CAUSES OF ANOXIA AND ANOXEMIA AND METHODS OF EXAMINATION.

Anoxia means lack of oxygen, no matter where it is or how it is produced. 

Anoxemia means a lack of oxygen in the blood stream only. 

The two terms are not synonymous. There can be anoxia of a local part, such as the ear, the kidney or the bladder, while anoxemia is a condition of the general circulation.

For the purposes of this discussion, we will restrict anoxia to the open cavities, but it must continually be kept in mind that while we use the term anoxia to cover the parts of the open cavities that these parts also are affected by anoxemia of the general circulation. They are interdependent.

To explain this interdependence, let us consider a specific case, the ears; for example. We have found many people who are deaf, and upon examination have discovered that the nasal and eustachian tubes were wide open, the Fossa of Rosenmuller and the tonsils clear. Yet the hearing was imperfect. Examination of the blood revealed a low hemoglobin content. When this condition is present, we have noted a lack of vigor in the patients. Our diagnosis in this instance was that of fatigue deafness. This type of deafness may be found among those who are cyanotic, anemic or whose symptoms of illness were suppressed before the illness reached the healing stage. It may be caused by poisonous drugs, cooking utensils, or as a result of diseases contracted during the lifetime, especially during childhood.

The cause of anoxia is the reduction in the tension of oxygen in any part of the body. Anoxemia is the reduction of the tension of oxygen in the arterial blood. We do not refer to those deprived of oxygen by drowning or violent gases, but to those who are alive but appear half dead every day and are not fully aware of their condition.

Oxygen lack from a general viewpoint can be stated as starting from interference with the passage of oxygen from the air into the cavities of the head, or into the lungs, from the lungs into the blood, and from the blood into the tissue cells. Somewhere along that route obstructions are interfering. The obstructions may be caused by improper posture over a period of years which has caused a crushing or narrowing the aerating surfaces. There may be exudate and consolidation from long standing toxemias. Sedentary habits may consume the oxygen supply in the atmosphere without the availability of compensation. A workman may be confined all day in a small space of which he consumes continually the whole amount of oxygen. When leaving for home he compensates out of doors for awhile, but generally he is so fatigued he goes to his room to lie down before full compensation takes place.

Improper breathing habits produce strictures on the membranes. Adhesions, polypi and spurs may produce anoxia.

Accidents of birth and during childhood may produce a ptosis of the bones and tissues; this may also happen to the aged by the removal of teeth, and the lack of exercise of any sort. Governed more by the psychology of years than the needs of their bodies, older people are afraid to exert themselves, and as a result the tissues dry up, become withered and wan. The stupidity we often see in older people is not due to age, but due to a lack of oxygen in the blood stream, which in turn is due to the terrible psychology of "three score and ten" and the constant harassing of the folks around who say: "At your age, you should be quiet", and then wonder why the old man or woman loses all pep and interest.

Another cause of anoxia is wrong dietetic habits. It is generally supposed that oxygen supplies the iron to the body. Time and again, we have heard the remark: "Get out in the open and exercise and get more iron and oxygen in your lungs". Oxygen has no element of iron in its constitution, but it has within it the ability to attract iron, and transport it to all parts of the body. Without examination of the dietary habits of the patient, and also examination of the respiratory apparatus the above advice may lead to harmful results. For if the patient is not existing on a diet sufficient to furnish the iron and protein foods necessary for red corpuscles and hemoglobin development, exercises are only a further expenditure of those much needed elements, producing what is known as anemic anoxemia. Of course exercises, especially of walking, and deep nose breathing will help to produce hunger for iron foods and proteins, but before the exercises are instituted all obstructions to the free passage of air and oxygen should be removed, and a well-balanced diet prescribed.

Briefly, the terms covering the causes of anoxia and anoxemia are: toxemic, accidental, congenital, sedentary, and dietary habits.

EXAMINATION OF OPEN AND CLOSED CAVITIES.

Diagnosis is the recognition of disease and the art of distinguishing one from the other. Since Endo-nasal, Aural and Allied Techniques are supplemental to the techniques now in use by the physician, the examination methods given here are also supplemental. For complete examination methods see my book, "The Encyclopedia of Physical and Manipulative Therapeutics." They are four in number: personal, observational, chemical and peripheral.

The first step we recommend is while listening to the patient's story: "Look."  It is always best to quietly listen to the patient's story, asking wise questions, so as to elicit from them as much as possible the facts about employment, injuries, or tendencies to troubles in the nose, ear, throat, and other parts. Careful attention should be given to the symptoms of the disease from which he seeks relief. However, while this is going on the physician should look his patient over without being obvious. We always remember a verse of our childhood, a line which goes "There is life for a look."  It is well worth while. A slump here or a lump there may instantly give the cue to the location and cause of the trouble. To illustrate: Anoxia of any portion of the head will show the muscles of the neck swollen in the region of the carotid sinus, just under the ear, on the affected side. A football bulge at the lower abdomen will indicate a ptosis of the diaphragm and organs. The look will reveal color, twitchings, and general contour, which will help greatly in making deductions.

The physician should look at the tongue. Is it coated or clean; pale or flabby, or of natural color and resistance.  He should depress the tongue and observe the palate, the anterior pillars and tonsils, the posterior pillars and pharyngeal wall. Any changes in shape, mobility of the parts, or in the natural color, pus or hardened secretions should be noticed.

Then the nose externally should be looked at carefully. We mean "looked at" - anything in the contour of it that would suggest that (1) the nares are too small or narrow, (2) the turbinates ptosed or broken, (3) septum twisted or bent, or congested, which can be detected by the sound of the breathing. After the Look outside the next step is to Look inside. If^-the doctor has a rhinoscopic outfit of some kind, including the pharyngeal mirrors, he will more readily be enabled to view the anterior nares up to the infundibulum, and if he becomes expert, the whole of the pharyngeal space.

In connection with these examinations, the conditions of the parts should be noticed in the following order: (1) color and condition of the mucous membrane; ( 2) size and shape of the part examined; (3) loss of substance by ulcers, etc.; (4) presence of foreign bodies, neoplasms, or accumulated secretions; (5) mobility of the parts and functional disturbances. During the examination the physician should touch any suspicious swelling, so as to ascertain its mobility, and whether it is composed of bone, cartilage, or softer structures; then wipe away secretions and trace a flow of pus to its source in an ethmoid cell or one of the sinuses. He should also look for any deviation from the normal in size or shape.

In cases complaining of aural distresses, or deafness of the whole ear, the general formation and color should be observed. Is it dry, scaly and sensitive, or swollen and eczemic? Afterward the Endo-nasalist should inspect the parts of the ears made visible by means of an autoscope and carefully note whether the external auditory canal is clear or blocked, and if the drum head is wholly or partly destroyed, or if not, whether it bends too far forward or too far backward. The best method of getting experience in this type of examination is to ask acquaintances who have exceptionally good hearing to let you look in their ears. By that method, one will soon learn to pick out the abnormal from the normal conditions.

The hearing should then be tested. There are three tests that can be used. The tuning fork, according to Weber, is very simple and generally accurate. A large sized tuning fork, for instance a C-128, is excellent. The vibrating handle of the fork is placed against the front teeth or upon the cranium midway between each ear. The tuning fork sound will be best heard in the obstructed ear. The cause of the obstruction may be an impacted cerumen in the external auditory meatus, occlusion of the eustachian tube, mucus within the tympanum, or catarrh of the middle ear. If, on the other hand, the deafness is due to impairment of the labyrinth or the auditory nerve, the note of the tuning fork will be heard less distinctly in the affected ear. (Note: This examination should be made until the patient's answers can be freely accepted as reliable.)

The differentiation between deafness caused by obstruction of the hearing apparatus, and destruction of parts of the hearing apparatus is very valuable from a prognostic point of view. There are many other forms of testing with the tuning fork, but it is not necessary to state them here.

The testing of the eustachian tubes can be done by the following methods :

Valsalva's method consists of a forced expiration, the mouth and nose being closed. In this method air is forced from the pharynx through the eustachian tubes into the middle ear. If the aurist examined the membrana tympani while the patient inflates the middle ear by Valsalva's method, the drumhead will be observed to move outward, and in most instances it will become slightly congested. If an aural stethoscope be used to connect the ear of the patient with that of the aurist, a slight noise will be heard as the air enters the patient's middle ear.

In Politzer's method the patient is directed to hold a small quantity of water in his mouth until he is told to swallow. The aurist then takes the nosepiece of Politzer's airbag between his thumb and finger, and inserts it into one of the patient's nostrils, then closes both nostrils firmly about the nosepiece by pressure with his middle finger and forefinger. The patient is then told to swallow; as the patient's larynx is seen to rise at the commencement of the act of swallowing, the aurist quickly compresses the airbag held in his right hand, thus forcing air through the nose and eustachian tubes into the middle ear.

If an aural stethoscope is used during this procedure, the air will be heard to enter the middle ear with a click.

During the act of swallowing, the soft palate (trap door) rises, cutting off the mouth and the posterior nares, and at the same time the eustachian tubes are opened by the action of the tensor palati and other muscles; the air, having no other way of exit, must find its way into the middle ear through the tubes, if they are not twisted, ptosed or impaired by disease. Sometimes this can be accomplished with greater ease by just telling the patient to puff out the cheeks, and while the mouth is full of air, compress the airbag, asking the patient to say: "Hick, hack, hock".

The next step is chemical. We refer here to one aspect of the urinalysis, and the blood hemoglobin color index calculator. As to the first, an acid and alkaline balance is necessary for health. A high acidity reflects the lowered content of oxygen, and a rise in carbonic acid content in the blood stream. The manner in which the body fluids are kept physiologically neutral is of importance to the Endo­nasalist. This is accomplished in three ways, by respiration, excretion, and the various body salts of protein quality of the amino carboxyl groups.

We are interested in all of these processes, but just now our attention is on the respiratory aspect. The chief waste product of oxidation is carbon dioxide. This is carried as carbonic acid in the blood stream until it finally reaches the lungs and is released. The concentration of carbonic acid in the blood regulates the depth of breathing by stimulation of the respiratory center in the brain. Thus with increased acidity the breathing becomes faster and more carbon dioxide is released, which in turn reduces the acidity to normal, providing there are no obstructions. If the respiratory system is overtaxed by acid, however, the body attempts to rid itself of acid excess by way of the kidneys which are the most important agent for this purpose.

Acidosis is a disturbance of the acid-base balance on the acid side, while alkalosis is a disturbance on the alkaline side. One may be due to a deficiency of the other.

This is seen in characteristic form in the acidosis of diabetes and Bright's disease. In diabetes, the primary factor is excess of abnormal fixed acids B-oxybutyric aceto­acetic, resulting from incomplete oxidation of fats. These combine with the alkali of the blood and the combinations are excreted in the urine.

In nephritis, the kidney is unable to excrete the acids normally formed in metabolism, and their retention leads to reduction in the bicarbonate in the blood. With sufficient residual oxygen, and proper diet, the loss of one or the other can be compensated for, if tissue destruction has not ensued. 

The hemoglobin color index calculator or any hemo­globinometer test will give an indication of the residual content of oxygen to an approximate degree. The reading specifying 50% to 60% can be said to have a deficiency of 35°, 60% to 70%, 25°; 70% to 80%, 10°. A_. 35° deficiency is the most serious and the most common in chronic cases.

The last method of examination we shall mention is the Manual and Peripheral Touch.

The first step is to let the fingers slide slowly up and down and around the neck area, noticing carefully any depressions, swellings, muscle tightness, or flabbiness. These are significant features. The side on which unusual features are found is the side on which abnormal conditions are located anywhere in the body from head to foot."

Paralysis of one side of the body is due to a lesion on the opposite side of the brain, but it is on the side of the lesion that the neck will show the depression or swelling and tautness of the muscles. Many patients and physicians have been astonished by the accuracy of this method in locating the trouble before the condition was explained. Next, one of the fingers should be inserted in the Fossa of Rosenmuller, noting whether the space is clear or heavy with gummy secretion, whether there is dryness or criss­crossed strings of tissue, termed adhesions, and whether there are any cool lumps that can be termed adenoids, or hard hot small raised spaces in which polypi may rest.

The next step is to test and sound the lungs. We will mention a number of methods here, but only two will be elaborated on to any length. The hand is placed on the chest, the vibrations felt can be called vocal vibrations. If after practice, a resonance is felt similar to what is heard through the stethocope or through the ear, a physician can in time become quite expert in testing the whole chest. Standing behind the^, head of the reclining patient in the dorsal position, both hands are placed flat on the patient's chest, and on exhalation the physician compresses the walls downward with slow but persistent force, and noting whether the return is slow or instant. The return should take at least three seconds. The following other tests may be made by the Inspectional and Observational methods:

(1) Note the shape of the chest, and its measurement, movements and deformities, type of respiration, the amount of air inspired, the number of respirations per minute. The last is very important to the Endo-nasalist;

(2) By palpation: abnormal sensations, vocal vibrations, sense of resistance;

(3) By percussion: varieties of percussion sound, and their significance, the tympanic resonance, the normal sound, the impaired and dull sound.

(4) Auscultation by ear, hand or stethoscope to ascertain vocal resonance and varieties, and the sounds of breathing, and their varieties.

The next step is examination of the abdominal area.  The liver should be thoroughly examined. Its consistency in a healthy state is the consistency of the muscles of the  forearm just below the elbow. Of course the examiner must be in health himself to make this test. Verify the diagnosis with the elbow of the patient. A hard liver and an excessively soft liver are indications of abnormal conditions.

The next step in the abdominal examination is to mass all the muscles and organs of the abdomen upward as far as possible, and to note how quickly they fall back into place. If this process takes less than five seconds there is a ptosis of the diaphragm and organs. This can be verified by having the patient stand up and note whether there is a bulge just above the os pubis.

Every physician of the manipulative schools of healing has his own method of nerve examination and nerve tracing so we will not inject any one method here. However, the importance of such an examination should always be kept in mind, because the central nervous system and the heart are the parts of the body from which arise most of the

symptoms and practically all of the dangers of anoxia. Of all the tissues of the body these are the most sensitive to reduction in their own oxygen supply. The voluntary muscles are also affected directly, but the most serious effects of anoxia upon the muscular system are due to derangements in the central nervous system leading to faulty coordination and lack of voluntary control. Functions such as respiration, circulation, digestion, and metabolism are altered by anoxia, but the alterations are brought about by the regulating mechanisms of the central nervous system. Death from acute anoxia is due to damage of the heart and to the central nervous system. When the exposure is long-continued, but less severe, other tissues are likely to be involved, but changes in the central nervous system and cardiac weakness are still the most prominent features.

Not only is the above important, but, in chronic anoxemia we find the cause of neurotism in many patients. There apparently seems to be nothing wrong, and the tendency is to think that it is all in the mind and will of the patient. They persistently complain of emotional instability, weakness, and pains here and there, headaches, loss of appetite and many other symptoms that the physician is at a loss to account for.