Osteopathic Technique
Dr. J. Martin Littlejohn, Ph.D., M.D., D.O., L.L.D.
Date Unknown













1. The main thing is to know the history. Whether or not periodicity in the case, applies particularly to functional diseases, Object is to avoid spasms etc., before they come on. Find out what causes periodicity as irritation etc. In treatment to abort treat just before the condition is due, this is true of different types of heart diseases, as regurgitation of the heart.

2. Find out weak and strong points in patients system, history of diseases good way to know this. Many times the best way to strengthen weak parts is to make the strong parts stronger. Try to find out by questioning and by reasoning what relation previous diseases have to present disease. Find out in each particular case the strength and weakness of the blood and lymph system is predominate, in later life blood system becomes predominate. Note tendency to explosives.

3. Find out the susceptibilities of the nervous system, we can discover ways and means of aborting disease, especially nervous diseases.

4. Find out the different influences or effects that are caused by changes, as, changes in diet, changes in the time of taking food of resting periods, etc.

5. Object in diagnosis is to see whether the condition is physiological or pathological. Here we have weakness and strength of the system brought out. To strengthen heart, tone up heart from weak side, example, in the vast majority of the cases the trouble is on the sympathetic side, that is, it is over-active. Heart diseases are mostly heart habits. Heart life is acceleration and inhibition. Best thing to do is to inhibit its function, this is also best for sick children, same true of nervous patients and dipsomaniac patients. All diseases of children are on sympathetic side, tone down through the cerebro-spinal system. Quiet restless children by articulating the spine lightly, the average child can be put to sleep by the manipulation of the head. Read Halleck's "Education of the Central Nervous System".

6. Find out the condition and the extent of the intoxication of the system. One reason why paralysis agitates cannot be cured is that the cells are in a state of toxicity. Overcome intoxication by persistent nutrition. Auto-intoxication and hetero-intoxication are terms applied to two different means of acquiring diseases. In most cases of intoxication the excretory functions are abnormal and when abnormal attempt to restore. As a general rule the intoxication settles in (a) weakest point, (b) most over-worked point, all, (d) in injured part and field of traumatism; also filed of surgery. Treatment must be according to the kind and extent of the intoxication. In all cases of auto-intoxication we can deal with intoxication without any assistance from drug line, in cases of hetero-intoxication we can deal with these only in the toxicological field.

7. Physical examination and treatment are to be viewed from point of adjustment. In the field of the so-called osteopathic lesions there are three points to be looked into in particular:

        (a) Condition of adjustment of the structures of the body toward normal.

        (b) Harmony under the reign of vital force. (In treatment operate through nervous system.

        (c) Condition of harmony or disharmony in the elements or processes in the body. The elements equal the proximate principles, the processes are chemical, physical and vital. These three points include minute as well as crude structures of the body as heart, urine, blood, sweat, stomach, etc.

8. Note symptomatic condition in the history of the patient and try to form a diagnosis that will explain the symptoms. This is sometimes called the method of exclusion. In getting the history, get life history of the disease normal, as well as abnormal, try particularly to trace out the progressive development by (a) symptoms, (b) by changes in the patient as a whole; that is, if at one stage the patient lost appetite or the reverse, (c) by remission in the condition of the patient, that is, the reassertion of tendency to normal. Try to find out how the history of the disease processes taking place in the development has been modified by what the patient has been doing in the meantime, eating, resting, etc. There are direct and indirect differential methods; in direct method all symptoms point in one particular part of the body. In indirect method we differentiate weak, weaker and weakest organs. The value of this differential diagnosis lies in the field of therapeutics, there is an absolute rule which has no exception namely that all symptoms disappear in reverse order to their appearance, the last symptom disappears first. Note whether symptoms are at harmony or at variance with one another, in order to see whether the organism as a whole or only a part is disorganized, or whether one part is antagonistic to another part. The most serious condition is where one part is antagonistic to another part, in this case work to CO-ordinate.

Treatment. Based on Mechanic and Physiology; not anatomy.

1. Treat each case as if it were a particular case. How can you make an application to a particular case? It must be based on a theory of the disease in that particular case. It is of importance to find out whether the case is vaso-motor, lymphatic, nervous, cerebro-spinal or gastro-intestinal or intoxication and the treatment is always directed back towards your theory. If the case is lymphatic or cerebro-spinal give general treatment, if the lymphatics are weak treat down.

2. In the treatment object is not to replace but to adjust structures, activities or environments. Articulation is the basic principle of treatment; in doing this:-

    (A) Articulate spine to adjust spine to the ribs in this way always reach general blood and nerve supply.     Always articulate spine to set ribs. Each individual tissue has its own mobility and articulate in relation to contiguous tissues.

    (B) The objective point in treatment is not to relieve a symptom or soothe a condition of pain or remove pressure or irritation, but to make the patient, as a whole, better. There is a tendency in osteopathy to treat only in one field; to get the best results treat as a whole.

    (C) Always remember that manipulation is a mechanical means towards a physiological end. Physiology is the foundation of life and unless treatment is directed towards the physiological it is no good to patient. A mechanical treatment to be effective must be converted into a physiological equivalent.

    (D) Sometimes necessary to give general treatment, in this case the specific treatment will not cure. The lesions in many cases are secondary, the spine is not only the origin of disease but also the expression of disease. There are several conditions that call for general treatment:

    (1) Cases in which find general superficial rigidity, here necessary to produce general relaxation. Begin relaxation at a point as far from seat of pain as possible.

    (2) Cases of static condition of general superficial circulation or some part of the superficial circulation for example pulmonary congestion. In this case we must stir up the general superficial circulation. (Treat 2-3 cervical and 2-3 dorsal for eyes). (a) General relaxation of soft tissue over the body. (b) Strong articulation at 3-4-5 dorsal.

    (3) Where the nervous system is in a state of in CO-ordination or some part is under or over-active, or where some superficial condition causes the peripheral nervous system to be under or over-active, in this case stir up the general nervous system, especially in its peripheral distribution, by articulation of the spine, to get at spinal and sympathetic systems.

    (4) The body requires to be prepared for specific treatment. In nearly all cases whether acute or chronic, it is necessary to get relaxation of the muscles, ligaments and stimulation of the circulation. In some cases this general treatment will correct the specific conditions.

    (5) Cases of high or low circulation as applied to pressure, found in about fifty per cent of the cases. Pulse is hard or soft, Relaxation, followed by stimulation of circulation to and from point of obstruction, equalizes circulation.

    (6) Cases in which local condition depends on general or some wider constitutional condition, ex., asthma, in many cases the fifth rib on right side is involved, depending on condition, but the correction of the fifth rib may not remain corrected or the fifth on the right side may cause displacement of the fifth on the left side. Reason is that behind the local condition there is a constitutional condition, namely, condition of the spine or the general lung or chest expansion. The treatment called for in this case is treatment of the thorax as a whole, a general respiratory treatment.

    (7) In hyperemia, hyperdilatation or hyperacidity localized in some particular field as stomach or liver, the reason that this requires a general treatment is that this involves not only the stomach or liver secretion but also the entire secretory system.

    (E) Treatment should not be too hard, lighter treatment if it satisfies the condition is better. The force of the osteopathic treatment is a matter of skill. Physical force results in bruised tissues or straining of the soft tissues. The proper treatment of even bone takes place through the attachments of soft tissue, the vital element in the adjustment of the body structure is the soft tissue.

    (F) The best method of adjusting structures is that of articulation, this applies to bone, muscle, cartilage and even blood and nerve supply. It is not good policy to push a bone back into place forcibly, and in pushing a structure into place it is not good to tear or rupture structures. (Referring to Dr. Lorenz's method of tearing tissues to set dislocations). Articulation is the best method, because first it results in no injuries to tissues; and second, articulation always appeals to function, the primary law of tissue life is mobility. This applies to both organs and tissues, most applicable in the field of gynecology. In gynecology lay down this one principle; the less you can do of local treatment the better in the replacement of the organs. Let the organ itself alone unless it is so displaced as to require replacement and probably not one in a thousand need this. The organ if displaced is disarticulated. Apply the articulatory treatment to the attachments of the organ, this applied to the uterus, kidney, spleen, etc. In the replacement of the organ or in relieving the adhesions of the organs depend on:-

    (1) Supports and attachments of the organ.

    (2) Depend on nerve supply controlling activity of the organ, every organ has vaso-motors; stir up this action.

    (3) Depend on blood supply. (To restore free circulation between the uterus and rest of body is rotation of limbs. Pelvic congestion. Rotate fifteen to twenty times inward to relieve venous statis, then outward).

    (4) Correct internal cavity pressure, this is done by (a) toning up the muscles and attachments of the organ; (b) correct the adjustment of the organ in relation to the trunk of the body and to the organs. The more you work on the organ directly, the more it loses its tonality. If an organ is in an atonic state it will never stay in its place. The uterus is not supported by its ligaments, the anatomy of the uterus and its attachments demonstrates that they are lateral and downward, not upward. This means that the uterus, instead of being a supported body, is a floating body, and the only way to correct the uterus is to restore the normal condition of the structures represented by the abdominal and pelvic cavities. In this tubular structure of the pelvic cavity, the floor is the perineum, and the roof is the stomach and the intestines. The same principle applies to the kidneys, the liver and the spleen.

    (G) Each case must be treated as an individual case.

    (1) In many cases one cannot diagnose condition if by that is meant giving it a name. The point is to get the cause and if there are several causes differentiate between them as to primary and secondary.

    (2) The patient is to be treated as a whole, that is, in treating a particular condition deal with the patient as an organism, ex., in typhoid fever, do not deal with the small intestine alone, but deal with the derangement of the entire secretory apparatus; in pneumonia relieve entire lymphatic system. This is the only way you can reach pneumonia and if you can stimulate this strongly enough your patient will get well. One of the best symptoms is the appearance of perspiration. Why do we have to reach this lymph system? Because of differentiation of the vaso-motor in pulmonary field.

    (3) When all the typical lesions in the etiological field are found, classify as to primary and secondary and then begin to treat secondary so as to get back gradually to the primary. For ex., in appendicitis we have behind the condition, constipation, liver disorders, dyspepsia, and the appendicitis is a complication that develops in connection with these preceding conditions. There are many cases in which the one (i.e. primary) is treated without the other, for ex., in appendicitis you must remove the cause. There is no such thing as "Recurrent Appendicitis" either the primary or the secondary condition only has been cured and the other condition remains, you must remove the cause. Remove the last appearing condition, the main point is to get rid of the secondary condition before we deal with the primary. The removal of the primary cause without the removal of the secondary, as a general rule, will cause some complication. A complication implies first that the original disease is not cured, and second, that the disease is side-tracked along some weaker lines of organs or structures or functions. There are some cases in which we treat the primary before the secondary condition. Summary in one general rule:- in all cases where secondary condition represents chronic condition resulting from or kept up by original acute condition, the original acute has become the chronic. Two exceptions to this:-

    (a) The chronic of previous acute primary; example, curvature of spine of traumatic or organic origin; primary and tertiary conditions on the basis of toxic conditions, ex., curvature of the spine. It may be classified under two different headings, traumatic and organic. The organic is more frequently found being caused by some original weakening of some organic structure. In this case condition persists and we must get back to the organic cause, and not depend on articulation of the spine, which is the secondary condition. Tertiary conditions may come up, that is, acute manifestations of previous conditions, for ex., syphilis, in this case proceed as above. No use to attempt to cure the acute manifestations leaving the original conditions in primary form, remove that and then work down through the chronic and double chronic.

    (H) In treating patient always make patient assist in treatment, this does not necessarily mean the assistance given by the patient at the time you are giving the treatment. Here distinguish between active and passive treatment.

    Active of two types:

    (1) Absolutely active in which the patient assists certain passive movements, ex., the patient assists relaxation of the muscles of the abdomen by the active contraction of the muscles of the abdomen. Illustration, while kneading muscles have patient hold the breath, breathe deeply either exhale or inhale. Deep breathing when expanding the lungs.

    Passive treatment is given by the operator with the patient purely passive, this is the typical osteopathic treatment. Have your patient hold breath while inhibiting over the abdomen. The assistance of the patient is mainly in the field of exercise. The active exercise field is a field which as yet is undeveloped, chief point to note in this field is that:

    (1) Exercise should always be prescribed for patient specifically.
    (2) The exercise must be physiological, not physical.

    (3) In dealing with muscles it is necessary to exercise certain groups as in paralysis, locomotor ataxia, here we have to re-educate muscles on the same principle that a child is taught to walk. In some cases of paralysis one of the manipulations is stretching the muscles to be followed by some kind of active exercise, that will bring the will power down into the muscles. In this case best thing to do is first make the muscles do the work involuntarily (passive movement or treatment) second followed by making patient attempt to do it voluntarily while it is done involuntarily. For example, to touch the forehead with the hand, first lift the hand to the forehead (with patient passive) so he will understand just what you want him to do, then have the patient determine to help you and try with all his strength as you slowly lift the arm the second time. Same applied to body as to arm and limbs and different parts of the body.


    Suggestion as a therapeutic means or agent. Here we have auto-suggestion and aleino-suggestion. Suggestion is a means of reaching the voluntary side of the organism. Simple suggestion is applied continuously. Suggestion is not necessarily applied in the hypnotic sense, yet it is the same, no matter by whom it is applied.

    (1) In the application of suggestion the main point is to make the suggestion as simple as possible, also the suggestion must conform to the individuality of the patient.

    (2) In the use of suggestion, where the mind is involved, use the strong part of the mind to help to strengthen the weak part of the mind. If a patient has a hobby or is a maniac along one particular line try to open up some new field in his mental conception and perception.

    (3) Use suggestion to replace the principle idea in the mind by a substitute on a similar plane ex., when some people are sick they are sure they are going to die, give them something definite to life for (mother and her child, mother must live for her child). You cannot make a negative suggestion do any good.


    Remember the strongest method of influencing is by suggestion; that is why it is good to make a patient adhere strictly to a particular day or hour of the day; it is the suggestive part of it, also the same in treatment. Make the patient think only a certain time to take treatment will do, it will strengthen the individuality of the patient.

    In prescribing exercise always prescribe for the weaker parts of the organism, ex., paralysis is a disease which affects the motor side but paralysis nearly always starts on the sensory side. In paralysis the sensory side is the weaker side. Paralysis seems to come on suddenly when it in fact takes weeks, months and sometimes years to come on. The sudden onset of paralysis is the transference from sensory to motor side. Paralysis comes on suddenly when it comes on the motor side, but slowly on the sensory side. Make sensory stimulation the basis of movement, example, heat. The hypersensativeness of the muscle is the basis underlying the condition behind the paralysis. If you get the condition in the hypersensitive stage limit the hypersensativeness either from the active or passive side. Example, if the muscles are hypersensitive over-exercise them because that takes away the excessive impulses for example in writers cramp treat it osteopathically and make patient begin to write with the other hand, this takes the strain off the hand with the cramp and puts the strain on the other hand. In cases of hypersensativeness where the arms get sufficient exercise or where both arms are involved in cramp, give exercise for the lower limbs. Consequently in the field of diagnosis the test of muscles in paralysis is the test of reflexes. Test for sensitiveness or the degree of sensitiveness various ways test is applied:-

    (1) Use of heat and cold in minute form called heat pencils and cold pencils.

    (2) Pricking or pinching the tissues done by forceps.

    (3) Dynamometer test, the principle is to get grade of work a muscle can do in so many meters.

    (4) Ultimate test of muscle is the electrical test, this is used to discover the presence or absence of degeneration. Physiology calls it the negative variation of the muscles. Principle of this is that if the central nervous system is cut off from the peripheral nervous system, consequently no positive reaction when electrical test is applied, but get a negative variation. This is the test for locomotor ataxia. The curability or incurability of locomotor ataxia depends on whether the central nervous system is involved, if the central nervous system is involved the case is incurable, if the peripheral nervous system is involved the case is curable, no matter how long it has been developed. The last point is in connection with sensitiveness or hyper-sensitive. Test by pressure or friction.


    Limit the hypersensitive condition either from passive or active side, example, in the hypersensitive state the muscles get more stimuli than they should, consequently:

    (1) Exercise other muscles to take away impulses from hypersensitive muscles and distribute them.

    (2) To overcome hypersensitive condition:-

        (a) Inhibit directly over the muscle itself.

        (b) Stir up other muscles not involved by means of some passive treatment as kneading, rubbing etc., having patient in passive condition. One reason for the existence for these conditions is toxemia, the toxic elements depositing:-

    (1) In the field of the muscles.

    (2) In the field of the nerves.

    (3) Greatest evidence of this toxemia is found as a reaction in the tetanic condition of the muscles. The net result is congestion of the nerve where it leaves the spinal foramen enlargement. Hot water palliative in writers cramp. Put hands in water as hot as can be borne. There the nerve leaves the spinal foramen enlargement, the result is that the passage of impulses is prevented to and from the central nervous system. This leaves the peripheral arc complete but the peripheral 1 central arc broken. Example, apply electricity in case of locomotor ataxia at the point of the spine involved (this point is the point of the highest girdle pain) the result is there will be motion of the muscles in the lower extremities and this motion cannot be controlled by the patient voluntarily.

    Traumatism in some point in the peripheral system is the same as toxemia, this also may produce locomotor ataxia. In the majority of the cases the primary cause is obstruction involving blood circulation, and in the earliest stage can be treated by CO-ordination deep and superficial circulation. (This also applied to pneumonia). This is the secret of aborting diseases in whatever form it appears, that is if you can diagnose a disease when it is in its primary form it can be aborted by controling circlation either capillary superficial and deep circulation. Diseases can be aborted if we can get the disease in the blood stage of its symptomatology before it has passed on to the stage of neurosis. The secret of abortion of diseases is in CO-ordination, in some cases CO-ordination is difficult because of the natural defects of certain circulation fields, example, pneumonia as a tendency is present in every one because of two reasons:-

    (a) The vaso-motor condition of the lungs is imperfect in every one.

    (b) Because of the inequality between the systemic and pulmonic circulation. This is the reason why from the osteopathic side lay so much stress on circulation of the blood and this co-ordination of the spine. In co.-ordination from spine we attend to circulation:-

    (a) From its vaso-motor side.

    (b) In connection with the splanchnic or visero-motor side.

    (c) Through sympathetic system in relation to the spinal cord circulation itself.

    Note: 1/100 part of the blood is in spinal cord.

Fryette Technique

    The oasis of the spine is the sacrum and is the point from which to work in diagnosing and treating spinal lesions.

    There are two centers of gravity lines:-

    (1) With reference to the body anterior posterior.

    (2) With reference to the body from side to side.

    Owing to the locking of the lumbar vertebrae there can be but five lesions of the lumbar. (1) Posterior. (2) Rotation. (3) Separation. (4) Inpaction. (5) Tilting. Anterior or lateral lesions impossible.

    In the dorsal there may be a sixth form. (6) Lateral.

    Same in cervical, except, axis is only one that can be anterior with reference to one above. Atlas is only one that can be anterior with reference to one below.


    Acute always shows tissue lesions and usually bony lesions.

    Chronic cases always have bone lesions.

    To set innominate.

    (With reference to bodies of vertebrae).

    To reduce lumbar rotation, - patient seated on stool, stand on side of concavity and with one arm grasp upper chest of patient and give flexion and extension while the heel of the other hand makes pressure on the prominent transverse processes on side of convexity. Give thrust just when the patient is relaxed.

    Patient on table. To correct by holding spine of vertebrae above the rotated one. Place patient on side of rotated spines up. Have assistant take upper arm of patient and draw it to the front and down, putting the spine on a firm stretch. The operator stands at back of patient with one hand hold the spine of the vertebrae (right above the lesion) from below, with the other he takes the flexed legs and after getting relaxation rotate the whole pelvis and lumbar region below the other hand, this throwing the rotated vertebrae back into line.

    Not good practice to try to give this correction from the other end of spine because you could produce lesions in the dorsal region.


    In the field of diagnosis the first point is the condition of the scalp. Two possible conditions, hyperrigidity and hyperelaxation. Main point in relation to scalp in is relaxation to headaches, best way to treat the scalp is at the back of the neck at the base of the occipital region.

    1. Congestive Headache:

    This is commonly caused by rigidity of the scalp. Here the rigidity is accounted for by "Head's Law" congestion of blood and cerebro-spinal fluid in the cranial cavity, this involves:-

        (a) The venous blood fields represented by the sinuses.

        (b) The meninges of the brain particularly the pia mater.

        (c) Ventricles of the brain and subarachnoid spaces, in relation to lymph cushion. In this congestive headache there is partial suspension of the three rhythmic movements and of the peristaltic movement of the brain substance. Rhythm of systole of heart. One corresponding with the inspiration part of respiration. One corresponding with vaso-motion, all over the body. Basis of reflex headache 3rd, 4th, 5th dorsal, 2nd dorsal to 2nd lumbar. In differentiating between different factors that come in connection with congestive headaches, the type depends on which form of blood and cerebro-spinal fluid predominated:

    (1) Venous blood involvement caused general fullness all over the head, a sense of fullness with sensation of stupidity and ache, from within out, following particularly along the longitudinal sinus.

    (2) Pia mater involvement or arterial blood condition gives patient pain within the head from without in, from the superficial towards deep portion of the brain. Here symptomatology of congestion, example, epistaxis, blood shot eyes, stupor, dizziness, fainting etc.

    (3) In the cerebro-spinal fluid involvement find delirium, unusual or horrible dreams, rigidity of the suboccipital region and sense of weight, (distinguishing symptom) in the head as if the head were actually being weighed down into the neck.

    Treatment in dealing with these conditions:-

        (a) Always begin by relaxing muscles from base of neck to occipital region.

        (b) Relax the scalp from suboccipital to forehead in giving this treatment:-

        (1) Light rolling treatment with fingers, followed by deep inhibition all over scalp from the base of the neck upward.

        (2) Vibration following same path, friction in place of vibration if it does not cause special pain.

        (3) Rotation of the fingers over the scalp rotating the tissues as much as possible, beginning at the base of the head.

        (4) In cases of dry scalp (dandruff) apply rubbing or friction or vibration before giving inhibition, (before (1)) in giving this give in stroking fashion.

        (5) In the dry scalp also stimulate the lymphatic for head over the transverse processes of 5-6-7 cervical vertebrae upward (7-6-5) by articulation.

        (6) If the scalp is exceedingly relaxed begin by giving strong inhibitory treatment. In this case begin at forehead and move towards base of occiput.

        (7) If the relaxation amounts to congestion give strong inhibition in the suboccipital region of the neck before giving (6) treatment.

        (8) Extreme relaxation indicated by general lymphatic derangement, the blood congestion being produced by reaction from lymphatic system, in this case:-

            (a) Treat lymphatics by strong inhibition before treating sub- occipital in order to drain away lymph and lay down basis for relieving congestion 7-6-5 cervical.

            (b) Also raise clavicles, first, and second ribs, using the arms as levers, diagonally out and upward.

            (c) Treat downwards and towards and through the thoracic region from the 7th cervical vertebrae.

2. Pressure Headache

    When the involvement is within the cranium, main point in relieving brain headache is to reach the circulation to and from the brain.

            (a) When the brain is over supplied with blood begin treatment by giving strong pressure between suboccipital and forehead tipping the head backward at the same time, this backward movement of the head starts the cerebro spinal fluid in second and third lumbar begin at that point.

            (b) Follow this by strong vibratory treatment (good in paralysis), following the path of the longitudinal sinus, posterior to anterior.

            (c) Vibratory treatment around the sutures this reaches the sub arachnoid spaces and the lymph channels, the reason for this is that the brain is built on lymph fluid foundation. All through life brain tests on lymphatic and the direction of both blood and lymph is determined by lymph cushion. If this cushion is kept soft and in a fluid condition, the cycle of movements of the fluids in the brain is kept normal; if on the other hand, the cushion becomes rigid (as in intoxication), or if it rises upward from the base of the brain, then the fluid circulation within the brain is interfered with; treat by vibration over the sutures and pressure from sub-occiput to forehead.

            (d) Strong vibration right over the forehead itself will reach frontal sinus and the circle of Willis if it is made deep enough, this circle of Willis represents the center of the brain circulation. Use the hands, never use mechanical vibration in connection with the head in relation to the brain.

            (c) In relaxing the muscles of the neck do not treat patient sitting up in cases where there is heart trouble because liable to disturb heart and cause vertigo. Always test for yourself for possible presence of vertigo, have patient standing, then move head around laterally as far as possible, then shut eyes, then turn head back to normal and open eyes, other side the same way, if vertigo is present will stagger when eyes are opened. In treating this type -

    (1) Strong inhibition over muscles of the neck either by catching at the centre of the muscle and by stretching it or by general treatment downward along muscle from its origin. (Frees blood supply).

    (2) In most cases of headache of this type there is a thick layer of fat in the basi-occipital region, relax by inhibition and kneading from back of ear towards the posterior median line. In treating muscles treat upward from base of neck give circular movement from antero-lateral aspect of neck to postero-lateral, then up towards and over head.

3. Lymphatic Congestive Headache

    This is due to congestion of lymphatic fluid, here the congestion is outside of cranium, especially in the neck, the headache in this case is the reaction from the excess of lymph contiguous to the head.

    Treatment in this case:

        (a) Pressure between occipital region and forehead, tilting head backwards as far as possible. Apply pressure from anterior to posterior, note that it is not from posterior to anterior, but from anterior to posterior.

        (b) Stimulation of the circulation of arterial blood by friction or vibration or both over forehead just above eyes to reach Circle of Willis or articulation of the neck or rotation of the head or stimulation of the carotids or all of these in combination.

        (c) Stimulation of lymphatic circulation by articulation of the 5-6-7 cervical vertebrae, rotation and elevation of clavicle and first rib.

        (d) This is analogous to what is called the "jag headache", you can overcome the effects produced by alcoholism if you treat in the delirium trements condition, the after effects, or the headache is a semi-coagulation of the cerebro-spinal fluid. Treat this condition same as in alcoholism, that is stir up lymphatic system all over body.

        (e) Through treatment, articulation, in lower dorsal and upper dorsal simultaneously, lower dorsal and upper lumbar simultaneously, this reaches cerebro-spinal fluid. Drain cerebro spinal fluid out of brain. Rhythm of brain controlled by cerebro-spinal.

4. Vaso-Motor Headache

    In this case the head is either anemic or hyperemic, the congestive condition involving the blood. Always reaction to vasomotion in body.

Treatment in anemic headache.

        (a) Begin at 4-5 dorsal relaxing spinous muscles upward to occiput. Patient on back.

        (b) Follow this by relaxing scapular and interscapular muscles.

        (c) Articulation of the vertebrae from 4-5 dorsal upward.

        (d) Give scalp treatment from posterior to anterior.

        (e) Articulate hand on neck.


    In regard to the hair one thing to note in dryness and falling out of the hair is not to treat too often, to treat too often increases the tendency to fall out because the reaction from the deficient circulation will increase the dryness of the hair. Do not treat more than once a week.

    (1) Treatment of the scalp once a week so as to produce relaxation of the scalp, best methods in treatment are vibration and circular rolling movement of the fingers over the scalp.

    (2) The hair aught to be washed about once in two weeks and always by the use of salt and water slightly warmer than tepid water, this will cause absorbtion of the water and salt which tends to restore color and tonicity. Dry by means of a course towel or flesh brush (not electric brush), rubbing the hair until dry, not using any artificial heat. Give sun bath after the hair is dry, drying the hair in the sun bleaches it and causes the hair to fall out.

    (3) Do not use any ointment or lotions. In regard to the use of oils, where the hair is excessively oily use alcohol or lavender water for cleansing the hair, if it gets sticky use eucalyptus water in connection with warm water bath. If hair and scalp is dry use olive oil not on hair but on scalp or use "glycothymolin" heated with warm water.

    (4) In hyperemic condition give similar treatment in reverse order, instead of stimulation give inhibition to scalp from anterior to posterior, from subocciput downward instead of up, strong inhibition in lower dorsal region, sweat and lymphatic fields. Where there is too great relaxation of the scalp find rigidity of the facial muscles, for example, in many of the types of neuralgic headache the vice versa of this is also true. In treating headache of this kind first begin by relaxing facial muscles, same true in treating the scalp:-

        (a) Inhibit facial muscles until relaxation obtained, in any case of muscular rigidity, if you want to get permanent results, you must inhibit in the long muscles as nearly as possible in the centre of the muscle, follow this by

        (b) Inhibitory treatment followed by slow rotating treatment all over scalp from anterior to posterior. The reason why you begin at the anterior is because the rigidity is anterior, along the facial muscles.

        (c) Articulation of the spine from the 5th dorsal upward towards occipital region.

    Note: - In neuralgia of the face the best thing to do is relax the facial muscles. Hair exuding a fluid substance from itself - use alcohol or lavender water.
Muscles of the Face

    These are rigid in neuralgic headache, laryngeal troubles, bilious conditions, diseases affecting the salivary glands particularly when parotid gland is involved, hyperrelaxation of the scalp, hyperemia and enema of the brain.

    In cases of facial muscle rigidity there is concentration of the muscles of the face, the focusing center of contraction being the angle of the jaw (inferior angle). This causes a drawn condition of the face towards the angle of the jaw, sometimes taken for facial paralysis, example, in some cases of biliousness there is sometimes almost a paralysis of the facial muscles causing an effort in opening the mouth.

    (1) In this case articulation of the spine upward from lower dorsal relaxing spinous muscles at the same time, here vaso-motor field for the face.

    (2) Relax the facial muscles by application of tension at the angle of the jaw on opening the jaw. Stand at the head of the patient and catch with your fingers under the angle of the jaw, and pull up tight, have patient try to open the mouth, it may be impossible to open the mouth but the effort will tend to relax the muscles.

    (3) Give inhibition followed by rotatory treatment of the facial muscles beginning at the forehead along the angle of the nose, and treating downwards to the angle of the jaw.

1. The face and facial muscles are involved in many forms of diseases, example, in all pulmonary troubles, in acute tuberculosis and in pneumonia a drawn condition of the muscles of the face the center of origin of drawing or the focusing centre of contraction in this case being the chin, so that you have what is sometimes called a "pointed face". In this case give same treatment as in previous one:

        (a) Beginning with spinal treatment.

        (b) Follow by treatment to open up the circulation.

        (c) Treatment to relax muscles, inhibition and rotation ending at chin instead of angle of jaw.

2. The facial conditions are also found in gastro-intestinal and pelvic disturbances, in all of these there is a tendency to a drawn condition of the face, the focusing centre being in this case the forehead, so that you will find the facial muscles drawn up towards the forehead, the "drawn forehead" it is sometimes called. In this case give similar treatment instead of downward treat upward. (Palliative).

3. In some cases have to treat headache through the facial muscles, in these cases the headache is reflex and in some cases the headache takes in only part of the head, example, in bilious conditions find drawn condition of the face almost always on the left side, that is to say in acute form there is a condition exactly like hemiplegia, there is one different point, the movement of the tongue, there is no interference in that case with the movement of the tongue. In biliousness the tongue is dry, you could not depend on that as a differential point. In some cases the focusing centre is altered, example, sometimes the tongue. In biliousness we find at times two centres, one facial the other the tongue.

4. Another condition we require to take note of, the drawn condition of the muscles of the face the contraction passing to the scalp, and the region of the occiput becoming the focusing centre. This is found as an important diagnostic point in all nervous diseases particularly where the spinal cord is involved, this is exaggerated in spinal and cerebro-spinal meningitis, where the tension of the head is so great that the head is drawn backwards.

To overcome this:

    (1) Articulate dorso-lumbar region, beginning at the 9th dorsal articulate downward through the lumbar region. There is a static condition of the cerebro-spinal fluid, the congestive condition starts at the cauda equina. Outside of the nervous disease proper you will find this contraction at the back of the head, that is the focus in the scalp rather than in the occiput, this is a typical condition in Frysipoles.

    (2) Relax muscles and articulate vertebrae upward from lower dorsal to sub-occipital region.

    (3) Articulate (flex, rotate, etc.) the lower extremities to stir up circulation in the lower extremities and to and from the trunk.

    (4) Treatment of the facial muscles taking the forehead as the focus of contraction (that is treating up towards the forehead).

    (5) Scalp treatment from anterior to posterior. Many of the cases appending acute nervous diseases could be aborted by following this line of treatment.

    Dr. Hamlin's formulae of stimulation and inhibition and results as shown by sphygmomanometer.

1. Stim. 1 to 6 c - Vaso-constrict - H.B.P. - L.P.R.

2. Inhib. 1 to 6 c - Vasi-dilation - L.B.P. - H.P.R.


3. Stim. 6 to 12 d - Vasi-dilation - L.B.P. - H.P.R.

4. Inhib. 6 to 12 d - Vasi-constrict - H.B.P. - L.P.R.


5. Stim. 4 & 5 L - Vasi-constrict - H.B.P. - L.P.R.

6. Inhib. 4 & 5 L - Vasi-dilation - L.B.P. - H.P.R.

    Stimulation of the 6 and 7 dorsal, increases blood to stomach, increases secretion.

    Inhibition of 6 and 7 dorsal, decreases blood to stomach, decreases secretion.

    The two great fields of eye disturbances are represented by:

(1) Vascular disturbances, extending all the way from simple congestion to complete atrophy of the optic nerve.

(2) Interference with the nerve supply, producing symptomatic conditions of the eye really not eye diseases.

    Eye diseases in the proper sense of the term are but symptomatic conditions of the eye. Among the causes of the eye diseases classify:

        (a) Traumatic including direct injury to the eye.

        (b) Injuries to the head causing reflex disturbances in the eye.

        (c) Osseous and ligamentous lesions in the cervical and upper dorsal these vaso-motor and those in the upper cervical sensory.

        (d) Muscular of soft tissue contractions or relacations of upper dorsal these vaso-motor and those in the upper cervical, sensory.

    These last two (c) and (d) represent obstruction to either blood or nerve supply or both. In regard to blood supply, the supply to the eye comes from the opthalmic artery, a branch of the internal carotid; the drainage of the eye takes place through the ophthalmic vein which unites with the jugular vein along the side of the nose, this jugular vein drains into cavernous sinus at base of cranium, outside of the oranium drainage is established -

    (1) Through the internal jugular.

    (2) Through the subclavian and innominate veins.

    (3) Superior vena-cava in relation to the heart.

    It is very important to keep in mind the accessory drainage of the eye which serves the best purpose in drainage of the eye from the mechanical side when nature is weak, that it is an emergency field, drain through the superior and inferior palpebral veins and through the facial vein into the internal jugular, emptying tinto the internal jugular just below the angle of the jaw. This will explain why we treat down towards the angle of the jaw in the treatments of the eye.

The muscles of the eye

    The muscles of the eye act in opposition to each other (a) in changing the focus of the eye; (b) in determining the accommodation of the eye to light; (c) the muscles also act as protectors of the eye chiefly through the eye lids, that is, by opening and closing the lids to protect the eyes (1) from foreign substances; (2) excessive light; (3) excessive secretion.

    The principle nerves in connection with the eye are the optic, motor oculi, patheticus, abdusens and branches of the facial nerves, also sympathetic fibres in connection with the superior cervical ganglion and first dorsal ganglion of the sympathetics, the medium through which these nerves are distributed being the lenticular ganglion. The central origin of the nerves is in the medulla, the medulla representing three functions:-

    (1) The vital processes of mobility.

    (2) Co.-ordination of movement in determining accommodation, (a) centrally from the medulla, (b) coordinately from the cerebellum, the optic thalami and corpora quadrigerrina (space or angularity of vision).

    (3) The reflex centre field particularly in antagonistic action of the muscles to overcome abnormal changes in the eye.

    The medulla therefore as a centre is self adjusting in relation to the eye.


    The lesions found in eye disturbances are 1-2-3 cervical; 2-3-4 dorsal; 3-5 cervical posterior. Third dorsal representing cilio-spinal. Fifth cervical to fifth dorsal representing anterior condition of the whole field. The atlas is nearly always involved in congestive conditions of the eye, granulation’s etc.

    The muscular disturbances are of the nature of strabienus following supra and infra orbital nerve field indicated by tenderness over foramen, forehead and facial tension. The contraction of the forehead is intense. The optic neuritis involves engorgement of the veins with involvement of the sheath of the optic nerve.

    Reflex lesions. We get reflex lesions in the congestive and muscular conditions of the eye, example, lesions in stomach area, uterus, ovary, heart, intestinal, etc. there are two types of lesions:

    (1) Original lesions corresponding with the visceral disturbance; is transmitted (a) through sympathetic system, (b) through the spine, (c) blood in change of pressure, (d) special sense nerve.

    (2) The reflex lesion corresponding with the eye involvement generally this is nervous and blood involvement’s as in toxemia’s, (disturbances as in chronic constipation).

    General points in regard to eye treatments.

    (1) You can get a more direct effect upon the eye by treatment than any other organ in the body, that is by direct stimulation and inhibition.

    (2) Inhibitory pressure on the back of the neck, 2-3 cervical field represents visceral contraction field. This is given on both sides of the spinous processes causing dilation of the pupils of the eye, this is a very important point which renders it unnecessary to use, as oculistedo atropine. In the average case the dilation will be kept up from three to five hours by an inhibitory treatment, this varies in individuals, some retain the condition longer than others. Determine the length of the inhibition by the response, there may be blood causes that you must correct by equalising the circulation, but in average case you will get immediate results.

    (3) Relaxation by inhibition followed by strong stimulation of the muscles at the angle of the jaw, to stimulate the flow of blood away from the eyes, if the eyes are in a state of congestion.

    (4) If the venous blood is in a static state of if there is stasis of the lymph fluid strong inhibition at a point just beyond the external canthus of the eye will establish drainage from the eyes, outer angle of the eye one half inch towards the upper angle of the ear. This applies to lymphatic conditions of the eyes as puffy eyes except where caused by kidney conditions. If the condition is associated with the kidneys treat through the kidney. Puffy eyes generally indicates Bright's disease, though it may be diabetes, if from the kidneys the urine will show albumen, there is a tendency to become bluish. In both Bright's disease and diabetes the patient may become blind, in Bright's disease due to accumulation of fatty substance, in diabetes to cataracts. Taken in time it is curable by elimination, in many cases of diet, you can cure up a diabetes eye temporarily by dieting, when organisation takes place it is necessary to operate.

    (5) Strong inhibition of the second and third dorsal causes dilation of the eyes, this applies to (vasi-motor) the pupils of the eye. Stimulation at the same point will cause constriction. This is not true of (3) because at the second and third cervical there is only a dilator centre. Here (3-4 dorsal) there is rhythmic center of visero-motion in connection with the eyes. In this dorsal field we have a typical dilator and constrictor centre called the cilio-spinal centre, 2-3-4 dorsal taking in the entire field. Note this: - the strongest effects are gained by treatment on the right side because these fibers distribute themselves through the sympathetic system. In this distribution two things to note:

        (a) Third dorsal nerve sends out fibers passing through the sympathetic system to the muscular fibres of the iris. Rib relation to eye, 3-4 rib, common lesions.

        (b) The fourth dorsal nerve sends out fibers distributed vaso-motorily to the blood vessels of the eye; hence, the third dorsal nerve gives direct muscular dilation, the fourth dorsal gives vaso-constriction hence inhibition of this fourth dorsal nerve causes vaso-dilation.

    (6) The sensory fibres to the ciliary muscles, the iris and the cornea come from the nasal branch of the opthalmic branch of the fifth nerve, hence in cases of pain in the eye inhibit the fifth nerve along the side of the nose close to the eye, will relieve pain except in optic neuritic.

    (7) The accessory sensory fibres pass in connection with the short ciliary fibres from the ciliary ganglion (just back of eye). In this case pain is caused by over-stimulation of these ciliary fibres, causing a change of arterial pressure in the eye, this is relieved by inhibitory pressure in connection with the ciliary ganglion, lay the finger over the eye ball pressing eye ball gently back into the orbit against the ciliary ganglion.

    In summing up from the above treatments we find that: -

        (a) Nervous pain is relieved by treatment along side of nose and in general along face. (Manifested along muscle field).

        (b) Blood pain is treated directly over ciliary ganglion, pressure over ciliary ganglion.

        (c) Neuralgia pain of the stomach reflexed to the eyes is relieved by treatment along side of nose or any part of the fifth cranial nerve. This means that eye troubles can be traced back to the nerve and blood field as the direct fields of causation.

    For example, blood pain, congestive conditions - for example uterine congestion, or in connection with congestive headache, would be relieved by direct pressure over the ciliary ganglion through the eye ball itself. Give splanchnic treatment also. The direct causes of trouble in the eye can be traced to the regions that supply the nerves and blood to the eye. The indirect causes are to be traced to reflexes from diseases in other parts of the body as the abdominal and pelvic organs. Any soothing treatment to system will react beneficially on eyes.

    The eye processes the most delicate nerve mechanism in the body, and as such is more liable to derangement than any other organ or structure in the body, particularly when reflexes react on the nervous system.
Special Types of Eye Troubles

1. Myopia

    Here we have a condition in which the eye ball is too long and the rays of light are focused in front of the retina. All children are born with the condition of hypermetropia, the eye developing, under normal conditions, from the hypermotropia to emmetropia, the normal eye. If the child uses the eye too much or if the eyes are subjected to strain the eye balls enlarge slowly and as they enlarge the elongate with the result of myopia.


    Among the causes of myopia development is the effect caused by light thrown upon the eyes in the wrong direction or wrong angle. The light should be thrown over from behind or in front, the light to be thrown upon the eye in diffused form not so that the light will strike the eyes as direct rays. Another cause is the strain of the eyes by long continued use or close work, the stooping or sitting posture in children produces congestion resulting of softening of the eyes. The first part to suffer is the sclerotic coat this is the part of the eye that maintains the form or shape of the eye ball, it is the stroma of the eye. When the sclerotic coat looses its tension there is change of tension in extra-ocular muscles and this produces a lengthening of the antero-posterior diameter of the eye ball, if this goes on without check the softening continues and myopia results.

    Hence there are two conditions involved here: -

    (1) The extra-ocular (tension) muscles, modified tension.

    (2) Intra-ocular substance softening, that is excess of fluid.


    Myopia should yield quickly to treatment unless there is thickening or hardening of the sclerotic coat.

    (1) Patient should be fitted temporarily with glasses to maintain a restful condition until nature removes the abnormality, the glasses remove tension of the muscles and thereby make treatment more successful.

    (2) Correction of the tensions, 1st cervical, 3-4 cervical, 2-3-4 dorsal reflex fields.

    (3) Co.-ordination of the circulation applied to blood and lymph circulation of the eye.

    (4) Vaso-motor treatment, namely, articulation in the vaso-motor field of the eye. Constrictors 2-3-4 dorsal, dilators, 2-3-4 cervical.

    (5) Co.-ordination of functions that tend to react upon the eye. Thyroid gland, lungs, muscle system.

(2) Hypermetropia

    Here eye ball is too short in antero-postero diameter, the result is the eye requires an extra effort to focus the rays of light upon the retina; consequently the after effect of hypermetropia is strong tension on the extra-ocular muscles. The ommetropic eye (the normal eye) is absolutely at rest, and, like the heart, we ought not to be conscious of the existence. In hypermetropia there is a conscious effort to keep the eyes fixed, that is, in fixation on the object of vision, this fixation uses both the intra- and extra-ocular muscles. The cause, therefore, of hypermetropia is exaggeration of the congenital condition of the eye or of the nerve supply.

    Causes that exaggerate this congenital condition are:-

        (a) Too rapid development of the brain in early child life keeping up continued congestion of blood in the head area.

        (b) The reaction of gastric and intestinal diseases upon the eye causing reflex disturbances, sometimes in connection with the teeth.

    The hypermetropic eye is a much more serious condition to deal with than myopia because it may ultimately end in insanity. Among the symptoms are pain on top of head, the lower part of the neck, with nausea, vomiting, gastro and intestinal disturbances etc. The first symptoms of irritation of hypermetropia is slight itching of the eyes, this sometimes is a burning sensation. This symptom can be relieved by palliative treatment slight pressure on eye ball inward or gentle manipulation of the muscles around the eye or orbit.


    (1) Palliate symptoms (a) pain, vortex pain, this represents vaso-motor condition therefore go to vaso-motor area. Inhibit splanchnic - follow with articulation down the lumbar. (b) Irritating and itching sensation in the eyes, this is a secretory motor condition relieved by stimulation of the secretory processes in and around the eye, example, stimulate glands both lacrymal and meibornian glands.

    (2) Corrective treatment from structural standpoint. Increase antero-postero diameter by pressure between the two canthus

    (3) Establish drainage from the eyes by pressure at the notch beyond external canthus this is primarily from lymph side, follow this by pressure along the side of nose and downward towards the angle of the jaw represents venous blood.

    (4) Stimulate strongly circulation to and through eyes by treating blood field directly at 3-4 dorsal (articulation).

    (5) Correction of lesions in cases typical, 4-5 cervical (sympathetic also filed of ophthalmic goiter) and 2-3-4 dorsal (vaso-motor field).

(3) Astigmatism

    In this case the rays of light entering into the eye in one meridian are not focused at the same point as the rays that enter from the opposite meridian, the result is the blurring of a particular part of the field of vision, both for near and distant vision, or for one of these.

    There are two types of astigmatism:

    (1) a condition of the cornea in which we find different degrees of curvature in the different meridians, the most common is where the horizontal curvature is greater than the vertical curvature. Causes are:-

        (a) Congenital malformation, a very common one and easily cured in the child stage. Examine after 3rd or 4th year, the child's eye is myopic before and up to about the 3rd or 4th year.

        (b) Spasm of the muscles of the orbit of the eye results in either contraction or tetanus this causes squint.

        (c) Tumor in orbit of eye either blood or fat tumor just back of eye ball.

        (d) Ulceration in cornea or sclerotic coat.

        (e) Scar tissue formation result of abscess, accident or operation cornea or sclera.

    (2) Second type of astigmatism is astigmatism caused by spasm of the extra-ocular muscles or In CO-ordination in action of these muscles or intra-ocular pressure example increase of blood pressure or accumulation of fat around the eye orbit.

    The first type is called corneal astigmatism, the second type is called lenticular astigmatism. In the first type the trouble is in the cornea, in the second type in the lens, the lens being unable to index in all its parts at the same time, or with the same degree of inequality. The reason for this is the lens is made up of three sections and each section may have its own degree of density therefore if the density is unequal in the three sections there will be a corresponding inequality in the refraction.

    There is a third type, asthenopia, is a weakened vision and is very painful.


    (1) Main point is in connection with vaso-motor system. Vaso-motion to the eye originating in the medulla the fibers passing down along spinal cord to 2-3-4 dorsal nerves and then passing out along white ramie to the sympathetic chain distributing fibers to the eye from the cavernous and carotid plexuses through the sympathetic chain in connection with the ophthalmic division of the fifth cranial nerve and also through the long ciliary nerves. The medulla nerve trunk is tonic, that is constrictor. This passes down into the spine and distributes:- (a) Fibers through the 1-2-3-4-5 cervical nerves to and through the superior cervical ganglion, these represent the sensory fibers. (b) Establish connections with the fifth cranial nerve and are distributed through the ophthalmic division of the fifth cranial nerve and (c) through the long ciliary nerve. The centers for pupils of the eye are (a) the superior cervical ganglion and the first five posterior spinal nerves representing the sympathetic side of sensation, (b) the spinal or cerebro-spinal center is dilator center. This local or regional centre is dilator and located at the 2-3 dorsal. That center is simply and purely dilator, it is specific in action. Explains why we get the rhythmic center at 2-3-4 dorsal.

    (2) The treatment of astigmatism depends on whether it is complicated by myopia or hypermetropia. A simple (not complicated) case of astigmatism depends on In co.-ordination of the ocular muscles, spasm of ocular muscles, paralysis of some of the muscles. The causes of these mechanical conditions are generally reflex, unless there is a congenital defect in the structure of the muscles. The majority of these cases are curable (meaning by majority those that are reflex) and the cure depends on the restoration of the tonicity of the muscles. The congenital types are perhaps incurable, because it is impossible to alter the form or structure assumed by them. There is a very small percentage of congenital cases. Hypermetropia is congenital, but there are far more cases of astigmatism than either myopia or hypermetropia.

    (3) Correction of the lesions in the case, 1-4 cervical and 1-4 dorsal and occipital-atlantal lesions.

4. Cataract

    Here condition in which the lens of the eye becomes hardened and opaque. Have two types of cataract (a) cortical type which is practically incurable, (b) muscle type caused by mechanical obstruction to nutrition in the eye. Nutrition is governed in this case by the tunic coats of the eye ball, hence disturbed nutrition has some relation to those tunic coats.


    (A) Disease in which there is an abnormal accumulation of substance in the blood, example, toxins of scarlet fever, measles, smallpox, sugar of diabetes, albumen of Bright's disease. In this case the toxic substance must be eliminated. Many times the elimination of these toxic substances will cure the condition.

    Here are three lines of treatment.

    (1) Local circulatory treatment with object of flushing the eye with blood by persistent articulation of the cervical region upward.

    (2) Vaso-motor stimulation of the circulation aside from the correction of the lesions of 2-3 cervical, articulation of the 3-4-5 cervical stimulates contractile and dilator function.

    (3) Drainage of the eye from the venous side. Drain the eye from the outer canthus downward towards the angle of the jaw.

    (B) Second type of cause is traumatism

    This may be either local in the eye or in the spine. Under the head of traumatism include lesions, that is, a lesion, if it is the primary cause of the condition, is a traumatic injury, for example, find lesions 1-2-3-5 cervical, injuries or lesions involving the 7th cervical and 1st dorsal, in this latter case you have a lesion or direct injury interfering with the vertebral blood circulation. Overcome the traumatism or correct the lesion, and follow that up by stimulation of the circulation. If you have the cataract developed, that is, solidified, you must deal with that after you have corrected the circulation.

    In the cortical type nothing can be done outside of surgery to remove the lens. There are some methods that are recommended by some people as being of service in some cases, but it is a question whether anything can be done or not. Absorption can be obtained even in very severe cases, there is a German preparation that is used to absorb cataracts, made of mountain and honey and aloes (Father Kneipp). Those cataracts call for persistent treatment, not general but specific treatment.

(5) Glaucoma

    Here we have an increase in the ocular pressure, there are two forms:

    (1) Acute form

    Comes on suddenly with acute pain in the eye and sudden loss of vision, it is really a spasm of the vaso-motors and therefore can be relieved very quickly by vaso-motor treatment to stir up the vaso-motor system (rhythmic). Condition not generally one that depends so much on osseous lesions as muscular condition in the back of the neck. Glaucoma in the right eye generally involves muscles on the opposite side of the neck. Acute glaucoma will develop into inflammatory conditions.

(2) Chronic type

    This type comes on slowly and has two symptoms:- (a) bulging out of the cornea, (b) increase of tension of the eye ball. Patient will complain of eye ball squeezed on every side, that is, increased tension, a feeling like being squeezed in a vice. The chronic drainage type is a congestive condition of the eye, due to lack of drainage from the anterior chamber of the eye, in addition to this there is an excess of fluid in connection with the vitreous humor of the eye; the obstructive condition is probably always found in connection with the Schlemm's canal, that is, the canal that establishes drainage from the anterior chamber of the eye and also the vitreous humor of the eye. the cause may be a lesion in the cervical region, correct the lesion and give tonic vaso-motor treatment. If the chronic case is a long standing case it will perhaps stimulate or become optic atrophy. Many of the so called cases of optic atrophy are simple chronic glaucoma, and if you relieve the tensions you can relieve the condition; if it is kept up the sight is lost because of the tension and the accumulation of the fluid in the eye the light is prevented from getting back to the retina. The eye is not beyond repair unless it is long continued so that the retinal portion of the eye has begun to degenerate. In glaucoma the eye generally looks healthy except there is no normal elasticity and can get no normal reaction to light at least in the chronic type. In the acute there is deficiency of vision, in chronic type there is no vision at all. (Dr. L. has cured cases in which vision was gone, but no optic atrophy).

6. Optic Neuritis

    Here we have inflammation of the optic nerve caused by extension of the inflammatory process from some other field, meningitis, albuminuria. Also a type produced by pressure or tumors. There is also a type caused by excessive contraction of the muscles in eye strain. Also a type reflex from suppressed menstruation, gastric irritation, ptomaine poisoning, alcoholism, morphinism, cocainism. In this last (cocainism) there is apparalytical condition.

    In diagnosis of optic neuritis use the opthalmoscope test for congestion. The optic neuritis may be symptomatic in deep seated diseases of the brain. In using opthalmoscope look for a congested condition of the retinal arteries and veins. In diabetes and Bright's disease it is one of the first physical signs. In arterial sclerosis it is also one of the first signs.


    (1) Engorgement of the veins amounting to venous stasis.

    (2) In the secondary stages thickening and softening of the veins and nerve fibers.


    (1) Palliative. Rhythmic vaso-motor treatment to relieve congestion given in upper dorsal region 2-3-4 dorsal.

    (2) Give palliative treatment for congestion along the same lines as drainage of the eye and get back to irritating cause.

    (3) A traumatic cause in lesions of the cervical region especially at the 3-4 cervical for example in many cases following, the toxemia of epilepsy, in practically all cases of apoplexy, whooping cough.

    (4) Best line of treatment is articulation from upper cervical downward this will relieve pain associated with engorgement and venous stasis.

7. Optic Atrophy

    Here have condition seldom found. Among the causes here obstruction or pressure in connection with the optic tract or nerves in optic tract field, by tumors, in optic nerve lesions in cervical vertebrae 1-2-3 particularly. This is what is called primary optic atrophy. The secondary type is found in connection with tabes dorsalis.

8. Optic Neurosis

    This is a reaction of the optic nerve to embolism of the central retinal artery and in some cases spinal cord degeneration. One of the first signs is dimness of vision, the only absolute test being ophthalmic examination of the retinal membrane.


    (1) Fifth cranial nerve. (1st and 5th cervical).

    (2) Sympathetic nervous system especially the superior cervical ganglion.

    (3) Lesions in the middle cervical vertebrae field 3-4-5 cervical, here have connecting link between optic neurosis and optic neuritis.


    In cases of developing optic neurosis best results are gained by palliative tonic treatment.

    (1) To sympathetic chain from first dorsal upward, stimulation. Paying particular attention to superior cervical ganglion in order to get viscero-motor control over the eye.

    (2) Stimulation of the 5th cranial nerve at the angle of the jaw and Gisserion ganglion.

    (3) Direct treatment from the orbit of the eye down to the ciliary ganglion to effect the ciliary ganglion and ciliary fibers.

    (4) Inhibition to relieve hypersensativeness, (a) the inhibition of the eye over the eye, (b) inhibition all around neck and down long spine.

    (5) If the inhibition does not control the spinal neuritis sufficiently to check optic neurosis then articulation of the ribs is called for.

    (6) The curvature treatment of the optic neurosis depends on the continuing of the palliative treatment with correction of the lesions that may be found as causes particularly 3-4-5 cervical. (until complete balance is established in eye field).

9. Inflammation of the eye

    Two types, primary and secondary.

    The primary is due to traumatism or some specific lesion involving the blood or nerve supply to the eye, that is in any of the eye regions in the spine, in the neck or even around the eye itself. Secondary or reflex (a great majority of inflammations of the eye are reflex) in connection with pelvic conditions, general nervous debility, incoordination in the distribution of the blood, especially following or accompanying brain diseases.

    Diagnosis in inflammation is generally easy because of pain, heat, itching, prickling sensation, irritation, nearly all of these are present. Resulting from the inflammation we may find tertiary adhesions following degeneration in the cicatricial or scar tissue formation. In these cases practically the only thing that can be done is operation on the eye for the removal of the adhesions. Cut out the little adhesions, and bring parts together to get the connective tissue formation.


    (1) Always use some antiseptic in treatment of inflammatory processes in the eye "Alphozone" is the best. A very good antiseptic is boric acid, if you do not have complications; but the Alphozone is stronger, it is the best antiseptic in use at the present time for inflammatory conditions in the eye, you can use it internally as well as externally as it is non-poisonous. In typhoid fever give it in a glass or half glass of water to render the alimentary canal antiseptic. One of the advantages over boric acid is that while boric acid is an irritant to the eye Alphozone does not irritate.

    (2) Protect the eyes from the light by the use of the simple pebble glass, this is a glass that does not have any special refractive power but is used simply to shut off the rays and keep them from falling on the eye. Do not use dark or smoked glass unless there is hypersensitiveness in the eye. Pebble glass has no magnifying element in it.

    (3) If the patient is myopic or hypermetropic take off the correcting lenses and substitute the simple pebble glass, and have patient wear them all the time. The pebble glass is soothing to the eyes and prevents the rays of light from falling on the eyes.

    (4) Do not shut patient in a dark room as the medical men do. Darkness is an irritant itself, the rays of light in a dark room that are not taken away, not permeated by a white light, are worse for the eyes than the light. Blue light is good, any color except red is good, violet is the best color that we have (we can seldom get the real violet color), green is also good.

    (5) Attend particularly to the hygienic and nutrition of the patient. The nutritive irritation or irritant is carbohydrate food substances, therefore reduce the carbohydrate food substance to a minimum.

    Note: - Eliminate all cereal foods in all conditions of the eye, the only one that can be used is oatmeal and this not oftener than once a week.

10. Conjunctivitis - Under inflammations


    (1) Relaxation of the muscles of the neck downward.

    (2) Articulation of the vertebrae, 1-2-3 cervical, 2-3-4 dorsal (vaso-motor field) and the correction of the lesions in that field.

    (3) Direct local treatment to the conjunctiva membrane itself. This given by:

        (a) Extension or stretching of the conjunctival membrane by placing the fingers between the inner and outer canthus and pulling apart. This also brings a tension on the cartilage and ligaments of the eye.

        (b) Light tapping over eye lid followed by light pressure.

        (c) Where the conjunctival membrane is freely injected with blood or thickened by accumulation of blood, squeeze the eye lid gently between finger and thumb, pull the eye upward and inward and give your treatment in that direction, begin at the outer canthi and pull the lid toward the inner canthus, do not pull it in the opposite direction. You require to pull out the conjunctival membrane it is generally tight around the edge, you could not get far in. Wash your fingers and use antiseptic, the same as in the treatment of the eye.

        (d) In case of extreme congestion of the membrane manifested by a ridging along the conjunctiva in that case use a constrictant in the eyes, best are "adnophrin", this is the best, use one drop, or use adrenaline.

    (4) Strong inhibitory pressure just external to the external angular process, continuing that inhibitory pressure down towards the angle of the jaw, this drains blood from lymph side.

    In the case of puffy eyes give this the same treatment and along with it extension of the head and rotation of the head on its articulation with the atlas, and of the neck itself downward. Give articulation of head on its atlas by catching the transverse processes of atlas with fingers, hold atlas firm while moving head, keep trying until you get some movement, then go down to the next vertebrae, now move the head on the atlas and so on down the whole length neck. (Never give rotation with neck in extension).

    (5) Place the finger on the temple and the thumb between the atlas and axis and apply pressure at these two points while rotating the head on the axis and atlas. This is effective in reliving bloodshot eyes, inflammation and congesting of the eyes.

    If the muscles are involved for example tension contraction, particularly if there is an equality in the tension of the muscles apply:

        (a) Give strong inhibition at the 2-3 dorsal pressing in as deeply as you can at the junction. Then articulate. This a rhymtic centre to eye.

        (b) Follow this by a light inhibition over transverse process kneading muscles in this region upward and outward towards inferior cervical ganglion. Following upward from inferior cervical ganglion to superior cervical ganglion.

        (c) Give light kneading treatment around the orbit of the eyes pressing the tips of your fingers well inward around the side of the orbit.

        (d) Give light vibtory treatment right over the eye from inner cannthus outward using the first finger. Exception in lacrymal conditions reverse the order, threat from without in.

        (e) Give light gradually increasing pressure over the pulloys of the superior oblique muscles, treating the two pulloys at the same time,and this treatment is especially called for when you find what is called "Sparks" before the eyes, and in cases here the eyeball quivers, quivering eye. In quivering of the eye lid this treatment would not be of any importance, the best treatment you can give is to stretch the eye from the internal to the external canthus, stretching the cartilage between the canthi. Superior Oblique coordinates the muscular movements of the eye.

        (f) Give steady light pressure followed by gentle moving pressures over the tendo-oculi. Locate tendo-oculi (a)by pulling out outer canthus of eye and then place your finger beneath the inner canthuus of the eye and press towards the nose and palpate with the finger until you locate small thready tendon, this tendon overlaps the lacrymal sac. If the lacrymal sac is full of fluid you may locate the small sac in this case apply light vibration downward and towards the nose continuing this along side of nose to point of excretion of nasal duct.

        (g) In muscular conditions of the eye pay attention to the supra and infra orbital nerves, there is generally hypersensitiveness of the nerves and when irritated get twitching of the eyes. In this case:

    Apply pressure between the finger and thumb right in connection with the granulation itself, do not apply pressure sufficiently strong to break the little sacs, but increase the pressure to cause absorption from within . Remember to have fingers clean, use antiseptic.

    If the eye is congested and sore give similar treatment to conjunctivitis.

    Relive pain by the application of cold water to the eye, to do this use cotton In water or sponge or eye cup. Take a little piece of sponge and wrap it in gauze or absorbent cotton and keep it on for some time over the eye, put a bandage around the head. Use "thymolin" to cleanse the lids.

    Use milk instead of water (a)in case of excessive secretion: (b)where there is a whitish accumulation in the mucus membrane and remember to boil the milk.
    Note : In cases of secretory diarrhea one of the best and most effecient means of stopping that type of diarrhea is milk, boiling the milk is antiseptic, the lukewarm condition of the milk is also good.

    Another point in the application of the milk is that it has the power of separating the muccoid secretion from the mucas membrane. This is applicable in conditions outside of the eye for example in Tapeworm you can give milk freely and it will separate off the mucoid substance on the wall of the intestines and is frquently the means of bringing out the tapeworm, before the fangs of the tapeworm are fastened in the mucoid substance. For the mucoid substance in the conjunctiva the best thing that you can do is apply milk, take a piece of white bread and soak in milk and put over the eye.

    In cases of styes use the same thing and in addition dust the surface with the bread soaked in milk with powdered burned alum. Incase of destruction of the mucus menbrane, giving you a rare condition of the eye lid, the best thing to do is to make an application of milk sugar, grind absolutely fine between two flatirons and use same as burned alum. This is also a good means for overcoming proud flesh anywhere, will destroy proud flesh and the saccharine secretions it produces by disintegration of the proud flesh causes the healing of the tissues. Dust the sugar on the wounds. Some people use burned alum for thiis purpose but that is not so good as it is a caustic. Do not use sugar in liquid form.

Growths In The Eye

    The Special type of organized growth in the eye is cataract. In most cases his represents a muscular condition therefore first point in the treatment is treatment of the incoordination of the muscles. These developing cataract are quick to respond to treatment. When it has developed it represents a mucoid substance (a)destroying the normal characteristics of the lachrymal secretions;(b) accumulation in the lens of the eye over the surface of the eye,over the pupil,in solid form , this means that the second point in treatment of cataract is treatment of the lachrymal secretion to stir it up to normal . A cataract growth therefore is an artificial development either in connection with the lens of the eye or the surface membrane of the eyeball. Sometimes it is stimulated by injury to the eye , in this case it is generally a soft mucoid growth in connection with the external covering of the eye ball. This represents an accumulation of the deposit ,here we get white scummy growth all over the eye ball. The secondary conditions in cataracts are (a) Excessive mucoid secretion in connection with conjunctiva. (b)Diminished lacrymal secretion.


1. Through drainage in connection with the lacrymall sac the nasal duct. The best method to drain the eye is to stretch the tendo-oculi,one of the functions of the tendo-oculi is to drain the lacryal sac. Then vibrate along the nose.

2. Direct stimulation of the blood supply to the eyes (a) in carotid field (b) in vertebral circulation field. (c)Vaso-motorily by articulation of the third and second corvical and 2-3 dorsal.

3. Direct stimulation of the lacrymal gland to increase lacrymal secretion. Vibrate over joint of palpating finger.

4. In all cases of cataract something abnormal in function of the lacrymal gland therefore stimulate lymphatic function from upper half of the body.

5. The primary origin of most cataract is some defiency in the gastric apparatus. (This is the field if the mucus gland secretion). The best preventative of cataract is normal stimulation of the mucas glands of the mouth and stomach. The trouble in most cases is excessive action of the mucoid glands and insufficient action of the thyroid glands therefore stimulate to throw out excessive secretion in the blood,and it will be carried away by the blood circulation.

6. The reasons why the lesions are found in connection with the sympathetic systems are:

        a.  The sympathetic systems controls mucoid secretion;

        b.  Because cataract always represents a visero-motor distortion either in the stomach or in the eye field or both.

7.  In some cases lesions involving corda-tympani, here deficiency of the limpid secretion and this by reaction stimulates an excessive mucoid secretion.

    In the general treatment of cataract four points:

        (a) Limit conjunctivitis conditions (cannot cure it until cataract is removed)

        (b) Stir up lacrymal secretion

        (c) Up eliminative side of lacrymation,(Lacrymal sac and nasal duct)

        (d) Stir up lymph circulation of face and eyes by:-

    (1) Articulation in lower cervical region.

    (2) By stimulation of the lymph glands in the neck beginning at the lower end of the neck and going upward.

    (3) Strong stimulation at small notch at outer canthus of the eye.

    In some cases it is necessary to remove the growth, these are caisson which the growth becomes so orginised or solid that it cannot be absorbed.

8. Attend to the antiseptic condition of the eye in the cases of treatment of cataract. Best antiseptic is "Alphozone"

9. In the cases of the treatment of cataract limit the amount of light permitted to gain access to the eye and keep the eye as much as possible free from irritation of the wind.(very important). In regard to the light determine the amount of light by the effect of the light producing a glaring effect on the eye and producing the retention of the light in the eye especially during sleep.

10. Watch for development for the colours in the eye. In treating at this stage of cataract absolutely blind the eyes. First color to appear in the cure will be red and then all the other colours of the spectroscope in order, when violet reached then the next is white light. Test the eye in blindness to fine out if cataract is curable by one test,especially that at the 2-3-4 dorsal. Twist the spinal vertebrae at this point as strongly as possible and you get sparks before the eyes(see stars) the colour of the sparks will sometimes determine the stage. If the sparks are seen the case is curable. For a more minute test use the electric test,a strong electric current by placing the pole on forehead between the eyes, when current is turned sparks will appear before the eyes, if the case is curable. The above two test are very valuable. You can test the eyes frequently to see if both eyes are being cured equally. The same applies in optic atrophy.

    (Fasting essential. Two or three days at a time.)
The Nose

    The principal field of lesions in diseases of the nose are in the vaso-motor area:-

        (a) Sympathetically 1st to the 6th dorsal taking in the superior and middle ganglion.

        (b) Cerebro-spinal 2nd,3rd,4th,and 5th dorsal representing the vaso-m otor and the visero-motor. All of these originate in the vaso-motor paresis.

        (c) Reflexly in relation to the diaphragm 9-10 dorsal and corresponding ribs. Brachial and asthmatic at 3rd,4th and 5th ris and vertebrae. Gastro-intestinal 5th-7th dorsal. Mucas membrane in any field. Ovarian 12th dorsal; 1st,2nd,3rd lumber;2-3 sacral.

        (d) Nasal affections in connection with cerebral and meningeal disturbances, e,g, through cerbro-spinal fluid. Inflammatory conditions of the brain. Here we have subocciptal lesions 1-2 cervical.

    Of the diseases of the nose the most common is hemorrhage, epistaxis. The best method to stop a general hemorrhage from the nose is by strong inhibition, inhibitory pressure at the 6-7th cervical and the 1st dorsal. Inhibitory pressure at the outer tips of the transverse processes, where you catch the vertebral arterial circulation. Throw the head of the patient well back and give lateral movement from side to side while continuing this pressure. As an aid to this treatment use the ice pack in the lower cervical region, never apply over the head as it does not do any good, apply to neck.

    In vicarious Hemorrhage in connection with menstrual disorders:-

        (a) Give same treatment as above.

        (b) Inhibitory treatment in lower splanchnic

        (c) Inhibitory treatment in sacral region, object of this is to try to establish a congestion in the abdominal and pelvic area. Do not give the rotation and flexion of limbs because that tends to drive the blood away from the lower part of the body.

    In the case of rupture in the posterior naries apply inhibitory pressure through the mouth in posterior naries, if this fails insert plug of cotton(absorbent cotton)through the mouth. Use plug about the size of the first movable joint of the thumb of the patient. (this can be done with middle finger; wrap cotton around the finger).

    Some cases of rupture can be treated directly in posterior navies field, in addition to this give splanchnic and sacral treatment, and keep the patient in a semi-sitting posture, bolstered up with pillows.

Catarrh of the Nose

1.  Give local treatment around side of bridge of nose, consisting of light pressure followed by light kneading treatment downward.

2.  Try to establish drainage in connection with the venous blood and lymphatic systems. Drain venous blood from inner canthus of eye to inferior angle of the jaw. Foe lymphatic apply strong pressure at external canthus of the eye, continuing the pressure downward along side of cheek.

3.  Vaso-motor treatment. Treatment to neck from above downwards, extend down to the 5th dorsal.

    This includes:

        (a) Relaxation of the muscles of that area.(Palliative treatment for hay fever, use tapping treatment).

        (b) Articulation of the vertebrae in that entire field

4.  Look particularly to the condition of the scapula, there is found almost always in nasal catarrh a one sided rigidity (scapular) on the opposite side to the side involved. Sometimes both sides are involved, but not so common as with one side.

5.  If the throat is involved you will almost always find an involvement of the left scapula, rigidity, scapula bound down to the thorax. Also if there is a cough with the nasal catarrh you will find an involvement of the left scapula, and in some cases the ribs just below the inferior angle of the scapula involved . Right scapular involvement when nose without mouth is involved. Left scapular when nose and throat are involved.

6.  A very typical lesion in nasal catarrh is involvement of the 5th rib on the right side, this is a typical lesion found in hay fever cases. How compare with asthma ? When 5th rib is involved in asthma it is on the left side.

7.  Tapping over forehead light at first then heavier just over the bridge of the nose is a very good palliative treatment in nasal catarrh. In some cases you will find a soft (superficial) tissue ridge right up from the nose over the forehead , also may find tumor masses in forehead over nose. This is found in what is called the "snuffles". There is a softening of the cartilage’s, "snuffles" may be an indication of hereditary catarrh, if found at the time of birth it is one of the symptoms of hereditary syphilis.

    Hard breathing in case of "snuffles" can be relived by this tapping treatment. In grown persons where those snuffles are secondary to nasal catarrh, or where they come on account of irritation, tapping on the forehead and throwing the head back, and applying pressure from forehead to suboccipital will relieve.

8.  In irritating the nose use the normal salt solution atomizer or spray etc. Do not use dry salt. Salt solution is also good in hemorrhage from the nose. Pine oil pinoleum is valuable in catarrh or in hay fever. Where there is suppurative tendency of the nose use eucalyptus oil in spray for noose 50% solution. In irritated conditions of the nose in hay fever and catarrh use gum camphor liquid in pure Vaseline

9.  In chronic forms saturate small sponge with eucalyptus oil and breathe through the sponge. This is of use especially in epistaxis and incipient tuberculosis. In Diptheritic conditions of the throat the pine oil is one of the best that can be used . It is a relaxant and has given good results in relaxing rigid muscles. It is quite frequently used now by the doctor in dipitheritic conditions to relieve the rigid muscles of the throat and neck. Also used internally. If it is impossible to get pure pine oil use pure pineapple juice. Pineapple juice is an antiseptic. Sometimes in osteopathic treatments there are cases where you cannot manipulate the muscles to relax them, they are sometimes to sore that you cannot reach them and you must have something to use. At such times use the pine oil or the eucalyptus oil as a relaxant, eucalyptus is best used in combination with olive oil in ratio:

        Olive Oil--------------------1pt

        Eucalyptus Oil---------------1oz

    Water and eucalyptus oil 1-25 makes a good solution for rectal injections in intestinal catarrh or in any inflammation.


    The most common condition of the ear are catarrahal deaf-ness, nearly always secondary to a general catarrh or some general condition or some toxic condition of the blood for example secondary to an resulting from measles, tonsillitis, scarlet fever or diphtheria. In order named.


  • Catarrhal constitution.
  • Toxic condition of the blood representing a slow and sluggish circulation and thick blood
Lesions are:

    (1) Atlas, axis and third cervical, principally atlas representing cerebro-spinal type.

    (2) Vaso-motor lesions 4-5-6 cervical and 2-5 dorsal.

    (3) Lesions involving the ear through the throat especially where Eustachian tube involved lower corvical and upper dorsal, visero and vaso-motor field of the throat 5-6-7 cervical and 1-2-3 dorsal. The evidence of these ear conditions are crackling or buzzing sounds in the ears or noises in the ears indicating Eustachian tube involvement either closure or Quinzy; 2nd beating sound like a hammer sounds indicating verso-motor disturbance here the ear becoming dry and shriveled, this indicates secretory condition and at this stage the is a clear sizzling sound (instead of beating sound).

    Where both ears are involved you will find generally an atlas lesion either anterior or posterior, on both sides, the real lesion being occipital relation, occiput to atlas. Where one ear only is involved the most common lesion is anterior lateral or postero-lateral lesions of the atlas to opposite side to the ear that is effected. In this case there is a rotated and twisted atlas and therefore the lesion is atlanto-occipital and in other cases is occipito-atlantal.

    According to this where two ears are involved the primary trouble is suboccipital, where one ear is involved the trouble is atlanto-axial (that is an articulation between atlas and axis).


  • Correct lesions, that is one case in which correction of lesions is generally almost specific in relation to secondary conditions of the ear.
  • See that the muscles and soft tissues around the ears are thoroughly relaxed, using the external auricle of the ear(gently) to relax the muscles etc., use it as a lever.
  • Pay particular attention to the structures around the mastoid process, because the function of the mastoid cells is to equalizes the pressure of air between the Eustachian tube and ear. In most cases of ear involvement you will find a thickening or hypertrophy or infiltration of the mastoid cells.
  • The best treatment for (3) is vibration and tapping right over and around the mastoid cells. If you get the patient to give the ear a good relaxing treatment to the soft tissues around the ear ever morning it will help the case considerably. Sometimes periodical paraxyeme can be found and those can entirely overcome by this treatment , vibration and tapping. These operate through circulation and through vaso-motor side.
  • In mastoiditis be careful not ot treat mastoid process too severely, and give relaxing treatment away from mastoid into the neck. The reason for this is that the mastoid is so thin that there is liable to be absorption through the almost membranous structure into the ear and brain. If it develops into delirious conditions there maybe an operation. This absorption is what develops delirium in mastoditis. Do not use vibration over the mastoid process, but vibrate with fingers.
  • In all ear troubles remember there is a relation between the eye and the ear. This relation is especially through the sympathetic systems via, the ciliary ganglion and superior cervical ganglion.
  • Pay particular attention to the sterno-Mastoid muscles on the same side as the involved ear. In cases where there is ear trouble one good thing to do is to always to treat the two mastoid muscles (sterno-mastoid) simultaneously, give kneading relaxing treatment so as to stir them up to coordinated action.
  • In abscesses involving the antrum of highmore there is generally a connection of antrum and mastoid or abscesses condition of the ear. In this case treat directly over antrum by inhibition and vibration. (b)By pressing downwards towards the angle of the jaw followed by good rotation of the head and follow this by through lymphatic treatment in the glands of the neck and lower cervical region.
Mouth and Throat


    The principle condition to be dealt with is the condition of the mucus membrane and the gland; (1) secretory conditions,(2)visero-motor conditions from the side of peristalsis in mucus membrane; (3)circulatory conditions; for example, rupture,varicose veins, dilated arteries etc. (4)accumulations or deposits in connection with the mucus membrane or glands, for example leucoplasia as a preliminary stage in carcinoma of the tongue.


    (1) The principle treatment in connection with the mouth is internal treatment around the lower part of the mouth, under the tongue, towards the back of the mouth at the base of the tongue. This is applied in cases of excessive salivary glands secretion (inhibition) or diminished salivary secretion in which case give stimulation.

    (2) Secretory:

        (a)Sympathetic through superior and middle cervical ganglion of sympathetic in relation to solid secretion.

        (b)Cerebo-spinal representing limpid side of secretion.5-7-9-12 cranial nerves, spinal nerves 1-6 cervical. In excessive secretion give inhibition and in diminished give stimulation.

    (3) Local treatment in excessive secretion. With your fingers apply steady pressure backward towards root of tongue all over the internal surface of the mouth, follow this by inhibitory treatment around the lower jaw externally both in the upper part of the jaw and underneath always applying the pressure towards the base of the tongue.

    (4) In diminished secretion give light moving or kneading pressure both in the mouth and outside along the lower jaw,always backward towards the base of the tongue, also articulation of the 3-4-5 cervical, strong stimulation over superior cervica ganglion follow this by treatment called opening the mouth against pressure. "Catch the inferior angle of the jaw and make the patient open the mouth against your attempt to keep it closed.

    (5) In catarrh of the throat the mouth is always involved, secondary to the catarrh. In this case inhibit superior cervical ganglion which increases salivary secretion and washes away mucus.

    (6) In sore throat where the mouth is involved secondary to tonsillitis and pharynx similar treatment to back of mouth and root of tongue moving the fingers around upward and backward towards base of tongue.
    (7) Relaxation of the muscles in the neck, direct vibration over the tonsilar region externally, followed by kneading treatment from anterior median line towards mastoid process, amd then downward to region posterior to sterno-mastoid muscles. Object is to catch chain of lymphatics.

    (8) Where you have the condition of tonsilier enlargement and swelling it is as well to use some antiseptic, because the condition is so to develop and spread (autoinfection)use "alphzone" in addition to this use boric acid real hot (boric acid solution), white of an egg in water especially In intense inflammation. If the inflammation is high use the white of an egg alone. Putting the white of egg right on the inflamed tonsil, use it like a plaster and it will remove the inflammatory condition. Hot boric acid or lemon acid is useful in canker of the mouth. Use the white when cracks in the mouth, same true when have cracked or bruised skin anywhere, as the egg coagulates it becomes like skin and acts very much like colodian. Where there is any heat the egg also controls the localized heat and congestion. When have bruises and rupture combine white of egg with powdered white sugar. If tissue in mouth becomes gangrenous use peroxide of hydrogen. Do not use the peroxide of hydrogen in other case then gangrene as it will cause the condition to go down in the eliminatory canal. Listerene is not so strong as the peroxide of hydrogen hence not so valuable in this case.


    In the throat find similar conditions to those found in the mouth, that is involvement’s of the mucus membranes and the glands.

  • Secretory conditions. Over or under secretion in the mucus membrane and gland fields.
  • Visero-motor conditions from the side of peristalia in the mucus membrane and other organs of the throat.
  • Circulatory conditions, foe example ,rupture, varicose veins, dilated arterties, congested mucus membranes followed by thickening of the mucus membrane.
  • Accumulation of deposits in the mucus membrane, or glands. (sometimes resulting in growths).
Treatment: - General:

    (1) One of the main treatments is articulation of the neck with the patient either in the sitting posture or lying on the back.

        (a) Patient in sitting posture, stand at the side of the patient, place one hand over the vertex of the head, and with the other hand catch the transverse processes of the cervical vertebrae, beginning at the 7th or 1st dorsal, and atriculate up. Articulating by the push and pull movement and follow this by rotary movement of the neck against resistance of the head .Stand at the back of the patient (patient sitting) catch the transverse process of the 7th cervical in one hand between the finger and thumb, and with the other hand rotate the head. If the neck is very stiff put the arm around the head and give same movement. Be careful in this treatment

    If the anterior structures of the neck are very tight place the hand over the transverse processes with your finger and thumb, then apply the rotation of the head and neck as in the other case, and in addition push the neck and head forward while you pull the soft tissue Forward. This treatment sitting up is contra-indicated in heart conditions.

        (b) Patient lying on the back, this is always the position when the heart is involved and in some cases where great rigidity. Extend or stretch the neck by pulling the head up to the point of moving the body , that is to say , put the entire weight of the body of the patient into the neck and spine extension. Follow this by extension with lateral movement of the neck towards the two sides. Then place the fingers and thumb of one hand over the transverse processes in the lower cervical region moving the head and neck to the same side with the fingers on the transverse processes, pulling on the transverse processes in the opposite direction. Or place the fingers of the two hands on both sides of the neck, standing at the head of the patient, and give rotary and lateral movement to the head and neck. Remember to always keep the fingers back of the carotids.

    (2) Patient lying down on back. Place the fingers and thumb of one hand over the transverse process of the 7th cervical and apply pressure downwards towards the table and then with other hand under the occiput move the head slightly from side to side,and then gradually move the head upward from the table as far as you can and forwards towards the chest. Do not give jerky movements in throwing the head forward.

    (3) In relaxation of the muscles and ligamentous structures of the neck:

        (a) First should always be extension treatment.

        (b) Follow this by rotation of the head and neck on itself in relation to each of the separate vertebrae, beginning always at the lower part of the neck.

        (c) Give direct extension and kneading of the individuals muscles,sterno-mastoid, trapezius, If they are loose enough get your fingers in and pull on the muscle, if they are very tight go to the middle of the muscle and flex the head to the opposite while you pull on the muscle upward and outward

    (4) Active treatment of the head and neck by the patient, this is given in what is called head circulating; patient begins to rotate head and neck in a circle gradually increasing the size of the circle rotation

Special Treatment:

Croupy Conditions of The Throat.

    In croupy conditions of the throat we have a secratory disturbance.

    (1)Stagnation of the secretions. (2)accumulation (because of the suspension of visero-motion in mucus membrane)of theses secretions in connection with the surface membrane. The accumulations may represent(a)simply exudate as croup;(b)an organized structure here we have the secretory cell secreting abnormal substance and throwing it out in the mucus membrane as in diphtheria. (bacteriologists say membrane is produced by the germs-more visonier then sensory-a true secretion-substance accumulated and formed into a membrane by secretory cell-a perverted physiology.


    (1) Give through extension of the neck and spine.

    (2) Relax muscles upward, beginning at the coccygeal region;to appeal to sympathetic system.

    (3) Special attention to the heads of the ribs especially articulation to stir up the sympathetic system all along the spine.

    (4) The croup paroxysms always give rigidity of the neck, in this case treat spine upward to overcome spasmodic rigidity.

    (5) Articulation of the upper dorsal region representing vaso-motor field. In children be very careful in giving articulation because structures are cartilaginous. The best way in this case is to give articulation bu using the shoulder as a lever ,with the child on face.

    (6) Through relaxation of the muscles upward along neck, this give constrictor effect.

    (7) Pull up the trachea. Catch as low down as you can, get the fingers in, then throw patients head and neck backwards and lift up the trachea. This is very good treatment relaxation of the deep tissue.

    (8) Open the mouth and pull tongue, using a towel to catch hold of the tongue. This is good for stimulation of the heart.

    (9) As an aid in these cases of croup use pure lemon juice or better pineapple juice, allowing it to trickle down the throat or used as a gargle. Do not put this juice on the tongue,the object of throwing it on the throat is to prevent mixing with silica. Put on root of tongue, this cuts the membranous formation if applied to the small patches. If a cough is started by the use of the juice getting into the trachea, apply powdered milk sugar to the mucus membrane or allow it to drop down the throat the same as the juice. Sometimes the juice is mixed with powdered alum to draw out any tendency to inflammation that may be found. These things can be used as accessory to the treatment, or in times when you cannot be there. Do not use these things individually, but advise them until you get on to the scene.

    (10) In chronic croup the best thing to use as a preventive is to saturate the chest and throat with eucalyptus oil and olive oil in combination using heat to drive it in. Heat the two oils and apply, have rays of heat right on surface to be applied, keep this up until you get eucalyptus oil in breath. Use this every night if the child is susceptible to croup. In proportion of 1/5 eucalyptus to 4/5 olive oil.

    (11) Another accessory is steam. Pass the steam through tan eucalyptus medium, saturate a large sponge with eucalyptus oil and place it in a large funnel, if that is not at hand roll a newspaper in the shape of a funnel and put the sponge in and pass the steam through this. Have the child breath this steam. If goose grease is available that is the best kind of oil to use under any circumstances.


    Goiter represents abnormal activity of the thyroid gland. In goiter must distinguish first pseudo-goiter, here we have not enlargement of the thyroid but accumulation of the fluid in the cystic form or in the isthmus field. In the systic form have typical surgical goiter, in this case is obstruction to the circulation and that must be dealt with from the side of the obstruction. Function of the thyroid gland is detoxination and it may be said that the two gland In opposite sides of the neck are concerned in arterial and venous blood and in normal conditions there is in coordination of circulation and removable of whatever obstruction causes localization. (2) True goiter here the gland is abnormally active with resultant accumulations. Over functioning of the thyroid causes toxination. (3)Type in this true goiter. (a) Type that involves parathyroids without involving thyroid proper. Parathyrois have Mucin functions.(B)Type that involves the thyroid proper, either subdivision.

  • Enlargement by proliferation of the gland.
  • Systic enlargement of the gland.
    The worst condition of the throat that we can have to deal with is goiter largely because there is the prevision of circulation, this extends beyond the throat. The lesions commonly found from physical diagnosis side are(a first rib and clavicle lesions;(B)3-4-5 cervical; (C) 7th cervical,1-2-3 dorsal.
  • Palliative treatment, relive the tightness of the muscles and make the goiter floating. Relaxation and vibration around the base.
  • Relive rigidity of the clavicle, object of this is to relive congestion of the blood. To relax the clavicle if rigid;-
        (a) Take the arm of the patient, (on back) pull up at right angle to the body of the patient, then put the finger under the clavicle at the inner third, and pull the arm over the head, and then pull the arm around in a circle, keep it on the same plane as the body, and throw it right across the chest.
        (b) Take the arm of the patient. Place the arm resting across the chest at the level of the elbow, place the elbow of the patient against your chest and catch clavicle at the outer third, and pull the clavicle while you push down from the elbow, holding patients arms down tight.

        (c) Pull the arm of the patient across the chest in semi-circular direction around towards the opposite shoulder, then place the hand over the scalp, hold hand in that position and apply traction on the acromian process. The clavicle is most tightly bound on the same side as the goiter, in that case.:-

        (d) Pull head and neck of patient over towards the side as the goiter (laterally)as far as you can, then take the arm of the patient and pull up to the right angle to the body, drop it down at an acute angle to the axilla ,and while dropping it down give it the shaking vibratory treatment,and let it go down slowly, at the same time pull head and neck of patient down slowly, at the same time pull head and neck of patient to the opposite side. Repeat this three or four times.

    The primary condition is interference with vaso-motor condition representing excessive stimulation of the vaso-motor dilation. Normally the thyroid gland stimulates vaso-dilation by its secretion, stimulating the cerebro-spinal side of the vaso-motor (secretory) results in an accumulation of the substance we find in the gland or in the cyst of the gland.
    In some cases goiter is a reflex from some other organs, the reason for this is the gland has accessories, (1) in all of the mucus glands of the mouth, throat, stomach and brain, as these are accessory to the thyroid function, and as the whole secretion is controlled from the cerebro-spinal side, there is an excess of mucoid matter in the blood circulation. When the thyroid is in an abnormal state it is unable to destroy the excess, this is the cause of myxoedema and edema.

    (2) The reaction of all the vaso-dilator field in the body sometimes produces goiter, for example, the uterus particularly, in connection with dysmenorrhea at the period of menstrual puberty, also ovarian congestion.

        (b) Reaction of the disturbed heart or pulmonary condition on the thyroid gland, for example, exopthalmic goiter.here the heart is in a flabby condition allowing more than the normal amount of blood in the heart. We deal with this first through the periphery by construction; 2nd through the heart proper at 2-5-4-5 dorsal. In goiter then we find:

        (a) An involvement of the thyroid gland proper or

        (b) An involvement of the parathyroids or

        (c) Cystic condition.

        (d) Involvement of the accessories to the thyroid namely the mouth, throat, stomach, etc.

    Remember that the obstructive condition or the disturbing condition is cerbro-spinal that means always some type of vertebral lesion. In dealing with the condition of the goiter having found primary or irritating cause:-

1.Treat goiter in relation to the general secretion(the lesion is secondary to disturbed secretion). The first thing to do is to get hold of the general secretion by treating the lymphatic system. In treating for secretions look after gastric, salivary intestinal secretions, and the uterine functions.

    Most goiters depend on changes in life in the female (disorganization of internal secretion is the cause).

    If silvary secretion is involved, either too much or too little, all the other secretions will ultimately be involved.

2. Reestablish venous drainage from the thyroid gland particularly in relation to the clavicle and the first rib. In doing this remember that is also applies to the entire venous system of the body. In order to do this we must reorganize the vaso-motor control of the circulation of the blood, that is it means we must pay more attention to the cerbro-spinal than to the sympathetic side is exaggerated in its function. To get control apply inhibition, particularly over the three great cervical ganglions , this represents the real brain of the sympathetic systems. In dealing with secretions from the side of goiter we must rectify from cerebro-spinal side. That is pay attention to the inferior cervical ganglion, because this ganglion checks, or holds in check, the cervical sympathetic ganglia.

3. In the vaso-motor field look for some localized vaso-motor disturbance in relation to the ovarian and uterine organs. The liver or spleen or both . The disturbance of menstruation is not the cause of goiter, the suppressed menstruation is the result of extreme vaso-dilation over the rest of the body. The uterus attempting to balance the circulation by its own dilation, that is the uterine congestion of dysmorrhea is a compensatory condition.

    To meet this condition the only treatment Is to establish control of the vaso-constriction through the sympathetic system.

    In giving vaso-motor treatment, there are two points to be noted.

        (a) If you want to reach the cerebro-spinal side of the vaso-motor, articulate the spine thoroughly in the dorsal region ,2nd dorsal to 2nd lumber.
        (b) To reach the sympathetic side do not articulate the spine, but articulate the ribs, the heads of the ribs and the transverse processes of the vertebrae being objective points of treatment. Also deep manipulation along the spine.

4.  In all cases of goiter do not treat directly over the goiter

        (a) If goiter is rigid continue to treat around at the base to make it movable.

        (b) Treat muscles in the neck particularly by extension

        (c) As soon as the gland is freely movable apply frictional vibration to the gland and shaking treatment to the trachea.

        (d) Articulation of the spine contra-indicated, at least under the vaso-motor treatment.

The Neck

    Here we have field that particular controls a number of functions. (1 ) All vital functioning, in the field of the ribs, of the vital processes are controlled through the medulla in relation to the first five cervical nerves.

    (1) Respiration is controlled through the neck.
        (a) through the 10th cranial nerve,
        (b)through the phrenic nerve,

        (c) through the third cervical sympathetic ganglion.

    (2) The lymphatic function, this is in the field of the anterior transverse processes of the last three cervical vertebrae.

    (3) Secretion, chiefly salivary secretion this is controlled:

        (a) Through Lymph

        (b) Through spinal and cranial distribution to the glands.

    (5) Peristaltic movement, this applies to the entire alimentary field.

    (6) Visero-motor and vaso-motor in the pelvic organs, both male and Female.

    (7) Control of the entire sensor-motor apparti and their functions, this applies:

        (a) to the whole field of motion and locomotion.

        (b) to the entire field of mentality.

General Treatment Of The Neck.

1.  Articulate the upper three ribs in order to reach the sympathetic systems, this applies to vaso-motion particularly.

2.  Extension of the neck and spine. First extend the spine and then stretch the neck by pulling on the head. Break rigidity by articulation, then apply the twisting movement to the neck.

3.  Give articulation to the muscles of the neck by twisting movement beginning in the upper cervical region. If there is head or neck congestion relax muscles from below upward and articulate downward in the neck. Reason for this is congestion is localised condition not dependent on the general blood circulation but some lesion.

4.  Relax sterno-mastoid muscle, place thumb on one side and fingers on the other and hold these two points and rotate head increasing stretching treatment antero-laterally. Increase stretching on one side and decrease on the other and visa-versa until entire length of the neck is twisted.

5.  The best method is by articulation for neck lesions, applying pressure either rigidly or by jerking or twisting movement in the direction required for the correction of the lesion. Three principles were laid down before and these apply here in the neck as in any other part of the body.

        (a) Exaggeration , in the neck flexion to the opposite side.

        (b) Extension, that is pulling right out on the neck in exaggeration

        (c) Flexion, towards same side as the lesion maintaining extension. These are the three principles applied in the correction of any lesion. Applies o ribs, inmominates, vertebrae, any other part of the spine or any bone lesion in the body

6.  Best way to articulate the neck is to catch the head in the palm of the hands, one on either side and place fingers(index),on the transverse processes of the same vertebrae, with finger and hand in this position hold vertebrae and head in fixation, rotates head by the force that can be exerted by the hands assisted in some cases by the pressure on the vertebrae or pressure of the superior occipital region against the chest of the operator take such vertebrae in turn, one by one, and follow the treatment mentioned above in congested conditions,relax from below upward, and articulate down, in any case of the congestion of the head and neck, in all other cases relax and articulate down.

        (a) Treat the 10th cranial nerve in the neck, push neck to one side and extend it a little then push the carotid artery slightly forward so you can get your fingers right in behind the pulsation of the carotid, then apply the steady pressure or moving pressure, to the 10th nerve. There are several points at which we can reach the 10th nerve:

        (b) At the occipito-atlantal articulation here we catch the 10th nerve unmodified by sympathetic system,e.g.,on the heart trophic or inhibitory side. The visero-and vaso-motor functions of the 10th nerve are through the sympathetic at the 4-5 dorsal, the sensory through the superior cervical ganglion ( lower end 4 cervical)

        (c) At the lower end of the superior cervical anaglion we reach sensory function of the 10th cranial nerve via sympathetic system, e,g in palpation of the heart stimulate at this point on the left side.

        (d) Just above the clavicle along side of the sterno-mastoid muscle,here you get effect on the 10th cranial on the lungs and stomach outside of the sensory function to the right side only.

        (e) At the head of the 1st rib in its articulation with the vertebrae we get vaso-motor of the 10th cranial nerve through the depressor nerve function, this is the vaso-motor side of the 10th cranial nerve. The vaso -motor effect is dilator, (all cranio-spinal nerves are dilators) .

        (f) At the 4th and 5th dorsal through the sympathetic ganglion at the heads of the ribs we get 10th cranial nerve on the left side and phrenic nerve on the right side. These two nerves being correlative at this point through sympathetic system, the methods of reaching these two nerves is articulation at the head of the ribs. This is the visero-motor side of the 10th cranial and phernic nerves.

8.  In syphilis, cancer, scrofula enlarged and soft glands,(a)stir up glands by direct treatment around base of gland to make glands very movable.(b)As soon as the gland is gloating give treatment to the gland itself. (c) Use vibration or friction to gland to start up visero-motion.(d) In tuberculosis of the gland or glands loosen muscles in gland field and then kneed the glands. This condition we find in chronic hardening of the gland, this hardening of the gland may be found in syphilitics types and in bilious types,in the bilious types there is a brown discoloration of the enlargement. In tuberculosis the gland is hardened but not bound together like a solid mass, it is like a soft pulpy condition. In cancerous and sorofular glands there are irregularities in the internal part of the glands,in treating be careful not to get over the gland in any of these types. In simple hard gland that we get in a cold or sore throat we have a history of colds or tonsillitis or something to differentiate it from tuberculosis.. In this case we have a simple hard gland any kind of treatment is indicated.

    Direct treatment . In tuberculosis where we have enlarged glands or cancer it is not advisable to treat in any local way the gland itself but remove it surgically unless there is a septic condition of suppuration that endangers the organism

9.  In case of Boil and Carbuncle, (a)differentiation between boil and carbuncle is that the carbuncle has roots which are imbedded in that tissue, under the living tissue, where as a boil has localized base without roots. (b) In carbuncle there is infection or danger of infection, in boil there is not. Nature tries to shut in the process of pus formation and pus accumulation. In the carbuncle the walls become imbedded in the tissues. It is the wall rather than the carbuncle proper that forms the roots, if a carbuncle is taken in time the growth of these roots can be prevented because roots belong to the wall and not to the carbuncle proper.

Treatment of Boil and Carbuncle

1.  Cause the boil to be reabsorbed unless in the case where it has already pointed in that case it must be removed or opened to let out the pus. Pus unless infected is always sterile, hence no danger In reabsorbation into the system. We find boil, e,g,in cases where body is intoxicated with malaria without any bacteria or germs or where system is intoxicated by rheumatism and diptheritic poisons.

2.  Stimulate circulation to and through parts affected.

3.  Give good eliminative treatment.


1.  Apply treatment to root of carbuncle and keep soft tissue softened, use oil (Antiiphilogistine, etc.).

2.  In absorption of the boil keep tissue soft, stir up blood and lymph supply to stimulate the absorption process, assist this by pressure.

3.  In case of infection of the pus drainage must be established. In determining whether there is infection, it is determined by temperature.

4.  Another method is using ice loosely over he boil.

5.  In the case of drug poisoning this can be dealt with by antidotal treatment only.

6.  In the surgical treatment of boil all that is necessary is incision and drainage. In the carbuncle you must cut out the root or the sac. The old surgical method of aborting a boil was to bind a piece of ice with gauze over the boil or carbuncle. In the surgical removal of boil or carbuncle best to use some local anesthetic, as Ethel chloride. In small abscesses, e,g, abscesses that come out on the face or neck secondary to some infection or contagious disease treat by keeping soft tissue loose, pressure around and over abcess. Treat internal abcess in the same way as abcess of the stomach, small intestines etc. In the cases of abcess take away all fluid from the patient foe three or more days (cause the lymphatic system to operate as washing fluid to wash it out of the system). Give absolutely dry food, ( uninfected boil or abcess, dry diet. Infected boil or abcess plenty of water).

    In case of boils on the forehead or face, these are found as post menigeal disturbances, also hydrocephalus, also in hereditary syphilis and gonorrhea, in those cases where the scalp becomes the eliminative canal, cause the elimination externally and use surgical means to have them drained out.(Head is the favourite point for these types of hydrocephalus). In this case give patient "wet" food and deal with as a surgical abscess.

    Note: - In chicken pox where papules have intense itching use some mild acid as weak vinegar, carbolized Vaseline, etc.

    Boric acid is the best thing to use in the case of hives. "Glycothymoline" also good.

Trunk And Extremities


1. Position and examination.

    Patient sitting on stool or table, make patient take position himself (to get easiest position to himself). In the first examination of the patient have the patients hands resting lightly on the anterior surface of the limbs, to get the normal position have the limbs far enough apart so that the femurs will be exactly parallel.

    Three or four inches apart.

        (a)  In the examination and treatment of the scapular and the interscapular between the 2nd and the 6th dorsal, the sitting position is best because this gives the natural position of the body and the trunk. There are three sets of muscles that cone into prominence, the trapezius, latissimus dorsi and serrati muscles. Trapezius and Latissimus play in opposition to one another, for example, there is contraction of the trapezius muscle when there is relaxation of the latissimus dorsi unless in exceptional cases where you have more specific disturbances in the particular case. The serrati are in between the two other sets and has a mediating influence between the opposing actions, this means that in controlling the action of the trapezius and lattisimus dorsi we must depend on the serrati muscles, therefore in dealing with rigidity or relaxation the serrati muscles are the chief muscles to attend to.

        (b)  The interscapular area also takes in the vaso-motor area to the heart and lungs, also the stomach area, the area for the upper part of the intestines and liver. (2nd to 8th dorsal).

    Remember that in relation to the heart and lung rhythm the pulmonary plexus representing primarily the spinal nerves is intermediary. This also applies to the stomach, liver, intestines and Spleen. The nerve supply is primarily sympathetic through the solar plexus, this means that in the heart and lungs conditions the vertebrae and their attachments, and in the stomach intestines and liver, including the spleen it is the ribs and their attachments(intercostal etc.) that are involved. If you have a history of stomach trouble you will know what to pay particular attention to. If the rib condition is the condition that we find on examination for example you have the means of locating the intestines, and spleen where as if we find vertebrae conditions in some area then we look for heart and lung conditions; via pulmonary plexus. (spleen is not developed from gut tract, thus there is independent nerve control in relation to other abdominal organs)

    The most common type of lesion in this region is a lateral curvature, the next to this the anterior or posterior curvature. In the lateral curvature case, the starting in general of the curvature is a movement of the individual vertebrae, the most common individual movement being the 3rd ,(two forced (a) pressure above (b) suspension below), 5th (takes place from the rib side ) and 6th dorsal, (initial break between 5th and 6th dorsal vent. Thorax strong). The reason for this is that there are more motor nerves than sensory nerves supplying the general distribution, as there are two motor nerves supplies to one sensory nerve supply the disturbance tends to fall on the weaker side of the nervous system. That does not mean necessarily traumatism, but traumatism will tend to settle down in the weaker side. The lesion in the spine, therefore will be found generally one or two vertebrae above the common center for the organ involved, e,g, the heart centre localized at the 4-5 dorsal, will show a sensory lesion at the 2-3 dorsal. The 3rd dorsal is the weakest point in the upper half of the spine representing the lateral (posterior) apex of the dorsal arch. This is also accounts for the frequency of the posterior lesion, if lesions are primary anterior lesions in this case seldom if ever are primary, they are secondary to lesions in the lower in the lower dorsal or lumber region, in the pelvis, or to organic lesions, functional lesions involving organs.

    It is probably true that there are never anterior primary lesions in the upper dorsal or lumbar vertebrae field, they are always secondary to some other type of lesion, this is of importance in differentiating between the secondary and primary lesions in the upper dorsal which extends as far down as the 6th dorsal.

    The first dorsal belongs to the cervical region; the upper dorsal beginning at the second dorsal and extending down to the 6th dorsal; the lower dorsal from the 9th down. The 5th dorsal is also a weak point in the spine but this is due, not to a spinal condition, but to the weakness of the 5th rib, consequently the dorsal is weakening of the articulation between the 5th and 6th dorsal either the 5th or 6th showing a tendency, as a result, to be displaced. Where the individual vertebrae are involved the 6th tends to move posteriorly, the 5th tends to move anteriorly that is the general rule of cases.

        (c) The 5th rib nearly always bulges out anteriorly that tends to cause the 5th dorsal vertebrae to fall away in an anterior lesion secondary to the rib lesion, this tends to throw out the specific lesion of the 6th rib posteriorly while there seems to be no specific lesion at the 5th rib. That indicates the line of treatment to follow in correction of these lesions;

        (d) In cases of an involvement of a portion of an arch articulate the arch as a whole and its corresponding ribs where there are ribs. There are a number of points in connection with the arches to be noted. The 1st to 4th cervical vertebrae represent a unit, that is to say theses are an arch; the 5th articulates by itself. The 5th cervical 3rd dorsal, 9th dorsal and 5th lumber vertebrae are the individual vertebrae that are liable to be in single mal-position as distinguished from multiple mal-position in the arches or groups of vertebrae. All the other vertebrae are liable to be in mal-position because the other vertebrae outside of theses articulate in groups. The 6th cervical to the 8th dorsal represents the upper arch , the 9th dorsal lies in between the two arches, 10th dorsal to 4th lumber is the lower arch and the 5th lumber lies between the lumber arch and the sacrum. The point to emphasize is the ides of articulation in relation to the arches consequently if you have a third dorsal vertebrae lesion correct this by correcting the cause that weakens the dorsal arch, that is to say, the condition of the lumber vertebrae or the condition of the pelvis or lower extremities, or if it is a cervical lesion correct that.

    Among the individual vertebrae there are two classes:

        (a)  The 3rd and 9th dorsal , 5th lumber and the 5th cervical , theses are the articulating facets between the arches and therefore they represent variation in the positions of the arches themselves, that is to say if you have a 5th cervical lesion it may be in relation to the first four cervical or the 6th cervical to the 8th dorsal. The principle of correction here therefore would be to correct the position relation of the arches in order to correct the inter arch vertebrae.

        (b)  The 3rd dorsal stands alone as a vertebrae in the spine representing the centre of the cervico-dorsal arch and the pivoted point of the spine in relation to the centre of gravity line, therefore in all lesions of the third dorsal there are two things to be looked after:
(1)The condition of the spine as a whole in its relation to the central gravity line.

2. The 3rd dorsal is the key to the upper arch and therefore the correction of the 3rd dorsal lesions means rounding out of the upper arch, that is to say if you have anterior upper dorsal and along with that 3rd dorsal lesion correct the whole anterior upper dorsal, same true of posterior or lateral curvature of the upper dorsal. Correction of the 3rd dorsal depends on the cause, mechanical force is not osteopathic therapeutics,. It is impossible to say how to correct the 2-3 or the 3rd dorsal vertebrae unless you know its cause, that is the reason why some of the osteopathic work is so bad, and does not produce good results. In correcting the 3rd dorsal must get down to the cause, and that cause is the weakening of the articulation of the spine except in one single case where vertebrae is thrown out by violence. When you have corrected the cause of the weakening articulate the spine from the point of the lesion. If thrown out by violence you must follow the surgical rule , namely repeats as much as possible the original movement of the spine in causing the lesion, this is the only way in which we can correct the traumatic lesions of the vertebrae.

    In the 5th dorsal vertebrae lesion you must first correct the rib condition, there as we said before a 5th dorsal lesion is impossible unless there is a previous rib condition. In this case correct the rib and then articulate the vertebrae above and below the 5th dorsal, including the 5th dorsal itself. Begin at the 2nd dorsal because where you have a lesion in any vertebrae from the 3rd to the 8th dorsal you must treat the whole field as a unit. If there is a 6th dorsal lesion correct this also by correcting the 5th rib because in the 5th dorsal vertebrae lesion you will find that the 5th rib was primarily at fault, the cause of the 6th dorsal lesion being the rigidity of the dorsal vertebrae just below the 5th, that is the articulation of the 5th and 6th dorsal vertebrae. You require to pay attention to the rib first, and then articulate in the same region from the 2nd to the 8th.

    Vibration is of service in this field because of the direct effect of the vibration upon the ribs in establishing mobility. Hand vibration practically of no value here use a vibrator, the vibration is equally good for the ribs or vertebrae. It is impossible to get the delicate vibration on the long stretch of the ribs, that is where the vibrator comes in. Use it, not on the head of the rib, but at its sternal attachment, and it follows the path of the rib around to its head. The depth of the vibration is the important factor here because the deep vibration is valuable in reaching the ligamentous articulation (these bind vertebrae together)

    In the 7-8 dorsal lesions they are always secondary unless traumatic, this applies to the lesions of the liver field for example, 7-8 dorsal vertebrae are the liver lesion fields , if the liver is disturbed (a) primarily it will show itself at the fifth dorsal then (b) when there is a weakening at the 5th dorsal we get secondary lesion at the 7-8 dorsal because that is the motor field of the liver, passing around the nerve arch from the sensory side to the 7-8 dorsal motor. In correcting this lesion then go on to the primary origin at the 5th dorsal correct any disturbance there then articulate downward to the 8th dorsal. We often find lesions in this 7-8 dorsal secondary to dorso-lumber lesions in this case follow same principles as before, that is correct original cause in dorso-lumbar region and then articulate from point of cause to point of lesion. The reason for these points is that it is a question of laying the foundation and making the vertebrae into line , that is correct the position of the vertebrae and then correct the general position, for example a child growing quickly will tend to develop a straight spine, to correct this we cannot correct this by correcting the individual lesions but by establishing the normal curves of the arches and then forcing the individual vertebrae into line.

    In treating this area of the spine as a whole(2nd to 8th dorsal):-

    (1) The only way in which you can get free movement of the spine is by bending the head and shoulders slightly forward.

    (2) The clavicle and scapula must be free before this part of the spine can be articulated therefore in treating this part of the spine first give preparatory treatment (In this case relaxation) to the clavicle and scapula.

    (3) In articulating this portion of the spine have patient in sitting posture, if possible, place one hand in front of the patient, place the other hand underneath the axilla and support the lateral half of the body on that side in that position and (1) Apply articulation from under the other axilla with the other hand, or support the two lateral halves of the spine and trunk of the body with the two hands underneath the axilla. (2) Catch the neighbor vertebrae with the fingers of the two hand and pull the vertebrae in opposite directions from under the axilla. The operator in front of the patient. This finishes up position one.

    (4) Patient sitting on stool with arms folded tightly across the chest, in this position the scapula are:

        (a) Thrown close to the spine and therefore thrown out into prominence. Away from axillary line. Position of treatment in pigeon chest.

        (b) If there is a tendency to winged scapula this will exaggerate the winged condition, because in the movement of the upper part of the scapula towards the median line the lower part will resist, that will tend to throw it out in a more prominent position, for example particularly in relation to the scapula.

    (c) In relation to the scapular muscles and interscapular area and the interior condition of the vertebrae down to the 6th dorsal.

    (d) It is also used to test the degree of posterior expansion in the upper thorax in connection with respiration.

    Treatment in this position is of value principally in (a) treating the articulation of the shoulder, especially where it is rigid. With the patient in that position , for example, take one hand and lay it across the shoulder (clavicle and scapula) and with the other hand pull the arm up and down from this position in which it is lying as the patients arms are folded tightly across the chest , that will push the shoulder upward, with your hand over the clavicle and scapula, or if it is to rigid pull it out and allow the scapula to drop, that way you will get relaxation. It is (b) also of value rigid condition of the trapezius muscle, the best method is to stand behind the patient, apply one hand right over the trapezius muscle region as it comes down posteriorly, and with your other hand take the arm at the elbow, push up and back , pushing out the ribs from anterior to posterior, here you are pushing out the ribs from the anterior towards the posterior at the region of the angle of the scapula when you apply your pressure over the trapezius that strengthens the trapezius. Push or pull on the anterior spine of ilium while you pull on the spine of the 5th lumber, while you give swaying motion.

    Another method of treating the rigid articulation of the shoulder is to have the patient keep one arm folded across the chest, bring your arm up above the patient. Stand behind the patient and in doing this, and place your second hand lightly over the shoulder of the patient, first on the same side as the free hand and then on the other side, hold that part of the shoulder tight while you are giving that movement up over the head.

Treatment of the Ribs.

1.  Stand in front of the patient, apply pressure over the crossed arms (tightly folded) with your chest (for example) and with the hands behind the angles and heads of the ribs pull forward on the ribs , at the same time apply pressure over the ribs anteriorly and over the folded arms.

2.  Another way of treating the ribs in this position is to keep the one arm across the chest, use the free arm of the patient to pull up, apply pressure forward and upward at the angle of the rib on the same side as the free arm. This is especially valuable in one sided rib conditions.

    Same treatment with hands in lumbar region while you sway patient from side to side.

3.  Patient in the sitting position with arms lightly folded across the chest, in this position the inferior end of the scapula tends to move towards the spine, for example, this is the position particularly applicable in the examination and the treatment of the scapula, except where the scapula are winged, especially the scapula are too close or over lapped; for example, in this last case, where the scapula are to close to give treatment to the scapula separately. Stand at the side of the patient, throw one of your arms around the anterior thorax of the patient, with your hand grasp the outside of the arm( arms folded lightly) use your hand to pull the scapula on the same side as you stand, around towards oneself, then without changing position pull the scapula in the opposite direction treat the other scapula in the same way.

    Another method of relaxing the scapula is to stand in front of the patient, the arms folded lightly over the chest, push the head back and pushing the shoulders down as far as you can without any danger, leaving them in that position. Apply pressure outward on the two inferior angles of the scapula, put hands around patient and pull scapula outward towards the axillary line, apply pressure to the inferior angle of the scapula, apply pressure on head of patient with your chest. Bend head down as far as possible, put knee in lumbar region applying traction on sternal end of ribs and pull back. This can be used in articulation using thumb in place of knee.

    Another method: - With the patient in the same position, stand in front of the patient with the head, neck and shoulders of the patient erect ( in this case make the patient breath deeply)apply pressure against folded arms( across the chest), and then pull the two scapulae towards the axillary line on the two sides. (good pleurisy treatment).

    In this third position you can also articulate the spinal vertebrae. Stand in front of the patient, place the arms around the patient to the spine. Catch one vertebrae in each hand and the neighbor vertebrae with the other hand and pull in the opposite directions, do not pull too hard to pull them apart, this is a good method of applying articulation in cases where the patient cannot lie down, for example asthma. This can be given to patients who are bedridden even on back.

4.  Patient still in sitting posture, arms hanging down parallel to the sides of the body, head and shoulders inclined well forward, (this is the position for examination), and for treatment of the deeper layers of the muscles along the spine. The same kind of treatment can be applied with the patient on the side, when the patient is in that position. One advantage of the sitting posture is that you can reach the two sides sitting posture is that you can reach the two sides (muscles)of the patient at the same time. Stand in front, put your arm from anterior to posterior, grasp muscles near the spinal processes, move out and up.

    Same treatment applied to the side, only you must stand behind, and then it is a pushing movement, and you do not get too much good results. This applies to the muscles and articulation as far down as the 8th dorsal vertebrae.

    In the same position you can correct lateral, posterior and anterior displacements of the vertebrae. Stand at the side of the patient and apply the three principles we have mentioned for correcting lesion: -

    (1) Exaggeration

    (2) Extension and then

    (3) Flexion to same side and then to opposite, applying pressure against the direction the movement you will give.

5. Patient lying on the table , straight but on side, preferably on the left side, particularly in female patients, because of the difference in the length of the ligaments, you require the longer ligaments up so as not to cause strain. If you are treating on both sides treat the left side first , and then on the right side afterward. Have the patient on the left side first and then treat from the right side later on, if there is anything abnormal in the circulation it would be better to lie the right side, the blood is freer on the right side, sometimes the patient gets almost varicose veins when lying on the left side.

    This difference in the length and tension of the structure applies not only to the ligaments but also the peritoneum and the pleura, both of which are shorter on the left side, more tense, in case of localized peritonitis keep patient on the right side to obtain free circulation.

    Another reason for this position is that the spleen occupies less space than the liver, if there is an enlargement of the spleen then you are required to reverse the condition, both as too treatment and position in sleep.

    (1) When the patient is put on the right side for treatment or for examination make sure that you relax the tension of the muscles and ligaments, and this also applies to the peritoneum by flexing upper and lower extremities giving rotary treatment. With the patient in this position you can give articulator treatment, for example, for the upper half of the spine, stand in front of the patient catch the spine of the vertebrae at its under side pulling upward and applying resisting pressure over the shoulder.

    (2) In cases where vertebrae are exceedingly rigid, pull the upper dorsal and the lower lumber simultaneously, and then towards each other, down the dorsal and up the lumbar, to give the articulatory treatment, relaxing muscles and vertebral circulation.

    (3) In this position you can give the crossed or diagonal treatment-------pushing at the shoulder and pulling at the innominates. This is good where the diaphragm is involved. With the patient in this position (a) examine the soft tissue on the other side;(b)Examine the vertebrae particularly in connection with the rigidity, articulation with the shoulder and ilium as the two points of leverage, with the 8th dorsal as the dividing line between the two halves of the spine. (c)Examine the condition of the ribs with one hand at the head of the rib and the other at the angle and sternum alternatively.

6. Patient on back.

    (1) This is the position (a)for examination and treatment locally for the thoracic and abdominal organs in their relation to one another and the spine. Place one hand on the spinal area corresponding with the organ and with the other hand use palpitate pressure over the organ itself, for example, in examination on the liver examine the organ with your hand directly, and place your hand on the liver area of the spine. In many cases that are uncomplicated you can differentiate between, in that way, structure and function lesion primarily.

    (2) Examination of the individual ribs in treatment for the spreading of the ribs, and in testing for the depth and extent of respiratory action.

    (3) It has been demonstrated that by limiting down respiratory action we get such a rigid condition of the spinal muscles that in a few minutes it might be impossible to breath. In relaxation of the muscles apply circulatory treatment.

    (4) This is the position for flexion, rotation and articulation of the head and neck and lower limbs.

    (5) This is the position for stretching the diaphragm, in this case throw the anterior trunk of the body forward by placing something solid in the region of the 9th dorsal and then stretch the diaphragm from the costal cartilage’s.

    (6) This is the position for local treatment of the abdominal organs through the abdominal wall. If the abdominal muscles are tense always flex the limbs, in locating the organs for examination and in the treatment for the uterus and bladder flex the limbs as much as possible on the abdomen and apply palpating pressure through the abdomen moving the limbs upward and downward while palpating.

7. Patient on the face

    For the physical diagnosis of all conditions on the posterior wall of the thorax and abdomen and of the entire spinal column lesions muscular and osseous. Treatment for the patient in this position.

    (1) Relaxation of the muscles in the thoracic and abdominal fields here you apply kneading or vibrator treatment.

    (2) Articulation of the vertebrae and the ribs using the leverage of the shoulder and the hip.

    (3) Relaxation of the scapula and the arm in articulation at the shoulder.

    (4) Articulation of the head and neck on the upper dorsal vertebrae and the attachments of the same, especially for the posterior, catch the head across the forehead and use the pressure of the thumb and finger beginning at the middle dorsal region pushing the head to one side or the other.

    (5) Free articulation of the pelvis on the trunk using the leverage of the limbs and the other hand to keep the limbs solid. (Lumber region)

    (6) Articulation of the sacrum, here we use only one limb as a lever and the other hand in direct relation to the innomiinate or the sacrum.

    (7) Inhibition in the lumbo-sacral region this is given from the dilator side.

    (8) In dealing with conditions of the ankle and knees.

    (9) Interscapullar area place arm behind and on back and knee back at elbow and press on vertebrae.

8.Patient standing on head, held by operator

    This is especially valuable in treating the diaphragm as in incurable cases of hiccups or pelvic congestion, this is also the ideal position for the relaxation of the diaphragm. In stomach conditions of children’s cramps etc. Inability to vomit. Breaking up adhesions in rectal field.

9. Patient standing in the erect position .

    This is the position for the physical diagnosis

    (1) In relation to the line of gravity, that is the central line from the symphasis of the chin to the symphasis of the pubes.

    (2) In determining the relation of the shoulders to one another and also determining the relation of the innominates to one another.

    (3) In determining the relation of the head to the trunk of the body.

    (4) In determining the relation of the organs in the cavities of the body, more particularly the stomach the liver and spleen. (a)For treatment, this is the position for treatment of enteroptosis. (b)In giving the tapping and striking treatment and also the rolling and the kneading to the abdomen and its contents.


1. First position standing or sitting.

    This is the best position for the movement of the thorax either from the anterior or the posterior, for example.

        (a) Stand in front of the patient, and apply pressure against the chest, giving a springing movement to the thorax with one hand on either side, either at the angle of the ribs or at the heads.

        (b) The same treatment can be applied standing behind the patient , giving the springing movement in that case from a point just about one inch from the anterior rib attachments.

        (c) In the asthmatic rigidity of the thorax sometimes unilateral and sometimes bilateral, this is the treatment especially during paroxysms, pull the thorax well forward, for example apply pressure right along the sternum in any way then catch the ribs with the flat of the hand from the head or angle and pull forward.

        (d) In the case of the patient with stomach involvement stand behind the patient and give strong inhibitory pressure upward from the point of the stomach at the same time give expansion of the ribs from the cartilage’s, applying pressure with the flat of the hand, at the same time pulling the thorax forward. This is also good treatment for inhibition of the solar plexus by pressing the stomach back against the aorta. For stimulation of the solar plexus press backwards and let go with jerking movement. Put the knee at the solar plexus field right over the stomach, push upward and give the thoracic treatment at the same time. This is also good for those who are great eaters for the amount used in the bodily activities , generally found in old people.

        (e) For the correction of the ribs, for example , in the dislocation of the ribs, this excludes the 1st and 2nd ribs, attempt to articulate the rib, e.g. if the rib is on the right side catch the corresponding vertebrae, pulling the head around the right side (standing in front)and with the other hand catch the angles of the rib involved, and apply strong pressure anteriorly, really a pulling pressure, at the same time apply pressure on the anterior thorax and pressure on vertebrae, follow this by same treatment of the second hand at the head of the rib. Then catching the rib at its lower border midway between the head and the angle apply pressure upward upon the rib while you pull the vertebrae ,and with the arm that is around the patient push his body over to the right side, you will articulate the vertebrae and remove the rib at the same time. On the other side reverse the points. In twisted rib treat in the same way but apply pressure at the point of the twist or the center of the rib and also in the direction of the twist.

    In treating the thorax as a whole have the patient in a sitting or standing position, apply pressure either anterior or posterior. In case of anterior pressure stand in front of the patient and lift the thorax from behind, first at the 10th dorsal vertebrae then in connection with the 10th rib, on both sides. When the pressure is applied posterily apply traction outward and backward at the cartilidges of the lower solid ribs. In this case have the patient assist the treatment by deep breathing , determined by his condition and what is to be accomplished.

        (f) Treatment of the clavicles. Patient sitting or standing: -

    (1) Place fingers behind the acromion end of the clavicles, applying traction forward and slightly downward while you move the arms out at right angles to the lateral aspect of the body, and then gradually move the arms around the anterior of the body, arm still at right angles.

    (2) If the clavicles are tight pull the arms of the patient above the head before inserting fingers, and then give the above treatment. Follow this by placing the fingers behind and under the clavicle at its sternal end, and move the arms gently, being careful, if it is tight or you may break it ,and give vibratory treatment of the arms. Examine the clavicle for a previous fraction, palpating ridges, and in such cases you must be more careful in this treatment.

    (3) Place the arm of the patient across the thorax and apply pressure from the elbow while you pull on the clavicle or on the acromion process

2.Second position in treatment of the thorax.

    This is especially good for springing the ribs or for the twisted ribs.

Patient on the side

        (a) Stretch the entire length of the thorax by giving the diagonal pressure treatment from the shoulder and pull from the ilium.

        (b) Follow this by stretching the arm upward towards the head, then forward and around the head and upward across the chest

        (c) To help this movement place your hand at the angle of one of the lower flexed ribs, for example, the 10th and hold thorax above that point in fixation pressure. If the ribs are rigid apply anterior fixation over the 5th 6th 7th 8th, 9th ,10 ribs at the cartilage point while you move the arm above the head across the forehead and chest while applying the fixation pressure backward.

    In spreading or separating the ribs apply the same treatment.

        (d) In springing the spine . with the patient on the side apply similar treatment , and in addition when the arm of the patient is pulled across the chest and then pull forward on the ribs, one hand anterior with the fingers at the sternal end, and one posterior at the angle of the ribs.

3. Third position. For treating clavicles and springing the ribs.

    Patient on the back.

    One of the best methods is to stand at the side, take the arm of the patient and pull strongly above the head, then apply with the fingers.

        (a) At the angles of the ribs to spread the ribs

        (b) At the head of the ribs to articulate them:

        (c) Midway between the head and angle to give maximum tension to the rib to straighten or increase the movement. Do the above while you pull the arm down at right angles to the sides of the body, and as low down as possible.

    Also give the same treatment by putting your arm under the patient and at the same time place the other hand between the head and angle of the rib, push up while dropping the arm towards the floor, and give it a vibratory.

    In case of depression of the sternum. Apply strong pressure laterally on the ribs while you get some elastic movement, and then follow this by giving the treatment, just mentioned.

    In reaching the aorta. In case where the aorta is involved, particularly in anerurysmal condition give this treatment to relive blood circulation placing one hand over the cartilage instead of posteriorly, beginning at the ensiform cartilage.

4. Fourth position

    Patient on face

    This is a good position in treatment of unilateral conditions of the thorax, for example bulging of one side of the thorax, simple hypertrophy of the heart. In cases of sunken ribs posteriorly, for example, where ribs are depressed below too level of the other ribs, the depression being between the angles and the head, indicating a dislocation of the rib, give a similar treatment with the hand under rib anterior in this case. Apply pressure at angle instead of head. When rib is sunken anterior not twisted, there is a depression. The best position is patient sitting or on back, pull the arm over head, applying strong traction from posterior to anterior at the angle of the rib, at the same time putting the arm above the head and rotating it down and back in a circle while keeping traction on the rib from the posterior.

    In case of involvement of the 6th ,7th, 8th ribs apply strong pressure upward on the rib itself, between the angle and the head of the rib , while the patient breathes as deeply as possible. This is for articulation of the ribs and vertebrae in the thoracic area.


    In the examination of the diaphragm there are two positions:--

1. Standing, this gives the normal position.

        (a) In this position make the patient breath deeply to expand the thorax and bring out unilateral or bilateral condition of deviation

        (b) Have patient fold arms across the back and breath deeply this gives you extent and degree of relaxation of the diaphragm, in this exaggerate lumber curve by throwing the shoulders well back.

        (c) Have patient fold arms across the chest and gradually incline body forward (1) so as to obliterate the lumber curve; (2)to increase tension on the spinal column at the 8th,9th,and 10th dorsal, this throws the rib out into prominence posteriorly.

2. Lying on the back.

        (a) Lying on the back straight out on the table. This is particularly good where there is contraction of the diaphragm. If the diaphragm is contracted the patient will not be able to continue this position very long. If only a slight degree of contraction the patient will be able to retain this position longer.

        (b) Lying on the back with the limbs flexed, and with the limbs flexed on abdomen. In this position we can palptate the diaphragm and find out its tension, we can locate the position of the aorta and its relation to the heart, and also the relation of the diaphragm to the abdomen.

    In treating the diaphragm:

    Place the patient on the back and apply stretching and extension, standing at the head of the patient and extending and stretching from the cartilage’s of the ribs. This applies in both contracted and relaxed diaphragm. In the relaxed condition of the diaphragm it is better to have the patient in a position so that the extremities are on a higher plane than the heart or the upper part of the body, in this position you bring all the abdominal visera on the abdominal surface, and this acts as mechanical pressure.

    In this case we get:

        (a) Direct action on the nerve supply to the diaphragm, distributed on the under surface.

        (b) Mechanical pressure of organs from the abdominal and pelvic cavities which inhibits solar plexus and also in the diaphragm inhibiting visero-motion of the diaphragm. This explains the quieting effect of the treatment.

        (c) Blood pressure is altered largely through the reverse force of gravity action

        (d) No dragging of the aorta in connection with the diaphragm, hence, you relive the heart condition by reliving the dragging sensation, e.g. in aneurysm of the aorta the patient gets relief by lying in this position the greater part of the time.

    We can also treat the diaphragm with the patient sitting. Stand behind the patient and apply the same treatment, applying pressure posterily with the knee, first at the level of the 2nd lumber, and then gradually move up to the 9th dorsal, all the attachments of the diaphragm between these two points. This is the best treatment except where the heart is involved.

    In the examination of floating ribs.

    (1) Standing posture, here use palpation and percussion.

    (2) Patient lying on back.

        (a) Have patient lie flat on back limbs on the table.

        (b) Take limbs on the same side as the abnormal ribs on which examining, Flex the limbs and rotate it outward. Here we are able to discover degree of rigidity of the abdominal muscles or the spinous muscles or of both in relation to the floating ribs.

    (3) Patient on the side with the normal ribs down towards the table. Place a pillow under ribs normal side, place the hand over the last of the solid ribs extending the fingers towards the spine so as to place the thorax in fixation, and then apply pushing movement of the iluim. This will enable us to discover the amount of rigidity in the floating ribs and also the degree of displacement.

In Treating Floating Ribs:

    (1) Have the patient on the side or back , if ticklish have on side, with the limbs flexed. Place the fingers at the head of the rib involved and apply strong pressure upward from posterior to anterior.

    (2) While you keep up this pressure from posterior to anterior apply pressure over the abdominal end of the rib.

    (3) If there is not tension ( if rigidity has being relieved) raise the arm of the patient above the head and then apply increasing pressure at the head of the rib and then move the move the arm downward along the side of the body while keeping up the pressure at the head of the ribs, If the rib or ribs are dropped downward pull the arm well forward in this treatment. If the rib is dropped from the anterior towards the posterior pull the arm well backward in giving the treatment.

    (4) After relieving tension bring the arm of the patient resting above the head and get the fingers in inferior to the head of the rib and apply pressure on the anterior to posterior on the same rib and move rib up or down anteriorly according to the disturbance.

    (5) If the floating rib is overlapping the ribs above apply strong pressure from anterior to posterior or visa-versa, at the heads of the two ribs, tenth and eleventh or eleventh or twelfth, and move the two ribs at the same time both anterior and posterior, using the bow characteristic of the rib as a leverage.

    (6) Then apply pressure at the head of the overlapping rib above keeping up the pressure of (5) and get the fingers of the other hands at the anterior and articulate the rib and move rib according to the disturbance.

In Physical Examination of the Abdominal Cavity.

    (1) Patient standing, here we have the free pendent position of all the organs, the presence of fluid will tend to gravitate downward, if gas it will tend to gravitate upward in this position.

    (2) Patient on the back. Palpating with both of the limbs straight out on the table and with the limbs flexed, in this latter case we get the maximum of relaxation of the muscles and ligaments and the true position and condition of the kidneys and the spleen.

    (3) Patient on the side. This is chiefly used as a position in what is called floating organs, which are the stomach, intestines and uterus, therefore they float in the interabdominal negative pressure field, the other organs the spleen, liver, pancreas and the kidneys are the stable or fixed organs.

In The Treatment of The Abdominal Cavity.

1.  Patient sitting or standing. The advantage in standing is that we get the organs in their natural position, and you also get the organs in relation to one another without relaxation or extension for muscles, for example, it is the best position to apply the shaking , vibratory, kneading, hacking and stroking treatments to the abdomen. These are direct local treatments to abdomen. The stroking treatment is applied superficially by applying it quickly, or deep which is applied slowly and deep.

2.  Patient on the side.(a) Here the patient may be on either side except in heart trouble them left side. Put the patient on the left side in case of liver trouble except when the spleen is enlarged. The two sides of the abdomen are not symmetrical, the organs on the right side are larger and occupy a larger space in the abdominal cavity(b)The ligaments on the right are longer and more elastic in the normal subject.( C)In prolapse of the rectum, and in intense contraction of the sigmoid flexure, place the patient on the left side because this position throws the organs towards the left side and relieves the tension. (d)In the motor type of constipation make the patient lie on the left side while sleeping. (Visero-motor type as shown by loss of resistance or tonicity of the walls of bowels)Change to right side when bowel’s wall have been toned up its entire (colon)length. In motor type of constipation peristalsis begins at sigmoid flexture, begin treatment rotatory here.

3.  Patient on the back with the limbs flexed. This is the most common position in the treatment of the abdominal conditions:

        (a) Because it causes relaxation of the pelvic organs and their attachments.

        (b) It relives tension on the blood circulation.

        (c) This is a good position when heart is rapid in action because this relieves the pressure on the iliac circulation.

        (d) In the treatment of the abdomen in giving the general treatment use this position .Begin this treatment with the ball or soft part of the hand over the abdomen, starting pressure where contraction is at its maximum and relaxation at its mimuimn and gravitate toward the point of minium contraction. Apply the same principle in relaxation. In treating the organs determine the beginning by the organ involved e.g. where the pelvic organs are involved the contraction begins in or below the pelvic region, the organs in this case ought to be treated from the diaphragm down. In the abdominal organs therefore begin at or above the organ because relaxation and contraction begins below the level of the pelvic organ. (Pelvis organ begins at perineum.)

        (e) The second general treatment is light kneading treatment, given with the cushion part of the hand and fingers. Remember to give the treatment much more slowly than in treating the skeletal muscles. In the latter condition try to get elastic reaction, before giving the kneading treatment.

        (f) In treatment of the abdominal organs:

    (1) Give treatment to the solar plexus, (inhibition)lay down the fingers midway between the umbilicus and the ensiform cartilage, and apply steady pressure in ward and upward. If the anterior part is to be reached give the pressure inward and downward and if the posterior part is to be reached give treatment in and up. In stimulating the solar plexus as a whole give a moving pressure and give the treatment from left to right.

    (2) In treating the gall bladder (in relation to acid and alkaline)locate it first at the anterior cartilage of the ninth rib and follow it downward by a semi-inverted letter -s- from the cartilage of the 9th rib downward along the intestinal path. The best treatment for the excretory stimulation from the gall bladder is the miling treatment. Catch the duct between the finger and the thumb and treat downward. Slight pulling treatment. (vibration and hacking)

    (3) In treating the liver most important treatment:

        (a) Inhibition;

        (b) Rhythmic treatment, alternate stimulation and inhibition, when the organ is practically inactive reverse this. In giving treatment to the liver always begin at the left lobe and treat from left to right, in this treatment push the structures of the ribs.

        (c) Another treatment is to push the fingers forward and down, with the other hand at the median line applying pressure. This treatment has especial reference to the rhythmic or peristaltic action of the liver.

4.  In the treatment of the spleen place the patient in the same position as in the treatment of the liver;place the knee against the ribs in the spleen area and apply pressure to the ribs to push the spleen area towards the median line and then place the fingers under the ribs and give same treatment as to the liver. (flex right limb).

5.  In treating the stomach. The local treatment is similar to that of the liver :-

        (a) Inhibition

        (b) Rhythmic

        (c) Insert fingers of both hands on either side of the stomach and pull towards the median line. Flex the stomach on itself so as to increase the tension of the greater curvature. Get out the gas in this way if it is present.

    (1) Too tone up the stomach follow the direction of the peristaltic action

    (2) Where the pyloric oriface is involved in spasms of rigidity or contraction give deep inhibitory pressure over the pyloric end and follow this by kneading treatment upward and towards the cardiac orifice, and then inhibit over the cardiac oriface and then come down and around.

    (3) Where the cardiac orifice is in a state of chronic contraction knead upward from the pyloric to the cardiac orifice and then inhibit over the cardiac orifice.

    (4) In congestion, tumerous or cancerous conditions of the stomach, which generally effect the ends, apply your treatment to the body of the stomach as the treatment to the ends is contra-indicated.

    (5) In dilation of the stomach ,gas etc, apply steady inhibitory pressure over the body of the stomach up to the point of elastic reaction, and follow this by the treatment of the solar plexus from the alkaline point of view.

6.  In the intestines. In all treatment of the intestines :-

    (1) Begin by getting a complete relaxation of the abdominal walls as possible. If there is excessive relaxation give strong inhibition pressure up to the point of elastic reaction.

    (2) Pull up intestines from the iliac fossa region. In giving this treatment do not pull intestines up from the umbilical region as it may cause irritation.

    (3) Pull up small intestine by a pushing or wringing movement. Fix your fingers in about the symphasis, and lay the other hand above the stomach, apply pressure there and then push deep with the other hand above the symphasis, continue treatment until the intestines are drawn up.

    (4) In giving kneading treatment to the intestines first steady inhibitory pressure and then follow by rolling movement of the finger associated with the kneading treatment. As a general rule in this kneading treatment begin at the sigmoid flexure. This is useful in motor types of diarrhoea or constipation. In vaso motor types of begin at the ileo-coecal region, kneadaround to the sigmoid flexure and then back again.

    (5) In appendicitis, typhilitis, paratyphilitiis, etc. apply steady pressure over the appendical region, follow this by light vibratory and kneading treatment towards the appenndix from above, below and laterally to the organ.

    (6) In peritonitis, give steady inhibitory pressure deeply upward along the symphasis, (just above the symphasis), from side to side and below the ensform area, and then give gentle pressure followed by vibration and kneading treatment around the margin of the ilium both sides, and then over the abdominal wall treating upward.

7.  In treatment of the pelvis and lower extremities.

    (1) First position. In the sitting or standing posture. In the examination make the anterior and posterior spines the objective points of comparison, also the sterno-illiac synchrondrosis, looking particularly for rigidity and tenderness at this point. The advantage of examination with the patient standing is that the patient assumes a position that favours the weak side.

    The pelvis may be moved as a whole, or in parts. The most common lesion is one or both innominates and that lesion may be of three forms, upward ,backward and twisted.

    Best method of correcting is to have the patient on the back if the lesion is posterior, pull the body of the patient out to the end of the table so the limbs and part of the body hang over the table supported on the posterior superior spines. Elevate the limbs and the pelvis and then drop the limbs and pelvis gradually over the edge of the table giving (a) rotary movements, (b)artiiculatory movement applying pressure at any point at which the rigidity is greater than normal. That you will test by pulling of the muscles or the pain.

    (2) Second position. With the patient in the sitting posture put your knee in sacral region and apply strong pressure forward while you articulate the trunk of the body backward on this sacral articulation . (This requires two operators)

    (3) Third position. In the sacral displacement, place the patient on the back, place one hand under the patient at the sacrum so that the hand will reach the anterior superior spine on the opposite side, pull strongly downwards from the anterior superior spine while you rotate the limbs.(The swing is not so good.)

    (4) Fourth position. In the movement of the pelvis as a whole, we have the tipping of the pelvis forward or backward, and in some cases twisting, in this case give treatment similar to (3)on both sides. You also can give treatment by moving body downward on the table to the level of the 5th lumber, and then give articulatory treatment in that position, holding the feet up on the same level as the body while you rotate the limbs and pelvis on the 5th lumber.

A. Pelvis and Lower Extremities.

    The lumber region and the pelvis are very closely related, the pelvis is the base on which the entire spine, and in relation to which the entire spine articulates, the 5th lumbar therefore represents the pivotal point of articulation between the spine and the pelvis therefore it is liable to be a weak point and if weak it reacts on the entire spine.

    Among the 5th lumbar lesions we find first rotation of the vertebrae chiefly posterior. Second a lateral movement of the vertebrae ,in this case their is tenderness at the muscles at the anterior superior spines of the ilium and the ilium is elevated. (On the side of lesion).

    (1) Examine in relation to the spine because in pelvis lesions and spinal irregularities especially compensatory curves are found. The pelvis as a whole may be tipped anterior or posterior in relation to the spinal column.

    (2) The pelvis as a whole may be twisted on the spinal column. (Pelvis being twisted while the spine remains absolutely straight).

    (3) The pelvis as a whole may be tilted, one ileum up and the other down.

    In lesions of the entire pelvis the point of displacement is the lumbo-saral articulation.

        (a) In some cases the 5th lumber follows the pelvis.

        (b) In some cases it follows the entire lumbar region (2-3-4-5 lumbar as solid piece).

    (1) In the posterior luxation of the pelvis both posterior superior spines are prominate.

    (2) In the anterior luxation of the pelvis as a whole both posterior superior spines are depressed.

    (3) In the twisting of the pelvis as a whole one posterior or superior spine is prominate while the other is depressed.

    (4) In the tilting of the pelvis as a whole one posterior superior spine is elevated and the other is lowered. In this case also there is tenderness at the crest of the ilium at the lowered side and the waist line is deepened on the high side and there is an inequality in the length of the Limbs.

    Examine the patient in the sitting posture to find out the condition of the posterior superior spines and the crest of the ilila. Examine the patient with the patient lying on the back to find out the conditions of the crest of the ilium and the soft tissue around the crests. Examine patient with patient lying on face to find out the condition of the soft tissue in the sacro-illac region, here there is sensitiveness to pressure over the sacral prominence.

B. Parts Of The Pelvis.

The Indominates.

    These indominates may be moved anterior , posterior, up or down, or there may be a combination of these movements . Here the various bones in the pelvis are found in special positions, that is the lesions is a physical misplacement.

1. If the innominate is down the ischium is posterior and the iliumn is anterior

2. If the innominate is up the ischium is anterior and the ilum posterior.

3. If the innominate is forward or backward the ligamentous tension all around the innominate field is exaggerated.

4. If there is a combination in these other variations of movements , the most frequents is downward and backward movement with the limb lengthened on the corresponding side. Next to this is forward and upward movement with the limb shortened on the corresponding side. According to this the innominates are liable to rotate around some focal point forward or backward displacement depending on this rotation , that is the displacement is dependent on the abnormal rotation. (Twisting being the real lesion).The downward and backward movement is most common on account of the belved edge of the sacrum representing a broadened wedge lying upward in articulation with the ilium, it is this articulary relation that is rotated or twisted as the cause of the displacement.

        (a) In examining the patient have the patient sanding in the erect posture, in this position compare crest of ilia and the posterior superior spines of the ilia. The one is higher than the other in a lesion.

        (b) With the patient lying on the back grasp both ankles and rotate limbs laterally first to one side and then to the other side and give pull and push movements to the limbs to relax the muscles and then bring heels together and first compare the length of the limbs at the heels and at the internal malleoli. Second compare in relation to the anterior superior spines of the ilia (to find out if these are equal or higher or lower). If the innominates are effected a difference is noted at the internal malleoi and hell points, in no 1 the limb is lengthened and in no 2 there is a shortening of the limb. (Innominates being up).

    In addition to these in innominates lesions use the following sings and symptoms:-

    (1) Tenderness on symphasis pubis on side of lesion.

    (2) Tenderness at the ilio-sacral articulation on the side of the lesion and rigidity of the muscles and ligaments at the same points.

    (3) Tenderness along the iliac crest over the muscular attachments.

    (4) Tension of the tissue around the sigmod and iliac fossa on the effected side.

    (5) Tenderness of the pubic bones. (Bladder ,Uterus, Prostatic conditions, etc.)

    (6) Tenderness of the pubic nerve as it crosses the iliac spine on the sound side.

    (7) Test the length of the limbs with the patient on the back, relax the tissue, rotate, and apply pull the push movement to the limbs and then place the heels together.

    (8) Test The position of the posterior superior spines of the ilia with the patient in the sitting posture, and standing and compare.

    (9) The waist line is deepened on the side of lesion, on the other side it is fuller down towards the pelvis.

    (10) The curving of the spines are located in connection with the tension of the pelvis and on the same side as the tension of the soft tissue.


    In the examination of the patient to find out the condition have the patient first standing erect to find out the relations of the two innominates to the sacrum. (band one limb at knee and put foot on stool then examine ilia.)

    Second with the patient on the face , the sacrum is commonly or generally displace anterior and downward except in cases of traumatism when the displacement may be posterior. Physical signs of the anterior and downward displacement which is the most common one are:

    (1) Tenderness at the sacro-iliac articulation.

    (2) Separation from the 5th lumber vertebrae, the separation being downward.

    (3) Tenderness between the 5th lumber and the sacrum.


    Examine the coccyx (a) with the patient in the erect posture (standing);(b)with the patient lying on the face. The most common lesions of the coccyx is the anterior displacement or the lateral displacement. The lateral displacement is found in connection with rigid muscular conditions.

    Examine (a)by pressure directly over the coccyx. (b)By lateral pressure over the coccyx while elevating the limbs backward one at a time and then two together; (c)while rotating the limbs (apply lateral pressure),from side to side, that is also the routine of treatment of cocygeal lesions.


1. Relax the muscles with the patient on the face, manipulate the muscles upward following this by flexion and rotation of the limbs. The treatment is to be given in all cases especially in the case of pelvic lesions over the sacral foramina when the soft tissue are rigid.

2. In correcting the rotation of the pelvis on the 5th lumbar (a)patient on the side hold body firmly with one hand or arm and move pelvis back and forward.(b)With the patient on the back place one hand under the posterior superior iliac-spine and lift the limbs so as to get a good grip on the entire pelvis and lower the extremities and then rotate or articulate the pelvis and lower extremities on the 5th lumber. (c)Patient on the face, elevate the limbs and rotate the limbs and pelvis while holding spine in fixation at the 5th lumber. (especially when the 5th lumbar is posterior)(d) Patient sitting fix the pelvis while standing behind the patient by holding the crest of the ilum from the posterior;(1)in the tipping of the pelvis forward pull the pelvis backward while gradually working the trunk of the body forward; (2)In the backward tipping have an assistant standing in front and pulling the pelvis forward while you stand behind the patient grasp the patients body beneath the axillary raise and pull trunk of body backward, while pressing the knee against the sacrum and rotating the body trunk from side to side.

3. Correct the innominate lesions. Place the patient on the side, stand in front of the patient place one hand between the limbs and grasp the tuberosity of the iechium and place the other hand on the crest of the ilium posterior. In this position we can move the ilium up or down or backward or forward pulling or pushing on the two points.

        (a) In giving this treatment pull forward on the crest and push back on the tuberosity in the posterior lesions, and pull forward on tuberosity backward on crest on anterior lesions.

        (b) Patient on the back. Pass the arm under the spine and grasp with the hand the crest of the ilium raise the limb with the other hand and arm as a lever while pulling upward and downward, backward and forward on the crest of the iluim.

        (c) Patient lying on the side with the effected side up , stand behind the patient apply pressure with the hand on the upper part of the inanimate and draw thigh backward while pressing the bone forward. If the lesion is the one in which we find the ileum posterior and the ischium anterior, stand behind the patient, place the knee against the sacrum, one hand on iluim and with the other hand grasp the ankle on the effected side and apply pressure over the ilium then pull the limb backward and elevate or lower limb gently. In the upward displacement. Patient in the sitting posture. Have an assistant standing in front of the patient, placing in fixation the pelvis by firm pressure downward on the crest of the ilium. Operator standing behind the patient, grasping the trunk beneath the axilla lifting upward and rotating trunk away from side of lesion.

4. In lesions of the sacrum. If anterior displacement use the same treatment as in innominates lesions, in which the ilum was posterior and ischium anterior, because this is really the same thing as a posterior innominate lesion.

    In case of downward displacement of the sacrum have the patient sitting on the table, stand in front of the patient, grasp patient over the posterior superior spine of the ilium and give lateral rotation while someone stands behind the patient and pulls backward on the anterior crest of the ilium.

    In posterior displacement of the sacrum the patient sitting on stool, place the knees against the sacrum and grasp the anterior superior spines of the ilium and applying strong pressure with your knee, traction with the arms and at the same time give lateral rotation.

5. Coccyx In displacement of the coccyx;-

    (1) Relax all the tissues around the sacrum and coccyx and then insert the fingers back of the anterior aspect of the coccyx and elevate the limbs upward. On the other side do the same thing. The upward and backward pulling of the limbs with traction on the coccyyx from anterior will gradually loosen and relax the soft tissues and coccyx.

    (2) In some cases it may be necessary to insert the fingers into the rectum and first carefully relax the internal tissues and then place the fingers along the coccyx and apply pressure internally against resistance pressure from without .(Given with the fingers)"Only with fractures".

    In the fracture of the coccyx relive pain.

        (a) By relaxation of the soft tissues around the coccyx and internal tissues per rectum.

        (b) Inhibit the nerves internally per rectum.

        (c) Give strong inhibition over the rectum.

        (d) Replace in case of displacement, do not treat too frequently, not more than once a week.

6. Prostatic Gland This gland is located beneath the anterior wall of the rectum about one half of an inch from the anus. In enlarged prostatic gland apply pressure over and around the gland internally, gradually increasing the pressure upward and forward while you get entirely over the gland field. In some cases there is prolapsed condition of the rectal walls and in addition to corrective treatment the fingers are used to smooth the walls and push the soft tissues upward in order to aid in toning up and replacing the walls in normal position.

    In Hemorrhoids where great rigidity of tissues per rectum give internal manipulation to relax the tissuue and free circulation also to empty engorged blood vessels alone recto-vesicle walls. In connection with the pelvic condition the hypo-gastric plexus is an important nerve center. This is located by deep pressure about two inches below the umbilical region, just beneath the level of bifurcation of the aorta. The pelvic plexus which is accessory to the hypo-gastric is located slightly lower down and anterior from the median line lying deeply along each side of the rectum. The spermatic or ovarian blood vessels are located by deep pressure along a line beginning at the umbilical region, and one inch external to the anterior superior spines of the ilium. The iliac blood vessels are located by a line beginning at a point two inches below the level of the umbilical area and from there passing out diagonally to a point where femoral blood vessels pass out of the pelvis beneath Pouparts ligament.

    In attempting to reach the gluteal arteries rotate the thigh forward and then apply pressure at a point between the upper and middle thirds of a line drawn from the posterior superior spines of the ilium to the external side of the great trochanter.

    Pubic arteries and nerves are located by placing patient on side, stand in front of the patient and bend upper thigh backward to relax the soft tissues and then apply pressure over the spine of the ischium at the point between the middle and lower thirds of the line drawn from the posterior side of the ilium to the external side of the tuberischi.

    In examining The Uterus. It is not necessary for internal examination and treatment unless in specific cases and these are rare. In examining the uterus; first locate the uterus with the patient standing and then examine with the patient first on the back then on the side. In examination of the uterus:-

    (1) Locate the round ligament over the upper border of the pubic arch about one half inch external to the symphasis.

    (2) Place the fingers over the ligament and apply pressure while you rotate the limbs on the same side, then place the fingers over both ligaments and rotate and flex both limbs.

    (3) Follow this by flexing both limbs well on abdomen and inserting the fingers along the sides of the ligament in the iliac fossa region pressing the fingers deep so as to catch the uterosaral ligament. (In case of displacement you generally have to locate one side and then the other). Then push the finger and thumb down into the pelvis through the abdominal wall while flexing and rotating the limbs. In this way locate uterus and palpate around it to find out if it is floating or in fixation or if there are any adhesions, or weather the uterus is flexed on itself or is twisted on itself.

    (4) Pressure over both great ligaments if there is great tenderness indicates prolapsed uteri, if unilateral tenderness is present on side of greater tension the organ is falling to the opposite side, that is to say lateral displacement of the uterus. Normally uterus is to right.

    In the case of internal examination, this applies to cases particularly those representing tumerous conditions, have the patient on the back with the limbs flexed using the bimanual method of examination, the external hand locating the organ through the abdominal walls and the internal finger palpating (a)vaginal walls, especially for flabby hyperrelaxed condition of the walls, cystic conditions, warty conditions, polypoid growths etc.

        (b) Cervis as it projects into the upper vaginal canal. The main abnormal conditions found here are hardening, softening and tumorfaction. In hardening (benign tumors)we get rigid conditions, this is very typical of degenerative changes preceding maligent disease locally. Erosion and ulceration these are palpated as follows, the ulceration’s as little elevations and in the case of erosions little pits. The typical differential point is pain. In tense pain in palpating. (c)The internal ossuteri opens transversely at the lower end of the cervix, here the two chief conditions are hardening and softening.

In regard to the ossuteri:

    (1) If the transverse oss assumes an oblique position in the pelvic cavity then the uterus occupies a corresponding condition, turns to the one side or to the other corresponding with either prolapse or version of the uterus in one position or the other.

    (2) If the cervix points forward and upward the fundus is downward and back, this places the fundus against the rectum, or it may be turned (version), in falling backward the sciatic region and then have most extreme form of recto-flexion with pain over the sacrum.

    (3) If the cervix points back and upward the fundus had dropped forward upon the bladder. According to this the key note of determination in regard to malposition or displacement of the uterus depends on

        (a) The direction of the cervix

        (b) The direction of the oss uteri

        (c) The location of the fundus

        (d) In flexion’s the determination of the misplacement depends on the relative position of the cervix and the fundus. The uterus being either forward on itself or backward on itself. From the side of treatment it is of no importance to know the position of the uterus , the only thing to know is direction of the oss, and cervix, and position of the fundus.



    In case of pain in the arms or shoulders the cause may be in the shoulder joint, it may be due to the fibers contracting over the coracoid process, or due to clavicle or rib lesions. In some cases ,the fibers may slip out of the bicipital groove.

    Pain in the hand or fingers are generally secondary to rib, vertebrae, elbow or shoulder lesions.

    In the treatment of the arm.

    (1) General flexion and rotation of the arm.

    (2) Place closed hand in the axilla and force the arm of the patient against the side springing the head of the humerous outward in order to relax the ligaments and free the blood circulation.

    (3) Grasp the arm just above the elbow and flex the hand on the arm, or grasp the arm above the elbow and flex forearm to right side then pull away from elbow. This relaxes the tissues.

    (4) Inhibition or stimulation may be applied to the axillary artery. The fibers of the brachial plexus by pressure on the inner side of the humerous just beneath the axilla.

    Grasp arm just above elbow and pull it straight back at the level of the shoulder and then move it forward at the same level and upward to right angle level to the shoulder, that is the best treatment for relaxing the deltoid muscles.

    (5) To stretch the biceps extend the arm and stretch back and upward; in the case of displacement of the tendon of the biceps, long head , give same treatment then flex arm and apply pressure directly over tendon rapidity moving the flexed arm towards the sternum and then outward laterally and upward horizontally.


    In the limbs aside from the subject of dislocations a general treatment of the limbs is called for.

    (1) Flexion of the thigh on the abdomen followed by extension and internal rotation after this manipulate directly over the saphenous opening and under popliteal space to increase circulation and relax contracted muscles and ligaments. Here we get especially the stretching of the quadriceps extensor muscles, the posterior parts of the gluteal muscles and the gluteal portion of the sciatic nerve.

    (2) Hyper extension of the thigh stretches the anterior muscles and particularly the anterior crural nerve and femoral vessels. The hyperextension of the foot stretches the muscles of the foreleg and strong flexion of the foot extends the muscles of the calf of the leg.

    (3) Strong abduction is used to stretch the abdominal muscles of the thigh with patient on the back, one leg straight out on table the other is extreme abduction or circumduction stretches muscles in external rotation and also stretching the pyriformiis muscles and the obturators.

    (4) To stretch extensor muscles of the thigh and sciatic nerve extend the limb at right angles to the trunk, this extension is increased by extension of the foot while the limb at right angles to the trunk.(Dangerous in weak heart)

    (5) Patient on back, stimulation or inhibition of the popliiteal nerve or blood vessels in the popiteal space by drawing limbs over edge of table supporting foot between limbs while giving manipulation deeply just below the knee posteriorly.

    (6) Flexion, extension and version of the foot to relax ligaments of the ankle and also relaxation of the ligaments by spinal treatments, applying pressure on arch above and traction at the same time below by increasing and decreasing arching of the foot by pressure has similar effect. Similar treatment to the foot as a whole tends to free blood circulation of the foot, follow this by lateral rotation and flexion of the foot.

    (7) In order to free femoral circulation rotate thigh with limbs flexed at knee, first external then internal and follow this by manipulation over the saphenous opening downward to get relaxation of the tissues.

    (8) In order to relax the tissues place the patient on the back and note whether the foot as compared with the other, rotates outward or inward too much this indicating relaxation or rotated conditions of the muscles and ligament of the thigh. Elevate the foot gradually raising it up towards right angle position, when limb has been raised as high as patient can stand grasp the limb just above the knee and rotate limb in opposite direction to the rigid or relaxed condition of the limb. Then apply pressure right over knee rotating internal and then external while applying pressure over the thigh just below articulation of the head of the femur. (In treatment of extremities , hand and foot, begin at spine and work out).

    In Norton’s toe. Here is an involvement of the 2nd or 3rd toe with intense pain, surgery considering this a case for amputation. Either of the toes or removal of some of the small bones. Norton’s toe involved the cuneiform bone, which is displaced upward and anterior. Treat this condition by strong articulation at the ankle, followed by strong articulation at the ankle, followed by extension of the phalanges, and then articulation with pressure applied strongly over ankle joint, then take the foot in both hands and pull it upward from phlanges diagonally placing thumbs on tarsal bones to increase traction.

    In case of sprains, either in the ankle joint, in small bones or ligaments, for example, astragalus, on calciis, etc. We find frequently cuneiform or os calcis thrown upward. In treatment begin at the hip joint and thoroughly relax the muscles and soft tissue downward along the limb, then articulate the bones, giving at the same time through stretching to the bones and ligaments of the limb. If there is great pain in ankle sprain soak the foot of the limb in hot water just before treatment . This also applies to the arm. In sprains of ligaments give strong stretching treatment and apply bandage to the ankle and foot using cotton under bandage. In applying bandages in sprained foot or ankle begin at the leg and bandage down, in sprain at the toe begin at the toe . If tenderness is very great use a large amount of cotton. In cases of sprains leave the bandage on all day and night and do not leave bandage off only when bathing foot, say twice a day. The bandage should be changed twice a day. Best book on sprains is "Houllin’s book on sprains.