Principles of Osteopathy
4th Edition
Dain L. Tasker, D. O.

CHAPTER XVII - Inhibition

    Acceleration - Inhibition. - We have noted in a former chapter that the attributes of nervous tissue are irritability, conductivity and trophicity.  We may add to these acceleration and inhibition.  We do not use the terms stimulation and inhibition as denoting opposite conditions, because stimulation applies to the initiation of an impulse.  This impulse may be acceleratory or inhibitory in character.  We may stimulate a nerve whose chief function is inhibition.  An impulse, whether accleratory or inhibitory in character, is the result of stimulation.

    All bodily functions require stimulation, in the sense we have used the term, i. e., something must initiate an impulse which is designed to excite activity.  After this activity is started, it must be governed.  It is the means of governing these activities, we are interested in studying.

    Muscular Contraction. - Muscle may be stimulated to contraction.  This contraction may be increased or decreased, thus showing that after initiatory impulse starts on its way to the point of conversion into work done by the muscle, it is accelerated, increased, or inhibited, restrained by certain influences which we cannot easily analyze.  The contraction and relaxation phenomena of muscle are equally important.  Vaso-constriction and vasodilation are examples of these phenomena.

    Secretion. - The activity of secretary tissues is regulated by some arrangement similar to that controlling muscular action.  After a cell becomes active, it is still under the control of a governing center, which accelerates or inhibits, according to the necessities of the case.

    Acceleration and Inhibition as Attributes of Nerve Tissue. - Cells are full of potential energy, which needs a stimulus to start its conversion into kinetic energy.  We may ask ourselves the question; Why isn't all of the potential energy converted into kinetic at one time, or in response to a single stimulus?  If the explosive material in a magazine is ignited, it all explodes - there is complete conversion of potential into kinetic energy.  There is no restraining or accelerating in this case.  The element, nitrogen, whose liberation in this case causes such dire results, is the same element in the cells whose liberation is noted as "work" done by muscle or gland.  Why isn't all the nitrogen in the cells liberated by a single stimulus, as in the magazine?  We can think of no explanation except that impulses passing over nerves are qualified by other impulses passing over other nerves, the two stimuli of opposite character thus modifying each other, or in some cases, adding their forces when of like character.

    Inhibition as an attribute of the nervous system, does not seem to be exercised in short reflex arcs, neither does it appear to be exercised by centers in the spinal cord.  It may be that a certain amount of inhibitory influence is exerted in these subsidiary centers, but thus far investigations demonstrate this attribute to be possessed by the brain cells.

    Inhibition a Normal Attribute of the Central Nervous System. - Inhibition is a normal restraining influence possessed by the central nervous system.  When the osteopathic physician speaks of inhibition, he means a therapeutic procedure which exercises a restraining influence over some function, this restraining influence being independent of that inhibition which is an attribute of the central nervous system.

    Anything which decreases the number or strength of sensory impulses reaching a reflex center, is inhibitory in character.  The medical profession has made use of a large number of agents for this purpose, opium, for example.

    History. - Inhibition is a word found in literature bearing on the phenomena of the nervous system.  It is well for us to investigate the history of this word, and the phenomenon which it indicates.  The phenomenon which occasioned the use of this word was first observed by the brothers Weber (1845) and many investigators have since confirmed it.  They noted that excitation of fibers of the pneumogastric nerve occasioned slowing or stoppage of the contractions of the heart.  This new phenomenon must have a designative term, hence the word "stoppage" was used, meaning the arrest of activity of an organ, by arousing activity in a nerve supplying it.  The word "inhibition" was proposed later by Brown-Sequard and has remained in use, to the exclusion of the earlier terms.

    After observing the phenomenon of nerve arrest in the heart, other phenomena of a somewhat similar character were grouped under the same head.  Thus we find the term inhibition confused with such phenomena as the paralysis of motor nerves by curare, loss of sensation following the inhalation of chloroform, shock and fatigue.  We can thus realize the great confusion of meanings attached to this term.  Later investigators realized the essential differences in these phenomena, and drew attention to the fact that paralysis, shock and fatigue were not comparable to the phenomenon of arrest of cardiac contraction following stimulation of the pneumogastric.  Morot says, "In order to prevent this confusion, it is necessary to return to the experimental datum which lies at the foundation of the conception of inhibition.  This appellation will be given to every phenomenon reproducing the characters and the essential conditions of stoppage of the heart by the stimulation of the vagus nerves."

    Arrest of Activity. - Paralysis, shock, fatigue and inhibition all signify arrest of activity, but are not synonymous, as may be noted by examining into the pathology of the conditions thus described.  Paralysis ordinarily means arrest of activity, due to a destructive process involving nerve elements.

    Shock. - Shock is a phenomenon more closely allied to inhibition than the others.  It signifies arrest of activity of the whole nervous system, due to excessive stimulation of a part, as, for example, the making of a wound.  The stimulation produced by the wound reacts on the central nervous system, and produces arrest of activity.  This phenomenon fulfills the definition of inhibition, as it is given in physiology: "An activity which prevents the manifestation of other activities."

    Fatigue. - Fatigue is the arrest of activity due to over stimulation, and therefore involves the idea of destruction in a less degree than is signified by paralysis.

    Location of Inhibition. - In the consideration of reflexes, we presuppose the existence of a mechanism consisting of two nerve elements, motor and sensory.  The stimulation of the latter is transmitted to the former, and is manifested by work done by the terminal tissue which received it.  This simple mechanism presupposes the approximation of the motor and sensory elements at some central point.  To explain inhibition, we must add a third element to this reflex arc, interposing it at the point of contact of the motor and sensory elements.  Since the point of terminal contact of motor and sensory elements is in the gray matter, wherever it occurs, this inhibitory phenomenon evidently resides in the same location.

    Muscular Activity. - It is axiomatic that muscular activity is the evidence of the nervous elements which control it.  Likewise, it has been considered that non-activity of muscle implied quiescence of the nervous elements.  The phenomenon of inhibition would seem to imply a form of activity of nervous elements just as important as that which calls forth contraction.  Muscular repose is the result of nerve activity.  This is the important point, in the practical consideration of inhibition.

    Three Characteristics of the Nervous System. - The nervous system during its developing period, shows three special characteristics, i. e., it either appropriates or produces energy - it is undetermined how the energy is secured - transmits energy, and lastly retains the discharge of energy.  The last characteristic is inhibition.

    Development of Inhibition. - When watching the movements of a young babe, we are amused by the incoordinate activity of its extremities.  At this stage in its development, inhibition is not an accomplished function of its nervous system.  The bladder and bowels act reflexly.  If inhibition develops normally, the child soon controls defecation and micturition; if not, a case of enuresis exists, until such time as the inhibitory function is developed in the central nervous system.

    Neurotic Diathesis, Chorea. - The well recognized fact that many children are easily precipitated into the convulsive state, is an evidence of the poorly developed condition of this third attribute of nervous tissues.  The so-called neurotic diathesis seems to mean little more than faulty development of inhibition.  Inhibition may develop in a fairly normal manner, but on account of nutritional conditions, environment or accident, be in part impaired.  An example of this is exhibited by the well known uncontrolled movements in chorea.  Impairment of the inhibitory function of the central nervous system would seem to be sufficient cause for chorea.

    Paralysis Agitans. - To carry our theory into later life we may take paralysis agitans as an example of the impairment of the inhibitory function of the central nervous system.  This functional neuronic disease presents no lesion of the nervous tissue, which has been detected up to the present time.  It may be that future study of nerve tissue will discover a delicate mechanism, whose purpose is inhibition.

    Developing Inhibition by Training. - The functional activity of nerve tissue is augmented by use, just as muscular power is enhanced by proper training.  Knowing this fact is evidenced everywhere in the field of educational endeavor, we feel that inhibition, as an important function of the nervous system (in fact, we may call it a protective function) should be recognized and cultivated early in life.  The well-trained child is the one possessing a well balanced nervous system.  Such a child does not have spasms, because appetite and desire have been trained, and these virtues of self control manifest themselves in nerve power and control.  Thus do we find the consideration of a purely scientific aspect of the development of the nervous system leads us into thoughts concerning moral development of the units of human society.  Through such studies as this, the physician becomes an important factor in the development of a proper and healthful social life.

    Inhibitory Effect of Pressure. - Now, to return to another view of our subject, we call your attention to a few of the recognized phenomena constantly presented to us, by our efforts to alleviate disease conditions.  We know by many experiences that by pressure on the surface of the body, over the course of a nerve bundle, a restraining influence is often exercised over the function of the tissue receiving the terminals of that nerve bundle.  Even more interesting is the observed fact that a restraining influence is often exerted on tissues remote from the point of pressure, which do not receive any of the terminals of the nerve which is pressed upon, but receive terminals of other nerves from the same segment of the central nervous system.  We may even go farther and say that it is not an unobserved phenomenon to have functional activity restrained in very remote tissues, which do not seen ordinarily to be immediately connected with the segment of nerve tissue directly affected.  This diffusion of restraining influences, following external pressure, would seem to point to the probability that the pressure acts as a stimulus to an inhibitory mechanism in the central nervous system.  If this were not so, we could not expect any reflex restraining effects, such as we are constantly seeking.  As examples of pressure effects, let us call attention to pressure of the suboccipital nerves in cases of headache.  These nerves are in position to be compressed against bone.  The effect of compression seems to be manifested peripherally by a decrease in pain.  Pain in the abdominal viscera can frequently be lessened, to a very appreciable extent, by external pressure made over the proper associated spinal area.  In this we have a good example of the reflex effect of pressure, which seems to uphold the idea that pressure is really stimulation of a function residing in the central nervous tissues.  Pressure over the sacral nerves in a woman passing. through the menopause, and troubled by irregular heart action, has been known to be almost immediately followed by regular heart rhythm.  Since the cardiac irregularity was a reflex, occasioned by disturbance of the sacral plexus, there must have been a re-adjustment of nervous activity, due to some form of stimulation.  It seems very probable that a movement, which we name inhibition, may in reality be a form of stimulation which calls forth a function of the central nervous system, the resultant action of the central nervous system being merely evidence of the fact that re-adjustment takes place as a self preservative activity, i. e., a manifestation toward the normal.

    Dosage. - We are likely to be misled into the fatuous belief that if we give just enough stimulation, or inhibition, in a given case, i. e., if our dosage is just right, we will get perfect results.  This is the old stumbling block of homeopathy and allopathy.  Devotees of these systems beguile themselves with the idea that specificity of dosage is the needful thing.  If we observe closely, we are very cognizant of the fact that we can not exactly estimate the quantity of nerve force resident in the patient we are treating.  This being so, there is no possibility of exact dosage, hence stimulation and inhibition, as therapeutic measures, other than simply palliative procedures, are of little avail.  We are continually impressed with one of the fundamental ideas in osteopathic practice, that the only measurable guiding quantity in giving an osteopathic treatment is the palpable tissue change, the lesion.  Any case not presenting a palpable lesion, can only be treated on general principles underlying natural therapeutics, i. e., the tonic effect of change, readjustment.  These changes range all the way from slight variations in diet, habits, surroundings and thoughts, up to genuine shock.  Inhibition as a form of movement has a place in our practice, but it is well for us to have a realizing sense of its limitations.

    Impairment of Function. - Inhibition, as a function of the central nervous system, must necessarily impress us with a host of new ideas in connection with the manifestation of lack of restraint of functional activity in various tissues.  Enuresis in the babe is normal, but we look with suspicion on its presence in the four year old; there is retardation of development.  Chorea is an evidence of impairment of this function, after it has apparently been normally developed.  Paralysis agitans is an evidence of impairment of this function late in life.

    Physiological Activity Is the Result of Stimulation. - All the functions of our body are initiated by stimuli.  It must not be inferred from this statement that the author is satisfied that life consists of nothing but reflexes.  So far as we can note the phenomena of muscle and gland, we are compelled to recognize the fact that most of them are reflexes.  Work done by muscle and gland is initiated principally by sensory stimuli.  Excessive sensory stimuli excite increased work in muscle and gland, sometimes to the point of exhaustion.  To decrease the amount of work, we must decrease the number of stimuli.  The stimuli originate at the periphery of sensory nerves.  Sensory nerves are most numerous in the skin, mucous membrane and muscle.  Inhibitory influences must be applied to one or more of these structures.  Skin is the surface tissue, richly supplied by sensory nerves, and under it are muscles, also well supplied by sensory nerves.

    Hilton's Law. - Hilton, by showing that the skin, muscles and synovial membrane of a joint, or the skin, muscles of the abdomen and contents covered by peritoneum, are innervated from the same segment of the cord, laid a foundation far the rational use of inhibition, in osteopathic practice.

    Inhibition -Therapeutic. - Inhibition, as a therapeutic procedure, consists in a steady digital pressure made over some nerve trunk, or over an area which is closely connected with a spinal segment from which nerves pass to an internal viscus, which we desire to affect.

    In order to explain the necessity for this movement and its beneficial effects, we must note the phenomena of vasomotion.

    How Vasomotor Centers Act. - Vasomotor centers act according to the sum of the stimuli reaching them from skin, muscle, glands, etc.  If the sensory nerves of one lateral half of the body are stimulated, as by pricking with needles, the temperature of that half of the body will be higher than the other, thus demonstrating that excessive stimulation of sensory nerves ends in vasodilation, i. e., loss of tone of the muscular coat of the blood vessels.  Since excessive, i. e., over-stimulation of sensory nerves in this experiment, causes inhibition of vascular tone and hyperaemia results, we argue that any procedure, which lessens the excessive amount of stimulation passing to a vasomotor center, will favor the return of the vascular tone.  Therefore, since it is easily demonstrated that digital pressure lessens pain and sensitiveness in the area pressed upon, we know that the registering power of these peripheral nerves is decreased, and there results a better vascular tone in that area.

    Over-stimulation Equals Inhibition. - If over-stimulation results in inhibition of vascular tone, as the above experiment seems to demonstrate, then it appears rational to decrease the stimulation to a point where vascular tone is not disturbed.  Digital pressure does decrease the irritability; therefore we may express ourselves as follows: Inhibition of sensory nerves, in skin and muscle, which are over-stimulated, will favor the return of vascular tone in all areas which are supplied with nerves front the same segment of the cord.

    Over-stimulation of sensory nerves causes vascular dilatation.  Inhibition lessens the irritability of sensory nerves and hence decreases the number of stimuli reaching the vaso-motor centers, thus allowing a return of vascular tone.

    The Guide for the Use of Inhibition. - Knowing the complete distribution of any nerve trunk, we may judge the condition of the internal structures, supplied by one of its branches, by the physiological activity of surface tissues, supplied by others of its branches.  In this way we are guided as to our use of inhibition.

    Pathological Changes Which Accompany Over-stimulation. - If an individual eats a hearty meal, and before it is digested eats another, and continues the process, the stimulation of the sensory nerves in the mucosa of his digestive viscera results in a physiological hyperaemia which, under the ceaseless stimulation of the presence of food, finally becomes chronic.  The liver becomes hyperaemic, and its sensory nerves are stimulated by the increased amount of blood, present in the capillaries.  These sensory nerves do not register their impressions on the sensorium of the brain, but do excite that area of the spinal cord with which they are connected by means of the rami-communicantes.  This area of the spinal cord lies between the sixth and tenth dorsal spines.  From this area, nerves pass to the deep muscles of the back.  These muscles are excited to undue contraction, and their sensory nerves are thereby made sensitive.  The capillary circulation in these muscles is poor, thereby increasing the muscular sensitiveness.  This muscular sensitiveness, or rather increased stimulation of the sensory endings in the muscles, sends a new set of impulses to the same area of the spinal cord, sixth to the tenth dorsal, and the cord reflexes them back to the sympathetic system.  Thus a figure 8 is formed with the union of the circles representing the spinal cord.  With impulses entering the cord from both loops, sympathetic and cerebro-spinal, the cord itself becomes hyperaemic.  The constant interchange of reflexes which were originated by excessive demands on the physiological activity of the tissues involved, either ends in a spasmodic effort of nature to rid itself of the intolerable condition, by means of a "bilious spell," or the hyperaemia causes excessive secretion of mucous, hypertrophy of connective tissue, and atrophy of parenchymatous tissue.  The bilious spell is nature's safety valve.

    Rational Treatment. - After such a condition as we have described is well established, dieting merely lessens the reflexes in the sympathetic portion of our figure 8. The reflexes in the cerebro-spinal portion are still active, because the deep muscles of the back have become chronically contracted, and continue to over-stimulate the sensory nerves.  These cerebro-spinal reflexes still help to maintain the hyperaemia of the spinal cord, which continues to disturb the rhythm of the sympathetic.  Manifestly, the treatment must consider both portions of the figure 8. Dietetics will lessen to some extent the hyperactivity of the sympathetic loop.  Digital pressure, inhibition, will relax the spinal muscles, and lessen the hyperactivity of the cerebro-spinal loop.  The two lines of treatment will decrease the number of stimuli entering the segment of the spinal cord, sixth to tenth dorsal, hence there will cease to go out from that segment a series of impulses which have tended to pervert the secretion in the digestive viscera.

    The contraction of the spinal muscles may have subluxated a vertebra which then becomes a source of irritation.  In such a case, a movement to replace the vertebra in its true relation acts in the nature of inhibition, i. e., it ceases to cause excessive stimuli to enter the spinal cord.

    Digital pressure on contracted dorsal muscles causes sensitiveness, i. e., consciousness of the fact that the nerves in that region are abnormally irritable.  The sensitive area along the spine will be in direct central connection with an internal viscus which is equally if not more sensitive.

    Hyperaeathesia of Sensory Areas - Diagnosis. - The hyperaesthesia of sensory areas along the spine is of practical value for diagnostic and therapeutic purposes when we know their nerve connections.  By inhibiting a hypersensitive spinal area, we set up a change in an area of low sensibility, i. e., a visceral area.  The inhibitory pressure does not merely deceive consciousness by lessening the power of its informing nerves, which alone have power to stir up those reflexes which will tend to assist the diseased part to return to normal.

    Results of Inhibition. - We know that inhibition lessens pain in the area of conscious sensation.  The result of daily practice teaches us this.

    Inhibition of painful areas does more than lessen pain; it aborts those impulses which are the result of pain, and sends a counter impulse into the center which, in a measure, negatives the original impulse.  If this were not so, we could not stop vomiting, intestinal peristalsis or uterine colic.  We know that inhibition of a sensory area of the spine not only stops pain in that area, but also pain, if there is any, in the viscus which is in central connection with it.  Therefore, if we affect the tonus of both skeletal and involuntary muscles, sensation in the cerebro-spinal and sympathetic systems, we certainly affect the caliber of blood vessels and the activity of secretory and excretory glands.

    It is not too much to say that inhibition does not deceive consciousness by lessening the power of registering nerves, but does stop a storm of reflexes which have no reparative tendency, and that it does affect the area of low sensibility, as is evidenced by a change in the condition of its musculature, blood supply and secretary activity.

    There are many osteopaths who contend that the keynote of all manipulative work, according to osteopathic principles, is the discovery and removal of a "lesion," osseous in character.  With this idea carried to extreme, the author has no sympathy.  In connection with this idea the student is referred to the chapter on Subluxation, page 283.

    The Phrase "Remove Lesions." - The phrase "Remove Lesions" is a good one, and yet it is inexact in many cases.  It is an elastic phrase, and capable of many and varied interpretations.  Each year of active practice adds to the osteopathic idea of what lesions are.  Our literature contains many references to lesions which are not mentioned in Dr. Still's writings, and yet Dr. Still's basic work has made the later conception possible.  Osseous lesions have always been paramount in our work and thought, but muscular lesions now hold an equal place, and bid fair to lead, when we see more clearly into the subject.

    The Human Body Is a Vital Mechanism. - We say that "when the anatomical is absolutely correct, the physiological potentiates." This conception is based on the statement that the human body is a machine.  The human body is vastly more than a machine.  It is a vital mechanism, and the fact that it is vital, renders it susceptible to other influences besides mechanical, such as falls, twists, strains, etc.  We may truthfully say that when the physiological is over-active, the anatomical alignment is disarranged.  The principles of osteopathy, as they were first promulgated, declared that a structural defect is at the bottom of every physiological defect.  Structure always affects function.  A sufficient number of cases were found to give a foundation of fact to this statement.  Hasty reasoning tried to make this an all-embracing principle, applicable to every case of disease.  Other schools of medicine have made similar mistakes.  The allopathic school promulgated the "law of contraries." The homeopathic school holds aloft the "law of similars."  Neither of these are laws.  A law is absolute, no exceptions are tolerated.  If there are any exceptions to a so-called law it ceases to be a law.

    Osteopathic Meaning of Inhibition. - By the term inhibition, we do not attempt to convey any other meaning than that of pressure, applied at some particular point on the surface of the body, for the purpose of lessening the hyperactivity, or hyperaesthesia, of the immediate, or some distant part of the body.  The inhibition itself does in some cases remove what we may choose to call a lesion, in other cases it may make the removal of a lesion possible, but in the majority of cases, its effect is purely on the nerves, thereby acting on both the motor and sensory portions of the reflex arc, lessening muscular contraction and pain.

    The Scientific Use of Inhibition. - It has been proven many times that the osteopath is capable of checking excessive functional activity in viscera by the simple means of inhibition.  Some. would quibble as to the cause of this activity.  The original stimulus may have disappeared, but the reflexes which it initiated may be perpetuating the condition.  Many cases have been treated in which no definite cause or osseous lesion could be discovered.  Some of these cases came under the heading Indiscretions; others under purely mental conditions.  These cases were treated by inhibition, based on a knowledge of the anatomy and physiology of the parts involved.  The treatment was successful.  We are sure that such successes are just as gratifying, just as scientific, as are those in which the finding and reducing of a subluxation brings the glow of triumph to the eye of patient and physician alike.

    Inhibition as a Local Anaesthetic. - Inhibition is a local anaesthetic, and as such, is being used universally in the osteopathic profession today.  True, it is not a treatment which will secure results in a minute.  We can not inhibit for five minutes at the eighth dorsal spine, in a case of malarial fever, and expect to check the chill.  The chill can sometimes be controlled as long as the inhibition is maintained.  The influence thus gained over the muscular contractions seems to increase the patient's resistance.  The onset of the next chill usually shows a decrease in the intensity of muscular contraction, and the duration is shortened.  No one would say that we removed a physical lesion by this treatment, or the cause of the chill.  Muscular contraction of the deep dorsal muscles comes on with the chill, but does not cause it.  Surely inhibition in this case works a nervous change of a pronounced character.

    An example of the good results of inhibition is afforded by one of the author's cases.  Woman, fifty years of age, suffered from diarrhoea, two years' duration.  Five to seven bowel movements daily.  No formed feces.  Usually the stools were typhoid in character.  Uterine fibroid removed prior to development of diarrhoea.  History of continuous drug treatment.  Osteopathic examination did not reveal any osseous lesion.  There seemed to be nothing to lay the blame upon, except the once existent fibroid, or the result of the operation.  Since no definite lesion existed, the treatment was planned as a test of inhibition without any other method.  At the end of three months the patient had but one movement daily, and the feces were well formed.  Pressure, and gentle stretching of the muscles extending over the area between the eighth dorsal and fifth lumbar spines, constituted the methods used.  From fifteen to twenty minutes was the duration of the treatment, three times per week for two months, and twice per week thereafter.

    In cholelithiasis the intense pain can be modified by inhibition at ninth and tenth dorsal spines, right side.  Inhibition at this point also lessens the contraction of the abdominal muscles, and thus makes direct manipulative treatment possible.  The same is true in cases of appendicitis.  We could not give direct manipulative treatment in such cases, if it were not for the power of inhibition to lessen pain in the affected area, and the consequent muscular contraction.  How much more influence is exerted over the nerves of the appendix and surrounding region, it is hard to say.  It may be that the inhibition arouses other forces of a stimulatory character to be brought into action to empty the appendix.  Direct manipulation in these cases is frequently out of the question.

    Inhibition to Remove Lesions. - Inhibition is a large and necessary part of many treatments given for the purpose of removing a definite lesion, for if inhibition were not first used, the true lesion could not be touched.  This is the case in intestinal obstructions.  The intestinal irritation causes such bowel contractions, cramps, and contraction of the abdominal muscles, that the physician's fingers cannot palpate the disturbed area.  Inhibition over the spinal area from which the nerves to the disturbed area pass out, will cause relaxation of the muscles.

    In a case of pleurisy which came under the author's care, an opportunity was afforded to test inhibition unhampered by any other method.  The patient could not bear to have the right arm moved; respiration was exceedingly shallow, and the physical strength was very low.  Hot fomentations had been used, but to lift the arm caused excruciating pain in the side. It was a case of dry pleurisy.  Steady inhibition was given for fifteen minutes, between the transverse processes on the right side, in the area between the third and the seventh dorsal vertebrae.  After this length of time the patient could raise the right arm above the head and take much better inspiration.  As a result of this treatment given twice per day, the patient made a good recovery, though all the metabolic processes were carried on in a very unsatisfactory way.

    Inhibition as a Preparatory Treatment. - There is still another time when inhibition is of incalculable value: In making examination of the vagina or rectum, especially the former.  Several times, in the author's practice, examination of the vagina seemed impossible, without great distress to the patient.  The irritability of the mucous membrane of the vagina caused intense spasmodic contraction of the sphincter, but steady inhibition over the third and fourth sacral foramina for about five minutes, caused complete relaxation, and the examination could then be made without any trouble.  Cases have been reported to the author by many osteopaths, describing the good results of inhibition in gynecological cases.  These cases have ranged from simple nervous vaginismus to curetement.  Since the sacral nerves are so near the surface, and are not interrupted in their course to the pelvic viscera, they afford excellent opportunity for the good effects of inhibition to be demonstrated.