are pedunculate tumors found in nose or ear, or from any mucous membrane. They are classed under the head of inflammatory growths. They are edematous hypertrophies of the nasal mucous membrane, resulting from repeated congestion in the presence of chronic inflammation of the mucosa covering the middle turbinated bone.

Treatment. - Give General Technique Nos. 1, 2, 4 and 6. Prescribe a cleansing diet, using No. 2 for a few days. For specific treatment, if polypi can be felt, just put finger over and squeeze them. Remember it will take some time to get rid of them.

Septum Spurs. - These are localized thickenings or projections upon the septum. They may appear in the form of spines, crests, ridges or rounded masses; they may be composed of cartilage or bone, or both. Septal spurs may be congenital or result from malformations or traumatisms. In most cases they need no treatment, in others where there is an interference with respiration and drainage, the patient should be referred to those who are well trained in the use of the nose saw, the biting forceps, spokenshave, etc.

Treatment. - Some attempt should be made to enlarge the canal so that air can pass through. General Technique No. 6 will do this.

Deviations of the Septum. - A perfectly normal septum is rarely seen, but unless the deviation is sufficiently marked to cause obstruction to respiration and drainage or to produce pressure upon the turbinates with consequent irritation; or unless there are symptoms referable to the deformity, it should not be treated unless specially requested by the patient who desires to improve, if possible, the appearance of the nose. Cases involving abnormalities which interfere with drainage and respiration should be treated internally and externally.

Discover what causes the septum to go out of alignment. It may be due to neuroses or stigmata of degeneracy which causes either an arrest or an excessive development of the bones of the face including the nose. One of the expressions of neurosis is a deformed septa. A delayed eruption of the incisor tooth can displace the promaxillary wings and distort the vomer groove resulting in spurs and causing anterior or posterior deviations.

(* NOTE - Diets 1-2, can be found in Treatment by Neuropathy and The Encyclopedia of Physical and Manipulative Therapeutics, by the author.)

Acute attacks of catarrhal rhinitis are potent factors in producing deviations, but traumatic conditions are probably the most frequent cause. It may have occurred in early childhood, when the bones are soft, and little attention was paid to it.

Treatment. - Make sure that you have removed all toxemias, then determine what position the septum should be in. If anterior, then place small finger to lower tip of septum, thumb of other hand above and press in opposite directions very gently. If the deviation is posterior, take hold of inferior portion of septum with thumb and forefinger of the left hand. Hold firmly. Put back portion of right thumb on top of nose between the eyes, then pull gently but firmly out with left hand, and give a sharp, quick thrust with the right.

Adenoids. - The definition of adenoids must be somewhat elastic. Adenoid, specifically, is a lobulated lymphoid mass composed of lymphoid tissue similar to the tonsil and containing masses of lymphocytes. Lymphoid tissue is a normal constituent of mucous membrane, but, the question as to when it becomes pathological is not easy to answer. We can say this, however, that they are pathological when they can be felt by the finger or seen with the eye.

Treatment. - Since adenoids are from lymph congestion underneath the mucous membrane, the treatment consists of General Technique Nos. 1, 2 and 4, with friction right and left. For specific treatment, put the finger on the lump and press the lymph out of the sac.

Inflamed and Enlarged Tonsils. - We have given the functions and an outline of the anatomy in a previous chapter, and we have noted how important it is to save them, if possible. Tonsils become enlarged because of the excessive work placed upon them in absorbing infected waste products of frequent colds and so become injured. However, removal of them is not the solution to the problem, but removal of the causes of the toxemia and the obstructions creating anoxia and anoxemia are the best procedures.

Treatment. - Give General Technique Nos. 1, 2, 4, 6 and 7. In giving No. 7, dip the finger in ice cold lemon water, then press on the tonsil until pus is flowing. Then use the tonsil suction to remove all the pus. It usually takes about ten treatments to bring a tonsil back to normal. It may be necessary for the patient to fast for a few days. There are many electrical appliance methods that may accomplish this desired result, but since there are certain contraindications and danger, only experts should attempt the operation of them. The results that have been achieved by insisting that the patient gargle at least once a day with a 50-50 per cent of water and lemon juice have been astonishing.

Turbinate Enlargement. - Any one or all of the four turbinates can become enlarged or ptosed. The functions were discussed in a previous chapter. We might add that only when they are found to interfere with the respiratory processes is it necessary for specific treatment.

Treatment. - Give General Technique Nos. 1, 2 and 6, with little finger treatment technique added. Unless there are solidified growths, we have found the above techniques sufficient to overcome the abnormalities.

Cough acute and Chronic. - In acute congestive conditions, the cough is a life saver for it helps to remove the pus foreign waste matter. On the other hand, when chronic and non-productive, it is a serious matter because it may result in bronchial dilatation or complete diaphragmic prolapse. If the cough continues to be productive for any length of time, there is some source of infection in the respiratory system. If a chronic cough is present, that is, non-productive, something has gone wrong with the mechanism of respiration.

Treatment. - The treatment must depend on what the physician finds as the etiological factors, and they are too numerous to mention here. Recently a lady who had grown weak from persistent dry coughing for two months was treated by the writer: There seemed to be no etiological factors which could be blamed for the condition. After two treatments, using General Technique Nos. 1, 2, 4, 5, 6 and 10, the coughing disappeared and there has been no return of the affliction to this time. One spoonful of lemon juice and one spoonful of honey in a glass of water, the patient taking sips every fifteen minutes, is very soothing. One-half cup of lemon juice and one-half cup, of honey mixed, a spoonful every hour, is also very helpful. The diaphragm should be supported by a belt during a spell of chronic coughing because the diaphragm must attempt to control the cough, but if the cough is persistent the muscles of that organ may weaken and a ptosis of severe nature take place. For acute productive cough, nothing more should be done other than to increase the flow. For this purpose, General Technique Nos. 1, 2 and 6 will be of sufficient help.

Hay Fever. - The symptoms of hay fever are so well known that it is unnecessary to repeat them here. Because of the importance of hay fever, let us give special mention to the processes by which it is brought about. We regard the Allergic Theory as untenable, and do not subscribe to the methods employed under that theory. Let us look at the mucous membrane. It is a fine lining of sheath-like tissue that covers all the nasal canal and cavities like the paper on the wall of your house. The function of the mucous membrane is to protect the tissues underneath and establish a method of drainage for those tissues. This mucous membrane has thousands of tiny glands that secrete enough to keep the membrane moist and allow free drainage, but if they become irritated by a lack of oxygen caused by obstructions in the nasal canal, or more waste matter than oxygen can take care of, then they secrete great quantities of colorless mucus which if not thrown out quickly from the nose will become thick, and if germs gain access to this mucus will cause it to become white, yellow and streaked with blood. This condition is considered as "catching a cold." Should this mucus dry up and form a hard surface over the membrane, causing pressure on tiny nervelets, then the condition is called rhinitis. Still further irritation by pollens and dust (particularly in the summer time) produces a sneezing and a burning, sensation called hay fever. We, therefore, think of pollens, dust and summer heat and many other things as but the exciting causes for the distress that follows.

Treatment. - It is doubtful if much can be done in the way of permanent relief while the condition is in the acute state. To give as much relief as possible in the acute state, treat as for colds and rhinitis. It must be remembered that the tissues are very tender and sore. Ice cubes to the forehead will give some relief.

In considering permanent relief, it should be recalled that there are two important factors in the treatment of chronic hay fever: First, the toxemic and second the psychological. Hay fever has its beginnings in toxins and waste matters interfering with the physiological functions of the respiratory tract. Then in the due course of time there develops an expectation neurosis. The patient knows the month, date and hour when his respiratory disturbances will begin. Therefore, it is necessary to start treatments at least three months before the expectation period is realized, and earlier if possible. If the patient says his trouble starts in August, you can very well assure him (if he has no degenerative processes going on in his organs) that if he will come to you at least for three months, twice a week, he will be free from his hay fever. Then proceed as follows: Put patient on No. 1 and No. 2 diets alternately and insist on rigid enforcement. Then twice a week give all the General Techniques. If patient complains of the restrictions on diet and the length of time of treatments, he should be reminded of his complaints during the hay fever season.

Asthma, Acute and Chronic. - Asthma is a dyspnea caused by a spasm of the bronchial tubes. The primary cause may be cardiac, thymic or some other condition. But, if the air-conditioning apparatus above is kept clean and functioning, much relief can be given while working to remove the cause.

Treatment. - For relief in acute spasms, concuss seventh cervical for three minutes with one minute periods of rest. Then put the finger back of the soft palate in the pharyngeal cavity and pull outward. Hold as long as possible without giving pain. For chronic asthma, give all the General Techniques and, in addition, treatments for what may be found as the specific cause. (See Fig. 29.)

High Blood Pressure. - While working to relieve deafness, sinusitis, rhinitis and other head conditions particularly, it was found that the increased intake of oxygen had a profound effect on high blood pressure. Time and again we have seen high blood pressure go down after draining the external and posterior nares, and correcting the position of thyroid and parathyroid glands so they could oscillate and vibrate up and down, in and out. It is not generally known or accepted that these glands of the neck fall into the thyroid sinuses between the frontal and posterior branchial walls and become pinched. Their failing to function properly prevents their having normal influences on the processes of oxidation and metabolism.

One of the functions of the parathyroids is to control the deposits of calcium, or to act as a medium of control on the output of the adrenals. Another function is to secrete an enzyme that aids in keeping the calcium in solution. Along with correction of the position of the parathyroids must also go correction of the position of the thyroid gland, because thyroxin has a profound effect on oxidation.

Recently the theory has been advanced that a substance found in hog liver extract will reduce high blood pressure if there is a proper medium of oxygen in the blood stream. This substance has been given the name of amine oxidase. It is one of those fermenting substances which aids in the chemical combination of oxygen with the materials of the body's tissues. The thought is that the development of high blood pressure of the most frequent type is due to the chemical disturbance of the kidney. The kidney has a chemical reaction on the amino acids which are in number twenty-one, or components of all the known proteins. They are what make body tissues and blood plasma, and germ cell materials. In the kidneys, the amino acids are broken into smaller units, known as amines. If there is enough oxygen present, no harmful products are formed, but in the absence of oxygen or oxygen activity, special harmful amine substances are produced, and these raise blood pressure.

This theory is of special interest to the endo-nasalist from the viewpoint that these injections of substances of hog liver extract are of no value unless there is a good supply of residual oxygen in the blood stream, and that if there is enough oxygen present, no harmful products that create high blood pressure can be formed. We are in no position to verify or argue the point that the basis of high blood pressure is a malfunctioning of the kidneys, but we welcome the verification of our claims that residual oxygen in the tissues prevents it.

Treatment. - A low diet of 1250 calories per day is prescribed, with supplement foods of garlic and corn oil, also auto condensation by diathermy apparatus, or by instructing the patient to put the feet in hot water once a day for fifteen minutes with a cold wet rag on the head. General Technique Nos. 1, 2, 4, 6, and 12 should be performed twice a week until the blood pressure drops to normal.

Low Blood Pressure. - One of the functions of oxygen is to attract iron. In all cases of anemia ischemia and enervations, anoxia and anoxemia are fundamental causes no matter what accident, incident or long-drawn-out wrong habits of living preceded the trouble. People can be anemic even though they eat a carload of food a day and may be very fat. The food is of very little benefit unless there is sufficient oxygen to attract the iron from the food into the blood stream.

Treatment. - We have found that by giving all of the basic techniques of Endo-nasal Therapy with a diet largee in content of iron, and adjusting all subluxations, the majority of these cases respond.

Obesity. - Let us begin this discussion with a statement from a letter received from a practitioner of Endo-nasal Therapy. Of course, the statement must be taken as a hyperbole to express his deep conviction that a greater intake of oxygen has profound effect on obesity. He writes, "In obesity cases, we were surprised to see surplus fat on body, hips, legs and feet begin to disappear. Our once fat patients are asking for a refund to buy new clothes and shoes!" This has been our experience with many types of obese patients. The air we breathe contains twenty units of combustible oxygen gas per pint; this, coming in contact with the carbonic gases gives off heat and creates what is known as the process of oxidation, which produces the rate of metabolism. In obesity, the rate of metabolism is always below normal. The rate of metabolism is calculated from the rate of oxygen consumption. It is obvious, then, that by removing all obstructions to the intake and utilization of oxygen, a remedying effect is produced.

Treatment. - Diet No. 2 for .a considerable time. Give General Technique Nos. 1, 2, 4, 6, 10, 11, and 12.

Rheumatisms and Arthritis. - Those types of rheumatisms such as arthritis, lumbago, and so-called neuritis that are due to excess calcium respond very well to endo-nasal techniques, with the addition of diets and helps that are obtained from certain electrical apparatus. Two important results are desired in this condition: First, a dissolving of the calcareous deposits in the joints and muscles; second, to replace the protein destruction with new protein substances in joints and muscles. The first is accomplished by creating a greater intake of oxygen which has within it dissolvent properties. The second is accomplished by the Salisbury Steak regime.

Treatment. - Give General Technique Nos. 1, 2, 4, 6, and 12; Diet No. 2 for at least two days a week: Salisbury Steak.

Cysts and Fissures of the Thyroglossal Duct. - The thyroid gland in human beings arises from the pharyngeal floor, first as a shallow evagination and later as a gland body suspended from the pharyngeal floor by its stalk, the thyroglossal duct. The time of severance between the thyroglossal duct and the thyroid is variable in embryos of 3, 9 to 7 mm. When there are defects in the development of the thyroid gland, a portion of the thyroglossal duct may persist in the neck and cause disturbances.

Position and Function. - A full review of the embryology is too extensive for our purpose here. It may be recalled that the thyroid gland arises as an outpocketing in the pharynx between the first and second branchial arches.

This position is marked in adult life by the foramen cecum at the base of the tongue. The thyroid body descends in the midline, through the tissue which later becomes the hyoid bone, until it reaches its position in the neck in relation to the thyroid cartilage. In the majority of people, the thyro­glossal duct passes anterior to the hyoid bone. For practical purposes, however, it makes no difference in the treatment whether it passes behind, in front of, or through the hyoid bone. In normal development the thyroglossal duct is entirely separated from the pharynx and thyroid in fetal life, and disappears when the embryo is still very small. When defects in development have occurred, various abnormalities arise. These abnormalities depend upon the location and extent of the thyroglossal duct remnantt left. Its only known function up to this time is to supply blood to the thyroid and guide it until it reaches its place in relation to the thyroid tissue.

Abnormalities of Thyroglossal Duct. - The thyroid gland may fail to descend into the neck from the foramen cecum. It is then present at the base of the tongue showing an enlargement, small or large, at the curved middle dorsum which is sometimes called "lingual goiter." There are two types of abnormalities that are common. The most common defect is the simple cyst that has formed by retention of the duct's secretion, desquamation and inflammation of the epithelial cells in the closed portion of the duct. The cyst may remain of one size or grow to an. unsightly size. It may cause no apparent symptoms or pain, but by infection of any part of the pharynx, pain may be evidenced, breathing difficult, and emotions kept at a high pitch from nerve stimulation which has a tendency to tire the patient easily. Another abnormality is the thyroglossal fistula which occurs where there is a break in the duct. The only symptoms are a discharge of pus into the mouth and foul smelling breath.

Treatment. - The main purpose of the following techniques is to drain the duct and cyst of their contents; the same treatment is used for drainage of the duct with cyst or fistula. First give General Technique No. 8. Then with nurse holding head of patient, the physician grasps very gently with his left hand the upper portion of the external middle neck at line with the dorsum of the tongue. The most dexterous finger of the right hand is allowed to slide down the side of the mouth. When the root of the tongue is reached, move the finger over to the middle of the tongue with a little harder pressure. Maintaining an even pressure, slide the finger down to the epiglottis ring or until you feel you have reached an equal distance to where your left hand is located. Now, hold both hands still for a second or two. Give three rather hard presses inside with your right finger, at the same time pressing upward with your left hand. After the foregoing is done, quickly vibrate right and left with the right finger still holding the left hand firm. When withdrawing the right finger, keep pressure on tongue to raise the tongue. See instructions under General Technique No. 8. Have patient gargle with a half glass of water with a little lemon juice added.

Epilepsy. - Under General Technique No. 2 was given the physiological process of the production of a state of temporary unconsciousness known as epilepsy. The following is supplemental.

(1) That clonic convulsions arise from the cerebral motor cortex, and that tonic convulsion arises from the lower mechanisms in the period immediately succeeding an injury to the cortical motor mechanisms.

(2) Carotid Sinus: The syncope is caused by dilation at the proximal end of the internal carotid artery, situated at the angle of the jaw. It is associated with the glosso­pharyngeal and hypoglossal neoplasms, aneurysms, and coronary sclerosis in the conducting systems and may cause a physiological change creating a fall of blood pressure with consequent anemia and anoxemia of the brain with collapse.

(3) Gastro Intestinal Tract: Many patients show abnormal functions of the stomach or intestines.

(4) Respiratory: Many patients have diminished respiratory ventilation.

(5) Circulation: A large proportion of patients have cold, clammy, or cyanotic hands and feet, and an examination of venous blood demonstrates an abnormally low oxygen saturation. Consciousness is lost when the blood leaving the brain is less than 30% saturated with oxygen. This being the consensus of opinion, we follow this procedure and have had good results.       `

Treatment. - Prescribe Diet No. 1 for three weeks with plenty of the iron foods. In addition, give persistent treatments for months twice a week, using all the General Techniques with emphasis on the Lake Head Recoil Adjustment and parathyroid and thyroid glands, which are always affected in epilepsy.

Thyroid Condition. - Space does not permit going into details concerning thyroid conditions. The coagulation of blood within it, causing hypertrophy or the lack of blood supply causing atrophy are the two types that really matter here. One is due to injury by shock causing a sudden constriction of the vasodilator nerves and an excess of vaso­constrictor nerve activity with a consequent anemia and anoxemia. The other is caused by excessive waste and toxic matter which create an active congestion and a corresponding swelling.

Treatment:- In addition to the regular treatment a physician gives, add the General Endo-nasal, Aural and Allied Techniques with emphasis on No. I0.

In concluding this book on Endo-nasal, Aural and Allied Techniques, the author would like the reader to bear in mind that what has been written here is an effort to aid the manipulative physicians to become more useful in a field of healing which hitherto was considered outside of his sphere of practice.

There were not many sign posts along the road to assist in the preparation of the material for this book. The techniques were born of experience and experimentation. The volume was large in its beginning, but as the science was developed, its size dwindled to the bare essentials. Further research by members of the Endo-nasal, Aural and Allied Technique Society should produce more facts and better techniques than those given here.

The author would suggest that the book be read through several times, then carefully studied by sections. Bacon said, "Some books are to be tasted, others to be swallowed, and some few to be chewed and digested."

The author has but one wish, and that is, when this book is opened, it will be opened again and again with anticipations of pleasure, and when closed, it will be closed with profit.