The Practice and Applied
Therapeutics of Osteopathy
Charles Hazzard, D. O.
1905
CHAPTER XI
DISEASES OF THE RESPIRATORY TRACT
ASTHMA
DEFINITION: Asthma is a disease of the bronchial
tubes characterized by dyspnea. It is spasmodic in nature, the air
tubes being narrowed by spasm of their muscular fibers or by swelling of
the mucous membrane from hyperemia.
CAUSE: This disease always presents definite lesions,
muscular and bony, of the upper dorsal spine and of the thorax. Secondary
lesions usually occur in the cervical region. The chief bony lesions
affect the ribs from the second to the sixth on the right side. (Dr.
A. T. Still.) The majority of cases show lesions of this region, but they
may occur higher up or lower down. Lesion is often found in the neck.
The sternal ends of the ribs and the costal cartilages, as well as the
spinal ends of the ribs may show the lesions. Lesions of the ribs
from the second to the seventh on either side; of the corresponding dorsal
vertebra; of the anterior and posterior thoracic muscles; of the atlas,
axis, and hyoid bone, and of the cervical muscles are all active in producing
the disease. A case is reported in which the bony lesion was in the
lumbar spine, constipation also being a feature of the case. No treatment
was given above the lumbar region, but the asthma was cured. It was
regarded as being reflex from the lumbar lesion. (See case
13).
A review of the typical cases, reported from various
sources, and in which cures were made by the removal of the specific lesion,
shows a definite area in which such causes occur.
(1) Luxation of first, second and third left ribs.
(2) Fourth, fifth and sixth dorsal vertebra anterior;
the corresponding ribs lowered. Two treatments stopped the attacks,
and patient was discharged as cured after three weeks' treatment.
(3) Second dorsal vertebra lateral.
(4) Fifth right rib down and much tenderness of
tissues at the fifth dorsal vertebra.
(5) The scaleni, mastoid and anterior and posterior
thoracic muscles very tense.
(6) Right fourth and fifth ribs, and left fifth
and sixth ribs luxated.
(7) The axis luxated to the right, cervical muscles
contractured, all the ribs depressed.
(8) The left fifth and sixth ribs downward.
(9) The first to the eighth ribs on both sides
down; spinal of the same region contractured luxation of the atlas and
axis; depression of the hyoid bone.
(10) The second dorsal vertebra luxated laterally,
involving the corresponding ribs; several ribs down.
(11) All the upper dorsal vertebrae anterior, carrying
the ribs forward; closeness of the first rib to the clavicle.
(12) Third, fifth, and seventh right ribs luxated
downward at their anterior ends; their heads were also luxated; atlas and
axis to the right. The patient had previously been a sufferer from
bronchitis, with upper dorsal and rib lesions. Accidental slipping
of the third rib caused asthma at once. Irritation from the fifth
rib always caused expectoration of quantities of sputum, but if the third
rib were kept in place the asthma disappeared at once.
(13) Female; age 22; single; book-keeper.
Lumbar region much posterior constipation and dysmenorrhea accompanied
the asthma which was of two years' standing. No neck, rib, or thoracic
spinal lesion appeared. The heart was irregular, ,dropping one beat
in four. No treatment was given above the 12th dorsal, and as soon
as the constipation was cured (3 mos.) the asthma and dysmenorrhea disappeared.
The patient had not had a night's sleep in more than a year, without the
use of a powder which she burned, inhaling the fumes. The bony lesion
was removed, and cure resulted. The asthma was reflex from the lumbar
condition and diseases present.
(14) A fourth rib displaced, causing asthma, accompanied
by bronchitis and pleurisy. The whole spine was stiff. After
two treatments the patient was free from asthma and was discharged cured
after six treatments.
(15) Asthma and Hay Fever. Male, aged
38; grocer. One clavicle was depressed. Raising it gave immediate
relief. The upper spinal muscles were contractured. These were
relaxed and the ribs, from the 1st to 5th on the left side, were raised.
(16) Female, aged 23. A fall in childhood caused
a lateral curvature from the lower dorsal to the sacral region, the lumbar
region being also anterior. The right limb was much smaller and shorter
than the left; the ankle stiff; the flesh always cold; menstrual flow every
two weeks. After two weeks treatment the asthma disappeared.
Under further treatment constant improvement was taking place in the general
condition.
(17) Male, aged 43; married; overseer of
land and oil wells. 3d, 4th, 5th, and 6th dorsal vertebrae posterior, especially
the 3d. The cervical muscles were badly contractured, due to the
atlas being displaced to the right.
Relief was given at once in treatment by pressing
the dorsal vertebrae forward, throwing the upper ribs and clavicles forward.
The condition was complicated with hay-fever, which was also cured.
One can but note how all of these lesions occur in those regions in
which it is claimed the cause of asthma occurs. No other school of
practice notices such causes of this disease. Their theories are
various, many exciting causes are agreed upon, but Anders makes the statement
in regard to the real and original causes that they are of an unknown nature.
These lesions cause abnormal motor effects both
in arousing spasmodic conditions of the muscles of the bronchial walls,
and in the vaso-motor activity that produces the hyperemia of the mucous
membrane.
There are good ANATOMICAL REASONS why lesions in
these regions affect the lungs. The American Text Book of Physiology
states that stimulation of the vagus in the neck produces constriction
of the pulmonary vessels, while stimulation of the sympathetics in the
neck causes dilatation of them. Quain's anatomy says that the pneumogastrics
convey motor fibers to the unstriped muscle fibres of the trachea, bronchi,
and their subdivisions in the lungs. Vaso-constrictors for the lungs
exist, in some animals, in the second to the seventh spinal nerves. (Quain.)
The anterior pulmonary plexus is composed of the pneumogastrics and the
sympathetics; the posterior, of the pneumogastrics and branches from the
second, third, and fourth thoracic sympathetic ganglia. These regions
of the spine, with their important nerve connections with the lungs, are
naturally investigated by the Osteopath in relation to asthma. It
is reasonable that obstruction to the nerves here should cause the disease.
Anders gives among exciting causes "irritating lesions of the medulla."
The Osteopath finds in lesions of atlas, axis and cervical issues sufficient
cause of such irritation of the medulla as well as of the pneumogastric,
through their sympathetic and spinal nerve connections. In these
ways, lesion to the cervical, dorsal and upper thoracic structures act
as obstructors of these nerve mechanisms concerned in asthma, the pneumogastric
nerves, pulmonary plexuses, sympathetic and vaso-motors, and cause the
disease.
Exciting Causes of the paroxysm, such as bronchitis;
the inhalation of irritants, such as dust, fog, smoke, chemical vapors,
pollen of plants, odors of animals; reflex irritation from nose or stomach;
the results of other diseases, etc., would not act to cause asthma did
these anatomical lesions not exist. They are the real cause of the
condition. Existing in an individual, they obstruct the vital forces
of the bronchi and deteriorate the vitality of their tissues, perhaps gradually
during a term of years, and make it possible for these various exciting
causes to act.
The PROGNOSIS is good under osteopathic treatment,
though under medical treatment comparatively few cases recover. Very
many cases, a large number of them apparently helpless, have been cured.
The fact that most of these cases coming under osteopathic treatment are
of long standing and have usually tried every known remedy seems to make
little difference in gaining results upon them. Some cases the most
severe and longest standing yield quickest.
EXAMINATION AND TREATMENT are carried out according
to the methods described in Part I, (Chapters I, II, III, IV, VI, VII.)
Any of the lesions that may affect the bony parts in the regions mentioned
may produce the disease. Displacements of ribs, vertebrae, etc.,
need not take place in a particular direction. Rib and thoracic vertebral
lesions are more likely to act as causes. Lesions
in the neck alone seem quite unlikely to cause it. Those of the fourth
and fifth ribs upon the right side are most frequently the cause.
It is unnecessary to name the various probable causes of the anatomical
derangements or lesions named, as that subject has been fully dealt with
elsewhere, as well as the theory of the exact way in which such lesions
as the Osteopath finds act to cause disease.
TREATMENT must always depend for its success upon removing the causative
lesion, but treatment during the attack must look more particularly to
immediate relief of the patient, for as a rule these lesions can be removed
only by a course of treatments. At this time great relief is given
and the spasm usually quieted by thorough relaxation of the spinal muscles
(Chap. II, div. I), followed by raising of
all the ribs (Chap. VII) and clavicles to allow
free thoracic and lung action, and by relaxation of the muscles and other
soft tissues of the neck. Loosen the clothing about the neck.
The best time to treat for removal of the lesion is between attacks,
it being located and treated, according to its kind, by methods already
described. Attention should be given the sternal ends and cartilages
of the ribs, and to the intercostal tissues, as well as to the heads of
the ribs and the vertebrae. The scapular muscles should be relaxed
(Chap. II, div. XV.) the clavicles
raised (Chap. XII); the tissues of the
neck thoroughly relaxed, the spinal column relaxed (Chap.
II, div. II, III, IV, V.) and the ribs raised at their angles.
If the patient finds it difficult to take a full breath, raising or correcting
the fifth rib, or all of the ribs, will sometimes give relief. Pressure
upon the phrenic nerve aids the work by relaxing the diaphragm, which is
sometimes elevated (Chap. III, div. VIII.)
Treatment once a week or ten days is often enough
in most cases. Frequent treatment may undo the results accomplished
and keep up constant irritation. Many severe cases have been cured
by a few treatments at long intervals or by a single treatment.
Under this course of treatment the patient usually
feels relief at once. As a rule the spasms and the various attendant
symptoms terminate abruptly.
CARE OF PATIENT should include the wearing of loose
clothing, living out of doors in pure air if possible, or in large, well
ventilated rooms. The diet should be light and easily digested to
avoid danger of stomach reflexes, and the patient should avoid dust and
other exciting causes.
BRONCHITIS
Bronchitis is an acute or chronic inflammation of
the mucous large membrane of the middle sized air tubes. It is attended
by increased secretions and cough, and is caused by a vaso-motor disturbance
of the vessels of those membranes, due to specific lesions in the upper
spinal, anterior and posterior thoracic, and cervical, regions. These
lesions may be bony displacements, muscular contractures, ligamentous derangement,
etc.
CAUSE: These specific lesions cause the condition
by obstructing peripheral nerves or centers connecting with the vaso-motor
innervation of the bronchi. They usually occur high up in the thorax,
and in the neck, in close relation to the vaso-motor areas for the bronchi.
LESIONS found causing bronchitis are typified by
the following cases: (1) Luxation of atlas and axis, depression of hyoid-bone,
lowering of upper eight ribs, congestion of spinal muscles. (2) Third cervical
vertebra anterior, muscular tension from the second to the sixth dorsal
vertebra, second left rib much depressed. (3) Fourth dorsal vertebra lateral.
(4) Luxation of clavicle and first rib anteriorly. (5) Anterior and posterior
intercostal spaces as low as the fourth or fifth either chanced by misplacement
of rib, or the seat of irritation to the intercostal structures by contracture.
(6) Lesion to the vagus nerve by cervical luxation and contracture, also
luxation of the four upper dorsal vertebrae. (7) Luxation of the first,
second and third ribs. (8) Displacement of' the anterior ends of the first,
second and third ribs, and derangement of these cartilages. (9) Bilateral
contracture of the cervical and spinal muscles as low as the sixth dorsal.
(10) Second to fourth dorsal vertebrae lateral. (11) Luxation between
manubrium and gladiolus of the sternum. (12) A case accompanied by
torticollis and a weak heart in a female, age 24, teacher by occupation.
Upper four cervical vertebrae to the right and ankylosed; a lateral swerve
of the spine from the 4th to 9th dorsal.
The ANATOMICAL RELATIONS between these lesions and
the seat of the disease are clear. While generally located higher than
in the case of asthma, they still fall within the vaso-motor area to the
lungs. As to lesion of atlas, axis, and other cervical tissues, in
relation to the vagus and cervical sympathetics, as well as of the upper
dorsal vertebrae, ribs, and muscles to the vaso-motor innervation of the
bronchi, the same remarks apply as in case of asthma, q. v. Noting from
the above lesions that they, being higher, are more concentrated upon the
vaso-motor centers of the bronchi (2nd, 3rd, 4th dorsal) may explain in
part the reason for a more intense vaso-motor effect, necessary to produce
the inflammation of the membranes. Luxations of the clavicle and
first rib anteriorly are anatomically related to the disease as causing
contracture of the anterior deep cervical tissues, thus obstructing both
phrenic and pneumogastric nerves, concerned in innervation of the lungs,
retarding the circulation of the cervical vessels, and collaterally obstructing
circulation in the lungs. The general dilatation of the air tubes,
often seen in chronic cases, is likely caused by those lesions especially
affecting the vagus, which innervates the involuntary muscles regulating
the calibre of the bronchi. Lessened action of the nerve allows a
dilatation of the tubes through loss of those muscle fibers. The
same explanation probably accounts for local thinning and dilatation of
the walls of the tubes.
Osler's statement that the cause of the disease
is probably microbic is a confession that the real cause is not known.
We hold the true cause to be anatomical lesions as described. The
fact that the disease is often the sequel of catching cold is suggestive
from an osteopathic point of view. The contraction of muscles and
tissues from exposure may be sufficient lesion, or may produce actual bony
luxations by drawing parts out of place. The further fact that the
subjects of spinal curvature are prone to the disease is a confirmation
of the osteopathic idea of making bony lesions the cause. Also, it
is significant to note that the obese are particularly subject to bronchitis
because the weight of the flesh aggregated about the chest walls acts as
a mechanical impediment to free rib-action -- free breathing, thus favoring
sluggish circulation and weak tissues which are prone to congestions and
inflammations.
The PROGNOSIS is good for both acute and chronic
cases. Many of the latter are cured in a comparatively short
time varying usually from one month or less to three months. In the
former the first treatment gives great relief, and, if the case is seen
early enough, may abort the attack. A few treatments usually start
the patient well on the way to recovery, and as a rule he is well in about
half of the time these cases usually run, which is stated to be two or
two and a half weeks.
In the TREATMENT of the case the specific lesions
should be at once sought and treated. Often relief can be given only
in this way. A thorough treatment should be given the spine, thorax
and neck to relax all contracted tissues. Easing of the tension in
this way gives great relief, as the constriction of the chest and neck
causes much of the discomfort from which the patient suffers. This
is aided by raising all the ribs. Treatment of the neck corrects
the action of the vagus and aids in dispelling the inflammation by its
participation in the vaso-motor control. In the same way relaxation
of all the tissues of the dorsal region about the second, third, and fourth
vertebrae, particularly, also correction of these vertebrae themselves,
tends to the same end. The clavicle should be raised and the first
rib lowered to free irritation to the phrenic, vagus, and cervical vessels.
Thorough treatment of the spine from the second to the seventh dorsal vertebra
(vaso-motor area) aids in equalizing bronchial circulation, the work on
the left side as low as the sixth aiding this result by strengthening the
pulse beat. This initial portion of the treatment should be brisk
and energetic enough to arouse good reaction. It relieves the patient
at once of the constriction, languor, and aching pain in the back.
It frees the lungs and starts perspiration.
The patient should be laid on his back and the upper
anterior ribs, cartilages and intercostal structures be thoroughly treated.
Strong manipulation of the tissues upon the anterior chest and along the
sternum reddens them and acts as a mustard plaster would. These treatments,
together with treatment directly along the trachea in the neck will relieve
the cough. The pain along the sternum is relieved by raising the
ribs and by the above treatments along the anterior chest. The fever
is taken down by the equalization of circulation wrought by the general
treatment, and by pressure in the superior cervical region, affecting the
superior cervical ganglion via the upper cervical nerves. The blood-flow
may be diverted from the bronchi to the abdomen by a slow, deep, inhibitive
treatment over it, including pressure over the solar and hypogastric plexuses.
By the process of raising the ribs and treating the spine, the engorged
azygos major vein is emptied. The restoration of free thoracic play
by these treatments is an important consideration in the equalizing of
the circulation throughout the lungs.
A hot mustard plaster over the anterior chest, or
a hot full bath, are efficient aids.
An acute case should be treated daily at least once,
and oftener in case of need. One thorough general treatment daily
may be sufficient of the kind, some additional special treatment being
given for cough or fever at other times. In chronic cases the treatment
should be given two or three times a week. In cases of local or general
dilatation of the bronchi, and in the thinning of the walls, close attention
to the vagus nerve should be given for reasons already explained.
Good care should be taken of the patient, particularly
as to guarding against exposure, which may lead to complications.
Treatment should be given bowels and kidneys to keep them active.
The obese should be taught the habit of deep respiration, as should all
persons subject to attacks of the disease. This measure, together
with the daily cold sponge or shower bath, is a great aid in overcoming
the chronic tendency.
BRONCHIECTASIS is successfully treated. The
condition frequently comes under treatment as a complication in chronic
bronchitis, asthma, etc., being benefited or perhaps practically cured
along with the primary condition. As this condition is generally
a result of chronic bronchial catarrh, and is frequently associated with
emphysema, chronic bronchitis, and asthma, the lesions found causing it
are similar to those found in these diseases. One would expect such
lesions as have been pointed out as the cause of vaso-motor derangement
in the bronchi, leading to the chronic catarrhal condition which so often
causes it. These lesions occur mostly in the upper dorsal region, between
the 2d and 7th. One notes that in bronchitis the dilatation of the
air-tubes is probably due to lesion to the vagus nerve, whose fibers innervate
the muscles controlling the calibre of the tubes. Hence cervical
lesion to the vagus might be the cause of the disease. The lesion
may be entirely those of the primary condition, followed by bronchiectasis,
as in cases in which the tumors, aneurysms, enlarged glands, cicatricial
contractions in interstitial pneumonia, etc., cause mechanical obstruction
of the bronchi and lead to their dilatation.
The TREATMENT of this condition would give much
relief, but it is questionable whether the majority of cases could be cured
entirely. They are frequently much helped by the treatment of a case
of asthma, chronic bronchitis, etc. Some cases have been cured.
The removal of a foreign body or other obstructing
cause as pointed out above; the removal of lesion from blood and nerve-supply
of the bronchi: thorough stimulation of the vagi to give renewed tone to
the muscles in the bronchial walls and to aid their contraction; treatment
of the bronchial vaso-motor center (2nd to 7th dorsal) to aid in strengthening
the bronchial walls and in overcoming the chronic catarrhal condition of
their lining membranes, are all necessary. In this way the case could
be much improved. The purulent and fetid expectorations would be
remedied as the renewed blood-flow began to restore the secretions to their
normal quality. To some extent the structural changes in the bronchi
could be repaired and their further progress prevented.
HAY-FEVER
DEFINITION: Hay-fever, or Autumnal Catarrh, is a
disease of the upper respiratory tract, styled by some writers a form of
asthma. It is caused by specific lesions in the upper dorsal, thoracic
and (especially) cervical regions, which deteriorate the vitality of the
membranes of this tract and lay them liable to the effect of certain irritants,
such as the pollen of various plants, leading to an inflammatory or catarrhal
condition.
LESIONS: The anatomical causes for this condition
are, from the osteopathic point of view, held to be derangements, in the
regions mentioned, of bones or other tissues, which act as lesions upon
the motor, vaso-motor and sensory innervation, also upon the blood-vessels
of the upper respiratory tract.
CASES: (1) In one case, complicated with asthma
and bronchitis, the scaleni, sterno-mastoid, and anterior and posterior
thoracic muscles were contractured. (2) In another, lesions were found
affecting the inferior cervical and upper thoracic regions.
In other cases, lesions were found as follows: (3)
Right fifth rib; (4) contracture of the muscles from the first to 10th
dorsal vertebra, with ribs in this region drawn down; (5) second cervical
vertebra to the right and posterior; (6) second cervical vertebra right,
cervical muscles contractured, upper three or four dorsal vertebra, to
the right. (7) See "Asthma, case 15; (8) see
"Asthma," case 17. In addition to these, lesions of the atlas,
of the phrenic nerve, of the clavicles and upper three ribs (especially
the first) and of the dorsal vertebrae as far as the fifth are all found.
The fact that this disease is often found complicated
with asthma and bronchitis is readily explained by noting that lesions
for all of these conditions occur at the same area of the spine.
In all, as well, vaso-motor lesion seems a more potent cause than motor
lesion. In the case of hay-fever, as with the other two, upper cervical
lesion is less important than lower cervical lesion. The latter kind,
with those affecting the first few dorsal vertebrae, the clavicle and the
first and second ribs, are always expected in case of hay-fever.
Purely muscular lesions are relatively less important than other kinds
as they are more likely to be secondary lesions.
The ANATOMICAL RELATION of lesion to disease in
this case seems clear. The lesions mentioned affect the vagus, cervical
sympathetic, and vaso-motor nerves as already explained. They also affect
the fifth cranial nerve through the cervical sympathetic, including the
superior cervical ganglion. This is the nerve which causes the swollen
and painful face, the running eyes and nose, and the sneezing, all of which
are so noticeable in hay-fever.
The fifth nerve and the vagus are intimately related
in function, both of the respiratory and of the digestive tract, and are
closely connected by the floor of the fourth ventricle, the superior ganglia,
and the cervical sympathetic. Lesions to the vagus in the region
of the clavicle and first rib, and to the sympathetic in the cervical region
and in the upper thoracic region of the spine, may affect one or both of
these nerves. According to Howell's American Text Book of Physiology,
vaso-dilator fibers for the face and mouth leave the cord at the 2d to
5th dorsal, pass up the cervical sympathetic to the superior cervical ganglion,
thence to the Gasserian ganglion of the fifth and to the regions mentioned.
Thus a low lesion, affecting nerves which ascend to supply these parts,
may be sufficient cause of hay-fever. At the same time the close association
of this disease with asthma is shown, since the vaso-motors to the lungs
occupy this same region of the upper thoracic spine.
"Modern Medicine" describes Hay-Fever as "A vasomotor
paralysis."
While the common form of irritant producing the
attack is supposed to be dust or pollen in the atmosphere, the fact that
emotional excitement, a deflected nasal septum, the presence of a nasal
polypus, hypertrophied mucous membranes, etc., may produce attacks, shows
that there are other causes, some of them mechanical, accounting for an
irritable nasal mucous membrane or acting as an irritant upon it.
It is reasonable for an Osteopath to maintain that lesions act as obstructions
to natural nerve and blood-supply to these membranes, weaken them and lay
them liable to the action of various irritants, thus being the real cause
of the disease. Immunity from attack in certain climates or altitudes
is but alleviation, or possibly cure, by allowing Nature a chance.
The patient has gone away from the special irritant which produces the
attack in him. The real causes of the disease still exist, and it
generally returns upon his again exposing himself to the same irritant.
Although a patient is more liable to attacks in rural districts, more city
people contract the disease, showing that a locality in which much pollen
occurs has nothing to do, per se, with the matter. Osler says that
McKenzie induced attacks by offering the patient an artificial rose to
smell. Osier states that three elements are necessary to the production
of the disease; "a nervous constitution, an irritable nasal muscosa,
and the stimulus." Yet, nervous people, with colds or catarrhal inflammation
of the nasal membranes, may be with impunity in districts filled with the
common irritants which excite attacks in hay-fever subjects. Evidently
some further etiological factor is necessary, and is found in the specific
anatomical abnormality pointed out by the Osteopath, the removal of which
has, in great numbers of cases, cured the disease. The most severe
cases yield quickly, often, upon the removal of the specific lesion.
The length of standing of the case seems to have but little relation to
the length of the time necessary to cure. A case of fourteen years'
standing was cured in three weeks; one of twenty-four years, in three months,
one of five years, in one and one-half months. This rehearsal might
detail great numbers of cases, but the few mentioned illustrate the whole
matter. In view of these facts it seems incontrovertible that the
specific lesions found by the Osteopath, and held by him to be the cause
of disease, are the actual causes of this disease.
The PROGNOSIS, under osteopathic treatment, is good.
Many of the cases are cured. The most severe and oldest cases may
be safely encouraged to take the treatment. Of medical prognosis
in hay-fever, Anders says that permanent cure is a rare event.
THE EXAMINATION AND TREATMENT. The removal of lesion
is the first consideration. It may, occurring in the region described,
be any one of the maladjustments of tissue considered in the general chapters
relative to the examination and treatment of the parts. An immediate
effort should be made for its removal. In addition special treatment
is given to alleviate the condition. All the upper spinal, thoracic
and neck muscles, and deep
tissues should be thoroughly relaxed for freedom of circulation
and to release tension upon nerves. The ribs and clavicles, apart
from correction of displacement, should be raised. Attention should
be given to releasing and toning the vagus nerve, and the vaso-motor nerves
from the 2nd to the 8th dorsal. For lachrymation, itching of the
eyes, swelling and pain in the face, and rhinorrhea, special treatment
should be given the fifth nerve. This may be aided by deep manipulation
and pressure in the suboccipital fossa for the superior cervical ganglion,
but is done especially by relaxation and quiet, deep, inhibitive treatment
to the facial branches of the fifth nerve (Chap.
V. B.) Treatment is given along the sides of the nose (Chap.
V. D.) to free its blood vessels, nerves, and, to reduce the
swelling and irritation in the mucous membranes. Strong pressure
is made with the palm upon the forehead (Chap.
V. B. II) to open the nostrils. Cervical treatment, inhibition
at the superior cervical region, and opening the mouth against resistance
(Chap. IV, II), all relieve the congested
circulation about the head and face, and give much relief. Momentary
pressure upon both external jugular veins causes the blood in them to set
back and dilate the veins back to the capillaries, after which, being dilated,
they carry off more blood, relieving the congestion.
For the sneezing one may make inhibition of the
phrenic nerve (Chap. III, VIII),
may press upon the palatine branches of the fifth nerve where they run
over the hard palate, or may grasp the head as in Chap. V, div. IX,
4, and raise it from the spine. The latter is a particularly good
treatment.
Treatment is ordinarily given three times per week.
The patient should be kept from exposure to the particular irritant that
excites his attacks.
PNEUMONIA
DEFINITION: Lobar Pneumonia, or Lung Fever, is an
acute inflammation of the parenchyma of the lungs caused by specific lesions,
bony, muscular, or ligamentous, in the upper spinal, thoracic, and cervical
regions. In other forms of pneumonia the same lesions are found.
Lobular or Catarrhal Pneumonia is an inflammation of the capillary air
tubes, which extends also to the lung tissue proper. Chronic Interstitial
Pneumonia is characterized by increase of the interstitial connective tissues.
CASES: (1) In this case, acute lobar pneumonia, lesion ,existed at
the 2nd to 5th dorsal vertebrae; the intercostal, cervical, and spinal
muscles were contractured.
(2) Marked contracture of the spinal muscles about
the lung center (2nd to 7th dorsal).
(3) Acute lobar pneumonia in a woman, aged 38.
Temperature, 102 5-10; pulse, 100; respiration, 38. Cervical and
dorsal spinal muscles, as well as the intercostals, were rigid; vertebral
lesion from the 2nd to 5th dorsal inclusive. The crisis was reached
upon the second day of treatment, after which time no serious symptoms
existed. On the fifth day temperature, pulse, and respiration were
found normal and so remained.
(4) A case in which the temperature was found at
105. The cough could be well relieved each time by steady pressure
at the 2nd, 3rd and 4th dorsal; the pain in the side was relieved by raising
the ribs and pressing on the left side from the 6th to 8th ribs.
The crisis was reached in seven days and the patient was out upon the 12th
day.
CAUSES: Anatomical lesion in the form of displaced
bony parts, ligaments, etc., and of contractured or tensed muscles and
other soft tissues are found affecting the spine as low as the eighth or
ninth dorsal; the ribs in the corresponding region, but more generally,
the 1st, 2nd and 3rd, 4th and 5th; the intercostal tissues, including nerves
and vessels; the cervical vertebra and tissues; the clavicle and first
rib. More specifically, lesions have been found affecting the 2nd
to 5th dorsal vertebra; contracture of intercostal, cervical and spinal
muscles; thoracic muscles; 4th and 5th ribs; 8th and 9th ribs; the vaso-motor
area, the 2nd to 7th dorsal; neck lesions to the vagi; to the recurrent
laryngeal nerves at the 1st and 2nd ribs.
Dr. Still says that in pneumonia the ribs below
the 4th are twisted and the lower ribs are down. He lays some stress in
these cases upon sacral lesion, acting by effect through the sympathetic
system to constrict the blood-vessels of the superficial fascia, and to
thus throw congestion onto the lungs.
The ANATOMICAL RELATIONS of such lesions to the
lungs have been explained. It is to be noted that the neck lesions
assume greater importance in these cases than in asthma or bronchitis,
though there is considerable concentration of lesion about the portion
of the spine in which is located the most important vaso-motor area for
the lungs, the region as low as the fourth dorsal. In regard to neck
lesion, important consideration are pointed out by McConnell in regard
to the vagi and the recurrent laryngeal nerves. Such obstructions
to the vagi, which are motor nerves to the lungs, cause loss of motor power
in them and favor the stasis and engorgement present. Obstruction
to the recurrent laryngeal nerves by luxations of the 1st and 2nd rib,
or by engorgement of aorta or subclavian artery where they are in relation
to them, causes catarrhal inflammation of the air tubes. The lesions
of the 8th and 9th ribs, affecting fibres to the lower lobes of the lungs,
are more usual in cases in which the disease occurs in the lower lung.
The fact that more men than women are attacked by
the disease; that a debilitated system is more susceptible; that exposure,
winter season, and trauma are exciting causes, favors the theory that such
anatomical lesions cause the disease, for the reason that such conditions
are fruitful sources of mechanical lesions. The result may be caused
directly by them, or they may make the anatomical weak points that lead
to deterioration of the lung tissues and lay them liable to invasion.
The specific microbes found in such cases could not live and grow in tissues
whose vitality had not been weakened by such causes. It is of interest,
in this connection, to note the remark of Strumpell; that the diplococcus
pneumonia exists in the mouths of healthy persons.
If the case be seen before it has passed the stage
of engorgement, the fever may be gotten under control at once, and a few
treatments may abort the disease.
This is the experience of our practitioners, although
Osler says that the disease can neither be aborted nor cut short by any
means (medical) at command. The means at the Osteopath's command
to control vaso-motor action are sufficient to relieve the engorgement.
In the stages of red and gray hepatization it is natural that slower results
must be expected, as the treatment has more work to accomplish. Yet vaso-motor
correction must lessen the inflammatory process, allow of less solidification,
and hasten the process of resolution.
In the first stage there is better opportunity to
correct the specific lesion, as the patient's strength will allow of such
treatment. The work is also aided by the fact that the alveoli are
.still open, and lung action, stimulated by treatment, may become a valuable
aid in dispelling the engorgement. In view of these facts, and as
experience shows, every symptom of the case can be lessened because the
pathological processes are modified. Less poison is generated and
the patient's general condition remains better. In one case the treatment
was applied in the first stage; the fever was under control from the first,
and the temperature became normal in three days. In another it disappeared
in four days; in another in five days. A case in which the temperature
was 1O4 1/2 degrees when first seen showed three degrees less fever the
next morning. It had been treated in the evening. In a case
in which the temperature was 103 degrees, the temperature, pulse, and respiration
became normal in five days. It is true that cases vary naturally,
yet in view of the fact that Osler states that the fever persists for from
five to ten days, and that after its fastigium is reached (usually within
a few hours) it remains remarkably constant, it is evident that osteopathic
work is successful to a marked degree in bettering the case.
The PROGNOSIS is good under osteopathic treatment.
EXAMINATION AND TREATMENT for the location and removal
of lesion are made according to methods considered in Part I. In
beginning the treatment, as the patient finds it easy to lie on the sound
side, the muscles and deep tissues are gently but thoroughly relaxed along
the length of the spine, particularly upon the affected side. This
starts vaso-motion and brings a sense of relief from the constriction that
so distresses the patient. During this treatment upon the side, treatment
is given the centers for bowels, kidneys, and superficial fascia (2nd dorsal
and 5th lumbar), to rouse them to action and to aid in the elimination
of poison from the system.
This initial treatment has thus prepared for the
more specific treatment for the fever, itself being part of the process.
The next step consists in turning the patient gently upon the back and
thoroughly relaxing the cervical tissues, the tissues behind the clavicle
and first rib, raising the clavicle and depressing the first rib, after
relaxation of the scaleni muscles. Treatment should also be applied
to the course of the vagi, and to the recurrent laryngeal nerves at the
lower, inner parts of the sternomastoid muscles. In these ways motor
power to the lungs is increased, and vaso-motion is corrected. The
treatment for fever is now completed by steady pressure in the sub-occipital
fossae in the usual way. The fever is not likely to go down at once,
but is gradually reduced after the treatment, for some hours. This
is because of the freedom given to the vaso-motors in the course of the
treatment, and the gradual change now being brought in the patient's system
by the recuperated forces.
The treatment for fever may be aided by the deep
inhibitive treatment to the abdomen, before described, to dilate the immense
abdominal veins and aid in calling away the blood from the engorged lung.
Further treatment is given the lungs, with the patient
on the back, by gently elevating the ribs from the second to the seventh
on both sides. This stimulates the vaso-motor centers to the lungs.
Elevation of all the ribs gives much relief from tension, and is the specific
method of relieving the pain in the side.
Simulation of the accelerators of the heart, second
to fifth dorsal on the, left side, aids in circulation through the lungs,
and stimulates the heart against failure. "In consolidation, the
right ventricle is subjected to a strain and there is danger of heart failure."-
(Stevens.)
For the cough, the treatment should be close and
deep along the trachea from the larynx to the root of the neck, also relaxation
of the anterior tissues of the chest, including the upper intercostal tissues.
The middle and inferior cervical regions should be treated for the lymphatics
to the lungs.
The amount and strength of the treatment must be regulated by the patient's
condition. Strong treatments are not allowed on account of weakness.
The general treatment should be given, thoroughly but gently, once a day
at least. The patient should be seen three or four times per day,
but the whole treatment outlined need not be given each time. A little
treatment for the fever, to release tension over the lungs, to relieve
pain in the side, etc., may be enough at a time.
Hygienic precautions, the use of hot applications, foot baths, rectal
injections, etc., may be employed, if necessary. The patient should
have plenty of water to drink, and should be kept upon a liquid or semi-liquid
diet.
PULMONARY CONSUMPTION
DEFINITION: Pulmonary Consumption, or Tuberculosis
of the Lungs, is a destructive disease of the tissues of the lungs, characterized
by the presence of the bascillus tuberculosis, and caused by specific lesions
in the upper dorsal and thoracic regions.
CAUSES: Cases: (1) In a case of "quick consumption,"
acute pneumonic phthisis, the upper spine was swerved to the right; the
2nd dorsal vertebra was lateral; the 8th and 9th dorsal vertebrae lateral;
the ribs down, narrowing the thoracic cavity.
(2) Second and third ribs luxated; marked lesion
between the corresponding vertebra, and the tissues about them very tender.
(3) First, second and third left ribs down and in. (4) Left clavicle
down; 1st to 8th dorsal vertebrae flat; 8th dorsal to 1st lumbar vertebrae
posterior; 2nd right rib tilted; the spine and thorax flat. (5) The 4th
dorsal vertebra sore; 3rd to 5th lumbar vertebrae tight and irregular;
fifth and sixth left ribs close together; first rib on right luxated; all
ribs down and irregular. (6) First to fifth right ribs lowered, decreasing
the capacity of the chest and interfering with the vaso-motors of the lungs
through their spinal connections.
(7) A lateral lesion from the 2nd to 5th dorsal,
and a dropping downward of the ribs.
(8) A lateral curvature of the upper dorsal spine,
the 2nd and 3rd ribs were down, and the muscles of the neck much contractured.
Lesions are often found of the 2nd, 3rd and 4th
ribs; of the 5th, 6th, 7th and 8th ribs (A. T. Still); 2nd and 3rd
cervical vertebra, usually lateral, and lesions, to the middle and inferior
cervical sympathetic ganglia affecting the lymphatics of the lungs (McConnell);
of the clavicle.
ANATOMICAL RELATIONS: In these cases the neck lesion
is not generally of prime importance, the dorsal lesion being the particular
one, and of this variety, that more especially affecting the upper several
ribs. Lesion of the spine, muscles, ligaments, or ribs, as low as
the 10th may become the cause of the disease. In very many cases
the lesion will be found to involve the second dorsal vertebra or the second
rib.
There are important reasons why lesions of ribs
lead to pulmonary tuberculosis, and why the flattened thorax, characteristic
of the disease, is so closely related to the condition either as primary
lesion causing it, or as a lesion secondary to it. According to the
American Text-book of Physiology, stimulation of intercostal nerves causes
reflex constriction of pulmonary vessels. The intercostal nerves
are all connected directly with the sympathetic system by rami communicates,
and the sympathetic vaso-dilator and vaso-constrictor fibres of the system
are situated all along the thoracic spinal region. Luxation of ribs
and a flattened thorax (dropped ribs) set up irritation in the intercostal
nerves, leading to a constriction of the pulmonary vessels. A vast
area may be affected through the wide distribution of intercostal nerves.
Very general, or localized, anemia of lung tissues follows upon pulmonary
vascular constriction caused by this over-stimulation of the intercostal
nerves. This devitalizes the tissues of the lung, and gives a foot-hold
to the pathogenic bacteria, held by medical authorities to be the sole
cause of tuberculosis.
With regard to the microbic origin of this disease,
the Osteopath does not deny the presence of such bacteria in the lung,
nor their activity in destruction of lung tissue. He holds that there
is necessary a lesion to the lung, in the form of an impediment to proper
nerve and blood-supply to the lung tissues, weakening them to an extent
that allows the bacteria, which cannot grow in healthy tissues, to produce
their kind and to form their toxins.
It has already been pointed out that the vaso-motor
spinal area for the lungs (2nd to 7th dorsal), and particularly the region
of the 2nd, 3rd, and 4th thoracic sympathetic ganglia, is most apt to suffer
from lesion in diseases of the lungs. Rib, vertebral, intercostal
or spinal muscular lesion, etc., is more likely to cause lung disease in
this area than elsewhere. It is a well known fact that the apices
of the lungs are most generally the seat of the disease. This fact
is readily explained by the fact that upper rib and spinal lesions, most
frequent in consumption of the lungs, affects this region of the lung generally,
centering upon this important vaso-motor area. The further fact that
the apex of the lung is not usually so well developed on account of lazy
habits of breathing, makes lesion in this region more, important.
Anders states that special investigation has shown that the disease does
not begin at the tip of the apex, but about one and one-half inches below,
near the postero-external border. Posteriorly the first signs are
discovered over the lower part of the supra-spinous fossae; anteriorly,
immediately below the middle of the clavicle, along a line about one and
one-half inches from the inner ends of the second and third intercostal
spaces. The starting point may also be located at the first and second
intercostal spaces below the outer third of the clavicle. These points
of origin of this disease in the lung are thus in the close relation with
those upper ribs apparently most often luxated in this disease. In
this way the osteopathic view that such lesion causes the disease is supported
by the facts.
PROGNOSIS: Except in late and serious stages of
the disease, the chances of limiting its progress are good. Some
cases may be cured. The prognosis as to recovery, however, must be
guarded. In many cases much may be done for the benefit of the patient's
general health.
TREATMENT: The first consideration is the removal
of the specific lesion causing the trouble. This is accomplished
by methods already given. The removal of lesion has been followed
by recovery. Thorough spinal treatment should be given for the correction
and upbuilding of the vaso-motor activities. The spinal muscles and
deep tissues should be relaxed, and the ribs should be raised to allow
the greatest area of expansion possible. The vaso-motor area for
the lungs should receive especial treatment. In all these ways the
blood-supply to the lungs is upbuilt. This, next to the removal of
lesion, is the main consideration in the treatment of the case. Phagocytic
activity is said to constitute the natural power of resistance of the system
to the bascilli. By increasing blood-supply to the tissues, phagocytic
activity is increased, the tissues are strengthened, and the encroachments
of the bacteria are limited. As they cannot live and propagate in
healthy tissues, and as pure blood is a germicide, the progress of the
disease is checked as soon as pure blood and healthy tissue are opposed
to them in equal ratio. Thorough stimulation of the functions of
heart and lungs materially aids this process. The very important
nerve connections of the lungs, already pointed out in detail, afford the
Osteopath the surest means of reaching this result. His is the natural
method. Strong lungs remain immune to this disease because healthy
tissues will not harbor the microbe. Consumptives have been cured
by judicious exercise, fresh air, and careful regimen. In this way
the tissues of the lung have been built up, the circulation to it has been
increased, and the bacteria have been crowded out by the gain over them
of the natural healthy processes thus aroused. Osteopathy removes
the impediment to normal activities of the blood and nerve-forces that
make strong lung tissue. Its method does that which Nature unaided
could not do, and further aids Nature to recover from weakness caused by
the disease. No other method would seem more sure of success than
this.
The clavicles should be raised, and the pneumogastric, phrenic, and
cervical sympathetic nerves should be freed and toned for reasons already
explained. Fresh air, judicious exercise, and nutritious diet are
indispensable factors in the treatment. Antiseptic precautions in
regard to the patient's sputum, linen, etc., should be observed.
Bowels, kidneys, and skin should be stimulated to full activity.
General circulation must be increased.
The night sweats generally soon yield to the spinal
treatment. The cough may be relieved by treatment along the trachea
and anterior thorax, but it, as well as the expectoration, fever, and hemorrhages,
are relieved and checked by the favorable progress of the case. The
greatest care must be taken for the patient's general condition and nutrition.
Treatment is given in the ordinary chronic case
three times per week. In the acute form it should be given daily.
The modern method of having the patient live entirely,
or practically so, in the open air is a most valuable means of fighting
the disease.
CONGESTION OF THE LUNGS
DEFINITION: A vaso-motor disturbance of the lungs,
resulting in engorgement of the blood-vessels, and caused by lesions in
the upper dorsal, thoracic, and cervical regions.
The lesions producing this disease may be any of
the lesions interfering with the innervation, especially vaso-motor, and
with the blood-supply to the lungs. These have been described in
the discussion of the different diseases of the lungs already considered,
q. v. With these lesions present and weakening the circulatory energy
in the lungs, some direct exciting cause, such as exposure, over-exertion,
and the like, may bring on the attack. In the passive forms of congestion,
secondary to enfeebled heart action or to valvular disease, or coming on
through stasis of blood due to a long continued dorsal position of the
patient, also in the active form of pulmonary congestion, when the trouble
may be symptomatic of pneumonia, pleurisy, etc., the lesion must be investigated
with regard to the actual disease, and may be but in part responsible directly
for this condition.
The PROGNOSIS is good, numerous cases are treated
with marked success.
The TREATMENT must be directed at once to the removal
of the specific lesion if possible. The main object of the treatment
is to gain vaso-motor control. As soon as the impeded circulation
is released, and activity restored to the innervation of the vessels, further
progress of the disease is prevented. As in the first stage of pneumonia
the disease was aborted by gaining vaso-motor control of the parts, so
here the whole matter rests upon the correction of the circulation.
The accelerators of the heart, 2nd to 5th dorsal on the left, and the vaso-motors
of the lungs, 2nd to the 7th dorsal, should be stimulated at once, and
the treatment gives immediate relief from the dyspnea. Often the
patient is sitting up in the effort to get air, and the practitioner may
easily stand behind and thoroughly treat the upper dorsal region, releasing
contractured muscles, stimulating the centers mentioned, and raising the
ribs. Pressure with the knee upon the back, while the arms are both
raised high above the head, expands the chest, draws the air into the lungs,
and aids in restoring circulation. This work also aids the process
by increasing activity in intercostal vessels and nerves. The latter
should be thoroughly treated along the spine, intercostal spaces, and over
the chest anteriorly, as stimulation of the intercostal nerves has been
shown to cause reflex constriction of the pulmonary vessels.
Treatment should be given the pneumogastric nerves, and any cervical lesion
to them be removed, on account of their participation in the pulmonary
plexus. Treatment at the superior cervical region for general vaso-motor
effect, and in the abdominal region to call the blood away from the lungs,
will aid in the case. Turpentine stupes applied to the chest over
the affected areas are a great aid. In cases of hypostatic congestion
the patient's position in bed must be changed so as to drain the blood
from the parts affected, usually the postero-inferior.
Patients are usually relieved immediately upon treatment,
The dyspnea being most easily relieved. The cough and bloody
expectoration gradually subside with the betterment of the case, which
quickly yields to treatment. One or a few treatments ordinarily correct
the condition.
EDEMA OF THE LUNGS
DEFINITION: A condition in which there is transudation
of the serum of the blood from the vessels into the aveoli, bronchi, and
sometimes into the interstitial tissues of the lungs.
Cases are commonly met as complications of other diseases, as of heart,
lungs, etc.
LESIONS AND ANATOMICAL RELATIONS: As this condition
is generally secondary to lung, heart, kidney, or other disease, the lesions
would be those responsible for the primary disease.
Local lesion may be the cause of the condition. As it is pointed
out that generalized edema of the lungs may be due to any of the causes
producing active or passive congestion of the lungs, those lesions already
described as interfering with vaso-motor and motor activities of the lungs
would be sufficient to cause it. The general lesions, and their anatomical
relations, which interfere with the pulmonary innervation and circulation
have been fully discussed.
Circumscribed edema may result from localized disturbance
of the blood supply, due to the effects of a certain localized lesion.
"Obstruction to the aorta may cause it" (Anders.)
It must be borne in mind that lesion to the vagus
nerve interferes with muscular motion in the lungs and favors congestive,
and inflammatory conditions, and it may lead to edema. Lesions in
the vaso-motor area (2nd to 7th dorsal,) and the various rib, clavicular,
and other lesions affecting the lungs may cause this trouble. Eichhorst
shows that disturbances of the innervation of the pulmonary vessels may
cause it, and it is probable that the increased permeability of the vessel
walls which allows of the transudation of serum is directly due to the
lesions to the vaso-motors. Anders describes the condition as a "disturbance
of cardio-pulmonic innervation." Such disturbances are well known to be
the result of various bony lesions.
The PROGNOSIS must be guarded, especially in those
acute cases complicating other diseases, as in cardiac and renal dropsy.
In the chronic and recurring forms the prognosis is more favorable.
The prognosis must usually (depend upon that for the primary disease.
It is often symptomatic of approaching death.
TREATMENT includes that for the primary disease,
according to its kind. In any case the main object is to remove all
obstruction to free circulation throughout the lungs. To this end
the heart and the vaso-motor area for the lungs should be kept well stimulated.
Any lesion present must be removed as soon as possible.
With renewed activity of the circulation and increased
tone of the vessels the further progress of the trouble is limited, and
the absorption of the exudate is favored. Now the kidneys, bowels,
and skin should be kept active by thorough treatment. It has been
shown in dropsical cases that the kidneys may be aroused, by the treatment,
to enormous activity.
The spinal and intercostal muscles should be relaxed
and the ribs should be well raised to relieve the dyspnea. The expectoration,
due to the accumulation of fluid in the alveoli and bronchi, is relieved
by the general process of the treatment, and by the increased circulation
particularly.
A general spinal and cervical treatment, with flexion of the thighs,
abdominal stimulation, etc., should be given to keep the general circulation
active and thus to call away the congested blood from the lungs.
For the same purpose treatment should be given over the sternum and ribs
anteriorly.
In severe acute stages one must be continually on guard against an
emergency. In urgent situations it is necessary to take quick and
vigorous measures. In such situations the regular osteopathic measures
are greatly aided by the use of cafe noir, or by the application of hot
sponges or hot mustard-plasters to the chest.
PULMONARY HEMORRHAGE
I.
BRONCHO-PULMONARY HEMORRHAGE; HEMOPTYSIS.
II.
PULMONARY APOPLEXY; HEMORRHAGIC INFARCT.
CASES: (1) A young married woman, five months pregnant;
daily hemorrhage from the lungs for nearly a week. Had had similar
attacks 5 months before. They were due to congestion of the lung
tissue. Lesions were found in the form of a sensitive upper dorsal
spine, with contracture of the scapular, cervical, and intercostal muscles.
Treatment of the lesions caused rapid improvement.
(2) Hemoptysis in a case of bronchial disease; lesion as a lateral
curvature of the spine, and lesion at the 3rd dorsal vertebra. The
case was treated successfully. Cases of hemoptysis as a complication
of pulmonary tuberculosis, its commonest cause, are frequently treated
with success.
DEFINITION: Broncho-Pulmonary Hemorrhage, or Hemoptysis,
is a condition due to bleeding into the bronchus, whence the blood is coughed
up and expectorated.
Pulmonary Apoplexy, or Hemorrhagic Infarct is a
condition in which the bleeding takes place into the air-cells and lung
tissue. It may be diffuse (rare) or circumscribed. The former
is more copious. The latter is usually due to embolism, and is a
true hemorrhagic infarct.
LESIONS: There are commonly present lesions of spine,
ribs, cervical tissues, spinal tissues, etc., affecting the area of innervation
of the lung. These occur largely between the 2nd and 7th dorsal,
at the clavicle, among the upper ribs, or in the cervical region upon the
vagus nerves, weakening the lung and laying it liable to the action of
the numerous causes that may result in pulmonary hemorrhage. The
various, lesions that may affect the circulation and innervation of the
lung and the anatomical relations of such lesions to the lungs, have been
pointed out. Almost any of these various lesions may result in deranging
the vaso-motor state of the lungs either by directly affecting the vaso-motor
nerves, or indirectly, by weakening the lung function and impairing the
nutrition of the tissues and vessels.
Consumption, q. v. offers a good illustration of
the effects of lesion to the lungs resulting in a disturbed vaso-motor
condition which results in hemorrhage. Here, in the early stages,
the hemorrhage is due to a congestion of the membrane lining the small
bronchi. So any lesion weakening the vessels and leading to congestion
of the lungs may result in hemorrhage.
In cases in which the hemorrhages is secondary,
as in heart disease, pneumonia, bronchitis, ulcers, etc., the lesion must
be looked for as causing the primary disease.
The PROGNOSIS must be guarded. Hemorrhage
from the lungs is commonly a grave occurrence. In some cases it is
of but little consequence. A fair number of cases are handled successfully
by Osteopathy. The prognosis is favorable in cases due to consumption
in its first stages, pulmonary congestion, pneumonia, fibrinous bronchitis,
some forms of heart-disease, anemia, etc. It is grave in the later
stages of pulmonary tuberculosis, in rupture of an aneurism, in some forms
of heart-disease, etc.
TREATMENT:
I. IN HEMOPTYSIS: Here the first indication
is to keep the patient quiet, bodily and mentally. He should remain
in bed. In cases due to a congestive condition of the bronchial
mucous membrane, the main thing is to keep the patient quiet in this
way.
A valuable osteopathic treatment in all such cases
is inhibition of the heart. This is accomplished by continuous inhibitive
pressure from the 2nd to 5th dorsal. It meets the important requirement
of decreasing the power of the heart's contractions.
This inhibition may be carried down over the lung
area and over the splanchnics, thus decreasing the vascular tonus in the
lungs, and in the vessels of the splanchnic area. This object is
aided by deep, inhibitive abdominal work, dilating the abdominal veins,
and calling the blood away from the lungs. The general vaso-motor
center in the medulla should be inhibited, by pressure in the sub-occipital
fossae. In all these ways one quiets the circulation, slows the blood-flow,
and favors the formation of clots to stop the hemorrhage. This line
of treatment likewise meets the important requirement of confining the
blood to the systemic circulation.
One should avoid percussion, as it may increase
the hemorrhage. The fever should be treated in the usual way, but
it is not a troublesome symptom usually. All the upper spinal muscles
and tissues, as well as those of the cervical region, and the intercostal
muscles, should be carefully relaxed in order to remove any irritating
tension from the lungs. This treatment will aid in relieving the
cough, but it must be carried out very gently, in order not to move the
chest or ribs, as thereby the clots might be broken and the hemorrhage
increased.
Any lesion present may usually be left for treatment
until after the hemorrhage is fully controlled, as the handling of the
patient in repairing it would be likely to start the hemorrhage.. Later
a thorough course of treatment should be devoted to them.
The patient may eat ice and use iced drinks, but
hot drinks and alcoholics must be avoided. The diet should be light
and non-stimulating. In congestive conditions hot foot baths are
useful. Cold applications to the chest may be used. "A firm ligature
about one or both legs retards the flow of venous blood and aids in stopping
the hemorrhage." - (Stevens.) In severe cases no salt or fluids
should be allowed. It is sometimes necessary to withhold food entirely
for a time.
After the emergency due to the hemorrhage has been
safely met, and the patient has recovered sufficiently, to undergo a course
of treatment, attention should be given to the underlying condition of
the system responsible for the hemorrhage. The gout, suppressed menstruation,
heart affection, anemia, etc., must be treated as the circumstances require.
Of course many cases, in which the hemorrhage does not become severe enough
to be considered an emergency, fall at once into this category.
II. In pulmonary apoplexy one may follow the
same line of treatment largely, especially at the time of hemorrhage.
The patient must have absolute rest, etc., as described above.
In the diffuse pneumorrhagia, where the hemorrhage
is usually copious, the case is generally hopeless, and rest is the only
measure necessary. The cases are, fortunately, rare.
In the circumscribed form (pulmonary infarction)
the indications at the time of the hemorrhage are the same as above.
The syncope, dyspnea, pain in the side, cough, and convulsions will be
relieved by these measures.
Later indications are to repair lesion, build up
the strength of the lung, keep the local circulation active and absorb
the clot. This will prevent the formation of abscess or gangrene,
at the point of infarction.
EMPHYSEMA
DEFINITION: Alveolar Emphysema is a condition in
which air is retained in the aveoli, distending them, leading to atrophy
of the elastic tissue in their walls, and to destruction of the septa between
the alveoli. It may be localized, unilateral or bilateral.
It is compensatory when occurring from overwork of one lung, or a portion
of it, by disability of the rest, and may then be regarded as an hypertrophy;
it is essential when involving most of both lungs. SENILE EMPHYSEMA
is a variety, occurring in old people, in which atrophy and destruction
of the alveolar walls allows of the formation of large air-sacs by the
coalesced air-cells.
Interstitial Emphysema is a form in which air escapes
into the interalveolar and interlobular connective tissue.
The LESIONS AND ANATOMICAL RELATIONS before observed
in lung-diseases may be recalled here.
Various rib and vertebral bony lesions, contractures
of spinal muscles, etc., as well as lesions in the cervical region, interfere
with the sympathetic vaso-motor and trophic innervation of the lung, weaken
its tissues, derange its blood-supply, or interfere with its motor apparatus
in such a way as to lay it liable, (a) to diseases which result in emphysema,
or (b) to distention of tissues from weakness, due to bad trophic conditions,
upon the occasion of sudden strain put upon them by coughing or other strong
effort.
Thus, in the one class of cases the lesion would
pertain more particularly to the primary disease. The bony lesion
causing bronchial asthma by irritating the vagus nerve and causing spasmodic
contraction of the bronchioles, or that causing a vaso-motor derangement
resulting in catarrhal swelling of the mucous membrane of the bronchioles,
thus obstructing the exit of the air from the alveoli, is the underlying
cause of the emphysema.
In the other class the lesion is more directly responsible
for the condition.
These cases frequently come under our treatment,
most commonly as a complication of asthma or bronchitis.
The PROGNOSIS is favorable in that the patient's
life may be made comfortable and be prolonged. The conditions resulting
from emphysema may be modified or prevented.
The condition is incurable because it is impossible
to restore the elasticity of the lung tissue or the destroyed septa.
Great improvement in the patient's condition is
accomplished by the treatment.
In the interstitial form absorption of the air in
the tissues may take place, the case thus recovering. In cases of
acute inflation the prognosis is good.
The TREATMENT looks at once to the removal of the
lesions present, and to the relief of the primary disease, whatever it
is. The vaso-motor area (2nd to 7th dorsal) should be kept well stimulated
to increase the circulation. This is especially necessary because
of the compression or destruction of the capillary networks about the alveoli
in the affected portions. It also aids in restoring strength to the
tissues, and in correcting the catarrhal condition of the bronchi so likely
to result from this disease. Stimulation of the vagi is important
for the purpose of increasing the motor power in the lungs. The ribs
should all be raised to give the lungs free-play, and likewise the spinal
and intercostal muscles should be relaxed, the clavicles raised, and the
sternum and cartilages be well treated.
It is important to keep the heart well stimulated
to guard against venous stasis and its results, which are the most to be
feared. Eichhorst mentions rhythmic compression of the thorax in
these cases. Treatment to raise the ribs in inspiration and to compress
them in expiration may be used with profit.
In these ways danger of death from stasis or suffocation
is minimized. The patient's general health should be built up.
In these cases hypertrophy of the right heart usually results. The
patient must avoid dust, bad air, and exertion. In emergencies mustard
plasters to the chest and hot foot-baths are good. The patient must
be continually guarded against heart failure, which is likely to result
from acute dilatation of the right ventricle.
ACUTE NASAL
CATARRH, OR CORYZA, AND COLDS
CHRONIC NASAL CATARRH
RHINITIS, ACUTE AND CHRONIC
DEFINITION: Acute Nasal Catarrh is an inflammation
of the nasal mucous membranes, accompanied by an increased secretion of
mucous and by various general symptoms, and is caused by specific lesions,
in the cervical region chiefly, which may be secondary to contractures
of muscles and soft tissues by exposure. After repeated attacks the
disease becomes chronic, upon account of the confirmed condition of the
lesions.
A "cold in the head" is an acute attack of this
disease. Yet "colds" may settle in any part of the body, as a rule,
in "the weakest part," and then probably assume the form of congestion
instead of inflammation as in the case of coryza. Its manifestations
are various, one of the chief ones being the disturbed vaso-motor reflex
of the body. These weak places liable to such congestion are commonly
due to lesion of the part, which acts to deteriorate its vitality and lessen
its resistance power.
CASES: (1) A very severe and distressing cold, to
sudden attacks of which the patient was subject. They came on suddenly,
lasted nearly a week, and then gradually disappeared. Marked coryza,
lachrymation, and sneezing continually, were features of the case.
It stimulated hay-fever very closely. Upon treatment the sneezing
stopped almost immediately. Treatment was to the vaso-motor
control of general circulation, to the pulmonary circulation, to relaxation
of contractured muscles of cervical and upper dorsal regions, and to the
circulation to the head.
(2) Sneezing and coryza, with all the common
symptoms of "catching cold" were relieved at once by a treatment.
Marked lesion was present at the 2nd cervical vertebra.
(3) Intense nasal catarrh in a debilitated system
suffering from a complication of diseases yielded at once to the treatment.
After six week's treatment a cold contracted from exposure was well withstood.
(4) A case of nasal catarrh in a debilitated system
showing various spinal lesions was greatly relieved by three treatments,
and was progressing satisfactorily under treatment.
Very numerous cases, many of them in an aggravated
condition come constantly under treatment. The author has treated
several individuals who were subject to very severe colds, in whom one
treatment invariably broke up the most severe attack.
One case of chronic catarrh would, soon after a
treatment, begin to spit out catarrhal concretions which had formed in
the Eustachian tubes.
CAUSES: The specific lesions causing such disease
are, as a rule, high up in the cervical region, effecting especially the
1st to 3rd cervical vertebrae, but they may occur as low as the sixth dorsal.
One of the chief forms of lesion is that of contracture of the cervical
muscles and deep, soft tissues. These contractures, due primarily
to exposure, gradually act to warp, or draw, the cervical vertebrae and
intervertebral discs out of shape and out of their normal anatomical relations.
The result is obstruction to blood and nerve-supply, causing chronic catarrh.
The deeper anatomical lesions due to contracture and to other causes as
well, produce catarrh, and not some other disease, because of affecting
certain areas of nerve connections and certain centers. Thus lesions
of the upper three cervical vertebrae act upon the superior cervical ganglion,
in ways already discussed, and distort the fifth nerve through its very
intimate connections with the ganglion in question. In the same way,
lesion to the inferior cervical upper dorsal bony parts may affect those
sympathetic fibers (or the area of the cord giving origin to them) which
ascend in the cervical sympathetic chain, finally to reach the fifth nerve,
which thus supplies secretary fibers to the parts in question. The
very numerous vaso-motor, secretory and trophic fibers for all parts of
the head and face; for salivary glands, eye, car, tongue, face, mouth,
etc., etc., passing to particular points of distribution through various
of the cranial nerves, quite generally arise in the upper dorsal and cervical
cord, having also numerous connections with the cervical sympathetics.
This matter has been fully discussed in another place. (*See "Principles
of Osteopathy" Lectures XVI-XVIII. [Publisher's Note: Not included in this
database.]) This explains the importance of cervical and upper dorsal
lesions. Thus lesions low down act upon the amending fibers of nerve-supply
and affect a part much above, as in the case of dorsal lesion here.
The fifth nerve bears special mention in these cases
as the one concerned in the headache, lachrymation, sneezing, secretion
of mucous, and inflammation of membranes. This nerve is also, in
part concerned in the loss or alteration of the functions of taste and
smell, caused by pressure of the injected membranes upon the fine nerve
terminals.
The PROGNOSIS is good for all forms of the disease.
In acute cases it is particularly so, as one or a few treatments usually
end the symptoms. In chronic catarrh good results are generally easily
attained , and many times a cure is effected. In favorable climates
do much to prevent cure as the patient is constantly exposed, hence the
best results are attained in the favorable seasons of the year.
The EXAMINATION AND TREATMENT for the specific lesion
is made according to directions in Chaps. I to VII. The specific
lesion should be treated, and removed at once if possible. This applies
to both acute and chronic cases. In acute cases one of the first
steps is to relax all the upper dorsal and cervical tissues. A thorough
spinal treatment tones all the vaso-constrictors (2nd dorsal to 2nd lumbar),
and all the vaso-dilators (all along the spine), thus aiding to equalize
circulation, and reduce congestion of parts concerned.
This effect is aided in an important way by raising
all the ribs, and particularly by treating all the 2nd to 7th dorsal region
on both sides, in this way increasing the activities of heart and lungs.
The anterior thoracic region is treated to relax tissues and replace ribs;
the clavicle is raised, and separated from the first rib to relax the deep
anterior cervical tissues, to free circulation through the carotid arteries
and jugular veins, and to free the pneumogastric nerves. All the
cervical muscles are thoroughly relaxed, the ligaments released by deep
treatments, and the vertebrae of the whole region manipulated. This
frees the connections of the sympathetics, the venous flow from the head,
and tones vaso-motion in the affected parts. It is an important step
in remedying the congestion of the parts of the head. Inhibitive
treatment should be given the superior cervical ganglion to dilate blood-vessels
and allow the congestion to be swept out. The superior and inferior
hyoid muscles are relaxed, and the work is carried down along the trachea
to the root of the neck. The mouth is opened against resistance;
the tissues beneath the angles of the jaws are relaxed. This releases
the internal jugular veins, stimulates circulation through the carotid
arteries, and corrects circulation. One of the most efficient measures
for curing the congestion of the head, and to relieve the stoppage of the
nostrils is the momentary pressure upon both internal jugular veins, before
described, followed by heavy pressure with the palms of the hands upon
the forehead.
Particular attention is devoted to the treatment
of the fifth nerve for reasons already given. It is reached at points
upon the face already described, and all the tissues over them are relaxed.
Treatment of this nerve thus directly is a most important adjunct to that
given its sympathetic connections. It is most important as a means
of relieving the inflammation, secretion, lachrymation, and stopping of
the nostrils. Manipulation along the sides of the nose frees the
nasal ducts and relieves the congestion; strong pressure upon the root
of the nose and upon the forehead frees the nostrils; tipping over the
frontal sinus relieves congestion and pain in it. The headache is
relieved by the treatment in the general cervical, superior cervical, and
frontal regions; the cough is relieved by the treatment along the trachea;
the chilly feeling by the brisk spinal treatment. The soft palate
may be treated by placing the finger gently upon it and sweeping it laterally
across. This treatment may be carried well up toward the opening
of the Eustachian tube. The congestion of these parts is thus relieved.
The lungs must be kept well treated to prevent the
cold from settling upon them. Precautions must be taken against the
marked tendency of these congestions to move from part to part. This
is done by keeping all well stimulated by the treatment. The bowels
and kidneys are treated to keep their action free. The treatment
about the lower jaw and to the carotid arteries is efficient in reaching
the Eustachian tube, and in loosening the secretions that sometimes occlude
it. Deep treatment under the angles of the jaws is good in ill forms
of catarrh.
In chronic cases the treatment is devoted more particularly
to the removal of the specific lesion, and the building up of the blood-supply
to the nasal membranes. As these are often atrophied or hypertrophied.
(Atrophic or Hypertrophic Rhinitis, Ozena.) A long course of
treatment is generally necessary to their rehabilitation. The principal
treatment is directed to the cervical tissues, where chronic contracture
of the muscles exists.
Daily treatments in severe acute cases, and three
per week in chronic cases, are usually sufficient.
The patient should take care not to expose himself, but, on the other
hand, should not keep the body tender and susceptible by dressing too warmly,
sleeping under too many covers, or living in overheated quarters.
One may contract a cold by going suddenly from an extremely hot to a very
cold atmosphere, or vice versa. In all of these conditions it is
important that the patient should not go out too soon after the treatment,
as the system is relaxed and more cold may be contracted
EPISTAXIS
DEFINITION: Epistaxis is the term used to designate
hemorrhage from the nose. It is found in serious form in some people.
It may be caused by accident, as in fracture of the skull, or by local
irritation, such as picking at the nose. It is often an incident
in some other disease, as in typhoid or influenza, or in anemia, hemophilia,
plethora, etc. In all cases a careful search should be made for its
causes. For example, it may be due simply to rarefaction of air,
or to affections of the nasal mucosa, such as ulcers, polypi, hyperemia,
or to contracted kidneys or valvular heart lesions. Or it may be
brought on by over exertion, by vigorous blowing of the nose, or by overeating.
When the cause is found the case must be treated
accordingly. Specific lesions present often act as determining factors,
and their removal is an important measure in preventing recurrence of such
hemorrhages. Cervical lesion, involving the atlas and the muscles,
has been noted. Other forms of cervical lesion, affecting the superior
cervical ganglion or the cervical sympathetic may aid in causing it.
CASES: (1) A lady of 53 years of age, suffering
for three years with epistaxis, the hemorrhage coming generally after fatigue.
It was often profuse. Lesion existed as contractures of the muscles
of the right side of the neck, leading down to a tender area upon the point
of the right shoulder. The lady had been injured here just before
the trouble came on her. The condition was cured in ten treatments.
TREATMENT: Holding of the facial artery where it
crosses the inferior maxillary bone, and the nasal artery at the inner
canthus of the eye, also pressure applied to the carotid arteries slow
the blood-current and favor the formation of a clot. In some cases,
friction over the superior cervical region has been enough to arouse sufficient
vaso-constriction to stop the flow. The case may be helped by raising
the arms high above the head. It is frequently difficult to stop
the hemorrhage at the time, but the treatment applied to the correction
of the lesion and to the freedom of circulation through the neck will stop
the recurrence of the hemorrhages. In severe cases it may be necessary
to resort to plugging of the posterior nares. The application of
ice or cold water to the superior cervical region, and the use of hot or
cold injections into the nostrils are efficient domestic remedies for the
condition. The patient should rest quietly, and avoid blowing and
wiping of the nose. Holding the nostrils shut may facilitate the
formation of the clot. Injections of cold ,water and vinegar into
the nostrils are useful. A tampon of absorbent cotton in the nostril
may be sufficient.
PLEURISY
DEFINITION: An acute or chronic inflammation of a
part or the whole of one or both pleurae, attended by cough and pain in
the side, and caused by lesions affecting ribs, thoracic vertebrae, intercostal
and spinal muscles, nerves, etc.
CASES: (1) A case of pleurisy due to a displacement
of the 8th rib.
(2) In a dentist, a case of pleurisy was developed
by the irritation by the eighth and ninth left ribs, which were luxated
by continued bending over at his work. Correction of the lesion
cured the case.
(3) A case presented lesions in the form of the,
upper four ribs drawn together and (4) another ease showed merely vertebral;
lesions.
CAUSES: The important lesions in these cases affect
the ribs; cases are rare in which lesions of this kind are not present.
Other lesions are consequent or subsidiary to rib lesions. They may
affect the ribs of either side, as low as the 10th on the left and the
9th on the right, marking the lower limits of the pleurae. Secondary
lesions in the cervical region, affecting the pneumogastric, phrenic, sympathetic
nerves, concerned in the innervation of the pleurae, may occur. Lesions
of the clavicle and first rib, impeding circulation through the sub-clavicle
and internal mammary arteries, are important. The cervical lesions
mentioned, with lesions of the spinal muscles and dorsal vertebrae, affect
the innervation, composed of branches from the pneumogastric, phrenics,
sympathetics, and pulmonary plexuses. Important derangements of circulation
are thus caused by lesion to vaso-motors, aiding the process of inflammation,
which is the active morbid process in the case. The drawing of spinal
muscles, luxations of vertebrae, and the interference with spinal nerves
also aid the causation of rib lesions. The latter sort is by far
the most efficient in causing pleurisy because of its relation to the intercostal
vessels and nerves. These nerves and vessels all together total a
vast area of blood and nerve supply to the pleurae, especially to the parietal
portions. The nerves carry vasomotor and secretory fibres to the
parts supplied by them, hence to the pleura. Hilton points out that
the nerves innervating the linings of the body cavities supply also the
skin and muscles of the walls of these cavities. This is well instanced
in the case of the parietal pleurae, which are supplied by the intercostal
nerves, they also supplying the intercostal and abdominal muscles and the
overlying skin. Such being the case, lesion by displacement of ribs,
irritating intercostal nerves, disturbs the vaso-motor and secretary processes
in the pleura supplied by the same nerves. Hilton has also pointed
out that a joint, the muscles moving the joint, and the skin overlying
these muscles, are all supplied by branches of the same nerves. Hence
vertebral lesion and lesions affecting the relations of the heads of the
ribs may affect the nerves through their articular branches. In this
way spinal lesion might be the origin of such disease. But further,
since each intercostal nerve is connected by the rami communicantes with
the sympathetic system, lesion of these nerves affects the sympathetics.
These sympathetics in the dorsal region contain both vaso-dilator and vaso-constrictor
fibres; they enter into the formation of the pulmonary plexus, which in
part innervates the pleura. Hence intercostal lesion affects vaso-motor
control of the parietal pleura directly, and of the visceral pleura indirectly.
In another way does intercostal lesion act to set up the inflammatory process
of pleurisy. Lesions of the clavicle, deranging circulation through
the sub-clavian and internal mammary vessels, and of the other ribs, directly
obstructing the intercostal vessels, and indirectly deranging the circulation,
through related vessels to the visceral pleura!, (bronchial, mediastinal,
and diaphragmatic vessels) disturb the entire circulation to these parts.
In these ways may all the various lesions described
work together to produce inflammation. The affected area is larger or smaller
according to the nature and extent of the lesions. Lesion of a single
rib has frequently been found responsible for an acute attack of pleurisy,
either circumscribed and limited in extent, or spreading to involve considerable
areas. The same sort of lesion may produce all the various kinds
of pleurisy described in medical texts.
According to osteopathic theory, the bacteria present
in this disease and ascribed by some writers as its cause, could not live
and propogate their poisons in healthy tissues. The presence of the
lesions described may weaken the tissues and allow the microbes to gain
a foothold. It is significant that exposure to cold and wet, and
mechanical injuries cause the disease, as the osteopath looks for such
causes to produce the displacements and other legions to which he traces
the disease.
The PROGNOSIS is good. Cases generally recover
without difficulty. Often all the pain and other manifestations disappear
at once upon removal of lesion; the setting of a rib.
THE EXAMINATION AND TREATMENT: This lesion should
be removed as soon as possible, and at once if the condition of the patient
will allow. Treatment should be directed to the relaxation of spinal,
intercostal, and cervical tissues , and to the raising of the ribs, for
the purpose of removing obstruction from and toning the circulation and
innervation of the pleura. The raising of the ribs and clavicle,
including the repair of the particular luxation of ribs that is causing
the trouble, are the most important steps. If the case is seen before
the inflammation and exudation has progressed far, the process may be more
easily stopped, as the necessary point is to gain control of circulation,
which may be readily accomplished through nerves and vessels as already
explained. In the stage of exudation, where quantities of the exudate
occur in the pleural cavities, attention must be given to releasing the
tension in parts due to contractures of muscles, etc., to raising the ribs
to allow more free-play of the lungs; and to the relief of the pain in
the side, and the distressing cough, by carefully raising the ribs and
manipulating the tissues at the seat of the pain. But the main point
at this stage is, by the treatment to the circulation, to hasten the resorption
of inflammatory products. This may be done to a considerable extent.
Great care must be taken in handling the patient on account of the great
pain. By stimulating the process of absorption, and by keeping the
parts free from tension in the tissues, also by keeping up, carefully,
free motion of the ribs and parts, the adhesions of the pleurae, and the
retraction of parts likely to occur as a result of the inflammation, may
be avoided. This is during the convalescence of the patient, while
his condition must be carefully watched. The point may be reached
in some cases where tapping might be necessary, but if the ease is seen
in time the process may be so controlled as to obviate this difficulty.
In cases of adhesions between the pleurae if painful, they should be gradually
broken up. This is done in a course of treatment, carefully giving
the parts concerned the extremes of motion of which they are capable.
The process is aided by developing the circulation to, in part, absorb
the adhesive tissues. This must frequently be done in the chronic
case. The treatment of such cases consists mainly in correction of
lesion, and in maintaining free circulation for the absorption of pus,
if present.
In treatment of pleurisy, stimulation of heart and
lungs, of bowels, kidneys and superficial fascia, for the removal of poisonous
waste; and attention to the general health of the patient, are necessary.
Acute cases should be kept upon a light, easily digested diet. Exposure
must be prevented. One thorough treatment daily, with more treatment
at times during the day for the relief of pain, etc., will usually be sufficient.
Chronic cases should be treated three times per week.
PNEUMOTHORAX
(Hydropneumothorax, Pyopneumothorax)
HYDROTHORAX
(Dropsy of the Pleura) and HEMOTHORAX
In all of these conditions the situation which confronts
the Osteopath is much the same. No particular LESION can be mentioned
for the causation of these diseases directly. They are all usually
secondary to other diseased conditions, and the lesion of the primary disease
is the one responsible for the trouble. Pneumothorax and hemothorax
may occur from violence, no ordinary lesion, of course, having anything
to do with such a result. The lesion is otherwise the one producing
the disease of heart, lungs; kidneys, or of the general system, to which
these conditions are secondary, and must be sought and treated accordingly.
Naturally such lesions may have much to do with weakening the lung tissues,
vessels, and other structures, preliminarily to one of these diseases.
The PROGNOSIS in these conditions is, generally
speaking, fair. Much may be done for the relief of the patient.
The prognosis for cure depends upon that for the original disease.
In the TREATMENT the practitioner has in view three
main objects: (1) to relieve the painful, or troublesome symptoms, (2)
To treat the original; disease, or remove the active cause, (3) To
absorb the gas or fluid from the pleural cavity.
In cases of pneumo-thorax the treatment is in most
respects like that for pleurisy. Spinal inhibition, relaxation of
spinal and intercostal tissues, and careful elevation of the ribs quiets
the pain, gives more freedom to the lungs, and relieves the dyspnea.
A general spinal treatment should be given to equalize the systemic circulation.
For the absorption of the gas and fluid one should proceed as in pleurisy,
q. v. If much pus be present it should be drained.
In hydrothorax the treatment would be practically
the same. As these cases are usually due to chronic heart, lung,,
or kidney diseases, particular attention must be given to the treatment
of the diseased part. Any obstruction to free circulation must be
removed. In anemic and cachetic states attention must be given to
the general system to build up the health. As there is no inflammatory
process, the absorption of the transudate is accomplished as in that of
the pleuritic, effusion after the inflammation has been controlled.
The heart and lungs must be kept well stimulated to increase the vigor
of the heart, render the general circulation active, and thus decrease
the pressure in the venous system. If the accumulation of fluid threatens
suffocation, paracentesis must be performed.
In hemothorax the primary step is to insure absolute rest of the patient
and to control the hemorrhage. This may be done much as in pulmonary
hemorrhage, q. v. All stimulation must be avoided.
After the clot is formed absorption will proceed naturally. Later
one may give such treatment as will insure complete absorption, and restore
entire freedom to the activity of the lungs. (See Pleurisy.)
LARYNGITIS
DEFINITION: An acute inflammation of the mucous membrane
lining the larynx. In acute and chronic catarrhal forms the inflammation
is a catarrhal condition. In the spasmodic form (laryngismus stridulus),
the condition is a nervous one. (See Croup.) In the edematous form the inflammation
is accompanied by exudation arid infiltration of the tissues. This form
is also known as Edema of the Larynx.
CASES: (1) A case of chronic laryngitis due to lesions as
follows: left cervical muscles sore; 1st cervical vertebra up; 2nd, down; 5th
cervical vertebra posterior. The right eye was weak and the tear-duct
was closed. Aphonia would occur frequently for several weeks.
(2) An acute attack of laryngitis in a singer was overcome
by a single treatment upon several occasions, enabling him to sing in public.
(3) A case in which a few minutes treatment of the hyoids,
etc., enabled a singer to readily run the scale to a high note, previously beyond
her reach.
(4) A case in which chronic laryngeal disease had destroyed
a finely cultivated voice, in which, after the failure of treatment by specialists,
an Osteopath found weakness of the epiglottis. Treatment strengthened it, restored
it to free action, and recovered the voice.
(5) A case of aphonia frequently fully relieved by a few
minutes treatment.
(6) A case of aphonia, due to spinal injury, cured in two
months.
CAUSES: Lesions to the innervation and blood-supply of the
larynx are present. The chief ones are to the pneumogastrics and cervical
sympathetics, and occur at the atlas, axis and third cervical vertebra, where
they affect the superior cervical ganglion, and through it the nerves in question.
Cervical lesion may also affect the other cervical sympathetics concerned in
the innervation of the larynx. These lesions affect circulation of the
larynx through the innervation. Direct lesion to the blood-vessels may
occur at the clavicle and first rib, at the deep anterior cervical tissues,
and in the muscles along the neck anteriorly, and about the throat. They
may obstruct the circulation in the carotid arteries and thyroid axis, or may
impede the venous return through the small veins and the innominates and internal
jugulars. Local weakness of the glottis, or the laryngeal muscles, may
occur primarily or secondarily to other lesion. The edematous form is
especially likely to be caused by obstruction to the internal jugular veins.
Traumatism may be the sole cause, and irritation, etc., may act secondarily
to cervical lesion to cause the disease.
The PROGNOSIS is good. Immediate relief is obtained
from the treatment, and recovery soon follows.
In dangerous cases of edematous laryngitis great care must
be taken. Tracheotomy may become necessary in some cases, but ordinarily
this can be avoided by the treatment if the case can be seen in time.
The TREATMENT must be directed as far as possible to the
immediate removal of the specific lesion. This releases circulation and
nerve-supply as shown above. The tissues of the neck, particularly the
throat must be thoroughly relaxed; the clavicle is raised, and the deep anterior
muscles and tissues of the root of the neck are treated. These treatments
free the circulation in the vessels as shown above. The circulation in
the carotids is further aided by opening the mouth against resistance.
The vagus is treated along the course of the sterno-mastoid muscle, and at the
superior cervical region. Its superior laryngeal branch is treated behind
the superior cornua of the thyroid cartilage. Its recurrent laryngeal
branch is reached at the inner side of the lower portion of the sterno-mastoid
muscle at about the level of the cricoid cartilage.
Deep treatment is made along the course of the larynx and
trachea, from the hyoid bone and muscles to the root of the neck. Care
must be taken to apply the fingers of the operating hand, close
along the sides of the trachea. This is excellent treatment for the huskiness
and the spasm. The latter, however, is apt to depend upon some special
lesion. In spasmodic laryngitis the epiglottis is sometimes caught in
the rima, and must be released by introducing the index finger into the throat.
Treatment of the phrenics and the diaphragm aid in lessening the spasm by quieting
the action of the diaphragm. A warm bath is recommended to break up the
spasm. In a child with an overloaded stomach, to cause vomiting affords
relief.
The vagi and cervical sympathetics are treated at the superior
cervical region and along the posterior region.
In acute cases inhalations of steam are helpful. If
there be much swelling and pain, the patient may be relieved by sucking ice.
In case of stenosis, apply a mustard plaster or cold compress to the front of
the neck.
Chronic cases must avoid exposure, and irritation of the
throat, as from overuse, also smoking and alcohol.
Cases of aphonia, due to the changes in the vocal cords,
or to weakness of the epiglottis, may be cured by this treatment.
In edema of the larynx due to a dropsy from kidney, heart,
or lung disease, attention must be given to the general dropsical condition
and its cause. In dangerous cases of edema an operation becomes necessary
to prevent suffocation. Short of this, hot foot-baths, hot drinks, milk,
or seltzer-water give relief.
