Chapter X: Introduction (7)

A number of cases of bowel prolapse are associated with general prolapse of abdominal organs; that is, displacement of the stomach, kidneys, liver, spleen, etc. This general condition is termed enteroptosis or Glenard’s disease. It usually requires several months to treat it successfully. These patients are neurasthenic, malnourished, and often hysteriacs. The symptoms from which they suffer are innumerable. Mechanical weaknesses, lowered vitality, poor innervation and blood supply, and auto-intoxication are causative factors.

The Prolapsed Uterus

=Prolapse= of the =uterus= is of common occurrence. The prolapse may be incomplete or complete; the latter when the organ is presented to the external world. Of special interest are those affections exclusive of surgical cases. Ptosis of the abdominal organs upon the pelvic organs is a common cause of uterine prolapse. The abdominal prolapse crowds uterine space, congests the uterus, weakens the ligaments, and drives the uterus downward as a wedge.

Lumbar spinal curvatures are frequent causes of prolapse, as well as other displacements of the uterus. In this region vasomotor nerves to the pelvic organs make their exit, and, consequently congestions, inflammations, and weaknesses of supports are results. Also, slips of the innominata disturb the pelvic circulatory balance. Weakness of the uterine support from below, the vaginal walls and perineum, most often arises from lacerations at childbirth. Still, the vaginal walls may become relaxed through other causes. Tumors and extreme congestions are causes of prolapse. Heavy lifting is quite a frequent source of uterine displacements. Osteopathy is very successful in uterine prolapses; that is, any displacement of the uterus not of a surgical character. Correction of the external causes comes first. Then local treatment to replace, tone, and relieve congestion, and break up adhesions is necessary. The external treatment is usually the primary treatment. Local work is not always necessary. Lacerations and other surgical indications, of course, require surgery.

Ovarian Displacements

The ovaries may be prolapsed, the left much oftener than the right. When prolapsed, it drops backward, downward and inward.

Ovarian congestion, tumor, retroverted or retroflexed uterus, tubal disease, and pregnancy are among the principal causes. Back of these congestions, tumors and uterine displacements, are the osteopathic causes, particularly spinal and rib lesions from the ninth dorsal downward. Specific lesions at the ninth and tenth dorsals and corresponding ribs, affecting directly ovarian tissues, and lumbar and innominate lesions and abdominal prolapse disturbing uterine and tubal tissues, are the most frequent osteopathic causes. A retroverted or retroflexed uterus is often found. Uterine displacements bear down upon the ovary and cause its descent, and also disturb ovarian circulation.

As has been stated, the left ovary is more apt to be displaced than the right. This is owing to the absence of a valve in the ovarian vein on the left side, and also, this vein opens at a right angle into the renal vein; this anatomical feature easily leads to passive congestion of the ovary, and thus to diseases of the organ. Then the rectum is on the left side and large fecal masses are apt to crowd against the ovary, which tends to its displacement.

Thus it is readily seen that osteopathic treatment is very applicable to ovarian displacement unless the indications are surgical. A more or less constant burning or sharp pain in the ovarian region, with probably some feeling of weight, profuse and painful menstruation, depression, irritability, etc., are =diagnostic=. However, a local examination will reveal the status of the ovarian position and congestion.

The same =treatment= as in other organ prolapse is indicated: toning weakened tissues, relieving congestions, replacing organ, with careful attention to the bowels and the general health. There are no tissue disorders of any part of the body wherein osteopathy is more thoroughly indicated and the results more generally satisfactory than in prolapse. And especially should it be remembered that in prolapse of various organs many vague intestinal and pelvic disorders and even ureteral and bladder disturbances may be traced to bowel dislocations and excessive kidney mobility in which osteopathic measures are often successful.

=Conclusion.=—The purpose of this section on Prolapsed Organs has been to supplement the various articles on Dilatation of the Stomach, Movable Kidney, etc., with an outline that may include relaxation of a part or of the whole of the abdominal viscera. The physician is all too prone to simply note the most offending or conspicuously disturbed organ instead of carefully analyzing all the features, great and trivial, that may be either apparent or marked. A general relaxation of the abdominal and pelvic organs may be found, and a nearly complete restoration take place under treatment, but still a lacerated perineum may have to be repaired before a cure is completed. Or it may be in a general abdominal ptosis that a floating kidney will resist all measures for restoration, short of surgery, and before much improvement can be obtained the kidney will have to be stitched into place. An enlarged liver may crowd the kidney out of place or a transverse colon may prolapse and drag on contiguous tissues and still the annoying symptoms be referred elsewhere. Then the primal point of general relaxation may not be in one organ, but there may be a simultaneous displacement of several.

The thorax itself may be distorted from various diseases so that the chest is narrowed, the diaphragm displaced with consequent descension of the abdominal organs, and from the latter a displacement of the pelvic.

“Far down displacement, marked changes of form, and real disfigurements of the stomach are found in some cases of kyphosis and scolio-kyphosis.”[46] The osteopath will not only find this true in some cases, but in many cases, although he recognizes as causative factors injuries to the spine causing curvatures and postural defects as prolific sources of abdominal relaxation.

“Glenard’s whole theory of splanchnoptosia is based on the relaxation of the suspensory ligaments of the intestines, especially that of the transverse colon; and Stiller, the discoverer of the floating tenth rib, says that splanchnoptosia is a descent of the atonic stomach, of the colon (especially the transverse portion), of the kidney (the right or both kidneys), exceptionally of the liver or the spleen. A descent which has been developed mostly in tender age, in consequence of general relaxation, especially of the peritoneal suspensory ligaments in individuals with congenital general dyspeptic neurasthenia, tender muscles, lean habit, and slender bone structure, manifested in a higher degree by a floating tenth rib.” Stiller observed that when there is a floating tenth rib there is a displaced stomach and a floating kidney, although it is not found in every case, but never missing if the case is pronounced. The tenth ribs in these cases have only a ligamentous fastening and are as freely movable as the eleventh and twelfth.

That abdominal relaxation plays a very important part in many diseases of the abdominal and pelvic organs, in cardiac and pulmonary affections, disturbs the circulation in the legs, and is the source of many reflex affections no one can gainsay. The osteopath should always pay particular attention to tonic condition of the abdominal viscera, for relaxation of the suspensory tissues and walls, and atony and sluggishness of the organs are frequently paramount etiological factors. And the osteopathic treatment is the remedy par excellence.

FOOTNOTES:

[45] Rose and Kemp—Atonia Gastricia.

[46] Rose and Kemp—Atonia Gastricia.

SKIN DISEASES

Various skin diseases have been treated osteopathically with varying success. So much depends upon the cause of the disturbance and its removal, in skin diseases, that the cure does not rest so much with the mere treatment, as with the necessary skill in locating the disturbing factor. One has to be continually on his guard to locate external irritations and disorders of the digestive and genito-urinary tracts. A great deal depends upon the avoidance of external influences; eating nutritious food and having an unobstructed circulation. The leading object of osteopathic treatment is to free the circulation and thus promote a healthy and unobstructed flow of blood; in no other class of diseases is this more essential than in skin diseases. After the removal of cutaneous irritations and the correction of internal disorders, the cure of the case depends upon the removal of constrictions to the cutaneous blood-vessels. The osteopath corrects the lesions found, relaxes the muscles thoroughly and stimulates the circulation to the parts involved, and promotes a healthy activity of all the excretory organs. When the upper part of the body is affected, lesions are generally found at the atlas and axis, and when the lower part of the body is affected, lesions at the fifth lumbar are of common occurrence, although lesions may be located at various points corresponding with the seat of disturbance. The constant use of hot baths will be found a helpful measure in many skin diseases. But use of soap must be considered as too much alkali will neutralize the oil of the skin and cause undue dryness, but bran may be substituted to advantage. Cleanliness is necessary but the result sought is, also, flushing the cutaneous vessels. There are many cases where a specific vertebral lesion will cause, through the peripheral nerves, a cutaneous irritation with intense itching and discomfort. This, in turn, produces an exudate with or without a crust and a condition results which is not amenable to any local or constitutional treatment but an adjustment of the lesion will in most cases bring immediate relief. Application of this principle will aid greatly in treatment of any skin disease. In no disturbance of health is it more necessary to find the cause than in skin disease and once found to apply specific treatment.

=Eczema= is frequently met in osteopathic practice. It is the most common form of skin disease, comprising nearly one-third of all these disorders. For a differential diagnosis of the several varieties the student is referred to special texts. It is well to remember that the same underlying causes may be basic to the various forms, for several varieties may occur at the same time or one variety pass into another, though commonly one form is more prevalent. The limbs, face and genitalia are the most common sites, though the eruption may occur on various parts of the body.

=Etiology= includes a number of factors, constitutional and local. Dietetic errors, indigestion and faulty elimination comprise the principal underlying causes, often manifested through absorption of toxins and leucomains. In fact any disorder of the abdominal viscera, organic or functional, may be a predisposing factor, likewise various disorders of the pelvis, tuberculosis, diabetes, anemia, etc. should be considered. So-called gouty and rheumatic tendencies may be the constitutional basis.

The many osteopathic lesions play a very important role in lowering not only systemic resistance but of local tissue as well. This feature can not be over-emphasized.

Then local irritants, mechanical, chemical and thermal, are not to be neglected. These are usually of secondary importance. Micro-organisms are probably a complicating factor after the lowered resistance has been established. Vasomotor neurosis, through constitutional defects, toxins and the very significant osteopathic lesion, is probably an essential part of the pathogenesis.

=Treatment= is usually successful if the various etiologic factors are eradicated. Early treatment is very important. If the disorder is of more than local significance change the entire daily regimen of the patient. Diet, outdoor exercise and sufficient sleep should be definitely regulated. A certain amount of general treatment to improve digestion, assimilation and elimination is imperative. An unbalanced diet and over eating must be corrected. In certain moist types, eliminating fatty foods will be helpful, while in dry forms the starches and sugars should be reduced.

If there is an underlying disease this should be remedied if possible. Particular attention should be paid to constipation.

Common sense in diet, rest, change of environment and free elimination, coupled with due attention to the osteopathic lesions, will cure the vast majority of cases. The greatest difficulty arises where there is some underlying disease. The parts should be protected against irritation such as dirt, cold, soap, and too much water. Meddlesome local treatment is to be guarded against. A simple application is boric acid, rice-flour or cornstarch, or where there is much itching add carbolic acid to the saturated solution of boric acid. Substitute bran for soap for cleansing purposes.

=Herpes Simplex=, fever-blister, or “cold sore” comprise two principal varieties: =herpes facialis= and =herpes genitalis=. The first occurs upon or near the lips, face, neck or ears. When the herpes is on the tongue or the mucous membrane within the mouth it is commonly termed “canker sores.”

Herpes genitalis is located on the prepuce, glans penis or farther back upon the penis. In the female the labia majora and minora and vestibule are the usual locations. Lack of cleanliness, sexual excitement and adherent prepuce are causative factors, though predisposing factors such as faulty circulation and disturbed innervation are to be considered.

In “cold sores” there is often some gastro-intestinal disturbance, especially intestinal stasis, cold in the head and other infections that supply toxins which irritate the nerves. No doubt there are underlying osteopathic lesions that lower the local nerve resistance or block the impulses such as vertebral and inferior maxillary lesions. The predisposing disturbance is probably due to the Gasserian ganglion.

Cold winds and excessive exposure to the sun’s rays will effect the tissues over the mental and infraorbital foramina, tensing the muscles and irritating the nerves at these points. On palpation they will be found sensitive. Frequent rotary motion by tip of finger over foramina will open them and allow congestion to drain.

=Herpes Zoster=, or shingles, is an acute inflammatory disease characterized by groups of small vesicles, usually along the course of the intercostal nerves on one side of the body. Before the vesicles appear there is more or less severe neuralgia. The eruption is unilateral, very rarely bilateral. The nearby lymphatics are usually enlarged.

Though the intercostal nerves are the ones most frequently involved, still the lumbar, thigh, trifacial and other cutaneous nerves may be affected.

The most common lesion is an inflammation of the posterior spinal ganglion which usually involves the fibers of the entire nerve. Inflammation of the nerve outside of the ganglion will cause the disorder. Toxins from various infectious sources are often exciting causes. Vertebral and rib lesions are always found; and where the Gasserian ganglion is involved lesions of the inferior maxilla and upper cervical vertebræ are predisposing factors. Thus osteopathic lesions from traumatism, cold and wet, and imbalance of muscular tension are important. Exudates, tumors, pleuritic and pulmonary affections are to be considered as possible sources.

=Treatment.=—Adjust vertebral lesions and carefully raise and separate ribs if intercostals are affected. Look after vertebral origin of any other nerve or nerves if otherwise. Local application of talcum or starch or boric acid will generally be sufficient.

=Urticaria=, hives or nettle rash is a common affection often due to some derangement of the digestive tract. This may be a mechanical irritation or of a toxic nature. Every one is familiar with the various foods that are apt to cause the hives, shell fish, strawberries, cheese, pork, oatmeal, mushrooms, etc.

The irritation may be a reflex one from the visceral disturbance; also, there may be irritation of the pelvic organs that would give rise to the trouble. It is well known that certain drugs will produce urticarial eruptions. There are cases where the irritation is simply local due to the nettle, mosquito bites and wasp stings.

In chronic cases intestinal stasis, nervous exhaustion and nephritic diseases are important.

No doubt osteopathic lesions frequently determine the location of the wheals. These lesions affect the innervation and thus establish a basis for the reflex vasomotor effect. This is in the nature of spasm of the cutaneous vessels quickly followed by dilatation with exudation of serum. The irritant probably acts on the walls of the blood vessels.

=Treatment= consists of thoroughly emptying the bowels by warm water enema, correcting the diet, toning the viscera and adjusting the osteopathic lesions. Thorough attention to the patient’s environment, daily habits and occupation are of value. Warm soda baths will relieve the itching.

=Acne= is a common skin disorder that is characterized by an inflammation of the sebaceous glands of the nature of papules, tubercles or pustules. The face, shoulders, chest and back are the regions usually involved. It generally, appears about puberty. Blackheads is the starting point; these are accompanied with greasy skin and dust, and influenced by micro-organisms and more or less intestinal disorder.

The general or systemic health no doubt affects the local disorder, as in many skin diseases; for various intestinal derangements as indigestion, constipation, etc.; pelvic and menstrual irregularities; general ill health; anemia, etc. affect circulatory, glandular and nervous integrity. Any disturbance of normal elimination is important.

The =treatment= consists of careful attention to the general health and to the local innervation of the face or region involved. Measures that tone the bodily organs such as outdoor life, regular habits, plenty of sleep and correct diet are important. In some cases the X-ray is of value.

ANIMAL PARASITES

Tape Worms

=Varieties.=—Taenia solium; taenia saginata; bothriocephalus latus.

The larvæ of tape-worms are introduced into the intestinal canal by food and drink. The parasite reaches adult growth in the intestines. The larval forms are then found again in the muscles and solid organs.

=Taenia Solium.=—This is derived from the hog, and is the most common form in this country. When mature it is from two to four yards in length. The head is small, about the size of a pin, and provided with four cup-like suckers surrounded by a double row of hooklets, hence it is called the armed tape-worm. The head is fastened to the body by a thread-like neck, and following the neck, the body occurs in segments. The sexual organs, both male and female, occur in the center of the broad surface of the segment. The segments are about one millimeter in length and seven or eight millimeters in breadth. There are thousands of ova in each mature segment. The worm attains its growth in about twelve to fifteen weeks, after which time the segments are shed and passed. For further development the ova must gain entrance to the stomach of a pig or of man, and passing from the stomach they may reach the muscles and organs and develop into larvæ or cysticerci.

=Taenia Saginata.=—This is derived from beef, and is much longer and larger than the taenia solium. It is from five to six yards in length; the head is over two millimeters in breadth, is square shaped, and has four large sucking discs, without hooklets; hence it is called the unarmed tape-worm, in contra-distinction to the hooked variety. The segments are thicker and the ova larger, and they are passed and ingested in the same manner as the taenia solium.

=Bothriocephalus Latus.=—This is found especially in Europe and is very long, measuring from eight to ten yards; it is derived from fish, is not provided with hooklets, but has two lateral grooves. The segments are short and wide, the sexual organs being on the narrow side of the segment.

=Etiology.=—Unhealthy condition of the stomach and intestines is the predisposing, and uncleanliness an important, factor in the occurrence of tape-worm. Those eating imperfectly cooked beef, pork, fish or other meats, and those handling fresh meats, are liable to be affected with tape-worm.

When the ovum is taken into the stomach the capsule is dissolved and the embryo passes into the small intestines, fastening itself into the mucous membrane, by its hooklets and suckers and grooves.

=Symptoms.=—Tape-worms occur in the human being at all ages. Oftentimes symptoms are absent, the expulsion of segments being noticed and thus the worms accidentally discovered. The tape-worm is seldom dangerous, but if a worm is known to exist it is always a source of considerable anxiety on the part of the patient. Severe anemia may result and be wrongly diagnosed.

There are dyspeptic symptoms, colicky pains, nausea and occasionally diarrhea. The appetite is variable, sometimes ravenous. This condition is followed by loss of flesh and various reflex phenomena, as vertigo, headache, convulsions, palpitation, choreic movements, itching of the nose and anus, paralysis, and rarely, insanity. In addition to these symptoms there may be a wrinkled countenance, sensation of a cold stream winding itself toward the back immediately after a meal, pain in various parts of the body and ringing in the ears. The decisive diagnostic symptom is to find segments of the worm in the stools.

=Diagnosis.=—Discovery of the ova or segments in the passages of the bowels is the only proof of the presence of a tape-worm.

=Prognosis.=—Favorable in all cases.

=Treatment.=—Prophylactic treatment is necessary. Meats should be thoroughly cooked so that the larvæ will be destroyed; and all segments of tape-worms passed in the stools should be burned—by no means should they be thrown outside or in the water-closet.

The immediate expulsion of a tape-worm is not a necessity. First of all the mode of living, and then the general state of health should be corrected. Tape-worms invariably result from a general state of unhealthiness, and with improved health and corrected digestive processes the worms cannot exist, and in a short time will be expelled. Expulsion of the head is necessary before the case will be cured, for if the head is not expelled new segments will continue to grow.

Stimulating the liver to increase the amount of bile, and increasing the activity of the digestive glands of the stomach and intestines, by a thorough treatment of the splanchnic region and direct treatment over the abdomen, will usually be sufficient for the cure of intestinal parasites. The treatment will probably have to be repeated several times, in order that the intestines may regain a healthy tone, so that the parasite will not find favorable conditions for its existence within the intestines, and that the bile may be secreted in sufficient quantities to dislodge the worm.

Hahnemann claimed, “that during a period of comparative health tape-worms do not inhabit the intestines proper, but rather the remnants of food and fecal matter contained in the intestines, living quietly as in a world of their own without the least inconvenience to the patient and finding their sustenance in the contents of the bowels. During this state they do not come in contact with intestinal walls, and remain harmless. But when from any cause a person is attacked by an acute disease the contents of the bowels become offensive to the parasite, which in its writhing and distress touches and irritates the sensitive intestinal lining, thus increasing the complaints of the patient considerably by a peculiar kind of cramp-like colic. (In similar manner the human foetus in the womb becomes restless, twists its body and moves whenever the mother is sick, but floats quietly in the liquor amnii, without distressing her while she is well.)” This but harmonizes with the osteopathic theory and practice with regard to tape-worm, that there is an unhealthy condition of the intestines which predisposes to the affection, and consequently the cure must be a correction of such a disordered state.

During the treatment, if a light diet of milk and broths is given, it will favor an earlier removal of the parasite, by helping to remove the mucus in which the head is embedded. If this fails extract of male fern is suggested.

Ascaris Lumbricoides (Round Worm)

This is the most common parasite, and is found principally in children; it is also found in cattle and hogs. It is of a yellowish brown color and in form resembles earth worms. The worm is cylindrical, pointed at both ends; the female is from seven to twelve inches in length, and the male from four to eight inches. They are probably introduced into the stomach by food and drink. They occupy the upper part of the small intestine, and are usually one or two in number, though they may be numerous. Occasionally they migrate into the stomach and are ejected by vomiting, or into the trachea and produce suffocation, or into the larynx or Eustachian tube, or they may pass downward to the anus, or into the bile ducts.

=Symptoms.=—Oftentimes symptoms are absent. There may be dyspepsia, colicky pains, mucous stools, meteorism, vertigo, fretfulness, voracious appetite, anemia, sallow complexion, headache, chorea and convulsions. Other symptoms may be present, as grinding of the teeth and itching of the nose and anus. Obstruction of the bowels has occurred. If a worm enters the bile duct obstructive jaundice occurs. A decisive diagnosis can be given only when the worm is seen.

=Treatment.=—Particular attention should be paid the liver, for it is here that we must seek the natural remedy in the form of bile, in order to eject and cleanse the system from nematodes.

Modes of improper living should be corrected; cleanliness is essential, and there should be attention to the general health of the patient. Thorough correction of all defects of the spinal column in the region of the splanchnics, and careful direct treatment of the bowels is indicated. The child may be put to bed and fasted twenty-four hours, then the liver strongly stimulated to increase flow of bile.

If the above treatment is not successful oil of wormwood may be employed.

Oxyuris Vermicularis

(Thread-worm; Pin-worm)

This small parasite, commonly seen in children, is from three to five millimeters long in the male and about twenty millimeters in the female, is blunt at one end and sharp at the other, and occupies the colon and rectum. They are probably introduced into the intestines in the ova, by uncooked fruits and vegetables, or by the dirty hands of mothers and nurses of the infants. They vary greatly in number; migrate to the rectum where they deposit their eggs, and are often discharged in the feces, where they appear like pieces of ordinary white thread.

=Symptoms.=—Loss of appetite, anemia, restlessness and irritability are marked. The itching becomes intolerable when the worms come down in the rectum to the anus and within the folds about the anal orifice. In the female the worms may wander into the vagina where they become particularly distressing, and thus may produce excessive sexual excitement and cause nymphomania and masturbation.

=Treatment.=—Cleanliness of the most scrupulous kind should be demanded in every instance. Injections of cold salt water (repeated for at least ten days) and other agents within the rectum will destroy the eggs as soon as they are deposited, besides relieving the terrible itching. In obstinate cases use quassia decoction.

Attention to the general health of the patient and great care of the intestines and other digestive organs are absolutely necessary. The spinal treatment to the intestines and other digestive organs, as well as thorough direct treatment over the abdomen, is indicated.

Uncinariasis

(European hook-worm disease; Miner’s anemia; Ankylostomiasis; Hook-worm disease)

This disease results from infection by the hook-worm of any of the various types. In Europe it is found in Italy, Belgium, Germany, France and Switzerland. In America it seems to be of Africo-Asiatic origin but was first discovered in the Southern states and abounds chiefly in Texas, Florida, Georgia, North and South Carolina as well as in the West Indies. Infection comes from unprotected feces that are allowed to be spread where the feet or hands may come in contact as it is without doubt that the contagion occurs through the skin. One authority states that hook-worm is rarely found except in cases where ground itch has occurred within a period of eight years. Negroes harbor the parasite and transmit it but seem immune to its effects while the poorer whites are afflicted to a large degree. The worms are carried from some abrasion of the skin, by the blood to the heart and lungs, thence to the pharynx and swallowed, thence to the duodenum and jejunum where they attach themselves to the lining walls. Here they not only feed upon the blood but develop a toxin. The female worm is about twice the size of the male, 10 to 18 mm. as against 6 to 11 mm. and there is slight difference between the old and new world varieties. The head is provided with four hook shaped teeth which form the attachment to the intestine and it is very secure.

=Diagnosis.=—For years the languid, dull, expressionless, lack-luster of eye and general unambitious characteristics of the inhabitants of the great sand belt of the United States attracted attention and was attributed to laziness but the discovery of the hook-worm explained the cause. Children are stunted in mind and body and have a muddy, dirty white complexion.

At the beginning there must be a very considerable colony of the parasites to cause symptoms but as the disease advances there is a distention of the abdomen from enlargement of the spleen and liver and from flatulency. There is palpitation, shortness of breath, cardiac bruits from the severe anemia while edema of the feet and legs is rather common. The blood shows a severe secondary anemia with its coagulation time much increased. Leucocytosis is not common; hemoglobin is from one-tenth to one-half normal with erythrocytes about half normal.

=Treatment.=—The removal of the worms with the least possible harm to the body is indicated. Thymol is a poison which is not absorbed by the body, when carefully given, and which is very toxic to the parasite. The dose varies from eight grains for a child under five years of age, to forty-five for an adult. Thymol is soluble in fats and in alcohol, so that for a day or so before the thymol is given, and from one to four days after, no fats or alcohol should be taken. The best way to avoid poisoning by thymol is to give the patient charcoal, then no fats or alcohol is permitted until the treatment is completed. When the stools become black, the thymol is given on an empty stomach. A purgative is given a few hours later. Enemas should be used very freely in order to facilitate the removal of the injured or poisoned worms. Another dose of charcoal is given, and when the stools are black again, the patient may return to his ordinary diet. The denial of fats to the person so thoroughly accustomed to bacon three times a day is a factor met with difficulty in dealing with patients of the ordinary class with the disease. (Clinical Osteopathy.)

=Prophylaxis.=—After treatment it is imperative to prevent reinfection and to do that the most rigorous sanitary measures must be instituted. All feces must be disposed of and habits of cleanliness in defecation insisted upon while negroes, who harbor the worm without showing symptoms, must be looked after as well as the actual victims. Care of the feet is important and shoes should be worn in infected regions and all abrasions of the skin protected. Drinking water must be uncontaminated which presents a problem as wells and springs are usually unprotected. Absolute and persistent cleanliness is the answer to the question of prevention.

Trichiniasis

Trichiniasis is a name given to a disease produced by the embryos of the trichina spiralis. In the adult condition the trichina spiralis lives in the small intestines. The embryos migrate into the muscles where they finally become encapsulated. Man is infected by eating insufficiently cooked pork containing the encapsulated worm, which is set free during the digestive process. About the third day they attain their full growth and become sexually mature. Each one discharges large numbers of embryos. As soon as born the young brood is carried away from the bowel and invade the muscles through various channels—principally by means of the blood stream and along the connective tissue routes. The female trichina may bring forth several broods of embryos in succession. In nine or ten days after infection the first brood reaches its destination. They attain to maturity in about two weeks after entering the muscular tissue. In this process an interstitial myositis is excited and a fibrous capsule is formed in four to six weeks. The capsule gradually becomes thicker and finally calcareous infiltration may take place.

Thorough cooking destroys the parasite. The disease is most frequent among the Germans who eat raw ham and sausages.

=Symptoms.=—These are sometimes absent, especially when only a few are eaten. If large numbers have been ingested, gastro-intestinal symptoms develop in the course of a few days. Vomiting, diarrhea, and pain in the abdomen may be present.

In from one to two weeks muscular symptoms develop. There is fever, muscular pain, especially during motion, and the muscles are stiff, tense and sometimes swollen. When the respiratory muscles are involved dyspnea is produced, which may prove fatal. Eosinophilia is a helpful diagnostic point. Edema, especially of the face, is an important symptom. Profuse sweats, itching and tingling of the skin have been observed.

=Diagnosis.=—Epidemics of this disease are more easily diagnosed than an isolated case. Among the Germans, if cases of apparent typhoid fever occur after a picnic or other feasting occasion, where raw ham or sausages have been indulged in, this disease should be suspected. Examination of the stools and of the muscles will be of aid. The worms may be discovered in the pork, a portion of which has been eaten by the patient.

=Prognosis.=—This depends upon the number of worms ingested. The prognosis should always be guarded. Early, marked diarrhea is favorable.

=Treatment.=—Prophylactic treatment is of great importance in trichiniasis. Inspection of the meat supply, is doing much to prevent trichiniasis; although the most practical way to prevent the disease is to thoroughly cook all pork and sausages. The central portions of the meat should be well cooked.

In the feeding of hogs care should be taken that they do not receive any offal, but only milk, grain, vegetables, etc.

When a person is infected with trichiniasis, thorough and prompt evacuation of the bowels should be performed at once, so that the embryos will not have time to pass into the muscles, but will be ejected from the body. This should be followed by a thorough and persistent treatment for several days of the liver and intestines; treat both the liver and intestines directly and through the spine. The object of this treatment is to render all the digestive juices active, so that they may dislodge the animal parasite, and to prevent their passing into the muscles. Also keep the bowels active for several days.

When the larval parasites have entered the muscles, a treatment cannot be applied to affect them directly, but the health of the body should be maintained if possible, and the severer symptoms, as the muscular pains, weakness and insomnia combated. Thorough manipulation, massage and hot baths will be of special aid in relieving the stiffness and weakness of the muscles.

Filaria

(Filaria Sanguinis-Hominis)

There are two varieties. One is a thread-like worm with tapering, blunt ends, appearing in the blood at night, hence called =nocturna=, while the other is of slightly different form, appearing in the blood only by day and is called =diurna=.

The mosquito is the communicating host of the parasite. During the night, or should the patient sleep during the day, the =nocturna= appears in the peripheral circulation, while during the other interval they are probably in the other vessels, particularly the lungs.

After the mosquito has taken blood from an affected patient it requires from six to seven days for the metamorphosis of the minute filaria which are then lodged in the probosis of the mosquito and introduced into the blood of the next victim. The adult parasite is from three to four inches long and the thickness of a coarse hair, with clear sexual distinction.

=Pathologically= there are no distinct lesions, as the parent worm must establish one. Lymphatic engorgement may result from plugging of the thoracic duct or of a large lymphatic with consequent engorgement which may develop symptoms in the inguinal glands, pelvic and lumbar lymphatic trunks. As these varicosities develop rupture may occur; if into the genito-urinary tract chyluria or chylocele may result, or if in the abdominal cavity chylous ascites.

Lymphangitis follows a lymph stasis, which later results in =elephantiasis=. (Barbadoes leg.)

=Symptoms.=—Elephantiasis affects the legs, but the arms rarely; the labia of the female and scrotum of the male; occasionally the breasts and other parts of the body. Fever is present on account of the lymphangitis, accompanied by rigors and delirium and there is marked local inflammation. The attack terminates in a pronounced sweat. In deeper parts there is deep seated pain and signs of sepsis, while abscesses may develop over the inflamed area.

The varicose inguinal glands are doughy, soft and painless, with both sides affected alike. The scrotum is affected by the extension, and at times the testes.

=Treatment= is surgical, as the tumors must be removed. Unless the female worm is also removed this is, however, only palliative.

Methylene blue is said to be destructive to the filaria and it is practically harmless to the human body. The only treatment is one that will aid in building up the general health.

HEMORRHAGES

Nasal Hemorrhage

(Nose bleed; Epistaxis)

=Osteopathic Etiology= and =Pathology=.—Traumatism, such as picking the nose, blows, and surgical operations; straining when coughing; nasal tumors and ulcerations; lesions of the atlas, or any lesion of the upper cervical vertebræ, that would interfere with the vasomotor distribution to the nose and cause local congestion or weakness of the blood vessels; obstructions to the general circulation; irregularities or suppression of the menstrual flow may result in nose bleed, as a vicarious menstruation; suppression of a habitual hemorrhoidal discharge.

=Pathologically= the great frequency of nasal hemorrhage is due to the great vascularity of the nasal mucous membrane. Usually in cases of spontaneous origin, bleeding is from the region of the septal artery. Spontaneous bleeding may also occur from posterior hypertrophies or adenoid vegetations. The blood flowing downward into the fauces, is expectorated in such cases, and may be mistaken for a hemorrhage from the lungs.

=Treatment.=—The position of the individual is important. He should assume a sitting posture, or as nearly so as possible. Holding the nostrils tightly, or plugging them with a piece of cotton, will favor the formation and retention of a clot, so that the hemorrhage may be controlled. Pressure upon the carotid artery, or upon the facial artery at the angle of the inferior maxilla, will slow the blood current and favor the formation of a clot, also pressure on the sides of the bridge of the nose may influence it. Correcting any lesions that may exist in the superior cervical region, as derangement of the vertebræ or contracted muscles, will remove obstructions or irritations to the vasomotor system of the affected region, and thus equalize the vascular system. Holding the arms above the head, and the application of ice to the nose are of aid in some cases. Also, injection of cold or hot water into the nostrils. In serious and obstinate cases, where other methods fail, a plugging of the anterior and posterior nares should be resorted to, using absorbent cotton or gauze.

Broncho-pulmonary Hemorrhage

(Hemoptysis)

=Osteopathic Etiology= and =Pathology=.—Pulmonary congestion; croupous pneumonia; tuberculosis; hemorrhagic infarction; ulcers of the larynx, trachea or bronchi; gangrene of the lung; fibrinous bronchitis, carcinoma of the lung; lesions of the ribs or vertebræ from the second to the seventh dorsal inclusive, may cause diseases of the bronchial tubes or lungs, that result in hemoptysis, or the hemorrhage may be caused directly by extreme congestion resulting from the disordered vasomotor nerves; diseases of the heart, such as mitral disease, causing pulmonary congestion; aneurism of the branches of the pulmonary artery; vicarious menstruation from deranged menstrual functions; diseases of the vessel walls, or blood, as scurvy, anemia, hemophilia, etc.

=Pathologically= in many cases, the lesions are microscopic, consisting of ruptured capillaries. In other cases larger vessels may be ruptured, or are the seat of erosion. Many other lesions may be observed. After death the bronchial mucosa is occasionally found inflamed and the lung tissues paler than normal.

=Diagnosis.=—A differential diagnosis must be made between epistaxis, hemoptysis and hematemesis.

In =epistaxis= the blood may flow from the posterior nares into the pharynx; it causes coughing and a discharge of the blood may occur the same as in hemoptysis. A careful examination of the nasal region alone can determine the source of the bleeding.

In =hemoptysis= the history of the case as to pulmonary or cardiac diseases is to be considered. There is a feeling of weight and of uneasiness in the chest. A salty taste and a tickling of the throat precedes the bleeding. The blood is ejected by coughing and is bright red, frothy, very little coagula, and is alkaline in reaction.

In =hematemesis= the history would indicate disease of the stomach, spleen, liver or heart. Uneasiness, and occasionally nausea and faintness, precedes the bleeding. The blood is ejected by vomiting, and is dark, clotted or fluid, mixed with food, and is of acid reaction. In a few instances the blood due to hemoptysis may be swallowed, and vomited.

=Treatment.=—In all these cases of hemoptysis the patient should be placed in bed and absolute rest demanded. An attempt should at once be made to correct any lesion that may be found influencing the cause of the bleeding. Correcting lesions to the vasomotor nerves of the lungs and bronchial tubes, and equalizing the disturbed vascular area, may be sufficient in a number of cases. These lesions will be found principally in the upper dorsal region. In some cases, perhaps, there is an impairment of the trophic nerves by the same lesions, thus interfering with the tone of the vessel walls and pulmonary tissues. The diet should be light, nutritious and non-stimulating. The use of hot drinks is to be avoided. The rapidity of the heart’s action should be reduced. This is best performed by thorough treatment of the dorsal spinal nerves of the left side over the heart, and by inhibition in the suboccipital region. The ice-bag to the precordia is also helpful. Iced drinks and the eating of ice is of aid. Stimulation of the systemic circulation will be of value in helping to relieve the pulmonary congestion, although the two systems are somewhat independent of each other. Also, hot foot baths and the evacuation of the bowels may be of additional value. In cases due to organic disease of the heart, the mind and body should receive absolute rest, so that the diseased areas may be strengthened as much as possible; besides a tonic treatment for the heart’s action is necessary.

After the hemorrhage has subsided care should be taken that bleeding does not occur again. All irritations of the respiratory tract should be avoided. A stimulating diet, tobacco and alcohol should be avoided. Nutritious food and a moderate amount of exercise is indicated.

Hemorrhage of the Stomach

(Hematemesis)

=Osteopathic Etiology.=—Injuries to the stomach; local diseases, as congestion, ulcers and cancer; vicarious menstruation; a mechanical obstruction to the portal circulation; spinal lesions to the vasomotor nerves of the stomach; alterations in the blood; perforation of the stomach walls, involving a blood vessel; disease of some neighboring organ.

=Diagnosis.=—A careful examination of the case and of the blood ejected will be necessary to determine the nature of the cause. The differential diagnosis as to the source of the blood, whether from the stomach or lungs, was given under hemoptysis.

=Treatment.=—Correction of any lesions that may influence the blood pressure in the region of the stomach, is the first requisite. Treatment of the splanchnics has the greatest influence upon the vasomotor nerves to the stomach. Treatment of the vagi nerves and of the fourth and fifth dorsals, will quiet the violent movements of the stomach, and thus aid in controlling the hemorrhage. Stimulation of the cervical sympathetics and heat applied to the feet will tend to equalize the vascular system, and thus lessen the gastric congestion. The application of a broad flat ice-bag over the stomach will be of great value. Keep the patient quiet in bed. Surgical interference may be necessary.

Intestinal Hemorrhage

=Osteopathic Etiology.=—An obstructed circulation of the blood through the venaporta, as in diseases of the heart, lungs and liver; lesions of the vertebræ deranging spinal nerves to the intestinal blood supply; injuries caused by corroding or cutting substances; mechanical injuries to the intestines; degeneration or erosions of the blood-vessels from ulcers of the intestines, as from typhoid fever, typhus, dysentery, etc.; disordered menstrual or hemorrhoidal discharges.

=Diagnosis.=—The locality of the intestines affected can be approximately determined by an examination of the discharged blood. When the blood comes from the upper part of the intestines, it is generally dark and mixed with the intestinal contents, which gives it a tarry appearance. It is generally red and fluid when it comes from the lower portion of the bowels. If from the stomach, the blood is thoroughly mixed with fecal matter. Throwing the passage into water, the water is colored red when it contains blood, and if the contents contain bile the water is colored green or yellow. Also, noting the areas of contracted muscles, as in intestinal colic, will aid in the regional diagnosis.

=Treatment.=—Absolute rest in all cases is necessary, the patient remaining as quiet as possible. Food, in severe cases, should not be given for ten or twelve hours. The bed-pan should be used in caring for the evacuations. Correction of the lesions along the spinal region, chiefly of the lower dorsal and lumbar regions, that are impeding the innervation to the intestines, should be attended to at once. This treatment tends to relieve any hyperemic condition of the intestinal mucosa and influences the whole vasomotor area of the mesentery. Direct treatment of the abdomen in a few cases is of great value to relieve obstructed and contracted vessels in the mesentery, but in certain pathological conditions, e. g., typhoid fever, leave the abdomen alone. Treatment (inhibition) along the spinal column from the sixth dorsal to the coccyx is helpful in all cases to quiet the peristalsis of the intestines. In severe cases cold drinks, eating of ice and an ice pack to the abdomen are of aid. In a few instances surgical measures will be necessary.

Hematuria

=Osteopathic Etiology.=—Congestion and acute inflammation of the kidneys, exacerbations of pyelitis, renal calculi, chronic nephritis, traumatism, tuberculosis, etc.; affections of the urinary tract, as calculi or lacerations of the ureter; calculi, cystitis, ulcerations, etc., of the bladder; calculi, gonorrhoea, parasites, etc., of the urethra; general diseases, chiefly the acute specific fevers and blood diseases; blows, wounds and traumatic influences, external to the kidneys; lesions of the renal splanchnics.

=Diagnosis= of the locality of the hemorrhage in the urinary tract: In hemorrhage from the =kidney= the blood is thoroughly mixed with the urine, giving a uniform color. Blood casts and leucocytes are present. In hemorrhage from the =ureters= the blood is usually molded in clots which conform to the shape of the ureter. The clots appear like small dark worms. In hemorrhage from the =bladder= the blood is not thoroughly mixed with the urine and large clots form upon standing. In hemorrhage from the =urethra= the blood often discharges without micturition. When urine is passed the blood precedes the passage of urine.

=Treatment.=—Rest is essential. A correction of the lesions to the renal splanchnics is necessary to control the congestion and inflammation of the kidneys. When the ureters, bladder or urethra is involved, attention must be given to the condition of the spinal column below the renal splanchnics. In all cases the inhibitory treatment to the lower spinal column and ice to the loins are of value. If surgery is indicated, do not delay operation.

Uterine Hemorrhage

Most of the causes of uterine hemorrhage come under the subject of obstetrics; others under menorrhagia and metrorrhagia. Such will be found in obstetrical and gynecological works.

=Treatment.=—The patient should assume the dorsal position with the buttocks raised. If any displacement of the uterus is present or if there is any foreign material in the uterus, usually such should be corrected or removed at once. Stimulation of the clitoris is a most effectual means to control uterine hemorrhage; it contracts the circular fibres of the uterus. Stimulation of the uterus directly through the vagina, and over the abdomen, and stimulation of the upper wall of the vagina, will aid in contracting the uterus. A quick, unexpected pull of the hair on the mons veneris will have the effect of closing the capillaries by shock to the nervous control (Dr. Still). Before closing the os, however, it is well to know that there is no irritating foreign material within the body of the uterus. Correction of obstructions of the vasomotor nerves of the uterus through the splanchnic and lumbar region is important. Compression of the abdominal aorta, and vaginal injections of hot water may be of aid, as will also a hot water bag at the lumbar region and ice water bag over symphysis. In severe cases inversion of the body, if it can be done with safety, may be performed. Packing the vagina is a method resorted to occasionally in severe cases.

Hiccoughs

Occasionally there is a case of hiccoughs that has been continuous for hours or even days and that all efforts have failed to stop. They are caused by an irritation to the peripheral distribution of the phrenic nerve from some gastric disturbance or a local irritant acting upon the center in the medulla. It may follow fright or great emotion and be associated in persistent form in rheumatism, typhoid fever and other febrile diseases. It follows abdominal operations at times and is very distressing. When occurring in elderly people with pneumonia and in peritonitis with distention it usually marks the end. The same may be said in case of carcinoma of the stomach and bowels.

=Treatment.=—Go first to the origin of the phrenic nerve at the third, fourth and fifth cervical and, if there is a lesion as there will probably be, adjust it and note results. This will be sufficient in many cases. Failing, bring direct pressure on the nerve just above the clavicle and anterior to the sternomastoid muscle and release the scaleni muscles. After this examine and treat at the fifth and twelfth dorsals. Correct any lesions but best results will be had from inhibition at these points. Another method is to stand beside the patient and insert the fingers of both hands under the costal end of the ribs and lightly pull. Firm pressure over the solar plexus with flat of the hand is sometimes beneficial. In hysterical cases, drawing out the tongue will often be effective and it has been suggested that standing the patient on the head will stop them in short order. Tickling the nose to produce violent sneezing is an ancient remedy. Some one of these will cure the case, as osteopathy has never failed so far as recorded.

The stomach should be emptied of all irritating matter to prevent recurrence.

VARICOSE VEINS

In varicose veins there is a dilatation of the calibre of the veins and their valves are insufficient. The walls are irregularly thinned, lengthened and tortuous.

=Osteopathic Etiology= and =Pathology=.—The =internal saphenous= is the vein most frequently affected, although any vein throughout the body may become varicose. Commonly, varicose veins occur in the lower extremities and occasionally in the arms.

The =valvular insufficiency= is caused by stretching of the wall of the vein, thus separating the thin, free edges and leaving an interspace that allows regurgitation of the blood. The valves becoming insufficient, the column of blood in the veins has no support against gravity, and being interrupted in its course does not flow normally into collateral channels. The walls of the veins become thin, as does also the adjacent skin, thus increasing the danger of a rupture, either external or subcutaneous.

Varicose veins are most frequently found in females, following uterine enlargements. The condition may be due to any obstruction or constriction that prevents the free return of blood from the veins, such as dislocations of the hip, either slight or complete, dislocations of innominata, contractions of adductor magnus muscle affecting femoral vein, prolapse of diaphragm obstructing vena cava, tissue constrictions about the saphenous opening, garters, and, in fact, anything that might impede the free venous flow. The tendency to varicose veins increases as age advances, and many cases are found among people of middle life who have been accustomed to standing a great deal. Injuries to the pelvis, thigh or leg, lessening the nutrition to the leg, or injuries to the nerves, as vertebral dislocations in the lower dorsal or lumbar regions (the fourth lumbar especially) may be causes of varicose veins. Pregnancy or tumors in the abdomen or pelvis, causing pressure upon the iliac veins, are occasionally causes. Distention of the sigmoid flexure, causing pressure upon the left iliac vein, or distention of the cecum; pressing upon the right iliac vein, are fruitful sources, as are also diseases of the heart and lungs. Varicose veins of the upper extremities are due to occupations requiring overuse of the arms.

=Complications.=—Varicocele, hemorrhoids, labial varix in the female, varix over pubes, ulceration and eczema due to disturbances of nutrition, edema and thrombus.

=Symptoms.=—=Lower Extremities.=—Cramping pains in the limbs upon rising. Fullness and heaviness of the limbs. Inspection may reveal superficial varicose veins near the saphenous opening, upon the external thigh, in the popliteal space, upon the external leg or behind the ankles. Edema and congestion of the foot and ankles occur in a few cases. Pain is quite a prominent symptom, due to pressure upon the nerve fibres. Eczema and itching are due to disturbed innervation and blood supply to the skin. Ulceration may occur, due to the bursting of a vein.