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



    THE Osteopathic treatment consists in stimulation to the kidneys and correction of spinal lesion at eleventh, twelfth dorsal or first lumbar and in the cervical region interfering with the action of the vaso-motors.  Also, correction of any condition which may affect the action of the bowels. The
vaso-motors should be stimulated and all impediments to the circulation removed.  In cases of females it is essential that all uterine disorders be corrected. Some cases are remarkably obstinate. Pay especial attention to diet.

    Diet.  Milk, eggs, cereals, meat broths and game. Avoid all pastry, sweets, and greasy foods.


    In this disease the Osteopath considers a parasite as the exciting cause though the general condition of the patient makes the disease possible. Corrective treatment is directed towards the lesion usually found at the seventh to eleventh dorsal vertebrae.  To aid in restoring the system the liver and spleen should be vibrated daily as these glands are directly implicated.  The chill may be broken by strong stimulation of dorsal nerves, third to eleventh. This will usually produce a perspiration in three to five minutes.  To prevent the pyrexia, strongly bend head backward holding firmly the vertebral arteries at junction of atlas and occiput; this may be alternated with steady pressure on the inferior cervical ganglion at head of first rib. The sweating may be relieved by steady pressure in the upper dorsal region and by sponging with tepid water. The bowels must be kept open.

    Diet. Avoid all foods tending toward biliousness and constipation.


    Anaemia is not a disease but a symptom. The causes are various; so must be the nature of the treatment. The most common causing conditions are to be found in the lesions which produce constipation, digestive troubles, menstrual disorders and derangement of the circulatory system.  Common chlorosis will yield to strong  stimulation in the circulation centers, together with corrective treatment for various lesions mentioned above.  A very common lesion is in the lumbar region, second and third or fifth, causing either constipation or uterine disorders, one or both.  Thorough vibration of the liver and spleen, stimulation at the eighth and ninth dorsal, together with correction of any lesion at this place will be of value. Frequently a depressed clavicle and drooping ribs arc causes.    Should digestive disturbances accompany the condition, look for displaced rib or vertebra from fourth to eighth dorsal.  Outdoor exercise, cold baths, change of occupation will all be valuable.

    Diet.  Milk between meals and especially at bed time, eggs in all forms, rare meats and ice cream.
Avoid pickles, vinegar, gravies and rich sauces.


     In true angina there is a neurosis of the nerves to the heart. In pseudo anginas the trouble is intercostal. Occasionally it is reflected from the stomach.  Examine carefully the thoracic wall, second to sixth rib and vertebrae. In nearly all such cases the third, fourth or fifth ribs on left side will be found sub-dislocated. This dislocation is usually at the vertebral end. There is marked tenderness at the angle of the rib, at the costo-chondral or costo-sternal articulations, and usually along the
intercostal spaces.  Occasionally the first rib is deflected. Look carefully to the fifth and sixth cervical for disturbances at the middle cervical ganglion. Anterior or lateral curvature in upper dorsal region is common. In cases of tachycardia and high blood pressure a steady pressure on middle and inferior cervical ganglion will be effective.  In cases of bradycardia the heart may be aroused by thorough stimulation of these points.  Friction over the heart and separation of the ribs will be valuable. The use of tobacco, alcohol, etc., must be prohibited. Quiet outdoor life is indicated. The false anginas may be completely cured. True anginas can be relieved, but perhaps never cured.

    Diet. Use concentrated, nutritious and easily digested foods.


    The lesion in this disease is to be found in the lower dorsal and lumbar region. This may be either primary or it may be merely contraction, the result of constipation, impaction, etc. This disease may be a sequella to various acute diseases. The treatment should be directed towards correcting the slip in the vertebrae and this will in most cases be effective.  Examine the eleventh and twelfth ribs carefully. Gentle manipulation over the rigplaht iliac fossa, quiet manipulation of the limb with external rotation is of some value. Constipation and impaction must be overcome by the enema. Osteopathy has been marvelously successful in this disease. Hot applications will be of value in removing congestion and pain.  Treatment should be administered several times daily in order to keep the pain and inflammation under control. Avoid cases in the late stages.

     Diet.   Milk and buttermilk, beaten eggs, nutritive broth. Avoid foods with residue.


    In addition to the usual precautions in nursing, bathing, diet, etc., the Osteopath would proceed as follows:  First thoroughly relax the congested and contracted muscles of the cervical region; this will reduce pressure by facilitating drainage and by decreasing vaso-constrictor action. The circulation may be further equalized by thorough quieting manipulation of the muscles of the back on either side of the spine. Dislocated atlas and axis are apt to be causes of these conditions. Reduction of these dislocations will give relief in some cases.  Clavicle and first rib are important structures.

    Manipulation of affected nerves and muscles will be valuable in maintaining vitality of tissue.  Keep bowels open and kidneys active.  Ice bags at head and neck, and heat at feet are advised.

    Diet.  All nourishing foods in liquid form.  Soft cooked eggs, beef broth, etc.  Avoid alcoholic stimulants.


    The cause is often remote. Examine carefully for evidences of uterine trouble in female. The disease seems to be a referred effect upon the central nervous system of peripheral irritation. There are usually spinal lesions which correspond with joints affected. The treatment consists in correcting these lesions, manipulating the nerves to the joints and in thorough massage of surrounding structures to induce lymphatic absorption and to facilitate drainage. The depurative organs must be kept active and the circulation maintained at its normal.  The affected joints must be extended and flexed several times at each treatment. Bathing is a valuable adjunct to our treatment.  If taken in early stages a cure is the rule. Later, the prognosis is not so favorable. There is no particular virtue in a short course of treatment, and you should make it thoroughly understood that months and even
years may be required to effect a cure. Diet and exercises are valuable.

    Diet. Good roast beef, beefsteak, mutton, fowl, fish, eggs and milk. Avoid low diet.


    The lesions in this condition must vary with the cause.  The condition may result with disturbed heart action, valvular incompetency, hepatic and renal affections. Careful examination of these organs must be made to determine the location of the lesion. Vertebral or costal slip from seventh to tenth may be a cause of hepatic obstruction. The lesion will be eleventh to twelfth dorsal if from renal disturbance, and from third to sixth dorsal if due to cardiac incompetency. Stimulate the heart action, increase the drainage. A general treatment in addition to the specific treatment is indicated. Treat daily until the excess of fluid is overcome. Cases taken early yield readily; advanced cases are more obstinate, and in many instances cannot be controlled.  The diet is an important part of the treatment, and must be varied according to the organs affected.

    Diet. Must be dry diet, consisting of bread and meat chiefly. Some advise a liquid diet; we do not think this wise except where urine is very scant.


    The lesion in this disease is usually to be found in the region of the third to seventh rib. The condition is usually caused by one or more of these ribs being thrown downward. This lesion may occur on either side. There is usually tenderness on pressure at the angles of the ribs and at their costo-transverse articulation. Tenderness is sometimes manifest at the head of the first rib.

    Raise the ribs by any of the methods given. (See plates 13, 17 and 32.) Strong inhibition at the inferior cervical ganglion is palliative. In some cases pressure at the head of the first rib will relieve the most violent paroxysms. Treat twice a week; it is rarely necessary to treat oftener. Stop treatment when lesion is reduced.

     Prognosis. Is good.   Almost all uncomplicated cases yield in one or two months.


    In this disease there is always a spinal lesion, although it in impossible to say where it will be found in a given case. Usually the trouble is in the lumbar and lower dorsal regions. In some cases there are lesions of ribs implicating the intercostal nerves. Thoroughly relax the spine with extension, reduce the dislocations, separate the ribs. Control the gastric crises in the dorsal region by correction and by steady pressure. The exacerbation of pain may be overcome by inhibition in the lumbar region. Give strong external rotation and steady pressure on the sciatic nerve about midway between the great trochanter and the tuberosity ischii. Require patient to gradually leave off the use of morphine, as little or nothing can be done while the patient is using opiates. Applications of heat may be useful.

   Prognosis. Nearly all cases may be alleviated most of them permanently benefited - a few cured.  Long and persistent treatment is necessary.     Do not promise a cure, as it is impossible to foretell the result even where there is a definite lesion. It may be secondary or incidental.

    Diet. A generous diet may be prescribed, such as butter, gravies, cream, cod liver oil, etc. Avoid liquors, tobacco, etc., to excess.


    In this disease, whose cause is unknown to the medical world, the Osteopath has had but slight experience. The condition would indicate trouble in the upper dorsal and cervical regions. The trophic nerves to the muscles of the arm seem to be associated with the brachial plexus and may be affected either through it or through its vaso-motor control in the upper dorsal region. Attention to the cervical ganglion ix indicated. Look for involvement of the vertebral arteries. Thorough relaxation and extension of the cervical and dorsal spines will be helpful. Or the lesion may be found in the lower dorsal and lumbar region. Bathing and exercise in moderation are valuable.

    Prognosis. Is bad. All that may be expected in advanced cases is to stay the progress of the disease.

    Diet. Any nourishing foods.


    Look to the emunctory organs. As a preventative the skin must be thoroughly cleansed daily. Friction with a turkish towel will aid in obtaining this result. Where the boils are confined to certain regions the indications point to a local lesion interfering with the drainage.  If the head and neck are affected the trouble is in the cervical region.  If the lower limbs are affected look for the trouble in the lumbar and sacral regions. In all cases stimulate the lymphatics by manipulations.  Look for circulatory disturbances; the liver and spleen are frequent causes of this condition.  The sexual organs may be at fault. Sexual perversion or irregularity may cause it.

    Diet. Cereals, fruits, lean meats, broths, light vegetables and buttermilk. Avoid butter, gravies and all greasy foods, rich milk, sugars, etc.


    The Osteopath's work is directed toward two primary objects:

    First.  The equalizing of the general  circulation of the blood.

    Second. The continued control of the blood supply to the brain and the correlative drainage.

    To accomplish these ends the circulatory centers are first thoroughly treated; the muscles, ligaments and tissues which surround them are relaxed by pressure and by movements which will stretch the tissue. The next treatment is a stimulation put upon the deeper structures so as to secure the action of the heart and arteries. The third to fifth dorsal is the region for this work. Next, raise the clavicles; notice carefully the first rib and put steady pressure on the inferior cervical ganglion.  The solar plexus, controlling the lumen of the mesenteric vessels, aid in controlling blood pressure. The hand laid firmly over the solar plexus will reduce general arterial pressure and by equalizing the flow will relieve congestion in any part of the body. The tissues of the neck demand a complete relaxation. This is for drainage. Then by holding' the vertebral arteries for three to five minutes, the head thrown backward, the cerebral congestion is overcome. In cases of cerebral congestion the feet should be placed in warm water and ice bags applied at basis crani.

     Diet. A frequent change of diet is advisable. Foods should be light, nourishing and laxative.


    Spinal lesion is from tenth dorsal to second lumbar.  This must be corrected. There is always contraction of muscles and tightening of ligaments in this region, though there may be no osseous lesions.  The patient lies first on face, and steady pressure upward and outward of the muscles of the dorso-lumbar region will give a thorough relaxation. Oscillating lower part of spine has the desired result.  Patient lies fiat on face. Place one hand firmly on spine at point desired and apply steady pressure; with other hand oscillate the limbs from side to side. Place patient on back, legs and thighs flexed, leaning over patient place fingers under the spines and lift him on finger tips; or give the same treatment, the patient lying completely extended and thoroughly relaxed. The patient's weight is thus an aid to the end sought.  Stretching the spine in the swing is indicated. The warm pack, sweating and alkaline waters are adjuvants.   Several months' treatment will be necessary in pronounced cases.

    Diet. In no disease is the diet of more importance than in this.  Skimmed milk is the all-important food in many cases; if patient is an invalid, seven or eight pints a day will be sufficient; if patient exercises a good deal add cereals, nuts, rice and stale bread to his milk diet.  Avoid meats, alcohol, tobacco, etc.


    In either acute or chronic bronchitis the treatment is directed to the vaso-motors of the bronchial tubes as well as to the motor filaments. The best results are obtained by stimulation at the second, third and fourth ribs. The patient is placed on stool and these ribs are elevated by pressing thumb against the head of 'the rib and throwing the arm upward and slightly backward. Use care to avoid dislocating shoulder. Patient is placed on side and ribs are separated by holding rib with one hand and lifting rib next above with other hand. This is done with the first four ribs consecutively. The patient is next placed on back and the costal cartilages are separated by placing the fingers between them, then turning fingers and spreading hands at the same time. At close of treatment put your knee in upper dorsal and bring arms up and back, the patient taking deep inhalation, then exhaling as the arms are released.  Acute cases should be treated daily or oftener.

    Prognosis. Good.


    For this symptom the cause must be found. In most cases the trouble is in the sympathetic fibers of middle and inferior cervical ganglion. The lesion is usually in the upper dorsal. Rarely it is a reflex from peripheral disturbance to the pneumo-gastric (tenth cranial) nerve. Stretching the spine, raising the clavicles and correcting the upper ribs will usually correct the difficulty.  There is marked tenderness at the spines of the second to fifth vertebrae, with contractures and tenderness between the ribs at their vertebral portion.  There is usually a corresponding tenderness between the ribs anteriorally; in many cases it is most pronounced at the sternal - or costo-chondral articulation. I have found a strong dilation of the sphincter ani very effective in securing a permanent cure.

   Prognosis.   Recovery is the rule.


    The lesion may be peripheral through irritation from preputial adhesions, etc., or from morbific substances in the bladder itself.  In case of much pus it is best to thoroughly wash the bladder with movements. Then correct the osseous lesions, potassium bichromate or hydrogen peroxide.. The second, third and fourth sacral nerves will be found involved. Often the twelfth dorsal and first lumbar are at fault. Sometimes the trouble is at the second and the third lumbar. Always relax thoroughly in these regions by steady pressure and by stretching Thorough relaxation in the ischio-rectal fossa works through the perineal branches of the pudic nerve and thus allays the irritation of the bladder. The rectum should be examined, as it may reflexly affect the bladder.
The prostate gland is often involved.

      Prognosis.  Favorable.


   The liver is usually enlarged and shows marked tenderness on palpation. The characteristic lesion is usually to be found at the eighth to tenth dorsal, or at the corresponding ribs.  In case of paroxysms relief is obtained on pressing inward at a point two inches above and the same distance to the rigplaht of the umbilicus. Thorough manipulation of this entire region, together with a downward movement in the line of the bile duct, will aid in expelling the calculus from the duct. A strong stimulation at the margin of the cartilages of the ninth and tenth ribs will produce peristalsis of the cyst and ducts and aid in relieving this condition. The ribs should be elevated and separated.  Any osseous lesions at the eighth to tenth dorsal must be corrected. A general stimulation to the heart and lungs is indicated so as to increase oxidation processes.

    Prognosis. Relief is almost certain. A cure is the rule.


    The treatment is directed to the liver and the kidney regions in the spine. Gentle manipulation downward over the line of the ureter is indicated during the passage of a stone. Relief may also be obtained by steady pressure at tenth dorsal to first lumbar. Gentle manipulation of the abdomen over each kidney is useful. Thorough relaxation of the quadratus lumborum eases the condition. In case the urine shows uric acid, alkaline waters are indicated.  If oxalate of lime, then thorough general treatment must be given to increase oxidation. The patient must take plenty of outdoor exercise. The respiratory activity must be increased by placing the knee in back and drawing the arms upward, or by any other method. The hot bath frequently gives relief.

    Prognosis. Treatment usually effects a cure.

    Diet. Meats, if urine shows phosphates; milk and vegetables, if it hits uric acid deposit. In either condition patient must drink not less than four pints of water daily.


    In case there are irregularities or incompetency much may be done toward correcting the condition, but a cure is impossible in organic lesions after puberty.

    Lesions.  At cervical vertebrae, fifth to seventh; at head of first rib; at fifth dorsal and fifth rib on left side; tenderness at costo-chondral articulation of fifth rib, sometimes fourth to sixth.

    Treatment.  Relax the muscles in regions named; correct any osseous lesions. Raise the ribs and separate those on left side. Set fifth dorsal and fifth rib. Raise the clavicle. A cure is rare; marked improvement is the rule.

     Diet.  Give nourishing food, all digestible meats, etc. Avoid soups and liquid diet, coffee, tea and all alcoholic drinks.


    In this condition there is usually reflex or a primary disturbance at the atlas or the cilio-spinal center in the upper dorsal region. In 1 per cent there is diabetic condition; in 6 per cent urine shows albumen. This shows that the quality of the blood and the condition of the nervous system are strong conditions favoring the disease. Absorption by thorough drainage is the only Osteopathic indication. Correct any lesion in cervical and upper dorsal regions. Treat the superior cervical ganglion very lightly, not oftener than two or three times a week. The eye should be vibrated daily by laying the fingers of one hand on the closed lids, and rapidly, yet lightly, striking it with the other. By moving the eye from side to side with thumb and finger the lymphatics are stimulated.  The general health of the patient must be carefully attended to by out-door exercise. See that patient is correctly
fitted with glasses.

    Prognosis.  In many cases success has attended Osteopathic treatment.  Unless there is decided improvement after two or three months' treatment a surgical operation should be recommended.

    Diet. Must be nutritious in order to build up entire system.


    Lesion. Usually in upper cervical region.

    As an adjuvant, daily morning sponge-baths in cool or cold water, followed by it brisk rub down should be recommended.  Daily exercise in breathing deepest possible inhalation and holding the breath as long as possible, followed by forcible exhalation, is a great feature in securing proper circulation and oxidation. Do not allow mouth breathing; close mouth by chin support at night. Treat by relaxing the muscles in upper cervical. Treat superior cervical ganglion at the second and third cervical. Strongly inhibit at supra-orbital, infra-orbital and mental foramina. Strongly press on nose at inner canthus.  Bring the thumbs down on either side of nose briskly several times.  Dipping the finger in cold water, reach back through mouth to posterior nares and gently move the tissue from side to side. Put fingers just behind angle of inferior maxillary, and while pressing gently have patient open and close mouth; repeat several times.

   Prognosis. Favorable.


    This disease rarely requires the aid of a physician. Isolation until desquamation is completed is necessary. Daily sponge baths and airy rooms will aid. In case of temperature, reduce it by holding the sub-occipital region or by pressure on the inferior cervical ganglion. A general treatment will relieve any unpleasant feeling.  Vaseline or oil will allay the itching.   Prognosis.  Good.


    The Osteopathic treatment consists in steady pressure on abdomen over solar and inferior mesenteric plexuses. A very gentle manipulation of abdomen is good. Steady pressure over splanchnics and spinal nerves, from the dorsal to the coccyx, will usually give relief; the thumbs pressed on either side of spine in lumbar region, with patient lying on his face, is the most effective treatment. The spine should be sprung forward by bending legs upward and backward, pressing in lumbar region. Treatments must be given several times daily. Enemas, as hot as the elbow may comfortably endure, may be given. This should be of castile soap suds and not less than two pints so as to thoroughly wash the colon. This may be followed by an injection of cooler water with tannic acid, twenty grains to the pint, to precipitate the poisonous proteids.

   Prognosis. If taken early, good --  later, doubtful.

   Diet.  No milk must be given until all symptoms have abated. No food for twenty-four to thirty-six hours. A spoonful of champagne or a little whisky and water will prevent collapse. Baths in warm mustard water with friction also aids in preventing collapse. After twenty-four hours give barley water; next, meat-juice broths and egg albumen.


    To stop the nausea and vomiting, pressure is applied at fourth and fifth rib on rigplaht side, at same time separate the ribs by elevating the rigplaht arm.  Treat by steady pressure on the splanchnic and lumbar nerves. An enema of hot soapsuds is indicated. Keep the patient quiet. Little water should be allowed.  Thirst may be relieved by iced tea without sugar, or by cracked ice. Treatments may be rather severe in case of adults. Nothing should be eaten while symptoms are pronounced.

   Prognosis.  Good
   Diet.  Meat broths, milk and lime-water in small quantities until convalescent, then restore usual diet very gradually.


    Lesions. When affecting the face and arms only, the lesion is found in the cervical vertebrae or in the upper dorsal region, either the rib or the vertebrae. When only a set of muscles are involved the lesion is in the spinal region, which marks the emergence of the nerves to the muscles involved.  Thorough spinal treatment, including thorough extension, together with correction of the lesion will produce a cure. In cases of long standing there may be no marked tenderness at the seat of the lesion.

    Uterine trouble in females, constipation and flatulency are conditions to be suspected and corrected if present.

    Stimulating baths and outdoor exercise are beneficial.

    Prognosis.  About 50 per cent arc cured.

    Diet.  A nourishing diet should be prescribed.


    Look for lesion in the splanchnic region, usually at or near the eighth to tenth dorsal. Stimulation of these nerves with correction of the vertebral lesions will be effective. Raise the ribs from sixth to tenth. Often there is contracture of the intercostal muscles which irritate the nerves from this segment of the cord. Examine the nerves of the diaphragm and the ribs to which the diaphragm is attached, as this muscular partition may bc at fault by preventing drainage. The spleen is often involved and much enlarged. The patient should lie on his back with legs flexed. The liver should be thoroughly kneaded. The patient may take a deep inspiration, and as the breath is released the operator presses upward under the seventh to tenth costal cartilages. The use of alcohol must be interdicted. If accompanied by inanition, dyspepsia and malnutrition the stomach and intestines must be carefully manipulated. Give careful attention to the heart centers (first and fifth ribs). If ascites is present give a thorough
stimulation of the kidneys, anteriorly and a relaxation and inhibition over kidney center, eleventh dorsal to first lumbar; avoid liquid diet when ascites is present.

    Prognosis.   Doubtful.

    Diet. Milk with toast and crackers; hot water in large quantities.  Avoid fats, sweets and fried foods.


    Thorough relaxation of all the tissues of the neck and stimulation of cardiac centers are indicated. Thorough stimulation of the dorsal region will close the mesenteric capillaries and throw blood to the surface. Stimulation of the fifth nerve at all its exits is well. Put patient to bed; give hot foot bath and hot lemonade. Induce perspiration. Use caution that there is no exposure following sweating.

      Prognosis.  Good.


    Lesion. Lesion in lumbar region, usually twelfth dorsal to third lumbar. Sometimes due to dislocated coccyx. In females retro-flexion or retro-version may be the cause. Occasionally a lesion in the liver region, sixth to tenth dorsal, produces this condition. Atomy of the bowel, impaction and, in rare cases, invagination of the intestines are causes.

    Treatment.  Correct the vertebral lesions. In all cases, except strangulation, the liver must be treated both directly and in its splanchnic nerve supply. The bowels must be kneaded, following the line of the colon. Usually begin at the left iliac region over sigmoid, kneading with it downward motion, yet moving each time to a higher portion of the intestines. In this way the entire large intestines should be treated. The coccyx must be set if dislocated, and the sphincter dilated with a rectal dilator, as it is more effective than the fingers. Never use oftener than twice a week.

    Outdoor exercise will be helpful, as will light gymnastics.

    In complicated cases I have found most satisfactory results from liver vibrations and from kneading the abdomen. Urge regular hours for stooling.

    Prognosis.   Good. Treatment is usually effective in from four to ten weeks.

    Diet. The diet is an important adjunct.  Fruits, cereals and plenty of water are indicated.  Little meats but an abundance of oils and fats. A glass of cold water before breakfast and a pint of hot water on retiring will give good results.


    Always include a sputum test in your examination of pulmonary troubles.

    Lesions in addition to symptoms usually mentioned, ribs depressed and tenderness at angles of ribs covering effected part of lung.. Also marked tenderness in intercostal spaces, and at the costo-chondral articulations. The spine is invariably straight or anterior in the dorsal region, the normal curve being practically obliterated.

     Rarely a turned rib or, perhaps, two or three will be the sole cause of the symptoms in suspected cases. See that clavicles are not depressed.

     Treatment.  Treat vigorously in the dorsal region from first to eighth.  Pay particular attention to the circulation. Inhibit at inferior cervical ganglion to reduce rate of heart  beat. Raise the ribs by any method. Separate them anteriorly by placing fingers between the ribs with palmar surfaces flat downward, press gently and turn the hand. Place patient on a stool with knee in back, draw arms upwards and backwards, the patient inhaling' deeply. Night sweats are controlled by strong inhibition in dorsal region. Keep patient out doors as much as possible with some light occupation; insist on light exercise and sunlight.

    Prognosis.   Favorable in early stages. In advanced cases there is no hope of complete cure.  Unpleasant symptoms can be abated in all cases and patient made easy.

    Diet.  The diet is of primary importance. Idiosyncrasies  must be consulted, but meats, ripe fruits and fats are the basis.  Cream, butter, oils and eggs, unless there is gastric trouble. In emaciation there is nothing better than cod liver oil. It should be discontinued in case it interferes with digestion. Nutrition is the key to recovery.


    If from poisonings, of course the proper antidote is indicated.  Look for phimosis, ouitis, indigestion, teething, worms, etc. To check the convulsion, grasp the head firmly, one hand on forehead and the thumb and second finger of the other in the sub-occipital region. Bend head strongly backward. Hold in this position. An assistant grasping the ankles and putting extending force on spine is also helpful. Free the neck  so as to give perfect drainage to the brain.

      Knead the abdomen in intestinal and gastric troubles.

      In convulsions from dentition a hot bath, 95 to 96o F., is recommended, with cold applications to head.

      Prognosis.  Good.


    Treatment will depend on the nature of cough. In many cases it is due to an elongated uvula. For this, dip finger in cold water and gently manipulate the palate and uvula. In case it is pharyngeal look for lesions in upper and middle cervical. If bronchial, the lesion is usually at second or fourth dorsal or along the corresponding ribs. In all cases thoroughly relax the muscles of the neck. Then inhibit by steady pressure, slowly moving the hand downward over the trachea on either side from the first ring of trachea downward to sternum.

    Relax the sterno-hyoid and sterno-thyroid muscles. Contracted muscles often cause the irritation here.

    Pressure at the third dorsal will usually relieve the paroxysm. In pneumonia and other pulmonary troubles it is very necessary to be able to relieve the coughing as it prevents exhaustion.  The point will usually be found from second to fifth dorsal, at which place steady pressure and throwing the ribs upward will be efficacious.

    Remember, a cough may be symptomatic of many troubles; find the cause; it may be from any organ of the body.


    Thoroughly relax all muscles of the neck; steady and prolonged work is necessary. Extend the neck forcefully. Work downward over the jugulars to secure drainage. Dip finger in cold water and stimulate pharynx. Use cold compresses; flannel cloths wrung from ice water wrapped closely about the neck give instantaneous relief in many cases. The nerves involved are the ninth, tenth and eleventh cranial and the sympathetic. In chronic cases trouble will be found in cervical vertebrae.

    In case emesis is desired thrust finger down fauces or use ordinary emetics.

    In diphtheria and membraneous croup isolation and disinfection are necessary. A disinfecting spray is necessary to the diseased part. Bichloride of mercury l: 1000 or 2000 is perhaps best. Carbolic 3 per cent solution in 30 per cent alcohol is much used. Boric acid and hydrogen peroxide are also used.  Follow usual methods of reducing the fever.

    Prognosis.  Good if case is taken early.


    If pronounced, suspect tubercular trouble and seek for history. Examine carefully the condition of the organs of the chest. The heart and lungs may be causes of this condition. Look to the condition of the ribs. Depressed ribs and elevated costal cartilages are often secondary, yet must receive special treatment.

    In all cases of curvature except those from lack of osseous development thorough relaxation is required.  Extension either on swing or table is the first step.  Steady pressure is put on the deep muscles of the spine for thorough relaxation.

    In case of imperfect hardening of the bones cereal foods, morning baths and gymnastics, etc., together with extension of spine followed by stimulation will correct the troubles.


    In all lesions the theory is to thoroughly relax the part, then increase the dislocation and on movement in opposite direction the tendency is to overcome the luxation. After a thorough extension and relaxation, the patient should be placed on stool; the physician standing behind places knee in back just below the vertebrae which are anterior. Passing his arms below those of the patient he takes hold of the ribs corresponding to vertebrae to be corrected. As the patient takes a deep inhalation, strong traction is made against the ribs, the knee being held firmly in position. Another method is to have patient recline on table - the patient's legs and thighs are flexed and the physician and an assistant stand on either side, the hands are placed beneath  the  vertebra above the one to be set; using this as a fulcrum, the spine is forced backward by turning the body and legs up towards the head.  This is a successful method. This movement is not to be given in many cases.  It is successful from sixth dorsal downward. In the upper dorsal region the anterior tendency may be overcome by having the patient thoroughly relaxed on back. Elevate the head and shoulders, bending the upper  part of the spine upon the vertebra below the one to be set.

    A good method is to have the patient clasp his hands behind his neck; standing behind, pass your arms beneath his, clasp his wrists, force the head forward and sway the body from side to side. This will correct any anterior tendency.   Must be used cautiously.


    First, seat patient on stool. Standing at the side pass one arm around in front and back to angle of rib corresponding to vertebra involved. Lifting upward with this arm, at the same time sway the body first forward to the limit and then, pressing with the free hand on vertebra to be corrected, throw the body suddenly backward.

    A very good method is to have the patient lie on his face thoroughly relaxed.  The physician gently presses on the transverse processes of the vertebra in succession until the one which is posterior is reached, then in addition to the steady pressure the physician throws sudden weight upon the vertebra and it is slipped into place. A little practice will make one an adept. Care must be used in case of a fragile patient.

   Practically the same movements are used in overcoming a lumbar curvature, varying the movements to suit the changed condition.


    You will find the usual contracture and tendonous condition of the muscles. This contracture may be overcome by repeated application of steady pressure, although it may require some time to accomplish this. At each treatment the patient should be placed on his face and the spine made fixed  at the curvature, the body swung from side to side as above indicated.  Extension is most valuable.  Have the feet fastened, or an assistant may hold them, while you reach under the arms so as to put the force on the spine. The "swing" is a good  method of treating curvature. Swinging from a bar by the arms is always to be recommended, as well as gymnastics, physical culture, etc.

    In all spinal curvatures in which there has been no extended destruction of bone tissue, these measures will be successful.  The time will vary from two to thirty months, according to the severity of the case.

    When there is evidence of active tubercular processes little can be expected.  In all cases the circulation to the spine can be greatly improved by thorough manipulation along the spine and by the foregoing movements very gently applied.


    In dementia the lesion is to be found in the neck or else in the region controlling the genital organs.  The causes being so varied and the lesions so widely remote it is impossible to give a definite treatment.  A careful examination of the spine, finding the lesion and correcting it will be followed by a recovery.  It must be remembered that in many cases no osteopathic lesions can be found.  The causes in these cases being idiopathic, little or nothing can be promised.


    Lesion is found from eighth dorsal to second lumbar.  Occasionally lower.

    Treatment.  Correct lesion in this region.  Strong inhibition down spine from lower dorsal to sacrum.  Even the bladder region, second and third sacral, may profitably be inhibited.  Also in the ischiorectal fossa. Correction of above named lesions will cure in most cases.  Place patient on back, flex leg and thigh, and leaning over patient place hands beneath the dorsal and lumbar spine and spring it forward.

    Another method.   Patient on side, physician standing in front, flex the legs by putting them against your side or hip and reaching over, place your fingers on side of spinous processes and spring the spine forward.   Or have patient sit on stool, stand in front and have patient extend arms across your shoulders.  Strongly grasp and press forward the dorsal and lumbar spinal regions, at the same time lifting the shoulders and throwing them backward.

   Prognosis.   Must be guarded.

   Diet.  Meat and soup broths, eggs, fresh fish of all kinds, fowls and game, olive oil, fats, butter and gluten bread. Saccharin must be used instead of sugar.  Following vegetables may be allowed: Dandelion, horseradish, celery, lettuce and cranberries.

    Avoid breads, potatoes and other starches, sweets of all kinds and liver.


    Diarrhea is controlled by extension of the spine and by springing the spine forward in the lumbar and lower dorsal region.  The patient is first extended with force, the shoulders and ankles being the points of traction.  He is next laid on his face and a quiet, steady pressure is applied on either side of the spine from the middle dorsal region to the coccyx. This will occupy about ten minutes. One hand is then placed in the lumbar region of the spine, while the legs are strongly extended backward.  This will usually be sufficient in acute cases.  An enema of warm water is helpful.  Withhold food and curtail the drink for twelve hours.

    Prognosis.   Good.

    Diet. Diet and drinks must be restricted. Boiled milk and arrow root may be given when strength  is impaired.  Return to the usual diet gradually; oatmeal water, barley water, corn-starch pudding, broths and dry toast are allowable.


    Treatment same as for membraneous croup, which see.  Strict isolation is imperative.


    A displacement of the vertebrae at third and fourth lumbar is almost invariably found.  Correct this at once.  Then give strong and continued inhibition over the sacral region. The abdomen should be treated by steady pressure over the solar and inferior mesenteric plexuses.  In many cases one or two treatments will suffice. In others it is necessary to repeat the treatment several times.

   Prognosis.   Good.

   Diet.  Same as in diarrhea, q.v.


    The lesion is usually found in the region lying between the second and sixth dorsal.  Occasionally it may involve the intestines as well as the stomach, in which condition the lesion may be found lower in the dorsal region. Rarely does a lesion in the cervical region affect the stomach - such conditions being coincident rather than causative. There may be an irregularity of the cartilages of any of the ribs overlying the stomach. The gases present may be removed by steady pressure over the stomach - either absorbing them or in many cases forcing them down the intestines - pressure serving to relax the muscular walls.  The bowels and kidneys must be kept active.  Outdoor exercise is advisable.

    Prognosis.  Favorable.

    Diet.  No specific diet can be prescribed but the following are allowable: Cereals, breakfast foods, etc., chicken, turkey, broiled beefsteaks, fish (boiled or broiled), oysters and light vegetables, such as peas and lettuce.   Avoid rich soups, gravies, condiments, pickles, fresh bread, sugars, tea, coffee, tobacco,  very acid or very sweet fruits.


    The causes may be various. Some of the commoner ones being from the eyes, the stomach, the liver, the kidneys and the circulatory system. Examination will reveal the source of the trouble.  In many instances the glasses are at fault. Should it prove to be a vaso-motor disturbance the trouble is usually to be found in the cervical region.  To relieve this condition press deeply beneath the clavicle so as to reach the fibers of the cardiac plexus.  Throw the head well back, holding strongly with one hand at the junction of occiput and atlas.

    Draw the hands firmly downward over the lines of the jugulars. Raise the clavicles. Treat the various organs affected.  Correct the cervical lesions.

    Prognosis.   Good.


   Always examine with endoscope for perforated membrane and for accumulation of cerumen. Lesion is usually found from second to fourth cervical vertebrae.  Sometimes disturbance in the vaso-motors as remote as the lower cervical may produce disturbance.  Contractures of the scaleni, the sterno-cleido-mastoid, the omo-hyoid or the digastric may produce disease of the ear.

    Treatment.   Reach the great occipital at the second cervical and at the basi-occiput;  the seventh, at its exit from the stylo-mastoid foramen; the ninth and tenth at their exit from the jugular foramen just posterior and inferior to the lobule of the ear.  Thorough relaxation of the tissues in this region is very beneficial.  In addition, the finger should be inserted in the mouth and the tonsils and the openings of the Eustachian tubes thoroughly stimulated.  Cerumen should be removed with oil and soapsuds.

    Prognosis.   If trouble is catarrhal, favorable; if from other causes, doubtful.


    If the eruption is local, then it is certain that an interference in the drainage of that region, either lymphatic or venous, is the exciting cause.  The cause   is either a disturbance in the cervical sympathetics or else at the kidney center, interfering with excretion.  The atlas and axis are frequently misplaced, particularly in case of eczema of the head and face.  The bowels and kidneys should be kept open and the stomach in good condition.  By watching the diet carefully it is possible to make this a valuable adjunct to the treatment.

    Treatment. Correct any lesions in the cervical region (see cervical vertebrae).  Next treat kidneys and bowels thoroughly (see kidneys and bowels).  Cleanse the affected parts with a solution of hot boric acid twice daily.

    Prognosis.  Most cases can be cured.

    Diet.  The diet should be wholesome and nourishing. Remember, that more than half the cases are from too much or improper food. Milk, whole-wheat bread, fresh vegetables plainly cooked, chicken and fresh fish; meats very sparingly; oatmeal is often injurious.  Avoid pastry, sweets, sauces, rich soups and heavy vegetables.


    This disease is a sequel of other disturbances and represents changes which have taken place in the lung tissue.

    Lesion. In the lung region of the spine or else in the cervical sympathetic. The vagus may be involved. The costal lesions are compensatory and cannot be considered in the light of causes.

    For treatment. Correction of the spinal and costal lesions. The liver and heart must be carefully watched as these two organs are closely associated with the general condition of the blood. The only hopes of benefit is through the general vaso-motors and the vagal branches to the bronchial tubes, the vaso-motors to the lungs.

    Prognosis. Little can be done; there is no hope of curing cases of long standing.


    In acute cases rest and nourishing diet are the first essentials.

    Lesion. Tenderness will be found in the dorsal region from the third to the sixth, usually at the fourth and fifth.

    Treatment. Treat by strong inhibition anteriorly at fifth and sixth cervical, also at head of first rib and annulus of Vieussens. Raise the ribs gently but strongly.

    In chronic cases the ribs should be raised on left side. In many cases there is a displacement of the first rib upward, interfering with the inferior cervical ganglion. The fifth rib is usually displaced downward and correction of this lesion will be followed by marked improvement. In case there is mitral incompetency, the condition of the lower ribs and the diaphragm must be examined carefully. The diaphragm may by traction on the aorta occlude its lumen.

    Prognosis. Treatment is helpful.

    Diet.  (See heart troubles.)


    The lesion may be found anywhere in the dorsal or lumbar vertebra, usually in lower dorsal and upper lumbar. Some error in diet is usually the exciting cause; this should be carefully guarded until the recovery is complete.

    Treatment. Control by steady pressure in the splanchnic region. Relaxation by steady pressure in the lumbar region is helpful. The knee in the dorso-lumbar region, the spine being thrown backward, is usually sufficient to quiet the peristalsis. Steady pressure over the solar and mesenteric plexuses corrects flatulency and quiets peristalsis. Hot fomentations applied to abdomen or a hot bath will relieve the pain. The liver should be treated to throw the bile into the intestines to prevent decomposition.  Impaction, etc., must be relieved.

   Prognosis.  Cure is almost certain and permanent.


    Lesion.  Usually found at second to fourth lumbar.

    Treatment. Correct lesion. Spring the spine forward and give strong inhibition at the lower dorsal and lumbar, region. Use irrigplaation for the large intestines; cool or cold water. Rest in bed, and a proper diet in connection with treatment three to five times daily, will effect a cure.

    Prognosis. Good.

    Diet. Broths, egg albumen and beef juice are the proper food.  Avoid over feeding.


    Lesion. Lesions are as various as the causes. Most osteopathic cases show marked lesions in the cervical regions, but this is not always the case.  Occasionally a single lesion in the dorsal region is the entire cause. Rarely it is a reflex from uterine disturbances, phimosis, or masturbation, in which cases there will be secondary lesions in the lumbar region. In case no lesion is apparent and the case is of long standing, there is little hope for success.

    Treatment. The treatment will vary with the lesions, but the neck must always be carefully treated for the circulation to the brain. The spine must be thoroughly relaxed and the irritation to the nervous system released. A healthful attitude of mind on the part of the patient is essential as is outdoor exercise.

    Prognosis. Unfavorable; several months are required to accomplish anything.

    Diet. Nourishing diet; meat sparingly.


    Few cases have been treated osteopathically, but those have been with uniform success.

    Lesion. The lesion is usually found in the cervical region, either in the vertebrae themselves or the muscles.

    Treatment. Restlessness is overcome by sponging in cool or tepid water and by thorough manipulation down the spine. Thorough drainage must be} secured, and treatment of the lesions usually found in the cervical region, or as low as the fourth dorsal, is effective.  Avoid local treatments and confinement cases while attending erysipelas. Cold water is perhaps the best application.

    Prognosis. Good.

    Diet.  Food in small quantities, an ounce every hour; pancreatinized milk, beef juice, egg-nog and gruel.


    Stimulate the superior cervical ganglion. Steady pressure at inner canthus of eye. Thorough relaxation of the muscles over jugulars is indicated. Raise arms over head. Compress the facial artery at angle of inferior maxillary.  Ice may be applied at basi-occiput. In extreme cases the anterior and posterior nares may be plugged.

   Prognosis. Good.


    Three symptoms - exophthalmus, enlargement of the thyroid gland and a rapid and peculiar heart beat - are usually present, but only two of the three may be. Occasionally complications may occur.

    Lesion. In cervical vertebra usually the fifth or sixth, lateral; at the last cervical vertebra; or the upward dislocation of the first rib; also the fifth rib on the left side may be involved.  Vaso-motor fibers may come from the third dorsal nerve to the thyroid; hence the lesion producing vaso-motor change in the gland may be from this region. The eye should be gently manipulated and a relaxing treatment over the line of the internal carotid artery is suggested. The region just below the ear is very important. Keep the upper ribs raised and the upper dorsal spine thoroughly relaxed.

    Prognosis.  Thirty-three per cent cured; majority helped.


    It is not in the province of this work to give the minute details of this treatment in various troubles which affect the eye.

    Lesion.  The lesion is usually in the upper cervical region; either the first, second, third or fourth. There is a prevalent idea that the atlas is dislocated in all eye troubles. While this is true in some cases, yet not always do you find it so. Lesions are also found at the first rib and the second and third dorsal vertebrae and even as low as the fifth.

    Treatment. Find and correct the lesions. Additional treatment to the eyeball should be given by laying the tips of the fingers lightly on the closed lids, tapping these lightly and rapidly with the fingers of the other hand. By placing the thumb and forefinger, one at either canthus, the eye may be compressed. By gently working as far back of the eyeball as is possible, both above and below and laterally, the muscles of the eye may be reached and relieved. The fifth nerve at its various points of exit, - on the eyelids, at inner canthus, at supra-orbital notch, and infra-orbital foramen, should be treated chiefly by inhibition. The inferior maxillary branch may be reached below the tempero-maxillary articulation. If the circulation or drainage of the eye is interfered with, the application of hot and cold water alternately is recommended.

    Prognosis. Very favorable in most troubles.


    The general treatment for pyrexia is as follows: The muscles of the spine are thoroughly relaxed, giving particular attention to the splanchnic region. The ribs over the heart, third to sixth, are raised and the muscles of the neck are thoroughly relaxed. Steady pressure is now put upon the sub-occipital region, the hand covering the segment from the occiput to the fifth cervical vertebra. This diminishes the impulses sent in from the cervical nerves to the thermogenic center in the corpus striatum; next place the thumb and finger against the atlas, holding the vertebral arteries, and strongly bend the head backwards. This should be continued for some five or six minutes. Press deeply and steadily downward at the head of the first rib; you here reach the augmentor fibres to the heart.

    Next, put steady pressure on abdomen over the solar and inferior mesenteric plexuses. These steps carefully and quietly taken will usually reduce the rapidity of the heart beat, and after a half hour will reduce the temperature. Sometimes it is necessary to repeat the treatment within two or three hours. Do not allow the patient to take his temperature or pulse. A cool sponge bath or a dip into cool water is a very safe method of controlling temperature.

    Prognosis.  Good.

    Diet. Nutritious foods. Milk, eggs, etc.


     There is no disease in which more varied complications may occur than in scarlet fever, and for this reason the utmost vigilance is required on the part of the physician. The ear and the kidneys are the organs most likely to be affected. The temperature is to be controlled as in any other fever, by holding the sub-occipital region and by inhibition at the annulus of Vieussens. A gentle manipulation of the abdomen with steady pressure on the abdominal plexuses will aid in equalizing the circulation and in reducing the temperature. The muscles of the entire spinal region must be relaxed, particular attention being given to the upper dorsal and cervical groups. This relieves the hyperaemia of the nerve centers and restores normal heart action, heat production and dissemination. By careful manipulation, securing efficient drainage of the neck, the inflammation of the cervical lymphatic glands, so apt to follow cases in which the pharyngeal symptoms were severe, can be controlled or prevented.

    Should arthritis occur, gentle manipulation producing drainage is required. In case the fever become high, use the sponge bath, and if delirium, the cold pack or the cold bath should be used. A cold compress around the neck will relieve the throat symptoms. Should heart action become poor, stimulation of the inferior cervical ganglion and separating the ribs will be successful.  If the care has been thorough there is little danger of any of the complications.

     Diet. Milk, a small amount of vanilla ice cream, lemonade and barley water; but milk should form the basis.

     Isolation. and disinfection must be rigplaidly enforced.


    This, like gastric ulcer, gastralgia, gastrodynia and related troubles, presents no lesions differing from those of dyspepsia. The diet is of much importance but the chief reliance must be in correcting the lesions which occur either in the vertebrae or the ribs in the region of the third to sixth, or sometimes the seventh or eighth. In gastrodynia and gastralgia the trouble is frequently found to be a dislocated or turned rib. For specific lesions and treatment, see dyspepsia.


     Lesion will be found in the cervical, or the upper dorsal region The clavicle is most frequently depressed. The first or second ribs are elevated.  Thoroughly relax the muscles of the neck, and correct the lesions in the cervical vertebrae; gently manipulate the gland itself, following the direction of its drainage. Treatment similar to that of exophthalmic goitre is indicated.


    Correct any lesion in the splanchnic region. Keep the head low and the patient quiet. Inhibition of the vagi will quiet the peristalsis. Hot foot bath or dry heat applied to feet, with an ice bag over abdomen is valuable.


    Lesion is in region of eleventh dorsal to first lumbar. Correct this and thoroughly inhibit in the lumbar and sacral regions.  If hemorrhage is from bladder the trouble is at second to fifth lumbar. Ice bags should be applied to loins.

    Prognosis.  Favorable.


    This is usually an indication of tuberculosis  It may be the result of other conditions, as menstrual disorders, cardiac troubles, etc.

    To stop the hemorrhage is in many cases impossible. In case it is not too rapid, it may be checked by having patient lie in bed.  Stimulation of the pneumogastric nerve will reduce blood pressure in the pulmonary system by acting on the pressor nerves to the bronchial vessels and by decreasing the rapidity and strength of the heartbeat. Cracked ice held in the mouth is beneficial.

    Prognosis.  Uncertain.


    Constipation is a frequent complication, and when such is the case the cure of this condition will usually overcome the haemorrhoids. Examine the coccyx, as this is frequently a source of trouble; a slipped innominate, or a lumbar lesion, is often a cause. A congested liver causing  stasis in the portal circulation is oftimes a cause of poor drainage through the superior haemorrhoidal vein; therefore pay especial attention to the liver. Treat the pudic nerve, and especially relax structures in the ischio-rectal region. Stimulation of the ganglion impar is helpful to the drainage.

    Prognosis. Usually one to three months' treatment will effect a cure.

    Diet. Such as would prevent constipation or diarrhoea.


    Lesion in cervical region interfering with nutrition to the mucous membrane of the nasal passages.

    Treatment at the points of emergence of the fifth nerve and over the surface of the nose will give relief.

    Steady pressure with the fingers over the frontal sinuses and over the sinuses of the superior maxillary and ethmoidal bones, and on the sides of the nose will also relieve the symptoms. Relaxing the muscles at the occiput, and correcting the lesion in the cervical region will make the cure permanent.  Treating the pharyngeal plexus and the palatine nerves at the tonsils and over the hard palate helps the condition.  Meckel's ganglion also sends branches to the nasal fossa, which are both vaso-motor and trophic.

    Outdoor exercise, gymnastics, baths, etc., are adjuvants.

    Prognosis.  Favorable.


    In constant or periodic headache, lesion may be found either in cervical, upper dorsal or in lumbar regions.  It may be associated as a result with various conditions. To make the cure permanent these conditions must he corrected. The usual treatment is to thoroughly relax the tissues of the neck and of the upper dorsal region. Raise the clavicles, secure free drainage for the brain through the jugular veins by working downward from jugular foramina with thumbs following line of veins.  Quiet the heartbeat by steady pressure on the annulus. Steady pressure over the points of emergence of the fifth nerve will often stop the pain anteriorly, while pressure on the sub- and great occipital nerves will stop a posterior pain.  Firmly holding the sub-occipital region and throwing the head backward will stop the flow from the vertebral arteries and at the same time facilitate drainage. Press gently on solar plexus; give thorough relaxation in the splanchnic region.

     Prognosis.  Good.


    Reduce the heart action by freeing the ribs on the left side and holding the inferior cervical ganglia. Should there be nausea, it is relieved by elevating and separating the third to fifth rib on the rigplaht side.  Look for cervical lesions as well as in other regions. The treatment is similar to that for headache, q. v.


    The cause may be either cerebral or spinal. The circulation to the nerve centers must be maintained by relaxing the muscles in the entire spinal region from occiput to coccyx. In the spinal type of hemiplegia the lesion is found to be a slipped vertebra.

    There will be marked muscular and usually osseous lesions in the cervical region in cerebral cases. The treatment is correction, but it is more. The strongest extension must be used. Every muscle must be kneaded, every nerve traced and stimulated. All articulations, even to the phalangeal must be flexed and extended at each treatment. Experience shows the corrective spinal treatment should be given three times each week. The muscular, nerve and articular manipulations should be given daily.

    Keep the bowels, kidneys and the heart in good condition.

    Prognosis.  Improvement marked and permanent. A complete cure is rare.


   Inhibit the phrenic nerve over the third, fourth and fifth cervical. If severe, treat splanchnic area.  Often associated with other diseases, affecting the nervous system. Direct treatment to diaphragm is indicated.


    Lesion may be remote. This is reflex from various causes, such as intestinal, gastric, uterine, ovarian, renal or nervous troubles.  The whole spine must be examined and patient questioned for other symptoms. Irregularities in diet must be corrected. Give a general treatment to equalize the circulation and treat the special conditions according to requirements.


    Occurring along the distribution of a certain nerve, it clearly has a local cause. We treat it as due to a neurosis of the nerve caused by a failure of the veins and capillaries to drain the region.  Seek for the impediment - usually a contracted muscle.  A few local treatments daily along the course of the nerve is effectual.


    Find the local vaso-constrictor nerves, of the organ.   Stimulate them by the method of alternate or varying pressures. This will reduce capillary pressure. Next, see that the tissues of the organ are relaxed; third, secure drainage by relaxing all structures lying on or near the veins which drain the organ; fourth, reduce the pressure generally by an inhibitory treatment in heart centers, third to fifth dorsal and at the annulus of Vieussens.


   Though the strongest of the freely movable articulations, the hip is frequently partially or completely dislocated.  If the hip is completely out, the gait will usually indicate the condition.

    The Osteopath must bear in mind the fact that even partial or complete dislocation may be the result of tubercular processes. Motion in such cases is a positive injury, though treatment may be effective if directed toward the blood and nerve supply.  In dislocation the ilio-femoral ligament, the most resistant portion of the capsular, determines largely the position of the hip.

    To detect dislocation the patient should be lying straight, face upward; place the thumbs on the anterior superior spines of the ilia. A comparison of the two sides is usually the surest way of determining relative positions of the parts. Nelaton's line is useful. It is a line from the anterior superior spine to the tuberosity ischii. On this line lies the center of the acetabulum and at the same level as the trochanter major. The femur may he dislocated in any direction; backward, either above the dorsurn ilii, or below the obturator internus muscle into the sacro-sciatic notch, or it may be anterior on the pubes or inferior into the obturator or thyroid foramen.

    The effect of the dislocation may be manifest in the gait, muscular condition of the limb, pain at hip or at knee, and in the condition of the blood vessels of the limb; these various tissues may be affected in various ways. Venous stasis, neuritis and muscular atrophy are very common sequelae of femoral dislocation.

    To set a dislocated femur, have the patient lie on his side on a low table or couch with his dislocated hip upward. Flex both legs. With one arm clasp his leg at knee and with the other hand on the trochanter the hip may be turned into place. Patient may sit on stool and the physician sits on the knee of sound limb. Now take hold of ankle and trochanter, as above, and turn into place. Either of these positions relaxes the tissues and makes the work much easier.


    Find if possible the cause.  Local examinations for pelvic troubles may be necessary.  In many cases the cause seems to be a reflex, the deep muscles of the back being contracted.  In such a case a strong extension followed by quieting treatment along the spine is indicated. A turned rib may be the causus causans. Avoid all stimulants. Use nourishing and easily digested food.  Be master of your patient. Suggestion is, in such cases, a most valuable aid.  A gentle downward stroking of the spine will produce sleep.

    A cool bath each morning aids the circulation; the rest cure is some times productive of good. At other times a shock or a scolding will produce a change.

    Pressure in the sub-occipital region or on the ganglia of the cervical sympathetic will stop the muscular spasms. No two cases can be treated alike.


   This is a symptom of many diseases. The one constant condition is obstruction of the biliary ducts.

   Treatment. Vibrate the liver, the patient lying on left side or on back.  Press upward beneath seventh to tenth cartilages on rigplaht side. Knead the bowels. Open bowels thoroughly; relax the muscles in lower dorsal region.  Careful examination will reveal lesion in the dorsal region eighth to tenth.  Not infrequently a rib is pressing upon the liver. Readily yields to the treatment. Give light diet and abundance of water.


    The pelvis may be considered as formed of three bones, viz., the sacrum and the two innominates. Of course the sacrum articulates with the last lumbar vertebra above and the coccyx below, but these may be treated as vertebral articulations.

    This will then give us three points for dislocations - at the sacro-iliac synchondroses and at the pubic symphysis.

    Causes may be varied. The most common are sudden jars, strains in rowing or lifting, falls, and childbirth.

    The condition may be that of both innominates tipped either forward or backward, giving the patient a peculiar gait, halting step and a constant fear of falling; or one innominate may be slipped either upward or downward, the other remaining in its true position. In this case there will be it marked slip at the symphysis pubis accompanied by exalted sensitiveness.

    These conditions affect the cutaneous sensations and muscular condition of lower limbs. They are also accompanied by neuritis, rheumatism, sciatica and circulatory disturbances. They frequently produce a direct effect on the condition of all the pelvic organs, including the rectum and its sphincters.

    To correct a forward innominate, the iliac crest and the tuberosity ischii offer points for obtaining leverage, the patient lying on his side. Force, by a rotary motion, the crest backward and the tuberosity forward and the work is done. The reverse motion will replace a backward slip of the innominate; or, it. may be done as in plate 27.

    Should both innominates be tipped backward, they may be corrected by placing the patient on his face, placing solid yet soft padding beneath the pelvis so as to support the lumbo-sacral portion of the spine. Now place one hand on the sacrum and with the other arm draw upon the thighs so as to straighten the body and at the same time stretch the lower spinal region. A series of treatments of this kind will correct the condition and relieve the various symptoms mentioned.


    Examine for preputial adhesions or for irritations to the clitoris. In many cases relieving the trouble at these points is all that is necessary. The spinal lesion is found in the second to fourth lumbar, and irritation in the sacral region.

    Treatment.  Place the patient face downward. Put one hand in the upper lumbar region and with the other make strong traction of legs. Then place the hand firmly on third lumbar vertebra and move the legs from side to side bending the body at the middle lumbar region.  Then lay patient on side facing you. Flex the lugs and place them against your body reaching over with one hand and pressing against the vertebra that is affected. Now, again place the patient on face and beginning at lower dorsal region press strongly upward and outward opposite each spine successively till you have reached the coccyx. A complete cure will result.


    The osteopath is usually called to these cases several years after the condition first came on. Much can be done to restore use to the limb, yet the progress must be slow. Lesion is usually in the cervical or lumbar region, though it may be at any point. Thorough spinal extension is always indicated. Manipulation of the nerves to the paralyzed member is necessary.

    Prognosis.  Complete recovery is rare.    No promise can be made as to time. Little can be expected in less than six months, while two or three years may be required in some instances.


    Put patient to bed.  Strong and steady treatment along the spine from occiput to sacrum.  The fever must be controlled by holding the sub-occipital region and by steady pressure at the inferior cervical ganglion.  Use a sponge bath.  Relieve the headache by gently treating the fifth nerve, pressing steadily one hand on occiput and one on forehead; also press the temples between the palms, etc.  A hot lemonade and a good sweat must be given.  Do not allow patient to get up too soon.  Use little food.  Treat two or three times per day.  Of hundreds of cases of La Grippe treated osteopathically, scarcely a case has had a bad sequela.


    In many cases a definite spinal lesion will be found, usually in the cervical region.  In some cases where there seems to be only deep contractions, the relaxation from the treatment relieves nervous irritation and effects a cure. In others the treatment is ineffective.  The causes may be various.

   Prognosis.  Will depend on the case and the result of the examination.  As a usual thing it is not favorable.


    In this condition there is usually a marked contraction of the muscles in the cervical and upper dorsal region. In females it may be from pelvic diseases. Relaxation is the key to the cure. There will usually be found one or more osseous lesions in the upper spinal segments. Correction of these, accompanied by a thorough inhibition along the spine will be effective. Have patient cultivate deep breathing and holding breath as long its possible.  Outdoor exercise, light diet, sleeping in room alone and gymnastics will aid in the cure. Warm water drunk freely, or a glass of hot milk, at bed time, will produce good effects. Setting every muscle in the body with a forcible contraction will be followed by complete relaxation and sleep.

    Prognosis.  Good.  These means will always cure if persisted in.


    To treat the kidney, the patient is placed on his side facing the physician.  The lumbar spine may be relaxed by placing one hand on crest of ilium and the other on thoracic wall or shoulder and giving a bias stretch, pulling forward on ilium and backward on ribs, and vice versa.  Then reaching below the patient lift the body clear of table, the hand being beneath the lumbar vertebra. This will relax the quadratus lumborum muscle and also move the abdominal viscera, releasing pressure from the kidney, its veins and lymphatics. The patient is now placed on his back, his legs and thighs flexed.  Place the hand beneath the dorso-lumbar region, palms up, pressing one arm over the patient. Now elevate the patient on finger tips. Manipulate the patient over the kidneys anteriorly.

    Flex the legs and then separate the knees, the patient both passive and also resistant. Rotate the leg outward as far as possible to put traction on the psoas muscle. The lesion is usually found at the eleventh dorsal to the second lumbar. This must be corrected according. to its nature. The genupectoral position affords a convenient position for taking pressure from kidney structures.

    Diet.  Varies according to nature of the disease.   In nephritis avoid nitrogenous foods and use abundance of broths, skim milk and water.


    The lesion is evident. If there is tubercular process use care in movements.

    Treatment.  Thoroughly relax muscles along spine by pressure upward and outward.  Next thoroughly extend patient by stretching on the table, or seat patient on a stool and stand in front of him, his  hands clasped back of his head; then pass arms beneath his and draw his upper spine upward and forward.  This will relax and at the same time correct the spine.  Another method is to have patient lie on his face and after thoroughly relaxing him throw the posterior vertebra forward by putting pressure upon them suddenly.

    Another method: patient sits on stool, stand at his side, reach around in front with one hand lifting up, and with the other hand press the vertebra forward.


    Lesion in cervical vertebra causing disturbance to sympathetic nerve of larnyx and pharnyx.   Acute cases are often due to contraction of the muscles of this part of the neck, the sterno-cleido-mastoid, the scaleni, the infra-hyoid and the supra-hyoid groups of muscles.

    Treatment.  Relax by thorough manipulation the muscles of this region.  Gently work over the tonsils. Treat internally by wetting the linger in cold water and pressing it over the hard palate. The ninth, tenth and eleventh nerves may be reached just below the lobule of the ear. This region must be treated thoroughly. Acute cases may be treated twice per day.  Chronic cases daily or every alternate day.  A cold compress will aid the treatment.


    General relaxed condition of the spine. Look for lesions in the middle to lower dorsal region. Tenderness along the line of the ninth and tenth ribs.  These ribs are sometimes turned.

    Treat the liver and spleen.  Give general stimulating treatment to the heart. Knead the abdomen. Treat the splanchnic nerves. Pay close attention to the ribs from eighth to tenth. The daily morning bath, outdoor exercise and a nourishing diet are aids


    The liver is often at fault, therefore the lesion is in region of eight dorsal. Treat the  splanchnics. The kidneys must be treated. Look carefully to diet. Amount of meat should be small.  Raw apples and acid fruits of various kinds are tolerated, but sweet fruits, starches, etc., are to be avoided.


   This is it a most important gland and should be treated in many diseases.  The center is in the splanchnics, seventh to tenth dorsal.

   Treatment. First, relax in splanchnic region. Second, have patient sit; standing behind him, reach around in front and as he expels air after a deep inspiration, lift the abdominal wall and press up beneath the eighth, ninth and tenth ribs. Third, have the patient lie on his back and thoroughly knead the liver. Press inward and upward at a point two and a half inches above and to the rigplaht of the umbilicus. Fourth, have patient lie on left side, and standing at his back reach over and press upward on abdomen, just above umbilicus; then with the other hand vibrate forcibly the wall of abdomen lying over the liver. This changes the blood in the liver and increases its activities.  Gymnastics, outdoor exercise and plenty of water, three to six pints daily, must be supplementary to the treatment.

    Diet.  In all liver troubles alcohols and liquors arc forbidden. Avoid pork, fried foods, salt foods, sugars, starches and oils.  Only fresh food should be given and in reduced quantity; fish, oysters, sweetbread, lean meat, eggs, milk, buttermilk, green vegetables, dry toast and fresh fruit are allowable.  Do not drink at meals.  Rest an hour before and after eating.


    Treatment is for the circulation and drainage to the particular region and to the liver.


    Lesion usually found in the lumbar region; occasionally in the dorsal region.

    Treatment.  Relax muscles on either side. In all cases a strong extension.  In dorsal region, seat patient on stool, stand behind and lift up ribs and push them backward by grasping them at the sternal ends and pulling backwards.  The patient may be placed on side and bent forward, at the same time holding the spine from above and below so as to put the tension at the location of the anterior condition. Place the patient on his back and flex legs and thighs.  Place one hand under the vertebra above those to be moved; now come down with some force on the legs. If this anterior condition is in the upper dorsal region the same movement may be made with the neck and shoulders.


    Examine kidneys.  Lesion in the lumbar vertebrae or at the dorso-lumbar or the lumbo-sacral articulations. Sometimes in dorsal region. Look carefully for dislocations of the eleventh and twelfth ribs.

    Treatment. Nothing better than stretching the spine at this point. Correct the lesion. Flex the thighs on abdomen, or, if patient is on face, legs are vibrated from side to side. Any movement may be beneficial. Do not neglect the bias stretch. (q. v.)


    The one object in all treatment is to secure a return to normal conditions.  Good lung circulation and regular deep breathing will cure any incipient pulmonary trouble.

    Lesion. In dorsal region from second to sixth, usually a forward condition.  Also any one of the six upper ribs may be at fault. Examine carefully at both spinal and sternal ends.

    Treatment. First, lay patient on side and thoroughly manipulate interscapular region. Second, lay patient on table, stand at patient's head and placing one hand beneath the angle of the ribs take hold of arm with the other and draw it upward, downward, and then back to its position. Now move the hand to the next rib and repeat.  Do this for both sides. An assistant is valuable here as both sides can be manipulated at the same time. Third, patient lies on back; stand at his head, draw arms above his head; the patient inhales deeply; after holding breath as long as possible force the arms back to their normal position. Fourth, patient sits on stool and arm is pulled upward and backward. Fifth, patient lies on back. Separate the ribs and release the intercostal nerves by putting fingers between ribs near articulation and spreading them.


    Avoid exposure to cold.  No osseous lesions. A secondary lesion in cervical and upper dorsal region. Relax these muscles thoroughly. Should the eruption be imperfect, a  thorough stimulation in the upper dorsal region will produce it as well as sponging in tepid water; also hot drinks.  Protect the eyes from light.  Keep room cool and well ventilated and patient indoors; preferably in bed.  Watch the bronchial tubes.  Treat in the first to third dorsal and over the second and third ribs anteriorly.   General treatment along the spine with special treatment for the fever will be all that is necessary in worst cases.


    Treatment same as hysteria.  Change of surroundings and occupation is also helpful.


    Lesion may be in any part of spine producing the condition as a reflex from eye, stomach, hepatic, intestinal or uterine disturbances.  No specific treatment can be prescribed.  Correct these conditions. To effect a cure a thorough course of treatment is necessary.

    Do not expect to be successful in all cases during paroxysms of pain.  The treatment must be given regularly. During paroxysm give the regular headache treatment.


    The lesion is reflex, a contraction in cervical and upper dorsal regions.  Keep patient warm and quiet.  Good ventilation; avoid colds.  Relax cervical regions and especially relieve by gentle manipulation the swollen glands. Care for eyes and ears and the reproductive organs. Keep temperature down by usual fever treatment and do not permit patient to exert himself too soon.


    Lesion usually in the lower dorsal region, embracing the liver and kidney region; these organs are usually at fault.

    Treatment.  Treat the liver and kidneys according to directions given under head of those organs. Treat the upper dorsal and cervical regions for affections in the arms, and the lumbar and sacral regions for the legs. Relax the muscles and follow the nerves from their exit to the part affected, putting steady pressure on them. Thoroughly relax the spinal musculature.  Treat gently once or twice per day.  Hot fomentations often give relief.

    Diet.  Cereals, broths, and light meats.  Avoid meats in excess, sugars and starches.  Drink hot water in abundance.


    Lesion in upper dorsal region and in ribs.

    Treatment.  Separate and set the ribs. Treat the vaso-motors to lungs and heart. Relax all contractures in upper dorsal region. Outdoor air and exercise are helpful. Diet, light and strengthening.


    Lesion in the lower dorsal and upper lumbar. Correct this. (See kidneys.)  Watch the urine very carefully.

    Diet. Avoid all proteids, meats, heavy foods, etc. Meals should be light and consist chiefly of milk, buttermilk, gruel, broths. Should symptoms abate, eggs, meat-broths, etc., may be allowed. Diet is of utmost importance.


    Find the nerve affected and release the pressure, removing the irritation.  To do this, usually it is only necessary to trace the affected nerve to the spine and release it near its exit.

    Intercostal type. Either raise the rib or set the vertebra which is causing the trouble.

    Cardiac type.  Usually the trouble is in the third, fourth or fifth rib. Raise and separate these and put steady pressure at their angles or near spine.  Hot fomentations are useful.

    Gastric Type.   Trouble is usually in the intercostal nerves. Sometimes it is reflex from uterine troubles. Look for lesion in sixth to eighth ribs; sometimes it is higher and with the vertebrae. Steady pressure is always able to give relief. It is often difficult to restrain patient from taking morphine, but if the treatment is persisted in relief will follow. Corrective treatment must be administered between the attacks.

     Facial Neuralgia.   Frequently due to decayed teeth; also, often from dislocated axis or atlas. Treat the various terminal branches of the fifth nerve. Correct the lesion in the cervical region.


    Lesion.   Not in any definite point. It is a nervous irritation. Examine as to condition of sexual organs. The liver is often at fault. Lithemia is a common condition. Deep spinal contractures are always present.

    Treatment.   Stimulate the liver. Relax the muscles of spine in upper dorsal and cervical regions. Stimulate the heart. Manipulate the neck for drainage of head. A general treatment is indicated. A treatment just at bed time will often insure a night's rest. No two cases can be treated alike.


    Lesion is always in the spine near exit of affected nerve, or else at vaso-motors to the nerve. For the arms it is in cervical region second to seventh, or else in the upper dorsal. In many cases it is simply long standing contractures.

    Treatment.   Thoroughly relax these regions and correct any lesions present. Manipulation of the structures lying along the course of the affected nerve will aid in its recovery. A change of occupation is indicated.

    Prognosis is good.


    In these conditions there in a tightening of all the contractile substances along the spine including deep muscles and ligaments.

    Treatment.   A thorough relaxation of every vertebral articulation, followed by a stimulation to the nerves of the superficial spinal region.


    Lesion oftimes from dislocation or luxation of vertebra in the upper dorsal region. The nerve affected will point the lesion.

    Treatment.   Rest in bed. Relax the entire spine.  Gently massage the structures surrounding the nerve affected. Hot applications will aid in drainage and in reducing the pain. Diet should be nourishing and easily assimilated.


    Diet, exercise and gymnastics are all that can be done in this condition.


    It is safe to assume that a woman apparently well formed will come safely through childbirth, so it is not necessary to examine the pelvis unless there is a deformity or a rachitic history. But there are certain precautions which every woman should take during pregnancy. Diet of fruits and cereals, outdoor exercise and baths are conducive to an easy delivery and a perfect child.

    When called, the physician should carry with him a cool head and willing hands. In addition he should have a case containing tablets of mercury bichloride, shears, surgeons' cotton, a roll of clean muslin, a sponge and a spool of silk thread.

    Uncleanliness and untidiness in a case of this kind is a crime. The expectant mother should first be given a sitz bath, carefully cleansing the perinaeum. Then the hand of the operator, after a thorough scrubbing with soap and water, should be held in a bichloride solution, 1 to 1,000, for a few minutes, and then an examination of the patient should be made. The hand should be thoroughly cleansed and rendered aseptic previous to each examination. This must never be disregarded.

    The bed should be prepared by placing either oilcloth, rubber or a layer of newspapers beneath the sheet. The perinaeum and vagina should be thoroughly relaxed. Pressure upon and manipulations of the perineal body will produce a very satisfactory result. The dilatation of the os may be very much hastened by passing the finger, thoroughly aseptic, around the edge of the os, also by pressure on clitoris and on round ligaments. This will lessen pain. To reduce the pain, press on either side of the spine in the lumbar region, fourth and fifth, and in the eighth to tenth dorsal; this does not retard the progress of the case. Should the pains and the expulsive movements of the uterus become tardy, stimulation in the lumbar region may be effective. Relaxation of the round ligaments as they pass over the pubic crest will allow the uterus to protrude further into the canal of the vagina. Steady pressure at the symphysis pubis will also aid in relaxation of the parts and reduction of pain.

    Should the child be large and the labor difficult, it is well to guard the perinaeum by holding the hand against the perineal body, thus guiding the infant through the vaginal opening. Push the tissues from the symphysis toward the perineal body.

    As soon as the head is born examine to see if the cord be around the neck. If so, loosen and follow it with the fingers, one on either side, within the vagina to protect it from occlusion. In foot presentation, the body should be wrapped in cloth or cotton to protect from the air until the head is born. The cool air against the skin may stimulate the respiratory center, causing the child to breathe.

    As soon its the child is born, open its mouth, cleanse the mucous passages until it has given a good cry, then keep it covered and wait until the pulsations have ceased in the umbilical cord. Now draw the cord between the thumb and finger toward the umbilicus and tie with a clean thread about two inches from the infant's navel, and snip the cord just outside this point.

    If the placenta has not yet been delivered, gentle traction on the cord may produce it. The mother can usually assist by an expulsive movement, as coughing or blowing into the closed hand. There is no need to hurry in this matter; an hour may sometimes elapse before the placenta is passed.  In case it is not easily secured, pressure on the abdominal wall above the pelvis may secure it. Place the palms flat upon the walls and press forcibly downward. Do not insert the hand into the uterus unless absolutely necessary. If the hand is inserted, be sure that it is aseptic. Pass the fingers between placenta and the uterine wall, and the air entering will often release it. If this is not sufficient, gently force it from the wall of the uterus.

    After the delivery, if there has been no laceration and no cause to suspect infection, the external genitals should be carefully cleansed, the vulva protected by a cloth fastened as the napkins are usually fastened.  Between the napkin and the vulva should be a pad of surgeon's cotton. Should there be post-partum hemorrhage it can be checked by stroking sharply, with the cold hand, the mons veneris.

    The uterus must be reduced to contract the vessels and close the sinuses.  This is done by gently manipulating the fundus through the abdominal wall.  This will reduce the intensity and the number of the afterpains and shorten the lying-in period and prevent hemorrhage.

     The mother should, after being made scrupulously clean, be left to sleep.  Rest is the great restorer. The nurse should be instructed to carefully cleanse the external genitals with soap and water, following with a solution of bichloride of mercury, 1 to 2,000. Should it be deemed necessary to use an injection, a perfectly sterile pipe must be used, having been dipped in boiling water, and both tube and pipe having been left in a bichloride solution of 1 to 1,000 for ten minutes. The injection may be 1 to 4,000 bichloride, or creolin 1 to 100 (1%).

    The nurse should be given explicit directions as to the care of the patient. The breasts should be watched carefully. A scanty secretion of milk may be increased by a separation of the upper five or six ribs, lifting scapula, and freeing the subclavian and axillary arteries. This affects the internal mammary branches which supply the mammary gland. It also stimulates the intercostal nerves in this region. We spread the ribs, increasing the blood supply through perforating arteries, and giving a perfect drainage through the veins. The internal mammary artery may be reached at its origplain from the subclavian, producing effect through the plexus derived from the subclavian, and from the inferior cervical ganglion. Let me repeat that the introduction of the hand into the uterus to take the placenta is the most dangerous part of childbirth. It should be done only as a last resort.


    See cardiac troubles for treatment of heart. Press upon the inferior cervical ganglion, raise the ribs to overcome this condition. Press upon the solar plexus.


    Lesions affecting this gland are in the splanchnic area. The solar plexus affords the means of reaching it anteriorly. Treatment should be directed to ninth and tenth ribs and vertebra.


    Lesions. First, cerebral hemorrhage. Second, in cervical regions, atlas and axis. Third, in the upper dorsal region, and fourth, less often in cases of paraplegia in the lower dorsal and lumbar regions.

    Treatment. The various organs, as stomach, intestines and kidneys, must be carefully watched that proper nutrition and excretion may be performed. Give a general treatment, but treat specifically to correct the lesion. In case there is cerebral lesion the cervical region should have the most careful attention.  Relaxation and a soothing spinal treatment will overcome sleeplessness.  Manipulate each joint should there be tendency  toward anchylosis.

    Prognosis. Almost always an aid toward recovery, though complete recovery
is the exception.


    Lesion. Contraction of muscles of cervical region both anteriorly, laterally and posteriorly. Treatment consists in gentle manipulation of these.  Treatment around the enlarged glands will reduce the inflammation. Rest in bed and either hot or cold applications to the swollen glands will be helpful. In case of orchitis, rest and a support together with gentle manipulation around the external abdominal ring will be sufficient. Treatment in lumbar region will aid orchitic complications.


    For osteopathic treatment of, see Cardiac Troubles.


    Lesion. Muscular contraction in the splanchnic and lumbar regions. Usually osseous lesions in lumbar region.

    Treatment consists in opening the bowels by enemas of soap-suds, if necessary. Relaxation in the regions named above. Gentle manipulation and pressure over the areas of solar and inferior mesenteric plexuses. Hot bath with quiet abdominal manipulation will usually avert an attack. Hot fomentations are invaluable. Diet should be liquid or semi-solids; raw eggs and milk beaten together, or eggs and wine, custards, broths, gruel, etc., should be the diet until symptoms have subsided. Treatment should be given as often an pain returns.


    Lesion. Is always reflex, no constant osseous lesion. All muscles of throat and neck congested, the contraction extending down to mid-dorsal region. Examine scaleni affecting first and second ribs.

    Treatment.   Remove pressure from laryngeal filaments of tenth nerve by relaxing muscles of neck. Remove disturbance to the vaso-motors of the lungs in the upper dorsal region. Correct the upper two ribs and relax the muscles in the deeper layers at the heads of these ribs.

    Prognosis.   If treated at beginning, the disease may be aborted.  Paroxysms may be stopped by pressure at the second and third dorsal vertebrae.


    Lesion.  In cervical region; either muscular or osseoas, or both.

    Treatment.   Stimulate the superior cervical sympathetic after having thoroughly relaxed all the muscles of the infra-hyoid and lateral muscles.  Reach the ninth nerve just below the lobule of the ear. The tenth may be reached here or in the sheath of the carotid artery. Treatment internally with finger over the mucous membrane of tonsils and pharynx reduces inflammation. A cold compress from ice water is good.



    Lesion.  Invariably found in the dorsal region.  The ribs on the affected side are usually down. The location of the pain will indicate the lesion.

    Treatment. Raise the rib, stretch the intercostal muscles. Give steady pressure on the affected nerves at their exit from the spine. The usual lung treatment may be given. Perhaps an hour may be required to control the pain.

    Prognosis. Is very favorable.

    Diet. In the form of pleurisy with effusion, the diet should consist of very lean meat and  stale bread, with as little fluid as will allay thirst.  Ice may be sucked to avoid drinking much fluid.


    Lesion. In the dorsal region from second to sixth vertebra. The intercostal muscles are all contracted.

    Treatment.  Relax the muscles in the upper dorsal region. Use arm as a lever, put one hand between spine and scapulae and force arm and scapula backward. This will relax the levator angili scapula, the rhomboids, and the continuations of the erector spinae. Thoroughly relax all the muscles along the spine by pressing upward and outward. Manipulate anteriorly. Overcome sleeplessness by gently manipulating the spine downward and by treating filaments of fifth nerve. Bowels are to be kept regular by kneading. Stop coughing by pressing with thumb at third and fifth dorsal. Pain can be  relieved by pressure at certain point; examination will reveal it. Pyrexia controlled at sub-occipital region and first rib by steady pressure. Sponging with cool or tepid water will regulate temperature. This must be done daily.

    Diet.   Milk, custard, broths, fruit juice, etc., every two or three hours. Even after defervescence the return to solid diet must be very gradual.


    Lesion. In the dorso-lumbar region. Examine tenth, eleventh and twelfth ribs.

    Treatment.   Correct lesion. Relax quadratus lumborum muscle. Spring the spine forward in case of kyphosis, frequently a lateral trouble. Treat as a kidney lesion.

    Prognosis.  Recovery is usually accomplished by this treatment.


    Lesion. Is evident. Treatment is wholly corrective and to relax the muscles along the spine thus affecting drainage. In case the disease is well marked, care must be used to avoid violence. A swing is necessary to suspend the patient from his arms, thus relieving the pressure on the spine. No violent treatment should be given.

    Prognosis.   In advanced cases the prognosis is very poor. In early stages it is hopeful


    Treatment for pyelitis does not differ in any marked respect from that of nephritis.



    Lesion.   In spinal region at various levels.

    Treatment.  Stimulate the nerves to the digestive organs; particular attention to the splanchnics. Correct any lesions. Diet and hygiene are important. Special treatment. with exercise, baths, gymnastics and the following diet will overcome the condition.

    Diet for Infants.  Milk sterilized, oatmeal water and barley water.

    For older Children. Fats and proteids should form the basis of the diet.  Cream, bacon occasionally, stale bread, scraped beef and fruits. Avoid starches and sugars.


   Treatment.   Control function and nutrition of the rectum in the lumbar region through the pudic nerve; also in middle sacral region. The rectum may be treated through the ischio-rectal fossa. Always examine the liver, as portal stagnation may be a cause.


    Lesion. Referred, it may be at any point in the body.  Primary lesion in liver or kidney regions of the spine.

    Treatment.  The liver, kidneys and intestines are three points of attack.  In case of arthritis, the joints must be manipulated at each treatment.  Correct the spinal lesions and separate the ribs. Often the ribs overlying the liver are dislocated. The muscles in the vaso-motor region of spine, second to eighth dorsal, are invariably contracted and must be released. Thorough relaxation of the scapular attachments, together with the muscles overlying the brachial plexus, will relieve the arms. Steady pressure along the course of the median, ulnar and musculo-spiral nerves in the arm, and over the anterior crural, sciatic and oblurator nerves in the leg relieves pain and stiffness.

    Treat the liver and kidneys. In acute or articular rheumatism the utmost care must be used. The kidneys and the liver must be treated as in the above. Two or three treatments should be given per day.

    Diet.  Soups, broths and farinaceous foods, fish, eggs and fowl in small quantities. In chronic cases meats in small quantities may be allowed. Acid waters, as dilute lemonade, may be administered. Plain water in abundance is just as efficacious.     Fats are indicated, should arthritis be manifest.

    Prognosis.  Favorable in all recent cases.


    Lesion. In lumbar region, usually lateral. Sometimes due to muscular contractions around  sacro-sciatic notch.  There is often a sacro-iliac slip.

    Treatment.  Thoroughly relax all muscles in lumbar region. After relaxing structures around sacro-sciatic notch stretch the pyriformis muscle by rotating the thigh inward. To do this, flex the leg on the thigh and grasp the ankle. Hold the knee and turn the leg so as to rotate the thigh. Flex thigh on abdomen and leg on thigh, keeping the thigh flexed, straighten the leg. This stretches the sciatic. Treat in popliteal space and at saphenous opening.  Liver and kidneys are important. These treatments are paliative. The lesions in the lumbar vertebra, or at the sacrum must be corrected.

    Diet.   Same as in rheumatism.

    Prognosis.  Very favorable.


    Lesion. Since this is tuberculosis of the lymphatic glands, the location of the lesion will vary with the location of the disease. The glands of the neck and axilla arc controlled by nerves from the upper dorsal and cervical regions. The groin and limb by middle dorsal to lumbar (vaso-motor). The ribs are frequently at fault.

    Treatment.  Correct the usual vertebral lesion. Occasionally a rib is at fault. A general treatment is given here.  Exercise, outdoor life and nourishing foods are indicated. Avoid pork.


    Lesion.  Is near exit of nerve to muscle affected. For cranial nerves it is in cervical or upper dorsal regions.  Sometimes caused by improper nourishment to  nerve - disturbance in its vaso-motors.

    Treatment. Thorough manipulation of limb affected will give relief usually.  Steady pressure along course of the nerve will stop the spasm.  Effective treatment will be to correct the osseous lesion.


    The lesion is usually at the eighth to tenth vertebrae or else at the ninth or tenth rib on left side. Treatment is applied by manipulation in spinal region and by flexing the limbs on abdomen and treating the spleen beneath the costal margin. Thorough vibration over ninth rib on left side
changes circulation through spleen. In case of splenitis, heat is applied. The liver should always be treated with the spleen, as the venous drainage is via liver.


    Lesion.  In sunstroke or heat exhaustion the reflex lesion is a tensely drawn condition of the muscles from the sixth dorsal upward. These must be relaxed as soon as patient has been removed to a cool place. If the temperature is high, as in thermic fever, use the ice pack, the bath, ice water enema, ice cap, etc. In heat exhaustion when temperature is sub-normal the hot bath must be used. Do not omit the hydro-therapy.


    Lesion. The muscles of neck always tensely contracted; usually a primary lesion in middle or upper cervical region;  this is always present in chronic cases.

    Treatment.    In acute cases the manipulation must be gently applied to all muscles of neck Quietly apply pressure to the swollen tonsils until they have been reduced. Dip the fingers in cold water and press upon the tonsils and palate internally. The cold water prevents gagging.  A cold compress is useful. In case of suppuration a gargle of listerine, 1:3, or a spray, 1:2, is advised. In acute cases treat several times per day. In chronic cases the lesion in the vertebra must be corrected and the connective tissue removed by a natural process of absorption. This will follow when the circulation is equalized.

    Diet.  In advanced cases a liquid diet is necessary. Sometimes swallowing is impossible. A small ice bag to suck will relieve thirst and allay the pain. Rectal alimentation is rarely required.

    Prognosis.  Very favorable. If taken early, the case need not be serious.


    Lesion.  Can be found in the spinal region controlling the region either in its innervation or its blood supply.  Osteopathic practice proves that most tumors are caused by nervous irritation and imperfect drainage.  Should the tumor be of the breast, the lesion is found in the ribs of that side or in the lower cervical region. Should the tumor be uterine, the lesion may be either lumbar, sacroiliac, or  hyperaemia of the pelvic organs may result from an imperfect support of the abdominal organs.  In many of these tumors a restoration of the normal condition of blood supply and drainage is effective.  Do not manipulate the tumor itself very much, as irritation may follow.

    Prognosis.  Each case is a law unto itself. The progress of the case and condition of the patient must be considered. Many cases are helped, some are cured, some are not affected.


    Lesion. Very likely the lesions are secondary only  - a reflex of intestinal disturbance.

    Treatment.  The usual hydro-therapy treatment and nursing are important factors in the care of typhoid patients.  The bowels should be kept in a natural condition by thorough relaxation of the splanchnic and lumbar area twice each day. The cerebral symptoms are prevented or allayed by treatment in the upper dorsal and cervical regions. The fever can be controlled by cool spongings in some cases, in others it is necessary to use the bath. This treatment will not avert the disease, but it will lighten all symptoms. Gentle manipulation of the abdomen and pressure over the solar and hypo-gastric plexuses, will prevent the tympanitis if begun early. Holding the sub-occipital region will relieve the headache. Relax the entire spine.


    Lesion.  In middle cervical region usually, may be at the atlas or even in lower region.  It is a type of muscular  rheumatism.

    Treatment.  Put hand on sterno-cleido mastoid muscle at a point of entrance of the eleventh nerve. Turn the neck as far as possible each way.  Putting the neck on tension by bending it and suddenly rotating the head in that same direction will usually overcome tile condition.

    Prognosis.  Good in all recent cases. In some cases of long standing nothing can be done.


    In most cases of vomiting the lesion is located in the middle and upper dorsal region usually at the third to fifth ribs.  Elevation of these ribs, steady pressure at their angles and a thorough relaxation of the intercostal muscles will stop the paroxysms. This will usually stop vomiting in "morning sickness."


    In vaso-motor disturbances the heart, the eyes, the stomach and the vaso-motors are closely connected. If the disturbance is from the vaso-motors look for lesion in the upper dorsal region, usually from second to sixth dorsal.  Again the lesion may be in the lower cervical region affecting the middle or inferior cervical plexus.

    Treatment.   Correction or the lesion. Treatment of the stomach, thorough relaxation and stretching of neck will usually bring about the desired result.