The Practice and Applied
Therapeutics of Osteopathy
Charles Hazzard, D. O.
1905
CHAPTER XII
DISEASES OF THE DIGESTIVE TRACT
STOMATITIS AND GLOSSITIS
DEFINITION: Stomatitis is an inflammation of the
mucous membrane lining of the mouth. It may be catarrhal (simple
or acute stomatitis); ulcerative (putrid sore mouth); aphthous (aphthae,
vesicular stomatitis); parasitic (thrush, muguet); mercurial (ptyalism);
or gangrenous (noma, cancrum oris).
To the Osteopath these various forms present, in
each case, practically the same aspects, so far as lesion and method of
procedure are concerned.
Glossitis is an acute or chronic parenchyinatous
inflammation of the tongue.
Stomatitis and glossitis may be discussed together.
The latter condition commonly complicates the former; both are forms of
a vaso-motor disturbance referable to practically the same nerve and blood
mechanism; both present the same bony lesions and are treated in the same
manner.
CASES: (1) Glossitis; the tongue raw and fissured
for weeks; irritation was extending to the stomach. Lesion was present
as a contracture of the suprahyoid muscles, drawing the hyoid bone back
against the pneumogastric nerve, and obstructing the blood drainage via
the throat. After the tissues were relaxed and the bone restored
to its normal position the patient recovered.
(2) Glossitis, in a patient with a diseased gastrointestinal
tract, due to poisoning of the system by a patent medicine. Quickly
relieved by treatment to throat, neck, and emunctories.
(3) Case of glossitis, and stomatitis (ulcerative),
due to body neck lesions.
(4) Stomatitis associated with pharyngitis; medicines
were used to no purpose. The patient was unable to eat for 16 days.
After two days osteopathic treatment he could eat, and the condition was
cured in one week.
LESIONS AND ANATOMICAL RELATIONS
In these cases there is generally lesion to the bony
or other tissues in the cervical region (sometimes also in the upper dorsal)
which deranges vaso-motor control of the tissues of the mouth and tongue,
obstructs venous return, weakens the tissues, and lays them liable to the
effects of some particular irritant, local or in the system, but there
is, generally, lesion affecting the gastrointestinal tract which is the
real underlying cause of the trouble. Naturally there are many cases
due to the irritation of a poisonous drug, of a decayed tooth, etc., which
suffer from no specific lesion. Yet the ordinary case shows cervical
or upper dorsal lesion of some kind. Lesions to the atlas, axis,
lower cervical, or upper dorsal vertebrae; sometimes of the upper few ribs;
of the clavicle; of the cervical muscles, especially those of the throat;
of the hyoid bone; of the lower jaw, may be present.
These lesions derange the nerve and blood supply
of the mouth and tongue. Contractured throat muscles may shut down
upon the arterial and venous circulation (carotid, jugular), mechanically
deranging it. Lesion of the clavicle, first rib, and deep anterior
cervical tissues may cause the, game results. Contractured muscles
in the cervical region, displaced vertebrae and ribs, may all disturb the
spinal and sympathetic nerve connections having control of these tissues.
Inferior maxillary lesion may disturb the 5th nerve by impinging its articular
branches.
The vaso-motor supply of tongue and lining membranes
of the mouth are mainly from the fifth cranial nerve. According to
the American Textbook of Physiology, the vaso-dilator fibers for the face
and mouth are found in the cervical sympathetics; they emerge from the
spinal cord by way of the 2nd to 5th spinal nerves, and connect with the
fifth cranial nerve by passing from the superior cervical ganglion to the
Gasserian ganglion. Other dilator fibers for the mucous membrane of the
mouth seem to arise in the fifth nerve itself.
The same authority shows that the cervical s and
sympathetic contains vaso-constrictor fibers for the tongue. The
hypo-glossal nerve also contains vaso-constrictor fibers for the tongue.
The lingual (a branch of the fifth) and the glosso-pharyngeal nerves contain
vaso-dilators for the tongue.
In view of these facts it becomes at once apparent
that atlas and axis, lower cervical and upper dorsal vertebral lesion,
as well as upper rib lesion could affect these sympathetic connections
of the fifth nerve, along this portion of the spine, and lead to a derangement
of the vaso-motor state of the tissues of tongue and mouth. (See
also the anatomical discussion under Catarrh.) Upper cervical lesion
could likewise affect the glosso-pharyngeal and hypo-glossal nerves, since
both are connected with the superior cervical ganglion. The glosso-pharyngeal
is also connected with the fifth, and could suffer with it from lesion.
The hypo-glossal is connected with both the fifth and the facial nerves.
In these diseases, secondary lesions resulting in
constitutional conditions favoring them will be found.
The PROGNOSIS in stomatitis and glossitis is good.
The case usually quickly recovers under the treatment. One or a few
treatments give relief, and a short course of treatment is usually all
that the case requires. In gangrenous stomatitis, however, the prognosis
must be guarded. It is usually a surgical case.
The TREATMENT must be directed particularly to the
removal of the lesion. Frequently the removal of this irritation
results at once in a rapid recovery. Thorough cervical treatment
must be carefully given. Following corrective work upon the lesion,
and the cervical tissues must be entirely relaxed. Especially all
the tissues about the throat and angle of the jaws should be relaxed, but
the treatment in these places must be gentle to avoid irritation.
The deep anterior cervical tissues low down should be thoroughly relaxed,
and the clavicles should be raised to aid in free venous drainage from
the affected parts. The lower jaw should be carefully opened against
resistance. One should see that the adjustment of the temporo-maxillary
articulations is correct.
In all forms of stomatitis, proper attention must
be given to cleanliness of the mouth. It should be kept well washed
out. A mild alkaline wash is recommended. Proper attention
must be given to the general health. Bowels and stomach should be
kept active and in good condition. In aphthous stomatitis, especial
care must be taken to correct disturbed digestion, and the mouth should
be washed before food is given. In parasitic stomatitis the child's
tongue should be wiped off with a soft cloth. It is recommended to soak
the cloth in boric acid solution.
Gangrenous stomatitis usually becomes a surgical
case unless successfully handled early.
In catarrhal stomatitis and in acute glossitis ice may be applied to
the tongue and to the angles of the jaws. Antiseptic mouth washes
are good in glossitis. In chronic glossitis the food should be plain.
All stimulating or irritating articles, such as alcohol and tobacco should
be avoided. 'The teeth should be kept in good repair, and bowels
and stomach must be kept active.
In mercurial stomatitis stop all mercury and use
a mouthwash of listerine.
DISEASES OF THE SALIVARY GLANDS
HYPERSECRETION, XEROSTOMA
In Hypersecretion (Ptyalism) and Xerostoma (Dry Mouth)
one must expect much the same style of lesion as in glossitis and stomatitis,
as the fifth nerve and the cervical sympathetics are again the ones' chiefly
involved in the disease.
Quain's anatomy states that secretory fibres for
the submaxillary glands arise mainly from the second and third dorsal spinal
nerves. They ascend through the cervical sympathetic. The fifth
nerve according to Dana, is the nerve presiding over salivation.
The American TextBook of Physiology points out that vaso-constrictor fibres
for the salivary glands are contained in the cervical sympathetics.
The chorda-tympami branch of the facial nerve is the vaso-dilator of the
submaxillary, gland. The glosso-pharyngeal nerve furnishes secretory
and vaso-dilator fibres to the parotid gland. The glosso-pharyngeal
and facial nerves are closely connected with the fifth, and may suffer
with it
from lesion.
From the foregoing facts it is easily seen that
lesions in the upper dorsal and cervical regions, etc., as pointed out
for stomatitis, may, any of them, under the proper conditions, derange
the vaso-motor and secretory conditions of these glands and lead to hypersecretion
or dryness.
Hypersecretion is sometimes of reflex origin from
diseases of the teeth and mouth, digestive organs, sexual organs, etc.
In such cases it is still probable that the lesion has an affect in determining
the disease to these glands. No lesion may be present when ptyalism is
due to the use of a drug, such as mercury, gold, copper , etc. Xerostoma
is thought to be due to an affection of the nerve supply of all the glands
of the mouth.
PROGNOSIS: Ordinarily good success is had in correcting
these conditions. The prognosis must depend upon that for the disease
to which these are commonly secondary.
The TREATMENT must be directed to the removal of
the lesion, as well as of the disease upon which the condition may depend.
A thorough neck and upper dorsal treatment should be carried out upon the
lines laid down for the treatment of stomatitis. Removal of lesion
and treatment of nerve and blood supply does much to correct the secretions.
Local work over the region of the glands externally,
relaxing the tissues and stimulating the gland directly is much used in
dryness of the mouth in fevers. It is quite successful.
Care for the general health is an important measure
in the treatment of these conditions. It is fully as important
as is the specific treatment. The secretions of the body cannot be
restored to normal unless the general health be repaired, inasmuch as most
of these conditions depend, fundamentally upon systemic conditions.
The frequent use of small amounts of water, or of a little oil in the mouth,
is a measure of relief.
INFLAMMATION OF THE
SALIVARY GLANDS
For Specific Parotitis see "Parotitis." Parotid
Bubo and Chronic Parotitis would be regarded, osteopathically, from much
the same standpoint as parotitis, as far as specific lesion and mode of
treatment are concerned.
As parotid bubo is not a primary affection, particular
attention must be given to the condition which it complicates. .As most
of the cases are septic a special effort must be made to free the system
of poison by active work upon bowels, kidneys and skin. Thorough
treatment must be given to the gland to guard against suppuration.
TONSILLITIS
DEFINITION: Tonsillitis is an inflammation of the
tonsils accompanied by enlargement of the gland, fever and various constitutional
symptoms. It is caused by lesions m the cervical region.
CASES: (1) A case showing a right curvature of the
spine; 2nd and 4th cervical vertebrae were, sore; the cervical muscles
upon each side were contractured; the 3rd to 6th dorsal vertebrae posterior.
Vertigo was also present,
(2) A case showing a straight spine, with many vertebral
luxations, and emaciation of the upper dorsal muscles.
(3) An acute case cured by two treatments thirty
minutes apart.
(4) A case in which the tonsils were ulcerated.
After four treatments the swelling and inflammation were reduced, and the
ulcers healed in a few days.
(5) A case sick for five days, the usual medical
treatment affording no relief. The fever was high. After one
treatment the size of the tonsils was reduced and the patient slept for
the first time in two days. Upon the third day of treatment the patient
was out.
(6) A case in a boy three years old, in which, after
unsuccessful medical treatment for two months, removal of the tonsils was
advised. They were so enlarged as to almost close the throat.
They were soon restored to normal size by treatment directed to the upper
cervical region, and to the glands, externally and internally.
(7) A ease of acute tonsillitis in a boy of four
years, whose tonsils were chronically enlarged. The attacks were
frequent and severe, lasting four or five days, and confining the child
to his bed. During an attack, one treatment reduced the fever, and
four more treatments overcame all inflammation, The lesions were; contracture
of upper cervical ligaments and muscles, and slight luxation of the atlas
to the right. The lesions were corrected in less than two months,
the chronic enlargement was overcome, and in the nine subsequent months
but one slight acute attack occurred.
CAUSES: The lesion in the case may affect the general
cervical region, but usually occurs high up, affecting the atlas, axis,
or third vertebra. The lower vertebrae are often found luxated, and
contracture of the posterior and lateral cervical tissues often acts as
the primary lesion. Contracture of the upper hyoid muscles is always
present, frequently as secondary lesion. Luxation of the clavicle
and first rib, and tension in the deep anterior cervical tissues about
them are sometimes found. Systemic conditions
are often very prone to induce attacks. Often these begin as biliousness
and constipation, or as a nervous upset, or as a feature of a cold.
It is probable that many of the more particular lesions found are secondary.
Attention must be given to the system, and the general causes must be sought
in its condition.
Lesions of the atlas, axis, and third vertebra probably
act by affecting the fifth nerve through its connections with the superior
cervical ganglion. Lesions of the throat, of the deep anterior cervical
tissues, and of the first rib and clavicle, have an important effect by
obstructing the circulation through the carotid arteries and the internal
jugular vein.
In persons subject to tonsillitis through the presence
of these specific lesions, acute attacks are frequently aroused by exposure
to cold and wet, by bad hygienic surroundings, and by various nervous disturbances.
The PROGNOSIS is good in the acute follicular and
acute suppurative forms and in ordinary chronic enlargement of the glands.
One or a few treatments may cure the case in the acute forms.
Great relief is almost invariably given immediately by the treatment.
The chronic enlargement requires long continued treatment. In the
chronic form described as naso-pharyngeal obstruction, or mouth breathing,
the prognosis for cure is not good. Much relief can be given, and
long continued treatment aids the retarded mental and bodily development.
Although Salinger and Kalteyer's "Modern Medicine"
states that acute follicular tonsillitis cannot be aborted, it is the common
experience with Osteopathy to abort the disease.
In the TREATMENT of acute tonsillitis, due attention
must be given general constitutional condition. Liver, bowels, kidneys
and skin must be kept active. Thorough spinal treatment should be
given for tonic effect. The treatment should be directed at once
to the reduction of the lesion. Treatment
is given the upper three cervical vertebrae to affect the superior cervical
ganglion. All the muscles and tissues of the neck are; gently but
thoroughly relaxed. Careful treatment is made over the suprahyoid
muscles and over the region of the tonsils. The extreme tenderness
will allow of but gentle treatment, but by exercising care in applying
the treatment at first, a deep and thorough treatment may be given after
preliminary relaxation of the tissues. All the cervical vertebrae
and posterior tissues should be thoroughly treated for the sympathetic
connections of the fifth. (Chap. IV.) The treatment over the
throat as described is to relieve the inflammation by freeing the circulation
in the substance of the gland and in the carotid and internal jugular veins.
As the large arterial supply is from branches of the external carotids,
particular treatment is made along them by relaxing the muscles and tissues
over them and by opening the mouth against resistance as already described.
This work over the throat is carried down to the root of the neck over
the carotid and internal jugular veins.
Manipulation over the tonsil aids the flow of the
blood through the tonsillar plexus of veins into the internal jugular.
This vein is freed by raising the clavicle and relaxing the anterior -cervical
tissues about it arid the first rib. Momentary pressure should be
made upon these veins, one at a time, followed by downward stroking from
over the gland and down the vein. If this be repeated, and kept up
for a few minutes, the acute enlargement can be quite reduced for the time.
In the same way the carotid artery is stimulated in action. Circulation
in the substance of the gland is aided by internal treatment in the throat,
made by sweeping and pressing the index finger over the gland, fauces and
surrounding tissues. This gives much relief. All the treatment
directed to the throat and inferior cervical region is the most important
part of the treatment. The large blood supply of the gland, and our
ability to reach it directly more than through the innervation, make this
part of the treatment important. It is readily efficient. Treatment
to the first rib and over the upper anterior chest aids circulation.
The cold pack to the throat or hot applications give relief. The
diet should be liquid, bland and nourishing, such as milk and broth.
The tonsils should be kept free from accumulation
of secretions, which persist in chronic cases. The fever is treated
in the same way, being affected by the superior cervical and spinal work.
The spinal and general treatment relieves the chilly feelings, aches, etc.
The neck and throat treatments relieve the sore throat. Careful treatment
will prevent suppuration in the suppurative form (Quinsy). The general
tonic treatment must be persistent in these cases because of the severe
general symptoms.
Acute cases should be treated daily one or more
times as necessary. A few treatments are generally sufficient.
The chronic enlargements (hypertrophy) and the chronic naso-pharyngeal
obstruction should be treated three times per week. In the latter,
local treatment upon the gland from within the throat is very helpful.
Many of these cases are, in fact, tubercular, and the practitioners must
be observant of such condition. Long continued treatment should be
urged in all chronic cases to prevent, or to overcome, retarded mental
and physical development.
PAROTITIS
DEFINITION: Parotitis or mumps is an acute inflammation
of the parotid glands.
CAUSES: The lesions in such cases affect the upper
cervical region, mainly the atlas, axis and third vertebra. Other
cervical vertebrae may be luxated, and the cervical muscles are contractured.
The deep anterior cervical tissues may be tensed, and clavicle luxated.
Secondary contracture occurs in the muscles and tissues over the region
of the gland.
Lesions of the upper three cervical vertebrae and
to the tissues affect the superior cervical ganglion, and thus the carotid
plexus through its ascending branch; the fifth nerve through this ganglion
and through its sympathetic connections, and thus its auriculo-temporal
branch; the second cervical nerve, and thus its auricular branch; while
lesions to the muscles in this region may affect the facial nerve directly,
and these other lesions affect it through the sympathetic connections.
Contraction of the tissues over the course of the external carotid arteries
and the external jugular veins affect the flow of the blood to and from
the gland. Luxation of the clavicle and its tissues affects the external
jugular vein.
The PROGNOSIS is good. Treatment is rapidly
effective, and the course of the disease is shortened from the usual course,
seven to ten days, to three or four days. Some cases may become obstinate
and require longer treatment.
The TREATMENT is in most particulars identical with
that given for tonsillitis, q. v., the lesions to vertebrae, tissues, and
clavicle, etc., being practically the same.
The tissues over and about the gland may be more
readily relaxed as the condition is less painful. The swelling is
more persistent, and requires more treatment. The fever is treated
as before, and a thorough spinal and general treatment is given for the
constitutional symptoms. This should include treatment to the blood
and nerve-supply of the breasts, ovaries, and testicles to prevent metastasis,
which is probably usually due, in part, to lesions affecting these parts,
and rendering them liable to this invasion. Such should be looked
to. This point must not be neglected, as the inflammation may be
driven by the treatment to these parts. By thorough treatment of
them the danger of metastasis is much lessened. Thorough general
treatment prevents the serious sequelae that sometimes follow parotitis,
such as disorders of the eve, ear, optic nerve, albuminuria, arthritis,
facial paralysis, hemiplegia, etc. Careful nursing and care of the
patient are necessary to prevent relapse. The patient should remain
in bed (luring the acute attack. Hot or cold applications to the
gland, and support with cotton and a bandage, afford relief.
PHARYNGITIS, (Sore Throat)
DEFINITION: Acute Pharyngitis is an acute catarrhal
inflammation of the mucous membrane lining the pharynx.
Chronic Pharyngitis is a chronic catarrhal condition
of the membrane, with hypertrophy or atrophy of the follicles. It
may be a chronic naso-pharyngeal catarrh, chronic hypertrophic pharyngitis
(pharyngitis sicca), or follicular or granular pharyngitis.
CASES: (1) Chronic pharyngitis in a professional
singer. The voice was impaired, the patient being hardly able to
speak above a whisper. Lesion of one of the middle cervical vertebra
was found. Treatment to it cured the case.
(2) Acute pharyngitis and stomatitis. The
throat was ulcerated. The usual medical treatment, tried for a number
of days, was unsuccessful. The patient could not eat for sixteen
days. He was enabled to eat by two osteopathic treatments, and the
case was cured.
(3) A case of chronic pharyngitis, showing lesion
as marked tension and rigidity of the ligaments along the entire cervical
region, with tenderness at the 2d and 3d vertebrae. Chronically enlarged
tonsils were present. Both conditions were cured by restoring normal
anatomical conditions in the cervical region.
(4) Pharyngitis, chronic, caused by reflex irritation
by lesion at the fourth right rib, which was twisted at its articulation.
The rib was replaced and the trouble disappeared, not having returned at
a time six years later.
LESIONS AND ANATOMICAL RELATIONS: These conditions
are at once seen to be catarrhs. They are closely associated with
nasal catarrh, and with tonsillitis. Largely the same nerve and blood
supply suffers in pharyngitis as in these conditions, hence the remarks
made concerning lesions and anatomical relations in considering them will
apply with equal force to this disease.
The nerve supply to the mucous membrane of the pharynx
is from the pharyngeal plexus, composed of branches from the glosso-pharyngeal,
pneumogastric, spinal accessory, and cervical sympathetic. The sympathetic
supply is from the superior cervical ganglion. It has already been
discussed how cervical and upper dorsal lesion affects this nerve mechanism.
Under certain conditions it is readily seen that the vaso-motor equilibrium
of the pharyngeal mucous membrane would be upset, the lesion directly causing
the inflamed condition, or weakening it and laying it liable to the effects
of cold, exposure, tobacco, a depraved constitution, gout, scrofula, overuse,
etc., commonly regarded as the active cause of the condition.
It is significant from the osteopathic point of
view that exposure causes the condition, and that the neck is stiff and
sore.
The hyoid bone is sometimes drawn back against the
pneumogastric nerve by contraction of the hyoid muscles, irritating this
nerve, and through it causing pharyngitis. This is a very common
condition in people using the voice to excess, such as public speakers
and singers. Almost without, exception these cases show marked contracture
of the tipper hyoid muscles especially. It is common, in these cases,
to notice marked improvement after a few minutes treatment directed to
the relaxation of these muscles. In some cases lesions of the cervical
vertebra cause spasmodic contractions in these throat muscles, resulting
in pharyngitis in this way.
Upper rib and clavicle lesion is sometimes present,
deranging sympathetic connections and impeding circulation from the throat.
The clavicle may be back against the pneumogastric nerve. Dr. Still
holds this to be one of the commonest causes of irritation in the throat.
He also points out in these cases lesions of the first rib, sometimes at
its sternal end. but especially at its head.
Atlas, axis, and upper cervical lesions are the
most frequent, but lesion may be found anywhere in the cervical region.
The former act chiefly by affecting the superior cervical ganglion.
As pharyngitis is frequently associated with digestive
disturbances one sometimes meets lesion in the splanchnic area causing
pharyngitis indirectly in this way. In some cases various kinds of
lesions, causing depraved constitutional conditions, may be the ones present.
It is interesting in this connection, to note that many persons who have
suffered from la grippe, etc., can be made to cough by spinal manipulation
between the shoulders, which affects the vagus nerve through spinal sympathetic
connections. Lesions are usually present here.
One case of aphonia was cured by reduction of lesion
between first and second parts of the sternum.
The PROGNOSIS is favorable, good results being almost
uniformly gained. The acute case is at once greatly relieved, and
is cured in a few treatments. Chronic cases are often entirely cured.
They are more frequently presented for treatment than are the acute.
Relief is at once apparent under the treatment.
The TREATMENT is entirely that pointed out in detail
for Catarrh and Tonsillitis, q. v. Thorough correction of lesion,
freeing of the circulation, and relaxation of the tissues is to be accomplished.
Removal of specific lesion is often able at once to cure the case. One
must make a special point of keeping relaxed the tissues of the throat
from the angles of the jaws to the clavicle. This frees the circulation.
Likewise the clavicle should be raised. The circulation in the pharyngeal
plexus is also much relieved by the inward mouth treatment. It is
well to extend this well up to the openings of the Eustachian tubes, as
in this way one may prevent the inflammation spreading to affect the ears.
The work beneath the angles of the jaws externally, and opening the mouth
against resistance are particularly good treatments in this condition.
Sore throat and cough are often much relieved by grasping the larynx between
thumb and fingers and applying a rapid shaking movement to it, extending
the treatment down along the trachea as far as the sternum.
In the acute case the patient may suck ice for relief.
A hot foot-bath is good. The diet should be liquid or semisolid.
Daily sponge baths should be used, with first tepid
and then cool water, to harden the skin.
In all cases the active source of irritation must
be removed. This is often bony lesion. If it be smoking, the
use of alcohol, etc., it must be dispensed with.
The chronic case usually calls for a thorough course
of treatment to enable one to overcome the chronic inflamed, hypertrophied
or atrophied condition of the membrane.
The corrected blood supply loosens and dispels the
muco-purulent secretions, and normalizes the secretory function.
It heals the ulcerations, builds up the atrophied
membrane, or absorbs the hvper-trophied follicles. Constitutional treatment
is often necessity.
ESOPHAGITIS
DEFINITION: An acute inflammation of the mucous lining
or the submucous coat of the esophagus.
CAUSES: (1) A case in which the inflammation of
stomatitis extended downward into the esophagus. There was contracture
of the supra-hyoid muscles, drawing the bone back against the pneumogastric
nerve.
(2) A case in which irritation the length of the
esophagus, and a distressed feeling of the stomach were due to a posterior
condition of the upper 4 or 5 dorsal. Correction of this lesion removed
the irritation and relieved the stomach.
LESIONS AND ANATOMICAL RELATIONS: The lesions are
often the same as those for stomatitis and pharyngitis, as this condition
is often due to extension of inflammation downward from above. Thus
lesion to the hyoid bone and to the muscles of the throat, to the clavicle
and upper ribs are all likely to occur. Lesion to the clavicle and 1st
rib may interfere with the circulation to the esophagus via the subclavian
and thyroid axis. The various cervical lesions already discussed
as capable of derailing the activities of the pneumogastric and sympathetic,
both of which unite in forming the esophageal plexus, may react upon the
esophagus.
The esophageal plexus is in connection with the
pulmonary plexus and thoracic sympathetic. Thus is seen the close
connection between upper spinal lesion, common in derangement of the esophagus,
and its sympathetic, innervation, having charge of its circulation.
Spinal lesion in this way affects the circulation from the aorta to the
esophagus.
The cause is frequently traumatic, and no special
lesion is present.
The prognosis is good. Cases usually recover
in a few days; often spontaneously. Generally one or two treatments
are all that are required. In the suppurative form, perforation,
gangrene, or late stricture is apt to end in death.
The TREATMENT is simple. Any cause of irritation,
mechanical, thermal, or chemical must be removed. The circulation
is corrected and the inflammation reduced by correction of lesion, treatment
of the upper dorsal region, elevating the upper ribs and clavicle, and
freeing the, circulation through the neck and about the throat.
If due to catarrh, infectious fevers, etc., treatment
must be made accordingly.
A bland diet, especially of milk, is recommended.
In serious cases rectal alimentation may be necessary. Small pieces
of ice may be swallowed. Warm demulcent drinks are good.
In chronic cases the treatment must be more persistent.
Any source of continued irritation must be removed. This form is
often due to passive congestion from chronic heart or kidney diseases,
and attention must be then given to the primary condition.
SPASM AND STRICTURE
OF THE ESOPHAGUS
CASES: (1) A man, aged fifty, suffered from a constriction
of the esophagus, which occurred while eating. The physician allayed
the intense pain by injection of morphine, but was unable to overcome the
obstruction. The case became serious. An Osteopath was called
and after several hours effort relieved the condition. The case was
treated for two weeks and all effects of the trouble disappeared.
(2) A case of constriction of the esophagus was
cured by treatment to the pneumogastric nerves and in the upper dorsal
region.
The LESIONS in these cases are usually upper rib
and upper thoracic vertebral ones.
There are many of the cases which present no special
bony lesion, but are due to other causes, as when spasm depends entirely
upon a nervous reflex, e. g., from the uterus, etc., or when stricture
is due to congenital narrowing or to constrictive growth after burning
with a corrosive fluid.
Yet it is evident that a reflex irritation from
a rib or vertebral lesion upon the direct nerve connections of the esophagus
could be quite as effectual as a reflex irritation from the uterus in causing
spasm of the esophagus. Specific bony lesion may be the determining
cause of the spasm in cases of hysteria, chorea, epilepsy, etc.
In case of stricture the bony lesion may be the
ultimate cause of the epithelioma, polypus, or ulcer, and cicatrix finally
resulting in stricture.
The PROGNOSIS for spasm is good. It is commonly
easily overcome by the treatment. The prognosis for stricture is
not favorable. It is a surgical case, and can usually be relieved
only by passing a bougie.
The TREATMENT depends upon the cause. In cases
of spasm, if a nervous disease be present it must be carefully treated.
All cause of irritation must be removed. Rib and vertebral lesion
must be adjusted. Thorough treatment in the upper dorsal, lower cervical,
and upper thoracic region is quite successful. In cases of stricture
the diet should be semisolid or fluid, and concentrated. Rectal feeding
may become necessary. Osteopathic treatment as above may be applied
but it is likely that the bougie will have to be used.
ACUTE AND CHRONIC GASTRITIS
DEFINITION: The acute form is an acute catarrhal
inflammation of the mucosa of the stomach; acute indigestion. The
chronic form, chronic dyspepsia, is associated with structural changes
in the mucosa, and with change in the secretions and muscular activity
of the stomach..
CAUSES: Lesions have been noted in various cases
as follows: (1) 2d to 6th cervical vertebra to the right; 2nd cervical
anterior; 8th to 10th dorsal vertebrae separated; break at the fifth lumbar.
(2) Luxation of the 8th rib; tenderness at the 8th dorsal vertebrae. (3)
Cervical and dorsal curvatures of spine, and luxation of the ribs.
(4) A case of catarrhal gastritis in a man sixty-four
years of age, of twenty years standing. The patient was unable to
take nourishment. Lesion. was of the 4th and 5th right ribs, which
were slipped at their vertebral articulations. The patient was able
to get up on the fifth day of treatment and returned to work in three weeks.
The ribs were entirely corrected in two months.
(5) Chronic gastritis due to a downward displacement
of the right fifth rib. The lesion was corrected and the case cured.
These cases, almost without exception, show lesion
in the upper splanchnic region, between the shoulders, including the spinal
area from the second to the seventh dorsal. A common form is flatness
or anterior position of this region. Its tissues are often sore or
sensitive under pressure. The soreness may appear only coincidentally
with more acute manifestations of the stomach disorder, or it may be better
and worse according to the condition of that organ.
Lesions at the atlas, axis and third cervical affect
the vagus nerve through its connection with the superior cervical ganglion.
It may be obstructed along its course in the neck. Lesions to the
cervical region and to the pneumogastric nerves in the neck are of secondary
importance in causing stomach disease. The main lesions occur in
the spine, affecting the splanchnic area, and may be of the ribs and their
cartilages, of the vertebra, or of the spinal and intercostal muscles and
other tissues mentioned. Lesions to these structures occur mainly
between the fourth and tenth dorsal region, but may occur either a little
above or below these limits. The pneumogastrics and the splanchnics
both contribute to the solar plexus, which has charge of the functional
activities of the organ. The wide area of origin of the splanchnics
along the spine, and their importance in the innervation of the stomach,
accounts for the fact that lesions to this area are most potent in producing
derangement. At the same time this is so readily accessible to the
Osteopath's work that results are generally easily attained in the treatment
of such troubles.
Lesions to ribs and cartilages act in part through
interference with the intercostal nerves, which are in direct sympathetic
connection with the solar plexus through the splanchnics. Luxation
of the ribs may also interfere with spinal nerves by derangement of the
tissues about the head of the rib. Lesions of spinal muscles, ligaments,
and vertebrae act mainly through interference with the spinal nerves and
thus upon the connected splanchnics. Muscular lesion may often be
secondary to stomach disease, but in such case indicates the point of treatment,
and may point to spinal lesion at that place. The vagi nerves carry
sensory, motor and secretary fibers to the stomach. The splanchnics
contain vaso-motor and viscero inhibitory fibers for the stomach.
But as the influence of the abdominal brain is, according to Robinson,
supreme over visceral circulation, and controls as well visceral secretion
and nutrition, the results of our treatment upon the pneumogastrics and
the splanchnics must affect the stomach mainly through the solar plexus.
As the splanchnics contain these vaso-motors for the stomach, the main
treatment for gastritis, a vaso-motor disturbance, must be through them.
Lesions to the splanchnic area are likely to cause gastritis upon account
of their being the vaso-dilators.
McConnell states that lesion of the eighth and ninth
costal cartilages may cause gastritis.
The mechanical irritation of coarse, poorly masticated
food, the fermentation of overripe fruit in the stomach, and the effects
of constant overloading of the stomach and of indiscretion in diet, may
irritate the mucosa and cause gastritis in the absence of specific lesion.
But in such cases secondary lesions are generally produced by the trouble.
In the ordinary case of gastritis sometimes beyond these must be sought,
and the disease so frequently occurs without such indiscretions.
The PROGNOSIS for recovery is good in both acute
and chronic cases, The ordinary acute case is relieved immediately by a
treatment. More than one treatment may not be necessary.
The TREATMENT must be directed to the specific lesion,
generally of the splanchnic area, that is causing the trouble. Its
main object must be to correct the circulation, and thus to take down the
inflamed condition of the mucosa and restore normal secretion. The
splanchnics and solar plexus, having charge of the circulation and secretion,
afford a most convenient means of doing this. The correction of lesion
here, and the treatment given the splanchnics and solar plexus in conjunction
with the removal of lesion constitute the main treatment in such cases.
With the patient lying upon his side or upon his
face, the muscles and deep tissues of the splanchnic area are thoroughly
treated and relaxed. The patient now lies upon his side, or sits
up, and treatment is given the spinal vertebrae and ribs of this region.
The former are thoroughly treated and sprung, to relax all their related
tissues and remove obstructions to the nerves. The latter are raised,
and adjusted in case of lesion, to aid in this process. Vaso-motor
activity is thus aroused and corrected. This important process is
aided by deep treatment of the solar plexus from the abdominal aspect.
(VI. Chap. VIII). As this plexus has the main control
of visceral circulation and secretion, treatment of it rouses and normalizes
its functions. Mechanical pressure of displaced ribs upon the stomach
may be found. The upper abdominal treatment aids circulation in the
stomach. (V. Chap. VIII). Attention is given the upper
cervical region for lesions affecting the vagus. It may be treated
in the neck as a means of aiding the general treatment. Inhibition
by pressure upon the left vagus relaxes the pylorus. This pressure
may be made in the neck directly upon the nerve, or may be made at the
third or fourth intercostal space near the spine. This latter treatment
is much used to relieve nausea and vomiting. Its effect is probably
through the sympathetic connections with the vagus. In some cases
pressure at this intercostal space has caused vomiting. In some cases
abdominal manipulation induces vomiting. This should be encouraged
to relieve the stomach of its irritating contents. Excessive vomiting
should be checked. Thorough treatment along the spine (splanchnic
area) will aid in this. After inhibition of the left vagus to relax
the pylorus, the patient may be placed upon his right side and deep pressure
be made over or beneath the left hypochondrium, from the cardiac toward
the pyloric end, to aid in the passage of the stomach contents into the
intestine.
McConnell states that inhibition at the 8th and 9th dorsal relaxes
the pylorus; inhibition at the 6th and 7th dorsal relaxes the cardiac orifice.
He has found that correction of lesion in the lower left ribs aids in the
absorption of gas. Deep pressure over the solar plexus also aids
this process.
Liver, bowels, and kidneys must be kept in active
condition by treatment. The patient should be absteminous in diet.
It should be light and easily digested, and may he according to prescribe
dietaries. The patient should masticate thoroughly. He must
avoid fats, alcohol, and sweets. In severe cases he should be put
upon a milk diet.
Acute cases should be treated frequently, chronic
cases three times per week.
DISEASES OF THE STOMACH
(Continued)
CASES: (1) Strain from heavy lifting, followed by
severe lameness at the time, which gradually disappeared. In a few
months severe stomach disease followed: no food could be retained, and
rectal feeding was resorted to. Patient came under treatment too
weak to walk or talk. Muscular contractures under the right shoulder
and a slightly displaced rib were the lesions found. They are corrected
and the case cured.
(2) Ulceration of the stomach and complication of
troubles, due to spinal curvature. Correction of curvature gave great
relief.
(3) Acidity of the stomach and diarrhea, caused
by abnormal tension in the spinal tissues. Cured.
(4) Gastralgia: Attacks so severe that they induced
spasm in abdominal and neck muscles at the same time, The spasm was always
stopped at once by inhibition of the solar plexus and of the posterior
cervical nerves. Attacks grew less frequent under treatment.
(5) Gastralgia; agonizing pain followed taking even
small quantities of food as long as it remained in the stomach. 6th,
7th, and 8th right ribs were down. These being replaced the trouble
disappeared.
(6) Gastralgia of several years duration.
Lesions at 5th and 6th dorsal and 2d lumbar vertebrae. Luxation of
the 8th right rib. Case cured by four month's treatment.
(7) Gastralgia; three years standing; attacks after
nearly every meal. Lesion, a lateral twist of the 6th dorsal vertebra.
Cured in one year's treatment.
(8) Gastralgia; incessant pain in left side, stomach,
and bowels; 4th and 5th right and left ribs drawn together; 8th left under
7th; spinal muscles tense. Great relief was given by one month’s
treatment.
(9) Gastralgia. Seventh dorsal vertebra right;
great tension at the 12th dorsal.
(10) Gastralgia. Lesions at atlas and 4th
dorsal.
(11) Gastralgia. Luxation of the 11th rib.
(12) Tenderness over the stomach (hyperaethesia);
8th dorsal vertebra very tender and 8th rib luxated: cured by two weeks
treatment.
(13) Dilatation of the stomach and a complication
of diseases. The spine was straight and flat; thorax flat; 2d and
3rd cervical vertebrae lateral; left cervical muscles tense; slight lateral
curvature to left between the 5th dorsal and 3rd lumbar; spinal muscles
tense.
(14) A case of chronic dilatation of the stomach
of some years standing, with constipation and gastric pain. The appetite
was ravenous at times, at times, but taking food aggravated the pain.
The case was cured in 5 months, the weight having increased from 104 to
158 pounds.
(15) Chronic nervous dyspepsia of twenty years standing
in a man of 42. The stomach was dilated, and pain was present two
hours after eating, Lesion was posterior condition of 6th and 7th cervical;
lower dorsal and upper lumbar markedly posterior; compensatory anterior
swerve of the upper dorsal region; The case was cured in eight months.
(16) A severe acute attack of pain in the stomach
with nausea and constant vomiting for 48 hours. Medicine gave no
relief. One treatment greatly relieved the case, and in three
days the patient was at work.
(17) Gastric colic in a man of forty, resulting
from injuries received six years previously, in which the spine was injured,
and the lower right ribs were pressed inward. The first attack of
pain occurred 2 months after the accident, marked by severe pain and cramping
in the right side above the crest of the ilium, radiating upward.
Attacks every 10 days, and accompanied by extreme nausea and vomiting.
The patient was confined to bed three of four days at each attack.
At times the cramping was so severe as to extend to all the muscles of
the body.
Lesion was present as anterior condition of the
fourth dorsal vertebra. The lumbar portion of the spine was prominently
posterior. The condition of the ribs was as above noted. Kidneys
and liver were involved.
After the third treatment the patient was benefited.
The attacks grew less severe and less frequent. The case was practically
cured at the time of the report, three months having elapsed since the
last attack.
LESIONS: In all the above cases the splanchnic area
was affected; neck lesion was rare, and apparently of secondary importance;
lesions to the spine, including vertebrae and muscles were important; occurring
in ten of the cases: rib lesions were the most important and specific,
occurring in seven of the cases. Lesions of the 5th to 8th ribs (area
of greater splanchnic) occur most frequently.
Lesions to the splanchnic area through rib or spinal lesion, apparently
occur in all cases of stomach disease. We are not yet able to specialize
as to lesion, and say that one particular style of lesion, or lesion of
some individual rib or vertebra causes a certain kind of stomach disease.
It is probable that in the future compilation of
lesions may show considerable specialization of them in the etiology of
stomach disease. But it is also likely that such tabulation will
indicate the probabilities only, for it is a matter of experience that
a given lesion will produce in one patient one form of stomach disease,
and in another a different form, depending upon individual peculiarities,
and upon various attendant conditions. Hence one must be upon the
lookout for any various lesions in the splanchnic area in all stomach diseases.
They may cause a predominance of sensory, motor, secretary, or vaso-motor
derangements, and complications thereof, and according to the predominating
difficulty it may be that special lesion will be suspected, or that special
areas will be treated in conjunction with the removal of specific lesion
in the case.
The practitioner's simple duty in stomach disease
is most thorough examination of the splanchnic region of the spine, just
above and just below, and of the thoracic parts in relation thereto.
When he has done this he has located the trouble, almost invariably, and
his treatment of this region, removing the lesion, almost as generally
cures or benefits the case. Lesion outside of this area is of minor
importance, and treatment directed elsewhere (abdomen and neck) is either
secondary, or for alleviation merely.
Special lesions have been noted as follows: in acidity,
the lesser splanchnics and the 4th and 5th dorsal (A. T. Still);
in gastralgia, frequent luxation of the 8th and 9th ribs anteriorly (McConnell),
also of the 5th, 6th and 7th dorsal; for gastric ulcer, frequent lesion
of the 8th and 9th ribs anteriorly, and of the 5th to 8th ribs posteriorly
(McConnell.)
Secondary lesion in the form of contracturing of
spinal muscles, particularly along the splanchnic area, is of very frequent
occurrence in stomach disease. Although in this case the result,
and not the cause, of stomach disease, it is of much importance osteopathically.
(1) It indicates the point of treatment, for it is an indication upon the
surface of the body of what special nerve fibers or areas are suffering
derangement by the particular form of disease present. There is a
direct path between the diseased stomach and the contractured muscle, over
which the abnormal impulses, generated in the stomach, pass out.
It is Nature's landmark of a special diseased condition, or of a phase
thereof. Experience shows that in the absence of any other lesion
whatsoever, treatment at the point of contracture may cure the condition.
It is evident that the nerve area thus indicated was the one needing treatment.
(2) These contractures do not always occur at the
same location, nor always affect the spinal muscles over the splanchnic
area generally. They may occur upon the one side of the spine only,
high up in the splanchnic area or above it. They must therefore indicate
lesion in different nerve areas or fibers, according to some condition
present and determining which fibers shall thus suffer and produce contracture.
It is possible that they indicate seat of lesion in the spine not otherwise
discoverable. In such case this weak point would be the determining
condition in the location of the situation of the contracture. Thorough
treatment at this point may restore conditions and thus correct lesion
which is important in the causation of the stomach disease. Contracture
and soreness in the cervical or lumbar regions may follow stomach disease,
and possibly indicate important relations, by lesion or otherwise, between
these parts.
ANATOMICAL RELATIONS: Robinson states that the solar
plexus is supreme over visceral circulation, that it controls also secretion
and nutrition. The important lesions noted in stomach trouble affect
its spinal connections, the splanchnics, and may therefore cause circulatory,
secretary, or nutritional disturbances in its connected organs. Likewise
they may cause sensory and motor troubles, as the same authority, and the
American TextBook of Physiology, as well, states that this plexus receives
sensation and sends out motion. According to Quain, the terminal
branches of the pneumogastric unite with the gastric plexus of the sympathetic,
and carry motor and sensory fibers to the stomach. Flint shows that
the pneumogastric has much to do with gastric secretions, as section of
it leads to almost complete cessation of stomach secretions. It is
considered probable by investigators that its motor function in the stomach
is derived from its sympathetic connections. Osteopathic work seems
to influence it more largely through its sympathetic connections.
It is treated also in the neck directly. It is important in sensory
and motor diseases. The splanchnics contain vaso- and viscero-motor
fibers. Stimulation of the splanchnics lessens peristalsis; of the
pneumogastrics increases it. Thus important control is gained in
various conditions. Quain states that sensory nerves for the stomach
pass from the dorsal nerves from the 6th to the 9th, the 6th and 7th supplying
the cardia, the 8th and 9th the pyloric end.
The PROGNOSIS in stomach diseases as a class is
extremely good. Many severe cases of long standing have been cured.
As a rule relief is immediately given, and cure follows.
The TREATMENT of stomach diseases as a class is
very simple. It consists mainly in corrective treatment in the splanchnic
area, together with a certain amount of neck and abdominal work.
This is supplemented by certain special treatments for various purposes
in the treatment of special diseases. Through the pneumogastrics
and the sympathetic connections, the solar plexus and the splanchnics,
control is had, to a marked degree, over the processes regulated by them;
sensation, motion, nutrition, secretion, circulation. Few diseases
can remain after correction of these functions by removal of the lesion
disarranging them.
The treatment of the solar plexus, the spine (splanchnics),
the pneumogastrics, and the removal of the various lesions likely to occur
in these regions have already been discussed.
The various motor, secretory, and sensory neuroses,
described under the general name of nervous dyspepsia, are treated by removal
of special lesion and by the work for the control of various functions
as discussed. In cases of supermotility, peristaltic unrest, and
nervous eructation, special treatment may be given to stimulate the splanchnics
and solar plexus to lessen peristalsis. In nervous vomiting, the
work should be directed to the cerebral centers, by treatment in the superior
cervical region, and to the solar plexus. Strong inhibition to the
left pneumogastric in the neck will relax the pylorus and aid in passing
the stomach contents into the duodenum. Deep pressure at the 3rd
and 4th left intercostal space near the spine will relieve nausea and stop
the vomiting.
In spasm of the cardia, inhibition should be made
at the 6th and 7th dorsal for fibers controlling it, while in spasm of
the pylorus the inhibition should be on the 8th and 9th dorsal and upon
the left vagus. In atony of the stomach, thorough stimulation should
be given the vagi, splanchnic, and solar plexus, to increase muscular tone
and to develop circulation. Local manipulation over the region of
the stomach would aid in toning the muscular walls (see treatment of Gastritis.)
In insufficiency of the cardia stimulation should be given the 6th and
7th dorsal, while in pyloric insufficiency the 8th and 9th dorsal and the
left vagus must be looked to. Local stimulation, by brisk work over
the abdomen, aids the operation.
In secretory disturbances, hyperacidity, super-secretion,
and sub-acidity, work upon the vagus and solar plexus, through the splanchnics,
corrects circulation and rights secretion. Stimulation of the lesser
splanchnics and of the 11th and 5th dorsal is important.
In sensory disorder attention must be given the
sensory innervation. Hyperaesthesia needs a general stimulation.
Gastralgia needs deep inhibition at the solar plexus, splanchnics, and
vagi. Special inhibition should be made from the 6th to 9th dorsal,
8th and 9th ribs anteriorly, and the 5th, 6th and 7th dorsal vertebrae,
all of which points seem concerned in the sensory innervation of the stomach.
For the abnormal sensations of hunger, lack of appetite, etc., general
correction of secretions and sensation will be efficient.
For dilation of the stomach, rapid cutaneous stimulation
over the region of the stomach aids in contracting its muscular fibers.
Treatment should be given for the stimulation of the vagi, and accumulated
food must be kept worked out of the stomach. All causes of obstruction
of the pylorus should be removed. This obstruction may be of such
a nature as to demand surgical attention. In case the cause be overgrowth
of tissue, cancer, cicatrix of an ulcer, etc., an attempt may be made to
relax the pylons by inhibition of the vagus (vide supra), and to pass the
food on through the stomach by manipulation as before described.
In case the obstruction of the pylorus be not total one may succeed in
keeping the contents of the stomach passed until the course of treatment
can reduce the cause of obstruction.
Much the same plan must be followed in cases in
which the obstruction is due to external compression, or from growth, displaced
kidney, gallstones, etc. One may sometimes easily remove the
cause of obstruction.
In all cases not due to pyloric stenosis, as from
overstrain of the muscular coats by repletion; chronic gastric catarrh,
weakening the muscle; fatty, and other forms of degeneration; congenital
weakness; impaired innervation, etc., one may apply the treatment first
mentioned above for dilatation, always with due attention to the cause
and to the lesions present.
Careful attention to the diet is necessary.
It should be small in amount at a time, and fluid or semi-fluid or semi-solid.
In this way the food is soon passed through and has no tendency to dilate
the organ further or to interfere with its repair.
A thorough abdominal treatment should be given to
tone local circulation. Strengthen the abdominal walls, and stimulate
the walls of the stomach itself. (See treatment of gastritis.)
For gastroptosis one should apply treatment as described
for enteroptosis, q. v.
In peptic ulcer attention should be given to perfect
freedom of circulation. The condition of the 8th and 9th ribs anteriorly,
and of the 5th to 8th ribs posteriorly, must be looked to. Absolute
rest is necessary. The patient should remain in bed, and rectal feeding
be resorted to in part, for alimentation. The diet must be carefully
regulated, and of a sort mostly digested in the stomach. Skimmed
milk, buttermilk, and pancreatized milk gruel are recommended. The
latter is used also for rectal injection. A diet of ice cream is
reported as leaving cured a number of cases.
The vomiting, hematemesis and pain may be controlled
according to directions given for those conditions.
The removal of lesion and maintenance of a free
circulation are measures greatest importance, as thereby the ulcer is healed.
As a derangement of the secretions, such as hyperacidity, predisposes to
ulcer, it is seen that correction of circulation guards against it.
The same is true of the point that gastritis causes ulcer.
A general course of treatment should be given to
build up the health of the body and to improve the quality of the blood
in such conditions as anemia, chlorosis, and amenorrhea, which favor the
development of ulcers.
In hemorrhage from the stomach (Hematemesis); inhibit
the splanchnics, and the solar plexus carefully, to lessen the blood pressure
for the general vaso-motor center, and make deep inhibitive treatment of
the abdomen to dilate the great abdominal veins and call the blood away
from the stomach. One should proceed as in other internal hemorrhage.
(See Pulmonary Hemorrhage). One must treat the condition according
to its cause. If it be from local disease, such as ulcer, the first
measure is to stop the hemorrhage as above directed. The same remark
applies to hemorrhage from traumatic causes. If the cause be a mechanical
impediment to the portal vein, this should be removed; if vicarious menstruation,
the local hemorrhage of the stomach must be first controlled, while later
treatment looks to the reestablishment of menstruation.
In the treatment of hemorrhage from the stomach,
the organ must be given absolute rest. Rectal feeding may be resorted
to for this purpose. Cold applications may be made over the region
of the stomach. The patient must remain quietly upon his back.
No stimulants should be administered.
In cancer of the stomach, general corrective work
and particular attention to freedom of circulation must be relied upon.
(See treatment of "Tumors.")
Look for lesion to any of the special points mentioned
in relation to the various diseases. The bowels, kidneys and liver
must be kept in free action. The diet should in all cases be limited
and easily divested.
CONSTIPATION
DEFINITION: "Infrequent or incomplete alvine
evacuation leading to retention of feces" (Quain). "A neurosis of
the fecal reservoir" (Byron Robinson). Osteopathically it is regarded
as a neurosis due to obstructed action of the nerves supplying the bowel
with secretion, motion, and circulation. It may be symptomatic of
other disease, or a complication. It is very frequent idiopathic,
due to specific lesion to bowel innervation.
Cases have presented various lesions; (1) Contraction
of the sigmoid flexure, (2) Spinal lesions, mostly in the lumbar, causing
spinal cord disease and partial paralysis of limbs and bowel, (3) A posterior
prominence of the whole lumbar region, (4) Lesion at 5th and 6th dorsal,
2nd lumbar, and 8th right rib, (5) At 3rd and 4th dorsal, 9th dorsal, 5th
lumbar, (6) Intense contraction of the external sphincter am, (7)
Slight parting of 1st and 2nd lumbar, (8) Prolapsus of the sigmoid, (9)
Retroversion of the uterus against the rectum, (10) Right curve of spinal
column; 3rd to 6th dorsal vertebra posterior; 7th to 10th dorsal vertebrae
anterior and flat; 11th and 12th dorsal and 1st lumbar posterior; 12th
dorsal and 1st lumbar the seat of pain; 12th rib down; 2nd and 3rd lumbar
close; 5th lumbar sore and anterior. (11) 2nd and 3rd dorsal separated,
3rd and 4th together, 3rd to 5th flat, 6th to the left, 11th dorsal to
2nd lumbar posterior, (12) 6th and 7th dorsal posterior, 9th to 12th flat,
ribs irregular and prominent on the left, (13) Coccyx badly bent, lesion
of 5th lumbar, (14) Separation between vertebrae from 8th to 10th dorsal,
and between 5th lumbar and sacrum, (15) 2nd to 5th dorsal approximated
and to the right, separations between vertebra, from 8th dorsal to 3rd
lumbar, the right innominate up and back, (16) Spine rigid; atlas to the
left; 2d, 3d, and 4th cervical vertebra to the right; 12th dorsal, al posterior;
11th rib overlapping the 9th and 10th, (17) 6th dorsal anterior; 4th and
5th lumbar to the right; spine stiff from 6th dorsal to 4th lumbar; right
innominate posterior; 12th rib displaced upward, at its anterior end, under
the 12th, (18) Lateral lesion of 10th dorsal vertebra, with marked rigidity
of muscles and ligaments in the lower dorsal and lumbar regions.
An examination of cases shows wide distribution
of lesion, ranging from the upper dorsal to the coccyx, and affecting ribs,
vertebrae, spinal muscles and other tissues, innominates, coccyx, etc.
The most important lesions in these cases appear in the region of the lower
two or three dorsal, and in the lumbar region. It is in this portion
of the spine that origin is given to the sympathetic nerves supplying the
bowel. Particular attention should be given the 11th and 12th dorsal
and the 1st and 2nd lumbar, as the sympathetic branches from these points
supply the interior mesenteric ganglion and the rectum with motor fibers,
and the abdominal vessels with constrictor fibers. Sympathetic distribution
for the small intestine is from just above the first lumbar; for the large
intestine from the 1st to 4th lumbar, Hence the
importance of the lower dorsal and lumbar lesion in constipation, as it
may interfere with the functions of motion, secretion and circulation by
obstructing the spinal connections of these important sympathetics.
Lesions of the lower two ribs are important causes
of constipation, not only by spinal interference with the sympathetics
mentioned, but by direct mechanical pressure upon the bowel, sometimes.
In yet another important manner they may cause bowel trouble by lesion
to the diaphragm as already mentioned. The whole subject of change
in the diaphragm is an important one in relation to bowel disease.
It is reasonable to consider that certain spinal and rib lesions affect
the diaphragm. They may cause it as a whole to weaken and sag, may cause
contracture of the whole muscular structure, or may contracture or strain
certain portions of it. Thus impingement is brought upon the important
structures passing through the diaphragm, and having much to do with abdominal
activities. The aorta, ascending cava, thoracic duct, pneumogastric,
phrenics, and splanchnics may be interfered with. Or the sagging
of the diaphragm may set up ptosis of the abdominal organs, thug causing
constipation mechanically or otherwise. This subject has been discussed
at length elsewhere.
Lesion to the fourth sacral nerve may cause contracture of the external
sphincter, which it innervates. Lesion to the lower dorsal and the
lumbar nerves may lead to loss of energy of the muscles of the abdominal
walls, as may other causes, and lead to constipation. Robinson states
that such a condition favors constipation by allowing congestion of blood
and secretions, and by lessening intra-abdominal pressure. Lesions
to the liver and pancreas, usually from the 8th to 12th dorsal, or through
the splanchnics or solar plexus, aid constipation by lessening the secretions
of these organs, necessary to stimulation of peristalsis. McConnell
states that contractured muscles are generally found in constipation on
the right side of the spine over the region of the liver. Dr.
Still makes lesion of the 5th dorsal important in these cases.
The coccyx may be so misplaced as to act as a mechanical
obstruction to the passage of the stool. Lesion at this point may cause
contracture of the sacral tissues and interfere with the fourth sacral,
or it may interfere in a similar manner with the sympathetic distribution
to the rectum, and cause atony or contracture of its wars. A prolapsed
uterus, hernia, adhesions, or the presence of foreign bodies, fruitstones,
etc., may mechanically obstruct the bowel.
Various lesions, as of the diaphragm, the weight
of a loaded colon, of the spinal regions, etc., producing ptosis of the
abdominal organs, or of the colon itself, cause a kinking of the flexures
by their dragging upon their ligaments at those points. The same
causes allow of a sinking of the caecum and sigmoid into their respective
iliac fossae, allowing also the sigmoid to fold upon itself. In these
ways obstruction to the passage of fecal matter along the bowel is caused.
In enteroptosis the pressure of organs upon each other limits motion, peristalsis,
and circulation. The elongated omenta and ligaments, in which the
blood vessels and nerves run to the bowels, stretch these structures and
abridge their function. These become important causes of constipation.
The anatomical relations have been described in
detail in considering diarrhea, q. v.
Various lesions, acting to weaken circulation and
nutrition, lead to atony of the bowel muscles, and to constipation.
Any lessening of circulation acts to cause it, as the circulation of the
blood about the nerve terminals in the bowel wall is necessary to their
activity.
The PROGNOSIS is good. Most cases are cured
in a reasonable length of time. The ordinary acute form, occasional
constipation, is cured in one or a few treatments. Very quick results
are often obtained. Cases which have been most obstinate, and those
that have been from birth, have been readily cured. Many cases are
obstinate under treatment, and require time and patience to effect a cure.
The TREATMENT for constipation, from the nature
of the case, must look to the correction of the lesion that is obstructing
circulation, peristalsis, or secretion in the bowel, or to the removal
of the mechanical stoppage that sometimes causes the disease. Some
one or more of the special lesions described are found, and may be removed
by the appropriate methods. The main treatment is for nerve supply,
as practically all of the lesions, except mechanical causes, act in one
way or another through the innervation. The main treatment upon the
spine is in the lower dorsal and lumbar regions, the seat of the chief
lesions. The removal of the lesion is often all the treatment necessary,
but various points must be considered. The treatment must, by the
removal of lesion or otherwise tone the splanchnics, spinal
sympathetics, and solar plexus, as well as Auerbach and Meissner's plexuses,
controlling the motor, secretory, and other functions of the bowels.
Special attention must, be given to lesion at the points mentioned as liable
to them in this trouble.
Abdominal treatment should be a deep, slow, relaxing
treatment carried along the course of the bowel. Very successful treatment
is to spread both hands upon the abdomen, and work deeply, first with the
fingers pressing upon the ascending colon, then with the thumbs upon the
descending colon, thus alternating the pressure from side to side of the
abdomen. This treatment should begin low in the iliac fossae, and
ascend gradually. It relaxes all the tissues, and frees local circulation,
affecting also the local nerve distribution. It dwells particularly
upon those portions in which are felt the aggregations of fecal matters
releasing the tissues about them, softening and passing them along.
This is the special method of removing obstruction of foreign bodies,
such as fruit stones, etc. This treatment should be given especially
to the caecal and sigmoid portion as they are generally full. Attention
must be given to raising and straightening them when necessary. This
may be done in the treatments described in III and IV, Chap. VIII.
Likewise the colon is a whole should be raised and straightened to relieve
kinking at its flexures and the evil results to nerves and blood vessels
accruing from the stretching of its omenta in ptosis. The patient
should be placed in the Sims position, or, better, in the knee-chest position,
and the bowels should be thoroughly pulled up out of the pelvis.
Spinal work and the correction of lesion tones these omenta to hold in
position the replaced organs.
The liver should be thoroughly treated to stimulate the flow of bile.
By the removal of lesion, by treatment to its spinal connections through
the splanchnics, and by raising the 8th to 12th right ribs, this
is in part accomplished. It is treated at the abdomen, as are the gallbladder
and bile duct. (V, IX, Chap. VIII.)
The inferior mesenteric ganglion is the center for
the fecal reservoir, and should be treated at the location already described.
The vagi may be treated in the neck to aid in the general process.
The coccyx should be straightened as the case requires. (XX, Chap. II.)
A contractured sphincter should be dilated. (Chap. IX, D.) Or it
may be released by strong inhibition over the fourth sacral nerves.
They may be located, at the fourth sacral formania, just to the side of
and below the bony prominences that mark the termination of the sacral
canal, and which may be easily felt beneath the skin.
Peritoneal adhesions may be broken up gradually
by deep and careful work upon the bowel at their site. In the absence
of pain, or as it disappears, the treatment may be made strong, care being
taken not to set up inflammation.
Obstruction from volvulus may be sometimes overcome
by manipulation at the seat of the obstruction directed to the straightening
the bowel. This requires long treatment at a time, and much care
and patience.
Symptomatic cases must be treated in conjunction
with the primary disease.
The use of cold and hot drinks before breakfast,
rectal injections, cereal foods, fruits, regularity in habit, and exercise
are all helpful. The water should be drunk neither too soon nor too
long, before breakfast. About fifteen to twenty minutes generally
gives the best results.
CATARRHAL ENTERITIS; DIARRHEA
DEFINITION: An acute inflammation of the intestinal
mucous membrane due to specific spinal lesions. Diarrhea is often
symptomatic of other diseases.
CASES: Lesions were found as follows: 1) Tension
of the spinal tissues from the 3rd to 11th dorsal, (2) Lateral lesion of
the 7th, 8th and 9th dorsal vertebrae, (3) 9th to 11th right rib depressed,
(4) Right 11th rib down onto the 12th; 4th and 5th lumbar anterior; spine
weak, (5) 6th to 11th dorsal vertebra lateral to the left; 12th dorsal,
1st and 2nd lumbar posterior; extreme weakness and irritability of the
muscles along the affected area, especially opposite the 2nd lumbar; ribs
over the liver down, (6) 5th lumbar anterior; 6th and 7th dorsal posterior;
luxation of lower four right ribs.
Lesions may occur anywhere along the splanchnic along the spine as
low as the coccyx. The most important lesions effect the region of
the lower two dorsal and the lumbar vertebra. According to Dr. Still,
in all cases of diarrhea and dysentery there is lesion of the 5th lumbar,
which, through the connected sympathetic innervation, paralyzes the lymphatics
of the bowels, causing the exudations and the stools. The 11th and
12th ribs on each side are sometimes found luxated, most often downwards.
Lesion may occur at the 2nd lumbar, the 5th lumbar, to the innervation
of the small intestine above the fifth lumbar, to the innervation of the
large intestine from the 1st to 4th lumbar, to the coccyx, or to the innominates.
Lesions from the 8th to 12th dorsal and ribs may affect liver and pancreas
to aid the diseased condition.
ANATOMICAL RELATIONS: In intestinal diseases as
in stomach diseases, the importance of the splanchnics and solar plexus;
must be borne in mind. The former contain vaso- and viscero-motors
to the intestines, these vaso-motors being, according to Flint, among the
most important in the body, innervating the immense area of abdominal vessels,
which when fully dilated, are said to be able to accommodate one-third
of the total quantity of blood in the body. They contribute to the
solar plexus, which rules sensation, motion, secretion, nutrition, and
circulation in all these viscera. Our correction of circulation in
these cases is an important consideration. Robinson shows that movements
of the intestines are largely dependent upon the amount of blood circulating
in the intestinal walls. For these reasons lesions anywhere along
the splanchnic region may produce important disturbances of intestinal
secretions, circulation, or motion, all of which may be disturbed in diarrhea.
The whole abdominal sympathetic is important in
these diseases. Stimulation of it lessens peristalsis; stimulation
of the pneumogastric increases peristalsis. We, work not to directly
stimulate or inhibit either of these for the purpose of controlling peristalsis,
but to remove lesion from them as it produces through them abnormalities
of motion.
Auerbach and Meissner's plexus of nerves have to
carry on gastrointestinal secretion. Auerbach's is a motor plexus.
They lie in the intestinal walls, and may be directly influenced by work
upon the abdomen, but are corrected by us through the removal of lesions
affecting them through their sympathetic and spinal connections.
Lesions to them, disturbing both secretion and motion, are important causes
of diarrhea. Robinson states that the inferior mesenteric artery,
located, externally, a little below and to the left of the umbilicus, innervates
the muscular walls of the fecal reservoir, i. e., the left half of the
transverse colon, the descending colon, and the sigmoid. Spinal lesion
to it, through its connected nerves, is active in production of diarrhea.
The fact that afferent sympathetic fibers pass from
the abdominal viscera to the thoracic sympathetic cord may explain the
occurrence of secondary lesions in the form of contractured muscles along
the thoracic spine. The presumption is that they are sensory in function,
and if so, sensory fibers for the abdominal viscera may be associated with
them. Quain states that among the medullated fibers passing into
the sympathetic system, some derived from spinal nerves are sensory fibers.
This may be the explanation why inhibition of the splanchnic area will
stop pain in the stomach or intestines.
All these various facts indicate the importance
in diarrhea of spinal or lower rib lesion, from the 6th dorsal to the coccyx,
which may interfere with the spinal connections of all these abdominal
sympathetics and derange their functions.
Our most important treatment is given from the 10th
dorsal down, in these cases. Lesions in this lower spinal region
are of prime importance in causing diarrhea. The importance of the
lesion to 11th and 12th ribs and vertebrae, and to the upper two lumbar,
is found in the fact that nerve branches from the lower dorsal and upper
two lumbar pass to the inferior mesenteric ganglion, shown above to innervate,
the fecal reservoir. These branches are motor fibres for the circular,
and inhibitory fibers for the longitudinal, muscle fibers of the rectum.
At the same time these lower dorsal and upper two lumbar nerves send branches
to the sympathetics and supply vaso-constrictor fibres to the abdominal
vessels. The motor fibers to the longitudinal, and inhibitory fibres
to the circular, muscle fibres of the rectum are sent from the sacral nerves.
This explains why the lesion of the innominate or coccyx may cause a part
of the trouble in diarrhea, also why strong stimulation to the sacral nerves
relieves tenesmus.
Branches from the four lumbar ganglia go to the
plexus upon the aorta, and to the hypogastric plexus. Lesion in the
lumbar region may in this way further interfere, with the bowel.
The various forms of enteritis and diarrhea seem
to have as their basis derangement of nerve or blood supply in the form
of inflammation (catarrh); lack of proper vaso-innervation, leading to
congestion and exudation; improper preparation of digestive fluids, due
to deranged glandular activity; or increased secretion and exudation.
The removal of lesion obstructing nerve and blood
supply corrects these manifestations of such derangement.
The PROGNOSIS is good. Most cases of diarrhea
are checked at once by a single treatment, many needing no further treatment.
Cases of years standing have been in many instances cured in a short time.
The ordinary acute diarrhea needs but one or a few treatments. Acute
enteritis needs careful treatment for several days while the acute process
lasts. Even long standing cases that had their origin in army dysentery
have been cured.
TREATMENT for diarrhea consists in the removal of
lesion as found, affecting any of the special points named above as subject
to lesion in this disease. The main treatment aside from this is
very simple, and is often given as the sole measure of relief. It
consists of very strong inhibition of the spine from the lower dorsal to
the sacrum. It may be given with the patient on his side, as described
in III, Chap. II. The "breaking up" spinal treatment may be used
for the same purpose. (XXII, Chap. II.) The former seems preferable.
It may be applied to either side or to both sides of the spine.
Inhibition may be made at the 11th and 12th dorsal
region by setting the patient upon a stool, pressing the knee against the
spine, first on one side then upon the other, and grasping the arms of
the patient, raising them above his head, and bending the body backwards
against the knee. This not only inhibits these nerves, but stretches
all the anterior spinal parts and related tissues in the lower dorsal and
upper lumbar regions. This result is more important than the mere
inhibition. The 11th and 12th ribs are often displaced downward,
and may then drag portions of the diaphragm in such a manner as to prevent
free circulation of blood and lymph in the vessels perforting it.
This result alone might cause diarrhea.
Muscular contractions along the spine should be
removed. Deep but careful manipulation should be made upon the abdomen
over the intestines for the purpose of relaxing all their tissues, freeing
circulation and correcting the activities of the Auerbach and Meissner's
plexuses. One may treat to tone the solar plexus, splanchnics, and
general abdominal circulation. The liver should be thoroughly treated,
lesion to it be removed, and the secretion of bile corrected. Its
presence in abnormal quantities may cause diarrhea through increasing peristalsis.
In other cases its presence in the bowel does not hinder the case, and
it is said to allay irritation of the mucosa. Lesion of the 8th to
12th dorsal and ribs may derange either liver or pancreas. In fatty
diarrhea the latter must be looked to.
For tormina or griping, inhibition of the splanchnics is done.
For tenesmus, or bearing down pains in the bowel, strong stimulation of
the sacral nerves is made by thorough manipulation of the tissues over
the sacrum.
It is said that in such cases the abdominal facia
is contracted and causes congestion mechanically. (Charles Still.) When
contracted it should be relaxed by abdominal manipulation.
The vomiting and purging should not be checked if they are the evident
means of getting rid of the irritating content of the bowel and stomach.
The ordinary case is seen after plenty of opportunity has been afforded
Nature to remove the irritant by these means, and calls for immediate checking.
In acute enteritis the case must be seen several times daily.
Gentle relaxing treatment should be made over the abdomen. The liver
is to be lightly treated; spinal muscles relaxed; the spine gently sprung
to release tension in its tissues. The lower ribs may be raised a
little and the neck treated for relief of the head. Careful attention
must be given to the diet of the patient. It should be light and restricted.
Meat broths, mucilaginous drinks, etc., may be given according to prescribed
dietaries. Warm baths and rectal injections may be employed.
Cases of acute diarrhea and enteritis should remain
quietly in bed. The various measures described may employed as necessary.
Spinal inhibition alone may be sufficient. When diarrhea is symptomatic
of other disease it may be relieved by these treatments. Its care
depends upon the care of the disease present.
The various diarrheas of children; summer diarrhea,
gastroenteritis, cholera infantum, etc., are all treated along the same
lines, with special attention to condition present. There is quite
commonly an acute dyspeptic condition present. Hygienic and dietetic
measures must supplement the osteopathic treatment. Fresh air and
cleanliness are essential. Cool bathing is recommended. Cracked ice
may be given to ally the thirst or small quantities of water at a time.
Thin broths, egg albumen, etc., may be fed to the child.
These cases are frequently serious, but the success
of osteopathic treatment has been very marked.
Croupous or diphtheritic enteritis calls for no
special discussion. It should be treated as indicated for catarrhal
enteritis, with special attention to the particular causes.
INTESTINAL ULCERS
The various forms of intestinal ulcers are successfully
treated osteopathically. They are generally due to other intestinal
disease, and are assignable to those lesions so common as the causes of
derangement of intestinal function. These general lesions have been
described under "constipation," an "catarrhal enteritis."
DUODENAL ULCER
DEFINITION: This is a small, round, perforating ulcer
which attacks the walls of the duodenum. It is the homologue of the
gastric ulcer, q. v., and probably originates in the same way. Such
lesions as interfere with intestinal circulation and secretions are the
causes. An obstructed area of circulation in the tissues becomes
devitalized as a consequence of the spinal lesion interfering with the
nerves controlling blood flow. These devitalized tissues are acted
upon by the acid gastric juices, and the beginning of the ulcer is made.
These ulcers are associated with such conditions as cause gallstones and
Bright's disease, and are referable to the same lesions.
The TREATMENT is practically the same as that for
gastric ulcer before described. Lesion must be removed and circulation
be kept free to correct secretions and functions of the intestine, and
to heal the ulcer. Continued thorough treatment should be directed
to the seat of the ulcer to keep the tissues soft and prevent the occurrence
of cicatricial contraction, which may result in obstruction.
INTESTINAL HEMORRHAGE
(ENTERORRHAGIA)
Hemorrhage is one of the most constant symptoms of
duodenal ulcer, and may occur in other forms of intestinal ulcer, as well
as from other causes. The treatment of it must be upon the same plan
as described for peptic ulcer, q. v., for pulmonary hemorrhage, q. v.,
and for hemorrhage in typhoid fever, q. v.
Absolute rest must be enjoyed, and no food must
be allowed, with but a little ice to suck for thirst. Ice bags should
be applied to the abdomen, and the foot of the bed should be elevated about
six inches. If the bleeding comes from low down, small injections
of ice water are good. All active handling of the patient must be
avoided, but a little quiet inhibition may be made along the spine to quiet
heart and peristalsis.
FOLLICULAR ULCERS
These are due to necrosis of the apices of the solitary
glands in enteritis. They have the same etiology and pathology as
has catarrhal enteritis. The lesions and treatment described for
that disease apply exactly to this condition.
STERCOREAL ULCERS
These ulcers are due to mechanical irritation of
hard fecal scybala or enteroliths, and are referable to such lesions as
cause constipation. Their treatment is a most thorough one for bowel
as in constipation. Rectal injection may be used to soften fecal
accumulations. The course of treatment removes lesion and builds
up the circulation, which cures the ulcer. The diarrhea, tenesmus,
and colicky pains are treated as before directed.
SIMPLE ULCERATIVE COLITIS
This condition is usually the result of chronic intestinal
catarrh, and is due to such lesions and conditions as produce it.
The ulceration may involve considerable areas of the mucous lining of the
bowel, showing an extensive disturbance of the intestinal circulation.
The treatment must be thorough and continued long enough to overcome the
marked tendency of the condition to become chronic. The diarrhea,
in the stools of which pus and blood are constant, must be treated as before.
Constipation may alternate with it. Constitutional treatment must
be given, as the disease is a drain upon the system, and the patient may
become weak and emaciated. One must exercise much care with these
cases, especially in the aged. The diet should be fluid or semisolid.
NEUROSES OF THE INTESTINE
The various lesions producing derangement of the
intestinal innervation, sensory, circulatory, motor, secretary and trophic,
have been described. Their anatomical relations to intestinal diseases
have been fully discussed. Various of these lesions may occur and
produce intestinal derangements by special interference with certain functional
activities of the intestines, through acting as lesions to the particular
portion of the innervation having those functions in charge. Thus
the lesion may so act upon the sensory innervation as to cause sensory
disease. Or the predominating disorder may affect particularly the
secretory or the motor functions. Sensory, secretory, and motor neuroses
of the intestine are common. The lesion producing them are not different
in nature from the ordinary lesions found as the causes of gastrointestinal
disorders. For some reason, not well understood, certain of these
lesions may produce, in a given case, certain special kinds of disturbance
of function. In the diseases described below no special lesion has
been yet described as the special cause of each condition. One finds
lesions already described producing them. As a rule, however, these
special sensory, secretory, or motor neuroses are noted in cases of bad
intestinal health, and frequently seem to be specialized pathological manifestations
of this general bad condition. The sensory, secretary, or motor disturbance
has gained the upper hand. In some cases the neuroses is itself the
sole manifestation of the results of the lesion.
SECRETORY NEUROSES
Membranous Enteritis, Mucous Enteritis, or Mucous
Colitis, is often met, frequently occurring in subjects of intestinal disease.
The special lesions present and disturbing bowel innervation act particularly
upon the secretory fibers. The result is over action in the mucous
secreting glands. The mucous membrane is not pathologically altered,
and catarrh if present at all, is a secondary effect. It is a purely
nervous manifestation. Special lesion is commonly found to be the
active cause of irritation to the centers or fibers controlling this function.
Its results are apparent in the copious secretion of the intestinal mucous,
which passes away from the patient in conglomerate masses forming the whole
or a separate part of the stool, in long ribbon-like strips, or in a complete
cast of the intestinal canal of some inches in length.
It is not a serious condition, and removal of lesion,
with thorough spinal and abdominal treatment, will at once begin to correct
the over action of the glands. Its cure may depend upon the restoration
of a general healthy bowel condition. Relief is generally, obtained
at once from the treatment, but considerable treatment may be necessary
to eradicate the chronic condition. Tenesmus, when present, is relieved
by strong sacral stimulation. Colic is relieved by strong spinal
inhibition and by the local inhibitive treatment at the seat of the pain
in the abdomen.
SENSORY NEUROSES
These disturbances are due to irritation to the sensory
nerves supplied by the splanchnics to the intestines.
Enteralia, Colic, or Intestinal Neuralgia, is met
with in neurotic and anemic subjects, and attacks are induced by exposure,
gout and local irritation to the sensory nerves of the intestine by inflammation,
enteroliths, etc. Excepting mechanical irritants, lead poisoning
and like agencies, the actual cause that weakens the intestines and lays
them liable to the action of such exciting causes, is spinal lesion irritating
or weakening the sensory centers or fibers. Many cases occur spontaneously
from spinal lesion. This spinal lesion may act by causing increased
activity in the muscularis, leading to the ring-like contractions of the
intestine present in colic. In many of these cases intestinal cramps
cause localized contractions in portions of the intestines, which may be
readily seen or felt through the intestinal walls. Here the most
efficient treatment is by local manipulation over the seat of the contraction.
Deep inhibitive treatment here quiets the nerves and releases the spasm.
Such local work must be supplemented by corrective work upon the spine,
which prevents further attacks. Strong spinal inhibition may be used
to quiet the pain. Some point is generally found along the splanchnic
area at which inhibition is effective. This is often high up in the
splanchnic region, but, varies with the case, and is found by trial.
Special lesion is to be removed, and stoppage of the pain may depend upon
that.
Diminished Sensibility of the intestines is a common
neurosis. It may be both sensory and motor, and leads to diminished
peristalsis, constipation, and accumulation of the feces in a portion of
the intestine, often in the rectum. It is likely to occur in diseases
of the brain and cord in which the centers are effected. Special
spinal lesion is often the direct cause, or causes the cord disease.
Cure of this condition in such cases depends upon cure of the primary disease.
In other cases, removal of lesion and restoration of activity to the local
nerve mechanism overcomes the paresis. Spinal and abdominal treatment,
directed especially to the course of the intestine, to affect Auerbach's
plexus, and to the solar plexus, will aid a cure. Specific lesions
may cause a paretic condition of a bowel segment and be responsible for
the trouble. A general weak condition of the nervous system, on account
of which nervous shocks and other disturbances cause this condition, must
be remedied by upbuilding it.
MOTOR NEUROSES
Nervous Diarrhea is a condition in which increased
contractability of the muscularis of the bowel is aroused by purely nervous
causes. It is an over-action of the bowel, not presenting the usual
aspects of diarrhea. The stools are softer than normal, and frequent,
occurring two, three, four, or five times in twenty-four hours. The
subject is as a rule neurotic, being hysterical, neurasthenic, or of a
very nervous temperament, but the characteristic lesions found in diarrhea,
q. v., are present and so act upon the nervous mechanism of the bowel as
to lessen its motor stability. Thus its abnormal activity, made possible
by the lesions, becomes the special manifestation of the nervous condition.
There must be some sufficient reason why the general nervous condition
should be able to so center itself upon the bowel. The presence of
such lesions as anatomically weaken the bowel affords a reasonable explanation
of this phenomenon. These lesions usually of the lower dorsal and
lumbar regions, probably affect, through its connections with the 11th
and 12th dorsal and the 1st and 2nd lumbar nerves, the inferior mesenteric
ganglion ruling motor activity in the fecal reservoir.
A case of nervous diarrhea showed lesions of the
11th and 12th ribs, and of the lumbar spine. It readily yielded to
the usual treatment for diarrhea, coupled with tonic treatment to the general
system.
The treatment commonly employed for diarrhea is
efficient in checking this form. At the same time, thorough general
spinal and neck treatment must be given to strengthen the nervous system.
Spinal causes of the nervous condition must be sought and overcome.
The case yields rapidly to treatment, but is very prone to setbacks due
to nervous disturbance. For this reason the patient must be kept
as free from exciting influences as possible. The condition is apt
to recur until the nervousness has been lessened. Fortunately this
latter condition yields to treatment.
Enterospasm is a neurosis of the intestine in which
a spasmodic condition of portions of the intestinal walls recurs.
It may result in temporary obstruction, but its most usual manifestation
is to cause the stools to be passed in separate, rounded masses, or in
ribbon shape. The latter is most frequent. While often a nervous
phenomenon, special lesion is necessary to account for this peculiar manifestation
of nervousness. Special lesion may affect the inferior mesenteric
ganglion through its spinal connections, or the motor fibers of the circular
muscles of the rectum, originating from the lower dorsal and upper one
or two lumbar nerves, and passing thence through the inferior mesenteric
ganglion to the rectum.
CHOLERA MORBUS; CHOLERA
INFANTUM
DEFINITION: Cholera morbus is an acute catarrhal
inflammation of the stomach and intestines, characterized by severe abdominal
pain, colic, vomiting, purging and muscular cramps. This condition,
when present in children under two years of age, is called cholera infantum.
CASES: (1) A young man in intense pain; had vomited
blood several times, and continuous severe vomiting and purging were present,
had a chill; severe griping in the epigastric and umbilical regions.
Inhibition at the 4th and 5th dorsal vertebrae on the right stopped the
vomiting. Inhibition of the splanchnics stopped the purging.
Cracked ice was allowed the patient, and a hot enema was administered.
After the first treatment no vomiting or purging occurred, and rapid recovery
followed. In his previous attacks he had usually remained in bed
for three days, being incapacitated for a week. Morphine was usually
necessary to stop the pain.
LESIONS: Such lesions as described for enteritis,
q. v., are present in these cases, weakening the bowel and rendering it
susceptible to the agencies visually described as the exciting causes.
The irritation of bad food, etc., may affect a healthy bowel in this manner,
but there is often no such factor in the case. Simple chilling of
the body may cause the attack, or slight indiscretion in diet may bring
it on.
The PROGNOSIS is good. Treatment relieves
the case at once, stopping the pain, vomiting, cramps, etc. The patient
rapidly recovers.
TREATMENT: Correction of lesion protects the patient
against further attacks. The severe abdominal pain and colic are
removed by strong inhibition of the spine, especially over the splanchnic
area, and from the 9th to the 12th dorsal. This quiets the sensory
nerves of the viscera. Deep inhibitive treatment upon the abdomen,
over the seat of the pain and about it, aids in relieving it. The
vomiting is checked as before described, as is the diarrhea. The
cramps in the calves are relieved by strong inhibition over the sacrum
and upon the popliteal nerve in the popliteal space. The system should
be strengthened against collapse by stimulation of heart and lungs and
by spinal and neck treatment for the general system.
The patient should rest, in bed, and no food should
be allowed at first, but a little ice is to be used to relieve thirst.
Later a rigorously restricted diet is enforced. Hot injections are
a valuable measure, aiding in the removal of the irritant material from
the bowel. A mustard plaster over the abdomen relieves pain.
HEMORRHOIDS
DEFINITION: Varicose enlargements of the inferior
hemorrhoidal veins or of the hemorrhoidal plexus.
(1) Hemorrhoids and constipation. Lesion at
5th lumbar, coccyx badly bent. (2) 7th to 11th dorsal vertebrae posterior,
coccyx anterior, innominate forward. Hemorrhoids were accompanied
by indigestion and jaundice. (3) Protruding piles of several years standing,
constipation, prolapsed rectal walls. Lesion caused by strain from
heavy, lifting; a weakened lumbar region. Cured in one month.
(4) Constipation and piles of many years standing
caused by a bent coccyx. Four treatments gave great relief; case
still under treatment.
LESIONS AND CAUSES: The common bony lesion present
is a bent or dislocated coccyx, which acts as a local irritant and mechanical
impediment of the venous return from hemorrhoidal veins. Luxated
coccyx, by local irritation and interference with the fourth sacral nerve,
may cause obstinate, contracture of the external sphincter, leading to
constipation or straining at stool. Possibly coccygeal and innominate
or sacral lesion, by direct interference or by dragging of tissues, derange
the sacral nerves supplying motor fibers to the longitudinal muscle fibers
of the rectal walls, weakening them. This result would probably be
aided by the interference of these same lesions with the sympathetic (sacral)
nerve supply to the circulation through branches contributed to the lower
hypogastric and hemorrhoidal plexuses. That of the coccyx seems to
the most important lesion in hemorrhoids.
Lumbar and lower dorsal lesion may be present and
interfering with the innervation of the abdominal walls, relaxing them,
lessening intra-abdominal pressure, and allowing of congestion of the abdominal
circulation. By direct effect or by causing constipation, this condition
may cause hemorrhoids. Lower dorsal and upper lumbar lesion to the
nerve fibers which pass by way of the inferior mesenteric ganglion, to
supply motor fibers to the circular muscles of the rectal wills may become
a factor by weakening the wall, relaxing its tone, allowing of a congestion
in its vessels. Lesion to the splanchnic and lumbar areas, affecting
the sympathetic supply which, through the splanchnics, solar plexus, and
other sympathetic vaso- and viscero-motors originating along these same
areas, rules circulation and muscular tonus in the abdominal and pelvic
viscera, may contribute in an important way to causation of hemorrhoids.
Likewise those lesions to the spine and lower ribs, well known as causes
of liver derangement, become causes of hemorrhoids by producing obstructed
portal circulation and constipation. The chief drainage by the hemorrhoidal
plexus of veins is through the portal circulation by way of the superior
hemorrhoidal vein. Lesions causing disease of the heart and lungs,
q. v., may secondarily become causes of hemorrhoids through the systemic
circulation. Lesions causing atonic diaphragm and other causes of
enteroptosis, q.v., produce hemorrhoids by the mechanical obstruction of
circulation, and by deranged nerve supply, etc.
The ANATOMICAL RELATIONS are pointed out above.
The American TextBook of Surgery calls attention to the fact that these
veins are unsupplied with valves and also that they tend to become congested
by the natural upright position of the body. These facts aid in explaining
the potency of the above lesions, and of any obstructive condition (pregnancy,
overeating, etc.) in causing this condition.
The EXAMINATION must be made by both inspection
and palpation, the use of a proper speculum aiding a thorough inspection
of the rectum.
The PROGNOSIS is very favorable. The usual
medical treatment is palliative, or surgery is resorted to. The latter
may often become necessary, but the success of osteopathic treatment prevents
many operations.
Even the most severe cases have been successfully
treated. The treatment generally begins to succeed immediately.
Long standing cases are often cured in a few months. Some cases are
slow and obstinate.
The TREATMENT is local, abdominal, spinal and constitutional.
Local treatment is first directed to correcting
the coccyx if necessary. (XX, Chap. II.) The external sphincter should
be well dilated. This may be accomplished by inserting two, or even
three, fingers, well vaselined, and held together at the tips in wedge-shape.
After being well inserted, they are spread apart and withdrawn carefully.
The dilatation must be thorough. The rectal speculum may be used
for this purpose. All the surrounding tissues, both externally and
internally, are to be thoroughly but gently relaxed. Internally
this operation should be carried as far up along the rectal walls as the
index finger is able to work. Pressure is made upon the injected
veins to empty them of blood and to stimulate their local nerve and muscle
substance to proper tonus. In case of thrombi in strangulated veins,
the manipulation about and upon them must be gently applied with the purpose
of stimulating the circulation to a gradual absorption of them. They
must not be broken up or detached, as there is danger of their being swept
into the circulation as emboli.
After dilatation of the sphincter and relaxation
of the tissues, protruding piles, first emptied if possible, must be gently
pressed back beyond the sphincter. If the rectal walls are prolapsed,
as is often the case in protruding piles, they must be replaced by the
index finger directed to straightening out and pushing them up on all sides.
This local work removes irritation of the coccyx,
frees the whole local circulation, tones the local musculature and other
tissues, and stimulates the local sympathetics. It may be the sole
and sufficient treatment in many bad cases. It should be given but
once per week or ten days.
Abdominal treatment is for the purpose of increasing
freedom of circulation and to aid in the venous return. The solar
and hypogastric plexuses are stimulated and manipulation is made over the
course of the inferior mesenteric and common and internal iliac arteries.
Portal circulation is helped by deep abdominal work from the lower abdominal
region upward to the liver. Lesions to the latter organ are removed,
and thorough treatment given to the liver, as in the treatment for constipation,
q. v., which must be relieved, it being usually present. (V. Chap. VIII.)
The viscera are raised, and treatment is made deep
in the iliac fossae to stimulate the pelvic sympathetic plexuses and to
aid venous return from the hemorrhoidal, vescical, uterine, and other related
plexuses of veins. (II, III, IV, Chap. VIII). If the patient
is placed in the knee-chest position while abdominal treatment is performed
with the ideas explained above, the force of gravitation is made to assist
in venous drainage of the parts. This is an important treatment, and should
not omitted in these cases.
Enteroptosis and diaphragmatic lesion are repaired
as before explained.
Thorough spinal treatment is given from the sixth
dorsal down, stimulating splanchnics and other sympathetics, with all their
contained vaso- and viscero-motor, circulatory, and trophic fibers.
This treatment is to strengthen circulation and to maintain its freedom.
It is supplementary to the abdominal work. It also aids in restoring
tone to the vessel walls, as well as to prolapsed rectal walls, and thus
to maintain them in correct condition. Anatomical relations between
the spinal work and the effect gotten at the seat of the disease have been
explained.
Correction of spinal, rib, or innominate lesion
is made if necessary. In this way, and by work along the lower dorsal
and upper lumbar regions, coupled, with the local treatment upon the abdominal
walls, the latter are built up and restored to normal tonus if relaxed.
The constitutional treatment consists in the general
spinal treatment, and in special treatment for heart and lung diseases
if present and causing the hemorrhoids.
Light outdoor exercise and absolute personal cleanliness
should be enjoined upon the patient.
INTESTINAL TUMORS
Intestinal Tumors of various kinds, both benign and
malignant have been frequently treated osteopathically with success.
Medical treatment is but palliative, and the only means of removal has
been by surgical operation. The fact that in numerous instances these
tumors have been entirely removed by osteopathic treatment is in itself
remarkable, and helps to sustain the claim often made, that the use of
the knife is often obviated in the treatment of such conditions.
THE TREATMENT is simple, and consists in the removal
of spinal lesion, which may be of any of the kinds described as producing
gastrointestinal disease. At bottom the real cause of these growths
is some obstruction or irritation to local blood and nerve supply.
It has already been shown how special lesion causes this obstruction, or
lays the foundation of the condition which directly or indirectly produces
the irritation. The treatment is therefore the removal of lesion
and the restoration of normal nerve and blood supply. Spinal treatment,
aided by abdominal work, accomplishes this object. The latter is
done, not upon the tumor itself, but upon the surrounding parts.
It relaxes tensed tissues, opens arterial blood supply and venous and lymphatic
drainage, and restores normal condition. In this way the progress
of the morbid process is stopped, healthy tissue is built, and the tumor
disappears, by absorption. At least one case is upon record in which
the tumor, a fibroid, was loosened by the treatment and passed per rectum.
(Cosmopolitan Osteopath, Feb.., 1900, p. 30.) The diet should
be light, and of a sort easily digested. Rectal feeding has sometimes
to be resorted to in cases where the turner causes obstruction.
Attendant conditions, such as constipation, fecal
impaction, colic, etc., are treated as described elsewhere. See also
section upon "Tumors."
APPENDICITIS
DEFINITION: An inflammation of the vermiforni appendix,
acute or chronic, caused by traumatism, or by specific rib or spinal lesions.
These lesions obstruct bowel action, limit its motion, deplete its nerve
and blood supply, leaving a weakened condition, allowing of aggregation
of fecal matter, foreign bodies, etc. The vigor to pass these onward
is lacking, and they are pressed into the appendix, which itself is suffering
from a weakened state due to these causes. Or direct irritation of
lesion may affect nerve and blood mechanism, derange vaso-motion, and set
up the inflammation. Or the direct mechanical
irritation of displaced lower rib may set up the inflammation.
CASES: (1) Lesions; 2nd lumbar lateral, with heat
and pain about it; 11th right rib luxated. Treatment relieved at
once, and the patient was cured in two weeks. Surgeon had been ready to
operate. (2) 12th right rib down and inside of the crest of the ilium.
Setting the rib cured the case in a few days. (3) Recurring appendicitis;
spine posterior in lower dorsal and upper lumbar; lateral curve at 6th
to 9th dorsal; constipation chronic; cured by ten weeks treatment. (4)
Tenderness upon right side of spine from 6th dorsal to 2nd lumbar, especially
at the 6th to 10th dorsal and 1st and 2nd lumbar. (5) Lesion at lower dorsal
and upper lumbar; 10th and 11th ribs overlapping 12th, due to a fall.
Operation had been advised, but two months treatment cured the case. (6)
Appendicitis in a boy of twelve, for which operation bad been advised
Examination showed downward displacement of 11th and 12th ribs, a posterior
condition of the 5th lumbar vertebra. Incontinence of urine was also
a feature of the case. The case was cured by correction of the lesions.
(7) A severe acute case, in which operation was about to be performed.
The patient was in great agony when the treatment was begun. Treatment
gave immediate relief, and the case was cured. Lesion was found at
the 5th lumbar. (8) A chronic appendicitis of five months standing,
in a young man of twenty-five. Lesion was present as a lateral displacement
of the 9th to 12th dorsal vertebrae to the left. This same spinal
area was anterior. The bladder would not empty. By twenty-two
treatments the case was cured, within three months. Pain at McBurney's
point was relieved at the second treatment and did not recur.
LESIONS AND CAUSES: (1) There is usually a history
of constipation in these cases. In some it follows diarrhea.
There can be no doubt that the lesions causing these diseases, q. v., are
the real causes of appendicitis in many cases. Many apparently robust
men suffer from this disease, but experience shows that many such have
unhealthy bowels to begin with. Many show the specific spinal lesion.
The cases caused by a foreign body, seeds, shot, enteroliths, etc., would
probably not become victims of appendicitis but for weakened bowel condition
due to such lesions as cause constipation. The fact that very often
the body is a fecal concretion supports this view. The inflammation
is a vaso-motor disturbance. Such disturbances, due to lesion, have
been seen to be the causes of constipation, etc. The appendix must
suffer with the rest of the bowel from these causes, and thus being weakened
cannot further resist special causes of vaso-motor disturbance.
(2) Displacement, or dragging of the colon at the
hepatic flexure prevents the passage of fecal matter and forces the introduction
of fecal masses into the appendix. It also obstructs circulation,
causing congestion and favoring inflammation.
(3) The most important bony lesions seem to be displacements
of the lower two ribs on the right side. They may add mechanical
obstruction or irritation to deranged nerve connections at the spine.
(4) Lesions of the dorsal and lumbar regions are
very important on account of the nerve connections with the bowel.
From the 9th, 10th, 11th and 12th dorsal region sensory nerves pass through
the sympathetics; to supply the intestines down to the upper part of the
rectum. For this reason strong inhibition to this portion of the
spine is useful in controlling the pain in appendicitis. The sympathetic
vaso-constrictor fibers for the abdominal vessels pass from the lower dorsal
and upper two lumbar nerves, while branches from the lumbar ganglia pass
to the plexus upon the aorta and to the hypogastric plexus. Thus
lower dorsal and lumbar lesion has an important effect in disturbing the
vaso-constrictor innervation, necessary to the production of this inflammation.
(5) Direct traumatism to the region of the appendix,
the presence of foreign bodies in the bowel, or extended inflammation from
contiguous structures, may all be causative factors.
The anatomical relations given for lesion in diarrhea
apply to those in appendicitis.
The appendix has the same structure as the caecum,
practically; is nourished by a branch of the ileo-colic artery, possesses
innervation (Auerbach and Meissner's plexus?), causing in it peristalsis
and secretion of abundant tough mucous from its numerous mucous glands.
In health the free secretion of this mucous fills the cavity of the structure
to the exclusion of foreign bodies, but upon lesion to the blood or nerve
supply such as mentioned above, lessened secretion allows of room for the
entrance of foreign bodies. Byron Robinson says that active occupations
in men, contracting the abdominal walls, favor thus the forcing of matter
into the appendix, causing appendicitis. But it is very likely that some
lesion, of the kinds above described, first weakens the tissues of the
appendix and lessens its normal condition and secretions, laying it liable
to such accident.
Anemia may become a cause of the inflammation in
it.
The PROGNOSIS is favorable for recovery in nearly
all cases. The experience with cases, even the most dangerous acute
ones, has been very satisfactorily. Many such are upon record, restored
to health after operation had been advised as the last resort. If
seen in time, very few cases need ever come to the knife. The point
of surgical interference is, however, often reached. Osteopathic
treatment prevents the case falling into the chronic form so commonly met,
and in which operation, to prevent an attack, is so often resorted to.
The acute case is usually aborted by prompt treatment.
TREATMENT: The first consideration is the removal
of the lesion if possible in the patient's condition. This applies
particularly to displacements of the 11th and 12th ribs. Here gentle
manipulation and slight elevation may be sufficient to remove the irritation.
Immediate attention should also be given to the relief of the constipation
commonly present. If not soon affected by the treatment, rectal injection
should be employed. This measure materially aids conditions by removing
the pressure of bowel contents from tender points, by giving freedom of
circulation in the bowel, and by aiding to remove foreign bodies.
An essential part of the treatment is local treatment
of the tissues at or above the site of the inflammation. By care,
little difficulty will be experienced in applying such treatment even in
very painful cases. The relaxation of the tissues thus accomplished
gives immediate relief to the patient. Not only the abdominal walls,
but the deep tissues and circulation about the appendix are thus treated.
The treatment must be slow, deep, inhibitive and given with great care.
In the intervals of treatment, it may be necessary to apply the ice-bag
or hot fomentations at the seat of the inflammation.
It is not likely that in this contingency spinal
work to increase peristalsis would be at all successful in removing the
foreign body from the appendix. Local manipulation must be depended
upon for this. The pain is relieved by spinal inhibition from the
9th to the 12th dorsal particularly. Nausea, vomiting, fever, and
hiccough, aside from being relieved by the general treatment of the case,
may be relieved by the usual methods before described.
The patient should go to bed at once upon the attack
threatening. A restricted fluid diet, taken a little at a time, should
be enforced. Attention should be given the kidneys and general condition.
The patient should be seen several times daily until out of danger. Continued
treatment should be given for a while after recovery to prevent recurrence
or relapse.
The chronic case, possessing various degrees of
chronic pain, tenderness of tissues, and inflammation in the right iliac
fossa, is a familiar object. The purpose of the work is to remove
lesion, to restore perfect freedom of circulation, and by local treatment
of the tissues to remove tenseness and pain. Thorough spinal and
abdominal treatment, and attention to the general condition of the bowel
are necessary. The disappearance of tenderness in the right iliac
fossa does not remove the danger of acute attack, as extensive morphological
changes have usually taken place in the tissues of the appendix, which
call for a course of treatment to so restore circulation as to enable it
to repair them.
RECURRENT APPENDICITIS frequently comes under treatment,
and presents the same lesions as have been above described. No special
mention need be made regarding its treatment, in addition to what has been
in regard to the treatment of chronic and acute cases.
INTESTINAL OBSTRUCTION
DEFINITION: The occlusion of the bowel may be but
partial, persisting as a chronic condition. In acute cases it may
be wholly or partially obstructed. It may be due to strangulation;
to twists and knots, called volvulus; to strictures and tumors; or to intussuseption.
CASES: (1) Fecal impaction. Severe radiating
abdominal pains, griping, and some dysentery had been present for twenty-four
hours. The impaction was located at the hepatic flexure. Treatment
relieved the pain at once, and the manipulation removed the obstruction.
Complete recovery followed.
(2) Volvulus was diagnosed, located near the ileo-caecal
valve. The surgeon was ready to operate. Persistent treatment
straightened the bowel and a movement of the bowels was had. The
recovery was complete.
(3) Impaction of the ileo-caecal valve. The
attack came on violently at night. The family physician, after eighteen
hours work over the patient, advised operation. Osteopathic treatment
reduced pain and inflammation at once, and allowed a further examination.
The impaction was located at the ileo-caecal valve, and manipulation removed
it within a short time. The patient was asleep in thirty minutes.
(4) Intestinal obstruction from fecal impaction,
in a boy. Three physicians had given the patient up. The abdomen
was much swollen and intensely painful, and the seat of the obstruction
could not be located. Tension was found in the tissues of the spine
at the 10th dorsal. Inhibitive treatment was made here, while the
pneumogastric were stimulated. This treatment was kept up throughout
the night. An enema was given. Early in the morning the bowels
were gotten to move successfully, and in a few weeks the boy was quite
well.
(5) Intestinal obstruction in a child of 7 months
of age. Physicians gave up the case, and were ready to resort to
surgery as the last hope. By one treatment the baby’s bowels were
moved, and the case was entirely cured.
(6) In a case of fecal impaction in the splenic
flexure of the colon, ten minutes treatment relieved the intense pain and
opened the bowels. The patient had been about to undergo operation
for appendicitis, as the condition had been wrongly diagnosed.
LESION AND CAUSES: Only in rare cases would it be
likely that some specific lesion would lead directly to this trouble, but
in most of them it is probable that lesions would be present accounting
for the bad condition of the bowel that resulted in some form of obstruction.
In general one would expect such lesions as have already been described
as interfering with the abdominal organs. Intussusception is sometimes
due to irregular, limited, sudden, or severe peristalsis. In such
cases special lesion to the splanchnics, or to the sympathetic connections
of Auerbach's plexus might result directly in the abnormal peristalsis
producing the invagination. In such cases the outer layer, or receiving
portion of the bowel involved, draws up by contraction of its longitudinal
fibers. Such abnormal activity of these fibers might also be due
to some special lesion to motor innervation.
In some cases McConnell suggests that special spinal lesion could cause
paresis or paralysis of a bowel segment. Such a condition could allow
of a pouching of the affected portion, and of accumulation of feces or
foreign bodies. Specific lesion might also cause stricture by contraction
of a segment.
The fact that obstructions often follow constipation.
or diarrhea shows the importance of lesions producing a bad bowel condition.
Volvulus is especially frequent at the sigmoid and at the caecum, enteroptosis
being the cause, through allowing the parts to prolapse and turn.
Volvulus may be caused by a long or relaxed mesentery. The frequency
of spinal lesions causing the weakened omental supports that allow of the
ptosis shows the importance of spinal lesion as a factor in causing obstructions.
Spinal or rib lesion may be looked to as the original cause of a large
number of the various forms of obstruction. It may produce the tumor
whose pressure obstructs the bowel; the peritonitis, following which adhesions
cause strangulation; the ulceration in the bowel which gives place to cicatrization
and stricture; or the inactive condition of bowel motion and secretion
that allows of accumulation of fecal matters, foreign bodies, etc.
A healthy bowel, perfectly free from the effect of lesion of any kind,
could only under rare conditions become the seat of one of the various
forms of obstruction.
The importance of lesion producing unhealthy abdominal
or internal conditions must be acknowledged in the etiology of these cases.
The ANATOMICAL RELATION of these various lesions
have already been pointed out in the consideration of various intestinal
diseases.
The PROGNOSIS must be guarded. Very many cases
die, and surgical measures have generally considered necessary after the
third day of obstruction. Yet osteopathic treatment, has been successful
in a number of cases after the necessity for operation had been urged.
Probably, as in the case of appendicitis, many lives could be saved by
osteopathic means before surgery is resorted to.
In chronic cases the prognosis for recovery is very favorable.
Most cases could be prevented from coming to the point of absolute obstruction.
If they could be foreseen, most acute cases could no doubt be prevented
by osteopathic treatment.
TREATMENT: In such cases as depend upon a special
lesion, it should be removed. Generally the first consideration is
the alleviation of the patient's condition. Strong inhibition of
the splanchnic area, especially from the 9th to 12th dorsal, and of the
lumbar region, aids in lessening the pain. This step might be necessary
before abdominal manipulation can be borne. The solar plexus should
now be inhibited. A slow, deep, but gentle inhibitive treatment should
next be given over the bowel to relax the tissues, decrease the inflammation,
and lessen the pain. This treatment may be used to quiet abnormal
peristalsis if present. After this preliminary treatment the practitioner
may proceed by careful palpation to locate the seat of obstruction if possible.
This is often impossible, and in such cases one must work over the bowel
generally. In some cases the obstruction is felt, or the seat of
the pain is an indication of its position.
The main work must be done by abdominal manipulation.
The parts of the intestine must be so managed as to be raised, straightened,
and drawn away from each other. The caecum and sigmoid may be raised
and straightened, (Chap. VIII, divs. II, III, IV). Deep treatment
may be made in the right and left hypochondriac regions to free the hepatic
and splenic flexures. In intussusception the parts should be raised and
drawn from each other toward the extremities of the cylindrical tumor,
if it can be made out. In volvulus, raising and straightening the
involved portions is relied upon.
The stricture and adhesions may be manipulated with
the purpose of softening, relaxing, and breaking them down. Foreign
bodies and fecal aggregations must be gradually loosened and worked along
the bowel. They are more readily handled than other forms.
It may be necessary to manipulate them after rectal injection, to aid in
moving them. Copious injections sometimes aid in overcoming intussusception,
volvulus, etc. Injections of Sedlitz powder solutions, injected separately,
have been successfully used. During the abdominal treatment it is
well for the patient to be placed in various positions; upon the back,
sides, upon the abdomen, in the knee-chest position, etc., to get the aid
of gravity in righting the parts. Some writers recommend thorough
shaking of the patient. He is held by four men by the arms and legs,
first with the abdomen upward, then downward, while the shaking is done.
There should be much persistence in the treatment.
The practitioner should remain continuously with the case, and treat it
as much as practicable, until relieved. In the intervals, hot applications
over the seat of the pain may made.
In chronic cases the treatment may be carried on
as usual, upon the plan given above for the treatment of acute cases.
After removal of obstruction, a thorough course of general treatment should
be undertaken for the removal of lesions that have originally impaired
the bowel or have produced abnormal abdominal conditions.
ENTEROPTOSIS
Enteroptosia is a disease in which various of the
abdominal and pelvic viscera leave their natural positions, slipping downward
into the abdominal and pelvic cavities. It is a common and distressing
complaint, frequently overlooked or not recognized. It is sometimes
regarded as a symptom group, but may, from the osteopathic point of view,
be regarded as an idiopathic condition, due to specific lesion.
These cases are often treated for some one feature,
as for nervous dyspepsia, constipation, operation for floating kidney,
etc. It is a common error to overlook the essential condition of
the disease. The Osteopath who gives close attention to a class of
neurasthenic, flat-chested, constipated patients, who complain of lack
of bodily and mental vigor, many and various indefinite nervous symptoms,
abdominal pulsation, vaso-motor disturbance, etc., will find most interesting
material. The multitude of symptoms may vary greatly in different
cases, but the presence of neurasthenic conditions, altered thorax and
spine, and unnatural abdominal condition, either of walls, viscera, or
both, will usually afford an unmistakable sign of the disease. After
a little experience with such cases one learns to recognize them at a glance
when presented for examination. Once seen these cases can hardly
be mistaken, and a few moments examination reveals a story of disease beginning
imperceptibly, the growing conviction through many months or some years
that something was wrong, the attempt to seem well because no decided disease
seemed present, or a long course of treatment for various ills, none of
which reached the true condition. This most common disease it still
but seldom clearly recognized or intelligently handled.
LESIONS AND CAUSES: The common description of its
etiology is unsatisfactory. Tight lacing, traumatism muscular strain,
and repeated pregnancies are mentioned. The condition of relaxed
abdominal walls and prominent viscera due to repeated pregnancies may probably
be rightly regarded as a separate condition. It is due to a physiological
act, and does not present those specific lesions nor the resulting symptoms
found in neurasthenic enteroptosis. Tight lacing, traumatism, and
muscular strain may produce those lesions found to be the cause of such
conditions.
These cases commonly present spinal, rib, diaphragmatic
and abdominal lesions. Spinal lesions may be of any of the kinds
found in the spine ordinarily, and may occur anywhere along the splanchnic
or lumbar region. Rib lesions may occur in any or all of the lower
six ribs on either side.
Mobility of the tenth rib is regarded by a German physician, Dr.
B. Stiller, (Phil. Med. Journal, Jan. 13, 1900,) as a pathognomonic
cause of enteroptosis (Boston Osteopath, Jan. 14, 1900). Undoubtedly
it could interfere with the sympathetic connections of the abdominal viscera
and become a factor in causing this condition. But, from an osteopathic
viewpoint, lesions of other ribs, and of spinal vertebrae, etc., may be
as potent in producing the "basal neuropathy" concerned in this disease
as its fundamental pathological condition. Further, rib lesions may
cause a condition of the diaphragm in which its normal tone is lost, and
prolapse in it causes ptosis in the abdominal organs which it aids in supporting.
Spinal lesions may participate in causing the atonic condition of the diaphragm.
Spinal and rib lesions, aside from derangement of
the diaphragm, act to produce enteroptosis by interfering with the spinal
sympathetic connections of the viscera and of their omental supports.
Impeded circulation and nerves supply, vaso-motor, motor, secretary, trophic
and sensory produces at the same time derangement of function in the organs
and weakness in their mesenteric supports. These conditions work
together to bring about the disordered function and the displacement of
these organs. The displacement of itself furthers the present bad
conditions by mechanically interfering with the activities of organs, stretching
nerve fibers and blood vessels which are carried in the now elongated omenta,
kinking the colon at various points, etc. The viscera, having sunk
down into the abdominal cavity, cause prominence of the lower abdomen,
leaving a hollow in the upper abdomen, thus giving to it the peculiar boat-shaped
appearance described as "scaphoid abdomen."
Lower dorsal and lumbar lesion may interfere with
the spinal innervation of the abdominal walls, cause them to lose their
tone and to dilate. Intra-abdominal pressure is thus lessened and
the organs are allowed to prolapse.
According to Byron Robinson, enteroptosis begins
with a weakening of the abdominal sympathetic, which loses its normal power
over circulation, secretion, assimilation and rhythm. That this weakness
of the abdominal sympathetic and its consequent loss of function originates
in spinal lesion to its origin in the splanchnic nerves has already been
pointed out and fully discussed in considering the diseases of the stomach
and intestines, q. v. The anatomical relation of such lesions to parts
affected was pointed out.
The PROGNOSIS in these cases is very favorable,
but the progress of the cure is likely to be slow. Generally improvement
begins immediately upon treatment and may progress to a cure in a few months.
Other cases yield more slowly, though relief is soon given, and require
an extended course of treatment to effect a cure.
The TREATMENT must be both constitutional and local.
The latter consists in the removal of lesion and in abdominal treatment.
Lesions anywhere to the splanchnic and lumbar regions, to the ribs, thorax
and diaphragm, must be treated after their kind, according to directions
given in Part I. With spine, ribs, and diaphragm restored to normal condition,
the underlying causes of the enteroptosis have been removed. Corrected
nerve and blood supply to the organs and their supports aids in correcting
their function and strengthens the supporting tissues to hold them in place
when restored by abdominal manipulations.
Correction of spinal lesion also aids in restoring
nutrition and tone to the relaxed and atrophied abdominal walls.
This process is furthered by a thorough treatment upon the abdominal walls.
This renders the use of the favorite abdominal bandage unnecessary, and
it is gradually laid aside. Throughout the course of the case the
restored abdominal walls act as the bandage has done to hold the organs
to their places as replaced by the treatment. With corrected spine,
free blood and nerve supply to all the visceral supports, and a strengthened
abdominal wall, no difficulty is found in getting the parts to gradually
be retained in their normal positions. Thorough spinal stimulation
over the splanchnic and lumbar; areas is kept up for the purpose of increasing
the blood and nerve supply to the parts in question.
Abdominal work, aside from treatment of the walls,
is directed to raising and replacing the viscera. This is readily
accomplished by various treatments. (II, III, IV, Chap. VIII.) This
releases and renews circulation and nerve supply at the same time, removes
pressure of organs upon each other, gives freedom of motion, and aids in
strengthening the omenta to hold the parts in place. The diaphragm
has been restored to normal position, and tone by correction of those lesions
originally deranging it.
The constitutional treatment must be thorough and
general to restore the patient from the nervous, circulatory, nutritional,
and other effects of the disease. A most thorough general spinal
treatment must be given. Thorough stimulation of heart and lungs,
treatment of the cervical sympathetic, and attention to kidneys, liver
and skin accomplishes the desired object. The auto-intoxication usually
present is overcome by this treatment of the excretory organs. The
constipation, dyspepsia, and other functional disorders are corrected by
the restoration of the organs concerned.
The patient should be much out of doors, free from
worry, and careful not to become fatigued. Deep breathing exercises
are beneficial.
PERITONITIS
DEFINITION: An acute or chronic inflammation of the
peritoneum, localized or general.
CASES: (1) A case diagnosed as septic peritonitis,
probably caused by appendicitis, under the care of celebrated Chicago physicians
grew steadily worse until death was expected in a few hours. No hopes
of recovery were entertained, and it was evident that the best medical
treatment was of no avail. As a last resort an Osteopath was finally
called, all medical treatment was discontinued, and the treatment began.
Immediately, under the treatment, the great pain that had been present
for hours at a time, was controlled, and during the next four weeks not
two hours pain in all was experienced. The other symptoms were also
discovered upon examination, and led to inquiry concerning accident, which
brought out the fact that the boy had had a serious fall a few weeks before.
The resulting lesions were held to be the primary cause of the peritonitis,
and treatment directed to them was the cardinal treatment. The fact
that the child's life was saved at such a juncture, in disease of such
a nature, by the removal of spinal lesion, is a convincing demonstration
of the correctness of osteopathic theory and practice.
The LESIONS expected in such cases are to the lower
ribs, the lower dorsal and lumbar spine, and sometimes the pelvis.
In such cases as are secondary to other disease, such as inflammation in
the various abdominal organs, typhoid or diphtheritic ulcer, appendicitis,
volvulus, etc., the active lesion in the case must be sought for as the
cause of the primary disease. Such lesions may be various.
ANATOMICAL RELATIONS: The nerve supply to the parietal
peritoneum is from the lower intercostal and upper lumbar nerves, which
supply also the muscles of the abdominal walls. The abdominal sympathetics
also supply the peritoneum, being chiefly vaso-motors for the blood vessels
in the mesentery, but also having certain branches distributed directly,
to the substance of the peritoneum.
The blood supply is from the coeliac axis through
the hepatic and splenic arteries, and from the blood supply of the parts
with which the various portions of the mesentery are in relation.
The fact that the chief sympathetic supply to the
peritoneum is to the peritoneum is to the blood vessels in it is a significant
one.
The inflammation of peritonitis is a vaso-motor
disturbance. It has been before explained how spinal lesion deranges
spinal sympathetic connections of the abdominal sympathetic and produces
disease. Thus certain lesions among the lower ribs, and along the
lower spine, result in derangement of the sympathetic, which, when affecting
the peritoneum, becomes a chiefly vaso-motor disturbance because of the
peritoneal sympathetics being mostly vaso-motors, and the inflammation
results.
In another way, these lesions, affecting the lower
intercostal and upper lumbar spinal nerves, may become the active cause
of peritonitis. Hilton shows that these nerves, supplying the skin
and muscles of the abdominal walls, as well as the parietal peritoneum,
probably also supply the visceral peritoneum and send sensory branches
through the sympathetic to the intestinal walls. Quain's anatomy
shows that from, the 9th, 10th, 11th and 12th dorsal nerves, sensory nerves
pass through the sympathetic to the abdominal viscera. It also shows
that from thoracic sympathetic and from the lumbar sympathetic cord vaso-motor
fibres of the abdominal vessels take origin. The ultimate relation
between the spinal and sympathetic nerves is well known. Hilton uses
the facts he points out in regard to this connected nerve mechanism to
explain why the abdominal walls become painful and contracted from the
inward irritation of the inflammation. The connection of this nerve
mechanism for all these related parts also explains how lower rib, lower
dorsal, and upper lumbar spinal lesions may so interfere with vaso-motor
supply to the peritoneal vessels as to cause peritonitis. This immense
abdominal nerve supply, both superficial and internal, spinal and sympathetic,
offers the Osteopath, both through its surface distribution and spinal
connections, and its internal distribution, a vast and most readily accessible
field for his work by superficial and deep abdominal and spinal treatment.
This fact well explains his good results, even in bad cases, in gaining
control of the vaso-motor mechanism which is deranged in this inflammation.
Through the connection of this local vaso-motor
mechanism with the vaso-motor system of the whole body, reflex irritation
is set up which leads to a general vasoconstriction of the vessels of the
whole body surface. Robinson thus explains why the whole skin is
waxy pale and cold, saying that the patient, on this account, dies from
circumference to center.
Robinson also shows that traumatic action of the
left end of the diaphragmatic muscle upon the gut wall, of the psoas magus
upon the sigmoid, and abrasion of the bowel mucosa at the splenic and sigmoid
flexures, very frequently become the causes of peritonitis by allowing
the migration and foothold of pathogenic bacteria. Spinal, or other
specific osteopathic lesion, by causing bad bowel conditions which allow
of the possibility of such traumatism, may be present and must be removed
in the treatment for, or the prophylaxis of the disease.
The PROGNOSIS in these cases is fair. Considering
that peritonitis patients often die under medical treatment in the acute
form of the disease, and that operation must frequently be resorted to,
the success osteopathy has had with serious cases is marked.
The TREATMENT must aim at gaining vaso-motor control
and thus reducing the inflammation. Lesion must be corrected as soon
as possible. The treatment must be both spinal and abdominal.
The first step should be thorough but careful relaxation of all spinal
tissues. If the patient cannot be turned upon his side, he may continue
to lie upon his back, and the operating hand may be slipped under him to
work along the spine. Inhibition should be made along the splanchnic
and dorsal, to upper lumbar regions, especially of the 9th to 12th
to quiet the pain through inhibition of the sensory fibres. After
spinal relaxation and inhibition, the abdominal treatment will be better
borne. Through this spinal treatment effect upon vaso-motor activities
is gained by way of the sympathetic connections explained above.
This aids in freeing the circulation. During the progress of the
treatment of the case, the inhibitive spinal treatment may be alternated
with a thorough stimulation of the sympathetic connections of the parts
involved, to check peristalsis. As soon as possible, thorough general
spinal treatment should be given to equalize the general circulation, and
to overcome the intense vaso-constriction of all the superficial vessels,
so noticeable a feature of the case. Heart and lungs should be stimulated,
and inhibition of the superior cervical region be made.
After spinal inhibition very light abdominal treatment is given.
The walls are tense and painful, and much care is required in treating
them. The treatment should be gentle, relaxing, and inhibitive, thus
relaxing the contractured muscles, aiding general circulation, and decreasing
pain. On account of the relation between the nerves of the abdominal
walls and those of the inward parts involved, as pointed out above, work
upon the abdominal walls has an important corrective effect upon the morbid
conditions present internally. The theory that work upon nerve terminals
affects parts supplied by connected nerves is well supported by fact.
Thus restoration of a relaxed and natural condition of the abdominal walls
is an important aid in restoring natural condition, in the parts supplied
by these connected nerves. Gradually, deeper work may be done, affecting
the abdominal sympathetic locally, increasing circulation and stimulating
absorption of the inflammatory effusions and other products. Care
must be taken in the treatment over the intestines, as their walls are
intensely gorged with blood, and are friable.
The obstinate constipation present is due to pressure
from congestion of the bowel walls, and by edema into them, checking peristalsis.
As the circulation is restored this condition is corrected, and bowel action
can be stimulated by the usual means. The liver, kidneys, and skin
should be stimulated to aid in carrying off the effusions and the effete
products of the disease. The hiccough is relieved by inhibition of
the phrenic nerve (VIII, Chap. III). Treatment for the fever and
for the vomiting and tympanites is applied as before directed. The
treatment prevents the formation of adhesions, and takes down the thickening
of the peritoneum. The patient should be kept quiet in bed, no food
should be allowed as long the vomiting occurs. Later a restricted
liquid diet is used in small amounts at a time. Cracked ice may be
used to allay the thirst. Rectal injections may be necessary to relieve
the constipation at first.
The treatment of the chronic case is directed to
the gradual breaking down of adhesions; the restoration of circulation
to absorb pus or effusion, and to remove the chronic inflammation; and
to the relaxation of the abdominal tissues. Correction of the spinal
lesion must not be neglected.
Cases of acute peritonitis secondary to other diseases must be treated
in conjunction with them. Cases resulting from gunshot wounds and
other traumatisms are surgical cases. In the acute case the patient
should be seen two or three times per day as long as the severe acute symptoms
predominate.
ASCITES, (HYPEROPERITONEUM)
DEFINITION: A dropsical condition of the abdomen,
due to an accumulation of serous fluid in the peritoneal sac.
CASE: (1) Ascites following malarial fever, and
of more than one years standing. The condition was so pronounced
that the patient could walk but little. Lesion was present as a downward
displacement of each 11th rib, and the whole lumbar region of the spine
was affected. The pulse was 156. Under treatment rapid improvement
took place. The pulse, was reduced to 82, and the patient was able
to go to work.
(2) A case of ascites which had suffered from the
condition two times previously, at one time for fourteen years, at another
for one year. Recovery was made from these attacks, but the disease
again developed after an attack of the grippe, and was not relieved by
the means which had before been successful. It was of three years
standing when it came under osteopathic care. After the seventh treatment,
dropsical fluid began to be absorbed into the circulation and thrown off
by the kidneys. Ten pounds of fluid were excreted every twenty-four hours,
and the patient's weight was rapidly reduced from 190 to 153 pounds.
(3) See Cirrhosis of the Liver, case (1).
The LESIONS in this disease are various, as it is
commonly a condition secondary to some other disease, as of the heart,
lungs, kidneys, liver, etc. Lesions must be expected according to
the nature of the primary disease. If it be due to a local condition,
such as obstructed portal circulation (see Cirrhosis of the Liver), peritonitis,
q. v., or abdominal tumor, the lesions expected are the ones usually found
in these conditions. Lesions in the splanchnic area, the upper lumbar
region, and among the lower ribs occur often in these cases as underlying
causes, determining the local manifestation of the disease through interference
with the sympathetic innervation of the abdominal vessels, as before explained.
The vast area and capacity of the abdominal veins,
the ease with which they are dilated, and the relation of the portal circulation
to the liver, together with the frequent presence of lesions in the splanchnic
and upper lumbar regions of the spine, weakening vaso-motor control of
these vessels, are no doubt important anatomical factors in determining
the dropsy to the abdominal region.
The PROGNOSIS in these cases depends upon that for
the condition producing the trouble. Generally speaking, it is good
except in cases of atrophic cirrhosis of the liver.
The TREATMENT for ascites consists chiefly in the
treatment of the disease to which it is secondary. Special lesion
as found must be removed. Obstructed circulation must be opened,
general abdominal circulation stimulated, and the collateral circulation
through the superficial abdominal veins developed. This is accomplished
by spinal correction and stimulation of the splanchnic and lumbar vaso-motor
areas. The solar and other abdominal plexuses are stimulated, and
deep abdominal manipulation is made from below upward along the course
of the vena-cava and azygos veins, the portal vein, and the superficial
abdominal veins. Thorough stimulation of the liver and portal circulation
is the most important factor in the treatment of this condition. (See Cirrhosis
of the Liver). Treatment over the course of the superficial abdominal
veins results, in the course of a few treatments, in considerable enlargement
of them. As circulation is corrected the dropsical process is checked,
and absorption of fluid already effused begins to take place. Stimulation
of kidneys, bowels, and skin aid the process. The distention of the
abdomen may considerably hinder the treatment. By laying the patient
upon his side, so that the fluid gravitates away from the uppermost side,
the latter may be treated by deep manipulation. The patient may then
be laid on the other side, and the process be repeated. On account
of the accumulation of fluid, paracentesis may have to be performed, but
ordinarily under osteopathic treatment tapping does not become necessary,
except in cases of atrophic cirrhosis of the liver. The lower limbs
should be treated to increase circulation in them and to empty their dilated
veins.
The patient should be treated daily.
JAUNDICE
DEFINITION: A condition in which bile is absorbed
into the circulation and colors the tissues of the body and the secretions.
CASES: (1) Lesion from overexertion, in the form
of a "twist" between the 6th and 7th dorsal vertebrae. Jaundice followed
immediately after its occurrence. (2) 9th and 10th dorsal vertebra anterior;
intense congestion of the deep muscles of the right cervical region; looseness
of the 7th cervical vertebra. (3) Catarrhal jaundice following difficult
childbirth; extreme tenderness of the spine from the 10th dorsal to the
1st lumbar. (4) jaundice and constipation in a lady of 23. The jaundice
was of several months standing. There was a lateral lesion of the
10th dorsal vertebra, with marked rigidity of muscles and ligaments in
the lower dorsal and lumbar regions. The case was practically cured
in one month. (5) Jaundice of four years standing,. There was external
tenderness in the region of the hepatic flexure of the colon; luxation
of the 10th right rib; posterior condition of the 9th to 11th dorsal.
Correction of lesions, with occasional abdominal treatment, cured the case
in 4 months.
LESIONS AND CAUSES: Spinal lesion anywhere along
the splanchnic area has been known to produce the disease. Lesion
of the lower right ribs is common. Prolapsus of the transverse colon,
due to various lesions (see Intestinal Obstruction and Enteroptosis), may
obstruct the duct by compression. Various mechanical causes; stricture,
gallstones, parasites, tumors, etc., are well known as causes of obstructed
bile flow, leading to obstructive jaundice. The relation of lesion
to these causes, osteopathically, is found in the agency of various lesions,
whose nature and action are well understood from discussions in the previous
pages, in producing diseased conditions of the gastrointestinal tract leading
to the presence of such obstructive agents.
ANATOMICAL RELATIONS: The relation between spinal
and other lesion and abnormal liver conditions will be discussed
(see Cirrhosis and Gallstones). In catarrhal jaundice, the usual
form presented for treatment as jaundice, lesion has occurred in the splanchnic
area and is interfering with vaso-motor activity of the gastrointestinal
tract, producing, or allowing other causes to produce, an inflamed condition
of the mucous membrane of the gastro-duodenal mucosa and of the mucous
lining of the ductus communis.
The immediate appearance of jaundice after spinal
lesion, as in case 1 cited above, as well as the presence of spinal lesion
in other cases of jaundice, favors the probability of direct interference
of such lesions with the innervation of the gallbladder and duct.
The presence in the sympathetic supply of the liver (hepatic and cystic
plexuses, see (Gallstones) of spinal fibers which, upon stimulation or
inhibition of the splanchnics, cause constriction or dilatation of the
bladder and ducts; also the fact that stimulation of the pneumogastrics
constricts the bladder, while relaxing the sphincter of the opening of
the common duct into the duodenum, make it probable that certain lesion
to the splanchnic area or to the pneumogastric, directly or indirectly
through its sympathetic connections, might so pervert the normal workings
of this mechanism as to lead to retention of bile, i. e., a form of obstructive
jaundice.
The PROGNOSIS is good. The acute case yields
immediately to treatment. The usual course (two to eight weeks) is
materially shortened. In the chronic case, clearing of the tissues
from the pigmentation is rather a slow process.
The TREATMENT must look at once to the removal of
such active lesion as described above. Mechanical obstruction must
be located if possible and removed by work upon the duet, proceeding upon
the lines laid down for the manipulative removal of gallstones and of intestinal
obstructions, q. v. Prolapsus of the intestines and pressure from
surrounding organs must be relieved (see Enteroptosis).
In catarrhal jaundice the first step must be to
gain vaso-motor control and relieve the inflammation. A preliminary
inhibition of the splanchnic area of the spine may be necessary to relieve
pain and to gain a degree of relaxation of abdominal tissues before local
work is attempted. Next, slow, deep, inhibitive or relaxing treatment
is directed to the upper intestinal region and ductus communis. This
relieves the inflammation, aids in taking down the swelling of the mucous
membrane, and frees the secretion of mucous which may be obstructing the
duct. At the same time, treatment of the splanchnics aids in correcting
circulation in the parts.
After treatment for the inflammation and relaxation
of the duct, the next step is the emptying of the gallbladder and hepatic
ducts. This is done by local manipulation which acts mechanically
and by stimulation of the hepatic and cystic plexuses. The patient
ties upon his back and the operator stands at the left side; he places
the palm of the right hand beneath the postero-lateral aspect of the lower
four right ribs and, while raising them, presses down upon their anterior
portions with the right forearm. At the same time the left hand makes
careful but deep pressure beneath the tip of the ninth rib, against the
fundus of the gallbladder. This mechanically empties the liver and
ducts. It also stimulates the local cystic plexus to cause constriction
of the bladder and ducts.
This same treatment, and the lower costal treatment
Chap. VIII), carefully applied, are given to regulate the circulation through
the liver and to free it of accumulated bile. The splanchnics should
also be thoroughly treated for the circulation. By these treatments
the flow of bile is increased, and the system is cleared of it. Thorough
stimulation of the kidneys and skin (2nd dorsal, 5th lumbar) aids in freeing
the blood of the bile acids. This allays the itching. The superior
cervical region (medulla) should be inhibited to correct general vaso-motor
action. This is for the itching and localized sweating. The
bowels and stomach must be treated to relieve the constipation or diarrhea,
and the dyspepsia, as before directed. Other symptoms may be allayed
by appropriate treatment.
The diet should be plain, avoiding pastry, starchy,
fatty, and saccharine foods. Plenty of water should drunk, lemonade
and alkaline drinks are allowed. Skimmed milk and buttermilk, lean
meat, soups, bread, and green vegetables may be used. Frequent, bathing
is good to aid elimination and to clear the skin and restore its healthy
condition.
In toxemic jaundice the main object of treatment
must be the removal from the system of the poison that is causing the trouble.
If due to a toxic disease, the treatment must be to it. In any such
case all the avenues of excretion must be kept active to cleanse the system.
The usual liver treatments etc., may be also applied.
CONGESTION OF THE LIVER
DEFINITION: An excess of blood in the vessels
of the liver. In active congestion, or acute hyperemia, an excess
of arterial blood is circulating through it. In passive congestion
the liver is engorged by retention of blood in its portal circulation.
CASES: (1) A case of active congestion, which was
in a dangerous condition. Lesion was present as a severe contraction
of the muscles on the right side of the spine, from the 6th to 12th vertebra.
The intercostal muscles over the liver were also contracted. (2) Active
congestion in a woman of 45, of two weeks standing. There was muscular
lesion in the region of the splanchnics.
The LESIONS already discussed in connection with
liver diseases, i. e., these of the splanchnic area and of the lower ribs,
interfering with the vaso-motor control of the organ, lead to the congestion.
Heart and lung diseases are said to be almost always the causes of passive
congestion, but the ordinary congestion of the liver, found in dyspepsia,
biliousness, constipation, etc., is due, not to heart or lung disease,
but to lesions in the splanchnic area. The lesions here must be sought
according to the case, and treatment made as thus indicated.
PROGNOSIS is good. These cases are usually
readily cured.
The TREATMENT is merely one to gain vaso-motor control.
Thorough stimulation of the splanchnic area and solar and hepatic plexuses
is an important means of accomplishing this. The lower costal and
direct liver treatment indicated for jaundice, q. v., are used. Besides
directly stimulating the local nerve mechanism, these treatments, by squeezing
the liver and mechanically forcing the blood into and out of it, cause
the mechanical action of the blood upon the vessel walls to still further
arouse vaso-motor activity. Local treatment should be made upon the
liver to stimulate the flow of bile and prevent jaundice. A general
spinal, neck, and abdominal treatment aids in correcting general circulation.
Treatment for the abdominal vessels quiets active congestion by dilating
the abdominal vessels and drawing the blood to them.
In active hyperemia correct errors in diet, and
avoid the use of highly seasoned food and alcohol. A milk diet is
good. Keep the bowels active.
In passive hyperemia look well to the condition
of the heart. Keeping it stimulated. Due attention should also be
given to the lesser circulation.
CIRRHOSIS
OF THE LIVER, (SCLEROSIS OF THE LIVER.)
DEFINITION: A chronic disease, characterized by an
increase of connective tissue in or about the liver.
CASES: (1) Atrophic cirrhosis; a case brought on
by social drinking, diagnosed and treated by physicians as such.
The first tapping of the abdomen brought eight and one half quarts of fluid.
The case now came under osteopathic treatment, and it succeeded so well
that a second tapping was delayed some time beyond the expected time.
Later a third tapping became necessary, after that none was required.
Under the treatment the patient was restored to perfect health.
(2) Diagnosis of cirrhosis; 6th and 7th dorsal vertebrae
anterior, 9th to 12th flat; ribs irregular and prominent on left.
(3) Malarial, cirrhosis; entire lumbar region bad;
11th rib, on each aside down.
LESIONS AND CAUSES: The lesions commonly found in these cases affect
the splanchnic area, the lower ribs on each side, or the lower right ribs.
The latter may cause mechanical pressure and irritation upon the liver.
The various lesions weaken the vaso-motor sympathetic supply and lay it
liable to the action of special causes of the disease.
In those forms of cirrhosis in which ascites develops,
the contraction of the connective tissue causes pressure upon the soft
walls of the branches of the portal vein. Upon this account, and
because of the low pressure of the blood in the portal system, obstruction
soon follows, and ascites results.
The PROGNOSIS must be guarded in all cases.
Various cases have been cured, among them even atrophic cirrhosis.
In the latter case the prognosis is very unfavorable, It is probable that
other forms of the disease can be much benefited or cured under the treatment
in many instances.
The TREATMENT aims at gaining vaso-motor control,
and thus taking down the inflammatory or congestive process that is allowing
of the increase in connective tissue. In those forms complicated
with ascites as the main symptom , Special attention must be given to it
as being most immediately dangerous to the patient's life. (See Ascites.)
It is doubtful if connective tissue, once formed, could be absorbed by
the renewed blood supply. But the process of its formation could
be stopped, the liver substance could be kept softened by thorough work
locally over the organ, thus preventing hardening and contractions of it,
and maintaining freedom of circulation through it. In this way danger
of ascites could be avoided.
Vaso-motor control is gained by removal of lesion,
by thorough stimulation of the splanchnic area of the spine, and by local
abdominal work over the liver and over the course of the portal vein.
Local work may be done as described in V. Chap. VIII, working
beneath the right ribs, directly upon the liver, while the pressure from
above upon the ribs, pressing them down upon the liver, alternating with
what that applied directly to the liver, is an efficient mode of stimulating
the organ directly.
In atrophic cirrhosis attention must be given to
relieving the congestion of the spleen, stomach and intestines present.
This is done through treatment of the organs as described in considering
diseases of them. In case of the spleen only slight treatment should
be made over it locally on account of danger of rupture. Stimulation
of the lower splanchnic area and raising the lower four left ribs, together
with work upon the solar plexus and the abdominal circulation, are sufficient
for it. The constipation, gastric catarrh, nausea, vomiting, edema
of the lower extremities, etc., are treated as before described.
In billary cirrhosis, the chief object of treatment
is to remove the obstruction to the duct and to empty the gallbladder (IX,
Chap. VIII.) The general corrective treatment for the liver as described
is relied upon to soften the new tissue about the small ducts and to prevent
its further formation.
In congestive and malarial cirrhosis the chief point
is to remove and prevent the congestion.
Otherwise the treatment is as indicated for the general case.
In hypertrophic cirrhosis the main indication is
to prevent the formation of new connective tissue, or to limit its formation.
This connective tissue does not usually show a tendency to contract, as
in atrophic cirrhosis. Possibly much might be done by renewed and
stimulated circulation to absorb this tissue, since fibroid tumors have
been removed by like means. The kidneys must be kept well stimulated,
as the amount of urine is decreased. Careful treatment must be done
about the spleen and abdomen, as the former is enlarged and tender, and
there may arise perisplenitis and peritonitis. Such complications
may be avoided by proper attention to the circulation, etc. The heart
and general circulation must be looked after, to prevent cardiac complications
and hemorrhages.
In all cases the general treatment outlined, with
attention to the special symptoms manifested, should be applied.
In acute cases the patient should be seen daily.
GALLSTONES
DEFINITION: Concretions in the gallbladder, chiefly
of cholesterin, due to a pathological process usually caused by spinal
lesion to sympathetic nerves in charge of liver functions.
CASES: Very numerous cases of gallstones, some of
gallstones, some of them noted, have been successfully treated. It
is one of the most common things treated, and in no class of cases have
more uniformly good, even striking, results been attained.
(1) In a case of gallstones, with chronic constipation
and dysmenorrhea, the muscles of the lower dorsal region were much contracted,
and there was lesion between the 11th and 12th dorsal vertebrae.
The case was cured.
(2) A case of gallstones after typhoid fever, in
which operation had been advised. The stones were passed under osteopathic
treatment.
(3) A serious case of gallstones and catarrh of
the stomach, in which every medical means of cure had been tried without
avail. The patient grew continually worse. After a few osteopathic
treatments the stones began to pass, and a large number of them, a large
sized teacupful were gotten rid of.
After this a copious passage of mucus, amounting to several pints, took
place. Much of the mucous membrane lining of the intestines, gallbladder,
duct and stomach was cast. The stones continued to pass, and two
as large as a man's thumb were among them. At the passage of the
last large stone the patient’s limbs and lips were paralyzed, and her condition
became critical. The crisis was safely passed under treatment, however,
and entire recovery followed.
(4) In man of 45, who had been troubled for years
with gallstones, the common bile-duct became impacted, and the ordinary
methods of treatment were of no avail. Hypodermic injections of morphine
gave no relief from the pain, and an operation was advised. The intense
pain was relieved at the first treatment, which opened the duct.
After the second treatment thirty stones passed from the bowel. The
case was entirely cured.
(5) A case of gallstones of 18 years standing, lesion
was found as a depression of the 10th right rib, infringing the 10th intercostal
nerve, which was sensitive along its entire course. The treatment
was directed to the lesion, and to the gallbladder and duct. By two
treatments, the colic and pain were overcome, and the case entirely recovered
under further treatment.
The LESIONS found in these cases are usually low
down in the splanchnic area, affecting the lower four ribs upon either
side, frequently upon the left, for the spleen. Lesions of the 11th
and 12th vertebra may not be too low to cause it. However, any of
those lesions to the ribs and splanchnic area, characteristic of bad gastrointestinal
conditions may, from the nature of the case, affect the liver to produce
gallstones. The liver is innervated from the same nerve supply, gastrointestinal
diseases are usually complicated with deranged liver function, and it is
reasonable to find in the usual lesions producing the latter a sufficient
cause for disease in the former, which, owing to some particular form,
degree, or concentration of lesion, results in cholelithiasis.
ANATOMICAL RELATIONS of lesion to disease: The liver
is supplied by the splanchnics through the solar plexus, the secondary
plexus, the hepatic, in the formation of which the left pneumogastric nerve
participates, having special charge of the liver activities. Its
branches ramify throughout the liver upon the branches of the portal vein
and the hepatic artery, the chief supply being to the latter. The
blood supply from both of these sources is thought to be essential to the
activities of the liver cells. The nutrient blood supply (hepatic)
is chiefly governed by branches of the sympathetic. A cystic plexus
of the sympathetic supply is spread upon the gallbladder and bile ducts.
The American Textbook of Physiology states that special investigation has
shown that these nerves are similar in function to vaso-constrictor and
vaso-dilator nerves, and that stimulation of the peripheral end of the
cut splanchnics causes a contraction of the bile ducts and gallbladder,
while stimulation of the cut end of the same nerve cause reflex dilatation.
According to the same investigator, stimulation of the central end of the
vagus nerve causes contraction of the gallbladder and at the same time
an inhibition of the sphincter muscle closing the opening of the common
bile duct into the duodenum.
These interesting and instructive facts cannot
but be of much significance to the Osteopath. Doubtless he could
not avail himself of these detailed facts to manipulate at will the activities
of the biliary apparatus, but spinal and other lesions affecting the sympathetic
connections of the organs must be efficient causes in producing abnormal
function.
Osler states that any cause, such as tight lacing,
bending forward at a desk, enteroptosis, etc., which produces stagnation
of bile favors cholelithiasis. From an osteopathic standpoint, and
in view of the above facts, it is a reasonable conclusion that certain
spinal lesion, acting through this nerve mechanism above described, may
cause a stimulated, irritated, or overactive condition of the dilator fibers
of the ducts and gallbladder, thus maintaining a permanent dilated or sluggish
condition of the apparatus, favoring stagnation of the bile and the formation
of gallstones. Likewise one must concede the possibility of lesion
to the central end of the vagus nerve, cutting off the normal impulses
through the nerve which contract the gallbladder and relax the sphincter
of the common duct, thus allowing of a lack of normal contraction of the
bladder and opening of the duct; in other words, favoring a sluggish condition
of the biliary apparatus leading to retention and stagnation of bile, thus
to cholelithiasis. If any osteopathic spinal lesion can interfere
with sympathetic visceral supply, a point placed beyond controversy by
demonstrated facts, it is a reasonable conclusion that spinal lesion to
the sympathetic supply to the liver can become the cause of gallstones
in this way.
According to the catarrhal theory of the formation
of gallstones, lithogenous catarrh of the mucosa of the bladder and duct
modifies the chemical constitution of bile and favors the deposition of
cholesterin about some nucleus, such as epithelial debris. Cholesterin
and lime salts are produced by the inflamed mucous membrane to form the
calculus. As shown above, both the hepatic and portal blood supply
is under control of the hepatic plexus, i. e., of the solar plexus and
the splanchnics. According to the American Textbook of Physiology,
stimulation or inhibition (section) of the splanchnics produces at once
vaso-constriction or vaso-dilatation of the blood vessels of the liver.
Here, as in the case of gastric or intestinal catarrh, spinal lesion to
the splanchnics could disturb vaso-motor equilibrium in the liver and cause
catarrh of the mucous membrane.
It is the practice of Osteopaths to give close attention
to the condition of the spleen in case of gallstones. Important lesions
to this organ are often found in such cases (8th to 12th left ribs, A.
T. Still). Removal of this lesion seems to prevent further formation
of the calculi. What influence the spleen naturally exerts upon the
liver is not known. The splenic and superior mesenteric veins unite
to form the portal vein. The abundant venous flow from the spleen
is carried directly to the liver in the portal circulation. The American
Textbook shows that there is little doubt that the materials actually utilized
by the liver cells in forming their secretions are brought to them mainly
by the portal vein. The blood which has circulated through the spleen
must compose an important part of the blood brought by the portal vein
to the liver. It may be that certain products of splenic activity
are useful in maintaining the fluidity of the cholesterin and in preventing
the formation of gallstones. The spleen is enlarged and tender in
this case.
Sensory nerves pass through the sympathetic from
the (6th, 7th, 8th, 9th and 10th spinal nerves (Quain). This fact
may explain the radiation of the pain in hepatic colic to the spine and
right shoulder, and forms a good anatomical reason why inhibition over
this spinal region will aid in stopping the pain.
The PROGNOSIS is good, even in serious cases in
which operation has seemed advisable. The case is frequently presented
to the Osteopath as the last resort before operation, and results have
been almost uniformly good.
TREATMENT: The success of the treatment seems to
rest mainly upon the mechanical effect and upon the relaxation of all tissues
concerned, gall ducts included, gained by the use of osteopathic methods.
The main treatment in these cases is locally about the region of the liver;
is much of the relaxing and inhibitive treatment, and the main work of
removing the stone are done here. Spinal work is important, as here
inhibition for the pain of the colic is made, lesion is corrected, and
circulation is stimulated. Nervous control is an important factor
in the treatment. It is gained by both spinal and abdominal work,
perhaps alone by the removal of lesion.
The objects of the treatment are: (1) To remove
the stone, (2) To restore normal liver function and prevent further formation
of stones.
The former is palliative treatment; the latter is
the real cure.
In the acute case, if colic is present the first
step is to make strong inhibition over the 7th to 10th spinal nerves.
(Some say upon the right side). This will lessen or stop the pain,
and allow of work upon the abdomen. This is deep, relaxing inhibitive
work upon the tensed abdominal walls, over the epigastric and lower anterior
thoracic regions, arid over the course of the duct (IX, Chap. VIII).
The pain, which is due to inflammation of the mucosa of the duct and to
the rotary motion of the stone, which is given this motion by the spiral
arrangement of the Heisterian valve within the duct, is usually relieved
in a few minutes.
The stone is removed by working it along the duct
after the preliminary relaxing treatment. The patient should lie
upon his back with knees flexed and shoulders slightly raised. The
lower ribs are raised, by inserting the fingers beneath their anterior
edges, and manipulation is made deeply over the site of the fundus of the
gallbladder (tip of 9th rib) and down along the coarse of the duct.
The latter may vary from its course on account of sagging of the intestines
sometimes found. This treatment must be thorough and persistent.
It should be firmly and deeply, but most carefully applied. Sometimes
a few minutes work will pass the stone, but often continued treatment for
three-quarters of an hour or an hour be devoted to it. Only careful
manipulation could be borne by the patient for this length of time.
As long as the stone remains in the duct and causes the colic the attempt
to remove it should be continued, though it may not be advisable to treat
continuously all of the time. The stone may or
may not be large enough to be felt in the duct. Stones are often
passed without pain. Some stones are soft and may be carefully broken
down by the treatment.
The spleen is treated by careful abdominal work
over and beneath the lower left ribs, anteriorly. It is chiefly affected
by treatment to the splanchnics, raising the lower left ribs (8th to 12th),
and removal of lower spinal and rib lesion.
The jaundice, if intense, indicates impaction of
the stone in the common duct. Its cure depends upon the removal of
the stone. The kidneys should be kept active.
Fever, if present, is allayed in the usual manner.
Fatal syncope sometimes occurs. If imminent, the patient should be
fortified against it by thorough stimulation of the heart. For obstruction
of bowel by calculi, see Intestinal Obstruction.
A dilated gallbladder and duct are treated locally
by manipulation to remove the obstruction as for removal of the stone.
Thorough treatment must be given the liver locally, and thorough spinal
treatment must be kept up for the purpose of increasing circulation, etc.
According to Dr. A. T. Still the lesion of the 6th
to 10th left ribs, found in cases of gallstones, is obstructing pancreatic
secretions. These, he says, dissolve gallstones. They are absorbed
from the intestines by the lacteals and carried by them into the portal
circulation, and thus to the liver as portal blood, where they may influence
the secretion of bile, and, mingling with the latter as a constituent of
the bile, act upon stones already formed. The patient should drink
plenty of alkaline waters.
SUPPURATIVE CHOLANGITIS
This is a suppurative process in the mucous membrane
lining the duct, and is commonly the result of gallstones. It may
be due to parasites, or may arise after typhoid fever, dysentery, or other
acute disease.
The treatment is upon the lines laid down for the
treatment of the liver, gallstone, etc. The local circulation must
be kept free to overcome the suppuration and to repair the membranes.
This, with treatment along the course of the duct opens it, and lets free
the flow of bile.
DISEASES OF LIVER (Continued)
CASES: (1) Hepatic abscess, complicated with gastric
ulcer. Lesions at the 3rd cervical, and at the 4th, 5th, and 8th
dorsal; rigid spinal muscles; 7th to 10th right ribs overlapped.
The case was in a very serious condition, but began to improve after two
weeks, and was finally cured by the treatment. (2) Torpid liver, with chronic
gastritis; marked lesion at 4th and 5th dorsal; slight lesion at the 9th
dorsal
For HEPATIC ABSCESS the prognosis must be guarded
and unfavorable. While limited quantities of pus may be effectually
and safely absorbed through increased circulation, any large quantity could
probably not be thus disposed of. Some cases have been cured by osteopathic
treatment, and there are some chances of curing the ordinary case presented
for treatment. The fact that the disease has and can be cured warrants
thorough trial.
The TREATMENT must be to absorb the pus and heal
the ulcer through increased circulation of the blood. Removal of
lesion is naturally the important step in this process, as it is obstructing
proper circulation and innervation. The usual lesions in liver diseases
must be expected. Full directions have been given for treatment of
circulation to the liver. Great care must be taken in local treatment
over the liver because of danger of rupturing the abscess. Pain,
if present, is quieted as before. Attention must be given to the
gastrointestinal disorders, constipation and diarrhea. As abscess
is frequently secondary to some other disease, treatment must be made accordingly
in such cases. A bronchial cough, frequently present, may be guarded
against by stimulation of the vaso-motors to the lungs.
HYPERTROPHY OF THE LIVER is frequently presented
for treatment, and as a rule good results are gotten. Many cases
are cured. Complete restoration of size and function often results
from the treatment. In many other cases, while the size cannot be
reduced to normal limits, functions is restored. The general prognosis
is favorable. In true hypertrophy due to increase of connective tissue
the new tissue can probably not be absorbed, but the further increase of
it may be checked and the function is usually restored.
In true hypertrophy due to increase in size or number
of the parenchymatous cells, the treatment may reduce their size or number,
and normal size and function of the liver is restored. As the chief
causes of hypertrophy are active and passive congestion (lesion to the
vaso-motors), good results follow corrected circulation.
In false hypertrophy due to cancer or abscess little
is expected in the way of reduction. When due to fatty infiltration,
the renewed circulation removes the accumulated fatty particles and restores
normal size and function. In these cases diet is very important.
Avoid fats, starches, and wheat bread. Use gluten or bran bread,
also fish, lean meat, vegetables and fruit, but no alcohol. Exercise
and baths should be employed. The treatment in these cases consists
in the removal of lesion and correction and stimulation of circulation.
The prognosis is good. The size of the liver can be reduced to normal.
When secondary, the primary disease is treated.
In fatty degeneration of the liver good results
may be expected from the treatment. It consists simply in the removal
of lesion and in the active stimulation of the circulation, with due attention
to the primary condition upon which the degeneration depends. Diet,
exercise and baths should be used as in the treatment of fatty infiltration.
Recorded facts are lacking in regard to cancer and acute yellow atrophy
of the liver. The latter two are rare conditions, yellow atrophy
exceedingly so. Treatment for these diseases could be worked out
according to the fates and principles given in relation to the various
diseases of the liver already discussed.
In AMYLOID INFILTRATION of the liver the starch-like
deposit occurring in the connective tissues of the liver must be absorbed
in the renewed blood supply. But the condition of the blood is an
important factor, apparently, as it is thought that in suppurative processes
in the body, to which the disease is frequently due, the alkalinity of
the fluids of the body has been decreased. The general health must
be built up, the excretion stimulated, and the blood purified. The
primary disease, such as tuberculosis, rickets, etc., must be attended
to. Any local lesions must be repaired, and the circulation be kept
stimulated. A thorough general course of treatment is necessary.
The diet should be carefully attended to. It should consist of nitrogenous
or animal food. Starches and fats should be avoided. Lean meats and
green vegetables, etc., are allowed. Exercise and bathing should
be encouraged.
SPLENITIS
DEFINITION: Acute or chronic proliferative inflammation
of the spleen. Suppuration may occur.
CASES: (1) Lady, fifty years of age, suffering from
chronic inflammation of the spleen. Spleen was much enlarged, and
she was unable to wear corsets. Lesion was found in the form of a
misplaced rib pressing upon the spleen. Its replacement caused the
pain to disappear, and the waist measured two inches less the next morning.
(2) Splenitis; the case showing lesion as depression of the 9th, 10th,
and 11th left ribs, and a posterior swerve of the lower dorsal and lumbar
region.
LESIONS occur in downward and forward luxations of the 6th to 12th
left ribs. (A. T. Still). Diaphragmatic lesion thus caused
may interfere with position, circulation, or innervation of the organ.
Direct pressure of a misplaced rib, or lower splanchnic lesion causing
interference with spinal innervation, may cause the trouble.
ANATOMICAL RELATIONS: Stimulation of the peripheral
end of the splanchnic causes sudden and large diminution of the volume
of the spleen. It is probable that this diminution is due to contraction
of its trabeculae and capsule, which are plentifully supplied with involuntary
muscle fibers. "The organ is richly supplied with nerve fibers which,
when stimulated directly or reflexly, cause the organ to diminish in volume"
(American Textbook of Physiology). According to Schafer, these are
contained in the splanchnics, which carry also inhibitory fibers whose
stimulation causes dilatation of the spleen.
In view of these facts it seems that treatment over
the splanchnic area of the spine and locally over the spleen may produce
change in its volume (through thus directly or indirectly stimulating these
nerve connections) which is most useful in correcting circulation through
it. In addition to this, the same work would affect the vaso-motor
mechanism of the organ. The splenic plexus, ramifying upon the splenic
artery, is composed of sympathetic fibers from the solar plexus and of
branches from the right pneumogastric. Local or spinal treatment
affect these. It is readily apparent, in view of the whole mechanism
described above, that spinal and rib lesion may seriously affect the organ
by disturbance of these nerve connections, producing inflammatory or congestive
conditions.
Anders states that splenitis is probably never primary,
but in case (1) cited above it seems that the disease must have originated
primarily in the spleen by action of the disturbance caused by the displaced
rib.
TREATMENT: As splenitis and congestion are frequently
secondary to some other disease (malaria, typhoid, etc.) , such diseases
must be treated primarily. Removal of lesion, as in the above case,
may be the only treatment necessary. Stimulation or inhibition of the splanchnics
at the spine, and of the capsule and local plexuses by work directly upon
the organ, is made. Care must be taken in the latter process to avoid
danger of rupture of the organ.
Inhibitive work upon the splanchnics, the solar
plexus, and the abdomen will dilate the abdominal vessels and draw the
blood to them, away from the spleen.
SPLENIC HYPEREMIA, active or passive, is readily
reduced. Chronic cases may yield at once or may require a patient
course of treatment Contraction of the tissues about the splenic
vein has been known to cause great enlargement of the organ by passive
congestion. Upon removal of the obstruction the organ quickly returned
to its normal limits. The lesions and treatment are the same as indicated
for splenitis.
DISEASES OF THE PANCREAS
The lesions commonly found affecting the pancreas are those
occurring at the lower ribs and to the lower dorsal, vertebrae. Generally
the diseases of this organ are complications of, or secondary to, other diseases,
most frequently those of the gastrointestinal tract. As the blood and
nerve supply of these parts are closely related, it is not strange that the
lesions affecting this tract should also often be the cause of derangement of
the pancreas. The blood and nerve supply are especially closely related
to that of the liver, stomach, and spleen. The nerves are from the splenic
plexus, which is derived from the right and left semilunar ganglia and from
the right pneumogastric. The pancreatic plexus thus formed is closely
connected with the hepatic plexus and with the left gastro-epiploic plexus.
These are all the offsets of the coeliac plexus. The arterial supply is
from the superior mesenteric, and from the coeliac axis by way of the hepatic
and splenic arteries. The venous drainage is into the splenic and superior
mesenteric veins, thus directly into the portal system.
Thus it may be seen at a glance how the interrelation of
these anatomical parts lays the pancreas liable to the action of those lower
dorsal lesions that cause disease in the stomach, liver, intestines, spleen,
etc.
Treatment to the spinal nerve connections in the region mentioned,
and to these plexuses directly by work in the abdominal region over them, affects
the pancreas. Local or direct treatment is given it by deep manipulation
in the median plane of the abdomen, midway between the ensiform and the umbilicus.
Abdominal treatment may also mechanically affects its blood vessels, and may
remove obstruction from them, from the duct, or from the organ itself, when
caused by growths in the abdomen, malposition of the contiguous organs, etc.
Local treatment over the pancreas should be done when the stomach is empty.
ACUTE PANCREATITIS, hemorrhagic, suppurative, or gangrenous,
is generally due to gastrointestinal disorders, such as dyspepsia, glycosuria,
gallstones, catarrhal inflammation, etc. Doubtless the lesion responsible
for the primary disease is directly accountable for the effect upon the pancreas,
the same lesion deranging the nerve and blood supply of each diseased part.
Traumatism may directly affect the substance of the gland, or it may cause various
lesions to nerves and vessels, and produce either form of pancreatitis.
The disease is often secondary to tuberculosis, specific fevers, etc.
The treatment must depend to some extent upon the cause.
In any case it is necessary to remove the lesion, and to take down the inflammation
by removing all sources of irritation or obstruction to the circulation.
Treatment may be made along the course of the venous drainage as above pointed
out. The left lower ribs should be elevated, and the lower dorsal spine
relaxed. Local treatment over the organ must be carefully applied.
The pain should be treated by strong spinal inhibition and by relaxation of
the upper abdominal tissues. The nausea, vomiting, hiccough, constipation,
diarrhea, etc., may all be treated as before directed.
Every effort should be made to alleviate the patient's suffering.
Mild cases of hemorrhagic pancreatitis may recover; the other
forms are fatal.
Chronic pancreatitis is to be treated upon the same plan.
Treatment for other forms of pancreatic disease could be
worked out according to general points given above.
