Chapter XXXIX: Introduction (24)

6. Test the function of the groin. Always begin on the sound side for comparison in order that the patient may become accustomed to the manipulation before the limb suspected of disease is tested. Tuberculosis in a joint is always accompanied by muscular spasms that positively limit motion in every direction, while in other affections only one or more limitations are observed, but never in all directions. Compare closely the motions of the sound and affected limbs while the patient is on the back. Turn patient on face and test for extension by holding pelvis flat on table with one hand and gently elevating thigh with the other. The normal range in a child is about twenty degrees backward from the line of the body and limitation of this range is perhaps the earliest indication of hip-joint disease. It is due to psoas contraction. If this range of motion is unrestricted hip disease can be practically excluded.

The X-ray completes the diagnosis when used with a thorough knowledge of the physical signs. It must be remembered that in early life a larger part of the extremity of the femur is cartilaginous and does not show well in a radiograph. The X-ray picture shows clearly the destructive effect of the disease on the femur and acetabulum and gives a clear conception of the actual condition of the joint.

=Treatment.=—The object of treatment of this condition is threefold: first, to relieve the pain that depresses the vitality of the patient; second, to relieve the muscular spasms that induce distortion of the limb and which stimulates the destructive process by increasing pressure and friction of the diseased surfaces of the opposing bones; third, to correct and prevent deformity by lessening pressure and by restraining motion, thereby keeping the femur from upward displacement.

Rest and protection are the two cardinal features of treatment of this condition. Sunshine, fresh air and good nutritious diet are very important.

Complete rest of the joint offers the most favorable opportunity for nature to repair this disease. The recumbent period of the treatment necessitates rest in bed for the reduction of the deformity and subsidence of acute symptoms. By the aid of traction, which is applied to the length of the legs by means of a Buck’s extension. As much weight should be applied as can be borne without discomfort to the patient.

As soon as the deformity and acute symptoms have subsided, the ambulatory treatment should be substituted to keep up the general health of the patient. This merely consists of the application of a long plaster of Paris spica of the hip which should reach well up to the thorax and extend down and include the foot. All bony prominences should be well padded, and a moderate amount of traction with about twenty degrees abduction should be used while applying the plaster bandage. Though various forms of apparatus have been devised for fixation and traction, I believe that the plaster of Paris spica is far the most effective and should always be used, changing the cast as often as it becomes soiled. Locomotion is possible with crutches providing the shoe on the well side is stilted by an iron patten which is high enough to allow the casted limb to clear the floor.

The earlier treatment is begun, the better the outlook. Recovery with perfect motion occurs in about twenty-five percent of hospital cases; fifty per cent will obtain useful motion and the other twenty-five per cent will obtain practical fixation, but it must be remembered that results will range entirely according to the thoroughness of treatment, the severity of the disease in the individual case, and the natural resistance of the child. In general, the hip should be fixed as long as it is sensitive, it should be protected and distracted as long as there is muscular spasm, and protected until the congested and inflamed bone of the epiphysis is replaced by firm healthy bone.

Tuberculosis of the Knee Joint

Tuberculous disease of the knee is next to the hip in frequency. It is a chronic destructive process of the epiphysis of the femur or tibia, or it may start in the patella, head of the fibula, or primarily in the synovial membrane of the knee joint. The condition presents two distinct types; one, the adult type beginning as a chronic synovitis, of which the early symptoms are subacute; and the other, the childhood or most common class, in which the symptoms of pain, muscular spasms and deformity seem to indicate clearly a primary disease of the bone.

=Symptoms.=—This disease is commonly known as “white swelling” and the symptoms as a rule are quite characteristic. The affection begins with a limp and limitation of motion, and is usually slow in progress with periods of severe pain. There is usually much swelling and this together with the distortion of the limb by muscular spasm and atrophy of the muscles both above and below the joint, gives a most characteristic knock-kneed appearance. The affected limb is usually longer at first, owing to the congestion of the epiphysis of the knee. Local heat is always present in the more acute stages and the lameness is usually a constant symptom. The differential diagnosis from other joint troubles is easy because of the slow insidious onset.

=Treatment.=—Like other tubercular bone conditions the fixation treatment is best. Rest in bed with a Buck’s extension to overcome the deformity and the local application of hot packs until the acute symptoms have subsided, is the best preliminary treatment of this condition. Five- to ten-second exposures to the X-ray each day for ten days seems to relieve the pain and in most instances causes less marked infiltration of tissues.

When the acute stage has subsided, the ambulatory treatment by fixation in a plaster of Paris cast extending from the groin to the ankle, with about 10 degrees flexion, is most efficient.

The patient is allowed to walk about with the aid of crutches, having the shoe on the sound side stilted enough so that the diseased limb clears the floor. The functional results after conservative treatment are in the average case excellent, that is providing proper treatment is begun at an early stage. Useful motion is obtained in fifty per cent of these cases, perfect motion is restored in twenty-five per cent, and complete rigidity results in the other twenty-five per cent of cases.

Any chronic, painful inflammation confined to a single joint, in which motion is limited by muscular spasm, and in which there is a tendency towards deformity, is almost always tubercular in character.

The Plaster of Paris Bandage

The plaster of Paris bandage was perhaps first applied by Kluge of Berlin in 1829, but to the Dutch physicians Mathysen and Vander Loo belongs the credit of the modern bandage.

It is imperative to give, in this chapter, a detailed and complete description of what constitutes a properly made plaster of Paris bandage and the application of it, in order that the general practitioner may become familiar with its use. Even though one cares not to treat the conditions heretofore enumerated, I have found that for fractures of almost every bone in the body requiring immobilization, the plaster bandage properly applied is far superior and rather to be preferred to any other form of splints.

It has been used very little in the past in private practice because the ordinary commercial bandage found in any supply house does not come up to requirements, in that it is usually air slaked or the plaster has been shaken from it by the time it is received. Then too the mesh is too closely woven and the plaster lies on the bandage instead of in the meshes and there is, in consequence, an excess of plaster; also as a rule the bandages are rolled so tightly that the water does not reach the deeper layers.

The ordinary plaster of Paris bandage made in your own office can always be successfully applied because the right quantity of plaster can be incorporated in the bandage and it can readily be made into the desired widths. The plaster of Paris to be used should be of the superior quality used by dentists and should be of the quick setting kind. It can be procured at almost any drug store but the surest place for quality will be your dentist.

Absolutely, the only kind of gauze to be successfully used is white crinoline of the ordinary variety used by dressmakers and obtainable at any dry goods store in twenty-four yard bolts. It is especially desirable to get a kind not too rich in starch or dextrin and of a mesh running about one hundred holes to the square inch.

The bandages should be made in six yard lengths, and of widths ranging from three to five inches according to the part that is to be cast; for instance the three inch widths are most suitable for casts for the extremities, while the larger ones serve best for conditions of the spine. After the length had been measured and cut the desired widths can be torn the full length without trouble. The edge of the crinoline nearly always frays out and naturally will become so entangled as to prevent rolling in the plaster or as to hinder the free unrolling of the bandage when applying it. To prevent this, three threads should be plucked from each side of each strip before starting to roll in the plaster.

A hard surface of, at least, two feet in width should be used on which to roll in the plaster. Starting at one end, a handful of plaster of Paris is rubbed into the crinoline with the palmar surface of the hand, bearing down hard, so that all excessive plaster passes to either edge of the bandage. No more plaster should be rubbed into the crinoline than the meshes will hold, and as each successive yard is incorporated with the necessary amount of plaster, it is loosely rolled in such manner that in the center of the bandage there is a hollow cylinder of the thickness of the index finger, and the concentric layers are easily movable on one another. This manner of rolling permits of the rapid and uniform spread of water through the bandage when it is to be applied, and prevents parts of the bandage from being insufficiently moistened.

The general practitioner should always keep on hand about two dozen completed bandages that he is most accustomed to using in his daily practice. These should be corded as it were, to prevent unrolling, in an air tight container, either of glass or tin in the bottom of which is placed a small quantity of plaster of Paris, and should always be kept in a dry place. I have never found either a nurse or an office girl who could not make these bandages successfully so that in the future there is no excuse for a practitioner not using this superior form of splints.

The Immediate Use of the Bandage

While plaster of Paris is in no way harmful to either garments or surroundings, both the operator and the assistants should be properly gowned and the floor covered with newspapers to prevent unnecessary soiling. It should be borne in mind that if a properly made bandage is used, which is squeezed to the extent of ridding it of an excess of water, very few drippings will be scattered and the whole procedure of the application of the plaster differs in no way from simple roller bandaging.

The number of bandages intended for use should be taken from the container and placed in a pan near the pail holding the water, in which they are to be immersed, in a position in relation to the pail that will guard against water being splashed upon the dry bandages, which would render them unfit for subsequent use. Water as hot as the hand will tolerate, as opposed to cold, facilitates setting. I do not recommend any chemicals to hasten setting, because a properly made bandage, prepared as above, of quick setting plaster sets in remarkably fast time.

The area to be cast should be encased in ordinary absorbent cotton of the thickness in which it comes rolled, putting an extra pad over all marked bony prominences, and a roller gauze bandage applied to hold it in place and snug to the part. Under no consideration do I advise the use of flannel bandage or the ordinary sheet wadding cotton that are recommended by some authors, because padding with these materials is always conducive to applying a cast far too tightly, especially in fractures where the swelling increases after application thereby causing constriction of the limb and interference with circulation. The regular absorbent cotton as padding beneath a cast is always best for it is almost impossible to apply a cast too tightly when it is used.

The bandage should be completely submerged on its side, and should remain so until the bubbles cease to come off, which time takes place most readily in the properly rolled dressing. When the bubbling has ceased, the bandage is lifted out of the pail and squeezed with the hands merely to free it of the excessive water, the end is found and handed to the operator ready to apply. No undue traction should be made in applying the successive turns of the bandage, though it must be remembered the cast should fit snugly to the part, and the ordinary rules of simple roller bandaging followed, except that the reverse spirals are unnecessary. The assistant should constantly rub the layers as they are applied by the operator, as this not only helps the cast to fit more snugly, but also makes the rough edges of the bandage adhere more firmly to the layer beneath, thereby making a smoother cast.

As a rule there need be no dread of an increased swelling beneath the bandage because usually several hours have elapsed after the injury before the physician has arrived and made preparations to apply the plaster. Indeed, one of the best means of limiting swelling after a fracture is the prompt application of a plaster of Paris bandage. If there is any concern that the cast is too tight, while the plaster is still soft it can be easily cut through the entire length with a knife, and thus relieve the pressure existing. Also it is a good plan to cut a window or opening over the sight of injury, which would in no way harm the object of the cast and would allow a gentle massage to the part. A neat finish may be given to the edges of a plaster cast by turning over the ends of the cotton, in cuff-like fashion and held in the grasp of the last few turns of the plaster at either end.

On clothing you will find it best to allow the plaster to dry before removing, while on furniture or the hands it is readily removed by washing off in warm water. The water in which the bandages were immersed contains, of course, considerable plaster, and under no circumstances should this be emptied into a sink or waste pipe for it will certainly demand the services of a plumber. The water may be poured out on the ground and the paste shaken into a refuse barrel or ash pile. The best way to remove a cast is to moisten it with water or vinegar along the path of the knife. I might add that all patients are in constant fear of being cut either while you are trimming, cutting windows, or removing the cast, but because of the cotton padding underneath you will find that it is almost an impossibility. Care, of course, should be taken that the knife does not slip in any of these procedures and come in contact with the unprotected parts.

In general, for fractures of the extremities it is best to apply the plaster with the patient in the recumbent position to secure complete muscular relaxation, and the part to be cast should be supported by an assistant. It is also a general rule that in fractures of the shaft of the long bones, especially of the lower extremities, the plaster bandage should be applied to include the adjacent articulation and extend well beyond the joints.

INDEX

A

Abbott treatment, 98, 774, 778.

Abdomen pendulous, 127.

Abdominal examination, 51.
rheumatism, 466, 467.
technic, 77, 536, 539.
dangers of, 87, 540.

Abducens nerve, lesions affecting, 717.

Abscess of rectum, 174.
perinephritic, differentiate pyelitis, 628.
peritonsillar, 278.

Achylia gastrica, differential diagnosis, 508.

Acne, 150.

Accommodation in the eye, 192.

Acetabulum, migration of, 791.

Addison’s disease, 704.
differentiated from jaundice, 559.

Adenitis, tubercular, 384.

Adenoids, 273.

Adhesions, broken up after sprains, 108.

Adjustment, osteopathic, 90.

Adrenal glands, diseases of, 703.

Aged, spine of the, 101.

Agitans, paralysis, 723.

Agitata, melancholia, 297.

Ague, 347.

Alcohol in post-operative pneumonia, 319.

Amentia, 290, 307.

Amyloid kidney, 626.
liver, 562.

Amyotrophic lateral sclerosis, 762.

Angina pectoris, 666.
differential diagnosis, 667.
pathology in, 308.

Anemias, the, 672.

Anemia, costogenic, 673.
Burns, 673.
pernicious, 678.

Aneurism, cardiac, 660.

Animal experiments, 91, 490.
parasites, 151.

Ankle, 56.
sprain, 112.

Ankylostomiasis, 155.

Anterior dorsal lesions technic, 76.

Antidotes may be necessary, 62.

Antiseptics may be necessary, 62.

Aortic regurgitation, 649.
stenosis, 551.

Aphonia, 571.

Aphthous stomatitis, 488.

Appendectomy, colitis following, 552.

Appendicitis, 547.
differential diagnosis, 550.

Appendicitis from ileo-cecal trouble, 141.
pseudo, 550.

Appendix innervation, 498.

Arch supporters, 114.

Arhythmia, 665.

Arm affected by rib lesions, 740.

Arm examination, 56.
technic, 80.
vasomotor nerves to, 94.

Arteries, diseases of, 669.

Arteriosclerosis, 669.

Artery complications from typhoid, 332.

Arthritis deformans, 462.
rheumatoid, 462.
differentiated from inflammatory rheumatism, 459.
septic, differentiated from inflammatory rheumatism, 459.

Articular rheumatism, acute, 460.

Ascaris lumbricoides, 153.

Aspiration pneumonia, 605.

Asthenopia, 232.

Asthma bronchial, 589.
caused by rib lesions, 94.

Ataxia, Friedreich’s, 759.
hereditary, 759.
differentiate chorea, 726.
locomotor, 754.

Ataxic paraplegia, 761.

Atheroma, 669.
in heart, 647.

Atlas examination, 44.
lesions, 44.

Atrophy of optic nerve, 231.
progressive muscular, 762, 764.

Auditory—See also ear.

Auditory meatus, diseases of, 236.
nerve degeneration, 256.
nerve lesions affecting, 718.

Auerbach’s plexus, 494.

Auto-intoxication in nose diseases, 268.

Axis lesions, 45.

B

Backache, post-operative, 313.

Bandage, abdominal, for floating kidney, 137.
liver, 139.
sprain, 106.

Barbadoes leg, 158.

Baths, hot, in skin diseases, 147.

Bee sting near eye, 199.

Bell’s paralysis, 717.

Belt—See bandage; also brace.

Biceps, long tendon dislocated, 114.

Bile duct, diseases of the liver and, 553.

Biliary colic, 565.
differentiate, 551, 565, 632.

Binocular vision of osteopath (two pathologies), 489.

Birth injuries, causes of heart irregularities, 666.

Black eye, 199.

Blackwater fever, 351.

Bladder, diseases of, 635.
hemorrhage, 164.
sensory nerves to, 95.

Bleeders disease, 484.

Blennorrhea, acute, 209.

Blepharitis, 200.

Blood flow directed to abdomen, 582.

Blood, diseases of, 671.

Bones and joints, tuberculous disease, 788.

Bothriocephalus latus, 151.

Bowel—See intestine.

Brace in Pott’s disease, 103, 131.
in prolapse, 133.
in spinal curvature, 99, 103, 122.

Brachial neuralgia, 711.
neuritis, 123.
differential diagnosis, 125.
plexus, lesions affecting, 721.

Brachycardia, 664.

Brain, pathology of, 307.
its relation to mind, 307.
physiology of, 306.
tumors, differentiate migraine, 737.

Brand bath, 329, 343.

Breakbone fever, 356.

Bright’s disease, 618.

Bronchi, diseases of the, 579.

Bronchial asthma, 589.

Bronchiolectasis, 587.

Bronchitis, 579.

Bronchopneumonia, 605.
caused by tubercle bacillus, 606.

Broncho-pulmonary hemorrhage, 160.

Bulbar paralysis, 765.

Bunions, cause of, 112.

Bursitis, 123.
differentiate from neuritis, 125.

C

Calcification in heart, 647.

Calculus, renal, 631.

Cancer of liver, 562.
of stomach, differential diagnosis, 508.

Canker, 488.

Carcinoma, location of reflex pain in, 499.

Cardiac—See heart.

Caries—See Pott’s disease.

Catalonia, 286.

Cataract, 229.

Catarrh
dry, 583.
of conjunctiva, vernal, 216.
stomach, chronic, 505.

Catarrhal deafness, 246.
pneumonia, 605.
stomatitis, 487.

Center, diabetic, 474.

Centers, osteopathic, 88.
nutritional, 480.

Cephalodynia, 465, 467.

Cerebrospinal fluid interfered with, affects digestion, 492.
meningitis, 358.

Cerumen, inspissated, 236.

Cervical—See also neck.
examination, 41.
glands, examination of, 47.
lesions affect eye, 93, 86.
region, caution in treating, 66.
treatment for vasomotor effects, 92.

Cervico-occipital and cervico-brachial neuralgia, 711.

Chalazion, 200.

Character and disposition affected by alimentary disturbances, 502.

Chest examination, 51.

Chiasma, diseases of, 715.

Chicken-pox, 446.
differentiate from smallpox, 417.

Childbirth resulting in pendulous abdomen, 128.

Children—See also infants.
defective, 303.
diarrhea of, 529.

Chlorosis, 676.

Cholecystitis, 557.

Cholera infantum, 531.
morbus, 532.

Chorea, 725.
differential diagnosis, 726.
differentiate paralysis agitans, 724.

Choreiform affections, 727.

Choroid, diseases of, 226.

Choroiditis, 226.

Chromaffin system, 702, 703.

Chronic lesions, reduce gradually, 66.

Chvostek’s phenomenon, 701.

Chyluria, chylocele, chylous ascitis, 158.

Ciliary injection in keratitis, 221.
body, diseases of the, 225.

Ciliospinal center, 187.

Circulatory system, disease of, 638.

Circumflex nerve, lesions affecting, 721.

Cirrhosis of liver, 560.

Clavicle examination, 49.

“Claw hand,” 764.

Club foot, 784.

Coccygodynia, 713.

Coccyx examination, 55, 81.
fractured, 81.
technic, 81, 713.

“Cold in the head,” 257.

Cold in treating sprain, 106.

“Colds” inadvertently cured, 90.

Cole’s irrigator for high enema, 170, 546.

Colic, biliary, 565.
differentiation of, 535, 566.
intestinal, 535.
renal, 631.
differential diagnosis, 632.

Colitis following appendectomy, 552.

Colitis, mucous, 526.

Coma, diabetic, 472.

Confusion and stupor, delirium, 289.

Congestion of the lungs, 610.
thyroid, 686.

Conjunctiva, diseases of, 202.

Conjunctivitis, 202.
catarrhal, 204.
corneal ulcers complicating, 204.
follicular, 207.
differentiated from trachoma, 208.
gonorrheal, 209.
granular, 212.
phlyctenular, 214.
vernal, 216.

Constipation, causes and technic, 497, 537.
from pendulous abdomen, 127.
resulting in diarrhea, 538.

Constitutional diseases, 457.

Contracted muscles relieved by inhibition, 89.

Convulsions, infantile, 728.

Cornea, anatomy of, 217.
diseases of, 217, 219.
examination of, 219.
ulcer of, 219, 221.

Coughing, 573.

Coughing (superior laryngeal nerve), 719.

Cow-pox, 424.

Cramp, constitutional, 738.

Cranial nerves, diseases of, 715.

Cretinism, 698.

Croup treatment, 68.
differentiate from spasm of glottis, 573.
false, 574.

Croupous pneumonia, 597.

Curschmann’s spirals, 586.

Curvatures, spinal, 96, 99, 103, 122, 768.
See Abbott treatment,
braces for, 99, 131.
cervico-dorsal, 772.
complicated by innominate lesion, 99.
differentiate organic and functional, 769.
dorsal, 772.
dorso-lumbar, 772.

Cophosis, 97.
lateral, 98, 177.
lumbar, 772.
other organs affected, 770.
pathological, 96.
rotary lateral, 768.
postural, 128.
(scoliosis), 96, 768.
differentiated from Pott’s disease, 773.
false, 773.
structural, 774.
technic for, 98.
treatment for rotation and sidebending, 76.

Cystitis, 635.

Cystitis, differentiate pyelitis, 628, 636.

D

Dalrymple’s sign, 694.

Deafness, catarrhal, 246.
nerve, 255, 718.

Defective children, 303.

Deformans, spondylitis, 463.

Degeneration of heart muscle, 661.

Deglutition, 493.

Deglutition pneumonia, 605.

Delirium, confusion and stupor, 289.
senile, 300.

Dementia, arteriosclerotic, 300.
defined, 306, 307.
praecox, 287.
senile, 297.

Dengue, 356.

Dental troubles should be corrected, 490.

Descemetitis, 226.

DeSchweinitz, Dr., 215.

Diabetes, differential diagnosis, 477.
insipidus, 476.
mellitus, 470.

Diabetic coma, 472.

Diagnosis, osteopathic, 38.
see also under lesion.
reliable, osteopathic, 21.
sight, 38.

Diaphragm, paralysis of, 720.

Diarrhea, causes and technic, 497.
acute, 523.
dyspeptic, 529.
caused by constipation, 538.
of children, 529.
chronic, 529.
catarrhal, 524.
differential diagnosis of, 530, 533.
nervous, 524.
through impactions, 538, 544.

Diet and osteopathy, 22, 62.

Diet, diabetic, 475.

Dietl’s crisis, 137, 635.

Digestion, relation of lungs to, 494.

Digestive disturbances affect character, 502.
system, diseases of, 487.
trouble due to intra-cranial conditions, 492.

Digital surgery in hay fever, 226.
treatment in tonsillitis, 281.

Dilatation of heart, 657.
of sigmoid, 543.
of stomach, 153, 517.

Diopter defined, 192.

Diphtheria, 362.
differentiated from scarlet fever, 431.
laryngeal, 364.
nasal, 364.
neuritis following, 707.
pharyngeal, 364.

Disease should be studied by regions, 586.
constitutional, 457.
general and functional, 723.

Dislocation, differentiated from neuritis, 125.

Disposition and character affected by digestive disturbances, 501.

Diuresis, Paroxysmal, differentiated from diabetes insipidus, 477.

Dorsal spine examination, 49.
technic, 74.

Dorsodynia, 466, 467.

Drugs not useful in nose and throat work, 262.
Why medics give, 21.

Dubini’s disease, 727.

Duodenal ulcer, Gastric and, 512.

Duodenitis, 524.

Dupuytren’s contraction, 115.

Dysentery, 368.

Dysentery, a word on treatment, 170
amebic, 370.
bacillary, 368.
chronic, 371.
treatment, a word on, 170.
tropical, 370.

Dysmenorrhea caused by lumbar curvature, 126.

Dyspepsia, acute, 501.

Dystrichiasis, 201.

E

Ear—See also auditory

Ear, Diseases of, 236.
of inner, 254
of middle, 239.
foreign bodies in, cause cough, 575.
normal hearing, 249.
nose and throat, diseases of, 236.
pain in diagnosis of diseases of, 238.
test for hearing, 249.
vasomotor nerves to, 92.
wax, hardened, 236.

Eccymosis, 199.

Eclampsia, 728.

Ectropion, 201.

Eczema, 147.
in ear, 230.

Edema of the lungs, 611.

Edwards finger treatment in hay fever, 267.
trachoma treatment, 213.
turbinate adjuster, 197.

Egophony, Lænnec’s, 613.

Elbow, 56.
sprains, 114.

Elephantiasis, 158.

Emboli in endocarditis, 642, 641.

Emphysema, 592.
compensatory, 609.
differential diagnosis, 595.

Endocarditis, 641.
complicating pneumonia, 601.

Enema, directions for, 546.

Enteric fever, 329.

Enterocolitis, acute, 532.

Enteroptosis, 521.

Entropion, 201.

Enuresis, 637.

Epididymis sensory nerves to, 95.

Epilepsy, 729.
differential diagnosis, 734.
nocturnal, 733, 734.
grand mal, 732.
Jacksonian, 733.
petit mal, 733.

Epilepticus, status, 734.

Epistaxis, 160, 271.
differential diagnosis of, 161.

Erb’s phenomenon, 701.

Erysipelas, 372.

Esophagus, 493.
location of reflex pain from, 499.

Estivo-autumnal fever, 350.

Etiological factors, 25.

Etiology, osteopathic, 25.

Examination—See under various structures and regions.
thorough, essential, 38.

Exercise and postural defects, 120, 129, 131.
cannot take place of osteopathy, 120.
in treatment of ptosis, 521.
of false scoliosis, 773.
to reduce abdomen, 128, 139, 480.

External cutaneous nerve, lesions affecting, 722.

Eye, accommodation in the, 192.
affected by osseous lesions, 93, 185, and under individual
diseases.

Eye diseases, 183, 713.

Eye diseases, osteopathic manipulation in, 196, 223, 716.
examination by special methods, 191.
how to examine, 183.
lesions affecting certain nerves of, 716.
osteopathic, 184.
neuralgia, 197.
restored by osteopathy, A case history, 185.
schematic, 194.
strain and its reflexes, 231.
trouble, nose and throat in, 191.
vasomotor nerves, 92.

Eyelids, diseases of, 199.

F

Face examination, 46.
technic, 68.

Facial nerve, lesions affecting, 117.

Fatty degeneration of heart, 661.
liver, 561.

Fecal impactions palpated, 52, 543.
with diarrhea, 538, 544.

Feet, neuralgia of, 714.

Fetor oris, 491.

Fever, 325.
acute eruptive, mumps and whooping cough, 411.
enteric, 329.
estivo-autumnal, 350.
malarial, 347.
paratyphoid, 344.
remittent, 350.
rheumatic, 457.
simple continued, 379.
treatment, 325.
Brand method, 329.
usually beneficial, 327.
typhoid, 329.
typhus, 344.
yellow, 374.

Fibroid phthisis, 393.
induration, 609.

Fifth nerve, neuralgia of, 710.

Filaria, 158.

Fingers, sprains of, 114.
surgery in hay fever, 266.
treatment in catarrhal deafness, 252.
in tonsillitis, 281.
trigger, 115.

First rib—see rib.

Fissures of rectum, 174.

Fistulae, rectal, 174.

Flat foot, 112, 787.

Flatulency, technic for, 505, 537.

Focus of infection—see infection.

Foot, club, 784
neuralgias, some causes of, 112.
sprains of, 112.

Fractures, 115.
and sprains, 104.
summary of massage and immobilization in, 118.
of treatment of, 119.

Frequency of treatments—see treatments.

Friedreich’s ataxia—See ataxia.

Functional and general diseases, 723.

Furunculosis of ear, 238.

G

Gall bladder, sensory nerves to, 95.

Gall-stones, 563.
easily diagnosed by osteopath, 52.

Ganglion (weeping sinew), 115.

Gas in stomach, technic for, 505, 537.

Gastritis, acute, 502.
chronic, 505.
due to portal disturbance, 506.
gastric analysis essential to diagnose, 507.

Gastric—see also indigestion.

Gastric derangement, location of reflex pain from, 499.
and duodenal ulcer, 513.
neuralgia, 510.
neuroses, 510.
trouble often reflex, 510.

General treatment—see treatment.

Generative organs, vasomotor nerves to, 94.

Genitocrural nerve, lesions affecting, 722.

Genito-urinary system, 175.

Germ theory—its relation to osteopathy, 26.

German measles, 444.
differentiate measles and scarlet fever, 446.

Glands enlarged, differentiate from whooping cough, 454.
examination of thyroid and cervical, 47.

Glaucoma, 227.

Glenard’s disease, 521.

Glosso-pharyngeal nerve, lesions affecting, 718.

Glottis, spasm of, 572.

Goiter, do not treat direct, 691, 696.
exophthalmic, 690.
findings at Mayo clinic, 692.
parathyroid glands in, 699.
simple, 687.

Gonorrhea germs in prostate, 176.

Gonorrheal conjunctivitis, 209.
rheumatism, 459.

Gout, 467.
differentiated from rheumatic fever, 459.

Grand mal, 730, 732.

Grattage, 213.

Great occipital nerve, point of control, 719.

Great auricular nerve, point of control, 719.

Green Sickness, 676.

H

Habit spasm, 728.

Hammer toe, 112.

Hand, sprain of, 114.

Hay fever, 263.
relation of focal infection to, 266.
treatment, 68.

Head examination, 41.
technic, 64.
vasomotor nerves to, 92.

Headache, from eye strain, 188.
post-operative, 313.
sick, 736.
technic, 720.

Hearing—see also ear.
test, 249.

Heart, affected by stomach pressure, 498.
aneurism, 660.
changes in goiter, 693.
complications in typhoid, 332.
crowded by round shoulders, 121.
contraction mechanism, 665.
dilatation, 657.
diseases, 638.
due to ribs, 47.
causing hyperemia of liver, 554.
enlargement causing cough, 575.
failure in pneumonia, 603.
hypertrophy, 655.
hypertrophy and dilatation often recover, 654.
irregularities due to birth injury, 666.
muscle degeneration, 661.
neuroses of, 662.
palpitation of, 662.
sensory nerves to, 95.
stimulated through rectum, 169, 170.
trouble and osteopathy, 647, 648, 652.

Heat in treating ear, 238, 240, 241.
in treating sprain, 106.
prostration, 181.
stroke, 180.

Hebephrenia, 286.

Hematemesis, 162.
differential diagnosis of, 161.

Hematuria, 163.

Hemophilia, 484.

Hemoptysis, 160.
differential diagnosis of, 161.

Hemorrhages, 160.
in feces, 163, 174.
of intestines, 163, 174.
of lungs, 160.
of nose, 160.
of stomach, 162, 516.
of urinary tract, 163.
of uterus, 164.

Hemorrhoids, 171.
acute, 173.
due to portal obstruction, 560.
treatment briefly discussed, 170.

Hemorrhagia subdermalis, 199.

Hepatic colic. See biliary colic.
flexure prolapse, 140.

Heredity, See Inherited.

Hernia, 141.
treatment, 546.

Herpes, 149.
conjunctivæ, 214.
zoster, 712.
zoster ophthalmia, 199.

Hiccoughs, 165.

Hip, 56.
congenital dislocation, 778.
Lorenz operation, 781.
open operation, 784.
lesion affecting knee, 112.
the prominent, description and treatment, 125.
sprains of, 111.
treatment following intracapsular fracture, 111.
tuberculosis of, 791.

Hip-joint disease, 791.
treatment following, 111.

Hives, 149.

Hobnailed liver, 559.

Hodgkin’s disease, 684.
differentiate from mumps, 451.

Holmes electric auroscope, 236.

Homatropine, 194.

Hook-worm disease, 155.

Hordeolum, 200.

Hospital—See post-operative treatment.

Hot fomentations to relieve and relax, 95.

Hydrophobia differentiated from tetanus, 378.

Hydrotherapy in fever, 327.
bronchial asthma, 589.
often necessary with osteopathy, 62.

Hygiene necessary with osteopathy, 62.

Hyoid examination, 47.
lesion affecting sense of taste, 491.
causing cough, 46, 574.
furred tongue, 491.
in bronchial asthma, 589.
in laryngismus stridulus, 572.
in laryngitis, 571.

Hyperemia renal, 617.

Hypertrophy of heart, 655.

Hypoglossal nerve, lesions affecting, 719.

Hypopyon in keratitis, 221.

Hysteria, 740.

Hysterical convulsions, differentiated from epilepsy, 734.
spine, 101.

Hysterogenous zones, 743.

I

Icterus, 557.

Idiots, 305.

Ileocolitis, acute, 368.

Ileus, 540.

Iliohypogastric and ilio-inguinal nerves, lesions affecting, 722.

Imbeciles, 305.

Immobilization in relation to tuberculosis, 115.
See also under sprains.

Impacted lesions, 92.

Impactions, fecal, palpated, 52.
of intestines, 543.
of small intestine, 546.

Impotency, 177.

Indigestion—see also gastric.
and asthma, 590.
caused by pendulous abdomen, 127.
by round shoulders, 121.
nervous, 521.

Infantile convulsions, 728.
paralysis—see poliomyelitis.

Infants—see children.
constipation treatment, 539.

Infection differentiated from neuritis, 125.
foci of, look out for, 131.

Infectious diseases, 325.

Inflammatory rheumatism, 457.

Influenza, Spanish or epidemic, 399.
causes bronchitis, 79.

Inherited tendencies in defective children, 303.

Inhibition, Osteopathic, 89, 94.

Insanity, See also Mental diseases.
acute confusional, 290.
Circular, 293.
defined, 306.
(Physiology of brain), 305.

Innominate examination, 52, 54.
lesions preventing knee recovery, 112.
sprains, 111.
technic, 79.
dangerous, 87.

Insect bites and stings, 199.

Insipidus, diabetes, 476.

Interrenal system, 704.

Intestinal colic, 535.
diseases, 523.
relation of spinal lesions to gastro-, 489.
obstruction, 541.
differential diagnosis, 545.
strangulation, 541.

Intestine, examination of, 52.
foreign substances in, 542.
impactions of, 52, 543.
treatment, 545, 546.
with diarrhea, 538, 544.
knots of, 542.
treatment, 541, 545.
location of reflex pain from, 499.
obstruction of, 52, 78, 545, 546.
differentiate from appendicitis, 551.
prolapsed, 52, 139.
sensory nerves to, 95.
strictures of, 543.
treatment of, 545.
technic, 78.
tumors of, 543.
treatment, 545,
twists, 542.
treatment, 545.
vasomotor nerves to, 94.

Intranasal surgery, 266.

Introduction, 17.

Intercostal neuralgia, 712, 721.

Intussusception, 541.

Invagination, 541.
treatment, 545.

Iridocyclitis in keratitis, 221.

Iris, diseases of, 225.

Iritis complicating conjunctivitis, 204.
in keratitis, 221.

Iron not indicated in anemic conditions, 623.

J

Jaundice, 558.
differentiate from Addison’s disease, 559.
simple catarrhal, 555.

Jacksonian epilepsy, 730, 733.

Jaw, full motion essential, 490.
lesions, 46, 491.
technic, 68.

Joints and bones, tuberculosis of, 788.
function is motion, 489.

K

Keratoconus, 218.

Keratitis, 219.
cornea-phlyctenular, 214.
neuroparalytica, 223.
parenchymatous or interstitial, 224.

Keratitis, phlyctenular, 224.

Keratomalacia, 219, 223.

Kidney, amyloid, 626.
complications in typhoid, 331.
diseases of, 617.
examination, 52
hemorrhage, 164.
movable, 634.
prolapsed, 136.
belt for, 137.
sensory nerves to, 95.
stones, 631.
treatment, 78, 620, 623.
vasomotor nerves to, 94.

Knee, tuberculosis of, 793.

Kraepelin’s classification of dementia praecox, 283.

Kyphosis—See curvatures.

L

Labioglossopharyngeal paralysis, 765.

Laboratory experiments on animals (Lesions), 91.

Labyrinthitis, 254.

Lachrymal apparatus, Diseases of, 202.

Laennac’s egophony, 613.
pearls, 586.

Landmarks of spine, 39.

Landry’s disease differentiated from myelitis, 749.
paralysis, 753.

Laryngeal nerve technic, 719.
lesions affecting superior and inferior, 719.

Laryngismus stridulus, 572.
differentiated from croup, 573.

Laryngitis, acute catarrhal, 569.
chronic catarrhal, 570.
edematous, 577.
spasmodic, 573.
syphilitic, 577.
tuberculous, 575.

Larynx complications in typhoid, 332.
diseases of, 569.
examination, 47.
technic, 67.

Lateral curvature, 98.

Lead colic differentiated from intestinal colic, 535.
poisoning, Neuritis from, 707.

Leg examination, 56.
neuralgia of, 714.
technic, 80.
vasomotor nerves to, 91.

Lens, diseases of, 229.
opacity, 229.

Lenses explained, 191.

Leprosy, anesthetic, differentiated from syringomyelitis, 762.

Lesions of each part or organ indexed under respective names of
parts, but not under all diseases in which they may be found

Lesion affecting one viscus affects others also, 494.
caused by visceral disturbance, 501, 503.
chronic, reduce gradually, 66.
composite, 30.
dominant in causing gastro-intestinal disease, Osteopathic, 489, 490.
effects of, 33.
effects in heart cases, Osteopathic, 647, 648.
impacted, 92.
is absence of motion, 489.
ligamentous, 28.
muscular, 27, 41, 45.
caused by visceral disturbances, 500.
of various structures and regions, considered in connection with
osseous lesions of same.
osseous, 26.
also listed under various bones, organs and regions.
pathognomonic signs of, 39.
results stated by McConnell, 490.
to diagnose, 38, 30, 91.
visceral, 29.

Leyden’s crystals, 586.

Leukemia, 680.
acute myelogenous, 681.
lymphatic, 682.
splenomedullary, 681.

Lithemia, 469.

Liver, amyloid, 562.
and bile duct, diseases of, 553.
cancer of, 562.
(cholecystitis), 557.
cirrhosis of, 560.
complications in typhoid, 332.
examination, 51.
fatty, 562.
(gall-stones), 564.
hyperemia of, 554.
inactivity from pendulous abdomen, 127.
innervation, 474.
involved in rheumatism, 460.
(jaundice), 558.
location of reflex pain from, 499.
nutmeg, 553.
pain reflex to scapula, 721.
(simple catarrhal jaundice), 555.
prolapse, 138.
sensory nerves to, 95.
technic, 77.
vasomotor nerves to, 94.

Lobar pneumonia, acute, 597.

Lock-jaw, 377.

Locomotor ataxia, 754.
differentiated from Friedreich’s ataxia, 759.

Lordosis, 97.

Lorenz operation, 781.

Lumbago, 465, 466.

Lumbar curve and prolapsed uterus, 143.
prominent hip, 125.
examination, 49, 52.
lumbar nerves, lesions affecting, 722.
technic, 74.

Lumbo-abdominal neuralgia, 713.

Lungs affected by stomach pressure, 498.
complications in typhoid, 332.
congestion, 610.
crowded by round shoulders, 121.
diseases, 592.
due to ribs, 47.
causing hyperemia of liver, 554.
edema of, 611.
relation to digestion, 494.
sensory nerves to, 95.
stimulated through rectum, 169, 170.
vasomotor nerves to, 93.

Lymphatic leukemia, 682.

Lymphadenoma, 684.

M

McBurney’s point, 549.
why pain in appendicitis, 499.

Macula lutea, 195.

Maddox rod, 193.

Mal, grand, 730, 732.
petit, 730, 733.

Malaria associated with typhoid, 337.

Malarial cachexia, 351.
fever, 347.
pernicious, 350.
hematuria, 351.

Mammary gland innervation, 722.

Manic depressive psychoses, 291.

Massage following hip joint disease, 111.
intracapsular fracture of hip, 111.
of fractures, 116.
of sprains, 109.
not osteopathy, 19.

Mastoiditis, 240.

Mayo clinic’s goiter findings, 692.

Measles, 437.
a cause of bronchitis, 579.
differentiate German measles, 446.
scarlet fever, 432.
German, 444.

Meatus of ear, atrophic, 237.
infection of, 238.

Medulla contains vasomotor center, 92.

Meibomian cyst, 200.

Meissner’s plexus, 494.

Melancholia agitata, 297.

Mellitus, Diabetes, 470.

Meniere’s disease, 254, 718.
symptom complex, 253.

Meningeal tuberculosis, 387.

Meningitis, cerebrospinal, 358.
complicating pneumonia, 601.
tubercular, 360.

Menopause, thyroid enlargement during, 686.

Mental deficiency, 305.
diseases, 282.
osteopathic lesions in, 289.

Microcephalous, 308.

Migraine, 736.

Milk leg, 167.

Mind, relation to brain, 307.

Miner’s anemia, 155.

Mitral regurgitation, 648.
stenosis, 649.

Moebius’ sign, 694.

Morbilli, 437.

Mongolian amentia, 309.

Morons, 305.

Morphine habit, physicians responsible, 715.

Morton’s disease, 112.

Morvan’s disease, 762.

Mosquito carrier of filaria, 158.

Motion is function of joint, 489.

Motor oculi nerve, lesions affecting, 716.

Mouth, diseases of, 487.

Mucous colitis, 526.

Mumps, 449.
whooping cough and acute eruptive fevers, 410.
differential diagnosis, 451.

Murmurs, Heart, 642, 643.

Muscle contractions caused by visceral disturbances, how, 500.
relieved by inhibition, 89.

Muscular lesions, 27, 41, 45. Also considered in connection with
osseous lesions of various parts.
rheumatism, 465.

Musculacutaneous nerve, lesions affecting, and results, 721.

Myalgia, 467.

Mydriatic, 194.

Myelemia, 681.

Myelitis, 707.
acute, 748.
chronic, 750.
diffuse, 749.
transverse, 748.

Myelogenous leukemia, acute, 681.

Myeloid leukemia, 681.

Myocarditis, 659.

Myoclonia, 727.

Myxedema, 697.

N

Nasal—See nose.

Nasopharyngitis, 272.

Nasopharynx, diseases of, 272.

Neck—See also cervical.

Neck examination, 47.
muscle lesions, 46.
stiff, 465, 466.
technic, 64, 66.
dangers of, 66, 86.

Nephritis differentiated from pyelitis, 628.
hemorrhagic, chronic, 622.
interstitial, 624.
differentiated from diabetes insipidus, 477.
parenchymatous, acute, 618.
chronic, 621.
post-operative, 314.

Nerve centers (osteopathic), 88.
deafness, 255, 718.
degeneration, auditory, 256.
diseases of, 706.
cranial, diseases of, 715.
spinal, diseases of, 719.
sensory, 94.
vasomotor, 92.

Nervous indigestion, 511.
prostration from prolapse, 128.
system, diseases of, 706.

Neuralgia, 710.
cervico-brachial and brachial, 711.
cervico-occipital, 711.
differential diagnosis, 714.
intercostal, 721.
of eye, 197.
of fifth nerve, 710.
of foot, some causes, 112.
of legs and feet, 714.
of sacral nerve from impacted feces, 537.
of sacral region, 713.
of spinal column, 713.
of trunk, 712.
relieved by inhibition, 89.

Neurasthenia, 744.

Neuritis, 706.
brachial, 123.
differentiated from neuralgia, 714.
multiple, differentiated from Landry’s paralysis, 753.
from myelitis, 749.
optic, 230.
post-operative, 313.
retrobulbar, 231.

Neuroses of heart, 662.
gastric, 510.

Neurosis, occupation, 738.

“Neurotic spine,” 101.

Nocturnal epilepsy, 733, 734.

Nose and throat in eye troubles, 191, 196, 225, 229.
antiseptic sprays etc., 258, 262.
conditions in torticollis, 466.
diseases of, 257.
intranasal treatment, 260.
packing, 267, 268.
pharmacodynamics of, 262.
syphilis of, 270.
throat and ear, diseases, 236.
nosebleed, 161, 271.
differential diagnosis, 161.

Nursing necessary to osteopathy, 62.

Nutmeg liver, 554.

O

Obesity, 480.
exercises to reduce abdomen, 128, 139, 480.

Obstetric cases, innominate leosin in, 168.

Obstruction, intestinal—see intestinal.

Obturator nerve, lesions affecting, 722.

Occipito-atlantal examination and lesions, 45.
technic, 67.

Occupation neurosis, 738.

Olfactory nerve, diseases of, 715.

Omodynia, 466, 467.

Ophthalmia neonatorum, 210.
purulent, 209.
sympathetic, 227.

Ophthalmology, 183.

Ophthalmoscope, 193.

Optic disc, 195.
nerve atrophy, 231.
probably connection with third, 234.
neuritis, 230.
tract, diseases of, 715.

Oropharynx, diseases of, 274.

Orthopedic Surgery, 767.

Osteopathic centers—see centers.
diagnosis and prognosis, 38.
etiology and pathology, 24.
examination of eye, 184.
inhibition, 89.
lesion defined, 24.
manipulation in eye diseases, 196, 213.
readjustment, 90.
stimulation, 88.
theory, proof of, 34.
scientific demonstration, 89.
treatment, general directions, 58.

Osteopathy, definitions of, 18.
includes many measures, 62.
not massage, 19.
not passive exercise, 129.
not Swedish movements, 19, 63, 68.

Otitis media, acute suppurative, 239.
chronic suppurative, 243.
differential diagnosis, 244.
non-suppurative, 246.

Ovarian examination, 56.

Ovary, prolapse of, 144.
sensory nerves to, 95.

Oxyuris vermicularis, 154.

P

Pachymeningitis, cervical, differentiated from syringomyelia, 762.

Packing, nasal, 267, 268.

Pains, location of reflex, 499.

Palpation, educated, 60.
practice in, 87.

Palpitation, 662.

Pannus, 224.

Panophthalmitis, 227.

Papillae in rectum, 174.

Paralysis, acute ascending, 753.

Paralysis agitans, 723.
differential diagnosis, 724.
bulbar, 765.

Paralysis, infantile, 750.

Paranephritic abscess differentiated from pyelitis, 628.

Paranoia, 287.

Paraplegia, ataxic, 761.
spastic, 760.

Parasites, animal, 151.

Parathyroid glands, diseases of, 699.

Paratyphoid fever, 344.

Paris, plaster of, 795.

Parotiditis, epidemic, 449.
differential diagnosis of, 451.

Parotitis, epidemic, 449.

Patheticus nerves, lesions affecting, 716.

Pathologies, osteopathy recognizes two distinct, 489.

Pathology, osteopathic, 31.

Patient’s receptivity to treatment, 61.

Pearls, Lænnec’s, 591.

Pelvic examination, 52.
prolapse caused by abdominal prolapse, 128.
technic, 78.

Pendulous abdomen, 127.

Pericarditis, 638.
complicating pneumonia, 600.

Pericardium, diseases of, 638.

Peristalsis explained, 494.
reversed, normal in parts of colon, 497.
technic to affect, 495.

Peritonsillar abscess, 278.

Pernicious anemia, 678.

Pertussis, 452.

Petit mal, 730, 733.

Pharyngitis, 274.

Pharynx complications in typhoid, 332.
technic, 67.

Phenol-glycerine formula, 263.

Phlebitis, 167.
post-operative, 313.

Phlegmasia alba dolens, 167.

Phlyctenular keratitis, 224.

Phrenic nerve, lesions affecting, 720.

Phthisis, see tuberculosis.

Piles, 171.

Pin-worm, 154.

Plaster of Paris, 795.

Pleura, diseases of, 611.

Pleurisy, 611.
complicating pneumonia, 600.
differentiated from pneumonia, 601.
post-operative, 314.

Pleurodynia, 465, 466, 712.

Pneumogastric nerve, lesions affecting, 718.

Pneumonia, acute lobar, 597.
aspiration, 605.
alcohol not indicated in, 319.
associated with endocarditis, 644.
bronchial, 605.
caused by tubercle bacillus, 606.
catarrhal, 605.
complication of typhoid, 332.
chronic interstitial, 609.
croupous, 597.
differential diagnosis of, 609.
deglutition, 605.
differential diagnosis of, 601.
post-operative, 314.

Pneumonia, strychnine not indicated in, 320.

Pneumonic phthisis, 388.

Poliomyelitis, 750.
causing scoliosis, 770.
differentiated from myelitis, 749.

Polyuria, 476.

Portal system, vasomotors to, 94.

Posterior spine technic, 101.
thoracic nerve, lesions affecting, 721.

Post-operative treatment, 312.

Postural curves of spine, 128.
defects, 120.

Posture, correct, 127, 128.

Pott’s disease, 102, 788.
differentiated from kyphosis, 97.
from scoliosis, 773.
treatment, 102.

Proctitis, 170.

Prognosis and diagnosis, osteopathic, 38.
osteopathic, 56.

Progressive muscular atrophy, 764.
differentiated from syringomyelitis, 762.

Prolapse—See also ptosis.

Prolapsed hepatic flexure, 139.
intestines, 139, 170.
kidney, 136.
liver, 138.
organs, 127, 133, 521.
ovaries, 144.
rectum, 171.
sigmoid flexure, 141, 170.
stomach, 134.
uterus, 143.

Prominent hip, 125.

Prostate gland, 175.
technic, 637.
sensory nerves to, 95.

Prostatitis, 175.

Prostatorrhea, 176.

Pseudo-angina pectoris, 667.
appendicitis, 550.
croup, 572.
leukemia, 684.

Psychalgia, 293, 296.

Psychosis, involutional, 295.

Ptosis—See also prolapse.
of abdominal organs, 127.
of eyelids, 201.

Pulmonary regurgitation, 650.
stenosis, 650.

Punctum proximum, 192.
remotum, 192.

Purpura, 483.
variolosa, 420.

Pyelitis, 627.
differential diagnosis, 628, 636.

Pyelonephritis, 627.

Pyemia, 356.

Q

Quinsy, 278.

R

Radial nerve, lesions affecting, 739.

Rash, differentiate scarlet fever from drug or septic, 431.

Receptaculum chyli, vasomotor nerves to, 94.

Rectal conditions requiring surgery, 174.
disorders, brief discussion, 141.
examination, 55, 56, 169.

Rectum, 169.
to dilate, 170.
technic, 169.

Reflex gastric troubles, 509.
pains, location of various, 499.

Reflexes, somatic, Burns experiments, 189.

Regions of body should form basis of disease classification, 586.

Regurgitation, aortic, 649.
mitral, 648.
pulmonary, 650.
tricuspid, 650.

Remittent fever, 350.
differentiate from yellow fever, 375.

Renal calculus, 631.

Renal colic—see colic.
differentiate from appendicitis, 551.

Respiratory diseases, 569.
reflex inefficiency, 264.

Retina, diseases of, 230, 715.

Retinitis, 230.

Retrobulbar neuritis, 231.

Rheumatic fever, 457.

Rheumatism, abdominal, 466, 467.
cause of heart valve defects, 645.
chronic articular, 460.
differential diagnosis, 459.
and brachial neuritis, 125.
gonorrheal, 459.
inflammatory, 457.
muscular, 465.
subacute, 459.

Rheumatoid arthritis, 462.
differentiated from rheumatic fever, 459.

Rhinitis, acute, 257.
atrophic, 261.
chronic hypertrophic, 259.
hyperesthetic, 263.
purulent, 259.

Ribs, danger in elderly patients, 87.
examination, 47.
false, technic, 74.
first, examination, 49.
technic, 72.
floating, 49.
technic, 73.
lesions cause heart trouble, 648, 653.
described, 48.
sprains, 111.
technic, 69.

Rickets, 478.

Rose spots, 334.

Round shoulders, 121, 130.
worm, 151.

Rubella, 444.
differentiated from measles and scarlet fever, 446.

Rubeola, 437.

Ruddy nasal third finger, 197.
third finger eye instrument, 214, 229.
treatment of tonsillitis, 281.

S

St. Vitus’ dance, 725.

Saccules in rectum, 174.

Sacral nerves, lesions affecting, 722.
neuralgia, 713.
caused by impacted feces, 538.

Sacro-iliac—see innominate.

Sacrum examination, 55.
technic, 82.

Salivary glands, 491.

Sallow skin, 559.

Scalp, 46.
technic, 68.

Scapula, technic, 68.

Scapulodynia, 466, 467.

Scarlatina, 428.
differentiate diphtheria, 432.
drug rash, 431.
German measles, 432, 446.
measles, 432.
septic rash, 431.
types and forms, 432.

Scarlet fever—see scarlatina.

Schematic eye, 194.

Sciatica, 708, 714.

“Scissors” technic dangerous, 86.

Sclerosis, amyotrophic lateral, 762, 763.
differentiate from syringomyelia, 762.
cerebral, differentiate from chorea, 726.
disseminated, differentiate from paralysis agitans, 724.

Scoliosis—See curvatures.

Scrofula, 384, 396.

Scrofulous ophthalmia, 214.

Scurvy, 481.

Seminal vesicles, 176.

Senile delirium, 300.
dementia, 297.

Sensory nerves to various viscera, 94. See also under various viscera.

Septic rash, differentiate scarlatina, 431.

Septicemia, 355.

“Setting up” exercises for pendulous abdomen, 128.

Shaking palsy, 723.

Shoulder, 56, 80.
painful, 122.
round, 121.
sprain of, 114.

Sight—see eye.
diagnosis, 38.

Sigmoid impaction causing cough, 575.
prolapse, 141.

Sinusitis, 269.
vacuum, 270.

Skin diseases, 147.

Small occipital nerve, point to control, 719.

Smallpox, 412.
black, 420.
differentiate from chicken-pox, 417.

Smell, sense of, 491.

Snellin’s test type, 191.

Solar plexus inhibition, 582.

Somatic reflexes—Burns experiments, 188.

Spasm—see convulsions.
habit, 728.

Spastic paraplegia, 760.

Sphincters, alimentary, 496.
ani, external, 498.

Spinal accessory nerve, lesions affecting, 719.
centers (osteopathic), 88.
column, neuralgia of, 713.
postural curvatures of, 128.
cord, diseases of, 748.
curvature, pathological, 96.
technic, 97.
examination, importance of, 41.
landmarks, 39.
lesions—see lesions.
nerves, diseases of, 719.
stretching, dangers of, 86.

Spine the center of osteopathic interest, 38.
hysterical, description and technic, 101.
neurotic, description and technic, 101.
of the aged, description and technic, 101.
posterior, technic, 101.
sprains of, 110.
straight, 99.
technic, 100.
tubercular disease of, 788, 102.
typhoid, description and technic, 100.

Splanchnic technic, 495.

Spleen complications in typhoid, 332.
diseases of, 567.
examination, 52.
treatment, 78.
vasomotor nerves to, 94.

Splenitis, 567.

Splenomedullary leukemia, 681.

Spondylitis deformans, 463.

Sprains and fractures, 104.
bandaging not always good, 107.
heat and cold in treatment, 106.
immobilization and rest, 106, 115.
massage, 109, 116.
of ankle, 112.
of elbow, 114.
of fingers, 114.
of foot, 112.
of hip, 111.
of innominate, 111.
of knee, 112.
of ribs, 111.
of shoulder, 114.
of spinal column, 110.
of wrist and hand, 114.
passive movement, 107.
summary of treatment, 110.

Stand erect, how to, 127.

Status epilepticus, 734.
lymphaticus, 702.

Stenosis, aortic, 650.
mitral, 649.
pulmonary, 650.
tricuspid, 650.

Sternum examination, 49.
technic, 73.

Still, early struggles of Dr. A. T., 17.

Still-Hildreth Sanitarium 280, 291.
Several times in chapter on mental and nervous diseases.

Stimulation, osteopathic, 88.

Stomach,—see also digestive system.
cardiac relaxation by inhibition, 89.
conditions in bronchial asthma, 589.
dilatation, 134.
differentiate from gastroptosia, 134.
distention, 498.
examination, 52.
hemorrhage, 162, 516.
pain over pit of, due to cutaneous sensory nerves, 721.
prolapse, 134.
sensory nerves to, 95.
technic, 78.
ulcer, spinal causes of, 498.

Stomatitis, 487.

Stones, gall, 563.
kidney, 631.

“Straight spine,” 99, 130.
technic for, 100.

Strangulation of intestines, 541.

Stretching, indiscriminate, 86.

Strychnine not indicated in post-operative pneumonia, 320.
poisoning differentiated from tetanus, 378.

Stupor, delirium and confusion, 289.

Sty, 200.

Sunstroke, 180.

Supports, arch, 114.
in prolapse, 133, 142.

Suprarenal capsule, Dr. Still’s theory, 633.

Surgery, relation to osteopathy, 22.
in various conditions, taken up in connection with treatment.
orthopedic, 767.

Swallowing, 492.

Swedish movements not osteopathy, 19, 63, 68.

Synechiae in keratitis, 221.

Syphilis of nose, 270.
of thyroid, 687.

Syphilitic laryngitis, 577.

Syringomyelia, 761.
differential diagnosis, 762.

T

Tabes dorsalis, 754.

Tachycardia, 663.

Taenia flavo-punctata, 151.
saginata, 151.
solium, 151.

Talipes, 784.

Tape-worm, 151.

Taste, bad, in mouth, 492.
sense of, 491.

Technic, see under osteopathic treatment; also under various regions,
and organs.
dangerous, 86.
osteopathic, 60.

Teeth conditions in torticollis, 466.
defects should be corrected, 490.

Temporo-mandibular—see jaw.

Tenesmus treatment, 170.

Testes, sensory nerves to, 95.

Tetanus, 377.
differentiated from hydrophobia, 378.
strychnine poisoning, 378.

Tetany, 699.

Thorax examination, 51.

Thread-worm, 154.

Throat and nose in eye trouble, 191, 196, 225, 229.

Throat, diseases of the ear, nose and, 236.
(Edwards’ turbinate adjuster), 197.
irritation due to hyoid, 47.
(Ruddy’s nasal third finger), 197.
technic, 67.

Thrombosis from typhoid, 332.

Thrush, 488.

Thyroid gland, direct manipulation dangerous, 696.
diseases of, 686.

Thymus gland enlarged in goiter, 691, 693.
diseases of, 702.

Tic, convulsive, 728.
douloureux, 711.
general, 728.

Tongue, 490.
furred, 491.
vasomotor nerves to, 92.

Tonsils, 67.
function of, 276.
in rheumatism, 457, 460.
in torticollis, 466.
palpated, 47.
(peritonsillar abscess), 278.
trouble in eye disease, 196.

Tonsillectomy, 278.
summary of indications for, 280.

Tonsillitis, 276.
technic, 68, 279, 280.

Torticollis, 129, 465, 466, 719.

Touch, educated sense of, 60.

Trachoma, 208, 212.
differentiated from follicular conjunctivitis, 208.

Traction, reasons for, 62.

Transillumination in diagnosing sinuitis, 269.

Treating (over-treating), 84.
in influenza, 404.

Treatment—see also technic.
after a meal, 83.
frequency of, 83, 84.
general, 62, 68, 90.
should be given when, 63.
inhibition to begin, 89.
length of, 84.
misapplied, 85, 87.
position of physician and patient, 63.
receptivity of patient to, 61.
resulting in some motion, leave lesion for that time, 76.
to be avoided, 86.
value of vacation from, 85.

Tremors, differentiate from paralysis agitans, 724.

Trichiniasis, 156.

Trichiasis, 201.

Tricuspid regurgitation, 650.
stenosis, 650.

Trigeminus nerve, lesions affecting, 717.

Trigger-finger, 115.

Trousseau’s phenomenon, 701.

Tubal disease, differentiated from appendicitis, 551.

Tubercle bacillus may cause bronchopneumonia, 606.

Tuberculosis, 380.
and joint immobilization, 115.
of alimentary tract, 393.
acute, 386.
begins as chronic gastritis, 506.
bones and joints, 788.
bronchopneumonic, 388.
cerebral, 387.
deformities predisposing factors, 389.
differentiate from brachial neuritis, 125.
pneumonia, 601.
(fibroid phthisis), 393.
differentiate from chronic interstitial pneumonia, 609.
of genito-urinary tract, 394.
of hip, 791.
of knee, 793.
of lymph glands, 384.
of miliary, 386, 394.
pneumonic, 386.
pulmonary, 387, 389.
of spine, 102, 788.
orthopedic surgery necessary in, 767.
of thyroid, 687.

Tuberculous laryngitis, 575.

Tumor, brain, differentiate from migraine, 737.

Tuning fork tests, 294.

Turbinates, to clean around in rhinitis, 200.

Tussis convulsiva, 452.

Typhoid fever, 329.
afebrile, 334.
fever associated with malaria, 387.
do not manipulate abdomen, 163.
differentiated from appendicitis, 551.
spine, 100.

Typhus fever, 344.

U

Ulcer of cornea, 219, 221.
gastric and duodenal, 512.
location of reflex pain in gastric or duodenal, 499.
of stomach, spinal causes of, 498.
differential diagnosis, 508, 515.

Ulcerative stomatitis, 164.

Ulnar nerve, lesions affecting, 726, 739.

Uncinariasis, 155.

Uremia, 628.

Uremic convulsions, differentiated from epilepsy, 734.

Ureter, sensory nerves to, 95.
hemorrhage, 164.

Urethra hemorrhage, 164.

Urinary system, diseases of, 617.

Urine, blood in, 163.
massage prostate for retention of, 176.

Urticaria, 149.

Uterine examination, 56.
hemorrhage, 164.

Uterus, prolapsed, 143.
sensory nerves to, 95.

V

Vaccination, 424.

Vaccinia, 424.

Valve diseases, heart, 642, 644, 645, 649, 651.

Varicella, 424, 446.
differentiated from variola, 417.

Varicocele, 176.

Varicose veins, 166.

Variola, 412.
cornea, 421.
differentiated from varicella, 417.
hemorrhagica pustulosa, 420.
vera, 418.
verucosa, 420.

Varioloid, 420.

Variolosa purpura, 420.
sine exanthemate, 420.

Vasomotor nerves, 92.

Venereal disease and eye trouble, 184.

Vertebræ, landmarks for distinguishing, 39.

Vision explained, 230.

Volvulus, 541.

Vomiting, persistent, mostly reflex, 501.
post-operative, 312.
technic to relieve, 504.

von Graefe’s sign, 694.

W

Water, drink plenty, 540.

White swelling, 793.

Whooping cough, 452.

Whooping cough, mumps, and acute eruptive fevers, 411.
differentiate enlarged glands, 454.

Worms, intestinal, 151.

Wrist, 56.
sprain, 114.

Wry-neck—see torticollis.

Y

Yellow Fever, 374.
differentiate from remittent fever, 375.

Z

Zuckerkand’s organ, 703.

Transcriber’s Notes

pg 48 Changed: resistance is a helpful guide in dignosis
to: resistance is a helpful guide in diagnosis

pg 71 Changed: Still another method of adjustfng ribs
to: Still another method of adjusting ribs

pg 79 Changed: slip one hand bteween the thighs
to: slip one hand between the thighs

pg 91 Changed: In other words pathogological changes are just as real
to: In other words pathological changes are just as real

pg 111 Changed: Diagnosis, Etiology, and Tecnhique, and the general
to: Diagnosis, Etiology, and Technique, and the general

pg 112 Changed: Another joint frequent overlooked is the innominate.
to: Another joint frequently overlooked is the innominate.

pg 112 Changed: of the innominate that is preventing revovery
to: of the innominate that is preventing recovery

pg 130 Changed: There is often a shortning of the anterior structures
to: There is often a shortening of the anterior structures

pg 140 Changed: Of particular local interest to the osteopth
to: Of particular local interest to the osteopath

pg 186 Changed: goins then to the innominates
to: going then to the innominates

pg 214 Changed: The exact cause of ocular lesions, or phlycentular
to: The exact cause of ocular lesions, or phlyctenular

pg 215 Changed: diathesis and the exanthemata play their roll
to: diathesis and the exanthemata play their role

pg 220 Changed: progressive ulcer (second sage.)
to: progressive ulcer (second stage.)

pg 228 Changed: which begins by contration of the field
to: which begins by contraction of the field

pg 238 Changed: paraffin oil and the heat applied continusously
to: paraffin oil and the heat applied continuously

pg 254 Changed: Labyrinthitis is of several forms but in gerneral
to: Labyrinthitis is of several forms but in general

pg 261 Changed: mucopurulent discharge, accompanied by a bad ordor
to: mucopurulent discharge, accompanied by a bad odor

pg 271 Changed: The constitutioual causes of epistaxis
to: The constitutional causes of epistaxis

pg 275 Changed: treatment consists of throrough cleansing
to: treatment consists of thorough cleansing

pg 288 Changed: nearly always refers to the patinet’s exterior
to: nearly always refers to the patient’s exterior

pg 288 Changed: and hence before detrioroation has set in
to: and hence before deterioration has set in

pg 290 Changed: the term “acute confusional insantiy”
to: the term “acute confusional insanity”

pg 296 Changed: fears, particulary of impending danger
to: fears, particularly of impending danger

pg 306 Changed: mental capacity in man lie betweeen:
to: mental capacity in man lie between:

pg 311 Changed: gain is shown treatment is discontinuted
to: gain is shown treatment is discontinued

pg 314 Changed: if necessary completely elimination of the operation
to: if necessary complete elimination of the operation

pg 317 Changed: tried to cross the railraod track
to: tried to cross the railroad track

pg 340 Changed: care being taken that it is thoroghly digested
to: care being taken that it is thoroughly digested

pg 340 Changed: lymphoid elements of the inteatines
to: lymphoid elements of the intestines

pg 345 Changed: and maybe bronchial symptms.
to: and maybe bronchial symptoms.

pg 349 Changed: If there are two parosyxms in the same day
to: If there are two paroxysms in the same day

pg 350 Changed: twelve to twenty-four hours when consciouness
to: twelve to twenty-four hours when consciousness

pg 362 Changed: A derangement of the veretbral articulation
to: A derangement of the vertebral articulation