ASTHMA
(Paroxymal dyspnea, with oppression)

SYMPTOMS
    Recurrent and temporary difficulty in breathing, accompanied by a wheezing sound and a sense of constriction in the throat, with couch and expectoration.  Authors distinguish two varieties: dry convulsive or nervous. and humid or common.  In the first variety the attacks are sudden and violent and of short duration, the sense of constriction is hard, dry, and spasmodic, the cough slight, and expectoration scanty and only appearing toward the end of the paroxysm.  In the second variety the paroxysm is gradual and protracted, the constriction heavy, laborious, and humid, the cough violent, and expectoration commences early, and is at first scanty and viscid, but afterward copious, affording great relief.  In many cases the attack is in the night, and most frequently an hour or two after midnight.

CAUSE
    Asthma, pronounced incurable by the medical fraternity, can be relieved, and in most cases cured, by an application of the principles laid down in the following pages.
    The thorax is a bony cage formed by the ribs, dorsal vertebrae, and sternum, containing and protecting the principal organs of circulation and respiration.  The ribs are not only very elastic, but, being connected with the sternum by costo-cartilage and with the dorsal vertebrae by ligaments, have limited motion.  Thus it will be seen that they are easily affected by accident or contraction of the muscles.  In most cases of asthma a slight depression will be noticed over the second, third, and fourth ribs on the left side, about two inches to the left of the median line, while the cartilaginous portion of the corresponding ribs on the right side will be found elevated; occasionally this will be reversed, but in either case it is proof positive that the framework which is supposed to protect the vital machinery of life is out of gear.
    The great Creator, in His infinite wisdom, has arranged for just such an emergency as this by preparing a system of levers, one of which we will now use in raising the ribs, stretching the intercostal muscles, and expanding the chest.
    The pectoralis major, a large muscle which covers the entire front of the chest, attaching to the sternal half of the clavicle (collar-bone), the six or seven upper ribs, and the cartilages of all the true ribs, is inserted by a flat tendon into the external bicipital ridge of the humerus about two or three inches below the shoulder-joint.  If you will raise your arm high above the head, you will feel all the upper ribs move, thus proving that our theory is correct.

TREATMENT

1. Place the patient on the back with a pillow under the head.  Two assistants at the head of the table; one places his right, the other his left hand under the patient's shoulders on the angle of the second rib, half way between the scapula (shoulder-blade) and spine and one inch above the scapula.  With the disengaged hands take the patient's wrists, and, slowly drawing the arms upward high above the head (see cut 4), pull steadily and strongly for a moment; at the same time with the fingers press steadily on the angle of the ribs.  Lower the arms slowly, the elbows passing below and to the sides of the table.  Move the fingers down the spine one inch, to the angle of the next rib, and draw up the arms as before; repeat until you have raised the four or five upper ribs.  It will be also observed that this operation stretches the intercostal muscles.
2. The patient will now be seated upon a stool.  The operator places his knee between the shoulders, grasps the patient's wrists and raises the arms slowly but strongly high above the head, pressing hard with the knee and lowering the arms with a backward motion (see cut 5).  Each time as the arms are drawn upward the patient should inhale, filling the lungs to their utmost capacity, exhaling as the arms reach their normal position.
3. Standing beside the patient, with one hand upon each side of thorax, press the ribs forward and upward, holding them in this position while the patient fills the lungs with air.
4. Place the patient upon the back; and, with the fingers of one hand pressing upon the angle of the first rib which is depressed, with the other hand pressing outward and downward upon the cartilages of the ribs that are thrown forward towards the sternum, have an assistant draw the arm upon the side where the depression has been discovered, high and strong, above the head, the patient filling the lungs to their utmost capacity.  Lower the arm with a backward motion, the elbow passing below the edge of the table, at the same instant pressing hard with the fingers upon the angle of the rib, and with the other hand upon the cartilage which is thrown toward the sternum (cut 6).
5. Place the hand lightly upon the thorax, and vibrate gently for two minutes over that portion of the lungs or bronchi which seems to be affected.  See Vibration.
   It is very important in all cases of lung trouble that vibration should be given, as it assists in starting, stimulating, and equalizing the circulation through the lungs and bronchial tubes, and very materially aids in the recovery of the patient.  We might mention in this connection one case, of a lady, who had been unable to lie down without having a paroxysm for over four years, and after two weeks' regular treatment showed no signs of improvement.  After the first vibration a marked change was noticed for the better, and in four weeks a complete cure was effected.  Instant relief is often experienced after the first treatment, and a continuation of the treatment seldom fails to effect a cure.
   
   Coughs, colds on the lungs, short difficult breathing, and pleurisy never fail to respond quickly to our Asthma treatment.  Of the numerous cases treated by us in this manner, 90 per cent have been cured and all benefited.

    This entire treatment should occupy about fifteen minutes, and be given in acute or stubborn cases each day; in milder forms, every other day is sufficient.

VIBRATION

    Vibrations might be compared to fine shaking movements, in which the whole or part of the palmar surface of the fingers or hand is used.  The benefit to be derived from this treatment depends so largely upon the manner in which it is administered, and the treatment is so applicable in such a variety of cases, that we cannot be too particular in educating ourselves to vibrate correctly.  Place the hand lightly upon the patient, using no pressure.  The movements at the elbow are flexion and extension, while those of the wrist are adduction and abduction.  The vibrations are produced through a succession of quick individual movements.  There should be no straining of the muscles in the operator's arm, or strong contractions of the muscles of the hand, arm, or shoulder.  When given correctly, with the hand on the anterior surface of the thorax, the vibrations can be easily felt by the other hand placed upon the back of the patient while with a stiff hand and arm no motion can be distinguished upon the back.  To further give an idea of how delicately the movements should be made, place a tumbler of water upon a table, and the vibrations are given absolutely correct upon the same, the water will not move from side to side, but simply quicken in the center.  The table should be fairly large to make a fair test.

Asthma

    A paroxysmal, spasmodic contraction of the muscles surrounding the smaller bronchial tribes, with more or less bronchial catarrh.
    Causes: A true nervous affection of the respiratory apparatus. It is sometimes of reflex origin, starting from diseases of the nasal mucous membrane or from a pressure of the upper ribs on the lungs.
    Symptoms: The first attack of asthma may be sudden and abrupt, with a catarrhal inflammation of the nose, bronchial irritation, constriction of the chest, marked dyspepsia. In most cases the attacks occur in the early morning hours or during the afternoon, the breathing is accompanied by loud wheezing; the face is flushed and bathed in perspiration; during the attack there is a dry short cough, which becomes looser as the attack subsides. Early in the attack the sputum is raised with difficulty, but after a day or two it becomes looser and is thick, like a mixture of pus and mucus.
People who are subject to this disease are attacked with it in the fall, and an attack of hay fever frequently accompanies it.
    Treatment:

1. Have the patient lie on his side and give treatment No. 18, page 41, working only between the second and the sixth dorsal vertebrae, location of which may be seen in cut No. 1 B, page 24.
   [18.  MANIPULATION OF THE MUSCLES IN THE BACK, IN GENERAL TREATMENT OF THE SPINE:
       HAVE the patient lie on his side, with his arm loosely thrown over yours as shown; begin at the second dorsal vertebra and work all the way down the back to the end of the spine, working the muscles on the side of the spine towards you.  With considerable pressure, draw the muscles upward and outward away from the spine; now move your hands down the back a few inches and repeat the movement and so on down, releasing the patient's arm after you have reached the tenth dorsal vertebra.  (The location of the vertebrae may be seen in cut No. 1, page 24.)  Now turn the patient to his other side and work the muscles away from the spine in an endeavor to stretch them.  This treatment may be made more effectual and complete by placing your fingers on the opposite side of the spine and drawing it upwards towards you; work so all the way down the spinal column.]
2. Give a general treatment of the neck, Nos. 7, 8, 9, 37, pages 30, 31, 32, 60.
       [7.  MANIPULATION OF THE CERVICAL REGION IN THE BACK OF THE NECK:
   WITH the patient lying on his back, place the left hand on his forehead, and the right and on the muscles in the back of the neck near the spine, in the region of the upper cervical vertebrae, and, while rolling the head away from you with the left hand, pull the muscles of the neck towards you, but not allowing the fingers to slip on the skin, the idea being to stretch the muscles.  Now move the hand down the neck a little and repeat the above movement, and so on down as far as the 7th cervical vertebra, location of which may be seen in cut No. 1, A, page 24.
       8.  MANIPULATION OF THE MUSCLES IN THE SIDE OF THE NECK:
       WITH the patient on his back, place the left hand on his forehead, and with the other manipulate the muscles of the side of the neck from the angle of the jaw to the collar bone.  While turning the head away from you, draw on the muscles, pulling them towards you without letting your fingers slip on the skin.  This treatment and No. 7 should be given to both sides of the neck and should be given about three minutes.
       9.  STRETCHING THE NECK:
       WITH the patient lying on his back, place one hand under the chin and the other at the base of the skull and pull on the head until the body moves; next, while pulling, turn the head slightly from side to side two to three times.  This treatment frees the circulation in the neck and especially between the vertebrae of the entire spine.
       37.  MANIPULATION UNDER THE JAW:
       WITH the patient on his back, place one hand on his forehead, and with the other work deeply under the jaw, beginning near the ear and gradually working towards the chin, not allowing the fingers to slip on the skin.  Go through the same, movement on the other side of the head.  This treatment is given in case of catarrh, mumps, diphtheria, and any throat trouble.]
3. Have patient lie face downward and give treatment No. 45, page 68. Inhibit from the second to the sixth dorsal vertebrae, holding each point about a minute.
       [45.  GENERAL TREATMENT OF THE NERVES ALONG THE SPINE:
       WITH the patient lying face down and arms hung off at the sides of the table, place your thumbs,one on each side of the spine, and with a moderate pressure work the muscles, pushing them upward and outward; beginning at the second dorsal vertebra work down the entire length of the spine moving the thumbs down one inch each time.  This treatment should require about five minutes.]
4. With patient on back, give treatment No. 41, page 64.
       [41.  TO RAISE THE RIBS:
       WITH the patient on his back, stretch his arm out sidewise, and while bearing down and at the same time pushing it upward, press upward on the ribs with the fingers of the other hand, beginning with the third, as shown in above cut, then the fourth, fifth, and so on down to the seventh, the location of which may be seen in cut No. 2 C, page 25, This work should he done on both sides of the body alike, but only on the left side in case of neuralgia of the heart.]
5. Treatment No. 12, page 35, patient sitting on a chair.
       [12.  SPRINGING SPINE IN THE UPPER DORSAL REGION:
       WITH the patient sitting on a chair, grasp his wrist and raise the arms high above the head; at the same time place your knee in the middle of the back, high between the shoulder blades, and with the pressure there, bring the arms outward and downward to the side; this should be repeated several times, each time lowering the knee about two inches, until you get as low as the twelfth dorsal vertebra, the location of which is shown in cut No. 1, B, page 24.  This treatment is used in all affections of the throat, lungs, and heart.]
6. Treatment No. 16, page 39.
       [16.  TO LOWER THE FIRST RIB HAVE the patient lie on his back, with your left hand draw the patient's left arm above his head, and place the thumb of the right hand in the supra-clavicular fossa (see cut No. 3 E, page 26, for same).  Close to the neck, and while pulling on the out-stretched arm, press in the opposite direction with the thumb on the first rib, which may be plainly felt close to the neck, and now return the arm to the patient's side, with a forward and downward movement.  As the first rib is frequently drawn upwards by contraction of the muscles in the side of the neck, thus interfering with free circulation to the head and neck, this treatment will have the effect of removing the obstruction.  Use same treatment on opposite side if necessary.]
7. If there be marked dyspepsia give treatment for same, page 92, in addition to the other treatments.
       An attack may often be relieved by inserting one or two fingers into the rectum and stretching same.
       Diet: The evening meal should be very light, as an over-loaded stomach often brings on an attack; in case there be marked dyspepsia or indigestion, follow diet list No. 6, page 144.
   
       In general, fats and sweets should be avoided, and starchy foods, if eaten at all, should be well cooked and slowly masticated. Pork, veal, and cheese must never be eaten, and desserts are forbidden; no water is allowed with the meals and not for two hours after. A cup of hot water may be drank an hour before each meal and one before retiring. Malt liquors are forbidden.
   Hanging, suspended by the arms, for five minutes every day will have a tendency o raise the ribs and give freer action to the lungs. Treat only once a week, except in case there be dyspepsia or indigestion, when three treatments should be given.

ASTHMA

    DEFINITION: Asthma is a disease of the bronchial tubes characterized by dyspnea.  It is spasmodic in nature, the air tubes being narrowed by spasm of their muscular fibers or by swelling of the mucous membrane from hyperemia.
    CAUSE: This disease always presents definite lesions, muscular and bony, of the upper dorsal spine and of the thorax.  Secondary lesions usually occur in the cervical region.  The chief bony lesions affect the ribs from the second to the sixth on the right side. (Dr.  A. T. Still.) The majority of cases show lesions of this region, but they may occur higher up or lower down.  Lesion is often found in the neck.  The sternal ends of the ribs and the costal cartilages, as well as the spinal ends of the ribs may show the lesions.  Lesions of the ribs from the second to the seventh on either side; of the corresponding dorsal vertebra; of the anterior and posterior thoracic muscles; of the atlas, axis, and hyoid bone, and of the cervical muscles are all active in producing the disease.  A case is reported in which the bony lesion was in the lumbar spine, constipation also being a feature of the case.  No treatment was given above the lumbar region, but the asthma was cured.  It was regarded as being reflex from the lumbar lesion. (See case 13).
    A review of the typical cases, reported from various sources, and in which cures were made by the removal of the specific lesion, shows a definite area in which such causes occur.

1. Luxation of first, second and third left ribs.
2. Fourth, fifth and sixth dorsal vertebra anterior; the corresponding ribs lowered.  Two treatments stopped the attacks, and patient was discharged as cured after three weeks' treatment.
3. Second dorsal vertebra lateral.
4. Fifth right rib down and much tenderness of tissues at the fifth dorsal vertebra.
5. The scaleni, mastoid and anterior and posterior thoracic muscles very tense.
6. Right fourth and fifth ribs, and left fifth and sixth ribs luxated.
7. The axis luxated to the right, cervical muscles contractured, all the ribs depressed.
8. The left fifth and sixth ribs downward.
9. The first to the eighth ribs on both sides down; spinal of the same region contractured luxation of the atlas and axis; depression of the hyoid bone.
10. The second dorsal vertebra luxated laterally, involving the corresponding ribs; several ribs down.
11. All the upper dorsal vertebrae anterior, carrying the ribs forward; closeness of the first rib to the clavicle.
12. Third, fifth, and seventh right ribs luxated downward at their anterior ends;  their heads were also luxated; atlas and axis to the right.  The patient had previously been a sufferer from bronchitis, with upper dorsal and rib lesions.  Accidental slipping of the third rib caused asthma at once.  Irritation from the fifth rib always caused expectoration of quantities of sputum, but if the third rib were kept in place the asthma disappeared at once.
13. Female; age 22; single; book-keeper.  Lumbar region much posterior constipation and dysmenorrhea accompanied the asthma which was of two years' standing.  No neck, rib, or thoracic spinal lesion appeared.  The heart was irregular, ,dropping one beat in four.  No treatment was given above the 12th dorsal, and as soon as the constipation was cured (3 mos.) the asthma and dysmenorrhea disappeared.  The patient had not had a night's sleep in more than a year, without the use of a powder which she burned, inhaling the fumes.  The bony lesion was removed, and cure resulted.  The asthma was reflex from the lumbar condition and diseases present.
14. A fourth rib displaced, causing asthma, accompanied by bronchitis and pleurisy.  The whole spine was stiff.  After two treatments the patient was free from asthma and was discharged cured after six treatments.
15. Asthma and Hay Fever.  Male, aged 38; grocer.  One clavicle was depressed.  Raising it gave immediate relief.  The upper spinal muscles were contractured.  These were relaxed and the ribs, from the 1st to 5th on the left side, were raised.
16. Female, aged 23. A fall in childhood caused a lateral curvature from the lower dorsal to the sacral region, the lumbar region being also anterior.  The right limb was much smaller and shorter than the left; the ankle stiff; the flesh always cold; menstrual flow every two weeks.  After two weeks treatment the asthma disappeared.  Under further treatment constant improvement was taking place in the general condition.
17. Male, aged 43; married; overseer of land and oil wells. 3d, 4th, 5th, and 6th dorsal vertebrae posterior, especially the 3d.  The cervical muscles were badly contractured, due to the atlas being displaced to the right.
        Relief was given at once in treatment by pressing the dorsal vertebrae forward, throwing the upper ribs and clavicles forward.  The condition was complicated with hay-fever, which was also cured.  One can but note how all of these lesions occur in those regions in which it is claimed the cause of asthma occurs.  No other school of practice notices such causes of this disease.  Their theories are various, many exciting causes are agreed upon, but Anders makes the statement in regard to the real and original causes that they are of an unknown nature.

    These lesions cause abnormal motor effects both in arousing spasmodic conditions of the muscles of the bronchial walls, and in the vaso-motor activity that produces the hyperemia of the mucous membrane.
    There are good ANATOMICAL REASONS why lesions in these regions affect the lungs.  The American Text Book of Physiology states that stimulation of the vagus in the neck produces constriction of the pulmonary vessels, while stimulation of the sympathetics in the neck causes dilatation of them.  Quain's anatomy says that the pneumogastrics convey motor fibers to the unstriped muscle fibres of the trachea, bronchi, and their subdivisions in the lungs.  Vaso-constrictors for the lungs exist, in some animals, in the second to the seventh spinal nerves. (Quain.) The anterior pulmonary plexus is composed of the pneumogastrics and the sympathetics; the posterior, of the pneumogastrics and branches from the second, third, and fourth thoracic sympathetic ganglia.  These regions of the spine, with their important nerve connections with the lungs, are naturally investigated by the Osteopath in relation to asthma.  It is reasonable that obstruction to the nerves here should cause the disease.  Anders gives among exciting causes "irritating lesions of the medulla." The Osteopath finds in lesions of atlas, axis and cervical issues sufficient cause of such irritation of the medulla as well as of the pneumogastric, through their sympathetic and spinal nerve connections.  In these ways, lesion to the cervical, dorsal and upper thoracic structures act as obstructors of these nerve mechanisms concerned in asthma, the pneumogastric nerves, pulmonary plexuses, sympathetic and vaso-motors, and cause the disease.
    Exciting Causes of the paroxysm, such as bronchitis; the inhalation of irritants, such as dust, fog, smoke, chemical vapors, pollen of plants, odors of animals; reflex irritation from nose or stomach; the results of other diseases, etc., would not act to cause asthma did these anatomical lesions not exist.  They are the real cause of the condition.  Existing in an individual, they obstruct the vital forces of the bronchi and deteriorate the vitality of their tissues, perhaps gradually during a term of years, and make it possible for these various exciting causes to act.
    The PROGNOSIS is good under osteopathic treatment, though under medical treatment comparatively few cases recover.  Very many cases, a large number of them apparently helpless, have been cured.  The fact that most of these cases coming under osteopathic treatment are of long standing and have usually tried every known remedy seems to make little difference in gaining results upon them.  Some cases the most severe and longest standing yield quickest.
    EXAMINATION AND TREATMENT are carried out according to the methods described in Part I, (Chapters I, II, III, IV, VI, VII.) Any of the lesions that may affect the bony parts in the regions mentioned may produce the disease.  Displacements of ribs, vertebrae, etc., need not take place in a particular direction.  Rib and thoracic vertebral lesions are more likely to act as causes.     Lesions in the neck alone seem quite unlikely to cause it.  Those of the fourth and fifth ribs upon the right side are most frequently the cause.  It is unnecessary to name the various probable causes of the anatomical derangements or lesions named, as that subject has been fully dealt with elsewhere, as well as the theory of the exact way in which such lesions as the Osteopath finds act to cause disease.  TREATMENT must always depend for its success upon removing the causative lesion, but treatment during the attack must look more particularly to immediate relief of the patient, for as a rule these lesions can be removed only by a course of treatments.  At this time great relief is given and the spasm usually quieted by thorough relaxation of the spinal muscles (Chap. II, div. I), followed by raising of all the ribs (Chap. VII) and clavicles to allow free thoracic and lung action, and by relaxation of the muscles and other soft tissues of the neck.  Loosen the clothing about the neck.  The best time to treat for removal of the lesion is between attacks, it being located and treated, according to its kind, by methods already described.  Attention should be given the sternal ends and
cartilages of the ribs, and to the intercostal tissues, as well as to the heads of the ribs and the vertebrae.  The scapular muscles should be relaxed (Chap. II, div.  XV.) the clavicles raised (Chap.  XII); the tissues of the neck thoroughly relaxed, the spinal column relaxed (Chap. II, div. II, III, IV, V.) and the ribs raised at their angles.  If the patient finds it difficult to take a full breath, raising or correcting the fifth rib, or all of the ribs, will sometimes give relief.  Pressure upon the phrenic nerve aids the work by relaxing the diaphragm, which is sometimes elevated (Chap. III, div. VIII.)
    Treatment once a week or ten days is often enough in most cases.  Frequent treatment may undo the results accomplished and keep up constant irritation.  Many severe cases have been cured by a few treatments at long intervals or by a single treatment.
    Under this course of treatment the patient usually feels relief at once.  As a rule the spasms and the various attendant symptoms terminate abruptly.
    CARE OF PATIENT should include the wearing of loose clothing, living out of doors in pure air if possible, or in large, well ventilated rooms.  The diet should be light and easily digested to avoid danger of stomach reflexes, and the patient should avoid dust and other exciting causes.

ASTHMA.

    Asthma is a chronic affection of the bronchi, in which there are paroxysms of difficult breathing, supposed to be due to the muscular contraction of the smaller bronchial tubes.  It may last for a few minutes or for several hours, and often occurs nightly for a few days or up to two weeks.  Some patients have warning symptoms peculiar to each, while in other cases the attack comes suddenly, without warning.
    Asthma is supposed to be a nervous affection.  Heredity plays an important part.  There are many exciting causes acting as irritants, such as reflex irritations from other parts of the body, as stomach, bowels, ovaries, uterus, etc.  Chemical vapors, dust, fog, smoke, the smell of certain animals, as cat, horse, dog, also the pollen of plants, also colds, anger and fright may also excite the disease to activity.
    The real cause of the disease is to be found in anatomical derangement of the spine and ribs.  This is proven by the fact that many who have had the disease for years and have tried everything in the form of treatments, without benefit, were cured when the anatomical maladjustments were removed.  There will generally be found in the neck, clavicles, first to the sixth ribs and corresponding vertebra some lesion that will account for the disease.
    When we wish to relieve the patient the spinal muscles are relaxed, as are the tissues of the neck.  See Nos. 1, 5, 7B, 9, 10, 11, 13, 34, 36, 43, 44.  The clavicles and ribs are raised.  See Nos. 72, 73, 82, 83, 88.  Great relief should follow at once.  When there is no paroxysm the treatment may be given once in ten days.  Find and remove any vertebral or rib lesion present.  See treatment of spine and ribs.  See Nos. 52, 53, 57, 58, 86.  Give the relaxing treatment as above.
    In addition to this a thorough general treatment may be given.
    1. While the patient is in a sitting position on the side of the table, the operator, standing behind, the right hand placed on top of the patient's head, rotates the head so as to bring the neck of the patient against the thumb of the operator's left hand.  The left thumb is moved successively along against the arches of the vertebrae, as shown in Fig. 1. In this manner there is secured a free motion between the vertebra, and the movement also assists in relaxing the tissues preparatory to removing any vertebral lesion that may be present.
    5. The patient lies on his back.  The operator stands at one side with one hand on the patient's forehead, the other beyond to the other side of the neck.  The hand on the forehead rotates the head from side to side, alternately relaxing and stretching the muscles at the side and back of the neck, while the hand placed at the side of the neck stretches the muscles toward the operator with each movement of the neck.  The hand on the neck will be moved from one position to another as the tissues relax beneath it, and the hand may be brought down onto the shoulder during the process of relaxation.  This same treatment may be applied to all the tissues in front of the neck down to the clavicles.  See Fig. 5.
    7 B. The sub-occipital, great occipital,  small occipital, and great auricular nerves may be stimulated as in cases of fever, headaches, etc., by deep pressure on both sides of the spine, just at the base of the skull, as in Figs. 8 and 9. The founder of Osteopathy,
Dr. A. T. Still, when but a small boy, made pressure on these nerves by placing his head in a swing.  See Fig. 10.  He found that this pressure relieved his headache.  This accidental discovery may have had something to do with his discovery, later in life, of Osteopathy. 7 C. By deep pressure of the tissues of the neck against the transverse processes of the second and third cervical vertebrae we may stimulate the superior cervical ganglion.  See Fig. 9 A.
    9. The head may now be twisted as far as possible to one side without causing inconvenience to the patient; then to the other side in the same manner.  We often notice in executing this movement that it moves further to one side than to the other.  On the side to which it turns the least we look for muscular or ligamentous lesions.  See Fig. 13.
    10. The head may be pushed as far forward as possible onto the chest, loosening the posterior muscles and other tissues far down the spine.  See Figs. 14 and 15.
    11. Some operators can use a very effective spiral treatment of the tissues of the back of the neck.  One hand is placed on the forehead of the reclining patient, the other beneath the neck.  The neck and head are both raised.  The head is rotated in one direction, the neck in the opposite direction.  Then the movement is reversed.  See Fig. 16.
    13. The neck tissues may be stretched as in Fig. 18. In some cases it will be of material
assistance in the case of light patients, to have an assistant to hold the feet of the patient, to afford greater resistance.  Many other movements in the treatment of the neck will be developed in the regular routine of practice by the skillful operator.  This will be true of every portion of the anatomy as well as of the neck.
    34. With the patient sitting on the side of the table, and the operator standing behind, he may begin the treatment of the back by placing the tips of his fingers on the patient's shoulders and with the thumbs loosen the muscular tissues in the upper part of the back.  If the hands are long he can travel up and down a good portion of the back with the fingers in the above position.  See Fig.  34.  The fingers may now be used in relaxing all the tissues on the shoulders from the neck over the top of the shoulders.
    36. The patient sitting, and the operator standing behind places one hand on the top of the
patient's head and with the other hand makes fixed points with the thumb along the spine, using the head and neck as a lever. The use of the hands may then be reversed and the other side of the spine treated in the same manner.  The operator will be surprised with the efficiency of this movement and the power that can be exerted at any given point along the spine against the thumb by making the right pressure on the head.  See Fig. 37.
    43. The patient is sitting on the side of the table.  The operator is standing in front of the patient, with a pillow between himself and the patient.  Both hands clasp the spine of the patient as in Fig. 44, when deep pressure may be made, sinking the vertebrae well in; then by rotating the body pressure may be made to the side wished.  This is an excellent movement to correct a lateral curvature or any lateral or posterior displacement.  In case of an anterior displaced vertebra the vertebra above and below may be brought forward in this manner, thus gradually correcting the one which is anterior.
    44. The position is the same as in 43 for both operator and patient.  By grasping the spine firmly on each side the patient may be lifted and the spine stretched, or correction may be made in this manner when only two or three vertebrae are approximated too closely.  See Fig. 45.
    52.  The patient is in the prone position, and pressure is made in the lower part of the spine, while first one then the other limb is raised, as in Fig. 53.  This movement, as well as No. 51, assists the operator in relaxing the tissues and replacing posterior vertebrae.
    53. The patient lies on his side in a comfortable position.  The operator stands in front and
grasps the patient's uppermost arm, as in Fig. 54.  With the other hand he relaxes the tissues about the shoulders and down to the spine and pretty well down the back, using the arm as he holds it at the elbow as a lever, working it back and forth to aid in the manipulation.  The spine is manipulated and any deviations are corrected at the same time and in the same manner.
    57. The limbs of the patient may be flexed and braced against the operator, who bends over and grasps the spine thus brought into relief, as in Fig. 32. The spine at any point may now be manipulated by pulling it toward the operator.
    58. With one elbow on the hip, the other on the shoulder, as in Fig. 59, as the patient is lying on the side, the operator's arms may be extended, thus stretching the hip away from the shoulder while the hands are free to manipulate tissues and the spine as well.
    72. The clavicle, or collar bone, is frequently found displaced.  The sternal end, when out of position, affects the tissues of the throat and is a prominent factor in diseases affecting this region, including goiter and circulatory and nerve disturbances in the arms.  The operator stands at the side of the table and takes the elbow of the patient, who is reclining, and inserts the fingers of the other hand under and above the clavicle, near the sternal end.  The elbow is now brought over the breast of the patient and the fingers inserted more deeply under the clavical.  This movement brings heavy pressure onto the fingers by the clavical, which results in raising the latter, when the sternal end can be placed in or toward its normal position.  See Fig. 70.  This treatment may be applied at either end of the clavicle as the case may require.
    73. The clavicle may also be raised and placed in its normal position with the patient sitting, as in Fig. 71.  The elbow is grasped and raised, which raises the clavicle, when the thumb may be inserted above and under it.  By bringing the elbow upward and across the chest the clavicular ligaments may be stretched and the clavicle properly replaced.  This treatment is effective for either end of the clavicle.
    82. Fig. 46 represents another method of elevating and separating ribs.  The patient sits and the operator stands in front.  The operator forces the spine to the side in question, which helps to separate the ribs.  The arm of the patient is raised by the wrist on that side, which raises the ribs.  A combination of 81 and 82 is frequently effective.
    83. The patient sitting and the arm of the patient across the shoulder of the operator, as in Fig. 75.  This gives more of a hold on the lower rib while the patient's head is bent away from the side being treated, curving the spine and throwing the rib more into relief.
    86. The patient is reclining on the back.  The operator, standing to one side, reaches over and takes the arm of the patient on the other side.  With the free hand he takes the rib at or near the angle, as in Fig. 62, and as he pushes it into place he lifts up on the outstretched arm and rotates it backward.  This calls into play the anterior muscles attached to the rib or ribs and assists in the movement.  The patient may further assist the operator by taking a deep, full breath as the rib is lifted up, which the operator holds for a few seconds as the breath is exhaled.
    88. As the patient lies in the prone position the heads or angles of the ribs may be eplaced, as in Figs. 76, 50, 51, by working directly over them.
    138.  A General Treatment is given by a great many Osteopaths in connection with the specific treatment needed for the ailment for which the patient is being treated.  General treatment is an advantage in a number of cases.  It is given for nerve troubles and for the general circulation.  The treatments will vary greatly with different Osteopaths but the following is a sample:
    139. The patient reclines on a table, lying on his side.  The Osteopath begins by loosening up the tissues of the back, as indicated in Nos. 53, 56, 58. The shoulder is manipulated, as in Nos. 54, 55, the lower limb as in No. 113.  The spine is sprung from one end to the other, as in No. 57. The patient then lies on the other side and the treatment is given as before.  The patient then takes the reclining position, when further treatment is given the back as in Nos. 47, 48, 50, 51, 52.
    Afterward the patient lies on the back and the treatment is commenced at the head, as in Nos. 14, 15.
    The neck is treated as in Nos. 7B, 9, 10, 11, 13.  The arms are treated as in Nos. 130, 131.
    Further treatment is given the back, and the ribs are raised as in Nos. 61, 62, 86, 64.  The abdomen is treated as in Nos. 94, 95, 96, 100, 101, 102.  The lower limbs are treated as in Nos. 113, 114, 115, 116, 121.  The patient now sits on the side of the table and the back and spine are further treated as in Nos. 1, 2, 5, 34, 36, 37, 43, 44.
    Medical Relief.  A few whiffs of chloroform will give temporary relief.  The patient may inhale a solution of nitrite of amyl, three to four drops on a handkerchief.  For the prevention of the disease fifteen grains of iodide of potassium, given three times per day, is recommended.  Hot coffee or hot whiskey toddy will (sometimes) ward off an attack.  Tobacco smoke inhaled has proven helpful.  If the attack is caused by overeating or a disordered condition of the stomach or bowels or both they should be emptied.
    Diet.  It will be well to be careful with the diet.  The heavy meals should be taken not later than noon.  The sweets, or any article of food that tends to form gas in the stomach, should be interdicted.

ASTHMA

    Definition - A disease characterized by paroxysmal attacks of dyspnoea and a feeling of oppression.
    Causes - This is essentially a nervous affection and is caused by some irritation on the central nervous system. It is often hereditary. Pathological conditions of the air passages, such as adenoids, polypi, nasal spurs or bronchial catarrh are probable causes. Exciting causes are dust, tobacco, pollen of plants and certain drugs. It may follow gastric disorders, especially an overloading of the stomach.  Asthma is also symptomatic of hay fever, Bright's disease and affections of the heart. There is a spasmodic closure of the bronchi.
    Symptoms - The onset is usually sudden or may be preceded by a feeling of oppression about the chest, chilliness, flatulence and sneezing. The attack usually comes on at night or in the early morning hours, the patient being awakened by dyspnoea. The desire for air is intense and he assumes the position which gives him the greatest relief, which is usually that of leaning forward upon his arms. The respiration is not increased in rapidity. During an attack the face becomes flushed and at times livid, the eyes prominent and the skin cold and clammy. An attack usually lasts from half an hour to several hours and terminates with the expectoration of sticky, stringy mucus. On close examination, this mucus reveals little grayish balls, called Curshmann's spirals, which may sometimes be seen with the naked eye. The temperature is seldom elevated, but the pulse is slow and weak. At times, however, the pulse is rapid, small and irregular.
    Treatment -

1. Manipulation of cervical area, performed as follows: While both arms are strongly raised, apply pressure with the fingers on either side of the spinous processes along down the back, beginning on a level with the shoulders, or press the knee against the back while the arms are pulled strongly upward and backward, loosening the hold and lowering the pressure in the back three or four times, until the first six dorsal vertebrae are passed with the knee downward.
2. Give a general treatment.
3. Vibrate the entire chest with hand or hands for several minutes.
4. Raise the clavicles.
5. Stretch the body backward while pressing along the sides of the spinous processes with the fingers.
6. Pressure applied at the head of the first rib will relieve the most violent paroxysms.
7. Treat every second or third day.    

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