A Manual of Osteopathic Manipulations and Treatment
Wilfred L. Riggs, D. O.

    OSTEOPATHY bases its claim to rank as a science of healing upon the fact that there exists a definite and fixed relation between an organ and the central nervous system. This relation is secured through the segmented arrangement of the spinal nerves or through the sympathetic system, by means of rami communicantes. The order of this innervation is fairly constant, though, as in the case with other portions of the body, it may vary. This variation in no wise invalidates the claim of Osteopathy to rank as a science, but it emphasizes the necessity of our searching for lesions even in regions relatively remote from the center. Specific treatment in the sense of work exclusively upon a region said to be a center is rarely indicated. Owing to the diffusion of pain and its attendant conditions, it is necessary to remove any contracture which may be associated with it. Again, it sometimes occurs that disease of an organ produces no effect on its usual center, and in such an event it is necessary to carefully examine other regions for the trouble.  Know the location of the centers. Know also that occasionally a lesion causing the trouble must be found elsewhere. "Touching the button" is fascinating, both in theory and in practice, but the operator must be broad enough to expect it to be difficult occasionally to locate the button.

    Our use of the term center is in the sense of a convenient and advantageous place to reach fibres to or from a certain organ. We now point out some of the more important of these centers:

    The atlas is associated with disturbances to tile vaso-motors of the eye, ear, and with eczema and other diseases of the face.

    The axis and third cervical is a general vaso-motor center, through the superior cervical ganglion, and also a center for side of head, face, eye, nose, pharynx, tonsils and vessels of the brain.

    Third, fourth, and fifth cervical, origplain of phrenics, center for hiccoughs.

    Fifth and sixth cervical, middle cervical ganglion, center for thyroid gland, also augmentors to heart through middle cervical ganglion.

    The general function of the cervical region is that of (1) vaso-constrictor effect through sympathetic fibres passing into it from below through the second, third, fourth and fifth dorsal, and vaso-dilator fibres in the cervical spinal nerves, thus affecting all parts of the body; and (2) local vaso-motor effects on the neck, head and face of the same side. That the upper
cervical region is sometimes said to be a center for the kidney is based upon
its influence over the general vaso-motors of the entire body.

    Second to sixth dorsal are vaso-constrictors to the pulmonary blood vessels.

    Third to seventh dorsal, vaso-motors to arm via the brachial plexus.

    Seventh cervical and first dorsal, inferior cervical ganglion, heart, thyroid gland, vertebral and basilar arteries.

    Annulus of Vieussens and second, third, fourth, and fifth dorsal, augmentory fibres to the heart. The first three give regularity of rhythm.

    Fourth and fifth control regularity and strength of beat.

    Fourth dorsal, sometimes third or fifth, stomach center on rigplaht side usually. General effect as low as the eighth.

    Second and third dorsal, center for ciliary muscle. Center for vomiting.  Center for bronchial tubes and bronchi.

    Sixth to tenth dorsal, origplain of the great splanchnic, carrying viscero-inhibitory fibres and vaso-constrictor and secretory fibres to the stomach and small intestine.

    Eighth, ninth and tenth dorsal on rigplaht side, center for the liver.  This gives us the center for chills, as the liver and spleen are implicated in malarial attacks.

    Ninth and tenth dorsal on the left, center for the spleen. In treatment of chills the general condition must be controlled through cardiac and vaso-motor centers, directing especial attention to the liver and spleen.  Also center for uterus via hypogastric plexus.

    Eleventh  and twelfth dorsal and upper lumbar, the small intestine and kidney.

    Eleventh and twelfth dorsal, center for ovary.

    Second lumbar, center for parturition, micturition and uterus.

    Second, third and fourth lumbar, center for diarrhea.

    Fourth and fifth lumbar, hypogastric plexus, which with fibres from the aortic plexus forms the pelvic plexus, distributing fibres to the pelvic organs.

    The anterior division of the sacral nerves arc splanchnic in function and are distributed to the rectum, to the bladder, sphincter ani, vagina and uterus.  These seem to be chiefly viscero-motor in function.

    Second and third sacral, bladder.

    Fourth sacral, vagina.

    Fourth and fifth sacral, sphincter ani.

    After a general view of the centers along the spine it is necessary to form a resume of their location by mentioning the chief organs of the body and with them the regions in which they may be affected through their vaso-motor, viscero-motor, inhibitory and secretory nerve supply. Generally speaking the circulation is controlled through the great vaso-motor centers, reached in the upper cervical region. It is further controlled through the region from which the augmentor fibres make their exit -- the second to the fifth dorsal. It is also affected by treatment in the splanchnic region controlling the vaso-motors to the great capillary network of the mesenteries.

    In case of a disturbance in any of the following organs or members look for your spinal lesions as follows:

    Eye: Atlas, third cervical and second or third dorsal.

    Ear: Second to fifth cervical.

    Brain: From first cervical to first dorsal.

    Pharynx, larynx and tonsils: Second and third cervical.

    Thyroid gland: Fifth and sixth cervical, general vaso-motor and cardiac center; seventh cervical and first dorsal -- head of first rib, clavicle.

    Arm, motion, vaso-motor and nutrition: Brachial plexus in fifth, sixth, seventh, eighth cervical and first dorsal; also vaso-motors in third to seventh dorsal.

    Lungs and bronchi: Second to sixth or eighth dorsal; also vagus nerve.

    Heart: Fibres from second to fifth dorsal especial attention to fifth dorsal.

    Heart may also be reached through middle and inferior cervical ganglion, and at first rib, or annulus of Vieussens.

    Stomach: Third to fifth dorsal specific on rigplaht side; third to eighth generally; also vagus.

    Liver: Ninth and tenth dorsal, vaso-motor, vagus motor.

    Spleen: Eighth to eleventh dorsal, vaso-motor vagus motor.

    Duodenum: Great splanchnic, sixth to tenth dorsal.

    Jejunum and ileum: Lower dorsal and lumbar to fourth, and fibres from solar plexus.

    Colon: Second to fifth lumbar; also fibres from solar plexus.

    Rectum: Second to fifth lumbar via inferior mesenteric plexus, inhibitory.

    Sacral via hypogastric plexus, motor; also third and fourth dorsal.

    In treatment of the abnormal viscera in addition to specific treatment it is always beneficial to give direct treatment to the abdomen, paying particular attention to the region of the solar plexus. This has the effect of changing the blood by compression, thus relieving venosity and allaying increased peristalsis; or in case of sluggishness of any organ it stimulates the plexuses of Auerbach and Meissner to motion and secretion. It may, also, break up masses of fecal matter lying within the abdominal canal.

    Uterus: Second to fifth lumbar, ninth and tenth dorsal.

    Genitalia generally: Second to fifth lumbar.

    Bladder: Second, third and fourth sacral.

    Sphincter ani: Fifth sacral.

    The knowledge of the location of these centers is of incalculable advantage to the Osteopath since it is upon this knowledge that the accuracy of his diagnosis and treatment depends. An osseous lesion in the area which we have designated as a center for a certain organ may lead to a diseased condition of that organ; while a lesion of an organ may manifest itself in tenderness within its center along the spine. This tenderness may be found in the following localities:

    First. On the ends of the spinous processes, usually indicating an anterior condition.

    Second. Above the spinous processes and about an inch lateral at the articulation of the rib with the transverse process of the vertebra, indicating a lateral movement and often a tipping forward of the body of the vertebra.

    Third. The soreness may be manifested at the angle of the rib, indicating a rotation of the rib upward or downward on the axis connecting it two extremities.

    Fourth. Associated with any of these three conditions may be found soreness in the muscles lying in that region on either side of the spinous process.

    To determine these conditions the patient may be sitting or lying.

    Gentle pressure will determine any sensitiveness. To examine the angles of the ribs in the interscapular region the arm on the same side should be grasped at the elbow and firmly passed across the chest. This will tighten the muscles and expose the rib from the covering of the scapula. In all these cases the muscular contraction must be released; to do this the patient should be placed upon the table and a firm and steady pressure applied to the muscles, the skin being lax, passing either upward or downward. This will release the pressure and may be sufficient in acute cases. In addition to this, an oscillation of the body from side to side, bending at the lesion, will prove helpful, as will rotation around the same point. Springing the spine forward will produce a good effect by releasing muscular and ligamentous contractures.