Early American Manual Therapy

DEFINITION: A concise definition of both the terms may be: Abortion is the expulsion of the fetus between the fourth and the sixth months. But here we will use them as synonymous terms. Because the above terms are usually associated with criminality, the subjects are rather offensive to most people. But while there are great numbers of forced or criminal abortions, there are many others brought about by conditions of ill health, to which the physician must give his attention. Bland states that while there is no record of the number of criminal abortions performed, he believes that more than 35 per cent of all abortions result from criminal interference.
ETIOLOGY: Three types may be included in the etiology. In the majority of cases of premature expulsion of the ovum, the death of the fetus has been the beginning. So it is necessary to study what causes the death of the fetus. Accidents, and injuries to the pelvic regions, may cause a spontaneous expulsion.
DISEASES: Infection, and inflammation of the endometrium nephritis, malpositions of the uterus. Included in this group are all forms of infectious diseases, acute or chronic, which favor degenerative changes in the placenta, in the fetus, or both. Influenza, syphilis, toxemia, chronic visceral disease, drug or chemical intoxication, conditions brought about by repeated pregnancies that weaken the walls of the uterus, or adhesions that prevent the uterus from ascending up into the pelvis, and the growing infection forcing it to empty its contents. Induced abortion is one brought on intentionally either criminally or therapeutically. The latter is termed justifiable abortion when performed to save the mother’s life.
SYMPTOMS: In threatened abortion there is distress and pain in the pelvic region, accompanied by a bloody discharge. If the above symptoms should increase, then the abortion can be said to be imminent. Usually takes from three to six days.
The material expelled may be all the contents. That is termed a complete abortion. Again only a part of the contents may be expelled, creating an incomplete abortion. In the complete abortion the symptoms soon subside, and the tissues go back to normal. But in the incomplete abortion there is always danger of infection, which, spreading may cause peritonitis. There is a bleeding that may continue indefinitely.
PROGNOSIS: Favorable in the cases of complete abortion, but in the incomplete abortion, bleeding may lead to a severe secondary anemia, then to other complications including septicemia. In the cases of induced criminal abortion, it is said that probably one hundred or more thousand take place every year, and that about 6000 die.
TREATMENT: Threatened Abortion. Absolute rest in bed. Vitamin E, and a diet rich in lettuce, germ of wheat, liver and eggs. Also progestin, thyroid extract and vitamin F if there is jaundice. Ice bag to the abdominal wall, removed every two minutes or so, or a cold, wet towel laid over the abdomen.
Complete Abortion, without any complications. The patient must be kept in bed for some time and refrain from any movements that are of a fatiguing nature.
An Incomplete Abortion with danger of complications should not only have the attention of the patient’s physician, but also in consultation, with a surgeon versed well in the techniques of gynecology or obstetrics, because some or all of the following conditions may be found, and some or all of the following techniques may be necessary.
Hemorrhage, sepsis, and lacerations of the cervix are the immediate dangers. The pathologic conditions subsequent to an abortion are uterine subinvolution, endometritis, salpingitis in one of its forms, pelvic adhesions, chronic metritis.
Because of the tendency to retention of a portion of the deciduae, etc., with a resultant hemorrhage, chronic salpingo-oophoritis or septicemia. In criminal abortions there is the added risk of traumatism from unskillful use of instruments, and also of sepsis.
Marked bleeding without dilatation demands the use of a vaginal tampon of gauze, which is allowed to remain in situ for twelve to twenty-four hours and then replaced if it is needed. In many cases the cervix will have dilated enough, after the introduction of the first tampon, to allow the aseptic evacuation of the uterine contents, which is the best treatment. When the tampon is removed, moreover, it will be found in a number of cases that the fetus and membranes are wholly or in part extruded with it. In evacuating the uterus the woman is anesthetized, and removal accomplished with the finger, the dull curet, and Emmet’s curetment forceps. In addition to the above there may be some legal aspects that are easier explained by two physicians than by one.

ACIDOSIS DEFINITION: An abnormal condition caused by the accumulation in the body of an excess of acid, or the loss from the body of alkali. See also, Alkalosis.
SYMPTOMS: Loss of appetite, lassitude, listlessness, headache, weakness, nausea, occasional vomiting, dehydration, muscle aches, abdominal cramps, loss of weight, drowsiness and renal insufficiency.
The most pronounced symptoms of advanced acidosis are air hunger or hyperpnea and nausea. In diabetes mellitus, the defective oxidation of the fats results in the formation of the acetone bodies.
TYPES: Simple acidosis. Acidosis of Diabetes Mellitus of Nephritis, or Pregnancy.
The treatment of simple acidosis is of chief concern here. The others will come under the specific titles.
TREATMENT: Since the etiology is a concentration of blood bicarbonate below normal, it might be inferred that the treatment consists of merely giving the patient some sodium bicarbonate. But, it requires a good deal more than just that. The attempt must be made to restore the acid-base equilibrium to normal, which would bring the acidity to between 25 and 30 degrees.
PROGNOSIS: Is always favorable if not complicated with diabetes mellitus, nephritis, pregnancy or poisoning.
NEUROPATHIC TREATMENT: Lymphatic, with emphasis on the liver and kidneys. Stimulation or spondylotherapy of the segments of the spine to the above organs.
ENDO-NASAL THERAPY: Lake Head Recoil. Anterior and posterior nasal dilation and swabbing for relief of hyperpnea.
CHIROPRACTIC ADJUSTMENTS: Liver, kidney and atlas segments.
DIET: Foods from acid-alkaline balance chart.
DIETARY: In some cases a few days without meat is sufficient. In others a milk fast of one day. A 4-ounce glass of milk every two hours. Buttermilk fast or a lemon juice fast for one day has been found helpful. Tests made daily can determine how long the fast should be continued.
HERBOLOGY: The following has been used. One tablespoon of each to a pint of water. Calamus, Motherwort, Watercress. Bring to a boil. Let stand one hour. Strain and bottle. Tablespoonful after meals, and on retiring.

DEFINITION: A collection of serous fluid in the abdomen, or more correctly in the peritoneal cavity, characterized by a distended abdomen, fluctuation, dullness on percussion, displacement of viscera, embarrassed respiration, plus the symptoms of its cause.
CAUSES: Ascites may form part of a general dropsy, to wit: cardiac or nephritic. The most common factor in its production is a mechanical obstruction of the portal system from cirrhosis of the liver, pressure of tumors, diseases of the heart or lungs.
SYMPTOMS: The onset is insidious, and considerable swelling of the abdomen occurs before the disease attracts attention. Constipation from pressure of the fluid on the sigmoid flexure. Scanty urine, from pressure on the renal vessels. Embarrassed respiration and cardiac action from displacement of the diaphragm upward. The umbilicus is forced outward.
PHYSICAL SIGNS: On palpation, a peculiar wave-like impulse is imparted to the hand lying on the side of the abdomen, while gently tapping the opposite side.
PERCUSSION: Patient erect, the fluid distends the lower abdominal region, with dullness over the site of the fluid and a tympanitic note above; if the patient turns on his side, the fluid changes, and dullness over the fluid, tympanitic note over the intestines.
PROGNOSIS: Depends on the Etiology.
TREATMENT: When the physician is faced with a severe type of dropsy he must ask himself, how can I reduce the hydration in the shortest possible time? Then proceed to find the cause, and remove it. Medical opinion is charply divided on many points except one: surgical tapping. The division seems to be as follows: Fischer is chief exponent of the following -- To reduce the edema -- the physician must (1) Withhold water so as not to render too easily available the material needed for the swelling. (2) Neutralize the acids accumulated in the affected tissues, and (3) further their dehydration by increasing their salt intake. He advances the theory that in edema of any nature all salts are effective in reduction of the edema, by acting on the alimentary mucosa causing a secretion of water into the bowel, or upon the structure of the kidney, and so to cause an increased secretion of urine.
Gordon, on the other hand, maintains salt should not be allowed, and water kept at a minimum. Sajous Analytic Encyclopedia of Practical Medicine, P. 197. Both agree that when the pressure of the edema is uncomfortable to a great degree, surgical tapping is the proper procedure.
The writer in a number of cases has always judged the diet and care by the urinalysis reports and strives to establish a slightly balanced acid condition and, if possible, to maintain it at the level throughout the treatment.
NEUROPATHY: Sedation treatment to the Vaso-constrictors which have lost control.
CHIROPRACTIC: D. 6 to 10 and elsewhere as indicated.
ORIFICIAL THERAPY: Rectal dilations seem to have some beneficial effects.
DIETOTHERPY: Fasting for a day or two has produced very good results. The following regime is considered par excellent.
The patient gets a glass of milk every four hours. Hot, warm or cold. Nothing more. To quench thirst, mouth rinsing with water is permitted as often as desired but none swallowed. If food is craved and patient cannot be controlled No. 1 diet can be cut so as to allow the patient around 800 calories a day.
ELECTROTHERAPY: Ultra violet ray seems to be the only electrical appliance indicated in the acute stage. Abdominal exposure for 15 to 30 minutes daily four feet from the patient. Care must be exercised not to burn the patient.
COLONOTHERAPY: Distention prevents any radical irrigations. A very low enema may be administered internally when necessary.
HYDROTHERAPY: Neutral applications of warm and cool wet towels are sometimes helpful. The Physician must judge by each case what is best for the patient.
HERBOLOGY: Make infusion of equal parts of Composition Powder, Golden Seal and Peach Leaves. Use freely every three hours.

Acne Vulgaris

DEFINITION: An inflammatory disease of the sebaceous glands characterized by papules, and pustiles that are usually situated on the face and back.
TYPES: Acne populosa where the lesion only reaches the papular stage. Acne pustulosa, when the papules develop into pustules. Acne indurata, when the inflammation is deep seated and the papules or pustules are firm. Acne atrophica, in this form the lesions are followed by scars and pits.
ETIOLOGY: It is most common between the age of fifteen and thirty. Anemia, menstrual disorders, and gastrointestinal disturbances predispose. Certain drugs, such as iodid and bromide of potassium and copaiba may induce the disease.
SYMPTOMS: There is an aggregation of small papules, pustules, and comedones about the face, chest, and shoulders. Pustules or papules predominate according as the disease is acute or cronic. New lesions develop as the old disappear, so that the disease usually runs a protracted course unless stern measures are taken.
PROGNOSIS: Recovery is the rule, but sometimes very protracted.
TREATMENT: Both systemic and local. A complete check up is necessary with an investigation of teeth and tensils and other possible foci of infection. Neuropathic lymphatic treatment. Sedation of the whole spine. Chiropractic: D-6-10 and special liver, kidney local places. Hydrotherapy. Thorough washing with plenty of soap lather and warm water. Then a douching of the part with cold water. The salt glo in some cases is helpful. In others it has no effect. The area is thoroughly cleansed and the skin is left wet, then ordinary salt is lightly rubbed in. If, after five or ten times there is no improvement the salt glo should be discontinued. Shilling recommends the filling of a bottle with equal parts of Epsom Salts and Witch Hazel, dissolve thoroughly and apply, after steaming, at night.
DIETOTHERAPY: Each case must be judged and dieted according to the findings. We have found a short fast of grapes for a few days is effective in some cses. But, fasts must be regulated by whether anemia is present or the patient does hard labor. Diet No. 1 and 2 can fit most cases. Two or three days on No. 1, followed by alternating every other day with No. 2 has been a good procedure.
White determined that the following foods were the chief offenders--chocolate, milk, oranges, tomatoes and nuts. On the other hand, Wise and Sulzberger have found that Acne Vulgaris due to food is more imaginary than real, that it is due to the hyper-sensitivity of the pilosebaceous apparatus opening to hair and sweat glands, and of a lack of nervous and emotional control.
PSYCHIATRY: The patient, if showing any signs of emotional upsets should be examined carefully and efforts at orientation to the environment made. Every effort should be made to find the responsible tensions.
ELECTROTHERAPY: The best electrotherapy treatment for this condition is ultra violet, preceded ten to fifteen minutes by the infra red or deep therapy light. For lesions of the face the water cooled quartz light is best. The lights can be applied until a second degree erythema is produced.
Where the pimples have formed in heavy hard masses, the fulguration spark may be used to great advantage every five or six or seven days, letting the effect of the first treatment disappear before the second treatment is given. The gentler sparks from the glass vacuum electrode may be used instead of the above if desired and the treatment given six to eight or nine minutes daily.
HELIOTHERAPY: Sun bathing is very beneficial if exposure is limited to not more than ten minutes on the area at a sitting, but many sittings can be taken in a day.
VITAMINOTHERAPY: A and F.
VACUUM THERAPY: Cups suitable to fit the area, light suction for 20 to 60 seconds according to tolerance of patient, followed by light application of Derman Penatrin of Zemmer.
HERBOLOGY AND PHYTOTHERAPY: One ounce each of the following: Burdock Root, Yellow Dock Root, Yarrow, Marshmallow Root has been found helpful in the following form: Simmer in two quarts of water to two and one-half pints (50 ozs.) Strain and bathe the affected parts at least twice daily.
ACID AND ALKALINE BALANCE: The urine and skin tests for acid balance can be taken every day or every other day. If this can be attained, generally the condition is relieved quickly. The simple procedure of Litmasin pH Test is probably the quickest available.

DEFINITION: A rare disease due to a deficiency in function of the suprarenal capsule.
ETIOLOGY: An excessive constriction or degenerative changes in the sympathetic trunks or ganglia of the spinal segments leading to the suprarenal capsules. Tuberculosis elsewhere in the body or in the adrenals themselves is the most prominent etiological factor. Syphilis also is a factor. Atrophy of the glands because of vaso-constriction is a larger factor than heretofore given attention.
SYMPTOMS: The most prominent are anemia, general languor and debility. Cardiac feebleness, irritability of the stomach, marked gastro disturbances; also marked respiratory disturbances due to defects in the utilization of oxygen. Some others are, bronzing of skin, especially about the anus and surfaces subject to irritation; pigmentation of mucous membranes, extreme muscle weakness, loss of weight, low blood pressure, faintness or dizziness, nervousness and twitchings; psychic disturbances; white line on pressure of skin which lasts two or three minutes; renal insufficiency and dehydration.
PROGNOSIS: Is uncertain. Varies from a few weeks to fifteen or twenty years, marked by complications that may produce a crisis and death at any time. On the whole it can be said that the prognosis is decidedly unfavorable, because of complications that may arise.
DIAGNOSIS: This disease most frequently occurs between the ages of twenty and fifty years. Because it is rare and has many symptoms of other diseases, physicians often tell their patients they have it even when there is no bronzing of the skin. For a clear diagnosis of this disease, three tests can be made.
(1) Give a patient a pint of water to drink. Those having this disease are a long time getting rid of this excess water. In other words, in most cases of addison’s Disease the kidneys do not secret urine freely even after excess water has been taken.
(2) Patients suffering from Addison’s Disease excrete large amounts of sodium chloride and have retention of the urea.
(3) The pigmentation of parts or all of the skin. And the secondary anemia prognosis is largely unfavorable because it is not of a uniform type. It may last for a number of years with the patient improving for a time, then remissions. But, a patient who has improved, and continues his physical and manipulative treatments has possibilities of living a normal life-time.
TREATMENT: Neuropathic -- Thorough Lymphatic, dilation of kidney segments.
CHIROPRACTIC: D. 5-7-10.
DIET: There seems to be a division of opinion. Some say a fast on fruits and fruit juices for a few days, and others say: Plenty of nutritions, but easily digested, foods. We have used No. 1 Diet for three days, then No. 2 and No. 1 alternately for months, but changing daily the fruit juices, with beneficial results. Grape fruit juice diluted 20 times. A wine glass full four times a day is very helpful.
ELECTROTHERAPY: Sinnosoidal to adrenals for stimulation. Short wave for relief of pain.
VITAMINOTHERAPY: A and G.
ENDOCRINOLOGY: The adrenals on the sodium side, are said to be regulated by the anterior pituitary and especially the parathyroids. See “Technique” on Parathyroids in Endo Nasal, Aural and Allied Techniques -- Luke. Hormones for the Pituitary, Parathyroid and Adrenal glands may be considered.
ENDO-NASAL THERAPY: Lake Recoil. Breaking adhesions of Thyroid sinus, and opening and swabbing of anterior and posterior nares. This is necessary to raise the blood pressure and increase the oxidase and thyroidase.
HYDROTHERAPY: A teaspoonful of salt dissolved in an eight ounce glass of water drunk during each day will aid in overcoming the derangement of sodium metabolism and dehydration. If distasteful add fruit juices. Epsom Salts hot compresses laid over kidney areas for 20 minute periods three times daily.
PSYCHIATRY: These patients sometimes have emotional upsets. Rest, warmth, plenty of sleep and relaxation, free from worry, are necessities. See Chapter on “Suggestive Therapeutics” in “The Principles of Applied Psychiatry.” -- Page 135, Lake.
VACUUM THERAPY: Cups very lightly over the whole spine for six minutes at two minute intervals, then extremely light over the kidney area.
HERBOLOGY: Laxative. Diuretic and demulcent herbs. Botanicals are for laxative -- Senna, Cascara Sagrada, Ginger, Buckthorn, Blue Malva, Turtlebloom, Althea, Cheese Plant and Licorice, equal parts, using one teaspoonful of mixture to one cup of boiling water. Let cool, strain, drink in three installments. Proportion of ingredients to be adjusted to constitution of patient. For a mild diuretic and soothing demulcent -- Swamp Lily Root, Marshmallow Root, Bayberry leaves, Cheese Plant, Sassafras, bark or root, Buch leaves, Horsetail grass, Bluets and Corn Silk, made and taken in same manner as the laxative.
CAUTION: This is a treacherous disease and the patient should be under the observation of the physician constantly.
HABITS: The most prominent is that: The patient must be kept at rest, warm, relaxed, free from work and worry, and protected against strains of all kinds. Sufficient sleep and an adequate intake of food.
The two prime forms and purpose of treatment are:
(1) Care of dehydration by sodium chloride and glucose.
(2) Prevention of further destruction of the glands and prolonging life. But, it is stated by one authority on the subject that “up to the present time the treatments have been a thankless job.”

In common language, when adenoids are mentioned, it implies a hypertrophied lymphatic tissue in the nasal passages and in the upper lymphatic ring known as Waldeyers ring, which surrounds the orifices of the pharynx. They are situated in the pharyngeal cavity, on the back wall, just above the soft palate. They are lobulated lymphoid masses composed of lymphoid tissue similar to the tonsil, lymph nodes of spleen and in the nodules of the intestines.
ETIOLOGY: Enlargement is due to infection of excessive lymph substances. The most frequent causes are enlargement of the faucial tonsils, upper respiratory infections, or acute diseases, such as measles, mumps, scarlet fever or frequent colds. But more often the cause is more simple. Improper diet, creating an auto intoxication, improper habits of hygiene, poor ventilation will account for many, while injuries resulting in nasal stenosis early in life will account for others.
SYMPTOMS: A typical case of adenoid enlargement in the vault of the pharynx is not hard to recognize. The patient usually wears a dull listless expression. The nostrils are narrow and pinched; the bridge of the nose by contrast is widened. Usually on examination the septum is found deflected. The child has a sallow or pasty complexion, and palpation of the cervical glands reveals they are more prominent than in a normal child. Because of interference with smell, food is not enjoyed, and a tendency to hurry through the eating, with consequent gastric disturbances. The mental dullness is due to imperfect drainage and a certain degree of anoxia in the brain due to the obstruction of the denoidal enlargement. Snuffling, and noisy breathing by day and snoring at night, and also the non resonant type of voice, are among some of the distinct symptoms of adenoids. Some of the grievous sequelae of enlargement, infection of the adenoids, comes from their close proximity to the mouths of the eustachian tubes, and tonsils. Middle ear infections with severe ear ache, and tonsilitis frequently develops. Headaches, and sometimes long nose bleed may occur.
DIAGNOSIS: The above symptoms and the picture in the rhinoscopic mirror can be regarded as unmistakable.
The lobulated or fissured mass, or masses of various sizes can be seen hanging from the roof of the pharynx. They also can be felt with the finger. If they feel hot and dry to the touch, they are infected. If cool, they are merely enlarged. A test as to whether there is enough space for the passage of air, and oxygen, to avoid anoxemia, is to inject fluid into one nostril, and expect it to escape through the other nostril. If not this can be taken as an indication that very enlarged adenoids are present. Escaping by the mouth has no significance.
Adenoids may exist without enlargement of the faucial tonsils, but it is seldom that the faucial tonsils are enlarged, that the adenoids are not more or less affected.
PROGNOSIS: Is good. Many children outgrow it by a change in climate and diet.
TREATMENT: Neuropathic: A thorough lymphatic, embracing the whole lymph system. Stimulation of whole spine.
CHIROPRACTIC: Cervicals, kidney and liver place.
ENDO-NASAL THERAPY: Open all sutures of the face to enlarge the external nares. This involves seven moves in one technique. Then dilate external nares with little finger. Go into the pharyngeal cavity. Place finger over the adenoidal tissue and massage downward. See Endo-Nasal Aural and Allied Techniques on this subject.
SPONDYLOTHERAPY: Arnold states that the vaso-contrictor neural units of the mucous membrane of the nose are from 2nd, 3rd and 4th dorsal segments, and the vaso-dilator neural cells are in the nucleus of the 7th cranial. In adenoids the concussion then is on those segments, except that Neuropathic pressure is brought to bear on No. 7 on the face. (See Plate 10.)
HYDROTHERAPY: Relief has been given for a time by hot compresses over the nose. A few have been helped by ice cubes placed on bridge of the nose.
COLONTHERAPY: Enemas should be given at least twice a week while under treatment. A pint or quart of warm water is usually sufficient.
DIET: Since enlarged adenoids are practically a condition of lymph stasis, the diet must be very restricted. Excesses of starches and sugar foods must be stopped. If a fast of a few days on fruit juices is feasible, it should be instituted, but if it will injure the child’s psychi, it better not be attempted. A diet largely made up of proteins, vegetables and fruits will produce the best effects. Such a diet can be selected from Diet No. 1.
VITAMINTHERAPY: For simple hypertrophy Vitamin A and B. For infection, Vitamin C complex is recommended.
ELECTROTHERAPY: Ultra violet ray applied over the nose or in the external nasal passage by a glass applicator has been found helpful in many cases.
SURGERY: If the child’s life is endangered by constant illness from oxygen obstruction, surgery should be considered.
HERBOLOGY: Tablespoonful doses of Pineapple juice as often as necessary. Or gargle with Tincture of Myrrh in hot water. Or gargle “Ironite” (a trade preparation of herbs with active ingredients of Ferric Oxy Chloride and Thymol). Or use equal parts of Red Oak Bark, Persimmon Bark and Golden Seal made into a tea, as a gargle.

DEFINITION: The presence of Albumin in the urine, known to occur under many circumstaqnces without indicating the presence of any serious pathology.
ETIOLOGY: Over exertion of the lower extremities. Eating and faulty digestion of hearty meals. Menstruation, cold baths, emotional and physical excitement that bring about (1) Disturbance of circulation. (2) Changes in the tubular epithelial cells or walls of the blood vessels of the kidney. (3) Changes in the composition of the blood.
DIFFERENTIAL DIAGNOSIS: In simple Albuminaria the presence of albumin is intermittent and only a trace is noticed, while in nephritis, anemia, leukemia, and diabetes, it is more abundant and usually constant. It is present in more or less degree in all cases of kidney and constant in some forms of prostatitis.
PROGNOSIS: Few have any further trouble if a simple regime is carried out for a few days.
NEUROPATHY: Kidney and liver place.
Usually the following regime will clear this condition:
No. 2 Diet for two days. The grapefruit cleansing fluid. A grapefruit is chopped into small pieces, skin included. A pint of boiling water is poured over the chopped fruit. It is allowed to stand one hour, then strained and bottled. Place in refrigerator. A wine glass full is taken every three hours. If the presence of albumin still exists after the first day, the above may be repeated. If after the second treatment the albumin is still present, serious investigation must be made to determine whether morbid changes are taking place in the liver and kidneys.

DEFINITION: Acute and Chronic. Alcoholism is a result of excessive indulgence in ethyl alcohol. Often a result of personality complexes. The alcoholics present a great many clinical pictures, especially in the acute intoxications where the persistent heavy drinker is in danger of developing coma or amnesia. Flushing of face, quickening of pulse, mental exhilaration, followed by incoherent speech, deep respiration, loss of coordination, odor of alcohol on breath, thickened speech, dilated pupils, vomiting, delirium, slow pulse, subnormal temperature, impaired judgment, emotional instability, muscular incoordination, and finally stupor.
Acute Alcoholism has three stages. First, excitation and exhilaration. The second is when the nervous tensions are aroused, when there is an increase in the heart rate, a rise in blood pressure and the skin reddens. The higher psychic forces lose control and the alcoholic shouts out his grievances against everybody or the whole world, or is the best fellow in the world. In the second state the determination can be made whether the alcoholic is that way because of personality defects or because he has a real liking for liquor and has lost control. It is important to find out what he talked about before he went into the third stage, if a long range plan or recovery is in the mind of the physician. The third stage is that of unconsciousness and coma. In the diagnosis of coma it is essential to differentiate alcoholic coma from other types. An alcoholic in a coma can be roused for a few seconds and with the odor and absence of injury the diagnosis is certain.

Alcoholism -- Chronic

SYMPTOMS: Fine tremor, mental impairment, disturbed sleep, redness of nose, anorexia, coated tongue, nausea, vomiting, constipation, alternating with diarrhea. If long continued atheroma of arteries, cirrhosis of liver and chronic interstitial nephritis are apt to develop.
Here we can only be concerned with the future of the inebriate. Tremors must be overcome as they arise, and nothing is better than concussion of the whole spine, or the warm douche spray up and down the whole spine. All other symptoms must be treated just as they would be if they arose from a different etiology. While the symptoms are being treated, the physician can plan his course of action to free the patient from the alcoholic habit.
TREATMENT: Lymphatic of whole body. Neuropathic or Chiropractic adjustments of whole spine for stimulation. Ask the patient to take a warm spray on spine only, morning and night.
Mania is a pathological action on the nervous system. There may be great excitement, loud crying or cursing on the part of the patient. In some of the manias great harm and murder has been committed. If these continue the patient will end in a state of dementia precox. If a mania is violent, the physician should call the police to protect those around him. If of a deep, depressive nature some milk, iced milk will suffice to induce sleep.
VITAMINOTHERAPY: Many of the cases of polyneuritis in alcoholics that confront the physician are due to a deficiency of Vitamin B-1. It is assumed that if the alcoholic does ingest enough food with any Vitamin B-1 that the disturbance of the gastrointestinal tract by alcohol prevents proper absorption. A higher calorie diet with supplements of B-1 has produced great improvement of polyneuritis and often a quick cure. This may be also said that some of the cardiovascular disturbances of alcoholism may be prevented by B-1. It is claimed that a continuation of Vitamin B complex will destroy the craving for alcohol and some evidence of this is at hand.
PSYCHIATRY: Please read chapter on Alcoholic Psychosis in “The Fundamentals of Applied Psychiatry.” Lake. Technique is too long to state here. But, the physician must be a sympathetic friend to a man or woman who is fighting to be free from the cravings of alcohol, and he will need to make great use of the art of suggestive therapeutics.

Alkalosis as a clinical condition has received less attention than Acidosis, yet it is not infrequent and can cause as much distress to the patient.
DEFINITION: A condition of the blood in which the bicarbonate concentration is above normal.
SYMPTOMS: It has been found in patients with peptic ulcer and others who have headaches, drowsiness, anorexia, vomiting, muscle ache, nervousness, mental depression, feeling of weakness, faintness, numbness of extremities, rapid and irregular respiration and marked irritability. Burning of urine is a common complaint. Later, convulsions, edema and coma.
ETIOLOGY: This is the opposite of acidosis and occurs usually after taking sodium bicarbonate over a long period of time, or due to an excessive use of an alkaline diet. It is especially apt to occur in those whose liver or kidney functions have been impaired.
TREATMENT: This condition usually responds nicely to simply stopping the use of all alkalies. Then the treatments can be focused on the symptoms as enumerated by the patient.
HERBOLOGY: As nearly all fruits and vegetables contain excess alkali, change diet to include more meats and cereals. If cause is from vomiting which would decrease hydrochloric acid and sodium chloride, myrrh and Golden Seal equal parts with a bit of ginger is good, taking a teaspoonful about every two hours.

Alopecia (Baldness)

DEFINITION: A loss of hair in patches of the head. Baldness--a partial or a total loss of hair.
ETIOLOGY: The etiology of alopecia is to be determined after all the factors are taken into account by examination and diagnosis. Stevens states that baldness may be congenital, in these cases it is usually partial. It may be an expression of senility, in which case it usually begins on the crown or brow, and is associated with more or less atrophy of the scalp. It very rarely occurs early in life, as an idiopthic affection arising without obvious cause. It often occurs in early adult life as a result of seborrhea. It frequently results from general diseases, such as syphilis, myxedema, typhoid fever and other acute infections.
In addition to the above etiology, the claim is made that the loss of hair is due to a deficiency of Vitamin A.
PROGNOSIS: In congenital and senile is doubtful, although many claims of cures have been made. In alopecia of general diseases, the prognosis is favorable by removing the cause. Much has been accomplished in alopecia of seborrhic origin by persistent treatment.
TREATMENT: Remove the cause if possible.
NEUROPATHIC: General Lymphatic and dilation of all cranial centers.
CHIROPRACTIC: All cervicals and Atlas.
HYDROTHERAPY: Shampooing every one to three weeks with warm water and Castile Soap is recommended. Another form of treatment is to massage the head once a day with two drops of liquid Vaseline. Cold, wet, applications with towels to the head, followed by vigorous friction has been found of value.
VITAMINOTHERAPY: Vitamins A and B in large doses are recommended.
ELECTROTHERAPY: Ultra-violet is a valuable agent in this condition if the hair follicles are not dead. If they are, it is perfectly useless to attempt any treatment. The water-cooled lamp should be used in alopecia areata, and the air-cooled in general alopecia. When using the air-cooled lamp have it about ten inches from the scalp. The face and ears should be protected. The rays from either the air-cooled or water-cooled lamp should be given until a third degree erythema is produced. It will be a rather severe treatment, but necessary in order to be effective.
In addition to the local treatment, expose the entire body to ultra-violet rays for the general tonic action. Where there is a general systemic infection as in syphilis, care for it first, otherwise no results can be expected from the ultra-violet.
COLONOTHERAPY: Colonic irrigations are of value in helping to free the system of waste matters.
HERBOLOGY: Peach Tree Leaves made into a tea is good, putting on head daily. Sage is an old remedy. Nettle Leaves steeped in vinegar for several days, filtered, with about ten per cent glycerine added is good. Teas made of any of the following herbs are good: Boxtree, Hounds tongue, Elmtree, Marshmallow. Also oil from Lily of the Valley.

DEFINITION: Baldness appearing here and there over the scalp.
ETIOLOGY: Most authorities state that it is of parasitic or nervous origin. While others state that it may be a sequence of sclerodema, leukodema, Graves disease and lead poisoning. While others maintain it is of mental and sexual disturbances.
SYMPTOMS: The disease is characterized by the sudden or gradual appearance of circumscribed round patches of baldness. At first there is no change in the appearance of the skin, but later it may become pale and atrophied. Although the scalp is the most frequent seat, it occasionally involves other hairy parts, as the eyebrows, beard, etc.
PROGNOSIS: Is generally unfavorable in those whose eyebrows have been affected and whose finger nails are cribbed with holes. Otherwise good results have been attained in many cases.
TREATMENT: In addition to the treatment given under Baldness, the following have been found helpful. All foci of infection must be removed. Some recommend that the part be painted with pure phenol, iodine, or turpentine to stimulate an hyperemia of the affected areas.
The above treatment for Alopecia Areata in addition to the treatment for general Alopecia have produced some fine results in many cases.

DEFINITION: Absenvce, or suppression of menstruation. Normal before puberty. After the menopause and during pregnancy and lactation.
Some of the more common causes for its suppression at other times are change of climate and occupation, anemia, febrile diseases and chronic diseases such as nephritis, tuberculosis, and diabetes.
Primary amenorrhea is where the menses have never made their appearance.
Secondary amenorrhea is where they have appeared but subsequently cease.
Partial amenorrhea means appearing occasionally and at irregular intervals.
We are only concerned here with the secondary and partial amenorrheas.
ETIOLOGY: May be due to operations or pregnancy which the physician should make certain of. When in doubt of the latter, see tests under Pregnancy. Suppression may be due to benign or malignant tumors. Suppression of Amenorrhea produced by X-rays or radium may be temporary or permanent, it depends on dosage. Delayed or temporary Amenorrhea may be due to general diseases or disturbance of the endocrine functions.
Some authorites state that there is a direct nervous connection between the hypothalamus and the pituitary glands, and that the latter may be controlled in some way by a center in that portion of the brain. If true, then emotional states, hysteria, inhibition of the libido, suppression, etc., will cause changes in the pituitary that are reflected in the menstrual disturbances. Changes in climate from warm to a cold climate just before the period or a change in occupation may create menstrual disturbances.
TREATMENT: The treatment must be directed at the cause.
SYMPTOMS: There may be no other than the absence of menstruation unless they are symptoms of what is causing the amenorrhea. Nervous disorders may cause heat flashes, occasionally headache and vomiting and some forms of hysteria. When the Amenorrhea is due to obstruction, the patient has a continuous dull ache in the pelvis and over the sacrum aggravated at the periods when menstruation should take place and a profuse leucorrhea is manifested.
The general techniques of the treatment may be selected from the following:
CHIROPRACTIC: 1, 2 and 4.
NEUROPATHIC: Thorough lymphatic and dilation of the lower back region. Cranial adjustment of frontal lobe, and parietals.
ELECTROTHERAPY: Sine wave, Galvanism, Diathermy, or short wave, infra red.
HYDROTHERAPY: Hot fomentations. Hot towels to abdomen.
SPONDYLOTHERAPY: Arnold stated that the inhibitory cells of the Fallopian tubes and uterus which contract the cervix are chiefly in the 2-3-4th lumbar segments and that dilator units are found in the 3-4-5th sacrals. Then deep pressure on the sacrals and concussion of the lumbars is in order.
PNEUMOTHERAPY: Cups on the lumbar area, two minutes, and over the ovaries one-half minute lightly three times, one ovary at a time.
HERBOLOGY: The following herbs are applicable for infusions: Blessed Thistle, Cotton Root, Elecampane, Ginger, Ground Pine, Milfoil, Mugwort, Tausy, Shepherd’s Purse, Water Pepper.
A favorite treatment is to take a hot mustard bath every third night, retiring to bed immediately. Bowels should be thoroughly opened by a compound Senna mixture, or similar laxative, then take one dram each of Oil of Pennyroyal, Cayenne Pepper, Extract of Peppermint, Extract of Elder Flowers, Extract of Gentian, and heat into a uniform mass and divide into 60 pills. One pill to be taken three times daily under the flow commences.
DIET: No. 1 is generally sufficient with additions as the physician’s judgment deems best. Sometimes a glass of milk between meals cana be added for anemia associated with Amenorrhea. A glass of hot water with teaspoonful of honey daily befoe breakfast is beneficial.
VITAMINOTHERAPY: ENDOCHINOTHERAPY: Youman states that a deficiency of Vitamin A causes keratinization and desquamation of the normal epithelium of the uterus and other organs. Vitamin A is then important. For Anemia B-6, E plus and F. Three times daily. Ovarian Hormone, Pituitary Thyro Ovarian substances have been recommended.
PSYCHIATRY: If due to emotional upsets. See pages 117-176-191 of “The Fundamentals of Applied Psychiatry,” Lake.
ENDO-NASAL THERAPY: Dilate anterior nasal canals. Clean out the pharyngeal cavity. Lake Head Recoil, and break adhesions, if any, in thyroid sinus and raise the glands.

DEFINITION: A loss of memory. This may be from recent experiences, those subsequent to the disease, and is termed anterograde. When it involves more remote memory stores it is called retrograde. Amnesia is often applied to episodes during which the patient forgets his identity though he may conduct himself properly enough and following which no memory of the period persists. Such episodes are often hysterical, sometimes epileptic, while trauma, senility, alcoholism, and other organic reaction types account for a smaller number.
ETIOLOGY: There are several types. The traumatic, toxic and psychic.
An accident, such as would fracture the skull and result in perversions of the brain, may produce an amnesia about the accident, and about all events before the accident.
The toxic type may be produced by auto intoxication caused by wrong habits of living or by excessive use of alcohol and drugs.
The psychic type is a mechanism of defense against some impossible situations in life. Shell shock on the battlefield, intolerable home or working conditions.
TREATMENT: Of the traumatic type is largely surgical if there has been a fracture. But injury without fracture may be rested for a time, then suggestive therapeutics attempted. If after a reasonable time there is no appreciable change, hypnosis could be attempted to see if under the influence the patient would remember some of the facts of his life, which during his waking hours were forgotten. If he can, it shows that his memory images have not been destroyed, but he cannot bring them to consciousness. It is thought that all cases of Amnesia are purposeful as all people wish to forget unhappy experiences, but we cannot accept that view. There is a true and a spurious Amnesia, and the physician can judge much by surrounding circumstances which is true and which is false.
A witness in a court case recently developed such strange illusions and great falsification and incoordination of facts, that the attorney could not use her. Two days afterward she was perfectly normal. The toxic cases will clear up quickly as the primary cause is eliminated. Hysterical or wandering Amnesia are psychic and need the services of a physician versed in patience, kindliness, and trained in the arts of psychoanalysis and suggeestive therapeutics to help the patient orient himself to his environment. See Amnesia and Suggestive Therapeutics in “The Principles of Applied Psychiatry,” Pages 62, 83, Lake.

DEFINITION: A deficiency of red blood cells, hemoglobin or both. There are several forms.
ETIOLOGY: There is always some underlying cause for Anemia to develop. It does not just happen. Usually the cause may be found in one of the following organs that fail to function normally: the Salivary Glands, or an improper habit of eating; the Stomach, Intestinal, Liver and Spleen malfunctions. Again, Thyroxin, which regulates general metabolism, may be lacking in Vitamin C. due to defects in the thyroid and parathyroids. Then, the diet may be lacking in foods containing sufficient Vitamin B and Iron.
TRAUMATIC ANEMIA: Where there has been a hemorrhage is an exception to the above etiologies, but here we will confine ourselves to the results, not the method of traumatisms.
Because we regard Anemia as a result, or due to some underlying abnormalities or habits, and more of a symptom than a disease in itself, it is unnecessary to consider such terms as simple, essential, primary and secondary types of anemia. Here we will confine ourselves to two phases of these symptoms: Secondary Anemia and Pernicious Anemia.
DEFERENTIAL DIAGNOSIS: The term Anemia properly includes all conditions in which the blood is impoverished. Pernicious Anemia is a condition characterized by oligoeythemia, or such a great deficiency of red cells that life is seriously endangered.
ETIOLOGIES OF ANEMIA: Abnormalities of the digestive and absorptive systems. Deficient diet. Nervous derangements. Lack of food of proper quality of blood-building elements. Malfunctions of the stomach, liver, spleen and intestines. Wrong sedentary habits. Imperfect lymphatic circulation, and excessive vasomotor constriction to the arterioles.
PERNICIOUS ANEMIA: All the above, but the most outstanding is megaloblastic degeneration of the bone marrow, causing either decreased or imperfectly formed red blood cells to be delivered to the peripheral circulation, or some other serious infection.
SYMPTOMS: The outstanding symptoms of anemia are: Pallor of the skin and mucous membranes, loss of strength, and in severe cases intermittent fever. Full, rapid pulse, palpitations of the heart, heavy pulsations in neck, some dropsy in the feet. There may be ecchymosis and slight bleeding of the mucous membranes. Hard breathing is an outstanding symptom. Nervousness is marked. Headache, vertigo, disturbed sleep, slight pains are sometimes complained of. All the symptoms mentioned above may be associated with Pernicious Anemia with addition of symptoms of a more severe nature. Weakness and fatigue, shortness of breath, palpitations, are greatly increassed, and when the anemia goes below the one million blood count the bleeding becomes more evident, and the spiral nervous system perversions, lesions and subluxations become of such a type that alterations in the functions of the cord and fibers are very noticeable. The skin not only has a pallor as in anemia, but is covered with a yellow tint much in the nature of a lemon.
PROGNOSIS OF Primary Anemia is favorable, but very guarded in Pernicious Anemia.
TREATMENT: In both conditions is finding and removing the cause.
NEUROPATHIC: Light lymphatic. Stimulation of the whole spine.
CHIROPRACTIC: Kidney, Liver, Spleen and Lumbar places.
SPONDYLOTHERAPY: Concussion C, 7; D, 10.
ORIFICIAL THERAPY: Rectal dilation. While this is beneficial, great care must be taken in administration not to cause bleeding.
ELECTROTHERAPY: Ultra Violet Ray, starting with ten-minute treatment first day and doubling that time at each treatment until twenty minutes are reached, having the patient on a revolving stool in order that the whole body is covered. Short Wave, Sine Wave and Diathermy are beneficial on all the viscera and long bones.
DIET: Varioius types of diets are recommended, some of them which patients abhor. There is not much sense in giving patients food they do not like. For a while a diet may consist of 50 per cent calories, 20 per cent carbohydrates, 20 per cent vegetables and fruits, and 10 per cent fats. Then after a week or two another blood test can be made to see if a rise has taken place in the red blood cells. These may be selected from food lists elsewhere in this book. Liver, in various proportions, approximately from 16 to 20 ounces a day, may be given in addition to the above diet. A glassful of water with a spoonful of honey, and a half spoonful of lemon juice three times a day is a good tonic. Vegetables and fruits containing iron are necessary.
VITAMINOTHERAPY: Vitamins B-2, G, C, D, and E are recommended.
ENDO-NASAL THERAPY: This is one of the most important parts of the treatment. The patient needs much oxygen which has an affinity for iron, and encloses the iron in the gas units of it (the oxygen) and carries the iron via the hemoglobin to all parts of the body for absorption and assimilation as a nutritive element in all the tissues.
Anoxia anywhere in the body creates serious disturbances. Anoxemia is a general condition in all anemias. Turn to your Endo-Nasal, Aural and Allied Technique Book. Lake.
EXERCISE: Because the patient is in a weakened condition, exercises must not be extreme. Walking is the best. Gradually at first. Three blocks the first day, four the next, and so on until ten blocks a day or 1 ½ miles are covered, followed by a nap for one hour.
VACUUM THERAPY: Because the blood circulation is below normal and there is also an anemia of the spinal centers, light cupping of the whole spine is of unusual benefit.
COLON THERAPY: Enemas should be given twice a week in view of the large diet required in these cases.
HERBOLOGY: Herbs containing iron are selected in anemia, such as Yellow Dock, Strawberry Leaves, Dandelion, Dock, Salep, Raisins, Mullein Leaves, Stinging Nettle, Mustard Seed, Meadow Sweet, Parsley, Burdock, Sorrel, etc.
A good general tonic is made from Rocky Mountain Grape, Gentian, Marshmallow, Sacred Bark, Turtlebloom, Yellow Root, Fennel Seed, Jamaica Ginger, Anise Seed, Thyme, Juniper Berries, Colic Root and Bearberry Leaves. This combination has proven so helpful that Herbal Supply Houses sell it ready-mixed.
The red corpuscles being born in the red marrow of the bone (iron giving it its red color) and the main work it does being the gathering of oxygen and carrying it to the body cells, herbs containing iron are mainly indicated as iron gives energy and blood pressure. It also gives action to the heart, liver and kidneys and alkalizes the system. Iron nourishes the pancreas as well as the other glands.
Goat cheese is also excellent as a tonic.

DEFINITION: A starchy like degeneration of the kidney. The kidney is enlarged from infiltraton of amyloid substances. The amyloid is deposited in the glomeruli underneath the epithelium of the capillaries; the capillary loops are thickened, the lumen is obstructed and gradually the whole glomerulus is converted into an amyloid mass.
ETIOLOGY: It is due to Vaso-constriction of the kidney segments, preventing proper metabolism in the organ, or a subluxation of K.P. It also may be due to syphilis, tuberculosis, etc., or a similar degeneration in the liver and spleen. It may also be a sequence of degenerative Brights Disease, and to a deficiency of Vitamin “E”.
SYMPTOMS: Amyloid disease of the kidneys has been occasionally found without any renal symptoms having been present during life. The characteristic renal symptom is albuminuria. The amount of albumin varies considerably, from a few grams to as much as 30 to 50 grams per liter. Hyaline and granular casts are found in the seniment; waxy casts may also be found. The daily amount of urine varies considerably. When there is no edema, there may be polyuria; when edema is present, the amount of urine is diminished and the specific gravity is high.
The urine generally gives very fairly characteristic indications. Its quantity is increased, its specific gravity is somewhat, but not greatly, diminished, varying from 1015 down to 1005. It is usually singularly clear and translucent, and on standing yields very little sediment. Under the microscope may be found a few casts which are generally broad, hyaline, fatty and granular. The amyloid reaction may be obtained with the hyaline casts. In later stages, when degeneration has set in, the urine becomes reduced in quantity, is mostly turbid and then presents under the microscope the morphological signs belonging to the degenerative processes. There are associated with this condition of urine anemia, debility, but not often much dropsy with the characteristic transparent and delicate complexion. There is usually degeneration of blood; often diarrhea and vomiting. Cerebral symptoms are not at all common. The arteries are usually soft, and the heart generally shows very little change. Death comes by wasting, diarrhea, inflammation, and the kindred affections of the liver and other organs.
DIAGNOSIS: The diagnosis canot usually be made from the urinary examinations alone, or from perversions and subluxations. But, if following syphilis, tuberculosis, or chronic bone suppuration, the urine is found to be albuminous, of low specific gravity, and increased in quantity and the liver and spleen are enlarged, the diagnosis of amyloid disease may be made with comparative certainty.
PROGNOSIS: This depends to a great extent upon the disease which is the cause of the amyloid condition, but is usually very grave. In marked cases death occurs after a period varying from several weeks to several months.
TREATMENT: The treatment of amyloid disease is that of the original disease of which it is a complication. It occurs in the course of chronic suppuration somewhere in the body, chronic tuberculosis, in the course of congenital or acquired syphilis. Hodgkin’s disease, chronic dysentery chronic malaria, chronic gonorrhea, and in the course of malignant tumors. The general treatment may consist of the following:
NEUROPATHY: Thorough lymphatic of all lymph system. Dilation of spinal segments of kidney place, and other segments as necessary.
CHIROPRACTIC: Kidney Place and other zones as indicated.
ELECTROTHERAPY: Short Wave to kidneys and infra Red.
DIET: Short fast on fruit juices, then No. 2 Diet for a few days, then alternating daily with No. 1 and No. 2 for a week. Then make a complete examination to see if changes in diet are necessary.
ENDO-NASAL THERAPY: The largest element of the blood constituents lost in this disease is Oxygen. There is usually a severe anoxia in the lungs, kidneys, liver or spleen, or a general anoxemia. Therefore, all of the Endo-Nasal techniques should be performed with particular attention to the external and internal nares, and the thyroid.
HYDROTHERAPY: Is of great value. One plan has distinct value. A hot wet towel over the kidneys liver and spleen before retiring each night leaving on for five minutes. Other forms of hydrotherapy can be used as indicated by etiology.
VITAMINOTHERAPY: A, B, C, D and especially E as indicated by symptoms.

Aneurism

DEFINITION: Dilation of an artery, forming a sac filled with coagulated blood or serum.
It can generally be said that all aneurisms are due to conditions that weaken the arterial walls, to increasing blood pressure. It is more prevalent between the ages of 30 and 50, a period in which degenerative changes are found in those who have done laborious work without proper rest.
It affects many who are engaged in violent intermittent exercise. Males are affected 10 to 1 in comparison with females. It is said that the Anglo Saxon race is most frequently affected. The English more than the American due to a greater consumption of alcohol in England, and that it is three times as prevalent in the American Negro as the white race.
ETIOLOGY OF TYPES: Idiopathic Aneurisms may be due to some injury that has left a scar that has weakened the wall of the artery or by the lodgement of an embolism.
FUSIFORM: All the walls of the blood vessel dilate more or less equally creating a circular swelling.
SACCELATED: One due to the yielding of a weak patch on one side of the vessel and which does not involve the entire circumference; usually due to an injury.
DISSECTING: One in which the blood makes its way between the layers of a blood-vessel wall, separating them.
ARTERIO-VENOUS: One in which artery and vein become connected by a saccule following trauma or infection.
LOCATIONS: They may be located in any part of the body, often being seen on the lower part of the radial artery just above the wrist. But those that havc the most serious aspects and symptoms are: Aortic, Thoracic and Arterio-Venous Aneurisms.
The Aortic Aneurism is a more or less circumscribed dilation of the Aorta. If the whole vessel is involved in the swelling it is termed fusiform. If it is localized and only involving a portion of the circumference it is termed a saccular Aneurism. Rupture of the inner wall, with a passage of blood between the other walls is known as dissecting Aneurism. The chief cause of the aortic aneurism is weakening of the walls by syphilitic and other infections, and sometimes injury.
The Arterio-venous type where the artery and vein become connected one to to the other by a saccula following trauma, or gun shot wounds. Since the blood pressure in the artery is greater, the flow of blood will be from the artery into the vein.
DIAGNOSIS OF ANEURISMS: Inspection may reveal a bulging with an abnormal area of pulsation, and the skin directly over the area slightly reddened. If inflamed, look for abscess. Palpation of the hands will reveal a heavy pulse above the seat of the aneurism, and then gradually taper off. The seat is at the point of the greatest pulsation. Percussion will reveal an area of dullness around the point. The tuning fork is of great value here to those who have practiced with it. The Roentgen Ray also is of value in detecting and determining the size and shape of the dilation.
Tracheal tugging is often found in aneurism of the arch of the aorta and is due to the transmission of the aneurismal pulsations to the left bronchus, and is detected by inclining the head and lifting the larynx and trachea by the finger and thumb caught under the hyoid bone.
SYMPTOMS: The aneurism forms a smooth round or oval enlargement in the course of an artery. It is not sensitive, unless inflamed, is not adherent to the overlying skin, but may be associated with edema and venous congestion of the parts distal to the tumor. The swelling has an expansive pulsation up to the time that a sufficiently thick layer of clot forms within the sac to abolish this sign. Aneurismal dilation may occur suddenly from traumatism or a great increase of intravascular pressure and may be characterized by sharp pain and rapid enlargement along the course of an artery. The sac, however usually forms slowly and at first without pain or any other symptom.
Subjective symptoms include pain from the stretching and compression of the aorta of nerves and the arrest of the venous or lymphatic circulation.
The pressure and erosion of bone, especially noticed in aneurisms of the aorta, cause the characteristic boring, so-called osteopathic pains which are usually more severe at night.
Aneurism in the skull is the rushing of arterial or venous circulation creating headache and pressure that often leads to vomiting and dilated pupils, with some localized palsies, which may be classified as the main symptoms.
In the neck, the physical evidences are usually seen in the pulsations. In the neck the situation of the tumor, expansile pulsation, and the effect upon the distal vessels are characteristic symptoms.
In the chest the recurrent laryngeal nerve frequently is involved with the production of rasping voice, spasm or paralysis of the vocal cord, and brassy cough. Pressure upon the sympathetic may produce unilateral sweating and unilateral contraction or dilation of the pupil as well as tachycardia. Peripheral neuralgia may result from compression of the intercostals. Compression of the phrenic may cause dyspnea and hiccough, while pressure upon the esophagus may result in dysphagia.
PRESSURE EFFECTS: These are especially marked in aneurisms involving the transverse portion of the aortic arch. Dyspnea with stridulous inspiration may result from pressure on the trachea or a bronchus. Bloody sputa may occur from the same cause. Paroxysmal croupy cough may be excited by pressure on the trachea or recurrent laryngeal nerve. Hoarseness or aphonia may also result form pressure on the recurrent laryngeal nerve. Dysphaagia may result from press ure on the esophagus. Pain of a boring or lancinating character may arise from pressure on adjacent nerve-trunks or bones. Attacks of angina pectoris may occur as a result of the underlying aortitis. Inequality of the pupils and unilateral sweating may be excited by pressure on the sypathetic. Edema, cyanosis and enlargement of the veins of one or the other arm may arise from pressure on or rupture into one of the large venous trunks.
DIAGNOSIS: Mediastinal tumor may simulate aneurism, but in the former the pulsation is not expansil, there is no diastolic shock, the tracheal tug is usually absent, and there may be cachexia, enlargement of superficial glands, and leukocytosis.
PULSATING EMPYEMA: A left-sided purulent effusion may transmit a cardiac pulsation, but there is no diastolic shock, no thrill, and no murmur. The history, moreover, will usually suggest pleurisy.
AORTIC STENOSIS: In this condition there are no evidences of a tumor, no pressure symptoms, and no inequality in the radial pulses.
PROGNOSIS: Aneurisms of the aorta and thorax are of a very grave nature. By proper rest, treatment and care, life may be prolonged for many years. If death occurs from this cause, it is from rupture.
TREATMENT: There are two schools of thought besides that of surgery. One is to slow down the circulation and bring about a clot that will fill the sac by coagulation. The other is to keep circulation normal and help nature repair the sac. For the former, drugs are used to reduce cardiac frequency, and arterial pressures. The second idea seems to the writer to be the better one. Get the circulation normal and nature will do the healing.
NEUROPATHIC: Light lymphatic and quieting of the spinal centers covering the area where the aneurism rests.
CHIROPRACTIC: Local zone.
SPONDYLOTHERAPY: Concussion. If heart and pulse are too rapid concuss 7th vertical until normal, doing so intermittently of 30 seconds each, testing after every fourth application.
A. Abrams claims that the subsidiary center of the vaso-constrictor nerves of the aorta is vertebra, and that by stimulation of the center in question by concussion the normal as well as the abnormal aorta may be brought to contraction. Ample evidence is furnished of the latter fact in his work on spondylotherapy. The method, in brief, which he suggests in the treatment of aortic aneurism consists in concussion of the spinous process of the seventh cervical vertebra.
The writer has had some very remarkable results with this method in thoracic and aortic cases, in acute attacks and chronic cases. See spondylotherapy.
ELECTRO THERAPY: Short wave for three minutes directly through the seat of the aneurism, then sine, or galvanic directly below the aneurism to attempt to draw the infiltration away from the sac, so that new blood can rebuild the weakened walls.
VACUUM THERAPY: Is of excellent service for lessening of pressures in thoracic and abdominal aneurisms. For the former the cups are put only on the back. For the latter they are used on the back first, then beneath the affected area, followed by putting cup over the area. Caution—cups should be put on mildly at the first treatment and each allowed to stay in one place only a minute.
HYDROTHERAPY: In an acute attack the physician must decide which is best to use. Hot or cold wet towels, compresses of heat or cold. Depends on what in his judgment is necessary for the time being.
EXERCISES: It is best for the patient to rest most of the time, yet some movement is imperative. A slow raising of the arms upward, and slow throwing of the head backward, then bringing them back to normal, will aid in releasing pressures.

DEFINITION: An acute suppurative process beginning in the submaxillary region which may spread to all the mouth and pharynx to an alarming degree.
ETIOLOGY: Careless throat and mouth hygiene. Infections, extractions of teeth, caries, trauma and ulcerations.
SYMPTOMS: The onset is sudden beginning as a hard painful swelling in the submaxillary region, which may run a mild course for days and then suddenly assume an alarming character, because the swelling of the parts interferes with respiraton and the swallowing of nourishment. The temperature and pulse are very often comparatively low.
PROGNOSIS: Grave when respiration is interfered with extensively, after twenty-four hours of the onset. Very favorable otherwise.
TREATMENT: Neuropathy and Chiropractic same as in Vincent’s Angina which follows:
HYDROTHERAPY: Hot compresses, local antiseptics or oral hygiene.
DENTAL CARE of abscessed or impacted teeth. Oxygen inhalations. Endo-Nasal Therapy if possible.

DEFINITION: An acute infectious inflammation involving the mucous membranes of the throat and mouth. The disease may be associated with diphtheria, syphilis, or streptococcus or staphylococcus infection.
SYMPTOMS: The symptoms are usually those of subacute pharyngitis, unless mixed infection is present. Headache and general malaise, with a temperature up to 102 or 5, may be present. The breath is foul, the throat painful when swallowing and there is generally some swelling of the submaxillary glands.
PROGNOSIS: The prognosis, where no mixed infection is present is good, the symptoms abating in three or four days, although some redness of the pharyngeal mucous membrane may persist for many days. In cases of mixed infection the severity of the symptoms depends upon the character of the mixed infection.
TREATMENT: Two things are necessary. 1, to give relief from pain. 2, To remove the cause. Hydrotherapy is the main reliance in the painful aspects. Thorough cleansing of the mouth with antiseptics. Hydrogen Peroxide, diluted one-half with distilled water may be used. Ice pellets dissolved in the mouth help some. Hot compresses are excellent for pain and congestion.
NEUROPATHY: A thorough lymphatic for drainage purposes, with special attention to the liver and axillary segments of the lymph system. The cervical lymphatic can be mild at first, then heavier.
CHIROPRACTIC: Adjustment of condyle cervical, L. and K places.
COLONOTHERAPY: Bowels should be thoroughly cleaned out.
PSYCHIATRY: Patients are apt to become despondent and the physician will need to exercise the art of hopeful suggestive therapeutics.
ENDO-NASAL THERAPY when acute stage is passed, then all techniques can be used.
VITAMINOTHERAPY: A, B, C and D.
MEDICAL PROCEDURE: In complicated cases local treatment consists in the application of a solution of nitrate of silver (2 to 4 percent). The patient should apply to his throat, as a home treatment, the spray from an atomizer containing ½ to 1 per cent sulphate of copper. A mild quarantine had perhaps better be observed until the throat clears up. In the more severe forms of mixed infection the internal treatment is similar to that of phlegmonous pharyngitis.
When pseudomembrane or ulcerations are present, the parts should be cleansed and Loeffler’s solution applied once or twice a day by means of a cotton-tipped applicator. Neosalvarsan is useful in all diseases caused by spirilla. The remedy may be injected as in the treatment for syphilis, or a 3 per cent solution applied to the ulcers and pseudomembrane of severe Vincent’s angina.
When local treatment fails, injections of the arsenicals are indicated but not prolonged. If tonsils do not clear up, tonsillectomy is considered.

DEFINITION: Paroxysms of pain associated with sclerosis of the coronary arteries and degeneration of the myocardium. Early known as stenocardia breast pang.
ETIOLOGY: It is largely due to predisposing arteriosclerosis which may be an inherited condition. Emotional upsets due to prolonged anxiety may produce predisposing causes, or any of the causes that produce arteriosclerosis.
SYMPTOMS: Pain and oppression, about the heart; a paroxysmal affection characterized by severe pain radiating from the heart to the shoulder, thence down the arm, or rarely from the heart to the abdomen; apparently dependent upon some lesion of the coronary arteries of the heart, its walls or valves. Attacks may occur in lesions of the aortic valves. Generally afflicts males of middle age. The attacks are usually excited by strong emotion, muscular effort, exposure to cold, indigestion.
When the pain is extremely severe in the region of the heart there is great anxiety, fear of approaching death, and fixation of the body, face pale, livid, brow bathed in sweat. Dyspnea often noted; pulse variable, usually tense and quick. Attack lasts from a few seconds to several minutes.
PROGNOSIS: Always of grave import. Sudden death may occur at any time. In the false type, characteristic of hysterical men and women death never occurs, and they recover quickly when they get the pity or favor they crave.
TREATMENT: Treatment should be directed largely at the constitutional cause, but also to the relief of pain. The pain is explained by James MacKenzie as a sensory reflex due to irritation of the 1st, 2nd, and 3rd dorsal nerves, and also the 8th cervical nerves, and the sense of restriction to reflex stimulation of the intercostal nerves. These reflexes often cause complete numbness after an attack of pain, and sometimes vomiting, or a sharp movement of the bowels, which brings great relief to those who have the eliminative sequels.
During an attack of severe pain, something is necessary to dilate the arterioles. The vaso-constrictors are over active, and the heart and neighboring arteries are not getting enough nourishment to carry on their functions.
Abrams recommends at this period a concussion of all the lower dorsals to induce a heart reflex of dilation. It is seldom the patient has an attack in the physician’s office and it becomes necessary that the patient be instructed what to do in emergencies. If the arterioles can be quickly dilated the pain usually eases, and the patient can continue to take his treatments in the office to eliminate toxemia and to correct the nervous system.
Several methods are suggested for the relief of pain. Heat over the back, and chest with wet towels has helped some. Raising the arms up over the head, has been known to give some relief. If the physician is called out of his office and has a portable diathermy or short wave they are of great value. The patient may be instructed to carry an emergency supply of Amyl nitrate pearls which can be crushed in a handkerchief, in cotton or placed in the bottom of a glass tumbler and inhaled. If Nitroglycerin becomes necessary, this writer has always preferred that a Medical practitioner consult with him before such a prescription is given. Routine constitutional treatments are for avoidance of future attacks of pain, and removal of the causes creating the Angina.
NEUROPATHY: Light lymphatic on the first treatment, and stimulation of the cervicals and dorsals.
CHIROPRACTIC: H. P.
ORIFICIAL THERAPY: Rectal dilations with the finger, gentle pulling upward downward and laterally for a few minutes, has been found helpful in many cases.
COLON THERAPY: If there is constipation of any degree, colonics until freedom is attained.
ELECTROTHERAPEUTICS: Short Wave or Diathermy. One electrode on spine over the dorsals, and the other along the course, if the pain is noticed on the anterior portion of the body. Blood pressure may rise at first, then fall. But, if the blood pressure continues to rise, and reaches a constant point with no fall-back to the mean at which the treatments began then the treatments must be given with a weaker current. The physician should check the blood pressure before giving the treatments, and every three minutes during the treatment. In this way he can avoid, in a large measure, attacks of pain while giving the treatment. The treatments can run from five minutes to twenty minutes. It is best to start with a short treatment, then build up gradually to the longer duration. In this manner treatments can be given three times a week.
Recently we heard an M.D. say that in cases with hypertension, the surest way to give relief was by electrical auto condensation, and that in hypotension, the circulation was increased by putting sunlight on the feet, at the same time putting short wave electrodes on spine and over the heart. We are now giving this a trial, but it is too early to make a definite report, yet, the method does seem to have produced some favorable results.
ULTRA-VIOLET RAY: Patient sitting on revolving stool, and rays directed to upper portion of the body. The first portion to be exposed is the spine, then every two minutes patient is turned so the shoulder is exposed then the chest and then the other shoulder. This rotation can be continued on an average of ten to twenty minutes per treatment. CAUTION: The patient should never be left alone for any length of time during electrical treatments of this kind.
DIET: First day or two, Diet No. 2 can be given with variations in the fruit juices. If the patient does not object, a fast of a day or two on fruit juices may be found helpful. But, if it worries the patient, not much good will be accomplished. Heavy meals at one time are out of order, because they cause flatulency and bring on attacks. The writer has found it best to outline from Diet No. 1 and Diet No. 2, a program for eating six times a day for those who worry and finds that in this way the patient can gradually train himself in better dietetic habits.
HYDROTHERAPY: Cold baths of any nature are contraindicated. Hot towels to chest and back may be applied as often as convenient. One case we remember in particular of a farmer who could not get to the doctor’s office, but whose wife applied the hot towels faithfully morning, noon and night for three months, was relieved in a short time of severe attacks, and up to this time has had no recurrence after a period of five years. He was told to stop smoking tobacco and drinking of liquor. He said he would give one up but not the two. Liquor was dropped, but continuous smoking went on throughout his life. His daily toil was lightened by agreement not to lift anything that would weigh over fifty pounds. All working together on a compromose basis found the outcome very satisfactory.
PSYCHIATRY: The best thing the writer can do here, is to refer the reader to Alvarez: “Nervousness, Indigestion and Pain.” Pages 24, 174 and 409. And to “The Principles of Applied Psychiatry.” Pages 118 to 122. Lake.
VITAMINOTHERAPY: Garlic for hypertension. High B for Hypotension and C.
HERBOLOGY: The following may be considered:
If the pain and oppression in the region of the heart is from a weak heart, Skull Cap and Golden Seal is indicated. If from an enlarged heart Bitter Candy Tuft is good, so is Bugleweed (Lycopus) as it relieves the difficult and oppressed breathing. For Palpitation Skull Cap, Valerian and Tansy is indicated. Snow Berry will increase the heart action while Sheep Laurel will act as a sedative. Mexican Fever Plant is good for organic trouble, and Motherswort is a nervine and heart tonic.
Heart trouble being a result of toxic condition of the blood stream a general blood purifier should be used, such as Sarsaparilla, Yellow Dock, Bitter Dock and Stillingia or this combination, Sarsaparilla, Quassia Chips, Senna Leaves, Licorice Root and Yellow Dock.
MISCELLANEOUS: It is probably not necessary to say that the patient should try to live a regular life, especially relative to sleeping. The patient should not be ordered to bed at a certain hour, but allowed to discover himself, just whether he can get along the next day without fatigue on six or eight hours sleep. When he finds the required number of hours, then he should have sense enough to make it a habit. Regular habits of eating, relaxing, sleeping are the best healing agencies for this condition.

DEFINITION: Here we will define and limit its discussion to a lack of appetite for food without any organic disease or known explainable cause.
ETIOLOGY: In children it is due to tensions, hysteria, or melancholia. The writer recalls a boy actually starving himself without any apparent reason. Having gained his confidence we learned that his mother, a few years previous, had been a food crank and had told him that certain foods had no value, and they were the very foods that the boy liked, but, she insisted on his eating what he did not like, until his nerves were shocked by continuous quarreling, and a lasting rebellion was aroused in the boy.
In the older people, Anorexia may be due to either hysteria, or psychasthenia. The types of hysteria may be of the anxiety nature, and the mechanism of protection may pass into conversion hysteria. While the psychasthenia may partake of the compulsive nature due to a complication of the paranoid element of dementia precox. See chapters 3 and 4. “The Fundamentals of Applied Psychiatry.” Lake.
There are a great many other causes for this disturbance of appetite: anemia, cancer, alcoholism, drug addiction, constipation, nephritis, nicotine, or caffeine in excess, improper feeding, excessive carbohydrates, sweets. Too much milk over a long period of time. Great deficiency of vitamin B, with intestinal atony and diminished peristalsis. Ptosis of abdominal organs. But in general, the origin of Anorexia is due to a nervous condition largely of psychic origin, which may bring on a type of indigestion at the sight of food, by an over-activity of the vaso-constrictor nerves originating in the brain centers.
SYMPTOMS: The first objective symptom of anorexia nervosa is the loss of appetite. The second is the loss of weight, then listlessness and a general lack of interest. If food is forced there is belching and sometimes vomiting. It is about this time that the physician is consulted, and the patient is fully confirmed in his or her attitude regarding foods. Fatal cases have been reported, and autopsies have revealed no organic pathology.
PROGNOSIS: Generally good.
TREATMENT: When alterations in appetite are so great, that there is danger of a serious pathological condition, the physician should try to find the cause, and treat accordingly. But a general treatment may be as follows:
Another of a boy who, for some reason had taken a dislike for food. A few hours fishing trip and an explanation that good food was necessary for him; out in the open, and watching the writer eat a sandwich and some ice cream, soon made his mouth water, and he ate plenty and has since. His mother had to be cautioned not to try to force foods on him that he did not like.
Temporary Anorexia may be due to autointoxication, especially of the intestines. Colontherapy is sufficient to relieve that condition.
TREATMENT: NEUROPATHY. Light general lymphatic. Dilation of whole spine.
CHIROPRACTIC: Stomach, Atlas Places and other places as needed.
MASSAGE: Light massage of whole body may be helpful.
ENDO-NASAL THERAPY: Treat to enhance the sense of smell. See “Sense of Smell in Endo-Nasal, Aural and Allied Techniques.” Lake.
PSYCHIATRY: Psychoanalysis on the question side, rather than free association. See both methods “Principles of Applied Psychiatry” Lake. Pages 124 to 128. For the treatment of children see page 169. Suggestion is of paramount importance. The writer recalls an elderly lady who was gradually slipping away, that he took for an automobile ride one day and ascertained the reason why she would not eat was due to the idea that since her daughter-in-law was always picking at her, and son and husband about their table manners, she, the old lady, got the notion into her head that the daughter-in-law was, in a round about way, taking a back-handed slap at her. Upon questioning we also found out that this elderly lady had, as a child, been scolded continually for bad table manners which left a fixation neurosis against any rules of conduct at the table. The fresh air of the ride, and a little persuasion was enough to get her to eat a very hearty meal, with a little soda, to prevent indigestion. All was well, after a secret talk with the daughter-in-law.

DEFINITION: A functional disease in which fear (or the somatic evidence of fear) is the essential part of the picture. A symptomatic fear state can be differentiated by recognizing primary disease such as thyrotoxicosis. Fear may exist consciously, or present a group of somatic symptoms not recognized for what they are; in fact, even denied as representing anxiety. Ordinarily, fear as a response to an environmental threat is quite conscious, it may be equally conscious without the patient having the slightest insight as to the causation. Fear may be an emotional correlate of organic brain disease; it is outstanding in certain toxic states (notably delirium tremens), may co-exist with depression, and occur as night-waves. Anxiety neurosis is manifested when an intact personality without organic disease, during clear consciousness, complains of palpitation, heart-pain, dyspepsia, cold, sweating, tremulous extremities, constriction of the throat hand-like pressure about the head among other symptoms. Often these are interpreted as meaning regional disease. The real significance is a feeling of inadequacy in meeting some situation; e.g., a tempting situation which is so completely repressed as to be totally unacceptable to the patient as of significance. Homosexuality is such a frustrated impulse that may lead not only to an anxiety state but to the much more intense picture of panic-psychotic terror.
TREATMENT: Correction of all physical disorders. Then psychiatry. Turn to the Fundamentals of Applied Psychiatry, Lake, p. 118.

DEFINITION: A loss of power of comprehending, speaking or writing words, due to cerebral perversions.
ETIOLOGY and DIAGNOSIS: Pure aphasia is due to a perversion of the foot of the third left frontal lobe. If the perversion occupies but a portion of the region the aphasia may be partial only.
Aphasia must be distinguished from aphonia. The latter condition is an inability to utter sounds, a power not lost in aphasia, moreover, aphonia is generally dependent upon some abnormality of the larynx or of the nerves leading thereto.
Perversions that may produce aphasia are manifold; the most important are: Tumor, gumma, abscess, depressed fracture, embolism, thrombus, or softening in the localities that correspond to the various forms of aphasia. In right-handed subjects the lesion is on the left side of the brain; in left-handed it may, however, be on the right side. Aphasia is not always due to organic disease; it may occur as a transient condition in congestion of the brain, in sudden fright, in convalescence of fevers, in migraine, after epileptic seizures, and in hysteria. This depends entirely on the cause. After apoplexy the prognosis should be guarded. In cerebral softening it is absolutely unfavorable. When aphasia develops in the young, the outlook is much more hopeful.
SYMPTOMS: Patient comprehends, but is unable to express himself in words. Entire loss of voice is not common.
Divided into motor and sensory types, each of these are divided into cortical and subcortical, according to whether the perversion is in the center itself or in the tracts communicating with the center.
Sensory Aphasia is further classified as visual, and Auditory Aphasia.
MOTOR APHASIA: This is an inability to express thought in words. When the perversion is in the third frontal convolution (cortical motor aphasia) the power of silent talking and reading are lost as well as that of articulate speech. When the perversion is in the adjacent tracts which transmit speech impulses to the articulatory muscles (subcortical motor aphasia), the power of articulation alone is lost. This is the most common form of aphasia.
SENSORY APHASIA: This is an inability to understand printed or written words (visual aphasia or word-blindness), or to understand spoken words (auditory aphasia or word-deafness). The lesion is in the angular gyrus, where visual word memories are stored, or in the first temporal convolution, where auditory word memories are stored, or in one of the incoming (subcortical) tracts of special sense.
In cortical visual aphasia the patient cannot read aloud or to himself, nor can he write spontaneously or from dictation. In subcortical visual aphasia the patient can write spontaneously and from dictation, but he canot read what is written by himself or others.
In cortical auditory deafness the patient cannot understand spoken words or write from dictation. Not being able to comprehend his own speech he misplaces words or talks unintelligently. In subcortical aphasia the patient though word deaf, can speak spontaneously, read aloud, and write.
TREATMENT: Since aphasia is a symptom and not a disease, it is necessary to determine its cause and to treat this. If it is due to a cerebral thrombosis, embolus, or hemorrhage the indications are to treat that condition. If due to tumor, the latter must be removed, if possible. General treatment may be as follows:
NEUROPATHY: General lymphatic and dilation treatment. Neuropathic cranial techniques for opening of the frontal lobe sutures. This is preceded by opening of the facial sutures.
ENDO-NASAL THERAPY: All techniques necessary for proper intake of air and oxygen.
See Techniques in “Endo-Nasal, Aural and Allied Techniques” — Lake.
CHIROPRACTIC: C1, 4. D 1 to 6.
SPONDYLOTHERAPY: Concuss C1 to 3 and 4 to 7.
ORIFICIAL THERAPY: Rectal dilations.
SURGERY: An X-Ray picture should be made in all these cases to avoid overlooking of possible injuries and fractures. Injury to the skull, especially when there is depression of the inner plate, tumors, cerebral hemorrhage, and other conditions capable of inducing cerebral pressure, requires appropriate surgical procedures.
DIET: If any tumors exist the possibilities of the grape cure should have attention.
COLONTHERAPY: Enemas or colonics weekly.
PSYCHIATRY: A psychophysiological method of speech re-education is necessary. To reteach the motor acts of articulation, the writer favors the method which aims to restore the memory of sounds and the association between visual and auditory (word) impressions, beginning with individual syllables—some of which the patient can still articulate—and later building up polysyllabic words. The method is useful also where the usual method is inapplicable because of weakened intellection and attention, also the method is useful where the usual method is inapplicable. The person should be taught to write with the left hand and kept at it until by practice the movements of the left hand become instinctive as those of the right hand were before the attack of aphasia. The left-handed man vice-versa.

DEFINITION: Loss of voice.
ETIOLOGY: Among the most common causes are the following: Organic disease of the larynx—inflammation, neoplasms, cicatricial stenosis. Centric paralysis of the recurrent laryngeal nerves, as in bulbar palsy. Peripheral paralysis of the recurrent laryngeal nerves caused by pressure of an aneurysm, mediastinal tumor, or pericardial effusion. Hysteria. The lodgment of foreign bodies. Prolonged use of the voice. Excessive smoking, many colds, nasal seepage from cranial catarrh, sinusitis, childhood diseases, mechanical defects, etc.
SYMPTOMS: They are too apparent to review here.
TREATMENT: The specific treatment must be on the primary cause. General treatment may be as follows:
NEUROPATHY: Thorough lymphatic of the lymph vessel of the neck and liver.
CHIROPRACTIC: C. 4, D. 2-5.
SPONDYLOTHERAPY: Concussion of the 4th to 6th Dorsal.
ELECTROTHERAPY: Short wave or diathermy, with a pad on each side of the larynx is helpful. Infra-red applications may be given as often as indicated. Quartz light, applied through a special applicator to the larynx every other day, produces a slight erythema which is of decided value.
HYDROTHERAPY: Gargle with spoonful each of lemon juice and water twice a day. Gargle with pure pineapple juice. Hot or cold compresses. Ice cubes dissolved in the mouth have helped many.
ENDO-NASAL THERAPY: This is the treatment par excellence if there is not a malignant growth. Stretch and clean out the pharyngeal cavity. Then massage the affected laryngeal spaces. The technique for the laryngeal area is as follows: After washing hands thoroughly, dip finger covered by finger cot into cold water; now slide the finger down the side of the mouth until it reaches the root or base of the tongue, then quickly slide finger over to the middle of the tongue. (Get one pressure on finger and maintain it all through the operation; if air gets under finger, patient will gag.) Now, with your finger in middle of the tongue, move the finger backward until you reach the epiglottis. Your finger is now in the valleculae, one on either side of the glossoepiglottic fold. Now massage right and left and up and down five or six times. When you are withdrawing your finger, pull the tongue upward and outward. Many abnormal conditions in the larynx are due to ptosis of the tongue.
For anemia, enervation or congestion, this operation puts the tissues in place, and creates a freer circulation of blood fluids around the area. Some authorities have suggested using two fingers to perform this operation, one on each side of the mouth. We leave this to the discretion of the individual practitioner.
VITAMINOTHERAPY: Vitamin B1 and what is necessary for the cause.

DEFINITION: Hemorrhage into the brain or spinal cord.
ETIOLOGY: All causes that lead to diseases of the Arterial system, such as gout, syphilis, alcoholism, sclerosis, nephritis, high vascular tension and cardiac hypertrophy.
SYMPTOMS: PREMONITORY: Headache, dizziness, disturbance of vision, tinnitius aurium, insomnia, tremor, epistaxis, thickness of speech, loss of memory, and a sensation of tingling and numbness of the affected side. Vomiting is a common symptom, preceding the attack. Unconsciousness is measured by the degree of the hemorrhage, as also is the paralysis. In grave cases, the beginnings of paralysis can be detected while the patient is in the comatose state. While in some of the milder cases the paralysis and unconsciousness are absent or of short duration. If the hemorrhage is in the usual location, the internal capsule, and has not been very copious, the clot loses its color, shrinks, and is finally absorbed, and the damaged cerebral fibers are replaced by connective tissue, which contract and form a scar.
EXTENSIVE HEMORRHAGE is followed by great changes and extends in the direction in which the affected nerve transmits impulses toward the periphery. After an extensive lesion or perversion of the internal capsule, secondary degeneration of the motor tracts begins and may be traced by the fingers downward along the spinal column by the soft, lifeless condition of the muscles in the gutter of the spine.
If the attack proves fatal, the patient does not come out of the state of unconsciousness and death ensues from a few hours to within from one to three days.
PROGNOSIS: It can be said that prognosis is always uncertain. But, if the attack is not fatal, there is always a danger of recurrence as long as the original causes remain.
TREATMENT: The head should be elevated, and an ice cap applied to the carotid sinus, or on the side of the neck or head where the hemorrhage has taken place. Venesection may be called for if there are indications of regular, strongly acting heart and an especially strong pulse. The above should be done only after a consultation. Whatever measures that will have a tendency of the blood to clot are in order.
VITAMINOTHERAPY: Large doses of Vitamin K seem to be gaining favor, due to a decrease in prothrombin in the blood. Quietness is absolutely necessary.
Physical treatment, if any is required at all, may consist of downward light strokes with the hands to the cervical region, and down the back and on the limbs to prevent, if possible, any great degree of paralysis. As a catharsis, 1 to 3 drops of Croton Oil in a little glycerin or olive oil can be placed back of the tongue. Retention of the urine can be relieved by the catheter. If feeding becomes necessary after a lapse of a few days, it can be given by the rectum. The physician will recognize that not much more can be done until consciousness is restored, and the patient must be kept in bed for several weeks, then measures introduced to remove the causes can be instituted and also to prevent any further spread of the paralysis. See Hempheligia and Paralysis.

DEFINITION: Inflammation of the vermiform appendix, generally occurring between the ages of five and twenty, very rarely before the fifth year or after the fiftieth. It is more common in male adults than in female adults. The disease may be acute, subacute, or chronic.
SYMPTOMS: Any or all of the following may be present:
Abdominal pain, usually severe and generally throughout the abdomen, followed by nausea and vomiting. Localization of pain in the right lower quadrant of abdomen with tenderness and rigidity over right rectus muscle or McBurney’s point. Fever usually rises within several hours, 99 degrees F. to 101 degrees F. Pulse increases with temperature. Patient lies on back with right lower extremity flexed to relieve muscle tension. Leucocytosis present shortly after onset. In mild cases symptoms begin to subside on the second day, but in more severe cases there might be a cessation of pain indicating that the appendix has ruptured. After a few hours a well-defined abscess may be felt in the right iliocecal region showing that nature has walled off the affected area.
In the subacute or chronic, which may or may not follow an acute attack, there is a constant ache in McBurney’s point, and some gastric indigestion which may simulate a gastric ulcer, duodenal ulcer or gall bladder disease.
Pain or ache in McBurney’s point, in those whose appendix has been removed, may be due to adhesions, hernia, or ulcers.
Adhesions can be detected by palpation and the tuning fork. Ulcers by the warmth or heat of the hand, and the symptoms of ulcers, and hernias by the ptosis and hardness of the lump.
ETIOLOGY: Appendicitis is more common in males than in females. It is most frequent between the fifteenth and thirtieth years. Exposure, errors in diet, intestinal catarrh, traumatism, and the lodgment in the appendix of fecal concretions or foreign bodies predispose to the disease. It may follow some infection, as typhoid fever, influenza, or tuberculosis. It may be induced by twisting of the appendix.
Excessive vaso-constriction from the lumbar segments, which are found to be constricted and tender to the touch, are among the causes of appendicitis.
In the vast majority of cases the etiology can be traced to long-standing forms of constipation.
TREATMENT: Acute Appendicitis. All foods and purgatives are prohibited during the attack. Hot or cold wet towels are applied to the abdomen according to the reactions of the patient. Low enema may be given. Thirst being quenched with ice pellets, or rinsing the mouth with cold water. Counter-irritation has been found by the writer to be of great value. Put a vacuum cup on the left inguinal region, exactly opposite to the appendix. Inflate very mildly at first, using one cup at a time, leaving on one minute, then follow the course of the descending colon, across the transverse and down the ascending colon to the appendix. If, by this time, the patient can tolerate the cups, the process can be repeated, inflating the cups a little harder.
Adjustment of the second lumbar or Neuropathic hard pressure on the 10th dorsal has been of great help in many cases.
All, or any of the above methods have been successful in nearly all cases of acute conditions.
For those who have doubts, Riley makes the following statement to which the writer concurs.
“We are sometimes asked the question of what we would do if pus has formed in the appendix. This is easily answered. Let it be noted that there is a slight opening into the cecum from the appendix. If pus forms in the colon, it will usually, at the right time under proper treatment, following the line of least resistance, pass into the colon, and on out with the discharges from the bowels.
“Should there be a refusal to obey this law of least resistance, there would be an absorption of the matter back into the system, giving the kidneys an added work to do. This may throw some poison into the system, but the kidneys, under the treatment the spinal therapist may give, will be equal to the task of elimination, and an operation will be saved.
“Should there be a discharge into the pelvic region through a bursting that way, it may be remembered that the system, under good conditions, will be able to absorb great quantities of pus, and throw it off through the kidneys and the other eliminative organs.
“Of course, after all, there may occasionally arise some case that is too far gone, where adhesions may be hard to overcome, or some other complication be such as cannot be surmounted, but it will be very rarely, indeed, that any absolute necessity will arise under careful treatment that will require an operation.”
GENERAL TREATMENT: When the acute condition has passed, any or all of the following techniques may be used.
NEUROPATHY: Complete lymphatic and dilation of the nerve segments.
CHIROPRACTIC: L. 2-4.
NOTE: If there is a sacroiliac slip and reset.
SPONDYLOTHERAPY: Concussion of the tenth dorsal.
ORIFICIAL THERAPY: Rectal dilations.
HYDROTHERAPY: Whichever gives the most relief. The majority get relief quicker from hot compresses and hot fomentations.
COLONTHERAPY: Graduated colonics from low to high, once a week for a period of six weeks.
BODY MECHANICS: If there is a ptosis, an elastic belt, about five inches high in front, and seven inches high in back, is very helpful.
VITAMINOTHERAPY AND DIET: At present no specific has been found for appendicitis per se. But B with Bile Salts is considered to be of value with a bland diet, and nicotinic acid may also be considered.
ELECTROTHERAPY: When acute stage is passed then Sine Wave or Galvanic treatments can be given along the whole outline of the intestinal tract for stimulative purposes.
VACUUM THERAPY: Follow procedure as found under Acute Appendicitis.
HERBOLOGY: If not acute, just discomfort in lower right section of abdomen, take a cup of Timothy Seed, obtainable at any feed store, and pour on a quart of boiling water; then let boil for a couple of minutes, strain, sweeten preferably with honey and drink while hot. Can be taken cold, but is not as effective.
In acute cases, use enemas of a quart of plain water every two hours, lying on back or knee-chest position; hot applications over entire abdomen (not just over appendix) to encourage better circulation of blood and assist in draining lymphatics. Add half dozen or more drops of spirits of turpentine on each hot application cloth; when cloth is cool, put on another keeping up for hours until entirely relieved, as this disperses pus that is forming.
If, after the passing of the first acute attack considerable pain and some vomiting continues, the advisability of an appendectomy should be considered. But, it is wise for the physician to always remember that appendicitis is a disease of the young and is rare after fifty. This caution will save the physician embarrassment if, during an appendectomy he should be found wrong. Neuropathic minor surgery can be considered very seriously.
J. Montgomery Deaver, M.D., states that “No form of medical treatment, dietetic, hygienic or any other mode yet devised can eradicate the disease.” He also states that “some may have one or more attacks and get over them, but in that time extension of the pathology which will have far reaching consequences.” Naturally, he states that there are contraindications to operations when senility, cardiac weakness or systemic disease are present. But, on the whole, in a true case of appendicitis, medical practice does not ask whether to operate, but when to operate; and, operation is, by the medical profession, claimed to be the surest method of eradicating the disease.

DEFINITION: An inflammation of an entire joint, that begins in the synovial membrane and in the acute stage involves the capsule, cartilages and if not arrested, the bones.
ETIOLOGY: It may occur at any age, but is more common after middle life. One of the first signs of Atrophic Arthritis is bone atrophy which may be due to avitamosis of vitamins A, B, C and D. It may and may not have any relationship to Rheumatism or Gout.
It is not known just exactly what causes this condition, but the consensus of opinion now is that local infections of the teeth, tonsils, ears and nose may be given a large place in the etiology. In many cases the disease can be definitely associated with some local infection, such as tonsillitis, otitis media, pyorrhea alveolaris, dental abscesses, cystitis, gonorrhea, intrapelvic suppuration or an infected wound.
Enfeeblement of the general health from mental strain, over-work, unsanitary conditions, over-eating, constipation, etc., may be contributory factors.
SYMPTOMS; When the disease is in the acute form it is like rheumatism, there is pain, swelling and impaired mobility in the region affected. Then, signs of structural changes, producing rigidity, crepitation on movement and deformity with luxations of the bones.
Monarticular Form — This form occurs chiefly in old persons, and usually affects either the hip or shoulder. The symptoms are persistent pain, impaired mobility, and muscular atrophy.
Spondylitis Deformans — This term is applied to arthritis deformans of the spine; other joints may or may not be involved. The chief symptoms are pain in the back or in the limbs, especially the legs; limitation of motion, and ultimately extreme stiffness or fixation of the spine (“poker-spine”), exaggerated reflexes, gradual muscular wasting, and, in some cases, changes in the spinal curve or undue prominence of the spine. The X-Ray picture is a valuable aid to diagnosis. The disease is a common cause of sciatica and lumbago.
Heberden’s Nodes — These are small nodules at the sides of the terminal phalanges of the fingers; they are not often painful; they are sometimes the sole expression of mild arthritis deformans, but they apparently occur also in gout.
PROGNOSIS: A stubborn condition that requires long attention and treatment. Find cause and remove if possible.
NEUROPATHIC: All of these cases show a lymphatic stasis and vasoconstriction in and to the areas affected. The liver can generally be found congested. A thorough lymphatic including Hunter’s Canal is in order; along with a complete vaso-dilation.
CHIROPRACTIC: Local zones, kidney and liver places.
ELECTROTHERAPY: Fever therapy has many advocates. Short-Wave, Diathermy, Infra-Red fomentations, and Ultra-Violet are helpful. Infra-Red is excellent for pain.
EXERCISES: It is the general, accepted opinion that patients with arthritis should be at rest all the time. We sharply disagree with that opinion. We have found that the majority of those who have light employment and good sanitary surroundings should continue their employment, and all others to do some work to prevent complete rigidity of the part or parts. Certain little tricks can be devised to keep the joints flexible. A ball can be rolled in the hands for finger exercise.
DIET AND VITAMINOTHERAPY: The diet should consist of a minimum of carbohydrates, and, if possible the Salisbury Steak regime started. See under “Special Diets.” The specific Vitamin is D, but it is found that A, B, and C is also required in the majority of cases; also, viosteral and Calciferol all in large units.
STRAPPING: Strapping painful joints or replaced joints may be applied for support. Atrophic Arthritis of spine, hips and legs, may need a brace or belt to aid in the adjustment of the mechanics of those parts.
HYDROTHERAPY: The Borax and Washing Soda bath. Hot fomentations to the parts. Epsom Salts Baths Compresses to the parts will all produce a vaso-dilation.
Drinking of mineral waters, and lemon diluted, are helpful in maintaining an Acid-alkaline balance.
VACUUM CUPPING: It is possible sometimes to drain the joints by the use of the Vacuum cups, followed by Neuropathic minor surgery. The cups, in all cases, can be applied to the whole spinal column for stimulation purposes.
ENDO-NASAL THERAPY: These cases usually have a more or less anoxemia, and tests should be made to determine the degree. If below 35% the process will be long drawn out with the average patient. The external and internal nares should be thoroughly cleaned out, and the thyroid and parathyroids released from adhesions and raised up into the thyroid sinuses. A very interesting theory is expounded in relation to the parathyroids and adrenals. That blood hunger for calcium has drawn excessive amounts from the bones, and the blood hunger was so great that the parathyroids could not, in conjunction with the adrenals, control the quantity. This overflow contains only a small proportion of calcium tht is assimilable in the blood stream and the residue finds lodgment in the joints, resulting in inflammation and deformity. This theory has a large basis in fact, because Endo-Nasal Therapy seems to shorten the periods of recovery.
COLONOTHERAPY: A clean intestinal tract is essential when treatments are given for this condition.
MASSAGE: Gentle massage of the parts is always in order. When there is pain the massage can be given with the parts immersed in hot water.

DEFINITION: A degeneration and a hardening of the walls of the arteries, capillaries or veins, due to chronic inflammation and resulting in fibrous tissue formation.
ETIOLOGY: See under “Neuropathy. Section—Examination of Heart and Blood Vessels.” The main cause is excessive vaso-motor constriction to the walls of the arteries. Contributory causes can be, a process of old age, syphilis, alcoholism, over-eating, over-work, lead and intestinal toxins, kidney diseases, nervous infections and disturbances of the adrenals and parathyroids. Any of the foregoing may be contributing factors.
SYMPTOMS: These vary with extent and distribution of the sclerosis. If the process is general, it may be recognized by rigidity, and tortuosity of the accessible arteries, increasing pallor, and a gradual loss of physical and mental vigor. An increase of blood-pressure, accentuation of the aortic second sound, and signs of enlargement of the heart, especially of the left ventricle, are also commonly present, but are often absent in the senile and syphilitic forms of the disease.
If the coronary arteries are especially involved, the symptoms of chronic myocardial disease appear. If the renal vessels are especially affected, there may be symptoms of chronic interstitial nephritis. Involvement of the cerebral arteries may be indicated by headache, vertigo, insomnia, mental sluggishness, and, perhaps, transient paralysis. Sclerosis of the mesenteric vessels may lead to digestive disturbances and occasionally to attacks of abdominal pain.
Sclerosis of the arteries of the limbs may be manifested by painful muscular cramps, sudden lameness or “giving way” of the legs during walking. Some other symptoms may be fatigue, enlarged prostate, chronic bronchitis, dizziness and polyrina.
PROGNOSIS: Favorable if none of the following sequels have occurred. Cerebral hemorrhage or thrombosis, chronic myocardial disease, angina pectoris, interstitial nephritis, aneurysm, and gangrene of the extremities.
In all cases of suspected arteriosclerosis a complete urinalysis should be made, and traces of fully developed nephritis should be noted. Cardiograms are useful on noting strong tympanitis of second sound of the heart; and also increase if any, of blood pressure over normal.
Normal blood pressure should be one hundred plus the age of the person up to the age of twenty years. Beyond the age of twenty, where the blood pressure would measure 120, add one point to every two years of life. A person 50 years of age would register normally 135 blood pressure.
But, if the pressure is over 190, it can be considered on the dangerous side.
TREATMENT: NEUROPATHY — A thorough lymphatic, with special attention to the liver, spleen and kidneys. Spinal dilaton of all affected segments.
CHIROPRACTIC, according to findings of subluxations, but generally, D 4.
ELECTROTHERAPY: Auto condensation, for about ten to fifteen minutes daily by chair or mattress. If kidney or other conditions are present the electro-therapy principles can be applied specially to the areas involved. Infra-red Ray may also be applied to the specific areas.
SPONDYLOTHERAPY: Concussion of the 7th cervical if heart is too burdened and rapid, three minutes in ½ minute periods. Then, generally a concussion of the splanchnic vessels for dilation purposes, any of the Dorsal vertebrae from the 3rd, downward.
DIET: Someone has said of these cases, that there are three types:
1. Cases which respond to correction of diet and change in life habits.
2. Cases which require treatment in addition to the above to effect a cure.
3. Cases in which no lasting results can be obtained.
Diet is considered the most important of all, but the hardest to enforce. Fasting is probably the best of all curative methods. If not possible, then all heart stimulants and toxic substances should be discarded. Tea, coffee, alcohol in any form, and tobacco should be forbidden. Flesh foods of every description should be reduced to a minimum, and better still, discarded altogether. Gluttony should receive a death-blow. All high life, late hours, irregular meals and business tension should be abandoned.
A good plan we have followed is to lead the patient through No. 1 and No. 2 Diet on alternate days, for two weeks, then No. 2 for two weeks. A salt-free diet is considered essential. Fruit juices can be used in abundance.
HYDROTHERAPY: If severe hypertension is present with all the symptoms of red lines in the eyes, dizziness and pain in back of head, our plan has been to order the patient home to a quiet room, then instructed as follows:
Put feet in hot water, with ice bag, or cold wet towel on head for twenty minutes, at least four times a day. One garlic capsule is taken three times in the day. The patient may have a glass of fruit juice every hour or two hours the first day. If not content, then a glass of milk every three hours. The physician visits the patient and concusses the 7th cervical at the end of the first day. If the pressure then is not satisfactory, another or even two more days of the above regime is carried out before the patient is permitted to return for office treatment.
HYDROTHERAPY AND MASSSAGE: Thorough massage is permitted when the danger point has passed. Free sweating, by Cabinet Baths, Oxygen Baths, or the Borax and Washing Soda Baths may be used with certain precautions. Also, the cold or hot sheet pack.
EXERCISES: Waalking erect in the open seems to have the most beneficial effect, but light labor is also beneficial in keeping vessels flexible.
VITAMINOTHERAPY: Three Standard Garlic Capsules daily with meals. Also, B plus.
PSYCHIATRY: Many of these cases should be psychoanalized to note what fears, phobias and tensions they are living under. See p. 115, “Principles of Applied Psychiatry”—Lake.
ENDO-NASAL THERAPY: Oxygen and thyroxin are absolutely necessary for healthy arteries. So give at least the Lake Recoil. The swabbing of the pharyngeal cavity, the opening of the nasal canal, and the thyroid techniques. Breathing exercises are also beneficial.
COLONOTHERAPY: Duodenal lavage at least once a week is in order.
HERBOLOGY: As low breathing is one of the chief causes of this ailment, deep breathing is indicated.
Excellent botanical tonics are mistletoe, Yellow Dock Root, Life Everlasting, Mormon Valley.
Valerian, Lime Flowers, Wood Betony, Motherwort equal parts, take teaspoonful of mixed herbs to pint of boiling water, simmer three minutes; let stand for half an hour, strain and bottle; take wineglass three times a day.
Garden Garlic, cooked, is excellent for Arteriosclerosis and High Blood Pressure.

Asthma

DEFINITION: A sudden dyspnea accompanied by peculiar sounds caused by spasm of the bronchial tubes or swelling of the mucous membranes.
ETIOLOGY: No age is exempt. Males more than females. It is more frequent among those who do not take physical exercise. It can generally be said that asthma is an anoxia of a part, or an anoxemia of the whole body, due to improper ventilation and exercise.
Auto intoxication is one of the major causes. Some authorities have stated that one half of the cases are due to heredity. This writer cannot accept that theory. There is a specific cause for every case that started life with all the respiratory apparatus, and later development was due to carelessness, negligence or ignorance on the part of the parents or the affected persons.
There are many types of dyspnea:
Bronchial Asthma, due to dryness of bronchial tubes.
Cardiac, due to heart disease.
Renal, due to nephritis.
Dyspeptic, due to nervous reflex.
Thymic, due to enlargement of the thymus.
Nasal, due to obstruction in the nasal passages.
Nay Fever, due to obstructions in the nasal passages, dry membrane or rhinitus.
DRUGS; Fully 50% of the persons addicted to morphine have become victims of asthma—Sajous.
SYMPTOMS: A gasping for breath at stated intervals, with spasmodic severe attacks is enough to establish the condition of Asthma.
PROGNOSIS: The prognosis of asthma depends upon the nature of its underlying cause. Cases of reflex asthma in which the primary disorder is easily reached and properly treated—such as nasal hypertrophies, polypi, aural growths, etc.—are frequently cured and remain so, provided the causative affection does not remain. The prognosis is also good in young subjects with well-formed chests and in whom direct heredity cannot be traced. In all others, however, the chances of recovery are very limited.
Death rarely ensues from spasmodic asthma, but its complications may prove fatal.
McCoy stated the prognosis well as follows: “The patient usually wheezes along to a good age, with the misery of seeing every proposed remedy fail, until he dies from the effect of drugs taken in an attempt to relieve his symptoms. It may be truly said that at first he is afraid of dying and then afraid he will not.”
TREATMENT: The treatment of asthma consists of (1) arrest of the paroxysm; (2) prevention of the paroxysms by measures calculated to annul the effects of exciting factors and (3) removal of the pathological conditions forming the basis of the paroxysms.
The acute attack may be arrested quickly by concussion of the 7th cervical. This continued for a time will lessen the attack Then the pharyngeal cavity is opened, and cleaned out; after which the soft palate is held open, and the concussion continued. Many cases have responded for the writer with the above technique. General treatment should be concerned with preventing future attacks, and, second, to eliminate the causes.
NEUROPATHY: General thorough lymphatic, with special attention to liver, chest, arms, and neck. Thorough dilation of entire spine.
CHIROPRACTIC: D 2, 3, 4, 6.
Some writers have recommended the Epsic cigarette in acute attacks. An effective cigarette may also be made of equal parts of lobelia, stramonium, and green-tea leaves, or of stramonium leaves and ordinary tobacco. Tobacco sometimes proves useful alone where it has not been previously used.
The local application of epinephrine inhalent, which is available in small compressible tubes similar to those used for oil pigments and the tip of which can be inserted deeply into the nostrils, is often very efficient.
ELECTROTHERAPY: Johnson advocates the use of Galvanism. The positive electrode is placed under the lower cervical region, and the negative over the solar plexus, having the pneumogastric nerve in circuit. Dosage 8 to 10 Ma and time, 20 minutes—Johnson, p. 192.
ZONE THERAPY: Riley advocates for acute asthma the biting of the tongue or pinching thumb and index fingers; and also the diathermic current at 1500 milliamperes, but claims that the rapid sine wave and concussion are almost infallible. Riley, p. 118.
COLONOTHERAPY: If Autointoxication is present a complete flush of the whole colon is indicated. Otherwise low enemas are in order for some time.
SPONDYLOTHERAPY: Concuss C 4, 5, 7, alternately with D 3 to 8.
VACUUM THERAPY: Cups placed on the whole dorsal region, and followed by cups on the chest and neck, create a necessary dilation. These cups should be put on mildly at the first treatment.
DIET: The diet should follow the contents of the urinalysis, in an effort to keep an acid-alkaline balance. Selections can be made from the dietary charts in this book.
VITAMINS A, B, plus, C and D.
ENDO-NASAL THERAPY: The whole outline of endo-Nasal techniques are recommended in conditions of Asthma, with particular emphasis on the Lake Recoil, the nasal dilation, thyroid lifting and pharyngeal cavity swabbing. See technique in book: Endo-Nasal Aural and Allied Techniques, Lake, p. 101.
EXERCISES: Patient stands before open window with hands back of head. Before breathing the elbows are pulled to the front and touching. As breathing starts the arms are flexed outward and backward, slowly in rhythm with the intake of air.
The other is walking, and taking one long breath, then quickly two short breaths and a hard exhalation through the nose, which has practically the same effect as a sneeze.
HYDROTHERAPY: Cold and hot fomentations as each case requires.
BODY MECHANICS: If there is a diaphragmic ptosis a support belt can be considered. Or, the exercises as outlined in Endo-Nasal Therapy — Lake.
PSYCHOTHERAPY: This has long been practiced for the relief of asthma, which has been considered a nervous affliction almost since the time of its recognition as a disease entity. Occasionally cases are encountered wherein attacks are induced by excitement and emotional stress. Under these circumstances, the services of a competent neuropsychiatrist may be of much value, but such cases are occasional and selected ones. See “Hysteria” in Fundamentals of Applied Psychiatry—Lake.
HERBOLOGY: Such Antispasmodics and Carminatives as Wild Plum Bark, Skunk Cabbage, Wild Cherry Bark, Elder flowers, Elder Berries, Horehound, Mullein, Nettle, Elcampane, Grindelia and Celandine made into a tea are good.
Mullein Leaves, dried and crumpled, smoked in pipe or as cigarette gives relief from Asthmatic attacks.
Eating raw onions, red cabbage, raw linseed oil are common household remedies.
Steep a handful of bark of Wild Plum in a quart of water, boil down to one pint, add sugar or honey to make a syrup. Take about 3 tablespoons a day.

Autointoxication

DEFINITION: As understood here autointoxication is a condition due to absorption of poisons from the gastrointestinal canal.
ETIOLOGY: Autointoxication can usually be attributed to three factors, (1) Dietetic errors, the use of meat to excess and gorging, etc. (2) The efficiency of the liver, (3) The efficiency of the autodefensive activity of the blood. All of the above may bring about putrefactive elements, which are absorbed by the blood and bring about the condition known as autointoxication.
SYMPTOMATOLOGY and DIAGNOSES: True autointoxication must be distinguished from other possible disorders and infections. A true case of autointoxication will present symptoms given below in all types of cases.
The high liver or individual who eats meat in excess may be ruddy or even appear congested, he will complain of symptoms similar that would occur in a pale, sallow woman. In the former, the morbid phenomena will be due to excess of proteids over and above his ability to digest them and destroy the poisons in the blood-stream, though, perhaps, both his digestive and antitoxic powers be normal. In the pale woman, on the other hand, both these functions may be deficient and even a small quantity of protein suffice to bring on the symptoms of autointoxication because of the large relative proportion of protein which undergoes putrefaction. The third patient may appear muddy, yellowish and fat, or emaciated—a type often due to hepatic torpor or incipient renal disease of toxemic origin. This shows that the general appearance of the patient is not typical of the disorder, though it affords a clue to the underlying cause.
The symptoms are:
Headache, often frontal and extending to other parts of the head, finally becomes a true hemicrania; it is sometimes migratory, i.e., moving about from one place to the other. It may be continuous both day and night or recur at fixed intervals, sometimes once or twice a week. The face is apt to be pale during these headaches; there may also be vertigo, considerable lassitude, and, perhaps, nausea. During the intervals, the patient often complains of anorexia, dyspepsia, borborygmus, flatulence, with more or less stubborn constipation or, rarely, diarrhea. There may be insomnia, or, even if the patient sleeps, fatigue on rising, and drowsiness during the day. Palpitations or arrhythmia and dyspnea on exertion and a stuborn cough are not infrequent, and the sufferer is often irritable.
TREATMENT: Neuropathic dilation of the liver and intestinal segments. Neuropathic general lymphatic with special attention to the three corner liver squeeze. Chiropractic liver and spleen also kidney places.
SPONDYLOTHERAPY: Concussion of the stomach, liver, and intestinal segments.
DIET: Dietetic measures are of primary importance a few days to a week on No. 1 diet usually is sufficient to follow with a gradual return to No. 2 diet.
A fast of one or two days without milk, or fruit juices or with them is excellent. While protein putrefaction is the main cause sometimes carbohydrate putrefaction in the stomach is a cause. This can be discovered by personal examination of the patient’s eating habits. In cases of the latter type, sweets and starches can also be prohibited for a while.
COLONOTHERAPY: Enemas and colonics are always in order twice a week until the symptoms clear up. Constipation is a serious factor in this condition.
ENDO-NASAL THERAPY: This type of treatment is essential, for many of these cases are in a state of either anoxia of the intestines and liver, or are in a general state of anoxemia. When the patient complains of an all gone feeling without any pain, it can be taken for granted that his blood is not getting sufficient, or is not utilizing oxygen properly. Oxygen is one of the autodefensive elements of the blood, and a good supply is needed in cases of autointoxication. All the endo-nasal techniques that relate to respiration should be performed.

DEFINITION: A sclerosis affecting the posterior spinal cord.
ETIOLOGY: The disease develops most frequently between the ages of thirty and fifty, and is much more common in men than women. It has always been largely attributed to syphilis, but experience has shown that many cases have no trace of this disease. Much of it can be traced to overwork, sexual excesses, constant exposure to bad weather and alcoholic excesses. Recently, however, it has been found that there has been a long standing deficiency of nicotinic acid, and thamin bringing about a neutral degeneration.
SYMPTOMS: The symptoms of the early (pre-ataxic) stage comprise paroxysms of sharp, shooting pains, usually in the legs, and frequently regarded as “rheumatic;” various forms of paresthesia, such as numbness and tingling of the feet, and a sense of constriction about the body, girdle pain; disturbances of the urinary tract and sexual functions; loss of deep reflexes, especially of the knee jerk, and on Neuropathic examination, the lumber segments are soft and putty-like.
The most outstanding symptom of the ataxic stage is a want of certainty and precision in the movements of the legs especially in the dark. If the patient stands erect, with his eyes closed and feet in juxtaposition, he sways and tends to fall; or if the upper extremities are affected the ataxis becomes evident when he attempts to touch with his fingers the tip of his nose. In the recumbent position, with his eyes closed, he is unable to recognize the position in which his limbs are placed. In the course of time the gait becomes characteristic. The steps are awkward and jerky, the foot is raised high, projected forward and outward and brought down forcibly with a thud, the body is bent forward and the eyes are riveted to the floor.
PROGNOSIS: Doubtful of full recovery. Many are kept going the normal span of life by physical and manipulative treatments.
TREATMENT: Neuropathy. There are two stages. First, the period of sharp, shooting pain, when legs are regarded as rheumatic, or when there is a numbness. In this stage any of the following may be tried with good effect. Short Wave, Diathermy, High frequency spark, Foot adjustments, Vacuum cups on spine and all the way down the legs. For the girdle pain short wave is the best. The diagnosis is practically certain when girdle pains are associated with pains or numbness in the limbs, and there is some loss of reflex in the knee jerk.
GENERAL TREATMENT: Neuropathy. Thorough lymphatic and raising the discs of vertebrae especially of the lumber region.
CHIROPRACTIC: c. 1-7; d. 1, 2, 6, AND 10. l. All.
CONCUSSION: c. 7. d 9-10. Stretch spine.
VACUUM THERAPY: Lumber region and legs.
HYDROTHERAPY: Frequent bathing or swimming in warm water for a short period, then resting, then returning to the water, has been of great benefit to some. Hot fomentations to the spine and legs also are recommended.
ELECTROTHERAPY: Apply diathermy to the spine by means of a long narrow electrode about 3 x 18 inches. Place a similar one, only a little larger on the opposite side of the body. Continue the treatment about one-half hour using a tolerable number of milliamperes. This has a relaxing and soothing effect. Follow it by the static wave current to the spine. Much benefit is derived by giving static sparks to the legs. Sometimes in chronic cases they assist the other measures when applied to the spine. The Sine-Wave is helpful. The galvanic along the hips and legs for long periods has awakened sensation.
MASSAGE: In some cases where fatigue is easily acquired by any exercises, masssage will relax the muscles without the using up of energy. Give proper muscle training and reeducational exercises with the hope of increasing motion by strengthening other nerves and muscles which are not paralyzed.
VITAMINOTHERAPY: A, B2, E in large doses.
DIET: Nourishment must be adequate in proteins to make up for destruction of tissue.

DEFINITION: Acute Nasal Catarrh is an acute inflammation of the mucous membrane lining the nose and cavities. There is some loss of smell and abnormal discharge from nose.
The nasal branches of the ophthalmic division of the fifth nerve and the nasal branches of the anterior palatine descending from Meckel’s ganglion, which is in connection with the superior maxillary division of the fifth nerve, conduct the sensory impressions to the medulla. It is there reflected to the respiratory, pneumogastric and other centers; so what is termed a sneeze is the forced expiration, and the coincident spasm of the pharyngeal and laryngeal muscles.
The arteries of the nasal fossae are the anterior and posterior ethmoidal from the ophthalmic, the sphenopalatine branch of the internal maxillary, and the alveolar branch of the internal maxillary to the antrum.
The nerves of the nasal fossae are the nasal branch of the ophthalmic to the septum and outerwall, anterior branch of the superior maxillary to the inferior turbinated body, and the floor of the nose. The sphenopalatine ganglion gives off the Vidian nerve to the septum and superior turbinated body and the superior nasal branch to the same regions, the nasopalatine to the middle of the septum, and the anterior palatine to the middle and lower turbinates.
The olfactory or first cranial nerves from the olfactory bulb enter the nose through twelve or more openings in each side of the cribriform plate. They are distributed to the specialized nerve-endings in the mucous membrane of the superior turbinate nerve endings in the mucous membrane of the superior turbinate and a corresponding small region of the septum.
The lymphatics of the nose are numerous. The more anterior terminate in the submaxillary glands, the posterior communicate with the pharyngeal glands. Hence the not uncommon slight inflammation of the tonsils and cervical lymphatics after nasal operations.
PHYSIOLOGY AND PATHOLOGY OF MUCOUS MEMBRANES:
During respiration through a normal nose, the bulk of the air passes along the septum above the inferior, turbinated body, describing a semi-circle over and around each turbinate, smaller currents extend upward nearly to the roof of the nose, and then it spreads out like a fan in its passage through the nose. It is understood that the respiratory path changes with the shape of the nasal chambers. Abnormal dryness of the nasal mucous membrane, or nasal obstructions of any kind interfere with the free access of air.
The nose also serves as a resonant cavity during vocalizations, so that obstruction of the nasal chambers produces a peculiar nasal intonation during speech. Perhaps the most important function of the nose is to warm, moisten, and free from the dust inspired air. In health, exhaled air has a temperature of 98.5 degrees F., and it has been proved experimentally that most of the heat supplied to inhaled air comes from the nose, the turbinated bodies being well adapted not only to warm the inspired air, but to moisten it and free it from particles of dust which adhere to its moist, sticky surface.
The normal secretion of the nasal mucous membrane, is over 16 ounces of clear water mucus in twenty-four hours, a part of which in health passes unnoticed through the nasopharynx down into the esophagus and stomach But obstructions cause this mucus to congest and become infected and inflamed, creating anoxia and anoxemia.
To aid in elimination Endo-Nasal Aural and Allied Techniques are par excellent. The diet can be of light easily digested foods. No. 2 Diet would be helpful in the acute period if a fast of a day or two is not possible. High enemas are in order. See chronic nasal catarrh for other forms of treatment, that can be applied to the acute condition.

DEFINITION: A chronic inflammation of the nasal mucous membrane. This has several varieties—simple, chronic rhinitis; Hypertrophic Rhinitis and Atrophic Rhinitis.
ETIOLOGY: Repeated attacks of perversions of vaso constrictions of the nasal nerves. Repeated attacks of acute colds. Lowered vitality, continual inhalation of impure air, dust or vapors.
Secondary causes may be exposure to cold and wet which may act as a predisposing factor, but the exciting cause is microorganismal. In some cases coryza is symptomatic of a general infection, such as measles or influenza, of a drug intoxication, such as iodism, or overeating and lack of exercise.
SYMPTOMS: The disease is ushered in with chilliness, muscular soreness, general malaise, fullness in the head, and sneezing. The nasal chambers are obstructed, so that the patient is obliged to breathe through his mouth. At first there is no secretion, but in twenty-four or forty-eight hours a watery discharge is established, which later becomes mucopurulent. Slight fever and its associated symptoms are commonly present. The duration is from a few days to two weeks.
Some complications that may arise are extensions of the disease to the accessory nasal sinuses, Eustachian tube, middle ear, pharynx, larynx and bronchi, which is not uncommon, but repeated attacks may lead to chronic rhinitis.
PROGNOSIS: If the patient is seen by the physician early enough, and will confine the patient to his home and give a thorough lymphatic including Hunter’s Canal and a complete dilation of the cerebro spinal system, or adjust the cervicals, kidney and liver segments, and putting the patient’s feet in a hot bath, while giving the patient hot lemonade to drink, elimination should begin almost at once and the patient can be around in a few days. But, warning must be given to the patient as to possible complications, unless great care is exercised.

SYMPTOMS: In the simple type there is a constant discharge of mucoid or corpulent substance from the nose. The nose may swell, by retention of some of the pus. The other symptoms are similar to acute nasal catarrh.
In the hypertrophic type the membrane is red and the nasal passage almost blocked by engorgement of the blood vessels, causing the sense of smell to be impaired. In many of these cases Adenoid growths are found.
The atrophic type presents a different picture. Here the nasal cavities are enlarged due to the atrophy of the mucous membrane, and ulcers or scabs are frequently seen on the dry membrane. The secretion from the nose is thick and of a yellowish or greenish color and of a very offensive odor.
PROGNOSIS: The simple and hypertrophic types readily submit to treatment, but the atrophic requires a long series of treatments to eliminate.
TREATMENT: Neuropathy—A thorough lymphatic treatment and stimulation of the spine twice a week.
CHIROPRACTIC: Same as mentioned under Prognosis.
ENDO-NASAL THERAPY—Rhinitis can also be described as a filling up of the head and respiratory apparatus. It is the product of numerous colds aggravated by climate, drafts, drugs of suppressive nature, and many substances inhaled. Originally, however, it started by anoxia and anoxemia, and is perpetuated by a continued existence of those two conditions. The disease is usually in three stages. The first stage, the dryness of the mucous membrane, is so pronounced that even the head and body ache from nerve reflexes. There is sneezing, lacrimation and itching. There may be some fever. The second stage is when the healing crisis of the natural processes of the body are set in motion by fever to bring about the third state when the discharge becomes quite free and is sometimes streaked with blood. For a time there is relief, but unless the obstacles to normal respiration are removed, recurrence will take place, and since this is a condition of the mucous membrane that extends to all of the sinuses, the ears, pharyngeal space and tonsils, serious complications can result.
TREATMENT: Give the Lymphatic Drainage Technique, the Lake Head Recoil Adjustment, the Enlarging of the External Nares, and the Pharyngeal Dilation Technique.
There are two methods for nasal dilation. The suture opening method or the little finger method. The first may be accomplished by the following movements:
The first method, instructions: Have patient sit on low stool. Stand on right side. Place your left hand just above the fronto-zygomatic suture, the heel of your right thumb at the pisiform process, just below the fronto suture. Hesitate for a moment, then give a thrust downward. Beginners should start giving easy thrusts at first. Move 2. Stay on right side. Put left hand over the fronto-nasal suture. Place dorsal portion of thumb and hand on bony bridge of nose. Hesitate. Give thrust downward. Move 3. Go to left of patient and repeat technique on the right fronto-zygomatic suture, reversing hands. Move 4. Stay on left side and feel for the naso-maxillary suture on the right side. Having found it, place the two middle fingers of both hands on opposite sides of suture. Press deeply without hurting. With back of fingers of each hand touching the other, cup the hands around the face. Using the face as a brace, hesitate for a moment, then give a quick jerk in opposite direction with the fingers only. Go to the right side of the patient to adjust the left naso-maxillary suture and repeat as directed above. Stay on the right side of patient. Encircle head with right arm. Put pisiform portion or heel of thumb of left hand on the malar bone prominence. Press in deeply, hesitate, turn the hand downward slowly while pressing, then give a quick downward thrust. Go to left side of patient, reversing hands to adjust right malar bone and repeat as directed above.
The second Method: Stand on left side of patient with little finger of left hand in right nostril, right hand on malar prominence. With quick jerks on malar bone by right hand to open sutures, let the little finger slip up into the nostril. Do not push hard on the little finger or you will cause pain and bleeding which are not necessary if technique is performed correctly.
Patient should be instructed to maintain an erect posture and to breathe through the nose consciously for a time, so as to establish the habit. Most sufferers of rhinitis are mouth breathers.
ELECTROTHERAPY: Mild heat applied to head from a Short Wave set is of great value, providing there is no excessive high blood pressure. Ultra Violet Ray is helpful. Full body or just nasal radiation.
VITAMINOTHERAPY: Large units of A and D and Magnesium or Cod Liver Oil with vitamins A, D in the oil.
HYDROTHERAPY: Cleansing a nose with alkaline solutions is sometimes helpful. Or, plain salt solution.
For softening of mucous in head hot fomentations or compresses.
NASAL IRRIGATION: There are those who advocate nasal irrigations by filtering water through one side and having it come out the other side of the nose or through the mouth. There are some advantages to this method of treatment, but the disadvantages far outweigh its usefulness in therapeutics. Middle ear and sinus impairment are possibilities by irrigations and the writer has stopped using them. But, for those who wish to use them; an enema bag with a nasal bulb on the end of the hose. Have the bag hanging just high enough for the water to run slowly. The water or solution, preferably the Pink Rose Alkaline powder of Zemmer, in the water, is introduced by the bulb into one side of the nose. The mouth is held open, and then the water will come out the other side of the nose by mouth breathing. There are several devices on the market for the above purpose.
HERBOLOGY: A simple and effective remedy is Lemon Juice and Honey. Dilute with warm water at first and then gradually use less water. Snuff up nose four times a day. Mix equal parts of Yarrow, Boneset, Black Horehound, Balm and Sage. Simmer for 30 minutes in a loosely covered vessel. Add a small pinch of ginger and Capsicum. Take a wineglass three times a day.
Here is an old recipe from Bavaria where it is still called “Catarrh Tea.) It is here improved by adding some botanicals of Indian origin:

Elder Flowers 10 parts
Rocky Mt. Grape Root 4 “
Juniper Berries 4 “
Anise Seed 2 “
Black Mallow Flowers 4 “
Fennel Seed 4 “
Mullein 10 “
Coughwort 10 “
Turtlebloom leaves 3 “
Marshmallow Root 2 “

Mix herbs, take teaspoonful, put in cup of boiling water, let cool, strain. Drink 2 or 3 cupfuls per day. If desired the following can also be added: Sweet Gum Bark 4 parts, Coriander seed 2 parts, Water Plantian 4 parts, Licorice root 3 parts, Lungwort 4 parts.
Dried peach leaves are good as a smoke.
EXERCISE: Fresh air is essential and some outdoor exercises, with bathing and friction of the skin or massage is helpful.
TONICS: Teaspoonful of Honey and Lemon in a glass of hot water each morning is highly recommended.
VACUUM THERAPY: The cups can be applied on the whole spine, and a small bulb inserted in the nose for outward suction.
SPONDYLOTHERAPY: This can be given by tapping with the fingers in the area of the cranial nerve endings or by a vibrator or concussor on all the head and face. The blows being regulated to the resistance or comfort of the patient.

Backache is one of the most common ailments known to mankind. It is a symptom of a disease rather than a disease itself.
ETIOLOGY: Tuberculosis, Arthritis, curvature, malignancy of spine; sacroiliac strain, or sprain, pelvic disorder, abdominal and chest disorders; Nephritis and pyelitis, sciatica, tumors of the cord; subluxations and many other conditions too numerous to mention.
DIAGNOSIS: The patient can tell the physician of accidents and employment and relation of such to the pain. Tests of various kinds can be made to ascertain if there are any of the above mentioned etiologies. The patient then can be stripped to the waist and a thorough examination made. See “Examination of the Back,” under Neuropathy.
The types of backache may be classified as follows:
The Industrial, Lame back, which is due to the occupation of the patient. If not aggravated by other conditions, it is more a soreness or tiredness in the muscles.
Back strain; makes up a large proportion of the present day disabilities of the spine.
ETIOLOGY: Curvature of the Spine. This type of backache may be caused by curvature of the spine, either in the lateral or anteroposterior position; some mechanical disability of the shoulders, either drop of one shoulder, or both, or round shoulders; some mechanical foot complication or other static disability or derangement of the lower extremities; some disability of the thorax or abdomen, or a pendulous abdomen.
Rectal and gynecological conditions may also be considered as contributory causes.
Back Sprain. Most frequently encountered in those who do heavy lifting and receiving a twist of the body.
PROGNOSIS: Depends on the Etiology.
TREATMENT: General Neuropathy. Thorough lymphatic and dilation of segments and Lake Recoil, indicated by symptoms and diagnosis.
CHIROPRACTIC: Local zones.
HYDROTHERAPY: Hot towels, compresses, baths, etc.
STRAPPING: If, after a number of other treatments, relief is not obtained, strapping can be considered.
ELECTROTHERAPY: Short Wave or Diathermy or Sine Wave, should all be helpful. Infra-red, until a slight erythemia is obtained, is excellent.
MASSSAGE: The light tapement after rubbing, is of value in some cases.
HELIOTHERAPY: Exposure to the sun rays for ten to fifteen minutes a day is helpful.
VACUUM THERAPY: By the counter irritation method first, then by the direct method.
SPONDYLOTHERAPY: Vibration of the whole spine, by concussor or vibrator, or local zones are helpful.
FOOT ADJUSTING: Careful examination of the position of the cuboid bone should be made, for displacement causes many types of backache. The Neuropathic three point foot adjustment may prove helpful.

DEFINITION: Paralysis of the face. The vast majority being unilateral. It has also been called Bell’s Palsy; but the latter has some other peculiar phases.
ETIOLOGY: May result from a tumor, clot or abscess involving the facial center in the cortex of the brain or the nucleus of the facial nerve; from the pressure of inflammatory exudate on the nerve trunk between the brain and the skull; from paralysis of the nerve within the petrous portion of the temporal bone, excited by a fracture or by an extension of inflammation of the middle ear; from inflammation of the peripheral filaments, excited by exposure, injury, diabetes, or one of the infectious fevers; syphilis, colds, diseases of the middle ear, otitis media, abscess, and pressure in the pelvis of instruments in obstetrical cases, sleeping with face to wind, or riding in car with window open in cold weather may be a factor.
GENERAL SYMPTOMS: Paralysis usually occurs suddenly. On examination one side of the face is found to be paralyzed and the unaffected muscles drawn toward the sound side. Expression is lost and the natural wrinkles and lines are obliterated on the affected side. The corner of the mouth is dropped and saliva dribbles from it. The eyelid on the affected side cannot be closed and the eye waters. Swallowing is seriously interfered with and the tongue is directed toward the paralyzed side. The forehead cannot be wrinkled.
There are three types of this disease, determined by the symptoms: Simple facial, Bell’s, and Pontine Palsy.
In simple facial palsy the lesion is supranuclear, between the cortex and the pontine nucleus, there is only a weakness of the face, with slight affection of the frontalis muscle.
In Bell’s Palsy the whole side of the face is affected, and the lesion is nuclear or infranuclear, the muscles of one side of the face, including those of the forehead and eye, are involved, both emotional and voluntary movements are lost, and the electric reactions are altered in character. In nuclear lesions other cranial nerves are usually involved with the facial.
In pontine lesions there is often paralysis of the limbs on the side opposite to the facial palsy (crossed paralysis). When the nerve is involved within the Fallopian canal there is frequently loss of taste in the anterior part of the tongue on the paralyzed side.
PROGNOSIS: Slight cases of facial paralysis from any causes will recover in from one to six weeks. But the severe types may take from two to ten months or remain permanent, according to the etiology.
TREATMENT:
NEUROPATHY: Thorough lymphatic. Dilation 3, 4, 5, and pressure on fifth cranial nerve location on face.
CHIROPRACTIC: Adjustment of the condyle or any four of the upper cervicals and D6.
ELECTROTHERAPY: Short wave. Sine wave. Deep therapy lamps, faradic current. Hot pads according to tolerance of the patient, are helpful.
HYDROTHERAPY: Hot towels on the face. Irrigation of the antrum and bathing of the eye with a boric acid solution are considered beneficial.
MASSSAGE: Relax all the muscles of the neck and give freedom to the venous return blood.
Extend the neck and give gentle, firm and steady rotation.
Thoroughly manipulate the muscles high up under the angles of the lower jaw. Pull these muscles in different directions.
Manipulate the parotid, submaxillary and sublingual glands.
EXERCISE: Before the mirror the patient can go through mimic exercises of attempting to use the muscles of his face and eye, by trying to wink, or blow out his cheek.
PSYCHIATRY: The sufferers of this affliction are usually depressed and fearful of future complications. The art of hopeful suggestions is in order, but not in regard to the prognosis until the physician is sure of his diagnosis. To build up hope and fail, is to leave the patient’s last mental condition worse than his first. But the physician can cite his experience with this type of cases and relate the majority do get well, who cooperate faithfully with him.
SPONDYLOTHERAPY: Concussion of the 4 D for three minutes at intervals of half a minute at each sitting.
ENDO-NASAL THERAPY: With the addition of the Neuropathic lymphatic treatment, Endo-Nasal techniques has given the writer the best results. Swabbing the pharyngeal area, and the antrum area, the Lake recoil technique, then finish the treatment with the external carotid sinus technique, viz.:
Put the thumb and middle finger on the tip of the chin, slide them all the way back to the angle of the jaw. Drop fingers down one-half inch, push them easily into the neck walls and feel the tissues underneath your fingers. Hold steady for an instant, then thrust the fingers quickly inward and upward with about a three-pound pressure, then withdraw the fingers quickly. Note: Pressure can be measured on any ordinary scale.
HERBOLOGY: Prickly ash, pepper cress seed and imperial masterwort are all good. Also worthy of mention are baytree kidneywort, German golden locks, pimpernel, sage, mistletoe and false wild flax.

Perversions of the functions of the kidneys, and the classifications of those perversions is rather complicated. The usual classification is Acute Bright’s Disease, Chronic diffuse nephritis, Chronic interstitial nephritis. The new classification covers a few additional points in the instruction of the development of kidney perversions, briefly stated below.

DEFINITION: Inflammation of the kidneys.
ETIOLOGY: Bacteria or their toxins, scarlet fever, diphtheria, septicemia, or toxic drugs, such as mercury, arsenic, alcohol. Malnutrition, exposure to cold and wet. Streptococcus infection of throat, etc. The glomeruli may be affected, or the tubules of the interstitial tissues. It may be either acute or chronic.

ETIOLOGY: An inflammatory process involving more or less of the entire kidney but especially affecting the epithelium of the tubules and glomeruli.
SYMPTOMS: Acute onset, moderate fever, dull lumbar pain, marked edema and anasarca, hypertension, rapid pulse, vomiting, delirium, scanty, highly colored urine, containing large quantities of albumen and blood; bloody hyaline, and granular casts; uremic symptoms may develop any time.
PROGNOSIS: Guardedly favorable. May become chronic or death through exhaustive uremia or dropsy.

Moderately acute onset. Pulse rapid, marked hypertension and moderate edema and urine containing albumen, granular and hyaline casts. Urea, non-protein nitrogen, creatinin, and some salt retention.
ACUTE TUBULAR: Acute onset, marked anascarca, scanty urine, much albumen and blood, many granular hyaline, and bloody casts in urine. Great salt retention and moderate retention of nitrogenous products in the blood.

Entire structure of kidney may be affected, or affection may be confined to the glomerular or tubular processes. One variety of nephritis may merge causing a diffuse nephritis. Symptoms depend upon the tissues involved.

Onset gradual. Progressive loss of strength and flesh.
ETIOLOGY: Infections, fevers, alcohol, septicemia, or consequence of acute nephritis.
SYMPTOMS: Marked anemia, indigestion, pallor not warranted by blood count, skin pale, edema first of lower eyelids, then general. Gastrointestinal disturbances, increased arterial tension, some hypertrophy of left ventricle, uremic symptoms — vertigo, headache, nausea, sleeplessness, stupor, convulsions, coma. Urine diminished, color and appearance often normal; highly albuminous, with sediment, hyaline, fatty and granular casts, and fatty epithelial cells. Sodium chloride retention in blood. Nitrogen retention if glomeruli are affected.

ETIOLOGY: May follow chronic parenchymatous nephritis. Alcohol, lead, irritating toxins, bacteria, syphilis.
SYMPTOMS: Headache, weakness, digestive disturbances, retinal hemorrhages and eye disturbances, dry skin, slight edema of ankles. Vaso-motor disturbances such as tingling in fingers with blanching. Hypertension marked. Low, fixed specific gravity of urine, the quantity of which is considerable — as much by night as by day. Traces of albumen, few narrow hyaline casts and sometimes granular casts. Retention of urea, uric acid, creatinin, and non-protein nitrogen in blood.

Due to direct infection, considered largely as emboli of green streptococci that break off from the valves of the heart and lodge in the glomeruli.
The nonembolic focal glomerulo nephrotos due to a direct infection from acute tonsillitis, pharyngitis, otitis media, erysipelas, wound infections, septicemia, acute endocarditis, rheumatic fever, scarlet fever, etc. The three main types of nephritis in the following pages give a synthesis of all the types mentioned above.

DEFINITION: Acute inflammation of the kidneys. May be diffuse or it may involve chiefly the glomeruli or tubules. Also known as Acute Bright’s Disease.
ETIOLOGY: Excessive vaso-motor constriction of the kidney, and liver segments. Subluxation of the above segments. It may follow infections such as scarlet fever, streptococcus, septicemia, erysipelas and pneumonia. Focal infections, especially tonsillitis, or chemical poisons, mercury, cantharides and turpentine. Autointoxications that may come from liver and intestinal conditions, pregnancy, extensive burns, and generalized eczema. Laziness, or lack of exercise enough to consume the proteid ingestion is one of the principal causes.
SYMPTOMS: In many cases the only indications of acute nephritis are urinary changes, and slight edema about eyelids and ankles. In the severe cases the general symptoms are fever, dull lumbar pain, nausea, and vomiting. Increasing anemia. Increasing blood pressure and uremia and severe edema may occur at any period. (Please read again “The examination of the kidneys” in Book I.)
DIAGNOSIS: The exact diagnosis of this disease must largely rest upon the examination of the urine. The urine is scanty and sometimes suppressed. It is of high concentrated specific gravity 1.025 to 1.030. Color is smoky or milky under the Endo-albumen test. The urine contains a considerable amount of albumen, epithelial granular and erythrocytic casts and usually some blood. If there is a pronounced albumenuria and a constant amount of blood, with a constant decrease in excreted urea, then the indications are that there is a glomerulonephritis.
PROGNOSIS: Mild forms of acute tubular nephritis usually respond quick to treatments in a few weeks. But, sometimes become chronic. Mild glomerulonephritis also may respond quickly to treatments. But, sometimes the results are not lasting, and the disease passes into the chronic stage. In the severe stage of both types, complications and death may result from pulmonary edema, uremia, pneumonia and pericarditis.
TREATMENT: If severe ascites or dropsy has developed, turn to Section on that subject for the treatment of that phase of nephritis.
The general trend of the treatment is to relieve renal congestion, and to lessen the burden on the kidneys. Absolute rest in bed for several weeks is essential.
NEUROPATHY: Complete lymphatic of liver and spleen along with a general lymphatic. Dilation of the kidney, liver and spleen segments.
CHIROPRACTIC: K.P., L.P., S.P.
DIETOTHERAPY: Absolute fast for a few days to a week or several weeks as urine reports indicate. Milk slightly diluted with lime water, or Vichy is of great value. The grapefruit cleansing drink is very effective for liver congestion, which, in many cases brought on the disease. Spoonful of lemon juice to glass of water three times a day is helpful.
After the symptoms have abated and the physician decides the danger point has passed, then, cream, gruels, fruits, milk toast, can be given before placing the patient on No. 2 Diet for a few days and gradually leading him to No. 1 Diet.
VITAMINOTHERAPY: Vitamin A, Minerals, Chlorine, and Magnesium.
COLONOTHERAPY: Low enemas every day during acute period; or, purges may be given.
VACUUM THERAPY: If there is pain, cupping of the sections complained of may be of great value.
HYDROTHERAPY: Hot packs, hot air packs, hot vapor baths. If there is suppression, hot sitz baths. Hot douches on kidney region and along ureters and scrotum, in tub, if possible. Free sweating is an excellent aid in the treatment.
STRAPPING: If pain is severe it may become necessary to strap the patient. Usually just straight cross-strapping is enough. But, in some cases it is necessary to have the cross-strapping plus the up and down strapping from over one kidney then down and across to the hip on the other side. Two straps, two inches wide on each side and four across are considered sufficient. Should the strapping not ease the pain in a few hours, it should be removed.
ELECTROTHERAPY: Short Wave and Diathermy are very effective. Infra-red, and Ultra-violet seem to be of great value. Patient on side, or face down, and given a flow of from 15 to 25 minutes. Electric baths can be given to stimulate perspiration.
SPONDYLOTHERAPY: Dorsals 6 to 8 will aid in the circulation of blood, through kidneys.
HERBOLOGY: One ounce each of Fl. Extr. Poplar Bark and Juniper, ½ oz. Fl. Extra. Buchu, 2 ounces of Mucilage of Gum Acacia. Put a teaspoonful of this in a half cupful of Meadowsweet tea, and use every two hours.
Strong tea of Queen of the Meadow Roots is excellent.
Such Demulcents and Diuretics as Horsetail Grass, Marshmallow Root, Bearberry Leaves, Sassafras, Globe Flower Bark or Root, Huckleberry Leaves and Bugle Weed are good.
An ounce each of Sassafras, Cheese plant, Dwarf Elder root, Juniper Berries, Lily of the Valley root and make a tea, using at least a cupful a day, until relief.

DEFINITION: A Chronic inflammation of the intervening connective tissue of the kidneys, bringing about a degeneration of the tubular epithelium. Edema of the interstitial tissue, and more or less obliteration of the tubules, and glomeruli and a substitution of fibrous connective tissue. This can be termed a process of sclerosis of the kidney or a hardening which is large and white in the beginning, but which late in the disease shrinks to a small size.
ETIOLOGY: Vaso-motor constriction of the kidney segments. Impingement of the kidney nerves interfering so much with the calorific function, that there is excessive heat which produces inflammation resulting in a hardening process. The disease may follow an attack of acute tubular nephritis, but generally comes on gradually, as a result of chronic infections, such as tuberculosis, malaria, or some chronic local infection.
Acoholism is a prominent factor, as well as habitual exposure to wet and cold.
Epithelium degeneration may be due to a deficiency of Vitamin E in the diet, also of nicotinic acid deficiency and also of Vitamin A.
The disease may be present for a long time with no more symptoms than a small amount of albumin, and a few hyaline casts present in the urine. But, in the more severe cases the urine is reduced in amount and of high specific gravity (1018-1025). It contains a considerable quantity of albumin and yields an abundant sediment, which consists chiefly of fatty, granular and hyaline casts, cellular detritus, and fat droplets, and in very severe cases there is weakness, pallor, digestive disturbances, edema. As the disease progresses there is a failure of vision and the conjunctiva is edematous. There are headaches, vertigo, shortness of breath and palpitations. There is no tendency to high blood pressure, and uremia is not a common occurrence, but may develop toward the end of the patient’s life. Dropsy of the chest, and pulmonary edema are rather usual in the severe type. Pneumonia, pleurisy or pericarditis often develop in the late stages.
PROGNOSIS: In the milder cases, under rigid supervision of diets and habits life may be prolonged for many years. But in the severe cases complications may terminate life quickly.
TREATMENT: The treatment follows practically the same plan as in Acute Nephritis. Except, that there are times when a higher percentage of calories, protein and mineral elements are permitted. Epstein in the American Journal of Medical Science recommends a diet high in protein and low in fat. The latter consists of lean veal, lean ham, whites of eggs, oysters, gelatin, lima beans, lentils, split peas, green peas, mushrooms, rice, oatmeal, bananas, skimmed milk, coffee, tea and cocoa, with restricted fluids and only enough salt to make the food palatable. The daily amount of calories runs from 1280 to 2500 and the daily amount of proteins from 120 to 240 grams (4 to 8 ounces); of unavoidable fats, from 20 to 40 grams (10 drams); of carbohydrates, from 150 to 300 grams (5 to 10 ounces). Other articles of food are added gradually as conditions allow.
Numbers 1 and 2 Diets in this book are practically the same in the number of calories.
The manipulative and physical therapies of Acute Nephritis can be followed out with the inclusion of the above ideas on Diet. But, in the more pronounced forms of this disease, absolute rest, both mental and physical are required. Flannel or a silk binding would be helpful. The patient must always keep warm. All foci of infection removed if possible. Alcohol should be forbidden. Very little salt allowed. The bowels kept free.

ETIOLOGY: The disease may develop out of acute Glomerulonephritis, or may come by gradual septic infection, from foci anywhere in the body. This disease is most common between the ages of twenty and fifty years.
SYMPTOMS: Loss of flesh and strength and increasing pallor are often the earliest indications. Digestive disturbances are very common. Cardiac symptoms, especially dypsnea on exertion and palpitation, are sometimes prominent features. Headaches, dizziness, and insomnia often result from the disturbed circulation or from uremia. Impairment of vision from albuminuric retinitis is observed more frequently than in any other form of nephritis and is of serious import. Dropsy is somewhat exceptional, although edema sometimes appears late in the disease in consequence of cardiac insufficiency. Uremia is of frequent occurrence.
The blood pressure is high, a systolic figure of 200 or 220 not being unusual. The aortic second sound is accentuated, the heart is enlarged especially to the left, and the arteries are thickened and tortuous.
The urine is abundant (2000-4000c.c.)(the polyuria being especially marked at night. The specific gravity is low and somewhat definitely fixed at from 1013 to 1010; albuminuria is slight and at times may be absent; and casts are usually few in number and for the most part hyaline or faintly granular. Hematuria is sometimes noted.
DIAGNOSIS: Based largely on past history of albuminosis, or Acute Nephritis. The appearance of an enlarged liver or spleen or both, albumin in the urine. Hypertension and polyuria, the diagnosis is established.
PROGNOSIS: In mild cases it can be said to be favorable. Cures are possible if the primary cause can be found and removed. In well developed cases the outlook is grave because of developing complications such as Cerebral hemorrhage, Dilation of the heart, Pulmonary edema, Uremia, Pleurisy, Pericarditis and Pneumonia.
TREATMENT: Is, in general, the same as found in Chronic tubular nephritis. Rest is important and certain periods of the day set aside for naps of an hour or so. But, the patient must be instructed to be moderate in diet, exercise and work, or study himself to find out what agrees with him so he can establish a well regulated life in the avoidance of mental and physical strain, overeating, use of alcohol, chilling of the body and all other factors that may increase the blood pressure or overburden the heart. And he must be instructed against sudden chilling at any time. As long as the renal insufficiency is not marked, protein intake need not be limited much.
For the treatment of symptoms, such as hypertension, see treatment under that subject. Treatment for mycardial inadequacy can be found under the title of heart conditions.
Now, turn back to treatment of acute nephritis and use practically the same techniques in combatting this condition.
Some Extra Suggestions
“A deficiency of calcium causes excess albumen to pass out by way of the kidneys, often causing Bright’s disease.”
“Varying amounts of albumin may be found in the urine without it being any indication whatsoever of Bright’s disease.”
“The presence of albumin in the urine, at one time regarded as indicative of nephritis, is now recognized as occurring under many circumstances without the existence of any serious organic change in the kidneys.”
“Albumin is simply due to a sloughing off of the skin cells which line the kidneys.” It can come from “great physical exertion,” “ingestion of food rich in protein,” “Standing in cold water a long time,” “Sometimes albumin is absent in morning and only present after hard day’s work.” “While albumin is usually found in chronic interstitial nephritis, it is also true that a certain percentage of cases die of this disorder without once having shown albumin in the urine test.” — Dr. McCoy.
“Rapid recovery may be expected of acute Bright’s disease if simple eliminative measures are used to aid the overworked kidneys in recovering their normal functions.” However, chronic, offers many difficulties: dropsy, albumin and casts in urine, enlargement of kidneys, or becoming smaller and hard; persistent high blood pressure, often reaching to 250 or 300 mm; requires prolonged treatment with diet and other hygienic measures for correcting the faulty metabolism and toxic poisoning. Diseased kidney retains that which it should throw out and throws out that which the blood should retain. In the diet of chronic Nephritis it is necessary to give patient a reasonable amount of protein to make up for the loss of albumin thrown out in the urine. Fast should be followed with non-starchy nd non-protein diet for 3-4 weeks, then protein added in form of eggs and easily digestible meats — say one egg daily and 4 oz. of meat protein. Skin elimination necessary by sponge baths daily. One enema daily as long as albumin shows. Deep breathing can help much. Large amount of water should be taken during day, even at night if patient is awake. One to two gallons of water should be taken daily. Milk diet is good, 2-3 quarts of milk daily, taken say a glass every hour, preceded by a few drops of lemon juice to help in the stimulation of gastric secretions; continue several weeks. Alcohol, condiments taboo; salt intake small. In resume, essential things to remember is to use all methods to keep eliminative channels freely open and avoid any habits which may induce a general toxemia.” — Dr. McCoy.

DEFINITION: An inflammation of the bronchial tubes and mucous membrane.
Three types are found. Acute and Chronic Catarrhal bronchitis and fibrinous bronchitis.
ETIOLOGY: Acute catarrhal bronchitis; excessive vaso constriction of the 10th cranial nerve. A subluxation in the first and second dorsals, 7th cervical or kidney place. Secondary causes may be cold, damp climate; changeable weather; occupations that necessitate confinement or the inhalation of irritating dusts or vapors; the gouty diathesis; and chronic heart disease are general predisposing factors.
In many cases the disease follows exposure to cold and wet, particularly when the body is overheated, or the inhalation of irritating gases or dusts. Not rarely it is one of the manifestations of a general infection such as measles, whooping-cough, typhoid fever, influenza, etc.
The exciting cause may be the Micrococcus catarrhalis, pheumococcus, influenza bacillus, streptococcus or staphylococcus.
SYMPTOMS: The chief features are: Chilliness and general malaise; a sense of soreness and constriction behind the sternum, increased by coughing; slight fever (100-102 degrees F.), with its associated symptoms; and cough, which is at first dry and painful, but later accompanied by more or less abundant mucopurulent expectoration.
DIAGNOSIS: Influenza. — High fever, severe pain in the head, back, and limbs, and great prostration will serve to distinguish influenza from bronchitis when the former is present.
CATARRHAL PNEUMONIA: Moderately high and irregular fever, prostration, pronounced dypsnea, cyanosis, and physical signs indicating consolidation will aid in the recognition of pneumonia.
PROGNOSIS: Is generally good. In the young and aged great care must be taken lest it become chronic or lead to catarrhal pneumonia.

ETIOLOGY: Chronic bronchitis may be the result of repeated attacks of acute bronchitis, or it may develop gradually from chronic cardiac, pulmonary, renal disease or gout.
SYMPTOMS: The chief features are: Persistent cough with more or less mucopurulent expectoration; a sense of soreness behind the sternum. Fever is usually absent, and unless the disease is very severe, the general health may be fairly well preserved. Dyspnea on exertion is sometimes a troublesome symptom; it, however, belongs more to the resulting emphysema than to the bronchitis.
There is rales, and wheezing. In chronic bronchitis there are a number of forms it will take. The dry form, in which the coughing is very severe, and from which there is no expectoration. The wet form in which the expectorate is profuse, amount to several cupsful in a day. The third form is the purulent form in which pus is expectorated in large quantities due to an ulceration in the dilated bronchi. Fever is present. The fourth form is when the expectoration is putrid. The odor is due to the growth of certain molds in the secretions in the bronchial tubes. In the sputum small balls, varying in size from a pinhead to a pea, can be seen composed of fat crystals, bacteria, and inter-twined threads formed by a mold. These are called mycotic plugs. Fever, usually of a hectic type, is present in this form of the disease. It also may finally be complicated by gangrene of the lungs.

A primary inflammatory disease of the bronchi associated with formation of false membrane.
SYMPTOMS: Acute and chronic forms are recognized. Acute is rare, manifests symptoms of acute bronchitis but sputa contains fibrinous casts and there is marked dypsnea. Chronic form characterized by severe cough, dyspnea and the expectoration of fibrinous plugs. Often lasts a few weeks then disappears to return again at definite periods.
PROGNOSIS: Guarded; in acute may have death from suffocation.
TREATMENT: In acute bronchitis the following forms of treatment have been found effective.
NEUROPATHY: A thorough lymphatic with emphasis on the liver, axillary and cervical regions. Dilation of the 10th cranial nerve.
CHIROPRACTIC: Adjustment of the 1st and 2nd dorsals, 7th cervical and K. P.
SPONDYLOTHERAPY: Concussion of the 7th cervical for five minutes on half minute periods.
VACUUM THERAPY: This form of treatment is excellent to quicken the circulation. The large cups are applied over the spine and chest, and the small cups where applicable on the neck according to the tolerance of the patient.
DIET: If not debilitated, No. 2 diet for a week or more may be tried. Plenty of hot water to drink. Elimination of all mucous forming foods. If possible a fast on fruit juices for a few days. If cough is dry, an equal amount of honey and lemon juice mixed and a teaspoonful given every hour may cause expectoration.
HYDROTHERAPY: Hot compresses to spine and chest, or poultices.
ENDO-NASAL THERAPY: The Lake recoil. Dilating the external nares. Swabbing out and dilating the pharyngeal cavity, also releasing and raising the glands of the neck are excellent for dypsnea, and a greater intake of oxygen. The greater intake of oxygen is necessary if a cure is to be effected.
ELECTROTHERAPY: Infra-red or radiant light from a 1,000-watt deep therapy lamp is a splendid treatment. Place the generator the proper distance from the patient so the treatment can be given in one-half to one hour. Ultra-violet is also a very valuable modality to use in bronchitis.
Diathermy is one of the most valuable agents in the treatment of this disease. It not only relieves pain but greatly assists in allaying the inflammation. Either long or short-wave diathermy is valuable, but owing to the ease of application the short-wave therapy is gradually replacing the older type.
The carbon arc light is of exceptional value in bronchitis since it delivers infra-red, visible and ultra-violet rays, all of which are indicated.
COLONTHERAPY: Colonic irrigations are in order, and whether they are needed more often than twice a week must be left to the discretion of the physician.
ORIFICIAL THERAPY: Rectal dilations may prove of some value.
HERBOLOGY: Mild expectorants such as Mullein, Coughwort, Horsehound, Sundew Yarrow, Linden flowers, Honey, Marshmallow, figwort and Flax Seed will augment diet, sunlight and proper nursing, not forgetting a laxative.
An easily made remedy is two large handfuls of Mullein Leaves, steep in one quart of water down to a pint and add a cup of honey.
Equal parts of Wild Cherry bark, Horehound, Spikenard, Comfrey Root and Elcampane made into a tea is excellent. Sweeten with honey.
EXERCISE: Breathing exercises with the arms uplifted will aid in the expulsion of the mucous by intermittent pressure.

TREATMENT OF CHRONIC BRONCHITIS

The treatment used for the acute condition is applicable with a few additions of techniques. 1st: All foci of infection should be carefully searched for, particularly in the sinuses, tonsils and throat and removed by Endo-Nasal and Allied techniques.
A trip to a high altitude occasionally will aid much by the inhalation of dry air. But when due to cardiac disease or complicated by it, low altitude is best.
In cases complicated by arteriosclerosis, hypertension, autointoxication, colds, sinusitis and tonsilitis, see treatments under those titles.

The treatment for this type is the same as above with what additions the physician can find as a specific for the releasing of casts, and special attention to relieving dypsnea by Endo-Nasal therapy.

DEFINITION: Inflammation of a bursa, or inflammation of the sac or pouch containing fluid within the body often lined with membrane, especially found between tendons and bony prominences and other places where there is excessive friction.
There are two types: Acute and chronic and attacks can take place in many parts of the body especially the limbs.
ETIOLOGY: It can generally be said that they are practically all due to injury, over use, or irritation from some source. The chronic type may be due to a continuation of the acute etiology and disease.
There are many locations of the two types of bursitis — bursae about elbow; bursae about shoulder; bursae about hip; bursae about knee; deeper bursae, infrapatellar bursitis, gastrocnemius bursitis, medial tibial bursa, lateral tibial bursitis; bursae of foot; posterior group, posterior calcaneal bursae, anterior calcaneal bursa, anterior planter bursitis, lumbrical bursae.
SYMPTOMS: An acute inflammation of a bursa may be serous or purulent, and, as stated, is usually due to injury. When located superficially there is marked swelling, redness, and local heat. When an inflamed bursa is situated in the deeper tissues, the swelling can only be detected with difficulty, if at all, and the pain especially on motion, is severe. General febrile symptoms often appear when a deep bursa is involved, especially when there is a tendency to suppuration, this being likely to extend. The inflammatory process sometimes extends to a neighboring joint, including the synovial sac, which is easily penetrated. The diagnosis can usually be established by judging the effects of motion. Extreme abduction or adduction of the humerus, for instance, causes severe pain, if the inflamed bursa is under the deltoid; when the bursa between the quadriceps extensor and the femur or that under the ligamentum patellae, is the seat of the inflammatory process, flexion of the leg upon the thigh becomes painful, through the pressure thus exerted upon the bursa.
DIAGNOSIS: It is difficult to be misled in these cases If the patient complains of pain, and the examiner finds the pain is greater on touch over the bursae of any particular part he can feel certain of the diagnosis.
TREATMENT: In the acute type absolute rest for the bursa is necessary, removing all pressures and irritations. The part should be supported during the acute attack. If an arm or shoulder, in a splint, if in the foot a U strapping of adhesive tape under the heel. This strapping to come up one inch over the ankle on both sides. Cold applications, or cold compresses may be tried, and gives relief in some cases, but not in all cases. In many cases, hot antiseptic fomentations or compresses are necessary.
Infra-red, short wave and diathermy are of great value. Light massage may be given after the hot or cold applications. If in a few days of the above treatments, and the condition does not improve, blistering of the part, or absolute freezing of the part may be necessary.

This is met with much more frequently than in the acute form. It develops insidiously. The pain is slight, and the condition manifests itself by marked swelling, which varies in density to the bursal wall. It may present a feeling similar to that of bone. This is spoken of as bursitis with calcification.
TREATMENT: Diathermy, galvanism and the sine wave are noted for their effects on this condition. For the pain short wave may be used.
VACUUM THERAPY: Application of the cups over the bursa is a great help in the breaking up of the mass, but the cups should be applied very gently at first.
HYDROTHERAPY: Baking. Hot applications, or sitting in a tub, or standing under a shower, and allowing the water to hit the particular part affected for long periods of time. The water should be as hot as can be endured.
EXERCISES: This should be regulated by the physician. The average patient will use jerking movements that are sometimes too violent to make tests for pain, thereby creating more irritation. And, his movements should not be more than necessary to carry on normal life.
STRAPPING: If the pain is from shoulder bursitis, the arm can be supported by a loop gauze strap from the neck. At the same time an adhesive tape can be placed from a point on the spinous process, then drawn over the shoulder to about 2 inches in front. A strip 1 ½ inches wide, is sufficient. Care must be taken not to attach the tape over the lower neck muscles, if discomfort is to be avoided. If the patient must stay employed, the shoulder strap can be of itself a great benefit.
NEUROPATHY: Inhibition of pain can be obtained by hard pressure on the opposite side to the seat of the pain.
CHIROPRACTIC: The adjustments are according to the location of the subluxations and perversion.
VITAMINOTHERAPY: Large doses of E and D and smaller doses of A and B2.

Cancer, Carcinomas

DEFINITION: It is difficult to give a definition of cancer but since it is a disease of the epithelial cells in the majority of cases, and of some connective tissue cells, it can be said to be a malignant growth, that has a metastic effect upon other tissues, by the spreading of the epithelial and connective tissue cancer cells.
In the development of the cancer the invasion of the tissues having started, there is a slight thickening and hardening of the tissues. This is known as the precancerous stage, which may cause no distress to the afflicted person. But later on a swelling or tumor takes place, and when first noticed may assume a round or an irregular shape. Laboratory findings are of epithelial cells in compact aggregations without capillary vessels, for nourishment requiring the cells to live on such intercellular lymph as can reach them. The lymph containing waste, and only about twenty per cent oxygen, and since enough oxygen is not carried to destroy the cancer cells, they multiply rapidly, especially in soft adipose or edematous tissues, and large masses may be formed. In the firmer tissues, the lymph supply is not so great, and the cancer cells grow much slower, and smaller in size. The food, and oxygen supply becoming more inadequate with the growth of cancer cells, the tissues in the area involved become decadent and necrotic or dead and later putrefaction sets in. But before this stage is reached, invasion of all surrounding tissue may have taken place to a greater or less degree according to the resistance of the tissues, and the circulation of the blood, and the oxygen and nutritive supply. The writer is satisfied that metastasis of cancer cells to other parts of the body is largely due to the lymphatic circulation rather than the extension of the cancer cells themselves, or being carried by the arterial circulation. It seems reasonable to the writer, that the above is true because if the cancer cells were carried in the arterial circulation metastasis would be more rapid and death would be hastened a great deal. It is possible that a large proportion does get into the arterial stream, but are destroyed by the oxygen. But the lymph stream being slower they can lodge and colonize, then there is the primary and secondary cancer. However, there may be some cancers that can occur from blood metastasis. As the cancer spreads the mental and physical make up of the patient is disturbed. If they live long, no matter whether it be external or internal, there comes a time when they show signs of severe secondary anemia, wasting pallor, and slight yellowing of the skin. The skin becomes like wet moss, and it feels cold to the touch of the hand. There is usually a great shortness of breath, and weakness. The facial and eye expression is as if the patient is in a state of constant bewilderment.
ETIOLOGY:Hundreds of experiments have been carried on to explain the germination of cancer cells, and many interesting theories have been advanced, but to date none of them are totally acceptable. The traumatic theory has much support. Coley considers that there is an etiological connection between trauma, at least in its broadest sense, and cancer. Coley states that in 9 of 46 cases of sarcoma which he has previously reported the tumor developed within one week after the injury and at the exact site of the injury. Since this report he has observed 800 cases, making a total of 970 cases a definite history of trauma existed 225 times, or in 23 per cent. In 117 of the 225 cases, or in 52 per cent, the tumor developed within one month after the injury. Coley also has observed carcinoma of the breast following injury within one week’s time in 5 cases. Coley: Annals of Surgery 1911.
The irritation theory apart from trauma has many adherents, especially external cancers. Cancers of the lips were more frequent in pipe smoking days than at present, or cancers of the uterus from abortions or unrepaired traumatic parturition. Coal tar products, aluminum products and many other chemical elements such as sulfydryl compounds in the tissues themselves may upon trauma or irritation excite such productive activities of cells that may be the basis of cancerous tumor growth.
The hereditary theory has some advocates. But statistics on this phase of the question are puzzling.
Among 2389 women with cancer reported by Pierson from the Middlesex Hospital in London, 359 had family histories of cancer, while of the antecedents of 753 non-cancer cases only 120 were affected with cancer. This shows that cancer seems to be no more frequent in the families of patients with cancer than among those without it. Guillot has found a history of cancer in 11 per cent of antecedents of non-cancerous patients and in 17.4 per cent of the antecedents of cancer patients, and he estimates that the incidence of cancer in the parents of non-cancer cases is 16 per cent as against 17 per cent of the parents of cancer patients.
The question arises now: whether the cancer in those who had cancerous parents was transmitted from parents to children at birth, or whether later in life the production of cancer was not due to living the same kind of life as the parents, eating the same type of food, having the same sedentary habits, with the same environmental tendencies toward trauma and irritations.
The infective theory created great excitement some years ago by the announcement that certain microorganisms had been found in carcinomas, but later it was discovered that not a single microorganism was constantly present, and the excitement died down, and the conclusion now is that cancer is not an infectious disease.
The writer is inclined to the traumatic and irritative theory plus the existence of an anoxia or anoxemia. The functions of oxygen are too well known to recount them here. But it is well known that anoxia of any tissue of the body will create a basis for putrefactive elements to accumulate and constant irritation or trauma will increase the accumulation of putrefactive elements that will compound and destroy the surrounding tissues as long as there is anoxia or anoxemia.
In support of the above theory we quote the following from “Chemistry in Therapeutics:, page 132. Walter Bryant Gug.
“Dr. W. B. Bainbridge, of New York City, is quite convinced that injuries play a large part in the production of cancerous growths. As before explained, a lymph stasis is set up by inflammation or injury to any tissue. If an alkalosis is present the cancer occult virus may propagate in the injured tissues. The retained lymph and toxins and the deficiency of oxygen create the conditions favorable to its growth. In a lengthy paper printed in the Medical Times, May 1934, after quoting many undoubted authorities that trauma (injury) often precedes cancer growths, Dr. Bainbridge states that he ‘realizes, naturally that all blows do not result in cancer, and that all cancers at the sites of injuries may not be the result of trauma, but in a number of cases observed, where there are definite steps, from the injury to the tumor, it is his opinion that the finger of proof points directly to the trauma, as such as the cause of the subsequent malignancy.’
“If we could but visualize the pathology, for instance, of a gastric ulcer, we should see first of all a blocking of the lymph channels in the area involved. This stasis would shut off the nutrient fluids, also oxygen, from the cells. Likewise, a retention of toxic acids and other products of metabolic life would accumulate and cause an inflammatory congestion that accompanies this affection. Then would follow a coagulation necrosis with destruction of the epithelial cells. If the lymph stasis that causes the sore is relieved, healing takes place.” Now the trauma need not necessarily be a severe blow, but a constant irritation of some chemical, or food products.
TREATMENT: From the earliest time the idea was to rid the patient of the core or tumor of cancer. Caustics and hot irons were used for this purpose which meant death shortly for the patient. Then followed the present surgical procedures that, if performed early in the condition gave promise of a longer life than otherwise. Vaccines, serums and antitoxins followed, administered by those who accepted the infectious theory.
Another method was based on the theory that the tissues resent the presence of cancer cells and try to get rid of them by some kinds of immune bodies present in the blood. Attempts then were made to treat these patients by intravenous injections of exudates taken from other cancer cases and in this way aid the patient’s blood to become stronger in its immunizing qualities.
Hormonal therapy by injection of adrenal extracts injected directly into the tumor or elsewhere was tried, but the disturbances created led to its abandonment. Later, heat by electrical apparatus was tried, then the various types of lamps, especially ultra violet, sometimes giving relief from pain, but having no influence in retarding the growth.
An interesting theory is that of deficiency of Vitamin A may play a part in the conditioning of the epithelium for cancer cells, and also of Vitamin A in therapeutics, of the first Youmans is quoted as follows:
“The effect of a deficiency of Vitamin A on the epithelium is an atrophy of the cells followed by a replacement with undifferentiated epithelium through proliferation of the basal cells. This results in a stratified, cornified epithelium, similar to the epidermis and the same in all structures irrespective of their original structure or function. Disturbances in function result from this altered nature of the epithelium and the presence of masses of dead, cornified cells. Glandular structures such as the sebaceous and sweat glands diminish their secretion or cease entirely. Ducts are plugged, specialized epithelian surfaces become replaced by a flat, keratinized surface. Youman Nutritional deficiencies, page 23.
Today there are three standards of medical treatments, surgery being foremost and the best in medical procedure; second, X-ray treatment; third Radium. There are in some cases combinations such as surgery and X-rays and Radium, according to the biopsy reports or the grade of the tumor. Fulguration, electrodessication, electrocoagulation and the electroendotherm knife are also used as a part of surgery. Still the cancer toll piles up year after year. Drugless physicians are handicapped by the customs, habits and beliefs of the people influenced by the propaganda of the medical profession to such an extent that they are prevented from performing experiments of any degree with coalition among themselves. Always hanging over their heads is the danger of malpractice suits or being branded in their communities as quacks, charletans and fakirs.
The ethics of the medical profession demand that, if any improvement, method, discovery or remedy is found that gives better curative results than hitherto recorded, such information, through publication, must be made available to the entire medical world, in order that all may be aided; also, that any valuable discovery may not be lost to posterity. But here is the catch for the Drugless Physician. He would not be accepted as worthy of attention. His information would be distorted. He would be subjected to persecution by the Medical profession, and even some of his fellow drugless practitioners would join in the ridicule and denunciation.
All that could be if proper facilities were provided by some drugless organization, and funds for the equipment of a sanitarium and proper experimentation facilities, and proper reporting from time to time on the progress made. All reports put out by any physician as to so-called cures of cancer should be investigated and if accurate, and a number of cases have responded, this should be made known to the public, by a group of investigators which would save the individual physician embarrassment in his community. Surely there must be among the Drugless techniques a combination of methods that will get as good results if not better than the medical methods if agreement could be reached on the proper procedure. For the medical procedure is strictly arbitrary, the scope of the treatments being limited to surgery, X-ray, and Radium as the only orthodix method of therapeutics. At the time of this writing, there comes to my desk the following letter:
“Dear Friend: You have in the past shown your interest in the work of the Philadelphia Division, American Cancer Society by contributing to its support. We did not hear from you after our April appeal this year, but we hope that we can make you feel that your further cooperation is worth while.
The scope of the work of this group has been greatly enlarged, over 200,000 people having been reached this year. To them we have sent the word that Early Cancer is Curable, telling them of the danger signals, and urging consultation with their family physician, or another, if disturbing symptoms are present.
In addition we are supporting investigation and study of pelvic cancer, and are greatly interested in the problem of care of cases of incurable cancer.
Does this not warrant your support? We hope so.”
The above letter was signed by an M.D. Now why not signed by an N.D. or a D.C. It is the hour for all drugless Physicians to investigate and cause research by a body of responsible physicians into many of the claims made by individual physicians that they can detect the precancerous stage, and have a preventative, or some method of aborting a full attack. Iridiagnosis has never, to the knowledge of the writer, been thoroughly tested, as a detector of the precancer state, and a report made on results after a wait of a period of time to see if full cancer would develop. There are no statistics that a physician can call on for aid in diagnosis of the precancerous or the full stage.
Great claims are made for iridiagnosis in the detection of the presence of cancer and for the grape cure, certain types of plasters, diets, and other methods of therapeutics, but no responsible group of licensed physicians to prove or disprove these claims, and as a result if a physician does have a real discovery, he stands alone, and he falls alone, as soon as he tries to tell the world about it.
There are many questions an impartial paid group of physicians could spend their time in finding us the answers. Some might be as follows: To what extent does a condition of Alkalosis contribute to the precancerous state. To what extent does the loss of nerve control over the process of cell production contribute to the cancer state. To what extent does lymph stasis contribute and how, to a cancer state. It is within those three questions that the answer to the prevention and cure of cancer is to be found. Surely our dietitians, biochemists, nerve specialists and others who have developed some helpful therapeutics can get together some day, and give us a logical method in management of benign and malignant growths.
In the following pages on this subject, we will take up a few of the most serious types of cancer, and give what we could find in the management of such cases.

Cancer of the Liver

ETIOLOGY: Cancer of the liver is largely considered as secondary. Rarely primary. Usually attacks after 45. Is more common in men than women. The primary is usually of one big lump. The secondary a combination of smaller nodules or lumps.
SYMPTOMS: (1) The liver is enlarged and painful, and often presents one or more smooth, hard nodules. The latter may show a central depression. (2) Jaundice is common, but it is rarely intense. (4) Digestive disturbances are a prominent feature, and often precede the hepatic symptoms. Ascites sometimes result from portal obstruction. Toward the end, slight fever, delirium, stupor, and coma may develop.
PROGNOSIS: Considered to be generally hopeless. Much depends upon the position and course of the primary neoplasm in the secondary type on the size of the liver growth, and on the interference with hepatic function. In the majority of cases, the patient loses strength rapidly and emaciates, and the liver steadily increases in size. Stupor from cholemia takes place; but occasionally death is due to some intercurrent disease such as pneumonia.
TREATMENT: Much of the treatment is palliative; although surgery offers extirpation of a localized malignant growth, it is doubtful if a recurrence is prevented.
The nervous system may be quieted by light pressure on the liver segments. The itching of jaundice may be relieved by lotions of various kinds, baths or high frequency bulb applied to the annoying parts.
Herbology is found under cancer of the stomach.

ETIOLOGY: The primary malignant growths of the kidney comprise sarcoma, hypernephrona and carcinoma. Sarcoma seems to be the most common in children while the hypernephrona is most common in adults Carcinoma of the kidney is rare. But all types of tumors of the kidney can be regarded as malignant.
SYMPTOMS: There may be none until the tumor has reached a large size. The three outstanding symptoms are pain, bleeding and the palpation of a lump in the kidney. See methods of kidney examination in book on Neuropathy. In addition notice if area of kidney is cool, cold and moist. In addition to the above there are emaciation. Pain is inconsistent and the urine, apart from hematuria, often affords no indications. Metastasis is frequently observed, hypernephromas showing a special tendency to involve the lungs and bones and to invade the renal vein and vena cava.
PROGNOSIS: Depends largely on complications.
Medical treatment offers nothing more than surgery. Neither X-rays nor radium are considered effective because of the difficulty of applying sufficient dosage so far from the surface of the body.
A statistical study of the results of operation for renal tumor is that of Judd and Hand from The Mayo Clinic. In 367 cases they found that hematuria was the first symptom in 43; 86 per cent; pain in 37.32 per cent; and tumor in 13.62 per cent. Of the entire number of patients, 106 lived for from 3 to 22 years, or about 29 per cent. Judd and Hand. Journal of Urology, July 1929.
Drugless therapy up to now has no specific method of approach other than diets and comfort giving treatments. Some physicians have tried the grape cure of which nothing more has been heard by the writer after extensive efforts to get reports. One great difficulty of restricted diet in these cases is the great emaciation that has taken place before the disease was discovered. All cases the writer has had, the loss of blood and the depletion of the blood constituents by the disease made further depletion impractical by a restricted diet and the grape cure without sanitoria supervision. Vitamin E in large doses (wheat germ oil) has been reported as useful in all forms of carcinomas, but as yet is not fully established as a specific.
Herbology is found under cancer of the stomach.

Cancer of the pancreas is more common in males than in females. Pancreatic cancer generally involves the head of the gland, and is largely of the hardening nature.
SYMPTOMS: Cancer of the head of the gland is early. These include disturbances of digestion, rapid loss of flesh and strength, anemia, deep-seated, and often pulsatile from its relation to the aorta. The pain often occurs in paroxysms, especially at night, and may be associated with the symptoms of collapse. Progressively increasing jaundice, with enlargement of the gall-bladder, is a frequent symptom, and results from the pressure of the tumor upon the common bile-duct. Pressure on the portal vein may cause ascites. Glycosuria is an occasional symptom. In some cases the stools have contained much free fat and numerous undigested muscle-fibers.
SYMPTOMS: Cancer of the body or tail of the gland are late in developing but once developed present the same symptoms as the other.
DIAGNOSIS: Relentless loss of weight, the intense jaundice, and palpation of the spleen. (See Spleen examination.) The feel of the lump or lumps make the diagnosis rather certain. The condition of the gutter of the spine being soft and ropy, also subluxations will confirm the findings. Laboratory findings of urine show bile, glucose, lipase, diastase and chyle due to obstruction of the receptaculum chyle. The blood shows a very low red cell count. The stools show signs of blood, while the X-ray may be of great value in showing the amount of pressure and obstruction on adjcent organs.
PROGNOSIS: Death may result anywhere from one month to two years after the discovery of the symptoms. Treatments may show some improvement for a time, but the symptoms later become more severe. An operation is only a temporary relief. At the present time there is no drugless literature extant that gives any hope for even prolonging life let alone a cure. We have heard much of the fasting cure and the grape cure but no statistical reports as to the effects of these methods.
Herbology is found under cancer of the stomach.
MEDICAL PROCEDURE: Surgery of the pancreas is very limited but has not so far resulted in what could be a satisfactory outcome. Cholocystectomy has eliminated the jaundice and allowed some gain in weight. This operation is performed after abundant fluids, blood transfusions, and glucose are administered. After the operation pancreatin may be substituted for the failure of the functioning of the pancrease Gastric analysis reveals whether belladonna, hydrochloric acid or alkalis are necessary.

ETIOLOGY: Carcinoma of the stomach occurs somewhat more frequently in males than in females. About three-fourths of the cases occur between the ages of forty and sixty-five years. It is rare before thirty. Heredity seems to be a factor of some importance. Ulcer of the stomach undoubtedly increases to a great extent the predisposition to cancer.
Cancer of the stomach is almost always primary. The pylorus is the part most frequently attacked. After the pylorus the points of attack are the lesser curvature and the cardia.
SYMPTOMS: Obstinate dyspepsia, persisting in spite of rational treatment; persistent pain in the epigastric region, not greatly influenced by eating; progressive loss of flesh and increasing anemia; vomiting, possibly of coffee-ground material, with other symptoms of dilatation of the stomach; the absence of free hydrochloric acid in the gastric contents and the presence of lactic acid and the Oppler-Boas bacillus; tumor or tenderness in the epigastric region.
DIAGNOSIS: The gutter of the spine is soft and lumpy with tenderness. It is cold to the touch in advanced cases and there is subluxation at S.P. By palpation of the lump or irregularity of the contour of outline of the surface.
Owing to stenosis of the pylorus, the stomach is dilated in two-thirds of cases. The absence of hydrochloric acid. The differentiation between ulcer and cancer can be said to be as follows: Cancer: Rare before forty. Severe anemia and cachexia. Pain dull, not much influenced by eating. Vomiting delayed. Hemorrhages small and of characteristic “coffee-ground” appearance; tarry stools rare. Hydrochloric acid diminished or absent; lactic acid, and Oppler-Boas bacillus in gastric contents.
While in Ulcer, it may occur in the young. Chlorosis often present. Pain sharp, stabbing, or burning, localized in epigastrium and back; occurs soon after eating. Vomiting occurs soon after eating. Hemorrhages profuse; blood bright red, tarry stools. Hyperacidity. Lactic acid and Oppler-Boas bacillus absent.
Further help can be had by fluoroscopic examination as to the form, size and position of the stomach.
PROGNOSIS: The prognosis is grave. There have been reported what is known as five year cures. But up to the time of writing this the writer has not been able to substantiate some claims made of absolute cures. No reliable statistics are available that can be thoroughly investigated and substantiated by Drugless therapy procedures.
TREATMENT: The chief plan of treatment is to give relief and delay the fatality as long as possible. The dietary phase then claims the largest part of the treatment.
NEUROPATHY: Holding the fingers in the gutter of the spine until the vaso-constrictors and dilators show some response. A light lymphatic of the liver.
HERBOLOGY: The stages of this terrible disease of the blood need diagnosing by a specialist and proper progressive treatment given.
However, one can improve the general health and purity of the blood by taking the following: Fluid extract each of Yellow Dock, Burdock, Barberry, Agrimony one-half ounce; Fluid Extract Blood Root 2 dr.; Tincture of Capsicum 1 dr.; Camphor water 8 oz. Teaspoonful three times daily after meals.
Poultices of Scraped Carrots or Mashed Cranberries can be recommended. Or, Fresh Common Daisy 2 oz.; Lobelia Herb ½ oz. Boil in a little water and place some of the herb between muslin and apply, keeping the poultice wet with the liquid. Renew every six hours. Bathe often with half ounce each of Tinctures of Myrrh, Blood Root and Celandine in a gill of water. This can, if desired be used in with the poultice.
This is a simple but good remedy: Take 1 oz. of Narrow Dock leaves to a pint of boiling water; simmer to half pint, add dessertspoonful of pure honey. Take half teaspoonful three or four times a day.

ETIOLOGY: Age and local irritations seem to be the main factors. They are superficial, deep seated or papillomatous.
The first type begins usually as a firm wax like red-yellow papule, in time it becomes scaly and this is followed by loss of substance, soon followed by a brown crust. In time this is converted into an ulcer, exuding a discharge of greenish substance containing pus and blood. It is not painful. It may not spread, or it may spread and involve all the tissues of the part. Usually appearing on the face and if spreading may destroy the nose, eyes or the cranial bones.
The deep seated variety is much on the order of the superficial except there is a tubercle or lump and the ultimate ulcer is deep, causing pain and causes enlargement of the neighboring glands.
The papilomatous variety may begin as a wart, or from one of the other varieties mentioned above.
It is characterized by an ulcerated surface from which springs an aggregation of large, highly vascular papillae. Between the papillae there are often deep-seated fissures from which exudes an offensive viscid discharge. The general health is impaired and the neighboring glands are enlarged.
The above differ from lupus vulgaris in that lupus begins in the y oung, and there is more than one center, which are not hard but soft, and the discharge from the ulcer is slow and scanty and bones are never involved.
PROGNOSIS: Should be guarded in the type of epitheliomatous ulcer that eats away adjacent tissues and bones, known as rodent ulcer, and also guarded in the deep seated epitheliomas. Other types the prognosis is favorable and often a complete cure is effected.
TREATMENT: The general treatment for growths of this nature is by electrodesiccation, electro coagulation, X-rays, radium or excision by surgery, ointments of various types. Poultice of mashed grapes has been reported helpful. The Cabasil products have been reported as excellent for conditions of this nature.
The general health condition of the patient must be looked into. The thyroid gland, and all phases of respiration should be carefully examined. Many of these patients are anoxemic, and anemic, and show a sharp tendency toward alkalosis a big part of the time. Appropriate treatment then can be instituted for building up the general health of the patient.

DEFINITION: A hard, circumscribed, deep seated, painful inflammation of the subcutaneous tissue, accompanied by chill, fever, and constitutional disturbances, suppuration and the formation of a slough.
ETIOLOGY: A lowered vitality from any cause predisposes to this affection. It is especially common in diabetes. Microbic infection is the exciting cause.
SYMPTOMS: It is characterized by a painful node at first covered by a tight, reddened skin which later becomes thin and perforates, discharging pus through several openings. Most commonly found on nape of neck, on back, or on buttocks. There is at first a chill, followed by a febrile movement, which is generally well marked, and very severe. The lymphatics in the surrounding area, are all involved.
DIAGNOSES: Carbuncle is especially dangerous when located on the scalp, abdomen, and upper lip; in these locations it usually runs an acute course and may be fatal from pyemia. The prognosis is grave when extensive and attacking the elderly, especially if complicated with Bright’s disease or diabetes. The prognosis should always be guarded, even in the most hopeful cases. Death is not infrequent in the old and debilitated because of the development of thrombi and emboli.
TREATMENT: This is an unusual problem. For each carbuncle is a serious problem in itself. No set rule of thumb exists by which all can be treated, and not many conditions are found that require more care and judgment as to whether the process is a local and stationary one or spreading upon, or underneath the tissues. Very little literature is extant by drugless physicians. It is skipped over generally as a problem of surgery or blunt statements are made that certain adjustments will relieve the condition or a fast will break it all up. The above are helpful but the fact still remains that no one method of treatment is sufficient for relief of all cases. Each case is a peculiar problem. The treatment must be local and constitutional and at any time may require the services of a surgeon.
NEUROPATHY: A complete treatment of the lymphatic system, and release of the vasodilators.
CHIROPRACTIC: Local, S.P. and K.P.
ELECTROTHERAPY: Infra-red directed by a small funnel at the mass and held for three minute intervals, with a three minute wait each time for five consecutive times daily has been helpful. Dry fomentations of any nature are applicable. Hot dry towels. Hot water bag, etc. Surgery of any nature should only be performed after very serious consultation and with but three objects in mind. The relief of tension when it has become unbearable; the removal of dead tissue, and the prevention of the spreading of the infection. The writer has seen some results of surgical interference that raised the question “was it necessary or even worth while?” X-rays have many advocates. Biers hyperemia is also suggested. The writer has used the small suction cup with good effect in a few cases. Short wave diathermy seems to have the endorsement of most writers on this condition.
COLONTHERAPY: Colonic irrigations twice a week or daily enemas of hot water will aid in keeping a free and clean colon. The Cabasil products have been highly recommended for this condition.
DIET: This is of great importance but no general rule can be laid down. It is according to the blood and urine test reports. Yet it can be said that all rich pastries, spices, fatty foods, fried foods, warmed over foods, should be omitted from the diet, and alcohol should be forbidden.
MEDICAL PROCEDURE: General tonics like quinine and iron. Opium or other anodynes to relieve pain. Human and animal serums. Autogenous vaccines. Ichthyol, applied pure so as to cover the entire swelling, a new application each day. Sulphur in minute doses and sulphur baths are recommended. Liver diet is suggested when there is secondary Anemia. Some suggest that it is possible to transform chronic inflammatory processes into acute forms and hasten the healing of these by feeding the patient on a meat and oatmeal diet that contains a minimum of two and a half drams of sodium chloride daily, that the acidosis produced tends to make lesions flare up and this induces healing. Surgery, cautery, etc., are included in a host of other remedies that the medical profession individually or collectively advocate for this serious ailment.
HERBOLOGY: Constant bathing of the part with hottest water bearable allays pain and is essential in assisting the carbuncle to burst. Take internally: 1 ounce of Fluid Ext. of Yellow Dock, 1 ounce Fluid Ext. of Burdock and two drams of Fluid Ext. of Mandrake. Fullers earth when sore opens. One physician reports 120 F.M. as very effective for douching the slough, 20 drops to 30 drops of water.

DEFINITION: Mental and motor inertia, in which the person will remain in the same position for short or long periods of time, also called sleeping sickness.
ETIOLOGY: A syndrome from impairment of the carotid sinus in which the contents of the carotid sinus collapses creating anemia and anoxia of the brain. There is also a form called “Grippal Catalepsy” understood to follow influenza and LaGrippe. It may occur from extreme hysteria, hypnosis and psychosis especially of dementia praecox.
Certain drugs like morphine, poisons, like lead and alcohol, Microorganisms, disorder of the glands, Auto intoxications, influenza and cranial tumors have been found as contributory to attacks of catalepsy. Up to the present time reports are that previous attacks of influenza account for between forty and fifty per cent of catalepsy cases.
TYPES: There is the mild and severe type. The limp and the firm type. The mild type is when the attack of catalepsy is over anywhere from one minute to half an hour. Recently a young man was in the office, and while telling the history of his headaches, suddenly became rigid, and sat stiff in the chair staring into space. The attack lasted about five minutes, then, when he came to consciousness he had no recollection whatever of what he had been talking about for some few minutes. During this spell the pulse and repiration were not in any way impaired.
In the severe types the rigidity may last from one hour into days and months. In some cases of mild and severe types the muscular system is not rigid but limp, and the body can be moved in any direction. These limp types are considered as “incomplete catalepsy.”
SYMPTOMS: In the mild type there is a sudden onset, and the person will stand or sit still for a short period of time, then, they will awaken, with sighs and a dazed expression, as if awakening from a deep, long sleep.
In the severe type which is considered as “complete’ the onset may be sudden, or may be preceded by headache. The patient may be believed dead; for not only are the limbs inert, the eyes staring or half-closed and the pupils dilated, with drooping jaw, and the skin cold and pale; but their respiratory movements cease, the pulse is impalpable, and swallowing is not effected. Only the heart can be felt to beat faintly, for even the reflexes may be entirely suppressed; although most observers find the corneal reflex; and the rectal temperature approximates normal, and the patient may stay in that condition until she dies. Some victims have slept from two weeks to many months. The attacks may be grouped close together, with long periods of freedom, or there may only be one in a lifetime.
DIAGNOSIS: A method of differentiating the hysterical, and psychotic from the true catalepsy is as follows: A heavy weight is attached to the hand horizontally, in true catalepsy the hand falls slowly to its full length, while in false, the resistance of the patient to keep the arm in the horizontal position and when fatigue of the arm takes place, spasms of the arm follow.
TREATMENT: Catalepsy is only a symptom of some underlying disease. Malnutrition, Auto-intoxication, enervation, signs of infection, meningitis, tumor and other conditions that impair health, need to be investigated and when found treated as the primary cause. Look at the neck, and toe nail and find out which side of the brain is mostly affected. The side of the neck which shows the largest expansion is the best criterion for it reveals a carotid sinus syndrome. This condition then is closely related to epilepsy, and if any symptoms of epilepsy are found, the treatment then is found under that title.
In the paroxysm it is well to unload the bowels by giving a high enema of clear, warm water. Stimulation of the gutter of the spine by friction with the fingers; hot towels to the spine, or a mustard plaster to the nape of the neck may arouse the patient.
Chiropractic treatment of all cervicals and kidney place may be given. Nasal stimulants, such as ammonia may be used to advantage. When the cause is found, then the general treatment can be given as indicated. A general health building program of diet and exercise is always in order.

DEFINITION: Chlorosis is a form of anemia occurring in young girls about the time of puberty, and is characterized by a reduction of hemoglobin out of proportion to the number of red blood cells.
ETIOLOGY: The essential cause of the disease is unknown, but the evidence favors the view that the blood-making function is impaired in consequence of some disturbance in the ovaries. Chlorosis occurs exclusively in females, and develops between the fifteenth and twenty-fourth years.
It can be said to be an iron and oxygen deficiency in the blood.
SYMPTOMS: In addition to the general symptoms of anemia, the conspicuous features are a greenish hue of the skin; pallor and weakness without marked loss of flesh; dyspepsia with perversion of appetite; menstrual disorders, especially amenorrhea; and a tendency to hysteric outbreaks. The blood changes are chacteristic. The number of red cells is moderately reduced (not often below 3,500,000); the hemoglobin, on the other hand, is greatly reduced, usually below 50%. There is no leukocytosis.
DIAGNOSIS: The tests for iron deficiencies are so well known that it is unnecessary to repeat them here.
TREATMENT: The treatment follows much along the outline of Anemia (of which see).
NEUROPATHY: General lymphatic and stimulative techniques of the whole spine.
CHIROPRACTIC: C-1, D-7 and L. region.
DIET: Many of these patients have been freak eaters, refusing to eat eggs, meats and vegetables. Some getting along only on toast and tea or coffee or some kind of soda fountain drinks. A diet deficient in iron continued until it has become a habit is hard to overcome. But the physician must insist upon it. Whatever may be the fault in the diet must be overcome. The writer tries the No. 1 and 2 diet as a test before making either one a standard for some length of time. Honey added to the meal, or in water is an excellent builder.
VITAMINOTHERAPY: A, B, C, D, G may be considered and oxygen therapy.
ENDO-NASAL THERAPY: Same as under Anemia.
ELECTROTHERAPY: Ultra violet ray, starting with five minutes for the first treatment, then giving an extra two minutes at each sitting, if treatments are given twice or three times a week, until twenty minutes of exposure is reached.
The patient should be on a revolving stool so that all parts of the body can feel the exposure.
HERBOLOGY: Black Walnut Leaves made into a tea, used with meals, and between meals. A small handful of dried leaves to a pint of boiling water. As with all herbs, those over a year old are worthless.
EXERCISES: Moderate exercises are of great benefit. The writer advises his patients to join a hiking club. Those who do so generally pick up very quickly.

DEFINITION: St. Vitus’ Dance. Involuntary spasmodic muscular twitchings of a neurotic origin.
This condition is also known as Sydenham’s Chorea.
ETIOLOGY: This is essentially a disease of the young from five to fifteen years of age. The great fundamental cause is rheumatism. It is always more or less associated with it in the form of inflammatory rheumatism. The immediate attack, however, may not be preceded by rheumatism. There may be growing pains, tonsillitis, rheumatic endocarditis, but the rheumatism sooner or later manifests itself. Heredity, reflex conditions, dentition, fright and worms are said to play some part in it.
It seems to attack the high-strung, mentally alert children, while the dull, stupid and well-built child is immune.
The hyperthyroid type of child is more susceptible than the hypothyroid.
It sometimes occurs during or after pregnancy, and in the very aged.
VARIETIES: 1. Acute (St. Vitus’ Dance). This disease occurs chiefly in children, usually lasts from six to ten weeks, is prone to recur, and is frequently complicated by endocarditis. A severe form occurring chiefly in women during pregnancy and characterized by violent movements, fever and delirium, is known as chorea insapiens.
2. Huntingdon’s Chorea. This affection occurs in adult life and is hereditary. The movements in time become general involving the muscles of speech and deglutition, and are associated with a progressive mental deterioration. This disease is usually hereditary; it rarely develops before the age of thirty; it runs a chronic course; and it is characterized by slower and more incoordinate movements than occur in acute chorea, by progressive mental failure, and by a marked suicidal tendency.
3. Cerebral Diplegia and Hemiplegia. Choreiform movements are frequently observed in the cerebral paralysis of children and occasionally they occur in adults on the paralyzed side after cerebral apoplexy.
4. Senile Chorea. Occasionally aged persons with arteriosclerosis and degenerative changes in the brain become subject to chorea.
CHOREA INSAPIENS: This form occurs chiefly in adults and most frequently in pregnancy. The movements are very violent, almost constant, and in many cases associated with delirium and fever. Death sometimes results from exhaustion.
DIAGNOSIS: The recognition of chorea is rarely attended with difficulty. In habit spasm or tic the movements are coordinated, purposeful, more localized and partly or completely under the patient’s will.
SYMPTOMS: An attack usually comes on gradually with spasmodic twitching of the muscles of the hands or face. This increases in intensity until all control of the muscles of expression are lost. The eyelids close spasmodically and the facial muscles jerk. Speech is often indistinct and mumbling. Swallowing is sometimes difficult. The hands are in constant motion, and objects on being taken up by the hands are dropped. The gait is stumbling. Usually only one side is affected, later both. The person is peevish and fretful and is subject to sleeplessness and unpleasant dreams. The appetite is poor, patient is constipated and anemic, and there is a gradual loss of weight.
PROGNOSIS: This is good. Even under the worst conditions the tendency is to recover after a long period. Those who have recurrences of attacks may in time show neurotic or psychotic tendencies of a mild form in after years. Death only occurs where there is a severe exhaustion in the aged, or chorea insapiens, which also is rare, and when the jerkings are so violent as to cause mania, then death follows. The attacks may last from four weeks to one or two years, unless some method is found to abort it.
PATHOLOGY: Even today after all the years of research little is known about the morbid anatomy. Several things noticed at necropsy, are rheumatic endocarditis, brain hyperemia, and sometimes microscopic emboli, and hemorrhages scattered throughout the brain, and especially in the lenticular region.
TREATMENT: Physical and emotional quiet are imperative.
NEUROPATHIC: Sedation of the cervical segments especially. Then the dorsal segments.
CHIROPRACTIC: C 1, D 6, lumbar region.
SPONDYLOTHERAPY: Concussion at 10th dorsal for short periods each day. Some member of the family can be shown how to do it.
HYDROTHERAPY: Warm towels laid over the spine daily are of value.
VITAMINOTHERAPY: B, D, E and G with potassium, calcium and sulphur supplements may be considered.
ORIFICIAL THERAPY: Rectal dilations have been known to be helpful.
ELECTROTHERAPY: At the present time the author has found no form of practical electrotherapeutics for this condition because of the uneasiness of the patient. Short wave on spine has been recommended.
HERBOLOGY: One ounce each of Gentian, Peruvian bark, St. Johnswort, Skullcap, Valerian and Mistletoe boiled in 5 pints of water boiled down to 2 pints. Strain. Cut 3 large oranges, add to the tea, simmer again 10 minutes. Strain and add half pound sugar. Tablespoonful after each meal.
PSYCHIATRY: In view of the fact that this condition develops in the intelligent and ambitious youngster, school activities that involve contests of any description should be forbidden, and moderate study be insisted on. Dropping back a year is a small matter compared to the future welfare of the child. In fact, to take the child out of school entirely is the best thing that can happen as soon as any signs of chorea appear. A trip at the early stages to the country or seashore or to any new environment is always beneficial.
The parents must be cautioned against expressing too much sympathy for the child, lest they develop a false neurasthenia from which the child may grow up with mechanisms of self pity and the continual need of sympathy. See pages 49, 50 and 120 in “The Fundamentals of Applied Psychiatry,” Lake.
The child should be trained to spend as much time out-doors as possible under the watchful eyes especially when playing games or swimming, but should not be stopped unless the playing becomes violent and the swimming dangerous.
MASSAGE: Massage can be of a soothing nature by just rubbing the hands up and down the spine lightly, or by stretching the spine, also relaxing the muscles of the neck and shoulders and the affected muscles by heavy or light massage, judge which is of most benefit by the reacion of the patient.
DIET: In addition to a balanced diet a glass of milk in between meals is ample. For the cases that have complications of tapeworms and tonsillitis see treatments under those titles.

DEFINITION: A state of prolonged abnormal deep stupor, or unconsciousness, from which the patient can be aroused. Comas as produced by many conditions, some of which are as follows:
The temporary unconsciousness due to anoxia of the brain is termed a syncope. See Endo-Nasal book, page 50. In this the names of Catalepsy and Epilepsy are found. See treatments under those subjects.
The traumatic type is due to injury of which evidence can be found by bleeding from some part of head or face, with bruises.
Those due to organic brain disorders are usually the result of apoplexy, which may be recognized by a study of the history of arteriosclerosis and hypertension and also evidences of paralysis or stiffness on one side of the body.
Drug Comas may be from alcohol, opium poisoning, atropine, chloroform, cyanides, carbon monoxide, hyosine, phenols, treional, sulphonal, veronal, ether, etc.
In alcoholic poisoning the odor with the ability of the person to hear a shout will confirm the diagnosis.
Generally in drug poisoning the pupils are small, the respirations slow, and the temperature is low. The limbs are limp and show no signs of paralysis.
DIABETIC COMA: Occurring in diabetes, due to presence of diacetic acid in system and to acidosis. Paralysis not present. Symptoms are sweet breath, coma casts; showers of short granular casts may appear in urine when diabetic coma is threatened by acidosis. Hyperglycemia present and softening of eyeballs may occur.
UREMIC COMA: The result of disturbed kidney metabolism, causing autointoxication through the retention of unknown substances in the blood and producing acidosis. Seen in nephritis as a result of lack of elimination of kidney toxins. Symptoms are in general, respiration stertorous, face livid, skin dry, hard and rapid pulse, blood pressure raised, sphincters relaxed according to cause, urinous odor on breath, urine scanty and containing many casts and albumin.
Insulin coma is due to either an overdose of insulin or netlect to follow out the instructions given by the physician.
Infectious fever comas. The history of infection will give the diagnosis. Malaria is one of the chief causes.
Hysterical coma is much in the nature of a deep sleep from which the person can be aroused by painfully pinching some part of the body, or some other external stimuli. The history of previous hysterical attacks can aid in the diagnosis. Specific care of coma cases is according to the underlying cause. The general care may be as follows. The collar should be loosened. Cold compresses to head and hot ones to the spine and abdomen may be indicated. Stomach pump in case of poisoning indicated. Insulin injection for diabetic coma may be given unless the coma is due to too much insulin. Sugar may be administered if it can be taken. Urine should be examined for albumin, and dropsy looked for in pregnant women. In uremic coma, stimulate elimination. Lumbar puncture or bleeding may be necessary. Induce sweating. In hysteric coma no treatment is needed. The patient revives if ignored.
Riley recommends adjustment of C, 1, 4, D, 4, 6. Baths and rectal dilation.

ETIOLOGY: Cough may be induced by diseases of the pharynx, larynx, bronchi and lungs, catarrhal infections such as whooping cough, influenza, measles, typhoid fever, inhalations of dust, irritation of the nerves, especially those in relation with the vagus. It may be caused by an attack of hysteria.
DIAGNOSIS: Cough without expectoration is usually observed in those who have inflammatory conditions of the bronchi and lungs, in pleurisy and hysteria. Loose expectoration is especially noted in bronchitis, bronchiecstasis, pulmonary edema, pulmonary tuberculosis, also in pneumonia after the crisis; and in abscess of the lungs. A study of the expectoration will help to reveal the irritant.
TREATMENT: The specific treatment is of the underlying cause. The general treatment for severe paroxysmal coughing may be:
NEUROPATHY: Dilation treatment of the cough center in the medulla oblongata, the phrenic nerve, or the vagus nerve or all. Segments are D 3 to 8.
CHIROPRACTIC: Lower cervicals, D 5, for throat cough. Bronchial cough, D 1 and 2. Lung, D 3.
SPONDYLOTHERAPY: Concuss D 7.
Counter-irritation by a mustard plaster to breast and back is often sufficient to control cough.
If cough is from the ear, and persistent, the ear may be flushed with warm water, or if by a foreign body in the ear, it can be removed. Examination of the ear should always be made in children.
ENDO-NASAL THERAPY of the nose, throat, and pharyngeal cavity are often effective in easing the cough. See technique on raising tongue.
ELECTROTHERAPY: Short wave is of value in loosening mucous in dry coughing. Infra-red for abscess in ear. See under title of Ear in this book.
DIET AND VITAMINOTHERAPY are given according to the underlying cause.
HYDROTHERAPY: Neck and chest hot compresses are recommended. But the writer had a few cases that had to be suppressed for a time by cold compresses.
HERBOLOGY: Make a tea of Cheestnut Leaves for spasmodic coughs; Thstle tea for Winter coughs. General cough, take equal parts of Boneset, Pennyroyal, Mullein, Chestnut Leaves, Catnip, Hops, Mouse Ear, Wintergreen, Peppermint, Bloodroot and Coltsfoot, and make a tea. Some every few hours. Another good remedy is to take Wild Cherry Bark, boil down, strain, mix with honey. A tea, strong, made of only Boneset is good. Another remedy is a tablespoonful each of Mullein Leaves, Horehound, Elecampane and a teacup of cane sugar. Put in a quart of water, boil down to a pint. Tablespoonful when needed.
The writer has found a mixture of equal amounts of honey and lemon, taking a teaspoonful every half hour, to be very soothing. The treatment of habit or hysterical coughing is due to tensions. See “Hysteria” in “The Fundamentals of Applied Psychiatry,” Lake.
STRAPPING: If cough causes pain on the sides of the body semi-circular adhesive strapping is in order. If pain in the abdomen, a full circular binding for support of the muscles is of benefit.

DEFINITION: Convulsions are involuntary muscular contractions, interrupted or long-continued; resulting from excessive irritation of the motor centers. Interrupted contractions, occurring in rapid succession are termed “clonic” and long-continued contractions are termed “tonic.”
ETIOLOGY: The etiology may be said to follow the outline of the classification of the types of convulsions. The types may be outlined as follows: Terminal convulsions, of young infants. Just before death they develop twitching of the extremities and rolling of the eyes. The cause is attributed to malnutrition. This type is tonic.
In the toxic, the convulsions are generally attributed to poisons of a chemical or bacterial nature and usually occur when the temperature is very high. Other types may also occur during high fever. This type is clonic.
The convulsions due to intracranial perversions are from injury and are tonic, such as cerebral concussion, or skull fracture. Other forms may be from meningeal irritation, meningitis and encephalitis. Intercranial hemorrhage, and tumors of the brain are causes of convulsions.
Epileptic convulsions are clonic and may be included in this classification, but is a separate identity which is treated under an individual article elsewhere in this book.
Tetany is a motor neurosis, or “spasmophile diathesis.” The spasms or convulsions, appear suddenly, are occasionally preceded by sensory, or constitutional disturbances; they may last several hours, or even days, to reappear after remissions of equal length, and are often accompanied by alterations of sensibility in the affected limbs, without loss of consciousness. It is far from common, yet not rare.
Hysterical convulsions may come at any age, and are due to tensions of some nature from which the person finds a way of escape from the tensions or some embarrassing situation. These may be tonic or clonic as it suits the hysterical person. There is often an initial scream, which differs in quality from that of epilepsy, and which usually is not given until the patient is aware that she (usually a female) has an audience. The patient then falls to the ground in a way that she will not be hurt. Engorgement of veins about the head is frequently noted, and more or less active tonic spasm is present. After this follows a condition of relaxation with wild quasi-purposeful movements of the arms; broken short sentences, explosions of passion and profanity, weeping, laughing and grinding of the teeth often follow. The larger and more sympathetic the audience, the more varied and emotional will be the manifestations.
SYMPTOMS: Each type of convulsion has some symptoms that are peculiar yet through them all certain general symptoms are recognized with a few exceptions. Paroxysms of involuntary muscular contractions and relaxations generally in children. Tonic spasms in which the contractions are maintained for a time, as in tetany, distinguished from clonic spasms as in epilepsy. Tetanus and hydrophobia are easily distinguished and for the most part involve a small portion of the voluntary musculature. On the contrary, strychnine poisoning involves the entire body usually as do convulsions. The word is accurately applied to unilateral attacks as seen in Jacksonian epilepsy and less likely, in hysteria. When a convulsion occurs it usually is accompanied by unconsciousness and may properly be called epileptiform. This is not the case in strychnine poisoning, hysteria or in Jacksonian attacks until the second side is involved.
Other types of involuntary muscular activity must be differentiated. Chills or rigors are fine or coarse, diffuse, trembling, easily distinguished because of the sense of cold. More or less generalized tremors though due to many factors have in common their rythmicity and failure to accomplish gross movement of the part. Tics are localized motor contractions of a spasmodic nature simulating a purposive movement.
TREATMENT: Usually, the attack of convulsions is over before the physician arrives. But, even if the physician is present, the course of the attack is not influenced much. For ages past, it has been the custom to dip children with convulsions into warm water first, then into cold water this brings about quicker respiration. This is harmless, but not very good when fever is present.
If the cause is undetermined, keep the patient from injuring self. Soft pad between the teeth to avoid biting tongue or cheeks. Warm bath, with cold to head; if fever is present, tepid or cold bath. After care—Rest in bed, absolute quiet, careful diagnosis without unduly disturbing the patient; then the specific treatment must be according to the diagnosis of the underlying cause. It can be said that in practically all cases of spasms or convulsions there is a severe deficiency of Vitamin D and calcium.

DEFINITION AND ETIOLOGY: Spasm of the vocal cords, caused by catarrh of the larynx. Also known as catarrhal laryngitis. It is one of the most common diseases of early childhood, occurring most frequently in the changeable weather of spring and fall. It is said that ninety-three per cent of the cases occur during or before the fifth year, but the general ages are between two and eight years. Enlarged tonsils and adenoids may be contributing causes.
SYMPTOMS: In most cases the child has a slight cough and becomes hoarse during the day and perhaps has some fever. Late in the evening the cough becomes loud, dry, and hoarse, its characteristics being peculiar and distinctive. In the great majority of cases this occurs between the hours of 9 and 12. The child wakes suddenly with a barking cough and begins to struggle for breath. He frequently becomes alarmed at his inability to breathe, and his fright adds to the severity of the symptoms. In attacks of ordinary severity the respiration is loud and noisy; the voice is hoarse, but rarely lost; the dypsnea is sometimes extreme and the respiration so noisy it can be heard in an adjoining room. The temperature is usually somewhat elevated, but rarely reaches 102 degrees. The lips and nails frequently assume a purplish hue, but are rarely cyanotic. There is often a discharge from the nose, and the eyes are sometimes congested and watery. After two or three hours the symptoms usually subside. Occasionally they appear in less severe form later in the night, but, as a rule, all urgency is passed by early morning. In some instances the child is almost as well as usual during the following forenoon, but the following night there is a return of the attack, which may not be as severe as the first, and this may continue each night for some time. The night attacks are the rule, because of the horizontal position of the child, which tends to congest the membranes of the nose and respiratory tract, forcing mouth breathing, and the inspiration of dry, cold air, which produces a dry, tickling throat.
DIAGNOSIS: The common type can be recognized by the attack coming at the early hours of the night, the quick development of characteristic symptoms of loud, metallic, cough, the moist respiration, the frightened appearance of the child, and the rapidity with which the attack subsides.
In all cases the physician should examine the larynx, to make sure there is no diphtheria, or what may be termed Membranous or Pseudomembranous Croup. Hoarseness and dypsnea develop gradually, and the latter is not intermittent. False membrane may be seen in the throat or may be coughed up. The constitutional symptoms are more severe.
LARYNGISMUS STRIDULUS: This is a pure neurosis, and is often associated with rickets. The paroxysms resemble those of false croup, but are associated with a peculiar crowing inspiration, and lack catarrhal symptoms, such as hoarseness and cough.
PROGNOSIS: Ordinary types of catarrhal croup are never fatal. In very rare instances in which the catarrhal element predominates and is very severe, the prognosis may be grave. In other words, catarrhal croup is rarely or never fatal, while severe catarrhal laryngitis with spasm may be dangerous.
TREATMENT: To aid in relief of severe spasm, concussion of the cervicals 4 and 7 is very effective. Compresses of hot towels over the throat and chest will do much to relax the spasm. Hot camphorated oil is also very helpful. Hot, wet flannel is wrapped around the neck after the neck has been rubbed with one part turpentine to three parts of olive oil. General care and office treatments of the child. Exercise in the open air is vital. But, the child must be properly clothed. Wild running and loud talking and screaming are very harmful.
NEUROPATHY: A lymphatic treatment especially of the liver, axillary and cervical regions. A quieting treatment of the whole spine from cervicals to sacrum.
CHIROPRACTIC: C region and D 5 are specific.
Vacuum Therapy over the dorsals and to each side is of great benefit in aiding circulation.
ELECTROTHERAPY: Short wave on throat and chest, also Ultra Violet Ray.
DIET: Many of these cases are anemic, and need not only a good nutritious diet, but also some supplementary food such as thiamin. A balanced list of foods can be taken from Diets Nos. 1 and 2, supplemented by plenty of fruit between meals.
VITAMINS: B, D and others, according to the clinical findings.
COLONOTHERAPY: It is best not to start a child on enemas, unless absolutely necessary. Lax may be given, but not even those, unless “habit time” seems impossible. Unnecessary colon flushings in children sometimes starts a lifetime struggle with a laziness of the bowel that is difficult to overcome, and may lead to a form of neurasthenia, especially fear of poisoning from the bowel, and become a lifetime addict to colonotherapy or all kinds of physics sold in drug stores. Of course, in fevers of any degree, enemas may be necessary But, establishing “habit time” should be the physician’s aim with children, aided by the exercise a normal child usually obtains at play.
HERBOLOGY: Fresh pineapple juice is A-1 for this illness. Balsam copaiba 20 to 30 drops three times a day. Black Snake Root, made into a tea and sweetened to taste is good.

DEFINITION: Inflammation of the urinary bladder, involving one or more of its four coats.
ETIOLOGY: It is brought on by invasion of bacteria or microorganisms from above or below the bladder. Among them are found the Bacterium coli communis, streptococcus, Bacillus tuberculosis, gonococcus, and Bacillus typhosus. These bacteria gain entrance to the bladder in one or more of four ways, to wit: through the urethra, the blood or lymph channels, the kidneys, and the wall of the bladder. The inflammation thus produced by these germs is aggravated by the ammoniacal fermentation of the urine which the bacteria bring about. This fermentation is due to the decomposing action of microbes upon urea, with the resulting formation of ammonium carbonate. This fermentation is the result, and not the cause of cystitis.
It is also possible that many cases are produced by chemicals of various kinds, retention of urine, abnormalities of the urine, foreign bodies in the bladder, traumatism and neoplasms.
SYMPTOMS: In the acute form there is an urgency, and frequency to urinate, and the amount is small each time. There is pain over the bladder in the suprapubic regions. Temperature at the onset may be as high as 103 and the pulse is accelerated. Pyuria, or pus, is always present. The urine is of a blood or smoky color and strongly acid, or shortly turning to strongly alkaline, due to ammoniacal decomposition, and then there is burning. It contains albumin relative to the amount of blood and pus present. Sediment is abundant, consisting of blood-corpuscles, pus and various forms of epithelium.
SYMPTOMS OF CHRONIC CYSTITIS: In this type the symptoms continue the severity of the acute condition. The urine is only moderately diminished, or it may be of large quantity but never satisfactory; generally pale, but may be normal in color, or very slightly tinted with blood. The freshly passed urine is generally turbid, due to the presence of pus, epithelium, and bacteria. The reaction is frequently alkaline, but may be acid; specific gravity varies between 1012 and 1020. The sediment is abundant, consisting chiefly of pus, small round cells, epithelium, and usually a small (sometimes considerable) amount of blood. If the urine be alkaline (ammoniacal), the sediment contains also amorphous phosphates, triple phosphate crystals, and often crystals of ammonium urate.
While pain is not as great as in the acute form, there is a continuous discomfort in the suprapubic region, the bladder never seems to be satisfactorily emptied, although large amounts may be voided. A moderate rise in temperature is noticed.
DIAGNOSIS: The four factors that can establish the diagnosis, in chronic cystitis, are, (1) Low grade febrile reactions. (2) Frequency of micturition, (3) Dysuria, constant desire to urinate, burning of urine and (4) pyuria or pus and some blood. In the male, prostatitis or vesculitis can be distinguished by manual examination.
After the acute stage has passed a thorough general physical examination with detailed history of the patient can be made, including history of habits, etc., which may reveal injuries, alcoholism, nervous tensions, and abuses of various types. Bacteriological study of the urine will reveal the presence of infection. While cystoscopic examination will reveal the extent of the inflammation.
TREATMENT: Acute Cystitis. It is best for the patient to stay in bed for a few days. Plenty of water to drink, preferably hot, unless there is severe retention. Hot compresses to the suprapubic and lumbar region. Sitz bath, if there is any signs of retention. Hot colonic irrigations. If there is high acidity, alkaline liquids can be given, but as soon as the urine is alkaline, all alkaline diuretics should be stopped. If retention of urine becomes severe a catheter is used as a last resort. (See under title of “Retention”.)
Neuropathic dilation of the bladder segments can be given to release the motor constriction to the sphincters.
Chiropractic Adjustments of a mild nature may be given to D. 10 and L. 1. Mild rectal dilations, or massage are also indicated. If the physician has a portable short wave machine, it will be of great benefit at the bedside, applied directly over the bladder.
TREATMENT: Chronic Cystitis: Here the physician can make a complete examination and find the underlying cause and treat the cause and symptoms. In many cases the symptoms persist long after the original cause is removed, and the person may become accustomed to the symptoms, and bear this condition indefinitely. But, by persistent treatment, the majority of these cases can be made well again. An outline of treatment for the chronic condition may be as follows:
NEUROPATHY: A thorough lymphatic of the lymph system. Dilation of the spinal segments of the spinal cord controlling the bladder. See chart.
Chiropractic Adjustments of D. 10.
SPONDYLOTHERAPY: Light pressure on sacrals 2 to 5; or light tapping with fingers. Rectal dilations for a minute or two in every direction, with finger, not instruments, lest the tissues be irritated.
HYDROTHERAPY: Irrigations of the bladder. The writer is of the opinion, however, that catherization and irrigation of the bladder should not be used unless absolutely necessary, and if done at all it should be by an expert in that form of therapy, and the first attempt should be with a four or five per cent solution of warm, boric acid. For the female, hot vaginal douches daily are very effective. Hot sitz baths once or twice a day, or hot spray over the bladder, and lower spine from a bath tub spray are par-excellent.
DIET: A change from No. 1 to No. 2. Diets on alternate days for a few weeks will help keep the acid base balance of the urine, or the physician can select foods from the Acid-alkaline charts in this book.
VITAMINOTHERAPY: Vitamin A is the specific to be given in large doses. In addition, Cod Liver oil with vitamins B and D have been found to be of excellent benefit.
ELECTROTHERAPY: Fever therapy of various kinds have been recommended. Short Wave and Diathermy are also recommended. Infra-red for ten to twenty minutes over the bladder is very helpful.
COLONOTHERAPY: If the movement of the bowels is not normal, a few, hot, high colonic irrigations are in order, followed by low enemas until regularity is established, then all forms of colon therapy should be discontinued.
STRAPPING: If there is an abdominal ptosis a belt or some kind of a support should be worn.
GENERAL SUGGESTIONS: Patient should not use alcoholic beverages, nor eat spices or condiments, lest more irritation be set up. Patient should also be instructed to have regular hours for retiring at night.
HERBOLOGY: Mix 3 parts each of Cleavers, Uva Ursi; 2 parts each of Marshmallow, Couch Grass, Sanicle, and one part of Ginger. If there is constipation put in a little Senna. Steep a heaping teaspoonful in a cup of boiling water for 20 minutes A cupful or two during day. The pods and hulls of the common bean made into a tea and used freely is considered good.

DEFINITION: Morbid frequency of liquid bowel evacuation.
ETIOLOGY: Loss of vaso constrictor control, due to irritation or inflammation of the mucous membrane. The irritations may come from many sources. Excessive water drinking has been known to cause it. Faulty diets with excess of certain foods, such as fats, fruits, and certain coarse vegetables. It may also result from inflammation of the intestines, enteritis, ileocolitis, dysentery, (inflammatory diarrhea). It is a symptom of certain infectious diseases, such as typhoid fever and cholera (symptomatic diarrhea). It may be excited by cathartic drugs. It often occurs as a final symptom in cachectic states, as in cancer, diabetes, and chronic renal disease (colliquative diarrhea). It sometimes marks the crisis of acute infections, such as typhus fever and pneumonia. It may also result from certain nervous influences; emotional excitement, Graves’ disease, neurasthenia.
Infantile diarrhea is a serious matter. It is said that in the first two years of life, diarrheal conditions cause more deaths than any other classified disease or group of diseases. It is usually termed Infantile Gastroenteritis. But, in the summer time, it is designated as Summer Diarrhea. There is another term Cholera Infantum, which designated a heavy, watery type of diarrhea. Dysentery is included as a term of diarrhea when the stool contains blood. See under that title. In infants and children, improper feeding, spoiled fruit, or other food stuff, Toxic foods, such as impure milk, etc., may be the factors.
SYMPTOMS: In infants and children, there is usually a rise in temperature. Skin is dry, great thirst is evident, some pain, or great pain, according to the cause, and there may be vomiting, with increasing frequency of watery stools.
TREATMENT: Of infants or children. If possible breast feeding is the best way to raise an infant, but if not possible then the artificial feeding must be regulated by the proper amount and not overfeeding and perfect cleanliness of the methods of feeding the child, in an effort to prevent the child from becoming ill. Clothing is no small item in this respect. Some times the clothing is too heavy, preventing proper heat-radiation and also muscular activity. The actual treatment of the infant or child may begin by giving as much water by spoonful as the child will take. Vomiting does not need to stop the giving of fluids. The fluid given can be barley water, sweetened with saccharin, or some very weak tea. The fluids may be given at from two to three ounces per pound of body weight every twenty-four hours. Food should be withheld for some period of time. Low enemas may be carefully given.
Enemas are also in order when there is vomiting and temperature is high. Several may be needed to bring the temperature to normal.
NEUROPATHY: Sedation treatment of the 4th to 10th Dorsals, and inhibition treatments to the lumbar segments of the spinal cord. Heat of some nature may be applied to the abdomen for pain.
CHIROPRACTIC: Adjustments to fit the age of the patient. D 5-10, L 1, 2, 3.
VITAMINS “K” IN Bile Salts if blood is present in stools. Nicotinic Acid and Vitamin C may be considered in proper dosage, as beneficial. A small teaspoonful of table salt or sodium bicarbonate dissolved in a glass of water, and fed by teaspoonful may stop the vomiting. The above may be all that is necessary in mild cases.
An apple diet is recommended and is often helpful for the treatment of diarrheal conditions in infants and children and the treatment is as outlined: Only ripe and mellow apples are utilized. When the fruit has been peeled and cored, it is grated and the child is given from 1 to 3 pounds (500 to 1500 Gms) daily of this pulp, or from 3 1/3 to 10 ounces (100 to 400 gm) per feeding. After two days, a transitional diet containing neither milk nor vegetables is given, following which the patient may again be placed on a mixed diet.
HERBOLOGY: Half ounce each of Tormentil, Bayberry, Ginger. Boil two heaping teaspoonfuls in a cup of water for 30 minutes. Strain. Add ½ oz. tincture Catechu. Teaspoonful after each liquid movement. Diarrhea should not be checked too rapidly—rather remove the cause. After diarrhea has ceased then give a teaspoonful three times daily after meals of the tea made from half ounce each of Tincture Gentian, Tincture Columbo, quarter ounce of Tincture Ginger and 8 oz. of Cinnamon Water.
A mild astringent, carminative, having laxative and emollient properties is to make a tea of the following: Wild Alum Root, Prairie Plant, Buckthorn, Indian Sage, Fennel Seed, Flax Seed, Cheese Plant and Marshmallow Root.
A tea made only of Blackberry Root is a favorite with some.
An old German recipe is to take a handful of Pepper Grass and steep it in a pint of boiling water. Teacupful with each meal or after the meal.

TREATMENT: Find the cause and treat specifically. Go back to Etiology again. The general treatment may be as follows:
DIETARY: All food should be eliminated for about twelve to twenty-four hours.
NEUROPATHY: Sedation of the 4th to 10th Dorsals. Inhibition of the 1st, 2nd and 3rd lumbars.
CHIROPRACTIC: It may be that adjustments are required on L. P. S. P. K. P. L. P. according to the organs mainly involved.
COLONOTHERAPY: The hot enema, or flushings are in daily order. The physician judging whether any toxic matters are retained in the colon. Saline solutions are recommended. A teaspoonful to every quart of water.
SPONDYLOTHERAPY: Concussion or hard finger pressure alternately on the 11th dorsal, and first three lumbar will aid in controlling spasms.
ELECTROTHERAPY: For pain, the short wave or diathermy or the infra-red.
DIET: This must be according to the cause. But, as a general rule constipating food is used, such as boiled milk, boiled rice and cinnamon are considered for that purpose. Rough cereals and roughage for the time being are eliminated.
HYDROTHERAPY: Hot packs or cold packs over the abdomen may be used at the discretion of the physician. One plan that has been beneficial in the writer’s experience has been to have the patient dip a towel in cold spigot water and after wringing out laid over abdomen and allowed to remain for fifteen minutes.
Plenty of liquids should be used. The old type remedy of a dose of castor oil is sometimes more effective than all other forms of treatment.

Diphtheria

An acute infectious disease characterized by formation of false membrane on any mucous membrane or mucous surface, accompanied by great prostration.
ETIOLOGY: Predisposition by an enervation of the nerves to the neck and throat or any mucous membrane affected, or a general toxic condition of the above places where the ferments of the Klelbs-Loeffler bacillus may breed and multiply.
The vast majority of cases occur between the ages of two and ten, but older children and adults are not exempt.
There are several types. The Pharyngeal, which is the most common type, the symptoms of which are: Onset gradual. Usually slight headache; often backache. Temperature 100 to 103 degrees, and sore throat with presence of yellowish-white membrane adherent to tonsils or pharyngeal walls. Cervical adenitis may develop early in severe types.
NASAL DIPHTHERIA: Fever is much more evident. Adenitis often severe, serous discharge from nostrils which may be blood-tinged and of strong fetid odor.
LARYNGEAL DIPHTHERIA: In this type, croupy cough, aphonia, stridulous respiration due to narrowing of glottic opening, are early evidence of the disease. Restlessness, anxious expression, retractions of the supraclavicular and intercostal spaces evident on inspiration. In this type of infection, the danger from asphyxiation due to mechanical obstruction is far greater than any serious results from toxemia. Diphtheria of the conjunctiva, external auditory canal, lupus, or genitalia are sometimes seen.
SYMPTOMS: The general and specific symptoms may be as follows, before and during the full invasion.
The invasion may be mild, with rigors succeeded by moderate fever, headache, languor, loss of appetite, stiffness of the neck, tenderness about the angles of the jaw, or slight soreness of the throat.
In other cases the invasion is more abrupt and severe, with chilliness followed by great febrile reaction, 103 to 105 degrees F., pain in the ear, aching of the limbs, loss of strength, painful deglutition, and swelling of the neck, compelling the patient to take to bed from the onset.
The appetite is poor, the tongue slightly coated, sometimes more or less exudation appearing upon it, the bowels either regular or slightly relaxed. The pulse, at first full and strong, soon becomes either rapid or slow, but compressible. The urine is scanty, high colored and contains albumin.
The local symptoms in the majority of cases are associated with the throat. The patient often complains of a frequent and persistent desire to hawk, in order to clear the throat. On inspection, the fauces are seen red and swollen and more or less covered with a film of diphtheritic exudation, giving a glazed appearance, soon followed by the dirty-white membrane; sometimes the tonsils and uvula are greatly swollen and spotted with exudation. In severe cases, more or less ulceration or sloughing may be observed. Not infrequently fragments of exudation, the false membrane, are expectorated with particles of the ulcerated tissues, having an offensive odor which is transmitted to the breath. The lymphatic glands of the neck are enlarged and tender, and in severe cases the tissues of the neck are greatly tumefied.
Extension to the nasal cavities causes a sanious and offensive discharge from the nose, with attacks of epistaxis.
Extension to the larynx is indicated by hoarseness or complete loss of voice, croupy cough, and obstructive dypsnea, which often becomes urgent, the breathing being noisy and stridulous, and subject to paroxysmal exacerbations. If the inflammation extends to the bronchi, the breathing becomes still more embarrassed.
DURATION: Ranges from two to fourteen days, the average being about nine days, although complications and sequelae may prolong its course.
COMPLICATIONS: The most common complications are bronchopneumonia, heart failure, the result of myocarditis or of degeneration of the cardiac nerves, acute nephritis, hemorrhage from the ulcerated surfaces, otitis media, and suppuration of the lymph nodes. The most important sequel is paralysis, due to toxic neuritis. This occurs in about 20 per cent of the non-fatal cases and usually appears during the second or third week of convalescence. The pharynx is the most common seat, the palsy being manifested by difficulty in swallowing and the return of liquids through the nose. The external muscles of the eye are often involved, the result being ptosis or strabismus. In some instances the heart is affected and if sudden death does not ensue, the condition may be manifested by tachycardia or bradycardia. The muscles of the extremities may also be involved. The paralysis usually disappears in from a few weeks to several months. Those who recover are for weeks pale and cachetic in appearance.
DIAGNOSIS: Whenever the throat is red and swollen, having a glazed appearance accompanied by the necessary symptoms, a culture should be made from the deposit, and if the bacillus is present, the colonies can be seen under the microscope.
PROGNOSIS: This is always serious and there should be no delay in instituting measures to give relief.
TREATMENT: The laws of most states if not all make this a quarantinable disease. In the presence of such a case where such laws exist the drugless physician is required to withdraw from the case, report it to the health authorities, and have a member of the medical profession assigned to do the actual treating. Until that law is changed it is best for the drugless physician to adhere in order to avoid embarrassment, or a medical doctor may be called into consultation, and both treat together, if feasible.
There are certain things that the physician can do: When there is a suspicion of this disease, whether it be the pharyngeal, the laryngeal, nasal or black type, the case should be isolated at once, and no one allowed in the room except those that are absolutely necessary in attendance. Then a smear from the throat should be obtained, and laboratory examination made.
The manipulative treatment may be
NEUROPATHY: Complete lymphatic, paying particular attention to the liver, axillary and cervical regions.
CHIROPRACTIC: Adjustments, 3rd, 5th, and 7th cervicals, 5th, 10th, and 12th dorsals, and anywhere else necesssary.
HYDROTHERAPY: Washing or gargling the throat with warm ordinary table salt solution is helpful. Care must be taken that none is swallowed. The spraying of the throat with hydrogen peroxide solution is regarded as helpful. Swabbing with saline solution or water-soluble chlorophyll in two drops to nine drops of warm water. The latter may be used as a nasal spray also. 120 V. M. is excellent in relieving throat and nasal conditions. Only a little at a time should be put in the nose.
Hot compresses or cold compresses are helpful when there is much swelling of the cervical glands. Heat is better for infants and cold in ice bag for older children.
Croup kettle or steam inhalations may be old fashioned, but still a good procedure in the home. By making a tent of a towel thrown over the head and kettle, enough should be inhaled in ten minutes to give relief. Turpentine or eucalyptol may be added to the boiling water. The tent should not be air-tight. If fever is high, sponging may be given three times a day or a cool compress may be put around the neck.
ELECTROTHERAPY: If the physician has a portable short wave or ultra violet ray, he will find them of great service. A portable cold quartz with applicators for nose and throat are worth while.
ENDO-NASAL THERAPY: When the patient is recovering this type of therapy will be of great benefit in furthering elimination, and preventing complications, one of which may be otitis media, and also helping the child to build up a good oxygen content in the blood for rebuilding a strong vigorous body.
HERBOLOGY: Gargle every hour or two with lemon juice and water, using as little water as possible. Swallow a teaspoonful or less each time.
VACUUM THERAPY: The use of nasal and laryngeal suction has advantages if possible at all to perform.
DIET: Early in an attack, only a liquid diet should be given, plenty of water, fruit juices, and nourishing broths. Where the membrane is not extensive, a soft diet can be given including many vegetables, milk, beef tea and gruels. As the child recovers adequate feeding is necessary, and it is best to give him what he likes if it is nourishing.
SPONDYLOTHERAPY: Concussion with fingers of the 7th cervical.
COLONTHERAPY: It is essential that the bowels be kept in order. A small hand syringe is all that is required with the infant. But a larger child can be given douches of a pint a day.
Caution to the physician: After making sure or even after suspecting diphtheria, the physician should always wear a gown, mask and cap and leave them at the house he called at, or take them to his office properly sealed. They should be properly disinfected or destroyed, each time. And he himself should sit under ultra violet radiations for fifteen minutes before treating another patient or making a call. Besides the above he should spray his nose and throat with an antiseptic solution.

DEFINITION: A general term used to designate any inflammation, infection or injury of any portion or all of the prostate gland.
The present tendency is either to view the whole gland when abnormal, as either in an acute state, or a chronic state and to classify the types of prostatitis according to their etiology. The causes of prostatitis can be said to be as follows:
1. Infection
2. Retentive and Congestive
3. Mechanical
4. Biochemical
5. Traumatic
The infective type of prostatitis may be acute or chronic, according to the type of the infection and its discharge of bacteria into the prostate. The position of the prostate is such that it is vulnerable to infection by drainage from above it, and by suction from below it. Thus it may be infected from gonorrhea, from tooth decay, influenza, mumps, constipation, boils, abscesses, carbuncles, amoebic dysentery, etc., the infection being carried to the gland by the blood stream or transmitted through the urinary system, or it may come directly through the intestinal tract by osmosis.
For many years all cases of prostate trouble were frowned upon as only the penalty for loose living. A result of gonorrheal infection and many cases of prostatitis were ignored while a course of treatments was instituted for the supposed lingering infection in the blood stream of the patient before anything was done for the prostate itself. Much more harm was done to the prostate than good by this manner of treatment. The manipulative physician recognizes the unity of the whole body, and while eliminating the infection at most will only be a minor factor, whereas the body’s eliminative processes, and not kill the patient while trying to kill germs. It is not wise to assume that because a man has an enlarged or senile prostate that he has been exposed to sexual diseases. It is not even wise to consider gonorrheal infection as the cause, even in those who are past sixty years of age and who admit that as young men they were victims of gonorrhea two, three or four times, if, in the intervening years they have lived a normal life. Younger men with acute prostatitis and evident discharge might be considered as gonorrheal, but not told until the clinical findings have substantiated the suspicion. In acute or chronic prostatitis of the older generation, gonorrheal infection at most will only be a minor factor, whereas the mechanical, the chemical and traumatic etiologies will loom very large. It is a peculiarity of human nature to shun from anything that the mass of people make merry about. For years, if a person were known to have been examined by a psychiatrist, henceforth that patient was regarded as always acting somewhat queer. But today people have psychiatric examinations as a matter of course.
The writer has had men patients who showed evidence of prostate symptoms refuse to have that organ examined in fear that he would be told that it was the result of loose early living or sexual excesses. But, after the seriousness of the matter was explained to them, the examinations and treatments became a matter of periodical request by those men. There are many other causes besides gonorrhea and syphilis. Now we will take up the four main causes and try to put them in their right proportions.
The first, then, is Infection. Gonorrhea can be verified by the many chemical laboratory tests. The others can be ascertained by observation, palpation and urinalysis. This can be stated now, that no permanent relief can be obtained for the prostate gland until every foci of infection is removed. A case of record is of a man who took treatments for nearly a year, whose prostate gland would enlarge, and on treatments would be reduced to normal. Yet, in a few months would be very large again. Not until two foci of infection were removed was there any permanent results. Several bad teeth which had been decaying for years, a discharge of purulent mucus from the ears, some of which no doubt reached the prostate via the blood stream. It is of note though that the enlargement of the prostate ceased by the neutralization of the above infections.
Other forms of infection are, dripping sinusitis, tonsillar infection as a result of influenza, mumps, scarlet fever, or any contagious infectious diseases. Infection from any of the tissues adjacent to the prostate. One form of infection that is frequently overlooked is that incurred by intercourse during the menstrual period and, when there is leucorrheal discharge. These types of infection to the prostate are more numerous than realized by many men and physicians.
RETENTION OF WASTE PRODUCTS is a cause of prostatitis, largely due to faulty diet and sedentary habits. Constipation of a great degree for any length of time is practically death to the functions of the prostate gland, bringing along with it a host of inflammations to the surrounding tissues which cause pressures, straining, hence hemorrhoids and sometimes hemorrhages that have a deleterious effect on the prostate. Some have given this type the name of Congestive Prostatitis, where there is a filling up of the gland to an abnormal size with blood. Here the lobes may be two or three times their normal size. There is always great danger in the acute, congestive prostatitis if there is also an infection present at the same time and an abscess forms. This may rupture into the urethra, through the skin of the perineum, or into the rectum, leaving a cavity. If small, this cavity will contract and close with scar tissue, but if large it becomes a pus pocket capable of holding sufficient pus to maintain an irritation and infection for months or even years. In some cases the entire gland is in this way destroyed.
The retentive or congestive types may be also caused by sexual excitement without gratification. It is well to remember that failure to exercise vital functions of an organ leads to congestion or atrophy of that organ. Once the sexual functions have been accustomed, and a periodicity has been establlished for the discharge of that glandular secretion, and there is a sudden cessation and the secretions are not thrown out, more continue to form, and the prostate and vesicles will swell and become distended in proportion to the amount retained. It is well for the physician to note this point carefully in men who have recently lost their wives, for in a short while they show nervous and other symptoms that point to prostate congestion.
It is a matter of record that single men do not live, on the average, as long as the married men. It is conceivable that prostatic congestion in the single man is a factor in the difference in longevity.
When a man enters an active sexual life, the cells of his prostate gland as well as those of his testicles secrete more actively. In order to provide for this increase in the production of secretion, the muscles of the prostate stretch. As long as sexual activity is periodically indulged in, the prostate will exercise its normal function of expansion and contraction. Should the normal routine of this sex life be interrupted by continence, the prostate gland and vesicles will continue to fill with secretions. Continence produces flabby muscles, and the prostate becomes boggy. Periodic emissions occur, to be sure, but the force from the muscles, the nerves which stimulate ejaculation during coitus are not functioning properly and the emission only partly empties the prostate and vesicles. Unless the patient again establishes his sexual life, or goes to a Physical and Manipulative Physician for proper massage and treatment, he is sure of a prostatitis.
As has been said before, many of these patients never consult a physician until their condition becomes unbearable. They will suffer untold agony rather than go to a physician. The fault is not entirely theirs. The trouble reverts to the earlier discussion of sin and sex — they are ashamed to go. Yet, there is nothing to be ashamed of. Prostatitis and prostatic hypertrophy are diseases of respectable people all over the world.
The Mechanical Causes of Prostatitis. Abdominal ptosis creating a ptosis of the bladder is always worthy of investigation. In good body mechanics, in which the chest is held up and the diaphragm is high, and the abdominal wall is firm and flat below the umbilicus, the abdominal viscera exert little or no pressure on the pelvic organs. In poor body mechanics, where the chest and diaphragm are both low, and the lower abdominal wall — that below the umbilicus — is relaxed and protuberant, there must be a marked backward thrust of the lower abdominal viscera directly into the pelvic cavity. Not only can this cause local pressure and possible congestion, but it must also have an effect on the pelvic organs, since their only method of drainage is through the great abdominal veins.
With such a conception of the mechanical factors influencing the circulation of the pelvic organs, is it not possible that here is an explanation for the congestion of the bladder and prostate, so often found in older men, which may lead to prostatic hypertrophy and malignancy of the prostate. Other mechanical causes are many.
In this group the sexual element seems to be the greatest offender. Mechanical prostatitis results from coitus interruptus, coitus reservatus, coitus prolongatus, masturbation, frustrated sexual excitement, continence, impotency, sexual excesses, exposure to cold and chilling of extremities, etc., may be some of the mechanical causes.
The Biochemical group of causes come from overindulgence in alcoholic beverages, irritant action of impure alcohol, impure or irritating foods, drugs and tobacco.
The Traumatic group are caused by accidents and injuries affecting the prostate, urethra, rectum or bladder.

Men, generally, are reluctant to submit to an examination of the genital organs, unless there is great pain. Here the physician can be of great aid in opening the way by just asking a few questions. This brings us to the question, When is a prostatic examination required? A man forty-five to seventy years, presenting himself to the physician, will reveal certain of his symptoms. If, among those symptoms are one or more of the following, then a prostatic examination is in order, and the physician can explain to the patient, why.
1. When there is lower back, or hip, or groin pain, dull or severe.
2. Chronic constipation with a feeling of a lump in the rectum the patient would like evacuated and cannot.
3. Difficulty in starting micturition, feebleness of the stream, dripping at the end of urination.
4. When there is frequency of urination which is a symptom in all types of prostatitis. But, it is well to remember that frequency is also a symptom of many other diseases. It can be taken for granted, however, that in nearly all cases of frequency of urination, the prostate has become more or less involved. Some of the other causes of frequency are—strictures in the urethra. The seminal vesicles may be enlarged and infected. There may be stones in the bladder, or the bladder may be deformed from a ptosis of the abdominal wall. The kidneys may be afflicted by nephritis, or have stones, tuberculosis or dropped and floating. Diabetes, injury to the spinal column, large intestinal and external hemorrhoids, excessive drinking, smoking and drugs may also be causes of urgent frequency. This one complaint alone is sufficient to justidy a careful examination.
5. Burning of urine.
6. Constant tiredness, and shakiness of the limbs on required exertion.
7. When there is more than one rising at night to empty the bladder.
8. When there is complaint of lack of sexual vigor and lessened sexual satisfaction.
9. When there is complaint of nervousness and insomnia.
10. When there is occipital and neck muscle pain and side headache.
11. When a man complains of peculiar sensations of slight fever at times, nausea, and haziness of mind, and an all out-of-sorts feeling which he cannot explain.
Before proceeding with the plan of a suggested method of examination, it might be well to consider the size of the normal prostate.
The size of the prostate is important, since in old age enlargement of the prostate gives rise to a train of symptoms that may end in death. The diameter of the prostate varies to some extent within normal limits in healthy adult life. As given by Merkel, they are as follows: Basic to apex, 25 to 35 mm.; average, 30 mm. The greatest transverse diameter, 35 to 45 mm.; average, 40 mm. The greatest thickness, 15 to 25 mm.; average, 20 mm.
The best method of finding specimens in normal condition and comparing them with the abnormal is to have some one about forty years of age who has no complaint whatever, and make an examination. Notice the contour and size, then follow this with some one who does complain. The author found no difficulty in getting men to submit to the examination for comparison when the purpose was explained.
After the finger, covered with a finger cot, well lubricated, has been inserted into the rectum, the following general principles can be followed.
A uniform, smooth and bending enlargement of the prostate gland can be suggestive of chronic inflammation, or a senile enlargement if the age is enough to justify that conclusion. An irregular, hard and unbending prostate can be suggestive of a malignant disease A soft and extremely tender swelling suggests abscess formation in the prostate. More types under Chapter on Classification.

The prostate may be examined in a variety of ways, as follows:
1. Rectal Palpation.
2. Urethral examination with a metal catheter.
3. Cystoscopy and endoscopy.
1. RECTAL PALPATION. — The manipulative physician with his training should become par excellent in a short time at this form of examination. The steps taken are usually as follows:
The bladder should contain a moderate quantity of urine, i.e., be neither distended nor empty. The patient is placed in the knee-chest position on a table or bed, or may stand leaning over the back of a chair, one knee resting on the chair and the thighs separated. With the patient on his back the examination is not so satisfactory. The right forefinger of the physician, protected by a rubber glove or a thin rubber finger-cot, is lubricated and gently introduced into the anus with a slight boring motion. After passing the sphincter the finger comes in contact with the membranous urethra in the anterior rectal wall for about one-half inch, then with the prostate. Normally the prostate is felt as a slightly prominent, heart-shaped body, an inch and a half long, of firm, elastic consistence. By palpation one determines general or one-sided enlargement, the presence of nodules, or of general or localized change in consistence, as induration, fluctuation; also the presence of tenderness. Bimanual palpation of the prostate is seldom useful except in very slender subjects.
2. URETHRAL EXAMINATION WITH A METAL CATHETER. — The last two types of examination we shall mention here can only be made by those who have been well trained in this art, and have the proper facilities at hand. We mention them here that in case the results of the palpation method is not satisfactory, then an examination can be made by the following methods:
If a silver catheter of medium curvature be introduced into the urethra, and it is found necessary to depress the shaft of the instrument nearly to the horizontal before urine flows, we may conclude that the prostatic urethra is notably increased in length and that the prostate gland is correspondingly increased in size.
A maneuver, described by Socin, for the determination of the length of the prostatic urethra is thus performed. A silk or other catheter is introduced into the bladder until urine flows. The catheter is then withdrawn until the flow ceases, i.e., the lateral eye of the catheter is inclosed within the prostate. The length of the catheter protruding from the penis is then measured. The physician then introduces his finger into the rectum while an assistant holds the penis in an unchanging position; with his left hand the physician withdraws the catheter until he feels its tip emerge from the prostate into the membranous urethra. The length of the protruding catheter is again measured. The difference between the two measurements, less the beak of the instrument beyond the eye, is approximately the length of the prostatic urethra. When the prostatic urethra is considerably increase in length, it indicates an hypertrophy of the middle lobe or the formation of a marked prostatic bar. The length of the entire urethra in healthy male adults varies a great deal, according to the length of the penis. It may be from 16 to 20 cm.; on the average about 18 cm.—a little less than seven inches. Usually the length of the catheter introduced into the urethra before urine begins to flow is from seven and one-half to eight and one-half inches. Any marked increase over this distance indicates prostatic enlargement.

3. ENDOSCOPY AND CYSTOSCOPY. — It is possible, and not very difficult to introduce a straight endoscopic tube into the prostatic urethra, and to study the condition of its mucous membrane with more or less success. The verumontanum can be recognized, but not the sinuspocularis unless it is the seat of the disease when its orifice may gape or permit the observer to see a purulent or muco-prostatic hypertrophy. It is quite painful, but has been rather extensively used in America during recent years. This form of examination requires trianing and great skill.

In cases of prostatic hypertrophy, with unequal enlargement of the lobes or with a greatly increased urethral distance, the use of the cystoscope is not practicable, even under a general anesthetic, without undue violence. If the kidneys are faulty there is also risk of uremia. In elderly men, therefore, the use of the cystoscope should be preceded by an examination of the urine, with particular attention to the function of the kidneys, and by rectal palpation of the prostate. In acute inflammation of the prostate, in acute posterior urethritis, and in cases where malignant disease of the prostate is suspected, the use of the cystoscope is contraindicated. While we are here stating these methods of examination we will utter a word of caution. That instruments of solid substance should only be introduced into the urethra or rectum as a last resort for examination or for treatment. More harm than good is done by the use of those instruments when done unnecessarily.
The experience of this writer has led to the conclusion that over-much instrumental methods used on the prostate is not the proper procedure.
The chemical irrigations required in gonorrheal infection are helpful in the acute stage, but continued applications are harmful. The urethra has a sensitive membrane and the continuance of the administration of potassium permanganate solutions after the gonococcus is eliminated will cause persistence of urinary shreds and damage the urethra.
The writer is not very enthusiastic about the introduction of solid instruments of any kind, such as solid or hard electrodes. Of course, there are those who insist these are sometimes necessary for drainage. But, poor drainage is seldom if ever solely a matter of the follicular opening into the urethra, and stretching this minute aperture would not stretch the deeper portions of the follicular canal and thus cause the follicle to drain. Except in acute gonorrhea, and possibly, in what has been called descending prostatitis, the posterior urethra is a mirror to the prostate and it becomes normal because drainage of the prostate by massage reduces its activity as an infective feeder to the canal. Such chemical and instrumental treatment probably does not harm the prostate but it often harms the urethra. It is decidedly like trying to patch a ceiling harmed by a leak in the roof and doing nothing about the leak.
It takes a long practice for some to grasp the idea of finger tip examination, while others see its significance at once. A careful reading of what follows will convince the most skeptical that a little practice is all that is needed to make one proficient.

In the beginning of this section we think it would be well to state how the general masssage treatment is given and when some special form of physical therapy is indicated. That will be given and explained under its proper heading. There is no doubt that massage is the ideal and rational therapy for the majority of prostate troubles. It empties the ducts. Improves the circulation and tends to cause absorption of inflammatory products. For this procedure the patient may lie on the back with the thighs flexed and separated, or he may lie on his side. But the best position we have found and which allows of better drainage is the knee chest position. We will designate the general massage, Light and Heavy. Before giving the massage, a cot of absorbent cotton should be affixed, or tied over the penial meatus to absorb the residual thrown out of the prostate by the massage. This should be inspected after every treatment to see the effects of the treatments. The longest finger, covered with a rubber finger cot well lubricated, is then inserted in the rectum. The gland should be rubbed from the periphery toward the urethra, that is, pressure rubbing is made, first, on one lobe toward the center and then on the other, finally on the medium lobe, to evacuate the ducts into the urethra. See Fig. B. If strong, eight pound pressure is used a few strokes on each lobe is sufficient, if but gentle force is used each lobe may be stroked for one minute. The force used may have to be gradually increased according to the effects noted on the absorbent cot over the penial meatus. Brief massage and treatment of the seminal vesicles may with advantage precede all prostatic manipulations. The procedure should seldom be carried out oftener than two or three times a week. It may be continued until the symptoms have abated and the purulency of the drained fluid largely or entirely lost. Prostatic massage is contraindicated in acute inflammation of the prostate, vesicles or urethra, but given on abatement of the acute condition.
There are many types of electrical equipment advanced as being of great value in the treatment of prostatitis. But after years of experience we have discarded all those that require electrodes or any hard substance pressed against the prostate. Once in position, these electrodes may do a great deal of good. But in placing of them in position, and the pressure of the instrument while the patient is lying down may have an injurious effect upon the prostatic tubes, ducts and urethra. Diathermy, Galvanism, sine wave and short wave we used by the indirect method rather than direct. Finger massage, with hydrotherapy, and short wave as adjuncts, we now consider to be the ideal method in the majority of cases of prostatitis.

Before treatments are given to the prostate gland the muscular tissue of the lower abdomen may be relaxed with a great deal of benefit to the patient. It is not absolutely necessary, but, it does, in some cases hasten the recovery of the patient, especially those who have an abdominal ptosis. Many forms of tension relaxation have been taught and are practiced. After a trial of many of them, the writer has come to the conclusion that the following are of the best. However, no matter the method used, the importance of relaxation and the raising up of the lower abdomen in prostatic treatment cannot be overlooked. The first step we list in this process is to give what we call the Pneumo Tapotment Technique. A medium size vacuum cup is placed over the os pubis, inflated, according to the resistance of the patient, or until it hurts a little. Then the physician, putting his left hand on the lower side of the cup pushes it upward as far as possible without giving pain. After the position of the cup is fixed and held there, then with the fingers of the right hand the physician taps all around the abdomen not covered by the cup. These taps are very light, but the whole abdomen should be covered. It is best to do it in circle fashion. The cup is then put on right and left groin respectively and the tapotment repeated. The time spent on this at the first treatment should not be less than 15 minutes, and should be repeated at least every two weeks, if the patient is given the prostatic treatment twice a week. If a vacuum cup is not available, the relaxation treatment can be given by using just the left hand as a substitute. For the two-hand technique; start with left hand cupped above the os pubis, raise the tissue up as far as possible, then with the fingers of the right hand, tap the abdomen, going in circles and covering all the abdomen not under the left hand. The left hand is then brought to the left and right groin respectively and the circular taps are repeated. The tapping must be very light. This relaxation treatment if performed properly, need only be repeated every two weeks.
PAIN CONTROL — The theory of pain control comes under the old principle of counter irritation and inhibition. In the first theory, the circle of nerve circulation is the prime factor. That is, the body is a unit, that nerve, blood and lymph all have a complete cycle in distribution and circulation. The sensory impulses of pain starting at any part of the body travel to a nerve center or to a center in the brain and then to the opposite side center of the brain, and its circulation is completed on the opposite side in the peripheral nerve ending in the corresponding location. To test this out, the next time there is suspicion of appendical involvement with swelling or tenderness and pain try counter irritation by the cups or hand pressure or tapping on the exact location of the opposite side.
When giving the heavy pressure treatment to the prostate, if massaging the right lobe, press heavily on the opposite side of the anus. Hold all the while pressure is being used on the right lobe. When on the left lobe reverse to the other side. When on the median lobe, just above the massaging finger.
Inhibition to some extent can be created by pressure on the constrictors to the prostate. The first, second, and third lumbars. This is done by deep pressure in the gutter of the spine on the opposite side of the lobe being treated. If working on the right prostate lobe, with a finger of the right hand, the fingers of the left hand are pressed hard, at the same time, in the gutter of the spine on the left first, second and third lumbar segments.
After treatment of the prostate is completed, it is usually a good thing to stimulate the vaso Dilators to the prostate by vibration or friction of all the sacral segments.
Adjustments of the cranial sutures underneath of which are the anterior and posterior pituitaries can be adjusted once every two weeks for psychic and hormone relaxation, or stimulation as necessary.
The beginner should go easy the first two or three treatments and study the reactions of their patient, and gain by experience how much pressure to use. However, the exudate found on the penial cot can always be used as a guide to the amount of increased pressure to use.
The abdominal relaxation technique should precede all the prostate techniques, and the pain control technique whenever necessary.
There are those who advocate as strong a pressure as possible on the prostate. We heard a physician say: “Give them the works for all your worth” and then proceeded to give at least a twelve to fifteen pound pressure in spite of the screaming and howling of the patient. It must be remembered that drainage is the aim and not the crushing to pieces of the organ.
Look again at the cut showing the contents of the prostate from the superior to the inferior urethral crests, see Figures A and B, and the possibilities of causing strictures, elongations and congestions in the ejaculatory ducts and urethra, that greater chronic pain after than before the treatment can be experienced. If a patient is from far away, and cannot be treated but once or twice before leaving town, it may be justifiable to use a ten pound pressure with great care, and, also using the abdominal and pain controlling techniques.
Our classical Formula for the first treatment is as follows: First, a thorough examination. Second, no matter what the condition, give the abdominal relaxation treatment. If massage is indicated, along with the massage we give also the pain control technique. At the first treatment we sweep the fingers over the whole prostate five times with a four pound pressure ending up on the middle lobe holding for one-half minute. Then we deposit a rectal suppository of garlic composition which will have value in reducing inflammation, relieving pain and restoring normal tissue. It is better to replace the suppository in the center just at the base of the prostate, than just depositing it anywhere in the rectum. An appointment is made for the following day or not more than forty-eight hours later. The finger technique is then begun in earnest The finger is then inserted and a six pound pressure is exerted on the left and right lobes, with a sweeping motion toward the middle lobe. This motion is carried out five times on the middle lobe. This motion is carried out five times on each lobe then the middle lobe is pressed for half a minute with a four pound pressure in a rotary manner, from right to left, after which another suppository is inserted and the patient told to come back in a week. Our treatments are on the average of two a week until complete relief is obtained. After two treatments, suppositories are used once a week.
The vesicles often need to be treated for the reason that, when congested or inflamed they have a profound influence upon the virility of the patient and also on his psyche. He is the type of patient the doctor will put down as a neurasthenic, and his wife and others will say: “It is all in your head.” Let the patient think that it is a combination of Neurasthenia and physical symptoms and treat the vesicles at least once every two weeks, if necessary. The treatment for Vesiculitis is found in Chapter I. It was thought best to put the technique there to avoid confusion in this Chapter.

Here the gland is enlarged, tender and there is deep seated pain accompanied by a sensation of heat and weight in the perineum. The desire to pass water is frequent, and micturition is painful, particularly at the conclusion of the act. Defecation is painful, and digital examination of rectum reveals a hot and tender swelling of the prostate gland. Usually a muco prostate. The perineum is also hot and tender. The patient cannot sit comfortably, and supports his weight upon one buttock to avoid pressure upon the perineum. If suppuration occurs, as is often the case, the pain becomes more marked and of a throbbing character, the perineum becomes red and edematous, retention of urine may occur, fever is present, and there may be a marked chill. The abscess may discharge through the urethra, rectum, or perineum. Generally the condition is regarded as a result of gonorrhea, but traumatism, urethritis, strictures calculi and cystitis may also be causes. Treatment same as in acute gonorrheal prostatitis.

In these cases the symptoms of acute posterior urethritis will have preceded the prostatic involvement for days or weeks. If the prostate becomes involved in the course of a chronic posterior urethritis, there will be a history of an old uncured gonorrhea with acute excerbations. In this latter group the exciting cause may be prolonged sexual excitement, coitus, acute alcoholism, overfatigue, the passsage of a sound, or other source of local irritation. The involvement of the prostate is indicated in severe cases by a chill, a rise of temperature, and a rapid pulse, prostration, and other septic symptoms. Such an onset usually indicates that the process will end in suppuration. From my own experience in cases of prostatic abscess the original septic symptoms, including fever, often subside in a few days, though the abscess is still developing. The general symptoms of constitutional depression are usually marked. In several cases I have observed great mental depression, amounting almost to acute melancholia. Locally, the patient will complain of increased frequency of urination, of a sense of weight and fullness in the rectum and perineum and of pain in the sacral region. Defecation is painful and the sensation of a large foreign body in the rectum is present. Urination becomes more and more frequent, painful and difficult. If a large abscess forms, retention of urine is the rule. Rectal palpation reveals the prostate much enlarged, tender, hot and throbbing, and either hard or elastic. The abscess may be confined to a single lobe, or involve both sides of the gland. If the abscess ruptures, its contents may flow into the urethra, the ischiorectal fossa, or burrows along the urethra and perineum, or into the rectum, rarely into the bladder. Rupture into the urethra may occur during the straining efforts to urinate, or as the result of passing a catheter for the relief of retention This will be indicated by the discharge of considerable pus with the urine, sometimes also from the meatus independent of urination. Rupture of the abscess is followed by marked relief from the symptoms. By rectal massage, pus in quantity may sometimes be pressed out of the abscess cavity, and made to appear at the meatus. If the opening is small, it may close or drain imperfectly. In this event septic and painful symptoms may recur, sometimes with the formation of new and more serious lesions, and as long as the abscess cavity remains unhealed.
TREATMENT: Absolute rest in bed and liquid diet. The bowels should be kept loose to avoid the pressure of hardened feces upon the inflamed prostate. Hot hip-baths sometimes cause a marked diminution of the pain. If the pain is intense an ice bag can be applied to the perineum, or an alternating douche of hot and cold water from a spray in the bathtub have been found very helpful for relief of pain. Water applied in this manner has great therapeutic value. Short wave is helpful to a great degree. Massage is not indicated, neither is any hard substance projected into the rectum until all acute symptoms subside, and then light massage can be given twice a week. Should severe retention of urine occur the catheter may have to be used. See Chapter on Catheterization. In the acute condition which does not subside in from three to ten days, the physician is faced with some faulty conduct of the patient. Either he is disobeying order about diet, alcohol or sex relations, and he may be using some drugstore preparation on the side. For a urethral wash via the meatus—one drop of 120 VM in one-half ounce of water can be injected by the patient by use of a small syringe, four times a day. In starting prostatic treatments some urine should be left in the bladder. Several light strokes should be given from above downward. First on the lateral lobes, then ending with the middle lobe. This can be done several times a week if no recrudescence of symptoms occur, and if they do not occur, the full treatment after a few days can be given as outlined in the beginning of this chapter.
A fast for a day or two of milk or skim milk is of great value in favoring diuresis. A glass of milk every two hours, after which a light food diet is given until all symptoms subside. All the mild, alkaline drinks desired should be given. Sexual intercourse is entirely forbidden as well as the use of alcohols, spiced foods, etc., for some time after the acute symptoms subside.

Chronic prostatitis is a low-grade inflammation of the gland. It is always of long standing, may be associated with enlargement of one or both lobes of the prostate, a normal-sized gland, or a decrease in size of one or both lobes. It may be either specific or non-specific and may be due to any of the bacterial, mechanical, chemical or traumatic causes described. In this condition the ducts which lead from the prostate to the urethra become plugged with mucous pus and inflammatory products. The secretions of the prostate are held in the gland by these plugs, causing it to swell.
The patient with chronic prostatitis may have no symptoms for years, he may have the symptoms of any of the four groups mentioned above, or he may conplain of a dull pain and uncomfortable feeling in the perineum; a slight daily frequency of urination, six to seven times during his wakeful hours, and once at night; a slight burning on urination; a slight discharge, usually in the morning, during bowel movements, or when straining. This discharge is like the white of an egg in consistency and composition. There is a loss of sexual power and nocturnal pollutions may be frequent.
The feel of the prostate in this condition is varied and difficult, but as a general rule the lobes are smaller than in true hypertrophy, and larger than in atrophy. Yet one lobe may be larger than the others. If there are nodules particularly in the smaller ones, along with neurasthenic symptoms, and certain phobias, especially the fear of impotency, and with the symptoms enumerated above the diagnosis of chronic prostatitis can be considered certain.
TREATMENT: Every source of infection must be eliminated. The whole general constitution of the patient must be built up by tonics or tonic treatments. Psychiatry will play a big part in bringing about relief. (See book The Fundamentals of Applied Psychiatry, by the Author.)
The manipulative treatment will consist of three steps. (See Figures A and B). Note particularly the positions of the vas deferens as it turns over the epididymus then circles up the side and around the bladder to reach the sides of the vesicles. All of these must be treated in a case of chronic prostatitis. Light pressure can be exerted at the right and left of the penial crest, then moving up a half inch bringing pressure again. This pressure should be gradual but as deep as possible without giving pain. This is one of those conditions in which to remember that you are trying to get the prostate to function normally again. Do not squeeze out every drop of secretion from the prostate, but only enough to emulsify its contents and break up the congestion, and also to help the muscles regain their tone. In other words, massage in the same sense in which that term is used when applied to other portions of the body. Using powerful pressure on a sensitive prostate is like punching a man in the belly and calling it massage. Short Wave, Sine Wave without solid rectal Electrodes, Douches, Sprays and a liberal but easily digested diet all are helpful. But, it is the massage that emphasis must be placed on, and should be kept up for months until all symptoms are gone. Glandular substances may be considered as necessary.

Patients suffering from enlarged prostate often come to their physician complaining that there is something in their rectum which will not pass. The more the catharsis and straining at stool, the worse the condition gets. This is produced by pressure of the enlarged gland upon the rectum. This may become so great that defecation is impossible at times.
A number of theories have been advanced as to the cause and nature of prostatic enlargement. A few of these only can be cited. These theoretical causes of prostatic enlargement are: A fibrous change from advancing age, sexual excess, ungratified sexual desire, perverted action of the testes, an attempt on the part of nature to counteract the pouching of the bladder accompanying its muscular degeneration, the change normal to advancing years, a chronic inflammatory process, a septic catarrhal infection, a new growth or tumor. There can be no doubt that many of these are contributing factors.
The process begins with a swelling of the smallest sac-like dilations composing the prostate gland. This is due to a retention of the secretion which, under normal conditions is periodically evacuated by ejaculations. This secretion thickens, and by infection from any part of the body pus and inflammatory products accumulate, and since none of this can escape, cysts are formed. As this cyst formation progresses the entire gland enlarges.
As the gland swells, it bulges into the rectum and into the bladder interfering with bowel movements and increasing the size of the bladder floor. This usually carries the urethral opening to or near the summit of the projection and lengthens the canal. It is therefore evident that the neck of the bladder and the prostatic urethra become deformed and retention of urine results.
Many different theories have been proposed to explain this phenomenon of retention. One interesting conception is that contractions forcing the urine toward the neck of the bladder thrust the obstructing prostate against this opening as a stopper closes a bottle. Another is that the swollen gland in raising the bladder floor forms a curve in the middle, or two pockets on each side of the bladder. Only the urine which rises above the level of these pockets is voided. That which remains causes the muscles to sag, thereby increasing the amount retained. Sooner or later this urine becomes infected and a cystitis results. The bladder muscles, in their effort to force out this excess urine past the obstructing prostate, thicken and develop a network of ridges called trabeculae. As the obstruction grows, the bladder becomes stretched and the muscles lose their tone. A point is reached where the patient is unable to void, save for a few drops, and these with great pain and burning. If there is a ptosis of the abdomen, hypertrophy symptoms re greatly aggravated. Before the symptoms of a true hypertrophy appear there is generally a preprostatic stage. It may come a number of years earlier, shortly after forty, and then either disappear or remain quiescent. At this time the patient has attacks of frequent urination, burning when passing his urine with perhaps some tenesmus and pain. As true hypertrophy approaches, the symptoms return in a more aggravated form. Urination is more frequent, the burning and tenesmus more intense, there is a sense of fullness and a feeling of pressure in the perineum and bladder, the stream is feeble and urination is difficult. There may be retention, dribbling or incontinence.
Frequency of urination is due to bladder congestion, irritability of the nervous mechanism of the bladder and urethra, over-activity of the kidneys, or to residual urine in the bladder.

SYMPTOMS

In fifty percent of the cases there is very little inconvenience, the patient merely being annoyed somewhat by nocturnal frequency of micturition. The stream is sow to start and falls feebly from the end of the penis. The last drops fall entirely without control. In fifteen percent of all cases the bladder cannot be entirely emptied, and residual urine collects. Frequently of micturition comes on, particularly at night, the patient has to get up often, the bladder never feels empty, and cystitis is apt to arise. The urine, at first acid and clear, becomes neutral and cloudy, and finally ammoniacal and turbid.
It contains bacteria, muco-pus, precipitates of phosphates and sometimes blood. Enlargement of the lateral lobes can be detected by a finger in the rectum, The patient should be examined by rectal touch at once. The amount of residual urine should be determined and the urine carefully analyzed.

Night frequency is more significant as well as more distressing than that in the day time. In a man normally passing his urine four times a day and none at night, five times a day and once at night would be both a day and night frequency. If this same man urinated six times a day and three times at night, his night frequency would be relatively greater than his day, as he would only be going two more than his normal by day, but three more at night. Day implies the sixteen waking hours and night the eight hours for sleep.
As the patient is less active at night than during the day, the local circulation of the bladder and prostate becomes more sluggish. Congestion results, and the accumulation of smaller amounts of urine gives a feeling of fullness, and a desire to void. The change in posture, from a standing or sitting to lying alters the hydrostatic effect of the bladder. The intensity of these factors governs the number of times that a patient gets up. When night frequency first starts the patient awakens with a feeling of fullness and a desire to urinate an hour or so before his usual time of arising. As the trouble advances, this time will come two or three or even four hours earlier. Soon, unless he receives treatment, he may have an urgency to get up three times or every hour of the night. The constant passing of the urine leads to straining, causing congestion and irritation of the bladder and urethra. Acid urine coming in contact with the membranes creates a burning of those tissues. If excessive urea or crystals are present in the urine they make the burning much worse. The above symptoms along with the results ascertained by manual examination make the diagnosis certain. The finger feel of an enlarged prostate will be as follows:
In glandular hyperplasia the tumors or lumps in the lobes will be soft and the lobes will be warm. If muscle fibrous tissues are increased the gland will be symmetrically hard, cool and dry. In some cases one or two lobes will have muscular and fibrous enlargement while one lobe has a glandular hyperplasia.
The treatment largely consists of finger massage. We have found that after a few treatments that urination can be controlled. But here a word of warning. Patients are apt to stop coming to the doctor just as soon as he discovers he only has to get up once a night. He must be informed sharply that he must continue the treatments until there is no residual urine left in the bladder, and until the glandular hyperplasia, or the muscular and fibrous condition is reduced to normal, which may take from six months to a year, twice a week. If he does not do it his trouble will recur and recur in more severe form each time which will only result in an operation in the end.
There are many electrical apparatuses that can be used, and we have used them extensively, but apart from short wave we have not found them as effective as finger massage. For softening effect the garlic suppositories are par excellent. The physician can follow the usual course of massage as outlined in the beginning of this chapter. And lay special emphasis on what instruction for living as may be found under the chapter on instructions to the Patient. The daily use of the spray douche on the whole top of penis and underneath the testicles is of great value. The patient experimenting to find which gives the most relief, hot or cold water, or both, alternately. The hot water causes a relaxation and a dilation of the tissues. The cold and the force of the stream both causing reflex contraction of the congested blood vessels. In some cases hot hip baths for a few minutes each day are of service. Ichthyol suppositories may be prescribed. But we are sure if the finger massage is given intelligently and regularly a complete cure will be accomplished.

Stones in the prostate may be found at any age after puberty, but they are more common and larger in old age. They may be formed from prostatic secretion and become scattered throughout the substance of one or both lobes, or a number of these may become cemented together to form irregular or nodular concretion. Calculi may also form in the kidneys or bladder, and during their passage become lodged in the prostate gland. Calculi may cause enlargement, inflammation, destruction or abscess. The symptoms are frequently obscure. Pain is usually present. It may be felt only during and after urination, in which case it is sharp and pricking. It may, on the other hand, be a constant aching not connected with urination and sometimes relieved by it. In these cases it is a pain felt in the rectum, testicle, perineum, groin or thigh. Bowel movements usually aggravate the pain. Bloody urine is often present. In many cases there is a copious purulent discharge from the urethra. Frequent urination both day and night is a constant symptom. Small stones may be passed and occasionally difficult urination or retention are observed.
Prostatic stones may originate from one of two sources:
1. From concretions formed in the prostatic ducts.
2. From ordinary vesicle calculi which become impacted in the prostatic portion of the urethra. Such calculi may originally lodge in such a manner that a portion of the stone projects into the bladder. The continued growth by deposition of phosphates may cause such stones to become firmly fixed, so that a cutting operation may be necessary for their removal. Prostatic Calculi originating in the prostatic ducts are quite common in elderly men, though they rarely grow to a size larger than that of a pea, and sometimes do not give rise to any symptoms. We have detected them in the prostates of old men by means of X-ray pictures since they usually contain enough phosphates to cast a definite shadow. Yet, some of these patients made no complaint of pain but only of a heavy weight in the perineum. But, when these concretions multiply they may cause atrophy of the prostatic substance so that a considerable cavity is formed, containing numerous small stones, readily palpated per rectum, a grating sensation being imparted to the examining finger. When such calculi enter and remain in the prostatic urethra they produce the same symptoms as ordinary calculi in the same situation.
It is interesting to note the theories as to the etiology of stone in the urinary tract. Two of the most common components in urinary and prostatic stones are calcium oxalates and uric acid.
This theory was expounded for a long time, and that it was only a matter of excluding foods that contained those substances. Then it was found that uric acid was an end product of protein metabolism, and it was thought that by eliminating the proteins the cure was easy. However, people were found to have stones whose diet was free from any proteins, largely carbohydrates. Yet, diet does play a big part in the formation of stones. More because of substances lacking in the foods rather than the foods themselves. Chiefly among these was the lack of Vitamin A of animal origin.
Then, the following theory also will have to be considered as having an indirect bearing on the formation of stone:
Inflammatory bone lesions. Water drinking in which are lime deposits. Prolonged recumbency with infection. Excessive exposure to the sun’s rays. Injuries of the urinary tract. Diseases of the parathyroids. (See Chapter on Parathyroids in Endo-Nasal, Aural and Allied Techniques.) These theories are worthy of close investigation, but a discussion of all of them here would make the book too large for its purpose.
In prostataic calculi there is usually one or more of the following—blood, pus, bacteria, urinary crystals and sometimes a minute amount of gravel.
TREATMENT: Some have claimed that by Vitamin Therapy they have made it possible to dislodge the calculi and have it passed out. We have not been able to do so. Prevention of calculi by vitamins is possible, but the removal after formation and enlargement is another matter. Also, surgery is not always the answer. In most cases conservative treatment is the best. This applies particularly to small calculi. One should then proceed with the vitamins and plenty of drinking water. Light finger massage twice a week, with a careful watch being made on the different localities of the calculi. It is not wise to try to move them toward the prostatic tubes until weeks have passed and there has been time for reduction of their size. Hot baths are in order for pain, and one and one-half ounces of glycerin once a day for three day may be of benefit in emulsifying the calculi. If the glycerin causes flatulent distention an enema will give relief. Short wave will often give relief. Several cases have been reported that cod liver or olive oil taken over a period of several months, in addition to the prostatic massage, has caused the calculi to dissolve and be eliminated. But, should pain become unbearable, surgery must be considered.

Cysts due to the blocking of the ducts of the gland gradually distend as the fluid accumulates. They give no symptoms when small, but large cysts press upon the bladder and rectum with characteristic symptoms. Retention of urine as well as radiating pains in the testicles and thighs may follow. A large cyst has been mistaken for a distended bladder. The contents of a cyst consist of thickened prostatic secretion, granular material and concretions. The treatment for this condition is the same as under Hypertrophy.

Abscess of the prostate may follow an acute prostatitis. It may follow smallpox, chicken pox, scarlet fever, measles, typhoid, or any acute infectious disease. The chief symptoms are a sudden chill, elevation of temperature, repeated attacks of retention, a constant heavy throbbing pain in the rectal region, sweating and a headache. If the abscess ruptures, the symptoms clear. It may, however, rupture and close again. In this case the symptoms will return. Such an abscess may rupture into several organs and structures, but the most common location is the urethra, then the rectum, perineum, etc. An abscess of the prostate should receive immediate treatment for unless it breaks spontaneously, or by the physical therapist, the condition will remain chronic. Treatment is the same as in acute prostatitis.

Malignant growths of the prostate have many of the symptoms of hypertrophy. In the beginning, like all cancerous conditions, they are usually painless. For this reason the onset is insidious and the condition overlooked or neglected until great damage is done. Years may elapse between the first symptoms and the time when the patient goes to a physician for his first examination.
The urinary disturbances are usually the first symptoms to appear. Frequency, five or six urinations at night, exertion to empty the bladder, prolongation of the act of urination, a small, feeble stream, dribbling and finally retention. Incontinence may follow. Pain is not a part of, yet is made more severe in urination and defecation. The pain, once it starts, is a dull, constant aching which persists for months and years.
The pain will be not only in the perineum, but low down in the back, bladder, in hips and legs. The physician may be misled and treat for lumbago and sciatica. Bleeding takes place in about fifteen per cent of these cases, and for a short while after there is some relief. There is some constipation and sometimes intestinal obstruction.
In the majority of cases before the physician can realize the seriousness of the condition he has to deal with, the patient is beyond any possibility of cure either by manipulation or surgery. But in some cases there will be some physical signs that will aid in an early diagnosis. First when the finger comes in contact with the prostate it will feel knobby, and cold. If there are swollen, unequal and iliac glands, and a nodule or nodules in one of the glands, then diagnosis can be considered sure, and these cases can be referred to the surgeon.
In the majority of cases, however, the entire gland is soon involved, together with the prostatic urethra, the bladder, rectum, and seminal vesicles, yet the disease may run its course until death, including the formation of extensive secondary deposits in the pelvic and inguinal lymph nodes, together with metastatic tumors in the bones and other organs, without involving the entire gland. The original tumor may remain small, and even pass unrecognized.
Owing to the fact that cancer of the prostate occurs chiefly in elderly men, who are or might be suffering from enlarged prostate, and that the early symptoms of both conditions are similar, prostatic cancer often remains unsuspected until the disease is far advanced. Just how often cancer develops in the hypertrophied gland and what causal relation if any, exists between hypertrophy and cancer is still not definitely known.
For those who are beyond the scope of surgery, the physician will give as much relief as possible. Hydrotherapy and diathermy seem to fit in the treatment of these cases with the most effectiveness in giving relief.
If the patient can survive the ordeal, the grape diet regime may be tried which has been of great help to give relief. It is always best to have the patient where close supervision and watch can be kept over him.

This is a diminution in the size of the prostate. When the finger is inserted on top of it, it is flat and rather hollow in the middle, and its periphery has the feel of file-like ridges. This is particularly true of the elderly man. Arrested development of the gland is found in combination with other congenital malformations of the genital organs, especially the testicles. When one testicle has failed to develop, there may be a corresponding arrest of development in the prostatic lobe of the same side. Not infrequently, however, both lobes of the prostate are fully developed when one testicle is infantile.
Castration before puberty results in arrested development of the prostate gland. Castration after puberty is followed by diminution in size of the prostate. Castration at one time was supposed to be followed by diminution in size or atrophy of the hypertrophic prostate, and was practiced as a method of treatment for this condition. Reduction in congestion of the organ is produced, but it is no longer the belief that shrinkage of the enlarged organ takes place.
Atrophy may follow inflammatory diseases of the gland, such as acute or chronic gonorrheal prostatitis, tuberculosis, pressure from calculi or cysts. It is not infrequently present in long standing cases of stricture of the urethra.
Senile atrophy develops after the age of fifty, although cases have been reported in the fortieth year.
Frequent urination is the most constant symptom of atrophy of the prostate. The patient averages six to eight times during the day and two to six times at night. Occasionally there is great urgency and constant desire to urinate. Involuntary discharge of the urine at night is not uncommon, and in a few cases complete incontinence is reported. There is generally a loss of sexual vigor to a marked degree and sometimes complete impotency.
TREATMENT: In the aged, and those who have marked sexual weakness the prognosis to attain sexual vigor is very poor and great discretion must be used in making any promises. The aim of the treatment must be toward the most menacing symptoms. Light massage twice a week is in order. Short wave will have very beneficial effect.
Concussion of the lumbars and sacrals have been of great help. Sitz baths, or douche bathing are in order twice a week. If an abdominal ptosis is present a belt can be worn, and the posture corrected. A constant influx of blood and nerve force is the only way that atrophy of the prostate can be relieved, and nerve and blood circulation treatments can be given according to the methods practiced by the individual physician. Special attention should be given to anoxia and anemia. See Chapter on Anoxemia in book: Endo-Nasal, Aural and Allied Techniques.
Three outstanding features of this condition are immediately noticeable. First, a partial or complete impotency. Second, the constant urgency to urinate. Third, the effect on the physical appearance and mental fogginess of the patient as well as some unusual mannerisms. It would be well for the physician to read again the section on psychological impotency found in The Principles of Applied Psychiatry.

In tuberculosis of the prostate there is often a family history of this disease. An attack of gonorrhea frequently precedes tuberculous prostatitis, but it is often found in patients who give a negative history. Tuberculous prostatitis is generally due to an extension of the disease from elsewhere in the body. The predisposing cause may be anything producing congestion in the gland. Stricture, sexual irregularities or excesses, constipation and injuries are among the many possibilities. There may be complete absence of symptoms until the condition is well advanced—a strong argument favoring periodic health examinations. Frequent urination both day and night is often present. The urethral discharge which appears is not infrequently mistaken for a gonorrheal infection. Blood may appear in the urine as well as in the emissions at an early stage. In late cases the desire to urinate is constant, there is pain and burning along the urethra, great straining, and the painful discharge of a few drops of urine at each attempt. The patient is robbed of his sleep and rapidly loses flesh. All hygienic measures peculiar to tuberculosis should be observed. Plenty of sleep and fresh air and special food outlined for people afflicted with this condition. Tuberculosis of the prostate may be:
First, primary in the gland itself.
Second, secondary to tuberculosis in distant organs: namely, the lungs, the peritoneum, etc.
Third, the infection is secondary to tuberculosis of other portions of the genito-urinary tract. In the primary cases the infection may be tuberculosis from the start, or may be ingrafted upon a chronic gonorrheal prostatitis. The third group forms the most common type, the prostatic invasion being secondary to tuberculosis of the epididymis or of the kidney, the former being more common.

SYMPTOMS AND DIAGNOSIS

In the group of cases in which the tuberculous infection is ingrafted upon chronic gonorrheal posterior urethritis, the invasion with tubercle is not, as a rule, attended by any sudden change of symptoms. The patient gradually gets worse in spite of treatment, and examination of the prostate discloses a nodular enlargement, usually of one lateral lobe. In other cases bleeding from the prostatic urethra may first attract the physician’s attention to the probability of a tuberculous infection. In the cases not preceded by gonorrhea the patient usually presents himself, suffering from a chronic posterior urethritis for which there is not apparent cause. Gradually the signs and symptoms of a tuberculous lesion are developed.
In that group secondary to phthisis or tuberculosis of the peritoneum the symptoms of vesicle irritation, with pyuria sometimes hematuria, are gradually developed, usually when the patient’s general condition is already quite hopeless.
In the group of cases secondary to tuberculous epididymitis the presence of an enlarged, nodular, hard, usually painless epididymis upon one side is followed or accompanied by vesicle irritation, the appearance of pus and shreds in the urine, sometimes hematuria. Rectal examination discloses a nodular prostate.
The following are the data upon which the diaagnosis may be based. A tuberculous personal or family history. The presence of other tuberculous lesions, either distant or of other parts of the genito-urinary apparatus, notably of the epididymis. The extreme chronicity of the disease. The presence of tubercle bacilli in the urine. The utter futility of ordinary successful treatment. The fact that such treatment only aggravates the ssymptoms. The introduction of a sound or catheter and irrigation of the bladder is followed by an exacerbation of all the symptoms, but increases pain and frequency, a hemorrhage, an attack of epididymitis, etc. The irregular nodular enlargement of one or both lobes of the prostate. The formation of a tuberculous abscess or the existence of a tuberculous fistula as the result of such an abscess. The occurrence of one or more shaarp attacks of prostatic bleeding. These are the data whereby we arrive at the diagnosis of tuberculosis of the prostate.

The prognosis of prostatic tuberculosis is bad, though the course of the disease is very slow. Death comes from dissemination of tubercle, from exhaustion, from abscess formation with septic infection or urinary infiltration from kidney tuberculosis or from preexistent tuberculous lesions of the lungs. By hygienic measures, life out of doors in suitable climate, etc., cures are possible in a few cases. A few operative cures have been reported from incision and curettement of tuberculous prostatic abscesses. So far we have not been able to accomplish much with this condition except to give temporary relief. It is gratifying to know that not more than two per cent of all cases of prostatitis are of this nature.

If there is an abdominal ptosis or the football belly, an abdominal belt is advisable. If scrotum is large a suspensory support should be worn.
Moderate exercise is essential, should be regular and never carried to the point of fatigue, sawing wood, playing golf or walking. A walk of two miles a day in the open, with periods of rest is one of the best exercises.
Clothing in winter time should always be very warm. Woolen underwear if the patient is over sixty years of age.
Sitting suddenly on cold seats is bad.
A flannel abdominal binder can be worn in place of a belt, but should not be removed until warm weather.
The diet. No man should eat any foods that, by experience he has learned disagree with him and aggravate the condition. All greasy foods, insufficiently cooked vegetables, heavy breads and pastries, raw vegetables such as radishes and cucumbers, excessive uses of salt or any condiments and highly seasoned foods have been found to aggravate prostatic conditions. A patient with a prostatic condition should never overeat. Sometimes a milk fast for one day a week has worked wonders. A four ounce glass of milk every two waking hours is sufficient.
Alcohol is a direct irritant to the bladder neck and must be forbidden. But, if a man is a daily drinker, consuming a certain portion each day, and a sudden stopping at once would shock his psyche, then he must be ordered to taper off the amount gradually until he can break off completely.
Sound, relaxing sleep for six to eight hours can be called sufficient if the daily toil is not that of a laborer.
Sexual intercourse should be a regular habit and should be at uniform periods and be preceded by love-making. If a man, whose natural ability for intercourse, is, say — once or twice a week, indulges himself two or three times that number and must use artificial methods of forcing an erection it will injure his physical life, especially his prostate and vesicles, and will also build up a mental fear of not being able to accomplish the act, thereby bringing about for the time being at least a physical or physic impotency, which, if continued, will lead to a permanent impotency.
The husband must be taught to know his natural rhythm, that is, know how regularly he can have intercourse without artificial stimulation. When he has found this out then he should never neglect to prepare his wife by caresses for the act. It takes but a little loving and mutual respect for husband and wife to come to a real harmony of sex instincts. When the act is being performed, he should come at once to its termination, fulfilling it agreeably and completely. He must be warned that in his condition any psychic suggestion may cause him to delay and become impotent for that particular act. He must also be warned that sexual excitement without gratification creates a further blocking and congestion of the prostate and vesicles doing a great deal more damage. If he wakes at night with an erection due to a full bladder, he should urinate at once and not attempt to break his regularity of intercourse. If the erection is due to a full bladder, an attempt at intercourse will result in failure, and possibly do him unrepairable damage. If a complaint is made by the wife, then the physician should ask husband and wife to come to his office where he can fully explain why such a procedure needs to be followed.
A hobby is particularly beneficial for those who have a morbid state of mind, and worry too much about their loss of vigor and stamina. The patient must be told that constant thinking about the matter only creates greater psychic inhibitions, and the more he can occupy his mind and bodyinside and outside of his business hours the less annoying will become the symptoms of the prostate gland. This hobby business is a “must”—especially for the retired man or the man out of work for any length of time. Constipation must be avoided, for it is one of the great causes of prostatitis, and direct cause of irritation to an inflamed prostate. But, the purgative or foods eaten should not be of such a nature as to cause a thin, watery evacuation, for that will cause burning and much irritation in the rectum if continued over a period of time.
For men who are overanxious in regard to sex relations, and it seems to affect their psyche unduly, Hormones or Vitamins A, B, E, E+ and F, can be suggested. We do not know whether these glandular or vitamin substances have any physiological value or not, but they do have a powerful psychological value which has been demonstsrated again and again in giving the man confidence that he can accomplish the act without undue worry or fear of hysteria.
Long automobile driving or riding must be restraicted to not more than one hundred miles, before a stop is made, and some stratching of the legs is made. Prolonged sitting, hour after hour is not conducive to a free flow of blood through the lower parts. When the patient has pain at home he should be instructed to do one of two things. Spray with hot water on the parts, or cold water, one or the other will give relief. Or, if the pain is on one side of the crest of the penis, he can press deeply on the other side, goin in deep under the penis and holding steady for one minute; then release for one minute. This should be repeated three times. If the pain is on both sides then this technique should be performed on both sides. Many of my patients have actually helped to bring about permanent relief in this way.

DEFINITION: Any inflammation, infection or injury affecting the seminal vesicles. Diseases of these organs is rare, and even in most cases are associated with diseases of the surrounding genital organs.

The seminal vesicles are two hollow organs lying above the base of the prostate between the bladder and the rectum. They are two inches long and one-half inch in diameter, lie transversely along the upper border of the prostate, and incline upwards, especially at the outer end. They are bound to the bladder wall by a layer of tissue of fascia, continued upwards from the back of the prostate. Each seminal vesicle consists of a coiled and folded tube which will stretch to about six inches in length. At the inner and lower end is the narrow duct which unites with the corresponding vas deferens to form the ejaculatory duct. The function of the seminal vesicle is to store spermatic fluid to which it adds a secretion of its own. The vesicle consists of a convoluted, blind tube, about four inches in length, having many lateral blind pouches and sacculi, inclosed in a thin, fibrous capsule, but loosely attached, and containing some muscular fibre. In health their lower thirds feel like two irregularly cylindrical bodies, of elastic, soft consistence, extending upward from the prostate, separated by the width of a finger.
One or both vesicles may be absent. The tests are commonly absent in the latter case. The vesicles vary much in size, not only in different persons but in the same individual on the two sides. One, usually the right, may be much larger than the other.
The secretion of the seminal vesicles consists of a viscid, opalescent fluid. It is usually seen intimately mixed with the secretion of the testes, i.e., spermatozoa. The vesicles probably act to a considerable extent as storehouses for the semen. This is shown by the fact that in a normal individual who has been continent for some time the vesicles can be more distinctly felt and their distention recognized by touch than if palpated soon after sexual intercourse.
Since the vesicles are the contiguous organs that seem to have a more profound effect upon the prostate than any other organ in a diseased condition, a little more detail will be given.

METHOD OF OBTAIING THE CONTENT OF THE SEMINAL VESICLES FOR PURPOSES OF EXAMINATION

The patient passes his urine. The urethra is then washed clean with a mild salt solution and a few ounces are allowed to remain. The contents of the prostate are then carefully expressed by the finger in the rectum. A smear may now be taken from the meatus for miscroscopic examination. The patient now partly empties his bladder to wash out the urethra. The finger is then introduced into the rectum as far as possible, and the seminal vesicle is then repeatedly and firmly stroked from above downward on one or both sides. Some care and practice are necessary to drain the contents of the vesicles. The patient should bend his body over the back of a chair while the physician stands behind him. Since very firm pressure is needed against the perineum in order to reach the vesicles, the patient’s body should be solidly supported. The physician’s right forefinger is introduced into the rectum—he stands with his own elbow pressed against his own side, so that the weight of his body may be transmitted through the forearm and the examining hand—the same attitude, in fact, assumed in making a deep examination of the pelvic organs of women. The forearm, wrist, hand and forefinger should be held in a straight line, the third, fourth and fifth fingers sharply flexed into the palm. Palpation and treatment is made by flexion of the terminal joint of the index finger. Thus the weight of the physician’s body helps to invaginate the soft tissues of the perineum and by attention to these details one is enabled to reach a good deal higher. Some of the contents of the vesicles will usually appear at the meatus, and may be examined at once. If not, the patient empties his bladder, the liquid discharged is centrifuged, and the product examined under the microscope. As stated, spermatozoa will probably be found in moderate numbers. If, in addition, the fluid contains numerous pus cells, the seminal vesicle is inflamed. Search for gonococci should be made and if such be found, the fact will explain the obstinate persistence of chronic and relapsing gonorrhea in a certain proportion of cases. For a treatment of the vesicles, the same position is assumed as above by both physician and patient; when the vesicles are reached they are massaged downward, lightly the first time, then a little harder each week.
Some of the conditions that can afflict the seminal vesicles are: Gravel or concretions in the older men, that give rise to spermatic colic. The treatment for pain can be a hot rectal douche, or diathermy or short wave. Light massage is helpful. If pain is severe and continuous surgical interference may be necessary.
Acute and Chronic Vesiculitis may be due to result of gonorrhea, or some other organisms. The symptoms of the acute condition are: An uneasiness in the lower belly, then at the beginning of suppuration painful and frequent micturition, very painful defecation, and pains in the anus and rectum, perineum, and hips or back are likely to be complained of. Priapism and bloody ejaculations may be noted. True abscess formation is rare.
The vesicles on palpation from the rectum at the sides of, and behind the prostate are found enlarged, tense and very tender. The treatment must be then of a general nature, for removal of infection from all the genitalia.

DEFINITION: An inflammation of the epididymis, which may be syphilitic, tuberculous or of gonorrheal origin.
The testes, two in number, are suspended in the scrotum from the groin, or inguinal region, by the spermatic cords. The left testicle hangs somewhat lower than the right in the majority of cases. Each gland consists of two portions, the testis proper and epididymis. In each testis are from five to seven hundred little tubes, or tubules. The spermatozoa after being developed in these tubules are transmitted through the epididymis to the vas deferens. Thence, at orgasm, they reach the urethra through the ejaculatory duct. This duct is formed by the conjunction of the vas deferens and a narrow duct coming from the corresponding seminal vesicle. The testicles are subject to injuries, infections, torsions, congestions and many other conditions which can have a direct influence on the prostate. Hydrotherapy measures are the best treatment here. A torsion of the epididymis can be adjusted by the fingers, by twisting it to its proper place. Then strapping it.
SYMPTOMS: These are the inflammatory type — tenderness along the cord, hard swollen vas, and pain in the back. The testicle rapidly swells, and becomes exceedingly tender, the patient walking with a stooping posture and the legs wide apart. When the inflammation is at its height general malaise, anorexia and fever of 100 degrees or over may be included in the clinical picture. On examination the tenderness and swelling will be found confined to the posterior part of scrotum.
TREATMENT
HYDROTHERAPY: Rest in bed with the scrotum elevated. Hot fomentations, if pain is not too great. In that case an ice bag can be used, but it should not be used too long, because it will devitalize and cause a hardening of the part. When pain has eased it should be removed. Hot sitz baths are helpful. Spraying with hot water is very beneficial.
ELECTROTHERAPY: If of gonorrheal origin, the diathermy fever methods of treatment can be said to be the best. Infra-red eminations are helpful. Surgery is sometimes required.

DEFINITION: An inflammation of the testicle caused by gonorrhea, mumps, tonsilitis, tuberculosis, syphilis and traumatism.
SYMPTOMS: Dull, sickening pain, radiating towards the hips and back; the testicle rapidly swells, but retains its ovoid form. Occasionally an acute hydrocele develops, and as a result there is an increase in swelling and pain. Occasionally suppuration takes place.
DIAGNOSIS: Orchitis must be distinguished from epididymitis, which can be readily done by noting the position of the tenderness, this being posterior when the epididymis is involved.
TREATMENT: Short wave, ultra-violet ray lamp or by vacuum tube diathermy and infra-red may be used. The old time hydrotherapy procedure was to put hot applications on saturated with laudanum and lead. Rest is absolutely essential, with good nourishing food and plenty of fresh air. Cod liver oil with vitamins included of either A-B or C-D.

Retention of the urine may become so great that it will distend the bladder to such an extent that its upper border will reach almost to the level of the umbilicus, before the help of a physician is sought.
Instruments to overcome retention should be used only as a last resort.
The patient should first be given a hot douche bath. That is, hot water should be sprayed on the penis, testicles and bladder region, or given a hot sitz bath, to see if the tissues will relax and allow the urine to pass. A non-drug diuretic can be given. A low hot enema may enable the patient to relax the bladder sphincter while emptying the lower bowel. Some have found that by injecting warm glycerine into the peneal urethra then massaging it upward toward the bladder that relief has been obtained. After all these methods have failed then catheterization is in order.
Three important rules should always be kept in mind: First, clean hands; second, clean instruments; third, gentleness in the operation. Clean hands and clean instruments are necessary to avoid sepsis. Sepsis may also come from the patient himself. (See under Infection.)
In an emergency, after the previously mentioned methods have failed, the next best thing that can be done is to give an irrigation of the peneal urethra through the meatus by a fountain syringe or a hand syringe. A teaspoonful of boracic acid to a pint of warm water, after which a short rubber catheter is passed into the bladder and the urine is drawn off, the bladder then is irrigated with half the solution mentioned above, some of which is left in the bladder. When sepsis is very important, we are of the opinion that gentleness in introduction of the catheter is more important. We are inclined to the belief after careful observation that there is more danger from injury than from sepsis.
If it is at all possible to get some one who has had experience in this technique it is wise to do so and observe carefully the technique. But, emergencies do sometimes arise in which there is no time to delay, lest uremic poisoning set in and which may have a fatal termination. In that case the general practitioner must do his best, always aware of sepsis and gentleness.
Now, most men may be catheterized easily with a soft rubber catheter which is the safest with less risk of injury. The latex catheter is the best for this purpose. If you will recall that under hypertrophy of the prostate we mentioned that sometimes the prostatic urethra was enlarged by pressure. This enlargement may make it difficult to get the catheter into the bladder; this condition may make it necessary to use an especially long one which has a bend near the end and to use the largest size in diameter than can be introduced into the urethra. However, try the smallest size at first and sufficient urine to relieve the acute symptoms is allowed to escape. Then the catheter is withdrawn. After four or five hours if the patient feels the desire to micturate and cannot, then the catheter is reintroduced, and a larger quantity is drawn off. We are here writing of only one phase of retention of urine: The prostatic urethral.
Retention of urine may be due to an obstruction at any point of the channel of outflow:
At the neck of the bladder, as a result of an intravesicle tumor of hemorrhage filling the bladder or of pressure from without caused by pelvic tumor due to enlargement of the gland.
The result of senile change, malignant disease, calculus, or abscess formation in the membranous or penile urethra owing to the formation of a stricture (whether traumatic or inflammatory); or, from occlusion by an abscess at the external meatus at any part of the urethra, as the result of the impaction of a vesicle calculus or of a foreign body.
Retention may be due, however, to non-obstructive causes, such as tabes dorsalis, hysteria, lesions of caude equina and reflex inhibition.
The course of the more common lesions which produce obstruction to the outflow of urine are slowly progressive, senile, enlargement, or atrophy or some chronic condition. When, however, the lesion is complicated by inflammation or vascular engorgement, as may be produced by a drinking bout, or excessive exercise, or a long period of sitting on a saddle, acute retention may supervene.
It is necessary, therefore, to obtain all possible information of the previous history of the case so as to ascertain whether there has been any difficulty in passing water or any reduction of the stream, such as might be expected in the case of a stricture, or any frequency of micturation, particularly at night, which would suggest prostatic enlargement, or a discharge, if recent and profuse, due to an acute urethritis. The age of the patient, the acknowledgment of venereal infection, or history of injury must all be taken into account.
In cases of stricture, a large gum elastic catheter is used, and when the catheter is stopped the point of stricture is known. Then, smaller catheters can be used. If the stricture is finally passed by a very small catheter this is then tied in place and left there for about ten hours.

The catheter having been well lubricated on the tip with a water-soluble jelly and made slippery, the water-soluble jellies are more easily removed from the genitals than oils of any nature. Now that the catheter has been sterilized and lubricated, stand on the right side of the patient, who is flat on his back with legs spread apart. Gently stretch the penis forward with the left hand until it has reached its limit, slightly toward the left groin, then insert the catheter with the right hand into the meatus. After this is done, the penis is brought to the center and held directly upward. Now, with little force, if any, slide the catheter down the urethra as far as it will go. If obstruction is encountered do not use force of any nature without turning the catheter from the side line to the middle, then try to slip it past the obstruction with very little force; if this is not possible, turn the catheter gently, completely, around if necessary. The bladder will be entered as the shaft of the catheter becomes horizontal. The possibility of urethral shock must always be kept in mind. It is more apt to occur in the aged than young men at the first attempt, and particularly in those who have enlarged prostates, especially if metal sounds are used. This shock is due to a rapid emptying of a chronically distended bladder, which causes a fall of blood pressure averaging 40 mm. of mercury in the first twenty-four hours, and that in 60 per cent of the cases there is a further fall averaging 17 mm. in the next twenty-four hours.
The greatest peril lies in the removal of the first few ounces of urine, there being a fall of twenty-five per cent in the travesicle pressure with the removal of one ounce, and an additional fall of twenty-five per cent with the removal of the succeeding one to three ounces.
It is possible that a continued fall in pressure cn have a fatal termination. While this outcome is always possible, it can be avoided with proper care, in not allowing the bladder to be emptied rapidly but drawing one ounce at a time. If, after the first catheterization is a success, and the bladder has been evacuated slowly and further catheterization is necessary after a wait of a day, then the catheter can be placed in a position and tied to remain for a number of hours at a time.

When is surgery indicated? Prostatism is a progressive condition, which, if not relieved by treatments, leads to a fatal termination. But, surgery has prolonged the life of many men for years and years, some of whom have been able to exercise the sex function occasionally, but with hardly any satisfaction. The author has always considered it wise to have the patient consult a urological surgeon immediately after the second attack of retention of the urine. From that time on the patient has the alternative of operational relief, or a catheter life. The catheter life is a short one—not more than two to five years at the most. There may be some who by great care and natural living extend the period to a year or two longer, but they are few in number.

ETIOLOGY: Injuries to the drum membrane may be caused by blows on the ears, by attempts to remove wax, or stop itching by various instruments by the person himself, or by a physician who fails to remove the object properly and skillfully. Too forcefully blowing the nose has been known to break the tympanic membrane.
TREATMENT: The less done for this condition the better for the patient, other than wiping out what debris and putting a wad of cotton in the ear and wait for any results, often there is no impairment of hearing whatever.

The writer suggests to the reader that in addition to what follows, he should read pages 38, 50, 75 to 85 in Endo-Nasal, Aural and Allied Techniques Book by the writer. The diseases of the Auricle are many. There may be congenital or acquired malformations. These, if treatments are needed require the services of a surgeon. There may be inflammations of various kinds, one may be frost bite. The condition can become serious, varying from hyperemia to ischemia, and in some cases gangrene and death of the tissue. The treatment may be gentle massage. Application of snow to the auricles. If heat is available it should be applied gradually. The vacuum cup is also of excellent benefit, using discretion and the proper sized cup.
Erysipelas of the ear is the same as found in other parts of the body, and the discussion of it is contained in another part of this book under that title.
ECZEMA: This may be an extension of eczema of the face. The disease may be acute or chronic, moist or dry and may have the following forms — erythema, papules, vesicles and pustules. Symptoms may be weeping, fissures, crusting and scaling, in the severe form there may be pyrexia and swelling. The chronic form has a tendency to recur.
ETIOLOGY: This is usually constitutional, such as digestive disorders and malnutrition or a deficiency of all or one or the other vitamins of B, G, A and D. Rheumatisms, gout, rickets, anemia, and a host of other constitutional causes may be mentioned Some other causes are emotional, occupational and allergic disturbances. If there is a discharging ear, it may or may not play a part in the production of eczema of the ear.
TREATMENT: The treatment is largely constitutional. Find the cause and remove it. Tonics, diets, vitamins are all in order. The local treatment — moisture and irritation should be avoided as far as possible. Ultra-Violet from a cold quartz has been found effective by producing a second degree erythema, and repeated in a few days after the erythema has subsided. Sometimes in the moist type a non-vacuum electrode connected to the Audin pole of the high frequency machine and applied with slight pressure will give the best results. It is helpful to sprinkle the part with zinc stearate powder for it is antiseptic and allows the electrode to move freely over the part.
The above treatment may also be used in shingles and variola of the Auricle. One good addition to the above therapeutics is to have the patient clean the Auricle daily with a 50-50 solution of lemon juice and water. The above is in addition to treatment of the underlying cause.
Neoplasms, Cysts, Elephantiasis and Malignant tumors in and around the auricle usually require the services of a surgeon if they are troublesome.
FOREIGN BODIES IN THE EXTERNAL CANAL: The symptoms may be mild, or severe, according to the type of obstruction and location. There may be slight impairment of hearing, a fullness in the ears. They may be tinnitis, dizziness, itching and reflex coughing from irritation of the auricular branch of the vagus nerve. A good autoscope will reveal the type of the obstruction, which may include seeds, pencil points, impacted cerumen and some decomposed material. At times insects will get into the canal and cause great annoyance. Pouring some hydrogen peroxide into the canal will get rid of the insects. If not, then the use of the ear syringe is required. For removal of impacted cerumen and objects the following methods may be tried. If there is pain, heat of any kind applied first will give relief Then, warm wter should be used in the syringe first, followed by hot water of about 105 degrees F. The water is projected up over the object to be removed. A cup of some sort is held under the lobule, and a towel is put over the shoulder. Oil solutions of various kinds, or boric acid solution may help soften the mass. A small, smoothly working piston syringe is to be best recommended, with a small tip that will enter a little way into the canal without obstructing the view. Always, and ever, there should be care not to injure any of the hearing apparatus. Please turn to your Endo-Nasal Aural and Allied Technique Book, page 80, in the Fourth Edition and page 107 in the Third Edition for complete instructions.
Furunculosis or boil in the External Auditory Canal: The ear is rather susceptible to these boils, especially in debilitated persons. It may occur in the summer time, from swimming, or at any time from scratching the ear with foreign objects to relieve itching; causing a breaking of the canal membrane which becomes infected. They also may be caused by the same constitutional conditions that cause furunculosis in other parts of the body. The main symptom is extreme pain which is pulsating in character, due to the pressure of the narrow space for the development of the boil. The pain is increased by talking or moving the jaw or while eating. The temperature may rise a few points. The diagnosis can be fully established with a good autoscope. The treatment consists of two parts. First — to control the pain, then to remove the cause. Warm, moist compresses, continuously applied. Infra-red, with ear funnel, or a hot water bag or electric pad, can furnish the necesssary heat.
STENOSIS — or too narrow external ear canal may be helped by giving the Ear Fixation treatment, or continued dilation treatment with the little finger. Sometimes, a plastic surgeon’s services are necessary. If there is pain, heat in some form can be applied.
OTALGIA, EARACHE WITHOUT ANY IMPAIRMENT OF HEARING. — The importance of quick attention to any distress in the ear cannot be emphasized too strongly. It may be the beginning of an abscess in the middle ear, which if properly examined and treated may avoid more serious complications. Unless there is a deeper constitutional cause, most of the earaches come from swimming, or picking the ears with instruments that scratch the membrane or come in contact with the drum too forcefully. Too strong currents of air may strike the ears and set up a temporary irritation; mild reflex irritations from congestions in nose, throat, and the pharyngeal cavity may cause some symptoms of pain, or muscular rheumatic diathesis may be present. Every ear distress has a possibility of serious complications. Tympoil is highly recommended for pain. Roche-Renaud Pharmaceutical Company, Fairhaven, Mass. Radiant light heat and infra-red have been found to produce splendid results. Positive galvanism, which has been successful, is given by placing an electrode in the ear or a pad electrode behind the affected ear, with the negative pad on the opposite side of the neck Heat of some nature is necessary. After all the pain has been relieved, then Endo-Nasal Techniques can be instituted to remove the causes. See “Endo-Nasal Techniques.”

Otitis Media Non-Suppurative. — Otalgia of this nature is usually of catarrhal origin, created by anoxia of the middle ear. The middle ear, in health consumes great quantities of air and oxygen. This air is supplied through the eustachian tube. If the nose and the pharyngeal cavity and the cavity of Rosenmuller have obstructions by mucus, ptosis, adenoids, or adhesions the entrance of air and oxygen to the eustachian tube is shut off, and the air in the middle ear is rarified. This causes engorgement of the blood vessels and in time a serious exudate is poured out which fills the tympanic cavity, causing the tympanum to bulge, giving pain on pressure. This exudate becomes purulent and infected by bacteria because of the lack of cooling by the germ-destroying elements of air and oxygen. The amount of pressure against the drum will vary according to the amount of interference with air passing through the eustachian tube. If the interference is slight there may be a low degree of congestion, which may pass off in a day or two. When the pain is exceptionally severe, the interference by congestion of ptosis of the eustachian tube is very great. If the congestion is not released then the otitis will go on to rupture or paracentesis of the drum membrane.
The doctor has before him three tasks: First, to relieve the pain; second, to create drainage, and third, to remove all obstructions to the intake of air into the middle ear. We are convinced that if rupture and paracentesis can be avoided by establishment of the above three healing proesses, the patient will in future years be better off if afterward an occasional Endo-nasal treatment is given.
PHYSICAL SIGNS: The signs of this disease are pain and throbbing with certain degrees in loss of hearing. Some have tinnitis, redness, and a bulging outward of the drum tympani with disappearance of all signs of the malleus except the handle.
Extraneous points of examination for possible infiltration of toxemic substances and obstructions are the teeth, tonsils, nose, pharyngeal cavity, carotid sinus block, the liver and intestines through congestion and constipation.
TREATMENT: The first step as we have noted before is the relief of pain. Methods suggested for otalgia are all useful. In addition, the standard remedy for this particular condition is phenol and glycerin. Glycerin has osmotic power and attracts fluid from the membrane, while phenol has antiseptic properties that relieve pain. A blending of five per cent of phenol and ten per cent of pure glycerin is the proper proportion. The patient lies on the side opposite to the affected ear. The ear is pulled down a little and the solution poured in. The patient is told to lie in that position for at least a half hour. This can be repeated as often as necessary. This solution should not be used in purulent discharging ears.
Radiant heat light has been advocated as the ideal treatment for otitis media. It is claimed it will lessen the earache immediately, and in most cases the membrane and canal will clear up in two or three days, the exudate will be absorbed, and the bulging of the drum disappear, paracentesis avoided and infection controlled. While we can see how the pain should be lessened by the heat, yet we fail to understand how the obstructions of a static nature can be removed by the radiant heat. This, as we see it, can be done only by finger or instrumental surgery. This brings us to the second desired result; namely, removal of obstructions and drainage. After all pain has subsided, every General Technique should be given, with special emphasis on the external and posterior nares, Eustachian tube and tonsils. Treatments for at least six to eight weeks, twice each week, should follow an acute attack, with diets and vitamins to suit each particular case.
ACUTE AND CHRONIC PURULENT OTITIS MEDIA: Otitis is a discharging ear with small or large perforation or with complete obliteration of the membrane tympani. Barring accidents and paracentesis, it is otherwise a sequence of acute catarrhal otitis media with rupture. In some cases the discharge may last only a few days or weeks and then cease. In others, it will continue intermittently or almost continuously for a long time, even through life.
The symptoms are easily recognized; the discharge and odor. The odor of discharge is not as offensive in some cases as in others, but so far as we have been able to judge the odor has no special significance in evaluating the effect of treatments or of the virulence of the disease Both the non-offensive and offensive seem to respond alike in a given time. Some never respond except by surgery, and few patients care to submit to the operation because of the risk of total deafness in the affected ear. Many patients and others who have discharging ears can hear rather well without aids of any kind if the discharge does not block the ear entirely. It often happens that after the ear is blocked for a day or two, the pressure of pus forces the block out and there is an overflowing rush of fluid for a few seconds. It is known that people have lived for a half century and more with this condition, and gotten along very well except for some annoyance from the odor. Surgical interference of course, should be suggested only as the last resort.
TREATMENT: The damage having been done to the tympanum by rupture or paracentesis, and to the contents of the tympanic cavity by pus and other exudates, the effort of the Endo-nasalist must be directed toward saving as much of the hearing as possible, and to the removal of the causes of the discharge. The causes can be stated briefly as anoxia of the middle ear and imperfect drainage. There also may be anoxemia, created by the anemia or ischemia of tuberculosis, syphilis, or diabetes. These latter complications make such cases almost hopeless, but the physician should try at least to bring about some relief.
Since this condition is generally a sequence of otitis media, it follows then that after the acute attack, sufficient drainage and airifying did not take place and there was a prevention of the recession into the lymphatics or open cavities of the catarrhal substances. Draining must now be established. To overcome the blocking and anoxia, give the full General Endo-Nasal, Aural and Allied Techniques, with specific techniques on tonsils, the pharyngeal cavity, and the Eustachian tube cavity on the side of the affected ear. All sorts of remedies have been offered for discharging ears, but none of them will amount to much unless the obstructions to the intake of air and oxygen are removed.
AIDS: To keep the ear clean, a light wash of two ounces of warm water with ten drops of lemon juice has been found very suitable. The patient lies on the opposite side to that of the affected ear. The solution is put in by a dropper. After a few seconds the patient turns over and floods it out. This is repeated until the solution is used up. Ultraviolet light from a water cooled lamp is of some value, but should not be employed until obstructions have been removed in the nose, pharynx and the cavity of Rosenmuller.
Zinc ionization has been reported to bring about very favorable results, both alone and as an aid to Endo-nasal Therapy. This technique and its contraindications should be studied thoroughly before the operation is performed. Efforts should be made by diets and exercises, especially of walking, to build up the patient’s resistance.

This is a condition that is baffling to say the least. In a class room, our professor once remarked that otosclerosis is a condition about which the doctor is in the dark, can see nothing, and the poor patient can hear almost nothing, if not absolutely deaf. For a definition of this condition, we have searched the literature available, and all definitions are practically the same with some slight deviation in the use of words. The substance of them all is that otosclerosis is a spongification of the bony capsule of the labyrinth and fixation of the stapes due to ankylosis of the oval window, the membrana tympani are normal and the Eustachian tubes are of normal patency. It is easy to accept the first part of this definition relative to spongification, ankylosis and fixation, but difficult to accept the last part, in view of our experience. Most of these patients, on close examination, show some variations in color and contour of the tympanum, and a bulging of the carotid sinus area, which denotes a ptosis of the Eustachian tube.
Again, if the patency of the Eustachian tubes were true, it is extremely doubtful if spongification could have taken place. It may be true that the ear can be inflated and the sound can be considered to be that of the air going through the tube by force.
However, if there had not been an anoxia, thereby causing a rarefication of the air in the first place, no engorgement or spongification could have taken place. It is reasonable then to suppose that preceding the otosclerosis, there were toxemic infiltrations, stasis, exudates, and hardening due to a lack of free exercise of the Eustachian tube functions, and the assumption that the Eustachian tube is not fulfilling all its functions remain even after the disease has fully developed. The assumption also remains that the origin of the cause of auditory sclerosis is the same as sclerosis or arthritis anywhere else in the body. It is our practice in all cases of this nature to study thoroughly all signs of physical disturbances in the whole body. Intoxications from the intestinal tract, rheumatoid arthritis from excess calcium, use of drugs, tobacco and alcohol are all studied carefully. Anemia, local ischemia tuberculosis, and other symptoms which can produce anoxia and anoxemia are investigated.
Those who were not afflicted by heredity usually have a rather long history of congestions and colds affecting the nose, the pharyngeal cavities in particular. Extension of the congestion through the Eustachian tube to the middle ear diminishes the amount of air that normally should pass through the tube. Because of this diminished amount of air, the congestion begins to dry, a process which eventually affects the bones producing a hyperostosis with spongification and fixation of the ossicles.
SYMPTOMS: There is a gradual loss of hearing, but sometimes this varies, the hearing being better some days than others, especially if the weather is dry and clear, but trend is toward greater deafness. The membrane tympani is usually showing its normal luster, but careful examination will reveal some signs of congestion of the inner wall. Patients say they can hear better in noisy places; others say they hear the sound of the voice but cannot quickly distinguish the words spoken. This slow apprehension is due to the weight of the congestion on the inner wall of the tensor tympani. While in a noisy place, the weight of the external vibrations forces the congestion back of the tympanum to recede enough to allow the vibrations to go through. Noise and voice vibrations are blended, but by some inherent or developed faculty they are able to differentiate the sounds and interpret them one from the other. The patient will hear his own voice at a pitch higher than others, and if of a nervous temperament, he will be afraid of it and speak very low. It disturbs him to speak loudly because of the pitch in bone conduction and also from the fear he is yelling at people. Some overcome the fear and go to the other extreme, and they really do yell in conversation. Tinnitus is present in more or less degree and is worse at night than in the day time. Tinnitus, we have found, varies much in tensity according to the general physical condition and the temperament of the patient.
TREATMENT: This is a condition that involves the whole upper respiratory and auditory apparatuses. Therefore, all General Techniques should be given at least twice a week. Emphasis should be placed on external nasal, tonsil, and post nares drainage, with a thorough clearing away of adhesions, adenoids and toxic matters from the whole pharyngeal space, and an effort to get the finger in the fossa of Rosenmuller to massage and clear the auditory orifice. (See specific techniques on breaking adhesions and raising the Eustachian tube.) In addition to the above, every effort should be made to get more freedom in all the processes of respiration. It might be well to state here that we are decidedly opposed to the use of the Eustachian catheter both from personal experience and from reports that have reached us of some of the after effects. The technique is always painful and there is always great risk of some injury and even death. Should the point of the catheter make a break in the mucous membrane to the extent that emphysema is brought about, an obstruction to respiration may be so great as to cause a fatal anoxemia. We have experienced pain and distress for weeks after these operations without any beneficial results. Diathermy has proved itself of great value from reports we have received. The idea is that since diathermy is very useful in treating any conditions of fibrous connective tissue formations, or fixations of joints, it is reasonable to assume that it should act on the same principle in the middle ear. The purpose, then, of applying diathermy is similar to that of treating a joint. Absorption of calcified deposits may be affected to such a degree that function is at least partially restored. Diathermy increases the arterial flow in the part treated and augments the return circulation; intercellar tension is then altered and cellular acticity stimulated. Furthermore, it is fairly well accepted that sedative diathermy aids in the absorption of effusions, the softening of exudates and fibrous tissues, and in relaxation of muscle spasms. By giving the general endo-nasalist’s treatments and the few specific techniques as mentioned above, we believe we have the best approach to this problem, because of attention to the constitution as a whole. No. 1 and No. 2 diets, alternated day by day, for a period of a month or so, with supplemental vitamin therapy, especially that of the endocrine type, and some clear cut instructions to the patient on their habits of life, can be of assistance. Total deafness may be delayed, or hearing gradually restored to such a degree that the patient will not need to resort to lip reading or mechanical devices. It is wise to instruct the patient in living the positive life, or forming the habit in conversation of insisting on hearing distinctly what is being said before replying. This will in time rehabituate the functional faculties of reception and interpretation of sound waves. These are like any other portions of the body; if not exercised, they atrophy.
TEMPORARY FIXATION OF MEMBRANA TYMPANI AND THE OSSICLES: Very often patients will complain of a fullness in the ear with some sound as of wind coming out or going in. They complain of being dull of apprehension and also lack of alertness. Nothing seems to be wrong. However, a careful examination of the membrana tympani may reveal some slight deformities or variations in position.
Look into the ear of a normal hearing person who has not complained of any ear troubles worthy of note for some years. You will notice that the cone or membrana tensor is pearl gray and of transparent appearance. It is like a light in a cavern. The whole drum is oblique in appearance. Notice now the short process of the malleus located in the upper portion of the drum. In health, it is yellowish white. Then look at the long process of the malleus terminating in the lower middle of the “U” of the membrane at what is known as the umbo, or the funnel-shaped area of the drum membrane. Look carefully into the ears of several people of good hearing and you will notice some slight variations in color and light reflex; however, the variations are very slight, but all variations are of significance when a patient complains of pain. However, if there is a fullness felt and a slight lack of acuteness then we can regard it as a temporary fixation of the tympani itself and possibly a temporary fixation of the ossicles.
TREATMENT: A little heat applied in any form and then The General Endo-Nasal, Aural and Allied Techniques with emphasis on No. 4 and No. 5.
TINNITIS AURIUM — is discussed under the general topic of Meniere’s disease.

There are many kinds of deafness and many causes. Deafmutism is not considered here because it largely belongs to the field of education, and is a rather too long and complicated procedure for discussion in this book. It is a congenital or acquired deafness complicated by special inabiity that requires a special education of the person to make adjustments to normal living.
Deafness, as we define it here is the inability to hear sufficiently to carry on ordinary conversation. It is assumed under that definition that the person could hear well or fairly well at one time in his life and that as time went on the ability to hear was suddenly completely lost or gradually diminished to a certain degree of acuity. Accepting the above definition, the etiology may be stated as follows:
There is a deafness due to catarrhal infection. Endocrine disturbances, occupation, such as in noisy places of employment. Adhesions in and around the fossa of Rosenmuller. Cerebral deafness due to brain lesions. Ceruminous deafness due to impacted cerumen. Middle ear suppurative deafness. Ptosis of the eustachian tube deafness. Relaxation or a falling in or out of the ear drum. Pocket handkerchief deafness, or blowing nose too hard. Hysterical or psychological deafness, due to inattention, which in many cases is deliberate, or an involuntary reaction mechanism to escape some unpleasantness that has persisted long enough to become a fixed complex. Anemic deafness is quite common. Anemia and Anoxia of the ear structures. Throat deafness, those that are due to enlarged tonsils and other conditions that cause pressure on the eustachian tubes. Many other types are recorded.
TREATMENT: The treatment is divided then into three main divisions:
First. — Anatomical. The replacing of displaced structures, or enlarging of orifices.
Second. — The functional and physiological, giving the proper impetus to the nerves and blood stream through removal of obstructions, toxemias, and supplying the necessary oxygen and nourishment.
Third. — The psychic or mental; to determine whether general emotional tensions from the effort to avoid facing the difficulties of life have enough pressure to cause a restriction of activity on the ear drum, the ossicles, and the nerves to prevent proper functioning of the hearing apparatus.
In considering the treatment, all three must be taken into consideration. For methods of examination, see your Endo-Nasal Aural and Allied Technique Book, page 35, fourth edition, page 37, third edition. Also, “The Fundamentals of Applied Psychiatry,” pages 92 to 109. Also pages 115 to 128. No one form of treatment can be arbitrarily given, because each case of deafness is different in etiology and symptoms, except in those cases of the aged. However, a general finger treatment of the following type has produced some very beneficial results.
First. — The removal of all toxemias, habits, and other contributory causes. Then, removing pressures in the carotid sinuses of the neck by adjustments of the cervicals. By the jerking of the head upward, sometimes called the Lake Recoil, and it must be a recoil adjustment or pain will be caused. The recoil must be very mild, not rough or exaggerated. So important does the writer consider this technique that it is given in full here:

Sit the patient on a low stool. Stand on left of patient, put patient’s arm back of him. The left hand of the doctor is then placed on the forehead of the patient with the heel of the hand on the frontal ridge of the nose, while the fingers rest lightly on forehead. No pressure should be exerted The right arm encircles head all around, bringing the fingers to rest lightly on the wrist of the left hand. Now the adjustment emphasis is made just over the occipital, lamboidal and mastoidal sutures, and in order for the fatty part of the forearm to fit snugly on the skull turn the head to the right three times very slowly, then bring head to dead center. To make sure it is in dead center, bend the head forward a little, then bring it back. Now put your feet in position for a proper body balance, so you will not slip. Next bring your chest over against the patient’s head toward you. Now stretch the head of the patient upward slightly until all slack is taken out, then give a quick upward jerk, slightly raising the patient a little off the stool. Repeat on right side, reversing arms and contact.

Do not hurry, make positive contacts first.
Do not let encircling arm slip.
Do not press hard on the forehead.
Watch that ear is not squeezed by encircling arm.
The second step is to open the external nasal canals by a number of adjustments on the sutures of the face, or by the little finger. The third step is to jerk the lobe of the ear downward, outward and upward quickly, but with mild strokes so as not to give pain. This is known as the Ear Fixation technique.
The last step is to go into the pharyngeal cavity and clean it all out, then find the slit of the eustachian tube and if there are any obstructions, remove them. If not, start a pumping process with the finger inside, and a pushing up process on the outside with the thumb of the other hand. For further instruction and illustrations see Endo-Nasal, Aural and Allied Technique Book.
Other forms of treatment that may be tried are light cupping over the ears, Ultra Violet Ray, Negative galvanism, vibration and massage which produce excellent results in some cases. Inflating of the eustachian tube by the method of Politizers Air Bag is of value in some cases. The use of the catheter in the hands of an expert may be used with great effectiveness.

DEFINITION: A symptom complex, characterized by a loss of equilibrium of the body.
ETIOLOGY: It is not a disease of itself, but only a symptom of some other diseases or malfunctions of many types remote from the head. Some may be from disturbances of the cerebral circulation. The vertigo occurring in arteriosclerosis, arterial hypertension, chronic myocarditis, heart-block, valvular lesions of the heart and the severe anemias is included under this head.
Organic disease of the brain. Vertigo is especially common in lesions of the cerebellum, but it may also be present in lesions of the cerebrum.
Neuropathic conditions. Vertigo is not uncommon in hysteria, neurasthenia, traumatic neuroses, migraine, and epilepsy. In epilepsy it may precede, follow, or take the place of a convulsion.
Aural disturbances. Vertigo is most frequently observed in lesions of the labyrinth (Meniere’s disease), but it may make its appearance as a result of disease of the middle ear.
Ocular disturbances. Ocular vertigo is usually dependent upon paresis of the ocular muscles, and is probably due to false projection of the retinal images. It is relieved by closing the eyes.
Toxemic conditions. Vertigo is sometimes observed in indigestion, gout, uremia, diabetes, acute infections, and in poisoning by tobacco, alcohol, lead, and many other substances.
Mechanical causes. The vertigo experienced in seasickness, swinging, whirling, etc., is probably dependent upon violet excitation of the semicircular canals, produced by the rapid movements of the body.
The term “Essential Vertigo” is applied to those cases in which, after exhaustive study, no adequate cause can be found. The writer found that by adjusting the feet, relief was almost instant in a few cases of what he had decided was “Essential Vertigo.” The plan followed was that, if, after ten to twenty regular treatments had produced no appreciable results, to experiment with the case by treating the feet only. The treatment consists of the three Foot Moves found elsewhere in this book.
SYMPTOMS: The patient feels that either he, or the room, is moving around. It may assume two forms. The horizontal form when the attack comes while the patient is lying down, or, the erect form that comes while the patient is standing up. There are two other forms mentioned. One is called the objective, when the room and its contents seem to be on wheels, while in the subjective form only the patient seems to be whirling.
PROGNOSIS: Depends on the causes. In some cases it will last for years, in others only a short time.
TREATMENT: A diligent search should be made to find the cause. Read again the partial list of causes given above. In cases of vertigo of more than two weeks standing the etiology can be considered of a serious nature. Those that are of cardiovascular disease, hypertension or organic conditions of the brain or the ears, are among those regarded as serious, and require special attention. The treatment of the serious conditions mentioned are found under those titles, and under Meniere’s Disease.
For the treatment of an attack of vertigo in general, the following method may be employed:
NEUROPATHY: General lymphatic with more than passing attention to the liver and neck. Vaso-dilation of the 3rd to 5th Dorsals. Kidney and Spleen segments.
CHIROPRACTIC ADJUSTMENTS: C. 1-4. D. 5.
COLONOTHERAPY: A thorough daily cleansing of colon is important, and this may be continued until the symptoms subside.
HABITS: A change of habits should be tried; less, or eliminate entirely tobacco and alcohol. Hours of retiring should be readjusted. Overeating must be stopped. If, of a worrisome nature, then psychotherapeutics are needed to suggest some method out of his difficulties.
DIET: There are three types of blood conditions associated with vertigo. The hypertension, associated with arteriosclerosis, the hypotension and the anoxemic, associated with the anemias. If hypertension is present, see diets under the headings of those subjects.
The general diet, however, may be a fast for a day or two, with a four ounce glass of milk every hour or every two hours. Then No. 2 Diet for a day or two and a building up of articles of diet from No. 1 to its fullest complement in about a week.
At no time should the patient be allowed to overeat. Better that he eat every two hours than overeat at one meal. If acidity of skin or urine is present take diet from the Alkaline list chart in this book. If alkaline vice versa. An experiment with a salt-free diet for a week, is in order in all cases.
VITAMINOTHERAPY: Nicotinic Acid, Vitamins B-1, B-Complex, or B-6 and G may be considered.
ELECTROTHERAPY: The writer has searched diligently to find some form, of electro-therapeutics for Vertigo, but there are none that are specific. However, the writer used auto-condensation of ten minutes duration on a large number of stubborn cases, and several had very definite relief.
HERBOLOGY: This is a symptom, the cause of which may be indigestion, nervous dyspepsia, chronic constipation, tobacco, alcohol, certain drugs, ear or eye trouble. Might be from hardening of arteries with elderly people who have high blood pressure. Improved condition of the blood is remedy.
Take an ounce each of Black Horehound and Dandelion, half ounce of Sweet Flag, quarter ounce of Mountain flax; simmer in three pints of water down to 1 ½ pints. A wineglass after meals.
It is claimed that eating two cloves of garlic on whole wheat bread before going to bed for two weeks is excellent.
ENDO-NASAL THERAPY: Same as in Meniere’s disease, which see, Cranial Therapy, Lake recoil for occipital and lamboidal sutures and the coronal sutures.

Diabetes Insipidus (Polyuria)

DEFINITION: Many different definitions have been given of Diabetes Insipidis.
Diabetes Insipidis is a syndrome comprising several altogether dissimilar states, and characterized by marked increase in the quantity of urine without any necessary qualitative changes in the elements of which it is composed.
A chronic disease characterized by the excretion of large quantities of dilute but otherwise normal urine.
ETIOLOGY: There is no doubt that polyuria is due to a lack of vaso-constrictor nerve control to the kidneys. This is the primary cause; the secondary causes are numerous. It has been demonstrated that a section of the splanchnic nerve is followed both by polyuria and lowered vascular tension.
As for the details of the mechanism through which there occurs in the kidney an increase of the excretion of urine, in cases where there is no primary dyscrasia and, in particular no excess of water in the blood-stream, they are still shrouded in obscurity. The circulation through the glomeruli is known to be increased, and the possibility that this occurs owing to relaxation of the arterioles must be admitted. A relaxation of the efferent vessel may, in particular, be supposed to occur. If this be the case, the blood-pressure must increase in the capillary network which follows the glomerulus, and the mechanical conditions for the reabsorption of water are favorable to its occurrence. The benefit conferred by vaso-constricting treatments of Neuropathy tends to support the idea that vasomotor relaxation is an important factor in the production of polyuria.
The thought is that the above takes place from a reflex of some perversion of function in some part of the brain, notably the pituitaries and principally the posterior lobe. There being no pathological lesions in the kidney, except a slight engorgement, the conclusion is that this condition is due to reflex from perversions of function, or injuries to the brain, causing perversions of function in the pituitaries. Some things that may cause the above are—fracture of the skull, tumor, syphilis, tubercle, meningitis, etc. Other causes of polyuria may be: Excessive ingestion of fluids. Administration of diuretics. Suppression of perspiration. Crises of certain febrile diseases, and certain neurotic manifestations, such as neuralgia and hysteria. Absorption of serous effusions and transudations. Removal of some temporary obstruction in the urinary passages. Diabetes mellitus. Chronic glomerulonephritis. Amyloid kidney. Polycystic disease of the kidneys.
SYMPTOMS: Diabetes insipidus is not a common disease, and occurs most frequently in young adults. The onset may be gradual or sudden. The chief symptom is the passage of large quantities (5 to 20 liters) of sugar-free urine, of low specific gravity (1005-1001), over a long period. Accompanying the polyuria there is usually insatiable thirst. The skin and mouth are dry; the bowels are usually constipated and headache, lumbar pains and nervous irritability are present. In many cases there is weakness and emaciation, while in others this does not occur.
DIAGNOSIS: The differential between diabetes mellitus may be stated as follows:

Diabetes Mellitus	Diabetes Insipidus
Specific gravity of urine nearly always high, rarely low.	Specific gravity of urine low — never exceeding 1010.
Glucose constantly present.	Glucose absent.
Abnormal hunger and thirst, itching of the skin, tendency to boils and carbuncles, characteristic ethereal odor of the breath.	General symptoms of diabetes mellitus absent.

PROGNOSIS: The condition is chronic unless treated by one who understands the basic principles of reflex activity and knows how to apply the physical and manipulative therapies in proper places. Even as chronic the disease is seldom fatal directly, but leads to much discomfort of excessive water drinking, and excessive urination that may bring on a complete break-down and some serious complications.
TREATMENT: The chief feature is to find the contributing factors and treat them as well as giving the general treatment. Neuropathic Cranial Adjusting of the sutures adjacent to the pituitaries on each side of the head.
NEUROPATHY: The vaso-dilators and constrictors range from the 9th to the 5th lumbar. But, to bring about a constriction of the dilator nerves to the kidney, only the 10th to the 13th are given the inhibitory hard pressure. For the secondary cause, the cervical and the 3rd to the 5th dorsals, also the cranial nerves on the face (see numbers on cut of skull) are given light sedation treatment.
CHIROPRACTIC: Upper cervicals, condyle, kidney place. D. 10 and L. 1.
ELECTROTHERAPY: Irradiation over the pituitary area has been useful in some cases. The water cooled ultra violet seems to be the best for this purpose.
Concussion with one minute interruptions over the 5th lumbar, sine wave, or galvanic current, with the positive pole placed upon the spinal column at Dorsal 10 or the lumbars and the negative pole at the level of the hilum of the kidney.
DIET: Diet does not seem to have much influence on this condition, except that a large amount of fresh beef seems to give the patient some strength and slightly diminishes the amount of urine while