The Practice and Applied
Therapeutics of Osteopathy
Charles Hazzard, D. O.
1905
CHAPTER XVIII
DISEASES OF THE BLOOD AND DUCTLESS GLANDS
GOITRE; EXOPHTHALMIC GOITRE
CASES: (1) In a lady of twenty-five, a bilateral,
vascular goitre of about three months standing, growing rapidly, causing
considerable dyspnea and discomfort. The treatment consisted merely
of stretching the muscles and ligaments attached to the sternal end of
the clavicle, raising it, and depressing the first rib. Marked improvement
followed the treatment at once. Two months later the enlargement
and other symptoms had disappeared.
(2) Exophthalmic goitre and nervous prostration
of one months standing. The trouble followed nervous strain and overwork.
The goitre was as large as a hen's egg, and the usual symptoms of exophthalmic
goitre were present. The case yielded rapidly to treatment and at
the end of two weeks the goitre had disappeared and the eyes were normal.
In one month the patient had recovered from the goitre and nervous prostration,
and had gained twenty pounds in weight.
(3) In a boy of fourteen, a goitre of two years
standing. Lesion existed as lowering of the right clavicle and muscular
contracture in the lower cervical and upper dorsal region. One treatment
a week for twelve weeks cured the case.
(4) A case of goitre treated by raising the clavicles,
relaxing the tissues surrounding the gland. After one month there was a
perceptible change, after two months the growth had begun to get smaller
and after three months, the condition was cured.
(5) In a lady of thirty-four, a large exophthalmic
goitre with all the usual symptoms marked. The general system was
in bad condition. Lesion was luxation of the fourth cervical vertebra;
the spine was irregular. The case was cured in six months.
(6) In a lady, a goitre of one years standing.
No bony lesions were found. After one months treatment the diameter
of the neck had been decreased one and one half inches.
(7) Exophthalmic goitre of eight months standing
in a woman of twenty-six. Lesions were: 3rd and 4th cervical vertebra
posterior, 7th cervical lateral to the left; 3rd, 4th and 5th dorsal
posterior; subluxation of 4th rib on the left side. Benefit was
noted after the 2nd treatment, and the case was cured in four months.
(8) Dr. Still mentions a case of vascular goitre
in which he raised the clavicles and caused the goitre to entirely drain
away in 45 minutes.
DEFINITION: Goitre is defined as "chronic hypertrophy
or hyperplasia of a portion or the whole of the thyroid gland. It
is of obscure origin, involving one or more of the structural tissues,
and is subject to various degenerative changes."
The so-called simple goitre is met in various forms;
simple hypertrophic, follicular, fibrous, vascular, cystic, degenerative,
etc. They are frequently met and treated osteopathically.
Exophthalmic goitre (Graves' or Basedow's disease is quite a different
condition. It is defined as, "a chronic neurasthenic neurosis characterized
by rapid heartbeat, enlarged thyroid, protrusion of the eyeballs, and various
neurasthenic or vaso-motor symptoms.
Osteopathy simply regards goitre as an enlargement
of the thyroid gland due to a specific, usually bony, lesion which interferes
with the proper blood and lymph circulation of that body. This leads
to congestion, engorgement, and hypertrophy. In some cases, especially
in exophthalmic goitre, the lesion may act chiefly upon the innervation
of the gland, producing the various phenomena marking the disease.
The LESIONS bear, in conformity with the above view,
a close anatomical relation to the disease. They are generally bony
lesions of the cervical and upper thoracic regions, consisting in displacements
of middle and lower cervical vertebra, of the clavicle, or of the first
rib. Yet various muscular, and other tissue, contractures are often
found as the lesions in the case. These commonly occur together with
bony lesion, but may be independent of such. They occur mostly in
the anterior region of the neck, involving the infra-hyoid muscle and the
soft tissues down to the root of the neck. The scaleni muscles are
often involved. The posterior cervical and upper dorsal muscles are
sometimes found contractured and acting as lesion.
The chief bony lesions in simple goitre are of the
clavicle and first rib, while in exophthalmic goitre lesions of the cervical
vertebrae are more frequent. Dr. Still points out that in goitre
the heads of the first ribs will often be found to be displaced upward
and outward, away from the spinal column. Yet either form of lesion
may occur in either case. The clavicle and rib lesion, and the contracturing
of the anterior cervical tissues act specifically by obstructing arterial,
venous, and lymphatic currents to and from the gland. The inferior
thyroid artery arises from the thyroid axis, which, lying behind the clavicle
and scalenus anticus muscle may suffer pressure from them when abnormal
in position. The superior thyroid artery is related to the infra-hyoid
muscles, and may suffer from their contracture. But the interferences
of these lesions with the lymphatic and venous drainage of the gland are
doubtless most potent in causing goitre. The lymphatics of the gland
are large and numerous, emptying upon the right into the lymphatic duct,
upon the left into the thoracic duct, both avenues of lymphatic drainage,
therefore, lying where derangement of clavicle or of first rib may obstruct
them.
Just as clavicular and first rib lesion has been known to obstruct
lymphatic drainage of the breast and result in so-called cancer, the same
kind of lesion may prevent lymphatic drainage and cause goitrous enlargement
of the thyroid.
In a like manner the venous return becomes abridged.
The superior and middle thyroid veins are in relation the inferior hyoid
muscles, and suffer pressure front their contracture. They both empty
into the internal jugular vein which may be obstructed by clavicular lesion.
The chief venous flow is through the three or four large inferior thyroid
veins, and it may be impinged by clavicular and anterior cervical lesion.
This view of lesion is well supported by the fact that simple goitres often
rapidly disappear, after treatment restoring clavicle and first rib to
position, relaxing anterior cervical tissues, and re-establishing perfect
circulation of all fluid to and from the thyroid. This has been observed
in some cases, probably of vascular goitre, by Dr. Still, in which the
facts strikingly illustrate the correctness of the osteopathic etiology.
In these cases he saw, in a few hours, a great reduction in the volume
of the gland following removal of such obstructions to the vessels.
The glands seemed to have been rapidly emptied and the goitre drained away
by the renewed drainage.
The nerve supply of the thyroid gland is from the middle and inferior
cervical ganglia of the sympathetic. Consequently various vertebral
lesions are found, especially in exophthalmic goitre. Such lesions
have been found from the 2nd to the 7th cervical vertebra. In discussing
diseases of the eye and of the heart, the connections of the cervical sympathetic
mechanism with both of these organs has been pointed out. The lesions
occurring thus to the innervation of the thyroid, cervical lesions, are
likewise closely related anatomically to the innervation of eye and heart,
accounting in part for the related disturbance of these organs in exophthalmic
goitre.
This disease has been regarded by medical writers
as due to disturbed innervation of the gland, or to an affection of the
sympathetic nerves. It has been sometimes thought that the seat of
the disease is in the medulla, and that the disturbance of the thyroid
function causes the gland to throw into the blood substances that irritate
the nerves and cause the various neurasthenic symptoms accompanying the
condition. It is readily seen that cervical lesion may disturb the
innervation of the organ, set up the sympathetic disturbance and derange
the function of the thyroid. This disturbance of the sympathetic
innervation is further evident in the vascular condition of the gland,
its arteries being dilated, and in the paralysis of the orbital vessels,
which become distended with blood and cause the exophthalmos. Dana
explains all symptoms upon the theory of vasomotor and cardio-motor paresis,
a result that may readily be due to the operation of cervical lesion upon
the sympathetic.
The PROGNOSIS is good in all cases. It is
to be noted that according to Anders the prognosis in goitre (simple) is
but guardedly favorable as to life, but unfavorable as to cure, while but
few cases of exophthalmic goitre are expected to be cured. Yet under
osteopathic treatment very numerous cases of both kinds have been cured.
A cure is often effected, even in long standing cases which have tried
all the known remedies.
The prognosis is most favorable in younger and shorter
cases, and in those in which the gland is soft. Under treatment,
signs of softening in a part of the gland are indications of progress.
In the vascular and parenchymatous forms the progress is good. The
former promise the most for quick results. In the hard, fibrous forms,
and in those in which degeneration of the tissues, or calcareous infiltration
has taken place, the prognosis is not favorable.
Some cases of goitre yield quickly; some are very
slow. From one to three months treatment, or much longer, is usually necessary.
The TREATMENT looks at once to the removal of lesion,
and to the free opening of lymphatic and venous drainage. All the
cervical muscles must be relaxed. This direction applies to the deep
anterior cervical and the hyoid muscles, as well as to the tissues about
the gland.
Pressure is made downward over the goitre, out about
its edges, and along the course of the veins draining it. All the
tissues about the root of the neck anteriorly, and about clavicles and
first ribs, must be relaxed. The ribs and clavicles should be separated,
elevating the latter and depressing the former.
Close attention should be given to all the cervical
vertebral articulations, seeing that they are perfectly adjusted.
In exophthalmic goitre one must look particularly
to the cervical sympathetics, toning them to overcome the vaso-motor paresis.
Inhibitory cardiac and local eye treatment may be applied as before directed.
A moderate pressure of the eyeball back into its orbit aids in emptying
the blood from the distended vessels. For a similar reason pressure
upon the gland, in exophthalmic and in vascular forms of goitre, is good
measure. In the former kind one should look well to the constitutional
condition and to that of the general nervous system.
ANEMIA
DEFINITION: A condition in which there is a diminution
either in the quantity of blood or in one of its constituents.
The Anemias are divided into: I. Primary (simple,
chlorotic, and pernicious); II. Secondary (symptomatic); III.
Leucocytosis; V. Leucocythemia.
The lesions noted in anemia are merely of the general
spinal form. Cases of primary and secondary anemia come, with fair
frequency, under our treatment. They are almost without exception
successfully treated.
The TREATMENT in all the anemias is practically
the same, varying in different cases according to the manifestations and
needs of the case. In all forms the general plan of treatment is
to remove such lesions as may be found present and to give special attention
to the renovation of the general health by thorough general spinal treatments,
designed to increase heart action, tone the circulation, increase nutrition,
and thus to improve the quality of the blood.
In SIMPLE OR BENIGN ANEMIA (Primary), the treatment
embraces removal of lesion and the thorough general treatment, above described.
Special treatment should be given the spleen. The liver, kidneys,
skin and bowels should be kept active. In this way the quality of
the blood is improved, and nutrition of the tissues is increased.
The heart should be kept well stimulated in order
to overcome palpitation. This treatment also aids in overcoming the
dyspnea, which should be further treated by lower costal treatment to stimulate
the diaphragm and by raising the ribs and stimulating the lung area of
the spine (2nd to 7th dorsal). Headache should be treated in the
usual way. It is quite necessary to look after the hygienic conditions
under which the patient lives. Diet, drink, and manner of life need
attention.
In CHLOROSIS or "green sickness" one must follow
the general plan of treatment outlined above. This condition is characterized
especially by a deficiency of hemoglobin in the red corpuscles, and iron
is the specific drug remedy employed. There is a question whether
the iron thus administered is absorbed into the blood. The osteopathic
idea is to normalize the organic functions of the body and to build good
blood by increasing glandular activity in the body. This excretes
impurities and enables the blood to secure from the food the elements,
especially iron, that, are lacking in it.
The heart must be kept well stimulated, as the cardiac
muscle is often softened, and the organ may be dilated. Special attention
must be given to disorders of menstruation. The disease often dates
from a period of scanty menstruation, and while amenorrhea is said not
to be a cause of the condition, it is quite necessary to overcome it, if
present, in the process of restoring health.
The treatment must also be directed to a regulation
of the bowels, as toxemia due to the absorption of poison from retained
fecal matter has much to do in causing chlorosis, it is held by some.
Attention should be given to living conditions.
Pure air, plenty of nutritious food, good sleep, etc., are necessary.
Moderate exercise and hot baths are recommended.
Nervous, circulatory, gastrointestinal, and general
symptoms may be met according to the needs of the case.
PROGRESSIVE PERNICIOUS ANEMIA requires much care
in treatment, as it is considered a dangerous condition. However,
under osteopathic treatment it seems to be readily cured. A thorough
general spinal, muscular and abdominal treatment is necessary to overcome
the anemia condition of most of the organs and tissues. The general
treatment above described should be assiduously applied. In the course
of it heart, liver, kidneys, and gastrointestinal tract should be well
treated, as they show a tendency, to fatty degeneration. Increase
of general circulation overcomes the tendency to ecchymosis in skin and
mucous membranes.
Particular attention must be given to the spinal
treatment, spinal circulation should be kept active to guard against sclerosis
of the posterior and lateral columns of the cord, to which are due the
various paralytic symptoms which are likely to occur.
SECONDARY ANEMIAS are purely symptomatic.
They indicate some disease or abnormal process in the body, and may at
the same time be complicated one of the primary anemias. They occur:
(1) after hemorrhage as from bursting of an aneurysm epistaxis, piles,
menorrhagia, etc.; (2) in inanition, as from esophageal carcinoma, chronic
gastritis, etc.; (3) from excessive albuminious discharges, as in Bright’s
disease, lactation, extensive suppuration, dysentery, etc.; (4) from the
action of toxic agents, as in poisoning from lead, mercury, arsenic, phosphorus;
or in acute or chronic infectious diseases.
The prognosis depends upon that for the primary
condition.
The TREATMENT must be according to the cause.
After hemorrhage, rest and nutritious diet are required. The primary
disease in each case must be treated. Hygienic treatment, plenty
of fresh air, good food, sunshine, rest, and later, light exercise are
necessary. In toxic cases the excretories must be kept stimulated
to eliminate the poisons from the system.
LEUCOCYTOSIS is "a temporary increase in the number
of polymorphoneuclear leucocytes in the blood, though rarely in the mononuclear
elements." It may be continuous.
It is often a physiologic condition, as soon after
birth, during pregnancy, after meals, after exercise, after massage and
baths, etc.
It is frequently a pathologic condition, being secondary
to disease, as acute inflammations and acute infectious febrile diseases.
Being reparative and protective in nature, a natural
process, it calls for no treatment. Treatment should be directed
to the primary disease.
LEUCOCYTHEMIA, or leukemia, is a blood disease in
which there is marked end persistent increase of the number of leucocytes
in the blood. It is said to be due to lesion to the spleen, bone
marrow, and lymphatic glands. The spleen and lymphatic glands are
enlarged.
The prognosis is not favorable.
The TREATMENT should be upon the general lines before
laid down. The gastrointestinal symptoms; shortness of breath, edema
of ankles, face and hands, etc., occur as in the anemias.
Treatment should include the liver, which is found to be enlarged, and
the kidneys should be kept stimulated, as the leucocytes collect in them,
as in the liver.
MYXEDEMA
This is a condition in which there is a peculiar disorder
of the general nutrition of the system, due to atrophy and loss of function
of the thyroid gland. There is a myxomatous change of the subcutaneous
tissues, and a cretinoid cachexia.
The condition appears as, (1) True Myxedema, (2) Sporadic
Cretinism, or (3) Operative Myxedema.
But few cases have been treated Osteopathically. Results
are not satisfactory. McConnell states that serious lesions of the cervical
vertebrae have been found in these cases.
The TREATMENT must necessarily be a general one to increase
general nutrition, and to thus aid in overcoming the condition of malnutrition
of the system. The disease is regarded as being of tropho-neurotic origin.
It is supposed that the internal secretion of the active thyroid gland aids
in maintaining the normal metabolism of the body, consequently it is of great
importance in these cases to remove lesion to the gland, restore nerve and blood
supply to it, and thus regenerate its activities.
In case of congenital absence or removal of the gland it is obvious that nothing
could be done except to maintain the general health by the treatment, and overcome
in that way, if possible, the effects of the lack of thyroidin. It seems
that in these cases thyroid feeding, a treatment regarded as specific, would
be necessary.
In case of atrophy of the gland an attempt should be made
to upbuild it by local work on circulation and nerve supply. Cervical
treatment should be added to increase circulation to the brain, and the kidneys
should kept active to overcome the tendency for sugar and albumin to appear
in the urine. The local treatment should be upon and about the gland,
coupled with a cervical and upper thoracic treatment, as described for goitre,
q. v.
