,transcrib]'s ,note ,italic text display$ z3 italic ,bold text display$ z3 bold ,,! ,,practice ,,( ,,o/eopa?y ,illu/ration ,,c>l ,,philip ,mc,c,o,n,n,e,l,l ,presid5t ,am]ican ,o/eopa?ic ,association1 #aijd-je4 ,=m]ly ( ! ,faculty ,am]ican ,s*ool ( ,o/eopa?y4 ,memb] ( ! ,faculty ,*icago ,college ( ,o/eopa?y ,,*>les ,,clayton ,,teall ,presid5t ,am]ican ,o/eopa?ic ,association1 #aijb-jc4 ,dean ( ! ,faculty & ,pr(essor ( ,practice & ,cl9ical ,o/eopa?y ,am]ican ,s*ool ( ,o/eopa?y4 ,editor ,j\rnal ( ,o/eopa?y ,,f\r? ,,edition ,rewritt5 9 collaboration ) o/eopa?ic speciali/s ( note ) mu* new & orig9al matt] #aibj ,,j\rnal ,,pr9t+ ,,co4 ,,kirksville1 ,,mo4 ,,copyright #aibj ,,c>l ,,philip ,,mcconnell ,,& ,,*>les ,,clayton ,,teall ,,d$icat$ ,,to ,,! ,,memory ,,( ,,&rew ,,taylor ,,/ill ,,fir/ ,,edition #ahii ,,second ,,edition #aijb ,,?ird ,,edition #aijf ,,f\r? ,,edition #aibj ,,preface ,,to ,,! ,,f\r? ,,edition ,a sci5ce is said to be kn[n by its lit]ature &1 if t be true1 ,o/eopa?y is backw>d = !re are few available books on ! subject = ! /ud5t & inve/igator al?\gh !re is a va/ am\nt ( unclassifi$ j\rnali/ic matt]4 ,a pret5ti\s />t 0 made &1 = a "t1 x appe>$ t we %\ld h texts on all subjects = ! tea*+ ( ,o/eopa?y b1 = reasons n necess>y to give "h1 ^! books did n live al?\gh _! value & ne$ 0 nev] que/ion$4 ,! ?ird edition ( ! ,practice ( ,o/eopa?y 0 exhau/$ v soon aft] publication & !re h be5 insi/5t calls = a f\r? :i* is n[ pres5t$ ) ! hope t x w f9d z fri5dly a reception z 0 accord$ ! previ\s editions4 ,close att5tion to curr5t lit]ature has be5 giv5 & reports f exp]i5c$ practition]s 9 ! field has be5 s\ght & ?is mat]ial made use ( :]ev] possible4 ,besides ?is1 c]ta9 sections h be5 writt5 by speciali/s 9 _! sev]al l9es ^: sign$ articles we confid5tly pres5t4 ,! subject ( o/eopa?ic practice has be5 h&l$ to avoid undue optimism 9 ! light ( exp]i5ce b1 also1 n to lose sight ( ! fact t o/eopa?y won its way by p]=m+ ! s-call$ impossible 9 a multitude ( cases4 ,!re=e1 x has be5 ?\ght be/ n to draw a h>d & fa/ l9e on our limitations4 ,! bord] l9e betwe5 o/eopa?y & surg]y has be5 demon/rat$ z well z c be done on pap] )\t ! actual pati5t 9 h&4 ,m$ical lit]ature has be5 call$ ^u to give its /ore ( k :]ev] our ne$s h appe>$ & all o/eopa?ic pr9ts h1 also1 giv5 f _! accumulat$ wisdom & exp]i5ce4 ,! au?ors ackn[l$ge1 ) ?anks1 ?is in=mation f ! _m writ]s = o/eopa?ic j\rnals :o h creat$ a great fund ( k on o/eopa?ic subjects & p>ticul>ly ^? :o h contribut$ special sections4 ,,c>l ,,philip ,,mcconnell4 ,,*>les ,,clayton ,,teall4 #aibj4 8,o/eopa?y is n s mu* a "q ( books z x is ( intellig5ce4 ,a successful o/eopa? is 9 all cases1 or %\ld be1 a p]son ( individuality ) a me*anical eye beh9d all motions or ef=ts to readju/ any "p ( ! body to its orig9al normality1 because unguid$ =ce is dang]\s1 (t5 do+ h>m & fail+ to give relief t %\ld be ! rew>d ( well direct$ skill40--,a4 ,t4 ,,/ill4 ,,li/ ,,( ,,contributors ,,raymond ,w4 ,,bailey1 ,d4 ,o4 ,=m] memb] ( ! faculty1 ,philadelphia ,college ( ,o/eopa?y4 7,defective ,*ildr57 ,,edg> ,s4 ,,com/ock1 ,d4 ,o4 ,pr(essor ( ,pr9ciples ( ,o/eopa?y1 & ( ,respiratory & ,infecti\s ,diseases1 ,*icago ,college ( ,o/eopa?y4 7,infecti\s ,diseases7 ,j4 ,,deason1 ,m4,s41 ,ph4 ,g41 ,d4 ,o4 ,pr(essor ( ,rh9ology1 ,l>yngology & ,otology1 ,*icago ,college ( ,o/eopa?y4 7,e>1 ,nose & ,?roat7 ,l4 ,,van ,,horn ,,g]d9e1 ,a4 ,m41 ,m4 ,d41 ,d4 ,o4 ,neurologi/1 ,/ill-,hildre? ,sanatorium4 7,m5tal ,diseases7 ,a4 ,g4 ,,hildre?1 ,d4 ,o4 ,sup]9t5d5t1 ,/ill-,hildre? ,sanatorium4 7,m5tal ,diseases7 ,h4 ,s4 ,,ha91 ,d4 ,o4 ,pr(essor ( ,or?op$ics1 ,am]ican ,s*ool ( ,o/eopa?y1 ,or?op$ic ,surgeon1 ,a4 ,s4 ,o4 ,hospitals4 7,de=mities7 ,,e>l ,r4 ,,hosk9s1 ,sc4 ,b41 ,d4 ,o4 ,pr(essor ( ,cl9ical ,o/eopa?y1 ,x-,radiance & ,diagnosis1 ,*icago ,college ( ,o/eopa?y4 7,diseases ( ! ,blood7 ,,*>les ,j4 ,,mutt>t1 ,d4 ,o4 ,pr(essor ( ,diagnosis & ,te*nique & ( ,ga/ro5t]ology1 ,philadelphia ,college ( ,o/eopa?y4 7,diseases ( ! ,/oma*7 ,,george ,m4 ,,mccole1 ,d4 ,o4 ,o/eopa?ic ,practition] & ,writ]4 7,influ5za7 ,,*>les ,c4 ,,reid1 ,m4 ,d41 ,d4 ,o4 ,presid5t1 ,d5v] ,polycl9ic & ,po/-,graduate ,college4 7,oph?almology7 ,,george ,a4 ,,/ill1 ,m4 ,s41 ,m4 ,d41 ,d4 ,o4 ,pr(essor ( ,surg]y1 ,am]ican ,s*ool ( ,o/eopa?y1 ,surgeon 9 ,*ief1 ,a4 ,s4 ,o4 ,hospitals4 7,po/-,op]ative ,treatm5t7 ,,table ,,( ,,cont5ts ,,"p ,i4 ,,introduction #ag ,,o/eopa?ic ,,etiology ,,& ,,pa?ology #bd ,o/eopa?ic lesion2 ,etiological factors2 ,osse\s lesion2 ,muscul> lesion2 ,ligam5t\s lesion2 ,visc]al lesion2 ,composite lesion2 ,pa?ology2 ,sp9al lesions2 ,pro(4 ,,o/eopa?ic ,,diagnosis ,,& ,,prognosis #ch ,! ,sp9e2 ,exam9ation2 ,v]tebr2 ,position 9 exam9ation2 ,neck1 ,head & ,face1 ,atlas1 ,axis1 ,skull1 ,?ird ,c]vical1 ,muscles ( ! ,neck1 ,temporo-,maxill>y ,articulation1 ,scalp1 ,ribs1 ,clavicle1 ,/]num1 ,dorso-,lumb>1 ,?orax1 ,abdom51 ,gall ,bladd]1 ,sple51 ,/oma*1 ,inte/9es1 ,kidneys1 ,lumb>1 ,pelvis1 ,coccyx1 ,arms1 ,legs4 ,,o/eopa?ic ,,prognosis #ef ,,o/eopa?ic ,,te*nique #fj ,s5se ( t\*1 ,def9ite pr9ciples1 ,g5]al treatm5t1 ,position1 ,neck1 ,head1 ,ribs1 ,dorsal1 ,lumb>1 ,abdom51 ,pelvis1 ,legs1 ,arms1 ,h[ (t5 to treat1 ,l5g? ( treatm5t1 ,ov]-treatm5t1 ,misappli$ treatm5t4 ,,o/eopa?ic ,,c5t]s1 ,,/imulation1 ,,inhibition1 ,,readju/m5t1 ,,vasomotor ,,& ,,s5sory ,,n]ves #hh ,,sp9al ,,curvature #if ,,pott',s ,,disease #ajb ,,spra9s #ajd ,,flat ,,foot #aab ,,fractures #aae ,,po/ural ,,defects #abj ,r\nd ,%\ld]s1 ,pa9ful ,%\ld]s1 ,p5dul\s ,abdom51 ,po/ural ,curvature ( ! ,sp9al ,column4 ,,prolaps$ ,,organs #acc ,prolaps$ & ,dilat$ ,/oma*1 ,prolaps$ ,kidney1 ,liv] ,prolapse1 ,prolaps$ ,inte/9es1 ,prolaps$ ,ut]us1 ,ov>ian ,displacem5ts4 ,,sk9 ,,diseases #adg ,eczema1 ,h]pes ,simplex1 ,h]pes ,zo/]1 ,urtic>ia1 ,acne4 ,,animal ,,p>asites #aea ,tape ,worm1 ,r\nd ,worm1 ,p9 ,worm1 ,hook ,worm1 ,tri*9iasis1 ,fil>ia4 ,,hemorrhages #afj ,epi/axis1 ,hemoptysis1 ,hematemesis1 ,inte/9al ,hemorrhage1 ,hematuria1 ,ut]9e ,hemorrhage4 ,,hicc\ghs #afe ,,v>icose ,,ve9s #aff ,,phlebitis #afh ,,! ,,rectum #afi ,local ,treatm5t1 ,proctitis1 ,hemorrhoids1 ,rectal ,conditions4 ,,g5ito-,,ur9>y #age ,pro/ate ,gl&1 ,acute ,pro/atitis1 ,*ronic ,pro/atitis1 ,sem9al ,vesicles1 ,v>icocele1 ,impot5cy4 ,,heat ,,/roke #ahj ,,dep>tm5t ,,( ,,oph?almology #ahc ,exam9ation ( ! ,eye1 ,ciliosp9al ,c5t]1 ,somatic ,reflexes1 ,accommodation 9 ! ,eye1 ,! ,oph?almoscope1 ,diseases ( ! ,eye1 ,neuralgia1 ,diseases ( ! ,eyelids1 ,la*rymal ,app>atus1 ,conjunctiva1 ,oph?almia ,neonatorum1 ,tra*oma1 ,phlyct5ul> ,conjunctivitis1 ,v]nal ,conjunctivitis1 ,diseases ( ! ,cornea1 ,exam9ation1 ,ulc]1 ,x]osis1 ,k]atitis ,neuropatalytica1 ,pannus1 ,phlyct5ul> ,k]atitis1 ,int]/itial ,k]atitis1 ,diseases ( ! ,iris & ,cili>y ,body1 ,diseases ( ! ,*oroid1 ,glaucoma1 ,diseases ( ! ,l5s1 ,cat>act1 ,diseases ( ! ,ret9a1 ,optic ,neuritis1 ,optic ,atrophy1 ,a/h5opia4 ,,diseases ,,( ,,! ,,e>1 ,,nose ,,& ,,?roat #bcf ,exam9ation1 ,diseases ( ! ,auditory ,meatus1 ,diseases ( ! ,middle ,e>1 ,acute ,ma/oiditis1 ,*ronic ,ma/oiditis1 ,otitis ,m$ia1 ,cat>rhal ,deafness1 ,normal ,he>+1 ,diseases ( ! ,middle ,e>1 ,diseases ( ! ,nose1 ,rh9itis1 ,hay ,fev]1 ,s9uitis1 ,epi/axis1 ,diseases ( ! ,nasoph>ynx1 ,ad5oids1 ,diseases ( ! ,oroph>ynx1 ,tonsillitis1 ,tonsillectomy1 ,qu9sy4 ,,m5tal ,,diseases #bhb ,dem5tia ,praecox1 ,delirium1 ,confusion & ,/upor1 ,manic ,depressive ,psy*osis1 ,involutional ,psy*osis1 ,s5ile ,dem5tia4 ,,defective ,,*ildr5 #cjc ,t5d5cies1 ,am5tia1 ,treatm5t4 ,,po/-,,op]ative ,,treatm5t #cab ,vomit+1 ,backa*e & ,heada*e1 ,neuritis1 ,phlebitis1 ,nephritis1 ,pleurisy1 ,pneumonia4 ,,"p ,,ii4 ,,infecti\s ,,diseases ,fev] #cbe ,typhoid ,fev] #cbi ,typhus ,fev] #cdd ,mal>ial ,fev] #cdg ,septicemia #cee ,pyemia #cef ,d5gue #cef ,c]ebrosp9al ,m5+itis #ceh ,diph!ria #cfb ,dys5t]y #cfh ,acute ,ileocolitis #cfh ,amebic ,dys5t]y #cgj ,*ronic ,dys5t]y #cga ,erysipelas #cgb ,yell[ ,fev] #cgd ,tetanus #cgg ,simple ,cont9u$ ,fev] #cgi ,tub]culosis #chj ,influ5za #cii ,,acute ,,eruptive ,,fev]s #dab ,smallpox #dac ,v>ioloid #dbj ,vacc9ation #dbd ,sc>let ,fev] #dbh ,measles #dcg ,rubella #ddd ,v>icella #ddf ,mumps #ddi ,:oop+ ,c\gh #deb ,,con/itutional ,,diseases ,rheumatic ,fev] #deg ,*ronic ,articul> ,rheumatism #dfj ,ar?ritis ,de=mans #dfb ,muscul> ,rheumatism #dfe ,g\t #dfg ,diabetes ,mellitus #dgj ,diabetes ,insipidus #dgf ,rickets #dgh ,obesity #dhj ,scurvy #dha ,infantile ,scurvy #dhb ,purpura #dhc ,hemophilia #dhd ,,diseases ,,( ,,! ,,dige/ive ,,sy/em ,/omatitis #dhg ,cat>rhal ,/omatitis #dhg ,aph?\s ,/omatitis #dhh ,ulc]ative ,/omatitis #dhh ,p>asitic ,/omatitis #dhi ,diseases ( ! ,ga/ro-inte/9al ,tract ,appli$ ,anatomy #dij ,acute ,ga/ritis #ejb ,*ronic ,ga/ritis #eje ,ga/ric ,neuroses #eaj ,ga/ric & ,duod5al ,ulc] #eac ,dilatation ( ! ,/oma* #eag ,ga/roptosis & ,ent]optosis #eba ,diseases ( ! ,inte/9es ,acute ,di>rhea #ebc ,*ronic ,di>rhea & ,muc\s ,colitis #ebf ,di>rhea 9 ,*ildr5 #ebi ,acute ,dyspeptic ,di>rhea #ebi ,*ol]a ,infantum #eca ,acute ,ent]ocolitis #ecb ,*ol]a ,morbus #ecc ,inte/9al ,colic #ece ,con/ipation #ecg ,inte/9al ,ob/ruction #eda ,h]nia #edg ,app5dicitis #edg ,diseases ( ! ,liv] & ,bile ,duct ,hyp]emia ( ! ,liv] #eed ,simple ,cat>rhal ,jaundice #eee ,*olecy/itis #eeg ,jaundice #eeh ,cirrhosis ( ! ,liv] #efj ,fatty ,liv] #efb ,amyloid ,liv] #efb ,gall-/ones #efc ,diseases ( ! ,sple5 ,spl5itis #efg ,,diseases ,,( ,,! ,,respiratory ,,tract ,acute ,l>yngitis #efi ,*ronic ,cat>rhal ,l>yngitis #egj ,l>yngismus ,/ridulus #egb ,spasmodic ,l>yngitis #egc ,tub]cul\s ,l>yngitis #ege ,syphilitic ,l>yngitis #egg ,edemat\s ,l>yngitis #egg ,diseases ( ! ,bron*i ,acute ,bron*itis #egi ,*ronic ,bron*itis #ehb ,fibr9\s ,bron*itis #ehe ,bron*iectasis #ehg ,bron*ial ,a/hma #ehi ,diseases ( ! ,lungs ,emphysema #eib ,acute ,lob> ,pneumonia #eig ,bron*opneumonia #fje ,*ronic ,int]/itial ,pneumonia #fji ,conge/ion ( ! ,lungs #faj ,edema ( ! ,lungs #faa ,diseases ( ! ,pleura ,pleurisy #faa ,acute ,pleurisy #fab ,s](ibr9\s ,pleurisy #fab ,*ronic ,pleurisy #fae ,,diseases ,,( ,,! ,,ur9>y ,,sy/em ,diseases ( ! ,kidneys ,r5al ,hyp]emia #fag ,acute ,p>5*ymat\s ,nephritis #fah ,*ronic ,p>5*ymat\s ,nephritis #fba ,int]/itial ,nephritis #fbd ,amyloid ,kidney #fbf ,pyelitis #fbg ,uremia #fbh ,r5al ,calculus #fca ,diseases ( ! ,bladd] ,cy/itis #fce ,,diseases ,,( ,,! ,,circulatory ,,sy/em ,diseases ( ! ,p]ic>dium ,p]ic>ditis #fch ,endoc>ditis #fda ,*ronic ,endoc>ditis #fde ,hyp]trophy ( ! ,he>t #fee ,dilatation ( ! ,he>t #feg ,myoc>ditis #fei ,deg5]ation ( ! ,he>t ,muscle #ffa ,neuroses ( ! ,he>t #ffb ,ang9a ,pectoris #fff ,diseases ( ! ,art]ies ,art]ioscl]osis #ffi ,,diseases ,,( ,,! ,,blood ,g5]al ,consid]ation #fga ,! ,anemias #fgb ,co/og5ic ,anemia #fgd ,*lorosis #fgf ,p]nici\s ,anemia #fgh ,! ,leucemias #fhj ,spl5om$ull>y ,leucemia #fha ,lymphatic ,leucemia #fhb ,hodgk9's ,disease #fhd ,,diseases ,,( ,,! ,,?yroid ,,gl& ,conge/ion #fhf ,inflammation ( ! ,?yroid #fhf ,simple ,goit] #fhg ,exoph?almic ,goit] #fij ,myx$ema #fig ,cret9ism #fih ,,diseases ,,( ,,! ,,p>a?yroid ,,gl& ,tetany #fii ,diseases ( ! ,?ymus #gjb ,diseases ( ! ,adr5al ,gl&s #gjc ,addison's ,disease #gjd ,,diseases ,,( ,,! ,,n]v\s ,,sy/em ,diseases ( ! ,n]ves ,neuritis #gjf ,neuralgia #gaj ,diseases ( ! ,cranial ,n]ves ,olfactory #gae ,optic #gae ,motor ,oculi #gaf ,pa!ticus #gaf ,trigem9us #gag ,facial #gag ,auditory #gah ,glosso-,ph>yngeal #gah ,pneumoga/ric #gah ,sp9al ,accessory #gai ,hypoglossal #gai ,diseases ( ! ,sp9al ,n]ves ,c]vical ,n]ves #gai ,phr5ic ,n]ve #gbj ,bra*ial ,plexus #gba ,dorsal ,n]ves #gba ,lumb> ,n]ves #gbb ,sacral ,n]ves #gbb ,,g5]al ,,& ,,functional ,,diseases ,p>alysis ,agitans #gbc ,acute ,*orea #gbe ,*orei=m ,affections #gbg ,infantile ,convulsions #gbh ,epilepsy #gbi ,migra9e #gcf ,occupation ,neurosis #gch ,hy/]ia #gdj ,neura/h5ia #gdd ,,diseases ,,( ,,! ,,sp9al ,,cord ,acute ,myelitis #gdh ,poliomyelitis #gej ,acute ,asc5d+ ,p>alysis #gec ,locomotor ,ataxia #ged ,fri$rei*'s ,ataxia #gei ,spa/ic ,p>aplegia #gfj ,ataxic ,p>aplegia #gfa ,syr+omyelia #gfa ,amyotrophic ,lat]al ,scl]osis #gfc ,progressive ,muscul> ,atrophy #gfd ,bulb> ,p>alysis #gfe ,,or?op$ic ,,surg]y ,scoliosis #gfg ,functional ,curvature #ggc ,organic ,curvature #ggd ,cong5ital ,dislocation ( ! ,hip #ggh ,talipes #ghd ,pott's ,disease #ghh ,hip-,jo9t ,disease #gia ,tub]culosis ( ! ,knee ,jo9t #gic ,! ,pla/] ,ca/ ,b&age #gie ,index #gii ,,"p ,,fir/ ,,introduction ,:at ,hippocrates 0 to ! ,allopa?1 :at ,hahnemann 0 to ! ,homeopa?1 ,&rew ,taylor ,/ill is to ! ,o/eopa?1 & x is safe to say t :5 ano!r c5tury %all h roll$ away1 8 fame w be equal to t ( ei!r4 ,t he is a mak] ( hi/ory1 ev5 ! mo/ skeptical w admit4 ,8 tea*+s are revolution>y b are borne out 9 fact1 & on t z a f\ndation1 is built ! sup]/ructure ( ! "y !rapeutic giant--,o/eopa?y4 ,x w\ld be ( great int]e/ to trace ! hi/ory ( ! fir/ inception ( ! ?\ght t drugs 7 n only unnecess>y b h>mful1 !n view ! /ruggle to grasp some?+ tangible to take _! place1 !n see ! developm5t ( ! idea t ! human body has )9 x all t is ne$$ = its upbuild+ & repair until he came to ?is fundam5tal3 8,! p[] ( ! art]y mu/ be absolute1 univ]sal & unob/ruct$ or disease w result4 ,! mom5t ( its di/urbance means ! p]iod :5 disease beg9s to s[ ! se$s ( de/ruction 9 ! human body2 & 9 no case c x be done )\t a brok5 or susp5d$ curr5t ( art]ial blood10 capp$ by ! epo*-mak+ discov]y ( ! cause = ?is int]rupt$ fl[ ( ! blood /ream--! !ory ( ob/ruction by anatomical displacem5t4 ,x is ! only !ory ( ! etiology ( disease t w /& ! te/ ( sci5ce & its acceptance & practice means a revolution 9 ! field ( !rapeutics4 ,z x is1 he sets ! exact date1 ,june #bb1 #ahgd1 :5 ! light dawn$ & he saw ! outl9e ( 8 great philosophy--,o/eopa?y4 ,!n came ! ye>s ( adv]sity & /ruggle4 ,) ! eye ( a prophet he saw ! future ( t philosophy1 & ) ! firmness ( a ,sp>tan has def5d$ x s9ce bir?4 ,x mu/ be a sep>ate1 di/9ct sy/em4 ,outside ! fact t x 0 to heal ! sick & 0 f\nd$ on a k ( anatomy & physiology x _h no?+ 9 common ) exi/+ s*ools1 & if x 7 ev] to gr[ x mu/ be alone1 = 8 bro!r practition]s w\ld h none ( x & if left to _! t5d] m]cies x w\ld h 8di$ a-born+40 ,ev5 _h x be5 tak5 up ! result w\ld h be5 ! same = !y w\ld nev] h fully develop$ x4 ,& s ?r\gh ! lean1 t]rible ye>s he /ruggl$1 buoy$ by ! fai? ( a discov]]1 urg$ on by love ( ?is *ild ( 8 bra91 fanatical 9 8 det]m9ation to w94 ,& w9 he did = x 0 v\*saf$ to him 9 8 vigor\s old age to sit on 8 he>?/one & see ! results ( 8 "w1 8 /ruggle & 8 fai?4 ,x is some?+ to "k t 8 fame has circl$ ! e>?1 to be honor$ & sung by millions2 a boon n accord$ _m a sage or philosoph]4 ,n only has ! public accept$ x b ! m$ical pr(ession is mak+ t>dy b =c$ recognition ( c]ta9 c>d9al pr9ciples ( o/eopa?y by us+ !m1 b1 ( c\rse1 )\t cr$it4 ,o/eopa?y has be5 def9$ z 8t sci5ce or sy/em ( heal+ :i* emphasizes1 7a7 ! diagnosis ( disease by physical me?ods ) ! view ( discov]+1 n ! symptoms b ! cause ( disease 9 connection ) misplacem5ts ( tissue1 ob/ruction ( ! fluids & int]f]5ce ) ! =ces ( ! organism2 7b7 ! treatm5t ( disease by sci5tific manipulations 9 connection ) :i* ! op]at+ physician me*anically uses & applies ! inh]5t res\rces ( ! organism to ov]come disease & e/abli% heal?1 ei!r by remov+ or correct+ me*anical disord]s & ?us p]mitt+ nature to recup]ate ! diseas$ p>ts1 or by produc+ & e/abli%+ antitoxic & antiseptic conditions to c\nt]act toxic & septic conditions ( ! organism or its p>ts2 7c7 ! application ( me*anical & op]ative surg]y 9 sett+ fractures or dislocat$ bones1 repair+ lac]ations & remov+ abnormal tissue gr[?s or tissue elem5ts :5 ^! become dang]\s to organic life40#a ,9 a ^w1 o/eopa?y is adju/m5t & ! o/eopa? is an anatomical eng9e] :o kn[s :at is wrong & has ! ability to correct x4 ,dr4 ,/ill *ang$ diagnosis f guess "w to fact & on x 8 fame may well /&1 = :5 ! cause ( ! disease 0 f\nd1 treatm5t 0 easy4 ,he has ev] emphasiz$ ! necessity ( ?or\gh exam9ation & correct diagnosis4 ,all treatm5t mu/ be bas$ on ! def9ite1 specific object to accompli% c]ta9 def9ite1 specific ?+s4 8,o/eopa?y w\ld exp\nd & apply ! true philosophy ( manipulation4 ,:ile ! h&s are us$1 x is n ?is alone & *iefly t di/+ui%es its me?od ( op]ation1 b ! idea & purpose t lie beh9d manipulation40#b ,all manipulators are n o/eopa?s any m ?an all but*]s are surgeons4 ,! ne$ = deep /udy ( ! subject is app>5t f ?is *>act]i/ic /atem5t ( ,dr4 ,/ill's3 8,o/eopa?y is a sci5ce2 n :at we "k ( x1 b ! subject we are work+ is deep z et]nity4 ,we "k b little ( x4 ,i h work$ & worri$ "h 9 ,kirksville = tw5ty-two long ye>s1 & ,i int5d to /udy = tw5ty-?ree ?\s& ye>s yet40#c ,?is br+s u to ! po9t ( ! relations ( o/eopa?y ) o!r manipulative =ms ( treatm5t4 ,!y are n _m1 = ,g]d9e1#d 9 clos+ a long article on ! 8,physiological ,effects ( ,me*anical ,!rapeutics0 says3 8,i h /riv5 to %[ t 9 no way is ,o/eopa?y simil> to massage ei!r 9 !ory or practice if ,o/eopa?y is conceiv$ (1 accord+ to its f\nd]1 ,dr4 ,a4 ,t4 ,/ill1 z a sy/em ( heal+ 9 :i* a def9ite lesion 9 =m ( a bony displacem5t is ! causative factor & a removal ( ! same1 ! curative factor 9 disease40 ,! fact t use is made ( ! h&s to ! ext5t x is by bo? o/eopa?s & masseurs or ,sw$i% movem5t op]ators gives rise to ! mi/ak5 idea ( simil>ity 9 treatm5t4 8,! ess5tial di/9ction10 says ,g4 ,d4 ,hulett1 8betwe5 ,o/eopa?y & all o!r sy/ems ( heal+ bas$ on manipulation1 clu/]s ar\nd ! etiology ( disease4 ,:ile ^! o!r sy/ems1 z indicat$ at lea/ by _! practice1 look at disease f a p]iph]al /&po9t1 o/eopa?y views x f a c5tral /&po9t40#e ,massage is a small bran* ( manipulative !rapeutics1 b conc$+ t x is p]fect & sci5tific x c only resemble o/eopa?ic treatm5t 9 "o ramification ( o/eopa?ic practice1 viz3 relaxation ( muscles4 ,! fact t massage is (t5 employ$ by o/eopa?s 9 connection ) _! "w %[s ! limitations ( t =m ( treatm5t4 ,says ,mc,connell#f3 8,9 ! human body1 z 9 any delicate1 complicat$ me*anism1 !re is me*anism )9 me*anism2 &1 9 ord] to obta9 c]ta9 me*anical effects1 _m times !re is requir$ a s]ies ( complicat$ movem5ts1 all ( :i* be> a ratio "o to ! o!r accord+ to ! en]gy utiliz$ & ! me*anical pr9ciple involv$40 ,no o!r =m ( manual treatm5t takes ?is pr9ciple ( me*anics into consid]ation4 ,x is possible1 z ,g]d9e po9ts out1 = an undevelop$ o/eopa? to practice massage "u ano!r "n4 ,t ! two %\ld be conf\nd$ be=e ! public is due to 8 ignorance & n f any fault ( ! sy/em4 ,massage is a valuable aid 9 ! treatm5t ( disease b x is n ,o/eopa?y4 8,9 ! bright lexicon ( o/eopa?y !re is no su* ^w z rub#g40 ,o/eopa?y 9 its relation ) m$ic9e has little 9 common4 ,f ! beg9n+1 its f\nd] realiz$ _! pa?s %\ld run div]g5tly1 s ! fir/ /ep1 its tea*+1 mu/ be consid]$ f a diff]5t viewpo9t4 ,to quote f an address by ,teall#h3 8,b to adequately tea* o/eopa?y a va/ am\nt ( orig9al "w mu/ be done4 ,anatomy is anatomy b !re is a va/ diff]5ce 9 its application4 ,physiology mu/ be taught to mean some?+ m ?an an int]e/+ ph5om5on4 ,pa?ology has an unfill$ gap betwe5 cause & effect :i* mu/ be bridg$4 ,! po/-mortem has a great /ory to tell b an o/eopa? mu/ tell x4 ,a slide ( deg5]at$ tissue "u ! microscope is ( int]e/1 b :y ! deg5]ation8 ,x is describ$ at l5g? by ! au?orities1 b ! reason = ! causes & morbific *anges are n c>ri$ out4 ,ob/etrics along /rictly natural & physiological l9es insur+ bo? "m & babe aga9/ injury2 gynecology1 m9us ! knife & plus common s5se2 all ^!1 & m mu/ be put into %ape to tea* ! o/eopa?ic /ud5t4 ,! ar*ives ( o/eopa?y 7 empty t5 ye>s ago4 ,!re 0 no prec$5t to foll[ & ! ideas 9 tea*+ :i* _h prevail$ = c5turies dom9at$4 ,all ?is is *ang$4 ,! colleges tea* ! sci5ce along /rictly o/eopa?ic l9es1 mak+ ! application ( ! tru?s :i* h escap$ ! notice ( c5turies ( inve/igation40 ,all s*ools recognize ! wond]ful recup]ative p[] ( nature1 z ?is f ! introduction ( a /&>d allopa?ic text book w %[#i3 8,!re is no sci5tific dogma bett] e/abli%$ ?an ?is3 t ! liv+ organism is 9 itself adequate to ! cure ( all its curable disord]s4 ,?is natural law su/a9s ! m$ical skeptic 9 8 infidelity1 enables ! homeopa? to report 8 sug> cures1 & helps all physicians out ( m close places ?an !y are g5]ally will+ to ackn[l$ge40 ,b at times1 z all w agree1 nature is n able to ov]come its maladies & assi/ance is ne$$4 ,"h1 aga91 is a div]g5ce z to ! me?od & "* ( t assi/ance4 ,!re is no sy/em s trivial or absurd :i* _c po9t to its cures1 b a s*ool ( m$ic9e %\ld h a settl$ sy/em ) e/abli%$ me?ods ( proc$ure4 ,?is is n true ( any s*ool employ+ drugs z its pr9cipal !rapy4 ,9 ! ,presid5t's annual address at ,clevel& he says#aj3 8,! obs]vant read] ( ! progressive m$ical press is /ruck at once by ! unsettl$ condition 9 ! field ( mod]n !rapeutics4 ,! tr5d is emphatically away f drugs4 ,b1 9 ! ef=t to get away f m$ic9e1 ! m$ical inve/igator has w&]$ f> afield1 cutt+ loose f nature & resort+ to ! artificial40 ,x is ! la/ p>agraph ( ! extract quot$ :i* p>ticul>ly emphasizes ! po9t ( div]g5ce1 natural v]sus unnatural me?ods4 ,x mu/ be und]/ood at once t ! o/eopa? admits ! reality ( drug action = 8!re is no d\bt t ! ph>macopeia records _m drugs ^: action is rapid & effective s f> z secur+ activity or decrease ( secretion is conc]n$1 b ! elem5t ( dang]1 i4 e41 _! de/ructive p[] is great4 ,(t5times _! p[] does n /op at ! po9t desir$ or limit its effect to ! !rapeutic action s\ght#aa40 ,?is po9t ( unreliability ( ! drug is emphasiz$ by ! foll[+ f recogniz$ m$ical au?ority#ab3 8,we give drugs = two purposes3 7#a7 ,to re/ore heal? directly by remov+ ! sum ( ! conditions :i* con/itute disease4 ,"h we act empirically ) no def9ite k--(t5 inde$ ) little idea ( ! action ( our drugs1 b on ! gr\nd t 9 our h&s or 9 ! h&s ( o!rs !y h re/or$ heal? 9 l cases4 7#b7 ,to influ5ce "o or m ( ! sev]al tissues & organs :i* are 9 an abnormal /ate s z to re/ore !m to or t[>d ! normal2 ) ! hope t if we succe$ 9 our purpose recov]y w take place4 ,! purpose we effect by means ( ! influ5ce :i* ! *emical prop]ties or drugs ex]t on ! /ructure & function ( ! sev]al tissues & organs4 ,m9ute in=mation1 !re=e1 ( ! nature ( drugs & _! action is ess5tial = _! prop] employm5t40 ,o/eopa?y br+s into action ! lat5t or /agnant =ces ( nature by specific me?ods :i* are usually reliable4 ,naturally !re be+ su* a wide diff]5ce 9 !ory ( ! cause ( disease x w\ld be also %[n 9 diagnosis z well z treatm5t4 ,! mo/ /rik+ po9ts to ! layman 9 m$ical proc$ure are3 fir/1 wide diff]5ce 9 ! sy/em ( diagnosis & 9 its f9d+s by physicians ( ! same s*ool2 second1 ! great v>iance 9 rem$ies employ$ by diff]5t physicians ( ! same s*ool = ! same disease4 ,o/eopa?ic diagnosis is s physical 9 its "*1 dep5d+ ^u actual conditions f\nd & n ^u ! subjective symptoms alone1 t ! same pati5t exam9$ by a numb] ( exp]i5c$ o/eopa?s w be giv5 ! same diagnosis1 & he w also be able to detect 9 ea* ! same ef=t to correct 9 all _! te*nique4 ,all ! me?ods ( physical diagnosis are us$ plus ! di/9ctive o/eopa?ic proc$ure4 ,results :]ev] us$ be> out ! effectiv5ess ( ! sy/em4 ,! o/eopa? mu/ & does consid] ! necessity ( surg]y1 b 8 ef=t is always to prev5t ! op]ation if possible4 ,!re c be no d\bt t surg]y is c>ri$ to extremes & !re is a /rong s5tim5t gr[+ t mu* ( x is unnecess>y4 ,says ,hom] ,wakefield1 ,m4 ,d4#ac3 8,x is to ! ev]la/+ disgrace & mortification ( ! m$ical man t ! weal?y classes :o are cont9ually "u ! obs]vation & direction ( em95t m51 9 diet>y1 & all life habits1 9 heal? z well z 9 sickness1 are n only ! v ones :o develop app5dicitis & mo/ l>gely g to op]ation1 b are almo/ exclusively ^? :o atta9 to ?is di/9ction40 ,! op]ations ( today are wond]ful & ! surgeon %[s great skill & g5ius 9 _! p]=mance1 b great z he is 9 ^! matt]s h[ inf9itely great] is ! man :o c prev5t !m4 ,! ne$ ( ! o/eopa? today is to be tra9$ to recognize surgical conditions & nei!r all[ surg]y unnecess>ily nor make ! m t]rible error ( n act+ soon en\gh4 ,:]e surg]y is a necessity !re is always an etiological factor to be consid]$4 ,! cause ( ! manife/ation n always be+ remov$ :at is to prev5t a recurr5ce or s]i\s sequela 9 spite ( ! op]ation8 8,! speciali/ 444 if he has wit en\gh to read ! lesson pres5t$ to him1 t x is n suffici5t to remove an ov>ian tumor1 e4 g41 & t if no?+ is said at ! same "t or subsequ5tly z to ! causes :i* induc$ x1 a positive damage may be done to ! woman1 :o may1 !re=e1 :ile consid]+ h]self cur$1 proce$ to manufacture "o on ! o!r side1 or may f9d h]self 9 a few ye>s suff]+ f canc] 9 ! /ump ( ! previ\s "o#ad40 ,& s ! comb9ation ( o/eopa?y ) surg]y may be necess>y t ! cause %all be remov$4 ,o/eopa?ic treatm5t be=e op]ations 9 r$uc+ conge/ions & inflammations1 also 9 ton+ ! n]v\s sy/em1 is p>ticul>ly efficaci\s :ile ! aft] treatm5t gives gratify+ results4 ,9 fact1 ! two g h& 9 h& :5 cons]vatism rules bo?4 ,t diet %\ld receive p>ticul> att5tion f ! o/eopa? is n /range1 = 8 v5]ation ( nature peculi>ly fits him to realize ! necessity ( correct fe$+4 ,probably no subject is m discuss$ or pres5ts a wid] range ( op9ion ?an diet4 ,!re is ov]fe$+ & und]fe$+2 long int]vals & %ort betwe5 fe$+s4 ,!re is ! no breakfa/ & no supp] plan1 mix$ diet & ! veget>ian1 uncook$ foods1 & "o exclusively ( milk1 any?+ y want s long z y are hungry b *ew x well1 etc41 ad4 lib4 ,all are repres5t$ by o/eopa?s 9 _! foll[+ z !y are f o!r pr(essions1 b probably ?is w\ld m ne>ly repres5t ! views ( !m z a s*ool4 ,9 heal?1 fir/1 mo/ p eat too mu* & d n ?or\ghly ma/icate & insalivate4 ,?is applies to all /ations ( society4 ,second1 meat =ms too l>ge an item 9 ! daily diet>y4 ,?ird1 !re is n en\gh v>iety & ! ration is n well balanc$ z to elem5ts4 ,f\r?1 n en\gh c>e is us$ 9 prep>ation ( foods4 ,9 illness1 fir/1 ! /opp+1 complete or p>tial1 ( food until ! sy/em c take c>e ( x2 second1 ! giv+ ( easily dige/$ foods4 ,! man :o avoids viol5t extremes 9 diet z well z 9 o!r habits ( life w usually la/ longe/4 ,x is to be hop$ t "s rational sy/em c be evolv$ on :i* all factions may agree1 = ! pres5t confusion ( au?orities is bewild]+4 ,! o/eopa? gives att5tion to hygi5e1 sanitation1 ex]cise1 environm5t1 m5tal attitude1 etc41 z !y may affect ! welf>e ( 8 pati5t4 ,o/eopa?y c cure all curable diseases1 = ! same =ces :i* w ov]come "o malady w ov]come ano!r :5 set 9 motion4 ,=ces t produce a diseas$ condition w x normaliz$ re/ore ! e/abli%$ type4 ,,footnotes3 #a ,littlejohn1 7,j4 ,m47--,j\rnal ( ! ,sci5ce ( ,o/eopa?y4 #b ,encyclop$ia ,am]icana4 #c ,boo?--,hi/ory ( ,o/eopa?y4 #d ,j\rnal ( ,o/eopa?y1 ,may1 #aije4 #e ,pr9ciples ( ,o/eopa?y1 p4 #aij4 #f ,j\rnal ( ! ,sci5ce ( ,o/eopa?y1 ,dec4 #ae1 #aijj4 #g ,o/eopa?ic ,cal5d>1 #aijj4 #h ,report$1 ,portl&1 7,me471 ,adv]tis]1 ,feb4 #bg1 #aije4 #i ,pott]'s ,mat]ia ,m$ica4 #aj ,teall--,j\rnal ( ! ,am]ican ,o/eopa?ic ,association1 ,aug41 #aijc4 #aa ,task]--,pr9ciples ( ,o/eopa?y1 p4 #aaj4 #ab ,allbutt's ,sy/em ( ,m$ic9e4 #ac ,cyclopdia ( ,practical ,m$ic9e1 ,june1 #aijf4 #ad ,rabagliati--,air1 ,food & ,ex]cise1 p4 #abi4 ,,o/eopa?ic ,,etiology ,,& ,,pa?ology ,o/eopa?ic ,etiology ,o/eopa?ic etiology & pa?ology con/itutes ! mo/ int]e/+ *apt] ( o/eopa?ic sci5ce4 ,! primal div]g5ce ( ! o/eopa?ic s*ools f previ\s sy/ems is to be f\nd 9 ! o/eopa?ic int]pretation ( disease causes & processes1 & n 9 o/eopa?ic !rapy z "s may ?9k4 ,o/eopa?y makes claim to an indep5d5t s*ool because x possesses a di/9ct etiology1 pa?ology1 diagnosis & treatm5t4 ,?us o/eopa?ic practice is n a m]e me?od1 b in/ead a sy/em1 a s*ool1 a sci5ce4 ,at no p]iod ( m$ical hi/ory h physicians ( ! old] s*ools felt m ke5ly ! futility ( m$ical me?ods & ! lack ( an all-embrac+ pr9ciple ( m$ic9e ?an at ! pres5t4 ,a rec5t writ]#ae :o claims to h discov]$ a pr9ciple t encompasses ! entire field ( m$ic9e1 says3 8,we f\nd1 we may say1 t ! backbone ( m$ic9e 0 ! abs5t factor1 & t if ! pati5t labors ( s _m great m9ds _h n prov5 z useful 9 ! developm5t ( practical m$ic9e z !y %\ld1 x 0 because !y lack$ su* a fundam5tal framework to af=d a fix$ nidus = ea* discov]y1 :]e9 its true relation to o!r discov]ies w\ld at once become evid5t40 ,s9ce ! conception ( o/eopa?y its fundam5tal framework has n *ang$ "o iota z to pr9ciple1 al?\gh ! application ( ! pr9ciple has be5 greatly elaborat$4 ,:5 ,dr4 ,/ill proclaim$ t 8! rule ( ! art]y is supreme0 he gave utt]ance to a basic physiological tru?4 ,b :5 he demon/rat$ t osse\s & o!r anatamo-me*anical lesions di/urb$ ! art]y & caus$ disease1 & t readju/m5t ( ! anatomical cur$ ! disord]1 ?us all[+ ! physiological to pot5tiate & reveal+ t ! liv+ body conta9s all ! attributes ( a vital & physical me*anism1 did 8 tea*+ conta9 ! g]m ( a compreh5sive philosophy2 ?is gave o/eopa?ic sci5ce a 8backbone0 ) a consequ5t fix$ nidus = all exi/+ facts & future discov]ies4 ,& ?us1 x %\ld always be emphasiz$ t me*anical readju/m5t ( ! compon5t p>ts ( ! vital body is ! et]nal keynote ( ! o/eopa?ic s*ool ( heal+4 ,! ,o/eopa?ic ,lesion4--,broadly speak+ a lesion is 8any morbid alt]ation 9 a tissue :e!r att5d$ by a recognizable /ructural *ange or n2 b especially a *ange 9 :i* ! cont9uity ( "s ( ! tissue elem5ts is brok5 9 ^u4#af0 ,!re are sev]al k9ds ( lesions express+ ! tissue involv$1 "* ( deg5]ation1 locality ( same1 etc4 ,b ^u analyz+ ! m$ley ( arbitr>ily def9$ lesions ! fact w be evid5t t mu* ( m$ical etiology & pa?ology has n be5 logically & consi/5tly sift$ & arrang$2 & moreov]1 x w be f\nd ! cause ( causes ( _m diseases is unkn[n4 ,h]e91 arises ! great significance ( ! o/eopa?ic lesion1 = ! lesion alt]s ! v gov]n+ & controll+ tissues ( ! body1 viz41 ! n]v\s tissue & ! vascul> *annels4 ,hulett#ag def9$ ! o/eopa?ic lesion z 8any /ructural p]v]sion :i* by pressure produces or ma9ta9s functional disord]40 ,! con/ant ma9t5ance ( ! /ructural p]v]sion w1 also1 cause organic disease1 al?\gh x is grant$ t functional disord] mu/ necess>ily result prior to any organic *ange4 ,! o/eopa?ic conception ( a lesion1 functional & organic disord] caus$ by pressure f di/urb$ /ructures1 does n br+ u into an absolute new field4 ,m$ical lit]ature ( all ages conta9s ref]5ces to diseases caus$ by pressure ( tissues on n]ves1 blood vessels1 or o!r *annels4 ,b ! o/eopa?ic idea is an absolutely new "o 9 ! application ( ?is pr9ciple univ]sally4 ,x simplifies & makes uni=m ! arbitr>9ess ( pres5t semeiology4 ,?us ! o/eopa?ic idea t _m diseases orig9ate1 prim>ily1 f anatomically malalign$1 malposition$1 or malrelat$ tissues caus+ a blockage ( vital processes1 imm$iate or remote1 is a !ory inclusive ( di/urbances to all tissues4 ,?is pr9ciple is fundam5tal & is support$ by ! physiological tru? t un9t]rupt$ vital *annels pres]ve heal?2 moreov] cl9ical & exp]im5tal data1 z w be %[n lat]1 sub/antiate ?is fundam5tal4 ,x at once places int]pretation ( a lesion 9 an entirely new light f preconceiv$ concepts1 & is analog\s to & co-ext5sive ) etiology & pa?ology4 ,etiological ,factors4--,! o/eopa? believes 9 ! pot5cy ( inh]it$ & environm5tal influ5ces4 ,!re c be no "q t a few diseases & c]ta9 disease t5d5cies may be inh]it$1 ! pr9ciple feature1 h[ev]1 f ! /&po9t ( h]$ity is1 v>i\s organs & tissues h less vital resi/ance4 ,^! %\ld n be conf\nd$ ) cong5ital weaknesses & dia!tic t5d5cies4 ,environm5tal influ5ces are v important factors4 ,"o's surr\nd+s & daily habits 9 ! home1 %op1 or (fice c\nt = mu* 9 ! aggregate4 ,food1 dr9k1 air1 re/1 sleep1 clo?+1 ex]cise1 m5tal attitude1 etc41 are all factors 9 ! sum total ( heal?1 & consequ5tly ill heal? may be traceable to _! abuse4 ,9 fact1 all hygi5ic & sanit>y measures are duly consid]$ by ! o/eopa?4 ,v>i\s abuses1 ov] use1 & disuse ( ! functions w c]ta9ly be foll[$ by physiological discord4 ,! g]m !ory conta9s mu* tru?1 b 9 ! v l>ge p]c5tage ( cases :]e ! micro-organism is a factor its significance is only ( second>y consid]ation4 ,immunity & resi/ance comprise an important "p ( ! heal? problem1 ( :i* ! intact anatomical is ( fir/ consid]ation4 ,usually ! micro-organism plays ! role ( an excit+ & det]m9+ factor2 be=e x c multiply & gr[ !re mu/ be a field t is fir/ nutritionally di/urb$4 ,nutrition ( ! tissue is ! "o great po9t always to be consid]$4 ,! con/itution ( an individual is ! pivot ab\t :i* pr$ispos+1 environm5tal1 & excit+ factors ( disease c5t]4 ,heal? repres5ts ! integrity ( ! art]y z well z a ma9t5ance ( t ma/] tissue1 ! n]v\s sy/em1 & any?+ t produces or influ5ces1 directly or indirectly1 a di/urbance ( physiological function+ bord]s on ! pa?ological4 ,h5ce ! o/eopa? recognizes _m ( ! common m$ical causes ( disease1 b res]ves ! privilege ( re>rang+ _! relative positions1 = ! o/eopa?ic cause ( disease greatly modifies _! value4 ,o/eopa?ic ,etiology di/9ctively emphasizes /ructural d]angem5ts & p]v]sions4 ,( fir/ importance1 ow+ to /atic requirem5ts1 is ! osse\s lesion4 ,?is lesion is repres5t$ by any abnormal *ange ( position or relation ( ! _m bony con/itu5ts ( ! body4 ,! framework ( ! body is subject to n only any & e physical viol5ce ( any me*anism1 b moreov] be+ ! corporeal f\ndation ( a vital me*anism is subject to bo? direct & indirect bio*emic *anges & influ5ces4 ,?us ! osse\s lesion is caus$ 7a7 by traumatism1 e4 g41 /ra9s1 falls1 bl[s1 etc42 7b7 indirectly by atmosph]ic *anges1 ov] & viol5t ex]cise1 ! slump$ po/ure1 debilitat+ habits1 etc41 ?r\gh ! m$ia ( muscle *anges & imbalance2 7c7 by nutritional effects di/urb+ ! elem5ts ( bony tissue2 7d7 by ligam5t\s *ange su* z ?ick5+ ( a capsul> ligam5t2 7e7 by infections2 7f7 comp5satorily & reflexly ?r\gh ! m$ia ( body di/ortions & muscul> irritability or debility1 e4 g41 an innom9ate lesion may be comp5satory to a lumb> curvature1 dietetic errors may cause dorsal muscul> irritation & contraction produce a con/ant osse\s lesion :i* 9 turn may result 9 *ronic indige/ion4 ,! pa?ological *anges 9 ! osse\s lesion are commonly "o ( /ructural d]angem5t1 deviation or complete displacem5t4 ,! v]tebral segm5ts are ( prim>y consid]ation ow+ to _! important relations to ! sp9al n]ves1 sp9al cord c5t]s & sympa!tics2 ! ribs ow+ to ! close sympa!tic & sp9al n]v\s relations2 & !n o!r osse\s tissues1 z ! innom9ata1 clavicles1 etc41 dep5d+ ^u _! importance to contigu\s vessels1 n]ves & organs4 ,x %\ld always be rememb]$ & emphasiz$ t me*anical *anges ( ! anatomical /ructures is ! prim>y ess5tial 9 o/eopa?ic etiology2 ?is is ! "o great inception ( pa?ological v>iations f ! di/9ctively o/eopa?ic conception1 :i* ! osse\s lesion typifies4 ,consequ5tly ! osse\s lesion factor is actually a luxation 7complete1 or p>tial1 ev5 to a v slight degree71 or malalignm5t ( ! bony con/itu5ts1 :i* by virtue ( _! physical malposition imp+e or irritate contigu\s tissues4 ,! ess5tial te/ is ! functional "o1 movem5t4 ,! degree ( involvem5t may be "o ( _m gradations rang+ f a slight malposition or impaction to a m>k$ deviation or firm an*orage4 ,second 9 importance f ! /atic requirem5t ( support is ! muscul> lesion ?\gh f ! /&po9ts ( movem5t & dynamics x is (t5 ( ! fir/ consid]ation etiologically4 ,_m int]osse\s lesions are ! result ( spa/ic involvem5t ( deep seat$ sp9al muscles1 ( fibrotic *anges & ( t5sions & weaknesses t ei!r e/abli% a rigidness ( ! segm5ts1 compromis+ n]v\s /imulus or vascul> *annel1 or produce an imbalance ( muscul> tone & t5sion4 ,9 ! latt] in/ance "s type ( sideb5d+-rotation osse\s lesion occurs1 commonly an*or$ )9 ! physiologic movem5ts ( ! sp9e4 ,! muscul> lesion may be an actual dislocation ( ei!r muscle or t5don1 b r>ely4 ,commonly x is a contract$1 or t5s$1 or contractur$ muscle4 ,! muscle1 also1 may be diseas$ ei!r f prim>y or second>y causes ?r\gh nutritional & infecti\s s\rces & ?us be an etiological feature4 ,! muscul> lesion is caus$1 7a7 by direct or indirect viol5ce ! same z ! osse\s lesion2 7b7 by atmosph]ic influ5ces2 7c7 by slump$ po/ure1 debilitat+ habits & v>i\s errors ( liv+2 7d7 infections2 7e7 by reflex irritations2 7f7 by comp5satory *anges2 7g7 by disease caus+ hyp]trophy or atrophy2 &1 7h7 second>y to osse\s lesions1 be+ ! result ( imp+em5t to ! muscles' n]v\s control4 ,! t5s$ or /ret*$ muscle may result f a sep>ation ( ! po9ts ( orig9 & ins]tion4 ,h]e9 ! fundam5tal o/eopa?ic concept is ! result+ affection due to ! physical encroa*m5t1 directly or indirectly1 ( ! muscle tissue ^u vascul> *annel or n]ve fibre1 or ! effect ^u ! movem5t or alignm5t ( ! osse\s tissue4 ,muscul> contractions1 displacem5ts1 & t5sions play a mo/ important "p 9 acute disord]s1 al?\gh muscul> lesions t are second>y to o!r lesions are usually tak5 into acc\nt :5 treatm5t is giv54 ,muscul> lesions affect1 7a7 blood & lymph vessels2 7b7 n]ve fibres4 ,muscul> contractions1 especially1 imp$e me*anically ! return ( ! v5\s blood to ! he>t4 ,! lesions to ! n]ves may be manife/$ 9 innum]able ways1 dep5d+ ^u ! location ( ! muscle & ! function & di/ribution ( ! n]ve affect$4 ,!n !re is ! relax$1 ov]/ret*$1 & atoni$ muscle4 ,?is condition results z a second>y effect to me*anical /ra9s1 ^! be+ s sev]e & con/ant z to cause direct /ret*+ & possibly te>+ ( ! muscle fibres4 ,?is %\ld be di/+ui%$ f ! exhau/$ or debilitat$ muscle1 e4 g41 z f\nd 9 neura/h5ia & anemia4 ,diagno/ically !re are1 7a7 contractions ( m or less area1 due to atmosph]ical *anges2 7b7 ! deeply seat$ contractions involv+ a v small area1 caus$ by v]tebral & rib lesions2 7c7 contractions due to reflex di/urbances2 7d7 contractions caus$ by po/ural effects & de=mities2 7e7 contractions f spasms ( ! blood vessels z a result ( n]v\s irritations2 7f7 contractions due to toxicity ( ! blood4 ,all ( ^! *>act]i/ic muscul> lesions give a direct h9t z to bo? etiology & prognosis4 ,?ird1 ! ligam5t\s lesion1 z a lesion p] se1 is usually ( second>y importance to ! osse\s lesion4 ,9 *ronic cases affections ( ! capsul> ligam5t & muscul> fibrosis commonly ma9ta9 malalignm5t or rigidness4 ,!re are two features t %\ld be not$ 9 p>ticul> :5 consid]+ ?is lesion2 fir/1 ?ick5+s & adhesions2 &1 second1 relaxations4 ,! tone & integrity ( ! ligam5ts _c b be ( vital conc]n to ! /ability1 suppl5ess1 & adaptability ( ! bony framework 9 all physical movem5ts4 ,no matt] h[ slight ! osse\s lesion may be ! ligam5t mu/ ( necessity be involv$4 ,! osse\s d]angem5ts are ei!r a s\rce ( irritation to ! ligam5t\s tissue1 result+ 9 conge/ion & inflammation & h5ce ?ick5+ & adhesions1 or else ! ligam5ts are s /ra9$ & t5s$ t 9 "t atony may occur4 ,probably1 9 a fair p]c5tage ( atoni$ cases ! fir/ di/urbance to ! ligam5t is "o ( irritation & conge/ion1 & f long cont9u$ involvem5t irritation is supplant$ by debility4 ,consequ5tly ! prim>y consid]ation ( ! ligam5t\s lesion f ! etiological /&po9t is ! "* ( ! tissue 7ligam5t7 *anges4 ,?is1 also1 gives u a direct h9t t is ( ! utmo/ value 9 prognosis4 ,! indep5d5t displacem5t ( a ligam5t is r>e1 ?us ligam5t\s lesions f ! viewpo9t ( purely physical displacem5ts are second>y to if n an actual "p ( ! osse\s lesion4 ,ligam5ts1 :5 displac$ or t5s$1 readily imp+e or irritate contigu\s tissues1 b ! orig9al cause ( ! /ructural p]v]sion is commonly ei!r ! osse\s or muscul> lesion4 ,h5ce1 :atev] factors ent] into ! production ( ^! lesions w at lea/ indirectly produce ! ligam5t\s lesion4 ,f\r?1 ! visc]al lesion is frequ5tly ov]look$ z be+ ( mu* mom5t z an o/eopa?ic lesion4 ,visc]al displacem5ts act+ z a s\rce ( functional & organic annoyance on ! physical plane 7/ructural p]v]sion :i* produces & ma9ta9s pressure7 alone are n 9 ! lea/ uncommon4 ,any or all ( ! abdom9al visc]a1 or ev5 ! organs ( ! ?orax1 may be displac$ 7physically7 pa?ologically4 ,actual displacem5t ( ! viscus is a prolific s\rce ( di/9ct disord]s & _m obscure symptoms4 ,true x is ! organs are mo/ frequ5tly displac$ f indirect causes1 b nev]!less ! actual physical malposition is 9 turn a prim>y cause ( /ill ano!r tra9 ( symptoms & diseases4 ,visc]al lesions are caus$ by1 7a7 v]tebral lesions2 7b7 po/ural defects2 7c7 direct viol5ce2 7d7 nutritional disord]s2 7e7 *ildbir?2 7f7 unhygi5ic measures 7tight lac+1 heavy skirts1 etc472 7g7 cong5ital weakness4 ,f ! displac$ he>t due to valvul> & debilitat+ influ5ces to ! displac$ liv]1 ! /oma*1 ! kidneys1 ! inte/9es1 ! ov>ies1 & ! ut]us1 may arise a s\rce ( direct or indirect irritations1 a tra9 ( app>5t or mask$ symptoms1 or a gr\p ( nutritional di/urbances t include an extremely important *apt] 9 etiology4 ,moreov] n only may "o organ alone be involv$ b sev]al may be displac$ or prolaps$ z a :ole z 9 splan*noptosis2 & ev5 ^! 9 turn may be ! direct cause ( fur!r organic displacem5ts z ! abdom9al visc]a prolaps+ ^u ! pelvic organs4 ,"h is a v fruitful field = ! diagno/ician1 = to sep>ate cause f effect requires ke5 p]ception1 an acute s5se ( t\*1 & above all1 mo/ c>eful weigh+ ( all ! factors t ent] into ! maze4 ,fif?1 ! composite lesion is n always recogniz$ z an extremely important o/eopa?ic factor4 ,by composite lesion is meant a /ructural lesion t prim>ily includes ! osse\s1 muscul>1 & ligam5t\s tissues z a :ole4 ,?is may be t]m$ a lesion en bloc or en masse4 ,composite lesions are ( exce$+ly frequ5t occurr5ce4 ,inde$1 _m composite lesions are ov]look$ & in/ead ( treat+ ! en bloc di/urbance z a consi/5t :ole ! compon5t factors are treat$ sep>ately ) no conc]n or att5tion to ! :ole4 ,po/ural defects are excell5t types ( ! composite lesion4 ,! v>i\s curvatures1 ! tilt$ pelvis1 etc41 are repres5tative ( ! composite lesion4 ,etiologically1 pa?ologically1 diagno/ically1 & !rapeutically ! cont\r ( ! sp9e & ribs1 ! relation ( ! innom9ata to ! sacrum & sp9e1 & ! symmetry ( ! body g5]ally %\ld be recogniz$ & appreciat$4 ,! relation ( ! "p to ! :ole & ( ! :ole to ! "p are ( vital etiological conc]n4 ,an incipi5t curvature may be easily ov]look$1 a p5dul\s abdom5 neglect$1 & a slipp$ innom9atum pass$ unnotic$ :]e9 z a result ! entire v]tebral column is malalign$ 9 relation to ! physiological curves or to ! p]p5dicul> l9e ( gravity4 ,frequ5tly attempts are made to correct individual lesions :5 att5tion %\ld be direct$ to ! composite lesion & vice v]sa1 e4 g41 a displac$ rib is usually dep5d5t ^u a correspond+ v]tebral lesion1 & ?us ! transv]se plane or section ( ! body %\ld be consid]$ z a :ole4 ,a s+le lesion may be dep5d5t ^u a composite lesion or a composite lesion dep5d5t ^u "o or m s+le lesions4 ,a slipp$ innom9atum or a disord]$ hip jo9t may br+ ab\t a /ra9 to a great] or less section ( ! sp9al column1 or a twi/$ v]tebra may cause a curvature1 :]eas on ! o!r h& po/ural defects may cause a /ra9 at its maximum focal po9t result+ 9 ov]-/ret*+ & relax+ ( ligam5ts s t an osse\s lesion results1 or a sp9al curvature cause an innom9atum displacem5t4 ,?us !re is a con/ant e/abli%+ ( equilibrium1 physically & physiologically1 ?r\gh ! m$ium ( comp5sation1 b at "s phase ( ! *ange !re are apt to be pa?ological ph5om5a result+1 & v frequ5tly physiological h>mony is n ree/abli%$ b in/ead irritation1 debility & o!r disease symptoms are con/ant effects until reliev$4 ,consequ5tly o/eopa?ic etiology is _m sid$ & complicat$4 ,to "k :e!r an osse\s1 ligam5t\s1 muscul>1 visc]al1 or composite lesion is prim>y or second>y1 comp5satory1 reflex1 pr$ispos+1 or excit+1 requires a comm& ( !oretical k back$ by mu* actual cl9ical exp]i5ce4 ,9 not+ ! above di/9ctive o/eopa?ic etiologic features ! /ud5t %\ld n lose sight ( ! con/itutional /atus ( ! pati5t :i* may be modifi$ by inh]it$1 cong5ital1 dia!tic1 & environm5tal influ5ces1 all ( :i* g to make up ! pr$isposition ( ! individual & h an important relation to o/eopa?ic factors4 ,!n x %\ld be recall$ t disease processes may be ( insidi\s progress1 & ! products & effects ( pa?ologic *anges accumulative4 ,o/eopa?ic ,pa?ology ,9 ! etiologic /udy ! o/eopa?ic *>act]i/ics h be5 designat$ /ructural maladju/m5t1 al?\gh at ! same "t n los+ sight ( ! angle t ! body is n only a physical me*anism b also a vital organism4 ,/ructural p]v]sions *>act]ize ! o/eopa?ic di/9ction :5 deal+ ) ! physical body1 & rememb]+ ! vital or bio*emic me*anism1 m5tal attitude1 diet1 hygi5e1 etc41 are n =gott54 ,to reta9 or atta9 heal?1 ?or\gh appreciation ( bo? ! physical & vital me*anisms %\ld be kept 9 view1 = !re is bo? an indep5d5t & dep5d5t int]action on ! "p ( ea*4 ,! liv+ body be+ an entity premises a sy/em ( !rapeutics bo? physical & vital1 t acts 9 direct accord & h>mony ) physical laws & physiological function+4 ,o/eopa?ic pa?ology deals ) ! di/9ctive o/eopa?ic lesion z a factor 9 production & ma9t5ance ( disease4 ,!n ! prov9ce ( pa?ology is1 fir/1 to det]m9e :e!r ! lesion is 9 reality an etiologic factor2 second1 ! imm$iate "* ( ! lesion di/urbance2 &1 ?ird1 h[ organic life becomes involv$4 ,inspection1 palpation1 cl9ical results1 dissection & laboratory exp]im5tation include ! me?ods employ$ to prove t ! lesion is ( practical consequ5ce4 ,t ! lesion is an etiological factor c be kn[n only ?r\gh cl9ical & exp]im5tal pro(2 ! imm$iate "* ( ! lesion di/urbance c be det]m9$ by dissection2 & h[ organic life becomes involv$ requires ! summation ( hi/ological1 physiological & pa?ological data4 ,! foll[+ outl9e assumes t ! read] is famili> ) anatomy1 physiology & pa?ology4 ,o/eopa?ic pa?ology does n add to m$ical pa?ology an absolutely new pa?ology 9 all ( ! pres5t kn[n num]\s details1 b in/ead int]prets mu* ( cl9ical pa?ology anew1 & fur!rmore x pres5ts absolutely new data t is exclusive1 b g]mane to ! pres5t g5]al m$ical & surgical fields4 ,n]v\s tissue & art]ial blood are ! ma/] tissues1 ! controll+ & gov]n+ factors 9 heal?1 & di/urbances ( ^! tissues are necess>ily ! cause ( ill heal?4 ,! rule ( ! art]y & ! control ( ! n]ve mu/ cont9ue un9t]rupt$ly 9 ord] t physiological function+ rema9s intact4 ,! body %\ld be look$ ^u z a be+ complete1 no m or less1 ea* tissue & organ ess5tial to ! :ole & ! organism z a :ole ess5tial to e "p4 ,?is is fundam5tal & g]mane to a liv+ /ructure1 & h5ce di/urbance to ! gov]n+ & controll+ tissues1 ! n]ves & vascul> *annels1 mu/ necess>ily cause a break 9 ! concat5ation & disease mu/ logically foll[4 ,?us 9 ! o/eopa?ic pa?ology we look to ^? influ5ces t prim>ily di/urb ! n]ve or art]y1 /udy ! disease process or ext5sion f inception to effect & f prim>y lesion to morbid results1 & note action & int]action ( tissue ^u organ & organ ^u organ4 ,t all p>ts ( ! body are 9 intimate & dep5d5t relations ea* ) ! o!r ?r\gh ! m$ia ( ! n]v\s & endocr9e sy/ems is a well kn[n fact bas$ ^u hi/ological & physiological gr\nds4 ,! neurone be+ ! physiological unit implies t any di/urbance to ! cell quickly di/urbs any or all ( its processes4 ,x may be said t 8n]v\s tissue is dep5d5t = its integrity ^u two ?+s1 blood supply & trophic influ5ces4 ,! n]ve cell is solely dep5d5t on a prop] supply ( blood1 & dies :5 ?is is )drawn4 ,b ! n]ve fib] is m dep5d5t on ! trophic influ5ce ( ! cell ( :i* x is a prolongation4 ,x dies :5 cut (f f ! cell b x c get along = a "t ) b little direct blood supply4 ,on ! o!r h&1 if ! n]ve fib] is injur$ x reacts on ! cell1 lead+ to a p>tial b curable deg5]ation ( ! cell body40#ah ,"h is ! imm$iate pa?ologic key to _m diseases4 ,:atev] cuts (f or ob/ructs ! art]y lead+ to ! cell is a prim>y etiologic factor2 ?is !n leads to deg5]ation ( protoplasmic processes & axone4 ,x %\ld be c>efully not$ t if ! ob/ruct$ blood vessel is "o to ! n]ve fib] only ! resultant p>tial injury to ! cell is curable4 8,:5 an axone deg5]ates ! retrogressive process involves n only ! ma9 axone1 b also its t]m9als1 toge!r ) ! collat]als belong+ to x ) _! t]m9als40#ai ,?is is an exce$+ly important l9k 9 ! explanation ( o/eopa?ic pa?ology1 t di/ant organs may be affect$ by ! o/eopa?ic lesion4 ,moreov]1 8deg5]ations ( a second>y "* may occur 9 ^? sy/ems ( neurones :i* are m or less dep5d5t ^u ! p]iph]al s5sory neurone sy/em = _! impulses40#bj ,?is is equally true ) ! c5tral motor neurone1 or any neurone4 ,x %[s h[ f>-rea*+ a deg5]ative process & its effects may be4 ,x fur!r makes cle> t n]ve intactness is directly & absolutely dep5d5t ^u a normal circulation1 & t x is self-evid5t any blockage ei!r to blood vessels or to neurones w vitally affect ^? tissues t gov]n & control ! life processes ( ! body4 ,! integrative action ( ! n]v\s sy/em is "o ( ! out/&+ facts ( physiology4 ,! above is pres5t$ s ! /ud5t may see h[ o/eopa?ic sp9al lesions1 if deeply seat$ & effective en\gh1 c involve remote tissues & organs4 ,no "o w d\bt t fractures & complete dislocations ( ! sp9al column w s]i\sly affect visc]al life1 or a prolaps$ kidney w be a cause ( nutritive di/urbance1 or a displac$ ut]us ! cause ( ov>ian conge/ion1 or a dislocat$ hip ! cause ( atrophy ( ! leg muscles1 b x has rema9$ = ! o/eopa? to (f] pro( t slight misplacem5ts ( ! v]tebr or ribs1 incipi5t curvatures1 po/ural defects1 slight de=mities1 & unsymmetrical bodies are ( suffici5t etiological importance on ! physical plane to affect neurone integrity & ob/ruct art]y c\rses1 & ?us organic life4 ,! "q at once arises1 :at is ! imm$iate or direct effect ^u blood vessel or n]ve ( ! osse\s1 ligam5t\s1 muscul>1 visc]al or composite lesion8 ,! osse\s lesion w be tak5 z a type4 ,! direct effect is usually "o ( hyp]emia or is*emia1 g5]ally ! =m]1 = z physiologi/s & cl9icians obs]ve irritation commonly prec$es debility4 ,9 ! v]tebral & rib lesions !re may be direct pressure ^u ! sp9al n]ve at its sp9al =am5 exit or on ! sympa!tic *a9 directly contigu\s to ! heads ( ! ribs4 ,?is causes conge/ion1 inflammation1 ec*ymosis1 & deg5]ation ( ! n]ve fib]1 foll[$ by macroscopic & microscopic *anges z connective tissue prolif]ations1 art]ial scl]oses1 etc4 ,or1 z seems probable 9 exp]im5tal "w1 ! inception ( ! pa?ology may be frequ5tly ! result ( blockage to n]v\s /imuli1 :i* :5 ma9ta9$ affects ! eff]5t vasomotor1 secretory1 trophic & o!r fib]s s t circulation & nutrition are def9itely involv$4 ,?us ! cells s s5sitive to alt]$ vascul> *anges are directly & remotely affect$1 & disease *>act]i/ics dep5d5t ^u /ructure & function ( tissue1 & degree ( irritant are evid5t4 ,?is c v>y1 9 degree only1 ) ! muscul> lesion t involves collat]al sp9al cord circulation1 ! visc]al lesion t irritates sympa!tic life1 or ! composite lesion t de=ms or p]v]ts /ructure en masse4 ,b is ! physical noxa z pot5t an etiologic factor z ! *emical or bact]iologic8 ,adami#ba in=ms u :e!r an irritant is physical1 bact]ial or *emical1 no satisfactory di/9ction c be f\nd$ on ! duration ( ! irritation2 t a local irritation ( ! n]v\s sy/em may lead ap>t f 8direct reflex action1 to *anges ( n]v\s orig91 9 ! region ( ! injury & 9 ! reflexes affect+ associat$ regions1 ! high] c5t]s2 & ?r\gh !m ! sy/em at l>ge1 may become affect$ by pa?s t x is n always easy to trace40 ,aga9 he says t 8c5trifugal impulses alone1 ap>t f any local injury1 may orig9ate a succession ( ph5om5a ( inflammation 9 a "p40 ,& 89 all probability a n]v\s & c5tral orig9 mu/ be ascrib$ to "s1 at lea/1 ( ! sympa!tic inflammations se5 to occur 9 areas suppli$ by ! o!r bran*es ( a n]ve supply+ a "p prim>ily inflam$2 & aga9 9 areas suppli$ f ! same region ( ! bra9 or cord z ! inflam$ organ40 ,o!r inflammatory *anges1 ( c\rse1 may occur indep5d5tly ( c5trifugal n]v\s influ5ces1 & ! vessels react indep5d5tly ( c5tral influ5ces4 ,?is1 !n1 pres5ts a situation po/ulat$ ?us3 #a4 ,! body foll[s def9ite /ructural relations & is influ5c$ by me*anical arrangem5ts 9 its morphology4 #b4 ,! integrity ( tissue dep5ds ^u /ructural fre$om ( nutritive c\rses4 #c4 ,! above pr$icates a /ructural etiology z exact & precise z /ructural relations are important to nutrition4 ,:at pro(1 !n1 ( ! =ego+ h we to (f]8 ,fir/1 ! cl9ical pro(4 ,cl9ical results h be5 obta9$ 9 t5s ( ?\s&s ( cases t include disease ( v>i\s types & lesions1 & ( all sections & organs ( ! body4 ,! art ( o/eopa?y has be5 p]fect$ 9 _m ( its details1 bas$ ^u actual exp]i5ce & spl5did results4 ,! cure ( ! pati5t is p>am\nt to all o!r consid]ation1 & :]eas ! o/eopa?ic s*ool has be5 %[n a sup]ior sy/em x logically foll[s on a priori gr\nds t relief & cure ( suff]+ is ( ! fir/ & f9al importance4#bb ,7 x n = cl9ical results no new sy/em ( !rapeutics c\ld )/& criticism & calumny & f9ally triumph & be publicly1 legislatively1 & sci5tifically recogniz$4 ,second1 ! autopsy pro(4 ,_m dissections h be5 made & autopsies held ) ! view ( discov]+ ! "* & ! pot5cy ( ! o/eopa?ic lesion4 ,?is v important "w has borne out ! o/eopa?ic !ory ( disease4 ,v]tebral & rib displacem5ts h be5 not$1 correspond+ ligam5t\s tissues ?ick5$1 associat$ n]ve tracts & vascul> *annels di/urb$1 & f9ally ! relat$ organ f\nd diseas$4#bc ,?ird1 ! exp]im5tal pro(4 ,exp]im5tal pro( appeals1 logically1 to ! sci5tific m9d4 ,?is pro(#bd is be+ gradually develop$4 ,exp]im5tal inve/igation has be5 successfully c>ri$ out ^u num]\s animals4 ,! exp]im5ts conclusively prove t n only sp9al inhibitory & /imulatory manipulations 7me*anical7 are productive ( imm$iate physiological *anges 9 ! visc]a1 b t ! /ructural anatomical lesion or noxa is an important factor 9 ! etiologic field4 ,pa?ological *anges 9 sev]al organs directly foll[ ! artificially produc$ v]tebral & rib lesions1 %[+ beyond d\bt ! reality & effectiv5ess ( ! o/eopa?ic lesion4 ,?is emphasizes ! po9t t c5trifugal impulses orig9ate an inflammation 9 a previ\sly heal?y & un9jur$ tissue or viscus4 ,& z 8inflammatory ph5om5a may be sympa!tically develop$ 9 regions inn]vat$ f ! same area 9 ! bra9 or sp9al cord0 x rema9s to prove ! actuality ( v]tebral & rib lesions1 i4 e41 /ructural p]v]sions really affect contigu\s n]ve c\rses & vascul> *annels2 & ?is has be5 demon/rat$ 9 laboratory exp]im5ts & at ! autopsy4 ,consequ5tly ! v]tebral1 rib1 or o!r lesion may be an important etiologic factor ei!r to ! n]ve /r& f cord or bra9 to viscus or f viscus to cord or bra94 ,dr4 ,/ill says 9 8 ,autobiography t 8all n]ves dep5d :olly on ! art]ial sy/em = _! qualities1 su* z s5sation1 nutrition & motion1 ev5 ?\gh by ! law ( reciprocity !y furni% =ce1 nutrition & s5sation to ! art]y itself40 ,x matt]s little 9 ?is outl9e :e!r ob/ruction to n]v\s integrity is by way ( an imp+$ art]y or by direct pressure1 or bo?1 or o!rwise1 = ! prim>y consid]ation is ! not+ t ! o/eopa?ic lesion is a real & pot5t factor ( disease4 ,saj\s#be in=ms u t 8a neurone is directly connect$ ) ! circulation 7via neuroglia-fibril7 by "o or m ( its d5drites1 :i* s]ve z *annels = blood plasma10 t a neurone receives its nutrition directly f ! g5]al circulation1 & t f ! axone ! blood passes into a lymph space connect$ ) a ve94 ,?us 9 reality a "p ( ! circulatory sy/em is t ( ! entire c]ebrosp9al sy/em4 ,! /ud5t is ref]r$ to ! v>i\s publications ( ! ,rese>* ,in/itute & ,deason's ,physiology = exp]im5tal data confirm+ ! validity ( ! o/eopa?ic !ory1 al?\gh x %\ld be emphasiz$ t cl9ical evid5ce is q conclusive4 ,malalignm5t injuries ( ! v]tebral articulations1 = example1 rang+ f imbalance ( muscul> t5sion to infections1 is c]ta9 to result 9 "s type ( rotation & sideb5d+ ( ! segm5ts to an ext5t t apposition is compromis$ & abnormal an*orage sup]v5es4 ,!re are _m factors ( ! pa?ology3 muscul> t5sion & fibrosis2 damag$ ligam5ts1 p>ticul>ly ! capsul>2 int]f]5ce ( n]v\s /imuli1 blockage ( impulse directly & reflexly z %[n by pa?ologic involvem5t 9 cord c5t]s & sympa!tic ganglia1 & 9 c]ta9 cases direct ob/ruction ( n]ve fib]s z reveal$ by ,wall]ian deg5]ation2 involvem5t ( circulation z %[n by damage to blood-vessels1 local edema & local acidosis1 & effect ^u local tissue respiration & dra9age4 ,?r\gh a comb9ation ( ^! v>i\s factors circulation1 n]v\s equilibrium & *emism ( relat$ p>ts are involv$1 bo? anatomical & physiologic balance is upset1 & resi/ance ( correspond+ visc]a affect$4 ,reciprocal inn]vation & ! axone reflex are also di/urb$1 all ( :i* are important pr$ispos+ causes t di/urb resi/ance ( tissues & organs1 upset _! correlat$ me*anisms & r5d] active v>i\s possible infections & tox9s t o!rwise a normal circulation1 n]v\s & endocr9e sy/ems1 & oxyg5 supply w\ld rapidly & successfully combat & re/ore ! organism to normal4 ,?us f ! practition]'s /&po9t !re are ?ree po9ts to always keep 9 m9d3 readju/m5t ( ! lesion2 correction ( ! =ces1 habits1 environm5t1 etc4 t produce ! lesion2 & hygi5ic att5tion ( ! body aft] lesion adju/m5t 9 ord] t normal condition may be ma9ta9$4 ,a ?or\gh /udy ( ! physiologic movem5ts ( ! sp9e is a pr]equisite to an und]/&+ ( ! v>i\s possible abnormal appositions1 ?\gh x %\ld be appreciat$ t ^! movem5ts are n consonant or applicable to _m abnormal conditions4 ,pa?ology reveals _m gradations & comb9ations n f\nd 9 normal conditions4 ,frequ5tly ! key ( a successful te*nique re/s ^u an und]/&+ ( ! individual make up ( ! int]osse\s lesion4 ,x has n be5 ! purpose ( ?is section to g into details b r to foll[ logically an outl9e ( o/eopa?ic etiology & pa?ology4 ,! v>i\s details w be f\nd 9 ! o/eopa?ic works on ,pr9ciples z well z 9 ! exp]im5tal articles ref]r$ to4 ,x %\ld be und]/ood t ! o/eopa? believes ?or\ghly 9 vis m$icatrix naturae :e!r ! indications are = /imulation or inhibition or = ! basic readju/m5t4 ,g5]ally speak+1 h[ev]1 !rapeutic philosophy resolves itself 7ultimately7 into ! pr9ciple t a cure dep5ds ^u giv+ an impetus to impair$1 habitual & lat5t =ces1 :i* 9 ! o/eopa?ic field implies fundam5tally adju/ive manipulation :]eby ! resultant impetus or physiological /imulus is initiat$4 ,9 a ^w1 o/eopa?y premises t ! body is a vital & physical me*anism subject to d]angem5ts1 /ructural alt]ations1 & functional *anges1 z results ( viol5ce on ! me*anical plane1 z well z di/urbances on ! psy*ic & bio*emic planes4 ,h5ce1 o/eopa?ic philosophy is inclusive ( prev5tive1 palliative & curative measure4 ,,footnotes3 #ae ,saj\s--,! ,int]nal ,secretions & ! ,pr9ciples ( ,m$ic9e4 #af ,fo/]--,m$ical ,diction>y4 #ag ,hulett--,pr9ciples ( ,o/eopa?y4 #ah ,dana--,text ,book ( ,n]v\s ,diseases4 #ai ,b>k]--,ref]5ce ,h& ,book ( ! ,m$ical ,sci5ces4 #bj ,delafield ,prudd5--,h& ,book ( ,pa?ological ,anatomy & ,hi/ology4 #ba ,adami--,inflammation1 ,allbutt's ,sy/em ( ,m$ic9e4 #bb ,see ,case ,reports1 ,am]ican ,o/eopa?ic ,association4 #bc ,cl>k--,appli$ ,anatomy4 #bd ,mc,connell--,num]\s articles ,j\rnal ,a4 ,o4 ,a4 #aije-ai1 ,bullet9s ,rese>* ,in/itute2 ,deason1 ,bullet9s ,rese>* ,in/itute1 ,deason's ,physiology2 ,burns' ,o/eop4 ,_w1 ,aug4 #aije2 ,basic ,sci5ces1 ,bullet9s ,rese>* ,in/itute2 ,pe>ce1 ,o/eopa?ic ,physician1 ,nov4 #aije4 #be ,saj\s--,int]nal ,secretions & ! ,pr9ciples ( ,m$ic9e4 ,,o/eopa?ic ,,diagnosis ,,& ,,prognosis ,o/eopa?ic ,diagnosis ,9 o/eopa?ic diagnosis ! sp9e is ! fir/ & greate/ object ( int]e/1 = on ! result ( its exam9ation w dep5d ! treatm5t to be giv5 :i* is 9 turn hop$ to br+ ab\t recov]y4 ,z x is ! /ructure on :i* re/s ! weight ( ! body ! practic$ eye is able to detect at a glance1 by ! poise & gait ( ! pati5t1 if !re is an abnormal condition affect+ any consid]able area ( ! sp9al column4 ,x is well to obs]ve ^! po9ts1 especially 9 ! female1 be=e hav+ !m prep>e = exam9ation1 z x w (t5 give a clue to s\rces ( tr\ble ?r\gh faulty c>riage1 improp] dress1 p>ticul>ly corset & %oes4 ,slight *anges ( gait1 unnotic$ by ! pati5t may be ( great aid 9 det]m9+ ! beg9n+ ( disease 9 ! sp9al cord4 ,no o/eopa? is ju/ifi$ 9 accept+ a pati5t :o w n p]mit e exam9ation deem$ necess>y1 z remote & obscure lesions are frequ5tly ! cause ( disease1 s prep>ation ( ! pati5t = ! fir/ scrut9y is ( importance4 ,?is _c be made ) ! pati5t fully clo!d1 z visual obs]vation is second only to ! t\* 9 mak+ "o's d$uctions4 ,nei!r c palpation be made ?r\gh m ?an "o ?ickness ( clo?+ ) accuracy1 & exam9ation next to ! sk9 is always pref]able4 ,?is ne$ 9 no way ev] cause compla9t1 = ) ! use ( a loose fitt+ %ort kimono1 ) all out] clo?+ remov$ except ! knit und]g>m5t1 & ) skirt b&s loos$1 a complete survey ( ! :ole dorsum f occiput to coccyx c be _h )\t ! slighte/ unnecess>y exposure4 ,x is well to rememb] t ! pati5t has come = help & ! o/eopa? is n ju/ifi$ 9 sacrific+ ?or\ghness = any exagg]at$ feel+s ( mode/y4 ,) tact & c>e 9 ! use ( ! g>m5ts ! mo/ s5sitive ones ne$ feel no hesitation 9 com+ = treatm5t4 ,a complete hi/ory ( ! case %\ld be tak5 be=e ! exam9ation beg9s1 =m] me?ods ( treatm5t1 symptoms1 environm5t1 etc41 z x w aid 9 ! f9al conclusions4 ,x is well to h blanks = keep+ records ( all cases4 ,probably ! mo/ com=table mann] to beg9 physical exam9ation is to seat ! pati5t on a table squ>ely ) h&s plac$ ^u ! knees1 !n raise ! g>m5t & expose ! :ole back4 ,beg9 by not+ ! texture ( ! sk91 if x is cle>1 pigm5t$1 blot*$1 or has eruptions4 ,try ! capill>y reflex by p9*+ or /rok+ quickly ) ! f+] tips or ! blunt end ( a p5cil4 ,f9d if x is moi/ or dry & also outl9e ! areas ( *ang$ temp]ature1 if any4 ,!n obs]ve ! g5]al cont\r ( ! sp9e ) ! pati5t sitt+ upright1 to f9d h[ ne> x is to ! normal body curve4 ,occasionally hav+ ! pati5t alt]nately sit & /& w1 by comp>ison1 ?r[ light ^u ! condition4 ,) ! pati5t b5d+ =w>d place ! h&s on ! cre/ ( ! ilia & see if !y are ( equal height4 ,occupation may result 9 ov] developm5t ( "o side or !re may be cong5ital asymmetry#bf4 ,note position ( ! scapul & habit ( po/ure 9 sitt+ & /&+4 ,be=e tak+ up ! subject ( a critical exam9ation ( ea* v]tebra !re are c]ta9 po9ts x w be well to consid]4 ,x is easy to "k in/antly1 )\t c\nt+1 ! numb] ( ! v]tebra caus+ ! lesion if ^! l&m>ks are rememb]$3 ,fir/1 ! sp9e ( ! ?ird dorsal is on a level ) ! sp9e ( ! scapula4 ,second1 ! sp9e ( ! sev5? dorsal is on a level ) ! inf]ior angle ( ! scapula4 ,?ird1 ! sp9e ( ! la/ dorsal is on a level ) ! head ( ! la/ rib4 ,x w save mu* "t = ! busy o/eopa? to h ^! well 9 m9d4 ,! pa?ognomonic symptoms ( ! o/eopa?ic lesion are3 7a7 maladju/m5t2 7b7 contract$ muscles2 7c7 t5d]ness2 7d7 limit$ movem5t4 ,to ^! might be add$ *anges 9 local temp]ature & di/urbance ( function1 b ! =m] is n con/ant & ! latt] may be remote4 ,"h ! prim>y lesion is consid]$1 = an o/eopa?ic lesion may be1 also1 second>y or comp5satory4 ,=bes speaks ( comp5satory *anges z be+ an important diagno/ic sign4 ,diagnosis ( ! position ( a v]tebra is sometimes difficult to ! beg9n] f its hav+ long] or %ort] sp9es ?an normal4 ,horsley speaks ( ! occasional cong5ital abs5ce ( a sp9\s process4 ,!y may be b5t lat]ally1 upw>d or d[nw>d & ?us h all ! appe>ances ( a m>k$ displacem5t1 :ile occasionally ! body itself seems mu* at fault4 ,^! pres5t :at might be t]m$ normal abnormalities & make x necess>y = ! o/eopa? to be v sure ( 8 diagnosis be=e attempt+ to correct :at is n abnormal1 = disappo9tm5t1 at lea/1 & injury1 p]haps1 may foll[4 ,to avoid mi/ake1 c>efully palpate ! transv]se processes & det]m9e if !y are at "r angles ) ! adjo9+ normal sp9e4 ,9 ! c]vical & lumb> v]tebr x is possible to rea* ! tips ( ! transv]se processes1 & on mod]ate pressure1 if a lesion exi/s1 pa9 w be elicit$4 ,fur!r1 :]e t5d]ness is associat$ ) o!r diagno/ic po9ts x c be safely assum$ t a lesion exi/s1 & by outl9+ ! suspect$ v]tebra ) ! f+] & localiz+ ! s5sitive spot "o c be sure ( ! po9t ( greate/ irritation & ! "* ( ! displacem5t4 ,associat$ also ) ^! signs w probably be evid5ce ( conge/ion1 su* z ?ick5$ tissues1 contract$ muscles1 etc4 ,aft] hav+ exam9$ ! condition ( ! sp9al column ?or\ghly by inspection1 beg9 at ! fir/ dorsal & exam9e ! sp9al column d[n to ! sacrum4 ,place ! middle & r+ f+]s ov] ! sp9\s processes & /& directly back ( ! pati5t & draw ! flat surfaces ( ^! two f+]s ov] ! sp9\s processes f ! upp] dorsal to ! sacrum 9 su* a mann] t ! sp9es ( ! v]tebr pass tightly betwe5 ! two f+]s1 ?us leav+ a r$ /reak :]e ! cutane\s vessels press ^u ! sp9es ( ! v]tebr4 ,9 ?is mann] slight deviations ( ! v]tebr lat]ally c be not$ ) ! greate/ accuracy by obs]v+ ! r$ l9e4 ,:5 a v]tebra or a section ( v]tebr are too po/]ior a heavy r$ /reak is notic$ & :5 a v]tebra or v]tebr are ant]ior ! /reak is n s noticeable4 ,?us :5 suspici\s po9ts are notic$ a special exam9ation ( ! localiz$ po9t c be giv54 ,?is exam9ation simply takes into consid]ation ! cont\r & sup]ficial condition ( disord]$ portions ( ! sp9al column4 ,9 a few cases su* an exam9ation w n be necess>y1 = ! symptoms & signs ( ! disease w be s cle>ly manife/$ t "o's att5tion w be call$ directly to ! cause4 ,/ill1 great c>e %\ld be tak5 9 ! majority ( cases1 z ! o/eopa? f9ds causes ( disease remote f ! seat ( compla9t4 ,we mu/ always be> 9 m9d ! significance ( reflex /imuli & sympa!tic radiation4 ,9 mak+ a critical & exhau/ive diagnosis ( ! sp9al condition aft] ! =ego+ g5]al exam9ation has be5 made1 x w be be/ to h ! pati5t lie on ! side ^u ! op]at+ table4 ,:5 ! pati5t is 9 ?is position a m ?or\gh exam9ation c be made1 z !n ! sp9al muscles are n contract$ unless abnormally s1 = :5 a p]son is 9 ! upright position muscles are cont9ually contract+ fir/ on "o side & !n on ! o!r1 z "o ( _! functions is to act z a support 9 keep+ ! sp9al column erect4 ,! pati5t ly+ on 8 side1 ! physician %\ld !n /& 9 front ( him & rea* ov] ^u ! back & make a ?or\gh exam9ation ( ! affect$ portions ( ! sp9al column1 *iefly ?r\gh ! dorsal & lumb> regions4 ,consid]ation %\ld be giv5 ! contraction ( ! muscles along ! back1 *iefly ! deep] lay]s ( muscles4 ,x may ev5 be necess>y to relax "s ( ! muscles be=e a ?or\gh exam9ation ( ! v]tebr c be made4 ,f a pa?ological po9t ( view too mu* /ress %\ld n be put ^u ! contract$ /ate ( ! muscles2 al?\gh 9 a numb] ( in/ances ! contract$ muscles may be ! prim>y cause ( ! pati5t's tr\ble2 especially s :5 ! affection is due to atmosph]ic & o!r *anges4 ,contraction ( ! muscles may be second>y to ! lesions pres5t$ 9 ! bony frame "w4 ,= in/ance1 a dislocat$ v]tebra may be ! cause ( an irritation to ! inn]vation ( c]ta9 muscles along ! sp9al column & ?us cause !m to contract4 ,/ill1 we mu/ n lose sight ( ! importance ( ! contract$ muscles f a diagno/ic po9t ( view4 ,!y are (t5times prom95t signs t a lesion exi/s 9 ! imm$iate region & are ?us fai?ful guides 9 locat+ ! cause ( diseases4 ,9 clos+ ! g5]al consid]ation ( ! sp9al column x is well to emphasize ! importance ( tra9+ ! faculties to grasp at a glance ! /ory told by ! back z a region1 in/9ctively plac+ ! prop] value on ea* physical sign & weav+ !m into a composite :ole s t ! pati5t's condition /&s out a vivid picture on ! o/eopa?'s m9d4 ,:5 ?is is accompli%$ ! m detail$ obs]vations are b incid5tal4 ,relative to ! exam9ation ( ! sp9al column ,cl>k#bg says3 8,to ! o/eopa?ic physician1 ! mo/ important "p ( ! human body is ! sp9al column4 ,by its *anges 9 cont\r & condition ! v>i\s visc]al diseases c be diagnos$1 9 mo/ cases4 ,i believe t e disease is *>act]iz$ by extreme *anges or signs1 & ,i fur!r believe t e *ronic visc]al disord] is manife/ by *anges 9 ! sp9al column t c be1 by ! practical eye & t\*1 readily int]pret$4 ,9 %ort1 !re are v>i\s signs along ! sp9al column t po9t out ! weak5$ or diseas$ p>ts ( ! body4 ,?is me?od ( diagnos+ disease1 t is by not+ ^! sp9al *anges1 is di/9ctly o/eopa?ic1 & ,i believe ! "t w come :5 x w become su* an exact sci5ce t ! "* ( ! sp9al *ange or lesion is diagno/ic n only ( ! viscus affect$1 b ! way x is affect$40 ,regional exam9ations & diagnosis w n[ be tak5 up4 ,neck1 ,head & ,face4--,to make a ?or\gh diagnosis ( ! condition ( ! c]vical v]tebr probably requires m skill & a m acute s5se ( t\* ?an ( any o!r region ( ! body4 ,! irregul>ities & v>iations ( ! c]vical v]tebr1 ! num]\s muscles & ! passage ( _m vessels ?r\gh ! neck are v liable to mislead "o4 ,"o may exam9e ! c]vical v]tebr by hav+ ! pati5t ei!r ly+ d[n or 9 a sitt+ po/ure4 ,! =m] position is pref]able1 z !n ! muscles ( ! neck are passive1 & besides x is mu* easi] to relax ! muscles if su* %\ld be necess>y4 ,also "o has bett] control ( ! field ( exam9ation4 ,x is und\bt$ly be/ = ! /ud5t :5 le>n+ to exam9e ! c]vical v]tebr to fir/ exam9e along ! base ( ! skull ! condition ( ! occipital muscles 7aft] ! pati5t has assum$ ! dorsal position ^u ! treat+ table7 = any contractions2 = if disord] exi/s 9 ! upp] five c]vical v]tebr ! condition w be manife/$ by contraction ( muscul> fibres along ! base ( ! occipital bone4 ,! muscles ( ! occiput are suppli$ by fibres f ! po/]ior bran*es ( ! upp] five pairs ( sp9al n]ves1 & if lesions exi/ to ^! upp] n]ves a contract$ /ate ( m or less ext5t ( ! occipital muscles w occur1 no matt] h[ slight ! lesion4 ,?us ! exam9] aft] locat+ contract$ fibres "u ! occiput has a direct clue to lesions exi/+ some:]e 9 ! upp] five c]vical v]tebr4 ,aft] locat+ ^! contract$ fibres ( ! occipital region & !n /ill keep+ ! f+] ^u ! contract$ muscul> fibres & foll[+ !m d[nw>d until ! contractions are lo/ & seem to ent] ! sp9al cord1 "o has !n locat$ ! exact po9t ( disord] t is caus+ ! irritation to ! muscul> fibres involv$1 & mo/ probably ! cause ( ! affection f :i* ! pati5t is suff]+1 i4 e41 provid$ "o has reason to suspect ! tr\ble is 9 ! c]vical v]tebr4 ,simply foll[ ! contract$ muscul> fibre d[nw>d until x seems to ent] ! sp9al cord & !re "o w f9d a lesion4 ,aft] ! o/eopa? has become exp]t 9 diagnosis ?is w n be necess>y unless he has to make a v f9e diagnosis or unless he is exam9+ a /\t neck :]e x is h>d to exam9e ?r\gh ! heavy muscles4 ,) ?is me?od "o has a firm1 flat1 broad surface to "w on 7! occipital bone7 mak+ x v easy fir/ to locate contract$ muscles & second to trace ! c\rse ( contract$ muscles & ?us f9d ! disord]4 ,o!rwise ! beg9n] is apt to get confus$ by try+ to exam9e ! condition ( ! c]vical v]tebr4 ,lat]1 :5 a /ud5t becomes m exp]t su* a proc$ure w r>ely be necess>y only 9 cases t require special "w 9 ! exam9ation4 ,:5 ! po9t ( disord] has be5 locat$ ! diagnosis z to ! exact "* ( ! maladju/m5t has to be det]m9$4 ,! abnormal position ( ! v]tebra1 t5d]ness at ! po9t involv$1 local contract$ muscles1 & limit$ motion are ! f\r diagno/ic po9ts1 al?\gh ! temp]ature ( ! affect$ "p z comp>$ ) ! g5]al cutane\s temp]ature & ! /ate ( ! local vascul> *annels 7blood & lymphatics7 w occasionally be ( aid4 ,ow+ to ! irregul>ity ( ! sp9\s processes ( ! c]vical v]tebr 9 reg>d to _! l5g?1 great c>e has to be tak5 9 ! exam9ation4 ,probably !re is no o!r region ( ! body t w tax ! pati5ce ( ! o/eopa?ic /ud5t s mu* 9 8 practical "w z mak+ a diagnosis ( disord]s 9 ! c]vical sp9e4 ,x requires pati5t & p]si/5t "w to become a fair diagno/ician ( ! c]vical region1 & x w take mu* exp]i5ce to become exp]t 9 bo? ! exam9ation & treatm5t4 ,"o c dep5d t lat]al deviations ( ! sp9\s processes are abnormal 9 mo/ in/ances4 ,plac+ ! f+] ^u ! sp9\s processes ( two consecutive v]tebras ! /ud5t c readily tell :e!r or n !re is any lat]al displacem5t2 b tell+ z to o!r features is impossible z ! sp9\s processes v>y greatly 9 l5g?4 ,:5 a v]tebra is lat]al1 a slightly twi/$ condition w be felt by ! f+] :5 plac$ ^u & betwe5 ! two sp9\s processes4 ,to elicit ! v>i\s degrees & comb9ations ( rotation & sideb5d+ "o %\ld dep5d ^u ! symmetry ( ! transv]se processes4 ,rea*+ ant]ior to ! /]nocleidoma/oid muscle1 or bett] /ill1 pu%+ ! cleido muscles =w>d & rea*+ po/]ior to !m ^u ! transv]se processes1 a v fair exam9ation c !n be giv5 ! v]tebras4 ,:5 ! v]tebras are d]ang$1 especially ant]iorly or po/]iorly1 t is ! apposition ( ! articul> facets1 a slight elevation w be felt1 possibly n any l>g] ?an a v small pea1 ei!r ! ant]ior or po/]ior aspects ( ! transv]se processes1 dep5d+ ^u :i* way ! v]tebr are d]ang$4 ,rememb] t accompany+ ?is slight elevation w be degrees ( s5sitiv5ess ( ! v]tebra at ! po9t d]ang$4 ,9 cases :]e ! v]tebra is lat]al a slight em95ce w be not$ along ! outside ( ! process4 ,commonly disord]$ v]tebr are n entirely d]ang$ 9 "o direction b are (t5times slightly rotat$1 s we may f9d !m dislocat$ ant]o-lat]ally or 9 v>i\s comb9ations ( sideb5d+-rotation4 ,sev]al consecutive v]tebras may be d]ang$ 9 l mann] ( direction2 ?is condition is *iefly f\nd 9 pa?ological curves ( ! sp9al column4 ,probably ! mo/ common g5]al lesion is a /ra9$ condition ( sev]al consecutive v]tebr1 ea* "o be+ ne>ly intact b all ( !m z a :ole some:at /ra9$ or twi/$4 ,?us !re are _m pa?ological /ates to take into consid]ation1 al?\gh x is n surpris+ to ! o/eopa? :5 he realizes t _m ( our pa9s & a*es are due to anatomical d]angem5t4 ,frequ5tly b5d+ ! head /rongly =w>d & d[nw>d1 or d[nw>d pressure ) slight rotation w produce pa9 at ! po9t ( lesion4 ,subdislocations ( ! atlas are probably among ! mo/ common lesions pres5t$ to ! o/eopa?4 ,ow+ to ! articulation ( ! atlas & occipital bone be+ an anatomically weak po9t & ! neck muscles be+ expos$ con/antly to atmosph]ic *anges1 besides ! articulation betwe5 ! head & neck receiv+ ! brunt ( _m j>s1 falls & /ra9s1 ! atlas is especially susceptible to d]angem5ts4 ,on acc\nt ( ! intimate relation ( ! atlas to ! sup]ior c]vical ganglion ( ! sympa!tic & to ! v]tebral blood vessels x is c]ta9ly v necess>y t ! atlas %\ld be well tak5 c>e (4 ,no o!r tissue ma9ta9s su* a significant position 9 relation to ! blood & n]ve supply to & f ! bra94 ,to diagnose correctly ! position ( an atlas & to be able to correct x is und\bt$ly "o ( ! mo/ ess5tial a*ievem5ts ( ! practition] ( o/eopa?y4 ,! mo/ common disord]s ( ! atlas are ant]ior & lat]al displacem5ts4 ,next 9 ord] come 8rot>y0 lesions ( ! atlas1 i4 e41 :]e ! atlas has be5 d]ang$ diagonally or simply twi/$4 ,x may also be luxat$ ant]iorly & lat]ally1 or po/]iorly & lat]ally1 etc4 ,a po/]ior d]angem5t ( ! atlas is comp>atively a r>e disord]1 al?\gh ow+ to ! _m lesions t are f\nd 9 atlases "o has1 dur+ ! c\rse ( a ye>'s practice1 sev]al to correct4 ,! atlas may occasionally be slightly tipp$ lat]ally1 ant]iorly1 or po/]iorly1 & 9 a few cases x may be some:at impact$ aga9/ ! occipital bone4 ,_m times :5 ! atlas is displac$ ! axis is also d]ang$ on acc\nt ( ! close relation betwe5 ! atlas & axis by ! odontoid process ( ! axis4 ,to exam9e ! atlas ! pati5t may be ei!r 9 ! sitt+ or dorsal po/ure2 x matt]s b little :i* position is tak54 ,possibly ! dorsal position is bett]1 z !n ! neck muscles are m relax$ & if necess>y an exam9ation ( ! c]vical sp9e1 bel[ ! atlas1 c easily be made4 ,by plac+ ! middle f+] ( ei!r h& on ! transv]se processes ( ! atlas :5 ! pati5t is 9 ! sitt+ po/ure1 or ! ?umbs on ! transv]se processes :5 ! pati5t is 9 ! dorsal po/ure & comp>+ ! two sides1 undue prom95ce ( "o side or ! o!r c easily be not$4 ,rememb] ! transv]se processes ( ! atlas are slightly above & po/]ior to ! angle ( ! inf]ior maxilla4 ,always1 9 exam9+ "o side ( ! pati5t1 comp>e x ) ! o!r2 x may save consid]able emb>rassm5t4 ,"o side may seem abnormal :5 by comp>+ x ) ! o!r side1 bo? sides may be f\nd ! same & /ill be normal4 ,) ! f+]s /ill on ! transv]se processes note ! di/ance betwe5 ! process & angle ( ! jaw1 besides take into consid]ation ! t5d]ness ( ! locality1 &1 also1 :at is ( ess5tial importance 9 all int]osse\s lesions1 its articul> range ( movem5ts4 ,!re %\ld be room en\gh 7approximately7 to j com=tably w$ge ! end ( a m$ium siz$ middle f+] betwe5 ! transv]se process ( ! atlas & ! angle ( ! inf]ior maxilla :5 bo? are normal4 ,?us ) ! f+]s on ! transv]se processes an exp]t w be able to readily det]m9e :e!r or n an atlas is lat]al or ant]ior4 ,if an atlas is po/]ior ! di/ance betwe5 ! angles ( ! jaw & ! transv]se process w be increas$1 besides ! atlas w be q prom95t po/]iorly4 ,9 conjunction ) ! abnormality ( ! tissues 7prom95ce or depression ( ! bone & /ate ( ! muscles7 ! s5sitiv5ess ( ! locality is extremely significant4 ,outside ( displacem5ts ( ! atlas1 a lesion betwe5 ! axis & ?ird c]vical is mo/ common2 foll[+ next 9 frequ5cy are lesions ( ! skull & atlas4 ,by t is meant :]e all ! c]vical v]tebr are intact z f> z _! individual relation is conc]n$1 b ! skull is =w>d1 backw>d or lat]al ^u ! sp9al column4 ,?is condition occurs q frequ5tly4 ,to det]m9e its condition ! same me?ods are employ$ z 9 diagnos+ a d]ang$ atlas2 = if ! dislocations exi/ betwe5 ! atlas & skull ! same diagno/ic po9ts are pres5t$ z f> z ! skull is conc]n$ z :5 ! atlas1 or atlas & axis1 are dislocat$ f ! occipital bone or f ! axis or ?ird c]vical4 ,foll[+ ! prec$+ exam9ations1 additional exam9ation w h to be made to see :e!r or n ! atlas is intact ) ! v]tebr bel[4 ,if ! atlas is f\nd to be intact ) ! v]tebr bel[ & lesions are pres5t$ betwe5 ! atlas & ! skull1 !n ! disord] mu/ be betwe5 ! atlas & ! skull & n[h]e else4 ,occasionally !re are cases :]e ! skull is s f> po/]ior ^u ! sp9al column t ! angles ( ! jaw /rike aga9/ ! transv]se processes ( ! atlas :5 ! jaw is op5$ widely4 ,d]angem5t ( ! muscles ( ! ant]ior & lat]al regions ( ! neck are common4 ,especially are contractions ( ! muscles on ei!r side ( ! l>ynx liable to occur4 ,9 exam9+ ! c]vical region d n pay too mu* att5tion to ! sup]ficial muscles1 b exam9e c>efully ! deep] muscles4 ,x is f ^! t imp+em5ts ( n]ves & con/rictions ( vessels are likely to take place 9 ! contract$ fibres4 ,also1 imbalance ( muscul> t5sion may be ! s\rce ( ! result+ malalignm5t4 ,9 exam9+ = contract$ muscles d n g\ge into ! muscle nor grasp ! muscle r\ghly1 b be> d[n lightly 7inhibitory7 ^u ! muscles & !n gradually ex]t firm] pressure4 ,by c>efully & firmly ex]t+ pressure ov] muscul> areas ! deep muscles c !n be felt b5ea? ! sup]ficial ones4 ,o!rwise :5 ! muscles are manipulat$ sev]ely ! sup]ficial ones w contract to su* an ext5t t ! deep] ones _c be felt4 ,! muscles contract+ on ei!r side ( ! l>ynx t5d to draw ! l>ynx d[nw>d & ?us !re may arise a s\rce ( irritation4 ,! v>i\s muscles contract+ 9 ! ant]o-lat]al region ( ! neck are v (t5 ! s\rce ( *ronic irritations ( ! ph>ynx or ?roat4 ,! omo-hyoid muscle may become contract$ & cause slight traction on ! hyoid bone & ?us produce an irritat+ c\gh4 ,to exam9e ! muscles ( ! neck ?or\ghly x is be/ to h ! pati5t flat ^u ! back1 = !n all ! normal muscles are relax$4 ,lesions q frequ5tly occur 9 ! temporo-inf]ior maxill>y articulation4 ,! lesion may be ei!r unilat]al or bilat]al1 m commonly ! =m]4 ,! disord] usually consi/s ( a relaxation ( ! muscles & ligam5ts ab\t ! articulation :i* all[s a slight b p]ceptible dropp+ ( ! inf]ior maxilla on ! side involv$4 ,9 o!r cases !re may be pres5t$ a spa/icity ( tissue1 :ile 9 /ill o!rs "s degree ( jo9t infection may be f\nd4 ,lesions ( ?is articulation p>ticul>ly imp+e ^u fibres ( ! fif? cranial n]ve4 ,! po9ts ( diagnosis are click+ & t5d]ness at ! articulation4 ,^! two po9ts are ! symptoms ( :i* ! pati5t compla9s2 ^? notic$ by ! o/eopa? are a slight deviation ( ! jaw to "o side or ! o!r :5 ! jaw is op5$ & a fl9*+ ( ! pati5t due to t5d]ness :5 pressure is ex]t$ ov] ! articulation ( ! jaw4 ,:5 ! physician places 8 f+]s ar\nd ! jaw1 ant]ior to ! angles1 & ! ?umbs ov] ! bridge ( ! nose1 hav+ pati5t op5 ! m\?1 at ! same "t ex]t+ pressure ) ! f+]s & ?umb1 a %>p click may be elicit$ by ! return ( ! jaw into its articulation4 ,9 disease ( ! scalp ! condition ( ! muscles ( ! scalp %\ld be tak5 into consid]ation4 ,! muscles are usually f\nd contract$4 ,! contraction ( ! muscles is g5]ally due1 z well z ! disease ( ! scalp1 to d]angem5t exi/+ 9 ! po/]ior bran*es ( ! upp] five pairs ( ! c]vical sp9al n]ves4 ,9 ! neck1 ant]iorly ! hyoid is ! only bone to consid]4 ,x is easily palpat$ by /&+ at ! head ( ! table & ) ! second f+] ( ea* h& outl9e bo? ends to asc]ta9 its relation ) ! ?yroid c>tilage4 ,note c>efully any contract$ tissue or gl&ul> enl>gem5ts :i* might cause undue t5sion4 ,! tilt+ ( ei!r end ( ! hyoid f ^! contractions is productive ( mu* ?roat irritation4 ,at ! same "t ! l>ynx may be exam9$4 ,x may be prolaps$1 caus+ irritation ( ! l>yngeal gr\p ( n]ves4 ,! ?yroid & c]vical gl&s %\ld be palpat$ = enl>gem5ts1 & all ! muscles & ligam5ts = contractions4 ,ext]nally ! tonsil may be felt by deep pressure 9 front ( ! angle ( ! inf]ior maxilla4 ,! ,ribs4--,"u ! o/eopa?ic diagnosis ( ! ribs w be includ$ ! exam9ation ( ! clavicle & /]num4 ,to be able to diagnose intellig5tly1 ! position ( ! ribs 9 detail is v necess>y to ! o/eopa?4 ,_m ( ! diseases ( ! he>t & lungs1 besides a l>ge numb] ( ! diseases ( ! dige/ive tract1 may be trac$ to a d]ang$ rib2 also1 occasionally diseases ( diff]5t regions ( ! head & neck may be due to dislocat$ ribs4 ,9 mak+ a ?or\gh exam9ation ( ! ribs ea* rib %\ld be c>efully not$ z to its position4 ,! ribs may be exam9$ :5 ! pati5t is sitt+ up2 b x is bett] to h ! pati5t flat ^u ! back & especially s if ! float+ ribs are to be c>efully exam9$1 because ! muscul> tissues ( ! side if contract$ w int]f]e ) ! diagnosis4 ,9 _m in/ances ! rib lesion is second>y to a v]tebral subluxation4 ,an exp]t o/eopa?ic diagno/ician w be able to detect at once by a s+le passage ( ! h&s d[n ov] ! ribs if !re are any disord]s ( !m4 ,9 pass+ ! flat ( ! h&1 especially ! flat "p ( ! f+]s ov] ! ribs1 c>efully obs]ve if ! int]co/al spaces are too n>r[ or too wide1 & if any ( ! ribs are unduly prom95t or depress$4 ,if an int]co/al space is too n>r[ x %[s t ! ribs on ei!r side ( ! int]co/al space are too close toge!r4 ,!n ! "q arises1 :i* "o ( ! ribs is cr[d+ ^u ! int]co/al space1 or :e!r bo? ( ! ribs are cr[d$ toge!r4 ,usually :5 ! /]nal end ( ! rib is displac$ upw>d1 ! involv$ rib is prom95t & :5 displac$ d[nw>d ! rib is depress$4 ,?us x is commonly easy to diagnose :i* is ! involv$ rib4 ,besides f9d+ an abnormal position ( ! rib !re w be m or less t5d]ness ov] ! rib4 ,f9d+ a rib prom95t or depress$ & t5d] is g5]ally q conclusive t ! rib is displac$4 ,!n ! range ( movem5t z express$ ?r\gh ! s5se ( resi/ance is a helpful guide 9 diagnosis4 ,if a typical rib is plac$ ^u a flat surface & "o end ( x is depress$ ! o!r end w be elevat$ & vice v]sa4 ,?is peculi>ity holds true z well :5 ! ribs 7typical7 are dislocat$ 9 ! liv+ body4 ,if ! ant]ior end is elevat$ ! po/]ior end is commonly depress$ & vice v]sa4 ,c>e %\ld be tak5 9 exam9+ ! fir/ rib & ! false ribs1 = 9 ^! ribs ?is peculi>ity is n f\nd4 ,z a :ole a v complete diagnosis c be made ( ! condition ( ! ribs by exam9+ ! ant]ior "p ( ! ?orax1 al?\gh x is always be/ to exam9e along ! angles ( ! ribs if = no?+ m ?an to confirm ! diagnosis made at ! /]nal ends4 ,/ill x mu/ be rememb]$ t ! prec$+ only holds good :5 ! entire rib is dislocat$4 ,_m times simply "o end ( ! rib is d]ang$ & ! o!r end is practically intact4 ,besides c>eful exam9ation ( ! /]nal end ( ! rib1 att5tion %\ld be paid to ! condition ( ! co/al c>tilages4 ,! co/al c>tilages may become d]ang$ at ei!r ! articulation ) ! rib or ) ! /]num4 ,! same rule holds good :5 ! co/al c>tilages are dislocat$ z :5 ! ribs are dislocat$1 i4 e41 :5 ! c>tilages are prom95t1 !y are usually displac$ upw>d & :5 depress$ ! c>tilage is displac$ d[nw>d t[>d its neighbor4 ,"o is apt to ?9k t a rib is only dislocat$ at its v]tebral end4 ,al?\gh lesions ( ! v]tebral end are g5]ally ( great] significance z f> z ! etiological factors are conc]n$1 /ill ! /]nal end ( ! rib mu/ n be ov]look$4 ,9 exam9+ ! v]tebral end ( a rib att5tion %\ld be paid ! angles ( ! ribs1 = at ! angles a bett] opportunity = exam9ation is giv5 on acc\nt ( ! prom95ce4 ,x w be necess>y 9 _m cases to f9d out :e!r or n ! v]tebral end ( ! rib is ly+ betwe5 ! transv]se processes in/ead ( 9 front ( !m4 ,9 _m sev]e lesions ( ! ribs ! v]tebral end ( ! rib is dislocat$ upw>d or d[nw>d f ! transv]se process ( ! v]tebra & lies betwe5 ! transv]se processes ( ! v]tebr above & bel[ its atta*m5t4 ,?is c]ta9ly requires consid]able skill 9 ! diagnosis1 = (t5times ! po9t to be f\nd is b>ely an eigh? ( an in* 9 diamet]4 ,x is usually be/ be=e mak+ su* a close exam9ation to relax ! tissues well ov] ! field ( exam9ation4 ,! ribs z a :ole may be too transv]se or too oblique ^u "o side4 ,?is is *iefly f\nd 9 pa?ological curves ( ! sp9e1 b /ill su* conditions may exi/ :]e !re are sev]ely contract$ muscles1 especially 9 "s cases ( p>alysis4 ,?us ! cont\r ( ! ribs mu/ be tak5 into consid]ation by comp>+ "o side ) ! o!r4 ,9 exam9+ ! fir/ rib an exam9ation some:at diff]5t f ! o!r ribs %\ld be giv54 ,x is be/ to h ! pati5t assume a sitt+ po/ure2 !n place ! middle f+]s ( ea* h& ^u ! fir/ ribs ne> _! c5t]s & comp>e "o ) ! o!r4 ,also note ! diff]5ce ( ! spaces betwe5 ! ribs & clavicles4 ,g5]ally ! fir/ rib is dislocat$ upw>d1 r>ely d[nw>d4 ,besides f9d+ an abnormal prom95ce or depression ( ! rib at its c5t] consid]able t5d]ness w be notic$4 ,exam9ations ( ?is region are e day exp]i5ces ) ! o/eopa?4 ,:5 diagnos+ ! position ( ! float+ ribs x is be/ to h ! pati5t lie flat ^u ! back ) ! ?ighs flex$ ^u ! abdom51 s t ! tissues ab\t ! l[] ribs may be entirely relax$4 ,!n by plac+ ! flat ( ! f+]s c>efully ov] ! ribs ! outl9e & position ( !m c be easily disc]n$4 ,! float+ ribs are (t5times f\nd d]ang$ & are ! s\rce ( a great deal ( suff]+ ?r\gh ! iliac regions4 ,^! ribs may become dislocat$ f ! v]tebral ends & drop d[n obliquely t[>d ! iliac cre/1 or else ! free end may become lock$ b5ea? ! rib above4 ,occasionally bo? ends ( ! rib drop d[n q p]ceptibly & consequ5tly is ! cause ( consid]able di/ress4 ,9 su* in/ances ! rib is depress$ inw>d s t ! normal cont\r ( ! l[] ?orax is lo/4 ,an exam9ation ( ! clavicle %\ld be c>efully made4 ,always comp>e ! clavicle ) its fell[ & exam9e ?or\ghly its articulation ) ! /]num z well z at ! acromial prom95ce4 ,(t5 ! /]nal end ( ! clavicle is slightly dislocat$ po/]iorly to ! /]num2 al?\gh x may become completely luxat$4 ,! acromial end may be dislocat$ upw>d or d[nw>d4 ,9 exam9+ ! /]num special att5tion %\ld be giv5 ! articulation ( ! manubrium & gladiolus4 ,?is is due to ! cr[d+ ant]iorly ( ! articulation ( ! /]nal p>ts4 ,normally until well along 9 adult life !re %\ld be "s movem5t "h due to its membran\s atta*m5t4 ,occasionally ! ensi=m c>tilage is turn$ inw>d1 produc+ a t5d] po9t1 b ?is r>ely occurs4 ,also ! articulation ( ! c>tilages 9 ! region ( ! eigh?1 n9?1 & t5? ribs may be f\nd consid]ably d]ang$1 caus+ local t5d]ness & ev5 /oma* tr\ble4 ,dorsal & ,lumb> ,sp9al ,region4--,) ! pati5t sitt+ on ! table abnormal deviations c be readily not$4 ,!re may be lat]al sw]ves1 f muscul> weakness1 or unilat]al t5sion1 involv+ ! :ole sp9e or less1 or a rev]sal ( natural curves1 i4 e41 ! sp9e depress$ ant]iorly betwe5 ! %\ld]s & po/]iorly 9 ! lumb> mak+ ! /raight sp9e4 ,!re may be1 also1 an exagg]at$ normal curve 9 ! dorsal region produc+ a kyphosis ) a comp5satory lordosis 9 ! lumb> region suffici5tly great to *ange its relations ) ! pelvis4 ,by ! me?od previ\sly giv51 n[ outl9e ! sp9al column = lat]al & bilat]al scoliosis4 ,^!1 frequ5tly1 are at _! incipi5cy1 & to ! casual obs]v] w\ld pass unnotic$4 ,x is well to make an outl9e ( ! sp9e be=e beg9n+ treatm5t1 & at times foll[+1 t progress may be obs]v$4 ,a simple me?od is lead tape :i* c be _h f any plumb] %op & c be mold$ to ! de=mity & trac$ on pap] toge!r ) date ( exam9ation4 ,h4 ,f4 ,goetz has p]fect$ an appliance = outl9+ & record+ ^! deviations4 ,obs]ve well ! ligam5ts1 z well z ext5t ( jo9t movem5t1 "u deep palpation2 f irritation !y may become ?ick5$ & m or less fill ! spaces ab\t ! sp9es & transv]se processes1 caus+ a rigid1 smoo? sp9e4 ,to make a detail$ exam9ation ! pati5t %\ld be /ret*$ out on "o side ^u a treat+ table1 al?\gh ! g5]al exam9ation may be suffici5t4 ,!n1 /&+ 9 front ( ! pati5t & rea*+ ov] him1 a mo/ c>eful diagnosis c be made4 ,d n /& back ( ! pati5t z ! flat ( ! f+]s c n be us$ to advantage 9 outl9+ ! diff]5t v]tebr4 ,! v>i\s contract$ muscles t may be f\nd along ! sp9al column w be ( valuable aid 9 locat+ d]angem5ts ( ! v]tebr & v]tebral ends ( ! ribs4 ,by us+ contract$ muscles along ! sp9al column z a guide = locat+ lesions1 ref]5ce to ! l>ge sup]ficial muscles is n made1 b to ! small areas ( contract$ fibres ( ! deep muscles4 ,x is ! deep muscles t become m or less contract$1 & ev5 fibrotic1 :5 lesions ( ! v]tebr & ribs exi/4 ,! sup]ficial muscles are g5]ally contract$ by atmosph]ic *anges1 slump$ po/ures1 wrong habits1 etc41 & are n g5]ally ! result ( disord]s 9 ! osse\s sy/em4 ,! prec$+ po9ts 9 reg>d to contract$ muscles _c be too c>efully obs]v$ = !re is a t5d5cy among _m o/eopa?s to treat ! contract$ deep muscles z prim>y lesions 9 ne>ly e case4 ,rememb] t if !y are n due to ! motor n]ve fibres ( ! muscles be+ irritat$ by ! sp9al lesion1 or to a reflex /imulus1 or to a comp5satory *ange1 t al?\gh ! muscul> t5sion may be ! inception ( ! almo/ c]ta9 int]osse\s lesion1 /ill ! lev]ages secur$ ?r\gh bony adju/+ are v ess5tial n only 9 correct+ ! osse\s malposition b 9 loos5+ & releas+ fibr\s muscles & ?ick5$ ligam5ts4 ,?orax4--,exam9ation ( ! ?orax z a region has be5 l>gely gone ov] 9 speak+ ( ! ribs & _! /]nal atta*m5t1 c>tilages1 /]num & ! clavicles1 b its appe>ance z a :ole %\ld be c>efully not$ = x w be a valuable aid 9 diagnosis4 ,deviations f ! normal1 su* z ! emphysemat\s or b>rel-%ap$ *e/ 9 a/hmatic affections1 or *ronic c\gh1 or accompany+ kyphosis1 ! flat *e/ & its association ) ph?isis1 ! ra*itic1 etc41 %\ld be consid]$4 ,sp9al de=mities are reflect$ 9 ! ?orax by m>k$ *anges 9 cont\r1 su* z elevations & depressions correspond+ to ! sp9al *anges4 ,^! result 9 m>k$ int]f]5ce ) ! ?oracic organs & 9 "y subjects are ( p>ticul> int]e/4 ,rib *anges are frequ5tly ! result ( v]tebral deviations4 ,abdom54--,! position = exam9ation ( ! abdom9al visc]a is usually ) ! pati5t sup9e1 head slightly elevat$1 knees drawn up p>tially & support$ to relieve any muscul> /ra91 & ) ! h&s at ! sides4 ,9 ?is position complete relaxation is obta9$4 ,obs]ve any enl>gem5ts f gas1 fluid1 or tumor1 muscul> *anges1 color1 etc4 ,! pati5t may1 also1 be plac$ ^u ! side1 & 9 ! knee-*e/ position = fur!r v]ification ( ! diagnosis4 ,:]e ! abdom9al wall is mu* relax$1 or !re is a p5dul\s abdom5 ) ent]optosis1 !re w be f\nd a *ange ( relations ( ! visc]a by ^! diff]5t positions1 all[+ !m to be palpat$ 9 ano!r position4 ,:5 !re is m>k$ t5d]ness x is (t5 possible to g deep] ) less discom=t ) ! pati5t 9 ! knee-*e/ position4 ,! ,tr5del5burg position may also be utiliz$4 ,:]e ascites is suspect$ palpation %\ld be made ) ! pati5t 9 v>i\s positions 9 ord] to note *anges ( location ( ! fluid4 ,frequ5tly mu* c be le>n$ by inspection ) ! pati5t /&+4 ,clues to visc]al di/urbance c (t5 be _h by trac+ ! n]ve connection f ! sp9al lesions to ! suspect$ "p4 ,9 exam9+ ! liv] c>e mu/ be tak5 t any g\g+ or sev]e bruis+ ( ! organ does n take place4 ,! liv] c be outl9$ by p]cussion & also by palpation ( its l[] & inn] bord]s ,conge/ions1 atrophy1 enl>gem5t or h>d5+ %\ld be not$1 also any *ange 9 position4 ,a r complete exam9ation c be giv5 ! bili>y tract f ! gall-bladd] to ! duod5al orifice ( ! bili>y duct4 ,by a c>eful inhibitory pressure ov] ! duct ! outl9e ( ! tract c be disc]n$ provid+ ! pati5t is n too /\t4 ,:5 ! tract is swoll5 consid]able t5d]ness w be pres5t4 ,! pati5t w compla9 ( a /abb+ or pi]c+ pa9 ^u pressure & manipulation if ! duct is inflam$4 ,usually ! t5d]ness is greate/ ne>] ! duod5al orifice4 ,! duod5al orifice is ab\t "o & "o-half in*es diagonally d[nw>d to ! "r f ! umbilicus4 ,9 cases ( impact$ gall-/ones ! o/eopa? z a rule has v little tr\ble 9 locat+ ! /one4 ,! sple5 may be p]cuss$ & :5 9 a m>k$ly enl>g$ condition its l[] bord] c be palpat$4 ,great c>e mu/ be us$ 9 ! latt] condition z !re is dang] ( rupture4 ,9 exam9+ ! /oma* ! usual me?ods ( inspection1 palpation1 p]cussion1 analysis ( ! cont5ts1 etc41 are employ$4 ,palpation & manipulation ov] ! inte/9es are practic$ a great deal by ! o/eopa? 9 v>i\s inte/9al diseases4 ,by 8 educat$ s5se ( t\* he is usually able to locate at once any impactions ( fecal matt]4 ,su* impactions are g5]ally f\nd 9 ! ilio-cecal & sigmoid regions4 ,9 ! v>i\s acute ob/ructions f invag9ation1 tumors1 twi/s1 adhesions1 spa/icity1 knots1 etc41 _m times "o is able to readily locate ! seat ( ! di/urbance4 ,!re is "o po9t to specially emphasize2 t is1 d n ov]look prolaps$ regions ( ! inte/9es2 su* occur frequ5tly & are a s\rce ( consid]able di/ress1 especially con/ipation4 ,simple manipulation w nev] d mu* good1 nei!r w sp9al treatm5t or injections1 z a rule4 ,a specific treatm5t mu/ be giv5 &1 t is1 aft] locat+ ! exact po9t ( prolapse1 to rea* c>efully b5ea? ! fold & replace x4 ,9 emaciat$ subjects ! kidneys c be readily locat$1 & 9 a few in/ances :5 !y are diseas$ "o c feel ! contract$ tissues ab\t !m4 ,be v c>eful n to injure ! capsule ab\t ! kidney4 ,d n pun* or g\ge !m 9 ! lea/2 b locate ! kidneys by a c>eful inhibitory palpation4 ,lumb> & ,pelvis4--,! intimate relation betwe5 ! lumb> sp9e & pelvis make a consid]ation ( !m z a region necess>y4 ,outside ( ord9>y curvatures involv+ bo? ! dorsal & lumb> regions !re are c]ta9 conditions :i* involve b "o /ructure & require c>eful diff]5tial diagnosis to det]m9e :e!r ! lumb> or pelvis is at fault4 ,9 ! =m] ! fif? v]tebra is a weak po9t & is mo/ frequ5tly at fault4 ,! deviations are usually a sideb5d+ & frequ5tly accompani$ ) "s rotation4 ,occasionally a mal/ructure ( ! l[] lumb> or pa?ologically relax$ ligam5ts w approximate ! sp9es & be mislead+ z to ! real condition4 ,a rotation or lat]al tilt+ ( ! fif? lumb> may h ! effect ( elevat+ ! cre/ ( ! ilium s t ! innom9atum w\ld appe> involv$4 ,!re w be a diff]5ce 9 ! l5g? ( ! legs1 angles ( feet :5 pati5t is ly+ on ! back1 ant]ior sp9es out ( l9e & t5d]ness ( ! muscles atta*$ ne> !m4 ,h[ev]1 o!r diagno/ic po9ts ( innom9ate lesions1 i4 e41 t5d]ness ( symphysis & sacro-iliac articulation1 & prom95ce ( ! po/]ior sp9e1 w be lack+4 ,m>k$ deviation ( o!r lumb> v]tebr may produce practically ! same effect1 b ! lesion w be s app>5t t !re w be no d\bt z to ! cause4 ,to be able to diagnose accurately & intellig5tly ! pelvic region requires ne>ly z mu* skill z 9 exam9+ ! c]vical region4 ,! pelvic bones are liable to _m subdislocations1 especially 9 ! female4 ,h[ev]1 x %\ld be rememb]$ t _m app>5t innom9ate lesions are second>y or comp5satory *anges due to lumb> lesions4 ,! pelvis z a :ole may be tipp$ ant]iorly or po/]iorly ^u ! sp9al column4 ,x also may be twi/$ or rotat$ lat]ally ^u ! sp9al column4 ,! mo/ common lesions are subluxations ( an innom9atum =w>d1 backw>d1 upw>d1 or d[nw>d1 or v>i\s comb9ations ( ^! displacem5ts1 su* z a tipp+ =w>d & d[nw>d ( an innom9atum1 or a tipp+ backw>d & upw>d1 b ^! comb9ations d n always exi/ 9 ! mann] giv54 ,z a rule :5 ! ilium is ant]ior1 ! is*ium po/]ior1 !n ! innom9atum z a :ole is d[nw>d2 :5 ! ilium is po/]ior1 ! is*ium ant]ior1 !n ! innom9atum z a :ole is upw>d4 ,?is is only a rule1 !re are exceptions to x2 = 9 "s few cases :5 ! ilium is ant]ior1 ! is*ium po/]ior1 ! innom9atum may be high]1 & :5 ! ilium is po/]ior & ! is*ium ant]ior ! innom9atum may be l[]4 ,to be able to diagnose su* d]angem5ts w require skill & practice2 /ill !re are symptoms & signs t are *>act]i/ic ( su* disord]s4 ,9 exam9+ ! pelvic bones h ! pati5t flat ^u ! back at fir/4 ,be sure he is flat ^u ! back = a v slight v>iation may make consid]able diff]5ce 9 ! relation ( ! pelvic bones1 "o to ! o!r1 s f> z ! diagno/ic po9ts are conc]n$4 ,!n g to ! feet ( ! pati5t & grasp ! ankles firmly1 rotate lat]ally bo? legs1 fir/ to "o side & !n to ! o!r1 z well z pull & pu% bo? limbs slightly1 & !n br+ ! heels toge!r directly 9 ! m$ian f9e ( ! body & comp>e ! l5g? ( ! limbs at ! heels4 ,if !re is any disord] :atev] 9 "o innom9atum1 & ! ?igh muscles h be5 relax$ ?or\ghly by ! prec$+ movem5ts & ! heels are br\ght toge!r 9 ! m$ian l9e ( ! body1 a diff]5ce 9 ! l5g? ( ! limbs w readily be obs]v$ at ! inn] malleoli or ! heels4 ,= if ! ilium is =w>d ! is*ium mu/ be backw>d & z a rule ! innom9atum is ?r[n d[nw>d1 ?us caus+ an app>5t l5g!n+ ( ! limb :i* w be notic$ by comp>+ ! heels2 if ! ilium is backw>d ! is*ium mu/ be =w>d & z a rule ! innom9atum is !n upw>d1 caus+ an app>5t %ort5+ ( ! limb on ! affect$ side4 ,a v slight v>iation 9 ! pelvis w make consid]able diff]5ce 9 an app>5t l5g!n+ or %ort5+ ( ! limbs4 ,su* conditions are g5]ally met ) sev]al times a day by o/eopa?s4 ,! object ( ! lat]al rot>y movem5t & ! pu%+ & pull+ ( ! limbs is to make sure t all ! ?igh muscles are ?or\ghly relax$1 = x is a v easy matt] = contract$ muscles 9 "o ?igh to produce an app>5t %ort5+ ( ! limb4 ,also be v c>eful 9 comp>+ ! l5g? ( ! two limbs at ! heels :]e !y come toge!r t !y are exactly 9 ! m$ian l9e ( ! body1 = if !y %\ld be to "o side or ! o!r1 h[ev] slightly1 !re w\ld be an app>5t l5g!n+ ( ! out] limb z comp>$ ) ! limb ne> ! m$ian l9e4 ,:ile ! pati5t rema9s flat ^u ! back x is a good plan to comp>e ! ant]ior sp9es ( ! ilia4 ,x may be readily notic$ t "o is high] or m depress$ ?an ! o!r1 :i* w help to confirm ! diagnosis4 ,x is a good plan also to h ! pati5t sit up squ>ely ^u ! table & comp>e ! cre/s & po/]ior sp9es ( ! ilia2 ?us "o may be se5 to be high] ?an ! o!r4 ,!n1 also1 note ! angles ( ! feet :5 pati5t is sup9e2 an ev]t$ foot usually means t ! limb is %ort] due to ! tilt$ pelvis2 ! opposite is commonly true :5 ! foot is inv]t$4 ,h[ev]1 ?is is n an absolute rule4 ,c>e %\ld be tak5 9 diff]5tial diagnosis ( possible old fracture ( leg1 ( infantile p>alysis1 ( asymmetry1 etc4 ,!re are ?ree diagno/ic po9ts exclusive ( all o!r signs t are q conclusive :5 c\pl$ ) ! prec$+ exam9ation4 ,if an innom9atum is dislocat$ or subdislocat$ !re w be t5d]ness ov] ! symphysis pubis on ! side affect$1 t5d]ness ov] ! ilio-sacral articulation on ! side affect$1 & t5d]ness along ! cre/ ( ilium :]e ! abdom9al muscles are atta*$4 ,:5 t5d]ness is f\nd at ^! ?ree po9ts x is q conclusive t ! innom9atum is d]ang$1 = at ! symphysis pubis & ilio-sacral articulation t5d]ness mu/ exi/ if ! innom9atum is di/urb$1 & by a *ange 9 ! cre/ ( ! ilium ! abdom9al p>ietes w be affect$1 provid$ !y are n too mu* debilitat$4 ,m>k$ t5d]ness ( ! ext]nal cutane\s n]ve z x passes ov] ! cre/ ( ! ilium bel[ ! ant]ior sp9e w be notic$ on ! unaffect$ side 7,dr4 ,/ill74 ,!re w be1 on rectal exam9ation1 m>k$ t5sion ( ! tissues on ! affect$ side4 ,possibly ! pati5t may compla9 ( pa9 exclusively 9 "o side along ! pelvis & limb :i* w be a lead+ symptom tell+ :i* side is affect$4 ,additional diagno/ic signs w be rigidity ( muscles along ! ilio-sacral articulation & abnormal prom95ce or depression ( ! ilium at its articulation ) ! sacrum1 dep5d+ ^u :i* way ! innom9atum has slipp$4 ,consid]able deviation ( ! pubic bones may be notic$4 ,! pubic bone on ! side affect$ may be ei!r ?r[n upw>d or d[nw>d4 ,radiographs h repeat$ly reveal$ subluxations ( ! innom9ate bones 9 _m in/ances4 ,?is is c]ta9ly q conclusive 9 confirmation ( ! o/eopa?ic ideas 9 reg>d to ! pelvic bones becom+ dislocat$4 ,sacrum4--,exam9ation ( ! sacrum is be/ made ) ! pati5t ly+ on ! side1 ) ! o/eopa? /&+ 9 front & ) ! h& palpate its po/]ior surface4 ,9 ! sitt+ po/ure its relation ) bo? innom9ates c be det]m9$4 ,x is displac$ po/]iorly b seldom1 ! mo/ frequ5t be+ ant]ior1 d[nw>d1 & a comb9ation ( ! two4 ,9 ! ant]ior conditions t5d]ness at ! sacro-iliac articulations is a good po9t1 b x mu/ n be conf\nd$ ) an innom9ate lesion4 ,! d[nw>d displacem5t is %[n by comp>ison ) ! l[] lumb> v]tebr4 ,obs]ve ! relation betwe5 ! two1 z a *ange 9 cont\r ( ! sp9e w also *ange ! angle ( ! sacrum & vice v]sa4 ,coccyx4--,) ! pati5t & op]ator 9 same position z = ! sacral exam9ation outl9e ! coccyx1 z to fir/1 cont\r2 second1 rigidity2 ?ird1 s5sitiv5ess4 ,if abnormalities are detect$ g to ! o!r side ( ! table & ) a well lubricat$ index f+] palpate its ant]ior surface4 ,*ang$ cont\r1 displacem5ts1 & old fractures c be readily det]m9$4 ,! mo/ common deviation is ant]ior at its union ) ! sacrum4 ,! lat]al =m g5]ally result+ f muscul> contraction is next1 ) po/]ior b seldom4 8,if ! l[] "p ( ! sacrum is rotat$ backw>d1 ! sacro-coccygeal articulation or angle is affect$ or becomes m acute1 s9ce ! tip ( ! coccyx is n displac$1 b held 9 position by /ructures atta*$ to x4 ,if ! sacrum is displac$ d[nw>d ! effect is ab\t ! same4 ,(t5 ?is sort ( sacral lesion is mi/ak5 = an ant]ior luxation ( ! coccyx40#bh ,rememb] t normally !re %\ld be "s movem5t ( ! coccyx4 ,x has a fibro-membran\s articulation4 ,ut]9e1 ov>ian & rectal exam9ations are l>gely ( ! same nature z ^? giv5 by o!r practition]s1 al?\gh o/eopa?s f9d t (t5times o!r practition]s are mi/ak5 9 reg>d to ! etiology ( _m diseases to :i* ^! organs are subject4 ,arms & ,legs4--,!re is comp>atively little t is exclusively o/eopa?ic 9 reg>d to ! diagnosis ( disord]s ( ! arms & legs4 ,"o important feature t ! o/eopa? f9ds 9 exam9+ ! arms & legs is t _m ( ! disord]s suppos$ to orig9ate 9 ! affect$ memb] are f\nd to be caus$ f v]tebral or rib dislocations4 ,innom9ate & lumb> lesions are p>ticul>ly fruitful s\rces ( tr\ble 9 ! legs & feet4 ,always c>efully exam9e ! sp9e 9 ! region ( inn]vation to ! arms & legs :5 !y are affect$4 ,! %\ld] & hip jo9ts1 z well z all jo9ts1 are subject to p>tial dislocations4 ,_m times :5 pa9 or o!r symptoms are pres5t$ 9 ! arms or legs ! tr\ble is at ! %\ld] or hip jo9t or 9 ! sp9al column4 ,!re are two regions t are v apt to be ov]look$ 9 ! exam9ations ( ! arms & legs & !y are ! elb[ jo9t & ! fibula4 ,! small bones ( ! ankle & wri/ z well z ( ! foot & h& are subject to _m dislocations :i* are easily disc]n$ ^u exam9ation & (t5 ov]look$4 ,special emphasis %\ld be giv5 9 reg>d to _m suppos$ diseases ( ! knee jo9ts :i* are really caus$ by lesions 9 ! sp9e or at ! hip jo9t4 ,o/eopa?ic ,prognosis ,ev]yone is ( ! op9ion t to =eca/ ! probable result ( a disease is "o ( ! mo/ difficult problems ! physician has to meet4 ,to /ate ! duration1 c\rse1 & t]m9ation ( an attack ( disease z pres5t$ by its nature & symptoms implies an accurate k ( bo? disease processes & *anges1 & an insight into ! individual's idiosyncrasies back$ by ripe cl9ical exp]i5ce4 ,& aft] ea* ( ^! factors has be5 c>efully consid]$ to balance "o aga9/ ! o!r1 no?+ %ort ( sup]human k may pres5t a suffici5t insight 9 ord] to r5d] an accurate prognosis4 ,a prognosis repres5ts ! culm9ation ( "o's le>n+1 an und]/&+ ( disease *>act]i/ics1 & an insight into temp]am5t4 ,c4 ,m4 ,t4 ,hulett#bi says3 8,only :5 we c "k all ! conditions1 causative & sequ5tial1 ) _! possible complications & t]m9ations1 toge!r ) a full hi/ory ( !rapeutic results 9 a l>ge numb] ( simil> cases1 & c>efully analyz+ & weigh+ ^! v>i\s elem5ts1 are we prep>$ to really make a prognosis40 ,nettie ,h4 ,bolles#cj writes z foll[s3 8,! prognosis dep5ds ^u ! cause ( ! disease1 ! possibility ( remov+ ! cause1 or ! likelihood ( recurr5ce ( causes1 & ! *ances ( avoid+ su* recurr5ce4 ,! circum/ances to modify ! outlook are v>i\s & des]ve c>eful consid]ation40 ,x is n ! purpose "h to g into ! _m ess5tial details1 = t w\ld mean an outl9e & =eca/ ( all disease processes1 & ! effect ( num]\s ext5uat+ circum/ances4 ,! m$ical pr(ession h be5 ga!r+ data = ^! ?ree ?\s& ye>s & prognosis ) !m is /ill inaccurate & incomplete4 ,o/eopa?ic sci5ce w add j s mu* to ! accuracy ( prognosis z ! sum total ( ! k display$ 9 ! fields ( o/eopa?ic etiology1 diagnosis1 pa?ology & !rapeutics4 ,suffice x to give "h a few sali5t practical h9ts z not$ 9 ! o/eopa?ic treat+ room & at ! b$side4 ,o/eopa?ically x may be said t prognosis dep5ds1 fir/1 ^u ! true conception ( o/eopa?y2 second1 ^u ! relative value ( all factors p]ta9+ to heal? & disease2 &1 ?ird1 ^u ! skill 7te*nique & native ability7 ( ! o/eopa?4 ,! fir/ & second be+ grant$1 ! ?ird includes a rem>kably practical & pregnant field1 = 9 no s*ool does ! physician get into z close t\* & und]/&+ ( ! actual condition ( ! pati5t's disord] z 9 ! o/eopa?ic4 ,al?\gh ! fundam5tals & pr9ciples ( ! o/eopa?ic conception ( diseases are really broad1 lib]al1 & all-inclusive1 /ill ow+ to ! fact t ea* individual 7& ?us ea* disease7 is m or less a law unto himself %\ld !re n be absolute tables & prescriptions to be gov]n$ by2 rememb]1 h[ev]1 ?is does n imply our fundam5tals are n basic or our pr9ciples are n tru?s1 b r ! application & execution ( ! same are z v>i$ z ! individual's con/itution1 temp]am5t1 & disease4 ,h]e9 re/s ! really difficult practical consid]ation ( etiology1 pa?ology1 diagnosis1 treatm5t1 & prognosis4 ,9 o!r words1 if ! diagnosis & treatm5t are accurate ! result re/s entirely ) ! pati5t4 ,fir/1 too mu* emphasis _c be plac$ ^u ! fact t prognosis is dep5d5t ^u ! o/eopa?--8 education1 tra9+1 ability1 exp]i5ce1 & te*nique4 ,"o's fitness is mo/ important4 ,& fitness & p]sonality complem5t ea* o!r4 ,an o/eopa? may "k !ory & /ill n be practical2 /ill "o _c be practical unless he kn[s !ory4 ,second1 o/eopa?ic treatm5t frequ5tly *anges ! usual c\rse ( acute disease4 ,x is well kn[n t _m diseases h a c]ta9 regul> c\rse 9 _! hi/ory4 ,_m times ! o/eopa? w be able to abort1 less5 ! sev]ity1 or cut %ort ! ailm5t1 ?us *ang+ ! recogniz$ symptoms & t]m9ation4 ,?ird1 ! knack ( treatm5t1 or kn[+ h[ to treat1 n only "o region ( ! body b all regions1 n only "o temp]am5t b all temp]am5ts4 ,f\r?1 ! prep>atory treatm5t be=e correct+ ! lesion4 ,prev5tion1 palliation1 or cure1 & ?us prognosis1 may be dep5d5t ^u a necess>y prep>atory treatm5t4 ,"h is :]e a /udy ( ! pati5t's temp]am5t is v ess5tial4 ,fif?1 a prolong$ treatm5t may defeat "o's purpose4 ,z a rule a comp>atively %ort1 ?or\ghly indicat$1 specific treatm5t is be/4 ,six?1 mu*1 relative to prognosis1 c be told by ! tone ( ! v]tebral ligam5ts4 ,:5 a lesion corrects too easily or does n rema9 well 9 place x %[s a lack ( tonicity on ! "p ( ! ligam5ts & muscles4 ,improvem5t is 9 direct ration to ! increase ( tonicity4 ,sev5?1 special c>e %\ld be tak5 ) ! irritable sp9e4 ,?is sp9e commonly prec$es ! debilitat$ sp9e4 ,unless precaution is tak5 to apply inhibition be=e treat+ specifically a cure may be prev5t$ or at lea/ ! disord] prolong$4 ,eigh?1 relaxation ( muscles is n always ess5tial1 al?\gh ! lack ( x may prev5t ! correction ( prim>y lesions4 ,! relaxation %\ld be c>ri$ out ) c>e 9 ord] t all %ock & irritation may be kept at a m9imum4 ,n9?1 ne$less /ret*+1 traction1 ext5d+1 rotation1 & snapp+ ( ! neck is n only useless b may be positively dang]\s4 ,r>ely is x necess>y to g ?r\gh ! above 8movem5ts0 z _m are accu/om$ to d4 ,t5?1 x may be necess>y1 b n always1 to give z additional treatm5t1 aft] ! anatomical defect has be5 specifically treat$1 a c]ta9 am\nt ( /ret*+ & m\ld+ ( ! p>ts4 ,elev5?1 ow+ to ! close p]sonal relations ( physician & pati5t1 p]sonality has a p[]ful influ5ce on prognosis4 ,twelf?1 too mu* emphasis _c be plac$ ^u ! uselessness & injuri\s effects ( ov] & misappli$ treatm5t4 ,all ( ! above h a positive be>+ on prognosis4 ,! o/eopa? %\ld /udy 8 te*nique well4 ,he w f9d t x gradually *anges & improves f ye> to ye>4 ,9 a ^w1 z he ga9s 9 exp]i5ce he w become m skillful by giv+ c>eful att5tion to ! developm5t ( ! s5se ( t\*1 by not+ ! resi/ance ( ! tissues1 & a score ( details t are v h>d to describe b ! sum total ( :i* det]m9es & indicates ! successful o/eopa?4 ,ano!r practical po9t t be>s ^u prognosis z well z ^u ! heal? ( ! o/eopa? is ! mann] ( giv+ treatm5t4 ,fir/1 ! height ( ! treat+ table %\ld correspond to ! height ( ! practition]4 ,! table %\ld be made = ! practition] & n ! practition] fitt$ & w>p$ accord+ to a c]ta9 table4 ,second1 give "p ( ! treatm5ts on a treat+ /ool4 ,"h !re is great] fre$om ( movem5t on ! "p ( ! pati5t1 h5ce great] & m effective lev]age c be obta9$4 ,suit y\r treatm5t to ! pati5t1 n y\r pati5t to ! treatm5t4 ,?ird1 make y\r weight c\nt = en]gy exp5d$ 9 ! treatm5t4 ,z soon z "o set ( muscles become tir$ sub/itute ano!r set1 e4 g41 ! back muscles & ! arms1 ! arms & ! h&s4 ,f\r?1 :5ev] possible sub/itute ! weight ( ! pati5t = exp5d$ en]gy4 ,fif?1 :5 lift+ keep ! sp9al column /raight2 d ! b5d+ ( ! body at ! knees4 ,h5ce a bett] treatm5t & a m favorable prognosis1 & besides t new occupation neurosis1 ! 8o/eopa?ic back10 w be mat]ially less5$ 9 bo? sev]ity & frequ5cy4 ,,footnotes3 #bf ,see ,tubby1 ,de=mities4 #bg ,cl>k's ,appli$ ,anatomy1 p4 #ccd4 #bh ,cl>k's ,appli$ ,anatomy1 p4 #cca4 #bi ,prognosis--,j\rnal ( ! ,am]ican ,o/eopa?ic ,association1 ,jan41 #aijf4 #cj ,prognosis--,j\rnal ( ! ,am]ican ,o/eopa?ic ,association1 ,nov41 #aijb4 ,,o/eopa?ic ,,te*nique ,! te*nique ( treatm5t is1 9 a s5se1 a p]sonal factor1 = x is a well kn[n fact no two o/eopa?s treat j alike4 ,nev]!less1 ! pr9ciples ( te*nique are con/ant & univ]sally applicable1 & he :o applies !m ) specificity manife/ly secures ! be/ results1 & exhibits a te*nique t is f9i%$ & *>act]i/ically o/eopa?ic4 ,g5]al manipulations are n ess5tially o/eopa?ic1 al?\gh by employ+ !m a few def9ite results may be obta9$2 /ill su* te*nique %\ld n be class$ z di/9ctive o/eopa?ic !rapy4 ,e case is a law unto itself & mu/ be /udi$ individually 9 ord] to be able to und]/& x p]fectly4 ,s mu* dep5ds ^u ! ability ( ! o/eopa? 9 ! treat+ ( a case1 t 9 ord] to meet ! indications intellig5tly he mu/ h comm& ( ! v>i\s anatomical details ( ! body1 n only 9 8 m9d b ^u 8 f+] tips4#ca ,! s5se ( t\* %\ld be v acutely develop$ & ?is requires mon?s ( p]si/5t1 practical exp]i5ce4 ,a c>efully educat$ s5se ( t\* is ! keynote to bo? o/eopa?ic diagnosis & op]ative te*nique4 ,f ! v nature ( ! o/eopa?ic conception--! physical body view$ z a me*anism ^: disord]$ or diseas$ conditions dem& anatomical readju/m5t--x is imp]ative t a delicate & educat$ s5se ( t\* be acquir$ 9 ord] to logically & successfully apply its t5ets4 ,pr(ici5cy means n only be+ able to note c]ta9 small physical irregul>ities1 & v>i\s degrees & areas ( muscul> contractions1 & v>iations 9 body temp]ature1 b ! ext5t & /ate ( vital resi/ance1 t is1 tissue condition1 & ! feel+ ( organic resi/ance1 e4 g41 ! he>t1 lungs1 liv]4 ,^! are ! special features :]e9 o/eopa?ic f+]s detect disease causes & traces4 ,to "k ! diff]5ce betwe5 normal & abnormal /ructural deviations & di/ortions1 z well z organic *anges1 requires an accurate1 detail$ k ( anatomy & pa?ology ) a sy/ematic daily education ( ! s5se ( t\*2 b to realize1 appreciate & "k by tissue resi/ance feel+ t nutritional condition is improv+ requires mu* m practical exp]i5ce4 ,?us two v practical po9ts %\ld be taught to & ?or\ghly impress$ ^u e o/eopa?ic /ud5t3 ,fir/1 ! s5se ( resi/ance ( ! tissues4 ,?is gives u an absolute clue to ! vitality ( ! pati5t4 ,z has be5 /at$1 !re is a va/ diff]5ce betwe5 ! feel1 ! s5se ( resi/ance1 ( normal & abnormal tissues2 = in/ance1 a normal muscle & a contractur$ muscle1 a normal liv] & a conge/$ liv]1 a normal inte/9e & a prolaps$ inte/9e & ^! diff]5ces comprise innum]able gradations4 ,second1 ! receptivity ( ! pati5t to treatm5t4 ,?is is dep5d5t ^u ! vitality ( ! tissues4 ,! s5se ( resi/ance to t\* gives u an important diagno/ic clue2 ! receptivity ( ! pati5t to treatm5t tells u mu* z to prognosis4 ,aft] a few treatm5ts ! receptiv5ess w be positive or negative2 t is1 ! pati5t is1 or is n1 respond+ to treatm5t4 ,consequ5tly ! receptivity ( ! pati5t usually tells mu* z to ! /ate ( nutrition4 ,def9ite pr9ciples %\ld be foll[$ :5 apply+ ! te*nique1 = ! o/eopa?ic lesion is a 8/ructural p]v]sion10 ?us indicat+ me*anical readju/m5t = its correction4 ,! "t is com+ :5 ! te*nique w be taught graphically & ma!matically4 ,?is w\ld n be a difficult ?+ to d1 & x c\ld n b prove invaluable aid to ! /ud5t4 ,he c !n ! m readily & compreh5sively grasp ! pr9ciples involv$4 ,to resolve & illu/rate manipulative readju/m5t to & by ! pr9ciples ( me*anics w\ld add consid]able to o/eopa?ic developm5t4 ,= example1 h[ nicely ! correction ( c]ta9 innom9ata maladju/m5ts illu/rates ! pr9ciple ( ! :eel & axle4 ,v]tebral & rib displacem5ts :5 readju/$ make application ( ! pr9ciples ( ! simple ma*9es4 ,we are gradually approa*+ a m compreh5sive und]/&+ ( ! physiologic movem5ts ( ! sp9e & ( ! etiologic role ( muscle t5sion4 ,?is is "p ( ! f\ndation "w4 ,great c>e mu/ be ex]cis$ 9 correlat+ ?is data ) ! individual case1 = 9 !rapy we are deal+ ) abnormalities--n alone normal physiologic *anges4 ,if our di/9ctive dynamics & !rapeutics 7 taught 9 ?is mann] ! av]age o/eopa? w\ld be m specific & compreh5sive 9 8 "w & z a consequ5ce m sci5tific4 ,& consequ5tly ! pr9ciples involv$ 9 ea* & e case w\ld /& out cle>ly4 ,h5ce diagnosis w\ld be m exact1 r\t9e pommel+ disc>d$1 & bett] all ar\nd te*nique execut$4 ,two g5]al rules are applicable to all dislocations1 :e!r p>tial or complete3 #a4 ,exagg]ate or increase ! dislocation4 ,?is is to relax ! tissues ab\t ! dislocat$ articulation & to dis5gage ! articul> po9ts t h become lock$4 #b4 ,r$uce ! dislocation by retrac+ ! pa? along :i* ! p>ts 7 dislocat$4 ,h5ce to correct a lesion1 = example1 a v]tebral lesion3 7#a7 ,exagg]ate ! lesion4 7#b7 ,place ! f+]s ( ! h& t are n employ$ 9 exagg]at+ ! lesion ov] ! ext5d$ portion ( ! lesion4 7#c7 ,ext5d ! region t is flex$ :5 ! lesion 0 exagg]at$4 7#d7 ,:5 ! lesion is be+ ext5d$ produce traction & slight rotation ( ! region4 7#e7 ,at ! same "t ext5sion1 traction & rotation is be+ produc$ pu% 9 ^u ! ext5d$ portion ( ! lesion4 ,to ?is might be add$ = sake ( cle>ness & great] assurance ( success3 7a7 ,be positive ! focal po9t absolutely corresponds to ! lesion1 or else mo/ if n all ( y\r ef=t w be useless4 7b7 ,j be=e rea*+ ! maximum ( exagg]ation h y\r f+]s correctly plac$ = ! readju/m5t1 & at ! v mom5t ( maximum exagg]ation or j a fraction ( a second prior beg9 to correct or readju/1 or else y w lose ! vantage ga9$ & ! op]ation w probably be a failure4 7c7 ,! g5]al traction & rotation are to aid 9 unlock+ ! lesion1 n to readju/ z "s may ?9k4 ,inhibit+ & releas+ ! s(t tissues1 su* z spasms1 contractions & contractures ( muscles1 & /ret*+ ?ick5$ & adh]5t ligam5ts is v important prelim9>y "w4 ,!n1 next to secur+ exact lev]ages an ess5tial po9t is to ma9ta9 ! release or exagg]ation until ! readju/+ /ep is incept$4 ,9 o!r words1 coord9ation ( all factors is ! desid]atum4 ,! lack ( ?is is ! cause ( _m failures4 ,hot fom5tations frequ5tly assi/ 9 relax+ irritable & spa/ic s(t tissues4 ,?is1 h[ev]1 is b a prelim9>y measure4 ,all r\gh h&l+1 ne$less snapp+ ( p>ts1 & excessive rotation & /ret*+ are n only apt to tight5 ! lesion m1 %ock ! sy/em & irritate ! p>ts1 b x may be absolutely dang]\s4 ,x %\ld n be =gott5 t ! o/eopa? includes _m measures 9 8 treatm5t ( v>i\s diseases1 z nurs+1 diet+1 hygi5e1 sanitation1 hydro!rapy1 antidotes1 antiseptics1 etc41 & does n dep5d ^u readju/ive manipulation alone1 al?\gh correct+ disord]$ anatomical /ructures & p]v]sions are p>am\nt 9 ! treatm5t4 ,! ,g5]al ,treatm5t4--,a g5]al treatm5t b acc5tuates ! ignorance1 9 a majority ( cases1 ( _m s-t]m$ o/eopa?s4 ,x is a deplorable fact t !re is a t5d5cy among "s o/eopa?s to give g5]al treatm5ts 9 e case pres5t$4 ,! only explanation ( su* a proc$ure t "o c ?9k ( is a lack ( conception z to :at o/eopa?y really is4 ,to give a g5]al treatm5t 9 e case is n only actually detrim5tal to ! pati5t b x is ! height ( folly on ! o/eopa?'s "p1 = x gets him into a slov5ly habit ( proc$ure f bo? sci5tific & curative po9ts ( view1 besides giv+ ! outside _w an impression t o/eopa?y is b little diff]5t f massage & ,sw$i% movem5ts in/ead ( skillful1 me*anical eng9e]+ ( ! human body4 ,b a 8g5]al treatm5t0 is n to be confus$ ) def9ite att5tion to be a s]ies ( m or less int]relat$ lesions4 ,! ess5tial po9t is to normalize ! body :5 & :]e di/9ctly indicat$ & aft] a skillful mann]4 ,a g5]al treatm5t1 broadly speak+1 %\ld be giv5 only "u ?ree conditions3 7#a7 ,con/itutional diseases t are to be treat$ symptomatically4 7#b7 ,c]ta9 anemic cases4 7#c7 ,:5 "o is ignorant ( ! real cause ( ! disease4 ,ea* ( ^! conditions is self-evid5t :y a g5]al treatm5t %\ld be giv54 ,a f\r? might be add$1 = ^? individuals :o ?9k !y are n gett+ value receiv$ unless !y are treat$ f head to foot4 ,su* pati5ts are usually ignorant ( ! philosophy ( o/eopa?y & x is ! o/eopa?'s duty to tea* !m diff]5tly4 ,! g5]al treatm5t consi/s 9 /ret*+ ! sp9al column f ! atlas to ! coccyx & relax+ all contract$ muscles along bo? sides ( ! sp9al column1 besides giv+ special treatm5t to ! c]vical region1 betwe5 ! scapul1 ! splan*nics & int]nal & ext]nal rotation ( ! legs4 ,x is no wond] t fake o/eopa?s d cure a case occasionally4 ,!y are q c]ta9 to correct "s disord] by pull+ & haul+ a pati5t ar\nd 9 su* a mann]4 ,/ill on ! o!r h& !y are v likely to d injury to ! pati5t4 ,^? :o claim t no injury c come f o/eopa?ic treatm5t are mi/ak54 ,"o c injure a p]son by treatm5t if he is n c>eful4 ,x does n /& to reason t ! mo/ delicately con/ruct$ me*anism %\ld /& any am\nt ( manipulation & misdirect$ =ce t may be giv5 x4 ,positions ( ! ,pati5t & ,physician 9 ,treat+4--,! position ( ! pati5t :5 a treatm5t is giv5 dep5ds altoge!r ^u ! affection to be treat$4 ,probably ab\t "o-half ( ! cases c be treat$ to advantage ^u a table1 ! rema9d] sitt+ on a /ool4 ,_m o/eopa?s treat ne>ly all _! pati5ts ^u a table4 ,x is mu* bett] to *ange back & =?1 because to correct a c]ta9 disord] may be h>d ^u ! table1 b w be comp>atively easy :5 ! pati5t is on a /ool1 & vice v]sa4 ,besides1 con/antly *ang+ back & =? re/s a physician greatly4 ,le>n to treat 9 v>i\s positions1 because x w be impossible to h all cases assume a c]ta9 position :5 be+ treat$2 & especially 9 treat+ acute cases "o is oblig$ to suit 8 treatm5t to ! pati5t & n ! pati5t to ! treatm5t4 ,!re is also a t5d5cy = "o to get into slov5ly habits ( treat+ :5 pati5ts are all plac$ practically 9 "o position1 & c]ta9ly "o _c treat all cases 9 "o position to equal advantage4 ,also le>n to treat z well ) "o h& z ! o!r4 ,_m times "o w be 9 su* positions t equal use ( ei!r h& w be requir$4 ,c>efully educate ! s5se ( t\* 9 bo? h&s4 ,ano!r po9t %\ld receive consid]ation3 le>n to %ift ! /r5g? ex]t$ 9 treat+ f "o set ( muscles to o!rs4 ,= example1 :5 "o is /&+ = a long "t he w cont9ually %ift 8 weight f "o limb to ! o!r4 ,9 ! same mann] 9 treat+ use ! /r5g? ( ! h&s a:ile1 !n ! arms1 !n ! muscles ( ! back1 !n ! weight ( ! body1 etc42 all 9 su* a mann] t !re is a con/ant *ange by utiliz+ c]ta9 gr\ps ( muscles = ! same "w1 z well z utiliz+ ! weight ( ! body ( bo? physician & pati5t to advantage4 ,x re/s a physician greatly & ?us all[s him to p]=m a maximum am\nt ( "w ) a m9imum am\nt ( /r5g? & labor4 ,x is frequ5tly an advantage to ! physician to treat ^u ! nude sk91 ?us prev5t+ ! f+]s f becom+ t5d]4 ,g[ns c be easily made t op5 d[n ! back s t ! pati5t does n h to disrobe4 ,! ,neck & ,head4--,9 ! treatm5t ( ! neck ! pati5t may assume ! sitt+ po/ure or lie flat ^u ! back4 ,! latt] is pref]able1 z !n "o has complete control ( ! neck & head4 ,absolute control ( a "p is always necess>y & :5 ?is is secur$ ! dang]s are r$uc$ to a m9imum1 provid$ always t reasonable discretion z to ! am\nt ( /r5g?1 is us$4 ,be=e correct+ ! v>i\s deviations ( ! c]vical v]tebr x is usually be/ to ?or\ghly relax all ! muscles1 sup]ficial & deep1 ab\t ! field ( op]ation4 ,9 relax+ muscles ?ree me?ods may be employ$4 ,! muscle may be firmly grasp$ & manipulat$ until relax$1 or a firm pressure may be ex]t$ ^u ! muscle & ?us inhibit its n]ve =ce until ! muscle relaxes1 or ! muscle may be longitud9ally /ret*$4 ,! second me?od is comp>atively sl[ & is usually giv5 9 acute cases :]e ! pati5ts are s weak & exhau/$ t !y _c /& any sev]e manipulation4 ,?is me?od1 h[ev]1 has c]ta9 advantages :5 employ$ z a prep>atory /ep 9 int]osse\s adju/m5ts1 ?\gh /eady traction accompani$ ) slight rotation1 if precisely localiz$1 has _m advocates4 ,9 relax+ muscles by manipulation1 grasp firmly ! belly ( ! muscle & draw outw>d on ! muscle sev]al times until x relaxes4 ,if ! pati5t is sitt+1 place "o h& ^u ! head ( ! pati5t or ab\t ! *9 9 su* a mann] t complete control ( ! head is ma9ta9$ ?r\gh\t ! proc$ure2 !n ) ! f+]s ( ! o!r h& ^u ! contract$ muscul> fibres a manipulat+ or knead+ ( ! muscle c be giv54 ,x is be/ to flex ! neck & head to ! side :]e ! contract$ muscles are1 s t a bett] hold ( ! muscle may be ma9ta9$2 !n by a s]ies ( flexions & ext5sions ) manipulation ( ! contract$ muscles outw>d1 results c be readily obta9$4 ,:5 ! pati5t is ly+ on ! back ! physician may /& to "o side ( ! pati5t's head & ) "o h& on ! =ehead ( ! pati5t & ! o!r h& ar\nd ! opposite side ( ! neck1 a rot>y motion ( ! head & neck1 :i* is equal to flexion & ext5sion 9 ! sitt+ po/ure1 may be giv5 by ! h& on ! frontal region :ile ! o!r h& relaxes ! muscles2 or ! o/eopa? may /& at ! head ( ! pati5t & ) ei!r h& on ! side ( ! head & neck ( ! pati5t a s]ies ( rot>y movem5ts ( ! head & neck may be giv5 ) manipulation ( fir/ "o side ( ! neck & !n ! o!r2 ! h&s & f+]s be+ plac$ 9 su* a mann] t :5 ! f+]s ( "o h& are relax+ ! muscles on its side ! o!r h& is execut+ ! movem5ts ( ! head & neck1 ea* h& cont9ually alt]nat+ 9 ! "w4 ,?is latt] me?od requires "s practice 9 ord] to d ! "w readily & successfully1 = q a v>iety ( movem5ts are requir$4 ,9 ! =m] me?od aft] "o has work$ on "o side he is oblig$ to *ange to ! o!r side & g ?r\gh ! same process4 ,movem5ts may also be giv5 to /ret* ! contract$ muscles1 ?us ov]com+ ! contraction & produc+ relaxation ( ! muscles4 ,aft] hav+ relax$ ! muscles ov] ! field ( op]ation1 correct+ ! v]tebr w g5]ally be easi] to accompli%4 ,9 readju/+ an atlas x matt]s b little :e!r ! pati5t is sitt+ up or ly+ d[n4 ,a firm hold ( ! atlas c be gott5 9 ei!r in/ance4 ,9 correct+ ! middle & l[] c]vical v]tebr x is be/ to place ! pati5t ^u ! back4 ,9 correct+ dislocations1 z h]et(ore sugge/$1 two g5]al rules %\ld be foll[$3 7#a7 ,exagg]ate or increase ! dislocation4 ,?is is to relax ! tissues ab\t ! dislocat$ articulation & to dis5gage ! articul> po9ts t h become lock$4 7#b7 ,r$uce ! lesion by retrac+ ! pa? along :i* ! p>ts 7 dislocat$4 ,"o c readily see t a dislocat$ ball & socket jo9t c\ld be r$uc$ only by ! dislocat$ bone retrac+ ! pa? by :i* x left its socket1 = ! capsul> ligam5t w\ld at once prev5t its return+ to ! socket by any pa? o!r ?an t tak5 :5 dislocat$4 ,?is applies to all dislocations to a great] or less ext5t4 ,aft] locat+ ! exact position ( ! abnormal v]tebra ! fir/ rule is appli$1 i4 e41 exagg]at+ ! lesion by flex+ ! head 9 ! opposite direction to :i* ! v]tebra is dislocat$4 ,!n ) "o or two f+]s plac$ firmly ^u ! side ( ! v]tebra 9 ! direction dislocat$1 s t :5 ! prop] "t comes ! v]tebra may be pu%$ or slightly rotat$ back into its normal position1 ) ! o!r h& produce flexion ( ! neck1 s t ! angle ( flexion is exactly ov] ! involv$ v]tebra2 next produce slight traction1 s z to be sure t ! articul> po9ts w be dis5gag$2 & !n ) rotation & ext5sion ( ! head to a normal or upright po/ure1 at ! same "t pu%+ 9 on ! disord]$ v]tebra1 are ! movem5ts to be execut$ 9 r$uc+ a dislocat$ v]tebra4 ,x takes consid]able practice to be able to correct a v]tebra & to "k :5 x is correct$4 ,! am\nt ( =ce appli$ v>ies greatly 9 diff]5t cases4 ,cases ( rec5t subdislocation require b little =ce unless !re is m>k$ spa/icity ( tissue1 :ile 9 long /&+ cases _m times ! am\nt ( =ce requir$ is ab\t all t "o wi%es to ex]t4 ,z a rule 9 _m *ronic cases x is bett] to give a s]ies ( prep>atory treatm5ts 9 ord] to r$uce muscle fibrosis & ?ick5+ ( capsul> ligam5t4 ,rememb] t (t5 x is a slight rot>y movem5t or twi/ giv5 t aids ! mo/ 9 execut+ rule second4 ,no matt] to :at position a v]tebra is rotat$ or side-b5t ! pr9ciples appli$ are ! same 9 ea* case4 ,be v c>eful :5 flex+1 ext5d+ or rotat+ ! neck t too mu* /ra9 is n br\ght to be> ^u ! ligam5ts4 ,"s o/eopa?s seem to take delight 9 rotat+ & flex+ ! neck to a great degree4 ,x is a dang]\s proc$ure & moreov] does n accompli% any?+ 9 p>ticul>4 ,x %\ld be kept 9 m9d t o/eopa?ic treatm5t is sci5tific & n a numb] ( g5]al movem5ts ( v>i\s regions ( ! body4 ,locate ! lesions exactly & !n a specific treatm5t c be giv5 9 e in/ance4 ,to illu/rate ! treatm5t accord+ to ! prec$+ rules we w assume t a c]ta9 c]vical v]tebra is ant]ior1 say ! f\r? c]vical4 ,?is means t !re is an int]osse\s lesion betwe5 ! f\r? & fif?4 ,! inf]ior articul> processes & facets ( ! f\r? h slipp$ upw>d & =w>d on ! oppos+ facets ( ! fif?4 ,fir/1 hyp]ext5d ! head 9 su* a mann] t ! fulcrum comes exactly ov] ! displac$ articulat+ planes1 ?us ?r[+ ! f\r? v]tebra /ill m ant]ior1 or 9 o!r words1 exagg]at+ ! lesion or increas+ ! space ant]iorly betwe5 ! f\r? & fif? c]vicals1 s t :5 ! head is flex$ =w>d & pressure is ex]t$ ^u ! ant]ior "p ( ! v]tebra 7body or transv]se process7 ! v]tebra w h room & release en\gh to occupy its normal position4 ,second1 :5 ! head is hyp]ext5d$ place a f+] ant]ior to ! transv]se process ( ! dislocat$ v]tebra & ) ! o!r h& ar\nd ! head1 t is produc+ ! hyp]ext5sion1 ?r[ ! head =w>d ) slight traction & rotation & at ! same "t pu% po/]iorly q /rongly ^u ! dislocat$ v]tebra4 ,foll[ out ! same pr9ciples 9 all cases1 no matt] 9 :i* way ! v]tebr are d]ang$4 ,!re are sev]al me?ods ( apply+ ! und]ly+ pr9ciples ( adju/m5t4 ,relaxation & lev]ages may be secur$ 9 v>i\s ways4 ,precis5ess1 exp$iti\sness & skillfulness c be atta9$ only by consid]able p]sonal exp]i5ce4 ,9 cases :]e ! lesion is betwe5 ! skull & atlas h ! pati5t sit on a /ool ) ! back "p ( 8 head aga9/ y\r *e/1 & rea* ar\nd ! head ) "o h& "u ! *92 !n ) ! o!r h& ar\nd ! transv]se processes ( ?ree or f\r upp] c]vical v]tebr pull ! sp9al column t[>d ! m$ian l9e1 :ile at ! same "t lift+ up on ! skull ) ! o!r h& & ?r[+ ! skull t[>d ! m$ian l9e4 ,! object ( lift+ up on ! skull is to relax & dis5gage ! articulations1 by inhibition1 traction & rotation1 betwe5 ! occipital bone & atlas4 ,?is is "o me?od applicable to ! v>i\s lesions ( ! occiput1 :i* are ( frequ5t occurr5ce4 ,9 treat+ ! ph>ynx1 tonsils & l>ynx1 outside ( correct+ sp9al lesions1 an ant]ior treatm5t to ^! organs is v effective4 ,exam9e ! deep muscles b5ea? ! angle ( ! jaw :5 ! ph>ynx & tonsils are involv$2 & :5 ! l>ynx is affect$ note ! condition ( ! muscles on ei!r side ( ! l>ynx4 ,aft] locat+ deeply seat$ contract$ muscles 9 ! region ( ! angle ( ! inf]ior maxilla place ! f+]s ov] ! contract$ tissues1 & !n by a d[nw>d1 inw>d sweep+ motion t[>d ! m$ian l9e ! muscles may be readily relax$4 ,:5 treat+ ! l>ynx relax ! tissues on bo? sides by an upw>d1 inw>d movem5t4 ,^! treatm5ts are v effectual :5 appli$ directly to ! disord]$ tissues4 ,att5tion %\ld also be giv5 to ! lymphatics4 ,9 simple infections treat ! gl&s v lightly b attempt to break d[n ! surr\nd+ edemat\s b>ri]4 ,release all ! tissues d[n to & includ+ clavicles1 fir/ ribs & pectoral & axill>y regions4 ,to treat slight lesions ( ! inf]ior maxill>y articulation1 /& at ! head ( ! pati5t :5 he is ly+ d[n & hook ! f+]s ab\t ! jaw j 9 front ( ! angles1 & ) ! ?umbs ov] ! bridge ( ! nose h ! pati5t op5 ! m\? :ile consid]able =ce is ex]t$ aga9/ 8 ef=t4 ,?is r$uces any slight dislocation ( ! inf]ior maxilla4 ,:5 ! jaw is completely dislocat$ place a piece ( wood or h>d sub/ance betwe5 ! mol>s & ex]t pressure upw>d & backw>d on ! *94 ,if ! dislocation is bilat]al "w on "o side at a "t4 ,! object ( treatm5t to ! face is to /imulate or inhibit po9ts ( ! fif? n]ve t come ne> ! surface 7see neuralgia ( fif? n]ve74 ,:ile ! pati5t is ly+ flat ^u ! back c>efully /imulate ^! v>i\s po9ts1 especially ! supraorbital & nasal1 ) a d[nw>d & outw>d movem5t1 or inhibit z indicat$4 ,9 treat+ ! scalp relax ! muscles ov] ! scalp ?or\ghly4 ,?is is second>y treatm5t to correct+ ! inn]vation to ! scalp at ! upp] f\r or five c]vical v]tebr4 ,9 cases ( ph>yngitis1 tonsillitis1 cr\p1 hay fev]1 etc41 an effective local treatm5t may be giv5 ?r\gh ! m\? ^u ! s(t & h>d palate4 ,introduc+ a f+] into ! m\? cle> back ^u ! ro( ( ! s(t palate1 & ) a d[nw>d & backw>d sweep+ movem5t f ! m$ian l9e on ei!r side t[>d ! tonsils1 consid]able relief c be giv5 ! pati5t4 ,?is treatm5t relaxes ! tissues1 relieves ! conge/ion1 & gives a /imulat+ treatm5t to ! local n]ves4 ,a treatm5t ( ! same nature may be giv5 ov] ! h>d palate to affect ! palat9e n]ves1 especially 9 hay fev]1 :5 ! it*+ ( ! palate & sneez+ are extreme4 ,9 cases ( "y *ildr5 x is be/ to protect ! f+] by wrapp+ a piece ( clo? ar\nd x4 ,an o/eopa? %\ld nev] give a manipulation or movem5t unless he und]/&s :y4 ,j z soon z "o gives g5]al imitat+ movem5ts1 f t mom5t 8 "w is n t ( a sci5tific o/eopa?1 b ( a ,sw$i% movem5t curi/ & masseur & a poor "o at t4 ,! o/eopa?'s "w is to locate ! anatomical d]angem5t & correct x1 z a me*anic w\ld adju/ any disord]$ me*anism4 ,g5]al treatm5t am\nts l>gely to naught1 al?\gh 9 "s few in/ances x is ( b5efit4 ,to give a detail$ description ( ! treatm5t ( all lesions t may be f\nd 9 ! c]vical v]tebr w\ld be impossible 9 ?is sket*2 only a g5]al survey ( ! "w c be giv54 ,ea* case calls = special treatm5t1 b ! same g5]al pr9ciples are applicable 9 ea* case4 ,if !re is any "o ?+ t %\ld be elim9at$ f o/eopa?ic treatm5t x is ^? me*anical r\t9e movem5ts ( rotat+1 flex+1 ext5d+1 & v>i\s ,sw$i%-movem5t-massage-l manipulations t c]ta9 o/eopa?s give 9 ea* & e case4 ,x %[s t !y are imitators & d n h a correct conception ( o/eopa?ic !rapeutics4 ,true x is1 t r\t9e movem5ts w h /imulat+ & o!r effects ^u ! sy/em4 ,b does ! body require su* treatm5t8 ,is x lack ( ex]cise on ! "p ( ! pati5t8 ,if x is1 !n let ! pati5t ex]cise himself4 ,y d n want to l[] y\rself to be a m]e 8eng9e wip]10 or an ex]cis]4 ,if x is n ! lack ( ex]cise & ! sy/em is 9 ne$ ( c]ta9 treatm5t1 !n seek ! cause & apply a specific treatm5t4 ,d n hide beh9d g5]alities4 ,! ,ribs4--,9 correct+ dislocat$ ribs _m me?ods may be employ$1 b all are subject to ! same pr9ciples z giv5 "u ! treatm5t ( ! neck & head4 ,"o ( ! be/ me?ods to correct typical ribs is to h ! pati5t ^u ! side ) ! side ( ! affect$ ribs upw>d4 ,f9d out exactly ! nature ( ! dislocation1 i4 e41 :at is ! relation ( ! dislocat$ rib to ! o!r tissues4 ,note :e!r ! rib is upw>d1 d[nw>d1 inw>d or =w>d1 locate exactly ! dislocat$ rib4 ,!n1 :ile /&+ back ( ! pati5t1 place y\r f+]s ^u bo? ends ( ! rib4 ,place y\r f+]s 9 su* a mann] t :5 ! prop] "t 9 ! proc$ure arrives1 all t w be necess>y w be to pu% ! ends ( ! rib into _! articulations4 ,= in/ance1 if ! rib is rais$ ant]iorly & l[]$ po/]iorly1 y w place ! f+]s on ! /]nal end1 above ! affect$ rib & ! f+]s on ! v]tebral end1 bel[ ! rib1 s t :5 ! rib has be5 releas$ f its abnormal position x may be slipp$ into normal position4 ,aft] hav+ plac$ ! f+]s 9 ! exact position necess>y1 h an assi/ant take ! arm & draw x obliquely across ! face1 :ile at ! same "t ! pati5t takes a =c$ inhalation4 ,! object ( draw+ ! arm across ! face & ! deep inhalation is to exagg]ate ! lesion--to draw ! ribs out ( _! lock$ position--s t ! f+]s ^u ei!r end ( ! rib may pu% ! rib into normal position4 ,draw+ ^u ! arm raises all ! upp] ribs z well z ! dislocat$ typical rib1 pr9cipally by ! use ( ! s]ratus magnus2 also inhalation has an effect to ?r[ ! rib outw>d & upw>d & ?us away f its articulation4 ,?us aft] ! lesion has be5 increas$ suffici5tly to loos5 ! rib f its abnormal position1 ! arm is relax$1 ! pati5t exhales1 & ! f+]s ^u ! ends ( ! rib correct ! dislocation4 ,?is treatm5t is us$ to ! greate/ advantage :5 !re is a dislocation ( a typical rib2 x c be giv5 :ile ! pati5t is ly+ d[n or sitt+ up1 al?\gh ! =m] position is pref]able4 ,an excell5t me?od1 :5 ! /]nal end ( ! rib is dislocat$ is to h ! pati5t sit ^u a /ool ) 8 back t[>d ! physician2 !n by plac+ ! knee 9 ! back 7:ile /&+ up1 or easi] /ill = ! physician to sit ^u an op]at+ table back ( ! pati5t7 ov] ! v]tebral end ( ! rib s t ! rib may be held rigid po/]iorly1 rea* ar\nd ) "o h& ov] ! dislocat$ end ( ! rib & place ! f+]s ^u ! rib 9 ! direction dislocat$2 s t :5 ! rib is suffici5tly releas$ f its abnormal position x c be readily pu%$ into place2 !n ) ! o!r h& "u ! axilla ( ! arm on ! affect$ side1 pull up & back on ! %\ld]1 s t ! rib may be pull$ away f its /]nal articulation2 & at ! same "t h ! pati5t take a deep inhalation s z to aid 9 ?r[+ ! rib outw>d1 upw>d & away f its /]nal atta*m5t2 !n :5 ! end ( ! rib has be5 releas$ suffici5tly1 relax ! hold und]nea? ! axilla1 h ! pati5t exhale1 & slip ! rib into its normal position by ! f+]s ov] ! end ( ! rib4 ,?is is an excell5t me?od4 ,x is easy to give & does ! "w admirably4 ,practically ! same proc$ure may be gone ?r\gh :5 ! v]tebral end is dislocat$1 by *ang+ y\r position to ! front ( ! pati5t1 b !re is dang] ( ! knee slipp+ (f f ! /]num dur+ ! op]ation & injur+ ! ribs4 ,sev]al o!r treatm5ts may be giv5 to correct dislocations ( ! v]tebral ends ( ! ribs4 ,= example1 :ile ! pati5t rema9s sitt+ ! o/eopa? /&s 9 front ( ! pati5t & rea*es ar\nd bo? sides ^u ! angle ( ! ribs2 !n ) an outw>d & upw>d movem5t ( ! f+]s ^u ! angle ( ! ribs1 !y are pull$ away f _! lock$ position & all[$ to slip into normal articulation4 ,?is treatm5t is applicable only :5 ! ribs are dislocat$ d[nw>d1 b x is "o ( ! be/ treatm5ts = su* cases4 ,ano!r me?od (t5times employ$ 9 correct+ dislocations ( ! v]tebral end ( ! ribs is to h ! pati5t lie flat ^u ! side ) ! affect$ side upw>d2 !n by flex+ ! arm on ! =e>m & plac+ ! elb[ aga9/ ! *e/ or abdom5 rea* ov] ! pati5t ^u ! angle ( ! dislocat$ rib & pull x away f ! v]tebra2 :5 x is pull$ away f ! sp9al column suffici5tly1 pu% upw>d or d[nw>d on ! angle ( ! ribs1 z ! case may dem&4 ,! elb[ plac$ aga9/ y gives complete control ( ! pati5t & aids1 by y\r weight1 9 ?r[+ ! rib upw>d or d[nw>d4 ,a treatm5t some:at l ! prec$+ "o :i* is commonly employ$1 is to rea* und]nea? ! pati5t's upp] arm1 :5 he is ly+ ^u 8 side1 ) ! arm ext5d$ upw>d across ! face2 !n by plac+ ! f+]s ( ! h& und]nea? ! pati5t's arm ov] ! angles ( ! affect$ rib or ribs & re9=c+ ! h& by ! f+]s ( ! o!r h& an upw>d1 outw>d & rot>y movem5t c be giv5 ! ribs1 :i* pulls !m out ( _! abnormal position & all[s !m to return to _! normal articulations4 ,an effectual treatm5t to spread & raise ! upp] ribs is to h ! pati5t flat ^u ! back1 & ) ! f+]s ( "o h& und]nea? ! angles ( ! ribs & ! o!r h& ^u ! elb[ ( ! pati5t's arm ( ! same side ?r[ ! pati5t's arm across ! *e/ transv]sely & be> d[n ^u ! elb[1 at ! same "t spr+ upw>d & outw>d on ! angles ( ! ribs ) ! o!r h&4 ,by ?r[+ ! arm across ! *e/ & be>+ d[n ^u ! elb[ a /rong lev]age c be obta9$ ^u ! upp] ribs1 especially ^? betwe5 ! scapul4 ,?is treatm5t is v efficaci\s 9 c]ta9 lung & he>t diseases4 ,/ill ano!r me?od ( adju/+ ribs is to h ! pati5t flat on 8 face ^u an op]at+ table ) ! arms hang+ d[n on bo? sides ( ! table & a small pill[ or fold$ blanket b5ea? ! upp] "p ( ! *e/2 !n /&+ beside ! table1 or bett] /ill1 ) "o foot ^u a l[ /ool & ! knee ( ! o!r limb ^u ! table 9 su* a mann] t "o is directly ov] ! pati5t's dorsal region "o is !n 9 a position to h full control ( ! v]tebral end ( ! ribs4 ,if ! ends ( ! ribs are displac$ d[nw>d1 plac+ ! ?umbs ov] ! angles ( ! ribs & pu%+ upw>d & outw>d on ! angles1 ! ribs c be v readily cr[d$ into position4 ,if ! ribs1 especially betwe5 ! scapul1 are dislocat$ 9 any direction1 !y may be q readily correct$ by plac+ ! h& ov] ! %\ld] po/]iorly & ?r[+ x outw>d & upw>d & away f ! sp9al column 9 su* a mann] t ! ribs are pull$ away f ! abnormal position2 !n ^u relax+ ! hold ^u ! %\ld] ) ! "o h&1 ! f+]s ( ! unemploy$ h& may pu% upw>d or d[nw>d1 z ! occasion requires1 on ! angles ( ! affect$ side s t ! ribs may be slipp$ into place4 ,_m times "o is oblig$ to treat ! ribs ( "o side z a :ole4 ,9 su* in/ances ! ribs are almo/ inv>iably ?r[n d[nw>d except on "o side ( scoliosis ( ! dorsal region4 ,sev]al me?ods may be employ$ to raise ! ribs4 ,probably ! be/ me?od is to h ! pati5t ^u ! side & ) "o h& ^u ! angles ( ! ribs & ! o!r h& hold+ ! wri/ ( ! upp] arm ( ! pati5t1 an upw>d lift+ movem5t is giv5 bo? ^u ! angles ( ! ribs & ^u ! arm ( ! pati5t :ile ! pati5t inhales4 ,! "w ^u ! angles ( ! ribs is to raise ! ribs directly2 ! "w ^u ! arm is to raise ! ribs indirectly1 pr9cipally by ! use ( ! s]ratus magnus4 ,ano!r effective treatm5t is to h ! pati5t ^u ! back & ) "o h& ov] ! ant]ior ends ( ! ribs & ! o!r h& ov] ! angles ( ! ribs an upw>d movem5t is giv5 !m by spr++ ! ends ( ! ribs t[>d ea* o!r & by /rong inhalation on ! "p ( ! pati5t4 ,?is treatm5t is mo/ effective :]e ! false ribs are at fault & especially 9 case ( hemiplegia4 ,:ile ! pati5t is ^u ! back an assi/ant may take hold ( ! arm & draw x upw>d ov] ! head ( ! pati5t1 produc+ consid]able additional upw>d t5d5cy ( ! ribs1 & ! physician giv+ ! same treatm5t ( ! ends ( ! ribs z be=e2 or ! physician may take an arm 9 "o h& & raise x above ! head ( ! pati5t & ) 8 o!r h& ar\nd ! angles ( ! ribs1 & ! pati5t inhal+ deeply1 ! ribs may be rais$4 ,a treatm5t us$ a great deal 9 rais+ ! ribs z a :ole is to h ! pati5t sit ^u a /ool1 & rea*+ ar\nd ! pati5t f ! front1 place ! f+]s ^u ! angles ( ! ribs & raise !m upw>d on bo? sides at ! same "t4 ,?is treatm5t c also be giv5 by /&+ beh9d ! pati5t & rea*+ ar\nd ^u ! ant]ior ends ( ! ribs & lift+ upw>d :ile ! pati5t aids y by deep inhalation4 ,rememb] t _m times ! ribs are drawn d[nw>d by contraction ( ! muscles1 due to atmosph]ical *anges & slump$ po/ures4 ,"o %\ld beg9 at ! upp] ribs 9 all treatm5ts :]e ! ribs are to be rais$1 z a :ole1 & "w d[nw>d4 ,to correct ! fir/ & ! float+ ribs a diff]5t treatm5t has to be giv5 ?an ! =ego+4 ,an upw>d displacem5t is ! mo/ common lesion ( ! fir/ rib4 ,to correct su* a dislocation1 h ! pati5t sit ^u a /ool & ) "o h& pull ! head to ! opposite side 9 ord] t ! lesion may be exagg]at$ by traction ( ! lat]al muscles ( ! neck 7pr9cipally ! scal5i7 ^u ! rib2 ?is dis5gages ! rib f its abnormal position2 !n ) ! f+]s ( ! o!r h& ^u a po9t midway ( ! ends ( ! rib1 ex]t a d[nw>d pressure at ! mom5t ! ext5d$ head is relax$ describ+ a %ort arc4 ,b don't relax head until readju/+ pressure is ex]t$ ^u rib4 ,if ! pati5t is unable to sit up1 & x is n be/ to give ! =ego+ treatm5t1 h ! pati5t flat ^u ! back1 ) "o h& take hold ( ! arm on ! affect$ side & pull d[n & out ^u ! %\ld] s t ! rib may be some:at drawn away f its articulation & releas$ f its position2 !n ) ! f+]s ( ! o!r h& ^u ! c5t] ( ! rib1 or its highe/ po9t1 press d[nw>d :5 ! hold ^u ! arm is be+ relax$4 ,correction ( an upp] displacem5t ( ! fir/ rib is an e day occurr5ce4 ,d[nw>d dislocation ( ! fir/ rib1 is r>e4 ,to r$uce ?is dislocation1 place ! ?umb b5ea? ! v]tebral end ( ! rib1 & ) ! o!r h& lift up /rongly on ! %\ld] f b5ea? ! axilla1 at ! same "t ex]t+ pressure upw>d ) ! ?umb on ! end ( ! rib4 ,! float+ ribs may be dislocat$ obliquely d[nw>d1 or ! free end ( ! rib may be caught und]nea? ! end ( ! rib above4 ,9 ei!r case1 9 ord] to correct ! displacem5t1 place ! pati5t ^u ! back ) ! ?igh on ! affect$ side flex$ ^u ! abdom5 s t ! tissues ab\t ! field ( op]ation are relax$2 !n be> d[n c>efully b firmly ov] ! free end ( ! rib ) ! f+]s until "o f+] c be hook$ und]nea? ! end ( ! rib2 !n ) ! o!r h& ov] ! v]tebral end ( ! rib1 h ! pati5t take a deep brea?1 at ! same "t spr++ ! ends ( ! rib t[>d ea* o!r1 ?us relax+ ! rib f its lock$ position2 !n h ! pati5t exhale quickly & at ! same "t spr+ ! rib into its normal position4 ,x (t5times requires repeat$ trials1 especially 9 /\t p]sons1 & q (t5 ! op]ation is pa9ful to ! pati5t4 ,x is necess>y t "o %\ld und]/& ?is op]ation ?or\ghly1 z x is "o ( ! mo/ common treatm5ts 9 o/eopa?ic practice4 ,! float+ ribs are v liable to dislocations & may be ! cause ( _m pa9s 9 ! side1 di/urbances ( ! vessels z !y pass ?r\gh ! diaphragm & inflammation 9 ! iliac region4 ,a palliative treatm5t may be giv5 ! float+ ribs by hav+ ! pati5t lie flat ei!r on ! back or on ! side2 !n place ! h& ne> ! v]tebral end ( ! ribs & raise !m upw>d :ile ! pati5t takes a deep brea?4 ,treatm5t ( lesions betwe5 ! manubrium & gladiolus are be/ giv5 by plac+ ! pati5t ) ! face d[nw>d ^u ! op]at+ table1 & hav+ ! articulation ( ! manubrium & gladiolus j ov] ! edge ( ! table4 ,an assi/ant %\ld hold ! pati5t firmly ^u ! table :ile hyp]ext5sion or flexion1 z ! case may require1 ) traction1 is ex]t$ ^u ! head1 neck & %\ld]s1 & manipulation ( ! articul> po9ts is giv5 to r$uce ! dislocation4 ,! same pr9ciples are employ$ "h z 9 correct+ lesions else:]e4 ,correction ( ! c>tilages along ! /]num is v easily accompli%$ by hav+ ! pati5t sit ^u a /ool & ! o/eopa? /&+ beh9d ! pati5t places a knee 9 ! back2 !n rea*+ ar\nd ) "o h& ov] ! c>tilages & ! o!r h& und]nea? ! axilla1 execute ! same movem5t z giv5 9 correct+ dislocations ( ! /]nal ends ( ! ribs4 ,a treatm5t sometimes us$ to release a depress$ condition ( ! c>tilages ( ! false ribs is to /& beh9d ! pati5t :ile he sits ^u a /ool & rea* ar\nd him ) f+]s und]nea? ! c>tilages & raise !m upw>d z he inhales4 ,by hav+ ! pati5t take a deep brea? & !n exhale quickly :ile ! f+]s are ov] ! c>tilages a mu* bett] grasp ( !m c be obta9$4 ,?is treatm5t %\ld be c>efully giv51 z !re is dang] ( te>+ ! c>tilages loose f ! ribs4 ,! ,dorsal & ,lumb> ,sp9al ,regions4--,"h1 z 9 o!r regions ( ! body1 be=e an attempt is made to correct ! v]tebr ! muscles %\ld be ?or\ghly relax$4 ,"o ( ! easie/ me?ods to relax ! muscles is to h ! pati5t lie ^u ! side1 & !n by /&+ 9 front ( ! pati5t & rea*+ ov] him ) ! f+]s ^u ! contract$ muscles an upw>d & outw>d rot>y manipulation is giv52 or ! pati5t may sit ^u a /ool :ile ! physician /&s 9 front ) ! arms ar\nd ! pati5t & ! f+]s ov] ! contract$ muscles manipulat+ !m upw>d & outw>d4 ,ano!r v easy me?od is to /& beh9d ! pati5t :ile he sits ^u a /ool & place a ?umb ov] ! contract$ fibres1 ) ! o!r h& und]nea? ! axilla lift+ ! %\ld] upw>d & backw>d s z to favor a relaxation ( ! muscles1 :ile ! ?umb manipulates !m4 ,9 relax+ ! muscles ( ! lumb> region h ! pati5t on ! side ^u ! table2 !n flex ! ?ighs ^u ! abdom5 ) y\r weight aga9/ ! knees s z to control all movem5ts ( ! pati5t2 rea* ov] ! pati5t ) ! f+]s ^u ! contract$ tissues & manipulate !m outw>d & upw>d on ei!r side until !y are relax$4 ,a me?od sometimes employ$ to relax ! muscles ( ! dorsal1 lumb> & sacral regions is to place ! pati5t flat on 8 face ^u ! table2 !n by pu%+ up on ! muscles f above d[nw>d ) ! flat ( ! h& !y are easily relax$4 ,?is treatm5t %\ld be especially giv5 :5 ! pati5t's muscles are contract$ by atmosph]ical *anges & f /&+ 9 "o position = a long "t4 ,:5 ! muscles ( ! back are contract+ !y draw d[nw>d & _m times draw ! ribs ) !m1 z well z t5s+ ! tissues ov] ! sacral =am9a & ob/ruct+ or irritat+ ! sacral n]ves4 ,by us+ ! mod]n table longitud9ally relax+1 or /ret*+1 ! lumb> & dorsal musculature saves consid]able /r5g? & ef=t ( ! physician4 ,to correct v]tebral lesions ( ! dorsal region ! same rules %\ld be foll[$ z 9 treat+ lesions ( ! c]vical v]tebr4 ,treatm5ts may be giv5 ) almo/ equal ease :e!r ! pati5t is ly+ on ! side or sitt+ up4 ,to illu/rate ! treatm5t ( ! dorsal region :5 ! pati5t is ly+ d[n1 assume t !re exi/s a lat]al lesion1 comb9$ rotation & sideb5d+1 betwe5 two v]tebr2 if ! lesion is bel[ ! sev5? dorsal use ! legs z a lev]1 & if ! lesion is above ! sev5? dorsal use ! head & neck z ! lev]4 ,h ! pati5t lie ^u ! side t[>d :i* ! lesion is pron\nc$1 ei!r rea* "u ! neck or ar\nd ! limbs ) "o h&1 & ) ! o!r h& ^u ! lesion b5d ! head & neck or ! ?ighs 9 su* a mann] t ! angle ( ! flexion is directly ov] ! break 9 ! sp9al column2 ?is is to exagg]ate ! lesion2 !n by lightly lift+ up on ! neck or limbs & ) a slight rotation ( ?is lev] ! flex$ p>ts %\ld be ext5d$1 at ! same "t ex]t+ pressure ) ! h& ov] ! lesion 9 su* a mann] t ! v]tebra is pu%$ =w>d t[>d its normal position4 ,practically1 ! same treatm5t is giv5 :5 a pati5t is sitt+ up1 ) ! exception1 ( c\rse1 t ! limbs _c be us$ z lev]s4 ,lesions ( ! dorsal region or ev5 ! lumb> region c be correct$ :ile ! pati5t is sitt+ up4 ,by ?is me?od consid]able lift+ is done away )4 ,9 fact1 ! weight ( ! pati5t c be us$ to great advantage by sub/itut+ x = "o's /r5g?4 ,no matt] 9 :at direction ! lesion is1 ! physician rea*es ar\nd ! pati5t's %\ld]s s t he j holds ! weight ( ! pati5t f fall+ to "o side or ! o!r2 ?us ) "o h& manipulat+ ! lesion ! o!r arm is ar\nd ! pati5t guid+ ! weight ( ! body 9 flexion1 rotation & ext5sion4 ,x is n always necess>y to lift up on ! pati5t b j let ! weight ( ! pati5t act z /r5g? appli$ to ! p[] arm4 ,always make x a po9t :5 work+ ^u dislocat$ v]tebr 9 any region t j z soon z "o has obta9$ a slight movem5t 9 ! lesion d n attempt to correct x any m = ! "t be+4 ,a slight movem5t t[>d ! "r direction may be all t is necess>y to relieve ! ill effects ( ! lesion4 ,9 fact x might be impossible to get ! lesion anatomically correct z ! %ape ( ! v]tebra may h con=m$ 9 a great] or less ext5t to its abnormal position4 ,an excell5t me?od to correct ! v>i\s comb9ations ( rotation & sideb5d+ ( ! ?ird to n9? dorsals is to h ! pati5t sit up ) ! physician ei!r sitt+ or /&+1 dep5d+ ^u height ( seat1 back ( ! pati5t4 ,h ! pati5t lean back until head is support$ ^u %\ld] ( physician1 & ! ant]ior & po/]ior musculature ( torso1 abdom5 & pelvis are ?or\ghly relax$4 ,rea* ar\nd ! pati5t's *e/ ) "o arm1 ! h& ( :i* is plac$ b5ea? ! axilla4 ,! !n> em95ce ( ! o!r h& is plac$ ^u ! po/]iorly prom95t transv]se process ( ! lesion$ segm5t4 ,!n ) c>eful hyp]ext5sion1 traction1 & rotation &1 sideb5d+ ( ! torso1 ! an*orage is releas$1 c>e be+ tak5 t localization is exact2 ?is mom5t ( coord9ation is accompani$ ) a ?ru/ ( ! !n> em95ce ^u ! transv]se process4 ,relaxation1 lev]ages & ?ru/ mu/ be precise & ?or\ghly coord9at$4 ,to r$uce v]tebr t are deviat$ ant]iorly 9 ! dorsal region1 especially betwe5 ! scapul1 is (t5 a h>d matt]4 ,a satisfactory me?od is to /& beh9d ! pati5t1 :ile he is sitt+ ^u a /ool1 & rea* ar\nd bo? sides ( him ^u ! /]nal ends ( ! ribs correspond+ to ! ant]ior v]tebr2 !n h ! pati5t relax ) ! head ^u ! *e/1 & at ! same "t take a full inhalation :ile pressure is ex]t$ po/]iorly ^u ! /]nal ends ( ! ribs4 ,! object ( ?is me?od is to pull back ! rigid ribs 7! lungs be+ fill$ ) air7 :i* are atta*$ to ! ant]ior surfaces ( ! transv]se processes ( ! v]tebr1 & ?us ^u ! ant]ior v]tebr pu%+ !m po/]iorly2 all ( ! muscles ( ! body be+ q passive & ! head relax$ on ! body1 a sep>ation ( ! v]tebr is accompli%$1 ?us favor+ a cr[d+ po/]iorly ( ! subdislocat$ v]tebr4 ,to correct v]tebr ( ! lumb> region is on ! :ole mu* easi] ?an 9 ! dorsal region4 ,"h ! legs c be us$ z lev]s to great advantage4 ,by ! same me?od ( flexion1 rotation1 & ext5sion1 z employ$ 9 ! dorsal region :5 ! pati5t is ly+ on ! side1 ! result c g5]ally be obta9$4 ,sideb5d+ is ! mo/ common s+le lesion ( ! lumb> v]tebr1 ?\gh !re may be "s rotation at ! lumbo-sacral juncture4 ,occasionally mal=mation is f\nd at ! fif?4 ,to correct ! lumb> lesions ! foll[+ me?od is (t5 us$3 place ! pati5t ^u ! side ( ! rotation or sideb5d+ ) knees flex$1 buttocks well back & entire sp9al column /raight4 ,next br+ torso & head1 ) sp9e /raight1 well =w>d to edge ( table4 ,!n ) h& ^u ilium tilt x slightly =w>d1 & ) o!r h& ^u %\ld] rotate entire sp9e1 includ+ head1 s t sp9e is lock$ & ! po9t ( localization exactly corresponds to ! lesions4 ,?is br+s ! sp9e back to ne>ly a /raight position4 ,next1 aft] a mom5t or two ( t5sion-relaxation1 ei!r ?ru/ back ^u ! %\ld] or =w>d ^u ! ilium4 ,aga9 exactly coord9at+ localization1 relaxation & lev]ages is ! key ( ! me?od4 ,! ,abdom54--,direct treatm5t ( ! abdom5 is giv5 9 _m diseases ( its organs4 ,! pati5t %\ld lie flat ^u ! back1 ! legs flex$ ^u ! ?ighs & ! ?ighs flex$ ^u ! abdom51 s t ! abdom9al muscles w be ?or\ghly relax$2 & !n ! v>i\s organs ( ! abdom5 c usually be manipulat$ ) ease4 ,rememb] t 9 _m diseases ( ! abdom9al visc]a ! treatm5t ( ! splan*nics & vagi w be ! prim>y treatm5t r ?an direct abdom9al treatm5ts4 ,9 treat+ ! liv] directly1 ! ribs ov] ! liv] %\ld be rais$ & sep>at$1 & ! l[] bord] ( ! liv] manipulat$ directly1 z consid]able !rapeutic results c be obta9$1 p>ticul>ly :5 ! liv] is conge/$ & enl>g$4 ,manipulation ( ! bile ducts is v ess5tial 9 _m liv] diseases4 ,! treatm5t relieves conge/ion ( ! ducts & removes any collections ( mucus 9 ! ducts due to ! conge/ion1 z well z free+ ob/ruct$ fl[ ( bile4 ,! manipulation %\ld be a deep1 d[nw>d "o1 directly ov] ! pa? ( ! ducts 7f ab\t ! c>tilage ( ! n9? rib to ! duod5al orifice ( ! bili>y tract1 ! latt] be+ ab\t "o & "o-half in*es diagonally d[nw>d & to ! "r ( ! umbilicus74 ,be v c>eful :5 fir/ manipulat+1 & be> d[n lightly ov] ! duct s t ! /ructures sup]ficial to x may be relax$ z ! duct is deep bel[ ! surface ( ! abdom54 ,usually ! gall-gladd] c be empti$ by light pressure ov] ! sk9 above ! c>tilages ( ! eigh?1 n9? & t5? ribs4 ,! light manipulation acts1 probably1 by way ( ! sp9al segm5t1 z a /imulus to ! dilators ( ! sph9ct]s ( ! gall-bladd]4 ,v likely ?r\gh reciprocal inn]vation relax+ ! sph9ct] ( ! bile duct w contract fibres ( ! gall bladd]4 ,manipulation ( ! /oma* has consid]able effect 9 /r5g!n+ its circul> fibres & ton+ up ! coats 9 g5]al4 ,9 cases ( gas =mation1 ! gas 9 "s in/ances may by manipulat+ ov] ! /oma*1 be =c$ ?r\gh ! c>diac or pyloric orifices4 ,direct treatm5t ov] ! sple5 by rais+ ! eigh?1 n9?1 t5? & elev5? ribs ( ! left side is effectual 9 conge/ion & enl>gem5t ( ! organ4 ,9 ?9 subjects ! kidneys c be treat$ directly by press+ d[n c>efully b deeply ov] ! kidneys1 & lightly cr[d+ !m upw>d & outw>d4 ,?is treatm5t also has "s effect 9 reliev+ contract$ tissues ab\t ! r5al vessels & kidneys4 ,treatm5t to ! inte/9es ?r\gh ! abdom5 is an effective treatm5t4 ,9 ! v>i\s ob/ructions to ! inte/9es1 con/ipation1 etc41 ! direct "w is ess5tial4 ,treatm5t ( ! inte/9es is to correct any abnormal position t !y may h assum$1 to relieve con/rictions ( ! gut caus$ by contract$ tissues1 to relieve impactions & adhesions1 to increase p]i/alsis & to tone up ! inte/9al coats 9 g5]al4 ,! treatm5t consi/s 9 a manipulation ( ! inte/9es1 especially 9 ! "r & left iliac foss1 & ! pelvic colon1 asc5d+ colon & duod5um1 z impactions & prolapses ( ! gut are m liable to occur at ^! po9ts ?an 9 any o!r locality4 ,9 manipulat+ ! inte/9es1 "w = a def9ite purpose & n give a g5]al knead+ treatm5t unless ! walls ( ! abdom5 & ! coats ( ! inte/9es are weak5$2 9 ! latt] case ! sp9al treatm5t is ! prim>y "o4 ,9 treat+ ov] ! iliac region1 draw upw>d & inw>d on ! folds ( ! gut4 ,x is claim$ by "s au?orities t n]ves pass f ! cutane\s surface ( ! abdom5 directly to ! inte/9e by way ( ! p]itoneum2 if su* is ! case1 manipulation ( ! abdom9al walls w\ld h direct effect ^u ^! n]ve fibres4 ,! abdom5 may be treat$ :5 ! pati5t is sitt+ up1 b ! treatm5t is n satisfactory4 7,see ,prolaps$ ,organs74 ,! ,pelvis4--,! treatm5t ( ! pelvis is easy1 b ! difficult "w is 9 mak+ a diagnosis ( ! position ( ! pelvic bones4 ,! pelvis is especially apt to become d]ang$ by j>s & falls4 ,"s ( ! mo/ successful o/eopa?ic results h be5 obta9$ 9 correct+ ! pelvic region4 ,to relax ! muscles ov] ! pelvis1 ! pati5t %\ld be on ! side or ^u ! face2 !n relax ! muscles by manipulat+ !m upw>d1 *iefly ^? ov] ! sacral =am9a4 ,x is a good rule to adju/ ! lumb> fir/ ow+ to release secur$ to ! n]ves supply+ pelvic muscles & also to ! fact t _m pelvic di/ortions are second>y or comp5satory to lumb> lesions4 ,! easie/ me?od to correct ! innom9ata is to h ! pati5t lie ^u 8 side2 !n by /&+ 9 front ( ! pati5t slip "o h& betwe5 ! ?ighs & grasp ar\nd ! tub]osity ( ! is*ium1 & ) ! o!r h& ^u ! cre/ ( ! ilium1 ! innom9atum c be mov$ upw>d or d[nw>d & =w>d or backw>d 7:eel & axle pr9ciple74 ,simply pull+ or pu%+ ^u ^! two po9ts 9 :atev] direction necess>y is all t is requir$ provid+ ! s(t tissues are ?or\ghly relax$4 ,by hav+ ! pati5t flat ^u ! back practically ! same treatm5t c be giv51 b n to s great an advantage4 ,9 cases :]e ! ilium is po/]ior & ! is*ium ant]ior1 ! physician may /& back ( ! pati5t1 :ile he is ly+ ^u 8 side1 & place "o knee aga9/ ! sacrum & ) "o h& ^u ! ilium1 ) ! o!r take hold ( ! ankle ( ! affect$ side 7! involv$ side be+ upp]mo/ 9 all cases :]e ! pati5t is ly+ ^u 8 side72 pressure c be ex]t$ ^u ! ilium & ! limb pull$ backw>d1 ?us correct+ ! d]angem5t4 ,?is treatm5t %\ld be avoid$ z mu* z possible1 z !re is consid]able dang] ( pull+ back too sev]ely & injur+ ! pati5t2 ! lev] is long & ! am\nt ( =ce ex]t$ ^u x _c be judg$ precisely4 ,ano!r me?od is1 ) ! pati5t on ! back1 flex & ev]t ! knee to ! side s ! side ( ! foot lies flat on ! table4 ,grasp ! ankle ) "o h& & ) ! o!r on ! cre/ ( ! ilium ( ! opposite side !n1 by pu%+ d[n firmly on ! knee ! articulation is gap$ & at ! same "t ! op]ator pu%es ) 8 body aga9/ ! knee ) a %>p ?ru/4 ,?is may h to be repeat$ a few times be=e ! articulation is releas$ & if "o is ke5 he w easily detect ! slight concussion c>ri$ d[n ! femur z ! adju/m5t takes place4 ,?is w correct a =w>d & d[nw>d innom9ate4 ,= an upw>d & backw>d "o1 place ! pati5t 9 exactly ! same position & g ?r\gh ! same motions except t ! knee is pull$ t[>d ! op]ator4 ,if ! desir$ 8*ug0 is n felt & adju/m5t is n def9ite1 ! leg may be pull$ d[n r sm>tly by ! ankle to a p>allel ) ! o!r4 ,?is is a te*nique t is easy1 bo? = ! pati5t & op]ator1 & w correct any b ! mo/ /ubborn4 ,9 ! case ( a greatly relax$ & atonic condition ( ! ligam5ts ( ! pelvis mu* tr\ble is exp]i5c$1 (t51 9 mak+ ! adju/m5t p]man5t4 ,_m sugge/ions h be5 made & mo/ ( !m useless b1 probably ! use ( a belt ( non-ela/ic webb+ ab\t two in*es 9 wid? buckl$ tightly ar\nd ! pelvis j bel[ ! ant]ior sp9es w d z mu* z any?+ & is a proc$ure well to foll[ 9 all su* cases4 ,:]e !re is a p5dul\s abdom5 a support 9 ! %ape ( a simple belt :i* %\ld be s fitt$ z to act z a sl+ w transf] ! weight ( ! abdom9al visc]a f ! muscles1 already /ret*$ & atonic1 to ! belt & put ! burd5 ov] ! sacrum4 ,?is prev5ts ! pull+ ( ! innom9atum 9 lesion aga94 ,ov]correction is sugge/$ z a means on ! gr\nd t x sets up irritation & induces fibr\s ankylosis & = ! same reason ,w4 ,w4 ,h[>d places 8 pati5t prone & ) ?umb works ! ligam5ts associat$ ) ! jo9t until !y are ?or\ghly inflam$4 ,! pati5t is !n put 9 b$ a few days & aft] ! inflammation has cle>$ up ! ligam5ts w be f\nd to h %ort5$4 ,to correct a rot>y lesion betwe5 ! pelvis & fif? lumb> ! pati5t %\ld be plac$ ^u ! side1 & ) ! body held firmly1 ! pelvis c be =c$ backw>d or =w>d z ! occasion dem&s4 7,see ,coccyx74 ,! ,legs4--,! orig9 ( _m symptoms manife/$ 9 ! legs1 z 9 ! arms1 are due to sp9al lesions correspond+ to ! region ( inn]vation to ! affect$ tissues4 ,! d]angem5ts ( ! pelvic bones are a frequ5t s\rce ( symptoms t are ref]r$ to ! legs & feet4 ,! o/eopa? f9ds t a slight dislocation ( ! hip may occur :i* is especially likely to affect ! knee4 ,?is p>tial dislocation is apt to be an upw>d-po/]ior "o2 ! head ( ! femur re/+ 9 ! upp] & po/]ior "p ( ! acetabulum4 ,_m diseases ( ! legs & feet are due to local displacem5t ( ! bones4 ,! me?od ( treatm5t is ! same z giv5 9 surgical works4 7,see ,spra9s74 ,a g5]al treatm5t ( ! legs & ?ighs is (t5times necess>y2 x consi/s ( flex+ ! ?ighs q firmly ^u ! abdom51 & execut+ ?or\gh ext]nal & int]nal rot>y movem5ts ( ! ?ighs & legs4 ,9 a few cases bo? limbs are flex$ /rongly at ! same "t ^u ! abdom54 ,aft] giv+ ^! movem5ts manipulation ov] ! saph5\s op5+ & b5ea? ! popliteal space is p]=m$4 ,?is g5]al treatm5t t5ds to increase ! circulation ( ! entire limb & to relax ?or\ghly all contract$ fibres4 ,! ,arms4--,9 treat+ ! arms1 c>e has to be tak5 t ! affection is n due to sp9al d]angem5ts2 o!rwise ! arms are manipulat$ accord+ to ! disord]4 ,complete dislocations ( ! %\ld] comes "u ! prov9ce ( surg]y4 ,_m times ! o/eopa? locates slight or incomplete dislocations ( ! %\ld]4 ,p>tial dislocations ( ! %\ld] are g5]ally ant]ior4 7,see ,spra9s74 ,9 cases :]e pa9 exi/s 9 ! %\ld] or arm1 outside ( locat+ ! cause 9 ! %\ld] jo9t1 ! affection may be due to fibres contract+ ov] ! coracoid process1 or a dislocation ( ! second or ?ird rib1 & 9 "s in/ances ! clavicle is d]ang$4 ,special c>e %\ld be giv5 to a possible bursitis & t5do-synovitis4 ,occasionally muscul> fibres may slip out ( ! bicipital groove4 ,dislocations ( ! bones ( ! arm are treat$ accord+ to surgical me?ods4 ,! pa9s & v>i\s tr\blesome symptoms t may be manife/$ 9 ! f+]s or ! h&s are (t5times caus$ by slight dislocations ( ! elb[1 %\ld]1 ribs1 or v]tebr1 z l[ z ! six? to eigh? dorsals4 ,! coccyx4--,! coccyx1 ow+ to its expos$ position & r un/able atta*m5t1 is subject to _m injuries2 m inde$ ?an come to notice4 ,its injury results 9 _m local & g5]al di/urbances ow+ to its close relation to ! sympa!tics4 ,successful treatm5t ( deviations (t5 br+ />tl+ results4 ,!y may be divid$ into fractures & displacem5ts4 ,9 complete or p>tial fracture ( ! coccyx1 z well z 9 dislocation1 if ! pati5t c be se5 ) reasonable promptness aft] ! accid5t mu* c be done = relief ( ! pa9 & ! prognosis is good = complete recov]y4 ,exam9ation %\ld be made ext]nally & int]nally & aft] ! condition is diagnos$ ab\t ! same proc$ure is indicat$ = any ( ! conditions4 ,) ! pati5t on ! left side introduce ! "r index f+]1 well lubricat$1 into ! rectum & c>efully relax all tissue )9 rea* ( ! tip4 ,if !re are spasms ( ! coccygeal muscles1 inhibition ( ! ant]ior n]ves w quiet !m4 ,:5 ?is has be5 done place ! left index f+] ext]nally along ! body ( ! coccyx & hold+ x firmly bo? )9 & )\t release x longitud9ally & !n adju/4 ,aft] ?is has be5 done x is well to hold x !re until all dang] ( return+ spasm1 :i* might displace x aga91 is ov]1 :5 ! f+] c be )drawn4 ,! pa9 foll[+ w dep5d on ! sev]ity ( ! injury1 b w keep up m or less con/antly = sev]al days4 ,:5 sev]e1 relief is (t5 giv5 by introduc+ ! f+] & relax+ contract$ tissue :i* is pull+ x f its position4 ,hot wat] bags plac$ next to ! "p w be ( b5efit4 ,! b[els %\ld be kept conf9$ = =ty-eight h\rs if possible 9 cases ( fracture4 ,wat* c>efully ! progress ( union t ! bones are 9 situ s !re w n be de=mity4 ,9 diagnos+ ! fir/ injury be sure t !re is no splitt+ ( ! fir/ segm5t or spl9t]s :i* may require surgical int]f]5ce4 ,9 old cases ( fracture :]e !re is complete bony ankylosis x is n ju/ifiable to attempt any *ange1 b :]e !re is motion & a fibr\s union1 aft] prep>atory treatm5ts ab\t "o week ap>t1 x c usually be replac$4 ,look well to any muscul> contractions :i* might int]f]e ) x4 ,=ce mu/ nev] be us$ nor any attempt to replace until x has be5 fir/ releas$ f its articul> atta*m5t4 ,9 ! v>i\s =ms ( displacem5t ! same te*nique applies z 9 fractures1 or ! f+] & ?umb ( "o h& may be us$1 ! tip ( ! f+] int]nally at ! sacro-coccygeal articulation & ! ?umb ext]nally at ! same po9t4 ,complete control ( ! "p is secur$ 9 ?is mann]4 ,great c>e mu/ always be us$ 9 treatm5t ( any displacem5t ( ! coccyx4 ,contractions ( its muscul> atta*m5ts w (t5 cause deviations 9 cont\r4 ,removal ( ! irritation & relaxation w all[ x to assume its normal position4 ,! sacrum4--,adju/m5ts ( ! sacrum z di/+ui%$ f ! ilium 9 /rictly innom9ate lesions are n _m4 ,:5 po/]ior ) ! pati5t on a /ool ! knee ( ! o/eopa? covet$ by a pill[ & plac$ aga9/ ! sacrum & bo? h&s grasp+ ! ant]ior bord]s ( ! ilia1 /rong traction w move x into position4 ,9 a d[nw>d displacem5t ) ! aid ( an assi/ant f beh9d hold+ ! cre/s ( ! ilia firmly z ! pati5t sits on ! table1 ! o/eopa? 9 front clasp+ bo? arms ab\t ! pati5t & ) a rock+ motion f side dis5gages ! sacrum & at ! same "t lifts x into position4 ,= ant]ior displacem5ts use ! te*nique describ$ 9 replac+ upw>d & backw>d innom9ate dislocation fir/ "r side & !n left1 :i* w result 9 correct+ ! lesion4 ,! prec$+ o/eopa?ic te*nique includes a few ( ! treatm5ts giv5 by ! o/eopa?4 ,al?\gh _m o/eopa?s use me?ods n giv5 "h1 ^? outl9$ are suffici5t = illu/rative purposes4 ,a po9t :i* _c be too ?or\ghly impress$ ^u ! /ud5t is t o/eopa?ic treatm5t is 9 reality con/ructive "w1 t is1 readju/ive1 n only 9 detail1 b 9 view+ ! body /ructure z a :ole4 ,detail$ readju/m5t is an ess5tial1 /ill d n lose sight ( ! relation ( ! "p to ! :ole4 ,9 our di/9ctive "w anatomical con/ruction is ! basis ( physiological function1 al?\gh physiological /imulus is ess5tial to anatomical developm5t4 ,h[ (t5 to treat4--,h[ (t5 to treat a case dep5ds entirely ^u ! nature ( ! disease f :i* ! pati5t is suff]+4 ,j z 9 giv+ drugs ! frequ5cy ( treatm5t is entirely dep5d5t ^u ! seat ( ! disease & its sev]ity4 ,acute cases require a ?or\gh treatm5t at lea/ once daily1 & _m times 9 sev]e cases ! treatm5t has to be repeat$ sev]al times daily4 ,9 subacute & *ronic cases1 z a rule1 treatm5t %\ld n be giv5 z (t5 z 9 acute cases2 possibly once a day1 b usually alt]nate days is bett]4 ,9 (fice practice cases are commonly treat$ two or ?ree times weekly4 ,/ill x is bett] n to treat "s cases (t5] ?an once a week4 ,!re is m dang] 9 treat+ too (t5 & too long ?an 9 n treat+ (t5 en\gh4 ,! di/9ctive "w ( an o/eopa? is to correct disord]$ anatomical /ructures2 & :5 a c]ta9 d]angem5t has be5 correct$ ! tissues %\ld h re/ & pl5ty ( "t = repair4 ,:5 treatm5ts are giv5 (t51 x simply keeps ! tissues 9 an irritat$ /ate & nature does n h "t to heal ! diseas$ tissues4 ,always make x a po9t at ea* treatm5t to correct "s def9ite lesion1 & :5 ! "w is accompli%$ let ! p>ts alone until ! tissues h recov]$ z mu* z possible f ! effects ( ! previ\s treatm5t be=e ano!r treatm5t is attempt$4 ,! reason :y "s cases d n get cur$ "u o/eopa?ic treatm5t is simply because ! o/eopa? keeps ! diseas$ tissues 9 an aggravat$ /ate by ! con/ant treatm5t s t !y d n h ! lea/ *ance to heal2 ! physician is ?us add+ irritation to ! disease4 ,x is only by exp]i5ce t "o c tell h[ (t5 to treat4 ,ea* case is a special /udy2 :at w\ld be q suffici5t = a c]ta9 individual ) a giv5 disease w\ld n be at all suitable = a second individual ) ! same disease4 ,z 9 drugs :at is suitable = "o p]son w\ld n be adapt$ to ano!r1 because ! make up ( ea* individual is entirely diff]5t2 b "h ! p>allelism div]ges1 = 9 drugs !re is a =eign ag5t introduc$ into ! sy/em1 :ile 9 o/eopa?ic treatm5t ! curative ag5t is entirely h>moni\s ) ! idiosyncrasies ( ! individual4 ,x is = ?is reason t exp]i5ce 9 practice is s ess5tial4 ,mo/ cases %\ld n be treat$1 z a rule1 aft] a meal unless ! pati5t is suff]+ f "s dige/ive di/urbance2 = treat+ o!r regions ( ! body outside ( ! dige/ive tract causes m or less /imulation ( ! p>ts treat$ & !reby draws blood away f ! organs ( dige/ion4 ,cases ( disord]$ bra9 circulation1 :]e ! pati5t is unable to re/ or sleep at night1 %\ld be treat$ at ab\t _! retir+ "t s t ! circulation ( ! body may be equaliz$1 ?us giv+ ! pati5t undi/urb$ re/4 ,to %[ 9 a practical way ! me?ods ( exp]i5c$ o/eopa?s 9 ?is matt] ,g4 ,j4 ,helm]#cb is quot$3 8,i submit ! foll[+ table to illu/rate ! frequ5cy ( treatm5t 9 "o hundr$ cases tak5 f my practice3 "o case ?ree times p] week1 sixty-?ree cases two times p] week1 tw5ty-two cases "o "t p] week1 n9e cases once e two weeks1 five cases once e f\r weeks4 ,comp>+ ! pres5t ) ! pa/1 ,i f9d ,i am l5g!n+ ! "t betwe5 treatm5ts ) mu* bett] results40 ,ano!r v practical side ( ! "q & "o :i* w be greatly appreciat$ by ! pati5t1 is ! less5$ co/ = ! same result 9 ! less frequ5t treatm5ts1 z well z ! sav+ 9 "t4 ,) ! loss 9 go+ to ! (fice1 re/ aft] treatm5t1 n to m5tion possible wait :ile !re1 ?ree times weekly repres5ts m "t ?an ! av]age p]son c well sp>e & n infrequ5tly w det] him f cont9u+4 ,m especially is ?is true ( ^? com+ f a di/ance4 ,l5g? ( ,treatm5t & ,ov]treatm5t4--,naturally ! l5g? ( treatm5t dep5ds ^u ! case at issue & no?+ m4 ,!re is no reason :y any two cases %\ld be treat$ = ! same l5g? ( "t unless !y pres5t id5tical lesions & !n ! p]sonal equation ( ! two might pres5t su* a wide diff]5ce ( aspect z to =bid su* a proce$+4 ,! "q ( "t has no place 9 ! matt]1 save t x mu/ n exce$ physiological limits & be suffici5t = ! ne$s ( ! case4 ,! pati5t %\ld und]/& at once t x is to accompli% a specific purpose t ! treatm5t is giv51 j z def9ite z a surgical or d5tal op]ation1 & :5 ! "w is done x is "t to /op4 ,he w\ld h>dly be attract$ to ! d5ti/ :o gu>ante$ to use =ty-five m9utes 9 extract+ a too?4 ,good judgm5t is requir$ 9 ?is z 9 all matt]s p]ta9+ to o/eopa?y4 ,!re is a g5]ally express$ op9ion among ! old] o/eopa?s1 bas$ on exp]i5ce1 t3 fir/1 a %ort specific treatm5t is productive ( be/ results &1 second1 treatm5ts giv5 "u high t5sion :5 quick "w is necess>y are mo/ satisfactory4 ,long treatm5ts are debilitat+ & ov] /imulation am\nts to inhibition4 ,fur!r1 9 a long treatm5t x is necess>y to g ov] ! :ole body1 ?us disp]s+ ! vital =ces 7:i* h be5 /imulat$ = heal+ & upbuild+ ! pa?ological area7 to p>ts n involv$1 ?us defeat+ ! v purposes int5d$4 ,dr4 ,/ill always advocat$ & gave ! %ort1 specific treatm5t4 ,! po9t always to be consid]$ is ! individual *>act]i/ics ( ! pati5t1 & effects ( ! fir/ treatm5t %\ld be c>efully obs]v$4 ,aft] a pati5t has be5 "u treatm5t = any consid]able "t x is well to give him a vacation f treatm5t1 & x is rem>kable :at improvem5t w be %[n at times by su* a measure & h[ seldom he w lose gr\nd4 ,dr4 ,/ill pres5t$ ?is subject vividly z foll[s3 8,to treat ! sp9e m ?an once or twice a week & !reby irritate ! sp9al cord1 w cause ! vital assimilation to be p]v]t$ & become dea? produc+ by effect+ an absorption ( ! liv+ molecules ( life be=e !y are fully matur$ & :ile !y are 9 ! cellul> sy/em1 ly+ imm$iately "u ! lymphatics4 ,if y w all[ y\rself to ?9k = a mom5t ( ! possible irritation ( ! sp9al cord & :at effect x w h on ! ut]us1 = example1 y w realize t ,i h told y a tru?4 ,_m ( y\r pati5ts are well six mon?s be=e !y are dis*>g$4 ,!y cont9ue treatm5t because !y are weak1 & !y are weak because y keep !m s by irritat+ ! sp9al cord40 ,x is n a r>e exp]i5ce = a pati5t to leave app>5tly ) little or no improvem5t only to report a complete recov]y a little lat]4 ,misappli$ ,treatm5t4--,probably 9 sp9al treatm5t m risks are tak5 ?an 9 any o!r region ( ! body4 ,to u z a s*ool x is by f> ! mo/ important & int]e/+ area we h to treat1 consequ5tly x is n surpris+ t v>i\s g5]al treatm5ts & me?ods h be5 devis$ ) ! idea ( gett+ quick] & easi] results4 ,h]e9 lies ! dang] outside ( mi/ak5 diagnosis1 = %ort cut treatm5ts c nev] take ! place ( "t & skill4 ,te*nically speak+1 if "o ?or\ghly und]/&s ! philosophy ( o/eopa?y & is conv]sant ) ! und]ly+ pr9ciples ( its !rapeutics1 !re is absolutely no dang] ( ev5 ! slighte/ injury4 ,x is ! "o :o takes *ances by n prop]ly diagnos+ & by n be+ cauti\s en\gh ) delicate p]sons :5 apply+ 8 treatm5ts t is apt to ov]/ra9 "s tissue or organ & o!rwise d bodily h>m4 ,( ! treatm5ts consid]$ dang]\s n "o ( !m is )\t m]it if judici\sly appli$1 b un=tunately 9 _m cases !y are 9 g5]al & indiscrim9ate use4 ,x is well to rememb] t we are mov+ /ructures :i* h nev] be5 mov$ be=e & t "t en\gh has n elaps$ to obs]ve :at ! ultimate result may be4 ,aga91 9 adju/+ a subluxation ( ! sp9e d n =get t ! =ce necess>y = t adju/m5t1 if misappli$1 is suffici5t to produce a lesion1 & !re is no d\bt t ?is has happ5$4 ,y\r pati5t's int]e/s are above ev]y?+ & mu/ nev] be sacrific$ = any reason :atev]1 s if at any "t !re is unc]ta9ty always give ! pati5t ! b5efit ( ! d\bt4 ,on ! o!r h& ! o/eopa? mu/ h ! c\rage ( 8 convictions & =tunately :5 ^! are c\pl$ ) good judgm5t ! results are all t c\ld be desir$4 ,! foll[+ %\ld be us$ ) great caution if us$ at all3 ,fir/1 ,indiscrim9ate /ret*+ ( ! sp9al column ) ! aid ( an assi/ant4 ,x is n good o/eopa?y al?\gh !re are "s cases :]e x may be b5eficial4 ,:ile n specially dang]\s1 g5]ally1 9 delicate pati5ts1 eld]ly p1 art]ioscl]otic conditions1 & 9 "s /ages ( ,pott's disease x is absolutely contra9dicat$4 ,moreov] 9 mo/ sp9al cases except impact$ v]tebr & symmetrical curvatures ! /ret*+ ( ! v]tebral ligam5ts locks ! lesion firm]4 ,second1 ,extreme rotat+ ( ! c]vical region4 ,?is _c be consid]$ good treatm5t 9 any case ) ! exception ( ! muscle /ret*+4 ,on ! contr>y x is dang]\s2 fir/1 x is n o/eopa?y = x is n specific2 second1 ! n]v\s %ock is sev]e1 an important consid]ation 9 delicate p2 ?ird1 ! c]vical ligam5ts become /ret*$ & ! v]tebr are easily displac$1 :ile damage to a diseas$ v]tebra1 an aneurism or 9 art]ioscl]osis w\ld be irrep>able4 ,no o!r region ( ! body %\ld h great] c>e 9 treatm5t ?an ! neck4 ,?ird1 ,hyp]ext5sion ( ! sp9e ) ! pati5t on 8 face4 ,?is treatm5t is r>ely indicat$4 ,9 fact1 x is b>b>\s & a relic ( an e>ly day4 ,possibly m cases h be5 injur$ by ?is treatm5t ?an all o!rs comb9$4 ,f\r?1 ,r\gh sep>at+ ( ! v]tebr & ribs :ile ! pati5t is on 8 face4 ,?is is a mo/ excell5t treatm5t 9 _m cases1 b great judgm5t is necess>y4 ,delicate pati5ts1 he>t disease1 & necros$ v]tebr & ribs %\ld be c>efully exclud$4 ,fif?1 ,innom9ate adju/m5ts su* z plac+ ! pati5t on ! side & putt+ ! knee aga9/ ! sacrum :ile grasp+ ! leg at ! knee4 ,or1 ! plac+ ( ! pati5t face d[n ) "o h& on ! sacrum & ! o!r hold+ ! knee4 ,9 bo? ^! !re is a trem5d\s lev]age & 9 ! latt] ! /ra9 is at ! lumb> r ?an :]e ne$$4 ,!re are o!r unnecess>ily risky me?ods = ?is op]ation1 :ile x is easy to p]=m 9 mo/ cases & )\t dang]4 ,six?1 ,abdom9al treatm5t gives wond]ful results :5 intellig5tly appli$1 b x may be productive ( great h>m 9 conditions ( tumors1 malignancy1 & pus =mations4 ,misappli$ treatm5t is always dang]\s1 no matt] to :at "p ( ! body giv51 & x is pro( ( wrong diagnosis :5 giv54 ,z a rule treatm5t is giv5 )\t prop] diagnosis 9 su* cases1 s a misappli$ treatm5t has two int]pretations--fir/1 ignorance2 second1 laz9ess4 ,9 ! =m] lies ! great] dang] = ignorance c\pl$ ) =ce & lack ( skill is an appall+ comb9ation4 ,cases are frequ5tly report$ :]e tumors h pass$ f ! vag9a1 rectum1 nose1 etc41 ! o/eopa? ?9k+ x 0 ! result ( good treatm5t1 )\t consid]+ t x 0 simply ! break+ ( a long p$icle ) great dang] f hemorrhage4 ,! greate/ c>e %\ld be ex]cis$ 9 treat+ cases :]e aneurism1 o/eomalacia1 & art]ioscl]osis are pres5t1 also 9 ! leg treatm5t ( tabes dorsalis & 9 ! weak1 ?9 ribs ( eld]ly p & ^? ) a g\ty or rheumatic dia!sis4 ,imag9e treat+ an abscess directly1 yet x has be5 done1 z h v>icose ve9s ) ! t]rible dang] ( rupture & embolism4 ,aneurisms h be5 ruptur$ 9 ! same way4 ,"o c\ld g on indef9itely ) ?is subject1 b to sum up3 if ! o/eopa? is n famili> ) ! feel ( ! liv+ anatomy 9 its giv+ & resi/+ "u treatm5t bo? 9 heal? & disease & does n "k 8 o/eopa?y1 no?+ c prev5t him do+ h>m4 ,a successful practition] means an und]/&+ ( pa?ology1 !n exp]i5ce plus common s5se4 ,,footnotes3 #ca ,see ,a%more's ,o/eopa?ic ,me*anics4 #cb ,j\rnal ( ! ,am]ican ,o/eopa?ic ,association1 ,dec41 #aijc4 ,,o/eopa?ic ,,c5t]s 8,o/eopa?ic sp9al c5t]s0 0 a t]m commonly us$ 9 ! e>ly p]iod ( o/eopa?ic developm5t4 ,f ! facts1 fir/1 t a few c5t]s h be5 actually det]m9$ 9 ! cord1 viz41 g5ito-ur9>y1 vasomotor1 etc42 second1 t ! inn]vation f ! sp9al segm5t to v>i\s ?oracic1 abdom9al & pelvic visc]a correspond ) a consid]able degree ( accuracy to c]ta9 v]tebral sections1 & ?ird1 displacem5ts ( tissues ( ! sp9al column affect viscus integrity1 dep5d+ ^u ! locality ( ! /ructural p]v]sion z to ! organ involv$ & is a cl9ical obs]vation ( great import1 arose ! misnom] 8o/eopa?ic c5t]s40 ,= "o to ask :at 8c5t]s0 %\ld be 8treat$0 9 ?is or t disease %[s a lack ( ! conception ( o/eopa?y z if he ask$ :at 8movem5ts0 to give :5 8treat+0 a c]ta9 disord]4 ,x is z uno/eopa?ic1 z x is unsci5tific1 broadly speak+1 to suppose o/eopa?ic te*nique implies ! application ( movem5ts to c]ta9 n]ve c5t]s4 ,o/eopa?ic ,/imulation 8,o/eopa?ic /imulation0 is ano!r t]m loosely us$ )\t ext5sive cl9ical exp]i5ce to support x4 ,me*anical /imulation is frequ5tly utiliz$ 9 ! physiological laboratory4 ,b to employ x ext5sively & compreh5sively 9 ! treat+ room or at ! b$side ! !rapeutic pot5cy ( x w be f\nd want+2 t is1 to employ x to ! exclusion ( t mo/ important basic treatm5t1 readju/m5t1 is a great mi/ake4 ,cl9ically1 ! pa?ologically sl[$ he>t may be /imulat$ by a /imulus to ! c]vical sympa?ies1 ! gall-bladd] empti$ by a /imulus ne> ! co/al c>tilages ( ! n9? & t5? ribs 7?is is probably via ! sp9al segm5ts71 etc4 ,normally1 ^! organs & o!rs may be tempor>ily /imulat$4 ,exp]im5tally1 ,burns#cc ( ,los ,angeles & ,pe>ce#cd ( ,san ,francisco h %[n ! pot5cy ( o/eopa?ic me*anical /imulation4 ,= example1 /imulation 7me*anical7 9 ! middle & l[] dorsal regions irritates & increases p]i/altic action & vaso-con/riction 9 ! /oma* & inte/9es4 ,o/eopa?ic ,inhibition ,likewise ! t]m 8o/eopa?ic inhibition0 has n always be5 sci5tifically employ$4 ,me*anical inhibition is probably us$ less frequ5tly ?an /imulation b /ill x is ( m importance4 ,probably ! true int]pretation ( consid]able ( s-t]m$ /imulatory & inhibitory ef=ts1 is simply "o ( normalization ( tissues1 physiologic equilibrium result+ f su* *anges4 ,cl9ically1 to relax contract$ muscles by inhibition1 to relieve neuralgia by imp++ n]ve c\rses1 to relax ! c>diac orifice ( ! /oma* by pressure at ! n9? or t5? dorsal v]tebra on ! left side1 etc41 are excell5t examples ( ! !rapeutic value ( inhibition4 ,exp]im5tally ,pe>ce & ,burns produc$ ! opposite results to t ( /imulation4 ,inhibition 9 ! middle & l[] dorsal region caus$ relaxation ( ! muscles ( bo? ! /oma* & inte/9es1 decreas$ p]i/alsis1 & caus$ dilatation ( ! blood vessels4 ,! employm5t ( /imulation & inhibition r\nds out to a c]ta9 ext5t our !rapeutics1 t is1 makes x m practical & specific4 ,we %\ld n1 h[ev]1 ov]-rate ! relative value ( /imulatory & inhibitory treatm5t z comp>$ ) ! readju/ive treatm5t4 ,n b :at ! =m] is ( consid]able practical importance1 b ! po9t to be emphasiz$ is t x gives a sci5tific demon/ration ( h[ pa?ological effects result1 if long cont9u$1 f ! v>i\s o/eopa?ic lesions4 ,9 a ^w1 x %[s ! physiological process f cause to effect1 or r a /ep 9 ! beg9n+ pa?ological 7p]v]t$ physiological7 9 _m di/urbances4 ,!rapeutically1 all w agree ) ,*]ry#ce t 8/imulation & inhibition %\ld be employ$ 9 all =ms ( acute disease z palliative measures until su* "t z ! prim>y lesion may be remov$40 ,z a prep>ation = adju/m5t ( any bony lesion !re is no "q b t simple inhibition = a brief "t 9 ! area w br+ ab\t relaxation ( s(t tissues 9 a mu* m satisfactory mann] ?an ! usual massage l me?od4 ,mc,pherson1 ,montreal1 has develop$ a te*nique ( sacral pressure :i* he uses exclusively 9 8 practice4 ,)\t go+ into ! m]its ( 8 !ory !re is no d\bt t inhibition at ! second & ?ird sacral w br+ ab\t relaxation ( ! muscles ( ! l[] trunk 9 a mo/ gratify+ mann]4 ,ano!r ?+1 if !re is difficulty 9 introduc+ ! f+] 9 mak+ ei!r a vag9al or rectal exam9ation1 a m9ute's pressure at ^! po9ts w1 9 mo/ cases1 cause ! sph9ct] to relax s z to cause no discom=t to ! pati5t4 ,?is pressure w1 also1 h a great effect on ! hypoga/ric plexus & ! pelvic organs4 ,o/eopa?ic ,readju/m5t ,readju/m5t or adju/m5t is _m times p>ticul>ly emphasiz$ 9 ?is "w z ! key to o/eopa?ic !rapeutics4 ,if ! !ory ( readju/m5t c n /& ! mo/ se>*+ te/s ( sci5ce o/eopa?y w h to be relegat$ to a mo/ subs]vi5t place1 on a p> ) massage1 ,sw$i% movem5ts1 & v>i\s m$ical gymna/ics4 ,consequ5tly ! readju/m5t !ory is aga9 ref]r$ to1 & especially s :5 ! subjects ( o/eopa?ic c5t]s1 /imulation & inhibition are outl9$4 ,no d\bt _m /imulatory 7s-call$7 & g5]al treatm5ts ex]t _! greate/ influ5ce by inadv]t5tly readju/+ tissues4 ,!n h[ mu* m effective w\ld ! readju/m5t treatm5t be if appli$ intellig5tly4 ,9 c]ta9 acute disord]s1 e4 g41 8colds10 imm$iate relief is (t5 obta9$ by relax+ muscles ?r\gh ei!r /imulation or inhibition2 9 reality ! f9al result1 z f> z ! muscle is conc]n$1 is "o ( readju/m5t4 ,likewise 9 /ret*+ & rotation ( tissues & sections ( ! body ! effect may ei!r be /imulatory or inhibitory1 & /ill x may be1 also1 readju/ive4 ,aft] all has be5 said ! ultimate physiological effect ( any ( ^! treatm5ts1 if ( any !rapeutic value1 mu/ be "o ( /imulation to a "p or to ! body g5]ally4 ,b !re is a va/ diff]5ce betwe5 physiological /imulation & ! "o me?od ( obta9+ ! same t]m$ me*anical /imulation4 ,x is n ! purpose "h to ent] into any?+ l an exhau/ive survey ( /imulation & inhibition b simply to outl9e a few practical h9ts on ! relative values4 ,ev]yone is aw>e t ov]/imulation is equal to inhibition1 & ev5 apply+ x to v delicate subjects ! !rapeutic end we may wi% to obta9 may be lo/ & z a consequ5ce ! pati5t exhau/$2 :]eas at ! same "t readju/m5t possibly c\ld h be5 employ$ & real p]man5t effects secur$4 ,s we %\ld :5ev] possible utilize ! basic pr9ciple ( our !rapeutics1 readju/m5t1 = ?is repres5ts 9 ! majority ( cases1 fir/1 p]man5t results2 second1 a sav+ ( mu* "t1 & ?ird1 less exhau/ion on ! "p ( bo? pati5t & physician4 ,mc,connell#cf has %[n 9 8 s]ies ( laboratory exp]im5ts on animals ! reality & pot5cy ( ! readju/m5t fundam5tal4 ,! effect ( malalign$ v]tebr & ribs ^u contigu\s vascul> *annels & n]v\s tissues1 n only affects imm$iate skeletal muscles by simple contractions b ev5 produces int]/itial myositis4 ,?r\gh n>r[+ ( ! int]v]tebral =am9a & t5sion ^u ! fibr\s tissue an*or+ ! sp9al n]ve 9 its exit1 & ?r\gh pressure & /ra9 on ! sympa!tics 9 contact ) ! heads ( ! ribs1 :i* are secur$ !re by ! p>ietal lay] ( ! pleura1 organs 9 correspond+ cavities become diseas$4 ,"s ( ! diseases produc$ 9 ! s]ies ( exp]im5ts 7 cat>rhal & p>5*ymat\s *anges 9 ! /oma* & inte/9es1 conge/ion ( ! liv] & sple51 acute nephritis1 goitre1 inflammation ( ! lymphatics1 edema ( ! cornea1 & deg5]ations ( n]v\s tissues4 ,/ill too mu* emphasis %\ld n be plac$ ^u ! n>r[+ ( ! =am5 = c]ta9 pa?ologic *anges are %[n to be due to o!r conditions ?an ,wall]ian4 ,! o/eopa?1 z /at$1 may inadv]t5tly correct o/eopa?ic lesions4 ,vis m$icatrix naturae und\bt$ly corrects _m o/eopa?ic lesions2 ?is is evid5t f ! fact t _m bodily /ra9s1 spra9s1 & injuries are ov]come naturally or involunt>ily1 t is1 )\t any volunt>y assi/ance f an o/eopa?4 ,on ! o!r h& all o/eopa?ic lesions are n due to outside influ5ces or =ces1 e4 g41 9 pneumonia ! sev]ely contract$ dorsal muscles (t5 p>tially dislocate ! v]tebral ends ( ! ribs & ?us increase ! s]i\sness ( ! disease2 & ?is is true 9 _m acute conditions :]e9 visc]al *anges w reflexly contract sp9al muscles & also ?r\gh ^! contractions produce osse\s lesions4 ,"h is :]e o/eopa?ic treatm5t 9 acute diseases w n only correct ! prim>y lesion b also ^! second>y ones & ?us abort1 or %ort51 or less5 sev]ity1 or prev5t complications ( ! disease4 ,b x %\ld always be borne 9 m9d t :5 c]ta9 disease processes occur x w take a def9ite "t at be/ = curative *anges to pr$om9ate4 ,9 o!r words pa?ological *anges are j z real & pot5t z physiological facts or anatomical data & ! "* ( ! same %\ld always be consid]$4 ,consequ5tly 9 readju/m5t "w a di/9ctive etiology & pa?ology has to be tak5 into acc\nt4 ,! color1 cont\r 7:e!r ! lesion is simply a local "o or !re is a composite or gr\p lesion71 condition 7irritation1 debility1 contractions1 & t5d]ness71 & movem5t ( ! sev]al regions1 & ! sp9e z a :ole %\ld be not$4 ,& ! /ud5t %\ld always keep 9 m9d t ! osse\s v]tebral lesion may be1 7a7 a twi/ betwe5 two v]tebr 7?is g5]ally means a rotation ( "o section ( ! sp9e on ano!r section71 7b7 malalignm5t ( sev]al v]tebr 7! composite or gr\p lesion71 or 7c7 ! impact$ or /ra9$ lesion1 7?is is a lesion t ,cl>k atta*es consid]able significance to1 :]e9 !re is injury to ! articul> surfaces & ligam5ts )\t osse\s d]angem5t1 foll[$ by exudation & o!r inflammatory products1 limit$ motion1 etc474 ,vaso,motor ,n]ves ,x is extremely important t ! o/eopa? %\ld be ?or\ghly conv]sant ) ! regions :]e he may affect ! vasomotor n]ves to v>i\s tissues & organs4 ,_m anatomical d]angem5ts und\bt$ly involve ! vasomotor n]ves1 & x is !re=e necess>y to "k :]e !y may be affect$4 ,! foll[+ table is tak5 mo/ly f ! physiology ( ,l&ois & ,/irl+1 b _m ( ! /atem5ts h be5 not$ at v>i\s times2 x is1 !re=e1 impossible to give full cr$it4#cg ,! vasomotor c5t] is 9 ! m$ulla1 consequ5tly ! o/eopa? gives c]vical treatm5t to influ5ce ?is c5t]4 ,treatm5t ( ! upp] c]vical region has und\bt$ly a m>k$ effect 9 t5d+ to equalize ! vascul> sy/em ( ! body1 :5 x is di/urb$4 ,head4--,! c]vical sympa!tic = ! same side ( ! face1 eye1 e>1 saliv>y gl&s1 tongue1 etc41 & possibly ! bra94 ,lesions are f\nd 9 all ! tissues ab\t ! c]vical region1 b usually 9 ! v]tebr1 :i* influ5ce ^! n]ves4 ,deep contract$ muscles (t5times involve !m4 ,! sp9al vaso-con/rictors = ! vessels ( ! head are f ! fir/ five or six ?oracics4 ,_m lesions are locat$ 9 ! upp] five or six dorsal v]tebr1 or correspond+ ribs1 t h app>5tly a direct influ5ce ^u ! vessels ( ! head4 ,n only conge/ive heada*e & conge/ion ( ! bra9 tissues are influ5c$ by lesions 9 ?is region1 b disease ( ! eye1 e> & face occasionally arise f su* d]angem5ts4 ,x is always be/ :5 ! head1 neck or ev5 ! arms are involv$1 to exam9e c>efully ?is region4 ,vaso-dilator fibres = ! face & m\? are f\nd f ! second to ! fif? dorsals2 ^! fibres unite almo/ entirely ) ! trigem9us1 & pass f ! sup]ior c]vical ganglion ( ! sympa!tic1 to ! ganglion ( ,gass]4 ,?is fact is ( great importance to ! o/eopa?1 = (t5times :5 inflammation ( ! face & m\? occurs1 lesions may be locat$ along ! upp] dorsal v]tebr or ribs1 or 9 ! deeply contract$ muscles ( ?is region4 ,obs]vation reveal$ 9 sev]al cases ( erysipelas t ! causative lesion 0 locat$ 9 ! upp] dorsal region2 & ! cases 7 cur$ by correct+ ^! lesions1 ?us %[+ t probably ! vasomotor n]ves 7 ! seat ( ! tr\ble4 ,o!r dilator fibres arise app>5tly 9 ! trigem9us1 = /imulation ( ?is n]ve betwe5 ! bra9 & ,gass]'s ganglion causes dilatation ( ! vessels ( ! face4 ,! l+ual & glosso-ph>yngeal n]ves are ! dilators ( ! l+ual vessels4 ,! sympa!tic & hypo glossal are ! con/rictors2 ^! arise 9 ! sympa!tic & rea* ! n]ves by way ( ! sup]ior c]vical ganglion4 ,/imulation ( ! c]vical sympa!tic causes con/riction ( ! ret9al vessels4 ,?is po9t is extremely int]e/+ to ! o/eopa?1 because diseases ( ! ret9a & optic n]ve are (t5times due to subluxat$ c]vical v]tebr1 usually ! atlas or ?ird c]vical4 ,! ret9al fibres leave ! sympa!tic at ! sup]ior c]vical ganglion & pass along ! communicat+ ramus to ! ganglion ( ,gass]1 f :5ce !y rea* ! eye ?r\gh ! oph?almic bran* ( ! fif? n]ve1 ! gray root ( ! oph?almic1 ! ganglion & ! cili>y n]ves4 ,almo/ all ! fibres to ! ant]ior "p ( ! eye are f\nd 9 ! fif? n]ve2 ?is1 also1 is ano!r important po9t = ! o/eopa?'s consid]ation4 ,cases ( conjunctivitis1 k]atitis1 corneal a/igmatism & diseases ab\t ! eyelids & te> ducts are usually caus$ by lesions to ! fif? n]ve1 due to a d]ang$ atlas or ?ird c]vical4 ,! vaso-dilators = ! ant]ior "p ( ! eye1 & also dilat+ fibres to ! iris may be affect$ at ! fir/ & second dorsals4 ,?is po9t is also tak5 advantage ( by ! o/eopa?1 = lesions ( ^! fibres occur (t5times at ! upp] dorsal4 ,x is claim$ t important fibres t aid 9 ! control ( ! metabolism ( ! ret9a1 may be affect$ at ! f\r? & fif? dorsals4 ,lungs4--,reflex con/riction by /imulation ( ! int]co/als1 c5tral end ( ! sciatic1 abdom9al pneumoga/ric & abdom9al sympa!tic4 ,!re is n a ri* vasomotor supply4#ch ,! ess5tial feature to ! o/eopa? is t ! vaso-con/rictors to ! lungs & bron*ial tubes are v likely to be int]f]$ ) by rib & v]tebral dislocations1 f ! second to ! sev5? dorsals1 inclusive1 b *iefly at ! ?ird1 f\r? & fif?4 ,! heavie/ inn]vation be+ f ! ?ird1 f\r? & fif? spaces1 probably expla9s :y a/hma is (t5 due to a dislocation ( ! ?ird1 f\r? or fif? rib4 ,he>t4--,fir/ to fif? ?oracic via ganglion /ellatum & inf]ior c]vical ganglion4 ,vasomotor fibres to ! coron>y art]ies are f\nd 9 ! vagi4 ,inte/9es4--,sympa!tic1 *iefly ?r\gh ! splan*nic n]ves4 ,vaso-con/rictors ( ! jejunum f ! fif? dorsal d[n1 = ! ileum slightly l[] & = ! colon /ill l[]4 ,!re are none bel[ ! second lumb>4 ,dilators are pres5t 9 ! same %ea?1 b m abundant 9 ! la/ ?ree dorsals & ! upp] two lumb>s2 all probably end 9 ! sol> & r5al plexuses4 ,receptaculum ,*yli4--,/imulation ( ! splancl9ics causes dilatation4 ,liv]4--,! splan*nics *iefly on ! "r side4 ,! vagus conta9s vaso-dilators4 ,!re are also fibres f ! inf]ior c]vical ganglia ( ! sympa!tic4 ,kidneys4--,vasomotor n]ves f ! six? dorsal to ! second lumb>1 b pr9cipally f ! n9? to twelf? dorsals1 inclusive4 ,9 ! l>ge majority ( kidney diseases1 lesions are f\nd f ! t5? to ! twelf? dorsals4 ,/imulation ( ! sciatic c5t]s causes contraction4 ,!re are also fibres f ! sup]ior c]vical ganglion4 ,sple54--,vasomotor fibres are 9 ! splan*nics1 ?ird dorsal to ?ird lumb>1 pr9cipally1 on ! left side4 ,!re are "s fibres direct f ! bra94 ,/imulation ( ! vagi contracts ! sple54 ,portal ,sy/em4--,fif? to n9? dorsal4 ,g5]ative ,organs4--,= ,fallopian tubes1 ut]us1 vag9a1 vas def]5s & sem9al vesicles1 vasomotor fibres are f\nd 9 ! l[] dorsal1 & ! second1 ?ird1 f\r? & fif? lumb> n]ves1 pr9cipally4 ,coccyx & ,imm$iate ,region4--,?ird lumb> d[n4 ,back ,muscles4--,dorsal ,po/]ior bran*es ( ! lumb> n]ves & int]co/al n]ves4 ,^! n]ves arise f ! gray ramus ( ! correspond+ sympa!tic ganglia4 ,arm4--,f ! bra*ial plexus1 ! sympa!tic1 inf]ior c]vical ganglion & fir/ ?oracic ganglion1 & sometimes l[]4 ,leg4--,second dorsal d[n1 ! sciatic & crural n]ves1 & ! abdom9al sympa!tics4 ,s5sory ,n]ves ,inhibition ( v>i\s regions along ! sp9al column is frequ5tly giv5 by ! o/eopa? to less5 pa94 ,x is only a tempor>y or palliative treatm5t1 b _m times gives great relief4 ,"o %\ld inhibit usually ov] t5d] po9ts & contract$ muscles4 ,^! 7t5d] po9ts & contract$ muscles7 are signs to ! o/eopa? t di/urbances exi/ at ^! po9ts4 ,! foll[+ table is tak5 f ,qua91 :i* is ,head's classification3 ,he>t4--,fir/1 second & ?ird dorsals4 ,lungs4--,fir/1 second1 ?ird1 f\r? & fif? dorsals4 ,/oma*4--,six?1 sev5?1 eigh? & n9? dorsals4 ,c>diac end f six? & sev5?4 ,pyloric end f n9?4 ,inte/9es4--7a7 ,d[n to upp] "p ( rectum1 n9?1 t5?1 elev5? & twelf? dorsals4 7b7 ,rectum1 second1 ?ird & f\r? sacrals4 ,liv] & ,gall-bladd]4--,six?1 sev5?1 eigh?1 n9? & t5? dorsals4 ,kidney & ,uret]4--,t5?1 elev5? & twelf? dorsals4 ,upp] "p ( uret]1 t5? dorsal4 ,at l[] end ( uret]1 fir/ lumb> t5ds to appe>4 ,bladd]4--7a7 ,muc\s membrane & neck ( bladd]2 7fir/7 second1 ?ird & f\r? sacrals2 7b7 ov] di/5sion & ineffectual contraction1 elev5? & twelf? dorsals1 & fir/ lumb>4 ,pro/ate4--,t5?1 elev5? 7twelf?7 dorsals4 ,fir/1 second & ?ird sacrals1 & fif? lumb>4 ,epididymis4--,elev5? & twelf? dorsals & fir/ lumb>4 ,te/is4--,t5? dorsal4 ,ov>y4--,t5? dorsal4 ,app5dages1 etc4--,elev5? & twelf? dorsals1 fir/ lumb>4 ,ut]us4--7a7 ,9 contraction1 t5?1 elev5? & twelf? dorsals1 & fir/ lumb>4 7b7 ,os ut]i2 7fir/7 second1 ?ird & f\r? sacrals 7fif? lumb> v r>ely74 ,o!r po9ts are us$ by ! o/eopa? to relieve pa9 ( c]ta9 regions1 = su* ! read] is ref]r$ to ! article on neuralgia2 besides _m t5d] po9ts are f\nd along ! sp9e by ! o/eopa?1 :]e inhibition gives relief to ! pati5t1 provid$ su* po9ts h a connection ) ! case 9 "q4 ,hot fom5tations if prop]ty appli$1 ?r\gh reciprocal relation%ip ( ! n]v\s sy/em1 are ( value 9 reliev+ pa91 releas+ spa/ic musculature & normaliz+ visc]al function4 ,frequ5tly1 9 bo? acute & *ronic cases1 ?is is an excell5t prep>atory measure1 to be foll[$ by c>eful adju/m5t4 ,x w be recall$ t ! functional te/1 movem5t ( a v]tebral lesion is ( prim>y consid]ation4#ci ,,footnotes3 #cc ,burns--,p>tial ,report ( ,exp]im5ts ^u ,visc]al ,reflexes4 ,! ,o/eopa?ic ,_w1 ,aug41 #aije4 #cd ,pe>ce--,"s ,laboratory ,demon/rations ( ,o/eopa?ic ,pr9ciples4 ,! ,o/eopa?ic ,physician1 ,nov41 #aije4 #ce ,/imulation--,leslie ,e4 ,*]ry1 ,j\rnal ( ! ,am]ican ,o/eopa?ic ,association1 ,feb41 #aije4 #cf ,mc,connell--,! ,o/eopa?ic ,lesion1--,j\rnal ( ! ,am]ican ,o/eopa?ic ,association4 #cg ,see also ,gaskell1 ,! ,involunt>y ,n]v\s ,sy/em2 ,patt5g]1 ,symptoms ( ,visc]al ,disease2 ,mack5zie1 ,symptoms & ,_! ,int]pretation4 #ch ,mac,leod1 ,physiology & ,bio*emi/ry 9 ,mod]n ,m$ic9e4 #ci ,see ,luciani1 ,human ,physiology1 ,vol4 ,,iii2 ,mac,leod1 ,physiology & ,bio*emi/ry 9 ,mod]n ,m$ic9e4 ,,pa?ological ,,sp9al ,,curvatures ,,sp9al ,,curvatures ,any deviation ( two or m consecutive v]tebr f ! normal curves ( ! sp9al column is usually t]m$ by ! o/eopa? a pa?ological curvature4 ,( ! common pa?ological curvatures ( ! sp9al column !re are f\nd3 7#a7 scoliosis or lat]al curvature1 7#b7 kyphosis1 or excurvation1 an ant]o-po/]ior curve ) ! convexity backw>d1 &1 7#c7 lordosis1 or incurvation1 an ant]o-po/]ior curve ) ! convexity =w>d4 ,o/eopa?ic ,etiology4--,( prim>y importance 9 ! causation ( pa?ological curvatures ( ! sp9al column1 are injuries to ! sp9e1 su* z /ra9s1 falls1 bl[s1 & v>i\s physical =ces1 act+ directly or indirectly1 z injuries to ! *e/1 pelvis & limbs4 ,! o/eopa? 9 8 daily "w f9ds m curvatures1 z well z acute & *ronic diseases1 result+ f "s simple injury to ! sp9e1 z a slip1 /ra9 or twi/1 ?an f any o!r cause4 ,! dire effects ( any viol5ce to ! sp9al column _c be ov]e/imat$4 ,among pr$ispos+ causes may be m5tion$1 cont9u$ ill heal?1 g5]al weakness1 rapid gr[?1 ra*itis1 tub]culosis1 etc4 ,any habitual "o-sid$ position may result 9 a curvature4 ,an injury to ! *e/1 adhesions f pleuritis1 *ronic liv] disease1 obliquity ( ! pelvis produc+ unequal l5g? ( ! legs1 c>ry+ heavy weights on "o side1 & v>i\s morbid gr[?s ( ! *e/ & abdom51 may all produce curvatures4 ,_m cases are f\nd 9 s*ool *ildr5 :o are gr[+ rapidly1 & ^: muscul> /r5g? & developm5t d n keep pace ) _! gr[?4 ,unilat]al atrophy ( ! muscles1 due to c5tral *anges or ov]use1 may be ! cause ( deviations ( ! sp9al column4 ,sacro-iliac disease 9 "s in/ances is a pot5t factor4 ,?us !re may be a great v>iety ( causes productive ( ! incipi5cy1 & ! sp9e be+ /ra9$ or irritat$ at a s+le po9t & 9 a c]ta9 way gradually develops a curvature4 ,e sp9al & innom9ate lesion %\ld be consid]$ z a pot5tial cause = a curvature4 ,scoliosis4--,?is is ! mo/ common sp9al de=mity & is *>act]iz$ by lat]al deviation f ! m$ian l9e4 ,9 mo/ cases ! curve is to ! "r 9 ! upp] dorsal region1 ) a comp5satory curve 9 ! opposite direction 9 ! lumb> region4 ,! curve be+ to ! "r 9 ! majority ( cases1 is probably due to ! fact t mo/ p are "r-h&$4 ,morbid ,anatomy4--,! v]tebr 9 ! region involv$ are rotat$ s t _! sp9\s processes po9t t[>d ! concavity ( ! lat]al curve4 ,! bodies ( ! v]tebr on ! side next to ! concavity are ?9n]1 due to absorption2 ! int]v]tebral discs are made ?9 on ! same side by pressure & absorption4 ,! ribs are consid]ably di/ort$1 depress$ on ! concave side & prom95t on ! convex side4 ,! ligam5ts on ! concave side are contract$1 & /ret*$ on ! convex side4 ,! muscles on ! concave side are m or less contract$1 & on ! convex side !y are /ret*$1 caus+ atrophy & fatty infiltration ( _! tissues4 ,kyphosis4--,?is may be a slight po/]ior curve really am\nt+ to no?+1 or x may be a v grave pa?ological condition z 9 ,pott's disease4 ,!re=e x is v necess>y t "o %\ld make a mo/ c>eful diagnosis 7see ,pott's disease74 ,! mo/ common causes ( kyphosis are ,pott's disease1 ra*itis1 occupation1 g5]al weakness1 rheumatism & old age4 ,9 ,pott's disease1 ! po/]ior curve is *>act]iz$ by a %>p angle1 & by ! sp9e be+ v rigid4 ,?is1 tak5 9 conjunction ) ! hi/ory & o!r symptoms %\ld be suffici5t to enable "o to make a diagnosis4 ,radiographic exam9ation %\ld be made4 ,! condition ( r\nd %\ld]s1 :i* 9 "t produces m>k$ kyphosis1 is r>ely a habit z x is usually t]m$4 ,9 ne>ly e case x indicates ei!r a weakness ( ! back muscles or1 :at is m apt to be ! cause1 a /ra9$ po/]ior condition ( ! dorsal v]tebr1 commonly ( ! l[] dorsal region4 ,morbid ,anatomy4--,9 mild cases !re is simply a relaxation ( ! ligam5ts ( ! v]tebr & a sep>ation ( ! lam9 & sp9\s processes4 ,9 sev]e =ms !re may be absorption ( ! ant]ior portion ( ! int]v]tebral discs & ! bodies ( ! v]tebr 7,pott's disease74 ,lordosis4--,?is may be a cong5ital condition1 especially :5 occurr+ 9 ! lumb> region4 ,ant]ior curves ( ! sp9e are g5]ally f\nd 9 ! lumb> or c]vical regions1 b occasionally occur 9 ! dorsal region1 caus+ ! sp9al column to be m or less /raight1 & ?us weak5+ ! individual4 ,?is curve is commonly comp5satory to kyphosis1 hip-jo9t disease & cong5ital dislocations ( ! hip4 ,treatm5t ( ,sp9al ,curvatures4--,! treatm5t ( pa?ological curves ( ! sp9al column1 by o/eopa?ic me?ods1 has be5 highly satisfactory to bo? o/eopa? & pati5t4 ,! success ( ! o/eopa? 9 ^! cases has be5 due to 8 compreh5sive & exact k ( ea* v]tebra1 & ( ! sp9al column 9 g5]al4 ,he recognizes curvatures t ! ord9>y practition]1 & x is safe to say ! or?opa$ic speciali/1 w\ld n ev5 notice or recognize4 ,on acc\nt ( ! highly develop$ s5se ( t\* ( ! o/eopa?1 he is capable ( detect+ ! slighte/ deviation ( "o v]tebra f ano!r1 & ( ! sp9e 9 g5]al f ! normal4 ,?us by ! uniqu5ess & peculi>ity ( 8 "w he is capable1 n only ( discov]+ a curvature1 b also ( r$uc+ a curve :5 f\nd4 ,! "w consi/s (1 fir/1 relax+ any muscles t may h become rigid ov] ! seat ( ! curve4 ,!n foll[s a treatm5t to ea* v]tebra involv$1 by attempt+ to replace x1 & treatm5t to ! curve 9 g5]al by spr++ x t[>d its normal position4 ,at ea* treatm5t ef=t %\ld be made to accompli% some?+ t[>d correct+ ! sp9e2 too _m treatm5ts are giv5 9 a 8g5]al0 way1 & be+ unspecializ$ am\nt to no?+4 ,"o mu/ become famili> ) ! exact location ( ea* v]tebra involv$1 to attempt a correction ( a curvature intellig5tly4 ,^u ?is "o po9t x is impossible to speak too /rongly1 = a great _m treatm5ts h be5 wa/$ & improvem5t ( cases ret>d$ by n pay+ en\gh att5tion to ! details ( ! diagnosis1 ei!r f pure slo?fulness or f an imp]fect conception ( o/eopa?y4 ,corrective ex]cises are always ( value 9 addition to treatm5t4 ,^! rem>ks ref] to incipi5t & c]ta9 mod]ate curvatures4 ,9 o!r cases radical measures 7,abbott7 %\ld be employ$ if age & conditions p]mit4 ,rememb]1 h[ev]1 t ! practition] 9 8 daily "w ( adju/+ ! _m comb9ations ( rotation & sideb5d+ lesions corrects innum]able actual & imp5d+ curves4 ,lat]al curvature 9 ! dorsal region is und\bt$ly ! h>de/ to correct on acc\nt ( ! ribs1 :i* complicate ! condition4 ,a m>k$ curve 9 ! dorsal region is sure to be accompani$ by a dislocation ( ! v]tebral end ( "o or m ribs4 ,treat ea* di/9ct lesion sep>ately1 foll[ by g5]al /ret*+1 replac+ & mold+ ( ! tissues4 ,a good me?od to /ret* tissues & adju/ a mod]ate lat]al curve is to utilize ! sw+1 or 9 lieu ( ?is h ! pati5t /& j at arm's l5g? f ! wall ) concave side t[>d ! wall ) /raight arm at "r angles & palm re/+ aga9/ ! wall4 ,/& 9 front ( pati5t ^: feet are firmly on ! floor & rea* ar\nd ) bo? h&s ^u ! sp9e4 ,z ! pati5t sideb5ds t[>d ! wall x t5ds to correct ! de=mity1 s if ! op]ator coord9ates 8 adju/m5t ) t lat]al movem5t ( ! pati5t1 precise fulcra c be obta9$ & a c]ta91 def9ite correction secur$4 ,! significance re/s ) ! /ret*+ ( tissues & ! def9ite fulcra obta9$1 !reby secur+ a maximum sideb5d+ & rotation t[>d correction4 ,! dislocation ( an innom9ate sometimes complicates matt]s1 b is a simple po9t to rem$y1 & %\ld n be ov]look$4 ,! correction ( a curvature pres5ts a special /udy to ! o/eopa?1 :e!r x be scoliosis1 kyphosis or lordosis1 & special rules _c be laid d[n = treatm5t4 ,cases ( r>e occurr5ce are :at might be t]m$ 8symmetrical0 curves2 i4 e41 no v]tebra pres5ts sep>ately a m>k$ lesion1 ! column on ! :ole be+ simply b[$4 ,su* cases c be treat$ by spr++ back ! sp9al column1 & by ! use ( me?odical ex]cises4 ,un=tunately mo/ curvatures are *>act]iz$ by v>i\s lesions betwe5 ! v]tebr1 & ?us ea* lesion requires special "w4 ,9 simple curves ! use ( braces1 jackets1 & ! v>i\s me*anical appliances are ( v little use to ! o/eopa?1 9 fact1 m h>mful on ! :ole1 ?an b5eficial4 ,naturally !y w\ld apply to a 8symmetrical0 curve1 or :]e ! pati5t is too weak to sit or walk1 b !y c be ( v little use to ! av]age pati5t1 9 place ( correct o/eopa?ic treatm5t4 ,me*anical appliances conf9e ! movem5ts ( ! pati5t1 int]f]e ) ! developm5t ( ! muscles1 & imp+e to a great] or less ext5t ! sp9al n]ves4 ,due att5tion to hygi5ic surr\nd+s & diet are c]ta9ly ( aid4 ,prop] ex]cises & occupation = ! suff]] %\ld be advis$4 ,special c>e %\ld be tak5 9 exam9+ 7radiographic7 = infecti\s lesions 7ar?ritis74 ,/raight ,sp9e is a t]m us$ p>ticul>ly by o/eopa?s = a condition seldom recogniz$ by or?op$ic surgeons4 ,! foll[+ is f ,h4 ,w4 ,=bes#dj3 ,/raight sp9e is 8a dep>ture f ! normal 9 ! con=mation ( ! *e/2 *>act]iz$ anatomically by bilat]al dim9ution 9 size1 decrease 9 ! ant]o-po/]ior diamet]1 relative increase 9 ! transv]se diamet] & flatt5+ ( ! ant]ior & po/]ior walls2 *>act]iz$ cl9ically by dim9ution ( respiratory capacity1 l[]$ lung & he>t resi/ance1 impair$ g5]al nutrition & pr$isposition to neurosis4 8,( ! _m possible manipulations t may be us$ to lift & ov]come ! morbid b5d ( ! ribs ,i w attempt ! description ( b "o4 8,relax ! musculature ( ! back & *e/4 ,rotate1 flex & ext5d ! dorsal sp9e4 ,exam9e all ! ribs on ea* side & loos5 any t d n move freely4 ,hav+ done ?is1 ! pati5t is prep>$ = ! specific treatm5t4 ,h ! pati5t sit on a /ool & lean =w>d on a table4 ,h him sep>ate ! elb[s1 flex ! =e>ms1 place "o h& ov] ! o!r & 8 =ehead on ! h&s4 ,tell him to relax all ! muscles ( ! %\ld]s & arms & to brea! deeply )\t us+ ! muscles4 ,aft] a few trials he is able to fully exp& 8 *e/ )\t contract+ ! muscles connect+ ! upp] extremity ) ! trunk4 ,! physician !n takes a position at side 7ei!r side7 ( ! pati5t & places ! weight ( 8 trunk on ! ribs ( ! side he is on1 a little ext]nal to _! angles4 ,he passes 8 arms ar\nd ! pati5t's body2 ! arms pass+ across ! front ( ! *e/ are c>ri$ ar\nd f> en\gh to all[ ! h& to be plac$ on ! ribs j ext]nal to _! angles4 ,! o!r h& is plac$ on ! top ( ?is "o4 ,9 ?is position ! physician's body on "o side1 & 8 h&s on ! opposite1 occupy simil> positions4 ,! pati5t is n[ told to inspire deeply & at ! same "t to relax ! %\ld] muscles1 z be=e in/ruct$4 ,z ! *e/ exp&s drop ! weight ( ! trunk on "o side & make pressure =w>d 7=w>d mean+ t[>d ! ant]ior surface ( pati5t's body7 ) ! h&s on ! o!r side4 ,?is lifts ! ribs to a great] ext5t ?an ! pati5t unassi/$ c\ld lift !m4 ,at ! end ( inspiration & dur+ ! fir/ ?ird ( expiration ! *e/ is compress$ lat]ally4 ,! compress+ =ce1 if appli$ correctly1 w fix ! ribs 9 a position ( less obliquity & w also correct ! increas$ lat]al b5d+ ( !m4 ,! dorsal sp9e becomes m convex po/]iorly at ! mom5t ( lat]al compression ( ! ?orax1 if correctly made4 ,great =ce %\ld n be us$ at ! beg9n+4 ,repeat ! manipulation five to tw5ty times ea* treatm5t4 ,give treatm5t ?ree times a week4 ,a simil> movem5t may be giv5 on ! table4 8,! great] numb] ( flat *e/s 9 pati5ts "u ?irty ye>s ( age may be correct$4 ,if ! pati5t is above ?irty1 al?\gh complete correction may n always be accompli%$1 ! results are satisfactory4 ,two to six mon?s treatm5t is requir$40 ,a 8typhoid sp9e0 comes z a sequel to typhoid fev]4 ,!re is con/ant pa91 t5d]ness along ! lumb> region & rise ( temp]ature4 ,! pa9 is g5]ally increas$ :5 ! sp9e is mov$ =w>d or sidewise4 ,su* a condition is cle>ly und]/ood by ! o/eopa?4 ,!re are always f\nd di/9ct v]tebral lesions along ! region t is t5d] on pressure4 ,9 fact ^! v lesions may h be5 ! pr$ispos+ cause ( ! attack ( typhoid fev]4 ,! treatm5t is re/ & ! indicat$ manipulation to correct ! d]angem5ts4 ,x is ( great int]e/ to note t :]e ! typhoid pati5t is treat$ o/eopa?ically ! condition j describ$ seldom results4 ,obs]vations by ,c4 ,m4 ,t4 ,hulett confirm ?is /atem5t4 ,! ,neurotic ,sp9e may be ! result ( injury b ! subject is usually ( a n]v\s1 neura/h5ic type4 ,x occurs f ! age ( pub]ty to adult1 mu* m (t5 9 females ?an males4 ,! pati5t has dull pa9 9 ! back ( ! neck or 9 ! lumb> or sacral region1 compla9s ( a con/ant tir$ feel+ & (t5 ( a %>p neuralgic pa9 9 c]ta9 p>ts ( ! sp9e4 ,g5]ally !re is a droop+ po/ure 9 ! upp] dorsal ) %\ld]s ?r[n =w>d1 :i* is a sign ( weakness4 ,!re is extreme t5d]ness along ! sp9e & usually ! pa9 is conf9$ to ! s5sitive places4 ,treatm5t consi/s ( a con/itutional ton+ up1 & increas+ muscul> /r5g? ?r\gh judici\s ex]cise4 ,! po/]ior curve may be pu%$ t[>d ! m$ian l9e by lay+ ! pati5t on ! face2 also ) ! knee 9 ! back & ! flat ( bo? h&s on ! /]nal ends raise ! ribs2 or by ! arms mak+ use ( ! pectoral muscles accompli% ! same result4 ,deep brea?+ is also effective4 ,relief c usually be giv5 & a cure w dep5d ^u ! pati5t's g5]al condition4 ,! ,hy/]ical ,sp9e is usually consid]$ ! same z ! neurotic sp9e1 b !re are _m cases :i* h ! s5sitive sp9e )\t be+ hy/]ical4 ,!re is m de=mity usually pres5t1 p>ticul>ly 9 ! lumb> region4 ,probably !re w be a hi/ory ( "s injury4 ,! treatm5t is to correct ! curvature & build up ! g5]al heal?4 ,^! conditions are /ubborn & progress is sl[4 ,9 bo? ! neurotic & hy/]ical sp9es ! ligam5ts ( c]ta9 areas w be f\nd atoni$ & relax$4 ,?is is especially notic$ ^u attempt+ to spr+ a gr\p ( v]tebr :5 all ( a sudd5 ! section relaxes4 ,9 ei!r ( ^! sp9es ! lesions w irritate or ob/ruct n]v\s c\rses1 produce v5\s /agnation or art]ial />vation1 & di/urb lymph *annels4 ,h4 ,f4 ,goetz has obs]v$ t 9 functional n]v\s diseases ! dorsal sp9e is flat1 :ile 9 visc]al displacem5t ! dorso-lumb> sp9e is po/]ior4 ,! ,sp9e ( ! ,ag$ :]e9 is f\nd /oop$ %\ld]s & a rigid sp9al /ructure1 c be di/9ctly improv$ by sl[1 cauti\s traction4 ,?is tones weak5$ muscles1 releases contractures1 sep>ates ! compress$ int]v]tebral discs1 & def9itely tones ! visc]a4 ,c>eful "w is imp]ative4 ,,footnotes3 #dj ,j\rnal ( ! ,am]ican ,o/eopa?ic ,association4 ,,pott',s ,,disease ,an article on ,pott's disease does n really come )9 ! prov9ce ( a practice ( m$ic9e4 ,/ill x w be acceptable to ! practition]s & /ud5ts ( o/eopa?y1 z "o ( ! objects ( o/eopa?ic "w is to improve1 n only m$ical & ob/etrical practice1 b also surgical practice1 & besides ! o/eopa? w h _m cases ( spondylitis to treat4 8,pott's disease1 or c>ies ( v]tebral bodies1 0 fir/ describ$ by ,p]cival ,pott 9 #aggi4 ,x consi/s ( a de/ructive o/itis affect+ ! spongy tissue ( "o or m ( ! bodies ( ! v]tebr4 ,! o/itis is tub]cul\s1 & is simil> 9 "* to tub]cul> o/itis se5 9 ! epiphysis ( ! long bones4 ,ow+ to ! sup]9cumb5t weight ( ! head & %\ld]s press+ ^u ! c>i\s v]tebral bodies1 ! sp9e & trunk become peculi>ly & *>act]i/ically di/ort$4 ,! morbid process is limit$1 z a rule1 to ! bodies2 ! transv]se1 articul>1 & sp9\s processes are r>ely prim>ily affect$40 7,p>k74 ,! fir/ consid]ation 9 ! treatm5t ( ,pott's disease is re/4 ,if ! disease is a progressive "o1 re/ 9 b$ 9 ! recumb5t position is necess>y4 ,naturally1 ! object ( ! treatm5t is to secure resolution ( ! tub]cul> o/itis z soon z possible4 ,to d ?is1 c>eful manipulative treatm5t %\ld be appli$ to ! diseas$ v]tebr4 ,! treatm5t mu/ n be h>%1 = !re w\ld be dang] ( great] irritation to ! p>ts1 & possibly infect$ p>ticles f ! de/roy$ tissue might ga9 entrance to ! vascul> sy/em4 ,! o/eopa? mu/ be extremely c>eful h[ he manipulates ! sp9al column 9 ,pott's disease4 ,! object ( ! manipulation is n prim>ily to ov]come ! de=mity1 z "s may ?9k su* an act possible1 b to sep>ate ! v]tebr en\gh to all[ a fre$om ( ! circulation1 & to remove imp+em5ts ( ! n]ve tissue4 ,x is impossible to ov]come ! de=mity to any ext5t :5 "p ( ! body ( ! v]tebra is de/roy$2 b if "o c\ld treat ! case at ! incipi5cy1 mo/ probably de=mity w\ld be prev5t$4 ,!re is ano!r dang] 9 treat+ cases too sev]ely1 & t is caus+ exhau/ion ( ! pati5t4 ,treat ! sp9al column n only to sep>ate ea* articulation slightly1 b to c>efully cr[d ! diseas$ v]tebr t[>d _! normal position4 ,:5 ! disease is 9 ! dorsal region1 consid]able att5tion has to be paid to ! ribs1 z !y are inv>iably involv$ :5 ! sp9al curvature is great4 ,h5ce x is necess>y to treat ea* rib sep>ately1 & try to correct !m at lea/1 & remove any ob/ruction to n]ve fibres or vessels t may be f\nd4 ,"o ( ! /ronge/ argum5ts aga9/ ! indiscrim9ate use ( braces1 jackets & v>i\s me*anical appliances 9 sp9al de=mities1 is t !y t5d to /raight5 ! sp9e1 by simply cr[d+ ! v]tebr & ribs z a :ole into place1 besides int]f]+ ) ! cutane\s circulation4 ,! o/eopa? %\ld realize t ea* v]tebra & rib has to receive special treatm5t1 9 ord] to correct ! sp9al column1 & t me*anically ex]t+ pressure ^u all ! v]tebr at "o "t t5ds to lock ! v]tebr & ribs all ! m securely4 ,x is l try+ to correct a c]ta9 subdislocation ( ! c]vical v]tebr by pull+ & twi/+ ! neck in/ead ( apply+ specific treatm5t--! lesion is all ! m firmly fa/5$4 ,"y1 9 8 ,surg]y1 makes ?is obs]vation3 8,l *ronic abscess or *ronic bone disease1 ?is affection has its orig9 9 ! fact t ! tissues ( ! ant]ior p>ts ( ! bodies ( ! v]tebr h be5 p>tly depriv$ ( _! nutrition because ( luxat$ ribs or subluxat$ or twi/$ v]tebr40 ,aft] ! tissue de/ruction has be5 limit$1 & ! de=mity correct$ z mu* z c be1 an ankylosis %\ld be secur$ if possible4 ,promotion ( ankylosis dep5ds altoge!r ^u ! prec$+ treatm5t--re/ & an improv$ nutrition ( ! p>ts4 ,a truss or brace1 if correctly appli$1 is (t5 b5eficial 9 su* cases4 ,! treatm5t ( sp9al abscesses is entirely 9 accordance ) surgical treatm5t4 ,9 all cases ! g5]al heal? ( ! pati5t has to be well tak5 c>e (4 ,! o/eopa? mu/ n be ov] zeal\s = quick results4 ,x takes _m mon?s to p]=m a cure2 h[ev]1 !re is always a t5d5cy t[>d a cure4 ,treatm5t ( ! sp9al muscles & ( ! limbs1 & pure air1 sunlight1 massage & good food are v necess>y4 ,,spra9s ,,& ,,fractures ,,spra9s ,! o/eopa? is (t5 call$ ^u to treat spra9s ( v>i\s sections ( ! body z well z to relieve aft] effects ( fractures & re/ore function to ! "p4 ,! o/eopa?ic treatm5t is v effectual2 !re=e1 an outl9e ( ! purpose & me?od is giv54 ,spra9 is def9$ by ,dorl& z 8! wr5*+ ( a jo9t ) p>tial rupture or o!r injury ( its atta*m5ts1 & )\t luxation ( bones40 ,f an o/eopa?ic viewpo9t ! above def9ition is n fully explanatory1 = !re is 9 mo/ cases a p>tial luxation ( ! bones4 ,! mo/ common cause ( a spra9 becom+ *ronic is ! pres5ce ( p>tial bony displacem5ts4 ,rupture ( tissues may be ! cause ( a *ronic /ate b is n ne>ly s frequ5t z ! bony dislocation4 ,9 mo/ spra9s1 ! wr5*+ causes a displacem5t ( ! bony tissues1 :i* may or may n return to normal position & relation4 ,! function ( ! muscles is n prim>ily to hold ! bones 9 place2 ?is is left to ! ligam5ts1 s :5 a wr5* ( a jo9t is s sev]e z to cause rupture ( muscles or te>+ ( ligam5ts1 p>tial luxation ( ! bones is almo/ c]ta9 to foll[2 & ev5 :]e su* damage does n occur a *ange 9 ! relation ( ! bones is a frequ5t occurr5ce4 ,unless a spra9 c be se5 v e>ly x may be difficult to detect j :at has happ5$2 :e!r x re/s ) a rupture ( ! areol> & connective tissues1 a displac$ c>tilage1 t5don1 or bone1 a torn ligam5t1 or ruptur$ muscle4 ,hemorrhage & swell+ take place s rapidly t no "t %\ld be lo/ 9 critically exam9+ ! jo9t4 ,:5 9 d\bt z to ! /ructural di/urbances1 p>ticul>ly 9 acute cases if !re is a possibility ( a fracture1 & 9 *ronic cases any supposition t tub]cul> involvem5t is pres5t1 h a radiographic exam9ation4 ,!re is comp>atively little to be f\nd 9 m$ical lit]ature relative to ! pa?ology ( spra9s4 ,probably ,m\ll9 9 8 excell5t monograph on ,spra9s has giv5 z good an outl9e z c be f\nd#da4 ,he says t 8g5]ally speak+1 ! tissues on "o side ( a jo9t are ov]/ret*$ & torn2 ^? on ! o!r compress$ & cru%$ toge!r2 b !re is always s mu* twi/+1 & su* a diff]5ce 9 ! /r5g? & p[] ( resi/ance ( v>i\s /ructures1 t unless ! "p is exam9$ ) ! greate/ c>e x is almo/ impossible to say :at actually has giv5 way40 ,hemorrhage due to torn vessels is ! cause ( mo/ ( ! swell+ )9 ! fir/ few h\rs4 ,lat] on1 !re is consid]able lymph mix$ ) ! blood4 ,!re is n only extravasation ( blood into ! surr\nd+ tissues b also into ! synovial wall & cavity4 ,?is causes consid]able irritation & pa9 ow+ to ! r\gh5+ ( ! membrane1 & ! jo9t becomes inflexible4 ,& if ! jo9t or any /ra9$ tissue is kept too long at re/ ! mass becomes organiz$ & is ! cause ( mu* discom=t & annoyance4 ,simil> *anges may occur 9 ! burs due to ! extravasat$ blood4 ,/rong ligam5ts may be torn across1 b n frequ5tly4 ,! te> is usually a sep>ation f ! bone4 ,occasionally int]osse\s ligam5ts1 z = in/ance 9 ! knee1 may be injur$4 ,! muscles may be sev]ely torn1 b m (t5 !y are 8hurt by _! own sudd5 & spasmodic ef=t at recov]y ?an by any?+ else40 ,9 a few cases ! t5dons & muscles w be f\nd bruis$1 lac]at$1 & dislocat$4 ,! ve9s occasionally rupture & ?us results m or less effusion1 s t rigidity & edema may p]si/ = a long "t4 ,! bones are v frequ5tly damag$4 ,?is may be a simple bruis+ ( ! tissue b m (t51 z o/eopa?ic diagnosis %[s1 !re is p>tial displacem5t ( ! bony /ructure4 ,a po9t ( great importance t e exp]i5c$ o/eopa? w agree to is ! foll[+ f ,m\ll93 8,diseases ( ! sp9e1 hip1 & o!r jo9ts 9 *ildr5 may be due1 9 great measure1 to "s con/itutional ta9t1 ?\gh x is op5 to "q :e!r ! influ5ce ( ?is is n ov]rat$2 b x is q c]ta9 t ! imm$iate />t+ po9t 9 n9e cases out ( t5 is "s *ance spra91 (t5 s slight z sc>cely to h be5 notic$ at ! "t40 ,be=e treat+ a spra9 !re are "o or two po9ts ! o/eopa? %\ld c>efully note3 fir/1 t !re is no complicative fracture2 second1 9 *ildr5 t !re is n an epiphysial sep>ation2 &1 ?ird1 note peculi>ities ( a con/itutional "* t w\ld complicate matt]s4 ,:atev] is done1 always give ! pati5t ! b5efit ( ! d\bt4 ,if ! pati5t c be se5 e>ly1 be=e swell+ has rea*$ ! maximum1 _m times a v quick cure c be secur$4 ,d n at once put ! "p at re/ & apply cold1 b exam9e ! spra9 mo/ c>efully & ?or\ghly & readju/ fir/ ( all any bony defects2 !n replace ! s(t] tissues if displac$1 & next relax contractions2 foll[ ?is by light massage & passive movem5ts to r$uce & combat hemorrhage & swell+4 ,?is treatm5t alone 9 a fair p]c5tage ( cases w be all t is necess>y provid$ frequ5t subsequ5t treatm5ts ( massage & passive movem5ts are cont9u$ to r$uce & c\nt]act inflammation & to prev5t rigidity & /iffness ( ! s(t] tissues4 ,:]e ! o/eopa?ic treatm5t is di/9ctly indicat$ is 9 ! readju/ive manipulation4 ,?is is ! reason :y ! treatm5t is s efficaci\s1 & ! pati5t is cur$ 9 a fraction ( ! usual "t1 & few spra9s result 9 complications & become *ronic4 ,9 spra9s t h become *ronic !re w be f\nd almo/ inv>iably "s osse\s tissue slightly displac$4 ,aft] correct+ ?is1 apply c>eful & ?or\gh manipulation & massage & movem5ts to break up adhesions1 to remove effusions & extravasations1 to relax muscles1 & to promote normal circulation4 ,c>e %\ld be tak5 t !re are no displac$ c>tilages1 ligam5ts1 t5dons1 or muscles4 ,x is well to keep 9 m9d t ! o/eopa?ic readju/ive manipulation is n an ex]cise or movem5t1 b def9ite1 specific correction ( ! tissues anatomically4 ,d n treat ! displacem5t by any g5]al 8pommell+10 b apply ! me*anical pr9ciples indicat$ z 9 any dislocation4 ,?is w mean mu* to ! pati5t 9 m ways ?an "o1 & especially s %\ld ! spra9 be s sev]e & complicat$ z to dem& ane/hesia = correction4 ,!re is no objection to ! employm5t ( cold & heat2 9 fact1 bo? are b5eficial4 ,cold to prev5t extravasation & swell+1 & heat to remove & relieve ! same1 is a s\nd & practical me?od4 ,b d n apply a wet b&age4 ,p\r+ cold wat] ov] ! spra9 is ! be/ me?od2 ev5 bett] ?an imm]s+ ! "p4 ,an ice bag is ano!r good way to apply cold4 ,:5 ! sk9 beg9s to look blan*$ & dull ! maximum am\nt ( b5efit has be5 secur$4 ,heat at ! v fir/ may be employ$ in/ead ( cold1 = x has a t5d5cy to prev5t ble$+ & inflammation1 b ! temp]ature ( ! application mu/ be hot z c be borne or else ! desir$ effect w n be obta9$4 ,lat] on to relieve pa9 & rigidity1 & to relax ! muscles s t a bett] circulation w be secur$1 mod]ate heat w be b5eficial4 ,!n ! application ( heat & cold alt]nately w be ( s]vice1 employ$ z a d\*e = a tonic effect1 :5 ! "p is weak1 inactive1 & p[]less aft] ! elapse ( sev]al days4 ,x %\ld always be rememb]$ t ! employm5t ( heat & cold is only ( tempor>y b5efit1 s if us$ too long opposite effects to ^? desir$ w result4 ,b&ag+ ! spra9 may be helpful1 b n always4 ,great c>e %\ld be tak5 z to h[ pressure is appli$4 ,b&ag+ f p]iph]y t[>d ! trunk1 see+ t ! b&age is smoo?1 & padd+ all depressions s t ! b&age does n t\* bony prom95ces only1 are necess>y4 ,unless ! b&age is appli$ s t an ev5 pressure is secur$1 ! mat]ial us$ n too w>m1 & ! b&age att5d$ to ea* day1 ! effectiv5ess w am\nt to b little4 ,next1 d n make ! mi/ake ( re/+ ! injur$ jo9t too mu*4 ,! function ( a jo9t is movem5t1 & x has be5 obs]v$ t prolong$ re/ ( a heal?y jo9t may result 9 rigidity1 /iffness1 & di/5sion ( ! s(t "p1 & ev5 s]i\s organic *anges 9 ! ligam5ts1 synovial membrane1 & c>tilages h occurr$4 ,consequ5tly cont9u$ passive movem5ts %\ld be kept up f ! inception ( ! injury1 al?\gh x mu/ n be c>ri$ to extremes s t inflammation1 hemorrhage1 or lac]ation w be aggravat$4 ,m\ll9 says3 8,z a rule1 passive movem5t may be comm5c$ f ! second day ) ! c]ta9ty ( prev5t+ adhesions1 & )\t ! lea/ fe>40 ,o/eopa?ically1 ) due att5tion to readju/ive manipulation1 & c>e z to correct position & re/1 passive motion w be all[able usually f ! fir/ day4 ,!re is mu* corroborative evid5ce 9 curr5t m$ical lit]ature t be>s 9 a g5]al way ^u "p ( ! =ego+4 ,! ,int]national ,text ,book ( ,surg]y says3 8,massage %\ld beg9 e>ly1 9 ord] to avoid1 z f> z possible1 weakness ( ! muscles1 & to ensure security to ! position ( ! jo9ts by ! ret5tion ( a prop] tone 9 !m20 besides1 e>ly movem5t t5ds to r$uce ! effusion into ! t5don %ea?s ar\nd ! articulation1 :i* 9 "s cases1 p>ticul>ly ! ankle & wri/1 may be a v prom95t feature4 ,! ,ref]5ce ,h& ,book ( ! ,m$ical ,sci5ces voices ! same op9ion2 & ,mum=d is ref]r$ to z foll[s3 8,immobilization = m ?an a few days1 z "u ! old] me?ods1 is objectionable because adhesions are apt to =m1 ?us caus+ impairm5t ( function1 & because :5 !re is a tub]cul> ta9t1 prop] conditions = a localiz$ tub]culosis are e/abli%$40 ,among o!r /atem5ts ,hold] ,sneve 9 ! ,j\rnal ( ! ,am]ican ,m$ical ,association ( ,june #a1 #aija1 says3 8,immobilization ( muscles is n re/4 ,on ! contr>y1 9 all spra9s ! muscles %\ld h passive ex]cise ! fir/ few h\rs & days1 & active ex]cise aft] t4 ,9 ! majority ( cases active ex]cise %\ld be in/itut$ f ! beg9n+4 ,! pla/] ca/ %\ld n be us$ at all1 ev5 9 cases :]e we h a fracture1 unless x be impossible to ma9ta9 a prop] position ( ! jo9t40#db ,aga9 quotation is made f ,m\ll94 ,^! quotations are tak5 f ! *apt]s on ,manipulation & ,massage4 ,x w be obs]v$ he makes a di/9ction betwe5 ! two me?ods4 ,& ! o/eopa? %\ld c>efully keep 9 m9d n only ! diff]5ce betwe5 ! two1 b beyond ^! ! m fundam5tal treatm5t1 readju/m5t4 ,! *>act]i/ic feature ( o/eopa?y is anatomical readju/m5t1 & ?is 9 spra9s %\ld be supplem5t$ by massage 7sup]ficial "w71 & also manipulation 7deep & m or less =cible "w7 9 ord] to remove /iffness1 rigidity1 & fibr\s ankylosis4 ,! foll[+ is relative to =cible manipulation3 8,manipulation is mu* m useful ?an division2 x c be employ$ = su* a v>iety ( purposes4 ,9 ! e>ly /ages x prev5ts ! occurr5ce ( /iffness or ! =mation ( adhesions4 ,lat]1 :5 ! swell+ & heat h disappe>$1 x is no less successful 9 re/or+ fre$om & ease ( movem5t1 & aft]w>d1 :5 all me*anical ob/ructions h be5 cle>$ away by its use1 x is "o ( ! mo/ effectual me?ods kn[n = br++ back ! circulation & nutrition ( ! "p1 & giv+ aga9 to ! muscles & n]ves ! en]gy :i* has s long be5 want+4444 8,to c>ry ?is out effectively two ?+s are ne$$ beyond all o!rs4 ,! "o is a s5se ( t\* s delicate t x c appreciate ! lea/ resi/ance or irregul>ity ( movem5t2 ! o!r an accurate k1 n m]ely ( ! ord9>y anatomy ( ! "p1 b ( ! diff]5t degrees ( t5sion t fall on ! ligam5ts 9 e position ( ! limb4 8,ea* jo9t requires a diff]5t k9d ( manipulation accord+ to its con/ruction4444 8,!re %\ld be no j]k+4 ,! movem5ts mu/ be vigor\s & =cible1 b p]fectly smoo?2 & !y mu/ be c>ri$ out ?or\ghly1 ! jo9t be+ mov$ to its full ext5t 9 all directions t are natural to x4 ,ea* k9d ( action %\ld be comb9$ successively ) ! re/1 "o by "o1 s t ! t5sion may fall 9 turn ^u all ! diff]5t p>ts ( ! capsule4 8,movem5ts :i* are especially re/rict$ or pa9ful1 ( c\rse require mo/ att5tion1 b ! o!rs1 ?\gh !y may n be affect$ to ! same ext5t1 are n to be neglect$4 ,x sometimes happ5s if ^! are dealt ) fir/1 t a consid]able proportion ( ! ma9 ob/ruction is cle>$ away1 z x 71 by side attacks1 s t :5 its turn comes x yields m readily ?an x o!rwise w\ld4 8,rec5t slight adhesions give away at once )\t a s\nd1 ?\gh ! s5sation is g5]ally convey$ to ! h&4 ,:5 !y are old] ! noise may be z l\d & cle> z :5 a bone is brok54444 8,! aft] treatm5t ( ^! cases 7cases :]e !re has be5 te>+ & break+ ( adhesions7 %\ld be 9 all respects ! same z t ( a rec5t spra91 only if passive motion at an e>ly date is advisable to prev5t ! occurr5ce ( /iffness 9 ! "o1 x is absolutely necess>y 9 ! o!r40 ,! foll[+ p]ta9s to massage ( spra9s3 8,massage1 9 ! /rict s5se ( ! t]m1 is a great deal m efficaci\s1 especially ) old] spra9s4 ,its action is n limit$ to ! sk9 & sup]ficial /ructures4 ,^! und]go imm5se *anges1 x is true2 !y become s(t] & f9] :ile "u manipulation2 _! /r5g? & ela/icity increase1 ! extreme t5d]ness dim9i%es1 & ! natural appe>ance & texture return4 ,! surface loses its dry1 h>% "* & becomes w>m & moi/ aga92 ! livid blui% color gives away to a bright] hue1 & ! deep] lay]s ( fibr\s tissue yield & /ret*1 s t ! hide-b\nd1 %runk5 condition t is (t5 pres5t aft] long disuse gradually passes (f4 ,b ! good effect is n by any means limit$ to1 or ev5 mo/ conspicu\sly %[n by1 ?is4 ,:5 prop]ly c>ri$ out1 massage ex]ts a simultane\s influ5ce on muscles1 n]ves1 & vessels2 9 fact1 on all ! tissues )9 its rea*4 8,! circulation is ! fir/ ?+ to feel its p[]4 ,x has already be5 expla9$ h[1 aft] prolong$ re/1 ! blood1 z x 71 lies almo/ /agnant 9 ! tissues1 sl[ly circulat+ ?r\gh !m1 & nei!r giv+ !m suffici5t = _! nutrition1 nor remov+ f !m ! wa/e products ( _! action4 ,?is is *ang$ at once4 ,! life ( ! "p is quick5$4 ,! ve9s & absorb5ts are empti$ fir/1 & ! fluid !y conta9 driv5 out into ! he>t1 :i* fills m rapidly1 & contracts m vigor\sly & firmly4 ,!n ! pressure falls 9 ! small] vessels1 & ! t9y irregul> spaces1 full ( lymph1 :i* ext5d 9 all directions ?r\gh ! tissues4 ,^!1 9 _! turn1 are compress$ & me*anically empti$1 _! cont5ts be+ driv5 on into ! empty vessels1 f :i* any backw>d fl[ is prev5t$ by ! valves4 ,! circulation becomes m rapid2 nutrition is c>ri$ on ) great] en]gy1 & ! actual am\nt ( ! blood 9 ! tissues at any "o "t s mu* increas$ t !y become full & s(t to ! t\* & rega9 ! ev5 & r\nd$ cont\r ( active heal?4444 8,x is mo/ ess5tial to comm5ce z gradually & z g5tly z possible1 work+ on ! deep] tissues only aft] ! m sup]ficial ones h become ?or\ghly accu/om$1 & h be5 unload$ ( _! surplus fluid4 ,! sk91 ! s(t subcutane\s tissue1 ! muscles1 & ! deep] lay]s1 mu/ all be work$ 9 turn4 ,nor %\ld ! manipulation be conf9$ to ! injur$ "p4 ,9 a spra9 ( any /&+1 ! :ole ( ! limb is affect$ m or less4 ,x is usually bett] to devote att5tion fir/ to ! p>ts ne>] ! trunk ?an to deal ) ^? ar\nd ! injur$ area1 & only aft]w>d1 :5 ! circulation is ?or\ghly ree/abli%$1 to manipulate ! jo9t itself4 8,! t5d5cy is to make ! sitt+s la/ too long4 ,deep manipulation itself r>ely requires m ?an five m9utes2 b 9 deal+ ) a rec5t injury x may be advisable to sp5d a long] "t ?an ?is ov] ! friction & o!r prep>atory measures1 s t a qu>t] ( an h\r soon passes by4 ,:5 ! t5d]ness is v great1 & ! am\nt ( swell+ excessive1 mu* long] ?an ?is may be necess>y1 b %ort1 frequ5tly repeat$ sitt+s are ( great] b5efit ?an "o long "o4 ,a skillful op]ator1 too1 w (t5 effect m 9 a few m9utes ?an an ord9>y rubb] w 9 z _m sitt+s40 ,a summ>y ( ! g5]al treatm5ts ( spra9s w\ld be z foll[s3 #a4 ,readju/m5t ( p>ts & removal ( ob/ructions4 ,o/eopa?y is especially adapt$ 9 ^! cases1 = two ( ! primal !rapeutic factors 9 all cases f an o/eopa?ic viewpo9t are to readju/ ! anatomical & to remove ob/ructions4 ,"o %\ld con/antly keep 9 m9d1 8a tempor>y displacem5t foll[$ imm$iately by a return to place1 con/itutes a spra940 ,! o/eopa? (t5 f9ds t a p]fect return+ does n take place1 & ev5 remote lesions may affect a jo9t4 #b4 ,manipulation1 & massage ( s(t tissues1 to re/ore circulation & to prev5t & remove debris f rupture ( vessels & inflammatory products4 #c4 ,! employm5t ( cold1 heat & pressure1 & a c]ta9 am\nt ( re/4 #d4 ,anatomical readju/m5t & manipulation 9 *ronic cases to break up adhesions1 remove exudates1 ov]come ! organiz$ products ( inflammation1 & cure synovitis4 #e4 ,movem5ts bo? passive & active to /imulate & ex]cise functions ( ! jo9t4 ,! ,sp9al ,column4--,! o/eopa? is especially cognizant ( ! fact t _m spra9s occur to ! sp9al column4 ,^! may affect a s+le jo9t1 or m or less ( a section may be involv$4 ,! bones1 ligam5ts1 t5dons1 muscles1 or sp9al cord may be f\nd injur$4 ,ev5 di/ant organs1 ?r\gh involvem5t ( ! circulation to ! cord1 or ?r\gh irritation or imp+em5t ( sp9al n]ves & sympa!tics1 are frequ5tly disord]$4 ,x is n necess>y to g into detail$ description1 = ! po9ts be>+ ^u ?is w be f\nd "u ,o/eopa?ic ,diagnosis1 ,etiology1 & ,te*nique1 & ! g5]al description w1 also1 apply4 ,readju/m5t1 /rapp+1 heat1 massage1 manipulation1 iron+1 /ret*+ ( muscles1 fom5tation1 etc41 h _! place4 ,!re is no d\bt t spra9s1 /ra9s1 & bl[s to ! sp9al column are ! cause ( _m sp9al disord]s & consequ5t visc]al di/urbances4 ,! ,ribs4--,spra9s ( ! v]tebral ends frequ5tly occur1 result+ 9 a p>tial luxation1 /ret*+ ( ligam5ts1 contraction ( muscles1 & exudative =mation 9 ! jo9t /ructures1 :i* (t5 is ! cause ( irritation to ! sympa!tic n]ves4 ,! co/al c>tilages are frequ5tly /ra9$1 & may s irritate ! int]co/al n]ve z to cause consid]able pa9 bo? locally & reflexly4 ,! treatm5t is ess5tially "o ( replacem5t1 & relaxation ( ! s(t] tissues4 ,adhesive /rips to limit movem5t due to respiration may be helpful4 ,! ,innom9ata4--,spra9s ( ! innom9ata are also commonly met )4 ,besides be+ a s\rce ( discom=t to ! pati5t !y are an important cause ( pelvic disord]s & leg affections4 ,p>tial displacem5ts are ! rule1 ! correction ( :i* gives quick relief4 ,:]e !re is consid]able spasm ( muscles1 exam9e c>efully ! lumb> alignm5t4 ,9 *ronic cases fibrosis ( muscles & adhesions may complicate matt]s4 ,! ,hip ,jo9t4--,spra9s involv+ ! hip jo9t may be readily correct$1 & aga9 may be ! excit+ cause ( s]i\s involvem5t4 ,previ\s tub]cul> disease c be aggravat$ 9 ?is mann]1 or syphilitic *anges 9 ! jo9t di/urb$4 ,c>e %\ld be tak5 t !re are no complicat+ displacem5ts ( ! innom9ata or irritations to ! sp9al n]ves4 ,possibly ! hip may be s /ra9$ z to cause a twi/ ( ! femur 9 ! socket & ?us simulate a p>tial dislocation2 ?is1 9 fact1 w\ld probably be t]m$ a p>tial dislocation4 ,/ra9 ( "o set ( muscles ab\t ! hip jo9t is some:at r>e1 & sp9al lesions may di/urb ! inn]vation to "o set ( muscles4 ,9 cases ( intracapsul> fracture consid]able c be done by c>eful massage & manipulation aft] union has tak5 place1 to secure great] fre$om ( movem5t & /r5g? ( ! limb4 ,likewise 9 hip-jo9t disease1 aft] ! disease is heal$1 massage & manipulation w be v b5eficial4 ,c>e mu/ be tak5 if ! treatm5t causes spa/icity ( ! muscles2 ?is %[s ! treatm5t is irritative & %\ld be /opp$ until ! spa/icity has ceas$4 ,:]e ! limb is %ort5$ f ei!r hip-jo9t disease or intracapsul> fracture app>5t l5g!n+ may be secur$ by c>eful abductive & hyp]ext5sive /ret*+4 ,! ,knee4--,! knee is ! mo/ complicat$ jo9t1 & spra9s are apt to be v s]i\s4 ,! usual treatm5t = spra9s is employ$4 ,occasionally ! semilun> c>tilages are displac$ & may be a s\rce ( difficulty 9 diagnosis2 likewise injuries to ! patell> t5don & lat]al ligam5ts4 ,ano!r jo9t frequ5tly ov]look$ is ! innom9ate4 ,9 a numb] ( knee cases t t]m9ate 9 *ronic synovitis !re w be f\nd a displacem5t ( ! innom9ate t is prev5t+ recov]y4 ,a vill\s synovitis may arise 9 /ra9s f faulty po/ure1 especially 9 ! obese4 ,injury to ! hip-jo9t1 also1 may cause /ra9 or irritation at ! knee4 ,occasionally t5d] po9ts ab\t ! knee1 especially at ! inn] side1 are due to irritation at ! hip1 or possibly f ! sp9e4 ,ref]r$ pa9 ( ! knee jo9t is ( frequ5t occurr5ce4 ,! ,ankle & ,foot4--,! ankle is (t5 spra9$4 ,"o %\ld exam9e c>efully = a possible fracture ( ! malleolus1 & = fracture ( ! tibia4 ,!re may be a dislocation ( ! fibula1 also a sep>at+ ( ! tibia & fibula at ! ankle4 ,! common bony displacem5t takes place betwe5 ! a/ragalus & os calcis4 ,!n ! cuboid is frequ5tly displac$1 & occasionally ! navicul>4 ,! treatm5t %\ld fir/ ( all be direct$ to correction ( ! osse\s lesions4 ,! ar* ( ! in/ep may be weak5$ f ! ligam5t\s /ra9 & be an imm$iate /ep 9 ! production ( flat foot4 ,teall is ( ! op9ion t lumb> & innom9ate displacem5t are common pr$ispos+ causes4 ,faulty position ( ! foot 9 walk+ may be an und]ly+ factor4 ,bunions result f a malposition ( ! jo9t4 ,morton's disease due to a p9*+ ( ! metat>sal n]ve w (t5 yield to o/eopa?ic treatm5t alone4 ,!re is g5]ally displacem5t ( ! metat>sal bone4 ,a pad worn directly "u ! pa9ful po9t w be ( b5efit4 ,9 _m ( ! local neuralgias1 "s anatomical displacem5t w be f\nd z ! excit+ cause4 ,hamm]-toe if n complicat$ ) g\t1 rheumatism1 etc41 w yield to treatm5t if kept at p]si/5tly1 o!rwise surgical int]f]5ce w be necess>y4 ,likewise v>i\s de=mities ( ! foot & result+ neuralgias may be trac$ to local spra9s1 ill-fitt+ %oes1 or anatomical maladju/m5ts high] up ( su* a "* z to affect ! p$al circulation4 ,flat ,foot ,flat foot or weak foot is "o ( ! common disord]s t ! o/eopa? is con/antly call$ ^u to treat4 ,9 ! fir/ place ! pati5t %\ld be taught to walk correctly4 ,! feet %\ld be p>allel 9 walk+ s t ! weak5$ muscles may be develop$ & /r5g!n$4 ,?is w be difficult at fir/1 b recov]y dep5ds ^u ?is important po9t4 ,9 addition to ?is1 special ex]cises1 l turn+ ! toes "u & tip toe ex]cises1 %\ld be p]si/$ 9 = a few m9utes two or ?ree times daily4 ,^u ! o!r h&1 d n ov]do ! ex]cises b always c>ry !m to a po9t ( fatigue4 ,^! two features1 walk+ correctly & ex]cis+1 are ess5tial complem5t>y measures to ! adju/+ treatm5t4 ,9 conjunction ) ! above1 ! ,scot* d\*e at ! end ( ! day w prove ( consid]able b5efit4 ,9 ! te*nique "w1 fir/ make c]ta9 t !re are no innom9ate or sp9al lesions t be> ^u ! circulation & inn]vation ( ! feet4 ,!n frequ5tly faulty walk+ is due to ^! lesions4 ,9 rec5t cases1 simply remold+ ! ar*es ( ! foot w be all t is necess>y1 provid+ correct walk+ & foot ex]cis+ is ma9ta9$4 ,b 9 ! m *ronic cases consid]able adju/+ & remold+ ( ! tissues1 bones1 ligam5ts1 muscles & fascia1 are dem&$4 ,p]fect apposition betwe5 ! a/ragalus & navicul> bones1 ! highe/ po9t ( ! longitud9al ar*1 %\ld be fir/ secur$4 ,att5tion %\ld also be giv5 ! o!r articulat+ /ructures d[n to ! metat>sal bones4 ,?is ree/abli%es ! ar* & ov]comes ! ev]t$ t5d5cy4 ,consid]able repeat$ =ce is (t5 dem&$ to release ! fibrotic tissues1 b x is ! important "p ( ?is te*nique4 ,) ! pati5t on ! table1 sup9e1 place y\r ?umb firmly at ! articulation ( ! navicul> & a/ragalus4 ,!n ) ! o!r h& ar\nd ! metat>sals to be us$ z a lev] 9 ext5d+1 rotat+ & inv]t+ ! foot ) ! fulcrum at ! ?umb ( ! fir/ h&1 spr+1 ?ru/ & adju/ ! ar*4 ,?is requires consid]able /r5g? & exactness ( application4 ,! tissues mu/ give freely be=e ! result c be secur$4 ,?is is (t5 pa9ful to ! pati5t b %\ld be cont9u$ & repeat$ to ! fur!/ po9t ( motion until recov]y is complete4 ,treat z (t5 z ! condition p]mits4 ,sub/itut+ ! crot* ( ! ?umb & =ef+] or ! knee = ! ?umb w give add$ advantage4 ,foll[ ?is ) ?or\gh spr++ ( ! plant> tissues by ?umb & f+]s4 ,if ?is is kept up ) suitable ex]cises & correct walk+1 & prop] %oes 7,munson la/71 excell5t results w be obta9$ 9 ! great majority ( cases4 ,same pair ( %oes %\ld n be worn two days 9 succession4 ,_m times ! ant]ior ar* is involv$1 jo9tly or sep>ately4 ,p]si/5t adju/+ & remold+ ( ! ar* tissues w secure satisfactory results unless ! bones are m>k$ly de=m$ & ! weight ( ! body is relatively too great4 ,9 ?is disord]1 aside f pay+ special att5tion to ! metat>sal articulations1 ! great toe requires a p>ticul> te*nique4 ,= ?is grasp ! toe firmly1 ex]t traction until ! tissue gives slightly & rotate x inw>d1 t[>d ! m$ian l9e ( ! body1 on its longitud9al axis4 ,h ! pati5t frequ5tly turn ! toes "u1 or attempt to d x until ! ex]cise c be easily accompli%$4 ,d n employ ar* support]s except 9 hopeless cases4 ,!y simply spl9t ! foot & ?us fur!r weak5 ! foot muscles4 ,if ! above me?ods are p]si/5tly foll[$ to ! po9t ( actual adju/m5t1 accompani$ by releas+ ( fibr\s tissue & actual /r5g!n+ ( muscles ?r\gh ex]cise1 a v l>ge p]c5tage ( cases w recov]4 ,9 a few cases adhesive /rips w be ( b5efit4 ,! ,%\ld]4--,exclusive ( muscul> & o!r /ra9s !re may be a p>tial dislocation4 ,9 ^! cases ! acromial end ( ! clavicle is frequ5tly dislocat$1 & ow+ to a g5]al lack ( muscul> tone may be v h>d to keep 9 place4 ,! l[] & inn] "p ( ! capsule is (t5 affect$1 s t fre$om ( function is lack+ & !re is consid]able pa94 ,?is is due to ! ?9ness ( ! capsule & ! l>ge am\nt ( s(t tissue1 s t :5 ! arm hangs at ! side ! tissue is ?r[n into folds2 & be+ v vascul> is easily injur$1 s t ! vascul> lymph readily organizes & ! "p becomes /iff & unyield+4 ,x requires pati5t1 labori\s treatm5t to break up & absorb ?is fibr\s tissue4 ,!n ! long t5don ( ! biceps 9 "s %\ld] spra9s is dislocat$1 b r>ely4 ,9 %\ld] injuries1 exam9e also1 ! upp] ribs4 ,! ,elb[4--,! elb[ is ano!r complicat$ jo9t4 ,"o %\ld be c>eful t !re is no fracture1 & 9 *ildr5 t !re is n epiphysial sep>ation4 ,ext5d+1 flex+1 pronat+ & sup9at+ ! arm w aid mu* 9 ! diagnosis4 ,exam9e well ! rotation ( ! radius at ! elb[ jo9t1 & be positive t ! olecranon process drops normally into its fossa at ! end ( ! hum]us4 ,! ,wri/ & ,h&4--,! wri/ is ano!r jo9t commonly spra9$4 ,"h1 also1 c>e %\ld be tak5 t a fracture does n exi/4 ,colle's fracture is frequ5t4 ,! bursal & t5don %ea?s are usually m>k$ly involv$4 ,! scaphoid & semilun> are apt to be displac$2 also1 ! os magnum & ! unci=m4 ,spra9s ( ! f+]s are (t5 met )4 ,outside ( /ra9s to ! muscles1 ligam5ts1 & o!r tissues ! jo9t is apt to be some:at impact$4 ,traction w correct ! latt]4 ,c>e %\ld be tak5 t a fracture is n pres5t4 ,dupuytr5's contraction occurs f spra9s or injuries1 z ! result ( contraction ( ! fascia4 ,! r+ & index f+]s are memb]s usually affect$4 ,9 "s cases ! affection w be f\nd 9 bo? h&s 7symmetrical71 & a sp9al lesion w be ! pr$ispos+ factor4 ,treatm5t e day1 by /raight5+ ! f+]s & /ret*+ ! tissue w at lea/ ret>d ! de=mity1 b 9 a numb] ( cases surg]y w h to be resort$ to4 ,a ganglion or 8weep+ s9ew0 is a swell+ 9 connection ) ! t5don %ea?4 ,x pres5ts a r\nd1 firm outl9e1 usually ^u ! back ( ! wri/4 ,!re is g5]ally f\nd a displacem5t ( "o or m ( ! wri/ bones4 ,if treatm5t ( ! jo9t & t5don %ea? does n remove ! ganglion1 surg]y may be utiliz$4 ,trigg]-f+] is a r>e disord]4 ,!re is usually a hi/ory ( local /ra91 :i* probably result$ 9 "s ?ick5+ ( ! t5don4 ,manipulation & passive motion if cont9u$ w g5]ally give relief4 ,fractures ,immobilization & re/ h be5 ! p>am\nt po9ts ) mo/ physicians 9 ! treatm5t ( fractures & spra9s4 ,!y h claim$ t a spra9 %\ld be manipulat$ b r>ely1 mu* less a fractur$ bone4 ,re/1 quiet1 & fixation ( an injur$ jo9t or bone h be5 rules t %\ld n be violat$ "u any consid]ation4 ,9 cases ( spra9 ! great cry has be5 to let ! jo9t alone = fe> ( spread+ a possible tub]cul> infection4 ,x is well to recall ,mum=d's /atem5t t if immobilization is too long cont9u$1 %\ld !re be a tub]cul> ta9t1 prop] conditions = a localiz$ tub]culosis is e/abli%$4 ,& /ill a ^w ( caution "h1 t an o/eopa? %\ld n be ov] zeal\s & %\ld c>efully weigh all possible factors1 bo? local & con/itutional1 may n be amiss4 ,9 previ\s tub]cul>1 syphilitic1 & o!r diseas$ /ates discretion %\ld be employ$4 ,r$uc+ re/ & immobilization to a m9imum means mu* to ! pati5t1 n only 9 ! loss ( valuable "t b 9 annoy+ & s]i\s aft] effects4 ,_m cases ( spra9s & fractures come to ! o/eopa?4 ,9 spra9s t h become *ronic ?r\gh too mu* re/ ( ! "p & improp] treatm5t1 almo/ inv>iably !re is f\nd displacem5ts ( bone & adhesions t %\ld nev] h exi/$2 !n has foll[$ organiz$ exudates & *ronic synovitis4 ,9 fractures & ev5 9 complete dislocations ! o/eopa? cont9ually obs]ves t too mu* re/ has be5 giv5 ! "p1 result+ 9 unnecess>y adhesions1 contractions1 atrophy ( muscles1 & impairm5t ( function4 ,treatm5t almo/ always cures ! condition1 or at lea/ mat]ially relieves4 ,h[ mu* bett] if ! prop] treatm5t _h be5 fir/ in/itut$ & ?us a l>ge p]c5tage ( cases prev5t$ f becom+ *ronic4 ,( p>ticul> int]e/ to ! o/eopa? is ! pap] prep>$ by ,eis5dra? on 8,e>ly ,massage & ,movem5ts 9 ! ,treatm5t ( ,fractures & ,spra9s10 & ! discussion t foll[$ be=e ! ,*icago ,m$ical ,society4 ,! ,ill9ois ,m$ical ,j\rnal1 ,decemb]1 #aijc1 conta9s a report4 ,eis5dra? said 9 "p3 8,! =m] r\t9e ( immobiliz+ all fractures & ! adjac5t jo9ts = a p]iod ( f\r to six weeks mu/1 ,i feel1 be subject to slight modification 9 ! light ( rec5t exp]i5ce1 & x %all be ! aim ( ?is pap] to %[ :at ^! *anges are4 ,:5 we are call$ to a case ( fracture1 x %\ld be "o's fir/ duty aft] its r$uction to consid] h[ c ,i be/ aid ! pati5t 9 recov]+ ! usefulness ( 8 or h] limbs8 ,c we %ort5 ! long convalesc5ce ) its resultant loss ( valuable "t & e>n+ capacity8 ,h[ c we mo/ rapidly re/ore to ! limb its normal jo9t functions & prev5t an atrophy ( muscles & an ankylosis :i* w require _m mon?s to ov]come8444 8,! use ( massage & ( active & passive movem5ts 9 ! treatm5t ( fractures & ( sev]e spra9s has be5 gradually ga9+ 9 ! numb] ( its advocates ?r\gh ! writ+s ( ,lucas-,*ampionni]e ( ,p>is4 ,we owe him a great debt = call+ ! att5tion ( ! pr(ession to ! employm5t ( ^! me?ods 9 ord] to prev5t atrophy & ankylosis z well z to promote heal+4444 8,be=e tak+ up my subject 9 detail p]mit me to recall a few sali5t po9ts 9 ! surgical pa?ology ( fracture4 ,soon aft] ! injury ! blood clot ar\nd & betwe5 ! ends ( ! fragm5ts is absorb$ & replac$ by a jelly-l mass ( "y connective tissue cells call$ ! callus4 ,x corresponds to ! sold] :i* ! plumb] places ov] ! ends ( two pipes he desires to jo94 ,bone beg9s to =m at ! p]iph]y ( ! callus ab\t ! t5? day & advances t[>d ! c5t] rapidly1 =m+ a r+ ( bone ar\nd ! ends ( ! fragm5ts s t by ! end ( ! ?ird week !re is b slight abnormal motion at ! po9t ( fracture 7exception to ?is is ! femur74 ,?is entirely disappe>s by ! end ( ! f\r? week1 especially 9 "y p1 & ! union is firm4 ,9 ! case ( ! femur x requires six or eight weeks4 ,! great] ! displacem5t ( ! ends ( ! fragm5t1 ! l>g] ! callus & ! sl[] ! heal+ ( ! fracture4 8,dur+ ^! *anges 7callus =mation7 ! muscles :i* supply ! immobiliz$ jo9ts atrophy & ! circulation 9 ! sk9 & neighbor+ tissues is sluggi%1 result+ 9 swell+1 etc41 ( ! limb4 ,! en=c$ re/ causes m or less fluid to accumulate 9 ! t5don %ea?s & jo9ts4 ,?is becomes organiz$ & results 9 fibr\s ankylosis ( ! jo9ts & great imp$im5t to ! free action ( ! t5dons )9 _! %ea?s4 ,x is ?is atrophy1 fibr\s ankylosis & t5ovag9itis :i* int]f]e ) ! re/oration ( ! normal functions ( ! limb4444 8,c we decrease ! am\nt ( wa/+ ( muscles & control ! /iffness ( jo9ts & t5dons aft] fractures8 8,x is ! belief ( ! writ]1 bas$ on a l>ge exp]i5ce1 t ! e>li] use ( massage1 active & passive motions1 w to a great ext5t elim9ate ! above conditions1 :i* ret>d convalesc5ce & 9 "s cases cause p]man5t disability4 8,massage ( an injur$ limb increases ! am\nt ( blood suppli$ to x1 promotes ! absorption ( ! swell+ & prev5ts atrophy ( muscles4 ,9 ! case ( a jo9t injury ! exudate rapidly disappe>s & ! articul> surfaces c be aga9 approximat$ s t movem5t is facilitat$4 ,by ! cauti\s use ( active & passive movem5ts1 ei!r ) or )\t ! aid ( app>atus1 ! normal functions ( a jo9t c be rapidly re/or$4444 8,! active & passive movem5ts ( ! limbs c be c>ri$ out imm$iately aft] ! massage1 b %\ld only be p]mitt$ = a p]iod ( five m9utes at fir/ & ! "t !n gradually increas$4 ,:5 a sev]e spra91 say ! elb[ or ankle1 is fir/ massag$1 ! pa9 seems to be almo/ unbe>able1 b ?is discom=t z well z ! swell+ rapidly disappe>s1 & x is surpris+ to ^? :o h nev] appli$ ?is treatm5t h[ quickly ! normal function ( ! jo9t reappe>s4 ,! same applies to ! synovitis :i* accompanies fractures 9 close proximity or ev5 into jo9ts40 ,! relief giv5 ^! cases by massage1 movem5ts & manipulations by ! o/eopa? is a daily exp]i5ce1 & results to him are n surpris+4 ,!n 9 addition to :at ! surgeon w\ld d1 ! o/eopa? applies 8 pr9ciples ( c>eful detail readju/m5t4 ,eis5dra? cont9ues 8 pap] by ref]r+ to ! pr9cipal v>ieties ( fractures & giv+ ! treatm5t = ea*4 ,he says t if correct treatm5t is c>ri$ out ) prop] massage & movem5ts 9 fractures ( "o or bo? bones ( ! leg1 ! pati5t w be at "w 9 six or sev5 weeks in/ead ( ?ree or f\r mon?s1 t 9 ,colle's fracture "s surgeons d n employ a spl9t1 & t 9 fractures ( ! olecranon1 massage f ! fir/ week on is ( ! greate/ use4 ,?is "p is v int]e/+ b space =bids giv+ x4 ,he !n concludes 8 article ) citation ( sev]al v int]e/+ cases ( fractures & sev]e spra9s4 ,^! cases are exceptionally int]e/+ to ! o/eopa?1 b /ill ! same good treatm5t & results are duplicat$ e day 9 ! o/eopa?ic s*ool4 ,! doctor's contra9dications to ! use ( e>ly massage 9 fractures or spra9s are ! foll[+3 8#a4 ,t5d5cy to displacem5t ( fragm5ts 9 oblique fractures4 ,"u su* conditions x is be/ n to beg9 ei!r massage or movem5ts until ! union is firm 7f\r? to fif? week74 8#b4 ,9 comp\nd fractures until ! w\nd is heal$4 8#c4 ,:5ev] ! condition ( ! sk9 is su* z to p]mit ( infection2 = example1 ! pres5ce ( blebs1 or ext5sive abrasions4 8#d4 ,! pres5ce ( fragm5ts :i* project b d n p5etrate ! sk940 ,8 conclusions are3 8#a4 ,massage1 active & passive motions prev5t atrophy ( muscles1 t5ovag9itis & ankylosis s frequ5tly accompany+ & foll[+ fractures1 especially ^? close to ! %\ld]1 elb[1 wri/1 knee & ankle jo9ts4 8#b4 ,!y give f> bett] results ?an complete immobilization 9 ! majority ( fractures40 ,9 ! discussion t foll[$ ,h5rot9 said t = "s "t1 8,i h nev] put a re/ra9+ app>atus ( any k9d1 nor h ,i us$ any lotions on any spra91 no matt] h[ sev]e4444 8,x has tak5 _m ye>s to br+ ?is subject be=e ! pr(ession4 ,x is a me?od t is absolutely effective z reg>ds spra9s & "s =ms ( fractures4 ,i h treat$ sev]al hundr$ su* cases ) ! greate/ success40 ,he also said t1 8,9 treat+ an inflam$ jo9t x is improp] to use a re/ra9+ app>atus ( any k9d4 ,i consid] t ! pla/] ca/ is ! bane ( all inflam$ jo9ts unless !re is a specific =m ( infection1 a traumatic condition40 ,nei!r does he believe t an inflam$ jo9t %\ld be put at re/4 ,he says ! pati5t is a good judge z to ! am\nt ( quiet ! jo9t ne$s4 ,he has treat$ ,colle's fractures & fractur$ clavicles )\t b&ages or app>atus4 ,to sum up1 ! o/eopa?ic proc$ure 9 ! treatm5t ( fractures w\ld be z foll[s3 #a4 ,immobilization 9 ^? cases especially dem&+ x1 f ! "* ( ! fracture1 until =mation assures solid & firm union4 #b4 ,manipulation & massage & movem5ts ( p>ts at an e>ly p]iod1 compatible ) ! above1 to r5d] s(t tissues pliable1 to remove /iffness & adhesions1 to re/ore a normal circulation1 & to ex]cise & function ! p>ts4 #c4 ,9 cases ( lac]ation ( s(t tissues1 abrasions1 etc41 great c>e %\ld be tak5 s z n to infect ! p>ts4 #d4 ,great c>e %\ld be tak5 :]e fracture is comp\nd1 & :]e fragm5ts exi/4 #e4 ,9 all cases1 bo? acute & *ronic1 critically exam9e = slight anatomical deviations locally & remotely4 ,9 dislocations ! fundam5tals ( ! above are applicable4 ,d n let *ronic /iffness1 or rigidity1 adhesions1 or synovitis sup]v5e if possible to prev5t4 ,an important consid]ation 9 all cases ( spra9s1 fractures1 & dislocations t become *ronic is ! probable effect ^u dep5d5t tissues by way ( n]ve impairm5t & vascul> ob/ruction2 = examples1 ! spra9$ back may readily impair organic life1 ! fractur$ elb[ prev5t use ( ! arm1 ! injur$ leg pr$ispose to flat foot4 7,see ,j4 ,b4 ,littlejohn--,o/eopa?ic ,surg]y1 includ+ ,treatm5t ( ,fractures1 ,j\rnal ( ! ,am]ican ,o/eopa?ic ,association1 ,nov41 #aije47 ,,footnotes3 #da ,see also ,jones' late/ "w1 ,injuries to ,jo9ts4 #db ,see also ,:>ton ,hood1 ,spra9s & ,fractures4 ,,po/ural ,,defects ,a po/ural defect is any abnormal position1 cong5ital or acquir$1 ( ! body1 assum$ 9 sitt+1 /&+ or walk+4 ,?is leads to a symmetrical developm5t1 causes /ructural *anges1 & z a sequel1 di/urbance ( function & organic life results4 ,defects 9 po/ure are ( v common occurr5ce4 ,a p]fect po/ure1 9 fact1 is some:at r>e4 ,consid]able is be+ accompli%$1 especially ( late ye>s1 by ! laity ?r\gh v>i\s physical me?ods & ex]cises to correct ! _m defects ( position 9 sitt+1 /&+ & walk+4 ,! orig9ators ( ! _m s-t]m$ sy/ems ( ex]cises h gone s f> z to ev5 adv]tise to cure v>i\s diseases ( ! body z well z attempt+ to improve ! normal tissues & /ructure4 ,ex]cises1 und\bt$ly1 h _! place1 p>ticul>ly 9 ! life ( ^? ( s$5t>y habits4 ,mo/ ( u d n ex]cise en\gh1 nei!r d we z a rule get en\gh fre% air & pure wat]4 ,b !re are _m defects ( ! anatomical t m]e gymna/ics c n adju/4 ,& !re are /ill o!r defects t gymna/ics may decid$ly aggravate4 ,9 ^! cases ! me*anism ( ! body has become s d]ang$ & di/urb$ t no?+ %ort ( actual readju/m5t c be effective4 ,9 ! consid]ation ( po/ural defects !re are a few po9ts t %\ld be p>ticul>ly emphasiz$4 ,fir/1 ^! defects may n only be ! result ( laz9ess or c>elessness1 b ( m frequ5t occurr5ce is "s previ\s /ra9 or injury to ! sp9al column or o!r p>ts ( ! body framework4 ,"s defect ( position or symmetry ( ! body may easily foll[ z a result4 ,"h gymna/ic "w may r$uce ! defect to a m9imum1 b r>ely c ! comp5satory =ces ( nature entirely oblit]ate ! /ructural disord]1 unless assi/$ by actual1 specific readju/m5t4 ,second1 9 ! exam9ation & treatm5t ( ! pati5t due att5tion %\ld be giv5 ! symmetry & figure ( ! body z a :ole s t relation ( ! "p to ! :ole & vice v]sa may be rightly proportion$4 ,rememb] t ! sp9al column is only "o "p ( ! body outl9e1 ?us "o %\ld consid] ! transv]se section ( ! body 9 relation to ! sp9al column & n ! sp9al column alone4 ,9 a ^w1 correction ( po/ural defects implies bo? /ructural re>rangem5t & mold+ ( ! cont\r4 ,d n make ! mi/ake1 = example1 :5 correct+ a de=mity t involves ! *e/1 ( pay+ att5tion to ! sp9e alone1 b take into consid]ation ! ?orax z a :ole ( :i* ! sp9e is only a "p4 ,r\nd ,%\ld]s ,r\nd ,%\ld]s are a defective po/ure ) :i* ev]yone is famili>4 ,h[ _m *ildr5 h escap$ ! p>5ts' criticism to sit1 /&1 & walk erect8 ,& n a few ( ! afflict$ h n succe$$ aft] p]si/5tly do+ _! be/4 ,r\nd %\ld]s or /oop %\ld]s are commonly attribut$ to indiff]5ce4 ,probably a few cases are due simply to laz9ess & indiff]5ce1 & o!rs may be c>elessness1 & usually :5 !y arrive at an age :]e pride ( _! physical demeanor & p[]s ent]s z a life factor1 ! *ild soon ov]comes ! po/ural weakness4 ,) /ill o!rs ! correct1 p]si/5t physical tra9+1 z exemplifi$ 9 milit>y s*ools1 w readju/ ! defect4 ,b !re is a class1 & by f> ! l>ge/1 :]e r\nd %\ld]s are a v real & active weakness ( ! physical body4 ,& ! weakness is n prim>ily 9 ! %\ld]s z ne>ly ev]yone ?9ks4 ,! /oop is a result4 ,! orig9 is 9 ! l[] dorsal sp9al column4 ,"h w be f\nd a po/]ior curvature t involves ne>ly ! entire dorsal & lumb> areas4 ,?is is ! real1 ! orig9al cause ( ! l>g] numb] ( r\nd %\ld]s4 ,?is backw>d curve ( ! sp9al column1 in/ead ( ! =w>d curve z x %\ld normally be at ! wai/1 oblit]ates ! brace or truss ( ! sp9al column t is s ess5tial 9 ma9ta9+ an erect po/ure ( ! %\ld]s4 ,x all[s ! individual to 8fall into 8 /oma*10 to drop ! %\ld]s1 & z a consequ5ce ! *e/ cavity is depress$4 ,! sp9e is "o cont9u\s backw>d b[1 & :5 he does try to sit /raight1 & x is always ) a con/ant ef=t1 ! normal1 ! physiological curves ( ! sp9e are n app>5t4 ,fir/1 !n1 !re is a sp9al weakness 9 ! region ( ! inn]vation to ! dige/ive organs4 ,indige/ion ( v>i\s =ms is a common accompanim5t4 ,second1 !re is less5$ lung & he>t capacity4 ,! ribs are depress$1 int]f]+ ) p]fect a]ation & elim9ation on ! "p ( ! lungs & ) normal activity & tone ( ! he>t muscles4 ,ph?isis is pr$ispos$4 ,is x any wond] ! *ild's blood is impov]i%$ & anemia results f ! insuffici5t a]ation & poor dige/ion & assimilation8 ,co/og5ic anemia may also be a result4 ,&1 ?ird1 ! %\ld]s are 8r\nd0 f ! sp9al weakness & flatt5$ *e/1 really an effect2 b :ile ! mo/ noticeable1 x is ! lea/ s]i\s4 ,x is evid5t f c>eful obs]vation & /udy ( ^! cases t ! treatm5t resolves itself into ! treatm5t ( a po/]ior sp9al curvature4 ,%\ld] braces1 /eel braces & jackets1 & ca/s h v little place1 if any1 al?\gh !re may be diseas$ bone ( su* "* & sev]ity t a ca/ w be necess>y2 ?is1 h[ev]1 w\ld ref] to treatm5t ( ,pott's disease & simil> conditions4 ,h5ce1 ! treatm5t is1 fir/ to replace & readju/ ! malalign$ v]tebr4 ,!re mu/ be an actual physical manipulation 9 ord] to correct ! v]tebr at fault4 ,?is is ! ess5tial1 & by f> ! primal1 treatm5t = ! key to ! truss or brace t holds & reta9s ! body 9 an erect position is !n replac$4 ,second1 rais+ ! depress$ ribs4 ,rememb] ! depress$ ribs are dep5d5t ^u ! sp9al condition4 ,! ?orax %\ld be treat$ z a compreh5sive :ole1 n ! sp9al column alone4 ,?ird1 ex]cises are a valuable aid4 ,! individual's "p is z necess>y1 9 a way1 z ! physician's1 = 9 ord] to accompli% ! maximum !re %\ld be consi/5t & appreciative "w on ! "p ( ! pati5t4 ,hold+ ! %\ld]s back1 ! head erect & ! *9 91 draw+ ! abdom5 9 & up1 all ) deep brea?+ by ! use ( ! *e/ muscles1 ! pati5t w be able to reta9 ! correction obta9$ dur+ treatm5ts4 8,sett+ up0 ex]cises are helpful4 ,develop+ ! muscles ( =c$ expiration is excell5t4 ,?us ! pati5t mu/ be consci\s ( ! "w requir$ ( him & act 9 conc]t ) ! physician4 ,m9ute in/ruction on ! requirem5ts ( ea* case is dem&$4 ,good food1 pure wat]1 & fre% air are necess>y1 p>ticul>ly 9 ! anemic4 ,"r liv+ & correct environm5t are always 9 ord]4 ,pa9ful ,%\ld]s ,"u ?is head+ may come a v>iety ( conditions affect+ "o or bo? %\ld]s caus+ mu* di/ress &1 at times1 total disability4 ,! conditions may be ! result ( direct injury to ! jo9t1 sy/emic1 or f sp9al lesions4 ,anatomically ! %\ld] (f]s frequ5t opportunity to injury z x has ! greate/ range ( motion ( any jo9t1 is lea/ secure 9 its articulation1 & is mo/ vuln]able f location4 ,once ! %\ld] has be5 dislocat$ x is r>ely back to normal function+ aga9 z ?is injury te>s ! capsul> ligam5t & /ret*es ! /ructures 9 relation4 ,_m times !re is only a subluxation 9 :i* ! head ( ! hum]us is driv5 upw>ds 9 ! fossa1 usually f a fall or bl[ on ! po9t ( ! elb[4 ,z a rule1 aft] su* an accid5t1 ! only ?+ done is to re/ ! jo9t & apply a l9im5t &1 aft] a "t1 beg9 ! use ( ! arm4 ,x is1 h[ev]1 pa9ful & to save himself1 ! pati5t ea* "t re/ricts movem5t until he rea*es a po9t :]e he is unable to dress )\t assi/ance4 ,x is !n f\nd t normal motion is r$uc$ fully "o-half & ev5 ?is w be accompani$ by pa9 on movem5t & 9 b$4 ,a radiograph w1 usually1 %[ ! condition4 ,articul> crepitus & fibr\s adhesions are pres5t :ile ! adjo9+ /ructures h und]gone *anges s t a r$uction is impossible )\t c]ta9 prep>ation4 ,v (t5 a trivial cause w disable a jo9t2 a sudd5 movem5t :i* f9ds ! muscles ab\t ! %\ld] unprep>$ & ! result+ lesion is s slight z to1 (t51 defy detection4 ,at fir/ !re w be swell+ & pa9 b1 9 "t1 x settles d[n to a limit$ motion ) m or less di/ress4 ,bursitis4--,?is is a condition 9 :i* ! subdeltoid bursa is involv$ or :]e !re h be5 a numb] ( burs =m$ f ov]use ( ! jo9t4 ,"o au?ority reports z _m z tw5ty-five 9 a %\ld]4 ,!re may be1 also1 t5osynovitis prim>ily or f ext5sion4 ,^! conditions may n be easily diagnos$ at fir/4 ,bra*ial neuritis 7*ronic7 beg9n+ ) or )\t an acute attack is usually f a c]vical lesion involv+ ! bra*ial plexus b mo/ frequ5tly x is ! #e? & #f? c]vicals at ! orig9 ( ! circumflex n]ve4 ,f ?is ! deltoid is p>ticul>ly affect$ & its contraction leads to pressure on ! n]ve & subsequ5t p>tial or complete p>alysis4 ,bra*ial neuritis is f\nd 9 an increas+ numb] ( o/eopa?ic practicians & is ! result ( ov]work ( ! arms & to /ra9 ( ! upp] dorsals & l[] c]vicals4 ,!re are contractions ( /ructures ab\t ! jo9t con/antly limit+ motion & pa9 :5 a /ra9 is put on !m4 ,_m me?ods = ! treatm5t ( ! conditions describ$ h be5 employ$1 all involv+ ! same pr9ciple b none ( !m sy/ematiz$4 ,c4 ,h4 ,sp5c] has work$ out a te*nique :i*1 :ile orig9ally int5d$ = bursitis1 has be5 f\nd well adapt$ to all conditions describ$4 ,x gives a /ret*+ ( all /ructures & gradually breaks up adhesions1 bo? 9 ! jo9t & 9 ! t5don %ea?s1 s !re is no result+ irritation :i* c\ld easily result if sudd5ly done4 ,8 te*nique is#dc3 8,fir/3 ,! pati5t on ! side1 ! affect$ %\ld] up2 op]ator fac+ ! pati5t1 places "o h& on ! top ( ! %\ld]1 does no?+ m ?an fix+ x2 ) ! h& grasp+ ! =e>m above ! wri/1 pu% ! elb[ backw>d1 ! arm p>allel to & almo/ 9 contact ) ! body1 !n pull =w>d 9 ! same plane4 ,second3 ,elevate ! elb[ ) ! h&s ( ! op]ator 9 ! same position z be=e1 c>ry ! elb[ 9 z wide a circle z possible4 ,?ird3 ,) ! h&s /ill 9 ! same position1 ext5d ! =e>m ) traction2 c>ry x z high 9 front ( ! pati5t z possible4 ,! =ego+ are design$ to relieve ! conge/ion ab\t ! %\ld]1 br+ pressure to be> on ! subdeltoid bursa & mod]ate traction on ! suprasp9atus1 infrasp9atus1 subscapul>is1 t]es m9or & major1 latissimus dorsi & ! t5don ( ! biceps4 ,^! manipulations w be all t is possible 9 ! m aggravat$ cases = "s consid]able p]iod ( "t4 ,z ! t5d]ness subsides1 ! second gr\p may be cauti\sly />t$1 ! h&s 9 ! same position z above not$1 ) ! arm ext5d$ z ne>ly z possible at "r angles ) ! body1 c>ry ! arm 9 z wide a circle z ! pa9 w p]mit4 ,aga91 ) ! arm flex$ at ! elb[1 "o h& ( ! op]ator on ! po9t ( ! %\ld] & ! =e>m ( ! pati5t across ! =e>m ( ! op]ator1 ! o!r h& ( ! op]ator re/+ on ! po9t ( ! pati5t's elb[1 pu% d[n t[>d ! middle l9e ( ! body & c>ry ! elb[ t[>d ! head4 ,!n flex ! arm & place ! back ( ! h& beh9d ! pati5t1 flex+ ! %\ld] 9 front ) "o h& grasp+ ! po9t ( ! elb[ & pull =w>d4 ,?is gr\p ( movem5ts accompli%es ) great] =ce ! same ends obta9$ 9 ! previ\s1 & ! fir/ 9 ?is gr\p is ! mo/ effective 9 ov]com+ swell+ ( ! subdeltoid bursa4 ,direct manipulation ( ! muscle masses & ?is bursa is desirable f ! fir/40 ,x w be notic$ 9 all ^! movem5ts t ! jo9t is protect$ by "o h& ( ! op]ator :ile ! o!r is grasp+ ! arm ( ! pati5t4 ,?is is desirable z x makes ! te*nique absolutely safe4 ,an additional treatm5t w be f\nd v effective1 especially :]e ! deltoid is involv$4 ,) ! pati5t on ! well side1 fac+ ! op]ator1 locate ! quadrilat]al space :i* is b\nd$ by ! subscapul>is above1 ! t]es m9or bel[ & ! long head ( ! biceps m$ially & ! surgical neck ( ! hum]us ext]nally1 & ! circumflex n]ve c be easily palpat$ along ) ! art]y4 ,if ^! /ructures are /ret*$ & ! deltoid lift$ f ! %\ld] x w be f\nd to free ! action ( bo? n]ve & art]y1 "o supply+ ! jo9t ) nutrition & ! o!r inn]vat+ x4 ,c]ta9 conditions = :i* ^! movem5ts are contra9dicat$ arise & ! foll[+ diff]5tial po9ts by ,h4 ,glasscock are well to rememb]#dd3 8,rheumatism3 ,fev] 9 ! jo9t1 ) r$ness1 swell+ & o!r jo9ts involv$4 ,tub]culosis3 ,daily temp]ature & o!r tub]cul> foci4 ,neuritis3 ,pa9 9 ! neck & %\ld] muscles1 also ne> ins]tion ( deltoid & 9 ! =e>m1 p>ticul>ly musculo spiral4 ,pa9 worse at night4 ,no pa9 on movem5t4 ,no swell+4 ,bursitis3 ,no pa9 9 neck4 ,pa9 9 ant]ior & po/]ior "p ( jo9t & on motion4 ,pa9 ne> ins]tion ( deltoid4 ,arm held close to ! body1 motionless4 ,infection3 ,*ill1 limit$ motion1 sev]e pa9 ) temp]ature4 ,dislocation3 ,de=mity ) pret]natural mobility4 ,dislocation ( acromio-clavicul> jo9t3 ,t5d]ness ov] articulation4 ,arm _c be rais$ beyond "r angle ) ! body1 b elb[ may be br\ght across ! *e/ ) ext]nal rotation ( arm & rais$ p]p5dicul> ) ! body )\t pa940 ,! infect$ jo9t %\ld nev] be manipulat$ & all conditions %[+ swell+1 r$ness & pa9 on t\* %\ld be view$ ) suspicion4 ,rememb] t all o!r conditions w almo/ inv>iably h v]tebral lesions1 prim>y or second>y & a p]man5t result w dep5d ^u _! correction4 ,! ,prom95t ,hip ,a hip t is prom95t & l>g] ?an its fell[ is ( frequ5t occurr5ce4 ,x may n be necess>ily conducive to a defect 9 po/ure1 b x (t5 is4 ,! female is m frequ5tly afflict$ ) ?is anatomical irregul>ity ?an ! male4 ,9 ! fir/ place1 ! female pelvis is n s /able & rugg$ z ! male pelvis1 i4 e41 a me*anical wr5* or fall w m easily displace ! relative position ( ! tissues 9 ! female4 ,!n1 9 ! second place1 ! dress ( ! woman acc5tuates irregul>ities ( ! figure1 s t possibly 9 "s in/ances ! defect1 f a diseas$ or de=m$ po9t ( view1 is m app>5t ?an real4 ,b ( /ill m importance is ! fact t _m cases ( a prom95t hip are due to a lat]al curvature ( ! lumb> sp9al column4 ,lumb> curvatures are ( common occurr5ce 9 ! woman2 fir/1 ! sp9al column is n s /rong z 9 man1 simply on acc\nt ( ! physique n be+ s robu/2 second1 mod]n dress con/ricts ! wai/ by ! use ( corsets & _m wai/ b&s1 & ! weight ( heavy skirts ^u ! wai/1 hips & abdom52 &1 ?ird1 sev]e /ra9s f *ildbir?4 ,c>e %\ld be tak5 t !re is no cong5ital abnormalities ( ! lumb> sp9e1 or t cong5ital asymmetry ( "o-half ( body1 or trunk or leg is n pres5t4 ,?us ! pr9cipal cause ( a prom95t hip is ! lat]al lumb> curvature4 ,?is1 ?r\gh comp5satory action1 r5d]s ! hip on ! concave side prom95t & high1 :ile ! hip on ! convex side is depress$ & less pron\nc$ 9 appe>ance4 ,dressmak]s & tailors are all too famili> ) ?is feature ( ! irregul>ly outl9$ figure1 &1 consequ5tly1 h to resort to 8padd+0 to r\nd out ! symmetry ( ! body4 ,! m]e irregul>ity ( ! figure1 un=tunately1 is by f> ! less s]i\s "p ( ! defect4 ,_m ailm5ts & diseases c be readily & directly trac$ to ?is4 ,n t ! prom95t hip itself necess>ily always plays a lead+ "p1 b r ! lumb> curvature is ! cause ( v mu* suff]+ & mis]y4 ,to enum]ate ! _m disord]s t arise f malalign$ lumb> v]tebr may be unnecess>y b a few w be giv54 ,a po9t to be emphasiz$ is t ! prom95t hip (t5 plays ! role ( a sign or symptom1 or an effect1 t an ailm5t or disease may be else:]e4 ,9 ! female "o ( ! mo/ common causes1 if n ! mo/ common cause by f>1 ( disord]s ( m5/ruation1 :e!r pa9ful1 pr(use1 or irregul>1 is irritation or ob/ruction ( ! lumb> sp9al n]ves due to lumb> curvatures4 ,x is well kn[n ! lumb> sp9al n]ves control1 to a l>ge ext5t1 ! pelvic organs2 consequ5tly ! o/eopa? pays p>ticul> att5tion to ?is area4 ,!n c]ta9 inte/9al disord]s1 su* z app5dicitis1 typhoid fev]1 dys5t]y1 rectal diseases1 owe _! orig9 to pr$ispos+ lesions "h2 also1 bladd] ailm5ts1 & sexual diseases ( m51 & _m affections ( ! legs1 z sciatica1 v>icose ve9s1 etc4 ,9 a numb] ( in/ances ! prom95t hip w be due to a displac$ innom9atum4 ,!n a lumb> curvature w result z a comp5satory condition4 ,?is rev]ses ! comp5satory act z h]et(ore ref]r$ to2 ! prom95t hip1 9 ?is in/ance1 is ! cause & n ! effect4 ,to diagnose :i* is cause & :i* is effect w frequ5tly require consid]able te*nical k & exp]i5ce4 ,! slipp$ innom9atum !n produces symptoms & disord]s directly f its *ang$ anatomical relations2 ! po9ts ( diagnosis are giv5 9 ! *apt] on ,diagnosis4 ,! prom95t hip c easily be detect$ :5 ! subject sits d[n ^u an ev51 firm surface1 or /&s up1 & ! "o side is comp>$ ) ! o!r4 ,9 "s cases :]e ! prom95t hip is due to a lumb> curvature1 & ! prom95ce is a second>y feature1 ! legs w be f\nd unev5 9 l5g?1 b n always1 = ! lumb> curvature may /raight5 out :5 ! pati5t lies flat ^u ! back4 ,to diagnose ! cause f effect & to diff]5tiate ! maze ( signs & symptoms t may be pres5t is n always easy ev5 = ! skill$ practition]4 ,! correction ( a prom95t hip is n ord9>ily a difficult matt]4 ,9 ! cases :]e lumb> v]tebr are pr9cipally at fault1 & ^! include ! great] numb]1 ! problem is "o ( correct+ ! sp9al curvature4 ,lumb> curvatures are ! easie/ ( any ( ! curvatures to correct1 = "o is n hamp]$ by ! rib articulations1 & ! lumb> section pres5ts an area :]e a lev]age c readily be obta9$4 ,:]e ! innom9atum is prim>ily at fault x is simply a matt] ( readju/+ ?is1 ) probably "s att5tion to ! lumb> region4 ,c>e %\ld be tak5 t ! prom95t hip is n caus$ by a tub]cul> sacro-iliac disease1 by hip-jo9t disease1 by a dislocat$ hip1 or by an ov]lapp+ ( ?igh or leg bones f fracture4 ,/&+ erect w1 ( c\rse1 be a valuable help1 = /&+ ) ! weight on "o foot w t5d to make ! hip on t side m prom95t4 ,b g5]ally ! reason :y "o favors a c]ta9 side is because ! o!r side is weak]2 a weak back1 a slipp$ innom9atum1 or an injur$ leg are common causes4 ,!re are _m cases :]e ! skirts w h to be consid]ably alt]$ aft] ! hips h be5 made symmetrical4 ,p5dul\s ,abdom5 ,! p5dul\s abdom5 is ano!r defect t is all too common4 ,a great _m p h prom95t abdom5s because !y d n /& prop]ly1 b a p5dul\s or prom95t abdom5 is n necess>ily synonym\s ) a /\t abdom54 ,!y attempt to /& erect by draw+ ! %\ld]s back & ext5d+ ! abdom54 ,if !y w\ld hold ! head erect & ! *9 91 ) ! %\ld]s back & ! *e/ =w>d1 & draw ! abdom5 inw>d & upw>d1 _! figures & physiques w\ld und]go %ortly a wond]ful trans=mation4 ,^! directions also apply to pregnant wom54 ,draw+ ! abdom5 upw>d & inw>d w at fir/ require consid]able ef=t4 ,x c]ta9ly w n be an involunt>y act = ! fir/ few days4 ,! sagg+ ( ! abdom5 n only causes an unsightly appe>ance b results 9 great relaxation ( ! abdom9al muscles1 int]f]es ) dige/ive functions1 displaces ! pelvic organs1 & weak5s ! action ( ! lungs & he>t4 ,! laxity ( ! abdom9al muscles all[s ! abdom9al organs--! inte/9es1 /oma*1 kidneys1 etc4--to displace d[nw>d4 ,?is t5ds to indige/ion1 con/ipation1 inactivity ( ! liv]1 etc41 & causes a score ( reflex symptoms4 ,! organs become simply weak5$ f a lack ( prop] tone4 ,?is is a frequ5t cause ( n]v\s pro/ration4 ,also x is "o ( ! common causes ( prolaps$ & displac$ pelvic organs1 because ! abdom9al organs sag d[n ^u !m & ! pelvic organs ?us receive ! brunt ( ! gravitative effect4 ,int]nal local treatm5t ( ! pelvic organs c only be a make%ift 9 ^! cases4 ,! lungs & he>t are weak5$ because ! abdom9al organs are dragg+ on ! *e/1 ! lungs c n a]ate ! blood freely ow+ to ! abdom9al weight & to ! blood be+ ob/ruct$ 9 pass+ f ! abdom9al organs ?r\gh ! liv] to ! he>t & lungs4 ,! he>t is h&icapp$ 9 its "w ?r\gh less5$ *e/ capacity & ob/ruct$ circulation4 ,j 8suck0 up ! abdom9al organs & see h[ mu* easi] x is to exp& ! *e/ & to brea!4 ,!re are o!r causes = a p5dul\s abdom51 su* z a weak5$ sp9al n]ve supply to ! abdom9al muscles & organs4 ,! weak5$ n]ve supply may cause a loss ( tone to ! abdom9al organs !mselves1 s t c]ta9 organs1 z ! /oma* & inte/9es1 become dilat$ & prolaps$2 to ! ligam5ts1 & to ! tissues & organs z a :ole s t !y become gravitat$4 ,?r\gh *ildbir? muscul> fibres ( ! abdom9al walls (t5 rupture1 leav+ sc>s & a relax$ condition4 ,actual ruptures1 h]nia1 ( ! abdom9al muscles occur & cause a p5dul\s abdom54 ,!n !re are cases ( obesity :]e ! p5dul\s abdom5 is a symptom4 ,mu* c be done ) all ( ^! conditions ?r\gh o/eopa?ic "w2 ! pati5t mu/ also help himself4 ,! c5t] ( gravity ( ! body mu/ be *ang$1 & kept *ang$2 correct po/ure & a con/ant ef=t w accompli% consid]able4 ,! 8sett+ up0 milit>y ex]cises are excell5t4 ,ev5 9 "s cases ( obesity ! abdom9al prom95ce c be m>k$ly less5$ by c>eful ex]cis+ & keep+ ! abdom5 drawn 9 s t ! abdom9al muscles1 ! diaphragm1 & ! *e/ may be /r5g!n$4 ,= ! relax$1 flabby abdom51 self manipulation ( ! weak muscles :5 ly+ on ! back w mat]ially aid4 ,po/ural ,curvatures ( ! ,sp9al ,column ,und\bt$ly1 ! great p]c5tage ( po/ural defects1 or slump$ /ates1 are dep5d5t1 directly or indirectly1 ^u weaknesses 9 ! sp9al column4 ,z 0 se51 r\nd %\ld]s1 ! prom95t hip1 or ! p5dul\s abdom51 are (t5 initiat$ by sp9al deviations & de=mities1 s naturally sp9al column curvatures are a mo/ fruitful s\rce ( direct defects ( po/ure4 ,x is some:at uncommon to f9d an anatomically true sp9al column1 al?\gh ?is does n preclude t "o's po/ure is defective1 = (t5 ?r\gh pride & ef=t "o may consci\sly ov]come a defective po/ure4 ,x is ! purpose "h to (f] a few sugge/ions relative to ! developm5t ( a great] symmetry ( ! body4 ,ne>ly e "o is m or less int]e/$ 9 physical ex]cises & developm5t4 ,& especially to ^? ( s$5t>y habits d means & me?ods ( ex]cise appeal4 ,curi\sly en\gh1 9 a way1 ne>ly e layman looks ^u defects 9 po/ure1 symmetry & /ature z an effect aris+ f lack (1 or improp]1 ex]cise4 ,he seems to be imbu$ ) ! idea t ! body 9 mo/ in/ances is practically p]man5t 9 con/ruction & :5 irregul>ities 9 figure occur c]ta9 ex]cises w correct ! defect4 ,?us h individuals be5 prone to look ^u o/eopa?y z a me?od ( passive ex]cises4 ,o/eopa?s %\ld believe mo/ ?or\ghly 9 ex]cis+1 p]sonal hygi5e1 etc41 b ! idea ( o/eopa?ic manipulation is prim>ily "o ( anatomical recon/ruction1 & n muscul> developm5t alone4 ,! "w ( ! o/eopa? is to readju/ or to re-mold ! body framework & ! _m tissues t clo! x s t normality ( function may pr$om9ate4 ,! manipulation is n r\t9ism b me*anical rebuild+ ( ! tissues s t p]fect fre$om ( vital =ces may be =?com+4 ,! sp9al column pres5ts ! mo/ frequ5t z well z _m extremely int]e/+ phases = re-correct+ "w4 ,! numb] ( abnormalities z to cont\r to :i* x is subject are _m & v>i$4 ,emphasis %\ld be plac$ ^u possible cong5ital abnormalities & developm5tal defects z s\rces ( c]ta9 d]angem5ts4 ,any v>iation or comb9ation ( v>iations ) ! normal or physiological curves con/itutes an abnormality or pa?ological curve4 ,& z a consequ5ce defective po/ure1 unless ?or\ghly comp5sat$1 is readily initiat$4 ,n only may ! normal curves be exagg]at$1 less5$1 elim9at$ or rev]s$1 b lat]al & rot>y curvatures are ( frequ5t occurr5ce4 ,curvatures involv+ ! c]vical region to ! ext5t ( produc+ noticeable defects ( po/ure are pr9cipally lat]al deviations ( sev]al v]tebr4 ,wry-neck is probably ! mo/ noticeable di/urbance4 ,! head & neck be+ drawn & slightly twi/$ to "o side is a defect t is bo? noticeable & pa9ful4 ,ano!r common s\rce ( po/ural affection is an exagg]at$ =w>d curv+ ( ! neck v]tebr4 ,?is produces a /oop$ appe>ance ( ! neck4 ,! dorsal v]tebr are (t5 curv$ backw>d too f>4 ,?is produces r\ndness ) too decid$ a fullness ( ! upp] back & %\ld]s4 ,! *e/ may be some:at flatt5$ z a second>y effect b n necess>ily s4 ,nei!r are ! %\ld]s :at may be t]m$ 8r\nd %\ld]s10 /ill su* a condition may occur1 = 8r\nd %\ld]s0 are m (t5 caus$ by a backw>d sw]ve ( ! column at ! wai/ l9e4 ,!re is (t5 a %ort5+ ( ! ant]ior /ructures :i* pull ! po9t ( ! %\ld]s =w>d4 ,=c+ !m backw>d w aid 9 correct+ ! fault4 ,! dorsal v]tebr may be =w>d f :at is t]m$ a 8/raight0 sp9e2 ?is results 9 an exagg]at$ 8brac$0 back position4 ,!n lat]al curvatures ( ! dorsal sp9e are common1 :i* 9 "t may develop into a rot>y curvature2 t is1 ! v]tebr are actually rotat$ on _! axes4 ,lat]al curvatures ( ! dorsal sp9e are sl[ & difficult to correct1 = ! ribs complicate matt]s v mat]ially4 ,!n1 also1 ! v]tebr are apt to be de=m$4 ,curvatures ( ! lumb> sp9e1 :e!r po/]ior1 lat]al or ant]ior1 are common4 ,bo? dorsal & lumb> curvatures1 z any "o c readily see1 are extremely common s\rces ( po/ural defects4 ,erect positions ( ! body are ma9ta9$ ?r\gh ! support ( ! dorsal & lumb> v]tebr4 ,/oop$ %\ld]s1 "o %\ld] l[] ?an its fell[1 sitt+ hump$ ov]1 sitt+ on ! sacrum in/ead ( squ>ely on ! buttocks1 ! prom95t hip1 /&+ fir/ on "o foot & !n on ! o!r 9 ord] to re/ ! back1 & ! _m alli$ v>iations ( incorrect po/ures are l>gely dep5d5t on ! condition ( ! lumb> & dorsal sp9es4 ,x is n to be suppos$ t ! above defects are ! only ailm5ts & di/urbances t sp9al curvatures cause1 =1 inde$1 ! defective po/ure may be by f> a m9or consid]ation4 ,disord]s ( body functions & affection ( organic life itself are v (t5 trac$ to ! malalign$ v]tebr4 ,! causes ( sp9al curvatures are _m1 b )\t "q "o ( ! mo/ common causes is me*anical wr5*+ or twi/+ ( ! column f falls1 j>s1 etc4 ,(t5 ! /ra9 or spra9 ( ! sections are readju/$ ?r\gh ! inh]5t p[]s ( ! body1 b !re is a po9t :]e vis m$icatrix naturae requires extrane\s help to correct ! p]v]sion2 &1 naturally1 su* aid1 by virtue ( ! cause ( ! di/urbance1 %\ld be physical =ce me*anically appli$4 ,o!r causes ( sp9al curvatures are contractions ( muscles on "o side ( ! column or p>alysis ( ! muscles on "o side2 9 ei!r in/ance1 muscul> action is great] on "o side ?an ! o!r1 :i* easily results 9 a curvature4 ,?is imbalance ( muscul> t5sion1 :e!r due to ! above or o!r s\rces su* z ov]fatigue or v>i\s delet]i\s habits1 is a prolific s\rce ( lesions4 ,& among /ill o!r causes may be not$1 bone diseases ( ! sp9al column1 comp5satory de=mities1 & con/itutional weak5+ & irritat+ diseases4 ,also1 "s occupations pr$ispose to c]ta9 curvatures4 ,"o c readily see t ! treatm5t :i* is direct$ specifically to ! cause ( ! v]tebral deviation w\ld be ! mo/ sci5tific4 ,?is is j :at o/eopa?ic "w implies1 direct readju/m5t ( ! sections at fault--n ex]cises1 or r\t9e /ret*+1 or braces2 al?\gh ^! latt] me?ods may 9 "s cases h _! place z second>y aids4 ,( c\rse ex]cises are usually physiological & may be employ$1 9 _m in/ances1 z an auxili>y4 ,c>e %\ld be tak5 to eradicate infecti\s foci :5 pres5t4 ,:]e curvatures are extreme1 complicat+ & de=m+ ! ribs1 & absorb+ ! bodies ( ! v]tebr s !y become w$ge-%ap$1 & result+ f abscesses1 no "o c expect )9 reason to absolutely correct ! po/ure4 ,"s aggressive "w c be accompli%$1 b a p]fect symmetry w n be =?com+4 ,x may be well to emphasize aga9 t :]e ! ribs are involv$ ! o/eopa? is n cont5d+ ) ! de=mity ( ! sp9al column alone1 b 9 addition ! entire transv]se area ( ! body4 7,see also ,sp9al ,curvatures74 ,conclusion4--,9 conclud+ ?is rapid survey ( a numb] ( po/ural defects ! pr9cipal lesson to be drawn is n "o ( develop+ ! physique & ?us p]fect+ a bett] po/ure1 s mu* z curtail+ & elim9at+ insidi\s beg9n+s ( disease4 ,^! little ailm5ts & de=mities1 ( :i* po/ural defects may be ! mo/ noticeable1 are s (t5 ! inception ( m s]i\s disord]s4 ,! anatomical /ructure be+ maladju/$1 -align$1 or -position$1 easily & readily leads to consequ5ces t require mu* "t & pati5ce to ov]come4 ,poise ( body repres5ts mu* to e "o4 ,poise or correct po/ure c\pl$ ) c>eful & me?odical ex]cise & correct brea?+ are mat]ial aids 9 con/ructive developm5t1 z well z 9 elim9at+ disease1 = n alone may abdom9al1 pelvic & ?oracic integrity be b5efit$1 b ! upp] respiratory tract may be ton$4 ,! mo/ important goal t o/eopa?ic sci5ce & art is /riv+ = is t ( a fully develop$ & r\nd$ out prophylaxis or prev5tive treatm5t4 ,:5 ! public realizes t ! prov]bial ounce ( prev5tion is an e/abli%$ m$ical reality !n x c truly be said our sci5ce has rea*$ its ultimate good4 ,to ^? :o are famili> ) o/eopa?ic !ory1 facts1 & developm5t1 x is an op5 secret t ?is s*ool holds ! key to successful prev5tive treatm5t4 ,! "t is rapidly approa*+ :5 ! actual less5+ ( diseases w be an e/abli%$ fact4 ,!n w be ! univ]sal practice ( ! layman go+ p]iodically to 8 o/eopa? to see if !re are any small or insidi\s beg9n+s ( disord] or disease4 ,n only mu/ ! _m delet]i\s habits & errors ( ! daily regim5 be correct$1 b aft] environm5tal1 physiological & /ructural adju/m5t1 9 s f> z possible1 has be5 atta9$1 a daily regim5 to ma9ta9 ! normal %\ld be in/itut$4 ,,footnotes3 #dc ,j\rnal ,am]ican ,o/eopa?ic ,association1 ,jan4 #aiaf4 #dd ,o/eopa?ic ,physician1 ,nov4 #aiai4 ,,prolaps$ ,,organs ,prolapse ( v>i\s organs or tissues are among ! v common ailm5ts t afflict all classes4 ,prolapse ( ! /oma*1 a kidney1 ! ut]us1 or ! rectum is a famili> t]m to e "o4 ,b ?is condition may also re/ ) ! inte/9es1 ! liv]1 an ov>y1 or ev5 ! he>t4 ,outside ( injuries1 cong5ital weaknesses1 & s-t]m$ surgical disord]s1 !re are commonly two con/ant =ces pr$ispos+ to prolaps$ organs1 viz3 gravitation & weak5$ inn]vation2 ! "o1 ( c\rse1 is a con/ant factor 9 ei!r heal? or ill heal?1 ! o!r is dep5d5t ^u acquirem5t4 ,"h ! latt]1 or acquir$ n]v\s weakness1 w especially dem& our att5tion4 ,:]e tissues are torn or lac]at$1 or cong5ital mal=mations are pres5t1 or tissues are weak5$ f ulc]ation & ) a resultant sc> tissue1 or c]ta9 tumors are pres5t1 ! disord] mu/ be am5able l>gely to surgical measures if at all4 ,! p]p5dicul> position ( ! body favors a decid$ gravitation ( ! abdom9al & pelvic organs4 ,?is gravitative effect be+ a con/ant "o1 _m me?ods1 bo? surgical & me*anical1 h be5 devis$ to hold 9 approximate & relative position c]ta9 organs & tissues t may be prolaps$4 ,b x is well kn[n t outside ( a c]ta9 few in/ances :]e surgical measures are cle>ly indicat$ ! preval5t use ( braces1 b&ages1 supports & ! l are usually poor make%ifts4 ,! "o great feature 9 ^! cases is t tonicity to organs & support+ muscles & tissues is m or less impair$4 ,! tissue atony may v>y f m]e weakness to actual te>+ & sep>at+ ( ! fibres4 ,! indications 9 ! cases ab\t to be describ$ are to /imulate a l[]$ n]ve supply & to increase a less5$ blood supply2 if ?is c be accompli%$1 support+ muscles1 ligam5ts & o!r tissues w be able to re/ore ! prolaps$ organs to normal positions1 ?us improv+ functions & elim9at+ disease symptoms4 ,9 discuss+ ! prolapse ( ! foll[+ organs1 p]haps x %\ld be not$ "h t all ( ! abdom9al organs may be prolaps$ z a :ole4 ,! inte/9es1 /oma*1 liv]1 kidneys1 etc41 may actually prolapse toge!r4 ,?is is m apt to occur 9 p]sons ^: abdom9al walls are ?9 & flabby4 ,9 wom5 pregnancy is a common cause4 ,:5 ! abdom9al organs h gravitat$1 ! pelvic organs1 also1 are v likely to be di/urb$ & displac$2 9 fact1 ! pelvic organs are frequ5tly disord]$ ?is way4 ,prolapse & ,dilatation ( ! ,/oma* ,dilatation ( ! /oma* is a mu* m common & s]i\s affection ?an prolapse ( ! /oma*1 al?\gh usually ! two are associat$4 ,prolapse1 or ptosis1 ( ! /oma* means simply a d[nw>d displacem5t ( ! organ4 ,?is is apt to take place 9 ^? cases :]e all ( ! abdom9al organs h gravitat$4 ,!re is inv>iably "s dilatation ( ! organ z well4 ,weakness ( ! abdom9al walls & ( ! supports ( ! /oma* con/itute ! pr9cipal causes ( ! prolapse4 ,sp9al deviations t imp+e or ob/ruct ! n]ve /r&s 7or ob/ruct ! blood & lymph supply to ^! /r&s7 to ! support+ /oma* tissues is ! mo/ frequ5t cause ( ! ailm5t4 ,g5]al debilitat+ diseases1 z anemia1 canc]1 etc41 are indirect causes ( weak5$ organs ) consequ5t displacem5ts4 ,9 dilatation ( ! /oma* ! condition may be ei!r acute or *ronic4 ,! =m] is f\nd :]e imm5se am\nts ( food or dr9k h be5 introduc$4 ,"o ( ! pr9cipal causes ( *ronic dilatation is "s ob/ruction to ! op5+ f ! /oma* into ! inte/9e1 s t ! /oma* cont5ts d n pass readily into ! b[el4 ,?is leads to *ronic di/urbances ( ! /oma* walls1 & ! food rema9+ 9 ! /oma* some:at indef9itely weights d[n & /ret*es ! walls ( ! /oma*4 ,! ob/ruction may be a tumor1 or "s /ricture or adhesion f sc> tissue result+ f ulc]ation or inflammation4 ,! treatm5t ( ^! cases comes )9 ! prov9ce ( surgical int]f]5ce r ?an o!r me?ods4 ,! second important cause ( *ronic dilatation is muscul> weakness ( ! walls f poor n]ve supply4 ,?is is a common cause & o/eopa?y is v successful 9 cur+ ^! cases4 ,! splan*nic n]ves are bel[ normal1 usually f a slight lat]al or po/]ior sp9al curvature4 ,! n]ve =ce to ! walls ( ! /oma* n be+ normal causes atony ( ! muscles & dilatation results4 ,?is n]vo-muscul> atony1 also1 results f a *ronic cat>rh1 or f a g5]al nutritional disord] z tub]culosis or anemia4 ,! treatm5t ( ! =m] w\ld imply direct correction ( n]ve & blood supply ) att5tion to diet2 ! latt] c be cur$ only ?r\gh reliev+ ! nutritional disord] ( :i* ! /oma* condition is a symptom4 ,dilatation ( ! /oma* is mo/ common 9 p ( middle age or old]4 ,! disease is usually easily diagnos$4 ,! symptoms may n be indicative ( ! tr\ble beyond %[+ t ! /oma* is di/urb$4 ,indige/ion1 uneas9ess1 & nausea are common4 ,vomit+ ( l>ge quantities ( mat]ial f ! /oma* is likely to occur4 ,! pati5t is g5]ally emaciat$1 ! sk9 is dry1 ! b[els con/ipat$1 & ! ur9e scanty4 ,! diagnosis1 z a rule1 is n h>d to make4 ,?r\gh ! m$ia ( inspection1 palpation & p]cussion1 ! c>eful o/eopa? w h little tr\ble to det]m9e ! size ( ! /oma*4 ,kemp's#de di/9ction betwe5 ga/roptosia & dilatation ( ! /oma* is z foll[s3 8,9 dilatation ! less] curvature reta9s its relation to ! diaphragm4 ,! di/ance betwe5 ! less] & ! great] curvature is increas$1 b ! less] curvature /ill ma9ta9s its relation to ! diaphragm1 ) ! exception t ! pyloric end may ext5d f>!r ov] & some:at f>!r d[n40 ,ano!r in/ructive po9t relative to diagnosis ! above au?ors make is ! importance ( ! spla%+ s\nd4 ,ow+ to ! fact t ! /oma* 9 heal? closes conc5trically ab\t its cont5ts & ?us adapts itself to ! volume ( +e/a1 no spla%+ s\nd c be elicit$4 ,?ree diff]5t degrees ( relaxation are diagno/icat$ z foll[s3 8,spla%+ s\nd1 :i* c be elicit$ only dur+ ! normal p]iod ( dige/ion1 means simple atony2 spla%+ s\nd produc$ aft] ! legitimate "t ( dige/ion has expir$ means motor insuffici5cy2 & spla%+ s\nd produc$ 9 ! morn+1 aft] ! night's fa/+1 be=e liquid or food has be5 introduc$1 may mean /agnation1 dilatation ( ! /oma*1 z und]/ood by mo/ writ]s40 7,= a m complete outl9e see ,dilatation ( ! ,/oma*4 ,! object ( ?is section is to pres5t an outl9e ( prolaps$ organs z a :ole1 & to ref] especially to ! effectiv5ess ( o/eopa?ic treatm5t 9 ?is condition74 ,?is is a disease :]e o/eopa?y has be5 p>ticul>ly successful 9 n only reliev+ di/ress+ symptoms1 b 9 actually cur+ ! disord]4 ,?is ref]s to ! n]vo-muscul> atony type1 = :]e !re is ob/ruction due to /ricture or tumor ( ! pylorus1 result+ 9 /oma* dilatation1 ! treatm5t1 f ! v nature ( ?+s1 mu/ be l>gely surgical4 ,/oma*s t h be5 dilat$ & prolaps$ sev]al in*es h be5 entirely re/or$ to function & organic integrity4 ,to cure ^! cases is a matt] ( /imulat+ n]ve control & blood supply to ! /oma* tissues1 &1 (t5 ( great] importance1 remov+ sp9al imp+em5ts to ! /oma* n]ve fib]s1 ?us all[+ nature to fully ass]t h]self4 ,9 reality1 outside ( s-t]m$ surgical cases & o!r cases :]e ! /oma* dilatation is m]ely a symptom ( g5]al nutritional disord]1 ! prim>y treatm5t1 by f>1 is ! sp9al "o4 ,treatm5t ov] ! /oma* is a decid$ly b5eficial treatm5t2 x aids mat]ially 9 ton+ bo? abdom9al & /oma* muscles2 /ill ?is is mo/ly a second>y treatm5t4 ,diet+ is ess5tial4 ,c>eful diet+ less5s ! t5d5cy to cat>rhal inflammation & r$uces ! "w ( ! /oma* to a m9imum4 ,/ill1 n\ri%+ food is necess>y & ! diet+ c easily be c>ri$ to an extreme4 ,liquids %\ld n be tak5 freely4 ,fatty & />*y foods %\ld be elim9at$4 ,give ! pati5t food at %ort int]vals4 ,v>i\s nutriti\s meats are excell5t4 ,9 dilatation1 & also g5]al abdom9al relaxation1 daily abdom9al treatm5ts may be indicat$4 ,if ! relaxation is pron\nc$1 keep+ ! pati5t 9 b$ ) ?or\gh sp9al treatm5t two or ?ree times a week1 daily abdom9al treatm5t1 hav+ ! pati5t ex]cise abdom9al p>ietes by draw+ ! walls 9 & up1 upp] ?oracic brea?+1 & frequ5t fe$+ w accompli% comp>atively quick results4 ,! progress ( ea* case dep5ds v mat]ially ^u ! g5]al heal?1 ! physical /atus ( o!r tissues1 con/itution1 inh]itance1 environm5t1 age1 etc4 ,"s cases w yield 9 two or ?ree mon?s1 o!rs w require two or ?ree ye>s 9 ord] to obta9 ! greate/ possible b5efit4 ,! ,prolaps$ ,kidney ,a prolaps$ kidney is (t5 t]m$ a float+ kidney1 or movable kidney1 or dislocat$ kidney4 ,x is ( common occurr5ce1 especially 9 ?9 p]sons4 ,"s au?orities /ate t "o woman out ( e f\r has a float+ kidney4 ,x is m common 9 wom5 ?an 9 m51 & among ! work+ class ?an o!r classes4 ,! condition is usually an acquir$ "o1 foll[+ sev]e /ra9s f lift+1 falls1 injuries1 etc4 ,x is claim$ by "s t a float+ kidney arises f cong5itally weak5$ & relax$ tissues ab\t ! kidney1 t is1 ! tissues t keep ! kidney normally at an*orage4 ,?us a cong5ital loos5ess ( ! kidney w\ld easily be a pr$ispos+ cause :5ce me*anical viol5ce1 repeat$ pregnancies1 an enl>g$ liv]1 or tight lac+ w\ld act z an excit+ cause4 ,und\bt$ly 9 "s in/ances !re is a cong5ital pr$isposition1 ! p]itoneal fold atta*+ ! kidney to ! sp9e be+ loose & ! capsule ( fat reta9+ ! kidney be+ scanty1 b o/eopa?ic exp]i5ce has amply demon/rat$ t ! tissues an*or+ ! kidney may 9 _m case become atoni$ & relax$ f l[] dorsal sp9al lesions4 ,r>ely is a case pres5t$ to an o/eopa? t does n exhibit two app>5tly *>act]i/ic causative features1 viz3 sp9al irregul>ity 9 ! l[] dorsal sp9e1 & con/riction ( ! zone ab\t ! wai/1 i4 e41 dropp+ & con/rict+ ( ! float+ ribs4 ,fur!rmore1 correction ( ^! lesions w almo/ inv>iably less5 ! mobility ( ! palpable kidney4 ,! symptoms ( a float+ kidney are _m & v>iable4 ,! kidney may be slightly movable or x may be s loose t "o c easily grasp x ?r\gh ! walls ( ! abdom54 ,mo/ ( ! symptoms are ( a n]v\s reflex nature4 ,indige/ion1 :i* is likely to be v p]si/5t1 flatul5cy1 he>t palpitation1 pa9ful m5/ruation1 irritable bladd]1 etc41 are ! mo/ common symptoms4 ,/ill1 blu5ess1 depression & morbidness are frequ5tly pres5t4 ,! mo/ di/ress+ direct di/urbance is ! feel+ ( weight 9 ! abdom51 especially on /&+1 runn+ or lift+4 ,sometimes ! uret] becomes twi/$ & sev]e pa91 colic & ev5 collapse occurs4 7,dietl's crisis47 ,! diagnosis ( a dislocat$ kidney is n a p>ticul>ly difficult matt]4 ,a little exp]i5ce c\pl$ ) a delicate s5se ( t\* w usually readily detect abnormal mobility ( ! kidney4 ,a po9t to always rememb] is t ! kidney normally desc5ds ab\t "o-half an in* ) ea* inspiration4 ,c>e %\ld be tak5 n to mi/ake a float+ kidney = a movable sple51 al?\gh ?is is n likely1 z ! %ape ( ! sple5 is diff]5t4 ,! treatm5t ( a movable kidney "u o/eopa?ic measures is usually successful4 ,9 ! fir/ place a numb] ( cases require b little att5tion1 simply ton+ up ! g5]al heal?1 & especially direct+ att5tion to ! abdom9al walls & organs4 ,!re are a numb] ( cases :]e ! kidney prolapse is incid5tal to g5]al abdom9al laxness & weakness4 ,9 m sev]e cases1 treat+ ! sp9e1 rais+ ! float+ ribs1 c>efully manipulat+ ov] ! abdom51 keep+ ! b[els op51 & less5+ liv] conge/ion %\ld x arise1 w suffice2 9 fact1 w rem$y a good p]c5tage ( ! cases4 ,) o!rs1 a well fitt+1 m$ium wid?1 ela/ic b&age ) pad und]nea? w be b5eficial4 ,9 ^! cases ! pati5t %\ld be taught h[ to treat ! abdom9al organs1 to manipulate ! abdom9al walls1 & to replace ! prolaps$ kidney2 p>ticul>ly aft] go+ to b$ ?is c be done successfully by ! pati5t & w prove a decid$ help 9 ob/9ate cases4 ,surgical measures = fix+ ! kidney %\ld seldom be resort$ to4 ,if ! pati5t w live a c>eful life1 avoid unduly /ra9+ himself1 keep ! b[els normal1 & h ! anatomical lesions correct$1 he w come v ne> be+ entirely reliev$1 if n absolutely4 ,surgical measures are n always a success4 ,surgeons are n op]at+ = ?is disord] s (t5 z 9 pa/ ye>s4 7,see ,movable ,kidney--,diseases ( ! ,kidney47 ,liv] ,prolapse ,?is is commonly t]m$ a float+ liv]4 ,!re is prolapse ( ! organ z well z its be+ abnormally movable4 ,x is n ( frequ5t occurr5ce2 wom5 suff] f x mu* (t5] ?an m54 ,normally1 ! liv] is p>tially held 9 place1 9 ! concavity ( ! diaphragm1 by a numb] ( p]itoneal folds4 ,! atta*m5t ( ^! ligam5ts is to ! sp9e & ! diaphragm2 _! pr9cipal function is to prev5t ext5d$ lat]al movem5ts4 ,( great] importance 9 support+ ! liv] 9 a normal position is ! integrity ( ! abdom9al walls1 & ! position ( ! /oma* & inte/9es4 ,if ! abdom9al walls are ( normal tone ! liv] is v apt to be 9 correct position4 ,& ! re/ ( ! abdom9al organs1 especially inte/9es & /oma*1 act z a cu%ion support4 ,(t5 :5 ! liv] is displac$ ! rema9+ abdom9al organs are1 also1 out ( normal position & relation to ea* o!r2 9 fact1 g5]al prolapse ( ! abdom9al visc]a is a frequ5t cause ( liv] prolapse4 ,an additional support ( ! liv] is a c]ta9 cohesion ( ! liv] & diaphragm1 & ! ela/ic traction ( ! lungs4 ,=emo/ among ! causes t pr$ispose to inela/ic & atoni$ abdom9al walls are sp9al irregul>ities1 deviations1 & curvatures1 :i* imp+e n]ve =ce & ob/ruct blood supply4 ,^! same lesions weak5 ligam5t\s supports ( ! liv] & less5 tonicity ( ! o!r abdom9al organs1 s t local or g5]al displacem5ts are readily =?com+4 ,/ra9s1 injuries1 frequ5t pregnancies1 etc41 also act z causes t weak5 ! supports ( abdom9al tissues & organs4 ,9 a ^w x is v (t5 ! p5dul\s abdom5 t is ! imm$iate cause ( a float+ liv]4 ,x is v r>e to f9d ! liv] displac$ to ! l[] region ( ! abdom54 ,! ptosis is usually some:at slight4 ,! organ g5]ally rotates on desc5t1 ! "r lobe be+ ! l[e/ portion1 ow+ to ! atta*m5t ( a ligam5t1 ! ligam5tum t]es1 to ! umbilicus4 ,probably 9 "s cases !re is a cong5ital t5d5cy to relaxation ( ! ligam5ts1 &1 ?us viol5t ex]tions & atonic & flabby abdom9al walls & diaphragm are second>y b important factors4 ,! pr9cipal symptom ( a float+ liv] is a tumor 9 ! "r side1 :i* may be l[ d[n4 ,palpation w usually det]m9e ?is4 ,!n ! abdom9al walls are flabby4 ,pa9 & be>+ d[n ( ! "r side are common4 ,!re is apt to be consid]able indige/ion4 ,v>i\s reflex symptoms are (t5 pres5t4 ,! float+ liv] w seem l>g] ?an normal1 z ! liv] is bel[ ! co/al ar* & mu* ( x c be felt4 ,p]cussion w be ( value 9 det]m9+ ! ext5t ( ! disord]4 ,mu* c be accompli%$ by treatm5t1 especially :]e ! displacem5t is ( a less] degree4 ,correct+ ! sp9al lesions1 ton+ up ! abdom9al walls & diaphragm1 & replac+ ! displac$ organs w be extremely effectual4 ,! abdom9al b&age may be ( s]vice4 ,c]ta9ly abdom9al ex]cises w be b5eficial4 ,a po9t to rememb] is1 /imulation ov] ! abdom5 b5ea? ! "r co/al ar* w cause ! liv] to contract & retract4 ,?is is ( consid]able o/eopa?ic note4 ,! liv] w (t5 rec$e at lea/ a half an in*4 ,?is is a liv] reflex 7,abrams74 ,prolaps$ ,inte/9es ,prolapse ( ! b[els1 z a :ole1 or1 m frequ5t /ill1 ( a "p1 is und\bt$ly ! mo/ common =m ( organ prolapse4 ,! inte/9es are s situat$ t !y readily feel ! effect ( gravitative influ5ces1 ( atonic & anemic /ates1 & ( weaknesses & disord]s ( o!r abdom9al organs4 ,sp9al irregul>ities come fir/ z pot5t causes ( b[el prolapse4 ,! sp9al n]ves to ! supports ( ! inte/9es1 to ! muscul> coats ( ! inte/9es1 & to ! abdom9al walls1 are ob/ruct$ 9 _! normal activity1 & consequ5tly ^? tissues to :i* ^! n]ves are di/ribut$ are affect$4 ,wa/+ diseases1 z anemia1 consumption1 canc] & ! l pr$ispose to inte/9al atony4 ,! sev]e me*anical wr5*es1 /ra9s1 frequ5t pregnancies1 tight lac+1 heavy skirts1 l>ge abdom9al tumors1 obesity1 cause m or less g5]al or local weakness4 ,! p5dul\s abdom51 f wrong or c>eless po/ure1 & exclusive ( o!r causes1 is a common s\rce ( g5]al b[el displacem5t4 ,?is =m ( disord]1 besides be+ unsightly1 favors abdom9al /\tness4 ,!re are a numb] ( in/ances :]e simply volunt>ily hold+ or 8suck+0 ! abdom5 into place1 until x becomes /rong en\gh to support itself1 has r$uc$ "o's weight by five1 t5 or fifte5 p\nds4 ,^! 7 cases :]e mo/ ( ! adipose tissue 0 ab\t ! abdom54 ,?us ex]cis+ & ton+ ! abdom9al organs by keep+ !m 9 normal position rectifi$ a dormant blood & lymph circulation1 :i* 0 foll[$ by absorption ( ! abdom9al /\tness4 ,cong5ital weaknesses are to be consid]$ 9 _m cases4 ,! muscul> ligam5ts may n be develop$1 ! mes5t]ic atta*m5ts may be too long1 & v>i\s o!r abnormalities may result f cong5ital di/urbances4 ,( p>ticul> local int]e/ to ! o/eopa?1 outside ( ! b[els dislocat+ z a :ole1 are3 fir/1 ! hepatic flexure2 second1 ! ileo-cecal region2 ?ird1 ! sigmoid flexure2 f\r?1 ! rectum2 & fif?1 h]nias4 ,ea* ( ^! sections are ( sep>ate int]e/ & w be consid]$ pres5tly4 ,! symptoms are extremely v>iable4 ,con/ipation1 a feel+ ( discom=t 9 ! b[els1 n]v\sness1 depression1 lassitude & anemia are frequ5t4 ,colicky pa9s 9 ! inte/9es1 indige/ion1 hy/]ia at times1 are also among ! symptoms4 ,9 reality a great v>iety ( symptoms may be pres5t4 ,! pati5t is likely to be emaciat$4 ,9 "s cases exhau/ion is m>k$4 ,diagnosis1 z a rule1 is n a difficult matt]4 ,! v>i\s neura/h5ic symptoms 9 a lean pati5t ) con/ipation1 indige/ion1 & /oma* & inte/9al di/ress w\ld lead "o to suspect inte/9al displacem5t4 ,! outl9e or cont\r ( ! abdom5 w (t5 reveal ! "* ( ! tr\ble4 ,! atonic1 ?9 & relax$ walls ( ! abdom5 may readily give view ( ! displac$ organs4 ,!n c>eful exam9ation by palpation & p]cussion w help v mat]ially 9 ! diagnosis4 ,radiographic exam9ation is a decid$ly helpful diagno/ic me?od4 ,! hepatic flexure is frequ5tly prolaps$4 ,! b[el 7colon7 asc5ds f bel[ upw>d to b5ea? ! co/al ar* & !n angles %>ply into ! transv]se colon1 :i* ext5ds directly across ! abdom5 to ! left side4 ,! ligam5ts t support ?is flexure are apt to become weak5$ or /ret*$ & all[ a desc5t ( ?is section ( ! b[el1 :i* is foll[$ by con/ipation1 indige/ion1 etc4 ,! ligam5t especially involv$ is ! colo-hepatic ligam5t4 ,! duod5um may require att5tion4 ,?is c be rais$ by gett+ b5ea? x :]e ! organ desc5ds alongside ( ! asc5d+ colon4 ,! effect ( treatm5t is to release t5sion ( ! duod5o-hepatic ligam5t :i* is closely associat$ ) ! portal ve91 hepatic art]y & bile-duct4 ,! ileo-cecal region is an area t readily becomes conge/$ & cat>rhally inflam$1 especially f con/ipation or impaction at ?is po9t4 ,! section (t5 becomes atonic & prolaps$ ) resultant clogg+ ( fecal matt]4 ,ow+ to ! close proximity ( ! v]mi=m app5dix1 app5dicitis frequ5tly results f ! above condition4 ,! o/eopa? c d mu* 9 ^! cases ( app5dicitis4 ,lesions are inv>iably f\nd 9 ! lumb> v]tebr or ! float+ ribs are depress$4 ,! sigmoid flexure is also frequ5tly prolaps$4 ,! fecal mass (t5 becomes impact$ "h1 ow+ to a settl+ or prolapse ( ?is "p4 ,9 "s cases ! prolapse is s m>k$ t x ext5ds to ! rectum bel[ & drags on ! spl5ic flexure above4 ,lumb> & innom9ate lesions are ! usual causes1 al?\gh1 x seems 9 a numb] ( in/ances1 t relax$ walls ( ! abdom5 cause a 8contraction ( ! diaphragm result+ 9 kidney displacem5t & foll[$ by inte/9al prolapse40 ,! v]tebral lesions1 probably1 fir/ weak5 ! muscul> coat ( ! b[el1 !n1 second1 ! b[el supports 7o!r ?an its own inh]5t tonicity7 & ! abdom9al walls4 ,prolapse ( ! rectum is ( su* sep>ate importance t x w be b p>tly outl9$ "h4 ,z /at$ above1 a s\rce ( rectal displacem5t arises f ! section ( ! b[el above settl+ d[nw>d & ultimately caus+ invag9ation ( "o or m coats ( ! rectum4 ,dislocation ( ! coccyx is a pot5t cause ( rectal disord]s4 ,lumb> lesions1 especially twi/s betwe5 ! f\r? & fif?1 & fif? & sacrum are common causes ( rectal weaknesses4 ,slips ( ! innom9ata are o!r causes ( prolapse4 ,o/eopa?y has _h m>k$ success 9 ^! cases4 ,cures may result f a s+le treatm5t to readju/ ! coccygeal displacem5t or tempor>ily relieve excessive physiological activity by dilat+ ! rectal sph9ct]1 or ! treatm5t may dem& a numb] ( mon?s' "w 9 correct+ g5]al abdom9al prolapse4 ,rais+ ! sigmoid is effectual4 ,a h]nia is 8! protrusion ( a loop or knuckle ( an organ or tissue ?r\gh an abdom9al op5+40 ,two ( ! common h]nias ( ! inte/9es are +u9al & femoral4 ,^! conditions are mo/ (t5 acquir$ f sev]e /ra9+1 s t a loop ( ! b[el protrudes ?r\gh a weak5$ & /ret*$ area ( ! abdom9al walls1 ?\gh !re is reason to suspect t cong5ital defects are (t5 pr$ispos+ factors4 ,m5tion ( ! h]nia is "h made because1 9 a way1 x is a =m ( b[el prolapse2 t is1 a limit$ =m1 & o/eopa?y conta9s c]ta9 possibilities = a successful treatm5t4 ,h]nia has always be5 look$ ^u z purely a surgical disord]2 i4 e41 rem$iable by surgical measures only4 ,:]e a truss has fail$ to give relief surg]y has be5 resort$ to4 ,?is is true 9 mo/ in/ances1 b :]e ! h]nia is 9 ! incipi5cy c>eful abdom9al ex]cises 7?is %\ld be c>ri$ out ) great c>e1 = sev]e ex]cise may produce a h]nia or increase "o already exi/+71 massage to ! tissues ab\t ! h]nia1 att5tion to ! b[els1 & sp9al /imulation correspond+ to ! weak5$ tissue1 & avoidance ( /ra9s may /r5g!n ! tissues mat]ially ab\t ! h]nia4 ,occasionally a loop ( ! inte/9e w prolapse into ! cul-de-sac back ( ! ut]us4 ,a heavy dragg+ pa9 l[ d[n 9 ! c5t] ( ! abdom5 & con/ipation or complete ob/ruction are ! pron\nc$ symptoms4 ,c>eful lift+ ( ! loop ( b[el by pressure )9 ! vag9a & traction f above ) a h& outside1 ) ! pati5t1 on h] back1 ) buttocks elevat$1 gives spe$y relief4 ,! treatm5t ( ! prolaps$ b[els repres5ts ^? measures t w replace & keep 9 position ! displac$ organs4 ,naturally1 ! sp9al & abdom9al treatm5t comes fir/2 ?is /r5g!ns inte/9al ligam5ts1 tones inte/9al muscles1 & contracts ! abdom9al p>ietes1 & at ! same "t ! b[els are regulat$1 dige/ion & nutrition improv$1 & ! g5]al heal? built up4 ,9 "s cases abdom9al support]s w be ( value4 ,9 a numb] ( in/ances att5tion to *e/ mobility & diaphragm tonicity w be ( value4 ,"r liv+1 :i* is repres5t$ by prop] diet1 suffici5t outdoor ex]cise & regul> habits1 is invaluable4 ,! really specific treatm5t is to correct sp9al1 rib & innom9ate deviations & abnormalities4 ,b direct local "w w be1 9 _m in/ances1 necess>y4 ,g5]al abdom9al manipulation is good1 b ?is %\ld be supplem5t$ by c>eful local treatm5t4 ,! hepatic flexure requires a direct /imulat+ & replac+ treatm5t4 ,! ileo-cecal section %\ld be rais$1 /imulat$ & empti$ ( ! fecal mass4 ,direct upw>d manipulation ( ! sigmoid flexure 9 ! left iliac fossa & ( ! spl5ic flexure b5ea? ! left co/al ar* is extremely efficaci\s4 ,c>e mu/ be tak5 n to bruise ! p>ts4 ,gett+ b5ea? ! prolaps$ area & g5tly & intellig5tly rais+ ! b[el s t x is empti$1 ton$ up1 & vascul> conge/ion reliev$1 are ! indications4 ,?is requires c>eful "w & ! necessity ( g5tl5ess c n be emphasiz$ too mu*4 ,/ill 9 all ( ?is treatm5t we %\ld nev] =get ! absolutely ess5tial sp9al readju/m5t4 ,rectal prolapse requires lacol int]nal treatm5t1 ext]nal tissue correction1 especially ( ! coccyx1 an innom9atum or ! lumb> sp9e1 &1 ( mu* importance1 deep1 c>eful & ?or\gh "w ov] ! sigmoid section4 ,cases ( b[el prolapse are e day exp]i5ces ) ! o/eopa?4 ,! o/eopa?ic treatm5t is ( great value 9 ^! & a successful issue is v (t5 ! result4 ,cases ( p5dul\s abdom51 ( ob/9ate con/ipation1 ( *ronic indige/ion1 ( _m nutritional disord]s1 ( feel+ pa91 weight or dragg+1 locally or g5]ally1 9 ! abdom51 are v apt to be 9 p]sons suff]+ f prolaps$ inte/9es4 ,a numb] ( cases ( b[el prolapse are associat$ ) g5]al prolapse ( abdom9al organs2 t is1 displacem5t ( ! /oma*1 kidneys1 liv]1 sple51 etc4 ,?is g5]al condition is t]m$ ent]optosis or ,gl5>d's disease4 ,x usually requires sev]al mon?s to treat x successfully4 ,^! pati5ts are neura/h5ic1 maln\ri%$1 & (t5 hy/]iacs4 ,! symptoms f :i* !y suff] are innum]able4 ,me*anical weaknesses1 l[]$ vitality1 poor inn]vation & blood supply1 & auto-intoxication are causative factors4 ,! ,prolaps$ ,ut]us ,prolapse ( ! ut]us is ( common occurr5ce4 ,! prolapse may be incomplete or complete2 ! latt] :5 ! organ is pres5t$ to ! ext]nal _w4 ,( special int]e/ are ^? affections exclusive ( surgical cases4 ,ptosis ( ! abdom9al organs ^u ! pelvic organs is a common cause ( ut]9e prolapse4 ,! abdom9al prolapse cr[ds ut]9e space1 conge/s ! ut]us1 weak5s ! ligam5ts1 & drives ! ut]us d[nw>d z a w$ge4 ,lumb> sp9al curvatures are frequ5t causes ( prolapse1 z well z o!r displacem5ts ( ! ut]us4 ,9 ?is region vasomotor n]ves to ! pelvic organs make _! exit1 &1 consequ5tly conge/ions1 inflammations1 & weaknesses ( supports are results4 ,also1 slips ( ! innom9ata di/urb ! pelvic circulatory balance4 ,weakness ( ! ut]9e support f bel[1 ! vag9al walls & p]9eum1 mo/ (t5 arises f lac]ations at *ildbir?4 ,/ill1 ! vag9al walls may become relax$ ?r\gh o!r causes4 ,tumors & extreme conge/ions are causes ( prolapse4 ,heavy lift+ is q a frequ5t s\rce ( ut]9e displacem5ts4 ,o/eopa?y is v successful 9 ut]9e prolapses2 t is1 any displacem5t ( ! ut]us n ( a surgical "*4 ,correction ( ! ext]nal causes comes fir/4 ,!n local treatm5t to replace1 tone1 & relieve conge/ion1 & break up adhesions is necess>y4 ,! ext]nal treatm5t is usually ! prim>y treatm5t4 ,local "w is n always necess>y4 ,lac]ations & o!r surgical indications1 ( c\rse1 require surg]y4 ,ov>ian ,displacem5ts ,! ov>ies may be prolaps$1 ! left mu* (t5] ?an ! "r4 ,:5 prolaps$1 x drops backw>d1 d[nw>d & inw>d4 ,ov>ian conge/ion1 tumor1 retrov]t$ or retr(lex$ ut]us1 tubal disease1 & pregnancy are among ! pr9cipal causes4 ,back ( ^! conge/ions1 tumors & ut]9e displacem5ts1 are ! o/eopa?ic causes1 p>ticul>ly sp9al & rib lesions f ! n9? dorsal d[nw>d4 ,specific lesions at ! n9? & t5? dorsals & correspond+ ribs1 affect+ directly ov>ian tissues1 & lumb> & innom9ate lesions & abdom9al prolapse di/urb+ ut]9e & tubal tissues1 are ! mo/ frequ5t o/eopa?ic causes4 ,a retrov]t$ or retr(lex$ ut]us is (t5 f\nd4 ,ut]9e displacem5ts be> d[n ^u ! ov>y & cause its desc5t1 & also di/urb ov>ian circulation4 ,z has be5 /at$1 ! left ov>y is m apt to be displac$ ?an ! "r4 ,?is is ow+ to ! abs5ce ( a valve 9 ! ov>ian ve9 on ! left side1 & also1 ?is ve9 op5s at a "r angle into ! r5al ve92 ?is anatomical feature easily leads to passive conge/ion ( ! ov>y1 & ?us to diseases ( ! organ4 ,!n ! rectum is on ! left side & l>ge fecal masses are apt to cr[d aga9/ ! ov>y1 :i* t5ds to its displacem5t4 ,?us x is readily se5 t o/eopa?ic treatm5t is v applicable to ov>ian displacem5t unless ! indications are surgical4 ,a m or less con/ant burn+ or %>p pa9 9 ! ov>ian region1 ) probably "s feel+ ( weight1 pr(use & pa9ful m5/ruation1 depression1 irritability1 etc41 are diagno/ic4 ,h[ev]1 a local exam9ation w reveal ! /atus ( ! ov>ian position & conge/ion4 ,! same treatm5t z 9 o!r organ prolapse is indicat$3 ton+ weak5$ tissues1 reliev+ conge/ions1 replac+ organ1 ) c>eful att5tion to ! b[els & ! g5]al heal?4 ,!re are no tissue disord]s ( any "p ( ! body :]e9 o/eopa?y is m ?or\ghly indicat$ & ! results m g5]ally satisfactory ?an 9 prolapse4 ,& especially %\ld x be rememb]$ t 9 prolapse ( v>i\s organs _m vague inte/9al & pelvic disord]s & ev5 uret]al & bladd] di/urbances may be trac$ to b[el dislocations & excessive kidney mobility 9 :i* o/eopa?ic measures are (t5 successful4 ,conclusion4--,! purpose ( ?is section on ,prolaps$ ,organs has be5 to supplem5t ! v>i\s articles on ,dilatation ( ! ,/oma*1 ,movable ,kidney1 etc41 ) an outl9e t may include relaxation ( a "p or ( ! :ole ( ! abdom9al visc]a4 ,! physician is all too prone to simply note ! mo/ (f5d+ or conspicu\sly di/urb$ organ in/ead ( c>efully analyz+ all ! features1 great & trivial1 t may be ei!r app>5t or m>k$4 ,a g5]al relaxation ( ! abdom9al & pelvic organs may be f\nd1 & a ne>ly complete re/oration take place "u treatm5t1 b /ill a lac]at$ p]9eum may h to be repair$ be=e a cure is complet$4 ,or x may be 9 a g5]al abdom9al ptosis t a float+ kidney w resi/ all measures = re/oration1 %ort ( surg]y1 & be=e mu* improvem5t c be obta9$ ! kidney w h to be /it*$ into place4 ,an enl>g$ liv] may cr[d ! kidney out ( place or a transv]se colon may prolapse & drag on contigu\s tissues & /ill ! annoy+ symptoms be ref]r$ else:]e4 ,!n ! primal po9t ( g5]al relaxation may n be 9 "o organ1 b !re may be a simultane\s displacem5t ( sev]al4 ,! ?orax itself may be di/ort$ f v>i\s diseases s t ! *e/ is n>r[$1 ! diaphragm displac$ ) consequ5t desc5sion ( ! abdom9al organs1 & f ! latt] a displacem5t ( ! pelvic4 8,f> d[n displacem5t1 m>k$ *anges ( =m1 & real disfigurem5ts ( ! /oma* are f\nd 9 "s cases ( kyphosis & scolio-kyphosis40#df ,! o/eopa? w n only f9d ?is true 9 "s cases1 b 9 _m cases1 al?\gh he recognizes z causative factors injuries to ! sp9e caus+ curvatures & po/ural defects z prolific s\rces ( abdom9al relaxation4 8,gl5>d's :ole !ory ( splan*noptosia is bas$ on ! relaxation ( ! susp5sory ligam5ts ( ! inte/9es1 especially t ( ! transv]se colon2 & ,/ill]1 ! discov]] ( ! float+ t5? rib1 says t splan*noptosia is a desc5t ( ! atonic /oma*1 ( ! colon 7especially ! transv]se portion71 ( ! kidney 7! "r or bo? kidneys71 exceptionally ( ! liv] or ! sple54 ,a desc5t :i* has be5 develop$ mo/ly 9 t5d] age1 9 consequ5ce ( g5]al relaxation1 especially ( ! p]itoneal susp5sory ligam5ts 9 individuals ) cong5ital g5]al dyspeptic neura/h5ia1 t5d] muscles1 lean habit1 & sl5d] bone /ructure1 manife/$ 9 a high] degree by a float+ t5? rib40 ,/ill] obs]v$ t :5 !re is a float+ t5? rib !re is a displac$ /oma* & a float+ kidney1 al?\gh x is n f\nd 9 e case1 b nev] miss+ if ! case is pron\nc$4 ,! t5? ribs 9 ^! cases h only a ligam5t\s fa/5+ & are z freely movable z ! elev5? & twelf?4 ,t abdom9al relaxation plays a v important "p 9 _m diseases ( ! abdom9al & pelvic organs1 9 c>diac & pulmon>y affections1 di/urbs ! circulation 9 ! legs1 & is ! s\rce ( _m reflex affections no "o c ga9say4 ,! o/eopa? %\ld always pay p>ticul> att5tion to tonic condition ( ! abdom9al visc]a1 = relaxation ( ! susp5sory tissues & walls1 & atony & sluggi%ness ( ! organs are frequ5tly p>am\nt etiological factors4 ,& ! o/eopa?ic treatm5t is ! rem$y p> excell5ce4 ,,footnotes3 #de ,rose & ,kemp--,atonia ,ga/ricia4 #df ,rose & ,kemp--,atonia ,ga/ricia4 ,,sk9 ,,diseases ,v>i\s sk9 diseases h be5 treat$ o/eopa?ically ) v>y+ success4 ,s mu* dep5ds ^u ! cause ( ! di/urbance & its removal1 9 sk9 diseases1 t ! cure does n re/ s mu* ) ! m]e treatm5t1 z ) ! necess>y skill 9 locat+ ! di/urb+ factor4 ,"o has to be cont9ually on 8 gu>d to locate ext]nal irritations & disord]s ( ! dige/ive & g5ito-ur9>y tracts4 ,a great deal dep5ds ^u ! avoidance ( ext]nal influ5ces2 eat+ nutriti\s food & hav+ an unob/ruct$ circulation4 ,! lead+ object ( o/eopa?ic treatm5t is to free ! circulation & ?us promote a heal?y & unob/ruct$ fl[ ( blood2 9 no o!r class ( diseases is ?is m ess5tial ?an 9 sk9 diseases4 ,aft] ! removal ( cutane\s irritations & ! correction ( int]nal disord]s1 ! cure ( ! case dep5ds ^u ! removal ( con/rictions to ! cutane\s blood-vessels4 ,! o/eopa? corrects ! lesions f\nd1 relaxes ! muscles ?or\ghly & /imulates ! circulation to ! p>ts involv$1 & promotes a heal?y activity ( all ! excretory organs4 ,:5 ! upp] "p ( ! body is affect$1 lesions are g5]ally f\nd at ! atlas & axis1 & :5 ! l[] "p ( ! body is affect$1 lesions at ! fif? lumb> are ( common occurr5ce1 al?\gh lesions may be locat$ at v>i\s po9ts correspond+ ) ! seat ( di/urbance4 ,! con/ant use ( hot ba?s w be f\nd a helpful measure 9 _m sk9 diseases4 ,b use ( soap mu/ be consid]$ z too mu* alkali w neutralize ! oil ( ! sk9 & cause undue dryness1 b bran may be sub/itut$ to advantage4 ,cleanl9ess is necess>y b ! result s\ght is1 also1 flu%+ ! cutane\s vessels4 ,!re are _m cases :]e a specific v]tebral lesion w cause1 ?r\gh ! p]iph]al n]ves1 a cutane\s irritation ) int5se it*+ & discom=t4 ,?is1 9 turn1 produces an exudate ) or )\t a cru/ & a condition results :i* is n am5able to any local or con/itutional treatm5t b an adju/m5t ( ! lesion w 9 mo/ cases br+ imm$iate relief4 ,application ( ?is pr9ciple w aid greatly 9 treatm5t ( any sk9 disease4 ,9 no di/urbance ( heal? is x m necess>y to f9d ! cause ?an 9 sk9 disease & once f\nd to apply specific treatm5t4 ,eczema is frequ5tly met 9 o/eopa?ic practice4 ,x is ! mo/ common =m ( sk9 disease1 compris+ ne>ly "o-?ird ( all ^! disord]s4 ,= a diff]5tial diagnosis ( ! sev]al v>ieties ! /ud5t is ref]r$ to special texts4 ,x is well to rememb] t ! same und]ly+ causes may be basic to ! v>i\s =ms1 = sev]al v>ieties may occur at ! same "t or "o v>iety pass into ano!r1 ?\gh commonly "o =m is m preval5t4 ,! limbs1 face & g5italia are ! mo/ common sites1 ?\gh ! eruption may occur on v>i\s p>ts ( ! body4 ,etiology includes a numb] ( factors1 con/itutional & local4 ,dietetic errors1 indige/ion & faulty elim9ation comprise ! pr9cipal und]ly+ causes1 (t5 manife/$ ?r\gh absorption ( tox9s & leucoma9s4 ,9 fact any disord] ( ! abdom9al visc]a1 organic or functional1 may be a pr$ispos+ factor1 likewise v>i\s disord]s ( ! pelvis1 tub]culosis1 diabetes1 anemia1 etc4 %\ld be consid]$4 ,s-call$ g\ty & rheumatic t5d5cies may be ! con/itutional basis4 ,! _m o/eopa?ic lesions play a v important role 9 l[]+ n only sy/emic resi/ance b ( local tissue z well4 ,?is feature c n be ov]-emphasiz$4 ,!n local irritants1 me*anical1 *emical & !rmal1 are n to be neglect$4 ,^! are usually ( second>y importance4 ,micro-organisms are probably a complicat+ factor aft] ! l[]$ resi/ance has be5 e/abli%$4 ,vasomotor neurosis1 ?r\gh con/itutional defects1 tox9s & ! v significant o/eopa?ic lesion1 is probably an ess5tial "p ( ! pa?og5esis4 ,treatm5t is usually successful if ! v>i\s etiologic factors are eradicat$4 ,e>ly treatm5t is v important4 ,if ! disord] is ( m ?an local significance *ange ! entire daily regim5 ( ! pati5t4 ,diet1 outdoor ex]cise & suffici5t sleep %\ld be def9itely regulat$4 ,a c]ta9 am\nt ( g5]al treatm5t to improve dige/ion1 assimilation & elim9ation is imp]ative4 ,an unbalanc$ diet & ov] eat+ mu/ be correct$4 ,9 c]ta9 moi/ types1 elim9at+ fatty foods w be helpful1 :ile 9 dry =ms ! />*es & sug>s %\ld be r$uc$4 ,if !re is an und]ly+ disease ?is %\ld be rem$i$ if possible4 ,p>ticul> att5tion %\ld be paid to con/ipation4 ,common s5se 9 diet1 re/1 *ange ( environm5t & free elim9ation1 c\pl$ ) due att5tion to ! o/eopa?ic lesions1 w cure ! va/ majority ( cases4 ,! greate/ difficulty arises :]e !re is "s und]ly+ disease4 ,! p>ts %\ld be protect$ aga9/ irritation su* z dirt1 cold1 soap1 & too mu* wat]4 ,m$dlesome local treatm5t is to be gu>d$ aga9/4 ,a simple application is boric acid1 rice-fl\r or corn/>*1 or :]e !re is mu* it*+ add c>bolic acid to ! saturat$ solution ( boric acid4 ,sub/itute bran = soap = cleans+ purposes4 ,h]pes ,simplex1 fev]-bli/]1 or 8cold sore0 comprise two pr9cipal v>ieties3 h]pes facialis & h]pes g5italis4 ,! fir/ occurs ^u or ne> ! lips1 face1 neck or e>s4 ,:5 ! h]pes is on ! tongue or ! muc\s membrane )9 ! m\? x is commonly t]m$ 8cank] sores40 ,h]pes g5italis is locat$ on ! prepuce1 glans p5is or f>!r back ^u ! p5is4 ,9 ! female ! labia majora & m9ora & ve/ibule are ! usual locations4 ,lack ( cleanl9ess1 sexual excitem5t & adh]5t prepuce are causative factors1 ?\gh pr$ispos+ factors su* z faulty circulation & di/urb$ inn]vation are to be consid]$4 ,9 8cold sores0 !re is (t5 "s ga/ro-inte/9al di/urbance1 especially inte/9al /asis1 cold 9 ! head & o!r infections t supply tox9s :i* irritate ! n]ves4 ,no d\bt !re are und]ly+ o/eopa?ic lesions t l[] ! local n]ve resi/ance or block ! impulses su* z v]tebral & inf]ior maxill>y lesions4 ,! pr$ispos+ di/urbance is probably due to ! ,gass]ian ganglion4 ,cold w9ds & excessive exposure to ! sun's rays w effect ! tissues ov] ! m5tal & infraorbital =am9a1 t5s+ ! muscles & irritat+ ! n]ves at ^! po9ts4 ,on palpation !y w be f\nd s5sitive4 ,frequ5t rot>y motion by tip ( f+] ov] =am9a w op5 !m & all[ conge/ion to dra94 ,h]pes ,zo/]1 or %+les1 is an acute inflammatory disease *>act]iz$ by gr\ps ( small vesicles1 usually along ! c\rse ( ! int]co/al n]ves on "o side ( ! body4 ,be=e ! vesicles appe> !re is m or less sev]e neuralgia4 ,! eruption is unilat]al1 v r>ely bilat]al4 ,! ne>by lymphatics are usually enl>g$4 ,?\gh ! int]co/al n]ves are ! ones mo/ frequ5tly involv$1 /ill ! lumb>1 ?igh1 trifacial & o!r cutane\s n]ves may be affect$4 ,! mo/ common lesion is an inflammation ( ! po/]ior sp9al ganglion :i* usually involves ! fib]s ( ! entire n]ve4 ,inflammation ( ! n]ve outside ( ! ganglion w cause ! disord]4 ,tox9s f v>i\s infecti\s s\rces are (t5 excit+ causes4 ,v]tebral & rib lesions are always f\nd2 & :]e ! ,gass]ian ganglion is involv$ lesions ( ! inf]ior maxilla & upp] c]vical v]tebr are pr$ispos+ factors4 ,?us o/eopa?ic lesions f traumatism1 cold & wet1 & imbalance ( muscul> t5sion are important4 ,exudates1 tumors1 pleuritic & pulmon>y affections are to be consid]$ z possible s\rces4 ,treatm5t4--,adju/ v]tebral lesions & c>efully raise & sep>ate ribs if int]co/als are affect$4 ,look aft] v]tebral orig9 ( any o!r n]ve or n]ves if o!rwise4 ,local application ( talcum or />* or boric acid w g5]ally be suffici5t4 ,urtic>ia1 hives or nettle ra% is a common affection (t5 due to "s d]angem5t ( ! dige/ive tract4 ,?is may be a me*anical irritation or ( a toxic nature4 ,e "o is famili> ) ! v>i\s foods t are apt to cause ! hives1 %ell fi%1 /rawb]ries1 *eese1 pork1 oatmeal1 mu%rooms1 etc4 ,! irritation may be a reflex "o f ! visc]al di/urbance2 also1 !re may be irritation ( ! pelvic organs t w\ld give rise to ! tr\ble4 ,x is well kn[n t c]ta9 drugs w produce urtic>ial eruptions4 ,!re are cases :]e ! irritation is simply local due to ! nettle1 mosquito bites & wasp /+s4 ,9 *ronic cases inte/9al /asis1 n]v\s exhau/ion & nephritic diseases are important4 ,no d\bt o/eopa?ic lesions frequ5tly det]m9e ! location ( ! :eals4 ,^! lesions affect ! inn]vation & ?us e/abli% a basis = ! reflex vasomotor effect4 ,?is is 9 ! nature ( spasm ( ! cutane\s vessels quickly foll[$ by dilatation ) exudation ( s]um4 ,! irritant probably acts on ! walls ( ! blood vessels4 ,treatm5t consi/s ( ?or\ghly empty+ ! b[els by w>m wat] enema1 correct+ ! diet1 ton+ ! visc]a & adju/+ ! o/eopa?ic lesions4 ,?or\gh att5tion to ! pati5t's environm5t1 daily habits & occupation are ( value4 ,w>m soda ba?s w relieve ! it*+4 ,acne is a common sk9 disord] t is *>act]iz$ by an inflammation ( ! sebace\s gl&s ( ! nature ( papules1 tub]cles or pu/ules4 ,! face1 %\ld]s1 *e/ & back are ! regions usually involv$4 ,x g5]ally1 appe>s ab\t pub]ty4 ,blackheads is ! />t+ po9t2 ^! are accompani$ ) greasy sk9 & du/1 & influ5c$ by micro-organisms & m or less inte/9al disord]4 ,! g5]al or sy/emic heal? no d\bt affects ! local disord]1 z 9 _m sk9 diseases2 = v>i\s inte/9al d]angem5ts z indige/ion1 con/ipation1 etc42 pelvic & m5/rual irregul>ities2 g5]al ill heal?2 anemia1 etc4 affect circulatory1 gl&ul> & n]v\s integrity4 ,any di/urbance ( normal elim9ation is important4 ,! treatm5t consi/s ( c>eful att5tion to ! g5]al heal? & to ! local inn]vation ( ! face or region involv$4 ,measures t tone ! bodily organs su* z outdoor life1 regul> habits1 pl5ty ( sleep & correct diet are important4 ,9 "s cases ! ,x-ray is ( value4 ,,animal ,,p>asites ,tape ,worms ,v>ieties4--,ta5ia solium2 ta5ia sag9ata2 bo?riocephalus latus4 ,! l>v ( tape-worms are introduc$ into ! inte/9al canal by food & dr9k4 ,! p>asite rea*es adult gr[? 9 ! inte/9es4 ,! l>val =ms are !n f\nd aga9 9 ! muscles & solid organs4 ,ta5ia ,solium4--,?is is d]iv$ f ! hog1 & is ! mo/ common =m 9 ?is c\ntry4 ,:5 mature x is f two to f\r y>ds 9 l5g?4 ,! head is small1 ab\t ! size ( a p91 & provid$ ) f\r cup-l suck]s surr\nd$ by a d\ble r[ ( hooklets1 h5ce x is call$ ! arm$ tape-worm4 ,! head is fa/5$ to ! body by a ?read-l neck1 & foll[+ ! neck1 ! body occurs 9 segm5ts4 ,! sexual organs1 bo? male & female1 occur 9 ! c5t] ( ! broad surface ( ! segm5t4 ,! segm5ts are ab\t "o millimet] 9 l5g? & sev5 or eight millimet]s 9 bread?4 ,!re are ?\s&s ( ova 9 ea* mature segm5t4 ,! worm atta9s its gr[? 9 ab\t twelve to fifte5 weeks1 aft] :i* "t ! segm5ts are %$ & pass$4 ,= fur!r developm5t ! ova mu/ ga9 entrance to ! /oma* ( a pig or ( man1 & pass+ f ! /oma* !y may rea* ! muscles & organs & develop into l>v or cy/ic]ci4 ,ta5ia ,sag9ata4--,?is is d]iv$ f beef1 & is mu* long] & l>g] ?an ! ta5ia solium4 ,x is f five to six y>ds 9 l5g?2 ! head is ov] two millimet]s 9 bread?1 is squ>e %ap$1 & has f\r l>ge suck+ discs1 )\t hooklets2 h5ce x is call$ ! un>m$ tape-worm1 9 contra-di/9ction to ! hook$ v>iety4 ,! segm5ts are ?ick] & ! ova l>g]1 & !y are pass$ & +e/$ 9 ! same mann] z ! ta5ia solium4 ,bo?riocephalus ,latus4--,?is is f\nd especially 9 ,europe & is v long1 measur+ f eight to t5 y>ds2 x is d]iv$ f fi%1 is n provid$ ) hooklets1 b has two lat]al grooves4 ,! segm5ts are %ort & wide1 ! sexual organs be+ on ! n>r[ side ( ! segm5t4 ,etiology4--,unheal?y condition ( ! /oma* & inte/9es is ! pr$ispos+1 & uncleanl9ess an important1 factor 9 ! occurr5ce ( tape-worm4 ,^? eat+ imp]fectly cook$ beef1 pork1 fi% or o!r meats1 & ^? h&l+ fre% meats1 are liable to be affect$ ) tape-worm4 ,:5 ! ovum is tak5 into ! /oma* ! capsule is dissolv$ & ! embryo passes into ! small inte/9es1 fa/5+ itself into ! muc\s membrane1 by its hooklets & suck]s & grooves4 ,symptoms4--,tape-worms occur 9 ! human be+ at all ages4 ,(t5times symptoms are abs5t1 ! expulsion ( segm5ts be+ notic$ & ?us ! worms accid5tally discov]$4 ,! tape-worm is seldom dang]\s1 b if a worm is kn[n to exi/ x is always a s\rce ( consid]able anxiety on ! "p ( ! pati5t4 ,sev]e anemia may result & be wrongly diagnos$4 ,!re are dyspeptic symptoms1 colicky pa9s1 nausea & occasionally di>rhea4 ,! appetite is v>iable1 sometimes rav5\s4 ,?is condition is foll[$ by loss ( fle% & v>i\s reflex ph5om5a1 z v]tigo1 heada*e1 convulsions1 palpitation1 *oreic movem5ts1 it*+ ( ! nose & anus1 p>alysis1 & r>ely1 insanity4 ,9 addition to ^! symptoms !re may be a wr9kl$ c\nt5ance1 s5sation ( a cold /ream w9d+ itself t[>d ! back imm$iately aft] a meal1 pa9 9 v>i\s p>ts ( ! body & r++ 9 ! e>s4 ,! decisive diagno/ic symptom is to f9d segm5ts ( ! worm 9 ! /ools4 ,diagnosis4--,discov]y ( ! ova or segm5ts 9 ! passages ( ! b[els is ! only pro( ( ! pres5ce ( a tape-worm4 ,prognosis4--,favorable 9 all cases4 ,treatm5t4--,prophylactic treatm5t is necess>y4 ,meats %\ld be ?or\ghly cook$ s t ! l>v w be de/roy$2 & all segm5ts ( tape-worms pass$ 9 ! /ools %\ld be burn$--by no means %\ld !y be ?r[n outside or 9 ! wat]-closet4 ,! imm$iate expulsion ( a tape-worm is n a necessity4 ,fir/ ( all ! mode ( liv+1 & !n ! g5]al /ate ( heal? %\ld be correct$4 ,tape-worms inv>iably result f a g5]al /ate ( unheal?9ess1 & ) improv$ heal? & correct$ dige/ive processes ! worms _c exi/1 & 9 a %ort "t w be expell$4 ,expulsion ( ! head is necess>y be=e ! case w be cur$1 = if ! head is n expell$ new segm5ts w cont9ue to gr[4 ,/imulat+ ! liv] to increase ! am\nt ( bile1 & increas+ ! activity ( ! dige/ive gl&s ( ! /oma* & inte/9es1 by a ?or\gh treatm5t ( ! splan*nic region & direct treatm5t ov] ! abdom51 w usually be suffici5t = ! cure ( inte/9al p>asites4 ,! treatm5t w probably h to be repeat$ sev]al times1 9 ord] t ! inte/9es may rega9 a heal?y tone1 s t ! p>asite w n f9d favorable conditions = its exi/5ce )9 ! inte/9es1 & t ! bile may be secret$ 9 suffici5t quantities to dislodge ! worm4 ,hahnemann claim$1 8t dur+ a p]iod ( comp>ative heal? tape-worms d n inhabit ! inte/9es prop]1 b r ! remnants ( food & fecal matt] conta9$ 9 ! inte/9es1 liv+ quietly z 9 a _w ( _! own )\t ! lea/ inconv5i5ce to ! pati5t & f9d+ _! su/5ance 9 ! cont5ts ( ! b[els4 ,dur+ ?is /ate !y d n come 9 contact ) inte/9al walls1 & rema9 h>mless4 ,b :5 f any cause a p]son is attack$ by an acute disease ! cont5ts ( ! b[els become (f5sive to ! p>asite1 :i* 9 its wri?+ & di/ress t\*es & irritates ! s5sitive inte/9al l9+1 ?us increas+ ! compla9ts ( ! pati5t consid]ably by a peculi> k9d ( cramp-l colic4 7,9 simil> mann] ! human foetus 9 ! womb becomes re/less1 twi/s its body & moves :5ev] ! "m is sick1 b floats quietly 9 ! liquor amnii1 )\t di/ress+ h] :ile %e is well470 ,?is b h>monizes ) ! o/eopa?ic !ory & practice ) reg>d to tape-worm1 t !re is an unheal?y condition ( ! inte/9es :i* pr$isposes to ! affection1 & consequ5tly ! cure mu/ be a correction ( su* a disord]$ /ate4 ,dur+ ! treatm5t1 if a light diet ( milk & bro?s is giv51 x w favor an e>li] removal ( ! p>asite1 by help+ to remove ! mucus 9 :i* ! head is emb$d$4 ,if ?is fails extract ( male f]n is sugge/$4 ,asc>is ,lumbricoides 7,r\nd ,worm7 ,?is is ! mo/ common p>asite1 & is f\nd pr9cipally 9 *ildr52 x is also f\nd 9 cattle & hogs4 ,x is ( a yell[i% br[n color & 9 =m resembles e>? worms4 ,! worm is cyl9drical1 po9t$ at bo? ends2 ! female is f sev5 to twelve in*es 9 l5g?1 & ! male f f\r to eight in*es4 ,!y are probably introduc$ into ! /oma* by food & dr9k4 ,!y occupy ! upp] "p ( ! small inte/9e1 & are usually "o or two 9 numb]1 ?\gh !y may be num]\s4 ,occasionally !y migrate into ! /oma* & are eject$ by vomit+1 or into ! tra*ea & produce suffocation1 or into ! l>ynx or ,eu/a*ian tube1 or !y may pass d[nw>d to ! anus1 or into ! bile ducts4 ,symptoms4--,(t5times symptoms are abs5t4 ,!re may be dyspepsia1 colicky pa9s1 muc\s /ools1 meteorism1 v]tigo1 fretfulness1 voraci\s appetite1 anemia1 sall[ complexion1 heada*e1 *orea & convulsions4 ,o!r symptoms may be pres5t1 z gr9d+ ( ! tee? & it*+ ( ! nose & anus4 ,ob/ruction ( ! b[els has occurr$4 ,if a worm ent]s ! bile duct ob/ructive jaundice occurs4 ,a decisive diagnosis c be giv5 only :5 ! worm is se54 ,treatm5t4--,p>ticul> att5tion %\ld be paid ! liv]1 = x is "h t we mu/ seek ! natural rem$y 9 ! =m ( bile1 9 ord] to eject & cleanse ! sy/em f nematodes4 ,modes ( improp] liv+ %\ld be correct$2 cleanl9ess is ess5tial1 & !re %\ld be att5tion to ! g5]al heal? ( ! pati5t4 ,?or\gh correction ( all defects ( ! sp9al column 9 ! region ( ! splan*nics1 & c>eful direct treatm5t ( ! b[els is indicat$4 ,! *ild may be put to b$ & fa/$ tw5ty-f\r h\rs1 !n ! liv] /rongly /imulat$ to increase fl[ ( bile4 ,if ! above treatm5t is n successful oil ( wormwood may be employ$4 ,oxyuris ,v]micul>is 7,?read-worm2 ,p9-worm7 ,?is small p>asite1 commonly se5 9 *ildr51 is f ?ree to five millimet]s long 9 ! male & ab\t tw5ty millimet]s 9 ! female1 is blunt at "o end & %>p at ! o!r1 & occupies ! colon & rectum4 ,!y are probably introduc$ into ! inte/9es 9 ! ova1 by uncook$ fruits & vegetables1 or by ! dirty h&s ( mo!rs & nurses ( ! infants4 ,!y v>y greatly 9 numb]2 migrate to ! rectum :]e !y deposit _! eggs1 & are (t5 dis*>g$ 9 ! feces1 :]e !y appe> l pieces ( ord9>y :ite ?read4 ,symptoms4--,loss ( appetite1 anemia1 re/lessness & irritability are m>k$4 ,! it*+ becomes intol]able :5 ! worms come d[n 9 ! rectum to ! anus & )9 ! folds ab\t ! anal orifice4 ,9 ! female ! worms may w&] into ! vag9a :]e !y become p>ticul>ly di/ress+1 & ?us may produce excessive sexual excitem5t & cause nymphomania & ma/urbation4 ,treatm5t4--,cleanl9ess ( ! mo/ scrupul\s k9d %\ld be dem&$ 9 e in/ance4 ,injections ( cold salt wat] 7repeat$ = at lea/ t5 days7 & o!r ag5ts )9 ! rectum w de/roy ! eggs z soon z !y are deposit$1 besides reliev+ ! t]rible it*+4 ,9 ob/9ate cases use quassia decoction4 ,att5tion to ! g5]al heal? ( ! pati5t & great c>e ( ! inte/9es & o!r dige/ive organs are absolutely necess>y4 ,! sp9al treatm5t to ! inte/9es & o!r dige/ive organs1 z well z ?or\gh direct treatm5t ov] ! abdom51 is indicat$4 ,unc9>iasis 7,european hook-worm disease2 ,m9]'s anemia2 ,ankylo/omiasis2 ,hook-worm disease7 ,?is disease results f infection by ! hook-worm ( any ( ! v>i\s types4 ,9 ,europe x is f\nd 9 ,italy1 ,belgium1 ,g]many1 ,france & ,switz]l&4 ,9 ,am]ica x seems to be ( ,africo-,asiatic orig9 b 0 fir/ discov]$ 9 ! ,s\!rn /ates & ab\nds *iefly 9 ,texas1 ,florida1 ,georgia1 ,nor? & ,s\? ,c>ol9a z well z 9 ! ,we/ ,indies4 ,infection comes f unprotect$ feces t are all[$ to be spread :]e ! feet or h&s may come 9 contact z x is )\t d\bt t ! contagion occurs ?r\gh ! sk94 ,"o au?ority /ates t hook-worm is r>ely f\nd except 9 cases :]e gr\nd it* has occurr$ )9 a p]iod ( eight ye>s4 ,negroes h>bor ! p>asite & transmit x b seem immune to its effects :ile ! poor] :ites are afflict$ to a l>ge degree4 ,! worms are c>ri$ f "s abrasion ( ! sk91 by ! blood to ! he>t & lungs1 !nce to ! ph>ynx & swall[$1 !nce to ! duod5um & jejunum :]e !y atta* !mselves to ! l9+ walls4 ,"h !y n only fe$ ^u ! blood b develop a tox94 ,! female worm is ab\t twice ! size ( ! male1 #aj to #ah mm4 z aga9/ #f to #aa mm4 & !re is slight diff]5ce betwe5 ! old & new _w v>ieties4 ,! head is provid$ ) f\r hook %ap$ tee? :i* =m ! atta*m5t to ! inte/9e & x is v secure4 ,diagnosis4--,= ye>s ! languid1 dull1 expressionless1 lack-lu/] ( eye & g5]al unambiti\s *>act]i/ics ( ! inhabitants ( ! great s& belt ( ! ,unit$ ,/ates attract$ att5tion & 0 attribut$ to laz9ess b ! discov]y ( ! hook-worm expla9$ ! cause4 ,*ildr5 are /unt$ 9 m9d & body & h a muddy1 dirty :ite complexion4 ,at ! beg9n+ !re mu/ be a v consid]able colony ( ! p>asites to cause symptoms b z ! disease advances !re is a di/5tion ( ! abdom5 f enl>gem5t ( ! sple5 & liv] & f flatul5cy4 ,!re is palpitation1 %ortness ( brea?1 c>diac bruits f ! sev]e anemia :ile edema ( ! feet & legs is r common4 ,! blood %[s a sev]e second>y anemia ) its coagulation "t mu* increas$4 ,leucocytosis is n common2 hemoglob9 is f "o-t5? to "o-half normal ) ery?rocytes ab\t half normal4 ,treatm5t4--,! removal ( ! worms ) ! lea/ possible h>m to ! body is indicat$4 ,?ymol is a poison :i* is n absorb$ by ! body1 :5 c>efully giv51 & :i* is v toxic to ! p>asite4 ,! dose v>ies f eight gra9s = a *ild "u five ye>s ( age1 to =ty-five = an adult4 ,?ymol is soluble 9 fats & 9 alcohol1 s t = a day or s be=e ! ?ymol is giv51 & f "o to f\r days aft]1 no fats or alcohol %\ld be tak54 ,! be/ way to avoid poison+ by ?ymol is to give ! pati5t *>coal1 !n no fats or alcohol is p]mitt$ until ! treatm5t is complet$4 ,:5 ! /ools become black1 ! ?ymol is giv5 on an empty /oma*4 ,a purgative is giv5 a few h\rs lat]4 ,enemas %\ld be us$ v freely 9 ord] to facilitate ! removal ( ! injur$ or poison$ worms4 ,ano!r dose ( *>coal is giv51 & :5 ! /ools are black aga91 ! pati5t may return to 8 ord9>y diet4 ,! d5ial ( fats to ! p]son s ?or\ghly accu/om$ to bacon ?ree times a day is a factor met ) difficulty 9 deal+ ) pati5ts ( ! ord9>y class ) ! disease4 7,cl9ical ,o/eopa?y47 ,prophylaxis4--,aft] treatm5t x is imp]ative to prev5t re9fection & to d t ! mo/ rigor\s sanit>y measures mu/ be in/itut$4 ,all feces mu/ be dispos$ ( & habits ( cleanl9ess 9 defecation insi/$ ^u :ile negroes1 :o h>bor ! worm )\t %[+ symptoms1 mu/ be look$ aft] z well z ! actual victims4 ,c>e ( ! feet is important & %oes %\ld be worn 9 infect$ regions & all abrasions ( ! sk9 protect$4 ,dr9k+ wat] mu/ be uncontam9at$ :i* pres5ts a problem z wells & spr+s are usually unprotect$4 ,absolute & p]si/5t cleanl9ess is ! answ] to ! "q ( prev5tion4 ,tri*9iasis ,tri*9iasis is a "n giv5 to a disease produc$ by ! embryos ( ! tri*9a spiralis4 ,9 ! adult condition ! tri*9a spiralis lives 9 ! small inte/9es4 ,! embryos migrate into ! muscles :]e !y f9ally become encapsulat$4 ,man is infect$ by eat+ insuffici5tly cook$ pork conta9+ ! encapsulat$ worm1 :i* is set free dur+ ! dige/ive process4 ,ab\t ! ?ird day !y atta9 _! full gr[? & become sexually mature4 ,ea* "o dis*>ges l>ge numb]s ( embryos4 ,z soon z born ! "y brood is c>ri$ away f ! b[el & invade ! muscles ?r\gh v>i\s *annels--pr9cipally by means ( ! blood /ream & along ! connective tissue r\tes4 ,! female tri*9a may br+ =? sev]al broods ( embryos 9 succession4 ,9 n9e or t5 days aft] infection ! fir/ brood rea*es its de/9ation4 ,!y atta9 to maturity 9 ab\t two weeks aft] ent]+ ! muscul> tissue4 ,9 ?is process an int]/itial myositis is excit$ & a fibr\s capsule is =m$ 9 f\r to six weeks4 ,! capsule gradually becomes ?ick] & f9ally calc>e\s infiltration may take place4 ,?or\gh cook+ de/roys ! p>asite4 ,! disease is mo/ frequ5t among ! ,g]mans :o eat raw ham & sausages4 ,symptoms4--,^! are sometimes abs5t1 especially :5 only a few are eat54 ,if l>ge numb]s h be5 +e/$1 ga/ro-inte/9al symptoms develop 9 ! c\rse ( a few days4 ,vomit+1 di>rhea1 & pa9 9 ! abdom5 may be pres5t4 ,9 f "o to two weeks muscul> symptoms develop4 ,!re is fev]1 muscul> pa91 especially dur+ motion1 & ! muscles are /iff1 t5se & sometimes swoll54 ,:5 ! respiratory muscles are involv$ dyspnea is produc$1 :i* may prove fatal4 ,eos9ophilia is a helpful diagno/ic po9t4 ,edema1 especially ( ! face1 is an important symptom4 ,pr(use sweats1 it*+ & t+l+ ( ! sk9 h be5 obs]v$4 ,diagnosis4--,epidemics ( ?is disease are m easily diagnos$ ?an an isolat$ case4 ,among ! ,g]mans1 if cases ( app>5t typhoid fev] occur aft] a picnic or o!r fea/+ occasion1 :]e raw ham or sausages h be5 indulg$ 91 ?is disease %\ld be suspect$4 ,exam9ation ( ! /ools & ( ! muscles w be ( aid4 ,! worms may be discov]$ 9 ! pork1 a portion ( :i* has be5 eat5 by ! pati5t4 ,prognosis4--,?is dep5ds ^u ! numb] ( worms +e/$4 ,! prognosis %\ld always be gu>d$4 ,e>ly1 m>k$ di>rhea is favorable4 ,treatm5t4--,prophylactic treatm5t is ( great importance 9 tri*9iasis4 ,inspection ( ! meat supply1 is do+ mu* to prev5t tri*9iasis2 al?\gh ! mo/ practical way to prev5t ! disease is to ?or\ghly cook all pork & sausages4 ,! c5tral portions ( ! meat %\ld be well cook$4 ,9 ! fe$+ ( hogs c>e %\ld be tak5 t !y d n receive any (fal1 b only milk1 gra91 vegetables1 etc4 ,:5 a p]son is infect$ ) tri*9iasis1 ?or\gh & prompt evacuation ( ! b[els %\ld be p]=m$ at once1 s t ! embryos w n h "t to pass into ! muscles1 b w be eject$ f ! body4 ,?is %\ld be foll[$ by a ?or\gh & p]si/5t treatm5t = sev]al days ( ! liv] & inte/9es2 treat bo? ! liv] & inte/9es directly & ?r\gh ! sp9e4 ,! object ( ?is treatm5t is to r5d] all ! dige/ive juices active1 s t !y may dislodge ! animal p>asite1 & to prev5t _! pass+ into ! muscles4 ,also keep ! b[els active = sev]al days4 ,:5 ! l>val p>asites h ent]$ ! muscles1 a treatm5t _c be appli$ to affect !m directly1 b ! heal? ( ! body %\ld be ma9ta9$ if possible1 & ! sev]] symptoms1 z ! muscul> pa9s1 weakness & insomnia combat$4 ,?or\gh manipulation1 massage & hot ba?s w be ( special aid 9 reliev+ ! /iffness & weakness ( ! muscles4 ,fil>ia 7,fil>ia ,sangu9is-,hom9is7 ,!re are two v>ieties4 ,"o is a ?read-l worm ) tap]+1 blunt ends1 appe>+ 9 ! blood at night1 h5ce call$ nocturna1 :ile ! o!r is ( slightly diff]5t =m1 appe>+ 9 ! blood only by day & is call$ diurna4 ,! mosquito is ! communicat+ ho/ ( ! p>asite4 ,dur+ ! night1 or %\ld ! pati5t sleep dur+ ! day1 ! nocturna appe>s 9 ! p]iph]al circulation1 :ile dur+ ! o!r int]val !y are probably 9 ! o!r vessels1 p>ticul>ly ! lungs4 ,aft] ! mosquito has tak5 blood f an affect$ pati5t x requires f six to sev5 days = ! metamorphosis ( ! m9ute fil>ia :i* are !n lodg$ 9 ! probosis ( ! mosquito & introduc$ into ! blood ( ! next victim4 ,! adult p>asite is f ?ree to f\r in*es long & ! ?ickness ( a co>se hair1 ) cle> sexual di/9ction4 ,pa?ologically !re are no di/9ct lesions1 z ! p>5t worm mu/ e/abli% "o4 ,lymphatic engorgem5t may result f plugg+ ( ! ?oracic duct or ( a l>ge lymphatic ) consequ5t engorgem5t :i* may develop symptoms 9 ! +u9al gl&s1 pelvic & lumb> lymphatic trunks4 ,z ^! v>icosities develop rupture may occur2 if into ! g5ito-ur9>y tract *yluria or *ylocele may result1 or if 9 ! abdom9al cavity *yl\s ascites4 ,lymphangitis foll[s a lymph /asis1 :i* lat] results 9 elephantiasis4 7,b>badoes leg47 ,symptoms4--,elephantiasis affects ! legs1 b ! arms r>ely2 ! labia ( ! female & scrotum ( ! male2 occasionally ! brea/s & o!r p>ts ( ! body4 ,fev] is pres5t on acc\nt ( ! lymphangitis1 accompani$ by rigors & delirium & !re is m>k$ local inflammation4 ,! attack t]m9ates 9 a pron\nc$ sweat4 ,9 deep] p>ts !re is deep seat$ pa9 & signs ( sepsis1 :ile abscesses may develop ov] ! inflam$ area4 ,! v>icose +u9al gl&s are d\ghy1 s(t & pa9less1 ) bo? sides affect$ alike4 ,! scrotum is affect$ by ! ext5sion1 & at times ! te/es4 ,treatm5t is surgical1 z ! tumors mu/ be remov$4 ,unless ! female worm is also remov$ ?is is1 h[ev]1 only palliative4 ,me?yl5e blue is said to be de/ructive to ! fil>ia & x is practically h>mless to ! human body4 ,! only treatm5t is "o t w aid 9 build+ up ! g5]al heal?4 ,,hemorrhages ,nasal ,hemorrhage 7,nose ble$2 ,epi/axis7 ,o/eopa?ic ,etiology & ,pa?ology4--,traumatism1 su* z pick+ ! nose1 bl[s1 & surgical op]ations2 /ra9+ :5 c\gh+2 nasal tumors & ulc]ations2 lesions ( ! atlas1 or any lesion ( ! upp] c]vical v]tebr1 t w\ld int]f]e ) ! vasomotor di/ribution to ! nose & cause local conge/ion or weakness ( ! blood vessels2 ob/ructions to ! g5]al circulation2 irregul>ities or suppression ( ! m5/rual fl[ may result 9 nose ble$1 z a vic>i\s m5/ruation2 suppression ( a habitual hemorrhoidal dis*>ge4 ,pa?ologically ! great frequ5cy ( nasal hemorrhage is due to ! great vascul>ity ( ! nasal muc\s membrane4 ,usually 9 cases ( spontane\s orig91 ble$+ is f ! region ( ! septal art]y4 ,spontane\s ble$+ may also occur f po/]ior hyp]trophies or ad5oid vegetations4 ,! blood fl[+ d[nw>d into ! fauces1 is expectorat$ 9 su* cases1 & may be mi/ak5 = a hemorrhage f ! lungs4 ,treatm5t4--,! position ( ! individual is important4 ,he %\ld assume a sitt+ po/ure1 or z ne>ly s z possible4 ,hold+ ! no/rils tightly1 or plugg+ !m ) a piece ( cotton1 w favor ! =mation & ret5tion ( a clot1 s t ! hemorrhage may be controll$4 ,pressure ^u ! c>otid art]y1 or ^u ! facial art]y at ! angle ( ! inf]ior maxilla1 w sl[ ! blood curr5t & favor ! =mation ( a clot1 also pressure on ! sides ( ! bridge ( ! nose may influ5ce x4 ,correct+ any lesions t may exi/ 9 ! sup]ior c]vical region1 z d]angem5t ( ! v]tebr or contract$ muscles1 w remove ob/ructions or irritations to ! vasomotor sy/em ( ! affect$ region1 & ?us equalize ! vascul> sy/em4 ,hold+ ! arms above ! head1 & ! application ( ice to ! nose are ( aid 9 "s cases4 ,also1 injection ( cold or hot wat] into ! no/rils4 ,9 s]i\s & ob/9ate cases1 :]e o!r me?ods fail1 a plugg+ ( ! ant]ior & po/]ior n>es %\ld be resort$ to1 us+ absorb5t cotton or gauze4 ,bron*o-pulmon>y ,hemorrhage 7,hemoptysis7 ,o/eopa?ic ,etiology & ,pa?ology4--,pulmon>y conge/ion2 cr\p\s pneumonia2 tub]culosis2 hemorrhagic inf>ction2 ulc]s ( ! l>ynx1 tra*ea or bron*i2 gangr5e ( ! lung2 fibr9\s bron*itis1 c>c9oma ( ! lung2 lesions ( ! ribs or v]tebr f ! second to ! sev5? dorsal inclusive1 may cause diseases ( ! bron*ial tubes or lungs1 t result 9 hemoptysis1 or ! hemorrhage may be caus$ directly by extreme conge/ion result+ f ! disord]$ vasomotor n]ves2 diseases ( ! he>t1 su* z mitral disease1 caus+ pulmon>y conge/ion2 aneurism ( ! bran*es ( ! pulmon>y art]y2 vic>i\s m5/ruation f d]ang$ m5/rual functions2 diseases ( ! vessel walls1 or blood1 z scurvy1 anemia1 hemophilia1 etc4 ,pa?ologically 9 _m cases1 ! lesions are microscopic1 consi/+ ( ruptur$ capill>ies4 ,9 o!r cases l>g] vessels may be ruptur$1 or are ! seat ( erosion4 ,_m o!r lesions may be obs]v$4 ,aft] dea? ! bron*ial mucosa is occasionally f\nd inflam$ & ! lung tissues pal] ?an normal4 ,diagnosis4--,a diff]5tial diagnosis mu/ be made betwe5 epi/axis1 hemoptysis & hematemesis4 ,9 epi/axis ! blood may fl[ f ! po/]ior n>es into ! ph>ynx2 x causes c\gh+ & a dis*>ge ( ! blood may occur ! same z 9 hemoptysis4 ,a c>eful exam9ation ( ! nasal region alone c det]m9e ! s\rce ( ! ble$+4 ,9 hemoptysis ! hi/ory ( ! case z to pulmon>y or c>diac diseases is to be consid]$4 ,!re is a feel+ ( weight & ( uneas9ess 9 ! *e/4 ,a salty ta/e & a tickl+ ( ! ?roat prec$es ! ble$+4 ,! blood is eject$ by c\gh+ & is bright r$1 fro?y1 v little coagula1 & is alkal9e 9 reaction4 ,9 hematemesis ! hi/ory w\ld indicate disease ( ! /oma*1 sple51 liv] or he>t4 ,uneas9ess1 & occasionally nausea & fa9tness1 prec$es ! ble$+4 ,! blood is eject$ by vomit+1 & is d>k1 clott$ or fluid1 mix$ ) food1 & is ( acid reaction4 ,9 a few in/ances ! blood due to hemoptysis may be swall[$1 & vomit$4 ,treatm5t4--,9 all ^! cases ( hemoptysis ! pati5t %\ld be plac$ 9 b$ & absolute re/ dem&$4 ,an attempt %\ld at once be made to correct any lesion t may be f\nd influ5c+ ! cause ( ! ble$+4 ,correct+ lesions to ! vasomotor n]ves ( ! lungs & bron*ial tubes1 & equaliz+ ! di/urb$ vascul> area1 may be suffici5t 9 a numb] ( cases4 ,^! lesions w be f\nd pr9cipally 9 ! upp] dorsal region4 ,9 "s cases1 p]haps1 !re is an impairm5t ( ! trophic n]ves by ! same lesions1 ?us int]f]+ ) ! tone ( ! vessel walls & pulmon>y tissues4 ,! diet %\ld be light1 nutriti\s & non-/imulat+4 ,! use ( hot dr9ks is to be avoid$4 ,! rapidity ( ! he>t's action %\ld be r$uc$4 ,?is is be/ p]=m$ by ?or\gh treatm5t ( ! dorsal sp9al n]ves ( ! left side ov] ! he>t1 & by inhibition 9 ! suboccipital region4 ,! ice-bag to ! precordia is also helpful4 ,ic$ dr9ks & ! eat+ ( ice is ( aid4 ,/imulation ( ! sy/emic circulation w be ( value 9 help+ to relieve ! pulmon>y conge/ion1 al?\gh ! two sy/ems are some:at indep5d5t ( ea* o!r4 ,also1 hot foot ba?s & ! evacuation ( ! b[els may be ( additional value4 ,9 cases due to organic disease ( ! he>t1 ! m9d & body %\ld receive absolute re/1 s t ! diseas$ areas may be /r5g!n$ z mu* z possible2 besides a tonic treatm5t = ! he>t's action is necess>y4 ,aft] ! hemorrhage has subsid$ c>e %\ld be tak5 t ble$+ does n occur aga94 ,all irritations ( ! respiratory tract %\ld be avoid$4 ,a /imulat+ diet1 tobacco & alcohol %\ld be avoid$4 ,nutriti\s food & a mod]ate am\nt ( ex]cise is indicat$4 ,hemorrhage ( ! ,/oma* 7,hematemesis7 ,o/eopa?ic ,etiology4--,injuries to ! /oma*2 local diseases1 z conge/ion1 ulc]s & canc]2 vic>i\s m5/ruation2 a me*anical ob/ruction to ! portal circulation2 sp9al lesions to ! vasomotor n]ves ( ! /oma*2 alt]ations 9 ! blood2 p]=ation ( ! /oma* walls1 involv+ a blood vessel2 disease ( "s neighbor+ organ4 ,diagnosis4--,a c>eful exam9ation ( ! case & ( ! blood eject$ w be necess>y to det]m9e ! nature ( ! cause4 ,! diff]5tial diagnosis z to ! s\rce ( ! blood1 :e!r f ! /oma* or lungs1 0 giv5 "u hemoptysis4 ,treatm5t4--,correction ( any lesions t may influ5ce ! blood pressure 9 ! region ( ! /oma*1 is ! fir/ requisite4 ,treatm5t ( ! splan*nics has ! greate/ influ5ce ^u ! vasomotor n]ves to ! /oma*4 ,treatm5t ( ! vagi n]ves & ( ! f\r? & fif? dorsals1 w quiet ! viol5t movem5ts ( ! /oma*1 & ?us aid 9 controll+ ! hemorrhage4 ,/imulation ( ! c]vical sympa!tics & heat appli$ to ! feet w t5d to equalize ! vascul> sy/em1 & ?us less5 ! ga/ric conge/ion4 ,! application ( a broad flat ice-bag ov] ! /oma* w be ( great value4 ,keep ! pati5t quiet 9 b$4 ,surgical int]f]5ce may be necess>y4 ,inte/9al ,hemorrhage ,o/eopa?ic ,etiology4--,an ob/ruct$ circulation ( ! blood ?r\gh ! v5aporta1 z 9 diseases ( ! he>t1 lungs & liv]2 lesions ( ! v]tebr d]ang+ sp9al n]ves to ! inte/9al blood supply2 injuries caus$ by corrod+ or cutt+ sub/ances2 me*anical injuries to ! inte/9es2 deg5]ation or erosions ( ! blood-vessels f ulc]s ( ! inte/9es1 z f typhoid fev]1 typhus1 dys5t]y1 etc42 disord]$ m5/rual or hemorrhoidal dis*>ges4 ,diagnosis4--,! locality ( ! inte/9es affect$ c be approximately det]m9$ by an exam9ation ( ! dis*>g$ blood4 ,:5 ! blood comes f ! upp] "p ( ! inte/9es1 x is g5]ally d>k & mix$ ) ! inte/9al cont5ts1 :i* gives x a t>ry appe>ance4 ,x is g5]ally r$ & fluid :5 x comes f ! l[] portion ( ! b[els4 ,if f ! /oma*1 ! blood is ?or\ghly mix$ ) fecal matt]4 ,?r[+ ! passage into wat]1 ! wat] is color$ r$ :5 x conta9s blood1 & if ! cont5ts conta9 bile ! wat] is color$ gre5 or yell[4 ,also1 not+ ! areas ( contract$ muscles1 z 9 inte/9al colic1 w aid 9 ! regional diagnosis4 ,treatm5t4--,absolute re/ 9 all cases is necess>y1 ! pati5t rema9+ z quiet z possible4 ,food1 9 sev]e cases1 %\ld n be giv5 = t5 or twelve h\rs4 ,! b$-pan %\ld be us$ 9 c>+ = ! evacuations4 ,correction ( ! lesions along ! sp9al region1 *iefly ( ! l[] dorsal & lumb> regions1 t are imp$+ ! inn]vation to ! inte/9es1 %\ld be att5d$ to at once4 ,?is treatm5t t5ds to relieve any hyp]emic condition ( ! inte/9al mucosa & influ5ces ! :ole vasomotor area ( ! mes5t]y4 ,direct treatm5t ( ! abdom5 9 a few cases is ( great value to relieve ob/ruct$ & contract$ vessels 9 ! mes5t]y1 b 9 c]ta9 pa?ological conditions1 e4 g41 typhoid fev]1 leave ! abdom5 alone4 ,treatm5t 7inhibition7 along ! sp9al column f ! six? dorsal to ! coccyx is helpful 9 all cases to quiet ! p]i/alsis ( ! inte/9es4 ,9 sev]e cases cold dr9ks1 eat+ ( ice & an ice pack to ! abdom5 are ( aid4 ,9 a few in/ances surgical measures w be necess>y4 ,hematuria ,o/eopa?ic ,etiology4--,conge/ion & acute inflammation ( ! kidneys1 exac]bations ( pyelitis1 r5al calculi1 *ronic nephritis1 traumatism1 tub]culosis1 etc42 affections ( ! ur9>y tract1 z calculi or lac]ations ( ! uret]2 calculi1 cy/itis1 ulc]ations1 etc41 ( ! bladd]2 calculi1 gonorrhoea1 p>asites1 etc41 ( ! ure?ra2 g5]al diseases1 *iefly ! acute specific fev]s & blood diseases2 bl[s1 w\nds & traumatic influ5ces1 ext]nal to ! kidneys2 lesions ( ! r5al splan*nics4 ,diagnosis ( ! locality ( ! hemorrhage 9 ! ur9>y tract3 ,9 hemorrhage f ! kidney ! blood is ?or\ghly mix$ ) ! ur9e1 giv+ a uni=m color4 ,blood ca/s & leucocytes are pres5t4 ,9 hemorrhage f ! uret]s ! blood is usually mold$ 9 clots :i* con=m to ! %ape ( ! uret]4 ,! clots appe> l small d>k worms4 ,9 hemorrhage f ! bladd] ! blood is n ?or\ghly mix$ ) ! ur9e & l>ge clots =m ^u /&+4 ,9 hemorrhage f ! ure?ra ! blood (t5 dis*>ges )\t micturition4 ,:5 ur9e is pass$ ! blood prec$es ! passage ( ur9e4 ,treatm5t4--,re/ is ess5tial4 ,a correction ( ! lesions to ! r5al splan*nics is necess>y to control ! conge/ion & inflammation ( ! kidneys4 ,:5 ! uret]s1 bladd] or ure?ra is involv$1 att5tion mu/ be giv5 to ! condition ( ! sp9al column bel[ ! r5al splan*nics4 ,9 all cases ! inhibitory treatm5t to ! l[] sp9al column & ice to ! lo9s are ( value4 ,if surg]y is indicat$1 d n delay op]ation4 ,ut]9e ,hemorrhage ,mo/ ( ! causes ( ut]9e hemorrhage come "u ! subject ( ob/etrics2 o!rs "u m5orrhagia & metrorrhagia4 ,su* w be f\nd 9 ob/etrical & gynecological works4 ,treatm5t4--,! pati5t %\ld assume ! dorsal position ) ! buttocks rais$4 ,if any displacem5t ( ! ut]us is pres5t or if !re is any =eign mat]ial 9 ! ut]us1 usually su* %\ld be correct$ or remov$ at once4 ,/imulation ( ! clitoris is a mo/ effectual means to control ut]9e hemorrhage2 x contracts ! circul> fibres ( ! ut]us4 ,/imulation ( ! ut]us directly ?r\gh ! vag9a1 & ov] ! abdom51 & /imulation ( ! upp] wall ( ! vag9a1 w aid 9 contract+ ! ut]us4 ,a quick1 unexpect$ pull ( ! hair on ! mons v5]is w h ! effect ( clos+ ! capill>ies by %ock to ! n]v\s control 7,dr4 ,/ill74 ,be=e clos+ ! os1 h[ev]1 x is well to "k t !re is no irritat+ =eign mat]ial )9 ! body ( ! ut]us4 ,correction ( ob/ructions ( ! vasomotor n]ves ( ! ut]us ?r\gh ! splan*nic & lumb> region is important4 ,compression ( ! abdom9al aorta1 & vag9al injections ( hot wat] may be ( aid1 z w also a hot wat] bag at ! lumb> region & ice wat] bag ov] symphysis4 ,9 sev]e cases inv]sion ( ! body1 if x c be done ) safety1 may be p]=m$4 ,pack+ ! vag9a is a me?od resort$ to occasionally 9 sev]e cases4 ,hicc\ghs ,occasionally !re is a case ( hicc\ghs t has be5 cont9u\s = h\rs or ev5 days & t all ef=ts h fail$ to /op4 ,!y are caus$ by an irritation to ! p]iph]al di/ribution ( ! phr5ic n]ve f "s ga/ric di/urbance or a local irritant act+ ^u ! c5t] 9 ! m$ulla4 ,x may foll[ fright or great emotion & be associat$ 9 p]si/5t =m 9 rheumatism1 typhoid fev] & o!r febrile diseases4 ,x foll[s abdom9al op]ations at times & is v di/ress+4 ,:5 occurr+ 9 eld]ly p ) pneumonia & 9 p]itonitis ) di/5tion x usually m>ks ! end4 ,! same may be said 9 case ( c>c9oma ( ! /oma* & b[els4 ,treatm5t4--,g fir/ to ! orig9 ( ! phr5ic n]ve at ! ?ird1 f\r? & fif? c]vical &1 if !re is a lesion z !re w probably be1 adju/ x & note results4 ,?is w be suffici5t 9 _m cases4 ,fail+1 br+ direct pressure on ! n]ve j above ! clavicle & ant]ior to ! /]noma/oid muscle & release ! scal5i muscles4 ,aft] ?is exam9e & treat at ! fif? & twelf? dorsals4 ,correct any lesions b be/ results w be _h f inhibition at ^! po9ts4 ,ano!r me?od is to /& beside ! pati5t & ins]t ! f+]s ( bo? h&s "u ! co/al end ( ! ribs & lightly pull4 ,firm pressure ov] ! sol> plexus ) flat ( ! h& is sometimes b5eficial4 ,9 hy/]ical cases1 draw+ out ! tongue w (t5 be effective & x has be5 sugge/$ t /&+ ! pati5t on ! head w /op !m 9 %ort ord]4 ,tickl+ ! nose to produce viol5t sneez+ is an anci5t rem$y4 ,"s "o ( ^! w cure ! case1 z o/eopa?y has nev] fail$ s f> z record$4 ,! /oma* %\ld be empti$ ( all irritat+ matt] to prev5t recurr5ce4 ,,v>icose ,,ve9s ,9 v>icose ve9s !re is a dilatation ( ! calibre ( ! ve9s & _! valves are insuffici5t4 ,! walls are irregul>ly ?9n$1 l5g!n$ & tortu\s4 ,o/eopa?ic ,etiology & ,pa?ology4--,! int]nal saph5\s is ! ve9 mo/ frequ5tly affect$1 al?\gh any ve9 ?r\gh\t ! body may become v>icose4 ,commonly1 v>icose ve9s occur 9 ! l[] extremities & occasionally 9 ! arms4 ,! valvul> insuffici5cy is caus$ by /ret*+ ( ! wall ( ! ve91 ?us sep>at+ ! ?91 free edges & leav+ an int]space t all[s regurgitation ( ! blood4 ,! valves becom+ insuffici5t1 ! column ( blood 9 ! ve9s has no support aga9/ gravity1 & be+ int]rupt$ 9 its c\rse does n fl[ normally into collat]al *annels4 ,! walls ( ! ve9s become ?91 z does also ! adjac5t sk91 ?us increas+ ! dang] ( a rupture1 ei!r ext]nal or subcutane\s4 ,v>icose ve9s are mo/ frequ5tly f\nd 9 females1 foll[+ ut]9e enl>gem5ts4 ,! condition may be due to any ob/ruction or con/riction t prev5ts ! free return ( blood f ! ve9s1 su* z dislocations ( ! hip1 ei!r slight or complete1 dislocations ( innom9ata1 contractions ( adductor magnus muscle affect+ femoral ve91 prolapse ( diaphragm ob/ruct+ v5a cava1 tissue con/rictions ab\t ! saph5\s op5+1 g>t]s1 &1 9 fact1 any?+ t might imp$e ! free v5\s fl[4 ,! t5d5cy to v>icose ve9s increases z age advances1 & _m cases are f\nd among p ( middle life :o h be5 accu/om$ to /&+ a great deal4 ,injuries to ! pelvis1 ?igh or leg1 less5+ ! nutrition to ! leg1 or injuries to ! n]ves1 z v]tebral dislocations 9 ! l[] dorsal or lumb> regions 7! f\r? lumb> especially7 may be causes ( v>icose ve9s4 ,pregnancy or tumors 9 ! abdom5 or pelvis1 caus+ pressure ^u ! iliac ve9s1 are occasionally causes4 ,di/5tion ( ! sigmoid flexure1 caus+ pressure ^u ! left iliac ve91 or di/5tion ( ! cecum2 press+ ^u ! "r iliac ve91 are fruitful s\rces1 z are also diseases ( ! he>t & lungs4 ,v>icose ve9s ( ! upp] extremities are due to occupations requir+ ov]use ( ! arms4 ,complications4--,v>icocele1 hemorrhoids1 labial v>ix 9 ! female1 v>ix ov] pubes1 ulc]ation & eczema due to di/urbances ( nutrition1 edema & ?rombus4 ,symptoms4--,l[] ,extremities4--,cramp+ pa9s 9 ! limbs ^u ris+4 ,fullness & heav9ess ( ! limbs4 ,inspection may reveal sup]ficial v>icose ve9s ne> ! saph5\s op5+1 ^u ! ext]nal ?igh1 9 ! popliteal space1 ^u ! ext]nal leg or beh9d ! ankles4 ,edema & conge/ion ( ! foot & ankles occur 9 a few cases4 ,pa9 is q a prom95t symptom1 due to pressure ^u ! n]ve fibres4 ,eczema & it*+ are due to di/urb$ inn]vation & blood supply to ! sk94 ,ulc]ation may occur1 due to ! bur/+ ( a ve94 ,upp] ,extremities4--,be=e ! v>icosity appe>s !re is usually pa9 or a feel+ z ( a spra9 9 ! involv$ region ( ! arm4 ,! pa9 is usually conf9$ to a muscle or gr\p ( muscles4 ,treatm5t4--,! majority ( cases are due to disord]s ab\t ! pelvis1 hip or ?igh1 & ! treatm5t resolves itself into ! removal ( ^! ob/ructions or con/rictions4 ,occasionally cases are caus$ by p>tial dislocations ( ! hip jo9t1 :i* c be easily ov]look$ dur+ a hurri$ exam9ation4 ,! slipp+ ( an innom9atum is an important factor4 ,re/ 9 a recumb5t position1 att5tion to ! g5]al heal?1 & especial att5tion to ! b[els & liv]1 are ess5tial 9 acute attacks4 ,occasionally ! he>t & lungs are at fault4 ,treatm5t twice p] week %\ld consi/ ( remov+ any ( ! num]\s causes ( ! condition1 & sp9al treatm5t z well2 !n ! leg %\ld receive special att5tion4 ,rememb]1 ?rombi may =m & ! ve9 mu/1 "u no circum/ances1 be t\*$ 9 ! treatm5t4 ,beg9 by c>efully rotat+ ! leg to /ret* contract$ tissue ab\t ! saph5\s op5+1 !n sep>ate ! t5dons ( ! popliteal space & foll[ ! c\rse ( ! ve9 to ! abdom5 & relax tissue ab\t x4 ,keep pati5t (f ! feet z mu* z possible & elevate ! leg :5 sitt+4 ,9 rupture ( v>icose ve9s ! hemorrhage c be arre/$ by elevat+ ! limb & apply+ pressure ) ! f+]s1 above & bel[ ! w\nd1 until a compress & b&age c be appli$4 ,! support ( ! v>icose ve9s by ela/ic /ock+s w ease ! pa9 & prev5t edema 9 _m cases1 b1 z a rule1 x is a direct h9drance to ! circulation on acc\nt ( ! necessity ( hav+ ! /ock+ fit closely4 ,surgical op]ations are r>ely indicat$4 ,phlebitis 7,phlegmasia alba dol5s2 milk leg7 ,an inflammation ( a ve94 ,9 ! condition describ$ "h x is a pu]p]al septic inflammation ( ! femoral ve94 ,ab\t ! ?ird week aft] conf9em5t !re is a swell+ ( ! leg ) or )\t r$ness4 ,great pa9 accompanies ! condition & ! temp]ature gradually rises to #ajb-c4 ,z und]/ood by o/eopa?s1 ?is is ! result ( a p>tial clos+ ( ! saph5\s op5+ dur+ p>turition s t ! v5\s fl[ is p>tly /opp$4 ,treatm5t consi/s 9 c>efully rotat+ ! leg at ! hip s t ! fascia lata is spread1 op5+ ! lum5 ( ! ve9 s ! conge/ion w dra9 out4 ,!re w1 also1 probably be f\nd innom9ate or lumb> lesions :i* mu/ be adju/$ ) ! result t almo/ imm$iate relief is giv5 z a rule4 ,*ronic ,phlebitis ,! *ronic =m %[s consid]able inflammation along ! l9e ( ! ve9 m>k$ by t5d]ness1 edema & ?ick5+ ( tissue4 ,! entire leg may be m or less involv$ ?r\gh circulatory injury4 ,9 ^! cases w be f\nd def9ite innom9ate lesions ( a prim>y type or ! di/ortion is sup]9duc$ by lumb> lesions4 ,a few cases are quickly cle>$ up ?r\gh adju/m5t t is readily secur$4 ,h[ev]1 9 o!rs1 !re be+ consid]able ?ick5+ ( ! sacro-iliac articulat+ tissues1 "s "t may be requir$ to get complete adju/m5t & consequ5t re/oration ( femoral circulation4 ,9 addition to ?is1 c>eful abduction1 flexion1 hyp]ext5sion & circumduction is indicat$4 ,?is la/ te*nique %\ld be execut$ ) great c>e & ) due reg>d to pa?ology4 ,if ,dr4 ,/ill's emphatic comm& 7 foll[$1 t all mat]nity pati5ts %\ld h bo? legs rotat$ & innom9ates inspect$1 !re w\ld be no phlebitis cases1 acute or *ronic4 ,,! ,,rectum ,to treat ! rectum intellig5tly & ?or\ghly1 requires special k on ! "p ( ! o/eopa?4 ,a speculum %\ld be us$ 9 _m cases :5 mak+ an exam9ation1 & all abnormal conditions c>efully inspect$ ) ! eye2 al?\gh mu* c usually be not$ by ! exam9ation ) ! f+] alone4 ,! be/ position 9 :i* to give an exam9ation & treatm5t is to h ! pati5t on ! side1 ) ?ighs flex$ ^u ! abdom54 ,9 a few cases ! pati5t may lean ov] an op]at+ table4 ,! objects ( rectal treatm5t are _m--to relieve hemorrhoids1 etc41 ( ! muc\s membrane2 to correct a dislocat$ coccyx2 to treat an enl>g$ pro/ate gl&2 to replace a prolaps$ rectum2 to tone ! l[] b[el 9 cases ( con/ipation2 to give reflex /imuli to ! he>t & lungs1 9 cases ( fa9t+1 p>oxysms1 etc42 to relieve sev]e pa9s 9 ! rectum at ! "t ( ! m5/rual p]iod1 & to relieve conge/ion1 inflammation1 contract$ tissues1 etc41 ( local s\rces2 to relax spasms 9 cr\p1 & to remove t5sion to ! n]v\s sy/em 9 "s =ms ( insomnia4 ,9 fact1 s _m diseases are affect$ by reflex irritations f ! rectum t its exam9ation is a necessity 9 _m cases4 ,! phrase 8:5 9 d\bt treat ! rectum0 0 co9$ by a progressive /ud5t & !re is an elem5t ( tru? 9 x4 ,surgical assi/ance to treatm5t w be consid]$ "u hemorrhoids4 ,! pr9cipal ne$ ( o/eopa?ic int]nal rectal treatm5t1 is3 7#a7 ,to relax all contract$ & con/rict$ fibres ab\t ! walls ( ! rectum & betwe5 ! sacrum & coccyx4 7#b7 ,to correct a dislocat$ coccyx4 7#c7 ,to dilate ! sph9ct]s ?or\ghly1 9 ord] to relieve irritations ab\t ! sph9ct]s1 & to /imulate ! sympa!tic n]ves4 ,"w ?r\gh ! rectum to treat an enl>g$ pro/ate gl&1 to correct a displac$ ut]us1 & to make a m ?or\gh exam9ation ( ! ut]9e tissues1 ! ,fallopian tubes & ! ov>ies1 is a frequ5t occurr5ce4 ,9 giv+ local treatm5t1 cleanse ! f+]s & oil ! index f+]2 !n1 aft] introduc+ x into ! rectum relax ! contract$ tissues by an upw>d sweep+ motion on all sides4 ,?is treatm5t relieves all ob/ructions to vessels & n]ves caus$ by contract$ fibres1 & tones ! rectal walls4 ,9 prolaps$ sigmoid1 caus+ ob/ructive con/ipation1 ! f+] c be us$ to sep>ate ! folds ( muc\s membrane & op5 ! lum5 ( ! b[el4 ,frequ5tly !re w be en\gh tone to ! muscul> coat s t ! irritation w set up slight p]i/alsis & cause ! b[el to draw up to a consid]able degree4 ,9 *ildr5 :]e !re is mu* /ra9+ at ! /ool1 ! sigmoid w (t5 be f\nd d[n & by us+ ! little f+] ! same results c be accompli%$ & mu* relief giv54 ,to dilate & /ret* ! sph9ct]s ?or\ghly a speculum or dilator %\ld be us$ "u ane/hesia2 /ill1 consid]able c be done by "o or two f+]s4 ,! sph9ct] %\ld be ?or\ghly /ret*$ 9 all directions1 c>e be+ tak5 :5 an in/rum5t is us$ t too mu* =ce is n appli$4 ,secure z mu* volunt>y relaxation ( ! sph9ct] z possible4 ,inhibition at #b;d & #c;d sacral w aid4 ,?is treatm5t is ( aid 9 cases ( hemorrhoids & prolapse ( ! rectum1 9 con/ipation due to ! loss ( tonicity ( ! l[] b[els1 9 tightness ( ! sph9ct]s1 9 pa9 ( ! rectum1 & 9 /imulat+ ! he>t & lungs4 ,9 cases ( a prolaps$ rectum1 due to irritation ab\t ! sph9ct]s1 caus+ t5esmus1 ?is treatm5t is ( special value1 z x gives ! sph9ct] a physiological re/4 ,frequ5cy ( treatm5t p] rectum mu/ dep5d entirely on ! pati5t & disease4 ,x c be giv5 daily 9 _m cases & is frequ5tly s indicat$ 9 acute hemorrhoids1 pro/atic tr\bles1 etc4 ,accord+ to ,qua91 ! s5sory n]ves to ! rectum are f ! second1 ?ird & f\r? sacrals4 ,"s ( ! motor fibres ( ! circul> muscles ( ! rectum are f ! l[] dorsal & upp] two lumb> n]ves2 ^! pass by ! aortic plexus to ! inf]ior mes5t]ic ganglion4 ,associat$ ) ^! fibres1 are ! inhibitory fibres ( ! longitud9al muscles ( ! rectum4 ,! sacral n]ves conta9 motor fibres to ! longitud9al muscles1 & inhibitory fibres to ! circul> muscles ( ! rectum4 ,9 all cases ( rectal tr\ble1 ! l[] dorsal & upp] lumb> v]tebr may be f\nd d]ang$1 & ?us int]f]e ) ! rectal n]ves4 ,relaxation ( ! sacral muscles ov] ! sacral =am9a has a m>k$ effect 9 reliev+ t5esmus4 ,9 dys5t]y1 :]e !re is a con/ant desire to defecate1 a ?or\gh upw>d relaxation ( ! sacral muscles w give great relief4 ,proctitis or inflammation ( ! rectum is n an uncommon disord]4 ,! disease has be5 divid$ into acute1 *ronic1 gonorrheal1 dys5t]ic1 & diph!ritic4 ,=eign bodies1 impact$ feces1 cold1 purgatives1 prolapse ( ! sigmoid1 & lumb>1 coccygeal & innom9ate lesions are ! mo/ important causative factors4 ,! acute =m is m frequ5tly f\nd 9 old] p4 ,! symptoms are t5esmus1 frequ5t evacuations ( blood & mucus 7possibly pus71 prolapse ( ! muc\s membrane1 feel+ ( fullness1 & radiat+ pa9s4 ,! gonorrheal1 diph!ritic & dys5t]ic =ms are ( r>e occurr5ce1 ) ! exception t ! dys5t]ic may be some:at frequ5t4 ,! treatm5t is to remove all local irritations1 cleanse ! b[els1 & put ! pati5t 9 b$4 ,all irritat+ foods are to be prohibit$4 ,use milk1 s\ps1 beef juice1 s(t boil$ eggs & simil> foods4 ,correct all o/eopa?ic lesions2 especially w inhibition ov] ! sacral =am9a relieve ! t5esmus4 ,cold wat] 9 ! rectum & appli$ to ! anus w be b5eficial4 ,if abscesses occur1 employ surgical measures4 ,prolapse ( ! rectum is ano!r common rectal disord]4 ,acute cases are especially f\nd 9 *ildr51 due to /ra9+ at /ool4 ,! sacrum is m /raight1 & ?us viol5t /ra9+1 c\gh+1 etc41 ! m readily produces prolapse4 ,prolapse ( ! muc\s membrane is ! mo/ common1 al?\gh all ( ! rectal coats may be involv$4 ,prolapse ( ! upp] "p ( ! rectum into ! l[] or invag9ation is frequ5tly met ) by o/eopa?s4 ,! sigmoid may prolapse & also affect ! rectum4 ,! treatm5t is to return ! mass1 us+ an ane/hetic if necess>y4 ,if x is n reta9$1 place /raps across ! buttocks4 ,!n ) att5tion to lesions t may be di/urb+ & weak5+ ! rectal walls1 & ?or\gh local ton+ treatm5t1 ! prognosis %\ld be favorable4 ,9 high rectal prolapse local att5tion is necess>y z well z deep treatm5t ?r\gh ! abdom9al walls to ! sigmoid & upp] rectum4 ,! use ( ,cole's irrigator = high enema w replace & elevate bo? ! upp] rectum & sigmoid & greatly aid 9 a cure4 ,regul>ity ( habits & prop] food are ess5tials4 ,hemorrhoids ,def9ition4--,a dilat$ or v>icose condition ( ! plexus ( ve9s ly+ 9 ! submuc\s tissue ( ! l[] "p ( ! rectum4 ,! dilatation ( ^! hemorrhoidal ve9s may ext5d into ! adjo9+ subcutane\s tissues & muc\s membrane1 & ! p]irectal plexus & adjo9+ v5\s plexuses ( ! bladd]1 ut]us1 vag9a & sacral canal may become involv$4 ,o/eopa?ic ,etiology & ,pa?ology4--,! *ief pr$ispos+ cause ( piles is man's erect position & ! abs5ce ( valves 9 ! hemorrhoidal ve9s4 ,?us a ret>dation or /agnation ( ! portal ve9 w\ld cause a backw>d movem5t ( ! entire column4 ,x is evid5t t su* a d[nw>d pressure ( ! blood 9 ! portal sy/em w\ld dilate & ext5d ! blood vessels1 to ! v capill>ies 9 ! rectal region4 ,?is ret>dation may arise f sev]al causes3 ob/ruction ( ! portal ve91 f diseases ( ! liv]2 diseases ( ! he>t2 ob/ruction or de/ruction ( ! capill>ies ( ! lungs2 pressure f a gravid ut]us1 tumor1 etc42 a g5]al loss ( tonicity ( ! abdom9al walls1 z 9 p]sons :o take b little ex]cise2 ! excessive use ( w9e1 tea & c(fee2 injuries to ! sp9al column1 especially 9 ! lumb>1 sacral & coccygeal regions2 a dislocation ( an innom9ate bone2 lift+2 con/ipation2 /ra9+ at /ool2 c>elessness ( ! calls ( nature1 etc4 ,cat>rh ( ! b[els may cause a conge/ion ( ! muc\s membrane & consequ5tly piles4 ,h]$it>y influ5ce may be a factor 9 a few cases4 ,hemorrhoids are divid$ into two classes1 ext]nal & int]nal4 ,an ext]nal pile is "o t arises f ! m>g9 ( ! anus outside ( ! ext]nal sph9ct] muscle4 ,x diff]s f ! int]nal pile f ! fact t x is always compos$ ei!r ( sk9 or hyp]trophi$ connective tissue1 =m+ a m]e cutane\s tag1 or else x is compos$ ( a small cutane\s ve9 enl>g$ by a clot ( blood4 ,! int]nal hemorrhoids are compos$ mo/ly ( enl>g$ ve9s & are connect$ by hyp]trophi$ connective tissue4 ,!y h a free art]ial supply & are cov]$ by ! muc\s membrane ( ! rectum4 ,!y are due1 usually1 to an affection ( ! middle hemorrhoidal blood supply1 !reby be+ a "p ( ! visc]al vascul> sy/em4 ,int]nal hemorrhoids1 :5 protrud+1 c be return$ )9 ! rectum1 :ile ! ext]nal ones _c4 ,! v5\s turgesc5ce v>ies 9 size f a pea to a walnut4 ,!y may be s+le or may surr\nd ! entire anal op5+ l a bun* ( grapes4 ,repeat$ attacks ( engorgem5t ( ! ve9s involv$1 w 9 "t *ange ! muc\s membrane or ! submuc\s tissue1 & cause cat>rhal swell+ ( ! muc\s membrane1 or hyp]plasia ( ! connective tissue4 ,at fir/ ! hemorrhoid is usually a blood tumor1 b 9 *ronic cases x is (t5times made up l>gely ( connective tissue4 ,ow+ to pressure ( ! v>icose ve9s1 atrophy ( ! muc\s & submuc\s tissue may occur4 ,! :ite or slimy hemorrhoids occur :5 ^! r\gh5$ p>ts ( ! muc\s membrane become inflam$ & ?ick5$1 result+ 9 suppuration4 ,symptoms4--,! symptoms are q diagno/ic & ne$ n be mi/ak54 ,besides ! appe>ance ( tumors1 !re may be con/ipation1 pa9 dur+ /ools1 indige/ion1 heada*e & pa9 9 ! back4 ,hemorrhages frequ5tly occur1 & if sudd5ly *eck$1 z by cold1 o!r di/urbances may occur1 z conge/ion ( ! head1 lungs1 /oma*1 liv]1 kidneys1 etc41 :i* may result 9 hemorrhages f ^! organs4 ,fissures ( ! anus1 contraction ( ! rectal sph9ct]s & prolapse ( ! rectum may occur4 ,occasionally 9 old p !re is a v>icose /ate ( ! ve9s ( ! neck ( ! bladd]1 & 9 females1 ( ! ut]us & vag9a1 :i* causes hemorrhages ( ^! organs4 ,! communicat+ plexus ( ! sp9al canal may be affect$1 caus+ weight1 numbness & pa91 s z to simulate a lesion ( ! cord4 ,! pati5t may h a hypo*ondriacal disposition & be dis9cl9$ to "w1 especially at m5tal labor4 ,prognosis4--,dep5ds ^u ! pr$ispos+ & imm$iate causes1 b a l>ge majority ( cases c be cur$4 ,treatm5t4--,a ?or\gh exam9ation ( ! pati5t %\ld be made1 n only to asc]ta9 ! ext5t ( ! local tr\ble1 b to und]/& ?or\ghly ! g5]al heal? ( ! suff]]1 especially ! /ate ( ! he>t1 lungs & liv]4 ,_m cases ( hemorrhoids are caus$ by lesions 9 ! lumb> & sacral regions1 & especially dislocations ( ! coccyx 7usually ant]ior7 & ! innom9ata4 ,correct+ ^! lesions w (t5times cure ! hemorrhoidal disord]4 ,simple dilatation ( ! rectum once a week1 9 addition to o!r treatm5t1 is ( great aid 9 cur+ hemorrhoids1 n a few ( ! cases be+ cur$ by dilatation alone4 ,x relaxes ! tissues ab\t ! tumefi$ vessels4 ,treatm5t is r>ely necess>y above ! second lumb>1 7unless !re is m or less ( a con/itutional disord]7 z ! sup]ior hemorrhoidal blood vessel ( ! inf]ior mes5t]ic is giv5 (f ab\t opposite ! second lumb>4 ,9 cases :]e ! abdom9al walls h become relax$1 a treatm5t %\ld be giv5 to /r5g!n ! abdom9al muscles & visc]a4 ,p>ticul> att5tion %\ld be giv5 ! liv]4 ,treatm5t %\ld be giv5 ov] ! abdom9al muscles directly1 & also to ! sp9al n]ves ( ! same region4 ,! diet %\ld be /rictly regulat$ & ! b[els kept loose1 & /imulants1 indige/ible food1 full meals & too mu* meat %\ld be avoid$4 ,injection ( cold wat] be=e /ools is a good prophylactic1 & applications ( cold wat] to ! protrud+ pile w be ( "s help 9 reliev+ ! conge/ion4 ,a squatt+ position dur+ defecation w relieve consid]able /ra94 ,hemorrhoids 9 ! acute /ate1 )9 twelve or tw5ty-f\r h\rs f ! engorgem5t1 yield quickly to treatm5t4 ,! local te*nique is to relax ! tissues ab\t ! tumor1 especially above & along ! l9e ( ! ve91 !n ) pressure at its base c>efully =ce out ! engorg$ blood4 ,foll[ ?is up by ano!r treatm5t ! next day & cont9ue until normal4 ,! ve9 wall1 n be+ p]man5tly /ret*$1 w contract & if ! irritat+ cause is f\nd1 !re is little dang] ( return4 ,rememb]1 9 a case l ?is1 ! dang] ( embolism & be sure a clot has n =m$4 ,cases ( hemorrhage at /ool1 dur+ or imm$iately foll[+ evacuation1 :5 n f a ble$+ pile1 may be ( consid]able quantity & ! s\rce difficult to locate4 ,x may be due to ulc]ations or easily ruptur$ capill>ies ( ! mucosa1 b ! cause w 9 _m cases be f\nd 9 ! innom9ata & a r$uction ( ! lesion give relief4 ,rectal conditions1 associat$ ) piles1 & requir+ surg]y aft] treatm5t has fail$1 are3 hemorrhoids1 :i* are ( su* long /&+ z to become organiz$ tissue1 7^! w keep up cont9ual irritation & _c be absorb$72 saccules or pocket1 =m$ by folds ( muc\s membrane cat*+ & hold+ p>ticles ( feces1 gradually enl>g+ & end+ ) consid]able reflex symptoms2 fi/ulae1 complete or incomplete1 may frequ5tly be heal$ by adju/+ coccygeal or innom9ate lesions1 b are apt to recur f ! tract n be+ clean 9 ! c5t] or bottom2 abscesses 9 or ab\t ! anus or rectum are usually trac$ to coccygeal1 innom9ate1 or local int]f]5ce to circulation2 fissure1 complete dilatation "u ane/hesia to insure physiological re/ ( p>ts1 is probably ! be/ treatm5t4 ,x is sugge/$ t a fissure may be heal$ by mak+ surgically clean1 t\*+ ) iod9e & coat+ ) collodium4 ,papillae are small1 h>d black-capp$ papules 9 ! l[] rectum1 ea* "o involv+ a n]ve t]m9al & caus+ mu* di/ress4 ,all ^! conditions give rise to mu* discom=t & ) surgical assi/ance c be cur$ )\t mu* tr\ble4 ,x is n necess>y to make !m a major op]ation & d uncall$-= ?+s4 ,! less surg]y ab\t ! rectal sph9ct] ! bett]4 ,c>e ( ! anus & rectum aft] op]ation or successful treatm5t is a factor 9 prev5t+ return4 ,fir/1 !re %\ld be soluble1 non-irritat+ /ools1 :i* d n t5d to br+ ab\t prolapse f /ra9+4 ,diet & regul>ity contribute to ?is4 ,second1 absolute cleanl9ess4 ,?is c only be obta9$ by foll[+ ! /ool ) an enema ( f\r or five ounces ( cool wat] & imm$iately pass+ x4 ,x w br+ =? a consid]able quantity ( feces :i* w\ld o!rwise h be5 reta9$ = ano!r tw5ty-f\r h\rs4 ,?is proc$ure foll[+1 z x does1 ! /ool does n 9 any way int]f]e ) ! normal function or create a habit4 ,! anus %\ld !n be ?or\ghly wa%$ 9 cool wat] & z ?or\ghly dri$4 ,du/+ ) borat$ talcum p[d]1 />*1 etc41 w prev5t *af+4 ,,g5ito-,,ur9>y ,,! ,,pro/ate ,,gl& ,?is gl& is subject to sev]al pa9ful & annoy+ diseases1 controll+1 z x does1 ! fl[ ( ur9e & ex]t+ su* a pr(\nd influ5ce ov] ! sexual functions4 ,! n]ves to ! pro/ate pass betwe5 ! gl& & ! levator ani muscle1 & ! secretory bran*es are f ! sacral n]ves1 :ile ,qua9 gives ! s5sory z f ! t5?1 elev5? 7twelf?7 dorsal1 fir/1 second & ?ird sacral & fif? lumb>4 ,lesions affect+ ! pro/ate are occasionally f\nd at ! t5? & elev5? dorsal & fif? lumb>1 :ile ! innom9ate lesions are common causes ( tr\ble4 ,^! %\ld be correct$1 if pres5t1 & local treatm5t giv5 to ! gl&4 8,massage ( ! pro/ate10 says ,lyd/on1#dg 8prop]ly p]=m$1 is "o ( ! mo/ valuable advances 9 g5ito-ur9>y !rapeutics t has be5 develop$ 9 _m ye>s40 ,o/eopa?ic te*nique is to place ! pati5t on ! side1 knees flex$1 & /&+ 9 front ins]t ! index f+]4 ,c>e mu/ be us$ n to bruise ! gl& & x mu/ be t\*$ lightly :5 s5sitive4 ,relax tissue ab\t ! gl&1 &1 !n1 f ! m$ian l9e ) an outw>d movem5t1 massage ! surface ( ea* lobe4 ,?is influ5ces ! blood & n]ve supply1 :ile ! pressure w t5d to relieve conge/ion4 ,l5g? ( treatm5t1 z well z frequ5cy1 dep5ds entirely ^u conditions4 ,d n make ! mi/ake ( treat+ ! p]9eum in/ead ( ! gl& & d n g\ge x ) ! f+]4 ,rememb] x is s5sitive tissue4 ,hyp]trophy is mo/ commonly met ) 9 practice1 z tw5ty p] c5t ( m5 pa/ middle life are said to be afflict$4 ,x is probably n a sequ5ce ( old age1 b due to *ronic1 conge/ive & inflammatory conditions4 ,any?+ :i* w\ld produce ^! conditions--sp9al lesions1 excessive v5]y1 ma/urbation1 or o!r m innoc5t causes--w\ld 9 "t br+ ab\t enl>gem5t4 ,z ! l5g? ( ca!t] life is e/imat$ at six ye>s x is ( great importance t ! condition be e>ly recogniz$1 = 9 advanc$ /ages surg]y is ! la/ resort4 ,9 e>ly /ages ! prognosis is good1 ei!r = a cure or to /op fur!r enl>gem5t1 :ile _m enl>g$ ones at ! ca!t] /age h be5 greatly b5efit$ or cur$4 ,treatm5t ( ! gl& once p] week is usually en\gh1 b 9 old] cases c be giv5 semi-weekly4 ,look well to n]ve & blood supply4 ,acute ,pro/atitis is a s]i\s & pa9ful inflammation1 caus+ ur9>y ret5tion usually4 ,x results f trauma1 horseback rid+1 ov] ex]tion1 gonorrhea & its maltreatm5t1 etc4 ,l[] dorsal & lumb> lesions are frequ5t4 ,?is condition mu/ be closely wat*$4 ,inhibition ( ! sacral n]ves w help control pa9 & /op any spasm ( ! sph9ct]4 ,cold applications to ! gl& ext]nally at ! p]9eum w aid 9 r$uc+ inflammation4 ,local treatm5t %\ld at fir/ be giv5 to ! adjac5t tissues z ! gl& w be v s5sitive4 ,lat] direct massage w be ( great b5efit4 ,*ronic ,pro/atitis may foll[ an acute attack or x may orig9ate z a *ronic or subacute affection4 ,frequ5t micturition & dull pa91 ref]r$ to ! p]9eum & rectum1 ) ! local exam9ation1 make diagnosis sure4 ,! sp9al lesions %\ld be correct$ & ! gl& massag$4 ,?is w induce absorption1 by squeez+ out ! inflammatory products & d mu* t[>d prev5t+ future hyp]trophy4 8,massage is done by ! f+]4 ,! pati5t is plac$ 9 ! knee-elb[ position & massage employ$ = f\r m9utes daily4 ,! value ( massage 9 *ronic pro/atitis is v great1 b %\ld be employ$ ) mu* caution & nev] 9 cases ( suppuration40#dh ,pro/atorrhea is (t5 tak5 = sp]matorrhea & any irritation ( ant]ior sacral n]ves w\ld cause undue activity to ! secretory n]ves to ! gl&4 ,?is is easily det]m9$4 ,! ,sem9al ,vesicles c be rea*$ j above ! pro/ate1 & if inflam$ & t5d] or if engorg$ by inspissat$ sem9al fluid1 local treatm5t w be ( b5efit4 ,frequ5t massage1 daily 9 "s cases1 to ! gl& & treatm5t to ! sympa!tic n]ves above ! trigone ( ! bladd]1 to ! n]ve fibres pass+ along ! sp]matic cord1 & to ! art]ies directly1 w be ( ! greate/ aid 9 impot5cy4 ,9 ,*ronic ,gonorrhea1 :]e ! gonococcus has f\nd lodgem5t 9 & ab\t ! gl&1 x c be m readily dislodg$ by massage ?an by any o!r =m ( treatm5t4 ,ret5tion ( ur9e f n]v\s excitem5t or o!r m9or causes1 c (t5 be ov]come by local massage ( ! pro/ate4 ,spa/ic /ricture c usually be cur$ by "w ab\t ! pro/ate & its inn]vation4 ,v>icocele ,a v>icose enl>gem5t ( ! ve9s ( ! sp]matic cord1 epididymis & te/icle4 ,9 v>icocele ! pamp9i=m plexus is usually enl>g$1 b all ! ve9s ( ! cord may be involv$4 ,! swell+ gets small] "u compression or 9 a horizontal position & enl>ges aga9 on /&+ erect4 ,x is almo/ inv>iably f\nd on ! left side1 & ! te/icle on ! affect$ side is g5]ally small] & s(t] ?an its fell[4 ,! pr$ispos+ causes are a long] & tortu\s sp]matic ve9 on ! left side2 ! abs5ce ( support ( ! ve9s f surr\nd+ muscles2 ! imp]fect valves2 ! entry ( ! left sp]matic ve9 into ! r5al ve9 at a "r angle1 in/ead ( at an acute angle l ! "r ve92 ! m liability ( compression ( ! left sp]matic ve9 by accumulation ( feces 9 ! sigmoid flexure2 ! lack ( normal ex]cise ( ! sexual functions 9 "y1 unm>ri$ adults4 ,lesions 9 l[] dorsal & upp] lumb> affect ! condition2 ! elev5? dorsal p>ticul>ly4 ,a lesion at ! second lumb> may cause neuralgia ( ! te/icle ) engorgem5t ( ! ve94 ,! excit+ causes are /ra9+ dur+ /ool1 heavy lift+1 excessive sexual indulg5ce or any?+ t w\ld det]m9e m blood to ! te/icles4 ,v>icocele is simil> to ! v>icose /ate ( ! hemorrhoidal ve9s & may h l causes4 ,! diagnosis is easily made4 ,! feel+ ( ! ve9s betwe5 ! f+]s l a convolution ( e>? worms2 dull1 a*+1 dragg+ s5sation1 & possibly pro/ration1 weakness & deject$ness ( spirits1 are *>act]i/ic symptoms4 8,! condition is devoid ( dang]1 except t x (t5 begets morbid fe>s on ! "p ( ! pati5t1 usually ! result ( sugge/ion40#di ,! treatm5t consi/s ( regulation ( ! b[els1 removal ( su* pr$ispos+ & excit+ causes z may be f\nd1 treatm5t ( ! vessels along ! sp]matic cord1 & treatm5t to ! l[] dorsal & lumb> regions4 ,9 sev]e cases a susp5sory b&age w give tempor>y relief4 ,surgical int]f]5ce may be necess>y 9 "s cases 9 ord] to effect a cure4 ,impot5cy ,results f treatm5t 9 ^! conditions are p>ticul>ly gratify+ & (f] a great field ( activity 9 ?is day ( s5sational m$ical adv]tis+4 ,?is condition c well be class$ "u f\r heads1 ,exhau/ive1 ,traumatic1 ,psy*ic & ,organic4 ,exhau/ive ,impot5cy is ! result ( functional abuse1 ma/urbation 9 e>ly life1 excessive v5]y1 c\pl$ ) intemp]ate use ( alcohol & improp] diet )\t suffici5t sleep4 ,x c be symptomatic 9 neura/h5ia4 ,!re is at fir/ irritation ( ! sp9al c5t]s1 :i* causes exagg]at$ sexual activity1 & lat] ?is is foll[$ by complete or p>tial loss ( function4 ,! fir/ /ep is = a radical re=m 9 habits2 regulation ( ! b[els1 z !y w likely be con/ipat$2 direction ( ! m9d into :olesome *annels1 & !n skillfully direct$ sp9al treatm5t4 ,:]e !re has be5 ma/urbation1 look well = s\rces ( irritation to ! p>ts2 a long =esk9 or adh]5t prepuce indicates surgical aid1 or !re may be a lesion at ! sacrals involv+ ! n]vi erig5tes or1 ( great] importance1 ! pudic n]ve4 ,! innom9atum c be at fault 9 ?is4 ,! l[] dorsal1 ribs & upp] lumb> are ( importance4 ,kraft-,eb+ says3 8,conditions ( absolute impot5cy are1 h[ev]1 r>e1 & are caus$ only by sev]e v]tebral & n]v\s diseases40 ,n]ve irritation und\bt$ly is ! cause ( sexual p]v]sion 7outside ( h]$ity & mal=mation7 s _! relief is z necess>y to br+ ab\t re=m ( habits z to effect a cure4 ,:]e ! g5]al heal? is affect$ con/itutional treatm5t %\ld foll[4 ,mots*utkovsky uses susp5sion 9 treat+ ^! cases ) good results4 ,! effect is to sep>ate ! v]tebr1 free+ sp9al n]ve & blood *annels4 ,! pro/ate w probably be f\nd 9 an irritat$1 s5sitive condition1 z well z ! sem9al vesicles4 ,treat z outl9$ "u ! pro/ate gl&4 ,ligation ( ! dorsal ve9 ( ! p5is is recomm5d$ by "s au?orities z t5d+ to aid turgesc5ce ( ! organ4 ,prognosis is s dep5d5t on h[ well ! pati5t foll[s directions1 age1 environm5t & g5]al condition t x is h>d to give1 b z a rule is r favorable4 ,traumatic ,impot5cy is a /rictly o/eopa?ic classification1 = ! reason t sexual weakness is (t5 trac$ to lesions result+ f remote injuries4 ,^! injuries may be to ! sp9e1 ribs or sacrum4 ,! l[] sp9e may be impact$ f a fall or ! result ( long cont9u$ rid+ on r\gh /reets or ! railway4 ,?is inhibits ! n]ve supply to ! ext5t ( (t5 s]i\sly impair+ ! sexual functions4 ,if ! cord is injur$ to any ext5t ! results are m s]i\s4 ,treatm5t 9 ^! cases has giv5 uni=mly good results4 ,x w always be due to a specific lesion1 s ! exam9ation mu/ be ?or\gh4 ,psy*ic ,impot5cy is ! =m mo/ frequ5tly met ) & g5]ally ! mo/ difficult to cure1 yet x %\ld n be if ! pati5t's confid5ce c be secur$1 = 9 _m cases sexual p[] is b slightly impair$1 b ow+ to ! sugge/ions giv5 by ! m$ical adv]tis]s ! victim diagnoses 8 own case z hopeless4 8,x is n uncommon t virility returns ) ! peace ( m9d40#ej ,obs]ve all ! proc$ure giv5 & !n inspire hope :]e x c be hone/ly giv51 & if ! pati5t is progress+ favorably1 o!r ?+s be+ equal1 advise e>ly m>riage "u /rict rules ( conduct4 ,if already m>ri$1 conjugal relations %\ld be mo/ c>efully inve/igat$ & ! wife tak5 into y\r confid5ce4 ,h] coop]ation 9 correct+ v possible errors 9 sexual matt]s1 z well z sympa!tic aid 9 eas+ ! pati5t's anxiety & *agr91 w be invaluable4 ,no?+ b ! franke/ und]/&+ betwe5 all p>ties is p]missible & ! o/eopa? mu/ be 9 absolute control4 ,organic ,impot5cy is ! result ( a cortical injury or disease4 ,! latt] is ! mo/ common1 z x foll[s tabes dorsalis1 p>alysis affect+ ! lumb> cord1 "s cases ( diabetes1 etc4 ,also1 any cong5ital mal=mations or abs5ce ( all or "p ( ! organs4 ,prognosis 9 ^! cases is bad1 z cure is seldom possible4 ,9 no o!r class ( cases w hone/y1 tact & good judgm5t c\nt = s mu* or ! rew>ds be great]4 ,,footnotes3 #dg ,tw5tie? ,c5tury ,practice ( ,m$ic9e1 ,vol4 ,,xxi4 #dh ,c4 ,krug]1 ,mun* ,m$4 ,wo*4 #di ,deav]'s ,surgical ,anatomy1 ,vol4 ,,ii1 p4 #feb4 #ej ,vecki1 ,sexual ,impot5ce4 ,,heat ,,/roke 7,heat ,exhau/ion3 ,sun/roke7 ,an affection produc$ by exposure to excessive heat4 ,two v>ieties are recogniz$2 heat exhau/ion & !rmic fev]4 ,heat ,exhau/ion4--,?is is caus$ by prolong$ exposure to high temp]atures1 comb9$ ) physical ex]tion4 ,fatigue1 ov]eat+1 alcoholic dr9k+1 & poor sanitation pr$ispose4 ,?is may occur )\t exposure to ! direct rays ( ! sun1 ! heat be+ artificial1 or 9 mid-summ]1 9 close1 conf9$ rooms ! same result w be produc$4 ,!re is vasomotor p>alysis1 ! surface ( ! body is usually cool1 ! temp]ature may be z l[ z #ie degrees ,f41 :ile ! pulse is small & rapid4 ,sun/roke or ,!rmic ,fev]4--,?is is usually caus$ by prolong$ "w "u ! direct rays ( ! sun 9 a humid1 v hot & sultry atmosph]e4 ,?is is caus$ by ! action ( ! heat ^u ! he>t c5t]s produc+ a p>alysis ( ^? c5t]s4 ,pa?ologically1 rigor mortis develops e>ly & is m>k$4 ,putrefactive *anges appe> e>ly1 ow+ to ! high temp]ature ( ! cadav]4 ,! v>i\s organs are deeply conge/$1 ! v5\s engorgem5t is extreme 9 ! c]ebrum4 ,!re is rigid contraction ( ! left v5tricle2 :ile ! "r is dilat$ & fill$ ) blood4 ,! blood is fluid & d>k4 ,p>5*ymat\s *anges take place 9 ! liv] & kidneys4 ,9 heat exhau/ion ) l[]$ temp]ature !re is a p>alysis ( ! vasomotor c5t] 9 ! m$ulla1 & ! heat is dissipat$ m rapidly ?an x is produc$4 ,9 !rmic fev] ! heat regulat+ c5t]s become p>alyz$ by ! action ( ! excessive temp]ature & m heat is produc$1 & less dissipat$ ?an normal4 ,symptoms4--,heat ,exhau/ion4--,?is may occur gradually or sudd5ly ) a sev]e attack ( fa9tness1 pallor1 dizz9ess1 heada*e1 cold p]spiration & sometimes bl9dness z ! fir/ symptoms4 ,consci\sness is r>ely entirely lo/4 ,9 sev]e cases !re is m p]man5t collapse4 ,! pulse is rapid & feeble & !re is great re/lessness & delirium4 ,"u prompt treatm5t mild cases may recov] 9 a few h\rs1 :ile 9 extreme cases dea? may occur almo/ at once f he>t failure4 ,!rmic ,fev]4--,9 "s cases ! pati5t is /ruck d[n1 becomes quickly unconsci\s1 & may die )9 an h\r1 or dea? may be almo/ in/antane\s4 ,9 o!r cases !re is pa9 9 ! head1 oppression1 dizz9ess1 nausea1 vomit+ & sometimes di>rhea or frequ5t micturition4 ,soon unconsci\sness sets 91 ! face is flu%$1 ! eyes inject$1 ! brea?+ labor$ & !re is a temp]ature ( f #aje to #aaj ,f4 ,! pulse is full & rapid1 ! sk9 hot & dry & ! pupils are contract$4 ,!re is usually complete relaxation ( ! muscles1 & 9 "s cases !re is twit*+ & jactitation4 ,epilepti=m convulsions are r>e4 ,9 fatal cases ! coma deep5s1 ! pulse becomes feeble1 rapid & irregul>1 ! brea?+ hurri$ & %all[ & dea? occurs 9 a few h\rs4 ,favorable cases are indicat$ by a fall 9 ! temp]ature & by ! return ( consci\sness4 ,9 ^! cases recov]y may be complete4 ,9 "s cases ! pati5t may nev] be able to /& ev5 mod]ate degrees ( temp]ature1 :i* (t5 produce excitem5t1 heada*e & pa9 9 ! c]vical region4 ,failure ( ! memory1 & ! loss ( p[] to conc5trate ! m9d are sometimes sequel4 ,m5+itis1 epilepsy & insanity are also sequel4 ,diagnosis4--,?is pres5ts little difficulty4 ,! hi/ory & circum/ances prec$+ ! attack are v important 9 mak+ ! diagnosis4 ,! diagnosis betwe5 heat exhau/ion & sun/roke fev] is readily made4 ,9 heat exhau/ion ! temp]ature is l[]$1 ! pulse is feeble1 consci\sness is r>ely completely lo/2 9 sun/roke fev] ! temp]ature is extremely high1 !re is usually complete unconsci\sness1 & ! pulse is full & rapid4 ,prognosis4--,?is %\ld be gu>d$1 dep5d+ ^u ! sev]ity ( ! case4 ,treatm5t4--,9 cases ( heat exhau/ion remove ! pati5t to a %ady place & apply wat] to ! face1 *e/ & sp9e4 ,?or\ghly treat ! upp] c]vical region1 9 ord] to control ! impair$ vasomotor c5t]s & n]ves4 ,if ! temp]ature is bel[ normal a hot ba? %\ld be giv54 ,keep ! he>t & lungs /imulat$4 ,9 sun/roke1 place ! pati5t 9 a recumb5t position & loos5 all con/rict$ clo?+1 & /imulate ! he>t's action4 ,! high fev] is to be met promptly4 ,place ! pati5t 9 a ba? ( wat]1 to :i* add ice freely4 ,! pati5t may also be rubb$ ) ice1 & ice wat] enemata may be employ$4 ,! muscles ( ! neck w be f\nd contract$1 probably due to c]ebral hyp]emia4 ,a ?or\gh relaxation ( ^! muscles w be ( great aid 9 equaliz+ ! vascul> sy/em4 ,x is a good plan to ?or\ghly relax all ! muscles along ! sp9al column = ! same purpose4 ,:5 ! temp]ature ne>s normal ! ba?s %\ld be /opp$4 ,aft] ! temp]ature has be5 r$uc$ place ! pati5t ^u a cot ) ice to ! head4 ,! c]vical treatm5t %\ld be repeat$ z (t5 z necess>y4 ,! diet ( ! pati5t %\ld be liquid = a few days4 ,pl5ty ( wat] & /imulation ( ! kidneys & b[els w be f\nd b5eficial4 ,! sequel are to be treat$ accord+ to ! condition4 ,mu* c be done = ! sequel ( heat exhau/ion & sun/roke4 ,lesions w be f\nd correspond+ to ! regions involv$4 ,deep contract$ muscles are common4 ,,dep>tm5t ,,( ,,oph?almology ,by ,c4 ,c4 ,,reid ,x is ! desire to make ?is discussion on ! eye ! mo/ useful possible to ! :ole pr(ession4 ,let x be pla9ly und]/ood t !re is no ef=t to cov] e phase ( eye pa?ology b to elaborate eye diseases & !rapeutics /rictly f ! /&po9t ( o/eopa?y4 ,!re are _m v elaborate & ext5sive text books & ev5 encyclop$i writt5 on ! eye by ! m$ical pr(ession4 ,! _w ( oph?almic lit]ature is ext5sive & pr(\nd4 ,j s are ! elaborations on ! g5]al field ( m$ic9e4 ,su* ?+s z h]$it>y influ5ces1 cong5ital de=mities1 amblyopias1 alb9ism1 coloboma & ! field ( oph?almic surg]y does n conc]n u at ! pres5t "t 9 an o/eopa?ic text book4 ,?is dep>tm5t is d$icat$ to a sci5tific developm5t ( oph?almic !rapeutics along o/eopa?ic l9es ( ?\ght4 ,"s ?+s 9 ! !rapeutics ( ! eye conc]n all s*ools alike4 ,= in/ance1 prop] cleanl9ess & antiseptic precautions 9 reg>d to ! eye1 dietetics1 hygi5e & ! c>e ( ! g5]al heal?4 ,! same anatomy & _m ( ! same me?ods ( exam9ation & diagnosis obta9 9 all s*ools4 ,x is ! int5tion to g into ! op?halmic !rapeutic field 9 ^! discussions :]e o/eopa?y has a diff]5t outlook ) a def9ite di/9ct re=m to (f] 9 ! viewpo9t ( ! anatomy1 me?ods ( diagnosis & ! sy/em ( treatm5t4 ,h[ to ,exam9e an ,eye ,x has be5 said t "o %\ld be a good g5]al man 9 ord] to be a compet5t speciali/4 ,?is is especially true 9 reg>d to oph?almic !rapeutics4 ,_m sy/emic diseases h eye symptoms & pa?ology4 ,! same blood & lymph t n\ri%es & ba!s diff]5t p>ts ( ! body1 also circulates 9 ! /ructures ( ! eye4 ,9 ! exam9ation ( ! eye1 h]$ity1 occupation & environm5t are to be tak5 into consid]ation4 ,o/eopa?ic lesions may exi/ f falls1 /ra9s1 twi/s1 bl[s1 colds & exposure & impair ! integrity ( ! metabolic processes ( ! eye ?r\gh ! n]ve connections & blood supply & lay ! f\ndation = a great v>iety ( eye diseases4 ,) ^! lesions exi/+ ab\t ! neck & upp] dorsal1 x is only requir$ to h "s insignificant local irritant to />t symptoms & cause pa?ology app>5tly out ( all proportion to ! etiology4 ,x is important !n t "o und]/& ! n]ve c5t]s & reflexes & ! o/eopa?ic logic und]ly+ ^! conditions or else he mu/ frequ5tly "w )\t a satisfactory explanation ( ! etiology & consequ5tly be m or less unsci5tific 9 8 treatm5t4 ,! eye exam9ation %\ld consi/ ( ! case hi/ory1 ! family hi/ory1 inspection1 o/eopa?ic exam9ation1 especially f ! f\r? dorsal v]tebra to ! occiput & especial exam9ation ( ! eye by inspection & o!r me?ods4 #a4 ,! ,case ,hi/ory4--,?or\ghness ( ! doctor1 or ! lack ( x1 w be readily display$ at ?is po9t4 ,e little ?+1 z f> z possible1 t has a be>+ on ! case %\ld be obs]v$ & uncov]$ 9 ! case hi/ory4 ,! physician %\ld want to "k e fact t helps him to bett] und]/& 8 case4 ,pati5ce 9 he>+ ! hi/ory w (t5 be ( great assi/ance4 ,x gives light on ! physical & m5tal condition ( ! pati5t4 ,mu* c be ga9$ by be+ c>eful & att5tive4 ,notice c>efully :at he emphasizes & :at he ?9ks is ! mo/ important4 ,inquire 9 reg>d to heada*es1 n]v\s symptoms1 previ\s eye tr\ble & pa/ illnesses4 ,get a v5]eal hi/ory if pres5t1 z _m eye diseases are complicat$ or caus$ by syphilis or gonorrhea4 #b4 ,! ,family ,hi/ory4--,inquire z to bl9dness 9 ! family & ab\t ! age x occurr$1 if any4 ,get a v5]eal hi/ory if possible4 #c4 ,inspection4--,mu* inspection c g on :ile ! hi/ory is be+ tak54 ,obs]ve ! c\nt5ance1 :e!r !re is /rabismus or fr[n+ due to eye /ra91 photophobia z sugge/$ by ! ef=t to avoid ! light2 note symmetry4 ,look closely at ! la%es1 lids1 conjunctiva1 cornea & iris4 ,note any scales or cru/s on ! lids at ! root ( ! la%es4 ,turn ! lids = fur!r inspection4 ,note ! size & relation ( ! eyes4 ,exoph?almos may be due to an enl>g$ globe 9 high myopia1 to ,graves' disease1 orbital tumor & p>alysis ( ! extr9sic muscles1 or /aphyloma4 ,9 bleph>ospasm !re may be a corneal ulc] or a rupture ( ! eyeball4 ,an exact exam9ation mu/ be made at ! fir/ visit 9 ord] = a diagnosis to in/itute ! be/ treatm5t possible4 ,/udy ! conjunctival sac = conge/ions1 hyp]trophy1 swell+1 tumors1 =eign bodies1 tra*oma bodies & secretions4 ,9 all =ms ( conjunctivitis ! conge/ion is mo/ m>k$ 9 ! =nix & decreases t[>d ! scl]ocorneal junction4 ,9 iritis & cyclitis !re is a circumcorneal injection1 a p9k or r$ color radiat+ f ! cornea4 ,note any corneal pa?ology 9 ! way ( ulc]s or abrasions & =eign bodies4 ,comp>e ! t5sion ( ! eyes4 #d4 ,! ,o/eopa?ic ,exam9ation ( ! ,eye4--,?is head+ is put "h 9 ord] to %[ :at o/eopa?y has to (f] t is di/9ct z belong+ to our sy/em & n practic$ by any o!r s*ool4 ,o/eopa?ic rese>* s f> has %[n t o/eopa?ic sci5ce has mu* to (f] on etiology & diagnosis & treatm5t 9 eye diseases4 ,! case hi/ory1 family hi/ory & inspection %\ld require b a few m9utes b !y are ess5tial to a prop] exam9ation & may aid u 9 :at to expect o/eopa?ically4 ,weak n]ves w cause a/h5opia4 ,a brok5 ar*1 an innom9ate lesion or a slipp$ axis may cause weak n]ves4 ,! o/eopa?ic eye exam9ation !n %\ld consid] ! :ole me*anism ( ! body4 ,9 case glasses are be+ worn = a/h5opia !y may readily be made unnecess>y by o/eopa?ic treatm5t 9 ! correction ( ! lesions & build+ up ! sy/em4 ,"s "t ago "s p>5ts s5t _! daught] to me to h h] eyes fitt$ = glasses4 ,!y /at$ t %e _h be5 to diff]5t doctors & opticians & no "o _h ev] giv5 satisfaction4 ,!y said %e 0 all "r e o!r way if h] eyes 7 prop]ly fitt$ ) glasses4 ,!y did n want h] exam9$ or treat$ o!rwise because %e w\ld be well e o!r way ) correct glasses4 ,h] vision 0 "r eye #e-bj1 left eye #e-ae or ab\t "o f\r? vision 9 ea* eye4 ,a plus 4#hg diopt] sph]e comb9$ ) a plus #c diopt] cyl9d] 9 axis #ij gave h] p]fectly normal #e-e vision 9 ea* eye4 ,?is gave h] p]fect satisfaction until %e />t$ to s*ool 9 ,septemb]1 a c\ple ( mon?s lat]4 ,be=e ! end ( ! fir/ mon? %e 0 hav+ tr\ble ) h] eyes & 0 aga9 s5t to me by h] p>5ts4 ,h] vision 0 r$uc$ to #f-ae 9 ea* eye ) h] glasses on4 ,%e wond]$ & no d\bt ! p>5ts did1 if x 0 n ano!r case ( a misfit 9 glasses simil> to all h] previ\s exp]i5ces4 ,?is "t ,i insi/$ ^u a ?or\gh physical exam9ation aga9/ all prote/4 ,! foll[+ lesions 7 discov]$3 ! left innom9ate 0 up & back or tilt$ po/]iorly1 fir/ lumb> ant]ior & to ! "r1 six? & fir/ dorsals to ! "r4 ,! case 0 n refract$ aga94 ,i took p>ticul> c>e ! fir/ "t & ,i 0 q sure ! refractive error 0 correct$4 ,x 0 all expla9$ to ! p>5ts & regul> o/eopa?ic treatm5t 0 begun4 ,9 less ?an a mon? practically e lesion 0 correct$1 h] vision return$ to normal & %e also 0 cur$ ( an annoy+ backa*e ) :i* %e _h be5 bo!r$ = ye>s4 ,h] n]ves 7 deplet$ a great deal4 ,%e got b5efit 9 ways t %e _h n dream$ (4 ,?is approa* to ! eye is n consid]$ by physicians 9 g5]al1 ev5 ! oculi/s4 ,i h _h ab\t t5 special c\rses 9 m$ical colleges & hospitals on ! eye1 e>1 nose & ?roat1 & ,i h nev] he>d any?+ m5tion$ t w\ld indicate any ideas ( ! logic involv$ 9 ?is case4 ,surely o/eopa?y has mu* to (f] 9 eye tr\bles t is new & unique4 ,! o/eopa?ic exam9ation ( ! eye !n %\ld beg9 ) ! feet1 go+ !n to ! innom9ates1 lumb>1 dorsal1 ribs & c]vical regions4 ,oculi/s are too prone to rely ^u crut*es 7glasses7 9 ! treatm5t ( a/h5opia4 ,x is easy = ! o/eopa? to conceive h[ lesions ( ! upp] dorsal & c]vical regions may occur & di/urb ! n]ve & blood supply to ! eye4 ,?is is :y a/h5opia appe>s s frequ5tly ) ord9>y use ( ! eyes1 ev5 )\t abuse or refractive errors4 ,! ,lumb> ,region ,! lumb> region %\ld be c>efully exam9$1 especially = any curvature :i* might cause a di/urbance ( ! equilibrium above4 ,comp5satory curves or individual lesions w\ld be ! result ) a consequ5t int]f]5ce ) ! integrity ( ! n]v\s reflexes to ! eye4 ,! ,dorsal ,region ,! same may be said ( ! dorsal region z ( ! lumb> 9 reg>d to curvatures4 ,!re is "o individual lesion 9 ?is region t v frequ5tly exi/s ) eye tr\bles1 i4 e41 ! #bnd dorsal v]tebra lat]al4 ,any ( ! upp] f\r dorsals 9 lesion may be a causative factor 9 pr$ispos+ to disease ( ! eye b x has be5 my obs]vation t ! #bnd is involv$ mo/ (t54 ,9 sev]e heada*es due to eye /ra9 f refractive error1 a good diagno/ic symptom is t5d]ness & contraction at ! #bnd dorsal ev5 :5 !re is no subluxation4 ,! ,c]vical ,region ,?is region %\ld h p>ticul> c>e 9 se>* = individual lesions4 ,x is q easy to pass ov] "s small c]vical lesion t may be caus+ s]i\s di/urbance1 especially if ! neck happ5s to be fle%y4 ,i h correct$ c]vical lesions & /opp$ twit*+ ( ! eyelids 7orbicul>is palpebr>um7 & o!r muscles ab\t ! face4 ,! fir/ case ,i ev] saw 0 tw5ty-two ye>s ago :5 ,i 0 a junior at ,kirksville4 ,dr4 ,f4 ,p4 ,mill>d1 n[ ( ,toronto1 0 a room mate ( m9e4 ,he 0 con/antly annoy$ by a twit*+ ( an eyelid4 ,i did n f9d any lesion = x4 ,we w5t "o day to see ,dr4 ,/ill at 8 home & told him ( our difficulty4 ,he said )\t exam9ation t ! #crd c]vical 0 9 lesion4 ,!re 0 a s5ior /ud5t pres5t :om ! 8,old ,doctor0 direct$ h[ to use ! prop] te*nique4 ,!re 0 a %>p pop1 ! v]tebra evid5tly w5t into "r relation1 ! twit*+ /opp$4 ,i und]/& ! pati5t has _h v little tr\ble s9ce4 ,injuries1 exposure & /ra9s to ! sp9e may h ant$at$ an innom9ate lesion & caus$ weak jo9ts1 muscul> & ligam5t\s t5sion1 local inflammations & p>tial immobilization ( jo9ts4 ,all ?is w\ld h its modify+ effects ^u ! manife/ation ( second>y lesions f ! innom9ate abnormality4 ,?is makes ! /udy ( ! bony relations v complex & ! effect ^u ! num]\s blood vessels1 n]ves & o!r s(t tissues /ill m complicat$4 ,! ,ciliosp9al ,c5t] ,foll[+ o/eopa?ic exam9ation & giv+ prop] importance to lesions bel[ ! f\r? dorsal v]tebra1 we mu/ rememb] a special significance to be atta*$ to lesions ( ! upp] dorsal 9 relation to ! eye4 ,almo/ any au?or on n]v\s diseases or diagnosis w discuss ?is c5t]4 ,_m ( u h x n suffici5tly impress$1 h5ce ,i repeat "s kn[n relations4 ,! ciliosp9al c5t] consi/s ( a nucle> gr\p ( cells 9 ! lat]al horn ( ! la/ c]vical & two upp] dorsal segm5ts ( ! sp9al cord4 ,f ?is nucleus fib]s pass to ! ant]ior division ( ! eigh? c]vical & fir/ & second dorsal n]ves & become ! :ite rami communicantes :i* are eff]5t 9 _! function4 ,^! fib]s pass to ! inf]ior c]vical sympa!tic ganglion1 !nce upw>d ) ! sympa!tic trunk ?r\gh ! middle & sup]ior c]vical sympa!tic ganglia1 along ! c>otid plexus to ! vessels ( ! face & eye1 to ! gl&s ( t region1 to ! un/rip$ muscul> fib]s ( ! levator palpebr sup]ioris & to ! dilator pupillae muscle4 ,any /rong feel+ or emotion 7:i* ( c\rse is p]ceiv$ & int]pret$ by ! bra9 cortex7 w cause a dilatation ( ! pupil ( ! eye4 ,! c]vical sympa!tic be+ cut1 dilatation does n take place4 ,! rami ( ! c]vical1 fir/ & second dorsal cut1 ! ph5om5on /ops4 ,x is evid5t ! ciliosp9al c5t] is "u ! influ5ce ( a c5t] or c5t]s 9 ! bra94 ,b+ says 8,!re is ev5 an idiomotor mydriasis1 :i* may be br\ght ab\t by a v vivid m5tal conception ( d>kness40 ,x has be5 not$ t p>alyz+ lesions ( ! c]vical sympa!tic1 ( ! la/ c]vical & two upp] dorsal segm5ts ( ! cord1 & ( ! ant]ior roots & rami communicantes ( ! same1 w result 9 myosis4 ,! eff]5t rami are also vasomotor1 secretory & trophic4 ,x mu/ necess>ily foll[ t conge/ive & inflammatory conditions1 secretory p]v]sion ( ! la*rymal1 ,meibomian1 ,zeissian & p]spiratory gl&s1 & di/urbance ( ! normal nutrition ( any ( ! orbital tissues may result f lesions ( ! l[] c]vical & upp] dorsal v]tebr4 ,o/eopa?ically we "k t su* a lesion may n be suffici5t to be p>alytic 9 its effect1 b /imulatory4 ,9 ?is case we may note a pupil habitually too wide & m or less photophobia f a sup]abundance ( light4 ,! un/rip$ muscle fib]s 9 ! levator palpebr sup]ioris may be unduly contract$ mak+ an appe>ance ( a slightly bulg+ eyeball :5 x is only a wide op5 eye4 ,"o :o has eye /ra9 f a refractive error1 ov]use ( ! eyes1 or unbalanc$ muscles w z a rule h t5d]ness at "s spot 9 ! region ( ! ciliosp9al c5t]4 ,a me*anical lesion at t "p ( ! sp9e may or may n exi/ 9 su* conditions1 b ,i believe ! sor5ess is !re e "t4 ,?is is "o ( ! diagno/ic po9ts 9 diff]5tiat+ heada*e ( eye /ra9 f o!r conditions4 ,:ite rami are only 9 ! dorsal region & to ! second lumb> & f ! second1 ?ird & f\r? sacral4 ,x has be5 not$ t lesions ( ! c]vical v]tebr d n h z pr(\nd an effect ^u ! eyes z d lesions ( ! fir/ ?ree dorsal v]tebr4 ,! plausible explanation ( t is t ! c]vical v]tebr h no :ite rami f _! correspond+ n]ves 9 ! bulbo-sp9o-sympa!tic-cili>y arc z h ! upp] dorsal4 ,f all ! =ego+ /atem5ts "o c readily contemplate ! intricate complexity ( our o/eopa?ic problems 9 relation to ! eye4 ,comb9e ?is logic ( ! lesions outl9$ & ! ramifications ( ! /ructures ) _! normal & p]v]t$ functions & comb9e x ) contribut+ causes1 su* z infection1 exposure1 irritants1 etc41 & amid/ ! great div]sity we r$uce mu* miscellane\s1 unclassifi$ mat]ial to a degree ( simplicity4 ,_m o!rwise unexpla9able conditions become reasonably cle>4 ,dr4 ,l\isa ,burns "u 8,! ,exp]im5tal ,demon/ration ( ,o/eopa?ic ,c5t]s0 has ?is to say3 8,somatic ,reflexes0 8,9 ! fir/ s]ies ( exp]im5ts1 ! electrodes 7 plac$ ^u ! nasal muc\s membrane ( animals "u ane/hesia4 ,! muscles ne> ! ?ird ?oracic v]tebra 7 at once /rongly contract$4444 8,! electrodes 7 !n plac$ ^u ! conjunctiv4 ,! muscles ne> ! second v]tebra 7 !n contract$4 ,!re 7 also slight & incon/ant contractions ( ! c]vical muscles4444 8,! electrodes 7 plac$ ^u ! eye ball4 ,! muscul> contractions 7 sometimes not$ ne> ! second ?oracic v]tebra1 b ! reaction 0 n con/ant4 ,! c]vical muscles 7 sc>cely contract$ at all4 8,! electrodes 7 plac$ ^u ! out] surface ( ! eye lids4 ,! facial muscles 7 contract$ v quickly & =cibly1 b no contraction ( ! muscles ( ! upp] dorsal region 7 not$4444 8,! sup]ior c]vical ganglion 0 expos$ to view1 & ! electrodes plac$ ^u x4 ,! pupils became greatly dilat$1 ! conjunctiv became light] 9 color1 & ! muc\s membranes ( ! nose & ?roat 7 also light5$4444 8,! ,gass]ian ganglion 0 expos$ to view4 ,! ganglion 0 /imulat$ directly4 ,! upp] ?oracic muscles 7 v /rongly contract$1 & ! blood vessels 9 ! area ( ! di/ribution ( ! fif? n]ve 7 imm$iately & /rongly contract$4 ,"s ( ! sympa!tic fib]s are c>ri$ by way ( ! fif? n]ve4 ,9 ord] to exclude ! effect ( ! direct /imulation ( ^! fib]s1 ! fif? n]ve 0 cut1 & ! c5tral end 0 /imulat$ by ! electrodes4 ,! muscles ( ! upp] ?oracic region 7 contract$1 z be=e4 ,! vessels 9 ! area ( di/ribution ( ! fif? n]ve 7 contract$ aft] lat5t p]iod ( a m9ute or s4444 8,! /imulation ( ! c5tral end ( ! cut fif? n]ve caus$ /rong muscul> contractions 9 ! upp] ?oracic region1 & also con/riction ( ! vessels 9 ! area ( di/ribution ( ! fif?4 ,direct /imulation ( ! sup]ior c]vical ganglion produc$ effects id5tical ) ^? produc$ be=e ! mutilation4 8,! sp9al cord 0 cut above & bel[ ! sup]ior c]vical ganglion4 ,?is cut 0 made f beh9d1 & ! sympa!tic *a9 0 un9jur$4 ,! effects not$ aft] bo? op]ations 7 ! same1 & c be describ$ z "o4 8,! /imulation ( any cranial /ructure fail$ to cause reflex contraction ( ! muscles 9 ! upp] dorsal or ! c]vical region4 8,/imulation ( ! cranial /ructures did n produce any vascul> *anges except ^? :i* might be ref]r$ to ! direct effects ( ! electricity ^u ! vessel walls4 8,direct /imulation ( ! sup]ior c]vical ganglion produc$ ! effects not$ be=e mutilation4 8,!re=e ! c]vical portion ( ! sp9al cord is an ess5tial elem5t ( ! reflex arc by way ( :i* s5sory impulses f ! cranial /ructures are able to affect ! condition ( ! upp] dorsal muscles1 & also 9 ! pa? by :i* ^! impulses are able to affect ! size ( ! blood vessels ( ! cranial /ructures !mselves4444 8,me*anical /imulation ( ! tissues ne> ! second ?oracic sp9e 0 foll[$ by a contraction ( ! blood vessels ( ! cranial muc\s membranes & ! conjunctiv1 by a dilatation ( ! pupils1 & an increas$ secretion ( saliva4 ,^! effects 7 practically inv>iable4444 8,! sup]ior c]vical ganglion 0 subject$ to me*anical /imulation by ! manipulation ( ! tissues ov] x4 ,9 animals1 ?is maneuv] 0 foll[$ by dilatation ( ! pupils & by a contraction ( ! cranial vessels1 :i* 0 soon foll[$1 if ! /imulation cont9u$1 by a dilatation :i* 0 r p]si/5t4 8,aft] ! extirpation ( ! ,gass]ian ganglion )\t ! injury ( ! sympa!tic n]ves1 ! me*anical /imulation ( ! tissues ne> ! second & ?ird ?oracic v]tebr caus$ ! same vaso-con/riction & pupilo-dilation z 0 obs]v$ 9 ! animal be=e mutilation4 8,aft] ! de/ruction ( ! c]vical portion ( ! sympa!tic *a91 & aft] ! extirpation ( ! ,gass]ian ganglion 9 mo/ animals1 ! me*anical /imulation ( ! tissues 9 ! upp] dorsal region did n produce any p]ceptible effects4444 8,me*anical /imulation ( ! tissues ne> ! second & ?ird ?oracic sp9es caus$ dilatation ( ! pupils & contraction ( ! vessels ( ! cranial muc\s membranes4 8,inhibition1 or ! ma9t5ance ( an artificial lesion1 caus$ dilatation ( ! vessels ( ! nasal muc\s membranes & ( ! conjunctiv4 ,! eye ball 0 also some:at conge/$4 ,! pupils 7 dilat$ 9 ?is case also40 ,! ,nose & ,?roat 9 ,eye ,tr\ble ,an exam9ation ( ! eye w\ld n be complete )\t a c>eful inspection ( ! nose & ?roat4 ,! same n]ve & blood supply t g to ! eye is ti$ up s def9itely ) ! nose & ?roat t :5 !re are lesions ( ! nose & ?roat ! eye is (t5 affect$ second>ily4 ,j rec5tly a case ( dacryocy/itis came into my (fice4 ,aft] ,i _h c>efully exam9$ h] eye1 sp9e1 nose & ?roat1 %e in=m$ me t %e _h be5 to ?ree eye speciali/s be=e & n "o ( !m _h ev] look$ at h] nose & ?roat1 n to m5tion ! sp9e4 ,%e _h c]vical & dorsal lesions1 & diseas$ tonsils4 ,! inf]ior turb9ate on ! side ( ! dacryocy/itis 0 curl$ out s t x lay aga9/ ! ext]nal wall ( ! nose almo/ if n altoge!r block+ ! entrance ( ! lacrymal duct to ! inf]ior meatus4 ,?is 0 evid5tly ! pr$ispos+ cause ( h] dacryocy/itis4 ,9 neuralgia ( ! eye1 bleph>itis1 obscure pa91 conjunctivitis & (t5 deep] tr\bles y w f9d a bad condition ( ! nasoph>ynx1 su* z ad5oids1 vegetations1 pus pockets1 adhesions 9 ! fossa ( ,ros5mull]1 contraction ( ! s(t palate1 di/urb$ relations ( ! septum & turb9ates1 s9us tr\ble1 poor dra9age1 exo/oses & polyps4 ,9 eye disease all ^! ?+s %\ld be discov]$ if !y are pres5t1 9 ord] to get be/ results & 9 ord] to make a c>eful diagnosis4 ,exam9ation ( ! ,eye by ,special ,me?ods ,! fir/ ?+ aft] ! family hi/ory1 p]sonal hi/ory1 inspection ( ! eye & ! o/eopa?ic exam9ation1 is to f9d out h[ well ! pati5t c see4 ,to te/ ! acut5ess ( vision c]ta9 te/ lett]s are us$4 ,snell5's ,te/ ,lett]s are good4 ,! normal eye c read #c-h in* lett]s at tw5ty feet4 ,! te/ lett]s on ! c>ds usually range 9 size to be read at #aj1 #ae1 #bj1 #cj1 #dj1 #ej1 #gj1 #ajj & #bjj feet4 ,! mo/ desirable di/ance is #bj feet4 ,if at ! di/ance ( tw5ty feet he reads ! #c-h in* lett]s 8 acut5ess ( vision w\ld be m>k$ #bj-bj or normal4 ,always use ! di/ance betwe5 pati5t & *>t z ! num]ator ( ! fraction & ! numb] above ! lett]s :i* he reads z ! d5om9ator4 ,if he is tw5ty feet away1 ! num]ator rema9s tw5ty & ! d5om9ator *anges accord+ to ! l9e ( lett]s se5 on ! te/ c>ds ?us3 #bj-ae1 #bj-cj1 #bj-gj1 or #bj-bjj may express ! vision4 ,if ! pati5t c\ld n see ! #bjj feet lett]s at #bj feet he mu/ be br\ght ne>]1 say #aj feet1 = him to see ! l>ge lett]s2 8 vision w\ld be #aj-bjj4 ,^! fractions repres5t+ ! acut5ess ( vision may be express$ 9 met]s4 ,"s *>ts h lett]s numb]$ t way4 ,if ! vision is good en\gh = small objects to be cle>1 ! ne> po9t %\ld be tak54 ,?is w\ld %[ ! am\nt ( accommodation ( ! eye4 ,?is is express$ 9 diopt]s4 ,a diopt] is ! unit ( measurem5t ( ! refractive p[] ( l5ses4 ,l5ses are numb]$ by _! refractive p[] 9 diopt]s4 ,a l5s t has a curvature t w refract p>allel rays ( light & br+ !m to a focus at "o met] di/ance is said to be a "o diopt] l5s4 ,?is unit ( measurem5t = ! refractive p[] ( l5ses 0 propos$ by ,nagel 9 #ahff4 ,x soon became q g5]ally us$4 ,! focal di/ance ( a l5s decreases z ! /r5g? ( a l5s increases4 ,"o diopt] l5s 7writt5 #a ,d7 has a focus ( "o met] 7#a ,m7 or #ajj cm di/ance4 ,a #b ,d l5s has a focal di/ance ( ,m or #ej cm4 ,a #d ,d l5s has #be cm focal di/ance & a ,d l5s has #ajj cm #bjj cm di/ance or #b ,m4 ,trial cases h 9 !m l5ses v>y+ 9 /r5g? f 4#ab ,d or 4#be ,d to #bj ,d ( ! sph]ic =m4 ,we w n discuss ! trial case "h4 ,accommodation 9 ! ,eye ,accommodation 9 ! eye is ! ability ( ! eye to v>y its focal po9t4 ,:5 ! normal eye 7emmetropic7 is at re/ its focal po9t is at inf9ity s f> z p>allel rays are conc]n$4 ,?is is call$ ! f>-po9t or ! 8punctum remotum0 7,p4 ,r474 ,:5 ! eye looks at lett]s tw5ty feet away x sc>cely accommodates at all to get a focus1 or s little t x may be disreg>d$ 9 ord9>y practice4 ,n[ if "o br+s f9e pr9t close to ! eye he w f9d a po9t s close t x becomes indi/9ct4 ,?is po9t is ! ne>-po9t ( focus or ! 8punctum proximum0 7,p4 ,p474 ,! range ( accommodation is ! diff]5ce betwe5 ! refractive p[] ( ! eye :5 x is at re/ & :5 ! accommodation is ex]t$ to ! utmo/1 ! diff]5ce betwe5 ! ,p4 ,r4 & ! ,p4 ,p4 ,if "o mu/ accommodate "o diopt] to get a focus at "o met] or =ty in*es di/ance1 at ?irte5 in*es or read+ di/ance "o mu/ accommodate at lea/ #c ,d 9 ord] to see ! lett]s cle>ly4 ,if #c ,d 7 ! total ( 8 accommodation he c\ld n read at t di/ance b a few m9utes2 because ! accommodation c\ld n be held at its maximum = long at a "t4 ,eye /ra9 ) its tra9 ( symptoms w\ld result4 ,h5ce x is q important to f9d ! ne>-po9t or punctum proximum 9 ord] to judge 9 reg>d to eye /ra9 9 an emmetropic eye4 ,if !re is a refractive error1 all[ance = x mu/ be made accord+ly4 ,z a p]son gets old] ! accommodation 9 ! eye becomes less & less until at #de ye>s ( age he c only use #d to #e ,d ( accommodation4 ,?is is s close to ! am\nt requir$ = read+ t he has "s eye /ra94 ,he beg9s to hold 8 pap] f>!r away f him s he requires less accommodation4 ,?is condition we call 8old sight0 or presbyopia4 ,an emmetropic eye at =ty-five to fifty ye>s ( age requires a plus glass to make up = "s accommodation 9 read+4 ,frequ5tly !re are lat5t di/urbances ( equilibrium ( ! extr9sic muscles ( ! eye4 ,?is is het]ophoria4 ,if x is a lat5t conv]g5ce x is esophoria2 if a lat5t div]g5ce x is exophoria4 ,! latt] is m frequ5t4 ,hyp]- & hypophoria are us$ = upw>d or d[nw>d t5d5cies4 ,normal muscul> balance is or?ophoria4 ,cause ! pati5t to fix on an object ab\t ?irte5 in*es away ) bo? eyes2 pu% a %eet ( pap] 9 front ( "o eye & wat* beh9d ! pap]1 ! eye ?us cov]$4 ,if het]ophoria exi/s ! eye w move slightly f its po9t ( fixation s9ce x no long] sees ! object4 ,9 or?ophoria x w rema9 fix$ z long z ! o!r eye sees ! object2 ! inn]vation to ! diff]5t muscles is prop]ly di/ribut$4 ,a ,maddox rod f\nd 9 any complete trial case may be plac$ be=e "o eye4 ,h ! pati5t fix on a c&le flame1 say tw5ty feet away4 ,! flame appe>s drawn out into a lum9\s l9e4 ,?is l9e c n be fus$ ) ! c&le flame z ! o!r eye sees x if !re is het]ophoria4 ,! am\nt & k9d ( di/urbance is some:at indicat$ by ! di/ance & direction ( ! lum9\s l9e & ! flame4 ,! exact am\nt c be measur$ by ! use ( a prism t w cause !m to fuse4 ,next ! pati5t %\ld be tak5 to ! d>k room & a c>eful inspection ( ! ant]ior segm5t ( ! eye %\ld be made ) oblique illum9ation4 ,fir/ use ! unaid$ eye1 !n use a l5s t magnifies4 ,! #bj ,d plus l5s f y\r trial case w suffice = ! magnification4 ,note ! transp>5cy or lack ( x 9 ! cornea & cry/all9e l5s2 ! dep? ( ! ant]ior *amb] & ! appe>ance ( ! pupil & iris4 ,n[ we are ready = ! oph?almoscopic exam9ation4 ,! ,oph?almoscope4--,?is is an in/rum5t t comm&s great respect4 ,any "o :o is int]e/$ 9 eye tr\bles mu/ h & use ! oph?almoscope if he expects to be effici5t 9 diagnosis1 ^u :i*1 ( c\rse1 intellig5t treatm5t mu/ =ev] dep5d4 ,"o mu/ try & try aga9 9 ord] to become pr(ici5t 9 ! use ( ! oph?almoscope4 ,a ,s*ematic ,eye is ( great assi/ance to a beg9n] :o does n h cl9ics or pati5ts on :om to practice4 ,su* an eye ) full directions c be obta9$ at almo/ any optical goods /ore4 ,x w make ! /udy ( oph?almoscopy easy & int]e/+4 ,! pupil c be regulat$ to any size & ! eye c be made %ort 7hyp]opic71 long 7myopic7 or normal 7emmetropic7 = /udy4 ,! effici5t use ( ! oph?almoscope makes ! diagnosis ( int]nal diseases ( ! eye z easy z ! diagnosis ( ext]nal diseases ( ! eye4 ,only "s r>e conditions w puzzle1 & t is true ( any "p ( ! anatomy4 ,! oph?almoscope is a simple in/rum5t2 its *ief function is to illum9ate ! int]ior ( ! eye4 ,! value ( oph?almoscopic f9d+s dep5ds on _! correct int]pretation by ! exam9]4 ,! oph?almoscope has a mirror to reflect ! light into ! eye4 ,x has two discs on :i* are m\nt$ convex 7plus7 & concave 7m9us7 l5ses4 ,! l>g] disc has sev5 plus & eight m9us l5ses4 ,to ^! may be add$ ! l5ses 9 ! small] disc mak+ _m comb9ations4 ,a drop ( a #b solution ( coca9e or homatrop9e may be us$ z a mydriatic :]e "o c n o!rwise see cle>ly ! fundus4 ,if no mydriatic is us$ a some:at weak illum9ation %\ld be employ$ 9 ord] n to ar\se ! accommodation to mu* activity & make ! pupil small4 ,if !re is any opacity 9 ! m$ia a /rong illum9ation %\ld be us$4 ,! room %\ld be d>k2 ! d>k] ! bett]4 ,!re are two me?ods ( us+ ! oph?almoscope4 ,! indirect & ! direct me?ods4 ,"o is m useful at "o "t & ! o!r at ano!r "t4 ,by ! indirect me?od we view ! :ole field ( ! fundus m readily b less 9 detail4 ,) ! oph?almoscope be=e 8 eye ! exam9]'s face is twelve to fifte5 in*es f t ( ! pati5t4 ,:5 ! 8r$ reflex0 ( ! eye is se5 a plus #ac or #af ,d l5s is int]pos$ ne> ! pati5t's eye4 ,?is magnifies ! field4 ,! image is inv]t$4 ,z a rule x is be/ se5 ) a #d ,d l5s 9 ! ap]ture ( ! oph?almoscope4 ,?is me?od is especially m satisfactory 9 high degrees ( myopia & a/igmatism4 ,! optic disc is ! objective po9t4 ,"o may see a ret9al vessel fir/2 ?is %\ld be foll[$ to its em]g5ce f ! disc4 ,f ?is po9t view all p>ts ( ! fundus by hav+ ! pati5t look 9 diff]5t directions4 ,?is is bett] by ! indirect me?od ?an = ! exam9] to v>y 8 position4 ,! direct me?od ( oph?almoscopy is bett] = detail "w & 9 all cases except high degrees ( myopia & a/igmatism4 ,x is also bett] 9 det]m9+ errors ( refraction4 ,! pati5t looks /raight across ! room4 ,= a beg9n] x may be ess5tial to dilate ! pupil1 h5ce ! s*ematic eye z sugge/$4 ,if ! exam9] has a refractive error1 he %\ld we> 8 own glasses or correct by ?r[+ 9 front ( 8 eye prop] l5ses 9 ! oph?almoscope4 ,face ! pati5t & sit on ! side ( ! eye to be exam9$4 ,use left eye to exam9e ! pati5t's left eye & "r eye = ! pati5t's "r4 ,exam9] & pati5t keep bo? eyes op54 ,! exam9] may n be able to suppress ! image ( 8 o!r eye & may h to close x "p ( ! "t4 ,cat* ! 8r$ reflex0 "s #ae to #ah in*es away & move close to ! pati5t's eye4 ,! 8r$ reflex0 color v>ies ) ! error ( refraction1 ! transp>5cy ( ! m$ia1 ! degree ( pigm5tation & ! size ( ! pupil4 ,a blood clot w make x r$d]1 "s exudates w make x gray or yell[4 ,! exam9] may approa* z close z half an in* f ! eye to be exam9$4 ,f9d ! optic disc & exam9e all po9ts ( ! fundus f x4 ,rotate 9 glasses to correct ! pati5t's refractive error if he has any4 ,! /ronge/ plus glass ) :i* ! f9e ret9al vessels c be cle>ly se5 w repres5t ! hyp]opia ( ! eye4 ,?is is true only if ! exam9]'s accommodation is at re/4 ,! weake/ m9us glass ) :i* ! f9e ret9al vessels c be cle>ly se5 repres5ts ! myopia4 ,a ,normal ,fundus4--,! color ( ! fundus is due to ! blood vessels ( ! ret9a & *oroid & ! connective tissue ( ! *oroid & scl]a4 ,v>iation is due to ! pigm5t4 ,9 ! alb9o x is light p9k4 ,9 ! negro x is d>k r$di%4 ,!re are all gradations betwe5 ! two4 ,! optic disc is ! end ( ! optic n]ve z x comes into ! eye2 x is circul> 9 %ape1 p9k 9 color1 & %>ply def9$4 ,x is ab\t #a-af? ( an in* 9 diamet]2 ab\t #ae to ! nasal side ( ! pole ( ! eye & slightly above ! horizontal4 ,!re may be a d>k *oroidal r+ ar\nd ! disc or "p way ar\nd4 ,!re may also be a :ite r+ caus$ by ! scl]a4 ,z a rule !re is a depression 9 ! c5t] ( ! disc out ( :i* ! ret9al vessels em]ge & spread out ov] ! fundus4 ,! fovea c5tralis or po9t ( cle>e/ vision is locat$ two & a half disc diamet]s to ! temporal side ( ! disc4 ,ar\nd ?is is a circul> area ( light yell[1 ! macula lutea4 ,! subject ( oph?almoscopy has be5 t\*$ ^u some:at 9 detail because ( its great importance to ! g5]al practition]4 ,e o/eopa?ic physician %\ld "k ! oph?almoscope well en\gh to recognize ! ord9>y lesions inside ! eye4 ,:5 we take up pa?ological conditions ( ! eye we w h occasion frequ5tly to ref] to ! oph?almoscopic appe>ance4 ,)\t ! use ( ?is in/rum5t all ( our cl9ical field rese>* on int]nal diseases ( ! eye is valueless4 ,_m h told me !y h cur$ cat>act ) o/eopa?ic treatm5t1 "s say !y h cur$ specific neuroret9itis ) no sequel1 o!rs te/ify to opacities & bl9dness f v>i\s causes4 ,inv>iably we ask if !y us$ ! oph?almoscope 9 _! diagnosis & ) x wat*$ ! progress ( ! case4 ,almo/ inv>iably ! answ] is 8no1 x look$ l x10 8! symptoms indicat$ x10 or 8,dr4 s & s1 an oculi/ diagnos$ x z su*40 ,fell[ ,o/eopa?s6 we c n base our claims on ?is k9d ( data4 ,) a little /udy & practice ! oph?almoscope c be ma/]$4 ,n till !n c we get reliable /ati/ics on int]nal diseases ( ! eye 9 our case reports4 ,o/eopa?y has mu* to reveal to u 9 ?is field & = ! sake ( ! sci5ce & our pati5ts we appeal to e "o to d ! "w "h set =?4 ,diseases ( ! ,eye ,,o/eopa?ic ,,manipulation ,,= ,,eye ,,diseases ,a g5]al correction ( lesions %\ld be made 9 ord] to give p]fect alignm5t & equilibrium4 ,lesions t affect ! n]ve & blood supply w be f\nd f ! f\r? ?oracic to ! occiput2 m (t5 at ! occiput1 atlas & axis 9 ! c]vical region & ! second & ?ird ?oracic 9 ! dorsal region includ+ ! ribs4 ,correction ( ^! lesions mu/ h specific att5tion 9 e case ( eye disease t %[s any t5d5cy to *ronicity or 9 repeat$ eye disease & exac]bations4 ,a ?or\gh upp] sp9al treatm5t to insure good mobility ( all jo9ts & e/abli% fre$om ( fluids & =ces is recomm5d$4 ,! nose1 ?roat & s9uses %\ld be exam9$ = pa?ology4 ,if ! tonsils & ph>ynx are n normal ! cott$ index f+] %\ld be introduc$ into ! m\? until ! ant]ior pill> ( ! fauces is rea*$4 ,a m\? gag may or may n be us$4 ,massage ! tonsil ?r\gh ! ant]ior pill> !n move to ! top & press d[n on ! tonsil ) a pump+ motion4 ,repeat ?is f bel[ ! tonsil & po/]iorly4 ,slip ! f+] "u ! s(t palate & /ret* x ?or\ghly4 ,clean out any adhesions & vegetations 9 ! vault ( ! nasoph>ynx & fossa ( ,ros5mull]4 ,/ret* ! pill>s ( ! fauces by press+ d[n on ea* side at ! root ( ! tongue4 ,if ! s9uses are diseas$ !y %\ld be dra9$4 ,if ! nose is diseas$ & has abundance ( secretion1 fir/ use irrigation = cleanl9ess4 ,manipulation 9 ! nose w be ( great b5efit 9 "s eye diseases z pa?ology !re frequ5tly has an important be>+ on diseases ( ! eye4 ,! nose is (t5 too n>r[ & contract$4 ,! fir/ in* ( ! nose is muscul> & c>tilag9\s2 x is ( ev5 m importance to dilate ! nose 9 contractur$ conditions ?an x is ! sph9ct]s at ! l[] end ( ! rectum4 ,! great b5efit d]iv$ f rectal dilatation has be5 recogniz$ = ye>s4 ,9 dilat+ ! contract$ nose a wide blade nasal speculum may be us$4 ,! cott$ & oil$ little f+] may be us$ :]e x is prop]ly adapt$ 9 size4 ,! dilat+ c be done ) practically no pa9 & no damage to membranes or o!r tissues4 ,x %\ld n be ext5d$ beyond ! c>tilag9\s & muscul> "p4 ,manipulation ( ! turb9ates & tissue fur!r back may be done if ne$$1 by ! use ( in/rum5ts4 ,! ,edw>ds turb9ate adju/] in/rum5t 7,aloe ,co41 ,/4 ,l\is7 or ! ,ruddy ,nasal ,?ird ,f+] 7,%>p & ,smi?1 ,*icago7 are ! be/ in/rum5ts s f> devis$ = ?is op]ation4 ,a ?or\gh /ret*+ ( ! eyelids1 manipulation ( ! eye ball & ! po9ts ( ! fif? n]ve are indicat$ 9 _m diseases4 ,! lids may be /ret*$ by pull+ !m f side to side4 ,! cott$ =ef+] well oil$ 7/]ile vasel9e7 may be slipp$ into ! conjunctival sac back ( ei!r lid & ) ! ?umb on ! outside ! lid may be massag$ or /ret*$ 9 any direction4 ,! po9ts ( ! fif? n]ve may readily be influ5c$ at _! respective exits ab\t ! orbit4 ,! eye ball & deep] cont5ts ( ! orbit c be pr(\ndly treat$ by press+ ! f+] into ! orbit above1 bel[ & at ! sides ( ! bulb & pu%+ x 9 all directions z f> z possible4 ,! ,ruddy eye f+] in/rum5t 0 devis$ = ?is deep manipulation ( ! orbital & bulb> /ructures4 ,x is ( high value4 ,"o f+] may be laid on ! clos$ eye & ) a tapp+ motion ) ! o!r h& a vibration or oscillation ( ! orbital /ructures may be _h4 ,?is is a useful treatm5t4 ,! wise selection & skillful use ( ^! v>i\s me?ods ( treatm5t = ! eye w solve mo/ ( our difficulties4 ,?is %ort survey ( o/eopa?ic me?ods w aid u 9 ! m specific discussions to foll[4 ,neuralgia ,a consid]able numb] ( p seem to be subject to attacks ( pa9 9 "o or bo? eyes4 ,^! attacks ( pa9 come at v>y+ int]vals2 9 "s cases sev]al times a day1 9 o!rs z f> ap>t z "o or two weeks4 ,! pa9 w sudd5ly />t almo/ )\t w>n+ & ) v little provocation1 & la/ f "o to tw5ty-f\r h\rs4 ,x is v sev]e & ! pati5t frequ5tly ?9ks some?+ t]rible is wrong4 ,some?+ t]rible is wrong s f> z 8 com=t is conc]n$4 ,b 9 ^! cases to :i* ,i am ref]r+ !re is no organic tr\ble ) ! eye4 ,! pati5t does n ne$ glasses4 ,!re is no sign ( inflammation4 ,vision is n di/urb$4 ,local exam9ation ( ! eye ) ! oph?almoscope reveals t ! fundus ( ! eye is normal4 ,!re is no symptom connect$ ) ! eye except pa91 occasionally accompani$ by a slight r$ness4 ,i h _h sev]al cases 9 my own practice & my att5tion has be5 direct$ to cases ( o!r physicians4 ,^! cases diff] f tic d\l\reux 9 t !re is no muscul> spasm4 ,9 fact1 motor n]ves d n seem to be involv$4 ,! involvem5t seems to be l>gely 9 ! fif? cranial n]ve1 usually ! supraorbital1 or o!r small] bran*es ( ! oph?almic division ( ! fif? cranial4 ,sometimes we note slight dilatation ( ! pupil ) m or less conge/ion4 ,?is w\ld indicate an involvem5t ( ! sympa!tic bran* to ! eye4 ,! lesions discov]$ 9 ^! cases h be5 a subluxation ( ! occiput ^u ! atlas or an upp] c]vical lesion & frequ5tly "s involvem5t at ! second dorsal4 ,!re has be5 not$ also tr\ble 9 ! nasoph>ynx su* z contractures ( ! muscles ( ! s(t palate & adhesions 9 ! fossa ( ,ros5mull]4 ,misplacem5ts ( ! ut]us h also be5 f\nd 9 "s cases4 ,treatm5t ,ne>ly all ^! cases are curable ) f "o week to six weeks treatm5t4 ,( c\rse ! treatm5t mu/ be intellig5tly direct$ aft] a correct diagnosis z to ! cause4 ,! cause c usually be remov$4 ,"o case to :i* my att5tion has be5 direct$ 0 t ( a woman ab\t =ty ye>s ( age :o _h v sev]e pa9s4 ,) all ! local treatm5t ( ! eye & o!rwise %e got practically no results until %e _h replacem5t ( ! ut]us1 :i* br\ght imm$iate relief4 ,o!r cases h no tr\ble on t k9d b h lesions ( ! c]vical region & on correction ( ^! lesions ! neuralgia disappe>s4 ,o!r cases h _h ! nasoph>ynx clean$ out by ! f+] op]ation & ! /ret*+ ( ! s(t palate :i* reliev$ ! neuralgia imm$iately or 9 a few days4 ,numb]s ( cases h be5 to m$ical physicians & _h v>i\s eye rem$ies adm9i/]$ locally ) no p]man5t b5efit4 ,( c\rse ! treatm5t 0 adm9i/]$ at ! wrong place4 ,! ramifications ( ! sympa!tic & fif? cranial n]ves are s complex & f>-rea*+ t we mu/ keep 9 m9d t "o or m ( _m causes = ! tr\ble may exi/ & be q remote f ! seat ( ! pa94 ,diseases ( ! ,eyelids ,occasional factors are bee /+s or insect bites1 :i* completely occlude ! palpebral fissure4 ,we may h "s palpebral edema f lid abscesses1 *alazion1 hordeolum1 dacryocy/itis1 panoph?almia & s =?4 ,9 hemorrhagia subd]malis !re is s mu* spongy tissue b5ea? ! sk9 ab\t ! eye t ! blood ext5ds easily & f>4 ,! r$ t9t w soon *ange to a r$di% blue & !n become d>k1 :at is kn[n z a black eye 7ec*ymosis74 ,?is frequ5tly results f a bl[4 ,! sk9 is %>ply atta*$ ar\nd ! orbital m>g9 by t5se connective tissue s ! area ( ! hemorrhage is limit$ to ! region ( ! orbit4 ,!re may be spontane\s rupture ( "s ( ! vessels by h>d sneez+ or c\gh+1 especially 9 "y *ildr54 ,9 old] p x may indicate a fragile condition ( ! vessels1 art]ioscl]osis or "s tr\ble ) ! kidneys4 ,! diagnosis ( ! eye condition is n difficult b ! cause ( ! hemorrhage 9 t region might be inve/igat$ fur!r4 ,local treatm5t is ( "s value 9 ^! conditions4 ,!y may be soo!d by cold compresses4 ,9 bee /+s & insect bites use an alkal9e compress4 ,manipulation ab\t ! eye & o/eopa?ic treatm5t ( ! neck ) a view to direct+ a bett] circulation to t region w aid mu*4 ,h]pes ,zo/] ,oph?almia ,?is affection ( ! supraorbital bran* ( ! fif? cranial n]ve may ext5d to ! eyelids4 ,x may n g beyond ! /age ( bli/]+ & r$ness ) "s edema4 ,h[ev]1 x is possible = x to become gangr5\s & ev5 ext5d to ! conjunctiva & cornea4 ,i _h "o case ( h]pes zo/] gangr5osa ( ?is region4 ,!re 7 sev]al gangr5\s spots z l>ge z a dime on ! =ehead & ext5d+ d[n 9 ! region ( ! eyelid4 ,! process ext5d$ to "s ext5t on ! cornea & 9 heal+ left a condition ( irregul> a/igmatism4 ,treatm5t4--,! prognosis 9 h]pes zo/] is always favorable "u o/eopa?ic treatm5t4 ,lesions ( ! c]vical region w almo/ inv>iably be f\nd int]f]+ ) ! sympa!tic connections ( ! fif? cranial n]ve caus+ ! trophic di/urbance to ! region4 ,o/eopa?ic treatm5t appli$ to ^! conditions w always ha/5 normalization4 ,! affect$ "p might be kept cov]$ ) "s soo?+ lotion to keep ! sk9 s(t4 ,hordeolum ,?is is commonly kn[n z a /y4 ,x is due to suppuration ( ! gl&s ( ,zeiss4 ,x is a h>mless affection b causes pa9 & inconv5i5ce4 ,diagnosis4--,swell+ & pa9 ) a small inflamm$ nodule 9 ! palpebral m>g9 is q diagno/ic4 ,treatm5t4--,! circulation is ob/ruct$ 9 ?is region4 ,! ef=t %\ld be made to op5 ! circulation be=e pus has =m$4 ,?is c frequ5tly be done & ! hordeolum abort$ by c>efully pick+ up ! eyelid & roll+ ! nodule betwe5 ! f+]s4 ,?is w cause "s pa9 b if x is kept up = a mom5t or two ab\t e h\r ?r\gh ! day ) an occasional ?or\gh treatm5t ( ! neck ! /y w usually be abort$4 ,if pus =ms x %\ld be op5$ z soon z x po9ts & !n ! squeez+ & roll+ process may be employ$ aga91 :i* w aid rapidly 9 ! free+ ( ! circulation4 ,*alazion ,?is is a ,meibomian cy/ 9 ! eyelid4 ,x %[s z a circumscrib$ swell+ on ! inn] side ( ! lid4 ,x frequ5tly becomes l>ge en\gh to produce "s de=mity ( ! lid4 ,a *alazion is movable on ! t>sal c>tilage4 ,x is a *ronic condition & ! cy/ may become z l>ge z a bean4 ,!re may be m ?an "o 9 ! same lid4 ,treatm5t4--,:5 a *alazion is small & n ( long /&+ x c frequ5tly be cur$ by o/eopa?ic treatm5t4 ,introduce ! f+] into ! conjunctival sac "u ! lid1 & ) ! ?umb ext]nally1 grasp ! *alazion betwe5 ! f+] & ?umb2 roll x ?or\ghly4 ,squeeze & massage x two or ?ree times a week = a:ile4 ,?is1 comb9$ ) a ?or\gh treatm5t ( ! neck1 w result 9 a cure4 ,if at ! end ( six weeks ! condition has n disappe>$ surg]y %\ld be resort$ to4 ,bleph>itis ,?is is an inflammation ( ! eyelid4 ,x is ei!r acute or *ronic accord+ to ! cause4 ,acute bleph>itis may be due to heat or injury4 ,*ronic bleph>itis affects ! gl&s ( ! lid caus+ a p]v]sion ( ! secretions4 ,!re is usually ! =mation ( cru/s & scales4 ,?is condition is kn[n z bleph>itis sicca4 ,9 "s cases infection w =m little pu/ules at ! roots ( ! cilia4 ,!re is sor5ess & a*+4 ,!re may be photophobia4 ,! nasal region may be involv$4 ,osse\s lesions ( ! c]vical region are usually pres5t4 ,refractive errors frequ5tly exi/ 9 ^! cases4 ,occupation or environm5t may expose to du/ or w9d suffici5t to keep up ! irritation4 ,treatm5t4--,*ange environm5t4 ,see t !re is ?or\gh cleanl9ess ( ! lid4 ,rub or pick away all scales4 ,use a bl& o9tm5t4 ,correct any c]vical or upp] dorsal lesions4 ,ptosis ,?is is cong5ital or acquir$4 ,9 cong5ital ptosis op]ation seems to be ! only treatm5t4 ,acquir$ ptosis is am5able to treatm5t frequ5tly4 ,! cause is "s lesion int]f]+ ) ! passage ( prop] n]ve =ce to ! levator muscle ( ! lid4 ,! lesion may be at ! orig9 ( ! ?ird n]ve1 at ! cortical nucleus 9 ! sigmoid gyrus or 9 ! trunk ( ! ?ird n]ve1 or a lesion ( ! muscle itself4 ,tumor1 trauma1 syphilis1 scl]osis1 hemorrhage1 g\t or rheumatism1 or any?+ t w produce a p]iph]al neuritis are causative factors4 ,lesions ( ! c]vical & upp] dorsal by reflect+ back ^u ! n]ve c5t]s may produce a ptosis4 ,treatm5t4--,rem$ial measures accord+ to indications4 ,cases due to o/eopa?ic lesions z indicat$ w usually yield readily to treatm5t4 ,:]e !re are o!r factors treatm5t mu/ be v>i$ accord+ly4 ,tri*iasis ,?is is a condition 9 :i* "p or all ( ! eye la%es turn inw>d & t\* ! eye ball1 due to cicatricial contractions 9 ! conjunctiva & t>sus4 ,_m ( ! cilia are s small 9 ^! conditions t x is v difficult to see !m4 ,a l\pe or a magnify+ glass mu/ be us$ 9 ord] to discov] !m4 ,dy/ri*iasis is a condition :]e ! cilia come 9 irregul>ly gr[+ 9 all directions1 "s ( !m turn+ 9 t[>d ! eye ball & caus+ irritation4 ,treatm5t4--,an epilatory %\ld be us$ to extract all ( ! wild hairs4 ,c>e %\ld be tak5 to get out ! f9e/ ones z !y w frequ5tly cause irritation if n remov$4 ,entropion & ,ectropion ,entropion is a turn+ 9 ( ! eyelid & ectropion is a turn+ out4 ,^! conditions may be spasmodic & tempor>y4 ,entropion is m (t5 due to cicatricial contraction 9 old bleph>itis or tra*oma conditions4 ,9 "s cases ! condition may be correct$ by ! use ( /rips ( adhesive pla/]4 ,9 cicatricial conditions op]ation is ! rule4 ,spasmodic ectropion may be correct$ sometimes by cur+ ! conjunctivitis4 ,b&ag+ may be resort$ to4 ,9 p>alytic ectropion o/eopa?ic treatm5t may s]ve to produce a complete cure4 ,op]ative proc$ure %\ld be a la/ resort4 ,diseases ( ! ,la*rymal ,app>atus ,dacryocy/itis ,dacryocy/itis is an inflammation ( ! lacrymal sac4 ,x is due to "s lesion 9 ! nose1 malposition ( ! inf]ior turb9ate or a poor blood & n]ve supply to ! lacrymal region z det]m9$ by c]vical lesions4 ,! sac becomes infect$ & we h a dacryocy/obl5norrhea4 ,pus & te>s are regurgitat$ into ! eye ?r\gh ! puncta4 ,!re is irritation & ! conjunctiva may become infect$ at any "t1 also ! cornea4 ,x is a dang]\s & annoy+ affection4 ,treatm5t4--,o/eopa?ic measures h some?+ to (f] along ?is l9e4 ,! m$ical idea seems to be completely surgical 9 rec5t ye>s4 ,! fir/ & only ?+ to be done surgically is to oblit]ate ! sac or dissect x out & curette ! nasal duct1 completely de/roy+ ! app>atus4 ,lanc+ does n affect a cure4 ,by treat+ = a good n]ve & blood supply to t region1 ! irrigation ( ! nose & a ?or\gh squeez+ ( ! sac ea* "t ) a view to =c+ ! solution 9 ! sac d[n ?r\gh ! nasal duct into ! nose1 a cure may be effect$ 9 _m cases4 ,if ^! cases c be gott5 be=e infection has tak5 place1 9 ! /ate ( epiphora or ! back+ up ( ! te>s into ! eye1 ?or\gh treatm5t along ! l9es j indicat$ w 9 ne>ly all cases result 9 a cure4 ,boric acid solution %\ld be us$ to wa% out ! sac :5 pus is pres5t4 ,! attempt %\ld be made to =ce x into ! nose4 ,prob+ prop]ly done is ( value 9 _m cases4 ,^! cases %\ld be foll[$ up ) great c>e4 ,treat ! neck ?or\ghly & spr+ ! inf]ior maxilla4 ,diseases ( ! ,conjunctiva ,conjunctivitis ,! conjunctiva is a muc\s membrane t coats ! po/]ior surface ( ! eyelids & ! ant]ior surface ( ! eyeball4 ,x =ms a sac1 :i* is slit op5 9 front 9 ! l9e ( ! palpebral fissure4 ,! conjunctiva consi/s ( ?ree p>ts 7#a7 ! conjunctiva t>si1 ! "p on ! lids2 7#b7 ! conjunctiva bulbi1 ! "p on ! eyeball1 & 7#c7 ! conjunctiva =nicis1 ! "p connect+ ! fir/ & second2 x is ! retrot>sal fold or ! region ( transition1 (t5 call$ ! =nix4 ,! fir/ "p c be se5 by ev]t+ ! lids4 ,x is adh]5t to ! t>sus4 ,x is cov]$ ) a lam9at$ cyl9drical epi!lium4 ,! membrane conta9s an abundance ( lymphocytes simil> to ad5oid tissue4 ,?is increases ) e inflammation ( ! conjunctiva4 ,?is is :y *ronic conjunctivitis (t5 results 9 ?ick5$ lids4 ,! blood supply ( ! conjunctiva ( ! lids is f ! muscul> bran*es ( ! oph?almic art]y4 ,! n]ve supply is f ! oph?almic division ( ! #e? cranial & ! sympa!tic4 ,! bulb> conjunctiva cont9ues ov] ! cornea4 ,x is cov]$ ) lay]s ( pavem5t epi!lium4 ,its blood supply comes f ! po/]ior conjunctival vessels ab\t ! retrot>sal fold1 & ! ant]ior cili>y art]ies :i* accompany ! t5dons ( recti muscles2 ^! two sy/ems ana/omose 9 ! conjunctiva4 ,conjunctival injection or conge/ion %[s a sup]ficial net "w ( l>g] or small] vessels t move ) ! conjunctiva4 ,! color is sc>let or brick r$4 ,cili>y injection occurs z a rose-r$ or pale violet zone ar\nd ! cornea1 spok5 ( z p]i-or circumcorneal injection4 ,x does n move ) ! conjunctiva & occurs m ) diseases ( ! cornea1 iris & cili>y body4 ,9 ! etiology ( conjunctivitis a great v>iety ( g]ms are consid]$ by diff]5t writ]s4 ,coll9s & ,mayo give a report ( 8g]ms f\nd 9 normal conjunctiva40 ,bacillus ,x]osis 9 #id ( normal conjunctiv2 ,/aphylococcus ,albus 9 #gi2 ,pneumococcus 9 #i2 ,diplobacillus 9 #f2 ,/aphylococcus ,aureus 9 #f2 ,/reptococcus 9 #e4 ,if ?is be true1 & ,i d n d\bt _! /atem5t1 we are practically compell$ to say t ^! g]ms at lea/ are only second>y 9 ! etiology ( conjunctivitis4 ,j at ?is po9t o/eopa?y comes ) its flood ( light & makes x easily expla9able :y "s conjunctiv become inflam$ :ile o!rs d n1 :5 all h g]ms pres5t4 ,! lesion di/urb+ ! integrity ( blood supply & n]ve =ce to ! eye is ! prim>y cause :ile ! pres5ce ( g]ms may be ! aggravat+ cause4 ,! lesion prep>es ! soil 9 :i* ! g]ms ?rive suffici5tly to become an irritant4 ,!re are all gradations ( ?is soil prep>ation4 ,! m f]tile ! field 7i4 e4 ! m pr(\nd ! effect ( ! lesion7 ! m virul5t g]m life may become2 ! resi/ance is proportionately less4 ,conjunctivitis is classifi$ = conv5i5ce 9 /udy1 diagnosis & treatm5t z foll[s3 7#a7 ,cat>rhal1 7a7 acute1 7b7 *ronic1 7c7 follicul>2 7#b7 gonorrhoeal2 7#c7 oph?almia neonatorum2 7#d7 tra*oma2 7#e7 diph!ritic2 7#f7 eczematosa 7phlyct5ulosa72 7#g7 v]nalis2 7#h7 tub]cul>2 7#i7 traumatic4 ,?is is ! cl9ical classification aft] ,fu*4 ,treatm5t ( ,conjunctivitis ,9 ord] to give ! be/ c>e 9 ^! cases x is q ess5tial t bo? ! prim>y & second>y causes be giv5 att5tion4 ,"s good g]micide or antiseptic is to be us$ ) intellig5ce4 ,?is is 9 h>mony ) ! great pr9ciples ( antisepsis & cleanl9ess taught by o/eopa?y f its inception4 ,! use ( ! microscope 9 ! bact]iology ( conjunctivitis aids 9 m def9ite diagnosis & ! selection ( a prop] g]micide4 ,= ! ,ko*-,weeks bacillus1 ! pneumococcus & ! influ5za bacillus silv] nitrate #a or a #be solution ( argyrol is us$2 = ! diplo bacillus 7,morax-,ax5feld7 z9c sulphate #a gr4 to ! ounce is almo/ a specific4 ,a good way to prep>e ! z9c prescription w\ld be3 ,boracic acid & wat] oz4 #a4 ,z9c sulphate gr4 #a4 ,! boric acid & wat] ( c\rse be+ a saturat$ solution4 ,apply "o drop to ea* eye ab\t f\r times a day4 ,if "o c n h ! use ( ! microscope to make specific ! diagnosis1 ! z9c solution may be alt]nat$ ) ! argyrol z ! g]micide4 ,ice cold applications are good 9 _m ( ^! cases4 ,cat>rhal ,conjunctivitis ,acute4--mo/ly affects ! conjunctiva ( ! lids 9 ! light =m4 ,if sev]e x invades ! bulb> conjunctiva4 ,!re is r$ness & swell+ & increas$ secretion :i* dries at night ^u ! edges ( ! lids & glues !m toge!r4 ,! eyes are bett] 9 ! morn+ & worse t[>d ev5+4 ,corneal ulc]s & iritis may arise z complications4 ,*ronic inflammation may result4 ,etiology4--,textbooks on ! eye give bact]ia z ! *ief cause2 "s sc>cely m5tion any?+ else4 ,aft] discuss+ h[ ! bact]ia get !re & multiply1 !y usually br+ 9 "s /atem5t to indicate t 9 _m cases no bact]ia c be f\nd 9 ! secretions f ! conjunctiva4 ,^! latt] are unacc\nt$ = 9 ! etiology4 ,cat>rhal conjunctivitis is non-specific 9 its orig94 ,! great sci5ce ( o/eopa?y w fill 9 ! miss+ l9ks to works o!rwise v exhau/ive on ! eye4 ,if ! cause is due only to a pass+ irritant z du/1 smoke1 poll5 or w9d ! di/urbance may v>y f hyp]emia only1 to a sev]e attack ( conjunctivitis4 ,fu* says ! majority ( cases are produc$ by bact]ia1 b ,,t ,,9 ,,n ,a ,,few ,,cases ,,( ,,conjunctival ,,cat>rh ,,! ,,exam9ation ,,( ,,! ,,secretions ,,= ,,bact]ia ,,proves ,,negative4 ,he also says t ! usual c\rse ( ! disease is f eight to f\rte5 days1 b ,,n ,,infrequ5tly ,,!re ,,rema9s ,a ,,condition ,,( ,,*ronic ,,cat>rh ,,protract$ ,,ov] ,a ,,long ,,"t2 ,,t ,,n ,,infrequ5tly ,,! ,,normal ,,conjunctival ,,sac ,,conta9s ,,pa?og5ic ,,g]ms4 ,"s au?ors divide ! etiology into 7#a7 specific1 7#b7 non-specific4 ,! fir/ !y acc\nt = by irritants due to du/1 heat1 smoke1 metal1 poll51 cold1 w9d1 gl>e ( light1 eye /ra9 f ov]work ( ! eyes1 ametropia & *ronic alcoholism4 ,! second !y acc\nt = by g]m life1 mo/ (t5 ! ,morax-,ax5feld diplobacillus or ! ,ko*-,weeks bacillus1 ! latt] g]m be+ f\nd 9 ! s-call$ 8p9k-eye40 ,x is contagi\s4 ,?is is "o condition = :i* ! z9c sulphate 7 to #b solution7 is almo/ a specific4 ,no d\bt ! irritants & ! bact]ia m5tion$1 ) o!rs1 d cause mu* ( our cat>rhal conjunctivitis & t "o :o fails to consid] prop]ly ! local conditions 9 practice w be sadly lack+ 9 be/ results4 ,on ! o!r h& _m cases1 treat$ = local conditions only by v compet5t m5 :o us$ ! be/ antiseptics & g]micides1 h v indiff]5t results4 ,! acute condition w\ld cont9ue & gradually become *ronic4 ,f obs]vation1 /udy & exp]i5ce !re are causes aside f local irritants1 ametropia1 bact]ia1 syphilis1 rheumatism or measles4 ,!re is "s di/urbance to ! integrity ( ! sp9ocili>y sympa!tic arc4 ,9 _m cases ( eye disease note lesion & t5d]ness at ! upp] dorsal1 ! removal ( :i* w cause improvem5t ( ! eyes4 ,_m cases ( eye /ra9 c be reliev$ by correction ( ! fir/1 second or ?ird dorsal1 & ! use ( glasses made unnecess>y4 ,irritation ( ! eye w cause m or less t5sion ( ! muscles at ! second & ?ird dorsal1 & /imulation ( ! tissues ne> ! second & ?ird dorsal sp9es w cause dilatation ( ! pupils & contraction ( vessels ( ! cranial muc\s membranes2 :i* means vasomotor1 secretory & trophic di/urbances4 ,x foll[s !n t an o/eopa?ic lesion at ! second or ?ird dorsal w cause or t5d to cause disease ( ! eye4 ,!re may be all gradations 9 ! effect produc$1 ! light] be+ m]e t5d5cy1 :ile aga9 x may be en\gh to set up pr(\nd vasomotor1 secretory & trophic *anges 9 & ab\t ! eye4 ,! fir/ effect ( ! lesion may be /imulatory1 & lat]1 inhibitory4 ,! normal resi/ance ( ! eye w\ld be l[]$ & naturally1 local irritants1 bact]ia & ametropia w\ld h a m pr(\nd effect4 ,?is w expla9 h[ "o c develop conjunctivitis 9 ! abs5ce ( a local irritant ) no bact]ia pres5t1 & no eye /ra94 ,all ( ^! causes1 or any numb] ( !m1 may be act+ toge!r1 & ea* m virul5t because ( ! influ5ce ( ! o!r4 ,lesions ( ! occipito-atlantal jo9t or any ( ! c]vical articulations may cause eye di/urbance4 ,!re are no eff]5t ramicommunicantes 9 t region & ! c\rse ( ! physical di/urbance mu/ be great] 9 proportion to ! eye tr\ble produc$1 ?an at ! upp] dorsal4 ,x is important h[ev] to make a close exam9ation ( ! entire c]vical region 9 eye tr\ble4 ,:at has be5 said on ! o/eopa?ic causes ( acute cat>rhal conjunctivitis applies ) equal =ce to *ronic & follicul> concat>rhal conjunctivitis4 ,:at has be5 said on ! o/eopa?ic causes ( acute cat>rhal conjunctivitis applies ) ev5 great] =ce to ! *ronic =m4 ,! great v>iety ( local irritants may acc\nt = acute conjunctivitis1 & does 9 mo/ in/ances2 b 9 *ronic conjunctivitis local irritants are m (t5 second>y or incid5tal :ile ! o/eopa?ic lesion ) its effect ^u ! bulbo-sp9o-sympa!tic cili>y arc is ! fundam5tal cause4 ,( c\rse "s cont9u\s local irritant1 e4 g41 an uncorrect$ refractive error1 excessive light1 heat1 du/ or g]m life 9 ! environm5t may cause a *ronic conjunctivitis4 ,o!r causes may be retract$ lids 7lagoph?almus7 leav+ ! eyeballs too prom95tly expos$2 turn+ 9 ( ! cilia 7entropion1 tri*iasis or dy/ri*iasis7 :i* imp+e ^u & irritate ! bulb> conjunctiva4 ,*ronic bleph>itis may spread to ! palpebral conjunctiva & !n ! bulb>4 ,=eign bodies 9 ! eye1 or inf>ction ( ,meibomian gl&s may be causes4 ,! diplobacillus 7,morax-,ax5feld7 is ! mo/ common g]m 9 *ronic cat>rhal conjunctivitis4 ,symptoms & ,c\rse4--,9 mild cases ! r$ness is only mod]ate4 ,! conjunctiva is smoo? & n swoll54 ,old cases h hyp]trophy ) ?ick5+4 ,!re 0 a small girl :o came into ! (fice rec5tly :o _h ! conjunctiva ( ! lids decid$ly swoll5 ) "s hyp]trophy4 ,h] eyes 7 glu$ %ut ) pus e morn+4 ,pus pockets 7 =m+ along ! follicles ( ! cilia & on ! direct edge ( ! lid4 ,h] tr\bles />t$ a ye> ago & got gradually worse4 ,a few o/eopa?ic treatm5ts 7 giv5 dur+ ?ree mon?s 7%e 0 irregul> 9 com+7 & argyrol1 #bj1 us$ locally4 ,all pus & debris 7 cle>$ (f ! lids & conjunctiva ea* "t4 ,! swell+ all left & ! ?ick5+ became inconsid]able2 ! eyes look$ almo/ cle>4 ,on pressure !re 0 t5d]ness at ! "r side ( ! second dorsal4 ,no me*anical lesion 0 app>5t !re b 9 treatm5t t region 0 ?or\ghly loos5$4 ,! subjective symptoms are usually worse at night2 pa91 heav9ess ( ! lids2 feel+ ( a =eign body 9 ! eye2 burn+2 it*+ & dryness 9 _m cases4 ,?is condition is "o ( ! mo/ frequ5t ( eye diseases 9 adults2 may be s5ile cat>rh 9 advanc$ age4 ,x is frequ5tly complicat$ ) bleph>itis1 ectropion1 epiphora & ulc]ations ( ! cornea4 ,treatm5t4--,! o/eopa?ic treatm5t dep5ds on ! f9d+s 9 ! o/eopa?ic exam9ation4 ,no case ( *ronic cat>rhal conjunctivitis %\ld be treat$ )\t a ?or\gh exam9ation ( ! :ole sp9al1 rib & innom9ate me*anism4 ,c>eful & detail$ adju/m5t %\ld be made ( any lesions t might di/urb ! cili>y arc1 ! o!r n]ve connections1 ! blood supply or ! body equilibrium4 ,?is does n mean t local treatm5t ( ! eye %\ld be neglect$ 9 any way4 ,any measure t w aid 9 gett+ rid ( local pa?ology z quickly z possible %\ld be ours4 ,:]e !re is abundant secretion1 silv] nitrate #a to #b solution put on ! conjunctiva ) a bru% :5 ! lids are turn$1 or argyrol #bj to #be dropp$ into ! eye are among ! be/ antiseptics = local use4 ,if ! diplobacillus is pres5t z9c sulphate solution is indicat$4 ,! nose1 nasoph>ynx & ph>ynx %\ld nev] be ov]look$ 9 ?is disease4 ,follicul> ,conjunctivitis ,follicul> conjunctivitis is ( cat>rhal orig94 ,x is *>act]iz$ by ! pres5ce ( follicles4 ,!re may be only a few or a great _m4 ,if num]\s !y are (t5 9 r[s on ! palpebral conjunctiva4 ,microscopically !y %[ z circumscrib$ masses ( ad5oid tissue4 ,9 ?is !y resemble ! granules ( tra*oma4 ,sometimes cases p]si/ = ye>s ) little or no inflammatory symptoms4 ,on acc\nt ( ! follicles ?is disease is frequ5tly confus$ ) tra*oma4 ,we h he>d numb]s ( well mean+ consci5ti\s o/eopa?ic physicians te/ify to cur+ cases ( tra*oma ) a %ort c\rse ( o/eopa?ic treatm5t ) no pa?ology rema9+4 ,we are absolute believ]s 9 ! effectiv5ess ( o/eopa?ic treatm5t & want to give x full cr$it = do+ all x w2 b "h we want to ent] a plea to ! pr(ession t we ne$ m discrim9ation & def9it5ess 9 our diagnosis4 ,te*nique is be+ emphasiz$ & we say ,am56 ,x is prop] = u to be ?or\ghly compet5t 9 te*nique b diagnosis %\ld be made j z emphatic because sci5tific te*nique dep5ds ^u diagnosis = ea* individual case4 ,diff]5tiation ( follicul> conjunctivitis f tra*oma4 ,follicul> conjunctivitis occurs 7#a7 *iefly 9 ! "y2 7#b7 ! follicles are small]1 m %>ply limit$1 project m above ! conjunctiva1 are (t5 9 r[s1 & oval 9 %ape2 7#c7 ! disease cle>s up ) no bad aft] effects (t5 )\t any treatm5t & ! t5d5cy is to ultimately get well2 7#d7 x nev] leads to %r9k+ ( ! conjunctiva1 to pannus or o!r de/ructive sequel2 7#e7 x c arise )\t contagion & is n consid]$ contagi\s al?\gh1 l tra*oma1 x does attack l>ge numb]s ( p :o are conf9$ 9 a small place4 ,tra*oma4--7#a7 ,x seldom occurs 9 *ildr52 7#b7 ! follicles are l>g]1 d n h %>p outl9es1 are less prom95t "u ! conjunctiva1 are r\nd 9 %ape & nev] 9 r[s2 7#c7 t5ds to lead to m or less pa?ology & seldom recov]s spontane\sly2 7#d7 sc> tissue becomes a product ( ! inflammation 9 ! conjunctiva & leads to %r9k+ ( ! conjunctiva1 caus+ 9 turn entropion & tri*iasis4 ,pannus is ! sure result ( un>re/$ cases z !re is a t5d5cy to infection ( ! cornea f ! infect$ conjunctiva mov+ ov] x & rema9+ 9 contact2 7#e7 tra*oma has be5 prov$ to be contagi\s4 ,tra*oma bodies :i* are consid]$ ! infective ag5t h be5 isolat$4 ,! use ( atrop9e 9 "s in/ances w cause a follicul> cat>rh :i* cle>s up on /opp+ ! use ( ! poison4 ,p>9auds 8,infecti\s conjunctivitis0 has granulations b almo/ always occurs 9 only "o eye & is accompani$ ) con/itutional symptoms4 ,treatm5t ( ,follicul> ,conjunctivitis4--,! treatm5t %\ld be direct$ aga9/ ! inflammation4 ,! trophicity ( ! n]ve t]m9als to ! conjunctiva may be alt]$ by o/eopa?ic lesions4 ,sugge/ions "u *ronic cat>rhal conjunctivitis apply "h4 ,if !re is no inflammation ! follicles t5d to disappe>1 leav+ no trace ( pa?ology1 h5ce a few o/eopa?ic treatm5ts ( ! lids & ! c]vical region w ha/5 normalization4 ,gonorrheal ,conjunctivitis ,?is disease is sometimes call$ purul5t oph?almia or acute bl5norrhea1 ,x is caus$ f an infection ( ! conjunctival sac ) ! gonococcus ( ,neiss]4 ,contact ) soil$ f+]s or l95 may transf] ! g]m4 ,symptoms4--,)9 #ab-dh h\rs aft] inoculation ! fir/ symptoms ( r$ness & irritation occur4 ,?is is soon foll[$ by mu* swell+ & t5sion ( ! lids & *emosis ( ! conjunctiva4 ,!re is mu* pa9 & a copi\s dis*>ge ( pus com+ f b5ea? ! lids4 ,at fir/ ! pus is yell[ or yell[i% gre54 ,lat] ! symptoms beg9 to subside2 !re is less t5s5ess & heat2 ! lids c be m readily ev]t$ & ! dis*>ge ceases aft] #f or #h weeks4 ,! puck]$ conjunctiva becomes r\gh & granul>4 ,9 ^! cases ! prognosis is always grave2 m s ?an 9 oph?almia neonatorum4 ,! eye is almo/ always m>r$ 9 "s way4 ,"o ( ! great dang]s is involvem5t & de/ruction ( ! cornea4 ,if ! cornea becomes hazy soon aft] symptoms beg9 x is n a good om54 ,ulc]s w likely =m & !n !re is a t5d5cy to puncture ! cornea4 ,9 mild cases ! cornea may escape )\t injury4 ,9 sev]e cases x is likely to ulc]ate4 ,if x p]=ates1 ! ant]ior *amb] is empti$ & ! iris prolapses into ! p]=ation2 adhesions take place & !re is heal+ ) re=mation p>tially ( ! ant]ior *amb]4 ,an adh]5t leucoma is ! result ) practical loss ( vision4 ,!re may be a bulg+ ( ! cornea kn[n z ant]ior /aphyloma4 ,! iris & cili>y body may become involv$1 caus+ iritis & cyclitis1 or ! :ole inn] /ructures may be affect$ mak+ a panoph?almitis ) atrophy ( ! eyeball4 ,! cornea is affect$ by ! infective mat]ial direct or ! nutri5t vessels to ! cornea at ! limbus may be ob/ruct$ by ! extreme swell+ & pressure4 ,complications ( ar?ritis1 rh9itis1 septicemia & endoc>ditis may arise4 ,if !re is none ( ^!1 at lea/ !re is a g5]al debilitat$ condition :i* ne$s att5tion4 ,treatm5t4--,! treatm5t %\ld be local & con/itutional1 ,! diagnosis %\ld be made quickly f ! hi/ory1 symptoms microscopically1 & local cleans+ begun at once & foll[$ dilig5tly4 ,excessive dis*>ge %\ld be wip$ away ) cotton4 ,! conjunctival sac %\ld be ?or\ghly irrigat$ e h\r or (t5] if necess>y to keep x clean4 ,?is is to be done day & night4 ,a saturat$ solution ( boric acid may be us$1 or corrosive sublimate "o gra9 to ! p9t1 or p]manganate ( potassium solution #a-ejjj4 ,! irrigation %\ld be foll[$ by ! free use ( argyrol #be4 ,?is proc$ure w keep ! eye clean & be ! means (t5 ( sav+ ! cornea f de/ruction & ! eye f bl9dness4 ,if !re %\ld be ulc]ation ( ! cornea a drop ( atrop9e %\ld be us$ 9 ! eye (t5 en\gh to keep ! pupil dilat$ & ! cili>y body at re/4 ,o/eopa?ic physicians no less ?an o!r physicians %\ld n neglect ?is local1 c>eful1 p]si/5t1 antiseptic cleans+ ( ! eye 9 su* cases4 ,! o/eopa?i/ c d m4 ,he is n limit$ to antisepsis ev5 9 ?is k9d ( "w1 h[ev] important x might be4 ,! unaffect$ eye %\ld be c>efully protect$4 ,bull]'s %ield %\ld be us$4 ,! o/eopa? %\ld give ?or\gh treatm5ts to ! neck & ! fif? n]ve4 ,support+ treatm5t to ! sy/em accord+ to indications %\ld be giv5 e4 g41 b[els1 kidneys1 n]ves1 muscles1 jo9ts z 9 con/ipation1 nephritis1 neurosis1 rheumatism1 ar?ritis1 endoc>ditis1 septicemia1 rh9itis etc4 ,oph?almia ,neonatorum ,?is is an acute purul5t conjunctivitis 9 ! new-born4 ,neonatorum comes f a junction ( ! ,greek ^w ,neos--new1 to ! ,lat9 ^w natus--born2 new-born4 ,?is disease is ! bugbe> to ! ob/etrician4 ,he mu/ always be on ! look\t = x & act promptly 9 ord] to save sight4 ,e g5]al practician %\ld make a c>eful /udy ( ?is disease if he expects to treat *ildr54 ,sixty to sev5ty p]c5t ( conjunctivitis neonatorum is due to ! infection ) ! gonococcus ( ,neiss]4 ,x usually comes f a gonorrheal dis*>ge f ! g5itals ( ! "m4 ,! nurse or anyone :o h&les ! baby might be ! ag5t 9 ! transmission ( ! infection4 ,! disease is n always ( gonorrheal orig94 ,"s cases are due to ! pneumococcus1 /reptococcus1 diplobacillus or "o v>iety ( /aphylococci4 ,?us !re are two v>ieties or types ( oph?almia neonatorum2 a sev]e type :i* is gonorrheal or specific & a mild type :i* is non-specific4 ,9 "s /ates !re is a law :i* requires ! use ( silv] nitrate 9 ! eyes ( all babies at bir?4 ,e baby's eyes %\ld be ?or\ghly wa%$ at bir?1 ) boric acid & :]e !re is ! lea/ suspicion ( gonorrhea silv] nitrate #a or argyrol #be %\ld be us$4 ,a r\t9e use ( "o ( ! silv] salts w\ld be good practice4 ,symptoms4--,gonorrheal cases beg9 usually ! ?ird day aft] bir?1 non-gonorrheal1 on ! fif? or six? day4 ,bo? eyes are usually involv$1 "o worse ?an ! o!r4 ,! lids swell mu*4 ,!re is *emosis ( ! conjunctiva :i* may put ! cornea 9 a pit4 ,! dis*>ge is abundant4 ,x is yell[ or gre5i% yell[4 ,! disease gradually decl9es & ! dis*>ge ceases 9 six to eight weeks4 ,! conjunctiva is ?ick5$ & looks granul>4 ,may be "s cicatricial *anges4 ,! *ief dang] is to ! cornea1 m s if x becomes hazy ! fir/ two days4 ,corneal lesions seldom occur 9 non-specific =ms4 ,if ! cornea is involv$ p]=ation is likely1 ) a g5]al inflammation ( ! eyeball 7panoph?almitis7 foll[$ by atrophy 7ph?isis bulbi74 ,complications su* z rh9itis1 m5+itis1 endoc>ditis & g5]al septicemia may occur4 ,diagnosis is made f ! onset1 "*1 symptoms & c\rse ) ! use ( ! microscope4 ,prognosis4--,delay$ or improp] treatm5t 9 ^! cases w likely be fatal to sight z sl\gh+ ( ! cornea w occur4 ,) prompt & prop] c>e ! prognosis is favorable4 ,treatm5t4--,mild cases 7non-specific7 are treat$ 9 ! same mann] z simple conjunctivitis4 ,9 sev]e cases 7specific7 clean ! eye c>efully & apply cold compresses ( gauze #ae to #bj m9utes at a "t e h\r or two4 ,keep ! gauze on a block ( ice & *ange e few m9utes4 ,if ! cornea is involv$ heat may prove m satisfactory4 ,!re mu/ be con/ant removal ( ! dis*>ge4 ,wipe away ! excess & irrigate freely ) boric acid at lea/ e h\r day & night & m (t5 if necess>y4 ,aft] ea* wa%+ use a solution ( argyrol #be4 ,once a day silv] nitrate #a solution may be us$ & wa%$ out ) a salt solution4 ,if ! cornea %\ld ulc]ate ! treatm5t ne$ n be alt]$4 ,! att5dants %\ld be c>efully in/ruct$ z to ! importance ( ! c>e & ! contagi\s nature ( ! pus4 ,antisepsis & cleanl9ess "h is m ess5tial1 effective & exclusive ?an 9 any o!r disease ( ! eye4 ,wisdom 9 ! use ( antiseptics is a /rong po9t 9 ! armam5t>ium ( e progressive o/eopa?4 ,tra*oma ,?is disease is kn[n z granul> lids or granul> conjunctivitis4 ,al?\gh ! g]m has n be5 discov]$1 we "k ?is is an infecti\s disease4 ,a r\ghness & hyp]trophy ( ! conjunctiva develops4 ,!re is developm5t ( follicles or granulations4 ,lat] ^! products are absorb$ & cicatrization ( ! tissues foll[s4 ,cause4--,tra*oma is f\nd mo/ common 9 ,egypt & ,arabia4 ,x spreads easily 9 cr[d$ in/itutions4 ,x is 9 _m in/ances a mix$ infection ) ! ,morax-,ax5feld bacillus1 ,ko*-,weeks bacillus & ! gonococcus4 8,tra*oma bodies0 h be5 discov]$ :i* are claim$ by "s to be a causative factor 9 ! disease4 ,^! small bodies are n f\nd 9 all cases h[ev]4 ,sp9al lesions ( ! c]vical & upp] f\r ?oracic v]tebr w di/urb ! blood & n]ve supply to ! eye :i* w pr$ispose to ! disease %\ld "s ( ! virus or g]ms ( tra*oma be pres5t4 ,9 practically all ^! cases !re is t5d]ness if n an actual twi/ at ! second & ?ird ?oracic4 ,symptoms4--,a small boy came to our cl9ics compla9+ t 8 left eye 0 small] ?an ! "r4 ,no inflammation or swell+ 0 prom95t4 ,! eye look$ normal except slightly small] ?an ! "r4 ,on turn+ ! lid granules 9 ! =nix ( t eye 7 readily notic$4 ,tra*oma _h a good />t4 ,! tissues 7 s hyp]trophi$ 9 t region t ! eye c\ld n be op5$ q z wide z ! o!r "o1 h5ce ! impression t t eyeball 0 small]4 ,! granulation (t5 develops s insidi\sly t ! victim may h ! disease = mon?s be=e he realizes he has a bad eye4 ,:5 symptoms appe> !re may be photophobia1 la*rymation1 glu+ ( ! lids f a scanty secretion1 pa91 & blurr+ ( vision4 ,! granules are gray1 transluc5t & r\ndi% "u ! conjunctiva4 ,hyp]trophy increases to a c]ta9 height :5 cicatrization & contraction beg94 ,! duration may be ye>s4 ,! m ! hyp]trophy ! long] ! duration & ! great] ! contraction4 7,note "h t treatm5t %\ld be direct$ t[>d combatt+ ! hyp]trophy by e/abli%+ circulation74 ,sequel4 ,i m]ely m5tion ! sequel "h3 pannus1 ulc]ation ( ! cornea1 tri*iasis1 dy/ri*iasis1 entropion1 ectropion1 symbleph>on1 x]osis1 corneal opacities4 ,= ! explanation1 pa?ology & treatm5t ( ^! sequel n cov]$ 9 ?is treatise1 see any good works on diseases ( ! eye z ,weeks1 ,fu*s or ,de ,s*we9itz4 ,treatm5t ( ,tra*oma4--,9 report+ cases ( tra*oma treat$ & cur$ by o/eopa?y we %\ld be sure ( our diagnosis4 ,! treatm5t is antiseptic1 hydro!rapeutical1 o/eopa?ic & op]ative4 ,a saturat$ solution ( boric acid %\ld be us$4 ,argyrol #bj is good if !re is mu* secretion4 ,nitrate ( silv] #b & copp] sulphate are /ill us$ 9 "s cases to advantage z claim$ by "s physicians4 ,! o/eopa? %\ld c\nt on c>eful cleanl9ess4 ,hot compresses ov] ! eyes are (t5 v agreeable4 ,op]ations are (t5 p]=m$ = tra*oma4 ,! granules are roll$ out ) ,knapp's roll] =ceps1 & o!r me?ods4 ,grattage is practic$ ) "s wond]ful results4 ,x is done z foll[s3 ,get "s f9e s& pap] & cut x 9 /rips ab\t "o-half in* wide by ?ree or f\r in*es long4 ,put x 9 alcohol 9 a vessel = t5 to fifte5 m9utes4 ,p\r (f all ! alcohol except a few drops t w cl+ to ! vessel by capill>y attraction4 ,t\* a mat* to ! residue4 ,?is w burn j en\gh to make ! s& pap] absolutely /]ile )\t burn+ ! latt]4 ,put ! pati5t "u somn(orm4 ,use a small art]y =ceps to grasp ! edge ( ! eyelid1 roll ! lid back ov] ! art]y =ceps to expose all granulations cle> to ! =nix4 ,use a protector to ! eyeball4 ,n[ ) ! s&pap] quickly scrape or curette away all ( ! tra*oma bodies & granulations4 ,repeat ! process on ! o!r eye if x is involv$4 ,wa% out well ) a saturat$ solution ( boric acid & b&age ! eyes = a few h\rs4 ,?is w cause consid]able swell+ & inflammation4 ,use cold applications & keep ! eyes dis9fect$4 ,i h se5 "s v good results f ?is me?od4 ,o/eopa?ic4--,foll[+ ! s& pap] op]ation a ?or\gh treatm5t ( ! c]vical & upp] dorsal region w\ld add consid]ably to ! rapidity ( ! pati5t's recov]y & s5se ( well be+4 ,g5]al tonic treatm5t is ( special b5efit 9 ne>ly all tra*oma cases z !y are subnormal 9 _! g5]al heal?4 ,"o =m ( te*nique :i* has be5 us$ by myself & o!rs to advantage 9 ^! cases is z foll[s3 ,/]ilize ! f+]s c>efully1 lubricate ) vasel9e or ,k4 ,y4 ! =ef+] ( ! "r h&4 ,) ! left h& raise ! upp] lid & introduce ! =ef+] ( ! "r h& ) ! ?umb above4 ,cat*+ ! lid betwe5 ! ?umb & f+] squeeze & massage ! :ole /ructure cle> to ! =nix z ?or\ghly z possible4 ,repeat ! process on ! o!r eye4 ,a te*nique us$ by ,dr4 ,edw>ds ( ,/4 ,l\is is z foll[s3 ,aft] /]iliz+ & lubricat+ ! =ef+] lift ! lid & introduce ! f+] z f> z possible into ! orbit pu%+ ! =nix back into ! orbit4 ,?is /ret*es all ! tissues ar\nd ! =nix1 op5+ up a bett] conjunctival & palpebral circulation4 ,! cili>y vessels & n]ves are /ret*$ & /imulat$4 ,x is r surpris+ to "o :o has n tri$ x1 h[ f> ! f+] c be introduc$ into ! orbit4 ,"o set ( n]ves t %\ld be especially /udi$ & consid]$ 9 tra*omat\s conditions is ! c]e-brobulbo-sp9o-sympa!tic-cili>y arc4 ,?is has already be5 elaborat$4 ,all sp9al lesions %\ld be c>efully diagnos$ & correct$4 ,dr4 ,t4 ,j4 ,ruddy's ?ird f+] eye in/rum5t is v useful 9 ^! conditions 9 re/or+ normal circulation ab\t ! orbit4 ,see t ! nose & ?roat are normal4 ,phlyct5ul> ,conjunctivitis ,by "s ?is disease is consid]$ an eczema ( ! conjunctiva4 ,?is w at lea/ enable u to get an idea ( ! conjunctival pa?ology4 ,:at is said ( phlyct5ul> conjunctivitis applies l>gely to its correspond+ disease ( ! cornea-phlyct5ul> k]atitis4 ,scr(ul\s oph?almia is appli$ by "s because s _m ( ^! phlyct5ul> pati5ts h scr(ula4 ,h]pes conjunctiv is us$ z a "n because ( ! small bli/]s or blebs t =m 9 ! beg9n+ /age4 ,little r$ em95ces develop ne> ! limbus 7scl]ocorneal junction74 ,!y are cone %ap$1 slightly elevat$ ab\t ! surr\nd+ tissue4 ,!re may be "o or sev]al1 usually n m ?an "o or two4 ,aft] a few days ! cone breaks & on top appe>s a small gray ulc]4 ,!re is fur!r break+ d[n & ! cone disappe>s leav+ an ulc] on level ) ! conjunctiva4 ,vessels are conge/$ ab\t x4 ,!re may (t5 be not$ an area ( small vessels1 fan l 9 %ape1 runn+ f ! out] region ( ! conjunctiva to ! ulc] or phlyct5ule4 ,etiology4--,?is is a disease ( frequ5t occurr5ce 9 *ildr51 mo/ly among ! poor classes4 ,su* ?+s z eczema1 dirt1 ad5oids1 scr(ula1 rh9itis1 malnutrition1 abuse ( tea & c(fee & exan!mat\s disease are m5tion$ by oculi/s z causes4 ,i h no d\bt any or all ^! conditions pr$ispose to phlyct5ul> conjunctivitis4 ,de ,s*we9itz 9 8,diseases ( ! ,eye10 #aiaf edition1 p4 #bdb1 says3 8,! exact cause ( ocul> lesions1 or phlyct5ul> eruption1 has n be5 det]m9$40 ,i h met ,dr4 ,de ,s*we9itz & he>d him lecture on ! eye4 ,i consid] him "o ( ! be/ eye speciali/s 9 ! c\ntry4 ,8 exp]i5ce & /udy ) ! eye dates ov] _m ye>s & 8 book has gone ?r\gh eight editions4 ,he is pr(essor ( oph?almology 9 ! ,univ]sity ( ,p5nsylvania2 ,oph?almic ,surgeon to ! ,philadelphia ,polycl9ic ,hospital1 ! ,philadelphia ,g5]al ,hospital etc41 etc4 ,8 op9ion repres5ts ! summ>y ( ! inve/igation ( ! oph?almic pr(ession ! _w ov] & ?r\gh all ! pa/ d[n to ! pres5t "t4 8,! cause ( phlyct5ul> conjunctivitis is n kn[n40 ,bact]iology4--,at times 9 ! ulc]s h be5 f\nd ! /aphylococcus pyog5es aureus & albus4 ,!y are also f\nd 9 a normal conjunctival sac4 ,!y c\ld n ) logic be tak5 z a causative factor2 at lea/ !y w\ld be only second>y4 ,if oculi/s & o!r /ud5ts ( ! eye all _h a good deep o/eopa?ic vision to ?r[ light ^u ^! problems _m causative factors w\ld take on a new mean+4 ,su* suppos$ causes z h be5 m5tion$1 e4 g4 eczema1 ad5oids1 rh9itis & malnutrition may easily be second>y to ! o/eopa?ic lesions4 ,micro-organisms may be enabl$ to act because ( trophic & circulatory di/urbances to ! conjunctiva ?r\gh di/urb$ n]ve connections f lesions 9 ! c]vical & upp] dorsal regions4 ,h]pes zo/] is purely a trophic n]ve di/urbance manife/ation on ! sk9 z blebs or bli/]s ) m or less neuritis4 ,any lesion t w\ld affect ! integrity ( ! function ( ! fif? cranial n]ve might easily manife/ itself z h]pes ( ! conjunctiva4 ,we believe ! o/eopa?ic lesion is prim>y & fundam5tal 9 ! causation ( mo/ ( our phlyct5ul> conjunctivitis4 ,( c\rse insanitation1 scr(ul\s dia!sis & ! exan!mata play _! role4 ,a good diagno/ician %\ld figure out ! relative importance4 ,! hi/ory1 onset & exam9ation w usually elim9ate ^! conditions4 ,symptoms4--,la*rymation1 photophobia1 bleph>ospasm & inject$ vessels are ! *ief symptoms4 ,!re is pa9 z well z fe> ( light4 ,! *ild fights exam9ation4 ,! attack subsides 9 t5 to f\rte5 days unless !re is multiplicity ( blebs4 ,"s pati5ts h repeat$ attacks = mon?s or ye>s4 ,_m ( ^! cases 9 m$ical cl9ics keep com+ = mon?s ) repeat$ attacks4 ,nev] leave out c>eful o/eopa?ic treatm5t4 ,prognosis4--,?is is favorable = a f9al cure4 ,if !re %\ld be multiple blebs & frequ5t recurr5ce & ! cornea is invad$1 ! prognosis is n good = p]fect sight4 ,! pa?ology goes deep en\gh to affect ,b[man's membrane ( ! cornea di/urb+ ! sub/antia propria4 ,?is causes a macul> condition ( ! cornea :i* impairs sight4 ,!rapy4--,diet %\ld be bl&2 ! eyes %\ld be protect$ f irritants2 yell[ oxide o9tm5t %\ld be us$ 9 ! eye once a day or #aj argyrol4 ,! o9tm5t is pref]r$4 ,moi/ w>m compresses on ! eye are com=t+4 ,a boric acid wa% 9 almo/ all conjunctival tr\ble is good4 ,if !re is mu* irritation giv+ a suspicion ( iris involvem5t a drop ( atrop9e %\ld be us$4 ,! g5]al regimes ( liv+ %\ld be regulat$4 ,o/eopa?ic treatm5t %\ld be direct$ t[>d build+ up ! g5]al heal? & correct+ all lesions1 especially t may h a specific be>+ on ! eye tr\ble4 ,su* lesions w be f\nd m (t5 at ! fir/1 second & ?ird ?oracic1 b may be any:]e f !re to ! occiput4 ,v]nal ,conjunctivitis ,?is disease is kn[n by _m z v]nal cat>rh or spr+ cat>rh ( ! conjunctiva4 ,x is a *ronic inflammation :i* sets up *anges 9 ! conjunctiva & t>sus4 ,?is disease may be confus$ ) tra*oma unless "o obs]ves closely4 ,!re are broad flat papill on ! conjunctiva4 ,^! papill may readily be tak5 = granulations4 ,!y are l>g] ?an ! granules 9 tra*oma4 ,!y some:at resemble ! arrangem5t ( cobble /ones4 ,! conjunctiva has a blui%-:ite filmy appe>ance call$ by "s1 milky %imm]4 ,! disease 0 ?\ght at fir/ to appe> only 9 ! spr+1 h5ce ! "n v]nal4 ,_m cases cont9ue ?r\gh ! ye> ) exac]bations 9 ! spr+4 ,x occurs m (t5 9 boys4 ,bo? eyes are attack$4 ,x may heal & leave no trace4 ,x may la/ f f\r to tw5ty ye>s4 ,causes4--,almo/ all works on ! eye say ! cause is n kn[n4 ,de ,s*we9itz says1 8,def9ite in=mation 9 reg>d to ! cause ( ?is disease is lack+40 ,!re may be a micro-organism :i* has n be5 discov]$4 ,i wi% to call ! att5tion ( ! o/eopa?ic pr(ession to ! great fact t !re are numb]s ( diseases ( ! eye z well z ( o!r p>ts ( ! body ab\t :i* ! m$ical pr(ession are entirely 8at sea40 ,?is gives valuable gr\nd = sci5tific rese>* by our pr(ession4 ,my exp]i5ce ) ?is disease is n suffici5t = me to speak ) any positiv5ess or f9ality z to its cause4 ,! alt]$ trophic p>ts & ! v *ronic condition exi/+ leads me to ! firm belief t we w ultimately f9d ! cause z a me*anical lesion affect+ ! trigem9al or sympa!tic 7or bo?7 n]ve connections4 ,gl>e ( light & local irritants act only z second>y causes4 ,nasal disease may be associat$ & act z a cause4 ,symptoms4--,!re is photophobia1 "s mucus1 slight p]icorneal injection1 r$ness ( ! conjunctiva ( bo? ! bulb & lids2 t ( ! lids is ?ick5$ & ( dull pale color due to sub-epi!lial hyal9e ?ick5+4 ,! fact t !re is no pannus1 & flat granulations & recurr5ce ) spr+1 m>ks x f tra*oma4 ,prognosis4--,"u m$ical treatm5t x is unfavorable2 may la/ tw5ty ye>s4 ,slight opacity ( ! cornea may develop4 ,treatm5t4--,! eyes %\ld be protect$ ) d>k glasses4 ,cold compresses give "s relief4 ,boric acid is good z a wa%4 ,yell[ oxide ( m]cury o9tm5t may be ( s]vice z an antiseptic & alt]native4 ,if nasal disease exi/s1 x1 ( c\rse1 %\ld be treat$ accord+ to indications4 ,fundam5tally ! lesions 9 ! sp9e 9 ! c]vical & upp] dorsal regions %\ld be specifically correct$4 ,:5 en\gh cases ( v]nal cat>rh h be5 obs]v$ & treat$ o/eopa?ically mu* light & b5efit w be br\ght to be> ^u ?is obscure & intractable disease ( ! conjunctiva4 ,diseases ( ! ,cornea ,anatomy ,! cornea ) ! scl]a =ms ! out] coat or tunic ( ! eye ball4 ,! cornea is 9 front & =ms "o-six? ( ! envelope4 ,x is a segm5t ( a small] globe ?an t ( ! scl]a4 ,x is ab\t #ab mm4 horizontally & #aa mm4 9 ! v]tical diamet]4 ,its ?icke/ "p is at its junction ) ! scl]a :]e x is ab\t #a mm4 ,?is junction is call$ ! limbus4 ,! cornea is ins]t$ into & re/s on ! scl]a l a wat* cry/al4 ,! fib]s ( ! cornea pass cont9u\sly into ! scl]a1 h[ev]4 ,! normal cornea is transp>5t4 ,mo/ morbid *anges ( ! cornea cause a dim9ution 9 ?is transp>5cy4 ,9 old age a n>r[ gray l9e ne> ! corneal m>g9 makes its appe>ance4 ,?is is kn[n z ! arcus s5ilis4 ,!re is a little /rip ( p]fectly cle> cornea betwe5 ! arcus s5ilis & ! limbus4 ,! cornea has five lay]s4 ,^! lay]s %\ld be not$ ) c>e1 z 9 w\nds ( ! eye1 =eign bodies 9 ! cornea & ulc]ations1 ! results dep5d mu* ^u :i* lay]s are affect$4 #a4 ,! ant]ior epi!lium consi/s ( pavem5t cells ( sev]al lay]s4 ,?is lay] ( ! cornea may be damag$ or scrat*$ (f 9 l>ge pat*es & /ill x w heal readily leav+ no trace ( ! injury4 #b4 ,! ant]ior ela/ic lam9a or ,b[man's membrane is v ?9 & homog5e\s2 x is j b5ea? ! epi!lial lay] & =ms a resi/+ %ea? to prev5t damage to ! next lay]4 #c4 ,! /roma or sub/antia propria4 ,?is lay] composes ab\t n9e-t5?s ( ! cornea4 ,x is compos$ ( m9ute connective tissue fib]s betwe5 :i* lie "s /roma cells or corneal corpuscles4 ,"s ( ^! cells are fix$ :ile o!rs are motile4 ,! motile ones are ! :ite blood-corpuscles :i* move ab\t 9 ! lymph passages ( ! /roma4 ,!y increase 9 any irritation ( ! cornea4 #d4 ,descemet's membrane4 ,?is is a t\gh homog5e\s hyaloid membrane back ( ! /roma4 ,:5 ! /roma is diseas$ & breaks d[n ,descemet's membrane may be suffici5t to prev5t a puncture ( ! cornea4 #e4 ,! ,endo!lial lay] is a s+le lay] ( flatt5$ cells :i* coat ! po/]ior surface ( ,descemet's membrane4 ,! m>g9 ( ! cornea is 9 relation ) ?ree membranes1 ! conjunctiva1 ! scl]a & ! uvea 7iris & cili>y body74 ,9 a disease ( ! cornea1 a conjunctivitis1 an iritis or a cyclitis is easily />t$4 ,! cornea conta9s no vessels4 ,x is n\ri%$ by imbibition4 ,at ! limbus !re is a ri* network ( m>g9al loops suppli$ by ! ant]ior cili>y vessels4 ,f ^! loops ! blood plasma passes into ! /roma ( ! cornea4 ,! n]ves ( ! cornea come f ! cili>y n]ves & ! n]ves ( ! bulb> conjunctiva4 ,^! are f ! trigem9us & ! sympa!tic4 ,! n]ves ext5d num]\sly 9 ! /roma pass+ =w>d ?r\gh ,b[man's membrane into ! epi!lial lay]4 ,?is makes ! cornea v s5sitive to ! t\*4 ,exam9ation ( ! ,cornea ,note ! size & =m4 ,bo? may be modifi$ by morbid processes4 ,note ! surface ) reg>d to curvature1 ev5ness & smoo?ness4 ,9 k]atoconus ! curvature is greatly increas$4 ,not+ ! reflex images 9 ! cornea & comp>+ ^! ) ^? ( a normal cornea w %[ any v>iation 9 curvature4 ,also any unev5ness ( ! surface may be not$ by ! irregul>ity or di/ortion ( ! images4 ,unev5 spots on ! cornea may be depressions or elevations f loss ( sub/ance2 wr9kles or collapse f l[]$ t5sion4 ,if ! smoo?ness or poli% ( ! cornea is lo/ x looks l glass t has be5 brea!d ^u or greas$4 ,x is lu/]less & dull4 ,note also ! transp>5cy ( ! cornea & det]m9e ! =m1 ext5t & d5sity ( ! opacity2 :e!r x is diffuse or 9 spots2 9 ! deep or sup]ficial lay]s4 ,a magnify+ glass %\ld be us$ 9 ! /udy ( opacities4 ,accord+ to ! d5sity ( ! opacity ( ! cornea x is kn[n z a nebula or a nebul\s opacity1 a macula or a leucoma4 ,! nebula is ! lea/ noticeable & ! leucoma is ! d5se/ opacity4 ,a leucoma is a condition ( complete opacity4 ,! cornea looks :ite4 ,defects 9 ! corneal epi!lium may be made to %[ cle>ly by ! use ( a #b solution ( fluoresce9 :i* /a9s !m gre54 ,note ! s5sitiv5ess ( ! cornea by t\*+ x ) ! end ( a ?read1 a little cotton or a %r$ ( pap]4 ,! s5sitiv5ess is dim9i%$ or lo/ 9 glaucoma & "s o!r diseases4 ,diseases ( ! ,cornea ,almo/ all diseases ( ! cornea h "s =m or degree ( inflammation4 ,k]atitis is ! ^w g5]ally us$ = inflammation ( ! cornea4 ,9 ord] to aid cle>ness 9 discussion !re are v>i\s subdivisions ( k]atitis made by diff]5t writ]s4 ,suppurative & non-suppurative are ! pr9cipal types4 ,9 suppurative k]atitis !re is always "s de/ruction ( corneal tissue :i* on heal+ leaves an opacity ) p>tial loss ( vision4 ,g]ms ga9 entrance into ! tissues usually f ! ext]ior & "s =m ( ulc]ation results4 ,! foll[+ classification is tak5 f ,fu*s3 ,suppurative ,k]atitis4--7#a7 ,ulc] ( ! cornea2 7#b7 ,s]pig9\s ulc]2 7#c7 ,k]atomalacia or ,x]osis2 7#d7 ,k]atitis neurop>alytica4 ,non-suppurative ,k]atitis4--7,a7 ,,sup]ficial3 7#a7 ,pannus1 or k]atitis ) blood vessels2 7#b7 ,phlyct5ul>1 or k]atitis ) vesicles4 7,b7 ,,deep3 7#a7 ,p>5*ymat\s or int]/itial4 ,9 k]atitis !re is fir/ an infiltration or ! increase ( cells 9 ! sub/antia propria or ! p>5*yma ( ! cornea4 ,?is is ! exudate ( ! inflammation4 ,x causes ! cornea to look m or less dull or cl\dy4 ,! disease may cle> up at ?is po9t or g on to suppuration4 ,if x cle>s up x is kn[n z resorption4 ,if ! lamell ( ! sub/antia propria are n de/roy$ by ! process1 resorption takes place ) no loss ( sub/ance4 ,! exudate disappe>s & !re is p]fect transp>5cy ( ! cornea aga94 ,!re may be slight damage ( ! /roma prev5t+ p]fect transp>5cy4 ,resorption ( ! exudate may n be q complete :i* may become p>tly organiz$ & left p]man5tly fix$ 9 ! cornea4 ,cases resorb+ )\t de/ruction ( ! /roma are =ms ( ! non-suppurative k]atitis gr\p4 ,if ! /roma breaks1 suppuration occurs4 ,?is is ! second /age & is associat$ ) a localiz$ de/ruction ( ! cornea4 ,^! cases are kn[n z suppurative k]atitis or ulc]ation ( ! cornea4 ,! dis9tegration beg9s 9 ! mo/ ant]ior lay]s ( ! cornea4 ,a slight depression 9 ! cornea c be notic$4 ,! infiltration is all ab\t ! ulc]1 gett+ less z x is m remote f x4 ,if ! floor & walls ( ! ulc] are f\l ) ! infiltrate x is kn[n z a progressive ulc]4 ,sl\gh+ may cont9ue to spread ! ulc]4 ,if ! cl\d9ess ar\nd x disappe>s & ! ulc] acquires a smoo? transp>5t base & edges x is kn[n z a retrogressive or clean ulc]4 ,! dis9tegrat$ areas ( ! cornea may be replac$ by newly =m$ tissue4 ,?is is ! ?ird /age or t ( cicatrization4 ,?is new tissue is connective tissue4 ,x is opaque1 leav+ a p]man5t opacity4 ,/ages ( k]atitis3 ,suppurative4--7#a7 ,infiltration2 7#b7 ,suppuration & 7#c7 ,cicatrization or ,rep>ation4 ,! suppuration is progressive or retrogressive4 ,non-suppurative4--7#a7 ,infiltration2 7#b7 ,resorption4 ,9 ! diagnosis ( a k]atitis "o %\ld look at x v c>efully4 ,a l\pe :i* has ?ick plus sph]e l5ses w magnify ! field & may be ( great assi/ance 9 obs]v+ closely ! condition4 ,if ! cornea is cl\d$ & dull ! tr\ble is rec5t & if !re is no loss ( sub/ance x is an infiltrate 7fir/ /age74 ,if !re is loss ( sub/ance x is a progressive ulc] 7second /age47 ,if ! surface is lu/r\s b cl\dy ! tr\ble is an old "o & if !re is loss ( sub/ance x is a retrogressive ulc]2 if no loss ( sub/ance x is a cicatrix4 ,frequ5tly blood vessels gr[ 9 f ! m>g9 9 ulc]ations ( ! cornea4 ,?is is usually a process ( heal+ ( ! corneal ulc]4 ,! adv5t ( ! blood vessels is favorable4 ,aft] heal+ ! blood vessels gradually disappe>4 ,!y nev] entirely disappe> f l>ge cicatrices4 ,9 "s cases new vessels accompany ! inflammatory process & l ! exudate are a "p ( ! cl9ical picture ( ! disease z 9 p>5*ymat\s or int]/itial k]atitis4 ,pannus also has vessels4 ,!y are n 9 ! cornea b are 9 new tissue deposit$ ^u x4 ,symptoms appe>+ 9 k]atitis3 #a4 ,cili>y injection or a r$ area encircl+ ! cornea4 ,if ! k]atitis is sev]e !re w be consid]able inflammation ( ! conjunctiva :i* may hide to "s ext5t ! cili>y injection4 #b4 ,iritis or iridocyclitis may set 94 ,! iris & cili>y body are 9 su* intimate relation ) ! cornea t ^! /ructures are v subject to involvem5t 9 any sev]e k]atitis4 ,) iritis w\ld come dang] ( syne*iae or adh]5ce ( ! iris to ! ant]ior surface ( ! l5s4 #c4 ,hypopyon4--,9 suppurative k]atitis !re is "s exudate into ! ant]ior *amb] ( ! eye4 ,?is exudate drops to ! bottom ( ! *amb] & looks l pus _h ga!r$ 9 ! bottom ( ! aque\s4 ,?is condition is call$ hypopyon4 #d4 ,o!r symptoms :i* are frequ5tly prom95t are dim9i%$ vision1 pa91 photophobia1 excessive la*rymation & bleph>ospasm4 ,edema ( ! lids & conjunctiva may occur4 ,intellig5t treatm5t ( k]atitis ( c\rse is bas$ ^u ! exact conditions pres5t4 ,great c>e 9 diagnosis & treatm5t %\ld be ex]cis$4 ,ulc] ( ! ,cornea ,inflammation ( ! cornea sets 9 f "s cause4 ,!re is an infiltrate into ! sub/antia propria4 ,a spot becomes cl\dy & ! surface ov] x becomes dull2 at ?is po9t ! epi!lium breaks d[n or exfoliates & ! loss ( sub/ance 9 ! p>5*yma is ! beg9n+ ( an ulc]4 ,cause4--,! cause may be con/itutional or local4 ,! causes usually ?\ght ( f ! m$ical /&po9t may be not$ 9 su* books z 8,diseases ( ! ,eye0 by ,de ,s*we9itz or ,weeks4 ,i wi% especially to call att5tion to ! fact t !re is frequ5tly a prim>y & und]ly+ cause ( corneal ulc]s n m5tion$ 9 any m$ical texts1 i4 e4 ! o/eopa?ic lesion4 ,by ?is ,i mean m ?an ! sp9al lesion al?\gh ! subluxation lesions t result f ! occiput to ! f\r? dorsal are ( mo/ importance4 ,any t5sion or *ange ( tissue 9 ! c]vical region t may int]f]e ) p]fect fre$om ( circulation ( blood to ! tracts & c5t]s 9 ! cord1 is to be consid]$4 ,! o/eopa? ( c\rse %\ld take into consid]ation all causes prim>y & second>y & gov]n himself accord+ly4 ,symptoms & ,c\rse4--,!re is a gray area surr\nd+ ! ulc] at fir/1 also ! floor is grayi% 9 color4 ,9 ?is condition x is kn[n z a progressive ulc] or a f\l or unclean ulc]4 ,?is cl\d9ess or gray area may increase 9 size & ! ulc] keep spread+1 or x may g deep] ev5 to p]=ation ( ! cornea4 ,"s ulc]s advance or spread on "o side & heal on ! opposite side s t !y creep along on ! cornea--^! are ! s-call$ s]pig9\s ulc]s4 ,) corneal ulc]s !re is irritation1 pa91 photophobia & increas$ la*rymation4 ,!re is usually "s cili>y injection :i* is an indication ( involvem5t ( ! iris & cili>y body4 ,if iritis occurs !re is contraction ( ! pupil ) sl[ reaction4 ,hypopyon may develop4 ,) iritis & ! exudate !re is likely to be adhesions betwe5 ! iris & ! l5s kn[n z po/]ior syne*ia4 ,a few corneal ulc]s are a/h5ic & d n h irritative symptoms & yet are dang]\s4 ,:5 ! ulc] beg9s to heal x is call$ retrogressive4 ,dead tissue is ca/ (f2 o!r tissue becomes transp>5t f resorption4 ,we h a clean ulc]4 ,symptoms disappe> & cicatrization beg9s4 ,vessels ext5d to ! ulc]s & soon x is level$ up ) ! corneal surface4 ,cicatrization may leave x slightly bel[ ! corneal level or above x4 ,if !re %\ld be p]=ation ( ! cornea f ! ulc] !re may be complications1 e4 g4 k]atocele1 loss ( aque\s1 dislocation & expulsion ( ! l5s1 intra-ocul> hemorrhage1 flatt5+ ( ! cornea1 fi/ula ( ! cornea1 glaucoma1 intra-ocul> suppuration1 prolapse ( ! iris into ! op5+1 etc4 ,^! complications & sequel t occur occasionally w n be consid]$ "h4 ,aft] heal+ is complete by cicatrization !re is opacity ( ! cornea 9 proportion to ! dep? & size ( ! ulc]4 ,9 mon?s & ye>s ( "t !re is "s cle>+ ( ! opacity s t small sup]ficial opacities may become invisible4 ,treatm5t ( ,corneal ,ulc]s4--,mo/ ulc]s ( ! cornea are q am5able to prop] treatm5t & ! prognosis is favorable4 ,neglect or wrong treatm5t is v dang]\s4 ,! treatm5t is local & con/itutional4 ,(t5 ! ulc] is kept go+ by un:olesome con/itutional conditions4 ,local ,treatm5t4--,?is v>ies accord+ to ! /age ( ! ulc]1 :e!r progressive or retrogressive4 ,9 a progressive or f\l ulc] if due to trauma any =eign bodies %\ld be remov$4 ,if ! ulc] is a result ( pa?ology ( ! conjunctiva x is ( prim>y importance to treat ! conjunctival condition4 ,9 mild cases ( ulc] a dress+ ov] ! eye ) atrop9e to keep ! pupil dilat$ is suffici5t local treatm5t4 ,! b&age protects ! eye f bright light & o!r environm5t & ! atrop9e puts ! iris & cili>y body at re/ prev5t+ complications & giv+ nature h] be/ *ance to "w4 ,if ! ulc] is rapidly progressive1 w>m compresses an h\r or two a day are good2 iod(orm spr9kl$ on ! ulc] or actual caut]y may be us$4 ,9 ! retrogressive /age 7clean ulc]7 heal+ has begun & we desire to get z ne> z possible a resi/ant transp>5t cicatrix4 ,yell[ oxide o9tm5t is useful at ?is /age4 ,o/eopa?ic4--,! local measures j m5tion$ are n incompatible ) o/eopa?ic !ory or practice4 ,!y are m]ely adjunctive 9 gett+ nature's reaction t[>d normalization1 z also are hot & cold applications4 ,o/eopa?y comes 9 n[ 9 a mo/ important & fundam5tal way ) ! con/itutional & specific lesion treatm5t4 ,! bulbo-sp9o-sympa!tic-cili>y arc has be5 m5tion$ & expla9$4 ,?r\gh ?is important n]ve connection ) ! eye1 pr(\nd & :olesome effects on ! eye may be gott5 by o/eopa?ic treatm5t4 ,frequ5tly lesions ( ! occiput1 c]vicals & upp] dorsals w affect ! integrity ( ! ocul> /ructures ?r\gh di/urbances ( n]ve & blood supply4 ,! /oma*1 b[els1 liv] & kidneys %\ld be c>efully not$ 9 corneal ulc]s4 ,poor circulation1 indige/ion1 con/ipation & auto-intoxication may h an important be>+ on ! recov]y ( ! ulc]4 ,x]osis or ,k]atomalacia ,?is is a disease ( ! eye 9 *ildr5 due to insuffici5t nutrition ( ! cornea4 ,h]$it>y influ5ces1 deplet+ diseases & lesions affect+ ! trophic n]ves to ! eye are causes4 ,treatm5t consi/s ( build+ up ! n\ri%m5t ( ! *ild1 correction ( lesions & c>eful diet+4 ,hot applications to ! palpebral region helps to br+ ! blood supply to ! eye = local effects4 ,k]atitis ,neurop>alytica ,?is disease is due to a p>alysis ( ! #e? cranial n]ve4 ,! cornea becomes slightly cl\dy4 ,! epi!lium gradually sl\ghs away4 ,an ulc] may or may n =m4 ,pa9 & la*rymation are abs5t because ( p>alysis ( ! trigem9us4 ,!re is usually cili>y injection4 ,treatm5t4--,! mo/ important treatm5t = ?is un=tunate condition is manipulation to re/ore ! integrity ( ! #e? cranial n]ve & ! blood supply to ! eye4 ,c]vical1 sp9al1 nasal1 nasoph>ynx treatm5t %\ld be giv54 ,spr+ ! inf]ior maxilla4 ,a drop ( atrop9e 7#a7 %\ld be us$ locally because ( ! cili>y injection4 ,w>m compresses us$ locally w help4 ,! heal+ usually leaves "s opacity ( ! cornea4 ,keep ! eye b&ag$ to protect ! cornea4 ,pannus ,?is =m ( k]atitis is sup]ficial & is *>act]iz$ by ! =mation ( blood vessels 9 ! cornea4 ,x is caus$ by "s irritative influ5ce4 ,mo/ (t5 x is a complication ( tra*oma4 ,if ! irritation c be remov$ ! vascul>ity gradually rec$es1 leav+ a cle> cornea unless ! deep] /ructures ( ! cornea h be5 involv$4 ,phlyct5ul> ,k]atitis ,?is disease is an involvem5t ( ! cornea ) an eczemat\s process simil> to phlyct5ul> conjunctivitis4 ,!re is m likely to be cili>y injection & iritis1 9 :i* case atrop9e %\ld be us$4 ,! treatm5t is ! same o!rwise z = phlyct5ul> conjunctivitis4 ,p>5*ymat\s or ,int]/itial ,k]atitis ,?is is %[n by a diffuse inflammatory infiltration ( ! sub/antia propria ( ! cornea4 ,"p or :ole ( ! cornea ( "o or bo? eyes may be involv$4 ,v f9e blood vessels may invade ! deep /ructures ( ! cornea4 ,cause4--,syphilis1 tub]culosis1 rheumatism1 diabetes & ra*itis are sy/emic diseases f\nd back ( ?is tr\ble4 ,symptoms4--,irritation1 la*rymation1 photophobia ) cili>y injection are ! *ief symptoms4 ,treatm5t mu/ be local & con/itutional4 ,locally atrop9e %\ld be us$4 ,d>k glasses %\ld be worn or ! pati5t mu/ be kept 9 a d>k room4 ,treatm5t to ! trigem9al n]ve & tissues ( ! orbit %\ld be giv54 ,con/itutional treatm5t %\ld be sp9al ) ! idea ( ar\s+ all ! =ces ( ! body to great] activity4 ,c>eful diet+ %\ld be foll[$ accord+ to indications4 ,! infiltration & blood vessels w ultimately disappe>4 ,sometimes en\gh may rema9 to cl\d ! vision4 ,diseases ( ! ,iris & ,cili>y ,body ,! iris & cili>y body h ! same blood & n]ve supply4 ,t is1 !y are suppli$ by ! same set ( vessels & n]ves4 ,= ?is reason x is practically impossible to h an iritis absolutely indep5d5t ( a cyclitis or "s inflammation ( ! cili>y body4 ,if ! iris is ! prim>y seat ( ! tr\ble !re are c]ta9 symptoms t may indicate su* a /ate4 ,h[ev]1 :5 we are treat+ ! iris or diagnos+ conditions ( ! iris we mu/ rememb] t ! cili>y body is v likely m or less involv$ & may be ! prim>y seat ( ! tr\ble4 ,9 iritis !re are "s symptoms :i* are caus$ f ! hyp]emic condition ( ! eye1 su* z a slight *ange 9 color4 ,! pupil becomes r inactive1 !re is "s cili>y injection ) photophobia1 lacrymation & pa94 ,9 case ( an exudate 9 ! iris !re may be ?ick5+1 & ! exudate 9 ! ant]ior *amb] ( ! eye w =m a hypopyon4 ,sometimes ! small vessels w break & !re w be a little ble$+ :i* w be mix$ ) ! debris 9 ! bottom ( ! ant]ior *amb]4 ,?is is kn[n z hyphemia4 ,!re are likely to be adhesions betwe5 ! iris & ! ant]ior capsule ( ! l5s kn[n z po/]ior syne*ia4 ,! pupil is m or less irregul>4 ,if atrop9e is dropp$ into ! eye to dilate ! pupil1 p>ts ( ! edge ( ! pupil w be adh]$ :ile ! o!r p>ts dilate mak+ x v irregul>4 ,9 case ( cyclitis !re is an exudate f ! cili>y body into ! po/]ior *amb]4 ,?is may cause a total adh]5ce ( ! iris to ! cry/all9e l5s4 ,) ! oph?almoscope1 opacities 9 ! vitre\s may be notic$4 ,^! are exudates4 ,! t5sion ( ! eye is liable to increase a little at fir/ b z ! exudates absorb !re is m or less s(t5+4 ,vision is l[4 ,also 9 cyclitis !re is cili>y injection1 photophobia1 lacrymation & pa91 simil> to t ( iritis4 ,pressure on ! eye ball w reveal a v t5d] condition ar\nd ! scl]ocorneal junction or ov] ! area ( cili>y injection4 ,! causes ( iritis1 cyclitis or iridocyclitis frequ5tly are sy/emic conditions & infection su* z syphilis1 rheumatism1 gonorrhea1 tub]culosis1 infecti\s diseases & metabolic *anges1 x may be ( traumatic orig9 or sympa!tic4 ,fu*s says 8,!re are _m cases ( iritis = :i* no cause c be discov]$ & !re=e :i* _c be plac$ "u ^! causes40 ,we agree ) him & advance ! !ory ( c]vical & upp] dorsal lesions or tr\ble 9 ! s9uses1 nose1 nasoph>ynx or ?roat4 ,no d\bt o/eopa?y c ?r[ "s important light on ! causes ( diseases ( ! iris & cili>y body4 ,! nose & ?roat %\ld be exam9$ 9 all ^! cases4 ,treatm5t4--,atrop9e mu/ be us$ 9 ! sore eye to put ! iris & cili>y body at re/ & dilate ! pupil to draw x back f ! l5s s t adhesions may n =m4 ,w>m compresses w give mu* com=t4 ,sweat+ %\ld be br\ght ab\t4 ,all fluid %\ld be r$uc$ to a m9imum4 ,diet %\ld be v mod]ate & ! b[els kept unusually free4 ,! eye %\ld be protect$ by d>k goggles4 ,?or\gh treatm5t ( ! neck & upp] dorsal region ) att5tion to ! nose & ?roat %\ld be giv54 ,con/itutional treatm5t %\ld be giv5 accord+ to ! indications m5tion$ "u causes4 ,if annul> syne*ia or total po/]ior syne*ia =m or !re is atrophy ( ! eyeball op]ative "w may be ne$$4 ,also = injuries1 tumors1 anomalies & s =? ( ! iris see ! late/ m$ical works on ?is subject4 ,diseases ( ! ,*oroid ,! *oroid is ! vascul> tunic ( ! eye4 ,) ! iris & cili>y body x =ms ! uvea4 ,! iris & cili>y body are ri* 9 n]ve t]m9als & :5 inflam$2 pa9 is a prom95t symptom4 ,! *oroid has no s5sory n]ve t]m9als4 ,:5 x is involv$ alone2 pa9 is n pres5t h[ev] sev]e ! pa?ology4 ,embryologically ,descemet's membrane is a "p ( ! uvea4 ,:5 ! uveal tract is diseas$ we frequ5tly note symptoms ( a descemetitis z a turbidity ( ! ant]ior *amb] & spots on ,descemet's membrane4 ,:5 "o "p ( ! uvea is inflam$ ! t5d5cy is to pass to ! o!r p>ts because ( ! intimate blood supply4 ,*oroiditis ,!re are _m =ms ( *oroiditis giv5 by writ]s accord+ to ! cl9ical picture & ! pa?ology4 ,symptoms4--,no pa9 is exp]i5c$ unless !re are complications4 ,vision is alt]$ 9 "s degree4 ,! use ( ! oph?almoscope may reveal opacities 9 ! vitre\s4 ,pigm5tation spots & exudation may be not$ 9 ! fundus4 ,9 dissem9at$ *oroiditis spots ( exudate appe> 9 ! fundus :i* g on to atrophy1 leav+ irregul> circul> light pat*es4 ,treatm5t4--,9 all =ms ( *oroiditis c>eful diagnosis ( con/itutional conditions %\ld be made & treatm5t giv5 accord+ to indications4 ,nasoph>ynx & orbital treatm5t z outl9$ "u manipulation = diseases ( ! eye %\ld be giv54 ,re/ & protect ! eyes4 ,secure free elim9ation4 ,panoph?almitis ,by injury or o!rwise pa?og5ic g]ms are introduc$ into ! eye4 ,! tr\ble beg9s z a suppurative *oroiditis & rapidly spreads to all ! eye /ructures4 ,! vitre\s *amb] becomes fill$ ) pus4 ,symptoms4--,pa9 is sev]e & sight is lo/ e>ly4 ,! conjunctiva & lids are mu* swoll54 ,!re is a mucopurul5t dis*>ge4 ,! cornea becomes gray & may sl\gh4 ,9 ab\t two weeks ! inflammation subsides & ! globe passes into atrophy4 ,treatm5t4--,elim9ation mu/ be ?or\gh4 ,sp9al treatm5t = keep+ up /r5g?4 ,c]vical1 upp] dorsal & nasoph>ynx treatm5t = ! eye4 ,moi/ hot compresses to ! eye4 ,op]ation1 incision = dra9age1 or evisc]ation may h to be p]=m$4 ,sympa!tic ,oph?almia ,! o!r eye may become inflam$ by ! process f ! panoph?almitis pass+ ar\nd ?r\gh ! circulation or ! cont9u\s /ructures4 ,all symptoms ( a g5]al inflammation appe> & vision gradually dim9i%es4 ,treatm5t4--,9 panoph?almitis ( "o eye always wat* ! o!r eye closely4 ,if x becomes irritable or %[s any signs ( be+ affect$ ! diseas$ eye %\ld be promptly remov$1 especially if vision is lo/ 9 t eye4 ,if no irritation occurs1 cont9u$ cons]vative treatm5t ( ! panoph?almitis may result 9 a subsid5ce ( ! disease )\t ! well eye becom+ affect$4 ,sympa!tic inflammation r>ely develops e>li] ?an a mon? aft] injury to ! excit+ eye4 ,soon] ?an t or ev5 a few m9utes aft] injury !re may be "s signs ( sympa!tic irritation & ! symptoms cont9ue ) no evid5ce except a slight circumcorneal injection4 ,x %\ld be treat$ l iritis4 ,a ?or\gh ton+ ( ! sy/em by sp9al treatm5t %\ld be giv54 ,ord] a limit$ diet4 ,secure free elim9ation4 ,glaucoma ,glaucoma is ess5tially an increase 9 ! intra-ocul> pressure4 ,all o!r symptoms ( ! tr\ble may be trac$ to ?is condition4 ,9 ,prim>y ,glaucoma ! increase 9 pressure sets 9 )\t any discov]able antec$5t disease ( ! eye4 ,9 ,second>y ,glaucoma ! increase 9 pressure is due to "s o!r disease ( ! eye4 ,x is a symptom1 a complication or accessory & is conf9$ to ! eye diseas$4 ,prim>y glaucoma affects bo? eyes1 b n always at ! same "t4 ,fu*s says prim>y glaucoma con/itutes ab\t #a ( all eye diseases4 ,x is (t5 mi/ak5 = iritis or iridocyclitis & treat$ ) atrop9e :i* is contra9dicat$4 ,x may be reg>d$ z beg9n+ cat>act & "t lo/ 9 expect+ x to become ripe4 ,^! delays & wrong treatm5t h caus$ mu* bl9dness4 ,palpation ) ! f+] or ! use ( ! tonomet] may readily detect any increase 9 t5sion4 ,a correct diagnosis mu/ be made e>ly & prop] treatm5t in/itut$ if vision is to be sav$4 ,prim>y glaucoma may or may n h signs ( inflammation4 ,if ! t5sion rises sudd5ly inflammatory symptoms develop 7acute7 :ile if ! increase 9 t5sion develops gradually ^! symptoms are lack+ 7simple74 ,acute prim>y glaucoma--,symptoms4--,fir/ /age1 rise 9 t5sion1 vision obscur$1 sees a color$ r+ ar\nd lights1 cornea dull1 pupil dilat$ & sluggi%1 "s cili>y injection4 ,! attack may cle> up = a day or = weeks4 ,gradually ! symptoms become p]man5t aft] repeat$ attacks4 ,second /age1 :5 ! attack comes !re is mu* pa91 visual p[] fails rapidly1 may be edema ( ! lids & *emosis ( ! conjunctiva1 all symptoms become mu* exagg]at$1 ! cornea becomes cl\dy4 ,aft] a viol5t attack ! vision is m or less p]man5tly damag$4 ,?ird /age1 aft] _m attacks ! optic n]ve becomes excavat$ & atrophy takes place4 ,simple ,prim>y ,glaucoma ,symptoms4--,t5sion comes gradually2 no inflammatory signs2 pupil some:at dilat$ & sluggi%1 ! cornea may look slightly smoky4 ,) ! oph?almoscope a cupp$ disc may be not$4 ,!re is gradual dim9ution ( sight1 :i* beg9s by contraction ( ! field4 ,!re are _m !ories advanc$ z to ! cause ( intra-ocul> t5sion 9 glaucoma4 7,fu*s1 ,weeks1 ,de ,s*we9itz74 ,treatm5t4--,es]9e is us$ in/ead ( atrop9e4 ,! object is to contract ! pupil & draw x away f ! side wall ( ! eye ball s ! s9us 7,s*lemm's canal7 & ! pect9ate ligam5t 7! filt]+ angle7 may become free4 ,! good effect ( ?is is m m>k$ 9 inflammatory glaucoma4 ,9 simple prim>y glaucoma miotics d little good4 ,reports f o/eopa?ic treatm5t ( ?is condition h be5 favorable 9 a numb] ( cases4 ,c>eful manipulation ( ! /ructures ( ! orbit ) ! f+] or ) ,dr4 ,ruddy's ?ird f+] eye in/rum5t is good 9 re/or+ bett] circulation ( ! lymph & blood4 ,special att5tion to ! v5\s dra9age %\ld be giv54 ,treat ! po9ts ( ! fif? n]ve1 ! nasoph>ynx & c]vical region1 spr+ ! jaw4 ,treat second dorsal4 ,h ! pati5t avoid /rong emotions or excitem5t4 ,keep ! b[els free & use only a v bl& diet4 ,iridectomy is consid]$ ! be/ op]ation 9 glaucoma4 ,9 ! treatm5t ( second>y glaucoma ! o!r diseases or complications mu/ be consid]$ 9 conjunction ) ! =ego+ treatm5t4 ,diseases ( ! ,l5s ,opacities or ,cat>act ,symptoms4--,beg9n+ opacities c be/ be recogniz$ ) ! oph?almoscope4 ,advance opacities c be se5 at a glance ) ! nak$ eye4 ,vision is di/urb$ accord+ to degree & location ( ! opacity4 ,if ! opacity is 9 ! c5t] ( ! l5s & ! p]iph]y is transp>5t !y see bett] :5 ! pupil is dilat$4 ,:5 ! opacities are 9 ! p]iph]y ( ! l5s !y see bett] by day4 ,musc volitantes & polyopia are pres5t until increas+ opacity closes up all cle> areas %utt+ out ^! visual p]v]sions4 ,!re are _m cl9ical v>ieties ( cat>acts :i* may be /udi$ 9 works on oph?almology4 ,causes4--,"s int]f]5ce ) ! nutrition ( ! l5s acc\nts = ! condition4 ,h]$ity is suppos$ to play a "p 9 "s cat>acts4 ,rickets1 convulsions1 traumatism1 old age1 "s drugs 7ergot71 inflammation ( iris1 cili>y body & *oroid are giv5 z causes4 ,c]vical & upp] dorsal lesions & disease ( ! ?roat1 nasoph>ynx & nose w int]f]e ) p]fect circulation & dra9age ( ! orbit1 & may well h mu* to d ) _m idiopa?ic cat>acts4 ,treatm5t4--,_m cases h be5 report$ cur$ by o/eopa?ic measures4 ,correct lesions & treat to e/abli% free n]ve =ce & circulation ( blood & lymph to ! orbit4 ,manipulation ( ! orbital tissues & mild vibration ( ! bulb are measures ( value4 ,m hope may be held 9 symptomatic1 toxic1 second>y & progressive cat>acts4 ,! process may be /opp$ & 9 _m cases !re is hope ( a cle>+4 ,diseases ( ! ,ret9a ,! ret9a l9es ! back "p ( ! eye ball4 ,x comes =w>d to ! ora s]rata4 ,x consi/s ( t5 lay]s :i* h be5 demon/rat$ microscopically4 ,"o lay] ( x passes ov] ! cili>y body & back "p ( ! iris to ! pupil4 ,! fib]s ( ! optic n]ve spread out ov] ! ret9a4 ,! po9t ( entrance ( ! optic n]ve is ! papilla4 ,x is to ! inn] side ( ! po/]ior pole ( ! eye4 ,! ret9al vessels emanate !re4 ,! macula lutea is ! yell[ s5sitive spot at ! po/]ior pole ( ! eye4 ,! fovea is ! c5t] ( ! macula4 ,! rods & cones con/itute ! ext]nal lay] ( ! ret9a4 ,?is lay] is ! light p]ceiv+ /ratum4 ,= vision to be p]fect all ! o!r lay]s mu/ be p]fectly transp>5t4 ,! visual purple is a *emical sub/ance 9 ! rods t gives ! ret9a a purpli%-r$ color4 ,! light %9+ into ! eye =ms images :i* are conv]t$ into n]v\s /imuli by *emical action ( ! visual purple & by physical *anges & fibrillations 9 ! rods & cones4 ,ret9itis ,symptoms4--,! oph?almoscope mu/ be us$ 9 diagnosis4 ,!re is at fir/ cl\d9ess ( ! ret9a2 ! outl9es ( ! papilla become indi/9ct4 ,we may note light pat*es ( exudates4 ,! vessels are m tortu\s & (t5 !re are hemorrhagic spots4 ,opacities 9 ! vitre\s due to ! exudate may be se54 ,vision is di/urb$ 9 proportion to ! inflammation4 ,weeks or mon?s are requir$ = recov]y4 ,atrophy may set 9 & cause bl9dness4 ,cause4--,_m g5]al diseases are f\nd back ( ?is tr\ble1 e4 g4 album9uria1 diabetes1 leukemia1 syphilis1 g\t & art]ioscl]osis4 ,idiopa?ic cases occur ) none ( ^! diseases pres5t1 :i* gives a field = o/eopa?ic rese>*4 ,treatm5t %\ld be direct$ aga9/ ! g5]al disease :5 pres5t4 ,= local effects treatm5t %\ld be giv5 to all ! c5t]s & localities t affect ! trophism1 n]ve supply & circulation to ! eye4 ,protect ! eye by d>k glass or conf9em5t to a d>k room & complete re/4 ,keep ! b[els free & produce diaphoresis4 ,optic ,neuritis ,?is disease :5 manife/ 9 ! eye ball is call$ papillitis4 ,if back ( ! bulb x is retrobulb> neuritis4 ,symptoms ( papillitis4--,pupils are dilat$ & sight dim9i%es4 ,! color ( ! papilla is alt]$ to a :ite1 r$di% or gray & may %[ extravasation ( blood4 ,! papilla is swoll5 7*ok$ disc71 ! art]ies are ?9 & ! ve9s are engorg$4 ,x takes mon?s = ! inflammation to cle>4 ,atrophy is likely to occur4 ,causes4--,bra9 diseases are ! mo/ frequ5t cause1 e4 g4 tumors4 ,syphilis1 febrile diseases1 nutritive di/urbances1 lead poison+1 h]$ity & gr[?s 9 ! orbit are cit$ z causes4 ,symptoms ( ,retrobulb> ,neuritis4--,!re is little or no *ange 9 ! papilla4 ,! diagnosis mu/ be made mo/ly f ! way ! vision is affect$4 ,! rule is a c5tral scotoma 9 ! field ( vision4 ,! fir/ colors to disappe> are r$ & gre54 ,9 ! acute =m !re is quick di/urbance ( vision4 ,! eye looks normal outside & %[s practically no *ange inside4 ,cause4--,toxemia1 cold1 influ5za2 nasal1 nasoph>yngeal & s9us disease 7e?moids71 & infecti\s diseases are causes4 ,idiopa?ic inflammation ( ! optic n]ve is not$ by mo/ oculi/s4 ,"h ! pr(\nd effects ( sp9al lesions ^u ! eye adds "s important light4 ,treatm5t ( ,papillitis & ,retrobulb> ,neuritis4--,9 ea* individual case ! treatm5t requires consid]ation ( ! causal factor4 ,!re may be requir$ con/itutional treatm5t 9 _m cases4 ,9 o!rs ! cause may be f\nd 9 ! nose1 nasoph>ynx1 or sp9e4 ,ef=t %\ld be made to remove ! lesion 9 ea* case4 ,diaphoresis w aid 9 acute /ages4 ,atrophy ( ! ,optic ,n]ve ,!re are _m causes = ?is condition su* z optic neuritis1 m5+itis1 acute infecti\s diseases1 locomotor ataxia1 art]ioscl]osis1 nasal disease1 syphilis1 traumatism1 alcoholism1 exposure1 embolism ( ! c5tral ret9al art]y1 diabetes & poison+4 ,diagnosis mu/ det]m9e ! orig9al cause4 ,treatm5t4--,i h m5tion$ conditions 9 ! nose z frequ5tly acc\nt+ = v>i\s eye tr\bles4 ,if ^! atrophies ( ! optic n]ve c be gott5 e>ly1 _m ( !m w be influ5c$ v favorably by o/eopa?ic treatm5t4 ,sp9al treatm5t to direct ! circulation to ! area ( ! orbit at ! base ( ! bra9 is b5eficial4 ,regulation ( ! pati5t's diet1 habits1 me?ods ( liv+ & s =? is important4 ,excessive m5tal /ra91 excessive sexual int]c\rse & /resses ( e k9d %\ld be prohibit$4 ,special treatm5t %\ld !n be giv5 accord+ to ! causal factors ent]+ into ! case4 ,eye ,/ra9 & ,its ,reflexes ,= ! subject ( refraction & refractive errors su* z ! diff]5t =ms ( hyp]metropia1 myopia & a/igmatism ! read] is ref]r$ to ! _m excell5t works on oph?almology :i* cov] ^! subjects q ?or\ghly4 ,!y are only us$ "h 9 ! relation to eye /ra9 & its reflexes4 ,! o/eopa?ic logic "h giv5 %\ld be comb9$ ) a read+ ( ! refractive errors 9 su* works z ,fu*s1 ,weeks1 ,de ,s*we9itz & o!rs4 ,a/h5opia ,eye /ra91 weak sight or a/h5opia embraces ! gr\p ( symptoms dep5d5t ^u fatigue ( ! cili>y muscles or ( ! extraocul> muscles4 ,!re are ?ree v>ieties ( a/h5opia4 7#a7 ,ret9al or n]v\s1 7#b7 muscul> & 7#c7 accommodative4 ,! symptoms are heada*e--frontal1 fronto-temporal or fronto-occipital4 ,x may ext5d into ! neck betwe5 ! %\ld]s4 ,eye balls may be t5d]1 diplopia at times1 may be photophobia1 la*rymation1 conge/ion ( ! eye1 it*+ & burn+ ( ! lids4 ,accommodative ,a/h5opia4--,9 ?is =m ! cili>y muscle is fatigu$4 ,! cause is usually ov]use ( ! eye :5 hyp]opia & a/igmatism exi/2 sometimes 9 myopia or presbyopia4 ,treatm5t4--,9 ?is =m ! treatm5t is ! prop] fitt+ ( glasses & improvem5t ( ! g5]al heal?4 ,muscul> ,a/h5opia is due to tir+ ( ! extraocul> muscles1 usually ! int]nal rectus4 ,?is may result 9 a phoria or a non-p>alytic squ9t4 ,ametropia may exi/ b a/h5opia may come ev5 9 emmetropia due to ov]use ( ! eye4 ,treatm5t4--,correct ametropia if pres5t1 ) glasses4 ,ex]cise ! weak5$ muscle4 ,correct ! n]ve supply to ! weak muscle4 ,treat c]vical & upp] dorsal4 ,manipulate tissues ( ! orbit4 ,spr+ ! jaw4 ,correct any nose & ?roat pa?ology4 ,n]v\s1 ,neura/h5ic or ,reflex ,a/h5opia4--,! cause is suppos$ to be "s functional disord]1 m (t5 f\nd 9 females4 ,may be due to too dim or too bright light1 ov]use ( ! eyes4 ,hy/]ia may foll[ ametropia4 ,treatm5t4--,(t5 ! treatm5t is tr\blesome & ! case is v ob/9ate accord+ to old s*ool me?ods4 ,re/1 hygi5e1 g5]al heal? & habits are look$ aft]4 ,! cause mu/ be f\nd or ! treatm5t _c be specific4 ,^! are ! diff]5t =ms ( eye /ra9 z ord9>ily classifi$4 ,n[ z we /udy ! reflex symptoms f ^! & attempt to trace out ! reflexes f an o/eopa?ic po9t ( view1 we may f9d "s m def9ite causes ( ^! conditions & consequ5tly "s me?ods ( treatm5t n f\nd 9 /&>d text books might naturally sugge/ !mselves4 ,reflex symptoms t h be5 trac$ to eye /ra9 by oph?almologi/s are z foll[s3 ,con/ipation1 indige/ion1 he>tburn1 nausea1 vomit+1 n]v\s attacks1 fe> ( imp5d+ calamity1 irritability1 despond5cy1 insomnia1 re/less sleep1 epilepsy1 n]v\s twit*+s & enuresis4 ,all ^! symptoms h be5 se5 to disappe> aft] eye /ra9 0 correct$4 ,!re is no absolute way ( prov+ t all ^! symptoms h exi/$ because ( eye /ra94 ,! exi/5ce & disappe>ance ( "s ( !m at ! "t ( treatm5t = eye /ra9 may be a co9cid5ce4 ,x is evid5t t eye /ra9 9 v>y+ degrees may produce a tra9 ( symptoms simil> to _m above m5tion$4 ,a pati5t1 n]v\s1 anxi\s1 uneasy1 & despond5t1 con/ipat$1 & hav+ "s indige/ion1 %[$ on exam9ation contractures & t5d]ness at ! ?ird dorsal4 ,x 0 f\nd he 0 suff]+ f eye /ra9 f ov]use ( glasses t 7 too /rong = him4 ,! eyes 7 refitt$4 ,he 0 we>+ a 7,r7#d4ej ,d4 ,s4 4#ej cyl4 ,ax4 #ahj4 7,l7#d4ej ,d4 ,s4 4#ej cyl4 ,ax4 #ij = close "w & a 7,r7#b4jj ,d4 ,s4 4#ej cyl4 ,ax4 #ahj 7,l7#b4ej ,d4 ,s4 4#be cyl4 ,ax4 #ij = di/ance4 ,! new glasses 7--,read+-- 7,r7#c4jj ,d4 ,s4 4#be cyl4 ,ax4 #ahj 7,l7#c4jj ,d4 ,s4 4#be cyl4 ,ax4 #ahj ,di/ance3 7,r7 #a4ej ,d4 ,s4 4#be cyl4 ,ax4 #ahj 7,l7 #a4ej ,d4 ,s4 4#be cyl4 ,ax4 #ahj ,he 0 fitt$ two ye>s previ\sly4 ,at t "t ! /rong] glasses 7 correct4 ,eyes *ange m or less con/antly1 especially betwe5 ! ages ?irty-five to fifty-five ye>s4 ,:5 glasses are fitt$1 a weak cili>y muscle aft] a re/ may become /rong] & all[ weak] glasses to be worn4 ,if a "y p]son is fitt$ = myopia1 9 a few ye>s he may disc>d 8 glasses z presbyopia develops4 ,a p]son fitt$ correctly1 :o has a /rong cili>y muscle may n be able = a:ile to see z well ) ! glasses z )\t !m4 ,aft] !y are worn a:ile ! cili>y muscle w cease its ef=ts to accommodate s mu* & ! glasses give ! desir$ effect4 ,9 "s cases ! doctor's reputation to fit glasses prop]ly may suff] at ! h&s ( su* p :o sometimes refuse to take glasses1 or aft] gett+ !m refuse to we> !m4 ,9 ! case ( ! man j m5tion$ a refitt+ quiet$ ! n]v\s symptoms--he became m *e]ful & ceas$ to worry4 ,indige/ion & con/ipation improv$4 ,! sor5ess & contractures 7 ov]come 9 a few treatm5ts4 ,n[ let u ask ! "q1 :y is x t eye /ra9 w cause nausea & vomit+8 ,also :y w indige/ion affect ! eyes by caus+ 8spools0 9 ! vision8 ,a little o/eopa?ic logic1 bas$ z x always is or %\ld be1 ^u anatomy & physiology1 may ?r[ "s light on ?is subject4 ,no d\bt e "o ( u has demon/rat$ _m times cl9ically t indige/ion f ov]eat+ w cause sor5ess & contractures at ! ?ird & f\r? dorsal1 ! n]ve c5t] 9 ! sp9e = ! /oma*4 ,! reflexes betwe5 ! visc]a & ! eye are complex & difficult to foll[4 ,9 giv+ ! probable c\rse ( ! n]ve reflexes f ! optic n]ve to ! ?ird n]ve ,dr4 ,l\isa ,burns sugge/s ! foll[+3 8,! n]ve elem5ts ( ! ret9a />t ! impulse2 x passes ov] t portion ( ! optic n]ves :i* ent] ! ant]ior quadrigem9ates1 ! cells ( ! quadrigem9ates :]e ! impulses are coord9at$1 !n by axons ( ^! cells to ! lat]al or visc]o-motor nucleus ( ! ?ird n]ve1 !nce to ! cells ( ! cili>y ganglion1 & by ! non-m$ulat$ 7sympa!tic7 fib]s ( ^!1 ! %ort cili>y n]ves to ! non-/riat$ muscles conc]n$1 viz3 ! cili>y muscle1 "s fib]s ( ! levator palpebral & ! sph9ct] ( ! iris40 ,! ?ird n]ve arises 9 ! floor ( ! aqu$uct ( ,sylvius f two nuclei2 a lat]al nucleus :i* is a visc]o-motor gr\p ( n]ve cells1 & a c5tral nucleus or a somato-motor gr\p ( cells4 ,! somato-motor nucleus supplies all ! extr9sic muscles ( ! eye except ! ext]nal rectus & sup]ior oblique :i* are suppli$ by ! six? & f\r? respectively4 ,! nasal bran* ( ! oph?almic division ( ! #e? s5ds fib]s to ! cili>y muscle4 ,association fib]s connect ! nuclei ( ! #crd1 #d?1 #f? & #g?4 ,! evid5ce is 9 favor ( ! #aj? or pneumoga/ric hav+ su* association fib]s4 ,we not$ f\r places 9 ! bra9 to :i* ! optic tracts g be=e ! radiations rea*$ ! c5t] ( sight 9 ! occipital lobe4 ,if we _c foll[ all ! reflexes ?r\gh ! bra9 & cord at lea/ ) ! facts we h x is n difficult to imag9e abnormal impulses com+ ov] ! ?ird n]ve f a /ra9+ ( ! cili>y nucleus1 !nce ov] visc]o-motor fib]s 9 ! lat]al horn ( ! cord1 ov] ! :ite ramicommunicantes1 ?r\gh ! sympa!tic ganglia1 ov] ! splan*nics to ! /oma*1 produc+ abnormal p]i/alsis1 nausea & vomit+4 ,9 turn we w\ld h ! somato-motor n]ves to ! muscles affect$ z be=e describ$1 contraction & conge/ion ( muscles ( ! sp9e4 ,:5 we h pati5ts consult u & describe a tra9 ( symptoms l nausea1 vomit+1 n]v\sness1 frontal & occipital heada*e1 we %\ld h eye /ra9 9 m9d & inquire = la*rymation1 photophobia1 it*+ & burn+ lids & conge/ion ( ! eye4 ,any ( ^! ?+s %\ld make u ?9k ( te/+ = ametropia 9 its v>i\s refractive errors1 z well z a c>eful sp9al & a nose & ?roat exam9ation4 ,g5]al physical & laboratory diagnosis %\ld n be neglect$4 ,ref]5ces ,fu*s's ,text ,book ( ,oph?almology1 ,duane4 ,heada*es & ,eye ,disord]s ( ,nasal ,orig91 ,slud]4 ,ext]nal ,diseases ( ! ,eye1 ,greeff4 ,vol4 ,,iii ,practical ,m$ic9e ,s]ies3 ,! ,eye1 ,e>1 ,nose & ,?roat by ,casey ,a4 ,wood1 ,alb]t ,h4 ,&rews1 ,geo4 ,e4 ,%ambaugh4 ,diseases ( ! ,eye1 ,weeks4 ,diseases ( ! ,eye1 ,e>1 ,nose & ,?roat1 ,posy & ,wright4 ,diseases ( ! ,eye1 ,de ,s*we9itz4 ,diseases ( ! ,eye1 ,may4 ,text ,book ( ,oph?almology1 ,roem] & ,fo/]4 ,diseases ( ! ,eye1 ,jackson4 ,oph?almic ,surg]y1 ,mell]4 ,,diseases ,,( ,,! ,,e>1 ,,nose ,,& ,,?roat ,by ,j4 ,,deason ,diseases ( ! ,e> ,me?ods & ,te*nic ( ,exam9ation4--,! ext]nal e> may be exam9$ by direct inspection ) or )\t ! aid ( artificial light4 ,! ext]nal auditory meatus may be exam9$ by means ( a simple conical e> speculum & reflect$ light f a head mirror4 ,?is me?od requires consid]able practice b effici5cy c & %\ld be atta9$ because x c be us$ "u all conditions & !re=e is a reliable me?od4 ,! ,holmes electric auroscope :i* we use & recomm5d = exam9+ ! meatus & e> drum1 is v effici5t b l o!r electrical equipm5t is n always dep5dable4 ,!re are _m electrical equipm5ts = exam9+ ! e>1 b s f> ,i h f\nd none o!r ?an ! "o above m5tion$ t is wor? space 9 an in/rum5t cab9et4 ,to exam9e ! meatus1 grasp ! p9na & draw x firmly upw>d & backw>d4 ,?is t5ds to /raight5 ! canal s t ! aural speculum may be ins]t$ well into ! ext]nal canal4 ,x mu/ be rememb]$ t ! auditory canal is always s5sitive & :ile !re is really little dang] ( do+ any h>m by ex]cis+ ord9>y c>e1 ! pati5t is always afraid ( be+ hurt & "o c accompli% bett] results by practic+ c>eful te*nic4 ,if ! electric auroscope is us$1 ! eye %\ld be plac$ v close to ! l5s & e "p ( ! canal1 walls & drum membrane c>efully exam9$4 ,! ,holmes auroscope has a small tube & bulb1 pressure ^u :i* w v>y ! air pressure 9 ! meatus & cause ! drum to move4 ,?is mu/ be done v c>efully because 9 v ?91 atrophic membranes !re is "s dang] ( ruptur+ ! drum4 ,diseases ( ! ,auditory ,meatus ,inspissat$ ,c]um51 or h>d5$ e> wax is "o ( ! mo/ common affections ( ! meatus4 ,! cause 9 "s cases c be trac$ to lesions ( ! m&ible1 b 9 _m cases ! cause is unkn[n4 ,treatm5t4--,protect ! clo?+ by means ( a t[el or rubb] neck piece4 ,by means ( a s(t rubb] e> syr+e1 wa% ! canal ?or\ghly by =c+ w>m soap solution into x4 ,i pref] conc5trat$ liquid ca/ile soap 7any good soap w d7 dilut$ ab\t "o to f\r 9 wat] z w>m z ! pati5t c be> x4 ,! soap solution is conta9$ 9 a pus b[l held tightly aga9/ ! neck "u ! e>4 ,!re is little dang] ( us+ too mu* =ce ) ! s(t rubb] syr+e4 ,9 mo/ cases ! h>d5$ c]um5 w be dislodg$ by ! syr++ only4 ,if ?is _c be done1 x may be well to discont9ue ! treatm5t until ! foll[+ day4 ,! solv5t action ( ! soap solution w fur!r r$uce ! h>d5$ mass & x usually c be remov$ by syr++ ! foll[+ day4 ,?is me?od is pref]able 9 _m cases because pati5ts dislike ! pa9 :i* usually accompanies ! use ( a curet4 ,! dull loop curet is ! mo/ effici5t & safe/ in/rum5t = remov+ h>d5$ c]um5 t ! syr+e may fail to dislodge4 ,?is in/rum5t mu/ be us$ ) great c>e because ! membranes1 long protect$ by ! cov]+ ( c]um5 are hyp]s5sitive & ble$ easily4 ,aft] remov+ ! c]um51 ! canal %\ld be ?or\ghly dri$ & lubricat$ ) "s non-irritat+ lubricant4 ,x is also well to place a small pl$get ( absorb5t cotton into ! ext]nal op5+ to protect ! s5sitive membranes f ! cold1 air & du/4 ,9 dry+ ! canal ,i pref] to use a small alum9um applicator1 twi/+ a small piece ( absorb5t cotton on ! end 9 su* a way z to cov] ! tip well1 ?us mak+ any injury f its use impossible4 ,atrophic ,meatus ,s5sitive or it*+ e>s z ! pati5t commonly describes x1 is a v common disease caus$ by any atrophic condition ( ! membranes ( ! auditory meati & frequ5tly f\nd 9 common ) auditory or o!r cranial n]ve defici5cy or deg5]ation4 ,! direct cause ( ! irritation is ! collection ( p>ticles ( dry c]um54 ,treatm5t4--,! local treatm5t consi/s ( syr++ ) w>m 7#aah to #abj;,f7 soap solution until all ( ! scaly c]um5 has be5 remov$4 ,! canal is !n dri$ & lubricat$ z describ$ above4 ,sev]al su* treatm5ts may be requir$ aft] :i* ,i pref] ! use ( ! cont9u\s irrigat+ e> cup1 us+ salt mixture in/ead ( ! soap4 ,! same salt mixture z is recomm5d$ = nose & ?roat irrigation is satisfactory4 ,aft] su* irrigations ! application ( ph5ol-glyc]9e 7#aj ph5ol 9 glyc]9e7 seems to be an effici5t treatm5t4 ,! local treatm5t mu/1 ( c\rse1 be accompani$ by corrective treatm5t to ! m&ible & upp] c]vicals4 ,furunculosis ,!re are ?ree acute affections ( ! e> :i* may usually be diagnos$ f _! po9ts ( t5d]ness or pa94 ,pa9 ^u mov+ ! lobe or p9na indicates furunculosis4 ,pa9 on pressure po/]ior to ! angle ( ! jaw or ext]nally 9 front ( ! e> indicates middle e> infection & pa9 on pressure ov] ! ma/oid region sugge/s ma/oiditis4 ,probably ! mo/ common ( ! pa9ful diseases ( ! ext]nal meatus is furunculosis1 :i* is a subcutane\s infection ( ! l9+ membrane ( ! meatus4 ,! po9t ( swell+ may usually be se5 b 9 "s cases ! entire canal is clos$4 ,treatm5t4--,9 all cases ( occlud$ pus1 dra9age mu/ be obta9$1 b 9 ! e>ly /ages ( furunculosis1 x is n always possible to det]m9e ! place ( 8po9t+0 or ! mo/ desirable po9t to lance4 ,z soon z ! place ( 8po9t+0 c be locat$ x is advisable to lance deeply by means ( a curv$ p>ac5tesis knife4 ,! p>ts are ?or\ghly cleans$ & ane/hetiz$ by apply+ ph5ol & neutraliz+ ) alcohol4 ,! ext]nal p>ts are fir/ pa9t$ ) alcohol to prev5t 8burn+0 f any ph5ol :i* may be dropp$ ^u !m4 ,a small cotton applicator is us$1 apply+ ! conc5trat$ solution ( ph5ol or ! cry/als 7us+ only a small am\nt ( ph5ol7 to ! affect$ p>ts & imm$iately neutraliz+ ) alcohol4 ,c>e mu/ be obs]v$ n to apply any ph5ol to ! drum membrane & ! op]ator mu/ be sure t ! action ( ! c>bolic acid is completely neutraliz$ by a lib]al application ( alcohol4 ,! knife blade is plac$ beyond ! furuncle1 its curv$ po9t turn$ outw>d & quickly drawn =w>d ?r\gh ! furuncle1 cutt+ deeply4 ,! canal is !n pack$ ) a pl$get ( cotton dipp$ into ph5ol-glyc]9e4 ,if ! place ( po9t+ _c be se51 palliative treatm5t may be appli$ by ?or\ghly clean+ ! meatus1 dry+ & apply+ a ph5ol-glyc]9e pack4 ,heat may be appli$ by means ( a !rapeutic lamp4 ,any electric light bulb or ! dry electric pack w d4 ,! ext]nal p>ts are well lubricat$ ) p>aff9 oil & ! heat appli$ cont9u\sly or int]mitt5tly until ! pa9 is reliev$4 ,infection ( ! ,meatus ,infections ( ! meatus are frequ5tly second>y to1 or accompani$ by furunculosis4 ,! treatm5t1 !re=e1 is simil> to t ( furunculosis4 ,always try to locate ! po9t ( infection1 lance or curet1 apply ph5ol or o!r *emical g]micide1 neutralize1 dry & pack ) ph5ol-glyc]9e4 ,aft] ! po9t ( infection has be5 ?or\ghly dra9$1 cleanl9ess & protection f du/ or fur!r infection is all t is necess>y4 ,9 all cases ( infection ( ! ext]nal meatus1 suspect middle e> abscess z a cause4 ,!re may be a p9-po9t op5+ ?r\gh ! drum1 f :i* ! infection has orig9at$ & is be+ ma9ta9$4 ,otomycosis or fungus infection ( ! auditory meatus is r>e4 ,x usually resembles o!r infections symptomatically1 b (t5 )\t pus4 ,a microscopic exam9ation w s]ve to diagnose ! condition4 ,! treatm5t consi/s ( ?or\gh cleans+1 dry+ & ! free application ( alcohol4 ,alcohol is dropp$ into ! e> until ! canal is full & a pl$get ( cotton appli$ to reta9 x4 ,usually two or ?ree applications are suffici5t to effect a cure4 ,eczema ( ! auricle & meatus is ( two types1 ! squam\s or scaly =m & ! scl]otic =m4 ,bo? =ms are *ronic & may be readily diagnos$ by ! appe>ance4 ,treatm5t4--,"s cases are v difficult to cure b we h _h excell5t results ) ! foll[+ treatm5t3 ,c>eful adju/m5t ( c]vical & m&ibul> lesions2 ?or\gh treatm5t ( any local infections ( head or neck2 direct application ( ph5ol-glyc]9e1 local cleanl9ess & protection f irritation4 ,diseases ( ! ,middle ,e> ,cl9ically ! middle e> consi/s ( ! tympanic cavity & its cont5ts1 ! ,eu/a*ian tube & ! ma/oid cells4 ,acute ,suppurative ,otitis ,m$ia ,acute infections ( ! middle e> result f acute nasoph>yngeal affections su* z colds1 influ5za1 measles1 mumps1 :oop+ c\gh1 etc4 ,ba?+ 9 contam9at$ wat] (t5 results 9 infection to ! middle e> ?r\gh ! ,eu/a*ian tube4 ,diagnosis4--,e>a*e1 pa9 on pressure "u ! angle ( ! jaw & sudd5 deafness are ! symptoms4 7,!re are also ! common febrile symptoms47 ,! *ief physical signs are3 r$ness & bulg+ ( drum membrane1 & contraction & t5d]ness ( upp] c]vical muscles4 ,treatm5t4--,if ! pati5t is se5 be=e ! drum has ruptur$ x is seldom necess>y to lance ! drum if ! prop] treatm5t is giv5 promptly4 ,dra9age mu/ be obta9$ & ma9ta9$ by ca!t] aspiration ?r\gh ! tube irrigation ( ! nasoph>yngeal cavity1 irrigation ( ! meatus by means ( ! cont9u\s e> irrigator & application ( dry heat ov] ! affect$ "p4 ,heat is be/ appli$ by means ( a !rapeutic lamp4 7,any lamp ) reflector t w furni% prop] heat is effici5t z !re is no virtue 9 color$ light47 ,! sk9 surface ov] ! e>1 side ( face & ma/oid region is fir/ well lubricat$ ) "s m9]al oil to prev5t bli/]+ & ! heat is appli$ ei!r con/antly or int]mitt5tly4 ,a pl$get ( absorb5t cotton dipp$ into ph5ol-glyc]9e is plac$ 9 ! meatus & =c$ loosely aga9/ ! drum4 ,?is %\ld be remov$ e few h\rs & a fre% pl$get put 94 ,! neck & upp] dorsal muscles %\ld be kept relax$ & adju/ive treatm5t giv5 frequ5tly4 ,"u ?is treatm5t ! pa9 %\ld be reliev$ & ! bulg+ ( ! drum %\ld disappe> 9 f two to twelve h\rs4 ,if ?is is n accompli%$ or if ! condition gr[s worse1 ! drum %\ld be lanc$4 ,see "s text on otology = te*nique4 ,9 my exp]i5ce1 v few cases h requir$ p>ac5tesis4 ,x mu/ be rememb]$ t treatm5t %\ld be cont9u$ regul>ly & = "s "t aft] ! pa9 & o!r symptoms h be5 reliev$ or a recurr5ce is probable4 ,pati5ts %\ld h daily treatm5t until ! physician is sure t no complication or recurr5ce is likely to result4 ,if ! pati5t is n se5 until aft] ! drum has ruptur$1 ! same treatm5t may be appli$ except ! irrigation or syr++ ( ! meatus4 ,?is1 9 case ( ruptur$ drum1 may =ce pus into ! ma/oid cells result+ 9 ma/oiditis4 ,in/ead ( syr++1 ! auditory meatus is clean$ by means ( a cotton applicator or by aspirat+ ) a ca!t]4 ,at all times dra9age ?r\gh ! meatus mu/ be ma9ta9$ until ! drum beg9s to heal4 ,acute ,ma/oiditis ,acute ma/oiditis results f acute or *ronic otitis m$ia4 ,9 "s cases ! otitis m$ia may h be5 only a mild attack4 ,diagnosis4--,!re is no "o symptom t is positively diagno/ic b a numb] ( signs & symptoms mu/ be consid]$ z foll[s3 #a4 ,always suspect ma/oid complications 9 acute otitis m$ia & wat* = ?is complication daily4 ,mo/ cases h "s ma/oid inflammation4 #b4 ,pa9 or swell+ ov] ma/oid4 ,pa9 may n be pres5t1 b usually is1 sometimes radiat+ ov] temples & eye on affect$ side4 #c4 ,t5d]ness on pressure n always pres5t4 ,may be v m>k$4 ,t5d]ness ext5d+ to tip or above e> means ext5sion ( infection4 ,if p]si/5t t5d]ness ov] tips ) m>k$ swell+ & discoloration--op]ation is indicat$4 #d4 ,swell+1 n always pres5t1 b sometimes v m>k$4 ,if extreme swell+ & blui% discoloration--usually means op]ation4 #e4 ,temp]ature v>ies f normal to #ajd or #aje ,f4 ,temp]ature ( m ?an "o or two degrees means sy/emic absorption & sugge/s surgical dra9age4 ,/reptococcus or /aphylococcus infections cause high] temp]atures & require dra9age e>li] ?an o!r infections4 #f4 ,transillum9ation n positive1 b ( "s value4 ,l ,x-ray1 usually %[s d>k1 because ( inflammation1 b mu/ rely ^u symptoms1 z above4 #g4 ,microscopic4--,/a9 = pus1 bact]ia & bone debris4 ,hematoxyl9 /a9 %[s d>k bone p>ticles if !re is bone dis9tegration4 #h4 ,blood ,c\nt4--,if absorption1 !re w be "s v>iation 9 proportions ( leucocytes4 ,any high leucocytosis %[s sy/emic absorption & ! natural attempt to ov]come ! infection4 ,non-,surgical ,treatm5t4--#a4 ,dra9age mu/ be ma9ta9$ f middle e> ?r\gh tube or drum or bo?4 ,ca!t] aspiration ?r\gh tube4 ,sometimes g5tle inflation to cle> ! tube1 foll[$ by aspiration is effective4 #b4 ,if drum is ruptur$1 aspirate middle e> by ca!t] or by ,moore's me?od or bo?4 ,?is is v important4 ,if no aspirat+ ma*9e1 use syr+e & pump meatus & tube p]si/5tly4 ,dry meatus & keep well op54 #c4 ,pati5t %\ld be kept 9 b$ if symptoms are m>k$1 ) light diet & b[els well op54 #d4 ,heat4--,apply oil or o!r lubricant ov] :ole side ( face & head & apply heat by means ( 8!rapeutic0 lamp int]mitt5tly4 ,?irty m9utes light on & fifte5 m9utes light (f4 ,! light-heat 7any electric lamp ) reflect+ %ade w d7 is mu* bett] ?an hot wat] bottle or electric pad or s& bag4 ,! heat mu/ be kept go+ day & night if symptoms are m>k$ until ! pa9 has entirely subsid$4 ,heat is mo/ effici5t 9 ! e>ly /ages4 ,aft] symptoms are well m>k$1 ! ice pack is m desirable4 #e4 ,if drum is n ruptur$1 heat may be appli$ by means ( ,deason's cont9u\s irrigat+ cup4 ,/>t at #aaf ,f4 & gradually increase to #abc ,f4 if pati5t c be> x4 ,surgical4--,if drum has n ruptur$ & symptoms cont9ue1 x is be/ to make free incision ( drum1--keep op5 & apply 7#b7 above4 ,indications = ,ma/oid ,op]ation4--,!re are no def9ite signs1 symptoms or te/s t w det]m9e positively :5 op]ation %\ld be done4 ,if ! above non-surgical me?ods are practic$1 few cases w require op]ation1 b _m w develop into *ronic ma/oiditis & s x is v difficult to decide :e!r a ma/oid op]ation %\ld or %\ld n be done4 ,x is be/ to expla9 ?or\ghly ! possible complications to ! pati5t & relatives & reque/ !m to assume responsibility4 ,ma/oid op]ations are att5d$ by v little dang] :5 prop]ly done4 ,signs & ,symptoms ,sugge/+ ,op]ation4--,acute otitis m$ia ) ma/oiditis4 7#a7 ,p]si/5t pa9 & swell+ n reliev$ by non-surgical treatm5t4 7#b7 ,m>k$ protrud+ ( po/]ior wall or meatus4 7#c7 ,m>k$ t5d]ness1 swell+ & discoloration above e> or ov] tip ( ma/oid4 ,^! ) temp]ature ( m ?an #ajb usually are en\gh to dem& imm$iate dra9age4 7#d7 ,any evid5ce ( ext5sion ( pus "u sk9 ( neck bel[ tip4 ,a positive indication = dra9age4 7#e7 ,any indications ( bra9 or m5+eal involvem5t su* z v m>k$ & p]si/5t heada*e1 p>tial or total loss ( consci\sness1 etc4 7#f7 ,indications ( labyr9?9e involvem5t su* z m>k$ v]tigo1 etc4 7#g7 ,sudd5 cessation ( dis*>ge means ob/ruct$ dra9age f middle e> or f ma/oid into middle e> & if dra9age _c be re/or$ by aspiration1 ?is means op]ation4 7#h7 ,! :ole cl9ical picture mu/ be c>efully consid]$ at all times4 ,take no *ances4 ,advise op]ation be=e someone else f9ds x too late4 ,*ronic ,ma/oiditis ,cause4--,always f unsuccessfully treat$ acute =m or f *ronic suppurative otitis m$ia4 ,non-surgical treatm5t4--,see *ronic suppurative otitis m$ia4 ,we h _h a few cases t 7 seem+ly p]man5tly cur$ by non-surgical treatm5t1 b believe !y are r>e4 ,indications = ,op]ation4--#a4 ,recurr5t exac]bation ( acute or *ronic otitis m$ia4 #b4 ,con/ant dis*>ge :i* resi/s treatm5t = *ronic suppurative otitis m$ia4 #c4 ,cont9u$ pa9 or recurr5t pa9 & swell+ foll[+ acute otitis m$ia4 #d4 ,op5 s9us into ma/oid ei!r ext]nal or ?r\gh meatus4 #e4 ,*ole/eatoma4 #f4 ,symptoms ( labyr9?9e or bra9 involvem5t foll[+ acute otitis m$ia4 #g4 ,def9ite evid5ce ( bone dis9tegration 9 ma/oid4 ,z /at$ above1 none ( ^! are def9ite indications4 ,! :ole gr\p ( signs & symptoms are to be consid]$4 ,*ronic ,suppurative ,otitis ,m$ia ,etiology4--,*ronic suppurative otitis m$ia usually results f an unsuccessfully treat$ acute otitis m$ia4 ,if 9 acute otitis m$ia !re has be5 bone erosion or ext5sive de/ruction ( ! muc\s membrane by a virul5t infection1 *ronic suppuration is likely to result4 ,a p]si/5t ma/oid infection foll[+ otitis m$ia is likely to result 9 *ronic otitis m$ia & ?is is /rong argum5t = e>ly ma/oid op]ation4 #a4 ,otitis m$ia result+ f "s virul5t infection su* z ! rec5t influ5za p&emic or sc>let fev] is always m likely to result 9 ma/oiditis & *ronic suppuration ( ! middle e>4 #b4 ,su* infecti\s ag5ts z /reptococcus1 /aphylococcus1 long-*a9 pneumococcus or bacillus influ5z are likely to result 9 *ronic suppurations4 #c4 ,l[]$ vitality f any cause4 #d4 ,ineffici5t dra9age f failure to aspirate ! ,eu/a*ian tube1 delay$ p]=ation or failure to lance drum suffici5tly e>ly4 #e4 ,ma/oid necrosis1 :i* ma9ta9s dra9age into ! tympanic cavity4 #f4 ,abnormal granulations1 polypi1 etc4 9 tympanic cavity4 #g4 ,*ronic inflammation ) suppuration ( ! epiph>ynx or ,eu/a*ian tubes4 #h4 ,*ole/eatoma result+ f p]=at$ drum & gr[?s ( epi!lium ext5d+ into ! middle e> cavity4 ,diagnosis4--,! diagnosis is easy because ne>ly e case ( dis*>g+ e> )\t pa9 is *ronic suppurative otitis m$ia4 ,! det]m9ation ( ! exact nature ( ! condition pres5t is n only v important b v difficult4 ,diff]5tial diagnosis consi/s 9 det]m9+ ! nature ( ! infect+ organism & ! nature & ext5t ( ! pa?ology4 #a4 ,direct exam9ation ( ! ext]nal meatus aft] dry+ ) cotton applicator usually det]m9es ! location & ext5t ( p]=ation ( ! drum & ! g5]al nature ( ! dis*>ge1 :e!r purul5t or mucopurul5t4 ,v r>ely "o f9ds a s]i\s dis*>ge :i* means a v slight infection or dis*>ge f non-infective inflammation4 ,! pres5ce ( :iti% or greyi% pus1 mucoid & /r+y1 usually means pneumococcus infection4 ,greyi%1 purul5t non-mucoid dis*>ge usually indicates /reptococcus or bacillus influ5z infection4 ,yell[1 purul5t dis*>ge sugge/s /aphylococcus infection4 ,! g5]al appe>ance ( ! dis*>ge1 h[ev]1 _c be consid]$ ( important diagno/ic value because mo/ *ronic suppurations are mix$ infections1 because ( long exposure to ext]nal contam9ation4 #b4 ,aft] clean+ ! meatus1 sev]al sme>s %\ld be made directly f ! op5+ 9 ! drum4 ,by /a9+ ) me?yl9 blue or g5tian violet1 ! nature ( ! bact]ial infection c be det]m9$ & ?is is v important4 ,by /a9+ ano!r sme> ) hematoxyl9 & wa%+ 9 wat]1 any d>k irregul> p>ticles1 bone debris1 may be f\nd1 :i* means bone dis9tegration4 ,?is too1 is v important4 #c4 ,transillum9ation is sometimes ( value4 ,! ma/oid may be transillum9at$ by plac+ a good rubb] cov]$ transillum9at+ lamp ov] ! ma/oid & obs]v+ ! ext]nal meatus ?r\gh an aural speculum4 ,if ! ma/oid is free f infection ! light w pass ?r\gh & illum9ate ! meatus4 #d4 ,! ,x-ray plate is1 ( c\rse1 ! be/ means ( det]m9+ ! nature & ext5t ( ma/oid involvem5t4 ,treatm5t4--,?is is c]ta9ly "o ( ! mo/ difficult diseases ( ! e> t "o is ev] call$ ^u to treat & ! physician %\ld be caution$ aga9/ (f]+ a favorable prognosis4 ,p]haps ! mo/ difficult ?+ ab\t its treatm5t t ! doctor has to le>n is t practically none ( ! s-call$ antiseptic wa%es d any good1 b on ! o!r h& !y (t5 d h>m4 ,c]ta9 g5]al pr9ciples are important & ! treatm5t mu/ dep5d ^u ! nature & ext5t ( ! infection & pa?ology pres5t 9 ea* case4 ,! con/itutional treatm5t consi/s ( ev]y?+ t w increase ! pati5t's g5]al resi/ance & c]ta9ly all lesions ( ! c]vical1 upp] dorsal & m&ibles mu/ be prop]ly adju/$1 b ?is is n en\gh4 ,all sp9al lesions t may ex]t an influ5ce on metabolism & elim9ation are ( important consid]ation4 ,! diet1 habits & environm5t ( ! pati5t mu/ be consid]$4 ,a c>eful exam9ation ( ! nasoph>yngeal tract may reveal "s o!r focal infection1 su* z *ronic tonsillitis1 ph>yngitis or s9uitis1 :i* is ma9ta9+ ! infection ?r\gh ! ,eu/a*ian tube4 ,!re may be a focal or g5]al infection ( "s o!r "p ( ! body1 :i* is r$uc+ resi/ance or caus+ a hematog5\s infection ( ! tympanic cavity or ma/oid cells4 ,dra9age mu/ be ma9ta9$ 9 all cases1 bo? ?r\gh ! ,eu/a*ian tube by ca!t] aspiration & ?r\gh ! drum by aspirat+ & dry+4 ,if ! p]=ation 9 ! drum is small or 9 ! middle or upp] "p1 x %\ld be op5$ d[n to ! floor s t ! cont5ts may be m easily remov$ & bett] dra9age e/abli%$4 ,x is well fir/ to ?or\ghly cleanse ! meatus & tympanic cavity by syr++ ) salt mixture 7salt #c p>ts1 borax #b p>ts & soda #a "p1 a teaspoonful to a half pus b[l ( wat]7 at f #aaf to #aah ,f4 ,aft] syr++1 ! meatus is c>efully dri$1 & ! middle e> cavity aspirat$ ?r\gh ! tube & drum op5+4 ,! advantage ( ?is simple treatm5t is ?or\gh cleanl9ess & dra9age ) ! m9imum ( irritation4 ,?is treatm5t giv5 daily or ?rice weekly w (t5 cure ! case4 ,/aphylococcus & /reptococcus infections usually respond to ! foll[+ treatm5t3 ,aft] ?or\ghly cleans+ z above1 ! meatus & tympanic cavity is syr+$ ) a "o to f\r or "o to five dilution ( ,dak9-,c>rel solution 7,hyclorite may be us$ in/ead7 foll[$ by aspiration1 ! fluid be+ drawn ?r\gh ! tube1 ?us prev5t+ re9fection f t s\rce4 ,pneumococcus infections d n respond to ei!r ( ^! me?ods ( treatm5t4 ,! pneumococcus1 because ( its capsule1 is n affect$ by antiseptics1 b on ! o!r h& ! irritation ( ! tissues caus$ by _! use1 only gives ! infective ag5t a bett] opportunity = gr[?4 ,9 pneumococcus infections we h f\nd ! foll[+ me?od effici5t3 ,?or\ghly cleanse ! meatus & middle e> cavity by salt mixture syr++1 aspiration & dry+4 ,! meatus & tympanic cavity is !n fill$ ) a neutral m9]al oil4 ,! oil is also pump$ ?r\gh ! ,eu/a*ian tube4 ,x is ! purpose to fill ! entire cavity & its op5+s s ?or\ghly t no air c ent]4 ,9 "s cases we h us$ bismu? pa/e aft] ! oil+ ) excell5t results4 ,! pneumococcus is a]obic & if all air c be kept away = a consid]able "t1 x furni%es an unfavorable culture environm5t ) little irritation to ! membranes4 ,surgical treatm5t4--,! pres5ce ( bone debris indicates bone dis9tegration 9 ! tympanic cavity or ma/oid cells4 ,if ! ma/oid cells are ?us involv$ !re is little *ance = direct treatm5t4 ,if su* cases d n respond 9 a %ort "t to any ( ! above me?ods ( local treatm5t1 ossiculectomy or ma/oid op]ation may be necess>y4 ,"s speciali/ surgeons claim f #hj to #ij favorable results f ma/oid op]ation 9 su* cases4 ,non-,suppurative ,otitis ,m$ia--,cat>rhal ,deafness ,deafness is any impairm5t ( normal he>+ & is t symptom next to pa9 & *ronic dis*>ge t causes ! pati5t to visit ! doctor4 ,if acute diseases ( ! e>1 nose & ?roat c\ld always be successfully treat$1 !re w\ld be little tr\ble f ! symptoms ( *ronic pa?ology4 ,x mu/ be und]/ood t cat>rhal deafness is a symptom ( *ronic otitis m$ia & is1 !re=e1 seldom ( rec5t orig94 ,etiology4--,*ronic otitis m$ia is ne>ly always ! result ( ! ext5sion ( infection ?r\gh ! ,eu/a*ian tube & has come f "s acute or *ronic nasoph>yngeal infection4 ,*ronic colds1 ph>yngitis1 tonsillitis1 s9uitis1 etc41 result+ 9 acute or *ronic otitis m$ia ei!r ) or )\t suppuration1 con/itutes ! beg9n+ ( cat>rhal deafness4 ,symptoms4--,!re is seldom any pa9 ) ?is disease4 ,"s cases h an occasional acute attack ) pa9 & o!r symptoms ( acute otitis m$ia4 ,deafness1 v>y+ ) ! progress ( ! pa?ologic *anges1 is always pres5t4 ,! pati5t 9 ! e>ly /ages w seldom admit t he suff]s f deafness & (t5 he is hone/ because he may n realize t he _c he> normally until 8 otitis m$ia has progress$ to ! second or ?ird /age4 ,mo/ pati5ts1 9 fact1 d n become al>m$ ab\t _! he>+ until x is too late to re/ore normal he>+4 ,= ?is reason1 physicians %\ld be on ! look\t = su* conditions & %\ld advise special treatm5t e>ly4 ,! human species 9 its pres5t environm5t1 dep5ds mu* less ^u ! organs ( special s5sation ?an d ! animals ( ! wild1 & !y may !re=e be v defici5t 9 sight1 he>+1 smell1 etc4 )\t actually realiz+ ?is loss4 ,9 addition to deafness !re are o!r symptoms su* z occasional or con/ant fullness or feel+ ( 8/uff9ess0 z ! pati5ts express x1 due to p>tial or complete occlusion ( ! ,eu/a*ian tubes4 ,t9nitus aurium or head noises is v common & (t5 ! mo/ annoy+ symptom4 ,autophony1 or ! l\d s\nd ( ! pati5t's voice to himself1 :i* (t5 causes him to speak l[ & indi/9ctly1 occurs 9 ! lat] /ages4 ,presbyacusia1 or ! inability to adju/ ! he>+ app>atus to v>iations 9 pit*1 commonly occurs 9 ! second /age & is evid5c$ by ! fact t ! pati5t does n he> :5 m ?an "o p]son is talk+4 ,p>ac\sis or p]v]t$ ph5om5a ( he>+1 su* z ! bett] he>+ ( "s p]sons 9 a noisy environm5t1 is a symptom ( ! ?ird /age ( otitis m$ia & (t5 means an unfavorable prognosis1 s f> z m>k$ improvem5t 9 he>+ is conc]n$4 ,pa?ologic ,/ages4--,= conv5i5ce ( discussion we may consid] *ronic otitis m$ia 9 ?ree /ages4 ,! ,fir/ ,/age4--,! active pa?ology is limit$ to ! ph>yngeal portion ( ! ,eu/a*ian tube ) "s inflammation ( ! membranes ( ! tympanic cavity4 ,closure ( ! tube foll[$ by absorption ( ! oxyg5 causes a decreas$ pressure 9 ! tympanic cavity & ?us a retraction ( ! drum1 decreas$ movem5t ( ! ossicles & a g5]al decrease 9 function ( all tympanic /ructures4 ,deafness 9 ?is /age may be v m>k$1 especially if ! ,eu/a*ian occlusion has occurr$ f "s nasoph>yngeal acute inflammation4 ,!re may be pa9 b !re is always a *>act]i/ic 8fullness0 & sometimes dizz9ess4 ,deafness 9 ^! cases v>ies ) wea!r *anges4 ,if prop] treatm5t is _h 9 "t1 ! progress ( ! pa?ology c be /opp$ & e case c be re/or$ to normal he>+4 ,! ,second ,/age4--,! active pa?ology has ext5d$ ?r\gh\t ! ,eu/a*ian tube caus+ m>k$ occlusion & "s /5osis4 ,!re is fur!r inflammation ( ! tympanic /ructures ) an increase 9 ! symptoms ( ! fir/ /age4 ,! drum membrane is less movable b !re is no fixation ( ! ossicles4 ,pressure ^u ! bulb ( ! auroscope causes movem5t ( t "p ( ! drum to :i* ! malleus is atta*$4 ,! drum is ?ick]1 m retract$1 & less movable ?an 9 ! fir/ /age4 ,presbyacusia is common & (t5 m>k$1 b !re is no p>ac\sis4 ,m ?an #ij ( ^! cases c be mat]ially improv$ & _m c be made to he> normally if prop] treatm5t is giv5 9 due "t4 ,! ,?ird ,/age4--,! active pa?ology 9 ! ?ird /age consi/s ( an involvem5t ( ! entire muc\s membrane l9+ ! ,eu/a*ian tube & tympanic cavity4 ,^! membranes are all *ronically hyp]trophi$4 ,! ,eu/a*ian tube1 h[ev]1 is sometimes fairly well op51 b ! ossicul> atta*m5ts are m or less fix$ by hyp]trophi$ tissue & adhesions & ! drum is m>k$ly retract$1 ?ick5$ & usually v immovable4 ,! deafness is usually q m>k$1 head noises are commonly pres5t & (t5 v annoy+4 ,pati5ts usually d n notice a v>iation 9 _! he>+ f wea!r *anges4 ,presbyacusia is pres5t 9 #hj ( cases & _! he>+ = l[ tones is mu* r$uc$4 ,unless !re is a complicat+ n]ve affection ^! cases he> well by telephone1 :i* means t !y c also use an electric he>+ in/rum5t to advantage4 ,^! cases c nev] be re/or$ to normal he>+1 b _m ( !m 7#cj ( my cases7 c h "s improvem5t & 9 mo/ cases ,i believe ! progress ( ! pa?ology c be /opp$1 & ?is is always well wor? :ile because _! he>+ is likely to be entirely lo/ if some?+ is n done4 ,psy*ologic ,/ages4--,!re are ?ree r di/9ct psy*ologic /ages 9 cat>rhal deafness4 ,! fir/1 ! p]iod 9 :i* mo/ pati5ts refuse absolutely to admit t !y are deaf ev5 to ! auri/ ^u :om !y call = treatm5t4 ,!y insi/ t !y he> p]fectly if p w\ld only speak di/9ctly4 ,?is is p>tially true1 because up to ! ?ird /age ( deafness ! voice c be fairly well he>d if p w\ld only articulate cle>ly4 ,9 ! second /age pati5ts admit t !y don't he> well1 b insi/ t !y are go+ to recov] normal he>+ & (t5 resort to v>i\s k9ds ( injuri\s treatm5t4 ,9 ! ?ird /age !y give up all hope ( ev] rega9+ _! he>+1 become morose1 & avoid company4 ,^! psy*ic /ages d n always correspond ) ! pa?ologic /ages giv5 above4 ,diagnosis4--,! ext]nal auditory meatus1 drum membrane & ossicul> *a91 con/itute ! app>atus ^: function is t ( conduction ( s\nd waves to ! p]ception app>atus ( ! inn] e>4 ,! function ( ! conduction app>atus v>ies inv]sely ) ! progress ( pa?ologic *ange 9 ^! /ructures4 ,! p]ception app>atus1 ! /ructures ( ! inn] e>1 are n necess>ily affect$ by middle e> pa?ology1 b on ! o!r h&1 s\nds transmitt$ by bone conduction n only seem l\d] b !y la/ long] because ! 8escape ( ! excess0 ( s\nd ?us transmitt$ is h9d]$ by defici5t conductive me*anism4 ,?is expla9s :y su* p]sons he> well by telephone & :y ! tun+ =k1 ^: base is held to ! ma/oid 7provid$ !re is no n]ve affection7 may be he>d = a great] "t ?an normal4 ,likewise ! prong ( ! vibrat+ tun+ =k :5 held ne> ! con*a is he>d = a %ort] "t ?an normal1 because ( ! defici5t function ( ! conduction me*anism4 ,tun+ =ks are kn[n by _! numb] ( vibrations p] second1 su* z #af1 #cb1 #fd1 #abh1 etc4 ,?ree or m =ks are requir$ to make an accurate measurem5t ( ! conduction & p]ception functions--a l[ =k ab\t a #cb1 = ! l[ tones1 #abh or a #eab = ! m$ium tones & a #bjdh = ! high tones4 ,a good set ( =ks %\ld be select$ & /&>diz$1 i4 e41 ! normal bone & air conduction ( ea* =k det]m9$ by te/+ x on a numb] ( p]sons ^: he>+ is kn[n to be normal4 ,= ! g5]al practition] :o c>es only to get a g5]al idea ( ! ext5t ( ! pa?ology1 "o =k ( m$ium pit* su* z a #abh or #eab w be suffici5t4 ,to measure ! function ( he>+1 ! =k is set into maximum vibration1 its base held aga9/ ! ma/oid & ! pati5t is ask$ to /ate :5 he no long] he>s x4 ,?is l5g? ( "t 9 seconds is record$ z 8bone conduction40 ,! =k is !n held ne> ! con*a & ! pati5t aga9 /ates :5 he does n he> x4 ,?is l5g? ( "t 9 seconds is record$ z air conduction4 ,normal ,he>+ ,tun+ ,=k ,te/4--,! normal "t rate 9 seconds set ( =ks is z foll[s3 ,=k #cb #fd #abh #eab #bjdh #djif ,b4 ,c4 #be #cj #cj #bj #aj ,a4 ,c4 tone #gj #ij #ij #dj #bj ,! tun+ =k te/1 c>efully made1 is ! only kn[n me?od ( measur+ ! functions ( ! v>i\s /ructures conc]n$ 9 audition4 ,! ,:isp] ,te/ is made by produc+ a cle> :isp] f residual air only1 :i* %\ld be he>d ab\t tw5ty feet by a normal e>4 ,! ,wat* ,te/ is made by us+ "s l\d tick+ wat* 7,i pref] an ,+]soll71 hold+ x fir/ ne> ! e> until ! pati5t recognizes ! tone1 & !n tak+ x beyond ! he>+ di/ance & approa*+ ! e> until x is he>d4 ,i pref] also to move away f ! e> until ! limit is rea*$ & /rike an av]age ( ?is ) ! above results4 ,! av]age eighte5 size ,+]soll wat* c be he>d = f #ajj to #aej in*es by ! normal e>4 ,! practical te/ = ! pati5t is 8 he>+ f ! spok5 voice1 & is ! mo/ reliable s f> z p]man5t results are conc]n$4 ,l[ ,tone ,limit4--,! l[e/ limit ( he>+ is ab\t sixte5 d\ble vibrations p] second1 b ! l[e/ practical limit is ab\t ?irty-two4 ,!re are few p ) normal he>+ & ) musically tra9$ e>s :o c recognize a def9ite tone l[] ?an ?is1 s ,i consid] ! ?irty-two =k suffici5tly l[ = all practical te/s4 ,conduction ,deafness4--,l[ tones are lo/ 9 tympanic involvem5t or conduction deafness1 & are diagno/ic 9 su* cases1 b are ( no p>ticul> value 9 n]ve deafness except :5 t is complicat$ by cat>rhal deafness4 ,practical ,he>+ ,limits4--,! human voice v>ies f ab\t #fj to #aej d\ble vibrations p] second1 & mo/ s\nds t we really ne$ to he> are less ?an #gjj vibrations p] second4 ,?is is ! reason = us+ ! l[ =ks1 #fd1 #abh & #eab4 ,measurem5t ( ,n]ve ,=ce4--,to measure auditory n]ve =ce1 ! =k 7say ! #abh1 ^: normal ,b4 ,c4 is #cj seconds7 is set into vibration & held g5tly & ) ev5 pressure aga9/ ! ma/oid & ! pati5t is ask$ to tell or signal ! doctor :5 he ceases to he> ! tone4 ,two or m te/s may be made to det]m9e ! pati5t's p]sonal equation1 b ! use ( control =ks 7! #fd & #eab7 w %[ any su* error4 ,grant+ t !re is no complicat+ pa?ology1 tympanic or labyr9?9e1 ! numb] ( seconds ( he>+ ov] #cj w be ! pati5t's auditory n]ve =ce4 ,= example1 if he he>s ! =k #cj seconds 8 he>+ w be ?irty-?irtie?s or normal4 ,if 8 he>+ is #be1 #bj1 #ae or #aj seconds1 8 auditory n]ve =ce w be respectively #be-cj1 #bj-cj1 #ae-cj or #aj-cj4 ,by means ( ?is me?od an accurate measurem5t ( ! functions ( he>+ c be made & a def9ite prognosis c be giv54 ,i nev] use any ( ! v>i\s nam$ qualitative =k te/s = he>+1 because !y h no value to "o :o employs ?is sy/em4 ,,foot ,,note--,9 ! *>t ,t is us$1 mean+ t tone is he>d1 :ile ,s indicates s\nd b no tone4 ,,foot ,,note--,x is n ! purpose to give any detail$ or diff]5tial me?ods ( diagnosis because if "o c>es to treat ^! diseases he w ( c\rse1 /udy a special text on ?is subject4 ,! me?ods "h giv5 are only = ! g5]al practician :o wi%es a g5]al idea ( ! condition pres5t4 ,summ>y ( ,diagnosis ( ,diff]5t ,/ages ( ,cat>rhal ,deafness ,fir/ ,/age4 #a4 ,=k #cb #abh #bjdh ,b4 ,c4 #ce #bj ,a4 ,c4 ,t #gj #dj #b4 ,! drum is only slightly retract$ b freely movable4 #c4 ,:isp] he>d f five to tw5ty feet4 #d4 ,+]soll wat* he>d f #cj to #aej in*es4 ,second ,/age4 #a4 ,=k #cb #abh #bjdh ,b4 ,c4 #dj #bj ,a4 ,c4 ,t #fj #dj ,note t ! tone ( ! #cb =k is he>d1 ! #abh =k has increas$ 9 bone conduction & r$uc$ 9 air conduction b t ! bone-air ratio is direct1 t is ! pati5t he>s long] by air ?an by bone conduction4 ,note also t ! high =k is /ill normal4 #b4 ,! drum w be f\nd retract$ b t "p to :i* ! malleus is atta*$ is /ill movable :5 te/$ ) ! auroscope4 #c4 ,! :isp] is he>d f two to t5 feet4 #d4 ,! ,+]soll wat* is he>d f six to sixty in*es4 #e4 ,presbyacusia b n p>ac\sia is pres5t4 ,?ird ,/age4 #a4 ,=k #cb #abh #bjdh ,b4 ,c4 #de #ae ,a4 ,c4 ,s #bj #cj ,! typical diagno/ic po9ts 9 ?ird /age cat>rhal deafness are3 #a4 ,tone = ! #cb =k is lo/4 #b4 ,!re is an inv]t$ bone-air ratio = ! m$ium =k4 ,! drum is retract$ & ! malleus fix$4 #d4 ,! :isp] may be he>d at less ?an "o foot or n at all4 #e4 ,! ,+]soll wat* is he>d less ?an six in*es f ! ma/oid4 #f4 ,p>ac\sis ,willisiani is pres5t4 ,= ! g5]al practician ?is is important because he c make a r def9ite prognosis4 ,treatm5t4--,! treatm5t w be giv5 briefly because space w\ld n p]mit ( l5g?y discussions ( details ( me?ods & te*nic4 ,,foot ,,note--,note t ! pati5t he>s ! tone ( ! l[ =k1 t ! #abh =k has its bone conduction slightly increas$ 7#cj to #ce7 t ! air conduction is slightly decreas$ 7#ij to #gj7 & t ! high =k rema9s normal4 ,a c>eful exam9ation %\ld be made = "s s\rce ( focal infection ab\t ! nasoph>yngeal tract4 ,*ronic or subacute tonsillitis1 ph>yngitis or s9uitis or root abscess are (t5 a cause1 & n mu* w be accompli%$ 9 improv+ ! otitis m$ia until ^! focal infections are f\nd & prop]ly treat$4 ,! orig9al cause ( ^! focal infections may h be5 "s bony lesion1 b to successfully correct su* lesion n[ does n mean t ! s\rce ( infection w be remov$4 ,auto-intoxication f ga/ro-inte/9al disease is common4 ,9 my cases1 #hj ( ! ?ird /age h *ronic con/ipation or o!r *ronic ga/ro-inte/9al affection4 ,9 _m sev]e acute affections ( ! nasoph>ynx ! inflammatory process has left ! ,eu/a*ian tube occlud$ or /5os$ & ! ph>yngeal fossa fill$ ) adhesive b&s4 ,x is n uncommon to f9d ! epiph>ynx & ph>yngeal fossa fill$ ) p>tially atrophi$ ad5oid tissue or if ! curet me?od has be5 us$ = remov+ ad5oids1 !re is (t5 connective tissue adhesions & any or all ( ^! may prev5t ! normal v5tilation ( ! tympanic cavity by way ( ! ,eu/a*ian tube4 ,9 su* cases surgical removal ( ^! ob/ructions & dilation ( ! tube is necess>y4 ,my practice has be5 to give a g5]al ane/hetic 7nitr\s oxide or somn(orm w be suffici5t 9 _m cases7 & by means ( an ad5otome 7,la ,=ce or ,cradle1 ,i nev] use a curet7 remove all ad5oid tissue4 ,!n by means ( ! f+] ,i c>efully remove any ad5oid tissue 9 ! po/]ior n>es & ph>yngeal foss t ! ad5otome may h fail$ to get & also dilate ! ph>yngeal portion ( ! tube by ins]t+ ! f+]4 ,?is op]ation if c>efully & ?or\ghly done & if prec$$ & foll[$ by ! prop] surgical cleanl9ess & supportive treatm5t1 w :5 indicat$1 accompli% excell5t results4 ,! aft] treatm5t is ev5 m important because if ?is is n well done1 no results or ev5 unfavorable results may occur4 ,! aft] treatm5t consi/s ( daily irrigations ( ! nasoph>ynx1 ?or\gh att5tion to upp] ?oracic1 c]vical & m&ibul> lesions1 aspiration ( ! ,eu/a*ian tubes & o!r local treatm5t to ! nasoph>yngeal membranes4 ,aft] ! op]ation has be5 done x is be/ to d no digital manipulation ( ! ph>ynx = f ?ree to six days4 ,aft] ?is "t digital treatm5t1 g5tle dilation ( ! ,eu/a*ian orifice to ma9ta9 its pat5cy1 /ret*+ ( ! s(t palate to ree/abli% prop] n]ve function & ! application ( deep pressure 9 ! ph>yngeal foss to /imulate ! otic ganglion is important4 ,?is treatm5t is n massage 9 any s5se b def9ite1 purposeful1 manipulation & if c>efully done w be foll[$ by excell5t results4 ,s9ce ! orig9 ( ?is me?od ( treatm5t1 !re has be5 mu* comm5t on its value & _m h tri$ or at lea/ !y ?\ght !y tri$ x ) unfavorable results4 ,! causes ( failure are1 attempt+ treatm5t 9 cases impossible ( cure1 or poor diagnosis1 improp] te*nic ( op]ator or incomplete op]ative proc$ure & ineffici5t supportive treatm5t4 ,x mu/ be und]/ood t n all cases ( otitis m$ia ev5 9 ! beg9n+ /ages require ! above me?od ( treatm5t or w be b5efit$ by x4 ,^? cases :i* h result$ f o!r causes ?an acute ph>yngitis seldom require su* radical me?ods ( treatm5t4 ,9 e case1 ! cause mu/ be f\nd & consi/5t treatm5t giv54 ,9 my exp]i5ce1 ! radical me?od ( treatm5t has n be5 f\nd necess>y 9 m ?an tw5ty p] c5t ( cases ( *ronic otitis m$ia4 ,9 ! o!r cases ! treatm5t consi/s ( remov+ s\rces ( focal infection 7ab\t =ty p] c5t7 & normaliz+ nasoph>yngeal reflexes by o/eopa?ic & local treatm5t 7ab\t =ty p] c5t74 ,9 all cases1 ! treatm5t mu/ be complete4 ,to remove ?or\ghly all ob/ruction f ! epiph>ynx & leave a s\rce ( focal infection 9 ! tonsils w accompli% little1 or to remove c>efully all ph>yngeal ob/ruction & all s\rces ( focal infection w n re/ore normal functions ( ! middle e> /ructures if ! o/eopa?ic lesions & ga/ro-inte/9al p]v]sions are neglect$4 ,surg]y 9 itself1 ev5 ?\gh c>efully & ?or\ghly done1 is n effici5t treatm5t & ?is is :y ! m$ical speciali/s fail 9 ?is disease4 ,aft] ! necess>y surg]y has be5 done1 !n normal tone mu/ be re/or$ to ! v>i\s tissues involv$4 ,normal reflex me*anisms mu/ be ree/abli%$ & ?is c be done by ?or\gh & effici5t o/eopa?ic corrective "w & ! prop] local treatm5t directly to ! /ructures affect$4 ,m5i]e's ,symptom ,complex ,?is is a =m ( cat>rhal deafness ) all ! *>act]i/ic pa?ology ( ! fir/ or second /age1 b 9 :i*1 due probably to sudd5 tubal occlusion1 !re results a m>k$ v>iation 9 ! intralabyr9?9e pressure & !re are1 !re=e1 ! symptoms ( conduction deafness comb9$ ) labyr9?9e involvem5t some:at resembl+ ,m5i]e's disease4 ,!re is dizz9ess or ev5 v]tigo1 ) head noises1 b n ! m>k$ pro/ration & nausea :i* *>act]izes ,m5i]e's disease4 ,treatm5t4--,! treatm5t is ! same z 9 ! fir/ /ages ( cat>rhal deafness & ! prognosis is always good4 ,! labyr9?9e symptoms are usually completely reliev$ z soon z ! middle e> is v5tilat$4 ,diseases ( ! ,inn] ,e> ,acute ,suppurations4--,acute suppurative diseases ( ! labyr9? occasionally result f ! ext5sion ( infection f ! tympanum b !y are c]ta9ly v r>e4 ,su* conditions may result f acute suppurative otitis m$ia 9 :i* !re has be5 an excessive collection ( pus )\t rupture ( ! drum or dra9age ?r\gh ! tube b ?is v r>ely occurs & aft] dra9age has be5 e/abli%$1 labyr9?9e infection is h>dly possible4 ,diagnosis4--,labyr9?itis is ( sev]al =ms b 9 g5]al1 !re are ! symptoms ( labyr9?9e involvem5t su* z3 ny/agmus1 v]tigo1 nausea1 vomit+1 heada*e1 e>a*e1 deafness & febrile symptoms4 ,:5 labyr9?itis is suspect$1 an auri/ ( mu* exp]i5ce %\ld be call$ into consultation at once4 ,treatm5t4--,suppurative labyr9?itis is n 9 itself a fatal disease b dang]\s complications may result because ( ! close proximity to s _m delicate /ructures4 ,?reat5$ m5+eal infection requires surgical dra9age1 b unless m5+eal infection is imm95t1 surg]y is contra9dicat$4 ,s9ce ! mortality1 consid]+ dang]s ( complications1 is n high 7ab\t #aj7 & s9ce su* op]ations are v complicat$ & require great surgical skill1 we may conclude t surg]y is g5]ally contra9dicat$4 ,non-surgical treatm5t consi/s ( keep+ ! pati5t quiet 9 b$1 liquid diet1 & good elim9ation4 ,dra9age ?r\gh ! middle e> or ,eu/a*ian tube mu/ be ma9ta9$4 ,deep manipulation ( ! c]vical /ructures w help to ma9ta9 lymphatic dra9age b any treatm5t :i* necessitates mu* movem5t ( ! head %\ld be avoid$ until ! symptoms ( ve/ibul> irritation h ceas$4 ,non-,suppurative ,labyr9?9e ,diseases ,m5i]e's ,disease4--,?is disease is caus$ by hemorrhage into ! labyr9? ) ! foll[+ symptoms3 ,!re is sudd5 & int5se ve/ibul> irritation su* z v]tigo1 m>k$ t9nitus1 nausea1 vomit+ & complete deafness on ! affect$ side4 ,!re may also be c]ebral di/urbances & loss ( consci\sness4 ,! ,prognosis dep5ds ^u ! ext5t & sev]ity ( ! pa?ology4 ,x is probable t ^? cases 9 :i* recov]y occurs quickly are n true cases ( ,m5i]e's disease b h "s causes o!r ?an labyr9?9e hemorrhage4 ,su* cases are p]haps ,m5i]e's ,symptom ,complex4 ,! ,treatm5t consi/s ( complete re/ 9 b$1 light diet1 & good elim9ation until ! m>k$ irritation has pass$4 ,x has be5 my practice to c>ry out fur!r treatm5t simil> to t ( ! treatm5t ( n]ve deafness to be giv5 lat]4 ,_m ( ^! cases w make complete recov]y4 ,n]ve ,deafness ,! t]m 8n]ve deafness0 is g5]ally us$ v c>elessly to apply to any *ronic or non-suppurative process ( ! labyr9?9e /ructures o!r ?an ^? m5tion$ above1 :i* cause impair$ he>+4 ,n]ve deafness is n an uncommon disease4 ,9 my cases ( deafness !re has be5 "s involvem5t ( ! labyr9?9e /ructures or auditory n]ve 9 #bg ( ! cases exam9$4 ,i ?9k ! reason = mo/ au?ors putt+ ! p]c5tage ( n]ve deafness mu* l[] ?an ?is is because ( inexact me?ods ( diagnosis4 ,! above p]c5tage is bas$ ^u ! actual measurem5t ( n]ve =ce4 ,see measurem5t ( n]ve =ce "u non-suppurative otitis m$ia above4 ,a c>eful /udy ( cases by ! me?od ( actual measurem5t ( n]ve =ce1 %[s t !re are two di/9ct =ms ( n]ve deafness4 ,9 "o !re is only a defici5t function ( ! /ructures ( ! labyr9?1 due p]haps to "s p]v]t$ physiologic function1 & ?is =m we may call auditory n]ve defici5cy4 ,! o!r =m ( n]ve deafness1 due probably to an actual deg5]ation ( ! n]ve or its end organs 9 ! labyr9?1 may be prop]ly kn[n z auditory n]ve deg5]ation4 ,auditory ,n]ve ,defici5cy4--,a /udy ( our case reports %[s t 9 #fd ( ! cases 9 :i* ! n]ve =ce 0 #af-cj or high] 7m ?an half7 favorable results 7 obta9$1 provid$ t !re 0 no complicat+ labyr9?9e affection4 ,^! cases h be5 class$ z 8n]ve defici5cy0 & ! pa?ology z functional4 ,a favorable prognosis 7#fd7 may be (f]$4 ,example ( tun+ =k f9d+s3 ,=k #cb #fd #abh #eab #bjdh #djif ,b4 ,c4 #ah #bj #bj #bj #aj ,a4 ,c4 ,t #ej #fj #fj #dj #bj ,9 addition to ! tun+ =k f9d+s ! voice & wat* te/ w be r$uc$ to f "o-t5? to two-?irds normal4 ,! pati5t (t5 compla9s ( it*+ meati & dry n>es4 ,!re are usually no signs or symptoms ( labyr9?9e affection4 ,treatm5t4--,! treatm5t consi/s ( local treatm5t to ! nasoph>ynx1 tubes & meati z describ$ "u ! treatm5t ( *ronic otitis m$ia4 ,ev]y?+ %\ld be done to build up ! pati5t's g5]al heal? & improve ! local nutrition4 ,x is highly ess5tial to se>* ! entire sy/em = s\rces ( focal & g5]al infection4 ,auto-intoxication f *ronic ga/ro-inte/9al disease 0 f\nd 9 #ij ( our cases4 ,any treatm5t !re=e t w re/ore normal ga/ro-inte/9al function is indicat$4 ,rec5tly we h _h "s excell5t results f colonic irrigation & ! prop] adju/m5t ( diet 9 su* cases4 ,any s\rce ( focal infection mu/ ( c\rse receive prop] att5tion4 ,! o/eopa?ic corrective treatm5t consi/s l>gely ( c>eful att5tion to lesions ( ! splan*nic area because ( ! importance ( normal dige/ion1 metabolism & elim9ation4 ,?is is c]ta9ly a mo/ important "p ( ! treatm5t & %\ld nev] be neglect$4 ,upp] c]vical & m&ibul> lesions h mu* to d ) ! local nutrition to ! e> /ructures & ^! mu/ n be neglect$4 ,! fact t we almo/ con/antly f9d evid5ce ( defici5t nutrition to ! meati & drums 9 ?is disease toge!r ) lesions ( ! m&ible1 sugge/s a local o/eopa?ic cause4 ,auditory ,n]ve ,deg5]ation4--,9 ^? cases 9 :i* !re is a measurable defici5cy ( n]ve function ( less ?an half ! normal we h f\nd t v few respond to treatm5t4 7,see table above47 ,! cause has !re=e be5 attribut$ to a /ructural pa?ology & ! condition call$ auditory deg5]ation4 ,example ,table3 ,=k #cb #fd #abh #eab #bjdh #djif ,b4 ,c4 #aj #ab #h #e #b ,a4 ,c4 ,s #bj #be #ae #g #e ,!re is usually v m>k$ impairm5t ( he>+ = voice & all o!r s\nds4 ,! ,+]soll wat* may be he>d five or t5 in*es1 b usually n at all1 & ! :isp]$ voice he>d only a few in*es or n at all4 ,!re are ne>ly always signs & symptoms ( labyr9?9e deafness & evid5ce ( tone isl&s4 ,! deafness 9 ^! cases is usually progressive reg>dless ( any treatm5t4 ,9 ?is disease !re is ne>ly always an associat$ affection ( ! labyr9? z %[n by ! high =ks4 ,! fractions repres5t$ by ! high =ks w agree 9 proportion provid$ !re is no labyr9?9e involvem5t4 ,our results 9 auditory n]ve deg5]ation h be5 measurable improvem5t 9 only #b ( ! cases treat$4 ,! prognosis is !re=e v poor & ,i believe we %\ld always tell our pati5ts frankly t !re is almo/ no *ance = improv+ _! he>+ 9 su* cases4 ,! treatm5t is ! same z t giv5 = n]ve defici5cy & because ( ! g5]al good t may be _h f treatm5t1 t is1 ! improvem5t ( ! g5]al resi/ance1 x is (t5 well = ! pati5t to h su* treatm5t to /op ! progress ( fur!r special s5sory deg5]ation4 ,x %\ld always be our purpose to treat ! pati5t r ?an to treat "s p>ticul> organ only & if ?is me?od is foll[$1 our g5]al results w surely be mu* high]4 ,diseases ( ! ,nose ,me?od ( ,exam9ation4--,= use 9 nasal exam9ations & treatm5t1 a suitable *air ) adju/able headre/ is ( mu* value because if ! pati5t is n com=table & 9 a conv5i5t position1 ! "w is v difficult4 ,a few in/rum5ts1 su* z ! foll[+1 are v ess5tial3 ,a /]iliz] = in/rum5ts1 head mirror & reflect+ lamp1 nasal speculum1 tongue depressor1 tonsil pill>-retractor1 a nasal pack+ =ceps & a few alum9um cotton applicators4 ,^! in/rum5ts are few & comp>atively inexp5sive1 b are ( m practical value ?an a lifetime collection ( electrical app>atus4 ,any physician c readily le>n ! use ( ^! in/rum5ts & ! me?ods ( exam9ation by att5d+ ! cl9ical sessions ( our conv5tions4 ,me?ods & te*nic ( treatm5t1 h[ev]1 require mu* practice & exp]i5ce to develop effici5cy4 ,acute ,rh9itis ,?is disease1 commonly kn[n z a 8cold 9 ! head0 is "o ( ! mo/ common1 & because ( ! complications :i* s commonly result1 a disease :i* really requires c>eful consid]ation4 ,etiology4--,! pr$ispos+ cause is r$uc$ resi/ance & individual susceptibility to air-borne irritants & infective organisms4 ,direct exposure ( "s insuffici5tly protect$ "p ( ! body su* z ! feet 9 cold1 damp wea!r1 exposure ( "s unprotect$ "p ( ! body to draughts or exposure ( ! :ole body to slightly r$uc$ temp]ature = a consid]able "t1 are ! common causes4 ,9 cold wea!r1 x is v important t ! prop] indoor humidity be ma9ta9$1 because ! dry+ ( ! muc\s membranes r5d]s !m susceptible to infection4 ,?is disease is n only contagi\s at times b may ev5 become endemic f "s specific & virul5t organism4 ,! complications :i* may & (t5 d foll[ su* infections are l>yngitis1 bron*itis1 pneumonia1 etc4 & any "o or m ( ! focal infections1 su* z s9uitis1 tonsillitis1 or middle e> infection4 ,a focal infection ?us caus$ may become *ronic & r5d] ! pati5t con/antly susceptible to head colds4 ,9 fact 9 ^? p]sons :o suff] f *ronic head colds1 !re may ne>ly always be f\nd "s focal infection1 su* z ! above nam$1 & x is (t5 impossible to get p]man5t relief until su* s\rces ( focal infection h be5 prop]ly treat$4 ,! influ5ce ( gross /ructural lesions1 o/eopa?ic lesions ( ! c]vical & upp] ?oracic region1 v]tebr & ribs mu/ n be ov]look$ because !y ex]t a p[]ful influ5ce ^u ! blood supply1 p>ticul>ly ! v5\s & lymphatic dra9age & ^u ! autonomic n]v\s me*anism1 :i* regulates ! physiologic control ( su* functions4 ,gross /ructural abnormalities ( ! intranasal *amb]s1 su* z deflect$ septum1 enl>g$ turb9ates or cellul> turb9ates1 :i* cause defici5t or abnormal brea?+ space1 may cause & ma9ta9 head colds4 ,diagnosis4--,! diagnosis is usually easy4 ,nasal conge/ion ) ! usual 8/uffy0 feel+ ( ! head1 sneez+1 heada*e1 etc4 are well kn[n symptoms4 ,on direct exam9ation ! n>es are conge/$1 !re is a wat]y dis*>ge & all ( ! membranes ( ! nasoph>yngeal tract are conge/$4 ,treatm5t4--,if !re is ev] a dem& = good1 ?or\gh & specific o/eopa?ic "w1 c]ta9ly x is dem&$ 9 su* cases4 ,i am an advocate ( ?or\gh1 deep relax+ treatm5t foll[$ by specific adju/m5t 9 su* cases4 ,complete re/ 9 b$ ) light diet & c>eful att5tion to ! elim9ation are v ess5tial4 ,p]haps ! mo/ difficult problem is to conv9ce ! pati5t t a head cold is really a s]i\s disease & dem&s ?or\gh & prompt treatm5t4 ,e e>1 nose & ?roat speciali/ has _h ample opportunity to "k t mo/ ( ! really s]i\s complications ( ! head & neck result f ! lack ( prompt & prop] att5tion to head colds4 ,! local treatm5t consi/s ( irrigation ( ! nasoph>ynx foll[$ by oil spray to protect f fur!r irritation & ! ma9t5ance ( prop] dra9age f ! s9uses & middle e>s4 ,i am n an advocate ( ! s-call$ 8antiseptic sprays0 because !y nei!r de/roy bact]ia suffici5tly to be effective nor d !y ma9ta9 dra9age4 ,9 all cases1 ! physician %\ld be ev] wat*ful = ! complications & %\ld n hesitate to call consultation ( a speciali/ :5 su* symptoms develop4 ,purul5t ,rh9itis ,p]si/5t inflammations ( ! nasal membranes are usually ( a purul5t nature or at lea/ h _h su* a cause 9 ! beg9n+4 ,etiology4--,purul5t rh9itis may be a result ( an unsuccessfully treat$ infection ( ! nose or ?roat foll[+ "s disease ( *ildhood or e>ly life4 ,x may be due to infection at bir?4 ,commonly !re is a subacute or *ronic s9us infection t ma9ta9s ! infection ( ! nasal mucosa4 ,polyps1 enl>g$ or cellul> turb9ates1 ad5oids or adhesions 9 ! epiph>ynx1 (t5 reta9 ! secretions & cause *ronic rh9itis4 ,9 _m cases ,i h f\nd t o/eopa?ic lesions ( ! c]vical or upp] ?oracic region are effective causes ( *ronic rh9itis4 ,! ,pa?ology consi/s ( hyp]emia1 hyp]trophy & exfoliation ( ! cellul> membrane4 ,! turb9ates & all membranes become enl>g$ & ?ick5$ & ! brea?+ space is usually greatly decreas$4 ,! ,symptoms are nasal ob/ruction1 & muc\s or mucopurul5t dis*>ge ) usually hyp]s5sitiv5ess1 :i* causes sneez+ & o!r symptoms common to 8head colds40 ,treatm5t4--,! same treatm5t z giv5 above = acute rh9itis applies "h4 ,a ?or\gh exam9ation %\ld be made = all ( ! v>i\s causes giv5 above & ! prop] corrective treatm5t giv5 = any or all su* causes4 ,*ronic ,hyp]trophic ,rh9itis ,etiology4--,*ronic rh9itis is usually a result ( an infective rh9itis & has = its cause any "o or m ( ! v>i\s causes giv5 above "u purul5t rh9itis4 ,pa?ology4--,! pa?ology 9 *ronic rh9itis v>ies ) ! cause1 b is usually *>act]iz$ by a s]ies ( *anges beg9n+ ) infection & hyp]emia & foll[$ by an actual & usually m>k$ hyp]trophy ( ! int]/itial tissue4 ,! po/]ior ends ( ! inf]ior or1 less (t51 ! middle turb9ates are usually enl>g$ & ext5d backw>d into ! ph>ynx4 ,! ,symptoms are mu* ! same z 9 purul5t rh9itis1 except t ! purul5t dis*>ge is (t5 n pres5t4 ,^! cases usually suff] f *ronic head colds1 heada*es & p]si/5t nasal ob/ruction4 ,! s5ses ( smell & ta/e are usually impair$ & !re is a nasal twang to ! voice4 ,treatm5t4--,9 ^! cases1 x is common to f9d o/eopa?ic causes :i* prev5t prop] dra9age f ! head & neck & ?is is important because1 if all ! local causes are prop]ly correct$1 ?is is n suffici5t to effect a cure4 ,surgical treatm5t = ! removal ( polyps1 syne*ia1 ad5oids1 adhesions1 correction ( septum1 or hyp]trophi$ or cellul> middle turb9ates is (t5 ess5tial & c]ta9ly infect$ s9uses mu/ be prop]ly dra9$4 ,we h _h cases 9 :i* root abscesses seem$ to be active causes1 b x mu/ n be ?\ght t surg]y & surg]y alone is likely to cure *ronic rh9itis1 & ,i want to caution aga9/ ! :olesale removal ( turb9ates = su* conditions4 ,! m]e fact t ! turb9ates are enl>g$ is n suffici5t reason = _! removal4 ,!re has be5 a cause = ?is enl>gem5t & turb9otomy or turb9ectomy does n remove ?is cause4 ,caut]y is worse1 because x seldom accompli%es m ?an v tempor>y results & (t5 leaves ! membranes worse ?an be=e4 ,caut]y de/roys muc\s membrane1 leav+ a dry & easily irritat$ surface :i* is (t5 impossible to normalize4 ,! prop] surg]y1 c>efully done1 foll[$ by effici5t o/eopa?ic corrective "w & ?or\gh irrigation ( ! nasoph>yngeal tract ) ! necess>y oil spray protection aft] irrigation1 w con/itute effici5t treatm5t4 ,treatm5t1 ?or\gh & long cont9u$1 w 9 due "t re/ore nutrition1 dra9age & normal reflex n]ve control to ! tissues4 ,treatm5t aft] surg]y is ess5tial4 ,intranasal ,treatm5t4--,_m cases are caus$ by ! ret5tion ( secretions "u ! turb9ates & 9 ! sup]ior vault4 ,9 all cases1 !re=e1 x is ess5tial to ?or\ghly free all possible ret5tion cavities by means ( a small cotton-w\nd probe be=e irrigation4 ,! intranasal membranes are adr5aliz$ & ane/hetiz$ & a ?or\gh exam9ation is made us+ a good reflect+ lamp1 nasal speculum & cotton tipp$ probe4 ,e "p ( ! intranasal region is inspect$ = s\rces ( purul5t dis*>ge1 mucus collections1 syne*ia & = hyp]s5sitive areas4 ,! probe is curv$ at ! end & pass$ "u ea* turb9ate & drawn =w>d & backw>d ) consid]able pressure to insure t any collection ( =eign matt] is ?or\ghly remov$4 ,e "p ( ! intranasal region %\ld be ?or\ghly treat$ 9 ?is way4 ,! hiatus semilun>is mu/ be kept well op5 to p]mit free antrum dra9age & all o!r s9us op5+s %\ld be kept free f any ob/ruction t may block ! dra9age4 ,?is p>ticul> te*nic requires great c>e & practice1 b x is v effective & s commonly we h f\nd t ?is "w ?or\ghly done w r$uce mu* & 9 "s cases all ( ! turb9ate hyp]trophy r5d]+ surg]y unnecess>y4 ,atrophic ,rh9itis ,z ! t]m sugge/s1 ?is disease is j ! opposite f hyp]trophic rh9itis 9 t ! membranes are %runk51 ! n>es are wide op5 & usually ! membranes are coat$ ) a mucopurul5t dis*>ge1 accompani$ by a bad odor4 ,x is a *ronic disease & progressive 9 nature4 ,etiology4--,defici5t nutrition1 sy/emic or local1 or "s deg5]ative infective process con/itutes ! cause4 ,"s cases may be trac$ to syphilis1 b ?is is c]ta9ly n always ! cause4 ,*ronic s9uitis1 ! cause ( :i* is "s virul5t infection1 is (t5 ! cause4 ,too mu* or incorrect surg]y & caut]y is c]ta9ly a cause 9 _m cases4 ,pa?ology4--,! m>k$ atrophic appe>ance1 ! retract$ turb9ates1 ! excessive purul5t or mucopurul5t f\l dis*>ge are *>act]i/ic & diagno/ic4 ,! tissues und]ly+ ! muc\s membranes are %runk51 & atrophic & ?is tissue has usually be5 replac$1 sometimes almo/ completely1 by connective tissue1 & ?us ! blood supply is m>k$ly defici5t4 ,treatm5t4--,9 *ronic cases1 ^? 9 :i* ! atrophy is well progress$1 !re is no hope ( re/oration to normal conditions1 b ,i believe t ! progress ( practically e case c be /opp$ & t1 9 mo/ cases1 a p]man5t cure c be effect$ "u prop] treatm5t4 ,e possible s\rce ( focal infection1 su* z s9uitis1 ph>yngitis1 tonsillitis1 etc4 %\ld receive prop] att5tion promptly4 ,aft] ?is has be5 done & suffici5t "t all[$ = normalization1 a blood c\nt may reveal "s o!r s\rce ( focal or g5]al infection1 :i* may be r$uc+ ! g5]al resi/ance4 ,auto-intoxication f "s ga/ro-inte/9al affection is commonly a cause & mu/ receive prop] att5tion4 ,! g5]al heal? ( ! pati5t mu/ be re/or$ & ma9ta9$4 ,?or\gh o/eopa?ic treatm5t mu/ be giv5 = any cause ( l[]$ nutrition1 local or g5]al4 ,! failure1 ,i believe1 9 m$ical practice 7,!y admit failure 9 ?is disease7 is due to ! lack ( att5tion to ! re/oration ( normal nutrition4 ,:y dra9 a s9us & leave an atlas or upp] ?oracic lesion :i* decreases ! local nutrition & leaves ^! membranes susceptible to fur!r infection8 ,be=e & aft] surgical dra9age1 irrigation ( ! nasoph>yngeal tract4 ,?or\gh irrigation to cleanse e "p4 ,hot irrigation 7"o gallon ( salt mixture solution1 salt #c p>ts1 borax #b p>ts1 & soda #a "p1 a tablespoonful to ! gallon at #aah;,f4 to #abc;,f47 to cleanse1 to free all p>ts f infection & to re/ore blood supply to ! affect$ p>ts4 ,frequ5t irrigation1 daily = a suffici5t "t to ?or\ghly /]ilize & re/ore circulation4 ,aft] ea* irrigation1 an oil spray 7any non-irritat+ petroleum oil7 is appli$ freely to protect ! membranes f irritation & fur!r infection4 ,be=e ea* irrigation a ?or\gh probe treatm5t1 z describ$ "u hyp]trophic rh9itis1 %\ld be giv5 t ! membranes may be ?or\ghly fre$ f all reta9$ secretions4 ,aft] ! membranes are once clean1 ! s9uses free f infection & ! blood supply ree/abli%$1 ! treatm5t may be r$uc$ 9 frequ5cy to ?ree times weekly1 b ! treatm5t mu/ be cont9u$ = mon?s or ev5 ye>s to effect a p]man5t cure4 ,! pati5t c be taught to d 8 own irrigation aft] ! disease is well "u control4 ,all irritat+ sprays1 *emical caut]ies1 etc4 mu/ be avoid$4 ,! s-call$ 8antiseptic sprays0 d h>m by irritat+ ! membranes & c]ta9ly d no good1 because !y d n cleanse ! p>ts4 ,!y only s]ve to deodorize1 b actually accompli% no?+ 9 ! way ( cure4 ,x has be5 my exp]i5ce t iod9e & ! silv] salts 9 any ( _! v>i\s prep>ations are n effici5t b t !y actually d h>m4 ,my exp]i5ce indicates t practically e case c be cur$ if ! prop] treatm5t is giv5 = suffici5t "t4 ,ph>macodynamics ,if ,i may be p>don$ = discuss+ ?+s ph>macological 9 a text on practice1 ,i want to urge t *emicals z su*1 are usually a failure 9 treatm5t4 ,my results f v>i\s s]ies ( exp]im5tal "w bo? laboratory & cl9ical1 %[ q conclusively t !re are v few1 if any1 *emical sub/ances t h actual value by virtue ( _! *emical prop]ties alone4 ,!re are1 h[ev]1 cases 9 :i* *emical ag5ts may be us$ to advantage to obta9 desirable physical results & physiologic reactions4 ,! salt mixture m5tion$ above increases ! solv5t p[] ( ! wat] = mucus1 pus1 & o!r collect$ mat]ial & x also r5d]s ! wat] less irritat+ to ! muc\s membranes4 ,o!r ?an ?is1 x has no value s f> z ,i "k4 ,?is solution is c]ta9ly n antiseptic or g]micidal1 fur!r ?an t cleanl9ess may be consid]$ an antiseptic proc$ure4 ,! ph5ol-glyc]9e 7#aj ph5ol & #ij glyc]9e7 :i* we h recomm5d$1 is some:at g]micidal1 non-irritat+1 except to ! nasal mucosa1 is a protectant to inflam$ membranes 9 "s in/ances & is also some:at hygroscopic4 ,^! virtues to ! limit$ ext5t t !y may be ( advantage1 dep5d *iefly ^u physical qualities4 ,adr5al9 9 high dilutions 7#a to #ejjj to #a to #aj1jjj7 is ( value 9 retract+ ! erectile tissues ( ! n>es = purposes ( exam9ation & = obta9+ bett] dra9age1 etc4 ,x also con/ricts ! small blood vessels & ?us r$uces ! *ances = hemorrhage or absorption ( n>cotic drugs :i* may necess>ily be us$ z local ane/hetics4 ,! effects ( adr5al9 are v tempor>y & x is1 !re=e1 ( little value 9 treatm5t4 ,foll[+ irrigation ,i h us$ ! petroleum oils 7liquid petrolatum7 to advantage z a protection to ! muc\s membrane4 ,"o-half gram ea* ( m5?ol & camphor & two or ?ree drops ( c9namon oil to ! p9t ( ?is oil1 is readily dissolv$ & produces a pleasant1 soo?+ effect to inflam$ membranes1 b fur!r ?an ?is1 ! add$ sub/ances h no p>ticul> value4 ,! above nam$ *emical ag5ts con/itute1 except 9 r>e in/ances1 my /ock ( 8drugs0 = treatm5t purposes4 ,hyp]e/hetic ,rh9itis--,hay ,fev] ,!re is p]haps no disease 9 :i* !re has be5 m speculation conc]n+ ! etiology ?an 9 hay fev]1 & :ile o/eopa?y has accompli%$ a wond]ful advance 9 ! treatm5t ( ?is disease1 ,i am n sure t ! cause or causes are yet ?or\ghly und]/ood4 ,etiology4--,! !oretic causes ( ?is disease may be express$ 9 ! v>i\s names :i* h be5 giv5 to x z foll[s3 ,! t]m ,hay ,fev] sugge/s t x is a febrile condition caus$ by hay poll5 irritation4 ,pea* cold1 ,rose cold1 ,rose fev]1 ,rose cat>rh1 ,rye fev] & ,ragwe$ fev] sugge/ simil> specific causes4 ,idiosyncratic coryza means no?+ & ?is probably expresses :at ! !ori/s "k ab\t its cause bett] ?an any o!r "n4 ,hy/]ic rh9itis sugge/s a probable psy*ic cause1 :i* c]ta9ly does exi/ 9 "s cases4 ,if ,i may be p>don$1 & ,i "k ,i nev] w be1 let me sugge/ j "o m "n--8,respiratory ,reflex ,ineffici5cy40 ,intoxications4--,auto-intoxication f focal infections or f ga/ro-inte/9al p]v]sions c]ta9ly h an important influ5ce ei!r directly or z pr$ispos+ factors & %\ld always be c>efully consid]$ 9 treatm5t4 ,o/eopa?ic ,lesions4--,o/eopa?ic lesions1 su* z int]osse\s1 muscul> & ligam5t\s1 seem to function z pr$ispos+ causes by _! g5]al effects ^u ! sy/em4 ,x seems probable t _! effects ^u ! organs ( metabolism & elim9ation are ( great] importance ?an any direct or specific effect 9 caus+ ! imm$iate symptoms4 ,9 practically all cases lesions ( ! upp] ?oracic v]tebr & ribs & ( ! c]vical region are pres5t4 ,x is my op9ion t su* lesions are m (t5 second>y ?an prim>y4 ,respiratory ,reflex ,ineffici5cy4--,measurem5t ( n]ve =ce 9 ^! cases %[s t none are really possess$ ) 8an excess ( n]ve =ce10 b t practically all v>y f two-?irds to f\r-fif?s normal1 %[+ t probably all cases are defici5t 9 n]ve =ce4 ,?is in/ability ( ! n]v\s sy/em c be expla9$1 ,i believe1 9 ! !ory ( p]iph]al reflex insuffici5cy4 ,z evid5ce ( ?is ! foll[+ facts may be cit$3 #a4 ,x is kn[n t p]iph]al irritation ( almo/ any nature1 to ! muc\s membranes ( ! nasoph>yngeal tract1 w excite an attack 9 susceptible individuals4 #b4 ,t any treatm5t :i* t5ds to increase ! resi/ance ( ^! membranes w prev5t or relieve an attack4 #c4 ,t p]iph]al inhibition to ^! surfaces w tempor>ily relieve an attack4 #d4 ,t complete normalization ( ^! membranes w make ! pati5t resi/ive to ! s-call$ specific irritants1 su* z poll51 du/1 etc4 #e4 ,t ! muc\s membranes ( ! entire respiratory & ga/ro-inte/9al tract react to irritants to br+ ab\t 8! hay fev] /ate0 & t any treatm5t :i* t5ds to normalize ^! membranes1 r5d]s ! pati5t m resi/ive to hay fev] attacks4 ,excit+ ,causes4--,!re is no d\bt t v>i\s air-borne irritants1 su* z poll51 du/1 *emical fumes1 emanations f animals1 etc41 act z excit+ causes ( acute attacks1 & yet !re are cases t develop acute attacks out ( season or at a "t :5 x seems t !re c\ld be no air-borne irritation4 ,f evid5ce :i* w be (f]$ lat] 7see prognosis7 ,i am l$ to believe t probably all susceptible cases c be made entirely resi/ive to ! air-borne irritants4 ,pa?ology ,functional ,pa?ology4--,c]ta9ly 9 ?is disease !re is ample evid5ce ( m>k$ p]v]sions ( function or functional pa?ology4 ,kyle believes t 9 _m cases ! cause ( local irritation lies 9 8"s *emical *ange 9 ! con/itu5ts ( ! mucus-secret+ gl&s10 & 8x is a well kn[n fact t 9 _m cases ( hay fev] ! irritation is n limit$ to ! nasal muc\s membrane4 ,! eyes & muc\s membrane ( ! /oma* & bladd]1 & ev5 ! inte/9es may be m>k$ly irritat$40 ,^! *emical *anges 9 ! secretion ( ! muc\s membranes1 toge!r ) ! excess ( uric acid w\ld seem to po9t ei!r to a g5]al p]v]sion ( ! secretory me*anism or to a defici5t elim9ation1 or to bo?4 ,! p]iodic occurr5ce may be acc\nt$ = by assum+ t ! sy/emic /ra9 is suffici5t to initiate ! symptoms4 ,! fact t ! attack is actually delay$ or ha/5$ 9 susceptible individuals by ! late or e>ly beg9n+ ( hot wea!r1 & t ^! cases get relief by go+ to a m mod]ate climate is fur!r evid5ce ( ?is4 ,aga9 we are rem9d$ ( ,dr4 ,/ill's tea*+1 t ! body ma9ta9s its own *emical laboratory :i* adju/s or t5ds to adju/ its "w to ! ne$s ( t body1 b "u abnormal /ra9 ?is adju/ive me*anism may fail to meet all ( ! dem&s ( function4 ,x seems "h t ! o/eopa?ic concept may easily include all environm5tal causes z well z int]nal causes 9 ! pr$isposition to defici5t function or disease4 ,/ructural ,pa?ology4--,dur+ ! attack !re is a g5]al cat>rhal inflammation ( all nasoph>yngeal membranes1 accompani$ by a wat]y dis*>ge & m>k$ swell+ ( ! turb9ates4 ,s5sitive areas may be f\nd on ! middle turb9ate & opposite wall ( ! septum4 ,probably x is ?is hyp]susceptibility to irritation t causes ! attack f ! air-borne irritants4 ,! pseudo-membrane :i* may be f\nd cov]+ a "p or all ( ! muc\s membranes ( ! n>es probably results f ?is irritation & is =m$ = ! purpose ( protection4 ,cl9ical ,types4--,cl9ically1 ?ree r indef9ite types ( hay fev] may be recogniz$1 viz43 ,v]nal1 ^? cases :i* h _! attack sometime dur+ ,may1 ,june or ,july2 ,autumnal1 9 :i* ! attack occurs 9 ,augu/ or ,septemb] & usually la/s until ! beg9n+ ( cold wea!r1 & an indef9ite or pseudo =m occurr+ at any "t ( ! ye>1 ) no *>act]i/ic attack1 z 9 ! o!r =ms1 b ) indef9ite symptoms resembl+ hay fev]4 ,symptoms & ,diagnosis4--,pati5ts usually g to ! physician self diagnos$4 ,! *>act]i/ic sneez+1 ! wat]y dis*>ge f ! nose1 & ! irritation ( all membranes ( ! nasoph>ynx & conjunctiva w s]ve to make a diagnosis 9 mo/ cases4 ,direct exam9ation w reveal ! nasal conge/ion & o!r *>act]i/ic pa?ology z describ$ above4 ,t]m9ation4--,mo/ cases ( ! autumnal =m1 unless successfully treat$1 cont9ue ) equal or increas$ sev]ity until aft] ! fir/ or second fro/1 :5 !y usually t]m9ate 9 a/hma1 bron*itis or s9uitis1 :i* la/s = sev]al weeks or mon?s4 ,ea* ye> ! attack la/s long] & is m sev]e & ! a/hma occurs e>li] & is m sev]e4 ,treatm5t ,intranasal ,surg]y4--,intranasal abnormalities1 su* z deflect$ septum1 spurs on ! septum1 hyp]trophi$ turb9ates1 polypi1 etc41 :i* mat]ially r$uce ! brea?+ space1 usually dem& surg]y4 ,nasal surg]y1 c>efully & prop]ly done1 is always a great aid & (t5 absolutely ess5tial to ! successful treatm5t ( hay fev] & a/hma1 b nasal surg]y c>elessly done frequ5tly does m h>m ?an good4 ,! correction ( a deflect$ septum or ! removal ( a spur on ! septum by submuc\s op]ation (t5 aids mat]ially 9 ! prev5tion ( pressure irritation1 increases ! brea?+ space & normalizes dra9age f ! s9uses4 ,surg]y is !re=e v ess5tial 9 _m cases ( hay fev]1 b surg]y is nev] ! all ess5tial "p ( ! treatm5t1 because if ! prop] aft] treatm5t is n giv51 ! surg]y alone w seldom result 9 ei!r tempor>y relief or cure4 ,focal ,infection4--,! importance ( focal infection ( ! s9uses1 tonsils1 tee? & occasionally o!r p>ts1 su* z ! nasal cavities1 epiph>ynx1 middle e> & ma/oid cavities _c be ov]e/imat$4 ,su* conditions may be effective 9 caus+ hay fev]1 by caus+ direct infection ( ! membranes ( ! nasoph>yngeal tract or by auto-intoxication4 ,digital ,surg]y1 = ! removal ( adhesions 9 ! po/]ior n>es & ph>ynx1 is 9 my op9ion1 v ess5tial1 & ?is "w %\ld be done ?or\ghly4 ,massage ( ! s(t palate or ph>yngeal walls is ( no p>ticul> value4 ,all adhesions & ad5oid tissue mu/ be remov$ because ?is removes an effective s\rce ( con/ant irritation & focal infection & t5ds to normalize ! direct & reflex n]ve me*anism4 ,! practice ( ! radical intranasal te*nique z orig9at$ by ,j4 ,d4 ,edw>ds1 ,d4 ,o41 is indicat$1 ,i believe1 9 "s cases 9 :i* ! cru%+ ( cellul> middle turb9ates1 or ! break+ ( adhesions is indicat$1 b ,i am n yet ready to accept ?is !ory ( 8curett+0 ! muc\s membrane by radical digital te*nique4 ,! fracture ( ! turb9ates is n necess>ily a bad te*nique provid$ !y are prop]ly readju/$ z ,dr4 ,edw>ds does x1 b to fracture & n readju/ is a dang]\s practice4 ,! effici5cy & safety ( any me?od dep5ds ^u ! op]ator's def9ite k ( :at ne$s to be accompli%$ & h[ x is to be done4 ,!re are contra9dications to digital1 z well z any o!r k9d ( nasoph>yngeal surg]y1 su* z3 7#a7 ,acute infection ( any "p ( ! nasoph>yngeal tract2 7#b7 evid5ce ( s9us involvem5t2 7#c7 septal deflections1 spurs & hyp]trophi$ turb9ates1 :i* w\ld n p]mit su* "w )\t undue trauma4 ,!re are c]ta9 o!r precautions su* z ?or\gh cleanl9ess ( ! p>ts to be treat$2 aspiration ( ! s9uses be=e & aft]w>d1 & ! use ( a f+] ( suffici5t size :i* w n produce undue trauma4 ,9 my op9ion v few doctors h su* f+]s4 ,failure 9 accompli%+ results is due to ?ree ?+s1 viz41 7#a7 ,insuffici5t k ( diagnosis & prognosis2 7#b7 insuffici5t k ( :at %\ld be accompli%$ & ! te*nique ( do+ x1 & 7#c7 ! necess>y additional or supportive treatm5t4 ,x is a great mi/ake to ?9k t ! removal ( adhesions 9 ! ph>ynx or n>es is suffici5t1 because if ?is is n foll[$ by ! prop] supportive treatm5t1 no results or ev5 bad results w frequ5tly occur4 ,?is treatm5t is n a massage 9 any s5se1 b a def9ite op]ative proc$ure & requires z mu* c>e & skill z ! removal ( ad5oids or tonsils4 ,space w n p]mit an explanation ( ! digital te*nique & ! radical treatm5t %\ld n be attempt$ )\t "s def9ite k ( ! me?ods & te*nique4 ,intranasal ,treatm5t4--,! intranasal me?od ( treatm5t z expla9$ above "u hyp]trophic rh9itis is v effective & if c>efully & ?or\ghly done is 9 mo/ cases j z effici5t z intranasal digital surg]y4 ,?is treatm5t foll[$ by irrigation & oil spray & nasal pack+ w be f\nd effective 9 mo/ cases if ! treatm5t is prop]ly done4 ,nasal ,pack+4--,?or\gh pack+ ( ! nasal cavities aft] all s\rces ( focal infection h be5 remov$ & aft] ?or\gh cleans+ has be5 done1 by means ( long /rips ( absorb5t cotton is effective 9 r$uc+ ! swell+ & irritation4 ,! ,radical ,pack+ ,me?od4--,?is me?od c be done be/ 9 a hospital4 ,! n>es are prep>$ z = surgical op]ation1 by complete retraction ( all erectile tissue1 ?or\gh cleans+ by irrigation & ! application ( a local ane/hetic4 ,ane/hesia ne$ n be complete4 ,a c>eful exam9ation is !n made = any syne*ia1 or focal infections4 ,pack+ %\ld nev] be done until ! doctor is sure !re is no s9us involvem5t4 ,! entire nasal cavity is !n pack$ v firmly ) /]ile gauze4 ,?is is be/ done by means ( a special pack+ in/rum5t or long nasal pack+ =ceps1 us+ n>r[ gauze conta9$ 9 tubes4 ,9 "s cases ! nasal cavity is lubricat$ be=e pack+4 ,! pack+ %\ld be done e>ly 9 ! morn+ & remov$ j be=e b$-"t1 s t ! pati5t may sleep4 ,?is treatm5t is repeat$ daily until all signs & symptoms ( nasal irritation are gone & !n replac$ by irrigation & oil spray4 ,if ?is treatm5t is prop]ly done1 !re w be a complete sl\gh+ ( ! pseudo-membrane foll[$ by a re/oration ( normal & resi/ive tissue4 ,! results ( our two ye>s' exp]i5ce 7we h tri$ ?is on only a few pati5ts ea* ye>7 are v enc\rag+4 ,relief f ! symptoms are v prompt & seem+ly m p]man5t ?an f o!r me?ods4 ,treatm5t ( ,auto-intoxication4--,all s\rces ( focal infection are ?or\ghly treat$4 ,s9us infection is v common & mu/ receive prop] att5tion be=e any o!r treatm5t c be effective4 ,our exp]i5ce %[s t _m cases h auto-intoxication ( ga/ro-inte/9al orig94 ,! hospital c>e ( su* cases makes possible ! ?or\gh cleans+ ( ! colon by irrigation & ! ree/abli%m5t ( an acid produc+ flora :i* seems to prev5t f]m5tation4 ,o/eopa?ic ,corrective ,"w4--,?or\ghness ( treatm5t = ! removal ( all causes is ! secret ( success4 ,to successfully remove ! imm$iate s\rces ( auto-intoxication by treat+ a s9us infection or by ?or\ghly free+ ! colon f f]m5tation products means only tempor>y results if ! und]ly+ causes are n correct$4 ,a ?or\gh o/eopa?ic exam9ation is necess>y to det]m9e su* causes & c]ta9ly su* treatm5t %\ld n be neglect$4 ,correction ( all c]vical & upp] ?oracic lesions & p>ticul>ly ! clavicles & ribs is important4 ,^! lesions seem to be ! result r ?an ! cause1 b normal respiratory functions seem+ly _c be ma9ta9$ unless su* treatm5t is done4 ,s9uitis ,acute or *ronic inflammatory disease ( ! nasal accessory s9uses ) or )\t suppuration is m common1 ,i believe1 & is responsible = m complications & *ronic affections ( ! nose & ?roat ?an is g5]ally kn[n4 ,etiology4--,! cause 9 mo/ cases lies 9 unsuccessfully treat$ acute infections involv+ ! nose & ?roat4 ,abnormalities ( ! nasal respiratory passages su* z deflect$ septum1 enl>g$ or cellul> turb9ates1 adhesions result+ f caut]y or c>eless surg]y1 caus+ defici5t dra9age1 con/itute ! local causes4 ,und]ly+ "s ( ^! direct causes1 lesions ( ! c]vical region :i* impair ! nutrition to & dra9age f ! head are to be consid]$4 ,symptoms & ,diagnosis4--,acute or *ronic heada*es & neuralgic pa9s ( ! head are common symptoms4 ,acute s9uitis ( ! frontal s9uses is accompani$ by m>k$ & p]si/5t frontal heada*e & pa9 9 ! eyes4 ,9 infections ( ! maxill>y s9us !re is usually pa9 ov] ! affect$ "p1 b !re is (t5 ref]r$ pa9 to o!r p>ts ( ! head4 ,sph5oidal s9uitis usually causes g5]al heada*e ) no def9ite location4 ,by direct exam9ation ( ! nasal cavities a purul5t or mucopurul5t dis*>ge may be se5 & ! s\rce det]m9$4 ,9 _m cases1 h[ev]1 ! pus may be reta9$ or insuffici5t 9 am\nt to detect by direct exam9ation4 ,transillum9ation 9 a d>k room by means ( a good transillum9ator w usually %[ a d>k5$ area ov] ! affect$ "p4 ,! av]age batt]y equipm5ts commonly sold = ?is purpose are ( little value4 ,! ,x-ray plate :5 prop]ly done1 is m dep5dable ?an ! transillum9ator4 ,9 "s cases1 all ( ^! me?ods fail to locate ! affect$ s9us & ! cause c be f\nd only by op5+ into ! s9uses1 aspirat+ ) a ca!t] & mak+ microscopic exam9ation ( ! aspirat$ mat]ial4 ,! microscope is indisp5sable = ?is "w4 ,e suspici\s dis*>ge %\ld be /a9$ until pus is f\nd & except 9 well def9$ cases1 ?is is ! only practical me?od ( positive diagnosis4 ,treatm5t4--,local treatm5t ( ! nasal cavities by retract+ ! turb9ates & irrigation w be successful 9 _m cases1 b unless !re is a l>ge normal op5+ ! pus w n dra9 suffici5tly & probe treatm5t is requir$4 ,9 acute cases 9 :i* ! pa9 is m>k$1 o/eopa?ic treatm5t ( ! c]vical region1 deep relaxation ( ! submaxill>y /ructures & ! application ( heat ov] ! affect$ "p1 toge!r ) ! local nasal treatm5t %\ld be giv51 b if ?is does n relieve ! pa9 )9 tw5ty-f\r h\rs1 ! s9us %\ld be op5$ & ?or\ghly dra9$4 ,if effici5t dra9age is n e/abli%$ e>ly ! symptoms w usually increase until ! pa9 is almo/ unbe>able & s]i\s complications may result4 ,9 practically e case ( acute s9uitis1 ,i believe x is be/ to make a good1 free op5+ into ! affect$ s9us fir/ & secure complete dra9age by ca!t] aspiration4 ,if ?is is prop]ly done e case w recov] mu* m quickly & )\t complications or dang] ( *ronic infection4 ,non-,suppurative ,s9uitis ,cases ( non-suppurative s9us involvem5t are n at all uncommon4 ,! s-call$ 8,vacuum s9uitis0 :i* results f a closure ( ! normal op5+1 result+ 9 inflammation )\t pus =mation1 is responsible = _m ( ! complicat$ cases ( ref]r$ pa91 :i* are s (t5 improp]ly diagnos$4 ,*ronic heada*es & ! v>i\s symptoms ( fif? n]ve affections1 ! neuralgias ( ! head1 are frequ5tly caus$ by non-suppurative s9us involvem5t4 ,treatm5t4--,! treatm5t consi/s ( e/abli%+ good dra9age & prop] v5tilation ( ! affect$ s9us or s9uses foll[$ by ?or\gh intranasal treatm5t z expla9$ above4 ,! o/eopa?ic corrective "w mu/ n be neglect$4 ,syphilis ( ! ,nose ,9 o/eopa?ic practice syphilis is n a common disease4 ,! occurr5ce ( syphilis ( ! nose is /ill m r>e b c]ta9ly %\ld be recogniz$4 ,diagnosis4--,! local lesions ( ! nose are ( two types1 ^? ( acquir$ syphilis & ( cong5ital syphilis4 ,!re are ?ree *>act]i/ic manife/ations ( acquir$ syphilis z foll[s4 ,! prim>y lesion or h>d *ancre is a firm1 indurat$ ulc]at$ mass ) only slight dis*>ge4 ,*ancre ( ! nose is exce$+ly r>e4 ,9 second>y syphilis !re is ! muc\s pat*1 ! result ( muc\s membrane necrosis4 ,9 t]ti>y syphilis ! local lesion is ! gumma or m commonly1 ! ulc]ation left f necrosis ( ! gumma4 ,^! lesions may appe> f a few to _m ye>s aft] ! initial infection1 b !y nev] foll[ imm$iately4 ,! lesions may appe> on almo/ any "p ( ! intranasal /ructures4 ,!y resemble ! lesions ( atrophic rh9itis b 9 atrophic rh9itis !re is nev] ! ext5t ( de/ruction t s frequ5tly results f t]ti>y syphilis4 ,treatm5t4--,x has be5 my practice to ref] all suspect$ cases to ,dr4 ,f4 ,j4 ,/ew>t = diff]5tial diagnosis & treatm5t & 8 me?od ( ! use ( salv>san has prov5 effici5t4 ,epi/axis--,nose ,ble$ ,! causes ( nose ble$ may be divid$ into two g5]al gr\ps1 local & con/itutional4 ,! fir/ gr\p consi/s ( trauma directly to ! nose ei!r ext]nal or int]nal1 f nasal op]ations & o!r causes4 ,! pres5ce ( a clu/] ( ?9-wall$ ve9s on ! ant]ior "p ( ! septum :i* readily rupture f slight cause1 con/itutes p]haps ! mo/ common cause ( nose ble$4 ,! ulc]s ( atrophic rh9itis or syphilis occasionally cause ble$+4 ,malignant gr[?s ( ! nose may cause frequ5t & pr(use hemorrhage4 ,! con/itutional causes ( epi/axis are1 ! acute fev]s1 c>diac & art]ial diseases1 :i* cause excessive t5sion2 & cases ( alt]$ composition ( ! blood su* z ! anemias1 mal>ia1 purpura1 *lorosis1 hemophilia1 etc4 ,diagnosis4--,direct exam9ation ( ! nose w usually reveal ! cause4 ,if !re are no signs ( trauma or rupture ( ! ant]ior gr\p ( vessels & ! ble$+ does n respond quickly to pack+ ( ! affect$ side1 !re is ei!r a rupture ( a l>ge vessel1 :i* requires long cont9u$ pack+1 or x belongs to ! class ( con/itutional disease4 ,if !re is evid5ce ( "s necrotic disease ( ! nose or if !re are areas ( expos$ bone or c>tilage f c>eless surg]y1 ^! may usually be se5 & ! po9t ( ble$+ locat$4 ,treatm5t4--,cold applications1 irrigation ( ! n>es ) cold normal salt solution & ! application ( an absorb5t cotton or gauze pack is usually suffici5t to /op ! av]age case ( epi/axis f any cause4 ,! direct application ( cold to ! l[] c]vical region w cause capill>y re/riction4 ,!re are _m cases 9 :i* ! membranes ( ! nose h lo/ _! tone due to v>i\s irritants or f defici5t nutrition to ! p>ts4 ,^! are cases ( a :olly diff]5t type f t ( ! well kn[n necrotic diseases su* z atrophic rh9itis & syphilis4 ,hay fev] is a result ( su* a cause4 ,! treatm5t 9 su* cases consi/s ( remov+ any local causes or o/eopa?ic lesions & !n normaliz+ ! resi/ance ( ! membranes by ! me?ods describ$ "u ! treatm5t = hay fev]4 ,! treatm5t = ^? cases ( epi/axis due to con/itutional disease dep5ds :olly ^u ! causative factors & ! prop] treatm5t ( ^!4 ,any local treatm5t 9 su* cases w be expect$ to produce only tempor>y results4 ,diseases ( ! ,nasoph>ynx ,! nasoph>ynx may be ! location ( acute or *ronic inflammations1 neoplasms1 malignant or nonmalignant1 processes ( atrophy or hyp]trophy1 adhesions1 etc4 ,x is important to rememb] t ! nasoph>ynx admits ! ,eu/a*ian tubes & supports f\r sup]ficially locat$ ganglia ( ! fif? n]ve4 ,acute ,nasoph>yngitis4--,acute inflammatory processes ( ?is region may result f rh9itis1 infections ( ! l[] ph>ynx1 focal infections ( ^! p>ts or f direct involvem5t ( its own /ructures4 ,! symptoms are po/ nasal t5d]ness & mucus dropp+4 ,"s pati5ts exp]i5ce ! s5sation ( a =eign body 9 t location4 ,! ?ick1 adh]5t collections ( mucus are difficult to dislodge & sometimes are s p]si/5t t !y cause nausea4 ,!re is usually occlusion ( ! ,eu/a*ian tubes1 result+ 9 p>tial deafness1 t9nitus & (t5 dizz9ess4 ,! ,treatm5t consi/s ( ?or\gh cleanl9ess by irrigation & o/eopa?ic corrective "w to ! c]vical region4 ,x is also ess5tial to keep ! ant]ior neck /ructures p>ticul>ly ^? ( ! submaxill>y region1 ?or\ghly relax$ to ma9ta9 effici5t dra9age4 ,*ronic ,nasoph>yngitis ,?is is "o ( mo/ common diseases ( ! nasoph>yngeal tract1 causative ( _m complications & yet p]haps ! lea/ recogniz$ 9 proportion to its significance4 ,! frequ5t occurr5ce ( adhesions ( ! ph>yngeal foss1 hyp]trophi$ membranes1 enl>g$ spongy ext5sions ( ! inf]ior & middle turb9ates 7! po/]ior turb9ate bodies7 occlusion ( ! orifice ( ! ,eu/a*ian tubes & *ronic1 excessive secretion ( ?ick mucus all %[ t ?is disease has ei!r gone unrecogniz$ or at lea/ has n receiv$ prop] treatm5t4 ,treatm5t4--,complete surgical removal ( all abnormal gr[?s1 adhesions1 etc4 z describ$ "u ! treatm5t ( *ronic non-suppurative otitis m$ia & ?is foll[$ by ?or\gh irrigation & o!r me?ods ( local treatm5t describ$ above are effici5t4 ,! successful treatm5t ( ?is disease requires "t4 ,!re has be5 a p>tial or1 9 "s cases1 almo/ a complete loss ( ! normal functions ( ! n]ve reflex me*anism ( ^! p>ts1 p]iph]al reflex ineffici5cy & ?is mu/ be re/or$4 ,effici5t & long cont9u$ treatm5t ( ! lesions commonly f\nd 9 ! c]vical & upp] ?oracic regions w d mu* to re/ore ^! normal functions1 b ?is alone )\t ! surgical treatm5t w nev] effect a p]man5t cure4 ,nei!r w ! surg]y & local treatm5t alone effect a cure4 ,! :ole treatm5t is requir$4 ,ad5oids ,ad5oids are ! hyp]trophi$ lymphoid tissue ( ! nasoph>ynx4 ,!y occur commonly 9 *ildr51 z a result ( acute inflammations4 ,possibly ! suckl+ process ( ! *ild produces a p>tial vacuum ( ! epiph>ynx & ?us causes excessive blood supply to ! "p & !re=e excessive gr[? ( ^! s(t tissues4 ,ad5oids1 h[ev]1 are n conf9$ to *ildr5 b frequ5tly occur 9 adults4 ,9 all cases !y are a s\rce ( mu* annoyance & (t5 ! cause ( acute & *ronic disease4 ,symptoms & ,diagnosis4--,m\? brea?+1 head colds1 p>tial deafness1 etc4 are ! common symptoms4 ,! flatt5$ nose1 ! high ar* ( ! h>d palate & ! /upid appe>ance ( ! face are diagno/ic4 ,by direct palpation to ! nasoph>ynx ! nature & ext5t ( ! ad5oid mass c be det]m9$ & ?is is ! be/ me?od ( diagnosis4 ,treatm5t4--,_m me?ods ( non-surgical treatm5t h be5 employ$1 b !re is no?+ z satisfactory z complete surgical removal4 ,ad5oid tissue has no kn[n function diff]5t f t ( o!r lymphoid tissue & !re is always suffici5t to p]=m any necess>y function )\t excess ( ad5oid gr[?4 ,! excessive ad5oid gr[? is 9 e case a detrim5t to normal developm5t1 because x impairs nasal respiration & usually causes *ronic nasoph>yngitis & ?us r$uces resi/ance aga9/ all diseases ( *ildhood4 ,!re is !re=e1 no excuse1 mu* less a reason1 :y excessive ad5oid gr[?s %\ld n be remov$ surgically1 provid$ x is prop]ly & ?or\ghly done4 ,! op]ation = remov+ ad5oids requires 9 *ildr51 a g5]al ane/hetic4 ,9 adults1 a local ane/hetic is us$ by "s op]ators4 ,i h f\nd x be/ to fir/ break ! ad5oid mass away f ! side walls ( ! ph>ynx digitally4 ,a ,la,force or ,gradle ad5otome is !n us$ to remove ! ad5oid mass4 ,if ei!r ( ^! in/rum5ts is prop]ly us$ x w always remove ! great] "p ( ! ad5oid mass )\t undue trauma or injury to any ( ! ph>yngeal /ructures4 ,curets %\ld nev] be us$ because !y almo/ nev] remove ! ad5oid mass prop]ly1 b !y usually d injure ! ph>ynx4 ,_m cases ( ph>yngeal adhesions1 ,eu/a*ian tube occlusion & nasoph>yngitis result f direct injury caus$ by curets4 ,aft] ! ad5oid mass has be5 remov$ ! f+] is ins]t$ into ! ph>ynx & any ad5oid gr[?s 9 ! po/]ior n>es are remov$4 ,! ph>yngeal foss are also ?or\ghly fre$ f ad5oid tissue & adhesions & ! orifices ( ! ph>yngeal portions ( ! tubes are g5tly dilat$4 ,?is me?od insures complete removal ( all excessive ad5oid tissue1 & normal functions ( ! nasoph>ynx4 ,ad5oids ?us remov$ d n return4 ,aft] ! surgical "w has be5 complet$ ! nasoph>yngeal tract %\ld be ?or\ghly irrigat$ ) hot salt mixture solution4 ,?is ?or\ghly cleanses ! membranes1 ha/5s heal+1 prev5ts hemorrhage & avoids po/-op]ative infection4 ,irrigation ( ! nasoph>ynx %\ld be cont9u$ = "s days or until all evid5ces ( inflammation h ceas$4 ,! ph>ynx %\ld !n be exam9$ to be sure t no adhesions h develop$ f inflammation1 b if ! op]ation is c>efully done1 complications w nev] result4 ,diseases ( ! ,oroph>ynx ,acute ,ph>yngitis ,acute inflammations ( ! ph>ynx alone or 9 common ) inflammations ( o!r p>ts ( ! nasoph>yngeal tract are common4 ,?is disease is mo/ common z a result ( ! acute infections affect+ ! nose & ?roat4 ,etiology4--,! pr$ispos+ causes are focal infections ( ! nasoph>ynx1 su* z tonsillitis1 s9uitis1 etc4 ,defici5t nutrition or anemia ( ! ph>ynx or sy/emic anemia are common causes4 ,lesions ( ! c]vical1 upp] ?oracic & hyoid are common pr$ispos+ causes4 ,undue exposure ( ! neck 9 susceptible p]sons or too mu* or too tight clo?+ ab\t ! neck may also pr$ispose to inflammations ( ! ph>ynx4 ,! excit+ causes are ! acute infections1 colds & focal infections4 ,p]haps ! mo/ common excit+ cause is tonsillitis1 acute or *ronic4 ,symptoms & ,diagnosis4--,! *>act]i/ic dryness ( ! ph>ynx1 pa9 & p]si/5t c\gh+ are diagno/ic4 ,^u direct exam9ation1 ! r$d5$1 swoll5 appe>ance ( ! ph>ynx & po/]ior pill>s c be se54 ,treatm5t4--,! treatm5t %\ld be g5]al & local & %\ld be det]m9$ by ! causes & conditions pres5t4 ,?is disease is usually an acute infection & l o!r acute infections1 ! usual sy/emic treatm5t %\ld be appli$4 ,! local treatm5t consi/s ( ?or\gh cleans+ ( ! nasoph>ynx 7by irrigation if ! pati5t c p]mit7 & ! frequ5t 7or occasional z requir$7 use ( "s g>gle until ! inflammation has subsid$4 ,any cleans+ nonirritative solution may be us$ = a g>gle4 ,equal p>ts ( p]oxide1 alcohol & glyc]9e1 a tablespoonful to a half glass ( v w>m wat] or t5 to fifte5 drops ( ph5ol-glyc]9e to a half glass ( w>m wat] w make a good cleans+ g>gle4 ,! o/eopa?ic treatm5t consi/s ( corrective "w to ! c]vical1 upp] ?oracic & hyoid & ?or\gh relaxation ( ! submaxill>y musculature to obta9 good v5\s & lymphatic dra9age4 ,if suffici5t c>e be tak5 to avoid trauma1 digital /ret*+ ( ! s(t palate & ph>yngeal muscles by ! use ( ! f+] int]nally1 is v efficaci\s4 ,*ronic ,ph>yngitis ,*ronic ph>yngitis may be hyp]trophic1 atrophic or granul>4 ,9 hyp]trophic ph>yngitis ! pa?ologic *anges h pass$ beyond ! /age ( hyp]emia & !re is always hyp]trophy or hyp]plasia1 usually ! latt]1 ( ! ph>yngeal membranes4 ,^! *anges 9 mo/ cases1 h ext5d$ to & involv$ all ( ! nasoph>yngeal membranes4 ,*ronic granul> ph>yngitis1 or s-call$ cl]gyman's sore ?roat1 has a simil> pa?ology to t describ$ above1 b ) swoll5 & inflam$ lymph follicles4 ,?is condition seems to be a result ( excessive use ( ! voice4 ,*ronic atrophic ph>yngitis has a simil> etiology & ! diagno/ic signs are also simil> to atrophic nasoph>yngitis ) :i* x is usually associat$4 ,etiology4--,! causative factors are simil> or ! same z ^? ( nasoph>yngitis4 ,lesions ( ! c]vical & upp] ?oracic & *ronic focal infections su* z tonsillitis1 s9uitis1 etc4 are ! common causes4 ,treatm5t4--,! nature ( ! treatm5t %\ld be det]m9$ by ! causes f\nd4 ,! nature ( ! pa?ology requires long cont9u$ treatm5t & c>eful att5tion to all causes4 ,?or\gh o/eopa?ic corrective "w1 ! removal ( all s\rces ( focal infection1 prop] att5tion to any ga/ro-inte/9al p]v]sions :i* may be caus+ auto-intoxication & ?or\gh cleanl9ess ( ! p>ts by g>gl+ ) "s cleans+1 non-irritat+ solution & by irrigation4 ,9 mo/ cases !re is a consid]able collection ( adhesions 9 ! nasoph>ynx or po/]ior n>es or 9 bo?4 ,enl>g$ 8po/]ior turb9ate bodies0 & ! ext5sion ( ! inf]ior turb9ates into ! ph>ynx are also common results ( ! hyp]trophic process4 ,complete surgical removal ( ?is excess tissue & ! aft] treatm5t z describ$ above "u *ronic nasoph>yngitis are frequ5tly requir$ to obta9 complete & p]man5t results4 ,^! cases c be successfully treat$ if ! prop] att5tion is giv5 to all possible causes 9 ea* individual case4 ,x is ! individualization1 ! specific & detail$ att5tion to ! cause or causes1 & su* treatm5t cont9u$ = suffici5t "t1 t w obta9 results4 ,9 atrophic ph>yngitis1 normal nutrition to ! p>ts & usually to ! entire sy/em mu/ be re/or$4 ,_m su* cases are second>y to sy/emic anemia or to rheumatic intoxication4 ,a c>eful exam9ation %\ld be made = evid5ce ( sy/emic causes4 ,9 _m cases1 ,i believe t ?or\gh o/eopa?ic corrective "w appli$ to ! mid & l[] sp9e is ! mo/ ess5tial "p ( ! treatm5t4 ,o!r ?an ?is ! local treatm5t z describ$ "u atrophic rh9itis applies "h4 ,tonsillitis ,!re is p]haps no o!r organ ( ! body1 diseases ( :i* h caus$ a great] v>iance ( op9ion relative to treatm5t ?an ! tonsils4 ,!re are ^? :o believe t e hyp]trophi$1 atrophi$1 or infect$ tonsil toge!r ) its fell[ ( ! opposite side %\ld be remov$4 ,!re are also ^? :o believe t no tonsils1 reg>dless ( _! pa?ology1 %\ld ev] be remov$4 ,^! are ! radicals & _! views are n at all 9 keep+ ) pres5t day facts4 ,^? physicians & surgeons :o h tri$ to arrive at "s safe conclusion on ?is subject1 believe t !re are c]ta9 me?ods ( non-surgical treatm5t :i* are effective 9 _m cases & !y also believe t 9 o!r cases1 tonsillectomy is imp]ative4 ,functions ( ! ,tonsils4--,_m & v>i$ functions = ! tonsils h be5 held by v>i\s !ori/s su* z3 ! absorption ( ! products ( saliv>y dige/ion2 ! secretion ( an amylolytic f]m5t2 t !y are atavi/ic /ructures & !re=e h no function2 t !y elim9ate sy/emic tox9s2 t !y s]ve z culture tubes = ! production ( vacc9es2 t !y protect ! deep] c]vical tissues f bact]ial invasion2 ! !ory ( int]nal secretion & a score ( o!r !ories :i* s f>1 h nev] be5 sub/antiat$ by ei!r cl9ical or exp]im5tal evid5ce4 ,! hematopoietic !ory or ! !ory ( blood =mation has a r def9ite basis because su* a function w\ld be possible f ! hi/ologic /ructure4 ,! =mation ( small lymphocytes has be5 attribut$ to tonsil tissue 7,flemm+7 & ?is view has be5 g5]ally accept$4 ,"s ( ! lymphocytes h[ev]1 f9d _! way ?r\gh ! epi!lial walls into ! crypts & are dis*>g$ z 8muc\s plugs01 :ile o!rs are c>ri$ by ! eff]5t lymphatics into ! circulatory sy/em4 ,9 ?is respect1 ! tonsils1 l o!r lymphoid tissue1 produce lymphocytes :i* are ess5tial con/itu5ts ( ! blood4 ,?is function is p>ticul>ly m>k$ dur+ ! gr[+ p]iod1 b ?is function is also highly develop$ 9 all lymph nodules dur+ ?is p]iod1 & 9 ! gr[+ *ild !re is an abundance ( su* tissue & ?us x seems t ! tonsils1 :ile important to ! gr[+ *ild1 w\ld n be at all indisp5sable /ructures4 ,"s physicians claim to h obs]v$ defici5cies 9 gr[? & developm5t ( *ildr5 ^: tonsils _h be5 remov$ dur+ ! fir/ t5 or fifte5 ye>s ( life1 b ?is is n commonly accept$4 ,! tonsils h _! greate/ cellul> activity dur+ ! gr[+ p]iod & unless *ronically hyp]trophi$ !y atrophy dur+ adult life4 ,tonsillectomy ,we may safely conclude f ?is evid5ce1 t 9 ! gr[+ *ild1 x may be well to reta9 ! tonsils provid+ !y are n directly affect$ 9 su* a way z to endang] ! g5]al heal? ( ! *ild1 b t !re is little1 if any1 dang] 9 _! e>ly removal4 ,9 adults1 !re seems to be no reason :y !y %\ld n be remov$ 9 cases 9 :i* !re is evid5ce ( involvem5t beyond re/oration by treatm5t or ^? cases 9 :i* !re is evid5ce ( toxic absorption4 ,:5 surgical removal ( ! tonsils is indicat$1 ! complete removal or tonsillectomy %\ld always be done4 ,a c>eful & complete enucleation ( ! tonsils :5 prop]ly done w nev] be foll[$ by any unt[>d results o!r ?an ! tempor>y surgical sore ?roat4 ,!re is nev] any excuse1 mu* less a reason1 = p>tial removal ( ! tonsils or tonsillotomy1 because su* op]ations nev] accompli% ! desir$ result & !y ne>ly always require tonsillectomy lat]4 ,9 association ) a reputable vocal tea*] ,i h /udi$ ! results ( tonsillectomy on ! voice4 ,9 none ( ! tw5ty cases /udi$ 0 !re any impairm5t foll[+ ! op]ation1 b on ! o!r h& sixty p] c5t 7 improv$ ei!r 9 range ( pit*1 quality or endurance1 9 addition to _! be+ m free f l>yngitis1 ph>yngitis1 etc4 = :i* ! op]ation 0 done4 ,doctors ,ruddy1 ,edw>ds & ,reid ( our pr(ession h told me ( simil> exp]i5ces1 s ,i am c]ta9 t tonsillectomy prop]ly done w 9 select$ cases1 improve ! voice4 ,acute ,tonsillitis ,acute tonsillitis is an acute infecti\s & (t5 a contagi\s disease *>act]iz$ pa?ologically by inflammation ( ! tonsils4 ,"s au?ors diff]5tiate betwe5 follicul> tonsillitis 9 :i* ! crypts or lacun are involv$1 & p>5*ymat\s tonsillitis 9 :i* ! p>5*yma is involv$4 ,etiology4--,! pr$ispos+ & excit+ causes are ! same z 9 o!r acute infections ( ! upp] air passages except t !re is usually a *ronic tonsillitis z a result ( "s previ\s attack4 ,symptoms & ,diagnosis4--,! symptoms also are simil> to o!r acute infections ( ! nasoph>yngeal tract1 ) sore ?roat1 v>iable temp]ature1 heada*e1 etc4 ,by direct exam9ation ( ! ph>ynx1 ! protrud+ masses ) :ite or yell[ pat*es are readily se54 ,treatm5t4--,infection1 dra9age & elim9ation are ?ree words insep>able 9 ! !rapeutics4 ,! local treatm5t 7,i d\bt if _m w agree7 9 ei!r acute or *ronic tonsillitis is ess5tially ! same--radical aspiration dra9age4 ,9 all cases1 except "y *ildr5 :o w n p]mit x1 ,i place a vacuum cup directly ov] ! tonsil & apply z mu* vacuum z c be obta9$4 ,?is treatm5t w1 :5 prop]ly done1 empty ! crypts ( all pus4 ,?is accompli%$1 ea* crypt is prob$ ) a cotton applicator dipp$ into ph5ol-glyc]9e4 ,c]vical & upp] ?oracic treatm5t & deep relaxation ( ! sub-tonsil tissues to increase ! normal blood supply & to decrease conge/ion by dra9age elim9ation are ess5tial4 ,! l[] ?oracic & lumb> %\ld receive due att5tion = ! purpose ( increas+ g5]al elim9ation4 ,! diet & o!r treatm5t are no diff]5t f t 9 o!r infecti\s fev]s4 ,p]itonsill> ,abscess 7,qu9sy ,sore ,?roat47 ,p]itonsill> abscess results f ! collection ( pyog5ic bact]ia & pus =mation betwe5 ! tonsil & ! pill>s ( ! fauces4 ,x is p]haps a result ( ! clos+ ( an infect$ crypt caus+ deep p5etration ( ! pus4 ,diagnosis4--,! symptoms are ^? ( acute tonsillitis b usually m m>k$ & ) "o tonsil decid$ly m protrud+ ?an ! o!r4 ,9 "s cases ! location ( ! abscess c be se5 & x is comp>atively easy to op5 ) a knife or probe1 b 9 _m cases ! abscess is s situat$ t x _c be locat$ except by exploratory prob+4 ,treatm5t4--,dra9age by direct incision ( ! abscess pocket is indicat$ z e>ly z a def9ite diagnosis c be made4 ,!re is no def9ite te*nic to be foll[$ except to obs]ve c]ta9 g5]al pr9ciples4 ,if ! 8po9t+0 ( ! abscess c be locat$1 x is comp>atively easy to make a good1 free1 direct incision & accompli% complete dra9age4 ,9 _m cases ! only way to locate ! pocket is to employ a probe or small1 long1 scalpel & explore betwe5 ! pill> & tonsil until ! pus pocket is f\nd4 ,z soon z ?is is locat$ ! pus p\rs out ar\nd ! probe & ?is gives ! location4 ,free dra9age by means ( a lib]al incision %\ld !n be made4 ,aspiration ( ! pus pocket & fill+ ) ph5ol-glyc]9e is effective aft] dra9age has be5 obta9$1 b a lib]al dra9age mu/ be ma9ta9$4 ,! non-surgical treatm5t z describ$ "u acute tonsillitis is to be appli$ "h4 ,*ronic ,tonsillitis ,*ronic tonsillitis usually is ! result ( "o or _m attacks ( acute infections ( ! tonsils4 ,occasionally cases ( m>k$ *ronic tonsillitis occur 9 :i* ! pati5t d5ies ev] hav+ _h an acute attack4 ,! pa?ology consi/s ( hyp]trophy ( ! lymphoid tissue & connective tissue4 ,diagnosis4--,! purpose 9 diagnosis is n to det]m9e :e!r ! tonsil is hyp]trophi$ b to det]m9e :e!r ! tonsil is caus+ any local or g5]al physiological p]v]sions & if s1 :e!r local treatm5t or surg]y %\ld be appli$4 ,! direct exam9ation %\ld be made v c>efully1 because o!rwise a bad tonsil may be readily ov]look$4 ,! m]e fact t a tonsil is l>ge or has op5 crypts f :i* a :iti% mass may be express$ does n mean t su* a tonsil is directly responsible = local or sy/emic physiologic p]v]sions4 ,! exam9ation %\ld be made by means ( a tongue depressor1 tonsil retractor & a good head mirror & reflect+ lamp4 ,e "p ( ! tonsil & surr\nd+ pill>s %\ld be c>efully exam9$4 ,firm pressure appli$ aga9/ ! tonsil f 9 front & beh9d w (t5 =ce mat]ial f ! crypts or out ar\nd ! capsul> m>g94 ,any su* mat]ial ?us express$ %\ld be exam9$ microscopically4 ,by prob+ ! crypts ) a small po9t$ cotton-w\nd probe & /a9+ ! mat]ial obta9$1 ! condition ( ! deep p>ts ( ! tonsil c be det]m9$4 ,! symptoms 9 e case1 are to be consid]$ ) ! microscopic f9d+s1 b !re are cases 9 :i* ei!r ( ^!1 toge!r ) appe>ance on direct exam9ation1 is suffici5t to det]m9e ! advisability ( tonsillectomy4 ,9 g5]al1 we may say t ! foll[+ factors w\ld indicate tonsillectomy4 #a4 ,*ronic1 recurr5t tonsillitis ) or )\t complications1 :i* does n respond to non-surgical treatm5t4 #b4 ,positive evid5ce ( ar?ritis ( any =m ) microscopic evid5ce ( "s virul5t organism1 su* z /aphylococcus1 /reptococcus or long-*a9 pneumococcus1 pres5t deep 9 ! tonsill> tissue4 #c4 ,any p]si/5t dis*>ge ( pus f ! tonsil 9 :i* ! microscope %[s ! pres5ce ( virul5t bact]ia & :i* w n be reliev$ by treatm5t4 #d4 ,m>k$ly hyp]trophi$ tonsils :i* directly int]f]e ) ! voice1 deglutition or respiration & :i* d n respond to treatm5t4 #e4 ,p]si/5t focal infections ( ! middle e>s1 or s9uses or root abscesses :i* d n respond to treatm5t & 9 :i* case !re is a virul5t infection ( ! deep p>ts ( ! tonsil1 %[n by microscopic exam9ation4 ,! above are only g5]al conditions & !re are probably _m o!r indications or gr\ps ( symptoms t w\ld indicate tonsillectomy4 ,9 mo/ cases1 unless ! f9d+s %[ positively t tonsillectomy %\ld n be delay$1 we advise treatm5t4 ,if treatm5t does n re/ore to normal1 x w probably r$uce ! "t ( ! surgical sore ?roat foll[+ ! op]ation4 ,non-surgical treatm5t4--,! local direct treatm5t1 z we practice x1 consi/s (3 #a4 ,direct aspiration by means ( ! tonsil cup1 apply+ f fifte5 to tw5ty in*es ( vacuum4 #b4 ,application ( ph5ol-glyc]9e by means ( cotton applicator to ! full dep? ( ea* crypt4 #c4 ,irrigation ( ! crypts by means ( a ca!t] & hot salt mixture solution4 #d4 ,syr++ ( ! crypts by means ( ! ca!t] & ph5ol #aj1 alcohol #bj & glyc]9e #gj4 ,! digital treatm5t ( ! tonsil consi/s (3 #a4 ,apply+ pressure aga9/ ! ant]ior pill> ?us =c+ ! cont5ts out ( ! tonsil1 ! ,ruddy me?od4 #b4 ,by ! bidigital te*nic1 ! front f+] ( "o h& inside1 po/]ior & inf]ior to ! tonsil & ! f+]s ( ! o!r h& outside ex]t+ deep pressure & oppos+ ! f+] inside4 ,9 ?is way ! tonsil c be lift$ =w>d & upw>d & its cont5ts express$4 ,! digital treatm5t is n z effective z t describ$ above4 ,! o/eopa?ic corrective treatm5t consi/s ( adju/m5t ( ! atlas & axis & ! m&ibul> articulation & ! obta9+ ( free movem5t ( ! hyoid & ! relaxation ( ! submaxill>y musculature & o!r deep /ructures4 ,?is treatm5t1 if foll[$ p]si/5tly1 w relieve ! local symptoms ( a v high p]c5tage ( cases ( *ronic tonsillitis1 & 9 _m cases ev5 ! sy/emic complications w be reliev$4 ,:e!r 9 cases ( sy/emic absorption ?is is ! pref]able treatm5t ,i am n sure1 because1 once ! local condition is improv$ ! pati5t w usually refuse op]ation & ev5 if ! physician f9ds def9ite evid5ce ( toxic absorption he _c conv9ce ! pati5t t 8 tonsils require surg]y4 ,,m5tal ,,diseases ,,by ,l4 ,,van ,h4 ,,g]d9e ,,& ,a4 ,g4 ,,hildre?4 ,,introduction ,! subjects h]e) pres5t$1 :ile includ+ c]ta9 ( ! mo/ important sections ( m5tal disease1 make no claim to complet5ess ei!r 9 ! subject matt] pres5t$ or 9 ! attempt to cov] ! entire field ( ! psy*oses4 ,!y cov] ^? portions1 h[ev]1 ) :i* we h come 9 close/ t\* at ! ,/ill-,hildre? ,sanatorium1 & 9 :i* we h ! mo/ complete records4 ,i h be5 aid$ 9 ! compilation ( ! ess5tial facts & /ati/ics by ! able /aff ( ! in/itution & wi% to ackn[l$ge especially ! valuable coop]ation ( ,dr4 ,c4 ,m4 ,van,duzer 9 ! ,dem5tia ,praecox gr\p1 ,dr4 ,h4 ,p4 ,hoyle 9 ! ,manic ,depressive gr\p1 ,dr4 ,b4 ,l4 ,jemmette 9 ! gr\p entitl$ ,delirium1 ,confusion & ,/upor1 ,dr4 ,j4 ,c4 ,snyd] 9 ! ,s5ile ,dem5tia gr\p & ,dr4 ,g4 ,s4 ,elk9s 9 ! ,involutional gr\p4 ,! op9ions conc]n+ ea* type held by ,dr4 ,a4 ,g4 ,hildre? are app5d$ "u its appropriate head+4 ,i wi% to /ate emphatically t ! sole treatm5t c>ri$ out 9 ! ,macon ,in/itution is specific corrective "w ^u sp9al lesions1 & x is ^u ?is treatm5t t ! /ati/ics are bas$ :i* are to be f\nd ?r\gh\t ! text4 ,^! records cov] m ?an #gjj cases1 includ+ complete hi/ories ( ! pati5ts ) ! physical & m5tal f9d+s on exam9ation2 ^! repres5t1 !re=e1 by f> ! l>ge/ body ( /ati/ics ev] accumulat$ 9 ! /udy ( o/eopa?ic results 9 m5tal disord]s4 ,:ile ! results naturally v>y 9 diff]5t types ( m5tal disease ! gr& total %[s t m ?an "o-half ( all pati5ts admitt$ recov]$4 ,details = ea* gr\p w be m5tion$ "u its appropriate head+4 ,:ile adjuncts su* z diet & hydro!rapy h be5 utiliz$2 we c]ta9ly _c attribute any curative value to _! influ5ce4 ,x %\ld be fur!r emphasiz$ t 9 no case :atsoev] has m$ic9e be5 us$ z a curative ag5t4 ,& ! same may be said ( surg]y4 ,x has inde$ be5 conclusively prov$ ev5 9 ! m$ical _w t m$ic9es & surgical proc$ures are absolutely ineffective2 f ! o/eopa?ic viewpo9t ?is ( c\rse is p]fectly reasonable s9ce ! !ory calls = def9ite lesions z causative factors & ^! lesions c h>dly be rea*$ o!r ?an by ! o/eopa?ic me?od ( correction4 ,! results obta9$1 !re=e1 c\ld only be attribut$ to ! g5u9e o/eopa?ic pr9ciple enunciat$ by ,dr4 ,a4 ,t4 ,/ill :o kept 9 close t\* ) ! "w & gave x 8 approval up to ! "t ( 8 dea?4 ,he _h always ma9ta9$ t ! o/eopa?ic pr9ciple c\ld accompli% rem>kable results 9 ?is field & consid]+ ! previ\s ineffici5cy ( any o!r me?od 8 confid5ce has be5 fully ju/ifi$4 ,dem5tia ,praecox ,?is condition ref]s to m5tal disord]s aris+ usually dur+ ! p]iod ( pub]ty or adolesc5ce1 !re=e1 betwe5 ! ages ( f\rte5 & tw5ty-five = ! mo/ "p1 al?\gh app>5tly simil> cases may arise 9 lat] ye>s4 ,! t]m dem5tia ref]s to m5tal det]ioration & enfeeblem5t1 :ile 8praecox0 signifies adolesc5ce1 ?\gh "s writ]s inf] t ! t]m praecox may be us$ to indicate ! e>ly or precoci\s developm5t ( ! m5tal enfeeblem5t4 ,c]ta9 x is t 9 mo/ cases det]ioration1 ) its result+ symptoms ( m5tal enfeeblem5t giv+ rise to ! t]m dem5tia1 usually occurs 9 "t1 ?\gh by no means always e>ly4 ,x is a *ronic progressive disease :i* may t]m9ate 9 a complete loss ( m5tality2 9 o!r cases x may become arre/$ 9 any /age & rema9 s p]man5tly2 9 /ill o!rs x may recov]1 ?\gh ?is is r>e4 ,by reason ( ! v>iability ( ! symptoms1 ?ree gr\ps are g5]ally recogniz$1 fir/ sugge/$ by ,kraepel94 ,ea* is diff]5tiat$ by m or less *>act]i/ic symptoms & ref]r$ to "u ! head ( ! ,hebephr5ic1 ,catatonic & ,p>anoid types1 al?\gh all h c]ta9 symptoms 9 common & !re are mix$ types4 ,etiology4--,accord+ to ! au?orities "s =m ( h]$it>y factor c be f\nd 9 "s fifty p] c5t or m ( all cases2 ?is is suppos$ to create a pr$isposition1 a natural weakness ( ! n]v\s sy/em1 :i* r5d]s x unable to be> ! ord9>y /orm & /ress ( life1 s t ! me*anism becomes accord+ to ! ,fr5* expression1 8wreck$ ^u ! rock ( pub]ty or adolesc5ce20 9 o!r words1 a premature giv+ way ( ! n]v\s sy/em1 be+ inh]5tly unable to /& ! /ra9 ( life4 ,ano!r sugge/ion is t x repres5ts ! outcome ( abnormal types or reactions ( ! individual to ! environm5t1 ) a failure ( prop] adju/m5t to surr\nd+s & ! =mation consequ5tly ( m5tal problems :i* to ! pati5t are incapable ( solution4 ,?is may be call$ ! psy*ological !ory4 ,! mo/ commonly accept$ idea1 h[ev]1 is ! physical causation4 ,accord+ to ?is ! disease results f auto-intoxication1 ! intoxicant aris+ f ! di/urbances ( ! gl&s ) int]nal secretions1 m p>ticul>ly ! sexual gl&s4 ,?is endocr9e !ory is suppos$ to be support$ by ! fact ( ! appe>ance ( ?is disease mo/ commonly at ! "t ( pub]ty & %ortly !reaft]4 ,! o/eopa?ic conception fits 9 v well ) ?is latt] view1 inasmu* z ! sp9al lesions are q capable ( expla9+ n only a di/urbance ( inn]vation to ! gl&s ) ! resultant int]f]5ce 9 _! normal secretion1 b also c\ld produce disord] ( ! circulation & nutrition to ! bra94 ,symptomatology4--,al?\gh ea* v>iety ( ,dem5tia ,praecox has special symptoms *>act]i/ic ( ! type !re are c]ta9 symptoms common to all =ms1 & ^! w be fir/ consid]$4 ,all ! functions ( ! m9d 9 ! c\rse ( "t t5d to become di/urb$ & to be weak5$1 b 9 ! e>li] /ages we f9d m>k$ diff]5ces z reg>ds ! di/urbance ( diff]5t functions1 ?us memory & ori5tation 9 mo/ cases seem good2 on ! contr>y1 att5tion & association ( ideas some:at poor4 ,emotional life is almo/ always m>k$ly affect$1 ev5 9 ! beg9n+4 ,v commonly at fir/ !re is depression to be foll[$ lat] by expansive feel+s & !n by apa?y 9 g5]al4 ,! w p[] is alt]$ e>ly & ! conduct is apt to be peculi>4 ,! judgm5t becomes impair$4 ,all ( ^! symptoms m5tion$ are deviations f ! normal 9 ! pati5t & !re=e presuppose t ! pati5t 0 =m]ly normal4 ,?is %\ld %>ply diff]5tiate ! praecox gr\p f cases ( defective developm5t 7imbecility or idiocy74 ,9 ?is latt] gr\p !re is an arre/ ( developm5t ( ! m9d1 :]eas 9 praecox !re is a loss 9 a develop$ intellect4 ,we see a "y pati5t1 = example1 :o has lo/ int]e/ 9 ?+s ab\t him1 neglects 8 "w at s*ool or at home1 rema9s alone = long p]iods ( "t & seems unwill+ to m+le ) o!r p4 ,he gives ! impression ( "o depress$ & worri$ ab\t some?+ he is try+ to solve1 p]haps he mutt]s to himself or gives way to unprovok$ laught]1 he may refuse to eat1 or to talk unless que/ion$ & may ev5 !n n answ]4 ,:5 he does talk x w be discov]$ t he kn[s p]fectly well :]e he is1 & kn[s p ar\nd him & und]/&s ev]y?+ t is go+ on2 8 memory w be f\nd good1 he c usually recall pa/ incid5ts & tell :at he has be5 do+ rec5tly4 ,z ! condition progresses1 h[ev]1 :ile ! pati5t may /ill = a long "t reta9 fair ori5tation & memory = pa/ ev5ts1 8 accumulation ( rec5t ideas w be f\nd poor1 s t he w recall !m ) difficulty4 ,we notice t x is difficult to get ! pati5t's att5tion & conc5tration seems to be impossible1 he may answ] a direct "q1 b imm$iately seems to be occupi$ ) o!r ?\ghts & x takes "s little ef=t to ga9 8 att5tion aga94 ,if he cont9ues to talk x is pla9 t ! association ( ideas is poor1 giv+ rise to disconnect$ phrases :i* usually come =? sluggi%ly & )\t %[ ( emotion4 ,dissociation ( ideas occurs2 t is1 diff]5t ideas express$ may practically contradict !mselves4 ,= example1 ! pati5t may say he is a k+ & yet :5 ask$ to sweep ! floor w d x p]haps )\t hesitation1 n consid]+ t is h>dly ! k9d ( "w a k+ w\ld d4 ,! dissociation is also m>k$ 9 ! contradiction f\nd betwe5 ! cont5t ( ! ?\ght & its associat$ emotional idea1 = example1 ! pati5t may speak ( a ne> relative z dy+ rec5tly1 yet ) no %[ ( emotion1 ev5 ) a mean+less laugh4 ,?is dissociation may ultimately result 9 complete incoh]5ce1 9 :i* no s5se c be f\nd :atsoev] 9 8 spee*4 ,emotional indiff]5ce is noticeable e>ly & sluggi%ness ( reactions to /imuli1 ev5 failure ( su* reactions2 ! pati5t w neglect himself1 /ay away f meals1 express no desires & make no compla9ts4 ,9 ! e>li] /ages1 h[ev]1 ! pati5t :o may h be5 = "s little "t apa!tic1 sudd5ly )\t app>5t cause becomes angry1 noisy1 & possibly viol5t & de/ructive1 aga9 gradually relaps+ into 8 quiet1 apa!tic /ate4 ,! ?\ght cont5t is commonly associat$ ) delusions1 t is obvi\sly false ideas1 b :i* ! pati5t is unable to p]ceive are false4 ,delusions ( p]secution are mo/ common1 ! pati5t feel+ 9 a dim way t ev]y?+ is n "r2 & 9 attempt+ to expla9 to himself ! reason1 (t5 attributes causes to p or =ces outside ( himself1 & on acc\nt ( ! feel+ ( bodily discom=t1 also by reason ( ! depression1 he expla9s ! ext]nal =ces z unfri5dly to himself4 ,halluc9ations may be pres5t & furni% ! mat]ial ar\nd :i* ! delusions =m2 on ! o!r h& halluc9ations may result f ! delusions4 ,by halluc9ation is meant a false s5se p]ception1 z ! pati5t may /ate he sees someone be=e him :o is n !re1 or t he he>s voices f individuals :o are n ar\nd him2 he may also compla9 ( receiv+ electrical %ocks1 or wireless messages1 :i* he usually /ates come f 8 p]secutors4 ,symptoms ( ?is nature =m a good example ( ! s-call$ split p]sonality1 or 8s*izophr5ia10 :]e9 c]ta9 idea complexes are split (f f ! ma9 p]sonality & address !mselves to ! ma9 portion1 ! pati5t attribut+ ^! noises 7voices71 s5sations 7visc]al & tactile71 ta/es & smells to an objective r ?an a subjective s\rce & subsequ5tly =m+ delusions4 ,h[ev]1 unless we are deal+ ) ! p>anoid =m ! delusions are fragm5t>y1 transi5t & absurd4 ,hebephr5ia4--,?is is a progress+ m5tal enfeeblem5t1 t]m9at+ usually 9 det]ioration1 & )\t %[+ m>k$ peculi>ities 9 ?\ght or action aside f ! progress+ defici5cy4 ,! pati5t appe>s 9 g5]al inactive1 lack+ 9 en]gy & ambition1 indiff]5t1 depress$1 incapable ( mu* conc5tration & h5ce ! effici5cy becomes progressively impair$ until he is unable to accompli% any?+4 ,f "t to "t !re may be p]iods ( confusion1 depression1 passivity1 at o!r times p]iods ( excitem5t4 ,catatonia4--,9 ?is =m ! g5]al symptoms are simil> to ^? ( ! simple type above describ$ ) ! addition ( ! special symptoms ref]r$ to z catatonic excitem5t & catatonic /upor4 ,! excitem5t p]iod is manife/$ by an unre/ & monoton\s activity1 /]eotyp$ actions & spee*1 ! pati5t con/antly repeat+ "s act1 su* z mov+ ! h&1 foot or head ov] & ov] aga9 9 ! same way1 or repeat+ ! same ^w or phrase indef9itely4 ,?is occurs app>5tly involunt>ily1 ! actions be+ automatic 9 "*4 ,! pati5t :o has be5 9 a semi/upor\s /ate may pick up a glass or *air & )\t %[ ( emotion break x aga9/ ! wall4 ,9 catatonic /upor ! pati5t may %[ 9 ! light] degrees a simple loss ( int]e/ & feel+ ) sluggi% reaction to /imuli1 or a pr(\nd inactivity & /upor 9 :i* /ate he _c app>5tly be rea*$ by any /imuli2 nev]!less1 he app>5tly reta9s consci\sness4 ,9 ?is type we obs]ve ! int]e/+ symptom ( negativism 9 :i* ! pati5t always does ! opposite ( :at he is reque/$1 or refuses outright to obey any comm&4 ,!re may be a refusal ( food s t ! pati5t has to be f$ by a tube1 mutism may be pres5t1 ! pati5t may g = weeks or mon?s )\t say+ a ^w2 /]eotype ( attitude results 9 cataleptic poses & rigidity1 9 :i* ! pati5t may ma9ta9 any p>ticul> pose = a prolong$ p]iod ( "t1 & if plac$ 9 "s o!r attitude may simil>ly reta9 ! new attitude = a long "t4 ,?is con/itutes ! s-call$ wax l rigidity1 ! pati5t rem9d+ "o ( a wax figure4 ,pa?ologic sugge/ibility occurs 9 :i* ! pati5t imitates movem5ts1 or repeats words & phrases t are spok5 or p]=m$ be=e him4 ,p>anoiac ,=m4--,9 ?is type delusions pr$om9ate & are *>act]iz$ by v>iability1 inconsi/5cy1 illogicality & transitor9ess on ! "o h&1 ) _m gradations to ! opposite extreme :]e !y become m or less fix$1 & (t5 dovetail into ea* o!r =m+ app>5tly a sy/ematic :ole4 ,!y t5d to be usually ( a p]secutory & hypo*ondriacal "* & 9 lat] /ages :5 ! m9d is di/9ctly weak5$ are (t5 ( a gr&iose type4 ,sometimes ! pati5ts h "s k9d ( explanations = !m & at o!r times none :atsoev]1 & !y are (t5 curi\sly dissociat$ f ! emotional accompanim5t4 ,! pati5t may /ate !re is poison 9 8 food1 9 an indiff]5t tone ( voice or ev5 ) a laugh2 he may claim t 8 tee? are all set 9 wrong & (f] no explanations to ^! obvi\sly false ideas4 ,! pati5t commonly ?9ks t somebody 8has x 9 = him10 someone w d him mis*ief1 w kill him1 t p are talk+ ab\t him & criticiz+ him1 ev]y?+ t he he>s or reads he ?9ks has "s be>+ on himself1 s-call$ 8delusions ( ref]5ce40 ,halluc9ations may be pres5t1 ! pati5t he>+ voices1 or receiv+ impressions or ideas :i* he claims come f )\t4 ,^! ext]nal impressions he mis9t]prets z voices or =ces :i* are accus+1 ?reat5+ & sl&]+ him4 ,lat] on1 ! pati5t t5ds to *ange f ! depress$ p]secutory /age to an expansive "o1 :5 he claims he is "s celebrat$ p]son1 k+ or presid5t1 or pope4 ,! impairm5t ( ! judgm5t is cle>ly demon/rat$ 9 ^! cases s9ce ! pati5t :o may claim to be ! k+ ( ,engl& may beg ! att5dant to *ange 8 place at ! table or = a po/age /amp4 ,pa?ologic ,anatomy4--,?is is obscure4 ,s9ce a c]ta9 proportion ( cases recov]1 !re c evid5tly be no deg5]ative *anges at ! outset1 ?\gh "s cases det]iorate fairly e>ly1 o!rs only aft] sev]al ye>s4 ,9 "s *ronic cases !re h be5 obs]v$ deg5]ative *anges 9 ! cortical cells4 ,diagnosis4--,fir/1 ! common age ( onset dur+ pub]ty & adolesc5ce1 f\rte5 to tw5ty-f\r 9 ! va/ majority ( cases1 ?is be+ ! only common m5tal disease occurr+ dur+ ?is age p]iod4 ,second1 ! progressive "* t]m9at+ 9 m5tal enfeeblem5t or det]ioration1 t is 8dem5tia0 prop]4 ,?ird1 ! evid5ce ( defect or defici5cy symptoms indicat+ t ! pati5t's m9d has alt]$ 9 ! s5se ( det]ioration f its =m] normal condition1 :]eas1 9 imbeciles or idiots ! m9d has fail$ to develop 9 ! fir/ place4 ,f\r?1 9 ! e>li] /ages p>ticul>ly ! m>k$ dissociation ( ! bra9 p[]s1 "s be+ well ma9ta9$ z memory & ori5tation 7t is k ( "t & space71 o!rs be+ weak5$1 su* z judgm5t1 p[] ( att5tion & ! l4 ,fif?1 ! e>ly appe>ance ( ! emotional defect1 a rem>kable indiff]5ce & apa?y ( ! pati5t to p & surr\nd+s1 ! pati5t be+ unsocial & tak+ no int]e/ 9 any?+4 ,six?1 all ! peculi> motor reactions1 :i* are m5tion$ above "u ! catatonic head1 & :i* v r>ely occur 9 any o!r m5tal disord]4 ,sev5?1 ! delusional cont5t ne>ly always ref]s to ! pati5t's ext]ior1 =ces outside ( him1 p or ?+s :i* are ex]t+ an unfavorable influ5ce ^u him1 delusions ( p]secution & ref]5ce4 ,! pati5t practically nev] accuses himself1 z is ! rule 9 cases ( true melan*olia1 nev] blames himself1 b always ! o!r p>ty or ! o!r =ce outside ( him4 ,eigh?1 ! delusions ( gr&eur are usually indicative ( a /age ( det]ioration4 ,prognosis4--,"s au?orities are incl9$ to d\bt if any case ev] completely recov]s1 claim+ t 9 app>5t recov]y x may h be5 a "q ( mi/ak5 diagnosis1 or t ! recov]y is m app>5t ?an real1 t ! pati5t is n truly well1 or w h a relapse1 s t a p]man5t cure w be impossible4 ,o!r au?orities admit ! possibility ( recov]y ?\gh 9 a v small m9ority ( cases4 ,! /ati/ics ( ! ,/ill-,hildre? ,sanatorium1 cov]+ m ?an two-hundr$ fifty cases %[ total recov]ies ( at lea/ "o-?ird4 ,?is includes all types & all /ages ( progress1 _m be+ advanc$ on entrance4 ,( ! less advanc$ cases & ^? ( n m ?an two or ?ree ye>s' /&+ !re h be5 "s fifty p] c5t recov]y4 ,_m cases make improvem5t or become /ation>y 9 greatly improv$ condition1 b are n includ$ 9 ! ?irty p] c5t4 ,( ! ?ree types1 ! catatonic (f]s ! be/ prognosis1 ! hebeprh5ic ! poore/1 :ile ! p>anoiac occupies an int]m$iate position4 ,treatm5t4--,( ! etiologic factors above m5tion$1 t ( auto-intoxication1 result+ possibly f endocr9e di/urbances or o!r s\rces1 is mo/ g5]ally accept$ 9 ! m$ical _w & agrees excell5tly ) ! o/eopa?ic po9t ( view4 ,sp9al lesions are regul>ly f\nd m p>ticul>ly 9 ! dorsal region1 :i* are q capable ( di/urb+ ! inn]vation to ! gl&s2 !re=e1 _! nutrition & activity4 ,a correction ( ^! be=e ! di/urbance has cont9u$ too long1 & h5ce be=e det]ioration has set 91 %\ld !oretically normalize ! gl&ul> condition & !re=e prev5t det]ioration & enable ! pati5t to recov]4 ,su* is ! probable explanation ( ! results1 & 9 _m cases ! recov]ies 7 obta9$ 9 pati5ts previ\sly consid]$ hopeless4 ,rem>ks by ,dr4 ,hildre? ,9 a great majority ( ! cases ! cause lies 9 ! int]f]5ce betwe5 ! f\r? dorsal v]tebra & ! eigh?1 :i* analyz$ means a di/urbance ( ! great splan*nic n]ves1 ?r\gh ^: int]f]5ce w\ld be caus$ ! toxic condition & ev5 ! sexual di/urbance describ$ 9 s _m cases f /&>d au?orities4 ,! same lesion1 if deep seat$ en\gh1 c\ld produce an int]f]5ce ) ! vasomotors & reflexly int]f]e ) ! circulation to ! bra94 ,9 _m we also f9d a fir/1 second or ?ird c]vical lesion4 ,! effects ( ^! lesions on ! equilibrium ( ! circulation to ! bra9 are easily trac$ ?r\gh ! sup]ior c]vical sympa!tic ganglia4 ,^! lesions1 namely1 ! mid-dorsal & upp] c]vical1 especially :5 correct$ 9 ! e>li] /ages1 h ?us f> prov5 to produce successful results4 ,9 a less] numb] ( cases we f9d ! cause to be f ! fir/ to ! f\r? dorsal v]tebr2 our reason+ "h be+ t ! int]f]5ce or ! physical di/urbance mu/ be s deep t x rea*es & int]f]es ) ! deep] n]ve curr5ts1 bo? d[nw>d & upw>d1 ?us di/urb+ ! equilibrium ( ! circulation to ! bra94 ,we h f\nd ?is class to be ! h>de/ to respond to treatm5t2 h[ev]1 t may be due to ! fact t ! physical defects at t po9t are h>d] to correct4 ,o/eopa?ic treatm5t appli$ to ! lesions above describ$ )\t "q (f]s !rapeutics ( intr9sic value to ?is class ( pati5ts4 ,delirium1 ,confusion & ,/upor ,?is cl9ical gr\p has become well e/abli%$1 n only 9 its recognition f ! dom9ant symptoms z indicat$ above1 b also f r def9ite causes4 ,! imm$iate cause seems to be an abnormal blood /ate1 or s-call$ toxemia1 :i* may result f infecti\s diseases1 or /ates ( exhau/ion1 or auto9toxications1 or =eign poisons2 ! poison acts z an irritant to ! bra94 ,9 /ates ( exhau/ion s-call$ 8fatigue bodies0 are =m$ & are app>5tly toxic 9 "*4 ,! auto9toxicants may h v>i\s s\rces1 su* z *ronic kidney disease1 or diabetes1 & ! l4 ,! mo/ important ( ! =eign poisons are alcohol & morph9e4 ,?is morbid gr\p is fur!r *>act]iz$ n only by a toxic cause & dom9ant symptom complex ( delirium1 or confusion1 or /upor1 b by a simil> onset & c\rse4 ,! onset is usually acute & ! c\rse some:at wave l1 gradually rea*+ a climax & subsid+1 or result+ 9 dea? or becom+ *ronic4 ,to emphasize ! cl9ical symptoms ( confusion :i* is s important ! t]m 8acute confusional insanity0 has (t5 be5 us$1 or 8am5tia10 accord+ to ! common ,g]man t]m9ology4 ,halluc9ations also play a prom95t "p1 p>ticul>ly ^? ( vision2 h5ce1 ano!r common appellation1 8acute halluc9atory confusion40 ,h]$ity is m5tion$ at mo/ z creat+ a pr$isposition1 ?\gh (t5 ! p]sonal & family hi/ories %[ no su* evid5ce :atsoev]4 ,intellectually !re is a def9ite lack ( ori5tation1 ! pati5t is unable to id5tify himself or 8 surr\nd+s 9 "t & space4 ,he _c cle>ly und]/& :at goes on ar\nd him1 t is1 consci\sness is 8cl\d$20 ! cl\d+ may be ( su* extreme degree ! pati5t's m9d becomes blank1 due to complete psy*ic inhibition4 ,?is is ref]r$ to z /upor4 ,! emotional life plays a second>y role subord9ate to ! intellectual cont5t4 ,! pati5t may be greatly excit$ = example1 result+ f a frightful halluc9ation4 ,! halluc9ations are ma9ly ( ! visual type & are almo/ always pres5t4 ,! pati5t lives 9 a p]petual /ate ( s5se deception z if he 7 con/antly dream+2 ! halluc9ations = ! mo/ "p are ( di/ress+1 disagreeable or ev5 frightful "*4 ,^! may give rise to delusions1 :i* are manifold1 (t5 fanta/ic & usually transitory4 ,physical *anges are always f\nd associat$ ) ! di/urb$ m5tal /atus4 ,if x arises dur+ ! active /age ( an infecti\s process !re is ( c\rse ! high temp]ature & all o!r physical signs ( fev]4 ,9 a c]ta9 numb] ( cases ) temp]ature no def9ite signs c be f\nd indicative ( any ( ! well kn[n fev]s1 h5ce has be5 call$ by v>i\s names1 su* z 8,bell's ,delirium10 8,acute ,mania ,gravis10 or 8,acute ,febrile ,delirium40 ,?is ord9>ily runs an acute rapid c\rse ) v high temp]ature1 v m>k$ delirium1 foll[$ by /upor & usually dea? f exhau/ion4 ,ev5 ?\gh no temp]ature be pres5t ! physical condition rem9ds "o v mu* ( t f\nd 9 fev] diseases4 ,!re is ! lo/ appetite1 result+ emaciation & malnutrition1 insomnia1 exhau/ion1 etc4 ,o/eopa?ic ,!ory4--,:ile x may be admitt$ t ! v>i\s factors m5tion$ above may take "p z excit+ or pr$ispos+ causes1 x is obvi\s t 9 num]\s in/ances m5tal disord]s d n arise :atsoev]1 ev5 :5 ! pati5t is subject$ to ^! factors4 ,!re mu/ necess>ily be o!r elem5ts ess5tial to produce ! psy*osis4 ,! o/eopa?ic !ory comes 9 at ?is po9t to fill 9 & complete ! *a9 ( causes & to initiate ! onset by ! introduction ( ! idea ( nutritional & circulatory di/urbances result+ f ! sp9al lesions4 ,! records ( ! ,/ill-,hildre? ,in/itution %[ #ah ( ! toxic type1 9 :i* ! poison is d]iv$ f )\t1 :o 7 treat$1 ) #ag recov]ies4 ,!re 7 #be cases connect$ ) ! infection & exhau/ion gr\p1 ) #bj recov]ies4 ,rem>ks by ,dr4 ,hildre? ,9 ?is gr\p we h to d ) blood disord]s1 result+ f ! infections1 conditions produc+ exhau/ion1 & ! v>i\s tox9s1 or poisons1 :e!r orig9at+ )9 ! body or d]iv$ f )\t4 ,^! disord]s are l>gely functional 9 "*1 result+ f bra9 irritation due to ! toxemia or di/urbance to ! c5t]s ( nutrition4 ,! ma9 object ( ! o/eopa?ic treatm5t1 !re=e1 is to aid elim9ation & regulate & build up ! nutrition4 ,9 mo/ ( ! pati5ts ! physical lesions are f\nd 9 ! mid-dorsal area1 *iefly f ! #d? to ! #g?1 & 9 ! c]vical region1 ! #a/ to ! #c;d4 ,9 aid+ ! kidneys 9 elim9ation ! #aj? & #aa? dorsal v]tebr mu/ be look$ aft]4 ,^! conditions commonly respond v rapidly to ! treatm5t & repres5t "o ( our mo/ successful gr\ps s f> z results are conc]n$4 ,manic ,depressive ,psy*oses ,! psy*oses :i* are br\ght toge!r "u ?is classification include m5tal disord]s :i* at fir/ glance w\ld appe> to be ( v wide v>iation1 namely1 conditions ( maniacal excitem5t & ^? ( depression4 ,fur!r consid]ation1 h[ev]1 reveals ! v evid5t reasons :y !y %\ld be unit$ z sub gr\ps "u ! "o head4 ,! fact t ^! two m5tal /ates ( seem+ly opposite *>act]i/ics (t5 appe> alt]nately 9 ! same individual1 t 9 c]ta9 cases ( ea* type !re is a wave l feature 9 ! nature ( ! attack & ! frequ5cy ) :i* !y t5d to recur1 toge!r ) o!r po9ts ( simil>ity 9 respect to duration1 prognosis1 etc41 t5d to po9t to _! v close relation%ip4 ,kraepel9 0 ! fir/ to draw att5tion to ^! facts & advocate ! pres5t conv5i5t & widely accept$ classification ( ^! disord]s4 ,! out/&+ feature is ! di/urb$ emotional /ate :i* dom9ates & ov]%ad[s all o!r symptoms & is fundam5tally ! same :e!r express$ ?r\gh ! excitem5t ( mania or ! depression ( melan*olia4 ,etiology4--,h]$ity is consid]$ an important factor4 ,v>i\s au?orities claim to h demon/rat$ direct h]$it>y influ5ces 9 z _m z eighty p] c5t & m ( cases4 ,individual pr$isposition resolves itself into a matt] ( con/itution & temp]am5t 9 :i* !re seems to be a great] t5d5cy among ^? :o are subject to ! emotional extremes4 ,e>ly adult life is by f> its mo/ frequ5t p]iod ( onset1 ?\gh x may arise also some:at lat]4 ,9 c]ta9 cases ! beg9n+ ( ! disord] dates f "s psy*ic or emotional %ock4 ,j :at importance ^! factors h z causes is little kn[n s9ce o!r cases develop 9 :i* ! con/itutional elem5t alone seems responsible & no imm$iate excit+ cause c be demon/rat$4 ,! o/eopa?ic viewpo9t emphasizes ! all important influ5ce ( sp9al lesions z excit+ factors4 ,9 individuals :o h a t5d5cy to ?is reaction _! pres5ce di/urb+ ! c]ebral circulation & nutrition may act z ! direct causative factor4 ,manic ,phase4--,! manife/ation ( ?is condition is br\ght ab\t by ! release ( ! inhibit+ influ5ces :i* normally gov]n all psy*ic function4 ,v>i\s t]ms z hypomania1 acute mania1 deliri\s mania1 etc41 h be5 us$ to diff]5tiate ! diff]5t degrees 9 :i* ! symptoms appe>4 ,9 ! mild] types we f9d ! foll[+ symptoms pres5t4 ,!re is a m>k$ feel+ ( well be+4 ,! pati5t1 hav+ lo/ sight ( 8 p]sonal limitations1 feels a consequ5t exalt$ op9ion ( himself4 ,8 conduct is (t5 r boi/]\s1 he talks a great deal1 (t5 swe>+ & us+ obsc5e language4 ,he is inconsid]ate ( o!rs & tries to impose 8 w ^u ^? ab\t him4 ,!re goes ) ?is a c]ta9 un/ability ( ! emotional tone z manife/$ by ! quickly *ang+ feel+ ( good humor1 irritability & ang]4 ,!re is a rapid fl[ ( ideas ) a m>k$ loss 9 ! ability to conc5trate & direct ?\ght4 ,! ideas :i* pass ?r\gh ! m9d d n coord9ate !mselves t[>d a def9ite goal1 b deviate f ! c\rse ( consecutive ?9k+ by any pass+ association4 ,aga9 !re is a re/lessness & activity beyond all normal b\nds4 ,! individual feels /rong physically & m5tally4 ,! appetite is unusually good & if activity is n too extreme !re may be a ga9 9 weight4 ,! p]iod ( sleep is dim9i%$ & ! feel+ ( fatigue is r$uc$4 ,9 ! m exagg]at$ cases ! flight ( ideas becomes m m>k$1 ! associations are m rapid & sup]ficial & ! att5tion is focus$ b mom5t>ily4 ,illusions & delusions may be pres5t due to ! imp]fect preceptions f inability to conc5trate att5tion & f abnormal associations4 ,rhym+ spee*1 disconnection ( phrases & ev5 app>5t incoh]5ce are (t5 pres5t4 ,! /ate ( m9d may be su* t ! pati5t te>s 8 clo?+1 breaks up furniture1 jumps1 dances & %\ts & (t5 w n take "t to eat4 ,! mo/ extreme cases :i* refuse food ov] "s p]iod ( "t progress rapidly to exhau/ion & measures to cons]ve /r5g? become imp]ative4 ,depressive ,phase4--,9 ?is phase ( ! disord] are enc\nt]$ manife/ations :i* are 9 direct contra/ to ^? pres5t$ 9 ! manic phase4 ,9 place ( ! exalt$ emotional /ate !re is a depression4 ,!re is a t5d5cy to worry ov] trivial matt]s ( ! daily r\t9e & ( in/ances 9 pa/ life4 ,introspection is ! pr$om9ant m5tal attitude & ! :ole out] _w is color$ by ! inn] feel+ ( worry & unc]ta9ty4 ,replac+ ! rapidity ( ?\ght 9 ! manic phase !re is a di/9ct sl[+ ( m5tal processes 9 ! depressive phase4 ,?9k+ is m difficult & labor$1 que/ions are answ]$ sl[ly & ) an app>5t ef=t & !re is usually a t5d5cy to avoid social life4 ,aga9 replac+ ! excessive activity 9 mania ! depressions %[ a ret>d$ action4 ,!re is dis9cl9ation or disability t[>d any ef=t ei!r motor or m5tal4 ,! pati5t feels weak & incapable ( ef=t1 ! body assumes a b5t attitude & ! facial expression is "o ( despond5cy4 ,! appetite is usually impair$ ) resultant loss ( weight1 ! b[els are sluggi%1 ! p]iod ( sleep r$uc$4 ,9 ! m exagg]at$ cases ! ret>dation may be complete4 ,introspection is c>ri$ to ! degree :]e ! pati5t tries to take unto himself ! responsibility = all ! s9 9 ! _w4 ,he himself is ! ar* s9n] & he feels himself ! subject ( puni%m5t by div9e wra? 9 a mann] 9 :i* no o!r individual 0 ev] puni%$4 ,also ! introspection t5ds to produce v>i\s hypo*ondriacal ideas4 ,! pati5t may feel t he has contract$ "s incurable disease & t c]ta9 bodily functions h ceas$ op]at+4 ,m5tal processes become n only ret>d$ & difficult1 b actually pa9ful1 a symptom :i* has be5 t]m$ psy*algia4 ,suicidal t5d5cies are also q frequ5tly pres5t4 ,9 extreme conditions ! pati5t may become s ret>d$ 9 ?\ght & activity t he app>5tly receives no /imulus f ! out] _w4 ,he lives 9 a m or less /upor\s /ate1 ev5 requir+ t food be adm9i/]$ by tube4 ,circul> ,insanity & ,mix$ ,=ms4--,9 addition to ! conditions 9 :i* simply mania or melan*olia are manife/ !re are c]ta9 cases :i* %[ v>iations & comb9ations ( ^! =ms4 ,a common type is t 9 :i* !re is an alt]nation ( ! manic & depress$ conditions4 ,! pati5t may pass directly f "o /ate into ! o!r1 or !re may be an int]v5+ p]iod ( lucidity4 ,! t]m circul> insanity has be5 appli$ to ?is type4 ,o!r v>iations are ^? 9 :i* !re are recurr5ces ( ! manic or depressive attacks (t5 at m or less regul> int]vals1 ea* recurr5ce be+ a practical repetition ( ! prec$+4 ,!re is also possible a consid]able int]m+l+ ( ! *>act]i/ics ( ! two types4 ,9 ! manias may occur difficulty ( ?9k+1 pass+ feel+s ( depression & ev5 almo/ /upor\s conditions4 ,9 depressions !re c exi/ a m>k$ degree ( re/lessness & activity & a rapidity 9 ! fl[ ( ideas4 ,prognosis4--,! outlook = recov]y f ! individual attack is good4 ,! attack may la/ f a p]iod ( days to "o ( a numb] ( mon?s & recov]y comes ) r>ely any evid5ce ( m5tal det]ioration4 ,!re is a t5d5cy to recurr5ce ( ! tr\ble4 ,9 fact recurr5ce is ! rule r ?an ! exception4 ,9 ! o/eopa?ic h&l+ ( ^! cases x has be5 ! endeavor to demon/rate t ! correction ( lesions _h a t5d5cy to less5 ! duration ( ! individual attack & r$uce ! t5d5cy to recurr5ce4 ,judg+ f ! exp]i5ce ?us f> ga9$ 9 ! obs]vation ( cases "u treatm5t dur+ ! attack & ! comp>ative few recurr5ces report$ bo? ( ^! aims h be5 atta9$4 ,treatm5t4--,! o/eopa?ic measures are aim$ at ! correction ( ! sp9al lesions1 especially ^? locat$ 9 ! upp] dorsal & ! c]vical regions4 ,"s reflex effects f lesions 9 m remote areas may h _! influ5ce s t x is wise to look to ! correction ( any o!r /ructural v>iations :5 pres5t4 ,rem>ks by ,dr4 ,hildre? ,! m5tal disord]s ( ?is type are purely functional & may cov] a broad scope z to causes2 h[ev]1 f ! o/eopa?ic viewpo9t a great majority ( !m seem to h z _! specific excit+ cause1 lesions 9 ! upp] dorsal & upp] c]vical regions4 ,! treatm5t %\ld be appli$ specifically to ! cause :i* may range any:]e f ! #a/ to ! #h? dorsal1 or f ! #a/ to ! #c;d c]vical1 cov]+ ! nutritional & circulatory c5t]s & ?us controll+ ! nutrition & circulation to ! bra94 ,!re c be no "q b :at ! o/eopa?ic !ory ( adju/m5t ( physical defects =ms ! basis ( p]man5t cure1 s9ce _m ( our recov]ies _h be5 previ\sly "u o!r me?ods ( treatm5t )\t results4 ,our records cov] ov] #bjj cases ) recov]y 9 m ?an two-?irds1 & v few recurr5ces up to ! pres5t4 ,involutional ,psy*osis ,9 ! mid ye>s ( life1 betwe5 =ty & sixty1 a decl9e beg9s1 :i* 9 ! old] ye>s results 9 decay2 x is especially true at ?is p]iod ( ! sexual life & ! organs und]ly+ x4 ,:ile ^! organs und]go a v def9ite *ange con/itut+ ! s-call$ climact]ic p]iod 9 wom51 x is n at fir/ sight s evid5t 9 m52 h[ev]1 ! evid5ce is t a some:at simil> process1 ?\gh mu* sl[]1 t5ds to occur 9 ! male4 ,associat$ ) ! decay ( ! sexual organs is a di/urbance presumably ( ! int]nal secretions2 if ?is latt] di/urbance takes place sl[ly & ev5ly ! body may n notice any m>k$ *anges2 on ! o!r h&1 if x takes place m quickly1 or unev5ly1 x may give rise to di/9ct symptoms :i* indicate a di/urbance ( ! n]v\s sy/em 9 g5]al & (t5 ev5 ( ! m5tality4 ,h5ce1 ! significance ( ! t]m1 ,involutional ,psy*osis4 ,9 a l>ge majority ( cases ! m5tal disord] is m>k$ by ! dom9ance ( depression & is frequ5tly ref]r$ to z melan*olia4 ,= a long "t x 0 consid]$ t ?is repres5t$ a special m5tal disord] hav+ little or no?+ 9 common ) o!r psy*oses4 ,9 rec5t times ,dumas has /udi$ ?is gr\p v c>efully & %[n t x 9 reality has v mu* 9 common ) ! depress$ phases ( ! ,manic ,depressive ,gr\p ( psy*oses4 ,kraepel9 himself1 :o 0 ! fir/ to demon/rate ! unity ( ! ,manic ,depressive ,gr\p1 has accept$ ! conclusions ( ,dumas & incorporat$ ! ,involutional ,depressions z a sub type ( 8 ,manic ,depressive ,psy*osis4 ,among etiologic factors h be5 m5tion$ h]$it>y elem5ts1 :i* h be5 claim$ to h be5 f\nd 9 at lea/ fifty p] c5t ( all cases1 =m+ presumably a pr$isposition2 x is also /at$ t a pr$isposition may be acquir$ ?r\gh v>i\s debilitat+ causes4 ,excit+ factors are claim$ to be pres5t1 su* z m5tal %ock1 grief1 worry & ! l4 ,! disease w\ld !n seem to occur :5 we h a comb9ation ( excit+ factors & pr$isposition4 ,c>eful consid]ation w %[1 h[ev]1 t no su* m5tal di/urbance occurs at ?is age 9 _m p :o %[ evid5ces ( su* pr$isposition & ( excit+ factors1 !re=e x w\ld seem t /ill o!r causes 7 necess>y2 if we consid] ! sugge/ion above m5tion$ t !re are atrophic processes tak+ place 9 ! sexual gl&s lead+ to a loss ( ! int]nal secretions & if we fur!r consid] t ?is may take place unev5ly & 9 an unbalanc$ way1 ?us aid+ 9 giv+ rise to ! symptoms1 we w f9d a def9ite po9t ( contact = ! o/eopa?ic conception4 ,o/eopa?ically consid]$1 we may say t ! sp9al lesions lead to a di/urbance ( inn]vation & nutrition to ! ductless gl&s1 & !re=e produce disord]$ secretions 9 ^? pati5ts develop+ ! disease1 :]eas su* a condition may n be pres5t 9 o!rs :o at ! same age p]iod d n develop ! psy*osis4 ,symptomatology ,! emotional tone ( depression dom9ates ! picture4 ,associat$ symptoms are anxiety1 fe>s1 p>ticul>ly ( imp5d+ dang]1 ! loss ( int]e/ 9 ! ext]nal _w1 ) a conc5tration ( att5tion ^u self2 psy*ic di/ress is usually pres5t1 (t5 to an extreme degree1 lead+ app>5tly to real m5tal pa91 s-call$ psy*algia4 ,delusions are usually pres5t & manifold 9 v>iety2 !y ma9ly ref] to ! pati5t himself & are ( a self-accusatory nature2 !y frequ5tly ref] to notions ( s9s hav+ be5 committ$1 also unwor?9ess ( ! pati5t1 ( pov]ty1 nihili/ic ideas1 ei!r ab\t 8 own body or ext]nal ?+s4 ,he may claim = example t he has no /oma* or kidney1 or he>t1 t ! ext]nal _w is unreal & ! l4 ,8 motor reactions become ret>d$1 or ev5 9 ! m extreme cases inhibit$1 produc+ a =m ( /upor4 ,! ineffici5cy :i* results along ) ! psy*ic pa9 & di/ress may det]m9e suicidal t5d5cies :i* are v frequ5t4 ,ori5tation is usually good1 ! pati5t rema9+ aw>e ( 8 own id5tity & t ( 8 surr\nd+s2 ! judgm5t ( c\rse is impair$ s t ! pati5t is unable to appreciate ! unreality ( 8 delusions2 z a result he sees no hope 9 ! future & on acc\nt ( pres5t suff]+s pref]s dea? to life4 ,! pati5t may rema9 9 a p]fectly passive mood1 giv+ ! appe>ance ( extreme depression1 pay+ no att5tion to ! surr\nd+s1 possibly mute1 giv+ no reg>d to ! necessity ( ! toilet1 pay+ no att5tion to 8 clo?+ & ! l4 ,?is may cont9ue = h\rs or days4 ,food (t5 has to be =c$ on him1 possibly ev5 by ! tube2 ! result is usually m or less emaciation & may result 9 m>k$ malnutrition2 simil>ly ! sleep may be s]i\sly int]f]$ )1 ev5 ?\gh ! pati5t is quiet4 ,! result+ loss ( sleep & malnutrition sometimes lead to ! dea? ( ! pati5t4 ,on ! o!r h&1 ! pati5t may moan & wr+ 8 h&s 9 angui%1 walk+ up & d[n1 cry+ out t he is a s9n] & t he wants to die & ! l4 ,?is is ! s-call$ melan*olia agitata4 ,! physical symptoms ( importance are sleep di/urbances1 poor appetite1 ) emaciation1 cyanosis1 (t5 a subnormal temp]ature1 l[ blood pressure1 sl[$ he>t action & weak5$ circulation4 ,! hair may become gray1 ! sk9 dry & h>% & inde$ any ( ! signs ( s5ile decay may appe>4 ,diagnosis & ,prognosis4--,^! dep5d p>tly ^u ! m5tal symptoms1 p>tly ^u ! physical4 ,on ! m5tal side is to be emphasiz$ m>k$ depression1 ) ! relatively cle> ori5tation1 resembl+ ! depress$ phase ( ,manic ,depressive insanity2 also ! dom9ance ( ! self-accusatory delusions4 ,on ! physical side ! age p]iod1 & ! evid5ce ( previ\s attacks1 ev5 ?\gh v slight4 ,! prognosis f ! /udy ( ! m5tal symptoms dep5ds on ! pres5ce or abs5ce ( signs ( defect1 or det]ioration1 z = example fooli% & silly delusions4 ,on ! physical side ! pres5ce or abs5ce ( conditions l kidney or art]ial disease2 9 g5]al1 x may be said if ! physical f9d+s are negative & ! m5tal symptoms %[ no det]ioration !re %\ld be a good outlook1 p>ticul>ly if ! condition has n become too *ronic4 ,a favorable outlook is always possible if ! disease is treat$ e>ly & ! lesions di/urb+ ! activities ( ! gl&s & ( nutrition & ! circulation are correct$ & if ! o!r physical f9d+s are negative & signs ( det]ioration abs5t4 ,s9ce ?is is probably only a sub-gr\p ( ! ,manic ,depressive ,psy*oses1 z has be5 m5tion$ above1 ! results obta9$ "u o/eopa?ic treatm5t are not$ "u ! ,manic ,depressive gr\p4 ,rem>ks by ,dr4 ,hildre? ,our exp]i5ce ) ?is class ( cases inv>iably lead u to ! n]ve c5t]s :i* regulate & control ! process ( nutrition & circulation2 x is a matt] ( keep+ up normal equilibrium ( all organic life & especially ! circulation to ! bra94 ,! basis ( ! treatm5t !re=e is to be f\nd 9 ! nutritive c5t]s1 z well z ^? c5t]s :i* control ! circulation to ! bra91 ! ductless gl&s1 etc4 ,s5ile ,dem5tia ,s5ile ,dem5tia may be def9$ z an abnormal weak5+ ( ! m9d aris+ 9 old age4 ,z ! ^w dem5tia implies1 ! intellectual *ange is quantitative r ?an qualitative1 ! prime *>act]i/ic ( ! disease be+ m5tal loss r ?an m5tal p]v]sion4 ,x is commonly /at$ t a mo/ important cause ( ! disease is ! g5]al malnutrition incid5t to age4 ,s9ce only a small proportion ( ! ag$ develop dem5tia1 ?is is probably only a coop]at+ factor4 ,o!r causes m5tion$ are ov]work1 emotional /ra91 traumatisms1 intoxications 7especially alcoholism71 c]ebral art]ioscl]osis & p]haps h]$ity4 ,pa?ologic ,anatomy4--,! disease is organic1 ! bra9 exhibit+ def9ite pa?ological tissue *anges4 ,!re is an atrophy ( _m n]ve cells & a prolif]ation ( neuroglia fib]s1 s t ! c]ebrum becomes %runk5 & h>d1 ) ?ick5$ m5+es & ?9n$ cortex1 & %[s a loss ( weight4 ,! c]ebral art]ies may or may n exhibit scl]osis1 ?rombosis1 or mili>y aneurisms1 ) resultant areas ( s(t5+4 ,! cells %[ pigm5t>y deg5]ation & _m ( ! association fib]s h disappe>$4 ,onset4--,! onset ( ?is dem5tia is usually v gradual1 ! condition n be+ recogniz$ until r m>k$4 ,x occurs ma9ly 9 ! sev5ties & lat] & 9 ! late sixties1 be+ r>e be=e sixty4 ,x (t5 foll[s f9ancial rev]ses1 emotional %ock1 or v>i\s diseases4 ,! e>lie/ symptoms are a *ange 9 ! p]son's disposition1 slight disord]s ( memory1 & trivial lapses ( v>i\s sorts4 ,z ! disease progresses ! symptoms become m m>k$ & fundam5tal1 involv+ n only ! intellectual b also ! emotional & volitional phases ( consci\sness4 ,int]e/ 9 ! outside _w beg9s to flag1 att5tion to w&]1 p]ception to be incomplete & inaccurate1 association ( ideas to be sl[1 memory to weak5 & judgm5t to be impair$4 ,memory ( ! mo/ rec5t incid5ts is ! fir/ to be lo/1 ( rec5t ye>s next1 & !n ( middle age s t ! pati5t may n recognize 8 own *ildr5 or "k1 = example1 t 8 wife is dead2 f9ally ! memory ev5 ( y\? is lo/ & ! pati5t is to all int5ts & purposes a *ild1 8 condition be+ an exagg]ation & aggravation ( t commonly kn[n z 8second *ildhood40 ,sev]al =ms ( ,s5ile ,dem5tia exi/1 ( :i* ! mo/ common is probably ! simple or non-delusional type4 ,o!r =ms are fundam5tally ! same z ! simple1 b ) c]ta9 sup]impos$ symptoms4 ,fairly e>ly 9 ?is type x becomes unsafe = ! pati5t to cont9ue 9 bus9ess4 ,due to impairm5t ( memory & judgm5t he is apt to lose 8 prop]ty4 ,soon 8 "w is poorly done or neglect$ entirely4 ,he becomes g>rul\s & annoys 8 associates ) tiresome repetitions ( *ildi% rem9isc5ces1 cont9ually w&]+ f "o subject to ano!r4 ,8 spee* becomes incoh]5t & 8 s5t5ces fragm5t>y4 ,he gr[s untidy & indiff]5t to ! ord9>y niceties & conv5tions ( life4 ,8 appetite is ei!r poor or voraci\s2 9 ! latt] case ! weight may keep up fairly well4 ,he may be ei!r apa!tic or turbul5t4 ,if ! =m]1 he seems /upid1 indiff]5t1 & sleepy4 ,he is cr$ul\s1 docile1 & v sugge/ible4 ,pati5ts ( ! turbul5t type are re/less & always mov+ ab\t1 ei!r depress$ or elat$1 giv+ unreasonable ord]s & !n contradict+ !m4 ,sleep+ poorly1 !y are apt to get up & w&] ab\t ! h\se at night4 ,9 m51 pro/atic disease may cause a recrudesc5ce ( sexual feel+4 ,pati5ts ( ei!r type ev5tually become fil?y1 soil+ _! clo?+1 etc4 ,ev5 9 well advanc$ cases1 h[ev]1 s5ile dem5ts are (t5 able to p]=m well c]ta9 habitual activities1 su* z sign+ _! names1 or play+ c]ta9 games1 su* z *eck]s or dom9oes4 ,confusional ,type4--,ano!r =m ( ,s5ile ,dem5tia1 :i* may 9 sev]e cases u%] 9 ! attack1 b :i* usually1 :5 pres5t1 is sequ5t to ! simple =m1 ( :i* x is a m sev]e grade1 is ! confusional4 ,! additional symptoms ( ?is type are probably due to defective elim9ation & ! consequ5t toxicity4 ,usually unsy/ematiz$ delusions1 & sometimes halluc9ations are pres5t4 ,except = a possible occasional p]iod ( remission ! confusion is cont9u\s4 ,x v>ies greatly 9 degree1 n[ be+ mild & passive & aga9 active1 p]haps develop+ into delirium4 ,ori5tation z to bo? "t & place may be lack+4 ,su* pati5ts may ask = d9n] a few m9utes aft] a meal1 g to b$ at noon1 be unable to f9d _! own room1 or to recognize _! own *ildr54 ,!y are apt to be ob/9ate & peevi%4 ,delusions v>y 9 type b bo? ^! & ! halluc9ations are usually pa9ful &1 be+ ref]r$ to ! pati5t's associates1 give rise to ! ?\ght t !y are try+ to kill or o!rwise h>m him4 ,delusional ,type4--,a ?ird type ( ,s5ile ,dem5tia is ! p>anoid =m4 ,dem5ts ( ?is type1 ow+ to delusions ( p]secution & auditory halluc9ations are s5sitive & suspici\s4 ,su* cases may sometimes %[ good ori5tation1 app>5tly uncl\d$ m9ds1 & little evid5ce ( s5ility1 requir+ c>eful /udy to diff]5tiate ! condition f true p>anoia4 ,a pati5t may1 on acc\nt ( halluc9ations ( ta/e & smell1 refuse food 9 ! belief t x is poison$4 ,memb]s ( 8 family :o are devot$ly c>+ = him are suspect$ ( designs on 8 money1 & ?is suspici\s attitude frequ5tly leads to unju/ wills4 ,! delusions & suspicions may be entirely conceal$ f ! family4 ,weal?y p>anoid elem5ts are peculi>ly apt to become ! prey ( s*em+ adv5turesses1 p>ticul>ly 9 case ( ! above m5tion$ sexual recrudesc5ce1 & m>ry !m4 ,opposition ( ! family is reg>d$ z "p ( _! g5]al p]secution or z due m]ely to _! desire to get ! e/ate4 ,"s pati5ts m]ely appe> odd1 suspici\s1 untidy1 peevi%1 & *ildi%4 ,"s h expansive delusions & exhibit ! euphoria s frequ5tly f\nd 9 syphilitic dem5ts4 ,s5ile ,delirium4--,a f\r? type has be5 describ$ by "s psy*iatri/s "u ! title ( s5ile delirium4 ,?is may appe> z ! initial =m ( ! disease or z an acute attack 9 "o ( ! above =ms4 ,x is *>act]iz$ by great incoh]5ce & re/lessness1 entire abs5ce ( ori5tation1 & num]\s rapidly *ang+ delusions & halluc9ations1 ! condition resembl+ delirium trem5s4 ,x is probably due to "s somatic cause1 su* z nephritis1 pneumonia1 or cy/itis1 :i* is (t5 fatal4 ,complications may arise 9 ,s5ile ,dem5tia1 su* z apoplectic /rokes1 hemiplegia1 epilepti=m seizures & aphasias4 ,prognosis4--,x is evid5t f ! pa?ology ( ! conditions t ! prognosis is n at all good :5 ! disease is well advanc$4 ,x is a *ronic disease & usually progressive until dea?1 :i* is due to "o ( ! complications1 malnutrition1 or especially pneumonia4 ,h[ev]1 _m cases h %[n improvem5t1 & 9 incipi5t /ages recov]y4 ,a cure ( advanc$ cases be+ impossible1 ! important consid]ation is prev5tion or arre/ 9 its incipi5cy4 ,x is evid5t t ?is c be done only by prev5t+1 or remov+ z f> z possible1 ! pr$ispos+ causes4 ,a glance at ! li/ ( ^! %[s t mu* dep5ds ^u ! coop]ation ( ! pati5t by regulat+ 8 habits ( life4 ,physical & m5tal ov]/ra9 mu/ be avoid$1 delet]i\s habits1 su* z ! use ( intoxicants or n>cotics giv5 up4 ,mu* c be done by o/eopa?y to elim9ate ! effects ( ^! ^u ! organism4 ,c>dio-vascul> & r5al symptoms are v important & %\ld be wat*$ = 9 ord] t e>ly treatm5t may *eck ! process initiat$4 ,to ?is end ! pati5t's habits & diet mu/ be regulat$ & treatm5t in/itut$ to relieve toxicity & promote elim9ation4 ,lesions mu/ be correct$1 special att5tion be+ giv5 to ! l[] dorsal t affect ! kidneys1 ! upp] dorsal t affect blood pressure1 & bo? ! upp] c]vical & upp] dorsal t affect ! blood supply & nutrition ( ! bra94 ,art]ioscl]otic ,dem5tia4--,?is is a m5tal enfeeblem5t aris+ sometimes 9 ! f\r?1 b *iefly 9 ! fif?1 decade ( life1 & associat$ ) symptoms ( art]ial h>d5+4 ,! cause is art]ioscl]osis1 :i* may be second>y to "s =m ( nephritis4 ,! art]ial h>d5+ may be g5]al or may be conf9$ to ! art]ies ( ! c]ebrum4 ,x is likely t ! art]ioles supply+ ! cortical cells are especially involv$ 9 an a!romat\s condition4 ,! disease is organic1 *ronic & progressive4 ,hemorrhage1 embolism1 or ?rombosis may occur1 produc+ focal lesions & areas ( s(t5+1 ) hemiplegia1 aphasia1 etc4 ,! e>lie/ symptoms may be heada*es & dizz9ess4 ,! blood pressure is usually f\nd to be high b n inv>iably4 ,an a!romatosis may be pres5t 9 "s "o ( ! palpable p]iph]al art]ies1 su* z ! radials4 ,fur!r symptoms on ! physical side are quick fatigue1 loss ( en]gy1 numbness & p>e/hesias ( ! extremities1 & somnol5ce 9 ! daytime or p]haps insomnia at night4 ,/rokes may occur1 usually slight & tempor>y1 probably due to spasm 9 a deg5]at+ art]y or p]haps to s]\s effusion4 ,toxic symptoms appe>1 due to disord] 9 kidneys1 liv]1 & o!r organs4 ,epilepti=m seizures are possible4 ,m5tally ! pati5t %[s impairm5t ( memory1 & p]haps "s confusion & halluc9ations4 ,r>ely /upor occurs4 ,he may be agitat$ & irritable or melan*oly & depress$4 ,suspici\s & p]secutory ideas ( ! p>anoid type may appe>2 also hypo*ondriacal ideas4 ,o/eopa?ic ,!ory4--,9 ^! psy*oses ( ! old] ye>s ( life ! t]m9ation is usually dem5tia1 :i* means m5tal enfeeblem5t1 & :i* results f deg5]ative *anges 9 ! bra9 sub/ance4 ,z has be5 %[n x is l>gely a nutritional "q & ! nutritional condition v>ies trem5d\sly 9 diff]5t eld]ly p2 x is well kn[n t _m old p pres]ve _! bra9 p[]s fairly well to ! end2 on ! o!r h& o!rs fail relatively e>ly1 "s ev5 9 ! fifties2 ^! cases ( e>li] failure are ref]r$ to z ! 8pres5ile type40 ,! o/eopa?ic conception w\ld be to f9d out ! s\rce productive ( ! nutritional disord] & correct x at ! v outset1 !re=e mak+ x q possible to prev5t ! disease process f tak+ place4 ,! prognosis !n 9 ! e>li] /ages is v good4 ,rem>ks by ,dr4 ,hildre? ,:ile _m coop]at+ factors may be f\nd 9 ! causation ( ! m5tal disord] ( eld]ly p1 our exp]i5ce %[s !re is always v def9ite di/urbance ( nutrition & ! nutritional c5t]s4 ,we f9d *ief physical int]f]5ce betwe5 ! #c;d & #h? dorsal v]tebr1 mo/ def9ite z a rule at ! #d?1 #e? & #f?1 ) ! correspond+ ribs on ! "r side4 ,contribut+ causes may be f\nd 9 o!r areas1 associat$ ) ! di/urbances ( ! he>t & circulation & ( ! kidney4 ,9 ! c>dio circulatory disord]s we f9d abnormal sp9al conditions 9 ! upp] dorsal region & especially ! #e? rib on ! left side4 ,9 ! kidney disord]s we f9d ! lesions usually at ! #aj?1 #aa? & #ab? dorsal4 ,! above m5tion$ areas 9 g5]al repres5t ! c5t]s ( control ( ! splan*nic n]ves & !re=e ! important processes ( dige/ion1 metabolism & assimilation4 ,specific treatm5t appli$ to ^! po9ts is v helpful & results 9 m>k$ improvem5t & inde$ 9 reliev+ ! pati5t's symptoms completely :5 9 ! e>li] /ages ( ! disease4 ,,defective ,,*ildr5 ,by ,,raymond ,w4 ,,bailey ,x is our purpose "h to impress on o/eopa?s ! almo/ unlimit$ possibilities 9 ! /udy & treatm5t ( m5tal conditions ( *ildr51 :i* h]et(ore h be5 consid]$ hopeless4 ,o/eopa?y has demon/rat$ t x has mu* to (f] to ?is class ( defectives b ! pr(ession has n ?or\ghly appreciat$ its great possibilities4 ,x has be5 ! cu/om to s5d ^! *ildr5 to in/itutions :]e !y h receiv$ c>e ) "s attempt t[>d education b ) absolutely no ef=t be+ made ?r\gh physical treatm5t to ov]come _! debility4 ,we %all %[ t ! o/eopa?ic lesion is ( prime importance 9 ^! cases1 & t we h be5 sl[ to realize ! efficacy ( o/eopa?ic treatm5t = su* seem+ly hopeless *ildr54 ,we _c emphasize too /rongly ! importance ( accept+ & treat+ ^! cases :]ev] possible4 ,! m5tal diseases are consid]$ "u two g5]al heads3 7#a7 ,inh]it$1 & 7#b7 ,acquir$ ,t5d5cies4 #a4 ,inh]it$ ,t5d5cies4--,9 ?is class are ^? cases aris+ f poor end[m5t ( ! protoplasmic /ructure ?r\gh l[]$ vitality ( ! p>5ts or o!r prog5itors4 ,^! ta9ts may come f ei!r p>5t1 or bo?1 & may exi/ 9 ! (fspr+ f "s prec$+ g5]ation4 ,su* diseases are con/itutional & are am5able to support+ treatm5t 9 direct proportion to ! am\nt ( end[$ en]gy inh]5t 9 any giv5 organism4 ,( ! inh]it$ t5d5cies1 we h two k9ds3 #a4 ,cong5ital ,diseases4 7a7 ,f any influ5ce ( an inh]it$ nature n directly act+ on ! environm5t ( ! p>5t :ile ! fetus is 9 ut]o1 & 7b7 ,f any influ5ce :i* directly affects ! developm5t ( ! ovum ?r\gh imp]fect f]tilization com+ ?r\gh ei!r p>5t or bo?4 #b4 ,g5]al ,impairm5t4--,?is condition exi/s 7a7 ,:]e a simil> defect has exi/$ 9 =ego+ g5]ations & is /rictly h]$it>y2 7b7 ,:]e g5]al vitality is dim9i%$ f su* causes z neuropa?ic p>5ts1 or :]e !re h exi/$ con/itutional defects1 su* z tub]culosis1 syphilis1 epilepsy1 alcoholism1 abuse1 ov]work1 /ra91 acute inflammatory diseases1 & poor heal? ( ! "m dur+ ge/ation2 also consangu9ity4 7c7 ,premature bir? t5ds to impairm5t physically & m5tally ( gr[? ( organism & frequ5tly leaves its manife/ations ( m>asmus1 ra*itis & o!r nutritional di/urbances4 7d7 ,prolong$ labor may leave its m>k on ! *ild :]e m or less asphyxia has occurr$ result+ 9 ob/ruction to c]ebral circulation4 ,causes act+ aft] bir? to ! already impair$ g]m cell & result+ 9 _m ( ! afflictions ( e>ly life1 bo? m5tally & physically1 are #a4 ,traumatism4 #b4 ,convulsions4 #c4 ,ra*itis4 #d4 ,infecti\s fev]s4 #e4 ,m5+itis4 ,all ( ^! s]i\sly affect ! metabolism )9 ! newly-born1 a process :i* is begun1 d\btless ) difficulty1 & susceptible to easy d]angem5t1 & ! same effect magnifi$ ) gr[? into its subsequ5t m5tal & physical de=mity4 #b4 ,! ,acquir$ ,t5d5cy4--,9 ?is ! second great class are ^? conditions aris+ subsequ5t to conception :]e g]m plasm is heal?y b gr[? is arre/$ by "s ext]nal factor ei!r intra- or extra-ut]9e4 ,?us ! acquir$ t5d5cy may be giv5 to ! fetus 9 ut]o & n be consid]$ cong5ital z 9 case ( injury affect+ heal? & gr[? ( o!rwise heal?y conception4 ,9 %ort1 ! acquir$ has its beg9n+ at conception or subsequ5t to x :ile ! cong5ital is previ\s to conception or already inh]5t 9 ! g]m plasm lead+ to conception4 ,any influ5ce :i* ret>ds ! #a4 ,inh]5t capacity ( cell = gr[? or1 #b4 ,adequate blood supply ei!r 9 quantity or quality results 9 enfeebl$ (fspr+ & ^! causes are enhanc$ by 7a7 ,traumatism or ,injury 7b7 ,dr9k or ,abuse 7c7 ,dirt or ,unhygi5ic surr\nd+s 7d7 ,depravity or ,ignorance ,factors ent]+ into acquir$ t5d5cies affect+ (fspr+ direct are divid$ into ?ree classes1 ^?3 ,i4 ,be=e ,bir? su* z 7a7 ,abnormal condition ( "m's heal? dur+ pregnancy z 9 disease ( any nature1 m5tal or physical or 7b7 ,injury to fetus direct by bl[1 fall ( p>5t1 or in/rum5t4 ,,ii4 ,dur+ ,bir? f3 7a7 ,abnormal labor f any cause4 7b7 ,primog5iture4 7c7 ,premature bir?4 ,,iii4 ,aft] ,bir?4 7a7 ,traumatism4 7b7 ,toxic causes su* z sc>let fev]1 :oop+ c\gh1 m5+itis1 measles1 mumps & exan!mata4 7c7 ,convulsions4 7d7 ,nutritional di/urbances4 ,consangu9ity or int]m>ry+ ( blood relations1 or 9-bre$+ results 93 #a4 ,in/ability ( ! n]v\s sy/em4 #b4 ,int5sify+ ( con/itutional defects4 #c4 ,decrease 9 size ( (fspr+4 #d4 ,pr$isposition to disease ?r\gh l[]$ vitality4 #e4 ,impairm5t ( reproductive function4 ,imm$iate consangu9\s (fspr+ may manife/ a high degree ( intellectual or physical atta9m5t b successive processes t5d to neurotic types & are prone to physical weaknesses & insanity4 ,?is practice is f\nd among ,quak]s & ,jewi% peoples1 inhabitants ( ! ,isl&s nor? ( ,scotl&1 9 isolat$ rural localities1 & among ,african tribes4 ,m5tal ,defici5cy 9 ,*ildr5 ,synonyms4--,am5tia2 feeble-m9d$ness4 ,!re are ?ree grades ( am5tia3 #a4 ,morons3 ^? ^: m5tal age corresponds closely to _! *ronological age or is ne>ly normal4 #b4 ,imbeciles3 ^? 9 :om !re is a wide disp>ity betwe5 ! m5tal age & ! *ronological age4 #c4 ,idiots3 ! l[e/ =m ( arre/$ m5tality or ^? :om x is impossible to tea*4 ,def9ition4--,m5tal defici5cy is a pa?ological /age 9 :i* ! m9d has fail$ to atta9 normal developm5t4 ,v>i\s degrees ( intellig5ce or m5tal capacity 9 man lie betwe53 7#a7 ,g5ius su* z ,bacon1 ,newton1 ,plato1 ,galileo1 ,%akespe>e4 7#b7 ,less] ,ability b /ill conspicu\s 9 developm5t su* z our great lead]s 9 sci5ce1 lit]ature1 re=m & ! arts & m$ic9e1 fur!r+1 ea* _! respective causes4 ,^! m]ge easily into 7#c7 ,av]age mass ( mank9d4 7#d7 ,dull>ds or ^? ( inf]ior intellig5ce4 7#e7 ,feeble m9d$1 m]g+ imp]ceptibly into 7#f7 ,imbeciles & by ins5sible gradation into 7#g7 ,idiots & gross idiots4 ,! m5tally defective is :olly incapable at maturity ( adapt+ himself to 8 environm5t or local conditions 9 ord] to ma9ta9 exi/5ce indep5d5t ( any ext]nal support4 ,dem5tia is a disease ( ! m9d or t :i* 0 once possess$1 & by "s neuronic di/urbance is lo/ totally or p>tially4 ,insanity is a di/urbance ( neuronic function :i* may or may n end 9 deg5]ation ( bra9 tissue4 ,physiology4--,! normal bra9 beg9s its developm5t %ortly aft] f]tilization ( ! g]m cell1 by ! expansion ( ! ant]ior end ( ! rudim5t>y sp9al cord into f\r prim>y c]ebral vesicles4 ,^! develop into a s]ies ( elaborate infold+s1 ea* ) multiple cells ar\nd !m4 ,at or ab\t ! six? mon? ( fetal life ?is embryonic bra9 assumes ! %ape ( ! adult bra91 m9us ! second>y fissures & convolutions :i* are *>act]i/ic ( full developm5t4 ,at bir? !re are sometimes _m convolutions & ! bra9 weighs f #bhj to #ccj grams4 ,gr[? is !n rapid & at six mon?s x weighs f #efj to #fhj grams2 ,at "o ye>1 #gej grams4 ,x cont9ues to increase until ,at #ab to #ad ye>s x weighs #aaej grams 9 ! female1 & #acjj 9 ! male2 ,at #bj to #ba ye>s ! weight is #abdd grams 9 ! female & #acgd 9 ! male4 ,gr[? is sl[ f ?is "t until at #be to #ce ye>s ! av]age weight ( ! bra9 is #abfi grams 7#de oz47 9 ! female1 #adba grams 7#ej oz47 9 ! male4 ,?is gr[? ( ! bra9 is due1 fir/ to ! rapid multiplication ( n]ve cells &1 secondly1 to ! individual enl>gem5t ( ea* n]ve cell4 ,^! cells arise f ! floor ( ! f\r prim>y vesicles & are ea* simil> to its fell[4 ,!y f9ally %[ diff]5ces 9 feature & become *>act]i/ic 9 size & %ape :i* process cont9ues ?r\gh\t life4 ,?is process ( diff]5tiation ( n]ve cells results 9 ! peculi> lam9at$ appe>ance ( ! bra9 cortex4 ,at ! p]iod ( lam9ation1 ! n]ve cells ?r[ out delicate processes :i* pursue def9ite directions ?r\gh\t ! bra9 mass con/itut+ a sy/em ( association fib]s :i* l9k toge!r 9 a mo/ complicat$ mann] all p>ts ( ! bra91 & are call$ ! association fib]s ( ,fle*sig4 ,projections f ^! cells =m ! v>i\s pa?ways by :i* ! bra9 is connect$ to ! v>i\s p>ts ( ! body4 ,n]ve cells 9 ! diff]5t p>ts ( ! bra9 mature at diff]5t p]iods1 ^? areas :i* h to d ) ! highe/ intellectual functions1 viz41 ! frontal & p>ietal regions1 matur+ la/4 ,at ! sev5? mon? ( intraut]9e life ! bra9 cell is a small r\nd type ( neurobla/1 undiff]5tiat$1 ly+ 9 a matrix4 ,! cells increase 9 size until ab\t ! second week 7extra-ut]9e7 ( life1 t9y processes beg9 to develop4 ,at ! ?ird to fif? ye> ^! cells are mature & possess axons1 d5drons & gem9ules4 ,^! communicate1 =m+ ! above nam$ association sy/em convey+ impulses to & f all p>ts ( ! c]ebrosp9al sy/em4 ,!y multiply & elaborate aft] pub]ty into a complicat$ sy/em up into middle life aft] :i* gr[? ceases & !y sl[ly dim9i%4 ,greate/ ,gr[? is betwe5 ! fir/ appe>ance ( ! primitive bra9 & ! end ( ! six? mon? ( life 7extra-ut]9e71 h5ce x is dur+ ?is p]iod t any adv]se conditions relative to developm5t ( n]ve cells may cause ! greate/ damage4 ,m9d & ,bra94--,:atev] may be ! connection betwe5 ^! two1 we "k t ! =m] develops ) ! gr[? ( bra9 cells & fails ) _! decay4 ,am5tia is associat$ ) ! incomplete developm5t ( bra9 cells & ,dem5tia is co9cid5t ) _! deg5]ation & dea?4 ,pa?ology--,bra94--,/ructural abnormality ( ! bra9 tissue may exi/ )\t v>iation ( m5tality or defect4 ,e>ly obs]v]s gave ^! gross defects z a cause = am5tia4 ,h[ev]1 x has be5 demon/rat$ beyond d\bt by microscopic exam9ation ( c]ebral neurosis t cellul> *anges occur & t imp]fect & arre/$ developm5t exi/s & is an ess5tial basis ( am5tia4 ,hi/ology--,blood ,cells4--,cortical blood cells 9 ! am5t are #a4 ,num]ically few]4 #b4 ,irregul> 9 arrangem5t4 #c4 ,imp]fectly develop$4 #d4 ,microscope reveals *anges proportionate to ! defici5cy dur+ life4 ,blood-vessels 9 ,am5tia %[ no m>k$ *anges f ^? ( ! normal bra94 ,hyal9e deg5]ation may be pres5t2 also pigm5tation4 ,^! conditions are n con/ant 9 am5tia h5ce _c be consid]$ causal4 ,neuroglia 9 ,am5tia4--,scl]osis & hyp]trophy occur 9 a l>ge proportion ( cases4 ,?is is diffuse ?r\gh\t ! bra91 ) "h & !re c]ta9 circumscrib$ areas =m+ nodules4 ,n]ve ,fibres ( ,cortex 9 ,am5tia4--,association sy/em fibres are always dim9i%$ 9 numb] & n s complicat$4 ,cl9ical ,v>ieties ( ,am5tia4--,!re are two v>ieties ( am5tia & conv5tionally = sake ( /udy we mu/ arrange !m into ^? f 7#a7 ,cong5ital causes & 7#b7 acquir$ causes4 ,among ^? :i* arise f cong5ital causes we h ! microcephal\s & ,mongolian types4 ,9 bo? cases !re exi/ con/itutional ta9ts ?r\gh successive or imm$iately =go+ g5]ations ( su* diseases z syphilis1 tub]culosis1 epilepsy1 & acute alcoholism affect+ prop] collaboration ( g]m cells previ\s to f]tilization & h5ce impair$ g]m9al end[m5t ?r\gh a weak5$ n]v\s sy/em4 ,^? aris+ f acquir$ causes are f injury to "m or fetus4 ,macrocephalus4--,a p]son ^: skull measures less ?an sev5te5 in*es 9 its greate/ circumf]5ce4 ,?is class comprises less ?an #aj ( all am5ts4 ,cause4--,! type is nei!r a freak rev]sion ( ! species to a l[] grade ( developm5t nor accid5tal1 b due to an inh]it$ blight on ! n]v\s sy/em aris+ f con/itutional disease1 alcoholic & sexual excesses1 consangu9\s unions & too num]\s latt]-life pregnancies 9 und]m9$ heal? /ates4 ,!y come entirely f neuropa?ic /ock & _! bro!rs & si/]s are deg5]ates4 ,_m dw>fs exhibit ?is type4 ,*>act]i/ics ( ,microcephaly4--7#a7 ,circumf]5ce ( skull dim9i%$2 7#b7 ,bra9 small]2 7#c7 ,/ature small 7#e feet72 7#d7 ,r>ely live to advanc$ age2 7#e7 ,die ( tub]culosis2 7#f7 ,mo/ly imbeciles & idiots 7few morons74 ,!y h _! s5sory impressions intact & are g5]ally vivaci\s & muscul>ly active1 ev5 re/less4 ,!y h good sight & he>+ & are highly initiative b h n ! ability to any su/a9$ ef=t4 ,!y are actively obs]vant & ! majority are affectionate & well behav$4 ,"s are un/eady 9 walk+1 o!rs are helpless1 & ab\t "o-half are subject to epileptic fits4 ,mongolian ,am5tia 7,mongolism74--,?is type 7,kalunk or ,t>t> v>iety7 receiv$ its "n f ,dr4 ,j4 ,langdon ,d[n f _! facial resemblance to memb]s ( ! ,mongolian race4 ,!y numb] ab\t #e ( all am5ts includ+ ! semi-mongols :o h only a few ( ! *>act]i/ics ( ?is type4 ,cause4--,elev5 out ( tw5ty-five are f syphilitic orig94 ,gl&ul> or nutritional defects are sugge/$ z a cause4 ,!y w %[ negative ,wass]mann te/ & positive tub]cul9 te/s4 ,ut]9e exhau/ion & ill heal? ( "m dur+ ge/ation are factors suspect$ ( ent]+ into ?is condition4 ,! latt]-born ( l>ge families are frequ5tly affect$4 ,pa?ology ( ,mongolian ,idiocy4--,! bra9 ( ! ,mongolian am5t is consid]ably "u-siz$ & has less convolutions & is m %all[4 ,! pons1 m$ulla1 & c]ebellum are ab\t half ! size ( ord9>y feeble m9d$ types4 ,! cells by microscopic exam9ation %[ an immature condition4 ,?is lack ( bra9 developm5t results 9 defici5t expansion ( base ( skull1 h5ce ! *>act]i/ic physiognomy4 ,!re is no gl&ul> abnormality4 ,description ( ! ,mongol ,type4--,?is type is di/+ui%$ by *>act]i/ics ( skull1 eyes & tongue & is usually obs]v$ at bir?4 #a4 ,! skull 7,bra*ycephal\s7 is r\nd$ & dim9i%$ 9 size p>ticul>ly ?r\gh ! ant]o-po/]ior diamet]4 ,! face is flatt5$1 !re be+ no recession ( frontal & supra-occipital regions4 ,eyes4--,! palpebral fissures are n>r[ & slope obliquely d[nw>d & inw>d4 ,lids inflam$4 ,tongue protrudes1 is l>ge & m>k$ by l>ge papill & scor$ by transv]se fissures due probably to tongue suck+1 pr$ispos+ to inflammation ( ! muc\s membranes4 ,e>s are small & r\nd & h poorly develop$ & irregul> lobules4 ,nose is %ort & flat & has triangul> no/rils4 ,tee? are s(t & ill =m$ & t5d to decay4 ,hair is usually scanty & wiry & v dry4 ,*eeks are flu%$4 ,palate is high & n>r[ & m\? is op51 & lips are crack$4 ,ad5oids exi/ 9 all cases4 ,h&s & ,feet are broad & clumsy4 ,flat foot & knock-knees are common4 ,sk9 is r\gh1 co>se & dry4 ,abdom5 is l>ge & mu%y4 ,umbilical h]nia (t5 pres5t4 ,circulation is r>ely good1 caus+ blu5ess & coldness ( extremities1 ) sores & *ilbla9s4 ,he>t lesions are frequ5t4 ,lesions ( a *ronic inflammatory nature 9 respiratory & dige/ive tracts exi/4 ,nasal & bron*ial cat>rh & di>rhea are common4 ,mongols die e>ly 7ab\t #ad ye>s7 usually ( ph?isis4 ,available /ati/ics %[ ! v>i\s types & v>iations ( ^! conditions 9 great detail2 h[ev]1 ! above w enable ! read] to classify & prop]ly diagnose 9 giv5 cases4 ,x is n ! writ]'s int5tion to portray "h :at is easily a treatise by itself4 ,o/eopa?ic ,consid]ation ( ,am5tia4--,dur+ a p]iod ( five ye>s1 obs]vation ( ! v>i\s types has l$ me to believe t mu* c be done to correct circulation to c]ebral /ructure ) consequ5t developm5t ( bra9 tissue & function1 :]e discov]able trauma exi/s4 ,f all available s\rces !re is traumatic int]f]5ce 9 f #ae to #de ( ^! cases1 accord+ to diff]5t au?ors4 ,:]e hi/ory involves con/itutional f9d+s 7syphilis1 tub]cul>1 gl&ul> & *ronic alcoholism7 ,i h treat$ !m ) ! int5t ( reliev+ only until ! next phase ( ! condition w\ld appe>4 ,:]e trauma alone exi/s & ! family hi/ory is good1 ,i "k ! case is 9 ! field ( o/eopa?y alone1 & c be develop$ to a degree limit$ only by ! intellig5t c>e ( ^? hav+ ! case 9 *>ge4 ,especial att5tion %\ld be giv5 to discipl9e1 h\s+1 sanitation1 p]sonal hygi5e & g5]al environm5t4 ,lesions4--,atlas1 g5]ally rotat$4 ,r>ely po/]ior b frequ5tly re/+ b5ea? a po/]ior occiput4 ,lat]al mass on ! po/]iorly re/+ portion ( misplac$ atlas w become int]lock$ ) transv]se process ( axis 9 a few in/ances1 comb9+ ! am5tia ) a progressive inflammatory t5d5cy to ! middle e> :i* by successive abscesses ultimately de/roys /ructure & function2 possibly traumatic epilepsy1 & surely cat>rhal inflammations 9 all muc\s membranes ( ! head4 ,_m bony & ligam5t\s irregul>ities exi/ 9 ! v>i\s types ( m5tal defective :]e ! cause is inh]it$ weakness1 nutritional diseases or k9dr$ s\rces4 ,sp9al luxations exi/ s+ly & 9 s]ies1 caus+ v>i\s palsies1 spa/ic muscles1 & de=mity4 ,po/ural defects1 p>ticul>ly ( ribs & co/al c>tilages cause functional di/urbance ?r\gh\t ! ?orax & abdom54 ,treatm5t4--,inv>iably ! c>e ( am5ts entails wisdom ( proc$ure4 ,recon/ruction is ! prime object 9 e in/ance1 h5ce "t & numb] ( treatm5ts mu/ n be consid]$4 ,treat to correct /ructure2 tea* z f> z possible2 tra9 always4 ,deft & intellig5tly appli$ te*nique are c]ta9ly requir$ 9 ! correction ( ^! c]vical lesions4 ,treatm5t %\ld be giv5 ?rice weekly 7nev] less ?an twice = progress7 ) def9itely e/abli%$ m5tal te/s be=e1 to disc]n ! m5tal level1 & at succe$+ p]iods ( ?ree mon?s ea*1 not+ progress1 if any4 ,! ,b9et-,simon scale or "s o!r available m5tal te/ %\ld always be made & record c>efully kept ( ea* case = y\r own b5efit z well z ! pati5t's4 ,aft] six mon?s1 if no appreciable ga9 is %[n treatm5t is discont9u$ & ! case mu/ be c>$ = 9 ano!r mann] z beyond y\r special field ( ef=t4 ,usually x is app>5t by ! end ( ! ?ird mon? if any?+ c be done to improve ! m5tality4 ,! physical advantages1 9 "s cases w>rant cont9u$ treatm5t :]e !re is no appreciable m5tal ga94 ,in/itutional c>e ( ^! types is ! only practical means ( h&l+ !m prop]ly f an o/eopa?ic /&po9t1 z x requires "s "o prop]ly equipp$ to make y\r te/s & keep y\r record2--x is suffici5t = ! doctor to d ! "w dem&$4 ,!y c ?us be classifi$ & progress sy/ematically %[n4 ,! high] grades mu/ be taught & ?\gh self dep5d5ce may nev] be atta9$ !y c 9 _m cases by tra9+ be capable ( useful pursuits & q frequ5tly remun]ative "w4 ,x makes = happ9ess at lea/ to keep !m busy & =e/alls ! mis*ief t w\ld o!rwise result4 ,ev5 imbeciles c help 9 r\t9e "w ( an in/itution or home1 & idiots may1 by tra9+1 ga9 "s p[] ( self help & cleanl9ess4 ,tra9+ dep5ds on ! individual capacity = su* 9 ea* case--8 habits1 & g5]al "* ( 8 prop5sities4 ,prev5tion ( _! m>riage %\ld be positive & = prev5tion ( _! propagation ?is & _! /]ilization by op]ation are ! only two measures at h&4 ,/]ilization1 h[ev]1 is repugnant to "s elem5ts ( society & c\ld be abus$1 h5ce ! segregation ( am5ts w\ld appe> to be our only solution at pres5t4 ,! ultimate int5tion ( treat+ any case is to use any measure t5d+ to /abilize ! n]v\s sy/em4 ,corrective ef=t alone is n suffici5t b ^! o/eopa?ic endeavors 9 conjunction ) prop] discipl9e1 good food1 regul> re/ & p]sonal hygi5e bo? m5tal & physical & a scrut9iz+ re/riction t5d+ to any k9d ( excess is r5d]+ ! o/eopa?ic proc$ure 9 su* cases rapidly indisp5sable = ! treatm5t ( am5tia4 ,,po/-,,op]ative ,,treatm5t ,by ,,george ,a4 ,,/ill ,at ! conv5tion ( ! ,am]ican ,o/eopa?ic ,association held 9 ,bo/on 9 #aiah1 ,i gave a %ort talk on ! above subject1 & dur+ ! day aft] ,i _h giv5 ! lecture1 two wom5 & "o man1 graduate o/eopa?s1 ask$ me if ,i really meant to convey ! impression t we actually gave o/eopa?ic treatm5ts to rec5t surgical cases4 ,i d n "k :e!r ,i conv9c$ !m or n1 b ,i d "k t !y conv9c$ me t !re are p practic+ o/eopa?y :o h absolutely no concept ( its m]its & und]ly+ pr9ciples4 ,to my surprise ,i h f\nd t a great _m o/eopa?s :o consid] !mselves absolutely 8pure0 are j a bit />tl$ at ! ?\ght ( h&l+ po/-op]ative complications by treatm5t4 ,^! are inv>iably fell[s :o h _h mo/ ( _! exp]i5ce 9 (fice "w1 & :o d n come 9 contact ) acute cases4 ,/ill x is difficult to conceive h[ a man c believe t o/eopa?y is specific = c]ta9 diseas$ conditions & n = o!rs4 ,z a matt] ( fact o/eopa?ic treatm5t has n prov$ itself m satisfactory 9 any field ( !rapeutics ?an x has 9 po/-op]ative conditions4 ,! common po/-op]ative conditions are pneumonia1 pleurisy1 backa*e & heada*e1 nephritis1 vomit+1 neuritis1 phlebitis4 ,tak+ up ^! subjects & discuss+ ! lea/ s]i\s fir/ we w\ld ( necessity discuss pneumonia la/1 z x is ! mo/ s]i\s1 & is less influ5c$ by o!r conditions4 ,x w also s]ve to illu/rate _m ( ! details 9 treatm5t4 ,we w !re=e briefly take up ! o!r conditions & !n discuss pneumonia m fully4 ,vomit+ ,we believe !re is no "q t a good "p ( ! prev5tion ( ane/hetic vomit+ is 9 ! prep>ation ( ! pati5t1 includ+ a good clean+ out ( ! b[els )\t debilitat+ ca?>tics4 ,9 o!r words1 ! vomit+ is increas$ if ! alim5t>y tract is load$1 or if on ! o!r h& x has be5 irritat$ to ! ext5t ( los+ its tone4 ,comb9+ a c>eful prep>ation ) a /raight e!r ane/hesia & o/eopa?ic treatm5t to ! neck & splan*nics we h be5 able to elim9ate any s]i\s po/-op]ative nausea4 ,i d n recall a case 9 ! la/ few ye>s t vomit$ on ! foll[+ day unless ! condition = :i* !y 7 op]at$ 0 "o t ess5tially 9 itself w\ld cause vomit+2 = in/ance if ! pati5t _h p]itonitis & _h be5 vomit+ due to ! toxic ileus4 ,!y might ev5 vomit aft] ! abdom5 _h be5 op5$4 ,?is c\ld h>dly be call$ 8po/-op]ative0 vomit+4 ,! improvem5t 9 our records 9 po/-op]ative vomit+ is 9 proportion to our increas$ fai? & use ( ! o/eopa?ic treatm5t4 ,"t & aga9 pati5ts h told u t !y _h tak5 ane/hetics be=e & 7 sick f ?ree to five days & ev5 a week4 ,inv>iably we h be5 able to surprise ^! pati5ts by ! fact t !y 7 sick less ?an a day4 ,! usual treatm5t ) bismu? sub-nitrate1 c]ium oxylate1 s\r w9e & ! o!r usual rem$ies 7 n us$ 9 any case or 9 any am\nt4 ,no drugs :atev] 7 employ$4 ,backa*e & ,heada*e ,!re is practically no diff]5ce 9 ! po/-op]ative heada*e & ! (fice heada*e4 ,!re is ( c\rse ! usual multiplicity ( causes1 & z a matt] ( fact 9 ?is condition treatm5t c m ne>ly approa* ! ord9>y (fice treatm5t1 & ! results are ab\t ! same4 ,z = backa*e1 we f9d t spe$ ( op]at+ & n keep+ ! pati5t "u ! e!r too long has a m>k$ influ5ce4 ,also we h a f\r in* ,seely mattress on ! op]at+ table :i* helps "s4 ,treatm5t does ! re/ & does x effectively4 ,= ?is complication ev5 ! ord9>y nurse kn[s en\gh to give a treatm5t ( "s sort4 ,neuritis ,n9e times out ( t5 ! po/-op]ative neuritis is really a local osse\s lesion1 a slipp$ innom9ate1 rib1 v]tebra1 clavicle1 biceps t5don or some?+ ( ! sort1 & responds quickly to a specific treatm5t4 ,phlebitis ,?is complication usually comes on q late aft] an op]ation & at fir/ x is sometimes h>d to diff]5tiate x f a neuritis4 ,absolute re/ ( ! involv$ "p ) l[] sp9al treatm5t gives relief1 b "u no circum/ances %\ld ! affect$ "p be freely mov$ :ile !re is active inflammation4 ,! reason = treatm5t ( ! l[] sp9al area is t practically always "o ( ! saph5\s ve9s is involv$4 ,nephritis ,?is complication is to a v big ext5t elim9at$ by a c>eful ur9alysis prior to ! op]ation1 & c>eful prelim9>y treatm5t 9 indicat$ cases1 & 9 o!r cases ! po/ponem5t or if necess>y complete elim9ation ( ! op]ation :]e x is n a case ( life & dea?4 ,:]e ! condition does appe> we h f\nd x ! h>de/ ( ! po/-op]ative complications to control4 ,inde$ x is ! only "o t we h n f\nd v easy to manage4 ,we d n v>y ! treatm5t = a po/-op]ative nephritis f :at we w\ld use 9 any ord9>y case ( nephritis4 ,we h obs]v$ treatm5t ( ?is condition 9 _m cases "u m$ical managem5t1 & :ile we are satisfi$ ) ! o/eopa?ic treatm5t comp>atively we are n yet satisfi$ t we h x develop$ to its greate/ effici5cy4 ,pleurisy ,?is condition 9 ne>ly e in/ance c be correct$ ) "o or two treatm5ts ( a twi/$ rib unless x is ! pleurisy ( a beg9n+ pneumonia4 ,z f> z ! pa9 is conc]n$ ! simpl] type hurts z mu* z ! "o t is go+ to develop a real complication4 ,= ?is reason relief obta9$ by a s+le treatm5t (t5 seems little %ort ( miracul\s to ! pati5t4 ,pneumonia ,:5 ,i took *>ge ( ! surgical "w at ,kirksville1 o/eopa?y 0 n us$ 9 po/-surgical treatm5t4 ,po/-op]ative vomit+ 0 treat$ m$ically1 z 7 o!r po/-op]ative conditions1 includ+ pneumonia4 ,cases ( a real major surgical nature r>ely got an o/eopa?ic treatm5t4 ,! idea seem$ to be t o/eopa?ic po/-op]ative treatm5t _h to be along ! same l9es z x w\ld be = su* an illness z lumbago1 bra*ial neuritis1 or ord9>y pneumonia1 & o!r non-surgical conditions :]e ! pati5t c\ld be plac$ = giv+ a treatm5t 9 a position t 0 n p]missible foll[+ an op]ation1 z x w\ld "w great h>m to ! w\nd4 ,x seem$ to me t if o/eopa?y 0 effective 9 a case ( ord9>y non-surgical pneumonia1 x %\ld c]ta9ly be good = a case ( pneumonia t 0 po/-op]ative & t all we _h to d to h&le ! condition 0 to apply a new te*nique ( treatm5t t c\ld be us$ on a pati5t :o _h a surgical w\nd4 ,all we _h to d 0 to s manipulate ! sp9e t we w\ld get ! results locally1 & yet h&le x 9 su* a mann] z n to affect ! w\nd4 ,_m laym51 & ev5 "s physicians ( our own s*ool1 express surprise at ! sugge/ion t we d mu* o/eopa?ic "w 9 ! aft] c>e ( surgical pati5ts4 ,b ! fact is we h work$ x out s t n[1 except = pa91 dur+ ! imm$iate aft] effects ( ! op]ation drugs are absolutely n us$ 9 our hospital = any ( ! po/-op]ative complications4 ,! opiate imm$iately foll[+ ! op]ation1 is really a foll[ up ( ! ane/hetic1 & we use t z r>ely z possible4 ,ne$less to say1 !re are cases su* z un-unit$ fractures1 ext5sive adhesions1 etc41 :]e ! em]g5cy conditions positively call = "s relief ( ! pa9 = a %ort :ile1 b t is ! only condition t we _c control ) me*anical treatm5t4 ,i am v glad t ,i _h ! confid5ce to give ?is an e>ly trial & a ?or\gh trial1 )\t be+ afraid to leave (f ! drugs4 ,! big field1 h[ev]1 :]e o/eopa?ic treatm5t has won ! mo/ impressive success & prov$ itself a mo/ absolute specific1 is 9 ! field ( po/-op]ative pneumonia ) :i* ,i am pr\d to ann\nce a "o hundr$ p] c5t4 success = comb9$ o/eopa?ic treatm5t 9 my f\rte5 ye>s cont9u\s surgical "w4 ,n to h lo/ a s+le case is p>tly due to luck4 ,9 o!r words1 ) any s]ies ( s]i\s cases1 x is impossible b t !re be "s fatality f9ally4 ,po/-op]ative cases h "o advantage along ) _! disadvantage4 ,:ile !y h ! %ock ( ! op]ation to cont5d )1 & ! weak5$ condition f ! disease = :i* !y 7 op]at$1 /ill except 9 extreme em]g5cy !y w\ld n h be5 op]at$ on unless !y _h a good he>t & good kidneys & a good blood pressure1 s t 9 cases 9 :i* we are mo/ conc]n$ 9 combatt+ pneumonia1 we usually />t ) a pati5t :o has ^? organs 9 a heal?y condition4 ,fir/ ,po/-op]ative ,pneumonia ,cases ,treat$ ,o/eopa?ically4--,at ! ,*icago ,conv5tion 9 #aiaa1 ,i report$ ! fir/ po/-op]ative pneumonia cases t _h be5 treat$ o/eopa?ically4 ,i believe at t "t t !re _h be5 only ?ree cases4 ,at t meet+ ,i m5tion$ ! fact t "s ( ! doctors & "s ( ! int]nes :o treat$ ^? cases felt sure t !y 7 n treat+ !m prop]ly because !y c\ld n get away f ! idea t pneumonia ne$$ /ry*n9 & o!r drugs4 ,"o ( ^! cases got well 9 ?ree days f ! develop$ lob> pneumonia symptoms4 ,! results 7 s miracul\s t ! "y man treat+ x began to d\bt :e!r x c\ld h be5 pneumonia4 ,he c\ld n und]/& h[ he1 a s5ior /ud5t1 c\ld ov]come ?is dread$ disease by m]ely work+ on ! sp9e4 ,he c\ld n believe t o/eopa?y1 a sci5ce t he _h be5 able to le>n himself1 s easily c\ld cure a condition t he _h ?\ght mu/ be almo/ necess>ily fatal4 ,"o ( ! weaknesses ( o/eopa?y is ! fact t !re is no my/icism ab\t x4 ,x is s simple t any p]son ) ord9>y intellig5ce c le>n to use x1 & yet x is s simple t x takes an unusual intellig5ce to be able to grasp ! fact t x is ! !rapeutic discov]y ( ! age4 ,_m1 _m times ,i h _h "y int]nes & /ud5ts cure g5u9e lob> pneumonia & d x ) su* obvi\s ease t x caus$ !m to wond]1 9 a way1 if x really c\ld be pneumonia4 ,x is br$ 9 our v tissues to look = "s my/icism1 some?+ impossible to und]/&1 some?+ sup]natural1 some?+ connect$ ) ! ,unkn[n associat$ ) ! treatm5t ( disease & accord+ly x is j human nature to f9d x difficult to believe1 ev5 :5 we see x1 t a simple me?od ( treatm5t c actually effect a cure4 ,real pneumonia1 z we und]/& x1 is a consolidation ( ! lung tissues *>act]iz$ by fibrosangu9\s exudate into ! pulmon>y tissues & spaces1 associat$ ) "o or m p>ticul> g]ms z excit+ factors & prov$ by ! physical te/s & ! "* ( ! expectoration4 ,h[ _m cases h be5 cur$ t _h n ent]$ consolidation ,i d n "k because up until ! "t ( actual consolidation !re may be a "q z to :e!r or n !y w\ld h _h pneumonia4 ,i "k t _m cases ) m>k$ symptoms ( pneumonia h fail$ to develop "u treatm5t or ! case has be5 abort$4 ,pneumonia lacks a great deal ( be+ a self limit$ disease4 ,! numb] ( cases ) beg9n+ symptoms t fail to develop is too great to be ascrib$ to co9cid5ce4 ,( c\rse ,i "k t "s ( ^! might h be5 only pleuritis1 "s only neuritis1 etc4 ,h[ev]1 9 giv+ ! /ati/ics ( pneumonia cures we w give only ^? 9 :i* pneumonia develop$ & %[$ a h>d5+ or consolidation ( ! lung tissue4 ,9 ^! cases !re c be no argum5t z to :e!r !re 0 pneumonia4 ,:5 we h an acute condition associat$ ) ! symptoms ( consolidation1 we c h>dly be confus$ z to ! diagnosis4 ,we may make a mi/ake 9 our physical f9d+s1 b h>dly aft] a little exp]i5ce1 & c]ta9ly :5 we are sure ( ! physical f9d+s !re w be no tr\ble 9 nam+ ! disease4 ,! ,cl9ical ,f9d+s4--,po/-op]ative pneumonia is a little diff]5t f ! common pneumonia4 ,x always comes on a little m insidi\sly4 ,"o has to wat* = po/-op]ative pneumonia m closely ?an he w\ld = ! attack t we may meet 9 ord9>y practice4 ,a pati5t may h consid]able pa9 f 8 w\nd1 may h "s pa9 9 ! back f ! position he is 92 !re may be heada*e1 & an upset feel+ f e!r2 & ! pa9 comes 9 ! *e/4 ,all ^! symptoms are =]unn]s ( pneumonia1 b ! pa9 9 ! *e/ is n notic$ until x gets q sev]e4 ,9 o!r words1 !re are o!r ?+s to annoy ! pati5t z well z ! att5dant1 & at fir/1 ?is condition does n cause compla9t4 ,a /rong & heal?y individual :o feels a pa9 9 8 pleura1 :i* is ! =]unn] ( pneumonia1 kn[s x at once1 because t is ! only di/ress he has4 ,8 entire att5tion is attract$ & he asks = a physician's help4 ,b 9 ! po/-op]ative case1 ! physician has to keep a look out 9 ord] to prev5t a case f gett+ well "u way be=e x is recogniz$4 ,z an example ( ?is ,i _h a case ( a man :o 0 ) a p>ty driv+ an automobile & !y tri$ to cross ! railroad track 9 front ( a tra94 ,?is pati5t ,i speak ( 0 "o ( ! survivors4 ,he _h a fracture ( ! femur1 fracture ( ! skull1 fracture ( ?ree ribs1 & o!rwise m or less bruis$ up4 ,naturally ! prelim9>y "w consi/$ 9 gett+ ! ribs & legs att5d$ to z well z possible & look+ out = c]ebral hemorrhage or m5+itis4 ,?is pati5t develop$ consolidation 9 bo? lungs 9 spite ( regul> treatm5t1 & x precipitat$ on him v rapidly1 p>tly mask$ by ! di/urb$ brea?+ f o!r s\rces ( irritation4 ,we put him on h\rly treatm5t1 b aft] a few h\rs 8 condition f ! injuries & ! pneumonia 0 su* t 8 wife ask$ u n to treat him any m4 ,%e put x ?is way1 t %e knew he w\ld die 9 spite ( all t c\ld be done & z long z he 0 go+ to die he might z well die easy4 ,e "t he 0 treat$ x _h ! effect ( br++ him out ( 8 /upor1 & he w\ld compla91 & %e ?\ght x w\ld be a k9d act to let him slide (f into ! next _w uncompla9+4 ,pneumonia 9 a case ( ?is sort _c be h&l$ ) kid gloves if we wi% to save ! pati5t4 ,we mu/ give firm1 /rong treatm5t4 ,light treatm5t 9 ?is condition w d no good4 ,inde$ light treatm5ts 9 any sort ( pneumonia are ( little avail4 ,_m times ,i h *ang$ int]nes 9 a pneumonic case t 0 n respond+ & ! results 7 imm$iate4 ,t is1 ! turn = ! bett] 0 obvi\s f ! beg9n+ ( ! good /rong treatm5t4 ,! case above m5tion$ 0 treat$ a good "p ( ea* h\r = twelve h\rs4 ,he _h no /ry*n91 no oxyg51 no?+ b treatm5ts1 b he got well & is n[ liv+1 & aside f a limp has no evid5ce ( ei!r 8 injury or 8 illness4 ,"s cases1 9 private practice1 may get well on a treatm5t a day1 b ,i w\ld hate to h&le ! k9d ( cases we get 9 t mann]4 ,i h _h sev]e cases1 especially hemorrhagic cases1 :]e ! treatm5t 0 almo/ cont9u\s = h\rs prec$+ ! crisis4 ,( c\rse1 aft] ! crisis we c ease up4 ,on ! o!r h&1 x is n infrequ5t t a few good /rong e>ly treatm5ts1 giv5 at ! beg9n+ ( a case absolutely /op x4 ,i h se5 cases :]e a consolidation area ( ! apex ( ! l[] "r lobe z l>ge z ! palm 0 easily outl9$1 & ?is toge!r ) ! cl9ical symptoms w\ld be cle>$ up 9 two or ?ree days4 ,!re is no possible m$ical me?od by :i* ?is c be done4 ,m$ical au?orities agree t "u _! treatm5t pneumonia runs an un%ort5$ c\rse2 9 o!r words1 a c\rse 9 ! individual case t has n be5 affect$ by ! m$ication4 ,m$ically1 ev5 :]e ! crisis occurs e>ly1 ! consolidation p]si/s = "s "t1 b ,i h se5 x cle>$ up "t & aga9 "u o/eopa?ic treatm5t 9 ! l5g? ( "t t c\ld h be5 br\ght ab\t only by o/eopa?ic treatm5t4 ,i h previ\sly call$ att5tion to ! fact t _m ( ! m$ical text books on physical diagnosis m5tion a po9t t is a v practical & v pla9 demon/ration ( ! effici5cy ( o/eopa?y 9 pulmon>y conditions4 ,^! books only m5tion ?is fact )\t po9t+ any moral or draw+ any conclusions4 ,! po9t is ?is3 t frequ5tly :5 a pr(essor is hav+ a class or a section ( a class exam9+ a case ( pneumonia1 !y w outl9e ! size ( ! consolidation at ! beg9n+1 ! in/ructor m>k+ x (f :5 he makes ! fir/ exam9ation2 !n aft] ! /ud5ts h exam9$ x1 by p]cussion1 palpation1 etc41 possibly a doz5 or tw5ty ( !m1 ! lat] /ud5ts w f9d t ! area has %runk5 p]haps an in*4 ,?is fact has be5 frequ5tly not$4 ,x is said1 inde$1 t if c>eful exam9ation is made x w always be not$4 ,h[ ,manipulative ,treatm5t ,b5efits ,d\btless ?is prov$ t accid5tal manipulations ( ! ribs helps cle> up ! conge/ion ab\t ! real consolidation & r$uces "s ( ! dull area4 ,v likely ?is expla9s "s ( ! cases ( p>tial or real results f spondylo!rapy4 ,naturally1 sci5tific o/eopa?ic treatm5t w\ld necess>ily magnify su* results v mu*4 ,x is a great wond] ) ! obvi\s failure ( m$ical treatm5t 9 pneumonia1 t at lea/ "s crude f ( manipulative treatm5t has n be5 devis$ by ^? practition]s4 ,we h already m5tion$ t ! treatm5t ( po/-op]ative cases v>ies ma9ly 9 ! mann] ( apply+ x4 ,9 o!r words1 :5 we raise ! ribs we keep ! pati5t on 8 back1 9 treat+ ! sp9al c5t]s we treat ) pati5t on 8 back1 & ! physician :o has no grip 9 8 h&s w n be able to treat a po/-op]ative pneumonia to any advantage4 ,9 ^! cases "o has to get at ! pati5t's back by rea*+ "u & ! weight ( ! pati5t helps to give ! treatm5t1 b a /rong grip is necess>y4 ,x is mu* saf] = ! w\nd to h&le ! pati5t 9 ?is way b n infrequ5tly beg9n]s we> _! knuckles pretty ne>ly (f be=e !y get ! f9] te*nique2 aft] :i* x is easy4 ,9 rais+ ! ribs !re is no m difficulty 9 treat+ 9 ?is position ?an !re is ) a pati5t :o c sit up or turn f side to side & 9 "s cases a pati5t c1 ( c\rse1 be p>tially turn$4 ,!ory is all "r b 9 ^! cases practice has be5 add$ to x 9 some?+ ov] ?ree hundr$ cases treat$ 9 ?is mann]1 & 9 ?is mann] only4 ,i h _h no case die4 ,none ( my cases _h oxyg5 & none ( !m _h /ry*n9 or alcohol unless x 0 a p]son :o _h us$ alcohol con/antly or daily & 9 ^! cases ,i consid] t ! sy/em has become suffici5tly us$ to x t x is practically a food & t sudd5 )drawal is apt to br+ on delirium4 ,x is n necess>y 9 ^? cases t indulge deeply n[ & !n1 b x is advisable 9 ^? t take a small am\nt regul>ly1 j z !y take food4 ,^! pati5ts are us$ to a con/ant he>t /imulant & its )drawal is also apt to be reflect$ 9 ! he>t action4 ,^! are ! only cases 9 :i* ,i h ev] au?oriz$ any?+ 9 ! way ( a *emical /imulant ( ! he>t dur+ pneumonia4 ,y w und\bt$ly recall t 9 read+ ! newspap] acc\nts ( m5 :o are big en\gh & prom95t en\gh to h bullet9s 9 ! newspap]s :5 !y are dy+1 t almo/ univ]sally ! next to ! la/ bullet9 0 t oxyg5 is be+ adm9i/]$4 ,! la/ bullet9 ann\nces ! "t ( dea?4 ,y w also note t 9 case ! pati5t lives t oxyg5 !n is n m5tion$1 & a few days lat] ! pati5t is all "r4 ,my obs]vation is t ! use ( oxyg5 may attract ! att5tion ( ! family1 x may attract ! att5tion ( ! pati5t1 b z = any actual b5efit on ! pati5t ,i d n believe x is 9 ! lea/ helpful1 & t ! only treatm5t = pneumonia is o/eopa?ic4 ,i am s conv9c$ ( x t ,i am us+ only t me?od4 ,z to /ry*n91 "s say /ry*n9 mu/ be giv54 ,"s say x mu/ be giv5 at ! crisis1 & o!rs say x mu/ be giv5 f ! inception ( ! disease4 ,i d n believe ! majority ( cases w d z well "u /ry*n94 ,i "k !y w n d z well "u /ry*n9 z "u o/eopa?ic treatm5t4 ,i w n say !y w n d z well z if "u no treatm5t4 ,x is possible t !re w\ld be an occasion = its use at ! crisis1 & ,i h se5 su* cases1 & ,i h us$ x :ile /udy+ m$ic9e4 ,i us$ x at ! crisis1 & ,i us$ x 9 cases :]e ,i am conv9c$ t x help$ !m ov] ! crisis1 b ,i am also conv9c$ n[ t by o/eopa?ic treatm5t !y w\ld h done /ill bett] & ! crisis w\ld n h be5 s acute4 ,9 o!r words :at /ry*n9 does 9 favorable cases1 o/eopa?ic treatm5t does bett] 9 all cases4 ,9 our po/-op]ative cases /udy ! *>ts & y w see t !y d n h ! acutely viol5t crisis t usually occurs "u o!r treatm5t4 ,!y are "u bett] control & if we c get !m ne> ! beg9n+1 z we usually d1 we c keep up ! resi/ance s t :]e !y w\ld o!rwise h a h>d crisis !y h an easy "o4 ,in/ead ( hav+ a temp]ature ( #aje1 pulse #afe1 respiration #gj1 or su* a condition1 !y are m apt to run a temp]ature ( #ajb1 pulse #abj1 respiration #ce or #dj & !y g ?r\gh x )\t t sudd5ness & acut5ess t is common "u o!r me?ods ( treatm5t4 ,9 sev]al in/ances1 z an example ( %[+ h[ ?is resi/ance is kept up1 ,i _h lett]s f boys 9 ! camps4 ,"o lett] told ( a wide epidemic ( sev]e tonsillitis4 ,9 "o gr\p ( soldi]s !re 7 ?ree o/eopa?s :o treat$ all ! m5 & ?is 0 ! only gr\p t 0 n s5t to qu>ant9e4 ,?is gr\p develop$ sore ?roat & 0 treat$ o/eopa?ically & ! sore ?roats *eck$ s t qu>ant9e 0 unnecess>y4 ,among ! detail$ reports 9 ! ,a4 ,m4 ,a4 ,j\rnal !re w be no?+ ab\t ?is1 nor ab\t _m o!r in/ances :]e o/eopa?ic treatm5t1 giv5 by m5 =c$ to rema9 9 ! ranks1 has done ?+s t m$ic9e _c d4 ,^! examples are too frequ5t to be co9cid5ts4 ,if ,i _h _h ?ree cases ( po/-op]ative pneumonia & !y _h all got well1 x w\ld n be surpris+4 ,if ,i _h t5 cases & !y all got well1 !re are m$ical hospitals t h be5 ?is lucky4 ,b !re are no m$ical hospitals 9 ! _w t c report "o hundr$ cases or two hundr$ cases or ?ree hundr$ ) develop$ pneumonia & all liv$4 ,! p]c5tage ( pneumonia cases t die n[ 9 m$ical hospitals1 is mu* less ?an =m]ly4 ,b ! cause ( ?is is n vacc9e1 antitox9 or drugs4 ,x is due to ! fact t pneumonia cases n[1 l typhoid1 are giv5 v little m$ic9e & are turn$ ov] to g5]al nurs+ treatm5t2 t is1 9 ! be/ m$ical hospitals4 ,! mortality is 9 inv]se ratio to ! drugs giv54 ,! advance m$ical tea*+ is aga9/ s mu* drugs 9 pneumonia1 ?\gh ( c\rse ! hick doctors use x because !y are practic+ m$ic9e ( ! by-gone age1 be=e ,&rew ,taylor ,/ill =c$ on ! _w ! idea p>tly />t$ by homeopa?y1 t ! less drugs ! bett]4 ,homeopa?y fail$ 9 n q disc>d+ drugs & 9 n hav+ a sub/itute t reprov$ drugs4 ,z a matt] ( int]e/ ,i wi% to m5tion t :ile 9 m$ical college ,i _h ! advantage ( be+ taught surg]y by ! greate/ surgeon t ev] liv$1 ,john ,b4 ,murphy4 ,i only wi% t circum/ances c\ld h p]mitt$ me to h %[n him :at o/eopa?y c\ld d 9 po/-op]ative conditions1 because ,murphy 0 a broad m9d$ man & no man liv+ ev] ?\ght less ( or?odox m$ic9e & old fa%ion$ drug treatm5t ?an ,murphy4 ,he & ! ,old ,doctor w\ld h be5 great fri5ds _h !y ev] met4 ,murphy1 :om ,i consid]$ a mo/ wond]ful surgeon1 & ^: skill ,i nev] hope to approa*1 /at$ to me _m times :ile a /ud5t t he lo/ m cases f po/-op]ative pneumonia ?an any o!r condition & t 9 upp] abdom9al conditions l gall bladd]1 /oma*1 & simil> op]ations1 po/-op]ative pneumonia con/itut$ ! mo/ ( 8 mortality4 ,?is great man 0 afraid ( po/-op]ative pneumonia1 :ile ,i1 a mu* less skill$ surgeon1 am no m afraid ( po/-op]ative pneumonia ?an ,i am ( some?+ occurr+ 9 a di/ant /ate because ) o/eopa?ic treatm5t1 we h elim9at$ po/-op]ative pneumonia z a fatal condition4 ,,"p ,,second ,,infecti\s ,,diseases ,fev] ,fev] is due to v>i\s causes1 s t a def9ite /atem5t _c always be giv5 z to ! cause ( fev] 9 e disease4 ,ea* fev] case1 l all o!r disord]s1 is a law unto itself2 diff]5t causes are f\nd 9 diff]5t cases4 ,moreov]1 (t5 only !ories1 & n absolute facts1 c be giv54 ,fev] may be pres5t :5 a local disease assumes a con/itutional "* or :5 ! con/itutional "* is manife/$ f ! beg9n+ ( ! disease4 ,fev] may be a sy/emic disord] or a symptom ( disease1 & is *>act]iz$ by an increase ( body temp]ature4 ,o!r symptoms are usually pres5t1 z an accel]at$ pulse1 di/urbances ( di/ribution ( ! blood1 increas$ catabolism1 & disord]$ secretions4 ,etiology4--,9 infecti\s diseases fev] is due *iefly to ! action ( v>i\s toxic or h>mful ag5ts1 produc$ by ! disease1 ^u ! fluids ( ! body & ^u ! n]v\s sy/em4 ,di/urbances ( ! !rmog5ic c5t]s & n]ves ( ! bra9 or cord by h>mful ag5ts1 or by lesions ( ! anatomical /ructures affect+ ^! n]ves1 are s\rces ( fev]4 ,also di/urbances ( ! vasomotor c5t]s 79 ! m$ulla & auxili>y c5t]s along ! cord7 & n]ves are causes ( fev] 9 _m in/ances4 ,a di/urb$ or less5$ function ( ! n]ves controll+ sweat+ is an important factor4 ,! multiplication ( micro-organisms 9 ! body1 act+ directly on ! tissues or by produc+ toxic sub/ances :i* affect ! n]v\s sy/em1 is a fruitful s\rce ( fev]4 ,a few cases may be caus$ by direct affection ( ! n]v\s sy/em1 z is %[n by appe>ance ( fev] 9 epileptic attacks1 or by ! passage ( a ca!t] into ! bladd]4 ,9 a l>ge numb] ( all cases a demon/rable cause c be f\nd ^u c>eful exam9ation1 :e!r ! fev] be due to a necros$ mass ( tissue1 ! introduction into ! sy/em ( decompos$ food1 infecti\s diseases1 a lesion ( "s anatomical /ructure affect+ a !rmog5ic1 vasomotor or sweat c5t]1 a lesion to ! inn]vation to ! he>t 7vagi & c]vical sympa!tic7 caus+ a rapid he>t1 or a lesion to ! lymphatic sy/em4 ,treatm5t4--,! treatm5t ( fev]s 9 a g5]al way consi/s pr9cipally ( ?or\gh inhibition to ! po/]ior sp9al n]ves ( ! upp] c]vical region 9 ord] t ! c5t] ( ! vasomotor sy/em 9 ! m$ulla may be affect$1 probably by ! way ( ! sup]ior c]vical ganglion ( ! sympa!tic4 ,?us ! entire vascul> sy/em is equaliz$1 = !re is always a di/urbance 9 ! di/ribution ( ! blood 9 fev] & if ! c5t] controll+ ! n]ves t gov]n ! lum5 ( ! blood-vessels c be br\ght "u control1 !re w result an equalization ( ! vascul> sy/em2 if su* occurs1 heal? mu/ ensue4 ,besides ! vasomotor n]ves to ! blood-vessels be+ affect$ by ?is treatm5t1 ! n]ves gov]n+ ! lymphatics & ! sweat gl&s w also be controll$4 ,! sweat gl&s z a rule are r5d]$ active by affect+ directly ! inn]vation ( ! gl&s1 also ! gl&s are controll$ indirectly by ! blood supply2 ?is aids mat]ially 9 less5+ ! temp]ature ( ! body4 ,treatm5t = a few m9utes to ! upp] po/]ior c]vical region w\ld also affect ! !rmog5ic c5t]s & n]ves ( ! bra9 reflexly 9 ! same mann] z ! vasomotor & sweat c5t]s & n]ves are affect$1 ?us t5d+ to equalize ! me*anism ( ! !rmog5ic sy/em4 ,besides ?is action on ! vasomotor1 sweat1 & ! !rmog5ic n]ves1 !re is produc$ an increas$ exhalation ( moi/ure f ! lungs1 on acc\nt ( an increase ( vascul> area 9 ! lungs ?r\gh vasomotor action4 ,also ! l>ge vascul> area 9 ! abdom51 "u control ( ! splan*nic n]ves1 becomes con/rict$4 ,?us !re is br\ght ab\t a less5+ temp]ature by evaporation1 heat radiation1 & p]spiration2 & an increas$ action ( ! g5]al n]v\s sy/em1 a /rong] c>diac =ce1 an equalization ( ! vascul> sy/em1 & a m p]fect elim9ation ( toxic prop]ties by ! sk91 kidneys & lungs2 consequ5tly a r$uction ( ! fev]4 ,! =ego+ treatm5t is successful to a limit$ ext5t1 only 9 su* cases :]e causative factors ( ! fev] are involv+ ! pr$om9at+ c5t]s controll+ ! heat production or disp]sion & ! vasomotor sy/em directly2 = if ! lesion t is caus+ ! disord] %\ld be affect+ an auxili>y c5t] along ! sp9al cord in/ead ( ! pr$om9at+ c5t]1 z is (t5times ! case1 treatm5t ( ! pr$om9at+ c5t] w\ld be useless z f> z any p]man5t b5efit is consid]$2 al?\gh a tempor>y effect w be ga9$ by less5+ ! fev] at t po9t4 ,consequ5tly1 9 _m cases1 ! lesion lies )9 ! jurisdiction ( auxili>y c5t]s :i* are situat$ at v>i\s po9ts along ! sp9al cord4 ,:5 su* is ! case1 x w be ( little b5efit to give ! c]vical treatm5t4 ,9 su* in/ances ! lesion to ! auxili>y c5t] w\ld h to be remov$ 9 ord] to cure4 ,"o _c dep5d ^u a set rule to r$uce a fev]2 det]m9e ! cause1 z 9 any o!r disease or symptom1 & remove x4 ,9 addition to ! treatm5t to ! c]vical region & along ! sp9al column1 z are indicat$ ^u an exam9ation1 att5tion %\ld be giv5 to ! he>t's action4 ,! equilibrium betwe5 ! accel]ator & inhibitory n]ves 7c]vical sympa!tic & vagi7 %\ld be ma9ta9$4 ,! int]*ange ( gases 9 ! lungs %\ld be r5d]$ z ne>ly normal z possible2 ?is is be/ accompli%$ by rais+ & spread+ ( ! ribs f ! second to ! sev5? dorsals1 p>ticul>ly 9 ! region ( ! fif? & six?4 ,also /imulation ( ! vagi w aid by increas+ ! motor p[] ( ! lungs4 ,! kidneys & b[els %\ld be kept active s z to favor a rapid elim9ation ( v>i\s toxic prop]ties2 besides !y h control ov] l>ge vascul> areas4 ,treatm5t ov] ! uret]s w prev5t any clogg+ t might occur 9 !m f a cond5sation ( ! ur9e4 ,att5tion1 also1 %\ld be giv5 ! tissues at ! fif? lumb> & ov] ! iliac vessels to influ5ce ! circulation 9 ! pelvis4 ,! food ( ! pati5t %\ld be liquid--milk1 s\p1 bro?s1 etc41 & almo/ any quantity ( wat] all[$ if call$ =1 giv5 little at a "t & at frequ5t int]vals4 ,! room %\ld be well light$1 v5tilat$1 clean & kept at an ev5 temp]ature4 ,two po9ts %\ld always be rememb]$ relative to fev]3 ,fir/--,t !re are _m causes ( fev]2 & 9 ord] to r$uce ! fev] ! cause mu/ be det]m9$ & remov$1 ! same z 9 any disord]4 ,a def9ite fev] treatm5t _c be giv5 any m ?an a def9ite con/ipation treatm5t2 ! case mu/ be se5 9 ord] to det]m9e ! cause4 ,second--,! r$uction ( fev] is n necess>y2 ! fev] %\ld be treat$ only z a symptom ( disease :5 x exi/s z su*4 ,9 fact1 fev] is b5eficial1 = x is "o ( nature's me?ods to relieve an ov]-burd5$ sy/em f h>mful ag5ts1 unless ! temp]ature is excessive & cont9u\s & is likely to cause m h>m ?an ! prim>y tr\ble4 ,absolute re/ 9 b$ always is ( decid$ b5efit 9 less5+ ! temp]ature4 ,hydro!rapy is ( imm5se value 9 r$uc+ a fev]4 ,x is an ag5t t has be5 greatly us$1 & if appli$ intellig5tly _c b be ( aid4 ,!re is mu* ignorance 9 reg>d to ! pr9ciples & practice ( hydro!rapy1 n only among all classes ( p1 b among well in=m$ practition]s 9 m$ic9e4 ,! mo/ important function ( ! sk9 is z a heat regulator4 ,kn[+ ?is fact1 ! o/eopa? treats ! vasomotor n]ves t control ! cutane\s circulation & ! n]ves t control ! excretion ( ! sk92 ! n]ve supply be+ f ! c]ebrosp9al & sympa!tic n]ves4 ,9 _m difficult & ob/9ate cases hydro!rapeutic measures %\ld be us$ to aid ! sk9 9 regulat+ ! temp]ature1 z well z to enhance sy/em functions = ! same reason t o/eopa?ic manipulations are giv54 ,ma9ta9+ an equilibrium 9 heat production & heat disp]sion is necess>y 9 ord] t ! /&>d ( ! body temp]ature may be kept2 & ! am\nt ( ! art]ial blood circulat+ )9 a tissue det]m9es its temp]ature4 ,! pr9cipal effect ( wat] z a !rmic ag5t :5 appli$ ext]nally is due to ! influ5ce ( ! action ( ! wat] ^u ! cutane\s circulation4 ,less] effects w\ld be ! m]e extraction ( heat f ! body by evaporation & ! equalization ( temp]atures ( two bodies com+ into contact4 ,z ! body is end[$ ) comp5satory p[]s1 ?is latt] means w\ld apply only to a limit$ ext5t4 ,! temp]ature ( ! wat] us$ is important1 z ! cold] ! ba? ! less effective w\ld its p[] be 9 r$uc+ int]nal temp]ature4 ,:5 a cold ba? is us$ !re is a driv+ ( ! blood away f ! surface on acc\nt ( ! contraction ( ! p]iph]al vessels2 consequ5tly increas+ ! cutane\s circulation & cool+ by radiation is prev5t$ & less heat is lo/4 ,a collat]al hyp]emia occurs 9 ! und]ly+ p>ts :i* acts z a protection to ! deep] tissues4 ,! cold also inhibits ! vasomotor n]ves controll+ ! abdom9al splan*nics1 & ?us a l>g] am\nt ( blood passes to ?is imm5se vascul> area4 ,on ! o!r h&1 :5 a w>m] ba? is us$ ! effect is opposite1 & a l[]+ ( ! temp]ature is ! result4 ,! cutane\s vessels be+ dilat$1 ! sup]ficial blood is rapidly replac$ by blood f ! deep] vessels1 ?us all[+ a cool+ ( ! body to a l>ge degree4 ,9 ! v>i\s fev]s :]e hydro!rapeutic measures are employ$1 ! object to be ga9$ by su* me?ods is n prim>ily an anti-!rmic "o b an anti-febrile reaction2 consequ5tly ! use ( cold wat] is employ$4 ,9 m]e heat r$uction ! w>m] wat] w\ld be m effective2 b by ! aid ( ! cold] wat] ! cause ( ! increas$ temp]ature1 z 9 infecti\s fev]s1 is less5$2 besides a refre%+ & /imulat+ effect ^u ! entire sy/em is ga9$4 ,?us ! aim ( ! cold ba? & friction1 is n prim>ily to subdue ! temp]ature by heat radiation or evaporation1 b to correct di/urbances gov]n+ ! =mation & ! dissipation ( heat caus$ by infecti\s fev]s1 &1 moreov]1 to /imulate ! n]v\s sy/em1 prev5t he>t failure1 increase ! elim9at+ p[] ( ! sk91 kidneys & lungs1 & to influ5ce ! corpuscul> & *emical con/itu5ts ( ! blood to a m normal condition4 ,! full cold ba? & friction 7,br& ,me?od7 is commonly employ$ 9 infecti\s fev]s4 ,! half ba?1 wet pack1 or spong+ may be us$4 ,! modus op]&i ( ea* is giv5 "u ! hydro!rapeutic treatm5t ( typhoid fev]4 ,typhoid ,fev] 7,,ent]ic ,,fev]7 ,9 writ+ ( ^! acute diseases :i* are self-limit+1 x is und]/ood t o/eopa?y aborts1 ov]comes symptoms & o!rwise *anges conditions frequ5tly4 ,:5 ?is occurs ! case is n typical & x is a typical case :i* is "h describ$4 ,def9ition4--,an acute1 infecti\s disease caus$ by ! bacillus typhosus4 ,x is *>act]iz$ anatomically by hyp]plasia & def9ite lesions ( ,pey]'s pat*es & mes5t]ic gl&s1 & enl>gem5t ( ! sple51 & cl9ically by its sl[ onset1 (t5 di>rhea1 abdom9al t5d]ness1 tympanites1 fev]1 heada*e1 & rose color$ spots on ! abdom54 ,o/eopa?ic ,etiology & ,pa?ology4--,lesions to ! l[] dorsal & lumb> regions are always f\nd1 :i* impair ! inn]vation & vascul> supply ( ! inte/9es & cause defective nutrition4 ,?is is ! mo/ important pr$ispos+ cause1 al?\gh g5]al l[]$ vitality f ov]work1 improp] food1 unhygi5ic environm5t1 & insanit>y surr\nd+s1 are also ( great importance4 ,x is possible t "o's vitality may be s l[]$ t ! bacillus ( ,eb]?1 if ( suffici5t numb]s or virul5cy1 w f9d a suitable m$ium :]e9 to multiply & gr[1 & ?us ! sp9al lesions f\nd 9 ^! cases are ! result ( reflex irritation4 ,b ! mo/ probable und]ly+ cause is ! sp9al lesion1 & giv5 two individuals ) equal likelihood to infection1 "o ) ! sp9al lesions & ! o!r n1 ! =m] )9 all probability w be ! m likely to suff] an attack4 ,! sev]ity & ext5t ( ! o/eopa?ic lesion und\bt$ly be>s a direct ratio to ! probability ( attack f an infecti\s disease4 ,typhoid fev] usually occurs betwe5 ! ages ( fifte5 & ?irty ye>s4 ,"s families are m susceptible ?an o!rs4 ,! autumn mon?s1 especially aft] a dry1 hot summ]1 favor ! disease4 ,"o may be reasonably c]ta9 t :5ev] !re is a case ( typhoid ! individual has n be5 c>eful z to diet1 or dr9k+ wat]1 or "s rule ( heal?1 & :]ev] !re is an epidemic x c always be trac$ to insanit>y surr\nd+s1 ! wat] supply1 contam9at$ g>d5 truck or o!r food1 sewage1 etc42 al?\gh ?is does n preclude ! probability t ! o/eopa?ic lesion or l[]$ vitality ( ,pey]'s pat*es & mes5t]ic gl&s f o!r causes are important & _m times primal etiological factors4 ,! specific poison may be s virul5t t practically no "o escapes & aga9 ^? ( l[]$ vitality only w succumb to an attack4 ,! excit+ cause is a special micro-organism1 ! bacillus ( ,eb]?4 ,! contagion may be c>ri$ ?r\gh ! air f "o p]son to ano!r1 b ?is is r>ely ! case4 ,?\gh ! wat] is ! mo/ common mode ( conveyance1 ! bacillus has be5 f\nd dur+ epidemics 9 bo? wat] & milk4 ,! wat] may be contam9at$ by ! inte/9al dis*>ges :i* h n be5 prop]ly dis9fect$4 ,extreme cold does n de/roy ! typhoid g]ms4 ,milk may be infect$ f ! milk-c be+ wa%$ ) ! contam9at$ wat] or ! unclean h&s ( ! milk]4 ,9 fre% milk ! g]ms multiply rapidly4 ,salads1 cel]y1 ice & fruits may be contam9at$4 ,oy/]s h become infect$ :ile be+ fatt5$ or fre%5$4 ,x is ?\ght by "s t ! poison is n elim9at$ f ! sick 9 a condition capable ( transf]r+ disease to a heal?y p]son1 b mu/ und]go *anges 9 ! soil be=e x is able to cause ! disease 9 ano!r4 ,typhoid fev] may be caus$1 h[ev]1 by direct contact ) ! /ools4 ,fil?1 sew]s1 or cesspools d n directly cause ! disease1 b !y =m a suitable m$ium = ! pres]vation ( ! typhoid g]ms4 ,pa?ologically1 ! *>act]i/ic lesions 9 typhoid fev] consi/ ( *anges 9 ! lymphoid elem5ts ( ! b[els4 ,^! *anges are mo/ /rik+ 9 ! solit>y gl&s & ,pey]'s pat*es4 ,! alt]ations :i* occur may be divid$ into f\r well def9$ /ages3 7#a7 ,infiltration--! gl&s are enl>g$ f infiltration & !re is m>k$ cell prolif]ation1 p>ticul>ly ,pey]'s gl&s 9 ! jejunum & ileum & to a less] ext5t ^? 9 ! l>ge inte/9e4 ,! gl&s become pale & prom95t4 ,occasionally ! solit>y gl&s1 :i* are usually deeply imb$d$ 9 ! submucosa1 become prom95t also4 ,microscopically1 ! capill>y blood-vessels are at fir/ consid]ably dilat$1 b lat] become m or less contract$1 giv+ an anemic appe>ance to ! follicles4 ,! adjac5t mucosa & muscul>is may become infiltrat$4 ,! cells h ! "* ( lymph corpuscles1 "s ( :i* are l>g]1 epi!lioid 9 "*1 conta9+ sev]al nuclei4 ,f ! eigh? to ! t5? day ?is m$ull>y infiltration rea*es its height & !n und]goes ei!r resolution or necrosis4 7#a7 ,resolution takes place by a granul> or fatty infiltration ( ! cells4 ,?is produces pitt+ ( ! swoll5 follicles1 :i* may cause small hemorrhages4 7#b7 ,necrosis4--,) all ! sev]e cases ( cell infiltration1 hyp]plasia ( lymph follicles rea*es a /age :]e resolution is impossible & necrosis occurs4 ,! necrosis is p>tly due to ! *ok+ ( ! blood-vessels & p>tly to ! direct action ( ! bacilli4 ,! necrosis may involve only ! sup]ficial lay]s ( ! mucosa or x may ext5d deep into ! muscul> coat & ev5 p]=ate ! out] or s]\s coat4 ,usually1 h[ev]1 ?is does n ext5d bel[ ! submucosa1 mucosa1 or muscul>is4 ,n all ( ! pat*es necess>ily sl\gh1 b z a rule x is always m int5se t[>d ! ilio-cecal valve4 7#c7 ,ulc]ation4--,! ext5t & dep? ( ! ulc]s dep5d ^u ! am\nt ( ! necrosis4 ,l>ge ulc]s are sometimes =m$1 especially 9 ! l[] end ( ! b[el1 by ! union ( sev]al4 ,! edges are swoll5 & und]m9$4 ,! base is usually smoo? & =m$ ( submucosa4 ,p]=ation ( ! b[el occurs 9 a small p]c5tage ( cases2 m commonly ! ulc]s heal4 ,! p]=ations may be multiple1 b r>ely exce$ two 9 numb]4 7#d7 ,heal+4--,cicatrization beg9s ab\t ! f\r? week4 ,?is granulation tissue cov]s ! floor4 ,x is sometimes =m$ ) connective tissue & a new gr[? ( epi!lium results4 ,! gl& is ultimately replac$ by a depress$ sc> ) a smoo?1 pigm5t$ surface4 ,! majority ( dea?s occur be=e ?is /age is rea*$4 ,! gl& /ructure is nev] reg5]at$4 ,! mes5t]ic gl&s %[ int5se hyp]emia & lat] become enl>g$ & s(t5$1 b r>ely ruptur$4 ,! gl&s at ! l[] end ( ! ileum are m>k$ly involv$4 ,! sple5 is enl>g$1 s(t5$1 & difflu5t4 ,occasionally rupture occurs4 ,inf>ction is n a r>e occurr5ce4 ,! liv] %[s p>5*ymat\s & granul> deg5]ation1 & ! cells are f\nd to conta9 mu* fat4 ,inf>ction abscesses & acute yell[ atrophy occur 9 r>e in/ances4 ,diph!ritic inflammation ( ! gall-bladd] sometimes occurs & ! bile is ?9n] & pal] ?an normal4 ,! kidneys also %[ p>5*ymat\s deg5]ation4 ,!y are pale 9 appe>ance1 ) slight cl\dy swell+4 ,microscopically1 !re are se5 granul> & fatty infiltration ( ! cells ( ! convolut$ tubules4 ,r>ely1 !re is acute nephritis :i* may be hemorrhagic4 ,!re may be mili>y abscesses 9 :i* typhoid bacilli h be5 f\nd by "s obs]v]s4 ,diph!ritic1 b m frequ5tly cat>rhal1 inflammation ( ! pelvis ( ! kidney may occur4 ,cat>rh ( ! bladd] is n infrequ5t & ev5 sometimes diph!ritic inflammation is pres5t4 ,r>ely or*itis is enc\nt]$4 ,hypo/atic conge/ion ( ! lungs is n uncommon4 ,gangr5e & hemorrhagic inf>ction are sometimes pres5t4 ,lob> pneumonia may be a complication4 ,9 ! l>ynx ulc]ation is sometimes met ) bacilli1 h[ev]1 h n yet be5 f\nd 9 ^! ulc]s4 ,diph!ritis ( ! ph>ynx & l>ynx may occur4 ,cat>rhal or cr\p\s ph>yngitis may occur2 :ile swell+ ( ! follicles ( ! ph>ynx & base ( ! tongue is frequ5tly notic$4 ,p]itonitis is always pres5t 9 fatal cases 9 :i* p]=ation ( ! b[el has tak5 place4 ,! p]=ation may occur 9 ulc]s f :i* ! sl\ghs h already sep>at$1 or x may be caus$ by a necrosis ( all ! coats4 ,ext5sive p]itonitis may occur )\t p]=ation1 & is probably due to ext5sion ( ! inflammation to ! p]itoneum4 ,! he>t may be affect$4 ,endoc>ditis is r>e1 :ile p]ic>ditis is mu* m frequ5t4 ,myoc>ditis is frequ5tly met )1 ! c>diac muscles pres5t+ p>5*ymat\s & r>ely hyal9e deg5]ation4 ,! art]ies are frequ5tly f\nd to be involv$4 ,^! conditions 7oblit]at+ art]itis & p>tial art]itis7 may affect ! small] vessels1 especially ^? ( ! he>t1 b m commonly affect ! art]ies ( ! l[] extremities4 ,?rombosis ( ! ve9s1 especially ( ! femoral1 & m r>ely ( ! c]ebral ve9s & s9uses1 occurs4 ,granul> & hyal9e *anges 9 ! volunt>y muscles may occur4 ,?is deg5]ation does n affect ! :ole muscle b involves only c]ta9 fibres4 ,reg5]ation takes place dur+ convalesc5ce4 ,) ! n]v\s sy/em m5+itis is r>e4 ,! p]iph]al n]ves are frequ5tly ! seat ( p>5*ymat\s *anges4 ,! ganglia ( ! trunks ( ! vagi pres5t an inflammatory *ange4 ,! blood pres5ts little *ange4 ,dur+ ! fir/ two weeks ! r$ corpuscles gradually decrease 9 numb] until ! fir/ week ( convalesc5ce1 aft] :i* !y gradually increase 9 numb]4 ,!re is (t5 a m>k$ decrease 9 ! numb] ( leucocytes4 ,leucocytosis is abs5t4 ,! hemoglob9 is always r$uc$4 ,symptoms & ,c\rse4--,! incubation p]iod v>ies f a few days to two weeks or long]4 ,dur+ ?is "t ! pati5t may feel 9 8 usual heal?1 b m (t5 !re is a feel+ ( languor & indisposition to ex]tion1 loss ( appetite1 slight coat+ ( ! tongue1 nausea1 heada*e1 *ill9ess1 b seldom a decid$ rigor1 pa9s 9 ! back or legs & nose-ble$+4 ,any ( ^! symptoms may be pres5t & la/ usually f a few days to a week or m4 ,^! symptoms increase 9 sev]ity & ! pati5t takes to 8 b$4 ,! invasion z a rule is gradual4 ,! fir/ week dates f ! onset ( ! fev] :i* g5]ally 7b by no means 9 all cases7 rises /eadily dur+ ! fir/ week a degree or a degree & "o-half ea* day1 rea*+ #ajc or #ajd degrees ,f4 ,! pulse is quick5$ to #ij to #aaj p] m9ute & is full1 ( l[ t5sion & sometimes dicrotic4 ,!re is great ?ir/1 also a coat$ tongue4 ,! sk9 is hot & dry & !re is r int5se heada*e4 ,unless ! fev] is high !re is no delirium4 ,! sleep is di/urb$ & !re may be m5tal confusion & w&]+4 ,c\gh ) "s ?oracic oppression is n uncommon at ! onset4 ,! abdom5 is slightly di/5d$ & t5d]4 ,!re may be ei!r con/ipation or di>rhea4 ,! sple5 is some:at swoll5 & a rose color$ ra% appe>s on ! sk9 ( ! abdom5 & *e/4 ,dur+ ! second week ! fev] rema9s high & exhibits ! cont9u$ type1 ! morn+ remission be+ slight4 ,! pulse is accel]at$4 ,! heada*e disappe>s1 b !re is m>k$ m5tal dullness & sl[ness & !re may be a mild delirium at night4 ,! tongue is coat$ & ! lips are dry4 ,! abdom5 is tympanitic & t5d]4 ,di>rhea replaces con/ipation4 ,! case may prove fatal dur+ ?is week f ! result ( n]v\s or pulmon>y symptoms1 hemorrhage1 or p]=ation4 ,! fev] *anges 9 ! ?ird week f a cont9u\s to a remitt5t type4 ,! pulse ranges f #aaj to #acj4 ,! pati5t is v weak4 ,complications may arise1 z pulmon>y symptoms1 feebl5ess ( he>t1 inte/9al hemorrhage1 p]=ation1 & p]itonitis4 ,9 favorable cases dur+ ! f\r? week ! fev] beg9s to decl9e & ! g5]al & local symptoms gradually disappe>4 ,9 protract$ cases ! f\r? & fif? weeks may pres5t ! symptoms ( ! ?ird week4 ,frequ5tly ! foll[+ aggravat$ symptoms are add$3 /upor1 delirium1 increas$ weakness1 rapid1 feeble pulse1 & di/5d$ abdom54 ,he>t failure & inflammatory complications increase ! dang]4 ,dur+ ! fif? & six? weeks a few cases w %[ irregul> fev]4 ,great c>e %\ld be tak5 t complications d n occur4 ,! fev] is ! mo/ important & *>act]i/ic symptom & f ! temp]ature alone a diagnosis may be made4 ,dur+ ^! /ages ( developm5t1 :i* is ! fir/ f\r or five days1 ! temp]ature rises /eadily2 ! ev5+ temp]ature be+ ab\t a degree or a degree & "o-half high] ?an ! morn+ remissions1 rea*+ #ajd or #aje degrees ,f4 at ! end ( ! fir/ week4 ,:5 ! fa/igium is rea*$ ! fev] p]si/s ) slight morn+ remissions4 ,at ! end ( ! second & ?r\gh\t ! ?ird week ! temp]ature becomes m remitt5t & !re may be a diff]5ce ( ?ree or f\r degrees betwe5 ! morn+ & ev5+ temp]ature4 ,dur+ ! la/ /age ! fev] falls by lysis1 =m+ a m or less regul> /ep-l l9e ( desc5t4 ,! /age la/s f "o week to t5 days4 ,:5 ! disease sets 9 ) a sev]e rigor ! fev] frequ5tly rises at once to #ajc or #ajd degrees ,f4 ,9 ! lighte/ =ms ! fa/igium may be almo/ abs5t2 def]vesc5ce sett+ 9 ^u ! fir/ day ( ! fa/igium & 9 _m cases def]vesc5ce occurs at ! end ( ! second week & ! temp]ature may fall rapidly1 becom+ normal 9 t5 or tw5ty h\rs4 ,?is fall 9 ! temp]ature may take place )\t any app>5t cause or x may foll[ an inte/9al hemorrhage4 ,! temp]ature (t5 falls _m h\rs be=e ! blood appe>s 9 ! evacuations4 ,! occurr5ce ( p]itonitis is also m>k$ by a sudd5 fall 9 ! temp]ature4 ,hyp]pyrexia 9 typhoid fev] is n v common except j be=e dea?4 ,aft] ! temp]ature has be5 normal = sev]al days !re may be a sudd5 rise ( ! temp]ature to #ajb or #ajc degrees ,f4 ,?is may p]si/ = a c\ple ( days & !n return rapidly to ! normal4 ,^! recrudesc5ces1 z !y are call$1 are q common & are caus$ mo/ frequ5tly by errors 9 ! diet1 con/ipation1 excitem5t or m5tal emotion4 ,^! elevations 9 ! temp]ature are f\nd mo/ frequ5tly 9 *ildr5 & p]sons ( a n]v\s temp]am5t4 ,afebrile ,typhoid is ( v r>e occurr5ce4 ,! pati5t has all ! *>act]i/ic symptoms ( typhoid fev] ) ! exception ( a fev]4 ,! ra% is highly *>act]i/ic4 ,x appe>s ab\t ! eigh? or t5? day1 usually ^u ! sk9 ( ! abdom5 or *e/1 r>ely f\nd else:]e on ! body4 ,x consi/s ( a v>iable numb] ( rose color$ spots di/9ctly elevat$1 & disappe> on pressure4 ,^! spots la/ ?ree or f\r days & appe> 9 successive crops4 ,vivid r$ ery!mat\s eruptions ^u ! *e/ & abdom5 are commonly se5 dur+ ! fir/ week ( typhoid fev]4 ,urtic>ia is r>ely se54 ,sweat+ *>act]izes "s cases ( typhoid fev]1 b g5]ally ! sk9 is dry4 ,?is may occur ) or )\t *illy s5sations or actual rigors4 ,9 "s cases !re may be recurr+ p>oxysms ( *ills1 fev]1 & sweats & !y may be mi/ak5 = int]mitt5t fev]4 ,edema ( ! sk9 may occur & is usually due to anemia or ca*exia & sometimes to nephritis4 ,local edema may occur z ! result ( vascul> ob/ruction1 p>ticul>ly ?rombosis ( ! femoral ve94 ,!re is a peculi> mu/y odor exhal$ f ! sk9 9 typhoid fev]1 p>ticul>ly if ! sk9 has be5 neglect$4 ,9 all protract$ cases b$-sores are likely to develop4 ,! hair is apt to fall out b is g5]ally r5ew$4 ,! nails also suff] & ridges c usually be obs]v$ ^u !m4 ,inte/9al symptoms are v incon/ant4 ,usually !re is con/ipation at ! onset & ?is may p]si/ ?r\gh\t ! disease al?\gh a mod]ate di>rhea may occur ?r\gh\t ! disease4 ,! sev]ity ( ! di>rhea is due mo/ probably to ! degree ( ! cat>rh r ?an to ! ext5t ( ! ulc]s4 ,x is probable t ! dis*>ges are m frequ5t :5 ! cat>rh involves ! l>ge inte/9e4 ,! numb] ( dis*>ges av]age1 z a rule1 f two to f\r or m daily4 ,! /ools are ei!r fluid or ( ! consi/5cy ( jelly1 ( a grayi%-yell[ color1 alkal9e 9 reaction & are v (f5sive4 ,hemorrhage is a s]i\s symptom1 b by no means always fatal4 ,?is usually occurs 9 cases ( consid]able sev]ity & x g5]ally occurs at ! "t ( ! sep>ation ( ! sl\ghs dur+ ! ?ird week4 ,:5 x occurs q e>ly 9 ! disease x is g5]ally ! result ( hyp]emia4 ,x may be s slight z n to be notic$ by ! eye or x may be f "o to ?ree p9ts4 ,inte/9al hemorrhage1 h[ev] slight1 is always a grave symptom4 ,!re may be symptoms ( collapse & fall ( temp]ature1 or x may occur )\t any symptoms4 ,meteorism is an almo/ con/ant symptom1 & :5 excessive adds to ! s]i\sness ( ! case & corresponds g5]ally ) ! ext5t ( local lesions4 ,abdom9al t5d]ness & gurgl+ ^u pressure 9 ! "r iliac fossa may be pres5t2 pa9 is g5]ally abs5t1 & :5 pres5t is usually slight4 ,p]=ation almo/ inv>iably causes fatal diffuse p]itonitis & is ! mo/ s]i\s complication4 ,x may occur at any "t b is mo/ common betwe5 ! second & f\r? weeks4 ,x is usually indicat$ by sudd5 acute pa9s 9 ! abdom5 & symptoms ( collapse4 ,z a rule symptoms ( p]itonitis appe> at once2 di/5sion ( ! abdom51 great t5d]ness1 & rigid abdom9al walls4 ,vomit+1 p9*$ features1 & rapid1 small pulse %[s g5]al collapse ( ! circulatory sy/em4 ,bron*itis is almo/ inv>iably pres5t z an initial symptom4 ,x is indicat$ by ! exi/5ce ( sibilant rales4 ,! c\gh is g5]ally slight4 ,hypo/atic conge/ion ( ! lungs & edema1 due to enfeeblem5t ( ! c>dio-pulmon>y circulation1 9 ! latt] "p ( ! disease are n infrequ5t4 ,! pulse z a rule is n v frequ5t & is g5]ally n 9 proportion to ! fev] until late 9 ! disease2 #ij to #abj is ! usual range4 ,dur+ ! fir/ week x is ab\t #ajj1 full1 & frequ5tly dicrotic2 lat] x becomes m rapid1 feeble & small4 ,9 sev]e cases dur+ ! extreme debility ( ! ?ird week ! pulse may rea* #aej or m 7! s-call$ runn+ pulse74 ,dur+ convalesc5ce ! pulse occasionally becomes subnormal & bradyc>dia is met ) m frequ5tly ?an aft] any o!r acute fev]4 ,! blood pres5ts def9ite *anges1 "s ( :i* are important4 ,9 cases :]e !re is pr(use sweat+ or copi\s di>rhea1 ! r$ corpuscles may be relatively increas$2 ?is is due to ! loss ( wat]4 ,9 mo/ cases !re is little *ange until ! end ( ! second week4 ,dur+ ! ?ird week !re is g5]ally a decrease 9 ! numb] ( corpuscles & ( ! hemoglob91 :i* is always r$uc$4 ,leucocytosis is always abs5t4 ,! :ite corpuscles are slightly dim9i%$ especially t[>d ! end ( convalesc5ce4 ,dur+ ! fir/ week !re is g5]ally p]si/5t heada*e1 sometimes neuralgia4 ,!re are a few cases 9 :i* ! effects ( ! typhoid bacilli or _! poison is manife/$ 9 ! n]v\s sy/em f ! v onset4 ,!re are viol5t heada*es1 retraction ( ! head1 rigidity1 photophobia1 twit*+ ( ! muscles1 r>ely convulsions1 all indicat+ m5+itis z :i* x is occasionally diagnos$4 ,x mu/ be rememb]$ h[ev]1 t all n]v\s symptoms may occur indep5d5tly ( a lesion ( ! n]v\s sy/em4 ,delirium may exi/ f ! onset1 b x usually is n pres5t until ! second or ?ird week & only 9 ! sev]] cases4 ,z a rule x is mo/ m>k$ at night4 ,x is g5]ally ( ! l[1 mutt]+ type1 v seldom maniacal4 ,:5 ! pati5t picks at ! b$ clo!s or grasps at imag9>y objects !re is indication ( dang]1 z x is a s]i\s symptom4 ,convulsions are r>e4 ,! ur9e is dim9i%$ 9 quantity1 high specific gravity1 & ( d>k hue4 ,bo? urea & uric acid are increas$ & ! *lorids are dim9i%$ dur+ ! fir/ /ages4 ,ab\t ! /age ( decl9e ! ur9e becomes light 9 color & great] 9 quantity ?an normal4 ,! specific gravity is l[]$1 urea & uric acid are dim9i%$1 & ! *lorids are increas$4 ,febrile album9uria is v common b ( no special significance4 ,acute nephritis may develop z a complication4 ,pyuria is n an uncommon complication & po/-typhoid pyelitis may also develop4 ,mal>ial fev] may be associat$ ) typhoid1 especially 9 mal>ial di/ricts4 ,p]sons ) tub]culosis1 epilepsy1 *orea1 & o!r =ms ( *ronic n]v\s diseases are liable to typhoid fev]4 ,9 epilepsy & *orea ! movem5ts & fits usually cease dur+ ! attack ( typhoid fev]4 ,v>ieties ( ,typhoid are num]\s & are nam$ ) ref]5ce to ! degree ( sev]ity :i* v>ies f extreme mildness to extreme sev]ity4 ,! mild or abortive =m is ( frequ5t occurr5ce4 ,! onset is usually sudd54 ,! symptoms are simil> to ^? ( a typical case b mu* mild] & appe> e>li] ?an 9 ! usual type4 ,?is =m runs its c\rse 9 ab\t two weeks4 ,! fev] usually rea*es #ajd degrees ,f4 ,9 ! sev]e or grave =m !re is high fev] & ! n]v\s symptoms %[ a pr(\nd intoxication ( ! sy/em4 ,! grave types are ^? associat$ ) s]i\s complications or ^? cases :i* set 9 ) pneumonia1 ,bright's disease1 or c]ebrosp9al symptoms4 ,9 ! lat5t or ambulatory =m 7walk+ typhoid7 ! symptoms are v slight1 ! pati5t be+ h>dly sick en\gh to g to b$4 ,! symptoms may be ( ?is "* ?r\gh\t ! attack1 & ! pati5t may be able to be up & ab\t4 ,9 o!r cases ! fir/ symptoms are v mild1 b lat] !y may develop symptoms ( ! sev]e/ type4 ,! ,afebrile =m is r>e4 ,hemorrhagic typhoid is a v fatal b r>e =m4 ,9 ?is type !re are cutane\s & muc\s hemorrhages4 ,diagnosis4--,z a g5]al rule typhoid fev] is easily recogniz$4 ,! ,widal te/ %\ld be made4 ,at times ! diagnosis may h to be delay$ until ! di/9ctive signs appe>1 especially 9 ^? cases :i* come on ) sev]e heada*e1 delirium1 twit*+ ( ! muscles1 & retraction ( ! head4 ,9 ^! cases ! diagnosis ( c]ebrosp9al m5+itis is inv>iably made1 until ! appe>ance ( ! color$ spots on ! abdom51 :i* mu/ decide ! diagnosis2 c]ebrosp9al m5+itis be+ a r>e disease & typhoid fev] ) sev]e n]v\s symptoms q frequ5t1 x is m probable t x is typhoid4 ,at lea/ "o-half ( ! cases t]m$ bra9 fev] belong to ?is class ( n]v\s typhoid4 ,prognosis4--,a positive prognosis c n be made1 z ev5 ! milde/ cases are liable to h sev]e complications develop at any /age ( ! disease4 ,"u o/eopa?ic treatm5t ! prognosis is und\bt$ly m favorable ?an ) ! treatm5t ( ! old] s*ools4 ,if ! o/eopa? c see ! case e>ly1 ! fir/ week1 !re is always a *ance to abort ! attack4 ,9 all cases !re is ! probability t ! attack w be %ort5$2 ?is is a common exp]i5ce4 ,price ( ,mississippi1 has treat$ _m cases1 & inv>iably :5 ! pati5t is se5 e>ly ! attack has be5 %ort5$ to ?irte5 or f\rte5 days1 :]eas "u o!r treatm5t ! disease runs ! usual c\rse4 ,adsit ( ,k5tucky1 ,:ite ( ,new ,york1 & ! /aff ( ! ,am]ican ,s*ool ( ,o/eopa?y 7,kirksville71 z well z _m o!rs1 h _h ! same exp]i5ce4 ,& if ! attack _c be abort$ or %ort5$ !re is ! fur!r probability t ! sev]ity w be less5$ & complications prev5t$4 ,! prognosis is always m favorable 9 w9t] ?an 9 summ]1 & especially favorable 9 *ildr54 ,m wom5 die ?an m51 & fat p]sons /& ! disease badly4 ,treatm5t4--,typhoid fev] is "o ( ! diseases t practition]s ( all ! s*ools are agre$ t drug !rapeutics avail b little 9 its treatm5t4 ,! treatm5t ( ! old] s*ools consi/s ( prophylaxis1 good nurs+1 att5tion to hygi5ic pr9ciples1 diet+1 & hydro!rapy4 ,all ( ^! h _! places & are recogniz$ by ! o/eopa?ic s*ool4 ,b ! above me?ods are ( ! def5sive only--all[+ ! disease to run its usual c\rse & r$uc+ ! likelihood ( complications4 ,on ! o!r h& ! above treatm5t c\pl$ ) o/eopa?y1 n only attacks ! ravages ( ! disease def5sively1 b ( m importance1 ! disord] is attack$ (f5sively4 ,h]e9 is :]e attacks are abort$1 or %ort5$1 or sev]ity less5$1 or complications prev5t$4 ,! efficacy ( o/eopa?y is due to ! ability ( ! o/eopa? to treat disease1 n only prophylactically & palliatively1 b ( m consequ5ce1 aggressively4 ,! correction ( ! sp9al lesions 9 typhoid fev] is ( fir/ importance4 ,?is treatm5t effects a t5d5cy t[>d equaliz$ circulation ( ! inte/9es4 ,! vasomotor n]ves are di/urb$ by ! above lesions :i* 9 turn produces /asis 9 ,pey]'s pat*es & ! mes5t]ic gl&s4 ,rev]sely "s ( ! sp9al lesions may be due to reflex /imuli1 = 8,kirk 444 /ates t muscul> contractions produc$ by reflex activity are (t5 m su/a9$ ?an ^? produc$ by direct /imulation ( ! motor n]ves !mselves40#ea ,prophylactic treatm5t is v ess5tial1 = typhoid fev] z a rule is a prev5table affection4 ,mod]n hygi5ic & sanit>y res\rces enable a community to r$uce ! numb] ( cases to a m9imum4 ,! numb] ( cases 9 a locality dep5ds almo/ directly ^u ! condition ( ! wat] supply & dra9age4 ,c>e %\ld always be tak5 9 reg>d to ! s\rce ( dr9k+ wat] & milk4 ,dur+ an epidemic ! wat] %\ld be boil$ = half an h\r be=e be+ us$4 ,! pati5t %\ld be isolat$4 ,9 hospitals !y %\ld h special w>ds2 9 families a special ap>tm5t %\ld be giv5 !m4 ,hygi5ic pr9ciples %\ld be foll[$ z 9 o!r infecti\s diseases4 ,! me?ods ( dis9fection mu/ be rigid to prev5t ! spread ( an infection4 ,! excreta 7/ools1 ur9e1 vomitus1 & sputum7 are to be receiv$ into a b$-pan or any appropriate receptacle conta9+ half a p9t ( c>bolic acid 7"o to tw5ty74 ,?ree or f\r p9ts ( ! c>bolic acid 7"o to tw5ty7 %\ld !n be add$ to ! b$-pan & ! cont5ts mix$ c>efully be=e empty+4 ,all ut5sils us$ 9 h&l+ ! excreta are to be c>efully dis9fect$ by ! same mat]ial1 & dri$4 ,aft] e /ool ! nates ( ! pati5t %\ld be cleans$ by a clo? compress1 wet ) a solution ( c>bolic acid 7"o to =ty7 & ! clo? burn$4 ,! sick room %\ld be ?or\ghly v5tilat$ ea* day4 ,all ut5sils us$ ab\t ! pati5t 9 fe$+ %\ld be boil$ 9 wat] imm$iately aft] us+4 ,! b$ & body l95 is to be *ang$ z soon z soil$ & ^!1 ) all *ang$ ba? t[els1 blankets & rubb] %eets1 %\ld be receiv$ 9 a %eet r9s$ 9 c>bolic acid 7"o to =ty7 & plac$ :]e !y may be soak$ 9 ! solution = f\r or five h\rs4 ,! clo!s are to be boil$ = half an h\r4 ,! rubb] blanket is to be wa%$ 9 ! solution1 dri$ & air$4 ,! ,g5]al ,managem5t1 c>eful nurs+ & a regulat$ diet1 is ( p>am\nt importance 9 ! treatm5t ( typhoid fev]4 ,! pati5t %\ld be plac$ 9 b$ z soon z ! disease is det]m9$ & !re rema9 until ! end ( ! attack4 ,! room %\ld be well v5tilat$ & h a sunny exposure if possible4 ,! s+le wov5 wire b$ ) s(t hair mattress & two folds ( blankets is be/4 ,a rubb] clo? %\ld be plac$ smoo?ly "u ! %eet4 ,:5 a good nurse _c be _h1 ! att5d+ o/eopa? %\ld write out directions reg>d+ diet1 b$ l951 & ut5sils1 & ! dis9fection ( ! excreta4 ,a liquid diet %\ld be adm9i/]$4 ,milk is mo/ commonly us$2 c>e be+ tak5 t x is ?or\ghly dige/$4 ,if milk is n borne well by ! pati5t1 o!r foods1 z :ey1 s\r milk1 butt]milk1 & bro?s may be sub/itut$4 ,give food t is easily dige/$ & :i* leaves b little residue4 ,:5 milk is us$ alone1 ?ree p9ts at lea/ may be giv5 to an adult 9 ! c\rse ( tw5ty-f\r h\rs2 & x %\ld always be dilut$1 pref]ably ) pla9 wat]4 ,beef juice1 mutton or *ick5 bro? may also be us$ :5 milk is n agreeable4 ,album9 wat]1 prep>$ by /ra9+ ! :ite ( eggs ?r\gh a clo? & add+ an equal am\nt ( wat]1 is an excell5t food4 ,well /ra9$1 ?9 b>ley gruel is consid]$ by _m an excell5t food = typhoid fev] pati5ts4 ,cases n able to take n\ri%m5t into ! /oma*1 on acc\nt ( vomit+ & o!r causes1 %\ld be f$ rectally to support life4 ,d n =ce fe$+ to an unw>rant$ degree4 ,rec5tly a numb] ( new diets h receiv$ comm5dation4 ,^! include ! 8high calory0 diet1 :i* includes ?ree p9ts ( milk ) "o ( cream1 two to eight ounces ( milk sug>1 eggs1 butt]2 sometimes c]eals1 toa/1 potato1 & o!r s(t foods are giv54 ,a full sug> diet1 z ( c&y alone1 is bas$ ^u ! imm$iate absorption ( sug>1 its value z a s\rce ( en]gy1 & ! fact t a pl5tiful c>bohydrate supply less5s ! dang] ( acidosis4#eb ,! be/ dr9k = fev] pati5ts is pure1 cold wat] & !y %\ld be enc\rag$ to dr9k freely ( x4 ,b>ley wat]1 ice tea1 lemonade1 or ev5 mod]ate quantities ( c(fee or cocoa1 may be giv54 ,by ,o/eopa?ic ,treatm5t _m cases ( typhoid fev] may be abort$1 if treat$ correctly1 dur+ ! fir/ week4 ,if ! /age ( necrosis ( ,pey]'s pat*es has set 91 "o c ei!r less5 ! sev]ity ( ! attack or1 at lea/1 %ort5 ! usual c\rse4 ,dur+ ! /age ( infiltration1 treatm5t to ! inte/9al splan*nics 7*iefly f ! n9? to twelf? dorsal1 ! inn]vation to ! jejunum & ileum7 & c>eful treatm5t ov] ! abdom5 is indicat$4 ,?is treatm5t w t5d to less5 ! inte/9al cat>rh & dim9i% ! infiltration & cell prolif]ation ( ! lymphoid elem5ts ( ! inte/9es1 & ?us produce unfavorable ! conditions = ! bacillus ( ,eb]?4 ,9 o!r words1 increase ! tone & activity ( ! inte/9es s t ! micro-organisms ( typhoid fev] w n f9d ! prop] tissue-soil 9 ord] to gr[ & multiply4 ,all cases ( typhoid fev] pres5t lesions 9 ! dorsal or lumb> sp9e & ?is is really ! great pr$ispos+ cause ( typhoid fev]4 ,correct+ ^! lesions is absolutely necess>y 9 ord] to abort ! disease4 ,"s pati5ts may h su* a l[]$ vitality to beg9 ) t ! recup]ative p[]s ( ! body _c be r5d]$ =ceful en\gh 9 a %ort "t to combat ! effects ( ! micro-organism4 ,c>efully rais+ ! cecum is v effective 7,a4 ,t4 ,/ill71 b ?is mu/ be done ) ! greate/ ( caution & judgm5t4 ,dr4 ,/ill consid]s a po/]ior condition ( ! ?ird1 f\r? & fif? lumb>s z typical 9 typhoid & t x inhibits ! lymphatics to ! inte/9es4 ,r4 ,l4 ,price has _h excell5t success 9 %ort5+ ! usual typhoid c\rse4 ,8 fir/ treatm5t is to ?or\ghly empty ! b[els by enemata4 ,?is is foll[$ by sp9al1 liv] & spl5ic treatm5t1 & a liquid diet4 ,e4 ,c4 ,:ite has also treat$ a l>ge numb] ( typhoid cases ) m>k$ success4 ,he pref]s to employ ! ,br& me?od 7& x mu/ be prop]ly us$7 f ! />t4 ,he is1 also1 a ?or\gh advocate ( ! sp9al treatm5t4 ,9 cases ( con/ipation give a v light treatm5t ov] ! left iliac fossa4 ,) all pati5ts obs]ve c>eful diet+4 ,:ite believes t _m lesions ( ! sp9e arise f reflex irritations dur+ acute attacks4 ,c>eful1 frequ5t att5tion to ! sp9e is dem&$4 ,hildre?1 relative to abdom9al & sp9al treatm5t1 writes z foll[s3 8,9 ! abdom9al treatm5t ( typhoid fev]1 too mu* c>e _c be ex]cis$2 or 9 ! sp9al treatm5t1 too mu* judgm5t us$ 9 giv+ j ! "r k9d ( manipulation4 ,!re c be no "q relative to ! seat ( ! disease1 & consequ5tly !re %\ld be no tr\ble 9 kn[+ :]e or h[ to affect ! n]ves to control ! same4 ,t ,pey]'s pat*es or ! "r iliac region is always involv$1 we all "k4 ,! sp9al treatm5t %\ld be appli$ f ! eigh? dorsal to ! fir/ lumb> inclusive2 ?is affects all ! less] splan*nics & ?us controls ! circulation ( ! entire b[el4 ,& ?is treatm5t %\ld be giv51 accord+ to ! symptoms indicat$1 9 ea* & e case4 ,if ! pati5t is con/ipat$1 !n ! treatm5t %\ld be m ( a /imulative "*1 b if di>rhea is pres5t1 z is commonly ! case1 ! treatm5t %\ld be an inhibitory "o4 ,9 ! above ,i always f9i% ) a v c>eful treatm5t ( ! float+ ribs on ! left side2 ?is affects ! less] splan*nic n]ves4 ,9 all cases ,i always c>efully treat ! l[] two or ?ree lumb> v]tebr1 :i* directly affects ! hypoga/ric plexus ( n]ves1 & ?us controls ! circulation to ! l[] b[el4 8,9 all cases ,i always treat ! b[els directly1 m or less1 b ?is treatm5t mu/ be giv5 ) ! v greate/ c>e & ! be/ judgm5t1 always gov]n$ by ! condition ( ! b[el4 ,by no means manipulate ! b[el1 b j lay y\r h&s flat on ! abdom51 & ) ! mo/ g5tle pressure inhibit ! p]iph]al n]ves1 ?us ei!r quiet+ an excit$ p]i/alsis or equaliz+ a di/urb$ circulation4 ,& ) ?is treatm5t rememb] t ! two specific po9ts 9 typhoid fev] are ! l[] dorsal & l[] lumb> n]ves4 8,! above treatm5t is us$1 ( c\rse1 9 connection ) all ! o!r necess>y treatm5ts1 su* z diet+1 nurs+1 spong+1 reliev+ ! heada*es1 etc4 ,i am unalt]ably oppos$ to ice-packs = ! b[els 9 typhoid1 = ! reason x is too mu* ( a %ock4 ,cold clo?s are good & mu* bett] ?an ice1 & %\ld always be us$ in/ead ( ice40 ,aft] ! disease has become ?or\ghly e/abli%$ always make x a po9t dur+ ea* visit to exam9e ! entire l5g? ( ! sp9al column c>efully & readju/ any tissue1 :e!r x be v]tebra1 rib1 or muscle1 t may be f\nd disord]$4 ,! b[els are to be wat*$ c>efully & if con/ipat$1 !y %\ld be mov$ ) a light enema4 ,great c>e mu/ be tak5 n to treat ! abdom5 r\ghly1 if at all1 aft] ! fir/ week4 ,! treatm5t might be v injuri\s to ! /ructures diseas$4 ,a light treatm5t ov] ! liv] & kidneys ea* "t is a wise precaution4 ,! he>t's action1 %\ld be wat*$ c>efully4 ,9 addition to ! hydro!rapeutic treatm5t1 ! g5]al fev] treatm5t %\ld be employ$4 ,! pati5t %\ld usually be se5 twice a day4 ,abdom9al pa9 is be/ reliev$ by light treatm5t ov] ! abdom5 & by ?or\gh treatm5t ( ! l[] dorsal or lumb> region4 ,applications ( hot wat] w be helpful4 ,meteorism c be reliev$ by rais+ ! l[] ribs & by direct treatm5t to ! abdom54 ,a *ange ( diet may be b5eficial4 ,:5 gas is 9 ! l>ge b[el an enema may be giv5 to remove x4 ,di>rhea & con/ipation are be/ controll$ by ! usual treatm5t giv5 ! sp9e 9 su* cases1 & ov] ! abdom5 & ! liv]4 ,light enemata may be giv5 = con/ipation4 ,! /ools %\ld be exam9$ :5 di>rhea occurs1 z ! pres5ce ( curds may cause ! aggravation4 ,hemorrhage f ! b[els dem&s absolute re/4 ,x is probably bett] to h ! pati5t use ! draw %eet = ! evacuation4 ,imm$iate & ?or\gh treatm5t mu/ be giv5 to ! sp9al column 9 ! region ( ! inte/9al n]ves to ! diseas$ area1 s t exi/+ lesions may be correct$ & ! vascul> area ( ! mes5t]y equaliz$4 ,ice %\ld be giv5 freely & an ice pack plac$ ov] ! abdom54 ,food %\ld be re/rict$ = t5 or twelve h\rs4 ,if ! p]i/alsis ( ! inte/9es is increas$1 an ef=t %\ld be made to control x ?r\gh ! vagi & splan*nic n]ves4 ,9 p]=ation hot applications1 re/ & ?or\gh treatm5t ( ! inn]vation to ! p]itoneum are ( value1 b imm$iate op]ation is usually advisable4 ,insomnia is be/ reliev$ by att5tion to ! c]vical region4 ,relaxation ( ! muscles 9 ?is region & a quiet+ treatm5t to ! po/]ior occipital n]ves1 c\pl$ ) cold sponge ba?s1 w usually induce sleep4 ,9 delirium att5tion to ! circulation ( ! bra91 by c>eful treatm5t ( ! vasomotor sy/em1 & ! ,br& me?od ( ba?s w relieve ?is di/ress+ symptom4 ,dur+ convalesc5ce ! pati5t %\ld be re/rict$ f any m5tal or physical ex]cise = a week or t5 days & !n %\ld move ab\t ) c>e4 ,solid food %\ld n be giv5 = t5 days or two weeks4 ,if ! temp]ature has be5 normal = t5 days1 x is !n safe to all[ su* food z eggs1 milk pudd+s1 & milk toa/4 ,if di>rhea %\ld p]si/1 be+ due to ulc]ation1 ! diet %\ld be re/rict$ & ! pati5t conf9$ to ! b$4 ,if con/ipation is tr\blesome relieve x by enemata4 ,!re are sev]al b5eficial effects obta9$ by hydro!rapeutic measures t %\ld receive c>eful consid]ation4 ,probably x is ( ! lea/ significance to l[] ! temp]ature2 o!r b5eficial effects be+ ( great] importance4 ,:5 ! ba?s are sy/ematically c>ri$ out1 7#a7 !re is obta9$ a g5]al improvem5t ( ! n]v\s sy/em1 ! m9d is r5d]$ cle>1 muscul> twit*+s are less5$1 sleep is induc$ & ! he>t's action /r5g!n$2 7#b7 ! respiration is /imulat$1 ?us dim9i%+ ! liability ( lung complications2 7#c7 ! activity ( ! r5al function is increas$1 consequ5tly all[+ m rapid elim9ation ( toxic matt]2 7#d7 r$uction ( ! temp]ature1 & ov]com+ ill effects ( high fev]4 ,a cold wat] ba?1 or :at is g5]ally t]m$ ! ,br& me?od1 is commonly employ$4 ,! foll[+ plan is usually foll[$4 ,:5 ! temp]ature is above #ajb4e degrees ,f41 rectally1 a ba? ( #gj degrees ,f4 is :eel$ to ! pati5t's b$side & he is plac$ into x = t5 or fifte5 m9utes4 ,! pati5t %\ld be l[]$ into ! ba? by means ( a %eet4 ,en\gh wat] is us$ to cov] ! body & neck ( ! pati5t4 ,! head is spong$ & ! limbs & trunk are rubb$ ?or\ghly dur+ ! entire proc$ure4 ,:5 ! pati5t is tak5 out he is wrapp$ 9 a dry %eet & cov]$ ) a blanket4 ,?is proc$ure is gone ?r\gh ) e ?ree h\rs if ! case is sev]e1 o!rwise once e sev5 or eight h\rs w be suffici5t4 ,! luke-w>m ba? is occasionally us$ 9 private practice :5 "o is unable to use ! ,br& me?od4 ,a ba? ( #ij degrees ,f4 is employ$1 :i* is gradually cool$ t5 or twelve degrees1 aft] ! pati5t has be5 plac$ 9 x1 by p\r+ cold wat] on ! pati5t4 ,?is ba? is f\nd v helpful4 ,also 9 private practice ! cold pack is f\nd satisfactory4 ,! pati5t is wrapp$ 9 a %eet wrung out ( wat] at #fe degrees ,f4 & cold wat] is spr9kl$ ov] him4 ,:5ev] !re is objection to any ( ^! me?ods ! body may be spong$ (f ) tepid or cold wat] :5 ! temp]ature rises above #ajb4e degrees ,f41 rectally4 ,"o limb %\ld be tak5 at a "t & !n ! trunk1 occupy+ altoge!r "s tw5ty or ?irty m9utes4 ,! ,great ,w> br\ght ! subject ( typhoid vacc9ation be=e ! _w ) emphasis b its results are n1 z yet1 9 %ape s an unbias$ op9ion c be =m$4 ,! army m$ical dep>tm5t w tell u t x 0 an unqualifi$ success b we d "k t !re 7 s]i\s outbreaks among inoculat$ troops :o 7 liv+ "u mo/ hygi5ic surr\nd+s 9 ,am]ica4 ,!re 71 also1 outbreaks among protect$ troops 9 ,france to ! ext5t t ! m$ical au?orities felt call$ ^u to w>n all m$ical (fic]s t vacc9ation %\ld n be consid]$ z protect+ aga9/ unsanit>y surr\nd+s & t great precaution mu/ be obs]v$1 ! same z "u non-vacc9ation conditions4 ,?is does n imply implicit confid5ce4 ,x is1 also1 a hi/orical fact t ! ,japanese army1 dur+ ! ,russo-,japanese w> _h z l[ a rate ( typhoid )\t vacc9ation z c1 probably1 be %[n ) x 9 ?is w>4 ,at t "t !y dep5d$ entirely ^u pure wat] & sanitation4 ,see reports ( typhoid fev] 9 ,a4 ,o4 ,a4 ,case ,reports z foll[s3 ,c4 ,m4 ,t4 ,hulett1 ,s]ies ,i1 p4 #g1 ,j4 ,h4 ,wilson1 ,s]ies ,,iii1 p4 #c1 ,f4 ,e4 & ,h4 ,p4 ,moore1 & ,f4 ,a4 & ,e4 ,s4 ,cave1 ,s]ies ,,iv1 pp4 #d & #e4 ,9 p>atyphoid fev]1 an acute infecti\s disease caus$ by ! p>atyphoid bacillus1 ! treatm5t is ! same z = typhoid fev]4 ,x is mild] & simil> to typhoid fev]4 ,typhus ,fev] ,def9ition4--,an acute1 infecti\s disease2 *>act]iz$ by sudd5 invasion1 high fev]1 m>k$ n]v\s symptoms1 a peculi> maculat$ & pete*ial eruption & a t]m9ation by crisis ab\t ! f\rte5? day4 ,etiology & ,pa?ology4--,typhus fev] is becom+ less frequ5t ?an =m]ly & is r>ely se5 9 ?is c\ntry4 ,x 0 v de/ructive dur+ ! ,great ,w>1 p>ticul>ly 9 ! ,balkan /ates4 ,fil?1 ov]-cr[d+1 fam9e1 intemp]ance & bad food are ! pr$ispos+ causes4 ,typhus fev] is highly contagi\s & is transmitt$ by ! p$iculus corporis 7cootie7 z 0 fir/ discov]$ by ! ,am]ican ,r$ ,cross work]s 9 ,s]bia4 ,probably infection may come by contact & fomites4 ,! specific organism is ! bacillus typhi exan!matici 7,platz74 ,pa?ologically1 !re are no con/ant lesions4 ,!re is a g5]al hyp]plasia ( ! lymph follicles1 b no ulc]ation4 ,! blood is d>k1 ?9 & less5$ 9 fibr94 ,hypo/atic conge/ion ( ! lungs & bron*ial cat>rh are frequ5tly met )4 ,! liv]1 kidneys & sple5 are f\nd to be some:at enl>g$ & s(t5$4 ,! pete*ial ra% rema9s aft] dea?4 ,symptoms4--,! incubation p]iod is ab\t twelve days4 ,! onset is usually sudd51 u%]$ 9 by *ills4 ,! temp]ature quickly rises to #ajd or #aje degrees ,f4 ,!re is heada*e1 pa9s 9 ! muscles1 especially ( ! back1 & e>ly1 pr(\nd pro/ration4 ,! pulse is at fir/ full & /rong1 #ajj to #adj1 b soon becomes weak & frequ5t4 ,!re may be di/ress+ vomit+4 ,! face is flu%$1 ! eyes inject$1 ! expression /upid1 & !re is g5]ally l[1 mutt]+ delirium4 ,! tongue is furr$ & :ite1 soon becom+ dry4 ,! b[els are con/ipat$ & ! ur9e is usually scanty & ( high specific gravity4 ,!re is great ?ir/4 ,conjunctiva inject$2 pupils contract$2 e>ly pro/ration4 ,! eruption appe>s ab\t ! fif? or sev5? day4 ,x fir/ makes its appe>ance ^u ! abdom5 & *e/4 ,x rapidly ext5ds all ov] ! body ) ! exception ( ! face4 ,! eruption is ( two k9ds--rose spots1 :i* disappe> ^u pressure1 & ^? :i* become hemorrhagic 7pete*ial72 pressure has no effect ^u !m4 ,dur+ ! second week ! symptoms are increas$4 ,! tongue is dry1 br[n & fissur$1 & sordes appe> on ! tee?4 ,ret5tion ( ! ur9e1 due to p>alysis ( ! bladd]1 is common4 ,! brea?+ becomes m rapid & ! he>t's action m feeble2 ! pati5t may die f exhau/ion4 ,?is u%]s 9 ! typhoid /ate ) l[1 mutt]+ delirium1 ataxic symptoms1 subsultus1 tremors1 & maybe bron*ial symptoms4 ,9 favorable cases ! crisis occurs at ! end ( ! second week4 ,pati5t s9ks into a s\nd sleep1 ! temp]ature falls rapidly1 !re is pr(use sweat+ & a critical di>rhea b ! pati5t n[ ga9s rapidly4 ,convalesc5ce is usually rapid2 relapses r>ely occur4 ,! ur9e is scanty1 high color$ & frequ5tly album9\s4 ,b$-sores are common4 ,! temp]ature cont9ues high1 rea*+ #ajf degrees ,f41 or m1 ) slight nocturnal remissions4 ,9 fatal cases ! fev] (t5 rises to #ajh or #aji degrees ,f4 j be=e dea?4 ,diagnosis4--,! sudd5 onset1 frequ5t *ills1 e>ly pr(\nd pro/ration1 "* ( ! ra%1 hi/ory ( exposure to ! poison & unhygi5ic surr\nd+s decide ! diagnosis4 ,dur+ an epidemic !re is usually no d\bt1 b 9 sporadic cases ! diagnosis is sometimes extremely difficult4 ,prognosis4--,?is is usually grave1 b ! mortality rate is be+ greatly r$uc$ 9 consequ5ce ( ! bett] sanit>y arrangem5ts4 ,treatm5t4--,typhus fev] is highly contagi\s & great c>e %\ld be tak5 9 controll+ ! disease4 ,isolation1 dis9fection & ext]m9ation is imp]ative4 ,s f> z kn[n none ( ! o/eopa?s h _h exp]i5ce 9 ! treat+ ( typhus fev] o/eopa?ically1 b !re is no reason :y ! disease %\ld n be treat$ ) ! same success z is met ) by o/eopa?ic treatm5t 9 o!r diseases4 ,x is claim$ t ! disease %\ld be treat$ 9 ! op5 air1 9 t5ts1 z ! recov]y ( ! pati5t & ! safety ( ! att5dants are greatly favor$4 ,= high temp]ature1 besides ! treatm5t giv5 to remove any disord] t may be f\nd1 ! g5]al fev] treatm5t is indicat$1 & hydro!rapy w\ld also be ( aid--spong+ ! surface ( ! body1 or ! use ( ! ba?4 ,a/h5ia is :]e9 ! greate/ dang] lies1 & a /imulat+ treatm5t along ! sp9e & to ! he>t %\ld be giv52 al?\gh correction ( ! prim>y tr\ble may be suffici5t4 ,hydro!rapeutic measures1 ! sy/ematic use ( ! cold ba?1 w\ld be ( s]vice ! same z 9 typhoid fev]4 ,heada*e & delirium :i* are apt to arise1 caus$ by too mu* blood 9 ! head1 may be reliev$ by treatm5t ( ! c]vical sp9e4 ,also cold appli$ to ! head w aid4 ,! b[els %\ld be wat*$ c>efully2 treat ! splan*nics ?or\ghly & ! inte/9es & liv] directly4 ,n\ri% ! pati5t z 9 typhoid fev] by nutriti\s liquids--milk1 bro?s1 etc4 ,al?\gh typhus is n[ a comp>atively r>e disease1 an outl9e has be5 giv5 to emphasize :at correction ( unhygi5ic conditions & insanit>y surr\nd+s w accompli%4 ,x is p>ticul>ly a disease ( fil?4 ,mal>ial ,fev] 7,,ague7 ,def9ition4--,an infecti\s disease caus$ by ! hemocytozoon ( ,lav]an4 8,x is *>act]iz$ by p>oxysms ( int]mitt5t fev] ( ! quotidian1 t]tian or qu>tan type1 a cont9u$ fev] ) m>k$ remissions1 a p]nici\s or rapidly fatal =m1 & a *ronic ca*exia ) anemia & enl>g$ sple540 7,halb]t74 ,! v>ieties ( mal>ial fev] are3 int]mitt5t fev]2 p]nici\s int]mitt5t2 remitt5t fev]2 mal>ial ca*exia2 mask$ int]mitt5t2 mal>ial hematuria4 ,o/eopa?ic ,etiology & ,pa?ology4--,mal>ial fev]s are caus$ by a p>asite kn[n z ! hematozoon ( ,lav]an4 ,?ree v>ieties ( ! p>asite h be5 sep>at$1 correspond+ ) ! ?ree lead+ =ms ( ! affection4 ,! p>asite ( t]tian fev] is ab\t z l>ge z a normal r$ blood-corpuscle1 beg9n+ z a small hyal9e ameba 9 ! r$ blood-corpuscles4 ,! p>asite ( qu>tan fev] is v simil> 9 its appe>ance to ! t]tian p>asite b small]2 its ameboid movem5ts are sl[] & ! r$ blood-corpuscle embrac+ x %r9ks ab\t ! p>asite1 assum+ a deep] gre5i% color4 ,! p>asite ( ! e/ivo-autumnal fev]s is /ill small]4 8,if only "o gr\p ( p>asites exi/s ! p>oxysms--qu>tan int]mitt5t--w occur e f\r? day4 ,d\ble qu>tan infection w result 9 p>oxysms on two successive days ) an int]mission ( "o day4 ,infection by ?ree gr\ps ( p>asites w create daily p>oxysms--! quotidian int]mitt5t4 ,infection by m ?an ?ree gr\ps is r>e40 7,&]s74 ,only 9 ! e>li] /ages ( developm5t1 small hyal9e bodies are to be f\nd 9 ! p]iph]al circulation2 be+1 9 ! lat] /ages1 9 ! blood ( c]ta9 int]nal visc]a1 sple51 & bone m>r[1 p>ticul>ly4 ,x is an accept$ fact among m$ical obs]v]s t to ! mosquito1 anopheles1 is due ! spread ( mal>ia & x has be5 ! subject ( mu* inve/igation 9 all p>ts ( ! _w4 ,! mosquito becomes infect$ f bit+ an individual ^: blood conta9s ! mal>ial p>asite1 ?is is !n develop$ 9 ! mosquito to maturity & lat] is transmitt$ to ! next subject bitt54 ,?is explanation w\ld %[ :y c]ta9 localities favorable = ! bre$+ ( mosquitoes are p>ticul>ly giv5 to mal>ial outbreaks4 ,l[1 m>%y gr\nds1 banks ( riv]s1 small ponds1 etc41 z well z w>m wea!r1 are ne$$ to produce ! conditions = ! developm5t ( ! anopheles4 ,z ! c\ntry has develop$ ! int5sity & ext5t ( mal>ia has dim9i%$ until x is n[ conf9$ l>gely to ! s\!rn /ates4 ,x is practically unkn[n 9 ! nor?we/ & 9 ! ,/4 ,lawr5ce bas94 ,regions :i* h nev] _h cases1 h[ev]1 h develop$ !m :5 ! anopheles has appe>$4 ,:it+ notes cases 9 ,s\!rn ,cali=nia1 ! result ( ! insect be+ br\ght 9 by %ips f ,mexican or ,c5tral ,am]ican ports4 ,9 c]ta9 regions ! anopheles is pres5t b has n app>5tly come 9 contact ) a mal>ial victim1 s is incapable ( spread+ ! disease4 ,also 9 cold] climates ?is species is h>mless4 ,by dra9+ ! l&s & prev5t+ ! bre$+ places1 ! numb] ( ! pe/s is r$uc$1 :ile ! scre5+ ( h\ses & c>e aga9/ exposure to ! bites make x possible to live 9 mal>ial sections & n become infect$4 ,naturally ! resi/+ p[] ( a pati5t is call$ into acc\nt :5 bitt5 by ! mosquito4 ,:]e x is epidemic ! inhabitants w be f\nd1 g5]ally1 poorly n\ri%$ or debilitat$ f climatic or o!r conditions4 ,?is r5d]s infection easy1 = immunity mu/ come f ! ability ( ! blood to combat ! invad+ p>asite4 ,! o/eopa?ic pr$ispos+ causes = mal>ia are usually int]f]5ce ) ! vasomotor n]ves to ! sple5 & liv]1 z ^! two organs are s conc]n$ 9 ma9ta9+ ! /ability ( ! blood tissue4 ,ligon1 ( ,alabama1 notes t mo/ cases h lesions betwe5 ! n9? & twelf? dorsal on ! "r side4 ,! *ief morbid *anges are clue to ! direct effect ( ! mal>ial p>asite ^u ! blood4 ,!re are also *anges 9 ! liv]1 kidneys1 & sple51 :i* *anges usually v>y ) ! duration & int5sity ( ! disease4 ,! dis9tegration ( ! r$ blood-corpuscles1 accumulation ( ! pigm5t ?us =m$1 & ! tox9 eng5d]$ by ! mal>ial p>asite are responsible = ! morbid lesions ( ! disease4 ,9 p]nici\s mal>ia ! blood is m or less hydremic1 & ! discs are se5 9 all /ages ( de/ruction4 ,! sple5 is enl>g$ & s(t & ! pulp d>k f ! accumulation ( ! pigm5t1 & spontane\s rupture has occurr$ 9 a numb] ( cases4 ,! liv] is swoll5 & turbid2 pigm5tation occurs1 b is g5]ally only visible by means ( ! microscope4 ,by ! aid ( ! microscope all ! tissues ( ! body1 ev5 ! bra91 may be f\nd to be pigm5t$4 ,! sple5 9 *ronic mal>ia is greatly enl>g$1 firm1 pigm5t$ & ! capsule ?ick5$4 ,! liv] is enl>g$1 ! color v>y+ f a slight gray to a deep slate gray1 accord+ to ! am\nt ( pigm5t4 ,! kidneys may be enl>g$ & deeply pigm5t$1 z is also ! muc\s membrane ( ! /oma* & inte/9es4 ,r4 ,w4 ,connor obs]ves t ! kidneys & liv] are mo/ noticeably involv$1 vasomotor ob/ructions ! rule1 ! sple5 9 ! majority ( cases %[s engorgem5t & t special att5tion to ^! c5t]s w give ! be/ results4 ,he inv>iably f9ds sp9al lesions f ! sev5? dorsal to ! fir/ & second lumb>1 mo/ frequ5tly ! eigh?1 n9? & t5? dorsals4 ,a l[]$ vitality pr$isposes to infection f ! bite ( ! mosquito4 ,symptoms4--,int]mitt5t ,fev]4--,?is =m is :at is kn[n z fev] & ague1 9 :i* *ills1 fev] & sweat foll[ ea* o!r4 ,! p]iod ( incubation v>ies f six to fifte5 days1 b x may be mon?s aft] exposure be=e ! fir/ p>oxysms set 94 ,! p>oxysm is usually prec$$ by a feel+ ( uneas9ess & discom=t1 sometimes by nausea or heada*e4 ,! p>oxysm consi/s ( ?ree /ages1 cold1 heat & sweat+4 ,9 ! cold /age ! *ill usually beg9s gradually2 x is g5]ally int5se1 ! tee? *att] & ! body %akes viol5tly4 ,! sk9 is cool & pale1 ! lips are blue1 ! face is p9*$ & ! pati5t looks v cold4 ,dur+ ! *ill ! temp]ature rises rapidly4 ,nausea1 vomit+ & heada*e are common4 ,! pulse is frequ5t1 small & h>d4 ,! ur9e is increas$ 9 quantity & ( l[ specific gravity4 ,! *ill la/s f a few m9utes to a c\ple ( h\rs4 ,! hot /age succe$s ! *ill4 ,! sk9 gradually loses its coldness & becomes hot4 ,! face is flu%$1 !re is great ?ir/1 ! m\? is dry1 & ! tongue is coat$4 ,usually at ! t]m9ation ( ! *ill ! temp]ature has rea*$ its maximum level1 f #ajd to #ajf degrees ,f4 ,! pulse is full1 & !re may be a ?robb+ heada*e4 ,! duration ( ?is /age is f half an h\r to ?ree or f\r h\rs4 ,dur+ ! sweat+ /age drops ( p]spiration appe> ^u ! face2 ! p]spiration soon becomes pr(use1 ext5d+ all ov] ! body4 ,! temp]ature soon falls1 ! heada*e disappe>s & 9 a c\ple ( h\rs ! p>oxysm is ov]4 ,! entire duration ( ! p>oxysm is f eight to twelve h\rs2 ! pati5t usually feel+ p]fectly well betwe5 ! p>oxysms4 ,! sple5 is enl>g$4 ,if ! p>oxysms ( fev] occur daily at ! same h\r !y are call$ quotidian int]mitt5t fev]2 if e o!r day !y are kn[n z t]tian int]mitt5t2 & if e ?ird day !y are call$ qu>tan int]mitt5t4 ,if !re are two p>oxysms 9 ! same day ! t]m d\ble quotidian is us$2 if ! p>oxysms occur a c\ple ( h\rs lat] ea* successive day !y are call$ 8ret>d+20 if a c\ple ( h\rs e>li] !y are nam$ 8anticipat+40 ,remitt5t ,fev]4--7,e/ivo-,autumnal ,fev]74--,?is is *>act]iz$ by a cont9u$ fev] ) p>oxysmal exac]bations & remissions4 ,x occurs especially 9 w>m & tropical climates4 ,9 temp]ate climates x usually occurs 9 ! late summ] & fall4 ,x is also t]m$ bili\s remitt5t fev] on acc\nt ( ! int5sity ( ! ga/ro-inte/9al manife/ation4 ,! e/ivo-autumnal p>asite is ! excit+ cause4 ,x is v (t5 prec$$ by malaise1 heada*e1 nausea & vomit+4 ,! onset is usually gradual & ! *ill may be :olly abs5t4 ,z a rule1 h[ev]1 a *ill g5]ally occurs at ! onset1 b x is less sev]e ?an t ( int]mitt5t fev]4 ,aft] ! *ill ! temp]ature rises rapidly to #ajb or #ajd degrees ,f4 or ev5 high]4 ,! pulse is full1 ris+ to #ajj or #abj4 ,!re is viol5t heada*e1 flu%$ face1 pa9s 9 ! limbs & lo9s1 nausea & vomit+1 & delirium :5 ! temp]ature is v high4 ,! ur9e is scanty or ev5 suppress$1 slightly album9\s1 sometimes bloody1 high color$1 & deposits a s$im5t ( urates4 ,jaundice is n infrequ5t2 ! sple5 is enl>g$ & h]pes labialis is q common4 ,aft] six to tw5ty-f\r h\rs ! symptoms abate & slight sweat+ occurs4 ,! temp]ature usually drops to #ajj degrees ,f41 ! heada*e disappe>s & vomit+ ceases2 ?is is foll[$ by a new exac]bation ( fev] at ! end ( ab\t twelve h\rs1 g5]ally )\t ! *ill2 & ?is hot /age is 9 turn aga9 foll[$ by ! remission4 ,^! attacks may la/ ?ree or f\r weeks4 ,p]nici\s ,mal>ial ,fev]4--,?is is r>e 9 temp]ate climates & is always associat$ ) ! e/ivo-autumnal p>asite4 ,! pr9cipal types are ! c]ebral & algid4 ,! c]ebral type usually beg9s ) a sev]e *ill2 sometimes1 h[ev]1 ! *ill is abs5t4 ,! pati5t is viol5tly seiz$ ) grave c]ebral symptoms1 z acute delirium or sudd5 coma4 ,! comatose condition la/s f twelve to tw5ty-f\r h\rs :5 consci\sness usually returns1 ! prim>y p>oxysm r>ely prov+ fatal2 x is1 h[ev]1 (t5 foll[$ 9 a %ort "t by fatal relapse4 ,! ,algid v>iety is *>act]iz$ by int5se pro/ration & extreme coolness ( ! surface ) ! int]nal temp]ature high4 ,! ga/ric symptoms are extreme nausea & vomit+4 ,! pulse is feeble2 ! brea?+ frequ5t & %all[4 ,!re is int5se ?ir/4 ,! voice is feeble & indi/9ct4 ,! m9d is cle>4 ,! ur9e is suppress$4 ,9 ?is type ! p>asites ga9 entrance to ! ga/ro-inte/9al mucosa1 sometimes =m+ di/9ct ?romboses ( ! small] vessels4 ,?is =m may be confus$ ) yell[ fev]4 ,mal>ial ,ca*exia4--,?is is a *ronic condition :i* (t5 occurs 9 cases t h n be5 prop]ly treat$ or 9 p]sons t live 9 mal>ial di/ricts & are con/antly expos$ to ! infection4 ,! two mo/ /rik+ symptoms ( ?is condition are anemia & an enl>g$ sple5 or 8ague cake40 ,!re is fev] at int]vals1 b *ills r>ely occur4 ,! sk9 is ( a dirty yell[ color4 ,! sple5 is greatly enl>g$ & ! blood is pr(\ndly anemic4 ,!re is debility1 & frequ5t sweat+1 & ! h&s & feet are cold4 ,! dige/ion may be d]ang$ & !re may be slight jaundice4 ,sometimes !re is edema ( ! feet & ev5 dropsy occurs4 ,hemorrhages ( ! v>i\s muc\s surfaces are common4 ,p>aplegia & or*itis are r>e symptoms4 ,^! cases usually d well "u prop] treatm5t1 & if ! pati5t c be mov$ f ! mal>ial di/rict4 ,mask$ ,int]mitt5t4--,mal>ial neuralgia mo/ frequ5tly involves ! supraorbital bran* ( ! trigem9us2 also ! occipital1 ! int]co/als1 sciatic & bra*ial n]ves may be affect$4 ,su* =ms ( mal>ia are call$ 8mask$ mal>ia40 ,9 ?is =m !re is no fev] & z a rule x is v h>d to diagnose4 ,a blood analysis %\ld be made to confirm ! diagnosis4 ,9 "s cases "o or m /ages 9 ! p>oxysm ( int]mitt5t fev] is omitt$2 ?is is especially true ) ! *ill1 9 :i* case x is t]m$ 8dumb ague40 ,mal>ial ca*exia is also sometimes call$ 8dumb ague0 & bo? are f\nd among ! old] inhabitants ( mal>ial di/ricts4 ,p]sons liv+ 9 mal>ial di/ricts are sometimes affect$ ) con/ipation1 heada*e1 loss ( appetite1 nausea1 vomit+ & a languid feel+2 ?is is call$ 8lat5t int]mitt5t fev]40 ,frequ5tly 8bili\s attacks0 are ( a mal>ial orig94 ,mal>ial ,hematuria4--,hemorrhages may occur f ! muc\s membrane 9 all sev]e & p]si/5t types ( mal>ial infection4 ,x is a frequ5t symptom ( ! p]nici\s v>iety4 ,! p>asites de/roy ! r$ blood-corpuscles2 ?is is ! cause ( ! hemoglob9uria4 ,pro/ration & anemia are m>k$4 ,9 blackwat] fev]1 a tropical disord]1 acute hemolysis1 is ! cause ( ! hemoglob9uria4 ,diagnosis4--,?is is usually easy4 ,! *>act]i/ic /ages ( ! p>oxysms1 ! p]iodicity1 resid5ce 9 mal>ial di/ricts & ! alt]ations 9 ! blood w usually remove e d\bt z to ! diagnosis4 ,typhoid ,fev] may simulate mal>ial fev]1 b a c>eful analysis ( symptoms & blood exam9ation w diff]5tiate4 ,prognosis4--,?is is almo/ always favorable "u e>ly & p]si/5t treatm5t4 ,! unfavorable symptoms are uremia1 hemorrhage & m>k$ jaundice4 ,treatm5t4--,att5tion %\ld fir/ be giv5 to prophylactic measures4 ,environm5t1 isolation ( ! pati5t1 & de/ruction ( ! mosquito are important consid]ations4 ,cases ( mal>ial fev] pres5t di/9ct lesions 9 ! v]tebr & ribs correspond+ to ! vasomotor n]ve supply ( ! sple5 & liv]4 ,! mo/ common lesion f\nd is a m>k$ lat]al deviation betwe5 ! n9? & t5? dorsal v]tebr & a consequ5t d[nw>d displacem5t ( ! t5? ribs4 ,a di/urbance w always be f\nd 9 ! region ( ! eigh? to ! elev5? dorsal v]tebra1 inclusive1 or 9 ! correspond+ ribs on ei!r side4 ,^! lesions und\bt$ly d]ange ! vasomotor n]ves to ! sple5 & liv]2 ?us p]mitt+ a weakness or l[]$ resi/ance ( ! sy/em1 especially ( ! blood4 ,! blood resi/+ p[]s are less5$1 probably on acc\nt ( ! sple5 be+ affect$1 z x is an elaborat+ gl& ( ! blood2 & ! liv]'s action is some:at dep5d5t ^u ! action ( ! sple52 besides1 ! liv] is a secretory & excretory organ4 ,! pr9cipal o/eopa?ic treatm5t giv5 9 cases ( mal>ial fev] is correction ( ^! subdislocations1 & ?or\gh treatm5t to ! liv] & sple5 directly4 ,ligon obs]ves t :5 ! case does n respond quickly to treatm5t x is v liable to be ( consid]able duration1 al?\gh 9 ! majority ( cases ! disease is controll$ f ! ?ird to sev5? day2 ! mo/ con/ant lesions f\nd are f ! eigh? to t5? dorsal & also ! f\r? lumb>4 ,dur+ ! *illy /age ?or\gh treatm5t ( ! vasomotor n]ves 9 ! upp] c]vical1 ! upp] dorsal1 ! l[] dorsal & ! lumb> regions is indicat$2 ?is treatm5t is giv5 to equalize ! vascul> sy/em4 ,dur+ ! hot /age ! same treatm5t z 9 ! *illy /age %\ld be giv5 to control ! vascul> sy/em2 besides a ?or\gh treatm5t ( ! sple5 & liv] is necess>y4 ,spong+ ! body ) wat] w be ( "s aid 9 r$uc+ ! temp]ature4 ,dur+ ! sweat /age ?or\gh inhibition at ! sup]ior c]vical ganglion to control ! sweat c5t] ( ! m$ulla1 & treatm5t at ! upp] dorsal & fir/ lumb> to control auxili>y sweat c5t]s are indicat$4 ,! b[els %\ld be kept active4 ,:5 9 a comatose =m & :5 int]nal temp]ature is high1 place ! pati5t 9 a ba?4 ,9 *ronic cases1 *ange ( climate ) ?or\gh sy/ematic treatm5t w usually result 9 recov]y4 ,tete#ec1 ( ,l\isiana1 makes ! foll[+ int]e/+ /atem5t3 8,a specific o/eopa?ic treatm5t giv5 )9 an h\r be=e ! expect$ *ill is a specific cure = mal>ia40 ,he foll[s ?is up by treat+ on ! ?ird1 fif?1 sev5?1 f\rte5?1 & tw5ty-fir/ days1 on acc\nt ( ! t5d5cy ( ! return ( an attack on ^? days4 ,8 obs]vation ( ! value ( treatm5t j be=e ! attack is borne out by a report by ,teall#ed :]e ! case 0 cur$ 9 "o treatm5t1 b ! lesion 0 z high z ! f\r? dorsal4 ,n4 ,*apman confirms ?is z be+ h] exp]i5ce 9 _m cases4 ,! sple5 has be5 obs]v$ by ,b&el to become engorg$ & ^u empty+ !re w\ld foll[ a rise ( temp]ature ( "o f\r? to half a degree4 ,?is has also be5 spok5 ( by ,tuck] z ! 8spl5ic wave40 ,ligon makes ! /atem5t t :]e ! o/eopa?ic lesion 7! pr$ispos+ cause7 has be5 ( long /&+ prior to ! attack1 & z a consequ5ce h>d to correct1 x is difficult to %ort5 ! mal>ial attack4 ,?is w\ld emphasize ! po9t t ! ess5tial treatm5t mu/ be a ?or\ghly readju/ive "o1 & t /imulatory & inhibitory "w c only palliate4 ,?is is borne out by sev]al practition]s :o h _h consid]able exp]i5ce4 ,v satisfactory results foll[ adju/m5t ( ! sev5? to t5? dorsals4 ,qu99e has be5 accept$ by m$ical au?orities z a specific = mal>ia4 ,x is suppos$ to act directly ^u ! intracorpuscul> hematozoa4 ,t x is n infallible is %[n by ! num]\s cases :i* come to ! o/eopa?1 suff]+ f bo? ! disease & ! qu99e4 ,& ev5 drug au?orities /ate t o!r treatm5t is also requir$4 ,x has rema9$ = ,dr4 ,/ill to demon/rate t excell5t results foll[ o/eopa?ic treatm5t 9 mal>ia4 ,frequ5tly a s+le treatm5t has be5 suffici5t to free & regulate ! body fluids & =ces s t ! p>asite 0 r5d]$ in]t1 & ?is treatm5t 0 direct$ *iefly to ! f\r? & twelf? dorsals4 ,:]eas ! o/eopa? recognizes & appreciates ! importance ( micro-organisms z excit+ & det]m9+ factors 9 _m diseases1 /ill he values !m z second>y factors only & relies prim>ily ^u remov+ ! pr$ispos+ & true etiologic factors1 s t nature's =ces may n be ob/ruct$ & ?us pr$om9ate4 ,o/eopa?ic etiology & pa?ology has %[n s conclusively1 9 a l>ge numb] ( cases1 t ! exi/5ce ( micro-organisms is dep5d5t ^u devitaliz$ tissue1 :e!r ! tissue is a local "o or a circulat+ "o1 z ! blood2 & j s soon z ! anatomical is adju/$ ! physiological w function & antitoxic & antimicrobic sub/ances are secret$4 8,:5 ! pati5t has ! qu>tan p>asite1 z soon z ! temp]ature beg9s to fall ,i give him f two to six ounces ( r$ meat juice1 extract$ f r>e beef/eak1 sometimes z mu* z five p\nds 9 ! fir/ tw5ty-f\r h\rs foll[+ ! *ill4 ,9 almo/ all cases ( qu>tan mal>ia ! blood is built up suffici5tly by ! "t !y rea* ! second cycle to pass )\t ! p>oxysm1 or *ill4 ,by ! "t = ! ?ird cycle1 :i* is ! sev5? day1 ,i always h built up ! pati5t's resi/ance s z to enable him to pass by ?is cycle )\t any symptoms ( mal>ia :atev]4 ,9 cases ( d\ble or triple ,i f9d ! same treatm5t causes ab\t ! same results4 ,i d n give any o!r diet1 except dry toa/ if !y eat ! beef in/ead ( tak+ ! juice4 ,if !y c take ! /eak ,i pref] _! tak+ x1 b almo/ all cases pref] ! juice4 99 99 99 ,! treatm5t = ! t]tian type ( mal>ia is practically ! same z ! treatm5t = ! qu>tan4 8,! e/ivo-autumnal type ( mal>ia diff]s f ! qu>tan & t]tian types2 fir/1 9 t ! p>oxysms are1 z a rule1 mu* m irregul>2 second1 !y are mu* long] 9 duration2 ?ird1 ! *ills are m frequ5tly abs5t2 f\r?1 ! fev] is (t5 irregul>1 int]mitt5t1 remitt5t1 or cont9u\s 9 "*4 ,?is type v (t5 takes ! =m ( blackwat] or hemoglob9uric type ) hemorrhagic symptoms1 ) hemorrhage f nose1 gums1 & b[els4 ,! fir/ ?+ to d 9 a case ( hemorrhagic mal>ia is to put an ice bag on ! abdom51 :i* w t5d to control ! hemorrhage f ! kidneys4 ,give ! pati5t all ! r$ beef juice y c get him to take1 provid$ he has n develop$ a v sick /oma*2 if s1 give him high sal9e enemas & 9 "o-half h\r give him f\r ounces r$ beef juice p] rectum4 ,repeat ! fe$+ p] rectum 9 f\r h\rs4 ,z soon z he c reta9 any?+ on /oma* give him all ! juice he c take com=tably4 ,treat ! liv] ?or\ghly--at lea/ ?ree times 9 ! fir/ tw5ty-f\r h\rs4 ,at ! end ( ?irty-six h\rs ! yell[ ca/ w be v mu* light]1 :i* is a sure sign t ! pati5t is gett+ bett]4 ,wat* ! ur9e closely4 ,! ?ird day !re may occur a suppression4 ,if s1 give /rong /imulation to ! r5al plexus ?r\gh ! abdom51 & be sure !re is a ?or\gh relaxation ( ! dorsal & lumb> muscles4 8,x is an e/abli%$ fact t p 9 ! mal>ial di/ricts eat v little beef4 ,i f9d t n9ety-n9e p] c5t ( ! cases ( mal>ia nev] eat x1 or :5 !y on r>e occasion d1 x has be5 s ov]cook$ t all ! blood-build+ sub/ances h be5 de/roy$4 ,! beef raw w\ld be bett] 9 my op9ion2 al?\gh1 ! possible *ance ( gett+ a tape-worm or animal p>asite is s consid]able t ,i w\ld advise t ! beef %\ld be heat$ to #bej degrees40--,e4 ,c4 ,,arm/rong1 ,cl9ical ,o/eopa?y4 ,septicemia ,?is t]m is appli$ to any toxic condition caus$ by ! invasion ( ! blood by pa?og5ic micro-organisms1 ) or )\t any visible site ( infection4 ,etiologically1 ! micrococci1 /reptococci1 pneumococci1 or /aphylococci1 z to frequ5cy1 9 ord] nam$1 are ! cause4 ,! infection is usually introduc$ by a w\nd1 ( any degree ( sev]ity4 ,! ut]us is a frequ5t seat foll[+ misc>riage1 p>turition or op]ation4 ,! virus may be absorb$ by ! muc\s membrane4 ,x may also arise f infection ( ! deep] tissues4 ,pa?ologically1 ! *anges are n m>k$1 b consi/ 9 br[ni% color ( ! muscles1 ec*ymotic spots 9 ! pia mat] & d>k appe>ance ( ! blood1 :i* is also less coagulable4 ,sple51 liv] & lymphatics are enl>g$ ) "s *anges 9 ! o!r organs4 ,symptoms4--,! incubation p]iod is f f\r to six days & ! onset is gradual1 ?\gh (t5 ann\nc$ by a di/9ctive *ill1 foll[$ by a pr(use sweat4 ,! mo/ common type is ! cont9u\s =m ( fev]1 :i* may1 9 morn+ remissions1 become subnormal4 ,pulse is rapid at ! beg9n+1 b z c>diac failure comes on1 x becomes weak]4 ,9 ! e>li] /ages !re may be vomit+ ) di>rhea lat]4 ,!re are puncti=m hemorrhages ( ! sk9 & possibly o!r eruptions4 ,blood exam9ation w settle any d\bt z to diagnosis4 ,prognosis is good 9 l>ge p]c5t ( cases & dep5ds ^u ! g5]al heal? ( ! pati5t4 ,treatm5t4--8,incise & dra9 ! infect$ "p2 if possible1 apply hot boracic acid compresses or keep "p susp5d$ 9 hot boracic acid solution4 ,o/eopa?ic treatm5t w aid mat]ially 9 /imulat+ & /r5g!n+ ! pati5t4 ,b[els1 kidneys & sk9 mu/ be kept active4 ,normal salt solution1 hypod]mically or p] rectum is ( value4 ,diet %\ld be liquid1 fruit juices1 bro?s1 s\ps until temp]ature has rema9$ normal tw5ty-f\r h\rs !n milk1 eggs etc41 9 gradually increas+ am\nts until g5]al diet is re/or$4 ,amputation ( ! "p may be necess>y40--,l4 ,e4 ,,br[ne4 ,pyemia ,a febrile disease aris+ f an invasion ( ! blood by pa?og5ic bact]ia1 :]e9 sepsis & multiple abscesses occur f absorption & meta/asis4 ,etiologically1 ! cause may be trac$ to v>i\s specific organisms :i* ent] ! blood /ream & produce ?rombophlebitis4 ,f ^! po9ts & f o!r bact]ia1 new foci are e/abli%$4 ,occasionally ! lymphatics c>ry ! g]ms4 ,! disease may also />t f ulc]ative endoc>ditis or :5 ! app5dix is infect$4 ,pa?ologically1 ?rombosis ( ! ve9 may take place 9 any region4 ,abscesses may =m 9 ! lungs1 liv]1 sple5 or o!r int]nal organs4 ,! small abscesses may unite & =m a l>ge "o4 ,! sk9 pres5ts eruptions & hemorrhagic extravasations1 :ile !re may be ulc]s ( ! muc\s membrane1 also ! s]\s surfaces may be purul5tly inflam$4 ,! muscles1 subcutane\s & osse\s tissue occasionally h abscesses4 ,ulc]ative & suppurative he>t lesions occur4 ,symptoms4--,! incubation p]iod is %ort4 ,!re may be slight fev]1 b commonly a *ill is ! fir/ symptom1 :i* may reoccur = "s "t4 ,! fev] is ei!r remitt5t or int]mitt5t & :5 ! temp]ature is l[1 sweat+ is a feature4 ,! pulse becomes rapid & weak1 :5 ! disease is sev]e2 brea?+ becomes difficult4 ,sk9 symptoms1 su* z eruptions & pu/ules1 g5]ally occur4 ,9 a ^w1 !re is a g5]al intoxication4 ,!re is a less5$ numb] ( r$ blood corpuscles & leucocytosis is a *>act]i/ic4 ,9 grave cases1 delirium & coma are pres5t4 ,diagnosis4--,! hi/ory ( ! case & symptoms w usually r5d] diagnosis easy1 al?\gh c>e is necess>y to det]m9e f septicemia4 ,mal>ia1 typhoid & acute tub]culosis mu/ be exclud$4 ,prognosis4--,mu* dep5ds on asepsis & surg]y b on ! :ole x is unfavorable4 ,treatm5t4--,surgical int]f]5ce & treatm5t z outl9$ "u septicemia is ! only hope4 ,d5gue 7,,breakbone ,,fev]7 ,def9ition4--,an acute infecti\s disease2 *>act]iz$ by a d\ble febrile p>oxysm1 sev]e pa9s 9 ! muscles & jo9ts & sometimes a sk9 eruption4 ,etiology4--,x is a disease ( tropical & subtropical regions4 ,unhygi5ic conditions pr$ispose to an attack4 ,dur+ an epidemic a s+le attack is ! rule4 ,! disease spreads f place to place along ! l9es ( travel1 attack+ bo? sexes1 & all ages4 ,x occurs 9 epidemics1 practically affect+ e "o4 ,! specific g]m has nev] be5 isolat$ z x is probably ultra-microscopic b !re is no d\bt b t x is c>ri$ by ! mosquito ,culex fatigans4 ,symptoms4--,! incubation p]iod la/s ab\t f\r days4 ,! onset is abrupt ) a slight *ill1 heada*e1 & extreme pa9 9 ! jo9ts & muscles1 ( a bor+ or break+ "*4 ,! jo9ts become r$1 swoll5 & pa9ful4 ,! fev] rises gradually to #ajc or #ajf degrees ,f41 or ov]4 ,! pulse is rapid & full & ! respirations are mu* quick5$4 ,! face is flu%$1 ! tongue coat$1 ! appetite is lo/1 & slight nausea occurs4 8,black vomit10 simil> to t ( yell[ fev]1 has be5 obs]v$ 9 ?is disease4 ,hemorrhages f v>i\s organs may occur & ! lymphatic gl&s are swoll54 ,! ur9e is scanty & ! b[els con/ipat$4 ,febrile album9uria & delirium are r>e4 ,at ! end ( ?ree or f\r days ! temp]ature falls & !re is a p]iod ( remission2 ! pati5t is free f pa91 b pr(\ndly pro/rat$4 ,dur+ ?is "t ! eruption g5]ally appe>s1 b is nev] con/ant 9 "*4 ,aft] a remission ( two or ?ree days1 ! symptoms reappe> & a second febrile p>oxysm sets 94 ,?is is usually mild] & %ort] ?an ! fir/1 la/+ two or ?ree days1 :5 convalesc5ce beg9s4 ,! duration is1 accord+ to m$ical writ]s1 f sev5 to t5 days1 & convalesc5ce sl[4 ,dea? seldom occurs1 s practically no pa?ological *anges h be5 record$4 ,by o/eopa?ic treatm5t1 ,e4 ,b4 ,ligon has be5 able to conf9e ! attack to f\r or five days duration2 ?is is confirm$ by ! exp]i5ce ( ,n4 ,*apman4 ,diagnosis4--,dur+ an epidemic ! disease attacks all classes alike1 & ! di/9ct remission r5d]s ! diagnosis comp>atively easy4 ,an occasional case might be mi/ak5 = acute rheumatism1 b ! abs5ce ( any gl&ul> swell+ or eruption1 :ile ! pa9 is m closely limit$ to ! jo9ts1 w aid 9 ! diagnosis4 ,c>e has to be tak5 t yell[ fev] is n mi/ak5 = d5gue4 ,treatm5t4--,! indications ( ! treatm5t are to ma9ta9 ! pati5t's /r5g? & to treat ! lead+ symptoms z !y arise4 ,! sev]ity ( an attack c probably be less5$ at ! />t by /rong & ?or\gh treatm5t ( ! suboccipital1 upp] dorsal1 l[] dorsal & l[] lumb> regions1 respectively1 s z to control ! l>ge vascul> areas by means ( ! vasomotor n]ves ( ! cranial region1 ( ! lungs1 ( ! splan*nic region1 & ( ! l[] limbs1 ?us equaliz+ ! entire vascul> sy/em4 ,elim9ation %\ld be pu%$ & ! excretory organs /imulat$4 ,ligon has obs]v$ t ! c]vical & lumb> regions are especially t5d] on ! second day & ! l[] dorsal region on ! ?ird day4 ,! mo/ sev]e symptoms disappe>$ )9 a few h\rs aft] treatm5t & ! attack 0 m>k$ly %ort5$4 ,! high fev] may be treat$ by ! usual me?ods & by ! ext]nal application ( cold wat]4 ,! pa9 is to be controll$1 accord+ to ! region affect$1 by a correction ( p>ts imp++ ^u ! n]ve tissues & by /rong inhibition4 ,! entire sp9al region %\ld be kept con/antly 9 a relax$ condition1 z f> z muscul> contractions are conc]n$4 ,p>ticul>ly %\ld ! treatm5t be ext5sive along ! sp9e dur+ pro/ration4 ,n4 ,*apman1 9 addition to ! o/eopa?ic treatm5t1 has ! pati5t dr9k consid]able hot wat]2 also employs ! hot ba?4 ,! treatm5t frequ5tly %ort5$ ! attack4 ,dur+ ! entire attack ( ! disease1 ! pati5t %\ld be kept 9 b$ & a c>efully regulat$ diet adm9i/]$4 ,relapses are n infrequ5t4 ,a suitable *ange ( air may ha/5 convalesc5ce4 ,c]ebrosp9al ,m5+itis ,def9ition4--,a specific1 infecti\s disease caus$ by ! diplococcus intracellul>is m5+itidis1 occurr+ sporadically & 9 epidemics4 ,x is *>act]iz$ by inflammation ( ! membranes ( ! bra9 & sp9al cord & an irregul> c\rse4 ,o/eopa?ic ,etiology & ,pa?ology4--,! specific excit+ cause ( ! c]ebrosp9al m5+itis is due to ! diplococcus intracellul>is m5+itidis ( ,wei*selbaum4 ,lesions are f\nd 9 ! v]tebr correspond+ to ! c]vical & dorsal enl>gem5t ( ! cord1 z well z 9 correspond+ deep muscles2 also1 z is well kn[n1 ! muscles ( ! entire back are sev]ely contract$1 especially ( ! c]vical1 upp] & l[] dorsal regions4 ,m commonly x attacks ! "y1 al?\gh x may occur at any age4 ,ov]ex]tion1 exposure1 ov]cr[d$ & illy-v5tilat$ build+s1 b>racks & t5em5ts1 & depress+ m5tal influ5ces are pr$ispos+ causes4 ,_m times ! disease occurs among ! poor] classes4 ,sometimes ! disease prevails 9 ! c\ntry r ?an 9 ! city4 ,9 cases t prove spe$ily fatal !re may be no *>act]i/ic *anges2 simply m>k$ conge/ion4 ,o!r cases 9 :i* dea? occurs aft] ! disease has be5 fully develop$1 !re is f\nd e degree ( inflammation f slight hyp]emia to suppurative *anges4 ,!re c be no d\bt t ! o/eopa?ic lesion1 z v]tebral & rib lesions & deep muscul> contractions1 affects ! circulation ( ! m5+es ( ! bra9 & cord & ?us favors ! invasion ( ! specific micro-organism4 ,! art]ies1 ve9s & s9uses are greatly engorg$4 ,! walls ( ! v5tricles s(t5 & ! v5tricles conta9 s]\s exudate4 ,! bra9 matt] may be conge/$ & s(t5$ 9 spots4 ,9 ! sp9al membranes simil> *anges take place & at times !re is extravasation ( blood4 ,! *anges are m m>k$ on ! po/]ior ?an ! ant]ior surface ( ! cord4 ,abscesses sometimes =m4 ,! exudate may foll[ ! lymph %ea?s ( ! cranial n]ves1 especially ! auditory & optic4 ,9 long /&+ cases ! membranes become ?ick & adh]5t & areas ( s(t5+ or atrophy ( ! cortex develop4 ,! ?ick5+ & adhesions ( ! membranes may cause v>i\s symptoms = mon?s or ev5 ye>s aft] recov]y f ! acute disord]4 ,! sple5 may be normal 9 size1 b :5 ! fev] has be5 int5se1 x is apt to be slightly enl>g$4 ,bron*itis1 pneumonia1 endoc>ditis & pleurisy may occur4 ,! liv] may become hyp]emic & ! kidneys conge/$4 ,symptoms4--,! prodromes v>y1 al?\gh ! onset is apt to be sudd5 ) a decid$ *ill2 heada*e2 vomit+1 & pa9 9 ! neck & back1 :i* is usually sev]e1 b may be s slight z n to be notic$ by ! pati5t4 ,! temp]ature rises to #aja to #ajb degrees ,f41 9 mo/ cases4 ,h[ev]1 x may rise to #aje degrees or #ajf degrees & ev5 to #ajh degrees 9 fatal cases1 & ! pulse is full4 ,hyp]e/hesia1 photophobia1 & dread ( noise are apt to be prom95t symptoms4 ,! muscles ( ! neck & back become rigid1 & !re are pa9s 9 ! limbs4 ,or?otonos occurs m frequ5tly ?an opi/hotonos4 ,convulsions are common 9 *ildr54 ,!re may be p>alysis1 especially ( ! muscles ( ! face & eyes4 ,delirium usually appe>s e>ly2 x may be mild1 b x is (t5 maniacal4 ,! b[els are usually conf9$1 ?\gh !re may be di>rhea4 ,!re is mod]ate & con/ant leucocytosis & jaundice has be5 met )4 ,! ur9e is sometimes album9\s1 & sug> has be5 not$ 9 r>e cases4 ,! ur9e may be increas$1 b m (t5 x is less5$ z 9 o!r infecti\s diseases4 ,h]pes facialis occurs %ortly aft] ! onset 9 m ?an half ! cases4 ,! cont5ts ( ! vesicles may be purul5t & "o or two may coalesce4 ,! pete*ial eruptions are occasionally num]\s & cov] ! entire sk92 !y d n disappe> ^u pressure & ! numb] ( spots v>ies greatly4 ,o!r eruptions z sudam9a1 ec?yma1 pemphigus1 urtic>ia1 erysipelas1 rose color$ spots1 & gangr5e ( ! sk9 7r>ely7 h be5 met )4 ,9 cases t are rapidly fatal1 ! onset is sudd51 usually ) viol5t *ills1 heada*e1 depression1 & 9 a few h\rs coma & collapse1 :i* are soon foll[$ by a fatal t]m9ation4 ,! temp]ature may rise slightly1 b x is (t5 subnormal4 ,! pulse is feeble2 brea?+ is labor$4 ,^! cases occur m frequ5tly at ! beg9n+ ( an epidemic4 ,!y occasionally occur sporadically4 ,! abortive =m t]m9ates abruptly aft] ! developm5t ( "o or m pron\nc$1 *>act]i/ic symptoms4 ,! mild =m c only be recogniz$ dur+ ! preval5ce ( an epidemic4 ,! symptoms are v mild2 slight vomit+1 little or no fev]1 heada*e & slight pa9 9 ! back & limbs4 ,! int]mitt5t =m is *>act]iz$ by increase 9 ! fev] e day or second day4 ,! /rict p]iodicity se5 9 mal>ia is n obs]v$2 ! fev] resembles t ( pyemia4 ,9 ! *ronic =m ! condition may p]si/ = weeks or mon?s4 ,complications4--,pneumonia 7lob> & lobul>7 is a frequ5t complication4 ,pleurisy1 p]ic>ditis1 p>otitis1 ar?ritis1 ent]itis1 optic neuritis & otitis m$ia may be o!r complications4 ,sequel4--,bl9dness1 deafness1 k]atitis 7r>ely71 p]si/5t heada*e1 *ronic hydrocephalus1 abscess ( ! bra91 m5tal feebl5ess1 defective articulation1 aphasia1 & p>alysis ( c]ta9 cranial n]ves or ( ! l[] extremities h occurr$4 ,diagnosis4--,typhoid fev] beg9s sl[ly & is unaccompani$ by vomit+1 muscul> spasms or rigidity1 or hyp]e/hesia4 ,9 typhoid ! fev] is high] & !re is a *>act]i/ic temp]ature curve4 ,widal's te/ w confirm4 ,tub]cul> m5+itis is n epidemic & has no *>act]i/ic eruption4 ,x is usually less sudd5 9 its developm5t & is inv>iably fatal4 ,retraction ( ! neck1 muscul> spasms ( ! legs & arms are n s m>k$ z 9 sp9al m5+itis4 ,pneumonia may be complicat$ ) m5+itis1 especially :5 ! m5+itis is conf9$ to ! c]ebrum4 ,if ! case is n se5 e>ly1 x is almo/ impossible to say :i* is ! prim>y affection1 z pneumonia may h m5+eal complications or c]ebrosp9al m5+itis may be associat$ ) pneumonia4 ,!re w be motor spasms & tremors1 b ! head is r>ely retract$1 & !re is less myalgiac pa9 ?an 9 c]ebrosp9al m5+itis4 ,prognosis4--,?is v>ies accord+ to ! sev]ity ( ! type4 ,x is a grave disease4 ,cases h be5 treat$ successfully by sev]al o/eopa?s4 ,! duration is v v>iable--f two or ?ree days to weeks or ev5 mon?s1 b probably 9 all cases ?is "t c be mat]ially %ort5$ by judici\s o/eopa?ic treatm5t4 ,convalesc5ce is v sl[ & relapses are prone to occur4 ,treatm5t4--,! o/eopa?ic treatm5t ( c]ebrosp9al m5+itis requires mo/ ?or\gh1 b v c>eful1 "w along ! sp9al column1 especially ! c]vical region & ! region ( ! dorsal enl>gem5t ( ! sp9al cord1 9 relax+ & keep+ relax$ ! deep muscles on ei!r side ( ! sp9e & correct+ ! d]angem5ts ( ! v]tebr1 p>ticul>ly 9 ! upp] c]vical sp9e4 ,su* treatm5t has a m>k$ effect on ! circulation ( ! sp9al cord & bra94 ,probably1 a l>ge am\nt ( ! "w along ! sp9e1 9 all cases :]e muscles are relax$1 has a direct effect ^u ! circulation ( ! sp9al cord4 ,?is treatm5t con/itutes ! prim>y o/eopa?ic "w 9 c]ebrosp9al fev] & %\ld be frequ5tly appli$ until a cure is obta9$4 ,ev5 9 *ronic cases :]e limbs h be5 greatly affect$ by pressure ^u ! n]ve c5t]s1 due to a ?ick5$ membrane1 cont9u$ o/eopa?ic treatm5t along ! sp9e has _h a m>k$ effect 9 absorb+ ! pa?ological condition & re/or+ /r5g?4 ,! prec$+ sp9al treatm5t is also a v great safegu>d 9 keep+ ! v>i\s visc]a heal?y & ?us prev5t+ complications4 ,9 all con/itutional diseases ( an acute nature1 x is a wise precaution to ?or\ghly exam9e ! entire l5g? ( ! sp9al column at ea* visit2 & if su* precaution is tak5 _m s]i\s complications w nev] occur t might o!rwise h tak5 place4 ,! pati5t %\ld be isolat$ 9 a some:at d>k5$ room1 & c>e tak5 t ! disease is n all[$ to spread4 ,keep ! pati5t ^u 8 sides z mu* z possible4 ,! diet %\ld be a nutriti\s "o ( milk & bro?s4 ,!y %\ld dr9k freely ( wat]4 ,cold to ! head & sp9e w be ( s]vice 9 controll+ ! inflammation2 x %\ld be appli$ ) an ice-cap & a sp9al ice-bag4 ,spong+ ! body %\ld be employ$ if ! temp]ature is above #ajb ,f4 ,! g5]al ba?1 z 9 typhoid fev]1 may be employ$ if practicable4 ,direct treatm5t to ! b[els1 kidneys1 liv] & sple5 %\ld be giv5 at ea* treatm5t4 ,lumb> puncture & ! ,flexn]-,jobl+ s]um are consid]$ ( value by ^? :o h _h an ext5sive exp]i5ce4 ,diph!ria ,def9ition4--,an acute1 infecti\s disease1 caus$ by ! ,klebs-,loeffl] bacillus1 & *>act]iz$ by a membran\s exudation on ! muc\s membrane ( ! fauces1 l>ynx or nose1 & by con/itutional symptoms4 ,! pres5ce ( ! ,klebs-,loeffl] bacillus di/+ui%es true diph!ria f any o!r =m ( membran\s inflammation4 ,! t]m diph!roid is appli$ to all su* =ms z are n due to ! ,klebs-,loeffl] bacillus4 ,o/eopa?ic ,etiology & ,pa?ology4--,! excit+ cause is ! ,klebs-,loeffl] bacillus4 ,! pr$ispos+ cause is ob/ruction to ! circulation ( ! ph>ynx & tonsils by subdislocations ( upp] c]vical v]tebr1 & ev5 ! l[] c]vical & upp] dorsal1 & sev]ely contract$ deep muscles ( ! neck4 ,! /asis ( blood favors ! gr[? ( ! bacillus4 ,l9k#ee says3 8,! cause ( nasal1 ph>yngeal or l>yngeal diph!ria is ob/ruction ( ! blood & lymph ?r\gh ! neck & ! ob/ruction occurs z a result ( lesions 9 ! c]vical region1 affect+ ! c]vical sympa!tics1 or lesions 9 ! upp] ?oracic region :5ce ! vasomotor fib]s arise4 ,a d]angem5t ( ! v]tebral articulation ( ! fir/ rib is usually f\nd4 7,?is affects ! /ellate ganglion & fib]s ( ! sympa!tic *a974 ,^! lesions cause a condition ( l[]$ vitality ( ! mucosa ( ! nose & ?roat2 ! abnormal secretion favor+ ! rapid multiplication ( ! ,klebs-,loeffl] bacillus--! excit+ cause ( ! disease40 ,dr4 ,/ill believ$ t1 among o!r lesions1 contract+ ( tissues involv+ ! scal5i & di/urb+ ! relations ( ! fir/ rib ) ! clavicle & v]tebra are causative factors4 ,! con/itutional symptoms are produc$ by ! tox9s g5]at$ by ! bacillus & absorb$ f ! diseas$ spots by ! lymphatics & blood-vessels4 ,! bacillus is non-motile & does n usually p5etrate ! mucosa1 b rema9s v ne> ! site ( ! local *anges al?\gh !re are in/ances :]e x may ent] ! blood & o!r tissues4 ,! bacillus is v resi/ant & c ma9ta9 an exi/5ce = mon?s outside ( ! body4 ,!re is great v>iation 9 ! virul5ce ( ! ,klebs-,loeffl] bacillus2 x has be5 f\nd 9 heal?y ?roats1 & sometimes ! bacillus may exi/ 9 ! ?roat aft] an attack ( diph!ria = mon?s aft] all ! membrane has disappe>$4 ,x has also be5 f\nd 9 cases ( simple cat>rhal ang9a )\t membrane1 & 9 simple tonsillitis ,( ! bact]ia associat$ ) ! bacillus ( diph!ria1 ! /reptococcus pyog5es is ! mo/ common & probably ! mo/ active4 ,! /aphylococcus1 micrococcus lanceolatus & bacillus coli communis are also f\nd4 ,! contagion is communicat$1 z a rule1 ?r\gh ! air1 by means ( fomites f ! membran\s exudate or dis*>ges f ! diph!ritic pati5ts1 or dur+ convalesc5ce1 f secretions ( ! nose & ?roat4 ,infect$ milk may cause ! disease4 ,mo/ cases occur 9 *ildhood1 betwe5 ! second & sev5? ye>4 ,! disease is mo/ preval5t 9 ! cold autumn & spr+ mon?s4 ,x is mo/ frequ5tly met ) 9 temp]ate & cold climates4 ,defective dra9age1 cat>rhal conditions ( ! ?roat1 enl>g$ tonsils1 g5]al weakness1 & feeble resi/+ p[] are pr$ispos+ factors4 ,"o attack does n conf] immunity f ano!r1 b r pr$isposes to a second4 ,! false membrane is usually f\nd on ! tonsils1 ! pill>s ( ! fauces & ! ph>ynx1 & 9 fatal cases x may be ext5sive & involve ! uvula1 ! s(t palate & ! po/]ior n>es1 & ev5 ! tra*ea & bron*i4 ,at fir/ ?is membrane is yell[i% :ite1 b lat] may become gray2 x is m or less adh]5t & :5 torn (f leaves a raw surface4 ,! diph!ritic poison com+ 9 contact ) ! ?roat leads to1 fir/1 a necrosis or dea? ( ! epi!lial cells1 especially ! m sup]ficial1 & ! leucocytes4 ,! second *ange is ! hyal9e trans=mation1 & simultane\sly coagulation2 h5ce ! t]m coagulation-necrosis4 ,! irritation produc$ by ! bacilli causes a migration ( leucocytes & ^! are de/roy$ & und]go hyal9e trans=mation4 ,?is process proce$s f )\t inw>d & is usually sup]ficial1 & ! necrosis may be ext5sive1 involv+ ! deep] tissues1 caus+ ulc]ation & a gangr5\s condition ( ! p>ts4 ,! erosion ( ! tonsils may be s sev]e z to attack ! c>otid art]y4 ,! lymphatic gl&s are consid]ably swoll54 ,! sple5 is commonly enl>g$4 ,! kidneys %[ p>5*ymat\s *anges4 ,! blood is d>k & fluid4 ,fatty deg5]ation ( ! he>t is n infrequ5t4 ,sometimes fibr9\s coagula are f\nd 9 ! he>t4 ,capill>y bron*itis1 cat>rhal pneumonia & areas ( collapse are almo/ con/antly f\nd on exam9ation ( ! lungs 9 fatal cases4 ,! ur9e is typically febrile ) e>ly album9 & (t5 tube ca/s & r5al epi!lium4 ,! blood %[s an excess ( r$ blood cells :i* may rea* #g1ejj1jjj4 ,hemoglob9 is slightly r$uc$4 ,!re is consid]able anemia dur+ convalesc5ce dep5d+ ^u sev]ity ( toxemia4 ,symptoms4--,! incubation p]iod v>ies f "o to t5 days1 usually two or ?ree days4 ,accord+ to ! location1 diph!ria may be divid$ into ph>yngeal1 l>yngeal & nasal =ms4 ,9 ,ph>yngeal ,diph!ria1 :i* is mo/ common1 !re is fir/ a slight *ill or *ill9ess1 foll[$ by fev] & sore ?roat1 bo? ( :i* increase rapidly4 ,! ?roat is swoll5 & r$ & ! pati5t compla9s ( difficult swall[+4 ,! membrane beg9s on ! tonsils 9 ! =m ( grayi%-:ite pat*es2 x !n spreads f ! tonsils to ! s(t palate1 sometimes cov]+ ! uvula4 ,! c]vical gl&s are swoll5 & t5d]4 ,! neck muscles are contract$ & some:at difficult to relax4 ,! temp]ature rises to #ajb or #ajd degrees ,f4 ,! pulse is rapid & feeble1 rang+ f #abj to #adj4 ,!re is loss ( appetite4 ,!re is m or less pro/ration dep5d+ ^u ! gravity ( ! con/itutional symptoms4 ,! av]age duration is f "o to two weeks4 ,l>yngeal ,diph!ria 7,membran\s ,cr\p7 may be second>y to ext5sion f ! fauces or x may be prim>y4 ,at fir/ !re is slight ho>s5ess & a h>%1 metallic1 r++ c\gh4 ,^! symptoms may p]si/ = a day or two1 :5 ! *ild sudd5ly becomes worse2 !re is m>k$ dyspnea & ! lips & f+] tips become livid4 ,! *ild soon becomes v re/less4 ,! temp]ature may be slightly above normal & ! pulse increas$ 9 frequ5cy4 ,9 favorable cases ! dyspnea is n v m>k$ & ! *ild probably w h only "o or two p>oxysms1 :5 x w fall asleep & wake 9 ! morn+ feel+ v com=table4 ,! next night1 h[ev]1 ! attack may be m pron\nc$4 ,9 extreme cases dea? may result f suffocation4 ,9 "s cases ! suffocation is sl[] & results f ext5sion ( ! membrane d[nw>d into ! bron*i4 ,dr4 ,/ill f\nd same conditions z 9 diph!ria1 b also ! hyoid is involv$ ) ! sup]ior l>yngeal n]ve4 ,! sacral & lumb> n]ves are also involv$4 ,he always emphasiz$ *ill+ ( gluteal region z a cause = cr\p & t heat %\ld be appli$ at ! inception ( ! disease4 ,nasal ,diph!ria is g5]ally second>y1 b x may be a prim>y affection4 ,9 _m cases no membrane is f\nd2 9 o!rs !re may be a pseudo-membrane =m$ 9 ! nose1 b !re is abs5ce ( any sy/emic di/urbance4 ,! ,klebs-,loeffl] bacillus is sometimes pres5t 9 ^! membranes4 ,nasal diph!ria may be a v grave disease--! con/itutional symptoms be+ great pro/ration1 high fev]1 m>k$ gl&ul> swell+1 irritat+ & (f5sive dis*>ges f ! nose1 & epi/axis4 ,inflammation occasionally ext5ds ?r\gh ! te> duct to ! conjunctiva4 ,a diph!ritic membrane may gr[ :]e ! sk9 has be5 cut or bruis$1 b ! bacillus _c live on normal sk94 ,x n\ri%es on a raw1 moi/ surface & membranes h gr[n on ! lips1 tongue1 vulva1 glans p5is1 & on ulc]ative surfaces & w\nds4 ,diph!ria occurs occasionally 9 ! conjunctiva & ! ext]nal auditory meatus4 ,x %\ld be rememb]$ t !re are _m atypical =ms ( diph!ria4 ,bact]iological exam9ation %\ld always be made 9 suspici\s & puzzl+ cases4 ,! complications ( diph!ria are nephritis1 hemorrhages1 ra%es1 capill>y bron*itis1 pulmon>y collapse1 cat>rhal pneumonia1 myoc>ditis1 ar?ritis1 otitis m$ia1 & p>alysis4 ,diagnosis4--,! pres5ce ( ! ,klebs-,loeffl] bacillus w at once decide ! diagnosis ( diph!ria4 ,prognosis4--,! prognosis %\ld always be gu>d$4 ,! nasal & l>yngeal =ms are always grave4 ,! causes ( dea? are involvem5t ( ! l>ynx1 septic infection1 he>t failure1 bron*opneumonia dur+ convalesc5ce1 & r>ely1 uremia4 ,treatm5t4--,hygi5ic & prophylactic measures are important4 ,a room %\ld be select$ t is v5tilat$ & expos$ to ! sunlight4 ,all unnecess>y articles ( furniture %\ld be remov$4 ,great c>e mu/ be tak5 aga9/ ! spread ( ! disease4 ,always isolate ! pati5t & dis9fect ev]y?+ t has come 9 contact ) him4 ,! greate/ dang] lies 9 ! spread ( ! disease dur+ convalesc5ce & 9 ! ambulatory =m1 :5 pati5ts are ab\t & com+ 9 contact ) individuals1 especially *ildr5 ) cat>rhal conditions ( ! nose & ?roat4 ,! physician %\ld be c>eful ab\t dis9fect+ himself4 ,9 view ( ! fact t _m o/eopa?s h treat$ successfully num]\s cases ( diph!ria & t ! o/eopa?ic treatm5t is peculi>ly indicat$ & effective1 ! probable requirem5t ( antitox9 7! use ( :i* we d n feel call$ ^u to discuss7 w\ld be less5$4 ,relative to ! antitox9 ,osi] says3 8,! pr9ciple ( action dep5ds on ! circum/ance t ! blood s]um ( an animal r5d]$ immune1 :5 introduc$ into ano!r animal1 protects x f infection ) ! diph!ria bacilli1 & has also an important curative influ5ce ^u diph!ria1 :e!r artificially giv5 to animals1 or spontane\sly acquir$ by man40 8,! treatm5t ( diph!ria by o/eopa?ic me?ods is (t5 a pleasure r ?an a trial because ( ! success :i* rew>ds u = our ef=ts4 ,!re has be5 consid]able discussion by ! memb]s ( our pr(ession reg>d+ ! me?ods to be employ$ 9 successfully ov]com+ ?is disease1 & _m h express$ ! view t s9ce antitoxic s]um is a physiological rem$y1 :i* naturally belongs to all s*ools ( heal+1 x %\ld be employ$ by ! o/eopa?ic physician 9 cases ( diph!ria4 ,i h no objections to ! use ( ! s]um !rapy by memb]s ( ! pr(ession :o consci5ti\sly feel t !y ne$ x 9 _! practice to secure ! highe/ success4 ,h[ev]1 ,i feel1 on ! o!r h&1 t if !y 7 well acqua9t$ ) ! te*nique ( ! me?ods 99 99 99 !y w\ld n feel x to _! advantage1 f ! /&po9t ( success1 to use injections 9 a s+le case40--,r4 ,d4 ,,em]y1 ,cl9ical ,o/eopa?y4 ,! local treatm5t %\ld be c>efully1 b vigor\sly1 giv54 ,by prop] treatm5t ( ! ?roat ! ext5sion ( ! disease may be prev5t$4 ,! muscles ab\t ! ?roat1 especially ! deep ones1 %\ld be ?or\ghly relax$ & ! c]vical v]tebra2 correct$ if displac$4 ,! vasomotor n]ves to ! blood vessels ( ! affect$ region require c>eful treatm5t at ! sup]ior c]vical ganglion1 & ! c]vical lymphatics f ! atlas to ! fir/ rib %\ld be closely wat*$4 ,! n]ves to control are ! vagi1 glosso-ph>yngeal1 sp9al accessory1 & sympa!tic n]ves to ! ph>yngeal plexus1 & 9 cases ( nasal diph!ria ! fif? n]ve has to be c>efully treat$4 ,an ext]nal treatm5t to ! ph>ynx w h ! greate/ effect on ^! n]ves4 ,an int]nal treatm5t to ! n]ves ( ! s(t palate w be ( consid]able s]vice4 ,! p>ts diseas$ %\ld be dis9fect$ & kept z clean z possible4 ,bi*loride ( m]cury 7#a 3 #djjj7 us$ z a spray w be f\nd satisfactory1 al?\gh !re are sev]al o!r dis9fectants & g]micides t may be us$4 ,pellets ( ice 9 ! m\? w be a com=t to ! pati5t4 ,cold appli$ ext]nally w be f\nd be/ = ! adult2 heat ext]nally is bett] = ! *ild4 ,e possible means %\ld be us$ to prev5t ! disease f spread+4 ,"o ( ! *ief dang]s ( diph!ria is ! spread ( ! disease to ! l>ynx1 tra*ea & bron*i4 ,:5 ! disease has ext5d$ to ^! p>ts x pres5ts all ! symptoms ( true cr\p4 ,! deep c]vical muscles %\ld be ?or\ghly relax$ to aid 9 reliev+ ! passive hyp]emia & ) a view ( disorganiz+ ! exudate4 ,att5tion %\ld be giv5 to ! upp] ribs1 z int]f]5ces ) ! vasomotor n]ves ( ! muc\s membrane ( ! tra*ea & bron*ial tubes usually occur4 ,direct treatm5t ov] ! l>ynx & local treatm5t ?r\gh ! m\? ^u ! s(t palate w be ( aid4 ,a ?or\gh relaxation ( all ! dorsal muscles1 ev5 z l[ z ! t5? dorsal1 %\ld be giv54 ,inhalations ( slak$1 fre%ly burnt lime may be useful 9 loos5+ ! exudation4 ,9 desp]ate cases tra*eotomy or intubation ( ! l>ynx %\ld be p]=m$4 ,will>d#ef says1 relative to membran\s cr\p3 8,x matt]s n :e!r or n ! l>yngeal inflammation 0 imm$iately caus$ by a g]m2 x w\ld n1 nor c\ld n1 h be5 produc$ by su* _h !re n be5 an unnatural condition ( ! circulation ( & ab\t ! l>ynx40 ,a con/itutional treatm5t %\ld always be giv5 ) a view ( prev5t+ ! spread ( ! disease f "o organ to ano!r & to prev5t complications4 ,! he>t's action %\ld be c>efully wat*$ ?r\gh\t ! entire c\rse ( ! disease4 ,treatm5t ( ! sp9al cord w gu>d aga9/ p>alysis t sometimes foll[s ! v5\s hyp]emia ( ! vascul> l9+s & sub/ance ( ! bra9 & sp9al cord4 ,pay p>ticul> att5tion to ! upp] dorsal region to prev5t possible he>t involvem5t4 ,po/-diph!ritic p>alysis seldom if ev] occurs 9 cases t are treat$ o/eopa?ically4 ,?is is a common sequela & is pres5t 9 f #aj p]c5t to #cj p] c5t ( cases1 appe>+ )9 ?ree weeks ( app>5t recov]y4 ,sometimes x is ! only result to %[ diph!ria 0 pres5t4 ,x seems to foll[ use ( antitox9 r frequ5tly4 ,att5tion to ! splan*nics & to ! abdom5 directly w t5d to keep ! /oma*1 liv]1 kidneys1 & inte/9es 9 a heal?y /ate4 ,! diet ( ! pati5t %\ld consi/ ( liquid food--milk1 bro?s1 meat juice1 raw eggs & b>ley wat]4 ,let ! pati5t dr9k freely ( wat]4 ,treatm5t ( ! rectum may be employ$ ) b5efit :5 ! ph>ynx is greatly di/urb$4 ,v>i\s sequel & complications are be/ reliev$ or prev5t$1 accord+ to ,l9k1 z foll[s3 8,fir/1 limit+ ! production ( tox9s by a mo/ ?or\gh relaxation ( ! muscles ( ! neck1 !reby favor+ ! unob/ruct$ circulation ( ! blood & lymph2 second1 by ! correction ( lesions :i* affect ! vasomotor ( ! head & neck2 ?ird1 by sp9al treatm5t affect+ ! vasomotor to ! areas involv$2 f\r?1 by increas+ ! activity ( ! excretory organs1 by treatm5t 9 ! splan*nic & lumb> areas1 t ! tox9s may be m rapidly elim9at$4 ,9 cases :]e l>yngeal /5osis is m>k$ & suffocation is imm95t1 intubation %\ld n be delay$40 ,po/-diph!ritic p>alysis usually yields to o/eopa?ic treatm5t4 ,apply treatm5t accord+ to location4 ,dys5t]y 7,,bloody ,,flux74 ,dys5t]y is an infecti\s disease :]e9 ! l>ge inte/9e is inflam$1 ) ulc]ation ( ! muc\s membrane2 is *>act]iz$1 cl9ically1 by frequ5t /ools conta9+ blood & mucus2 fev] & exhau/ion4 ,o/eopa?ic lesions ( an osse\s "* & deep muscul> contractions ( ! lumb> region are always pres5t4 ,^! involve ! vasomotor n]ves to blood vessels & lymph *annels4 ,cat>rh ( ! inte/9al tract is an important pr$ispos+ cause4 ,! disease usually occurs 9 ! summ] & autumn1 & is m common 9 hot1 mal>ial regions1 al?\gh x is f\nd 9 v>i\s climates4 ,unhygi5ic conditions are also important pr$ispos+ factors4 ,9 no disease m ?an dys5t]y does specific correction ( ! osse\s lesion effect quick & satisfactory results4 ,acute ,ileocolitis 7,,bacill>y ,,dys5t]y7 ,?is is ! v>iety mo/ frequ5tly f\nd 9 temp]ate climates4 ,x occurs ei!r sporadically or endemically4 ,! ,flexn] bacillus is frequ5tly f\nd1 z well z pus micro-organisms4 ,!re are v>i\s /ra9s ( ! bacillus4 ,!re is a cat>rhal inflammation ( "p or ! :ole ( ! l>ge b[el4 ,o!r =ms may occur1 z ulc]ative & membran\s4 ,o/eopa?ic ,etiology & ,pa?ology4--,sudd5 atmosph]ic *anges & simple irritants1 su* z unripe & indige/ible food1 are usually ! imm$iate causes4 ,! pr$ispos+ cause ( acute cat>rhal dys5t]y is always f\nd by ! o/eopa? to be due to sp9al d]angem5ts 9 ! lumb> region4 ,! lesion is g5]ally a slight lat]al deviation ( a v]tebra4 ,x is g5]ally f\nd at ! second or ?ird lumb>2 /ill1 ! tr\ble may be f\nd at any po9t 9 ! lumb> section4 ,! lesion involves vasomotor n]ves to ! inte/9al muc\s membrane1 ?us caus+ ! inflammation4 ,! dr9k+ ( impure wat] 9 itself may n be ! cause ( ! disease1 b is a favorable m$ium = ! developm5t ( ! organisms :i* may excite x4 ,dyspeptic conditions & con/ipation seem to pr$ispose to ! disease4 ,! muc\s membrane is inject$ & swoll5 & (t5 cov]$ ) bloody mucus4 ,! follicles ( ,lieb]kuhn are enl>g$ f ret5tion ( _! cont5ts1 ! result ( ! swell+2 ! follicles are (t5 ruptur$ & ! muc\s membrane sl\ghs (f 9 pat*es1 =m+ ulc]s4 ,^! may ext5d along ! :ole colon & frequ5tly into ! ileum4 ,symptoms4--,di>rhea is ! mo/ common initial symptom2 ! /ools be+ copi\s & pa9less4 ,! /ools soon become small & frequ5t1 cov]$ ) mucus & /reak$ ) blood4 ,^! are pass$ ) /ra9+ & t5esmus1 accompani$ by colicky abdom9al pa9s ( a grip+ "*4 ,*ills are r>e4 ,! tongue is furr$ & moi/3 lat] x becomes dry4 ,nausea & vomit+ may be pres5t1 b n z a rule4 ,!re is fev] & (t5 excessive ?ir/4 ,lat] ! /ools become gre5 9 color1 due to ! bile :i* causes a burn+ s5sation 9 ! rectum4 ,on exam9ation !re are f\nd r$ blood-corpuscles & leucocytes1 & l>ge1 r\nd & oval epi!lioid cells conta9+ fat drops & vacuoles4 ,9 mild cases1 ! c\rse is ab\t eight days2 sev]e cases subside )9 f\r weeks1 b if ! o/eopa?ic treatm5t is c>eful & specific1 ! usual duration c g5]ally be r$uc$ "o-half4 ,prognosis4--,! prognosis is g5]ally favorable 9 ! cat>rhal =m :5 ! disease is treat$ prop]ly4 ,! previ\s g5]al heal?1 hygi5ic conditions1 & sanit>y surr\nd+s are ( great importance4 ,:5 !re is ulc]ation or membranes ! prognosis %\ld be gu>d$4 ,! condition may become *ronic4 ,treatm5t4--,! b[el %\ld be ?or\ghly wa%$ out by w>m wat] enema1 sev]al times1 if necess>y1 to remove irritat+ mat]ial4 ,inv>iably a lesion ( ! sp9al column is f\nd at ! ?ird & f\r? lumb>s or ne> by4 ,x is g5]ally a subluxation1 ( a lat]al nature1 betwe5 ^! v]tebr3 r>ely is ! lesion above or bel[ ?is po9t4 ,! treatm5t %\ld be appli$ imm$iately & directly to ?is region4 ,"t is valuable 9 ^! cases & "o %\ld g to "w at once to correct ! irritation4 ,an attempt %\ld be made at ea* treatm5t to correct ! disord]4 ,?is %\ld n be delay$ by wa/+ "t 9 relax+ muscles & inhibit+1 = unusually ?is gives only tempor>y relief4 ,:5 a slight movem5t has be5 accompli%$ betwe5 disord]$ v]tebr1 treatm5t %\ld be /opp$ & results wat*$1 because ! adju/m5t may h releas$ all ob/ructions or irritations caus+ ! disease4 ,9 _m cases1 to get an anatomically correct sp9e is an impossibility1 f ! fact t ! displacem5ts may be ( long /&+ & naturally ! subluxat$ v]tebr h con=m$ !mselves to "s ext5t to _! unnatural position4 ,9 o!r words1 :at has be5 lo/ 9 ! position & relation ( a v]tebra may h be5 comp5sat$ by r$uc+ ! effect ( ! lesion to a m9imum4 ,a lesion ( ?is nature at ! ?ird lumb> impairs ! inn]vation to ! colon & consequ5tly produces a /asis ( blood 9 ! mes5t]ic circulation1 foll[$ by inflammation1 bloody dis*>ges1 cramps1 etc4 ,a s+le treatm5t is usually q suffici5t 9 mild] cases4 ,o!r cases require treatm5t e few h\rs or !reab\ts1 until recov]y4 ,treatm5t directly ov] ! abdom5 ?r\gh ! mes5t]ic circulation & gl&s is an effective treatm5t 9 mo/ cases & especially :5 ! attack is sev]e4 ,x relaxes ! tissues ab\t ! mes5t]y1 !reby reliev+ ! /asis & free+ ! circulation4 ,! greate/ c>e1 h[ev] %\ld be ex]cis$ 9 giv+ ?is treatm5t4 ,! con/ant desire to defecate1 t is common to _m cases1 is a v annoy+ symptom4 ,/rong1 ?or\gh treatm5t ov] ! sacral region1 by inhibition ov] ! sacral =am9a & by relax+ ! t5se muscles ( ! sacrum1 w relieve ?is condition4 ,9 relax+ ^! muscles1 place ! :ole h& aga9/ ! muscles & pu% upw>d t[>d ! occiput4 ,?is treatm5t inhibits ! n]ves to ! rectum & less5s ! t5esmus4 ,att5tion %\ld be paid to ! liv] to keep x active4 ,wa%+ out ! l>ge b[el ) tepid wat] produces a soo?+ effect1 besides hav+ a t5d5cy to allay inflammation4 ,! bl&e/ ( liquid foods1 z peptoniz$ or boil$ milk1 bro?s1 beef juice1 b>ley & rice1 %\ld be giv54 ,! pati5t %\ld rema9 9 b$ until completely cur$4 ,amebic or ,tropical ,dys5t]y ,?is =m prevails 9 ! tropical & subtropical c\ntries = ! mo/ "p1 & is caus$ by an animal p>asite1 ! ameba dys5t]iae4 ,?is is con/antly f\nd 9 ! /ools1 ! tissue ( ! inte/9e & also 9 ! pus ( ! liv] abscesses1 :i* are second>y to dys5t]y4 ,amebae are sometimes f\nd 9 ! /ools ( heal?y m51 hav+ probably ent]$ ! sy/em ?r\gh ! dr9k+ wat] or uncook$ food4 ,pa?ologically1 ! muc\s membrane ( "p or :ole ( ! l>ge inte/9e is swoll54 ,r\nd or irregul> ulc]s :i* und]m9e ! muc\s membrane1 especially ( cecum1 asc5d+ & pelvic colon1 are f\nd4 ,9 lat] /ages !re is infiltration ( ! connective tissue foll[$ by necrosis4 ,9 "s cases false membranes & sl\ghs are =m$4 ,symptoms4--,! onset may be ei!r sudd5 or gradual1 ) a v irregul> di>rhea1 mod]ate fev]1 & copi\s1 liquid /ools1 ab\nd+ ) ! amebae coli4 ,! /ra9+ may be less sev]e & p]si/5t ?an 9 cat>rhal dys5t]y & may be abs5t4 ,sometimes !re is nausea & vomit+4 ,abscess ( ! liv] is ! mo/ common complication1 :i* may be s+le or multiple4 ,:5 s+le x usually involves ! "r lobe4 ,multiple abscesses are small4 ,! m rec5t abscess walls are necrotic2 ! old] h :iti%1 smoo?1 fibr\s walls4 ,^! abscesses d n conta9 pure pus1 b a fatty & granul> debris conta9+ ! amebae & a few cellul> elem5ts4 ,sometimes !y ext5d into ! lung4 ,diagnosis4--,?is dep5ds ^u sev]ity ( attack & g5]al condition ( ! pati5t4 ,relapses (t5 occur & ! case may become *ronic4 ,cases h be5 treat$ o/eopa?ically ) success4 ,treatm5t4--,9 ?is =m ( dys5t]y ! treatm5t is l>gely ! same z 9 acute ileo-colitis4 ,! sp9al lesions affect ! inn]vation to ! inte/9e1 ?us produc+ a /asis 9 ! circulation2 ?is condition favor+1 & 9 fact1 invit+ ! ret5tion ( ! ameba coli 9 ! sy/em at ?is po9t4 ,! diet is ! same z 9 o!r =ms ( dys5t]y4 ,rectal injections & hot applications to ! abdom5 are useful4 ,9 all cases :]e /rong treatm5t has be5 giv5 to ! sp9al column1 a quiet+ treatm5t to ! n]v\s sy/em & an inhibitory treatm5t to ! he>t w be gratefully receiv$ by ! suff]]4 ,bo? ( ^! effects c be accompli%$ at ! same "t by simple inhibition to ! occipital n]ves4 ,! /ools %\ld be tak5 c>e ( imm$iately & dis9fect$4 ,ice wat] enemas giv5 frequ5tly are report$ z giv+ good results4 ,= ! t5esmus1 inhibit /rongly at #c;d1 & #d?1 sacrals4 ,*ronic ,dys5t]y ,?is is g5]ally resultant f an acute attack1 ?\gh ! amebic =m may be subacute f ! onset4 ,pa?ologically1 ! coats are g5]ally ?ick5$1 especially ! submucosa & ! muscul> coats be+ hyp]trophi$4 ,ulc]s are usually pres5t1 al?\gh !re are cases 9 :i* !re are no ulc]s4 ,cicatricial contractions sometimes foll[ & ! calibre ( ! b[els is r$uc$1 /rictures be+ r>e4 ,symptoms4--,!re is a progressive loss ( fle% & /r5g?1 little or no t5esmus1 slight1 colicky pa9 & extreme anemia4 ,! /ools conta9 mucus1 at times blood1 & ! b[els move f two to twelve times a day4 ,diagnosis4--,! hi/ory ( ! initial symptoms w e/abli% ! diagnosis4 ,x is n always possible to di/+ui% betwe5 *ronic dys5t]y & *ronic di>rhea4 ,! duration is f a few mon?s to sev]al ye>s1 al?\gh o/eopa?ic treatm5t has prov5 v effici5t 9 _m in/ances4 ,treatm5t4--,re/ & a liquid diet are mo/ ess5tial4 ,foods t are easily assimilable & n\ri%+1 ) a m9imum am\nt ( residue1 are requir$4 ,beef juice1 beef peptonoids & peptoniz$ milk are ! types ( food4 ,*ange ( air1 hygi5ic measures & environm5t are important4 ,9 cases t become *ronic1 ! sp9al column (t5times exhibits lesions above & bel[ ! lumb> region4 ,und\bt$ly !y are lesions ( second>y importance 9 comp>ison to ! lumb> lesions1 b x is important t !y be correct$4 ,! treatm5t requires ?or\gh1 c>eful "w ( ! disord]$ sp9al column & l[] ribs4 ,occasionally a slight kyphosis is pres5t 9 ! dorso-lumb> region t dem&s p]si/5t "w 9 ord] to correct x4 ,an occasional rectal injection is b5eficial1 especially 9 cases t h slight ulc]ation ( ! sigmoid flexure or rectum caus+ colicky pa9s & a few loose /ools 9 ! morn+1 ! pati5t be+ fairly com=table dur+ ! re/ ( ! day4 ,erysipelas ,def9ition4--,an acute1 infecti\s1 specific disease1 *>act]iz$ by a peculi> inflammation ( ! sk91 due to ! /reptococcus erysipelatis1 ) a t5d5cy to spread4 ,o/eopa?ic ,etiology & ,pa?ology4--,o/eopa?ically1 lesions are f\nd to ! vasomotor n]ves & lymphatics ( ! affect$ area4 ,dr4 ,/ill gives lesions ( ! 8inf]ior maxilla1 ! c]vical v]tebr1 ! clavicles or ! upp] ribs0 z specially important factors4 ,^! lead to conge/ion & pr$ispose to infection4 ,x occurs 9 epidemic =m1 especially 9 ! late w9t] & spr+4 ,"o attack pr$isposes to a second4 ,family pr$isposition ex]cises a slight influ5ce4 ,abrasions1 lac]at$ w\nds1 especially ( ! scalp1 may be ! />t+ po9t ( an attack4 ,p]sons hav+ sk9 diseases & w\nds1 & wom5 :o h be5 rec5tly deliv]$ are liable to be affect$4 ,*ronic ,bright's disease1 *ronic alcoholism1 syphilis1 debility1 ph?isis1 organic he>t disease & unhygi5ic surr\nd+s are pr$ispos+ causes4 ,! specific virus is ! /reptococcus erysipelatis1 :i* acts z a local irritant produc+ ! d]matitis4 ,^! are f\nd 9 ! lymph vessels & cutane\s connective tissue4 ,! fev] & con/itutional symptoms are due to toxic ag5ts4 ,x is an inflammation ( ! sk91 & if uncomplicat$1 no o!r /ructures are involv$4 ,subcutane\s & muc\s tissues may be involv$1 b r>ely2 if s1 !re is apt to be suppuration4 ,visc]al complications are ( a septic "*4 ,endoc>ditis1 p]ic>ditis1 pleuritis-pneumonia1 & nephritis are possible complications4 ,symptoms4--,! incubation p]iod v>ies f two to sev5 days4 ,! onset is g5]ally sudd5 ) *ill1 foll[$ by fev]1 #ajd or #aje degrees ,f4 ,!re may be nausea1 heada*e1 & pa9 9 ! back & limbs4 ,! local inflammation ( ! sk9 foll[s1 usually on *eeks & bridge ( nose1 or at site ( an abrad$ surface4 ,! area is r$1 smoo?1 & edemat\s4 ,x spreads rapidly1 ! pat* be+ elevat$ above ! surr\nd+ tissue & t5se4 ,! swell+ may be s great z to close ! eyes & di/ort ! features4 ,! c]vical gl&s are swoll54 ,! temp]ature cont9ues high = f\r or five days & falls by crisis4 ,! eruption beg9s to subside & a mod]ate desquamation occurs4 ,if ! disease takes a fre% />t ! fev] aga9 rises & cont9ues z long z ! disease spreads4 ,!re is usually heada*e & sometimes delirium4 ,! tongue is furr$1 & b[els con/ipat$ & ! ur9e scanty4 ,z a result ( int5se infiltration ! "p may become gangr5\s4 ,suppuration frequ5tly occurs 9 facial erysipelas4 ,! inflammation may ext5d to ! muc\s membrane ( ! ?roat & m\?4 ,diagnosis4--,?is is n difficult4 ,! fev]1 ! acut5ess ( ! disease1 ! rapidily spread+ eruption1 & ! con/itutional di/urbances w s]ve to di/+ui% x f all o!rs4 ,prognosis4--,?is is usually favorable2 heal?y p]sons r>ely die4 ,convalesc5ce may be sl[4 ,treatm5t4--,isolate ! pati5t = ! disease is contagi\s1 & a ?ird p]son may convey ! virus4 ,! poison may cl+ to clo?+1 furniture1 etc4 ,! physician %\ld n take c>e ( conf9em5t cases4 ,a numb] ( cases ( erysipelas h be5 cur$ by correct+ disord]s 9 ! region ( ! second1 ?ird1 f\r? & fif? dorsals4 ,! lesions are pr9cipally subluxations ( ! ribs & sev]ely contract$ muscles4 ,! disord] at ! po9ts nam$ int]f]es ) ! vasomotor n]ves to ! face1 ?us pr$ispos+ to an attack ( erysipelas by all[+ ! micro-organism cong5ial tissue = its deva/ations4 ,9 _m o!r cases d]angem5ts h be5 f\nd high] ?an ! upp] dorsal1 pr9cipally ?r\gh ! middle & upp] c]vical v]tebr4 ,lesions 9 ^! regions w\ld also int]f]e ) vasomotor fibres1 especially ?r\gh ! fif? n]ve directly4 ,! treatm5ts on ! :ole are to exam9e = lesions to ! inn]vation ( ! affect$ region & remove !m1 besides giv+ special att5tion to ! b[els1 a nutriti\s diet1 & absolute re/4 ,9 cases :]e !re is mu* re/lessness & insomnia1 treat ! upp] c]vical region1 especially ! deep po/]ior muscles#eg4 ,locally1 use cold wat] applications2 adhesive /rips appli$ ne> ! inflam$ area or t9cture ( iod9e1 may prev5t ! disease spread+4 ,yell[ ,fev] ,def9ition4--,an acute1 infecti\s disease1 *>act]iz$ by a febrile p>oxysm foll[$ by %ort remission & !n relapse1 jaundice1 toxemia1 suppression ( ! ur9e1 & ga/ric hemorrhage4 ,o/eopa?ic ,etiology & ,pa?ology4--,:ile a specific g]m is ! cause ( yell[ fev]1 x has n z yet be5 isolat$4 ,ext5d$ te/s by ,unit$ ,/ates ,army surgeons 9 ,cuba %[ conclusively t ! infection is alone c>ri$ by ! /egomyia fasciata1 b 8,x rema9s some:at unc]ta9 :e!r ! mosquito is ! sole means ( transmission40 7,&]s74 ,season is ! *ief pr$ispos+ cause z ! outbreak is usually 9 summ] & a fro/ ends its spread4 ,immunity is g5]ally conf]r$ by "o attack4 ,tuck]#eh not$ t all cases exam9$ _h liv] lesions & t mo/ ( ! pati5ts 7 ( ! mal>ial or bili\s type4 ,sp9al lesions 7 n m>k$ 9 "s cases1 b :5 pres5t 7 9 ! liv] & r5al areas4 ,tete#ei believes x to be a virus secret$ 9 ! human organism "u c]ta9 atmosph]ic & o!r conditions 9 c]ta9 types1 i4 e4 p subject to hepatic & r5al di/urbances4 ,he also says ! vagus is an important factor4 ,pa?ologically1 !re is m or less jaundice & hemorrhagic extravasations "u ! sk94 ,! blood s]um is r$-t9t$1 ow+ to ! de/ruction ( ! r$ cells4 ,! liv] is pale & pres5ts ext5sive fatty deg5]ation1 ) necrotic masses 9 & betwe5 ! cells4 ,! ga/ro-inte/9al muc\s membrane is swoll51 conge/$ & pres5ts num]\s m9ute hemorrhages4 ,! kidneys %[ p>5*ymat\s inflammation4 ,! sple5 is n enl>g$4 ,! he>t sometimes %[s fatty deg5]ation4 ,! /oma* conta9s m or less ( ! 8black vomit10 :i* is a mixture ( transud$ s]um & trans=m$ blood pigm5t4 ,symptoms4--,! incubation p]iod v>ies f "o to five days4 ,! attack g5]ally beg9s ) a *ill1 fev]1 #ajb to #aje degrees1 heada*e & pa9s 9 ! lo9s & legs4 ,! pulse is accel]at$1 ! face is flu%$1 ! tongue is coat$1 ! ?roat sore1 ! b[els con/ipat$ & ! ur9e scanty & album9\s4 ,rec5t obs]v]s /ate t bile is pres5t 9 mo/ cases be=e ! album9 is not$4 ,nausea & vomit+ may be pres5t at ! onset1 b become m sev]e ab\t ! second or ?ird day :5 ! black vomit appe>s4 ,! febrile /age or /age ( invasion1 la/s f a few h\rs to sev]al days & is foll[$ by a decl9e 9 ! fev] :5 ! sev]ity ( ! o!r symptoms abates4 ,?is is call$ ! /age ( remission & 9 favorable cases convalesc5ce sets 9 or ! pati5t may pass into ! second febrile p>oxysm4 ,! temp]ature rises aga91 jaundice appe>s rapidly1 nausea & vomit+ return4 ,! tongue becomes dry & coat$4 ,! /ools are black & (f5sive1 ! ur9e is album9\s1 scanty & may be suppress$2 !re may also be hematuria4 ,dea? may occur f exhau/ion or f uremia4 ,recov]y may foll[ ! grave/ symptoms1 ev5 :5 !re has be5 black vomit4 ,! duration ( ! entire attack cov]s ab\t "o week4 ,relapses sometimes occur4 ,price says !re is a po9t 9 diff]5tial diagnosis 9 yell[ fev] & x is a symptom n met ) 9 any o!r febrile affection4 ,x is ! progressive fall ( ! pulse-rate dur+ ! conge/ive /age ( ! fir/ sixty or sev5ty h\rs1 i4 e41 a v>iation ( f five to t5 beats less ea* morn+ & ev5+4 ,he adds1 8,z long z ! kidneys are active !re is b little to fe>40 ,diagnosis4--,remitt5t fev] has n ! deep jaundice1 ! cle> m9d1 ! black vomit1 or ! album9uria ( yell[ fev]4 ,! enl>g$ sple5 & ! pres5ce ( ! organism ( ,lav]an 9 ! blood 9 remitt5t fev] w decide ! diagnosis4 ,d5gue is sometimes confus$ ) yell[ fev]4 ,prognosis4--,?is is always a grave disease1 & 9 its sev]e =ms v fatal4 ,recov]y1 h[ev]1 may occur aft] ! sev]e/ symptoms h be5 manife/$4 ,black vomit is n always a fatal sign4 ,en\gh cases h be5 treat$ o/eopa?ically to /ate t o/eopa?y is p>ticul>ly effective4 ,improv$ sanitation is do+ mu* to r$uce mortality4 ,treatm5t4--,prophylactic treatm5t %\ld be c>efully c>ri$ out4 ,all pati5ts %\ld be qu>ant9$ & c>efully scre5$ s !y _c be bitt5 by ! mosquito & ! disease spread fur!r4 ,p t are n acclimat$ %\ld keep away f infect$ di/ricts4 ,all pools1 ci/]ns & o!r places :i* c bre$ mosquitoes %\ld be dra9$ or scre5$4 ,a sy/ematic w>f>e %\ld be wag$ aga9/ !m4 ,! pati5t mu/ be put to b$ at once & pl5tifully suppli$ ) fre% air4 ,ev]y?+ mu/ be scrupul\sly clean--body & b$ l954 ,use a tube = n\ri%m5t & a b$-pan = excretions z ! pati5t mu/ n make ! slighte/ ex]tion4 ,sp9al lesions may or may n be f\nd4 ,!y h be5 obs]v$ 9 ! c]vical1 eigh? dorsal & second lumb>4 ,! treatm5t on ! :ole is symptomatic4 ,! *ills & fev] ( ! fir/ /age %\ld be controll$ by ?or\gh "w at ! upp] c]vical1 upp] dorsal1 l[] dorsal & l[] lumb> regions4 ,treatm5t at ^! po9ts controls ! sup]ficial & deep vascul> areas ( ! body ?r\gh ! vasomotor n]ves4 ,! irritable /oma*1 delirium & sev]e neuralgic pa9s ( ! head1 back1 epiga/rium & limbs are to be treat$ accord+ to ! conditions & sev]ity ( ! symptoms4 ,! kidneys & b[els %\ld be wat*$ c>efully1 & at ! onset %\ld be freely op5$ & control ( ! kidneys nev] lo/4 ,let ! pati5t dr9k freely ( wat]1 :i* w aid4 ,hydro!rapeutic measures1 z a cold ba? or spong+1 may be employ$ to aid 9 controll+ ! fev]1 ! n]v\s symptoms1 & ! elim9ative p[] ( ! excretory organs4 ,discont9ue ! use ( hydro!rapy :5 a spontane\s fall ( temp]ature occurs4 ,at ! beg9n+ ( ! fir/ /age & dur+ ! /age ( remission are ! p]iods t ! o/eopa? %\ld d v effectual "w by pay+ p>ticul> att5tion to ! f\r l>ge vascul> areas ( ! body1 viz43 head1 lungs1 abdom5 & legs4 ,treat ! vasomotor n]ves to ^! regions1 ?or\ghly1 z giv5 9 ! treatm5t ( ! fir/ /age4 ,dur+ ! ?ird /age ev]y?+ %\ld be done t is possible to support ! sy/em4 ,ice sl[ly dissolv$ 9 ! m\? w be ( aid to an irritable /oma*4 ,hemorrhages & ! v>i\s symptoms are to be treat$ z !y arise4 ,good nurs+1 diet+1 v5tilation & keep+ ! sk91 kidneys & b[els active are ! prim>y po9ts to consid]4 ,dur+ ! p]iod ( depression1 ! he>t mu/ be closely wat*$4 ,! diet %\ld be a light1 liquid "o1 ( ! nature ( peptoniz$ milk or light bro?s4 ,no food is recomm5d$ by "s at ! onset nor until ! crisis is pass$4 ,o!rs fe$ dur+ ! /age ( remission & give /imulants4 ,dur+ ! la/ /age rectal fe$+ is sugge/$ if ga/ric irritability is pron\nc$4 ,tetanus 7,,lock-,,jaw7 ,def9ition4--,an infecti\s disease1 caus$ by ,nicolai]'s tetanus bacillus1 *>act]iz$ by p]si/5t1 tonic spasms ( ! muscles ) viol5t exac]bations4 ,etiology & ,pa?ology4--,! excit+ cause ( tetanus is a specific bacillus :i* usually ga9s access to ! sy/em ?r\gh "s w\nd4 ,! site ( infection is ! only place ! g]ms are f\nd4 ,! disease is mu* m preval5t 9 "s localities ?an 9 o!rs4 ,x is f\nd 9 hot c\ntries1 z 9 ,india & ! ,we/ ,indies1 f> m commonly ?an 9 temp]ate regions4 ,exposure to damp cold is "o ( ! recogniz$ causes1 also ^? localities :]e !re are rapid *anges f cold4 ,su* regions seem to produce conditions favorable to ! exi/5ce & gr[? ( ! bacilli4 ,e>? m\ld1 p>ticul>ly :]e putrefaction is tak+ place1 z 9 soil t has be5 manur$1 is especially favorable to ! exi/5ce ( ! bacillus4 ,x is frequ5tly f\nd 9 ! inte/9al tract ( ! horse1 s t ! soil ab\t /ables is apt to conta9 ! g]ms4 ,! highly f]tiliz$ soil ( ,france & ,belgium r5d]$ x a special m5ace to ! w\nd$ ( ! ,great ,w>4 ,antitetanic s]um1 accord+ to all reports1 0 p>ticul>ly efficaci\s4 ,w\nds & abrasions ( v>i\s k9ds1 p>ticul>ly contus$ & punctur$ w\nds ( ! h&s & feet1 favor ! excitation ( tetanus4 ,:5 an op5 w\nd is pres5t1 ! t]m traumatic tetanus is giv5 to ! disease2 idiopa?ic tetanus :5 no w\nd is discov]able2 tetanus neonatorum :5 x attacks infants--?is =m is usually due to insanit>y conditions1 especially ! improp] c>e ( ! umbilical cord2 lock-jaw or trismus :5 ! jaw alone is affect$2 cephalic tetanus :5 ! ?roat & face is involv$4 ,*>act]i/ic lesions h n be5 f\nd 9 ! cord or ! bra94 ,! bacilli develop at ! site ( ! w\nd :]e ! tox9 is manufactur$4 ,! bacilli d n invade ! blood & organs4 ,! toxalbum9 is "o ( ! mo/ virul5t poisons kn[n4 ,conge/ion occurs 9 v>i\s organs1 due to ob/ruction ( ! movem5t ( ! blood dur+ a spasm4 ,! bra91 cord1 lungs & muscles are conge/$4 ,! n]ves are (t5 f\nd swoll54 ,symptoms4--,! p]iod ( incubation is f "o to tw5ty days4 ,?is is "t requir$ = ! poison 8to be absorb$ by ! end plates 9 ! muscles & to pass up ! motor n]ves to ! sp9al cord40 ,9 mo/ cases ! incubation is f five to t5 days4 ,a *ill prec$es o!r symptoms 9 a few cases4 ,! onset is q sudd51 ) /iffness 9 ! neck1 jaw & tongue4 ,!re are heada*e1 /oma* di/urbance & languor4 ,op5+ ! m\? is difficult1 b is n pa9ful4 ,deglutition is difficult4 ,! /iffness increases & ext5ds to ! sp9al muscles1 abdom5 & legs :i* are held 9 a firm spasm4 ,?us1 ! trunk & legs are inflexible4 ,^! symptoms v>y 9 degree ( sev]ity1 dep5d5t ^u ! ext5t ( involvem5t4 ,! jaws may be firmly lock$ or !y may yield to =c$ ext5sion--8lock-jaw40 ,! muscles ( ! face may be involv$1 ! angle ( ! m\? drawn out1 & ! eyebr[s rais$--8risus s>donicus40 ,! neck & trunk muscles affect$ produce opi/hotonos4 ,spasms ( ! ph>ynx & esophagus may occur1 especially :5 !re are injuries to ! fif? n]ve4 ,associat$ ) ^! tonic convulsions is int5se pa94 ,! di/ress ( ! pati5t is extreme :5 ! *e/ muscles are affect$4 ,all symptoms are increas$ dur+ ! p>oxysm4 ,a foot fall1 ! slamm+ ( a door1 a draught ( air or any slight s5sory impression may excite a p>oxysm4 ,! p>oxysm may relax & dur+ ! int]val ! pati5t may walk ab\t4 ,! spasms v>y 9 frequ5cy f a few m9utes to "o 9 sev]al h\rs4 ,dur+ spontane\s or induc$ sleep ! spasm usually ceases4 ,! febrile reaction is g5]ally slight & app>5tly ( n]v\s orig92 9 _m cases #ajb degrees ,f4 ,9 sev]e cases ! temp]ature may be consid]ably high]4 ,p]spiration is excessive4 ,! ur9e is scanty & high color$4 ,! b[els are usually con/ipat$4 ,! m9d rema9s cle> ?r\gh\t4 ,dea? is g5]ally caus$ by exhau/ion4 ,*ronic tetanus pres5ts simil> symptoms1 b less m>k$1 & x develops sl[ly4 ,diagnosis4--,! hi/ory ( a w\nd foll[$ by ! *>act]i/ic symptoms w\ld r>ely occasion an error4 ,/ry*n9e poison+ diff]s f tetanus 9 ! hi/ory1 9 ! m rapid developm5t ( ! symptoms1 no trismus at ! beg9n+1 m>k$ involvem5t ( ! extremities1 & abs5ce ( rigidity betwe5 ! p>oxysms4 ,9 tetany ! extremities are *iefly affect$ by ! spasms1 ! muscles are relax$ dur+ int]vals1 & trismus is a late or v r>e condition4 ,9 hydrophobia trismus does n occur & ! respiratory spasm is caus$ by attempts at swall[+4 ,! m5tal symptoms increase4 ,prognosis4--,! prognosis is unfavorable4 ,eighty p] c5t ( traumatic & fifty p] c5t ( ! idiopa?ic cases prove fatal4 ,cases t are fatal usually die )9 six days4 ,cases :]e !re is slight elevation ( temp]ature1 & :]e ! spasm is localiz$ to ! muscles ( ! face1 neck & jaw1 or :]e muscle /iffness is late 9 appe>+1 are m likely to recov]4 ,treatm5t4--,free incision & ?or\gh dis9fection ) hydrog5 p]oxide & caut]ization ) pure c>bolic acid1 ( ! w\nd are necess>y4 ,! pati5t %\ld be put 9 a d>k room & !re rema9 z quietly z possible4 ,avoid all s\rces ( p]iph]al irritation4 ,liquid food is to be giv51 & if ! jaws are firmly set1 rectal fe$+ may be employ$ or food may be pass$ ?r\gh ! nose ) a ca!t]4 ,= ! spasms1 /rong inhibition ( ! n]ve c5t]s controll+ ! affect$ muscles may be ( use4 ,probably ! mo/ effectual treatm5t = ! p>oxysms w\ld be /rong1 ?or\gh treatm5t ( ! upp] c]vical region4 ,hot ba?s give relief to ! spasms4 ,all ! excretory organs %\ld be greatly /imulat$1 p>ticul>ly ! kidneys1 lungs & b[els4 ,o!r symptoms are to be treat$ z !y arise4 ,tetanus antitox9 is highly comm5d$ by surgeons :o us$ x dur+ ! ,great ,w>4 ,z dea? is at a two to "o ratio any me?od ( treatm5t is ju/ifi$4 ,a few cases h be5 treat$ o/eopa?ically ) fair success1 foll[+ antiseptic measures4 ,simple ,cont9u$ ,fev] ,def9ition4--,an acute1 febrile disease1 mild 9 "*1 ( %ort duration1 n excit$ by any special organism & dep5d+ on a v>iety ( irritat+ causes4 ,o/eopa?ic ,etiology4--,! mo/ frequ5t cause ( ?is =m ( fev] is probably ga/ro-inte/9al di/urbance4 ,9 *ildr5 x may be due to ga/ro-inte/9al d]angem5t1 or to ! eat+ ( decompos+ food or to exposure to wet & cold4 ,x may be caus$ by exposure to ! sun or great heat1 or m5tal or physical fatigue4 ,x may be ! result ( exposure to cold suffici5t to produce a slight bron*itis1 tonsillitis or o!r affection produc+ an unnotic$ localiz$ inflammation4 ,x may foll[ a prolong$ exposure to noxi\s odors or gas4 ,lesions1 osse\s or muscul>1 are always pres5t1 correspond+ to ! tissues & organs di/urb$4 ,muscul> lesions1 especially1 are prom95t4 ,symptoms4--,! onset is usually sudd5 ) a feel+ ( lassitude1 we>9ess1 *ill9ess1 & heada*e4 ,! temp]ature rises quickly to #ajb or #ajc degrees ,f4 or ov]1 & is usually apt to t]m9ate sudd5ly by crisis on ! ?ird or f\r? day4 ,! pulse is frequ5t & ! face is flu%$4 ,! *ild is (t5 irritable4 ,mild delirium may occur4 ,anorexia is pres5t1 & ! b[els are con/ipat$4 ,convalesc5ce is rapid4 ,diagnosis4--,?is dep5ds ^u exclud+ o!r probable diseases4 ,if ! fev] _c be attribut$ to "s ( ! causes already ref]r$ to1 !re may be a d\bt z to its "* = ! fir/ tw5ty-f\r h\rs1 b1 if aft] a c>eful exam9ation1 "o f9ds no o!r cause & no symptoms develop ( any ( ! recogniz$ diseases1 acute cont9u$ fev] c h>dly be mi/ak5 = any o!r disease4 ,prognosis4--,always favorable1 recov]y )\t sequel be+ ! rule4 ,treatm5t4--,x is necess>y to f9d out ! irritative cause 9 ord] = "o to be able to treat intellig5tly4 ,re/ 9 b$ ) treatm5t ( ! di/urb+ factor ( ! disease1 :atev] t may be1 is ! pr9cipal treatm5t to be giv54 ,c>eful exam9ation ( all ! organs1 ) due consid]ation ( ! symptoms1 w g5]ally leave no d\bt z to ! cause1 & treatm5t appli$ accord+ly w be suffici5t4 ,if !re is any ga/ro-inte/9al disord]1 ?or\gh treatm5t ( ! splan*nics1 ant]ior treatm5t to ! abdom5 & ?or\gh evacuation ( ! b[els are indicat$4 ,use an enema if necess>y4 ,besides ! usual fev] treatm5t1 spong+ ! body ) tepid wat] at ! "t ( day :5 ! fev] is highe/ w aid 9 less5+ ! temp]ature & r5d] ! pati5t m com=table4 ,9 cases :]e n]v\s symptoms are prom95t1 c>e %\ld be tak5 aga9/ any excitem5t &1 if insomnia results1 a quiet+ treatm5t 9 ! c]vical region is usually suffici5t4 ,use pl5ty ( wat] int]nally1 :i* is n only necess>y = ! tissues on acc\nt ( ! fev]1 b is ( great aid 9 keep+ ! sk9 & kidneys active1 & ?us a great help 9 ! elim9ation ( wa/e mat]ial4 ,a liquid1 nutriti\s diet is be/4 ,milk1 bro?s & s\ps w be en\gh4 ,! dem&s on ! dige/ive tract are n great :5 a light diet is adm9i/]$1 besides n excit+ ! n]v\s & vascul> sy/ems unduly4 ,tub]culosis ,def9ition4--,a g5]al or local infecti\s disease caus$ by ! bacillus tub]culosis ( ,ko*4 ,! bacillus produces specific lesions ( ! =m ( nodul> bodies call$ tub]cles t und]go case\s necrosis ) a t5d5cy to involve neighbor+ tissue4 ,!re may be a diffusion ( ! infection by way ( ! lymph & blood vessels to v>i\s tissues & organs4 ,o/eopa?ic ,etiology & ,pa?ology4--,tub]culosis exi/s 9 all c\ntries4 ,x g5]ally prevails m ext5sively 9 w>m ?an 9 cold climates1 & is ( m frequ5t occurr5ce 9 ! city ?an 9 ! c\ntry4 ,altitude1 h[ev]1 ex]ts m influ5ce ?an latitude4 ,! disease r>ely occurs 9 m\nta9\s c\ntries1 ow+ to ! purity ( ! atmosph]e4 ,! disease is v preval5t 9 ! ,we/ ,indies & ! ,s\? ,sea ,isl&s4 ,tub]culosis is frequ5tly met ) 9 ,canada among ! ,fr5* ,canadians & ! ,engli%4 ,all races are subject to tub]culosis1 b ! ,indians ( ?is cont95t1 ! ,s\? ,sea ,isl&]s & ! color$ race are v susceptible to ! disease4 ,x is e/imat$ t f sev5 to t5 p]c5t ( ! pres5t dea? rate 9 ! ,unit$ ,/ates is due to tub]culosis4 ,! tub]cle bacillus 0 discov]$ by ,ko* 9 #ahha4 ,x is a %ort1 /raight or slightly b5t1 rod4 ,?is bacillus has an exce$+ly t5aci\s hold on life & is f\nd 9 great] or less numb]s 9 all tub]cul\s lesions4 ,x c live almo/ indef9itely outside ! body4 ,! bacilli are f\nd 9 great numb]s 9 ! sputum1 :i* dries & flies 9 ! atmosph]e 9 ! =m ( du/4 ,! organism is ?us widely spread 9 regions frequ5t$ by ph?isical pati5ts4 ,! bacillus ga9s entrance into ! body by way ( ! respiratory tract 9 ! va/ majority ( cases4 ,milk f tub]cul\s c[s w produce ! disease1 especially 9 *ildr51 caus+ inte/9al & mes5t]ic tub]culosis4 ,! meat ( tub]cul\s animals is n necess>ily infecti\s1 al?\gh !re is a possibility ( infection by ?is means4 ,tub]culosis may be transmitt$ by direct inoculation2 ?is does n (t5 occur 9 man1 b :5 x does1 ! disease usually rema9s local1 al?\gh g5]al infection may occur4 ,p]sons :o foll[ c]ta9 occupations1 z but*]s1 dissectors ( dead bodies1 & h&l]s ( hides1 are m or less subject to local tub]cles ( ! sk94 ,! virus may ent] ! body ?r\gh any fissure or excoriation on ! sk92 ?us by wa%+ ! clo!s or b$ l95 ( ph?isical pati5ts1 by ! bite ( a consumptive1 or by a cut f a brok5 sputum glass ( a consumptive1 "o may become infect$4 ,x is /at$ t !re may be h]$it>y transmission4 ,9 "s cases ! virus may be transmitt$ & ! disease may n appe> = _m ye>s4 ,pr$ispos+ ,causes4--,h]$it>y pr$isposition1 :i* r5d]s ! p]son m liable to accid5tal infection2 delicate con/itution2 scr(ul\s t5d5cy2 previ\s infecti\s diseases1 z influ5za1 :oop+ c\gh1 measles1 typhoid fev]2 diabetes mellitus1 etc4 ,9 "y *ildr5 m5+eal1 mes5t]ic & lymphatic =ms ( tub]culosis are ! mo/ frequ5t4 ,pulmon>y tub]culosis is usually met ) 9 adults1 especially betwe5 tw5ty & ?irty ye>s or age4 ,! developm5t ( tub]culosis is favor$ by damp localities2 by improp] & insuffici5t food2 con/ant inhalation ( impure air2 injuries to ! *e/1 ) or )\t lac]ation ( ! lungs1 & v>i\s o/eopa?ic lesions t weak5 ! tissue ?r\gh faulty nutrition4 ,correspond+ to ! inn]vation ( ! organ or tissue diseas$ w always be f\nd anatomical d]angem5ts4 8,e case has a defective sp9e & ?orax40 7,hayd5#fj74 ,bron*ial cat>rh1 tonsillitis1 diseases ( ! /oma* & inte/9es1 especially ent]ocolitis1 tub]cul> pneumonia1 pleurisy 7r>ely71 intra?oracic tumors & cong5ital or acquir$ contraction ( ! orifice ( ! pulmon>y art]y increase ! susceptibility to infection4 ,less5$ vitality ( ! tissues1 :e!r inh]it$ or acquir$1 is necess>y be=e ! g]m c become implant$ & prolif]ate1 produc+ tub]culosis ( ! tissues & organs4 ,9 ne>ly e in/ance1 :5 ! lungs are involv$1 lesions are f\nd at ! second1 ?ird1 or f\r? ribs4 ,^! lesions und\bt$ly pr$ispose to ! tub]cul> infection1 by less5+ ! vitality ( ! lung tissues ?r\gh int]f]5ce ) ! inn]vation or vascul> supply4 ,possibly a lesion at ! second rib or second dorsal v]tebra w\ld int]f]e directly ) ! vasomotor n]ves ( ! upp] ?oracic ganglia4 ,! condition ( ! middle & l[] c]vical v]tebr %\ld be c>efully exam9$1 = lesions at t po9t w\ld involve ! lymphatics ( ! lungs4 ,! l[]$ vitality caus$ by ! lesion is ! pr$ispos+ cause & ! tub]cul> bacillus is ! excit+ cause :i* det]m9e ! "* ( ! affection4 ,c4 ,a4 ,:it+ 9 ,cl9ical ,o/eopa?y says3 8,! sp9al outl9e *>act]i/ic ( tub]culosis & ( ! pretub]cul> /ages pres5ts ! foll[+ peculi>ities3 ,! c]vical sp9e pres5ts v>i\s abnormalities1 usually lesions involv+ s+le v]tebr & associat$ ) irregul> muscul> t5sions4 ,! upp] ?oracic sp9e is ant]ior1 ! ribs droop+ & r m freely movable ?an normal2 ! v]tebral articulations are less movable ?an normal2 ! tissues 9 ! neighborhood ( ! upp] two or ?ree dorsal sp9es are abnormally s5sitive & ! muscles inn]vat$ f ^! segm5ts are contract$ irregul>ly :5 ! disease involves ! apices4 ,! l[] int]scapul> region is f\nd s5sitive & ^! muscles are contract$ :5 ! l[] lobes ( ! lung are involv$1 & ! location ( ^! s5sitive areas may be employ$ 9 ! localization ( ! lung area infect$4 8,9 e case record$ 9 ?is cl9ic1 lesions involv+ ! area ( ! orig9 ( ! upp] & middle splan*nic n]ves h be5 f\nd4 ,! typical tub]culosis sp9e mu/ include lesions ( ! l[] dorsal area4 ,probably ^! lesions are pr$ispos+ factors 9 tub]culosis1 p>tly because ( ! effects produc$ ^u nutrition !reby1 b d\btless ! lack ( ! normal mobility ( ?is "p ( ! sp9e prev5ts ! normal /imulation ( ! liv]1 ! sple51 p]haps ! pancreas1 ?us ! normal opsonic index is lo/1 & immunity brok54 ,! treatm5t ( tub]cul> cases %\ld include c>eful att5tion to ! splan*nic area1 ! ma9t5ance ( ! normal mobility & /ructural relation%ip ( ! entire sp9al column1 & su* /imulat+ movem5ts to ! n9? & t5? ?oracic neighborhood z is indicat$ 9 ea* individual case40 ,pa?ology4--,9 adults ! mo/ common site ( tub]cles is ! lungs2 9 *ildr5 x is ! lymphatic gl&s1 jo9ts & bones4 ,no organ is exempt2 ! saliv>y gl&s & pancreas are ! lea/ frequ5tly involv$4 ,! milit>y tub]cle is ! beg9n+ ( tub]cul> deposits4 ,?is may develop 9 any tissue :]e ! tub]cle bacillus is f\nd & x is only di/+ui%$ by ! pres5ce ( a tub]cle bacillus1 z simil> conditions are produc$ by ! asp]gillus glaucus & act9omyces4 ,9 ! developm5t ( a tub]cle !re is prolif]ation ( ! fix$ tissue cells1 p>ticul>ly ^? ( ! connective tissue & ! endo!lium ( ! capill>ies1 due to ! irritation ( ! bacillus1 produc+ ! epi!lioid cells & 9 "s in/ances ! giant cells1 9 bo? ( :i* bacilli may be f\nd4 ,! epi!lioid cells v>y 9 %ape4 ,! giant cells are =m$ by enl>gem5ts ( ! epi!lioid cells & a repeat$ division ( _! nuclei or possibly by fusion ( sev]al cells4 ,on acc\nt ( ! inflammation produc$ by ! bacillus1 !re is migration ( leucocytes f ! adjac5t vessels & lymphoid cells4 ,! leucocytes are l>gely polynucle> & are rapidly de/roy$1 b lat] mononucle> leucocytes appe>1 :i* are able to resi/ ! action ( ! bacilli s t !y are n s readily de/roy$4 ,a reticulum ( connective tissue is =m$ ar\nd ! v>i\s cells4 ,! tub]cles are non-vascul> & :5 once =m$ und]go caseation & scl]osis4 ,caseation is a process ( coagulation-necrosis or de/ructive *ange1 beg9n+ at ! c5tral "p ( ! gr[?1 due to ! action ( ! bacilli4 ,! prim>ily transp>5t tub]cul> tissue may become a gray gelat9\s body conta9+ bacilli4 ,frequ5tly ! caseation is foll[$ by s(t5+2 less frequ5tly1 calcification1 or x may be surr\nd$ by fibr\s tissue4 ,dur+ ! "t ! cell de/ruction is go+ on at ! c5t] ( ! tub]cle1 hyal9e & fibr\s *anges may r5d] ! tissues scl]otic4 ,^! *anges1 caseation1 ! de/ruction ( =ces1 :i* are dang]\s to ! pati5t1 or scl]osis1 :i* is a heal+ process1 dep5d ^u ! p[] ( ! body to produce an antitox9 to ov]come ! effects ( ! special tox9 produc$ by ! bacilli4 ,!re may be a widespread tub]cul\s involvem5t4 ,?is is ! result ( fusion ( ! new foci ( infection or ( mili>y tub]cles4 ,! lungs are ! usual site ( infection1 v>y+ f a small area1 to a lobe or a /ill great] area4 ,! irritation ( ! bacilli is capable ( produc+ associat$ inflammatory processes 9 its own neighborhood4 ,!re may be an ov]gr[? ( int]/itial tissue4 ,9 o!r in/ances1 *anges to cat>rhal or cr\p\s pneumonia may occur4 ,suppuration is associat$ ) tub]culosis1 especially ( ! lungs1 & is due to a mix$ infection or ! pres5ce ( pus organisms4 ,"s au?orities claim t ! tub]cle bacilli alone are able to produce suppuration2 x is1 h[ev]1 m probable t suppuration is due to a mix$ infection4 ,! con/itutional features 9 tub]culosis are m dep5d5t ^u ?is second>y infection1 especially by ! /reptococci1 ?an ^u ! prim>y infection4 ,tub]culosis ( ! ,lymph ,gl&s 7,,scr(ula7 ,scr(ula is a true tub]culosis ( ! lymphatic gl&s4 ,! virus is less virul5t ?an t f o!r s\rces1 :i* acc\nts = ! sl[ developm5t & mild] c\rse ( tub]culosis ( ! gl&ul> sy/em4 ,tub]cul\s ,ad5itis may occur at all ages1 b is mo/ common 9 *ildr5 & "y adults4 ,x is r>ely cong5ital4 ,cat>rhal inflammation ( ! muc\s tissues weak5s ! resi/+ p[] ( ! lymph tissue1 ?us all[+ ! bacilli to develop1 & is an important pr$ispos+ cause4 ,! gl&s mo/ frequ5tly affect$ are ^? ( ! neck2 m r>ely !re is involvem5t ( all ! lymphatic gl&s ( ! body4 ,inv>iably lesions ( ! upp] & middle c]vical v]tebr & upp] dorsals & correspond+ ribs are f\nd1 z well z lesions to ! lymphatics at v>i\s po9ts along ! sp9al column & ribs4 ,^! lesions affect ! inn]vation to ! lymph gl&s1 z well z muc\s membranes1 & ?us pr$ispose to ! disease4 ,9 all cases anatomical d]angem5ts are f\nd 9 ! region ( ! inn]vation to ! involv$ gl&4 ,9 g5]al tub]cul\s ad5itis all ! lymph gl&s ( ! body are m or less involv$1 :ile ! o!r organs & tissues are r>ely affect$4 ,all ! visible gl&s are f\nd to be swoll51 t5d] & pa9ful4 ,!re is m or less protract$ fev]1 ) wa/+ & debility4 ,?is is a r>e affection4 ,9 local ad5itis ! gl&s ( ! neck are mo/ frequ5tly affect$ & ?is is especially ! case ) *ildr54 ,negroes are m frequ5tly affect$ ?an :ites4 ,x is se5 especially among ^? liv+ 9 an unsanit>y environm5t4 ,measles1 :oop+ c\gh & an h]$it>y t5d5cy are pr$ispos+ factors4 ,! submaxill>y gl&s are usually ! fir/ affect$4 ,at fir/ !y are swoll5 to v>i\s degrees & are t5d]2 lat] !y suppurate & rupture if "o is n able to cure !m4 ,!re may be fev]4 ,! sk9 ov] ! gl&s is usually freely movable2 x may1 h[ev]1 be adh]5t4 ,! gl&s above ! clavicle1 ^? 9 ! po/]ior c]vical triangle1 & ! axill>y gl&s may all be affect$4 ,9 su* cases x is likely t ! bron*ial gl&s are also involv$ & may infect ! liv+ tissue4 ,lesions ( ! upp] & middle c]vicals & deep muscles are always f\nd & und\bt$ly are ! und]ly+ causes4 ,lesions ( ! l[] c]vical1 upp] dorsal1 ribs & clavicle1 are ( frequ5t occurr5ce4 ,infection may ga9 entrance by way ( ! ph>ynx & tonsils4 ,! affection (t5 runs a sl[ c\rse4 ,! bron*ial gl&s may be affect$ prim>ily1 b usually second>ily to infection ( ! lungs4 ,! prim>y =m is se5 mo/ commonly 9 *ildr5 & is apt to be associat$ ) suppuration4 ,lesions ( ! upp] & middle dorsals & ( ! c]vicals w be f\nd4 ,cat>rh ( ! bron*ial tubes is a pr$ispos+ cause4 ,! ,x-ray is ( great value 9 ! diagnosis4 ,! mo/ noticeable symptoms are ^? due to pressure or irritation4 ,sy/emic infection may foll[ rupture into a vessel4 ,local infection ( ! lung may occur & ! p]ic>dium become infect$4 ,mes5t]ic cases occur among *ildr5 & may be prim>y or second>y4 ,! prim>y =m is r>e4 ,swall[$ sputum is a frequ5t cause4 ,! trunk & limbs are puny4 ,! *ild is anemic1 & (t5 ! abdom5 is tympanitic4 ,di>rhea is m>k$ & !re is pa9 & indige/ion4 ,fev] is almo/ con/antly pres5t & ( an int]mitt5t type4 ,! disease is mo/ frequ5tly met ) among poor *ildr5 9 unhygi5ic1 poorly v5tilat$ h\ses4 ,!re may be an associat$ tub]culosis ( ! p]itoneum4 ,acute ,tub]culosis ,?is %[s be/ ! truly infecti\s nature ( tub]culosis4 ,9 x mili>y tub]cles develop 9 _m & v>i\s p>ts ( ! body4 ,9 "s cases ^! gr[?s seem to be uni=mly di/ribut$ ?r\gh\t all ! visc]a4 ,9 o!r in/ances !y are localiz$ 9 ! lungs or 9 ! m5+es ( ! bra94 ,9 ne>ly e in/ance x is an auto-infection1 aris+ f an old tub]cul\s focus1 :i* may be lat5t & q unsuspect$4 ,g5]al infection1 9 mo/ in/ances1 arises f ! rupture ( a nodule into a ve91 f tub]cul\s lymph gl&s1 tub]culosis ( ! bones1 jo9ts1 or ev5 ! sk94 ,g5]al ,mili>y ,tub]culosis or ,typhoid ,=m4--,?is is simil> to a g5]al infection ( ! body & resembles1 to a m>k$ degree1 ! symptoms ( typhoid fev]4 ,! onset is r>ely rapid4 ,9 mo/ cases !re is a p]iod ( incubation1 dur+ :i* ! heal? fails1 ! appetite is lo/1 heada*e occurs1 & ! pati5t soon becomes fev]i%1 ) increas$ debility4 ,! temp]ature rises & ! pulse is rapid & feeble4 ,! tongue is dry4 ,! respirations are increas$4 ,delirium may be pres5t4 ,9 r>e cases1 !re may be little or no fev]4 ,! temp]ature ranges f #aja to #ajc or ev5 #aje degrees ,f4 ,x is irregul> & m>k$ by ev5+ exac]bations & morn+ remissions4 ,occasionally !re is an inv]se type ( temp]ature 9 :i* x rises 9 ! morn+ & falls 9 ! ev5+4 ,9 "s cases ! pulmon>y symptoms are m>k$1 :ile 9 o!rs ! m5+eal symptoms are m prom95t4 ,tub]cle bacilli are r>ely f\nd 9 ! sputum4 ,! sple5 is usually enl>g$4 ,con/ipation is pres5t1 z a rule1 b !re may be di>rhea1 & hemorrhage f ! b[els may occur4 ,! ur9e may conta9 traces ( album94 ,!re may be excessive sweat+1 & h]pes is (t5 pres5t4 ,*oroid tub]culosis is frequ5tly met )4 ,9 d\btful cases ! blood %\ld be exam9$ = tub]cle bacilli1 al?\gh !y are n always pres5t4 ,! duration is f two to f\r weeks1 ! disease usually t]m9at+ unfavorably4 ,diagnosis4--,x is (t5 v h>d to diff]5tiate betwe5 ?is =m ( tub]culosis & typhoid fev]4 ,9 typhoid fev] epi/axis is a common1 e>ly symptom4 ,! temp]ature curve ( ! cont9u$ type is q diagno/ic4 ,! ,widal te/ %\ld be made4 ,! respirations are mod]ately hurri$ & ! pulse is (t5 dicrotic4 ,di>rhea is frequ5t4 ,typhoid ra% is diagno/ic4 ,no tub]cles are f\nd on ! *oroid4 ,no tub]cle bacilli are f\nd 9 ! blood4 ,hemorrhages f ! b[els are common4 ,pulmon>y ,=m4--,:5 ! lungs are *iefly affect$ ! pulmon>y symptoms are m>k$ f ! onset4 ,x may develop sudd5ly or !re may be a long p]iod dur+ :i* ! g5]al heal? fails m>k$ly4 ,9 *ildr5 ! disease may foll[ measles or :oop+ c\gh4 ,!re is dyspnea1 c\gh & ! expectoration is mucopurul5t4 ,!re is bron*o-vesicul> brea?+ ) sibilant & subcrepitant rales4 ,! temp]ature is high1 rang+ f #ajc to #aje degrees ,f41 or high]4 ,respiration & pulse are rapid4 ,! disease may la/ f sev]al weeks to mon?s1 or1 on ! o!r h&1 x may prove fatal )9 a few days4 ,z ! end draws ne> ! signs ( suffocation become int5sifi$4 ,diagnosis4--,! hi/ory & g5]al symptoms1 toge!r ) ! dyspnea & cyanosis1 w g5]ally decide ! diagnosis4 ,! blood %\ld be exam9$ = mal>ial p>asites4 ,! ,widal te/ w diff]5tiate typhoid4 ,c]ebral or ,m5+eal 7,tub]cul\s ,m5+itis74--,?is =m :i* is sometimes call$ acute hydrocephalus1 occurs q frequ5tly & is an infection ( ! pia mat] ( ! bra9 or cord4 ,x occurs mo/ frequ5tly 9 ! fir/ two ye>s ( life1 al?\gh x may occur lat]4 ,x is usually tub]cul\s 9 "s o!r region1 especially 9 ! bron*ial gl&s4 ,r>ely does ! disease involve ! m5+es prim>ily4 ,! m5+es at ! base ( ! c]ebrum is ! pr9cipal involvem5t4 ,!re is m or less inflammation1 ) fibr\s purul5t exudation4 ,!re are tub]cles along ! blood vessels4 ,! v5tricles may be di/5d$4 ,symptoms4--,! onset is sl[1 la/+ "o or m weeks4 ,heada*e1 con/ipation1 vomit+ & *ills1 foll[$ by a fev]1 are ! initial symptoms4 ,:5 ! onset is sudd51 ! disease is g5]ally u%]$ 9 ) a convulsion4 ,! fev] r>ely rises above #ajb or #ajc degrees ,f4 ,! pa9 is (t5 sev]e1 caus+ ! *ild to give a sudd5 cry--! hydrocephalic cry4 ,dur+ sleep ! *ild is re/less & !re are slight muscul> twit*+s4 ,! irritative symptoms n[ abate4 ,! *ild becomes quiet & is dull & apa!tic4 ,con/ipation /ill p]si/s4 ,! abdom5 is boat-%ap$1 & ! neck may be retract$4 ,! pupils are dilat$4 ,convulsions & o!r c]ebral symptoms may occur4 ,! temp]ature ranges f #ajj to #ajc degrees ,f4 ,! respiration is irregul> & sigh+4 ,foll[+ ?is1 ! m5tal faculties are lo/ & coma occurs4 ,convulsions or spasmodic contractions ( ! muscles ( ! neck1 back & limbs may occur4 ,! pupils are dilat$ & d n respond to light4 ,! pulse is frequ5t1 irregul> & small4 ,! temp]ature rises to #ajc to #aje degrees ,f41 or x may be subnormal4 ,! duration is f two to five weeks2 *ronic cases may la/ = a numb] ( mon?s4 ,prognosis4--,g5]ally v unfavorable4 ,acute ,pneumonic ,ph?isis ,! infection ( ! lungs is rapid & may be prim>y or second>y4 ,?is =m is met ) mo/ frequ5tly 9 *ildr5 & "y adults1 b may occur at any age4 ,! ,pneumonic =m is m r>e ?an ! bron*opneumonic =m & may be v rapid 9 its c\rse4 ,! attack sets 9 abruptly ) a *ill & ! temp]ature rises rapidly4 ,!re is pa9 9 ! side2 c\gh2 dyspnea & muc\s & ru/y sputum1 :i* may conta9 tub]cle bacilli4 ,!re is impairm5t ( resonance1 increas$ fremitus1 & bron*ial brea?+4 ,! :ole or "p ( ! lung may %[ signs ( consolidation & dullness1 all ! symptoms ( pneumonia be+ pres5t4 ,! pati5t rapidly loses fle%4 ,?is attack may come on a p]son 9 good heal? aft] exposure to cold2 b !re may h be5 a debilitat$ condition1 or a pr$isposition to ph?isis4 ,dea? may occur 9 ! second or ?ird week or ! case may cont9ue f ?ree to f\r mon?s4 ,"o or bo? lungs may be involv$4 ,! lung is heavy & airless1 s9k+ quickly 9 wat]4 ,!re is de/ruction ( lung tissue & ^u section1 cavities are f\nd4 ,! cavities are g5]ally small & are surr\nd$ by tub]cles4 ,old] case\s areas ( a yell[i% :ite color may be visible4 ,mili>y tub]cles are f\nd ^u c>eful exam9ation4 ,! bron*opneumonic =m is ! mo/ common & occurs mo/ frequ5tly 9 *ildr54 ,x (t5 foll[s ! infecti\s diseases1 especially measles & :oop+ c\gh4 ,! *ild may be tak5 ill sudd5ly ) :at seems to be an ord9>y bron*itis1 ! temp]ature rises1 ! c\gh is sev]e1 & !re may be consolidation ) submuc\s & subcrepitant rales4 ,rapid respiration & sweat+ are (t5 m>k$4 ,! c\rse ( ! disease v>ies4 ,!re is rapid loss ( fle%1 & 9 _m cases ! disease develops into *ronic ph?isis4 ,9 o!r in/ances dea? occurs 9 f ?ree to eight weeks4 ,! disease may attack ! adult ^: resi/ance is impair$4 ,*ills1 fev]1 pa9 9 ! *e/1 hemorrhages1 wa/+ are mo/ noticeable symptoms2 ^! are ! v>i\s signs ( bron*opneumonia4 ,tub]cle bacilli are (t5 f\nd 9 ! sputum4 ,! c\rse is usually f ?ree to eight weeks1 :ile a numb] pass into a *ronic /age4 ,areas ( case\s tub]cles are f\nd1 :i* lat] suppurate1 break d[n & =m cavities4 ,! bron*ial lymph nodes are f\nd enl>g$1 & usually !re is acute tub]cul\s pleurisy4 ,diagnosis4--,9 ! pneumonic =m x may be impossible to make a diagnosis e>ly 9 ! disease4 ,tub]culosis may be suspect$ if ! pati5t has be5 9 bad heal?1 has a pr$isposition to ph?isis1 or has _h any pulmon>y disord]4 ,pneumonia w pres5t ! typical symptoms1 b if fev] cont9ues1 tub]culosis w be suspect$4 ,exam9ation ( ! sputum w probably decide4 ,9 ! bron*opneumonic =m x is v difficult1 9 ! e>ly /ages1 to di/+ui% x f simple bron*itis & bron*opneumonia4 ,! irregul> fev] & rapid loss ( fle% are important signs4 ,! sputum w %[ ela/ic tissue & tub]cle bacilli e>ly 9 ! disease & %\ld be c>efully exam9$4 ,*ronic ,pulmon>y ,tub]culosis ,! *ronic =m ( ! disease is m common ?an ! acute4 ,x seems probable t _m cases ( pulmon>y tub]culosis are due to inhalation ( ! tub]cle bacillus1 ?\gh no d\bt1 p>ticul>ly 9 *ildr5 ! bacillus frequ5tly ga9s entrance to ! sy/em ?r\gh ! inte/9al tract f infect$ milk & food4 ,de=mities ( ! *e/1 especially :]e !re is con/riction & rigidness ( ! upp] "p1 ) m or less immobility ( ! fir/1 second & ?ird ribs & ! junction ( ! manubrium & gladiolus1 associat$ ) weak muscles & a /oop$ po/ure are def9ite pr$ispos+ factors4 ,?is condition may be cong5ital or acquir$4 ,! local inn]vation1 blood supply & lymphatic dra9age is involv$1 s t ! individual is less resi/ant & consequ5tly susceptible to infection4 ,! bron*i are ?us weak5$1 favor+ ! infecti\s process s t ! disease may advance & involve ! neighbor+ tissues1 or if infection has ga9$ entrance to ! lymph or blood /ream else:]e1 ! susceptible pulmon>y organs may become diseas$4 ,ow+ to ! above pr$ispos+ factors ! prim>y lesion ( ! lungs is (t5 9 ! bron*us a little bel[ ! apex ne> to ! po/]ior & ext]nal bord]s4 ,a l[] lobe may be involv$1 or sev]al lesions may occur at ! same "t1 involv+ "o or bo? lungs4 ,frequ5tly ! o!r lung is infect$ f ! lesion or lesions ( ! fir/4 ,9 ! acute cases ! exudative process involves ! lung tissue1 becomes case\s & s(t5$1 & lat] necrotic ) cavity =mation4 ,9 ! *ronic type ! exudative process is sl[]1 ) ?ick5+ ( ! walls ( ! air vesicles & increase ( fibr\s tissue4 ,cavities1 ! result ( caseation1 are ( v>i\s size1 ragg$1 (t5 coalesce & op5 into ! bron*us4 ,fibr\s tissue =ms ab\t !m & frequ5tly arre/ ! process4 ,9 ! necrotic involvem5t blood vessels are (t5 injur$ caus+ hemorrhages4 ,pleurisy1 empyema1 cat>rhal bron*itis1 & bron*iectasis are (t5 associat$ involvem5ts4 ,9 addition to ! tub]cle bacillus1 o!r micro-organisms1 /reptococcus & /aphylococcus pyog5es1 influ5za bacillus1 & diplococcus pneumoni1 are (t5 f\nd1 & no d\bt are important excit+ factors4 ,! bron*ial gl&s are swoll51 & conta9 tub]cles4 ,!y may und]go purul5t dis9tegration4 ,tub]culosis ( ! l>ynx is common4 ,9 sev]e cases !re may be amyloid *anges ( liv]1 kidneys1 sple51 & muc\s membrane ( ! inte/9es4 ,tub]cul\s lesions are f\nd 9 ! inte/9es1 sple51 kidneys1 & bra9 9 ne>ly equal proportions2 !n come ! liv] & p]ic>dium4 ,symptoms4--,! onset ( ! disease is ei!r abrupt or gradual4 ,frequ5tly x succe$s influ5za1 measles1 or bron*itis4 ,!re is a c\gh1 expectoration1 loss ( weight1 aft]noon temp]ature & probably night sweats4 ,! disease is likely to develop sl[ly4 ,9 o!r cases ga/ro-inte/9al disord]s are ! fir/ symptoms1 especially ) weakness & debility4 ,aga91 ! disease may foll[ pleurisy4 ,:5 ! attack is abrupt1 pneumonia is simulat$4 ,h[ev]1 ! apex ( ! lung1 in/ead ( ! middle or l[] lobe1 is involv$2 expectoration is consid]able & ! fev] is n s high & pron\nc$4 ,hemoptysis frequ5tly occurs4 ,! local symptoms are important4 ,pa9 is an e>ly ei!r mod]ate or sev]e1 symptom1 al?\gh !re are cases :]e x is abs5t4 ,:5 associat$ ) pleurisy1 x is sev]e4 ,! pa9 is usually situat$ at ! base1 ant]iorly or lat]ally1 ( ! scapul1 b may be betwe5 !m4 ,c\gh is pres5t1 9 ! majority ( cases1 ?r\gh\t ! entire c\rse4 ,x usually gr[s worse1 & is dry & hack+ at ! beg9n+ b loos] & p>oxysmal & accompani$ by a mucopurul5t expectoration lat] on4 ,! expectoration1 at fir/1 is slight & !re may be m or less blood mix$ ) x1 or ev5 hemorrhage may occur4 ,) ! =mation ( cavities1 ! expectoration increases & is ( a gre5i%-gray or gre5i% yell[ color4 ,9 "s in/ance ! sputum is m or less fetid4 ,! expectoration is compos$ ( pus cells1 blood1 ela/ic tissue1 fat globules & tub]cle bacilli4 ,hemoptysis is pres5t 9 a majority ( cases4 ,e>ly hemorrhages are usually slight1 due to rupture ( weak5$ vessels4 ,:5 !re is s(t5+ or cavity =mation1 erosion ( vessels may be pron\nc$ & hemorrhage consid]able4 ,dyspnea is a v>iable symptom1 b is *>act]i/ic ( lung *anges4 ,fev] is a *>act]i/ic symptom4 ,x is probably always pres5t at ! beg9n+ & ! aft]noon increase ( temp]ature is common4 ,:]e !re is s(t5+ & =mation ( cavities1 a remitt5t or int]mitt5t type is pres5t4 ,! pulse is frequ5t1 regul> & compressible4 ,sweats may occur at any "t1 b especially dur+ sleep4 ,!y indicate fev] activity1 & are increas$ dur+ cavity =mation4 ,emaciation is a prom95t symptom4 ,?is is due to ga/ro-inte/9al disord]s & prolong$ fev]4 ,loss ( weight is gradual1 especially if ! disease is advanc+4 ,:]e ! lung is consid]ably diseas$1 he>t di/urbances are common4 ,o!r disord]s1 z ( ! ga/ro-inte/9al tract1 g5ito-ur9>y1 cutane\s1 & n]v\s sy/ems1 are frequ5t1 especially 9 long /&+ cases4 ,! ga/ro-inte/9al di/urbances are ga/ric cat>rh1 vomit+1 loss ( appetite1 coat$ tongue1 con/ipation1 & lat] on1 di>rhea4 ,among g5ito-ur9>y symptoms1 album9uria is frequ5t4 ,! kidney involvem5t may be ei!r ( an acute or *ronic "*4 ,pyelitis & cy/itis are pres5t 9 "s cases1 & amyloid deg5]ations are n uncommon4 ,) ! cutane\s symptoms1 ! sk9 is frequ5tly dry & scaly1 & ! hair ( ! head dry4 ,! hectic flu% is common4 ,^u ! *e/ & back !re may be pigm5t>y /a9s4 ,! n]v\s symptoms v>y accord+ to ! involvem5t4 ,tub]cul\s m5+itis is r>e4 ,! m9d usually is cle> & ev5 9 advanc$ /ages ! pati5t is always hopeful4 ,physical ,signs4--,inspection reveals t ! %ape ( ! *e/ is (t5 *>act]i/ic4 ,a ph?isical ?orax is flat1 especially ! ?oracic op5+ ) wide int]co/al spaces1 prom95t co/al c>tilages1 & depress$ /]num4 ,sometimes ! l[] /]num =ms a deep concavity 7funnel brea/74 ,ano!r type ( ?orax is long & n>r[1 ) v oblique ribs1 & little expansion4 ,9 o!r in/ances ! *e/ is ( app>5tly normal build4 ,defective expansion is obs]v$ e>ly1 especially at ! apex ( ! affect$ side4 ,! clavicle ( ! affect$ side (t5 /&s out m prom95tly4 ,palpation %[s !re is decreas$ expansion & increas$ fremitus4 ,normally1 ! fremitus is /rong] at ! "r ?an at ! left apex4 ,if ! pleura is ?ick5$1 ! fremitus is decreas$1 b increas$ 9 lung involvem5t4 ,on p]cussion1 if ! diseas$ areas are m9ute1 ! p]cussion note may n be *ang$4 ,always comp>e ! two sides ( ! *e/4 ,dullness is fir/ not$1 z a rule1 above1 on or bel[ ! clavicle4 ,z ! disease progresses1 ! dull s\nd increases4 ,! size ( ! cavity1 its walls & ! am\nt ( secretion modify ! note4 ,l>ge1 ?9-wall$ cavities elicit ! 8crack$-pot0 s\nd4 ,consolidation1 ?ick5$ pleura1 l>ge am\nt ( mat]ial 9 a cavity & a connect+ bron*us impair resonance4 ,on auscultation ! brea?+ is h>% & ! expiration is prolong$ & high-pit*$ 7bron*ial74 ,e>ly 9 ! disease crackl+ rales may be he>d4 ,aft] consolidation takes place !re is bron*ial brea?+ & crepitant rales4 ,:5 s(t5+ occurs !y become moi/1 l\d] & sometimes bubbl+4 ,^! may be he>d ^u inspiration & expiration4 ,pleuritic friction s\nds1 z 9 case ( pleurisy1 may be he>d at any /age4 ,vocal resonance is increas$4 ,! signs ( cavity are3 ,p]cussion4--,!re is m or less defective resonance or tympany4 ,ov] l>ge cavities a 8crack$-pot0 resonance is obta9$4 ,?is is be/ obta9$ :5 ! pati5t has 8 m\? op54 ,!re may be normal resonance if ! cavities are cov]$ ) a consid]able ?ickness ( unaffect$ air cells4 ,auscultation may detect cav]n\s or amphoric brea?+1 pectoriloquy & co>se1 bubbl+ rales4 ,metallic t9kl+ may be he>d ov] l>ge cavities4 ,vocal resonance is increas$4 ,complications4--,! l>ynx & tra*ea frequ5tly und]go tub]cul> inflammation1 due to invasion f ! lung tissue4 ,pneumonia is ( common occurr5ce4 ,gangr5e1 pleurisy & endoc>ditis are o!r complications4 ,diagnosis4--,bacilli may be f\nd 9 ! sputum be=e ! physical signs are well develop$4 ,x may be necess>y to exam9e ! sputum sev]al times be=e ! tub]cle bacilli are detect$4 ,! pres5ce ( bacilli w set ! diagnosis at re/1 provid$ cl9ical symptoms are pres5t4 ,fev]1 hemoptysis1 c\gh1 emaciation & a cont9u\s1 local induration are diagno/ic4 ,! ,x-ray %\ld be employ$ z an aid 9 diagnosis4 ,prognosis4--,! prognosis ( pulmon>y tub]culosis v>ies greatly 9 diff]5t cases4 ,und\bt$ly a numb] ( cases h be5 cur$2 _m arre/$2 ev5 spontane\s cures h occurr$4 ,a great deal c be done to prolong life & to make ! pati5t com=table4 ,! av]age duration is ab\t ?ree ye>s1 al?\gh by c>eful treatm5t ?is "t is probably be+ increas$4 ,fibroid ,ph?isis ,?is t]m is appli$ to a =m 9 :i* !re is induration1 foll[$ by contraction ( ! affect$ lung tissue1 due to an ov]gr[? ( fibroid tissue4 ,! great] numb] ( cases are prim>ily tub]cul>1 b h run a fibroid c\rse4 ,o!r cases are prim>ily fibroid1 foll[$ by tub]cul\s infections4 ,x may beg9 z an ord9>y ulc]ative ph?isis1 or x may beg9 z an inhalation bron*itis4 ,9 o!r in/ances x may foll[ a *ronic tub]cul\s bron*ial pneumonia or pleurisy4 ,! onset is extremely insidi\s4 ,!re is p]si/5t c\gh1 (t5 p>oxysmal 9 "*4 ,dyspnea is m>k$1 especially on ex]tion1 b little or no fev] is pres5t4 ,! expectoration is pr(use & mucopurul5t4 ,!re is slight loss ( weight4 ,9 ! lat] /ages edema is m>k$4 ,x is a disease ( long duration1 la/+ f t5 to tw5ty ye>s4 ,! pati5t is (t5 able to pursue "s occupation & may h fair heal?4 ,!re is m>k$ dullness ov] ! affect$ side1 :i* is commonly mu* depress$4 ,!re is di/9ct bron*ial brea?+ at ! base1 :ile at ! apex !re may be cav]n\s s\nds4 ,! he>t is frequ5tly displac$ & ! "r v5tricle hyp]trophi$4 ,! bron*i are dilat$4 ,! cl9ical hi/ory is id5tical ) t ( simple cirrhosis ( ! lung f :i* x is (t5 sep>at$ ) difficulty4 ,bo? lungs may become ! seat ( tub]cul\s disease4 ,prolong$ suppuration results 9 amyloid *anges 9 ! liv]1 sple51 kidneys & inte/9es4 ,x-ray plates are ( value 9 diagnosis4 ,tub]culosis ( ,o!r ,tissues ,! alim5t>y tract is frequ5tly ! seat ( tub]cul> inflammation4 ,! inte/9es may be involv$ prim>ily or else second>ily f ! lungs or p]itoneum4 ,! prim>y =m is mo/ common 9 *ildr54 ,!re is slight fev]1 pa9s ( a colicky nature1 irregul> & p]si/5t di>rhea4 ,! disord] is commonly unrecogniz$1 be+ mi/ak5 = app5dicitis or o!r inte/9al disord]s1 until emaciation1 sweats1 ! cont9u$ fev] or lung involvem5t are manife/$4 ,! /oma*1 esophagus1 ph>ynx1 tonsils1 palate1 tongue & lips may be ! seat ( a tub]cul> lesion4 ,! s]\s membranes are usually second>ily involv$4 ,! p]itoneum is g5]ally invad$ f contigu\s organs1 especially ! inte/9es1 al?\gh ! pleurae may be ! />t+ po9t 7& 9 ! female ! g5]ative tract is a s\rce74 ,! disease may be ei!r acute or *ronic4 ,9 ! =m] x />ts abruptly ) vomit+1 pa9 9 ! abdom51 fev]1 & possibly di>rhea4 ,9 ! *ronic =m !re are fev]1 pa9s1 emaciation1 weakness & ! abdom5 is di/5d$4 ,! enl>g$ gl&s may be felt ?r\gh ! walls4 ,!re may be ascites1 or ! walls ( ! p]itoneum are adh]5t1 or ! tub]cles may ulc]ate4 ,! endoc>dium is occasionally ! seat ( acute or *ronic tub]culosis4 ,x is usually second>y4 ,likewise ! pleurae are sometimes involv$4 ,! *ronic =m is m common4 ,! g5ito-ur9>y sy/em is subject to tub]culosis4 ,! bladd]1 uret]s & pelvis ( ! kidney are attack$1 & f ^! ! kidney2 or possibly ! kidney involvem5t is "p ( a g5]al tub]culosis4 7,see pyelitis74 ,! ov>ies1 ,fallopian tubes & ut]us are also subject to tub]cul> invasion4 ,! diagnosis dep5ds ^u f9d+ ! bacilli1 ! symptoms indicat+1 (t5times1 an inflammation only4 ,also ! pro/ate1 te/icles & sem9al vesicles are attack$4 ,tub]culosis ( ! mamm>y gl&s is r>e4 ,9 mili>y tub]culosis ! liv] is commonly affect$1 (t5 second>y to o!r tissues1 especially ! p]itoneum1 lymphatics & lungs4 ,! blood-vessels & he>t are sometimes involv$ f ne>by organs or f mili>y tub]culosis4 ,! bra9 & cord are also at times invad$4 ,?is has be5 describ$ "u m5+eal tub]culosis4 ,diagnosis & ,prognosis ( ,tub]culosis4--,! o/eopa? %\ld be famili> ) ! v>i\s =ms ( ! disease4 ,an und]/&+ ( ! pa?ology & cl9ical symptoms is ess5tial4 ,! f9d+ ( ! bacillus1 provid$ !re are symptoms ( inflammation1 is diagno/ic4 ,mu* dep5ds ^u ! pati5t's con/itution1 hygi5e1 sanitation1 food1 fre% air & g5]al managem5t4 ,! o/eopa?ic lesion is decid$ly an important factor1 b ! treatm5t mu/ be balanc$ f bo? ! di/9ctive o/eopa?ic view & t ( g5]al managem5t4 ,!n ! pati5t's "p is z necess>y z ! o/eopa?'s4 ,"u prop] c>e & treatm5t1 unless ! disease has progress$ to a m>k$ degree1 !re is always a t5d5cy t[>d recov]y1 b1 to emphasize aga91 ! o/eopa?ic treatm5t1 ! environm5t & g5]al hygi5e %\ld be ?or\ghly und]/ood & appreciat$1 = at be/1 ! disease is trea*]\s4 ,ev5 aft] an app>5t recov]y is made1 ! pati5t %\ld be "u obs]vation2 !re is always dang] ( recurr5ce4 ,tub]culosis c (t5 be treat$ successfully1 or arre/$1 provid$ ! disease has n progress$ to a late /age2 al?\gh _m times1 9 ! lat] /ages1 life c be consid]ably prolong$ by c>eful treatm5t4 ,treatm5t ( ,tub]culosis4--,! prophylactic treatm5t ( tub]culosis %\ld receive fir/ consid]ation4 ,! sputum %\ld be ?or\ghly dis9fect$ & c>e tak5 t ! pati5t does n spit ab\t c>elessly4 ,a spit-cup %\ld be provid$ & ! sputum collect$ & de/roy$ by burn+ & ! cup /]iliz$4 ,! pati5t %\ld be well tak5 c>e ( & giv5 a sep>ate ap>tm5t1 s t ! dang] ( convey+ ! disease to o!rs is r$uc$ to a m9imum4 ,he %\ld occupy a s+le b$4 ,all unnecess>y furni%+s ( ! room %\ld be remov$ & ! objects t rema9 9 ! room %\ld be frequ5tly air$ & dis9fect$4 ,! g5]al & sanit>y environm5t ( ! pati5t %\ld be z favorable z possible to hygi5ic liv+4 ,_m times a *ange ( resid5ce is ( great b5efit4 ,:5 possible ! pati5t %\ld be out ( doors & light ex]cise tak54 ,! body %\ld be well protect$ by flannels1 ! ye> ar\nd4 ,ke5e#fa w\ld c>ry prophylaxis to c>eful exam9ation ( ! pregnant woman to av]t a sudd5 developm5t ( tub]culosis aft] p>turition2 also ( ! *ild1 aft] bir?1 to remove any pr$ispos+ lesions4 ,! "m ) a tub]cul> t5d5cy %\ld1 "u no circum/ance1 nurse ! *ild & %\ld be in/ruct$ to obs]ve any disposition on ! "p ( ! *ild to acquire malpositions 9 sitt+1 /&+ or walk+4 ,ano!r important consid]ation 9 ! prophylactic treatm5t is ! inspection ( dairies & slaught] h\ses4 ,! disease may be transmitt$ by infect$ milk4 ,!re is less dang] ( infection ?r\gh meat2 al?\gh all animals t pres5t di/9ct lesions %\ld be confiscat$4 ,sanatoria & o!r special arrangem5ts = ! c>e ( pati5ts %\ld be enc\rag$4 ,! ,treatm5t ( ! disease consi/s prim>ily 9 locat+ ! cause ( ! devitaliz$ condition ( ! cellul> tissue4 ,?is is ! vital po9t to be consid]$ & requires a ?or\gh exam9ation ( anatomical /ructures 9 ! region involv$4 ,!re is a reason :y ! tissues are 9 a deprav$ /ate & x is our "w to exam9e ?or\ghly ! /ructures t might become d]ang$ anatomically & cause an ob/ruct$ inn]vation or vascul> supply4 ,! disease is n prim>ily due to ! bacilli2 ! bacilli w\ld n h infect$ ! sy/em _h x be5 9 a heal?y /ate4 ,h5ce1 ! object ( ! treatm5t 9 tub]culosis is to favor a build+ up ( normal1 well-n\ri%$ tissues s t x is impossible = ! bacilli to infect ! region4 ,( c\rse1 de/ruction ( ! bacilli is important1 b we _c expect to d mu* by ! use ( a p>asiticide1 = we are n !n influ5c+ or affect+ ! real cause ( ! disease4 ,if we c improve ! art]ial circulation to ! diseas$ tissues1 we w be /rik+ at ! root ( ! disease & ! heal?y blood w be ! only p>asiticide necess>y4 ,?is is :]e ! o/eopa?ic !ory ( ! cause ( disease diff]s f t ( o!r s*ools ( m$ic9e4 ,at ! local po9ts ( infection !re is a decid$ malnutrition ( ! tissues1 due to a lack ( prop] blood to ! p>ts1 ?us favor+ ! lodg+ ( micro-organisms2 by ree/abli%+ normal nutrition nature w repair ! tissues if ! condition is curable4 ,h5ce1 x c be se5 at once t if ! case is curable o/eopa?ic treatm5t w meet ! dem&s sci5tifically4 ,! prec$+ is ! keynote ( o/eopa?ic !rapeutics2 n only 9 ! treatm5t ( tub]culosis1 b 9 all diseases :]e micro-organisms play an important "p4 ,9 tub]culosis ( any "p ( ! body1 x is ! duty ( ! o/eopa? to c>efully exam9e ! /ructures t may become anatomically d]ang$1 f any cause1 affect+ ! n]ve1 blood & lymphatic supply to ! tissues or organs diseas$4 ,correction ( anatomically d]ang$ tissues & att5tion to ! hygi5e1 diet & g5]al heal? ( ! pati5t con/itute ! treatm5t4 ,on ! subject ( ,pulmon>y ,tub]culosis1 ,w4 ,banks ,mea*am says3 8,9 cases ( pulmon>y tub]culosis x %\ld be rememb]$ t ! pa?ological lesion 9 ! lung is a result ( a g5]al sy/emic int]f]5ce--an int]f]5ce s great t ! body z a :ole loses its /or$-up heat 9 excessive temp]ature1 loses its res]ve nutrition1 z manife/$ by e>ly & cont9u\s loss ( weight4 8,!re=e ! causative o/eopa?ic lesion %\ld n be s\ght alone ov] ! site ( ! pa?ological lung lesion b r 9 t area :]e g5]al nutrition is o/eopa?ically affect$4 8,a few g5]al consid]ations ( o/eopa?ic me*anics involv$ 9 nutrition %\ld be ev] pres5t ) ! se>*] = ! cause ( pulmon>y tub]culosis4 ,= in/ance we "k t +e/$ fat is act$ ^u by ! pancreatic enzymes2 t ! inv]t9 ( ! inte/9e is an endocr9e secretion4 ,9 diet we seek to adm9i/] an excess ( fats to take ! place ( fat-loss 9 ?is disease1 (t5 los+ sight ( ! fact t "s me*anical maladju/m5t prev5ts fat-splitt+ into a =m suitable = tissue assimilation4 8,x is common o/eopa?ic k t lesions ( ! upp] dorsal area h a pr(\nd influ5ce on g5]al nutrition4 ,consequ5tly x is to ?is area t we mu/ look = ! causative o/eopa?ic lesion 9 ?is disease4 ,! influ5ce ( ?is area is due to ! fact t ! n]v\s me*anism ( ! secretory gl&s gets its mo/ direct di/urbance 9 ?is area :]e ! n]ves leave ! sp9al cord to become di/9ct inn]vation to ^! organs4 8,ap>t f ! nutritive & g5]al circulatory influ5ce ( upp] dorsal lesions we mu/ consid] ! g]micidal action ( ! endocr9\s secretions 9 devitaliz+ ! specific bact]ial ag5t 9 tub]culosis4 ,und\bt$ly ^! int]nal secretions h m>k$ effect 9 agglut9at+ ! bacilli1 ?us enabl+ ! phagocytes to p]=m a l>g] duty4 8,! correction ( upp] dorsal lesions1 ) due reg>d = ! pa?ological condition )9 ! ?oracic cavity gives a sci5tific physiological & bact]iological !rapeutic action 9 tub]culosis4 8,o!r lesions may & d dem& att5tion & correction :5 possible4 ,b we mu/ n lose sight ( ! fact t our specific action comes f a correct$ relation ( ! upp] dorsals4 ,9 ! cl\d ( unprov$ !ories & guesses 9 ! lit]ature ( pulmon>y tub]culosis no?+ seems ne>] an e/abli%$ tru? ?an t x is a disease contract$ 9 infancy1 t x develops1 lat]1 9 ^? p]sons :o reta9 ! infantile type ( *e/--?orax ( l>ge ant]o-po/]ior diamet] 9 contra/ ) ! lat]al diamet]4 8,9 ! progress ( ! disease we d get a co/al mal=mation giv+ ! #8horse-coll>' ?orax1 ) an app>5t lesion ( ! osse\s walls ( ! ?oracic cavity4 ,b ^! lesions are ! result ( nutritive *anges br\ght on by ! active infection already pres5t2 & are n 9 any true s5se1 causative factors 9 ! e/abli%m5t ( pa?ological areas )9 ! lung4 8,! o/eopa?ic treatm5t1 !n1 ( ?is disease is1 manife/ly1 a correction ( a pla/ic po/]ior upp] dorsal lesion4 ,& :]e ! pa?ological lesion ( ! lung contra9dicates =ceful correction1 mobility ( ! area %\ld be s\ght4 8,! g5]al c>e ( ! case %\ld look to ! normal function+ ( all organs1 ) emphasis on ease to ! pati5t4 ,! diet %\ld be :at ! pati5t c assimilate prop]ly ev5 ?\gh x be mu* less ?an ! am\nt a normally active p]son %\ld +e/4 ,altitude has a favorable effect 9 select$ cases only4 ,x is rem>kable t _m cases recov] 9 ! extremes ( ! ,rockies & ! coa/s ( ,cali=nia & ,florida4 8,no viol5t ex]cise %\ld be und]tak5 on acc\nt ( ! possible emb>rassm5t ( an already ov]work$ he>t & 9 consid]ation ( ! possibly engorg$ pulmon>y vessels4 ,= ^! reasons1 too1 re/ 9 b$ is advisable ) temp]ature above #ii ,f4 & pulse above #he40 ,9 scr(ula1 lesions w be f\nd to ! lymphatic gl&s1 impair+ _! inn]vation & function4 ,! treatm5t is n to be appli$ ov] ! gl&s directly4 ,fir/1 x is necess>y to locate ! lesions ( ! bones1 ligam5ts & muscles or su* tissues t w\ld cause di/urbances to ! gl&s1 !n readju/ ! p>ts4 ,! object ( ! treatm5t is to modify ! soil conditions on :i* ! bacilli multiply1 by correct+ ! local d]angem5t ( ! tissues4 ,! entire body is n 9 su* a deprav$ /ate t ! bacilli w gr[ & multiply :]ev] !y happ5 to come 9 contact ) ! body2 tissues ( any organ favor a receptivity = ! bacillus only :5 ^! local tissues are 9 a morbid condition4 ,x is !n our "w to aid nature 9 reliev+ ob/ruct$ =ces t are caus+ su* an effect4 ,!re are g5]al measures :i* influ5ce ! tub]cul> process4 ,! diet ( ! pati5t %\ld be nutriti\s4 ,a diet ( milk1 butt]milk1 egg album5 & meat juice w probably be f\nd be/1 al?\gh _m w be able to take ord9>y food4 ,! pati5t %\ld be out ( doors z mu* z possible4 ,mea*am#fb says 8,fre%1 pure air1 :]ev] f\nd1 is ess5tial2 elevation is an individual requirem5t1 an ev5 temp]ature is n necess>y & sun%9e is important only z x all[s ! pati5t to be out ( doors4 ,ex]cise %\ld n be tak5 :5 ! pati5t has a temp]ature above #ii degrees40 ,! dry1 ev5 climate ( ! ,s\?we/ c]ta9ly tempts ! pati5t to be out ( doors m ?an "o ) opposite conditions4 ,ev5 :5 ! pati5t is greatly debilitat$ & weak5$1 insi/ ^u 8 tak+ outdoor ex]cises or rides4 ,gymna/ic & me?odical brea?+ ex]cises are ess5tial 9 wid5+ & /r5g!n+ ! *e/4 ,bolles#fc believes t ! appetite %\ld control ! diet & =c$ fe$+ be n insi/$ ^u4 ,fa/+1 to te/ ! s5se ( food desires1 has po9ts well wor? look+ into1 z ga/ric di/urbances ) a loss ( /r5g? foll[ ov]fe$+4 ,he also recomm5ds deep brea?+ & physical culture to elevate ! ribs & increase ?oracic expansion4 ,outdoor sanatoria are be+ e/abli%$ ov] ! c\ntry1 9 _m cases by /ate appropriation z1 8! treatm5t ( tub]culosis itself has n be5 a satisfactory proc$ure except by climatic *anges or ! outdoor treatm5t p]si/5tly appli$40 7,halb]t74 ,! fre% air treatm5t may be tak5 at home by sleep+ 9 ! op5 air or by appliances fitt$ to ! w9d[ ( ! room s only ! head is expos$ to ! air4 ,! only factor is to get ! air4 ,! sk91 z well z ! excretory organs1 %\ld be kept active4 ,always make x z com=table = ! pati5t z possible4 ,! fev] is indicative ( ! activity ( ! disease1 s t treatm5t to influ5ce ! process & to promote elim9ation is be/4 ,spong+ ) ei!r cold or tepid wat] w be helpful4 ,! c\gh is a tr\blesome symptom4 ,att5tion to ! und]ly+ irritation is dem&$1 al?\gh "o _c hope to influ5ce1 to any great ext5t1 ! c\gh dep5d5t on cavity =mation4 ,cat>rhal processes 9 ! respiratory tract c be less5$4 ,lesions t are act+ z a cause ( irritation1 w frequ5tly be f\nd 9 subluxat$ ribs or v]tebr4 ,! sev5? & eigh? dorsals are frequ5t s\rces ( c\gh4 ,! tissues ab\t ! ph>ynx & l>ynx1 & ! hyoid bone1 di/urb+ ! vagus & o!r n]ves1 %\ld be c>efully wat*$1 also possible reflex irritation f ! abdom5 & pelvis4 ,night sweats are due to tub]cul> processes weak5+ ! sy/em & p>ticul>ly less5+ n]v\s control4 ,^! w subside z ! body is /r5g!n$4 ,spong+ w be ( s]vice4 ,disord]s ( ! /oma* & inte/9es1 su* z nausea1 vomit+ & di>rhea1 require treatm5t ( ! splan*nic area & regulation ( diet4 ,consid]able c be done to relieve tub]cul> l>yngitis by c>eful treatm5t ( ! l>ynx & contigu\s tissues4 ,hemorrhage is likely to be self-limit+4 ,att5tion to ! upp] dorsal v]tebr & ribs & muscles w t5d to equalize ! circulation4 ,re/ & use ( ice ^u ! *e/1 z well z int]nally1 w be b5eficial4 ,mc,intyre1 9 an article on 8,fat ,food 9 ,consumption10 sums up ! treatm5t = tub]culosis 9 ! foll[+ words3 8,! treatm5t1 !n1 = consumption %\ld include ri*1 /imulat+ diet1 proportion$ to ! dige/ive p[] ( ! pati5t1 conta9+ an excess ( fats 9 mo/ dige/ible =m1 ( :i* sweet cream1 fre% butt] & well-cur$ bacon are ! be/ examples1 & ! free use ( pure dr9k+ wat]1 c\pl$ ) ! promotion ( blood fl[1 respiration & elim9ation ( wa/e by o/eopa?ic means40 ,surgical measures may be necess>y :]e gl&ul> or o!r tissue has brok5 d[n & is a m5ace to recov]y4 ,spani% or ,epidemic ,influ5za#fd ,by ,,george ,m4 ,,mccole ,! epidemic ( influ5za :i* swept ov] ! _w & rea*$ ! ,unit$ ,/ates 9 ,augu/ #aiah1 />t+ 9 at ! ,atlantic sea-bo>d cities1 develop$ rapidly !re & pass$ we/w>d ov] ! c\ntry4 ,x reappe>$ ! foll[+ w9t]4 ,epidemiology4--,9 ! ,unit$ ,/ates x 0 call$ ,spani% influ5za1 z x 0 at its wor/ 9 ,spa9 at ! "t x broke out "h & 0 ?\ght to h be5 br\ght f t c\ntry4 ,9 ,europe x 0 call$ ! ,ukra9ian influ5za & 9 s\!rn ,russia x 0 said to h emanat$ f ! ,ori5t4 ,no c\ntry 9 ! _w 0 exempt4 ,x 0 at "o "t ?\ght to be a type ( ! pneumonic plague & :ile plague is ! sev]e/ toxemia kn[n _m cases ( ,spani% influ5za 7 equally z pro/rat+ & fatal z ! ord9>y type ( pneumonic plague4 ,! bacillus pe/is 0 nev] prov$ to be ! cause ( ?is p&emic ( influ5za b ! cl9ical analogy 0 v evid5t4 ,a /udy ( ,european conditions ( heal? & hygi5e %[s h[ reasonable x is to believe t "s disease w\ld develop & sweep a _w l[]$ 9 vitality & immunity by ! abnormal conditions ( w>4 ,e kn[n communicable disease 0 rag+ 9 ,europe & ,asia :]e millions ( p exi/$ "u exce$+ly poor hygi5ic conditions4 ,! p]iod ( incubation ( influ5za 0 extremely %ort1 av]ag+ ab\t two days4 ,all ages 7 attack$1 al?\gh p]sons ov] #fj r>ely4 ,^? betwe5 #be & #ce seem$ to be ! mo/ susceptible b x 01 p]haps1 because !y 7 9 active life & m expos$4 ,!re is consid]able evid5ce t ! disease 0 n air-borne b convey$ by contact ) active cases4 ,! secretions ( ! m\?1 nose & eyes 7 consid]$ ! active c>ri]s4 ,masks1 made ( sev]al lay]s ( gauze fa/5$ ov] ! face1 h be5 worn by _m p b exp]i5ce taught t _! use did n avail aga9/ infection4 ,mortality4--,! mortality "u drug m$ication z %[n 9 a /atem5t by ,h5ry ,s4 ,bunt+ 0 z foll[s3 8,new ,york ,city #i4h2 ,*icago #ad4e2 ,bo/on #bg4 ,o/eopa?y's influ5za salvage repres5ts ! diff]5ce betwe5 ^! figures & ! l[ score ( "o f\r? ( #a40 ,he gives ! foll[+ /ati/ics on pneumonia foll[+ influ5za "u drug m$ication4 8,reports f #adh heal? commission]s %[ an e/imate 7call$ cons]vative7 ( #cc ( fatalities 9 epidemic pneumonia "u m$ical c>e4 ,9 "s l>ge c5t]s x ran z high z #fh to #gc4 ,z (ficially compil$ to date1 ! fatalities 9 epidemic pneumonia 9 our army & navy cantonm5t hospitals am\nt$ to #cd4 ,o/eopa?y's fatalities 7 only #aj :i* includ$ all ^? elev5?-h\r appeals to ,o/eopa?y4 8,! ,*icago & ,new ,york dep>tm5ts ( heal? figures1 ea* %[ total dea? losses ( #ah 9 all ( _! epidemic cases4 ,o/eopa?y's rem>kable salvage ( life is be/ measur$ f ?is po9t ( comp>ison4 ,its total dea? rate f bo? influ5za & pneumonia has be5 actually less ?an "o p]c5t40 ,& ?is is bas$ on #aaj1jjj cases report$ to ! ,am]ican ,o/eopa?ic ,association4 ,pa?ology4--,! pa?ology ( ,spani% influ5za is practically a /udy ( lung involvem5t4 ,!re we f9d an exudative pneumonia ( a rapidly conflu5t type1 a transudate ( blood s]um & r$ cells appe>+ 9 ! l[] lobes ( bo? lungs & rapidly flood+ ! entire space4 ,air bubbles 7 scatt]$ ?r\gh ! s]um soak$ lungs1 giv+ a fro?y appe>ance to "s p>ts4 ,at times "s p>ts ( ! lungs %[$ drops ( liquid pus4 ,:]e pneumonia did n develop !re 0 no typical pa?ology4 ,! tox9s left an irritat$ bron*ial tube1 inte/9e or kidney j z 9 any o!r sev]e toxemia4 ,bron*ial & ! old type ( lob> pneumonia also appe>$ z a complication ( ,spani% influ5za1 mak+ ?ree types ( pneumonia :i* 7 to be gu>d$ aga9/4 ,symptoms4--,! attack is usually u%]$ 9 by a *ill or prolong$ *illy s5sations1 sometimes la/+ = two or ?ree h\rs2 fev] #ajc to #aje ,f42 if x does n fall 9 ?ree days or if x comes up aft] once fall+1 pneumonia is to be suspect$2 pulse1 full & b\nd+ ) a v>y+ rate2 heada*e usually g5]al 9 type & 9 sev]ity f slight discom=t to a mo/ viol5t type2 int5se pa9 9 ! back & legs2 t5d]ness ! :ole l5g? ( ! sp9e b especially di/ress+ 9 ! upp] dorsal1 l[] lumb> & sometimes ! upp] c]vical2 a dyspnea :i* is be/ describ$ z be+ a con/rict$ feel+ ( ! *e/ ) air hung]2 (t5 ! bron*ial tubes are raw & dry1 ! pati5t feel+ z if ! brea!d-9 air 7 hot to ! bron*ial tubes1 an active exudative bron*itis develop+2 sometimes !re is an active bron*itis ) di/ress+ c\gh2 nose ble$ is a frequ5t symptom 7& is (t5 a sign ( ?reat5+ pneumonia72 mo/ cases sweat m or less1 "s h dr5*+ sweats2 sleeplessness2 album9uria frequ5t4 ,:5 ! temp]ature breaks x practically always falls bel[ normal dur+ ! c\rse ( t day4 ,a typical case ( sev]e "* (t5 pres5ts all ( ! above symptoms2 ! light] cases p]haps only two or ?ree ( !m1 ( :i* ! *illy s5sations1 fev] & b\nd+ pulse are ! mo/ common enc\nt]$4 ,a sev]e case is impossible to diff]5tiate f ! fir/ symptoms ( smallpox4 ,:]e a case ( ?is type is enc\nt]$1 x is always advisable to get hi/ory ( vacc9ation or smallpox4 ,exam9ation4--,! successful treatm5t ( disease calls = att5tion to little ?+s4 ,"s little ?+ prop]ly c>$ = v (t5 gives u our m>g9 ov] adv]se conditions & spells success 9 ! c>e ( our pati5t4 ,dur+ ! epidemic ,i f\nd a few cases :i* ran a temp]ature mu* bel[ normal1 sometimes z mu* z ?ree or f\r degrees1 & /ill ) en\gh symptoms to be easily diagnos$ z influ5za4 ,pulse 0 tak5 at ! "t ! !rmomet] 0 9 ! m\?4 ,pulse 0 practically always b\nd+ & h>d4 ,its rate v>i$ widely1 be+ influ5c$ by _m o!r conditions4 ,i (t51 e>ly 9 ! attack & :]e o!r symptoms 7 indef9ite1 made a diagnosis pr9cipally f ! pulse4 ,respiration 0 tak5 :ile hold+ ! wat* & ) ! f+] on ! pulse s t pati5t w\ld n "k t brea?+ 0 be+ wat*$4 ,_m pati5ts compla9$ ( a s5sation ( weight on ! *e/ & difficult brea?+--h>dly :at "o w\ld t]m true dyspnea yet a real air hung] & s5sation ( con/riction 9 ! *e/4 ,! brea? 0 (t5 ta9t$ ) ! odor ( acetone1 indicat+ a high degree ( acidosis & giv+ an important diagno/ic po9t4 ,! he>t 0 !n exam9$1 bo? by auscultation & p]cussion4 ,! exam9ation 0 !n ext5d$ ov] ! lungs & pleural rub li/5$ =4 ,pati5t 0 que/ion$ z to hav+ _h a *ill1 g5]al heal?1 occupation1 undue exposure1 fatigue1 :at physic if any1 _h be5 tak5 or o!r drugs us$1 b[el movem5ts & bloody /ools1 food tak51 sleep ! night be=e1 & dreams1 heada*e & backa*e4 ,! full exam9ation c\ld n be giv5 at ea* call & n all ( x to ea* pati5t1 z "t w\ld n p]mit dur+ ! height ( ! epidemic4 ,?roat 0 always exam9$4 ,?is is an important po9t4 ,! ur9e 0 exam9$ 9 a great _m cases & (t5 album9 & sometimes ca/s 7 f\nd4 ,treatm5t4--,i consid] x advisable to give a /rong deep treatm5t if ! pati5t is se5 be=e ! attack has ga9$ full headway2 aft] t ,i give %ort light treatm5ts4 ,if ! disease has n develop$ mu* at ! "t ( ! fir/ visit vigor\s treatm5t ) adju/m5t ( ! deep-ly+ & tight5$-up ligam5ts ov] ! sp9al cord is indicat$4 ,subsequ5t treatm5ts are giv5 to ov]come ! inv>iable & recurr+ contractions along ! sp9al cord4 ,! sp9e is g5tly sprung & ! muscles pull$ away f ! int]v]tebral =am9a s t art]ies1 ve9s & n]ves ( ! sp9al cord are free to function4 ,i might note "h t ,i consid] ,spani% ,influ5za does its damage ?r\gh ! attack ( its peculi> & virul5t tox9 & ! accompany+ acidosis1 on ! body's res]voir ( en]gy--! sp9al cord & relat$ /ructures1 ! vegetative gl&s & n]ves4 ,if ! pati5t is 9 a s]i\s condition he is (t5 treat$ 9 ! position 9 :i* f\nd1 s z n to di/urb him4 ,c>e is p>ticul>ly tak5 to keep a pati5t :o is moi/ ) sweat f tak+ cold or be+ expos$4 ,an extra cov]+ is ?r[n across ! neck & %\ld]s1 & pull$ d[n z ! b$ cov]s are mov$ to get to ! area to be treat$4 ,! musculature ( ! upp] dorsal & c]vical region is giv5 special att5tion1 ! region ( ! fir/ & second c]vical & ! fir/ to six? dorsal be+ special seats ( tr\ble4 ,! region betwe5 ! sp9e & scapula on ! left side1 fir/ to six? ribs left1 & ! region ( ! suprascapul> not* on ! left side are giv5 specific treatm5t to free !m ( contractions4 ,! tissues ( ! suprascapul> not* are 9 direct connection ) ! n]ve supply ( ! he>t muscle & treatm5t "h is a/oni%+ly effective4 ,?is treatm5t = ! he>t is be/ giv5 ) ! pati5t ly+ on ! "r side1 lean+ a little =w>d1 ) 8 left =e>m aga9/ ! *e/1 h& at neck or *94 ,/& !n at ! pati5t's head & ) ! ?umbs give all ! region on ! left side at ! base ( ! neck & ar\nd ! suprascapul> not* ?or\gh muscul> adju/m5t = circulation & removal ( contractions :i* di/urb ! he>t's vitality4 ,treat fir/ to six? dorsal region4 ,i consid] ?is treatm5t specific = ! he>t debility ( influ5za & _m o!r he>t conditions1 z well4 ,i h f\nd x especially effective 9 ! weak5$ & n]v\s /ates foll[+ influ5za & 9 s-call$ 8run d[n conditions0 g5]ally4 ,vibration ) ! tips ( ! f+]s on ! ant]ior *e/ wall is (t5 us$4 ,t5d] & contract$ tissues are (t5 f\nd along ! ant]ior ends ( ! ribs :i* are involv$ at _! sp9al ends4 ,^! are g5tly treat$4 ,*ildr5 are (t5 giv5 vibration1 hold+ _! *e/s ) my h&s "u _! arms4 ,if ! pati5t is /\t & n easy to treat ,i h him sit up 9 b$ & give ! upp] dorsal ?or\gh p]cussion ) ! side ( ! h&#fe4 ,ab\t #ajj /rokes at ea* treatm5t are usually giv54 ,i rememb] "o v fat pati5t 9 ! eigh? mon? ( pregnancy to :om ,i c\ld give h>dly any o!r treatm5t4 ,x 0 especially valuable "h & we sav$ ! "m aft] a h>d fight1 ?\gh ! *ild 0 /ill-born4 ,:5 nature is meet+ ! em]g5cy & hold+ h] own 9 ! battle aga9/ infection we h a mod]ate fev]--a b5ign fev]4 ,:5 ! body is ov]work$ ) o!r duties & irritations ! fev] may rise dang]\sly high4 ,"h x is t ! physician mu/ give fur!r aid4 ,"h x is t o/eopa?ic treatm5t fur!r aids by giv+ re/ to ! pati5t1 eas+ pa9 & promot+ g5]al circulation 7?is 9 itself (t5 quickly r$uces fev]74 ,"h x is t ! att5tion we give to clo?+1 diet1 v5tilation1 quietness1 good nurs+1 etc41 comes 94 ,! body is reliev$ ( all duties b ! "o4 ,its functions are all turn$ to "o end--! de/ruction ( ! invad+ infection4 ,! o/eopa?ic physician adju/s4 ,nature cures4 ,x is all a matt] ( adju/m5t4 ,= labor$ brea?+1 an effective treatm5t is to h ! pati5t ) h&s clasp$ & arms rais$ above ! head1 pati5t be+ 9 b$1 face up4 ,/& directly at head ( pati5t4 ,rea* ov] pati5t's arms & "u ! upp] dorsal & lift up aga9/ ! heads ( ! ribs ) y\r f+]s1 ?us rais+ ! *e/1 beg9n+ z f> d[n ! sp9e z y c & work+ up z y treat4 ,relax ! muscles at ! same "t4 ,frequ5cy & ,am\nt ( ,treatm5t4--,frequ5cy & ext5t ( treatm5t dep5d ^u ! condition ( ! pati5t4 ,9 influ5za ! pati5t is approa*$ ) ! idea ( a daily visit4 ,if !n !re is any d\bt ab\t 8 be+ entirely safe = #bd h\rs he is se5 9 #ab h\rs or z (t5 z ! condition indicates4 ,pati5ts are usually se5 m ?an once a day4 ,! av]age "t :i* ! pati5ts are conf9$ to ! b$ is ab\t five days4 ,"s are free f fev] 9 ?ree days2 "s n = six or sev5 days4 ,accord+ to conditions !y are !n kept 9 b$ f "o to ?ree days long]4 ,z to ! am\nt & l5g? ( treatm5t1 ,i agree ) ,james ,m4 ,fras]1 :o says adju/m5t ( ! s(t tissues %\ld be made & made ) z little di/urbance to ! pati5t z possible4 ,he says#ff3 8,! ill effects ( too long-drawn-out g5]al treatm5ts1 or 9 %ort1 ov]-treatm5t1 ,i consid] "o ( ! mo/ important que/ions = o/eopa?s because ,i incl9e to ! belief t 9 _m acute infections m h>m may be done by su* fatigu+ ov]-treat+ ?an if ! pati5t 7 really n treat$ at all4 ,a 8flu0 or pneumonia pati5t %\ld nev] be treat$ ov] fifte5 m9utes at ! longe/ 9 "o treatm5t4 ,x is mu* bett] to treat (t5 & n treat s long1 z ov]-treatm5t may result f a desire to be ?or\gh4 ,if we always w\ld /op & ?9k :at we are do+ & j :at we are try+ to prev5t we w\ld be m c>eful :5 we treat ^! infecti\s cases4 ,a pati5t's resi/ance may really be l[]$1 8 b[els inhibit$1 8 he>t ov]/imulat$1 8 muscles fatigu$ & 8 n]ve =ce deplet$ by treat+ ov]time4 ,:5 ! reaction beg9s1 /op40 ,conge/ions & contractions %\ld be remov$ :]ev] !y are f\nd1 be x 9 ! region ( ! ?roat1 sp9e1 ribs1 liv] or sple54 ,i ord] a daily enema & give positive in/ructions--aft] hav+ _h "o or two almo/ fatal cases f ?is cause--to use no physics4 ,purg+ kill$ m p "h ?an any "o o!r ?+4 ,if a heavy physic be giv5 two or ?ree times & ! pati5t comes to a crisis1 s mu* vitality has be5 tak5 out ( ! blood t he does n h en\gh /r5g? to c>ry him ov] & he dies4 ,if ! pati5t comes to pneumonia ,i f9d x good & effective to use ! 8con/ipation treatm5t40 ,x is be/ to let ! b[el take c>e ( itself4 ,nature c d _m ?+s1 & c>+ = ! b[el 9 a crisis is "o ( !m1 provid+ ! correct diet has be5 giv5 ! pati5t4 ,if ! pati5t is gett+ no?+ b fruit juices !re may be a natural b[el movem5t & ev5 if he has be5 gett+ o!r food x is bett] to leave ! b[el alone until aft] ! crisis & !n give ! enema4 ,a pati5t ) a frank pneumonia foll[+ influ5za has b little *ance ( liv+ if 8 /r5g? is be+ dra9$ f ! blood /ream ?r\gh ! b[el e few h\rs4 ,i see to x t no draft bl[s on ! pati5t's b$4 ,9 a w9dy location a cold draft c appe> sudd5ly & d great damage 9 a %ort "t4 ,! pati5t %\ld n brea! cold air4 ,fre% air is all "r b x mu/ n be cold air4 ,i ord] extra cov]+ = ! neck1 arms1 %\ld]s1 back & *e/4 ,i l a wool work%irt be/ b use pneumonia jackets1 extra und]%irts1 sweat]s1 etc41 :5 ! wool %irt is n to be _h4 ,9 fact cont9u$ w>m? seems to be an almo/ necess>y condition to ! prop] h&l+ ( influ5za4 ,x is because heat1 ev5 ! heat ( ! fev] itself seems to aid ! n]v\s sy/em 9 build+ up antitox9s4 ,! pati5t is in/ruct$ t if a sweat comes on1 ei!r f a hot ba?1 hot dr9k or z a result ( ! disease1 to lie & take x1 = ?r[+ (f ! cov]s is a sure way ( tak+ cold & invit+ pneumonia4 ,if ! h\se is cold or ! pati5t weak or v sick ! ur9al & b$ pan are us$4 ,9 fact ,i pref] _! use ev5 :5 ^? conditions are n pres5t1 z ! less ! exposure ! less *ance ( pneumonia & ! quick] recov]y4 ,re/ ly+ 9 b$ is absolutely necess>y to a satisfactory c\rse & quick recov]y4 ,= lung conge/ions & bron*ial irritation1 9 addition to o/eopa?ic treatm5t along ! sp9al cord1 rais+ ! ribs & *e/1 & vibration ( ! *e/ wall1 ,i sometimes use ! old fa%ion$ mu/>d pla/] 7made ) "o teaspoon ea* ( fl\r & mu/>d1 mix$ ) olive oil or ) wat] & :ite ( egg71 keep+ x on ab\t t5 to ?irty m9utes or until a good1 r$ reaction is br\ght ab\t4 ,! feet mu/ be kept w>m ) hot wat] jugs4 ,a hot mu/>d foot ba? is excell5t :5 ! feet p]si/ 9 /ay+ cold4 ,at fir/ ,i did n use ! hot tub-ba?4 ,i am n[ ord]+ x if ,i see ! pati5t e>ly 9 ! attack & :]e !re is no contra9dication1 su* z a dang]\s he>t condition4 ,i d n use x unless x c be giv5 prop]ly & )\t undue exposure to ! pati5t4 ,i nev] give x late 9 ! disease4 ,a good me?od is to get ! pati5t into ! tub1 lay two canes or /icks across ! tub1 & cov] all ) a blanket or rug4 ,place a ba? t[el = ! head to re/ on & pull ! blanket ar\nd ! neck4 ,! pati5t c !n take a good hot sweat 9 com=t4 ,8 arms & %\ld]s1 8 knees & legs w n be expos$ to *ill4 ,:5 he gets up ! blanket c be drawn ab\t him if desir$4 ,he !n goes back to b$ = a good re/ & sweat4 ,a cold t[el is plac$ on ! head & wat] giv5 to dr9k4 ,e pati5t %\ld h a good sweat e>ly 9 ! attack4 ,ano!r good me?od is to cov] ) a blanket & place outside fruit j>s or jugs fill$ ) hot wat]1 cold t[el to ! head & sev]al glasses ( wat] or lemonade to dr9k4 ,! use ( cold compresses on ! *e/ ,i d n favor4 ,!y are us$ by "s o/eopa?ic physicians1 b ,i believe ! result is bett] ) o!r me?ods4 ,appli$ 9 a hospital :]e ! te*nique is well 9 h& !y might be successful1 b p]sonally ,i fe> !m4 ,i am ev5 c>eful ab\t putt+ an ice bag on ! he>t4 ,cold packs are sometimes us$ 9 my practice b only on ! head = pa9 or delirium4 ,*ill mu/ be avoid$4 ,w>m? mu/ be cons]v$1 ev5 ! fev] is b5ign4 ,nei!r d ,i favor 8rub-on0 ( camphor1 turp5t9e or onions :5 !y irritate ! pati5t4 ,if ! pati5t has be5 us$ to !m or has fai? 9 !m & wants !m ,i ord] !m4 ,i also ord] some?+ ( ! k9d :]e 8some?+ mu/ be done04 ,:5 a family calls a doctor !y 8want some?+ done10 & x is be/ to d some?+2 ev] keep+ 9 m9d1 h[ev]1 t our pati5t's /r5g? mu/ be cons]v$4 ,i d favor 8rub-ons0 9 t ,i ?9k x is well to keep ! sk9 s(t ) "s oil4 ,x helps to keep an ev5 temp]ature & ! sk9 active4 ,! sk9 %\ld be wip$ dry (t51 h[ev]1 to remove ! sk9 secretions :i* if left on become /ale4 ,i rememb] be+ call$ to see "o little girl :o c\ld n get h] brea?1 & f\nd %e 0 hold+ h] nose ) ! b$ clo!s4 ,%e told me t ! smell & /ick9ess ( ! l>d & turp5t9e & ! onions made h] s sick & uncom=table t %e felt %e c\ld /& x no long]4 ,:5 %e 0 clean$ up1 & clo!d 9 nice clean :ite cotton %e %[$ a wond]ful improvem5t1 & x 0 real z well z app>5t4 ,z to ba?s 9 influ5za1 ,i in/ruct ! nurse to ba! ! pati5t only z necess>y = cleanl9ess & 8 com=t4 ,dabbl+ ar\nd 9 wat] is n a safe proc$ure 9 a disease :]e pneumonia is s easily contract$4 ,i d n use alcohol rubs :]e ! pati5t is 9 any?+ l a s]i\s condition1 z alcohol closes ! pores & dries out ! sk94 ,a rubb+ or massage by ! nurse is good = a re/less1 n]v\s pati5t1 b x _h bett] be done ) olive oil or "s o!r good oil4 ,9 influ5za we d n want ! pores clos$4 ,we ne$ elim9ation1 & all we c get4 ,a small sav+ ( vitality or a little elim9ation ( tox9s may be ! m>g9 t saves a pati5t = u4 ,i d n favor ! use ( turp5t9e1 = if x is absorb$ x irritates an already sick kidney2 if x is n absorb$ x is useless4 ,:y di/urb ! pati5t8 ,= ! bron*ial irritation1 9 addition to o/eopa?ic treatm5t1 & ! accessory mu/>d pla/]s1 inhalation ( /eam is (t5 us$4 ,a pan ( boil+ wat] is set by ! b$ & ! pati5t leans ov] ! edge ( ! b$ ) a b$-%eet or pap] ov] ! head & /eam vessel1 brea?+ ! /eam z long z x la/s4 ,= ! ?roat mo/ any cleans+ g>gle c be us$ b ,i pref] ! use ( ! common bak+ soda g>gle4 ,i h ab\t "o-half teaspoonful ( soda plac$ 9 a glass & boil+ hot wat] p\r$ ov] x4 ,z soon z ?is is cool en\gh to use ,i h ! pati5t g>gle ?or\ghly4 ,! idea is to get ! m\?1 ph>ynx & tonsill> area clean & free f accumulations4 ,lemon-wat] g>gle is (t5 gratefully accept$4 ,if a v sick pati5t brea!s ?r\gh a dirty & dri$-out m\?1 all ! /age is set = him to draw into ! devitaliz$ lung l>ge quantities ( infecti\s mat]ial4 ,= ?is reason if n = ! com=t ( ! pati5t x is necess>y t ! m\? be kept clean & also moi/4 ,x is n possible to kill ?is g]m life ) any antiseptic4 ,! field mu/ be made & kept clean4 ,! nasal passage also %\ld be look$ aft]1 to keep x clean z possible & also to all[ ! pati5t to brea! ?r\gh ! nose4 ,= ! nasal passage any good non-irritat+ oil is effective b ,i l be/ #b iod9e 9 oil4 ,x is a good lubricant & z f> z possible we d get ! g]micical action ( ! iod9e4 ,pati5ts ask+ me :at to d to avoid influ5za are advis$ to keep ! m\? clean & clos$ & to use ! oily solution ( iod9e 9 ! nasal passages4 ,& :5 treat+ ! respiratory tract we mu/ keep 9 m9d ! fact t all heal+ comes f ! blood side ( a membrane4 ,no heal+ ev] comes to a membrane f its expos$ surface4 ,local treatm5t to a membrane mu/ be a treatm5t :i* removes irritation1 n "o :i* adds m4 ,heal+ mu/ come f )94 8,! rule ( ! art]y is supreme40 ,diet4--,! diet us$ is liquid1 s t ! dige/ive functions w be tax$ z little z possible1 = !y are weak at ?is "t4 ,fruit & vegetable juices only are us$4 ,! influ5za g]m propagates l>gely 9 ! inte/9e & if ! inte/9e has 9 x ! products ( a full diet ! bact]ial gr[? soon ov]p[]s ! pati5t4 ,g]m life _c develop on fruit & vegetable juices4 ,ano!r reason = us+ ! liquid & fruit diet is t influ5za is a disease runn+ a %ort c\rse & fe$+ is n necess>y4 ,if x 7 a disease su* z typhoid1 runn+ a fev] = sev]al weeks1 we w\ld !n give a m lib]al diet1 b ! pati5t's /r5g? w n be lo/ on a liquid & fruit-juice diet 9 ?ree or ev5 eight days4 ,! frequ5cy ) :i* ! ur9e conta9s album9 9 ?is disease %[s u :at a heavy load ! kidneys are c>ry+4 ,?is makes a salt-free diet advisable & aga9 br+s fruit juice to our favorable att5tion4 ,to activate ! kidneys & ?us relieve ! heada*e we give always pl5ty ( wat] & (t5 hot lemonade4 ,orange juice & lemonade are us$ frequ5tly z are blackb]ry1 raspb]ry1 p9eapple1 loganb]ry & grape juices4 ,:5 ! acid juices are n well borne we use non-acid juices1 su* z pe> & raspb]ry juice4 ,a ripe1 cook$ pe> ma%$ ) a =k & mix$ ) "o or two diff]5t fruit juices makes a satisfy+ di%4 ,bottl$ sweet cid] is also a mo/ valuable food & a good bev]age4 ,we use x 9 almo/ e case & f9d x ! mo/ acceptable to ! pati5t ( any food (f]$4 ,i am ( ! op9ion t apple cid] has be5 neglect$ z an article ( diet1 bo? 9 disease & heal?1 b especially 9 fev]s4 ,x conta9s consid]able iron = ! blood1 z well z hav+ consid]able food value4 ,x has ! add$ virtue ( be+ pleas+ to ! pati5t4 ,9 addition to ^! juices we (t5 use sp9a* juice4 ,i h ! nurse get a c ( ! be/ grade sp9a* & s]ve ! juice hot1 z a bro?1 ) a little salt & pepp] & p]haps cel]y salt & a piece ( bacon 9 x to flavor x & to appeal to ! pati5t4 ,sp9a* juice conta9s mu* iron & iod9e 9 a =m readily absorbable by ! blood4 ,x also is useful 9 ma9ta9+ ! alkal9ity ( ! blood & body fluids1 ?us c\nt]act+ ! acidosis ( ! disease4 ,x r5d]s ! ur9e alkal9e & ?us relieves ! kidneys ( ! irritation ( acidosis & ( an acid ur9e4 ,:]e ! kidneys are or are likely to be involv$ ! sp9a* juice mu/ be s]v$ )\t salt4 ,all ! m5tion$ fruit juices t5d to c\nt]act acidosis & produce alkal9ity1 b are n s effective z ! sp9a* juice4 ,!y h ! advantage1 h[ev]1 ( be+ us$ 9 l>g] quantities4 ,! sp9a* juice has consid]able food value & has ! add$ value ( appeal+ to ! pati5t's reason1 :5 ! iron & iod9e cont5t is expla9$ to him4 ,x is especially useful :5 treat+ ^? pati5ts :o are wond]+ if !y %\ld n be gett+ "s sort ( 8tonic40 ,! juice tak5 f gr\nd fre% lettuce is also valuable4 ,x conta9s m iron1 iod9e & phosphates ?an ! sp9a* b x is n s easy to prep>e4 ,i h us$ x 9 ! cases ( sev]al anemic & q sick babies & consid] x well wor? all ! exp5se & ef=t x took to secure x4 ,! break+ d[n ( ! alkal9e res]ve ( ! body & ! consequ5t acidosis1 comes e>ly 9 ! disease & is disa/r\s1 & all ! att5tion giv5 to ! diet is amply repaid 9 results4 ,c>eful att5tion to ! diet is ! only way ! acidosis c be ov]come4 ,raw fruit & vegetable juices also supply t mo/ valuable elem5t1 vitam9es4 ,= ?is "o ?+ alone is ! raw fruit juice mo/ valuable4 ,i d n believe too mu* att5tion c be giv5 to secur+ a lib]al supply ( vitam9es = ! body1 especially dur+ an attack ( fev]4 ,"s especially int]e/+ po9ts are br\ght out by contributors to ! ,j\rnal ( ! ,am]ican ,o/eopa?ic ,association 9 ! ,m>*1 #aiai numb]4 ,i wi% "h to add a discussion ( ^! po9ts4 ,! contributors are physicians & good repres5tatives ( our pr(ession & !y report uni=m & excell5t success 9 h&l+ ! rec5t epidemic4 ,x seems to be ! cons5sus ( op9ion t ! treatm5t %\ld be specific & light to avoid fatigue1 ) ! possible exception ( ! fir/ treatm5t1 :i* (t5 %\ld be g5]al & vigor\s4 ,all are agre$ t ! pati5t %\ld be kept 9 b$1 n ev5 leav+ x to g to ! ba? room4 ,! pati5t mu/ be protect$ 9 e way f fatigue & exposure4 ,! enema 0 us$ by all4 ,a numb] ( writ]s /ate pla9ly _! opposition to ! use ( physics & laxatives4 ,a hot tub-ba? is recomm5d$ by sev]al1 b !re is opposition to mu* ba?+4 ,practically all ! writ]s us$ ! fruit-juice diet4 ,h[ev]1 a few gave a heavi] diet & 7 successful ) _! pati5ts1 :i* is "o m pro( t ! o/eopa?ic treatm5t is ! decid+ factor 9 br++ ab\t a cure4 ,j4 ,r4 ,?ornton wrote aft] hav+ _h ab\t #ajj cases4 ,he speaks especially ( 8 cases ( pneumonia4 ,!y resolv$ by crisis4 ,!re 7 no dea?s4 ,he says3 8,all cases 71 prec$+ ! fir/ treatm5t1 giv5 a g5]\s pla9 wat] enema4 ,ord]s 7 left = two enemas p] day until told to discont9ue1 & 9 mo/ cases ! pati5t got ! enema4 ,a few cases1 ) ! highe/ fev]1 ! /ation>y fev]1 7 giv5 tap-wat] enemas1 "o ea* h\r until ! temp]ature dropp$ two or ?ree degrees4 8,sponge ba?s 7 giv5 to r$uce fev] 9 e case4 ,diet 0 liquid until ! temp]ature 0 normal4 8,! o/eopa?ic treatm5t ( ! usual sp9al "w1 pay+ special att5tion to c]vical & dorsal areas1 & /rong inhibition4 8,pneumonia cases 7 treat$ ?ree to five times a day & _h z mu* "t z !y requir$ at ea* visit4 ,!y requir$ action4 ,heat+ compresses 7 us$ on ea* case1 except ! ice bag to ! he>t :5 rapid4 ,"o case ( delirium 0 treat$ ) ice caps to ! head & neck4 ,normal salt solution p] rectum4 ,murphy drip 0 giv5 9 ea* case4 ,diet1 liquid consi/+ ( egg-nog1 milk1 /ra9$ s\p & bro?40 ,m>y ,alex&] ,patton3 8,treatm5t %\ld be quick1 e motion significant s z n to tire ! pati5t1 = exhau/ion is always pres5t4 ,ea* pati5t 0 treat$ two or ?ree times a day until temp]ature became normal4 ,! nasal d\*e 0 giv5 twice a day foll[$ by ,k-,y jelly4 ,hot soap ba? foll[$ by soap enema & ent]oclysis :5 fev] p]si/$40 ,w4 ,curtis ,brigham ord]$ 8,hot packs ! full l5g? ( ! sp9e tw5ty to ?irty m9utes1 ?ree times a day4 ,?is w produce pr(use sweat+ & (t5 put ! pati5t to sleep40 ,i h us$ ?is same treatm5t1 especially 9 n]v\s cases1 & hold x 9 high e/eem4 ,i h ! pati5t put a ba? robe on backw>ds s t ! arms & legs are well protect$ b ! sp9e easily accessible4 ,! hot packs c !n be us$ & cov]$ ov] & ! pati5t n expos$4 ,r4 ,h4 ,nuckles ma9ta9s t lung & e> tr\ble w n foll[ influ5za :]e o/eopa?ic treatm5t has be5 giv5 to adju/ ! c]vical & upp] dorsal circulation4 ,h4 ,a4 ,price3 8,we h kept p>ticul>ly 9 m9d1 fir/1 ! n]ve1 blood & lymphatic supply to ! lungs2 second1 ! circulation to ! sp9e 7mean+ sp9al cord72 ?ird1 ! int]nal secretory functions & to ! g5]al excretion40 ,ralph ,m4 ,crane says3 8,a great deal ( my "w is among ! ,italians4 ,x 0 necess>y to give quick specific treatm5t t ,i might d z mu* good z possible to ! greate/ numb]4 ,i did n treat !m z (t5 z ,i w\ld l to1 & because ( ?is fact ,i le>n$ t o/eopa?y got control ( ! #8flu' imm$iately1 ! fir/ treatm5t suffic+ to />t !m on ! road to recov]y2 9 fact1 _m ( !m got no m ?an "o treatm5t40 ,,footnotes3 #ea ,h9ckle--,! ,sci5tific ,basis ( ,o/eopa?y4 #eb ,cl9ical ,o/eopa?y4 #ec ,j\rnal ( ,o/eopa?y--,prize ,article ,july1 #aijf4 #ed ,a4 ,o4 ,a4 ,case ,reports--,s]ies ,i4 #ee ,e4 ,l9k1 ,diph!ria--,! ,bullet91 #aije4 #ef ,a4 ,m4 ,will>d1 ,membran\s ,cr\p--,j\rnal ( ,o/eopa?y1 ,m>*1 #aijd #eg ,see ,dr4 ,/ill--,philosophy & ,me*anical ,pr9ciples ( ,o/eopa?y4 #eh ,j\rnal ( ,o/eopa?y1 ,octob] #aije4 #ei ,j\rnal ( ,o/eopa?y1 ,octob] #aije4 #fj ,j\rnal ( ! ,am]ican ,o/eopa?ic ,association1 ,m>* #aijf4 #fa ,j\rnal ,am]ican ,o/eopa?ic ,association1 ,decemb] #aijd4 #fb ,j\rnal ,am]ican ,o/eopa?ic ,association1 ,may1 #aije4 #fc ,j\rnal ,am]ican ,o/eopa?ic ,association1 ,may1 #aije4 #fd ,rewritt5 f article 9 ,o/eopa?ic ,physician1 ,june #aiai4 #fe ,?is treatm5t 0 describ$ by ,h5ry ,m4 ,/ovel1 9 ,! ,o/eopa?ic ,physician ( ,janu>y #aiag4 #ff ,o4 ,p4 ,june #aiai4 ,,acute ,,eruptive ,,fev]s1 ,,mumps ,,& ,,:oop+ ,,c\gh ,by ,,edg> ,s4 ,,com/ock ,,g5]al ,,consid]ation ,9 ! consid]ation ( ^! diseases1 x is well to be> 9 m9d t l[]$ resi/ance is ! prim>y condition t has made ! infections possible1 & t l[]$ resi/ance implies an imbalance ( or ob/ruction to ! vital fluids & =ces ( ! body1 !reby int]f]+ ) ! functional activity ( ! body's normal protective me*anism4 ,! imbalance ( or ! ob/ruction to ^! vital fluids & =ces1 :i* is /ructural 9 nature1 is produc$ by _m conditions1 z fatigue1 exposure1 sudd5 *anges ( heat & cold1 emotions1 dietetic errors1 physical =ce or viol5ce1 etc4 ,^! conditions1 because ( ! response ( ! tissues ( ! body to environm5tal *anges1 produce contractures ( ! ela/ic tissues1 su* z muscle1 fascia1 etc41 :i* di/urbs ! /ructural integrity ( ! body & ?us produces ob/ructions1 irritations or int]f]5ce ) ! m$ia ( ex*ange ( ^! vital fluids 7blood & lymph7 & =ces 7n]v\s en]gy7 ( ! body4 ,x is evid5t1 !n1 t ! mo/ pot5t curative factor 9 ! treatm5t ( ^! diseases1 z 9 all o!rs1 is ! removal1 :5ev] possible1 ( ! ob/ructions & int]f]5ces t p]v]t ! activity ( ^! protective =ces4 ,x is necess>y1 !re=e1 to remove ! excit+ causes 7fatigue1 dietetic error1 etc47 & by su* physiological means z may seem necess>y to readju/ ! /ructures ( ! body s z to remove ! above m5tion$ ob/ructions & int]f]5ces4 ,! /ructural lesions mo/ frequ5tly f\nd 9 ! infecti\s diseases are ( ! muscul> & fascial type & are v evid5t to ! c>eful obs]v]4 ,! int]osse\s lesions are probably (t5 ! pr$ispos+ factors to ! susceptibility ( ! s(t] tissues to reaction to environm5tal *anges1 b x has be5 ! exp]i5ce ( ! writ] t ! adju/m5t ( ! s(t] tissues 0 ( great] prim>y importance 9 ! acute /ages ( ^! diseases4 ,! int]osse\s lesions may be easily adju/$ 9 ! v e>ly /ages ( ^! diseases1 t is be=e ! sev]e symptoms h appe>$1 b aft] ! m sev]e conditions h appe>$ x has be5 our exp]i5ce t ! s(t tissue "w 0 suffici5t unless ! int]osse\s lesions 7 v easily adju/$4 ,x is ! writ]'s desire to impress ^u ! read] ! necessity ( c>eful att5tion to ! /ructural lesions t are always con/ant 9 ^! diseases1 us+ :atev] physiological means seem necess>y to adju/ ^! lesions & keep !m adju/$1 & to insi/ ^u c>efully re/rict$ diet2 cont9u\s1 ?or\gh elim9ation ( ! wa/e products ( ! body2 hygi5ic surr\nd+s & well-regulat$ environm5ts bo? m5tal & physical4 ,!n ,nature1 :i* has giv5 ! body its own protective me*anism1 may h full control ( ! situation & all ( ! normal protective *emicals & =ces 9 ! body organism are utiliz$ 9 ! battle ) ! invad+ infective =ces3 ! gl&s secrete ! *emicals ( protection2 ! antibodies are rapidly develop$ & ?r[n into ! battle area2 metabolism beg9s to return to normal2 elim9ation becomes increas$ because ( ! /imulat+ action ( =eign sub/ances 9 ! body /ructures2 & ! "w ( repair & recup]ation beg9s4 ,if reliance is plac$ ^u ! inh]5t protective =ces ( ! body1 ! k ( ! special type or "* ( ! invad+ organism is ( little importance f ! /&po9t ( ! treatm5t ( ! disease aft] x has become e/abli%$4 ,! value ( ! k ( ! specific organisms is 9 prev5tive m$ic9e1 9 seek+ out ! habitat & bre$+ gr\nd ( ! organism & its mode ( transmigration4 ,kn[+ ^!1 effective measures may be adopt$ to prev5t _! propagation & spread4 ,examples ( ?is are ,yell[ ,fev] & ,mal>ia4 ,v>iola 7,,smallpox7 ,def9ition4--,v>iola is an acute1 specific1 highly infecti\s & contagi\s1 epidemic disease4 ,its beg9n+ is sudd5 ) a *ill1 vomit+1 sev]e heada*e & lumbo-sacral pa9s4 ,x has a typical fev] curve & a typical eruption on ! sk9 & mucos ( macules1 papules1 pu/ules & cru/s successively4 ,hi/ory4--,prevail$ 9 ,*9a & ,india at lea/ #ajjj ye>s be=e ! ,*ri/ian era4 ,epidemics occurr$ 9 ! six? c5tury & dur+ ! crusades4 ,its fir/ cl9ical description 0 giv5 9 ,arabia dur+ ! n9? c5tury4 ,x 0 br\ght into ,mexico ab\t #aebj by ! ,spani>ds & betwe5 ?ree & f\r million p contract$ ! disease4 ,9 #agah prev5tive inoculation 0 introduc$ into ,engl& & 9 #agif ,j5n] discov]$ vacc9ation4 ,etiology4--,! specific ag5t :i* is ! cause ( ?is disease is unkn[n1 b ! virul5ce ( ! ag5ts is reta9$ = a long p]iod & is ! mo/ virul5t f\nd 9 all diseases4 ,!re is no p]iod f ! initial fev] to ! f9al desquamation t ! disease is n contagi\s1 al?\gh ! /age ( suppuration is ! mo/ viol5t4 ,al?\gh ! disease is s highly contagi\s & ! entrance ( ?is p>ticul> poison into ! sy/em produces ?is disease1 /ill no "o has yet be5 able to discov] a g]m nor :at ! nature ( ! infective ag5t is4 ,to contract ! disease x is n necess>y to t\* an individual already afflict$1 n to ev5 approa* ! sick room4 ,x may be only necess>y to t\* a g>m5t t has once be5 9 contact ) a smallpox pati5t1 or :i* has simply hung 9 8 vic9ity4 ,! blood is infecti\s at a v e>ly /age4 ,z smallpox is contagi\s )\t eruption x seems t ! secretions & excretions convey ! virus4 ,! dri$ pu/ules seem to h ! greate/ infecti\sness4 ,cadav]s ( smallpox 7,v>iola7 victims are v dang]\s & relatives ( !m %\ld be c>efully w>n$4 ,! disease (t5 p]si/s 9 infect$ communities = ye>s4 ,! disease is evid5tly spread by fomites1 contact ) ! pu/ul> cont5ts1 & cru/s or scales ( ! desquamat+ sk94 ,x attacks all classes1 ages & conditions ( p1 :i* is unlike o!r ery!mat\s diseases4 ,a previ\s attack usually conf]s immunity4 ,vacc9ation is claim$ to conf] immunity b app>5tly 9 n all in/ances1 = !re are records ( 8successfully vacc9at$0 individuals hav+ sev]e attacks ( ! disease4 ,! susceptibility to smallpox1 z to all o!r infecti\s diseases1 v>ies 9 diff]5t individuals1 9 diff]5t races1 & "u ! influ5ce ( conditions z yet unkn[n4 ,"s p]sons are n susceptible to ! disease1 nor are !y to vacc9ation1 & yet o!rs h be5 kn[n to h _h ! disease z mu* z ?ree times4 ,! ,negro & ,indian races seem to be m susceptible ?an ! ,caucasian4 ,!n aga9 at int]vals ( a few ye>s1 ! g5]al susceptibility ( ! p seems to be increas$ s t cases ( smallpox become f> m num]\s ?an usual4 ,a po9t ( consid]able int]e/ is ! fact t ! *ild1 :ile 9 ! "m's womb1 may exp]i5ce ! disease along ) ! "m & !reby acquire1 be=e bir?1 ! usual immunity conf]r$ by "o attack ( ! disease4 ,9 mo/ cases ( smallpox 9 pregnant wom51 abortion or misc>riage occurs1 yet a suffici5t numb] ( in/ances are on record 9 :i* heal?y *ildr5 h be5 born1 exhibit+ ! *>act]i/ic pitt+ ( smallpox1 & possess+ no susceptibility to vacc9ation4 ,aga9 !re are o!r cases 9 :i* pregnant wom5 h smallpox & ! babes 9 ! wombs h escap$ entirely2 :ile ! mo/ s+ul> fact is t :ile ! fetus may exp]i5ce ! disease1 ! "m ?r\gh :om ! exposure 0 effect$1 escapes1 ei!r because ( a previ\s attack or possibly because ( vacc9ation4 ,:ile !re seems to be no reason = believ+ t an attack ( smallpox c be1 or ev] has be51 abort$ by artificial means1 yet !re is a preval5t belief t ?is process occurr$ dur+ c]ta9 epidemics ( smallpox1 cases hav+ be5 kn[n 9 :i* individuals pres5t$ all ! symptoms indicat+ ! invasion ( smallpox1 & yet no eruption occurr$1 & yet su* individuals 7 !reaft] insusceptible to smallpox or vacc9ation4 ,! mortality ( smallpox v>ies l ! susceptibility ( x--) ! age ( ! pati5t & ) "s unkn[n conditions ( ! atmosph]e or soil :i* favor ! occurr5ce ( ! epidemics4 ,! av]age 9 scatt]$ cases--sporadic--is probably n great] ?an "o 9 n9e or t54 ,a fatal result occurs m frequ5tly 9 ! second week ( ! disease ?an at any o!r "t4 ,pa?ology4--,granul> & fatty deg5]ation occurs 9 ! liv]1 sple51 kidneys & he>t4 ,infiltration is f\nd 9 ! adr5al gl&s & te/icles4 ,dur+ ! papul> /age1 !re is local hyp]emia ( ! papill1 ) int]/itial exudation & colliquative necrosis ( rete cells1 s t a vesicle is =m$1 peculi> 9 t x is trav]s$ by delicate b&s ( epi!lial cells4 ,?is1 ) ! fact t coagulation-necrosis occurs ma9ly 9 ! c5t]1 gives x ! umbilicat$1 or depress$ appe>ance4 ,! cont5ts ( ! vesicle are plasma1 fibr9 & cell detritus4 ,leucocytic invasion conv]ts vesicles into pu/ules4 ,?is has a m globul>1 elevat$ appe>ance ?an ! umbilicat$ vesicle4 ,pyog5ic organisms are f\nd 9 ! pus4 ,:5 ! inflammation injures ! corium1 sc>s are apt to result2 ?is occurs :5 ! sk9 is scrat*$4 ,! act9ic light rays increase ! dang]4 ,diagnosis4--,mi/akes 9 ! diagnosis ( ! fir/ cases ( smallpox 9 an epidemic are almo/ inevitable4 ,hemorrhagic sc>lat9a or measles sometimes cause confusion2 9 ! hemorrhagic sc>lat9a ! muc\s membrane hemorrhages are less frequ5t ?an 9 smallpox4 ,! prodromal eruptions plus purpura are v sugge/ive4 ,! invasion /age la/s ab\t ?ree days4 ,smallpox is *>act]iz$ by sudd5 onset ) viol5t *ill & %iv]+2 agoniz+ pa9 9 ! back & legs2 int5se heada*e1 mo/ly frontal2 temp]ature rapidly rea*+ #ajb to #ajd degrees ,f42 full1 /rong1 rapid pulse1 go+ to #ajj to #adj2 uncontrollable vomit+2 ph>yngitis2 r$ face1 bright eyes1 coat$ tongue2 anorexia2 con/ipation2 sleeplessness2 delirium2 (t5 copi\s p]spiration & extreme pro/ration4 ,an 8initial exan!m10 cle>+ )9 #bd to #dh h\rs1 appe>s4 ,x is ei!r hemorrhagic or ery!mat\s4 ,ab\t ! ?ird day ! true eruption appe>s1 fir/ ^u ! =ehead & 9 ! scalp1 !n ! re/ ( ! face1 ! backs ( ! wri/s1 trunk1 arms1 & la/ly ! legs1 mo/ abundant ^u ! p>ts expos$ to ! atmosph]e4 ,) ! appe>ance ( ! eruption1 all symptoms abate1 ! temp]ature falls1 & ! pati5t may feel q com=table4 ,! eruption consi/s ( co>se1 r$ spots ^u ! body1 l flea-bites1 rapidly becom+1 )9 #bd h\rs1 slightly rais$ r$ papules1 feel+ h>d & %otty to ! t\*1 & ea* surr\nd$ by a broad r$ inflammatory b&1 ! areola4 ,usually by ! six? day ! papules become conv]t$ into umbilicat$ vesicles1 at fir/ cle>1 !n turbid4 ,!y are h>d & indurat$ to ! t\*1 & on ! eigh? or n9? day !y become pu/ul>4 ,! areola becomes mu* d>k]1 ! temp]ature rises to #ajc to #aje degrees ,f41 & ! pulse to #aaj to #abj4 ,! o!r symptoms all reappe>1 ) salivation & delirium4 ,m>k$ edema ( ! sk9 r5d]s ! sk9 unrecognizable4 ,! pu/ules are pa9ful1 especially 9 places :]e ! sk9 is ?ick5$4 ,! maturation la/s ab\t ?ree days1 :5 ! fev] falls by lysis4 ,if fatal1 dea? usually takes place ab\t ! t5? day1 prec$$ by feeble & m rapid pulse1 m>k$ delirium1 subsultus & sometimes di>rhea4 ,ab\t ! elev5? day1 desiccation beg9s1 ! pu/ules beg9 to dry1 =m+ tight scabs :i* are closely adh]5t4 ,! fev] & o!r symptoms subside b it*+ becomes annoy+4 ,! odor f ! pu/ul> /age on is a peculi> greasy "o4 ,aft] ! rupture ( l>ge pu/ules ! c5t]s frequ5tly dry & s9k 91 (t5 9 ! %ape ( ! ,maltese cross4 ,?is is mo/ typically se5 on ! backs ( ! h&s & is pa?ognomonic4 ,t[>d ! end ( ! ?ird week ! scabs fall1 leav+ r$ gli/5+ pits :i* disappe> or *ange into deep :ite /riat$ sc>s4 ,! hair falls b may gr[ aga94 ,! diagnosis is n c]ta9 until ! eruption is se54 ,9 ! smallpox )\t eruption ! diagnosis mu/ be made f ! hi/ory ( exposure1 ! pres5ce ( an epidemic1 fev]1 lumb> & head pa9s1 delirium1 & possibly ! initial ra%4 ,mi/akes 9 diagnosis may be made ev5 by smallpox exp]ts1 b att5tion to ! hi/ory1 somatic f9d+s & ! c\rse ( ! disease1 r ?an to ! eruption1 w prev5t disa/r\s results4 ,always isolate any & all suspect$ pati5ts4 ,v>icella ,comp>$ ) ,v>iola ,vacc9ation & smallpox nev] ,smallpox may closely resemble prev5t4 *ick5 pox2 especially mild cases4 ,,age--usually be=e pub]ty1 may ,usually aft] pub]ty 7_m occur 9 adults4 exceptions47 ,initial /age practically abs5t4 ,initial /age sev]e1 ev5 9 mild cases4 ,,temp]ature1--no remission on ,typical remission & second>y onset ( ra%4 fev]4 ,:ite cells normal or decreas$4 ,leukocytosis4 ,prodromal ra% v exceptional4 ,prodromal ra% q frequ5t4 ,vesicles 9 crops4 ,vesicles nev] 9 crops4 ,vesicles r>ely %otty4 ,vesicles1 foll[+ macules1 are h>d & %otty4 ,,ra% ,,evolution1-- ,,ra% ,,evolution1-- ,v rapid1 vesicles on fir/ or ,mu* sl[]1 vesicles on sev5? second day4 day4 ,eruption is univ]sal1 successive ,developm5t progresses d[nw>d1 crops1 mo/ abundant on back1 face fir/1 !n wri/s1 beg9s on body1 less on face1 trunk1 arms & la/ly legs4 ,less scalp1 h&s & feet4 on trunk4 ,vesicle is sup]ficial & fluid ,fluid pe>l-color$ & ,,n transp>5t4 transp>5t4 ,?ick] cov]+4 ,halo 7areola7 usually abs5t4 ,areola is m>k$4 ,involution is q rapid4 ,involution is sl[4 ,! ,second>y ,toxic or ,septic ,ra% appe>s dur+ ! /age ( decru/ation1 sometimes ) a mild fev]4 ,x may be ei!r sc>lat9i=m1 morbilli=m1 or hemorrhagic4 ,! sk9 imm$iately surr\nd+ ! dry+ pocks is (t5 exempt leav+ an anemic halo4 ,! ra% la/s ab\t ?ree days & fades or desquamates4 ,) ! developm5t ( ! sk9 eruption1 an exan!m appe>s ^u ! muc\s membranes ( ! body cavities1 develop+ into ulc]s4 ,?is may develop be=e ! d]mal ra% & be ( diagno/ic importance4 ,=ms or ,v>ieties ,i4 ,v>iola ,v]a4 a4 ,discrete4 b4 ,conflu5t4 c4 ,purpura v>iolosa ,,ii4 ,v>iola ,hemorrhagica4 7black smallpox7 d4 ,v>iola hemorrhagica pu/ulosa4 ,,iii4 ,v>ioloid4 e4 ,smallpox modifi$ by vacc9ation or p>tial immunity4 ,discrete ,v>iola ,v]a4--,incubation symptomless & av]ages #ab days4 ,prodromal /age1 f fir/ symptom to eruption4 ,av]ages ?ree days4 ,! long] ! /age ! m sev]e ! infection4 ,int5sity be>s little if any relation to prognosis2 h[ev]1 if onset is mild1 disease w n be conflu5t or hemorrhagic4 ,invasion beg9s ) sev]e *ill1 (t5 repeat$4 ,initial fev] rises sudd5ly to #ajc or #ajd1 & rea*es maximum on second or ?ird day4 ,pulse is rapid & full4 ,sk9 is r$1 hot & dry4 ,!re may be sweat+ 9 ! discrete =m & 9 ! favorable cases4 ,! heada*e appe>s ) ! *ill & is usually frontal4 ,:5 sev]e & accompani$ ) necka*e & vomit+ x may sugge/ m5+itis4 ,! backa*e appe>s ) ! *ill & la/s ab\t two days4 ,x is a lumb> pa91 v l lumbago2 x occurs slightly less frequ5tly ?an ! heada*e & vomit+4 ,?is pa9 is r>e 9 o!r fev]s likely to be confus$ ) smallpox4 ,vomit+ is con/ant 9 *ildr5 & usual 9 adults4 ,! initial eruptions1 :i* are pres5t 9 ab\t #aj to #ab p] c5t1 are ( consid]able diagno/ic importance4 ,!y are usually limit$ to ! l[] abdom51 inn] side ( ! ?ighs1 axill1 & sometimes on ! ext5sor surfaces ( ! knees & elb[s4 ,! ,eruptive /age consi/s ( ! foll[+ sub-/ages3 macules & papules2 vesicles1 & pu/ules4 ,! macules & papules occur on ! f\r? day & progress = ab\t ?ree days4 ,!y beg9 on ! =ehead1 ne> ! hair1 ) it*+ & burn+ & resemble flea-bites4 ,^! soon become papules1 :i* are r$di%1 elevat$1 circul>1 h>d or %otty & discrete4 ,on second day ( ?is /age !y appe> on ! body1 & on ! next day on ! ext5sor surfaces ( ! extremities4 ,if ! eruption appe>s on ! second day ! conflu5t type may be anticipat$2 if on ! ?ird day ( ! disease1 ! discrete type4 ,! vesicles :i* occur on ab\t ! sev5? day ( ! disease1 conta9 lymph4 ,umbilication occurs 9 ! c5t]s ( _m ( ! vesicles1 & x is sugge/ive ( smallpox4 ,! suppurative /age beg9s ab\t ! n9? day ) cl\d+ ( ! vesicles & inflammation ar\nd !m4 ,?is cont9ues = ?ree days4 ,! pu/ules become opaque1 !n yell[1 & a ?ick pus oblit]ates ! umbilication4 ,! inflammatory 8halo0 becomes m vivid & edema may foll[ ar\nd ^! haloes4 ,?is edema causes increas$ t5sion & de=mity1 p>ticul>ly ( ! face1 & produces great t5d]ness & pa94 ,! pu/ulation foll[s 9 ! ord] ( eruption1 f ! face d[nw>d1 & are ! ?icke/ on ! extremities & head4 ,! pu/ules evacuate spontane\sly1 or may dry up )\t rupture4 ,! sk9 gives (f a peculi>1 (f5sive odor4 ,b$-sores are n[ mo/ likely to develop4 ,! eruptions also may occur 9 ! muc\s membranes1 p>ticul>ly 9 ! m\? & nasoph>ynx4 ,^! pass ?r\gh ! successive /ages z d ^? ( ! sk91 b less typically4 ,) ! pu/ulation !re is usually a gradually ris+ second>y fev]4 ,9 ! discrete type ! second>y fev] does n rema9 high m ?an tw5ty-f\r to ?irty-six h\rs1 ) morn+ remissions4 ,a m>k$ leucocytosis occurs ) ! second>y fev] & its ext5t dep5ds ^u ! sev]ity ( ! infection4 ,delirium1 album9uria1 acute exhau/ion & he>t p>alysis are to be gu>d$ aga9/ dur+ ?is /age4 ,! /ate ( involution1 or decru/ation1 beg9s ab\t ! twelf? day4 ,x foll[s ! ord] ( eruption1 & is accompani$ ) a decrease 9 edema1 r$ness & pa91 b is att5d$ ) intol]able it*+4 ,cru/s =m1 ! hair falls out & by ! end ( ! second week ! temp]ature returns to normal4 ,if fev] p]si/s dur+ ?is /age x indicates "s complications4 ,sc>s occur :5 ! true sk9 is involv$ & la/s ?ree or f\r weeks4 ,complete convalesc5ce foll[s ! disappe>ance ( ! la/ cru/4 ,conflu5t ,v>iola ,v]a4--,?is is a malignant type & us$ to be m preval5t ?an n[4 ,! initial /age is viol5t1 & ! heada*e & backa*e v agoniz+4 ,! fev] remission is v slight or abs5t1 & att5d$ ) h>dly any improvem5t 9 symptoms4 ,! e>li] ! exan!m occurs 9 v>iola ! m likely x w be ( ! conflu5t type4 ,! conflu5t eruptions occur especially ^u ! face & head1 sometimes on ! h&s & feet4 ,x is l>gely discrete on ! body & extremities4 ,great edema appe>s ) ! fusion ( ! eruption1 ) ! swell+ & erosion ( ! muc\s membrane1 ! eyes close & ! no/rils become ob/ruct$4 ,! fev] is high1 pulse high & rapid 7(t5 irregul>71 dilirium1 album9uria1 p]si/5t nausea & vomit+1 great ?ir/1 husky voice1 enl>g$ c]vical gl&s1 salivation 9 adults & di>rhea 9 *ildr5 are symptoms pres5t4 ,dea? occurs f acute toxemia1 usually )9 a week1 b may la/ a little long]4 ,recov]y f conflu5t v>iola is v infrequ5t4 ,purpura ,v>iolosa4--,?is is 8,black ,smallpox40 ,t is1 smallpox ) prim>y hemorrhage 9 ! initial /ages4 ,x is ! wor/ type & results almo/ inv>iably 9 dea?4 ,x is v important because x is s difficult to diagnose4 ,its incubation p]iod is %ort 7#f to #h days71 invasion v sev]e1 lumb> pa9s almo/ unbe>able1 pro/ration great1 pulse s(t1 small & rapid & respiration unusually high4 ,! initial pa9s & vomit+ may la/ until dea?4 ,on ! fir/ or second day a plum color$ eruption appe>s1 ) brick-r$1 purple or inky ec*ymoses p>ticul>ly ab\t ! eyes4 ,! condition is desp]ate4 ,hemorrhages may occur f any cavity ( ! body1 sometimes accompani$ by gangr5e ( ! ph>ynx4 ,! disease does n usually rea* ! p]iod ( real eruption1 because dea? usually occurs )9 f\r or five days4 ,! diagnosis ( ?is condition is by hi/ory ( exposure to smallpox & ! *>act]i/ic prodromes4 ,v>iola ,hemorrhagica ,pu/ulosa4--,?is is ! type ) ! second>y hemorrhage1 or ! hemorrhage aft] ! eruption appe>s1 & is m common ?an prim>y hemorrhage4 ,x occurs 9 weakly & alcoholic subjects4 ,! initial /age is sev]e1 & ! hemorrhages occur into ! vesicles or pu/ules4 ,!re may be epi/axis1 hematuria & metrorrhagia4 ,! outcome is almo/ always fatal1 ?\gh ! hemorrhage at ! vesicul> /age may be foll[$ by rapid abortion ( ! ra% & recov]y4 ,v>ioloid4--,?is is modifi$ or mitigat$ smallpox2 also kn[n z v>iola b5igna4 ,p]sons expos$ to smallpox sometimes suff] f v>ioloid1 & p]sons :o h _h smallpox may suff] f v>ioloid at subsequ5t exposure to smallpox4 ,vacc9ation appe>s to initiate an attack 9 p]sons peculi>ly susceptible1 or z a result ( improp]ly p]=m$ vacc9ation4 ,! lesions rema9 9 ! epid]mis1 ! c\rse ( ! eruption is %ort]1 ! papules vesicate by ! fif? day1 ! process ( suppuration is abridg$1 decru/ation occurs rapidly ) little or no sc>r+1 & all symptoms are mild]4 ,!re are _m modifications4 ,o!r v>ieties are 7#a7 ,v>iola s9e exan!mate1 :i* has ! usual symptoms )\t ! eruption2 7#b7 ,v>iola v]rucosa1 :i* has l>ge1 solid1 conical papules ) small vesicles at _! apices1 :i* rapidly desicate & =m cru/s1 & f9ally disappe> )\t sc>s2 7#c7 ,v>iola cornea 7horn pox7 :i* is kn[n by ! l>ge mahogany cru/s4 ,complications & ,sequel4--,v>iola is (t5 accompani$ by _m complications & sequal :i* are an e>ly sev]e toxemia & a lat] second>y infection4 ,dur+ ! second>y fev]1 !re may be bron*opneumonia1 pleurisy1 dys5t]y1 hemorrhages ( all k9ds1 ulc]ative eye1 e> or l>yngeal conditions1 purul5t ar?ritis1 or*itis1 gangr5e :5 ! swell+ is great & subcutane\s abscesses =m1 (t5 attack+ ! p5is & scrotum1 erysipelas attack+ ! face1 & r>ely nephritis4 ,dur+ convalesc5ce1 c>buncles1 boils & o!r subcutane\s abscesses are v common4 ,di/urbances ( ! p]iph]al n]v\s sy/em z neuritis1 p>alyses especially ( ! palatal muscles1 neuroret9itis1 & otitis m$ia are less common4 ,! sequal mo/ common are boils1 abscesses1 deep pitt+1 otitis m$ia1 bl9dness & p]man5t baldness4 ,! ur9e has ! usual febrile *anges4 ,:ite blood cells rea* #aj1jjj to #bj1jjj or m4 ,lymphocytosis occurs dur+ pu/ulation2 polymorphonucle> cells are decreas$ to #dj1 sometimes to #ab2 myelocytes & irritation =ms are f\nd4 ,dur+ ! febrile /age !re is a polycy!mia foll[$ by an anemia to #c1jjj1jjj or less dur+ ! pu/ul> /age4 ,reg5]ation is sl[1 la/+ ab\t f\rte5 days4 ,normobla/s are r>e except 9 hemorrhagic =ms4 ,exudate tak5 f ! pu/ules %[ /reptococci1 /aphylococci1 & pseudodiph!ria bacilli4 ,treatm5t4--,! imp]ative dem&s ( treatm5t are isolation1 v5tilation1 cleanl9ess & dis9fection4 ,if symptoms are suspici\s ( smallpox1 notify ! prop] au?orities at once & isolate pati5t4 ,:5 diagnosis is made1 cut hair & be>d v %ort4 #a4 ,isolate pati5t 9 room free f drap]ies1 rugs1 c>pets1 curta9s1 pictures1 etc4 #b4 ,dis9fect all vessels us$ 9 room ( ! pati5t 9 c>bolic acid solution or 9 bi*loride ( m]cury solution4 #c4 ,family ( pati5t %\ld be isolat$ = f sixte5 to tw5ty days4 #d4 ,room %\ld be well v5tilat$1 ) w9d[s scre5$ & slightly d>k5$ ) r$ curta9s to exclude ! ultra-violet rays ( light4 ,temp]ature %\ld be ma9ta9$ at #fe degrees4 ,door-way may be protect$ by a %eet damp5$ ) a #a3fj c>bolic solution4 #e4 ,nurse mu/ be robu/1 p]fectly immune & n afraid4 ,if male nurse1 hair mu/ be v %ort & mu/ h no be>d2 if female1 hair mu/ be %ort & mu/ we> close fitt+ cap4 #f4 ,absolute cleanl9ess is secur$ by pl5ty ( ba?s1 clean b$ & p]sonal l951 & c>eful nurs+4 ,physician mu/ put on special suit ) cap & gloves :i* are kept 9 ! h\se1 b n 9 ! sickroom4 ,! fir/ symptoms be+ ! heada*e1 nausea & vomit+ & ! lumb> pa9s1 ! fir/ po9ts ( attack 9 ! treatm5t w\ld be ! relief ( ^! pa9s 9 ! head & back by ?or\gh relaxation ( ! sp9al muscles1 pay+ p>ticul> att5tion to ! suboccipital1 mid-dorsal & lumb> areas4 ,! heada*e may be p>tially reliev$ by /eady pressure betwe5 ! frontal & occipital regions4 ,no int]osse\s adju/m5ts requir+ pa9ful or difficult te*nique %\ld be giv5 aft] ! m sev]e symptoms h appe>$4 ,pati5t %\ld be visit$ f "o to ?ree times p] day1 & ! reflex contractures ( ! muscles mu/ be reliev$ z (t5 z !y occur4 ,dys5t]y & di>rhea are controll$ by /rong inhibitory pressure 9 ! sacral & lumb> regions4 ,give vasomotor treatm5t to ! sup]ior c]vical ganglion4 ,/imulate ! ant]ior aspect ( ! sol> plexus to /ir up its acid function1 ! blood be+ alkal9e 9 smallpox4 ,dur+ all ! /ages up to ! /age ( pu/ulation1 ! pati5t responds v readily & successfully to o/eopa?ic treatm5t4 ,! heada*e1 ! backa*e & ! a*+ jo9ts respond to treatm5t z readily z1 if n m readily ?an1 ! heada*e & backa*e ( influ5za d to o/eopa?ic c>e4 ,! con/ipation is usually q readily reliev$4 ,x has be5 ! exp]i5ce ( ^? :o h h&l$ smallpox cases1 t ! t5d5cy to ! conflu5t type is greatly r$uc$ by ?is treatm5t & t ! response ( ! pati5t to o/eopa?ic treatm5t is v gratify+4 ,inde$1 ^? ( exp]i5ce h less fe> ( ! outcome ( _! smallpox cases ?an d !y h ( sc>let fev] or pneumonia4 ,aft] ! pu/ules h =m$1 ea* pu/ule is treat$ ) iod9e pa9t$ on ! pu/ule ) a camel's hair bru%4 ,dur+ ! pu/ul> /age x is n necess>y to give manipulative treatm5t1 & inde$ x is sometimes impractical because ( ! t5d]ness ( ! sk94 ,h[ev]1 ab\t all t is ne$$ dur+ ?is p]iod is good hygi5ic treatm5t & good nurs+4 ,dur+ convalesc5ce con/itutional treatm5t %\ld be giv54 ,diet4--,dur+ p]iod ( vomit+1 pellets ( ice 9 ! m\? are com=t+4 ,dur+ p]iods ( fev] give pl5ty ( wat] )1 pref]ably1 lemon juice4 ,z ! fev] decl9es beg9 ) b>ley & oatmeal wat] ) lemon juice2 !n foll[ ) easily dige/$ & nutriti\s diet ( milk1 eggs1 bro?s1 beef juice & gruels4 ,fe$ e ?ree h\rs dur+ t p]iod b n l>ge quantities4 ,dur+ convalesc5ce a full1 well-regulat$1 nutriti\s diet %\ld be ord]$4 ,hygi5ic ,c>e4--,keep nose cleans$ ) glyc]9e1 cold cream or olive oil1 :i* keeps ! cru/s s(t4 ,! m\? & nasoph>ynx may be cleans$ ) any mild antiseptic4 ,! eyes are wa%$ ) w>m boric acid solution4 ,cold compresses appli$ ov] ! eyelids assi/ 9 r$uc+ ! edema4 ,a daily tepid sponge ba? is necess>y4 ,ba? may be giv5 ) bi*loride ( m]cury solution 7#a3bj1jjj7 or creol9 7#a3ejj74 ,heada*e4--,deep1 /eady digital pressure 9 ! suboccipital fossa & at eigh? ?oracic sp9e2 ice bag to ! head2 or a mu/>d pla/] at ! back ( ! neck may relieve4 ,vomit+4--,?or\gh relaxation & adju/m5t ( ! great splan*nic & c]vical areas1 ) deep1 /eady digital pressure 9 ! occipital triangles1 & at ! f\r? & fif? dorsal v]tebr on ! "r side w usually control ! condition4 ,fev]4--,relaxation ( ! upp] dorsal area1 relaxation ( ! c]vical area1 & deep1 /eady pressure 9 ! suboccipital region (t5 r$uce temp]ature4 ,w>m spong+ 9 l[] grades ( fev]1 ba? at #gj ,f41 & cold pack may be ne$$4 ,if temp]ature goes v high give a cont9u\s cool colonic irrigation4 ,pitt+4--,cold wet dress+s ( l9t soak$ 9 any com=table mildly antiseptic solution1 or ( ice wat] & glyc]9e1 are to be us$ on ! h&s & face to prev5t pitt+4 ,hot wat] dress+s are m com=table to "s pati5ts4 ,x is well to protect ! sk9 f ! light1 especially f ! ultra-violet rays4 ,?is1 h[ev]1 mu/ n lead to any lack ( v5tilation4 ,:5 cru/s are =m+ keep !m moi/ ) vasel9e1 oil1 glyc]9e1 or c>bolic acid 9 lanol9 or vasel9e4 ,odor4--,ba?s1 ! daily toilet & ! use ( du/+ p[d] or #e iod(orm p[d]1 an op5 bottle ( smell+ salts or ( weak ammonia are good4 ,pl5ty ( fre% air is be/ ( all4 ,c>diac ,weakness4--,if pulse is feeble & frequ5t1 a g5]al quiet+ treatm5t %\ld be giv51 includ+ relaxation ( ! c]vical area & ( ! f\r? & fif? dorsal segm5ts4 ,an ice bag 9 flannel directly ov] ! he>t is (t5 v useful4 ,g5tle1 c>eful sp9al ext5sion is v re/ful & eases ! sp9al circulation4 ,delirium is usually reliev$1 or prev5t$1 by sp9al ext5sion1 ! prolong$ w>m ba? or ! cold pack1 if giv5 :5 signs ( n]v\sness appe>4 ,morphia or *lor(orm may be necess>y 9 viol5t & suicidal cases4 ,l>yngeal ,ob/ruction4--,usually caus$ by edema & may require tra*eotomy4 ,b$-sores4--,^! & abscesses may occur ev5 "u ! be/ ( c>e4 ,place pati5t ^u a wat]-b$ or 9 a cont9u$ w>m ba?4 ,convalesc5ce is n complete until ! sk9 is entirely free f cru/s & is p]fectly smoo?4 ,prognosis4--,prognosis dep5ds ^u age ( pati5t2 complications2 & environm5t f :i* pati5t comes1 z well z ^u ! nurs+4 ,9 v>ioloid ! prognosis is recov]y2 9 ! discrete v>iety1 good2 9 ! conflu5t type ov] #ej are fatal2 9 ! malignant types practically all die4 ,9 pati5ts "u five ye>s old & ov] =ty ye>s old ! prognosis is v grave4 ,a fil?y environm5t pr$isposes to complications4 ,recurr5ces seldom occur2 second attacks are usually v>ioloid4 ,prophylaxis4--,usual rules ( heal? au?orities are3 rigid qu>ant9e or isolation1 vacc9ation1 dis9fection ( ! sk9 & all fomites1 & f9al fumigation4 ,qu>ant9e ( a suspect$ individual is sixte5 days aft] exposure4 ,isolation cont9u$ until e trace ( eruption has disappe>$4 ,! dead body is v dang]\s & a public fun]al is n p]mitt$4 ,! clo!s us$ by ! pati5t mu/ be /eam$ & o!r articles mu/ be wa%$ ) bi*loride ( m]cury & fumigat$ ) =maldehyde vapor4 ,dis9fection ( ! h&s1 face1 be>d & hair ( att5dants ) bi*loride solution is imp]ative4 ,vacc9ation 7,,vacc9ia2 ,,c[-,,pox7 ,def9ition4--,vacc9ia is an eruptive disease ( ! c[1 communicable only by inoculation & caus+1 :5 transmitt$ to ! human be+1 local reaction 9 ! =m ( a pock & con/itutional di/urbances :i* are foll[$ by a m or less la/+ immunity aga9/ smallpox4 ,vacc9ation is ! artificial inoculation ( vacc9e virus = ! purpose ( produc+ an immunity aga9/ smallpox4 ,arm to arm vacc9ation 0 =m]ly v g5]ally practic$ b has be5 practically discont9u$ because ( ! possibility ( infection f syphilis & o!r infections4 ,:5 x is necess>y to use ! human lymph x %\ld be tak5 ^u ! eigh? day f a typical unbrok5 vesicle 9 a p]fectly heal?y *ild at lea/ ?ree mon?s old4 ,! vesicle mu/ be prick$ at sev]al po9ts1 c>e be+ tak5 n to draw blood4 ,! bov9e vacc9e lymph is n[ 9 g5]al use because x practically elim9ates ! possibility ( syphilis & o!r infections4 ,also because x is m easily transport$4 ,x is ?\ght be/ by _m au?orities to vacc9ate 9 infancy aft] ! six? mon?1 at ! sev5? & eigh? ye>1 at pub]ty1 & !reaft] at int]vals ( ab\t sev5 ye>s1 b dep5d+ consid]ably on ! preval5ce ( small pox4 ,! virus is prep>$ "u /]ile conditions f c>efully select$ & te/$ calves4 ,x is put up "u aseptic conditions 9 h]metically seal$ capill>y tubes or1 9 ! old /yle1 on ivory po9ts4 ,!re is a great v>iety ( op9ions z to ! efficacy ( vacc9ation 9 produc+ immunity aga9/ small pox1 ?is v>iety ( op9ion be+ v preval5t among repres5tatives ( ! m$ical s*ools4 ,dr4 ,f4 ,p4 ,mill>d ( ,toronto says ! lymphatic sy/em is ! keynote1 & t vacc9e virus poison+ spreads ?r\gh ! lymphatics1 caus+ diph!ria & alli$ ?roat affections4 ,dr4 ,a4 ,t4 ,/ill said1 8,we are oppos$ to vacc9ation40 ,he repeat$ly emphasiz$ ! fact t 8,nature furni%es )9 ! body all ! rem$ies necess>y to cure disease40 ,9 ! rec5t ,canadian epidemic 7#aiai-aibj7 ! m$ical au?orities h met ) a mo/ /r5u\s opposition4 ,! ,homeopa?ic pr(ession1 almo/ to a man1 w5t on record z oppos$ to compulsory vacc9ation4 ,! ,ill9ois ,supreme ,c\rt has rul$ t compulsory vacc9ation is uncon/itutional4 ,te*nic4--,! area usually select$ is ! left arm at a po9t above ! ins]tion ( ! deltoid muscle4 ,"s pref] ! leg ov] ! junction ( ! two heads ( ! ga/rocnemius muscle1 because x is m easily c>$ =1 &1 because ( ! /yle ( we>+ %ort sleeves among wom51 x does n expose ! sc> :i* results f ! vacc9ation4 ,! surface mu/ be wa%$1 dri$1 ) a s(t t[el1 & !n /]iliz$ ) alcohol4 ,) a /]iliz$ ne$le or lance scrat* an area ab\t a qu>t] ( an in* 9 diamet]1 be+ c>eful n to produce ble$+ b m]ely an ooz+ ( p9ki% lymph4 ,a drop ( ! virus %\ld be deposit$ ^u ! abrad$ surface1 rubb$ 9 ) ! side ( ! ne$le & let dry4 ,a ?9 lay] ( /]iliz$ gauze %\ld be lightly appli$ & held by means ( adhesive pla/]1 n encircl+ ! limb4 ,?is %\ld be occasionally remov$ & r$ress$4 ,! pock %\ld be kept dry & clean1 & may be lightly du/$ ) />* or toilet p[d]4 8,p]sons expos$ to ! contagion ( small pox %\ld be imm$iately revacc9at$4 ,! immunity conf]r$ dim9i%es ) "t40 ,x is ! writ]'s p]sonal op9ion t1 ) ! am\nt ( complications t s frequ5tly foll[ vacc9ation & ) ! fact t 8x is necess>y to revacc9ate dur+ an epidemic or aft] exposure10 x 7 bett] to def] vacc9ation1 if p>ties are favorably incl9$ to ! practice1 until su* "t z ! pres5ce ( small pox 9 ! community make x app>5tly necess>y4 ,typical ,vacc9ation4--,! p]iod ( incubation v>ies f ?ree to five days4 ,at ! end ( ?is "t local reaction %[s itself 9 ! =m ( r$di% papules at ! po9t ( inoculation4 ,9 ab\t five days ^! develop into comp\nd vesicles1 :i* at fir/ h cle> & !n lat] opaque cont5ts4 ,ab\t ! eigh? day ! vesicle is fully develop$ & is r\nd or oval ) prom95t & well def9$ edges & a depress$ c5t]4 ,an ery!mat\s areola usually appe>s ab\t ! t5? day & ! cont5ts are purul5t4 ,! surr\nd+ sk9 is swoll5 & t5d]1 & a scab n[ beg9s to =m 9 ! c5t] ( ! pock & rapidly ext5ds t[>d its edges4 ,ab\t ! end ( ! second week ! areola fades1 & ! pock is *ang$ into a ?ick br[ni% cru/ :i* becomes dry & h>d1 & comes (f betwe5 ! tw5tie? & tw5ty-fif? days aft] vacc9ation4 ,a dusky r$ sc> is left & ?is gradually becomes :ite & pitt$4 ,dur+ ! evolution ( ! pock ! gl&s ?r\gh :i* lymphatic dra9age takes place become slightly enl>g$ & t5d]4 ,! con/itutional reactions are usually mod]ate fev]1 re/lessness at night1 irritability & loss ( appetite4 ,^! symptoms usually appe> ab\t ! f\r? day & cont9ue ab\t ?ree to five days4 ,at any "t dur+ ! vacc9ia ery!ma1 roseola or urtic>ia may appe>4 ,! con/itutional reaction 9 revacc9ation is sometimes v sev]e4 ,!re are _m atypical symptoms foll[+ vacc9ation z v>iation 9 ! numb] ( ! pocks1 9 ! size1 9 ! sev]ity ( ! con/itutional symptoms1 9 ! cont5ts ( ! pock1 9 ! heal+ & =mation ( ! sc> & 9 ! transmission ( specific diseases z syphilis1 tub]culosis1 leprosy1 canc] & tetanus4 ,complications4--,all cases are n b5ign1 z due to impurity ( vacc9e1 c>elessness 9 te*nic1 improp] c>e 9 dress+1 h&l+ ( ! w\nd by ! pati5t himself1 scrat*+ x ) ! f+] nails1 & o!r accid5ts ( l nature1 infections may set 9 & v s]i\s complications arise4 ,^! result 9 abscesses1 erysipelas1 tetanus & v>i\s eruptions4 ,otitis m$ia may leave deafness4 ,! writ] kn[s p]sonally ( a "y man 9 ! ,army dur+ ! ,_w ,w> :o 0 vacc9at$ :ile 9 ! ,army & two abscesses develop$ :i* ate entirely ?r\gh ! arm1 "o abscess pass+ ?r\gh ! arm j ant]ior to ! hum]us & ! o!r j po/]ior to x4 ,x 0 _m1 _m mon?s 9 heal+1 & ne>ly caus$ loss ( ! arm4 ,!re are _m cases ( record :]e vacc9ation 0 foll[$1 directly or indirectly1 by p>alysis1 de=mities1 & *ronic con/itutional diseases4 ,x is usually claim$ ^! conditions 7 due to accid5ts foll[+ ! vacc9ation & n due to ! vacc9ation itself4 ,h[ev]1 x c n be d5i$ t ! vacc9ation 0 at lea/ ! indirect cause ( ^! deplorable conditions4 ,g5]al ,vacc9ia4--7,vacc9al eruptive fev]2 ,vacc9ola74 ,?is consi/s ( a vacc9e ra%1 develop+ usually f ! f\r? to ! t5? day foll[+ vacc9ation1 & appe>+ 9 v>i\s p>ts ( ! body1 p>ticul>ly ab\t ! wri/s & on ! back4 ,! second>y pocks usually develop ab\t ! eigh? or t5? day aft] vacc9ation & are usually m abundant on ! vacc9at$ limb ?an on any o!r "p ( ! body4 ,z ! pocks appe> 9 successive gr\ps1 all /ages ( ! disease may be se5 at "o "t1 & ! condition may la/ = _m weeks4 ,fev] may be abs5t or pres5t1 b is usually proportionate to ! ext5t ( ! eruption & ! associat$ complications4 ,treatm5t4--,aft] vacc9ation1 ! pati5t %\ld be told to return 9 sev5 days1 :5 ! dress+s %\ld be remov$1 & if ! vacc9ation has be5 successful1 a pe>l-l vesicle w be pres5t4 ,if ! vesicle has be5 brok5 by accid5t or by rubb+ ( ! gauze1 ! free portions ( ! dress+ %\ld be cut away & ! adh]5t "p left undi/urb$4 ,a new gauze %\ld be appli$ 9 any case1 & 9 five or six days m1 ! dress+ %\ld be aga9 *ang$1 & ?is *ang+ cont9u$ at int]vals until ! cru/ falls1 :i* is usually dur+ ! ?ird or f\r? week4 ,if no vesicle =ms by ! t5? or twelf? day1 ! vacc9ation has n be5 successful4 ,x is sugge/$ by ! vacc9ation advocates t ano!r attempt %\ld be imm$iately made4 ,prognosis4--,unev5tful recov]y is to be usually expect$4 ,pitt+ f g5]aliz$ vacc9ia2 v>i\s con/itutional diseases2 p>alyses & o!r maim+ disabilities sometimes occur4 ,:ile x is n usually consid]$ dang]\s to life1 !re are nev]!less _m cases ( record :]e dea? has result$4 ,x is n :olly unatt5d$ ) dang]4 ,! be/ ( c>e %\ld always be tak5 foll[+ vacc9ation to prev5t ! possibility ( complications1 ?\gh ev5 !n !y d occur4 ,sc>let ,fev] 7,,sc>lat9a7 ,def9ition4--,sc>let fev] is an acute1 specific1 contagi\s1 infective disease ( unkn[n orig91 *>act]iz$ by v sudd5 onset1 fev]1 vomit+1 sore ?roat & diffuse exan!m4 ,hi/ory4--,x 0 fir/ recogniz$ 9 ! sixte5? c5tury1 b fir/ fully describ$ & diff]5tiat$ f measles by ,syd5ham 9 #affj4 ,x 0 introduc$ into ,am]ica ab\t #agce4 ,etiology4--,! causative organism or ag5t is unkn[n4 ,! virus ( sc>let fev] produces sev]e necrosis1 b no suppuration4 ,! /reptococcus is ! mo/ important factor 9 ! production ( complications & 9 _! mortality4 ,x is claim$ to be ! cause ( ! malignancy ( ! disease b n ( ! disease itself4 ,susceptibility to ! disease is by no means univ]sal z only #ch ( *ildr5 & b #e ( adults expos$ to ! infection acquire ! disease4 ,ov] #ij ( ! cases occur "u t5 ye>s ( age1 & r>ely dur+ ! fir/ ye> ( life4 8,sc>let fev] is a toxic sup]ficial expression ( int]nal malnutritive conditions ( ! blood z a tissue4 ,! cause ( ! toxicity is usually ov]fe$+1 or ! fe$+ beyond ! dem&s ( ! proximate pr9ciples ( ! body1 or ! ov]fe$+ "u unhygi5ic conditions4--,j4 ,,m>t9 ,,littlejohn4 8,x 0 once held t ! virus 0 dissem9at$ dur+ desquamation1 b oral1 nasal & otitic dis*>ges probably p]petuate ! infection1 p]haps mon?s aft] scal+ is complete4 ,9 no o!r disease is ! virus s t5aci\s4 ,x may p]si/ t5 ye>s on clo!s1 furniture1 etc40--,a4 ,r4 ,,edw>ds4 ,! light =ms are z contagi\s z ! sev]e ones1 & inoculations h occurr$ f ! liv+ subjects z well z f autopsy cuts4 ,9 degree ( infecti\sness smallpox ranks fir/1 measles second & sc>let fev] ?ird4 ,! infection may be spread by any ?ird p]son or by articles com+ 9 contact ) ! pati5t1 & (t5 ! mode is obscure4 ,sporadic cases app>5tly frequ5tly appe>4 ,! reason = ! sporadic cases may easily be expla9$ by ! !ory ( ,j4 ,m>t9 ,littlejohn1 giv5 above4 ,"o attack usually conf]s immunity1 b n always4 ,?is disease occurs m (t5 9 ! autumn & w9t]1 & is m preval5t 9 cities ?an 9 ! c\ntry4 7,measles is m preval5t 9 ! c\ntry47 ,sc>lat9a sometimes occurs ) o!r infections1 su* z diph!ria or measles1 & m r>ely ) v>icella1 p]tussis1 etc4 ,pr$ispos+ ,factors4--,age1 "o to t5 ye>s2 l[]$ resi/ance f ov]fe$+1 unhygi5ic environm5ts1 exposure to sudd5 temp]ature *anges2 lesions1 bo? muscul> & int]osse\s :i* int]f]e ) ! di/ribution ( ! fluids & vital =ces ( ! body2 season ( ! ye> 7autumn & w9t]72 pu]p]al wom51 & w\nds4 ,pa?ology4--,no specific lesions are f\nd4 ,no trace ( ! ra% %[s aft] dea? except 9 ! hemorrhagic =m4 ,! anatomical *anges 9 cases com+ to autopsy are ^? ( simple inflammation1 follicul> tonsillitis1 or diph!roid ang9a4 ,/reptococci are abundantly f\nd 9 ! gl&s & foci ( suppuration4 ,symptomatology4--,sc>let fev] is divid$ into f\r /ages3 7#a7 ,incubation1 7#b7 ,invasion1 7#c7 ,exan!m1 7#d7 ,desquamation4 ,incubation ,/age4--,has no noticeable symptoms & la/s f two to f\r days4 ,"s au?ors claim z high z t5 to f\rte5 days4 ,invasion4--,! invasion la/s "o day4 ,! onset is v sudd5 beg9n+ ) a *ill :i* is foll[$ by a *>act]i/ic vomit+1 occurr+ 9 #ge ( ! cases1 :i* is m frequ5t ?an 9 any o!r disease ( *ildhood except pneumonia4 ,! vomit+ is foll[$ by heada*e & ! beg9n+ evid5ce ( sore ?roat1 :i* usually soon develops into a tonsillitis4 ,! sev]ity ( ! sore ?roat is indicative ( ! sev]ity ( ! sc>let fev] t foll[s4 ,! temp]ature sudd5ly rises to #ajc or m1 ! pulse becomes unduly rapid = ! temp]ature1 #abj to #afj p] m9ute1 & ! respiration is increas$4 ,! sk9 beg9s to burn1 !re is dysphagia & intumesc5ce ( ! c]vical gl&s4 ,! muscles ( ! back become hyp]s5sitive to t\* & to extremes ( heat & cold2 & p>ticul>ly s5sitive spots are f\nd ov] ! transv]se processes ( ! fir/ to #d? c]vical v]tebras1 ! #d? & #e? dorsal & ! #aa? & #ab? dorsal v]tebras4 ,at ^! po9ts w be f\nd int5sely contractur$ tissues :i* mu/ be kept relax$4 ,exan!m4--,! eruption appe>s at ! end ( ! fir/ day or e>ly ! second day1 %[+ fir/ ov] ! clavicles & on ! neck1 !n ov] ! upp] trunk1 next ! l[] trunk & limbs4 ,! eruption on ! extremities appe>s p>ticul>ly ov] ! flexor surfaces ( ! jo9ts4 ,by ! end ( ! second day ! eruption has cov]$ practically ! entire body1 leav+ a :ite circle ab\t ! eyes & m\?4 ,! eruption pales1 or disappe>s on pressure1 quickly return+ to ! sc>let color on ! removal ( ! pressure4 ,frequ5tly1 ! sk9 it*es & is v uncom=table4 ,a puncti=m eruption 9 ! arm-pits1 ov] ! gro9s1 or on ! ro( ( ! m\? is consid]$ positive pro( ( sc>let fev]4 ,! eruption at fir/ consi/s ( small r$ spots :i* fuse z ! sk9 swells & results 9 an int5se lob/]-color$ ery!ma4 ,?is la/s f\r to six days4 ,! tongue1 at fir/1 is r$ at ! tip & m>g9s ) a greyi%-yell[ or :iti% fur 9 ! c5t] ?r\gh :i* is (t5 se5 ! swoll5 r$ papill1 ! 8/rawb]ry tongue40 ,! 8fur0 desquamates on ! ?ird or f\r? day1 leav+ a surface int5sely r$ ) m>k$ rais$1 swoll5 papill1 ! 8raspb]ry or cat tongue10 :i* la/s ne>ly a week4 ,! brea? has a heavy1 sweet odor4 ,! ph>ynx1 uvula & tonsils become swoll51 & (t5 creamy-:ite pat*es cov] ! m\?s ( ! tonsill> follicles4 ,betwe5 ! second & ?ird day ! eruption rea*es its height1 :5 x has a vivid sc>let hue unlike any o!r eruption1 & becomes d>k] ea* day until x may be a blui%-r$1 :5 x gradually fades & desquamation beg9s4 ,by ! sev5? or eigh? day ! ra% has disappe>$1 toge!r ) ! fev]4 ,desquamation4--,scal+ beg9s on ! face fir/1 f ! six? to ! n9? day & la/s sev]al weeks4 ,! sk9 looks some:at /a9$1 is a little r\gh l 8goose-fle%0 & gradually ! upp] lay] beg9s to sep>ate1 & ! scal+ beg9s 9 l>ge lamell or flakes4 ,ca/s ( ! f+]s or toes may be %$4 ,! swell+ ( ! gl&s disappe>s1 & ! fev] falls by lysis1 & convalesc5ce beg9s1 unless complications int]v5e4 ,diagnosis4--,9 typical cases diagnosis is easy1 especially dur+ epidemics or :5 ! eruption is accompani$ by o!r crit]ia4 #a4 ,sudd5 onset1 ) nausea & vomit+1 sore ?roat1 quick appe>ance ( fev] & rapid developm5t4 #b4 ,punctate spots 9 ! ?roat1 swell+ & dysphagia are usually pres5t4 ,! sev]e sore ?roat symptoms ) ! above are always v suspici\s4 #c4 ,/rawb]ry tongue is con/ant4 #d4 ,eruption1 typical 9 "*1 appe>+ on second day1 fir/ %[+ on ! neck above ! clavicles1 int5se on ! body & practically abs5t ar\nd ! m\?4 ,eruption conflu5t1 ) no int]v5+ free areas ( ! sk91 foll[$ by desquamation4 #e4 ,lymphad5itis mu* m pron\nc$ 9 ! +u9al & o!r gl&s ?an 9 ! c]vical4 #f4 ,desquamation1 t5d] jo9ts & album9uria w =ce ! conclusion ( sc>let fev]1 if =m] symptoms h be5 indef9ite4 ,9 ! atypical cases we may h v light attacks ) all ! symptoms pres5t b v poorly develop$2 or "s symptoms abs5t z 9 cases ) no temp]ature1 or o!rs ) no ra%4 ,"s cases are s atypical z to be impossible ( diagnosis4 ,! writ] has v rec5tly _h ! exp]i5ce ( "o case :5 !re 7 absolutely no typical symptoms pres5t aft] be+ call$ on ! case1 b f\r days aft] ! invasion ( ! disease 9 ! pati5t a si/] ( ! *ild develop$ typical sc>let fev]1 & n until ! six? day did any eruption or sore ?roat appe>1 & !n ! eruption 0 m *>act]i/ically measles ?an sc>let fev]4 ,consultants ) ! writ] agre$ ) him t ! case 0 "o ( an atypical1 non-eruptive sc>let fev]4 ,diff]5tiation4--,sc>let fev] is n always easily diff]5tiat$ f o!r diseases1 su* z a septic ra%1 drug ra%es1 diph!ria1 measles & ,g]man measles4 ,a4 ,r4 ,edw>ds gives ?is diff]5tiation betwe5 sc>let fev] & septic ra%4 ,sc>let ,fev] ,sepsis4 ,bright r$ ery!ma1 ) small ,a v deep purple-r$ ra%1 r$ papules4 sometimes spread+ ov] ! entire body4 ,! eruption is mu* ! same 9 bo? diseases1 ! same places be+ exempt4 ,mili>ia are r>e4 ,mili>ia are frequ5t4 ,r typical desquamation4 ,desquamation obs]v$ less frequ5tly4 ,,crit]ia3 ang9a1 tongue1 onset1 ,etiology1 *ills1 sweats1 fev] gl&s1 etc4 irregul>ity1 polymorph\s exan!ms1 etc4 ,diph!ria4--,(t5 difficult to diff]5tiate4 ,! simple ery!ma is sometimes obs]v$ 9 diph!ria1 b is d>k]1 m on ! trunk1 & m transitory ?an 9 sc>let fev]4 ,drug ,ra%es4--,^! ra%es are caus$ by belladonna1 iod(orm1 qu99e1 iodide1 *loral1 copaiba or aspir94 ,!y may be easily diff]5tiat$ if ! c>d9al symptoms ( sc>let fev] are consid]$ in/ead ( ! ra% alone4 ,at ! pres5t "t1 p]haps ! mo/ frequ5t drug ra% t we meet is t produc$ by aspir94 ,x is sometimes h>d to diagnose because ! aspir9 has be5 tak5 = a sore ?roat or tonsillitis1 :i* s resemble ! e>ly symptoms ( sc>let fev]4 ,measles & ,g]man ,measles4--,! symptoms ( ! invasion /age ( ^! diseases is sometimes q simil>1 & ev5 ! ra% may be q simil>2 ! diff]5tiation w be discuss$ "u measles 7q4v474 ,types & ,=ms4--7a7 ,mild & abortive =m 7sc>lat9a s9e eruptione74 ,9 ?is ! ra% may be sc>cely p]ceptible1 :ile ! fev]1 sore ?roat & /rawb]ry tongue are pres5t4 ,desquamation may be pres5t & x may be foll[$ ) a sev]e nephritis4 7b7 ,malignant =ms1 7#a7 ,atactic v>iety1 viol5t intoxication1 onset ( great sev]ity1 fev] v high 7#ajg to #ajh71 extreme heada*e1 delirium1 & (t5 convulsions4 ,initial delirium gives place to coma2 dyspnea may be urg5t2 pulse v rapid & feeble2 & dea? occurs be=e eruption appe>s4 7#b7 ,hemorrhagic v>iety3 !re are hemorrhages into ! sk91 beg9n+ ) scatt]$ pete*i1 becom+ m ext5sive & ultimately involv+ ! :ole sk94 ,x is *>act]iz$ by sev]e fev] & bra9 symptoms at ! onset2 incomplete exan!m1 necros+ ang9a1 m>k$ gl&ul> & spl5ic swell+2 subcutane\s1 s]\s & muc\s membrane hemorrhages ) ulc]ation4 ,dea? may take place on ! second or ?ird day4 ,?is is m common 9 enfeebl$ *ildr51 al?\gh x may attack adults 9 app>5tly full heal?4 7c7 ,ang9ose =m 7,sc>lat9a ang9osa47 ,?is =m resembles septic diph!ria1 ) m>k$ toxemia1 necrosis & ad5itis4 ,! ?roat symptoms appe> e>ly & progress rapidly4 ,temp]ature high1 cyanosis1 di>rhea1 rapid weak irregul> pulse1 & /upor occur4 ,! fauces & tonsils are cov]$ ) a ?ick membran\s exudate :i* may ext5d to ! po/]ior wall ( ! ph>ynx1 =w>d into ! m\?1 upw>d into ! nasal *amb]s1 & may occasionally rea* ! tra*ea & bron*i4 ,! ,eu/a*ian tubes & middle e> are usually involv$4 ,! gl&s ( ! neck rapidly enl>ge & become ! seat ( brawny induration1 & ! inflammation ext5ds beyond _! limits4 ,necrosis occurs 9 ! tissues ( ! ?roat1 fetor is extreme1 ! con/itutional symptoms are great & ! *ild dies ( toxemia4 ,if he does n die1 ext5sive abscess =mation 9 ! tissues ( ! neck takes place ) sl\gh+ & dang] ( hemorrhage f ! op5+ ( a l>ge art]y4 ,blood ,pressure4--,rises at fir/1 !reaft] x foll[s ! pulse & temp]ature4 ,aft] ! sev5? or eigh? day x may be bel[ normal4 ,cases ( album9uria %[ hyp]ext5sion & sl[+ ( he>t action4 ,) ! subsid5ce ( ! kidney irritation ! pulse-rate is increas$ & ! blood pressure returns to normal4 ,ur9e4--,%[s ord9>y febrile "*1 be+ scanty & high color$4 ,slight album9uria is r common aft] ! /age ( eruption1 ev5 a few tube ca/s may be pres5t )\t any s]i\s irritation ( ! kidneys4 ,ur9alysis %\ld be made daily4 ,blood4--,! r$ cells are mod]ately r$uc$ to #c1jjj1jjj or #d1jjj1jjj p] c4 mm4 dur+ convalesc5ce4 ,!re may be "s poikilocytosis1 & normobla/s are occasionally se54 ,leucocytosis is e>ly1 #ae1jjj to #cj1jjj p] c4 mm41 fall+ ) ! decl9e ( ! fev] usually by ! f\rte5? day1 b may p]si/ = weeks aft] ! temp]ature is normal4 ,! c\nt runs r\ghly p>allel to ! temp]ature4 ,ov] #dj1jjj leucocytes p] c4 mm4 are ( bad progno/ic om54 ,polymorphonucle> cells are increas$ to #hj or #ij2 e>ly return+ to normal 9 favorable cases4 ,eos9ophilia is pres5t 9 all b malignant cases4 ,x rea*es its maximum two or ?ree days aft] ! ra% appe>s & returns to normal aft] ! leucocytosis has disappe>$4 ,! e>ly pres5ce ( eos9ophilia excludes septic conditions4 ,:5 ^! cells are abs5t 9 sc>let fev]1 myelocytes are to be f\nd4 ,treatm5t4--,cl9ically sc>let fev] repres5ts1 f ! o/eopa?ic viewpo9t1 7a7 a toxic condition due to int]nal malnutrition & a decrease ( ! detox9at+ function ( ! ?yroid gl&2 7b7 second>ily associat$ ) ! sore ?roat is a type ( toxic tonsillitis1 b x is due to ! toxic elem5ts 9 ! blood2 7c7 9 ! lesion field x is associat$ ) extreme /iffness & muscul> t5sion 9 ! upp] c]vical area & also 9 ! entire dorsal area1 ov]lapp+ ! upp] lumb>4 ,! eruption is a sup]ficial expression ( ! attempt ( ! body to elim9ate ! tox9s1 & ?is elim9ation %\ld be aid$ by enhanc+ ! activity ( all ! o!r elim9ative functions4 ,cases are on record :]e pati5ts h be5 expos$ to sc>let fev]1 h gone ! usual incubation p]iod & develop$ ! invasion symptoms1 & by ?or\gh1 (t-repeat$ o/eopa?ic treatm5ts1 ) ! aid ( enemata & copi\s hot wat] dr9k+1 h n gone beyond ! invasion p]iod & ! disease app>5tly abort$ )9 two or ?ree days4 ,x is !re=e well to give ?or\gh1 (t-repeat$ att5tion to ^! cases dur+ ! v e>ly /ages4 7#a7 ,9 all cases :]e ! fir/ symptoms indicate ! possibility ( a contagi\s disease1 ! pati5t %\ld be imm$iately isolat$ & kept isolat$ until all dang] ( contagion is pa/4 ,9 sc>let fev] cases get a compet5t nurse4 ,keep room light1 quiet & ?or\ghly v5tilat$ ) a con/ant temp]ature ( z ne>ly #gj z is possible4 7,x 7 bett] to h two rooms if possible1 "o = day & "o = night3 h room or rooms on upp] floor if 9 a h\se74 ,arrange suitable means = ?or\gh dis9fection ( all articles us$ 9 ! sickroom4 ,^! are v ess5tial4 7#b7 ,pati5t %\ld be clo!d 9 usual night we>+ app>el4 ,! b$ clo?+ %\ld be w>m1 b n heavy4 ,! physician %\ld we> an op]at+ g[n or a %eet :i* ?or\ghly cov]s 8 clo?+1 also a cap4 ,he %\ld c>efully wa% 8 face & h&s imm$iately aft] leav+ ! sickroom4 ,! qu>ant9e %\ld be ma9ta9$ = ! legally requir$ p]iod1 & ev5 aft] if !re cont9ue dis*>ges f ! nose1 nasoph>ynx or ! e>4 ,bi*loride wrapp+s %\ld be plac$ ab\t ! body ( ! dead1 & fun]al mu/ be private4 7#c7 ,h enema giv5 imm$iately to cleanse ! l[] b[el4 ,foll[ ?is ) frequ5t draughts ( hot wat]1 or bett] hot lemonade = ! fir/ day4 ,place hot wat] bottles at feet4 ,if eruption is sl[ 9 com+ out1 x may be aid$ by a hot ba?1 foll[$ by wrapp+ ! pati5t 9 w>m blankets to prev5t *ill+4 7#d7 ,?or\gh o/eopa?ic treatm5t %\ld be giv5 along ! entire sp9al area f ! atlas to ! sacrum1 inclusive1 to keep ! muscles well relax$1 giv+ special att5tion to ! relation%ip ( ! v]tebr & ! t5sion ( ! muscles f ! occiput to ! f\r? c]vical2 ! ?ird to ! six? dorsal2 & ! t5? to ! twelf? dorsal areas4 ,also give special att5tion to ! deep c]vical muscles1 p>ticul>ly ^? at ! angle ( ! inf]ior maxilla1 & at ! articulation ( ! inf]ior & sup]ior maxill4 ,rememb] ! t5d5cy ( ! kidneys to complication 9 sc>let fev]1 !re=e d n neglect ! r5al splan*nics1 = "h y n only control ! r5al functions b also regulate ! adr5al functions & _! int]nal secretions4 ,keep ! clavicles prop]ly adju/$ & articulate !m by br++ !m well =w>d to relieve any irritation t may h />t$ 9 t area4 ,c>eful direct treatm5t to ! abdom5 %\ld usually be giv5 at ea* visit besides ! "w 9 ! splan*nic area to keep ! b[els1 kidneys & liv] active4 ,diet4--,wat] mu/ be giv5 freely4 ,if fev] is v high1 pellets ( ice held 9 ! m\? w give com=t4 ,dur+ ! height ( ! fev] x is pref]able to )hold all n\ri%m5t1 b if 9 a p>ticul> case x seems to be indicat$1 conf9e ! n\ri%m5t to fruit juices1 especially oranges4 ,nev] =ce fe$+ dur+ ! fev]4 ,= infants cut d[n _! fe$+ to at lea/ half1 mak+ ! milk v ?9 ) wat] or gruel4 ,aft] def]vesc5ce1 c>efully increase to a light diet us+ sp>+ly ( nitrog5\s foods except milk4 ,aft] f\r weeks 9 ! usual case1 gradually return to ! ord9>y diet4 ,?is is a good "t to make corrections 9 ! ord9>y diet if any are ne$$4 ,! b[els mu/ be kept regulat$4 ,an enema is usually indicat$ aft] ! onset ( ! disease4 ,dur+ ! "t t food is p]mitt$ x %\ld be ( a laxative "*4 ,dur+ ! fev] /age ! enema %\ld be giv5 daily to help keep ! b[el cleans$ & to help r$uce ! temp]ature4 ,if b[els are p]si/5tly sluggi% & ! fev] is con/antly high ! abdom9al heat+ compress 7s-call$ 8cold compress07 w give mu* relief4 ,! nose & ?roat %\ld be con/antly look$ aft]4 ,! nose may be cleans$ by in/illation by means ( a m$ic9e dropp]1 us+ normal salt solution4 ,if ! ?roat symptoms are mild1 a g>gle ( w>m normal salt solution is en\gh = cleanl9ess ( ! membrane4 ,if ! ?roat symptoms are too sev]e to p]mit ! use ( ! g>gle1 or if ! pati5t is too small to be taught ! use ( ! g>gle or to wa% ! ?roat1 irrigation may be employ$4 ,! use ( raw lemon juice1 or ( raw p9eapple juice1 on a cotton swab is ( great value 9 cleans+ ! tonsils & ?roat4 ,! swabb+ %\ld be repeat$ sev]al times p] day4 ,! tee? %\ld be c>efully & ?or\ghly cleans$ twice p] day4 ,! sk9 mu/ be con/antly c>$ =4 ,dur+ ! fev] x is well to cov] ! sk9 ) l95 or s(t cotton4 ,daily sponge ba?s ( c>boliz$ wat] 7#a3dj7 ( tepid temp]ature foll[$ by applications ( cocoa-butt] w give mu* com=t4 ,use only good toilet soap & d n use ! s-call$ antiseptic soaps because1 au?orities claim1 !re is a *ance ( r5al injury4 ,dur+ ! p]iod ( desquamation ! use ( ! cocoa-butt] w assi/ 9 limit+ ! s\rce ( infection by prev5t+ ! diffusion ( ! dry scales :i* are consid]$ infecti\s by _m physicians4 ,a4 ,r4 ,edw>ds says3 8,dur+ desquamation1 oil-rubs 7 once employ$ to decrease ! dissem9ation ( dry scales1 b !y decrease ! function ( ! sk91 :i* is ( great importance :5 ! kidneys are involv$2 also1 infection is c>ri$ by means ( ?roat secretions4 ,soap & wat] s]ve equally well40 ,"s au?orities sugge/ t dur+ ! desquamation1 aft] ba?+ ! pati5t1 ! sk9 %\ld be ?or\ghly rubb$ & !n ! oily application us$1 us+ cocoa-butt]1 unm$icat$ cold cream1 liquid albol5e or ! l4 ,olive oil & vasel9e are usually irritat+4 ,! writ] incl9es to ! op9ion t ! soap & wat] ba?+ is suffici5t1 except p]haps ! use ( cocoa-butt] ov] ! areas t are desquamat+ sev]ely4 ,! temp]ature c usually be controll$ by ! usual o/eopa?ic me?ods2 /eady deep pressure appli$ 9 ! suboccipital region = a few m9utes1 foll[$ by relax+ ! muscles ( ! back f ! fir/ to ! eigh? dorsal1 by rais+ & spread+ ! ribs 9 ! mid-dorsal area1 & by light inhibition ov] ! sol> plexus4 ,! tepid enema w assi/ 9 l[]+ ! temp]ature4 ,if temp]ature is high & pati5t is deliri\s & has o!r n]v\s symptoms ! cold pack is useful4 ,! ice cap may be us$ almo/ con/antly 9 high fev]4 ,if gl&s are swoll5 treat by cr[d+ ! tissues t[>d ! gl& b nev] "w ^u ! gl& itself4 ,if pa9 is felt 9 ! e> imm$iate att5tion mu/ be giv5 x4 ,correct any deviations ( ! atlas or o!r upp] c]vical v]tebr1 relax ! deep muscles at ! angle ( ! jaw1 & relieve any imp+em5ts 9 ! l[] c]vical & upp] dorsal regions4 ,! e> %\ld also be treat$ ) copi\s boric solution irrigations1 z hot z c be borne & at l[ pressure4 ,! condition ( ! e> drum membrane mu/ be wat*$ daily & if !re is bulg+ & conge/ion x is saf] to puncture ! drum "u coca9e ?an to await spontane\s rupture4 ,use small am\nt ( boric p[d] aft] ruptur+4 ,! he>t mu/ be exam9$ daily4 ,vigor\s treatm5t ?r\gh ! ?oracic region is indicat$1 if c>diac symptoms appe>1 & ! pati5t mu/ be kept quiet & 9 b$4 ,if he>t seems feeble x may be well support$ by ! cold packs directly ov] ! he>t4 ,nephritis is mo/ common 9 ! second & ?ird weeks ( ! illness1 b may develop lat]4 ,9 all cases :]e any symptoms ( nephritis appe>1 light or sev]e1 ! pati5t mu/ be conf9$ to b$ = at lea/ f\r weeks1 & kept on a milk diet4 ,all irritants mu/ be absolutely avoid$4 ,hot ba?s %\ld be giv5 twice daily to increase ! sweat & ! ur9>y functions1 ! ba? la/+ half an h\r & ! pati5t kept aft]w>d betwe5 blankets4 ,treat ?or\ghly1 daily1 ! splan*nic & r5al areas1 pay+ p>ticul> att5tion to ! tissue conditions 9 ! l[] dorsal region4 ,9 ! mild] cases1 ! ur9e conta9s album9 & a few tube ca/s1 v r>ely blood1 & edema is slight or transi5t4 ,?\gh ! pati5t improves1 he rema9s pale & !re is a slight trace ( album9 9 ! ur9e = mon?s4 ,if recov]y does n take place1 !n *ronic nephritis becomes e/abli%$4 ,9 ! m sev]e cases !re may be a puffy appe>ance ( ! eyelids1 slight edema ( ! feet1 ur9e dim9i%$ 9 quantity1 smoky1 conta9+ album9 & tube ca/s4 ,! kidney symptoms dom9ate1 dropsy p]si/s & !re may be effusion into ! s]\s sacs4 ,! condition may become *ronic1 ! pati5t may succumb to uremia1 b 9 ! majority ( cases recov]y takes place4 ,! nephritis may be hemorrhagic1 9 :i* ! ur9e is suppress$ or !re may be a v small am\nt ( bloody fluid lad5 ) album9 & ca/s2 con/ant vomit+ & convulsions foll[ & ! pati5t dies ) symptoms ( acute uremia4 ,o!r complications are ar?ritis1 malignant endoc>ditis1 sev]e toxic myoc>ditis & acute phlegmon\s inflammation1 ! la/ ?ree ( :i* are usually fatal4 ,*orea is a fairly frequ5t n]v\s complication4 ,! m5tal symptoms are mania & melan*olia4 ,progressive p>alysis ( ! limbs ) wa/+1 may simulate infantile p>alysis4 ,! fev] may p]si/ aft] ! eruption disappe>s & ! *ild rema9 9 a septic /ate 7sc>lat9al typhoid74 ,relapses are r>e4 ,sc>lat9a may coexi/ ) almo/ any o!r acute infection4 ,x l[]s ! resi/ance ( ! body to disease & is (t5 foll[$ by o!r acute infections or by tub]culosis4 ,!re=e ! necessity ( c>e dur+ ! entire convalesc5t /age4 ,measles 7,,rubeola2 ,,morbilli7 ,def9ition4--,measles is an acute infecti\s1 contagi\s1 ery!mat\s disease1 occurr+ 9 epidemics1 *>act]iz$ by an initial coryza1 bron*ial cat>rh & an eruption ( a g5]al maculopapul> type2 also by ! pres5ce ( ,koplik's buccal spots4 ,etiology4--,pr$ispos+ ,influ5ces3 ,! *ief pr$ispos+ factor 9 measles1 z 9 all o!r contagi\s diseases1 is a l[]$ resi/ance 9 :i* "s /ructural or functional *ange has tak5 place t r$uces ! functional activity ( ! body's inh]5t protective ag5cies4 ,^! pr$ispos+ factors may be class$ "u ?ree heads1 namely2 7a7 /ructural1 7b7 environm5tal1 7c7 dietetic4 ,"u ! fir/ we f9d /ructural di/urbances 9 ! upp] c]vical area affect+ ! functional control ( ! nose1 ?roat & head1 z well affect+ ! ?yroid & its int]nal secretions3 /ructural di/urbances 9 ! upp] & mid-dorsal areas affect+ ! vasomotor control to ! head1 neck1 & *e/1 !reby p]v]t+ nutrition to all ^! /ructures & r5d]+ !m m susceptible to ! infective organisms2 also ! dorsal lesions di/urb ! functional integrity ( ! lungs & he>t1 ) ! result ( di/urb$ respiration & circulation1 bo? ( :i* are vital factors 9 body resi/ance3 we also f9d /ructural lesions 9 ! l[] dorsal region1 affect+ ! function ( ! kidneys & _! elim9ation & ! function ( ! adr5als & _! int]nal secretions4 ,"u ! second or environm5tal1 we h unsanit>y & unhygi5ic conditions1 exposure to sudd5 *anges ( temp]ature1 wet clo?+1 fatigue1 etc41 all ( :i* produce second>y /ructural lesions & ! effects above m5tion$4 ,"u ! ?ird or dietetic classification1 we h ! errors ( diet s common 9 *ildr5 & adults z well2 su* z too mu* c&ies & o!r sug>s1 also too mu* />*es1 z well z ov] eat+ & unbalanc$ diet4 ,measles prevails 9 all climates & attacks all races1 ! ,negroes appe>+ to suff] m sev]ely ?an ! :ites & to be m subject to complications4 ,outbreaks are m common 9 w9t] & spr+1 b occur at all seasons4 ,! disease is p>ticul>ly a *ildr5's disease b adults may contract x if n protect$ by an attack 9 e>ly life1 & ) adults ! disease frequ5tly manife/s ! m aggravat$ =ms4 ,x is m common aft] pub]ty ?an sc>let fev]4 ,excit+ ,cause4--,:ile ! disease is probably produc$ by a micro-organism1 x has n yet be5 demon/rat$4 ,inoculation exp]im5ts ^u human be+s h %[n ! pres5ce ( ! infect+ pr9ciple 9 ! blood1 9 ! te>s1 9 ! secretions ( ! nasal1 ph>yngeal & bron*ial muc\s membranes1 & 9 ! cont5ts ( vesicles occasionally pres5t4 ,inoculation ) ! epi!lial scales ?r[n (f at ! end ( ! disease has be5 unsuccessful4 ,ord9>ily ! transmission ( ! disease takes place ?r\gh ! brea? or ! nasal & bron*ial secretions4 ,! disease may be c>ri$ by a ?ird p]son or by fomites4 ,! infect+ pr9ciple is int5sely active1 b n s t5aci\s nor p]si/5t z sc>let fev]4 ,measles is communicable ?r\gh\t its entire c\rse f ! e>lie/ appe>ance ( ! coryza4 ,! individual pr$isposition t[>d measles is app>5tly s g5]al t few1 ^u exposure1 escape x1 ?\gh we h obs]v$ cases :]e *ildr5 h be5 directly expos$ & :o 7 imm$iately !reaft] put "u o/eopa?ic c>e & did n develop ! disease4 ,second1 or ev5 ?ird1 attacks may occur at int]vals ( "s ye>s1 b ^! are unusual4 ,sporadic cases d occur & are (t5 ! />t+ po9ts = epidemics4 ,ext5sive outbreaks occur at int]vals ( five or six ye>s4 ,! incubation p]iod is f sev5 to eighte5 days1 usually ab\t t5 days4 ,symptoms4--,prodromes are common1 usually consi/+ ( loss ( appetite1 re/less sleep1 fretfulness1 & (t5 fev]i%ness4 ,!re are ?ree /ages1 7a7 ,invasion1 7b7 ,eruption1 7c7 ,desquamation4 7a7 ,/age ( ,invasion4 ,! prodromal symptoms are int5sifi$4 ,!re is (t5 *ill9ess b seldom di/9ct *ills4 ,! temp]ature rises1 (t5 rea*+ #ajb to #ajd degrees1 ^u ! fir/ & second day4 ,x !n falls "o degree or m to rise aga9 ^u ! appe>ance ( ! eruption4 ,nausea1 vomit+ & heada*e are (t5 pres5t4 ,! tongue is furr$4 ,) ^! symptoms coryza has develop$ & is sometimes int5se1 (t5 simulat+ sev]e influ5za4 ,irritation & sm>t+ ( ! eyelids1 la*rymation1 photophobia1 p]si/5t sneez+1 runn+ ( ! nose1 sore ?roat1 discom=t 9 swall[+1 ho>s5ess1 & c\gh1 at fir/ ( a cr\py "*1 appe> 9 rapid succession & ) v>y+ int5sity4 ,^! initial cat>rhal symptoms are *>act]i/ic & occur 9 ! milde/ cases 9 :i* *ill9ess1 fev] & ! associat$ signs ( ! reaction ( ! organism to g5]al infection are n obs]v$4 ,! vessels ( ! conjunctiv are inject$1 ! eyelids swoll51 ! nasal mucosa tumid & r$d5$4 ,! muc\s membrane ( ! m\? & ?roat is ery!mat\s1 :ile ^u ! s(t palate & ! ro( ( ! m\?1 & p>ticul>ly ^u ! buccal muc\s membrane1 are to be se5 p9 head or split pea siz$1 circumscrib$1 r\nd or irregul>ly %ap$ r$di% blot*es slightly or sc>cely at all rais$ above ! surr\nd+ tissues1 usually discrete1 b sometimes conflu5t4 ,?is eruption also %[s itself 9 ! l>ynx & is und\bt$ly ! cause ( ! cr\py c\gh & o!r ?roat symptoms4 ,9 a /rong light !re may be se5 ^u "s ( ! spots on ! muc\s membrane ( ! *eeks & lips m9ute bright :iti%1 or blui%-:ite flecks :i* are call$ ,koplik's ,spots4 ,^! spots appe> e>ly & soon disappe>1 & z !y are n f\nd 9 any o!r disease !y are ( value 9 ! e>ly diagnosis ( measles4 ,! duration ( ?is /age is usually ?ree or f\r days2 r>ely x is %ort] or x may be z long z a week4 7b7 ,/age ( ,eruption4 ,on ab\t ! f\r? day ! temp]ature aga9 rises1 increas+ z ! ra% develops1 (t5 to #ajd or #aje degrees & rea*+ its maximum ab\t ! six? day :5 x usually falls by crisis2 foll[$ on ! sev5? or eigh? day by normal temp]ature4 ,! pulse-rate increases ) ! fev]1 (t5 rea*+ #adj or high]4 ,! eruption usually appe>s on ! f\r? day1 & %[s fir/ ab\t ! hair l9e on ! =ehead1 spread+ to ! face1 *e/1 trunk & ! arms & legs4 ,! eruption is att5d$ by it*+ & burn+1 & completely develops 9 f twelve to ?irty-six h\rs1 ! cat>rhal symptoms p]si/+ dur+ ?is "t4 ,dur+ ?is "t1 9 ! m sev]e cases1 delirium or /upor may be pres5t1 & ! pati5t compla9s ( sore ?roat & g5]al discom=t1 & is re/less & wakeful4 ,usually ^u ! second or ?ird day ( ! eruption1 great & rapid amelioration ( all ^! symptoms takes place & ! fev] falls to normal or subnormal4 ,:5 ! eruption is fully develop$ ! individual spots are irregul>ly circul> or oval1 & diff] greatly 9 size1 av]ag+ ab\t ! size ( a split pea4 ,! eruption is unev5ly set1 b usually close toge!r & sometimes conflu5t1 especially on ! face1 buttocks1 h&s & feet4 ,frequ5tly !y take on a cresc5tic arrangem5t & ! spots are circumscrib$1 ! int]v5+ sk9 be+ normal or slightly hyp]emic4 ,ab\t ! n9? day ! ra% beg9s to disappe>1 on ! face fir/1 !n ! neck & ! re/ ( ! body 9 ab\t ! same ord] z ! eruption appe>$4 ,! sk9 takes on a yell[i% discoloration & ! ra% disappe>s 9 a bran-l desquamation :i* la/s sev]al days to a week4 ,9 ! beg9n+ ( ! /age ( eruption1 & 9 _m cases ?r\gh\t its c\rse1 ! sk9 is moi/ & (t5 ba!d 9 free p]spiration4 ,at ! height ( ! eruption ! sup]ficial lymphnodes ( ! neck1 & else:]e1 are (t5 slightly swoll5 & t5d]4 7c7 ,/age ( ,desquamation4 ,! f9e branny scales ( desquamation are (t5 s f9e z to be easily ov]look$4 ,?is process occupies ab\t a week4 ,! cat>rhal symptoms 9 uncomplicat$ cases gradually disappe>1 s t1 by ! end ( ! second week f ! initial coryza1 convalesc5ce is fully e/abli%$4 ,! c\gh frequ5tly p]si/s & is ( a bron*ial nature4 ,epi/axis is common at ! height ( ! attack4 ,relapses ( measles are extremely r>e4 ,di>rhea is apt to occur at "s "t dur+ ! attack1 )\t any p>ticul> significance4 ,v>ieties4--,atypical cases may occur b are n common4 ,!y are z foll[s3 7#a7 ,morbilli ,papulosi1 developm5t ( di/9ct papules1 h>d to ! t\* b n ext5d+ deeply into ! sk94 7#b7 ,m4 ,vesicul>2 a vesicul> =m4 7#c7 ,m4 ,s9e ,exan!ma1 cases 9 :i* ! eruption does n appe>1 b g5]al symptoms & coryza are pres5t4 7#d7 ,m4 ,s9e ,exan!ma1 9 :i* ! muc\s membranes are n involv$4 ,v>iations 9 con/itutional symptoms4--7#a7 ,m4 ,afebriles1 r>e cases 9 :i* !re is no rise ( temp]ature4 7#b7 ,m4 ,hemorrhagica4 ,?is is ! malignant =m & 9 x ! organism is unable to )/& ! int5sity ( ! infection & dea? takes place 9 ! c\rse ( two or ?ree days aft] su/a9$ hyp]pyrexia1 pr(\nd adynamia1 or hemorrhages into ! sk9 & muc\s membranes4 ,^! malignant =ms are v r>e 9 private practice1 b !y occasionally occur 9 asylums & 9 ! fi]ce epidemics ( camps1 & 7 common 9 ! fir/ outbreaks among ! natives ( ! ,fiji ,isl&s1 :]e measles prevail$ z a sc\rge4 ,dea? may occur be=e ! ra% appe>s or a few papules may %[ !mselves ^u ! =ehead & wri/s4 ,?is is also kn[n z black measles1 & x is *>act]iz$ by convulsions1 delirium & coma1 pete*i1 ble$+ f ! muc\s surfaces & pr(\nd con/itutional depression4 ,! pati5t is rapidly exhau/$1 ! pulse frequ5t & ?ready1 ! sk9 pale & cold1 & dea? occurs4 7#c7 ,adynamic measles is a s]i\s type 9 :i* ! symptoms are grave f ! onset b )\t hemorrhages & a typhoid /atus is e>ly pres5t4 ,complications4--,9 ! abs5ce ( complications1 measles is comp>atively a b5ign disease1 b ^! complications are frequ5tly en\gh pres5t to place measles among ! m s]i\s diseases ( *ildhood4 ,! ord9>y complications are due to ! ext5sion or int5sification ( ! cat>rhal processes peculi> to ! disease4 7#a7 ,otitis m$ia is q common1 & may result 9 p]=ation ( ! tympanic membrane & p]man5t impairm5t ( ! he>+2 or lead to s9us ?rombosis1 m5+itis1 or abscess ( ! bra94 7#b7 ,bron*opneumonia is ! mo/ common complication4 7#c7 ,purul5t conjunctivitis may occur & 9 neglect$ cases infiltration & ulc]ation ( ! cornea4 7#d7 ,cat>rhal l>yngitis is a frequ5t complication4 7#e7 ,pseudo-membran\s type is v uncommon b v dang]\s4 7#f7 ,edema ( ! glottis is n common b does occur4 7#g7 ,diph!ria is mu* less common 9 measles ?an 9 sc>let fev]4 ,! high dea? rate ( measles is due to ! bron*opneumonia complication 9 :i* ! lesions become ext5sive1 ! symptoms become urg5t & a l>ge proportion ( ^! cases die4 7#h7 ,acute ent]ocolitis is a frequ5t & s]i\s complication4 7#i7 ,gangr5\s /omatitis occurs 9 "y & debilitat$ *ildr51 & 9 girls gangr5e ( ! pud5da occur dur+ convalesc5ce ) great] frequ5cy ?an 9 o!r infecti\s diseases4 ,sequel4--,! m common sequel are *ronic local inflammations1 conjunctivitis1 otitis1 nasal cat>rh1 l>yngitis1 & bron*itis4 ,tub]culosis is a common sequel4 ,diagnosis4--,dur+ an epidemic1 coryza1 p]si/5t sneez+ & fev] are suspici\s4 ,! appe>ance ( ! eruption on ! ?ird or f\r? day ^u ! muc\s membrane ( ! m\? & ?roat1 & ,koplik's spots are positive4 ,measles is (t5 confus$ ) #a4 ,rubella or ,g]man measles1 #b4 ,v>iola1 #c4 ,typhus ,fev] & #d4 ,sc>let ,fev]1 :i* see4 ,occasionally drug exan!ms are confus$ ) measles4 ,^! may be caus$ by salicylates1 antipyr91 qu99e1 turp5t9e or copaiba4 ,^! ra%es are n accompani$ by fev] or ?roat symptoms unless !y h be5 giv5 to allay ^! v conditions4 ,treatm5t4--,measles is s (t5 a s]i\s disease t x %\ld n be att5d$ ) c>elessness z x s (t5 is1 b ! be/ ( c>e & att5tion giv54 ,p>5ts %\ld be in=m$ ( ! dang] ( complications & ( ! absolute necessity ( prop] c>e & att5tion4 ,z soon z a susceptible individual is expos$ to ! measles1 he %\ld be imm$iately isolat$1 wat*$ & corrections made ( any dietetic errors1 unsanit>y conditions or /ructural lesions t may exi/4 ,he %\ld be protect$ f sudd5 atmosph]ic *anges & c>efully wat*$ = ! fir/ symptoms ( ! prodromal coryza4 ,on ! appe>ance ( ! prodromal1 or invasion symptoms ! pati5t %\ld be put to b$ 9 an isolat$1 well v5tilat$ room ( z ne>ly con/ant temp]ature z is possible1 f :i* all hang+s1 rugs & unnecess>y furniture h be5 remov$4 ,! w9d[s mu/ be %ad$ to protect ! eyes f direct or /rong light1 & any artificial lights 9 ! room mu/ also be well %ad$4 ,! cases c usually be easily h&l$ by c>eful1 well-direct$ o/eopa?ic treatm5ts4 ,9 ! manipulative treatm5t we mu/ pay especial att5tion to ! muscul> & o!r s(t tissue conditions 9 ! suboccipital region1 ov] ! transv]se processes ( ! upp] f\r or five c]vical v]tebr1 "u ! angle ( ! l[] maxilla & ! lat]al c]vical tissues to remove any ob/ructions to ! circulation & n]ve control ( ! head & ?roat2 see t ! muscles 9 ! l[] c]vical & upp] dorsal areas are kept well relax$1 & articulation ( ^! v]tebr1 ! upp] ?ree ribs & ! clavicles are kept free2 remove all lesions 9 ! mid-dorsal area1 :e!r muscul> or o!rwise1 to prev5t involvem5t ( ! lungs or he>t1 & to keep up function ( ! respiratory & circulatory sy/ems2 treat & keep normal ! tissues & ! articulations at ! kidney & adr5al c5t]1 #aa? & #ab? dorsal2 raise ! ribs & keep !m freely movable1 ?is especially = ! bron*ial c\gh4 ,pa9ful manipulations %\ld be avoid$ & are n necess>y4 ,dr4 ,/ill said1 8,! arms mu/ be rais$ & ! axill>y region fre$ & kept s40 ,dur+ ! acute /age two or ?ree treatm5ts p] day are advisable4 ,d n treat sev]ely or to cause discom=t to ! pati5t4 ,be/ results are obta9$ 9 ! g5tle1 b ?or\gh1 treatm5ts4 ,9 ! beg9n+ ( ! case h ! b[els cleans$ ) an enema1 & !n c>eful att5tion mu/ be con/antly giv5 to ! b[els & kidneys4 ,! b[els c be kept op5 by manipulations & diet4 ,! diet %\ld be light & easily dige/$2 dur+ ! fev] x is be/ to )hold all food b give pl5ty ( wat]4 ,foll[ fa/ ) fruit juices & !n ! light diet4 ,! temp]ature is usually controll$ by treatm5t1 b if x rema9s high = "s "t & if ! physician _c rea* ! pati5t1 ! nurse %\ld be direct$ to give a tepid sponge ba? ( t5 to tw5ty m9utes duration1 & repeat$ at int]vals ( two or ?ree h\rs4 ,also ! tepid enema w (t5 r$uce ! temp]ature4 ,= ! it*+ ( ! sk91 a tepid ba? ) wat] at #ajj degrees giv5 twice daily %\ld be us$1 ! pati5t dri$ c>efully1 & an application ( olive oil1 cold cream1 liquid albol5e1 or a two p] c5t m5?ol salve1 rubb$ ov] ! entire body w give relief4 ,! c\gh is be/ reliev$ by ?or\gh treatm5t ( ! ant]ior ?oracic regions & ! correction ( any upp] rib or clavicul> lesions4 ,keep+ ! air ( ! room moi/ ) vapor is agreeable to ! muc\s membranes4 ,! dropp+ ( a few drops ( eucalyptus oil 9 ! boil+ wat] produces a v soo?+ vapor4 ,if ! eyes are mu* involv$1 !y %\ld be ba!d e h\r or two ) a ?ree p] c5t solution ( boric acid1 us+ cotton :i* is imm$iately de/roy$ aft] use4 ,d>k glasses 9 a well v5tilat$ room is bett] ?an an unair$ d>k5$ room4 ,! nose & m\? %\ld be c>efully cleans$ at regul> int]vals & ! clo?s burn$4 ,! ?roat %\ld be c>efully exam9$ daily at fir/1 & at lea/ e o!r day lat]1 until ! case is dis*>g$4 ,! conditions ( ! lungs mu/ be obs]v$ by daily exam9ations1 & ! lung & bron*ial areas %\ld be daily treat$ to prev5t ! possibility ( respiratory involvem5t4 ,if ra% is sl[ 9 appe>+ & ! temp]ature is high1 a hot ba? 7#aje to #aaj degrees7 = ?ree to five m9utes w (t5 br+ out ! ra% & relieve ! m s]i\s symptoms4 ,dur+ convalesc5ce ! pati5t mu/ be protect$ aga9/ cold4 ,recov]y is ha/5$ by ! cont9uation ( treatm5t dur+ convalesc5ce & treatm5t giv5 %\ld be indicat$ by ! symptoms pres5t4 ,prognosis4--,practically all uncomplicat$ cases recov]4 ,9 ! hemorrhagic & adynamic types1 ! majority succumb4 ,"o attack usually conf]s immunity4 ,sequel are frequ5t "u ! 8old s*ool0 treatm5t1 b are infrequ5t "u c>eful1 consci5ti\s o/eopa?ic treatm5t & c>eful nurs+4 8,9 & ( itself measles is usually n p>ticul>ly s]i\s1 b ! aft] effects are s f>-rea*+ & s s]i\s t /ud5ts ( ! hi/ory ( m$ic9e rank measles ?ird among infecti\s diseases = caus+ dea?4 ,dur+ recov]y f measles ! pati5t /&s 9 special dang] f pneumonia1 & pneumonia foll[+ measles is m dang]\s ?an uncomplicat$ pneumonia4 ,!re is a consid]able l5g? ( "t dur+ :i* he is p>ticul>ly susceptible to tub]cul> infection4 ,?is is s (t5 insidi\s1 & its evid5ces are s obscure1 t by ! "t ! disease has fully develop$1 "o may h =gott5 ! mild attack ( measles :i* really pav$ ! way = ! s]i\s malady40--,c4 ,a4 ,,:it+4 ,rubella 7,,g]man ,,measles2 ,,rubeola ,,no?a2 ,,ro!ln2 ,,epidemic ,,roseola7 ,def9ition4--,a specific acute1 contagi\s1 infecti\s1 eruptive disease1 *>act]iz$ by a diffuse maculopapul> eruption & swell+ ( ! sup]ficial lymphatic gl&s4 ,x is att5d$ by a mild fev]1 suffus$ eyes1 mild c\gh1 slight sore ?roat b no cat>rh1 a macul> rose-r$ eruption ( ! ?roat accompani$ by ! swell+ ( ! c]vical lymph gl&s & by a rose-r$ eruption ( irregul> size & %ape appe>+ on ! fir/ day ( ! disease4 ,rubella1 9 "s ways1 resembles sc>let fev] & also measles & 0 at "o "t consid]$ a hybrid ( ! two4 ,x is n[ kn[n to be an indep5d5t disease4 ,etiology4--,! excit+ cause1 or ! infective pr9ciple1 has n yet be5 discov]$4 ,! disease is probably c>ri$ by fomites1 is readily transmissible1 attacks *ildr5 especially1 & usually occurs 9 epidemics1 ?\gh sporadic cases are frequ5tly f\nd4 ,! epidemics usually occur at int]vals ) sev]al ye>s int]v5+1 dur+ :i* "t !re are comp>atively few cases4 ,p]sons ( all ages are susceptible unless hav+ acquir$ an immunity ?r\gh an attack ( ! disease at "s =m] "t4 ,rubella does n conf] immunity aga9/ any o!r disease1 z sc>let fev] or measles1 nor d ^! diseases conf] immunity aga9/ rubella4 ,"o attack ( rubella conf]s immunity aga9/ any succe$+ attacks4 ,! incubation p]iod is f five to tw5ty-"o days & is )\t symptoms4 ,! pr$ispos+ factors are ! same z 9 measles or o!r infecti\s or contagi\s diseases4 ,symptoms4--,invasion ,p]iod4 ,?is /age is usually ( v %ort duration1 la/+ f a few h\rs to p]haps two days4 ,! initial symptoms are usually mild1 be+ a sudd5 *ill9ess1 b n *ills2 mild fev] ( ab\t #ajj degrees2 a slight heada*e2 mild sore ?roat2 swoll5 c]vical & po/ auricul> lymphatic gl&s2 little or no coryza2 sometimes slight pa9s 9 ! back & legs2 & ! macul> rose-r$ eruption 9 ! ?roat :i* is con/antly pres5t4 ,(t5 ! initial symptoms are s mild t ! pres5ce ( a disease is n recogniz$ until ! eruption appe>s1 :i* usually occurs on ! fir/ day & r>ely n until ! f\r? day4 ,eruption ,p]iod4--,! ra%1 :i* consi/s ( r\nd or oval r$di% spots ab\t ! size ( a split pea1 mo/ly discrete1 b sometimes conflu5t1 & surr\nd$ by areas ( hyp]emic sk91 usually %[s fir/ ^u ! face & foll[s a wavelike progression ov] ! body & limbs4 ,! ra% usually beg9s to fade ^u ! face be=e x has appe>$ ^u ! la/ affect$ areas1 & usually rema9s 9 "o region f a few h\rs to a half day4 ,x ext5ds ov] ! entire body 9 f tw5ty-f\r to ?irty h\rs4 ,occasionally ! sk9 is s hyp]emic 9 ext5sive tracts t ! ra% m resembles sc>let fev] r ?an measles4 ,! cresc5tic arrangem5t ( ! papules usually se5 9 measles c n be made out 9 rubella4 ,9 ! c\rse ( two or ?ree days ! ra% disappe>s ) v f9e desquamation1 leav+ a fa9t pigm5tation1 :i* rema9s = a %ort "t4 ,slight et*+ usually accompanies ! ra%4 ,relapses are r>e & complications infrequ5t4 ,!re are no special sequel1 b album9uria1 bron*itis & pneumonia h be5 not$4 ,al?\gh "o attack usually conf]s immunity1 second attacks h be5 report$1 :i* may h be5 real second attacks or ! fir/ attack may h be5 an error 9 diagnosis4 ,diagnosis4--,e>ly or sporadic cases may pres5t great difficulty 9 diagnosis1 b :5 an epidemic is pres5t diagnosis becomes mu* easi]4 ,! direct diagnosis ( ! disease re/s ^u ! v mild nature ( ! disease1 its %ort initial onset1 ! "* ( ! eruptions & ! e>ly enl>gem5t ( ! gl&s ) ! abs5ce ( sev]e ?roat symptoms & coryza4 ,rubella is frequ5tly mi/ak5 = mild cases ( measles or sc>let fev]4 ,unlike measles1 x does n h ! prom95t cat>rhal symptoms1 ! high] fev]1 ! cresc5tic gr\p+ ( ! eruption & ,koplik's sign4 ,9 measles ! ad5itis is n s sev]e z 9 rubella1 & especially are ! suboccipital & po/-auricul> gl&s involv$ 9 rubella4 ,sc>let fev] has a v sudd5 onset ) sev]e symptoms1 a v sore ?roat1 ! *>act]i/ic tongue & ! peculi> ra%1 all ( :i* are decid$ly diff]5t f rubella4 ,9 ! latt] /ages ! "* ( ! desquamation is also a di/+ui%+ feature4 ,treatm5t4--,pati5t %\ld be kept 9 a prop]ly heat$ & well v5tilat$ room1 be+ c>eful t no draughts *ill ! pati5t1 & %\ld rema9 9 b$ = at lea/ two days4 ,pati5t %\ld be isolat$4 ,treatm5t %\ld be direct$ to ! upp] c]vical1 mid-dorsal & l[] dorsal areas to keep normal ! function ( ! int]nal secret+ me*anism1 & to normalize & keep normal ! respiratory & circulatory sy/ems4 ,treat c>efully to upp] lymphatics1 work+ ar\nd ! enl>g$ gl&s & n directly ov] !m4 ,wat* ! excretory functions & keep !m active by judici\s measures4 ,if annoy+ it*+ occurs1 ! hot ba? foll[$ by be+ wrapp$ 9 a s(t w>m blanket w usually relieve4 ,daily tepid spong+ %\ld be giv5 & if hot ba? does n relieve it*+ an application ( olive oil or cold cream w (t5 relieve4 ,diet %\ld be r$uc$ & regulat$ accord+ to age ( pati5t & sev]ity ( ! case4 ,usually ! above is all t is indicat$1 b if m sev]e symptoms pres5t !mselves v>y y\r treatm5t accord+ to ! symptoms pres5t4 ,prognosis4--,recov]y is ! g5]al rule4 ,relapses sometimes occur1 & are usually mu* m sev]e ?an ! initial attack4 ,! symptoms are (t5 m sev]e 9 adults ?an 9 *ildr54 ,l measles1 ?is disease seems to l[] resi/ance to o!r infections1 & !re=e especial c>e %\ld be tak5 to protect ! pati5t f exposure to o!r diseases = "s "t aft] recov]y f rubella4 ,see t ! pati5t is built up con/itutionally aft] recov]y by pl5ty ( fre% air1 suitable ex]cises & good food4 ,v>icella 7,,*ick5 ,,pox7 ,def9ition4--,*ick5 pox is an acute1 specific1 contagi\s1 slightly febrile1 eruptive disease1 usually ( *ildhood1 affect+ ! :ole organism ?r\gh ! blood4 ,x is an epidemic disease t spreads rapidly1 is highly contagi\s b n inoculable1 & conf]s immunity4 ,hi/ory4--,v>icella 0 fir/ recogniz$ ab\t #aeec & 0 di/+ui%$ f smallpox by ,tr\sseau4 ,etiology4--,! ag5t t causes ! disease is n kn[n2 ! disease usually affects *ildr5 "u t5 ye>s ( age1 b does occasionally attack adults4 ,x be>s no relation to v>iola1 except ! v slightly simil> eruption4 ,x is transf]r$ by direct p]sonal contact1 by ! air or by a ?ird p]son4 ,x is infective f ! fir/ symptoms until all ! cru/s h disappe>$4 ,al?\gh ! disease usually occurs 9 epidemics1 frequ5tly we see sporadic cases4 ,z 9 all o!r contagi\s or infecti\s diseases ! pr$ispos+ causative factors are ^? conditions :i* l[] ! resi/ive p[]s ( ! body1 su* z fatigue1 improp] diet1 exposure to sudd5 temp]ature *anges & imp]fect elim9ation ( ! body wa/es4 ,! /ructural lesions f\nd z pr$ispos+ factors are contractur$ muscles ( ! neck & beh9d ! jaw1 & muscul> & int]osse\s lesions ( ! upp] c]vical1 mid-dorsal & dorso-lumb> areas1 also ( ! clavicle & upp] ribs4 ,symptoms & ,diagnosis4--,!re are ?ree /ages to ! disease3 7#a7 ,incubation1 7#b7 ,prodromal1 7#c7 ,eruptive4 #a4 ,incubation ,p]iod4--,?is p]iod la/s ab\t f\rte5 days ?\gh x may v>y f sev5 to sev5te5 days4 ,dur+ ?is p]iod !re is practically no symptomatology except p]haps ! la/ two or ?ree days1 :5 ! *ild %[s evid5ce ( a little excitability & irritability4 ,(t5 on ! day be=e ! fir/ noticeable symptoms ! *ild appe>s ev5 m active ?an usual4 #b4 ,prodromal ,/age4--,prodromal symptoms are n common & usually la/ b ab\t tw5ty-f\r h\rs4 ,! fir/ noticeable symptom is ! irritability ( ! pati5t1 :i* is foll[$ by a temp]ature1 usually #ii to #aja1 :i* temp]ature p]si/s dur+ ! c\rse ( ! disease4 ,!re are sometimes ?ir/1 anorexia1 con/ipation1 seldom vomit+1 & a furr$ tongue4 ,"s cases h be5 obs]v$ to h ! foll[+ z prodromal symptoms1 b ^! we believe are usually due to concurr5t conditions t exi/ at ! "t ( ! infection3 delirium1 convulsions1 ang9a1 conjunctivitis1 dysphagia1 bloody vomit+ & /ools1 & an initial ery!ma1 usually sc>lat9i=m4 #c4 ,eruptive ,/age4--,! eruption comes )9 tw5ty-f\r h\rs & is (t5 ! fir/ symptom t is notic$4 ,x appe>s fir/ z hyp]emic macules & !n rose color$ papul> spots1 some:at comp>able to ! typhoid roseola & n h>d4 ,^! papules rapidly become rais$1 flatt5$1 ovoid1 p9-head to pea-siz$ vesicles conta9+ a fluid at fir/ wat]y & !n pe>ly4 ,!y disappe> on pressure4 ,! vesicles mature )9 tw5ty-f\r h\rs1 are v sup]ficial1 & leave a slight areola ab\t !m1 :i* is n inflammatory z 9 smallpox4 ,! eruption appe>s fir/ on ! *e/ & !n on ! neck1 face1 scalp1 & !n trunk & limbs 9 ! ord] nam$4 ,! eruption is mo/ abundant ^u ! back1 & ov] ! entire body !y may numb] any:]e f eight to _m hundr$ & are usually scatt]$4 ,! vesicles are n umbilicat$1 b "s may h slightly depress$ c5t]s1 are discrete1 & appe> 9 successive crops :i* require f ?ree to six days to complete4 ,pu/ulation & hemorrhage into ! vesicle r>ely occur4 ,on ! ?ird or f\r? day yell[i%-br[n cru/s =m & gradually disappe>4 ,sc>s may result f scrat*+ or infection4 ,by ! fif? day we may f9d all /ages ( ! eruption because ( ! appe>ance ( ! successive crops4 ,!re may be an effloresc5ce ^u ! muc\s membrane ( ! oral cavity & ( ! ph>ynx caus+ slight difficulty 9 deglutition4 ,! it*+ may be m or less int5se4 ,z scrat*+ may cause pitt+ x %\ld be gu>d$ aga9/4 ,! fev] :i* is usually slight may p]si/ dur+ ! entire eruptive /age1 b if x is high & p]si/s z high temp]ature x sugge/s complications4 ,muscul> t5sion ( ! c]vical muscles1 especially ^? 9 front1 & ar\nd ! angle ( ! inf]ior maxilla are usually f\nd1 & (t5 ! clavicles are b\nd d[n1 & relation ( ribs is di/urb$4 ,ulc]ation sometimes foll[s scrat*+1 & ev5 gangr5e may appe> ar\nd ! vesicles 9 debilitat$ *ildr51 especially ^? :o are tub]cul> or cong5itally syphilitic4 ,x is apt to be fatal 9 ^! cases4 ,complications ( tubul> nephritis1 :i* occurs )9 two weeks2 c>diac hyp]trophy2 uremia2 otitis m$ia2 & bron*ial affections1 are sometimes met )4 ,treatm5t4--,isolate pati5t s z n to come 9 contact ) o!r *ildr54 ,! y\ng] *ildr5 %\ld be put to b$ until ! cru/s h =m$2 old] *ildr5 may be all[$ to be up ar\nd ! room if _! cases are light4 ,pay p>ticul> att5tion to ! muscul> lesions ( ! neck1 l[] maxilla1 mid-dorsal & dorso-lumb> regions1 keep+ !m relax$ by g5tle relax+ treatm5ts4 ,a g5]al sy/emic treatm5t is soo?+ & helps to prev5t complications4 8,be v c>eful & v ?or\gh 9 y\r neck adju/m5ts4 ,loos5 ! atlas & axis & draw =w>d ! inf]ior maxilla f its pressure ^u ! vessels & n]ves back ( its angle4 ,draw ! hyoid bone =w>d & secure good circulation ( blood ?r\gh\t ! entire c]vical area40--,a4 ,t4 ,,/ill4 ,give treatm5t at ! #d? & #e? dorsals to /imulate ! sup]ficial circulation & ?us increase elim9ation ?r\gh ! eruption z well z ! sweat gl&s4 ,rememb] ! eruption is ! expression ( ! body's attempt to elim9ate ! tox9s )94 ,keep ! b[els active by splan*nic & abdom9al manipulations & by laxative diet4 ,if b[els are p]si/5tly inactive use enemata4 ,diet %\ld be bl& & easily dige/$4 ,dur+ fev]1 diet %\ld be liquid or bett] re/rict$1 giv+ only wat] 9 abundance4 ,dur+ ! eruptive /age d n use tub ba?s4 ,daily tepid sponges ) ei!r pla9 wat] or boric acid solution answ]s bo? z an antiseptic wa% & ba?+4 ,aft] ! daily spong+1 & z (t5 z necess>y to control it*+1 ano9t ) a #aj boric acid o9tm5t or ) c>boliz$ vasel9e4 ,if scrat*+ c n be controll$1 ! h&s %\ld be ti$ 9 musl9 bags4 ,z 9 smallpox ! ultra-violet rays seem to irritate ! eruptions & to increase ! t5d5cy to sc>r+1 !re=e ! w9d[s & lights %\ld be scre5$ ) a dull r$ mat]ial4 ,prognosis4--,inv>iably favorable unless complications set 91 :i* is seldom4 ,recurr5ces are v r>e4 ,prophylaxis4--,! *ild %\ld be kept 9 qu>ant9e = ?ree weeks or until ! sk9 is entirely clean4 ,epidemic ,p>otitis 7,,mumps2 ,,epidemic ,,p>otiditis7 ,def9ition4--,mumps is an acute1 infecti\s1 contagi\s disease1 occurr+ 9 limit$ epidemics1 & *>act]iz$ by inflammation ( ! saliv>y gl&s1 p>ticul>ly ! p>otid1 swell+ slight fev] & pa9 ov] ! involv$ gl&s4 ,!re is special liability to or*itis or to ma/itis4 ,etiology4--,pr$ispos+ ,factors3 ,mumps is peculi>ly a disease ( *ildhood & adolesc5ce1 n be+ common 9 infancy or aft] ! tw5tie? ye>4 ,x affects boys ne>ly twice z (t5 z girls4 ,m&ibul> & upp] c]vical lesions1 bo? ( ! int]osse\s & s(t tissue types1 are und\bt$ly pot5t pr$ispos+ factors1 z !y ob/ruct & int]f]e ) n]ve & circulatory function to ! gl&s affect$4 ,also any condition :i* l[]s ! *ild's resi/ance to infections makes !m m susceptible to ?is disease ?an to any o!r1 ^! conditions be+ fatigue1 exposure to dampness & sudd5 wea!r *anges1 dietetic errors1 etc4 ,! cases are m num]\s 9 ! spr+ & autumn seasons4 ,ext5sive epidemics are infrequ5t1 b d occur 9 re=matory in/itutions & *ildr5's homes4 ,x is mu* m widespread 9 l>ge cities ?an 9 ! c\ntry or villages4 ,excit+ ,cause2 ,! specific cause has n be5 demon/rat$4 ,! disease is usually transmitt$ by direct contact1 b !re are in/ances :]e x has be5 transmitt$ by a ?ird p>ty or by fomites4 ,!re are two views z to ! mode ( infection2 ! fir/ be+ t ! active pr9ciple travels along ! c\rse ( ! saliv>y ducts f ! m\? to ! gl&s1 probably mo/ (t5 ?r\gh ! duct ( ,/5son to ! p>otid gl&4 ,?is is ! mo/ g5]ally accept$ !ory4 ,! second is t ! infection is a g5]al "o to :i* c]ta9 /ructures are m susceptible1 pr9cipally ! saliv>y gl&s1 & ! p>otid 9 p>ticul>4 ,symptoms4--,! p]iod ( incubation is f f\rte5 to tw5ty-"o days4 ,prodromes are usually abs5t1 ?\gh 9 ! m sev]e cases con/itutional di/urbances1 ) *ill9ess1 vomit+ & mild fev] may prec$e ! local inflammation4 ,9 ! mild] cases ! local swell+ may be ! fir/ manife/ation ( ! disease4 ,! temp]ature is usually mod]ate b may rise to #ajc or #ajd degrees 9 ! m sev]e cases4 ,! left side is m (t5 affect$ ?an ! "r4 ,! disease is *>act]iz$ by a feel+ ( t5sion ) sor5ess j bel[ ! e>4 ,soon a slight swell+ may be obs]v$ directly "u ! e> & 9 ! c\rse ( =ty-eight h\rs x rea*es its maximum size4 ,! p>otid gl& becomes greatly enl>g$ & ! adjac5t tissues ( ! neck & face become t5se & edemat\s4 ,! sk9 becomes h>d & glossy & usually :ite 9 color because ( ! ob/ruction to ! circulation f pressure4 ,! swell+ is betwe5 ! angle ( ! jaw & ! ma/oid process1 pu%+ ! e> upw>d & its lobule is pu%$ %>ply outw>d4 ,9 ! majority ( cases ! o!r side becomes affect$ 9 two or ?ree days1 b sometimes ! spread ( ! disease to ! o!r side is delay$ = sev]al days1 & occasionally ! o!r side escapes ! infection4 ,frequ5tly ! swell+ ( ! o!r side is s slight t x is only recogniz$ by ! close/ scrut9y4 ,infrequ5tly ! submaxill>y gl&s become affect$ )\t involv+ ! p>otid gl&s1 b ^! cases are r r>e4 ,! pati5t is usually unable to op5 ! m\? )\t consid]able pa92 acids1 & r>ely sweets1 produce spasms ( ! jaw muscles2 spee* & ev5 deglutition are difficult2 ! saliv>y secretions are usually increas$ b q frequ5tly !y are decreas$4 ,! brea? is f\l & ! tongue is furr$4 ,! muc\s membrane ( ! *eek & ph>ynx are r$d5$ & !re may be a slight ang9a4 ,! sp9e %[s subluxations ( ! upp] c]vical area1 p>ticul>ly ( ! atlas & axis1 also upp] rib lesions & upp] dorsal lesions are frequ5tly f\nd4 ,! lesions ( ! second & ?ird dorsal1 & _! ribs1 are mo/ frequ5tly f\nd :5 ! submaxill>y gl& is involv$4 ,! symptoms p]si/ f six to f\rte5 days1 :5 ! swell+ disappe>s & ! pati5t rega9s normal heal?4 ,or*itis occurs 9 ab\t "o-?ird ( ! cases aft] pub]ty4 ,9 infancy & *ildhood x is extremely r>e4 ,usually "o te/icle is involv$1 & is *>act]iz$ by weight1 swell+ & pa9 9 ! scrotum4 ,! te/icle may become greatly enl>g$ :5 ! pa9 becomes int5se4 ,atrophy may result & if bo? te/icles are affect$ ! loss ( reproductive ability may result4 ,9 females1 usually aft] pub]ty1 ! brea/s may become enl>g$ & t5d]1 pa9 & t5d]ness ( "o or bo? ov>ies1 hematoma ( ! labia1 or a vulvovag9al dis*>ge may occur4 ,h[ev] ^! complications are v r>e4 ,z a rule ! pati5t is n v sick & relapses are v uncommon4 ,! attack conf]s immunity :i* is practically p]man5t4 ,diagnosis4--,"u ord9>y conditions1 especially dur+ an epidemic1 ! diagnosis ( mumps is v easy4 ,! swell+ 9 front ( & bel[ ! e>1 ) ! displacem5t ( ! lobule outw>d is q indicative ( mumps4 ,! relative rapidity ) :i* ! swell+ appe>s1 develops & subsides is *>act]i/ic ( mumps4 ,9 acute c]vical ad5itis ! swell+ is bel[ ! angle ( ! jaw & does n at any "t correspond ) ! outl9e ( ! p>otid gl&4 ,9 ,hodgk9's disease1 :i* is a *ronic affection ( ! lymphatic gl&s1 ! saliv>y gl&s are n involv$4 ,treatm5t4--,! pati5t %\ld be kept away f o!r *ildr51 & %\ld rema9 9 a well light$1 well v5tilat$ room ( ev5 temp]ature1 & if ! temp]ature is high or mod]ately high he %\ld be kept 9 b$4 ,! correction ( all int]osse\s lesions is indicat$1 especially ( ! upp] c]vical area1 ?\gh ! second & ?ird dorsal %\ld be giv5 att5tion because ( ! influ5ce ( ^! dorsal n]ves ^u ! submaxill>y gl&s4 ,also correct upp] rib lesions t may exi/4 ,z mumps is an infective disease ! *annels ( elim9ation %\ld be wat*$ & /imulat$4 ,build up ! body resi/ance by treatm5t at ! mid-dorsal area to affect circulation & respiration2 & l[] dorsal area to affect kidney & adr5al function4 ,wat* ! b[els & keep ?is av5ue ( elim9ation function+ freely1 us+ enemata if necess>y4 ,! diet %\ld be liquid1 ( fruit juices1 ?9 gruels1 milk & pl5ty ( wat]4 ,tepid spong+ allays ! fev] & re/lessness4 ,relaxation ( ! deep muscles ( ! neck & %\ld]s w d mu* to make ! pati5t com=table1 also ! muscles "u ! angle ( ! jaw4 ,a v g5tle relax+ ( ! tissues ar\nd ! gl& itself1 by cr[d+ !m t[>d ! gl&1 assi/s 9 reliev+ ! t5sion by secur+ a bett] v5\s & lymphatic dra9age4 ,hot applications to ! swoll5 gl&s w give a consid]able relief2 ^! may consi/ ( hot fom5tations1 hot salt bag1 electric heat+ pad1 hot wat] bottle1 etc4 ,! m\? is kept 9 good condition by ! use ( a mild antiseptic m\? wa%4 ,or*itis %\ld n occur if ! boy is kept w>m & 9 b$4 ,if x does occur ! be/ treatm5t is relaxation ( ! l[] dorsal & upp] lumb> sp9al muscles1 re/ 9 b$1 support & protection ( ! scrotum ) cotton wool1 cold applications1 correction ( any bony lesions affect+ ! pelvic visc]a4 ,if ma/itis occurs1 rib lesions w be f\nd & %\ld be correct$1 z !y are probably ! pr$ispos+ factor to ?is complication4 ,treatm5t w\ld consi/ ( correction ( ^! lesions1 if x c be done )\t irritat+ ! inflam$ gl&s4 ,! manipulation ( ! surr\nd+ tissues1 ) g5tle cr[d+ ( ! normal tissues t[>d ! inflam$ gl&s1 )\t ex]t+ any pressure on ! gl& itself1 is helpful & com=t+4 ,free tissues back to ! axill>y lymphatics4 ,prognosis4--,! outcome is usually favorable4 ,9 ! r>e fatal cases1 m5+itis is ! usual cause ( dea?4 ,"u o/eopa?ic c>e ! duration ( ! swell+1 fev] & pa9 is usually greatly less5$4 ,qu>ant9e ( tw5ty-f\r days is necess>y4 ,:oop+ ,c\gh 7,,p]tussis2 ,,tussis ,,convulsiva7 ,def9ition4--,x is a specific1 epidemic1 infecti\s1 contagi\s disease affect+ ! respiratory organs1 *>act]iz$ by a cyclic c\rse1 a sev]e convulsive c\gh1 p>oxysmal1 ) ! *>act]i/ic 8:oop40 ,etiology4--,x usually occurs 9 *ildr51 mo/ frequ5tly dur+ ! f\r? ye>1 & extremely seldom aft] ! tw5tie? ye>4 ,x appe>s to be slightly m frequ5t among girls1 & mo/ cases occur 9 ,m>* & ,april4 ,p]tussis is highly contagi\s1 be+ c>ri$ by direct contact & by fomites4 ,! ,bordet & ,g5g\ bacillus is ! specific cause4 ,?is is f\nd 9 ! sputum mo/ abundantly dur+ ! fir/ week1 ! mo/ infecti\s p]iod1 & becomes gradually less4 ,"o attack usually conf]s immunity4 ,! incubation p]iod is f sev5 to t5 days4 ,! pati5t may be consid]$ non-infecti\s five weeks aft] ! fir/ :oop4 ,lesions ( ! c]vical & upp] dorsal v]tebr & ( ! fir/1 second & ?ird ribs1 affect+ ! vagi1 ! phr5ic1 ! sympa!tic1 ! recurr5t l>yngeal or ! vasomotor n]ves pr$ispose to ! disease4 ,! bact]ia 7 f\nd by ,mallory & ,horn] to be *>act]i/ically betwe5 ! cilia ( ! tra*ea & ! bron*i4 ,!y int]f]e1 me*anically1 ) ! movem5ts ( ! cilia1 prev5t+ ! normal removal ( secretions4 ,symptoms4--,! disease is divid$ into ?ree /ages3 #a4 ,! cat>rhal /age1 :i* la/s "o to two weeks2 #b1 ! spasmodic /age1 ?ree to six weeks2 #c1 ! decl9+ /age1 ?ree weeks4 ,! ,cat>rhal ,/age3 ,*>act]iz$ by heada*e1 photophobia1 conjunctivitis1 coryza & a c\gh :i* becomes dri] & h>d] t[>d ! end ( ?is /age4 ,(t5 ! invasion is insidi\s & sometimes well m>k$ ) a temp]ature ( #ajj to #ajb4 ,frequ5tly ?is /age _c be diff]5tiat$ f a 8h>d cold10 except t[>d ! end ( ! /age :5 ! c\gh becomes worse in/ead ( bett]1 & ! *ild w seek "s support to /eady itself dur+ ! c\gh+ p>oxysm4 ,also ! eyes w wat] freely dur+ ! c\gh+ spell & ! *ild w n be able to 8get 8 brea?0 betwe5 c\ghs1 b w h a numb] ( c\ghs )\t inhal+4 ,"o to two weeks4 ,! ,spasmodic ,/age3 ,?is /age dates f ! 8fir/ :oop40 ,! fev] n[ usually ceases1 unless !re are complications4 ,! c\gh becomes p>oxysmal1 consi/+ ( a succession ( fifte5 or m %ort1 rapid expiratory puffs ) no int]v5+ inspirations1 imm$iately foll[$ by a deep1 l\d inspiration1 :i* is ! *>act]i/ic 8:oop10 & is due to ! p>tial closure ( ! glottis4 ,ea* p>oxysm is compos$ ( ?ree or m su* spells1 ! la/ "o (t5 foll[$ by ! expectoration ( a small plug ( mucus or by vomit+4 ,dur+ ! p>oxysm ! facies pres5ts a swoll51 dusky appe>ance1 eyeballs protrud+1 eyes r$d5$1 & puffy1 p9ki% lids4 ,! *ild is well except = ! p>oxysm1 :i* has an aura1 tickl+ 9 ! l>ynx1 ?oracic con/riction1 a creep+ s5sation1 :5 ! *ild attempts to brace himself1 or runs 9 t]ror = support4 ,! 8:oop0 is a deep1 s++ or :i/l+ inspiration :i* is absolutely *>act]i/ic4 ,dur+ ! c\gh ! *ild's body is b5t =w>d & he is p]fectly helpless1 (t5 pass+ ur9e & feces involunt>ily4 ,cyanosis (t5 occurs f ! /ra94 ,aft] ! attack pati5t rega9s control ( himself1 ! respiration is fa/1 & !re is fatigue1 sweat+ & (t5 pa9 9 ! abdom5 f ! /ra9 ( c\gh+4 ,dur+ ! sev]e c\gh pete*i ( ! =ehead1 ec*ymosis ( ! conjunctiv1 epi/axis1 ble$+ ( ! ext]nal auditory meatus or f ! fr5um ( ! tongue may occur4 ,ulc] ( ! fr5um ( ! tongue is q common4 ,! p>osyxms v>y f f\r to a great _m p] day1 av]ag+ ab\t tw5ty4 ,?ree to six weeks1 usually f\r weeks4 ,! ,t]m9al or ,decl9+ ,/age3 ,?is /age is long] 9 proportion 9 ! mild cases4 ,! p>oxysms occur at long] int]vals1 are ( %ort] duration & ( less int5sity1 ! cat>rhal symptoms are m m>k$1 ! expectoration becomes ?9n]1 fluid1 mucopurul5t1 & loos]4 ,! 8habit c\gh0 may foll[4 ,x is dur+ ?is /age t complications are mo/ likely to occur1 !re=e x is ! mo/ dang]\s4 ,complications4--,cat>rhal inflammations are common 9 ! initial /age4 ,bron*opneumonia is ! mo/ frequ5t & sev]e complication4 ,lob> pneumonia1 exudative pleurisy1 endoc>ditis1 p]ic>ditis1 m5+itis & nephritis are infrequ5t complications4 ,spasms ( ! glottis 9 n]v\s or scr(ul\s *ildr5 is l>gely nocturnal1 & may cause dea? f asphyxia ev5 9 ! lighte/ cases4 ,hemorrhages may occur 9 ! sk91 conjunctiv1 nose1 ?roat1 e>s or c]ebrum4 ,! writ] kn[s ( "o case :]e dea? 0 sudd5 f a c]ebral hemorrhage 9 an app>5tly mild case4 ,o!r complications are c>diac dilatation1 emphysema1 bron*iectasis1 pneumo?orax1 aneurysm h]nias1 muscul> ruptures1 & visc]al prolapses4 ,spasmodic c\gh f diseas$ bron*ial gl&s v closely resembles :oop+ c\gh4 ,b>!z & ,sannee give ! foll[+ diff]5tiation3 ,:oop+ ,c\gh vs ,enl>g$ ,gl&s #a4 ,contagi\s1 epidemic4 ,isolat$1 n contagi\s4 #b4 ,?ree p]iods1 #bnd p>osyxmal4 ,no di/9ct p]iods4 #c4 ,p>oxysmal c\gh ) :oop1 ,p>oxysms )\t :oop1 vomit+1 viscid expectoration4 expectoration or vomit+4 #d4 ,respiratory s\nds normal4 ,signs ( enl>g$ gl&s sometimes pres5t4 #e4 ,respiration normal 9 int]val2 ,a/hma 9 "s cases1 febrile apyrexia if simple4 movem5ts1 sweats1 wa/+1 etc4 #f4 ,voice natural4 ,voice sometimes *ang$4 #g4 ,acute4 ,*ronic4 ,treatm5t4--,isolation ( pati5t 9 well v5tilat$1 sunny room :]e !re is pl5ty ( fre% air day & night is ess5tial4 ,*ildr5 expos$ to infection %\ld be dis9fect$ & isolat$ = ?ree weeks1 z ! disease c n be diagnos$ dur+ ! cat>rhal /age4 ,if case is at all sev]e1 pati5t %\ld be put to b$4 ,cases receiv+ e>ly treatm5t are sometimes abort$4 ,treatm5t ( ! :ole respiratory tract ) correction ( v]tebral & rib lesions1 & relaxation ( ! contract$ muscles %\ld be giv54 ,treatm5ts = ! fir/ few days %\ld be at lea/ twice p] day4 ,pay especial att5tion to ! vagi & phr5ic n]ves4 ,lesions ( ! fir/ & second ribs w affect ! recurr5t l>yngeal n]ves :i* w aggravate ! c\gh4 ,! muscles ( ! %\ld] girdle are always v t5se & %\ld be kept well relax$1 z %\ld ! subscapul> muscles4 ,frequ5tly aft] treatm5t ! *ild w h a c\gh+ spasm & raise l>ge quantities ( mucus1 aft] :i* !re w be no m spasms = sev]al h\rs4 ,*ildr5 :o play & live out ( doors get along be/4 ,to support ! diaphragm & abdom9al muscles f ! /ra9 ( c\gh+ a musl9 b&age tightly p9n$ ab\t ! trunk is v valuable1 a pad be+ plac$ ov] ! /oma* "u ! b&age4 ,9 a v "y *ild in/ruct ! nurse to /rongly flex ?ighs on abdom5 dur+ ! sev]e c\gh+4 ,inhalations ( /eam f wat] ) a v few drops ( eucalyptus oil 9 x (t5 relieves ! fir/ tickl+ s5sations4 ,if cyanotic symptoms appe> !y may be reliev$ by rais+ ! ribs1 especially ^? ov] ! he>t2 by relax+ ! subscapul> muscles2 & by support+ ! he>t by application ( cold clo? ov] ! he>t4 ,elevat+ ! abdom9al visc]a & diaphragm is1 also1 ( di/9ct b5efit4 ,! diet %\ld be nutriti\s & easily dige/$1 re/rict$ to liquids dur+ ! fev]4 ,! *ild %\ld be w>mly clad & protect$ f drafts4 ,! excretory sy/ems %\ld be kept active by pl5ty ( wat] dr9k+ & by diet4 ,treatm5t %\ld be cont9u$ dur+ ! t]m9al /age to prev5t ! possible complications4 ,irritants1 z beef-tea1 /imulants1 dry bread1 cookies & ov]fe$+1 provoke c\gh+ & vomit+4 ,food %\ld be giv5 at frequ5t int]vals 9 conc5trat$ =m--gruels1 milk ) lime wat]1 zwieback 9 milk1 eggs1 meat juice1 etc4 ,old] pati5ts tol]ate m solid food4 ,prognosis4--,) ! complications1 ?is is ! mo/ fatal ( ! acute infections "u five ye>s ( age4 ,infants & little *ildr5 %\ld receive special c>e4 ,ord9>y uncomplicat$ cases are favorable = recov]y4 ,! prognosis dep5ds ^u ! age & /r5g? ( ! pati5t1 ! sev]ity & numb] ( ! p>oxysms1 & ! pres5ce or abs5ce ( complications4 ,no recurr5ce is to be expect$4 ,dea? is due to spasm ( ! glottis or to ext5sive subdural hemorrhage1 occurr+ *iefly 9 ! *ildr5 ( ! poor & 9 delicate infants4 ,prophylaxis consi/s ( isolation1 dis9fection ( sputum & f9al fumigation ( ! premises4 ,*ildr5 %\ld be protect$ f exposure to infection f :oop+ c\gh4 ,x mu/ be realiz$ t x is a v s]i\s disease4 ,,con/itutional ,,diseases ,rheumatic ,fev] 7,,inflammatory ,,rheumatism7 ,def9ition4--,an acute1 febrile1 non-contagi\s disease2 x is infecti\s1 al?\gh !re is "s controv]sy z to its exact nature2 *>act]iz$ by a multiple ar?ritis & a t5d5cy to involve ! he>t4 ,o/eopa?ic ,etiology & ,pa?ology4--,! prevail+ ?\ght is t ! disease is an infection due to a diplococcus4 ,?is micro-organism is call$ by o!rs micrococcus rheumaticus & /reptococcus rheumaticus4 8,rheumatic fev] occurs mo/ frequ5tly 9 ! temp]ate zone1 among p :o live "u conditions :i* are unheal?ful & :i* especially induce focal infection4 ,x is mo/ preval5t 9 ! "y & 9 ! m expos$ male ( all ages4 ,! excess ( lymphoid tissue 9 ! ph>ynx & nose ( ! "y expla9s ! frequ5cy ( ! incid5ce ( ! focal infection & ! subsequ5t rheumatism4 ,! frequ5t association ( ! onset ( rheumatic fev] ) l[]+ ( ! body temp]ature by exposure to cold & a wett+ is expla9$ by ! increas$ specific virul5cy ( ! bact]ial cause acquir$ by a l[ temp]ature & ! co9cid5t less5$ resi/ance ( ! pati5t due to ! exposure4 ,! frequ5t abs5ce ( evid5ce ( acute focal infection at ! onset ( ! sy/emic disease is n an evid5ce t no focus exi/s4 ,! lat5t *ronic /reptococcus infection ( tonsillitis1 pyorrhea alveol>is1 s9usitis1 etc41 may sudd5ly acquire increas$ virul5ce & specific pa?og5ic aff9ity ) v>y+ degrees ( focal tissue reaction4 ,?is transmutation ( type & pa?og5icity c]ta9ly occurs 9 ! focus ( infection4 ,! removal ( ! tonsils & o!r sites ( focal infection has be5 foll[$ by complete recov]y ( prolong$1 subacute & *ronic types ( ar?ritis & has unque/ionably prev5t$ recurr5t attacks ( rheumatic fev] to :i* ! susceptibility is increas$ by "o or m attacks4 ,! occurr5ce ( rheumatic fev] aft] ! removal ( an app>5t focus may be due to second>y sy/emic lat5t foci 9 lymph nodes proximal to jo9ts1 9 ! neck or else:]e4 ,! /reptococci ( ^! second>y foci may take on new virul5ce & specific pa?og5icity1 f ! same causes :i* induc$ l *anges 9 ! pa?og5ic bact]ia ( ! prim>y focus4#fg0 ,o/eopa?ic lesions play an important role1 bo? 9 _! relation%ip or be>+ ^u ! tissues ( a possible site = a focal infection & ^u sy/emic conditions t d]ange g5]al bodily tone4 ,?is has be5 def9itely confirm$ 9 ^? cases ( rheumatism :]e correction ( ! o/eopa?ic lesions1 ) att5tion to hygi5ic measures1 h result$ 9 recov]y4 ,?is is a feature ( o/eopa?ic etiology & !rapy t c h>dly be ov]-emphasiz$1 = an intact inn]vation1 circulation & *emism ( ! organism is basic to bo? prev5tive & curative !rapy4 ,rheumatism1 l mo/ diseases1 is ( local orig9 & if tissues & /ructures c be kept up to ! normal1 infecti\s or ! o!r pa?ologic processes c r>ely become active4 ,pa?ologically1 ! synovial membrane is hyp]emic4 ,! muscles & ligam5ts are inflam$4 ,! fluid is s]\s ) m or less fibr9 & leucocytes4 ,9 sev]e cases slight erosion ( ! c>tilages is f\nd4 ,acute rheumatism is r>ely fatal2 :5 dea? does occur x is g5]ally due to ! complications :i* arise4 ,symptoms4--,! onset is usually sudd52 al?\gh x may be prec$$ by slight fev]1 a*+ 9 jo9ts1 *ill9ess1 & sore ?roat4 ,x g5]ally involves ! l>g] jo9ts & is almo/ always multiple2 x has a t5d5cy to move f "o jo9t to ano!r4 ,! pa9 9 ! jo9ts usually develops rapidly ) slight *ill9ess & a rapid rise 9 ! temp]ature f #ajb to #ajd degrees ,f4 ,! pulse is frequ5t1 (t5 disproportionately to ! fev]4 ,!re are pr(use acid sweats1 (t5 caus+ sudam9a4 ,!re is loss ( appetite & ?ir/ is pres5t4 ,! ur9e is scanty1 high color$1 v acid1 & deposits urates ^u /&+4 ,! tongue is coat$ & ! b[els are con/ipat$4 ,! jo9ts are r$d5$1 swoll51 extremely pa9ful & t5d] to ! t\*4 ,e movem5t1 j>r+ ( ! b$1 or ! pressure ( ! b$ clo!s is agony to ! pati5t4 ,! blood is greatly d]ang$1 anemia develops rapidly & !re is well m>k$ leucocytosis4 ,! duration v>ies f a few days to sev]al weeks4 ,complications4--,! temp]ature may rise to #ajf or #aji degrees ,f42 ?is is (t5 associat$ ) delirium1 great pro/ration & a feeble1 frequ5t pulse4 ,endoc>ditis1 p]ic>ditis1 myoc>ditis1 pneumonia1 pleurisy1 iritis1 *orea1 convulsions & m5+itis may occur4 ,coma may develop )\t prec$+ delirium or convulsions2 ?is is v s]i\s & may prove fatal4 ,subcutane\s fibr\s nodules atta*$ to t5dons & fascia sometimes develop4 ,!y v>y 9 size & are mo/ common 9 *ildr5 & 9 "y adults1 occurr+ mo/ frequ5tly 9 ! f+]s1 h&s & wri/s4 ,!y are also sometimes se5 ab\t ! elb[s1 knees1 scapul & sp9es ( ! v]tebr4 ,!y usually la/ a few days1 sometimes = mon?s1 & g5]ally develop dur+ ! decl9e ( ! fev]4 ,cutane\s affections1 su* z urtic>ia1 ery!ma1 nodosis1 purpura & sweat vesicles sometimes appe>4 ,diagnosis4--,?is is seldom v difficult2 !re are1 h[ev]1 sev]al affections :i* resemble acute articul> rheumatism4 ,9 septic ar?ritis its association ) "s o!r septic process & ! t5d5cy ( ! inflammation to end 9 suppuration ) m or less de/ruction ( ! jo9ts1 w det]m9e ! diagnosis4 ,septic ar?ritis may develop dur+ ! c\rse ( pyemia1 pu]p]al fev]1 or acute o/eomyelitis4 ,g\t is r>ely mi/ak5 = acute rheumatism4 ,g\t occurs lat] 9 life & usually affects ! great] toe2 hi/ory & mode ( onset w usually r5d] ! diagnosis easy4 ,9 gonorrheal rheumatism ! hi/ory ( rec5t infection1 its ob/9ate "* & be+ g5]ally connect$ ) a s+le jo9t f ! />t are diagno/ic4 ,x especially affects ! knee4 ,he>t complications are r>e4 ,rheumatoid ar?ritis beg9s 9 ! small jo9ts2 !n attacks !m all1 leav+ p]man5t de=mity4 ,!re is no fev] or sweats & ! he>t is n affect$4 ,acute ar?ritis ( infants usually attacks ! hip or knee4 ,! effusion becomes purul5t4 ,prognosis4--,recov]y is ! rule1 b ! prognosis nev]!less1 mu/ be gu>d$4 ,relapses & recurr5ces are common4 ,subacute ,rheumatism4--,9 ?is =m bo? ! local & g5]al symptoms are ( a mild] type & are m prolong$ ?an 9 ! acute =m4 ,! temp]ature seldom rises above #aja degrees ,f4 ,! inflammation ( ! jo9ts is n s sev]e & few] jo9ts are involv$4 ,x may la/ = weeks or mon?s1 & !n x may pass into ! *ronic =m4 ,usually ?\gh1 :5 ! c\rse is prolong$1 ! jo9ts return to _! normal /ate4 ,treatm5t4--,place ! pati5t 9 a room t is well v5tilat$ & ma9ta9 a temp]ature ( ab\t #gj degrees ,f4 ,avoid draughts ( air4 ,! b$ %\ld be s(t & smoo? & blankets %\ld be us$4 ,! diet %\ld consi/ l>gely ( milk1 & let ! pati5t dr9k freely ( wat]4 ,oatmeal1 b>ley wat]1 egg album5 & meat juices may also be us$4 ,treatm5t %\ld be giv5 along ! entire sp9e1 especially if ! rheumatism *anges f "o jo9t to ano!r2 o!rwise treat ! inn]vation directly to ! affect$ jo9t4 ,correct any d]angem5ts t may be f\nd along ! sp9al column & c>efully relax ! deep back muscles4 ,p>ticul> att5tion %\ld be giv5 to ! b[els & kidneys4 ,also1 treat ! liv] mo/ ?or\ghly dur+ ea* treatm5t4 ,! liv] is _m times consid]ably enl>g$ & t5d] 9 rheumatism & a ?or\gh treatm5t ( x seems to favor a m rapid cure4 ,c>efully treat ! affect$ tissues4 ,if y _c treat ov] ! jo9t1 !n manipulate ! tissues above & bel[ ! jo9t2 & usually aft] a few m9utes' manipulation ! swell+ is some:at reliev$ s t direct treatm5t ( ! jo9t c be giv54 ,x is be/ to wrap ! inflam$ jo9ts 9 flannel if ! pa9 is sev]e4 ,besides treatm5t ( ! inn]vation ( ! jo9t1 hot applications w be helpful4 ,"s claim t cold compresses are ( aid to ! inflam$ jo9ts4 ,complications are to be treat$ sep>ately4 ,besides ! ord9>y fev] treatm5t = ! fev]1 ! cold ba? is v effectual4 ,aft] convalesc5ce has be5 e/abli%$1 ! pati5t %\ld be c>efully protect$ = sev]al days f cold & damp4 ,= any /iffness t may p]si/1 manipulation & hot ba?s w be q suffici5t4 ,h4 ,m4 ,/ill#fh writes 8,if ! fev] is n ov] #ajc degrees ,i d n try to r$uce x4444 ,aft] treatm5t 9 a majority ( cases1 ! fev] is r$uc$ )9 tw5ty-f\r h\rs unless complications h set 94 ,^! are usually ( ! he>t1 s no matt] h[ mild ! attack1 keep ?is 9 m9d4 ,if ! action is irregul> & weak1 /imulate x two or ?ree times a day4 ,if x is rapid & high fev]1 g to ! vasomotor c5t]s & r$uce fev]1 !n inhibit ! he>t action & keep ! excretions active4 ,if ! jo9ts are affect$ ,i always move !m g5tly no matt] h[ great ! inflammation4 ,z yet ,i h nev] _h a case ( rheumatism 9 :i* c>diac lesions or ankylos$ jo9ts 7 a sequela40 ,if ! tonsils are evid5tly badly diseas$ & o/eopa?ic treatm5t does n cle> !m up d n hesitate to h !m remov$4 ,*ronic ,articul> ,rheumatism ,o/eopa?ic ,etiology & ,pa?ology4--,?is disord] %\ld be /udi$ 9 connection ) ar?ritis de=mans ow+ to simil> s\rces ( infection & v>i\s common factors4 ,x usually develops sl[ly & foll[s an acute or subacute attack & is common among ! poor1 especially ^? expos$ to damp & cold4 ,h]$ity1 advanc$ ye>s1 al?\gh ! disease may appe> at any age1 & con/ant exposure to cold & wet are pr$ispos+ causes4 ,*ronic lesions to ! sp9al column correspond+ to ! affect$ area are f\nd4 ,too mu* /ress f an o/eopa?ic po9t ( view _c be plac$ ^u ! importance ( lesions to bo? ! dige/ive organs & to ! jo9ts especially involv$4 ,!n1 9 addition1 p>ticul> att5tion %\ld be giv5 o/eopa?ically or surgically1 or bo?1 to sites ( focal infection4 ,pa?ologically1 ! capsules & ligam5ts ( ! jo9ts are ?ick5$ also1 ! %ea?s ( ! t5dons ar\nd ! jo9t1 s t 9 long /&+ cases ! movem5ts are impair$4 ,9 sev]e cases ! c>tilages may be erod$4 ,atrophy ( ! muscles cov]+ ! jo9ts sometimes occurs1 especially :5 !re is neuritis2 ?us produc+ m>k$ de=mity4 ,?is muscul> atrophy is p>ticul>ly m>k$ :5 ! %\ld]s or hips are involv$4 ,! atrophy is caus$ p>tly f disease2 9 cases :]e ! jo9t is di/5d$ ) effusion1 ! wa/+ may be due to pressure ^u ! muscles or blood-vessels4 ,symptoms4--,sev]al jo9ts are usually affect$2 b x may be limit$ to "o jo9t1 p>ticul>ly ! knee1 hip or %\ld]4 ,pa9 & /iffness are ! mo/ common symptoms4 ,! pa9 is increas$ ^u motion1 :ile ! /iffness is (t5 less5$ by us+ ! limbs4 ,! jo9ts are slightly swoll51 b seldom r$d5$ & are usually t5d] ^u pressure4 ,all ! symptoms are aggravat$ on ! approa* ( /ormy wea!r4 ,!re is fev] b ! g5]al heal? is n greatly impair$4 ,!re may be di/ortion ( ! jo9ts & ankylosis may occur4 ,art]ial deg5]ation & *ronic endoc>ditis may develop z complications4 ,prognosis4--,?is %\ld be gu>d$ s f> z a complete cure is conc]n$2 al?\gh mo/ cases are greatly b5efit$4 ,treatm5t4--,! treatm5t ( *ronic articul> rheumatism is l>gely correct+ lesions ( ! sp9al column1 :i* affect ! diseas$ tissues z well z ! dige/ive organs1 local treatm5t ( ! jo9ts1 & removal ( focal infections4 ,a c]ta9 p]c5tage w respond to o/eopa?ic measures alone1 ?\gh surg]y has a def9ite place 9 o!rs4 ,! jo9ts & limbs %\ld be ?or\ghly treat$ s z to re/ore a bett] circulation & relieve ! inflam$ tissues4 ,wrapp+ ! affect$ jo9t ) cold clo?s & !n cov]+ ! clo?s ) flannel & oil$ silk is (t5 helpful4 ,due att5tion %\ld be giv5 ! g5]al heal?1 su* z n\ri%+ food1 free elim9ation & outdoor ex]cise4 ,probably 9 "s cases :]e ! prim>y infection has be5 elim9at$ second>y foci are pres5t & a g5]al treatm5t w ar\se suffici5t reaction to cope ) ! condition4 ,ar?ritis ,de=mans 7,,rheumatoid ,,ar?ritis7 ,def9ition4--,a *ronic affection ( ! jo9ts1 *>act]iz$ by progressive *anges 9 ! c>tilages & synovial membranes1 & by new osse\s =mations re/rict+ ! motion ( ! jo9t & caus+ de=mity4 ,o/eopa?ic ,etiology & ,pa?ology4--,x is due to lesions ( ! sp9al column affect+ ! sp9al & sympa!tic n]ves z well z di/urb+ ! circulation to ! cord4 ,lesions ( ! sp9al column & ribs are f\nd correspond+ to ! inn]vation ( ! diseas$ jo9ts4 ,! o/eopa? has be5 able 9 e case to demon/rate cl9ically important o/eopa?ic lesions4 ,9 addition ! symmetry ( jo9t involvem5t1 muscul> atrophy1 sweat+1 etc41 po9t to n]v\s lesions4 ,falli f\nd ^u autopsy t ! ant]ior horns _h und]gone atrophic *anges4 ,n]v\s lesions are probably ( a pr$ispos+ "* :ile "s infection is ! excit+ cause4 ,a ?or\gh se>* ( ! entire body %\ld be made = foci ( infection4 ,malnutrition1 traumatism1 exposure to cold1 & pelvic diseases are important causative factors4 ,9 all cases lesions w be f\nd di/urb+ ! organs ( dige/ion4 ,females are m frequ5tly affect$ ?an males4 ,! disease is frequ5tly se5 9 wom5 suff]+ f ov>ian & ut]9e tr\bles1 especially at ! m5opause4 ,h]$it>y influ5ce may be a factor1 also auto-intoxication4 ,! disease is mo/ common betwe5 ! ages ( tw5ty & ?irty4 ,m5tal worry1 anxiety1 grief & injury are also pr$ispos+ factors4 ,pa?ologically1 9 "o class ( cases1 ! cells ( ! c>tilages & ( ! synovial membrane prolif]ate4 ,! c>tilages und]go atrophy1 or may become s(t1 deg5]ate1 & are absorb$1 leav+ ! ends ( ! bone b>e4 ,! bones naturally atrophy & become smoo?4 ,9 ano!r class ! edges ( ! c>tilages :]e ! pressure is slight1 ?ick5 & =m outgr[?s :i* ossify & enl>ge ! heads ( ! bones1 =m+ o/eophytes :i* greatly impair ! motion2 true ankylosis is r>e4 ,! synovial membrane becomes ?ick5$1 also ! capsule & ligam5ts1 ?us greatly re/rict+ ! movem5ts ( ! jo9ts4 ,! muscles ar\nd ! jo9ts atrophy4 ,9 ! sp9al cord atrophic & deg5]ative lesions are f\nd4 ,9 ,/ill's disease !re is an enl>g$ sple5 & m>k$ *anges 9 ! jo9t4 ,symptoms4--,pa9 & swell+ ( ! jo9ts & fev] & enl>gem5t ( ! lymphatics ne> ! jo9t are *>act]i/ic4 ,! sple5 is conge/$ & lat] on !re is ga/ro-inte/9al di/urbance4 ,multiple ar?ritis de=mans1 also kn[n z ,heb]d5's nodosites1 is *>act]iz$ by nodules develop+ at ! sides ( ! di/al phalanges4 ,x occurs mo/ frequ5tly 9 wom5 betwe5 ! ages ( ?irty & =ty1 & gradually increases ) age4 ,at fir/ ! jo9ts are swoll51 t5d] & pa9ful & !n app>5tly become bett]4 ,^! attacks may appe> at diff]5t int]vals :ile ! nodules at ! sides ( ! jo9ts gradually increase 9 size4 ,! l>g] jo9ts are r>ely affect$4 ,! progressive =m may be ei!r acute or *ronic4 ,! acute =m at ! onset may resemble articul> rheumatism4 ,x is m common 9 wom5 betwe5 ! ages ( tw5ty & ?irty1 b may occur 9 *ildr54 ,pregnancy1 rec5t deliv]y1 lactation1 ! m5opause1 & rapid *ild be>+ are common antec$5ts4 ,!re is swell+ & t5d]ness ( ! jo9ts & slight fev]4 ,sev]al jo9ts are usually involv$4 ,! *ronic =m is mo/ common4 ,symmetrical jo9ts are usually involv$4 ,! affect$ jo9ts sl[ly enl>ge & are pa9ful & r$4 ,usually ! h& is fir/ affect$2 !n ! wri/s1 knees1 toes1 jaws & sp9e2 9 extreme cases e jo9t is affect$4 ,! v]tebr1 spondylitis de=mans1 may be attack$4 ,! c]vical sp9e may be alone involv$1 9 :i* case ! head _c be mov$ up or d[n1 al?\gh rotation usually rema9s4 ,9 "s in/ances ! entire sp9al column is affect$ & may become p]fectly rigid4 ,9 "s cases !re is h>dly if any pa91 :ile 9 o!rs ! pa9 is agoniz+ & is almo/ con/ant4 ,! jo9ts gradually become de=m$1 /iff & creak :5 mov$2 lat] !y become completely ankylos$4 ,?is de=mity is due p>tly to ! ?ick5+ ( ! capsule1 to ! pres5ce ( o/eophytes1 & to ! contraction ( ! muscles4 ,^! contractures flex ! leg ^u ! ?igh & ! ?igh ^u ! abdom54 ,muscul> atrophy increases ! de=mity4 ,numbness1 t+l+1 pigm5tation & gloss9ess ( ! sk91 & local sweat+ may be pres5t & are ( trophic orig94 ,! mono>?ritic =m affects old p]sons *iefly1 & wom5 m frequ5tly ?an m54 ,x affects p>ticul>ly ! hips1 ! knees1 ! %\ld]s1 & ! v]tebral articulations4 ,?is is (t5 caus$ by an injury4 ,! muscles wa/e away & ! knee-j]k is usually increas$ ^u ! affect$ side4 ,diagnosis4--,c>e has to be tak5 9 n confus+ x ) rheumatic fev] or g\t4 ,radiographs %\ld be made4 ,prognosis4--,if treat$ e>ly !re is a fair *ance = cur+ ! disease4 ,advanc$ cases usually improve "u treatm5t4 ,! o/eopa?ic treatm5t %\ld be p]si/5t = at lea/ sev]al mon?s4 ,treatm5t4--,o/eopa?ic treatm5t1 if long cont9u$ 9 rheumatoid ar?ritis1 has giv5 satisfactory results1 al?\gh ow+ to ! ext5t ( ! de=mity1 a cure 9 advanc$ cases _c be expect$4 ,an important cause ( ! disease is probably a trophic or vasomotor di/urbance to ! tissues ( ! jo9t4 ,o/eopa?ically1 !re is nev] any difficulty to locate disord]s 9 ! sp9al column correspond+ to ! inn]vation ( ! involv$ jo9ts4 ,! fact t _m ( ! jo9ts are affect$ symmetrically indicates t ! lesion is a sp9al "o involv+ ! n]ve c5t]4 ,dur+ ! incipi5cy m>k$ improvem5t is ! rule4 ,a ?or\gh attempt %\ld be made 9 e case to discov] ! s\rce ( infection & remove x1 ?\gh ?is does n preclude ! ess5tial o/eopa?ic adju/m5t4 ,! treatm5t consi/s ( attempts to correct ! sp9al d]angem5t & c>eful manipulation ( ! diseas$ jo9ts to re/ore vitality & motion 9 !m4 ,! prec$+ simple1 b effective treatm5t1 mu/ be cont9u$ two or ?ree times p] week = mon?s or ev5 ye>s 9 ord] to be ( p>ticul> value4 ,c\pl$ ) ! specific treatm5t %\ld be a c>eful consid]ation ( ! g5]al heal?4 ,! emunctories %\ld be kept active & ! food ( ! pati5t be nutriti\s4 ,! o/eopa? %\ld require ! pati5t to take consid]able physical ex]cise at regul> int]vals1 w>m ba?s & pl5ty ( fre% air4 ,massage & friction ( ! diseas$ jo9ts w be ( aid 9 absorb+ effusions & 9 re/or+ ! tone ( atrophi$ muscles4 ,hot compresses are a help4 ,! ba?s at v>i\s hot spr+s are sometimes ( b5efit1 & *ange ( climate is invigorat+4 ,o4 ,j4 ,snyd]#fi has ?is to say3 8,i mu/ be v emphatic1 h[ev]1 to "h advise exceptional caution 9 y\r manipulative proc$ure4 99 99 99 ,y _c attempt to move ! jo9t1 =1 if y d y w cause excruciat+ pa9 & d irrep>able h>m 9 t y w cause break+ d[n ( ! c>tilage & cancell\s bone tissue4 ,y\r fir/ endeavor %\ld be to r$uce inflammation & to mitigate pa94 99 99 99 ,o/eopa?ically mu* com=t & r$uction ( pa9 c be accompli%$ by inhibition 9 ! prop] sp9al areas4 ,a little friction & v g5tle ext5sion or traction ( ! jo9t c be attempt$ z soon z ! condition ( ! jo9t1 by ! =ego+ treatm5t1 has be5 made possible4 ,at no "t %\ld rotation or sideb5d+1 or any o!r manipulation t produces irritation ( tissue be attempt$40 ,9 /\t adult wom5 a vill\s ar?ritis ( ! knees may develop ow+ to faulty po/ure & poor elim9ation4 ,^! conditions are (t5 am5able to treatm5t4 ,muscul> ,rheumatism ,def9ition4--,a pa9ful disease ( ! volunt>y muscles & ( _! fascia & ! p]io/eum4 ,x is reg>d$ by _m z a neuralgia ( ^! muscles4 ,! pa9 is greatly increas$ by motion & pressure4 ,o/eopa?ic ,etiology & ,pa?ology4--,o/eopa?ic exp]i5ce ) cases ( muscul> rheumatism %[s t ! n]ves1 z !y pass to & f ! sp9al muscles1 are affect$4 ,! lesion is caus$1 pr9cipally1 by subdislocations ( ! v]tebr1 ribs or pelvis1 accord+ to ! region involv$4 ,a g\ty or rheumatic dia!sis1 h]$ity1 exposure to cold & wet & previ\s attacks are pr$ispos+ causes4 ,m5 are m (t5 affect$1 ow+ to _! m frequ5t exposure4 ,! disease affects p]sons ( all ages4 ,x occurs 9 acute1 subacute & *ronic =ms4 ,9 cases ( frequ5t recurr5ce focal infections & inte/9al tox9s are (t5 important factors4 ,v]tebral & muscul> lesions1 septic foci1 inte/9al /asis1 exposure to cold & drafts are pr9cipal causes4 ,pa?ologically1 !re is swell+ ( ! muscles ( ! nature ( myositis4 ,9 *ronic cases !re is (t5 atrophy ( ! muscles1 due to int]f]5ce ( ! trophic n]ves4 ,symptoms4--,^! are g5]ally local & are nev] accompani$ by m>k$ con/itutional di/urbances4 ,!re is seldom fev]1 & ! pulse is only slightly increas$ 9 frequ5cy4 ,pa9 is ! *ief symptom2 x is increas$ by motion or pressure4 ,t5d]ness is g5]ally pres5t & !re may be swell+ ( ! tissues4 ,rheumatic nodules h be5 f\nd4 ,! duration is usually ?ree or f\r days1 ?\gh x may la/ long] ) frequ5t recurr5ces4 ,lumbago is a pa9ful affection ( ! muscles ( ! lumb> area & _! t5d9\s atta*m5ts4 ,! onset is g5]ally sudd54 ,9 sev]e cases x sometimes r5d]s ! pati5t helpless4 ,9 torticollis1 or /iff neck1 ! muscles ( ! side & back ( ! neck are affect$4 ,x is usually conf9$ to "o side ( ! head4 ,any attempt to turn ! head causes a %>p pa94 ,9 pleurodynia ! int]co/al muscles1 & sometimes ! pectorals & s]ratus magnus1 are affect$4 ,x usually affects b "o side1 m frequ5tly ! left2 x is ! mo/ pa9ful =m ( ! disease1 s9ce ! pa9 is aggravat$ by brea?+4 ,! respiratory movem5ts are consequ5tly re/rict$ on ! affect$ side4 ,! abs5ce ( fev] & physical signs w di/+ui% x f pleurisy4 ,9 int]co/al neuralgia ! pa9 foll[s ! di/ribution ( ! n]ves & !re are t5d] spots along _! c\rses4 ,cephalodynia affects ! muscles ( ! scalp4 ,scapulodynia1 omodynia & dorsodynia affect ! muscles ( ! %\ld] & upp] dorsal4 ,abdom9al rheumatism affects ! muscles ( ! abdom54 ,prognosis4--,! prognosis is good4 ,favorable results are ! g5]al rule "u c>eful treatm5t4 ,treatm5t4--,muscul> rheumatism is usually an easy affection to cure4 ,! cause ( ! di/urbance is g5]ally f\nd 9 ! region involv$1 & is due1 9 ! majority ( cases1 to "s dislocat$ tissue1 usually osse\s1 t irritates ! n]ves to ! muscles4 ,9 addition to correct+ ! lesions1 removal ( septic foci1 free elim9ation1 less5$ diet1 /ret*+ ( ! muscles1 application ( heat1 iron+ & re/ are b5eficial4 ,9 lumbago !re is inv>iably f\nd a slight lat]al deviation ( "s v]tebr along ! l[] dorsal or lumb> region4 ,occasionally de=mity ( ! v]tebr1 asymmetry1 or ar?ritis are factors4 ,! radiograph may be a diagno/ic aid4 ,occasionally1 a float+ rib or an innom9ate becomes displac$4 ,/ret*+ ! lo9s by plac+ ! pati5t ^u 8 side or back & flex+ ! ?ighs on ! abdom5 is v b5eficial4 ,ma9ta9 ! t5sion = ?ree or f\r m9utes4 ,hot fom5tations & re/ are helpful4 ,torticollis1 or /iff neck1 is g5]ally due to a lesion ( ! middle c]vical v]tebr4 ,! lesion is usually betwe5 ! ?ird1 f\r? & fif? v]tebr1 occasionally z l[ z ! second dorsal4 ,a r$uction ( ! subdislocation w (t5 relieve ! attack4 ,/ret*+ ( ! muscle & application ( heat w also be ( aid4 ,9 "s cases ( torticollis 7*ronic7 !re is a curvature ( ! c]vical sp9e1 & occasionally ! muscles are m or less fibr9\s4 ,surgical measures may be in/itut$4 ,9 su* in/ances a cure _c always be accompli%$4 ,! tonsils1 nose & tee? %\ld be exam9$ = s\rces ( infection4 ,a few cases ( acute torticollis are caus$ by "s ( ! deep muscul> fibres becom+ caught ar\nd a process ( a v]tebra4 ,sev]e contraction ( ! muscles by cold or ext5sive rot>y flexions ( ! neck1 may result 9 torticollis4 ,occasionally a case is f\nd due to injury at bir?4 ,! c]vical v]tebr %\ld be c>efully exam9$4 ,! sp9al accessory is ! n]ve g5]ally involv$4 ,lesions to ! sp9al accessory occur commonly at ! ?ird1 f\r? & fif? c]vicals1 or ! atlas & axis4 ,! muscles involv$ 9 torticollis are ! /]nocleidoma/oid1 trapezius1 spl5ius & scal5i4 ,op]ations %\ld n be p]=m$ until a ?or\gh c\rse ( treatm5t has fail$ to relieve4 ,pleurodynia is (t5 a neuralgia ( ! pleural n]ves4 ,x is usually caus$ by subdislocations ( ! ribs exactly ov] ! regions involv$4 ,occasionally1 a lesion may exi/ to ! correspond+ v]tebra1 b r>ely4 ,! rib is at times completely dislocat$4 ,applications ( heat & re/ ( ! "p are ( aid4 ,/rapp+ ( ! region w give consid]able relief4 ,9 cephalodynia ! muscles ( ! scalp are g5]ally involv$ by lesions 9 ! upp] five c]vical v]tebr4 ,9 scapulodynia1 omodynia & dorsodynia ! muscles ( ! %\ld] are usually affect$ by displacem5ts ( ! second & ?ird ribs1 al?\gh ! lesion may be f\nd slightly l[] 9 ! ribs1 or 9 ! correspond+ v]tebr4 ,! l[] c]vical v]tebr may also be at fault4 ,9 recurr+ & *ronic cases c>efully exam9e = infecti\s s\rces4 ,dislocations ( ! %\ld] occur frequ5tly2 & muscul> fibres may slip out ( ! bicipital groove 7r>ely74 ,9 a few cases muscles may become contract$ ab\t ! coracoid process1 or ! acromial end ( ! clavicle may become dislocat$4 ,abdom9al rheumatism is g5]ally caus$ by lesions 9 ! l[] six dorsal v]tebr1 :i* involve ! inn]vation to ! muscles4 ,9 "s cases lesions ( ! l[] ribs are f\nd1 & 9 a few in/ances a lesion may be disc]n$ 9 ! upp] lumb> v]tebr4 ,myalgia ( ! upp] extremity is caus$ by lesions ( ! c]vical or upp] dorsal v]tebr or upp] ribs4 ,occasionally "s tr\ble may be f\nd 9 ! %\ld] or elb[ jo9ts4 ,9 ! l[] extremity lesions may be f\nd 9 ! l[] dorsal or lumb> v]tebr1 or !re may be d]angem5ts ( ! pelvic bones4 ,occasionally disord] is f\nd at ! hip & knee jo9ts4 ,g\t ,def9ition4--,a nutritional disord] 9 :i* !re is an abnormal accumulation ( uric acid & o!r pur9 bodies 9 ! blood & tissues2 & ar?ritis1 de=mity ( jo9ts & visc]al d]angem5ts be+ ! *>act]i/ic features4 ,o/eopa?ic ,etiology & ,pa?ology4--,h]$it>y influ5ces are ! pr$ispos+ factors ( ab\t "o-half ( ! cases ( g\t4 ,m5 are m frequ5tly affect$ ?an wom54 ,x r>ely develops be=e ! age ( ?irty4 ,ov]eat+1 s$5t>y habits1 dr9k+ alcohol1 especially f]m5t$ dr9ks1 & lead poison+ are pr$ispos+ factors4 ,emotional di/urbances may excite an attack4 ,g\t is n conf9$ to ! ri* by any means2 b !re is also a 8poor-man's g\t10 due to poor food1 unhygi5ic surr\nd+s1 & to an excessive use ( malt liquors4 ,uric acid seems to be a causative factor1 b :e!r !re is an increas$ =mation or a dim9i%$ excretion ( ! uric acid has n yet be5 fully decid$4 ,! ultimate result is ! same 9 ei!r case2 !re is an accumulation ( uric acid & o!r pur9 bodies 9 ! blood1 :i* is responsible = "s ( ! effects ( ! disease4 ,o/eopa?ic exp]i5ce ) cases ( g\t %[s t lesions affect+ ! n]v\s sy/em are important factors t control uric acid accumulation or excretion4 ,! n]ve c5t]s controll+ ! affect$ portions ( ! body are almo/ inv>iably involv$1 z well z ! n]ve control to ! dige/ive & excretory organs4 ,a neurosis ( ^! n]ve c5t]s probably occurs & is ?us a pr$ispos+ cause ( g\t4 ,consid]able c be accompli%$ 9 ! treatm5t ( g\t by c>eful exam9ation ( ! sp9al column1 9 ! region correspond+ to ! inn]vation ( ! affect$ area1 = v]tebral lesions1 & correct+ !m4 ,usually1 slight dislocations ( ! bones ( ! foot are f\nd1 :5 t region ( ! body is involv$4 ,! mo/ common subdislocations ( ! foot are involvem5ts ( ! a/ragalus ) its articulations & ! metat>sals4 ,pa?ological *anges are ^? ( ! jo9ts pr9cipally4 ,!re is deposit ( uric acid 9 c>tilages1 synovial membranes & ligam5ts4 ,! jo9t ( ! great toe is mo/ frequ5tly affect$1 !n ! f+]s1 ankles1 knees1 h&s & wri/s4 ,! exudates become h>d & are !n call$ tophi4 ,9 sev]e cases ! c>tilages ( ! e>s1 nose1 eyelids & l>ynx are involv$4 ,f9ally ! jo9ts become /iff1 de=m$ & ankylos$1 & sometimes !re is ulc]ation4 ,! kidneys are usually ! seat ( *ronic int]/itial inflammation ) a deposit ( urates4 ,! he>t & blood-vessels almo/ always pres5t *anges4 ,art]ial scl]osis is q a con/ant lesion2 ! left v5tricle ( ! he>t is hyp]trophi$4 ,urate ( sodium has be5 f\nd deposit$ ^u ! valves4 ,!re is an excess ( uric acid 9 ! blood4 ,*ronic bron*itis1 emphysema & a/hma are among ! *anges 9 ! respiratory sy/em4 ,symptoms4--,9 acute g\t1 be=e ! attack1 ! pati5t may compla9 ( dyspeptic disord]1 re/lessness & tw+es ( pa9 9 ! small jo9ts4 ,he is apt to h irritability ( temp] & depression ( spirits4 ,! fir/ symptom ( ! attack is great pa9 9 ! metat>so-phalangeal jo9t ( ! great toe1 :i* usually comes on sudd5ly at night ) swell+1 heat & discoloration ( ! jo9t4 ,! temp]ature rises to #ajb & #ajc degrees ,f4 ,t[>ds morn+ ! symptoms g5]ally abate to recur aga9 ! next night4 ,?is la/s = sev]al days1 ! symptoms gradually abat+4 ,! ur9e is scanty1 high color$1 ( high specific gravity & acid 9 reaction4 ,x deposits urates & (t5 conta9s a small quantity ( album94 ,!re may be ga/ro-inte/9al symptoms--pa91 vomit+1 di>rhea1 fa9tness & a rapid1 feeble pulse4 ,ph>yngitis is an occasional symptom4 ,! c>diac symptoms are pa91 %ortness ( brea? & irregul> action ( ! he>t4 ,^! attacks may appe> ) v>y+ sev]ity4 ,9 "s cases !re may be sev]e c]ebral symptoms4 ,*ronic g\t foll[s repeat$ attacks ( ! acute =m4 ,! articul> symptoms cont9ue = a long] "t & ! condition ext5ds to o!r jo9ts4 ,! *alk deposits sl[ly increase until ! jo9t becomes swoll5 & de=m$4 ,! morbid *anges already describ$ are *>act]i/ic4 ,! ur9e is increas$ 9 quantity1 is ( l[ specific gravity & may conta9 album9 & hyal9 & granul> ca/s4 ,involvem5t ( ! he>t & blood-vessels gradually occurs4 ,irregul> g\t or li!mia is se5 9 p]sons :o h be5 g\ty or h a h]$it>y pr$isposition4 ,x includes a set ( symptoms t are n alone di/9ctive1 b :5 tak5 ) ?is g\ty t5d5cy1 all =ms ( irregul> g\t c be recogniz$4 ,!re are v>i\s ga/ro-inte/9al di/urbances2 cutane\s eruptions2 he>t & blood vessel *anges2 pa9s 9 ! v>i\s muscles & jo9ts2 n]v\s symptoms1 z heada*e1 neuralgia & neuritis2 ur9>y symptoms1 & pulmon>y & ocul> disord]s4 ,diagnosis4--,only ! irregul> =m ( g\t %\ld be difficult to diagnose4 ,diff]5tiation is to be made f ar?ritis de=mans & acute & *ronic rheumatism4 ,treatm5t4--,! hygi5ic treatm5t ( g\t is v ess5tial4 ,! pati5t %\ld live a quiet life1 avoid+ m5tal & physical /ra9s4 ,pl5ty ( fre% air1 ex]cise & regul> h\rs %\ld be insi/$ ^u4 ,alcoholic dr9k+ %\ld be avoid$ & ! food tak5 9 mod]ate quantities4 ,keep+ ! sk9 active by ! use ( cold ba?s1 if ! pati5t is /rong1 & w>m ba?s %\ld he be weak1 is a helpful measure4 ,! dress ( ! pati5t %\ld be w>m & suitable = ! climate4 ,a regulat$ diet ( nutriti\s food1 tak5 at regul> h\rs1 is necess>y4 ,ea* pati5t %\ld receive sep>ate in/ructions z to diet4 ,! food giv5 may be small am\nts ( beef1 mutton & *ick51 ) fre% vegetables2 ) ! exception ( /rawb]ries1 tomatoes & bananas1 fruits may be us$2 fats1 milk & /ale bread are also suitable4 ,! pati5t %\ld avoid tea1 c(fee1 pa/ry1 hot breads1 highly season$ di%es1 & su* articles4 ,! free use ( wat] is b5eficial4 ,! o/eopa?ic treatm5t consi/s ( c>eful correction ( ! lesions ( ! sp9al column 9 ord] to free ! n]ve =ce to ! affect$ region4 ,! sp9al treatm5t 9 g\t is ! mo/ ess5tial treatm5t & is effective4 ,a mo/ ?or\gh exam9ation %\ld be made ( ! tissues ab\t ! diseas$ area2 9 ! foot ! a/ragalus (t5times is subdislocat$ f its articulations1 caus+ ob/ructions to ! local vessels & n]ves4 ,! metat>sal bones %\ld receive due att5tion1 z occasionally "o ( ! bones correspond+ to ! affect$ tissues is dislocat$1 usually d[nw>d4 ,all ! jo9ts betwe5 ! diseas$ tissues & ! sp9al n]ve c5t]s %\ld be c>efully manipulat$ s z to favor a bett] circulation4 ,dur+ a sev]e attack ( g\t1 besides c>eful treatm5t ( ! blood supply to ! diseas$ region1 wrapp+ ! jo9t 9 cotton wool & apply+ w>m? & moi/ure to ! jo9t may be helpful4 ,! kidneys1 liv] & b[els are to be kept active4 ,a light treatm5t to ! kidneys & liv] ea* "t is v helpful 9 aid+ ! organs to elim9ate ! wa/e mat]ial1 & especially 9 controll+ any inflammation t may exi/ 9 ! kidney4 ,! ess5tial treatm5t 9 g\t is to relieve ! disord] ( ! n]ve c5t]s1 to increase ! activities ( ! emunctories & to regulate ! hygi5e ( ! pati5t4 ,diabetes ,mellitus ,def9ition4--,a nutritional disord] 9 :i* !re is an abnormal am\nt ( sug> 9 ! blood1 *>act]iz$ by an excessive ur9>y dis*>ge1 9 :i* grape sug> is con/antly pres5t1 & by a progressive loss ( fle% & /r5g?4 ,o/eopa?ic ,etiology & ,pa?ology4--,almo/ inv>iably !re w be f\nd a po/]ior dorso-lumb> curvature :]e9 ! sp9al column tissues are mu* contractur$4 ,?is condition probably involves ! sympa!tics 7vasomotor & trophic7 to ! pancreas1 liv] & inte/9es4 ,important lesions may also be f\nd z high z ! occiput4 ,t5d]ness & conge/ion ov] ! abdom51 especially ! liv]1 are frequ5t4 ,x affects m5 m frequ5tly ?an wom5 & is a disease ( adult life1 rang+ betwe5 ! ages ( ?irty & sixty1 ?\gh cases h occurr$ 9 ! v "y4 ,x is m s]i\s 9 ! "y1 ! v "y seldom recov]+4 ,h]$it>y influ5ces are believ$ to be a pr$ispos+ cause4 ,x affects ! bett] classes pr9cipally & especially ^? ( a neurotic temp]am5t4 ,! ,hebrew race is specially pr$ispos$4 ,! color$ race is seldom affect$4 ,obesity1 c]ta9 *ronic diseases 7mal>ia1 g\t1 syphilis71 occupations tax+ ! m9d1 & pregnancy are pr$ispos+ influ5ces4 ,injury or disease ( ! sp9al cord or bra9 frequ5tly cause diabetes1 especially any irritation ( ,b]n>d's diabetic c5t] 9 ! m$ulla4 ,d]angem5ts ( ! endocr9e sy/em are important4 ,injuries to ! sp9e1 *iefly 9 ! dorso-lumb> & sacral regions1 & to ! abdom51 & diseases ( ! pancreas or liv] are1 z has be5 /at$1 (t5times causes4 ,lesions to ! sp9e may di/urb ! glycog5ic function ( ! liv]1 ! glycolytic f]m5t ( ! pancreas1 or produce an alim5t>y glycosuria4 ,extirpation ( ! pancreas is imm$iately foll[$ by diabetes1 b if a fragm5t ( ! pancreas is left x is n always foll[$ by diabetes4 ,! normal am\nt ( sug> 9 ! blood is #a-ajjj :ile 9 diabetes ! am\nt ( sug> is #c to #d-ajjj up to #g or #h-ajjj4 ,! heal?y kidney w n excrete sug> :5 x is at ! normal ratio4 ,conc]n+ ! pres5ce ( acetone-bodies von ,noord5#gj says3 8,! excretion ( acetone-bodies may s]ve1 l glycosuria1 z a measure ( ! int5sity ( ! diabetic disease 444 x w be at once und]/ood t 9 no o!r disease d ! acetone-bodies occupy s important a position z 9 diabetes40 ,irritation ( ! c5t]s ( ! vasomotor n]ves to ! liv] or direct /imulus to ! liv] cells is foll[$ by glycosuria4 ,int]f]5ce ) ! pneumoga/ric n]ve also influ5ces diabetes4 ,pa?ologically1 ! liv] is enl>g$1 firm] & d>k] 9 color ?an normal4 ,(t5 !re is fatty deg5]ation ( ! organ4 ,! pancreas is diseas$ 9 ab\t "o-half ( ! cases ( diabetes1 especially ! isl&s ( ,lang]hans4 ,! lesions f\nd are granul> atrophy1 occlusion ( ! pancreatic duct1 atrophy f pressure1 fat necrosis1 & sometimes x is small1 s(t & anemic4 ,! kidney *anges are ^? ( cat>rhal nephritis4 ,9 ! fatty deg5]ation hyal9 *anges take place4 ,! he>t is hyp]trophi$ 9 a few cases4 ,art]ial scl]osis is frequ5tly met )4 ,9 ! lungs bron*itis1 pneumonia & tub]culosis occasionally develop4 ,9 ! /oma* & inte/9es cat>rh is common4 ,! blood pres5ts an increase ( sug>4 ,9 ! n]v\s sy/em are f\nd _m lesions1 especially conge/ion1 extravasation & scl]osis ( ! bra92 di/urbances ( ! po/]ior "p ( ! cord1 & conge/ion & scl]osis ( ! sympa!tic ganglia4 ,! bony lesions1 h[ev]1 7almo/ inv>iably a po/]ior l[] dorsal & lumb>7 mu/ involve ! sympa!tics1 via ! splan*nics1 to ! ext5t ( pr(\nd metabolic di/urbance1 = 9 no o!r way c ! results ( o/eopa?y be expla9$4 ,! importance ( specific treatm5t at ?is po9t _c be ov] e/imat$4 ,symptoms4--,! onset is gradual2 ?ir/ & frequ5t micturition be+ ! fir/ symptoms notic$4 ,aft] an injury or a sudd51 sev]e n]v\s %ock1 diabetes may set 9 abruptly4 ,z ! disease progresses !re w be m>k$ ?ir/1 polyuria1 an abnormal appetite1 wa/+ & debility4 ,! tongue is dry1 r$ & coat$4 ,!re is con/ipation & ! sk9 is dry & h>%4 ,temp]ature is (t5 subnormal2 pulse frequ5t ) increas$ t5sion4 ,9 "s cases ! ur9e is n increas$ 9 quantity2 usually h[ev]1 ! am\nt v>ies f f\r to five p9ts to sev]al qu>ts 9 tw5ty-f\r h\rs4 ,x is pale 9 color1 ( high specific gravity & acid reaction4 ,sug> is pres5t 9 v>iable quantities f "o or two p] c5t to five or t5 p] c5t4 ,sug> 9 ! ur9e mu/ be con/ant 9 ord] t ! affection is a true diabetic "o4 ,album9 is (t5 pres5t2 urea is increas$ & uric acid may be slightly increas$4 ,acetone-bodies are (t5 f\nd & usually indicate a m s]i\s condition4 ,diabetic ,coma is ! mo/ important & grave/ complication4 ,!re is ei!r a sudd5 or gradual loss ( consci\sness4 ,?is may occur aft] "s =m ( exhau/+ ex]cise4 ,!re may be previ\s heada*e or a feel+ ( intoxication4 ,x may be prec$$ by nausea1 vomit+1 colicky pa9s or "s local affections1 su* z ph>yngitis or pulmon>y complications4 ,p]iph]al neuritis1 neuralgia1 numbness1 are possible symptoms4 ,impairm5t ( he>+1 cat>acts1 /rabismus1 diabetic ret9itis & atrophy ( ! optic n]ve may occur4 ,! sexual function is lo/ e>ly 9 ! disease4 ,eczema1 ) burn+ & it*+ ( ! labia & vic9ity1 7& 9 m5 a balanitis71 furuncles1 boils & c>buncles are common4 ,gangr5e & edema are n uncommon4 ,acute pneumonia1 bron*itis & tub]culosis are possible complications4 ,progressive loss ( fle% is a s]i\s indication4 ,diagnosis4--,! diagnosis is easy1 z !re is no o!r disease ) :i* x c be conf\nd$4 ,c>eful ur9alysis %\ld always be made4 ,exam9ation = acetone1 diacetic acid & oxybutyric acid is valuable4 ,prognosis4--,_m cases h be5 cur$ by o/eopa?ic measures :ile ne>ly all treat$ h be5 b5efit$4 ,if ! pati5t is put ^u a diet free f c>bohydrates1 9 mild cases ! sug> w disappe>1 :ile 9 sev]e cases x w /ill be pres5t4 ,mild cases usually yield readily to treatm5t4 ,9 cases ov] =ty ye>s ( age ! outlook is q favorable1 b 9 cases "u =ty1 & especially ! "y1 ! prognosis is n s favorable4 ,9 cases "u pub]ty ! results are apt to be fatal4 ,/\t p]sons be> diabetes bett] ?an lean4 ,all cases are liable to complications1 :i* r5d] ! prognosis m s]i\s4 ,x is a disease ( long duration1 al?\gh dea? has occurr$ 9 a few weeks4 ,treatm5t4--,9 ne>ly all cases ( diabetes mellitus exam9$ !re h be5 f\nd po/]ior conditions ( ! l[] dorsal & lumb> regions4 ,! po/]ior curve has always be5 fairly well m>k$ & g5]ally is a symmetrical curve4 ,by t is meant a sp9al curve t is n irregul> & ! relation ( ! v>i\s v]tebr1 "o to ! o!r1 is n s]i\sly d]ang$4 ,correction ( ?is condition ( ! sp9al column has almo/ inv>iably giv5 satisfactory results & 9 ! majority ( cases ! condition ( ! pati5t has improv$ rem>kably1 & _m entirely cur$4 ,to get ! be/ results ! pati5t %\ld be laid on 8 side on ! op]at+ table & ! knees drawn up s t ! ?ighs are flex$ ^u ! abdom54 ,! o/eopa? /&+ 9 front ( ! pati5t ?r[s 8 weight aga9/ ! flex$ ?ighs & rea*+ ov] ^u ! sp9al column spr+s ! entire weak5$ portion ( ! sp9e t[>d its normal position1 /ret*+ ! sp9al column to sep>ate ea* v]tebra f its neighbor s t ! d]ang$ n]ves1 z !y pass ?r\gh ! int]v]tebral =am9a1 may be releas$4 ,meek]#ga reports a case ) a m>k$ kyphosis :i* 0 treat$ two ye>s be=e en\gh motion c\ld be _h betwe5 ! v]tebr to produce any results1 b aft] t !y 7 favorable4 ,direct treatm5t to ! abdom9al organs to correct liv] conge/ion & /imulate ! pancreas & increase activity ( ! inte/9es is ess5tial4 ,! n]ves affect$ by ! po/]ior pa?ological curve ( ! sp9e1 m5tion$ above1 & by sep>ate lesions t may exi/ )9 ! pa?ological curvature1 are probably ! vasomotor n]ves to ! portal sy/em1 pancreas & ! inte/9es4 ,! vasomotor n]ves to ! portal sy/em bran*es are giv5 (f pr9cipally f ! fif? to ! n9? dorsal v]tebr1 al?\gh fibres may escape f ! cord z l[ z ! fir/ lumb> v]tebra4 ,! n]ves to ! inte/9es are giv5 (f pr9cipally f ab\t ! n9? dorsal to ! l[] lumb> v]tebr4 ,possibly !re are n]ve fibres direct to ! hepatic cell protoplasm4 ,h[ lesions 9 ! dorso-lumb> region cause diabetes mellitus is an important "q & is h>d to answ]4 ,an unnatural accel]ation ( ! portal circulation may cause an increas$ quantity ( sug> to pass to ! liv]1 result+ 9 "p ( ! sug> n be+ *ang$ into glycog5 & ?us pass+ into ! circulation2 or a p>alysis ( ! vasomotor n]ves to ! liv] causes conge/ion & sl[ness ( ! blood /ream4 ,?us a di/urb$ circulation ( ! liv] may cause accumulation ( sug> 9 ! liv]1 s t ! blood f]m5t has "t to act ^u ! glycog5 & trans=m x into sug>2 or !re may be a sac*>9ity ( *yle or blood 9 ! portal ve91 due to an imp$$ conv]sion ( sug> 9 ! inte/9es into lactic acid2 or !re may be an accel]at$ absorption ( sug> due to an abnormal /ate ( ! inte/9es2 or ! n]v\s control to ! pancreatic functions may be di/urb$4 ,h5ce1 "o or _m pa?ological *anges may occur & influ5ce a case ( diabetes1 due to a disord]$ dorso-lumb> region4 ,! c5t] = ! hepatic vasomotor n]ves1 8diabetic c5t]10 is 9 ! floor ( ! f\r? v5tricle at ! level ( ! orig9 ( ! vagi n]ves4 ,a lesion ( ! 8diabetic c5t]0 or an ob/ruction to ! pneumoga/ric any:]e along its c\rse may cause diabetic symptoms2 h5ce1 !re may be lesions ( ! c]vical region t w\ld affect reflexly ! diabetic c5t]1 or lesions ( ! pneumoga/ric may occur1 p>ticul>ly at ! atlas or axis1 & cause diabetic symptoms1 or1 at lea/1 ^! may influ5ce ! c\rse ( a case ( diabetes mellitus4 ,or ! upp] c]vical lesions may di/urb ! pituit>y gl& :i* is ( importance 9 c>bohydrate metabolism4 ,!re are n]ves f ! sup]ior & inf]ior c]vical ganglia ( ! sympa!tic t h consid]able influ5ce ^u ! liv]4 ,^! n]ves d n pass d[n ! cord to ! splan*nics1 b pass 9 ! sympa!tic to ! celiac & hepatic plexuses & !n to ! liv]4 ,/imulation ( ^! n]ves causes ! hepatic vessels at ! p]iph]y ( ! liv] lobules to become contract$4 ,possibly 9 a v few cases1 a /agnation ( blood 9 o!r vascul> regions ( ! body may cause ! blood f]m5t to accumulate 9 ! blood to su* an ext5t t diabetic symptoms occur4 ,dietetic treatm5t is ess5tial1 b is n s necess>y z "s m$ical au?ors w\ld h u believe4 ,a regulat$ diet %\ld be insi/$ ^u 9 all cases1 b "o %\ld n g to extremes 9 diet+4 ,a complete elim9ation ( ! c>bohydrates is no long] consid]$ ! be/ treatm5t1 z x )draws too important an elem5t f ! diet1 produc+ weakness )\t any correspond+ return = good4 ,a pati5t's appetite is (t5 inord9ate & x w be necess>y to regulate ! quantity & "* ( foods4 ,proctor#gb m5tions a case :i* recov]$ :5 c>bohydrates 7 re/or$1 z ! pati5t 0 too />v$ to build up4 ,"u o/eopa?ic treatm5t mu* m lib]ty c be all[$ 9 selection ( foods4 ,von ,noord5#gc report$ a numb] ( cases 9 :i* excretions ( sug> cont9u$ ^u ! /rict anti-diabetic diet1 b :i* 7 sug> free :5 !y receiv$ a l>ge am\nt ( oatmeal along ) "s vegetable proteid or :ite ( egg & butt]1 o!r c>bohydrates be+ exclud$4 ,x is sugge/$ by ! editor ( ! ,s]ies t ! oatmeal may be us$ alt]nately ) diabetic diet1 & relieve ! monotony greatly4 ,x c also be us$ z a te/ ( ! pati5t's dige/ive & sug> de/roy+ p[]s4 ,! foll[+ food may be includ$ 9 ! diet>y3 ,animal ,foods4--,meats ( e v>iety1 except liv]s2 game1 p\ltry1 fi% & eggs4 ,vegetables4--,cabbage1 caulifl[]1 cel]y1 lettuce1 gre5 /r+ beans1 ! gre5 ends ( asp>agus1 tomatoes1 sp9a*1 mu%rooms1 cucumb]s1 wat]cress1 "y onions1 or any o!r gre5 vegetable4 ,bread & ,cakes4--,made ( glut5 fl\r1 bran fl\r or almond fl\r2 griddle cakes1 biscuits1 porridges1 etc41 may be made ( ^! fl\rs4 ,bev]ages4--,skimm$ milk1 butt]milk1 c(fee & tea )\t sug>1 & c>bonat$ wat]4 ,reli%es4--,pickles1 cream *eese & nuts ( all k9ds except *e/nuts4 ,fruits4--,oranges1 lemons1 cranb]ries1 *]ries1 /rawb]ries1 all 9 mod]ate quantities4 ,o!r foods may be us$1 b ea* case requires a ?or\gh /udy 9 ord] to det]m9e :at is be/ to d4 ,v>i\s foods %\ld be te/$ out & controll$ by ur9alysis4 ,! po9t is to increase metabolism s t ! body c /ore up consid]able c>bohydrates )\t ! appe>ance ( sug> 9 ! ur9e4 ,9 sev]e cases ,all5's fa/+ treatm5t to be foll[$ by a l[ diet %\ld be in/itut$4 ,h[ev]1 x %\ld be rememb]$ t ! correction ( dorsal & upp] c]vical lesions is invaluable4 ,m5tal excitem5t & worry %\ld be avoid$ z mu* z possible4 ,frequ5t ba?+ & regulat$ ex]cise w be ( consid]able value4 ,! diabetic pati5t %\ld h a well v5tilat$ room & pl5ty ( re/ & sleep2 flannels are to be worn next to ! sk9 ! ye> ar\nd4 ,v>i\s symptoms & complications are liable to arise1 :i* ! compet5t o/eopa? is prep>$ to meet by foll[+ g5]al rules4 ,keep ! b[els op54 ,& frequ5tly exam9e = acetone & diacetic acid4 ,if !re are any symptoms ( coma fa/ ! pati5t1 & neutralize ! acid intoxication ) bic>bonate ( soda until ! ur9e is alkal9e4 ,diabetes ,insipidus 7,,polyuria74 ,def9ition4--,a con/itutional disord] 9 :i* !re is a cont9u$ excessive secretion ( ur9e1 free f album9 & sug>4 ,!re is con/ant ?ir/4 ,o/eopa?ic ,etiology & ,pa?ology4--,?is disease is m frequ5t 9 males ?an 9 females4 ,x occurs mo/ commonly betwe5 ! ages ( tw5ty & ?irty4 ,x is due to *ronic di/urbances ( ! n]ves4 ,! lesions usually f\nd ^u o/eopa?ic exam9ation are lat]al d]angem5ts ( ! v]tebr 9 ! r5al splan*nic region1 7n9? to twelf? dorsal inclusive7 or a slight kyphosis 9 ! same locality4 ,su* lesions probably affect ! c5tral n]v\s sy/em 9 ! region ( ! sympa!tic n]ves to ! kidneys1 by a p>alysis ( ! muscul> coat ( ! r5al vessels4 ,! disease may be associat$ ) o!r conditions1 z injuries & diseases ( ! n]v\s sy/em else:]e2 exposure to cold2 prolong$ debility & fatigue2 c]ebral diseases1 z m5+itis1 p>alysis ( ! six? n]ve1 tumor ( ! bra91 & bl[s on ! head2 injuries ( ! c]vical region2 sun/roke2 c]ebrosp9al fev]2 mal>ia2 syphilis2 pregnancy2 hy/]ia2 h]$it>y influ5ces1 & dr9k+ too freely ( cold wat]4 ,!re are _m diseases & conditions :i* may be associat$ ) diabetes insipidus2 & :i* act z irritants1 directly or reflexly1 ^u ! c5t] 9 ! m$ulla oblongata 7:i* is j above ! diabetic c5t]71 or ^u ! sympa!tic ganglia 9 ! abdom9al region4 ,?us1 !re is a vasomotor neurosis1 due ei!r to c5tral or reflex lesions4 ,second 9 importance to lesions ( ! r5al splan*nics are lesions ( ! upp] c]vical region4 ,irritations 9 ! c]vical region may act ^u ! c5t] 9 ! m$ulla or ! lesions may affect "s ( ! sympa!tic fibres z !y pass f ! bra9 to ! r5al sympa!tics4 ,! pituit>y gl& may be di/urb$4 ,probably axis & atlas lesions are factors4 ,lesions ( ! n]ve c5t]s & ( ! sympa!tic ganglia h be5 f\nd ^u po/-mortem exam9ation1 b !y are n con/ant4 ,n]v\s lesions h be5 f\nd 9 ! region ( ! base ( ! bra94 ,! kidneys are sometimes conge/$ & enl>g$4 ,! tubules may be dilat$4 ,symptoms4--,great ?ir/ & an enorm\s secretion ( ur9e ( a pale1 wat]y & slightly acid nature are ! *>act]i/ic symptoms4 ,! sk9 is usually dry & h>%1 ! b[els are con/ipat$1 & ! appetite may be voraci\s4 ,! heal? on ! :ole is q p]fect1 al?\gh if ! affection is n arre/$1 consid]able loss ( fle% & /r5g? may result4 ,!re is a t5d5cy = ! disease to become *ronic4 ,! n]v\s lesion caus+ polyuria may be ! outcome ( a debilitat$ condition ( long /&+ or ! symptoms may occur sudd5ly4 ,prec$+ ! l>ge fl[ ( ur9e su* symptoms z n]v\sness1 irritability1 heada*e1 sleeplessness1 failure ( memory1 & inability to conc5trate ! m9d commonly occur4 ,o!r symptoms may be pres5t 9 addition1 z debility1 di>rhea1 epiga/ric & lumb> pa9s1 & impair$ sexual function4 ,diagnosis4--,! diagnosis is n difficult4 ,?ir/1 polyuria & ! abs5ce ( album9 & sug> *>act]ize ! disease4 ,9 diabetes mellitus1 f9d+ ( grape sug> 9 ! ur9e w\ld at once exclude polyuria4 ,9 p>oxysmal diuresis1 ! increas$ am\nt ( ur9e is n p]man5t4 ,9 int]/itial nephritis1 !re is album91 ca/s1 etc4 ,prognosis4--,dep5ds ^u ! cause4 ,! disease yields to treatm5t mu* quick] ?an diabetes mellitus & is )\t d\bt mu* less s]i\s4 ,! disease1 9 a l>ge majority ( cases1 c be cur$4 ,"u o/eopa?ic treatm5t mo/ cases w yield good results or be cur$ 9 f a few weeks to six mon?s4 ,treatm5t4--,! treatm5t ( ! disease caus+ diabetes insipidus is ( fir/ consequ5ce1 b frequ5tly su* a disease is undiscov]able4 ,!re is (t5 a t5d5cy t[>d neura/h5ia2 consequ5tly1 habits1 environm5t1 etc41 %\ld be c>efully att5d$ to4 ,exam9e = sexual1 rectal & o!r reflex irritations4 ,correct+ lesions ( ! r5al splan*nics is important2 9 fact1 9 a fair numb] ( cases treatm5t ( ?is locality w entirely cure ! disease4 ,a v effective treatm5t1 9 addition to ! ord9>y me?ods ( treatm5t1 is to h ! pati5t lie flat ^u ! back :ile ! o/eopa? rea*es ar\nd ! pati5t on ei!r side1 plac+ ! f+]s firmly ^u ! transv]se processes ( ! l[] dorsal v]tebr & spr++ ! sp9e =w>d by lift+ upw>d on ! pati5t1 en\gh ev5 to raise ! pati5t f ! surface he is ly+ on4 ,?is treatm5t is especially effective 9 less5+ ! increas$ am\nt ( ur9e4 ,att5tion %\ld be giv5 to ! false ribs on ei!r side & to ! condition ( ! sp9e bel[ & above ! r5al splan*nics4 ,! c]vical v]tebr %\ld be exam9$ c>efully = disord]s1 & if any are f\nd !y %\ld be remov$ at once1 if possible4 ,hygi5ic treatm5t is ( z mu* importance z 9 diabetes mellitus4 ,! clo?+ %\ld be w>m1 w>m ba?s tak51 & g5]al friction & c>e ( ! sk9 utiliz$ s t ! circulation may be some:at div]t$ f ! kidneys4 ,re/riction ( wat] is n always necess>y1 except 9 cases :]e excessive dr9k+ has become a habit1 z ! ?ir/ is caus$ by ! diuresis & n ! diuresis by ! l>ge +e/ion ( wat]4 ,regulate ! diet & see t ! b[els are act+ normally4 ,rickets ,,ra*itis ,def9ition4--,a con/itutional disease ( *ildr51 *>act]iz$ by impair$ nutrition & *anges 9 ! gr[+ bones1 caus+ de=mities4 ,! physical gr[? is di/urb$ & ! bone de=mity is due to an ov] gr[? ( c>tilages & delay$ calcification4 ,etiology & ,pa?ology4--,rickets may occur 9 ! new-born1 b x r>ely beg9s be=e ! *ild is six mon?s old4 ,x is a disease ( ! fir/ & second ye>s ( life4 ,h]$ity is probably n a factor b c]ta9 races1 especially ! ,negro & ,italian1 h a t5d5cy to be rickety4 ,! disease is mu* m common 9 ! l>ge cities ?an 9 rural di/ricts2 also x is m common 9 ,europe ?an ,am]ica4 ,! disease is mo/ frequ5tly met ) among ! ill-f$ & badly h\s$ poor ( ! l>ge cities1 ?\gh x is n r>e to f9d x among ! well-to-d4 ,lesions to ! dige/ive organs pr$ispose4 ,brea/-f$ *ildr5 seldom h ! disord]4 ,improp] or insuffici5t food 7a diet too l[ 9 fats & prote9s7 bad air1 want ( sunlight1 prolong$ lactation1 exposure to cold & dampness are pr$ispos+ factors4 ,pa?ologically1 ! mo/ m>k$ *anges are se5 9 ! long bones & ! ribs4 ,! c>tilage betwe5 ! epiphysis & %aft is ?ick5$ & is s(t & irregul> 9 outl9e4 ,und]nea? ! p]io/eum ! tissue is spongy4 ,microscopic exam9ation %[s an increase ( prolif]ation ( ! c>tilage cells ) scanty calcification4 ,! bones are s(t & !re is a dim9ution 9 ! calc>e\s salts4 ,9 a ^w ossification is delay$ & ! bones are n p]fectly develop$4 ,9 ! cranium ! frontal & p>ietal em95ces are prom95t1 :ile ! top ( ! head & ! occiput are flatt5$1 giv+ ! head a squ>e appe>ance4 ,! fontanelles rema9 op5 until ! second or ?ird ye> ( life4 ,! ribs become affect$ v e>ly4 ,at ! po9t :]e ! ribs jo9 ! co/al c>tilages1 bulg+ occurs1 =m+ ! s-call$ 8ra*itic ros>y40 ,! normal %ape ( ! *e/ walls is m>k$ly *ang$4 ,j outside ! junction ( ! ribs ) ! c>tilages1 ! ribs fall 91 produc+ a %all[ depression1 :ile ! /]num & c>tilages are pu%$ =w>d4 ,! bones ( ! leg may be di/ort$4 ,! normal curves ( ! sp9e are occasionally di/urb$4 ,! liv] & sple5 are (t5 increas$ 9 size4 ,symptoms4--,! onset is sl[4 ,9 _m cases dige/ive di/urbances1 ) _! usual effect ^u ! nutrition1 prec$e ! appe>ance ( ! *>act]i/ic lesions4 ,! *ild is irritable & re/less1 & !re is usually slight fev] & pr(use sweats4 ,! *ild is (t5 languid1 pale & feeble4 ,! lymph gl& are enl>g$4 ,! tissues are s(t & flabby & skeletal *anges beg9 to make _! appe>ance4 ,among ! fir/ are *anges 9 ! ribs & head1 already describ$ "u pa?ology4 ,*anges sometimes occur 9 ! bones ( ! face1 p>ticul>ly ! maxill4 ,d5tition is delay$4 ,! sp9al column is frequ5tly curv$ ant]o-po/]iorly or lat]ally4 ,! long bones are curv$ & _! extremities become ?ick5$4 ,! pelvis is di/ort$ & twi/$ & 9 wom5 ?is may s]i\sly complicate labor4 8,*ick5 brea/0 & 8b[ legs0 are common1 z well z muscul> weakness1 & ! *ild walks late4 ,! abdom5 is l>ge & prom95t1 due to flatul5cy & to ! enl>gem5t ( ! liv] & sple54 ,diagnosis & ,prognosis4--,by obs]v+ ! symptoms1 diagnosis is n difficult4 ,prognosis %\ld be gu>d$1 ow+ to dang] f o!r diseases2 /ill1 on ! :ole1 prognosis is fairly favorable4 ,treatm5t4--,rickets be+ a disease ( malnutrition due to weakness ( ! dige/ive organs1 improp] food1 or to influ5ces ( disease1 ! treatm5t mu/ be pr9cipally foll[+ hygi5ic rules & good diet+4 ,! *ild "u six mon?s1 if n nurs$ satisfactorily by ! "m1 %\ld be giv5 dilut$ c['s milk4 ,salts may be obta9$ f b>ley gruel & :ole :eat4 ,dilut+ ! milk ) b>ley wat] is highly recomm5d$4 ,fre% meat juice & cream are invaluable4 ,if curds are f\nd 9 ! /ools1 ! dige/ion is n p]fect & is usually due to ov]fe$+ ! *ild4 ,! *ild %\ld be out doors z mu* z possible4 ,fre% air is a necessity4 ,! wor/ air outside is bett] ?an ! be/ air ( ! h\se z f> z purity is conc]n$4 ,protect ! *ild c>efully ) w>m clo!s1 & :5 sitt+ or walk+ ! *ild %\ld be support$4 ,ba?s w be f\nd b5eficial4 ,9 ! old] *ild1 beef juice1 light meats1 yolks ( eggs1 gre5 vegetables & fruits may be giv54 ,less5 ! am\nt ( c>bohydrates4 ,c>eful o/eopa?ic treatm5t ( ! v>i\s affect$ tissues ( ! *ild w aid a great deal 9 correct+ de=mities4 ,att5tion to ! lesions f\nd w also aid 9 increas+ ! nutrition to ! involv$ tissues z well z correct+ dige/ive di/urbances4 ,?is1 also1 is ( di/9ct b5efit 9 improv+ ! assimilation ( lime salts4 ,possibly treatm5t ( ! 8nutritional0 c5t]s1 7f\r? dorsal & f\r? lumb>7 w\ld be effectual4 ,c>efully gu>d aga9/ complications ( ! n]v\s & respiratory sy/ems4 ,aft] ossification ! de=mities may be correct$ by ! or?op$ic surgeon1 ?\gh 9 ! "y *ild consid]able c be accompli%$ by repeat$ attempts at /raight5+ by b5d+ & mold+ ! long bones4 ,all ^? conditions :i* pr$ispose to rickets %\ld receive att5tion2 *ief among ^! is ! c>e ( ! nutrition ( ! "m dur+ pregnancy4 ,nurs+ %\ld be regulat$1 & possibly future pregnancies disc\rag$4 ,obesity ,def9ition4--,obesity is ess5tially a nutritional disease & is an inconv5i5t accumulation ( adipose tissue 9 ! body1 sometimes impair+ ! bodily function4 ,) "s individuals obesity is a normal condition4 ,9 o!rs x means impair$ heal?1 especially poor elim9ation4 ,etiology & ,pa?ology4--,h]$ity1 ov]eat+1 s$5t>y habits1 hot1 moi/ climates are pr$ispos+ causes4 ,excit+ causes are especially ! eat+ ( fat-mak+ food1 excessive use ( alcohol & insuffici5t ex]cise4 ,obesity may foll[ ! m5opause or an infecti\s disease4 ,o/eopa?ic lesions are frequ5tly f\nd 9 ! upp] & middle dorsal region4 ,^! probably are causes ( a di/urb$ metabolism4 ,an excessive diet ( />*es & sug>s w indirectly act z a fat produc]4 ,9 "y p ! possibility ( hypopituit>ism %\ld be consid]$4 ,lesions ( ! upp] c]vical1 9 ^! cases1 are frequ5t4 ,pa?ologically1 adipose tissue is deposit$ ?r\gh\t mo/ ( ! tissues4 ,usually ! abdom5 is encumb]$ ) a l>ge am\nt4 ,passive conge/ion probably favors ! deposition ( fat1 = 9 cases ( p5dul\s abdom51 simply draw+ ! abdom5 9 & up & ! pati5t1 ?r\gh volunt>y ef=t1 keep+ x up1 w frequ5tly cause absorption ( ! fat 9 a few days or weeks4 ,! fat is di/ribut$ und]nea? ! sk91 ?r\gh\t ! visc]a & ab\t ! he>t4 ,! tissues may suff] f fatty infiltration1 especially ! he>t1 art]ies & ve9s2 also ! liv]1 kidneys & /oma*4 ,!re is an increase ( specific gravity ( ! blood4 ,edema occurs f passive conge/ion1 due to weak he>t4 ,symptoms4--,! r\nd1 fat face1 d\ble *91 hang+ *eeks1 l>ge wai/1 ! ?ick1 prom95t1 sometimes p5dul\s abdom51 & ! bulky extremities =m *>act]i/ic features4 ,at fir/ obesity pres5ts no h>mful symptoms4 ,usually ! fir/ tr\blesome symptom is increas$ frequ5cy 9 ! brea?+1 due to a weak & ov]work$ he>t1 & to ! fact t ! motion ( ! lungs is hamp]$ by ! heavy *e/ walls1 & also by ! int]f]5ce ) ! desc5t ( ! diaphragm on acc\nt ( ! enl>g$ liv]4 ,dyspnea1 passive conge/ion1 anemia1 poor dige/ion1 ut]9e disord]s1 & m5tal inactivity are common4 ,!re is c>diac hyp]trophy2 lat] ! he>t is ov]laid ) fat4 ,! pulse is usually frequ5t1 b may be irregul> & sl[4 ,treatm5t4--,obesity be+ a nutritional disease x seems b reasonable t alt]ations ( ! anatomical /ructures w produce a *ange 9 ! prop] balance ( nutrition4 ,along o/eopa?ic l9es1 d]angem5t ( tissues affect+ ! n]ves to ! dige/ive & lymphatic sy/ems w produce obesity4 ,9 ! majority ( cases exam9$ h be5 f\nd di/urbances at ! six? & sev5? c]vical1 f\r? & fif? dorsal & f ! t5? dorsal to ! second lumb>4 ,lesions at ^! po9ts c\ld readily int]f]e ) ! ?oracic duct & ! receptaculum *yli1 z well z ) ! processes ( dige/ion1 assimilation & elim9ation4 ,x is claim$ t /imulation ( ! splan*nic n]ves causes dilatation ( ! receptaculum *yli4 ,direct treatm5t to ! abdom5 & to areas ( fatty deposit w aid v mat]ially 9 absorption4 ,! dietetic treatm5t is ess5tial1 ! pr9ciple be+ to furni% less food to oxidize4 ,re/rict fats1 sug> & />*es & limit ! am\nt ( wat]4 ,alcohol %\ld be prohibit$4 ,ano!r important po9t 9 ! treatm5t is ex]cise1 :i* mu/ be c>ri$ out 9 a sy/ematic way4 ,rules c be laid d[n only 9 individual cases & %\ld be gov]n$ by ! o/eopa? 9 *>ge4 ,! pr9cipal effect ( g5]al me*anical treatm5t is to promote oxidation4 ,massage & ba?s are b5eficial4 ,! pati5t c d mu* = ! abdom5 by keep+ x 9 & up1 & walk+ erect4 ,scurvy ,def9ition4--,a con/itutional disease1 *>act]iz$ by extreme g5]al weakness1 anemia1 spongy condition ( ! gums1 dis9tegration ( tissue & a t5d5cy to hemorrhages4 ,etiology & ,pa?ology4--,9 comp>ison ) =m] times scurvy is n[ a r>e disease4 ,lack ( fre% vegetables or _! sub/itutes1 ov]-cr[d+1 dampness1 bad hygi5ic surr\nd+s1 & prolong$ fatigue "u depress+ influ5ces are ! pr$ispos+ causes4 ,arctic explor]s h %[n t fre% be>'s meat & be>'s blood are a prev5tative4 ,!re are extravasations ( blood into ! sk91 muscles & muc\s membranes4 ,hemorrhages may occur 9 ! int]nal organs1 especially ! kidneys & liv]1 & 9 ! s]\s membranes4 ,! gums are swoll5 & spongy4 ,! tee? decay4 ,! sple5 is s(t & enl>g$4 ,p>5*ymat\s deg5]ation ( ! he>t1 liv] & kidney is frequ5t4 ,ulc]s occasionally occur 9 ! sk9 & b[els4 ,! blood is ?9 b !re is no leucocytosis4 ,symptoms4--,! disease is usually sl[ 9 developm5t4 ,! g5]al manife/ations ( anemia ) debility are among ! fir/ symptoms4 ,! gums are swoll51 s(t & spongy1 !y ble$ easily & 9 sev]e cases !re is ulc]ation4 ,pete*ial spots appe> ^u ! body4 ,subcutane\s ec*ymosis occurs1 fir/ on ! legs1 !n on ! arms & trunk4 ,! eyes & face are swoll52 ! pati5t appe>s z if he _h be5 bruis$4 ,hemorrhages f ! muc\s membrane frequ5tly occur4 ,! temp]ature is usually normal4 ,! pulse is small1 feeble & frequ5t2 sometimes irregul> & sl[4 ,! appetite is impair$ & con/ipation is pres5t at fir/1 z a rule1 al?\gh ?is may be foll[$ by scorbutic dys5t]y4 ,diagnosis4--,! disease is readily recogniz$ :5 sev]al cases occur toge!r4 ,x is some:at h>d to recognize 9 isolat$ cases1 & to be able to di/+ui% x f c]ta9 =ms ( purpura4 ,! etiology1 ! g+ival *anges & ! hemorrhages usually decide ! diagnosis4 ,prognosis4--,scurvy be+ a disease due to malnutrition1 x is necess>y to rem$y su* condition by att5tion & correction ( ! faults produc+ x4 ,hygi5ic surr\nd+s & a :olesome diet w d m 9 cur+ ! disease ?an any?+ else4 ,an outdoor life & good v5tilation ) anti-scorbutics1 z fruit juices1 especially lemons & oranges1 fre% vegetables1 7onions1 potatoes1 etc47 & fre% milk1 are necess>y4 ,x is held by ,g>rod t scurvy is caus$ by an abs5ce ( pota%1 = a defici5cy ( potassium salts is f\nd 9 ! blood4 ,! anti-scorbutics nam$ above conta9 pota%4 ,a c>eful treatm5t along ! splan*nics w\ld help to improve ! appetite & dige/ion4 ,treat ! gums & ulc]s accord+ to surgical indications4 ,infantile ,scurvy ,,scorbutus ,?is =m usually foll[s ! prolong$ use ( cond5s$ milk1 /]iliz$ milk or propriet>y foods = *ildr54 ,! disease occurs dur+ ! fir/ two ye>s ( life1 b x is mo/ common f ! sev5? to ! f\rte5? mon?4 ,x develops rapidly4 ,jo9t pa9s1 anemia & irritability are e>ly symptoms4 ,! *ild is pale1 has a muddy complexion & may %[ signs ( rickets4 ,! gums may be s(t & spongy4 ,!re is t5d]ness & pa9 on motion4 ,!re may be hemorrhages "u ! sk94 ,! l[] limbs are drawn up & motionless4 ,! bones become ?ick5$ f sub-p]io/eal hemorrhage1 & !re is apt to be s(t5+ betwe5 ! %aft & epiphysis4 ,! back & legs become v weak4 ,! lesions are usually symmetrical4 ,! temp]ature is v>iable4 ,treatm5t4--,! treatm5t ( scurvy 9 *ildr5 consi/s 91 fir/1 omitt+ all propriet>y foods & sub/itut+ fre% c['s milk1 meat juice1 /ra9$ gruel & a mod]ate quantity ( fre% orange or lemon juice4 ,"u ?is treatm5t1 cases t h n progress$ too f> w promptly recov]4 ,nor?rop says3 8,x is a significant fact t ! c\ntry :i* furni%es mo/ ( ! lit]ature on scorbutus 9 *ildr5 is ! same :i* is po/$ f end to end ) adv]tisem5ts ( propriet>y foods40 ,purpura ,purpura is a symptom r ?an a disease4 ,x is *>act]iz$ by extravasation ( blood into ! sk9 & ble$+ f ! muc\s membranes1 irrespective ( direct injury4 ,^! extravasations d n disappe> ^u pressure & v>y greatly 9 size4 ,!y may be small1 7pete*i7 or l>ge 7ec*ymoses74 ,!y are bright r$ & gradually become d>k]4 ,clott+ ( normal blood requires ?ree to five m9utes1 purpuric blood1 t5 to fifte5 m9utes4 ,x is a symptom ( infecti\s diseases1 z 9 pyemia1 septicemia1 mycotic endoc>ditis1 typhus fev]1 smallpox1 etc4 ,toxic1 z produc$ by v5om\s snake bites & by c]ta9 m$ic9es1 z copaiba1 m]cury1 qu99e1 iodides & o!rs 9 ov]doses4 ,ca*ectic purpura may be obs]v$ 9 canc]1 tub]culosis1 ,bright's disease1 scurvy1 etc4 ,9 s5ile purpura ! spots are g5]ally conf9$ to ! extremities4 ,9 c]ta9 n]v\s diseases1 ble$+ spots appe> on ! sk91 z 9 tabes1 myelitis & sev]e neuralgia4 ,me*anical purpura is se5 9 v5\s /asis2 ?is is r>e4 ,purpura simplex affects only ! sk94 ,x occasionally foll[s attacks ( infecti\s diseases4 ,! spots are f\nd ^u ! legs1 m r>ely ^u ! trunk & arms4 ,articul> pa9s may or may n occur4 ,fev] is seldom pres5t4 ,loss ( appetite1 di>rhea & slight anemia may be manife/$4 ,! duration is "o to f\r weeks4 ,purpura rheumatica is a mu* m s]i\s affection1 *>act]iz$ by multiple ar?ritis ( rheumatism4 ,seldom se5 "u five ye>s1 & la/s ab\t two weeks4 ,! jo9ts are swoll5 & pa9ful & ! temp]ature rises to #aja & #ajc degrees ,f4 ,! am\nt ( edema v>ies greatly & occasionally x is q excessive4 ,9 addition to ! purpura !re is usually urtic>ia4 ,h5o*'s purpura is se5 mo/ frequ5tly 9 *ildr5 & is *>act]iz$ by sev]e ga/ro-inte/9al di/urbances z pa91 vomit+ & di>rhea1 hemorrhages f ! muc\s membranes & acute enl>gem5t ( ! sple51 9 addition to ! symptoms already nam$ "u ! =ego+ =m4 ,!re is "s dang] ( hemorrhage into ! kidneys4 ,! disord] ( purpura hemorrhagica is usually associat$ ) rheumatism1 mal>ia & o!r infecti\s diseases4 ,?is is ! mo/ s]i\s =m ( purpura4 ,x is mo/ commonly met ) 9 delicate girls dur+ e>ly life2 b x may occur at any age & 9 ! mo/ robu/ ( ei!r sex4 ,fev]1 weakness1 vomit+ & di>rhea are ! e>ly symptoms4 ,aft] a c\ple ( days ( languor & weakness1 purpuric spots appe> ^u ! sk92 & ble$+ occurs f ! muc\s membranes & may cause pr(\nd anemia4 ,hemorrhages into ! int]nal organs occur4 ,favorable cases recov] 9 t5 days or two weeks4 ,o!rs may end fatally4 ,c>e %\ld be tak5 n to confuse ! disease ) scurvy4 ,treatm5t4--,9 ! treatm5t ( purpura ! disease f :i* x develops %\ld receive due att5tion4 ,occasionally !re is dang] ( ov]look+ ! prim>y disease & treat+ "s symptoms ( ! disease1 al?\gh x is true t sometimes an important symptom is ne>ly all t is manife/$4 ,outside ( treat+ ! conditions "u :i* purpura arises1 g5]al measures %\ld be consid]$1 z a nutriti\s diet1 re/1 fre% air1 & g5]al treatm5t ( ! pati5t s t normal circulation & /r5g? may be re/or$4 ,! treatm5t ( ! purpura locally %\ld be su* z to re/ore normal circulation ( ! "p by remov+ any ob/ruction or irritation ( ! blood supply t may be f\nd1 by c>eful manipulation ( ! tissues4 ,z /at$ ! managem5t ( ! disease "u :i* x arises %\ld be embrac$ 9 ! treatm5t4 ,9 cases ( hemorrhage f v>i\s organs see article "u hemorrhage4 ,"s cutane\s hemorrhages are be/ reliev$ by local manipulation4 ,hemophilia 7,,ble$]',s ,,disease74 ,hemophilia is a h]$it>y condition manife/$ by a t5d5cy to uncontrollable hemorrhage ) or )\t injury4 ,! usual mode ( transmission is ?r\gh ! female l9e1 r ?an by ! male4 ,! "m does n necess>ily h to be a ble$]1 b ! daught] ( "o1 9 ord] to transmit ! disease to h] (fspr+4 ,atavism ?r\gh ! female alone is almo/ ! rule4 ,n all ! *ildr5 ( a ble$+ family are afflict$2 ! male *ildr5 are m subject to ! condition ?an ! female *ildr54 ,! t5d5cy usually appe>s )9 ! fir/ two ye>s ( life4 ,! families ( ble$]s are (t5 l>ge & are commonly heal?y look+ & h f9e s(t sk9s4 ,x is claim$ blondes are mo/ likely to be afflict$4 ,pa?ologically1 an unusual ?9ness ( ! blood-vessels ) a fatty deg5]ation ( ! intima has be5 not$4 ,9 _m cases !re is defici5t coagulability ( ! blood & a less5$ numb] ( leucocytes4 ,hemorrhages h be5 f\nd 9 & ab\t ! capsules ( ! jo9ts1 & 9 a few in/ances inflammation ( ! synovial surfaces4 ,! art]ies are situat$ sup]ficially1 b t does n expla9 any?+4 ,! real nature ( ! disease has n be5 det]m9$4 ,emotional excitem5t is a factor1 consequ5tly vasomotor di/urbances may be important4 ,! frailty ( ! blood-vessels & ! peculi> con/itution ( ! blood prev5t+ ?rombotic =mation are ! two facts ( importance t h be5 recogniz$4 ,symptoms4--,hemorrhages occur f ! mo/ trifl+ injuries4 ,bl[+ ! nose may cause sev]e epi/axis2 ! extraction ( a too? is a frequ5t cause ( hemorrhage2 ! prick ( a p91 a slight cut1 a scrat*1 or a bl[ may result 9 pr(use ble$+4 ,! ble$+ may occur spontane\sly f ! muc\s membrane ( ! m\?1 nose1 lungs1 inte/9es1 etc42 or x may occur directly f ! f+]s1 toes1 back ( ! h&s1 & lobes ( ! e>s4 ,! hemorrhages may la/ sev]al h\rs4 ,z soon z *eck$ ! pati5ts rapidly resume natural appe>ance provid+ ! ble$+ is n (t5 repeat$1 !reby caus+ a p]man5t anemia4 ,!re may be attacks ( ar?ritis ) fev]1 z ) acquir$ hemorrhagic t5d5cy1 closely resembl+ rheumatism4 ,diagnosis4--,h]$it>y t5d5cy & p]si/5t hemorrhage f slight injury4 ,prognosis4--,9 a few cases ! t5d5cy to ble$ gradually dim9i%es until at la/ x entirely ceases4 ,! y\ng] ! subject ! m is x liable to prove fatal4 ,9 ! majority ( cases dea? occurs betwe5 ! fir/ & eigh? ye>s4 ,aft] maturity ! *ances ( an attack are mu* less5$4 ,treatm5t4--,memb]s ( ! ble$]'s family1 p>ticul>ly ! boys1 %\ld be gu>d$ aga9/ traumatic influ5ces1 & op]ations ( all k9ds %\ld be avoid$4 ,outdoor ex]cise1 fre% air1 ba?+ & pla9 n\ri%+ food1 9 fact1 ! hygi5ic surr\nd+s1 & all food %\ld be c>efully wat*$ s t ! ?reat5$ subject may become /r5g!n$ & h>d5$4 ,m>riage %\ld be disc\rag$1 especially ) ! daught]s1 z x is ?r\gh !m ! t5d5cy is propagat$4 ,possibly1 c\pl$ ) ! =ego+ prophylactic treatm5t1 a /imulation ( ! gl&s ( elaboration ( ! blood w be ( s]vice to build up ! physical con/itution ( ! pati5t4 ,dur+ attacks absolute re/ & ! requir$ symptomatic treatm5t %\ld be giv54 ,= resultant anemia ! usual treatm5t is to be employ$4 ,9 sev]e cases direct transfusion %\ld be consid]$4 ,,footnotes3 #fg ,bill+s1 ,focal ,infection4 #fh ,massa*usetts ,j\rnal ( ,o/eopa?y1 ,jan4 #aijf4 #fi ,j\rnal ( ! ,am]ican ,o/eopa?ic ,association1 ,novemb] #aiai4 #gj ,diabetes1 p4 #ij4 #ga ,j\rnal ( ! ,am]ican ,o/eopa?ic ,association1 ,oct41 #aijd4 #gb ,j\rnal ( ! ,am]ican ,o/eopa?ic ,association1 ,oct41 #aijd4 #gc ,practical ,m$ical ,s]ies1 #aije4 ,,diseases ,,( ,,! ,,dige/ive ,,sy/em ,diseases ( ! ,m\? ,/omatitis ,def9ition4--,inflammation ( ! m\?4 ,etiology4--,*emical1 me*anical1 !rmal or p>asitic irritations2 second>y to disord]s ( ! ga/ro-inte/9al tract1 sc>let fev]1 measles & v>iola2 ca*exia1 due to su* diseases z canc] & ph?isis2 d5tition2 artificial fe$+2 hot wea!r & poor hygi5ic surr\nd+s are ! mo/ common causes4 ,lesions to ! inn]vation & vascul> supply ( ! m\? are f\nd1 pr9cipally1 9 ! upp] c]vical v]tebr1 occasionally 9 ! upp] dorsal v]tebr & correspond+ ribs4 ,v>ieties4--,cat>rhal1 aph?\s1 ulc]ative1 p>asitic1 gangr5\s4 ,cat>rhal ,/omatitis ,etiology4--,mo/ common 9 infants & *ildr54 ,hot & irritat+ sub/ances2 second>y to diseases ( ! /oma*1 to measles1 sc>let fev] & v>iola2 difficult d5tition2 alcoholic or tobacco excesses4 ,hazz>d says 9 all cases ( /omatitis 8!re is g5]ally lesion to ! bony or o!r tissues 9 ! c]vical region 7sometimes also 9 ! upp] dorsal71 :i* d]anges vasomotor control ( ! tissues ( ! m\? & tongue1 ob/ructs v5\s return1 weak5s ! tissues & lays !m liable to ! effects ( "s p>ticul> irritant1 local or 9 ! sy/em1 b !re is1 g5]ally1 lesion affect+ ! ga/ro-inte/9al tract :i* is ! real und]ly+ cause ( ! tr\ble40 ,symptoms4--,diffuse1 r$ swell+ ( ! muc\s membrane1 heat & pa9 9 ! m\?1 increas$ fl[ ( saliva1 fetor ( brea?1 re/lessness & languor4 ,9 *ildr5 !re is a dis9cl9ation to nurse & a slight fev] may be pres5t4 ,! s5se ( ta/e is blunt$ & !re is commonly a bitt] ta/e 9 ! m\?4 ,! neck gl&s are enl>g$4 ,treatm5t4--,removal ( ! excit+ cause is ! mo/ important po9t 9 ! treatm5t4 ,good hygi5ic conditions mu/ be en=c$4 ,! m\? %\ld be kept clean4 ,wipe x out at frequ5t int]vals ) a s(t piece ( absorb5t cotton & cold wat]4 ,a borax solution is frequ5tly us$4 ,att5tion %\ld be paid to ! diet & secretions4 ,light b ?or\gh treatm5t ( ! upp] c]vical region is to be giv51 ) c>eful att5tion to ! tissues ab\t & bel[ ! angles ( ! jaw1 s t ! inn]vation1 blood & lymphatic supply may be equaliz$4 ,aph?\s ,/omatitis 7,,cank]7 ,?is disease is *>act]iz$ by little1 pa9ful1 grayi%-:ite spots ^u ! sup]ficial lay] ( ! muc\s membrane4 ,!y consi/1 prim>ily1 ( an exudate ( fibr9 & w&]$-out leucocytes4 ,x is pr9cipally a disease ( *ildhood4 ,among ! common causes are difficult d5tition1 disord]s ( dige/ion & uncleanl9ess ( ! m\?1 su* z neglect to cleanse ! *ild's m\? aft] nurs+4 ,x may be a symptom ( measles or ( local diseases4 ,probably ! inn]vation to ! region ( ! little grayi%-:ite spots or cank] is ob/ruct$ at "s po9ts by a disord]$ tissue4 ,! lesion may be me*anical or x may arise f a disord]$ dige/ion4 ,if "o is able to locate su* a lesion & remove x1 a cure w be ha/5$4 ,! seat ( ! infection is ! int]nal surface ( ! *eeks1 gums1 ro( ( ! m\?1 tongue & lips4 ,symptoms4--,!re is r$ness ( ! muc\s membrane ( ! m\?1 foll[$ by ! appe>ance ( ! vesicles ) a r$ areola4 ,pa9 9 ! m\? & an increas$ fl[ ( saliva occur4 ,ma/ication1 deglutition1 & ev5 speak+1 may be pa9ful4 ,?is condition is foll[$ by sleeplessness1 fev]i%ness1 di>rhea & fetor ( ! brea?4 ,treatm5t4--,removal ( ! cause1 z 9 o!r v>ieties ( /omatitis1 is p>am\nt4 ,give att5tion to ! food4 ,! milk %\ld be /]iliz$4 ,! disord]$ dige/ion %\ld be correct$ at once4 ,all secretions mu/ receive prompt att5tion4 ,! *ild %\ld be nurs$ at regul> int]vals4 ,locally1 keep ! p>ts clean & c>efully treat ! inn]vation4 ,ulc]ative ,/omatitis ,?is is a disease ( *ildr51 al?\gh x may n be limit$ to !m1 z x occasionally occurs 9 epidemics & affects all ages4 ,x occurs *iefly 9 ! families ( ! poor & 9 places :]e ! hygi5ic surr\nd+s are bad1 ! food poor & p]sonal cleanl9ess lack+4 ,x may beg9 z an aph?\s /omatitis4 ,(t5 suff]]s f sev]e1 acute diseases are subjects ( attack4 ,symptoms4--,! gums ( ! l[] jaw are *iefly affect$4 ,!y are at fir/ conge/$1 swoll5 & ble$ readily4 ,pa9 is increas$ by ma/ication & deglutition1 ! m\? is hot1 ! brea? fetid1 ! saliva dribbles & ! dige/ion & b[els are disord]$4 ,! ulc]s may appe> at v>i\s po9ts ^u ! *eeks1 lips & tongue2 ! deposit is yell[i%-gray4 ,9 ! m sev]e cases ! gums are spongy & ! tee? are loos5$4 ,9 proportion to ! con/itutional di/urbances1 fev] & enl>gem5t & t5d]ness ( ! submaxill>y gl&s occur4 ,ev5 necrosis ( ! bone may foll[4 ,p>asitic ,/omatitis 7,,?ru%7 ,! excit+ cause is a fungus kn[n z ,lac*>omyces albicans4 ,x is claim$ t a cat>rhal /omatitis is ! soil ^u :i* ! fungus develops4 ,p>asitic /omatitis is *iefly a disease ( nurs+ *ildr5 & is promot$ by unhygi5ic conditions4 ,x is seldom se5 aft] t5 ye>s ( age1 occurr+ 9 adults only 9 ! la/ /ages ( consumption1 canc]1 & sev]e *ronic diseases4 ,symptoms4--,^u inspection !re are se5 num]\s milk-:ite elevations4 ,^! appe> fir/ ab\t ! angles ( ! m\?1 soon ext5d+ to all p>ts ( ! m\?1 & 9 a few cases1 ev5 to ! ph>ynx & to ! esophagus4 ,:5 remov$ ble$+ po9ts are left4 ,! g5]al symptoms ( /omatitis are pres5t--pa9 ^u ma/ication & swall[+2 fetid1 hot brea?2 increas$ saliva2 increas$ temp]ature2 re/lessness2 swoll5 lips & disord]$ dige/ion occur4 ,diagnosis4--,! microscope w remove all d\bt z to ! nature ( ! affection4 ,9 aph?\s /omatitis ! ulc]s are prec$$ by ! =mation ( vesicles4 ,prognosis4--,is favorable 9 ! majority ( cases4 ,treatm5t4--,hygi5ic measures1 absolute cleanl9ess1 correction ( ! disord]s ( ! ga/ro-inte/9al tract & local treatm5t z 9 o!r =ms ( /omatitis1 is ! requir$ treatm5t4 ,a boric acid solution w be f\nd b5eficial4 ,,sp9al ,,lesions ,,& ,,_! ,,relation ,,to ,,diseases ,,( ,,! ,,ga/ro-,,inte/9al ,,tract ,acute ,ga/ritis1 ,*ronic ,ga/ritis1 ,ga/ric ,neurosis1 ,ga/ric & ,duod5al ,ulc]4 ,by ,,*>les ,j4 ,,mutt>t ,! in/ant relief t ,o/eopa?y c give 9 acute indige/ion is "o ( its out/&+ a*ievem5ts4 ,x impresses ! pati5t & 8 fri5ds ) a deep conviction ( ! sup]iority ( o/eopa?ic !rapy4 ,! results 9 ^! cases are n1 9 any s5se1 a matt] ( *ance4 ,!y foll[ logically f ! o/eopa?ic viewpo9t1 tea*+1 reason+1 & practice4 ,9 deal+ ) ! manife/ations ( disease1 su* z h]$ity1 onset1 c\rse1 duration1 subjective & objective symptoms1 etc41 & 9 ! ef=t to diff]5tiate cause f effect1 & to recon/ruct a m5tal picture ( ! sequ5ce ( cause1 effect & sequel1 ! o/eopa? has ! advantage ( b9ocul> vision 9 t he recognizes two di/9ct pa?ologies coop]at+ to produce ! symptom complex1 syndrome or disease :i* he is call$ ^u to treat4 ,"o pa?ology is to be f\nd 9 "o or m ( ! v]tebral & rib articulations & ! imm$iately adjac5t or correspond+ segm5ts ( ! sp9al cord4 ,! o!r is 9 "s "o or m ( ! organs or tissues connect$ ) ! pa?ological segm5t or segm5ts ( ! cord4 ,! function ( ! jo9t is ,,motion4--,unre/rict$ normal range ( motion is ess5tial = ! normal function ( all p>ts ( ! articulation z well z = ! nutrition ( ! n]ve me*anisms imm$iately adjac5t4 ,:5 a sp9al articulation ceases to p]=m its function all ( its p>ts are m or less impair$1 muscles atrophy1 ligam5ts lose _! tone1 & circulation to & f ! sp9al segm5t is int]f]$ ) because action is a l>ge factor 9 promot+ ! fl[ ( blood & lymph & ma9ta9+ normal /imulus4 ,z a result ( ?is sp9al pa?ology1 int]nal organs & tissues1 suppli$ by n]ves aris+ 9 ! segm5t t is 9 lesion1 w be v>i\sly di/urb$ 9 _! function4 ,dr4 ,c>l ,p4 ,mc,connell says3 8,my obs]vation ( lesion$ animals s f> z ! dige/ive organs are conc]n$ is t ! lesion affects ! reflexes ( & ?r\gh sp9al & sympa!tic ganglia s t ! vasomotors are involv$ ) a consequ5t hyp]emia ( ! submuc\s coat4 ,?is means involvem5t ( ! endo!lial lay] ( ! blood-vessels1 diap$esis1 d]angem5t ( ! secretory function & di/urbance ( ! motor me*anism1 all ( :i* lead to functional upset & di/urbance40 ,! dom9ant "p play$ by ! o/eopa?ic lesion z a causative factor 9 acute & *ronic diseases ( ! alim5t>y canal becomes increas+ly evid5t z cl9ical obs]vation & laboratory rese>* p]mit a m ?or\gh appreciation ( ! anatomy & physiology ( ! p>ts involv$4 ,! abnormal /&s out m cle>ly f ! normal4 ,f9ally1 ! task ( re/or+ normality is becom+ a cle>-cut problem to :i* ! correction ( ! o/eopa?ic lesions furni%es an almo/ complete solution4 ,! normal alim5t>y canal transports food1 mac]at+ x1 mix+ x1 & treat+ x ) v>i\s *emicals & enzymes on ! way1 break+ x d[n physically & *emically1 & absorb+ f x su* end-products z are ne$$ to ma9ta9 metabolism4 ,! abnormal alim5t>y tract may be at fault 9 any ( ^! functions4 ,?is del9qu5cy is g5]ally traceable to a me*anical orig94 ,correction ( ! me*anical deviation is foll[$ by re/oration ( normal function except 9 cases :]e ext5sive tissue *anges h occurr$4 ,?or\gh ma/ication is ess5tial to good dige/ion4 ,any d5tal defects or defici5cies %\ld be correct$4 ,! temporo-m&ibul> articulation %\ld be exam9$1 & full free motion re/or$ if lack+4 ,! muscles on ! affect$ side are s(t] ?an on ! s\nd side4 ,tonic spasm rigidly closes ! m\?4 ,x may be due to tetanus1 c>ies ( ! l[] tee?1 cutt+ ( ! l[] wisdom too?1 or o!r irritations to ! s5sory bran*es ( ! inf]ior maxill>y n]ve4 ,!re is en\gh space back ( ! wisdom tee? to pass a ca!t] to adm9i/] food4 ,! tongue assi/s 9 ma/ication & deglutition & is ! seat ( mo/ ( ! n]ves ( ta/e4 ,! hypoglossal n]ve1 :i* supplies x1 leaves ! skull ?r\gh ! ant]ior condyloid =am5 & may be imp+$ !re or l[] 9 its c\rse4 ,lesions ( ! occiput & upp] c]vical v]tebr & ob/ructions to ! lymphatic dra9age at ! angle ( ! jaw may cause pressure on ?is n]ve & cause di/urbances 9 ! movem5ts ( ! tongue1 atrophy1 swell+1 etc4 ,swell+ may be due also to endocr9e di/urbance1 con/itutional diseases1 anemia1 glossitis1 local irritants1 injuries1 etc4 ,pressure may be made on ! hypoglossal n]ve beh9d ! angle ( ! jaw4 ,! special s5se ( ta/e plays an important role 9 normal dige/ion4 ,! l+ual n]ve supplies ! ant]ior two-?irds ( ! tongue ) ta/e4 ,! s5se ( ta/e may be lo/1 impair$1 p]v]t$ or o!rwise abnormal4 ,! s5se ( smell plays an important "p 9 our appreciation ( flavors1 & :5 x is impair$ by colds1 ad5oids1 or o!r affections ( ! nose or ph>ynx1 ! s5se ( ta/e is measurably impair$4 ,normalization ( nose & ph>ynx re/ores ! s5se ( ta/e 9 su* cases4 ,impairm5t or loss may also be due to lesions ( ! *orda tympani1 or glosso-ph>yngeal n]ves4 ,lesions ( ! m&ible1 hyoid1 occiput or upp] c]vical n]ves1 p>otid disease or ob/ruct$ lymphatic dra9age beh9d ! angle ( ! jaw may cause pressure directly or indirectly on ! glosso-ph>yngeal & *orda tympani n]ves4 ,p]v]sion ( ta/e occur 9 pregnancy1 hy/]ia1 epilepsy & insanity4 ,f\l ta/e1 fetororis 9 ! m\? is frequ5t 9 pneumonia1 typhoid fev]1 p]itonitis1 septicemia & o!r sev]e fev]s2 also aft] +e/ion ( pung5t foods or /rong drugs2 9 con/itutional diseases2 z a result ( inatt5tion to oral hygi5e1 excessive smok+1 m\? brea?+ at night1 furr$ tongue1 etc4 ,x cle>s up on remov+ ! cause4 ,furr$ tongue occurs 9 ga/ritis1 fev]s1 & a v>iety ( o!r conditions4 ,! fur is compos$ ( brok5 d[n epi!lium :i* w\ld normally be remov$ by friction ) solid food4 ,:5 none is tak51 ! fur accumulates4 ,:5 blood or hemat9 becomes mix$ ) ! brok5 d[n epi!lium1 ! fur is br[n4 ,ord9>ily x is :ite4 ,a clean r$ tongue is frequ5tly f\nd 9 hyp]acidity4 ,x is probably due to vasodilatation due to hyp]activity ( ! autonomics or inhibition ( sympa!tics4 ,! sympa!tic supply is f ! sup]ior c]vical ganglion4 ,x may be affect$ by lesions ( ! occiput1 atlas1 axis & ?ird c]vical v]tebra1 ( ! hyoid1 by ant]ior c]vical muscul> contractures1 by ob/ruction to v5\s & lymphatic dra9age & blood supply4 ,correction ( ! lesions nam$ & normalization ( ! o!r /ructures involv$ w usually re/ore ! tongue to normal condition4 ,! saliv>y gl&s h a two-fold inn]vation4 ,! ?91 full1 wat]y1 salty secretion is produc$ by activity ( ! cranial autonomic fib]s2 ! sp>se1 visc\s secretion conta9+ ! organic elem5ts1 ptyal91 etc41 is produc$ by ! sympa!tics4 ,! sympa!tic n]ve supply is f ! middle & sup]ior c]vical ganglia & c be di/urb$ by lesions affect+ !m z m5tion$ above4 ,! secretion ( ptyal9 may be di/urb$ by any lesion f ! fif? dorsal up4 ,x mu/ n be =gott5 t a po/]ior occiput draws ! sup]ior c]vical ganglion back aga9/ ! axis & ?ird c]vical ) j z mu* pressure z is ex]t$ by an ant]ior atlas or ?ird c]vical4 ,?is pressure or /ret*+ t5ds to inhibit x1 prev5t+ vaso-con/riction & p]mitt+ vasodilatation ( ! int]nal c>otid art]y & its bran*es & conge/ion ( ! p>ts suppli$1 mid-bra91 c]ebrum1 etc4 ,if1 = any reason1 ! v5\s dra9age f ! lat]al s9us into ! int]nal jugul> ve91 or ! ebb & fl[ ( ! c]ebrosp9al fluid betwe5 bra9 & cord1 is r$uc$ or hamp]$1 an extra burd5 is ?r[n on ! c]ebral ve9s & s9uses1 & ! intra-cranial pressure is rais$ at ea* he>t-beat1 ultimately produc+ pressure on ! m5+es & caus+ viol5t heada*e ov] ! fif? & t5? cranial n]ves :i* supply ! m5+es ) s5sation4 ,^! n]ves are intimately connect$ ) ! dige/ive sy/em4 ,any increase ( intra-cranial pressure causes increas$ irritability & hyp]activity ( ! cranial n]ves1 _m ( :i* are conc]n$ ) v>i\s functions ( ! dige/ive sy/em4 ,moreov]1 ! nuclei ( ^! n]ves lie on ! floor ( ! f\r? v5tricle :i* is suppli$ ma9ly by ! v]tebral art]ies & ! basil> art]y4 ,lesions ( ! c]vical v]tebr affect+ ! plexus on ! v]tebral art]y or filam5ts to x f ! upp] p>ts ( ! c]vical gangliat$ sympa!tic cord1 may impair ! blood fl[ ?r\gh ! v]tebral art]ies & cause simil> increas$ irritability ( ! n]ve cells 9 ! m$ulla1 mid-bra9 & c]ebellum4 ,su* di/urbance is reflect$ 9 awkw>d movem5t1 hyp]e/hesia1 & symptoms due to increas$ irritability ( ! autonomic n]ves su* z sl[ pulse & respiration1 wat]+ ( ! m\?1 hyp]secretion & hyp]motility ( ! ga/ro-inte/9al tract1 rapid dige/ion & poor assimilation1 vasodilatation1 impov]i%$ blood1 & s ?r\gh a vici\s cycle back to /ill great] impairm5t ( nutrition to ! n]ve cells )9 ! cranium4 ,until ! lesions are correct$1 ! condition becomes progressively worse till exhau/ion occurs4 ,ord9>y m$ical hygi5e c d little or no?+4 ,! palliative rem$ies employ$ simply mask ! symptoms1 or actually accel]ate ! de/ructive process4 ,lesions t irritate ! c]vical sympa!tics w\ld cause vaso-con/riction & give rise to opposite symptoms1 namely1 c]ebral is*emia1 decreas$ fl[ ( saliva1 atony ( /oma*1 lack ( dige/ive juices1 sluggi% inte/9al p]i/alsis1 rapid pulse & respiration1 etc4 ,correction ( ! lesions & re/oration ( normal blood supply & dra9age to ! bra9 & removal ( any lesions t5d+ to inhibit ! sympa!tics f ! fif? dorsal up1 w usually 9 a %ort "t re/ore ! activity ( ! saliv>y gl&s to normal4 ,! otic & sph5opalat9e ganglia c be di/urb$ by abnormal conditions )9 ! ph>ynx4 ,^! mu/ be correct$ :5 f\nd4 ,deglutition1 or swall[+1 is a v rapid1 highly complex movem5t4 ,x takes n m ?an a second = ! food to cross ! ph>ynx4 ,! s(t palate & l>ynx are rais$ to close (f ! air-way1 mak+ ! food-way practically cont9u\s = ! second ne$$ to complete ! transf] ( ! food across ! air-way4 ,! tongue is press$ aga9/ ! ro( ( ! m\? & ! mylohyoid contracts vigor\sly & %oots ! bolus ( food across ! ph>ynx4 ,bolt+ ! food leads to s]i\s dige/ive di/urbances1 n ! lea/ ( :i* is ! loss ( ! normal reflex :i* prev5ts swall[+ unprep>$ food4 ,:5 lo/1 ?is reflex c be re/or$ by ?or\gh ma/ication = ?ree or f\r mon?s4 ,! volunt>y "p ( swall[+ is p]=m$ by ! motor portion ( ! fif? cranial & ! hypoglossus4 ,! involunt>y "p involves aff]5t impulses ov] ! sup]ior l>yngeal & eff]5t impulses ov] ! inf]ior l>yngeal4 ,! levator palati :i* raises ! s(t palate is probably suppli$ by ! sp9al accessory n]ve ?r\gh ! ph>yngeal plexus4 ,?is n]ve c be affect$ by lesions ( ! occiput1 atlas1 m&ible & hyoid1 & by any ob/ruction to lymphatic dra9age :i* increases pressure beh9d ! angle ( ! jaw4 ,9 p>alysis ( ! levator palati1 z aft] diph!ria or o!r p]iph]al neuritis1 fluids regurgitate ?r\gh ! nose dur+ ! act ( swall[+4 ,! rais+ & clos+ ( ! l>ynx is accompli%$ by ! sup]ior & recurr5t l>yngeal n]ves by way ( ! ph>yngeal plexus4 ,pa9 9 swall[+ is g5]ally due to "s inflammation or infection ( ! tonsil or ph>ynx4 ,?is does n occur :5 ev]y?+ is normal f ! fif? dorsal up4 ,! second & ?ird /ages ( swall[+ occur 9 ! esophagus4 ,! esophagus receives esophageal bran*es f ! vagus1 c>ry+ autonomic fib]s :i* contract its longitud9al muscles & dilate its art]ies4 ,x also receives sympa!tic impulses f ! plexus on ! art]ies :i* supply x4 ,^! sympa!tic impulses convey vaso-con/riction & con/riction ( ! circul> muscles ( ! esophagus4 ,any lesion f sev5? c]vical to n9? dorsal might affect ! esophagus2 probably fif? dorsal is ! mo/ ne>ly specific1 z ! he>tburn :i* results f regurgitation into ! esophagus is usually localiz$ !re4 ,lesions ( ! upp] six dorsal v]tebr int]f]e ) dige/ion & nutrition 9 ano!r vital way by r$uc+ ! activity ( ! lungs & consequ5t intake ( oxyg5 into ! sy/em4 ,if !re is n suffici5t oxyg5 to oxidize ! prote9s to am9o-acids !re w be h>mful products left = ! tissues to neutralize4 ,lesions ( ! ?ird1 f\r? & fif? c]vical affect+ ! phr5ic may h a l effect4 ,sub-oxidation mu/ be not$ :5 pres5t & treat$ by remov+ lesions affect+ respiration1 by deep brea?+ ex]cises1 & by diet ri* 9 ! ne$$ m9]al salts1 & prop]ly balanc$4 ,an improp]ly balanc$ diet *anges ! /ructure ( ! tissues & am\nts 9 effect to an o/eopa?ic lesion :i* causes di/urb$ function4 ,x mu/ be se>*$ =1 f\nd if pres5t1 acc\nt$ =1 correct$ & kept correct$ to obta9 maximum !rapeutic results4 ,! /oma*1 inte/9es & rectum are intimately relat$ ) ! o!r abdom9al visc]a4 ,x w !re=e be readily se5 t any di/urbance ( ! liv]1 gall-bladd]1 pancreas1 sple51 duod5um1 pleura or p]itoneum w di/urb ! function ( ! /oma*1 & t any di/urbance ( any organ w di/urb ! function ( ! inte/9e4 ,9 fact1 cl9ically1 x w\ld seem t ! majority ( cases c be acc\nt$ = by ! lesions f\nd1 ! /oma* or inte/9al di/urbances :i* are reg>d$ z reflex f "s o!r organ1 be+ 9 reality caus$ by ! same lesion z di/urb$ ! organ :i* fir/ manife/$ di/urbance4 ,go+ m deeply into ! nature ( ! me*anism :]eby symptoms ( ga/ro-inte/9al di/urbance are produc$1 we f9d t ! alim5t>y tract has an +5i\s convey] me*anism ) a numb] ( sph9ct]s4 ,^! are op]at$ by intr9sic sympa!tic or my5t]ic n]ves1 call$ plexuses ( ,meissn] & ,au]ba*4 ,9 convey+ food1 impulses are pass$ f "o portion ( ! tract to ! next ov] ^! my5t]ic arcs4 ,normally ! p]i/altic movem5t is always =w>d because ! po9t ( highe/ irritability is at ! proximal end4 ,!re is an exception to ?is rule 9 ! asc5d+ colon1 :]e antip]i/alsis occurs normally4 ,:5 ! irritability ( a di/al po9t ( ! alim5t>y tract becomes great] ?an ! m proximal po9ts1 an antip]i/altic wave is set up caus+ vomit+4 ,! my5t]ic activities are regulat$ by ! autonomic impulses ov] ! vagus1 & by ! sympa!tic impulses ov] ! splan*nic n]ves4 ,! autonomics contract ! longitud9al muscles1 dilat+ & %ort5+ ! tube4 ,!y also /imulate secretion ( dige/ive juices & fluids & mucus & dilate ! blood-vessels4 ,! sympa!tics contract ! circul> fib]s & sph9ct]s1 n>r[+ & l5g!n+ ! tube1 ret>d+ ! food1 inhibit+ ! secretions & con/rict+ ! blood-vessels4 ,! my5t]ic reflexes c cont9ue aft] ! vagi & splan*nics are cut4 ,! vagi simply /imulate !m & ! splan*nics inhibit !m4 ,! pa?ways are f ! coeliac plexus :]e ! vagi & splan*nics meet ) v>i\s o!r plexuses on ! art]ies & foll[+ ! c\rses ( ! art]ial supply to ! m9ute/ p>ts ( ea* organ4 ,ea* cell is surr\nd$ by n]ve fib]s4 ,visc]al-aff]5t fib]s ov] bo? vagi & splan*nics convey impulses to ! cord segm5ts & m$ulla :i* modify ! sy/emic blood supply1 draw+ blood f ! head & surface by con/rict+ _! art]ies dur+ dige/ion & fill+ ! abdom9al art]ies4 ,if opposite impulses %\ld be receiv$ draw+ blood away f ! abdom9al art]ies1 dige/ion w\ld be int]f]$ )4 ,any lesion or o!r condition caus+ hyp]irritability or ov]/imulation ( ! vagus w result 9 ov]/imulation ( ! my5t]ic n]ves1 ) vasodilatation1 hyp]secretion1 contraction ( ! longitud9al coat1 wid5+ & %ort5+ ( ! dige/ive tube1 sluggi% p]i/alsis b rapid movem5t ( food ?r\gh ! sph9ct]s1 incomplete dige/ion & und]n\ri%m5t4 ,inhibition ( ! splan*nic n]ves w produce a l result4 ,! opposite condition w\ld come ab\t z a result ( inhibition ( ! impulses ov] ! vagus to ! my5t]ic n]ves1 or ( ov]/imulation ( ! splan*nic n]ves4 ,inhibition ( ! splan*nic n]ves may be secur$ by extreme flexion ( ! sp9al column4 ,?is raises ! cord 9 ! sp9al canal1 l5g!ns x1 /ret*es or draws on ! n]ve roots & vessels1 squeezes ! fluid out ( ! cord1 & inhibits ! splan*nics 9 two ways1 fir/ by a p>tial anemia or is*emia ( ! cord1 & secondly by direct traction ( ! visc]al aff]5t fib]s 9 ! po/]ior & ant]ior roots4 ,conv]sely1 /imulation ( ! splan*nic n]ves may be secur$ by complete ext5sion ( ! sp9al column4 ,?is l[]s ! cord 9 ! sp9al canal1 %ort5s x1 releases ! /ra9 on ! n]ve roots & vessels1 flu%es ! cord ) blood1 & tones up ! sympa!tic impulses 9 two ways1 fir/ by increas+ _! relative & absolute nutrition1 ?r\gh ri*] supply ( ri*] blood1 & secondly by releas+ ! n]ve roots f /ra91 p]mitt+ free entry ( aff]5t impulses ov] ! po/]ior roots1 & free exit ( visc]al-eff]5t impulses ov] ! ant]ior roots4 ,any lesion1 inasmu* z x limits or alt]s ! normal motion 9 a jo9t1 produces an exagg]ation or dim9ution ( ! normal sp9al curves1 & m or less lat]al curvature4 ,! alt]$ equilibrium ?us produc$ affects ! visc]a 9 ?ree ways3 #a4 ,me*anically1 by pressure1 gravity1 alt]$ position ( ribs1 v]tebr1 diaphragm1 etc42 #b4 ,reflexly1 influ5ce on n]ves to & f affect$ segm5t2 #c4 ,directly1 by int]f]5ce ) nutrition ( n]ve cells by hyp]emia or is*emia4 ,!re is always a functional kyphosis 9 visc]optosis or splan*noptosis4 ,! n]ves 9 ! cord are inhibit$4 ,! skeletal muscles are hypotonic1 all[+ ! functional kyphosis to occur1 & ! visc]o-motor n]ves are inhibit$1 all[+ ! abdom9al visc]a to become hypotonic & sag out ( place )9 ! abdom9al cavity4 ,! ribs are held up by ! c]vical fascia1 & ! abdom9al muscles are held up by ! ribs4 ,! hypotonic condition ext5ds to int]co/als & abdom9al muscles1 ) ! result t ! abdom9al muscles are unable to play _! "p 9 ma9ta9+ ! visc]a 9 _! prop] places4 ,! contraction or tonus ( ! abdom9al muscles1 ! ext]nal & int]nal oblique1 transv]salis1 rectus abdom9is1 diaphragm & levator ani1 ma9ta9 ! visc]a firmly 9 position4 ,x is only :5 ! muscles ( ! abdom9al wall h lo/ _! tone t any /ra9 or weight is ?r[n on ! p]itoneal & vascul> supports4 ,! inhibition ( ! re/ra9+ sympa!tic impulses via ! splan*nic n]ves1 all[s hyp]secretion & hyp]motility ( ! alim5t>y tubes & fur!r complicates ! cl9ical picture by a colicky di>rhea or spa/ic con/ipation4 ,!re are eight sph9ct]s ( circul> un/rip$ muscle 9 ! alim5t>y tract4 ,inhibition ( sympa!tic supply or increas$ autonomic supply causes sph9ct] insuffici5cy1 ov]/imulation by sympa!tic impulses or an insuffici5t supply ( balanc+ autonomic impulses causes sph9ct] spasm1 /asis1 vomit+1 f]m5tation1 putrefaction1 auto-intoxication4 ,at ea* ( ^! sph9ct]s food is held back & controll$ till ! prop] "t has elaps$ & ! prop] *emical environm5t is prep>$ = x 9 ! next portion ( ! tract4 ,normal function ( ^! sph9ct]s is absolutely ess5tial to normal metabolism & nutrition4 ,! upp] esophageal sph9ct] controls ! entrance to ! esophagus2 ! c>dia controls ! entrance to ! /oma*1 ! pylorus controls ! entrance to ! duod5um1 ! ,x-,ray %[s a duod5al sph9ct] t controls ! entrance ( food into ! jejunum4 ,"h ! food ent]s ! long tract ( ! jejunum & ileum :i* measures tw5ty-five feet :5 ! longitud9al muscles are relax$ & ! circul> muscles tonic1 & :i* a %ort "t lat] may measure only fifte5 feet :5 ! longitud9al muscles are contract$ & ! circul> are relax$4 ,?is section ends at ! ileo-cecal valve1 :i* controls ! entrance ( food into ! cecum4 ,!re is ! mid-colic sph9ct] ab\t ! junction ( ! proximal ?ird ) ! di/al two-?irds ( ! transv]se colon1 & ! recto-colic sph9ct] :i* controls ! passage f ! sigmoid to ! rectum4 ,! rectum ends 9 ! int]nal sph9ct] ani4 ,!re is "s evid5ce ( a n9? sph9ct]1 ! mid-ga/ric at ! po9t :]e ! p]i/altic waves ( ! /oma* beg94 ,absorption takes place mo/ly f ! ileum & jejunum & x is wor?y ( note t f\r ( ^! sph9ct]s hold ! food up on its way into ?is "p ( ! tract1 & f\r ( !m hold x back on its way out4 ,any lesion may affect "o or o!r ( ^! sph9ct]s4 ,x is believ$ t antip]i/alsis f ! mid-colic sph9ct] to ! cecum dur+ dige/ion is normal p]mitt+ m complete absorption ( n\ri%m5t4 ,yet "h1 aft] absorption is complete1 & at all times else:]e 9 ! alim5t>y tract1 p]i/alsis is normally =w>d because ! po9t ( highe/ irritability is at ! upp] esophageal sph9ct] & ! irritability decreases z ! tract is fur!r f ! esophagus4 ,:5 ! splan*nics are inhibit$ & ! vagus autonomic impulses are normal or increas$1 ! inte/9al sph9ct]s f ! pylorus d[n may all be incompet5t1 s t food passes along too rapidly to be prop]ly dige/$ & absorb$4 ,?is results 9 und]n\ri%m5t4 ,any lesion any:]e 9 ! body w affect p]i/alsis4 ,x beg9s at ! l[] ?ird ( ! /oma* :]e x jo9s ! pyloric portion & goes =w>d to ! int]nal sph9ct] ani1 be+ modifi$ 9 its c\rse by local conditions4 ,comp5sation may be e/abli%$4 ,_m cases ( di>rhea & con/ipation are ?us to be acc\nt$ =4 ,di>rhea is a symptom due to vasodilatation1 hyp]secretion & relaxation ( ! circul> muscles especially at ! sph9ct]s4 ,:5 ^! ?ree factors are cle>$ up by correction ( ! lesions & hyp]ext5sion ( ! sp9e1 ! di>rhea /ops unless "s o!r factor is at "w to irritate ! my5t]ic n]ves or to excite ! autonomics or inhibit ! splan*nics4 ,lesions f ! six? dorsal d[n are usually accompani$ at fir/ by "s di>rhea1 :i* aft]w>ds becomes con/ipation1 ?r\gh loss ( tone 9 ! longitud9al muscles especially 9 ! di/al "p ( ! colon4 ,9 ^! cases1 correction ( lesions1 & extreme flexion ( ! l[] dorsal & lumb> sp9e w give relief :ile ! body is return+ to normal4 ,:5 ga/ric dige/ion beg9s1 simultane\s action is set up 9 ! ileum4 ,:5 disease ( ! cecum1 app5dix or asc5d+ colon is pres5t1 !re is contraction ( ! ileo-cecal valve caus+ /asis ( ! l[] ileum & di/urb$ or ret>d$ action ( /oma* & duod5um4 ,^! reactions are br\ght ab\t by impulses to & f ! my5t]ic plexus4 ,! sympa!tic & autonomic n]ves affect ! motor sy/em ( ! alim5t>y tract n directly b ?r\gh ! my5t]ic or ,au]ba*'s plexus4 ,! ext]nal sph9ct] ani muscle is suppli$ by ! pud5dal n]ve f ! ?ird & f\r? sacral segm5ts4 ,x is 9 a /ate ( tonic contraction1 & hav+ no oppos+ muscles keeps ! anal orifice clos$4 ,! autonomic supply to ! longitud9al muscles 9 ! desc5d+ colon & rectum is f ! second & f\r? sacral4 ,inhibition "h w1 !re=e relax ! longitud9al muscles & ext]nal sph9ct] & p]mit free p]i/alsis 9 ! desc5d+ colon & rectum4 ,pelvic di/urbances may affect ^! n]ves1 or pressure due to visc]optosis1 etc4 ,! circul> muscles ( ?is section are suppli$ f ! lumb> cord4 ,!y may be affect$ 9 any lumb> lesion1 ) ! end result ( spa/ic con/ipation by reason ( a %ort5$ m>k$ly di/5d$ desc5d+ colon1 sigmoid & rectum1 & little p]i/alsis because ( inhibition ( ! circul> fib]s1 & contraction ( ! ext]nal sph9ct] ani4 ,! fundus ( ! /oma*1 ly+ 9 ! left dome ( ! diaphragm1 always conta9s a cu%ion ( air :i* supports ! left dome ( ! diaphragm1 z ! convexity ( ! liv] supports ! "r4 ,normally ! air is regulat$ & causes no symptoms4 ,a lesion1 usually ( ! mid-dorsal or l[] dorsal segm5ts may inhibit ! circul> fib]s & p]mit di/5sion1 :i* becomes enorm\s :5 ! pylorus is ob/ruct$4 ,! %ortness ( brea?1 palpitation ( ! he>t1 etc41 accompany+ ?is di/5sion are probably due to pressure on ! he>t & lungs f :i* ! /oma* is sep>at$ only by ! diaphragm4 ,eigh?1 n9? & t5? dorsal lesions play a l>ge "p 9 peptic ulc]s by p]mitt+ hyp]emia1 hyp]secretion1 & l[]$ vitality ( ! mucosa1 & pyloric incompet5ce or spasm1 because ! pylorus1 pyloric end ( ! /oma* & fir/ "p ( ! duod5um get _! *ief sympa!tic supply f ! n9? & t5? dorsal segm5ts ( ! cord4 ,! t5? v]tebra is m freely movable ?an ! high] dorsal jo9ts & is !re=e m frequ5tly 9 lesion1 :i* helps to acc\nt = ! great] frequ5cy ( duod5al ulc]4 ,! ma9 sympa!tic supply to ! app5dix seems to be d]iv$ f ! elev5? dorsal segm5t4 ,! app5dix has ! same motor & secretory me*anism z ! re/ ( ! alim5t>y tract b is ri*ly suppli$ ) lymphoid follicles4 ,"o ( ! twigs f ! elev5? dorsal n]ve pi]ces ! rectus muscle to supply ! sk9 at ,mc,burney's po9t1 ?us expla9+ ! great frequ5cy ( pa9 & cutane\s hyp]algesia at ?is situation 9 app5dicitis4 ,l[] dorsal & upp] lumb> lesions are unque/ionably causes ( _m cases ( app5dicitis & o!r obscure diseases traceable to app5dicitis4 ,correction ( ^! lesions has re/or$ ! app5dix & relat$ /ructures to normality 9 hundr$s ( cases4 ,s5sory reflexes are %[n 9 hyp]algesia & pa9 or t5d]ness 9 ! abdom9al sk9 & muscles & ! p>ietal lay] ( ! p]itoneum f ! ensi=m c>tilage to ! pubes 9 an area ext5d+ ab\t two in*es on ea* side ( ! mid-l9e1 correspond+ to ! di/ribution ( ! twigs ( ! l[] six ?oracic n]ves :i* supply s5sation to ?is region4 ,esophageal di/urbance at ! c>dia causes pa9 9 ! region suppli$ ) s5sation by ! fif? & six? dorsal1 ne> ! ensi=m4 ,ga/ric d]angem5t causes pa9 midway betwe5 ! ensi=m & umbilicus1 :i* radiates to ! left1 9 ! area suppli$ by ! eigh? dorsal4 ,hepatic di/urbance causes pa9 on ! "r ( ! m$ian l9e1 radiat+ to ! "r 9 ! s5sory di/ribution ( ! n9? dorsal4 ,inte/9al pa9 is locat$ 9 ! s5sory di/ribution ( ! t5? dorsal n]ve 9 an oval area ar\nd ! umbilicus4 ,pa9 due to duod5al ulc] is %>ply localiz$ at a po9t ab\t an in* or two above & to ! "r ( ! umbilicus :]e twigs ( ! t5? dorsal n]ve come to ! surface4 ,?is po9t corresponds closely to ! normal position ( ! und]ly+ duod5um1 ?\gh ! duod5um may be displac$1 & ! s5sitive spot rema9 at ! same po9t4 ,! pa9 f fundal ga/ric ulc] or c>c9oma is usually localiz$ %>ply ab\t an in* or two to ! "r ( ! m$ian l9e midway betwe5 ! ensi=m & umbilicus1 at ! spot :]e ! twigs f ! eigh? dorsal n]ve pi]ce ! rectus & come to ! surface4 ,9 ! disease ( ! pylorus1 reflex pa9 is l[]2 ( ! c>diac end1 high]4 ,! reflex pa9 at ,mc,burney's po9t 9 app5dicitis has be5 ref]r$ to1 b x mu/ be borne 9 m9d t pa9 f di/urbance 9 ! colon also %[s 9 ! s5sory di/ribution ( ! elev5? dorsal n]ves midway betwe5 ! umbilicus & pubes4 ,pa9 may also be ref]r$ to areas suppli$ 9 ! back by ! correspond+ segm5ts4 ,^! reflex pa9s c usually be /opp$ by inhibit+ along ! sp9e correspond+ to ! s5sory area affect$4 ,?is r$uces ! impulses ent]+ ! po/]ior roots & l[]s ! irritability ( ! segm5t4 ,! motor reflexes f ga/ro-inte/9al di/urbances result 9 muscul> contractures ( sp9al1 abdom9al & o!r muscles suppli$ by motor n]ves aris+ 9 ! ant]ior horn ( ! segm5t :i* inn]vates ! "p ( ! viscus t is affect$4 ,/oma*1 liv]1 gall-bladd]1 pyloric & duod5al di/urbances cause increas$ tone1 contraction1 contracture & rigidity ( ! rectus muscles above ! umbilicus1 = in/ance1 & ! o!r visc]a contract x 9 l[] portions4 ,m important are ! extreme contractures ( ! musculature ( ! back :i* is suppli$ by ! segm5ts :i* supply ! affect$ "p ( ! viscus4 ,^! contractures produce "s di/ortion & loss ( motion 9 sp9al jo9ts & !reby produce ! same effects z prim>y lesions1 caus+ widespread di/urbance :i* p]si/s until ! sp9al musculature is normaliz$4 ,9 colic1 ! lumb> segm5ts be+ involv$1 !re is m>k$ contraction ( ! ilio-psoas :i* causes ! *>act]i/ic draw+ up ( ! ?ighs on ! abdom51 :ile ! extreme contraction ( ! rectus abdom9is draws ! ?orax d[n4 ,mo/ p]si/5t vomit+ may arise reflexly f o!r organs z 9 s-call$ bili\sness1 jaundice1 pregnancy1 bra9 affections1 app5dicitis1 onset ( acute infecti\s diseases1 alcoholism1 sea-sickness1 colic1 h]nia1 inte/9al ob/ruction1 migra9e1 %ock1 & ane/hesia4 ,irritation ( any s5sory bran* ( ! vagus or ( n]ves :i* connect ) x 9 ! m$ulla1 or reflexly f consci\sness via ! c]ebral cortex1 z 9 ! case ( nauseat+ sights1 smells1 ta/es1 z well z irritation f any visc]a inn]vat$ f ! six? dorsal d[n1 may ov]/imulate ! correspond+ eff]5t n]ves go+ to p>ts ( ! alim5t>y tract suppli$ by t segm5t1 increase its irritability & />t antip]i/alsis4 ,simil>ly di/urbances 9 almo/ any viscus may reflexly di/urb ! normal balance betwe5 sympa!tic & vagal autonomic /imuli result+ 9 hyp]salivation1 hyp]*lorhydria1 pylorospasm1 di/5sion1 ga/ric atony1 ga/rosulcorrhea1 ent]ocolitis1 spa/ic con/ipation1 a*ylia1 or colicky di>rhea4 ,9 ^! cases1 ! d]angem5t ( ! viscus reflexly di/urbs ! alim5t>y tract ?r\gh c5tral n]ve connections4 ,correction ( ! prim>y tr\ble is foll[$ by removal ( ! reflex symptoms4 ,9 ?is connection x is important to note t ! visc]al reflex symptoms may arise f irritation ( ! alim5t>y tract by improp] diet1 poor cook+1 or wrong comb9ations4 ,c>bohydrates dige/ quick] ?an prote9s1 & ^! m rapidly ?an fats4 ,food is h&l$ by ! fundus 9 ! ord] 9 :i* x 0 swall[$4 ,if ! fats are swall[$ fir/1 ! />*es may be held up = five or six h\rs1 subject$ to ! acid /oma* secretions & all[$ to f]m5t caus+ di/5sion1 :i* reflexly produces a v>iety ( symptoms4 ,m5tal ex]tion1 /rong emotions1 heavy physical ex]tion1 int]f]e ) ! function ( ! alim5t>y tract & set up di/urbances 9 ! balance ( sympa!tic & vagal autonomic impulses1 ?r\gh ! n]v\s reflexes via ! cortex1 & ?r\gh ! dem& = blood1 :i* impov]i%es ! abdom9al circulation at a "t :5 x ne$s all ! blood x c get4 ,! is*emia produc$ 9 ?is way has ab\t ! same effect z is*emia produc$ by a sp9al lesion4 ,conv]sely1 di/urbances ( ! alim5t>y tract produce pr(\nd *anges 9 "* & p]sonality1 by reflexes to ! c]ebral cortex caus+ dullness ( p]ception1 9 all ! s5ses1 poor memory1 sluggi% ?\ght1 erratic judgm5t1 irritable disposition1 fe>1 worry1 lack ( ambition1 indecision1 lack ( en]gy1 vacillation1 & f9ally a psy*osis 9 :i* manic depressive symptoms are balanc$ by p>anoiac symptoms4 ,! alim5t>y tract is s intimately b\nd up ) ! :ole /ream ( vital activity1 :e!r vegetative1 s5sorimotor1 or psy*ic1 t any di/urbance ( body or m9d is likely to affect x 9 "s "p1 & conv]sely any di/urbance ( ! alim5t>y tract is b\nd to affect all ! re/ ( ! body & ! m9d4 ,a satisfactory classification ( its diseases is !re=e difficult to make1 b ! "o "h adopt$ is probably ! be/ = ! purpose4 ,! e>ly /ages ( ga/ro-inte/9al diseases are (t5 s simil> t x is ne>ly impossible to diff]5tiate !m ) c]ta9ty2 ! classification is !re=e bas$ on ! cl9ical picture & pa?ology ( advanc$ /ages4 ,=tunately1 ) ! exception ( canc]1 diseases treat$ 9 ! e>ly /ages usually cle> up :5 ! lesions are correct$1 & ! necess>y att5tion giv5 to ! o!r causative factors pres5t4 ,acute ,ga/ritis ,acute dyspepsia is "o ( ! frequ5t disord]s ( ! /oma*4 ,x may occur z an e>ly symptom ( an infecti\s disease1 b v (t5 x is due to "s non-specific irritation4 ,! usual excit+ causes are errors ( diet1 ov]-indulg5ce 9 improp]ly cook$ & highly season$ food1 or food t has be5 spoil$1 su* z meat1 fi% & milk1 or ov] or "u ripe fruit4 ,food t is ei!r too hot or too cold may develop an attack4 ,alcohol is a common cause 9 ^? n accu/om$ to its use4 ,ov]use ( tobacco may br+ on an attack4 ,_m acute 8bili\s0 attacks are br\ght ab\t by "s m5tal %ock or excitem5t at ! "t ( tak+ food1 = x has be5 %[n by ! rese>*es ( ,pawl[ t bo? ga/ric motion & secretion are alt]$ by m5tal irritation dur+ dige/ion4 ,unque/ionably o/eopa?ic lesions ( ! splan*nics & vagi are important pr$ispos+ factors4 ,^! lesions produce a l[]$ resi/ance ( ! tissues1 :i* w frequ5tly expla9 :y c]ta9 excit+ factors t w initiate an attack 9 "o individual w n d s 9 ano!r4 ,a heal?y mucosa w n be s readily irritat$ by ei!r indige/ible or p>tly decompos$ food4 ,o/eopa?ic exp]im5tal "w reveals t ! v]tebral & rib lesions readily affect bo? ! sp9al n]ves & ! sympa!tic ganglia1 :i* is foll[$ by vasomotor & trophic disord] to ! muc\s & submuc\s coats ( ! /oma*1 z %[n by eccymosis & hemorrhage ( ! submucosa & beg9n+ p>5*ymat\s deg5]ation ( ! free ends ( ! gl&s ( ! mucosa4 ,^u ! o!r h& irritation ( ! muscles f dietetic errors always causes m or less contraction ( ! muscles 9 ! upp] & middle dorsal1 :i*1 9 turn1 may produce ?r\gh imbalance ( t5sion & fibrositic *anges1 con/ant int]osse\s lesions & ?us be ! cause ( ! cat>rh becom+ *ronic4 ,?is vici\s cycle ph5om5on %\ld n be ov]look$4 ,visc]o-motor1 visc]os5sory & visc]otrophic reflexes may be factors 9 ! pa?og5esis ( ! o/eopa?ic lesion4 ,pa?ologically1 ! muc\s membrane is m or less cov]$ ) mucus4 ,^u removal ( ! mucus ! membrane is f\nd r$ & swoll51 & ! epi!lial cells ( ! gl&s are granul>4 ,?is is especially not$ 9 ! pyloric area4 ,!re are m9ute extravasations ( blood & hemorrhages ( ! muc\s coat1 & infiltration ( ! submuc\s lay]4 ,symptoms4--,acute ga/ritis occurs at all ages1 s p>ticul>ly 9 *ildr5 c>e has to be tak5 t ! attack is n ! beg9n+ ( "s infecti\s disease4 ,a c>eful inquiry into ! hi/ory1 & exam9ation ( ! vomitus w usually make ! diagnosis cle>4 ,! sudd5 onset ( nausea1 vomit+1 pa9 9 ! epiga/ric region ref]r$ to ! back & head1 v]tigo 9 "s cases1 if ! infections c be rul$ out %\ld leave no d\bt z to ! nature ( ! disord]4 ,o!r symptoms are weakness1 & *ill9ess :i* lat] if ! attack is sev]e1 is foll[$ by fev]4 ,! tongue is coat$1 ! lips dry1 & !re may be h]pes4 ,bel*+ ( gas1 con/ipation 9 "s & di>rhea 9 o!rs1 & d>k color$ ur9e are noticeable4 ,!re is t5d]ness on palpation ov] bo? ! /oma* & splan*nic areas4 ,exam9ation ( ! /oma* cont5ts %[ defici5t hydro*loric acid1 ! pres5ce ( organic acids1 bile & undige/$ food1 & consid]able mucus4 ,diagnosis4--,9 "y *ildr5 acute ga/ric indige/ion is common1 ?\gh a casual ga/ritis is r>e4 ,9 ! =m] pro/ration1 vomit+1 & undige/$1 gre5i% /ools are not$4 ,9 "s cases !re is no fev]1 :ile 9 o!rs x may range f #ajb to #aje degrees4 ,9 all cases c>e %\ld be tak51 z has be5 /at$1 t ! attack is n ! beg9n+ ( "s infecti\s disease4 ,app5dicitis1 acute b[el con/riction1 pregnancy1 uremia1 m5+itis1 gall-/one colic1 & ga/ric crises ( tabes dorsalis %\ld be diff]5tiat$4 ,mo/ attacks ( acute dyspepsia are ov] 9 tw5ty-f\r h\rs4 ,! prognosis dep5ds ^u elim9at+ ! cause4 ,! ,x-ray may be ( value 9 protract$ cases4 ,treatm5t4--,if ! case is se5 e>ly1 empty+ ! /oma* by induc$ vomit+ or ! /oma* tube is ! fir/ indication4 ,if sev]al h\rs h elaps$ & mu* ( ! /oma* cont5ts h pass$ into ! inte/9e1 empty+ ! colon ) an enema w commonly give quick relief4 ,)hold all food = f twelve to tw5ty-f\r h\rs1 or long] if necess>y4 ,9 "s cases ! sipp+ ( hot wat] w be b5eficial1 :ile 9 o!rs pellets ( ice 9 ! m\? w give "s relief4 ,:e!r or n !re exi/$ previ\s sp9al lesions !re w always be f\nd muscul> t5sion & sp9al rigidness dur+ an attack ( acute ga/ritis4 ,^! %\ld be correct$ = imm$iate relief1 b :at is ( great] importance1 if ^! acute lesions are n correct$ ! pati5t's recup]ative =ces are int]f]$ ) & recov]y is delay$4 ,!n1 also1 ^! lesions t5d to *ronicity & pr$ispose to future attacks4 ,treatm5t %\ld be giv5 daily1 or (t5] if special indications arise4 ,?\gh ! mo/ common area t dem&s att5tion is f ! f\r? to t5? dorsals1 /ill ! vagi n]ves1 especially ! "r1 %\ld n be neglect$4 ,lesions ( ! upp] ?ree c]vicals are ! mo/ frequ5t di/urbances ( ! vagi4 ,vomit+ is a common & di/ress+ symptom4 ,pa?ologically1 x is due to an antip]i/altic contraction ( ! /oma* & a spasmodic contraction ( ! diaphragm & ! abdom9al muscles4 ,x is caus$1 usually1 by irritation ( ! vagus 9 ! /oma*1 or 9 ! ph>ynx by irritation along ! sp9e 7p>ticul>ly 9 ! c]vical & upp] dorsal regions71 or to ! sympa!tic n]ves or to v>i\s p>ts ( ! body1 or by direct influ5ce ( ! bra94 ,relief c usually be giv5 by inhibition ( ! vagus 9 ! occipital region or by inhibition at ! f\r? or fif? dorsal v]tebra on ! "r side4 ,9 a few in/ances1 plac+ ! pati5t 9 ! knee-*e/ position & g5tly rais+ ! abdom9al organs gives relief4 ,if ?is does n suffice ! /oma* & colon %\ld be empti$1 provid+ ! vomit+ is protract$4 ,a frequ5tly effective measure = nausea & vomit+ t c be c>ri$ out by ! att5dant1 is ! application ( hot fom5tations to ! dorsal sp9e4 ,flatul5cy may be v di/ress+4 ,! sp9al treatm5t may be suffici5t to control ?is condition1 or c>eful direct pressure = a few m9utes ov] ! pit ( ! /oma*4 ,adju/m5t ( ! l[] ribs1 especially ( ! left side1 may be effective4 ,occasionally ! gas c be pass$ into ! inte/9es by c>eful inhibitory treatm5t 9 ! region ( ! eigh? & n9? dorsals4 ,! inhibitory treatm5t causes relaxation ( ! pyloric orifice2 also1 inhibition ( ! left vagus relaxes ! pylorus4 ,inhibition at ! six? & sev5? dorsals relaxes ! c>diac orifice1 ?us favor+ ! pass+ ( ! gas f ! /oma* out ?r\gh ! esophagus4 ,9 all cases subject to ga/ritis ! dorsal sp9e %\ld receive consid]able att5tion 9 ord] t recov]y may be complete4 ,! habits ( ! pati5t %\ld be ?or\ghly regulat$ & ov]fatigue gu>d$ aga9/4 ,&1 also ( special importance 9 recurr+ attacks1 is ! fact t a numb] ( cases pres5t "s d]angem5t ( ! bili>y tract1 or duod5um1 or ! app5dix region4 ,diet4--,aft] tw5ty-f\r or =ty-eight h\rs1 if ! attack has be5 sev]e1 album9 wat] may be giv5 9 small quantities2 also :ey1 milk1 b\illon1 & *ick5 or lamb bro?4 ,if !re is no return ( ga/ric di/ress1 add junket1 cu/>d1 corn/>* pudd+1 gelat9e1 dropp$ eggs1 scrap$ beef1 & :ite meat ( *ick52 vegetables purees made ) cream or meat /ock are usually well borne at ?is "t4 ,foods conta9+ mu* cellulose1 fats & sweets %\ld be )held until all symptoms h subsid$4 ,*ronic ,ga/ritis ,x is unnecess>y "h to repeat ! causes ( acute ga/ritis1 any "o ( :i* cont9u$ ov] a long p]iod ( "t w cause *ronic cat>rh ( ! /oma*1 z x is sometimes call$4 ,sp9al & rib lesions any:]e f ! occiput to ! coccyx1 b m p>ticul>ly f ! f\r? to ! t5? dorsal1 w pr$ispose to *ronic ga/ritis1 ! p>ticul> type & degree ( local pa?ology dep5d+ ^u ! excit+ factor4 ,a commonly f\nd en bloc lesion is a flatt5+ ( ! normal convexity 9 ?is region1 ) m or less immobilization1 %[n by attempt+ to ree/abli% ! normal convexity ?r\gh flexion4 ,9 addition !re may be s+le sp9al or rib lesion 9 ! same area1 or c]vical lesions affect+ ! pneumoga/ric1 :i* is ! secretory n]ve to ! /oma*4 7,see *apt] on ! 8,lesion & ,its ,appli$ ,anatomy407 ,pa?ology4--,*ronic ga/ritis probably nev] develops z su* )\t go+ ?r\gh sev]al prelim9>y /ages beg9n+ ) alim5t>y hyp]secretion1 or hyp]secretion occurr+ only dur+ ! active p]iod ( dige/ion4 ,^! are ! cases usually classifi$ z hyp]*lorhydria4 ,at ?is "t no actual pa?ology c be demon/rat$ 9 ! gl&ul>is4 ,if ! condition is n treat$ intellig5tly at ?is "t ! next /ep w be p]iodic attacks ( :at is kn[n z 8hyp]secretion p]iodica *ronica0 foll[$ by 8hyp]secretion cont9ua *ronica40 ,! /oma* conta9s abnormal am\nts ( ga/ric juice ev5 aft] a night's re/4 ,at ?is /age !re is a transition f ! functional to ! organic condition4 ,all /ages are *>act]iz$ by an abundant secretion ( mucus4 ,if all[$ to g on !re w f9ally result a de/ruction ( ! secret+ cells kn[n z ,atrophic ,ga/ritis or ,a*ylia ,ga/rica 9 :i* ! /oma* pres5ts a smoo? functionless appe>ance4 ,second>y ,*ronic ,ga/ritis4--,portal ob/ruction f any cause pr$isposes to *ronic ga/ritis4 ,! mo/ common ( ^! is fail+ comp5sation 9 he>t lesions1 :i* ?r\gh back pressure causes portal /asis2 ! same ?+ may foll[ ob/ruction 9 ! liv] itself4 ,*ronic ga/ritis is also a late accompanim5t ( ! nephritic tr9ity1 kidneys1 he>t & art]ies4 ,x may also be associat$ ) diabetes1 g\t1 anemia & o!r con/itutional disord]s4 ,tub]culosis is commonly u%]$ 9 by symptoms ( *ronic ga/ritis4 ,we %\ld be con/antly on ! al]t to avoid ! mi/ake s commonly made ( treat+ ! /oma* z an entity & ov]look+ ! real tr\ble 9 "s o!r "p ( ! anatomy4 ,x is probably safe to say t !re are only two prim>y diseases ( ! /oma*1 ulc] & canc]4 ,all o!rs are suspici\sly associat$ ) diseas$ processes else:]e1 & :5 ! sp9al lesion is giv5 its full significance ev5 ^! w be f\nd to be directly traceable to anatomical p]v]sions some:]e )9 ! me*anism ( local nutrition4 ,symptoms4--,^! are gov]n$ by ! /age ( progress 9 :i* ! pati5t is se54 ,dur+ ! /age ( hyp]secretion ( acid ga/ric juice !re w be vague feel+s ( di/ress1 fullness & burn+ 9 ! /oma*1 & 8he>tburn0 dur+ dige/ion4 ,:5 ! /oma* is empty all symptoms w subside4 ,lat] !re w be p]iods ( a few days or weeks :5 !re w be m or less cont9u\s di/ress ) "s vomit+ ( highly acid ga/ric juice conta9+ mucus4 ,:5 ! condition has progress$ to ! /age ( cont9u\s hyp]secretion !re w be cont9u\s symptoms z above1 b ) nausea1 vomit+ becom+ m frequ5t especially late at night or 9 ! morn+1 always accompani$ by /icky mucus4 ,appetite is v>iable1 !re is (t5 a disagreeable ta/e 9 ! m\? 7! 8d>k br[n0 ta/e ( ! *ronic alcoholic74 ,he>t palpitation & v]tigo & o!r vagus symptoms are common4 ,diagnosis4--,on physical exam9ation ! /oma* is f\nd di/5d$1 & 9 "s cases displac$ 7ga/roptosis74 ,!re w be diffus$ t5d]ness on pressure ov] ! :ole organ :i* %\ld help to di/+ui% x f ga/ric ulc] or canc] 9 :i* ! t5d]ness is q localiz$4 ,*ronic ga/ritis _c be positively diagnos$ )\t mak+ a ga/ric analysis4 ,_m cases are wrongly diagnos$ ?r\gh neglect ( ?is v important proc$ure4 ,! cases 9 :i* ga/ric analysis %\ld be made are s well /at$ by ,lockwood t we w take ! lib]ty ( quot+ !m 9 _! entirety4 87#a7 ,ga/ric analysis %\ld always be made 9 e case ( dyspepsia1 no matt] :e!r ^! symptoms be app>5tly ga/ric or inte/9al1 unless passage ( ! tube is contra9dicat$4 87#b7 ,ga/ric analysis %\ld be made 9 e case ( *ronic di>rhea t is n due to evid5t disease ( ! colon or rectum4 87#c7 ,ga/ric analysis %\ld always be made 9 all cases ( inte/9al toxemia1 or recurr+ heada*e ( toxic orig91 & 9 pati5ts :o compla9 ( ! symptom complex :i* is spok5 ( by ! laity z #8bili\sness'4 87#d7 ,ga/ric analysis %\ld be made 9 all cases ( anemia & g5]al physical wret*$ness )\t kn[n cause & :i* are rebelli\s to treatm5t40 ,! f9d+ ( excessive ga/ric mucus intimately mix$ ) food remnants is ! *ief diff]5tial po9t 9 ! diagnosis ( *ronic ga/ritis4 ,diff]5tial ,diagnosis4--,a complete /atem5t ( diff]5tial diagnosis by ,kemp _c be well improv$ ^u4 8,,*ronic ,,ga/ritis4--,no sev]e pa91 no circumscrib$ spot1 pa9ful to pressure2 no hematemesis2 no ca*exia2 no m>k$ emaciation1 except 9 sev]e cases ( long duration2 free hydro*loric dim9i%$ or abs5t2 ga/ric mucus pres5t2 sl[ c\rse4 8,,ulc] ,,( ,,! ,,/oma*4--,hyp]*lohydria pres5t1 b n inv>iably s2 sev]e pa9 9 ! epiga/rium ) int]vals free f pa9 :5 /oma* is empty2 local t5d]ness :i* is circumscrib$2 dorsal pa92 hematemesis1 or occult blood 9 ! /ool or ga/ric cont5ts2 microscopic pus2 no mucus2 pati5t has appe>ance ( suff]+2 no true ca*exia4 8,,canc] ,,( ,,! ,,/oma*4--,age usually ov] =ty-five2 rapid c\rse2 free hydro*loric acid usually m>k$ly dim9i%$ or abs5t2 lactic acid pres5t2 pa9 g5]ally cont9u\s1 b n s acute z 9 ulc]2 ,boas-,oppl] bacillus2 ca*exia2 tumor on physical exam9ation2 small am\nt ( visible or occult blood2 hematemesis mu* less ?an ulc]2 f\l odor to vomitus at times pres5t4 8,,a*ylia ,,ga/rica4--,sl[ c\rse2 sc>cely any ga/ric juice2 acidity v l[ or entirely abs5t2 abs5ce ( peps9 & r5n92 usually no mucus or lactic acid4 8,^! diff]5tial consid]ations apply to typic cases1 & ! obs]v] mu/ be on ! qui vive = v>i\s gradations & modifications ( ^! cl9ical pictures40 ,prognosis4--,! outcome ( *ronic ga/ritis dep5ds ^u our ability to locate & remove e factor 9 ! etiology1 ! will+ness ( ! pati5t to coop]ate & ! pati5ce & res\rcefulness ( ! physician4 ,at be/ ! progress is sl[ & "o mu/ expect tempor>y setbacks usually due to failure ( ! pati5t to c>ry out in/ructions4 ,treatm5t4--,! mo/ successful treatm5t is prophylactic1 b until ! public has be5 educat$ up to ?is =m ( economy we mu/ beg9 ) conditions z we f9d !m4 ,fir/ get ! pati5t's confid5ce by mak+ an intellig5t exam9ation1 a sci5tific diagnosis1 & a reliable prognosis bas$ ^u y\r f9d+s4 ,all lesions1 bony1 ligam5t\s1 muscul> & psy*ic mu/ be intellig5tly & c>efully remov$4 ,specific lesions :i* w\ld directly or reflexly int]f]e ) ! n]ve & blood to ! /oma* mu/ be correct$4 ,! rigidness commonly f\nd 9 ! v]tebr & ribs ( ! splan*nic area mu/ be ov]come fir/ by specific adju/m5t1 & ! normal flexibility ma9ta9$ by tea*+ ! pati5t prop] ex]cises = ! purpose4 ,?is %\ld include deep brea?+ ) ! sp9e flex$ to ! limit1 & ! ribs fix$1 by ! pati5t rea*+ ar\nd z f> z possible & grasp+ ! ribs z describ$ by ,dr4 ,h>ry ,=bes4 ,?is w t5d to ov]come ! flat dorsal s *>act]i/ic 9 all ga/ro-inte/9al conditions4 ,direct manipulation ov] ! /oma* has no p>ticul> value & may be ev5 h>mful4 ,inasmu* z nausea & vomit+ & excessive gas =mation are only ! result ( hyp]secretion we _c expect to give m ?an tempor>y relief except by me?ods :i* remove causes4 ,mu* com=t may be giv5 by inhibition 9 ! splan*nic area4 ,9 sev]e cases x may be necess>y at times to wa% out ! f]m5t+1 irritat+ mass by ga/ric lavage4 ,outdoor life1 frequ5t vacations & *ange ( occupation are (t5 ( decid$ b5efit4 ,diet4--,indiscretions ( diet mu/ be avoid$ & ?is _c be too positively impress$ ^u ! pati5t4 ,x is always be/ to make a li/ ( foods to be tak5 = breakfa/1 lun* & d9n] & insi/ t no o!r foods be tak5 )\t fur!r in/ruction4 ,j :at ^! foods %all be dep5ds ^u ! ga/ric secretions z %[n by ga/ric analysis4 ,!y %\ld always be nutriti\s & giv5 9 quantities suffici5t to ma9ta9 nutrition4 ,! /oma* %\ld h re/ & yet is expect$ to d its "p 9 ! process ( dige/ion4 ,all foods mu/ be giv5 9 a f9ely divid$ =m & well ma/icat$ to sp>e ! /oma* ! me*anical ef=t ( gr9d+4 ,9 hyp]acid ga/ritis all foods ( an irritat+ nature mu/ be positively prohibit$4 ,! classical breakfa/ ( grapefruit1 oatmeal1 ham & eggs & c(fee w n d4 ,/>*y foods mu/ be r$uc$ ow+ to _! t5d5cy to f]m5t 9 ! pres5ce ( highly acid juice & ! delay 9 ! /oma* due to ! high acidity4 ,9 subacid ga/ritis advantage mu/ be tak5 ( ! fact t c>bohydrates dige/ well & prote9s d n4 ,diet = ,hyp]acid ,ga/ritis4--,be=e breakfa/3 ,wa% ! /oma* ) w>m wat] & an ounce ( ,phillips ,milk ( ,magnesia1 all[+ ! wat] to rema9 9 ! /oma* #bj m9utes or a half h\r1 ly+ d[n & turn+ f side to side on ! face 9 ord] t ! wat] & magnesia may be br\ght 9 contact ) all p>ts ( ! /oma*4 ,= breakfa/3 ,prunes1 all[$ to simm] = f\r h\rs1 )\t boil+1 & put ?r\gh a col&]1 to remove ! sk9s4 ,s(t c]eals1 su* z f>9a1 cream ( :eat1 or :eatlet1 ?or\ghly cook$1 & s]v$ ) middle heavy cream1 no sug>4 ,two eggs1 s(t boil$1 or poa*$4 ,zweiback1 ?or\ghly ma/icat$1 ) a lib]al quantity ( butt]4 ,cocoa 7,phillips74 ,lun*eon3 ,puree ( peas1 beans or l5tils1 made ) cream4 ,asp>agus1 gre5 peas1 boil$ rice1 sp9a* *opp$ v f9e1 cream$ c>rots1 boil$ onions1 bak$ potato1 well done4 ,*ick51 boil$ lamb or beef1 gr\nd2 oy/]s 9 any =m b fri$2 fre% fi%4 ,dess]ts3 ,*oice ( junket1 corn/>*1 cu/>d1 rice pudd+1 float+ isl&1 gelat9e or tapioca4 ,ev5+ meal3 ,same z lun*eon except sub/itut+ eggs = meat4 ,cup ( hot wat] be=e lun*eon & d9n]4 ,if pati5t requires quick build+ up give milk betwe5 meals & at b$-"t4 ,ga/ric ,neuroses ,ga/ric neuroses include motor1 s5sory & secretory d]angem5ts4 ,?\gh ! s5sory di/urbance is (t5 ! mo/ m>k$1 /ill motor & secretory symptoms are usually pres5t4 ,9 o!r words !re is commonly a complex ( ! diff]5t =ms4 ,:]e ga/ric neuroses c be positively diagnos$1 by a process ( elim9ation1 !re is no m plausible explanation ?an t ( ! sp9al lesion4 ,! success ( o/eopa?ic physicians 9 treat+ s-call$ 8/oma* tr\ble0 proves conclusively ! sup]iority ( ! o/eopa?ic me?od4 ,a note ( w>n+ %\ld be s\nd$1 h[ev]1 = z diagno/ic me?ods h become m exact x is f\nd t _m cases :i* 7 =m]ly diagnos$ z neuroses prove to be ref]r$ f "s organic *ange1 su* z infect$ gall bladd]1 app5dix1 tube or ov>y1 tonsil1 too? or s9us4 ,x has be5 prov5 t _m cases ( s5sory & secretory di/urbances h entirely cle>$ up :5 ^! causes h be5 remov$4 ,?\gh infection may play an important role1 /ill 9 "s in/ances1 especially gall bladd]1 duod5um & app5dix1 ! ga/ric neurosis may be simply due to a n]v\s reflex4 ,ga/roptosis1 atony1 & 9 _m cases splan*noptosis1 has be5 f\nd to be ! und]ly+ cause ( _m hi!rto unacc\ntable ga/ro-inte/9al symptoms4 ,ga/ric crisis ( locomotor ataxia if n prop]ly diagnos$ by ! f9d+ ( ! o!r well kn[n symptoms may give u mu* tr\ble & disc\ragem5t4 ,ulc] & canc] h q *>act]i/ic symptoms1 yet x is well kn[n t !y are (t5 treat$ z neuroses 9 ! e>ly /ages1 mu* to ! detrim5t ( ! pati5t1 especially if ! case proves to be canc]4 ,9 ! s5sory di/urbances1 :i* are probably ! mo/ common1 hyp]e/hesia & neuralgia are ! special features4 ,9 ! =m] a feel+ ( weight1 fullness & burn+ are compla9$ (1 :i* are frequ5tly manife/ations ( a neurotic temp]am5t4 ,9 fact1 hy/]ia & neura/h5ia are v (t5 basic conditions4 ,! same is true 9 ga/rodynia1 :]e ! pa9 />ts 9 ! pit ( ! /oma* & ext5ds ar\nd ! l[] *e/ & ribs4 ,!re may be o!r neurotic symptoms su* z excessive hung] & a con/ant desire = food4 ,m5/rual irregul>ities1 ! m5opause1 worry1 con/ipation1 & anemia are important factors4 ,special c>e %\ld be tak5 t !re is no organic disord] ( ! ga/ro-inte/9al tract or ( ! n]v\s sy/em4 ,! motor neuroses comprise a v>iety ( d]angem5ts4 ,excitation ( ! motor functions ( ! /oma*1 z a direct result ( irritat$ n]ves or ( reflex /imuli1 are n uncommon4 ,ow+ to ?is ! food may n rema9 9 ! /oma* long en\gh or ! /oma* activity may be too pron\nc$4 ,!re may be also m or less rapid vomit+ ( ! food1 )\t any p>ticul> /ra94 ,o!r motor neuroses may be spasms ( ei!r ! c>diac or pyloric sph9ct]s1 & 9 a few in/ances !re may be atony ( ! /oma* walls4 ,al?\gh ^! conditions may be ( a neurotic "*1 /ill great c>e %\ld be tak5 t "s organic disease is n basic4 ,! secretory d]angem5ts consi/ ( hyp]acidity1 sup]secretion1 & less5$ am\nt ( acid secretion or a*ylia ga/rica4 ,_m ( ^! cases are associat$ ) hy/]ia & neura/h5ia1 ?\gh 9 a*ylia ga/rica1 canc] may be ! cause4 ,hyp]acidity may be associat$ ) ulc]4 ,pelvic diseases1 n]v\s reflexes f ! ga/ro-inte/9al tract1 con/ipation1 & anemia are to be consid]$ z possible etiological factors4 ,diagnosis4--,^! cases require ! mo/ pa9/ak+ inquiry into ! hi/ory1 ! mo/ complete physical exam9ation1 & all f9d+s c>efully *eck$ up by laboratory te/s4 ,inquiry w (t5 %[ t all symptoms subside :5 on a vacation ) a *ange ( sc5e & climate4 ,lockwood gives ! foll[+ rules = arriv+ at a diagnosis ( 8n]v\s indige/ion40 87#a7 ,a diagnosis ( n]v\s indige/ion %\ld n be made 9 ! pres5ce ( m ?an #cj c4 c4 ( fluid 9 ! fa/+ /oma*1 ! fluid giv+ a /rong reaction = hydro*loric acid4 ,hyp]secretion is g5]ally an expression ( pyloric /5osis1 organic or spasmodic1 & ?is is due to an organic cause4 87#b7 ,a diagnosis ( n]v\s indige/ion %\ld n be made 9 ! pres5ce ( p]si/5t hyp]acidity accompani$ by epiga/ric pa94 ,n]v\s hyp]*lorhydria may occur1 b is n accompani$ by ei!r pyrosis or pa94 ,! association ( ei!r ( ^! latt] symptoms %\ld sugge/ an organic orig9 = ! compla9t4 87#c7 ,a*ylia ga/rica may be ( n]v\s orig91 b ?is is n probable :5 s]i\s motor error is 9 evid5ce4 ,a*ylia ) food-/agnation is /rongly sugge/ive ( canc] ( ! /oma*4 87#d7 ,a*ylia ga/rica1 accompani$ by pa9 or vomit+1 indicates an und]ly+ organic cause4 87#e7 ,! diagnosis ( n]v\s indige/ion %\ld n be made :5 recognizable food rema9s are repeat$ly f\nd 9 ! fa/+ /oma*4 ,"u ! influ5ce ( fe>1 n]v\s %ock1 or vicissitudes ( temp]am5t ! motor functions may be tempor>ily int]f]$ )1 b ?is w\ld n be ! case p]man5tly4 87#f7 ,! diagnosis ( n]v\s indige/ion %\ld n be made :5 epiga/ric di/ress or pa9 occurs regul>ly at a def9ite "t aft] eat+4 ,! v fact ( ?is di/urbance com+ on at a def9ite "t argues aga9/ a neurosis4 87#g7 ,! diagnosis ( n]v\s indige/ion %\ld n be made :5 "o symptom alone p]si/s1 )\t o!r evid5ces ( n]v\s in/ability4 ,! pres5ce ( "o def9ite symptom 9 itself presupposes an organic cause4 87#h7 ,! physician %\ld be on ! qui vive = drug addictions1 = ^! habitues c sometimes pres5t a syndrome ( symptoms t w puzzle ! mo/ exp]i5c$4 87#i7 ,! diagnosis ( n]v\s indige/ion %\ld n be made 9 p]sons ov] =ty or =ty-five1 9 :om indige/ion is a new symptom4 ,su* pati5ts are usually develop+ a s]i\s sy/emic or malignant disord]4 87#aj7 ,f9ally1 dige/ive n]v\s neuroses & organic disease may be concomitant1 & ! pres5ce ( ei!r ne$ n exclude ! o!r40 ,treatm5t4--,fir/ get ! pati5t's confid5ce by mak+ a mo/ complete exam9ation4 ,?is desirable beg9n+ is usually ha/5$ by ! o/eopa?ic physician1 :5 aft] a few treatm5ts symptoms are greatly reliev$4 ,correct all lesions :]ev] f\nd1 p>ticul>ly ^? anatomically connect$ ) ! /oma*4 ,:5 ! symptoms are s5sory relief c always be giv5 by inhibition ov] ! splan*nic area4 ,occasionally ! ensi=m process & ! l[] co/al c>tilages are lesion$4 ,diet4--,:5 hyp]*lorhydria is ! *ief symptom foods mu/ be select$ :i* b9d acidity or ^? :i* less5 its secretion1 su* z milk1 eggs1 cream *eese1 fats su* z butt]1 cream1 olive oil1 boil$ or broil$ fre% fi%1 boil$ beef or lamb run ?r\gh a gr9d]1 oy/]s 9 any =m b fri$1 :ite meat ( *ick51 vegetable puree made ) cream or milk 7no meat /ock71 gelat9e1 cu/>d1 junket or sponge cake4 ,_m neurotic pati5ts are "u-n\ri%$ ?r\gh fe> ( food4 ,!y mu/ be positively assur$ t if ! food is well *os5 & c>efully ma/icat$ !re ne$ be no fe> ( discom=t4 ,c>e %\ld be tak5 t ! pati5t is n con/ipat$4 ,"s cases c only be rea*$ by a 8re/ cure0 ( f\r to six weeks1 :i* toge!r ) ! treatm5t outl9$ above w prove mo/ satisfactory4 ,9 all cases gu>d aga9/ worry & ov]fatigue4 ,build up ! g5]al heal? z rapidly z possible4 ,outdoor life1 suffici5t sleep1 frequ5t vacations1 & *ange ( sc5e are specially b5eficial4 ,ga/ric & ,duod5al ,ulc] ,/ati/ics %[ t peptic ulc] is f> m preval5t ?an is suppos$ by ! casual obs]v]4 8,9 ! comb9$ /ati/ics ( #ei1dej autopsies ( v>i\s s]ies evid5ce ( heal$ or unheal$ ulc] 7 obs]v$ 9 #d4d p] c5t40 7,bassl]47 ,! reason = ?is is t peptic ulc] may pres5t v def9ite symptoms :i* are readily int]pret$ or !y may be s atypical z to make def9ite diagnosis impossible4 ,l all ga/ro-inte/9al diseases1 _m ( ! symptoms are easily confus$ ) s-call$ indige/ion or 8/oma* tr\ble40 ,etiology4--,"o *>act]i/ic ( ga/ric & duod5al ulc] is t x only occurs :]e ! muc\s membrane is subject to ! influ5ce ( hydro*loric acid & peps92 l[] end ( esophagus1 /oma* & fir/ "p ( duod5um4 ,simil> ulc]s are (t5 f\nd 9 ! sigmoid & rectum :]e ! feces (t5 become acid due to bact]ial action1 or on acc\nt ( sl[ movem5t1 hydro*loric acid & peps9 :i* may h escap$ neutralization 9 ! duod5um may attack ! mucosa4 ,= ! "p play$ by sp9al & rib lesions on ! gl&ul> lay] ( ! /oma*1 ! read] is ref]r$ to a previ\s discussion ( ! lesion4 ,probable second>y causes ( ga/ric ulc] are3 7#a7 ,embolism ( an art]y 7ga/ric art]ies are t]m9al74 ,^! emboli are suppos$ to be caus$ by toxic & infecti\s ag5cies :i* ent] ! circulation1 z sometimes occurs 9 pyemia & l>ge burns ( ! sk94 7#b7 ,:ile hydro*loric acid associat$ ) peps9 seems to be an important factor1 x is d\btful :e!r x c attack ! mucosa )\t !re be+ a previ\s abrasion or o!r injury4 ,x is said t a normal secretion ( mucus is nature's protection aga9/ self dige/ion4 ,! swall[+ ( sub/ances ( a co>se or irritat+ nature or ^? *emically corrosive or at extremely high temp]ature may s injure ! muc\s membrane z to p]mit an attack by ,h,cl & peps94 ,c]ta9 occupations seem to pr$ispose to ga/ric ulc]1 su* z cobbl]s1 or o!rs :o 9 _! "w press v>i\s objects aga9/ ! /oma*4 ,%>p bl[s ov] ! /oma* h be5 foll[$ by acute ulc]4 ,a frequ5tly associat$ condition is ga/roptosis1 :i* seems to be expla9$ on ! basis ( n>r[+ ( ! blood vessels & _! m ready occlusion4 ,probably sagg+ ( ! duod5um is an important pr$ispos+ factor4 ,anemia & *lorosis %\ld n be ov]look$ z pr$ispos+ causes4 ,& tub]culosis & syphilis are possible associat$ disord]s4 ,( all ! !ories advanc$1 ! l[]+ ( vitality1 due to lesions ( ! splan*nics & vagus n]ves rema9s ! mo/ logical4 ,symptoms4--,! mo/ *>act]i/ic symptom is pa91 :i* 9 a typical case comes on at a regul> "t aft] tak+ food4 ,x may be a half h\r1 an h\r or two h\rs1 & 9 ! case ( duod5al ulc] may be z late z f\r h\rs4 ,! di/ance beyond ! c>dia at :i* ! ulc] is locat$ seems to gov]n ! "t2 also ! "t at :i* ! secretion ( hydro*loric acid rea*es its height1 :i* v>ies 9 diff]5t individuals4 ,! pa9 is due to free acidity 7t :i* is n comb9$ ) ! food7 irritat+ ! raw surface ( ! ulc]4 ,pa9 is (t5 increas$ or less5$ by po/ure4 ,if turn+ on ! left side gives relief ! ulc] is probably at ! pylorus2 if worse :5 /&+ ?an recl9+ ! ulc] is probably on ! great] curvature4 ,! pa9 is usually localiz$ by ! pati5t1 & pressure at ! giv5 spot increases ! pa94 ,9 _m cases !re is ref]r$ pa9 9 ! region ( ! #i?1 #aj? & #aa? ribs on ! left side4 ,at ! height ( pa9 vomit+ may occur1 due probably to pylorospasm result+ f high acidity4 ,vomit+ always gives relief4 ,! tak+ ( prote9 food or alkali w usually relieve ! pa9 ( ulc]1 7hung] pa974 ,ulc] pati5ts are usually well n\ri%$ ow+ to ! habit ( reliev+ !mselves by eat+1 or !y may be ?9 due to _! fe> ( food4 ,9 acute ulc] frank blood may %[ 9 ! vomit1 & may be ! fir/ indication ( tr\ble1 :]eas 9 ! *ronic type x may be occult1 or occult blood may be f\nd 9 ! feces4 ,! hemorrhage ( ulc]1 unlike t ( canc]1 is n con/ant4 ,diagnosis4--,diagnosis ( duod5al ulc]1 z di/+ui%$ f ga/ric1 is made by f9d+ ! t5d] spot to ! "r & bel[ ! pylorus1 ! pa9 com+ on ?ree or f\r h\rs aft] tak+ food1 & ! f9d+ ( blood 9 ! feces 7t>ry /ool7 & n 9 ! /oma* cont5ts4 ,repeat$ exam9ations may be necess>y ow+ to ! fact t hemorrhage is n con/ant4 ,! l>ge p]c5tage ( /oma* ulc]s are ne> ! pylorus1 & ( ! duod5al ulc]s ! asc5d+ portion is ! area almo/ inv>iably involv$4 ,ulc] is diff]5tiat$ f functional disord]s by a hi/ory ( real pa9 z di/+ui%$ f ! vague di/urbances ( s5sation (t5 call$ pa9 by neurotic pati5ts4 ,also its regul> appe>ance 9 relation to food4 ,! pa9 ( 8ga/ralgia0 has no regul> habit & is n influ5c$ by food4 ,ref]r$ pa9 f *olecy/itis1 *ronic app5dicitis1 etc4 has no relation to food & is n reliev$ by food or alkalies4 ,ulc] is to be di/+ui%$ f canc] by ! age ( ! pati5t 79 canc] usually ov] #dj7 ) a previ\sly good ga/ric hi/ory1 except 9 cases :]e canc] has be5 graft$ on to a *ronic ulc]4 ,9 ^! cases a c>eful inquiry w br+ out a *>act]i/ic ulc] hi/ory up to a c]ta9 "t1 :5 all symptoms *ange2 pa9 becomes con/ant2 is n reliev$ by food or alkali2 vomit becomes d>k 9 color & has a *>act]i/ic odor1 appetite fails1 & signs ( ca*exia set 94 ,ga/ric ulc] %\ld be suspect$ 9 all cases ( p]si/5t ga/ric symptoms :i* are n readily reliev$ by treatm5t & regulation ( diet1 & 9 :i* !re is f\nd high acidity & cont9u\s hyp]secretion n accompani$ by mucus4 ,! ,x-ray & ga/ric analysis %\ld nev] be neglect$ 9 suspect$ cases1 keep+ 9 m9d ! possible injury f ! tube 9 case ( rec5t hemorrhage4 ,treatm5t4--,o/eopa?ic treatm5t ( ga/ric ulc] w be almo/ uni=mly successful if we w analyze all ( ! factors ent]+ into ! problem4 ,x is obvi\s t 9 ord] to heal ! ulc] we mu/ remove all factors :i* int]f]e 9 any way ) nutrition4 ,!n give ! /oma* z ne> absolute re/ z possible :ile at ! same "t build+ up ! nutrition by a g5]\s b well *os5 diet4 ,:5 acute hemorrhage has rec5tly occurr$1 complete re/ 9 b$ ) a tra9$ nurse 9 att5dance is ! fir/ indication4 ,complete re/ ( ! /oma*1 all n\ri%m5t be+ giv5 by nutri5t enema4 ,an ice bag is to be plac$ ov] ! /oma*1 & remov$ e ?ree or f\r h\rs to all[ surface circulation to react4 ,w>m applications %\ld n be us$ :ile !re is any m>k$ ble$+4 ,dur+ ?is p]iod no ef=t on ! "p ( ! pati5t %\ld be p]mitt$1 & no manipulative treatm5t :i* w\ld t5d to increase blood pressure %\ld be giv54 ,aft] all evid5ce ( hemorrhage has ceas$ = t5 days1 or at once 9 case ( *ronic ulc]1 we may c>efully correct all sp9al or rib lesions 9 ! splan*nic area especially ! #f? dorsal1 or c]vical lesions affect+ ! pneumoga/ric4 ,pa9 & pylorospasm may be reliev$ by /eady pressure at ! #d? & #e? dorsal on ! "r side4 ,aft] sp9al lesions h be5 correct$ )\t unduly irritat+ ! /oma*1 c>eful relax+ treatm5t %\ld be giv5 ) ! pati5t on ! back1 keep+ 9 m9d t all ex]tion w t5d to irritate ! ulc]4 ,if special c>e is obs]v$1 frequ5tly def9ite relief may be giv5 by plac+ pati5t 9 knee-*e/ position & g5tly rais+ ! l[] portion ( duod5um :]e x lies alongside ( asc5d+ #crd & colon1 #d? lumb>4 ,dur+ ?is p]iod a hot wat] bag or a !rmal pad %\ld be kept ov] ! /oma* night & day4 ,9 c]ta9 cases ( p]=ation 9 a few ob/9ate conditions1 & 9 a few :]e me*anical ob/ruction is m>k$1 surg]y may be indicat$4 ,! foll[+ diet w be f\nd be/ dur+ ! fir/ week3 #g ,a4 ,m4 ,a half glass ( cook$ milk1 ) ! lea!ry sub/ance :i* rises on ! top remov$1 & ! yolk ( "o egg /irr$ into x & sweet5$1 if desir$2 tak5 luke w>m or cool1 b nev] ice cold4 ,?is am\nt to be increas$ on ! second day to ?ree-f\r?s ( a glass1 & on ! ?ird to a full glass1 :i* is to be cont9u$ = a week4 ,if ! milk produces di>rhea1 add two tablespoonfuls ( lime wat] to ea* portion4 #i ,a4 ,m4 ,a sauc]ful ( gelat9e 7,knox's or ,cry/al ,rock7 ) #b tablespoonfuls ( cream & a teaspoonful ( sug>4 #ab ,m4 ,a half to full glass ( milk prep>$ z above4 #c ,p4 ,m4 ,a sauc]ful ( gelat9e1 ) cream 7m$ium7 & sug> z at #i ,a4 ,m4 #f ,p4 ,m4 ,a half to :ole glass ( milk1 z be=e1 ) "o egg /irr$ 9 & sweet5$4 ,! egg yolks at #g ,a4 ,m4 & #f ,p4 ,m4 are to be increas$ until six are tak5 daily at ! end ( ! week4 #h ,p4 ,m4 ,a half to a full glass ( milk4 ,! :ites ( ! eggs are to be /irr$ up 9 ! wat] 9 ! proportion ( a :ite to a glass ( wat]1 #d teaspoonfuls ( sug> to be add$ to e glass1 ?is to be tak5 by ! pati5t only :5 ?ir/y4 ,if ! b[els d n move1 no laxative c be tak51 b an injection ( w>m wat] or a little soap may be employ$4 ,if mu* discom=t is produc$ by ! food1 a hot compress mu/ be laid ov] ! /oma* or above ! navel4 ,dur+ ! second week ! diet %\ld rema9 mu* ! same except = ! addition ( "o or two pieces ( ,zweiback ?ree times a day4 ,dur+ ! ?ird week1 if pa9 & blood 9 ! feces are less5+1 we may add s(t1 well cook$ c]eal l cream ( :eat1 cocoa1 puree ( split pea made ) cream4 ,fif? week add m9c$ *ick51 coddl$ egg1 boil$ beef or lamb put ?r\gh a meat gr9d]1 s(t vegetables su* z *opp$ sp9a*1 squa% & ma%$ or bak$ potatoes ) lib]al quantities ( butt]4 ,dur+ & aft] ! six? week we may add all vegetables :i* c be s]v$ 9 puree =m1 fre% fi%1 oy/]s1 apple sauce1 inside ( a bak$ apple1 prune :ip1 cu/>d junket1 corn />* pudd+4 ,at ?is "t also if all goes well ! pati5t may sit up 9 b$ & gradually move ab\t1 be+ c>eful to avoid all sudd5 movem5ts :i* w\ld put a /ra9 on ! epiga/ric region4 ,if necess>y we may also increase our manipulative treatm5t at ?is "t4 ,! pati5t mu/ be w>n$ aga9/ ! use ( any article ( diet :i* w be *emically or me*anically irritat+ to ! /oma*1 = a p]iod ( mon?s1 & an exam9ation ( feces %\ld be made f "t to "t to make sure ( no return ( hemorrhage4 ,dilatation ( ! ,/oma* ,a dilat$ /oma* is a /ret*$ /oma* hav+ increas$ capacity1 due to n]vo-muscul> atony or to pyloric ob/ruction4 ,e /oma* :i* is n retract$ :5 empty is a dilat$ /oma*4 ,a dilat$ /oma* may occur ei!r z an acute or z a *ronic condition1 b x is to be di/+ui%$ f tempor>y di/5tion & a normally l>ge /oma*4 ,o/eopa?ic ,etiology & ,pa?ology4--,! n]vo-muscul> atony caus+ dilatation may be due to ob/ructive lesions 9 ! /oma* splan*nics1 or to a g5]al debility ( ! sp9e 9 ! dorsal region 7usually a kyphosis71 or to cont9u$ ov]eat+ & improp] food caus+ a /asis & f]m5tation4 ,x may also be due to ov]dr9k+ & v>i\s diseases1 z ph?isis1 liv] & lung diseases1 anemia1 *lorosis1 acute fev]s & kidney diseases1 caus+ m or less ( a g5]al n]vo-muscul> atony4 ,dilatation may result f a me*anical ob/ruction1 or n>r[+ ( ! pylorus or ! duod5um1 by a cicatricial contraction ( an ulc]2 by hyp]trophic ?ick5+ due to v>i\s diseases1 by adhesions & tumors4 ,occasionally ! pyloric ob/ruction is cong5ital4 ,a float+ kidney may fall ^u ! horizontal portion ( ! duod5um & ?us me*anically ob/ruct ! passage ( food f ! /oma*1 :i* consequ5tly dilates4 ,tight lac+ might prev5t ! liv]1 :5 conge/$1 f pass+ 9 front ( ! kidney1 ?us luxat+ ! kidney4 ,dilatation ( ! /oma* occurs at all ages1 al?\gh mo/ frequ5tly 9 middle ag$ p]sons4 ,pa?ologically1 ! muscul> coat is ?9n] & pal] ?an normal1 ) m or less atrophy ( ! gl&ul> tissues & an increase 9 capacity ( ! /oma*4 ,:5 ob/ruction exi/s at ! pylorus1 hyp]trophy ( ! muscul> coat may occur4 ,symptoms4--,! symptoms are ^? ( ! disease caus+ ! dilatation plus ^? ( p]si/5t *ronic cat>rh4 ,! pati5t compla9s ( a s5se ( fullness 9 ! epiga/ric region & !re is flatul5cy1 eructations & vomit+4 ,! cavity ( ! /oma* be+ mu* enl>g$1 great quantities :i* are usually consid]ably decompos$ are vomit$ ea* day or two4 ,!re is (t5 less5$ acidity ( ! vomit$ mass1 ?\gh 9 "s cases x is increas$4 ,passage ( ! food f ! /oma* to ! inte/9e is delay$ & ! b[els are con/ipat$1 ! fecal matt] be+ dry & h>d4 ,! ur9e may be scanty & ! sk9 dry4 ,anemia1 debility & emaciation are always pres5t to a great] or less ext5t1 & on acc\nt ( ! absorption ( poison\s matt] dr[s9ess may occur4 ,physical ,signs4--,inspection4--,9 "s cases ! outl9e ( ! di/5d$ /oma* c be pla9ly se54 ,!re is prom95ce ( ! epiga/ric region1 ! tumefaction be+ at ! pyloric end ( ! /oma*4 ,palpation4--,! resi/ance ^u manipulation ( a dilat$ /oma* is l t ( an air cu%ion4 ,if ! pati5t is made to dr9k a half tumbl] ( wat]1 bimanual palpation w cause a spla%+ s\nd to be he>d along ! circumf]5ce ( ! /oma* at its l[e/ po9t2 & by mov+ ! wat] ab\t by *ang+ ! position ( ! pati5t1 ! outl9e ( ! /oma* c be made4 ,if ! s\nd is n he>d at ! fir/ manipulation1 x mu/ n be conclud$ t ! /oma* is normal = ! /oma* may be s dilat$ & flabby t x falls beh9d ! abdom9al wall l an apron4 ,p]cussion4--,! note is tympanitic ov] ! great] "p ( ! /oma* until ! l[] curvature is rea*$ :5 ! s\nd is dull 7due to ! liquid cont5ts ( ! /oma*71 foll[$ by a tympanic s\nd aga9 :5 ! inte/9es are rea*$4 ,:5 p]cussion is made ! pati5t %\ld always be 9 a /&+ position if possible4 ,:5 !re is pyloric ob/ruction a tumor usually pres5ts itself1 & vomit+ is m sev]e & p]i/alsis m active ?an :5 ! dilatation is due to atony ( ! walls ( ! /oma* f an ob/ruct$ inn]vation4 ,diagnosis4--,?is is usually easy if due c>e is tak5 9 mak+ ! exam9ation4 ,goetz has %[n by ! use ( 8 sp9egraphomet] t 9 cases ( visc]al prolapse ! sp9e is commonly po/]ior 9 ! dorso-lumb> region4 ,! ,x-ray is ( value 9 det]m9+ ! size & function ( ! organ4 ,prognosis4--,9 a case ( n]vo-muscul> atony ! prognosis is favorable4 ,if due to a malignant disease recov]y is usually impossible4 ,9 hyp]trophy ( ! pylorus or ! duod5um1 recov]y is probable by means ( surgical int]f]5ce4 ,treatm5t4--,:5 ! dilatation is due to atony ( ! muscul> walls ( ! /oma* f ob/ruct$ inn]vation at ! sp9al column1 treatm5t is usually successful4 ,att5tion %\ld be giv5 to ! condition ( ! sp9al column 9 ! splan*nic region 7f\r? dorsal to twelf? dorsal71 ! sp9e be+ usually po/]ior4 ,a ?or\gh & p]si/5t c\rse ( treatm5t mu/ be giv51 n only to re/ore ! normal activity ( ! n]ves to ! muscul> coat & gl&s ( ! /oma*1 b to build up & re/ore /r5g? 9 ! weak5$ sp9al column4 ,lesions 9 ! sp9al column1 ev5 high] ?an ! f\r? dorsal1 may affect ! inn]vation ( ! /oma*4 ,!re are cases :]e lesions h be5 f\nd at ! fif?1 six? & sev5? c]vicals t int]f]e consid]ably ) ! action ( ! /oma*1 caus+ nausea1 flatul5cy1 eructations1 & ev5 vomit+4 ,su* an affection may be ?r\gh ! fib]s ( ! splan*nic n]ves or ?r\gh fib]s ( ! vagi n]ves4 ,! vagi n]ves h an important be>+ ^u ga/ric dilatation z p>alysis ( ! ga/ric bran*es ( ! vagi arre/s ! p]i/alsis ( ! /oma* & ?us t5ds to favor ret5tion ( food )9 its cavity4 ,! /oma* 9 su* cases becomes enl>g$1 ma9ly by ! weight ( ! food & ! pres5ce ( gases due to decomposition ( ! reta9$ food4 ,?us lesions may be f\nd high] ?an ! l[] c]vicals & cause ob/ruction & p>alysis ( ! fib]s ( ! vagi to ! /oma*4 ,direct /imulation ov] ! /oma* 9 ! =m ( ?or\gh manipulation ( ! /oma* walls causes contraction ( ! muscul> fib]s ( ! /oma*1 ma9ly ! circul> fib]s4 ,?is treatm5t1 ) additional treatm5t ( ! splan*nic & ! vagi n]ves1 w t5d to build up ! weak5$ plexuses ( ! /oma*4 ,mu* "t c be sav$ by putt+ ! pati5t to b$ & treat+ him e day = sev]al weeks4 ,:5 ! /oma* is dilat$ or dilat$ & prolaps$1 to any ext5t1 x usually requires ?ree to five mon?s treatm5t at lea/2 ?is "t c be %ort5$ "o-half by keep+ ! pati5t 9 b$1 treat+ ! sp9e ?ree times a week1 & ! abdom5 e day4 ,light food at frequ5t int]vals1 upp] ?oracic brea?+1 & frequ5t draw+ up & 9 ( ! abdom5 %\ld be requir$4 ,! pati5t may also manipulate 8 own abdom5 twice a day to advantage2 tea* him to manipulate1 draw & pull x upw>d4 ,!re is no dang] ( too frequ5t treatm5t z long z !re is no bruis+ ( ! p>ts2 ?is1 h[ev]1 does n apply to ! sp9e4 ,x is n an uncommon ?+ to correct a dilat$ /oma* or a dilat$ & prolaps$ /oma* t is an in* & a half or two in*es bel[ ! umbilicus4 ,c>e mu/ be tak5 9 all cases t o!r visc]a are n prolaps$4 ,x is a common exp]i5ce to f9d ent]optosis1 :i* c usually be readily functionally correct$1 ) ! /oma* ptosis4 ,b :]e ! kidney1 or possibly bo?1 is mu* prolaps$ only fair results c be secur$ until ! kidney is replac$ & kept !re1 & if necess>y by surgical means4 ,also1 note :e!r ! liv] is enl>g$4 7,see special article on ,prolaps$ ,organs74 ,:5 ! disease is due to canc] & v>i\s gr[?s ( ! pylorus or ! duod5um1 no?+ c be done b palliate4 ,su* cases require surgical att5tion4 ,9 all cases x is necess>y t c>e & preoccupation ( ! pati5t %\ld be remov$4 ,ba?s1 *anges ( air1 a c>efully regulat$ diet & caution 9 ! use ( liquids w be ( great aid to ! g5]al heal? ( ! pati5t1 & ?us ! weak5$ n]v\s sy/em w be indirectly b greatly b5efit$4 ,too great c>e _c be tak5 ( ! pati5t1 z !re is creat$ 9 ! organism a special aptitude = ! tissues to become inflam$ & ?us weaknesses at v>i\s p>ts ( ! body may occur4 ,ph?isis1 typhoid fev] & v>i\s diseases are apt to foll[ dilatation ( ! /oma*1 z ! nutritive & resi/ive process ( ! body are impair$4 ,! meals %\ld be tak5 regul>ly & ) great c>e1 ! pati5t n eat+ too quickly nor too mu*4 ,solids %\ld be us$ b little2 ! artificially dige/$ foods1 su* z peptoniz$ milk & beef peptonoids1 probably be+ ! be/4 ,beef juice & scrap$ beef are excell5t foods1 z !y are easily dige/$4 ,fatty & />*y foods %\ld be avoid$4 ,wa%+ out ! /oma* is useful1 b x %\ld n be indiscrim9ately employ$4 ,lavage w n be necess>y 9 all cases ( me*anical ob/ruction4 ,x relieves ! di/5tion1 by remov+ ! weight & ! f]m5t+ & decompos+ mat]ial4 ,9 acute dilatation1 :i* may be due to prolong$ diseases1 g5]al ane/hesia1 injuries ( ! sp9e1 & to n>r[+ ( ! duod5um1 vomit+1 pa9 & collapse occur4 ,empty ! /oma*1 & place pati5t 9 knee-*e/ position4 ,rea* b5ea? ! duod5um & raise ?is "p ( b[el4 ,/>t well d[n1 z l[ z ?ird or f\r? lumb>4 ,if ?is does n give quick relief /& pati5t on 8 head4 ,ga/roptosis & ,ent]optosis#gd 7,,gl5>d',s ,,disease7 ,def9ition4--,a displacem5t ( ! /oma* & inte/9es4 ,o/eopa?ic ,etiology & ,pa?ology4--,a weak5$1 debilitat$ sp9e is ! common cause4 ,a slight po/]ior curvature is a frequ5t occurr5ce4 ,a debilitat$ sp9e impairs ! inn]vation to ! abdom9al visc]a & to ! muscles ( ! abdom54 ,_m cases are ( cong5ital orig9 due to lack ( complete developm5t & weakness ( ! support+ tissues4 ,o!r causes are muscul> /ra91 repeat$ pregnancies1 tight lac+ & malnutrition4 ,a d[nw>d displacem5t ( ! float+ ribs1 & a consequ5t prolapse (1 & atony ( ! diaphragm1 is an important cause4 ,prolapses ( ! /oma* & inte/9es are ( frequ5t occurr5ce 9 bo? sexes1 & v common 9 wom54 ,x is a condition (t5times ov]look$1 & :5 recogniz$1 little has be5 done 9 ! way ( a cure4 ,x is ! cause ( mu* di/urbance1 n only to ! /oma* & inte/9es1 b to ! v>i\s abdom9al visc]a & to ! pelvic organs1 & x is ! cause ( a l>ge p]c5tage ( prolapses ( ! ut]us1 7exclud+ lac]ations f *ildbir?7 = n only is ! great susp5sory ligam5t ( ! ut]us 7! p]itoneum7 prolaps$ z a consequ5ce1 b all ( ! abdom9al visc]a & ! p>ietes ( ! abdom5 are also prolaps$ & cr[d$ d[n into ! pelvis4 ,! small or l>ge inte/9e or ! /oma* may be prolaps$ s+ly4 ,?is is frequ5tly ! case ) ! transv]se portion ( ! colon1 :i* may be elongat$ & tortu\s & prolaps$ ne>ly to ! symphysis pubis4 ,prolapse ( ! liv]1 sple5 & kidneys may occur s+ly or ) a g5]al displacem5t ( all ! organs4 ,symptoms4--,! abdom9al walls are weak1 (t5times flabby4 ,! visc]a ( ! abdom5 d n h normal resi/ance ^u manipulation4 ,! sp9al column pres5ts lesions4 ,!re is dyspepsia1 flatul5cy1 con/ipation1 abdom9al pa9s & v>i\s neura/h5ic symptoms4 ,diagnosis4--,is readily made by ! lack ( tone to ! abdom9al walls & visc]a & ! g5]al debility ( ! pati5t4 ,inflation ( ! /oma* ) air w det]m9e betwe5 ga/roptosis & dilatation4 ,! ,x-ray is ( special value 9 det]m9+ position1 function1 spasms1 k9ks1 etc4 ( ! dige/ive tube4 ,!re are innum]able gradations & phases ( ?is condition4 ,treatm5t4--,to remove ! cause is ( prim>y importance4 ,?is is to be foll[$ by treatm5t ( ! sp9al column1 correct+ its v>i\s d]angem5ts & improv+ ! inn]vation to ! atoni$ visc]a & abdom9al p>ietes4 ,direct treatm5t ov] ! abdom5 helps to give tone to bo? ! visc]a & abdom9al muscles4 ,9 _m cases ! treatm5t w h to be a prolong$ "o 9 ord] t ! tissues may rega9 _! normal condition4 ,usually a treatm5t f two mon?s to a ye>1 or possibly m1 is requir$4 ,ex]cises & manipulations t tone ! tissues1 correct ! po/ure1 & raise ! *e/1 diaphragm1 abdom9al & pelvic visc]a1 & release spasms1 k9ks1 & adhesions1 are indicat$4 ,! diet ( ! pati5t %\ld be nutriti\s1 & suffici5t 9 emaciat$ cases to increase 8 weight if possible4 ,a support+ b&age w (t5 give "s relief4 ,a few cases w require surg]y4 ,p>ticul> att5tion %\ld be giv5 to ! colon1 duod5um & diaphragm4 ,relative to ! treatm5t ( ga/roptosis & ent]optosis1 ,w4 ,e4 ,h>ris writes z foll[s3 8,i fir/ set to "w try+ to correct ! sp9al irregul>ities2 c\pl$ ) ?is ,i give deep & c>eful manipulation ( ! ga/ric & inte/9al walls--treat+ my pati5t two or m times p] week = a p]iod ( "o to ?ree ye>s4 ,a less] p]iod is n long en\gh to br+ ! desir$ result 9 su* cases4 ,i also in/ruct ! pati5t to knead 8 own b[els1 :i* ,i prescribe z a necess>y proce$+1 & to be p]=m$ twice daily on retir+ & be=e ris+4 ,( equal importance ) ! o/eopa?ic treatm5t1 come local1 specific abdom9al ex]cises4 ,^! are to be ( ! resi/ive type1 & mu/ also be tak5 = ! g5]al musculature4 ,i h my pati5t retract ! abdom9al walls & volunt>ily draw ! abdom9al cont5ts t[>ds ! diaphragm1 9 regul> s]ies4 ,^! ex]cises mu/ be fai?fully p]=m$ & cont9u$ aft] ! treatm5t has ceas$ 9 ord] to be ( real value4 ,i d n f9d our treatm5t1 )\t ! he>ty coop]ation ( ! pati5t 9 do+ 8 ex]cises consci5ti\sly1 to be suffici5t 9 itself4 ,h ! pati5t avoid ov]load+ ! dige/ive tract4 ,use conc5trat$ foods1 9 small quantities1 i4 e41 only suffici5t to su/a9 /r5g?1 twice daily & )\t tak+ fluids at meal times4 ,( c\rse wat]1 9 small quantities & at frequ5t int]vals1 may be tak5 betwe5 meals4 ,to summ>ize--,fir/1 corrective treatm5t4 ,second1 resi/ive ex]cises4 ,?ird1 att5tion to diet40 7,see ,dilatation ( ! ,/oma*47 ,,diseases ,,( ,,! ,,inte/9es#ge ,acute ,di>rhea ,def9ition4--,a diffuse inflammation involv+ ! entire inte/9al tract to a great] or less degree4 ,usually ! seat ( disease is f\nd 9 ! small inte/9e & ! upp] "p ( ! l>ge b[el4 ,o/eopa?ic ,etiology & ,pa?ology4--,acute di>rhea may be caus$ by ov]eat+1 dr9k+ impure wat]1 unripe fruits1 & poisons produc$ 9 decompos$ & f]m5t$ milk & o!r articles ( food4 ,?is sometimes takes place 9 p]fectly h>mless sub/ances 9 an inexplicable mann]4 ,milk & ice cream may produce inte/9al cat>rh4 ,dr4 ,/ill (t5 ref]r$ to ! h>m result+ f ic$ dr9ks4 ,*anges 9 ! wea!r1 t5d+ to weak5 ! sy/em1 (t5 cause di>rhea2 hot wea!r favors ?is1 al?\gh a *ill+ ( ! sy/em by a sudd5 fall 9 ! temp]ature may produce ! disord]4 ,dr4 ,/ill 0 ( ! op9ion t sitt+ on ! cold gr\nd 7a common habit ( *ildr57 is a frequ5t s\rce ( inte/9al d]angem5ts4 ,*anges 9 ! quantity & quality ( ! secretions also induce ! disord]2 ?us ! bile1 if 9 too great a quantity1 increases ! p]i/alsis to su* a degree t di>rhea is produc$2 if dim9i%$1 x favors ! f]m5tation & decomposition ( ! food4 ,pancreatic diseases may be a cause ( di>rhea4 ,infecti\s diseases1 ?r\gh _! specific poisons1 su* z *ol]a1 dys5t]y & typhoid fev]2 inflammation1 ext5d+ into ! b[els f adjac5t p>ts2 inflammation caus$ by p]itonitis & inte/9al ob/ructions1 z invag9ation & h]nia2 hyp]emia1 second>y to diseases ( ! liv]1 he>t & lungs2 ca*ectic /ates met ) 9 ,addison's disease2 ! la/ /ages ( ,bright's disease2 canc] & m>k$ anemia are all among ! causes ( di>rhea4 ,z 9 con/ipation1 di>rhea is (t5times simply a symptom ( v>i\s disord]s2 /ill1 x may be ! only symptom manife/$4 ,lesions are f\nd 9 v>i\s regions ( ! body1 b *iefly 9 ! l[] dorsal & lumb> v]tebr & ! l[] ribs at ei!r side4 ,also lesions may be f\nd to ! vagi1 ?us increas+ ! p]i/alsis or affect+ ! blood supply ( ! inte/9es4 ,! lesions to ! splan*nics may involve ! motor1 vasomotor or secretory fib]s to ! inte/9es4 ,(t5times ! inn]vation to ! liv] is di/urb$1 affect+ ! secretion ( ! bile4 ,! left side ( ! sp9al column is involv$ m (t5 t ! "r side1 by v]tebral1 rib & muscul> lesions4 ,n]v\s ,di>rhea frequ5tly foll[s fright & o!r causes ( n]v\s excitem5t1 & is (t5 f\nd 9 hy/]ical wom54 ,!re is simply an increase 9 ! p]i/alsis & secretion ( ! b[el1 due to a vasomotor p>esis ( ! inte/9al vessels1 produc+ an outfl[ ( ! s]um4 ,! inte/9al condition is "o ( hyp]emia4 ,! secretory gl&s are frequ5tly inflam$4 ,9 decid$ cases ! muc\s membrane may be r$ & inject$1 b m (t5 x is pale & cov]$ ) a lay] ( mucus4 ,sometimes ! solit>y follicles are consid]ably enl>g$4 ,^! enl>gem5ts may become fill$ ) pus1 =m+ abscesses :i* rupture1 leav+ an ulc]4 ,pey]'s pat*es may also be involv$4 ,symptoms4--,! di>rhea is ! important1 & (t5 ! only1 symptom ( ent]itis2 ! /ools are frequ5t1 v>y+ f two or ?ree to fifte5 or m a day2 !y are ?9 & wat]y1 v>y+ 9 color accord+ to ! am\nt ( bile !y conta94 ,!y are usually ( a yell[i% or gre5i% color4 ,!y conta9 undige/$ food1 mucus1 column> epi!lium & muc\s cells1 micro-organisms & triple phosphate4 ,! reaction ( ! dis*>ge is ei!r acid or neutral4 ,!re are colicky pa9s 9 ! abdom51 rumbl+ noises or borborygmi1 int5se ?ir/1 dry & coat$ tongue1 ) loss ( appetite1 &1 r>ely1 a fev]4 ,:5 fev] is pron\nc$ c>e %\ld be tak5 t "s infecti\s disease is n ! cause4 ,*ronic cat>rhal di>rhea may foll[ ! acute =m4 ,if ! /ools conta9 mu* undige/$ food ! inflammation is 9 ! upp] b[el2 if ?91 wat]y & conta9+ mucus1 ! l[] b[el is involv$4 ,9 prolong$ cases ! g5]al heal? is affect$4 ,def9ite t5d] areas along ! sp9e & deep muscul> contractions are inv>iably important etiologic & diagno/ic clues4 ,diagnosis4--,?is is ord9>ily made easy by giv+ att5tion to ! above symptoms4 ,9 di/+ui%+ z to :e!r ! l>ge or small inte/9es are involv$ ! foll[+ is important3 ,9 cat>rh ( ! small inte/9es1 di>rhea is n s well m>k$2 !re is mu* undige/$ food1 b v little mucus2 & !re is usually pa9 ( a colicky nature 9 ! middle or inf]ior "p ( ! abdom54 ,:5 ! l>ge inte/9e is involv$ !re may be no pa92 :5 pres5t1 x is int5se & usually 9 ! upp] & lat]al p>ts ( ! abdom52 !re are borborygmi & ?91 s\py /ools1 mix$ ) mu* mucus4 ,if ! l[] portion ( ! b[el is involv$ !re may be m>k$ t5esmus1 ) m>k$ contraction ( ! muscles ov] ! sacral =am9a4 ,duod5itis is (t5 associat$ ) acute ga/ritis4 ,plac+ ! pati5t 9 ! knee-*e/ position "o may be able to palpate ! duod5um4 ,if ! inflammation involves ! bile duct1 !re is jaundice2 9 ^! cases ! ur9e may be bile-/a9$4 ,prognosis4--,commonly favorable if e>ly & prompt treatm5t is employ$2 ?\gh x %\ld be rememb]$ t "s infections1 or con/itutional disease1 or inte/9al ulc] may be an und]ly+ cause4 ,treatm5t4--,_m cases ( acute di>rhea w recov] by re/rict+ ! diet1 ) re/4 ,:]e improp] food & wat] are ! causes1 an entire *ange ( diet %\ld be consid]$4 ,)drawal ( all food & ! sub/itution ( boil$ milk w be ( great aid4 ,! b[els %\ld nev] be conf9$ if !re is reason to suspect t all irritat+ matt]s h n be5 remov$2 & :5 f]m5tation & irritation exi/ 9 ! l[] b[el1 an enema w (t5 be b5eficial4 ,! sp9al column %\ld be exam9$1 especially on ! left side1 f ! fif? dorsal d[n to ! coccyx4 ,! v]tebr may become displac$ & cause di>rhea1 by d]angem5t ( ! vasomotor n]ves4 ,ei!r an increas$ blood supply ?r\gh ! inte/9es1 or an affection ( ! motor n]ves w produce an increas$ p]i/alsis4 ,an active condition ( ,meissn]'s plexuses may be produc$ sympa!tically1 result+ 9 increas$ secretion ( inte/9al juice & ?us 9 di>rhea4 ,! ribs may become displac$ & be a s\rce ( irritation to ! n]ves ( ! inte/9es4 ,! muscles ( ! sp9e are apt to become contract$ by colds1 injuries1 /ra9s1 etc41 & /imulate or inhibit ! action ( c]ta9 c5t]s 9 ! cord & produce disord]$ inte/9es4 ,conv]sely ! muscles ( ! back may be ?r[n into a contract$ condition by irritat+ sub/ances 9 ! b[els act+ z a /imulus to ! c5t]s 9 ! cord1 & ?us reflexly to ! muscles4 ,tr\ble may arise 9 ! colon & rectum by lumb> lesions1 ! slipp+ ( an innom9ate1 a dislocat$ coccyx1 or contract$ muscles ov] ! sacrum4 ,9 a ^w1 ?or\gh inhibition1 relax+ contract$ muscles & correct+ abnormal v]tebr & ribs are ! o/eopa?ic ess5tials ( treatm5t = di>rhea4 ,inhibition ( ! l[] dorsal & lumb> is v effective2 x dilates ! mes5t]ic vessels by way ( vasomotor fib]s1 & ?us controls secretions & less5s p]i/alsis4 ,?is has be5 cle>ly prov5 9 ! o/eopa?ic exp]im5tal "w ( ,burns & ,pe>ce4 ,hot fom5tations ov] ! dorsal & lumb> sp9e w frequ5tly1 ?r\gh ! n]v\s reciprocal relation%ip1 be ( decid$ value4 ,direct treatm5t ov] ! mes5t]ic circulation1 i4 e41 ?r\gh ! abdom5 ant]iorly1 w be helpful 9 "s cases4 ,x relaxes tissues1 removes irritations & frees ! circulation g5]ally ab\t ! mes5t]ic vessels & inte/9es4 ,:5 giv+ ?is treatm5t "o %\ld be c]ta9 ( ! und]ly+ pa?ology4 ,! liv] %\ld be kept active4 ,treatm5t ( ! vagus n]ves is important1 z !y help to control ! blood supply & ! motor n]ve =ce ?r\gh ! inte/9es4 ,daily hot ba?s & increas$ activity ( ! sk9 & kidneys are b5eficial4 ,*ronic ,di>rhea1 & ,muc\s ,colitis ,def9ition4--,a *ronic inflammation ( ! muc\s membrane ( m or less ( ! l>ge inte/9es4 ,!re may be ulc]ation4 ,o/eopa?ic ,etiology & ,pa?ology4--,*ronic di>rhea may be ! result ( repeat$ attacks ( ! acute =m or may be caus$ by canc]1 tub]culosis1 ,bright's disease1 typhus fev]1 disease ( ! liv]1 organic disease ( ! he>t & lungs1 ob/ructions to portal circulation or impactions ( any nature t occasion passive conge/ion4 ,frequ5tly cases ( long /&+ are due to *ronic lesions ( ! l[] ribs or l[] dorsal or lumb> v]tebr4 ,! lesions ( ! l[] ribs usually consi/ ( d[nw>d displacem5t ( ! ribs1 affect+ ! inn]vation to ! inte/9es directly1 or possibly dragg+ ! diaphragm d[nw>d to su* an ext5t z to int]f]e ) ! blood & lymph vessels z !y pass ?r\gh x1 ?us caus+ conge/ion ( ! inte/9es by ob/ruction to ! lum5 ( ! vessels4 ,9 _m cases ! pa?ological *anges are simply ^? ( ! acute =m4 ,9 m pron\nc$ cases ! muc\s membrane becomes a br[ni% r$1 livid gray or slate color2 ?is discoloration be+ due to hyp]emia & blood extravasation4 ,! muc\s coat is also swoll5 & ?ick5$4 ,atrophy ( ! muc\s membrane1 & 9 "s cases ( all ! coats1 ) de/ruction ( ! gl&s1 may be a result ( ! *ronic =m4 ,ulc]ative *anges occur *iefly 9 ! l[] "p ( ! ileum & colon2 ^! may be follicul> or !re may be l>ge ulc]s & consid]able areas ( ulc]ation4 ,symptoms4--,con/ipation & di>rhea frequ5tly alt]nate2 ! /ools are ?91 mix$ ) a l>ge am\nt ( slimy mucus2 ! small inte/9e is mo/ frequ5tly involv$1 & ! pati5t compla9s ( pa9 9 ! umbilical region2 !re is di/5tion ( ! b[els ) gas2 ! heal? gradually decl9es2 !re is great pallor1 & ! pati5t becomes emaciat$1 gloomy & irritable4 ,muc\s ,colitis is a *ronic =m ( colitis1 *>act]iz$ by p>oxysms ( sev]e pa9 & ! dis*>ge ( l>ge masses ( mucus1 =m+ gray transluc5t ca/s1 :i* are n fibr9\s b mucoid 9 "*4 ,?is disease occurs usually 9 wom5 ( n]v\s type1 b is occasionally se5 9 m5 & *ildr54 ,:5 !re is no und]ly+ organic disease1 x is probably l>gely a secretion neurosis4 ,m5tal emotions & worry1 sometimes errors 9 diet1 or dyspepsia br+ on ! attack4 ,ov]fatigue is (t5 an excit+ factor4 ,! nutrition is g5]ally well ma9ta9$1 b 9 o!r cases !re may be a gradual emaciation & ultimate dea?4 ,?is is und\bt$ly "o ( ! mo/ p]si/5t & tr\blesome diseases t "o w meet2 /ill ! o/eopa? c d mu* = ^! cases & n infrequ5tly br+ ab\t a cure4 ,b ! treatm5t mu/ be consi/5t & p]si/5t4 ,muc\s colitis is n h>d to diagnose1 al?\gh _m cases are treat$ = simple indige/ion4 ,x is ne$less to say t a correct diagnosis is p>am\nt4 ,9 ^! cases !re is almo/ inv>iably "s visc]al prolapse1 :i* und\bt$ly is ! und]ly+ cause1 by favor+ v5\s conge/ion ( ! b[els4 ,! liv] is usually conge/$2 ?is alone may cause ! v5\s /agnation1 b m (t5 x is simply due to ! common cause4 ,back ( ! visc]al prolapse & conge/ion w almo/ inv>iably be f\nd a po/]ior dorso-lumb> curvature2 /ill !re may be a scoliosis or s+le lesions only1 & a d[nw>d displacem5t & con/riction ( ! float+ ribs4 ,! treatm5t requires mo/ p]si/5t & c>eful "w = at lea/ ?ree mon?s1 & probably six to n9e mon?s4 ,correction ( ! sp9e & float+ ribs %\ld be ( fir/ consid]ation2 !n intellig5t treatm5t ov] ! abdom51 by rais+ & ton+ ! b[els1 n only ! b[els z a :ole1 b especially 9 ! ileo-cecal1 hepatic flexure1 transv]se colon1 spl5ic flexure1 sigmoid flexure1 & rectal regions4 ,! direct treatm5t %\ld be cauti\sly giv5 :5 !re are indications ( ulc]ation4 ,h ! pati5t help himself by manipulat+ 8 b[els night & morn+1 draw+ ! abdom5 up & 91 & by ?oracic brea?+4 ,prescribe pl5ty ( dr9k+ wat] & r$uce />*y & sac*>9e food to a m9imum4 ,aga9 emphasis is plac$ ^u ! necessity ( p]si/5t treatm5t1 two & ?ree times p] week1 = sev]al mon?s4 ,! mucus is h>d to remove4 ,x is t5aci\s & frequ5tly causes colicky pa9s4 ,to ! /ud5t ,von ,noord5's#gf monograph on ?is subject is especially in/ructive4 ,he notes t almo/ )\t exception ! pati5ts suff] = "s weeks or mon?s prior to ! developm5t ( colica mucosa f ob/9ate con/ipation4 ,= acute attacks1 among o!r ?+s1 he advises re/ 9 b$1 hot applications1 & high wat] injections4 ,he believes 9 massage ( ! l>ge inte/9e 7p>ticul>ly ( ! sigmoid flexure71 9 cases ( atonic con/ipation & also 9 spa/ic con/ipation1 provid$ ! pati5t has a diet t leaves a l>ge residue4 8,a co>se1 laxative diet ( ,graham bread1 legum9\s plants1 includ+ ! husks1 vegetables conta9+ mu* cellulose2 fruit ) small se$s & ?ick sk9s1 l currants1 gooseb]ries1 grapes2 besides1 l>ge quantities ( fat1 p>ticul>ly butt] & bacon40 ,diagnosis4--,diagnosis is always easy4 ,! pres5ce ( blood1 pus1 or fragm5ts ( tissue 9 ! /ool po9t to ulc]ation4 ,ulc]s 9 ! rectum1 & z high z ! sigmoid flexure1 w be recogniz$ by exam9ation ) ! speculum4 ,prognosis4--,o/eopa?y has und\bt$ly *ang$ ! prognosis ( o!r treatm5t4 ,_m cases c be cur$ & mo/ o!r cases greatly b5efit$4 ,! deep seat$ ulc]ations may cause circumscrib$ p]itonitis1 or ev5 abscess1 & ! prognosis becomes grave z ^! complications arise4 ,treatm5t4--,z di>rhea may be caus$ by lesions any:]e f ! six? dorsal to ! coccyx1 a mo/ ?or\gh exam9ation is necess>y4 ,on ! "o h&1 di>rhea may be due to a m>k$ lat]al or po/]ior sp9al curvature1 :i* is pla9ly se5 ^u inspection1 b on ! o!r h&1 x may be due to a slight twi/ or deviation f normal ( a v]tebra :i* w\ld require consid]able o/eopa?ic ability to exactly locate4 ,di>rhea may result f subluxation 9 ! l[] co/al region1 "o or m ( ! ?ree l[] ribs on ei!r side be+ involv$4 ,record ( "o case1 9 p>ticul>1 ( *ronic di>rhea is ( int]e/ z x 0 due to a rib dislocation4 ,x 0 ! case ( a man fifty ye>s ( age1 :o _h suff]$ f *ronic di>rhea1 sev]al /ools a day1 = ov] ?irty ye>s4 ,he 0 completely cur$ 9 "o treatm5t by correct+ ! dislocation ( ! v]tebral end ( ! t5? rib on ! left side4 ,?is case is cit$ to impress ^u ! /ud5t ! necessity ( precise diagnosis & treatm5t4 ,r>ely w diseases be cur$ by a s+le treatm5t1 b :5 su* happ5s x exemplifies ! pot5cy ( ! o/eopa?ic lesion4 ,treatm5t on ! left side is usually m effective 9 di>rhea ?an treatm5t on ! "r side4 ,:5 di>rhea is a symptom ( "s con/itutional di/urbance1 correction ( dorsal1 lumb> & rib lesions1 ) ?or\gh inhibition1 c>eful diet+ & re/1 w commonly suffice provid$ ! prim>y disease is intellig5tly look$ aft]4 ,*ronic lesions ( ! vagi n]ves may exi/ & produce *ronic di>rhea 9 ! same mann] z 9 acute di>rhea4 ,re/ & a liquid diet1 pref]ably boil$ milk & album9 wat]1 w be a helpful treatm5t2 ! diet requirem5t is to h a m9imum am\nt ( wa/e1 s t ! residue w cause ! lea/ possible irritation4 ,beef peptonoids ) ! milk w be a nutriti\s addition to ! diet1 & *ange ( air & surr\nd+s may be an aid to a m spe$y cure4 ,! sk9 & kidneys %\ld be kept 9 a heal?y condition &1 if necess>y1 ! b[els ?or\ghly empti$ by injections4 ,di>rhea ( ,*ildr5 ,?ree =ms ( di>rhea are recogniz$ 9 *ildr53 ,acute dyspeptic di>rhea1 *ol]a infantum1 acute ent]ocolitis4 ,acute ,dyspeptic ,di>rhea ,?is disease is mo/ frequ5tly due to errors 9 diet2 ! "m's milk may be alt]$ 9 quantity or quality f tak+ improp] food2 ! *ild may be ov]-nurs$1 or ! foods giv5 9 place ( ! "m's milk are at fault4 ,too (t5 a fil?y bottle is ! cause4 ,! pr$ispos+ causes are d5tition & extreme heat2 & ^!1 comb9$ ) con/itutional weakness1 bad hygi5e & a weak sp9e1 dim9i% ! resi/+ p[] ( ! infant4 ,h5ce1 9 artificially f$ *ildr5 ( ! poor] classes1 ?is disease is v preval5t4 ,pa?ologically1 !re is cat>rhal swell+ ( ! mucosa ( bo? ! small & l>ge inte/9es4 ,! am\nt ( mucus is increas$1 & !re is m or less involvem5t ( all ! lymphoid tissue4 ,! submuc\s membrane is (t5 infiltrat$4 ,if !re is mu* inflammation ulc]s may occur4 ,symptoms4--,! *ild may seem to be 9 its usual heal?1 ) slight re/lessness at night & an increas$ numb] ( /ools4 ,?is re/lessness may be due to nausea & colicky pa94 ,! /ools are copi\s & (f5sive1 conta9+ undige/$ food & curds4 ,9 *ildr5 ov] two ye>s old ^! attacks may foll[ ! eat+ ( unripe food or dr9k+ ta9t$ milk4 ,9 o!r cases ! onset may be sudd5 ) vomit+1 purg+1 & grip+ pa9s4 ,! fev] may rise rapidly to #ajc or #ajd degrees or m1 sometimes foll[$ by convulsions4 ,! /ools become m num]\s--!re may be tw5ty 9 ! tw5ty-f\r h\rs--gray or gre5 9 color1 & sometimes conta9+ mu* mucus1 r>ely blood4 ,diagnosis4--,! sudd5 onset & ! "* ( ! /ools1 :i* nev] h a wat]y1 s]\s "*1 di/+ui% ?is f *ol]a infantum4 ,& ! small am\nt ( mucus :i* ! /ools conta9 di/+ui%es !m f ^? ( ileo-colitis4 ,?is =m (t5 prec$es ! onset ( specific fev]s4 ,prognosis4--,among ! bett] classes ?is is g5]ally favorable1 b among ! weak1 half-/>v$ *ildr5 ( ! poor x is (t5 unfavorable1 especially 9 hot wea!r4 ,treatm5t4--,! *ild %\ld be clad w>mly1 kept absolutely clean & giv5 a *ange ( diet & air if possible1 ) frequ5t ba?s4 ,/]iliz$ milk %\ld be giv5 at regul> int]vals2 or if ! di>rhea cont9ues1 beef juice & egg album9 in/ead4 ,! b[els %\ld be ?or\ghly cleans$ by injections4 ,! sp9e %\ld be ?or\ghly treat$ ?r\gh ! l[] dorsal & lumb> regions1 & if ! abdom5 is n s5sitive1 a light treatm5t to ! b[els directly w aid recov]y4 ,frequ5tly x w be f\nd t ! muscles ( ! neck & upp] dorsals are consid]ably contract$1 especially :]e ! *ild has fev] & is v re/less4 ,= acute inte/9al indige/ion ,ruhrah gives ! foll[+ dietetic treatm5t3 8,)hold all food = ! fir/ tw5ty-f\r h\rs1 except a little album9 wat]4 ,?is is be/ giv5 9 small doses at n too great int]vals4 ,pla9 boil$ wat] may be us$ in/ead4 ,v weak tea to :i* a little r$ w9e has be5 add$ may be giv5 if ! *ild is weak4 ,on ! second day ! album9 or b>ley wat] may be giv5 ) ! addition ( weak /ra9$ bro?1 & on ! ?ird day malt$ milk may be add$ to ! li/4 ,aft] f\r or five days c['s milk dilut$ & boil$ or peptoniz$ may be tri$4 ,x is be/ mix$ ) a f>9ace\s gruel or ) malt$ milk to />t )4 ,x may be giv5 e o!r fe$+ = a day or two if x agrees1 & ! =m] fe$+ gradually resum$4 8,9 nurs+ infants )hold ! brea/ tw5ty-f\r h\rs & fe$ z above4 ,aft] t ! brea/ may be giv5 once = a few m9utes & ! fe$+ piec$ out ) album9- or b>ley wat]4 ,if x agrees ! brea/ may be giv5 = ?ree or f\r fe$+s1 e o!r fe$+ foll[$ by album9- or b>ley wat]4 ,on ! foll[+ day ! brea/ may be giv5 at ea* fe$+4 ,! "t ( nurs+ %\ld be increas$ gradually until ! *ild is back on its old s*$ule40 ,*ol]a ,infantum ,def9ition4--,an acute1 cat>rhal inflammation ( ! muc\s membrane ( ! /oma* & inte/9es1 ) "s di/urbance ( ! sympa!tic ganglia4 ,?is is a disease ( *ildhood dur+ ! fir/ d5tition4 ,etiology & ,pa?ology4--,probably due to ! poison\s products ( decompos+ & f]m5t+ foods act+ ^u ! sy/em4 ,! pr$ispos+ causes are hot wea!r1 d5tition1 bad hygi5e1 ! previ\s pres5ce ( "s slight dyspeptic d]angem5t1 dyspeptic di>rhea1 & ent]ocolitis4 ,! pa?ological *anges are simil> to ! morbid anatomy ( cat>rhal ga/ritis & ent]itis4 ,! s]\s dis*>ges & rapid collapse are due to ! int5se irritation ( ! sympa!tic sy/em4 ,! kidneys & liv] may become involv$1 & bron*opneumonia is a possible complication4 ,symptoms4--,! disease is ( sudd5 onset1 sett+ 9 ) sev]e vomit+1 :i* is increas$ by giv+ food or dr9k4 ,! /ools are copi\s & frequ5t1 at fir/ conta9+ "s (f5sive fecal matt]1 & lat] becom+ wat]y1 & odorless4 ,!re is decid$ fev]1 rea*+ z high z #aje degrees4 ,! pulse is rapid & feeble1 rang+ f #acj to #afj4 ,pro/ration1 p9*$ features1 holl[ eyes1 depress$ fontanelles & loss ( weight are *>act]i/ic symptoms4 ,! tongue is coat$ at fir/1 b soon becomes dry & r$1 & ?ir/ is int5se4 ,ev5 at ?is "t a reaction may set 91 b m commonly dea? results ) symptoms ( collapse & high temp]ature4 ,9 o!r cases !re are re/lessness1 convulsions & coma4 ,z !re is no c]ebral lesion1 ?is condition is probably due to toxic ag5ts absorb$ f ! inte/9es4 ,diagnosis4--,?is is n difficult1 z ! toxic symptoms1 ! sev]e vomit+1 ! pr(use wat]y dis*>ge1 rapid emaciation & pro/ration1 & ! hyp]pyrexia are significant4 ,prognosis4--,grave1 ev5 ) ! mo/ favorable surr\nd+s1 al?\gh 9 num]\s in/ances o/eopa?s h successfully treat$ ?is disord]4 ,mu* dep5ds ^u ! promptness ( treatm5t4 ,treatm5t4--,a *ange ( air1 complete re/1 removal ( all foods = a %ort "t1 & absolute cleanl9ess are ( great importance4 ,?or\gh treatm5t %\ld be giv5 along ! entire sp9e1 p>ticul>ly to ! splan*nics ( ! /oma* & ! inte/9es1 & to ! vagi n]ves 9 ! c]vical region4 ,frequ5t ba?+ ) cool wat]1 or bett] /ill1 wrapp+ ! *ild 9 cold1 wet %eets1 w r$uce ! hyp]pyrexia4 ,?or\gh cleans+ ( ! /oma* & inte/9es ) w>m wat] occasionally gives excell5t results4 ,9 collapse ! use ( a hot ba? is indicat$1 foll[$ by wrapp+ ! *ild w>mly 9 blankets & plac+ him 9 a horizontal position4 ,! food ( ! *ild %\ld consi/ ( peptoniz$ milk1 raw beef juice1 dilut$ egg album91 b>ley wat] & *ick5 bro?4 ,n\ri%m5t %\ld be giv5 gradually1 & only aft] ! int5se symptoms h subsid$4 ,acute ,ent]ocolitis ,9 ent]ocolitis ! ileum & colon are *iefly affect$1 especially ! lymphatic gl&s or lymph follicles4 ,o/eopa?ic ,etiology & ,pa?ology4--,w>m wea!r1 ! artificial fe$+ ( *ildr51 d5tition & bad hygi5e are pr$ispos+ causes4 ,! disease usually occurs betwe5 ! ages ( six & eighte5 mon?s1 b x is n infrequ5t 9 ! ?ird or f\r? ye>4 ,?is disease is n conf9$ to ! w>m wea!r1 b may set 9 at any season ( ! ye>4 ,previ\s light attacks ( di>rhea are (t5 a pr$ispos+ factor4 ,lesions 9 ! sp9e occur f ! elev5? dorsal to ! f\r? lumb>4 ,! muc\s membrane is conge/$ & swoll51 & ! solit>y follicles & ,pey]'s pat*es are swoll5 & (t5 ulc]at$4 ,! *anges may end "h or ! ulc]s enl>ge & ext5d into ! muscul> coat ) ! sep>ation ( a sl\gh4 ,!re may be infiltration & ?ick+ into ! submuc\s & muscul> coats1 foll[$ by induration ( ! tissue1 produc+ abnormal rigidity4 ,symptoms4--,! disease may be a sequel ( dyspeptic di>rhea or *ol]a infantum4 ,! temp]ature increases & ! /ools *ange 9 "*1 be+ at fir/ yell[1 & lat] gre54 ,!y conta9 traces ( blood & mucus4 ,vomit+ may be pres5t1 b is n a con/ant symptom4 ,! abdom5 is di/5d$ & t5d] along ! c\rse ( ! colon4 ,! disease may abate "h1 recov]y f ! condition be+ sl[2 or ! symptoms may increase 9 sev]ity ) p]si/5t1 small1 pa9ful /ools1 ma9ly ( blood & mucus1 t5esmus1 & ) scanty ur9e4 ,! *ild gr[s pale & emaciat$1 & assumes a s5ile appe>ance4 ,^! cases la/ five or six weeks1 dea? be+ prec$$ by coma & convulsions2 ?\gh a few recov]4 ,relapses are n uncommon & %\ld be gu>d$ aga9/4 ,ulc]ative & membran\s =ms may occur4 ,pneumonia & nephritis are possible complications4 ,diagnosis4--,ent]ocolitis is di/+ui%$ f dyspeptic di>rhea by ! great] sev]ity1 m fev]1 great] pro/ration1 ! /ools conta9+ m mucus & ev5 blood1 & by ! great] pa9 & suff]+4 ,*ol]a infantum may be recogniz$ by ! abrupt onset1 v high fev]1 con/ant vomit+1 & e>ly collapse4 ,if typhoid fev] seems a possibility1 ! ,widal te/ %\ld be us$4 ,prognosis4--,grave2 recov]y foll[s prompt treatm5t ) favorable surr\nd+s4 ,treatm5t4--,att5tion %\ld be giv5 to ! condition ( ! sp9e f ! elev5? dorsal to ! fif? lumb>4 ,an inhibitory relax+ treatm5t ov] ! sacral =am9a w less5 ! t5esmus4 ,:5 ! ileum & colon are involv$1 disord] is usually pres5t at ! ?ird & f\r? lumb> v]tebr1 al?\gh ! lesion may be high]4 ,relaxation ( all muscles 9 ?is region & correction ( ! v]tebral lesions are ess5tial4 ,irrigation ( ! b[els once a day ) a p9t ( cold wat] is v b5eficial & ev5 pieces ( ice may be introduc$ into ! rectum4 ,fre%1 pure air1 re/ & cleanl9ess1 ) a re/rict$ diet & daily w>m ba?s are important4 ,9 a ^w1 hygi5ic & dietetic treatm5t simil> to t = acute di>rhea %\ld be employ$4 ,9 all =ms ( di>rheal diseases 9 *ildr5 mu* dep5ds ^u previ\s o/eopa?ic att5tion1 diet1 hygi5e1 & environm5t4 ,*ol]a ,morbus ,def9ition4--,an acute1 ga/ro-inte/9al cat>rh ( sudd5 onset1 *>act]iz$ by viol5t abdom9al pa9s1 incessant vomit+ & purg+4 ,etiology & ,pa?ology4--,?is disease greatly resembles ,asiatic *ol]a2 s mu* s t "o seems ju/ifi$ 9 suspect+ t *ol]a morbus1 l true *ol]a1 is due to a specific organism4 ,no s+le bacillus has yet be5 designat$ z ! specific g]m1 al?\gh "o has be5 recogniz$ resembl+ v mu* ! common bacillus ( true *ol]a4 ,until ?is has be5 fully decid$1 *ol]a morbus mu/ be reg>d$ z sev]e inflammation ( ! muc\s membrane ( ! /oma* & inte/9es1 due to "s poison g5]at$ f ! improp] food1 :i* seems to be ! cause ( ! disease1 su* z indige/ible fruits1 cabbage & cucumb]s4 ,x is mo/ preval5t 9 hot wea!r1 b is also caus$ by exposure to cold & damp4 ,! condition ( ! muc\s l9+ ( ! inte/9es is ! same z 9 acute di>rhea4 ,9 fatal cases ( *ol]a morbus !re is ! same %runk51 a%y appe>ance ( ! sk9 t *>act]izes *ol]a4 ,symptoms4--,! onset is sudd51 ) int5se cramps 9 ! epiga/rium & frequ5tly 9 ! l[] limbs2 nausea2 vomit+1 & purg+ ( bili\s mat]ial1 :i* lat] becomes almo/ l wat]1 & 9 sev]e cases ! dis*>ge becomes s]\s1 f9ally resembl+ ! rice wat] dis*>ges ( true *ol]a4 ,!re are also int5se ?ir/1 mod]ate fev]1 rapid emaciation & loss ( /r5g?2 ! surface becomes cold & cov]$ ) clammy sweat2 ! pulse is frequ5t & feeble4 ,! pati5t becomes re/less & anxi\s4 ,diagnosis4--,asiatic ,*ol]a4--,!re is no way ( di/+ui%+ betwe5 ,asiatic *ol]a & *ol]a morbus1 except by exam9ation ( ! dis*>ges = ! bacillus4 ,simil> attacks are produc$ 9 poison+ by ars5ic1 corrosive sublimate & c]ta9 fungi1 & are only discrim9at$ f x by cl9ical hi/ory & cause4 ,prognosis4--,9 ! majority ( cases ! prognosis is favorable1 dea? r>ely occurr+4 ,! duration is f tw5ty-f\r to =ty-eight h\rs4 ,treatm5t4--,a /rong inhibitory treatm5t to ! ga/ro-inte/9al n]ves is at once dem&$4 ,?is relaxes ! muscles ( /oma* & inte/9es1 dilates ! blood-vessels & less5s p]i/alsis4 ,! treatm5t %\ld be kept up until relief is giv54 ,9 "s cases1 g5tle treatm5t ov] ! /oma* & inte/9es quiets ! di/ress4 ,inhibition at ! occiput gives relief1 especially to ! nausea & vomit+4 ,hot applications %\ld be appli$ to dorsal & lumb> sp9e4 ,! vomit+ is reliev$ pr9cipally at ! f\r? & fif? dorsal v]tebr on ! "r side ne> ! angle ( ! ribs4 ,cold c>bonat$ wat] & pieces ( ice swall[$ are useful4 ,! diet mu/ be regulat$1 ! fur!r aft] treatm5t be+ symptomatic4 ,cle> ! b[el by w>m enema if any irritat+ matt] is /ill pres5t4 ,inasmu* z food passes ?r\gh ! small inte/9e 9 #d to #f h\rs1 & requires #bj h\rs to pass ?r\gh ! colon1 ! colon %\ld be empti$ by high irrigation 9 all acute inte/9al disord]s4 ,inte/9al ,colic ,?is is a pa9ful spasmodic contraction ( ! muscul> lay] ( ! inte/9es4 ,o/eopa?ic ,etiology4--,lesions ( ! splan*nics d]ange ! inte/9al n]v\s me*anism1 ) a consequ5t upsett+ ( circulatory equalization & *emical function ( ! inte/9es4 ,?us irritations & ob/ructions ( ! reflex arc pr$ispose to l[]$ resi/ance1 conge/ions1 & di/urb$ *emism4 ,indige/ible food1 flatul5cy & impaction ( feces (t5times produce inte/9al colic4 ,exposure to cold & emotional upsets may be factors4 ,=eign bodies1 inte/9al worms1 abnormal am\nts ( bile dis*>g$ into ! inte/9es1 & reflex causes f diseases1 z f ! ov>ies1 ut]us1 liv]1 kidneys1 etc41 w produce ! disord]2 also lead poison+1 syphilis1 rheumatism1 locomotor ataxia1 *ronic mal>ia & hy/]ia4 ,k]ley says3 8,*ildr5 :o take too mu* milk1 too /rong milk1 or :o take milk too frequ5tly are ! usual subjects ( colic4 ,probably ! mo/ frequ5t cause ( colic is indige/ion ( ! proteid ( ! milk2 ei!r ! proteid is 9 excess or ! *ild has poor proteid capacity4 ,n a few cases ( colic are due second>ily to defective b[el action40 ,symptoms4--,sev]e p>oxysms ( pa91 c5t]+ ar\nd ! navel & diffus$ ?r\gh\t ! entire abdom54 ,! pa9 is ( a pi]c+1 cutt+ & twi/+ nature1 reliev$ ^u pressure4 ,! abdom5 is di/5d$ & ! pati5t re/less & cont9ually *ang+ 8 position4 ,! attacks alt]nate ) p]iods ( complete quietude4 ,9 sev]e attacks ! features may be p9*$ & ! surface cold1 ) feeble pulse1 vomit+ & t5se abdom9al walls1 all indicat+ incipi5t collapse4 ,! duration ( ! attack is f a few m9utes to sev]al h\rs1 eas$ at int]vals & usually end+ by a dis*>ge ( flatus4 ,diff]5tial ,diagnosis4--,9 lead colic ! hi/ory1 ! slate-color$ sk91 blue l9e on ! gums1 sweeti% metallic ta/e1 con/ipation1 sl[ pulse1 retract$ abdom9al walls1 & lead 9 ! ur9e w designate ?is disease4 ,bili>y colic pres5ts pa9 9 ! hepatic region1 radiat+ to ! back & "r %\ld]2 also jaundice1 calculi 9 ! /ools & bile 9 ! ur9e4 ,t5d]ness ov] ! gall bladd] is important4 ,nephritic colic is accompani$ by pa9 radiat+ d[n "o or bo? uret]s to ! inn] side ( ! ?igh1 ) retraction ( te/icle ( side affect$1 or ! labia1 & blood1 mucus1 pus or calculi 9 ! ur9e4 ,9 ut]9e colic !re is dysm5orrhea & pa9 9 ! pelvis4 ,9 ov>ian colic !re is extreme pa9 ^u pressure ov] ! ov>ies1 & hy/]ia4 ,abdom9al aneurism pres5ts tumor1 pulsation1 bruit4 ,9 inflammatory & ulc]ative disord]s ( ! abdom5 !re is t5d]ness ^u pressure1 & fev]4 ,! pa9 ( acute app5dicitis is at fir/ g5]al1 c5t]+ 9 ! "r iliac fossa 9 ab\t #bd h\rs4 ,! ,x-ray may be ( def9ite aid 9 r5al & bili>y conditions & v>i\s disord]s1 su* z inte/9al adhesions1 angulations1 etc4 ,treatm5t4--,relief ( pa9 is ! fir/ indication & is be/ accompli%$ by /rong inhibition 9 ! splan*nic region1 :i* relaxes ! spasm ( ! inte/9al muscles1 by normaliz+ ! reflex arc4 ,if disord]s ( ! sp9al column are locat$1 x is ( prim>y importance t !y be correct$4 ,9 cases ( irritation ( ! inte/9al muc\s membrane1 a contraction ( muscles ( ! sp9e w be f\nd accord+ to ! area ( ! inte/9es involv$1 e4 g41 irritation ( ! muc\s coat ( ! jejunum causes contraction ( ! muscles at ! t5? & elev5? dorsals4 ,x is a visc]o-motor1 visc]os5sory or visc]otrophic reflex sign4 ,on ! o!r h&1 a lesion at ! t5? & elev5? dorsals may produce colic or o!r disord]s ( ! jejunum4 ,! portion ( ! b[el affect$1 !re=e1 c be (t5 told by notic+ ! places ( muscul> contraction along ! sp9al column4 ,g5]ally ! jejunum & ileum are ! portions ( ! b[el affect$ 9 inte/9al colic4 ,! pa9 c frequ5tly be controll$ if 9 ! jejunum1 at ! t5? & elev5? dorsals2 if 9 ! ileum1 at ! twelf? dorsal2 if 9 ! ileo-cecal region1 includ+ ! v]mi=m app5dix1 at fir/ to ?ird lumb>2 if 9 ! colon1 at ! ?ird to ! fif? lumb>2 & if 9 ! rectum1 ov] ! sacral & coccygeal n]ves4 ,occasionally ! duod5um & jejunum are rea*$ by n]ves z high z ! fif? dorsal 7usually vasomotor n]ves1 n s5sory71 & ! o!r portions ( ! b[el l[]1 accord+ to _! respective positions4 ,! relief is giv5 by way ( ! splan*nics & sympa!tics to ! muc\s 7s5sory7 coat ( ! inte/9es1 al?\gh inhibition relaxes inte/9al muscles 7motor n]ves7 & dilates blood-vessels 7vasomotor n]ves74 ,?\gh precisely localiz$ inhibition is ( decid$ value1 /ill if normal alignm5t1 ?r\gh adju/m5t1 c be secur$ results are usually quick] & m satisfactory4 ,ant]ior treatm5t to ! abdom5 helps to relieve ! contract$ fascia ( ! mes5t]y1 ) a consequ5t free+ ( ! circulation4 ,x aids p]i/alsis ( ! inte/9es & expulsion ( ! irritat+ mat]ial4 ,?is probably produces consid]able effect by way ( ! axone reflex4 ,direct treatm5t to ! abdom5 = ! p]i/alsis relieves also con/ipation1 impactions & ! ent]algia1 ! latt] pr9cipally by firm pressure4 ,p]i/alsis is also increas$ by /imulation ( ! vagi & inhibition ( ! splan*nics4 ,! latt] treatm5t1 ( c\rse1 is n giv5 to relieve pa9 directly1 b to facilitate ! removal ( irritat+ sub/ances if su* are ! s\rce ( tr\ble4 ,if ?is does n produce a movem5t ( ! b[els promptly1 a w>m enema w assi/ greatly4 ,! cecum & sigmoid %\ld n be ov]look$4 ,flatul5cy c be reliev$ by direct pressure ^u ! sol> plexus1 :i* app>5tly removes ob/ructions to ! abdom9al n]v\s sy/em 7p>ticul>ly ! n]ves ( ! dige/ive gl&s1 z f]m5tation & flatul5cy are due to a disproportionate secretion ( dige/ive juices7 & ?us ! gase\s =mations are absorb$4 ,additional treatm5t to ! l[] dorsal v]tebr & l[] ribs to relieve n]ve lesions & increas+ bo? ?oracic & abdom9al circulation may be indicat$4 ,z /at$ 9 ! etiology ( inte/9al colic1 ! splan*nic n]ves conta9 n only s5sitive fib]s1 b motor & vasomotor fib]s z well4 ,! same is true ( ! vagi n]ves2 !y ex]t ^u ! inte/9es n alone a motor influ5ce1 b also a blood control2 consequ5tly1 our "w 9 a c]ta9 region c be = m ?an "o purpose4 ,hot applications to ! abdom5 may be ( b5efit4 ,& hot fom5tations to ! sp9e = #bj or #cj m9utes 7affect+ reciprocal inn]vation7 is (t5 ( great b5efit4 ,! diet %\ld always be regulat$ = a few days at lea/4 ,con/ipation#gg ,con/ipation is an unnatural ret5tion ( feces f any cause4 ,! foll[+ causes are frequ5tly met )3 ,a defici5cy ( ! bile or o!r secretions t aid p]i/alsis2 _m acute & *ronic diseases :i* less5 ! secretions & impair p]i/alsis1 su* z anemia1 hy/]ia1 *ronic affections ( ! liv]1 /oma* & inte/9es & acute fev]s2 c]ta9 drugs & /rong purgatives2 /rictures2 conc5trat$ food2 s$5t>y habits1 ov]fatigue & neglect ( ! calls ( nature4 ,atony ( ! colon may be caus$ by *ronic disease ( ! mucosa & by g5]al disease caus+ debility4 ,!re may be weakness ( ! abdom9al muscles1 due to obesity & ! di/5tion ( frequ5t pregnancies1 or ob/ructions1 su* z displac$ ut]us1 pregnancy1 prolaps$ cecum1 sigmoid or rectum1 & displac$ coccyx4 ,con/ipation is really a symptom1 9 mo/ cases1 ( "s disease2 _m times x is ab\t ! only symptom obs]v$4 ,"o has to take into consid]ation ! _m causes t w\ld produce con/ipation :5 ! treatm5t ( a case is und]tak54 ,a disord]$ /ructure may be f\nd 9 almo/ any region ( a body1 :i* w\ld be> directly or indirectly 9 ! causation ( con/ipation4 ,irregul> habits (t5 br+ on ! mo/ ob/9ate cases ( con/ipation 9 lat] life4 ,!re may also be local causes1 su* z di/urbances ( ! normal secretions1 impairm5t ( inte/9al walls1 due to inflammation1 & me*anical ob/ructions caus$ by tumors1 intussusception1 twi/s1 etc4 ,con/ipation 9 infants is usually caus$ by errors 9 diet1 b may be cong5ital4 ,9 all ob/9ate cases ! ,x-ray %\ld be employ$ 9 diagnosis4 ,9 ! majority ( cases lesions w be f\nd 9 ! v]tebr ( ! l[] dorsal & lumb> regions1 or 9 ! l[] ribs ( ei!r side4 ,! lesions may affect ! vascul> supply & inn]vation ( ! inte/9es directly1 or ! lesion may cause ! con/ipation by affect+ "s o!r dige/ive organ fir/4 ,lesions to ! vagi affect+ ! p]i/alsis ( ! inte/9es are common4 ,! usual symptoms are frequ5t /ools1 debility1 lassitude1 heada*e1 loss ( appetite1 anemia1 furr$ tongue & fetid brea?4 ,s]i\s symptoms may result 9 long cont9u$ cases1 su* z piles1 ulc]ation ( ! colon1 p]=ation1 ent]itis & occlusion4 ,! fecal mass may become *annel$ & di>rhea may occur f ! irritation4 ,9 long /&+ cases ( con/ipation1 if ! pati5t sudd5ly develops di>rhea ! rectum %\ld be well exam9$ to see if !re are impact$ feces pres5t4 ,neuralgia ( ! sacral n]ves may also be caus$ by impact$ feces 9 ! sigmoid flexure4 ,treatm5t4--,naturally1 ow+ to ! num]\s etiological factors1 ea* case is a special /udy & ! treatm5t is necess>ily v>i$4 ,_m cases w pres5t slight impaction ( ! b[els1 a sluggi% liv]1 sp9al lesions & s on1 :i* simply require a specific treatm5t & all ! symptoms w be remov$4 ,on ! o!r h&1 con/ipation may be due to prolong$ ill heal? & ?us require a c>eful1 sy/ematic treatm5t1 n only ( ! b[els1 b ( ! entire sy/em4 ,( prim>y importance 9 ^! cases is regulation ( ! diet1 pl5ty ( ex]cise1 suffici5t sleep1 & regul>ity 9 go+ to /ool at a fix$ h\r ea* day4 ,! effect ( att5tion to ! latt] po9t1 9 "s in/ances1 w be suffici5t to p]=m a cure4 ,too mu* _c be said 9 reg>d to ! b5eficial effect ( sy/ematic habits4 ,lesions may be f\nd 9 ! sp9al column produc+ con/ipation f ab\t ! fif? dorsal to ! coccyx1 al?\gh pr9cipally ! l[] ?ree dorsal & upp] two lumb> v]tebr are at fault4 ,con/ipation may be caus$ by defects at any po9t 9 ! inte/9es1 & consequ5tly ! sections ( ! sp9al column s5d+ n]ves ?r\gh ! int]v]tebral =am9a to ! sev]al sections ( ! b[els %\ld be exam9$4 ,at any po9t f ! fif? dorsal to ! coccyx1 c]ta9 vasomotor1 motor & secretory n]ves ( ! inte/9es may be affect$ by v>i\s lesions4 ,! vasomotor n]ves keep up ! vascul> tone ( ! b[els1 ! motor n]ves ! p]i/altic action & ! secretory n]ves att5d to ! inte/9al juices4 ,9 con/ipation1 disord]s ( ! sp9al column are g5]ally f\nd on ! "r side4 ,!re is no good reason (f]$ z to :y ?is is s4#gh ,9 ^? cases :]e ! liv] is impair$1 ! answ] might be because mo/ ( ! n]ves to ! liv] are on ! "r side1 b ! "r side is j z (t5 affect$ :5 ! lesions are 9 ! lumb> region & ! n]ve supply to ! hepatic region intact4 ,dr4 ,/ill consid]$ ! fif? dorsal ( importance4 ,! vagi n]ves h important be>+ ^u ! motor app>atus ( ! inte/9es4 ,lesions 9 ! upp] c]vical1 involv+ inte/9al fib]s ( ! vagi1 occur occasionally4 ,/imulation ( ^! fib]s increases ! p]i/alsis ( ! inte/9es4 ,me*anical /imulation ( ! mid & l[] dorsal region1 z %[n by o/eopa?ic exp]im5ts1 increases p]i/altic action & vaso-con/riction 9 ! /oma* & inte/9es4 ,! value ( direct treatm5t ov] ! inte/9es f ! duod5um to ! rectum 9 mo/ cases ( con/ipation _c be ov]e/imat$4 ,x aids p]i/altic action1 removes impactions1 /ret*es adhesions1 /r5g!ns weak5$ muscles ( ! inte/9es & abdom51 & 9 g5]al gives tone to all ( ! abdom9al organs4 ,! treatm5t %\ld n be giv5 9 a hap-haz>d mann]1 b ea* ef=t %\ld be = a def9ite purpose4 ,c>e %\ld be tak5 n to bruise ! inte/9es or o!r organs1 z by g\g+ or sev]e pun*+2 ! flat surface & ! palms ( ! h&s %\ld be us$4 ,?is means t ! "p ( ! b[el involv$ %\ld be treat$ intellig5tly1 ! o/eopa? rea*+ und]nea? ! section & ! pati5t draw+ ! b[els up & 94 ,ob/ructions & impactions ( ! gut1 especially at ! ileo-cecal & sigmoid regions1 %\ld be c>efully correct$4 ,at all angles ( ! gut1 impactions & prolapses may occur4 ,j4 ,h4 ,sullivan#gi makes ! foll[+ obs]vation conc]n+ sev]e1 deep abdom9al treatm5t3 8,i h not$ t ?is (t5 result$ 9 ! rev]se ( good effects4 ,9 con/ipation1 naturally !n1 ,i am *>y ab\t treat+ abdom9ally1 conf9+ my "w pr9cipally to ! bili>y regions1 ! ileo-cecal & left iliac regions & h atta9$ good results :5 a promiscu\s work+ ( ! abdom5 _h n s result$40 ,?is emphasizes ! po9t t specific treatm5t is z mu* indicat$ = ! abdom5 z x is = ! sp9e4 ,frequ5tly !re w be f\nd a spa/ic condition ( ! pelvic colon1 (t5 associat$ ) conge/ion & adhesions4 ,?is probably sets up a rev]s$ p]i/alsis4 ,treatm5t by inhibitory relaxation1 ) pati5t 9 knee-*e/ position1 & adju/m5t ( lumb> & innom9ate lesions1 is indicat$4 ,direct treatm5t to ! liv] & bili>y ducts is necess>y 9 _m cases1 z ! bile secretion is (t5 defective2 ?us a sl[ness or inactivity ( ! liv] & bile ducts might cause co/iv5ess4 ,"s cases result f ane/hesia ( ! rectum1 due to pressure ( ! fecal matt] collect+ 9 ! rectum4 ,simple dilatation ( ! rectal sph9ct]s & a /imulat+ treatm5t ?r\gh ! sacral n]ves w br+ ab\t a heal?y activity ( ^! p>ts4 ,occasionally ! coccyx becomes displac$ & produces p>esis ( ! rectal n]ves2 or a displac$ ut]us or a tumor may produce ! same result4 ,! use ( prop] food is ess5tial4 ,co>se food leaves a great am\nt ( residue1 & on ! o!r h&1 da9ty food leaves b little residue1 bo? caus+ co/iv5ess4 ,z a rule increase ! am\nt ( fruit & vegetables4 ,! pati5t %\ld dr9k consid]able wat]1 & ! "t is ( importance4 ,h a glass ( cool1 n ic$1 wat] tak5 on aris+ & if breakfa/ is delay$ suffici5tly1 ano!r 9 half an h\r4 ,mo/ p d n dr9k en\gh wat]4 ,unless contra9dicat$ eight or t5 glasses daily %\ld be insi/$ ^u4 ,an enema#hj occasionally is indicat$ & is a great aid :5 us$1 p>ticul>ly 9 cases ( p>alysis ( ! inte/9es & 9 impactions4 ,correct brea?+ & out door life are b5eficial4 ,treatm5t ( ! ,con/ipation ( ,infants4--,repeat$ small enemata at a fix$ h\r ea* day w (t5 be satisfactory b be c]ta9 t ! tissue is n irritat$4 ,two ounces ( tepid wat] at a "t %\ld be inject$4 ,c>eful sp9al treatm5t & massage to ! abdom5 w be useful1 z w slight dilation ( ! anus1 :i* is usually done ) ! little f+]1 b 9 ob/9ate cases a soap /ick may be us$4 ,:5 !re has be5 cont9u$ /ra9+ at ! /ool1 ! sigmoid & rectum w (t5 be f\nd prolaps$1 caus+ a me*anical ob/ruction4 ,) ! f+] well lubricat$ ?is c be correct$ & (t5 is all t is ne$$4 ,^! directions1 ) c>e 9 ! foods1 are usually suffici5t 9 any case n cong5ital4 ,9 *ronic con/ipation ,ruhrah outl9es dietetic treatm5t z foll[s3 8,9 infants see t !y get suffici5t fat & prote92 well cook$ & sweet5$ oatmeal gruel is useful4 ,orange juice1 bak$ apple1 or prune juice tak5 on an empty /oma* is ( s]vice4 ,olive oil1 ! malt$ foods1 or malt extracts are useful4 ,9 old] *ildr5 fre% fruits1 vegetables1 & oatmeal porridge are ( value4 ,graham bread1 dates1 figs1 & prunes may be us$40 ,inte/9al ,ob/ruction 7,,ileus7 ,?is is due to a sudd5 or gradual closure ( ! inte/9al canal at any po9t4 ,closure ( ! gut may be caus$ by /rangulation1 intussusception1 twi/s & knots1 abnormal cont5ts1 /rictures1 tumors1 k9ks1 spa/ic /ates1 adhesions1 etc4 ,/rangulation4--,?is is ! mo/ frequ5t cause ( acute ob/ruction ( ! b[els4 ,!re may be /ricture ( ! b[els due to inflammatory processes produc+ b&s or adhesions1 or due to ! adhesion ( a b[el to an abdom9al w\nd2 a vitell9e remnant1 z a blood vessel1 may rema9 & act z a /rangulat+ cord1 or 9 ,meckel's div]ticulum "o end may be atta*$ to a mes5t]y or abdom9al wall & ?us =m a r+ ?r\gh :i* ! gut may pass & become /rangulat$4 ,/rangulation may take place ?r\gh ! =am5 ( ,w9sl[ or ! =am5 ovale1 or betwe5 ! p$icle ( a tumor & ! abdom9al wall4 ,p]itoneal p\*es1 mes5t]ic & om5tal slits1 adh]5t app5dix or ,fallopian tubes & diaphragmatic h]nia may be o!r causes4 ,an int]nal /rangulation 7h]nia7 may take place 9 ! crural or +u9al canal1 9 ! umbilicus1 9 ! sacro-sciatic not* or 9 ! op5+ ?r\gh :i* ! infra-pubic vessels pass4 ,9 /rangulation !re is a con/riction ( a portion ( ! b[el caus+ an arre/ ( ! circulation ( blood at t po9t1 & m or less /oppage ( fecal matt] ( ! inte/9e4 ,9 n9ety p] c5t ( cases ! /rangulat$ "p is 9 ! l[] abdom5 & sixty-sev5 p] c5t occur 9 ! "r iliac fossa1 accord+ to ,fitz4 ,intussusception or ,invag9ation4--,intussusception is a slipp+ ( a "p ( ! inte/9e into ano!r "p imm$iately bel[ x1 z ! slipp+ ( a "p ( a f+] ( a glove or a coat sleeve into ano!r "p4 ,! portion involv$ may be any:]e f half an in* to a foot or m 9 l5g?4 ,?is produces compression & inflammation ( ! inte/9e1 & ob/ruction to ! inte/9al cont5ts4 ,x occurs pr9cipally 9 *ildr5 & is m common 9 males4 ,spasms ( ! inte/9al muscles & p]v]t$ p]i/alsis are probably ! mo/ common causes4 ,"o "p ( ! b[el may be dilat$ & an adjac5t portion contract$1 ?us all[+ an invag9ation4 ,di>rhea1 habitual con/ipation & inte/9al polypi are important excit+ causes4 ,invag9ations (t5times occur j be=e dea?1 probably due to irregul> p]i/alsis4 ,foll[+ engorgem5t & inflammation ( ! invag9at$ portion1 a tumor is usually pres5t1 & lymph is exud$ :i* may cause ! lay]s ( gut to adh]e1 s t ! invag9at$ portion is firmly held4 ,necrosis & sl\gh+ are !n likely to take place4 ,intussusception v>ies accord+ to location & is nam$ accord+ to ! "p ( ! b[el involv$4 ,!re are commonly recogniz$ 7#a7 ,ileo-colic1 :5 ! ileo-cecal valve ent]s ! colon4 7#b7 ,ent]ic1 ( ! small inte/9es4 7#c7 ,colic1 ( ! l>ge inte/9e4 7#d7 ,colico-rectal1 ( ! colon & rectum4 7#e7 ,rectal1 ( ! rectum4 ,twi/s & ,knots4--,^! occur m frequ5tly 9 males1 usually betwe5 ! ages ( ?irty & =ty4 ,9 ne>ly all cases ! twi/ is axial1 accompani$ by relax$ & l5g!n$ mes5t]y4 ,"o portion ( ! b[el may be twi/$ ab\t ano!r1 or a loop ( b[el twi/$ ^u its long axis4 ,a b[el be+ impact$ or ov]di/5d$ by feces & gas1 is q likely to roll on its axis or knot & become dislocat$1 its weight & inactivity ?us produc+ compression & ob/ruction ( ! b[els4 ,! volvulus commonly occurs 9 ! l>ge inte/9e1 at ! sigmoid flexure & 9 ! ileo-cecal & cecal regions4 ,x occasionally occurs 9 ! small inte/9e4 ,abnormal ,cont5ts4--,ob/ructions may be caus$ by gall-/ones1 ent]oli?s1 lumbricoid worms1 c]ta9 m$ic9es 7su* z magnesia & bismu?71 fruit /ones1 co9s1 ne$les1 p9s1 buttons1 etc41 & fecal matt]4 ,=eign bodies usually lodge 9 ! ileo-cecal region & 9 ! small inte/9e1 :ile fecal impactions occur 9 ! l>ge inte/9e1 m frequ5tly 9 ! l[] "p4 ,females are m subject to x ?an males4 ,its causes are _m & are simil> to ^? ( con/ipation4 ,sp9al lesions are v frequ5t1 probably caus+ p>esis or p>alysis ( a segm5t ( ! b[el2 or all ! =ces t ma9ta9 a normal activity ( ! inte/9es may become impair$4 ,hemmet]#ha says x is 8m frequ5tly ! result ( defective inn]vation ( ! inte/9e40 ,impactions are frequ5tly met ) & are easily ov]look$ "u any diagnosis :i* does n include ?or\gh palpation ( ! abdom9al visc]a4 ,! impaction may be s l>ge z to produce dilation ( ! b[el4 ,! ob/ructive mass becomes v h>d & dry & p]haps *annel$1 all[+ "s mat]ial to pass until1 f9ally a l>ge piece ( fecal matt] w ob/ruct ! passage completely4 ,9 diagnosis x mu/ n be confus$ ) neoplasms1 tumors1 etc4 ,impactions may occur at any po9t ( ! colon & ! weight s drags ! b[el out ( position z to be mislead+4 ,! pr9cipal po9ts are ! ileo-cecal region1 sigmoid flexure1 & rectum4 ,t5d]ness is usually pres5t1 z may be di>rhea :i* mu/ n be tak5 z evid5ce t ! b[el is cle>4 ,impaction gives rise to _m reflex symptoms & is (t5 ! real cause ( _m mi/ak5 conditions4 ,too mu* _c be said on ! importance ( a ?or\gh exam9ation ( colon & its connections1 :i* %\ld be r\t9e ( e exam9ation z ! l>ge b[el is impact$ mu* m (t5 ?an suspect$ & may be ! seat ( _m reflex & direct di/urbances4 ,! he>t may be affect$ by weight ^u ! vessels1 ga/ric di/urbances & signs ( auto-intoxication f absorption may appe>4 ,dilatation ( ! sigmoid flexure1 especially :5 x is cong5itally long1 may ev5 be s great z to cr[d up & int]f]e ) ! liv] & diaphragm2 9 ^! cases ! coats ( ! inte/9es are usually hyp]trophi$4 ,/rictures & ,tumors4--,^! usually occur 9 adults1 m frequ5tly 9 wom5 & g5]ally involve ! l>ge inte/9e & l[] "p ( ! abdom51 mo/ ( !m occurr+ 9 ! left iliac fossa4 ,!y frequ5tly result 9 *ronic ob/ruction4 ,occasionally1 a /ricture may be spa/ic1 due to v]tebral lesions1 t is sev]e en\gh to cause complete blockage ( inte/9al cont5ts4 ,^! are usually ( ! pelvic colon4 ,!re are cases :]e ! opposite condition1 p>alysis ( a section1 g5]ally ( ! small inte/9e1 occurs4 ,?is may be due to injuries to ! b[el1 or to damage ( ! blood supply1 or to d]angem5t ( ! inn]vation4 ,sc> tissue1 foll[+ ulc]ation ( ! b[el2 tumors ( v>i\s k9ds2 & cong5ital defects1 are possible s\rces ( inte/9al ob/ruction4 ,symptoms4--,acute ,ob/ruction4--,!re is con/ipation1 nausea1 vomit+1 & pa94 ,! pa9 is ( a colicky nature & may come on abruptly4 ,aft] ! cont5ts ( ! /oma* h be5 vomit$1 ! mat]ial becomes color$ ) bile1 & f9ally /]corace\s vomit+ occurs4 ,obs]v+ ! cont5ts vomit$ 7ga/ric1 bile-/a9$1 & fecal7 w greatly aid 9 ! diagnosis4 ,! cont5ts ( ! b[el1 bel[ ! ob/ruction1 may be empti$ or complete con/ipation may rema94 ,all ! symptoms1 z a rule1 rapidly gr[ m pron\nc$4 ,! pa9 is m sev]e2 t5d]ness occurs ov] ! abdom5 9 limit$ areas2 !re is slight tympany2 ! eyes are sunk52 ! sk9 is cold & clammy2 ! pulse is quick5$ & feeble2 !re is rapid increase ( leucocytes2 ! ur9e highly color$2 ! tongue is dry & !re is incessant ?ir/2 t5esmus & tumor may be m>k$1 & fev] occasionally occurs4 ,! above condition may cont9ue f ?ree days to a week1 :5 collapse & dea? may occur1 if relief is n obta9$4 ,*ronic ,ob/ruction4--,9 fecal impactions con/ipation ( long /&+ is commonly obs]v$4 ,9 "s cases ! fecal mass has become *annel$1 all[+ ! b[els to rema9 op52 ! pati5t possibly n kn[+ t !re is any tr\ble4 ,9 fact1 di>rhea may be pres5t1 due to irritation above ! impaction4 ,f9ally1 h[ev]1 ob/ruction occurs2 ! brea? is (f5sive1 ! appetite is poor1 ! abdom5 swells1 & !re is fullness & weight )9 ! abdom51 accompani$ by pa9 & vomit+4 ,^u exam9ation be=e complete closure1 ! fecal impactions c easily be felt ?r\gh ! abdom5 ext]nally4 ,! tumor is a yield+ mass4 ,x has be5 mi/ak5 = an enl>g$ liv] or gall-bladd]1 a kidney1 or a tumor ( ! /oma* or duod5um4 ,o!r symptoms may be pres5t z hicc\gh1 jaundice1 t5esmus1 tumultu\s p]i/alsis1 local p]i/alsis1 local p]itonitis & collapse4 ,9 /ricture caus$ by cicatrices t may h be5 =m$ ye>s be=e1 complete ob/ruction takes place4 ,transi5t attacks (t5 occur4 ,usually ! g5]al heal? is greatly impair$ long be=e complete occlusion4 ,diagnosis4--,a diagnosis c usually be made by c>eful1 ?or\gh exam9ation ?r\gh ! abdom9al wall1 9 connection ) ! symptoms1 & ! physical signs4 ,! region ( inte/9al tr\ble is manife/$ by contract$ muscles at c]ta9 po9ts along ! sp9al column1 correspond+ ) ! p>ticul> portion ( ! b[el involv$1 z indicat$ "u inte/9al colic4 ,exam9+ ! pati5t 9 ! knee-*e/ position w (t5 give a bett] opportunity to locate & outl9e ! ob/ruction4 ,rectal & vag9al exam9ations %\ld n be neglect$4 ,inte/9al ob/ruction may be conf\nd$ ) tumors1 h]nia1 inte/9al colic1 ent]itis1 p]itonitis1 hepatic colic & r5al colic4 ,p]itonitis may be diff]5tiat$ by ! hi/ory1 ! e>ly fev]1 diffus$ t5d]ness & abs5ce ( fecal vomit+4 ,:5 invag9ation occurs1 besides ! symptoms ( ob/ruction1 ! age1 t5esmus1 bloody dis*>ges & ! sausage-%ap$ tumor 9 ! l9e ( ! colon1 w be diagno/ic4 ,9 /ricture1 ! hi/ory1 gradual onset1 & ribbon-l & bloody /ools w di/+ui% t disord]4 ,9 tumors ! gradual onset1 age1 bloody dis*>ges1 & ca*exia w be important symptoms4 ,x-ray diagnosis may be ( value 9 c]ta9 cases4 ,treatm5t4--,treatm5t ( ! b[els directly is requir$1 & ea* case mu/ dep5d = its relief ^u ! +5uity ( ! o/eopa?4 ,rules to be foll[$ _c be giv51 z cases v>y 9 mann] ( involvem5t & 9 location1 consequ5tly ! correction ( ! disord] dep5ds z mu* ^u ! ability ( ! o/eopa? z does ! det]m9ation ( ! diagnosis4 ,taxis is ! me?od commonly us$ 9 reliev+ inte/9al ob/ructions1 ?\gh o!r me?ods may be employ$4 ,9 invag9ation1 rais+ ! buttocks & l[]+ ! *e/1 ) ?or\gh injection ( oil or tepid soapsuds1 or an inflation ( ! colon ) air1 may give relief4 ,9 addition to ?or\gh b cauti\s manipulation ( ! b[els z 9 impaction1 irrigation ( ! l[] b[el ) w>m wat]1 soapsuds1 or glyc]9e & wat]1 w usually be ( mat]ial aid4 ,9 /rangulation1 high injections ( w>m wat]1 & assum+ ! knee-elb[ or lat]al position1 may /raight5 out ! acute ob/ruction4 ,twi/s & knots are be/ reliev$ by direct treatm5t1 al?\gh injections may be ( aid4 ,k9ks ( ! pelvic colon1 ileum1 & duod5um are be/ treat$ ) ! pati5t 9 ! knee-*e/ position4 ,tumors & /rictures w require1 soon] or lat]1 surgical int]f]5ce 9 mo/ cases1 b to treat z 9 impaction w be effective = a %ort "t at lea/4 ,if !re is no indication ( imm$iate relief )9 ?ree days1 surgical int]f]5ce %\ld be in/itut$4 ,besides ! ord9>y treatm5t = ! nausea & vomit+1 wa%+ out ! /oma* w help allay su* disord]1 quiet ! p]i/alsis & relieve ! abdom9al di/5tion & pressure above ! seat ( ob/ruction4 ,/rong ?or\gh treatm5t ( ! sp9al n]ves to ! /oma* & inte/9es w be ( great help 9 less5+ pa91 e/abli%+ normal p]i/altic action & 9 suppress+ inflammation4 ,! vagi also %\ld be treat$ = p]v]t$ p]i/alsis4 ,hot fom5tations w be ( s]vice4 ,! nutrition ( ! pati5t is be/ reta9$ by rectal injections ( food4 ,spa/ic /ates1 p>ticul>ly ( ! pelvic colon1 frequ5tly cause con/ipation ( v>i\s degrees ( *ronicity4 ,rea*+ b5ea? ! spa/ic area & inhibit+ & rais+ 7knee-*e/ position7 ! p>ts w (t5 give m>k$ relief4 ,adhesions c (t5 be /ret*$ suffici5tly to re/ore normal function ( ! b[els4 ,treatm5t ( impactions & abnormal cont5ts requires an additional ^w4 ,! fir/ /ep is to free ! colon ( ! fecal mass4 ,! enema is ( great assi/ance 9 ?is1 = cases ( long /&+ pres5t a h>d1 dry mass1 (t5 adh]5t1 & ! muc\s membrane is s5sitive f inflammation4 ,mu* abdom9al treatm5t mu/ n be giv5 until ! mass is s(t5$ by wat]4 ,:5 9 ! sigmoid or rectum x may1 if n dislodg$ by repeat$ enemata1 h to be remov$ by a colon spoon1 p]haps "u ane/hesia4 ,impaction ( ! small inte/9e is r>e & out ( rea* ( ! enema1 al?\gh if tak5 z hot z c be borne1 x w ex]t consid]able influ5ce high up4 ,9 ^! t5d5cies & 9 con/ipation1 :5 ! b[el mu/ be kept op5 be=e treatm5t has produc$ mu* effect1 !re %\ld be an ef=t made to break up any ca?>tic habit :i* may be =m$4 ,! enema is a mo/ valuable aid1 b x mu/ be giv5 correctly4 ,! pati5t %\ld be in/ruct$ t a f\nta9 syr+e is pref]able1 & t x mu/ nev] be tak5 /&+4 ,?is m]ely fills & di/5ds ! rectum1 or l[] sigmoid at ! be/1 & is pass$ )\t any or ) v little effect4 ,ly+ on ! "r side is a v good position1 z is also on ! back ) hips elevat$1 b ! knee & *e/ is be/ 9 mo/ cases4 ,! wat] %\ld be a little above body temp]ature & c be saponifi$ or us$ cle>4 ,! effect w be ab\t ! same4 ,! tube %\ld be p]fectly smoo? & well lubricat$ & introduction mu/ be made ) c>e s z n to bruise or irritate4 ,! wat]1 hav+ be5 all[$ to run to expel ! air1 may be n[ />t$ & w sep>ate ! muc\s folds & all[ easy p5etration4 ,! rubb] tube %\ld be held betwe5 ! ?umb & f+]1 s ! fl[ c be /opp$ z soon z x meets an ob/ruction4 ,:5 ?is is pass$ ! fl[ c beg9 aga9 & cont9ue until ! requir$ am\nt 7f "o to two qu>ts = an adult71 has be5 tak51 or until ! feel+ ( di/5tion becomes too great4 ,by foll[+ ?is me?od1 mu* ( ! di/ress & colicky pa9s :i* sometimes accompany an enema1 may be avoid$4 ,wat] %\ld be held = "s m9utes1 to all[ s(t5+ ( ! fecal mass4 ,9 _m impactions x is important to get ! wat] into ! asc5d+ colon4 ,= t purpose no?+ is bett] ?an a ,coles sigmoid irrigator4 ,?is is %ap$ some:at l ! lett] ,s & is ab\t a foot long f tip to tip4 ,its introduction is n difficult1 b c>e mu/ be us$4 ,place ! pati5t on ! "r side & /& 9 front1 hav+ ! bag susp5d$ ne>4 ,introduce ! tube & ) sl[1 g5tle pressure let x foll[ ! c\rse ( ! b[el4 ,:5 ! spl5ic flexure is rea*$1 x w /op1 b by lett+ a little wat] fl[1 ! b[el w di/5d & x w pass4 ,:5 9 ! full l5g?1 ! end w be ne> ! m$ian l9e & 9 ! transv]se colon4 ,n[ let ! wat] fl[ sl[ly1 /opp+ frequ5tly1 & ) "o h& g5tly lift & "w ! abdom54 ,?is w bo? s(t5 ! cont5ts & aid ! wat] 9 rea*+ ! f>!/ po9t4 ,x is n well to give m ?an a qu>t ! fir/ "t1 z !re is apt to be "s pro/ration4 ,! tube also has ! me*anical effect ( rais+ & replac+ ! sigmoid1 desc5d+ colon & spl5ic flexure4 ,:5 !re is lack ( tone to ! b[el or :5 v little /imulus is ne$$1 a half p9t ( cold wat] tak5 9 ! morn+1 w (t5 act quickly4 ,appliances :i* =ce ! wat] into ! b[el :5 ! pati5t is sitt+1 are n recomm5d$1 z !y t5d to /ret* ! muscul> coat by pressure f lift+ a column ( wat]4 ,h]nia4--,!re are sev]al me?ods ( replac+ a h]nia4 ,! fir/ endeavor1 9 e in/ance1 mu/ be to r$uce x1 :e!r x be /rangulat$1 inc>c]at$ or simply protrud$4 ,"o ( ! easie/ & commone/ me?ods is to place ! pati5t on 8 back1 ! buttocks elevat$1 ! legs flex$ ^u ! ?ighs1 ! ?ighs flex$ ^u ! abdom51 & ! limb on ! affect$ side slightly rotat$ inw>d1 s t ! columns ( ! r+ ab\t ! h]nia may be relax$4 ,aft] ! h]nia is protrud$ a little m1 s t its cont5ts may be empti$ readily1 a g5tle pressure ) ! ?umb & f+] is made ^u ! upp] "p ( ! tumor1 :5 ! re/ w foll[4 ,a gurgl+ noise is he>d ^u r$uction4 ,cases t _c be r$uc$ & are caus+ acute ob/ruction ( ! inte/9es1 %\ld be treat$ surgically4 ,incomplete h]nia1 :i* does n %[ ext]nally1 may be pres5t & cause sev]e reflex symptoms4 ,consid]able att5tion has be5 giv5 to ?is by "s inve/igators4 ,! pati5t is plac$ 9 ! ,tr5del5burg position & ! b[el lift$ out ( ! fossa4 ,if any signs ( h]nia are pres5t a well fitt+ truss w (t5 cause x to heal4 ,ex]cises1 9 a few in/ances1 w be b5eficial4 ,app5dicitis ,app5dicitis is an inflammation ( ! app5dix v]mi=mis4 ,9 a few cases ! cecum & surr\nd+ tissues are involv$ 7typhlitis1 p]ityphlitis74 ,! vasomotor n]ve supply comes f ! l[] ?ree dorsals & upp] two lumb>s4 ,! s5sory n]ves make _! exit f ! ?ree l[] dorsals4 ,app5dicitis is ne>ly always pr$ispos$ by injury to ! inn]vation ( ! v]mi=m app5dix & imm$iate region1 v]tebral d]angem5ts or subdislocations f ! t5? dorsal to ! ?ird lumb>4 ,! v]mi=m app5dix is a peculi>ly con/ruct$ organ1 & its function has n be5 det]m9$ ) positiv5ess4 ,x und\bt$ly has a function & possibly a v useful "o4 ,sir ,william ,macew5#hb does n %>e 9 ! g5]al belief t ! app5dix is )\t function1 b prote/s aga9/ its indiscrim9ate removal1 believ+ x has a p[]ful influ5ce ov] ! function ( ! colon4 8,yet ?\s&s h be5 op]at$ & %[ no ill effect40 ,?is is 9 keep+ ) ! ideas ( ,dr4 ,/ill1 :o always ma9ta9$ t ! app5dix is ( importance to ! human economy4 ,al?\gh ! organ has be5 f\nd 9 v>i\s localities ( ! abdom51 ?is fact & o!rs d n necess>ily indicate t x is a functionless relic4 ,x is ri*ly suppli$ ) lymphatic & blood-vessels & has a p]i/altic action peculi> to itself4 ,:5 ! organ is 9 p]fect condition1 =eign mat]ial probably w\ld n f9d a lodg+ po9t 9 x1 on acc\nt ( its p]i/alsis4 ,dr4 ,/ill#hc sugge/s t ! app5dix has a sph9ct]1 also ! p[] to contract1 dilate or %ort51 %\ld any =eign sub/ance ent]1 & he work$ ) ?is idea 9 view ) uni=m success4 ,! tru? ( ?is !ory has be5 prov$ by ,abrams#hd :o has demon/rat$ by ! aid ( ! fluoroscope t p]i/alsis ( ! app5dix c be /imulat$ by p]cussion at ! #aj? dorsal & x made to empty & fill itself4 ,abrams makes use ( ?is fact 9 ! treatm5t ( cat>rhal app5dicitis4 ,app5dicitis may also be caus$ by fecal impactions & =eign bodies 9 ! b[el contigu\s to ! app5dix4 ,9 ^! cases !re is usually an impair$ inn]vation f ! sp9e1 due to v]tebral & l[] rib lesions1 result+ 9 a weak5$ muscul> coat & cat>rhal conge/ion ( ! mucosa4 ,9 a ^w1 prolapse ( ! b[el at ?is po9t is a pr$ispos+ common cause4 ,9 v>i\s in/ances abrasions ( ! coats ( ! tube occur1 or ! inn]vation or vascul> supply is impair$1 & pa?og5ic bact]ia1 z bacilli coli communis1 /reptococci pyog5es1 /aphylococci pyog5es aureus1 typhoid bacilli1 tub]cle bacilli & o!rs1 f9d a favorable lodg+ po9t & det]m9e ! nature ( ! disease4 ,injuries to ! sp9al column & displacem5ts ( ! v]tebr 9 ! l[] dorsal & lumb> regions1 /ra9+ & lift+1 tight lac+1 torsion ( ! app5dix1 traumatism1 impaction ( feces1 concretions & =eign bodies1 acute indige/ion1 indige/ible food1 ov]eat+1 exposure to wet & cold1 & infecti\s diseases 7z typhoid fev]1 tub]culosis & influ5za71 are all 9 ! li/ ( causes ( app5dicitis4 ,pa?ologically1 9 mo/ cases ! inflammation is cat>rhal4 ,?is includes _m ( ! mild attacks4 ,! mucosa is inflam$ simil>ly to cat>rhal processes else:]e1 al?\gh ! inflammation may rapidly spread to ! deep] /ructures unless imm$iately c>$ =4 ,! inflammation may be s sev]e t ! lum5 becomes clos$4 ,?is is t]m$ oblit]at+ app5dicitis4 ,:5 ?is occurs ! attack may cease & dang] f subsequ5t attacks are at an end1 b inflammation may g on to purul5t involvem5t & ev5 to ulc]ation1 gangr5e & p]=ation or p]itonitis4 ,an abscess may be )9 or )\t ! app5dix4 ,adhesions are likely to =m ab\t ! mass4 ,symptoms4--,a sudd51 viol5t pa9 9 ! abdom51 usually localiz$ 9 ! "r iliac region1 al?\gh at fir/ ?is pa9 may be g5]al4 ,! po9t ( greate/ t5d]ness is detect$ ov] ,mc,burney's po9t--a po9t at ! int]section ( a l9e betwe5 ! umbilicus & ! ant]ior iliac sp9e1 ) a second drawn along ! out] edge ( ! "r rectus muscle4 ,! pati5t usually lies on ! back ) ! "r leg drawn up4 ,! sev]ity ( pa9 is n indicative ( ! s]i\sness4 ,if ! pa9 ceases sudd5ly1 x is commonly a s]i\s indication4 ,!re is usually fev] at ! onset1 ! temp]ature be+ f #ajj to #ajb or ev5 #ajd degrees ,f41 & v r>ely prec$$ by a *ill4 ,9 favorable cases ! temp]ature gradually falls1 rea*+ normal 9 f five to sev5 days4 ,if recov]y has n begun by ?is "t an abscess is probably =m+4 ,if suppuration takes place ! temp]ature cont9ues ) b slight fall1 al?\gh 9 "s cases !re is a rise1 or x may become almo/ normal4 ,pa9 9 ! "r iliac fossa1 )\t fev]1 r>ely po9ts to an acute attack ( app5dicitis4 ,vomit+ & nausea are m or less frequ5t1 & m commonly pres5t 9 ! ev5t ( p]=ation or rupture ( an abscess4 ,9 favorable cases vomit+ r>ely la/s beyond ! second day4 ,9 ! majority ( cases con/ipation is pres5t f ! beg9n+ ( ! attack1 due to p>alysis ( ! b[els4 ,!re may be di>rhea1 p>ticul>ly 9 *ildr54 8,ur9e is febrile 9 "* ) l>ge quantities ( indican4 ,! blood %[s leucocytosis4 ,a leucocyte c\nt ( #bj1jjj is high & indicates an acute app5dicitis1 ) pus1 gangr5e or p]itonitis40 ,on inspection ( ! abdom5 at ! onset ( ! attack1 ! sides look alike1 b on palpation !re is rigidity ( ! rectus abdom9is muscle & ! o!r muscles ov]ly+ ! seat ( inflammation4 ,! :ole abdom5 may be slightly di/5d$4 ,9 ! majority ( cases !re is a progressive developm5t ( a h>d swell+ or tumor 9 ! "r iliac fossa4 ,^! tumors v>y 9 size1 b are usually oval & ! size ( a h5's egg1 & g5]ally situat$ a little above ,p\p>t's ligam5t4 ,fluctuation ( ! tumor is indicative ( suppuration4 ,!re is (t5 great irritability ( ! bladd] & frequ5t micturition4 ,a sudd5 fall 9 ! temp]ature (t5 indicates t a p]=ation has tak5 place1 or t a small abscess has ruptur$ into ! inte/9es4 ,9 favorable cases ! temp]ature falls at ! end ( ! ?ird or f\r? day1 ! pa9 less5s1 ! tongue becomes cle>] & ! b[els are mov$4 ,if ! tumor p]si/s1 ! pati5t is v liable to h a recurr5ce ( ! condition4 ,rapid gr[? ( ! tumor & aggravation ( ! sev]al symptoms po9t to suppuration1 especially extreme t5d]ness ov] ! po9t ( inflammation4 ,if ! app5dicitis goes on to suppuration1 !re is dang] ( rupture into ! p]itoneum4 ,9 a few cases ! abscess may rupture into ! b[el1 9 :i* case ! pati5t recov]s4 ,o!r t]m9ations are lumb> abscess1 hepatic abscess & p]9ephritic abscess4 ,dea? may be caus$ by septicemia or pylephlebitis4 ,^! ev5ts may be delay$ a v>iable l5g? ( "t1 dep5d+ ^u ! ext5t & /r5g? ( ! adhesions t =m ab\t ! abscess4 8,! gravity ( ! app5dix disease lies 9 ! fact t f ! v outset ! p]itoneum may be infect$2 ! initial symptoms ( pa91 ) nausea & vomit+1 fev]1 & local t5d]ness1 pres5t 9 all cases1 may indicate a widespread infection ( ?is membrane40 7,osl]74 ,he also says local signs are n s tru/wor?y z ! g5]al symptoms4 ,!re is liability to relapse 9 app5dicitis4 ,! attacks may recur = ye>s at diff]5t int]vals4 ,9 "s cases ^! int]vals are v %ort4 ,9 "s cases p]fect recov]y may take place aft] repeat$ attacks4 ,diagnosis4--,9 _m cases ! diagnosis is easy1 b o!r cases require c>eful /udy & close obs]vation4 ,sudd5 pa9 becom+ localiz$1 t5d]ness & rigidity 9 ! "r iliac region are ?ree symptoms t toge!r almo/ positively indicate app5dicitis4 ,! leucocyte c\nt is ( p>ticul> value4 ,a pseudo-app5dicitis1 ) all symptoms ( true app5dicitis 9 ! initial /age1 may be caus$ by ! d[nw>d dislocation ( ! twelf? rib on ! "r side1 & occasionally ! elev5? rib on ! same side4 ,! rib lies obliquely d[nw>d t[>d ! cre/ ( ! ilium4 ,9 a few cases ! obliquity ( ! l[] rib is s great z to v ne>ly t\* ! ilium4 ,! dislocat$ rib may produce sev]e irritation1 pa91 t5d]ness1 rigidity1 & ev5 inflammation1 ( ! abdom9al muscles4 ,! pati5t ne>ly always compla9s ( ! pa9 be+ deeply seat$1 ?us possibly confus+ "o4 ,9 typhoid !re is a gradual developm5t ( ! fev]1 *>act]i/ic temp]ature curve1 enl>gem5t ( ! sple51 epi/axis & di>rhea4 ,! ,widal te/ %\ld be made4 ,! abs5ce ( fev] & int]mitt5t pa9 9 ! abdom51 ) complete con/ipation1 fecal vomit+1 g5]al di/5tion ( ! abdom51 bloody /ools & m>k$ t5esmus w\ld det]m9e inte/9al ob/ruction4 ,9 tubal disease a gradual onset1 a m dull & con/ant pa91 ! hi/ory1 & pelvic exam9ation w usually diff]5tiate ?is disord] f app5dicitis4 ,kelly#he gives ^! po9ts 9 diff]5tial diagnosis1 betwe5 acute salp+itis & app5dicitis3 8,9 ! =m] x w usually be f\nd t !re has be5 a yell[i% vag9al dis*>ge = "s p]iod be=e ! attack4 ,! local pa9 & t5d]ness1 usually locat$ deep] 9 ! pelvis1 is mo/ int5se on palpation 9 ! region ( ,p\p>t's ligam5t4 ,on vag9al exam9ation exquisite t5d]ness is felt on ei!r side ( ! ut]us40 ,9 bili>y colic ! pa9 is high] along ! bili>y ducts & gall-bladd]1 ext5d+ ev5 z high z ! %\ld]1 & jaundice is g5]ally pres5t4 ,9 r5al colic ! pa9 ext5ds along ! uret]s d[n to ! inn] side ( ?igh & te/icle1 & back into lumb> region4 ,!re is abs5ce ( fev] & rigidity4 ,! pa9 9 p]9ephritic abscess is d[nw>d into gro91 z 9 nephritic colic1 & !re is t5d]ness ( ! lumb> region4 ,exploratory incision may be necess>y4 ,prognosis4--,naturally1 ! prognosis dep5ds ^u ! "* ( ! app5dicitis1 b on ! :ole ! prognosis is favorable4 ,a l>ge proportion ( cases recov]4 ,surgical op]ations are _m times def]r$ until too late2 und\bt$ly on acc\nt ( ! unc]ta9ty ( ! condition4 ,/ill1 on ! o!r h&1 _m s]i\s cases recov] "u ! prop] treatm5t :5 an op]ation seem$ almo/ absolutely necess>y2 all go+ to prove ! fact t v mu* dep5ds ^u diagnosis ( ! true condition4 ,! /atem5t t !re is 8no m$ical treatm5t = app5dicitis10 seems r broad 9 view ( ! report ( ! m$ical inspector#hf ( ! ,fr5* ,army 9 ,alg]ia4 ,out ( #ffh pati5ts suff]+ f app5dicitis1 #ahh 7 op]at$ ^u & #bc di$1 :ile #djh 7 treat$ m$ically & only ?ree di$4 ,he conclud$ t a meat diet t5d$ to increase ! numb] ( cases4 8,x is exce$+ly common & ! prognosis is1 on ! :ole favorable4 ,tafft1 ( ,cop5hag51 f\nd adhesions 9 ! neighborhood ( ! app5dix 9 #ce p]c5t1 ( all bodies subject$ to po/-mortem exam9ations#hg4 ,treatm5t4--,conf9e ! pati5t 9 b$ at once4 ,cases h und\bt$ly be5 lo/ by n en=c+ ?is po9t4 ,attempts %\ld be made to correct ! disord]$ condition ( ! dorsal & lumb> regions4 ,?or\gh & c>eful treatm5t %\ld be giv5 at ?is po9t1 & 9 mo/ in/ances ! pa9 c be reliev$ by correction ( ! disord]$ v]tebr4 ,if ! case is se5 at ! beg9n+ ( ! attack1 c>eful manipulation t especially lifts ! cecum & surr\nd+ /ructures & local application ( ice are indicat$4 ,h[ev]1 great c>e %\ld be ex]cis$ "h1 = "s ( ! mo/ sev]e cases %[ no induration4 ,temp]ature1 pulse1 & blood picture are invaluable z guides4 ,:5 ! case is advanc$1 extreme c>e %\ld be us$ 9 manipulat+ ov] ! swoll5 & inflam$ region4 ,hot applications w be helpful 9 su* in/ances4 ,:5 due to fecal impaction & =eign bodies1 ?or\gh1 direct1 elevat+ treatm5t ov] ! involv$ region1 & high rectal injections are indicat$4 ,?is applies to ! onset1 = if ! disease has progress$ to ! po9t :]e pus may be pres5t1 ! b[el mu/ be absolutely at re/4 ,d n give or all[ to be giv5 purgatives at any /age ( ! disease4 ,:5 sure t !re is no pus1 direct1 c>eful "w ov] ! cecum & app5dix is all[$ & is ( value4 ,x %\ld be a lift+ ( ! colon & relax+ ( ne>by tissues1 to promote ! circulation4 ,treatm5t ( ! sp9e is necess>y 9 all cases1 to relieve pa91 to correct ! n]ve & vascul> supply1 & to increase p]i/alsis s z to remove irritat+ bodies f ! v]mi=m app5dix4 8,colitis foll[s app5dectomy m frequ5tly ?an any o!r abdom9al op]ation4 ,! explanation = ?is is t ! app5dicitis is seldom localiz$ 9 ! app5dix b is complicat$ by colitis1 or r ! colitis is complicat$ by ! app5dicitis4 ,9 su* cases1 removal ( ! app5dix aggravates r ?an alleviates4 ,a conclusion to be drawn is1 to c>efully palpate ! colon 9 all app5dicitis cases & res]ve diagnosis1 prognosis & advis+ ( an op]ation until x c be def9itely det]m9$ z to ! location1 ext5t & degree ( ! disease4 ,! =mation ( pus is an indication requir+ imm$iate evacuation4 8,if good surgical advantages are available & ! case beg9s ) consid]able virul5ce & a surgeon c be _h )9 ! fir/ tw5ty f\r h\rs1 x is 9 all probability be/ to op]ate2 b if ! case beg9s sl[ly or no good hospital advantages are available1 or if ! case is n se5 until "s =ty-eight h\rs h elaps$ aft] ! onset1 9 all probability x is /rictly an o/eopa?ic case & %\ld n be t\*$ by surg]y4 ,"s advocate 9 all in/ances to wait until pus is =m$ be=e op]ative proc$ure is resort$ to4 ,?is is a r dang]\s attitude to take1 = ,i h se5 hundr$s ( cases op]at$ & h op]at$ ^u a great _m myself & ,i h nev] se5 a case die unless x 0 a pus case40--,s4 ,l4 ,,taylor4#hh ,! case %\ld be mo/ c>efully wat*$1 & a surgeon %\ld be promptly call$ = consultation if ! occasion dem&s x 9 ! lea/2 & if ?\ght advisable1 op]ation %\ld be resort$ to be=e too late4 ,d n assume too mu* responsibility 9 ^! cases4 ,! pati5t %\ld be n\ri%$ on a re/rict$ diet ( milk & animal bro?s4 ,asa ,will>d#hi /rongly recomm5ds no food by m\?1 z x is b\nd to set up p]i/alsis & cause increas$ irritation4 ,he su/a9s ! /r5g? by rectal fe$+4 ,?is view is held by o!r au?orities1 ev5 to )hold+ wat] :5 ! inflammation is at its height4 ,task] confirms ! advisability ( re/rict$ fe$+ & advises re/+ ! b[el ev5 to ! po9t ( discont9uance ( food4 ,! c\rse ( ! attack is usually s %ort t !re is no dang] ( />vation & little loss ( /r5g? results4 ,?is po9t is a highly important "o 9 cases ( any degree ( sev]ity4 ,9 *ronic cases ( a fibrotic "*1 no pus1 c>efully lift+ ! p>ts & loos5+ adhesions 9 addition to sp9al adju/m5t w (t5 re/ore normal circulation4 ,^! conditions aside f ! local disord] frequ5tly cause hyp]*loridia & o!r dige/ive di/urbances4 ,diseases ( ! ,liv] & ,bile ,duct ,prim>y diseases ( ! liv] w inv>iably pres5t o/eopa?ic lesions f ! f\r? or fif? dorsals to ! elev5? or twelf?4 ,! ribs on ! "r side are commonly involv$4 ,^! lesions probably di/urb ! liv] by way ( ! vasomotor fib]s4 ,displacem5ts ( ! duod5um1 ( ! hepatic flexure & transv]se section ( ! colon & displacem5ts ( ! "r kidney are frequ5t s\rces ( liv] disord]s4 ,c>e %\ld be tak5 9 diff]5tiat+ prim>y f second>y diseases1 = naturally ! relative importance ( ! v>i\s factors 9 treatm5t w v>y4 ,9 _m second>y diseases !re w be f\nd pr$ispos+ o/eopa?ic lesions1 & ^! second>y disord]s & deg5]ations c at lea/ be palliat$ & occasionally ! deg5]ation ret>d$ or /opp$ by p]si/5t o/eopa?ic treatm5t1 diet1 & hygi5ic measures4 ,hyp]emia ( ! ,liv] ,?is is an abnormal fullness ( ! blood-vessels ( ! liv]1 foll[$ by an enl>gem5t ( t organ4 ,x is active :5 !re is abnormal pressure 9 ! portal ve9s 7aff]5t vessels72 passive :5 !re is excessive pressure 9 ! sublobul> ve9s 7eff]5t vessels74 ,o/eopa?ic ,etiology & ,pa?ology4--,active hyp]emia is usually due to indiscretions 9 diet4 ,aft] ea* meal a physiological hyp]emia ( ! liv] occurs1 :i* is greatly increas$ by habitually ov]eat+ & ov]dr9k+4 ,?is condition may lead to functional di/urbance & possibly to organic *ange4 ,traumatism & lesions ( ! v]tebr & ribs1 irritat+ vasomotor n]ves1 are important4 ,habitual con/ipation1 mal>ia1 heat1 & arre/$ m5/rual epo*1 & infecti\s fev]s are also causes ( ! active =m4 ,ent]optosis is n a r>e cause4 ,passive hyp]emia is due to ob/ructions ( ! eff]5t circulation4 ,valvul> he>t disease is ! mo/ common cause4 ,lung diseases1 z emphysema or cirrhosis2 ob/ruction to ! v5a cava or int]f]5ce ) ! fl[ ( blood ?r\gh ! liv]2 & diseases ( ! pleura1 are among ! causes4 ,mo/ cases ( conge/ion ( ! liv] pres5t lesions to ! vasomotor n]ves ( ! liv]1 fif? to n9? dorsal4 ,especially are ! ribs ov] ! liv] apt to become displac$ & affect ! organ4 ,pa?ologically1 ! liv] is enl>g$ & engorg$ ) blood4 ,! appe>ance ( ! organ dep5ds ^u ! duration ( ! hyp]emia4 ,9 passive hyp]emia ! c5tral portion ( ! lobule & ! area ( ! hepatic ve9 are deeply color$4 ,! p]iph]y & ! area ( ! portal ve9 are pale4 ,?is alt]nation ( ! d>k & light color gives rise to ! nutmeg liv]1 :i* is s noticeable ^u section4 ,9 cases ( long /&+1 atrophy ( ! liv] cells & ov]gr[? ( connective tissue result4 ,symptoms4--,active ,hyp]emia4--,dull a*+ & a s5se ( fullness 9 ! "r hypo*ondrium1 a*+ ( ! limbs1 coat$ tongue1 nausea1 vomit+1 con/ipation1 highly color$ ur9e1 & slight jaundice4 ,9 passive hyp]emia ! symptoms are ! same1 b less m>k$4 ,! onset is gradual & ! liv] may atta9 consid]able size4 ,9 sev]e cases foll[+ tricuspid regurgitation ! liv] may pulsate4 ,9 sev]e cases dropsy takes place4 ,diagnosis4--,active hyp]emia is occasionally conf\nd$ ) cat>rhal jaundice4 ,usually conge/ion ( ! liv] is easily diagnos$4 ,prognosis4--,9 active hyp]emia ! prognosis is good1 unless repeat$ attacks lead to atrophic deg5]ation4 ,9 passive hyp]emia ! prognosis dep5ds entirely ^u ! cause4 ,treatm5t4--,active hyp]emia4--,! treatm5t consi/s ( measures :i* t5d to dim9i% ! conge/ion1 pr9cipally a ?or\gh1 direct manipulation ov] ! liv] by rais+ & spread+ ! ribs4 ,c>eful & ?or\gh treatm5t to ! dorsal splan*nics ( ! liv] is also indicat$4 ,! sub/itution ( a scanty = a heavy diet is ess5tial4 ,! foods giv5 %\ld be su* z are easily dige/$1 z milk & bro?s2 fats & sug>s are to be avoid$4 ,9 passive hyp]emia ! treatm5t consi/s ( correct+ ! disord] caus+ x4 ,(t5 he>t diseases are ! cause4 ,a ?or\gh depletion ( ! b[els w aid l>gely 9 reliev+ ascites t may foll[ passive conge/ion 7,see ascites74 ,9 liv] conge/ions x is well to pay att5tion to ! inte/9al condition 9 ord] t ! circulatory me*anism "h may be ?or\ghly coord9at$ ) ! hepatic4 ,simple ,cat>rhal ,jaundice ,def9ition4--,jaundice due to inflammation ( ! t]m9al portion ( ! common duct1 n ! result ( impact$ gall-/one4 ,! disease probably />ts z a cat>rhal inflammation ( ! /oma* & upp] portion ( ! small inte/9e4 ,! bile is reta9$ & absorb$4 ,o/eopa?ic ,etiology & ,pa?ology4--,a frequ5t pr$ispos+ cause is ! subdislocation ( ! t5? rib on ! "r side1 ?us int]f]+ ) ! inn]vation to ! bile ducts1 & caus+ conge/ion ( ! muc\s membrane ( ! common duct2 al?\gh lesions above & bel[ ?is po9t may occur4 ,ext5sion ( ga/ro-duod5itis into ! common duct is a common s\rce ( ! inflammation4 ,sagg+ ( ! duod5um w di/urb ! bile-duct ?r\gh its be+ a portion ( ! duod5o-hepatic ligam5t4 ,duod5al cat>rh usually foll[s errors 9 diet1 exposure1 mal>ia1 ,bright's disease1 portal ob/ruction & *ronic he>t disease4 ,infecti\s fev]s1 z pneumonia & typhoid fev]1 & emotional di/urbances are among ! causes4 ,cat>rhal jaundice may occur 9 epidemic =m4 ,pa?ologically1 ! duod5al end ( ! duct is mo/ commonly involv$4 ,! muc\s membrane is swoll5 & ! orifice fills ) mucus4 ,! inflammation may involve ! common & cy/ic ducts & ev5 ! hepatic4 ,! liv] is enl>g$ & ! gall-bladd] di/5d$4 ,symptoms4--,! only symptom pres5t may be simply ! jaundice4 ,!re is always t5d]ness ^u pressure ov] ! ducts4 ,! pati5t _m times compla9s ( a /abb+ pa9 :5 pressure is ex]t$ ov] ! duod5al op5+4 ,usually ! c\rse ( ! bile duct c readily be felt ^u deep pressure1 ow+ to ! tumefaction4 ,accompany+ ?is condition may be g5]al malaise1 loss ( appetite1 nausea1 vomit+1 con/ipation or irregul> action ( ! b[els1 pa9s 9 ! back & limbs & a slight fev]4 ,diagnosis4--,:]e jaundice is pres5t )\t pa91 x g5]ally indicates cat>rhal jaundice4 ,! abs5ce ( emaciation or ( evid5ces ( canc] or cirrhosis usually makes ! diagnosis easy4 ,good g5]al nutrition & a negative physical exam9ation favor simple jaundice z to ! diagnosis4 ,prognosis4--,! prognosis ( cat>rhal jaundice is favorable1 unless accompani$ ) infecti\s diseases or hyp]trophic cirrhosis4 ,:5 diseases are associat$ ) jaundice ! dang] is usually f ! disease4 ,! duration ( ! disease is g5]ally giv5 z f two to eight weeks1 b o/eopa?ic treatm5t g5]ally less5s t "t at lea/ "o-half4 ,treatm5t4--,! treatm5t is direct$ t[>d reliev+ ! inflammation ( ! bile ducts & increas+ ! fl[ ( ! bile into ! inte/9es4 ,great relief to ! pati5t w be exp]i5c$ f ?or\gh treatm5t ov] ! bile ducts1 especially at ! duod5al end4 ,press sl[ly b firmly ov] ! region ( ! ducts1 !n execute a d[nw>d motion ) firm pressure ov] ! c\rse4 ,?is p]=mance %\ld be repeat$ sev]al times1 until ! t5d]ness 9 ?is region is almo/ or entirely reliev$4 ,! idea ( ?is treatm5t is1 fir/1 to sl[ly b firmly be> d[n ^u ! abdom9al muscles ov] ! conge/$ tissues1 s z to relax ! tissues & get z close to ! ducts z possible1 & second1 ) ! d[nw>d movem5ts to r$uce ! conge/ion ( ! ducts & at ! same "t to remove any mucus or o!r mat]ial f ! orifice1 ?us all[+ a fre] fl[ ( bile4 ,x w be recall$ t ! normal fl[ ( bile is "u v l[ pressure4 ,c>e %\ld be tak5 n to g\ge or dig into ! tissues ) ! ends ( ! f+]s1 b to use ! flat surface ( ! f+]s4 ,any g\g+ or sev]e treatm5t w n all[ "o to accompli% 8 purpose1 ow+ to ! /imulus or irritation x w\ld give ! abdom9al muscles & ?us cause !m to contract2 & fur!rmore1 x w\ld m or less bruise ! p>ts4 ,an inhibitory treatm5t %\ld be giv5 along ! sp9e on ! side affect$ to help relax ! abdom9al muscles be=e ?is treatm5t is adm9i/]$4 ,9 all circulatory di/urbances ( ! bile-duct & o!r hepatic tissues lift ! duod5um at ab\t ! second lumb> :]e x lies beside ! asc5d+ colon4 ,?is t5ds to release portal ve91 hepatic art]y & bile-duct1 ! duod5o-hepatic ligam5t4 ,direct treatm5t is giv5 to ! liv] by m or less knead+ or work+ ! organ & also by rais+ & spread+ ! ribs4 ,?is treatm5t is to /imulate ! activity ( ! liv]4 ,rea*+ "u ! c>tilages ( ! eigh? & n9? ribs on ! "r side & be>+ inw>d & d[nw>d w empty ! gall-bladd] & ?us be ( aid 9 reliev+ ! t5sion 9 ! bili>y passages4 ,x is probably a /imulus to ^! cutane\s fib]s t causes a relaxation ( ! sph9ct] muscles ( ! gall-bladd] & ?us all[s x to empty4 ,/imulation ( ! t5? n]ve contracts ! gall-bladd]4 ,!n x %\ld also be not$ t "w ov] ! duod5al end ( ! bile-duct relaxes ! orifice :ile ?r\gh reciprocal relation%ip ! fib]s ( ! gall-bladd] contract4 ,:5 all ( ! muscles ( ! hepatic region h be5 c>efully relax$ & s(t5$1 a ?or\gh exam9ation c !n be made ( ! v]tebr & ribs t might emb>rass ! inn]vation or vascul> supply ( ! liv]4 ,lesions ( ! v]tebr & ribs affect+ ! liv] may occur f ! six? to ! elev5? dorsal4 ,lesions to ! vagus & phr5ic n]ves may occasionally involve ! organ4 ,irrigation ( ! l>ge b[el ) cold wat] may be employ$4 ,! cold excites p]i/alsis ( ! gall-bladd] & ducts4 ,dr9k+ freely ( wat] w be helpful4 ,a non-/imulat+ diet %\ld be giv54 ,! /oma* may n be 9 a condition to be> solid food2 & fur!rmore1 food on ent]+ ! duod5um w increase ! local inflammation ( ! common bile duct4 ,give dilut$ milk1 butt]milk1 light meat-bro?s1 clam-bro?1 egg album9 & press$ beef juice4 ,aft] ! pa91 vomit+ & fev] subside1 ! diet c be gradually increas$4 ,*olecy/itis ,*olecy/itis is an inflammation ( ! gall-bladd] caus$ by infection4 ,/agnation ( bile due to ob/ruction 7especially gall-/ones7 ( ! bile ducts1 or a sl[+ ( ! bile fl[ ow+ to d]ang$ inn]vation f o/eopa?ic lesions or sagg+ b[el1 are pr$ispos+ factors4 ,fibrotic *anges 9 ! app5dix are fairly common s\rces t d]ange ! n]v\s reflexes ( ! bili>y function4 ,! disord] may be associat$ ) specific fev]s4 ,excit+ factors are ! colon bacilli1 /reptococci1 /aphylococci1 typhoid bacilli1 & pneumococci4 ,symptoms4--,! gall-bladd] feels h>d & full4 ,!re is inflammation & ?ick5+ ( ! muc\s membrane1 ) consid]able increase ( mucus4 ,ow+ to ! infection !re may be ulc]ation & suppuration1 ) possible p]=ation & p]itonitis4 ,:5 ! inflammation ext5ds outside ( ! bladd] !re are usually adhesions4 ,! onset is commonly sudd51 ) pa9 & t5d]ness 9 ! "r hypo*ondrium4 ,great c>e %\ld be tak5 9 decid+ ! location ( ! inflammation1 = ! pa9 & t5d]ness may be ov] ! /oma*1 or along ! duod5um or asc5d+ colon z l[ z ! cecum4 ,nausea1 fev]1 con/ipation1 & possibly jaundice1 are o!r symptoms4 ,treatm5t4--,ex]cise special c>e 9 treat+ ^! cases4 ,al?\gh 9 _m in/ances ! inflammation w rapidly subside1 /ill ow+ to suppuration !re is dang] ( aggravat+ ! condition4 ,x is bett]1 9 d\btful cases1 to conf9e ! treatm5t to sp9al "w1 & to influ5ce dra9age by plac+ ! pati5t 9 knee-*e/ position & c>efully raise cecum1 asc5d+ colon & duod5um4 ,re/1 re/rict$ diet1 pl5ty ( wat]1 & hot fom5tations w be b5eficial4 ,9 sev]e cases surgical int]f]5ce is indicat$4 ,jaundice 7,,ict]us7 ,jaundice is a symptom & n a disease4 ,x consi/s ( ! discoloration ( ! sk9 & o!r tissues by mat]ial d]iv$ f ! bile4 ,! discoloration may v>y f a m]e pal5ess to a yell[ or br[n olive hue4 ,toxic jaundice occurs 9 acute yell[ atrophy1 p]nici\s anemia1 pyemia1 specific fev]s1 & ! action ( poisons4 ,ob/ruction by =eign bodies z gall-/ones & p>asites are important causes4 ,inflammation & swell+ ( ! bili>y ducts & duod5um are common causes z well z /ricture ( ! duct by tumors & v>i\s gr[?s1 ei!r int]nal or ext]nal1 to ! bili>y ducts4 ,9 "s in/ances pressure f )\t by ! pancreas1 /oma*1 kidneys1 enl>g$ gl&s1 fecal matt]1 a pregnant ut]us1 etc41 has be5 ! cause4 ,irritations & ob/ructions ( ! splan*nic n]ves1 due to lesions 9 ! l[] dorsal v]tebr & ! ribs f ! six? to ! elev5?1 w (t5 m>k$ly affect ! liv]4 ,also lesions at ^! po9ts may pr$ispose to inflammation & tumefaction ( ! bile ducts4 ,symptoms4--,besides ! discoloration ( ! sk91 !re is it*+ ( ! sk91 on acc\nt ( bile pigm5t deposits2 ev5 eruptions may occur4 ,! muc\s membranes are (t5 color$ & a con/ant symptom is ! bright yell[ discoloration ( ! scl]otic coat ( ! eye4 ,! secretions are color$4 ,x may be fir/ notic$ 9 ! ur9e4 ,! p]spiration is color$1 r>ely ! saliva & te>s4 ,!re is frequ5t sweat+4 ,z v little bile passes into ! inte/9e1 ! feces are pale & gray1 & /icky4 ,! b[els are g5]ally con/ipat$1 b di>rhea may occur1 ow+ to decomposition result+ f abs5ce ( ! normal +r$i5ts4 ,o!r symptoms may be associat$ ) ! ga/ro-inte/9al d]angem5ts1 z nausea1 fetid brea? & loss ( appetite4 ,a sl[ pulse may occur1 due probably to "s /imulat+ effect on ! inhibitory action ( ! vagus n]ve4 ,lesions are (t5 f\nd at ! atlas & axis1 affect+ ! vagus4 ,pa9 back ( ! "r scapula is a symptom ( liv] tr\ble2 x has be5 sugge/$ t x is due to a /imulus pass+ up ! vagus to ! sp9al accessory1 & !nce to ! trapezius muscle4 ,v>i\s c]ebral symptoms may be pres5t1 z great depression1 irritability1 heada*e & v]tigo4 ,9 sev]e cases !re may be delirium & coma4 ,9 hemolytic & toxic jaundice ! de/ruction ( blood is due to "s toxic ag5t4 ,! feces are n clay color$ & ! ur9e is less /a9$ ) bile4 ,! g5]al symptoms may be v sev]e dep5d+ ^u ! und]ly+ cause4 ,diagnosis4--,to mi/ake = jaundice ! dirty yell[i% discoloration ( ! sk9 commonly t]m$ sall[ness is an error (t5 made4 ,?is condition indicates mal>ia1 ut]9e disease or g5]al ill heal?4 ,v likely x is an anemia & is readily diagnos$ f ! jaundice z ! secretions & conjunctiva are n /a9$4 ,addison's disease some:at resembles jaundice1 b ! feces are normal1 ! ur9e & scl]otic coat are n color$1 b expos$ portions ( ! body & flexures ( ! jo9ts are deeply /a9$4 ,prognosis4--,dep5ds entirely on ! cause produc+ x4 ,ord9>y cases run f two to six weeks1 :ile o!rs may n recov] = sev]al mon?s4 ,jaundice f impaction ( ! bile ducts may be manife/ = only a few days4 ,toxic =m may t]m9ate fatally1 ow+ to ! disease caus+ x4 ,! ext5t ( resorption ( bile & de/ruction ( r$ blood cells 9 ! liv] v>ies to a consid]able degree4 ,treatm5t4--,! treatm5t = ! diff]5t =ms result+ second>ily w be f\nd "u ! diseases caus+ !m4 ,a simple ict]us1 caus$ by di/urbance ?r\gh ! inn]vation ( ! liv] & bile ducts directly1 c be reliev$ readily by ?or\gh treatm5t ( ! liv] & bile ducts z describ$ "u cat>rhal jaundice4 ,c>efully raise ! inte/9es if !y are prolaps$1 especially ! colon & duod5um4 ,cirrhosis ( ! ,liv] ,?is is a *ronic disease ( ! liv]1 *>act]iz$ by hyp]plasia ( ! connective tissue ) de/ruction ( ! liv] cells1 result+ 9 ! organ becom+ h>d & usually small4 ,etiology4--,! disease usually occurs 9 ! male sex & 9 middle life4 ,:5 occurr+ 9 *ildr51 x is commonly ( ! syphilitic =m1 ?\gh x may be due to o!r infections4 ,! abuse ( spiritu\s liquors is a common cause4 ,x foll[s *ronic diseases1 su* z syphilis1 long cont9u$ mal>ial intoxication1 g\t & tub]culosis4 ,passive conge/ion1 due to *ronic he>t & lung disease1 causes "s cases4 ,a few cases are caus$ by inflammation ( ! bile ducts1 due to infection & ob/ruct+ calculi2 o!rs to a /imulat+ diet1 :ile "s cases are inexplicable4 ,pa?ologically1 ! fir/ /age is hyp]plasia ( ! connective tissue & consequ5t enl>gem5t ( ! organ4 ,z ?is increases ! connective tissue de/roys imm5se numb]s ( ! hepatic cells1 ow+ to ! pressure4 ,(t5 ! enl>gem5t is accompani$ by t5d]ness4 ,9 ! lat] /age ! ov]gr[? ( imp]fectly develop$ tissue seems to contract ! hepatic cells t /ill rema91 caus+ atrophy & deg5]ation ( mo/ ( !m1 & ?us r$uc+ ! size ( ! organ1 :i* is foll[$ by scl]osis4 ,! portal & hepatic circulations are greatly ob/ruct$4 ,an occasional =m is t]m$ hyp]trophic scl]osis 9 :i* scl]osis is f\nd :ile ! organ cont9ues enl>g$4 ,!re are two common & well def9$ v>ieties1 atrophic cirrhosis & hyp]trophic cirrhosis2 o!r =ms 7r>e7 are met )4 ,atrophic cirrhosis is ! common =m1 & is usually due to alcoholic excess4 ,! surface ( ! liv] is r\gh & unev5 9 addition to its h>dness & r$uction 9 size4 ,x may also be greatly de=m$ & cov]$ ) granulations 78hob-nails074 ,! normal weight is f\r or five p\nds1 b x may be s r$uc$ z to weigh no m ?an "o p\nd or a p\nd & "o-half4 ,sometimes !re is fatty infiltration1 :i* enl>ges ! liv] to su* an ext5t t ! contraction is n notic$4 ,!re is an ov]gr[? ( ! connective tissue1 :i* contracts & con/ricts ! bran*es ( ! portal ve91 causes atrophy & deg5]ation ( ! hepatic cells1 & ev5 sometimes oblit]ates ! bile ducts4 ,! new connective tissue is well suppli$ ) blood-vessels f ! hepatic art]y1 ?us aid+ greatly 9 ! gr[?4 ,9 ! hyp]trophic =m1 z well z 9 ! atrophic cirrhosis1 !re is an ov]gr[? ( connective tissue1 b 9 ! hyp]trophic =m ! new =m ( tissue exhibits no disposition to contract4 ,! enl>gem5t ( ! organ is l>gely due to hyp]emia4 ,z ! tissue does n contract !re is no pressure on ! portal ve9 & atrophy is prev5t$4 ,!re is e>ly jaundice 7:i* is a *>act]i/ic symptom7 ow+ to ob/ruction ( ! bili>y *annels4 ,! surface is smoo? & its color is gre5i% yell[4 ,symptoms4--,atrophic ,=m4--,!re may be practically no symptoms4 ,z !re is ob/ruction ( ! portal circulation1 !re may be conge/ion ( ! /oma* & inte/9es1 result+ 9 *ronic ga/ric or inte/9al cat>rh hav+ ! foll[+ symptoms--anorexia1 di/ress aft] eat+1 di/5tion1 con/ipation & coat$ tongue4 ,ow+ to ! ana/omotic communication betwe5 ! portal & caval circulations1 z ! portal circulation becomes m ob/ruct$1 ! sup]ficial abdom9al ve9s become greatly di/5d$4 ,hemorrhoids occur1 ow+ to ! communication ( ! sup]ior hemorrhoidal1 :i* is a bran* ( ! portal ve9 ?r\gh ! inf]ior middle hemorrhoids1 ) ! hypoga/ric ve9 & ! v5a cava2 h5ce hemorrhoids are a *>act]i/ic symptom4 ,!re is enl>gem5t ( ! sple5 & hemorrhage f ! /oma* or b[els4 ,edema ( ! legs & ascites are due to engorgem5t ( ! portal sy/em4 ,ascites is mu* m common ?an edema ( ! legs4 ,!re may be slight jaundice1 al?\gh ?is is a r>e symptom 9 atrophic cirrhosis4 ,!re is always decid$ emaciation4 ,on exam9ation !re is a dim9i%$ area ( hepatic dullness1 :ile ! spl5ic dullness is enl>g$4 ,x is (t5 impossible to outl9e ^! organs1 z ! abdom9al di/5tion prev5ts x4 ,! ur9e is scanty1 high color$ & (t5 load$ ) urates1 b seldom bile-/a9$4 ,9 ! hyp]trophic =m slight jaundice appe>s at ! onset1 :i* gradually deep5s until x is int5se & p]si/5t4 ,occasionally !re is fev]4 ,! disease z a rule is decid$ly *ronic1 ?\gh acute symptoms may develop at any p]iod4 ,! ur9e is (t5 bile-/a9$1 b ( normal quantity4 ,on exam9ation ! liv] is l>ge1 smoo? & r\nd & c be felt bel[ ! ribs4 ,! sple5 is greatly enl>g$4 ,diagnosis4--,9 atropic cirrhosis4--,) ascites )\t dropsy else:]e1 hi/ory ( alcoholism1 hemorrhage f /oma* or b[els & r$uction 9 size ( liv]1 ! diagnosis is absolute4 ,hyp]trophic cirrhosis4--,9 canc] ( ! liv] ! pati5t is advanc$ 9 ye>s1 has no spl5ic enl>gem5t1 & m commonly ascites is pres5t2 :ile 9 hyp]trophic cirrhosis !re is *ronic bili>y ob/ruction1 ! liv] is only mod]ately enl>g$ & h>d1 m>k$ jaundice1 ) causes lead+ to or evid5ce ( hepatic ob/ruction4 ,?is =m ( cirrhosis is also to be diff]5tiat$ f amyloid liv] & e*9ococcus cy/4 ,prognosis4--,unfavorable1 al?\gh 9 "s cases ! disease c be arre/$ dur+ ! e>ly /age1 provid$ ! habits are regulat$ & treatm5t is cont9u\s & p]si/5t4 ,dea? usually occurs f "o to two ye>s aft] appe>ance ( dropsy4 ,ascites is difficult to cont5d )4 ,treatm5t4--,if ! disease is recogniz$ at ! beg9n+ & p]si/5t treatm5t giv5 to ! liv]1 ! *ances are t atrophy ( ! cells & connective tissue =mation w n take place4 ,b ord9>ily cases ( cirrhosis are incurable4 ,! mo/ t c be done is to ree/abli% a comp5satory circulation 9 ! liv]4 ,o!rwise x w\ld be no m unreasonable to say t "o c\ld cure a *ronic valvul> lesion ( ! he>t4 ,! pati5t %\ld live a quiet outdoor life4 ,alcoholic dr9k+ %\ld be /opp$4 ,! diet %\ld be light & nutriti\s1 pref]ably a milk diet4 ,! b[els %\ld be kept op51 ! sk9 active & ! kidneys closely wat*$4 ,fatty ,liv] ,9 fatty infiltration !re is no loss ( function4 ,! fat infiltrates ! cell1 cr[d+ aside ! protoplasm4 ,?is is l>gely a normal process1 ?\gh fatty deg5]ation may be associat$4 ,9 fatty deg5]ation ! cell loses its /ructure & is *ang$ into fatty tissue4 ,*ronic intoxication f infecti\s diseases1 su* z ph?isis pu]p]al fev]1 typhoid fev]1 pneumonia & syphilis are ! pr9cipal causes4 ,alcoholism & phosphor\s poison+ are o!r causes4 ,amyloid ,liv] ,!re is infiltration into ! tissues ( ! liv]1 ( ! s-call$ amyloid sub/ance4 ,! infiltration beg9s 9 ! blood-vessels1 ! hepatic art]y fir/1 !n ! c5tral zone or p]iph]y1 & f9ally all /ructures ( ! liv]4 ,?is disord] %\ld be view$ z a di/urbance ( metabolism4 ,etiology & ,pa?ology4--,?is condition is usually f\nd 9 cases ( prolong$ suppuration1 especially associat$ ) tub]cul> disease ( ! bones z 9 hip-disease1 syphilis1 rickets1 mal>ia1 canc] & leukemia4 ,x is believ$ by "s to be ! result ( microbic invasion1 especially ! tub]cle bacillus & /aphylococcus4 ,lesions are frequ5tly f\nd f ! fif? to ! t5? dorsal v]tebr1 :i* probably act z pr$ispos+ factors4 ,! liv] is consid]ably enl>g$ & r\nd$4 ,x is pale or waxy 9 appe>ance & is d\ghy 9 consi/5cy4 ,on section x is anemic & :iti%1 p>tly due to infiltration into ! walls ( ! blood-vessels n>r[+ ! lum54 ,! amyloid *anges may be circumscrib$ & 9 "s cases fatty infiltration is pres5t4 ,symptoms4--,!re are no *>act]i/ic symptoms except ! enl>gem5t ( ! liv]1 al?\gh ! complexion may be waxy & !re may be "s ga/ro-inte/9al di/urbances4 ,pa9 is abs5t1 al?\gh occasionally !re is a dragg+ s5sation1 due to ! weight ( ! organ4 ,jaundice is n pres5t1 b ! /ools may become light color$1 ow+ to a dim9i%$ secretion ( bile4 ,! ur9e may be increas$ 9 am\nt & conta9 "s album9 if amyloid occur 9 ! kidneys4 ,emaciation & anemia are pres5t & ascites seldom occurs4 ,amyloid *anges involve ! sple51 kidneys1 inte/9es & o!r organs4 ,diagnosis4--,! organ be+ l>ge1 h>d & smoo?1 ) abs5ce ( jaundice & ascites1 ! pres5ce ( album9uria & an enl>g$ sple5 & ) ! hi/ory ( ! case1 mi/akes are n likely to be made4 ,prognosis4--,dep5ds ^u ! cause4 ,! progress may be rapid or sl[4 ,treatm5t4--,c>eful att5tion to ! prim>y di/urb+ factor & direct treatm5t to ! liv] w1 9 "s in/ances1 r$uce ! size ( ! organ4 ,nitrog5\s food & hygi5ic measures %\ld be in/itut$4 ,! vasomotor n]ves ( ! portal sy/em 7fif? to la/ dorsal7 %\ld be treat$ ?or\ghly4 ,gall-,/ones ,gall-/ones are concretions t orig9ate 9 ! gall-bladd] & occasionally 9 ! hepatic ducts4 8,! prim>y =mation ( gall-/ones is itself l>gely dep5d5t ^u /agnation ( bile1 su* z may arise 9 ! gall-bladd] if an int]mitt5t or incomplete closure ( ! cy/ic duct be br\ght ab\t by su* ?+s z tight lac+1 pregnancy1 or ev5 unequal sagg+ ( ! abdom9al visc]a40--,mac,callum4 ,! /one is l>gely compos$ ( *ole/]91 & may =m )\t any inflammation ( ! gall-bladd]1 ow+ probably to ! /agnation affect+ ! bile salts s t ! *ole/]9 is precipitat$ in/ead ( be+ held 9 solution4 ,m (t5 !re is inflammation ( ! wall ( ! gall-bladd] due to micro-organisms4 ,?is causes an exudate f :i* is d]iv$ ! calcium4 ,! calcium ) bilirub9 is deposit$ 9 lay]s on ! /one :i* give x ! v>i\s colors ( yell[1 br[n or gre54 ,a r>e type is "o =m$ 9 ! hepatic ducts1 :i* is s(t1 gre51 & compos$ ( calcium bilirub9 concretions4 ,! /ones 8conta9 a great deal ( organic mat]ial d]iv$ f desquamat$ epi!lial cells & coagulat$ album9\s matt]1 z well z pigm5t40 ,! colon bacilli1 /aphylococci1 /reptococci1 typhoid bacilli1 & pneumococci are ! bact]ia mo/ frequ5tly f\nd4 ,a *olecy/itis may be a pr$ispos+ factor or x may be second>y to ! concretion4 ,o/eopa?ic ,etiology & ,pa?ology4--,?is is a disease ( middle life & is m frequ5tly f\nd 9 wom54 ,s$5t>y habits & con/ipation comb9$ ) ov]eat+1 are o!r important factors4 ,x is f\nd 9 /\t subjects :o are p>ticul>ly fond ( />*y & sac*>9e food4 ,cat>rhal jaundice is a pr$ispos+ factor4 ,depress+ m5tal influ5ces may pr$ispose4 ,! ?ick] ! bile ! m likely x is to deposit4 ,dr4 ,/ill's !ory is t lesions ( ! ribs on ! left side f ! six? to ! t5? dorsal are factors 9 ! =mation ( ! /ones z !y int]f]e ) pancreatic secretions4 ,no matt] h[ x comes ab\t1 ! fact is t 9 all cases ( gall-/ones ! o/eopa? f9ds lesions to ! eigh?1 n9? & t5? ribs on ! left side1 z well z lesions f ! fif? or six? to ! t5? dorsal1 d]ang+ inn]vation to ! liv] & bile ducts4 ,x is possible t lesions ov] ! sple5 probably int]f]e ) ! activities ( ! sple5 & ?us 9 "s mann] ?is organ does n prop]ly elaborate ! blood be=e x passes to ! liv]4 ,sagg+ ( ! duod5um may1 ?r\gh t5sion on ! duod5o-hepatic ligam5t1 int]f]e ) ! fl[ ( bile4 ,?is w\ld cause d]angem5t ( ! n]v\s reciprocal relation%ip betwe5 op5+ at duod5al orifice & gall-bladd]4 ,9 c>c9oma ( ! liv] & /oma*1 gall-/ones are said to be frequ5t4 ,! /one itself is a br[ni% object1 ne>ly sph]ical1 facet$ & 9 "s in/ances polygonal 9 %ape1 v>y+ 9 size f a pea to a h5's egg4 ,! /ones are f\nd any:]e 9 ! bili>y tract f ! duod5al orifice to ! ramification ( ! bile vessels4 ,usually !re is m or less ( an accumulation 9 ! gall-bladd]4 ,at any po9t ! /one may produce ulc]ation & suppuration4 ,p]=ation may occur into ! p]itoneal cavity or adjac5t organs4 ,symptoms4--,gall-/ones may be 9 ! gall-bladd] = ye>s )\t giv+ rise to any symptoms4 ,_! pres5ce is made kn[n only by _! expulsion f ! gall-bladd]4 ,if !y lodge 9 ! duct 9 transit f ! gall-bladd] to ! duod5um bili>y colic is produc$1 :i* is ! *>act]i/ic symptom ( an impact$ gall-/one4 ,small /ones may pass into ! inte/9e )\t produc+ symptoms4 ,! pa9 is v sudd51 pi]c+ & excruciat+ 9 ! region ( ! gall-bladd]1 :5 a /one attempts to pass4 ,! pa9 radiates ?r\gh ! abdom51 "r *e/ & %\ld]1 & ! pati5t wri!s 9 agony & occasionally fa9ts4 ,d[n+#ij emphasizes ! po9t t :5 a pati5t comes 9 ) a hi/ory ( repeat$ attacks ( bili>y colic & no /one f\nd 9 ! /ools "o %\ld at once suspect t "o ( consid]able size ob/ructs ! common duct4 ,!re is always t5d]ness 9 ! bili>y region ) m or less contraction ( ! abdom9al muscles4 ,nausea1 vomit+ & sweat+ are usually pres5t1 foll[$ by a weak pulse1 cool sk9 & pale & anxi\s face4 ,fev] is soon pres5t & a *ill is common4 ,! p>oxysms cont9ue z long z ! /one rema9s lodg$1 :i* may be f an h\r to sev]al days4 ,!re are remissions ( pa91 entire relief be+ giv5 z soon z ! /one rea*es ! duod5um4 ,jaundice usually foll[s a prolong$ attack4 ,! liv] is sometimes enl>g$4 ,! sple5 is enl>g$4 ,%\ld ! /one become impact$1 ulc]ative p]=ation1 ) consequ5t p]itonitis & %ock1 foll[s4 ,diagnosis4--,! diagnosis is conclusive :5 ! gall-/ones are f\nd 9 ! /ools or :5 !y c be felt 9 ! gall-bladd]4 ,all ! above symptoms are *>act]i/ic4 ,if a pati5t compla9s ( sev]e pa9 radiat+ f ! hepatic region1 & nausea & vomit+ are pres5t1 subsid+ sudd5ly ) a slight jaundice1 ! disease %\ld h>dly be mi/ak54 ,t5d]ness ov] ! gall-bladd] frequ5tly indicates infection or gall-/ones or bo?4 ,radiographic exam9ation may be ( aid4 ,nephritic colic %\ld nev] be conf\nd$ ) hepatic colic z 9 ! =m] ! pa9s />t 9 ! lumb> region & radiate d[nw>d into ! gro91 ! te/icle & ! inside ( ! ?igh4 ,9 app5dicitis1 jaundice & bile-/a9$ ur9e are n f\nd4 ,a pseudo-bili>y colic is occasionally f\nd 9 n]v\s individuals especially :5 ! elev5? & twelf? ribs 7or ribs z high z ! sev5?7 on ! "r side are displac$ d[nw>d4 ,prognosis4--,is usually favorable4 ,ulc]ation1 p]=ation1 & suppuration may prove fatal1 al?\gh mu* dep5ds ^u surgical int]f]5ce4 ,treatm5t4--,dur+ ! attack ( bili>y colic1 ! o/eopa? %\ld usually be able to readily locate ! position ( ! gall-/one 9 its transit f ! gall-bladd]4 ,he %\ld usually proce$ at once to aid ! /one 9 its d[nw>d passage by c>eful manipulation ov] ! duct4 ,/ill ?is treatm5t %\ld be giv5 ) great caution1 = if !re is suppuration or ulc]ation1 p]=ation & resultant p]itonitis may occur4 ,usually "o w n h mu* difficulty 9 dislodg+ ! /one & reliev+ ! suff]] 9 a few m9utes4 ,! recumb5t position1 ) ! ?ighs flex$ on ! abdom51 is ! position assum$ = treatm5t1 & if ! muscles 9 ! hepatic region are v t5se & rigid1 int]f]+ ) locat+ ! gall-/one1 an inhibitory treatm5t to ! po/]ior sp9al n]ves supply+ ! contract$ muscles w aid "o mat]ially4 ,an inhibitory treatm5t ( ! n]ves ( ! bili>y tract 7! n9? & t5? dorsals71 may be a helpful measure 9 dilat+ ! duct4 ,also1 hot application ov] ! affect$ area & to ! dorso-lumb> region w aid4 ,dur+ remissions two or ?ree treatm5ts p] week %\ld be giv5 to correct ! lesions at ! eigh?1 n9?1 t5? & elev5? segm5ts4 ,give p>ticul> att5tion to any ent]optosis t may be f\nd4 ,av]age cases %\ld n require m ?an two or ?ree mon?s' treatm5t4 ,hildre?1 :o has _h _m cases1 is mu* oppos$ to op]ation z 8 exp]i5ce has be5 t :]e !re is n complete ob/ruction ! correction ( lesions w prev5t fur!r =mation ( /ones4 ,:ile he f9ds ! tr\ble ranges f ! ?ird to ! eigh? dorsal1 /ill1 z a rule1 x is betwe5 ! fif? & six? t be/ results are obta9$4 ,probably if ! treatm5t is a rightly direct$ "o ! /ones already =m$ may be dis9tegrat$4 ,will>d#ia reports #cic cases4 ,p]man5tly impact$ gall-/ones require surgical treatm5t4 ,prophylactic treatm5t1 z a regulat$ diet1 daily ex]cise & a discont9uance ( excesses1 %\ld be /rongly urg$4 ,! pati5t %\ld n be all[$ any fatty or sac*>9e food4 ,wat] freely tak5 w be ( aid4 ,diseases ( ! ,sple5 ,diseases ( ! sple5 are usually second>y to o!r disord]s4 ,! foll[+ o/eopa?ic treatm5t "u ,spl5itis w1 9 addition to ! probably prim>y di/urbance1 be applicable to active & passive spl5ic hyp]emia & amyloid deg5]ation ( ! sple54 ,surgical & o!r measures are to be employ$ :5 indicat$4 ,ow+ to ! role t ! sple5 plays 9 infections1 ! o/eopa? pays consid]able att5tion to /imulat+ ! organ ?r\gh its sp9al inn]vation 9 ^! cases4 ,spl5itis ,9 acute spl5itis !re is g5]ally a block+ up ( ! small] spl5ic art]ies by fibr\s coagula 7hemorrhagic inf>ct71 :i* h =m$ 9 ! left v5tricle ( ! he>t 9 consequ5ce ( endoc>ditis4 ,mal>ial infections1 septicemia1 typhus & acute exan!mat\s fev]s may cause coagula =mation 9 ! spl5ic ve9s4 ,injuries to ! v]tebr or ribs on ! left side ov] ! sple5 7n9? to elev5? ribs inclusive7 are occasionally ! pr$ispos+ cause ( prim>y inflammation ( ! sple54 ,foll[+ ! =mation ( abscesses ! entire organ may suppurate2 x may produce pyemia1 or x may bur/ & ! pus be dis*>g$ into ! p]itoneal sac1 caus+ p]itonitis1 or into ! pleura1 /oma* or colon4 ,*ronic spl5itis is induc$ by passive conge/ion1 leukocy!mia & spl5ic anemia4 ,symptoms4--,t5d]ness & enl>gem5t ( ! sple5 are ! pr9cipal symptoms4 ,! organ may be twice its normal size1 b 9 a few cases ! tumefaction is s insignificant t x c h>dly be f\nd on p]cussion4 ,dull pa9 g5]ally exi/s if ! envelop+ membrane or adjac5t organs are involv$1 ! pa9 be+ increas$ ^u p]cussion & deep inspiration4 ,9 a few cases ! pa9 radiates to ! left %\ld] & if ! p]itoneal cov]+ is involv$1 a %>p pa9 w be pres5t4 ,fev] & rigor foll[ if suppuration has tak5 place1 & p]itonitis foll[s 9 case ( rupture or p]=ation4 ,m>k$ hyp]trophy & *ronic inflammation may cause c\gh1 nausea1 vomit+ & dyspnea4 ,treatm5t4--,9 ! treatm5t ( bo? ! disease produc+ spl5itis1 & ( prim>y spl5itis1 a ?or\gh treatm5t ( ! sp9e1 eigh? to ! elev5? dorsal1 is necess>y4 ,! n]ves 7vasomotor7 to ! sple5 are f ! left splan*nics1 consequ5tly treatm5t ( ! left side is m effectual4 ,p>ticul> att5tion %\ld be giv5 ! ribs ov] ! sple5--! n9?1 t5? & elev5?--z disord]s ( ^! ribs are a common cause ( spl5ic di/urbances4 ,c>eful & fairly firm treatm5t is always indicat$1 c>e be+ tak5 n to add irritation to an already inflam$ organ1 & especially bew>e t =ce is n us$ :]e !re is dang] ( rupture4 ,/imulation ( ! t5? n]ve contracts ! sple54 ,9 cases ( suppurative spl5itis ! direct treatm5t %\ld n be giv54 ,/imulat+ treatm5t ov] ! sple51 z ov] ! liv] & kidneys1 gives tone to ! /rong ela/ic capsule surr\nd+ x1 s t direct manipulation ov] ^! organs1 c\pl$ ) ! p[] ( ! /rong ela/ic capsule & highly ela/ic tissue ( ! inn] organ1 w greatly aid 9 less5+ ! engorgem5t & hyp]emia4 ,9 a few cases :]e ! sple5 is involv$1 lesions are f\nd 9 ! upp] c]vical :i* affect ! "r pneumoga/ric n]ve & ?us impair ! normal activity ( ! gl&4 ,,footnotes3 #gd ,see special article1 ,prolaps$ ,organs1 ,"p ,i4 #ge ,! /ud5t w receive _m helpful sugge/ions by read+ ,macleod1 ,physiology & ,bio*emi/ry 9 ,mod]n ,m$ic9e2 ,cannon1 ,! ,me*anical ,factors ( ,dige/ion2 ,c>lson1 ,! ,control ( ,hung] 9 ,heal? & ,disease2 ,gaskell1 ,! ,involunt>y ,n]v\s ,sy/em2 ,pott5g]1 ,symptoms ( ,n]v\s ,disease4 #gf ,von ,noord51 ,colitis1 #aijd4 #gg ,see ,philosophy & ,me*anical ,pr9ciples ( ,o/eopa?y1 p4 #aij4 #gh ,!re are sev]al possible sugge/ions4 7#a7 ,developm5tal 7,see ,mayo1 ,relation ( ! ,developm5t ( ! ,ga/ro-inte/9al ,tract to ,abdom9al ,surg]y4 ,j\r4 ,a4 ,m4 ,a4 ,feb4 #g1 #aibj74 7#b7 ,ow+ to ! app5dix1 cecum1 asc5d+ colon1 duod5um1 & bili>y tract be+ frequ5tly disord]$4 7#c7 ,imbalance ( muscul> t5sion1 ow+ to ! muscles ( ! "r side be+ (t5 ! bett] develop$4 ,muscul> lesions & lymphatic involvem5t ( ! c]vical region seem to occur (t5] on ! "r side ?an on ! left4 #gi ,j\rnal ( ,o/eopa?y1 ,may1 #aijj4 #hj ,= po9ts on enema1 see treatm5t "u ,inte/9al ,ob/ruction4 #ha ,diseases ( ! ,inte/9es1 ,vol4 ,i1 p4 #bdj4 #hb ,! ,lancet1 7,london17 ,oct41 #aijd4 #hc ,philosophy ( ,o/eopa?y1 p4 #bbf4 #hd ,m$ical ,record4 #he ,! ,v]mi=m ,app5dix & ,its ,diseases1 p4 #gaa4 #hf ,dr4 ,*auvel1 #aijb4 #hg ,rose & ,c>less4 #hh ,cl9ical ,o/eopa?y4 #hi ,j\rnal ( ! ,am]ican ,o/eopa?ic ,association1 ,dec1 #aijb4 #ij ,j\rnal ( ,am]ican ,o/eopa?ic ,association1 ,m>*1 #aije4 #ia ,j\rnal ( ,am]ican ,o/eopa?ic ,association1 ,m>*1 #aije4 ,,diseases ,,( ,,! ,,respiratory ,,sy/em ,,diseases ,,( ,,! ,,l>ynx#ib ,acute ,cat>rhal ,l>yngitis ,def9ition4--,an acute1 cat>rhal inflammation ( ! muc\s membrane ( ! l>ynx4 ,?is may be u%]$ 9 z an indep5d5t disease or x may be associat$ ) inflammation ( ! upp] respiratory passages4 ,o/eopa?ic ,etiology & ,pa?ology4--,"o ( ! pr9cipal causes ( acute cat>rhal l>yngitis is exposure to cold & dampness1 :i* contracts ! muscles ( ! neck region1 especially ab\t ! l>ynx4 ,lesions 9 ! upp] & middle c]vical v]tebr are important pr$ispos+ causes4 ,occasionally ! fir/ rib becomes luxat$1 caus+ a great] or less conge/ion ( ! l>yngeal muc\s membrane by contract+ ! l[] ant]o-lat]al muscles ( ! neck1 & affect+ lymphatic dra9age4 ,improp] plac+ ( tone1 z well z too con/ant use ( ! voice 9 speak+ & s++1 are common causes4 ,inhalation ( irritat+ gases or du/1 & me*anical injuries to ! l>ynx are occasional causes4 ,! disease may be associat$ ) c]ta9 infecti\s diseases1 z measles1 diph!ria1 influ5za & :oop+ c\gh4 ,pa?ologically1 ! muc\s membrane is int5sely r$d5$ & inflam$2 ?is inflammation involves bo? ! true & false vocal cords & may ext5d into ! tra*ea & ab\t ! epiglottis4 ,! membrane is cov]$ slightly ) muc\s secretion4 ,9 r>e in/ances edema ( ! glottis may occur4 ,! muscul> contraction ab\t ! l>ynx imp$es blood & lymphatic dra9age & ?us induces conge/ion4 ,! contraction may be s sev]e z to slightly prolapse ! organ4 ,! v]tebral lesions imp+e ^u or affect vasomotor fib]s & ?us br+ ab\t conge/ion4 ,symptoms4--,!re is ho>s5ess & c\gh ) a s5sation ( tickl+ 9 ! l>ynx2 ^! are ! mo/ con/ant symptoms4 ,! c\gh is dry & ! voice alt]$4 ,at fir/ ! voice is husky1 b "s attempts at speak+ are att5d$ ) m or less pa9 & f9ally ! voice may be entirely lo/4 ,deglutition is pa9ful4 ,at fir/ ! expectoration is scanty1 b lat] x becomes mucopurul5t4 ,!re is r>ely mu* fev]4 ,:5 !re is consid]able edema1 dyspnea & asphyxia are prom95t features4 ,prognosis4--,simple cat>rhal l>yngitis nev] t]m9ates fatally4 ,:5 !re is dyspnea or asphyxia indicat+ edema ( ! l>ynx1 ! prognosis is grave4 ,! attack usually la/s f "o week to t5 days1 b ?is c be mat]ially %ort5$ by c>eful o/eopa?ic treatm5t4 ,9 sev]e infections x may be two or ?ree weeks be=e ! l>ynx returns to its =m] condition4 ,treatm5t4--,9 a few cases conf9em5t ( ! pati5t to 8 room1 & possibly ! b$1 w be necess>y2 especially %\ld ! l>ynx h re/ f phonation1 & ! tak+ ( food ( an irritat+ "* %\ld be avoid$4 ,smok+ is to be prohibit$4 ,! room %\ld be at an ev5 temp]ature1 f #gj to #ge degrees ,f41 & ! atmosph]e saturat$ ) moi/ure by ! g5]ation ( /eam4 ,! tissues 9 ! c]vical region ab\t ! c]vical sympa!tic & vagi n]ves %\ld be c>efully adju/$4 ,! deep po/]ior muscles ( ! c]vical sp9e are to be relax$ & direct treatm5t giv5 ov] & ab\t ! l>ynx4 ,relax+ tissues & rais+ ! l>ynx w be v effectual 9 reliev+ ! husk9ess ( ! voice & 9 controll+ ! conge/ion & inflammation ( ! l>yngeal mucosa4 ,besides ! treatm5t ( ! vagi n]ves at ! atlas & _! c\rse d[n ! lat]al & ant]ior portion ( ! neck1 ! sup]ior l>yngeal may be treat$ at ! upp] portion ( ! great cornu ( ! hyoid bone & ! inf]ior l>yngeal at ! inn] side ( ! cleido muscle ne> its /]nal atta*m5t4 ,adju/ ! tissues along ! c\rse ( ! ext]nal c>otid & subclavian art]ies1 *iefly ! fir/ rib = ! latt]4 ,give c>eful treatm5t to ! int]nal jugul> & innom9ate ve9s4 ,correct any tissues t may imp+e ^u ! lymphatics ( ! muc\s & submuc\s coats ( ! l>ynx :]e !y are dra9$ into ! deep c]vical gl&s4 ,release any immobility ( ! upp] *e/1 relax ! pectoral1 auxili>y & upp] dorsal muscles1 & adju/ ! fir/ f\r or five dorsal v]tebr4 ,prompt action ( ! sk91 fre$om ( ! b[els1 plac+ ! feet 9 a hot ba? & cont9u$ local hot packs1 or ev5 an ice-bag 9 sev]e cases1 w be ( special value at ! onset2 b due att5tion %\ld be giv5 ^! ?r\gh\t ! entire c\rse4 ,! fev] is easily abort$ by ! c]vical treatm5t & prop] att5tion to ! b[els & sweat gl&s4 ,*ronic ,cat>rhal ,l>yngitis ,def9ition4--,a *ronic1 cat>rhal inflammation ( ! muc\s membrane ( ! l>ynx4 ,o/eopa?ic ,etiology & ,pa?ology4--,! causes ( *ronic l>yngitis may be num]\s1 b lesions ( ! c]vical v]tebr are ! mo/ common4 ,! contractur$ c]vical muscles1 especially ! deep v]tebral ones1 are usually ! result ( correspond+ osse\s deviations4 ,o!r causes giv5 "u ! acute =m1 z ov]use & abuse ( ! voice1 inhalation ( irritat+ sub/ances1 excessive use ( tobacco & alcoholic dr9ks1 tumors1 etc41 are important etiological factors4 ,?us irritations induc+ acute attacks1 if repeat$1 w result 9 *ronic cat>rh4 ,! pa?ological *anges z reveal$ by ! l>yngoscope are swell+ ( ! muc\s membrane1 occasional sup]ficial erosions1 & r>ely ulc]ation4 ,symptoms4--,! voice is usually ho>se & r\gh1 be+ due to a ?ick5+ ( ! vocal organs4 ,9 sev]e cases ! voice may be lo/4 ,!re is fatigue & pa9 aft] slight use ( ! voice1 a s5se ( tickl+ 9 ! l>ynx :i* produces a desire to c\gh1 & expectorations ( viscid mucus & mucopus4 ,prognosis4--,! prognosis is sometimes unfavorable1 al?\gh _m cases are cur$4 ,treatm5t4--,! pati5t mu/ le>n to take c>e ( himself prop]ly4 ,he %\ld avoid ov]heat$ rooms & ! use ( tobacco & alcohol1 & ! ?roat %\ld n be protect$ too mu*4 ,x is a good plan to ba! ! neck e morn+ & night ) cold wat]4 ,he %\ld avoid l\d speak+2 ! s\nd %\ld be expell$ by ! abdom9al muscles & diaphragm & n by ! muscles ( ! ?roat4 ,exam9e ! upp] air passages c>efully = any ob/ructions & infections t might exi/ :i* are a s\rce ( irritation to ! l>ynx4 ,special att5tion %\ld be giv5 to ! atlas1 axis & ?ird c]vical4 ,lesions l[] d[n ! sp9e may be f\nd1 = o!r l>yngeal n]ve fib]s1 o!r ?an ^? f ! sup]ior c]vical ganglion1 may be at fault4 ,palpate ! hyoid to see if x is tilt$ by contract$ muscles1 z w (t5 be ! case4 ,aphonia is commonly caus$ by a dislocat$ atlas4 ,! aphonia may also be caus$ by swell+ ( ! vocal cords & tissues ab\t !m & by s]\s effusions ( ! l>yngeal muscles4 ,! l>ynx may be prolaps$ slightly & if rais$ quickly reliev$4 ,difficult brea?+ & ho>s5ess are occasionally v tr\blesome symptoms4 ,! =m] is due to an inability ( ! glottis to dilate1 on acc\nt ( swell+ ( ! muc\s membrane ( ! diseas$ p>ts & f dry+ ( ! secretions on !m1 ?us increas+ ! ob/ruction 7?is is sometimes t]m$ pseudocr\p7 b expiration is easy1 ! /ridor is f ! inspiration2 ! latt] is due to a collection ( mucus on ! vocal cords or ! cords may become relax$1 swoll5 or r\gh5$4 ,ano!r annoy+ symptom sometimes pres5t$ is pa9 on deglutition1 :i* is due to swell+ ( ! muc\s membrane ( ! upp] l>yngeal passages & ! epiglottis4 ,9 all ( ^! annoy+ symptoms1 p]si/5t1 ?or\gh1 direct treatm5t ( ! l>ynx is ( value4 ,on ! :ole1 c>eful1 cont9u$ treatm5t ( ! c]vical inn]vation & vascul> supply ( ! l>ynx1 z 9 ! acute =m1 is indicat$4 ,9 all l>yngeal disord]s1 if condition p]mits1 hyp]ext5d ! neck :ile ! pati5t is ly+ sup9e & ?or\ghly relax ! s(t tissues ab\t ! organ & !n c>efully raise x4 ,l>yngismus ,/ridulus 7,spasm ( ! ,glottis7 ,def9ition4--,a spasm ( ! muscles ( ! l>ynx t are suppli$ by ! inf]ior or recurr5t l>yngeal n]ves4 ,?is is commonly n excit$ by an inflammatory condition1 b x is usually a purely n]v\s condition4 ,o/eopa?ic ,etiology & ,pa?ology4--,spasm ( ! glottis is usually f\nd 9 *ildr5 ) enl>g$ tonsils & ad5oids4 ,x has be5 obs]v$ t rickets & syphilis are probably frequ5t und]ly+ causes4 ,! spasm is occasionally associat$ ) tetany4 ,! n]v\s factor is ! imm$iate & important consid]ation4 ,c]vical lesions1 bo? v]tebral & muscul>1 are inv>iably f\nd4 ,!n nasoph>yngeal & tra*eal disord]s & reflex dige/ive di/urbance are excit+ causes4 ,an elongat$ uvula or a d]ang$ hyoid bone w occasionally be excit+ factors4 ,subluxation ( ! upp] two or ?ree ribs & ( ! clavicle may also be excit+ factors4 ,! affection is usually f\nd 9 *ildr5 "u five ye>s ( age4 ,all cases are n ( a di/9ct n]v\s type1 = slight acute cat>rhal l>yngitis may be pres5t4 ,symptoms4--,!re is a sudd5 onset & ! spasm may occur on wak+ f sleep1 b x may come on ei!r 9 ! night or day4 ,! disease />ts ) a sudd5 arre/ ( brea?+1 ! *ild /ruggles = brea?2 !re are tonic muscul> spasms & ! face becomes conge/$ 9 a few seconds4 ,?is is foll[$ by sudd5 relaxation ( ! spasm & ! air is drawn ?r\gh ! glottis ) a %rill1 cr[+ s\nd4 ,sev]al spasms may occur 9 a day or !y may be weeks ap>t4 ,dea? r>ely occurs4 ,diagnosis4--,! abs5ce ( fev]1 c\gh & ho>s5ess & its di/9ctly int]mitt5t nature w diff]5tiate x f cr\p4 ,%\ld !re be any "q ( diagnosis a bact]iological exam9ation is advisable4 ,prognosis4--,! prognosis is almo/ always favorable4 ,9 v "y *ildr5 dea? f suffocation may occur1 b r>ely4 ,treatm5t4--,! treatm5t %\ld be appli$ ei!r c5trally or p]iph]ally1 dep5d+ altoge!r ^u ! location ( ! irritation4 ,if ! irritation is ( c5tral orig91 t is1 ?r\gh ! inn]vation f ! bra9 & sp9e1 a correction ( ! sup]ior & inf]ior l>yngeal n]ves is necess>y2 if ! /ridor is due to p]iph]ial irritations1 a correction ( ! end-plates 7muscles7 ov] & ab\t ! l>ynx is requir$ 9 ord] t ! spasms be reliev$4 ,?or\gh treatm5t %\ld be appli$ to ! upp] "p ( ! *e/ & diaphragm1 *iefly ! phr5ic n]ves at ! ?ird1 f\r? & fif? c]vicals & ov] ! eigh?1 n9? & t5? ribs ant]iorly1 9 ord] t ! spasms may be prev5t$ f ext5d+ to ! int]co/al muscles & ! diaphragm4 ,plac+ ! pati5t 9 a hot ba? w be ( s]vice 9 "s cases :5 ! spasms are sev]e4 ,alt]nat+ hot & cold packs ab\t ! ?roat are ( s]vice4 ,! air ( ! room %\ld always be kept moi/4 ,c>e %\ld be tak5 t ! tr\ble is n due to ga/ro-inte/9al disord]s or to d5tition4 ,keep ! *ild ^u a fluid diet ( milk1 meat bro?s & egg album94 ,9 ! m sev]e cases ! well kn[n o/eopa?ic me?od ( relax+ & inhibit+ ! s(t palate & contigu\s tissues w /op ! spasm4 ,spasmodic ,l>yngitis 7,false ,cr\p7 ,def9ition4--,a cat>rhal inflammation ( ! muc\s membrane ( ! l>ynx ) spasm ( ! glottis4 ,o/eopa?ic ,etiology & ,pa?ology4--,?is affection is practically ! same z l>yngismus /ridulus associat$ ) cat>rhal inflammation ( ! muc\s membrane4 ,x is a disease ( "y *ildr54 ,d]angem5ts ( ! inn]vation & blood supply to ! l>yngeal muc\s membrane & muscles ( ! l>ynx are f\nd 9 ! same locality z not$ "u acute cat>rhal l>yngitis & l>yngismus /ridulus4 ,!re is acute cat>rh caus+ a cr\py c\gh1 & difficult brea?+ due to spasm ( ! glottis4 ,symptoms4--,^! attacks g5]ally occur dur+ ! night1 ! *ild be+ sudd5ly awak5$ by sev]e p>oxysms ( suffocat+ & a dry1 h>d c\gh1 associat$ ) evid5ces ( dyspnea4 ,9 half an h\r or an h\r or two ! c\gh+ ceases1 p]spiration foll[s & ! *ild falls asleep4 ,if prop] treatm5t is n giv51 ^! attacks may occur = sev]al successive nights1 ! *ild appe>+ almo/ or q well dur+ ! day4 ,diagnosis4--,! symptoms are s *>act]i/ic t ! diagnosis is easy4 ,9 all in/ances ! prognosis is favorable4 ,treatm5t4--,! cat>rhal inflammation ( ! muc\s membrane ( ! l>ynx %\ld be treat$ 9 ! same mann] z simple inflammation ( ! l>yngeal mucosa1 i4 e41 ?or\gh treatm5t ( ! c]vical sp9e & direct treatm5t ov] ! l>ynx4 ,dur+ ! p>oxysm1 if ! pati5t _c be reliev$ v %ortly by ! c]vical treatm5t1 he %\ld be plac$ 9 a hot ba? ( a temp]ature f #ih to #aaj degrees ,f4 ,?is w1 9 ! majority ( cases1 relieve ! attack4 ,9 addition a hot compress may be plac$ ab\t ! ?roat4 ,produc+ emesis by irritat+ ! fauces ) ! f+] is necess>y 9 a numb] ( cases 9 ord] t ! secretions 9 ! l>yngeal region may be eject$1 ?us reliev+ suffocation & labor$ brea?+4 ,also1 an ov]load$ /oma* :i* is caus+ an irritation1 %\ld be empti$ at once by vomit+4 ,! b[els %\ld be kept well op5 9 all cases4 ,occasionally ! epiglottis becomes w$g$ 9 ! *9k ( ! glottis4 ,su* a condition requires an introduction ( a f+] into ! fauces to release ! disord]4 ,c>e %\ld be tak51 especially foll[+ an attack1 t ! *ild is n expos$ to cold or rapid *anges ( temp]ature1 s z to avoid repetition ( ! spasms4 ,c\gh+4--,c\gh+1 n only 9 spasmodic l>yngitis1 b also 9 v>i\s diseases :]e c\gh+ is a prom95t symptom1 is a mo/ irritat+ & annoy+ feature4 ,! o/eopa? is _m times call$ ^u to relieve ! c\gh1 :e!r x is due to slight irritation ( a n]ve fib] alone or is a symptom ( a s]i\s *ronic disease4 ,! c\gh+ c5t] is locat$ 9 ! m$ulla oblongata2 ! aff]5t n]ves are s5sory bran*es ( ! vagus2 ! eff]5t n]ve fib]s are f\nd 9 ! n]ves ( expiration & 9 ^? t close ! glottis4 ,consequ5tly1 c\gh+ may be caus$ by /imuli to v>i\s s5sory n]ves1 v>i\s cutane\s areas 7*iefly ! upp] "p ( ! body71 muc\s membrane ( ! respiratory & dige/ive tracts1 ! mammae1 liv]1 sple51 ov>ies1 ut]us1 kidneys1 etc4 ,p]haps ! mo/ common cause ( c\gh is contraction ( "s ( ! muscles ( ! neck1 irritat+ s5sory fib]s4 ,contraction ( ! omo-hyoid muscle may produce an irritat+ c\gh by caus+ traction on ! hyoid bone4 ,9 a few cases ! l>ynx may prolapse to "s ext5t & ?us be a s\rce ( irritation4 ,lesions ( ! sp9al cord betwe5 ! sev5? & eigh? dorsal1 also at v>i\s po9ts above 9 ! dorsal v]tebr & 9 ! ribs 7especially at ! second & ?ird ribs71 are v apt to produce a c\gh4 ,impaction ( ! sigmoid flexure is (t5times accompani$ by c\gh+4 ,enl>gem5t ( ! he>t may cause pressure ^u ! respiratory tract directly & cause a deep1 dull c\gh4 ,=eign bodies 9 ! ext]nal meatus ( ! e> are occasionally a s\rce ( irritation :i* is accompani$ by c\gh+4 ,?us !re are innum]able s\rces ( /imuli t may produce c\gh+4 ,9 all cases x is necess>y to make a c>eful diagnosis z to :e!r x is an irritation to "s fib] t c be correct$ at once or :e!r x is a symptom ( a disease t c only be reliev$ by ! cure ( ! disease4 ,9 local conge/ions ! cold pack w (t5 be ( s]vice4 ,tub]cul\s ,l>yngitis ,def9ition4--,an inflammation ( ! l>yngeal tissues ( tub]cul\s orig94 ,o/eopa?ic ,etiology & ,pa?ology4--,tub]culosis ( ! l>ynx is commonly second>y to pulmon>y tub]culosis4 ,9 a few cases ! l>yngeal invasion may be ( prim>y orig94 ,9 ei!r in/ance !re w be f\nd a di/urb$ inn]vation or alt]$ blood supply ( ! l>ynx t pr$isposes to ! multiplication & gr[? ( ! bacilli4 ,! o/eopa?ic lesions are simil> to ^? f\nd 9 o!r involvem5ts ( ! l>ynx4 ,pa?ologically1 ! muc\s membrane is inflam$ & swoll51 & exhibits scatt]$ tub]cles1 :i* are usually ab\t ! blood-vessels4 ,! tub]cles clu/]1 caseate & leave %all[1 irregul> ulc]s4 ,!re is ?ick5+ ( ! mucosa ab\t ! ulc]1 & ! ulc] is g5]ally cov]$ by a grayi% exudate4 ,!y may erode ! true vocal cords1 (t5 de/roy+ !m completely4 ,! ulc]s sl[ly involve ! tissues 9 all directions1 caus+ p]i*ondritis ) necrosis ( ! c>tilages4 ,! muc\s membrane ( ! ph>ynx1 esophagus1 fauces1 & tonsils may be involv$1 & ! epiglottis may be completely de/roy$4 ,?is disord]1 /rictly1 %\ld be discuss$ "u pulmon>y tub]culosis =1 z h]et(ore /at$1 x is g5]ally a second>y affection2 ! l>ynx be+ invad$ by ! tub]cul> bacilli 9 ! sputum aris+ f ! bron*ial tubes & lungs4 ,! bacilli 9 inspir$ air may prim>ily invade ! l>yngeal mucosa4 ,h[ev]1 9 ei!r case ! circulation ( ! mucosa is n normal & o/eopa?ic correction ( ! same is effective4 ,symptoms4--,husk9ess ( ! voice1 foll[$ by ho>s5ess1 & 9 advanc$ /ages aphonia1 are prom95t symptoms4 ,a hack+ c\gh is usually pres5t & ! pati5t compla9s ( pa9 9 ! ?roat1 p>ticul>ly on c\gh+1 swall[+ or speak+4 ,! loss ( voice1 pa9ful speak+ or :isp]+ are q *>act]i/ic4 ,:5 ! ulc]ation ( ! tissues ( ! l>ynx has progress$ to a lat] /age1 dysphagia1 suffocation & di/ress+ p>oxysms ( c\gh occur4 ,diagnosis4--,is n difficult1 z pulmon>y ph?isis is usually associat$ ) x4 ,exam9ation ( ! sputum = ! specific bacilli w be conclusive4 ,prognosis4--,! prognosis is n ( ! be/ at any "t4 ,on ! :ole1 x is unfavorable4 ,treatm5t4--,9 ?is disease o/eopa?ic treatm5t has be5 q effectual4 ,cases ( prim>y orig9 are m successfully treat$ ?an :5 ( second>y cause1 al?\gh "o w be surpris$ _m times at ! results obta9$ :5 ! disord] is n prim>y4 ,! treatm5t mu/ necess>ily be bo? con/itutional & local4 ,c>e ( ! g5]al heal? z to hygi5e & diet is absolutely necess>y4 ,! food mu/ be nutriti\s & non-irritat+4 ,scrap$ beef1 raw oy/]s1 raw eggs1 s\ps & gruel are requir$4 ,9 cases :]e difficulty ( deglutition occurs1 x may be l>gely ov]come if ! pati5t hangs 8 head ov] ! side ( ! b$ & sucks ?r\gh a tube liquid n\ri%m5t plac$ 9 a di% ^u ! floor4 ,! local treatm5t requir$ is c>eful1 p]si/5t "w ov] ! l>ynx & adjac5t tissues4 ,! treatm5t is giv5 to increase ! blood supply to ! diseas$ tissues s t heal+ may take place1 & t ! bact]ia may be depriv$ ( ! conditions favorable to _! activity4 ,treatm5t along ! c]vical sp9e & upp] dorsal w aid 9 correct+ ! vasomotor disord]s t exi/4 ,local application ( hot wat] w assi/ 9 reliev+ ! pa94 ,:5 pulmon>y ph?isis exi/s1 att5tion & correction ( x is important2 9 fact1 is ( prim>y consid]ation 9 l>yngeal affection4 ,syphilitic ,l>yngitis ,etiology4--,?is disease is ( frequ5t occurr5ce1 due to inh]it$ syphilis1 or to ! second>y or t]ti>y /ages ( ! acquir$ =m4 ,symptoms4--,!re is a ho>s5ess ( ! voice1 a hack+ c\gh1 difficulty 9 swall[+ & ! v>i\s symptoms ( cat>rhal l>yngitis4 ,! second>y =m may pres5t sup]ficial1 :iti% ulc]s on ! cords or v5tricul> b&s1 :ile 9 a t]ti>y /age ! lesions are ext5sive & s]i\s4 ,deep ulc]s ) rais$ edges are pres5t1 gummata develop on ! submuc\s coat ( ! epiglottis & !re may be necrosis & exfoliation ( ! c>tilages4 ,de=mity is produc$ by ! cicatrices foll[+ ! heal+ ( ! ulc]s & scl]osis ( ! gummata4 ,edema ( ! l>ynx may sudd5ly prove fatal4 ,diagnosis4--,! hi/ory ( ! case1 ! pres5ce ( o!r symptoms ( ! disease1 ! deep1 symmetrical ulc]s1 ! abs5ce ( tub]culosis else:]e & ! abs5ce ( m>k$ pa91 w usually make a diagnosis easy4 ,prognosis4--,is some:at favorable1 m s at lea/ ?an ! tub]cul> =m ( l>yngitis4 ,!re is great dang] ( de=mity & p]man5t impairm5t ( ! voice4 ,treatm5t4--,! treatm5t %\ld be bo? con/itutional & local4 ,active measures mu/ be tak5 to rid ! sy/em ( ! virus ( syphilis1 & ?or\gh1 direct treatm5t %\ld be appli$ to ! l>ynx & to its inn]vation4 ,if ! cicatricial /5osis has progress$ s f> t !re is little hope f manipulative treatm5t1 tra*eotomy or gradual dilatation %\ld be p]=m$4 ,! ulc]at$ portion is always to be kept clean4 ,edemat\s ,l>yngitis ,def9ition4--,an acute inflammation ( ! muc\s membrane ( ! l>ynx ) infiltration ( s]\s fluid into ! submuc\s tissue4 ,etiology4--,?is is a v s]i\s affection4 ,x may occur 9 connection ) acute l>yngitis1 ?\gh r>ely1 & occasionally ) *ronic diseases ( ! l>ynx1 z tub]culosis & syphilis4 ,x may be a complication ( "s acute infecti\s disease l diph!ria1 sc>let fev]1 or erysipelas ( ! face4 ,x sometimes occurs sudd5ly 9 ! c\rse ( ,bright's disease4 ,lesions z 9 acute l>yngitis are pr$ispos+ factors4 ,pa?ologically1 !re is m>k$ swell+ ( ! epiglottis4 ,! swell+ c v easily be felt ) ! f+]s4 ,! muc\s membrane is t5se & *ang$ 9 color4 ,!re is infiltration ( a s]\s or s]o-purul5t fluid into ! loose connective tissue ( ! l>ynx4 ,! aryt5oepiglottic folds are greatly involv$1 & !y may be swoll5 to su* a degree t !y almo/ meet4 ,symptoms4--,extreme dyspnea & /ridul\s respiration4 ,ho>s5ess ( ! voice & lat] aphonia4 ,!re is a feel+ ( int5se oppression or suffocation4 ,evid5ce ( dyspnea1 anxi\s face1 blue lips1 protrud+ eyes & retraction ( ! base ( ! *e/ occur4 ,! /]nocleidoma/oid muscle is v prom95t4 ,diagnosis4--,?is is n difficult4 ,! hi/ory ( ! case1 l>yngoscopic exam9ation1 & ! swoll5 epiglottis :i* c be easily felt ) ! f+]s make diagnosis easy4 ,prognosis4--,g5]ally unfavorable4 ,at any "t x is extremely grave1 b ) prompt & vigor\s treatm5t recov]y is possible4 ,! duration v>ies f a few h\rs to sev]al days4 ,treatm5t4--,"o mu/ att5d /rictly & c>efully to ! l>yngeal inn]vation1 z 9 acute cat>rhal l>yngitis4 ,ob/ruction to ! sup]ior or inf]ior ?yroid1 facial1 int]nal jugul> or innom9ata w cause tumefaction & edema ( ! l>ynx & adjac5t tissues4 ,also1 enl>gem5t ( ! lymphatics ab\t ! l>ynx & saliv>y gl&s may produce edema ( ! l>yngeal region2 consequ5tly1 p>ticul> c>e %\ld be tak5 ( ! v>i\s tissues ab\t ^! vessels & ( ! inn]vation f ! c]vical sp9e1 s ! ve9s are n ob/ruct$ or ! lymphatic *annels disord]$1 s t infiltration ( ! tissues may be fur!r prev5t$4 ,! mo/ prom95t symptom is l>yngeal dyspnea & ?is dep5ds altoge!r ^u ! swell+ ( ! s(t p>ts4 ,if ! swell+ is great & ! disord] _c be remov$1 suffocation w foll[4 ,9 su* cases1 besides giv+ direct treatm5t ov] ! l>ynx1 introduc+ a f+] into ! m\?1 & rea*+ cle> back "u ! ro( ( ! s(t palate1 ) a firm1 d[nw>d1 outw>d & sweep+ movem5t on ei!r side1 relax ! s(t tissues4 ,! p]si/5t use ( small pellets ( ice1 held f> back 9 ! m\?1 w be f\nd v b5eficial2 also1 application ( ! ice-bag1 provid$ ! edema is ( inflammatory orig94 ,if "o is n able to control ! rapid infiltration ( ! l>ynx & glottis :5 su* cases arise1 tra*eotomy or intubation %\ld be p]=m$ at once4 ,:5 edemat\s l>yngitis is due to diseases ( ! he>t1 lungs & kidneys1 treatm5t ( ! prim>y disease %\ld be giv5 9 addition to ! local treatm5t4 ,,footnotes3 #ib ,= diseases ( ! nose see ,deason1 ,"p #a1 ,page #beg4 ,,diseases ,,( ,,! ,,bron*i ,acute ,bron*itis ,def9ition4--,a cat>rhal inflammation ( "p or :ole ( ! muc\s membrane ( ! l>ynx1 tra*ea & bron*ial tubes1 or x may ext5d into ! capill>y tubes4 ,?is is bilat]al1 affect+ m or less ! bron*ial tree 9 bo? lungs4 ,o/eopa?ic ,etiology & ,pa?ology4--,! mo/ common cause ( acute bron*itis is 8cat*+ cold40 ,x is m preval5t 9 ! w9t]1 & x (t5 succe$s an ord9>y cold 9 ! head1 coryza or l>yngitis1 ! inflammation ext5d+ d[nw>d f ! upp] air passages4 ,a case ( acute bron*itis always pres5ts a contract$ condition ( ! muscles on ei!r side ( ! sp9e 9 ! upp] dorsal region4 ,! contract$ muscles may ext5d z f> d[n z ! middle dorsal or z high z ! entire c]vical4 ,occasionally1 ! ribs po/]iorly are drawn d[nw>d by ! extreme contraction ( ! muscles1 & ! upp] ant]ior "p ( ! *e/ may be some:at con/rict$ & limit$ 9 its movem5ts by ! t5s$ muscles4 ,?us1 9 a few cases ! ribs & upp] dorsal v]tebr are actually subdislocat$ by ! extreme contraction ( ! muscles4 ,! pr9cipal po9ts affect$ are ! second1 ?ird1 f\r? & fif? dorsal regions4 ,9 a few in/ances c]vical lesions di/urb+ ! vagus & result+ 9 motor weakness ( ! tubes1 w be not$4 ,! o/eopa?ic control ( ! bron*ial vasomotor n]ves is 9 ?is region 7dorsal74 ,! disease is also associat$ ) measles & x is usually a symptom ( influ5za4 ,"o attack pr$isposes to ano!r4 ,x affects ei!r sex & especially *ildr5 & ! old1 9 :om x mo/ frequ5tly involves ! small] bron*i4 ,9 adult life x involves ! l>g] bron*i4 ,micro-organisms1 p>ticul>ly ! pneumococcus1 influ5za bacillus1 & micrococcus cat>rhalis1 act z excit+ causes4 ,pa?ologically1 ! muc\s membrane ( ! portion ( ! tra*ea & bron*i t are implicat$ become r$d5$1 conge/$ & m or less cov]$ ) a t\gh mucus m+l$ ) epi!lial cells4 ,! hyp]emia is mo/ m>k$ ab\t ! muc\s gl&s4 ,"s ( ! small] bron*ial tubes are dilat$4 ,9 sev]e cases !re is desquamation ( ! ciliat$ epi!lium1 swell+ & edema ( ! submucosa1 & infiltration ( ! tissues ) leucocytes4 ,! affection involves *iefly ! vasomotor n]ves4 ,9 cases on ! v]ge ( *ronicity1 look well to ! diet2 especially less5 9 am\nt ! />*y & sac*>9e foods4 ,symptoms4--,! onset ( acute bron*itis is accompani$ by ! symptoms ( a common 8cold40 ,9 ! beg9n+ ! c\gh is h>d & dry )\t expectoration2 b lat] x is loos]1 ! secretion becom+ mucopurul5t & abundant & f9ally purul5t4 ,! scanty sputum is at fir/ glairy & mucoid1 :ile lat] x becomes m abundant & mucopurul5t & conta9s pus cells & desquamat$ epi!lium4 ,:5 ! bron*ial inflammation becomes fully e/abli%$1 !re is a feel+ ( tightness & rawness b5ea? ! /]num & a s5sation ( oppression 9 ! *e/1 due to swell+ ( ! muc\s membrane & ! pres5ce ( secretions :i* cause /5osis ( ! bron*ial lum9a4 ,!re is a slight fev]1 r>ely exce$+ #aja degrees ,f4 ,! disease la/s f f\r or five days to ?ree weeks4 ,!re is ei!r a complete recov]y or *ronic bron*itis is develop$4 ,physical ,signs4--,!re may be no physical signs 9 slight attacks ( acute bron*itis ( ! l>g] tubes4 ,9 sev]] cases ! physical signs are well m>k$4 ,inspection may recognize increas$ frequ5cy ( brea?+1 & :5 ! small] tubes are involv$ !re is dyspnea4 ,palpation4--,! bron*ial fremitus may (t5 be felt1 provid+ !re is suffici5t n>r[+ ( ! brea?+ tubes4 ,p]cussion4--,s\nds are normal z long z ! bron*itis is uncomplicat$4 ,auscultation4--,9 ! e>ly /age pip+1 sibilant rales may be he>d on bo? sides4 ,^! rales are incon/ant & appe> & disappe> ) c\gh+4 ,!re may be h>%ness ( brea?+ add$ to ^!4 ,:5 resolution sets 91 ! rales *ange & become muc\s & bubbl+ 9 quality4 ,vocal resonance 9 bron*itis is normal1 unless complications occur4 ,diagnosis4--,?is is g5]ally easy4 ,! abs5ce ( dullness & bl[+ brea?+ & ! bron*ial "* ( ! c\gh & expectoration are usually suffici5t to di/+ui% x f pneumonia & pleurisy4 ,if ! physical signs are notic$ c>efully1 ! diagnosis is r5d]$ easy & positive 9 all cases4 ,prognosis4--,9 ! v "y & ! v old1 ! prognosis is unfavorable1 b 9 a previ\sly heal?y adult ! mo/ t c happ5 to a case ( acute bron*itis is to become *ronic4 ,recov]y is ! rule2 ev5 9 ! ag$ & feeble dea? is r>e4 ,if o/eopa?ic treatm5t c be in/itut$ f ! inception1 ! disease w probably be abort$4 ,! treatm5t almo/ inv>iably less5s ! sev]ity & duration ( an attack4 ,= capill>y bron*itis see ,bron*opneumonia4 ,treatm5t4--,complete re/ 9 a w>m b$1 & a hot foot ba? w\ld cure a l>ge majority ( cases 9 a day or two if ! pati5t w\ld only submit to su* treatm5t4 ,mo/ ( !m wi% to be ar\nd & out doors & v likely att5d+ to _! usual "w1 s t a cure 9 "s cases is h>d to p]=m4 ,!y are v liable to take m 8cold0 & 9 a few cases x w take great ef=t to prev5t ! bron*itis f becom+ *ronic4 ,"o ?or\gh treatm5t p] day w usually be suffici5t4 ,! hyp]emic condition ( ! bron*ial tubes is due to a vasomotor di/urbance1 g5]ally caus$ by a sev]e contraction ( ! muscles ( ! back 9 ! region ( ! fir/ to f\r? dorsal2 al?\gh ! vasomotor n]ves to ! muc\s membrane ( ! bron*ial tubes may be affect$ any:]e f ! fir/ to ! sev5? dorsal inclusive4 ,contraction ( ! muscles ov] ! ant]ior "p ( ! *e/ correspond+ to ^! regions & caus$ by ! same influ5ces 7*iefly atmosph]ical *anges7 is ( q common occurr5ce4 ,9 ! majority ( cases ! contraction ( ! *e/ & back muscles is s sev]e t ! ribs are p>tly displac$ by ! t5sion & ?us is add$ a complication to ! disord]1 & f ?is complication *ronic bron*itis is liable to occur4 ,! ribs or ev5 v]tebr to ! correspond+ region (t5times rema9 p>tly dislocat$ & are a s\rce ( cont9u$ & p]man5t irritation to ! inn]vation ( ! bron*ial tubes4 ,s x is always necess>y 9 treat+ any =m ( bron*itis to see at ea* treatm5t t ! ribs & v]tebr f ! fir/ dorsal to ! sev5? dorsal1 inclusive1 are anatomically correct4 ,z has be5 /at$1 ! disord]$ muscles or ribs may be affect$ ant]iorly z well z po/]iorly2 consequ5tly1 ! treatm5t appli$ is a ?or\gh relaxation ( ! *e/ & back muscles & ! correction ( ! ribs & v]tebr 9 ord] t ! vasomotor di/urbance ( ! bron*ial mucosa may be correct$ & ! inflammation reliev$4 ,an excell5t me?od to release ! immobiliz$ ant]ior upp] *e/ is to place pati5t flat ^u 8 back ) pill[ b5ea? upp] dorsal4 ,?is hyp]ext5ds sp9e1 enl>ges sp9al =am9a1 & t5ds to elevate ribs4 ,!n by use ( arms z lev]s1 mod]ate inspiration1 & employm5t ( "o h& ov] ant]ior end ( ribs !y may be easily releas$ & rais$4 ,?is treatm5t effects circulation1 inn]vation1 lymph tissue1 & rib bone m>r[4 ,9 addition to ! dorsal sp9al n]ves1 & ! sympa!tic1 ! vagi are to be consid]$ 9 ! treatm5t ( bron*itis1 z all ( ^! n]ves1 sympa!tic1 sp9al1 & vagi1 g to make up ! ant]ior & po/]ior pulmon>y plexuses f :i* ! bron*ial mucosa receives its inn]vation4 ,! ve9s p>ticul>ly involv$ 9 passive hyp]emia ( ! bron*ial tubes are ! sup]ior int]co/al & azygos major2 s raise & spread ! ribs to give great] fre$om to ^! blood-vessels4 8,! blood fl[ may be div]t$ f ! bron*i to ! abdom5 by a sl[1 deep1 inhibitive treatm5t ov] x1 includ+ pressure ov] ! sol> & hypoga/ric plexuses40 7,hazz>d74 ,! excretory organs & ! diet ( ! pati5t %\ld be att5d$ to4 ,especially 9 *ildr51 ! diet _h be/ be a fluid "o1 z milk1 egg album91 meat bro?s & meat juice4 ,= ^? :o are subject to ! disease an outdoor life is be/4 ,*ronic ,bron*itis ,def9ition4--,a *ronic inflammation ( ! muc\s membrane ( ! l>ge & middle siz$ bron*ial tubes4 ,o/eopa?ic ,etiology & ,pa?ology4--,*ronic bron*itis may be ei!r prim>y or second>y4 ,! prim>y =m is ! result ( exposure to wet & cold or to ! daily inhalation ( irritat+ vapors or du/4 ,?is =m is r>e1 ! affection be+ almo/ always a second>y "o1 & is mo/ commonly met ) 9 *ronic lung affections1 he>t disease1 g\t or r5al disease4 ,x may be caus$ by any disease :i* favors conge/ion ( ! air tubes by ob/ruction ( ! circulation2 especially mitral diseases & ,bright's disease4 ,x is also caus$ by *ronic alcoholism & may be ! result ( repeat$ attacks ( ! acute =m4 ,*ronic v]tebral & rib lesions are f\nd f ! fir/ to ! sev5? dorsal1 inclusive4 ,eld]ly p are (t5 subject to ! disord]4 ,pa?ologically1 ! lesions ( *ronic bron*itis pres5t great v>iation1 z to bo? _! nature & ext5t4 ,9 "s cases ! muc\s membrane is atrophi$1 s t "s ( ! ela/ic fib]s are noticeable4 ,! epi!lial lay] is 9 great "p miss+4 ,! muscul> coat & muc\s gl&s are atrophi$4 ,9 c]ta9 cases ! muc\s membrane ( ! bron*i is ?ick5$1 & !re may be ulc]ation4 ,9 long /&+ bron*itis1 !re is frequ5tly dilation ( ! tubes 7bron*iectasis7 & emphysema4 ,symptoms4--,pa9 is r>ely pres5t2 !re is m]ely a feel+ ( con/riction b5ea? ! /]num4 ,! c\gh v>ies ) ! wea!r & season & !re is (t5 an abs5ce ( ! c\gh dur+ ! summ]4 ,x is apt to be worse at night ?an 9 ! morn+1 & is frequ5tly p>oxysmal4 ,!re is r>ely any fev]4 ,z a rule1 !re is free expectoration ( mucopurul5t or di/9ctly purul5t matt]4 ,sometimes x is abundant1 s]omuc\s 9 "*1 & aga9 !re are sev]e cases ( dry c\gh 9 :i* !re is almo/ no expectoration4 ,unless associat$ ) o!r diseases1 ! g5]al heal? suff]s b little1 if at all4 ,! appetite1 z a rule1 is good & ! body weight is well ma9ta9$4 ,physical ,signs4--,inspection4--,!re is consid]able immobility ( ! *e/ & if emphysema is pres5t !re is di/5sion4 ,p]cussion is cle>1 & hyp]resonant 9 emphysema4 ,auscultation4--,! expiration is prolong$ & =cible4 ,?is is associat$ ) sonor\s & sibilant rales & moi/ rales ( all sizes4 ,special ,v>ieties4--,bron*orrhea1 dry cat>rh1 putrid bron*itis or fetid bron*itis4 ,bron*orrhea4--,9 ?is =m !re may be an excessive bron*ial secretion4 ,?is may be liquid & wat]y1 b m frequ5tly x is purul5t1 ?9 & conta9+ gre5i% masses2 or aga9 x may be ?ick4 ,dilation ( ! tubes & fetid bron*itis may be develop$4 ,fetid ,bron*itis4--,fetid expectoration is associat$ ) gangr5e ( ! lungs1 abscesses1 bron*iectasis1 decomposition ( matt] )9 ph?isical cavities1 or empyema ) p]=ation ( ! lungs2 or x may occur indep5d5tly4 ,!re is consid]able expectoration t is ?9 & (f5sive4 ,:5 putrefactive *anges take place dur+ ! c\rse ( *ronic bron*itis1 z a rule1 ! foll[+ symptoms imm$iately appe>3 fev]1 :i* may be septic2 increase ( c\gh2 pa9 9 ! side1 & sometimes a *ill4 ,!re is increas$ pro/ration4 ,! symptoms may abate foll[$ by ! usual c\rse ( bron*itis4 ,dry ,cat>rh4--,! c\gh is di/ress+ & p>oxysmal4 ,x is usually associat$ ) emphysema & is a v tr\blesome =m4 ,diagnosis4--,?is is n usually difficult4 ,ph?isis--! abs5ce ( fev]1 ( hemorrhage1 ( tub]cle bacillus & ! signs ( localiz$ consolidation 7usually at "o or o!r apex7 w s]ve to di/+ui% betwe5 ! two4 ,prognosis4--,recov]y is n always accompli%$4 ,! diseases be+ g5]ally a second>y affection1 ! prognosis mu/ dep5d ^u ! prim>y condition4 ,! dang] f developm5t ( emphysema1 bron*iectasis & dilatation ( ! "r v5tricle mu/ be ?\ght (4 ,frequ5tly cures w be obta9$1 ev5 9 old p]sons4 ,c>e mu/ be tak5 t !re are no s]i\s organic lesions4 ,deep treatm5t to readju/ ! upp] & middle dorsals is mo/ ess5tial4 ,treatm5t4--,9 ! fir/ place !re mu/ be a c>eful regulation ( ! hygi5e ( ! pati5t4 ,! diet %\ld be a nutriti\s "o1 c>e be+ tak5 to give food t is easily dige/$4 ,a lib]al diet c easily be select$ f ! v>i\s meats1 vegetables1 c]eals1 fruits1 s\ps1 bro?s1 eggs & milk4 ,! clo?+ %\ld be c>efully select$4 ,flannel %\ld be worn next ! sk9 ! ye> ar\nd1 c>e be+ tak5 t ! suff]] is n too w>mly clad4 ,due att5tion %\ld be giv5 to ba?+1 ex]cis+1 etc4 ,! pati5t %\ld be out 9 ! op5 air a great deal1 b be c>eful t x is n too /ormy4 ,! air ( ! room %\ld be kept at an ev5 temp]ature & n subject to abrupt *anges4 ,two or ?ree treatm5ts p] week w be requir$1 & :5 ! condition is consid]ably aggravat$1 d n hesitate to treat (t5]1 b be c>eful n to unduly irritate ! lesions4 ,lesions w be f\nd to ! ribs & v]tebr f ! fir/ to ! sev5? dorsal inclusive4 ,_m cases pres5t lesions 9 ! v]tebr f ! second to f\r?1 usually ( a lat]al nature4 ,o!r lesions ( frequ5t occurr5ce are displacem5ts ( bo? v]tebr & ribs4 ,correct+ ^! deviations relieves ! *ronic inflammation ( ! tubes4 ,also 9 ^? cases :]e dilatation ( ! bron*ial tubes occurs1 ! ob/ruction to ! motor fib]s is to be remov$ by ! correction ( ! v]tebr & by remov+ ob/ruction to fib]s ( ! pneumoga/ric2 ! fib]s ( ! latt] supply+ ! transv]se muscles ( ! bron*ial tubes4 ,x g5]ally requires a consid]able c\rse ( treatm5t = ! cure ( *ronic bron*itis1 & "o ( ! h>de/ ?+s to cont5d ) 9 ! treatm5t is ! likelihood ( ! pati5t 8cat*+ cold40 ,:5 a fre% cold gets ?or\ghly />t$1 x is almo/ impossible to prev5t ! disease f ext5d+ d[n ! bron*ial tubes1 z ! inn]vation is less ri* 9 ! small] tubes4 ,hazz>d says3 8,! obese %\ld be taught ! habit ( deep respiration1 z %\ld all p]sons subject to ! attacks ( ! disease4 ,?is measure1 toge!r ) ! daily cold sponge or %[] ba?1 is a great aid 9 ov]com+ ! *ronic t5d5cy40 ,^? cases t are due to c>diac or nephritic diseases require ! treatm5t ( ! prim>y disease 9 addition to a light bron*ial treatm5t4 ,a lesion betwe5 ! gladiolus & manubrium ( ! /]num may be f\nd1 b x is ( r>e occurr5ce 9 ^! cases4 ,! upp] portion ( ! /]num may be held v rigidly & slightly und]nea? ! middle portion ( ! /]num2 or at ! po9t ( articulation ( ! two portions a di/9ct ridge may be f\nd1 caus$ by ! articul> ends be+ pu%$ ant]iorly4 ,probably su* lesions affect ! inn]vation to ! bron*ial tubes & lung tissues4 ,associat$ ) ?is condition ! upp] *e/ is consid]ably immobiliz$1 affect+ ! lymph & rib bone m>r[ function4 ,exam9e ! fir/ ribs & clavicles c>efully4 ,*anges ( climate are (t5 b5eficial4 ,fibr9\s ,bron*itis ,def9ition4--,a r>e1 acute or *ronic inflammatory disease ( ! bron*i1 9 :i* a fibr9\s m\ld ( ! bron*us & its bran*es is =m$4 ,^! are expell$ 9 p>oxysms ( c\gh & dyspnea4 ,! ca/s block ! bron*ial tubes4 ,:5 ^! m\lds are l>ge or m$ium siz$1 !y are g5]ally holl[1 :ile ^? ( ! small] bron*i are solid4 ,etiology & ,pa?ology4--,! causes are unkn[n4 ,"y m51 betwe5 ! tw5tie? & =tie? ye>s1 are ! usual subjects2 b ! disease may occur at any p]iod ( life4 ,lesions occur z 9 o!r =ms ( bron*itis4 ,! attack occurs mo/ frequ5tly 9 ! spr+ mon?s4 ,9 "s cases !re seems to be "s h]$it>y influ5ce4 ,*ronic pulmon>y diseases1 l ph?isis1 emphysema & pleurisy1 are occasionally pr$ispos+ causes4 ,x is sometimes associat$ ) sk9 diseases1 su* z h]pes1 impetigo & pemphigus4 ,! pa?ology is n kn[n4 ,! masses t are expell$ are usually r\nd & mix$ ) blood & mucus4 ,! ca/s are m d5se1 b ! membrane is id5tical ) t ( cr\p\s exudates4 ,?is affection1 h[ev]1 is limit$ to c]ta9 bron*ial tubes & recurs at /at$ or irregul> int]vals1 sometimes = a p]iod ( sev]al ye>s4 ,!re is loss ( epi!lium 9 ! affect$ bron*i & ! submuc\s tissue is (t5 swoll5 & infiltrat$ ) s]um4 ,symptoms4--,acute cases are r>e4 ,! attacks may set 9 ) rigor1 high fev]1 pa9 9 ! side1 sor5ess1 sev]e p>oxysms ( c\gh & sometimes a slight hemoptysis4 ,! symptoms are ^? ( an ord9>y acute bron*itis1 b ( sev]] "*2 aggravat$ c\gh & dyspnea & fatal t]m9ation are n uncommon4 ,dea? occasionally results f suffocation4 ,!re may be b "o attack )\t any recurr5ce1 b 9 ! *ronic =m ! p>oxysms recur at irregul> int]vals1 ?\gh !y are less sev]e ?an 9 ! acute =m4 ,! disease may la/ = t5 or ev5 tw5ty ye>s1 ! attacks recurr+ weekly1 or a p]iod ( a ye> or m may int]v5e4 ,! onset is m>k$ by bron*ial symptoms ) or )\t fev]4 ,! c\gh soon becomes di/ress+ & p>oxysmal 9 "*4 ,! sputum may be blood-/a9$ & occasionally !re is pr(use hemorrhage4 ,! expectoration is 9 ! =m ( ball-l masses :i*1 :5 unravel$ are f\nd to be m\lds ( ! bron*i4 ,!y may be holl[ & lam9at$ or q solid4 ,:5 exam9$ "u ! microscope !y are se5 to consi/ ( a fibrillat$ membrane 9 :i* are imb$d$ leucocytes1 mucus1 corpuscles1 fat drops & epi!lial cells4 ,leyd5's cry/als & ,curs*mann's spirals are occasionally f\nd4 ,physical signs are usually ^? ( bron*itis4 ,! weak5$ or suppress$ brea? s\nds 9 ! affect$ t]ritory may occasionally be det]m9$4 ,!re is sometimes a dim9i%$ expansion or ev5 retraction ( ! *e/ wall ov] ! affect$ area4 ,!re is no dullness on p]cussion1 unless ! portions ( ! lung suppli$ by ! affect$ tubes collapse4 ,aft] dislodgem5t ( ! ca/s1 ! normal respiratory murmur returns4 ,diagnosis4--,! fibr9\s ca/s alone are suffici5t = a positive diagnosis4 ,prognosis4--,g5]ally favorable4 ,9 uncomplicat$ cases !re is r>ely any dang]1 ev5 ?\gh !re may be sev]e p>oxysms ( c\gh & dyspnea4 ,9 fatal cases ! lesions ( associat$ or prec$+ affections h be5 f\nd1 su* z *ronic pleurisy1 pneumonia & ph?isis4 ,al?\gh ?is is a r>e disease1 cases h be5 treat$ ) success by o/eopa?ic means4 ,if uncomplicat$ !re %\ld be a fair *ance = a cure1 dep5d+1 ( c\rse1 ^u ! con/itutional condition & ! p]man5cy ( ! lesions4 ,treatm5t4--,! treatm5t is l>gely t ( acute bron*itis4 ,! disord] is m ext5sive ?an 9 acute bron*itis1 consequ5tly sev]e subluxations ( ! ribs & v]tebr ( ! upp] & middle dorsals occur1 besides ext5sive muscul> contractions ( ! *e/ & neck4 ,! fibr9\s ca/s are some:at ( ! same nature ( membran\s exudates else:]e1 !re=e ! treatm5t %\ld be direct$ to a correction ( ! hyp]emia ( ! muc\s membrane ( ! bron*ial tubes1 ?us loos5+ & disorganiz+ ! exudate4 ,! vagi n]ves supply a "p ( ! inn]vation to ! bron*ial tubes & lungs4 ,any disord] to !m %\ld be correct$ :5 diseases ( ! bron*ial tubes & lungs exi/4 ,!y conta9 motor fib]s to ^! organs1 & to ! bron*ial tubes !y supply1 pr9cipally ! transv]se fib]s4 ,9 bron*itis ( v>i\s =ms1 m>k$ effect c be secur$ by close att5tion & treatm5t to ! inf]ior l>yngeal n]ve4 ,?is is be/ treat$ at ! inn] side ( ! l[] portion ( ! /]nocleido muscle4 ,! diff]5t =ms ( bron*itis illu/rate ! po9t s (t5 not$ 9 o/eopa?ic etiology & pa?ology1 t ! v>i\s affections ( ! same region %\ld n be /udi$ s mu* z types ( sev]al diseases or disease entities z diff]5t degrees ( involvem5t1 dep5d+ on ! sev]ity ( ! causative lesion1 ! function ( ! n]ves di/urb$1 & ! "* ( ! tissues4 ,x is /ra9+ a po9t to diagnose & classify _m diseases accord+ to signs & symptoms in/ead ( /udy+ ! process f c5tral causes1 =1 at be/1 p]iph]al manife/ations1 micro-organisms1 etc41 are really incid5tal to ! importance ( ! prim>y s\rce ( di/urb$ nutrition4 ,consequ5tly1 ! same treatm5t1 if sci5tific1 is frequ5tly indicat$ = all ( ! disord]s t may affect a giv5 locality4 ,aft] all has be5 said & done1 ! !rapy z well z ! pa?ology1 mu/ h+e ^u ! fundam5tal--un9t]rupt$ blood *annels & n]ve c\rses are ess5tial to heal?4 ,:e!r a disease is ( prim>y or second>y orig91 or :e!r or n x pres5ts diff]5t symptoms 9 v>i\s types1 ! above basic pr9ciple is inv>iably applicable4 ,?is simplifies etiology1 pa?ology & treatm5t & furni%es a backbone to !ory & practice1 & "s day rational m$ic9e w adopt x4 ,bron*iectasis ,bron*iectasis is a dilatation ( a "p or ! :ole ( ! bron*ial tube4 ,z a rule ?is affection is a second>y "o1 ! mo/ common cause be+ *ronic bron*itis4 ,! inflammation weak5s ! bron*ial walls s t !y are unable to resi/ ! /ra9 t is put ^u !m dur+ viol5t p>oxysms ( c\gh+4 ,aft] dilatation has once comm5c$1 ! weight ( ! secretion :i* accumulates t5ds to fur!r di/5d ! weak5$ walls & ! ela/icity1 becom+ impair$1 is f9ally lo/4 ,dilatation ( ! bron*i is also associat$ ) emphysema1 compression ( a bron*us1 aneurism or m$ia/9al tumor1 bron*opneumonia1 measles & :oop+ c\gh 9 *ildr51 & also traction associat$ ) fibroid induration4 ,h5ce ! bron*ial dilatation is especially associat$ ) bron*itis1 int]/itial pneumonia1 & sometimes *ronic pleurisy4 ,x is r>ely a cong5ital effect 9 su* cases4 ,x is commonly unilat]al4 ,! lesions pres5t$ to ! o/eopa? are l>gely l ^? f\nd 9 *ronic bron*itis1 i4 e41 d]angem5t ( ! upp] f\r or five dorsal v]tebr & ribs1 & lesions ( ! c]vical v]tebr involv+ ! vagi4 ,^! lesions ob/ruct ! n]ve =ce to ! bron*ial tubes & ?us cause ! dilatation4 ,pa?ologically1 ! dilatation is usually ei!r cyl9drical or saccul>1 :i* may occur 9 ! same lung4 ,! entire bron*ial tree may be conv]t$ into a s]ies ( sacs op5+ into ea* o!r4 ,^! h smoo?1 %9+ walls 9 ! mo/ dep5d5t p>ts :i* are sometimes ulc]at$4 ,9 extreme conditions ! dilatations may =m l>ge cy/s imm$iately b5ea? ! pleura2 z a rule1 ! lung tissue ly+ betwe5 ! sacculi becomes cirrhotic4 ,p>tial dilatation is m common4 ,! bron*ial muc\s membrane is involv$ ) an occasional n>r[+ ( ! lum54 ,! n>r[+s are mo/ commonly cyl9drical1 sometimes saccul>4 ,9 all =ms !re is decid$ *ange 9 ! bron*ial wall4 ,9 ! l>ge dilatations1 ! epi!lium is *ang$4 ,! ela/ic & muscul> lay]s are ?9 & atrophi$4 ,^! dilatations frequ5tly conta9 fetid secretions & :5 ^! secretions are reta9$1 ! l9+ membrane becomes ulc]at$4 ,symptoms4--,!re is always c\gh1 :i* occurs 9 sev]e p>oxysms4 ,9 "s cases a *ange ( position w cause a p>oxysm ( c\gh+--v likely due to ! empty+ ( ! cont5ts ( a dilat$ tube into a normal "o4 ,! sputum is mucopurul5t & is gre5i% br[n 9 color1 is fluid1 & has a s\r1 or m frequ5tly1 a fetid odor4 ,on /&+1 x sep>ates into ?ree lay]s2 ! upp] is fro?y & ?91 ! middle mucoid1 & ! l[] is a ?ick s$im5t ( cells & granul> debris4 ,microscopically1 ! s$im5t consi/s ( pus corpuscles1 fatty acid cry/als :i* are arrang$ 9 ! =m ( bundles1 & sometimes r$ blood discs & hematoid9 cry/als4 ,ela/ic fib]s may be f\nd if ulc]s are pres5t4 ,physical ,signs4--,:5 di/9ctly pres5t1 !y are ^? ( a cavity 9 ! lungs4 ,:5 *ronic pleurisy & int]/itial pneumonia are associat$1 !re may be retraction ( ! *e/ wall4 ,! p]cussion resonance is impair$4 ,on auscultation1 bron*ial1 or ev5 amphoric1 brea?+ is he>d occasionally ) metallic rales4 ,diagnosis4--,9 a numb] ( cases ?is 0 =m]ly impossible1 :]e ! ,x-ray is n[ prov+ ( great assi/ance4 ,hi/ory1 p>oxysmal c\gh1 *>act]i/ic copi\s sputum & an abs5ce ( tub]cle bacilli ) little impairm5t ( ! g5]al heal? w s]ve to di/+ui% bron*iectasis f pulmon>y tub]culosis4 ,circumscrib$ empyema :i* has ruptur$ into ! lung may simulate bron*iectasis4 ,?is is ( a mu* m sudd5 onset1 has a hi/ory ( previ\s pleurisy1 ! heal? is gradually impair$1 & !re is ?oracic oppression & dyspnea on ! slighte/ ex]tion4 ,prognosis4--,is g5]ally unfavorable4 ,h[ev] ?is l>gely dep5ds ^u ! cause4 ,treatm5t4--,l>gely ! same z 9 *ronic bron*itis4 ,sev]e lesions are f\nd 9 ! dorsal v]tebr ab\t ! region ( ! ?ird1 f\r? & fif?1 & _m times lesions ( ! pneumoga/ric at ! upp] c]vical v]tebr are also f\nd4 ,! lesions are mu* ( ! same nature z ^? ( bron*itis1 b1 z a rule1 !re is a mu* deep] or m ext5sive lesion4 ,^! lesions weak5 ! motor inn]vation to ! muscul> coats ( ! bron*ial tubes1 & 9 _m in/ances ! ext5sive lesions involve ! vasomotor n]ves controll+ ! blood supply to ! bron*ial tubes4 ,9 mo/ cases m>k$ lesions ( ! ribs on ei!r side w be f\nd1 usually 9 ! region correspond+ to ! affect$ v]tebr4 ,! position ( ! pati5t is important2 ! head %\ld be l[ 9 sleep+4 ,9 c]ta9 fetid cases surg]y %\ld be consid]$4 ,c>e %\ld be tak5 z to ! hygi5ic surr\nd+s ( ! pati5t4 ,! diet %\ld be c>efully regulat$ & nutriti\s1 z 9 *ronic bron*itis4 ,bron*ial ,a/hma ,bron*ial or spasmodic a/hma is a *ronic affection1 *>act]iz$ by a p>oxysmal dyspnea due to a spasmodic contraction ( ! muscles ( ! bron*ial tubes or to swell+ ( _! muc\s membrane4 ,o/eopa?ic ,etiology & ,pa?ology4--,! majority ( lesions caus+ bron*ial a/hma are f ! second to ! sev5? dorsal region1 inclusive1 ei!r 9 ! ribs po/]iorly or ant]iorly1 or 9 ! v]tebr4 ,^! lesions involve vasomotor n]ves to ! bron*ioles :i* produce ! n>r[+ ( ! tubes & ?us cause ! dyspnea4 ,usually ! lesion is at ! ?ird1 f\r? or fif? rib on ! "r side1 al?\gh1 z /at$1 a lesion may be f\nd above or bel[ ?is po9t at ! ant]ior or po/]ior ends ( ! ribs or 9 ! v]tebr correspond+ to ! same region4 ,probably lesions are f\nd m on ! "r side1 because mo/ p are "r-h&$2 ^! muscles be+ bett] develop$ w\ld t5d1 :5 contract$1 to draw ! ribs f _! articulation4 ,! ?ird1 f\r? & fif? ribs are usually f\nd involv$ because x is ! region ( greate/ vasomotor inn]vation to ! bron*ial tubes4 ,9 a numb] ( cases !re w be f\nd a po/]ior curvature ( ! dorso-lumb> region2 & accompany+ ?is condition w be cat>rh & dilatation ( ! /oma*1 conge/ion ( ! liv]1 &1 p]haps1 inte/9al indige/ion & con/ipation4 ,c>eful att5tion %\ld be giv5 to ! dige/ive organs4 ,lesions involv+ ! pneumoga/ric at ! atlas & axis are fairly frequ5t4 ,^! irritate fib]s ( ! pneumoga/ric to ! muscles ( ! bron*ioles & ?us produce n>r[+ ( ! tubes & consequ5tly ! p>oxysms4 ,o!r po9ts to note are ! co/al c>tilages & hyoid bone1 & probably1 9 a few in/ances1 lesions to ! phr5ic4 ,attacks may be induc$ reflexly by v>i\s excitants1 z du/1 diseases ( ! upp] respiratory tract1 etc41 b ! lesions to ! vasomotor & motor n]ves are ! pr$ispos+ causes4 ,laughl9#ic says3 8,x is que/ionable :e!r reflex causes alone are suffici5t to produce g5u9e a/hma )\t ! exi/5ce ( specific lesions affect+ ! direct n]ve connections ( ! "p involv$40 ,no d\bt a neurotic t5d5cy is (t5 a pr$ispos+ factor4 ,ov]eat+1 & p>ticul>ly c]ta9 foods w frequ5tly excite an attack4 ,pa?ologically1 true a/hma is a pure neurosis4 ,!re is m or less *ronic inflammation ( ! bron*ial tubes1 %[n by injection & ?ick5+ ( ! bron*ial mucosa 9 ! majority ( cases4 ,!re may be f\nd ! morbid /ates peculi> to *ronic bron*itis & emphysema4 ,:e!r ! con/riction ( ! tubes is due to spasms ( ! bron*ial muscles or to swell+ ( ! mucosa1 or to bo?1 ! prim>y1 pr$ispos+ & irritat+ influ5ces are common to bo?4 ,^! are v]tebral & rib lesions affect+ ! sp9al n]ves at _! exit & ! sympa!tic *a9 along ! head ( ! ribs2 irritat+ lesions to ! vagi1 con/rict+ pulmon>y vessels1 & to ! c]vical sympa!tics1 caus+ di/urbance ( ! same1 w\ld be factors 9 ! pa?ological *a94 ,reflex irritations may be f\nd 9 v>i\s regions1 b ! pr9cipal osse\s lesions1 accord+ to ,dr4 ,/ill1 are on ! "r side f ! second to ! six? dorsal4 ,symptoms4--,! attack may come on at any "t1 b usually x comes on 9 ! night dur+ sleep4 ,! onset may be sudd5 or ! attack may be prec$$ by premonitory s5sations1 su* z tightness 9 ! *e/1 flatul5ce1 sneez+1 *ill9ess & a copi\s dis*>ge ( pale ur9e4 ,n]v\s symptoms1 heada*e1 v]tigo1 neuralgia1 & an anxi\s1 n]v\s1 re/less feel+ may prec$e ! attack4 ,!re is a s5se ( oppression & anxiety1 foll[$ by dyspnea4 ,soon ! respiratory ef=ts become viol5t1 ! pati5t is oblig$ to sit up or runs to ! w9d[ = air4 ,! %\ld]s are rais$1 ! h&s are plac$ ^u some?+ firm to keep ! %\ld]s fix$ s t ! accessory muscles ( respiration c be br\ght into play4 ,! contract$ tubes resi/ ! entrance ( air4 ,expiration is prolong$ & :eezy4 ,9 sev]e cases ! face becomes pale1 ! sk9 is cov]$ ) p]spiration1 ! extremities are cold1 ! lips1 f+] tips & eyelids are livid1 ow+ to defective oxyg5ation ( ! blood4 ,! pulse is small & quick & ! temp]ature is normal or subnormal4 ,! attack may t]m9ate sudd5ly1 sometimes ) a spell ( c\gh+2 ?is is especially s ( sev]e cases1 z ! c\gh is g5]ally abs5t 9 brief p>oxysms4 ,! c\gh is at fir/ v tight & dry & accompani$ by a t\gh1 scanty expectoration :i* is expell$ ) great difficulty4 ,! sputum conta9s r\nd$ masses ( matt]1 ! s-call$ 8pe>ls0 ( ,lnnec4 ,microscopically1 !y are f\nd to be ( a spiral /ructure1 conta9+ cells d]iv$ f ! bron*ial muc\s membrane & fatty deg5]at$ pus cells4 ,a second =m is conta9$ 9 ! inside ( ! coil$ spiral ( muc91 a filam5t ( great cle>ness & transluc5cy1 t is mo/ probably compos$ ( trans=m$ muc94 ,curs*mann's spirals are f\nd 9 ! e>ly /ages ( ! attack & = a "t ^! 7 suppos$1 by _! irritation1 to excite ! p>oxysms4 ,_! spiral =m is unexpla9$4 ,curs*mann believes t ^! spirals are f\nd 9 ! f9] bron*ioles & to be a product ( bron*iolitis4 ,physical ,signs4--,inspection %[s enl>gem5t ( ! *e/ :i* is fix$ & b>rel-%ap$4 ,! brea?+ is labor$ & ! *e/ moves b slightly4 ,! diaphragm is l[]$ & fix$4 ,p]cussion yields hyp]resonance1 especially 9 cases :i* h _h repeat$ attacks or :5 ! a/hma is associat$ ) emphysema4 ,auscultation4--,) inspiration & expiration are he>d sonor\s sibilant rales :i* are m m>k$ on expiration4 ,z ! secretion increases1 :i* is lat] 9 ! attack1 ! rale becomes moi/4 ,! attack la/s = a v>iable p]iod1 r>ely less ?an an h\r4 ,9 sev]e attacks ! p>oxysms recur = ?ree or f\r nights or m ) spontane\s remissions dur+ ! day4 ,9 "s cases ! relief seems to be absolute1 b 9 ! majority ( cases !re is m or less oppression & c\gh = a day or two1 sometimes = _m days4 ,diagnosis4--,! physical signs1 exam9ation ( ! sputum & ! hi/ory ( ! case makes ! diagnosis easy4 ,prognosis4--,x is n a fatal disease & only dang]\s :5 complications arise4 ,"u o/eopa?ic treatm5t ! prognosis is usually favorable1 unless !re are s]i\s complications1 z ?is is a disease t o/eopa?y has treat$ ) signal success4 ,9 long /&+ cases emphysema inv>iably develops4 ,treatm5t4--,a/hma1 unless complicat$ ) bron*ial & lung diseases1 is usually readily reliev$ dur+ ! p>oxysms4 ,cases ( _m ye>s' /&+ h be5 cur$ 9 a few treatm5ts4 ,x %\ld be borne 9 m9d t a/hma is a respiratory neurosis4 ,to relieve an attack ! o/eopa? %\ld locate ! lesion &1 if possible1 correct x4 ,oium#id1 9 ! acute attack1 /&+ at ! head ( 8 pati5t ins]ts ! tips ( bo? ?umbs well "u ! angles ( ! jaw & !n br+s direct pressure on bo? vagi z !y pass ov] ! transv]se processes ( ! axis4 ,pressure mu/ be brief & let up to be appli$ aga94 ,imm$iate relief is giv5 9 _m cases4 ,adju/ upp] ?ree c]vicals if f\nd d]ang$4 ,if ! muscles are s sev]ely contract$ t x is impossible to make out ! nature ( ! lesion1 !n /rong inhibition1 ) an upw>d1 outw>d movem5t ov] ! angles ( ! ribs involv$1 w be suffici5t4 ,! object to be ga9$ 9 e case is to relieve pressure or irritation to ! vasomotor or motor n]ves1 s t ! n>r[$ tubes may be relax$4 ,/rong inhibition1 su* z plac+ ! knee 9 ! pati5t's back1 at ! same "t pull+ on ! %\ld]s1 w h tempor>y effect1 b x is always be/ to r$uce ! lesion if possible4 ,9 sev]e cases dilatation ( ! rectum may relieve ! p>oxysm1 & 9 a few in/ances x w be necess>y to treat ! ut]us locally4 ,dur+ ! int]val betwe5 ! attacks is ! "t to rem$y ! disease4 ,!n "o is able to locate exactly ! position ( ! di/urb$ tissues t are caus+ ! p>oxysms & apply treatm5t 9 ! regions giv5 "u etiology4 ,_m cases ( a/hma are cur$ 9 f "o to ?ree mon?s' treatm5t4 ,"o treatm5t a week is suffici5t1 provid$ "o is able ea* "t to accompli% some?+ t[>d a correction ( ! lesion & t ! pati5t does n suff] dur+ ! meantime4 ,too frequ5t treatm5ts may simply act z an irritant to ! n]v\s lesions4 ,att5tion %\ld always be giv5 to ! diet & hygi5e4 ,ga/ric dige/ion %\ld be complete be=e retir+ or x may induce an attack4 ,complications are treat$ accord+ to ! disease4 ,exam9e ! upp] respiratory tract1 ! dige/ive tract1 & ! pelvic organs :5 !re is reason to believe ! p>oxysm may be induc$ reflexly4 ,laughl9 sums up ! treatm5t z foll[s3 7#a7 ,removal ( specific lesion2 7#b7 removal ( excit+ causes2 7#c7 removal ( reflex causes2 &1 7#d7 treatm5t ( ! pati5t to improve ! condition ( ! g5]al n]v\s sy/em4 ,,footnotes3 #ic ,laughl9--,a/hma--,j\rnal ( ! ,am]ican ,o/eopa?ic ,association1 ,oct41 #aiad4 #id ,j\rnal ,a4 ,o4 ,a4 #aiah4 ,,diseases ,,( ,,! ,,lungs ,emphysema ,us$ 9 a g5]al way1 emphysema is a t]m :i* implies ! pres5ce ( air 9 ! int]/itial tissue1 b :5 appli$ to ! lungs !re are two applications ( ! t]m1 hav+ widely diff]5t significations1 viz3 ,int]lobul> or int]/itial emphysema & vesicul> emphysema4 ,int]lobul> ,emphysema4--,?is is caus$ by rupture ( air vesicles1 deep 9 ! lung /ructure1 ! air escap+ into ! int]lobul> connective tissue4 ,x is n a v s]i\s condition1 r>ely produces symptoms & af=ds no physical signs4 ,x usually results f viol5t acts ( c\gh+ 9 :i* ! expiratory /ra9 is v great1 z 9 :oop+ c\gh & 9 bron*ial a/hma2 also1 f w\nds ( ! lung4 ,! air bubbles escape into ! int]lobul> septa & are sometimes se5 l little r[s ( beads outl9+ ! lobules4 ,! pleura may become deta*$ & l>g] vesicles may =m4 ,9 r>e cases ! rupture may take place at ! root ( ! lung & ! air passes along ! tra*ea into ! subcutane\s tissue ( ! neck & *e/ wall1 :i* gives rise to a v peculi> & di/9ctive crepitation ^u palpation4 ,r>ely !re is rupture ( ! sup]ficial vesicles1 produc+ pneumo?orax4 ,vesicul> ,emphysema4--,dilatation ( ! infundibul> passages & alveoli or an increase 9 _! size ei!r symmetrical1 involv+ bo? lungs1 or localiz$4 ,vesicul> emphysema is divid$ into comp5satory1 hyp]trophic & atrophic =ms4 ,comp5satory4--,?is occurs :5 a region ( ! lung has be5 disabl$ f any cause & does n exp& fully dur+ inspiration2 ! heal?y portion ( ! lung mu/ !n di/5d & d vic>i\s "w or ! *e/ wall w s9k 9 to occupy ! space4 ,?is happ5s ) portions ( heal?y lungs 9 ! neighborhood ( tub]cul> areas & cicatrices1 areas ( collaps$ lung or p>ts prev5t$ f expansion by pleuritic adhesions 79 ?is case ! comp5satory emphysema is *iefly at ! ant]ior m>g9s ( ! lungs74 ,z a rule ?is di/5tion is physiologic & b5eficial1 ! alveol> walls be+ simply /ret*$4 ,lat] !y may atrophy1 ! air cells becom+ fus$4 ,hyp]trophic ,emphysema4--,?is is enl>gem5t ( ! lung1 due to dilatation ( ! air vesicles & atrophy ( ! walls4 ,o/eopa?ic ,etiology & ,pa?ology4--,an important pr$ispos+ cause ( emphysema is (t5 f\nd to be due to d]angem5ts ( ! tissues1 usually v]tebr & ribs1 :i* affect ! inn]vation to ! lung tissues4 ,su* lesions are f\nd 9 ! vagi & sp9al dorsal n]ves4 ,! atlas may be involv$1 b x is g5]ally ! ribs & dorsal v]tebr4 ,di/9ction %\ld be made betwe5 cause & effect 9 ! skeletal *anges4 ,no d\bt 9 _m in/ances a vici\s circle is ?us e/abli%$4 ,cong5ital weakness ( ! lung tissues1 probably due to non-developm5t ( ! ela/ic tissue1 is a pr$ispos+ factor4 ,?is disease has a m>k$ly h]$it>y "* & frequ5tly />ts e>ly 9 life4 ,! height5$ pressure )9 ! air cells ^u an already weak5$ lung tissue produces emphysema4 ,h5ce1 ! ob/9ate c\gh ( *ronic bron*itis & expiratory /ra9+ ( a/hma are sometimes ! imm$iate cause4 ,9 all attacks ( sev]e c\gh+ or /ra9+ ef=ts1 ! glottis is clos$ & ! air is =c$ into ! upp] "p ( ! lungs1 =cibly exp&+ !m1 & "h is :]e emphysema is f\nd to be mo/ advanc$4 ,?is disease is also f\nd 9 play]s ( w9d in/rum5ts1 9 glass bl[]s & 9 ^? ^: occupation necessitates heavy lift+ or /ra9+4 ,pa?ologically1 ! ?orax is b>rel-%ap$4 ,! lungs are enl>g$ & d n collapse :5 ! ?orax is op5$1 z !y h lo/ _! ela/icity4 ,! organs are pale1 s(t & d[ny to ! feel+ & pit on pressure4 ,enl>g$ air vesicles may readily be se5 b5ea? ! pleura4 ,microscopically1 !re are se5 atrophy ( ! vesicul> walls & a dim9i%$ am\nt ( ela/ic tissue4 ,!re is m or less oblit]ation ( ! capill>ies1 & ! epi!lium ( ! air cells und]goes a fatty *ange4 ,!re is usually *ronic inflammation ( ! bron*ial tubes1 :i* may be r\gh5$ & ?ick5$4 ,! diaphragm is l[]$ & ! subjac5t visc]a are displac$4 ,! mo/ important morbid *anges are f\nd 9 ! he>t1 ! "r *amb] be+ dilat$ & hyp]trophi$4 ,?is is caus$ by ! increas$ t5sion 9 ! pulmon>y art]y1 :i* is enl>g$ & ! seat ( a!romat\s deg5]ation4 ,9 long /&+ cases ! hyp]trophy is g5]al4 ,*anges 9 ! liv]1 kidneys & o!r visc]a are ^? associat$ ) prolong$ v5\s engorgem5t4 ,symptoms4--,! onset ( ! disease is usually gradual4 ,! fir/ symptom to be notic$ is ! %ortness ( brea?4 ,9 r>e cases x may exhibit a m acute developm5t1 z aft] :oop+ c\gh1 & !n ! fir/ symptom w be dyspnea4 ,9 "s cases ?is p]si/s all ! "t1 :ile 9 mod]ate emphysema ! dyspnea is notic$ only on slight ex]tion1 su* z go+ up-/airs1 runn+ or walk+ rapidly4 ,! lungs are always fill$ ) air :i* is *>g$ ) c>bon dioxid & does n *ange1 z ! pati5t is con/antly mak+ ineffectual ef=ts to draw 9 air4 ,! inspiration is %ort5$ & ! expiration is greatly prolong$ & is (t5 h>% & :eezy4 ,! pulse-rate is accel]at$2 ! temp]ature is usually normal4 ,cyanosis is a *>act]i/ic symptom 9 well e/abli%$ cases & is ( an extreme grade n se5 9 any o!r affection4 ,bron*itis is frequ5tly f\nd 9 comb9ation1 especially 9 w9t]4 ,9 ?is case !re w be ! symptoms ( ! associat$ bron*itis1 c\gh1 expectoration & sometimes oppression4 ,z ! pati5t advances 9 age & !re are successive attacks ( bron*itis1 ! condition gets worse4 ,9 advanc$ cases1 ! result ( c>diac failures1 !re may be v5\s engorgem5t1 dropsy & effusions into ! s]\s sacs4 ,physical ,signs4--,inspection4--,!re is a m>k$ *ange 9 ! %ape ( ! ?orax4 ,! *e/ is r\nd$ ) increas$ circumf]5ce1 giv+ ! *>act]i/ic b>rel-%ap$ *e/4 ,! /]num bulges1 z d also ! co/al c>tilages4 ,! int]co/al spaces are wide1 especially 9 ! hypo*ondriac region1 & n>r[ above4 ,! clavicles & muscles ( ! neck /& out ) great prom95ce & ! neck itself seems to be %ort5$ on acc\nt ( ! elevation ( ! ?orax & /]num4 ,! curve ( ! sp9e is increas$ & !re is a w+$ condition ( ! scapul4 ,^! *anges give ! pati5t a /oop+ po/ure4 ,! *e/ does n exp&1 b is rais$ up by ! scal5i & /]nocleidoma/oid muscles :i* /& out prom95tly & are hyp]trophi$4 ,! he>t's apex beat is invisible & !re is usually m>k$ epiga/ric pulsation4 ,on palpation1 vocal fremitus is f\nd dim9i%$1 b n abs5t2 ! apex beat is r>ely felt4 ,!re is di/9ct %ock ov] ! ensi=m c>tilage4 ,?is is due to ! displacem5t ( ! he>t & engorgem5t ( ! "r v5tricle4 ,!re is m>k$ pulsation 9 ! epiga/rium4 ,on p]cussion !re is sometimes increas$ resonance1 almo/ am\nt+ to tympany4 ,! upp] level ( hepatic dullness is depress$4 ,! he>t dullness may be oblit]at$ & ! upp] limit ( spl5ic dullness may also be l[]$4 ,! p]cussion note is greatly ext5d$4 ,auscultation reveals t ! inspiration is %ort & feeble :ile !re is prolong$ expiration1 ! normal ratio be+ rev]s$4 ,9 associat$ bron*itis rales are frequ5tly he>d4 ,diagnosis4--,unless complicat$ ! diagnosis is g5]ally easily made4 ,! enl>gem5t ( ! ?orax1 ) dyspnea & hyp]resonance & a prolong$ expiration w diff]5tiate emphysema f *ronic bron*itis4 ,pneumo?orax is ( sudd5 developm5t :ile emphysema is ( sl[ developm5t4 ,pneumo?orax is usually unilat]al1 & x gives a tympanitic p]cussion note4 ,9 auscultation !re is amphoric brea?+ & metallic t9kl+ & abs5ce ( any vesicul> murmur4 ,prognosis4--,! disease is r>ely fatal1 al?\gh dea? may result f he>t failure1 dropsy or pneumonia4 ,?or\gh & p]si/5t treatm5t w g5]ally relieve ! prim>y condition4 ,! disease1 z a rule1 runs a long c\rse b does n necess>ily %ort5 life4 ,atrophic emphysema is a s5ile *ange4 ,treatm5t4--,9 cases ( rec5t occurr5ce "o may be able to build up ! alt]$ lung tissue by treatm5t ( ! inn]vation to ! lung /ructure1 viz43 ! vasomotor n]ves f ! second to ! sev5? dorsal1 ! vagi1 & ! c]vical & dorsal sympa!tics4 ,:5 a numb] ( air vesicles h be5 conv]t$ into "o sac1 x is impossible to re/ore ! alt]$ lung /ructure & a treatm5t to relieve ! symptoms & to prev5t ! fur!r progress ( ! disease is indicat$4 ,9 all cases treatm5t %\ld be appli$ to correct any v]tebr or ribs ( ! upp] dorsal region t may be displac$1 & to raise & spread ! ribs s t ! lung /ructure may be bett] n\ri%$ & /r5g!n$ & t ! a]ation ( ! blood w be m p]fect4 ,treatm5t ( ! vagi n]ves is important1 z _! physiological action on ! lungs is to increase _! movem5t4 ,! g5]al heal? ( ! pati5t is an important consid]ation & ev]y?+ %\ld be done to promote z heal?y a condition z possible4 ,! dige/ion %\ld be c>efully look$ aft] & ev]y?+ done to re/ore a normal /ate ( ! blood4 ,a *ange ( climate may prove b5eficial4 ,/r5g!n+ ! c>diac action w be ( s]vice 9 reliev+ any dropsical t5d5cy t might occur on acc\nt ( ob/ruction to ! pulmon>y circulation4 ,if bron*itis or a/hma occurs1 _! respective treatm5ts are indicat$4 ,a g5]al treatm5t ( ! splan*nic & lung vascul> areas %\ld be giv5 to prev5t any di/urbance 9 ! circulation :i* might cause conge/ion ( ! liv]1 conge/ion ( ! hemorrhoidal ve9s1 or cat>rh ( ! /oma* & b[els4 8,free evacuation ( ! b[els & measures to relieve any flatul5t di/5tion are v ne$ful 9 cases ( emphysema to take (f f ! diaphragm any pressure f bel[1 & to all[ x to desc5d z freely z possible4 ,) ?is view also ! food %\ld be conc5trat$1 n\ri%+1 & n bulky40#ie ,x is a good plan to in/ruct ! nurse or att5dant to aid inspiration by rais+ ! arms /rongly above ! head dur+ inspiration & to compress ! *e/ dur+ expiration s z to co9cide ) natural brea?+1 :i* w r5d] ! a]ation ( ! blood great] & increase ! ela/icity ( ! vesicles4 ,acute ,lob> ,pneumonia 7,,cr\p\s ,,pneumonia7 ,?is is an acute1 infecti\s disease :]e9 v>i\s v]tebral1 rib & muscul> lesions pr$ispose to a l[]$ nutritive /ate ( ! p>5*yma ( ! lung1 p]mitt+ ! invasion ( ! diplococcus pneumoni1 ) consequ5t local inflammation & pron\nc$ con/itutional di/urbances1 *ill1 extreme pro/ration & fev]1 :i* t]m9ates abruptly by crisis4 ,second>y infective processes are frequ5t4 ,9 describ+ a typical case ( pneumonia x is consid]$ z a self-limit+ disease4 ,by o/eopa?ic treatm5t x is (t5 abort$ or1 at lea/1 its c\rse mu* %ort5$4 ,9 su* a case x is n typical pneumonia & c\ld n be describ$ z su*4 ,o/eopa?ic ,etiology & ,pa?ology4--,pneumonia occurs m (t5 9 ! "y up to ! six? ye> & 9 ! ag$4 ,x is m frequ5t dur+ ! w9t] & spr+ mon?s4 8,colds10 exposure & wett+ are pr$ispos+ influ5ces t l[] resi/ance4 ,climate ex]ts little pr$ispos+ influ5ce4 ,males are1 on ! :ole1 m frequ5tly attack$4 ,pneumonia may foll[ injuries ( ! *e/4 ,v>i\s d]angem5ts ( ! ribs & v]tebr are always f\nd 9 pneumonia2 su* d]angem5ts correspond ) ! regions ( vasomotor1 motor & trophic fib]s ( ! lungs1 viz41 second to sev5? dorsal1 inclusive1 & ! upp] c]vical v]tebr1 ! latt] region affect+ ! vagi4 ,! muscles ( ! *e/ region are always sev]$ contract$4 ,^! v>i\s disord]s produce a l[]$ vitality ( ! bron*ial & lung tissues1 ?us favor+ ! exi/5ce ( ! micrococcus lanceolatus4 ,unhygi5ic surr\nd+s1 alcoholism1 any or all habits t t5d to depress ! n]v\s sy/em1 or l[]$ vitality f "s pre-exi/5t disease1 l diabetes1 ,bright's disease1 organic he>t affection or "o ( ! infecti\s fev]s1 favor its developm5t4 ,"o attack und\bt$ly pr$isposes to ano!r & repeat$ attacks may occur 9 ! same individual4 ,! excit+ cause is ! invasion ( ! lung by pa?og5ic bact]ia1 especially by diplococcus pneumoni4 ,pneumococci are frequ5tly f\nd 9 ! ?roat & m\? ( ! heal?y4 ,pa?ologically1 ! lung 9 cr\p\s pneumonia exhibits ?ree di/9ct /ages--conge/ion1 r$ hepatization & gray hepatization4 ,9 ! /age ( engorgem5t ! tissue is r$ 9 color1 firm & solid & less crepitant ?an ! heal?y lung4 ,! cut surface is ba!d 9 blood & /a9$ s]um4 ,microscopic exam9ation %[s ! capill>ies to be dilat$ & tortu\s4 ,! alveol> epi!lium is swoll5 & ! air cells fill$ ) a v>iable numb] ( r$ corpuscles1 deta*$ alveol> cells & a few leucocytes4 ,dur+ ! /age ( r$ hepatization ! tissue is solid4 ,x is r$di% br[n 9 color & ( a dry1 mottl$ appe>ance4 ,x is v friable & does n crepitate1 z ! affect$ portion is airless4 ,its weight & specific gravity are increas$ s t x s9ks 9 wat]4 ,! torn surface pres5ts a granul> appe>ance1 !re be+ fibr9\s plugs 9 ! air cells4 ,on microscopic exam9ation ! air spaces are f\nd fill$ ) coagulat$ fibr94 ,! tissue conta9s r$ blood-corpuscles & pus cells & ! walls ( ! air cells are infiltrat$4 ,9 sections prop]ly treat$ ! diplococcus is detect$1 & 9 "s cases also ! /reptococcus & /aphylococcus4 ,9 ! /age ( gray hepatization1 ! lung is /ill d5se & heavy1 b ! surface is moi/] & s(t]1 :ile ! lung tissue is ev5 m friable & ! r$ color gives place to a mottl$ gray4 ,! exudate loses its granul> "* & a yell[i% :ite purul5t liquid fl[s f a cut surface4 ,microscopically1 ! air cells are fill$ ) leucocytes1 :ile ! r$ corpuscles & fibr9 filam5ts h disappe>$4 ,! /age ( gray hepatization is ! /age ( beg9n+ resolution4 ,! exudate is s(t5$4 ,! cell elem5ts are dis9tegrat$ & absorb$ by ! lymphatics & l>gely elim9at$ ?r\gh ! kidneys4 ,9 unfavorable cases ! consolidat$ lung may become infiltrat$ ) pus1 & abscesses occur4 ,9 "s in/ances ! tissue is gangr5\s1 or x may become ! seat ( fibroid induration4 ,^!1 h[ev]1 are r>e4 ,symptoms4--,! disease beg9s abruptly1 usually ) a sev]e *ill1 la/+ f half an h\r to an h\r1 ! fev] ris+ rapidly4 ,!re is a %>p pa9 9 ! side1 ! sk9 becomes h>% & dry1 ! face is flu%$1 ! eyes are bright & ! expression anxi\s4 ,a %ort1 dry1 pa9ful c\gh soon develops4 ,! expectoration pres5ts a *>act]i/ic1 ru/y or blood t+$ appe>ance & is extremely t5aci\s4 ,! temp]ature rises rapidly1 frequ5tly to #ajd or #aje degrees ,f41 & cont9ues high = f five to t5 days & g5]ally t]m9ates by crisis4 ,! pulse is full1 b ! pulse-respiration ratio is n ma9ta9$4 ,!re is m>k$ dyspnea1 ! respirations rang+ f =ty to fifty p] m9ute4 ,!re are _m f9e rales4 ,heada*e1 ga/ro-inte/9al di/urbances1 sleeplessness1 epi/axis1 r>ely delirium except 9 drunk>ds1 may also be pres5t4 ,! symptoms giv5 are ^? ( a typical case ( pneumonia1 b all are subject to modification4 ,! onset may be gradual & ! *ill abs5t4 ,9 all cases1 & especially drunk>ds1 ! temp]ature may n be high1 :ile ! pulse is (t5 feeble & rapid in/ead ( full & /rong1 & ! physical signs may n make _! appe>ance until ! second or ?ird day4 ,special ,symptoms4--,! fev] rises abruptly 9 ! initial *ill1 ! temp]ature rea*+ #ajd or #aje degrees ,f41 & is cont9u\s ) a v>iation ( a degree or two4 ,! fev] t]m9ates by crisis aft] hav+ cont9u$ f five to n9e days4 ,! temp]ature commonly falls dur+ ! night & is accompani$ by a pr(use p]spiration4 ,! temp]ature may fall f five to eight degrees 9 eight to twelve h\rs4 ,!re is a wide range "h dep5d+ ^u promptness & skillfulness ( treatm5t1 ! reaction ( ! tissues1 & previ\s heal?4 ,e>ly treatm5t is invaluable 9 modify+ ! c\rse ( ! disease4 ,! sputum at fir/ is mucoid & fro?y4 ,ab\t ! second day x becomes ( a *>act]i/ic color1 q copi\s & consi/+ ( a fro?y1 fluid mucus1 conta9+ small viscid masses4 ,x is v viscid & glut9\s1 9 "s cases almo/ f ! onset4 ,9 old & previ\sly weak p]sons1 !re may be no expectoration4 ,"u ! microscope ! sputum is se5 to conta9 r$ blood-corpuscles1 leucocytes1 alveol> epi!lium1 ! micrococcus lanceolatus z well z o!r micro-organisms1 pus corpuscles & small fibr9\s ca/s4 ,a /abb+ pa9 is a common e>ly symptom1 z well z a dry1 %ort c\gh4 ,! ur9e is febrile1 scanty & high color$4 ,urea & uric acid are increas$4 ,a trace ( album9 is (t5 pres5t1 & !re may be symptoms ( acute nephritis4 ,h]pes is common4 ,! nasolabial h]pes appe> f ! second to ! fif? day1 & !y may occur ^u ! *eek1 g5itals & also ^u mucosa ( ! tongue4 ,x is suppos$ to indicate a favorable prognosis4 ,!re is r$ness ( ! *eek1 usually on ! affect$ side4 ,! muc\s membrane ( ! m\? is dry4 ,! tongue is :ite & furr$4 ,anorexia & ?ir/ are pres5t4 ,! pati5t is usually con/ipat$1 b di>rhea may occur4 ,vomit+ is common4 ,! sple5 is usually enl>g$1 b ! liv] is n p]ceptibly increas$ 9 size1 unless !re is extreme engorgem5t ( ! "r he>t4 ,! pulse is b\nd+4 ,! av]age pulse-rate is f #ajj to #ajh p] m9ute4 ,9 consolidation ! left v5tricle receives a less5$ am\nt ( blood & ! pulse may become small4 ,9 ! ag$ & debilitat$1 a small1 weak & rapid pulse may be pres5t4 ,! he>t s\nds are l\d & cle>1 & 9 favorable cases ! pulmon>y second s\nd is acc5tuat$1 ow+ to ! increas$ t5sion 9 ! pulmon>y vessels4 ,^u di/5sion ( ! "r side ( ! he>t & p>tial failure ( ! "r v5tricle1 ! second s\nd becomes less di/9ct :i* is a v unfavorable symptom1 = v mu* dep5ds ^u ! /r5g? ( ! "r v5tricle 9 pneumonia4 ,! blood usually exhibits leucocytosis :i* disappe>s ) ! crisis4 ,9 malignant pneumonia ?is is abs5t & its cont9u$ abs5ce is an unfavorable sign4 ,! proportion ( fibr9 is also greatly increas$4 ,! diplococci c r>ely be se54 ,heada*e is common z an initial symptom & may be p]si/5t4 ,! disease is (t5 u%]$ 9 by convulsions1 especially 9 *ildr52 consci\sness is usually reta9$ ?r\gh\t ! :ole attack1 ev5 9 sev]e cases1 ?\gh 9 "s cases !re is delirium4 ,9 drunk>ds delirium trem5s may be pres5t f ! onset4 ,9 ^! cases ! pati5t (t5 w&]s ab\t until ! prelim9>y excitem5t gives way to coma4 ,physical ,signs4--,/age ( ,conge/ion4--,dim9i%$ expansion1 ! movem5ts ( ! affect$ side are defective1 ! face is flu%$ & ! pati5t lies on ! affect$ side4 ,tactile fremitus is slightly increas$4 ,!re may be tympany ov] ! involv$ area f dim9i%$ intrapulmon>y t5sion4 ,9 ! latt] "p ( ?is /age !re is impairm5t ( resonance4 ,f9e crepitant rales are he>d at ! end ( =c$ inspiration4 ,great c>e has to be tak5 9 exam9ation :5 !re is deep seat$ consolidation4 ,/age ( ,r$ ,hepatization4--,! brea?+ is m>k$ly abnormal4 ,v little or no expansive motion ( ! *e/ ov] ! affect$ region4 ,vocal fremitus is m>k$ly exagg]at$4 ,! sk9 is hot & dry & ! pulse frequ5t4 ,dullness ov] ! affect$ p>ts ) an increas$ s5se ( resi/ance is pres5t4 ,!re is high-pit*$1 prolong$1 bron*ial brea?+ :5 ! lung becomes solidifi$4 ,:5 ! l>g] bron*i are completely fill$ ) exudate1 tubul> brea?+ is abs5t4 ,crepitant rales may also be he>d4 ,/age ( ,gray ,hepatization4--,l>gely ! same physical signs are repeat$ 9 ?is /age z 9 ! second4 ,! normal mann] ( brea?+ returns1 z does also ! normal expansive movem5t ( ! affect$ side4 ,crepitant rales reappe>4 ,! temp]ature ( ! sk9 is less5$1 brea?+ *anges f bron*ial to vesicul> & bron*ial resonance cont9ues = "s "t4 ,complications4--,pleurisy is ! mo/ frequ5t complication4 ,pneumonia on "o side & pleurisy on ! o!r is possible4 ,! pa9 is m acute & localiz$4 ,! respiration is greatly affect$ & ! usual signs ( effusion are pres5t4 ,empyema may be a complication4 ,p]ic>ditis is m common 9 ! pneumonia ( *ildr54 ,?\gh usually pla/ic x may be s](ibr9\s1 b r>ely ! fluid is purul5t4 ,!re is increas$ dyspnea1 ! pulse becomes weak]1 & ! he>t s\nds are gradually suppress$4 ,endoc>ditis is a comp>atively frequ5t complication4 ,x is m liable to attack pati5ts ) old valvul> disease & to affect ! left he>t4 ,! physical signs are sometimes abs5t & ev5 :5 pres5t are liable to be v deceptive4 ,x may1 h[ev]1 be suspect$ 9 cases :]e ! fev] is protract$2 :5 septic manife/ations1 su* z *ills1 sweats or irregul> temp]ature1 develop2 :5 embolic symptoms appe>1 or :5 a r\gh1 dia/olic murmur develops4 ,m5+itis is a complication t comes on at ! height ( ! fev]4 ,?is complication is r>ely recogniz$ unless ! basil> m5+es are involv$4 ,x is frequ5tly associat$ ) ulc]at$ endoc>ditis4 ,c]ebral embolism caus+ hemiplegia has be5 obs]v$4 ,o!r possible complications are neuritis1 ar?ritis1 nephritis1 p>otitis & v>i\s dige/ive disord]s4 ,diagnosis4--,a typical case ( pneumonia is easily recogniz$4 ,! abrupt onset ) rigor1 ! rapidly develop$ fev]1 ! sputum1 physical signs & abnormal pulse-respiration ratio1 z a rule make ! diagnosis easy4 ,frequ5t exam9ation ( ! lungs %\ld be made 9 ,bright's disease1 diabetes1 organic affections ( ! he>t1 canc] & alcoholism1 z all ^! affections are liable to become complicat$ ) acute pneumonia4 ,pleurisy is (t5 conf\nd$ ) pneumonia4 ,! resemblance betwe5 friction s\nds & crepitant rales is (t5 v close4 ,9 pleurisy vocal resonance & vocal fremitus are dim9i%$2 !re is no 8ru/y0 sputum2 ! p]cussion dullness may *ange ) ! po/ure ( ! pati5t1 & ! brea?+ is di/ant & weak4 ,a typhoid /ate may be mi/ak5 = typhoid fev]4 ,hypo/asis occurs late 9 typhoid fev] :ile dullness sets 9 e>ly 9 pneumonia4 ,! hi/ory ( ! onset w be ( aid1 z pneumonia z a complication sets 9 late 9 ! disease4 ,! ,widal te/ w be ( value4 ,acute ph?isis may beg9 ) a *ill & may resemble pneumonia v closely1 especially ! physical signs4 ,exam9ation ( ! sputum w %[ ! bacilli ( tub]culosis4 ,! ,x-ray w (t5 be ( aid z a diagno/ic measure4 ,prognosis4--,?is l>gely dep5ds ^u ! previ\s heal? ( ! pati5t4 ,at ! extremes ( life ! prognosis is mu* m unfavorable4 ,x is especially fatal 9 drunk>ds4 ,by compet5t o/eopa?ic treatm5t ! mortality rate may be mat]ially less5$ & ?is disease1 dread$ by bo? physician & pati5t1 ne$ n seem s fe>ful4 ,! dea? rate f pneumonia dur+ ! pa/ few ye>s has be5 appall+4 ,9 ,new ,york & ,*icago ne>ly "o-eigh? ( ! dea?s ! ye> ar\nd are due to pneumonia1 & dur+ c]ta9 mon?s ( ! ye> tw5ty-sev5 or eight p] c5t4 ( all dea?s are due to ?is disease4 ,drug m$ication is notori\sly unreliable1 ! mo/ compet5t physicians freely admitt+ t !y are practically p[]less to /ay ! ravages4 ,giv5 a pati5t ) a fair con/itution1 o/eopa?ic treatm5t w (f] reasonable hope to ! suff]]4 ,!re is no "q t o/eopa?y m]its mu* comm5dation 9 ! treatm5t ( pneumonia4 ,_m sev]e cases h be5 cur$ & _m m h und\bt$ly be5 abort$4 ,! treatm5t is directly applicable & specifically indicat$1 & c\pl$ ) good nurs+ & hygi5e1 ! mortality rate ( ! old s*ools is be+ m>k$ly less5$4 ,treatm5t4--,! treatm5t ( pneumonia mu/ be bo? con/itutional & local4 ,by ?is is meant t ! sy/emic /r5g? & vigor mu/ be ma9ta9$ 9 addition to treatm5t ( ! *ief lesion ( ! disease1 :i* is locat$ 9 ! lungs4 ,dur+ ! v>i\s /ages ( ! disease1 ! treatm5t %\ld be direct$ to ! n]ves ( direct inn]vation t control ! capill>ies1 & to ! vasomotor n]ves ( ! pulmon>y circulation1 9 ord] t ! hyp]emic & inflam$ /ate ( ! pulmon>y capill>ies & adjac5t tissues may be less5$ & ! circulatory sy/em equaliz$4 ,! disord]$ tissues t %\ld be correct$ 9 ord] t ! c5t]s ( ! sp9al cord & ! n]ves t influ5ce ! function & /ructure ( ! lungs may be reliev$1 are3 contraction ( ! ?oracic & dorsal muscles1 subluxations ( ! ribs & dorsal v]tebr f ! second to ! sev5?1 inclusive1 & ! upp] c]vical v]tebr t may become disord]$ & imp+e ^u ! vagi n]ves4 ,h[ev]1 ow+ to ! fact t ! vasomotors are n especially abundant "h1 all increas$ *e/ mobility & deep brea?+ & abdom9al aid w mat]ially assi/ ! circulation4 ,also1 c>efully treat ! middle & inf]ior c]vical regions = ! lymphatics ( ! lungs4 ,ea* ( ^! regions %\ld be c>efully exam9$ & ?or\ghly treat$ :5ev] f\nd involv$4 ,! specific micro-organisms t influ5ce ! c\rse ( pneumonia are naturally v important factors2 b obs]v+ & improv+ ! g5]al heal?1 & e/abli%+ an unob/ruct$ circulation ?r\gh ! diseas$ lung tissues w ha/5 ! crisis by favor+ a rapid =mation ( antidotal sub/ances to neutralize ! poison\s sub/ance produc$ by ! micrococcus lanceolatus4 ,heal?y tissues1 :i* occur only :]e !re is un9t]rupt$ fre$om ( vascul> supply & n]ve =ce1 are obta9$ by correction ( any & all anatomical disord]s4 ,?is w rapidly decrease any le?al t5d5cy 9 ! pati5t & (t5 abort ! disord] s t all t is ne$$ is suffici5t "t = nature to heal ! diseas$ tissues4 ,! pr9cipal pr$ispos+ cause ( _m specific diseases1 is "s disord] ( ! anatomical tissues t int]f]es ) normal physiological functions2 & ! det]m9+ ( ! diff]5t types ( disease is (t5 due to ! location ( ! lesion & ! "* ( ! micro-organism involv$ 9 ea* disease4 ,:at is necess>y 9 _m cases is a correction ( ! me*anical pr$ispos+ condition & ! excit+ & det]m9+ influ5ces w be r5d]$ inactive4 ,! importance ( close att5tion to bo? vagi c n be ov]e/imat$4 ,any ob/ruction above or bel[ ! orig9 ( ! sup]ior l>yngeal n]ve is foll[$ by loss ( motor p[] ( ! lungs1 ?us caus+ difficult & labor$ brea?+4 ,! lungs become sur*>g$ ) blood1 because ! air pressure 9 ! lungs is l[ & ! ?orax is di/5d$4 ,?is condition is foll[$ by s]\s exudation4 ,?us ob/ruction ( ! vagi may be "o factor 9 ! cause ( pneumonia4 ,ob/ruction ( ! vagi bel[ ! orig9 ( ! recurr5t l>yngeal n]ves affects ! l[] & middle lobes ( ! lungs1 & produces also a cat>rhal inflammation ( ! upp] lobes4 ,! recurr5t l>yngeal n]ves may be ob/ruct$ by dilatation ( ! aorta or subclavian art]y z !y w9d ab\t !m2 also by dislocations ( ! fir/ & second ribs1 :i* may affect ! n]ves n only directly1 b by caus+ an ob/ruction to ! subclavian vessels ) a consequ5t di/urbance ( ! aorta & ! he>t4 ,! recurr5t l>yngeal n]ves may be treat$ directly at ! inn] l[] "p ( ! /]noma/oid4 ,"o ( ! *ief objects ( ! treatm5t %\ld be to prev5t he>t failure & to less5 ! pulse-respiration ratio4 ,! av]age pulse-rate 9 typical cases is f #ajj to #aaj p] m9ute & :5 x exce$s ?is to any ext5t1 say #abj1 !re is cause = al>m4 ,at fir/ ! pulse is full & b\nd+1 lat] x is small on acc\nt ( a less5$ am\nt ( blood rea*+ ! left v5tricle & sy/emic circulation1 ow+ to ! ext5sive consolidation4 ,9 treat+ he>t failure p>ticul> att5tion %\ld be paid to ! condition ( ! ribs on ! left side ov] ! region ( ! he>t1 ! second to ! fif?1 inclusive4 ,a correction ( any di/urbance to ! inhibitory n]ves ( ! he>t1 7! vagi7 & ! accel]ator fib]s ( ! he>t 7! c]vical sympa!tic7 %\ld be made4 ,?is means close att5tion to probable d]angem5ts ( ! v]tebr f atlas to fir/ dorsal4 ,g5]al treatm5t ( ! entire sy/em w relieve ! he>t ( "s "w & favor an equalization ( ! vascul> sy/em4 ,also by ! use ( hydro!rapy ! ma9t5ance ( ! he>t's action may be accompli%$4 ,cold compresses1 & n w>m ones1 %\ld be us$1 z ! latt] relax ! vessel walls1 produc+ m or less p>esis ( ! vessels1 :ile ! =m] /imulate ! vaso-dilators1 produc+ dilatation & tone ( ! vessels1 !reby caus+ a vigor\s increase 9 ! fl[ ( blood4 ,?is relieves ! he>t by increas+ ! cutane\s circulation1 besides increas+ art]ial t5sion4 ,! "r he>t is indirectly aid$ by ! increase ( ! t5sion 9 ! g5]al vascul> sy/em1 & ! vessels ( ! pulmon>y circulation h m =ce exp5d$ ^u !m & a great] contraction ( _! vessels occurs on acc\nt ( ! dilatation ( ! cutane\s vessels4 ,! temp]ature ( ! wat] us$ %\ld be #fj degrees ,f41 & ! compress appli$ = ?irty m9utes or z long z necess>y4 ,att5tion to ! abdom9al area & diaphragm w h a def9ite effect ^u ! circulation & elim9ation4 ,x is b5eficial 9 its influ5ce ^u lungs & he>t & 9 combatt+ toxemia4 ,c>efully graduat$ deep brea?+ is ( di/9ct b5efit4 ,9 addition to ! fev] treatm5t 9 ! c]vical & dorsal regions1 ! gradually cool$ tub-ba? w be ( aid4 ,! temp]ature at fir/ %\ld be n9ety degrees ,f4 & !n gradually cool$ to eighty degrees ,f4 ,! duration %\ld n be ov] t5 or fifte5 m9utes4 ,c>e %\ld be tak5 t ! pati5t does n ex]t himself4 ,he %\ld be lift$ 9 & out ( ! ba?s4 ,^! ba?s also h a m>k$ effect ^u ! respiratory & n]v\s c5t]s4 ,! ice-bag ov] ! *e/ & sp9e has a b5eficial influ5ce2 /ill1 ) feeble *ildr5 be exce$+ly c>eful :5 apply+ or us+ cold me?ods4 ,dur+ all /ages ( ! disease1 ! be/ possible c>e %\ld be tak5 ( ! pati5t4 ,see ! pati5t frequ5tly1 probably twice a day or (t5]4 ,ea* "t ?or\ghly relax ! dorsal muscles & readju/ ! ribs1 = z e o/eopa? ( exp]i5ce w note 7& ,dr4 ,/ill p>ticul>ly emphasizes7 ! contract$ muscles frequ5tly & cont9ually displace ! ribs4 ,! treatm5t %\ld n be prolong$ to a po9t ( ov]fatigue1 b a def9ite reaction ( tissues %\ld be secur$ b no fur!r4 ,c>efully raise all ! ribs & mod]ately hyp]ext5d ! sp9e4 ,release ! c]vical1 pectoral & axill>y lymphatics1 & /imulate sple5 & liv]4 ,exp]i5ce has %[n t ! fir/ treatm5t is ( ! greate/ importance & if ! o/eopa? w control ! pr$om9ant symptoms at t "t ! result w be mu* simplifi$4 ,= t reason x is be/ n to leave ! pati5t until ! *e/ pa91 fev]1 high pulse or :atev] may be pres5t1 are well 9 h&1 al?\gh x may mean a long visit ) fairly frequ5t treatm5ts4 ,treat ! conditions exi/+ & wait2 !n treat aga9 & ! result w m ?an repay4 ,!re is always m ?an a *ance ( abort+ ! disease1 b ! fir/ treatm5t is (t5 ! crucial te/4 ,f4 ,e4 ,moore & _m o!rs report num]\s cases treat$ )\t a fatality & ! av]age duration ( ! disease n exce$+ five days4 ,! ap>tm5t %\ld be well air$ & a temp]ature ( #fe degrees ,f4 ma9ta9$4 ,9 ! v "y ! temp]ature %\ld be high]4 ,! diet is exce$+ly important4 ,give a liquid1 light & nutriti\s "o1 a milk diet be+ pref]able4 ,o!rwise give meat juice1 bro?s1 egg album9 & :ey4 ,avoid />*y & sac*>9e foods1 & give pl5ty ( wat]4 ,good nurs+ & complete re/ ( body & m9d1 ) c>eful att5tion to ! activity ( ! b[els1 kidneys & sk91 w indirectly aid ! clogg$ up lung fascia to p]=m its function & ha/5 an e>ly recov]y f ! disease4 ,9 epidemic =ms be p>ticul>ly vigilant 9 ! employm5t ( antiseptics4 ,bron*opneumonia 7,,cat>rhal ,,pneumonia7 ,def9ition4--,an inflammation ( ! m9ute bron*i & air vesicles4 ,! affection beg9s ) an inflammation ( ! capill>y bron*i1 :i* ext5ds to ! air vesicles4 ,! micrococcus lanceolatus1 /reptococcus pyog5es1 influ5za bacillus1 & /aphylococcus aureus et albus are ! pr9cipal excit+ micro-organisms4 ,o/eopa?ic ,etiology & ,pa?ology4--,! disease is mo/ preval5t among ! v "y & ! old1 & may be ei!r prim>y or second>y4 ,x may occur z a sequ5ce or 9 association ) measles1 diph!ria1 :oop+ c\gh & sc>let fev]4 ,exposure to cold1 impure air1 rickets & di>rhea are m>k$ pr$ispos+ causes 9 *ildr54 ,9 ! old1 debilitat+ affections & *ronic diseases are pr$ispos+ causes4 ,bron*opneumonia occurs sometimes z a complication 9 smallpox1 erysipelas1 typhoid fev] & influ5za4 ,! pr9cipal lesions f\nd ^u exam9ation are subdislocat$ ribs affect+ ! pulmon>y vasomotor n]ves4 ,! ?ird1 f\r? & fif? ribs are especially apt to be subdislocat$4 ,! muscles ?r\gh\t ! ?oracic region are g5]ally sev]ely contract$4 ,ano!r gr\p ( cases1 ! s-call$ aspiration or deglutition pneumonia1 are caus$ by ! inhalation ( food p>ticles or o!r sub/ances4 ,a less5$ s5sitiv5ess ( ! l>ynx 7z 9 comatose /ates7 may all[ small p>ticles ( food to rea* ! small] bron*i & produce inflammation1 :i* may ev5 cause suppuration & sometimes gangr5e4 ,cases are liable to occur aft] op]ations ab\t ! nose & m\?4 ,x is (t5 second>y to c>c9oma ( ! l>ynx & esophagus & aft] tra*eotomy & glosso-ph>yngeal palsy4 ,a s]i\s =m ( bron*opneumonia is caus$ by ! tub]cle bacillus4 ,pa?ologically1 bo? lungs are usually involv$ & become heavy4 ,on ! pleural surfaces1 especially at ! base1 sunk5 purpli% or slaty pat*es are notic$1 repres5t+ collaps$ lung tissue4 ,on section small1 project+ portions ( consolidation are se51 sep>at$ f ea* o!r by un9flam$ & collaps$ tissue4 ,! section ( lung tissue is ( a d>k r$di% color4 ,! t]m9al bron*i are fill$ ) t5aci\s1 purul5t mat]ial4 ,microscopically1 ! t]m9al bron*i & air cells are fill$ ) a plug ( exudation compos$ ( leucocytes & desquamat$ epi!lium4 ,! walls ( ! bron*i are swoll5 & conta9 _m leucocytes4 ,symptoms4--,! symptoms are frequ5tly m>k$ by ^? ( ! prim>y affection4 ,! onset may be ei!r abrupt or gradual4 ,! *ild becomes fev]i%2 !re is increas$ frequ5cy 9 respiration & !re is an aggravat$ c\gh4 ,! temp]ature rises to #ajb or #ajd degrees ,f42 respiration may rise z high z #fj or #hj4 ,! c\gh is h>d1 di/ress+1 frequ5tly pa9ful & accompani$ by a mucopurul5t expectoration4 ,! pulse is greatly accel]at$--#abj to #ahj p] m9ute4 ,z ! disease advances1 signs ( defici5t a]ation ( ! blood are notic$4 ,at fir/ !re is a pale & anxi\s expression ( ! face1 ! lips are blue & ! *ild makes /r5u\s ef=ts to brea!4 ,! blood soon becomes highly *>g$ ) c>bon dioxide &1 by its b5umb+ influ5ce ^u ! n]ve c5t]s1 s5sibility is r$uc$ & ! c\gh & suff]+ subside4 ,! face becomes livid & dea? may occur )9 tw5ty-f\r h\rs f p>alysis ( ! he>t4 ,at ! beg9n+ ( ! attack dullness is abs5t & subcrepitant & sibilant rales are pres5t4 ,areas ( consolidation soon become manife/$4 ,!re is slight impairm5t ( resonance & ! brea?+ is h>%4 ,^u inspection !re is1 9 grave cases1 retraction ( ! /]num due to defective expansion4 ,diagnosis4--,?is is usually easy1 develop+ z x g5]ally does 9 ! c\rse or at ! conclusion ( ano!r disease1 ) a gradual onset z a rule1 & irregul> fev] & a long duration1 besides usually occurr+ 9 *ildr5 "u five4 ,if ! areas ( consolidation are l>ge1 involv+ ! great] "p ( a lobe1 x is sometimes v difficult to di/+ui% bron*ial pneumonia f lob> pneumonia4 ,lob> pneumonia1 :5 occurr+ 9 *ildr51 is usually betwe5 ! ages ( five & fifte54 ,! onset is abrupt 9 a *ild ( good heal?2 x resolves rapidly2 !re is ru/y color$ sputum & cont9u$ fev] fall+ by crisis4 ,tub]cul\s bron*opneumonia is v h>d to diff]5tiate f simple bron*opneumonia4 ,a great _m cases c be correctly diagnos$ only aft] ! lapse ( consid]able "t4 ,! pres5ce ( signs ( s(t5+1 consid]able disease ( ! apices1 & exam9ation ( ! sputum1 or 9 ! case ( a *ild1 ( ! vomit$ matt]1 w\ld diagnose ?is =m4 ,if ela/ic fib]s & tub]cle bacilli are f\nd 9 ! sputum or vomit$ matt]1 ! diagnosis is at once decid$ 9 favor ( tub]cul\s bron*opneumonia4 ,x-ray diagnosis %\ld be consid]$4 ,prognosis4--,! prognosis dep5ds on ! cause4 ,9 *ildr5 t are previ\sly weak & debilitat$ ! disease is v fatal4 ,:5 ! disease foll[s measles & :oop+ c\gh1 ! fatality is n s great4 ,9 adults ! prognosis is ab\t ! same z 9 ! cr\p\s =m4 ,! deglutition v>iety is apt to be fatal4 ,treatm5t4--,a great deal c be done to prev5t ! disease1 by c>eful att5tion to debilitat$ *ildr5 9 keep+ !m w>m & protect$ at all times4 ,!re is usually a preexi/+ bron*itis4 ,9 measles & :oop+ c\gh & dur+ convalesc5ce1 ! *ild %\ld be well tak5 c>e (4 ,a ?or\gh1 p]si/5t treatm5t1 b n to a po9t ( ov]fatigue1 ( ! dorsal vasomotor n]ves po/]iorly %\ld be giv54 ,g5tle "w ov] ! c]vical & axill>y lymphatics to free ! edemat\s b>ri]1 correction ( ! t5s$ scal5i & d]ang$ fir/ ribs & clavicles1 & /imulation ( sple5 & liv]1 ) suffici5t g5]al treatm5t to />t reaction1 w be effective4 ,d]angem5ts to ! ?ird1 f\r? & fif? dorsal n]ves are mo/ likely to be f\nd2 ! pr9cipal vasomotor inn]vation to ! bron*ials & air vesicles is f ?is region4 ,treatm5t ov] ! *e/ ant]iorly is ( great aid1 especially an upw>d & outw>d manipulation to release ! ribs %\ld be giv54 ,att5tion %\ld be giv5 ! vagi n]ves to increase ! activity ( ! lungs z well z = ! effect ga9$ ^u ! circul> fib]s ( ! bron*i4 ,c>e %\ld be tak51 t ! fir/ rib is n imp++ ^u ! fir/ ?oracic ganglion1 or int]f]+ ) lymphatic dra9age4 ,ice-bags ov] ! *e/ are helpful4 ,! *e/ %\ld be protect$ f *anges 9 temp]ature by a jacket ( cotton batt+4 ,! diet %\ld consi/ ( milk1 egg album9 & bro?s4 ,keep ! temp]ature at ab\t #gj degrees ,f4 & ! air ( ! room moi/ & free f draughts4 ,:5 ! fev] is high1 spong+ or ! wet pack is helpful4 ,! b[els f ! beg9n+ ( ! attack %\ld be c>efully wat*$4 ,!re is dang] ( a fail+ he>t2 ?is is g5]ally associat$ ) muc\s rales & cyanosis4 ,d\*+ alt]nately ) hot & cold wat] w usually excite c\gh+ & ov]come ! difficulty4 ,! gradually cool$ ba? w h a m>k$ effect 9 r$uc+ ! temp]ature1 quiet+ ! n]v\s symptoms1 increas+ ! respiratory p[] & promot+ sleep4 ,raise & c>efully /imulate ! abdom9al visc]a1 & elevate ! diaphragm4 ,?is is effective 9 bo? cyanosis & toxemia4 ,9 ! fir/ /age ( pneumonia1 ,hazz>d#if says1 8,!re is bett] opportunity to correct ! specific lesion1 z ! pati5t's /r5g? w all[ ( su* treatm5t4 ,! "w is also aid$ by ! fact t ! alveoli are /ill op51 & lung action1 /imulat$ by treatm5t1 may become a valuable aid 9 dispell+ ! engorgem5t40 ,?is is a mo/ valuable sugge/ion1 b be exce$+ly c>eful 9 subsequ5t treatm5ts n to treat too h>d & ?us lame & bruise ! pati5t4 ,s]ies ,i1 ,,ii1 ,,iii1 & ,v ( ! ,am]ican ,o/eopa?ic ,association ,case ,reports pres5t sev]al int]e/+ cases ( pneumonia :i* typify ! importance ( imm$iate & direct correction ( ! o/eopa?ic lesions4 ,h]man#ig cites an int]e/+ case ( delay$ resolution1 due to a depress$ condition ( all ! ribs on ! affect$ side ) m>k$ luxation ( ! eigh?4 ,! lesion at ! eigh? 0 ! cause ( a prolong$ attack ( hicc\ghs :i* prev5t$ resolution4 ,x is po9t$ out t !re is an abundant int]co/al n]ve supply to ! diaphragm f ! eigh? & n9? int]co/als4 ,c4 ,e4 ,a*orn in/ances an autopsy ( pati5t dy+ ( pneumonia1 :]e a bony ankylosis 0 f\nd at ! second dorsal2 ?is lesion 0 probably an important pr$ispos+ factor4 ,broadly speak+1 "o %\ld keep 9 m9d ! foll[+3 ,fir/1 e>ly treatm5t w frequ5tly abort :at w\ld ultimately be pneumonia--/ill1 9 ! prec$+ x is n ^! cases t are especially ref]r$ to1 b ^? foll[+ ! c\rse ( a typical pneumonic process2 second1 bo? specific & g5]al treatm5t prior to ! crisis w mat]ially less5 ! sev]ity ( ! disease2 ?ird1 ! crisis corresponds to beg9n+ resolution 7dur+ resolution expectoration & liquefaction & absorption ( ! exudate are p>am\nt features7 & mu/ be met promptly & vigor\sly1 special att5tion be+ paid to ! he>t2 &1 f\r?1 dur+ convalesc5ce1 good1 g5]al att5tion & c>e ( pati5t z to treatm5t1 hygi5e1 diet1 & climate1 are important4 ,*ronic ,int]/itial ,pneumonia 7,,fibroid ,,induration7 ,def9ition4--,a *ronic1 inflammatory disease ( ! lungs1 *>act]iz$ by an ov]gr[? ( fibr\s or connective tissue4 ,etiology4--,) few exceptions *ronic affections ( ! lungs cause m or less fibroid ov]gr[?4 ,?is is especially frequ5t aft] bron*ial pneumonia & pulmon>y tub]culosis4 ,x is also excit$ by abscesses1 hydatids1 syphilis1 emphysema1 s>coma & old fibr9\s pleurisy4 ,x may also be caus$ by compression1 by aneurism or neoplasms4 ,x may arise z a prim>y affection1 due to ! inhalation ( irritat+ du/s 7/one du/1 coal du/ & metal du/74 ,!re w be f\nd deeply seat$ osse\s lesions ( ! upp] & middle dorsal region & correspond+ ribs1 & frequ5tly ( ! c]vical v]tebr4 ,pa?ologically1 z x involves limit$ or ext5sive areas1 x is recogniz$ z local or diffuse4 ,x is a unilat]al affection4 ,! involv$ portion is %runk5 & on section x is f\nd to be t\gh1 firm1 ( a gre5i% color & conta9+ an ov]gr[? ( fibr\s tissue4 ,if x affects ! left side ! he>t may be displac$4 ,! unaffect$ lung is usually enl>g$ 7comp5satory emphysema74 ,!re is hyp]trophy ( ! "r v5tricle ( ! he>t4 ,symptoms4--,!re is a *ronic c\gh1 :i* v>ies greatly 9 its sev]ity2 mod]ate dyspnea1 & a v>iable expectoration4 ,!re is no fev] & ! g5]al heal? ( ! pati5t may be pres]v$ = a numb] ( ye>s4 ,! expectoration is g5]ally copi\s1 muco- or s]o-purul5t1 r>ely fetid4 ,!re is retraction ( ! affect$ side1 displacem5t ( ! apex beat & lat]al curvature ( ! sp9al column4 ,! unaffect$ side is enl>g$4 ,! int]co/al spaces disappe>1 ! ribs sometimes ev5 ov]lapp+4 ,! tactile fremitus is g5]ally increas$1 b if ! pleural membrane is ?ick5$ ! fremitus may be decreas$4 ,!re is g5]ally impairm5t ( resonance4 ,a tympanitic or amphoric note may be he>d ov] a dilat$ bron*us4 ,on ! s\nd side ! p]cussion note is g5]ally hyp]resonant4 ,! brea?+ s\nds may be feeble4 ,!y may be bron*ial or cav]n\s1 b r amphoric4 ,late 9 ! disease c>diac murmurs are n uncommon4 ,diagnosis4--,?is is nev] difficult4 ,x is ma9ly to be di/+ui%$ f fibroid ph?isis4 ,9 ! latt] bo? lungs are involv$ & !re is fev] & bacilli are f\nd 9 ! sputum4 ,an ,x-ray exam9ation %\ld be made4 ,prognosis4--,! disease is exce$+ly *ronic & may la/ = _m ye>s4 ,dea? may result f gradual failure ( ! "r he>t1 hemorrhage or f int]curr5t attacks ( acute pneumonia involv+ ! o!r lung4 ,treatm5t4--,little c be done = ?is condition4 ,int]curr5t bron*itis may be some:at reliev$ by ! treatm5t = *ronic bron*itis4 ,! pati5t %\ld dwell 9 a mild climate4 ,hygi5ic surr\nd+s & nutriti\s food are indicat$4 ,some?+ c be done by attempt+ to correct ! condition ( ! ribs & v]tebr1 b ?is measure1 f ! nature ( ! disease1 is g5]ally palliative at be/4 ,conge/ion ( ! ,lungs ,conge/ion ( ! lungs may be active1 passive or hypo/atic4 ,! two =m] h p>ticul> o/eopa?ic significance1 ow+ to ! lesions involv$4 ,active conge/ion may result f viol5t physical ex]tion1 excessive alcoholic indulg5ce1 inhalation ( hot air or z a symptom 9 pneumonia & o!r pulmon>y affections4 ,!re is dyspnea & c\gh ) ru/y expectoration ( a fro?y nature4 ,!re may be abs5ce ( fev]4 ,b g5]ally a slight *ill foll[$ by mod]ate fev]1 pa9 9 side1 & c\gh are ! pr9cipal symptoms4 ,on p]cussion1 ! note is dull ) increas$ tactile fremitus & bilat]al involvem5t4 ,prognosis is good "u o/eopa?ic treatm5t1 b x mu/ be promptly met z x is usually a symptom ( ano!r disease4 ,treatm5t is ! same z 9 ! beg9n+ ( pneumonia4 ,passive conge/ion1 :5 n hypo/atic1 is me*anical & due to an imp$$ return ( blood to ! left he>t f mitral /5osis1 or regurgitation1 dilatation ( ! "r v5tricle & c]ebral disease4 ,! lungs are l>ge ) di/5d$ pulmon>y vessels ) v5\s blood 9 ! air spaces4 ,!re is dyspnea & c\gh1 ) blood-/reak$1 fro?y expectorations4 ,! treatm5t is prim>ily ( ! condition caus+ ! conge/ion1 b 9 addition ! upp] ribs %\ld be rais$ & ?or\gh treatm5t ( ! abdom5 & elevat+ ! diaphragm are b5eficial4 ,hypo/atic conge/ion results f a weak5$ he>t 9 exhau/ion1 infection or old age2 also f cont9u$ dorsal decubitus4 ,rheumatic fev]1 tub]culosis & o!r con/itutional diseases1 z well z organic gr[?s1 may pr$ispose4 ,! condition gives rise to a mild =m ( lob> pneumonia4 ,symptoms are n well def9$ & (t5 are n recogniz$4 ,!re may be slight dullness1 increas$ fremitus1 moi/ rales & o!r signs ( a v5\s engorgem5t4 ,9 treatm5t ! fir/ move is to *ange position ( ! pati5t & !n look aft] any und]ly+ cause4 ,o/eopa?ically1 foll[ treatm5t ( pneumonia4 ,9 all cases ( circulatory involvem5t ( ! lungs1 treatm5t to relax muscles or to adju/ v]tebr & rib lesions to ! vasomotor n]ves ( ! lungs is v efficaci\s4 ,l&ois 7#aijd7 says3 8,irritation ( s5sory n]ves1 p>ticul>ly if int5se & long cont9u$1 causes a dilatation ( ! vessels 9 ! areas inn]vat$ by !m40 ,edema ( ! ,lungs ,!re are two =ms ( edema1 collat]al & g5]al1 :i* foll[ an int5se conge/ion ) transudation ( s]um into ! air vesicles & int]/itial tissue4 ,! collat]al =m is localiz$ & usually appe>s 9 connection ) pneumonia1 pulmon>y inf>ction or abscess4 ,9 g5]al edema ! base ( ! lung is involv$ to a great] ext5t1 b ! :ole /ructure is affect$ & hydro?orax is g5]ally pres5t4 ,! cause ( edema is n well und]/ood1 b may result f a long l9e ( con/itutional diseases4 ,! symptoms are dyspnea1 c\gh ) copi\s1 blood-/reak$ sputum :i* is expell$ ) difficulty4 ,!re may be fev] 9 ! inflammatory type ) weak1 increas$ pulse4 ,dullness ov] ! affect$ area1 bron*o-vesicul> brea?+ & small liquid rales are audible4 ,! diagnosis mu/ l>gely be made ^u ! bilat]al dullness at ! base ( ea* lung & physical signs not$ above4 ,x-ray exam9ation w usually be ( value4 ,prognosis dep5ds on ! condition caus+ ! edema & treatm5t %\ld be direct$ to correct+ x4 ,frequ5tly edema is a t]m9al affection4 ,?is %\ld be foll[$ by o/eopa?ic treatm5t to free ! lungs ( ! effusion z outl9$ "u pneumonia1 especially relaxation ( ! upp] dorsal & c]vical muscles1 sep>ation ( ! upp] ribs & /imulation ( ! he>t4 ,,footnotes3 #ie ,yeo--,a ,manual ( ,m$ical ,treatm5t or ,cl9ical ,!rapeutics1 ,vol4 #a1 p4 #eig4 #if ,hazz>d--,practice ( ,o/eopa?y p4 #ia4 #ig ,h]man--,an ,unusual ,feature 9 a ,case ( ,pneumonia--,j\rnal ( ! ,am]ican ,o/eopa?ic ,association1 ,july #aijf4 7,?is ref]s to lob> pneumonia47 ,,diseases ,,( ,,! ,,pleura ,pleurisy ,def9ition4--,an inflammation ( "o or bo? pleural membranes4 ,v>ieties4--,etiologically1 x may be divid$ into prim>y & second>y pleurisy2 also1 into acute & *ronic pleurisy4 ,anatomically1 ! cases may be divid$ into dry pleurisy & pleurisy ) effusion 7s](ibr9\s1 purul5t1 hemorrhagic74 ,acute ,pleurisy 7,,fibr9\s ,,or ,,pla/ic ,,pleurisy7 ,! affection may be prim>y or second>y4 ,z an indep5d5t affection x is r>e4 ,x may foll[ exposure to wet & cold or x may be due to me*anical injury4 ,! disease may set 9 ) pa9 9 ! side1 slight fev] & ! friction s\nd ( pleurisy may be pres5t4 ,^! symptoms la/ a few days & !n disappe> & no exudation occurs4 ,! pleural surfaces become m or less unit$4 ,z a second>y process1 dry pla/ic pleurisy arises f ext5sion ( ! inflammation 9 acute or *ronic diseases ( ! lung1 especially pneumonia4 ,abscesses1 gangr5e & canc]s are also causes4 ,x sometimes occurs 9 acute articul> rheumatism1 & 9 a l>ge numb] ( cases is associat$ ) tub]culosis4 ,?is condition may be a complication 9 *ronic ,bright's disease & 9 *ronic alcoholism4 ,9 ! fibr9\s =m ( pleurisy ! s]um is scant & ! membrane is cov]$ ) a %ea?+ ( lymph1 :i* f9ally organizes & adhesion takes place betwe5 ! oppos+ surfaces4 ,s](ibr9\s ,pleurisy ,?is =m is kn[n z pleurisy ) effusion4 ,!re is little lymph1 ! exudate be+ ma9ly compos$ ( s]um4 ,o/eopa?ic ,etiology & ,pa?ology4--,_m cases rapidly foll[ exposure to cold1 wet or an injury to ! ?orax4 ,exposure to cold is consid]$ a m]e pr$ispos+ ag5t1 p]mitt+ ! action ( v>i\s micro-organisms4 ,! l>ge majority ( cases are due to tub]cul\s infection ( ! pleura4 ,! o/eopa? f9ds t important pr$ispos+ causes ( pleurisy are injury to ! *e/ wall1 ribs & v]tebr1 & exposure to cold1 caus+ contraction ( ! ?oracic muscles4 ,^! injuries & /ra9s ?r\gh\t ! *e/ result 9 an int]f]5ce ) ! int]co/al & phr5ic n]ves1 & also ) ! int]co/al & int]nal mamm>y art]ies2 consequ5tly1 !re is produc$ a l[]$ vitality ( ! pleural tissues1 :i* p]mits ! attack ( ! micro-organisms4 ,x may be second>y to rheumatism1 ,bright's disease1 canc] & cirrhosis ( ! liv]4 ,pa?ologically1 !re is an abundant exudation ( s]um4 ,fibr9 is f\nd on ! pleura1 & is r>ely abundant 9 ! s]\s fluid 9 ! =m ( flocculi4 ,! fluid is /raw color$ z a rule4 ,x v>ies greatly 9 quantity f "o-half to f\r litres4 ,microscopically1 !re are f\nd leucocytes1 r$ blood-corpuscles1 %r$s ( fibr9 & occasionally *ole/]91 uric acid & sug>4 ,! composition ( ! fluid resembles blood s]um1 & is ri* 9 album94 ,v>i\s displacem5ts ( ! adjac5t organs are caus$ by ! effusion4 ,! lung is m or less compress$ into ! back "p ( ! pleural sac4 ,! he>t is displac$4 ,! diaphragm may be cr[d$ d[nw>d4 ,on ! "r side ?is l[]s ! liv]2 on ! left x displaces ! /oma*1 transv]se colon & sometimes ! sple54 ,symptoms4--,! onset may be abrupt ) a *ill1 sev]e pa9 9 ! side & fev]4 ,) few exceptions ! disease comes on insidi\sly1 pa9 9 ! side be+ ! fir/ symptom4 ,! pa9 is %>p & cutt+ & is aggravat$ by brea?+ or c\gh+4 ,!re is mod]ate fev]1 ! temp]ature rang+ f #ajb to #ajc degrees ,f4 ,dyspnea may be pres5t at ! onset4 ,?is is due to ! fev] & pleuritic pa94 ,:5 ! fluid is effus$ sl[ly1 dyspnea may be abs5t except on ex]tion4 ,x is mo/ m>k$ :5 ! effusion has develop$ rapidly4 ,z ! effusion accumulates & ! inflam$ surfaces sep>ate1 ! pa9 dim9i%es &1 z a rule1 soon disappe>s4 ,physical ,signs4--,immobility & bulg+ ( ! affect$ side1 dep5d+ on ! am\nt ( exudation4 ,! int]co/al spaces are oblit]at$4 ,! apex beat ( ! he>t is displac$4 ,^u palpation ! limit$ movem5t ( ! *e/ is m accurately det]m9$4 ,tactile fremitus is l>gely dim9i%$4 ,! position ( ! he>t's impulse c be readily locat$ by palpation4 ,displacem5ts ( ! liv] & sple5 c be felt ?r\gh ! abdom9al walls4 ,at fir/ ! p]cussion notes are impair$ & lat] !re is dullness :i* gradually rises z ! fluid increases4 ,! upp] l9e ( dullness is n horizontal :5 ! pati5t is 9 ! erect po/ure1 b is high] beh9d ?an 9 front4 ,above ! effusion 9 ! sub-clavicul> region1 p]cussion gives a tympanitic note1 ! s-call$ ,skoda's resonance4 ,9 mod]ate effusions ! level ( dullness (t5 *anges ) ! position ( ! pati5t4 ,e>ly 9 ! disease a friction rub c usually be he>d4 ,z ! fluid accumulates1 ! brea? s\nds become weak1 di/ant & may h a tubul> or bron*ial quality4 ,vocal resonance is usually less5$4 ,!re may be bron*ophony1 or x may manife/ a nasal or metallic quality1 resembl+ some:at ! bleat+ ( a goat 7,lnnec's egophony74 ,x-ray exam9ation %\ld be made4 ,duration4--,! c\rse is extremely v>iable4 ,! fev] is due to inflammation & may la/ = two or ?ree weeks1 :5 x may subside4 ,! c\gh & pa9 disappe> & ! effusion1 :i* is usually slight 9 ^! cases1 may be absorb$ quickly4 ,9 cases :]e ! effusion is p\r$ out rapidly x may be absorb$ j z quickly4 ,9 cases :]e ! effusion is p\r$ out sl[ly or :]e ! effusion rea*es z high z ! f\r? rib1 recov]y is usually sl[]4 ,l>ge effusions may p]si/ )\t *ange = mon?s & f9ally ! case may become subacute or *ronic4 ,?is is p>ticul>ly true ( tub]cul\s cases4 ,prognosis4--,?is dep5ds l>gely ^u ! cause2 on ! :ole1 prognosis is favorable4 ,dea? is a r>e t]m9ation ( s](ibr9\s effusion2 dea? may1 h[ev]1 occur sudd5ly )\t suffici5t lesions to expla9 ! cause4 ,! exudate may become purul5t4 ,treatm5t ( ,acute ,pleurisy ,an e>ly treatm5t & re/ 9 b$ ) a liquid diet are ! measures to be employ$ at ! beg9n+ ( ! attack4 ,pay p>ticul> att5tion to any prim>y disease & to ! g5]al heal?4 ,r>ely is !re any difficulty 9 locat+ c]ta9 pr$ispos+ causes ( ! di/urbance4 ,!n (t5 a rib or correspond+ v]tebra is badly subdislocat$ ov] ! seat ( ! disease4 ,! sympa!tic & phr5ic n]ves are involv$ ?r\gh ! int]co/al & phr5ic n]ves4 ,a c>eful exam9ation ( ! side ( ! affect$ *e/ %\ld be made1 z !re may be m or less ob/ruction ( ! int]co/als & ! int]nal mamm>y art]ies f _! bran*+ ( ! aorta & subclavian vessels4 ,a dislocation ( ! fir/ or second rib may affect ! subclavian vessels & _! bran*es m>k$ly2 al?\gh all ! upp] ribs & ! ?oracic muscles %\ld be exam9$ c>efully = d]angem5ts :i* w\ld affect ^! blood-vessels & produce an exudation4 ,ice-bags ^u ! *e/1 z 9 pneumonia1 may be us$4 ,limit+ ! movem5ts ( ! *e/ ) a b&age or adhesive /rips w give consid]able relief4 ,:5 ! effusion has tak5 place1 c>efully rais+ & spread+ ! ribs ) att5tion to special po9ts ( involvem5t1 w at times cause absorption ( ! fluid4 ,! daily am\nt ( liquid food %\ld be greatly less5$ ) a view ( deplet+ ! blood s]um f v>i\s tissues2 ?us ! s]um collect+ 9 ! pleura1 :i* is a lymph space1 w also be absorb$4 ,treatm5t ( ! b[els1 kidneys & sk91 s t !y may be r5d]$ active1 w aid 9 ! depletion ( ! blood s]um4 ,x may be necess>y 9 "s cases to aspirate1 especially if o!r me?ods fail & if ! effusion is l>ge4 ,! po9ts ( op]ation are 9 ! mid-axill>y l9e at ! six? int]space or at ! angle ( ! scapula at ! eigh? int]space4 ,9 punctur+1 ! ne$le %\ld be held close to ! m>g9 ( ! upp] rib s z to avoid ! int]co/al art]y4 ,)draw ! fluid sl[ly & if fa9tness is produc$1 desi/4 ,empyema %\ld be treat$ surgically4 ,simply tapp+ is r>ely suffici5t4 ,a free incision1 z 9 abscess1 & ?or\gh dra9age %\ld be made4 ,c>e mu/ be tak5 t ! dra9age tube is l>ge en\gh4 8,9 cases ( pleurisy ! axilla & ! inn] arm may be t5d] & pa9ful2 ?is is due to ! pleuritic inflammation be+ c>ri$ by ! way ( ! #8n]ve ( ,wrisburg4' 8,! pleuritic pa9 9 ! co/al muscles compels re/rict$ movem5t ( ! ribs & also limits ! respiratory function ( ! diaphragm4 ,^! pa9ful cramps & /it*es are indep5d5t ( ! pa9 aris+ alone f ! inflam$ pleural surface1 & ! dim9ution ( ! respiratory movem5ts is due to a p>ticul>ly contractur$ /ate ( ! muscles ( ! *e/ z is demon/rat$ by ! fact t ! pati5t c n draw a long brea?2 h5ce "o may reasonably conclude t nature has s di/ribut$ n]ves to ! pleura z to enable t s]\s membrane to control ! muscles :i* create movem5ts ( ! adjac5t co/al surfaces & ?us insure its quietude dur+ ! /ages ( inflammation or repair40 7,ranney74 ,*ronic ,pleurisy ,def9ition4--,*ronic inflammation ( ! pleural lay]s4 ,!re are two =ms1 exudative & dry or pla/ic pleurisies4 ,*ronic ,pleurisy ) ,effusion4--,?is may foll[ an acute s](ibr9\s type4 ,"s cases develop v sl[ly4 ,9 mo/ cases 9 *ildr51 ! fluid *anges to pus e>ly 9 ! disease4 ,! fluid may rema9 = mon?s )\t *ang+ to a purul5t "*4 ,9 su* cases ! "* & physical signs d n diff] f ^? 9 acute s](ibr9\s pleurisy4 ,*ronic ,dry ,pleurisy4--,^! cases orig9ate 9 two ways3 ,fir/1 ?is may succe$ pleural effusion :5 ! fluid portion ( ! exudate is absorb$ & ! pleural lay]s are oppos$4 ,!y are sep>at$ only by fibr9\s elem5ts t become organiz$ into firm connective tissue4 ,?is process goes on at ! base1 pr9cipally1 :i*1 if x foll[s ! acute =m1 produces b slight flatt5+1 b if x succe$s ! *ronic =m or empyema1 ! ext5t ( retraction & flatt5+ w be m>k$4 ,calcification may occur 9 ^! firm1 fibr\s membranes & occasionally little p\*es ( fluid are f\nd betwe5 ! false b&s4 ,second1 a l>ge numb] ( cases are dry f ! onset4 ,?is condition may foll[ directly acute pla/ic pleurisy4 ,x may be ( tub]cul\s orig9 or x may set 9 )\t any acute symptoms4 ,no matt] h[ slight ! pla/ic exudate may be1 x inv>iably t5ds to become organiz$1 ?us produc+ adhesion ( ! lay]s4 ,?is is und\bt$ly ! result :5 ! pleurisy is prim>y or second>y4 ,! adhesions are g5]ally circumscrib$4 ,:5 ! adhesions are ( tub]cul\s orig9 !y may be locally conf9$ to "o pleura or !y may be bilat]al4 ,9 ^! cases bo? ! p>ietal & co/al lay]s are ?ick5$1 & embodi$ 9 ! ?ick5$ pleura are f\nd firm fibr9 masses & small tub]cles4 ,occasionally1 vasomotor symptoms arise 9 *ronic pleurisy1 especially 9 cases ( tub]cul\s orig91 & are probably due to ! involvem5t ( ! fir/ ?oracic ganglion4 ,^! almo/ inv>iably mean t !re is a displacem5t ( ! fir/1 second1 or ?ird rib4 ,unilat]al flu%+ or sweat+ ( ! face or dilatation ( ! pupil are frequ5tly noticeable4 ,symptoms4--,def9ite symptoms are r>ely pres5t4 ,9 "s cases ! physical signs are q pron\nc$1 :ile1 on ! o!r h&1 !y may be entirely negative4 ,9 mild cases !re may be slight immobility ( ! affect$ side ) feeble brea? s\nds4 ,9 o!r cases !re may be v full *e/ expansion :ile ! brea? s\nds are feeble4 ,9 a l>ge numb] ( in/ances ! physical signs are q di/9ct4 ,!re is displacem5t ( ! visc]a1 retraction ( ! *e/ walls1 curvature ( ! sp9al column & dropp+ ( ! %\ld]s4 ,!re are feeble brea?+ & creak+1 lea!ry friction s\nds4 ,dullness is f\nd at ! base4 ,treatm5t4--,! treatm5t ( *ronic pleurisy is l>gely t ( acute pleurisy4 ,gymna/ic & me?odical brea?+ ex]cises %\ld be employ$ 9 help+ to correct ! ?oracic walls4 ,c>e mu/ be tak5 n to injure ! *e/ & pleura if adhesions h =m$4 ,surgical "w may be necess>y 9 "s cases4 ,! vasomotor symptoms t are sometimes manife/$ 9 *ronic pleurisy & are claim$ to be due to involvem5t ( ! fir/ ?oracic ganglion1 are an int]e/+ feature to ! o/eopa?4 ,su* cases w\ld probably pres5t to ! o/eopa? a m>k$ lesion ( ! upp] dorsal v]tebr or ! second or ?ird rib4 ,^! vasomotor symptoms are also f\nd 9 pleurisy associat$ ) tub]culosis ( ! apex ( ! lung4 ,! o/eopa? frequ5tly treats ^! cases & he %\ld be cauti\s ab\t ov]-treat+ or /ra9+ ! *e/ wall4 ,! adhesions are p]si/5t & (t5 !re is m or less pa91 s c>e mu/ be ex]cis$ :5 attempt+ to /ructurally readju/4 ,d n expect to completely relieve e case1 b nev]!less !re are few cases b t c be b5efit$4 ,occasionally ! pa9 alone is due simply to pleurodynia4 ,,diseases ,,( ,,! ,,ur9>y ,,sy/em ,diseases ( ! ,kidneys 7,,r5al ,,hyp]emia7 ,def9ition4--,an increase 9 ! am\nt ( blood to ! vessels ( ! kidney4 ,x is active hyp]emia :5 !re is art]ial conge/ion1 passive hyp]emia :5 !re is v5\s conge/ion4 ,o/eopa?ic ,etiology & ,pa?ology4--,active hyp]emia may be caus$ by injuries to ! r5al splan*nics1 especially ! t5? to twelf? dorsal segm5ts2 injuries ov] & to ! kidneys2 exposure to cold :5 ! body is v w>m2 poison giv51 z diuretics2 eruptive fev]s & pregnancy1 or foll[ g5ito-ur9>y op]ations4 ,passive hyp]emia may be caus$ by ob/ructive diseases ( ! g5]al circulation1 z *ronic he>t1 lung & liv] diseases1 or by pressure on ! r5al ve9s by tumors1 gr[?s & ! pregnant ut]us4 ,?rombosis ( ! r5al ve9s may produce passive hyp]emia1 b r>ely4 ,pa?ologically1 9 active hyp]emia ! kidney is swoll5 & slightly enl>g$4 ,^u removal ( ! capsule1 ! kidney is f\nd to be br[n & mottl$4 ,on section ! p>ts ble$ freely1 ! ,malpighian bodies are di/5d$1 & microscopical exam9ation %[s a cl\dy swell+ ( ! r5al epi!lium4 ,9 passive hyp]emia ! kidney is swoll51 h>d1 firm & ( a blui% r$ color4 ,lat] !re is an ov]gr[? ( connective tissue & "s infiltration betwe5 ! tubules4 ,! ,malpighian bodies occasionally become %rivel$ & ! r5al epi!lium fatty4 ,symptoms4--,9 active hyp]emia ! ur9e is scanty1 ( high specific gravity & ( high color1 conta9+ "s album9 & ca/s4 ,pa9 is exp]i5c$ ov] ! lo9s1 foll[+ ! c\rse ( ! uret]s1 & ! bladd] is irritable4 ,!re are heada*e1 nausea & vomit+4 ,:5 f infection1 fev] may be pres5t4 ,9 passive hyp]emia ! symptoms are prim>ily ^? caus$ by ! disease produc+ ! disord]4 ,!re is weight ov] ! lo9s & dropsy4 ,! ur9e is dim9i%$1 ( high specific gravity1 highly color$1 album9\s & occasionally %[s a few hyal9e ca/s4 ,prognosis4--,active hyp]emia4--,usually favorable if x c be treat$ 9 "t4 ,if prolong$1 acute nephritis may develop4 ,passive hyp]emia4--,dep5ds on ! cause4 ,if ! disease is prolong$1 x t]m9ates 9 int]/itial nephritis4 ,treatm5t4--,active hyp]emia4--,absolute re/ & ?or\gh treatm5t to ! r5al splan*nics & treatm5t ov] ! abdom5 to ! kidneys directly by c>efully rais+ !m4 ,adju/ ! l[] ribs if f\nd lesion$4 ,wat] %\ld be drunk lib]ally & ! pati5t enc\rag$ to use vapor ba?s4 ,favorable hygi5ic surr\nd+s1 w>m? & good food are indisp5sable4 ,w>m applications ov] ! lo9s are helpful4 ,passive hyp]emia4--,! treatm5t l>gely dep5ds ^u ! cause1 b too mu* importance _c be giv5 to ! treat+ ( ! vasomotor fib]s ( ! kidneys f ! eigh? dorsal to ! fir/ lumb>4 ,textbooks /ate t ! vasomotor fib]s to ! kidneys are f ! n9? to ! twelf? dorsal v]tebr1 inclusive1 b o/eopa?ic exp]i5ce %[s we c affect vasomotor fib]s slightly high]4 ,treatm5t "h has a di/9ct effect on ! blood pressure )9 ! glom]uli4 ,! r5al epi!lium is extremely s5sitive to circulatory *anges4 ,ev5 ! compression ( a r5al art]y = only a few m9utes causes m>k$ di/urbances4 ,h5ce any irritation or ob/ruction to ! vasomotor inn]vation ( ! r5al blood-vessels may result 9 s]i\s conditions4 ,! sup]ior c]vical ganglion ( ! sympa!tic & ! sciatic c5t] h important be>+ on ! secretions ( ! kidney1 ?r\gh vasomotor fib]s4 ,due att5tion %\ld be paid to ! b[els1 & ! pati5t requir$ to take pl5ty ( re/ & a light diet4 ,acute ,p>5*ymat\s ,nephritis 7,,acute ,,bright',s ,,disease7 ,def9ition4--,an acute1 inflammatory process affect+ ! epi!lium ( ! ur9if]\s tubules & due to ! action ( cold or toxic ag5ts ^u ! kidneys1 z well z to injuries to ! r5al splan*nics2 is *>act]iz$ by c]ta9 n]v\s symptoms ) fev]1 dropsy1 & scanty & highly color$ ur9e4 ,?is inflammation involves m or less ! :ole kidney4 ,o/eopa?ic ,etiology & ,pa?ology4--,?is disease is caus$ by exposure to cold & wet :ile ! body is w>m & p]spir+4 ,excessive use ( alcohol may be a factor4 ,may be caus$ also by infecti\s diseases1 su* z sc>let fev]1 diph!ria1 measles1 smallpox1 acute tub]culosis & o!rs2 also by c]ta9 specific poisons :i* are elim9at$ by ! kidneys1 z turp5t9e1 *lorate ( pota%1 c>bolic acid1 phosphorus1 g+]1 can?>ides & oil ( mu/>d2 also by pregnancy1 z ?is is suppos$ to compress ! r5al ve9s1 or ?r\gh toxic ag5ts4 ,syphilis may be an und]ly+ cause4 ,bl[s & injuries to ! back at ! t5?1 elev5? & twelf? dorsals are frequ5tly ! cause4 ,lesions are f\nd f ! six? dorsal to ! f\r? lumb>4 ,! l[] ?ree ribs may be at fault1 :ile ! innom9ate & muscul> contractions h be5 f\nd to be pa?ological factors4 ,lordosis may be a contribut+ cause4 ,l\don places consid]able importance on c]vical lesions & ,mc,connell believes vasomotor di/urbance plays an important causative role 9 ! disease4 ,pa?ologically1 at times ! kidney alt]ation may be s slight z n to be recognizable by ! nak$ eye1 ! appe>ance v>y+ accord+ to ! /age & sev]ity ( ! disease4 ,! kidneys become enl>g$1 engorg$ & ( a bright r$ color1 & lat] h a mottl$ appe>ance2 & :5 ! capsule1 :i* is non-adh]5t1 is /ripp$ (f1 ! kidney is f\nd to be s(t & inela/ic4 ,9 mo/ ( ! cases 9 :i* ! disease is due to toxic ag5ts br\ght to ! kidney ?r\gh ! blood-vessels1 ! glom]uli suff] fir/4 ,! epi!lium ( ! glom]uli & tubules is ! seat ( cl\dy swell+ &1 9 ! lat] /ages1 ( fatty *ange & hyal9e deg5]ation4 ,! tubules are clogg$ by alt]$ cells1 leucocytes & blood-corpuscles4 ,9 mild cases ! int]/itial tissue is simply inflam$1 b 9 all cases x becomes m or less mix$ ) leucocytes & r$ blood-corpuscles4 ,o/eopa?ic lesions produc$ ^u animals 9 ! region ( ! n9? to ! twelf? dorsal1 result$ 9 acute nephritis4 ,! autopsy f9d+s 7 di/9ctly typical4 ,symptoms4--,! onset is usually sudd51 ) mod]ate fev]1 pa9 9 ! back 9 ! lumb> region & ov] ! kidneys & foll[+ ! uret]s4 ,nausea & vomit+ may be pres5t4 ,dropsy soon appe>s1 beg9n+ ) slight swell+ or puff9ess 9 ! face bel[ ! eyes1 lat] %[+ itself 9 edema ( ! abdom9al walls & extremities4 ,uremic symptoms may develop4 ,! ur9e is *>act]i/ic2 is dim9i%$ 9 quantity & ( high specific gravity2 at fir/ ! s$im5t is copi\s & r$di% br[n 9 color1 becom+ less 9 am\nt & ( high color4 ,?is s$im5t conta9s ca/s ( ! ur9if]\s tubules1 free blood1 epi!lial cells1 uric acid & urates4 ,!re are l>ge quantities ( album9 9 ! ur9e4 ,! pres5ce ( album9\s matt] 9 ! ur9e1 ev5 9 l>ge quantities1 is n suffici5t evid5ce to w>rant a diagnosis ( ,bright's disease nor is ! am\nt a guide z to ! sev]ity ( ! case1 = grave conditions (t5 %[ a slight am\nt 7,l\don74#ih ,diagnosis4--,! g5]al symptoms may be v slight1 = ! mo/ sev]e cases may manife/ slight edema ( ! feet1 or !re may be only ! puff9ess "u ! eyes & ( ! eyelids4 ,9 su* cases ! diagnosis mu/ dep5d ^u exam9ation ( ! ur9e4 ,) previ\s hi/ory1 sudd5ness ( ! attack & "* ( ! ur9e1 ord9>ily ! diagnosis w be q easy4 ,prognosis4--,al?\gh ?is disease is g5]ally grave1 ! prognosis is favorable & ! majority ( cases recov] "u judici\s treatm5t4 ,treatm5t4--,cases ( acute nephritis require re/1 quiet & w>m?4 ,_m cases recov] "u ^! conditions alone4 ,x is absolutely necess>y1 h[ev]1 t ^! conditions exi/ no matt] :at o!r treatm5t is us$4 ,a ?or\gh treatm5t to ! r5al splan*nics _c be ov]e/imat$ = x is "h 7t5? to twelf? dorsal1 inclusive7 t a majority ( ! lesions produc+ acute nephritis occur4 ,besides correct+ ! v]tebral & rib displacem5ts 9 ?is region1 a v effective treatm5t is to h ! pati5t lie flat ^u ! back & !n ! o/eopa?1 rea*+ ar\nd ! pati5t ) ! f+]s ( "o h& on ei!r side ne> ! sp9es ( ! l[] dorsal v]tebr1 raise ! pati5t s t ! entire body1 except ! %\ld]s & ! feet1 are lift$ cle> ( ! b$4 ,?us ! treatm5t spr+s ! sp9e ant]iorly & produces a m>k$ effect ^u ! kidneys ?r\gh ! r5al vasomotor n]ves4 ,occasionally lesions 9 ! upp] c]vical region int]f]e ) ! normal activity ( ! r5al n]ve fib]s pass+ to ! kidneys by way ( ! sup]ior c]vical ganglion ( ! sympa!tics4 ,ano!r v effectual treatm5t = ! kidneys is treat+ !m ?r\gh ! abdom5 by a c>eful pressure ^u ! kidneys ?r\gh ! abdom5 on ei!r side ( ! umbilicus1 ?us lightly work+ ea* kidney outw>d & upw>d4 ,?is treatm5t relaxes any tissues ab\t ! blood-vessels1 n]ves & lymphatics to & f ! kidneys t may be contract$ & ?us aids 9 e/abli%+ a normal activity ( ! involv$ organs4 ,x also helps 9 relax+ tissues ab\t ! uret]s & prev5ts ! clogg+ up ( ! latt] ) debris4 ,b&el & ,/e>ns report cases 9 :i* an impact$ colon 0 an important factor 9 ?is p>ticul>4 ,! above means h = _! object ! direct relief ( ! conge/ion ( ! kidney4 ,?is is fur!r aid$ by keep+ ! b[els active1 :i* supplem5ts ! action ( ! kidneys1 & by increas+ ! activity ( ! sk94 ,?is also aids 9 reliev+ dropsical effusions4 ,! hot pack1 9 :i* ! pati5t is wrapp$ 9 a wet %eet & !n cov]$ by a numb] ( blankets1 is an exce$+ly good me?od to relieve ! kidneys ( "s ( ! "w & less5 _! conge/ion1 besides arre/+ uremic intoxication4 ,?is c be repeat$ daily if necess>y4 ,:]e !re is dropsy & scanty ur9e1 ! indications are to increase ! secret+ action ( ! kidney2 besides treatm5t ?r\gh ! r5al splan*nics1 :i* conta9 ! vasomotor n]ves ( ! kidneys1 /imulat+ treatm5t to ! vagi w help to increase ! ur9>y secretion4 ,hot fom5tations1 plac$ directly ov] ! region ( ! r5al splan*nics1 is a valuable aid 9 cases :i* d n respond quickly to o/eopa?ic /imulation4 ,treatm5t ( ! liv] is important4 ,injections ( cold wat] into ! inte/9es w t5d to /imulate ! secretion ( ! kidneys1 b ?is %\ld be us$ ) ! greate/ caution2 9 "s cases tepid wat] w\ld be bett] 7see uremia74 ,! diet ( ! pati5t ) acute nephritis is important4 ,give food t is easy ( dige/ion & :i* conta9s a m9imum am\nt ( nitrog54 ,! /oma* is q likely to be irritable1 consequ5tly food t is adapt$ to x %\ld be select$4 ,milk & weak animal bro?s are und\bt$ly ! be/ foods4 ,! return to a solid diet1 especially ( meat1 %\ld be v sl[4 ,suitable adjuvants to ! milk diet are rice & f>9ace\s prep>ations4 ,l\don#ii recomm5ds complete )drawal ( all foods = tw5ty-f\r to =ty-eight h\rs & ! r$uc+ ( nitrog5\s foods to a m9imum2 a diet ( milk & cream aft] ! fa/1 foll[$ by c]eals & bro?s1 !n eggs & fi% until album9 disappe>s f ! ur9e4 ,alkal9e m9]al wat]s are useful to help ma9ta9 an alkal9e ur9e1 ?us t5d+ to )draw exudates4 ,! pati5t %\ld be treat$ daily at fir/ & lat] on e o!r day1 = case reports %[ frequ5t treatm5ts ha/5 recov]y4 ,= treatm5t ( acute uremia 9 ,bright's disease1 see uremia4 ,complications %\ld be treat$ z affections indep5d5t ( ! r5al disord]4 ,*ronic ,p>5*ymat\s ,nephritis ,def9ition4--,a *ronic inflammation ( ! kidney1 involv+ ! epi!lium1 glom]uli & int]/itial tissue1 *>act]iz$ by dropsy1 increas+ anemia1 album9\s ur9e & acute uremia4 ,o/eopa?ic ,etiology & ,pa?ology4--,x may be ! result ( acute nephritis4 ,x foll[s ! same diseases z already m5tion$ 9 acute nephritis4 ,m (t5 x foll[s ! same diseases z already m5tion$ 9 ! acute =m1 syphilis1 tub]culosis1 purul5t conditions1 focal infections 7/reptococcus71 alcohol1 sc>lat9a & pregnancy contribut+ ! great] numb]4 ,x is m common 9 ! male sex & 9 e>ly adult life4 ,habitual exposure to cold & dampness2 *ronic lesions ( ! sp9e1 *iefly 9 ! l[] dorsal region1 are causative factors4 ,pa?ologically1 ! l>ge :ite or a yell[i% :ite kidney is ! mo/ common kidney lesion4 ,9 ?is =m ! kidney is enl>g$1 (t5 to twice its normal size1 is smoo?1 & ! capsule v ?94 ,! tubes1 on microscopic exam9ation1 are f\nd to be *ok$ ) brok5 d[n granulat$ epi!lium & fibr9\s ca/s4 ,! capill>ies %[ hyal9e *anges4 ,! int]/itial tissue is increas$ ev]y:]e1 b n to an extreme degree4 ,cat>rhal swell+ & hyp]emia 7to a slight degree7 are f\nd 9 ! pelvis ( ! kidney4 ,9 ! second /age--t ( ! small :ite kidney--!re is a r$uction 9 ! size ( ! organ1 due to ! de/ruction ( ! r5al epi!lium & ! contraction ( ! ov]gr[n connective tissue4 ,"s hold t ?is may be a prim>y1 indep5d5t =m & n always prec$$ by ! l>ge :ite kidney4 ,! organ is pale 9 color1 r\gh & granul>1 ! capsule be+ ?ick5$ & some:at adh]5t4 ,!re is an accumulation ( fatty epi!lium 9 ! convolut$ tubules1 con/itut+ m>k$ areas ( fatty deg5]ation & giv+ ! organ a :ite or :iti% yell[ appe>ance4 ,x is ?is :i* gives ! "n ( small granul> fatty kidney to ?is =m4 ,!re are ext5sive int]/itial *anges1 deg5]ation ( tubules & de/ruction ( great numb]s ( ! glom]uli4 ,*ronic hemorrhagic nephritis is a v>iety associat$ ) ?is /age4 ,! organ is enl>g$1 & scatt]$ ?r\gh\t ! cortex are f\nd br[n hemorrhagic foci due to hemorrhages into & ab\t ! tubes4 ,o!rwise ! *anges are simil> ) ^? f\nd 9 ! fir/ =m4 ,symptoms4--,x usually beg9s z a *ronic affection & ! symptoms sl[ly become app>5t4 ,fail+ heal? & loss ( /r5g?1 dyspepsia & anemia1 waxy appe>ance ) puff9ess ( ! face1 dropsy & increas$ art]ial t5sion ) hyp]trophy ( ! left v5tricle1 gradually make _! appe>ance4 ,uremic symptoms are common1 :ile dropsy is m>k$ & p]si/5t4 ,vomit+ & sometimes pr(use di>rhea occur2 9 fatal cases !re is sometimes f\nd to be ulc]ation ( ! colon4 ,! ur9e1 z a rule1 is dim9i%$ 9 quantity1 is (t5 v scanty1 al?\gh x is frequ5tly normal 9 color & appe>ance4 ,!re is an abundance ( album91 heavy s$im5t1 hyal9e & granul> tube ca/s1 epi!lium f ! kidneys & pelvis1 leukocytes & (t5 r$ blood-corpuscles4 ,if fatty deg5]ation takes place1 !re w be fatty ca/s & oil globules4 ,9 ! lat] /ages ! ur9e is abundant1 l[ specific gravity1 consid]able album91 & _m ca/s4 ,diagnosis4--,9 ! inflammatory /age1 :]e !re is enl>gem5t ( ! kidney1 extreme pallor1 scanty ur9e1 album91 & tube ca/s1 hi/ory ( infections1 pregnancy1 or exposure to cold & wet1 & lesions 9 ! l[] dorsal region1 ! diagnosis is cle>4 ,prognosis4--,always give a gu>d$ prognosis2 relapses are frequ5t1 b cases h be5 cur$4 ,!re is always a t5d5cy = ! sub*ronic =ms to become *ronic4 ,treatm5t4--,! treatm5t requires p]si/5t "w1 especially ov] ! r5al splan*nics1 & /rict att5tion on ! "p ( ! pati5t to hygi5ic pr9ciples4 ,! l[] dorsal lesions are v apt to be refractory ow+ to ext5sive fibrotic *anges ( ! deep muscles & capsul> ligam5ts4 ,b repeat$ ef=t w usually secure results4 ,c>e %\ld be tak5 z to exposure to cold & ov]ex]tion4 ,! quality ( ! blood %\ld be improv$1 z x is anemic & conta9s v>i\s toxic products4 ,/rict att5tion %\ld be paid to ! diet4 ,iron is l>gely us$ = anemic conditions1 b ?is pr9ciple we hold to be wrong4 ,x is n m iron t is want$1 b an ability ( ! sy/em to assimilate ! iron :i* x has4 ,relative to diuretics von ,noord5 says3 8,x w\ld be ! greate/ p>adox to economize ! r5al "w to ! utmo/ 9 "o direction 7diet1 sweat+1 etc47 & on ! o!r h& excite !m to increas$ activity by means ( ! /ronge/ /imulants we possess1 7drugs74 ,i reg>d su* prescrib+ z radically wrong40 ,! diet %\ld be c>efully select$ & ( m9imum am\nt4 ,! pure milk diet is und\bt$ly ! be/4 ,! use ( meat seems to favor uremic convulsions4 ,! dige/ive organs %\ld be kept 9 z good condition z possible1 p>ticul> att5tion be+ paid to ! liv] & b[els4 ,! use ( suitable clo?+ is important2 wool %\ld be worn next to ! body4 ,! sk9 is a p[]ful adjuvant to kidney elim9ation1 & ! suppression ( ! action ( ! sk9 ?r[s extra "w on ! kidneys4 ,possibly /imulation ( ! lung function w\ld aid 9 ! elim9ation4 ,re/1 ) a prop] am\nt ( fre% air & outdoor ex]cise1 is ess5tial4 ,9 conditions call+ = att5tion to ! sk9 & b[els ! treatm5t w be ! same z 9 acute p>5*ymat\s nephritis4 ,!re is a ganglion on ea* side ( ! umbilicus )9 a radius ( an in* t s5ds fib]s to ! kidneys 7,dr4 ,/ill74 ,j :at is ! function ( ^! ganglia is unkn[n4 ,! treatm5t ( ! complications is indep5d5t ( t = ! r5al tr\ble4 ,= direct treatm5t to ! kidneys see acute ,bright's disease4 ,int]/itial ,nephritis ,def9ition4--,a *ronic inflammation ( ! kidney 9 :i* !re is r$uction 9 its size due to an ext5sive de/ruction ( ! tubul> sub/ance1 ) an ov]gr[?1 & lat] a contraction1 ( ! connective tissue elem5ts4 ,c>dio-vascul> *anges1 art]ioscl]osis & c>diac hyp]trophy are usually associat$4 ,o/eopa?ic ,etiology & ,pa?ology4--,o/eopa?ic lesions to ! r5al splan*nics are important pr$ispos+ causes4 ,! disease may foll[ p>5*ymat\s nephritis2 or x may be caus$ by a cont9u$ passive conge/ion due to valvul> he>t disease4 ,g\t2 cy/itis 7(t5 foll[+ gonorrhea71 ! inflammation ext5d+ up ! uret]s to ! kidney2 h]$ity2 old age2 long cont9u$ worry1 anxiety or grief2 *ronic alcoholism1 ov]eat+2 syphilis2 tub]culosis2 focal infections1 especially ( /reptococci2 *ronic m9]al poison+ 7z f lead71 & alt]ations 9 ! r5al ganglionic c5t]s are causes4 ,x *iefly occurs 9 males dur+ middle life4 ,pa?ologically1 bo? kidneys are involv$ 7al?\gh "o may be m affect$ ?an ! o!r71 & r$uc$ 9 size1 (t5 to less ?an half _! normal size4 ,aft] remov+ ! capsule1 :i* is ?ick5$ & adh]5t1 ! surface is f\nd to be unev51 or granul> & conta9+ small cy/s4 ,! kidney is h>d1 t\gh & resi/ant1 ! color v>y+ f a d>ki% br[n to a yell[i% gray4 ,! cortical portion is especially r$uc$ 9 size4 ,on microscopic exam9ation1 ! connective tissue appe>s greatly increas$2 ?is contracts1 compress+ ! tubules & blood-vessels1 caus+ _! de/ruction4 ,!re is g5]al art]ial scl]osis1 & ! left side ( ! he>t is hyp]trophi$4 ,!re are frequ5t nasal & ret9al hemorrhages1 due to ! brittl5ess ( ! art]ial walls :i* pr$ispose !m to rupture2 h5ce1 apoplexy is a frequ5t t]m9ation4 ,! ganglionic c5t]s1 be+ int]f]$ )1 und]go fatty deg5]ation & atrophy4 ,!re are m>k$ ret9al *anges--ret9itis1 fatty deg5]ation ( ! ret9al tissues & scl]osis ( ! n]ve fib] lay]s4 ,symptoms4--,! onset is insidi\s4 ,9 mo/ cases ! symptoms are lat5t4 ,! g5]al heal? is di/urb$2 !re are frequ5t micturition1 ga/ric di/urbances1 t5se & b\nd+ pulse1 hyp]trophy ( ! left v5tricle1 high blood pressure1 disord]s ( vision1 sleeplessness1 heada*e1 furr$ tongue1 slight swell+ ( ! feet1 dry sk91 scurvy & %ortness ( brea?4 ,! ur9e is increas$ 9 quantity1 ( acid reaction1 light 9 color1 l[ specific gravity1 ) a small am\nt ( album91 a few hyal9e ca/s1 & "s epi!lial cells4 ,!re is increas$ ?ir/ & ! pati5t may h to ur9ate two or ?ree times dur+ ! night4 ,!re is well m>k$ muc\s cl\d1 slight s$im5t1 & z ! disease advances ! ur9e may be dim9i%$1 ! album9 increas$ & ! ca/s become m num]\s1 :ile occasionally blood cells w be f\nd4 ,mu* importance %\ld be atta*$ to ! blood pressure condition4 ,diagnosis4--,! e>ly /ages are n always recognizable4 ,lat]1 :ile !re is high art]ial t5sion1 ?ick5+ ( ! art]ial walls & m>k$ hyp]trophy ( ! he>t1 ! ur9e %\ld be exam9$ v c>efully bo? night & morn+1 z ! diagnosis w greatly dep5d ^u ! condition ( ! ur9e1 :i* is increas$ 9 quantity1 ( l[ specific gravity1 ) a trace ( album91 n>r[ hyal9e & pale granul> ca/s1 mak+ ! diagnosis usually easy4 ,prognosis4--,x is g5]ally incurable1 b favorable s f> z ! p[] to prolong life is conc]n$1 provid$ ! diagnosis be made e>ly 9 ! case1 & ! pati5t lives a quiet life4 ,! case usually t]m9ates ) convulsions1 coma & dea?4 ,apoplexy is frequ5tly associat$ ) *ronic nephritis4 ,9 all =ms ( *ronic nephritis "s int]curr5t infecti\s disease is q possible1 :i* is apt to be s]i\s ow+ to ! ca*ectic /ate4 ,treatm5t4--,! dietetic & hygi5ic treatm5t is ! same z 9 *ronic p>5*ymat\s nephritis4 ,! n]ve & vascul> supply to ! kidneys %\ld be treat$ z 9 acute p>5*ymat\s nephritis4 ,fre$om f worry & ov]work1 & if possible *ange ( climate1 %\ld be prescrib$4 ,frequ5t ba?+1 ) friction ( ! sk91 %\ld be insi/$ ^u & ! b[els kept regul> by a treatm5t ( alkal9e wat]4 ,9 all kidney cases special att5tion %\ld be giv5 ! liv]4 ,! alkal9e wat] is a good diuretic2 besides x flu%es ! kidneys & helps to remove ! debris4 ,^! cases inv>iably pres5t a rigid sp9e :i* %\ld be c>efully b ?or\ghly treat$1 traction be+ "o ( ! me?ods t give comp>atively quick & excell5t results4 ,ov]com+ sp9al immobility1 correction ( ! dorsal area1 att5tion to ! *e/ rigidness1 & frequ5tly rais+ ! abdom9al organs w (t5 consid]ably r$uce ! blood pressure4 ,! accid5ts & complications :i* s (t5 endang] ! pati5t1 mu/ be treat$ z !y arise4 ,amyloid ,kidney ,def9ition4--,a pa?ological /ate ( ! kidney 9 :i* !re is a peculi> infiltration into ! kidney /ructure ( an album9oid mat]ial ( a waxy appe>ance4 ,etiology & ,pa?ology4--,?is is associat$ ) ,bright's disease & o!r wa/+ diseases4 ,x is mo/ frequ5tly caus$ by pr(use & long cont9u$ suppuration1 especially ( ! bones1 by syphilis1 tub]culosis1 canc]1 lead poison+ & g\t4 ,pa?ologically1 ! kidney is l>ge & pale1 b x may be normal 9 size or ev5 small1 pale & granul>4 ,! capsule is n adh]5t1 ! surface ( ! kidney1 aft] remov+ ! capsule1 is pale & anemic4 ,on section ! cortex is se5 to be enl>g$4 ,x is homog5e\s1 anemic1 pale1 waxy & resi/+4 ,on microscopic exam9ation !re is f\nd to be an infiltration ( a homog5e\s or wax-l mat]ial4 ,?is progresses until all p>ts ( ! organ are infiltrat$4 ,z ! result ( ?is pressure ! /ructures ( ! kidney und]go an atrophic deg5]ation1 ! kidney becom+ contract$1 small]1 r\gh & ev5 di/ort$ 9 %ape4 ,! cortex becomes n>r[$ & ! capsule adh]5t4 ,if a section ( an amyloid kidney be /a9$ ) a solution ( iod9e1 num]\s mahogany r$ po9ts appe>4 ,symptoms4--,!re are simil> *anges 9 ! liv]1 sple5 & (t5 ! inte/9al canal4 ,!re is a pr(use1 wat]y di>rhea1 due to amyloid *anges 9 ! inte/9al canal1 ) loss ( fle% & /r5g?1 edema ( ! l[] extremities1 & ascites4 ,!re is an increas$ fl[ ( pale1 wat]y ur9e1 ( l[ specific gravity2 album9 is abundant & usually hyal9e1 (t5 fatty or f9ally granul> tube ca/s occur4 ,prognosis4--,z a rule ! prognosis is decid$ly unfavorable & x mu/ be controll$ by ! disease ) :i* x is associat$4 ,treatm5t4--,! prim>y disease dem&s att5tion1 o!rwise ! measures ( treatm5t indicat$ are ^? ( *ronic p>5*ymat\s nephritis1 ) special att5tion to ! g5]al heal? & surr\nd+s ( ! pati5t4 ,give a g5]\s diet & be p]si/5t ) ! treatm5t4 ,pyelitis ,pyelitis is inflammation ( ! pelvis ( ! kidney4 ,:5 a suppurative inflammation ext5ds into ! int]/itial tissue ( ! organ1 x produces a condition call$ pyelonephritis4 ,! inflammation usually />ts 9 ! pelvis ( ! kidney1 ! infection be+ c>ri$ !re ei!r by ! circulation or ! ur9>y tract1 b x soon involves ! re/ ( ! kidney4 ,pyelitis is usually second>y to "s o!r conditions su* z ure?ritis1 cy/itis1 or uret]itis4 8,infection ( ! kidney r>ely takes place ?r\gh ! blood & only :5 ! vital membrane ( ! kidney is impair$40 ,x may />t f )9 ! organ 9 ! int]/itial tissue1 caus$ by infecti\s embolism or traumatism1 or ! tubules may become ob/ruct$ by concretions4 ,o/eopa?ic ,etiology & ,pa?ology4--,reta9$ decompos$ ur9e due to pressure ^u ! uret]s by tumors or bladd] disease2 calculus concretion1 k9k$ uret]1 displac$ kidney1 traumatic ag5cies1 z falls1 bl[s1 /ra9s1 kicks or p5etrat+ w\nds2 nephritis1 pregnancy1 cold & wet1 are causes4 ,pyelitis may foll[ cy/itis1 ! inflammation ext5d+ up ! uret]s to ! pelvis ( ! kidney & !nce to ! sub/ance ( ! organ1 induc+ pyelonephritis4 ,tub]culosis1 focal infections1 & inte/9al disord]s 7colon bacillus71 are o!r causes4 ,lesions f ! n9? dorsal to second lumb> or l[]1 & malnutrition are pr$ispos+ factors4 ,pa?ologically1 ! muc\s membrane ( ! pelvis is usually ! fir/ affect$1 ! inflammation g5]ally ext5d+ f bel[ upw>d4 ,x is swoll5 & sometimes visibly conge/$ & ( a gray color4 ,! pelvis & calyces are m or less dilat$1 :ile ! papill are flatt5$4 ,!re is a gradual dilatation ( ! calyces & atrophy ( ! kidney sub/ance1 until ! :ole organ may be conv]t$ into a pus sac4 ,if complete ob/ruction occurs1 ! fluid portion may be absorb$ & ! pus become inspissat$ & *eesy4 ,! uret] is (t5 dilat$4 ,9 tub]cul\s pyelitis ! apices ( ! pyramids are also invad$1 ! kidney sub/ance is brok5 d[n & ! result is ! same4 ,9 ! pyelitis caus$ by cy/itis1 ! infection passes up ! tubules or is c>ri$ by ! lymphatics4 ,! abscesses ext5d along ! pyramids1 bur/ ?r\gh ! papill & calyx into ! pelvis ( ! kidney1 & ?us also ! kidney becomes a purul5t sac4 ,symptoms4--,pa9 & t5d]ness ov] ! region ( ! kidney fir/ appe>4 ,9 a few cases cy/itis w be ! only symptom4 ,! suppurative /age is m>k$ by high fev] & a *ill or a succession ( *ills4 ,! g5]al condition ( ! pati5t d5otes prolong$ suppuration4 ,!re is failure ( heal? & m or less wa/+ & anemia4 ,! ur9e is *>act]i/ic1 conta9s pus1 :i* v>ies 9 quantity greatly1 & :]e only "o kidney is affect$1 may be suppress$ = a "t & !re w be a sudd5 outfl[ ( ! pus1 due to ! break+ ( ! sac4 ,blood is also v con/ant1 b h>dly ev] ( suffici5t quantity to be se5 by ! nak$ eye4 ,! ur9e is usually dim9i%$ 9 quantity & ! color pale2 ! specific gravity is l[ on acc\nt ( ! small am\nt ( urea pres5t4 ,! reaction ( ! ur9e is acid4 ,pus & blood r5d] ! ur9e slightly album9\s4 ,ca/s f ! kidney1 & ev5 portions ( ! kidney1 may be pres5t4 ,diagnosis4--,f nephritis by ! abs5ce ( mu* album91 tube ca/s & dropsy4 ,f cy/itis1 by ! hi/ory1 lumb> pa9s & acid ur9e4 ,9 cy/itis ! ur9e is always alkal9e4 ,f p]9ephritic abscess1 by ! abs5ce ( edema ov] ! lumb> region4 ,! ur9e may be normal & !re are lumb> pa9s & hectic fev]4 ,9 tub]cul\s pyelitis !re is a hi/ory ( tub]culosis 9 o!r organs & !re are tub]cles 9 ! ur9e4 ,mal>ia or typhoid may be suspect$4 ,! ,x-ray & cy/oscope %\ld be employ$4 ,an exploratory incision may be necess>y4 ,prognosis4--,dep5ds altoge!r on ! cause & ext5t ( kidney involvem5t4 ,9 simple cases & "s tub]cul>1 recov]y may occur1 al?\gh !re is a t5d5cy 9 all cases = ! disease to become *ronic4 ,treatm5t4--,dep5ds ^u ! cause1 b ?or\gh treatm5t along ! l[] dorsal1 ! lumb> & sacral regions w be ( consid]able b5efit 9 controll+ ! cat>rhal process 9 ! kidney1 its pelvis1 ! uret] & ! bladd]4 ,if pa?ology p]mits1 g5tly rais+ ! kidneys1 uret]s & neighbor+ organs1 knee-*e/ position1 w mat]ially assi/ circulation & dra9age4 ,fre% spr+ wat]s = dilu5ts & re/rict+ ! diet to light food1 pref]ably milk1 are indicat$4 ,re/ is important & w>m applications locally are sometimes helpful4 ,! g5]al heal? mu/ be c>efully wat*$ z !re is always consid]able dra9 ^u ! sy/em4 ,a timely op]ation may mat]ially l5g!n ! life 9 _m cases4 ,att5tion to ! bladd]1 ure?ra & pro/ate is necess>y4 ,uremia ,! "n appli$ to a s]ies ( manife/ations result+ f ! ret5tion ( poison\s mat]ials 9 ! blood1 :i* %\ld h be5 remov$ by ! kidneys4 ,uremic symptoms may occur any "t dur+ an attack ( nephritis4 ,9 *ronic cases x seems likely t ext5sive de/ruction ( r5al tissue is ! pr9cipal factor t leads to ! toxemia4 ,!y may also occur :5 ! circulation ( ! blood 9 ! kidneys is int]f]$ ) or ! uret]s are ob/ruct$4 ,!y are n due alone to ! urea 7:i* is f\nd to be increas$ 9 ! blood71 b m probably sev]al poisons t are reta9$ 9 ! blood4 ,traube's !ory is t acute c]ebral edema ) anemia acc\nts = ! symptoms4 ,halb]t says3 8,a m rec5t & m plausible claim is to ! effect t a poison is develop$ 9 ! body z ! result ( nephritis10 = ret5tion ( effete matt] or ligation ( r5al art]ies & uret]s or impair$ r5al activity does n fully expla9 ! cause ( ! /upor1 coma1 convulsions1 sometimes p>alysis1 & ga/ro-inte/9al disord]s4 ,symptoms4--,loss ( appetite1 nausea1 vomit+1 heada*e & dr[s9ess are ! initial symptoms4 ,heada*e is usually at ! back ( ! head & may ext5d d[n ! neck4 ,! next symptom is coma1 alt]nat+ ) convulsions :i* may range f only a slight twit*+ to viol5t epilepti=m spasms4 ,^! spasms may occur )\t ! slighte/ w>n+ & are (t5 foll[$ by bl9dness :i* may la/ = sev]al days4 ,^! attacks ( coma & convulsions are sometimes ascrib$ to localiz$ edema ( ! bra94 ,transi5t p>alysis is also due to conge/ion or edema ( ! bra9 & x may be ( ! cord4 ,!re may be mania :i* comes on abruptly1 al?\gh ! delirium is n at all viol5t1 :ile pr(\nd melan*olia may be f\nd4 ,!re may be n]v\s symptoms develop1 su* z numbness 9 ! h&s & f+]s1 it*+ ( ! sk9 & cramps 9 ! muscles--especially ^? ( calves ( ! legs4 ,pulmon>y symptoms are sometimes cont9u\s--dyspnea1 p>oxysmal dyspnea & ,*eyne-,/okes' brea?+4 ,^! attacks ( dyspnea may be z di/ress+ z true a/hma4 ,*eyne-,/okes' brea?+ may be pres5t )\t coma4 ,uncontrollable vomit+ may set 9 ) great abruptness1 foll[$ by hicc\gh & purg+4 ,!re may be a cat>rhal or diph!ritic inflammation ( ! colon ) di>rhea4 ,! brea? has a ur9\s odor & ! tongue is (t5 v f\l4 ,! pulse is sl[ & full1 ) a temp]ature bel[ ! normal1 al?\gh dur+ convulsions ! pulse may become rapid & ! temp]ature rise4 ,occasionally !re are atypical =ms ( uremia :i* may be v confus+ & obscure4 ,diagnosis4--,! hi/ory1 subnormal temp]ature1 ! ur9\s odor ( ! brea?1 high art]ial t5sion & increas$ second s\nd ( ! he>t w di/+ui% ! condition4 ,feel+ ( numbness1 palpitation1 heada*e1 re/lessness1 m5tal w&]+ are n infrequ5tly e>ly symptoms4 ,! ph5olsulphoneph?ale9 te/ = ! secret+ p[] ( ! kidney1 & ! exam9ation ( ! urea 9 ! blood are ( great aid 9 diagnosis4 ,prognosis4--,extremely grave1 b "o %\ld always be v c>eful 9 8 prognosis1 = !re is a possibility ( recov]y1 ev5 aft] ! mo/ s]i\s symptoms h be5 manife/$4 ,treatm5t4--,z imp]meability ( ! kidneys produces uremia1 by n all[+ ! v>i\s poisons to be elim9at$ by ! r5al pa? z !y %\ld be1 ! treatm5t mu/ be appli$ directly to ! kidneys4 ,elim9ation is dem&$ & if treatm5t ?r\gh ! abdom5 to ! kidneys directly & to ! r5al splan*nics does n br+ ab\t prompt & ?or\gh elim9ation ( ! intoxicat+ prop]ties1 ! b[els & sk9 mu/ be made active4 ,! vapor or hot air ba? or hot pack %\ld at once be us$4 ,an ice-bag to ! head w be b5eficial4 ,an increase 9 ! quantity ( ur9e may be br\ght ab\t by ! displacem5t ( a "p ( ! mass ( blood1 :i* is 9 relative /agnation 9 c]ta9 p>ts ( ! vascul> sy/em4 ,=c+ x into ! ma9 circulation 9 ord] to increase ! pressure )9 ! vessels ( ! kidney1 is ! treatm5t indicat$4 ,?is great /agnant mass ( blood is f\nd 9 ! art]ial capill>ies ( ! portal sy/em 9 ! liv] & spl5ic tissues & %\ld be manipulat$ into ! g5]al circulation 9 ord] to increase ! art]ial t5sion ( ! kidneys & ?us favor elim9ation4 ,! treatm5t %\ld ma9ly be appli$ to ! vasomotor n]ves ( ! portal sy/em1 f ! fif? to ! n9? dorsal1 & directly ov] ! abdom51 liv] & sple54 ,! introduction ( wat]1 f #aaj degrees to #abj degrees1 or ev5 #aej degrees1 into ! colon by means ( injections1 is useful2 w>m irrigations increase r5al secretion1 b[el action & sweat+ ) a decrease ( t5sion4 ,cold dr9ks w /imulate ! abdom9al vessels & induce absorption ( a c]ta9 quantity ( wat] to /ill fur!r increase diuresis4 ,cold irrigation increases blood pressure tempor>ily1 b lat] x less5s ! pressure2 x %\ld be us$ only ) great caution4 ,milk is "o ( ! be/ dr9ks to be us$4 ,secretions ( ! liv] mu/ n accumulate4 ,! bile mu/ be expell$ s t its toxicity w n be add$ to ! o!r poisons4 ,! food ( ! pati5t is an important matt]4 ,a milk diet is be/2 avoid meat & nitrog5\s foods & any food t leaves mu* residue4 ,9 ?is way ! nutrition ( ! pati5t is kept up ) a m9imum ( urea =mation &1 besides1 !re w be v little inte/9al putrefaction4 ,em]g5cy measures n m5tion$ above are repeat$ high normal salt enemata 7two to ?ree p9ts71 ! alcohol sweat & v5esection 7ab\t "o p9t74 ,:5 ! attack is brok5 ! condition resolves itself into ! r5al disord]1 g5]ally acute ,bright's disease4 ,?is disease illu/rates "o phase ( ! uselessness ( drugs2 = :5 ! imp]meability ( ! kidney has become su* t x ceases to h ! p[] ( elim9at+ toxic sub/ances =m$ by ! organism1 !re is !n reta9$ ! m$ic9al sub/ances4 ,! kidney is z imp]meable = !rapeutic poisons z = ! natural poisons & ! employm5t ( toxic m$ic9es 9 su* cases has (t5 no o!r effect ?an to br+ an association ( m$ic9al intoxication ) an uremic4 ,r5al ,calculus ,r5al calculi are concretions =m$ by precipitation ( solids d]iv$ f ! ur9e1 & are f\nd 9 ! kidney or its pelvis4 ,if l>ge1 !y are call$ /ones2 ! small] masses are kn[n z gravel or s&1 accord+ to _! size4 ,:5 ! /ones attempt to pass ?r\gh ! uret]s1 x br+s on an attack ( r5al colic2 r>ely are !y void$ )\t ?is symptom4 ,o/eopa?ic ,etiology & ,pa?ology4--,! affection occurs at all ages1 m commonly1 h[ev]1 9 *ildr5 & 9 old p4 ,! male sex is m liable ?an ! female4 ,s$5t>y habits1 g\t & excessive meat eat+ are pr$ispos+ causes4 ,h]$ity seems to be a pr$ispos+ cause 9 "s families4 ,inflammation ( ! pelvis ( ! kidney1 caus$ by d]angem5t ( ! ribs & v]tebr ( ! t5?1 elev5? & twelf? dorsals or fir/ lumb>1 is an important etiological factor4 ,pa?ologically1 ! *emical v>ieties are3 7#a7 ,uric acid & urates are ! mo/ common4 ,! /ones are usually smoo? or lobulat$2 are h>d & ( a r$di% color4 ,usually 9 ^! /ones1 bo? uric acid & urates are to be f\nd4 ,?is mat]ial may be pass$ 9 ! =m ( s& or l>ge /ones4 ,! s$im5t 9 ! ur9e may be ! nuclei ( ! /ones2 z may =eign matt]s1 su* z ! mucus or desquamat$ epi!lium caus$ by ! inflammation ( ! pelvis ( ! kidney1 blood clots1 or1 9 fact1 any =eign matt] t may rea* ! ur9>y passages4 ,individuals pass+ a small am\nt ( ur9e1 & old p are ! pr9cipal subjects4 8,z a consequ5ce ( conc5tration & high acidity ( ! ur9e1 ! uric acid & urates are readily sep>at$ 9 solid =m & held toge!r by ! album9\s matrix40 7#b7 ,phosphatic ,calculi are :ite 9 color1 s(t & mort>like4 ,!y are compos$ ( phosphate ( lime1 ammonia & magnesium phosphate4 ,^! are f\nd m (t5 9 ! bladd] ?an ! kidney4 ,disease ( ! bladd] is ! cause4 7#c7 ,oxalate ( ,lime are a mixture ( oxalate ( lime & uric acid4 ,!y are d>k 9 color1 v h>d & unev51 ) h>d1 po9t$ projections4 ,on acc\nt ( _! unev5 %ape !y h be5 nam$ mulb]ry calculi4 ,^! /ones produce great pa9 z !y pass ?r\gh ! uret]s4 ,!re are o!r concretions ( r>e occurr5ce4 ,symptoms4--,!re is pa9 9 ! back 9 ! region ( ! kidneys ) m or less t5d]ness4 ,! pa9 may be sev]e & p>oxysmal4 ,!re may be ble$+1 :i* is seldom pr(use2 ?is w give ! ur9e a smoky hue1 b may be pres5t to su* a small degree z to be only app>5t by ! use ( ! microscope4 ,! /one may ob/ruct ! uret] & cause pyonephrosis or hydronephrosis4 ,pyelitis ( a cat>rhal "* is common4 ,9 pyelitis !re may be int]mitt5t fev] ( sev]al degrees1 !n sweat+4 ,!re may or may n be pus 9 ! ur9e4 ,r5al ,colic is caus$ :5 ! calculus attempts to pass ?r\gh ! uret] s t uret]al spasms result4 ,! /one1 h[ev]1 may become lodg$ at ! entrance to ! uret]4 ,!re is a sudd5 onset & great pa9 :i* />ts 9 ! back1 radiat+ d[nw>d into ! gro91 d[n ! side ( ! ?igh & into ! te/icle & glans p5is4 ,! te/icle is (t5 retract$1 ! face pale1 ! features p9*$1 & !re is frequ5tly vomit+4 ,!re are cold sweats & ! pulse is weak4 ,! p>oxysm may la/ only a few m9utes or ext5d ov] sev]al h\rs4 ,if uric acid is f\nd1 x po9ts to uric acid or oxalate ( lime calculi & ! ur9e is acid 9 reaction4 ,if alkal9e phosphatic /ones may be suspect$1 exam9ation ( ! ur9e directly aft] ! attack aids greatly 9 diagnosis1 = at o!r times ! ur9e is usually negative4 ,diagnosis4--,bili>y ,colic4--,! jaundice 9 bili>y colic comes on v soon aft] ! ob/ruction beg9s4 ,! /ools are )\t bile & ! pa9 ext5ds f ! "r hypo*ondriac region to ! upp] abdom5 & ! "r %\ld]4 ,! ur9e is negative & a /one may be pass$ 9 ! /ools4 ,r5al colic is (t5 simulat$ :5 ! uret] is ob/ruct$ f any cause :atev]4 ,x may be compress$ f a float+ kidney or tumor1 or ob/ruct$ by a clot ( blood1 fragm5ts ( hydatid cy/s or plugs ( mucus4 ,lumbo-abdom9al neuralgia1 inte/9al colic1 & r5al tub]culosis may simulate r5al colic4 ,! ,x-ray plate is ( decid$ value4 ,prognosis4--,z complications may arise1 x is be/ to give a gu>d$ prognosis1 b ! prognosis is g5]ally favorable4 ,x is a disease t is v apt to recur :5 /ra9s or falls affect ! inn]vation to ! kidney1 b _m cases h be5 p]man5tly cur$4 ,if ! /one is l>ge1 its passage along ! uret] may prove fatal unless surgical int]f]5ce is in/itut$ at once1 b if x is r5al s& x may be easily void$ 9 ! ur9e & ?us ! prognosis w be favorable4 ,treatm5t4--,treatm5t %\ld be giv5 t[>d ov]com+ ! cause produc+ ! calculi1 :i* w (t5 be f\nd at ! t5? rib4 ,treat ! kidneys ?or\ghly1 bo? ?r\gh ! r5al splan*nics & directly ?r\gh ! abdom51 ant]iorly4 ,b direct abdom9al treatm5t %\ld be giv5 v cauti\sly4 ,treatm5t "h corrects disord]s & seems to release "s solv5t t acts ^u ! v>i\s =ms ( calculi & dis9tegrates ! ones already =m$ & prev5ts ! =mation ( o!rs4 ,possibly ?is solv5t is an int]nal secretion ( "s gl&2 possibly l ! spl5ic secretion is to ! bili>y calculi 7,dr4 ,/ill474 ,dr4 ,/ill held t "o ( ! functions ( ! supr>5al capsule 0 to prev5t ! =mation ( ^! concretions4 ,9 ! uric acid t5d5cy1 ! free use ( alkal9e m9]al wat]s = ! solution ( uric acid may be helpful4 ,mu* may be done by diet+4 ,! am\nt ( nitrog5\s food %\ld be limit$1 eat+ a m9imum am\nt ( meat & us+ pl5ty ( milk & vegetables4 ,9 ! phosphatic t5d5cy1 dilut$ dr9ks freely us$ are helpful4 ,meats are indicat$4 ,milk & vegetables %\ld n be us$ freely z !y t5d to make ! ur9e alkal9e4 ,9 all in/ances c>e ( ! g5]al heal? & avoidance ( be] dr9k+ & excessive meat eat+ are dem&$4 ,dur+ an attack ( r5al colic1 :5 a /one _h lodg$ 9 a uret]1 "o may be able1 by v c>eful manipulation1 to aid ! /one 9 its progress d[nw>d1 7some:at aft] ! mann] ( manipulat+ gall-/ones71 b d n delay surgical measures too long4 ,by inhibit+ ! n]ve =ce ( ! sp9al n]ves along ! lumb> & sacral regions 7*iefly t5? dorsal & fir/ lumb>71 relief may be giv54 ,! n]ves ( ! uret]s are d]iv$ f ! inf]ior mes5t]ic1 sp]matic & pelvic plexuses4 ,employ ! hot ba?2 ?is may relax ! spa/ic condition4 ,clo?s wrung out ( hot wat] & appli$ locally are ( aid4 ,occasionally a *ange ( po/ure w give relief4 ,ev5 inv]sion ( ! pati5t is sometimes foll[$ by imm$iate cessation ( ! pa94 ,! pati5t may dr9k freely ( hot lemonade or wat]4 ,an ane/hetic may be ( aid 9 ! manipulation ( a r5al calculus 9 ! uret]1 z ! ane/hetic w relax ! tissues ov] ! abdom51 mak+ x mu* easi] = "o to get ne> ! impact$ calculus1 b be cauti\s4 ,morph9e may be necess>y4 ,dur+ ! int]vals ! pati5t %\ld lead a quiet life & avoid sudd5 ex]tions ( any k9d4 ,x is important to keep ! ur9e abundant1 consequ5tly h ! pati5t dr9k a l>ge quantity ( di/ill$ wat]4 8,r5al calculus is br\ght ab\t by lesions affect+ ! supr>5al capsule ( ! kidney1 or sp9al lesions f ! t5? dorsal to ! fir/ lumb>1 affect+ ! l[] ribs40 ,movable ,kidney ,?is means a di/9ctly mobile condition ( ! kidney 7almo/ always acquir$1 b may be cong5ital71 due to ! lax condition ( ! tissues :i* support x & to ! elongation ( ! r5al vessels :i* all[ ! kidney to move 9 c]ta9 directions4 ,rapid loss ( tissue t absorbs ! fat surr\nd+ ! kidney is a cause4 ,!re are almo/ inv>iably lesions 9 ! dorso-lumb> region t pr$ispose to an abnormal mobility ( ! kidney4 ,^! lesions und\bt$ly weak5 ! inn]vation to ! surr\nd+ & support+ kidney /ructures4 ,a po/]ior sp9e1 ) consequ5t d[nw>d & con/rict+ displacem5t ( ! float+ ribs1 is common1 al?\gh lat]al & ant]ior sp9es 7dorso-lumb> region7 may be f\nd4 ,/ra9s1 heavy lift+1 & v>i\s viol5t ex]tions are important excit+ factors4 ,tight lac+1 pregnancies1 an enl>g$ liv] & ga/ro-- & ent]optosis are also important factors4 ,?is condition is f\nd m commonly 9 wom51 & und\bt$ly is a frequ5t cause ( direct1 ga/ro-inte/9al1 reflex1 & obscure di/urbances4 ,!re are v diff]5t degrees ( mobility 9 diff]5t cases4 ,x may be s slight z h>dly to be recogniz$ or s great t x c easily be felt by ! h& ?r\gh ! abdom9al walls1 resembl+ a movable tumor 9 ! abdom54 ,symptoms4--,(t5 !re are no noticeable symptoms4 ,sometimes :5 ! displacem5t & mobility ( ! kidney are mo/ m>k$1 ! reflex symptoms are n noticeable4 ,! "r kidney is ! "o usually affect$1 on acc\nt ( its relation to ! liv] :i* moves dur+ ! respiratory act4 ,usually !re is pa9 9 ! lumb> region & ! pati5t exp]i5ces a heavy1 dragg+ pa9 9 ! abdom51 :i* especially manife/s itself :ile /&+ & walk+4 ,!re may be int]co/al neuralgia4 ,v>i\s colicky & o!r ga/ro-inte/9al pa9s1 & n]v\s symptoms z neura/h5ia1 melan*olia1 hy/]ia & heada*e are common4 ,!re may be ob/9ate indige/ion1 palpitation ( ! he>t1 flatul5ce & c>dialgia2 also1 an irritable bladd]1 due to pressure4 ,at times ! kidney becomes t5d] & swoll5 z a result ( twi/+ ( ! r5al vessels or ( ! uret] 7,dietl's crises71 caus+ engorgem5t ( ! organ2 ?is may be associat$ ) agoniz+ pa9 & symptoms ( collapse4 ,hydronephrosis may be manife/$4 ,diagnosis4--,! %ape ( ! tumor1 m>k$ mobility1 & less5$ resi/ance on p]cussion ( ! r5al region w make ! diagnosis4 ,! disord] v r>ely proves fatal4 ,9 d\btful cases utilize ! ,x-ray4 ,treatm5t4--,_m cases r>ely give tr\ble directly1 b may be a s\rce ( reflex & obscure symptoms4 ,att5tion to ! g5]al heal? ( ! pati5t & p]si/5t treatm5t ( ! dorso-lumb> region greatly /r5g!n ! relax$ tissues ab\t ! kidney & cure a numb] ( cases4 ,hav+ ! pati5t attempt to replace ! organ aft] he goes to b$ w be ( value4 ,treatm5t ( ! abdom5 to /r5g!n ! walls & less5 any liv] conge/ion & to keep ! b[els active is v b5eficial4 ,tea* ! pati5t h[ to /& & walk correctly1 especially hold+ ! abdom5 9 & up4 ,a lib]al diet to ! po9t ( increas+ ! weight is wor?y ( trial4 ,! use ( supports is n always satisfactory4 ,surgical treatm5t = fix+ ! kidney is ( p]man5t value1 b d n advise op]ation unless absolutely indicat$4 7,see ,prolaps$ ,organs1 ,"p ,i74 ,to det]m9e ! pres5ce ( a movable kidney1 x is be/ to h ! pati5t 9 ! dorsal position1 ! head slightly l[]$ & ! abdom9al walls relax$ by flex+ ! ?ighs mod]ately ^u ! abdom54 ,!n ) ! left h& 9 ! lumb> region beh9d ! elev5? & twelf? ribs1 & ! "r h& 9 ! hypo*ondriac region1 ! kidney c usually be detect$ aft] full inspiration foll[$ by complete expiration2 or1 h ! pati5t 9 a /&+ po/ure ) ! body b5t slightly =w>d & ! h&s plac$ ^u a table1 !n p]=m bimanual palpation2 or1 p]=m ! manipulation 9 ! knee-elb[ position4 ,:5 9 ?is position 7knee-elb[71 if ! kidney has become dislodg$1 a resonant note w be obta9$ by p]cussion ov] ! normal location ( ! kidney4 ,,footnotes3 #ih ,j\rnal ( ! ,am]ican ,o/eopa?ic ,association1 ,july1 #aijd4 #ii ,j\rnal ( ! ,am]ican ,o/eopa?ic ,association1 ,dec41 #aijd4 ,,diseases ,,( ,,! ,,bladd] ,cy/itis ,cy/itis is an inflammation ( ! muc\s membrane ( ! bladd]4 ,ret5tion ( ! ur9e2 =eign bodies1 su* z /ones1 9 ! bladd]2 ! use ( dirty ca!t]s2 exposure to wet & cold2 injuries to ! bladd] & ov] ! pubes2 irritations to ! sacral n]ves2 sp9al lesions 9 ! dorsal enl>gem5t ( ! cord2 innom9ate lesions2 irritat+ drugs2 enl>g$ pro/ate & ure?ral /rictures are ! pr9cipal causes ( cy/itis4 ,! disease may be second>y to fev]s1 infecti\s diseases & inflammation ( adjac5t organs4 ,a displac$ ut]us may produce a *ronic irritation ( ! bladd]4 ,pa?ologically1 !re is hyp]emia ( ! muc\s membrane ( "p or ( ! :ole ( ! bladd]1 ) r$ness1 conge/ion & edema4 ,! secretion ( mucus t cov]s ! muc\s membrane is ( a dirty gray color4 ,if ! conge/ion is v ext5sive1 a bur/+ ( ! capill>ies may take place4 ,9 a few cases ! neck ( ! bladd] & ! ure?ra1 :]e x passes ?r\gh ! pro/ate1 is involv$4 ,9 *ronic cases ! muc\s membrane becomes ?ick5$ & cov]$ ) pat*es ( false membrane4 ,! muscul> coat ( ! bladd] becomes hyp]trophi$ & ! ve9s tortu\s4 ,symptoms4--,! onset may be sudd5 ) rigors & fev]1 b 9 _m cases a frequ5t desire to micturate w be ! fir/ symptom4 ,?is is foll[$ by t5d]ness & pa9 ov] ! bladd] & contigu\s p>ts1 loss ( appetite1 depression & sleeplessness4 ,t5esmus ( ! bladd]1 caus$ by a spa/ic condition ( its muscles1 & a burn+ along ! ure?ra are usually pres5t4 ,! ur9e is alkal9e 9 reaction & conta9s pus1 epi!lium & blood4 ,diagnosis4--,! diagnosis is usually easy4 ,pyelitis causes pa9s 9 ! lumb> region & along ! uret]s & !re is a frequ5t desire to ur9ate4 ,! bladd] is n subject to spasms & ! ur9e is ( an acid or neutral reaction4 ,prognosis4--,9 _m cases ! prognosis is favorable1 b 9 cases ( long /&+ & 9 hyp]trophy ( ! bladd]1 prognosis mu/ be gu>d$4 ,treatm5t4--,re/ 9 b$ ) /rict att5tion to diet is necess>y4 ,milk is ! be/ food & avoid highly season$ articles & acid foods4 ,! use ( pl5ty ( pure wat] is helpful to dilute ! ur9e1 & if necess>y ! bladd] %\ld be wa%$ out c>efully4 ,if ! case is sev]e1 empty+ ! bladd] sev]al times a day ) a ca!t] w be necess>y4 ,always be c>eful ab\t ! cleans+ ( ! in/rum5ts4 ,w>m applications ov] ! pelvic region w be com=t+ to ! pati5t4 ,lift+ ! abdom9al visc]a f ! bladd] is ( assi/ance4 ,! pati5t may be plac$ 9 ! knee & *e/ position = ?is or ! usual me?od employ$4 ,treatm5t to ! second1 ?ird & f\r? sacral n]ves controls ! neck ( ! bladd]1 & /rong inhibition w g5]ally control ! spasms ( ! sph9ct]4 ,! fundus ( ! organ is suppli$ by sympa!tic fib]s f ! pelvic plexus4 ,direct treatm5t ov] ! bladd]1 if appli$ c>efully1 w act on ! t]m9al fib]s ( ! sympa!tic4 ,lesions to ! n]ves ( ! sph9ct] ( ! bladd] (t5times occur betwe5 ! fif? lumb> & sacrum1 also f a displac$ innom9ate4 ,su* lesions are apt to be f\nd 9 cases ( incont95ce ( ur9e4 ,! lesion to ! v]tebra is usually a lat]al "o4 ,?or\gh treatm5t to ! g5ito-ur9>y c5t] 7l[] dorsal & upp] lumb>7 w also be ( aid4 ,9 males direct treatm5t ( ! pro/ate gl& is occasionally important z is also ! plexus ( n]ves at ! trigone ( ! bladd]4 ,9 treat+ ! pro/ate gl& introduce a f+] into ! rectum & "w ab\t ! base ( ! gl& to relax ! tissues1 & ?us remove ob/ructions ( ! vascul>1 lymphatic & n]v\s /ructures to ! gl&4 ,d n "w too mu* ^u ! gl& itself 7commonly once a week or t5 days71 z x may irritate1 b release surr\nd+ edema4 ,also treat ! inn]vation at ! elev5? & twelf? dorsals1 fif? lumb>1 & fir/1 second & ?ird sacrals4 ,spread+ ! is*ii w occasionally be b5eficial2 ?is t5ds to release ! ant]ior commissure :]e x is atta*$ to ! symphysis4 ,foll[ ! above ) a 8g5]al treatm5t0 9 ord] to secure a g5]al sy/emic reaction4 ,?is is ( value 9 all infecti\s disord]s4 ,x is important 9 "y boys to exam9e ! condition ( ! p5is 9 bladd] diseases4 ,! prepuce may become adh]5t or o!r irritations may be f\nd t are a s\rce ( di/urbance to ! bladd]1 or ev5 to ! kidneys1 on acc\nt ( ! intimate connection ( ! sympa!tic sy/em 9 ?is region & ! relation ( "o organ to ano!r4 ,an irritable bladd] is usually due to disord]s ( ne>by tissues1 especially ! ure?ra1 vag9a1 ut]us & rectum4 ,enuresis1 exclusive ( p>alysis1 is frequ5tly due to "s local me*anical di/urbance4 ,nocturnal enuresis or b$ wett+ is caus$ by l[] dorsal & lumb> lesions 7especially ! fif? lumb>71 displacem5ts ( ! innom9ate1 or phimosis1 hood$ clitoris1 contract$ meatus1 highly acid ur9e1 worms1 lack ( discipl9e1 etc4 ,! pati5t is usually neurotic1 :i* dem&s att5tion to ! neuromuscul> sy/em ( ! entire body4 ,c>e ( ! g5]al heal? & habits is important4 ,con/ipation may be pres5t4 ,,diseases ,,( ,,! ,,circulatory ,,sy/em ,,diseases ,,( ,,! ,,p]ic>dium ,p]ic>ditis ,p]ic>ditis is an inflammation ( ! s]\s membrane cov]+ ! he>t & its reflection 9 front ov] ! *e/4 ,prim>y inflammation ( ! p]ic>dium is r>e4 ,su* cases usually result f cold & exposure or injury or tub]culosis1 & are mo/ commonly met ) 9 *ildr54 ,! excit+ causes ( second>y p]ic>ditis are rheumatism1 ,bright's disease1 tub]culosis1 g\t1 diabetes1 eruptive fev]s1 v>i\s septic conditions & dyscrasia4 ,p]ic>ditis may result by ext5sion ( inflammation f contigu\s organs1 z ! disease may occur 9 pneumonia1 pleuropneumonia1 *ronic valvul> diseases1 & ulc]ative diseases ( ! esophagus1 bron*i1 v]tebr1 ribs1 /oma*1 etc4 ,displacem5t ( ! ribs ov] ! he>t & involvem5t ( ! correspond+ v]tebr pr$ispose to p]ic>ditis1 by weak5+ ! inn]vation ( ! p]ic>dium & ?us di/urb+ ! circulation4 ,lesions ( ! c]vical region affect+ ! left phr5ic are to be consid]$4 ,upp] rib lesions may di/urb ! int]nal mamm>y art]y & ! lymphatics1 :i* h important relation%ip ) ! p]ic>dium4 ,! disease may occur at any age4 ,males are m frequ5tly attack$ ?an females4 ,! morbid conditions v>y ) ! /age4 ,! /ages are 7#a7 acute1 pla/ic1 or dry p]ic>ditis2 7#b7 p]ic>ditis ) effusion1 s](ibr9\s1 hemorrhagic or purul5t2 7#c7 absorption or adhesive p]ic>ditis4 ,^! diff]5t /ages or v>ieties commonly succe$ "o ano!r1 al?\gh m$ical writ]s place s mu* importance 9 !m t ea* is describ$ sep>ately4 ,acute p]ic>ditis is by f> ! mo/ common & (t5 ! inflammation subsides at ?is po9t in/ead ( go+ on to m s]i\s involvem5t4 ,!re is a possibility t 9 "s cases ! =ms are indep5d5t ( ea* o!r4 ,! *anges are ! same z 9 v>i\s s]\s membranes4 ,hyp]emia & alt]ation ( ! epi!lium is mo/ m>k$ on ! visc]al lay]4 ,?is is foll[$ by an exudation f ! hyp]emic vessels4 ,!re is r\gh5+ & loos5+ ( ! epi!lium & ! fibr9 is precipitat$ ^u ! walls ( ! p]ic>dium4 ,m or less lymph is exud$ & sometimes inject$ capill>ies bur/ & cause a bloody exudation4 ,f ?is /age ! morbid appe>ances v>y accord+ to ! progress ( ! disease4 ,! disease may und]go resolution & fatty deg5]ation & absorption ( ! products 9 po9t take place4 ,z ! /age ( effusion occurs1 ! p>ietal & visc]al lay]s ( ! p]ic>dium are sep>at$ by a s](ibr9\s exudate4 ,?is condition may increase until ! quantity ( ! exudation is consid]able1 or ! effusion may become absorb$4 ,r>ely does ! exudate become purul5t4 ,adhesions may be =m$ betwe5 ! lay]s ( ! p]ic>dium1 dur+ ! la/ /age1 by b&s ( v>i\s l5g?s or ! lay]s are m or less sep>able4 ,symptoms4--,simple cases may n pres5t any symptoms4 ,usually a *ill or cold feel+ at ! he>t1 foll[$ by pa9s 9 ! c>diac region1 u%]s 9 ! attack4 ,fev] is commonly pres5t1 r>ely exce$+ #ajc degrees ,f4 ,t5d]ness ov] ! he>t is noticeable4 ,!re is dyspnea & ! pati5t is re/less4 ,9 ! effusive /age ! symptoms dep5d l>gely ^u ! am\nt ( diffusion4 ,! pa9 is %>p & /it*-l4 ,nausea1 vomit+ & hicc\gh sometimes occur4 ,! pulse is irregul> & feeble4 ,insomnia1 heada*e & ev5 delirium may occur4 ,di/5tion ( ! ve9s ( ! neck may cause dysphagia & a c\gh may be pres5t1 ow+ to ! irritation ( ! tra*ea4 ,! recurr5t l>yngeal n]ve may be compress$ z x w9ds ab\t ! aorta & ?us cause aphonia4 ,! friction s\nd is a *>act]i/ic physical sign ( ! fir/ /age4 ,9 ! effusive /age !re may be precordial bulg+4 ,! area ( dullness is enl>g$1 ! diaphragm & liv] may be cr[d$ d[nw>d1 caus+ an epiga/ric bulg+4 ,z ! effusion increases1 ! he>t s\nds become less di/9ct2 ! friction is n he>d4 ,9 ! ?ird /age !re is usually a return to normal1 al?\gh adhesions may =m & cause precordial retraction & p]man5tly emb>rass ! he>t's movem5ts4 ,! "y are m subject to p]man5t disability4 ,ext5sion ( he>t impulse1 :i* is undulatory2 dia/olic %ock to h& plac$ ov] he>t2 increas$ area ( dullness2 prom95t precordia2 position ( pati5t does n *ange apex beat2 & :5 p]ic>dium is adh]5t to diaphragm a sy/olic tug is not$ ov] po9ts ( atta*m5t1 are ess5tial signs & symptoms4 ,diagnosis4--,p]ic>ditis is frequ5tly ov]look$4 ,x is a s]i\s disease & "o %\ld be especially c>eful4 ,9 cases ( rheumatism ! o/eopa? mu/ always be on 8 gu>d4 ,tonsillitis may be ! orig9 ( ! infection4 ,c>e has to be tak5 9 di/+ui%+ betwe5 dilatation & c>diac hyp]trophy & p]ic>dial effusion4 ,hydro-p]ic>dium may be mi/ak5 = p]ic>dial effusion4 ,to di/+ui% betwe5 endoc>ditis & p]ic>ditis %\ld n be a difficult task if "o und]/&s ?or\ghly ! nature ( ea* disease4 ,a l>ge p]ic>dial effusion may be conf\nd$ ) a pleural effusion4 ,9 d\btful cases utilize ! ,x-ray4 ,prognosis4--,9 mild cases ( p]ic>ditis ! l>ge majority rapidly recov] 9 two to ?ree weeks4 ,9 ca*ectic subjects & :]e adhesions h =m$1 ! duration is long]4 ,relapses may occur4 ,! purul5t effusions are always s]i\s4 ,treatm5t4--,dem&s prompt & effective measures4 ,absolute re/ m5tally & physically1 is necess>y4 ,too mu* /ress _c be laid ^u ?is po9t1 z dea? has occurr$ f neglect ( ?is4 ,to quiet ! he>t's action is ! fir/ necess>y requisite1 & !n give treatm5t to limit ! inflammation4 ,9 ! e>ly /age relax+ ! upp] dorsal musculature to control inn]vation1 & rais+ & free+ all ! upp] ribs & clavicles to promote lymphatic dra9age is effective4 ,9 ! second /age prev5tion ( c>diac failure & promotion ( absorption are ! indications to be met4 ,too mu* importance _c be plac$ ^u ! po9t t g5]al /r5g?1 good nurs+1 diet+ & free elim9ation are ess5tial1 n only 9 secur+ a rapid subsid5ce ( ! inflammation1 b to prev5t fur!r complications4 ,rais+ & sep>at+ ! ribs ov] ! he>t w be ( great aid 9 less5+ ! inflammation & promot+ absorption4 ,9 _m cases lesions to ! ribs on ! left side & subdislocations ( ! v]tebr affect+ ! vasomotor n]ves1 ! lymphatics & n]ves to ! he>t w be f\nd4 ,! fir/ five ribs & correspond+ v]tebr is ! region :]e "o may expect to f9d ! lesions4 ,9 addition to absolute re/1 an inhibit+ treatm5t 9 ! dorsal region betwe5 ! scapul w aid 9 sl[+ ! he>t's action4 ,correct+ any lesion t may be f\nd to ! vagi n]ves w also be a help 9 controll+ ! he>t's action2 besides1 mo/ ( ! vasomotor fib]s to ! he>t are 9 ! vagi4 ,^! lesions are usually f\nd at ! atlas4 ,"o %\ld also exam9e c>efully all ! c]vical v]tebr = d]angem5ts t might affect ! c]vical sympa!tic1 especially ! sup]ior & middle c]vical ganglia4 ,^! ganglia are prim>ily affect$ f ! fif? c]vical to ! fir/ dorsal4 ,inhibition = a few m9utes betwe5 ! transv]se process ( ! atlas & ! occipital bone to ! po/]ior occipital n]ves w be ( great aid 9 controll+ ! tumultu\s action ( ! he>t2 also1 inhibit 9 ! upp] dorsal4 ,! w>m ba? w quiet ! he>t1 b c>e %\ld be tak5 n to weak5 ! pati5t4 ,! g5]al treatm5t has ! effect ( less5+ n]v\sness & quiet+ ! he>t4 ,! function ( ! phr5ic n]ve mu/ be borne 9 m9d :5 reg>d+ ! p]ic>dium4 ,! phr5ic is usually prim>ily affect$ at ! ?ird1 f\r? & fif? c]vicals1 & occasionally !re are connect+ fib]s z l[ z ! f\r? & fif? dorsals4 ,ice-bags may be f\nd ( value 9 ret>d+ ! progress ( ! effusion & 9 less5+ ! he>t's action4 ,liquid food1 z milk & bro?s1 %\ld be giv5 ?r\gh\t ! disease4 ,if ! effusion is v l>ge ! s]vices ( a surgeon %\ld be secur$ & tapp+ p]=m$4 ,if ! effusion is ( a purul5t nature1 a free incision %\ld be made ) antiseptic precautions4 ,9 *ronic cases c>efully graduat$ brea?+ ex]cises & mod]ate /ret*+ ( ! adh]5t regions1 if pa?ology p]mits1 %\ld be consid]$4 ,endoc>ditis ,endoc>ditis is an inflammation ( ! l9+ membrane ( ! he>t4 ,! process is usually conf9$ to ! valves2 ! l9+ ( ! cavity ( ! he>t may also be affect$1 especially 9 sev]e cases4 ,?ree =ms are recogniz$3 simple acute endoc>ditis1 ulc]ative endoc>ditis1 & *ronic endoc>ditis4 ,simple ,acute ,endoc>ditis4--,?is =m usually results f acute articul> rheumatism4 ,tonsillitis may be associat$ ) endoc>ditis4 ,x may also be caus$ by o!r infecti\s diseases1 especially sc>let fev]1 b r>ely1 by typhoid fev]1 measles1 *ick5-pox1 diph!ria1 smallpox & erysipelas4 ,acute endoc>ditis is frequ5tly f\nd 9 *orea4 ,x is also met ) 9 diseases att5d$ ) emaciation & g5]al weakness1 z canc]1 g\t1 ,bright's disease & diabetes4 ,x is n uncommon 9 ph?isis4 ,micro-organisms play an excit+ "p1 b back ( ?is ! o/eopa? f9ds lesions ( ! he>t inn]vation important pr$ispos+ features4 ,prophylactic o/eopa?ic treatm5t is a pot5t factor 9 prev5t+ endoc>dial *anges 9 ! above diseases4 ,keep+ ! muscles relax$ & ! osse\s tissues intact is ( great value4 ,pa?ologically1 ! left side ( ! he>t is mo/ commonly involv$4 ,! disease is *>act]iz$ by ! pres5ce ( small vegetations on ! segm5ts or on ! l9+ membrane ( ! *amb]s1 al?\gh 9 mild cases !re is simply swell+ ( ! valves4 ,! mitral valves are m (t5 affect$ ?an ! aortic4 ,! vegetations appe>1 usually1 on ! auricul> surface ( ! mitral & ! v5tricul> surface ( ! aortic valves1 a little back ( ! valve edge4 ,_! seat corresponds to ! po9t ( maximum contact 7,sibson74 ,^! gr[?s are liable to be brok5 (f at any "t & c>ri$ z emboli by ! blood curr5t to di/ant organs1 p>ticul>ly ! bra91 sple5 & kidneys4 ,?is is n uncommon 9 acute endoc>ditis or *ronic valvulitis4 ,9 favorable cases ! vegetation is ultimately absorb$ & ! valve is b slightly alt]$ beyond a simple scl]otic ?ick5+4 ,?is is (t5 ! />t+ po9t ( scl]otic valvulitis4 ,o/eopa?ic measures und\bt$ly less5 ! liability ( c>diac involvem5t1 prev5t ext5sive *anges & promote absorption ( disease products1 by l[]+ he>t t5sion & improv+ ! c>diac nutrition1 z well z increas+ free elim9ation ( ! tox9s 9 ! blood4 ,dur+ ! fetal life1 ! "r side ( ! he>t is mo/ commonly involv$4 ,! *orda t5d9 are sometimes affect$1 b r>ely alone4 ,! vegetations are compos$ ( prolif]at$ connective tissue cells4 ,! sup]ficial elem5ts und]go a coagulation-necrosis & fibr9 is deposit$ f ! blood4 ,micro-organisms are f\nd & are ! specific ag5t 9 caus+ acute endoc>ditis4 ,symptoms4--,a l>ge numb] ( cases are lat5t1 ! autopsy fir/ disclos+ ! lesion4 ,9 _m cases !re are slight fev]1 a frequ5t1 sometimes irregul>1 pulse1 palpitation & dyspnea4 ,!re is seldom any pa94 ,physical signs are v unc]ta94 ,!y may n be pres5t 9 mild cases & 9 ^? 9 :i* ! valves are n affect$4 ,usually auscultation furni%es ! only indication ( endoc>ditis--a s(t1 bl[+1 sy/olic murmur :i* is he>d mo/ frequ5tly at ! apex1 z ! mitral valves are ! ones g5]ally involv$4 ,:5 ! aortic valves are affect$1 ! murmur is he>d at ! second int]space at ! "r edge ( ! /]num4 ,diagnosis4--,?is dep5ds entirely ^u ! etiology & physical signs4 ,! greate/ dang] is 9 ! disease becom+ *ronic4 ,treatm5t4--,! pati5t %\ld be kept z quiet z possible1 s t ! "w requir$ ( ! he>t may be r$uc$ to a m9imum4 ,! di/urb$ circulation c be controll$ by c>eful att5tion to ! vasomotor n]ves at ! v>i\s c5t]s along ! sp9e4 ,att5tion %\ld be giv5 ! disease t is caus+ ! endoc>ditis4 ,keep ! pati5t well protect$ by flannels & bew>e ( damp rooms & sudd5 *anges ( temp]ature4 ,treatm5t %\ld be giv5 to correct any lesion f\nd 9 ! upp] five dorsal v]tebr or ribs & to raise & spread all ( ^! ribs s t ! he>t's action w n be unduly di/urb$ by int]f]5ces ) its inn]vation4 ,! vasomotor n]ves to ! he>t's vessels are f\nd 9 ! vagi n]ves1 consequ5tly c>e %\ld be tak5 t lesions to ^! n]ves d n exi/4 ,an inhibitory treatm5t to ! suboccipital n]ves acts reflexly on ! vasomotor n]ves & t5ds to equalize ! g5]al vascul> sy/em4 ,?is treatm5t quiets ! he>t's action4 ,ice appli$ locally is advocat$ by _m practition]s4 ,flannels %\ld be plac$ next to ! sk9 & ! ice-bag plac$ ov] ! flannel4 ,?is r$uces ! fev]1 less5s ! pulse-rate & quiets ! he>t action4 ,! same po9ts are obta9$ by ! inhibitory treatm5t at ! suboccipital region4 ,! ice-bag also relieves pa9 & oppression4 ,be v c>eful 9 ! use ( ice :5 !re is mu* c>diac dilatation4 ,treatm5t ( ! middle & inf]ior c]vical regions may h "s effect 9 controll+ ! he>t's action4 ,a g5]al treatm5t to quiet ! pati5t is effective4 ,d n all[ any ov]ex]tion4 ,! pati5t %\ld h n\ri%+ liquid food4 ,em]y#ajj says3 8,_m ( u h be5 9 ! habit ( say+1 j because we he> a decid$ murmur 9 ! he>t region1 t ! pati5t has valvul> he>t tr\ble2 t ! pati5t has organic he>t tr\ble4 ,?is is a common error444 ,:5 !re is an anemic condition ( ! body1 app>5tly ! cusps ( ! valve w be s weak5$1 & ! atta*m5t w be s weak5$ t ! blood w =ce its way betwe5 ! valves & back into ! he>t1 caus+ regurgitation murmur1 :5 z an actual fact !re is no de=mity & no real disease ( ! valves1 & z soon z ! g5]al condition ( ! anemia is improv$1 ! valve w d its "w fully & ! murmur entirely cease4 ,s if y h ! murmur )\t ! hyp]trophi$ condition1 :i* at once foll[s su* a valvul> lesion1 y mu/ be gu>d$ 9 y\r /atem5ts1 = if an actual valvul> lesion exi/$1 comp5sation w\ld take place1 & x w\ld be ! means ( corroborat+ su* a valvul> condition2 if no hyp]trophy is f\nd1 !n we are n ju/ifi$ 9 def9itely /at+ t a valvul> or organic lesion exi/s1 = su* a weak5$ condition z has be5 m5tion$ might be ! only pa?ology pres5t1 & be ! cause ( ! murmur40 ,ulc]ative or malignant endoc>ditis4--,?is is an acute1 infecti\s or septic disease1 *>act]iz$ locally by necrosis or ulc]ation ( ! valve4 ,x is g5]ally a second>y affection to septicemia1 pneumonia1 erysipelas1 sc>let fev] & acute rheumatism4 ,acute endoc>ditis (t5 prec$es ! ulc]ative v>iety1 ! latt] be+ simply an increase 9 sev]ity ( ! =m]4 ,etiology & ,pa?ology4--,x is d\btful if !re c be a prim>y =m ( ulc]ative endoc>ditis4 ,*ronic valvul> defects are ! mo/ important pr$ispos+ causes4 ,pneumonia is mo/ frequ5tly1 ( all ! acute diseases1 associat$ ) sev]e endoc>ditis4 ,x is r>e 9 tub]culosis1 diph!ria1 typhoid fev] & *orea4 ,x occurs 9 association ) erysipelas1 gonorrhea & rheumatism4 ,septicemia1 pleurisy1 m5+itis & pu]p]al fev] are o!r possible causes ( ulc]ative endoc>ditis4 ,deep seat$ lesions1 :i* means firmly an*or$ lat]al flexions & rotations due to fibrotic *anges1 are important pr$ispos+ local factors1 :ile o!r lesions t di/urb blood elaboration & resi/ance & less5 elim9ation1 are pr$ispos+ sy/emic causes4 ,pa?ologically1 ! lesions are ei!r vegetative1 ulc]ative or suppurative4 ,! vegetations are compos$ ( granulation tissue1 granul> & fibrillat$ fibr91 & colonies ( micro-organisms4 ,!y become necrotic & break d[n into ulc]s4 ,! ulc]ative *anges may lead to p]=ations or produce valvul> aneurisms4 ,( ! valves ! mitral is ! mo/ frequ5tly affect$2 !n ! aortic2 !n ! mitral & ! aortic toge!r2 !n ! he>t walls2 !n ! tricuspid2 !n ! pulmon>y4 ,9 a few cases ! "r he>t alone is involv$4 ,! lesion is n always conf9$ to ! valves1 b may involve ! mural endoc>dium4 ,! mo/ common organisms f\nd are ! pneumococcus1 /reptococci & /aphylococci4 ,! bacillus diph!ri1 bacillus coli1 gonococcus1 bacillus an?racis & o!r organisms h be5 f\nd4 ,associat$ pa?ological *anges include ! lesions ( ! prim>y disease & ! *anges due to embolism4 ,! sple51 kidneys1 bra91 inte/9es & sk9 may be ! seat ( embolism4 ,:5 f\nd 9 ! lungs1 !y orig9ate 9 ! "r he>t4 ,symptoms4--,if 9 ! c\rse ( any ( ! diseases previ\sly nam$ "u etiology1 *ills foll[$ by fev] & sweats occur1 ulc]ative endoc>ditis %\ld at once be suspect$ & a ?or\gh exam9ation be made4 ,! g5]al symptoms are high1 irregul> fev]1 delirium1 sweat+1 great pro/ration1 rapid pulse1 hurri$ brea?+ & sometimes jaundice & di>rhea occur4 ,! occurr5ce ( delirium1 coma or hemiplegia po9ts to involvem5t ( ! bra92 pa9 9 ! region ( ! sple51 ) increas$ dullness on p]cussion1 po9t to tr\ble 9 t organ2 hematuria may occur f involvem5t ( ! kidneys4 ,m r>ely !re w be impair$ vision f ret9al hemorrhage2 & !re may be suppuration & sometimes gangr5e 9 v>i\s locations1 dep5d+ ^u ! position ( ! embolism4 ,! septic type is second>y to suppurat+ ext]nal w\nds1 pu]p]al sepsis or acute necrosis4 ,occasionally gonorrhea is ! cause4 ,! symptoms pres5t$ are rigors1 irregul> fev]1 sweats & exhau/ion--! signs ( septic infection4 ,! symptoms may resemble a quotidian or a t]tian ague4 ,! typhoid type is ! mo/ common4 ,! *>act]i/ic symptoms are irregul> temp]ature1 sweat+1 pro/ration1 delirium1 dr[s9ess1 di>rhea1 pete*ial & o!r ra%es1 di/5tion ( ! abdom5 & pa9 9 ! "r iliac region4 ,! he>t symptoms may be ov]look$1 z 9 ! septic type4 ,! c>diac type are cases ( *ronic valvul> diseases 9 :i* fev]1 rigors & sweats1 & ! symptoms ( embolism may develop4 ,9 ! c]ebral cases ! symptoms may simulate m5+itis4 ,acute delirium may be ! di/9ctive symptom4 ,he>t symptoms may be ov]look$4 ,physical ,signs4--,! he>t symptoms may be lat5t4 ,ev5 aft] a c>eful exam9ation1 !re may be no murmur pres5t4 ,:5 murmurs are pres5t x is (t5 difficult to locate !m4 ,diagnosis4--,! previ\s hi/ory %\ld be consid]$ & ?is1 toge!r ) ! symptoms1 makes a correct diagnosis possible1 ev5 ?\gh physical signs are abs5t4 ,! duration is f a few days to sev]al weeks4 ,treatm5t4--,! treatm5t ( ?is =m ( endoc>ditis is likely to be ( little avail1 al?\gh 9 a few cases :]e ! s\rce ( infection c be eradicat$ ! condition may be consid]ably improv$ & life prolong$4 ,ab\t ! same treatm5t z 9 simple endoc>ditis %\ld be foll[$4 ,absolute re/ is ess5tial & ?is1 c\pl$ ) ! local treatm5t ( simple endoc>ditis & a n\ri%+ liquid diet1 con/itutes ! pr9cipal treatm5t4 ,*ronic ,endoc>ditis ,?is condition may beg9 z a *ronic inflammation or foll[ ! acute =m1 :i* is m (t5 ! case4 ,!re is a scl]osis ( ! valves :i* causes de=mity1 ow+ to ! contractions4 ,! onset is usually insidi\s4 ,x is well kn[n t ! l>g] p]c5tage ( valvul> lesions are ! result ( ei!r acute or *ronic endoc>ditis4 ,?us rheumatism /&s =emo/ z a cause ( valvul> defects4 ,alcoholism & ov]eat+ 7?r\gh introduc+ irritat+ influ5ces into ! blood1 or by caus+ rheumatism1 g\t & alli$ diseases7 are important etiological consid]ations4 ,nephritis & syphilis are consid]$ among ! causative factors4 ,infections & s5ility1 :5 associat$ ) high blood pressure1 is a phase n to be ov]look$4 ,*ronic end>t]itis ext5d+ f ! aorta to ! valves1 result+ 9 ?ick5+ & deg5]ation ( ! tissue1 may be an insidi\s s\rce ( valve disease4 ,?is is probably (t5 ( syphilitic orig94 ,a pot5t cause ( special int]e/ to ! o/eopa? 7= ! reason t 8 treatm5t is s effective71 is cont9u$ muscul> /ra9 z se5 9 a?letes & labor]s4 ,! he>t muscle itself may be /ra9$1 p>ticul>ly ! valve leaflets & ! tissues ab\t ! valve1 :i* effect (t5 t]m9ates 9 valvul> leakage4 ,9 addition1 ! orifice ( ! valve op5+s may become /ret*$ & di/ort$ ?r\gh /ra9 sup]9duc$ by prolong$ ex]tion1 by flabb9ess ( he>t tissue1 & by dilatation ( ! v5tricles4 ,9 ^! latt] cases x is se5 t ! leaflets ( ! valves may rema9 intact1 b /ill !y are unable to /ret* completely across ! op5+4 ,) ! above condition x is readily not$ t ?ick5+1 curl+ & adhesions w take place :5 inflammation attacks ! valves & contigu\s tissues1 & foll[+ ^!1 limy infiltration & fatty deg5]ation may be a consequ5ce4 ,pr$ispos+ o/eopa?ic lesions z not$ 9 acute endoc>ditis1 are n to be neglect$4 ,?ick5+ & hyp]plasia are imm$iate consequ5ts ( connective tissue ov]gr[?2 & especially is *ronic end>t]itis accompani$ ) a!romat\s & calc>e\s deg5]ation4 ,?ick5+1 at times1 is only slight & ! function ( valves is n impair$4 ,9 curl+ or retraction1 !re occurs a %r9kage ( ! hyp]trophic or hyp]pla/ic tissues4 ,?is condition is v apt to become p]man5t4 ,adhesions ( ! valve leaflets is a self-evid5t condition4 ,x is well to note "h t 9 acute & *ronic endoc>ditis "s "p ( ! fibr\s valve ruptures or is lac]at$ or erod$ f /rong & rapid he>t action2 ! lac]ation or rupture or erosion always occurs at ! po9t ( maximum contact4 ,?us ! erod$ surface all[s an opportunity = ! rheumatic or septic micro-organisms to lodge1 multiply & gr[1 & adhesions result4 ,c>efully appli$ o/eopa?ic me?ods are v efficaci\s 9 imp5d+ acute he>t di/urbances1 & ?is )\t d\bt is ! reason :y s _m ( our rheumatic cases get well )\t any he>t affections4 ,keep+ ! he>t quiet$ & sl[$ prev5ts ! /rong & rapid action & ?us less5s ! probability ( lac]ations1 ruptures & erosions ( ! valve tissues4 ,g5]al resi/ance is increas$ & elim9ation improv$1 :i* h a decid$ effect 9 prev5t+ complications4 ,calcification & a!roma1 z has be5 m5tion$1 may foll[ ! above diseas$ processes4 ,! calcification is sometimes s m>k$ z to be ( ! "* ( a bony r+4 ,! "q arises "h1 ,:at effect h o/eopa?ic lesions z direct causative factors 9 valvulitis8 ,x appe>s reasonable t ! he>t is n exempt f ! influ5ces ( ! v]tebral & rib maladju/m5ts4 ,fur!rmore1 cl9ical exp]i5ce has abundantly prov5 t ! he>t tissues are affect$ by ^! lesions 9 ! same mann] z any tissue or organ is affect$4 ,aga91 o/eopa?ic dissection reveals direct n]v\s connection f ! upp] dorsal sp9al ganglia to ! he>t ganglia4 ,no "o w "q t ! integrity ( he>t function & life are dep5d5t ^u normal coron>y art]y supply1 ^u vasomotor equilibrium1 & ^u motor control4 ,all ( ^! functions are influ5c$ by ! /atus ( c]vical v]tebr1 upp] dorsal v]tebr1 & rib relations4 ,j :at ! pa?ological affection is :5 ^! anatomical p>ts are di/urb$ is beyond u until m c>eful dissection & exp]im5tation h tak5 place4 ,h[ c]vical & dorsal sympa!tics1 vasomotor & motor n]ves ) _! sp9al connections1 vagi & phr5ic1 are s di/urb$ z to involve valvul> p>ts & induce inflammation1 is a problem = u to inve/igate4 ,?r\gh analog\s reason+ f o!r organic ailm5ts & ?r\gh ! fact t o/eopa?ic !rapeutics corrects he>t lesions1 we "k 9 a g5]al way t ! correction ( o/eopa?ic lesions decid$ly influ5ces ! he>t4 ,two well kn[n physiological facts relative to ! he>t are3 fir/1 ! he>t increases 9 size up to adult life1 &1 second1 ! he>t muscle c actually be increas$ 9 size4 ,?is latt] fact occurs 9 physical developm5t & tra9+4 ,a he>t t is weak & flabby c be increas$ 9 /r5g?1 tone & size4 ,?is helps u to und]/& h[ c]ta9 /ra9s & di/ortions ( ! he>t1 ) consequ5t valvul> lesions1 may be correct$ ?r\gh re/1 ex]cise & treatm5t2 some:at analog\s to ! correction ( an atonic1 prolaps$ & dilat$ /oma*4 ,!n x also seems probable t di/urb$ inn]vation & blood supply to he>t areas or to ! he>t z a :ole w\ld pr$ispose to conge/ions1 inflammations & deg5]ations :]eby rheumatism1 septic /ates1 etc41 & muscul> /ra9s w\ld act only z excit+ causes1 n true causes4 ,no "o is go+ to expect t ?ick5$1 retract$1 adh]$1 or ruptur$ valves are to be made anatomically correct2 b ! "r treatm5t w c]ta9ly r$uce ! morbid /ate to ! m9imum4 ,!n !re are cases :]e o/eopa?s h elim9at$ all murmurs :5 speciali/s /at$ ! disease 0 incurable2 %[+ t x is impossible by signs & symptoms to always diagnose ! morbid tissue /ate4 ,only ! result+ effects ( size & ( leakage are def9itely reveal$ by auscultation & p]cussion4 ,h5ce !re is a class ( valvul> diseases t c be successfully treat$ by o/eopa?ic measures1 :i*1 if left to t]m9ate "u drug m$ication1 w reveal 7at po/-mortem7 ! pa?ological signs ( valvul> he>t disease4 ,d[nw>d displacem5t ( ! fir/ rib may int]f]e directly ) ! subclavian art]y & ?us cause con/riction ( t vessel & a consequ5t regurgitation2 also1 c>diac fib]s ( ! recurr5t l>yngeal n]ves may be imp+$ by a dislocation ( ?is rib4 ,_m lesions :i* int]f]e ) ! "r side ( ! he>t occur at ! second & ?ird ribs & lesions ( ! ?ird1 f\r? & fif? ribs may int]f]e ) ! valves4 ,lesions ( ! correspond+ v]tebr produce ! same results z ! ribs4 ,^! lesions are probably to ! sympa!tic n]ves along ! dorsal region4 ,lesions may be f\nd any:]e along ! c]vical v]tebr :i* may involve inhibitory 7vagi7 fib]s or accel]ator 7sympa!tic7 fib]s to ! he>t4 ,also1 9 "s cases ! float+ ribs are dislocat$ d[nw>d & cause a prolapse ( ! diaphragm1 & ?us a con/riction ( ! aorta1 :i* may result 9 regurgitation & valvul> disord]4 ,mitral ,regurgitation4--,mitral regurgitation is a leakage ( blood f ! left v5tricle1 ?r\gh ! mitral valves1 into ! left auricle4 ,! op5+ ( ! valve may be di/ort$1 or ! valve leaflets ?ick5$1 rigid1 or retract$1 ?us all[+ an escape or reflux ( blood f v5tricle into auricle4 ,! t5d9\s cords may also be ?ick5$ & adh]$1 ) consequ5t prev5tion ( free action4 ,by a =c+ back ( a portion ( ! blood f v5tricle to auricle at ! same "t ! pulmonic ve9s are empty+ into ! auricle1 an ov]di/5tion ( ! auricle takes place4 ,! auricle1 !n1 f ! extra am\nt ( "w requir$1 becomes hyp]trophi$ & dilat$4 ,!re may be no noticeable symptoms at fir/4 ,lat] on %ortness ( brea?1 c\gh1 irregul>ity ( he>t's action1 indige/ion1 liv] conge/ion1 & s on1 occur4 ,! apex beat is =cible & d[nw>d to ! left4 ,( c\rse ! area ( dullness is to ! "r & left4 ,!re is a sy/olic murmur 9 ! mitral area1 :i* is transmitt$ to ! left axilla4 ,e o/eopa? %\ld und]/& ! me*anism ( ?is mo/ frequ5t valvul> lesion4 ,foll[+ hyp]trophy & dilatation ( ! left auricle1 ! reflux may be s excessive t a residue rema9s4 ,! auricle n be+ able to h&le all ! blood1 /asis ( ! pulmon>y vessels takes place1 & pulmon>y edema & hydro?orax are sequel4 ,!n comes dilatation ( ! "r v5tricle & back pressure on tricuspid valves & "r auricle4 ,! ve9s ?r\gh\t ! body become turgesc5t1 & ! liv] is apt to be indurat$4 ,x %\ld be emphasiz$1 h[ev]1 t 8back pressure0 is only an effect commonly due to myoc>dial deg5]ation1 caus$ by "s infection1 ( :i* auricul> fibrillation is an important "p ( ! pa?ology4 ,be=e ! break+ d[n ( ! left he>t comp5sation1 o/eopa?ic me?ods1 z all "k1 are effective 9 ma9ta9+ balance4 ,ev5 aft] ! lungs beg9 to be affect$1 c>eful & ?or\gh treatm5t w result 9 good1 & 9 cases ( g5]al v5\s sluggi%ness treatm5t1 p>ticul>ly to liv]1 diaphragm1 b[els & limbs1 w g5]ally mat]ially help 9 sl[+ ! d[nw>d c\rse ( ! disease4 ,mitral ,/5osis4--,9 /5osis !re is n>r[+ or con/riction ( ! valve op5+4 ,?us 9 mitral /5osis ! free fl[ ( ! blood f left auricle to v5tricle is h9d]$4 ,! cusps are usually ?ick5$1 rigid & adh]$4 ,! valve op5+ may be s /5os$ z to be b a n>r[ slit4 ,9 all cases /5osis is a /ructural defect4 ,x c occur by /ra9s1 z regurgitative effects sometimes result4 ,! symptoms ( mitral /5osis are practically ! same z ^? ( mitral regurgitation1 ow+ to simil> effects ^u ! circulation4 ,"u physical signs we f9d ! apex-beat is only slightly displac$4 ,palpation w reveal1 ne> ! apex1 a r\gh presy/olic ?rill4 ,! increas$ area ( dullness is to ! "r4 ,!re is an abruptly t]m9at+1 r\gh1 presy/olic murmur4 ,aortic ,regurgitation4--,aortic regurgitation is a reflux ( blood f aorta to left v5tricle1 foll[+ v5tricul> sy/ole4 ,?is is consid]$ ! mo/ s]i\s ( ! valvul> diseases4 ,! valve op5+ is ei!r too l>ge1 s ! valve leaflets d n fit tightly1 or ! segm5ts !mselves are ?ick5$ & retract$4 ,/ructural defects ( ! aortic valves are l>gely ( ! same "* z 9 diseases ( ! mitral valves4 ,! regurgitation fir/ causes dilatation ( ! left v5tricle4 ,?is is foll[$ by hyp]trophy4 ,if ! mitral valve holds intact1 no fur!r effects result4 ,b if ! mitral valve is diseas$ or becomes incompet5t f ! dilat$ v5tricle1 ! same morbid /ates foll[ z 0 not$ "u mitral regurgitation4 ,!re is a =cible apex-beat1 displac$ d[nw>d to ! left4 ,! increas$ dullness is to ! left4 ,!re is a long1 l\d dia/olic murmur4 ,! well kn[n 8wat]-hamm]0 pulse is felt4 ,aortic ,/5osis4--,aortic /5osis indicates a n>r[+ ( ! aortic orifice4 ,x is a /ructural defect4 ,! free fl[ ( blood is ob/ruct$ f ! left v5tricle into ! aorta4 ,aortic /5osis is mu* less frequ5t ?an regurgitation4 ,aortic /5osis & regurgitation are v apt to be associat$4 ,! beat is commonly =cible1 & ! increas$ area ( dullness is to ! left4 ,!re is a sy/olic murmur1 he>d be/ at ! "r second int]space1 :i* is conduct$ into bo? c>otid art]ies4 ,tricuspid ,regurgitation4--,tricuspid regurgitation is ! mo/ common valvul> lesion affect+ ! "r he>t4 ,x is r>e z a prim>y lesion4 ,! affection may be ( a /ructural "*1 or functional4 ,hyp]trophy ( ! "r v5tricle occurs aft] ! mann] ( left v5tricle hyp]trophy 9 mitral regurgitation4 ,! sequel ( v5\s turgesc5ce foll[1 also1 9 ! same way z 0 giv5 "u ! mitral lesions4 ,tricuspid regurgitation r>ely exi/s indep5d5t ( "s o!r c>diac or pulmon>y ailm5ts4 ,! apex-beat is diffus$ t[>d ! epiga/rium4 ,increas$ c>diac dullness is t[>d ! "r4 ,!re is a sy/olic murmur1 :i* is he>d be/ j above ! xiphoid c>tilage4 ,! jugul> ve9 pulsates2 9 sev]e cases !re is pulsation ( ! liv]4 ,o/eopa?ic treatm5t is usually effective 9 reliev+ ! engorgem5t ( ! ve9s1 & p>ticul>ly 9 r$uc+ liv] conge/ion4 ,tricuspid ,/5osis4--,?is affection is said to be ! mo/ r>e ( valvul> lesions4 ,?ick5+1 ob/ruction & adhesions f endoc>ditis cause ! /5osis4 ,z 9 o!r lesions ( ! he>t1 !re is a cong5ital =m4 ,!re is presy/olic murmur1 he>d be/ at ! xiphoid c>tilage4 ,! pulse is small & weak4 ,pulmon>y ,regurgitation4--,?is is ano!r r>e lesion1 & is seldom met ) 9 a simple =m4 ,!re is =cible pulsation 9 ! epiga/rium4 ,increas$ c>diac dullness is d[nw>d4 ,!re is a dia/olic murmur1 he>d mo/ di/9ctly at ! left second int]co/al space4 ,pulmon>y ,/5osis4--,ano!r r>e lesion4 ,! effect ( ?is lesion on ! "r v5tricle is ! same z t ( aortic /5osis on ! left4 ,! cong5ital lesion is apt to occur ) a patul\s =am5 ovale4 ,!re is a sy/olic murmur1 he>d be/ at ! second int]co/al space on ! left4 ,_m sy/olic murmurs he>d ov] ! pulmon>y op5+ are functional4 ,comb9$ ,valvul> ,lesions4--,:5 two or m lesions occur at ! same "t ! t]ms1 comb9$ or associat$1 are employ$4 ,?is is a v common occurr5ce4 ,two1 ?ree or all ( ! valves may be affect$ at ! same "t4 ,/5osis & regurgitation at ! same orifice is ! mo/ common association ( any two valvul> lesions4 ,:5 !re is a jo9t affection ( two or m valves1 ! aortic & mitral are mo/ commonly associat$2 !n mitral & tricuspid2 !n aortic1 mitral & tricuspid4 ,prognosis & ,treatm5t ( ,valvul> ,diseases4--,x is impossible to outl9e ) exactness ei!r prognosis or treatm5t ( he>t lesions4 ,all w agree t ! "* ( ! lesion is ! fir/ consid]ation1 & be=e records ( ^! cases c be ( any sci5tific b5efit1 we mu/ look well to ! nature ( ! valvul> leakage or ob/ruction & note precisely :at effect our !rapeutics has4 ,p]haps ( greate/ consid]ation 9 ! matt] ( prognosis is1 to :at ext5t comp5sation has be5 ma9ta9$4 ,we "k t comp5sation may be p]fect2 t hyp]trophy & dilatation may balance ! valvul> defect s ?or\ghly t ev5 ! pati5t is n aw>e ( a he>t lesion4 ,z soon z comp5sation beg9s to fail1 :5 palpitation1 irregul>ity ( pulse1 dyspnea1 edema1 etc41 appe>1 we "k t our treatm5t %\ld pass f ! realm ( ! def5sive to t ( ! (f5sive4 ,!n :5 comp5sation fails /ill m1 prognosis & treatm5t mu/ necess>ily be *ang$ accord+ to ! increas+ gravity4 ,9 our o/eopa?ic "w we %\ld nev] =get t ! condition ( ! lesion may be greatly influ5c$ by environm5t4 ,habits1 occupation & g5]al daily life may affect ! he>t ailm5t = good or bad4 ,?us 9 prognosis we h ?ree features 9 p>ticul> to note3 "* ( he>t lesion1 ext5t ( sy/emic involvem5t1 & environm5t4 ,9 ! imm$iate prognosis1 ! ext5t ( g5]al v5\s /asis1 if any1 is ( great importance4 ,9 o!r words1 ! gravity ( ! complications is ( fir/ consid]ation4 ,aortic regurgitation is rank$ by he>t speciali/s z ! mo/ s]i\s lesion4 ,aortic /5osis is a grave lesion1 b n s s]i\s z aortic regurgitation4 ,x is (t5 /at$ t ! "* ( ! lesion is n ( s mu* consequ5ce z ! ext5t ( involvem5t ! lesion has eng5d]$4 ,mitral /5osis is m grave ?an mitral regurgitation4 ,"r side he>t lesions are usually relative1 &1 naturally1 :5 ! "r he>t is diseas$ f ext5sion ( ! ailm5t f ! left side1 ! situation is s]i\s4 ,x %\ld be rememb]$ t a he>t normal 9 size & beat+ regul>ly is usually 9 a fairly heal?y condition ev5 if a murmur is pres5t4 ,9 our treatm5t ! fir/ po9t indicat$ is to improve1 if possible1 ! integrity ( he>t muscle & less5 ! valvul> defects1 if su* c be done4 ,ow+ to a de>? ( /ati/ics1 x is impossible to /ate to :at ext5t improvem5t 9 organic lesions has be5 accompli%$4 ,v likely if we _h /ati/ics & no po/-mortem f9d+s1 we w\ld /ill be 9 ! d>k z to mu* ( our "w4 ,?is mu* is positive3 o/eopa?s h "t & aga9 app>5tly cur$ grave valvul> lesions2 cases t em95t speciali/s diagnos$ z absolutely organic lesions4 ,our practition]s h elim9at$ ! murmurs1 r$uc$ ! size ( ! he>t1 & remov$ any & all sy/emic symptoms4 ,^! pati5ts are well1 h be5 well = ye>s1 & are lead+ active lives4 ,b 7 ^! cases suff]+ f organic lesions8 ,no d\bt !re 0 valvul> leakage1 hyp]trophy & dilatation1 b 0 ! valve defect a functional "o8 ,9 o!r words1 0 x due to /ra9 & di/ortion8 ,9 all probability ! pati5ts' days 7 numb]$ & po/-mortems w\ld h %[n grave lesions & q likely m or less organic *anges4 ,does x n seem likely t "s functional lesions may t]m9ate 9 organic lesions8 ,?r\gh cont9u$ /ret*+ ( ! valves & _! imm$iate tissues1 fatty deg5]ation may take place2 ! same z fatty deg5]ation ( ! he>t muscle1 occurr+ 9 dilatation ( ! *amb]s4 ,if we c rem$y functional lesions ?r\gh specific "w ^u n]ve c5t]s & fib]s1 :y _c we influ5ce organic lesions & at lea/ r$uce ! gravity to a m9imum8 ,we "k functional diseases ( ! he>t1 z palpitation1 rapid he>t1 sl[ he>t1 etc41 c be correct$1 & f all indications1 functional valvul> leakages are g5]ally easily & quickly rem$i$2 x is only a /ep f>!r to affect truly organic lesions4 ,! same valves1 ! same n]ves1 & ! same o/eopa?ic lesions are not$4 ,!n x is only a cont9uation ( ! same process f functional disease to organic disease4 ,inde$1 no "o is able to draw a l9e betwe5 ! two4 ,probably1 z 0 intimat$ be=e1 c>eful o/eopa?ic treatm5t 9 rheumatism & o!r diseases t are apt to pr$ispose to he>t affections1 w keep ! he>t s /rong functionally & organically t result+ valvul> lesions are n ne>ly s likely to develop4 ,! he>t c be treat$ & controll$ z c any tissue or organ4 ,x c]ta9ly /&s to reason t o/eopa?ic !rapeutics is rational 9 bo? prev5t+ & cur+ valvul> lesions4 ,! ,m4 ,d4 gives 8 drugs ) ! hope ( ma9ta9+ he>t muscle integrity1 ( less5+ a too =ceful beat1 ( increas+ wan+ p[]1 ( promot+ g5]al circulation1 ( prev5t+ & less5+ complications4 ,we c d ! same ?+ ) our me?ods1 ev5 m effectually1 & ) no probability ( h>mful effects4 ,x w\ld appe> !re are at lea/ two ways 9 :i* organic lesions may develop4 ,fir/1 z /at$ above1 ?r\gh functional di/ortion1 ! normal he>t muscle be+ /ra9$ f sev]e ex]cise1 or a weak1 flabby1 or disus$ he>t muscle be+ ov]tax$ by ord9>y ex]cise4 ,"h x w be se5 t 9 ! fir/ in/ance imm$iate re/ w probably correct ! weakness2 9 ! second1 re/ & g5]al build+ up ( ! body if ! atonic he>t muscle result$ f "s debilitat+ disease4 ,if f local causes correction ( ! specific o/eopa?ic lesion %\ld be effective4 ,secondly1 ?r\gh /rong & rapid he>t action ! valves are ruptur$ or lac]at$1 always at ! po9t ( maximum contact1 & ?us pres5t a favorable surface to micro-organisms4 ,ow+ to ! valves be+ a r$uplication ( ! endoc>dium1 !y h no muscles or blood-vessels1 s t 9 functional leakages1 inflammation does n play a "p1 h5ce1 a possibility ( deg5]ation occurr+ f excessive /ret*+4 ,! l>ge majority ( o/eopa?ic lesions are unque/ionably f\nd 9 ! upp] five dorsal v]tebr & ! fir/ five or six ribs on ! left side1 al?\gh c]vical lesions1 9 _m in/ances1 play an important second>y1 if n ! prim>y1 role4 ,^! maladju/m5ts affect vasomotor n]ves to ! he>t1 t is1 to coron>y vessels1 ! dorsal & c]vical sympa!tics1 ! vagi1 & ! phr5ic4 ,we are unable to /ate j h[ ^! lesions di/urb n]ve conductivity2 :at pres5t anatomy & physiology tea* u does n fully expla94 ,o/eopa?ic dissection mu/ be ! means to ! end ( ! explanation4 ,we h _m cl9ical results1 b n ! physiological k1 z yet1 to support x4 ,! dropp+ d[n ( ! fir/ rib1 z well z ! clavicle1 int]f]es ) ! l>ge blood-vessels1 especially ! subclavian1 & causes increas$ resi/ance ( ! he>t's action & probably a c]ta9 regurgitative effect4 ,?is regurgitative effect w\ld also occur 9 cases ( ob/ruction to ! aorta by con/riction ( ! diaphragm f dropp+ ( ! float+ ribs4 ,to :at ext5t ?is latt] feature has be5 demon/rat$ is n kn[n4 ,9 valvul> diseases x is practical to divide !m = treatm5t into1 fir/1 :]e ! lesion is comp5sat$2 second1 :]e comp5sation is incomplete2 ?ird1 :]e comp5sation is lo/4 ,) all cases we %\ld give consid]ation to environm5t1 temp]am5t1 habits1 food1 clo?+1 ex]cise1 etc4 ,(t5 ^! second>y matt]s are ( vital importance1 especially :5 comp5sation is fail+4 ,! ,s*ott me?od ( treatm5t may be ( "s avail2 ?is treatm5t1 :i* is compos$ ( a s]ies ( resi/ant ex]cises1 t5ds to less5 p]iph]al resi/ance1 develop he>t muscle1 & remove he>t /asis4 ,speak+ 9 g5]al1 hyp]trophy & dilatation foll[ valvul> leakage1 z a second>y effect4 ,x is a comp5satory condition1 & :5ev] comp5sation is fail+1 !re is naturally a break+ d[n ( ! /ructural tissues ( ! he>t2 t is1 ! muscul> hyp]trophy is los+ 9 integrity4 ,our prim>y aim1 !n1 %\ld be to keep up ! comp5sation1 :i* is repres5t$ 9 ! hyp]trophy1 al?\gh !re are cases t fail rapidly1 especially 9 emphysema & cirrhosis ( ! lungs4 ,g5]ally1 9 hyp]trophy & dilatation1 !re is a disproportion betwe5 ! am\nt ( "w ! he>t has to d & its ability to d x4 ,"o ( two ?+s has occurr$2 !re is an increase 9 p]iph]al resi/ance or ! volume ( blood ?r\gh ! he>t is abnormal 9 quantity#aja4 ,l\don#ajb says3 8,! treatm5t ( *ronic disease ( ! he>t requires a long] "t1 z a rule1 ?an ! same disord] 9 ! acute /age4 ,"s cases _c be mat]ially help$2 a va/ majority may be greatly b5efit$ aft] a ?or\gh trial2 :ile m ?an we might at fir/ suppose1 c be entirely cur$4 ,we desire to quote at l5g? f ,h>e relat+ to ?is po9t4 ,he says3 #8,a *ronic /ructural *ange 9 ! he>t result+ f an acute process is n always synonym\s ) *ronic he>t disease4 ,?us1 acute endoc>ditis occasions a v>iety ( *anges ( ! mitral & aortic valves :i* long may indicate _! pres5ce by _! *>act]i/ic murmurs1 & yet 9 "t ^! may :olly disappe>4 ,t _m su* cases outgr[ ! valvul> tr\ble1 especially mitral lesions1 !re c n[ be no d\bt4 ,! majority1 ev5 ( ^? 9 :om valvul> murmurs p]man5tly cont9ue1 d n h _! heal? unfavorably affect$ = ye>s1 & 9 _m ( ^!1 ! duration ( life is n appreciably %ort5$4'0 ,?is /atem5t1 f su* an au?or1 gives ! o/eopa? great enc\ragem5t2 = add to ^? above ref]r$ to1 :i* recov] 9 "t f all valvul> tr\ble1 ! _m cases ( valvul> insuffici5cy1 due to dilatation1 ow+ to o/eopa?ic lesions to ! trophic n]ves1 & :i* may be cur$ by remov+ su* lesions1 we f9d t q a p]c5tage ( cases are ?us dispos$ (4 8,x is d\btless true1 also1 t ! cases above m5tion$ hav+ valvul> ?ick5+ & vegetations1 c\ld h be5 cur$ 9 quick] "t & great] numb] _h o/eopa?ic treatm5t be5 giv5 to tone ! he>t1 upbuild ! g5]al circulation & increase ! activities ( ! excretory organs4 ,! importance ( ! lungs is (t5 ov]look$ 9 ! treatm5t ( c>diac diseases4 ,! o/eopa?'s ability to exp& ! *e/ & increase ! capacity ( ! ?orax %\ld be demon/rat$ 9 bo? c>diac & pulmon>y tr\bles4 ,x is said to be a univ]sal law ?r\gh\t ! animal k+dom #8t muscul> p[] is directly proportional to ! am\nt ( oxyg5 consum$4' ,h5ce give ! p[]1 & h y\r pati5t live z mu* out ( doors z practicable4 ,ex]cise %\ld be mod]ate & always /opp$ %ort ( fatigue40 ,treatm5t ( ! abdom9al organs %\ld n be neglect$1 = improv$ circulation "h & ?or\gh removal ( effete products w influ5ce ! he>t4 ,fre$om f worry1 /ra9s1 etc4 are ess5tial4 ,tepid ba?s are be/4 ,a p]son may h a valvul> leakage & n be aw>e ( x4 ,probably x is be/ to in=m !m1 except 9 c]ta9 neurotic individuals4 ,= !n !y c take special c>e ( !mselves1 z to ov]work1 /ra9s & int]curr5t infections1 & _! life & usefulness be greatly prolong$4 ,:5 comp5sation beg9s to break1 c]ta9 symptoms are notic$1 z he>t irregul>ity1 difficult brea?+1 p>ticul>ly at night1 %ortness ( brea?1 & m or less anemia4 ,lat] !re is di/urbance ( rhy?m1 cyanosis1 dilatation ( he>t & dropsy4 ,frequ5tly1 consid]able c be accompli%$ ?r\gh ! upp] dorsal treatm5t1 att5tion to ! *e/ mobility1 manipulation ( ! abdom9al organs & diaphragm1 & special att5tion to ! diet1 re/ & "s ex]cise4 ,a light g5]al treatm5t w assi/ ! labor$ circulation & improve assimilation1 & a *ange ( climate may be ( b5efit4 ,hyp]trophy ( ! ,he>t ,hyp]trophy ( ! he>t is an enl>gem5t ( ! he>t1 due to an increase 9 ! muscul> tissue4 ,x is usually associat$ ) dilatation4 ,! v5tricles are m (t5 involv$ ?an ! auricles1 & ! left v5tricle is m likely to be affect$4 ,etiology4--,valvul> disease ( ! he>t caus+ an ob/ruction to ! outfl[ ( blood1 z mitral insuffici5cy1 diseases ( ! aortic valve2 increas$ intra-vascul> pressure1 caus$ by scl]otic *anges 9 ! walls ( ! vessels2 contraction ( small] art]ies1 due to irritation ( toxic sub/ances 9 ! blood1 z 9 ,bright's disease4 ,ov]eat+ or dr9k+ & excessive physical ex]cise w\ld also induce hyp]trophy ( ! left v5tricle4 ,hyp]trophy ( ! "r v5tricle is caus$ by valvul> lesions on ! "r side4 ,lesions ( ! mitral valve caus+ an increas$ resi/ance 9 ! pulmon>y vessels are etiologic factors2 also diseases ( ! pulmon>y vessels 9 ! lungs1 z 9 cirrhosis & emphysema4 ,!re are conditions affect+ ! he>t1 z ! use ( tea1 alcohol & tobacco4 ,di/urb$ inn]vation1 z 9 exoph?almic goit]2 d]angem5ts ( ! v]tebr1 & ribs correspond+ to ! upp] five dorsals2 d[nw>d displacem5ts ( ! float+ ribs1 caus+ a prolapse ( ! diaphragm & a consequ5t ret>dation ( blood ?r\gh x to & f ! he>t1 w affect ! he>t's action4 ,simple hyp]trophy nev] occurs 9 ! auricles2 x is always accompani$ ) dilatation4 ,! condition develops 9 ! left auricle 9 mitral lesions2 9 ! "r auricle :5 !re are di/urbances ( ! pulmon>y circulation4 ,! tricuspid is r>ely affect$ prim>ily4 ,pa?ologically1 ! left side ( ! he>t is m commonly enl>g$ ?an ! "r2 ! v5tricles ?an ! auricles4 ,! %ape ( ! he>t v>ies :5 ! left v5tricle is hyp]trophi$1 ! conical %ape be+ m or less lo/2 x lies m horizontally & is elongat$4 ,:5 bo? v5tricles are enl>g$ ! he>t is r\nd4 ,:5 ! "r v5tricle is affect$1 x occupies ! l>ge/ "p ( ! apex4 ,! increase 9 ! size ( ! he>t is probably due to a num]ical increase 9 ! muscle cells4 ,! muscle is firm1 ( deep r$ color & cuts ) consid]able resi/ance4 ,normally1 ! he>t weighs f eight to n9e ounces4 ,9 g5]al hyp]trophy x may weigh f fifte5 to ?irty ounces4 ,symptoms4--,hyp]trophy1 be+ a cons]vative process or an act ( comp5sation1 does n necess>ily pres5t any symptoms at fir/4 ,at ! beg9n+ !re is r>ely any pa91 b a s5se ( fullness & discom=t is pres5t4 ,z ! hyp]trophy increases1 ! art]ies become full]1 ! ve9s less full & ! circulation accel]at$4 ,9 hyp]trophy associat$ ) art]ioscl]osis ! blood pressure is increas$1 & ! pulse full & firm4 ,epi/axis may be ( frequ5t occurr5ce & ! face conge/$4 ,pa9s occur 9 ! precordial region4 ,!re are n]v\sness1 heada*e1 hot flu%es1 palpitation1 c\gh & v]tigo4 ,9 hyp]trophy ( ! left v5tricle1 ! apex is l[] & to ! left4 ,! c>otids pulsate visibly & ! radial pulse is /rong & t5se4 ,p]cussion reveals enl>gem5t to ! left & d[nw>d4 ,! fir/ s\nd is l\d] & prolong$4 ,! aortic second s\nd is int5sifi$4 ,9 hyp]trophy ( ! "r v5tricle ! enl>gem5t is to ! "r edge ( ! /]num4 ,! second s\nd 9 ! pulmon>y area is increas$4 ,! apex-beat is displac$ outw>d4 ,! pulse at ! wri/ is usually small4 ,hyp]trophy ( ! auricles always occurs ) dilatation1 :i* is mo/ common 9 ! left auricle4 ,! physical signs are *>act]i/ic4 ,!y are caus$ by diseases ( ! mitral & tricuspid valves & diseases ( ! lungs1 z emphysema & cirrhosis4 ,diagnosis4--,if a c>eful exam9ation is made1 hyp]trophy c h>dly be mi/ak5 = any o!r condition4 ,!re may be a resemblance to p]ic>dial effusion1 pleuritic effusion1 aneurism or m$ia/9al tumor1 :5 ne> ! he>t4 ,! ,x-ray w be ( assi/ance4 ,prognosis4--,dep5ds l>gely ^u ! cause produc+ ! hyp]trophy4 ,rememb] t hyp]trophy is a comp5satory act4 ,! prognosis is m or less unfavorable if result+ f emphysema1 ,bright's disease or 9 old age2 also 9 deg5]ation ( ! vessels4 ,9 mo/ cases ( functional ov]action1 p]si/5t treatm5t c usually accompli% consid]able4 ,treatm5t4--,! treatm5t mu/ be accord+ to ! cause ( ! hyp]trophy4 ,!re are _m etiological factors1 consequ5tly ! treatm5t dep5ds ^u ! influ5ce ( ^! factors4 ,! pr9cipal treatm5t w be f\nd "u endoc>ditis1 z valvul> diseases are usually caus$ by endoc>ditis1 & hyp]trophy ( ! he>t is a cons]vative process ( nature--an act ( comp5sation second>y to valvul> & art]ial lesions4 ,! indications are to less5 ! =ce & numb] ( pulsations ( ! he>t & remove ! cause if possible4 ,dilatation ( ! ,he>t ,!re may be dilatation ) ?ick5+ ( ! walls1 & dilatation ) ?9n+ ( ! walls1 or !y may be normal4 ,x may be produc$ by impair$ nutrition ( ! c>diac muscle or increas$ endoc>dial t5sion4 ,m frequ5tly ! two conditions act jo9tly1 al?\gh !y may act s+ly4 ,impair$ nutrition ( ! c>diac muscle may dim9i% ! resi/+ p[] & ?us cause dilatation4 ,weak5+ ( ! c>diac walls may occur 9 sc>lat9a1 typhoid1 typhus1 rheumatic fev]1 etc4 ,x is met ) 9 *lorosis1 anemia & leukemia4 ,increas$ endoc>dial t5sion occurs 9 sudd51 extreme ex]tions & 9 valvul> diseases4 ,a normal he>t ?r\gh excessive ex]tion is r>ely if ev] dilat$4 ,! important causes are consid]$ "u hyp]trophy4 ,bo? impair$ nutrition & increas$ endoc>dial t5sion are influ5c$ directly by ! ext5t & sev]ity ( ! o/eopa?ic lesion4 ,?is po9t has be5 consid]$ "u *ronic endoc>ditis4 ,pa?ologically1 ! "r side is m commonly affect$ ?an ! left4 ,9 advanc$ aortic incompet5cy1 all ! divisions may be dilat$4 ,:5 "o v5tricle alone is dilat$ ! septum may be se5 to bulge4 ,9 ext5sive dilatation1 ! auriculo-v5tricul> r+s are (t5 dilat$4 ,o!r orifices may also be dilat$4 ,! condition is (t5 associat$ ) hyp]trophy & fatty deg5]ation4 ,! muscle may be normal 9 appe>ance4 ,! endoc>dium is (t5 opaque1 & r\gh5$ 9 pat*es4 ,!re is deg5]ation ( ! ganglia ( ! he>t4 ,symptoms4--,dilatation causes weakness ( ! walls ( ! he>t1 b z long z ! hyp]trophi$ walls c comp5sate1 no symptoms result4 ,:5 ! hyp]trophy weak5s1 great] dilatation occurs & symptoms ( v5\s /asis appe>1 z dropsy1 feeble irregul> pulse1 dyspnea1 c\gh & scanty ur9e4 ,9 "s in/ances !re may be brief precordial di/ress1 fa9tness or palpitation4 ,physical ,signs4--,on inspection ! apex-beat is diffuse & feeble1 or x may n exi/4 ,z obs]v$ by ,wal%1 ! impulse may be visible & yet n palpable4 ,palpation--! impulse is diffuse1 feeble & flutt]+4 ,! pulse is small1 rapid & irregul>1 r>ely is x sl[4 ,p]cussion--! area ( lat]al dullness is increas$ to ! "r4 ,!re is increase 9 ! dullness d[nw>d to ! six? int]space & upw>d to ! second rib 9 _m cases4 ,auscultation--! s\nds are weak & %>p4 ,! fir/ s\nd is %ort]1 lacks its muscul> elem5t & becomes m l ! second4 ,! s\nds are obscur$1 ! c>diac murmurs are pres5t4 ,9 _m cases ! *>act]i/ic gallop rhy?m is pres5t4 ,:5 ! "r he>t is *iefly dilat$1 ! true apex-beat _c be felt1 :ile an impulse may be felt bel[ ! xiphoid c>tilage1 & a wavy impulse is se5 9 ! f\r?1 fif? & six? int]spaces to ! left ( ! /]num4 ,diagnosis4--,:5 a cle> hi/ory c be obta9$1 toge!r ) ! *>act]i/ic features1 ! diagnosis c be readily made4 ,prognosis dep5ds ^u ! cause4 ,treatm5t4--,! treatm5t ( dilatation is t ( valvul> he>t disease4 ,x is important t ! pati5t %\ld h pl5ty ( re/1 suitable food & regulat$ ex]cises4 ,9 acute dilatation absolute re/ is necess>y4 ,limit ! fluid intake1 & op5 ! b[els ?or\ghly4 ,9 s]i\s cases1 ble$+1 a p9t or m1 %\ld be consid]$4 ,myoc>ditis ,myoc>ditis is an acute or *ronic inflammation ( ! he>t muscle4 ,9 _m cases :]e ! muscle sub/ance ( ! he>t is diseas$1 !re is no d\bt t o/eopa?ic lesions are pot5t und]ly+ factors4 ,! lesions less5 n]v\s integrity & ?us h a direct be>+ ^u ! muscul> /r5g? & ! likelihood ( inflammatory invasion4 ,acute ,int]/itial ,myoc>ditis4--,?is affection is met ) 9 fev]s1 9 connection ) endoc>ditis & p]ic>ditis4 ,( ! infections diph!ria & typhoid are ! mo/ frequ5t4 ,septic emboli may block ! coron>y art]ies 9 pyemia1 septicemia & malignant endoc>ditis & cause inf>cts 9 ! myoc>dium ) abscess =mation4 ,x may be a complication ( gonorrhea4 ,males are affect$ m (t5 ?an females4 ,pa?ologically1 9 acute int]/itial myoc>ditis ! *anges take place 9 ! int]muscul> connective tissue4 ,?is becomes swoll5 & r\nd-cell infiltration takes place4 ,! muscle sub/ance is pale & s(t4 ,acute p>5*ymat\s deg5]ation is *>act]iz$ by deg5]ation ( ! muscle fib]s1 :i* are infiltrat$ ) granules4 ,! c>diac muscle ?r\gh\t is pale & s(t4 ,acute suppurative myoc>ditis is a r>e condition4 ,9 ?is =m abscesses occur1 :i* v>y 9 size f a p9's head to a pea4 ,!y v>y greatly 9 numb] & are usually multiple4 ,!y may n cause any di/urbance & may n be recogniz$ be=e dea?4 ,on ! o!r h& ! abscess may rupture into ! he>t cavities or ! p]ic>dium1 or x may p]=ate ! intrav5tricul> septum1 ?us all[+ ! v5\s & art]ial blood to int]m+le4 ,x may cause a c>diac aneurism4 ,symptoms4--,^! are v unc]ta94 ,if dur+ ! c\rse ( any ( ! causal diseases1 ! pulse sudd5ly becomes rapid1 small & irregul> & compressible & palpitation & syncope develop1 all ( :i* po9t to c>diac weakness1 myoc>ditis may be suspect$4 ,signs ( v5\s /asis develop lat] 9 ! affection4 ,! physical signs are ^? ( dilatation4 ,?is is extremely grave4 ,cases d1 h[ev]1 recov]4 ,treatm5t4--,! treatm5t is ! same z t giv5 "u endoc>ditis & p]ic>ditis4 ,re/ 9 b$ is absolutely necess>y4 ,pay p>ticul> att5tion to ! n\ri%m5t & to ! hygi5ic surr\nd+s ( ! pati5t4 ,especially att5tion %\ld be giv5 to ! upp] dorsal area1 bo? to ! muscles & ! int]osse\s lesions1 = ?is influ5ces c>diac muscle inn]vation & nutrition4 ,!n lesions ( ! upp] c]vical are important ow+ to _! relation%ip to ! vagi :i* control muscul> impulses ( ! he>t muscle4 ,*ronic ,int]/itial ,myoc>ditis4--,among ! causes ( ?is =m ( myoc>ditis are ! excessive use ( tobacco or alcohol2 g\t1 rheumatism1 mal>ia1 diabetes1 *ronic nephritis1 syphilis & lead poison+4 ,acute int]/itial myoc>ditis may lead to ! *ronic =m4 ,?is =m is 8commonly caus$ by ! n>r[+ ( a coron>y bran* 9 a process ( oblit]ative end>t]itis0 7,osl]74 ,x may be due to injuries ( ! ant]ior & lat]al portions ( ! *e/4 ,unque/ionably o/eopa?ic lesions ( ! upp] dorsal v]tebr & ribs & c]vical region affect ! integrity ( ! he>t muscle & pr$ispose to conge/ion1 inflammation & debility ( ! tissue4 ,males ( middle life are m pr$ispos$ to *ronic myoc>ditis4 ,! pa?ological *anges occur mo/ frequ5tly 9 ! left v5tricle & ! septum1 b !y may occur 9 any portion4 ,! pat*es & /reaks t are 9 ! walls are sometimes only se5 ^u v c>eful exam9ation4 ,!y are ( a gray or grayi%-:ite color1 & :5 fib]s t h und]gone fatty deg5]ation are int]m+l$1 !y h a grayi% yell[ t9t4 ,! condition may be associat$ ) hyp]trophy & dilatation4 ,a "p ( "o ( ! he>t cavities may become dilat$1 produc+ :at is kn[n z c>diac aneurism4 ,!re is de/ruction ( ! muscul> fasciculi ) subsequ5t developm5t ( new fibr\s tissue4 ,fatty deg5]ation is also se54 ,symptoms4--,advanc$ fibroid myoc>ditis may be pres5t )\t any symptoms4 ,slight degrees pres5t no symptoms4 ,! symptoms :5 pres5t are3 a feeble1 irregul>1 sl[ pulse2 attacks ( ang9a pectoris & sometimes arhy?mia4 ,! blood pressure is increas$4 ,^u ex]cis+ !re is m or less pa91 c>diac di/ress & dyspnea4 ,if fatty deg5]ation is also pres5t ! pulse w be quick5$ & irregul>4 ,diagnosis4--,?is is (t5 v difficult & x requires c>eful & p]si/5t /udy ( a case to be able to make a correct diagnosis4 ,prognosis4--,?is is grave1 ?\gh unque/ionably a numb] ( cases h be5 di/9ctly improv$ ?r\gh o/eopa?ic me?ods4 ,sudd5 dea? is liable to occur at any "t f complete ob/ruction to ! coron>y art]ies1 z ?is condition is associat$ ) scl]osis & n>r[+ ( ^! art]ies or _! bran*es4 ,treatm5t4--,! treatm5t ( *ronic myoc>ditis is l>gely includ$ 9 *ronic endoc>ditis4 ,! cause ( ! disease %\ld be det]m9$1 if possible4 ,c>eful treatm5t to ! ribs ( ! left side1 f ! fir/ to ! six?1 & ! correspond+ v]tebr1 w be ( great aid 9 controll+ ! disease4 ,! c]vical region dem&s att5tion1 ow+ to ! influ5ce ( ! vagi on conduction ( ! he>t impulse & to vasomotor effect4 ,att5tion %\ld be giv5 to ! diet & hygi5e ( ! pati5t4 ,outdoor life1 ba?+ ( ! sk91 & c>eful treatm5t ( ! vasomotor n]ves w be ( great help4 ,direct att5tion to ! entire splan*nic region z vasomotor control "h mat]ially less5s ! "w ( ! he>t & assi/s g5]ally 9 ma9ta9+ ! dige/ive & nutritive functions4 ,deg5]ation ( ! ,he>t ,muscle ,9 fatty deg5]ation1 ! s>c\s sub/ance ( ! fasciculi is conv]t$ into fat4 ,9 fatty ov]gr[?s !re is an excess ( fat 9 & ab\t ! he>t4 ,fatty deg5]ation is v common & is due to an int]f]5ce ) ! nutrition ( ! c>diac muscles4 ,x is f\nd 9 ! impair$ nutrition ( old age1 ( ca*ectic /ates1 ( grave infecti\s diseases & ( wa/+ diseases4 ,9 poison+ by ars5ic & phosphorus1 int5se fatty deg5]ation is produc$4 ,p]ic>ditis may be associat$ ) *anges 9 ! sup]ficial lay]s ( ! c>diac muscle4 ,lesions ( ! coron>y art]ies w produce ?is condition2 also impairm5t ( ! oxyg5-c>ry+ p[] ( ! blood4 ,x occurs mo/ frequ5tly 9 m5 aft] =ty ye>s ( age4 ,! affection may be ei!r g5]al or local4 ,x is mo/ commonly se5 9 ! left v5tricle4 ,:5 ! condition is g5]al ! he>t is dilat$1 flabby & relax$4 ,microscopically1 ! muscul> fasciculi exhibit a loss ( nuclei1 & oil drops & granules appe> 9 ! fib]s4 ,! affection may be pres5t )\t any noticeable symptoms4 ,slight degrees & localiz$ fatty deg5]ation are unrecognizable4 ,dilatation mu/ be pres5t to produce symptoms4 ,?is is apt to occur e>ly4 ,dyspnea2 a/hma2 c\gh2 ang9a pectoris2 dropsy2 sl[1 weak pulse2 palpitation1 & t[>d ! end1 ,*eyne-,/okes brea?+ may appe>4 ,m5tal symptoms1 su* z maniacal delusions1 may come on & la/ = weeks4 ,prognosis dep5ds ^u ! cause & ext5t ( involvem5t4 ,! treatm5t is l>gely t ( dilatation ( ! he>t4 ,an ef=t mu/ be made to det]m9e ! cause1 & treatm5t %\ld be appli$ accord+ly4 ,consid]able c be done 9 improv+ ! nutrition ( ! tissues ( ! he>t by hygi5ic & dietetic measures4 ,light ex]cises w (t5 be ( aid1 b c>e has to be tak5 t ! ex]cises d n tax ! pati5t too sev]ely4 ,a g5]al treatm5t ( ! body w be a helpful measure 9 invigorat+ ! sy/em z a :ole & ton+ ! c>diac tissues4 ,! diet %\ld be nutriti\s2 l>gely nitrog5\s4 ,rais+ ! ribs ov] ! he>t & increas+ ! *e/ expansion w be ( help 9 cases :]e !re are attacks ( dyspnea & ang9a4 ,_m cases pres5t deep seat$ lesions 9 ! upp] dorsal region4 ,:5 !re are attacks simulat+ apoplexy1 lay ! pati5t flat ^u ! back ) ! head slightly elevat$4 ,fatty ov]gr[? is associat$ ) g5]al obesity & soon] or lat] ?is infiltration impairs ! nutrition ( ! c>diac muscle & true fatty deg5]ation results4 ,?is =m occurs m frequ5tly 9 m51 & betwe5 ! ages ( =ty & sev5ty ye>s4 ,! *>act]i/ic *anges consi/ ( an increase 9 ! normal fat4 ,! he>t may be enclos$ 9 a ?ick cov]+ ( fat4 ,! fat may also be deposit$ betwe5 ! fasciculi1 sometimes rea*+ ! endoc>dium4 ,fatty ov]gr[? is c]ta9 to exi/ 9 extreme obesity4 ,no symptoms are produc$ until ! muscul> fib]s weak5 s t dilatation occurs4 ,! pres5ce ( extreme obesity1 comb9$ ) signs ( c>diac weakness1 po9t to fatty ov]gr[?4 ,! treatm5t ( fatty ov]gr[? ( ! he>t is l>gely ! same z t ( obesity4 ,o]tel's me?od ( less5+ ! am\nt ( liquids1 proteid diet & graduat$ ex]cises is effective 9 cases :]e he>t comp5sation is intact4 ,neuroses ( ! ,he>t ,palpitation is a m or less rapid action ( ! he>t1 ( :i* ! pati5t is consci\s4 ,!re is usually an irregul> or =cible action ( ! he>t1 z well z a frequ5cy ( ! he>t-beat4 ,!re is g5]ally "s local irritation to ! c>diac n]ves2 especially are lesions f\nd to ! ?ird & f\r? ribs1 al?\gh a lesion may be high] or l[] 9 ! dorsals or x may be 9 ! c]vical area4 ,muscul> lesions are frequ5t4 ,^! lesions pr$ispose to ! di/urbances ( reflex /imuli1 /ill ! g5]al heal? may be s weak5$ or ! reflex irritation s pron\nc$ t palpitation results indep5d5tly ( pr$ispos+ o/eopa?ic lesions4 ,females are m liable to be affect$4 ,! neurotic /ate is a common s\rce ( ! disord]4 ,if palpitation is long cont9u$ x causes hyp]trophy4 ,x (t5 occurs at pub]ty1 dur+ m5/ruation & at ! climact]ic p]iod4 ,anemia1 ! acute infecti\s diseases1 dyspepsia1 di/urbances ( ! ov>ies & o!r pelvic organs are common causes4 ,! abuse ( c(fee1 tea1 alcohol1 tobacco2 diseases ( ! /oma*1 ov]work1 fright1 grief1 anxiety1 & sexual excesses are causative factors4 ,palpitation may be associat$ ) organic diseases ( ! he>t1 b z a rule x is a purely n]v\s affection4 ,! pati5t's p]ception ( ! increas$ action & =ce ( ! he>t is ! ess5tial elem5t 9 palpitation4 ,! action ( ! he>t v>ies greatly & at times x may be a m]e flutt]+ :i* la/s b a few m9utes4 ,9 sev]e cases ! he>t beats viol5tly & ! pulse may be rapidly increas$ & rea* #afj or m4 ,! face is usually pale1 b may be flu%$4 ,! he>t's action is n increas$ 9 "s cases4 ,! attack g5]ally la/s only a few m9utes4 ,! fir/ consid]ation 9 treatm5t is to locate ! di/urb+ factor4 ,rais+ ! ribs ov] ! he>t & l[]+ ! fir/ rib2 correct+ ! clavicle 9 a few in/ances1 or inhibit+ along ! upp] dorsal region w usually quiet ! he>t's action4 ,/imulation ( ! vagi n]ves1 z !y pass along ! side ( ! neck1 may be all t is necess>y2 9 "s cases inhibition ( ! sup]ior c]vical sympa!tic or ( ! middle c]vical region1 act+ on ! depressor n]ve ( ! he>t1 w less5 ! tumultu\s action ( ! he>t4 ,x w be recall$ t ei!r !re is irritation ( ! accel]ator n]ves ( ! he>t or ! vagus is inhibit$4 ,all reflex di/urbances1 z a displac$ ut]us1 indige/ion1 etc41 mu/ be remov$ be=e ! palpitation c be p]man5tly /opp$4 ,re/ & confid5ce 9 ! treatm5t are ( great importance4 ,a v few cases w require a hot ba? & a g5]al treatm5t & possibly an ice-bag ov] ! he>t to quiet ! increas$ activity4 ,9 anemic cases hygi5ic measures & a prop] diet1 c\pl$ ) ! treatm5t = anemia1 are indicat$4 ,if ! attack is sev]e1 ! pati5t %\ld re/ 9 a recumb5t po/ure & dr9k some?+ w>m1 besides receiv+ ! indicat$ treatm5t4 ,:5 ! pati5t is n a decid$ neura/h5ic a rapid five or t5 m9ute walk w (t5 normalize ! he>t's action4 ,ta*yc>dia is rapid action ( ! he>t & commonly occurs 9 p>oxysms4 ,!re are no he>t s5sations1 z 9 palpitation4 ,ei!r ! sympa!tics are /imulat$ or ! vagus inhibit$4 ,x is n g5]ally relat$ to lesions ( ! he>t1 b is 9 reality a disord] ( ! n]v\s sy/em4 ,9 "s in/ances ! condition is physiologic4 ,n]v\s /ra91 9 ! =m ( o/eopa?ic lesions to ! upp] dorsal or c]vicals irritat+ ! sympa!tic1 is ! mo/ common cause4 ,emotion1 fright & sev]e ex]cise are o!r causes4 ,x is f\nd 9 neura/h5ia1 anemia1 hy/]ia & 9 ^? us+ an excessive am\nt ( tobacco1 tea & c(fee4 ,reflex /imuli f abdom9al or pelvic disord]1 especially dur+ ! climact]ic may induce ta*yc>dia4 ,9 exoph?almic goitre ! sympa!tics are ov]/imulat$1 & 9 "s in/ances ! vagus inhibit$1 lead+ to 8he>t hurry40 ,tumors1 hemorrhages1 enl>g$ gl&s1 etc41 ob/ruct+ ! action ( ! vagus1 are a s\rce ( rapid he>t4 ,sudd5 onset ) rapid action ( ! he>t1 small weak pulse1 heada*e1 flu%$ face & fa9tness are common symptoms4 ,! treatm5t is some:at simil> to t outl9$ "u palpitation4 ,locat+ ! cause is ! fir/ ess5tial4 ,besides remov+ local o/eopa?ic lesions1 inhibition to ! c]vical & dorsal sympa!tics is effective4 ,rais+ ! ribs ov] ! he>t w less5 ! pulse-rate4 ,re/1 diet & g5]al c>e ( ! pati5t may be necess>y4 ,outdoor ex]cise & cold ba?+ are b5eficial4 ,9 a few cases spr++ ! dorsal sp9e =w>d1 rais+ ! float+ ribs1 & slight traction ( ! c]vical sp9e are effective 9 sl[+ ! he>t's activity4 ,a few cases are v refractory1 especially 9 neurotics4 ,bra*yc>dia1 or sl[ action ( ! he>t1 is ! opposite ( ta*yc>dia4 ,9 a few cases x is physiologic4 ,x usually occurs second>ily1 foll[+ infecti\s diseases2 accompany+ n]v\s disord]s1 z hy/]ia1 melan*olia & neura/h5ia1 & is associat$ ) diseases ( ! dige/ive organs1 pulmon>y disord]s & toxic effects ( c(fee1 tea1 tobacco1 & drugs & ! tox9s ( jaundice1 diabetes1 uremia1 etc4 ,ob/ructions to ! c]vical sympa!tics & irritations ( ! vagus1 f o/eopa?ic lesions1 may be ei!r direct causes 9 !mselves or pr$ispos+ factors 9 ! above diseases4 ,a sl[1 weak pulse is ! *>act]i/ic symptom4 ,! he>t s\nds are feeble4 ,:5 ! pulse beat is bel[ sixty p] m9ute x is diagno/ic4 ,9 ! treatm5t ( sl[ he>t1 z 9 ! o!r neuroses ( ! he>t1 ! cause %\ld be fir/ det]m9$4 ,a /imulat+ treatm5t to ! c]vical sympa!tics & inhibition to ! pneumoga/ric w readily relieve _m cases1 at lea/ tempor>ily4 ,! lesion may be directly to ^! n]ves & ( c\rse removal ( ! same is ess5tial4 ,inhibition ( ! pneumoga/ric probably affects ! activity ( ! depressor n]ve1 & /imulation ( ! c]vical sympa!tics1 besides act+ on ! accel]ator fib]s ( ! he>t directly1 influ5ces ! blood supply ( ! body & ?us increases art]ial t5sion4 ,/imulation to ! upp] *e/ ant]iorly & po/]iorly1 ov] ! c>diac region1 w increase ! rapidity ( ! sl[ he>t4 ,re/ & c>e ( ! g5]al heal? is necess>y4 ,arhy?mia1 or an irregul>ity ( ! he>t's action & pulse beat1 (t5 due to lesions 9 ! c]vical region int]f]+ ) ! vagi1 symis pa!tic or vasomotor n]ves to ! he>t4 ,9 a numb] ( cases ! fir/1 second or ?ird rib on ! left side is at fault & a correction ( x w relieve ! irregul>ity imm$iately4 ,x is claim$ t !re are n]ves at ! f\r? & fif? dorsals t t5d to control ! rhy?m ( ! he>t-beat4 ,o!r causes are organic diseases ( ! he>t & n]v\s sy/em1 reflex di/urbances1 excessive use ( tobacco1 c(fee & tea4 8,normally1 ! contraction ( ! he>t orig9ates at ! s9oauricul> node1 at ! m\? ( ! sup]ior v5a cava1 is conduct$ to ! auricle1 & !nce to ! v5tricle by way ( ! auriculo-v5tricul> bundle 7bundle ( ,8 or ,gaskell's ridge74 ,"u conditions ( abnormal /imulation1 contractions may orig9ate 9 ! auriculo-v5tricul> node 9 ! wall ( ! "r v5tricle ne> ! coron>y s9us2 or 9 ! auriculo-v5tricul> bundle on ! v5tricul> side ( ! node2 or 9 ! auricul> tissue itself40--,cl9ical ,o/eopa?y4 ,fib]s f ! "r vagus pass to ! s9oauricul> node1 & f ! vagus to ! auriculo-v5tricul> bundle4 ,lesions ( ! upp] ?ree c]vicals may readily di/urb ! vagi ?r\gh circulatory & *emical s\rces z well z ?r\gh ! communicat+ bran* ( ! second sp9al n]ve4 ,?us ! rhy?mic p[] ( ! he>t1 rate & /r5g?1 & conductivity ( impulse may be readily influ5c$1 :i* is borne out by cl9ical exp]i5ce4 ,!re are sev]al =ms ( irregul> he>t action4 ,= a description ( same x is probably be/ to ref] ! /ud5t to special works4#ajc ,! m common =ms are ,s9us ,irregul>ities1 ! ,extrasy/ole1 ,p>oxysmal ,ta*yc>dia1 ,auricul> ,fibrillation1 ,auricul> ,flutt]1 & ,he>t-block4 ,pulsus ,alt]nans is a r>e =m1 & is ( grave significance :5 ! he>t muscle is deg5]at$4 ,a k ( auricul> fibrillation is ( special value1 = x is a common =m & (t5 indicates a s]i\s condition4 ,mo/ ( ! irregul>ities are n ( special pa?ological importance1 provid+ ! he>t muscle is heal?y4 ,!y are be/ /udi$ ?r\gh in/rum5tal means & require consid]able exp]i5ce 9 ord] to det]m9e ! exact condition4 ,frequ5tly1 unnecess>y worry has be5 ! result 9 discov]+ irregul>ities 9 ! "y z well z 9 o!rwise heal?y adults4 ,only :5 ! c>diac muscle is diseas$ or deg5]at$ ?r\gh v>i\s infections & toxic prop]ties 9 ! blood %\ld !y receive unusual att5tion4 ,dorsal & l[] c]vical lesions t affect ! he>t by way ( ! sympa!tics no d\bt di/urb nutrition ( ! he>t tissues4 ,& lesions ( ! vagi1 p>ticul>ly ( ! upp] ?ree c]vicals1 w di/urb ! rhy?m1 rate1 /r5g?1 & conductivity ( ! impulse ?r\gh auricles & v5tricles4 ,9 no o!r organ ( ! body w ! o/eopa? be bett] rew>d$ = c>eful & pa9/ak+ "w ?an 9 normaliz+ ! /imuli f sympa!tic & vagi t influ5ce ! he>t4 ,/imulatory & inhibitory ef=ts w frequ5tly suffice1 b 9 our judgm5t x is always bett] to secure int]osse\s adju/m5t if possible4 ,?\gh a numb] ( individuals ) he>t irregul>ities are ( a neurotic type1 t pr$isposes to n]v\s di/urbances ( v>i\s k9ds1 /ill x w\ld be an int]e/+ /udy1 especially 9 cases ( *ildr51 to note :at p]c5tage are ! result ( upp] c]vical lesions caus$ by bir? injury4 ,ang9a ,pectoris ,ang9a pectoris is *>act]iz$ by pa9 9 ! c>diac region :i* usually ext5ds to ! inn] side ( ! upp] arm & =e>m4 8,?is region corresponds to ! p]iph]al di/ribution ( ! l[] c]vical n]ves 7#f? & #g? 9 ! arm7 & ! upp] ?ree or f\r dorsal n]ves 79 ! upp] arm & ! *e/740#ajd ,occasionally simil> areas ( ! "r side are affect$1 & 9 a few !re is pa9 9 ! l[] jaw & back ( ! e>s4 8,! />t+ ( ! pa9 is usually across ! *e/1 ab\t ! level ( ! ?ird ribs1 or z l[ z ! fif? ribs10 al?\gh ! inception may be any:]e 9 ! left *e/ or ! arm4 ,! duration ( ! pa9 is f a few seconds to sev]al m9utes2 sometimes x may rema9 = sev]al h\rs4 ,o/eopa?ic lesions are inv>iably f\nd 9 ! upp] dorsal1 includ+ ribs1 or l[] c]vical region1 :i* are pr$ispos+ factors t t5d to exhau/ & weak5 ! c>diac muscle1 & di/urb ! coron>y circulation1 s t resi/ance is l[]$4 ,?us toxic ag5ts & infections may readily involve ! c>diac tissues4 ,_m cases pres5t m or less art]ioscl]osis1 :i* involves ! he>t & affects its circulation4 ,inflammation ( ! root ( ! aorta f syphilis is a frequ5t cause4 ,valvul> he>t disease & *ronic nephritis are o!r und]ly+ factors4 ,worry1 /r5u\s liv+1 & cont9u$ physical /ra9 are to be consid]$4 ,!re are a gr\p ( cases1 t are comp>atively mild & frequ5tly f\nd 9 wom51 t are ( toxic orig91 due to inte/9al /asis z a result ( con/ipation1 adhesions1 etc4 ,! ileo-cecal section is commonly involv$ 9 ^! in/ances4 ,focal infections may be an excit+ cause4 ,! o/eopa?ic lesions und\bt$ly affect ! c>diac inn]vation1 p>ticul>ly vasomotor & trophic1 ?us lead+ to consequ5t di/urbances ( c>diac circulation & result+ irritation to ! ganglia4 ,scl]osis & spasm ( ! coron>ies1 is*emia1 cramp+1 exhau/ion1 & deg5]ation ( ! he>t muscle1 & c>diac neuralgia1 are v>i\s results t may take place4 ,! p>oxysm usually beg9s sudd5ly1 (t5 dur+ ex]tion or int5se m5tal emotion4 ,! pa9 is agoniz+ & ( a grip-l "*1 & !re is a feel+ ( imp5d+ dea?4 ,! int]co/al muscles are con/rict$ & !re may be a feel+ ( suffocation4 ,! pa9s radiate up ! neck & d[n ! arm1 & may be accompani$ by numbness or t+l+4 ,!re is usually extreme pallor1 & ! sk9 is a%54 ,sweat+ is n uncommon1 & dyspnea may be pres5t4 ,! attacks occur at int]vals1 v>y+ f a few days to _m ye>s4 ,aft] ! p>oxysms !re is in/ant relief4 ,o!r cases may pres5t less sev]e attacks4 ,9 ! diagnosis ! only condition ) :i* true ang9a pectoris is liable to be conf\nd$ is pseudo-ang9a pectoris4 ,pseudo-ang9a or hy/]ical ang9a occurs *iefly 9 wom5 or 9 neura/h5ic m54 ,^! cases are (t5 excit$ by toxemia4 ,! attack usually occurs at night & is unassociat$ ) organic he>t disease4 ,!re is a feel+ ( c>diac di/5tion in/ead ( con/riction z 9 true ang9a4 ,!re is emotional excitem5t & ! attack la/s "o or two h\rs1 :i* is usually long] ?an t ( true ang9a4 ,! prognosis is unfavorable1 al?\gh _m cases live = a numb] ( ye>s4 ,a few cases h recov]$ "u a ?or\gh c\rse ( treatm5t4 ,! treatm5t ( ang9a pectoris consi/s 9 correct+ ! disord]$ upp] dorsal v]tebr1 ! upp] left ribs ov] ! he>t1 & ! l[] c]vicals4 ,inv>iably lesions are f\nd 9 ?is region & if ! treatm5t is appli$ to correct ^! disord]s1 ! attack c frequ5tly be reliev$4 ,by foll[+ up ! treatm5t dur+ ! int]vals1 a numb] ( cases c be practically cur$4 ,a common lesion f\nd is a slight lat]al curvature 9 ! upp] dorsal region4 ,?is curvature is (t5times great en\gh to cause a subdislocation ( sev]al ( ! ribs1 :i* c]ta9ly complicates ! d]angem5t1 at lea/ z f> z a quick cure is conc]n$4 ,dur+ ! attack raise ! ribs ov] ! he>t at ! po9t ( con/riction s z to relieve ! imp+$ n]ve fib]s4 ,hot dr9ks are ( value4 ,! vagi & phr5ic n]ves may also be at fault 9 "s cases4 ,! s5sory n]ves to ! he>t are f ! fir/1 second & ?ird dorsals4 ,ice-bags or heat appli$ locally w be a helpful measure4 ,9 cases :]e !re is high art]ial t5sion1 an inhibitory treatm5t to ! upp] & middle c]vical regions w be ( special aid1 z x relieves ?is t5sion by affect+ ! vasomotor n]ves4 ,?is treatm5t w at lea/ ov]come ! vasomotor =m ( ang9a pectoris4 ,hot foot-ba?s & friction w also be f\nd ( value4 ,9 _m cases "u =ty or =ty-five syphilis is a cause4 ,9 cases pa/ middle life !re is (t5 organic disease ( ! circulatory organs4 ,! pati5t %\ld at all times avoid any excitem5t & live a v quiet life4 ,he %\ld take frequ5t vacations4 ,he %\ld take ! be/ ( c>e ( himself & 8 food %\ld be nutriti\s4 ,9 pseudo-ang9a ! treatm5t is to relieve ! irritation to ! n]ves affect$ z well z ! und]ly+ affection4 ,,footnotes3 #ajj ,j\rnal ( ! ,am]ican ,o/eopa?ic ,association1 ,april1 #aijf4 #aja ,valvul> ,he>t ,diseases1 ,a4 ,o4 ,a4 ,j\rnal1 ,m>*1 #aije4 #ajb ,j\rnal ( ,o/eopa?y1 ,febru>y1 #aijd4 #ajc ,mack5zie1 ,diseases ( ! ,he>t2 ,lewis1 ,me*anism ( ! ,he>t ,beat2 ,macleod1 ,physiology & ,*emi/ry 9 ,mod]n ,m$ic9e4 #ajd ,mack5zie1 ,ox=d ,m$ic9e1 ,vol4 ,,ii4 ,,diseases ,,( ,,! ,,art]ies ,art]ioscl]osis 7,,a!roma7 ,?is is a ?ick5+ ( ! intima ( ! art]ies1 due to an inflammatory increase ( ! connective tissue1 associat$ ) m or less fatty deg5]ation & calcification4 ,old age1 alcohol1 lead1 g\t1 syphilis1 rheumatism & o!r infections1 labori\s "w1 ov]eat+1 nephritis1 & calc>e\s wat] t5d to produce ! condition4 ,excessive eat+ & dr9k+ are common causes ( bo? a!roma & *ronic r5al diseases & %\ld always be regulat$4 ,physical ov]work1 *ronic intoxications1 etc41 produce hyp]t5sion ( ! vascul> sy/em & ?us lead to *anges ( ! vessel walls4 ,a rigid sp9e is inv>iably f\nd2 ?is may be a causative factor 9 itself1 or an associat$ condition4 ,all ( ! above li/ ( causes are important4 ,pa?ologically1 ! art]ies are ?ick5$1 tortu\s & rigid4 ,! intima may be occupi$ by r\gh1 calc>e\s plates4 ,9 extreme cases ! sub-endo!lial tissue und]goes deg5]ation & breaks d[n 9 spots1 =m+ 8a!romat\s abscesses40 ,! disease may be circumscrib$ or diffuse2 9 ! latt] !re is a widespread di/ribution ( ! affection4 ,ow+ to ! g5]al effect1 ! he>t1 liv] & kidneys receive less blood & t5d to atrophy4 ,microscopically1 !re is f\nd m or less fatty deg5]ation ( ! diff]5t coats1 & an ov]gr[? ( connective tissue 9 ! intima4 ,! art]ies mo/ frequ5tly affect$ are ! aorta & coron>y4 ,symptoms4--,circulatory4--,!re is a high t5sion pulse & acc5tuation ( ! second aortic s\nd4 ,!re is also dyspnea1 sev]e pa9 9 ! left side1 palpitation1 pallor1 & ! left v5tricle is hyp]trophi$4 ,c]ebral4--,su* symptoms z heada*e1 t9nitus1 aphasia1 v]tigo1 syncopal or epilepti=m attacks may be pres5t4 ,r5al4--,!re is an increase 9 ! quantity ( ur9e1 :i* is ( a pale color & l[ specific gravity2 at times x is album9\s4 ,! di/urbance leads to atrophic nephritis4 ,!re may be ga/ro-inte/9al symptoms1 z con/ipation1 pa91 etc41 due to h>d5+ ( ! splan*nic vessels4 ,9 "s cases ! p]iph]al art]ies become oblit]at$4 ,! ve9s become h>d5$4 ,sequel are c>diac dilatation1 he>t failure1 p>alysis1 apoplexy1 fatty he>t1 aneurism1 contract$ or s5ile kidney1 ang9a pectoris1 & 9 extreme cases1 gangr5e ( ! extremities4 ,diagnosis4--,! *>act]i/ic symptoms are h>d5$ art]ies1 high t5sion ( ! pulse1 hyp]trophy ( ! left v5tricle & acc5tuation ( ! aortic second s\nd4 ,! av]age blood pressure is f #afj to #ahj mm4 ( m]cury1 ?\gh x may be consid]ably high]4 ,prognosis4--,_m cases c be greatly b5efit$ by o/eopa?ic treatm5t1 & at ! incipi5cy ! improvem5t is g5]ally m>k$4 ,x usually runs a v *ronic c\rse4 ,treatm5t4--,! treatm5t mu/ necess>ily consi/1 pr9cipally1 9 ! removal ( su* conditions z are produc+ ! deg5]ation4 ,! rigid sp9e %\ld be c>efully treat$ by me?ods 7pref]ably traction7 t ov]come ! contractures & release ! int]v]tebral discs4 ,! dorsal & lumb> areas1 & ! abdom9al organs %\ld receive special att5tion4 ,outdoor life & pl5ty ( re/ are important4 ,alcoholism1 g\t1 rheumatism1 syphilis1 etc41 mu/ be rem$i$ be=e !re c be mu* *ange 9 ! art]ies4 ,freeliv+ & all excitem5t mu/ be /opp$4 ,! pati5t's coop]ation is invaluable4 ,a milk diet is (t5 b5eficial4 ,besides treatm5t ( ! prim>y disease1 a g5]al treatm5t w be ( mu* avail 9 equaliz+ & r$uc+ art]ial t5sion4 ,brunton#aje speaks ( cases ( a!roma be+ cur$ by ex]cise & manual treatm5t to ! rheumatic jo9ts !mselves4 ,"o1 app>5tly suff]+ f s5ile dem5tia1 0 mu* improv$ aft] two ye>s ( ?is treatm5t appli$ to ! jo9ts1 & %[$ b5efit to ! c]ebral circulation4 ,! b[els & kidneys %\ld be kept active1 & ! g5]al heal? ( ! pati5t c>efully wat*$4 ,keep+ ! sk9 active by daily ba?s is an ess5tial factor 9 ! treatm5t4 ,v frequ5tly ! disease is n only ret>d$1 b improv$4 ,9 high blood pressure v5esection may be ( b5efit4 ,,footnotes3 #aje ,lectures on ! ,action ( ,m$ic9e1 p4 #cdc4 ,,diseases ,,( ,,! ,,blood ,,by ,,e>l ,r4 ,,hosk9s ,g5]al ,consid]ations3--,x has be5 said t ea* individual is a "p ( all ! g5]ations :i* h prec$$ him4 ,9 ! same way x might be said t e drop ( our blood is a "p ( e o!r cell 9 our bodies4 ,! o!r tissues are able to ma9ta9 _! exi/5ce only ?r\gh ! m9i/rations ( ! blood & 9 turn ! blood d]ives its own sub/ance f tissues :i* x supplies4 ,we are accu/om$ to speak ( c]ta9 organs z be+ ^? ( blood =mation1 yet x is true t e tissue furni%es its quota ( blood composition1 mak+ up ! mass :i* we call blood4 ,x is 9 "o way an algebraic sum ( good & baneful sub/ances1 )\t :i* !re c be no normal function1 & sometimes be+ ( itself a m5ace z well z an aid to o!r tissues1 z 9 sepsis4 ,!re c be no p]v]t$ function ( any tissue )\t !re be+ a direct effect ^u ! blood4 ,we may n always be able to measure ?is effect ) our pres5t laboratory me?ods4 ,we may n be able to detect cl9ically ! result ( ?is alt]ation ( ! blood /ream because ( comp5satory influ5ces1 dilution1 phagocytic action1 enzymatic action1 oxidation1 & ! intricate processes ( excretion4 ,x mu/ also be rememb]$ t normal blood is n ( a c]ta9 def9ite *emical or physical composition4 ,x mu/ v>y f m9ute to m9ute accord+ to ! normal metabolic ph5om5a :i* make up our succession ( ev5ts associat$ ) life4 ,b comp>atively little is kn[n ab\t ?is mo/ important fluid4 ,we h accumulat$ data reg>d+ morphology & relative numb]s ( its =m$ elem5ts & _! behavior :5 suffici5t abnormality is pres5t to upset _! wont$ balance ( arrangem5t4 ,we h an ev] wid5+ field ( inve/igation 9 ! blood plasma 9 :i* we are con/antly be+ told ( newly discov]$ complexities4 ,c]ta9ly ! field ( ! unkn[n is big en\gh to conta9 our unexpla9$ blood reactions4 ,x is probable t z our k increases our numb] ( diseases really consid]$ z true blood diseases w decrease & be %[n to be ! effect ( blood pass+ ?r\gh c]ta9 pa?ologic tissues ( ! body4 ,we c measure ! numb] & proportion ( =m$ elem5ts1 & ! relative effici5cy ( ! ery?rocytes by ! am\nt ( hemoglob9 :i* !y c>ry4 ,! g5esis ( ! =m$ elem5ts is to be kept 9 m9d 9 consid]+ !rapy4 ,! ery?rocytes & granul> cells develop+ 9 adult life1 pr9cipally f ! r$ m>r[1 leads our att5tion 9 decrease or increase ( ^! p>ticul> cells to ! greate/ aggregation ( r$ bone m>r[ :i* happ5s to be 9 ! ribs4 ,! anatomical relation ( ! ribs to ! sp9e w\ld seem to r5d] !m v liable to di/urbances ( nutrition & n]ve control z a result ( /ructural maladju/m5t & cl9ically ?is presumption is v]ifi$4 ,limitation ( ! motion ( ! ?oracic sp9e is p]=ce accompani$ by co/al inactivity ) disuse effects ^u ! r$ m>r[ & ev5tually ^u ! relative cont5t ( ! blood /ream4 ,we c measure ! effici5cy ( ! ery?rocytes 9 c>ry+ oxyg5 to ! tissues by measur+ ! relative am\nt ( hemoglob9 :i* a giv5 volume ( blood conta9s4 ,! actual *anges tak+ place 9 blood "* are (t5 ?us suffici5tly indicat$ = u 9 t]ms ( our pres5t me?ods ( exam9ation1 to at lea/ aid 9 ! arrival at a diagnosis4 ,we sometimes h to rememb] t ! adaptation to abnormality may be effici5t en\gh to keep ! app>5t significance f tell+ ! 8:ole tru?40 ,! ,anemias ,! class ( diseases :i* are ref]r$ to z ! ,anemias are ^? 9 :i* !re is an actual1 or app>5t1 decrease 9 ! oxyg5 c>ry+ elem5t or hemoglob94 ,?is may n be due to an actual decrease 9 am\nt ( hemoglob91 b r to a decrease 9 ! ability ( ! r$ cells to c>ry x4 ,?is decrease 9 ability may be due to alt]ation 9 ! ery?rocytes !mselves1 or to effects ( *ange 9 ! molecul> conc5tration ( ! plasma 9 :i* !y are susp5d$4 ,! plasma may also conta9 c]ta9 poisons probably proti$1 :i* may make impossible ! effici5t c>ry+ ( hemoglob9 by ! ery?rocytes4 ,! simple/ =m ( anemia is t due to removal ( a l>ge p]c5tage ( ery?rocytes f ! body4 ,?is condition is fulfill$ 9 acute hemorrhage4 ,if ! am\nt ( blood lo/ does n exce$ ! am\nt necess>y to ma9ta9 circulation1 r\ghly fifty p] c5t ( ! total quantity1 ! fluid portion lo/ is quickly replac$ f ! fluids ( ! body & f mat]ial +e/$4 ,! =m$ elem5ts & proteids are less rapidly replac$ by a comp5satory increase 9 function ( ! hematopoietic tissues s t !re is a gradual return to ! orig9al numb] & proportion4 ,a blood cell may be consid]$ z pass+ ?r\gh a life cycle ( infancy1 adolesc5ce1 maturity1 & s5ility be=e x is f9ally de/roy$4 ,if ! dem& = new cells is n too great x w be met ) mature cells4 ,if ! call is m urg5t1 y\ng] & old] cells w bo? be put into ! conflict1 :ile 9 a "t ( extreme /ress all types ( cells1 f ! 8s*ool boys0 to ! 8gray-be>ds01 w h to be utiliz$ to ma9ta9 life4 ,s1 r\ghly1 we c judge ! sev]ity ( ! anemic process by ! reaction :i* ! body makes to x z indicat$ by ! "* ( ! cells 9 s]vice4 ,! pigm5t1 hemoglob91 is sl[ly reg5]at$ ev5 z comp>$ to ery?rocytes1 s t ! color index is usually ! la/ f9d+ to return to normal aft] a hemorrhage4 ,! leucocytes are usually increas$ aft] hemorrhage1 probably z a protective me*anism1 nature hav+ le>n$ by h>d exp]i5ce t %e has less resi/ance to infection1 :5 !re is loss ( a consid]able quantity ( blood4 ,to be consid]$1 also1 is ! fact t con/antly blood cells are outliv+ _! usefulness--"s mu/ be dispos$ (4 ,! extra function requir$ ( ^! old] cells gives ! same results z ov] "w ^u an old man--hurries 8 "t ( demise s t !re is a great] p]c5tage ?an usual to be s5t to ! salvage %ops4 ,! reg5]ation ( blood aft] hemorrhage dep5ds ^u ! sev]ity ( ! loss1 ! nutrition1 ^u ! treatm5t giv51 & indirectly ! ability ( resi/ance develop$ by ! pati5t4 ,9 ! *ronic anemias we may h ei!r defective developm5t ( ery?rocytes1 or defective function ( !m1 or a relatively too great de/ruction ( ^! same ag5ts4 ,a bank acc\nt may be deplet$ ei!r by too small deposits to acc\nt = curr5t exp5se1 or by extravagant )drawals4 ,x is sometimes difficult to det]m9e on :i* side ! fault lies4 ,x seems to be nature's plan n to subject to active "w an ery?rocyte until aft] ! nucleus has disappe>$1 judg$ by ord9>y me?ods ( /a9+4 ,a sudd5 call = an increas$ numb] ( ery?rocytes may =ce ! organism to s5d 9 "s ) nuclei1 b ! circulation does n receive ^? :i* h n be5 /&>diz$1 z to %ape & /a9+ reaction1 unless ! crisis is ( grave import4 ,evid5ce ( increas$ de/ruction ( ^! cells is %[n by brok5 =ms--%ad[ =ms1 & by an increas$ excretion ( ! pigm5ts d]iv$ f ! break+ d[n ( hemoglob91 namely bilirub9 & urobil94 ,a great deal ( in=mation c be obta9$ by a /udy ( ! o!r =m$ elem5ts ( ! blood4 ,9 g5]al ! symptomatology ( all ! anemias w be t ( less5$ metabolism because ( defici5t oxyg5ation4 ,?is is accompani$ by imp]fect nutrition & g5]al impairm5t ( function4 ,among ! usual results are muscul> weakness1 malaise1 heada*e1 dizz9ess1 anorexia1 & cutane\s & membran\s pallor1 ) t5d5cy to local hemorrhages4 ,! he>t is (t5 rapid1 easily di/urb$ 9 rhy?m1 may possess a hemic or functional murmur1 & gives a s(t compressible pulse ( l[ pressure4 ,z a comp5satory attempt ! respiration may be rapid1 b is likely to be %all[1 & dyspnea results f disproportionately small ex]tions4 ,!re may be ei!r tr\blesome con/ipation1 or di>rhea2 (t5 !re are alt]nat+ p]iods ( ea*4 ,9 ! sev]] =ms convulsions1 coma1 delirium1 /upor1 localiz$ edema ( ! ankles or eyelids may be se54 ,9 g5]al ! treatm5t ( ! second>y anemias w conc]n ! removal ( ! cause foll[$ by measures t5d+ to increase ! decreas$ elem5t or elem5ts 9 ! blood /ream4 ,9 ! anemia result+ f hemorrhage ! ?ir/ :i* foll[s is ! body's me?od ( call+ = m fluid ) :i* to ma9ta9 pressure 9 ! art]ies & capill>ies suffici5t to develop new =m$ elem5ts to take ! place ( ^? lo/4 ,if ! loss is sev]e en\gh to give rise to %ock1 em]g5cy measures are necess>y ( introduc+ into ! v5\s /ream an artificial fluid to make up = ! fluid "p ( ! blood lo/4 ,if ! condition c be pr$ict$ & a suitable donor obta9$1 blood transfusion is ( greate/ advantage to ! pati5t4 ,m (t5 ! urg5cy ( ! condition w require an artificial fluid to be giv5 9 ha/e4 ,probably ! be/ s f> devis$ solution is ,fis*]'s physiological salt solution4 ,9 ! anemias due to *ronic metal poison+ z f lead & m]cury1 or f sy/emic poison+ su* z syphilis or mal>ia1 or f ! ret5tion ( metabolic products z 9 "s ( ! diseases ( ! kidneys or ( ! liv]1 ! anemia c only be successfully treat$ by normaliz+ its prim>y cause--z x occurs 9 ! role ( a symptom or result1 & h5ce is only indirectly a blood condition4 ,co/og5ic ,anemia 7,,burns' ,,anemia7 ,co/og5ic ,anemia is a result ( functional disuse-atrophy ( ! hematopoietic organs1 !re be+ an insuffici5t supply ( ery?rocytes to meet ! dem&s ( ! metabolism ( ! body4 ,x results f insuffici5t opportunity = nutrition & dra9age ( ! r$ m>r[ ( ! ribs1 & gives ! cl9ical picture ( an anemia due to too sl[ production ( ery?rocytes4 ,etiology4--,! condition is pr$ispos$ to by any factor :i* t5ds to limit ! action & nutrition ( ! ribs4 ,we are too prone to =get t ! function ( ! ribs is to produce ery?rocytes2 x is really a matt] ( second>y importance t !y make up "p ( ! ?oracic wall4 ,! *ange f ! horizontal to ! upright position has t5d$ to a droop+ ( ! :ole *e/ f gravity4 ,! human animal seldom develops ! free h+e rib motion z (t5 se5 9 quadrup$s4 ,! passage ( bo? art]ial & v5\s blood1 is n normally free & copi\s1 & z a consequ5ce ! tissue suppli$ functions less effici5tly4 ,?is function ( ! r$ m>r[ is to produce ery?rocytes4 ,any /ructural lesion ( ! dorsal v]tebral column1 or its co/al articulations1 :i* int]f]es ) ! free motion ( ! rib ?us int]f]es directly ) ! effici5t function ( ^! p>ticul> ribs4 ,! sev]ity ( ! condition v>ies ) ! numb] ( ribs affect$ & ! imp$ance to nutrition & dra9age4 ,diagnosis4--,! condition may be ( gradual onset1 & may be associat$ or co9cid5t ) "s o!r condition lead+ to a loss ( tone or opportunity = free rib action4 ,! sy/emic symptoms are due to a defici5t oxyg5ation ( all tissues z a result ( ! above disuse4 ,! ?orax is usually rigid--=c$ respiration requires unusual ef=t )\t proportionate ?orax expansion4 ,! type ( brea?+ t5ds t[>d diaphragmatic4 ,! quantities ( tidal & supplem5tal air are bo? m>k$ly decreas$4 ,! lack ( tissue oxidation r5d]s elim9ation less active1 h5ce con/ipation4 ,gas accumulation1 weakness1 insomnia1 ) slightly increas$ am\nt ( ur9e1 & l[ 9 total solids1 is ! rule4 8,! blood itself is r *>act]i/ic4 ,coagulation "t is increas$2 specific gravity & viscidity dim9i%$2 r$ cell c\nt normal or only slightly dim9i%$2 hemoglob9 #f to #aj grams p] #ajj c4 c4 ( blood 7,meis*]72 #dj to #hj 7,d>e74 ,! r$ cells are small1 pale1 vacuolat$1 sometimes nucleat$4 ,! :ite cell c\nt is normal1 slightly increas$ or slightly dim9i%$4 ,! hyal9e cells are normal1 or slightly relatively increas$4 7,^!1 be+ =m$ 9 lymph nodes1 tonsils1 etc41 are n affect$ by rib *anges47 ,! mononucle> neutrophiles are relatively increas$4 ,! nucle> av]age ( ! polymorphonucle> neutrophile is l[4 ,vacuolat$ & atypical neutrophiles are (t5 f\nd4 ,basophiles1 myelocytes & amphophiles may be f\nd 9 consid]able numb]s4 ,nuclei 9 all granul> =ms pres5t evid5ces ( immaturity or deg5]ation--!y may be swoll51 vacuolat$1 extrud$1 ragg$1 or ) v>iable /a9+ reaction0 7,cl9ical ,o/eopa?y74 ,treatm5t4--,! treatm5t is to obta9 a normal function 9 ! inactive tissues4 ,?is is done by gett+ bett] rib hygi5e4 ,:atev] is int]f]+ ) rib function & metabolism is to be remov$4 ,brea?+ ex]cises are giv5 n only to 8v5tilate ! ?orax1 b to ex]cise its walls04 ,c>efully select$ horizontal b> "w is (t5 ( great value4 ,! diet %\ld be ( su* nature z to supply mat]ial = manufacture ( ery?rocytes & = load+ !m ) hemoglob9 z well4 ,h5ce ! foods ) high *lorophyl or hemoglob9 cont5t %\ld be emphasiz$4 ,prognosis4--,?is dep5ds on pati5t's desire = improvem5t ( 8 condition4 ,he c be improv$ by correction ( :atev] lesions !re may be int]f]+ ) 8 fre$om ( ?oracic motion4 ,he c be b5efit$ by manipulations :i* adju/ ! ribs1 b 8 coop]ation is ess5tial4 ,lack ( coop]ation on ! "p ( ! pati5t1 :i* w\ld t5d to increase ! mobility & metabolism ( ! ribs1 r5d]s him m liable to any ( ! int]curr5t pulmon>y infections1 z a result ( 8 defici5t ?oracic v5tilation4 ,enc\rage free ?oracic respiration especially :5 9 s*ool1 or :5 "u conditions :i* ord9>ily w\ld t5d to slov5ly habits ( brea?+4 ,*lorosis 7,,gre5 ,,sickness7 ,an anemia *>act]iz$ by great r$uction 9 ! am\nt ( hemoglob94 ,x mo/ frequ5tly occurs 9 adolesc5t girls4 ,x seems to be associat$ ) neurotic manife/ations & m5/rual irregul>ities4 ,etiology4--,its cause is n well und]/ood4 ,poor hygi5ic conditions may be a factor1 b x is a condition f\nd 9 all /ations ( life4 ,! age & sex h l$ to inve/igation z to probability ( lack ( an ov>ian int]nal secretion4 ,! reports ( work]s are contradictory4 ,! "n ( ! condition is d]iv$ f ! color ( ! sk91 :i* usually ranges f a pale gre5i% t9t to a slight pallor4 ,occasionally !re is localiz$ vasodilation ( ! *eeks giv+ brilliant color4 ,con/ipation accompani$ by copremia seems to be ei!r a causative factor or result4 ,9 _m cases x appe>s to act 9 ! dual role4 ,fixation ( ! middle & l[] ribs accompani$ by o/eopa?ic lesions f ! mid to ! l[] dorsal sp9e seem to be con/ant f9d+s4 ,! co/al fixation leads to less5$ respiratory excursion & result+ dim9i%$ oxyg5ation4 ,diagnosis4--,*lorosis may be suspect$ f ! color ( ! sk91 p]v]t$ appetite1 w&]+ neuralgias1 he>t palpitation1 edemat\s infiltration1 & %all[ type respiration1 b ! diagnosis is n to be made )\t ! aid ( ! blood c\nt4 ,! /rik+ "p ( ! blood picture is ! great r$uction 9 am\nt ( hemoglob9 c>ri$ by ea* ery?rocyte4 ,!re is usually "s r$uction 9 ! ery?rocyte p]c5tage b n 9 proportion to ! decrease 9 color index4 ,!re are usually _m pess>y-%ap$ & %ad[ ery?rocytes4 ,^! are ( all sizes1 b seldom is ! condition ( su* gravity z to cause m ?an an occasional nucleat$ r$ cell1 & :5 f\nd are mo/ likely to be normobla/s4 ,! /a9+ reaction is ( wide limits4 ,cells ( all degrees ( relative alkal9ity are f\nd & (t5 !re is a wide v>iation ( /a9+ reaction 9 ! same cell4 ,! numb] ( ery?rocytes is usually slightly decreas$ b n 9 ! proportion t ! hemoglob9 p]c5tage is1 s t ! color index is !re=e /rik+ly l[4 ,probably1 ! av]age color index = a typical case ( *lorosis is #ej1 ) an ery?rocyte c\nt ( #d1jjj1jjj & a hemoglob9 ( #dj p] c5t 7,d>e47 ,?is drop 9 color index 9 *lorosis is f> out ( proportion to ! cl9ical symptoms :i* w\ld be expect$ f a simil> r$uction result+ f ! ord9>y causes ( second>y anemia4 ,! blood plasma is increas$ & ! specific gravity is l[]$1 sometimes r$uc$ f #a4jee to ab\t #a4jcj4 ,treatm5t4--,! treatm5t ( any malady 9 :i* ! etiology may be app>5tly ( widely diff]5t natures w naturally rationally v>y ) ! app>5t cause4 ,if !re is copremia1 :i* seems to be a def9ite causative factor1 ?is %\ld be at once correct$4 ,^! pati5ts =m ! ca?>tic habit readily1 s physical & diet>y me?ods ( return+ ! dige/ive motility to normal %\ld logically be giv5 fir/ trial4 ,if x is a matt] ( less5$ metabolism z a result ( insuffici5t ex]cise1 or blood oxyg5ation1 outdoor gymna/ics & brea?+ ex]cises may incite ! /imulus to normal ery?rocyte hemoglob9ization4 ,! diet %\ld be ( su* nature z to furni% mat]ial bo? = ery?rocyte =mation & iron 9 =m = ready absorption by !m4 ,! organic iron comp\nds ( animal hemoglob9 & vegetable *lorophyl are our mo/ common & *eape/ z well z mo/ effective s\rces4 ,! m$ical treatm5t ( *lorosis is bas$ on ! empiric use ( inorganic iron4 8,! exact me?od 9 :i* iron ex]ts a favorable influ5ce ^u *lorosis /ill rema9s unsettl$4 ,x is difficult to und]/& :y iron salts 9 ! food :i* are suffici5t = all ord9>y ne$s1 are insuffici5t 9 *lorosis4 ,x seems mo/ probable t iron cures *lorosis by act+ z a /imulant to ! blood =m+ organs0 7,beifeld1 ,! ,basis ( ,symptoms47 ,cl9ically1 o/eopa?s are daily obta9+ rationally ! necess>y /imulus to ! blood =m+ organs by remov+ all imp$ance f ^! organs caus$ by v]tebral & co/al lesions & by obta9+ bett] dige/ive & respiratory hygi5e4 ,prognosis4--,recov]y is to be expect$ & its rate w dep5d ^u ! ?or\ghness ( ! o/eopa?ic "w & ! pati5t's ability to respond to ! /imulus4 ,! blood may %[ *lorotic relapses ) concomitant symptoms if 9 lat] life second>y anemia develops f hemorrhage1 hook-worm infection1 or o!r causes4 ,p]nici\s ,anemia ,?is anemia is ( obscure etiology1 *>act]iz$ by progressive de/ructive hemolysis ( ! ery?rocytes1 usually ) fatal t]m9ation4 ,! cells reta9 _! hemoglob9 c>ry+ ability1 s t :ile ! hemoglob9 is decreas$ 9 p]c5tage1 ! proportionately great] decrease 9 ! numb] ( ery?rocytes leads to a m>k$ increase 9 ! color index4 ,! de/ructive influ5ce ^u ! r$ cells may be suffici5t to all[ only a small p]c5tage ( ! ery?rocytes to appe> normal & %[ ! great] numb] to be de=m$1 or 9 v>i\s /ages ( deg5]ation4 ,cells :i* 9 times ( heal? w\ld h be5 s5t to ! 8salvage /ation0 are reta9$ to c>ry an ov]-load = !m ( hemoglob9 to ! ne$y tissues4 ,immature nucleat$ cells ( all types are drawn into ! battle long be=e !y c be effici5t c>ri]s to help supply oxyg5 to ! tissues4 ,seldom w a second>y anemia be sev]e en\gh to produce megalobla/s 9 ! blood /ream yet !y are a r con/ant f9d+ 9 p]nici\s anemia4 ,) ^! cells ( irregul> c>ry+ capacity & developm5t1 anisocytosis & poly*romatophilia are expect$ f9d+s4 ,symptoms4--,! condition mu/ be reg>d$ z a symptom complex or a result ( pa?ologic process or processes4 ,a type ( anemia v simil> 9 symptoms & blood f9d+s to ! p]nici\s anemia is produc$ by ! tox9s ( advanc$ malignancy1 & by at lea/ two =ms ( inte/9al p>asites1 ! ankylo/oma duod5ale & ! bo?riocephalus latus4 ,9 ! true p]nici\s anemia we h simil> results b are n able to locate ! prim>y pa?ology4 ,!re are pres5t syn*ron\sly1 enorm\sly increas$ de/ruction ( ery?rocytes & enorm\sly increas$ production ( !m b we are unable to det]m9e :i* is prim>ily at fault4 ,! belief t ! cells are m fragile & too easily brok5 up has l$ to ! removal ( ! ery?rocyte de/roy+ sple5 9 ! hope t de/ruction w\ld be delay$ until reg5]ation ( ev5 imp]fect cells w\ld balance ! ne$4 ,occasionally1 ! algebraic sum ( reg5]ation & de/ruction may be app>5tly balanc$ & n tell ! trem5d\s am\nt ( pa?ology bo? productive & de/ructive1 t ! body is go+ ?r\gh4 ,! fir/ symptoms are ( easily produc$ fatigue ( all ! body1 bra91 muscles1 dim9i%$ dige/ive secretion1 & dyspnea4 ,z a result ( poor tissue oxyg5ation1 fatty deg5]ation takes place 9 ! m active organs z ! he>t1 kidneys & liv]4 ,!re may be ext5sive deg5]ation ( v>y+ areas ( ! c5tral n]v\s sy/em4 ,"s ( ^! areas are due to hemorrhages f ! g5]al t5d5cy to break+ d[n ( vessel walls4 ,(t5 ^! areas ( de/ruction affect ! po/]ior horns ( ! sp9al cord1 &1 occasionally1 a blood c\nt diff]5tiates betwe5 simil> symptoms ( p]nici\s anemia & tabes dorsalis4 ,!re is seldom any emaciation2 usually ! pati5t appe>s 8puffy0 ) a 8pa/y0 color4 ,!re is v>iable subcutane\s edema4 ,! symptoms be+ ( su* wide di/ribution & "*1 ! pati5t is usually treat$ = all sorts ( suppos$ conditions until "s "o makes a blood c\nt at a "t :5 !re is en\gh di/urbance ( equilibrium to give ! f9d+s ( p]nici\s anemia4 ,treatm5t4--,! treatm5t ( ! =m due to inte/9al p>asites gives /rik+ results on removal ( ! causative organisms4 ,"s advise treat+ all cases hav+ ^! blood f9d+s on ! assumption t ! pres5ce ( ^! p>asites is responsible = ! condition4 ,! treatm5t ( ! idiopa?ic =m resolves itself into build+ up ! ability ( ! body to resi/ disease & ! remov+ ( all possible ag5ts = depress+ ! vitality ( ! body4 ,re/ 9 b$ c\pl$ ) ! dige/ible & assimilable limit ( nutrition (t5 gives tempor>y improvem5t4 ,removal ( que/ionable tee? also (t5 aids = a "t4 ,correction ( tr\blesome o/eopa?ic lesions is (t5 accompani$ by ! same result4 ,! symptomatic o/eopa?ic treatm5t always makes ! pati5t m com=table1 (t5 gives tempor>y improvem5t1 &1 occasionally1 has giv5 a return to normal t has p]si/$ = sev]al ye>s4 ,prognosis4--,x is ne>ly always possible to obta9 transi5t improvem5t1 b ! p]nici\s anemia pati5t is usually dead )9 two ye>s f ! "t ! diagnosis is well e/abli%$4 ,! ,leucemias ,z a result ( any inflammatory process1 !re is a physiological reaction or /imulus lead+ to an increase 9 ! numb] ( neutrophilic leucocytes f\nd 9 ! p]iph]al circulation4 ,z long z ?is increase does n cr[d out o!r cells1 r$ & :ite1 suffici5tly to int]f]e ) _! ability to function !re is no?+ b ga9 to ! body ( ! "* ( m effici5t bact]ial de/ruction4 ,aft] ! ne$ = ^! cells has pass$1 _! numb] is decreas$ by de/ruction & ! less5+ ( _! production1 until an equilibrium is rea*$ :i* w be ma9ta9$4 ,?is same process ( mak+ & de/roy+ is con/antly go+ on = all ( ! diff]5t classes ( cells f\nd 9 ! blood /ream4 ,ov]-production ( any type w lead to actual increase ( t sort ( cell 9 circulation1 &1 if unaccompani$ by ov]-production ( o!r types1 w lead to a relative decrease ( ! o!r elem5ts4 ,x is v difficult = ! body to furni% normal cells v mu* 9 excess1 relatively1 ( ! normal numb]1 s t :5 ! /imulus lead+ to imm5se ov]-production is at "w immature cells 9 great numb]s are apt to be ?r[n into ! blood /ream4 ,z an example1 ! case ( leucocytosis :i* has a :ite c\nt ( #fj1jjj is extreme & ! pati5t ne>+ dea?1 yet x may n %[ _m1 if any1 abnormal types ( cells4 ,a case ( myelog5\s leucemia ) a :ite c\nt ( #fj1jjj w\ld n be proportionately sick1 & w\ld be a mild case--yet ! great] "p ( 8 :ite blood cont5t w\ld be made up ( cells n f\nd 9 normal blood4 ,! leucocytosis pati5t is suff]+ m f ! cause ( 8 increase 9 numb] ( cells1 :ile usually ! leucemia pati5t suff]s because ( ! increase ( cells4 ,9 "o1 ! cause is usually extr9sic1 &1 9 ! o!r1 x is intr9sic z f> z ! blood is conc]n$4 ,9 g5]al1 !n1 ! symptoms ( a leucemia p>allel 9 int5sity ! increase 9 cells4 ,x takes en]gy to make ^! cells--o!r tissues are made to suff] f lack ( ?is en]gy4 ,ery?rocytes & :ite cells _c occupy ! same space at ! same "t4 ,! increase 9 :ite !re=e cr[ds ! r$ cells out ( function4 ,disease 9 relative & absolute cont5t ( ery?rocytes decreases ! oxyg5 c>ry+ capacity ( ! blood /ream4 ,h5ce1 metabolism ( ! :ole body suff]s4 ,(t51 !n1 ! :ole app>5t symptomatology ( a sev]e leucemia is t ( a second>y anemia4 ,! prim>y pa?ology is ( hyp]plasia ( ! p>ticul> g5etic tissue ( ! type ( cells :i* are 9 excess1 & is proportionate 9 am\nt to ! excess develop$4 ,spl5om$ull>y ,leucemia 7,,myeloid ,,leucemia2 ,,myelemia7 ,myelemia is a disease *>act]iz$ by an enorm\s increase 9 ! :ite cell cont5t ) proportionate *anges 9 ! sple51 liv]1 & ! blood m>r[4 ,etiology4--,x is a disease occurr+ at all ages1 b ! majority ( cases are recogniz$ 9 adult males4 ,h]$ity1 trauma to ! sple51 mal>ia1 syphilis1 & rapid repetition ( pregnancies seem to be at lea/ excit+ factors4 ,a few cases h be5 report$ 9 :i* t5?1 elev5?1 & twelf? rib lesions 7 def9ite etiologic factors by pressure4 ,diagnosis4--,! pati5t goes ?r\gh a p]iod ( vague1 indef9ite1 & w&]+ symptoms4 ,g5]al malaise1 weakness (t5 accompani$ by dyspnea1 & emaciation simil> 9 _m ways to incipi5t pulmon>y tub]culosis1 except t ! slight temp]ature *anges are n typical4 ,at ! same "t !re may be dige/ive discom=t ( v>i\s k9ds )\t typical pa?ology4 ,( ^! e>ly symptoms ! mo/ p]si/5t is ! dyspnea :i* is a /ructural result ( ! increase 9 size ( ! sple54 ,z a direct pressure result ( ?is hyp]plasia1 !re may develop dropsical infiltration ( ! l[] extremities & ascitic accumulation 9 ! abdom9al cavity4 ,) ! *anges 9 ! blood itself1 ! blood vessel walls break d[n m easily1 & subcutane\s hemorrhages1 epi/axis & hematemesis are common4 ,9 an attempt to de/roy ! excessive am\nt ( :ite cells1 ! liv] may become enl>g$4 ,b ?is occurs lat] & ( mu* less degree ?an ! enorm\s increase 9 size ( sple54 ,!re may be areas ( hemorrhage ) result+ s(t5+ 9 ! sp9al cord4 ,! mo/ likely areas to suff] are ! po/]ior & lat]al horns1 ) result+ p>aplegia1 spa/ic or ataxic4 ,usually1 ! c\rse is sl[1 & ! condition is truly *ronic4 ,b1 occasionally1 ! rapid increase & succession ( symptoms1 ) concomitant blood *anges1 *ange ! diagnosis to acute myelog5\s leukemia4 ,! total cell c\nt1 r$ plus :ite1 is dim9i%$1 = :ile !re is enorm\s relative increase ( ! :ite cells a great] actual decrease takes place 9 ! r$s4 ,?is decrease 9 r$s is p>tially relative f cr[d+ out ( ery?rocytes by leucocytes1 b !re is also actual decrease 9 _! =mation1 s t !re is an actual anemia pres5t z well z a leukemia4 ,9 "s respects ! r$ cells behave z 9 *lorosis1 ea* c>ry+ a dim9i%$ p]c5tage ( hemoglob91 result+ 9 a l[ color index4 ,atypical /a9+ reactions & morphology1 toge!r ) _m fractur$ =ms1 are ! rule4 ,normobla/s are common ?r\gh\t ! c\rse ( ! disease1 b megalobla/s seldom appe> until ne> fatal t]m9ation4 ,! *anges 9 ! :ite cells are enorm\s1 bo? z to numb]s & "* ( cells f\nd4 ,! total :ite c\nt (t5 exce$s #cej1jjj4 ,?is1 ) ! accompany+ r$uction 9 numb] ( ery?rocytes1 leads to a r$uction ( ! ratio betwe5 r$s & :ites to z l[ z #a to #e or #c1 or occasionally #a to #a4 ,!re is an actual increase 9 numb] ( all ! :ite cells ) ! possible exception ( ! lymphocytes4 ,9 ! actual increase ( polymorphonucle> neutrophiles & eos9ophiles is r5d]$ a %>p relative decrease by ! enorm\s production ( myelocytes4 ,basophiles are usually bo? relatively & absolutely increas$4 ,9 a :ite c\nt ( #cej1jjj x is n unusual to h pres5t #cbe1jjj myelocytes1 ) #be1jjj z ! actual numb] ( ord9>y leucocytes4 ,!re is1 !re=e1 a mild leucocytosis c\pl$ ) a viol5t leukemia4 ,^! two are comb9$ ) an anemia t v>ies ) ! c\rse ( ! disease4 ,treatm5t4--,! treatm5t is l>gely hygi5ic1 includ+ ?or\gh o/eopa?ic att5tion to ! l[] dorsal & co/al area4 ,symptomatic treatm5t is (t5 foll[$ by tempor>y improvem5t bo? cl9ically & 9 ! blood picture1 b complete recov]y seldom takes place4 ,occasionally1 ro5tg5 !rapy has giv5 a 8cure0 la/+ sev]al ye>s4 ,prognosis is n good4 ,^! pati5ts are frequ5tly c>ri$ away quickly by "s (t5times slight int]curr5t infection4 ,ev5 if c>efully gu>d$ f su*1 ! c\rse ( ! process usually leads to dea? f exhau/ion 9 two or ?ree ye>s4 ,lymphatic ,leucemia ,cl9ically1 ?is is a p>allel condition to myelog5\s leucemia1 except t ! hyp]plasia ( cells occurs 9 lymphoid tissue1 & leads to an enorm\s ov]-production ( lymphocytes r ?an myelocytes4 ,x is m readily divid$ into acute & *ronic =ms ?an myelog5\s leucemia f diff]5ces 9 symptomatology4 ,9 ! acute =m1 adolesc5ts are usually affect$1 ! condition beg9n+ ) tumefaction ( ! lymph gl&s1 fir/ not$ 9 ! c]vical region1 b usually a g5]al involvem5t4 ,dyspnea results f pressure ^u tra*ea & bron*i by ! enl>g$ gl&s ( ! m$ia/9um4 ,!re is pyrexia ( #ajc to #aje degrees1 int]mitt5t 9 "*4 ,! pressure ^u n]ve trunks & plexuses 9 ! ?orax leads to v>iable ang9as di/ribut$ n only 9 regions actually impos$ ^u b ov] all sorts ( possible reflex pa?s4 ,! blood vessels ( ! sk9 are easily brok5 d[n s t slight injuries result 9 great suggillation4 ,! pati5t rapidly develops anemia1 & lat] goes into a syndrome simil> to ! ca*exia ( malignancy4 ,9 fact1 ! rapid t]m9ation & cl9ical c\rse ( acute lymphatic leukemia is p>allel to ! action ( malignancy4 ,probably ! condition w ev5tually be prop]ly classifi$ z a neoplasm ( ! blood itself4 ,! *ronic =m occurs 9 lat] life1 &1 in/ead ( be+ an abrupt rapid process1 is sl[1 progressive & pa9less4 ,x has ! lymph gl& hyp]plasia1 b ! enl>gem5t is s gradual t comp5sation is e/abli%$ to a rem>kable degree4 ,x is usually a g5]aliz$ process1 fir/ not$ 9 ! c]vical & axill>y gl&s because ( _! accessibility4 ,usually bo? ! sple5 & liv] are enl>g$1 b ?is also is a sl[ & lat] developm5t4 ,!re may be exac]bations ( temp]ature1 b !y are n con/ant or usually sev]e4 ,hemorrhages into ! sk9 are n common1 b pruritus may be v tr\blesome4 ,! pati5t comes to a physician because ( symptoms result+ f 8 second>y anemia1 dyspnea1 dyspepsia1 & palpitation4 ,! diagnosis _c be made )\t ! aid ( a blood /udy4 ,! blood picture %[s a sev]e anemia ) bo? ! numb] ( ery?rocytes & ! hemoglob9 p]c5tage v mu* l[]$4 ,( ! two f9d+s1 ! hemoglob9 p]c5tage is relatively m decreas$1 s t ! color index is m>k$ly l[]$4 ,9 ! acute =m nucleat$ r$s are common4 ,j be=e dea? ^! may %[ v>i\s =ms & sizes z well z ! normobla/s4 ,9 ! *ronic =m normobla/s d n appe> except z ! case gr[s decid$ly worse4 ,z comp>$ to myelog5\s leucemia ! anemia ( lymphatic leukemia is ( great] sev]ity4 ,9 ! leucocyte c\nt !re is great increase 9 numb]s1 ! great] "p be+ compos$ ( ! lymphocytes4 ,! lymphocytes may be ei!r ( ! l>ge or small v>iety1 & occasionally are f\nd 9 ab\t equal proportions4 ,9 contra-di/9ction to ! myelog5\s type1 ! increas$ type ( cells are ( ! mononucle> nongranul> types4 ,x is n v unusual to f9d a well advanc$ case ( lymphatic leucemia )\t abnormal cells 9 ! blood c\nt1 ! expression ( pa?ology be+ 9 ! %ape ( di/urbance 9 numb] & proportion ( cells r ?an 9 developm5t ( abnormal types4 ,! actual numb] ( leucocytes does n g z high 9 proportion to ! gravity ( ! condition 9 lymphatic leukemia z x does 9 ! myelog5\s4 ,9 o!r words1 a pati5t ) lymphoid leucemia %[+ a c\nt ( #ij1jjj leucocytes ) #ij ( ^! lymphocytes is a mu* sick] man ?an ! myelog5\s case %[+ a #cej1jjj leucocyte c\nt4 ,usually !re is an actual z well z relative decrease ( all ! granul> types ( leucocytes ) ! polymorphonucle> neutrophiles especially decreas$4 ,! treatm5t is sy/emic & symptomatic4 ,recov]y is n to be expect$1 b ^! un=tunates c be made relatively com=table & giv5 occasional respite by judici\s o/eopa?ic c>e4 ,hodgk9's ,disease 7,,lymphad5oma2 ,,pseudo-,,leucemia7 ,9 a g5]al way1 ! sev]al conditions :i* are cl9ically leucemia1 yet d n possess leukemic blood1 c be classifi$ z pseudo-leukemias4 ,we d n def9itely "k ! cause ( leucemia z yet & c b little m ?an speculate on ! v>i\s etiologic factors ( ! pseudo-leucemias4 ,syphilis1 mal>ia1 tub]culosis1 & malignancy are all consid]$ z factors1 & probably c]ta9 cases c be def9itely associat$ ) ^! conditions4 ,all ( ?is gr\p ( pseudo-leucemias are *>act]iz$ by e>ly swell+ ( c]vical lymph gl&s1 foll[$ by g5]al gl& enl>gem5t1 & by great de/ruction ( ! ery?rocytes4 ,!re may be meta/atic-l gr[?s ( lymphoid tissue 9 o!r organs4 ,! enl>gem5t ( c]vical gl&s usually beg9s on "o side ne> ! angle ( ! jaw1 & mo/ commonly 9 "y male adults4 ,^! gl&s progressively increase 9 size1 fir/ are s(t1 !n lat] become h>d ?r\gh fibr\s prolif]ation4 ,ea* gl& t5ds to increase 9 size by itself1 n to coalesce ) its neighbors1 s t ea* sep>ate gl& c be palpat$4 ,?is is m readily done z !re is little t5d5cy to fibr\s adhesion =mation to ! ov]ly+ sk94 ,^! gl&s are pa9less ?r\gh\t ! c\rse ( ! disease1 & t5d nei!r to caseate nor to suppurate4 ,! excis$ gl&s %[ a comb9$ hyp]plasia & connective tissue prolif]ation4 ,9 ! s(t /age ( ! tumefaction1 ! lymphoid hyp]plasia is 9 prepond]ance1 :ile1 at ! /age ( h>d5+1 ! fibr\s tissue d]iv$ f ! trabeculae & capsule ( ! gl& is 9 prom95ce4 ,!re is increase 9 ! size ( ! sple51 & occasionally ( ! liv]1 b ^! are nev] z m>k$ z ^? result+ f leucemia4 ,! symptoms are1 fir/1 ^? due to ! gl&ul> enl>gem5t 9 ! ord] (3 dyspnea1 hydro?orax1 dysphagia1 ascites1 swell+ ( ! extremities1 & jaundice4 ,! de/ruction ( r$ cells gives a result+ anemia :i* goes ) & exagg]ates ! pressure symptoms4 ,a process ( ?is k9d to induce su* grave *anges ov] z well protect$ organs z make up ! lymph sy/em1 mu/ be virul5t en\gh to set up o!r symptoms1 to be associat$ ) ^? due to pressure or to anemia4 ,^! are usually emaciation 7giv+ great] prom95ce to gl&ul> tumefaction71 ca*exia1 & ! implantation ( masses ( lymphatic tissue 9 organs :]e normally only traces ( ?is tissue exi/4 ,fev] is dep5d5t ^u ! di/urb$ !rmic metabolism & may be practically abs5t or subject to wide v>iations4 ,! ery?rocyte c\nt %[s a progressive decrease ) a great] proportion ( brok5 d[n cells & abnormal types z ! condition advances4 ,! actual c\nt is usually betwe5 #b1jjj1jjj & #c1ejj1jjj p] cubic millimet]4 ,! hemoglob9 usually r$uces 9 proportion to ! ery?rocytes1 s t !re is little *ange 9 color index4 ,! leucocytes are n m>k$ly *ang$ 9 numb] 7seldom ov] #aj1jjj71 & ?is is (t5 ! diagno/ic f9d+ betwe5 leukemia & ! pseudo-leukemias4 ,hodgk9's disease usually has a high p]c5tage ( lymphocytes1 s t !re is an actual z well z relative decrease ( ! granul> leucocytes4 ,! treatm5t is unsatisfactory1 & is 9 ! ma9 symptomatic4 ,ro5tg5 !rapy has giv5 tempor>y improvem5t1 9 "s cases la/+ sev]al ye>s4 ,9 g5]al ! prognosis is hopeless1 ! end occurr+ )9 f\r ye>s ( ! "t ! condition is recogniz$4 ,,diseases ,,( ,,! ,,?yroid ,,gl& ,conge/ion ,physiological conge/ions ( ! ?yroid gl& are n uncommon dur+ pub]ty1 pa9ful m5/ruations1 pregnancy1 & ! m5opause4 ,! prem5/rual conge/ion may p]si/ aft] ! m5/rual function has be5 e/abli%$1 b ?is is comp>atively r>e4 ,:5 ! enl>gem5t rema9s !re is m or less hyp]trophy1 & x %\ld receive appropriate treatm5t4 ,upp] dorsal & c]vical lesions are common4 ,! conge/ion dur+ pregnancy occurs 9 ! majority ( cases & seems to be a physiological process1 :]e9 !re is m or less hyp]trophy & hyp]plasia1 :i* probably c\nt]acts ! wa/e products especially caus$ by ?is /ate1 or due to ! inactivity ( ! ov>y4 ,dur+ deliv]y ! gl& may rapidly enl>ge & rema9 s = an indef9ite "t4 ,x seems probable t ! /ra9+ due to labor may cause lesions ( ! upp] dorsal & neck t w d]ange ! function ( ! organ4 ,:5 ! enl>gem5t occurs dur+ ! m5opause special c>e %\ld be tak5 t ! goit] is n malignant4 ,o!r possible causes ( conge/ion are ov]fatigue1 p>ticul>ly :5 associat$ ) heavy lift+2 tight clo?+ ab\t ! neck2 ov]use ( ! voice2 & 9 a few cases x may be discov]$ 9 boys at pub]ty4 ,! symptoms are conge/ion1 ! gl& be+ v vascul>1 ei!r s(t or t5se1 some:at pa9ful ow+ to ! t5sion ( ! capsule1 & 9 p]si/5t cases !re may be hyp]trophy & hyp]plasia4 ,! treatm5t is ! same z giv5 "u simple goit]4 ,inflammation ( ! ,?yroid ,inflammation ( ! ?yroid is n ( frequ5t occurr5ce4 ,9 ! sev]al cases t ! au?ors h se5 !re 0 "s previ\s enl>gem5t ( ! organ1 :i* probably caus$ a l[]$ resi/ance ( ! local tissues4 ,!re is almo/ inv>iably "s infection else:]e 9 ! body4 ,! excit+ causes are usually /reptococcus1 /aphylococcus1 or bacillus coli4 ,! inflammation may foll[ pneumonia1 tonsillitis1 rheumatism1 typhoid1 pu]pal infections1 ent]itis1 diph!ria1 influ5za1 mumps1 etc4 ,trauma1 c>ry+ weights on ! head1 & cold1 may be etiological factors4 ,commonly1 "o lobe is involv$1 ?\gh ! entire gl& may be affect$4 ,!re is swell+1 ! capsule is di/5d$ & pa9ful1 & small hemorrhages occur :i* 9 ! case ( suppuration =m ! site ( ! abscess4 ,! swell+ involves ! p>5*yma & int]/itial tissue4 ,! onset is usually sudd5 ) *ills1 fev]1 & pa9 ov] ! gl&s4 ,! pati5t keeps ! head flex$ to release ! muscul> t5sion1 swall[+ is pa9ful1 & !re is a s5se ( con/riction4 ,a rapid he>t may be a prom95t symptom4 ,mu* dep5ds at ?is p]iod on ! treatm5t giv54 ,if ! dra9age c be fre$1 by l[]+ ! fir/ ribs & rais+ ! clavicles ) att5tion to ! dorsal & c]vical inn]vation1 prompt subsid5ce ( ! condition commonly takes place4 ,?is %\ld be c>efully accompli%$ 9 ord] n to bruise ! p>ts4 ,diagnosis is n difficult z a rule4 ,! symptoms & hi/ory ( infection w g5]ally suffice4 ,hemorrhage may occur 9 a goit] & some:at simulate inflammation4 ,a possibility ( malignancy is to be consid]$4 ,if ! condition does n yield to treatm5t1 surgical int]f]5ce may be necess>y4 ,tub]culosis & syphilis ( ! ?yroid are r>e conditions4 ,woody ?yroiditis may be mi/ak5 = malignancy4 ,! gl& is v fibr\s1 & :5 cut has a dry surface4 ,! connective tissue is h>d5$ & cr[ds ^u ! p>5*yma4 ,?is condition is usually f\nd 9 "y m54 ,x develops rapidly1 ) m or less pa9 & dyspnea4 ,ad5oc>c9oma1 c>c9oma1 & s>coma are r>e diseases#ajf1 /ill "o %\ld be on 8 gu>d z to _! possibility4 ,!y are mo/ apt to occur aft] =ty4 ,a rapid enl>gem5t %\ld be reg>d$ ) suspicion4 ,simple ,goit] ,we employ ! t]m simple goit] to designate *ronic enl>gem5t ( ! ?yroid gl& n due to inflammation1 exoph?almic goit]1 or malignancy1 al?\gh ! latt] conditions are frequ5tly associat$ ) or foll[ ! =m]4 ,!re is usually an enl>gem5t ( ! gl& 9 cret9ism1 & occasionally 9 myx$ema1 b ! functional grade ( ! gl& is f> diff]5t f t 9 o!r diseases ( ! ?yroid4 ,! disease is v preval5t 9 c]ta9 regions ( ,europe & ,asia1 al?\gh 9 ! ,unit$ ,/ates x is n s common1 except 9 ! environs ( ! ,great ,lakes1 ! ,di/rict ( ,columbia1 & ! ,nor?we/ /ates4 ,! second decade ( life1 probably ow+ to adolesc5t *anges1 especially 9 girls1 develop ! great] numb] ( goit]s4 ,x is infrequ5tly cong5ital1 & occasionally a case w develop z e>ly z f\r or five ye>s ( age4 ,etiology4--,di/urb$ inn]vation ( ! gl& unque/ionably seems to be ! pr$ispos+ cause ( ! d]ang$ secretion & vascul> *anges1 :i* if cont9u$ f9ally lead to hyp]trophy & hyp]plasia ( ! tissues4 ,^! lesions are f\nd f ! fif? dorsal to ! occiput & to ! correspond+ ribs4 ,!y probably involve secretory fib]s ( ! sympa!tic t em]ge f ! upp] dorsals1 fir/ to fif? inclusive1 maximum effect second1 ?ird & f\r?4 8,evid5ce is pres5t$ t ! impulses pass to outly+ neurones ^: cell bodies are locat$ close bel[ ! sup]ior c]vical ganglion & also 9 ! inf]ior c]vical ganglion40#ajg4 ,9 bo? ^! ganglia impulses to ! ?yroid pass f preganglionic fib]s to ! outly+ neurones4 ,?is also includes ! area ( vasomotor#ajh inn]vation ( ! head & neck4 ,9 a numb] ( cases c]vical lesions alone w di/urb ! ?yroid inn]vation1 especially f ! second to f\r? segm5ts4 ,^! may involve ! sup]ior c]vical sympa!tic1 ow+ to its relation%ip to ! rectus capitis anticus major muscle4 ,!n !re are aff]5t association fib]s t pass d[n ?r\gh ! lat]al horns & ^: connect+ fib]s em]ge via ! upp] dorsal4 ,! lymphatic dra9age ( ! ?yroid %\ld n be neglect$4 ,lesions ( ! upp] ribs & clavicles are v prone to imp$e its circulation1 & ?us pr$ispose to second>y infections4 ,infection f septic foci are important second>y factors4 ,?is is p>ticul>ly true ( focal infections ( ! upp] respiratory tract & buccal cavity1 al?\gh infections & tox9s f v>i\s regions may be excit+ factors4 ,toxemia due to inte/9al /asis is n r>ely an important consid]ation4 ,mc,carrison insi/s t infection f c]ta9 wat]s is ! cause ( goit]4 ,he f9ds t boil+ ! wat] r5d]s x h>mless4 ,pa?ologically1 ! fir/ effect ^u ! gl& is to less5 its iod9e cont5t4 ,! circulation is increas$1 ) hyp]plasia ( ! epi!lial tissue1 & a less5$ am\nt ( colloid mat]ial4 ,if ! condition cont9ues1 ! alveoli w aga9 become di/5d$ ) ! colloid mat]ial s t ! epi!lial tissue cells are almo/ flatt5$4 ,?is repres5ts ! s-t]m$ colloid goit]4 ,! gl&1 commonly ! :ole organ1 ?\gh "o side may be involv$1 is fairly uni=m 9 size4 ,9 r>e in/ances1 ! gl& may surr\nd ! tra*ea--! s-t]m$ circul> goit]4 ,hemorrhages may occur1 & !re may be v>i\s alt]ations & deg5]ations4 ,:5 ! vessels are mu* dilat$1 x is (t5 call$ a vascul> goit]1 ?\gh ! colloid *anges are pres5t4 ,! nodul> goit] is ano!r =m *>act]iz$ by new =mation ( gl& tissue t is n diffuse b circumscrib$4 ,^! cases are apt to foll[ p]si/5t involvem5t ( ! gl& at pub]ty4 ,! two =ms may occur toge!r1 & !re may be v>i\s comb9ations & *anges4 ,9 ! nodul> goit] !re is comp>atively little colloid4 ,!re are _m blood-vessels1 & small hemorrhages are frequ5t4 ,?is latt] po9t %\ld be rememb]$ by ^? :o treat ov] ! gl&1 :i* at be/ is a d\btful proc$ure4 ,v>i\s *anges may take place1 z local po9ts ( necrosis1 cy/ic =mation1 & calcification1 are n uncommon4 ,symptoms4--,! ess5tial feature 9 goit] is di/5sion ( ! alveoli & =mation ( new ones1 associat$ ) dilat$ vessels1 & usually deg5]ation ( ! colloid4 ,(t5 ! function ( ! gl& is n noticeably di/urb$4 ,usually1 x is = ! pressure symptoms or ! unsightl9ess1 due to ! di/5sion1 t ! pati5t seeks relief4 ,pressure ^u ! w9dpipe1 gullet1 or blood-vessels is n r>e1 & may cause m or less difficulty 9 brea?+ or swall[+4 ,c\gh+ & husk9ess may be tr\blesome4 ,! recurr5t n]ves & vagus may be compress$4 ,di/urbance ( ! he>t1 su* z palpitation1 ta*yc>dia1 & hyp]trophy may be caus$ by ! effect ( pressure ^u ! blood-vessels1 or to *anges 9 ! secretory function ( ! gl&4 ,treatm5t4--,adju/m5t ( ! upp] dorsal & c]vical lesions w be foll[$ by recov]y 9 ! majority ( cases4 ,dr4 ,/ill emphasiz$ ! po9t t ! v]tebral ends ( ! fir/ ribs are frequ5tly displac$ upw>d & outw>d4 ,?is lesion is (t5 f\nd 9 cases foll[+ conf9em5t4 ,! effect ( ! *ange "h is probably to ! /ellate ganglion1 or to ! lymphatic dra9age ( ! gl&4 ,treatm5t ov] ! gl& %\ld be cauti\sly giv51 if at all4 ,def9ite correction ( ! lesion$ v]tebr & ribs w be suffici5t1 b muscul> manipulation & halfway measures are practically useless4 ,lesions ( ! l[] sp9e may be ! prim>y s\rce ( a comp5satory lesion ( ! upp] dorsal1 or !y may d]ange ! pelvic organs1 or be ! pr$ispos+ factor ( inte/9al /asis4 ,att5tion to possible focal infections1 & ?or\gh elim9ation1 are to be consid]$4 ,9 goitr\s regions boil+ ! wat] is ( value4 ,9 ob/9ate cases ! ,x-ray may be ( s]vice1 & z a f9al resort surg]y may be employ$4 8,m>9e obs]v$ t ! am\nt ( iod9e is inv]sely proportional to ! degree ( hyp]plasia ( ! gl&1 & :5 ! hyp]pla/ic condition becomes fully develop$1 sc>cely a trace ( iod9e is conta9$ 9 ! gl&4 ,lat]1 :5 ! hyp]plasia gives place to colloid goit]1 ! iod9e increases aga91 bo? absolutely & relatively4 ,moreov]1 x has be5 f\nd t if iod9e be adm9i/]$ to an animal suff]+ f hyp]plasia1 ! hyp]pla/ic condition v quickly disappe>s & ! animal becomes normal40#aji4 ,8 viewpo9t ( ! hyp]plasia is t an ef=t is be+ made to comp5sate = an 8insuffici5cy due to inability to absorb or assimilate suffici5t iod9e01 & ?us ! effect ( ! adm9i/]$ iod9e is to normalize ! gl& by /imulation4 ,no "o c "q t ?is may be effective "u c]ta9 conditions1 p>ticul>ly :]e !re is defici5t iodide 9 ! wat]1 b x is an ess5tial elem5t ( ! body4 ,b x does n necess>ily foll[ t because 9 ?yroid di/urbance ! relation%ip betwe5 ?yroid function+ & ! sub/ance conta9+ iod9e is upset t recov]y dep5ds ^u furni%+ m iod9e to ! body economy4 ,x may be some:at p>allel to giv+ iron 9 anemia1 :5 (t5 ! real difficulty is "o ( assimilation1 & n insuffici5t iron 9 ! alim5t>y canal4 ,moreov]1 case aft] case ( goit] has recov]$ ?r\gh o/eopa?ic measures foll[+ a mo/ ?or\gh trial ( ! iod9e treatm5t4 ,x is v obvi\s t ! cause ( ! goit] re/$ else:]e4 ,dogs are susceptible to ?yroid enl>gem5t4 ,lesion+ ( ! c]vical region has result$ 9 goit] =mation1 & recov]y has foll[$ adju/m5t ( ! lesion4 ,& dogs hav+ goit] )\t exp]im5tal lesions h frequ5tly be5 normaliz$ by adju/+ an abnormal c]vical sp9e4 ,exoph?almic ,goit] ,9 exoph?almic goit] !re is an excess ( ! ?yroid secretion or ?yroid autacoid :i* passes into ! circulation1 due to hyp]trophy or hyp]plasia ( ! secret+ cells4 ,! disease is *>act]iz$ cl9ically by n]v\sness & irritability1 rapid pulse1 flu%$ & moi/ sk91 tremor1 & increas$ nitrog5\s metabolism4 ,a goit] is usually pres5t1 b n always noticeable4 ,!re is apt to be protrusion ( ! eyes1 especially aft] ! disord] is e/abli%$1 ?\gh x may nev] appe>4 ,a di/urb$ coord9ation ( ! muscles ( ! eyelid1 eyeball1 & orbit are frequ5t *>act]i/ic symptoms4 ,etiology4--,! ess5tial factor 9 ! cause ( ?is disease is probably o/eopa?ic lesions t irritate ! secretory fib]s ( ! ?yroid tissue4 ,^! lesions are almo/ inv>iably f\nd 9 ! upp] dorsal1 fir/ to fif?1 & mo/ (t5 localiz$ at ! second-?ird or ?ird-f\r? segm5ts4 ,!y are def9ite int]osse\s *anges1 comb9$ rotation & lat]al flexion1 & are g5]ally v s5sitive ^u palpation4 ,! con/ant /imulus ?us produc$ passes ?r\gh ! sympa!tic fib]s to ! c]vical ganglia1 & !nce to ?yroid secret+ tissue1 :i* ?r\gh vascul> *anges & hyp]trophy & hyp]plasia increases ! output ( ! ?yroid hormone4 ,! s5sitiv5ess ( ! lesions is probably ( m ?an pass+ int]e/4 ,= ?is actual t5d]ness is n to be confus$ ) a neura/h5ic /ate1 :i* may be associat$ ) ! disease1 or ev5 be a s\rce ( confusion 9 ! diagnosis4 ,! lesion is ( su* a di/9ct "* t !re is consid]able local irritation & conge/ion4 ,?is con/ant /imulus is a cause ( ! increas$ numb] ( impulses c>ri$ to ! sympa!tic1 & results 9 n only an excess ( ?yroid secretion & ! concomitant hyp]trophic *anges1 b also 9 ! rapid removal ( ! colloid into ! circulat+ blood4 ,?is seems to be a v important l9k 9 ! pa?ologic *a94 ,o!r und]ly+ lesions may be pres5t1 z outl9$ "u simple goit]1 & d n require repetition "h4 ,! me*anism ( ! ?yroid gl& may be fur!r upset or d]ang$ by v>i\s excit+ causes1 su* z focal infections1 toxic /ates1 inte/9al /asis1 & occasionally an enl>g$ ?ymus is an important factor4 ,an inh]it$ neuropa?ic t5d5cy1 excessive /ra91 worry1 & m5tal %ocks may h m or less influ5ce 9 ei!r pr$ispos+ or excit+ ! disord]4 ,! p>ticul> po9ts = ! practition] to rememb] are t exoph?almic goit] is due to a toxic /ate1 ( :i* !re are _m gradations1 f ! excessive secretion ( ! ?yroid gl&2 t ! normal resi/ance ( ! gl& is l[]$ ?r\gh def9ite lesions ( its inn]vation or circulatory *annels1 or occasionally ( lesions ( ! o!r organs ( int]nal secretion :i* are closely associat$2 t infections & tox9s are (t5 important consid]ations2 & t direct manipulation ( ! organ may increase ! disord]4 ,pa?ology4--,! enl>gem5t ( ! ?yroid gl& is commonly an e>ly symptom1 occurr+ be=e ! n]v\s1 c>diac & exoph?almic manife/ations4 ,!re are in/ances :]e x foll[s a simple goit]1 al?\gh ,graves' disease does n seem to be any m preval5t 9 regions :]e simple goit] is endemic ?an else:]e4 ,9 ^! p>ticul> in/ances inte/9al toxemia is (t5 pres5t4 ,!re are cases :]e ! gl& is v slightly enl>g$1 conta9+ only small areas ( hyp]plasia4 ,!re is usually v little colloid1 ?\gh !re may be m>k$ exceptions4 ,x %\ld be emphasiz$ t !re are v>i\s degrees ( *anges f\nd 9 ! gl& ?\gh fundam5tally ( ! same ord]4 ,! blood supply is ext5sive1 & ! ve9s especially are fragile4 ,! alveoli are di/ort$1 due to ! increase ( epi!lial cells4 ,lymphoid nodules are frequ5tly not$ ?r\gh ! gl&ul> tissue4 ,rese>* "w ( unusual int]e/ to ! o/eopa?ic physician p]ta9+ to ! etiology & pa?ology ( exoph?almic goit] has be5 c>ri$ out at ! ,mayo ,cl9ic4 ,an exam9ation ( c]vical sympa!tic ganglia remov$ at op]ation f su* cases & c]ta9 animal exp]im5tation has giv5 def9ite results4 ,! foll[+ is a summ>y ( _! pr9cipal f9d+s3 8,degree ( hyp]pigm5tation1 granul> deg5]ation1 & r$uction 9 ! numb] ( cells 0 9 direct ratio to ! cont9uance ( symptoms ( hyp]?yroidism4 ,! increas$ am\nt ( p]ivascul> connective tissue g5]ally ?r\gh\t ! gl& 0 simil>ly 9 direct ratio to ! "t dur+ :i* symptoms ( hyp]?yroidism _h cont9u$4 8,increase ( connective tissue 9 ! ganglia f ! *ronic cases may be int]pret$ z due to ! irritation f inflammation1 or z m]ely a replacem5t foll[+ ! de/ruction ( ! ganglionic n]ve cells4 8,ganglia 7 intimately connect$ by firm adhesions to ! surr\nd+ tissue4 8,!re 7 *anges 9 ! out] & middle coats ( vessels1 & 9 ! n]ve fib]s4 ,!re 0 an increase ( connective tissue ?r\gh\t ! ganglion4 8,x appe>s t def9ite hi/ologic *anges d occur z 7a7 hyp]-*romatization1 7b7 hyp]pigm5tation1 7c7 *romatolysis1 & 7d7 atrophy1 or 7e7 granul> deg5]ation ( ! n]ve cells4 ,all ( ^! are b successive /eps 9 deg5]ation :i*1 if un9t]rupt$1 proce$ to complete de/ruction ( ! ganglion cells affect$4 ,n all ( ! ganglion cells 9 any ( ! ganglia exam9$ 7 s completely de/roy$ z to r5d] improbable _! return to normal "u favorable conditions4 ,!re is "s evid5ce t 9 ganglia f cases cl9ically improv$ "s ( ! cells h p>tially or :olly recov]$40#aaj ,!y are incl9$ to ! view t local infection 9 ! c]vical sympa!tic ganglia plays an important "p 9 ! etiology4 ,! above pa?ologic *anges ( n]ve fib]s & ganglia support 9 _m ways ! f9d+s not$ at ! ,a4 ,t4 ,/ill ,rese>* ,in/itute1 n alone 9 ! c]vical region b 9 o!r regions ( ! body1 t is1 !y are *anges common to int]osse\s lesion pa?ology ( v>i\s areas ( ! sp9e1 & ?us are pr$ispos+ factors t e/abli% l[]$ resi/ance ( tissue & d]angem5t ( function4 ,an important feature ( ! pa?ology is hyp]plasia ( ! ?ymus4 ,simmonds f9ds x enl>g$ 9 ?ree out ( f\r cases4 ,mac,callum#aaa has f\nd x enl>g$ 9 all autopsies t he has se54 ,! lymphoid /ructures ( ! sple51 liv]1 kidneys1 inte/9es1 & bone m>r[ is increas$1 :ile ! lymphatic gl&s ( v>i\s regions ( ! body may be enl>g$1 especially ! c]vical1 bron*ial1 & axill>y4 ,?is is probably due to a toxic condition4 ,dilatation & hyp]trophy ( ! he>t is common1 & 9 advanc$ cases myoc>dial deg5]ation is apt to take place4 ,symptoms4--,! out/&+ feature ( hyp]?yroidism is ! excessive secretion ( ! gl&4 ,! symptoms seem to be l>gely dep5d5t ^u ! am\nt ?r[n into ! blood /ream2 /ill !re is a possibility t !re may be a c]ta9 p]v]sion ( ! secretion1 ?\gh if su* exi/s x has n be5 discov]$4 ,x %\ld be kept 9 view t 9 c]ta9 in/ances :]e ! secret+ activity ( ! gl& has be5 m>k$ly curtail$1 by surgical means1 = in/ance1 ev5 to hypo-function+ !re may /ill exi/ "s ( ! symptoms ( exoph?almic goit]1 :i* goes to %[ t o!r factors may be ( decid$ importance4 ,! ?ymus & o!r relat$ organs1 z well z ! sympa!tic n]ves1 are n to be neglect$4 ,k5dall & ,plumm] 7,mayo ,cl9ic7 8believe t ! location ( ! active con/itu5t ( ! ?yroid1 :5 x functions1 is )9 ! cells n ( any p>ticul> set ( organs or portion ( ! body1 b t x is a con/itu5t ( cellul> life & activity4 ,plumm] /ates t ! active con/itu5t ( ! ?yroid det]m9es ! rate at :i* any p>ticul> cell c produce en]gy1 t is1 x e/abli%es ! quantum en]gy :i* any cell c produce :5 x is /imulat$1 ei!r f )9 itself or f )\t1 s t ! ?yroid is directly relat$ to ! production ( en]gy )9 ! body4 ,he has %[n t "o-?ird ( "o milligram ( ! active con/itu5t ( ! ?yroid increases ! basal metabolic rate "o p] c5t 9 an adult weigh+ approximately #aej p\nds40 ,?is %[s h[ important ! secretion is n only to all relat$ gl&s b to e cell ( ! body1 & assi/s 9 e/abli%+ a physiological basis 9 ! correlation ( ! symptoms ( bo? hyp]- & hypo-function+ ( ! organ4 ,z a rule ! ?yroid is n greatly enl>g$4 ,! size1 %ape1 & consi/5cy v>ies4 ,x may foll[ a simple goit]4 ,_m ( !m are s(t & yield+1 or cy/ic2 o!rs are h>d1 ( a fibr\s resi/ance1 or nodul>4 ,probably 9 ! in/ances :]e hyp]trophy is n discov]able !re is hyp]pla/ic tissue scatt]$ ?r\gh ! gl&4 ,or x is possible !re may be an intra?oracic ?yroid1 or accessory tissue 9 o!r regions1 v>y+ f ! root ( ! tongue to ! aortic ar*1 :i* has become diseas$4 ,g5]ally1 bo? lobes are enl>g$1 ?\gh ! d]angem5t may be conf9$ to a portion4 ,(t5 !re is pulsation & a ?rill ov] ! gl&4 ,sy/olic murmurs are frequ5t4 ,9 ! e>ly /age ( goit]1 t5d]ness is noticeable due to ! di/5sion ( ! capsule4 ,! eye symptoms are3 wid5$ palpebral fissure or ,dalrymple's sign2 failure ( ! upp] lid to foll[ ! d[nw>d movem5t ( ! eyeball or ,v4 ,graefe's sign2 insuffici5cy ( conv]g5ce ( ! two eyes or ,moebius' sign2 exoph?almos1 :i* may be unilat]al 79 ab\t sev5ty five p]c5t ( ! cases72 & r>5ess ( involunt>y w9k+1 are ! pr9cipal eye signs4 ,rapid he>t action is an e>ly & important symptom4 ,?is is giv5 by all obs]v]s z ! mo/ con/ant ( all symptoms4 ,palpitation is (t5 di/urb+4 ,! pulse is =cible1 especially 9 ! vessels ( ! neck4 ,!re is g5]ally a l[ blood pressure4 ,! he>t is apt to be dilat$1 & 9 *ronic cases hyp]trophy & deg5]ation are (t5 f\nd4 ,a f9e tremor1 eight to t5 times a second1 is an important symptom4 ,?is is usually pres5t & is consid]$ "o ( ! c>d9al diagno/ic po9ts4 ,pr(use sweat+1 emaciation1 muscul> weakness1 especially ( ! legs1 vomit+1 di>rhea1 a feel+ ( dyspnea1 & polyuria are frequ5t symptoms4 ,anxiety1 appreh5sion1 heada*e1 irritability1 & fatigue are (t5 e>ly symptoms1 b c>e %\ld be tak5 t !y are n entirely dep5d5t ^u a neura/h5ic /ate4 ,pruritus may be a di/ress+ symptom4 ,!re may be abnormal pigm5tation4 ,m5/rual d]angem5ts are common1 especially am5orrhea1 ow+ to ! anemia4 ,& !re may be v>i\s sexual di/urbances4 ,exoph?almic goit] occurs (t5] 9 wom5 ?an 9 m54 ,! disease is commonly a *ronic "o la/+ sev]al ye>s1 unless ! morbid cycle c be brok52 /ill !re are cases :]e x appe>s v sudd5ly & runs a rapid c\rse4 ,mc,carrison#aab says3 8,our consid]ation ( ! morbid *anges met ) 9 ,graves' disease w h br\ght into prom95ce ! fact t !y are indicative ( toxic action4 ,! lymphocytosis1 ! lymphatic hyp]plasia1 ! lymphocytic infiltration ( ! ?yroid1 ! liv] & o!r organs2 ! *ronic toxic inflammatory *anges 9 ! ?yroid1 liv] & pancreas2 ! *anges 9 ! muscles1 9 ! n]v\s sy/em & 9 ! adr5als2 all ^! po9t to a condition ( *ronic irritation z ! und]ly+ factor 9 _! production1 & to ! ga/ro-inte/9al tract z ! mo/ common s\rce ( ! toxic irritant40 ,diagnosis4--,! diagnosis z a rule is n difficult4 ,difficulty may arise :]e !re is incomplete developm5t ( ! disord]4 ,irritation ( ! sympa!tic n]ves is ( ! greate/ significance1 = ! *>act]i/ic symptoms are dep5d5t ^u ?is condition4 ,neura/h5ia1 hy/]ia1 p>alysis agitans1 & tobacco poison+ & alcoholism may mislead "o4 ,! enl>g$ & active gl&1 ) murmur 9 ! majority ( cases1 loss ( weight1 excessive sweat+1 di>rhea1 tremor1 & ta*yc>dia1 ev5 )\t ! eye symptoms1 are specially significant4 ,! t5d]ness ( ! o/eopa?ic lesions is v (t5 noticeable4 ,prognosis4--,a great deal dep5ds ^u ! coop]ation ( ! pati5t4 ,re/ & diet are su* important features ( ! treatm5t1 t if ! pati5t is n will+ to foll[ in/ructions1 great difficulty w be enc\nt]$ 9 secur+ satisfactory results4 ,adju/m5t ( ! lesions & elim9ation ( tox9s are highly ess5tial1 b only 9 a c]ta9 numb] ( cases w ?is suffice4 ,?is1 h[ev]1 w usually less5 ! sev]ity ( ! condition1 & ! pati5t gets along fairly well1 b ?is may be f> f secur+ ! possible maximum results4 ,! duration ( ! disease is (t5 f five to tw5ty ye>s1 or ev5 long]4 ,& ! pati5t frequ5tly dies f "s int]curr5t disease1 p>ticul>ly pneumonia & tub]culosis4 ,weakness ( ! he>t is ! mo/ important cause ( dea?4 ,sev]e vomit+ & di>rhea may s exhau/ ! pati5t t a fatal t]m9ation takes place4 ,surgical int]f]5ce %\ld n be too long delay$ if !re is no indication ( improvem5t by o!r means4 ,treatm5t4--,e case requires individual /udy1 ow+ to ! _m possible excit+ causes1 especially ^? :]e infections & tox9s play s important a role4 ,! f\r c>d9al features ( treatm5t are3 adju/m5t ( ! o/eopa?ic lesions1 re/1 diet1 & elim9ation ( infecti\s & metabolic poisons4 ,specific adju/m5t ( ! upp] dorsal sp9e is prim>ily ess5tial4 ,! "w %\ld be def9itely & quickly accompli%$4 ,s(t tissue manipulations am\nt to b little except z a prep>ation = ! int]osse\s adju/m5t4 ,d n tire ! pati5t4 ,(t51 foll[+ exact adju/m5t a def9ite less5+ ( ! sev]e symptoms w be notic$4 ,! activity ( ! ?yroid w be appreciably decreas$2 ! he>t's action sl[$2 ! eye symptoms less noticeable2 ! tremor less5$2 & ! /r5g? ( ! pati5t improv$4 ,d n treat too (t54 ,once a week is f> bett] ?an e day4 ,b usually twice a week 9 ! majority ( cases w secure ! be/ results4 ,!n lat] once 9 two weeks w be ! be/ c\rse to pursue4 ,! tissues are irritable1 & require "t to e/abli% a physiological balance1 t if kept con/antly excit$ by too frequ5t or too sev]e manipulation w increase r ?an less5 ! condition4 ,?is1 h[ev]1 does n apply to ^? cases :]e a c]ta9 am\nt ( g5]al treatm5t is dem&$ to improve sy/emic tone & ov]come inte/9al /asis1 b ev5 "h d n unduly tire ! pati5t1 & keep away f ! ?yroid inn]vation except at /at$ int]vals4 ,!re is no?+ m important 9 o/eopa?ic !rapy1 except def9ite adju/m5t1 ?an n ov]-treat+4 ,! c]vical region %\ld be normaliz$1 & ! upp] ribs & clavicles c>efully adju/$4 ,b leave ! gl& alone1 = manipulation ov] x fur!r /imulates its function & !re is a possibility ( ruptur+ its fragile vessels4 ,normalization ( ! entire sp9e is important1 ow+ to its be>+ ^u int]dep5d5t relation%ip1 me*anically & physiologically1 & ! necessity ( correct+ all metabolic irregul>ities4 ,bo? physical & m5tal re/ are ess5tial4 ,?is t5ds to less5 ! excitability ( ! n]ves1 cons]ves ! /r5g?1 increases ! metabolism1 improves muscle tone1 & re/s ! he>t4 ,at lea/ sev]al extra h\rs 9 b$ is always be/4 ,ly+ d[n two or ?ree h\rs dur+ ! middle ( ! day w accompli% consid]able4 ,9 sev]e cases absolute re/ 9 b$ until ! disord] is "u control is imp]ative4 ,9 mild & mod]ate cases all excessive fatigue %\ld be avoid$4 ,unless su* measures are foll[$ ! treatm5t o!rwise may n accompli% any?+4 ,/opp+ %ort ( fatigue is ! rule t mu/ be foll[$4 ,! diet is important 9 ord] t ! /r5g? may be increas$ & h>mful foods elim9at$4 ,if ! c>bohydrates 9 ! small inte/9e are n suffici5t1 !y may decompose into toxic sub/ances t are h>mful :5 absorb$ into ! circulation4 ,an abundance ( gre5 vegetables & fre% fruit is be/4 ,milk1 f]m5t$ milk1 butt] milk1 butt] & cream are all[able4 ,! pati5t %\ld dr9k freely ( wat]4 ,meat %\ld be us$ sp>+ly1 & avoid tea1 c(fee1 & condim5ts4 ,free elim9ation & fre% air are also important4 ,x is ! aggregate ( details t c\nts s mu*1 p>ticul>ly 9 su* a toxic & excitable disease z exoph?almic goit]4 ,! neutral ba? 7#ie to #if degrees7 is bett] ?an ei!r hot or cold ba?s4 ,9 su* a n]v\s disease z ?is1 sugge/ion is unque/ionably a valuable measure 9 quiet+ ! n]ves & improv+ ! m5tal viewpo9t4 ,all focal infections1 su* z (t5 f\nd 9 ! ?roat1 nose1 & buccal cavity1 9 ! app5dix region1 gall-bladd]1 etc41 %\ld be eradicat$4 ,if "u c>efully controll$ treatm5t ! pati5t does n def9itely respond )9 f two weeks to a mon?1 surgical measures %\ld be s]i\sly consid]$4 ,myx$ema ,myx$ema is a *ronic disease due to loss ( ?yroid function1 & *>act]iz$ by m>k$ly decreas$ metabolism1 trophic di/urbances ( ! sk9 & subcutane\s tissues1 & a cessation ( m5tal developm5t correspond+ to ! "t ( ! injury ( ! ?yroid4 ,mc,carrison re/ricts ! t]m 8cret9ism0 to ^? cases :]e !re is cong5ital ?yroid defici5cy4 8,aft] ! fir/ ye> ( life1 :5 ossification has proce$$ to ! ext5t ( closure ( ! fontanelles1 ! case is only di/+ui%able f "o ( cret9ism by ?is fact40 ,9 ! *ild1 all ! functions are depress$1 !re is a l[ temp]ature1 ! bones d n develop1 & ! *ild may become /\t4 ,! m5tal developm5t is ret>d$1 & also ! sex organs4 ,9 ! adult cases !re is ! same depress$ metabolism4 ,! sk9 is sall[1 dry1 & increas$ 9 ?ickness4 ,! tongue is enl>g$1 ! lips ?ick1 & ! feet & h&s consid]ably *ang$ 9 size4 ,! nails may be ?ick5$1 & ! hair falls out4 ,! abdom5 is apt to be p5dul\s4 ,heavy pads occur bel[ ! clavicles & on ! *e/1 neck1 abdom51 & sexual organs4 ,usually ! ?yroid _c be palpat$4 ,9 a few1 ! gl& may be goitr\s4 ,! m5tal faculties are sluggi%4 ,! spee* is sl[1 & ! voice m or less *ang$4 ,physical ex]tion is an ef=t1 & ! pati5t may h "s difficulty 9 walk+4 ,& !re is anemia1 loss ( appetite1 & poor dige/ion4 ,! numb] & "* ( symptoms are innum]able1 dep5d+ ^u ! ext5t ( ?yroid insuffici5cy1 & (t5 ^u pr$ispos+ & associat$ disord]s4 ,b ! ess5tial symptoms are ^? p]ta9+ to ! sk91 & ! m5tal apa?y4 ,9 *ildr5 ! ret>d$ physical & m5tal gr[? is ! out/&+ condition4 ,developm5t ( ! disord] is sl[4 ,etiology4--,lesions ( ! ?yroid inn]vation may cause a less5$ function ( ! gl&1 = correction ( ! lesions has be5 foll[$ by m>k$ly def9ite improvem5t 9 a numb] ( cases4 ,! disord] has foll[$ op]ation on ! gl&4 ,9 o!r cases "s =m ( infection1 prim>y or second>y1 is probably ! cause ( ! injury & subsequ5t atrophy4 ,9 "s in/ances !re is evid5tly a family t5d5cy4 ,x occurs m frequ5tly 9 wom51 & 9 cold ?an 9 hot climates4 ,! m5opause seems to be a pr$ispos+ factor4 ,ov]work1 anxiety1 poor nutrition1 & conditions t l[] tissue resi/ance1 are among ! etiological consid]ations4 ,9 well m>k$ cases ! diagnosis is easy4 ,9 o!rs ! disease may be mi/ak5 = nephritis or jaundice4 ,x-ray exam9ation ( ! ossification c5t]s is ( decid$ value4 ,! prognosis1 9 untreat$ cases1 is consid]$ hopeless1 ! duration be+ f f\r to sev5 ye>s4 ,! treatm5t ) ?yroid extract1 or alpha-iod9e1 has result$ 9 m>k$ improvem5t1 ?\gh 9 sev]e cases x mu/ be kept up cont9u\sly 9 ord] to supply ! defici5cy4 ,treatm5t4--,!re h be5 sev]al well m>k$ cases t h respond$ to ! o/eopa?ic treatm5t4 ,adju/m5t ( ! lesions affect+ ! gl&1 & att5tion to ! g5]al heal? h be5 ! me?ods adm9i/]$4 ,! response 9 a numb] ( *ildr5 has be5 mo/ notable4 ,9 fact1 to su* an ext5t t all faculties & functions 7 completely recov]$4 ,ev5 9 cases :]e ?yroid extract _h be5 adm9i/]$ ) comp>atively little results1 ! adju/m5t ( ! upp] dorsal & c]vical lesions1 ) att5tion to ! diet1 elim9ation1 & g5]al hygi5e1 0 foll[$ by normalization4 ,t ! ?yroid function :5 d]ang$1 hyp]?yroidism1 hypo?yroidism1 or o!rwise1 c (t5 be recov]$ ?r\gh o/eopa?ic treatm5t1 adds a v important !rapeutic measure 9 ! treatm5t ( ?is gl&4 ,b 9 view ( ! brilliant results secur$ 9 hypo?yroidism1 ?r\gh ! adm9i/ration ( ! ?yroid extract1 "o %\ld n hesitate to use x if improvem5t is n o!rwise =?com+4 ,nev]!less1 ! v important po9t rema9s t ?yroid extract is only supply+ a necess>y sub/ance1 h[ev] ess5tial1 to ! bodily metabolism1 & does n /rike at ! ess5tial etiology ( ! disord]4 ,cret9ism ,x %\ld be kept 9 m9d t !re are _m gradations & alt]ations 9 bo? hyp]?yroidism & hypo?yroidism1 & t a 8goit]0 may pres5t ei!r picture1 p>tly or :olly1 or on ! o!r h& may be normally function+4 ,mac,callum says3 8,unlike ! myx$ema cases :i* occur any:]e & ev]y:]e1 reg>dless ( environm5t or h]$it>y ta9t1 ^! p1 kn[n z cret9s1 are f\nd 9 regions :]e ! condition seems to be endemic or inh]5t 9 ! environm5t1 & we c usually trace 9 _! p>5ts or ance/ors "s simil> ?yroid defect40 ,?is disease is f\nd 9 v>i\s c\ntries1 p>ticul>ly 9 c]ta9 p>ts ( ,switz]l&1 ,au/ria1 & ,italy4 ,mc,carrison pres5ts an int]e/+ /udy ( #bjc cases ( ,endemic ,cret9ism f\nd 9 ,himalayan ,india4 ,he ?9ks x is due to infection4 ,!re are a few cases 9 ,nor? ,am]ica1 probably mo/ly due to immigration4 ,x is frequ5tly confus$ ) myx$ema4 ,cret9s are ( %ort /ature1 flat-*e/$ & pot-belli$4 ,! face is broad1 l[ =ehead1 broad nose1 prom95t *eeks1 ?ick lips1 & l>ge nose4 ,! developm5t ( ! bones is ret>d$2 ! sk9 is ?ick5$ & edemat\s2 ! hair is ?91 & ! nails brittle2 ! sexual organs z a rule d n develop2 & 9 mo/ cases a goit]1 sometimes ( huge size1 is pres5t4 ,mo/ ( !m are /upid & apa!tic2 o!rs are di/9ct idiots4 ,deafness is common4 ,!re are sporadic & endemic cases1 b ! same und]ly+ cause is probably pres5t4 ,x is claim$ t mo/ cases ( ! =m] %\ld be class$ z cong5ital myx$ema4 ,e>ly diagnosis is ess5tial4 ,removal ( ! pati5t f ! goit] region1 & ?yroid sub/ance is ! treatm5t giv51 ?\gh results are n s m>k$ z 9 myx$ema4 ,,footnotes3 #ajf ,ew+1 ,neopla/ic ,diseases2 ,grotti1 ,?yroid & ,?ymus4 #ajg ,cannon & ,cattell1 ,! ,secretory enn]vation ( ! ,?yroid ,gl&1 ,am4 ,j\rnal ( ,physiology1 ,july1 #aiaf4 #ajh ,gaskell1 ,involunt>y ,n]v\s ,sy/em4 #aji ,macleod1 ,physiology & ,bio*emi/ry 9 ,mod]n ,m$ic9e4 #aaj ,collect$ ,pap]s ( ! ,mayo ,cl9ic1 #aiaf1 '#ag1 '#ah4 #aaa ,mac,callum1 ,a ,text ,book ( ,pa?ology4 #aab ,mc,carrison1 ,! ,?yroid ,gl&4 ,,diseases ,,( ,,! ,,p>a?yroid ,,gl&s ,tetany ,! cl9ical manife/ations ( ! insuffici5cy ( function ( ! p>a?yroid gl&s is well und]/ood4 ,?is came ab\t ?r\gh ! /udy ( endemic tetany1 &1 especially1 not+ t tetany foll[$ op]ations :5 ! entire ?yroid gl& 0 remov$4 ,consid]able exp]im5tal "w on animals 0 next 9 ord]1 until ! discov]y 0 made t ! ?yroid gl& & p>a?yroids are anatomically indep5d5t1 & t tetany is entirely dep5d5t ^u ! loss ( function ( ! p>a?yroid gl&s4 ,op]ative tetany is n[ comp>atively r>e1 s9ce ! surgeon is p>ticul>ly c>eful n to injure ! p>a?yroids 9 8 op]ations on goit]s1 ?\gh mild =ms may occur ?r\gh damage ( ! tissues or ext5sion ( inflammatory processes4 ,!re are o!r =ms ( tetany aside f op]ative1 t occur 9 bo? adults & *ildr51 b in/ability & insuffici5cy ( ! function ( ! gl&s are basic to all cases4 ,?is is ! common factor1 :i* may be modifi$ by tissue resi/ance & v>i\s hygi5ic factors4 ,9 tetany !re are p>oxysmal1 & (t5 pa9ful1 contractions ( ! muscles ( ! extremities4 ,bo? sides are affect$1 & occasionally ! spasms may ext5d to o!r muscles ( ! body4 ,?is is due to an abnormal excitability ( ! n]v\s sy/em4 ,probably ! secretion ( ! p>a?yroids h normally a re/ra9+ effect ^u ! n]v\s impulses1 :i* :5 remov$1 or insuffici5t1 or possibly p]v]t$1 results 9 ! tonic spasms4 ,?us ! pr$ispos+ condition ( tetany may be ei!r acquir$ or cong5ital4 ,*ildr5 may be born ) defective p>a?yroids4 ,9 su* in/ances !re is probably a hypoplasia ( tissue1 :i* may m>k$ly v>y 9 a s]ies ( cases1 & give rise to diff]5t degrees ( tetany4 ,o!r factors1 nutritional & toxic1 w\ld1 v likely1 be important excit+ causes4 ,hemorrhages & fibrosis h be5 not$ 9 "s cases1 t add to ! injury ( ! tissues4 ,! blood & n]ve tissues 9 tetany %[ a decreas$ am\nt ( calcium4 ,x is claim$ by "s t ! abnormal excitability ( ! n]v\s sy/em is due to ! lack ( calcium4 ,noel ,paton#aac believes t1 ?\gh ?is may be> "s relation%ip1 ! p>a?yroids control ! metabolism ( guanid9e1 & t guanid9e intoxication is ! cause ( ! symptoms4 ,guanid9e seems to regulate ! tone ( ! skeletal muscles1 & is closely relat$ to urea4 ,tetany may occur "u _m conditions3 dur+ pregnancy & nurs+1 ! infecti\s & nutritional diseases1 ! diseases ( ! ?yroid & v (t5 ga/ro-inte/9al disord]s4 ,!re are v>i\s excit+ causes1 su* z cold1 worry1 ov]fatigue1 etc4 ,alcohol1 ergot1 morph9e1 *lor(orm1 & o!r poison+ may precipitate an attack4 ,b 9 all ^! cases ! p>a?yroids are previ\sly damag$4 ,! blood supply to ! gl&s is f bran*es supply+ ! ?yroid organ4 ,?is intimacy implies t ! same sympa!tic n]ves to ! ?yroid vessels are 9 control4 ,probably !re are di/9ct secretory n]ves1 z well z vasomotors1 t are connect$ ) ! upp] dorsal & c]vical sympa!tics4 ,lesions relat$ to ! correspond+ sp9al areas probably affect ! integrity ( ! p>a?yroid function4 ,s*af] says3 8,! p>a?yroids are among/ ! mo/ vascul> organs 9 ! body4 ,!y are suppli$ ea* by a special bran* ( ! inf]ior ?yroid art]y4 ,! s9us-l capill>ies come into close relation%ip ) ! epi!lial cells ( ! gl&4 ,! n]ves ( ! p>a?yroids1 l ^? ( ! ?yroids1 pass bo? to ! vessels & to ! secret+ cells4 ,"s evid5ce has be5 adduc$ :i* seems to %[ t ! cell-activity is controll$ by ! n]v\s sy/em40 ,h5ce x w\ld seem t 9 _m cases ( tetany1 aside f ^? cases due to op]ative injury & possibly c]ta9 cong5ital in/ances1 o/eopa?ic lesions affect+ ! n]ve & vascul> supply ( ! organs may s less51 or p]v]t1 ! secret+ cells t tetanic /ates may sup]v5e1 especially :]e l[]$ nutrition1 tox9s1 & infections are incit+ factors4 ,symptoms4--,! tonic contraction ( ! muscles may la/ a few m9utes or may p]si/ = sev]al h\rs1 & are usually conf9$ to ! h&s & feet4 ,! f+]s & toes are fir/ affect$ by ! spasm1 :i* ext5ds upw>d t[>d elb[s & knees4 ,?is is commonly prec$$ by numbness & m or less pa9 9 ! p>ts4 ,occasionally !re is a g5]al ill-feel+1 depression1 & heada*e4 ,!re may be rise ( temp]ature1 & "s edema ( ! affect$ p>ts4 ,!re are no m5tal symptoms4 ,! f+]s are p>tly flex$ at ! metac>po-phalangeal jo9ts & rigidly ext5d$ at ! int]-phalangeal jo9ts1 ! ?umb is m>k$ly adduct$ & ! f+]s drawn close toge!r4 ,! wri/ may be flex$1 & 9 sev]e cases ! elb[s flex$ & adduct$4 ,:5 ! feet are contract$ ! toes are drawn toge!r1 flex$1 & may ov]lap1 & ! feet are ar*$4 ,tr\sseau's ph5om5on4--,! spasm is increas$ by pressure ov] ! m$ian or uln> n]ves1 or blood-vessels supply+ ! p>ts4 ,?is may also excite an attack4 ,*vo/ek's ph5om5on4--,p]cussion ov] ! facial n]ve w cause quick contraction ( ! muscles inn]vat$4 ,erb's ph5om5on4--,! electrical excitability ( ! motor n]ves is m>k$ly increas$4 ,diagnosis4--,! *>act]i/ic attitude1 & ! irritability ( ! motor & s5sory n]ves1 make diagnosis easy4 ,x may be confus$ ) m5+itis1 b 9 tetany !re are no bra9 symptoms1 :ile 9 m5+itis !re are no *>act]i/ic signs ( tetany4 ,g5]ally1 !re is little probability ( confus+ ! disease ) tetanus1 or hy/]ia4 ,treatm5t4--,mo/ cases are ( a mild type1 & recov]y is ! rule4 ,a great deal dep5ds ^u ! und]ly+ cause4 ,malnutrition1 if long cont9u$1 is a v important factor t may readily pr$ispose to ! disord]4 ,rickets 9 *ildr5 is (t5 a basic consid]ation4 ,re/1 w>m ba?s1 & c>eful inhibitory relaxation ( ! tissues mat]ially assi/ 9 controll+ ! spasms4 ,att5tion to ! ?yroid inn]vation %\ld n be neglect$4 ,9 indicat$ cases ?yroid fe$+ may be ( assi/ance4 ,! diet is ( special importance1 = _m cases pres5t "s disord] ( ! ga/ro-inte/9al tract4 ,meat %\ld n be giv54 ,milk is ( great value1 ow+ to its calcium cont5t4 ,! adm9i/ration ( calcium is highly recomm5d$1 = reasons /at$ "u etiology4 ,diseases ( ! ,?ymus ,!re is little kn[n relative to ! functions ( ! ?ymus4 ,x is mo/ active dur+ ! gr[? ( ! body1 atta9+ its greate/ weight f ! elev5? to fifte5? ye>s1 aft] :i* x gradually atrophies1 ?\gh a c]ta9 am\nt ( ! tissue rema9s ?r\gh\t life4 ,!re is usually a gradual atrophy ( ! organ aft] pub]ty1 associat$ ) increase ( connective & adipose tissues4 ,9 cases :]e x does n atrophy1 !re is (t5 hyp]plasia ( ! entire lymphatic sy/em 9 ! body4 ,!re is "s relation%ip betwe5 ! ?ymus & sexual organs1 & 9 exp]im5ts :]e ! organ has be5 remov$1 ossification is delay$1 muscul> weakness & tremor occur1 !re is hyp]plasia ( ! ?yroid1 p>a?yroids1 & adr5als1 & g5]al ca*exia1 acidosis1 & m5tal det]ioration take place4 ,! inf]ior ?yroid & int]nal mamm>y art]ies f above1 & ! p]ic>diophr5ic f bel[1 comprise its art]ial supply4 ,! n]ve supply is f ! sympa!tic1 vagus1 & possibly ! phr5ic4 ,9 cases ( exoph?almic goit] !re is frequ5tly an associat$ enl>gem5t ( ! ?ymus1 :i* may be %[n by ! ,x-ray1 due to failure ( normal involution or a r5ewal ( gr[?1 t may be def9itely influ5c$ by adju/m5t ( ! o/eopa?ic lesions4 ,9 "s ( ! acute infections z pneumonia ! ?ymus may atrophy ) "s fatty deg5]ation & increase ( connective tissue4 ,?is also occurs 9 />vation4 ,if ! condition is n ( long /&+ recov]y w take place4 ,9 /atus lymphaticus !re is hyp]plasia ( ! ?ymus & enl>gem5t ( ! lymphoid tissue ( ! body1 & hypoplasia ( ! c>diovascul> sy/em4 ,?is is a con/itutional defect1 s t slight injuries or infections may prove fatal4 ,x is f\nd 9 "s cases t !re is hypoplasia ( ! *romaff9 sy/em4 ,:e!r ?is latt] condition is prim>y or second>y has n be5 settl$4 ,9 males ! second>y sexual *>act]i/ics are n fully develop$4 ,! figure resembles ! fem99e type4 ,! sk9 is pa/y1 & ! be>d is lack+ or b little develop$4 ,9 females ! di/ribution ( ! hair may be some:at simil> to ! male sex1 sl5d] limbs & *e/1 & di/urbances ( ! m5/rual function are noticeable4 ,! ?yroid1 ?ymus & lymphatic tissues are usually enl>g$1 :ile !re is hypoplasia ( ! adr5als & *romaff9 sy/em4 ,! condition is met ) 9 *ildr5 :o h a weak muscul> sy/em1 increas$ adipose tissue1 pa/y complexion1 enl>g$ tonsils & ad5oids1 & frequ5tly are anemic4 ,9 *ildr5 :]e ! ?ymus is enl>g$ !re may be excessive lymphocytosis4 ,! enl>g$ ?ymus may compress ! tra*ea1 int]f]+ ) brea?+ s t cyanosis & tempor>y loss ( consci\sness occur4 ,"y *ildr5 may die 9 ! attack1 probably due to compression ( ! tra*ea or to he>t %ock4 ,dea? 9 adults has occurr$ f trifl+ injuries1 %ocks1 infections1 & ane/hesia4 ,! und]ly+ cause is probably a con/itutional weakness4 ,diagnosis is made f ! cl9ical signs1 p]cussion ( ! ?ymus & ! ,x-ray picture1 al?\gh ^! may n be positive4 ,an excessive lymphocytosis is sugge/ive4 ,treatm5t %\ld consi/ ( good g5]al c>e ( ! pati5t1 avoidance ( injuries & %ocks z f> z possible1 & c>eful att5tion to all lesions1 especially ( ! upp] *e/ & neck4 ,by foll[+ ?is plan ! *ild may ov]come ! condition4 ,x-ray treatm5t is be+ employ$ ) success 9 "s cases4 ,op]ations h be5 successful 9 ?ymic hyp]plasia :]e x has complicat$ exoph?almic goit]1 & also 9 s]i\s me*anical pressure 9 *ildr54 ,diseases ( ! ,adr5al ,gl&s ,exp]im5tal "w supports ! view t ! cortex & ! m$ulla h sep>ate functions4 ,! m$ulla ( ! adr5als is "p ( ! *romaff9 sy/em1 :i* includes tissue ( ! same "* 9 ! ganglia ( ! sympa!tic1 ! c>otid gl&1 & ! accessory gl& call$ ,zuck]k&'s organ4 ,?is sy/em is d]iv$ f ! same cells z ! sympa!tic n]ves4 ,! m$ulla receives a ri*] blood supply ?an any tissue 9 ! body4 ,! secretion ( ! *romaff9 tissue is call$ adr5al9 or ep9ephr94 ,! blood receives a cont9u\s supply ( ! secretion1 :i* acts ^u ! small blood-vessels & assi/s 9 ma9ta9+ blood pressure4 ,x also /imulates gl&ul> tissue1 & has "s effect ^u volunt>y muscle :i* t5ds to c\nt]act fatigue4 ,! cortex ( ! adr5al gl&s is ( epi!lial orig91 & is "p ( ! s-call$ int]r5al sy/em1 :i* comprises v small masses ( tissue 9 ! sympa!tic ganglia4 ,^! are locat$ 9 ! hilus ( ! kidney1 broad ligam5t1 +u9al canal1 pro/ate1 epididymis1 & along ! sp]matic ve9s 7,bak]74 ,! cortex is ! *ief gl&ul> tissue ( ! int]r5al sy/em4 ,! am\nt ( tissue is n s great aft] pub]ty z be=e4 ,! blood supply ( ! cortex is n s ri* z t ( ! m$ulla4 ,abnormal activity is claim$ to be ! cause ( c]ta9 sexual d]angem5ts1 p>ticul>ly sexual precocity4 ,s*af] /ates t ! adr5als are v ri*ly suppli$ ) n]ves4 ,ea* receives no less ?an ?irty-?ree n]v\s filam5ts 7,kollik]71 d]iv$ 9 "p directly f ! splan*nic1 9 "p f ! supr>5al plexus1 :i* is itself con/itut$ by bran*es f ! celiac1 phr5ic1 & r5al plexuses4 ,we h not$ t 9 lesions 7exp]im5tal7 ( ! splan*nics a few cases pres5t$ acute pa?ological *anges1 conge/ion ) "s deg5]ation ( cells1 9 ! adr5als4 ,macleod /ates t ( ! _m functions ( ! adr5als t :i* is mo/ directly associat$ ) ep9ephr9 is ! production ( glucose f glycog54 8,:5 ! n]v\s sy/em is /imulat$ 9 su* a way z to excite ! glycog5olytic process1 two effects bo? op]at+ 9 ! same direction ) reg>d to ! glycog5ic function are develop$3 ! "o1 a hyp]secretion ( ep9ephr91 :i* activates ! sympa!tic n]ve end+s1 ! o!r1 ! transmission ( ! n]ve impulse to ! liv] cell40 ,addison's ,disease ,?is is a r>e1 *ronic disease1 m (t5 occurr+ 9 m51 t is *>act]iz$ by muscul> & vascul> weakness1 dige/ive di/urbances1 & pigm5tation4 ,tub]culosis ( ! adr5als has be5 ! mo/ con/ant lesion f\nd4 ,9 o!rs1 syphilis & atrophy h be5 not$1 :ile 9 a few ! condition seem$ to be functional4 ,x %\ld be rememb]$ t x is possible t lesions else:]e 9 ! *romaff9 sy/em may be ! cause 9 "s cases1 = all ! *romaff9 tissues secrete adr5al94 ,x is q likely t 9 mo/ cases !re is "s con/itutional defect ( ! *romaff9 sy/em :i* und]lies a c]ta9 t5d5cy to ! disord]4 ,infections1 injuries1 physical & m5tal /ra9s may l[] resi/ance & pr$ispose to ! condition4 ,o/eopa?ic lesions ( ! splan*nics may conge/ ! organs1 or d]ange ! secretions1 or be ( su* a "* t hemorrhages result1 or fibr\s *anges foll[1 t w\ld def9itely incapacitate ! cells & l[] resi/ance4 ,pa?ologically1 ! mo/ common *ange is tub]culosis4 ,next 9 importance are atrophy & int]/itial inflammation4 ,canc] ( ! organs has be5 not$ 9 a few4 ,! adr5al ganglia1 ! semilun> ganglia1 & ! sol> plexus are (t5 involv$4 ,! ?yroid gl& may be alt]$1 :i*1 :5 affect$1 is usually decreas$ 9 size4 ,br[n atrophy ( ! he>t is common4 ,symptoms4--,an insidi\s onset ) muscul> weakness1 languor1 & weak action ( ! he>t are g5]ally ! fir/ symptoms4 ,dige/ive d]angem5ts1 su* z nausea1 hyp]acidity1 loss ( appetite1 may occur at ! same "t1 or %ortly succe$ ! g5]al debility4 ,heada*e1 insomnia1 & depression frequ5tly take place4 ,pigm5tation1 usually1 %ortly foll[s1 ?\gh !re are cases :]e x is only slightly not$4 ,! disease is v *ronic1 ( sev]al ye>s duration1 ) p]iods ( int]mission4 ,occasionally1 a case runs a v rapid c\rse4 ,! g5]al weakness is mo/ noticeable4 ,!re is l[ blood pressure4 ,! d]angem5t ( ! /oma* & inte/9es is *>act]i/ic4 ,& ! pigm5tation1 :i* at fir/ is light yell[ lat] assumes a d>k br[n color4 ,! pigm5tation may be m or less g5]al1 b ! axill1 nipples1 g5itals1 ! palms ( ! h&s1 & ! neck1 wai/ or :]ev] ! clo?+ presses ^u ! sk91 are mo/ pigm5t$4 ,& pigm5tation ( ! muc\s membrane may be not$4 ,diagnosis4--,9 typical cases1 :]e !re is e/h5ia1 pigm5tation1 & ga/ro-inte/9al di/urbances1 ! diagnosis is n difficult4 ,:]e ! cl9ical picture is incomplete1 ! diagnosis may be v difficult4 ,pigm5tation may occur 9 sev]al o!r disord]s1 notably3 9 bronz$ diabetes1 abdom9al malignancy1 tub]culosis ( ! p]itoneum1 exoph?almic goit]1 pellagra1 m>k$ inte/9al /asis1 /oma* ulc]1 p]nici\s anemia1 c]ta9 sk9 diseases1 etc41 s great c>e has to be tak5 9 atypical cases4 ,treatm5t4--,g5]al treatm5t1 ) special att5tion to ! adr5al inn]vation1 diet1 re/1 & fre% air w accompli% some?+4 ,9 functional d]angem5ts1 :i* are v few1 recov]y may foll[4 ,b ow+ to ! (t5 con/itutional defect1 ! probability ( tub]cul>1 syphilitic1 & o!r s]i\s lesions1 ! prognosis is unfavorable4 ,,footnotes3 #aac ,paton & ,f9lay1 ,j\r4 ,exp4 ,phys41 #aiag4 ,,diseases ,,( ,,! ,,n]v\s ,,sy/em ,,diseases ,,( ,,! ,,n]ves ,neuritis ,neuritis is an inflammation ( ! n]ve fib]s4 ,x may be conf9$ to a s+le n]ve1 localiz$2 or g5]al1 involv+ a l>ge numb] ( n]ves1 :5 x is kn[n z multiple neuritis4 ,o/eopa?ically1 !re are inv>iably lesions ( ! osse\s or muscul> tissues1 t correspond to ! n]ve fib]s involv$4 ,! lesion ei!r irritates ! n]ve directly or di/urbs ! circulation to ! n]ve4 ,9 ^? cases :]e ! o/eopa?ic lesion is n ! imm$iate excit+ cause1 !re w be f\nd anatomical irregul>ities t pr$ispose to ! affection4 ,localiz$ neuritis may be due to3 ,local o/eopa?ic lesions2 ,exposure to cold2 septic foci2 traumatism2 & inflammation ( contigu\s tissues4 ,multiple ,neuritis may be due to3 ,o/eopa?ic lesions1 :i* are associat$ ) infecti\s diseases1 z 9 diph!ria1 typhoid1 sc>let fev]1 etc42 prolong$ /ra9 or exposure2 metabolic poisons1 z 9 diabetes1 anemia1 tub]culosis1 canc]1 etc42 alcohol1 lead1 m]cury & ars5ic poison+2 & b]i-b]i1 :i* is probably due to lack ( vitam9s1 or possibly micro-organisms1 or c>bonic gas poison+4 ,! inflammation may *iefly involve ! connective tissue surr\nd+ ! n]ve--p]9euritis--or x may involve ! deep] /ructure--int]/itial neuritis4 ,p>5*ymat\s neuritis is really a deg5]ation1 due to excessive or prolong$ irritation or pressure :i* cuts ! n]ves (f f _! c5t]s4 ,?is is f\nd 9 deeply seat$ o/eopa?ic lesions4 ,9 exp]im5tal o/eopa?ic lesions ! fir/ effect is deg5]ation ( ! m$ull>y %ea?4 ,?is is foll[$ by deg5]ation ( ! axis cyl9d]4 ,! local circulation is notably impair$4 ,an acutely inflam$ n]ve is r$ & swoll54 ,9 p]9euritis !re is an infiltration ( ! n]ve %ea? ) leucocytes4 ,9 ! int]/itial =m1 lymphoid cells are f\nd betwe5 ! n]ve bundles4 ,9 ! p>5*ymat\s =m1 inflammatory signs are want+4 ,! muscles atrophy4 ,associat$ 9 all ^! =ms ! o/eopa?ic lesion plays ei!r an excit+ or pr$ispos+ role1 by di/urb+ nutrition to ! tissue & ?us sett+ up inflammation1 :i* may lead to ,wall]ian deg5]ation#aad4 ,symptoms4--,localiz$ ,neuritis4--,9 ! case ( a s5sory n]ve1 !re is sev]e pa9 foll[+ ! c\rse ( ! affect$ n]ve1 ) t5d]ness ^u pressure4 ,?is may be foll[$ by loss ( s5sibility4 ,trophic symptoms1 su* z gloss9ess ( ! sk9 & brittle nails1 arise 9 m *ronic cases1 :ile 9 advanc$ cases1 !re is wa/+ ( ! muscles4 ,sweat+1 h]pes1 & occasionally effusion into ! jo9ts1 occur4 ,:5 a motor n]ve is pr9cipally affect$1 muscul> p[] is impair$1 motion pa9ful & muscul> twit*+s w occur4 ,f9ally contractions1 wa/+ ( ! muscles1 & ev5 reactions ( deg5]ation1 may take place4 ,a r>e =m is ! s-call$ asc5d+ neuritis1 9 :i* ! inflammation ext5ds upw>d f ! p]iph]al n]ves to ! l>g] n]ve trunks1 or ev5 ! sp9al cord1 result+ 9 myelitis4 ,?is occurs mo/ commonly 9 traumatic neuritis4 ,! duration is v>iable4 ,_m acute cases get well 9 a few days4 ,o!r cases may p]si/ = mon?s & ev5 ye>s4 ,multiple ,neuritis4--,inflammation involv+ sev]al n]ves :i* are affect$ simultane\sly or 9 rapid succession4 ,acute =m4--,! attack usually foll[s ov]ex]tion or exposure to cold & wet1 ) probably "s infection4 ,?is =m is *>act]iz$ by a *ill1 foll[$ by a rapid rise 9 temp]ature :i* may rea* #ajc or #ajd degrees ,f42 heada*e2 pa9s 9 ! back & limbs4 ,!re is weakness ( ! legs or arms1 dep5d+ ^u region involv$1 :i* may be s sev]e t ! muscles atrophy4 ,s5sory symptoms are v>iable4 ,mo/ cases recov]1 ?\gh !re are in/ances :]e ! vagi1 ! n]ves to ! bladd]1 rectum1 or he>t1 may be involv$4 ,alcoholic ,neuritis results f a mod]ate am\nt ( alcoholic dr9k+1 cont9u$ ov] a long "t4 ,! fir/ symptoms are usually numbness & t+l+ 9 ! f+]s & toes4 ,loss ( p[] soon becomes m>k$1 fir/ 9 ! l[]1 & !n 9 ! upp]1 extremities4 ,! ext5sor muscles are mo/ affect$1 caus+ wri/ & foot drop4 ,occasionally !re is p>aplegia4 ,!re are hyp]e/hesia1 t5d]ness & pa91 especially 9 ! legs4 ,! cutane\s reflexes are commonly intact1 & ! deep reflexes1 z a rule1 are lo/4 ,delirium is common1 & halluc9ations or illusions occur4 ,neuritis f lead poison+ usually pres5t ! 8wri/ drop0 & 8foot drop01 ) colic1 & 8blue l9e0 on gums4 ,infecti\s ,diseases neuritis is due to an attack ( "s infecti\s disease1 & may be local or multiple4 ,x is due to toxic mat]ials absorb$ into ! blood4 ,x is mo/ common aft] diph!ria4 ,! symptoms pres5t$ are ^? ( neuritis due to any o!r cause4 ,s5ile neuritis is probably due to art]ioscl]osis4 ,diagnosis4--,z a rule1 ! diagnosis is n difficult4 ,9 ! alcoholic =m 9 "s in/ances1 !re may be difficulty1 & 9 cases ) p>alysis1 c>e %\ld be tak54 ,! prognosis ( neuritis is g5]ally favorable4 ,treatm5t4--,x is v evid5t t ! successful treatm5t ( neuritis dep5ds ^u be+ able to asc]ta9 ! cause4 ,re/ is important 9 all cases4 ,r>ely has "o any difficulty 9 locat+ ! d]ang$ /ructures t are pr$ispos+ to ! attack2 & usually correction ( ^! di/urbances1 :i* are 9 ! region involv$ w give consid]able relief4 ,if ! p>ts are too s5sitive to h&le insi/ on absolute re/ & hot fom5tations4 ,! affect$ area %\ld be kept w>m & protect$4 ,att5tion to ! diet1 & free elim9ation1 are important4 ,metabolic disord]s %\ld be correct$1 if possible4 ,give p>ticul> att5tion to any septic foci4 ,a *ange ( occupation may be necess>y 9 "s cases4 ,9 alcoholic cases1 ! alcohol %\ld be /opp$ z soon z possible4 ,passive movem5ts & massage are helpful1 b ( c\rse be> no comp>ison to specific o/eopa?ic treatm5t4 ,relaxation ( muscles along ! sp9al column & along ! c\rse ( ! n]ve w at lea/ give tempor>y relief4 ,if contractures & o!r *anges rema9 aft] ! acute attack1 p]si/5t treatm5t w g5]ally result 9 recov]y4 7,see also ,pa9ful ,%\ld]s1 ,"p ,i47 ,sciatica is usually a neuritis ( ! sciatic n]ve1 al?\gh all pa9ful affections ( ! n]ve are t]m$ sciatica4 ,9 "s cases x is a neuralgia :5 ! n]ve is swoll5 & pres5ts an int]/itial neuritis4 ,o/eopa?ic ,etiology4--,?is affection occurs m frequ5tly 9 males ?an 9 females4 ,! usual p]iod = sciatica is f ! tw5tie? to ! fiftie? ye> & ! pr9cipal causes are v]tebral lesions ( ! l[] dorsal & lumb> v]tebr1 especially lesions to ! f\r? & fif? lumb>4 ,occasionally ! lesion is a subdislocat$ innom9atum1 a d[nw>d displacem5t ( a float+ rib or a p>tial dislocation ( ! femur4 ,o!r causes are exposure to cold1 contraction ( muscles1 g\t1 rheumatism & syphilis4 ,contraction ( ! pyri=mis muscle may br+ direct pressure on ! n]ve4 ,focal infections1 ar?ritis ( ! articul> processes ( ! l[] sp9e1 & sacro-iliac & hip-jo9t disease %\ld n be ov]look$4 ,9 a few cases !re are intrapelvic causes1 su* z ut]9e & ov>ian tumors1 rectal accumulations & ! fetal head dur+ labor4 ,enl>g$ pro/ate may be a factor4 ,x is possible = ! r\gh5$ edges ( ! sacro-iliac jo9t1 int]nally1 to irritate ! sacral plexus z x passes ov] & ?us keep up ! pa94 ,?is may expla9 ! occasional failure ( treatm5t4 ,symptoms4--,pa9 9 ! n]ve along its c\rse is ! mo/ con/ant symptom4 ,! pa9 is mo/ int5se back ( ! ?igh & above ! hip-jo9t4 ,! pa9 radiates d[nw>d ?r\gh ! entire n]ve2 x is ( an annoy+ "* & walk+ is especially pa9ful4 ,9 r>e cases !re is wa/+ ( ! muscles1 cramps1 h]pes & edema4 ,9 a few cases ! neuritis may ext5d to ! sp9al cord4 ,diagnosis4--,! diagnosis ( sciatica is usually easy4 ,c>e has to be tak5 9 ! exam9ation to det]m9e :e!r ! affection is prim>y or second>y4 ,x is difficult1 9 "s cases1 to locate ! orig9 ( ! di/urbance1 especially if x is 9 ! lumb> v]tebr1 z frequ5tly a v slight deviation ( a v]tebra w cause ! disease2 or "s focal infection may be difficult to locate2 or mal=mation ( ! fif? lumb> may be pres5t2 or asymmetry ( ! legs or ! body be a factor4 ,c>eful palpation1 measurem5ts1 & ! ,x-ray are ( diagno/ic importance4 ,hip-jo9t disease & sacro-iliac disease c g5]ally be easily di/+ui%$ f ?is affection4 ,! lightn+ pa9s ( tabes may simulate sciatica1 b !n !re are o!r well def9$ symptoms ( ! disease4 ,treatm5t4--,sciatica r>ely runs a v long c\rse1 ?\gh !re are cases t la/ = ye>s4 ,! treatm5t almo/ :olly dep5ds ^u ! cause4 ,if ! cause c be det]m9$ at once1 ! probabilities are t sev]e cases may be reliev$ by a few treatm5ts4 ,correction ( ! v]tebr1 to relieve imp+em5ts to ! n]ve fib]s z !y pass ?r\gh ! int]v]tebral =am9a1 usually con/itutes ! prim>y treatm5t4 ,c>efully exam9e ! pelvic organs = di/urbances4 ,occasionally deep treatm5t ov] ! iliac vessels w be ( great help4 ,! innom9atum1 if d]ang$1 %\ld be correct$ & all tr\bles ( ! hip-jo9t t are f\nd mu/ be correct$4 ,cases ( rheumatism & g\t %\ld receive _! sep>ate treatm5ts1 besides c>eful manipulations ( ! affect$ leg4 ,re/ 9 b$ %\ld be insi/$ ^u2 ?is w usually m>k$ly less5 ! duration ( ! inflammation4 ,adju/m5t ( ! special po9ts f\nd d]ang$ & a ?or\gh treatm5t1 if conditions p]mit1 ( ! entire leg w be b5eficial4 ,hot fom5tations appli$ along ! c\rse ( ! n]ve1 & an inhibitory treatm5t back ( ! tro*ant] w at lea/ give tempor>y relief4 ,ext5sion ( ! leg is effective4 ,plac+ a pati5t ^u 8 back & flex+ ! leg & ?igh ^u ! abdom51 at ! same "t keep+ ! leg /raight & ! foot flex$1 is an effectual /ret*+ me?od4 ,z a rule1 sciatica readily responds to o/eopa?y4 ,neuralgia ,neuralgia means simply 8n]ve pa940 ,! t]m neuralgia %\ld be re/rict$ to su* n]ve pa9s z are n caus$ by /ructural *anges 9 ! n]ves4 ,9 cases :]e ! pa9 is due to organic *anges 9 ! n]ves1 ! disease %\ld n be class$ z a neuralgia1 al?\gh x is practically impossible to draw an absolute l9e betwe5 functional & organic di/urbances = ! "o may gradually progress 7pa?ologically7 into ! o!r4 ,9 neuralgia !re is always di/urbance ( ! blood supply to n]v\s tissue1 :i* may be ( ! "* ( conge/ive irritation1 is*emia or alt]$ /ates ( ! blood :]e9 x conta9s toxic sub/ances or is bel[ normal quality4 ,x is well kn[n t o/eopa?ic lesions are v common etiological factors4 ,o/eopa?ic ,etiology4--,neuralgia is ess5tially a disease ( adults4 ,x r>ely occurs be=e pub]ty or late 9 life4 ,wom5 are m prone to neuralgia ?an m5 & ! t5d5cy may sometimes be h]$it>y4 ,suff]]s f neuralgia (t5 pres5t a peculi> 8n]v\s temp]am5t40 ,! excit+ causes ( neuralgia are impairm5t ( g5]al heal?2 irritations ( ! n]ve fib] or trunk by a displac$ bone1 ligam5t or muscle1 :i* may affect ! n]v\s tissue directly by me*anical irritation1 or indirectly1 by ! di/urbance ( its blood supply1 or toxic ag5ts2 exposure to cold or damp2 ov]work & worry2 toxic influ5ces ( v>i\s diseases1 z mal>ia1 lead poison+ & alcoholism2 irritation f c>i\s tee?1 & v>i\s septic foci4 ,symptoms4--,pa91 :i* is spontane\s & p>oxysmal1 is ! mo/ prom95t symptom4 ,x may be describ$ z 8d>t+10 8%oot+10 8burn+10 8/abb+10 8bor+10 etc4 ,! pa9 is usually unilat]al1 foll[+ ! c\rse ( ! s5sory n]ves1 & !re are g5]ally t5d] po9ts along ! c\rse ( ! n]ve4 ,especially are !re po9ts ( t5d]ness ne> ! c5tral end ( ! n]ve1 :]e ! displac$ /ructures are irritat+ x4 ,aft] ! pa9 has cont9u$ = "s "t ! sk9 becomes t5d]1 r$d5$ & swoll54 ,! r$ness & edema are suppos$ to be due to vasomotor *anges4 ,muscul> spasms1 trophic di/urbances1 sk9 eruptions1 h]pes & grayness ( ! hair are ( r>e occurr5ce4 ,! duration ( an attack v>ies f a numb] ( m9utes to a few h\rs4 ,neuralgia ( ! ,fif? ,n]ve4--,?is is by f> ! mo/ frequ5t v>iety ( neuralgia1 & x is g5]ally due to a displac$ atlas or inf]ior maxilla4 ,! tee? s9uses1 & o!r possible regions ( focal infections %\ld be ?or\ghly inve/igat$4 ,anemia & products ( metabolism may be und]ly+ factors4 ,all ! bran*es ( ! fif? n]ve are r>ely involv$4 ,! oph?almic division is mo/ (t5 affect$2 pa9 & t5d]ness be+ pres5t ab\t ! supraorbital not* or =am51 ! palpebral bran* at ! out] "p ( ! eyelid1 ! nasal bran*1 & occasionally an ocul> pa9 w be felt )9 ! eyeball4 ,:5 ! infraorbital bran* is involv$1 pa9 & t5d]ness are pr9cipally pres5t at ! infraorbital1 nasal & mal> po9ts4 ,:5 ! ?ird division is affect$1 ! *ief t5d] places are ! inf]ior d5tal1 temporal & p>ietal po9ts4 ,9 ne>ly all cases ( neuralgia ( ! fif? n]ve1 !re is extreme t5d]ness 9 ! region ( ! articulation ( ! atlas & ! occipital1 p>ticul>ly ! side on :i* ! fif? n]ve is involv$4 ,?is t5d]ness 9 a few cases may be f\nd z l[ z ! second or ?ird c]vical v]tebra4 ,! pa9 may be s sev]e z to cause edema along ! c\rse ( ! affect$ n]ve fib]s1 grayness ( ! eyebr[s & locks ( hair *iefly 9 ! temporal region1 & convulsive twit*+ ( muscles4 ,tic ,d\l\reux is a va/ly exagg]at$ neuralgia ( ! fif? n]ve & is suppos$ to be a prim>y affection ( ! ,gass]ian ganglion4 ,/>t+ 9 middle life f no app>5t cause x increases 9 sev]ity until x becomes unbe>able & suicide is n an infrequ5t result4 ,_m me?ods to relieve h be5 tri$ includ+ de/ruction ( ! ganglion b ) v>i\s results4 ,treatm5t %\ld be ! same z 9 ! mild] =m ( neuralgia b x w require critical exam9ation to det]m9e ! causes :i* are liable to be obscure4 ,c]vico-,occipital ,neuralgia4--,?is v>iety involves ! po/]ior bran*es ( ! fir/ f\r c]vical n]ves1 affect+ ! region ( ! po/]ior "p ( ! neck & head4 ,! pa9 may ext5d z f> =w>d z ! p>ietal em95ce & ! e>4 ,! *ief t5d] po9ts are ab\t midway betwe5 ! ma/oid process & ! sp9e1 betwe5 ! /]noma/oid & trapezius 7bran*es ( ! c]vical plexus71 & a po9t j above ! p>ietal em95ce4 ,?is =m ( neuralgia is *iefly due to subluxation ( ! upp] f\r or five c]vical v]tebr irritat+ ! po/]ior bran*es ( ! sp9al n]ves4 ,a draught ( air or exposure to cold are common excit+ causes4 ,! pa9 is ( a %>p lanc9at+ nature or else x is heavy & t5se4 ,tub]culosis ( ! c]vical sp9e may be an und]ly+ cause4 ,c]vico-,bra*ial & ,bra*ial ,neuralgia4--,9 ^! =ms ( neuralgia ! pa9 is ref]r$ to ! area suppli$ by ! f\r l[] c]vical & ! fir/ dorsal n]ves4 ,! t5d] po9ts are 9 ! axilla along ! c\rse ( ! uln>1 ! circumflex at ! po/]ior "p ( ! deltoid & po9ts at ! l[] & po/]ior "p ( ! neck4 ,! lesions excit+ ?is =m ( neuralgia are usually f\nd 9 ! upp] dorsal & upp] c]vical sp9es1 b !y may be z l[ z ! six? dorsal or z high z ! atlas4 ,z f> z neuralgia ( ! uln> n]ve alone is conc]n$1 x c be trac$ to ! sev5? & eigh? c]vical & fir/ dorsal1 & ! lesion may be f\nd occasionally at ! fif? dorsal v]tebra or rib4 ,h[ a lesion z l[ z ! fif? dorsal affects ! uln> n]ve1 x is h>d to say def9itely4 ,!re may be fib]s directly to ! uln> n]ve z l[ z ?is region1 ! n]ve may be reflexly affect$1 ! vasomotor supply to ! uln> n]ve may be di/urb$1 or possibly ! lesion int]f]es ) fib]s ( ! deep lay]s ( ! back muscles & ?us contraction ( muscles = "s di/ance above ! lesion w\ld affect ! uln> & o!r n]ves4 ,! scal5i may be affect$ & involve ! plexus4 ,a bursitis may be pres5t 7,see ,pa9ful ,%\ld]s ,"p ,i74 ,focal infections are sometimes factors4 ,trunk ,neuralgia4--,?is includes dorso-int]co/al & lumbo-abdom9al neuralgia4 ,! =m]1 dorso-int]co/al neuralgia1 affects ! int]co/al n]ves f ! ?ird to n9? dorsal1 & is *>act]iz$ by pa9 along ! int]co/al spaces1 or 9 a few ( !m4 ,! pa9 may be bilat]al & symmetrical1 :i* usually %[s a v]tebral lesion4 ,?ree po9ts ( t5d]ness are usually not$1 viz41 ne> ! m$ian l9e 9 front1 & midway betwe5 ^! two po9ts 9 ! mid-axill>y l9e4 ,! pa9 is usually dull ) acute exac]bations4 ,lesions ( ! v]tebr & ribs 9 ! locality affect$ are by f> ! pr9cipal causes4 ,cold1 exposure1 /ra9s1 etc41 are excit+ causes ( e day occurr5ce4 ,:5 ! pa9 is bilat]al & symmetrical ! lesion is usually 9 ! v]tebra2 :5 unilat]al ! rib alone may be involv$4 ,! mo/ common lesion is a cr[d+ toge!r ( ! ribs ant]iorly at ! fif? & six? int]spaces4 ,c>efully exclude a possible tub]culosis ( ! sp9e or ribs1 aneurism1 etc4 ,! pa9 ( h]pes zo/] is n neuralgic1 b neuritic1 involv+ ! po/]ior sp9al ganglion4 ,pleurodynia1 /rictly speak+1 is neuralgia ( ! pleural n]ves1 & n ( ! int]co/als1 b a d]ang$ rib ov] ! region ( ! pa9 is commonly ! cause ( ! pleurodynia4 ,lumbo-abdom9al neuralgia involves ! po/]ior bran*es ( ! lumb> n]ves4 ,t5d] po9ts are f\nd ne> ! v]tebr1 middle ( ! iliac cre/1 l[] "p ( ! rectus1 & 9 ! male occassionally 9 ! scrotum1 9 ! female 9 ! labia4 ,^! are (t5 bilat]al & are usually ( a con/rict+ nature4 ,! ilioscrotal bran* is ! "o mo/ commonly affect$4 ,subluxation ( ! v]tebr1 & o!r lesions1 z contract$ muscles1 are f\nd along ! lumb> v]tebr1 & ev5 z high z ! l[] dorsal v]tebr4 ,also lesions are f\nd at ! lumbo-sacral articulation4 ,pelvic disease is also a cause4 ,a d[nw>d displacem5t ( ! l[] ribs1 elev5? & twelf?1 is a common disord] & may be ! cause ( sev]e neuralgic pa9s 9 ! region ( ! iliac foss4 ,x may simulate ov>ian inflammation1 r5al colic1 or ev5 app5dicitis if on ! "r side4 ,& septic kidney has be5 wrongly diagnos$ f ^! lesions4 ,9 fact x may be a cause ( inflammation ( ! deep] /ructures1 su* z ! ov>y & ,fallopian tube4 ,a subluxation ( ! v]tebr at ! f\r? & fif? dorsals may cause sev]e neuralgic pa9s 9 ! epiga/rium4 ,neuralgia ( ! ,sp9al ,column4--,accord+ to m$ical writ]s ?is is especially f\nd 9 weakly wom5 & aft] concussion ( ! sp9e2 t x is a tr\blesome symptom 9 hy/]ia1 & 9 _m cases x is due to a reflex /imulus f diseas$ visc]a4 ,mo/ ( ?is is und\bt$ly true1 b !y h n f\nd out ! real significance ( ^! neuralgic pa9s4 ,! v>i\s t5d] po9ts along ! sp9al column are ( p>am\nt importance to ! o/eopa? z a guide to 8 diagnosis2 n only 9 c]ta9 cases1 b 9 ne>ly e case4 ,! t5d] po9ts are n due1 9 ne>ly e in/ance1 to reflex /imuli f diseas$ organs1 b ^! t5d] po9ts are (t5 ! result ( a local lesion1 & are _m times ! cause ( ! disord] to ! diseas$ viscus4 ,! neuralgic pa9s are simply a symptom t a lesion exi/s 9 ! imm$iate locality4 ,neuralgia ( ! ,sacral ,region & ,coccygodynia4--,?is =m involves ! n]ves 9 ! sacral & coccygeal regions4 ,! n]ves betwe5 ! bone & ! sk9 are affect$4 ,! cause ( ! pa9 is g5]ally due to d]angem5t ( ! articulation ( ! lumb> & sacrum1 & to sev]ely contract$ muscles ov] ! sacral =am9a2 also to l[] lumb> lesions4 ,x may be a reflex f v>i\s possible disord]s ( ! organs & tissues ( ! pelvis4 ,9 coccygeal neuralgia1 ! coccyx is commonly displac$ 9 any "o ( ! v>i\s displacem5ts t are liable to occur4 ,special att5tion %\ld be giv5 to ! fibro-articulation ( ! coccyx1 & to ! /atus ( ! lumbo-sacral & innom9ata4 ,9 adju/+ ! coccyx1 place =ef+] 9 rectum up to proximal end ( coccyx1 & ) ?umb ext]nally ov] ! section1 ex]t traction until articulation is releas$2 !n adju/4 ,neuralgia ( ! ,legs & ,feet4--,?is includes ! crural =m1 9 :i* ! front ( ! ?igh is ! seat ( ! pa92 also ! =m 9 :i* t5d] po9ts are f\nd along ! c\rse ( ! sciatic n]ve4 ,! latt] =m is q a common "o1 al?\gh sciatica is r>ely a neuralgia4 ,x is a neuritis & w be f\nd class$ "u t head+4 ,! t5d] po9ts pres5t$ are ! lumb>1 sacro-iliac1 gluteal1 p]oneal1 maleol> & ext]nal plant>4 ,! v>i\s neuralgic pa9s ( ! legs & feet are g5]ally due to lesions ( ! lumb>1 pelvic & ?igh regions1 & to weak ar*es4 ,metat>salgia occurs :5 ! f\r? metat>so-phalangeal articulation is p>tially dislocat$4 ,neuralgia 9 ! heel1 ball ( ! foot & toes may be due to local causes or to lesions high] up4 ,aside f ! above c>e %\ld be tak5 t !re are no toxic factors t may be excit+ causes4 ,visc]al ,neuralgia4--,?is is a t]m appli$ to neuralgia ( ! ga/ro-inte/9al tract1 ! kidneys1 & ! v>i\s pelvic organs4 ,diagnosis & ,prognosis ( ,neuralgia4--,neuralgia is to be diagnos$ *iefly f neuritis1 rheumatism1 & ! effects ( sev]e pressure ^u ! n]ves4 ,9 neuritis !re is (t5times a symmetrical affection1 :ile 9 neuralgia !re is a unilat]al di/ribution & !re are _m remissions & int]missions & a v>y+ ( ! pa9 f "o place to ano!r4 ,9 sev]e =ms ( neuritis1 ane/hesia succe$s ! hyp]e/hesia ( ! s5sory n]ves4 ,9 cases ( sev]e pressure ^u n]ves1 ! pa9 is cont9u\s & neuritis w soon be manife/$4 ,9 rheumatism ! pa9 is localiz$ 9 muscles or gr\ps ( muscles & does n foll[ ! c\rse ( ! n]ve4 ,! pa9 is increas$ by motion4 ,! prognosis is g5]ally favorable1 no matt] h[ sev]e ! attack4 ,! prognosis is influ5c$ only by ! age ( ! pati5t & ! cause4 ,treatm5t ( ,neuralgia4--,consi/s1 fir/1 9 ! control ( ! p>oxysm &1 second1 9 ! removal ( its cause4 ,9 controll+ ! p>oxysm1 frequ5tly "o w be able to remove ! cause4 ,9 a l>ge majority ( neuralgias ! cause is directly due to a displac$ tissue1 g5]ally a bone or muscle 9 ! locality affect$2 (t5 all t is necess>y 9 ord] to p]=m a cure is to adju/ ! disord]$ tissue & ! pa9 w cease4 ,?is usually c be done imm$iately1 al?\gh !re are cases :i* require sev]al treatm5ts be=e an adju/m5t ( ! p>ts c be accompli%$2 besides1 9 acute cases ! involv$ region w be s t5d] t an attempt to correct ! tissues suffici5tly to relieve ! p>oxysm w be unbe>able to ! pati5t4 ,9 su* in/ances :5 ! cause _c be remov$ at once1 firm pressure or inhibition ov] ! involv$ n]ves = a few m9utes & local application ( hot packs g5]ally disp]se ! pa9 = ! "t be+4 ,! rules ( hygi5e %\ld be obs]v$ 9 all cases4 ,! be/ "t to remove ! cause ( neuralgia is betwe5 ! attacks :5 ! tissues are n z t5d] or contract$ to su* an ext5t z dur+ ! p>oxysm4 ,a diagnosis c !n be made mu* m easily1 & ! tissues adju/$ ) less pa9 to ! pati5t4 ,! details 7z to ! locality treat$7 = ea* =m ( neuralgia w be f\nd "u ! discussion ( ea* v>iety4 ,! g5]al heal? & diet %\ld be consid]$4 ,pet]son#aae says3 8,morph9e is1 among ! alkaloids1 ! mo/ frequ5t cause ( insanity4 ,x is a sad comm5t>y on ! he$lessness ( "s m$ical m51 b ! family physician is responsible1 9 almo/ e case1 = ! developm5t ( ! morph9e habit & its f>-rea*+ consequ5ces4 ,x %\ld be look$ ^u z a s9 to give a dose ( morph9e = insomnia or = any pa9 7su* z neuralgia1 dysm5orrhea1 rheumatism7 :i* is o!r ?an extremely sev]e & transi5t40 ,diseases ( ! ,cranial ,n]ves ,olfactory ,n]ves4--,?is n]ve may be affect$ at v>i\s po9ts f its orig9 to di/ribution4 ,! di/urbances may produce hyp]osmia1 or anosmia4 ,! lesions may be tumors1 injuries to ! head & v>i\s diseases ( ! bra91 or diseases ( ! nasal muc\s membrane4 ,! treatm5t ( ! n]ve 7beside treat+ ! disease caus+ ! di/urbance7 is to ! c]vical region ) a view to controll+ ! blood supply4 ,optic ,n]ve & ,tract4#aaf--,! ret9a1 optic n]ve1 *iasma & optic tract may be affect$ by v>i\s lesions4 ,! affections ( ! ret9a are organic or functional4 ,"u organic !re is hemorrhage & ret9itis4 ,ret9itis may be due to sev]al diseases1 z syphilis1 ,bright's disease1 anemia1 etc41 ,functional includes toxic & hy/]ical amaurosis1 tobacco amblyopia1 nyctalopia1 hem]alopia & ret9al hyp]e/hesia4 ,includ$ 9 ! lesions ( ! optic n]ve1 are optic neuritis & optic atrophy4 ,"u lesions ( ! *iasma & tract are diseases ( ! *iasma & unilat]al regions ( ! tract4 ,lesions ( ! tract & c5t]s may be f\nd 9 ! tract itself1 9 ! optic ?alamus & ! tub]cula quadrigem9a1 9 ! fib]s ( ! optic radiation1 9 ! cuneus1 & 9 ! angul> gyrus4 ,a brief summ>y1 only1 has be5 giv5 ( ! lesions f\nd1 x be+ ! idea n to dwell ^u symptoms1 morbid conditions1 etc41 b to br+ out ess5tial o/eopa?ic features 9 reg>d to ! cranial n]ves4 ,= ! v>i\s effects ( ^! lesions & po9ts ( diagnosis1 ! read] is ref]r$ to ! v>i\s works on n]v\s diseases4 ,lesions peculi> to o/eopa?ic practice1 t affect ! optic n]ve & tract1 are f\nd *iefly 9 ! upp] & middle c]vical v]tebr4 ,! disord]s to ^! v]tebr may involve fib]s ( ! optic n]ve directly--^? t are suppos$ to orig9ate 9 ! c]vical sp9e2 !y involve ! ret9a & optic n]ve by way ( ! fif?1 z claim$ by "s2 & ! above lesions especially affect ! blood supply to ! optic n]ve & tract1 ei!r int]f]+ me*anically ) ! blood-vessels or ob/ruct+ & irritat+ vasomotor n]ves4 ,! mo/ common lesions are subdislocations ( "o or all ( ! ?ree upp] c]vical v]tebr4 ,/ill1 lesions may be locat$ z l[ z ! ?ird or f\r? dorsal v]tebra1 :i* may influ5ce vasomotor & sympa!tic n]ves1 or ! lymphatics4 ,! ?ree or f\r upp] ribs %\ld also receive due consid]ation4 ,motor ,oculi4--,lesions ( ! ?ird n]ve may affect its c5t] or ! c\rse ( ! n]ve4 ,^! lesions produce spasms or p>alysis4 ,! only way t we c control ! motor oculi is by way ( ! sup]ior c]vical sympa!tic2 also1 x has a connection ) ! f\r?1 fif? & six? n]ves1 & we c influ5ce x to "s ext5t by direct treatm5t to ! eyeball & orbital muscles4 ,x %\ld be rememb]$ by ! o/eopa? t _m ( ! lesions affect+ ! cranial n]ves1 are f\nd ^u po/-mortem exam9ation1 to be ! effect ( lesions 9 ! sp9al region2 t _m pr$ispos+ lesions are ! disord]$ anatomical sp9al tissues2 z = in/ance 9 ! ?ird n]ve1 d]angem5ts ( ! atlas or axis may affect ! n]ve sympa!tically 7reflexly71 or possibly by direct fib]s1 & produce ! second>y effect--! s-call$ prim>y lesions ( o!r s*ools--at ! c5t] or 9 ! c\rse ( ! n]ve4 ,pa!ticus4--,?is n]ve may be involv$ by tumors at its nucleus1 or z x passes ar\nd ! out] surface ( ! crus into ! orbit4 ,aneurisms or ! exudation ( m5+itis may also compress its fib]s4 ,?is n]ve is purely motor1 al?\gh x receives a few recurr5t s5sory fib]s f ! fif? n]ve4 ,?is n]ve is controll$ o/eopa?ically1 pr9cipally at ! sup]ior c]vical sympa!tic4 ,x has connections ) ! sympa!tic by way ( ! cav]n\s plexus4 ,trigem9us4--,lesions ( ?is n]ve are f\nd 9 its nucleus & 9 ! pons1 & include scl]osis1 hemorrhage1 disease & injury at ! base ( ! skull1 tumors1 aneurisms1 inflammation ( ! n]ve1 & subdislocations ( ! upp] ?ree c]vical v]tebr1 or ! inf]ior maxill>y4 ,?is n]ve is an extremely important "o f an o/eopa?ic po9t ( view1 z x has a vasomotor influ5ce ov] v>i\s vessels ( ! head & face1 & secretory fib]s to ! la*rymal1 p>otid & submaxill>y gl&s2 also1 x controls ma/ication1 & to "s ext5t deglutition1 & influ5ces he>+ 7t5sor tympanum muscle74 ,diseases ( ! nasal muc\s membrane & disease ( ! ant]ior portion ( ! eyeballs are l>gely due to ! v]tebral subdislocations & to d]angem5ts to ! inf]ior maxilla4 ,our pr9cipal "w ^u ?is n]ve is at ! upp] c]vical v]tebr1 ! inf]ior maxilla1 & ! deeply contract$ muscles 9 ! upp] c]vical region4 ,= ! facial po9ts ( treatm5t see neuralgia ( ! fif? n]ve4 ,?is n]ve is closely relat$ to ! six?1 sev5?1 eigh?1 n9?1 t5?1 elev5? & twelf? n]ves4 ,p>ticul> emphasis is giv5 to ! importance ( treat+ ?is n]ve 9 nasal cat>rh & 9 eye diseases ( ! ant]ior portion ( ! eyeball4 ,x conta9s trophic fib]s to ! eye1 s5sory fib]s to ! scl]otic coat & iris1 & vasomotor fib]s to ! *oroid plexus4 ,abduc5s4--,?is n]ve is especially liable to be affect$ by tumors & m5+itis4 ,x is controll$ o/eopa?ically at ! sup]ior c]vical sympa!tic1 be+ connect$ ) ! sympa!tic at ! cav]n\s plexus4 ,facial4--,lesions may occur 9 ! cortical c5t]s ( ! n]ve1 ! nucleus & ! n]ve trunk4 ,p>alysis ( ! facial n]ve occasionally occurs 7,bell's p>alysis72 also facial spasm may occur4 ,?is n]ve is controll$ at ! /yloma/oid =am54 ,lesions to ! atlas1 ant]iorly or lat]ally1 are commonly f\nd4 ,9 ! region ( ! /yloma/oid =am51 ! n]ve communicates ) ! great auricul> ( ! c]vical plexus1 ! trifacial1 ! vagi1 ! glosso-ph>yngeal & ! c>otid plexus ( ! sympa!tic4 ,! facial n]ve may be affect$ directly z x passes above ! angle ( ! jaw4 ,ne>ly e case ( ,bell's p>alysis c be cur$ by o/eopa?ic treatm5t4 ,!re are usually lesions to ! upp] two or ?ree c]vicals4 ,correction ( ! c]vical v]tebr & massage ( ! p>alyz$ muscles1 ) c>e ( ! g5]al heal?1 w suffice1 provid$ !re is n an ext5sive c5tral lesion4 ,al?\gh ! disease may be due to syphilis1 m5+itis1 tumors1 etc41 ! mo/ frequ5t causes are lesions ( ! atlas1 axis1 & ?ird c]vical & exposure to cold4 ,! cold produces a neuritis 9 ! ,fallopian canal1 & deep treatm5t b5ea? ! angle ( ! jaw is effective4 ,! prognosis ( ,bell's p>alysis is favorable4 ,auditory4--,lesions#aag affect+ ?is n]ve may occur any:]e f its cortical c5t] to its di/ribution 9 ! co*lea & ve/ibule4 ,disord]s result+ f lesions to ?is n]ve are n]v\s deafness1 auditory hyp]e/hesia1 t9nitus aurium1 & ,m5i]e's#aah disease4 ,! control ( ! n]ve & ! treatm5t ( lesions affect+ x1 are effect$ pr9cipally at ! fir/ & second c]vical v]tebr4 ,! atlas is especially apt to be subdislocat$ ant]iorly or 9 a rot>y mann]4 ,! condition ( ! upp] dorsal region %\ld also be c>efully exam9$1 z vasomotor n]ves to ! e> may be imp+$ at ?is po9t4 ,! auditory connects ) ! fif?1 six? & sev5? n]ves4 ,glosso-,ph>yngeal4--,?is n]ve may be affect$ by tumors1 deg5]ations1 m5+itis & v>i\s lesions4 ,x is (t5 v h>d to det]m9e exactly ! pa?ology1 on acc\nt ( its v>i\s connections ) o!r n]ves1 ! vagi1 facial1 sp9al accessory1 olfactory & optic n]ves4 ,?is n]ve is *iefly controll$ at its exit at ! jugul> =am54 ,o/eopa?ically1 lesions ( ! c]vical v]tebr & upp] dorsal v]tebr affect x4 ,! deep muscles ( ! ant]ior & lat]al regions ( ! neck & subdislocations ( ! atlas especially affect ! n]ve4 ,pneumoga/ric4--,on acc\nt ( its ext5sive di/ribution1 & ! importance ( its functions ?is is "o ( ! mo/ important n]ves 9 ! body4 ,x di/ributes fib]s to five vital organs--he>t1 lungs1 /oma*1 liv] & inte/9es--& to o!r organs ( second>y importance4 ,?is n]ve is associat$ ) deglutition1 phonation1 respiration1 circulation & dige/ion4 ,hemorrhages1 s(t5+1 etc41 may involve ! nucleus ( ! n]ve1 :ile ! trunk may be imp+$ by tumors1 ?ick5$ m5+es1 aneurism ( ! v]tebral art]y & subdislocation ( ! upp] five or six c]vical v]tebr1 *iefly ! atlas4 ,! n]ve is mo/ easily controll$ at its exit f ! =am54 ,inhibition ( ! suboccipital region1 betwe5 ! ma/oid process & transv]se process ( ! atlas1 w influ5ce ! n]ve m>k$ly1 probably reflexly2 also direct treatm5t may be giv5 ! n]ve z x passes along ! ant]ior "p ( ! neck ne> ! tra*ea4 ,! sup]ior l>yngeal bran* may be treat$ bel[ ! great cornu ( ! hyoid bone & att5tion is p>ticul>ly call$ to ?is 9 all affections ( ! ?roat :]e c\gh+ is a feature2 ! inf]ior l>yngeal1 at ! inn] side ( ! l[] "p ( ! /]nocleidoma/oid muscle4 ,! inf]ior l>yngeal n]ve may be affect$ by dislocation ( ! fir/ & second ribs1 produc+ pressure ^u ! n]ve z x w9ds ab\t ! subclavian vessel4 ,fib]s ( ! n]ve h be5 trac$ to ! sp9al accessory n]ve1 z l[ z ! six? & sev5? c]vical v]tebr2 consequ5tly1 lesions to ! vagi n]ves may occur any:]e 9 ! c]vical region4 ,sp9al ,accessory4--,lesions ( ?is n]ve may cause p>alysis or spasms to ! /ructures to :i* x is di/ribut$4 ,! lesions consi/ ( subdislocations ( c]vical v]tebr1 *iefly ! upp] ?ree or f\r4 ,! nucleus may be involv$ by w\nds1 abscesses1 c>ies ( ! v]tebr1 tumors & m5+itis4 ,^! lesions may also involve fib]s ( ! trunk4 ,! special po9ts ( control ( ! n]ve are at ! jugul> =am51 ! six? & sev5? c]vicals & ! second1 ?ird & f\r? c]vicals4 ,torticollis or ,wry-neck is spasm ( ! muscles ( ! neck suppli$ pr9cipally by ?is n]ve4 ,!re w be f\nd ei!r d]angem5ts ( ! middle or l[] c]vical v]tebr or ! muscles are swoll5 f exposure to cold or f a bl[4 ,sometimes ! lesion is 9 ! upp] dorsal4 ,! disord] is ma9ly a neurosis &1 unless x has become *ronic1 ! prognosis is favorable1 & ev5 9 *ronic cases1 (t5 consid]able b5efit c be obta9$4 ,hypoglossal4--,?is n]ve may be affect$ by cortical1 nucle> & infra-nucle> diseases1 z well z by subdislocations ( ! upp] c]vical v]tebr4 ,x communicates ) ! sup]ior c]vical ganglion1 ! vagi1 ! upp] c]vical n]ves & ! gu/atory bran* ( ! fif? n]ve4 ,we control ! n]ve at ! ant]ior condyloid =am5 & at ! sup]ior c]vical ganglion4 ,diseases ( ! ,sp9al ,n]ves ,c]vical ,n]ves4--,! great occipital n]ve may be controll$ at a po9t on ! occiput betwe5 ! ma/oid process & ! fir/ c]vical v]tebra4 ,! small occipital & ! great auricul> n]ves may be controll$ at a po9t j beh9d ! ma/oid process4 ,! great auricul> n]ve & ! frontal bran* ( ! trigem9us n]ve meet ov] ! p>ietal protub]ance4 ,! prec$+ po9ts are ! places :]e "o may inhibit ! n]ves & control c]ta9 heada*es or neuralgic attacks1 al?\gh subdislocations ( ! upp] c]vical v]tebr1 or contract$ muscles betwe5 ! atlas & occiput are usually ! cause ( su* di/urbances4 ,adju/m5t ( ! lesion w usually correct ! di/urbance4 ,c>efully exclude possible c>ies or tumors4 ,treatm5t ( ! upp] c]vical region1 by relax+ muscles & correct+ d]ang$ v]tebr1 con/itutes ! pr9cipal treatm5t ( an ord9>y heada*e4 ,x is be/ to h ! pati5t flat ^u 8 back & ! o/eopa? /& at ! head ( ! pati5t1 &1 fir/1 ?or\ghly relax ^! contract$ muscles or correct ! d]angem5t ( ! v]tebr2 !n aft] ! =ego+ has be5 accompli%$1 give an inhibitory treatm5t ( ! suboccipital region4 ,9 inhibit+1 place ! f+]s ov] ! contract$ & t5d] tissue2 hold tightly = sev]al m9utes1 or at lea/ until ! tissues h ?or\ghly relax$4 ,_m times "o w be able to detect a slight twit*+ und]nea? ! f+]s1 & :5 su* is felt1 he kn[s at once t ! heada*e is reliev$4 ,9 inhibit+ at any po9t along ! sp9e1 seek ! contract$ fib]s & t5d] po9ts & inhibit exactly ov] ! area4 ,heada*es t are due to a di/urb$ circulation ( ! bra91 may be reliev$ by ?is inhibitory treatm5t 9 ! suboccipital region4 ,! treatm5t t5ds to ree/abli% a normal circulation to ! bra94 ,al?\gh ! l>ge vascul> areas su* z ! splan*nic1 %\ld1 if possible1 be normaliz$4 ,heada*es may also be due to lesions at v>i\s po9ts along ! sp9e & ribs1 & a correction ( su* po9ts is necess>y 9 ord] to cure ! affection4 ,a place (t5 f\nd involv$ is ! upp] dorsal region4 ,reflex heada*es c be cur$ only by reliev+ ! irritation4 ,! treatm5t to ! head w\ld only be tempor>y4 ,9 heada*es ( ! *ronic type x is well to exam9e ! scalp & if n freely movable ov] occipital region x may be adh]5t to ! skull & cause pressure on ! occipital n]ves4 ,lesions to ! phr5ic n]ve usually occur 9 ! region ( ! ?ird1 f\r? & fif? c]vical v]tebr4 ,! lesion may be due to a d]ang$ v]tebra1 or to disease ( ! membrane ( ! cord1 or ( ! ant]ior horn ( ! gray matt] 7,see ,hicc\ghs74 ,p>alysis ( diaphragm f ! phr5ic may be s+le or d\ble4 ,:5 s+le x is n v noticeable4 ,:5 d\ble1 respiration mu/ be c>ri$ on by ! int]co/als & accessory muscles4 ,:5 quiet1 ! pati5t may n notice x b on ex]tion !re may be tempor>y dyspnea4 ,bron*itis ) its con/ant c\gh+ is a bad complication4 ,v>i\s disord]s ( ! phr5ic n]ve are pr9cipally treat$ 9 ! area ( ! orig9 ( ! phr5ic n]ve4 ,tumors1 aneurism1 c>ies1 & neuritis are possible complications4 ,lesions to ! bra*ial plexus are usually d]angem5ts ( ! c]vical or upp] dorsal v]tebr4 ,focal infections %\ld n be ov]look$4 ,direct injuries1 contraction ( muscles1 a d]ang$ clavicle1 a c]vical rib1 or a dislocat$ %\ld] are to be ?\ght (4 7,see1 also1 ,pa9ful ,%\ld]s1 ,"p ,i7 ,! ,x-ray z a diagno/ic aid may be invaluable4 ,9 ob/ructions to ! musculo-cutane\s n]ve1 ! p[] to flex ! =e>m ^u ! arm is greatly impair$4 ,! lesion is mo/ likely to be f\nd betwe5 ! fif? & six? c]vical v]tebr4 ,cl9ically1 ! m$ian n]ve is ( special int]e/ f ! fact t atrophy ( ! muscles ( ! ball ( ! ?umb1 :i* is pa?ognomonic ( progressive muscul> atrophy1 may be caus$ by an affection ( ?is n]ve4 ,! lesion is usually f ! ?ird to ! sev5? c]vical v]tebr4 ,lesions ( ! uln> n]ve may arise betwe5 ! six? & sev5? c]vical v]tebr1 b are (t5times f\nd z l[ z ! fif? dorsal1 especially at ! fif? rib on ! side affect$4 ,lesions ( ! circumflex n]ve may be f\nd 9 ! l[] c]vical v]tebr1 b are commonly caus$ by dislocations ( ! hum]us & clavicle4 ,lesions ( ! supr>scapul> n]ve occur mo/ frequ5tly f ! fif? to six? c]vical v]tebr4 ,! po/]ior ?oracic may be lesion$ at ! fif? or six? segm5ts1 or by pressure injuries to ! s]ratus magnus4 ,dorsal ,n]ves4--,! ess5tial o/eopa?ic po9ts ( ! dorsal n]ves h be5 consid]$ "u int]co/al neuralgia4 ,x might be /at$ t ! po/]ior fib]s ( ! six? & sev5? dorsal n]ves supply ! sk9 ( ! pit ( ! /oma*4 ,?is is ( value1 cl9ically1 z sev]e pa9s 9 ! epiga/ric region :i* may result f imp+em5t ( ^! n]ves1 are suppos$ by ! pati5t to be due to /oma* disord]4 ,diseases ( ! liv] may be manife/$ by pa9s 9 ! region ( ! "r scapula4 ,x has be5 sugge/$ t ! /imulus passes f ! liv] up ! pneumoga/ric to ! sp9al accessory & d[n ! sp9al accessory to ! trapezius muscle & ?us causes ! 8liv] pa940 ,int]co/al neuralgia is m common on ! left side ( ! body4 ,! int]co/al ve9s ( ! left side empty into ! left sup]ior int]co/al ve9 or ! left azygos4 ,?us ! blood1 to rea* ! v5a cava1 is oblig$ to take a circuit\s r\te & /agnation is m likely to occur ?an on ! o!r side4 ,! gl&ul> /ructure ( ! mamm>y gl&s is suppli$ by int]co/al n]ves f ! ?ird to ! six? int]space4 ,lesions "h w cause v>i\s diseases ( ! brea/s & adju/m5t w cure _m ( !m4 ,lumb> ,n]ves4--,! lumb> n]ves may n only be d]ang$ by v>i\s gr[?s1 inflammatory processes & abscesses 9 ! abdom51 b by lesions1 infections1 p>turition1 & developm5tal defects ( ! lumb> v]tebr4 ,tub]culosis ( sp9e1 sacro-iliac & hip jo9ts1 is n r>e4 ,9 d\btful cases utilize ! ,x-ray plate4 ,lesions 9 ! region ( ! fir/ lumb> may affect ! iliohypoga/ric & ilio-+u9al n]ves & causes v>i\s irritations ( ! p5is1 scrotum1 labium & ?igh4 ,also1 ! p]9eal region may be involv$1 z well z connect+ bran*es ( ^! n]ves to v>i\s visc]al n]ves und]nea?4 ,! g5ital organs may be affect$ by lesions to ! g5itocrural & ext]nal cutane\s n]ves1 caus$ by v]tebral lesions ( ! second & ?ird lumb> v]tebr4 ,! latt] n]ve may be irritat$ by pressure und]nea? ,p\p>t's ligam5t4 ,lesions at ! ?ird & f\r? lumb> v]tebr & sacro-iliac articulation may affect ! obturator n]ve4 ,sacral ,n]ves4--,lesions to ! sacral n]ves are especially liable to occur :5 an innom9atum is subdislocat$1 z t *anges ! relative position ( ! femur ) ! body & causes imp+em5t to ! sacral n]ves4 ,contraction ( ! pelvic & ?igh muscles also affect sacral n]ves4 ,o!r lesions to ! sacral n]ves may be locat$ at ! fif? lumb> & sacrum4 ,x %\ld be rememb]$ t ! c5t]s ( ! sacral n]ves are 9 ! l[] dorsal & upp] lumb> region4 ,v>i\s lesions to ! sacral n]ves may be caus$ by pelvic inflammation1 compressions by gr[?s1 & injuries & contractions ( muscles )9 ! pelvis4 ,sciatica has be5 describ$ "u neuritis4 ,,footnotes3 #aad ,see ,o/eopa?ic ,lesion--,j\rnal ( ,am]ican ,o/eopa?ic ,association4 ,may1 #aijf1 & ,deason's ,physiology4 #aae ,n]v\s & ,m5tal ,diseases1 p4 #fbb4 #aaf ,see ,diseases ( ! ,eye1 ,"p ,i4 #aag ,see ,e> ,section1 ,"p ,i4 #aah ,r4 ,d4 ,em]y reports a case ( ,m5i]e's disease z cur$4 ,a4 ,o4 ,a4 ,case ,reports1 ,s]ies ,,iv4 ,,g5]al ,,& ,,functional ,,diseases ,p>alysis ,agitans 7,,%ak+ ,,palsy7 ,def9ition4--,a *ronic1 n]v\s disease1 *>act]iz$ by tremors1 muscul> weakness1 muscul> rigidity & alt]ations 9 ! gait4 ,etiology4--,! disease usually comm5ces aft] =ty ye>s ( age1 b occasionally x occurs f ! ?irtie? to =tie? ye>s4 ,x is m frequ5t 9 males ?an 9 females4 ,h]$ity seems to h b little influ5ce 9 ! cause ( ! disease4 ,among ! pr9cipal causes are physical injuries1 exposure to cold & wet1 emotion1 worry1 alcoholism1 sexual excesses & acute diseases4 ,physical injury1 9 conjunction ) exposure to cold is ! be/ det]m9$ cause4 ,disord] ( ! v]tebr ( ! c]vical or dorsal regions1 or ( ! upp] & middle ribs1 c g5]ally be f\nd4 ,traumatic influ5ces probably affect ! n]ve c5t]s1 caus+ a di/urb$ inn]vation1 ei!r by ! direct effect ( ! d]ang$ /ructures ^u ! n]v\s tissues or ob/ruct+ nutritive *annels to ! n]v\s tissues4 ,9 mo/ cases no *anges h be5 obs]v$ 9 ! c5tral n]v\s sy/em or 9 ! sympa!tic ganglia4 ,"s obs]v]s h not$ induration ( ! pons1 m$ulla & cord1 b ^! *anges may be due to s5ility or to ! indirect consequ5ces ( ! long di/urbance ( function4 ,9 a few cases1 int]/itial scl]osis ( ! p]iph]al n]ves is obs]v$2 ^! are probably second>y *anges4 ,o/eopa?ic exp]i5ce reg>ds p>alysis agitans z an affection ( ! c5tral n]v\s sy/em1 due to a disord]$ /ructure 9 ! locality affect$4 ,symptoms4--,! onset is usually gradual1 b may come on q sudd5ly aft] ex]tion4 ,! initial symptoms are usually tremor1 /iffness or weakness 9 "o h&4 ,9 r>e cases1 at fir/ !re may be neuralgic pa9s1 dizz9ess & symptoms ( a rheumatoid nature4 ,! tremor c be controll$ by ! w at ! onset ( ! disease4 ,! affection gradually ext5ds until an entire side or ! upp] or l[] limbs are involv$4 ,at ?is advanc$ /age ( ! disease1 a peculi> muscul> rigidity ( ! involv$ region takes place4 ,muscul> weakness comes on at ab\t ! same "t z ! rigidity1 & ! loss ( p[] v>ies mu* 9 degree4 ,! condition is mo/ m>k$ 9 ! f+]s & h&s1 :5ce x ext5ds to ! arms & legs4 ,x commonly passes f ! "r arm to ! "r leg1 !n to ! left arm1 & !n to ! left leg4 ,at ?is /age ! movem5t betwe5 ! ?umb & f+]s is l t ( crumbl+ bread4 ,! writ+ is greatly affect$ & 9 "t x is impossible to write4 ,! trembl+ may be s viol5t z to prev5t sleep+4 ,!re is occasionally an int]mission ( days 9 ! tremor4 ,on acc\nt ( ! rigidity ( ! muscles1 ! pati5t assumes a *>act]i/ic attitude & gait4 ,! position ( ! body is t ( a t5d5cy to g =w>d1 ! head is b5t =w>d1 ! back curv$ outw>d1 ! arm b5t at ! elb[ & held away f ! body1 & ! knees s close toge!r t !y rub 9 walk+4 ,! gait is a 8propulsive0 "o1 & :5 once />t$ 9 a =w>d walk1 ! pati5t's gait becomes m & m rapid & he _c /op until he comes aga9/ "s object4 ,! expression ( ! face is /iff & mask-l1 ! spee* sl[ & monoton\s & ! voice %rill4 ,! pati5t is g5]ally re/less & tr\bl$ ) insomnia4 ,! g5]al heal? is 9 fairly good condition4 ,reflexes are usually normal4 ,! intellect is g5]ally reta9$1 al?\gh ! physical ailm5t may cause m5tal depression4 ,diagnosis4--,is usually easy & c (t5times be made at a glance4 ,dissem9at$ scl]osis has a tremor1 b is %[n p>ticul>ly 9 volunt>y movem5ts4 ,! spee* is scann+ & ! gait ataxic4 ,! disease beg9s 9 ! l[] extremities1 ! attitude is diff]5t f t ( p>alysis agitans1 & !re is ny/agmus4 ,9 *orea ! movem5ts are g5]al1 irregul> & m int]mitt5t1 & x p>ticul>ly involves muscles ( ! face4 ,also *orea is a disease ( *ildr5 & "y adults4 ,! tremors ( old age1 hy/]ia1 & c]ta9 toxic conditions due to tobacco1 alcohol1 etc4 are g5]ally easily diagnos$4 ,prognosis4--,! disease does n necess>ily %ort5 life2 ! pati5t (t5times dies ) "s int]curr5t disease4 ,improvem5t usually results f c>eful1 prolong$ treatm5t4 ,e>ly treatm5t1 ( c\rse1 w give ! mo/ satisfactory results1 & occasionally1 if tak5 v e>ly1 ! case c be cur$4 ,treatm5t4--,a mo/ c>eful exam9ation ( ! physical /ructures ( ! pati5t %\ld be made1 p>ticul> att5tion be+ paid to ! c]vical & dorsal v]tebr1 ! upp] & middle ribs & ! muscles along ! sp9al column4 ,all irregul>ities f\nd %\ld be correct$ if possible1 & /rong1 ?or\gh treatm5t giv5 to ! region ( inn]vation ( ! affect$ p>ts4 ,traction ( ! rigid areas is ( "s value4 ,treatm5t ( ! arms & legs w also be ( aid4 ,all m5tal /ra9 & physical exhau/ion %\ld be prev5t$ if possible4 ,g5]al hygi5ic measures are to be employ$4 ,! life ( ! pati5t %\ld be quiet & regul>4 ,ba?+1 fre% air1 massage & outdoor life w aid 9 improv+ ! g5]al heal?4 ,p]si/5t treatm5t w ret>d ! progress & frequ5tly improve ! g5]al condition4 ,simple & hy/]ical tremor mu/ n be conf\nd$ ) t ( p>alysis agitans4 ,e4 ,a%more#aai reports an int]e/+ case :i* %[s ab\t :at may be expect$ "u treatm5t4 ,acute ,*orea 7,,/4 ,,vitus ,,dance7 ,def9ition4--,a functional disord] ( ! n]v\s sy/em1 *iefly affect+ *ildr51 m ?an twice z frequ5t 9 females z males2 *>act]iz$ by irregul> involunt>y muscul> contractions1 (t5 slight m5tal di/urbance1 & liability to endoc>ditis4 ,o/eopa?ic ,etiology4--,! disease affects *ildr5 ( all /ations1 b is m common among ! l[] classes4 ,! great] numb] ( cases occur be=e ! age ( tw5ty4 ,x sometimes develops dur+ ! e>ly mon?s ( pregnancy1 :5 x (t5 assumes ! maniacal type4 ,*orea is frequ5tly associat$ ) endoc>ditis & rheumatism & delay$ m5/ruation4 ,x occasionally foll[s infecti\s diseases ( *ildhood1 especially sc>let fev]4 ,fright1 m5tal worry1 sudd5 grief & ov]/udy may br+ on an attack4 ,*ildr5 ( neurotic /ock are m susceptible4 ,h]$ity plays "s "p z a pr$ispos+ cause4 ,reflex irritation f worms or f g5ital irritation has a slight influ5ce ^u ! disease4 ,ov]work 9 s*ool is an important factor4 ,d]angem5t ( ! anatomical /ructures1 involv+ ! n]v\s sy/em along ! sp9al column1 is ! mo/ common pr$ispos+ cause4 ,mo/ ( ! anatomical displacem5ts are f\nd 9 ! c]vical v]tebr1 al?\gh ! upp] dorsal may be involv$4 ,pa?ologically1 z yet1 no con/ant anatomical lesions h be5 f\nd4 ,emboli occur 9 "s cases1 b ?is might be expect$1 z endoc>ditis s frequ5tly occurs z an effect & n ! cause ( *orea4 8,9 cases n rheumatic1 ! mo/ probable explanation ( ! symptoms is to be f\nd 9 vascul> *anges1 hav+ _! orig9 9 di/urb$ nutrition40 7,holt7 ,accord+ to o/eopa?ic !ories & inve/igations1 ! disease is due to v>i\s irritations to ! sp9al c5t]s & n]ves ( ! affect$ region4 ,! disord]$ n]ve cells may be ! result ( direct pressure1 hyp]emia1 anemia1 etc41 & ! action ^u ! bra9 c5t]s is possibly a reflex act4 ,( late acute *orea is reg>d$ by "s z an infecti\s disease4 ,symptoms4--,9 ! majority ( cases ! muscul> movem5t is n sev]e4 ,!y are purposeless & ! *ild appe>s awkw>d4 ,re/lessness1 di/urb$ re/ at night1 cry+ spells1 pa9 9 ! limbs1 heada*e & irritability1 are "s ( ! premonitory symptoms4 ,9 mild cases "o h&1 or ! h& & face1 are involv$4 ,occasionally !re is "s difficulty 9 talk+4 ,! irregul>1 j]ky movem5ts are *>act]i/ic ( ?is disease4 ,! *ild is anemic1 & ! muscles are weak4 ,9 sev]e cases ! movem5ts are g5]al1 ! p[] ( spee* is lo/1 & ! pati5t is unable to get ab\t4 ,! condition usually occurs aft] "o or m mild attacks1 al?\gh x may occur prim>ily4 ,dur+ an attack ( *orea1 ! *ild's disposition *anges1 he becomes irritable1 _c conc5trate 8 m9d1 memory is affect$ & halluc9ations may occur4 ,! reflexes d n usually diff] f ! normal4 ,maniacal *orea is mo/ s]i\s1 & (t5 proves fatal1 al?\gh recov]y may occur4 ,?is =m occurs mo/ frequ5tly 9 pregnant wom54 ,spee* is greatly affect$ & insomnia1 fev] & maniacal delirium develop4 ,! duration is f six to t5 weeks1 9 ! av]age case4 ,mild cases may recov] 9 a mon? or less1 o!rs la/ six or m mon?s4 ,!re is a t5d5cy ( *orea to recur2 rheumatism seems to favor ?is t5d5cy4 ,9 *ildr5 recov]y is ! rule4 ,diagnosis4--,9 ! majority ( cases *orea is easily diagnos$4 ,! symptoms are g5]ally v *>act]i/ic4 ,9 a few cases ( hy/]ia !re may be difficulty ( diagnosis1 b hi/ory & rhy?mical movem5ts w usually diff]5tiate4 ,9 h]$it>y ataxia ! sl[1 irregul> movem5ts1 ! scolioses1 scann+ spee*1 talipes & ! exi/5ce ( o!r cases 9 ! family1 w diff]5tiate ?is f *orea4 ,c]ebral scl]osis usually occurs 9 infancy2 impair$ m5tality1 exagg]at$ reflexes1 rigidity & *ronic c\rse ( ! disease1 are po9ts :i* r5d] ! diagnosis easy4 ,treatm5t4--,ne>ly all cases c be cur$4#abj ,! pr$ispos+ causes ( *orea1 o/eopa?ically1 are usually f\nd to be subluxations ( ! v]tebr or ribs at any po9t1 b p>ticul>ly 9 ! c]vical v]tebr4 ,*orea is "o ( ! diseases ( ! n]v\s sy/em1 9 :i* con/ant morbid *anges are n f\nd ^u ! po/-mortem exam9ation4 ,possibly ! reason is because ! lesions caus+ ! diseas$ /ate are n deeply seat$ en\gh to prim>ily affect motor c5t]s2 b are lesions ( ! sp9al column & ribs1 affect+ simply ! n]ve fib]s reflexly1 z !y pass ?r\gh ! int]v]tebral =am9a4 ,!re w be f\nd well m>k$ lesions1 & ^u _! correction ! o/eopa? f9ds complete recov]y l>gely dep5ds4 ,! muscle1 or gr\p ( muscles1 involv$1 w give a direct clue z to :]e ! lesion w probably be f\nd4 ,9 ne>ly all cases1 x is 9 ! sp9al region ( inn]vation to ! affect$ muscles4 ,o!r cases may be due to c]ebral lesions1 z well z to inte/9al & ut]9e di/urbances4 ,se>* %\ld be made = possible reflex irritation1 su* z inte/9al p>asites1 adh]5t prepuce1 eye /ra91 nasal abnormalities1 etc4 ,all cases %\ld be tak5 f s*ool1 c>efully gu>d$ f excitem5t1 & plac$ "u ! mo/ favorable hygi5ic conditions1 ) a c]ta9 am\nt ( discipl9e z to self control4 ,! m s]i\s cases %\ld be plac$ 9 b$1 s t re/ w be secur$ z well z dim9i%$ liability to he>t complications4 ,! diet mu/ be c>efully wat*$ & ! b[els att5d$ to regul>ly4 ,a milk diet dur+ ! e>ly /age is highly recomm5d$4 ,d ev]y?+ possible to re/ore ! g5]al heal?4 ,mild gymna/ics1 9 mo/ cases1 w be f\nd ( s]vice4 ,amusem5t %\ld be giv5 ! *ild1 9 ! op5 air if possible4 ,9 sev]e cases :]e ! sk9 is h>% & dry1 ! hot air ba?1 provid+ ! /r5g? is good1 w give consid]able relief f ! int5sity ( ! disease4 ,a few cases ( acute *orea run into a *ronic =m1 b ! latt]1 z a rule1 yields to o/eopa?ic treatm5t4 ,*orei=m ,affections ,myoclonia is a sudd5 contraction ( a few muscle fib]s1 a s+le muscle or ( a gr\p ( muscles4 ,a neurotic t5d5cy1 infections & toxic conditions are factors4 ,occasionally epilepsy may be associat$ ) x4 ,o/eopa?ically !re c be b little d\bt t ! inn]vation to ! muscles involv$ is int]f]$ )4 ,! l[] extremities are usually fir/ affect$ & x may be sudd5 or gradual 9 appe>ance4 ,x is progressive & sl[ly involves ! arms &1 r>ely1 ! face4 ,usually ! spasms cease dur+ sleep4 ,prognosis is r favorable4 ,exam9ation %\ld %[ ! cause ( ! n]ve int]f]5ce & its correction br+ relief4 ,dub9i's disease is probably associat$ ) c]ta9 diseases ( ! cord & bra9 & is *>act]iz$ by sudd51 %>p pa9s 9 ! head1 neck & lumb> muscles1 ext5d+ to ! l[] extremities 9 ! =m ( a %ort1 %>p spasm1 usually at regul> int]vals4 ,lat] !re may be symptoms ( hemiplegia4 ,! disease is apt to progress & dea? may occur dur+ a convulsion4 ,habit spasm usually results f ov]/udy & n]ve exhau/ion ) impairm5t ( g5]al heal?1 & is incid5t to e>ly life4 ,! *ild is usually a neurotic4 ,! symptoms are twit*+ ( ! m\? & eyelids1 grimaces & j]k+ ( ! %\ld]s4 ,treatm5t = ! g5]al condition1 ) correction ( any sp9al lesions1 w g5]ally give relief4 ,g5]al tic resembles habit spasms closely4 ,9 "s cases ! pati5t is app>5tly heal?y1 :ile 9 o!rs !re is "s bra9 disord]4 ,!re are coord9ate spasmodic movem5ts ( ! head1 face & upp] trunk1 swall[+ & abnormal vocal s\nds4 ,! movem5ts are rapid & frequ5tly repeat$4 ,prognosis is unc]ta9 & w dep5d l>gely on g5]al conditions4 ,9 convulsive tic !re is usually a repetition ( c]ta9 words or s\nds ) a convulsive twit*+ or movem5t ( c]ta9 muscles4 ,infantile ,convulsions 7,,eclampsia7 ,infantile convulsions may be due to v>i\s causes4 ,a neurotic inh]itance is an important pr$ispos+ factor4 ,!y may prec$e ! developm5t ( _m diseases ( ! n]v\s sy/em1 & also occur z ! result ( p]iph]al irritation4 ,d5tition 9 association ) rickets1 & inte/9al p>asites are common causes4 ,!y may be ! e>ly symptoms ( acute1 infecti\s diseases4 ,sc>let fev]1 measles1 pneumonia & smallpox are v frequ5tly prec$$ by convulsions4 ,!y may be due to debility1 result+ f ga/ro-inte/9al disord]s4 ,malnutrition is a pr$ispos+ cause4 ,disease ( ! bones1 especially rickets1 may be associat$ ) convulsions4 ,lesions ( ! bra9 are o!r causes4 ,a protract$ in/rum5tal deliv]y may cause a hemorrhage ( ! m5+es4 ,symptoms4--,9 sev]e cases ! fit may be id5tical ) epilepsy4 ,x is m (t5 n s complete z true epilepsy4 ,convulsions v>y consid]ably1 b !re w be no difficulty 9 diagnosis4 ,x may come on sudd5ly1 or be prec$$ by re/lessness1 twit*+1 sometimes gr9d+ ( ! tee? & fev]4 ,! spasms may be ei!r ( a tonic or clonic type prec$$ by a cry & loss ( consci\sness4 ,! attack may be s+le1 b ! fits may foll[ ea* o!r ) great rapidity & t]m9ate fatally4 ,x is r>e = ! *ild to die dur+ a convulsion4 ,exhau/ion & asphyxiation may cause a fatal t]m9ation4 ,z 9 epilepsy ! temp]ature (t5 rises dur+ ! fit4 ,a transi5t p>esis sometimes foll[s1 if ! convulsions h be5 *iefly limit$ to "o side4 ,diagnosis4--,! diagnosis is g5]ally easy4 ,! attack is usually due to ! +e/ion ( "s indige/ible food or to "s p]iph]al irritation1 or an acute disease4 ,convulsions1 appe>+ imm$iately aft] bir? or injury1 are probably due to m5+eal hemorrhages or s]i\s injuries to ! cortex2 al?\gh a few ( ^! cases w pres5t grave lesions ( ! c]vical v]tebr1 probably (t5 due to protract$ in/rum5tal deliv]y4 ,infantile convulsions usually occur betwe5 ! fif? & tw5tie? mon?s4 ,convulsions occurr+ aft] ! second ye> are m likely to be true epilepsy4 ,! prognosis dep5ds almo/ :olly ^u ! cause1 sev]ity & duration4 ,treatm5t4--,! fir/ /ep 9 ! treatm5t is to det]m9e ! cause if possible4 ,treatm5t 9 ! region ( ! six? & sev5? dorsals w (t5 give relief2 ?or\gh "w along ! lumb> region & ! sacrum w _m times be suffici5t1 if ! convulsion is due to inte/9al disord]4 ,c4 ,m4 ,proctor reports t 9 male infants he has reliev$ convulsions quickly1 9 sev]al cases1 by pu%+ back ! =esk9 & has always f\nd1 9 su* cases1 ei!r a phimosis or an adh]5t prepuce4 ,9 female infants x might be well to exam9e ! clitoris4 ,dilatation ( ! rectal sph9ct] may be ( aid4 ,x may be necess>y to vomit ! pati5t1 :5 x is due to undige/$ food 9 ! /oma*2 & 9 "s cases an enema %\ld be us$1 :5 ! irritation is 9 ! inte/9es4 ,9 a few cases1 :5 ! convulsions are due to d5tition1 a lancet appli$ to ! gums w be all t is requir$4 ,a ?or\gh treatm5t to ! c]vical region1 to control ! circulation1 %\ld always be giv52 at ! same "t apply ice to ! head4 ,! pati5t %\ld be put 9 a ba? ( #ie to #ih degrees ,f41 %\ld ! prec$+ treatm5t n h ! desir$ effect1 or1 bett] /ill1 use ! ba? at once & treat at ! same "t4 ,ow+ to ! neurotic t5d5cy & ! (ttimes trivial causes t precipitate an attack ev]y?+ possible %\ld be done to build up ! g5]al condition--adju/m5t ( all lesions1 regulat$ diet & discipl9$ habits4 ,epilepsy ,def9ition4--,a *ronic affection ( ! n]v\s sy/em1 *>act]iz$ by attacks ( unconsci\sness1 :i* are usually accompani$ by g5]al convulsions4 ,:5 !re is m]ely a mom5t>y loss ( consci\sness x is call$ petit mal4 ,loss ( consci\sness ) convulsions is call$ gr& mal4 ,:5 ! convulsion is localiz$1 ) or )\t loss ( consci\sness1 x is call$ ,jacksonian epilepsy4 ,c]ta9 cases ( tempor>y loss ( consci\sness are t]m$ psy*ic epilepsy4 ,etiology4--,epilepsy usually beg9s be=e pub]ty1 & comp>atively seldom aft] ! tw5ty-fif? ye>4 ,males suff] some:at m frequ5tly ?an females4 ,h]$ity pr$isposes to ! disease to "s ext5t1 b probably n s greatly z _m writ]s w\ld claim4 ,neuroses1 z insanity & hy/]ia1 & int]m>riage ( relatives1 are important elem5ts to consid]4 ,:5 epilepsy is inh]it$1 x is almo/ always due to "s morbid /ate ( ! n]v\s sy/em4 ,o!r pr$ispositions to ! disease may be caus$ f defective g5]al developm5t ( ! bra91 f impairm5t ( ! g5]al heal?1 & f an exhau/$ n]v\s sy/em4 ,_m excit+ causes may be f\nd3 m5tal emotion1 fright1 excitem5t & anxiety2 bl[s & injuries to ! head2 infecti\s diseases2 syphilis2 alcoholism2 ma/urbation2 ocul> & aural irritation2 di/urb$ & delay$ m5/ruation4 ,epilepsy may be excit$ by reflex convulsions f inte/9al worms1 ga/ric irritation1 etc4 ,also ?ick5+ ( ! membranes ( ! bra91 pressure f a tumor at ! p]iph]y1 ut]9e diseases & _m o!r s\rces ( irritation may be f\nd1 t are ! excit+ causes ( epilepsy4 ,important excit+ causes ( epilepsy are1 und\bt$ly 9 _m cases1 due to lesions ( ! v]tebr & ribs especially ! v]tebr ( ! c]vical region1 al?\gh 9 "s cases ! lesion is 9 ! l[] splan*nic region or 9 ! ribs 7*iefly f ! f\r? to ! eigh?74 ,^! lesions to ! sp9al tissues di/urb ! nutrition to ! vasomotor n]ves4 ,if ! real seat ( ! disease is 9 ! c]ebral cortex & ! m$ulla1 ! c]vical lesion1 & 9 fact o!r lesions1 c\ld readily affect ! n]ve =ce & circulation to & f ^! regions4 ,! v]tebral art]y circulation1 :]e a c]vical lesion exi/s1 may be involv$ & affect ! bra94 ,9 cases :]e lesions ( ! v]tebr & ribs exi/ 9 ! upp] & middle dorsal region1 ! vasomotor inn]vation to ! bra9 may be involv$1 = 9 ?is region ! vasomotor n]ves to ! cranium1 etc41 pass f ! cord into ! sympa!tics4 ,bir? injuries may affect ! bra9 tissue1 ?r\gh c]vical lesions1 hemorrhages & asphyxiation4 ,conkl9 atta*es consid]able importance to /asis ( ! sigmoid & asc5d+ colon4 ,lesions involv+ ?is region may result 9 tox9s ent]+ ! blood & affect+ n]v\s tissue4 ,to illu/rate a specific excit+ lesion1 ! foll[+ is int]e/+4 ,! case 0 "o ( epilepsy t 0 evid5tly caus$ by a dislocat$ "r fif? rib4 ,by produc+ an irritation 9 ! region ( ?is rib1 s t ! lesion 0 increas$1 ! pati5t c\ld be made to imm$iately suff] f an attack ( epilepsy4 ,by resett+ ! rib1 at once ! suff]] w\ld be entirely reliev$4 ,! case 0 cur$ aft] ?ree mon?s' treatm5t1 ! *ief "w be+ to keep ! rib 9 place4 ,r>ely a subdislocat$ innom9ate bone1 or "s lesion remote f ! bra91 is locat$ & f\nd to be caus+ epilepsy4 ,important lesions 9 mo/ cases w be readily locat$ 9 ! c]vical region4 ,boo? reports3 8,i h records ( sev5 fairly def9$ cases ( epilepsy--su* z h be5 s pron\nc$ by ,m4 ,d4's4 ,i f9d 9 all ( !m m>k$ lesions 9 ! upp] c]vical & 9 mo/ ( ! cases ! occiput is po/]ior ^u ! atlas or twi/$4 ,9 all cases !re 0 a ?ick5+ ( ! s(t tissues1 especially 9 ! upp] c]vical4 ,! l[] c]vical 0 also mu* involv$ b n s noticeably4 ,all ( ! cases also pres5t$ m>k$ di/urbances 9 ! upp] dorsal2 mo/ 7 decid$ly ant]ior1 & "o v po/]ior4 ,"o 0 almo/ a confirm$ drunk>d2 not)/&+ ! fact1 he recov]$ to su* an ext5t t he w5t to "w1 & ,i und]/& has be5 hold+ 8 position = m ?an ?ree ye>s4 ,he _h _h to give up 8 "w entirely4 ,"o 0 a hopeless case 9 e p>ticul> & did n seem to receive any b5efit f ! treatm5t4 ,i ?9k x 0 entirely beyond help f any s\rce4 ,! o!rs respond$ v well & ! results 7 def9ite & decid$4 ,! l5g? ( treatm5t 9 successful cases ranges f ab\t five weeks to a little ov] a ye>4 ,b ^? t 7 treat$ ! great] l5g? ( "t 7 n treat$ cont9u\sly40 ,aft] "o convulsion has occurr$1 o!rs readily occur1 ow+ to ! pron5ess to *anges 9 ! n]ve c5t]s4 ,v little is kn[n z to ! pa?ology ( ?is disease4 ,convulsions may be caus$ f irritation ( bo? ! cortex c]ebri & ! m$ulla oblongata4 ,f a /udy ( ! "* ( ! aur1 "o is l$ to believe t !re is a di/urbance1 9 mo/ cases1 9 ! c5t]s ( ! c]ebral cortex2 & t ! lesions s g5]ally f\nd along ! sp9al column are ! true excit+ causes ( ! disease4 ,p]haps 9 a few cases ! irritation may be to ! m$ulla reflexly4 ,! lesions f\nd on o/eopa?ic exam9ation may act reflexly1 z has be5 /at$1 ^u ! c5t]s 9 ! bra9 & excite !m2 or ! circulation is d]ang$1 & consequ5tly ! nutrition to ! bra9 & m5+es1 by vasomotor control & ! v]tebral vessels1 is impair$4 ,! splan*nic area & ! c]vical region %\ld always receive special att5tion4 ,?is 9 conjunction ) all possible reflex s\rces1 &1 n lea/1 ! g5]al heal?1 re/or+ a /able n]v\s sy/em if possible1 are ( greate/ importance4 ,z a rule1 pa?ological lesions are n f\nd4 ,to ! nak$ eye ! appe>ance ( ! n]ve c5t]s is l>gely t ( heal?y organs4 ,! *anges reveal$ by ! microscope are mo/ probably ^? ( second>y orig94 ,rec5t exp]im5ts seem to %[ t ! motor zone ( ! cortex is affect$4 ,symptoms4--,^! w be consid]$ "u ! ?ree v>ieties1 kn[n z gr& mal1 petit mal & ,jacksonian4 ,gr& mal4--,9 mo/ cases ! seizure is prec$$ by a pron\nc$ s5sation kn[n z ! aura4 ,?is diff]s greatly 9 v>i\s individuals4 ,x may beg9 9 a f+] or toe & rise until x involves ! head1 :5 ! pati5t screams & falls to ! floor unconsci\s4 ,9 o!r cases ! s5sation may />t f o!r p>ts ( ! body1 z ! epiga/ric region1 :]e x may simply be a slight discom=t2 or o!r s5sations may be felt1 z t ( a ball ris+ f ! /oma*4 ,! aura may />t f any "p ( ! body z a numbness1 t+l+1 *ill9ess1 etc41 & may1 also1 be manife/$ ?r\gh ! optic1 olfactory1 auditory & gu/atory n]ves1 by fla%es1 smells1 s\nds & ta/es4 8,intellectual aur0 may also be manife/$4 ,"s =m ( aur is met ) 9 ne>ly "o-half ! cases ( epilepsy4 ,o!rs lose consci\sness s e>ly t ! pati5t is n aw>e ( ! onset4 ,9 cases n attack$ sudd5ly & n prec$$ by an aura1 a prolong$ prodrome may be pres5t = sev]al h\rs or a day4 ,! pati5t may feel irritable1 dizzy or dispirit$4 ,or he may be quiet & calmly await ! attack4 ,9 a few cases c]ta9 movem5ts may prec$e an attack1 z runn+ rapidly =w>d 9 a circle1 or /&+ on ! toes & rotat+ rapidly4 ,! attack prop] is sudd54 ,! pati5t falls ) a peculi> cry4 ,! convulsion or fit may be divid$ into ?ree /ages1 t ( tonic spasm1 ( clonic spasm & ( coma4 ,! tonic spasm succe$s ! epileptic cry2 !re are loss ( consci\sness1 pallor ( ! face & ! contraction ( pupils4 ,! body assumes a position ( tetanic rigidity1 ! head is retract$ & rotat$1 & ! sp9e curv$1 ow+ to an unequal affection ( ! muscles ( ! two sides4 ,! jaws are fix$1 ! arms are flex$ at ! elb[1 ! h&s at ! wri/1 & ! f+]s are cl9*$4 ,! legs & feet are ext5d$4 ,! muscles ( ! *e/ are involv$ & respiration is susp5d$4 ,?is /age la/s a few seconds4 ,! clonic spasm foll[s ! tonic spasm4 ,! muscul> contractions become int]mitt5t4 ,f slight vibratory motions1 ! int]mitt5t muscul> contraction becomes g5]al4 ,! arms & legs are ?r[n ab\t viol5tly1 ! muscles ( ! face are di/ort$1 ! eyes roll$1 & ! lips op5 & close4 ,! muscles ( ! jaw contract viol5tly & ! tongue is apt to be bitt54 ,! pupils are dilat$1 ! face cyanos$ 7?\gh at fir/ ! face is pale & pupils contract$7 & blood-/reak$1 fro?y saliva p\rs f ! m\?4 ,! feces & ur9e may be dis*>g$ involunt>ily4 ,! temp]ature rises ab\t "o degree ,f4 ,?is /age la/s ab\t "o or two m9utes4 ,! p]iod ( coma may la/ f a few m9utes to sev]al h\rs4 ,usually if left alone1 ! pati5t w awak5 aft] a few h\rs4 ,9 a few cases m5tal confusion foll[s ! wak+4 ,dur+ ! /age ( coma1 ! face is conge/$ b n cyanotic4 ,! muscles are relax$ & ! brea?+ is noisy4 ,epileptic attacks dur+ sleep1 nocturnal epilepsy1 are n r>e4 ,?is may cont9ue = "s "t )\t ! pati5t be+ aw>e ( x4 ,petit ,mal4--,9 ?is v>iety ( epilepsy1 convulsions are abs5t4 ,! seizure consi/s ( mom5t>y unconsci\sness ) fix$1 />+ eyes1 dilat$ pupils & r>ely any twit*+ ( ! muscles4 ,aft] ! attack ! pati5t resumes 8 "w4 ,!re may be attacks ( v]tigo1 )\t unconsci\sness1 & ! pati5t may fall4 ,9 a few in/ance !re may be aur ( v>i\s k9ds4 ,petit mal may be a =]unn] ( gr& mal or ! two may alt]nate4 ,betwe5 gr& & petit mal !re are _m grades ( epilepsy v>y+ 9 sev]ity4 ,jacksonian ,epilepsy4--,! affection is always symptomatic ( lesion 9 ! motor area ( ! cortex4 ,! lesion is q apt to be a tumor1 ?\gh v>i\s injuries1 inflammation1 scl]osis1 s(t5+1 hemorrhage or an abscess may be ! cause4 ,consci\sness is reta9$ & ! convulsions are limit$ 9 ext5t4 ,tonic & clonic spasms ( ! same "* z 9 g5]al epilepsy occur4 ,a slight numbness1 t+l+1 or twit*+ may prec$e ! attack4 ,! sev]ity ( epilepsy v>ies extremely4 ,! seizure may occur b once a ye> or x may occur sev]al times 9 a day4 ,9 _m cases a m>k$ p]iodicity is obs]v$4 ,! m5tal functions are n1 z a rule1 injur$1 b :5 ! seizures are frequ5t1 ! heal? fails & ! m5tal capacity is r$uc$4 ,_m suff]]s f epilepsy are subjects ( *ronic ga/ric cat>rh1 & h at ! same "t an inord9ate appetite4 ,q frequ5tly a fit may foll[ inord9ate eat+4 ,:5 !re is a s]ies ( convulsions1 :i* foll[ "o ano!r 9 rapid succession & :i* are associat$ ) high fev]1 ! t]m 8/atus epilepticus0 is appli$4 ,! mo/ common =m ( epilepsy is ! major =m4 ,ab\t two-?irds ( all attacks occur betwe5 eight a4 m4 & eight p4 m4 ,diagnosis4--,uremic convulsion closely resembles an epileptic convulsion4 ,:5 ! hi/ory ( ! case1 analysis ( ! ur9e1 increas$ temp]ature & ! g5]al heal? ( ! pati5t are all closely obs]v$1 error %\ld be avoid$4 ,9 reflex convulsions ( *ildr51 a c>eful se>*1 & if necess>y wait+ a %ort "t1 w readily det]m9e ! s\rce ( ! attack4 ,:5 nocturnal convulsions take place )\t ! k ( ! pati5t ! attack is epileptic4 ,9 hy/]ical convulsions ! pati5t r>ely loses consci\sness4 ,!y r>ely hurt !mselves1 nev] bite ! tongue1 ! temp]ature is normal1 opi/hotonos does n occur1 & ! duration is usually long]4 ,9 ,jacksonian epilepsy1 ! attack is limit$ to "s portion ( ! body1 or x may gradually ext5d into a g5]al convulsion4 ,c>e %\ld be tak5 to recognize petit mal4 ,prognosis4#aba--,records %[ t _m cases h be5 cur$ & a mu* l>g] numb] h be5 b5efit$4 ,treatm5t4--,o/eopa?ic treatm5t has be5 especially successful 9 epilepsy1 z comp>$ ) o!r treatm5t4 ,al?\gh ! o/eopa?s d n claim a cure 9 e case1 by any means1 /ill ab\t f\r out ( e t5 h be5 cur$1 :ile "o-half ( ! rema9+ h be5 greatly help$ 9 reg>d to ! less5+ ( ! sev]ity ( ! attack1 & 9 r5d]+ ! attacks less frequ5t4 ,conkl9 ?r\gh 8 special treatm5t ( fa/+1 diet+1 enemata1 sp9al adju/m5t1 & p>ticul> att5tion to ! l>ge b[el1 especially cecum & colon1 has increas$ ?is p]c5tage4 ,?is is bas$ on sev]al hundr$ cases4 ,important lesions are usually f\nd 9 ! c]vical region1 f ! ?ird to ! sev5? v]tebra1 ?\gh !y may be z high z ! atlas4 ,^! lesions may affect ! bra9 9 v>i\s ways2 probably 9 ! mann] describ$ "u ! etiology4 ,lesions are also f\nd 9 ! dorsal v]tebr & :5 occurr+ bel[ ! c]vical region1 ! lesions are g5]ally f\nd 9 ! upp] & middle dorsal regions1 ?\gh !y may be locat$ at any po9t along ! sp9al column4 ,! treatm5t is accord+ to ! rule t applies to all o/eopa?ic "w3 an individual correction ( ! lesions pres5t$ 9 ! case at h&4 ,if any g5]al movem5t or treatm5t might be giv51 x w\ld be /rong traction ( ! head to /ret* ! c]vical v]tebr1 or r to sep>ate !m1 s t ! circulation to ! bra9 may be equaliz$4 ,ano!r g5]al measure is to hyp]ext5d ! neck ) fulcrum at juncture ( atlas & occiput1 ?us releas+ ! upp] ant]ior tissues t may imp$e c]ebral circulation4 ,if ! lesions 9 su* cases are 9 ! c]vical v]tebr1 probably !y affect ! c]vical sympa!tics4 ,a c>eful se>* = a s\rce ( excitation mu/ be made ?r\gh\t ! entire body4 ,an irritation ( ! inte/9al tract may be ! excit+ cause2 or "s irritation ( ! g5ito-ur9>y tract may be f\nd1 z phimosis1 ma/urbation1 etc41 s t x is v necess>y t great c>e be tak5 9 ! exam9ation4 ,subjects ( ma/urbation usually pres5t lesions along ! g5ito-ur9>y c5t] 9 ! sp9e4 ,all possible reflex irritations %\ld be eradicat$4 ,prop] hygi5ic measures %\ld be add$4 ,pay p>ticul> att5tion to ! b[els4 ,place ! pati5t 9 ! knee-*e/ position & ?or\ghly raise ! cecum & asc5d+ colon 9 ord] to improve circulation & promote elim9ation4 ,ba?s are important1 & pl5ty ( fre% air & outdoor ex]cise are ( mu* significance4 ,! pati5t's m9d %\ld be occupi$4 ,! "q ( food is an important "o2 g5]al diet--c>efully regulat$ z to ! am\nt giv5--%\ld be prescrib$4 ,a vegetable diet is usually be/4 ,r$uction ( salt seems to h a good effect4 ,! pati5t mu/ n be all[$ to eat too mu* at a "t1 nor too (t54 ,if ! bromides are be+ us$1 !y %\ld be )drawn gradually4 ,9 mo/ cases ( true epilepsy a cont9u$ treatm5t ( sev]al mon?s is necess>y4 ,unless ! pati5t c foll[ out ! treatm5t = sev]al mon?s1 or ev5 ye>s1 9 a numb] ( cases x w be entirely useless to take ! treatm5t2 al?\gh if ! lesion pres5t is v app>5t1 & ! pati5t is enjoy+ fair heal? o!rwise1 & has n be5 affect$ long1 a treatm5t = a few mon?s1 or ev5 weeks1 might be all t is necess>y4 ,surgical int]f]5ce may be indicat$ 9 ,jacksonian epilepsy4 ,treph9+ has be5 practic$ successfully 9 a numb] ( cases & ! risk f op]ation ) mod]n surg]y is s r$uc$ t "o is frequ5tly ju/ifi$ 9 advis+ an op]ation4 ,dur+ an attack1 a special treatm5t _c be giv5 to less5 ! sev]ity ( ! fit 9 all cases2 9 fact1 mo/ pati5ts pref] n to h ! seizure %ort5$ z ! aft] effects are m disagreeable4 ,9 "s cases1 at ! beg9n+ ( ! seizure1 ex]t+ a firm pressure ^u ! suboccipital w quiet ! pati5t4 ,?is treatm5t probably controls ! circulation ( ! bra91 by way ( ! sup]ior c]vical ganglion4 ,9 cases :]e ! excit+ factor seems to be 9 ! inte/9es1 & ! p]i/altic action ( ! b[els is rev]s$1 caus+ a rev]sion ( ! n]ve curr5t ( ! vagi1 a rapid1 firm knead+ ov] ! abdom51 s z to e/abli% normal p]i/alsis1 w suffice to prev5t an attack1 if "o is notifi$ ( its approa*4 ,9 "s cases a rapid1 ?or\gh /imulation ( ! sol> plexus w less5 an attack4 ,possibly x r$uces ! blood pressure 9 ! bra91 by br++ blood to ! splan*nic region4 ,9 all cases dur+ ! convulsion ! pati5t %\ld be c>efully protect$ f injur+ himself4 ,a t[el %\ld be twi/$ & plac$ 9 ! m\?1 s t ! tongue _c be bitt54 ,d n place small articles z corks1 etc41 betwe5 ! tee?1 z !y are liable to ent] ! ph>ynx & cause suffocation4 ,! pati5t %\ld be wat*$ to protect him f any injury2 o!rwise ! attack %\ld usually be all[$ to sp5d itself4 ,migra9e 7,,sick ,,heada*e7 ,migra9e or sick heada*e is a neurosis1 *>act]iz$ by a p>oxysmal pa9 9 ! head1 usually unilat]al & p]iodical1 ) nausea1 frequ5tly vomit+1 & disord]s ( vision4 ,o/eopa?ic ,etiology4--,! disease usually beg9s 9 ! fir/ half ( life1 r>ely e>li] ?an pub]ty & is slightly m frequ5t 9 females4 ,"s weak5$ or depress$ condition ( ! n]v\s sy/em1 due to lesions ( ! upp] c]vical v]tebr1 lesions ( ! inf]ior maxilla1 anxiety1 ov]fatigue1 anemia1 dige/ive d]angem5ts1 eye /ra9 & m5/rual disord]s1 is g5]ally ! cause4 ,! h]$it>y factor is v important4 ,?is is frequ5tly associat$ ) d]angem5t ( ! l>ge b[el1 especially cecum & asc5d+ colon1 result+ 9 toxemia4 ,x is suppos$ by "s to be a vasomotor di/urbance1 because !re are symptoms1 z pallor & flu%+ ( ! sk91 :i* %[ an involvem5t ( ! sympa!tic sy/em4 ,x is possible a spasm ( c]ebral art]ies1 foll[$ by vascul> dilatation1 takes place4 ,! seat ( ! pa9 is believ$ to be 9 ! m5+es ( ! bra94 ,possibly 9 _m cases :]e ! atlas is f\nd involv$ & caus+ ! affection1 "s m5+eal fib] ( ! fif? n]ve is imp+$ by ! lesion4 ,c>ies ( ! tee? & nasal tr\bles are causes ( ! disease 9 *ildr54 ,symptoms4--,a p>oxysmal heada*e is ! pr9cipal feature ( migra9e4 ,! attack may occur )\t w>n+1 al?\gh !re are usually malaise1 re/lessness & a di/urb$ vision prec$+ ! heada*e4 ,! prodromal symptoms v>y to a great ext5t4 ,o!r prodromal symptoms besides ^? giv51 may be v]tigo1 spots be=e ! eyes1 t9nitus1 *ill9ess1 etc4 ,! pa9 is ( a %>p & /abb+ nature & is (t5times limit$ to ! temporal region ( "o side4 ,o!rs describe ! pa9 z ( a b9d+ or ( a bor+ nature4 ,x is cont9u\s4 ,x may be 9 ! occiput in/ead ( 9 ! side ( ! head4 ,hyp]e/hesia ( ! surface is notic$1 b ! t5d] po9ts ( neuralgia ( ! fif? n]ve are abs5t4 ,! pati5t is s5sitive to light & noise4 ,fla%es ( light occasionally att5d ! pa9 9 ! head4 ,hemianopia is n infrequ5t4 ,! temporal art]y may be contract$1 ! face pale & ! pupil l>ge4 ,9 o!rs ! eye is dilat$1 ! face flu%$ & ! pupil small4 ,nausea & vomit+ are frequ5t1 ) loss ( appetite4 ,9 "s cases :]e ! /oma* is full1 vomit+ ! cont5ts w relieve ! attack4 ,%\ld ! /oma* be empty1 vomit+ ( mucus may occur1 & is lat] foll[$ by vomit+ ( bile4 ,t5d]ness is commonly f\nd ab\t ! region ( ! occipital & upp] c]vical muscles4 ,attacks r>ely occur (t5] ?an once 9 t5 or fifte5 days4 ,dur+ ! int]vals ! pati5t may be q well4 ,! duration is any:]e f a few h\rs to sev]al days4 ,diagnosis4--,! s5sory symptoms1 ! p>oxysmal "*1 ! sev]ity & def9ite c\rse1 usually readily di/+ui% migra9e4 ,gr[?s ( ! bra9 may be ! cause ( symptoms closely simulat+ migra9e4 ,9 su* cases an oph?almoscopic exam9ation may reveal a *ok$ disc4 ,prognosis4--,is usually favorable :5 ! attacks are light & ( %ort duration4 ,cases ( long /&+ & ( great sev]ity are n s easily cur$1 al?\gh 9 mo/ in/ances great relief c be giv5 ! pati5t4 ,!re are v few cases 9 :i* ! sev]ity & frequ5cy ( attacks _c at lea/ be less5$4 ,(t5times attacks ( migra9e cease aft] middle life4 ,treatm5t4--,! atlas or "o ( ! upp] c]vical v]tebr is almo/ inv>iably subluxat$4 ,?is is n always ! direct cause ( migra9e1 b x is an important factor 9 ! causation4 ,dur+ ! attack _m cases c be completely1 or at lea/ p>tially reliev$1 by a c>eful treatm5t 9 ! upp] c]vical region4 ,b !re are "s cases :]e treatm5t ( ! c]vical region is entirely unsuccessful1 &1 9 fact1 aggravates ! attack4 ,! details ( treatm5t v>y 9 e case4 ,if any defects 9 g5]al heal? or any error 9 ! mode ( liv+ c be f\nd1 ^! ( c\rse mu/ receive fir/ att5tion4 ,re/1 diet 7a vegetable diet is be/7 & regul>ity ( meals are usually to be specially consid]$4 ,any?+ t is kn[n to induce an attack mu/ be c>efully avoid$4 ,9 "s pati5ts ! attacks cease s long z !y rema9 free f m5tal "w1 b z soon z !y return to _! /udies ! p>oxysms occur4 ,e case %\ld be ?or\ghly exam9$ be=e a c\rse ( treatm5t is laid d[n4 ,causal conditions c g5]ally be f\nd1 & ! correction ( su* usually results 9 a cure1 or at lea/ 9 great relief4 ,errors 9 diet2 dige/ive di/urbances1 z a disord]$ bili>y tract2 disord]s ( ! pelvic organs2 eye /ra92 nasal disord]s2 m5tal & physical fatigue1 & affections ( ! nose may induce attacks4 ,a b5eficial treatm5t = _m1 aside f adju/+ ! sp9al lesions1 especially ! c]vical & usually a rigid splan*nic area1 is to place ! pati5t 9 ! knee-*e/ position & ?or\ghly raise ! b[els ( ! "r side beg9n+ 9 ! "r iliac1 loos5+ possible adhesions1 etc4 ,! e>li] ! treatm5t1 ! m likelihood ( a cure4 ,cases ( long /&+ are g5]ally h>d] to cure4 ,prec$+ a p>oxysm1 relief c usually be giv51 b aft] ! p>oxysm has rea*$ its height x is h>d] to give relief4 ,! pati5t %\ld re/ 9 a quiet room :i* is d>k5$ & well v5tilat$4 ,besides ! indicat$ o/eopa?ic treatm5t 7g5]ally a c]vical "o71 hot applications to ! nape ( ! neck & keep+ ! extremities w>m are helpful4 ,! n]ves involv$ are ! vasomotor1 occipital1 frontal & temporal4 ,a free evacuation ( ! b[els w relieve a few cases1 :ile wa%+ out ! /oma* w help o!rs4 ,hot fom5tations ov] ! splan*nics = ?irty m9utes may be b5eficial4 ,dur+ ! int]vals1 valuable adjuncts w be f\nd 9 ! use ( sy/ematic ex]cises & frequ5t ba?+4 ,d n fail to h ! eyes exam9$4 ,occupation ,neurosis ,^! are a gr\p ( maladies ( ! n]v\s sy/em1 due to excessive use ( c]ta9 muscles 9 "s (t-repeat$ act1 & *>act]iz$ by spasm ( ! muscles conc]n$4 ,!re are sev]al v>ieties1 z writ]s' cramp1 telegraph]s' cramp1 piano play]s' cramp1 viol9 play]s' cramp1 typewrit]s' cramp1 etc4 ,pr(essional spasms1 t involve muscles ( ! %\ld] girdle1 are n r>e among o/eopa?ic practition]s1 due to prolong$ faulty me?ods ( te*nique4 ,o/eopa?ic ,etiology4--,a n]v\s temp]am5t pr$isposes to ! developm5t ( ! affection4 ,previ\s injuries & /ra9s ( ! involv$ p>ts are important factors4 ,faulty me?ods ( writ+1 & 9 ! o!r disord]s1 /ra9$ or cramp$ positions ( ! affect$ tissues1 pr$ispose to attacks4 ,slight lesions ( ! bones1 jo9ts1 ligam5ts & muscles are commonly f\nd1 involv+ ! motor & s5sory n]ves ( ! imm$iate locality4 ,! majority ( all cases occur betwe5 tw5ty & fifty ye>s ( age4 ,di/9ctive pa?ological *anges h n be5 f\nd4 ,ea* case has p>ticul> lesions ( its own4 ,! details ( ! case are *>act]i/ic ( ! "o case only4 ,! affection is (t5 prim>ily a sp9al "o1 due to d]ang$ action ( ! sp9al c5t]s conc]n$ 9 ! v>i\s acts2 ?\gh1 no d\bt1 excessive use ( a gr\p ( muscles may result 9 contractions1 spasms1 contractures & nutritional *anges1 t 9 turn w e/abli% def9ite o/eopa?ic lesions4 ,?is is an illu/ration ( a 8vici\s circle40 ,symptoms4--,symptoms ( ! v>i\s v>ieties ( pr(essional neuroses develop sl[ly & gradually4 ,a cramp or spasm affect+ ! us$ memb] is an e>ly symptom4 ,tremor1 weakness1 /iffness1 fatigue & heav9ess ( ! affect$ "p are pres5t mo/ ( ! "t4 ,9 sev]e cases neuritis may develop1 & a gloss9ess ( ! sk9 be pres5t4 ,associat$ ) ! inability to p]=m ! usual "w1 may be m5tal worry & depression4 ,diagnosis4--,! hi/ory ( ! case & ! limitation ( ! disease to "o memb]1 usually make ! diagnosis easy3 ,c]ebrosp9al diseases1 z hemiplegia2 e>ly tabes1 affect+ ! arms2 & progressive muscul> atrophy1 h to be c>efully exclud$4 ,prognosis4--,z a rule is favorable4 ,o/eopa?ic treatm5t1 9 ! majority ( cases treat$1 has result$ 9 recov]y4 ,treatm5t4--,re/ ( ! "p1 m5tal quiet & att5tion to ! nutrition ( ! pati5t1 are ! fir/ ess5tial consid]ations4 ,a *ange ( occupation may be necess>y if excessive use ( p>ts & faulty me?ods c n be correct$4 ,! treatm5t consi/s ( a correction ( ! p>ts irritat+ or di/urb+ ! sp9al c5t]s or n]ves affect$4 ,! uln>1 radial & m$ian n]ves all inn]vate muscles employ$ 9 writ+4 ,lesions ( ! cord affect+ ^! n]ves may be f\nd f ! fif? c]vical to ! six? dorsal4 ,9 a few cases lesions occur z high z ! atlas4 ,:5 ! radial & m$ian n]ves are involv$ ! lesions are pr9cipally f\nd 9 ! upp] dorsal v]tebra4 ,:5 ! uln> n]ve is involv$ ! lesions are usually slightly l[]4 ,! lesions may affect ! fib]s ( ^! n]ves directly 7me*anically71 b m probably ! vasomotor n]ves are involv$1 z 9 ?is region ! vasomotor fib]s to ! arm pass f ! cord to ! sympa!tic fib]s4 ,! bra*ial plexus orig9ates high] ?an ! upp] middle dorsal region1 /ill "s ( its n]ves are frequ5tly affect$ 9 ! dorsal region by o/eopa?ic lesions1 = removal ( ! same relieves ! disord]4 ,o!r lesions affect+ ! arms are (t5times f\nd 9 ! ribs on ! side involv$4 ,any ( ! fir/ five ribs may become d]ang$ & affect ! inn]vation ( ! arm4 ,! clavicle 9 a few cases may be abnormally l[4 ,a bursitis may be pres5t4 ,occasionally slight subdislocations ( ! %\ld] jo9t 7especially ant]ior7 & elb[ jo9t are f\nd4 ,gymna/ic ex]cises ( ! arm & h&1 c\pl$ ) a g5]al treatm5t ( ! %\ld]1 arm & h&1 are b5eficial4 ,hydro!rapy1 massage & friction ( ! involv$ memb] are useful4 ,9 sev]e cases 8break+ up0 fibrotic tissue1 & muscle tra9+ frequ5tly secures good results4 ,hy/]ia ,opp5heim def9es hy/]ia z 8a psy*osis1 :i* does n express itself by disord]s ( ! intellect1 b 9 defects ( "* & emotional di/urbances1 ^: real nature is hidd5 "u an almo/ unlimit$ & v>i$ numb] ( physical symptoms ( disease40 ,! affection is ab\t equally divid$ betwe5 ! two sexes4 ,a neurotic t5d5cy1 (t5 inh]it$1 is an important und]ly+ factor4 ,?is condition1 :5 associat$ ) lack ( m5tal discipl9e1 is v apt to lead to ! m5tal depression & outbreaks ( hy/]ia4 ,a l>ge numb] ( cases are betwe5 ! ages ( pub]ty & tw5ty-five4 ,aft] =ty-five ! disord] is infrequ5t4 ,:ite1 ,osl]'s ,sy/em ( ,m$ic9e1 says3 8,! significance ( ,freud's !ory is ! trac+ ( e case to sexual traumata dur+ *ildhood4 ,sexual exp]i5ces diff]1 h[ev]1 f ord9>y exp]i5ces--! latt] h a t5d5cy to fade out1 :ile ! idea ( ! =m] gr[s ) increas+ sexual maturity4 ,!re results a disproportionate capacity = increas$ reaction :i* takes place 9 ! subconsci\s4 ,?is is ! cause ( ! mis*ief40 ,a di/9ction is made betwe5 ! sexual & ! s5sual4 ,&]s po9ts out t lack ( prop] m5tal developm5t1 improp] hygi5ic surr\nd+s & *ronic toxemia are causes4 ,! direct causes ( hy/]ia may be _m1 & include physical & m5tal influ5ce1 or bo?4 ,traumatism ( v>i\s regions ( ! body1 b especially ( ! sp9al column1 may excite hy/]ia4 ,"s slight lesion ( ! v]tebra or rib may be all t is discov]able4 ,a correction ( ! same is occasionally all t is necess>y to remove ! direct cause2 /ill !re is usually consid]able di/urbance ( ! sp9al tissues1 especially slight curvatures & muscul> contractions4 ,prolong$ emotional excitem5t1 ov]work1 defective education & _m moral & m5tal influ5ces are pot5t & frequ5t causes4 ,ma/urbation or an adh]5t prepuce occasionally is ! cause ( ! affection 9 boys1 or any excitation t produces exhau/ion4 ,di/urbances ( ! sexual sy/em 9 bo? sexes are responsible = _m cases4 ,! m5/rual p]iod & ! m5opause are frequ5t p]iods = ! manife/ation ( ! disease4 ,! disease (t5 affects pro/itutes4 ,di/urbances ( ! dige/ive1 n]v\s & circulatory sy/ems1 & g5]al diseases ( an exhau/ive k9d are excit+ causes ( hy/]ia4 ,dr4 ,/ill said t occasionally ! colon is prolaps$ & cr[d$ d[n ^u ! pelvic organs4 ,hazz>d#abb is ( ! op9ion t 8a majority ( ! cases %[ a depression ( all ! ribs1 n>r[+ ! ?orax & (t5 caus+ ent]optosis40 ,symptoms4--,! symptoms may be extremely v>i$1 includ+ any symptom ( ! _m n]v\s diseases4 ,! s5sory symptoms are num]\s4 ,! mo/ common is ane/hesia1 :i* may be f\nd 9 c]ta9 p>ts ( ! body1 usually "o side 7! left7 ( ! body4 ,geometrical areas t be> no relation to ! inn]vation is *>act]i/ic4 ,! pati5t may n "k ( ! s5sory d]angem5ts until discov]$ by ! physician4 ,:5 !re is ane/hesia )\t o!r n]v\s symptoms1 ! case is commonly hy/]ical4 ,! mo/ m>k$ symptom is analgesia1 :]e ! pati5t is ins5sible to pa9ful impressions4 ,a p9 may be plac$ deeply into ! fle%1 & n be felt by ! pati5t4 ,! ane/hesia may ext5d to ! muc\s surfaces1 & ev5 deeply d[n to ! tissues ( ! jo9ts4 ,organic & t5don reflexes are n *ang$4 ,!re may be o!r symptoms ( di/urb$ s5sation2 z an abs5ce ( pressure1 temp]ature & muscul> s5sation4 ,hyp]e/hesia may be pres5t ne>ly z (t5 z ane/hesia4 ,hyp]e/hetic areas may be f\nd 9 v>i\s regions ( ! body1 b especially along ! sp9al column & 9 ! ov>ian region4 ,! 8hy/]ical sp9al irritability0 is ( special int]e/ to ! o/eopa?4 ,! sp9al column may be affect$ z a :ole1 or 9 segm5ts1 or conf9$ to a s+le v]tebra4 ,especially :5 a sp9al irritability is 9 segm5ts1 or conf9$ to a s+le v]tebra1 are local d]angem5ts ( ! sp9al column apt to be f\nd4 ,correction or ev5 pressure ^u ^! areas w (t5 relieve ! pati5t4 ,sev]e pa9 ov] ! he>t may simulate ang9a pectoris4 ,glob\s hy/]icus is ( q common occurr5ce4 ,*>cot ref]s to ! ov>ian hyp]e/hesia z foll[s3 8,x is indicat$ by pa9 9 ! l[] "p ( ! abdom51 usually felt on "o side1 especially ! left1 b sometimes on bo?1 & occupy+ ! extreme limits ( ! hyp]e/hetic region4 ,x may be extremely acute1 ! pati5t n tol]at+ ! slighte/ t\*2 b 9 o!r cases pressure is necess>y to br+ x out4 ,! ov>y may be felt to be tumefi$ & enl>g$4 ,:5 ! condition is unilat]al1 x may be accompani$ ) hemiane/hesia1 p>esis1 or contracture on ! same side z ! ov>ialgia2 if x is bilat]al1 ^! ph5om5a also become bilat]al4 ,pressure ^u ! ov>y br+s out c]ta9 s5sations :i* con/itute ! aura hy/]ia1 b firm & sy/ematic compression has frequ5tly a decisive effect ^u ! hy/]ical convulsive attack1 ! int5sity ( :i* x c dim9i%1 & ev5 ! cessation ( :i* x may sometimes det]m9e1 ?\gh x has no effect ^u ! p]man5t symptoms ( hy/]ia40 ,! special s5ses may be di/urb$1 al?\gh ^! symptoms are usually transi5t4 ,!re may be bl9dness2 n>r[+ ( ! field ( vision1 due to ane/hesia ( ! p]iph]y ( ! ret9a2 loss ( he>+2 loss ( smell or loss ( ta/e4 ,motor disord]s may be ( diff]5t =ms ( p>alysis1 z hemiplegia1 p>aplegia or monoplegia4 ,9 fact all =ms ( p>alysis may be f\nd 9 hy/]ical pati5ts4 ,osi] says3 8,!re is no type or =m ( organic p>alysis :i* may n be simulat$ 9 hy/]ia40 ,! affect$ muscles d n atrophy4 ,! p>alysis is usually g5]al1 & contractures are common4 ,local p>alysis1 z ( ! bladd]1 vocal cords & o!r p>ts ( ! body1 commonly occur4 ,contractures & spasms may also occur4 ,true epilepsy may ev5 be simulat$ by hy/]ical spasms1 b on c>eful obs]vation ! *>act]i/ic attack ( epilepsy is f\nd want+4 ,firm pressure may increase ! sev]ity ( an attack z well z br+ x on4 ,! spasms are ( v>i\s p>ts ( ! body1 z ! diaphragm1 bron*i1 abdom9al muscles1 bladd]1 etc4 ,v>i\s di/urbances ( ! visc]a may occur4 ,( ! dige/ive tracts1 ! appetite may be di/urb$ or deprav$4 ,di>rhea or con/ipation may be pres5t4 ,flatul5cy is a common symptom4 ,! respiratory tract may be ano!r po9t ( consid]able di/urbance 9 _m cases4 ,dyspnea1 aphonia1 hicc\gh1 c\gh1 & exagg]at$ brea?+1 z :5 cold wat] is p\r$ on "o1 are common manife/ations4 ,v>i\s c>diac vascul> symptoms may be manife/$1 especially a rapid he>t4 ,v>i\s vasomotor d]angem5ts are common4 ,physical manife/ations1 z amnesia1 lack ( w p[] & an excitable nature--easily mov$ to laught] or te>s--are frequ5t4 ,! moral tone may be l[]$4 ,ev5 delirium1 catalepsy1 ec/asy & trance1 may be m5tion$ among ! psy*ical ph5om5a4 ,! hy/]og5\s zones are ( m ?an pass+ int]e/ to ! o/eopa?4 ,tyson writes z foll[s1 9 reg>d to ! hy/]og5\s zones3 8,^! are hyp]e/hetic areas especially /udi$ by ,ri*et1 on :i* p]si/5t pressure w sometimes excite a hy/]ical attack4 ,:ile ! ov>ies are favorite hy/]og5\s zones1 ! zones may be 9 any "p ( ! body2 z = example1 ! sides ( ! trunk4 ,su* pressure may also cause an exi/+ attack to subside4 ,hy/]ical spasms may also be localiz$ or limit$ to gr\ps ( muscles40 ,especially :5 zones along ! sp9e & side ( ! trunk are locat$1 ! attack ( hy/]ia may be completely reliev$ by correct+ ! localiz$ d]ang$ tissues4 ,convulsive seizures are n uncommon & may foll[ v>i\s prodromal symptoms4 ,"s au?ors divide ! symptoms ( hy/]ia into convulsive & non-convulsive =ms4 ,^! are "p ( ! _m manife/ations t are pres5t$ by v>i\s hy/]ical pati5ts1 & x is readily se5 t an o/eopa? has to be cont9ually on 8 gu>d4 ,diagnosis4--,! diagnosis is g5]ally q easy4 ,! *>act]i/ic emotional symptoms1 associat$ ) any ( ! _m o!r symptoms :i* h no organic lesion1 are *>act]i/ic ( ! disease4 ,c>e has to be tak51 ?\gh1 9 "s cases :]e symptoms are pres5t$ :i* h organic lesions4 ,! hi/ory1 ! attack & neurotic temp]am5t1 w l>gely decide ! nature ( ! affection4 ,aft] ! 8outbreak0 ! pati5t (t5 feels decid$ly bett]4 ,prognosis4--,dea? may occur f exhau/ion1 b su* a t]m9ation is r>e4 ,recov]y is ! rule1 al?\gh ! duration may be long4 ,recov]y usually takes place rapidly1 aft] ! excit+ cause has be5 det]m9$ & remov$4 ,treatm5t4--,fir/ ( all1 ! o/eopa? %\ld h due appreciation ( ! m5tal *>act]i/ics ( ! disease4 ,:atev] is dom9at+ ! pati5t m5tally mu/ be ei!r *ang$ or aboli%$4 ,x is n always necess>y to be h>% & sev]e ) ! pati5t2 b "o %\ld be firm & unyield+4 ,he c d a great deal by hav+ complete m5tal control ( ! hy/]ical pati5t4 ,a mo/ c>eful exam9ation %\ld be made = an excit+ cause1 & :5 f\nd x %\ld be remov$4 ,?is naturally con/itutes a v important "p ( ! treatm5t4 ,a light g5]al treatm5t is commonly indicat$4 ,! g5]al heal?1 especially ! b[els1 %\ld be c>efully att5d$ to4 ,! hygi5e1 ex]cise & amusem5t ( ! pati5t %\ld receive due consid]ation4 ,"o has to ga9 ! confid5ce ( ! pati5t1 & !n be firm b k9d to him4 ,relative to diet ,yeo#abc says3 8,! diet %\ld be simple1 abundant1 & suppli$ regul>ly1 & at n too long int]vals z is frequ5tly ! case 9 bo>d+ s*ools4 ,all /rong /imulants are be/ avoid$1 & ! hy/]ical %\ld n indulge 9 /rong tea or c(fee1 or excit+ w9es & liquors40 ,! 8re/ cure0 z introduc$ by ,weir ,mit*ell1 is applicable 9 "s cases4 ,?is me?od consi/s ( pl5ty ( food1 especially milk1 absolute re/ ( ! body & m9d1 massage & electricity ) isolation ( ! pati5t f fri5ds & sympa!tic relatives4 ,d\btless a g5]al o/eopa?ic treatm5t w\ld be mu* bett] ?an massage4 ,yeo says t to ! application ( hypnotism & sugge/ion 8we look ) little sympa?y & less confid5ce40 ,dur+ ! hy/]ical convulsions1 ! pati5t %\ld be wat*$1 b extreme measures %\ld n be practic$4 ,!re is little dang] ( pati5ts hurt+ !mselves4 ,?r[+ cold wat] 9 ! face1 or a cold ba? may produce ! necess>y m5tal %ock4 ,pressure ov] ! ov>y z /at$ 9 hy/]og5\s zones1 or "s o!r zone ( ! body1 or pressure ^u a l>ge blood vessel1 z a c>otid1 w (t5times /op an attack4 ,neura/h5ia 8,closely alli$ to1 & 9 "s cases almo/ insep>able f1 hy/]ical /ates are ^? morbid conditions to :i*1 9 mod]n times1 has be5 appli$ ! t]m neura/h5ia40 7,yeo74 ,neura/h5ia is a fatigue neurosis t is *>act]iz$ by m5tal & physical irritability & ineffici5cy4 ,heada*e1 backa*e1 insomnia1 & debility ( ! ga/ro-inte/9al tract are common symptoms4 ,! affection is (t5 f\nd 9 t class ( p :o are pr$ispos$ to hy/]ia4 ,! disease is m common among m5 ?an wom51 usually occurr+ aft] ! tw5tie? ye>4 ,! pr$isposition may be inh]it$ or acquir$4 ,*ur* /ates t 8debilitat+ conditions 9 ! antec$5ts ( neura/h5ics10 & 8defective education t omits discipl9e & ! cultivation ( self control0 are important pr$ispos+ causes4 ,_m ( ! excit+ causes t produce hy/]ia w cause neura/h5ia4 ,v>i\s lesions along ! sp9al column1 *iefly 9 ! c]vical & upp] dorsal regions1 include ! pr$ispos+ causes ( a l>ge majority ( cases4 ,?is sp9al irritation1 tak5 9 conjunction ) ov]/ra9 ( m9d & body1 or probably 9 _m cases ! sp9al irritation z ! pr$ispos+ cause ( ! ov] /ra91 results 9 n]v\s exhau/ion4 ,p>ticul>ly ov]work1 associat$ ) c>e & anxiety1 is an excit+ cause ( great significance4 ,! neura/h5ic pati5t is g5]ally ( a neurotic temp]am5t4 ,! affection may1 also1 result f v>i\s *ronic diseases1 toxic conditions1 sexual excesses1 alcohol & tobacco4 ,?ompson#abd believes t improp] sexual hygi5e & p]v]sion or abuse ( ! m>ital relation are mo/ important factors 9 ! developm5t ( neura/h5ia 9 bo? sexes1 & a regulation ( ?is is imp]ative = a cure4 ,! symptoms are due1 to a great] or less ext5t1 ^u sp9al1 c]ebral1 c>diac & ga/ric di/urbances1 b all ( ^! conditions are usually dep5d5t ^u v]tebral & rib lesions ( ! upp] dorsal & c]vical regions4 ,c>e %\ld be tak5 :e!r ! condition is second>y to organic lesions4 ,! lesions 9 ! v]tebr are g5]ally slight lat]al deviations1 9 ! ribs upw>d displacem5ts ( ! v]tebral ends1 foll[$ by contraction ( ! deep muscles 9 ! neighborhood ( ! lesions4 ,a po/]ior condition ( ! atlas & a lat]al lesion betwe5 ! ?ird & f\r? dorsal are especially apt to be f\nd4 ,z to sp9al areas mo/ affect$ ,/e>ns#abe says ! pr$ispos+ irritations are locat$ p>ticul>ly 9 ! fir/ two c]vical1 ! fir/ two dorsal & ! la/ two lumb> v]tebr4 ,^! v>i\s lesions probably cause an impairm5t ( nutrition 9 ! n]ve c5t]s ( ! cord & bra91 or bo?4 ,def9ite morbid anatomical *anges h n be5 f\nd result+ f n]v\s debility or irritability4 ,/ill1 x seems probable t c]ta9 *anges 9 ! n]ve cells may result f excessive functional activity4 ,traumatism is a prom95t causative factor 9 bo? neura/h5ia & hy/]ia4 ,railway & o!r injuries frequ5tly produce o/eopa?ic lesions t result 9 n]v\s disord]s4 ,t !re is a demon/rable pa?ological basis re/+ 9 sympa!tics & sp9al n]ves1 !re c be no d\bt4 ,symptoms4--,to enum]ate ! _m symptoms ( neura/h5ia 9 detail is h>dly necess>y4 ,! n]v\s debility may affect any organ ( ! body1 ow+ to ! exhau/ion ( ! n]v\s en]gy1 ?us less5+ ! functional activity ( t organ4 ,! mo/ noticeable symptoms are v>i\s s5sory di/urbances & muscul> weakness1 dep5d5t 9 "p ^u ! sp9al lesions4 ,! pati5t g5]ally feels weak & tir$4 ,heada*e1 pa9s 9 ! back & sacrum1 t5d] po9ts along ! sp9e1 & v>i\s s5sations ( numbness1 t+l+1 etc41 are felt4 ,! m5tal faculties are (t5times irritable & weak4 ,an inability to conc5trate ! ?\ghts ) depression1 fe>1 v]tigo1 insomnia1 & _m o!r m5tal symptoms1 may be manife/$4 ,palpitation1 irregul> action ( ! he>t & pa9 ov] ! precordia may be pres5t4 ,ocul> di/urbances1 p>ticul>ly blurr+ ( lett]s & n>r[+ ( ! visual field1 visc]al symptoms ( _m k9ds1 & vasomotor ph5om5a1 z *ill9ess1 fla%es ( heat & sweat+1 are among ! _m symptoms ( :i* ! pati5t compla9s4 ,g5ito-ur9>y disord]s 9 ! male1 & ov>ian & ut]9e irritation & pa9ful m5/ruation 9 ! female1 are occasionally symptoms dread$ by ! suff]]4 ,polyuria is frequ5t4 ,! symptoms or signs ( great importance to ! o/eopa? 9 neura/h5ia1 z 9 _m o!r diseases1 are ! t5d] po9ts along ! sp9al column4 ,!y give direct clues z to :]e ! lesion may be f\nd4 ,diagnosis4--,error 9 diagnosis c usually be prev5t$ by a /udy ( ! hi/ory ( ! case & symptoms4 ,c>e mu/ be tak5 9 det]m9+ betwe5 symptoms ( organic diseases & ! symptoms ( a true n]v\s exhau/ion4 ,prognosis4--,is almo/ inv>iably good4 ,only 9 cases :]e !re is a t5d5cy to m5tal disord] %\ld ! prognosis be gu>d$4 ,mu* dep5ds ^u ! ?or\gh coop]ation ( ! pati5t4 ,x usually takes "s "t to p]=m a cure among ! poor] class1 z ! requirem5ts dem&$ = a cure are (t5times exp5sive4 ,treatm5t4--,naturally ! treatm5t1 exclusive ( ! manipulation to correct ! v>i\s lesions f\nd1 is extremely v>i$1 ow+ to ! _m excit+ causes & symptoms to cont5d )4 ,z has be5 /at$1 ! lesions are usually f\nd 9 ! upp] sp9al region2 /ill lesions are occasionally locat$ 9 ! l[] sp9al region1 especially 9 female suff]]s1 :5 ! pelvic organs are di/urb$4 ,! _m m5tal symptoms1 z inability to conc5trate ! m9d1 insomnia1 v]tigo1 heada*e1 etc41 are be/ treat$ ?r\gh ! c]vical region1 ) att5tion to ! he>t's action & ! excretory organs4 ,c>eful att5tion %\ld be paid to ! deep po/]ior muscles betwe5 ! atlas & occipital bones4 ,re/ is v necess>y4 ,*anges ( sc5e & occupation1 att5tion to ! surr\nd+s1 c>eful diet+1 hydro!rapeutic measures1 pleasant companions1 relief f responsibility1 ba?+1 etc41 %\ld receive c>eful att5tion & consid]ation by ! o/eopa?4 ,set rules _c be giv54 ,! details ( treatm5t t %\ld be adopt$ are dep5d5t ^u ! individual case4 ,e well tra9$ o/eopa? w be famili> ) su* measures4 ,c>eful att5tion mu/ be giv5 to ! secretions1 excretory organs & ! circulation4 ,a /udy ( ea* case w br+ out ! v>i\s irregul>ities t may exi/4 ,:5 ! n]v\s involvem5t is ext5sive1 a 8g5]al treatm5t0 may be giv54 ,su* a treatm5t w\ld affect ! entire n]v\s & muscul> sy/em1 & t5d to equalize di/urb$ n]ve =ce4 ,br++ ! muscul> sy/em into play & relax+ contract$ muscles calls = m blood & n]ve =ce1 & consequ5tly a nutriti\s diet4 ,! 8re/ cure10 z introduc$ by ,weir ,mit*ell1 may be employ$ to consid]able advantage 9 _m cases4 ,yeo says3 8,x is 9 c]ta9 cases ( ?is disease t ! #8re/ cure1' devis$ by ,weir ,mit*ell1 has prov$ s rem>kably successful4 ,b !re c be no sort ( d\bt t x has be5 appli$ f> too indiscrim9ately1 & t = ?is1 z inde$ = any special me?od ( treatm5t1 a c>eful selection ( suitable cases is ne$ful40 ,! diet %\ld consi/ pr9cipally ( milk at fir/1 foll[$ 9 a few days by s(t boil$ eggs1 boil$ rice1 lamb *ops1 graham bread1 /ew$ fruits & butt]1 & a little lat] by roa/ beef1 vegetables & light pudd+s4 ,port]'s sy/em ( milk diet has prov$ effective 9 _m cases4 ,tea1 c(fee & alcohol %\ld be avoid$4 ,dur+ ! entire c\rse ( ! treatm5t1 c>e %\ld be tak5 to correct any lesion t may be> directly ^u ! c]vical sympa!tic1 ! sol> plexus & ! hypoga/ric plexus1 z !y are ! great reflex c5t]s ( ! body4 ,,footnotes3 #aai ,a4 ,o4 ,a4 ,case ,reports1 ,s]ies ,,iv4 #abj ,see ,a4 ,o4 ,a4 ,case ,reports1 ,s]ies ,,ii41 ,,iii41 ,,iv41 ,v4 #aba ,see ,a4 ,o4 ,a4 ,case ,reports1 ,s]ies ,i41 ,,iii41 ,v4 #abb ,practice ( ,o/eopa?y4 #abc ,manual ( ,m$ical ,treatm5t4 #abd ,cosmopolitan ,o/eopa?1 ,octob]1 #aijc4 #abe ,j\rnal ( ,o/eopa?y1 ,janu>y1 #aijd4 ,,diseases ,,( ,,! ,,sp9al ,,cord ,acute ,myelitis ,acute myelitis is an acute inflammation1 ) s(t5+ ( ! sub/ance ( ! cord1 giv+ rise to m>k$ di/urbances ( motion1 s5sation & nutrition4 ,:5 ! :ole ?ickness ( a section ( ! cord is involv$1 ! condition is t]m$ transv]se myelitis4 ,:5 an ext5sive area is involv$1 x is t]m$ diffuse myelitis4 ,:5 ! gray matt] ar\nd ! c5tral canal is especially affect$1 x is t]m$ c5tral myelitis4 ,etiology4--,!re c be no d\bt t o/eopa?ic lesions are v pot5t pr$ispos+ factors4 ,o/eopa?ic lesions ( ! sp9e1 ev5 ( a muscul> nature1 readily di/urb ! cord circulation4 ,x may foll[ repeat$ exposure to wet1 cold or ex]tion2 or be a sequel to ! infecti\s diseases1 z smallpox1 typhoid fev]1 typhus1 pu]p]al fev] or measles4 ,x may be due to traumatism or disease ( ! v]tebr1 z c>ies or canc]4 ,syphilis is a frequ5t cause4 ,pa?ology4--,to ! untra9$1 nak$ eye1 ! cord may pres5t little or no *ange4 ,! n]v\s tissues are 9 v>i\s /ages ( deg5]ation4 ,on section ! sub/ance ( ! cord is r$ & s(t1 ! l9e ( dem>cation betwe5 ! gray & :ite matt] is lo/ or extremely indi/9ct1 & m9ute hemorrhages are sometimes se54 ,9 v acute cases1 affect+ ! :ite & gray matt]1 aft] injury1 :5 ! membranes are cut1 ! sub/ance ( ! cord may fl[ out z a r$di% creamy fluid4 ,! n]ve fib]s are mu* swoll5 & ! axis cyl9d]s brok5 up4 ,blood discs1 leucocytes1 & num]\s granul> fatty cells may also be pres5t4 ,! blood-vessels are di/5d$ & dilat$4 ,!re may be ?ick5+ & hyal9e deg5]ation ( ! vessel walls & hemorrhagic extravasation4 ,symptoms4--,acute ,transv]se ,myelitis4--,?is is ! type mo/ frequ5tly met )4 ,! symptoms diff] ) ! situation ( ! lesion1 :i* is g5]ally 9 ! dorsal cord4 ,at ! onset !re may be pa92 numbness & t+l+ 9 ! back1 radiat+ into ! limbs4 ,!re is usually mod]ate fev]1 malaise1 *ills1 muscul> pa9s1 a coat$ tongue & con/ipation4 ,symptoms ( motor p>alysis soon develop1 :i* may become m or less complete4 ,bo? motor & s5sory symptoms v>y to a m>k$ degree1 dep5d+ ^u ! pa?ologic involvem5t4 ,! reflexes are lo/ at fir/4 ,!y may soon return & are exagg]at$ bel[ ! lesion4 ,foll[+ ?is ! muscles (t5 become rigid & contract$4 ,unless ! lesion is 9 ! lumb> or c]vical cord1 reaction ( deg5]ation or mu* wa/+ ( ! muscles1 z a rule1 does n occur4 ,a girdle s5sation frequ5tly occurs at ! level ( ! disease4 ,at fir/ !re is ret5tion ( ! ur9e & feces1 lat] incont95ce4 ,b$-sores soon develop2 also dry+ & h>d5+ ( ! sk94 ,! nails become ?ick & brittle4 ,dea? may occur f exhau/ion1 or he>t or respiratory failure1 b x is r>e2 segm5ts ( ! cord may be completely & p]man5tly de/roy$1 caus+ p]si/5t p>aplegia4 ,h4 ,a4 ,gre5e#abf reports a case1 due to injury1 :i* 0 greatly b5efit$ by treatm5t4 ,acute ,diffuse ,myelitis4--,9 ! acute =ms ! c\rse ( ! disease is rapid4 ,! trophic di/urbances are m m>k$ ?an 9 ! =m] type4 ,?is =m is likely to foll[ exposure to cold1 injuries1 tumors1 syphilis or "o ( ! infecti\s diseases4 ,!re may be *ills1 fev]1 malaise1 pa9 9 ! back & limbs1 & occasionally convulsions4 ,! reflexes are g5]ally lo/4 ,! motor functions are rapidly lo/4 ,!re is incont95ce ( ur9e & feces1 rapid wa/+ ( ! muscles & b$-sores develop4 ,! disease may prove fatal 9 f six to t5 days4 ,diagnosis4--,l&ry's ,disease4--,9 ?is ! bladd] & rectum are n affect$4 ,trophic di/urbances are abs5t4 ,!re is b slight loss ( s5sation1 no reactions ( deg5]ation & no girdle pa9s4 ,multiple ,neuritis4--,bo? arms & legs involv$1 & sl[ onset4 ,! bladd] & rectum are r>ely involv$2 ! girdle pa9 is abs5t4 ,acute ,poliomyelitis4--,!re are no s5sory symptoms & ! rectum & bladd] are n affect$4 ,prognosis4--,9 v acute cases dea? occurs 9 f ?ree to t5 days4 ,mild] cases g5]ally recov] ) "s loss ( motor p[]1 al?\gh 9 a few cases treat$ by o/eopa?y recov]y 0 complete1 due probably to ! case be+ se5 e>ly & ?us deg5]ation prev5t$4 ,treatm5t4--,lesions ( ! v]tebr are usually readily f\nd 9 cases ( myelitis4 ,g5]ally1 d]ang$ v]tebr are f\nd 9 ! upp] dorsal region1 & occasionally lesions are locat$ 9 ! lumb> & c]vical v]tebr4 ,! treatm5t ( myelitis is *iefly to correct ^! lesions1 s t ! normal circulation ( ! cord may be ree/abli%$4 ,"o has to be v c>eful :5 treat+ ! lesions n to cause additional injury to ! cord4 ,an inhibitory treatm5t to ! muscles ab\t ! lesion may be all ! treatm5t t c be giv5 at fir/2 nev]!less1 x aids nature j s mu* 9 ov]com+ ! excessive irritation ( ! cord tissues4 ,nature has ! curative means1 provid$ !y may op]ate unob/ruct$ly4 ,9 a few cases ! ribs 9 ! region ( ! sp9al lesion w be f\nd d]ang$ & int]f]+ ) trophic fib]s1 blood-vessels & lymph vessels ( ! cord4 ,! pati5t %\ld be kept 9 ! prone po/ure at fir/4 ,w>m ba?s & massage w be f\nd ( additional value4 ,! b[els & bladd] %\ld receive special att5tion4 ,an ice-bag to ! sp9e may be b5eficial4 ,if !re is any dang] ( b$-sores1 use alcohol to /imulate & h>d5 ! sk94 ,re/1 liquid diet & good nurs+ are necess>y4 ,lat] on c>eful ex]cis+ ( ! limbs w be b5eficial4 ,*ronic ,myelitis4--,?is def9es ! conditions :5 ! inflammation is subacute ) ! p>aplegia & o!r symptoms :i* !n naturally appe>1 pres5t1 & also ) ! signs ( bo? deg5]ation & repair4 ,! symptoms develop sl[ly z comp>$ ) ! acute =m4 ,x %\ld n be confus$ ) atrophy1 pa*ym5+itis or tumors ( ! cord4 ,treatm5t is practically ! same z 9 acute =m4 ,surgical measures may be indicat$4 ,l\don#abg reports a case due to injury :i* 0 greatly b5efit$4 ,poliomyelitis 7,,infantile ,,p>alysis7 ,def9ition4--,an acute infecti\s disease occurr+ mo/ commonly 9 "y *ildr51 *>act]iz$ by p>alysis1 rapid wa/+ ( c]ta9 muscles1 & fev]4 ,x is an acute myelitis t affects ! ant]ior horns ( ! cord4 ,!re are no s5sory symptoms4 ,etiology4--,x usually occurs 9 *ildr5 "u t5 ye>s ( age1 & ! majority ( cases occur be=e ! f\r? ye>4 ,x is m common 9 summ] ?an 9 w9t]4 ,! infection seems to ga9 entrance ?r\gh ! nasal muc\s membrane4 ,traumatism1 exposure to cold & ov]ex]tion1 are probably pr$ispos+ causes4 ,x has occurr$ 9 sev]e epidemic =m4 ,morbid ,anatomy4--,! disease is mo/ frequ5tly se5 9 ei!r ! lumb> or c]vical enl>gem5t & is usually unilat]al1 ?\gh !re is consid]able v>iation 9 ! ext5t ( ! lesions4 ,9 v e>ly cases1 ! condition ( acute hemorrhagic myelitis1 ) deg5]ation & rapid de/ruction ( ! l>ge ganglion cells1 has be5 f\nd4 ,9 old] lesions ! ant]ior cornu 9 ! affect$ region is atrophi$ & !re is de/ruction ( ! multipol> ganglion cells4 ,! ant]ior n]ve roots are atrophi$1 ! muscles are wa/$ & und]go a fatty & scl]otic *ange4 ,symptoms4--,! *ild may h a slight fev]1 malaise1 muscul> twit*+1 heada*e1 "s rigidity ( ! neck1 & sometimes vomit+4 ,?is may la/ a day or sev]al days or only a few h\rs1 :5 p>alysis sets 9 abruptly4 ,! p>alysis is r>ely complete & gr\ps ( muscles only may be affect$4 ,z a rule1 ! p>alysis comes on abruptly1 b x may come on sl[ly1 tak+ sev]al days to develop4 ,9 a few weeks1 atrophy sets 9 & ! limb becomes flaccid1 s(t & wa/$4 ,! p>alysis rema9s /ation>y = a "t :5 improvem5t takes place1 b complete recov]y is r>e4 ,sometimes ! gr[? ( ! bone ( ! affect$ limb is impair$4 ,usually !re are no s5sory di/urbances & ! bladd] & rectum are n affect$4 ,! condition ( ! reflexes is dep5d5t ^u ! ext5t ( involvem5t ( ! cornual cells4 ,occasionally ! bulb> muscles are affect$4 ,diagnosis4--,?is is n difficult except 9 ! e>ly /ages4 ,c>eful /udy ( ! case is commonly all t is necess>y4 ,l&ry's p>alysis & p]iph]al neuritis are to be diff]5tiat$4 ,prognosis4--,complete recov]y is r>e4 ,improvem5t is ! rule4 ,ivie#abh tabulates sixte5 cases1 all %[+ good results4 ,w4 ,b4 ,davis#abi reports a case cur$ by six mon?s treatm5t & /ill well aft] ?ree ye>s4 ,t4 ,m4 ,k+#abi "o case cur$ & "o greatly b5efit$ & ,a4 ,s4 ,craig#abi "o mu* help$4 ,flor5ce ,gair1 ,f4 ,p4 ,mill>d1 ,a4 ,g4 ,walmsley & o!rs report gratify+ results 9 _m cases4 ,treatm5t4--,9 ! treatm5t ( *ronic cases1 ,f4 ,p4 ,mill>d#acj says 8,five m9utes' "t is suffici5tly long 9 treat+ a pati5t1 & sometimes too long4 99 99 99 ,/>t 9 & move e sp9al jo9t4 ,t takes ab\t two m9utes4 ,spr+ ! sacro-iliac articulations j en\gh to get motion4 ,!n give a specific c]vical treatm5t4 ,d n /op to relax muscles 9 a *ild4 ,adju/ z rapidly z possible4 ,make e sp9al jo9t yield to motion4 ,sp5d only "o m9ute1 or possibly two1 on ! c]vical v]tebr4 ,s f> we h consum$ f\r m9utes4 ,! la/ m9ute we loos5 up ! wri/ or ankle1 accord+ to ! extremities t are involv$40 ,?is outl9e has be5 foll[$ ) gratify+ success by ,gair1 ,gre51 ,bu% & o!rs 9 _m *ronic cases4 ,! proc$ure 9 acute cases is cond5s$ f ,a4 ,g4 ,walmsley#acj3 8,isolate1 keep cool & absolutely quiet4 ,/op all food until ! temp]ature drops to #ajj ,f4 or l[] & until ! pa9 subsides :5 fruit juices may be giv5 foll[$ by heavi] foods4 ,give pati5t all ! wat] he w dr9k4 ,:]e ! sp9e is s5sitive1 & x w be 9 _m1 use hot fom5tations until a specific treatm5t c be giv54 ,if ! fev] is runn+ high cool compresses w be grateful & help r$uce temp]ature4 ,irrigate ! colon twice daily ) sal9e wat]4 ,d ?is fir/ ?+ :5 call$4 ,lat] once daily w d & !n discont9ue4 ,look c>efully to ! nose & ?roat & wa% ) sal9e or boracic solution4 ,keep feet w>m z !y may be cold ev5 ) high fev]4 ,treat ! case ov] a long p]iod4 ,see t he does n ov]do & obs]ve all dietetic & hygi5ic measures40 ,bo? ^! m5 lay great /ress on ! importance ( specific adju/m5ts & massage ( muscle tissue has little place 9 _! treatm5t4 ,?is1 ) drill at home c be att5d$ to by ! "m4 ,ivie#aca1 among o!r good ideas on treatm5t1 gives ! foll[+3 8,may ,i sugge/ t :5 su* sev]e results 7! acute /age7 foll[ a slight infection1 t we may expect to f9d a lesion locat$ at su* a po9t z w int]f]e ) "o or m ( ! ant]ior root art]ies :i* jo9 & supply ! ant]ior sp9al plexuses4 ,z !re are only five or t5 ( ! ant]ior root art]ies 7,dana71 ! lesions affect+ !m c be locat$ ?r\gh\t a wide range ( ! sp9e4 ,9 a great _m cases we f9d t ! correction ( lesions well up 9 ! dorsal & ev5 9 ! c]vical region h increas$ ! am\nt ( ! improvem5t well beyond t receiv$ 9 ! correction ( ! lumb> lesions alone4 ,to promote resolution1 correct ! lesions1 bo? muscul> & bony1 & relax ! muscles ( ! sp9e daily2 move e v]tebra to ! limit ( all its possible motions2 use flexion1 ext5sion1 rotation1 & lat]al flexion at lea/ once e day = at lea/ a week2 & help to ov]come /asis by keep+ ! *ild (f its back1 turn+ x f side to side1 & lett+ x lie on its /oma* z mu* z possible4 ,! limb1 to be kept 9 its be/ condition1 %\ld be kept w>m2 treat$ g5tly2 held 9 a natural position by ! use ( s& bags & clo!s cradle1 ?us beg9n+ e>ly ! prev5tion ( de=mity2 ! p>alyz$ muscles %\ld n be kept on a /ret*1 z t w ret>d any possible improvem5t2 /imulat+ rubs & ba?s %\ld be giv5 frequ5tly40 ,9 ! *ronic /age he advocates3 8,n[ t ! n]ve cells h be5 giv5 a *ance to reg5]ate 7removal ( lesions71 ! be/ ?+ to d is to =ce !m to "w if possible4 ,to d ?is1 ! s-call$ resi/ance ex]cises or educational movem5ts are to be /rongly recomm5d$2 ! idea be+ to place ! limb 9 a giv5 position & !n ask ! *ild to fix all its att5tion on ! limb & to e>ne/ly attempt to hold x !re :ile y move x1 or to keep mak+ ! attempt :ile y move ! limb ?r\gh its :ole range ( motion 9 t direction4 ,^! movem5ts %\ld be s calculat$ t ! resi/ance ( ! *ild w ex]cise ! gr\p ( muscles affect$4 ,! "m or nurse c give ^! ex]cises e night on go+ to b$40 ,acute ,asc5d+ ,p>alysis 7,,l&ry',s ,,p>alysis7 ,def9ition4--,an acute disease1 *>act]iz$ by an advanc+ p>alysis1 beg9n+ 9 ! legs1 pass+ upw>d to ! trunk & ! arms & f9ally x may involve ! c5t]s 9 ! m$ulla4 ,toxic & infecti\s influ5ces t conge/ ! n]ve c\rses & ultimately de/roy ! cells seem to be ! important factor4 ,! ant]ior gray matt] ( ! cord is involv$1 & x is probable t _m cases are a =m ( acute poliomyelitis4 ,! sple5 is conge/$ & 9 "s in/ances ! lymphatics4 ,etiology4--,a def9ite cause has n be5 f\nd1 al?\gh o/eopa?ic lesions are important pr$ispos+ factors4 ,a toxic cause seems probable4 ,! disease is mo/ common 9 males betwe5 tw5ty & =ty ye>s ( age4 ,x may foll[ traumatism1 exposure1 cold or ! infecti\s fev]s4 ,symptoms4--,weakness ( ! l[] extremities is g5]ally ! fir/ symptom1 ?\gh ! arms may be involv$ fir/4 ,?is is %ortly foll[$ by p>alysis4 ,! p>alysis !n ext5ds to ! trunk & )9 a few days ! arms are also affect$4 ,! muscles ( ! neck are next involv$ & f9ally ^? ( respiration1 deglutition & articulation4 ,! reflexes are aboli%$4 ,! muscles are relax$1 b g5]ally d n wa/e or %[ electrical modification4 ,s5sation is usually n affect$1 b !re may be t+l+1 numbness1 hyp]e/hesia & muscul> t5d]ness4 ,! sph9ct]s are n involv$ z a rule4 ,! sple5 is usually enl>g$4 ,! c\rse is v>iable4 ,dea? (t5 occurs 9 f two days to a few weeks4 ,:5 ! improvem5t takes place1 ! "p la/ affect$ recov]s fir/4 ,diagnosis4--,?is is n always easy4 ,x is sometimes impossible to diff]5tiate betwe5 ?is disease & multiple neuritis4 ,! hi/ory1 ! motor p>alysis1 ! abs5ce ( wa/+ & ( electrical modification1 z well z ! abs5ce ( involvem5t ( ! sph9ct]s1 w def9itely aid 9 ! diagnosis4 ,prognosis4--,! prognosis is unfavorable4 ,a l>ge majority ( cases prove fatal4 ,9 a few cases treat$ o/eopa?ically1 results 7 favorable if ! pati5t 0 se5 e>ly4 ,! muscles ( ! sp9al column 7 m>k$ly contract$4 ,treatm5t4--,! treatm5t ( ,l&ry's disease consi/s pr9cipally ( ?or\gh treatm5t ( ! sp9e1 especially ( ! l[] dorsal & lumb> regions1 & att5tion to ! und]ly+ toxic condition4 ,! treatm5t %\ld be mo/ ?or\gh2 ! v]tebr & ribs f\nd disord]$ %\ld be correct$ & ea* v]tebra %\ld be c>efully sep>at$ 7if conditions p]mit7 f its neighbor4 ,:5 ! p>alysis has ext5d$ to ! trunk & neck1 a ?or\gh treatm5t all along ! sp9al column %\ld be giv5 ) a view to relax+ ! contract$ muscles & to r5d] flexible ! entire sp9al column1 s t ! cord may be prop]ly n\ri%$ & ! progress ( ! disease *eck$4 ,c>eful relaxation ( ! contract$ sp9al muscles unque/ionably has a pot5t effect ^u ! cord circulation1 :i* t5ds to *eck & ret>d deg5]ative processes4 ,treatm5t ( ! limbs directly w be f\nd a help1 z well z direct treatm5t ( all tissues p>alyz$4 ,if swall[+ is impossible1 ! pati5t %\ld be f$ ?r\gh ! rectum1 or by ! /oma* or nasal tube4 ,see t ! pati5t is c>efully nurs$4 ,massage is b5eficial4 ,locomotor ,ataxia 7,,tabes ,,dorsalis7 ,locomotor ,ataxia is frequ5tly met )4 ,x is a disease ( ! sp9al cord :]e9 ! ultimate effect is a scl]osis ( a progressive "* ( ! n]ve c\rses ( ! po/]ior column4 ,x is claim$ t ! orig9 is 9 ! protoplasmic processes ( ! po/]ior sp9al ganglion4 ,! *>act]i/ic symptoms are incoord9ation1 ,argyll ,rob]tson pupil1 lightn+ pa9s & loss ( knee-j]k4 ,o/eopa?ic ,etiology & ,pa?ology4--,mo/ cases develop betwe5 ! ages ( ?irty & =ty1 al?\gh x is occasionally se5 9 "y m51 & r>ely 9 *ildr5 f h]$it>y syphilis4 ,males are mu* m frequ5tly affect$ ?an females 7#aj to #a1 ,osl]71 & ! disease is mu* m frequ5t 9 cities4 ,pr$ispos+ causes are giv5 z syphilis1 prolong$ exposure to wet & cold1 & sexual excesses1 al?\gh !re is a disposition on ! "p ( neurologi/s to conf9e ! cause ( true tabes to syphilis1 "s records %[+ z high z #ij p] c5t4 ( ! cases f t cause4 ,tabetic symptoms develop 9 f five to fifte5 ye>s aft] syphilitic infection4 ,!re are no data to %[ ! probable proportion ( syphilitic cases :i* lat] develop tabes1 b x is und\bt$ly small4 ,z all cases ( tabes exam9$ by o/eopa?s %[ sp9al lesions1 x is reasonable to suppose t by int]f]+ ) ! nutrition to ! sp9al cord1 !y all[ consequ5t deg5]ation4 ,x is also q probable t o/eopa?ic treatm5t = syphilis w\ld1 = ! same reason1 prev5t scl]osis & resultant tabes4 ,t syphilis is n ! only cause1 is also held by "s au?orities4 ,/>r cites a true case f a sev]e bl[ 9 ! dorsal region4 ,o/eopa?ic obs]vation w\ld lead to a diff]5tiation ( tabes1 accord+ to ! cause4 ,cases h be5 record$1 :i* simulat$ true tabes 9 mo/ symptoms1 :i* did n h a hi/ory ( syphilis4 ,j4 ,kn[les makes ! po9t t probably c]ta9 cases simulat+ tabes h rea*$ :at might be call$ an irritation /age 7pa?ologically7 ( ! n]ves & _! c5t]s1 scl]otic *anges n hav+ tak5 place2 & he believes ^! cases w\ld naturally yield to o/eopa?ic treatm5t4 ,teall confirms ?is view by be+ ( ! op9ion t ^! cases are ! ones l>gely due to traumatism1 exhau/ion or exposure1 & ! probabilities are t 9 "t scl]otic *anges w\ld take place1 result+ 9 true tabes4 ,9 su* cases !re c be no "q z to ! o/eopa?ic lesion1 :i* w\ld be suffici5t to mat]ially int]f]e ) ! p]iph]al s5sory n]ves & di/urb ! protoplasmic processes to ! sp9al ganglia & s5sory tract4 ,z a rule !y are 9 ! l[] dorsal & lumb> regions4 ,cases are report$ :i* _h m>k$ sacral & coccygeal lesions4 ,pa?ologically1 ,dana speaks ( locomotor ataxia1 8z a po/-infective deg5]ation1 :i* fir/ attacks ! po/]ior sp9al ganglia or correspond+ cells ( ! special s5ses1 due to a prolong$ poison+ ( ^! p>ts by ! tox9s ( ! infection40 ,! fir/ *ange is 9 ! po/]ior roots4 ,)\t d\bt o/eopa?ic lesions c readily affect ! nutrition ( ^! roots4 ,?is is %[n ^u exam9ation 9 cases :]e ! v]tebral lesions imp+e ! tissues surr\nd+ ! sp9al n]ve at its exit1 7or o!rwise damage n]v\s /imuli & circulation7 & also :]e ! displac$ head ( ! rib cr[ds upw>ds aga9/ ! sp9al n]ve & aga9 :]e ! rib imp+es ! correspond+ sympa!tic ganglion :i* lies ant]ior to ! head ( ! rib4 ,v likely 9 _m cases ! syphilitic infection is an excit+ factor1 b x seems plausible t o/eopa?ic lesions1 traumatism1 cold1 exposure & excesses pr$ispose by di/urb+ ! circulation to involv$ areas4 ,! *anges are at fir/ inflammatory1 foll[$ by deg5]ative *anges 9 ! n]ve c\rses :i* cause connective & neuroglia ov]gr[?s to take ! place ( fib]s 9 ! s5sory tract1 & f9ally 9 ! motor tract4 ,?us f ! po/]ior ganglia1 a section betwe5 ! columns ( ,goll & ,burda* is involv$1 & ! progress ( ! scl]otic *ange is upw>d 9 ! cord4 ,! pia mat] & coats ( ! vessels are ?ick5$4 ,! pr9cipal *anges 9 ! cord are 9 ! l[] dorsal & upp] lumb> segm5ts & ! cord may be *ang$ 9 %ape4 ,9 long /&+ cases !re is deg5]ation ( ! asc5d+ ant]o-lat]al tract1 ( ! direct c]ebell> tract1 & ( ! pyramidal tract4 ,! c]ebral *anges 9 "s cases consi/ ( scl]osis 9 ! re/i=m bodies 9 ! inf]ior p$uncles ( ! c]ebellum1 & ( c]ta9 cranial n]ves1 especially ! ?ird1 optic1 vagus & auditory n]ves1 & also cortical *anges may occur4 ,symptoms4--,au?orities divide ! symptoms into ?ree /ages--! preataxic1 ataxic & p>alytic4 ,?is division is l>gely an arbitr>y "o4 ,motor symptoms are usually ! mo/ prom95t4 ,!re is inability to coord9ate ! muscles4 ,! pati5t fir/ notices t he _c walk /eadily :5 9 ! d>k or :5 he has 8 eyes clos$4 ,lat] he f9ds t he _c ma9ta9 8 equilibrium ev5 9 daylight2 ?is is asc]ta9$ :5 ! pati5t places 8 feet toge!r & ! eyes are clos$ 7sign ( ,romb]g74 ,z a rule ?is is unaccompani$ by muscul> wa/+1 s !re is no loss ( motor p[]4 ,soon ! gait becomes *>act]i/ic2 9 walk+ ! feet are lift$ high & are br\ght d[n heavily on ! heel2 ! ball ( ! foot comes d[n la/1 produc+ :at is call$ ! 8d\ble /ep20 ! walk is /raddl+3 ! limbs are ?r[n ab\t1 & !re is /agg]+1 due to incoord9ation4 ,incoord9ation also develops 9 ! h&s1 b usually lat] 9 ! disease4 ,sudd5 involunt>y movem5ts & palsies are o!r motor symptoms4 ,! latt] occur 9 ab\t tw5ty p] c5t ( cases & z a rule are ( %ort duration4 ,p>alysis & muscul> atrophy d n develop until aft] a few ye>s4 ,pa9 is an e>ly symptom & always pres5t2 x is ( a d>t+1 %oot+ or /abb+ "* & appe>s 9 p>oxysms4 ,x is mo/ common 9 ! legs1 la/+ b a second or two1 & (t5 accompani$ by a hot1 burn+ feel+4 ,h]pes may appe> along ! c\rse ( ! n]ve4 ,ane/hesia & hyp]e/hesia ( c]ta9 areas may occur4 ,a girdle s5sation may be a noticeable symptom4 ,! muscul> s5se is m or less impair$2 !re is a feel+ z if !re 7 cotton betwe5 ! pati5t's feet & ! floor4 ,ret>dation ( tactile s5sation is a common symptom4 ,! p[] ( localiz+ pa9 is (t5 lo/4 ,! knee-j]k is lo/ e>ly 9 ! disease4 ,occasionally1 h[ev]1 cases are met :]e x is reta9$4 ,! sk9 reflexes are also impair$2 9 "s cases !y may be increas$ at fir/1 b lat] are sure to be involv$ ) ! deep reflexes4 ,! pupil does n respond to ! light1 b /ill accommodates = di/ance1 con/itut+ ! ,argyll ,rob]tson pupil4 ,ptosis may develop ) or )\t /rabismus4 ,optic atrophy1 :i* may lead to bl9dness1 p>esis ( ! ocul> muscle1 & contract$ pupils1 may occur4 ,! ocul> symptoms may appe> e>ly 9 ! disease4 ,! visc]al pa9s or crises are *iefly ga/ric & are sometimes accompani$ by ob/9ate vomit+4 ,l>yngeal1 rectal1 ure?ral & nephritic crises may occur1 & at times are exce$+ly sev]e4 ,l>yngeal crises may be manife/$ by int5se dyspnea & noisy brea?+4 ,con/ipation is common4 ,!re may be ret5tion ( ! ur9e result+ 9 cy/itis4 ,sexual p[] is g5]ally lo/ e>ly4 ,trophic *anges occur lat] 9 ! disease4 ,! s-call$ ar?ropa?ies1 or jo9t lesions1 may occur at any p]iod ( ! disease4 ,x consi/s ( an enl>gem5t ( ! jo9ts1 associat$ ) s]\s exudations1 :i* r>ely become purul5t2 atrophy ( ! heads ( ! bones2 de/ruction ( ! bones & c>tilages2 or spontane\s fracture or dislocation may occur1 ow+ to ! brittl5ess ( ! bones4 ,!re is no pa9 & ! l>ge jo9ts are mo/ frequ5tly affect$2 ^! may be excit$ by an injury4 ,h]pes1 sk9 ec*ymoses1 edema1 local sweat+1 alt]ations 9 ! nails1 p]=at+ ulc] ( ! foot1 ony*ia1 decay ( ! tee? & atrophy ( ! muscles may occur4 ,! auditory n]ve is r>ely affect$1 b 9 "s cases !re may be deafness4 ,!re may be attacks ( v]tigo4 ,olfactory symptoms are r>ely met )4 ,c]ebral symptoms are r>e4 ,p>alysis may develop & ! pati5t becomes b$-ridd54 ,! disease itself does n prove fatal2 ! pati5t may live = ye>s until "s int]curr5t disease causes dea?4 ,diagnosis4--,?is is usually easy :5 ! *>act]i/ic symptoms are develop$4 ,! pres5ce ( lightn+ pa9s1 abs5ce ( ! knee-j]k1 e>ly ocul> palsies1 a squ9t1 ptosis & ,argyll ,rob]tson pupil make ! diagnosis conclusive4 ,c>e has to be tak5 9 mak+ diagnosis f p]iph]al neuritis1 p>esis1 ataxic p>aplegia1 c]ebral disease & "s diseases 9 :i* ! po/]ior columns are di/urb$4 ,prognosis w dep5d l>gely on ! excit+ cause1 z x is lea/ hopeful f syphilis1 b ! e>li] ! case is treat$ ! bett] ! *ance4 ,! progress ( ! disease c sometimes be arre/$ & occasionally cases pres5t+ symptoms ( ! fir/ & second /age are entirely reliev$ ) p]si/5t treatm5t4 ,treatm5t4--,exp]i5ce 9 ! treatm5t ( locomotor ataxia has be5 t (t5 ! disease c be *eck$ & ! symptoms reliev$2 b cur+ a case ( locomotor ataxia1 except 9 ! e>ly /ages1 is seldom possible4 ,:5 !re is deg5]ation ( n]ve c5t]s1 !re is no hope = a cure4 ,^? ) a syphilitic hi/ory are by f> ! h>de/ to relieve4 ,antisyphilitic treatm5t %\ld be consid]$4 ,cases ) a syphilitic hi/ory pres5t+ preataxic symptoms1 ,argyll ,rob]tson pupil1 lightn+ pa9s & loss ( patell> reflex h be5 cur$2 un=tunately ^! cases are n always diagnos$4 ,! treatm5t consi/s ( ?or\gh correction ( ! sp9al d]angem5ts f\nd1 especially ?r\gh ! lumb> & l[] dorsal regions4 ,if ! disease has involv$ ! arms or bra91 ?or\gh treatm5t %\ld be giv5 ! entire l5g? ( ! sp9e ) a view to increas+ ! circulation 9 ! sp9al cord & bra91 & ?us *eck+ or prev5t+ ! tissue deg5]ation4 8,9 ! e>ly /age1 deep massage to ! muscles ( ! back promotes ! fl[ ( v5\s blood ?r\gh ! sp9al vessels & _! ana/omotic bran*es1 & is ! be/ means ( reliev+ ! conge/ion :i* is suppos$ to exi/40 7,/>r7 ,! l[] sp9e w be f\nd to be rigid & %\ld be well sprung to get mobility4 ,c>eful treatm5t ( ! limbs %\ld be giv51 b be exce$+ly cauti\s 9 ! treatm5t ( ! limbs ( advanc$ cases1 z !re is consid]able dang] ( produc+ fractures4 ,/ret*+ ! ?igh muscles & int]nal & ext]nal rotation treatm5t ( ! legs %\ld be giv54 ,see t ! b[els are mov$ daily & be positive t !re is no ret5tion ( ! ur9e 9 ! bladd]4 ,a ca!t] has to be us$ 9 "s cases4 ,! pati5t %\ld be c>eful ab\t tak+ too mu* food1 & especially bew>e ( indige/ible food1 z x irritates or excites ga/ric crises4 ,dur+ pa9ful attacks ! pati5t %\ld re/ 9 b$1 & ) c>eful treatm5t ! attack c g5]ally be reliev$4 ,hot applications are ( consid]able aid4 ,at all times excesses %\ld be avoid$4 ,occupation ( "s "* %\ld be giv5 ! suff]]4 ,d n promise to cure ! pati5t1 & make x pla9 at ! />t t x w probably require a long "t to %[ mu* improvem5t4 ,sy/ematic ex]cises to ree/abli% coord9ation %\ld n be neglect$4 ,h]$it>y ,ataxia 7,,fri$rei*',s ,,ataxia7 ,?is is a r>e h]$it>y disease1 due to scl]osis ( ! columns ( ,goll & ,burda* & ! pyramidal tracts4 ,!re are ataxia1 muscul> weakness1 ny/agmus1 spee* disord]s & loss ( knee flex4 ,almo/ inv>iably !re w be f\nd a neuropa?ic hi/ory4 ,alcoholism1 syphilis & insanity 9 ! p>5ts are pr$ispos+ causes4 ,tub]culosis may be a factor4 ,acute diseases1 especially infecti\s fev]s1 d5tition & injuries to ! sp9e may be excit+ causes4 ,x occurs mo/ frequ5tly 9 males ab\t ! sev5? or eigh? ye> & v seldom aft] pub]ty4 ,sev]al memb]s ( ! same family are apt to be affect$4 ,! disord] is transmitt$ by ! female4 8,! deg5]ation ( ! po/]ior & pyramidal columns seems to occur at ! "t ( cord developm5t1 :5 malnutrition or h]$it>y dyscrasia w\ld di/urb x mo/40 ,pa?ologically1 8! sp9al cord is small] ?r\gh\t ?an normal2 we h also a comb9$ disease ( ! po/]ior & lat]al tracts 7,s*ultze71 a deg5]ation ( ,goll's tract 9 toto1 ( ,burda*'s almo/ entirely1 & ( ! direct c]ebell>1 ! cross$ pyramidal 7871 & ( ,cl>ke's columns1 9 :i* we f9d n only atrophy ( fib]s1 b also a deg5]ation ( ! ganglion cells4 ,g[]'s tract may likewise be involv$40 7,opp5heim74 ,symptoms4--,impair$ coord9ation1 beg9n+ 9 ! legs & lat] ext5d+ to ! arms1 is ! fir/ m>k$ symptom4 ,! gait is peculi>2 x is sway+ & irregul> & x lacks ! pron\nc$ /amp+ gait ( locomotor ataxia4 ,!re is a loss ( reflexes1 :ile no s5sory symptoms are pres5t z a rule4 ,! sph9ct]s are normal4 ,ny/agmus is pres5t & is a *>act]i/ic symptom4 ,! spee* is scann+4 ,talipes & lat]al curvature ( ! sp9e are common4 ,! m9d becomes sluggi% 9 lat] /ages4 ,! c\rse is always v sl[4 ,diagnosis4--,?is is n difficult z a rule1 ow+ to ! usual family hi/ory pres5t$4 ,! sp9al curvature1 ny/agmus1 incoord9ation1 scann+ spee*1 irregul> gait1 & de=mity ( ! feet are symptomatic4 ,9 locomotor ataxia ! gait1 %>p pa9s1 ane/hesia & ,argyll ,rob]tson pupil w diff]5tiate betwe5 ! two4 ,diff]5tiation w also h to be made f *orea1 ataxic p>aplegia & multiple scl]osis4 ,treatm5t4--,! same treatm5t z 9 locomotor ataxia is foll[$4 ,lesions pres5t$ h be5 f\nd at ! t5? & elev5? dorsals1 & at ! second & ?ird c]vicals1 al?\gh1 z a rule1 ! entire sp9al column is q debilitat$4 ,"s improvem5t w be not$ 9 ^! cases1 b n mu* c be expect$ f treatm5t2 contractures may be prev5t$4 ,spa/ic ,p>aplegia ,spa/ic p>aplegia beg9s z a /iffness 9 ! legs1 ) no s5sory symptoms1 b f9ally ! muscles become rigid & sl[ly p>alyz$4 ,! reflexes are exagg]at$4 ,x may occur1 9 a few in/ances1 z a prim>y disease1 8be+ a deg5]ation ( ! motor neurone1 ^: body lies 9 ! bra9 cortex & ^: axone lies 9 ! lat]al pyramidal tract40 ,usually x is second>y to tumors1 inflammation & s(t5+ ( ! bra94 ,multiple scl]osis1 hemorrhage1 transv]se myelitis1 syr+omyelia & o!r diseases ( ! cord1 injury1 exposure & ov]ex]tion are excit+ causes4 ,syphilis may be a cause4 ,x g5]ally develops betwe5 ! ages ( tw5ty & =ty4 ,pa?ologically1 ! deg5]ation involves ! lat]al pyramidal columns ( ! cord4 ,x beg9s at ! p]iph]y & ext5ds upw>d until f9ally ! axones atrophy & neuroglia ov]gr[? takes place & scl]osis ( ! motor tracts results4 ,symptoms4--,muscul> /iffness 9 "o leg is usually ! fir/ symptom1 :i* gradually di/urbs bo? sides4 ,! muscul> /iffness increases to a rigidity1 & ev5 cramps1 s t x is ) consid]able difficulty t ! pati5t moves ab\t4 ,! reflexes are exagg]at$4 ,! jo9ts1 z well z ! muscles are /iff1 s t ! toes are dragg$ ^u ! gr\nd & ! legs are kept close toge!r1 abduction ( ! limbs be+ difficult4 ,on ! :ole1 !re is mu* tir$ness1 /iffness1 rigidity & h>dness ( ! leg muscles1 s t all motions ) !m are p]=m$ ) great ef=t4 ,s5sory & trophic symptoms are lack+2 control ( ! bladd] & rectum is usually normal4 ,! progress ( ! disease is sl[4 ,! upp] extremities may be involv$ 9 aft] ye>s1 b ! common ext5sive di/urbance is ) ! legs1 s t !y may be entirely useless & ! muscles atrophy f disuse1 al?\gh rigidity & contractures rema94 ,treatm5t4--,! prognosis is usually unfavorable1 ?\gh frequ5tly ! pati5t may be consid]ably b5efit$4 ,a few cases t h be5 caus$ by traumatism1 cold or exposure h yield$ to o/eopa?ic treatm5t & all symptoms disappe>$4 ,! treatm5t is l>gely t ( locomotor ataxia4 ,! lesions are readily locat$ 9 ! sp9al column4 ,9 a few cases a slight po/]ior curvature ( ! dorso-lumb> region is f\nd1 b ! majority ( ! lesions are 9 ! l[] dorsal region4 ,special c>e %\ld be giv5 to ! bladd] & b[els4 ,prolong$ w>m ba?s are b5eficial4 ,treatm5t ( ! legs is always second>y to t ( ! sp9e4 ,! diet %\ld be nutriti\s & "o easily dige/$4 ,give ! pati5t pl5ty ( fre% air & sunlight ) *e]ful surr\nd+s4 ,e4 ,c4 ,l9k#acb reports two cases1 "o ( ov] "o ye>'s /&+1 completely recov]$1 & ano!r mu* improv$4 ,ataxic ,p>aplegia ,9 ataxic p>aplegia !re are ataxic & spa/ic symptoms1 due to bo? po/]ior & lat]al scl]osis4 ,traumatism1 cold & exposure are etiologic factors4 ,x is f\nd 9 diffuse myelitis1 g5]al p>esis1 leptom5+itis & 9 toxic conditions z 9 p]nici\s anemia4 ,! po/]ior & lat]al columns are deg5]at$1 s t 9 ! =m] !re is an asc5d+ deg5]ation & 9 ! latt] a desc5d+4 ,symptoms4--,^! comprise ^? ( tabes & spa/ic p>aplegia4 ,incoord9ation1 ataxia1 lightn+ pa9s1 ane/hesia1 rigidness ( muscles & exagg]at$ reflexes are ! pr9cipal symptoms4 ,! muscles easily fatigue2 s5sory symptoms are n s tr\blesome z 9 tabes2 !re may be visc]al crises1 sometimes ,argyll ,rob]tson pupil2 & possibly spasms ( ! upp] extremities & jaw4 ,! c\rse ( ! disease is sl[4 ,diagnosis4--,?is is n difficult z a rule4 ,fir/1 !re is ataxia2 !n increas$ reflexes1 fatigue ( ! muscles & p>aplegia4 ,tumor ( ! c]ebellum may confuse ! diagnosis4 ,treatm5t4--,!re is frequ5tly a *ance to greatly b5efit ^! cases1 & ev5 9 "s in/ances a cure may be p]=m$1 provid$ ! case is se5 e>ly4 ,?or\gh treatm5t ( ! sp9e to relax ! muscles & to adju/ ! ribs & v]tebr is ! indication4 ,/ret*+ ! sp9e1 if c>efully done1 is b5eficial4 ,muscul> manipulation improves ! sp9al cord circulation1 & osse\s correction removes probable imp+em5ts to nutri5t *annels & n]v\s influ5ces induc$ by cold1 exposure1 traumatism & second>y di/urbances4 ,c>e ( ! g5]al heal?1 hygi5e1 diet1 etc41 are important4 ,syr+omyelia ,def9ition4--,a *ronic affection ( ! sp9al cord 9 :i* !re is an embryonal neurogli> ov]gr[? ab\t ! c5tral canal1 ) cavity =mation4 ,x is *>act]iz$1 cl9ically1 by progressive muscul> atrophy1 peculi> di/urbances ( s5sation & v>i\s trophic & vasomotor disord]s4 ,! onset g5]ally takes place be=e ! ?irtie? ye>4 ,males are mu* m commonly affect$ ?an females4 ,x is claim$ by "s t ! disease is infecti\s4 ,x frequ5tly foll[s trauma4 ,pa?ologically1 ! condition beg9s ) an ov]gr[? ( embryonal neurogli> tissue4 ,?is is foll[$ by deg5]ation ( ! gliomat\s tissue ) a =mation ( cavities1 or ?is cavity =mation may be ! result ( hemorrhage4 ,! disease1 9 mo/ cases1 involves only ! c]vical or dorsal regions1 & is usually 9 ! po/]ior or po/]o-lat]al tracts4 ,! cavity may prevail ?r\gh\t ! entire cord1 b usually only ! c]vical & dorsal regions are involv$4 ,! cavities lie 9 ! gray matt] outside ( ! canal4 ,symptoms4--,! onset is sl[4 ,! symptoms dep5d ^u ! situation & ext5t ( ! cavity4 ,z ! disease mo/ frequ5tly involves ! c]vical region1 ! neck & arms are usually affect$4 ,at fir/ neuralgic pa9s may develop 9 ! muscles4 ,lat] !re is progressive muscul> atrophy & loss ( pa9ful & !rmic s5sations4 ,tactile & muscul> s5ses are usually intact4 ,! reflexes are increas$ & a spa/ic condition is pres5t4 ,! l[] limbs usually escape1 b :5 !y are involv$ ! cl9ical picture may be t ( amyotrophic lat]al scl]osis4 ,a lat]al curvature is pres5t4 ,:5 ! disease ext5ds into ! m$ulla1 !re w be v>i\s bulb> symptoms4 ,trophic *anges & vasomotor disord]s are common4 ,a =m ( syr+omyelia1 kn[n z ,morvan's disease1 is *>act]iz$ by neuralgic pa9s1 cutane\s ane/hesia & pa9less felons4 ,diagnosis4--,! progressive muscul> atrophy1 ! ret5tion ( muscul> & tactile s5ses1 & ! loss ( !rmic & pa9ful s5sations are typical symptoms4 ,! diseases ) :i* x may be conf\nd$ are3 ,c]vical ,pa*ym5+itis4 ,! pa9 is usually great]1 ! tactile s5se is lo/ & x runs a m rapid c\rse4 ,ane/hetic ,leprosy4 ,! trophic *anges are m m>k$1 tactile s5sation is lo/ & ! phalanges (t5 drop (f4 ,progressive ,muscul> ,atrophy & ,amyotrophic ,lat]al ,scl]osis4 ,s5sory symptoms are want+4 ,prognosis4--,! prognosis is unfavorable4 ,duration is f five to tw5ty ye>s4 ,treatm5t4--,little c be done except att5d+ to ! diet & hygi5e ( ! pati5t & meet+ urg5t symptoms4 ,probably1 cont9u$ treatm5t along ! sp9al column w\ld influ5ce to "s ext5t ! circulation ( ! cord 9 ! region ( ! involvem5t4 ,hot applications are ( value 9 reliev+ pa9 & cramps4 ,! ,x-ray has prov5 ( "s b5efit 9 *eck+ ! progress ( ! disease4 ,amyotrophic ,lat]al ,scl]osis 8,?is is a *ronic1 progressive =m ( sp9al p>alysis1 *>act]iz$ by ! symptoms ( progressive muscul> atrophy 9 ! arms & by lat]al scl]osis or spa/ic p>aplegia 9 ! legs40 7,/>r74 ,x is simil> to progressive muscul> atrophy1 except1 9 addition1 !re is scl]osis ( ! pyramidal tract4 7,see ,progressive ,muscul> ,atrophy47 ,osl] classes progressive muscul> atrophy ( sp9al orig91 amyotrophic lat]al scl]osis & progressive bulb> p>alysis z diseases ( ! :ole eff]5t or motor tract1 :]e9 ^! disord]s may simply be v>i\s /ages 9 ! same case4 ,he says1 8,a sl[1 atrophic *ange 9 ! motor neurones is ! anatomical basis1 & ! disease is "o ( ! :ole motor pa?1 involv+1 9 _m cases1 ! cortical1 bulb>1 & sp9al c5t]s40 ,!re c be no "q t = ! /ud5t1 a classification ( sp9al cord diseases accord+ to ! :ole motor tract1 ! upp] motor segm5t1 ! l[] motor segm5t1 etc41 is a sci5tific classification f our pres5t k ( ! hi/ology & physiology ( ! neurone1 b = cl9ical purposes ! usual classification is giv54 ,o/eopa?ically1 we are greatly 9 ne$ ( a new nosology1 ei!r accord+ to ! cause ( ! disord] or to ! physiological di/urbance4 ,amyotrophic lat]al scl]osis does n occur s frequ5tly z progressive muscul> atrophy4 ,h]$ity plays a "p1 & x affects old] p4 ,injury to ! sp9al column is und\bt$ly an important factor4 ,exposure & cold may be excit+ causes4 ,infecti\s diseases & syphilis are probably important causes4 ,pa?ologically1 !re are atrophy 9 ! ant]ior cornu & scl]osis ( ! cross$ & direct pyramidal tracts4 ,!re is scl]osis ( c5t]s 9 ! m$ulla4 ,symptoms4--,atonic atrophy1 muscul> weakness & fibrill>y contractions1 ( v>y+ degrees1 are *>act]i/ic4 ,! reflexes are exagg]at$2 ! arm & leg muscles become weak & f9ally rigid & atrophi$4 ,?is results 9 de=mity4 ,di/urbances ( s5sation are n pron\nc$4 ,! sph9ct]s may be slightly affect$4 ,diagnosis4--,! disease is n s prolong$ z progressive muscul> atrophy4 ,diff]5tiation has to be made f multiple ar?ritis & transv]se myelitis & syr+omyelia4 ,treatm5t4--,! same treatm5t z outl9$ = progressive muscul> atrophy is indicat$4 ,! disease may be ret>d$ & life prolong$4 ,progressive ,muscul> ,atrophy ,a disease *>act]iz$ by a sl[1 b progressive1 loss ( p[] & by muscul> atrophy4 ,anatomically1 x is *>act]iz$ by deg5]ation ( ! ganglion cells ( ! gray matt] 9 ! cord4 ,?is atrophic affection develops j opposite to t ( *ronic ant]ior poliomyelitis4 ,x is commonly a disease ( males 9 middle life4 ,syphilis1 rheumatism & lead poison+ pr$ispose4 ,x sometimes foll[s cold1 wet1 exposure1 traumatism1 m5tal worries1 ov]use ( c]ta9 muscles1 or prolong$ emotional excitem5t4 ,h]$it>y influ5ces are pres5t 9 "s cases4 ,9 all cases lesions are detect$ 9 ! v]tebr & ribs1 correspond+ to ! inn]vation ( ! diseas$ areas4 ,v likely ^! lesions are ! />t+ po9t ( ! disease1 by impair+ nutrition to ! motor cells ( ! ant]ior cornu1 & ?us result+ 9 atrophy4 ,pa?ologically1 ! muscles are wa/$1 ! fib]s und]go fatty deg5]ation & !re is an ov]gr[? ( connective tissue4 ,! p]iph]al motor fib]s are deg5]at$4 ,! ant]ior n]ve roots lead+ to ! horns are atrophi$4 ,! l>ge ganglion cells ( ! ant]ior horns are atrophi$1 or ev5 entirely remov$4 ,! neurogli> tissue is increas$4 ,!re is scl]osis ( ! ant]ior & lat]al pyramidal tracts ( ! cord 9 ! majority ( cases4 7,see ,amyotrophic ,lat]al ,scl]osis74 ,! pyramidal tracts h be5 f\nd deg5]at$ ?r\gh ! pons & int]nal capsule1 ev5 up to ! motor cortex4 ,:5 bulb> symptoms are pres5t1 !re is deg5]ation ( ! motor nuclei ( ! m$ulla4 ,! po/]ior columns are n involv$4 ,symptoms4--,irregul> pa9s1 numbness or exhau/ion are usually felt 9 ! region t is soon to become wa/$4 ,! upp] extremities are fir/ affect$4 ,! muscles ( ! ball ( ! ?umb wa/e fir/1 !n ! int]ossei4 ,f atrophy ( ! int]ossei & lumbricales & contraction ( ! long ext5sor & flexor muscles1 ! de=mity kn[n z 8claw h&0 results4 ,! wa/+ creeps up f ! =e>m1 arm & %\ld]4 ,! muscles ( ! trunk are gradually affect$4 ,! muscles ( ! l[] extremity may escape entirely4 ,! platysma myoides does n wa/e & is (t5 hyp]trophi$4 ,! face muscles are attack$ late or n at all4 ,! affect$ muscles (t5 twit*4 ,de=mities & contractures develop1 notably lordosis4 ,s5sation is n impair$ al?\gh ! pati5t may compla9 ( numbness & coldness4 ,! bladd] & rectum are n affect$1 b sexual p[] may be lo/4 ,! p>alysis is flaccid & ! reflexes abs5t 9 ! s-call$ atonic cases4 ,9 atonic atrophy !re is m or less spasm1 ! reflexes are greatly increas$1 !re are (t5 contractures & ! wa/+ is usually trifl+4 ,diagnosis4--,diff]5tial diagnosis has to be made f syr+omyelia1 *ronic ant]ior poliomyelitis1 lead palsy & muscul> dy/rophies4 ,prognosis4--,! prognosis ( progressive muscul> atrophy is n favorable1 al?\gh a numb] ( cases h be5 greatly help$ by an ext5d$ c\rse ( treatm5t4 ,treatm5t4--,! treatm5t consi/s ( a ?or\gh1 /imulat+ treatm5t ( ! inn]vation ( ! affect$ regions1 ) manipulation ( ! muscles & p>ts diseas$4 ,correction ( ! lesions to ! v]tebr & ribs1 :i* are involv+ ! inn]vation to ! diseas$ tissues1 is ( prim>y importance4 ,a cure _c be expect$ :5 deg5]ation ( ! n]ve c5t]s has occurr$2 /ill1 ! progress ( ! disease may be *eck$ 9 _m cases1 & ! pati5t occasionally ga9 consid]able /r5g?4 ,:5 atrophy />ts 9 ! muscles ( ! ball ( ! ?umb1 ! lesion is to ! m$ian n]ve1 & d]angem5ts ( ! c]vical v]tebr1 f ! fif? to ! sev5?1 may be f\nd4 ,att5tion to ! g5]al heal? is important4 ,outdoor life is pref]able & gymna/ic ex]cises are ( value1 b d n ov]tax ! /r5g?4 ,bulb> ,p>alysis 7,,labioglossol>yngeal ,,p>alysis7 ,a progressive atrophy & p>alysis1 invad+ ! lips1 tongue1 ph>ynx & l>ynx1 due to involvem5t 7scl]osis7 ( ! motor nuclei ( ! m$ulla oblongata t supply ^! tissues4 ,x is r>ely prim>y1 m frequ5tly second>y to tabes1 amyotrophic lat]al scl]osis & diseases involv+ ! motor nuclei ( ! m$ulla4 ,diph!ria1 syphilis & lead poison+ are said to pr$ispose4 ,o/eopa?ic lesions ( ! upp] c]vical are also important factors 9 _m cases4 ,halb]t says3 8,! nuclei ( ! hypoglossal1 ! sp9al accessory1 ! facial & ! motor "p ( ! trifacial n]ves suff] mo/ decid$ly f ! scl]otic deg5]ation4 ,! n]ve trunks & ! muscles :i* !y supply gradually %[ ! effects ( a simil> deg5]ation40 ,! acute =m results f hemorrhage1 embolism or inflammatory s(t5+4 ,! onset is usually sudd54 ,! spee* is difficult or entirely lo/4 ,!re are dribbl+ ( saliva1 difficult swall[+1 flabb9ess & flaccidity ( ! lips & frequ5t *ok+ spells occur4 ,^! cases may prove rapidly fatal4 ,! *ronic =m may result f progressive muscul> atrophy1 insul> scl]osis1 amyotrophic lat]al scl]osis1 acute asc5d+ p>alysis or *ronic poliomyelitis4 ,! p>alysis />ts 9 ! tongue1 ! fir/ symptom be+ a slight defect 9 ! spee*4 ,:5 ! lips become involv$1 ! pati5t _c :i/le & spee* is r5d]$ /ill m difficult4 ,! lips are prom95t & ! l[] "o drops4 ,! saliva is increas$ 9 am\nt & !re is drool+4 ,ma/ication ( ! food becomes difficult4 ,! tongue becomes atrophi$ & ! muc\s membrane wr9kl$4 ,fibrill>y tremors ( ! lips & tongue are pres5t4 ,s5sory symptoms are n pres5t4 ,ta/e is normal4 ,p>alysis ( ! l>ynx is n s pron\nc$ z ( ! o!r p>ts4 ,diagnosis4--,?is is g5]ally easy z ! symptoms are well m>k$4 ,! prognosis is unfavorable4 ,treatm5t4--,little c be done 9 ! majority ( cases4 ,only 9 ^? cases :]e ! p>alysis is caus$ by c]vical lesions c mu* hope be giv54 ,d]angem5ts ( ! c]vical v]tebr1 especially ! atlas & axis1 occasionally influ5ce ! circulation 9 ! m$ulla to su* an ext5t t ! motor nuclei are greatly involv$4 ,! subluxat$ v]tebras may int]f]e ) ! blood-vessels directly or ?r\gh ! vasomotor & trophic n]ves4 ,:5 ! onset is n abrupt1 ! prognosis is m favorable4 ,:5 deglutition is impair$1 ! /oma* tube %\ld be us$ 9 fe$+ ! pati5t to prev5t ! food pass+ into ! tra*ea4 ,,footnotes3 #abf ,a4 ,o4 ,a4 ,case ,reports1 ,s]ies ,v4 #abg ,a4 ,o4 ,a4 ,case ,reports1 ,s]ies ,,ii4 #abh ,a4 ,o4 ,a4 ,case ,reports1 ,s]ies ,v4 #abi ,a4 ,o4 ,o4 ,case ,reports1 ,s]ies ,i4 #acj ,mill>d1 ,poliomyelitis4 #aca ,j\rnal ( ! ,am]ican ,o/eopa?ic ,association1 ,febru>y #aijf4 #acb ,j\rnal ( ,o/eopa?y1 ,oct4 #aijd4 ,,or?op$ic ,,surg]y ,by ,h4 ,s4 ,,ha9 ,or?op$ic surg]y deals ) ! me*anical or surgical prev5tion & correction ( all de=mities1 especially ^? ( *ildr54 ,x is n alone ju/ifiable1 b imp]ative1 t or?op$ic surg]y be giv5 a prom95t position 9 any up-to-date text on ! ,pr9ciples & ,practice ( ,o/eopa?y4 ,! ju/ification is ?reefold3 ?\gh or?op$ics 0 practic$ to a limit$ ext5t be=e ! ,sci5ce ( ,o/eopa?y 0 develop$1 x has always be5 consid]$ to be outside ! realms ( true surg]y1 9 t x is practically bloodless1 & ^? engag$ 9 su* practice h s\ght to e/abli% x ^u a plat=m ( its own4 ,! basis ( ! practice ( or?op$ic surg]y & o/eopa?y is simil>1 if n id5tical1 9 t x deals almo/ entirely ) bony abnormalities4 ,x is recogniz$ by ! :ole o/eopa?ic pr(ession1 & unconsci\sly by "s adh]5ts ( m$ical sci5ce1 t ! ma9ta9ance & re/oration ( normal function are alike dep5d5t on a =ce inh]5t 9 bioplasm & t function p]v]t$ beyond ! limits ( self-adju/m5t1 is dep5d5t ^u a condition ( /ructure p]v]t$ beyond ^? limits4 ,?is1 !n is ! plat=m ^u :i* ! two sci5ces ( o/eopa?y & or?op$ic surg]y are erect$4 ,! te*nique ( o/eopa?ic practice consi/s ( passive manipulative measures1 design$ to r5d] to ! organism su* aid z w enable x to ov]come or adapt itself to ! di/urb$ /ructure2 & does n seek1 9 itself1 ! aid ( any in/rum5t1 me*anical appliance or pla/] ( ,p>is ca/4 ,surely x is b a %ort /ep f our o/eopa?ic !rapeutics to a sy/em ( !rapeutics :]e we f9d all sorts ( me*anical & pla/] ( p>is appliances1 etc41 to help our passive manipulation 9 r5d]+ to ! human organism su* aid z w enable x to ov]come or adapt itself to a di/urb$ /ructure4 ,?is latt]1 ( c\rse1 is ! mod]n sci5ce ( or?op$ic surg]y1 & because ( ! %ortness ( ?is /ep1 ,i insi/ t x is "o ( ! mo/ valuable adjuncts ( ! sci5ce ( o/eopa?y4 ,x is frequ5tly necess>y = ! o/eopa?ic practition] to take ?is /ep z conditions are met ) t h progress$ beyond ! possibilities ( passive manipulations & aga9 o!r conditions ( p]v]t$ /ructure c be mu* m quickly r$uc$ by ! aid ( ea*4 ,x is !n indisputable t ! !rapi/ :o approa*es disease f ! o/eopa?ic /&po9t1 above enunciat$1 is f> m compet5t to deal ) ! me*anical problems ( or?op$ic surg]y ?an any o!r kn[n !rapi/4 ,secondly1 9 _m conditions orig9ally treat$ by or?op$ic me?ods1 subsequ5t ord9>y o/eopa?ic manipulations obta9 a mu* m satisfactory & m la/+ result ?an if x is )held4 ,?irdly1 9 ord] to avoid possible error1 x is ( extreme importance t all o/eopa?ic practition]s be p>ticul>ly famili> ) ! conditions h]e9aft] describ$1 m especially tub]cul> conditions ( ! sp9e1 bones & jo9ts1 prim>y sp9al curvatures & o!rs4 ,x is reasonable & fur!rmore true t o/eopa?ic physicians are confront$ 9 practice ) an unusually l>ge p]c5tage ( cases indicat$ above1 & ! e>ly recognition ( su* conditions is ( fundam5tal importance 9 ord] t o/eopa?ic manipulations be )held & supplem5t$ or replac$ by or?op$ic me?ods4 ,space ( c\rse w n p]mit ( ! entire discussion ( ?is va/ subject b ! mo/ important & s]i\s conditions met ) 9 g5]al practice are fully discuss$ 9 ! foll[+ pages ( ?is *apt]4 ,p]haps ! commone/ condition com+ "u ?is l9e ( !rapeutics1 & "o 9 :i* we1 z o/eopa?s1 are mo/ vitally int]e/$ is rot>y lat]al curvature ( ! sp9e4 ,f my p]sonal obs]vation & f exp]i5ces ( "s ( ! mo/ prom95t memb]s ( our pr(ession1 ,i am l$ to believe t ?is is "o ( our mo/ difficult lesions to ov]come o/eopa?ically1 h5ce my desire to g fur!r into ?is condition ?an mo/ ( u might expect4 ,i _h opportunity to obta9 p]sonally "s v valuable in=mation f ,dr4 ,joa*im ,/ahl 9 ! ,k+'s ,*>ity ,hospital 9 ,b]l91 & to him ,i am deeply grateful = _m ( ! ideas ( treatm5t pres5t$ 9 ! foll[+ article4 ,i believe t ,i h an accurate conception ( ! pa?ological condition t exi/s 9 connection ) ?is de=mity1 & ,i believe t my treatm5t ( x has be5 m successful ?an any t ,i h se5 "u o!r me?ods1 9 t ,i h gott5 mo/ excell5t results1 9 select$ cases1 9 a comp>atively %ort "t1 entirely because o/eopa?ic manipulations & ex]cises 7 us$ 9 connection ) ! modifi$ ,abbott me?od4 ,scoliosis or ,rot>y ,lat]al ,curvature ,scoliosis or ,lat]al ,curvature ( ! ,sp9e is a de=mity :]e ! sp9e is deviat$ 9 :ole or 9 "p to "o or ! o!r side ( ! m$ian l9e1 :i* deviation is accompani$ by an elem5t ( rotation4 ,?\gh usually consid]$ z a sp9al de=mity its effects are obvi\s outside ! sp9al area 9 s mu* z x w cause de=mity ( ! pelvis1 legs1 ribs1 /]num1 scapul1 & 9 sev]e cases1 ( ! ?oracic & abdom9al visc]a4 ,curvatures ( ! sp9e are ! result ( "o ( two di/9ct factors3 fir/ :]e !re is a prim>y disease ( ! bone caus+ m or less de/ruction ( ! bone & sp9al articulations1 & result+ 9 p]man5t sp9al curvature4 ,! mo/ common example ( ?is condition is se5 9 ! angul> curvature ( ,pott's disease4 ,rickets is usually responsible = a g5]al long po/]ior curvature ( ! :ole sp9e1 z is o/eomalacia ) ! sup]imposition ( "s lat]al deviation4 ,fur!r1 any type ( inflammation or trauma is capable ( produc+ curvatures ( v>i\s types4 ,second1 :]e !re is no prim>y disease ( ! bone1 jo9ts1 or ligam5ts1 & :]e ! curvature is due to ext]nal =ces act+ con/antly or at frequ5tly recurr+ int]vals on ! sp9e4 ,scoliosis or lat]al curvature belongs to ! second class4 ,x is un=tunately necess>y to fur!r subdivide scoliosis into two classes2 "o :]e ! curvature is a position p]man5tly ma9ta9$ b capable ( be+ reproduc$ by extreme physiological movem5t ( a normal sp9e1 & secondly1 a position :i* no normal sp9e c assume & :i* necess>ily implies a *ange 9 ! normal %ape ( ! bones & int]v]tebral discs4 ,! fir/ may be describ$ z a functional or po/ural lat]al curvature1 & ! second z an organic or /ructural lat]al curvature4 ,fur!r1 ,i might say t ! fir/ type may progress until x becomes ! organic type4 ,pa?ology4--,9 scoliosis ! sp9e und]goes n only curvature or lat]al deviation b also rotation ( ! v]tebral bodies :i* y w note always takes place t[>ds ! convexity ( ! curve4 ,*anges 9 ! ,individual ,v]tebr4--,! bodies may be ei!r w$ge %ap$ or loz5ge %ap$4 ,9 w$ge %ap$ v]tebr1 ! bodies are compress$ on ! concave side & ext5d$ on ! convex side1 ! int]v]tebral discs be+ atrophi$ on ! %ort5$ side4 ,9 ! loz5ge %ap$ type1 ! *ange 9 ! bodies is mo/ m>k$ at ! junction ( ! opposite curves1 & is ?us m commonly obs]v$ 9 comp\nd curvatures4 ,! p$icles are direct$ m ant]o-po/]iorly on ! convex side & m transv]sely on ! concave side4 ,! transv]se processes on ! convex side are m ant]o-po/]ior ?an normal1 caus+ ! v]tical furr[ betwe5 !m & ! sp9e to be n>r[] on ?is side4 ,! sp9es po9t t[>ds ! concavity 9 /ructural curvatures & t[>d ! convexity 9 ! functional type4 ,! v]tebral =am5 is r\nd$ 9 ! convexity & po9t$ 9 ! concavity4 ,! edge ( ! ant]ior common ligam5t t[>d ! convexity is greatly ?9n$ :ile x has a well m>k$ edge on ! concave bord]4 ,a fibr\s deg5]ation occurs 9 ! muscles on ! convexity ow+ to /ret*+1 :ile atrophy f disuse takes place 9 ^? on ! concave side4 ,associat$ *anges 9 ! ,visc]a4--,! dorso-lumb> curvature decrease 9 ! volume ( ! l[] ?orax on ! dorso-convex side t5ds to cause pleural adhesions ) oblit]ation ( ! pleural sac & consequ5t collapse4 ,tub]culosis ( ! lung is common 9 pati5ts :o suff] f scoliosis4 ,! he>t is (t5 ov]work$ b ! above less5+ ( ! pulmon>y area 9 turn results 9 hyp]trophy & dilatation ( ! "r v5tricle & subsequ5t g5]al v5\s /asis4 ,! kidney on ! convex side is compress$1 & z a result deg5]ative *anges are prone to occur4 ,! sple5 is frequ5tly displac$ upw>d & is liable to pa?ological *anges4 ,organs su* z ! /oma*1 transv]se colon1 esophagus & tra*ea are frequ5tly displac$ ow+ to ! bony de=mity & are !reby m prone to pa?ological *ange4 ,etiology4--,! ess5tial factor 9 ! production ( scoliosis is sp9al insuffici5cy1 :i* includes sp9al muscles & ligam5ts z well z ! bones4 ,9 _m in/ances1 h[ev]1 ! foll[+ factors h an important augm5t+ or pr$ispos+ effect4 #a4 ,occupational ,de=mity4--,prim>ily "u ?is classification1 ,i h f\nd faulty positions adopt$ by s*ool *ildr5 z be+ ! mo/ com=table1 to be p]haps mo/ important4 ,occupations su* z ^? ( nurse-maids1 hod c>ri]s1 or /one cutt]s1 are apt to induce scoliosis4 #b4 ,diseases ( ! ,c5tral ,n]v\s ,sy/em4--,unilat]al weakness or p>alysis ( ! muscles ( ! trunk are common causes ( scoliosis4 ,ant]ior poliomyelitis plays a p>ticul>ly important "p z x may induce de=mity by di/ortion ( ! l[] extremity or by any inequality 9 ! l5g? ( ! limbs due to ret>dation ( gr[?1 z well z induc+ g5]al weakness ( ! muscles ( ! trunk4 ,o!r n]v\s disord]s t %\ld be consid]$ are spa/ic p>alysis1 locomotor ataxia1 syr+omyelia & ,fri$rei*'s ataxia4 #c4 ,incid5tal ,de=mity4--,scoliosis may be caus$ by direct injury or by fracture1 ,pott's ,disease1 or organic affections ( ! sp9e4 ,m>k$ de=mity caus$ by ,sciatica or lumb> neuritis1 if p]si/5t may f9ally induce p]man5t de=mity4 #d4 ,de=mities ,due to ,diseases ( ! ,*e/4--,9 empyema or pleurisy "o side ( ! *e/ is retract$ & x w be notic$ t ! curvature occurs t[>d ! heal?y side4 ,*ronic pulmon>y tub]culosis produc+ fibrosis ( ! lung gives ! same result z empyema & pleurisy4 #e4 ,de=mity due to obliquity ( ! pelvis4--,?is type may be due to any inequality ( ! limbs1 su* z equ9us ( ! foot4 ,cong5ital dislocation ( ! hip may play a "p :ile "o naturally lays /ress on pelvic & l[] lumb> lesions4 #f4 ,de=mity due to ,di/ortion ( ,o!r ,p>ts4--,unequal visions1 unequal he>+1 & torticollis by caus+ malposition are etiological factors especially 9 s*ool *ildr54 ,! loss ( an arm w t5d to cause an asymmetrical position ( ! trunk4 #g4 ,cong5ital ,de=mity4--,cong5ital scoliosis occurs1 b is usually associat$ ) o!r cong5ital de=mities ( ! sp9e1 su* z ! r$uction or increase ( ! v]tebr1 c]vical rib1 elevation ( ! scapula1 etc4 ,! de=mity is usually n app>5t until lat] ye>s1 ?\gh x may occur at bir?4 #h4 ,sp9al ,lesions4--,any o/eopa?ic lesion pr$isposes to curvature because x int]f]es ) ! n]ve supply & tonicity ( ! sp9al muscles & c\ld readily cause ! faulty position4 ,functional or ,po/ural ,lat]al ,curvature ,?is is a condition :]e !re is a gradual curve to "o side unaccompani$ by any m>k$ rotation4 ,! maximum deviation may be no m ?an "o in* & a half f ! middle l9e1 :i* po9t is g5]ally f\nd ab\t ! t5? dorsal v]tebra4 ,9 ! va/ majority ( cases deviation is to ! left & 9 su* ! foll[+ alt]ations w be notic$3 a g5]al convex curve to ! left2 elevation1 & ant]ior displacem5t ( ! left %\ld]2 po/]ior displacem5t ( ! "r %\ld]2 9 ext5sion1 ! "r side ( ! back w be high] ?an ! left & 9 addition "s torsion to ! concave side1 :i* is easily und]/ood if "o recalls ! exact *anges t take place dur+ side movem5t ( ! normal sp9e4 ,x is important to rememb] t functional scoliosis disappe>s :5 ! pati5t is susp5d$ or assumes ! recumb5t position4 ,organic or ,/ructural ,scoliosis ,?is t]m is appli$ to cases :]e def9ite *ange has tak5 place 9 ! v]tebr4 ,organic curves may be simple :5 ! deviation is unaccompani$ by any comp5satory curve1 or comp\nd :5 a comp5satory curve is pres5t4 ,we %all consid] ! de=mities z !y pres5t !mselves 9 ! v>i\s regions ( ! sp9e4 ,c]vico-,dorsal ,curvature4--,?is condition is comp>atively r>e & accord+ to ,lovett occurs 9 only ?ree & six t5?s p] c5t ( cases4 ,! head is slightly deviat$ t[>ds ! concave side1 ! %\ld] on ! concave side is l[]$1 :ile on ! opposite side or ! side ( ! convexity x is naturally at a high] level4 ,! angles ( ! upp] ribs are prom95t due to ! co-exi/+ rotation4 ,! ,dorsal ,curvature4--,! %\ld] is rais$ on ! convex side1 & ! rotation ( ! v]tebr is v m>k$1 caus+ a v def9ite projection ( ! angles ( ! ribs on ! convexity4 ,?is rotation also projects ! scapula backw>ds on ! convex side4 ,on ! concave side ! scapula is flat & sunk51 & ! inf]ior angle rotat$ inw>ds & at a high] level ?an ! opposite side4 ,view$ f ! front ! ?orax may n be displac$ at all1 or x may be displac$ t[>d ! convex side1 & if ! latt] is ! case x is1 ( c\rse m prom95t on ! concave side4 ,9 sev]e cases ! l[] end ( ! /]num is deviat$ t[>ds ! convexity & y w f9d t usually ! arm hangs fur!r f ! convex side ?an f ! opposite "o4 ,! ,lumb> ,curvature4--,"h we f9d ! trunk displac$ t[>d ! side ( ! convexity1 & ! wai/ retract$ on ! opposite side4 ,! diff]5ce 9 ! level ( ! hips is ! mo/ prom95t de=mity 9 ?is region1 & x w be f\nd t ! hips are rais$ on ! concave side4 ,rotation 9 ?is region is mu* less evid5t ?an 9 ! dorsal region1 b c be demon/rat$ by a fullness on ! convex side ( ! curve1 due to ! projection ( ! transv]se processes4 ,dorso-,lumb> ,curvatures4--,?is condition is simil> to a c]ta9 ext5t1 to a sev]e functional scoliosis4 ,! f9d+s obs]v$ 9 ! la/ two regions above describ$ w naturally be pres5t 9 ?is type ( curvature4 ,x is n s frequ5tly associat$ ) comp5satory curves z 9 ! o!r types describ$4 ,comp\nd ,/ructural ,curves4--,! appe>ance 9 ?is type ( scoliosis w1 ( c\rse1 be a comb9ation ( ^? describ$ above accord+ to ! types ( curvature 9 comb9ation1 t is to say "r dorsal & left lumb>1 etc4 ,if "o type pr$om9ates ! appe>ance w be *iefly t f\nd 9 t p>ticul> type ( curvature4 ,! relative frequ5cy ( ! common type1 z giv5 by ,s*altless1 9 elev5 hundr$ & ?irty sev5 cases is z foll[s2 functional scoliosis1 #ae4ci2 lumb>1 #aa4g2 dorsal1 #ai2 dorso-lumb>1 #bj2 c]vico-dorsal1 #c4f2 comp\nd1 #cj4 ,diagnosis4--,to ! o/eopa?ic physician ! diagnosis ( scoliosis is n difficult4 ,let me caution y t true scoliosis mu/ be di/+ui%$ f ! lat]al curvatures caus$ by ,pott's disease4 ,v]tebral rotation1 ! abs5ce ( pa91 ! extreme rigidity1 ! *>act]i/ic appe>ance ( ! ribs & ?orax %\ld1 h[ev]1 make ! diagnosis ( scoliosis easy4 ,treatm5t4--,9 g5]al ! treatm5t ( scoliosis is difficult to pres5t1 because e case is consid]ably diff]5t1 & ! am\nt ( correct+ =ce us$ 9 any =m is almo/ entirely a matt] ( judgm5t1 z is also ! "t :5 corrective pressure %\ld be discont9u$4 ,cont9ual practice 9 ! treatm5t ( ^! conditions is mo/ ess5tial to y\r success ) !m4 ,i h _h mo/ gratify+ results 9 a comp>atively %ort "t simply because ,i us$ o/eopa?ic treatm5t & ex]cises along ) a modifi$ ,abbott me?od4 ,functional or ,false ,scoliosis ,! functional or false scoliosis might be reg>d$ z a habitual inability to /& correctly1 simply a po/ural malposition & lack ( muscle tone )\t m>k$ /ructural *ange1 :i* is ma9ta9$ = a consid]able l5g? ( "t or :]e ! position is repeat$ sev]al times daily4 ,! treatm5t ( select$ types ( ?is de=mity is mo/ successful & may well be divid$ into ?ree proc$ures3 fir/1 ! sub/itution ( a correct attitude = ! faulty "o1 t is c>eful inve/igation %\ld be made to asc]ta9 ! condition :i* might be ! cause ( ! incorrect position su* z poor s*ool desks :i* might cause ! *ild to rea* ei!r up or d[n to write1 poorly fitt+ clo?+ :i* causes a pull+ on ! %\ld]1 eye /ra9 :i* w\ld cause tilt+ or twi/+ ( ! neck1 cong5ital %ort5+ ( "o limb or too rapid gr[?1 %\ld all be look$ = & remov$2 second1 regul> o/eopa?ic manipulation1 at lea/ ?ree times p] week to increase ! tonicity ( ! already weak5$ sp9al muscles & aid correction1 are highly ess5tial & %ort5s ! "t requir$ = a complete cure2 ?ird1 sup]vis$ gymna/ic ex]cises ( v>i\s k9ds are v b5eficial to develop & br+ ! musculature back to normal4 ,su* simple ex]cises z crawl+ on ! h&s & knees 9 a small circle t[>ds ! side ( ! convexity1 & ! hang+ f a horizontal b> by ! arm on ! side ( ! concavity w prove to be helpful4 ,"s au?ors recomm5d ! regul> army sett+ up ex]cises = "s cases or a frame by means ( :i* ! hips are fix$1 & rotat+ & side b5d+ ex]cises ( ! head & trunk giv54 ,^! la/ two ex]cises are inde$ v reasonable proc$ures b ,i h f\nd !m unnecess>y ma9ly because ,i us$ o/eopa?ic manipulations in/ead4 ,9 advis+ & sup]vis+ ex]cises x is be/ to h ! pati5t's back b>$ s t ! effect ( ea* movem5t c be notic$ & ! ex]cises direct$ accord+ly4 ,c>e & judgm5t %\ld be us$ z to ! numb] & sev]ity ( ! ex]cises & w\ld dep5d ( c\rse on ! vigor ( ! *ild4 ,treatm5t %\ld cont9ue until ! condition has be5 ov]come1 & ! pati5t %\ld be "u obs]vation = a c\ple ( mon?s aft]w>ds s t any recurr5ce ( ! de=mity w\ld be notic$ & att5d$4 ,organic or ,/ructural ,scoliosis ,! treatm5t ( organic or /ructural scoliosis is m complicat$ = x mu/ be rememb]$ !re are two elem5ts ( ! de=mity dem&+ correction2 "o1 ! lat]al curve to be correct$ by a side =ce1 & ! o!r1 ! rotation ( ! v]tebr to be correct$ by a twi/+ =ce4 ,i f9d bo? o/eopa?ic manipulation & gymna/ic ex]cises are ( great value 9 ! correction ( ?is de=mity z !y help to loos5 ! curve & develop ! musculature b us$ alone good results c r>ely be obta9$ especially 9 ob/9ate curvatures4 ,i believe t ,i h improv$ nutrition & probably prev5t$ fur!r de=mity by treatm5ts & ex]cises1 b ,i am q positive t x is n possible to correct an organic scoliosis )\t ! =cible correction us$ 9 ! ,abbott me?od4 ,z ! details ( treatm5t are t$i\s to foll[1 we w take = example a case ( "r dorsal curvature pres5t+ a m>k$ hump de=mity1 ) a comp5satory curve to ! left 9 ! lumb> region1 z ?is is ! mo/ common type4 ,i might say "h t :e!r or n a comp5satory curve is pres5t1 makes no diff]5ce1 z treatm5t is direct$ entirely to ! prim>y curve on ! assumption t ov]correction ( x w cause a second>y curve to disappe> by comp5sation4 ,! pati5t is prep>$ by putt+ on a snug fitt+ und]%irt & sew+ pads ( saddl]'s felt ov] all bony prom95ces1 especially ! cre/ ( ! ileum & ant]ior sup]ior sp9e4 ,sometimes ,i take a piece ( felt ( f\r or five in*es wide & long en\gh to g ar\nd ! entire pelvis1 j high en\gh to cov] ! brim1 & fa/5 x 9 front ) adhesive4 ,next ,i make a bun* ( pads two or ?ree in*es 9 ?ickness & l>ge en\gh to fill up ! concavity ( ! left side1 & fir/ sew !m toge!r1 & !n ) a few /it*es fa/5 !m to ! und]%irt !reby fill+ up ! space on ! concave side4 ,! edges ( ! pads %\ld1 ( c\rse1 be trimm$ d[n to con=m ) ! g5]al cont\r ( ! body1 ! ma9 ?ickness be+ 9 ! middle4 ,i !n sew a s+le pad on ! "r side ( ! ?orax 9 front & a little to ! "r side4 ,illu/ration3 ,pati5t susp5d$ on canvas hammock 9 regul> ,abbott frame ready to apply ca/ = a "r dorsal curvature4 ,notice mann] ( apply+ ! correct+ canvas /raps4 ,! pati5t is n[ ready = ! ,abbott frame & is plac$ on a canvas hammock ab\t twelve in*es wide1 :i* is cut on ! bias s ! "r side is ?ree in*es %ort] ?an ! left4 ,! hammock c be adju/$ to ! desir$ degree ( flexion by a rat*et at ! foot ( ! regul> ,abbott frame4 ,! limbs ( ! pati5t %\ld be elevat$ to increase ! flexion z ?is has a t5d5cy to unlock ! articulation & !reby help 9 ov]com+ ! rotation4 ,next a canvas b&age f\r in*es wide is pass$ ar\nd ! pati5t "u ! axilla ( ! concave side & fa/5$ to ! frame on ! opposite side1 & ano!r "o is plac$ ar\nd ! pelvis & fa/5$ to ! same side ( ! frame1 bo? on a level ) ! body plane4 ,a ?ird b&age is next plac$ ar\nd ! po9t ( greate/ convexity & fa/5$ to ! opposite side ( ! frame 9 su* a way t x c be tight5$ & a direct pull be made on ! curve4 ,be=e tight5+ ! la/ b&age ! left arm & %\ld] %\ld be br\ght up high beside ! face & pull$ backw>d t[>d ! floor z x is ?is twi/+ =ce t produces "s rotation ( ! ?orax4 ,! correct+ b&age is n[ tight5$ be+ c>eful n to cause ! pati5t too mu* discom=t4 ,illu/ration3 ,cross section sket* ( a "r dorsal curvature %[+ de=mity 9 ! ?orax & rotation ( ! v]tebr1 also w9d[s :i* are cut 9 ! ca/ to all[ expansion 9 ^! two directions & ! direct+ =ce ( ! pads4 ,^! are plac$ ov] ! angles ( ! ribs4 ,arr[s %[ directions ( ! v>i\s =ces4 ,i always use ord9>y absorb5t cotton = padd+1 :i* is held 9 place by ! regul> gauze b&age4 ,! pla/] ( ,p>is b&ages %\ld be appli$ high up "u ! left %\ld] & well d[n ov] ! sacrum & innom9ate bones & %\ld be ( a uni=m ?ickness ( half an in*4 ,sometimes ,i c>ry ! pla/] ov] ! "r %\ld] to hold x d[n & back1 ?\gh n always4 ,i always let ! ca/ set pretty well be=e remov+ ! pati5t f ! frame & if x has be5 appli$ 9 ! morn+ ,i f9d x be/ to wait until aft]noon be=e trimm+ & cutt+ ! w9d[s because !re is less dang] ( break+ x4 ,9 trimm+ ,i always smoo? up ! edges1 l[] ! "r %\ld]1 b keep ! left well up1 trim (f en\gh at ! bottom 9 front to all[ ! ?ighs to be readily flex$ )\t ob/ruction1 & leave x l[ beh9d s z to ma9ta9 ! flexion4 ,next1 two holes or w9d[s are cut 9 ! ca/1 "o ov] ea* area :]e ! pads 7 ins]t$1 & remove !m4 ,! hole 9 ! back on ! left or concave side p]mits expansion ( ! *e/ to ! back1 :ile ! hole on ! "r side 9 front all[s ! ribs1 :i* are po/]ior1 to move =w>d "u pressure or ! pads to be ins]t$ at ! po/]ior angle or backw>d prom95ce ( ! ribs ( ! convexity4 ,! canvas b&ages or /raps ar\nd bo? ! axilla & pelvis are remov$1 b ! "o ab\t ! convexity ( ! curve is left 9 place s z to assi/ 9 ! aft] treatm5t4 ,! pati5t usually suff]s "s discom=t su* z difficulty 9 brea?+ & ! inability to move ! body freely1 & %\ld rema9 9 b$ a day or two aft] ! ca/ has be5 appli$4 ,usually !y sleep v poorly ! fir/ few nights1 b ! sp9e soon gives "u ! pressure & !y become com=table4 ,:5 ! ca/ has become q com=table an assi/ant pulls on ! canvas b&age :i* 0 left ar\nd ! convexity1 :ile pads are ins]t$ s t ! greate/ pressure is ex]t$ on ! angle ( ! ribs to fur!r ov]come ! rotation & decrease ! lat]al de=mity4 ,also heavy felt pad may be ins]t$ ov] ! bulg+ ribs 9 front ( ! left side to pu% !m back4 ,c>e %\ld be tak5 t too mu* pressure is n br\ght to be> on ! side ( ! convexity because if m pressure is ex]t$ "h ?an on ! angles ( ! ribs1 x w t5d to increase r ?an decrease4 ,ca/s %\ld be worn = diff]5t p]iods1 "s be+ *ang$ 9 a mon? :ile o!rs c be worn = ?ree mon?s4 ,x is entirely a matt] ( judgm5t4 ,my be/ results h be5 secur$ by only slightly correct+ ! curvature at ! "t ! ca/ 0 appli$1 & rely+ m on ! prop] ins]tion ( ! pads4 ,(t5 at ! end ( a mon? or six weeks1 9 select$ cases1 ,i h split ! ca/ d[n ! front & remov$ x by spr++ x ap>t1 & adm9i/]$ o/eopa?ic manipulations to ! sp9e freely 9 all directions1 ?or\ghly loos5+ up ! muscles4 ,!n ,i replace ! ca/ & hold x toge!r 9 front ) molesk9 adhesive & ins]t ! pads z be=e4 ,i repeat ?is proc$ure ?ree times p] week = ano!r mon?1 toge!r ) daily ex]cises ea* morn+ & ev5+ ( draw+ ! left %\ld] up & =w>d :ile 9 ! ca/ to develop ! muscles ( ! left %\ld] girdle4 ,! treatm5ts & ex]cises c]ta9ly d build up ! sp9al muscles = x mu/ be realiz$ t !y h suff]$ 9 nutrition to a great ext5t z a result ( we>+ ! ca/4 ,next ! ca/ c be worn dur+ ! day & remov$ at night1 & gradually x c be left (f sev]al h\rs at a "t4 ,if no bad results occur x c be left (f = long] p]iods until f9ally its use c be discont9u$4 ,h[ev]1 ! pati5t %\ld /ill be "u obs]vation once a week = a c\ple ( mon?s to det]m9e any recurr5ce ( ! de=mity4 ,! resumption ( active corrective treatm5t1 or increas+ relaxation 9 gymna/ic "w1 w1 ( c\rse1 dep5d ^u ! progress ( ! case4 ,9 ! m ob/9ate cases1 ca/s %\ld be appli$ z long z fur!r correction c be obta9$4 ,! proc$ure is entirely ! same1 only ! "t requir$ = correction is long]1 sometimes a ye> or ye> & a half1 & :5 ov]correction has be5 ma9ta9$1 x is bett] to use a removable jacket made ( celluloid or light /iff5$ lea!r1 ) l>ge w9d[s cut ov] ! region :]e pressure is to be avoid$1 ?an ! removable ca/ describ$ above4 ,9 clos+ let me say t ?is me?od ( correct+ lat]al curvature is be/ adapt$ to pati5ts dur+ _! gr[+ p]iod & ?\gh x may be employ$ 9 old] cases y w usually be disappo9t$ 9 ! f9al result4 ,! only reason ,i c see = treat+ old] cases is purely m]c5>y4 ,cong5ital ,dislocation ( ! ,hip ,unilat]al ,und\bt$ly z f> back z #ahbi1 ! actual recognition ( ?is condition 0 due to ! pa?ological rese>* ( a ,fr5* surgeon ,dupuytr51 :o describ$ ?is de=mity ) great accuracy & insi/$ t !re 0 no possible *ance ( correction4 ,f !n on until #ahhf no?+ 0 done by m$ical sci5ce to ov]come ! de=mity1 ?\gh x is claim$ "s 7 made4 ,x 0 9 ?is ye> t ! fam\s ,bav>ian surgeon1 ,h(fa1 gave to ! m$ical pr(ession ! results ( 8 successful attempts at r$uction by op5+ ! hip jo9t f beh9d & enl>g+ ! acetabulum to a size suffici5t to hold ! head ( ! femur4 ,or?op$ic surg]y has to ?ank ! irritat+ effects on ! sk91 ( antiseptics necess>y 9 prep>+ 8 h&s = ord9>y surg]y1 z x 0 due to ?is triviality t ,lor5z1 a promis+ surgeon ( ,vi5na1 transf]r$ 8 en]gies to ! field ( bloodless surg]y & gave to u ! mo/ valuable e>ly "w & pres5t day te*nique 9 ! bloodless r$uction ( cong5ital dislocation ( ! hip4 ,! "n1 ( c\rse1 is appli$ to a cong5ital de=mity :i* involves "o or bo? hip jo9ts1 result+ 9 lam5ess1 due to a misplacem5t ( ! head ( ! femur f ! acetabulum4 ,( all cong5ital dislocations ! hip jo9t is by f> ! mo/ common & mo/ important4 ,! misplacem5t is f> m (t5 unilat]al ?an bilat]al & f> m frequ5t 9 females ?an 9 males1 ! cause = ! latt] probably be+ ! diff]5ce :i* exi/s 9 aspect & position ( ! acetabulum z well z ! disproportionate laxity ( ! capsule 9 ! two sexes4 ,x mu/ be rememb]$ t normally at bir?1 ! acetabulum cov]s only ab\t "o-?ird ( ! head ( ! femur1 & our mo/ accept$ !ory z to ! cause ( ?is de=mity1 is a defective developm5t ( ! acetabulum or its po/]ior m>g91 :i* may be prim>y or second>y to an abnormally prolong$ fixation ( ! limb 9 a position ( flexion or adduction :ile 9 ut]o4 ,at bir? x is q probable t ! dislocation is a subluxation only1 :i* becomes complete by muscul> action & ! use ( ! limb 9 /&+ & walk+4 ,! pa?ology ( ?is disease is cle>ly e/abli%$1 & v>ies1 ( c\rse1 ) ! age ( ! pati5t 9 /ra9 & friction to :i* ! misplac$ p>ts h be5 subject$4 ,9 *ildr5 ov] two & "o-half ye>s ( age ! acetabulum is usually %all[ & small1 & fill$ ) a deposit ( fat & fibr\s tissue4 ,x is cov]$ ) normal hyal9e c>tilage & ne>ly always ! ligam5tum t]es is pres5t1 b is s badly /ret*$ & ribbon-l t ultimately ! art]y accompany+ x fails to function1 result+ 9 a mal=mation ( ! head ( ! femur4 ,! capsul> ligam5t is elongat$ & ?ick5$ to accommodate ! upp] displacem5t ( ! femur1 & ! ant]ior wall ( x is /ret*$ tight across ! acetabulum l an h\r glass4 ,! int]ior ( ! capsule is always p>tly l9$ ) synovial membrane4 ,usually a second>y acetabulum is f\nd ^u ! ileum1 =m$ by ! direct pressure ( ! head ( ! femur ?r\gh ! capsule & ! result ( irritation ( ! p]io/eum ( ! ileum1 b x is z a rule1 n deep en\gh to =m a secure support = ! head ( ! bone4 ,! neck ( ! femur is usually %ort] ?an normal & ! upp] extremity ( ! bone is some:at atrophi$4 ,! pelvis is usually slightly atrophi$ on ! affect$ side1 & a lat]al incl9ation ( ! sp9e may be pres5t4 ,! long muscles ( ! ?igh are %ort5$2 :ile ^? atta*$ to ! pelvis & tro*ant] are *ang$ 9 direction & are usually l5g!n$4 ,illu/ration3 ,typical cong5ital dislocation ( ! hip1 %[+ ! 8h\r glass0 con/riction ( ! capsul> ligam5t4 ,symptoms4--,z a rule cong5ital dislocation ( ! hip is n accompani$ by ! defective developm5t or de=mity else:]e1 & ! symptoms are s diagno/ic t !re is little difficulty 9 recogniz+ ?is condition ev5 )\t ! ,x-ray :i* is1 ( c\rse1 a positive diagnosis4 ,r>ely does ! displacem5t attract att5tion until ! *ild beg9s to walk4 ,(t5 ! *ild does n walk z e>ly z x %\ld4 ,sometimes x may be delay$ until ! eighte5? mon? or second ye> & !n x walks ) a limp :i* becomes m pron\nc$ z ! *ild gr[s old] until at ! f\r? or fif? ye> x is v decid$4 ,! limp is peculi> & its "* is expla9$ by its cause2 = ! %ort5$ limb1 ow+ to ! ela/icity ( ! capsule1 becomes /ill %ort] :5 ! weight is borne ^u x1 ?us caus+ a peculi> lunge ( ! body t[>ds ! %ort side l ! normal motion ( walk+ d[n/airs4 ,9 comp5sation1 ( c\rse1 ! pelvis is tilt$ t[>ds ! %ort limb & its incl9ation is !reby increas$1 s t ! ant]ior sup]ior sp9e lies at a l[] level & 9 advance ( ! opposite side4 ,usually ! affect$ limb is ab\t an in* %ort] ?an ! s\nd "o1 & 9 adult life x is consid]ably m4 ,! range ( abduction is mu* dim9i%$1 b flexion1 ext5sion & adduction are q normal1 & ! tro*ant] w be f\nd elevat$ ab\t an in* above ,nelaton's l9e4 ,if ! ?igh be flex$ & adduct$ to its extreme limit1 ! neck & head ( ! femur c be easily di/+ui%$ mov+ "u ! gluteal muscles :5 ! limb is rotat$1 or ! head c usually be readily palpat$ 9 front :5 ! limb is ext5d$4 ,!n1 too1 by fix+ ! pelvis & us+ traction & upw>d pressure on ! limb1 ! abnormal mobility or telescopic motion is easily demon/rat$ & ?is1 ,i might add1 is a v important te/4 ,illu/ration3 ,outl9e ( a radiograph foll[+ r$uction & removal ( ! fir/ ca/ 9 unilat]al dislocation ( ! hip4 ,notice ! head 9 ! socket & ! ?igh /ill flex$ & abduct$4 ,r>ely d we f9d a unilat]al ant]ior dislocation1 9 :i* ! head ( ! bone lies b5ea? ! ant]ior sup]ior sp9e1 b :5 ?is position is pres5t1 ! symptoms are mu* less m>k$ ?an 9 ! ord9>y =m because ! relation ( ! pelvis to ! femur is m ne>ly normal4 ,! limp & ! %ort5+ ( ! limb are less noticeable because ! tissues atta*$ to ! ant]ior sup]ior sp9e =m a relatively secure support4 ,! ,x-ray1 ( c\rse1 makes ! diagnosis complete4 ,ev5 ?\gh ! cl9ical diagnosis is c]ta91 a radiograph is indisp5sable 9 e case1 p>ticul>ly = ! purpose ( asc]ta9+ ! exact position ( ! head & condition ( ! acetabulum & femur4 ,! acetabulum is usually %all[ & poorly develop$1 m p>ticul>ly ! iliac portion ( its rim4 ,aft] ! r$uction ( ! dislocation1 an ,x-ray picture %\ld always be tak5 )9 ! fir/ few weeks1 & be=e ! pla/] ( p>is ca/ has be5 remov$1 to asc]ta9 :e!r ! head ( ! femur is /ill 9 place4 ,illu/ration3 ,outl9e ( ! same case foll[+ removal ( ! second ca/4 ,! head ( ! femur is firmly fix$ 9 ! acetabulum & ! position ( ! limb is ne>ly normal4 ,z to bilat]al dislocation ( ! hip1 ! pa?ology1 ( c\rse1 is ! same z 9 ! unilat]al type4 ,! %ort5+ ( ! limbs is z a rule equal or ne>ly s1 & :5 bo? femurs are displac$ backw>d1 ! pelvis is tilt$ =w>d ?us pres5t+ a m>k$ lumb> lordosis & protrud+ abdom54 ,! pelvis seems to be abnormally wide1 bo? buttocks are flatt5$ & ! ?ighs are sep>at$ by a consid]able space4 ,! *>act]i/ic limp 9 ?is condition is an exagg]at$ waddle1 (t5 spok5 ( z 8sailor gait40 ,aga9 9 ?is condition r>ely d we f9d an ant]ior dislocation1 b :5 su* is ! case1 ! entire body is sway$ entirely backw>d1 ?\gh ! lumb> lordosis is n increas$1 9 fact usually pres5ts a peculi>ly flatt5$ appe>ance4 ,o!r symptoms diff] only 9 a slight degree f ^? ( ! ord9>y po/]ior displacem5t4 ,! physical signs are ! same z ! unilat]al displacem5t & are ev5 m readily recogniz$ by ! peculi> appe>ance & di/9ctive gait ( ! pati5t4 ,! swagg]+ gait ( lumb> ,pott's ,disease is some:at simil>1 b ?is is an acquir$ cl9ical condition ( ! sp9e 9 :i* ! hip jo9ts are normal 9 appe>ance & ne>ly s 9 function4 ,be=e tak+ up ! usual proc$ure = ! correction ( cong5ital dislocation ( ! hip1 x might be int]e/+ to t\* on sev]al cases ( ?is de=mity 9 "y *ildr5 t ,i h r$uc$ )\t an ane/hetic4 ,if future exp]i5ce proves z successful z ^! cases x w entirely revolutionize ! treatm5t ( ?is condition especially 9 *ildr5 "u tw5ty mon?s ( age4 ,to beg9 )1 ^! *ildr5 _h j />t$ to walk & x mu/ be rememb]$ t at ?is /age ! acetabula are ne>ly normal & !re has be5 no muscul> or ligam5t\s contraction because v little weight has be5 borne on ! limb4 ,fir/ ! pelvis is held fix$ by ! assi/ant1 & ! ?ighs completely flex$ on ! abdom54 ,next firm pressure is made on ! knee to =ce ! head ( ! femur b5ea? ! acetabulum & z ! limb is abduct$ 9 ! flex$ position1 ! head is rais$ into ! acetabulum ) ! ?umb ( ! op]ator's o!r h&4 ,! :ole proc$ure takes b a mom5t's "t & ! *ild %\ld be plac$ at once ^u ! floor & all[$ to walk4 ,"t w tell if ! r$uction has be5 successful1 & if failure ( ret5tion develops1 ! ,lor5z me?od foll[$ by pla/] ( ,p>is fixation c /ill be us$4 ,i %\ld always recomm5d ! trial ( ?is me?od 9 *ildr5 :o h walk$ n long] ?an six mon?s1 be=e resort+ to ! foll[+ ,lor5z treatm5t4 ,treatm5t by ! ,lor5z ,op]ation4--,?is treatm5t is bas$ on ! fact t !re is normally pres5t an acetabulum ( suffici5t size & capacity to reta9 ! head ( ! femur1 provid+ ! limb c be fix$ 9 a favorable attitude1 & z soon z possible weight borne ^u x to deep5 ! rudim5t>y acetabulum4 ,! typical op]ation ( today is be/ divid$ into f\r di/9ct /eps2 fir/1 to ov]come ! resi/ance ( ! tissues surr\nd+ ! jo9t2 second1 to r$uce ! dislocation1 or r to =ce ! head ( ! femur ov] ! po/]ior bord] ( ! acetabulum2 ?ird1 to increase ! security ( ! articulation by /ret*+ ! ant]ior bord] ( ! capsule2 f\r?1 to fix ! p>ts 9 a pla/] ( ,p>is b&age4 ,! *ild is completely ane/hetiz$1 & an assi/ant firmly fixes ! pelvis on ! table ) 8 h&4 ,! op]ator fir/ flexes ! ?igh to a "r angle ) ! body & =cibly abducts1 at ! same "t knead+ & /ret*+ ! t5se adductor muscles & if necess>y ruptur+ ! adductor t5dons 9 ord] to br+ ! limb d[n to ! plane ) ! body4 ,next to ov]come ! contraction ( ! po/]ior tissues1 ! limb fully ext5d$ is flex$ ^u ! trunk & gradually =c$ d[nw>d until ! toes t\* ! pati5t's face4 ,to ov]come ! resi/ance ( ! tissues on ! front ( ! jo9t1 x is be/ to move ! pati5t to ! edge ( ! table & =cibly ext5d ! ?igh d[nw>d beh9d ! plane ( ! body4 ,x is also well to apply direct traction 9 ! l9e ( ! body4 ,?is prelim9>y /ret*+ is absolutely necess>y1 because all ! tissues ab\t ! jo9t are s %ort5$1 & x w n[ be not$ t ) slight traction ! tro*ant] c be drawn d[n to ,nelaton's l9e4 ,next r$uction is attempt$ by grasp+ ! limb ) "o h& at ! knee & /rongly abduct+ x :ile ! palm ( ! o!r h& is plac$ on ! ant]ior sp9e ( ! ilium ) ! ?umb plac$ b5ea? ! great tro*ant] to act z fulcrum4 ,z ! limb is gradually =c$ d[nw>d to & beh9d ! body plane1 ! head ( ! femur is =c$ upw>d until x f9ally slips ov] ! po/]ior & inf]ior bord] ( ! acetabulum4 ,9 ! m resi/ant cases a padd$ w$ge-%ap$ block plac$ beh9d ! tro*ant] w be an aid 9 pu%+ ! head =w>d & upw>d :ile ! pati5t's knee is =c$ d[nw>d4 ,a successful r$uction is usually accompani$ by a di/9ct j> & audible ?ud1 & x w\ld be obs]v$ t ! t5sion ^u ! ham /r+ muscles causes fix$ flexion ( ! leg4 ,aft] r$uction has be5 made1 ! limb %\ld be br\ght d[n c>efully into a /raight position to te/ ! security ( ! re-position4 ,if dislocation appe>s dur+ ?is manipulation1 ! tissues mu/ be /ill fur!r /ret*$ & ! displacem5t fur!r r$uc$4 ,if displacem5t occurs readily due to a %all[ness ( ! acetabulum ! prognosis is n s good z :]e ! /ability rema9s :5 ! limb is br\ght d[n into a /raight position1 & "o mu/ be m p>ticul> 9 ! fixation ( x4 ,i h also obs]v$ t ! m difficult ! r$uction ! m /able ! end results4 ,! easy replacem5ts are usually j z easily displac$4 ,sometimes ! head slips into ! socket quietly )\t ! di/9ct j> or ?ud b ! results 9 ^! cases are j z good provid$ !y are prop]ly ca/4 ,illu/ration3 ,pati5t 9 position = ! fir/ ca/ 9 a left unilat]al dislocation4 ,! ?igh %\ld be a little pa/ a "r angle 9 relation to ! trunk1 ) ab\t #hj abduction4 ,! application ( ! pla/] spica is by f> ! mo/ important "p ( ! treatm5t1 z ! r$uction is usually q easily accompli%$ 9 *ildr5 "u six ye>s ( age4 ,if ! ca/ is improp]ly appli$1 ! hip w slip out ( ! socket & ! case is a failure4 ,a pair ( s(t knitt$ cotton draw]s are put on & ! pati5t is plac$ ^u a pelvic re/ ) ! limb held 9 ! position ( greate/ /ability at a "r angle ) ! trunk1 or ev5 slightly m & ab\t eighty degrees abduction4 ,9 a case :]e ! socket is v %all[1 ! position to be ca/ %\ld be ab\t "o hundr$ degrees flexion1 & 9 abduction ! limb %\ld lie slightly beh9d ! plane ( ! body to secure ! be/ results4 ,illu/ration3 ,correct position & prop] application ( ca/ = d\ble cong5ital dislocation ( ! hips4 ,! limb & pelvis are cov]$ ) ord9>y absorb5t cotton :i* is held 9 place ) a roll] gauze b&age4 ,a snug fitt+ pla/] ( ,p>is ca/ is n[ appli$ ar\nd ! pelvis & well d[n ov] ! knee4 ,i leave ?is ov] ! knee = five or six days or until ! *ild ceases to be fretful1 !n ,i cut x away j back ( ! knee jo9t to p]mit motion !re4 ,! ends ( ! draw]s are drawn back smoo?ly ov] ! ca/ & are sew$ to ea* o!r4 ,= ab\t a week foll[+ ! op]ation ! adductor region is swoll5 & discolor$ & m or less pa9ful due to ruptur+ & /ret*+ ( ^? t5dons4 ,aft] ?is discom=t has pass$ away1 walk+ is enc\rag$ on ! !ory t ! weight be>+ & ! /imulation ( functional activity w increase ! /ability ( ! jo9t by deep5+ ! acetabulum4 ,illu/ration3 ,prop] position ( ! limb 9 ! second ca/ = unilat]al dislocation4 ,! fir/ ca/ %\ld rema9 f ?ree to six mon?s accord+ to ! /ability ( ! jo9t at ! "t ( r$uction4 ,if 9 "y *ildr5 ! ca/ becomes (f5sive1 x mu/ be *ang$ z (t5 z is necess>y4 ,:5 ! fir/ ca/ is remov$1 ! limb is pull$ d[n to ab\t ?irty degrees abduction & ! same am\nt ( flexion1 )\t an ane/hetic1 & a second ca/ is appli$1 :i* ext5ds only to ! knee1 to be worn f ?ree to six mon?s long]4 ,aft] removal ( second ca/1 ! *ild is p]mitt$ to get ab\t c>efully4 ,! limb w be ev]t$ & slightly flex$1 :i* position inv>iably causes mu* conc]n among ! relatives ( ! pati5t1 b ?is abnormal condition disappe>s aft] a few mon?s' "t4 ,sometimes = ev5 a ye> foll[+ removal ( ! second ca/ !re w also be a noticeable hit* 9 ! walk ( ! *ild2 b ?is1 too1 disappe>s & 9 ! c\rse ( two ye>s' "t "o c\ld nev] tell t su* an op]ation _h be5 p]=m$4 ,massage ( ! po/]ior & lat]al muscles ( ! hip always helps consid]ably t[>ds ! relief ( any /iffness or lam5ess4 ,r$uction by ,op5 ,incision ,9 ! m resi/ant old] cases1 :]e manipulative r$uction has fail$1 r$uction by incision c be employ$ ) success1 b ?is proc$ure requires ! ex]cise ( c>e 9 ord] to d z little injury to ! muscles z possible4 ,a crucial incision ( ! capsule is made & ! capsul> con/riction & ilio-psoas t5don divid$4 ,) a little traction1 ! head ( ! femur slips easily into its socket4 ,! capsule is /ret*$ firmly ar\nd ! neck & ! incision into ! capsule is !n clos$ by suture1 & ! limb fix$ 9 a pla/] ( ,p>is spica 9 ! fully abduct$ position4 ,! op]ation %\ld ( c\rse be done "u ! /ricte/ asepsis4 ,talipes or ,club ,foot ,! ^w talipes signifies "s de=mity ( ! foot & is q common 9 or?op$ic practice1 be+ f\nd 9 ne>ly t5 p] c5t ( ! cases com+ "u ?is bran* ( ! sci5ce4 ,club foot may be classifi$ into two types--! cong5ital & ! acquir$4 ,! cong5ital type is ! mo/ common & is due probably to abnormal intraut]9e pressure or to a p]v]sion ( normal intraut]9e developm5t4 ,! acquir$ type is due usually to injury or infantile p>alysis1 b ei!r jo9t disease or c]ebral p>alysis may be ! cause4 ,! de=mity pres5ts six diff]5t =ms ) mo/ *>act]i/ic cl9ical pictures :i*1 ) ! exception ( talipes planus ,i h tak5 up 9 ! ord] ( frequ5cy4 ,illu/ration3 ,illu/rat+ ! m common types ( talipes4 ,a comb9ation ( any may be pres5t4 ,talipes ,equ9ov>us is usually cong5ital & is ! mo/ common type4 ,x is *>act]iz$ by inv]sion & torsion ( ! foot ) elevation ( ! heel4 ,! weight is borne on ! out] side ( ! foot & 9 extreme cases ^u ! dorsum z well4 ,calluses are always pres5t :i* are r$ & pa9ful ^u ! po9t :]e ! greate/ weight is borne4 ,! mo/ common me?od ( treat+ ?is condition is to divide ! t5do ,a*illes at a level ) ! malleoli4 ,! op]ation %\ld be done aseptically & "u complete ane/hesia4 ,z an assi/ant raises ! end ( ! foot s z to /ret* ! t5do ,a*illes ! surgeon ent]s ! knife p>allel to ! bord] ( ! t5don ?r\gh ! sk9 & t5don %ea? into ! t5don itself4 ,next ) a t5otome ins]t$ into ! incision & turn$ at "r angles to ! t5don1 ! t5don is divid$ fir/ on "o-half !n on ! o!r4 ,c>e %\ld be tak5 to di/urb ! t5don %ea? z little z possible = x s]ves an important purpose 9 repair4 ,:5 ! division is complete z indicat$ by ! sep>ation ( ! divid$ ends1 ! t5otome is )drawn & ! m9ute op5+ 9 ! sk91 f :i* !re is only slight ble$+1 is cov]$ ) aseptic gauze4 ,! foot is =c$ into dorsal flexion & if 9 sev]e cases ! de=mity is n !n correct$1 ! t5dons on ! out] side ( ! foot may be %ort5$1 :ile ^? on ! inn] side may be l5g!n$ 9 ! same mann] z ! t5do ,a*illes4 ,a pla/] ( ,p>is ca/ is !n appli$ well up to ! knee ) ! foot 9 ! ov] correct$ position1 c>e be+ tak5 t no undue pressure is br\ght ^u ! seat ( op]ation1 z ?is might int]f]e ) ! effusion ( pla/ic mat]ial4 ,p]sonally ,i believe t functional use ( ! limb & foot /imulate repair1 & ,i always enc\rage ! pati5t to /& & walk aft] ! discom=t ( ! op]ation has pass$4 ,at ! end ( f\r weeks ! space betwe5 ! two cut ends w be fill$ ) new mat]ial & ! ca/ c be remov$1 & 9 ano!r mon? ! splice1 :i* is some:at l>g] & ?ick] ?an normal1 %\ld be /rong en\gh = use4 ,9 ! c\rse ( a ye> ! l5g!n$ t5don is p]fectly normal4 ,talipes ,equ9us4--,9 ?is type ! pati5t walks on 8 toes ) ! heel highly elevat$1 9 ! same position z ! horse1 & x w be notic$ t ! foot has no dorsal flexion :atsoev]4 ,infantile p>alysis affect+ ! ant]ior muscles ( ! leg is usually ! cause ( ?is condition1 ?\gh sometimes %ort5+ ( ! leg foll[+ knee jo9t disease1 or fracture may lead to an adaptive equ9us :i* s]ves to make ! limb ( equal l5g? = walk+4 ,?is type is by f> ! easie/ to rem$y1 & ! results foll[+ op]ations are p]fect4 ,a simple division ( ! t5do ,a*illes is made "u ane/hesia & a ca/ appli$ z above1 9 a position ( exagg]at$ dorsal flexion4 ,functional use ( ! limb aft] ! ca/ has be5 remov$ ov]comes any /iffness t might occur & p]fect results are obta9$ 9 a %ort "t1 comp>$ ) ! o!r types4 ,talipes ,calcane\s4--,?is is a condition 9 :i* ! foot is held 9 a position ( dorsal flexion4 ,! pati5t walks on ! heel ) an inela/ic gait because ! spr+ ( ! foot is abs5t & ! :ole weight is borne ^u ! os calcis4 ,! be/ proc$ure 9 ?is type is manipulative treatm5t into a position ( plant> flexion to ov]come ! contraction ( ! ant]ior muscles ( ! foot & leg1 & br+ ab\t contraction & %ort5+ ( ! po/]ior muscles4 ,a t5otomy ( ! ant]ior t5dons or an ane/hetic is r>ely indicat$1 ?\gh 9 sev]e cases1 a s]ies ( ca/s hold+ ! foot 9 position ( plant> flexion may be necess>y to secure good results4 ,i h f\nd x a help to h a %oe ) a heel prolongat$ backw>d1 or a /eel spl9t lac$ to ! leg to prev5t ! foot f upw>d motion4 ,talipes ,valgus4--,?is is a v uncommon type ( de=mity1 *>act]iz$ by ev]sion ( ! foot4 ,! pati5t walks on ! inside ( ! foot &1 z a rule1 exp]i5ces v little tr\ble4 ,i f9d a manipulative treatm5t is be/ = ?is condition1 aid$ by braces4 ,talipes ,cavus4--,?is =m is sometimes call$ 8holl[ foot0 & is v uncommon 9 ?is c\ntry4 ,x is *>act]iz$ by a m>k$ly high ar* sometimes z 9 ,*9ese wom5 to ! ext5t t ! ant]ior "p ( ! foot is approximat$ to ! heel4 ,! plant> fascia is badly contract$ & "o c di/9ctly palpate ! b&s b5ea? ! sk94 ,?is condition is practically ! same z ! ord9>y s-call$ 8contract$ foot0 except t x is mu* m exagg]at$4 ,! ord9>y high ar* ( today is usually ! result ( we>+ too %ort a %oe1 & if pa9ful1 long la/ %oes1 aid$ by manipulations1 w usually correct ! tr\ble4 ,9 sev]e cases ( contract$ foot ! plant> fascia may be divid$1 "u ane/hesia & ! ar* br\ght d[n & put 9 a ca/1 ?\gh ?is proc$ure is n v successful4 ,9 case x is done ! pati5t %\ld be made to walk 9 two or ?ree weeks1 z ?is helps mat]ially to ov]come ! de=mity & ha/5 repair ( ! fascia4 ,talipes ,planus4--,?is condition is commonly kn[n z 8flat foot0 & is tak5 up 9 ano!r "p ( ?is text4 ,h[ev]1 x is "o ( ! classifications ( 8club foot0 & is f> ! mo/ common type4 ,prognosis4--,^! conditions nev] correct !mselves & if uncorrect$ usually get worse & ! m sev]e types c]ta9ly become ob/9ate mal=mations4 ,9 g5]al ! t5d5cy to relapse is /rong1 ?\gh if prop]ly treat$ ! results are excell5t4 ,9 infantile cases ! "t requir$ = correction is relatively %ort1 b ret5tive appliances are ne$$ = a long] "t4 ,! old] ! cases & l>g] ! foot ! m difficult1 ( c\rse1 ! correction1 b usually !re is less dang] ( relapse4 ,a p]fect correction1 t is :5 ! gait & attitude are normal1 w nev] relapse4 ,i f9d x bett] to leave ! fixation appliance on too long ?an n long en\gh4 ,nev] remove a ca/ "u f\r weeks except 9 ! cavus type1 !n apply a brace su* z c be obta9$ f any supply h\se = any type ( case1 = f "o to ?ree mon?s long]4 ,! t5dons involv$ 9 ^! conditions are s app>5t t x is almo/ impossible to make a mi/ake 9 ! division ( !m4 ,ab\t ! only precaution necess>y is to be assur$ t ! t5don itself is completely divid$1 b t ! t5don %ea? is only slightly di/urb$4 ,tub]cul\s ,disease ( ! ,bones & ,jo9ts ,p]haps no bony lesion has caus$ s mu* diff]5ce ( op9ion 9 ?is pr(ession z tub]cul> conditions ( ! sp9e1 bones & jo9ts & ,i wi% x und]/ood t 9 ! foll[+ discussion1 x is n my desire to reop5 ! argum5t4 ,my obs]vations h be5 ( cases treat$ bo? o/eopa?ically & by fixation1 9 private practice & in/itutional "w4 ,& ,i h come to ! conclusion t ! fixation me?od ( treatm5t is absolutely always indicat$4 ,9 g5]al ! pa?ology & etiology ( all tub]cul> bone conditions is ! same4 ,x beg9s z a tub]cul> infection ( ! spongy tissue ( ! epiphysis1 ! fir/ *ange be+ a local hyp]emia ( ! portion involv$1 foll[$ by "o ( ?ree c\rses3 ! diseas$ focus be+ absorb$ & a spontane\s cure result+2 x may ext5d to ! p]iph]y ( ! bone & break ?r\gh ! p]iositum & empty itself !re by abscess =mation2 or mo/ commonly x may ext5d to ! jo9t1 :i* becomes involv$ ?r\gh att5dant injury4 ,repair is br\ght ab\t by ! =mation ( fibr\s tissue probably aris+ f ! lay] ( non-tub]cul\s granulation tissue :i* gr[s 9 & replaces ! tub]cul\s tissue4 ,also ! replac+ mat]ial may become calcifi$ & encapsulat$4 ,a fibr\s or bony ankylosis may result f ?is process ( repair4 ,! vuln]ability ( gr[+ bone acc\nts = ! frequ5cy ( tub]cul> bone disease 9 *ildr5 z comp>$ ) adult life4 ,injury n only causes a local pr$isposition to ! disease1 b x favors its progress :5 x is once e/abli%$4 ,ab\t sev5-eigh?s ( ! cases ( ?is tr\ble occur "u f\rte5 ye>s ( age1 m especially :5 ! v]tebr or hip-jo9t are involv$4 ,! knee & ankle jo9ts z well z ! elb[ & %\ld] jo9ts are m (t5 diseas$ 9 lat] life4 ,:ile ! inh]it$ pr$isposition is v direct & positive 9 tw5ty-five p]c5t ( ! cases1 ! acquir$ pr$isposition is ( mo/ importance s9ce x includes less5$ vitality due to poor food & imp]fect hygi5ic surr\nd+s4 ,z to ! di/ribution ( ! disease ! v]tebr are mo/ commonly affect$1 foll[$ closely by ! hip & knee jo9ts1 & !n 9 ! ord] ( frequ5cy ! ankle1 elb[1 %\ld] & wri/ jo9ts4 ,tub]cul> ,disease ( ! ,sp9e ,?is condition is commonly call$ ,pott's ,disease or ,c>ies4 ,x is a *ronic de/ructive process ( ! bodies ( ! v]tebr4 ,! sp9e b5ds at ! weake/ po9t & ! compression & collapse ( ! affect$ p>ts cause ! *>act]i/ic po/]ior angul> projection at ! seat ( ! disease4 ,if "o v]tebral body is de/roy$1 ! projection w be %>p2 if sev]al are involv$ x w be less angul> & if "o side breaks d[n be=e ! o!r1 !re may be a lat]al z well z po/]ior di/ortion4 ,! size ( ! de=mity & its effect ^u ! pati5t dep5d ^u its situation2 t is1 if ei!r end ( ! sp9e is involv$ ! angul> projection is slight because ! area ( ! sp9e directly involv$ 9 ! de=mity is small comp>$ ) t :i* is free f ! disease4 ,if ! middle ( ! sp9e is affect$1 ! de=mity is great1 because ! entire sp9al column may ent] into ! angul> projection4 ,9 ! latt] area ! int]nal organs are compress$ &1 ( c\rse1 ! effect ^u ! vital organisms ( ! body is disa/r\s4 ,pa?ology4--,! fir/ indication ( tub]cul> disease ( ! sp9e is usually f\nd 9 ! ant]ior "p ( a v]tebral body j b5ea? ! fibro-p]io/eal lay] ( ! ant]ior longitud9al ligam5t4 ,f ?is po9t ! foci may advance along ! front ( ! sp9e foll[+ ! c\rse ( ! blood vessels & invad+ ! adjac5t v]tebral bodies4 ,! de/ruction may beg9 9 ! int]ior ( ! body itself1 m (t5 9 sev]al m9ute foci ne> ! upp] or l[] epiphysis1 :i* coalesce1 gradually enl>ge & =m a cavity surr\nd$1 = a "t1 by unbrok5 cortical sub/ances :i* f9ally collapse "u ! pressure ( ! weight above4 ,! int]v]tebral discs seem to (f] "s resi/ance to ! ext5sion ( ! disease f "o v]tebra to ano!r b once ! bone is de/roy$ on ei!r side1 !y too quickly dis9tegrate & disappe>4 ,p$icles & articulations :i* come into direct contact ) ! disease may become involv$4 ,orig9ally ! disease is conf9$ to "o or two adjac5t v]tebr & may ext5d 9 ei!r direction1 & ! f9al area ( de=mity & rigidity %[s t f ?ree to six bodies may be involv$ be=e a cure is e/abli%$4 ,! infect$ granulations advance rapidly ) ! usual retrograde *ange ( %ape & /ructure to a *eesy deg5]ation & frequ5tly liquefaction & abscess =mation may foll[4 ,symptoms ( ,pott's ,disease4--,!re are ?ree ma9 symptoms ( ,pott's disease1 namely ! peculi>ity ( attitude & gait1 limitation ( motion or muscul> /iffness & ! pa9 & ref]r$ pa9s4 ,9 ! c]vical region1 ! *9 is held some:at rais$ & ! pati5t may h some:at ! same appe>ance z 9 wry-neck4 ,9 ! mid-dorsal region "o w always f9d an elevation ( ! %\ld] besides ! de=mity4 ,9 ! lumb> region1 ! pati5t ne>ly always leans backw>d & has a sort ( sidl+ gait or waddle due to ! contraction ( ! psoas & iliacus muscles4 ,! pati5t 9 walk+1 /oop+1 or ly+ d[n mo/ c>efully gu>ds ! sp9e aga9/ any j> or motion1 & always assumes attitudes :i* w relieve ! /ra9 on ! involv$ v]tebr4 ,!re is always pres5t an unnatural mode ( /&+ or walk+1 especially :5 ! dorsal & lumb> regions are involv$1 z ! pati5t walks m on 8 toes & ) ! knees slightly b5t1 because 9 ?is po/ure all possible /ra9 ( ! /ep may be br\ght into play to dim9i% j>r+ ( ! sp9e4 ,! *ild becomes tir$ v easily & lies d[n or re/s on ! arms ( a *air or seat4 ,! pa9 r>ely occurs 9 ! back1 b is usually ref]r$ to ! p]iph]al end ( ! n]ves & is ?us felt 9 ! *e/1 abdom5 or limbs4 ,! abdom9al pa9 passes sometimes z a /oma* a*e & (t5 times 9 ! limbs1 z rheumatism or 8gr[+ pa9s04 ,i h notic$ also a peculi> grunt+ respiration & sometimes c\gh especially :5 ! mid-dorsal region is involv$4 ,muscul> /iffness is always pres5t1 all mobility be+ lo/4 ,! temp]ature is n at all diagno/ic1 ?\gh sometimes 9 ! aft]noon x w be "o or two degrees high] ?an normal & does occur indep5d5tly ( abscesses4 ,ab\t ! only complication t occurs is p>alysis or abscess =mations4 ,p>alysis is giv5 z a frequ5t complication1 ?\gh ,i h nev] se5 x4 ,x is usually flaccid & bilat]al & may exi/ f a m]e muscul> weakness to a complete loss ( p[]4 ,x is c]ta9ly uncommon "u prop] treatm5t1 & ! prognosis is favorable4 ,abscesses1 ?\gh a v di/ress+ complication1 are v uncommon 9 my exp]i5ce & are c]ta9ly an evid5ce ( improp] or incomplete treatm5t4 ,!y may subside 9 any region & be absorb$ )\t detrim5t to ! pati5t1 ?\gh if !y increase 9 size !re is no t5d5cy t[>ds absorption4 ,x is be/ to incise !m & secure complete dra9age4 ,x is h>d1 ( c\rse1 to d ?is on acc\nt ( ! dep?4 ,abscesses occur always 9 close proximity to ! disease4 ,treatm5t4--,"s au?ors recomm5d a brace = ! treatm5t ( ?is condition1 :ile o!rs recomm5d a frame to :i* ! pati5t is /rapp$1 & re/ 9 b$4 ,i h f\nd no?+ t gets results l a pla/] ( ,p>is jacket appli$ ) ! pati5t susp5d$ by ! neck & %\ld]s4 ,i make no attempt at correction ( ! de=mity pres5t o!r ?an ! traction ( ! weight ( ! body at ! "t ! ca/ is appli$4 ,! sp9e is1 ( c\rse1 fully ext5d$ by ?is & any undue pressure on ! cord reliev$4 ,! ca/ %\ld ext5d ov] ! %\ld]s & well d[n ov] ! pelvis & sacrum4 ,if ! disease is 9 ! neck ! ca/ %\ld include ! head z well4 ,a l>ge w9d[ is cut 9 front & "o mu/ be cut ov] ! involv$ area ( ! sp9e beh9d4 ,ord9>y absorb5t cotton is us$ = padd+ )1 ( c\rse1 extra padd+ ov] all bony prom95ces4 ,f two to five ye>s' "t is requir$ = a complete recov]y4 ,! ,x-ray is invaluable 9 diagnos+ ?is tr\ble1 & ea* "t a ca/ is remov$ to see h[ mu* progress has be5 made4 ,! ca/s %\ld be *ang$ z (t5 z !y become soil$4 ,tub]culosis ( ! ,hip ,?is is a *ronic tub]cul> condition ( ! head ( ! femur or ( ! acetabulum commonly kn[n z hip-jo9t disease4 ,pa?ology4--,prim>ily ! head ( ! femur is ! seat ( ! disease1 ! epiphysis be+ attack$ 9 sev5ty-five p] c5t ( ! cases & ! acetabulum 9 tw5ty-five p] c5t4 ,! irritat$ pelvic femoral muscles :i* are 9 a /ate ( *ronic contraction cr[d ! head ( ! femur aga9/ ! upp] & back bord] ( ! acetabulum4 ,"u ?is cont9ual pressure1 absorption ( t portion ( ! rim takes place ) actual enl>gem5t ( ! acetabulum f bel[ upw>ds4 ,?is is spok5 ( 8migration ( ! acetabulum0 & is "o cause = ! %ort5+ ( ! limb4 ,*anges 9 ! head ( ! femur are ! result ( inflammation & pressure4 ,p>tial de/ruction ( ! head also helps %ort5+ ( ! limb & elevation ( ! tro*ant] above its prop] level ! same z ! we>+ away ( ! acetabulum4 ,! synovial membrane is f\nd to be r$d5$ & ?ick5$ & granulation tissue is pres5t1 & usually ! c>tilage is gone f ! head ( ! femur4 ,r>ely does p]=ation ( ! floor ( ! acetabulum take place1 b if su* is ! case a d5se wall ( fibr\s tissue & ?ick5$ p]io/eum %uts (f ! head ( ! femur f ! pelvic cavity4 ,a natural cure results 9 two ways1--by absorption or calcification ( ! tub]cul> tissue1 or by ! evacuation & dis*>ge by an ext]nal op5+4 ,?is latt] suppuration seems to be nature's ef=t to elim9ate ! disease1 & :5 a cure is e/abli%$ ?is way x is usually *>act]iz$ by malpositions & %ort5+ ( ! limb1 &1 ( c\rse1 an ankylos$ jo9t4 ,e>ly ,symptoms4--,! mo/ *>act]i/ic symptoms ( ! disease are ! #8night cries'1 /iffness & limp+1 %ort5+ ( ! leg1 atrophy ( ! muscles ( ! hip1 leg1 & ?igh1 & ! unconsci\s protection ( ! jo9t4 ,a ref]r$ pa9 is usually pres5t to ! inside & front ( ! ?igh ne> ! knee or directly at ! knee jo9t itself1 due to ! intimate relations & ana/amosis ( sciatic1 obturator1 & ant]ior crural n]ves4 ,diagnosis4--,! *ief diagno/ic sign is muscul> spasms or ! pres5ce ( /iffness ( ! jo9ts & limitations ( its prop] arc ( motion1 due to ! tonic contraction ( ! muscles controll+ ! jo9t4 ,if !re is no limitation ( motion x is almo/ safe to say !re is no hip-jo9t disease4 ,! lam5ess may be int]mitt5t4 ,! attitudes or abnormal positions ( ! diseas$ limb are caus$ by ! action ( muscles hold+ ! limb /iffly 9 a di/ort$ position4 ,! pelvis is usually tilt$ & always "o w f9d ! pati5t assum+ attitudes :i* w favor ! diseas$ limb4 ,atrophy is v significant & a comp>ison ( ! two limbs %\ld be made by measur+ at ! middle ( ! ?igh & ! middle ( ! calf4 ,ne>ly always "o w f9d a deep ?ick5+ ov] ! front ( ! hip jo9t & beh9d ! tro*ant]4 ,physical ,exam9ation4--#a4 ,obs]ve ! g5]al condition ( ! pati5t4 #b4 ,note ! attitude 9 /&+4 #c4 ,note "* ( ! limp4 #d4 ,note %ort5+ ( ! limb4 #e4 ,remove ! clo?+ & lay pati5t on ! back4 #f4 ,te/ ! function ( ! gro94 ,always beg9 on ! s\nd side = comp>ison 9 ord] t ! pati5t may become accu/om$ to ! manipulation be=e ! limb suspect$ ( disease is te/$4 ,tub]culosis 9 a jo9t is always accompani$ by muscul> spasms t positively limit motion 9 e direction1 :ile 9 o!r affections only "o or m limitations are obs]v$1 b nev] 9 all directions4 ,comp>e closely ! motions ( ! s\nd & affect$ limbs :ile ! pati5t is on ! back4 ,turn pati5t on face & te/ = ext5sion by hold+ pelvis flat on table ) "o h& & g5tly elevat+ ?igh ) ! o!r4 ,! normal range 9 a *ild is ab\t tw5ty degrees backw>d f ! l9e ( ! body & limitation ( ?is range is p]haps ! e>lie/ indication ( hip-jo9t disease4 ,x is due to psoas contraction4 ,if ?is range ( motion is unre/rict$ hip disease c be practically exclud$4 ,! ,x-ray completes ! diagnosis :5 us$ ) a ?or\gh k ( ! physical signs4 ,x mu/ be rememb]$ t 9 e>ly life a l>g] "p ( ! extremity ( ! femur is c>tilag9\s & does n %[ well 9 a radiograph4 ,! ,x-ray picture %[s cle>ly ! de/ructive effect ( ! disease on ! femur & acetabulum & gives a cle> conception ( ! actual condition ( ! jo9t4 ,treatm5t4--,! object ( treatm5t ( ?is condition is ?reefold3 fir/1 to relieve ! pa9 t depresses ! vitality ( ! pati5t2 second1 to relieve ! muscul> spasms t induce di/ortion ( ! limb & :i* /imulates ! de/ructive process by increas+ pressure & friction ( ! diseas$ surfaces ( ! oppos+ bones2 ?ird1 to correct & prev5t de=mity by less5+ pressure & by re/ra9+ motion1 !reby keep+ ! femur f upw>d displacem5t4 ,re/ & protection are ! two c>d9al features ( treatm5t ( ?is condition4 ,sun%9e1 fre% air & good nutriti\s diet are v important4 ,complete re/ ( ! jo9t (f]s ! mo/ favorable opportunity = nature to repair ?is disease4 ,! recumb5t p]iod ( ! treatm5t necessitates re/ 9 b$ = ! r$uction ( ! de=mity & subsid5ce ( acute symptoms4 ,by ! aid ( traction1 :i* is appli$ to ! l5g? ( ! legs by means ( a ,buck's ext5sion4 ,z mu* weight %\ld be appli$ z c be borne )\t discom=t to ! pati5t4 ,z soon z ! de=mity & acute symptoms h subsid$1 ! ambulatory treatm5t %\ld be sub/itut$ to keep up ! g5]al heal? ( ! pati5t4 ,?is m]ely consi/s ( ! application ( a long pla/] ( ,p>is spica ( ! hip :i* %\ld rea* well up to ! ?orax & ext5d d[n & include ! foot4 ,all bony prom95ces %\ld be well padd$1 & a mod]ate am\nt ( traction ) ab\t tw5ty degrees abduction %\ld be us$ :ile apply+ ! pla/] b&age4 ,?\gh v>i\s =ms ( app>atus h be5 devis$ = fixation & traction1 ,i believe t ! pla/] ( ,p>is spica is f> ! mo/ effective & %\ld always be us$1 *ang+ ! ca/ z (t5 z x becomes soil$4 ,locomotion is possible ) crut*es provid+ ! %oe on ! well side is /ilt$ by an iron patt5 :i* is high en\gh to all[ ! ca/$ limb to cle> ! floor4 ,! e>li] treatm5t is begun1 ! bett] ! outlook4 ,recov]y ) p]fect motion occurs 9 ab\t tw5ty-five p]c5t ( hospital cases2 fifty p] c5t w obta9 useful motion & ! o!r tw5ty-five p] c5t w obta9 practical fixation1 b x mu/ be rememb]$ t results w range entirely accord+ to ! ?or\ghness ( treatm5t1 ! sev]ity ( ! disease 9 ! individual case1 & ! natural resi/ance ( ! *ild4 ,9 g5]al1 ! hip %\ld be fix$ z long z x is s5sitive1 x %\ld be protect$ & di/ract$ z long z !re is muscul> spasm1 & protect$ until ! conge/$ & inflam$ bone ( ! epiphysis is replac$ by firm heal?y bone4 ,tub]culosis ( ! ,knee ,jo9t ,tub]cul\s disease ( ! knee is next to ! hip 9 frequ5cy4 ,x is a *ronic de/ructive process ( ! epiphysis ( ! femur or tibia1 or x may />t 9 ! patella1 head ( ! fibula1 or prim>ily 9 ! synovial membrane ( ! knee jo9t4 ,! condition pres5ts two di/9ct types2 "o1 ! adult type beg9n+ z a *ronic synovitis1 ( :i* ! e>ly symptoms are subacute2 & ! o!r1 ! *ildhood or mo/ common class1 9 :i* ! symptoms ( pa91 muscul> spasms & de=mity seem to indicate cle>ly a prim>y disease ( ! bone4 ,symptoms4--,?is disease is commonly kn[n z 8:ite swell+0 & ! symptoms z a rule are q *>act]i/ic4 ,! affection beg9s ) a limp & limitation ( motion1 & is usually sl[ 9 progress ) p]iods ( sev]e pa94 ,!re is usually mu* swell+ & ?is toge!r ) ! di/ortion ( ! limb by muscul> spasm & atrophy ( ! muscles bo? above & bel[ ! jo9t1 gives a mo/ *>act]i/ic knock-kne$ appe>ance4 ,! affect$ limb is usually long] at fir/1 ow+ to ! conge/ion ( ! epiphysis ( ! knee4 ,local heat is always pres5t 9 ! m acute /ages & ! lam5ess is usually a con/ant symptom4 ,! diff]5tial diagnosis f o!r jo9t tr\bles is easy because ( ! sl[ insidi\s onset4 ,treatm5t4--,l o!r tub]cul> bone conditions ! fixation treatm5t is be/4 ,re/ 9 b$ ) a ,buck's ext5sion to ov]come ! de=mity & ! local application ( hot packs until ! acute symptoms h subsid$1 is ! be/ prelim9>y treatm5t ( ?is condition4 ,five- to t5-second exposures to ! ,x-ray ea* day = t5 days seems to relieve ! pa9 & 9 mo/ in/ances causes less m>k$ infiltration ( tissues4 ,:5 ! acute /age has subsid$1 ! ambulatory treatm5t by fixation 9 a pla/] ( ,p>is ca/ ext5d+ f ! gro9 to ! ankle1 ) ab\t #aj degrees flexion1 is mo/ effici5t4 ,! pati5t is all[$ to walk ab\t ) ! aid ( crut*es1 hav+ ! %oe on ! s\nd side /ilt$ en\gh s t ! diseas$ limb cle>s ! floor4 ,! functional results aft] cons]vative treatm5t are 9 ! av]age case excell5t1 t is provid+ prop] treatm5t is begun at an e>ly /age4 ,useful motion is obta9$ 9 fifty p] c5t ( ^! cases1 p]fect motion is re/or$ 9 tw5ty-five p] c5t1 & complete rigidity results 9 ! o!r tw5ty-five p] c5t ( cases4 ,any *ronic1 pa9ful inflammation conf9$ to a s+le jo9t1 9 :i* motion is limit$ by muscul> spasm1 & 9 :i* !re is a t5d5cy t[>ds de=mity1 is almo/ always tub]cul> 9 "*4 ,! ,pla/] ( ,p>is ,b&age ,! pla/] ( ,p>is b&age 0 p]haps fir/ appli$ by ,kluge ( ,b]l9 9 #ahbi1 b to ! ,dut* physicians ,ma?ys5 & ,v&] ,loo belongs ! cr$it ( ! mod]n b&age4 ,x is imp]ative to give1 9 ?is *apt]1 a detail$ & complete description ( :at con/itutes a prop]ly made pla/] ( ,p>is b&age & ! application ( x1 9 ord] t ! g5]al practition] may become famili> ) its use4 ,ev5 ?\gh "o c>es n to treat ! conditions h]et(ore enum]at$1 ,i h f\nd t = fractures ( almo/ e bone 9 ! body requir+ immobilization1 ! pla/] b&age prop]ly appli$ is f> sup]ior & r to be pref]r$ to any o!r =m ( spl9ts4 ,x has be5 us$ v little 9 ! pa/ 9 private practice because ! ord9>y comm]cial b&age f\nd 9 any supply h\se does n come up to requirem5ts1 9 t x is usually air slak$ or ! pla/] has be5 %ak5 f x by ! "t x is receiv$4 ,!n too ! me% is too closely wov5 & ! pla/] lies on ! b&age in/ead ( 9 ! me%es & !re is1 9 consequ5ce1 an excess ( pla/]2 also z a rule ! b&ages are roll$ s tightly t ! wat] does n rea* ! deep] lay]s4 ,! ord9>y pla/] ( ,p>is b&age made 9 y\r own (fice c always be successfully appli$ because ! "r quantity ( pla/] c be incorporat$ 9 ! b&age & x c readily be made into ! desir$ wid?s4 ,! pla/] ( ,p>is to be us$ %\ld be ( ! sup]ior quality us$ by d5ti/s & %\ld be ( ! quick sett+ k9d4 ,x c be procur$ at almo/ any drug /ore b ! sure/ place = quality w be y\r d5ti/4 ,absolutely1 ! only k9d ( gauze to be successfully us$ is :ite cr9ol9e ( ! ord9>y v>iety us$ by dressmak]s & obta9able at any dry goods /ore 9 tw5ty-f\r y>d bolts4 ,x is especially desirable to get a k9d n too ri* 9 />* or dextr9 & ( a me% runn+ ab\t "o hundr$ holes to ! squ>e in*4 ,! b&ages %\ld be made 9 six y>d l5g?s1 & ( wid?s rang+ f ?ree to five in*es accord+ to ! "p t is to be ca/2 = in/ance ! ?ree in* wid?s are mo/ suitable = ca/s = ! extremities1 :ile ! l>g] ones s]ve be/ = conditions ( ! sp9e4 ,aft] ! l5g? _h be5 measur$ & cut ! desir$ wid?s c be torn ! full l5g? )\t tr\ble4 ,! edge ( ! cr9ol9e ne>ly always frays out & naturally w become s entangl$ z to prev5t roll+ 9 ! pla/] or z to h9d] ! free unroll+ ( ! b&age :5 apply+ x4 ,to prev5t ?is1 ?ree ?reads %\ld be pluck$ f ea* side ( ea* /rip be=e />t+ to roll 9 ! pla/]4 ,a h>d surface (1 at lea/1 two feet 9 wid? %\ld be us$ on :i* to roll 9 ! pla/]4 ,/>t+ at "o end1 a h&ful ( pla/] ( ,p>is is rubb$ into ! cr9ol9e ) ! palm> surface ( ! h&1 be>+ d[n h>d1 s t all excessive pla/] passes to ei!r edge ( ! b&age4 ,no m pla/] %\ld be rubb$ into ! cr9ol9e ?an ! me%es w hold1 & z ea* successive y>d is incorporat$ ) ! necess>y am\nt ( pla/]1 x is loosely roll$ 9 su* mann] t 9 ! c5t] ( ! b&age !re is a holl[ cyl9d] ( ! ?ickness ( ! index f+]1 & ! conc5tric lay]s are easily movable on "o ano!r4 ,?is mann] ( roll+ p]mits ( ! rapid & uni=m spread ( wat] ?r\gh ! b&age :5 x is to be appli$1 & prev5ts p>ts ( ! b&age f be+ insuffici5tly moi/5$4 ,! g5]al practition] %\ld always keep on h& ab\t two doz5 complet$ b&ages t he is mo/ accu/om$ to us+ 9 8 daily practice4 ,^! %\ld be cord$ z x 71 to prev5t unroll+1 9 an air tight conta9]1 ei!r ( glass or t9 9 ! bottom ( :i* is plac$ a small quantity ( pla/] ( ,p>is1 & %\ld always be kept 9 a dry place4 ,i h nev] f\nd ei!r a nurse or an (fice girl :o c\ld n make ^! b&ages successfully s t 9 ! future !re is no excuse = a practition] n us+ ?is sup]ior =m ( spl9ts4 ,! ,imm$iate ,use ( ! ,b&age ,:ile pla/] ( ,p>is is 9 no way h>mful to ei!r g>m5ts or surr\nd+s1 bo? ! op]ator & ! assi/ants %\ld be prop]ly g[n$ & ! floor cov]$ ) newspap]s to prev5t unnecess>y soil+4 ,x %\ld be borne 9 m9d t if a prop]ly made b&age is us$1 :i* is squeez$ to ! ext5t ( ridd+ x ( an excess ( wat]1 v few dripp+s w be scatt]$ & ! :ole proc$ure ( ! application ( ! pla/] diff]s 9 no way f simple roll] b&ag+4 ,! numb] ( b&ages int5d$ = use %\ld be tak5 f ! conta9] & plac$ 9 a pan ne> ! pail hold+ ! wat]1 9 :i* !y are to be imm]s$1 9 a position 9 relation to ! pail t w gu>d aga9/ wat] be+ spla%$ ^u ! dry b&ages1 :i* w\ld r5d] !m unfit = subsequ5t use4 ,wat] z hot z ! h& w tol]ate1 z oppos$ to cold1 facilitates sett+4 ,i d n recomm5d any *emicals to ha/5 sett+1 because a prop]ly made b&age1 prep>$ z above1 ( quick sett+ pla/] sets 9 rem>kably fa/ "t4 ,! area to be ca/ %\ld be encas$ 9 ord9>y absorb5t cotton ( ! ?ickness 9 :i* x comes roll$1 putt+ an extra pad ov] all m>k$ bony prom95ces1 & a roll] gauze b&age appli$ to hold x 9 place & snug to ! "p4 ,"u no consid]ation d ,i advise ! use ( flannel b&age or ! ord9>y %eet wadd+ cotton t are recomm5d$ by "s au?ors1 because padd+ ) ^! mat]ials is always conducive to apply+ a ca/ f> too tightly1 especially 9 fractures :]e ! swell+ increases aft] application !reby caus+ con/riction ( ! limb & int]f]5ce ) circulation4 ,! regul> absorb5t cotton z padd+ b5ea? a ca/ is always be/ = x is almo/ impossible to apply a ca/ too tightly :5 x is us$4 ,! b&age %\ld be completely subm]g$ on its side1 & %\ld rema9 s until ! bubbles cease to come (f1 :i* "t takes place mo/ readily 9 ! prop]ly roll$ dress+4 ,:5 ! bubbl+ has ceas$1 ! b&age is lift$ out ( ! pail & squeez$ ) ! h&s m]ely to free x ( ! excessive wat]1 ! end is f\nd & h&$ to ! op]ator ready to apply4 ,no undue traction %\ld be made 9 apply+ ! successive turns ( ! b&age1 ?\gh x mu/ be rememb]$ ! ca/ %\ld fit snugly to ! "p1 & ! ord9>y rules ( simple roll] b&ag+ foll[$1 except t ! rev]se spirals are unnecess>y4 ,! assi/ant %\ld con/antly rub ! lay]s z !y are appli$ by ! op]ator1 z ?is n only helps ! ca/ to fit m snugly1 b also makes ! r\gh edges ( ! b&age adh]e m firmly to ! lay] b5ea?1 !reby mak+ a smoo!r ca/4 ,z a rule !re ne$ be no dread ( an increas$ swell+ b5ea? ! b&age because usually sev]al h\rs h elaps$ aft] ! injury be=e ! physician has arriv$ & made prep>ations to apply ! pla/]4 ,inde$1 "o ( ! be/ means ( limit+ swell+ aft] a fracture is ! prompt application ( a pla/] ( ,p>is b&age4 ,if !re is any conc]n t ! ca/ is too tight1 :ile ! pla/] is /ill s(t x c be easily cut ?r\gh ! entire l5g? ) a knife1 & ?us relieve ! pressure exi/+4 ,also x is a good plan to cut a w9d[ or op5+ ov] ! sight ( injury1 :i* w\ld 9 no way h>m ! object ( ! ca/ & w\ld all[ a g5tle massage to ! "p4 ,a neat f9i% may be giv5 to ! edges ( a pla/] ca/ by turn+ ov] ! ends ( ! cotton1 9 cuff-l fa%ion & held 9 ! grasp ( ! la/ few turns ( ! pla/] at ei!r end4 ,on clo?+ y w f9d x be/ to all[ ! pla/] to dry be=e remov+1 :ile on furniture or ! h&s x is readily remov$ by wa%+ (f 9 w>m wat]4 ,! wat] 9 :i* ! b&ages 7 imm]s$ conta9s1 ( c\rse1 consid]able pla/]1 & "u no circum/ances %\ld ?is be empti$ into a s9k or wa/e pipe = x w c]ta9ly dem& ! s]vices ( a plumb]4 ,! wat] may be p\r$ out on ! gr\nd & ! pa/e %ak5 into a refuse b>rel or a% pile4 ,! be/ way to remove a ca/ is to moi/5 x ) wat] or v9eg> along ! pa? ( ! knife4 ,i might add t all pati5ts are 9 con/ant fe> ( be+ cut ei!r :ile y are trimm+1 cutt+ w9d[s1 or remov+ ! ca/1 b because ( ! cotton padd+ und]nea? y w f9d t x is almo/ an impossibility4 ,c>e1 ( c\rse1 %\ld be tak5 t ! knife does n slip 9 any ( ^! proc$ures & come 9 contact ) ! unprotect$ p>ts4 ,9 g5]al1 = fractures ( ! extremities x is be/ to apply ! pla/] ) ! pati5t 9 ! recumb5t position to secure complete muscul> relaxation1 & ! "p to be ca/ %\ld be support$ by an assi/ant4 ,x is also a g5]al rule t 9 fractures ( ! %aft ( ! long bones1 especially ( ! l[] extremities1 ! pla/] b&age %\ld be appli$ to include ! adjac5t articulation & ext5d well beyond ! jo9ts4 ,,index ,a ,abbott treatm5t1 #ih1 #ggd1 #ggh4 ,abdom5 p5dul\s1 #abg4 ,abdom9al exam9ation1 #ea4 rheumatism1 #dff1 #dfg4 te*nic1 #gg1 #ecf1 #eci4 dang]s (1 #hg1 #edj4 ,abduc5s n]ve1 lesions affect+1 #gag4 ,abscess ( rectum1 #agd4 p]9ephritic1 diff]5tiate pyelitis1 #fbh4 p]itonsill>1 #bgh4 ,a*ylia ga/rica1 diff]5tial diagnosis1 #ejh4 ,acne1 #aej4 ,accommodation 9 ! eye1 #aib4 ,acetabulum1 migration (1 #gia4 ,addison's disease1 #gjd4 diff]5tiat$ f jaundice1 #eei4 ,ad5itis1 tub]cul>1 #chd4 ,ad5oids1 #bgc4 ,adhesions1 brok5 up aft] spra9s1 #ajh4 ,adju/m5t1 o/eopa?ic1 #ij4 ,adr5al gl&s1 diseases (1 #gjc4 ,ag$1 sp9e ( !1 #aja4 ,agitans1 p>alysis1 #gbc4 ,agitata1 melan*olia1 #big4 ,ague1 #cdg4 ,alcohol 9 po/-op]ative pneumonia1 #cai4 ,am5tia1 #bij1 #cjg4 ,amyloid kidney1 #fbf4 liv]1 #efb4 ,amyotrophic lat]al scl]osis1 #gfb4 ,ang9a pectoris1 #fff4 diff]5tial diagnosis1 #ffg4 pa?ology 91 #cjh4 ,anemias1 !1 #fgb4 ,anemia1 co/og5ic1 #fgc4 ,burns1 #fgc4 p]nici\s1 #fgh4 ,aneurism1 c>diac1 #ffj4 ,animal exp]im5ts1 #ia1 #dij4 p>asites1 #aea4 ,ankle1 #ef4 spra91 #aab4 ,ankylo/omiasis1 #aee4 ,ant]ior dorsal lesions te*nic1 #gf4 ,antidotes may be necess>y1 #fb4 ,antiseptics may be necess>y1 #fb4 ,aortic regurgitation1 #fdi4 /5osis1 #eea4 ,aphonia1 #ega4 ,aph?\s /omatitis1 #dhh4 ,app5dectomy1 colitis foll[+1 #eeb4 ,app5dicitis1 #edg4 diff]5tial diagnosis1 #eej4 ,app5dicitis f ileo-cecal tr\ble1 #ada4 pseudo1 #eej4 ,app5dix inn]vation1 #dih4 ,ar* support]s1 #aad4 ,arhy?mia1 #ffe4 ,arm affect$ by rib lesions1 #gdj4 ,arm exam9ation1 #ef4 te*nic1 #hj4 vasomotor n]ves to1 #id4 ,art]ies1 diseases (1 #ffi4 ,art]ioscl]osis1 #ffi4 ,art]y complications f typhoid1 #ccb4 ,ar?ritis de=mans1 #dfb4 rheumatoid1 #dfb4 diff]5tiat$ f inflammatory rheumatism1 #dei4 septic1 diff]5tiat$ f inflammatory rheumatism1 #dei4 ,articul> rheumatism1 acute1 #dfj4 ,asc>is lumbricoides1 #aec4 ,aspiration pneumonia1 #fje4 ,a/h5opia1 #bcb4 ,a/hma bron*ial1 #ehi4 caus$ by rib lesions1 #id4 ,ataxia1 ,fri$rei*'s1 #gei4 h]$it>y1 #gei4 diff]5tiate *orea1 #gbf4 locomotor1 #ged4 ,ataxic p>aplegia1 #gfa4 ,a!roma1 #ffi4 9 he>t1 #fdg4 ,atlas exam9ation1 #dd4 lesions1 #dd4 ,atrophy ( optic n]ve1 #bca4 progressive muscul>1 #gfb1 #gfd4 ,auditory--,see also e>4 ,auditory meatus1 diseases (1 #bcf4 n]ve deg5]ation1 #bef4 n]ve lesions affect+1 #gah4 ,au]ba*'s plexus1 #did4 ,auto-intoxication 9 nose diseases1 #bfh4 ,axis lesions1 #de4 ,b ,backa*e1 po/-op]ative1 #cac4 ,b&age1 abdom9al1 = float+ kidney1 #acg4 liv]1 #aci4 spra91 #ajf4 ,b>badoes leg1 #aeh4 ,ba?s1 hot1 9 sk9 diseases1 #adg4 ,bee /+ ne> eye1 #aii4 ,bell's p>alysis1 #gag4 ,belt--,see b&age2 also brace4 ,biceps1 long t5don dislocat$1 #aad4 ,bile duct1 diseases ( ! liv] &1 #eec4 ,bili>y colic1 #efe4 diff]5tiate1 #eea1 #efe1 #fcb4 ,b9ocul> vision ( o/eopa? 7two pa?ologies71 #dhi4 ,bir? injuries1 causes ( he>t irregul>ities1 #fff4 ,black eye1 #aii4 ,blackwat] fev]1 #cea4 ,bladd]1 diseases (1 #fce4 hemorrhage1 #afd4 s5sory n]ves to1 #ie4 ,ble$]s disease1 #dhd4 ,bl5norrhea1 acute1 #bji4 ,bleph>itis1 #bjj4 ,blood fl[ direct$ to abdom51 #ehb4 ,blood1 diseases (1 #fga4 ,bones & jo9ts1 tub]cul\s disease1 #ghh4 ,bo?riocephalus latus1 #aea4 ,b[el--,see inte/9e4 ,brace 9 ,pott's disease1 #ajc1 #aca4 9 prolapse1 #acc4 9 sp9al curvature1 #ii1 #ajc1 #abb4 ,bra*ial neuralgia1 #gaa4 neuritis1 #abc4 diff]5tial diagnosis1 #abe4 plexus1 lesions affect+1 #gba4 ,bra*yc>dia1 #ffd4 ,bra91 pa?ology (1 #cjg4 its relation to m9d1 #cjg4 physiology (1 #cjf4 tumors1 diff]5tiate migra9e1 #gcg4 ,br& ba?1 #cbi1 #cdc4 ,breakbone fev]1 #cef4 ,bright's disease1 #fah4 ,bron*i1 diseases ( !1 #egi4 ,bron*ial a/hma1 #ehi4 ,bron*iolectasis1 #ehg4 ,bron*itis1 #egi4 ,bron*opneumonia1 #fje4 caus$ by tub]cle bacillus1 #fjf4 ,bron*o-pulmon>y hemorrhage1 #afj4 ,bulb> p>alysis1 #gfe4 ,bunions1 cause (1 #aab4 ,bursitis1 #abc4 diff]5tiate f neuritis1 #abe4 ,c ,calcification 9 he>t1 #fdg4 ,calculus1 r5al1 #fca4 ,canc] ( liv]1 #efb4 ( /oma*1 diff]5tial diagnosis1 #ejh4 ,cank]1 #dhh4 ,c>c9oma1 location ( reflex pa9 91 #dii4 ,c>diac--,see he>t4 ,c>ies--,see ,pott's disease4 ,catalonia1 #bhf4 ,cat>act1 #bbi4 ,cat>rh dry1 #ehc4 ( conjunctiva1 v]nal1 #baf4 /oma*1 *ronic1 #eje4 ,cat>rhal deafness1 #bdf4 pneumonia1 #fje4 /omatitis1 #dhg4 ,c5t]1 diabetic1 #dgd4 ,c5t]s1 o/eopa?ic1 #hh4 nutritional1 #dhj4 ,cephalodynia1 #dfe1 #dfg4 ,c]ebrosp9al fluid int]f]$ )1 affects dige/ion1 #dib4 m5+itis1 #ceh4 ,c]um51 inspissat$1 #bcf4 ,c]vical--,see also neck4 exam9ation1 #da4 gl&s1 exam9ation (1 #dg4 lesions affect eye1 #ic1 #hf4 region1 caution 9 treat+1 #ff4 treatm5t = vasomotor effects1 #ib4 ,c]vico-occipital & c]vico-bra*ial neuralgia1 #gaa4 ,*alazion1 #bjj4 ,"* & disposition affect$ by alim5t>y di/urbances1 #ejb4 ,*e/ exam9ation1 #ea4 ,*iasma1 diseases (1 #gae4 ,*ick5-pox1 #ddf4 diff]5tiate f smallpox1 #dag4 ,*ildbir? result+ 9 p5dul\s abdom51 #abh4 ,*ildr5--,see also infants4 defective1 #cjc4 di>rhea (1 #ebi4 ,*lorosis1 #fgf4 ,*olecy/itis1 #eeg4 ,*ol]a infantum1 #eca4 morbus1 #ecb4 ,*orea1 #gbe4 diff]5tial diagnosis1 #gbf4 diff]5tiate p>alysis agitans1 #gbd4 ,*orei=m affections1 #gbg4 ,*oroid1 diseases (1 #bbf4 ,*oroiditis1 #bbf4 ,*romaff9 sy/em1 #gjb1 #gjc4 ,*ronic lesions1 r$uce gradually1 #ff4 ,*vo/ek's ph5om5on1 #gja4 ,*yluria1 *ylocele1 *yl\s ascitis1 #aeh4 ,cili>y injection 9 k]atitis1 #bba4 body1 diseases ( !1 #bbe4 ,ciliosp9al c5t]1 #ahg4 ,circulatory sy/em1 disease (1 #fch4 ,circumflex n]ve1 lesions affect+1 #gba4 ,cirrhosis ( liv]1 #efj4 ,clavicle exam9ation1 #di4 8,claw h&10 #gfd4 ,club foot1 #ghd4 ,coccygodynia1 #gac4 ,coccyx exam9ation1 #ee1 #ha4 fractur$1 #ha4 te*nic1 #ha1 #gac4 8,cold 9 ! head10 #beg4 ,cold 9 treat+ spra91 #ajf4 8,colds0 inadv]t5tly cur$1 #ij4 ,cole's irrigator = high enema1 #agj1 #edf4 ,colic1 bili>y1 #efe4 diff]5tiation (1 #ece1 #eff4 inte/9al1 #ece4 r5al1 #fca4 diff]5tial diagnosis1 #fcb4 ,colitis foll[+ app5dectomy1 #eeb4 ,colitis1 muc\s1 #ebf4 ,coma1 diabetic1 #dgb4 ,confusion & /upor1 delirium1 #bhi4 ,conge/ion ( ! lungs1 #faj4 ?yroid1 #fhf4 ,conjunctiva1 diseases (1 #bjb4 ,conjunctivitis1 #bjb4 cat>rhal1 #bjd4 corneal ulc]s complicat+1 #bjd4 follicul>1 #bjg4 diff]5tiat$ f tra*oma1 #bjh4 gonorrheal1 #bji4 granul>1 #bab4 phlyct5ul>1 #bad4 v]nal1 #baf4 ,con/ipation1 causes & te*nic1 #dig1 #ecg4 f p5dul\s abdom51 #abg4 result+ 9 di>rhea1 #ech4 ,con/itutional diseases1 #deg4 ,contract$ muscles reliev$ by inhibition1 #hi4 ,convulsions1 infantile1 #gbh4 ,cornea1 anatomy (1 #bag4 diseases (1 #bag1 #bai4 exam9ation (1 #bai4 ulc] (1 #bai1 #bba4 ,c\gh+1 #egc4 ,c\gh+ 7sup]ior l>yngeal n]ve71 #gai4 ,c[-pox1 #dbd4 ,cramp1 con/itutional1 #gch4 ,cranial n]ves1 diseases (1 #gae4 ,cret9ism1 #fih4 ,cr\p treatm5t1 #fh4 diff]5tiate f spasm ( glottis1 #egc4 false1 #egd4 ,cr\p\s pneumonia1 #eig4 ,curs*mann's spirals1 #ehf4 ,curvatures1 sp9al1 #if1 #ii1 #ajc1 #abb1 #gfh4 ,see ,abbott treatm5t1 braces =1 #ii1 #aca4 c]vico-dorsal1 #ggb4 complicat$ by innom9ate lesion1 #ii4 diff]5tiate organic & functional1 #gfi4 dorsal1 #ggb4 dorso-lumb>1 #ggb4 ,cophosis1 #ig4 lat]al1 #ih1 #agg4 lumb>1 #ggb4 o!r organs affect$1 #ggj4 pa?ological1 #if4 rot>y lat]al1 #gfh4 po/ural1 #abh4 7scoliosis71 #if1 #gfh4 diff]5tiat$ f ,pott's disease1 #ggc4 false1 #ggc4 /ructural1 #ggd4 te*nic =1 #ih4 treatm5t = rotation & sideb5d+1 #gf4 ,cy/itis1 #fce4 ,cy/itis1 diff]5tiate pyelitis1 #fbh1 #fcf4 ,d ,dalrymple's sign1 #fid4 ,deafness1 cat>rhal1 #bdf4 n]ve1 #bee1 #gah4 ,defective *ildr51 #cjc4 ,de=mans1 spondylitis1 #dfc4 ,deg5]ation ( he>t muscle1 #ffa4 ,deglutition1 #dic4 ,deglutition pneumonia1 #fje4 ,delirium1 confusion & /upor1 #bhi4 s5ile1 #cjj4 ,dem5tia1 art]ioscl]otic1 #cjj4 def9$1 #cjf1 #cjg4 praecox1 #bhg4 s5ile1 #big4 ,d5gue1 #cef4 ,d5tal tr\bles %\ld be correct$1 #dij4 ,descemetitis1 #bbf4 ,de,schweinitz1 ,dr41 #bae4 ,diabetes1 diff]5tial diagnosis1 #dgg4 insipidus1 #dgf4 mellitus1 #dgj4 ,diabetic coma1 #dgb4 ,diagnosis1 o/eopa?ic1 #ch4 see also "u lesion4 reliable1 o/eopa?ic1 #ba4 sight1 #ch4 ,diaphragm1 p>alysis (1 #gbj4 ,di>rhea1 causes & te*nic1 #dig4 acute1 #ebc4 dyspeptic1 #ebi4 caus$ by con/ipation1 #ech4 ( *ildr51 #ebi4 *ronic1 #ebi4 cat>rhal1 #ebd4 diff]5tial diagnosis (1 #ecj1 #ecc4 n]v\s1 #ebd4 ?r\gh impactions1 #ech1 #edd4 ,diet & o/eopa?y1 #bb1 #fb4 ,diet1 diabetic1 #dge4 ,dietl's crisis1 #acg1 #fce4 ,dige/ion1 relation ( lungs to1 #did4 ,dige/ive di/urbances affect "*1 #ejb4 sy/em1 diseases (1 #dhg4 tr\ble due to intra-cranial conditions1 #dib4 ,digital surg]y 9 hay fev]1 #bbf4 treatm5t 9 tonsillitis1 #bha4 ,dilatation ( he>t1 #feg4 ( sigmoid1 #edc4 ( /oma*1 #aec1 #eag4 ,diopt] def9$1 #aib4 ,diph!ria1 #cfb4 diff]5tiat$ f sc>let fev]1 #dca4 l>yngeal1 #cfd4 nasal1 #cfd4 neuritis foll[+1 #gjg4 ph>yngeal1 #cfd4 ,disease %\ld be /udi$ by regions1 #ehf4 con/itutional1 #deg4 g5]al & functional1 #gbc4 ,dislocation1 diff]5tiat$ f neuritis1 #abe4 ,disposition & "* affect$ by dige/ive di/urbances1 #eja4 ,diuresis1 ,p>oxysmal1 diff]5tiat$ f diabetes insipidus1 #dgg4 ,dorsal sp9e exam9ation1 #di4 te*nic1 #gd4 ,dorsodynia1 #dff1 #dfg4 ,drugs n useful 9 nose & ?roat "w1 #bfb4 ,:y m$ics give1 #ba4 ,dub9i's disease1 #gbg4 ,duod5al ulc]1 ,ga/ric &1 #eab4 ,duod5itis1 #ebd4 ,dupuytr5's contraction1 #aae4 ,dys5t]y1 #cfh4 ,dys5t]y1 a ^w on treatm5t1 #agj amebic1 #cgj4 bacill>y1 #cfh4 *ronic1 #cga4 treatm5t1 a ^w on1 #agj4 tropical1 #cgj4 ,dysm5orrhea caus$ by lumb> curvature1 #abf4 ,dyspepsia1 acute1 #eja4 ,dy/ri*iasis1 #bja4 ,e ,e>--,see also auditory ,e>1 ,diseases (1 #bcf4 ( inn]1 #bed ( middle1 #bci4 =eign bodies 91 cause c\gh1 #ege4 normal he>+1 #bdi4 nose & ?roat1 diseases (1 #bcf4 pa9 9 diagnosis ( diseases (1 #bch4 te/ = he>+1 #bdi4 vasomotor n]ves to1 #ib4 wax1 h>d5$1 #bcf4 ,eccymosis1 #aii4 ,eclampsia1 #gbh4 ,ectropion1 #bja4 ,eczema1 #adg4 9 e>1 #bcj4 ,edema ( ! lungs1 #faa4 ,edw>ds f+] treatm5t 9 hay fev]1 #bfg4 tra*oma treatm5t1 #bac4 turb9ate adju/]1 #aig4 ,egophony1 ,lnnec's1 #fac4 ,elb[1 #ef4 spra9s1 #aad4 ,elephantiasis1 #aeh4 ,emboli 9 endoc>ditis1 #fdb1 #fda4 ,emphysema1 #eib4 comp5satory1 #fji4 diff]5tial diagnosis1 #eie4 ,endoc>ditis1 #fda4 complicat+ pneumonia1 #fja4 ,enema1 directions =1 #edf4 ,ent]ic fev]1 #cbi4 ,ent]ocolitis1 acute1 #ecb4 ,ent]optosis1 #eba4 ,entropion1 #bja4 ,enuresis1 #fcg4 ,epididymis s5sory n]ves to1 #ie4 ,epilepsy1 #gbi4 diff]5tial diagnosis1 #gcd4 nocturnal1 #gcc1 #gcd4 gr& mal1 #gcb4 ,jacksonian1 #gcc4 petit mal1 #gcc4 ,epilepticus1 /atus1 #gcd4 ,epi/axis1 #afj1 #bga4 diff]5tial diagnosis (1 #afa4 ,erb's ph5om5on1 #gja4 ,erysipelas1 #cgb4 ,esophagus1 #dic4 location ( reflex pa9 f1 #dii4 ,e/ivo-autumnal fev]1 #cej4 ,etiological factors1 #be4 ,etiology1 o/eopa?ic1 #be4 ,exam9ation--,see "u v>i\s /ructures & regions4 ?or\gh1 ess5tial1 #ch4 ,ex]cise & po/ural defects1 #abj1 #abi1 #aca4 _c take place ( o/eopa?y1 #abj4 9 treatm5t ( ptosis1 #eba4 ( false scoliosis1 #ggc4 to r$uce abdom51 #abh1 #aci1 #dhj4 ,ext]nal cutane\s n]ve1 lesions affect+1 #gbb4 ,eye1 accommodation 9 !1 #aib4 affect$ by osse\s lesions1 #ic1 #ahe1 & "u individual diseases4 ,eye diseases1 #ahc1 #gac4 ,eye diseases1 o/eopa?ic manipulation 91 #aif1 #bbc1 #gaf4 exam9ation by special me?ods1 #aia4 h[ to exam9e1 #ahc4 lesions affect+ c]ta9 n]ves (1 #gaf4 o/eopa?ic1 #ahd4 neuralgia1 #aig4 re/or$ by o/eopa?y1 ,a case hi/ory1 #ahe4 s*ematic1 #aid4 /ra9 & its reflexes1 #bca4 tr\ble1 nose & ?roat 91 #aia4 vasomotor n]ves1 #ib4 ,eyelids1 diseases (1 #aii4 ,f ,face exam9ation1 #df4 te*nic1 #fh4 ,facial n]ve1 lesions affect+1 #aag4 ,fatty deg5]ation ( he>t1 #ffa4 liv]1 #efa4 ,fecal impactions palpat$1 #eb1 #edc4 ) di>rhea1 #ech1 #edd4 ,feet1 neuralgia (1 #gad4 ,fetor oris1 #dia4 ,fev]1 #cbe4 acute eruptive1 mumps & :oop+ c\gh1 #daa4 ent]ic1 #cbi4 e/ivo-autumnal1 #cej4 mal>ial1 #cdg4 p>atyphoid1 #cdd4 remitt5t1 #cej4 rheumatic1 #deg4 simple cont9u$1 #cgi4 treatm5t1 #cbe4 ,br& me?od1 #cbi4 usually b5eficial1 #cbg4 typhoid1 #cbi4 typhus1 #cdd4 yell[1 #cgd4 ,fibroid ph?isis1 #cic4 induration1 #fji4 ,fif? n]ve1 neuralgia (1 #gaj4 ,fil>ia1 #aeh4 ,f+]s1 spra9s (1 #aad4 surg]y 9 hay fev]1 #bff4 treatm5t 9 cat>rhal deafness1 #beb4 9 tonsillitis1 #bha4 trigg]1 #aae4 ,fir/ rib--see rib4 ,fissures ( rectum1 #agd4 ,fi/ulae1 rectal1 #agd4 ,flat foot1 #aab1 #ghg4 ,flatul5cy1 te*nic =1 #eje1 #ecg4 ,focus ( infection--see infection4 ,foot1 club1 #ghd neuralgias1 "s causes (1 #aab4 spra9s (1 #aab4 ,fractures1 #aae4 & spra9s1 #ajd4 summ>y ( massage & immobilization 91 #aah4 ( treatm5t (1 #aai4 ,frequ5cy ( treatm5ts--see treatm5ts4 ,fri$rei*'s ataxia--,see ataxia4 ,functional & g5]al diseases1 #gbc4 ,furunculosis ( e>1 #bch4 ,g ,gall bladd]1 s5sory n]ves to1 #ie4 ,gall-/ones1 #efc4 easily diagnos$ by o/eopa?1 #eb4 ,ganglion 7weep+ s9ew71 #aae4 ,gas 9 /oma*1 te*nic =1 #eje1 #ecg4 ,ga/ritis1 acute1 #ejb4 *ronic1 #eje4 due to portal di/urbance1 #ejf4 ga/ric analysis ess5tial to diagnose1 #ejg4 ,ga/ric--see also indige/ion4 ,ga/ric d]angem5t1 location ( reflex pa9 f1 #dii4 & duod5al ulc]1 #eac4 neuralgia1 #eaj4 neuroses1 #eaj4 tr\ble (t5 reflex1 #eaj4 ,g5]al treatm5t--see treatm5t4 ,g5]ative organs1 vasomotor n]ves to1 #id4 ,g5itocrural n]ve1 lesions affect+1 #gbb4 ,g5ito-ur9>y sy/em1 #age4 ,g]m !ory--its relation to o/eopa?y1 #bf4 ,g]man measles1 #ddd4 diff]5tiate measles & sc>let fev]1 #ddf4 ,gl&s enl>g$1 diff]5tiate f :oop+ c\gh1 #ded4 exam9ation ( ?yroid & c]vical1 #dg4 ,glaucoma1 #bbg4 ,gl5>d's disease1 #eba4 ,glosso-ph>yngeal n]ve1 lesions affect+1 #gah4 ,glottis1 spasm (1 #egb4 ,goit]1 d n treat direct1 #fia1 #fif4 exoph?almic1 #fij4 f9d+s at ,mayo cl9ic1 #fib4 p>a?yroid gl&s 91 #fii4 simple1 #fhg4 ,gonorrhea g]ms 9 pro/ate1 #agf4 ,gonorrheal conjunctivitis1 #bji4 rheumatism1 #dei4 ,g\t1 #dfg4 diff]5tiat$ f rheumatic fev]1 #dei4 ,gr& mal1 #gcj1 #gcb4 ,grattage1 #bac4 ,great occipital n]ve1 po9t ( control1 #gai4 ,great auricul> n]ve1 po9t ( control1 #gai4 ,gre5 ,sickness1 #fgf4 ,h ,habit spasm1 #gbh4 ,hamm] toe1 #aab4 ,h&1 spra9 (1 #aad4 ,hay fev]1 #bfc4 relation ( focal infection to1 #bff4 treatm5t1 #fh4 ,head exam9ation1 #da4 te*nic1 #fd4 vasomotor n]ves to1 #ib4 ,heada*e1 f eye /ra91 #ahh4 po/-op]ative1 #cac4 sick1 #gcf4 te*nic1 #gbj4 ,he>+--see also e>4 te/1 #bdi4 ,he>t1 affect$ by /oma* pressure1 #dih4 aneurism1 #ffj4 *anges 9 goit]1 #fic4 complications 9 typhoid1 #ccb4 cr[d$ by r\nd %\ld]s1 #aba4 contraction me*anism1 #ffe4 dilatation1 #feg4 diseases1 #fch4 due to ribs1 #dg4 caus+ hyp]emia ( liv]1 #eed4 enl>gem5t caus+ c\gh1 #ege4 failure 9 pneumonia1 #fjc4 hyp]trophy1 #fee4 hyp]trophy & dilatation (t5 recov]1 #fed4 irregul>ities due to bir? injury1 #fff4 muscle deg5]ation1 #ffa4 neuroses (1 #ffb4 palpitation (1 #ffb4 s5sory n]ves to1 #ie4 /imulat$ ?r\gh rectum1 #afi1 #agj4 tr\ble & o/eopa?y1 #fdg1 #fdh1 #feb4 ,heat 9 treat+ e>1 #bch1 #bdj1 #bda4 9 treat+ spra91 #ajf4 pro/ration1 #aha4 /roke1 #ahj4 ,hebephr5ia1 #bhf4 ,hematemesis1 #afb4 diff]5tial diagnosis (1 #afa4 ,hematuria1 #afc4 ,hemophilia1 #dhd4 ,hemoptysis1 #afj4 diff]5tial diagnosis (1 #afa4 ,hemorrhages1 #afj4 9 feces1 #afc1 #agd4 ( inte/9es1 #afc1 #agd4 ( lungs1 #afj4 ( nose1 #afj4 ( /oma*1 #afb1 #eaf4 ( ur9>y tract1 #afc4 ( ut]us1 #afd4 ,hemorrhoids1 #aga4 acute1 #agc4 due to portal ob/ruction1 #efj4 treatm5t briefly discuss$1 #agj4 ,hemorrhagia subd]malis1 #aii4 ,hepatic colic4 ,see bili>y colic4 flexure prolapse1 #adj4 ,h]$ity1 ,see ,inh]it$4 ,h]nia1 #ada4 treatm5t1 #edf4 ,h]pes1 #adi4 conjunctiv1 #bad4 zo/]1 #gab4 zo/] oph?almia1 #aii4 ,hicc\ghs1 #afe4 ,hip1 #ef4 cong5ital dislocation1 #ggh4 ,lor5z op]ation1 #gha4 op5 op]ation1 #ghd4 lesion affect+ knee1 #aab4 ! prom95t1 description & treatm5t1 #abe4 spra9s (1 #aaa4 treatm5t foll[+ intracapsul> fracture1 #aaa4 tub]culosis (1 #gia4 ,hip-jo9t disease1 #gia4 treatm5t foll[+1 #aaa4 ,hives1 #adi4 ,hobnail$ liv]1 #eei4 ,hodgk9's disease1 #fhd4 diff]5tiate f mumps1 #dea4 ,holmes electric auroscope1 #bcf4 ,homatrop9e1 #aid4 ,hook-worm disease1 #aee4 ,hordeolum1 #bjj4 ,hospital--,see po/-op]ative treatm5t4 ,hot fom5tations to relieve & relax1 #ie4 ,hydrophobia diff]5tiat$ f tetanus1 #cgh4 ,hydro!rapy 9 fev]1 #cbg4 bron*ial a/hma1 #ehi4 (t5 necess>y ) o/eopa?y1 #fb4 ,hygi5e necess>y ) o/eopa?y1 #fb4 ,hyoid exam9ation1 #dg4 lesion affect+ s5se ( ta/e1 #dia4 caus+ c\gh1 #df1 #egd4 furr$ tongue1 #dia4 9 bron*ial a/hma1 #ehi4 9 l>yngismus /ridulus1 #egb4 9 l>yngitis1 #ega4 ,hyp]emia r5al1 #fag4 ,hyp]trophy ( he>t1 #fee4 ,hypoglossal n]ve1 lesions affect+1 #gai4 ,hypopyon 9 k]atitis1 #bba4 ,hy/]ia1 #gdj4 ,hy/]ical convulsions1 diff]5tiat$ f epilepsy1 #gcd4 sp9e1 #aja4 ,hy/]og5\s zones1 #gdc4 ,i ,ict]us1 #eeg4 ,idiots1 #cje4 ,ileocolitis1 acute1 #cfh4 ,ileus1 #edj4 ,iliohypoga/ric & ilio-+u9al n]ves1 lesions affect+1 #gbb4 ,imbeciles1 #cje4 ,immobilization 9 relation to tub]culosis1 #aae4 ,see also "u spra9s4 ,impact$ lesions1 #ib4 ,impactions1 fecal1 palpat$1 #eb4 ( inte/9es1 #edc4 ( small inte/9e1 #edf4 ,impot5cy1 #agg4 ,indige/ion--see also ga/ric4 & a/hma1 #eij4 caus$ by p5dul\s abdom51 #abg4 by r\nd %\ld]s1 #aba4 n]v\s1 #eba4 ,infantile convulsions1 #gbh4 p>alysis--see poliomyelitis4 ,infants--see *ildr54 con/ipation treatm5t1 #eci4 ,infection diff]5tiat$ f neuritis1 #abe4 foci (1 look out =1 #aca4 ,infecti\s diseases1 #cbe4 ,inflammatory rheumatism1 #deg4 ,influ5za1 ,spani% or epidemic1 #cii4 causes bron*itis1 #gi4 ,inh]it$ t5d5cies 9 defective *ildr51 #cjc4 ,inhibition1 ,o/eopa?ic1 #hi1 #id4 ,insanity1 ,see also ,m5tal diseases4 acute confusional1 #bij4 ,circul>1 #bic4 def9$1 #cjf4 7,physiology ( bra971 #cje4 ,innom9ate exam9ation1 #eb1 #ed4 lesions prev5t+ knee recov]y1 #aab4 spra9s1 #aaa4 te*nic1 #gi4 dang]\s1 #hg4 ,insect bites & /+s1 #aii4 ,insipidus1 diabetes1 #dgf4 ,int]r5al sy/em1 #gjd4 ,inte/9al colic1 #ece4 diseases1 #ebc4 relation ( sp9al lesions to ga/ro-1 #dhi4 ob/ruction1 #eda4 diff]5tial diagnosis1 #ede4 /rangulation1 #eda4 ,inte/9e1 exam9ation (1 #eb4 =eign sub/ances 91 #edb4 impactions (1 #eb1 #edc4 treatm5t1 #ede1 #edf4 ) di>rhea1 #ech1 #edd4 knots (1 #edb4 treatm5t1 #eda1 #ede4 location ( reflex pa9 f1 #dii4 ob/ruction (1 #eb1 #gh1 #ede1 #edf4 diff]5tiate f app5dicitis1 #eea4 prolaps$1 #eb1 #aci4 s5sory n]ves to1 #ie4 /rictures (1 #edc4 treatm5t (1 #ede4 te*nic1 #gh4 tumors (1 #edc4 treatm5t1 #ede1 twi/s1 #edb4 treatm5t1 #ede4 vasomotor n]ves to1 #id4 ,intranasal surg]y1 #bff4 ,introduction1 #ag4 ,int]co/al neuralgia1 #gab1 #gba4 ,intussusception1 #eda4 ,invag9ation1 #eda4 treatm5t1 #ede4 ,iridocyclitis 9 k]atitis1 #bba4 ,iris1 diseases (1 #bbe4 ,iritis complicat+ conjunctivitis1 #bjd4 9 k]atitis1 #bba4 ,iron n indicat$ 9 anemic conditions1 #fbc4 ,j ,jaundice1 #eeh4 diff]5tiate f ,addison's disease1 #eei4 simple cat>rhal1 #eee4 ,jacksonian epilepsy1 #gcj1 #gcc4 ,jaw1 full motion ess5tial1 #dij4 lesions1 #df1 #dia4 te*nic1 #fh4 ,jo9ts & bones1 tub]culosis (1 #ghh4 function is motion1 #dhi4 ,k ,k]atoconus1 #bah4 ,k]atitis1 #bai4 cornea-phlyct5ul>1 #bad4 neurop>alytica1 #bbc4 p>5*ymat\s or int]/itial1 #bbd4 ,k]atitis1 phlyct5ul>1 #bbd4 ,k]atomalacia1 #bai1 #bbc4 ,kidney1 amyloid1 #fbf4 complications 9 typhoid1 #cca4 diseases (1 #fag4 exam9ation1 #eb hemorrhage1 #afd4 movable1 #fcd4 prolaps$1 #acf4 belt =1 #acg4 s5sory n]ves to1 #ie4 /ones1 #fca4 treatm5t1 #gh1 #fbj1 #fbc4 vasomotor n]ves to1 #id4 ,knee1 tub]culosis (1 #gic4 ,kraepel9's classification ( dem5tia praecox1 #bhc4 ,kyphosis--,see curvatures4 ,l ,labioglossoph>yngeal p>alysis1 #gfe4 ,laboratory exp]im5ts on animals 7,lesions71 #ia4 ,labyr9?itis1 #bed4 ,la*rymal app>atus1 ,diseases (1 #bjb4 ,la5nac's egophony1 #fac4 pe>ls1 #ehf4 ,l&m>ks ( sp9e1 #ci4 ,l&ry's disease diff]5tiat$ f myelitis1 #gdi4 p>alysis1 #gec4 ,l>yngeal n]ve te*nic1 #gai4 lesions affect+ sup]ior & inf]ior1 #gai4 ,l>yngismus /ridulus1 #egb4 diff]5tiat$ f cr\p1 #egc4 ,l>yngitis1 acute cat>rhal1 #efi4 *ronic cat>rhal1 #egj4 edemat\s1 #egg4 spasmodic1 #egc4 syphilitic1 #egg4 tub]cul\s1 #ege4 ,l>ynx complications 9 typhoid1 #ccb4 diseases (1 #efi4 exam9ation1 #dg4 te*nic1 #fg4 ,lat]al curvature1 #ih4 ,lead colic diff]5tiat$ f inte/9al colic1 #ece4 poison+1 ,neuritis f1 #gjg4 ,leg exam9ation1 #ef4 neuralgia (1 #gad4 te*nic1 #hj4 vasomotor n]ves to1 #ia4 ,l5s1 diseases (1 #bbi4 opacity1 #bbi4 ,l5ses expla9$1 #aia4 ,leprosy1 ane/hetic1 diff]5tiat$ f syr+omyelitis1 #gfb4 ,lesions ( ea* "p or organ index$ "u respective names ( p>ts1 b n "u all diseases 9 :i* !y may be f\nd ,lesion affect+ "o viscus affects o!rs also1 #did4 caus$ by visc]al di/urbance1 #eja1 #ejc4 *ronic1 r$uce gradually1 #ff4 composite1 #cj4 dom9ant 9 caus+ ga/ro-inte/9al disease1 ,o/eopa?ic1 #dhi1 #dij4 effects (1 #cc4 effects 9 he>t cases1 ,o/eopa?ic1 #fdg1 #fdh4 impact$1 #ib4 is abs5ce ( motion1 #dhi4 ligam5t\s1 #bh4 muscul>1 #bg1 #da1 #de4 caus$ by visc]al di/urbances1 #ejj4 ( v>i\s /ructures & regions1 consid]$ 9 connection ) osse\s lesions ( same4 osse\s1 #bf4 also li/$ "u v>i\s bones1 organs & regions4 pa?ognomonic signs (1 #ci4 results /at$ by ,mc,connell1 #dij4 to diagnose1 #ch1 #cj1 #ia4 visc]al1 #bi4 ,leyd5's cry/als1 #ehf4 ,leukemia1 #fhj4 acute myelog5\s1 #fha4 lymphatic1 #fhb4 spl5om$ull>y1 #fha4 ,li!mia1 #dfi4 ,liv]1 amyloid1 #efb4 & bile duct1 diseases (1 #eec4 canc] (1 #efb4 7*olecy/itis71 #eeg4 cirrhosis (1 #efj4 complications 9 typhoid1 #ccb4 exam9ation1 #ea4 fatty1 #efb4 7gall-/ones71 #efd4 hyp]emia (1 #eed4 inactivity f p5dul\s abdom51 #abg4 inn]vation1 #dgd4 involv$ 9 rheumatism1 #dfj4 7jaundice71 #eeh4 location ( reflex pa9 f1 #dii4 nutmeg1 #eec4 pa9 reflex to scapula1 #gba4 7simple cat>rhal jaundice71 #eee4 prolapse1 #ach4 s5sory n]ves to1 #ie4 te*nic1 #gg4 vasomotor n]ves to1 #id4 ,lob> pneumonia1 acute1 #eig4 ,lock-jaw1 #cgg4 ,locomotor ataxia1 #ged4 diff]5tiat$ f ,fri$rei*'s ataxia1 #gei4 ,lordosis1 #ig4 ,lor5z op]ation1 #gha4 ,lumbago1 #dfe1 #dff4 ,lumb> curve & prolaps$ ut]us1 #adc4 prom95t hip1 #abe4 exam9ation1 #di1 #eb4 lumb> n]ves1 lesions affect+1 #gbb4 te*nic1 #gd4 ,lumbo-abdom9al neuralgia1 #gac4 ,lungs affect$ by /oma* pressure1 #dih4 complications 9 typhoid1 #ccb4 conge/ion1 #faj4 cr[d$ by r\nd %\ld]s1 #aba4 diseases1 #eib4 due to ribs1 #dg4 caus+ hyp]emia ( liv]1 #eed4 edema (1 #faa4 relation to dige/ion1 #did4 s5sory n]ves to1 #ie4 /imulat$ ?r\gh rectum1 #afi1 #agj4 vasomotor n]ves to1 #ic4 ,lymphatic leukemia1 #fhb4 ,lymphad5oma1 #fhd4 ,m ,mc,burney's po9t1 #edi4 :y pa9 9 app5dicitis1 #dii4 ,macula lutea1 #aie4 ,maddox rod1 #aic4 ,mal1 gr&1 #gcj1 #gcb4 petit1 #gcj1 #gcc4 ,mal>ia associat$ ) typhoid1 #ccg4 ,mal>ial ca*exia1 #cea4 fev]1 #cdg4 p]nici\s1 #cej4 hematuria1 #cea4 ,mamm>y gl& inn]vation1 #gbb4 ,manic depressive psy*oses1 #bia4 ,massage foll[+ hip jo9t disease1 #aaa4 intracapsul> fracture ( hip1 #aaa4 ( fractures1 #aaf4 ( spra9s1 #aji4 n o/eopa?y1 #ai4 ,ma/oiditis1 #bdj4 ,mayo cl9ic's goit] f9d+s1 #fib4 ,measles1 #dcg4 a cause ( bron*itis1 #egi4 diff]5tiate ,g]man measles1 #ddf4 sc>let fev]1 #dcb4 ,g]man1 #ddd4 ,meatus ( e>1 atrophic1 #bcg4 infection (1 #bch4 ,m$ulla conta9s vasomotor c5t]1 #ib4 ,meibomian cy/1 #bjj4 ,meissn]'s plexus1 #did4 ,melan*olia agitata1 #big4 ,mellitus1 ,diabetes1 #dgj4 ,m5i]e's disease1 #bed1 #gah4 symptom complex1 #bec4 ,m5+eal tub]culosis1 #chg4 ,m5+itis1 c]ebrosp9al1 #ceh4 complicat+ pneumonia1 #fja4 tub]cul>1 #cfj4 ,m5opause1 ?yroid enl>gem5t dur+1 #fhf4 ,m5tal defici5cy1 #cje4 diseases1 #bhb4 o/eopa?ic lesions 91 #bhi4 ,microcephal\s1 #cjh4 ,migra9e1 #gcf4 ,milk leg1 #afg4 ,m9d1 relation to bra91 #cjg4 ,m9]'s anemia1 #aee4 ,mitral regurgitation1 #fdh4 /5osis1 #fdi4 ,moebius' sign1 #fid4 ,morbilli1 #dcg4 ,mongolian am5tia1 #cji4 ,morons1 #cje4 ,morph9e habit1 physicians responsible1 #gae4 ,morton's disease1 #aab4 ,morvan's disease1 #gfb4 ,mosquito c>ri] ( fil>ia1 #aeh4 ,motion is function ( jo9t1 #dhi4 ,motor oculi n]ve1 lesions affect+1 #gaf4 ,m\?1 diseases (1 #dhg4 ,muc\s colitis1 #ebf4 ,mumps1 #ddi4 :oop+ c\gh & acute eruptive fev]s1 #daj4 diff]5tial diagnosis1 #dea4 ,murmurs1 ,he>t1 #fdb1 #fdc4 ,muscle contractions caus$ by visc]al di/urbances1 h[1 #ejj4 reliev$ by inhibition1 #hi4 ,muscul> lesions1 #bg1 #da1 #de4 ,also consid]$ 9 connection ) osse\s lesions ( v>i\s p>ts4 rheumatism1 #dfe4 ,musculacutane\s n]ve1 lesions affect+1 & results1 #gba4 ,myalgia1 #dfg4 ,mydriatic1 #aid4 ,myelemia1 #fha4 ,myelitis1 #gjg4 acute1 #gdh4 *ronic1 #gej4 diffuse1 #gdi4 transv]se1 #gdh4 ,myelog5\s leukemia1 acute1 #fha4 ,myeloid leukemia1 #fha4 ,myoc>ditis1 #fei4 ,myoclonia1 #gbg4 ,myx$ema1 #fig4 ,n ,nasal--,see nose4 ,nasoph>yngitis1 #bgb4 ,nasoph>ynx1 diseases (1 #bgb4 ,neck--,see also c]vical4 ,neck exam9ation1 #dg4 muscle lesions1 #df4 /iff1 #dfe1 #dff4 te*nic1 #fd1 #ff4 dang]s (1 #ff1 #hf4 ,nephritis diff]5tiat$ f pyelitis1 #fbh4 hemorrhagic1 *ronic1 #fbb4 int]/itial1 #fbd4 diff]5tiat$ f diabetes insipidus1 #dgg4 p>5*ymat\s1 acute1 #fah4 *ronic1 #fba4 po/-op]ative1 #cad4 ,n]ve c5t]s 7o/eopa?ic71 #hh4 deafness1 #bee1 #gah4 deg5]ation1 auditory1 #bef4 diseases (1 #gjf4 cranial1 diseases (1 #gae4 sp9al1 diseases (1 #gai4 s5sory1 #id4 vasomotor1 #ib4 ,n]v\s indige/ion1 #eaa4 pro/ration f prolapse1 #abh4 sy/em1 diseases (1 #gjf4 ,neuralgia1 #gaj4 c]vico-bra*ial & bra*ial1 #gaa4 c]vico-occipital1 #gaa4 diff]5tial diagnosis1 #gad4 int]co/al1 #gba4 ( eye1 #aig4 ( fif? n]ve1 #gaj4 ( foot1 "s causes1 #aab4 ( legs & feet1 #gad4 ( sacral n]ve f impact$ feces1 #ecg4 ( sacral region1 #gac4 ( sp9al column1 #gac4 ( trunk1 #gab4 reliev$ by inhibition1 #hi4 ,neura/h5ia1 #gdd4 ,neuritis1 #gjf4 bra*ial1 #abc4 diff]5tiat$ f neuralgia1 #gad4 multiple1 diff]5tiat$ f ,l&ry's p>alysis1 #gec4 f myelitis1 #gdi4 optic1 #bcj4 po/-op]ative1 #cac4 retrobulb>1 #bca4 ,neuroses ( he>t1 #ffb4 ga/ric1 #eaj4 ,neurosis1 occupation1 #gch4 8,neurotic sp9e10 #aja4 ,nocturnal epilepsy1 #gcc1 #gcd4 ,nose & ?roat 9 eye tr\bles1 #aia1 #aif1 #bbe1 #bbi4 antiseptic sprays etc41 #beh1 #bfb4 conditions 9 torticollis1 #dff4 diseases (1 #beg4 intranasal treatm5t1 #bfj4 pack+1 #bfg1 #bfh4 ph>macodynamics (1 #bfb4 syphilis (1 #bgj4 ?roat & e>1 diseases1 #bcf4 noseble$1 #afa1 #bga4 diff]5tial diagnosis1 #afa4 ,nurs+ necess>y to o/eopa?y1 #fb4 ,nutmeg liv]1 #eed4 ,o ,obesity1 #dhj4 ex]cises to r$uce abdom51 #abh1 #aci1 #dhj4 ,ob/etric cases1 innom9ate leos9 91 #afh4 ,ob/ruction1 inte/9al--see inte/9al4 ,obturator n]ve1 lesions affect+1 #gbb4 ,occipito-atlantal exam9ation & lesions1 #de4 te*nic1 #fg4 ,occupation neurosis1 #gch4 ,olfactory n]ve1 diseases (1 #gae4 ,omodynia1 #dff1 #dfg4 ,oph?almia neonatorum1 #baj4 purul5t1 #bji4 sympa!tic1 #bbg4 ,oph?almology1 #ahc4 ,oph?almoscope1 #aic4 ,optic disc1 #aie4 n]ve atrophy1 #bca4 probably connection ) ?ird1 #bcd4 neuritis1 #bcj4 tract1 diseases (1 #gae4 ,oroph>ynx1 diseases (1 #bgd4 ,or?op$ic ,surg]y1 #gfg4 ,o/eopa?ic c5t]s--see c5t]s4 diagnosis & prognosis1 #ch4 etiology & pa?ology1 #bd4 exam9ation ( eye1 #ahd4 inhibition1 #hi4 lesion def9$1 #bd4 manipulation 9 eye diseases1 #aif1 #bac4 readju/m5t1 #ij4 /imulation1 #hh4 !ory1 pro( (1 #cd4 sci5tific demon/ration1 #hi4 treatm5t1 g5]al directions1 #eh4 ,o/eopa?y1 def9itions (1 #ah4 includes _m measures1 #fb4 n massage1 #ai4 n passive ex]cise1 #abi4 n ,sw$i% movem5ts1 #ai1 #fc1 #fh4 ,otitis m$ia1 acute suppurative1 #bci4 *ronic suppurative1 #bdc4 diff]5tial diagnosis1 #bdd4 non-suppurative1 #bdf4 ,ov>ian exam9ation1 #ef4 ,ov>y1 prolapse (1 #add4 s5sory n]ves to1 #ie4 ,oxyuris v]micul>is1 #aed4 ,p ,pa*ym5+itis1 c]vical1 diff]5tiat$ f syr+omyelia1 #gfb4 ,pack+1 nasal1 #bfg1 #bfh4 ,pa9s1 location ( reflex1 #dii4 ,palpation1 educat$1 #fj4 practice 91 #hg4 ,palpitation1 #ffb4 ,pannus1 #bbd4 ,panoph?almitis1 #bbg4 ,papillae 9 rectum1 #agd4 ,p>alysis1 acute asc5d+1 #gec4 ,p>alysis agitans1 #gbc4 diff]5tial diagnosis1 #gbd4 bulb>1 #gfe4 ,p>alysis1 infantile1 #gej4 ,p>anephritic abscess diff]5tiat$ f pyelitis1 #fbh4 ,p>anoia1 #bhg4 ,p>aplegia1 ataxic1 #gfa4 spa/ic1 #gfj4 ,p>asites1 animal1 #aea4 ,p>a?yroid gl&s1 diseases (1 #fii4 ,p>atyphoid fev]1 #cdd4 ,p>is1 pla/] (1 #gie4 ,p>otiditis1 epidemic1 #ddi4 diff]5tial diagnosis (1 #dea4 ,p>otitis1 epidemic1 #ddi4 ,pa!ticus n]ves1 lesions affect+1 #gaf4 ,pa?ologies1 o/eopa?y recognizes two di/9ct1 #dhi4 ,pa?ology1 o/eopa?ic1 #ca4 ,pati5t's receptivity to treatm5t1 #fa4 ,pe>ls1 ,lnnec's1 #eia4 ,pelvic exam9ation1 #eb4 prolapse caus$ by abdom9al prolapse1 #abh4 te*nic1 #gh4 ,p5dul\s abdom51 #abg4 ,p]ic>ditis1 #fch4 complicat+ pneumonia1 #fjj4 ,p]ic>dium1 diseases (1 #fch4 ,p]i/alsis expla9$1 #did4 rev]s$1 normal 9 p>ts ( colon1 #dig4 te*nic to affect1 #die4 ,p]itonsill> abscess1 #bgh4 ,p]nici\s anemia1 #fgh4 ,p]tussis1 #deb4 ,petit mal1 #gcj1 #gcc4 ,ph>yngitis1 #bgd4 ,ph>ynx complications 9 typhoid1 #ccb4 te*nic1 #fg4 ,ph5ol-glyc]9e =mula1 #bfc4 ,phlebitis1 #afg4 po/-op]ative1 #cac4 ,phlegmasia alba dol5s1 #afg4 ,phlyct5ul> k]atitis1 #bbd4 ,phr5ic n]ve1 lesions affect+1 #gbj4 ,ph?isis1 see tub]culosis4 ,piles1 #aga4 ,p9-worm1 #aed4 ,pla/] ( ,p>is1 #gie4 ,pleura1 diseases (1 #faa4 ,pleurisy1 #faa4 complicat+ pneumonia1 #fjj4 diff]5tiat$ f pneumonia1 #fja4 po/-op]ative1 #cad4 ,pleurodynia1 #dfe1 #dff1 #gab4 ,pneumoga/ric n]ve1 lesions affect+1 #gah4 ,pneumonia1 acute lob>1 #eig4 aspiration1 #fje4 alcohol n indicat$ 91 #cai4 associat$ ) endoc>ditis1 #fdd4 bron*ial1 #fje4 caus$ by tub]cle bacillus1 #fjf4 cat>rhal1 #fje4 complication ( typhoid1 #ccb4 *ronic int]/itial1 #fji4 cr\p\s1 #eig4 diff]5tial diagnosis (1 #fji4 deglutition1 #fje4 diff]5tial diagnosis (1 #fja4 po/-op]ative1 #cad4 ,pneumonia1 /ry*n9e n indicat$ 91 #cbj4 ,pneumonic ph?isis1 #chh4 ,poliomyelitis1 #gej4 caus+ scoliosis1 #ggj4 diff]5tiat$ f myelitis1 #gdi4 ,polyuria1 #dgf4 ,portal sy/em1 vasomotors to1 #id4 ,po/]ior sp9e te*nic1 #aja4 ?oracic n]ve1 lesions affect+1 #gba4 ,po/-op]ative treatm5t1 #cab4 ,po/ural curves ( sp9e1 #abh4 defects1 #abj4 ,po/ure1 correct1 #abg1 #abh4 ,pott's disease1 #ajb1 #ghh4 diff]5tiat$ f kyphosis1 #ig4 f scoliosis1 #ggc4 treatm5t1 #ajb4 ,proctitis1 #agj4 ,prognosis & diagnosis1 o/eopa?ic1 #ch4 o/eopa?ic1 #ef4 ,progressive muscul> atrophy1 #gfd4 diff]5tiat$ f syr+omyelitis1 #gfb4 ,prolapse--,see also ptosis4 ,prolaps$ hepatic flexure1 #aci4 inte/9es1 #aci1 #agj4 kidney1 #acf4 liv]1 #ach4 organs1 #abg1 #acc1 #eba4 ov>ies1 #add4 rectum1 #aga4 sigmoid flexure1 #ada1 #agj4 /oma*1 #acd4 ut]us1 #adc4 ,prom95t hip1 #abe4 ,pro/ate gl&1 #age4 te*nic1 #fcg4 s5sory n]ves to1 #ie4 ,pro/atitis1 #age4 ,pro/atorrhea1 #agf4 ,pseudo-ang9a pectoris1 #ffg4 app5dicitis1 #eej4 cr\p1 #egb4 leukemia1 #fhd4 ,psy*algia1 #bic1 #bif4 ,psy*osis1 involutional1 #bie4 ,ptosis--,see also prolapse4 ( abdom9al organs1 #abg4 ( eyelids1 #bja4 ,pulmon>y regurgitation1 #fej4 /5osis1 #fej4 ,punctum proximum1 #aib4 remotum1 #aib4 ,purpura1 #dhc4 v>iolosa1 #dbj4 ,pyelitis1 #fbg4 diff]5tial diagnosis1 #fbh1 #fcf4 ,pyelonephritis1 #fbg4 ,pyemia1 #cef4 ,q ,qu9sy1 #bgh4 ,r ,radial n]ve1 lesions affect+1 #gci4 ,ra%1 diff]5tiate sc>let fev] f drug or septic1 #dca4 ,receptaculum *yli1 vasomotor n]ves to1 #id4 ,rectal conditions requir+ surg]y1 #agd4 disord]s1 brief discussion1 #ada4 exam9ation1 #ee1 #ef1 #afi4 ,rectum1 #afi4 to dilate1 #agj4 te*nic1 #afi4 ,reflex ga/ric tr\bles1 #eji4 pa9s1 location ( v>i\s1 #dii4 ,reflexes1 somatic1 ,burns exp]im5ts1 #ahi4 ,regions ( body %\ld =m basis ( disease classification1 #ehf4 ,regurgitation1 aortic1 #fdi4 mitral1 #fdh4 pulmon>y1 #fej4 tricuspid1 #fej4 ,remitt5t fev]1 #cej4 diff]5tiate f yell[ fev]1 #cge4 ,r5al calculus1 #fca4 ,r5al colic--see colic4 diff]5tiate f app5dicitis1 #eea4 ,respiratory diseases1 #efi4 reflex ineffici5cy1 #bfd4 ,ret9a1 diseases (1 #bcj1 #gae4 ,ret9itis1 #bcj4 ,retrobulb> neuritis1 #bca4 ,rheumatic fev]1 #deg4 ,rheumatism1 abdom9al1 #dff1 #dfg4 cause ( he>t valve defects1 #fde4 *ronic articul>1 #dfj4 diff]5tial diagnosis1 #dei4 & bra*ial neuritis1 #abe4 gonorrheal1 #dei4 inflammatory1 #deg4 muscul>1 #dfe4 subacute1 #dei4 ,rheumatoid ar?ritis1 #dfb4 diff]5tiat$ f rheumatic fev]1 #dei4 ,rh9itis1 acute1 #beg4 atrophic1 #bfa4 *ronic hyp]trophic1 #bei4 hyp]e/hetic1 #bfc4 purul5t1 #bei4 ,ribs1 dang] 9 eld]ly pati5ts1 #hg4 exam9ation1 #dg4 false1 te*nic1 #gd4 fir/1 exam9ation1 #di4 te*nic1 #gb4 float+1 #di4 te*nic1 #gc4 lesions cause he>t tr\ble1 #fdh1 #fec4 describ$1 #dh4 spra9s1 #aaa4 te*nic1 #fi4 ,rickets1 #dgh4 ,rose spots1 #ccd4 ,r\nd %\ld]s1 #aba1 #acj4 worm1 #aea4 ,rubella1 #ddd4 diff]5tiat$ f measles & sc>let fev]1 #ddf4 ,rubeola1 #dcg4 ,ruddy nasal ?ird f+]1 #aig4 ?ird f+] eye in/rum5t1 #bad1 #bbi4 treatm5t ( tonsillitis1 #bha4 ,s ,/4 ,vitus' dance1 #gbe4 ,saccules 9 rectum1 #agd4 ,sacral n]ves1 lesions affect+1 #gbb4 neuralgia1 #gac4 caus$ by impact$ feces1 #ech4 ,sacro-iliac--see innom9ate4 ,sacrum exam9ation1 #ee4 te*nic1 #hb4 ,saliv>y gl&s1 #dia4 ,sall[ sk91 #eei4 ,scalp1 #df4 te*nic1 #fh4 ,scapula1 te*nic1 #fh4 ,scapulodynia1 #dff1 #dfg4 ,sc>lat9a1 #dbh4 diff]5tiate diph!ria1 #dcb4 drug ra%1 #dca4 ,g]man measles1 #dcb1 #ddf4 measles1 #dcb4 septic ra%1 #dca4 types & =ms1 #dcb4 ,sc>let fev]--see sc>lat9a4 ,s*ematic eye1 #aid4 ,sciatica1 #gjh1 #gad4 8,scissors0 te*nic dang]\s1 #hf4 ,scl]osis1 amyotrophic lat]al1 #gfb1 #gfc4 diff]5tiate f syr+omyelia1 #gfb4 c]ebral1 diff]5tiate f *orea1 #gbf4 dissem9at$1 diff]5tiate f p>alysis agitans1 #gbd4 ,scoliosis--,see curvatures4 ,scr(ula1 #chd1 #cif4 ,scr(ul\s oph?almia1 #bad4 ,scurvy1 #dha4 ,sem9al vesicles1 #agf4 ,s5ile delirium1 #cjj4 dem5tia1 #big4 ,s5sory n]ves to v>i\s visc]a1 #id4 ,see also "u v>i\s visc]a4 ,septic ra%1 diff]5tiate sc>lat9a1 #dca4 ,septicemia1 #cee4 8,sett+ up0 ex]cises = p5dul\s abdom51 #abh4 ,%ak+ palsy1 #gbc4 ,%\ld]1 #ef1 #hj4 pa9ful1 #abb4 r\nd1 #aba4 spra9 (1 #aad4 ,sight--see eye4 diagnosis1 #ch4 ,sigmoid impaction caus+ c\gh1 #ege4 prolapse1 #ada4 ,s9usitis1 #bfi4 vacuum1 #bgj4 ,sk9 diseases1 #adg4 ,small occipital n]ve1 po9t to control1 #gai4 ,smallpox1 #dab4 black1 #dbj4 diff]5tiate f *ick5-pox1 #dag4 ,smell1 s5se (1 #dia4 ,snell9's te/ type1 #aia4 ,sol> plexus inhibition1 #ehb4 ,somatic reflexes--,burns exp]im5ts1 #ahh4 ,spasm--see convulsions4 habit1 #gbh4 ,spa/ic p>aplegia1 #gfj4 ,sph9ct]s1 alim5t>y1 #dif4 ani1 ext]nal1 #dih4 ,sp9al accessory n]ve1 lesions affect+1 #gai4 c5t]s 7o/eopa?ic71 #hh4 column1 neuralgia (1 #gac4 po/ural curvatures (1 #abh4 cord1 diseases (1 #gdh4 curvature1 pa?ological1 #if4 te*nic1 #ig4 exam9ation1 importance (1 #da4 l&m>ks1 #ci4 lesions--see lesions4 n]ves1 diseases (1 #gai4 /ret*+1 dang]s (1 #hf4 ,sp9e ! c5t] ( o/eopa?ic int]e/1 #ch4 hy/]ical1 description & te*nic1 #aja4 neurotic1 description & te*nic1 #aja4 ( ! ag$1 description & te*nic1 #aja4 po/]ior1 te*nic1 #aja4 spra9s (1 #aaj4 /raight1 #ii4 te*nic1 #ajj4 tub]cul> disease (1 #ghh1 #ajb4 typhoid1 description & te*nic1 #ajj4 ,splan*nic te*nic1 #die4 ,sple5 complications 9 typhoid1 #ccb4 diseases (1 #efg4 exam9ation1 #eb4 treatm5t1 #gh4 vasomotor n]ves to1 #id4 ,spl5itis1 #efg4 ,spl5om$ull>y leukemia1 #fha4 ,spondylitis de=mans1 #dfc4 ,spra9s & fractures1 #ajd4 b&ag+ n always good1 #ajg4 heat & cold 9 treatm5t1 #ajf4 immobilization & re/1 #ajf1 #aae4 massage1 #aji1 #aaf4 ( ankle1 #aab4 ( elb[1 #aad4 ( f+]s1 #aad4 ( foot1 #aab4 ( hip1 #aaa4 ( innom9ate1 #aaa4 ( knee1 #aab4 ( ribs1 #aaa4 ( %\ld]1 #aad4 ( sp9al column1 #aaj4 ( wri/ & h&1 #aad4 passive movem5t1 #ajg4 summ>y ( treatm5t1 #aaj4 ,/& erect1 h[ to1 #abg4 ,/atus epilepticus1 #gcd4 lymphaticus1 #gjb4 ,/5osis1 aortic1 #fej4 mitral1 #fdi4 pulmon>y1 #fej4 tricuspid1 #fej4 ,/]num exam9ation1 #di4 te*nic1 #gc4 ,/ill1 e>ly /ruggles ( ,dr4 ,a4 ,t41 #ag4 ,/ill-,hildre? ,sanit>ium #bhj1 #bia4 ,sev]al times 9 *apt] on m5tal & n]v\s diseases4 ,/imulation1 o/eopa?ic1 #hh4 ,/oma*1--see also dige/ive sy/em4 c>diac relaxation by inhibition1 #hi4 conditions 9 bron*ial a/hma1 #ehi4 dilatation1 #acd4 diff]5tiate f ga/roptosia1 #acd4 di/5tion1 #dih4 exam9ation1 #eb4 hemorrhage1 #afb1 #eaf4 pa9 ov] pit (1 due to cutane\s s5sory n]ves1 #gba4 prolapse1 #acd4 s5sory n]ves to1 #ie4 te*nic1 #gh4 ulc]1 sp9al causes (1 #dih4 ,/omatitis1 #dhg4 ,/ones1 gall1 #efc4 kidney1 #fca4 8,/raight sp9e10 #ii1 #acj4 te*nic =1 #ajj4 ,/rangulation ( inte/9es1 #eda4 ,/ret*+1 indiscrim9ate1 #hf4 ,/ry*n9e n indicat$ 9 po/-op]ative pneumonia1 #cbj4 poison+ diff]5tiat$ f tetanus1 #cgh4 ,/upor1 delirium & confusion1 #bhi4 ,/y1 #bjj4 ,sun/roke1 #ahj4 ,supports1 ar*1 #aad4 9 prolapse1 #acc1 #adb4 ,supr>5al capsule1 ,dr4 ,/ill's !ory1 #fcc4 ,surg]y1 relation to o/eopa?y1 #bb4 9 v>i\s conditions1 tak5 up 9 connection ) treatm5t4 or?op$ic1 #gfg4 ,swall[+1 #dib4 ,sw$i% movem5ts n o/eopa?y1 #ai1 #fc1 #fh4 ,syne*iae 9 k]atitis1 #bba4 ,syphilis ( nose1 #bgj4 ( ?yroid1 #fhg4 ,syphilitic l>yngitis1 #egg4 ,syr+omyelia1 #gfa4 diff]5tial diagnosis1 #gfb4 ,t ,tabes dorsalis1 #ged4 ,ta*yc>dia1 #ffc4 ,ta5ia flavo-punctata1 #aea4 sag9ata1 #aea4 solium1 #aea4 ,talipes1 #ghd4 ,tape-worm1 #aea4 ,ta/e1 bad1 9 m\?1 #dib4 s5se (1 #dia4 ,te*nic1 see "u o/eopa?ic treatm5t2 also "u v>i\s regions1 & organs4 dang]\s1 #hf4 o/eopa?ic1 #fj4 ,tee? conditions 9 torticollis1 #dff4 defects %\ld be correct$1 #dij4 ,temporo-m&ibul>--see jaw4 ,t5esmus treatm5t1 #agj4 ,te/es1 s5sory n]ves to1 #ie4 ,tetanus1 #cgg4 diff]5tiat$ f hydrophobia1 #cgh4 /ry*n9e poison+1 #cgh4 ,tetany1 #fii4 ,?orax exam9ation1 #ea4 ,?read-worm1 #aed4 ,?roat & nose 9 eye tr\ble1 #aia1 #aif1 #bbe1 #bbi4 ,?roat1 diseases ( ! e>1 nose &1 #bcf4 7,edw>ds' turb9ate adju/]71 #aig4 irritation due to hyoid1 #dg4 7,ruddy's nasal ?ird f+]71 #aig4 te*nic1 #fg4 ,?rombosis f typhoid1 #ccb4 ,?ru%1 #dhh4 ,?yroid gl&1 direct manipulation dang]\s1 #fif4 diseases (1 #fhf4 ,?ymus gl& enl>g$ 9 goit]1 #fia1 #fic4 diseases (1 #gjb4 ,tic1 convulsive1 #gbh4 d\l\reux1 #gaa4 g5]al1 #gbh4 ,tongue1 #dij4 furr$1 #dia4 vasomotor n]ves to1 #ib4 ,tonsils1 #fg4 function (1 #bgf4 9 rheumatism1 #deg1 #dfj4 9 torticollis1 #dff4 palpat$1 #dg4 7p]itonsill> abscess71 #bgh4 tr\ble 9 eye disease1 #aif4 ,tonsillectomy1 #bgh4 summ>y ( indications =1 #bhj4 ,tonsillitis1 #bgf4 te*nic1 #fh1 #bgi1 #bhj4 ,torticollis1 #abi1 #dfe1 #dff1 #gai4 ,t\*1 educat$ s5se (1 #fj4 ,tra*oma1 #bjh1 #bab4 diff]5tiat$ f follicul> conjunctivitis1 #bjh4 ,traction1 reasons =1 #fb4 ,transillum9ation 9 diagnos+ s9uitis1 #bfi4 ,treat+ 7ov]-treat+71 #hd4 9 influ5za1 #djd4 ,treatm5t--see also te*nic4 aft] a meal1 #hc4 frequ5cy (1 #hc1 #hd4 g5]al1 #fb1 #fh1 #ij4 %\ld be giv5 :51 #fc4 inhibition to beg91 #hi4 l5g? (1 #hd4 misappli$1 #he1 #hg4 position ( physician & pati5t1 #fc4 receptivity ( pati5t to1 #fa4 result+ 9 "s motion1 leave lesion = t "t1 #gf4 to be avoid$1 #hf4 value ( vacation f1 #he4 ,tremors1 diff]5tiate f p>alysis agitans1 #gbd4 ,tri*9iasis1 #aef4 ,tri*iasis1 #bja4 ,tricuspid regurgitation1 #fej4 /5osis1 #fej4 ,trigem9us n]ve1 lesions affect+1 #gag4 ,trigg]-f+]1 #aae4 ,tr\sseau's ph5om5on1 #gja4 ,tubal disease1 diff]5tiat$ f app5dicitis1 #eea4 ,tub]cle bacillus may cause bron*opneumonia1 #fjf4 ,tub]culosis1 #chj4 & jo9t immobilization1 #aae4 ( alim5t>y tract1 #cic4 acute1 #chf4 beg9s z *ronic ga/ritis1 #ejf4 bones & jo9ts1 #ghh4 bron*opneumonic1 #chh4 c]ebral1 #chg4 de=mities pr$ispos+ factors1 #chi4 diff]5tiate f bra*ial neuritis1 #abe4 pneumonia1 #fja4 7fibroid ph?isis71 #cic4 diff]5tiate f *ronic int]/itial pneumonia1 #fji4 ( g5ito-ur9>y tract1 #cid4 ( hip1 #gia4 ( knee1 #gic4 ( lymph gl&s1 #chd4 ( mili>y1 #chf1 #cid4 pneumonic1 #chf4 pulmon>y1 #chg1 #chi4 ( sp9e1 #ajb1 #ghh4 or?op$ic surg]y necess>y 91 #gfg4 ( ?yroid1 #fhg4 ,tub]cul\s l>yngitis1 #ege4 ,tumor1 bra91 diff]5tiate f migra9e1 #gcg4 ,tun+ =k te/s1 #bid4 ,turb9ates1 to clean ar\nd 9 rh9itis1 #bjj4 ,tussis convulsiva1 #deb4 ,typhoid fev]1 #cbi4 afebrile1 #ccd4 fev] associat$ ) mal>ia1 #chg4 d n manipulate abdom51 #afc4 diff]5tiat$ f app5dicitis1 #eea4 sp9e1 #ajj4 ,typhus fev]1 #cdd4 ,u ,ulc] ( cornea1 #bai1 #bba4 ga/ric & duod5al1 #eab4 location ( reflex pa9 9 ga/ric or duod5al1 #dii4 ( /oma*1 sp9al causes (1 #dih4 diff]5tial diagnosis1 #ejh1 #eae4 ,ulc]ative /omatitis1 #afd4 ,uln> n]ve1 lesions affect+1 #gbf1 #gci4 ,unc9>iasis1 #aee4 ,uremia1 #fbh4 ,uremic convulsions1 diff]5tiat$ f epilepsy1 #gcd4 ,uret]1 s5sory n]ves to1 #ie4 hemorrhage1 #afd4 ,ure?ra hemorrhage1 #afd4 ,ur9>y sy/em1 diseases (1 #fag4 ,ur9e1 blood 91 #afc4 massage pro/ate = ret5tion (1 #agf4 ,urtic>ia1 #adi4 ,ut]9e exam9ation1 #ef4 hemorrhage1 #afd4 ,ut]us1 prolaps$1 #adc4 s5sory n]ves to1 #ie4 ,v ,vacc9ation1 #dbd4 ,vacc9ia1 #dbd4 ,valve diseases1 he>t1 #fdb1 #fdd1 #fde1 #fdi1 #fea4 ,v>icella1 #dbd1 #ddf4 diff]5tiat$ f v>iola1 #dag4 ,v>icocele1 #agf4 ,v>icose ve9s1 #aff4 ,v>iola1 #dab4 cornea1 #dba4 diff]5tiat$ f v>icella1 #dag4 hemorrhagica pu/ulosa1 #dbj4 v]a1 #dah4 v]ucosa1 #dbj4 ,v>ioloid1 #dbj4 ,v>iolosa purpura1 #dbj4 s9e exan!mate1 #dbj4 ,vasomotor n]ves1 #ib4 ,v5]eal disease & eye tr\ble1 #ahd4 ,v]tebr1 l&m>ks = di/+ui%+1 #ci4 ,vision expla9$1 #bcj4 ,volvulus1 #eda4 ,vomit+1 p]si/5t1 mo/ly reflex1 #eja4 po/-op]ative1 #cab4 te*nic to relieve1 #ejd4 von ,graefe's sign1 #fid4 ,w ,wat]1 dr9k pl5ty1 #edj4 ,:ite swell+1 #gic4 ,:oop+ c\gh1 #deb4 ,:oop+ c\gh1 mumps1 & acute eruptive fev]s1 #daa4 diff]5tiate enl>g$ gl&s1 #ded4 ,worms1 inte/9al1 #aea4 ,wri/1 #ef4 spra91 #aad4 ,wry-neck--see torticollis4 ,y ,yell[ ,fev]1 #cgd4 diff]5tiate f remitt5t fev]1 #cge4 ,z ,zuck]k&'s organ1 #gjc4 ,transcrib]'s ,notes pg #dh ,*ang$3 resi/ance is a helpful guide 9 dignosis to3 resi/ance is a helpful guide 9 diagnosis pg #ga ,*ang$3 ,/ill ano!r me?od ( adju/fng ribs to3 ,/ill ano!r me?od ( adju/+ ribs pg #gi ,*ang$3 slip "o h& btewe5 ! ?ighs to3 slip "o h& betwe5 ! ?ighs pg #ia ,*ang$3 ,9 o!r words pa?ogological *anges are j z real to3 ,9 o!r words pa?ological *anges are j z real pg #aaa ,*ang$3 ,diagnosis1 ,etiology1 & ,tecnhique1 & ! g5]al to3 ,diagnosis1 ,etiology1 & ,te*nique1 & ! g5]al pg #aab ,*ang$3 ,ano!r jo9t frequ5t ov]look$ is ! innom9ate4 to3 ,ano!r jo9t frequ5tly ov]look$ is ! innom9ate4 pg #aab ,*ang$3 ( ! innom9ate t is prev5t+ revov]y to3 ( ! innom9ate t is prev5t+ recov]y pg #acj ,*ang$3 ,!re is (t5 a %ortn+ ( ! ant]ior /ructures to3 ,!re is (t5 a %ort5+ ( ! ant]ior /ructures pg #adj ,*ang$3 ,( p>ticul> local int]e/ to ! o/eop? to3 ,( p>ticul> local int]e/ to ! o/eopa? pg #ahf ,*ang$3 go9s !n to ! innom9ates to3 go+ !n to ! innom9ates pg #bad ,*ang$3 ,! exact cause ( ocul> lesions1 or phlyc5tul> to3 ,! exact cause ( ocul> lesions1 or phlyct5ul> pg #bae ,*ang$3 dia!sis & ! exan!mata play _! roll to3 dia!sis & ! exan!mata play _! role pg #bbj ,*ang$3 progressive ulc] 7second sage47 to3 progressive ulc] 7second /age47 pg #bbh ,*ang$3 :i* beg9s by contration ( ! field to3 :i* beg9s by contraction ( ! field pg #bch ,*ang$3 p>aff9 oil & ! heat appli$ cont9us\sly to3 p>aff9 oil & ! heat appli$ cont9u\sly pg #bed ,*ang$3 ,labyr9?itis is ( sev]al =ms b 9 g]n]al to3 ,labyr9?itis is ( sev]al =ms b 9 g5]al pg #bfa ,*ang$3 mucopurul5t dis*>ge1 accompani$ by a bad ordor to3 mucopurul5t dis*>ge1 accompani$ by a bad odor pg #bga ,*ang$3 ,! con/ituti\al causes ( epi/axis to3 ,! con/itutional causes ( epi/axis pg #bge ,*ang$3 treatm5t consi/s ( ?ror\gh cleans+ to3 treatm5t consi/s ( ?or\gh cleans+ pg #bhh ,*ang$3 ne>ly always ref]s to ! pat9et's ext]ior to3 ne>ly always ref]s to ! pati5t's ext]ior pg #bhh ,*ang$3 & h5ce be=e detrioroation has set 9 to3 & h5ce be=e det]ioration has set 9 pg #bij ,*ang$3 ! t]m 8acute confusional insantiy0 to3 ! t]m 8acute confusional insanity0 pg #bif ,*ang$3 fe>s1 p>ticul>y ( imp5d+ dang] to3 fe>s1 p>ticul>ly ( imp5d+ dang] pg #cjf ,*ang$3 m5tal capacity 9 man lie betwee53 to3 m5tal capacity 9 man lie betwe53 pg #caa ,*ang$3 ga9 is %[n treatm5t is discont9ut$ to3 ga9 is %[n treatm5t is discont9u$ pg #cad ,*ang$3 if necess>y completely elim9ation ( ! op]ation to3 if necess>y complete elim9ation ( ! op]ation pg #cag ,*ang$3 tri$ to cross ! railraod track to3 tri$ to cross ! railroad track pg #cdj ,*ang$3 c>e be+ tak5 t x is ?oroghly dige/$ to3 c>e be+ tak5 t x is ?or\ghly dige/$ pg #cdj ,*ang$3 lymphoid elem5ts ( ! inteat9es to3 lymphoid elem5ts ( ! inte/9es pg #cde ,*ang$3 & maybe bron*ial symptms4 to3 & maybe bron*ial symptoms4 pg #cdi ,*ang$3 ,if !re are two p>osyxms 9 ! same day to3 ,if !re are two p>oxysms 9 ! same day pg #cej ,*ang$3 twelve to tw5ty-f\r h\rs :5 consci\ness to3 twelve to tw5ty-f\r h\rs :5 consci\sness pg #cfb ,*ang$3 ,a d]angem5t ( ! v]etbral articulation to3 ,a d]angem5t ( ! v]tebral articulation pg #cfi ,*ang$3 = unsually ?is gives only tempor>y relief to3 = unusually ?is gives only tempor>y relief pg #cgf ,*ang$3 ,let ! pati5t dr9k freely ( tat] to3 ,let ! pati5t dr9k freely ( wat] pg #cgg ,*ang$3 ,esposure to damp cold is "o ( ! recogniz$ causes to3 ,exposure to damp cold is "o ( ! recogniz$ causes pg #chb ,*ang$3 art]y increase ! susceptiblility to infection to3 art]y increase ! susceptibility to infection pg #daa ,*ang$3 blood & lympa?ic supply to ! lungs to3 blood & lymphatic supply to ! lungs pg #dbc ,*ang$3 ,dur+ conval5sc5ce a full1 well-regulat$1 to3 ,dur+ convalesc5ce a full1 well-regulat$1 pg #dcc ,*ang$3 fev] usually by ! f\rte5e? day to3 fev] usually by ! f\rte5? day pg #dcf ,*ang$3 temp]ature is high & pati5t is delirius to3 temp]ature is high & pati5t is deliri\s pg #dcg ,*ang$3 may simulate infantile p>aylsis to3 may simulate infantile p>alysis pg #dcg ,*ang$3 ,measles is an acute infecti\s1 congati\s to3 ,measles is an acute infecti\s1 contagi\s pg #dch ,*ang$3 functional integrety ( ! lungs & he>t to3 functional integrity ( ! lungs & he>t pg #dda ,*ang$3 great] frequ5cy ?an 9 o!r infecti\ss diseases to3 great] frequ5cy ?an 9 o!r infecti\s diseases pg #ddb ,*ang$3 rugs & unnecess>y funiture h be5 remov$ to3 rugs & unnecess>y furniture h be5 remov$ pg #ddd ,*ang$3 is readily transmissable1 attacks *ildr5 especially to3 is readily transmissible1 attacks *ildr5 especially pg #ddh ,*ang$3 /rat*+ may cause pitt+ to3 scrat*+ may cause pitt+ pg #ddi ,*ang$3 are und\bt$ly pot5t presispos+ factors to3 are und\bt$ly pot5t pr$ispos+ factors pg #deg ,*ang$3 tonsillitis1 pyorrhea alveol>is1 s9uitis1 etc4 to3 tonsillitis1 pyorrhea alveol>is1 s9usitis1 etc4 pg #dgh ,*ang$3 cold & dampness are presispos+ factors to3 cold & dampness are pr$ispos+ factors pg #dhg ,*ang$3 ,removal ( ! excit+ cause is ! mo/ improtant to3 ,removal ( ! excit+ cause is ! mo/ important pg #dib ,*ang$3 result ( inatt5tion to oral hygi5ce to3 result ( inatt5tion to oral hygi5e pg #dic ,*ang$3 ! ebb & fl[ ( ! crebrosp9al fluid to3 ! ebb & fl[ ( ! c]ebrosp9al fluid pg #dig ,*ang$3 fur!r complicacates ! cl9ical picture to3 fur!r complicates ! cl9ical picture pg #ejj ,*ang$3 ,/oma*1 liv]1 gall-gladd]1 pyloric & duod5al to3 ,/oma*1 liv]1 gall-bladd]1 pyloric & duod5al pg #ejh ,*ang$3 confid5ce by mak+ an intelleg5t exam9ation to3 confid5ce by mak+ an intellig5t exam9ation pg #eae ,*ang$3 ,ref]r$ pa9 f *olesy/itis1 *ronic app5dicitis to3 ,ref]r$ pa9 f *olecy/itis1 *ronic app5dicitis pg #ebb ,*ang$3 ,!re is dypspesia1 flatul5cy1 con/ipation to3 ,!re is dyspepsia1 flatul5cy1 con/ipation pg #ebg ,*ang$3 ,! nurtition is g5]ally well ma9ta9$ to3 ,! nutrition is g5]ally well ma9ta9$ pg #ecg ,*ang$3 7affect+ reciprocal inn]avtion7 to3 7affect+ reciprocal inn]vation7 pg #eci ,*ang$3 p]i/altic action & ! sec]tory n]ves to3 p]i/altic action & ! secretory n]ves pg #ede ,*ang$3 ,k9ks ( ! pelivc colon1 ileum to3 ,k9ks ( ! pelvic colon1 ileum pg #edf ,*ang$3 /ret*$ suffici5tly to resore normal function to3 /ret*$ suffici5tly to re/ore normal function pg #edh ,*ang$3 app5dix c be /imulat$ by purcussion to3 app5dix c be /imulat$ by p]cussion pg #edh ,*ang$3 pyog5es aureus1 typhoid baccilli1 tub]cle bacilli to3 pyog5es aureus1 typhoid bacilli1 tub]cle bacilli pg #eea ,*ang$3 l>ge proportion ( cases revov] to3 l>ge proportion ( cases recov] pg #eee ,*ang$3 t5? rib on ! "r side1 ?us int]f]r+ to3 t5? rib on ! "r side1 ?us int]f]+ pg #efd ,*ang$3 p>ticul>ly fond ( />*y & saccahr9e food to3 p>ticul>ly fond ( />*y & sac*>9e food pg #ega ,*ang$3 muc\s membrane1 osccaional sup]ficial erosions to3 muc\s membrane1 occasional sup]ficial erosions pg #egb ,*ang$3 ,on ! :ole1 c>eful1 cont9u$ tream5t to3 ,on ! :ole1 c>eful1 cont9u$ treatm5t pg #ehb ,*ang$3 ,! prim>y =m is ! result ( expossure to3 ,! prim>y =m is ! result ( exposure pg #ehc ,*ang$3 lungs1 abscesses1 bron*ie/asis to3 lungs1 abscesses1 bron*iectasis pg #ehe ,*ang$3 ,dea? occassionally results f suffocation to3 ,dea? occasionally results f suffocation pg #eig ,*ang$3 especially by diploccocus pneumoni4 to3 especially by diplococcus pneumoni4 pg #fcd ,*ang$3 symptoms z neure/h5ia1 melan*olia to3 symptoms z neura/h5ia1 melan*olia pg #fde ,*ang$3 /&s =emo/ z a cuase ( valvul> defects to3 /&s =emo/ z a cause ( valvul> defects pg #fdg ,*ang$3 ,?r\gh analag\s reason+ f o!r organic to3 ,?r\gh analog\s reason+ f o!r organic pg #fdh ,*ang$3 involve inhibitory 7vagi7 fib]s or accell]ator to3 involve inhibitory 7vagi7 fib]s or accel]ator pg #fef ,*ang$3 process or an act ( comp5ation to3 process or an act ( comp5sation pg #fff ,*ang$3 discov]+ irregul>tities 9 ! "y to3 discov]+ irregul>ities 9 ! "y pg #fge ,*ang$3 ,! mononucle> neurtophiles are relatively increas$4 to3 ,! mononucle> neutrophiles are relatively increas$4 pg #fha ,*ang$3 ,x is a disease occur+ at all ages to3 ,x is a disease occurr+ at all ages pg #fia ,*ang$3 supply is e/5sive1 & ! ve9s expecially to3 supply is ext5sive1 & ! ve9s especially pg #fib ,*ang$3 due to ! incresee ( epi!lial cells to3 due to ! increase ( epi!lial cells pg #gjc ,*ang$3 ,dea? 9 adults has ocurr$ f trifl+ injuries to3 ,dea? 9 adults has occurr$ f trifl+ injuries pg #gjh ,*ang$3 ,9 a few cases !re are intraplevic causes to3 ,9 a few cases !re are intrapelvic causes pg #gbj ,*ang$3 he kn[s at once t ! headad*e is reliev$ to3 he kn[s at once t ! heada*e is reliev$ pg #gbd ,*ang$3 kness s close toge!r t !y rub 9 walk+ to3 knees s close toge!r t !y rub 9 walk+ pg #gdb ,*ang$3 ^! phemom5a also become bilat]al to3 ^! ph5om5a also become bilat]al pg #ggj ,*ang$3 curvavature decrease 9 ! volume ( ! l[] to3 curvature decrease 9 ! volume ( ! l[] pg #ggj ,*ang$3 t %\ld be consid]$ are spa/ic p>laysis to3 t %\ld be consid]$ are spa/ic p>alysis pg #ghh ,*ang$3 aris+ f ! lay] ( non-tub]culus granulation to3 aris+ f ! lay] ( non-tub]cul\s granulation pg #gij ,*ang$3 flacid & bilat]al & may exi/ to3 flaccid & bilat]al & may exi/ pg #gij ,*ang$3 mu/ be cut ov] ! invov$ area to3 mu/ be cut ov] ! involv$ area