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Osteopathic 
 Diagnosis and Technique 
 
 WITH CHAPTERS ON 
 
 OSTEOPATHIC LANDMARKS 
 
 BY 
 
 MYRON R BIGSBY, D. O. 
 
 Profeisor of the -Above Branches at the Philadelphia College of Osteopathy 
 
 Copyrighted 1907 
 
 by 
 
 IMYRON H. BIGSBY, D. O, 
 
 Commercial Printing House, Incorporated 
 Vineland, New Jersey 
 
LIBRARY of CONGRESS 
 Two CoDles Receded 
 
 DCS 81 19& 
 
 OeDynght Entry 
 
 &<*•>>[ iqo-j 
 
 CLASS A XXc, No. 
 
 tiqqG? 
 
 COPY B. 
 
 DEDICATED to the founder, DR. A. T, 
 
 STILL and his disciples, who have taken 
 up the fight for the advancement of pure 
 Osteopathy. 
 
PREFACE 
 
 In preparing this work the author has been en- 
 deavoring to fulfill a long-felt and, of late, an often- 
 expressed want. 
 
 Students, teachers, practitioners and writers have' 
 needed a logical classification of osteopathic treat- 
 ments and a text book on a par with those of other 
 sciences ; one with its technique founded on mechan- 
 ical principles ; something that Can be reproduced, as^ 
 well as described, with anatomical correction as its 
 result. 
 
 It is hoped that it can no longer be Said that "one" 
 cannot reproduce another's methods of treatment ; that 
 each must originate their own." 
 
 Things are advancing too fast. Who of us that 
 have practiced a number of years cannot look back 
 to cases that our originality worked too glow, and 
 the patient is now out of our reach? True, we are 
 not all adapted to the same methods. The short and 
 fat, the tall and spare, the strong or weak find their 
 advantages and disadvantages. For this reason 3- 
 greater number of methods are described. Our dif- 
 ferent groups of muscles, with their varying strength, 
 also complicate matters. 
 
 The technique of the book is built on the simple- 
 mechanical principles as a ground work, leverage in its 
 different forms playing the most important part, as it 
 does in mechanics. 
 
II • PREFACE 
 
 Therefore if we wish greater efficiency get well out 
 on the patient's levers, as in the (V.I.E.) and (V.L.E.) 
 treatments, where not only trunk but limb leverage 
 is added beyond, to such a length that other support 
 is required to carry them. It is the utilizing of these 
 Osteopathic applications of mechanical principles 
 that has made necessary the movable supports, such as 
 Osteopathic swings, slings,, suspension hooks and 
 swinging tables. 
 
 Realizing the danger of questionable adjuncts, 
 there has been an endeavor to lessen the strain on 
 practitioners by various methods and means while, 
 keeping within the ranks of true Osteopathy. 
 
 I thank the various writers of Osteopathic books, 
 as-well as the faculties of the American School of Oste- 
 opathy during the course ending June, 190 1 \ the fac- 
 ulty of the Philadelphia College of Osteopathy during 
 the past few years; many piactitioners that have aided 
 from time to time, and, most of all, Dr. A, T. Still 
 for the aid received, both directly and indirectly. 
 
 I wish to thank Dr. Earl Scanland YVillard for 
 his encouragement and also for the correction of a 
 part of the text; as well as for his adoption of the 
 symbol classification in his classes in the Practice of 
 Osteopathy. 
 
 I thank Dr. J, B. Buehkr for his aid as stenographer 
 when a senior. 
 
 ■I am indebted to my wife for her w T ork in the 
 freehand drawing. 
 
 THE AUTHOR. 
 
KEY TO SYMBOtS 
 
 KEY TO SPINAL AND RIB SYMBOLS, ETC. 
 
 (Explained on pages 4 and 5) 
 
 (STRUCTURE) (REGION) (NATURE OF) No. 
 
 N— Neck 
 M-Muscles 1 
 
 T T-Upper 
 KJ Dorsal 
 
 \J — General 
 
 V 
 
 — Vertebra 
 
 -Inter 
 Scapular 
 
 -Indirect 
 
 R 
 
 -Rib* 
 
 D 
 
 Mid. and Low 
 — Dorsal 
 
 -Innominates 
 
 T -Lower, if Ribs D-Direet 
 J— l — Lumbar 
 
 B— ^Bones 
 (Abbreviations) 
 
 c 
 
 -Saeral 
 
 -Coccygeal 
 
 Extreme 
 
KEY TO SYMBOLS 
 
 KEY TO LIMB SYMBOLS 
 
 (Explained on pages 4 and 5) 
 
 (STRUCTURE) (DIRECTION) (NATURE OF) 
 
 DT T— Backward 
 DU -Upward 
 
 D — Backward 
 
 (And other bones of limbs T— 'T t Forward 
 1 V-J Upward 
 
 ^— Forward 
 — Downward 
 
 CIT1. — Femur 
 
 other bones ol 
 abbreviated) 
 
 Innominates 
 
 ./v— Anterior 
 1 — Posterior 
 
 1 —In 
 
 direct 
 
 D-d: 
 
 F^ 
 
 Extrt 
 
 (STRUCTURE) (REGION OR END) (DIRECTION) 
 
 Hi— At Elbow 
 
 I — Posterior 
 
 Rl (Abbreviated) 
 aCl.-Radius 
 
 (And other long bones) yy . ^ , 
 
 (And other joints) 
 
 V^&F.— Carpus OCcL.— Scaphoid 
 
 (or others) 
 
 A 
 
 -Anterior 
 
 Phal. 
 
 -Phalanges 
 
 I —No. 
 
KEY TO SYMBOLS 
 
 KEY TO VISCERAL SYMBOLS 
 
 (Explained on pages 4 and 5) 
 
 (ACTION} (STRUCTURE) (NAME) 
 
 Emptying V — Viscera V-^OI» — Colon 
 
 (or other Viscera) 
 
 X-j— Emptying V — Viscera V-^OI» 
 
 XX — Repl acing 
 
 KEY TO NECK SYMBOLS 
 
 (An exception to page 1) 
 (Exceptions to page I . Explained on pages 4 and 5) 
 
 (STRUCTURE) (REGION) (ASPECT) 
 
 M-M-d- N-Neck P_ Posteri „ r 
 
 JLi — Lateral 
 A-A 
 
 nterior 
 
EXPLANATION OF KEY 
 
 EXPLANATION OF KEY TO SYMBOLS. 
 
 The meaning of the symbols used to designate the 
 various treatments is as follows : 
 
 THE FIRST COLUMN indicates the structures 
 treated, as M., V., R., I., B., meaning Muscles, Verte- 
 brae, Ribs, Innominates and other Bones. 
 
 THE SECOND COLUMN indicates the region 
 treated, as N., U., I., D., L., S., C, meaning the Neck, 
 Upper Dorsal, Interscapular, Middle and Lower Dor- 
 sal, Lumbar (or Lower when indicating ribs), sacral 
 and Coccygeal regions. 
 
 THE THIRD COLUMN indicates the nature or 
 degree of treatment, as G., I., D., E., meaning General, 
 Indirect, Direct and Extreme. 
 
 NOTE: Though there are two letter D's and 
 three letter I's used, they each have different mean- 
 ings, because they are in different columns. 
 
 THE FOURTH COLUMN indicates the different 
 treatments having the same symbol. For example, 
 (R.I.E.) 4 indicates Ribs whose angles lie in the Inter- 
 scapular region, Extreme treatment No. 4. 
 
 Other treatments producing a similar effect on 
 same structures and region have same symbol, but 
 are numbered 1, 2 and 3, 
 
EXPLANATION OF KEY; EXCEPTIONS 5 
 
 To memorize the key to these symbols is as sim- 
 ple as learning a college yell. Thus; 
 
 M-V— R-I-B. 
 N-U— I— D— LS-C. 
 G— I— D— E. 
 
 i— 2— 3—. 
 
 Speak or think of it thus: 
 M-V— R-I-B. 
 
 N-U (New) I-D (idea) L-S-C (Less-see) (Let us 
 see). 
 
 G (u)I-D-E. 
 1-2-3. 
 
 EXCEPTIONS TO KEY TO SYMBOLS. 
 
 In muscular treatment of the neck the letters 
 P-L-A used in the third column indicate the Posterior, 
 Lateral and Anterior aspects respectively. 
 
 In the Innominate treatments the middle letters 
 indicate the position of bone before treatment. 
 
 In Visceral treatments the letters E & R of first 
 column indicate the words emptying and replacing. 
 The letter V in second column meaning viscera. The 
 abbreviations indicating the individual viscera. 
 
 In the treatment of the Limbs abbreviations are 
 used in first column. In second column the letters 
 indicate the end of the bone slipped, or the number 
 of the bone, as in the phalanges. 
 
 In the hip and shoulder joints and innominates 
 the second column indicates the direction of disloca- 
 tion. 
 
 Two letters in symbol without spacing and period 
 between indicate that they belong in same column. 
 
SYMBOL INDEX. 
 
 MUSCULAR TREATMENT 
 
 x 
 
 Q 
 2 
 
 T3 
 C 
 cd 
 
 •d-d <° 
 
 ^ £ T3 
 
 CO CO^ 
 CO CO N 
 N ? CM 
 
 r o r 
 T3 tH T3 
 
 O <; O 
 
 s «s 
 
 M cf M 
 
 o 
 
 PQ 
 
 S H H H 
 
 m Oh' hJ < 
 
 Bass 
 
 CO 
 
 CO 
 
 < 
 
 o - - 
 
 u cd •*-« 
 
 <u i-i iri 
 
 +i CD « 
 
 o<^< 
 
 O 
 
 o ~ r 
 
 aaa 
 
 T3 
 CM § 
 
 
 AS 
 
 22 
 
 o 
 
 z 
 
 P 
 
 < 
 
 O 
 PP 
 
 CO 
 
 i 2 
 I ° 
 
 O 
 W 
 M 
 
 uou 
 
 w 
 
 H 
 O 
 
 H 
 
 CO 
 
 
 
 M 
 
 H H H 
 
 CM CM 
 
 H-I HH HH i 
 
 
 aaa ; 
 
 General 
 
 Direct 
 
 Extreme 
 
 General 
 
 Direct 
 
 Extreme 
 
 Upper Dorsal 
 U " 
 U " 
 
 Interscapular 
 
 I 
 
 I 
 
 09 
 
 C/3 • 
 
 aaa. 
 
 aaa ; 
 
 CO 
 
 CO 
 
 of 
 
 cf 
 
 ~ 
 
 
 T3 
 
 T3 
 
 O 
 
 O 
 
 a 
 
 a 
 
 3 £ 
 
 S3 
 P 
 
 PW 
 PP 
 
 P w 
 
 PP 
 
 a a 
 
 0> 
 
 .hi *-< 
 
 H 
 
 cd 
 
 3j 
 
 a aa ; aa^^a 
 
 cd 
 <u 
 
 o 
 u 
 o 
 O 
 
SYMBOL INDEX. 
 
 VERTEBRAL TREATMENT 
 
 
 ■ cm 
 
 
 : M : 
 
 
 — 1 
 
 'II 1 : 1 
 
 "II 1 
 
 
 f \ III 
 
 y 10 nm \o 
 
 I I 1 I : 
 
 ; - co 10 ov vo \q 00 
 
 i C\h CM ^t-r^:cOcO^-^£> O 
 
 c/} w O O >- - 
 
 A £4 M M M 'in 
 
 : CM CM CM CM i CO CO CO 
 
 i c^ vf ^ "^ T : iO 10 iO 
 
 iO O 
 
 • c - 
 
 : w m CM CM 
 
 • co CO co 
 
 • ^"t't'tlO^MD^ 
 
 r^ t^ 
 
 <i £ N N N M 
 
 : CM CM CM CM 
 
 • CM CM CM 
 
 ;CMCMMCMCN|;CMCMCM 
 
 C4 CM- 
 
 p. g . 
 
 
 
 
 
 Oh lO 
 
 
 
 I'd VO i nj 
 
 
 ^^ 
 
 
 
 1 O . ! O 
 
 
 § t§ 
 
 * «■ 
 
 
 co ^^ : fo 
 
 
 2 *? es 
 
 < ^ *■ ~ - 
 
 co <o 
 <n - r 
 
 
 CO : 
 
 co ^ ioi co 
 
 *& - IT): *0 
 O ti *i O 
 
 § *":*■ S 
 
 
 „ M - CO CO 
 
 CO 
 
 <M ^ CO. CO M 
 
 CO 
 
 Em 
 
 W £ S5 fc £ 
 
 t) ID t) H) 
 
 H H M " 
 
 h-i t-H m 
 
 
 of 
 
 w 
 
 > > !> > 
 
 > > > > 
 
 >>>' 
 
 > *>>>!>>> 
 
 *> 
 
 ^^^^ 
 
 V ^^ \^s ^~S 
 
 Wv 
 
 v wVvvvv 
 
 V 
 
 H 
 
 
 
 
 
 DEGRE 
 
 General 
 Indirect 
 Direct 
 Extreme 
 
 03 £ -M 6 
 
 BB-S-tS 
 
 o£qh 
 
 F *» s 
 S s £ 
 
 h S a> ' ^ w tJ 
 
 S ■§ .5 tJ ■! S -g .s 
 
 
 O 
 
 *c3 
 
 CO 
 
 g 5 S 3 
 
 u 
 
 ^3 
 
 
 >— 1 
 
 Q 
 
 cd 
 
 ^ ; «-, 
 
 
 O 
 
 
 O «. ~ 
 
 ■—J /^N : Cd 
 
 
 W j* 3 3 3 1 
 
 tf 8 . - 
 
 CO - » 
 
 t-. ; S " 
 
 — • 3 
 
 ^ 
 
 « 8 
 
 
 4> 
 +-» 
 C 
 H-4 I-) hH j 
 
 * 
 
 £££2; 
 
 ££££) 
 
 Q QQQij^J 
 
 h4 
 
 H 
 
 
 
 
 
 « 
 
 
 
 
 
 ID 
 
 
 
 
 
 H , cd 
 
 
 
 
 
 2 
 
 
 
 
 
 & -8 
 
 
 
 
 
 pir ! ! ' 
 
 3 3 3 3 
 
 3 5 3 ; 
 
 3 3 3 3 : 8 ^ 5 
 
 3 
 
 H « 
 
 
 
 
 
 CO >>>> 
 
 >>>>: 
 
 >>>i 
 
 > >>>>>> 
 
 > 
 
SYMBOL INDEX. 
 
 VERTEBRA- RIBS-VISCERA 
 
 
 
 
 CO :' 
 
 
 
 w "p! 
 
 i • i 
 
 N Th ■ OlOO m: 
 ii ill 
 
 CO 
 1 
 
 a* 
 
 H (N ro-t \C vO Oi 
 
 1 : 1 
 
 1 1 1 
 
 <N N(JO 00 
 
 CM rf- t^ 00 
 
 CO 00 
 
 CO W vo vo aO : vo vo vC ; 
 
 t^i r^ 
 
 CO 00 CO O© O On 
 
 O O 
 
 o o 
 
 W — * •— * • — ' ■ — • — »-i fw : m ;. m • « m i-i i-i •— i-i 
 
 CS CNP' CN CM5 
 
 C* CN 
 
 in^cCCO CO 00: 
 
 On <0 
 
 O •"-■ i-h <N CM i 
 
 CM 
 
 
 <j Z pt (n n; 
 
 Ph S : 
 
 <m <n o» ; 
 
 0* : N 
 
 CO co CO CO CO CO" 
 
 CO 
 
 
 
 
 
 lO 
 
 
 
 d «- 
 
 
 *-d 
 
 
 
 53 ^ 
 
 
 
 
 
 < US 
 
 o CO 
 
 •a S «- ° 
 o 
 
 
 
 J S " 
 
 
 ^ ; CO 
 
 ^00 k^ CO COT3 
 
 - . ^ ~ ~ p 
 
 co 
 
 M 
 
 O M « 
 
 
 
 « *P H « M g 
 
 « 
 
 
 3 h M M 
 
 mvym 
 
 M M " 
 
 w Q W 
 
 qqq 
 
 
 
 
 P /^-v 
 
 >> 
 
 >>> 
 
 >!>> o^ iod 
 
 « ^ « « « 
 
 DdW ^Pi 
 
 «»J 
 
 ^•s_^"^^ 
 
 Vv-/ s-^- <w / : , w 
 
 ■s^/ 's-^'s-^^w' 
 
 ^u ^ w 
 
 v— •^-^ 
 
 
 
 
 
 CO 
 
 
 s 
 
 ft) 
 P O » 
 
 
 r-l +-» £ 
 
 i—i 
 > 
 
 "3 ll 
 
 CO 
 
 u 
 
 > P -V 
 
 DE 
 
 Indii 
 Dire 
 Extr 
 
 •g.S3 M 
 
 u : H 
 
 OOhQHH 
 
 8H 8& 
 
 C P C 
 
 
 
 « ; u ( 
 
 N 
 
 
 O 
 
 13 
 
 M ■ P: 
 
 
 M 
 1 
 
 M 
 M 
 
 
 td rt - » 
 
 two 
 
 O 
 
 . o 
 o 
 
 ^-•: cd 
 ' Ph! <u 
 
 . i— i 
 
 rt » . » » , 
 
 ; CO 2 v. - v. - 
 
 : !-< 
 
 i o 
 
 5 .22 
 
 2 s 
 
 w w cfl 'U U O 
 
 £>\£ 
 
 iPQPQPfi 
 
 J > > > > 
 
 H 
 
 
 
 
 
 
 ti 
 
 
 
 
 
 
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 O It 
 
 
 
 
 
 
 "3 - 
 
 
 
 
 
 . 
 
 «f * 
 
 :"* "* *• 
 
 1 en i 3 
 
 .» » N> W S> W 
 
 'a." 
 
 v. v» 
 
 H ° 
 
 
 
 <u 
 
 
 &o>>> 
 
 >>> 
 
 ! S j .tf 
 
 !«««««« 
 
 tf fttf& « 
 
SYMBOL INDEX. 
 
 VISCERA AND ORGANS OF SPECIAL SENSE 
 
 op 
 
 r^ r^ r^ 
 
 O O ^J M UO iT)vC 
 
 ft M f) N N C< M CN CH N 
 
 MO) CM 
 
 CN <N <N 
 
 6^> h Q 
 
 r <u H ._ 
 
 £ §^ M opq 
 
 
 
 ■3 So 
 
 >>>>>> 
 
 >>> 
 
 & oi ti W W W 
 
 WWW 
 
 V-^ ^w' ^^ V-/ \_X \^S 
 
 ^/V\> 
 
 
 
 
 Uterus 
 U " 
 Ovaries 
 Kidney 
 Stomac 
 Com. B 
 Duct 
 
 Colon 
 
 Rectum 
 
 Uterus 
 
 >>>>>> >>> 
 
 w««www www 
 
 a 
 
 43 
 
 W3 J_ G 
 
 +_> 4-» +j 
 
 *-ovo tN. 
 
 
 
 
 
 
 
 Sw 
 
 CN 
 
 <N 
 
 CN 
 
 CN 
 
 CM 
 
 CM 
 
 CM. 
 
 ,_, 
 
 -go--- 
 
 
 rt 
 
 o 
 
 
 o 
 
 +-» 
 o 
 
 
 
 
 a; t« -h tfi 
 3 ^0^3 
 
 X 
 
 3 
 
 c 
 
 CA3 C-TZ5 112 
 
 ng tis 
 hing 
 [ating 
 lated 
 
 D 
 
 a 
 
 > 
 
 O 
 
 o 
 
 ■X & * 2 
 
 Ti 
 
 
 JS s S § 
 
 u 
 
 i" 1 
 
 <u ^e \m »- 
 
 O 
 
 
 p^t^^o 
 
 H 
 
 ^ fo4 M - 
 
IO LANDMARKS AND DIOGNOSrS: INDEX 
 
 NOSE. page 
 
 1. Loosening secretions. 222 
 
 2. Shaping babies' noses. 222 
 
 TONSILS. 223 
 
 THE NECK. 
 Neck, The 
 
 " examination of 4r 
 
 Osteopathic landmarks of , 2 -% 
 
 " Differential diagnosis by motion , 2 
 
 " restricted mo- 
 
 tion 42 
 
 Cervical Osteopathic landmarks compared. 46-1 
 
 " Spinous processes 41-2 
 Transverse processes 46-^r 
 " Articular processes 41-44. 
 " Illustrated 
 lesions traced from muscular 
 Spine, the 
 
 Osteopathic landmarks compared 4S- " S 
 
 " spinous processes 44-55 
 
 ' transverse processes 4 6 - Q 
 
 articular processes 44- co 
 
 Illustrated 
 
 examination of 
 
 " general contour - 2 
 
 osseus lesions 
 tracing from bony to muscular lesions 
 muscular to bony lesions 
 vetrebral to rib lesion 
 
 .5 
 
 40-55 
 54 
 
 40-55 
 52 
 
 5? 
 54 
 56 
 
 58 
 
 rib to vertebral lesions 60 r 
 
 Postures, lying., sitting, kneeling, standing. 
 gyneeologicaL 
 
 567 
 204-11 
 
LANDMARKS AND DIOGNOSIS: INDEX II 
 
 OSTEOPATHIC LANDMARKS OF RIBS. page 
 
 Normal elevation at various lines 
 
 5« 
 
 Costo-cbondral line of diagnostic tenderness -g 
 
 A luxated typical rib ^ Q 
 
 Examination of First Ribs. 5 2 
 
 " Typical Ribs 64 
 
 Tracing from spine to ribs. -rg 
 
 " ribs to spine 60 
 
 Examination of eleventh and twelfth ribs 66 
 
 Extraordinary means of locating rib lesions 66 
 
 Examination of Innominates 68 
 
 Effect on surrounding structures 69 
 
 Dislocations of HUMERUS 227 
 
 " HIP 242 
 
12 SYMBOL INDEX; UPPER LIMB 
 
 Hum. HUMERUS. page 
 
 S. AT SHOULDER. 
 G. GENERAL TREATMENT. 
 (Hum.S.G.) i, 2, 3, 4 224 _ 7 
 
 (Hum.S.D.) i. SHOULDER. DIRECT RE- 
 DUCTION. 228 
 (Hum.S.E.) i. SHOULDER. EXTREME 
 
 REDUCTION. 23 o 
 
 Hum. HUMERUS. 
 
 A. ANTERIOR (at shoulder). 
 D. DIRECT REDUCTION. 
 (Hum.A.D.) i. 23Q 
 
 (Hum.A.E.) i. ANTERIOR. EXTREME. 23I 
 
 Ulna and Rad. ULNA AND RADIUS. 
 E. AT ELBOW. 
 
 G. GENERAL TREATMENT. 
 
 (Ulna and Rad.E.G.) i . 2 3 2 
 
 (Rad.E.E.) EXTREME REDUCTION. 232 
 
 (Rad.E.P.) AT ELBOW. POSTERIOR. 233 
 
 (Rad.E.A.) AT ELBOW. ANTERIOR. 233 
 
 Ulna and Rad. ULNA AND RADIUS. 
 W. LUXATED AT W r RIST. 
 G. GENERAL TREATMENT. 
 (Ulna, and Rad.W.G.) i. 23 4 
 
 Ulna and Rad.W.P. AT WRIST. POSTER- 
 IOR. 234-5 
 Car. CARPUS. 
 
 Os. OS MAGNUM, etc. 
 
 P. POSTERIOR. A. ANTERIOR. 
 (Car.O S.P.) 1. 236 
 
"RTJLE AND SYMBOL INDEX; LIMBS 1 3 
 
 Meta.Car. METACARPAL. page 
 
 1. No. 1, etc. 
 P. POSTERIOR. A. ANTERIOR. 
 ^Meta.C.i,P.) 1. 236 
 
 Phal PHALANGES. 
 1. No. 1, etc. 
 P. POSTERIOR. A. ANTERIOR. 236 
 
 THE LOWER LIMB. 
 
 GENERAL, PALLIATIVE, OR SECOND- 
 ARY TREATMENTS. (Tabulated.) 
 
 RULE 1 or RULE OF SPRINGING A 
 JOINT applied to flexors of foot, leg or 
 thigh, see table under Rule 1. 237 
 
 RULE 2 or RULE OF STRONG FLEXION 
 as applied to extensors of thigh, leg and 
 foot. (See table.) 2.38 
 
 RULE 3 or RULE OF ABDUCTION AND 
 ADDUCTION as applied to thigh and 
 great toe. .239 
 
 RULE 4 or RULE OF ROTATION AND 
 CIRCUMDUCTION as applied to the 
 thigh. 239 
 
 RULE 5 or RULE OF LATERAL 
 STRETCHING as applied to thigh and 
 calf. (See table.) 240 
 
SYMBOL FNDKX'J LOWTR LrMK 
 
 THE HIP. page 
 
 DIAGNOSIS. 243-4 
 
 Tests for Ancholosis 1, 2, 3. 24.1 
 
 Diagramatic classification of hip dislocations. 24 x 
 Fern. FEMUR. 
 
 BIL BACKWARD AXD UPWARD. 
 D. DIRECT REDUCTION, 
 
 (Fem.BU.D.) r. 245 
 
 (Fem.BU.D.) 1. Modified. 247 
 
 (Fem.BU.D.) 1. BACKWARD (INDIRECT.) 247 _ 9 
 (Fem.FU.L-) 1. FORWARD AXD UPWARD. 
 
 (INDIRECT.) ' 250 
 (Fem.FD.L) 1. FORWARD AND DOWN- 
 WARD. 25D 
 
 Tib. and Fib. TIBIA AND FIBULA, 
 K. AT KNEE. 
 I. INDIRECT. 
 (Tib. and Fib. K.I.) 1.. 25 , 
 
 (Fib.K.D.) 1. FIBULA. AT KNEE. DIRECT. 
 (Fib.K.E.) FIBULA. AT KNEE. EX- 
 TREME. 
 
 Tib. and Fib. TIBIA AND FIBULA, 
 A, AT ANKLE. 
 D, DIRECT. 
 (Tib. and Fib.A.D.) 1. 253 
 
 Tarsus, Metatarsus and Phalanges. Also see 
 
 bones of hand. . 254 
 
 (Phal.Ses.D.) 1. PHALANGES. (GT. TOE.) 
 
 SESAMOID. 254 
 
 251 
 
 252 
 
OSTEOPATHIC TECHNIQUE. 15 
 
 page; 
 M. MUSCULAR TREATMENT. 
 N. NECK (REGION). 
 P. POSTERIOR (ASPECT). 
 
 (M.N.P.) 1. Bilateral Stretching with Weight 
 
 of Head Opposing. (Illustrated.) 70 
 
 (M.N.P.) 1. Modified. 71 
 
 (M.N.P.) 2. Lateral Stretching with Hands 
 
 Clasped on Lesion. 72 
 
 (M.N.P.) 3. Lateral Stretching with Head Lev- 
 erage and Rotation. 72 
 
 (M.N.P.) 3. Modified. 73 
 
 M. MUSCULAR TREATMENT. 
 N. THE NECK. 
 
 L. LATERAL ASPECT. 
 
 (M.N.L.) 1. Lateral Stretching of Sterno-mast- 
 
 oid with Head Leverage and Rotation. yr 
 
 (M.N.L.) 2. Longitudinal Traction of Scaleni 
 Muscles with Head Leverage and Rotary 
 Oscillation. 75 
 
 (M.N.L.) 2. Modified Sitting. 76 
 
 (M.N.L.) 3. Lateral Stretching at Upper Bor- 
 der of Trapesius. 76 
 
 (M.N.L.) 3. Modified. Hand Reinforced. 77 
 
 M. MUSCLES. 
 N. NECK. 
 
 A. ANTERIOR. 
 
 (M.N.A.) 1. Lateral Stretching with Head 
 
 Fixed. . 78 
 
 (M.N.A.) 1. Modified (illustrated). 78 
 
l6 MECHANICAL PRINCIPLES OF 
 
 (M.N.A.) 2. Thyro-Hyoid and Infra-Hyoid page 
 
 Muscles. 79 
 
 (M.N.A.) 2. Modified. So 
 
 (M.N.A.) 3. Sterno Mastoid Muscle. 80 
 (M.N.A.) 4. Extreme Stretching with Fingers 
 
 at Lesion. 80 
 (M.N.A.) 4. Modified Thenar Eminence at Le- 
 sion. 81 
 
 C. COMBINED MUSCULAR AND BONE 
 TREATMENT. 
 N. THE NECK OR CERVICAL RE- 
 GION. 
 I. INDIRECT TREATMENT. 
 
 (C.N.I.) i. Exaggeration, Circling and Screw- 
 Driving Rotation (illustrated). 83 
 
 (C.N.I.) 2. Posterior Springing of Column and 
 
 Muscle Stretching. 85 
 
 C. COMBINED MUSCULAR AND VER- 
 TEBRAL TREATMENT. 
 
 » 
 
 N. THE NECK OR CERVICAL RE- 
 GION. 
 D. DIRECT TREATMENT. 
 
 (C.N.D.) 1. Lateral Springing of Spine with 
 
 Rotation. 86 
 
OSTEOPATHIC 'TECHNIQUE. I 7 
 
 M. MUSCULAR LESIONS. *** 
 
 U. UPPER DORSAL REGION. 
 
 G. GENERAL OR GENTLE TREAT- 
 MENT. 
 
 (M.U.G.) 1. Rocking Hand Leverage with Pa- 
 tient's Weight Opposing. .88 
 
 M. MUSCULAR LESIONS. 
 
 U. UPPER DORSAL REGION. 
 
 D. DIRECT TREATMENT. 
 
 (M.U.D.) i. Shoulder Gripping Aiding Thumb 
 
 at Lesion. 89 
 
 M. MUSCULAR LESIONS. 
 
 U. UPPER DORSAL REGION. 
 
 E. EXTREME TREATMENT. 
 
 (M.U.E.) 1. Rocking Hand Leverage Rein- 
 forced with Patient's Weight, 90 
 
 (M.I.G.) 1. Reinforced Hand at Lesion with 
 Fixed Elbow and Shoulder Leverage Op- 
 posing. 9 [ 
 
 (M.I.G.) 2. Arm Leverage with Fingers at Le- 
 sion. 9 l 
 
 M. MUSCULAR LESIONS. 
 
 I. INTER-SCAPULAR REGION. 
 D. DIRECT TREATMENT. 
 
 (M.I.D.) 1. Rotating Arm Leverage with In- 
 verted Thumb at Lesion. 92 
 
 (M.I.D.) 2. Shoulder Leverage with Inverted 
 
 Thumb at Lesion. g 2 
 
 (M.I.D.) 3. (See V.D.K) 6 or Arm and Shoul- 
 der Leverage Swinging Trunk with Opera- 
 tor's Weight at Lesion. 1 5 1 
 
18 MECHANICAL PRINCIPLES OF 
 
 M. MUSCULAR LESIONS, page 
 
 I. INTER-SCAPULAR REGION. 
 E. EXTREME TREATMENT. 
 
 (M.I.E.) i. Arm and Shoulder Leverage with 
 
 Reinforced Arm at Lesion. 93 
 
 M. MUSCULAR LESIONS. 
 D. DORSAL, MIDDLE AND LOWER. 
 G. GENERAL OR GENTLE TREAT- 
 MENT. 
 
 (M.D.G.) 1. Shoulder Leverage with Fingers 
 
 at Lesion. 93 
 
 (M.D.G.) 1. Modified. Sitting. 94 
 
 (M.D.G.) 2. Arm Leverage with Fingers at Le- 
 sion. 94 
 
 (M.D.G.) 3. Both Hands at Lesion with Body 
 
 Weight Opposing. 94 
 
 M. MUSCULAR LESIONS. 
 D. DORSAL REGION. 
 
 D. DIRECT TREATMENT. 
 
 (M.D.D.)i. Shoulder Leverage with Thumb 
 
 at Lesion. 94 
 
 (M.D.D.) 1. Modified. Lying. 95 
 
 (M.D.D.) 2. SEE (R.D.G. 6) and (R..DG. 6 
 
 Modified). 9 c 
 
 (M.D.D.) 3. Circling Trunk and Shoulder 
 Leverage with Thumb or Thenar Emi- 
 nence at Lesion (Swing). 95 
 
 M. MUSCULAR LESIONS. 
 D. DORSAL REGION. 
 
 E. EXTREME TREATMENT. 
 
OSTEOPATHIC TECHNIQUE. 
 
 (M.D.E.) i. Reinforced Thumb at Lesion with page 
 Operator's Weight Aiding. 97 
 
 (M.D.E.) 2. Give (R.D.E. 1) or shoulder lever- 
 age with knee at lesion. 97 
 
 (M.D.E.) 3. Arm and Shoulder Leverage with 
 
 Reinforced Hand at Lesion. 98 
 
 (M.D.E.) 4. (See M.L.E.) 4. The sixth fol- 
 lowing. (Swing.) 102 
 
 M. MUSCULAR LESIONS. 
 L. LUMBAR REGION. 
 
 I. INDIRECT TREATMENT. 
 
 (M.L.I.) 1. Longitudinal Stretching with 
 
 Trunk Leverage. 99 
 
 (M.L.I.) 2. Longitudinal Stretching with Limb 
 
 Leverage. 99 
 
 M. MUSCULAR LESIONS. 
 L. LUMBAR REGION. 
 
 E. EXTREME TREATMENT. 
 
 (M.L.E.) 1. Reinforced Thumb at Lesion with 
 
 Operator's Weight Aiding. 101 
 
 (M.L.E.) 2. Reinforced Fingers at Lesion with 
 
 Operator's Weight Aiding. 101 
 
 (M.L.E.) 3. Swinging Limb and Pelvic Lev- 
 erage with Thumbs at Lesion. (Assistant.) ioi 
 
 (M.L.E.) 4. Swinging Limb and Pelvic Lever- 
 age with Operator's Weight at Lesion. 
 (Swing.) 102 
 
 M. MUSCULAR LESIONS. 
 
 S. SACRAL REGION. (C. Coccygeal) 
 
 following. 
 
 D. DIRECT TREATMENT. 
 
 (M.S.D.) 1. Thumb Pressure at Posterior Sac- 
 ral Region. J03 
 
 (M.C.D.) 1. Trunk Leverage with Hand at Ex- 
 tensor Coccygeus. 104 
 
2G MECHANICAL PRINCIPLES OF 
 
 CERVICAL VERTEBRAE 
 
 V. VERTEBRAL LESIONS. m - 
 
 PAGE, 
 
 N. NECK OR CERVICAL REGION. 
 G. GENERAL TREATMENT. 
 
 (V.N.G.) i. Opposed Spiral or Corkscrew. (Il- 
 lustrated.) 105 
 
 (V.N.G.) 2. Lateral Springing via. Transverse 
 
 Processes. . Io6 
 
 V. VERTEBRAL LESIONS. 
 
 N. NECK OR CERVICAL REGION. 
 I. INDIRECT REMOVAL OF LE- 
 SION. 
 
 (V.N.L) 1. Rotation with Increasing Stress, 107 
 
 (V.NJ.) 2. Oscillation with Sudden Stress. 108 
 
 (V.N.I.) 3. Exaggeration, Circling and Screw- 
 Driving Rotation. (Illustrated.) 
 
 (V.N.L) 4. Rigid Neck Leverage with Shoul- 
 der Supporting Head io 9 
 
 V. VERTEBRAL LESIONS. 
 
 N. NECK OR CERVICAL REGION. 
 D. DIRECT TREATMENT. 
 
 (V.N.D.) 1. Exaggeration, Circling and Direct 
 
 Pressure. (Illustrated.) 
 (V.N.D.) 2. Exaggeration, Circling and Circ- 
 ling Within a Circle. (Illustrated.) 
 (V.N.D.) 3. Flexing with Oscillation. II3 
 
 (V.N.D.) 3. Combined. Modified. 1I3 
 
 (V.N.D.) 4. Traction and Pressure at Lesion. TI3 
 
 (V.N.D). 5. Exaggeration, Circling and Direct 
 
 108' 
 
 in 
 
 112 
 
 Pressure. 
 
 114 
 
OSTEOPATHIC TECHNIQUE. 21 
 
 V. VERTEBRAL LESIONS. page 
 
 N. NECK OR CERVICAL REGION. 
 E. EXTREME REMOVAL OF LE- 
 SION. 
 
 (V.N.E.) i. Reinforcing Opposed or Shearing 
 
 Movement. JI 6 
 
 (V.N.E.) 2. Rigid Neck Leverage and Lateral 
 
 Pressure with Weight Retarding. II 7 
 
 (V.N.E.) 3. Rigid Neck Leverage with Rein- 
 forced Posterior Pressure and Motion. 117 
 
 (V.N.E.) 4. Head and Neck Leverage for Ro- 
 tation, Flexion and Steady Pressure with 
 Traction. 118 
 
 (V.N.E.) 4. Modified, "9 
 
 (V.N.E.) 5. Rigid Neck Leverage with Both 
 
 Thumbs at Lesion. 1 1 9 
 
 V. VERTEBRAL LESIONS. 
 U. UPPER DORSAL REGION. 
 G. GENERAL TREATMENT. 
 
 (V.U.G.) 1. Longitudinal Traction Horizontal- 
 ly Applied. 121 
 
 (V.U.G.) 1. Modified. Head Overhanging. J 21 
 
 (V.U.G.) 2. Longitudinal Traction Vertically 
 
 Applied. 122 
 
 V. VERTEBRAL LESIONS. 
 U. UPPER DORSAL REGION. 
 
 I. INDIRECT TREATMENT. 
 (V.U.L) 1. Shoulder and Neck Leverage with 
 
 Hands Clasped and Knee Below Lesion. 133 
 
 (V.U.I.) 1. Modified or Lift, Drop and Catch. 123 
 
 (V.U.I.) 2. The Lift, Drop and Catch with 
 
 Operator Bowing Backward. 124 
 
 
2 2 MECHANICAL PRINCIPLES OF 
 
 V. VERTEBRAL LESIONS. page 
 
 U. UPPER DORSAL REGION. 
 
 D. DIRECT REMOVAL OF LESION. 
 
 (V.U.D.) i. Head and Neck Leverage with 
 
 Thumb at Lesion. 125 
 
 (V.U.D.) 1. Its Modifications. 125 
 
 (V.U.D.) 2. Head Fixed with Both Hands at 
 
 Lesion. 125 
 
 (V.U.D.) 3. Neck and Shoulder Leverage with 
 
 Thumbs at Lesion. 126 
 
 (V.U.D.) 4. Folded Arm Leverage. 126 
 
 V. VERTEBRAL LESIONS. 
 U. UPPER DORSAL REGION. 
 
 E. EXTREME REMOVAL OF LE- 
 
 SIONS. 
 
 (V.U.E.) 1. Reinforced Downward Pressure at 
 
 Spinous Process. I2 g 
 
 (V.U.E.) 2. Arm and Trunk Leverage with 
 
 Reinforced Arm at Lesion. j^o 
 
 (V.U.E.) 2. Modified or Shoulder and Neck 
 
 Leverage with Reinforced Arm at Lesion. 130 
 
 (V.U.E.) 3. Folded Arm Leverage Swinging 
 
 with Operator's Weight Aiding. (Swing.) j^ x 
 
 (V.U.E.) 4. Clasped Arm Leverage Bowing 
 Spine with Swinging Fulcrum and Thumb 
 at Lesion. (Swing.) (Illustrated.) 132 
 
OSTEOPATHIC TECHNIQUE. 23 
 
 V. VERTEBRAL LESIONS. page 
 
 I. INTER-SCAFULAR REGION. 
 
 G. DIRECT REMOVAL OF LESION. 
 
 (V.I.G.) 1. Similar to (M.G.I. 1) Elbow and 
 
 Shoulder Leverage with Hand Reinforced 136 
 
 V. VERTEBRAL LESIONS. 
 
 I. INTER-SCAPULAR REGION. 
 
 D. DIRECT REMOVAL OF LESION. 
 
 (V.I.D.) 1. Similar to (M.I.D.) 1, or Arm Lev- 
 erage with Inverted Thumb at Lesion. 136 
 
 (V.I.D.) 2. Neck, Arm and Shoulder Leverage, 
 
 Patient's Arms Clasped. (Illustrated.) 136 
 
 (V.I.D.) 3. Rigid Head and Neck Leverage, 
 
 Patient's Hands Clasped. 137 
 
 V. VERTEBRAL LESIONS. 
 
 I. INTER-SCAPULAR REGION. 
 
 E. EXTREME TREATMENT. 
 
 (V.I.E.) 1. Similar to (R.I.E. 3) or Arm and 
 
 Shoulder Leverage with Reinforced Arm 
 
 at Lesion. 
 (V.I.E.) 2. Neck, Arm and Shoulder Leverage, 
 
 Patient's Hands Clasped and Reinforced 
 
 Arm at Lesion. 
 (V.I.E.) 2. Modified, or Shoulder and Neck 
 
 Leverage with Reinforced Arm at Lesion. 
 
 138 
 
 138 
 
21 MECHANICAL FRIXCI7 7 7- 7 
 
 V. VERTEBRAL LESIONS. 
 
 D. DORSAL. MIDDLE AND LOWER 
 REGIONS. 
 GENERAL 
 
 (V.D.G.) i. Shoulder Leverage with Fingers 
 
 at Lesion. Lying on Side, i : : 
 
 (V.D.G.) 2. Shoulder Leverage with Fingers 
 
 at Lesion. -^n 
 
 (V.D.G.) 2. Modified. Reinforced. ^ 
 
 (V.D.G.) 3. Shoulder Leverage with Thenar 
 
 Eminence at Lesion. Lying. ^o 
 
 (V.D.G.) 3. Modified. :_: 
 
 (V.D.G.) 3. Modified. Sitting. -_: 
 
 (V.D.G.) 4. Shoulder Leverage with Thenar 
 
 Eminence at Lesion. 141 
 
 (V.D.G.) 5. Shoulder and Hip Leverage with 
 
 Forearms. 142 
 
 (V.D.G.) 5. Modified. 142 
 
 V. VERTEBRAL LESIONS. 
 D. DORSAL REGION. 
 
 I. INDIRECT TREATMENT. 
 
 (V.D.I.) 1. 5a::;e as (V.U.I. 1 Modified., or- the 
 
 Lift. Drop and Catch. 142 
 
 V. VERTEBRAL LESIONS. 
 D. DORSAL REGION. 
 
 D. DIRECT TREATMENT. 
 
 (V.D.D.) 1. Trunk Leverage to Spring. Circle 
 
 and Lift to Normal. 144 
 
 (V.D.D.) 1. Modified, Reinforced same as 
 
 (V.D.D. 1). 144 
 
OSTEOPATHIC TECHNIQUE. 25 
 
 TECH. 
 (V.D.D. i). PAGE 
 
 (V.D.D.) 2. Trunk Leverage to Spring Circle, 
 
 Rotate and Force to Normal. 145 
 
 (V.D.D.) 3. Lower Trunk and Limb Traction 
 
 with Thenar Eminence at Lesion. (Swing.) ^45 
 
 V. VERTEBRAL LESIONS, 
 D. DORSAL REGION. 
 
 E. EXTREME REMOVAL OF LE- 
 SIONS. 
 
 (V.D.E.) 1. Arm and Bilateral Trunk Lever- 
 age with Reinforced Arm at Lesion. A 
 Flying Wedge Treatment. 147 
 
 (V.D.E.) 2. Shoulder and Lateral Trunk Lev- 
 erage with Reinforced Arm at Lesion. 148 
 
 (V.D.E.) 3. Trunk Leverage to Spring and Cir- 
 cle with Reinforced Hand at Lesion. Simi- 
 lar to (V.D.D. 2), or Trunk Leverage to 
 Spring, Circle, Rotate and Force to Nor- 
 mal, and in Addition is Reinforced by El- 
 how, Knee and Foot. 149 
 
 (V.D.E.) 4. Shoulder and Arm Leverage with 
 Patient's Weight and Reinforced Arm at 
 Lesion. 149 
 
 (V.D.E.) 5. Circling and Bowing Spine. For 
 Alternate Exaggeration and Pressure for 
 Reduction of Lesion. (Swing.) I5 o 
 
 (V.D.E.) 5. Modified. (Swing.) i 5 o 
 
 (V.D.E.) 6. Arm and Shoulder Leverage 
 Swinging Trunk with Operator's Weight 
 at Lesion. (Swing.) 151 
 
26 MECHANICAL PRINCIPLES OF 
 
 TECH. 
 
 V. VERTEBRAL LESIONS. page 
 
 L. LUMBAR REGION. 
 
 G. GENERAL TREATMENT. 
 
 (V.L.G.) i, 2 and 3. Hip Leverage with Fing- 
 ers at Lesion. Same as (V.D.G.) 2 and 3, 
 or Shoulder Leverage with Fingers or 
 Thumb at Lesion. 153 
 
 (V.L.G.) 4. Shoulder Leverage with Thumb at 
 
 Lesion, 153 
 
 V. VERTEBRAL LESIONS. 
 L. LUMBAR REGION. 
 
 I. INDIRECT TREATMENT. 
 
 (V.L.I.) 1. Same as (M.L.D. 1), or Longitudi- 
 nal Stretching with Trunk Leverage. 153 
 
 (V.L.I.) 2. Same as (M.L.I. 2), or Longitudi- 
 nal Stretching with Limb Leverage. 153 
 
 V. VERTEBRAL LESIONS. 
 L. LUMBAR REGION. 
 
 D. DIRECT REMOVAL OF LESION. 
 
 (V.L.D.) 1. Lower Trunk and Limb Leverage 
 
 with Lesion at Edge of Table. 154 
 
 (V.L.D.) 2. Flexed Limb and Hip Leverage 
 
 with Reinforced Fingers at Lesion. 154 
 
 (V.L.D.) 2. Modified. i 55 
 
 (V.L.D.) 3. Swinging Limb and Pelvic Lever- 
 age with Lateral Pressure at Lesion. 
 (Swing.) 155 
 
15* 
 
 OSTEOPATHIC TECHNIQUE 27 
 
 TECH. 
 
 (V.L.D.) 3. Modified. P ^6 
 
 (V.L.D.) 4. Swinging Limb and Pelvic Lever- 
 age with Operator's Weight at Lesion. 
 (Swing.) 
 
 (V.L.D.) 5. Crank Leverage of Legs with 
 
 Thumb or Fingers Opposing at Lesion. 1^5 
 
 V. VERTEBRAL LESIONS. 
 L. LUMBAR REGION. 
 
 E. EXTREME TREATMENT. 
 
 (V.L.E.) r, 2, 3 and 4. Same as (V.D.E. 1, 2, 
 
 3 and 4), all flying wedge treatments. 160 
 
 (V.L.E.) 5. Flexed Limb and Lower Trunk 
 Leverage with Reinforced Arm at Lesion 
 Supporting Patient's Weight. (A Flying 
 Wedge Treatment.) y6& 
 
 V. VERTEBRAL LESIONS. 
 S. SACRUM. 
 
 I. INDIRECT REMOVAL OF LE- 
 SIONS. 
 
 (V.S.I.) 1. Knees Flexed on Abdomen Sup- 
 porting Operator's Weight. . - t 62 
 
 V. VERTEBRAL LESIONS. 
 S. SACRUM. 
 
 D. DIRECT REMOVAL OF LESION. 
 
 (V.S.D.) 1. Circling Flexed Knees over Abdomen 
 and Supporting lower Trunk with Hand at 
 Lesion: Supine. 1 03 
 
 (V.S.D.) 1. Modified. Patient on side. 163 
 
 V. VERTEBRAL LESIONS. 
 S. SACRUM. 
 
 E. EXTREME TREATMENT. 
 (V.S.E.) 1. Shoulder and Trunk Leverage 
 
 Forcing Lesion Against Knee. 164 
 
MECHANICAL PRINCIPLES OF 
 
 TECH. 
 
 (V.S.E.) 2. Direct Pressure from Operator's page 
 Weight. 164 
 
 (V.S.E.) 2. Modified. 165 
 
 (V.S.E.) 3. Similar to (V.U.E. 3), or Arm and 
 Trunk Leverage with Reinforced Arm at 
 Lesion. 165 
 
 (V.S.E.) 4. Same as (V.L.E. 5), or Flexed 
 Limb and Lower Trunk Leverage with 
 Reinforced Arm at Lesion Supporting Pa- 
 tient's Weight. 160-65 
 
 V. VERTEBRAL LESIONS. 
 C COCCYX 
 
 I. INDIRECT REMOVAL OF LE- 
 SIONS. 
 (V.C.I.) 1. External Method. l66 
 
 V. VERTEBRAL LESIONS. 
 C. COCCYX. 
 
 D. DIRECT REMOVAL OF LESION. 
 (V.C.D.) 1. Internal Method. 
 
 V. VERTEBRAL LESIONS. 
 C. COCCYX. 
 
 E. EXTREME METHOD. 
 (V.C.E.) 1. Combined Internal and External 
 
 Methods. 
 
 Clav. CLAVICLE. 
 
 S. AT STERNAL END. A. AT ACROMIAL 
 END. 
 
 D. DIRECT-E-EXTREME. 
 (Clav. S. D.) 1. Thumb fulcrum and circling arm 
 
 leverage, (setting.) 17° 
 
 (Clav. S. E.) 1 . Finger fulcrum and circling arm lever- 
 age, (lying.) 17° 
 
 (Clav. S. D.) 3. Lateral traction of shoulder girdle 
 
 with thenar eminence at lesion. 171 
 
 (Clav. A. D.) 1. Arm leverage with arm at lesion. 171 
 
 166 
 
 166 
 
OSTEOPATHIC TECHNIQUE. 2Q. 
 
 THE RIBS 
 
 TECH, 
 PAGE 
 
 R. THE RIBS. 
 
 U. THE UPPER DORSAL REGION. 
 
 D. DIRECT TREATMENT. 
 
 (R.U.D.) 1. Head and Neck Leverage for Mus- 
 cular Traction with Fingers at Head of 
 Rib. (Illustrated.) 172 
 
 (R.U.D.) 1. Modified. 175 
 
 (R.U.D.) 2. Head and Neck Leverage for Mus- 
 cular Traction with Thenar Eminence and 
 Operator's Weight at Lesion. 173 
 
 (R.U.D.) 3. Head and Neck Leverage for Mus- 
 cular Traction. 174 
 
 R. THE RIBS. 
 
 I. INTER-SCAPULAR (Angles.) 
 
 E. EXTREME REMOVAL OF LE- 
 
 SION. 
 
 (R.I.E.) 1. Reinforced Shoulder Leverage with 
 
 Operator's Knee at Lesion. 175 
 
 (R.I.E.) 2. Clasped Arm and Shoulder Lever- 
 age for Muscular Traction with Pressure 
 at Angles. (Swing.) 176 
 
 (R.I.E.) 3. Arm and Shoulder Leverage with 
 Reinforced Arm at Angles. (A Flying 
 Wedge Treatment.) I7 5 
 
 (R.I.E.) 3. Modified, with Anterior Muscular 
 
 Traction. jyn 
 
30 MECHANICAL PRINCIPLES OF 
 
 TECH. 
 
 R. RIB TREATMENT. page 
 
 D. MID-DORSAL OR TYPICAL RIBS. 
 G. GENERAL TREATMENT. 
 
 (R.D.G.) i. Rocking Hand at Angles with 
 Patient's Weight and Circling Arm Lever- 
 age Opposing. 1S0 
 
 (R.D.G.) 2. Rocking or lifting, Both Hands at 
 
 Angles with Patient' J Weight Opposing. igo 
 
 (R.D.G.) 3. Operator's Arm Leverage with 
 Shoulder Fulcrum and Patient's Weight 
 Opposing. 181 
 
 (R.D.G.) 4. Arm Leverage for Muscular Trac- 
 tion with Fingers at Angles. Sitting. 181 
 
 (R.D.G.) 4. Modified, Arm Leverage for Mus- 
 cular Traction with Fingers at Angles. 
 Lying. 181 
 
 (R.D.G.) 5. Arm Leverage with Thumb or 
 
 Thenar Eminence at Angles. 182 
 
 (R.D.G.) 6. Elbow and Shoulder Leverage 
 with Thenar Eminence at Angles and Ope- 
 rator's Weight Aiding. 182 
 
 (R.D.G.) 6. Modified. For low table. 183 
 
 (R.D.G.) 7. Arm ana Hip Leverage with Knee 
 
 at Angles and Patient's Weight Aiding. 183 
 
 (R.D.G.) 7. Modified, or Arm Leverage with 
 Knee at Angles and Patient's Weight Re- 
 inforced. 184 
 
 (R.D.G.) 8. Lowering Sternal End by Forced 
 Exhalations with Operator's Weight Aid- 
 ing. 184 
 
OSTEOPATHIC TECHNIQUE. 3 I 
 
 TECH 
 
 R. THE RIBS. pagk 
 
 D. MID-DORSAL OR TYPICAL RIBS. 
 I. INDIRECT TREATMENT. 
 
 (R.D.I.) i. Hip and Shoulder Leverage for 
 Trunk Rotation and Replacement by Mus- 
 cular Traction. x g 7 
 
 (R.D.L) i. Modified. Windlass principle. l8 _ 
 
 R. THE RIBS, 
 
 D. MID-DORSAL OR TYPICAL RIBS. 
 D. DIRECT REMOVAL OF LESION. 
 (R.D.D.) i. Arm and Shoulder Leverage with 
 
 Thumb at Lesion. T 8 9 
 
 (R.D.D.) 2. Combined Angle and Sternal Pres- 
 sure for Adjustment During Deep Respira- 
 tion. 189 
 
 (R.D.D.) 2. Modified. For sitting posture. ig Q 
 
 (R.D.D.) 3. Arm Leverage for Lateral Pectoral 
 
 Traction with Direct Pressure at Lesion. 191 
 
 (R.D.D.) 4. Shoulder Leverage with Pressure 
 at Angles and Anterior Muscular Traction 
 with Patient's Weight Aiding. (Swing.) 19 l 
 
 (R.D.D.) 5. Sternal End Leverage with Knee 
 
 at Angles and Anterior Muscular Traction. 193 
 
 (R.D.D.) 6. Angle Pressure with Shoulder 
 
 Leverage Opposing. 193 
 
32 PRINCIPLES OP TECHNIQUE 
 
 TECH. 
 
 R. THE RIBS. page 
 
 D. MID-DORSAL OR TYPICAL RIBS. 
 E. EXTREME REMOVAL OF LE- 
 SION. 
 
 (R.D.E) i. Both Shoulders for Upper Trunk 
 
 Leverage with Knee at Lesion. J 9^ 
 
 (R.D.E.) 2. Swinging Limb and Pelvic Lever- 
 age with Operator's Weight at Angles 
 Forcing Rotation. (Swing.) 196 
 
 (R.D.E.) 3. Shoulder and Trunk Leverage with 
 Reinforced Arm at Angles. (A Flying 
 Wedge Treatment.) 197 
 
 (R.D.E.) 4. Arm and Shoulder Leverage with 
 Pressure at Angles and Muscular Traction 
 with Patient's Weight Aiding. (Swing.) 198 
 
 (R.D.E.) 4. Modified. Supine. (Assistant.) 198 
 
 (R.D.E.) 4. Modified. On side. (Assistant.) 198 
 
 R. THE RIBS. 
 
 L. THE LOWER OR FLOATING RIBS. 
 D. DIRECT TREATMENT. 
 
 (R.L.D.) 1. Anterior End and Crank Leverage 
 
 with Respiration. 202 
 
 (R.L.D.) 2. Anterior End and Crank Leverage 
 
 Muscular Traction above Lesion. 2 ° 2 
 
 (R.L.D.) 3. Direct Pressure with Muscular 
 
 Traction by Way of Hip Leverage. 203 
 
EXPLANATION' OP TECHNIQUE 33 
 
 EXPLANATION OF 
 
 THE TECHNIQUE 
 
 SYMBOLS. 
 
 The symbols used to indicate the various treat- 
 ments are of value in writing Osteopathic prescrip- 
 tions, as in keeping case records, communicating with 
 other Osteopaths, preparing articles for publication, 
 teaching the practice of Osteopathy, etc. 
 
 These symbols, together with the logical classifica- 
 tion and naming of treatments, should aid practitioners 
 in the understanding and interchange of their mechan- 
 ical technique, as Esperanto does the interchange of 
 languages. 
 
 NAMING OF TREATMENTS. 
 
 Treatments are named according to the mechan- 
 ical principles they contain, as well as the method of 
 applying them. 
 
 They have been used in class and revised until 
 their naming is sufficiently clear, to enable students to 
 perform the treatments when the names of the treat- 
 ments are given. 
 
 THE SUBDIVISIONS OF THE TECHNIQUE. 
 
 USE. 
 
 Indicates the special use, range of its application, 
 etc., not indicated in the symbol. 
 
 POSTURE. 
 
 Indicates the general position, posture or pose of 
 both operator and patient. Also any support other 
 than treating table, also the fixtures used as supports. 
 
^4 EXPLANATION OF TECHNIQUE 
 
 POSITION: 
 Under position is given the position in detail of 
 the hands and other parts of the anatomy of either 
 operator or patient. 
 
 PRINCIPLE. 
 This heading is used where the mechanical prin- 
 ciple can be further illustrated than was convenient 
 in naming of the treatment. 
 
 ACTION. 
 This indicates the act of adjustment. When sub- 
 divided by letters they occur simultaneously. When 
 subdivided by figures they transpire consecutively. 
 DEGREE. 
 Indicates the amount of pressure or the limit safe- 
 ly given. Due consideration should be given the 
 strength and weight of the patient. 
 CAUTION. 
 Those mentioned are examples of what have 
 caused injury in previous cases, or evidently would if 
 carelessly applied. Or important details that, if omit- 
 ted, would result in a failure. 
 
 THE SIGNIFICANCE OF CAPITALS AND 
 BOLD-FACED TYPE IN DESCRIBING THE - 
 TECHNIQUE OF TREATMENTS. 
 The technique given under the headings Posture, 
 Position, Action, etc., is printed in capitals not only 
 for emphasis, but to enable the student or practitioner 
 to follow the text when trying them on a subject or 
 patient. 
 
 The words referring to the anatomy of the opera- 
 tor, as used in treating, are in bold-faced type. 
 
 The references to the patient's anatomy are in 
 •ordinary type. 
 
EXPLANATION OF TECHNIQUE 35 
 
 THE MEANING OF HAND ONE, HAND TWO, 
 SHOULDER ONE, FOOT ONE, ETC. 
 
 Hand one is always the operator's hand that is at 
 the lesion, unless otherwise specified. 
 
 The corresponding side or any of its parts of either 
 patient or operator is numbered one, as shoulder one 
 of operator, or shoulder one of patient 
 
 They are differentiated by printing- the parts of the 
 operator's anatomy in bold-faced type. 
 
 The operator's hand at the lesion is either the right 
 or left, and furnishes the key showing which side is 
 number one ; the opposite side or any part of them is 
 number two. 
 
 Thus, the operator's right hand and the patient's 
 right hand could be number one. 
 
 But the operator's left hand and the patient's right 
 hand could not both be numbered one. 
 
 CLASSES OF TREATMENT. 
 G. GENERAL. 
 
 This is the most common form. 
 
 It is the mildest, the least dangerous to apply, the 
 easiest on the operator. It is sometimes best to begin 
 a case with ; not always, however. 
 
 This is the class of treatment that we are apt to 
 drift back into if we are not well up in technique and 
 diagnosis. Even then, there is a tendency for Osteo- 
 pathists to lapse back into a routine of time killers 
 that are easy to apply, even though the patient has 
 passed the stage-indicating their use. 
 
 These are often used as a preparatory treatment 
 to specific work. Patients requiring daily treatment 
 should be able to take this without being overtreated, 
 as would be the case with direct or extreme treatments. 
 
36 EXPLANATION OF TECHNIQUE 
 
 I. INDIRECT. 
 
 This is the class of treatments where no direct 
 pressure is brought to bear on lesion. The muscular 
 lesions receive longitudinal traction, and the osseus 
 lesions receive either a general springing or rotation,, 
 without making a fixed point at or near lesion. 
 
 It is obvious that the latter are more general than 
 those classified as general, though there is some chance 
 of their being direct or specific in effect. This element 
 of chance is so marked where sudden rotation is given 
 that it is not a high grade of Osteopathic technique. 
 
 D. DIRECT. 
 
 In this class of treatments hand one acts as a ful- 
 crum in treating osseus lesions by making a fixed point 
 at or near lesion. A moderate degree of pressure is 
 applied and treatments are given specifically, as a rule. 
 
 By their use there is less risk of injury than with 
 the extreme. On the other hand, to get results may 
 require one more effective, or an extreme treatment.. 
 In both the direct and extreme treatments nearly all, 
 except acute cases, will get along best with two a week, 
 and every few months a vacation of a few weeks, dim- 
 inishing the length of term of treatment and increas- 
 ing the length of vacations. 
 
 E, EXTREME. 
 
 This class of treatment should be used sparingly 
 and only when diagnosis is positively correct. 
 
 It is a rare thing that a muscular treatment of this 
 class will not reduce malarial or typhoid fevers three 
 or more degrees the first treatment, if the fevers are 
 of but a few days' standing. It is applied to osseus 
 
EXPLANATION OF TECHNIQUE 37 
 
 lesions when other methods or practitioners fail, or in 
 critical cases when the right thing must be done im- 
 mediately. A writer has said, "There is always a 
 place for a person Avho will assume responsibility. " 
 This is the class of treatments for these people. 
 
 As a rule, the extreme treatments are not the 
 "follow-up" kind. One jolt at an osseus lesion is often 
 enough at a treatment. In contrast to the repetition of 
 a manipulation requiring more gentle touch, as in most 
 of the general treatments. 
 
 THE "FLYING WEDGE" SERIES. 
 
 This is a division of the extreme treatment that is 
 especially effective. To quote a student's answer to 
 an examination question regarding it, "It is method of 
 reducing a lesion at one operation." This was origi- 
 nally applied to the middle and lower dorsal region, 
 It was called a "flying wedge" after the old-time for- 
 mation in football, when the wedge-shaped formation 
 of the eleven carried everything in front of it. Like- 
 wise the treatment and its effect on the lesion. 
 
 These now cover about a dozen treatments from 
 the third rib to the sacrum. 
 
 Their principles are very much alike, and are as- 
 tollows : When the elbow is grasped, it is held, not 
 for leverage, but for pushing the shoulder backward, 
 therefore it should be held straight in front of body,- 
 not folded, "like a chicken's wing." 
 
 The operator's axilla often grasps the patient's 
 opposite shoulder for the purpose of carrying the trunk 
 back without rotation when reducing posterior condi- 
 tions. 
 
3§ EXPLANATION OF TECHNIQUE 
 
 Patient is inclined toward operator, so that pa- 
 tient's weight aids by allowing" operator to apply pres- 
 sure obliquely from beneath. 
 
 The characteristic position of operator's lesion 
 side or side cne (the side corresponding to the hand at 
 lesion) is that the thenar eminence is in firm contact 
 with lesion. The operator bends forward at hips, so 
 as to rest elbow on operator's thigh, near knee, with 
 heel on floor, or nearly so, steady pressure applied 
 when the action takes place. The heel is raised, or 
 the knee swung in, so that a sudden jolt is given the 
 lesion already on a tension, striking lesion from below 
 obliquely upward as patient's body is inclined back- 
 ward. This is most effective if patient is taken - un- 
 awares ; sometimes by following up with an extra jolt, 
 or two, if first produces no movement, will produce 
 the desired result. 
 
 Unless the operator takes the precaution to keep 
 his or her spine straight and to use the ankle move- 
 ment or the swinging in of the knee, the work will 
 be unnecessarily wrenching and tiresome to the ope- 
 rator. 
 
EXPLANATION OF TECHNIQUE 39 
 
 MECHANICAL AIDS 
 
 In this method of naming treatments according 
 to their mechanical principles, some of the simpler 
 ones were found to be almost without principle, while 
 some of the more complex required more hands or 
 supports than an operator might have. 
 
 Realizing that the direct and extreme treatments, 
 though effective, are hard on the operator, and that 
 there is a tendency in some to either slight a patient 
 or resort to a questionable adjunct to save strength or 
 increase results, also that gravity is one of the im- 
 portant factors in producing lesions, there has been 
 an effort to act on the McConnel & Teal idea of mak- 
 ing your weight and the patient's weight count for 
 energy expended. This means using gravity, the force 
 that aids in producing lesions, to aid in correcting 
 them. Other forces and conditions entering into the 
 production of lesions, properly used, should be made 
 to aid in correcting them. 
 
 Motion, wrenching, twisting, jolting, muscular 
 traction, direct pressure, leverage, etc., all play their 
 part in producing as well as reducing the lesions. 
 
 In order that more of these principles may be 
 brought to bear, the Osteopathic swing is introduced 
 in a score or so of treatments, it being used as a sup- 
 port in using muscular traction, gravity, motion and 
 increased leverage. 
 
40 
 
 NfECE LANDMARKS 
 
 Transverse Articular and Spinus Processes. 
 
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NECK LANDMARKS 41 
 
 THE NECK 
 
 OSTEOPATHIC LANDMARKS OF NECK. 
 
 1. ATLAS. Spinous process is scarcely felt. 
 Transverse process, or lateral mass is felt between 
 mastoid process and angle of inferior maxillary; also 
 felt from below upward one-half inch laterally beyond 
 the axis. 
 
 2. AXIS. Spinous process is usually long to 
 support ligament nuchae, therefore its neighboring 
 spinous processes are short, leaving the FIRST, 
 THIRD and Fourth scarcely felt. 
 
 3. FIFTH. Spinous Process is the next one felt 
 posteriorly, the SIXTH is more prominent, while the 
 SEVEXTH is the most prominent of the Cervical 
 vertebrae, though FIRST DORSAL is even more 
 prominenl 
 
 4. SIXTH. Tiansverse process is extra long. 
 
 5. THE CERVICAL AS A WHOLE HAVE: 
 
 (a) Articular processes lying less than one inch 
 to side of spinous process. 
 
 (b) Articular processes are at an angle of from 
 30 to 50 degrees from spinous process. 
 
 (c) Prominence of the lamina is one-half way be- 
 tween the superior articular and the spinous processes. 
 
42 NECK LANDMARKS 
 
 DIFFERENTIAL DIAGNOSIS BY MOTION. 
 SPINOUS PROCESS OP AXIS. 
 
 • I. Approximates head as head is flexed backward. 
 2. Remains stationary as head rotates, while afc-las 
 is turned with head. 
 
 SEVENTH CERVICAL. 
 
 1. Rotates while FIRST DORSAL is stationary. 
 DIAGNOSIS BY RESTRICTED MOTION. 
 
 If head will not flex backward the Atlas is at fault 
 or posterior. 
 
 If head will not rotate from side to side equally 
 the Axis is at fault. 
 
 If head will not flex to side, both the Atlas and 
 Axis are at fault or lateral. 
 
 If head rotates, so that chin does not travel in a 
 horizontal plane, the Axis and the Cervical Vertebrae 
 below it are at fault, causing the axis of rotation to be 
 at an incline instead of vertical. A marked Cervical 
 curve would cause it. 
 
 FOUR METHODS OF EXAMINATION. 
 A. Spinous processes method. 
 
 i. Its prominence or lateral deviations. 
 
 2. Tenderness on deep pressure. 
 
 3. Contractured or congested muscles in region. 
 
 4. Disturbed function of joint. 
 
 5. Symptoms. 
 
 B. Lamina. 
 
 1. Prominence felt as the rounded half of a split 
 lead pencil. 
 
NECK EXAMINATION 43^, 
 
 2. Tenderness over this elevation. 
 
 3. Contractured or congested muscles. 
 
 4. Disturbed function of joint. 
 
 5. Symptoms. 
 
 C. Articular Processes. 
 
 1. Prominence felt as a nodule at posterior orr 
 lateral aspect. 
 
 2. Tenderness of same. 
 
 3. Softened or congested ligaments and other- 
 tissues. 
 
 4. Muscular contractions. 
 
 5. Disturbed function of joint. 
 
 6. Symptoms. 
 
 D. Muscular Contractions. 
 
 1. Run from above downward, often obliquely to& j 
 cervical bony lesions, also from below upward as ira 
 the scaleni. 
 
 2. Are tender on pressure. 
 
 3. Beiomes tendinous, about the size of a round- 
 ed half of a split lead pencil, then disappear near lesion: ., 
 
44 
 
 THE SPIN'S 
 
 c 
 
 ■D 
 
SPINAL LANDMARKS 45 
 
 THE SPINE 
 
 OSTEOPATHIC LANDMARKS OF THE SPINE; 
 
 The SPINOUS PROCESSES of the DORSAL 
 VERTEBRAE are long bayonet-shaped levers direct- 
 ed obliquely downward with tubercular extremity.. 
 The region of greatest obliquity is from the> fifth to the - 
 eighth, the tips being about three-quarters of" an inch:, 
 lower in relation to the bodies, transverse processes,^ 
 ribs, etc., and about one-quarter of an inch flatter or 
 deeper in relation to transverse processes and sur- . 
 rounding structures. This scale-like formation of the 
 spinous processes increases the rigidity and with the 
 articular surfaces lessen the liability to antero-posteri-. 
 or deviations. On account of their length, muscular- 
 traction increases liability to lateral deviation. 
 
 The REGION of Normal Separation of Spinous 
 Processes is just above the fifth, and the Region of 
 Normal Approximation is just below the eighth, be- 
 cause of the drifting downward of the mass of spines, 
 above the ninth and the more horizontal position of; 
 those above the fifth and below the eighth. 
 
 The Cervical Spines are irregularly bifid, hence- 
 are less valuable in diagnosis. 
 
 The SPINOUS PROCESSES of the LUMBAR; 
 VERTEBRAE are clubbed and horizontal and pre--, 
 sent a rough, flatiron-shaped surface with the apex 
 ttp. The length of these surfaces is greater than thcs . 
 
'4^ SPINAL LANDMARKS 
 
 spaces between them, and they are equal to several 
 ".times the area of the dorsal spines. 
 
 The apex of the lumbar spines lies in the center 
 •of the four articular processes : the First is sometimes 
 "fcifkl and therefore much wider than the Twelfth Dor- 
 :sal. (Illustrated.) 
 
 "THE TRANSVERSE PROCESSES. (ILLUS- 
 TRATED.) 
 
 A. DISTANCE FROM MEDIAN LINE. As 
 
 a rule they are about one inch to the side, with the 
 following exceptions: At the First Dorsal they are 
 one-quarter of an inch more, and at the Twelfth are 
 
 ■ one-quarter of an inch less. i. e., they are in a line 
 -drawn between these points or one and one-quarter 
 ■'inches at First Dorsal and three-quarters of an inch 
 -at Twelfth Dorsal. In comparison the Cervical Trans- 
 verse Processes lie one inch lateral, except the Atlas, 
 •which is one-half inch more. Thus the Transverse 
 -process of the Atlas and the transverse processes of 
 
 the First and Fifth Lumbar Vertebrae are one and 
 
 ■ one-half inches from the median line, while the Mid- 
 dle Lumbar region is two inches distant. 
 
SPINAL LANDMARKS 
 
 47 
 
48 SPINAL LANDMARKS 
 
 B. HEIGHT and ANGLE from tips of the 
 Spinous Processes (patient sitting). In the Upper 
 and Lower Dorsal Region, the transverse processes 
 lie about three-quarters of an inch higher than tips 
 of spinous processes and at an angle of about 45 de- 
 grees. From the fifth to the eighth about one and 
 one-half inches higher and at an angle of about 60 de- 
 grees. 
 
 In the Cervical region the Transverse Processes 
 lie about three-quarters of an inch higher and at an 
 angle of about 40 degrees, though they lie more to the 
 front of the articular processes, which are of more 
 diagnostic value. 
 
 The Articular processes lie just above and below 
 the transverse process and about one-quarter of an 
 inch or 10 degrees, making the superior articular pro- 
 cesses lie at an angle of 50 degrees and the inferior 
 at an angle of 30 degrees from spinous processes. 
 
 In the Lumbar region the Transverse Processes 
 lie about one-half inch higher than the highest tip of 
 the flatiron surface of spinous process, or at an angle 
 of less than 30 degrees, and in line with the Articular 
 Processes, which are about half-way between the 
 transverse and spinous processes. 
 
SPINAL LANDMARKS 
 
 49 
 
50 SPINAL LANDMARKS 
 
 C. DEPTH OF TRANSVERSE PROCESSES 
 BELOW THE TIPS OF SPINOUS PROCESSES 
 
 (Patient Prone). 
 
 In Upper and Lower Dorsal Region they lie one- 
 half inch deep and one-quarter inch deep from fifth 
 to eighth. 
 
 In Lumbar Region three-quarters of an inch 
 above, deepening to one and one-half inches below. 
 
 In Cervical Region they lie anterior to the articu- 
 lar processes, and the cervical articular processes 
 are about three-quarters of an inch deep above and 
 one inch below, not counting the axis. 
 
 THE ARTICULAR PROCESSES. 
 
 In the Dorsal region the articular surfaces lie one- 
 half inch away from median line. The inner border 
 of the same lie about three-eighths of an inch apart or 
 three-sixteenths of an inch from the median line in the 
 same plane and facing backward, making lateral slips 
 the most liable. • - 
 
 In the Cervical region they face upward and back- 
 ward, making slips in all directions easy. 
 
 In the Lumbar region they lie between the spi- 
 nous process and the transverse process and about 
 equi-distant from apex of each. 
 
SPINAL LANDMARKS 
 
 51 
 
52 SPINAL EXAMINATION 
 
 OSTEOPATHIC EXAMINATIONS OF SPINEL 
 
 GENERAL CONTOUR. 
 
 Patient sitting or lving on side, with head raised 
 to normal position. 
 
 1. Look for lateral swerves, curves and angles 
 by tracing with index finger of same hand at either 
 side of spinous processes. 
 
 2. Look for anterior or posterior swerves, curves 
 and angles ; and for absence of normal curves ot 
 straightness by tracing fingers over spinous pro- 
 cesses ; or by direct friction. 
 
 3. Either abnormal rigidity or lax ligaments maj 
 be found by springing spine laterly or anteriorly. 
 
 4. Contractured muscles may aid in causing the 
 rigidity of the trunk. If generally contractured, they 
 may also mask bony lesions, making complete diag^ 
 nosis impossible until relaxed by treatment. 
 
 BONY LESIONS. 
 
 1. Note Anterior and Posterior slips and steps, 
 found by finger tips gliding longitudinally across spi- 
 nous processes over or under garment, or by two ot 
 three rapid rubs directly over spines to cause redness 
 of prominences. 
 
 2. Lateral Slips are found by tracing two fingers 
 laterally or one finger reinforced from above down- 
 ward, remembering the entire width of spines. 
 
 3. Spreads and Approximations are normal in 
 places. The abnormal having tenderness on direct 
 pressure with fingers at right angles to spine. 
 
SPINAL EXAMINATION 
 
 53 
 
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54 SPINAL EXAMINATION 
 
 A. TRACING FROM BONY TO MUSCULAR 
 LESIONS. 
 
 i. POSITION: 
 
 a. Of Spinous processes: Allow for its size and 
 distortion from muscular traction. 
 
 b. Confirm by prominence of Transverse pro- 
 cesses which are prominent and tender on side away 
 from lateral deviation. 
 
 c. There is likely to be a disturbance of the ad- 
 joining ribs. The rib is most likely to be carried 
 with the transverse process. 
 
 2. TENDERNESS: 
 
 a. Spinous Process: (i) on tip with deep pres- 
 sure; (2) on side from above downward, with fingers 
 reinforced with lateral pressure downward ; (3) inter- 
 spinous .ligaments. 
 
 b. Transverse Process — tenderness on one most 
 prominent at insertion of muscles. 
 
 c. Articular Processes. 
 
 3. CONTRACTURED MUSCLES: Leading 
 to Transverse process from below upward, in Dorsal 
 and Lateral Cervical region and from occiput down- 
 ward in Posterior Cervical Region, narrow and coni- 
 cal in shipe and tender. 
 
SPINAL EXAMINATION 
 
 55 
 
56 SPINAL EXAMINATION 
 
 B. TRACING FROM MUSCULAR TO BONY 
 LESIONS. 
 
 i. MUSCLES: 
 
 a. Find Contractured Muscle. 
 
 b. Trace up its Tendon, which feels like round- 
 ed side of a split lead pencil, feeling transversely. 
 
 c. Begin feeling vertically to find a tubcrble 
 marking Transverse Process beyond where muscle 
 outline is lost. 
 
 2. TENDERNESS is found in 
 
 a. The Muscle along its course. 
 
 b. At Bcny Points mentioned under A just pre- 
 ceding. 
 
 3 BONY LESION: 
 
 a. Transverse Process prominent or tender at 
 insertion of muscular lesion. 
 
 fe. Drop diagonally down to find Spinous Pro- 
 cess and note position. Note: If a lateral swerve, 
 look for a mass of contractured muscles on convexity. 
 
 4. DISTURBED FUNCTION. 
 
 LYING POSTURE. 
 Patient may be supported on treating table, bed 
 or couch or table with swing. If bed or couch is used, 
 head may be at foot, or if bed is used, patient may lie 
 diagonally across, or lie directly across, permitting 
 operator to treat from opposite side. 
 
 SITTING POSTURE. 
 Patient may be supported on table, high or low 
 
SPINAL EXAMINATION 57 
 
 stool or chair. With chair back at either side of pa- 
 tient, or seated on stool, with body inclined forward 
 with folded arms or axillae in swing. 
 
 KNEELING POSTURE. 
 
 Is given with swing when patient is taller than 
 operator -or when swing supports cubital fossa instead 
 of axillae for additional leverage. 
 
 STANDING POSTURE. 
 
 Patient may stand with swing supporting axillae 
 and with straps parallel, crossed or suspended from 
 one hook. The further they are crossed the greater 
 "the muscular traction when circling patient. 
 
58 RIB LANDMARKS 
 
 THE RIBS 
 
 OSTEOPATHIC LANDMARKS OF THE RIBS. 
 
 NORMALLY THE CROSS SECTIONS OF THE 
 SEVENTH RIBS ARE AS FOLLOWS: 
 
 AT TRANSVERSE PROCESS: 
 
 One-half inch external to it, the cross section of 
 a rib is at the same level. 
 
 AT ANGLES: 
 
 A cross section lies one inch lower than the trans- 
 verse process. 
 
 AT MID AXILLARY LINE: 
 
 A cress section lies two inches lower than at the 
 transverse process. 
 
 AT THE MAMMARY LINE (The lowest 
 point) : 
 
 Or a line drawn vertically half-way between the 
 mid axillary line and mid sternal line. A cross sec- 
 tion lies three inches lower than at transverse process. 
 Note: The slant of ribs i's proportionally greater in 
 ribs below the seventh and proportionally less above 
 the seventh. 
 
 THE COSTO CHONDRAL LINE OF DIAGNOS- 
 TIC TENDERNESS. 
 
 This extends from a point one-half inch external 
 to the sternum, or tip of second rib, to the tip of nirKh 
 rib. 
 
 Gliding across it with pressure is a quick aid in 
 locating the tenderness of ribs when they are inacces- 
 sible at interscapular region. 
 
RIB LANDMARKS 
 
 5y 
 
 
 -J^m wr mm its TIP 
 
 lustritmg height of Ribs at varying distances from tip of transverse processes 
 
6o rib LANDMARKS 
 
 A LUXATED TYPICAL RIB. 
 
 IF UPPER BORDER IS PROMINENT LATER- 
 ALLY : 
 
 The Anterior End is up. 
 
 The Treatment at Angle should be forcing it up- 
 ward in addition to forcing it forward, etc. 
 
 The rib having been luxated on the see-saw prin- 
 ciple ; one end going up and the other going down. 
 
 Remember the Key: Three Ups, i. e., UoDer 
 border prominent, anterior end, Up and treatment at 
 angle Upward. 
 
 IF LOWER BORDER IS PROMIXEXT LATER- 
 ALLY : 
 
 The Anterior End is low. 
 
 The Treatment at Angle should be forcing it 
 downward in addition to forcing it forward, etc. 
 
 This latter condition would represent the see-saw 
 tilted the reverse of the former. 
 
 Remember the Key: Three Lows, i. e., Lower 
 "border is prominent, anterior end is Low, treatment 
 .-at angle is to Lower the rib. This is the most com- 
 mon form, owing to the rib being supported slightly 
 above the costo transverse articulation, it easily glides 
 xipward and backward. 
 
 In the latter case, the lower border, and, in fact, 
 the entire rib is less prominent than in cases when 
 upper border is prominent. The first, eleventh and 
 twelfth ribs do not come under the above rules. 
 
RIB LANDMARKS 
 
 6l 
 
 ILLUSTRATING THE KEY TO RIB LESIONS 
 
 (Exaggerated) 
 
 
 
 The RIBS representing a see-saw- tilted 
 
 The AXIS OF RIB LESIONS representing the facrum stationary 
 
62 RIB EXAMINATION 
 
 THE FIRST RIB. 
 
 In the first illustration. Suppose the neck to be 
 'octagonal instead of round. Find the postro-lateral 
 side, or aspect. Locate a point midway of this side. 
 
 In the second illustration. Suppose the shoulder 
 to be horizontal and the neck vertical. Bisect this 
 angle or find the point one-half way between the vir- 
 tical and the horizontal line. 
 
 Third. Travel around the neck toward the poster- 
 ior surface until yen come to the middle of the line 
 first located, or a point at the postro-lateral aspect. 
 
 The result is the finding of a portion external to 
 the transverse process of the first dorsal vertebrae and 
 the tubercle of the first rib. This is a diagnostic point 
 of tenderness of the first rib. It is also the point for 
 greatest pressure in reducing subluxations of the same. 
 In other words* it is the point one-half way between 
 anterior and posterior and between vertical and hori- 
 zontal. 
 
 This is best palpated with patient sitting, opera- 
 tor at back, using index, middle and ring fingers. 
 
 You may find tenderness, elevation or depression 
 of rib at sternal end and middle, or below and above 
 clavical as well as at tubercle above mentioned. 
 
TUB EXAMINATION 
 
 63 
 
6\ RIB EXAMINATION 
 
 EXAMINATION OF RIBS. 
 
 FOR SINGLE SUBLUXATIONS. 
 
 (A) TRACING FROM SPIXE TO RIBS: 
 
 Examination in Detail. 
 
 1. AT SPIXE: 
 
 (a) At a transverse process of a luxated verte- 
 brae expect a rib to be carried with it, or to be thrown 
 above or below its articulation with the transverse- 
 process. If so, the rib will be carried anteriorly in 
 the former instance and posteriorly in the latter, that 
 is, slightly between the transverse processes. 
 
 (b) Perhaps tenderness only is found. 
 
 2. AT NECK: 
 
 (a) If posterior the neck is felt as the rounded 
 half of a split lead pencil. 
 
 (b) Tenderness is found at this point. Note: 
 This is the spot for extreme pressure in treating. 
 
 3. AT ANGLE: 
 
 (a) Trace to angle, or about three inches out, 
 and note the vertical spacing of the ribs. 
 
 (b) Tenderness is more noticeable at approxima- 
 tions — because tissues are pinched. 
 
 (c) Expect rotation of rib on its longitudinal 
 axis. 
 
 4. AT LATERAL ASPECT: 
 
 (a) Find prominence of a border of a rib, which 
 furnishes key to position and treatment of rib else- 
 where explained. 
 
 (b) The other border is displaced inward. 
 (C) Tenderness: 
 
 (1) On deep pressure over rib, 
 
R IE EXAMINATION 65 
 
 (2) At intercostal spaces. 
 
 (3) Approximations most tender. 
 
 5. AT STERNAL END: 
 
 (a) Prominence or depression: if rib is displaced 
 hack .vard at vertebral end, it is depressed at sternal 
 end. 
 
 (b) Tenderness at costo-chondral articulation. 
 
 (c) Distortion of costal cartilage; often found 
 with superior border bulging like an old coat pocket, 
 if sternal end of rib is depressed. 
 
 THE ELEVENTH AND TWELFTH RIBS. 
 
 Compare these ribs to a crescent with one end, 
 the head, attached, the other end free. The ANTER- 
 IOR END would have the greater range -of displace- 
 ment. 
 
 First. It may Rotate either way on an axis cor- 
 responding with posterior half, usually throwing its 
 anterior end upward and inward, or downward and 
 outward. 
 
 Second. It may Swing Up or Down About the 
 Head as a Center. 
 
 Third. They may be Carried Obliquely down- 
 ward with the head dislocated upward. 
 
 Fourth. Combination of the above may exist. 
 
 Fifth. May Drop downward, both ends being 
 carried nearly parallel. 
 
66 
 
 RIB EXAMINATION 
 
 EXAMINATION O? THE ELEVENTH AND 
 TWELFTH RIBS. 
 
 i„ Tenderness of Ribs: On pressure or motion. 
 
 (a) At vertebral end. 
 
 (b) At free end. 
 
 (c) At middle. 
 
 2. Prominence or Depression: 
 
 (a) Of borders. 
 
 (b) Vertebral end. 
 
 (c) Free end. 
 
 Intercostal Spaces: 
 
 (a) Size. 
 
 (b) Tenderness. 
 
 (c) Possibly ribs overlapped. 
 
 EXTRAORDINARY MEANS OF LOCATING 
 TENDERNESS OF RIB LESIONS. 
 
 Note: Often approximations protect intercostal 
 nerves and tissues, so that the fingers bridge the inter- 
 costal space without locating the tenderness. It is 
 then necessary to use the following means : 
 
 1. Use side of tip of index finger, reinforced by 
 
 remaining fingers of same hand. 
 
 2. Give pressure during deep respiration. Fing- 
 ers lying in intercostal spaces and parallel with them 
 in both instances. 
 
 3. During colds or acute attacks. 
 
 4. At monthly periods. 
 
rib Examination 
 
 67 
 
 / 1 
 
 m 
 
 Showing Slope of Ribs and Normal Throat. Scapula drawn outward 
 
68 INNOMINATES' EXAMINATION 
 
 IN NOMINATES 
 
 EXAMINATION OF INNOMINATES. 
 
 TENDERNESS IS FOUND ABNORMALLY AT: 
 
 1. Sacro-illiac articulation, also just above it at illio- 
 lumbar ligament. 
 
 2. Crest of illium; muscles above at origin; lymphat- 
 
 ics at its posterior extremity. 
 
 3. Below anterior superior spine; exterior cutaneous 
 
 nerve. 
 
 4. Affected side of pubis and at symplysis. 
 
 5. Contractured muscles internal to ischium, or side 
 
 of pelvic floor. 
 
 PROMINENCE OR DEPRESSION. 
 
 1. Of posterior superior spine. 
 
 2. Crest of illium ; elevation. 
 
 3. Anterior superior spine. 
 
 4. Symphyses of pubis, missmatch. 
 
 CONTRACTURES. 
 
 1. At sacro-illiac articulation. 
 
 2. At crest of illium. 
 
 3. Interval to ischium. 
 
 4. In rectum on affected side. 
 
 DISTURBED FUNCTION. 
 
 1. Of hip. 
 
 2. Of limb. 
 
 3. Of pelvic organs. 
 
INNOMINATAS' EXAMINATION 69 
 
 EFFECT OX SURROUNDING STRICTURES. 
 
 1. Lumbar curves; sometimes formed. 
 
 2. Vertical straightening at waist line. 
 
 3. Variation in length of limb; frequent. 
 
 4. Wedged sacrum ; possible with pair slipped. 
 
 5. Anterior coccyx; indirectly with pair slipped pos- 
 
 teriorly. 
 
70 NECK MUSCLES 
 
 TECHNIQUE 
 
 THE NECK 
 
 GENERAL RELAXING 
 
 Is given for contractures and as a preparation for 
 specific work m removing bony lesions. Do not allow 
 fingers to slip on skin or clothing or to dig into flesh. 
 Carry muscles as if they were a thick mitten on the 
 hand. 
 
 M. MUSCULAR TREATMENT. 
 N. NECK (REGION). 
 
 P. POSTERIOR (ASPECT). 
 (M. N. P.) i. BILATERAL STRETCHING WITH 
 
 WEIGHT OF HEAD OPPOSING. (Illustrated.) 
 
 NOTE. — This is best accomplished where table is 
 low enough so that Operator's arms hang about 
 straight when treating, and without stooping. 
 
 FOSTURE — Patient supine ; Operator at head. 
 
 POSITION— Finger tips of both hands at liga- 
 ment neuche. Patient's head may rest against Opera- 
 tor if table is high, enough. 
 
 PRINCIPLE — A wedge is formed by the lamina 
 and spinous processes, which aids the lateral stretch- 
 ing of the muscles. 
 
 ACTION — (a) Lift upward and outward carry- 
 ing mass of muscles away from spine. 
 
 (b) Grasp hands full, including the lateral and, 
 raise and lower. 
 
 (c) Swing from side to side with or without: 
 h*ad. 
 
 (d) Circle, keeping head fixed against Operator 
 and stationary, or nearly so. 
 
 Use either of the above, not all of them. 
 
NECK MUSCLES 
 
 71 
 
 
 ^ 
 
 (M.mi 
 
 (M/M3L 
 
 (M. N. P.) 1. MODIFIED. 
 
 Used when patient is too ill to move. 
 
 POSTURE— Patient supine at side of bed. Op- 
 erator at side facing head. 
 
 POSITION— Same as (M. N. P.) ^preceding. 
 
 ACTION — (a) Lift upward and outward as in 
 (a) preceding. 
 
 (b) Continue on out at root of neck stretching 
 muscles at right angles to trapesius border. 
 
7 2 XECK MUSCLES 
 
 (M. N. P.) 2. LATERAL STRETCHING WITH 
 HANDS CLASPED ON LESION. (Illustrated). 
 
 USE — An extreme treatment on bad contractures. 
 POSTURE — Patient sitting on stool or table. 
 Operator in front. 
 
 POSITION — Operator's hands clasped back of 
 patient's neck with heel of hands grasping posterior 
 group of muscles. 
 
 ACTION — Force wrists together and bring pres- 
 sure on muscles. 
 
 PRINCIPLE — About the same as a nut cracker 
 or a pair of second class levers ; except grip of hanas 
 causes most of pressure. The muscles are forced to- 
 ward the median line. The cervical lamina and spin- 
 ous processes acting as a wedge to force them poster- 
 ior, thus giving lateral stretching of muscles. 
 
 (M. N. P.) 3. LATERAL STRETCHING 
 WITH HEAD LEVERAGE AND ROTATION. 
 
 USE — For medium or mild relaxing. 
 
 POSTURE — Patient supine. Operator at side. 
 
 POSITION — Hand one reaches across throat and 
 around to posterior muscles of opposite side with fin- 
 ger tips at ligamentum neuche. Hand two on patient's 
 forehead. 
 
 ACTION— (a) Hand two rotates head from Op- 
 erator as (b). Hand one endeavors to drag mass of 
 muscles away from spine or slide them around an- 
 teriorly. 
 
 NOTE — For one more effective, see (M. N. C.) 1. 
 
 CAUTION — Keep thumb well back on hand one 
 to avoid striking chin. 
 
NECK MUSCLES 73 
 
 (M. N. P.) 3 MODIFIED. 
 
 POSTURE— Patient sitting on table, chair or 
 stool. Operator in front and to opposite side. 
 
 POSITION of Hands is the same. 
 
 ACTION — The same, i. e., Hand one carries mus- 
 cles anteriorly as Hand two opposes with rotation. 
 
 CAUTION — Stand at least one-half way around 
 Patient from the lesion to retain grip on muscles. 
 
 i st letter the Structure, 2d for Region, and 3d Class. 
 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE 3 
 
 POSTURE Patient : 4 
 
 Operator 5 
 
 ist POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION io 
 
 ii 
 
 12 
 
 PRINCIPLE 15 
 
 DEGREE 18 
 
 CAUTION 20 
 
 NOTE 22 
 
74 NECK MUSCLES 
 
 ist letter the Structure, 2d for Region, and 3d Class, 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 (---.■..-■) 1 
 
 2 
 
 USE 3 
 
 ist POSTURE Patient 4 
 
 . . ■ Operator 5 
 
 2d 6 
 
 ist POSITION Hand one .- 7 
 
 . . . , Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 Consecutively. Simultaneously. 
 
 1 or, a 11 
 
 2 or, b 14 
 
 3 or, c 12 
 
 4 or, d 13 
 
 PRINCIPLE acts as a ... class lever 15 
 
 acts as a fulcrum with . . 16 
 
 as the power and as the weight 17 
 
 DEGREE 18 
 
 19 
 
 CAUTION 20 
 
 21 
 
 NOTE 2.2 
 
 23 
 
 • 24 
 
NECK MUSCLES 75 
 
 M. MUSCULAR TREATMENT. 
 
 N. THE NECK. 
 
 L. LATERAL ASPECT. 
 
 (M. N. L. 1. LATERAL STRETCHING OF 
 STERNO-MASTOID WITH HEAD LEVER- 
 AGE AND ROTATION. 
 
 POSTURE — Patient supine. Operator at side. 
 
 POSITION — Hand one grasps muscles, ith hand 
 two on forehead. 
 
 ACTION — Carry muscles anteriorly and rotate 
 kead in opposition similar to (M. N. P.) 3 or Lateral 
 stretching with head leverage and rotation. 
 
 (M. N. L.) 2.— LONGITUDINAL TRACTION OF 
 SCALENI MUSCLES WITH HEAD LEVER- 
 AGE AND ROTARY OSCILLATION. 
 
 POSTURE — Patient supine. Operator at side 
 facing head. 
 
 POSITION — Fingers or heel of hand one passes 
 behind clavical at root of neck on opposite side to hold 
 down first and second ribs. 
 
 ACTION— (1) Hand two forces head to same 
 side; (2) Hand one holds ribs down firmly; (3) Hand 
 two forces head to opposite side ; (4) Oscillate head 
 with hand two. 
 
76 NECK MUSCLES 
 
 (M. N. L.) 2. MODIFIED. SITTING. 
 
 POSTURE— Patient sitting. Operator at back, 
 
 POSITION — The same, except if on low stool 
 thenar eminence of hand one is used. 
 
 NOTE— POSTURE, POSITION and the revers- 
 ed order of ACTION, or c, b, a are similar to R. U. D. 
 2 ©r head and neck leverage for muscular traction with 
 thenar eminence and operator's weight at lesion. 
 
 (M. N. L.) 3 LATERAL STRETCHING AT UP- 
 PER BORDER OF TRAPESIUS. 
 
 USE — At root of neck. 
 
 POSTURE — Patient sitting on high stool or ta- 
 ble. Operator at back. 
 
 POSITION — Fingers of both hands rest on su- 
 perior border of Trapesius at root of neck. 
 
 ACTION — Stretch downward carrying muscles 
 beneath diagonally downward toward I2th dorsal ver- 
 tebrae. This many be continued out toward shoulder. 
 
 NOTE — The stretching in the opposite direction 
 of ( M. N. P.j i Modified. The second treatment in 
 book. 
 
 
NECK MUSCLES 77 
 
 (M. N. L.) 3. MODIFIED. HAND REIN- 
 FORCED. 
 
 USE — Greater efficiency than (M. N. L.) 3 pre- 
 ceding. A very restful treatment for the Operator. 
 
 POSITION and ACTION same except hand one 
 is reinforced by hand two overlapping with fingers 
 crossing at less than right angles. 
 
 ist letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE 3 
 
 POSTURE Patient 4 
 
 Operator 5 
 
 ist POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 11 
 
 12 
 
 PRINCIPLE 15 
 
 DEGREE 18 
 
 CAUTION 20 
 
 NOTE ^ 
 
78 NECK MUSCLES 
 
 M. MUSCLES. 
 N. NECK. 
 
 A. ANTERIOR. 
 
 (M. N. A.) i. LATERAL STRETCHING WITH 
 HEAD FIXED. 
 
 POSTURE— Patient supine. Operator at side. 
 
 POSITION — Finger one and thumb one grasp hy- 
 oid bone laterally. Hand two steadies head. 
 
 ACTION — (a) Swing from side to side, stretch- 
 ing supra and infra hyoid muscles. 
 
 (M. N. A.) i. MODIFIED. 
 
 USE — From angle of inferior maxilary to clavicle. 
 
 POSITION— Middle finger one at side of hyoid. 
 Tkumb one rests on angle of jaw. Hand two on fore- 
 head or not. ■ 
 
 ACTION — (a) Finger one carries bone later- 
 ally and thumb two aids by griping or opposing at 
 angle, (b) Thumb one may carry bone as all fingers 
 rest on chest, (c) Hand two may rotate head in op- 
 position. 
 
NECK MUSCLKS 
 
 79 
 
 (M.A/.A.)// MMA)£ 
 
 (NIMA)X 
 
 (M. N. A.) 2.— THYRO-HYOID AND INFRA-HY- 
 OID MUSCLES. . (Illustrated.) 
 
 USE — Relaxing relieves pressure on superior lar- 
 yngeal artery, vein and nerve as they enter the larynx. 
 Hypersensativeness indicates inflammation. 
 
 POSTURE — Patient supine. Operator at side. 
 
 POSITION— Thumb one at lateral aspect of 
 hyoid bone. Middle finger one on opposite side of 
 thyroid cartilage. 
 
 Action — i st. Aim to force hyoid oneway and thy- 
 roid the opposite. 2d. Force them the reverse direc- 
 tion. 
 
8o NECK MUSCLES 
 
 (M. N. A.) 2. MODIFIED. 
 
 USE and POSTURE same. 
 
 POSITION — Grasp larynx laterally by placing; 
 finger one and thumb one between hyoid bone and thy- 
 roid cartilage so as to touch each. 
 
 ACTION — Pinch or wedge them apart. 
 STERNO MASTOID MUSCLE. 
 
 NOTE — Direct pressure above sternal origin re- 
 veals inflammation of lower trachea, as does pressure 
 over sterno hyoid. Thumb or finger pressing above 
 sternal origin of the sterno mastoid muscle may reveal 
 contracture, obstructing venus return from head and 
 neck, and pointing to bony lesion at second or third 
 cervical irritating its nerve supply. 
 
 (M. N. A.) 3. STERNO MASTOID MUSCLE. 
 
 Direct pressure above sternal origin may aid in 
 reducing its contractured condition or, at least, aid in 
 diagnosing the same. 
 
 (M. N. A.) 4. EXTREME LONGITUDINAL 
 STRETCHING WITH FINGERS AT LESION. 
 
 USE — For quick relief in freeing venus return, 
 as in tonsilitis and other acute trouble of this region. 
 Also in stretching trachea and oesophagus. 
 
 POSTURE — Patient supine with head and neck 
 extending beyond support. Operator at head. 
 
 POSITION— Fingers of hand one beneath ra- 
 mus of inferior maxilary at one side of median line. 
 Hand two supports back of head. 
 
NECK MUSCLES 
 
 ACTION — Pull strongest with hand one, drawing 
 neck and chin nearly into a straight line. Then repeat 
 on opposite side. 
 
 CAUTION — Never stretch severely and rotate 
 head at same time. 
 
 DEGREE — See modification. 
 
 (M. N. A.) 4. MODIFIED— THENAR EMINENCE 
 AT LESION. 
 
 POSTURE— Patient supine with head and neck 
 beyond table or bed. Operator at head facing the side. 
 
 POSITION — Thumb of hand one points at opera- 
 tor while thenar eminence of same engages soft parts 
 beneath inferior maxilary at one side of median line. 
 
 ACTION — (a) Same as No. 1 just preceding, 
 thenar eminence applies greatest traction at hand two 
 supports head. 
 
 (b) Or patient throws head back until mouth 
 opens and hand one closes it. 
 
 NOTE — The latter can be accomplished with pa- 
 tient sitting or standing. 
 
 DEGREE — For extreme cases pressure could be 
 enough to slide a medium weight patient on a panta- 
 sote surface. Considering strength of patient. 
 
S2 NECK MUSCLES 
 
 i st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) '-• 1 
 
 2 
 
 l-SE 3 
 
 1st POSTURE Patient 4 
 
 Operator 5 
 
 2d 6 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION ....10 
 
 Consecutively. Simultaneously. 
 
 1 or, a 11 
 
 2 or, b 12 
 
 3 or. c 13 
 
 4 or, d 14 
 
 PRINCIPLE acts as a . . . class lever 15 
 
 acts as a fulcrum with 16 
 
 as the power and as the weight 17 
 
 DEGREE 18 
 
 •• 19 
 
 CAUTION 20 
 
 21 
 
 NOTE 22 
 
 23 
 
 ------- 24 
 
NECK — COMBINED 83 
 
 C. COMBINED MUSCULAR AND BONE 
 TREATMENT. 
 
 N. THE NECK OR CERVICAL REGION. 
 I. INDIRECT TREATMENT. 
 
 (C. N. I.) 1. EXAGGERATION, CIRCLING AND 
 SCREWDRIVING ROTATION (Illustrated). 
 
 USE — As a deep, relaxing treatment. 
 
 POSTURE — Patient supine head level with body. 
 Operator at head. 
 
 POSITION— Thumbs together and hands at 
 crown of head. 
 
 ACTION — (a) Carry to side to exaggerate le- 
 sion. 
 
 (b) Circle forward a quadrant holding all the 
 tension you have gained. 
 
 (c) Simultaneous circle through second quad- 
 rant and rotate head ninety degrees, thus facing head 
 from front to side on which lesion is prominent. 
 
 (d) Apply pressure at top of forehead, flexing it 
 backward as head is rotated and carried back to first 
 position with a screw-driving movement. 
 
 NOTE — Letters of diagram correspond with those 
 under action. 
 
8 4 
 
 NECK COMBINED 
 
 (CM-/.) 
 
 ist letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 USE 3 
 
 POSTURE Patient 4 
 
 Operator 5 
 
 ist POSITION Hand one 7 
 
 Hand two 8 
 
 2d 
 
 ACTION 10 
 
 11 
 
 12 
 
 PRINCIPLE 15 
 
 DEGREE - 18 
 
 CAUTION 20 
 
 NOTE 22 
 
NECK — COMBINED 85 
 
 (C. N. I.) 2. POSTERIOR SPRINGING OF COL- 
 UMN AND MUSCLE STRETCHING. 
 
 USE — For anterior curves or preparatory treat- 
 ment in individual anterior subluxations to be followed 
 by attempts to force anterior the adjoining prominent 
 vertebrae. 
 
 POSTURE— Patient supine. Operator at head 
 
 POSITION — Hands below crown of patient's 
 head. 
 
 ACTION — (a) Raise head to bow cervical spine 
 posteriorly. 
 
 (b) Oscillate, keeping the tension on muscles. 
 
 (c) Circle head in arc each way from median line 
 retaining muscular tension. 
 
 (C. N. I.) 2. Modified WITH DEEP SUBOCCIPIT- 
 AL PRESSURE. 
 
 USE — Relieving muscular pressure or tension in 
 this region to make diagnosis and bony lesion treat- 
 ment possible. 
 
 POSTURE and POSITION— Same as (C. N. I.) 
 2 just preceding. 
 
 ACTION — (a) Neck is bowed as in action (a), 
 (C. N. I.) 2. 
 
 POSITION— Index finger one and thumb one at 
 sub-occipital fossae and hand two on forehead. 
 
 ACTION— (b) Hand two forces head to flex back- 
 ward and oscillate slightly, while finger one and thumb 
 one work deeply into muscles. 
 
86 NECK — COMBINED 
 
 C. COMBINED MUSCULAR AND VERTE- 
 BRAL TREATMENT. 
 
 N. THE NECK OR CERVICAL REGION. 
 D. DIRECT TREATMENT. 
 
 (C. N. D.) i. LATERAL SPRINGING OF SPIXE 
 WITH ROTATION. 
 USE — One of the most effective. 
 POSTURE— Patient supine. Operator at head. 
 
 POSITION — Hand one reaches under neck and 
 across to opposite side grasping contractured muscle. 
 Hand two on forehead. 
 
 ACTION — (ist) Hand one carries muscles to- 
 ward spine, or Operator, as Hand two rotates head 
 from Operator. 
 
 (2d) Hand one continues in same direction car- 
 rying spinnus processes beyond normal, thus spring- 
 ing the spine laterally. . 
 
 (C. N. D.) 1 MODIFIED— SITTING. 
 
 L'SED — When inconvenient to lie down. 
 
 POSTURE — Patient sitting. Operator at side and 
 in front. Diagonally opposite muscles treated. 
 
 POSITION of hands and ACTION the same. 
 
NECK — COMBINED * 87 
 
 i st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 1 ( ) 
 
 2 
 
 ^SE ' 3 
 
 rst POSTURE Patient 4 
 
 Operator . . 5 
 
 2d 6 
 
 1st POSITION Hand one '. 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 Consecutively. Simultaneously; 
 
 1 or, a 11 
 
 2 or, b 12 
 
 3 or, c 13 
 
 4 or, d 14 
 
 PRINCIPLE acts as a ... class lever 15 
 
 acts as a fulcrum with 16 
 
 as the power and as the weight 17 
 
 DEGREE 18 
 
 19 
 
 CAUTION 20 
 
 21 
 
 NOTE 22 
 
 • 23 
 
 24 
 
88 MUSCLES— UPPER DORSAL 
 
 SPINE 
 
 M. MUSCULAR LESIONS. 
 
 U. UPPER DORSAL REGION. 
 
 G. GENERAL OR GENTLE TREATMENT. 
 
 (When indicating muscular treatment) 
 (M. U. G.) i. ROCKING HANDS LEVERAGE 
 WITH PATIENTS' W T EIGHT OPPOSING. 
 USE — A mild treatment on table or for bed-fast 
 
 patients. Also applied as low as fifth lumbar verte- 
 brae. 
 
 POSTURE— Patient supine. Operator at side. 
 
 POSITION — Operator's hands over patient's 
 shoulders. 
 
 Operator's finger tips at spinous processes, meta- 
 carpal knuckles on tabic. 
 
 NOTE. — In using this treatment below interscap- 
 ular region reach directly from sides. 
 
 ACTION — (a) Fingers carrying mass of muscles 
 up and away from spine by rocking movement. 
 
 (b) If in bed lift and pull out instead of rocking. 
 (Note: See second treatment following.) 
 
 (c) It can be given more forcibly by reinforcing 
 one hand with the other. 
 
 PRINCIPLE— Knuckles act as fulcrum as hand is 
 flex at right angles. 
 
MUSCLES — UPPER DORSAL 89 
 
 M. MUSCULAR LESIONS. 
 
 U. UPPER DORSAL REGION. 
 D. DIRECT TREATMENT. 
 
 (M. U. D.) 1. SHOULDER GRIPPING AIDING 
 
 THUMB AT LESION. 
 
 POSTURE— Patient sitting-. Operator at back. 
 
 NOTE. — If in bed have patient's back at side of 
 bed, and supported with operator's thigh or knee. 
 
 POSITION — Tips of thumbs at spinous processes, 
 fingers over shoulders. 
 
 ACTION — Thumbs carry muscles up and away 
 from spine aided by a grasping movement of hands. 
 
 1 st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE 3 
 
 POSTURE Patient 4 
 
 Operator 5 
 
 ist POSITION Har.d one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION io 
 
 IT 
 
 12 
 
 PRINCIPLE 15 
 
 DEGREE ....18 
 
 CAUTION 20 
 
 NOTE 22 
 
90 MUSCLES UPPER — DORSAL 
 
 M. MUSCULAR LESIONS. 
 
 U. UPPER DORSAL REGION. 
 E. EXTREME TREATMENT. 
 
 "(M. U. E.) i. ROCKING HAND LEVERAGE, RE- 
 INFORCED WITH PATIENT'S WEIGHT 
 AIDING, OPPOSING. Same as (M. U. G.) 2, 
 except one hand reinforces the other. 
 
 (M. U. E.) 2. SHOULDER GRIPPING WITH 
 THUMBS REINFORCED AT LESION. 
 
 Same as (M. U. D.) 1, except thumb one is rein- 
 forced by the other thumb. 
 
 1st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) * 
 
 2 
 
 USE 3 
 
 POSTURE Patient 4 
 
 Operator 5 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 ir 
 
 12 
 
 PRINCIPLE 15 
 
 DEGREE 18 
 
 CAUTION 20 
 
 NOTE 22 
 
a:u£CLrs — interscapular 91 
 
 M. MUSCULAR LESIONS. 
 
 I. INTER-SCAPULAR REGION. 
 
 G. GENERAL OR GENTLE TREATMENT. 
 
 (M. I. G.) 1. REINFORCED HAND AT LESION 
 WITH FINED ELBOW AND SHOULDER LEV- 
 ERAGE OPPOSING. 
 POSTURE— Patient on side. Operator in front. 
 
 POSITION — Fingers of hand one at spinous pro- 
 cess, hand two reinforces hand one, elbow of patient 
 against operator. 
 
 ACTION — Hands carry muscles up and away 
 from spine as pressure on elbow opposes. 
 (M. I. G.) 2. ARM LEVERAGE WITH FINGERS. 
 
 AT LESION. 
 
 USE — For patients unable to turn in bed. Ap- 
 plied to lower dorsal and lumbar region by hand two 
 shifting to anterior superior spine. 
 
 POSTURE— Patient supine. Operator, at side 
 facing head. Operator's forearms crossed. 
 
 POSITION— Hand one reaches beneath patient 
 with finger tips at spine. Operator's hand two grasps 
 arm at elbow. 
 
 ACTION. — Hand one pulls muscles laterally away 
 from side as hand two circles elbow upward and back- 
 ward opposing hand one by forcing arm and shoulder 
 down, 
 
92 MUSCLES — INTERSCAPULAR 
 
 M. MUSCULAR LESIONS. 
 I. INTER-SCAPULAR REGION. 
 D. DIRECT TREATMENT. 
 
 (M.I.D.) i. ROTATING ARM LEVERAGE 
 WITH INVERTED THUMB AT LE- 
 SION. 
 
 POSTURE. Patient sitting. Operator at back. 
 
 POSITION. Operator's thumb points downward 
 and engages muscles at opposite side of spine ; hand 
 two grasps arm two at elbow. 
 
 ACTION. Thumb carries muscles to opposite 
 side, that is, away from side as hand two rotates arm 
 in opposition, or toward operator. (From top of cir- 
 cle.) 
 
 (M.I.D.) 2. SHOULDER LEVERAGE, with IN- 
 VERTED THUMB at LESION. 
 Same as (M.I.D. i) except: 
 
 Position. Hand one grasps shoulder from above 
 or below. 
 
MUSCLES — DORSAL 93 
 
 M. MUSCULAR LESIONS. 
 
 I. INTER-SCAPULAR REGION. 
 E. EXTREME TREATMENT. 
 
 (M.I.E.) 1. ARM AND SHOULDER LEVERAGE 
 with REINFORCED ARM AT LE- 
 SION. (V) (A flying wedge treat- 
 ment.) 
 
 USE. This aids in raising the scapula and mak- 
 ing contractures more accessible. 
 
 POSTURE, POSITION and PRINCIPLE the 
 same as (R.I.E.3). 
 
 ACTION. Hand one carries muscles laterally as- 
 arm two opposes. 
 
 M. MUSCULAR LESIONS. 
 
 D. DORSAL, MIDDLE and LOWER. 
 
 G. GENERAL or GENTLE TREATMENT. 
 
 (M.D.G) 1. SHOULDER LEVERAGE with FIN- 
 GERS at LESION. LYING. 
 
 USE. As low as fifth lumbar vertebrae. 
 POSTURE. Patient on side. Operator in front. 
 POSITION. Finger tips of hand one at spinous 
 processes. Hand two against shoulder. 
 
 Note: For lower dorsal and lumber region hand 
 two shifts to anterior superior spine or crest of ilium, 
 with hand one the same. 
 
 ACTION, (a) Hand one carries muscles up 
 and away from spine greatest effort is used in lateral 
 direction. 
 
 (b) Hand two opposes hand one by forcing 
 shoulder away from operator. 
 
94 MUSCLES — DORSAL 
 
 (M.D.G.) i. MODIFIED. Sitting. 
 
 POSTURE. Patient sitting on table. Operator 
 in front and on opposite side of lesion. 
 
 POSITION of hands and 
 
 ACTIOX the same. 
 
 (M.D.G.) 2. ARM LEVERAGE with FIXGERS at 
 LESION. The same as (M.I.G.2), 
 only hands do not cross. 
 
 USE. For ted-fast patients from first dorsal 
 vertebrae to sacrum. 
 
 (M.D.G.) 3. BOTH HANDS at LESION with 
 BODY WEIGHT OPPOSING. 
 
 USX. Can be given stronger as a combination 
 treatment or for raising ribs. 
 
 POSTURE. Patient supine. Operator at side., 
 facing head. 
 
 POSITION. Both hands reach under patient — ■ 
 one from each side. Finger tips at spinous processes. 
 
 ACTION. Lift and carry muscles upward and 
 laterally away from spine. 
 
 M. MUSCULAR LESIONS. 
 D. DORSAL REGION. 
 
 D. DIRECT TREATMENT. 
 
 (M.D.D.) 1. SHOULDER LEVERAGE WITH 
 THUMB AT LESION. 
 
 USE. From middle dorsal region down. 
 
 POSTURE. Patient sitting. Operator at back, 
 
 sitting or standing. 
 
MUSCLES — DORSAL 95 
 
 POSITION. Thumb one pointing upward and 
 lying close to spine at side one of patient. Hand two 
 grasps shoulder one. 
 
 ACTION, (a) Thumb one applies strong pres- 
 sure and carries mass or individual muscles laterally. 
 
 (b) Hand two holds firm or pulls shoulder back- 
 ward in opposition. 
 (M.D.D.) 1. MODIFIED: LYING. 
 
 The same as (M.D.D.i) except: 
 
 POSTURE. Patient on side. Operator at back. 
 
 Note: For lower dorsal and lumbar region hands 
 change at lesion, hand two grasping anterior superior 
 spine of ilium to oppose. 
 
 (M.D.D.) 2. SEE (R.D.G.6) AND (R.D.G.6 
 .MODIFIED). 
 
 PRINCIPLE. The same as these, except lateral 
 stretching of muscles is given instead of pressure at 
 angles or is given as a combination treatment. 
 
 (M.D.D.) 3. CIRCLING TRUNK and SHOUL- 
 DER LEVERAGE WITH THUMB OR THENAR 
 EMINENCE AT LESION. (SWING.) 
 
 L^SE. High as inter-scapular region. 
 POSTURE. Patient standing with arms in 
 swing at axillae. Operator at back. 
 
 POSITION. Thenar eminence or thumb one at 
 lesion. Hand two grasps shoulder one from above. 
 
 PRINCIPLE. Lateral stretching with trunk in 
 motion. 
 
 ACTION. Hand one carries muscles and body 
 away from operator, and hand two opooses at shoulder 
 one to keep body from* rotating. Body circles and re- 
 turns to original position. Then repeat. 
 
gb MUSCLES — DORSAL 
 
 ist letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) • 1 
 
 2 
 
 USE 3 
 
 ist POSTURE Patient 4 
 
 Operator 5 
 
 2d 6 
 
 ist POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 Consecutively. Simultaneously. 
 
 1 or, a II 
 
 2 or, b 14 
 
 3 or, c 12 
 
 4 o r > d 13 
 
 PRINCIPLE acts as a . . . class lever .15 
 
 acts as a fulcrum with 16 
 
 as the power and as the weight 17 
 
 DEGREE 18 
 
 19 
 
 CAUTION 20 
 
 ■„.:.- 21 
 
 NOTE .- 22 
 
 23 
 
 M 
 
MUSCLES — DORSAL gj 
 
 M. MUSCULAR LESIONS. 
 D. DORSAL REGION, 
 
 E. EXTREME TREATMENT. 
 
 (M.D.E.) i. REINFORCED THUMB at LESION 
 with OPERATOR'S WEIGHT AIDING. 
 
 USED. For entire spine for individual contrac- 
 tures, badly contractured regions, for stimulation or 
 deep masses of muscles, as in lumbar region ; for lum- 
 bago, etc. 
 
 POSTURE. Patient prone. Operator on his 
 knees on top of ti.ble to one side, with stool to steady 
 foot. 
 
 POSITION. Thumb one near spinous processes, 
 thumb two reinforcing it. Get well over lesion, so that 
 operator's weight will aid. 
 
 ACTION, (a) Carry muscles upward and out- 
 ward. 
 
 (b) Steady pressure — to relax. 
 
 (c) Intermittent pressure — to stimulate. 
 
 (d) Pressure with rotary oscillation — for deep 
 effects. 
 
 (M.D.E.) 2. Give (R.D.E.i) or shoulder lever- 
 age with knee at lesion, except : 
 
 POSITION. Knee against muscles instead of 
 angles of ribs. 
 
 USE. Only where patients are extremely difficult 
 to treat. There are some objections to this, however* 
 as the patient is inclined to resist the same as if an 
 inanimate object were used instead of the operator's 
 hand. 
 
-98 MUSCLES — D ")RSAL 
 
 (M.D.E.) 3. ARM AND SHOULDER LEVER- 
 AGE WITH REINFORCED HAND AT LESION. 
 
 (V.) 
 
 L T SE. La grippe, colds, fevers, etc., if daily treat- 
 ment is not given. For deep muscular relaxing. For 
 large and rigid patients. 
 
 POSITION. Same as (R.D.E.3) of same name, 
 only applied to muscles instead of ribs, or given as a 
 combination treatment. 
 
 1st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 < ) 1 
 
 2 
 
 USE 3 
 
 POSTURE Patient 4 
 
 Operator 5 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 11 
 
 „ 1 2 
 
 PRINCIPLE 15 
 
 DEGREE 18 
 
 CAUTION 20 
 
 NOTE • 22 
 
MUSCLES — LUMBAR 99 
 
 M. MUSCULAR LESIONS, 
 L. LUMBAR REGION. 
 
 I. INDIRECT TREATMENT. 
 
 (M.L.I.) i. LONGITUDINAL STRETCHING 
 WITH TRUNK LEVERAGE. 
 
 POSTURE. Patient on stool or chair, hands be- 
 tween knees and bending forward. Operator in front. 
 
 POSITION. Both hands on patient's shoulders. 
 
 FIRST ACTION. Bear down on shoulders, 
 stretching multifidis and erector spinae muscles. 
 
 SECOND ACTION. Rock shoulders, keeping 
 the tension. 
 
 (M.L.I.) 2. LONGITUDINAL STRETCHING 
 WITH LIMB LEVERAGE. 
 
 L^SE. For male patients. Only good if contrac- 
 tured so that patient feels the stretching. 
 
 POSTURE. Patient supine on table. Operator 
 standing en feet of table, facing patient. Patient's 
 Tendon of Achilles rests on operator's shoulders. 
 
 POSITION. Operator's hands hold patient's 
 knees stVf. 
 
 ACTION. Flex limbs at hips by carrying heels 
 forward to stretch lumbar region, keeping hips on table. 
 
IOO MUSCLES — LUMBAR 
 
 ist letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 1 ; ( ) 
 
 2 
 
 use ... 3 
 
 tst POSTURE Patient 4 
 
 Operator 5 
 
 2d 6 
 
 ist POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 Consecutively. Simultaneously. 
 
 1 or, a 11 
 
 2 . . . . or, b 12 
 
 3 or, c 13 
 
 4 . or, d 14 
 
 PRINCIPLE ..... acts as a ... class lever 15 
 
 acts as a fulcrum with 16 
 
 as the power and as the weight 17 
 
 DEGREE 18 
 
 19 
 
 CAUTION 20 
 
 21 
 
 NOTE 22 
 
 23 
 
 24 
 
MUSCLES — LUMTAR IOI 
 
 M. MUSCULAR LESIONS. 
 L. LUMBAR REGION. 
 
 E. EXTREME TREATMENT. 
 
 (M.L.E.) i. REINFORCED THUMB AT LESION 
 WITH OPERATOR'S WEIGHT AIDING. 
 The same as (M.D.E.i) of same name. 
 (M.L.E.) 2. REINFORCED FINGERS AT 
 LESION WITH OPERATOR'S WEIGHT AID- 
 ING. 
 
 The same as (M.D.E.i), except: 
 
 POSITION. Fingers at lesion are reinforced by 
 thenar eminence. 
 
 (M.L.E.) 3. SWINGING LIMB AND PELVIC 
 LEVERAGE WITH THUMBS AT LESION. (As- 
 sistant.) 
 
 USE. High is sixth dorsal vertebrae, for lateral 
 or rigid conditions. 
 
 POSTURE. Patient prone. Operator at side 
 above. Assistant at side below, supporting patient's 
 limbs above patella. 
 
 POSITION. Thumbs of both hands or thenai 
 eminence at lesion. 
 
 ACTION. Assistant carries limbs back and forth 
 across table. Operator applies pressure at a point be- 
 tween spine and muscular contractures or directly on 
 the latter. 
 
 CAUTION. Do not raise knees over six or seven 
 inches from table. 
 
102 MUSCLES — LUMBAR 
 
 (M.L.E.) 4. Swinging Limb and Pelvic Leverage 
 with Operator's Weight at Lesion. (Swing.) Illus- 
 trated. 
 
 USE. High as sixth dorsal vertebrae for very 
 rigid patients. 
 
 POSTURE. Patient prone on table, facing away 
 from operator. Operator at side, standing on low 
 stool if table is very high, and on opposite side to le- 
 sion. 
 
 POSITION. Patient's knees in swing supported 
 above patella. Heel of hand one or thenar eminence 
 
 at contracture on opposite side of spine. Hand two 
 graps farther limb below the knee or the swing at 
 farther side. 
 
 ACTION. Hand two swings patient as a pendu- 
 lum ; hand one applies pressure as hand two draws 
 patient toward operator. 
 
 DEGREE. Greater weight is applied below; 50 
 to 75 pounds in extreme cases. 
 
 NOTE : Patient must always face away from 
 operator, so that body will incline toward operator. 
 
MUSCLES SACRUM AND COCCYX IO3. 
 
 M. MUSCULAR LESIONS. 
 S. SACRAL REGION. 
 
 D. DIRECT TREATMENT. 
 
 (M.S.D.) 1. THUMB PRESSURE AT POSTER- 
 IOR SACRAL REGION. 
 
 POSTURE. Patient prone or sitting. Operator 
 at side or back. 
 
 POSITION. Thumbs at either side of sacrum 
 above and external to posterior superior spine of ilium. 
 
 ACTION, (a) Apply gentle or medium pres- 
 sure, or (b) pressure with oscillation; (c) pressure in 
 carrying muscles laterally. 
 
 FIRST AREA. Continue downward toward me- 
 dian line, following external borders of the sacrum. 
 
 SECOND AREA. Working outward from last 
 two segments of sacrum over the great sciatic notch 
 and pyriformis muscle. 
 
 THIRD AREA. Working internal to posterior 
 superior spine over sacral formina one inch at the top 
 and one and one-half inches at the fifth sacral. 
 
 Note: See lower limb, Rule four. 
 
104 MUSCLES — SACRUM AND COCCYX 
 
 M. MUSCULAR LESIONS. 
 C. COCCYGEAL REGION. 
 D. DIRECT TREATMENT. 
 
 (M.C.D.) i. TRUNK LEVERAGE WITH HAND 
 
 AT ENTENSOR COCCYGEUS. 
 
 USE.- This also replaces the coccyx if anterior or 
 lateral. A combination treatment. 
 
 POSTURE. Patient sitting, bending far forward. 
 Operator at side. 
 
 POSITION. Finger tips of hand one at tip of 
 •coccyx. Hand lies flat. Hand two and forearm sup- 
 ports patient's body at upper chest. 
 
 ACTION, (a) Hand one carries entersor coccy- 
 geus up and back, dragging coccyx and stretching the 
 levator and sphincter ani as body is flexed on thighs, 
 (b) The same, except that shoulders are carried from 
 side to side, (c) Lifting and lowering body to in- 
 crease the stress. 
 
VERTEBRA — CERVICAL 105 
 
 CERVICAL VERTEBRAE 
 
 V. VERTEBRAL LESIONS. 
 
 N. NECK, OR CERVICAL REGION. 
 G. GENERAL TREATMENT. 
 
 (V.N.G.) 1. OPPOSED SPIRAL OR CORK- 
 SCREW. (Illustrated.) 
 
 USE. For general relaxing and attracting nutri- 
 tion. 
 
 POSTL^RE. Patient supine without elevation 
 under head, if possible. Head slightly beyond support 
 and somewhat raised. Operator at head. Supporting 
 patient's head against operator's body. 
 
 POSITION. Hand one grasps neck with fingers 
 at lamina reaching from beneath to opposite side. 
 Hand two grasps occiput at opposite side reaching be- 
 neath also. 
 
 ACTION. First. Draw each hand laterally 
 away in opposition. 
 
 Second. Continue, circling each segment in op- 
 position. Operator's body aiding hand two in holding 
 and carrying- head. 
 
 V 
 fECJC FfA'TfWAJt* 
 (V. N. G.) I 
 
 
106 VIRTEBRA — CERVICAL 
 
 (V.N.G.) 2. LATERAL SPRINGING VIA 
 TRANSVERSE PROCESSES. 
 
 USE. General or specific treatment. 
 
 POSTURE. Patient supine. Operator at head. 
 
 POSITION. Grasp neck at articular process of 
 each side with index ringers reinforced by second and 
 third fingers of same hand. 
 
 PRINCIPLE. Index fingers act as fulcrum on 
 fixed point with head and neck above as levers. 
 
 ACTION. Pry from side to side, loosening the 
 individual vertebrae 
 
 (V.N.G.) 2. Modified. 
 
 ACTION. Circle head in horizontal figure of 
 eight. Otherwise the same as (V.N.G. 2) preceding. 
 
 (V.N.G.) 3. LATERAL SPRINGING VIA 
 SPINOUS PROCESS. 
 
 L^se. General or specific treatment. Very effec- 
 tive. This is the same as (M.N.C. 1 b). 
 
 1st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 (• ) * 
 
 2 
 
 USE 3 
 
 POSTURE Patient 4 
 
 Operator 5 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d '. 9 
 
 ACTION 10 
 
 11 
 
 12 
 
 PRINCIPLE :■ 15 
 
 DEGREE ' i& 
 
 CAUTION 20 
 
 NOTE 22 
 
VERTEBRA -CERVICAL 107 
 
 V. VERTEBRAL LESIONS. 
 
 N. NECK, OR CERVICAL REGION. 
 I. INDIRECT REMOVAL OF LESION. 
 
 Note: If head will not bend backward atlas is 
 posterior, i. e., wedged between axis and occiput. 
 
 If head will not turn at right angles axis is at fault. 
 
 If head will not flex laterally the atlas and axis are 
 both at fault. 
 
 The atlas acts as a washer and is carried with 
 the head normally. Nature has made considerable al- 
 lowance for atlas slips. 
 
 (V.N.I.) 1. Rotation with Increasing Stress. 
 
 POSTURE. Patient supine or sitting. Operator 
 at head or back. 
 
 POSITION. Hand one on forehead. Hand two 
 on occiput. 
 
 ACTION. First. Turn head to side. 
 
 Second. Steadily force it beyond normal limit. 
 
 PRINCIPLE. The tiring and relaxing of liga- 
 ments and muscles and correcting lesion by way of 
 special strain on its attachments. 
 
 NOTE : Direct pressure will aid. 
 
IC8 VERTEBRA — CERVICAL 
 
 (V.N.I.) 2. Oscillation with Sudden Stress. 
 
 POSTURE. Patient supine. Operator at head. 
 
 POSITION. Operator's hands at side of patient's 
 head or at crown and temple for better leverage. 
 
 ACTION. First. Oscillate, or rock head from 
 side to side rapidly in less than norma] arc. 
 
 Second. Patients devitalize their necks, and when 
 sufficiently limp and oft" their guard give a sudden in- 
 crease of pressure to one side, exceeding the normal 
 limit. 
 
 (V.N.I.) 3. Exaggeration, Circling and Screw- 
 Driving Rotation. (Illustrated). 
 
 POSTURE. Patient supine, head level with 
 body. Operator at head. 
 
 POSITION. Thumbs together and hands at 
 crown of head. 
 
 ACTION. First. Carrv to side to exaggerate 
 
 && 
 
 lesion. 
 
 Second. Circle forward a quadrant, holding all 
 the tension you have gained. 
 
 Third. Simultaneously circle through second 
 quadrant and rotate the head ninety degrees, thus fac- 
 ing head from front to side on which lesion is promi- 
 nent. 
 
 Fourth. Apply pressure on top at about forehead, 
 flexing it backward as head is rotated and carried back 
 to first position with a screw T -driving movement. If 
 lesion is lateral to left, or the reverse if lateral to right. 
 
VERTEBRA — CERVICAL 109 
 
 PRINCIPLE of fourth is that of relaxing capsu- 
 lar ligaments or articular processes and grinding or 
 gliding articulation to normal position. 
 
 Figures of diagram correspond with those undsr 
 Action. 
 
 (V.N.I.) 4. Rigid Neck Leverage with Shoulder 
 Supporting Head. 
 
 L^SE. The lower cervical and upper dorsal re- 
 gion. General or specific. 
 
 POSTL^RE. Patient sitting on high stool or low 
 table. Operator in front and to one side. 
 
 POSITION. Operator's hands clasped in back 
 of patient's neck. Patient's forehead at operator's 
 shoulder. Pisiform bones engage lamina of lower cer- 
 vical region. 
 
 PRINCIPLE. Pisiform bones make fixed point 
 in breaking spine just below. 
 
 ACTION. First. Hold portion of neck clasped 
 as well as head and neck above it rigid as you circle 
 parts below grasp a quadrant forward and outward. 
 
 2nd. Return to normal. 
 
 3rd. Circle a quadrant to opposite side. Or repeat 
 the first. 
 
 4th. Return to normal, as in following illustration. 
 
 NOTE. Patient must relax entire spine and espec- 
 ially at L:mbar region. 
 
no 
 
 VERTEBRA — CERVICAL 
 
 (V. N. I.) 4 
 1st letter the Structure, 26. for Region, and 3d Class. 
 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( 
 
 USE 
 
 POSTURE Patient 
 
 , . Operator 5 
 
 1st POSITION Hand one . 7 
 
 Hand two 8 
 
 26. 9 
 
 ACTION 10 
 
 n 
 
 . . , 12 
 
 PRINCIPLE .15 
 
 DEGREE 18 
 
 CAUTION 20 
 
 NOTE 22 
 
VERTEBRA — CERVICAL I 1 1 
 
 V. VERTEBRAL LESIONS. 
 
 N. NECK, OR CERVICAL REGION. 
 
 D. DIRECT TREATMENT. 
 
 (V.N.D.) i. Exaggeration, Circling and Direct Pres- 
 sure. 
 
 USE. From atlas down. 
 
 POSTURE. Patient supine with head slightly 
 beyond table and against operator. Operator at head. 
 
 POSITION. Index ringer reinforced at articular 
 processes on each side with hands at side of head. 
 
 NOTE : In treating atlas fiingers grasp postero 
 lateral arch. 
 
 ACTION. First. Exaggerate lesion — carry head 
 to side. 
 
 Second. Tire ligaments and muscles — by holding 
 head to relax. 
 
 Third. Apply traction — to separate articulation. 
 
 Fourth. Circle with pressure during first quad- 
 rant — to exaggerate the lesion. 
 
 Fifth. Pressure is reversed to force lesion home 
 while circling last part of last quadrant. 
 
 PRINCIPLE. Head acts as lever, body as ful- 
 crum and lesion as weight. 
 
112 
 
 VERTEBRA —CERVICAL 
 
 (V. N. D.) 2. Exaggeration, Circling and Circling 
 Within a Circle. (Illustrated.) 
 
 USE. Best for short stout-fingered operator. 
 
 POSTURE. Patient sitting on low stool. Ope- 
 rator in front and to one side. 
 
 POSITION. Finger tips at lesion and hands 
 grasping head at sides with palms covering ears. 
 
 ACTION. Same principle as (V.N.D. i) just 
 preceding, except you describe a small circle the size 
 of a dollar with ringer tips at lesion when you reach 
 the middle of last quadrant, i. e., you continue in the 
 
 same direction during small circle. 
 
 NOTE : Head makes large circle and lesion 
 makes small circle. 
 
 PRINCIPLE. The finger tips acting as a ful- 
 crum over which to break the articulation of the lesion. 
 The little circle is given as if to loosen a box from all 
 sides that was frozen down. 
 
 ILLUSTRATION OF (N.N D.) 2 JUST PRECEDING 
 
VERTEBRA — C1RVICAL 113 
 
 (V.N.D.) 3. Flexing with Rotary Oscillation. 
 
 USE. For posterior conditions. 
 
 POSTURE. Patient supine. Operator at head. 
 
 FIRST POSITION. Hand two at crown of head. 
 
 FIRST ACTION. Hand two flexes head for- 
 ward. 
 
 SECOND POSITION. Thenar eminence or 
 metacarpal bones of thumb of hand one engages pos- 
 terior condition. 
 
 THIRD POSITION. Hand two changes to fore- 
 head. 
 
 SECOND ACTION. Flex head backward and 
 oscillate while lesion is supported by hand one as 
 above. 
 
 NOTE: Elbow one may rest on table as a re- 
 inforcement. 
 
 (V.N.D.) 3. Combined. Modified. 
 
 USE. For anterior conditions. 
 
 First give (V.N.I. 4) hands clasped with knee 
 supporting back, then apply (V.N.D. 3) just preced- 
 ing above and below the anterior condition directly on 
 the adjoining vertebrae. 
 
 (V.N.D.) 4. Traction and Pressure at Lesion. 
 
 USE. Atlas and all cervical region. 
 
 POSTURE. Patient supine. Operator at head. 
 
 POSITION. Hand one beneath neck, finger one 
 on spinous process or lamina, hand two at top of head. 
 
 ACTION. Hand one pulls laterally and at the 
 same time assists hand two in traction. 
 
 NOTE : Slightly circling may aid. 
 
T 1 4 VERTKR A — CERVICAL 
 
 (V.N.D.) 5. Exaggeration, Circling and Direct 
 Pressure with Screw-Driver Rotation, 
 
 First give (V.N.I. 3) or Exaggeration, Circling 
 and Screw-Driving Rotation to the end of the second 
 quadrant and modify the rest by placing hand one on 
 lesion, reaching from opposite side underneath. 
 
 ACTION. Bring head from lateral flexion to nor- 
 mal with the screw-driving movement, at the same 
 time applying pressure to force lesion to normal posi- 
 tion. 
 
 1st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE 3 
 
 POSTURE Patient 4 
 
 , Operator 5 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 IT 
 
 12 
 
 PRINCIPLE 15 
 
 DEGREE • • • • • • l8 
 
 CAUTION • 20 
 
 NOTE 22 
 
VERTEBRA — CERVICAL 115 
 
 i st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE 3 
 
 1st POSTURE Patient . . 4 
 
 Operator 5 
 
 2d 6 
 
 ist POSITION Hand one 7 
 
 Hand two 8 
 
 -2d 9 
 
 ACTION ......to 
 
 Consecutively. Simultaneously. 
 
 i or, a.. ii 
 
 2 .......... or, b 12 
 
 3 •• • or. c 13 
 
 4 or, d 14 
 
 PRINCIPLE acts as a . . . class lever 15 
 
 acts as a fulcrum with 16 
 
 as the power and as the weight 17 
 
 DEGREE 18 
 
 • 19 
 
 CAUTION 20 
 
 21 
 
 NOTE 22 
 
 23 
 
 24 
 
lib VERTEBRA — CERVICAL 
 
 V. VERTEBRAL LESIONS. 
 N. NECK, OR CERVICAL REGION. 
 
 E. EXTREME REMOVAL OF LESION. 
 
 (V.N.E.) i. REINFORCING OPPOSED OR 
 SHEARING MOVEMENT. 
 
 USE. Lateral slips in upper and middle cervical 
 regions. 
 
 First give (V.N.I.) or Exaggeration, Circling and 
 Screw-Driving Rotation treatment, then follow with : 
 
 POSTURE. Patient supine with head against 
 operator. Operator at head. 
 
 FIRST POSITION. Hand one beneath neck, 
 and ring finger on spinous process or lamina of promi- 
 nent side of lesion. Hand two reaching beneath neck 
 from opposite side of hand one and placing finger tips 
 near mastoid process. 
 
 SECOND POSITION. Thumb of hand two re- 
 inforces ring finger of hand one at lesion. 
 
 ACTION, (a) Operator's body steadies pa- 
 tient's head. Ring finger of hand one, assisted by its 
 reinforcement, or thumb of hand two, forces lesion 
 laterally to normal, keeping head and neck rigid. 
 
 (b) Fingers of hand two grip to oppose as head 
 and neck leverage are applied above. 
 
 PRINCIPLE is that of attempting to unscrew or 
 shear head from spine by forcing adjoining vertebrae 
 in opposite directions laterally, as the blades of a pair 
 of shears cutting off a match. 
 
VERTEBRA — CERVICAL I I 7 
 
 (V.N.E.) 2. RIGID NECK LEVERAGE AND LAT- 
 ERAL PRESSURE WITH BODY WEIGHT 
 RETARDING. 
 
 USE. Lateral conditions of middle and lower cer- 
 vical region. 
 
 POSTURE. Patient supine. Operator at head. 
 
 FIRST POSITION. Hand one beneath neck and 
 index or middle ringer on lesion at spinous process or 
 on lamina of prominent side above the joint, head 
 against operator. Hand two beneath neck from oppo- 
 site side. 
 
 SECOND POSITION. Thumb of hand two re- 
 inforces index finger of hand one. 
 
 ACTION, (a) Steady head with body, keeping 
 head and neck rigid to make break at lesion. 
 
 (b) Force lesion laterally to normal. 
 
 DEGREE. Force may be sufficient to drag a 
 medium-weight patient's shoulders two to four inches 
 across a pantasote-covered table, 
 
 (V.N.E.) 3. RIGID NECK LEVERAGE WITH 
 
 REINFORCED POSTERIOR PRESSURE 
 
 AND MOTION. 
 
 USE. Posterior conditions of lower cervical re- 
 gion. 
 
 . NOTE : See (V.N.D. 3) for posterior upper cer- 
 vical lesions. 
 
 POSTURE. Patient supine. Operator at head. 
 
I r 8 VERTEBRA — CERVICAL 
 
 POSITION. Index finger of hand one on lesion. 
 Index finger of hand two reinforces it together with 
 rest of hand. Hands reaching from opposite sides and 
 at the same time grasping side of head. Hold top of 
 head as a fixed point with hands and body of operator. 
 
 ACTION, (a) Apply pressure at lesion from 
 below upward as head swings from side to side. 
 
 (b) As lesion is raised and lowered. 
 
 (c) As lesion is circled. 
 
 (d) As lesion is circled in figure of eight later- 
 ally. 
 
 (V.N.E.) 4 . HEAD AND NECK LEVERAGE FOR 
 ROTATION, FLEXION AND STEADY PRES- 
 SURE WITH TRACTION. 
 
 USE. Rotated atlas at occipito atlantal articula- 
 tion. 
 
 POSTURE. Patient sitting. Operator at back. 
 
 POSITION. Index or middle finger of hand one 
 back of posterior transverse process ; thumb at opposite 
 side grasping neck. Hand two covers inferior maxil- 
 lary supporting chin. 
 
 ACTION. (1) Rotate head facing k from side 
 on which lesion is posterior. 
 
 (2) Also flex head to same side. 
 
 (3) Apply steady pressure a' lateral mass which 
 is most posterior, while rotating head and lifting it 
 back to normal position. 
 
VERTEBRA — CERVICAL 11$ 
 
 (V.N.E) 4. MODIFIED. (Lying.) 
 
 USE. Rotated atlas at occipito atlantal articula- 
 tion. 
 
 POSTURE. Patient supine. Operator at head. 
 
 POSITION. Thumb of hand one back of lateral 
 mass which is most posterior, the clenched fist resting 
 on table. Hand two covers inferior maxillary support- 
 ing chin. 
 
 ACTION. (1) Rotate head facing it from side 
 on which lesion is posterior. 
 
 (2) Also flex head to same side. 
 
 (3) Apply steady pressure at lateral mass which 
 is most posterior while rotating head and applying 
 traction thus ; lifting it back to normal position. 
 
 (V.N.E.) 5. RIGID NECK LEVERAGE WITH 
 BOTH THUMBS AT LESION. 
 
 USE. Sixth cervical to second dorsal, inclusive. 
 
 POSTURE. Patient prone with head and shoul- 
 ders overhanging head of table. Operator at head. 
 
 POSITION. Hands grasp head and neck later- 
 ally, holding them rigidly ; thumbs at lamina of verte- 
 bral lesion ; little fingers support chin. 
 
 ACTION. (1) Exaggeration or flexing to side 
 away from prominence of lesion. 
 
 (2) Flex neck upward, making break or fixed 
 point with thumbs on lesion. 
 
 (3) Flexion to prominent side of lesion with di- 
 rect pressure on lesion. 
 
-I20 VERTEBRA — CERVICAL 
 
 ist letter the Structure, 2d for Region, and 3d Class, 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 (.....•) 1 
 
 : 2 
 
 USE .3 
 
 ist POSTURE Patient 4 
 
 Operator 5 
 
 2d ' 6 
 
 ist POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 Consecutively. Simultaneously. 
 
 1 or, a 11 
 
 2 or, b 14 
 
 3 or, c 12 
 
 4 or, d 13 
 
 PRINCIPLE acts as a ... class lever 15 
 
 acts as a fulcrum with 16 
 
 as the power and as the weight 17 
 
 DEGREE 18 
 
 •• 19 
 
 CAUTION 20 
 
 21 
 
 NOTE 22 
 
 23 
 
 24 
 
VERTEBRA — UPPER DORSAL 121 
 
 THE SPINE 
 
 V. VERTEBRAL LESIONS. 
 U. UPPER DORSAL REGION. 
 G. GENERAL TREATMENT. 
 
 The general treatment is adapted to swerves, rigid 
 or straight spine, increasing spinal nutrition or reduc- 
 ing spinal congestion and inflammation. 
 
 NOTE. Vertebral spreads are treated by first 
 giving lateral springing and, second, direct forward 
 pressure on upper vertebrae, or upward on lower verte- 
 brae, or both. 
 
 (V.U.G.) i. LONGITUDINAL TRACTION HORI- 
 ZONTALLLY APPLIED. 
 
 USE. Entire spine ; also used in diagnosing spe- 
 cial lesions by way of tenderness. 
 
 POSTURE. Patient supine. Operator at head. 
 
 POSITION. Hand one at occiput, hand two at 
 chin. 
 
 ACTION. Pull steadily. 
 
 DEGREE. Enough to slide a medium-weight 
 patient on a pantasote surface. 
 
 (V.U.G.) i. Modified. Head Overhanging. 
 
 USE. For posterior conditions as low as sixth 
 dorsal. 
 
 POSTURE. Patient supine with head beyond 
 table, so that convexity rests on padded head of table. 
 
 ACTION. Pull away and slightly downward. 
 
 DEGREE. Less than (V.U.G. i) just preceding. 
 
122 VERTEBRA —UPPER DORSAL 
 
 (V.U.G.) 2. LONGITUDINAL TRACTION VER- 
 TICALLY APPLIED. 
 
 USE. For posterior conditions as low as sixth 
 dorsal and the entire spine. 
 
 POSTURE. Patient sitting on low stool. Ope- 
 rator at back. 
 
 POSITION. Operator's knee at convexity. Hand 
 one at chin or forehead. Hand two at occiput. 
 
 ACTION, (a) Rock hand two back with wrist 
 as a fulcrum. Hand one steadying and lifting at the 
 same time. 
 
 (b) Operator stands on chair and pulls up and 
 back steadily with both hands, drawing prominence of 
 lesion against operator's knee and shin. 
 
 i st letter the Structure, 2d for Region, and 3d Class., 
 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 ; 2 
 
 USE 3 
 
 POSTURE Patient 4 
 
 Operator . 5 
 
 1st POSITION Hand one . 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 11 
 
 12 
 
 PRINCIPLE 15 
 
 DEGREE 18 
 
 CAUTION 20 
 
 NOTE 22 
 
VERTEBRA — UPPER DORSAL I 23 
 
 V. VERTEBRAL LESIONS. 
 U. UPPER DORSAL REGION. 
 I. INDIRECT TREATMENT. 
 (V.U.L) 1. SHOULDER AND NECK LEVERAGE 
 WITH HANDS CLASPED AND KNEE 
 BELOW LESION. 
 
 USE. For absence of normal curve or anterior 
 swerve, or preparatory to direct pressure above and 
 below anterior slips. Effective as low as eighth dor- 
 sal vertebrae. 
 
 • POSTURE. Patient sitting. Operator at back. 
 
 POSITION. Patient's hands clasped over lower 
 cervical region, operator's knee touching at sixth to 
 eighth dorsal as in (V.U.G. 2) preceding. Operator's 
 forearms under patient's axilla and hands reaching up- 
 ward graps patient's wrists. 
 
 ACTION. Operator straightens arms, forcing 
 lower cervical region slightly forward as knee holds 
 firmly, thus bending spine backward. 
 
 (V.U.I.) 1. Modified or LIFT, DROP AND CATCH. 
 
 USE. Action (A) for entire spine; (B) as low as 
 eighth or tenth dorsal. 
 
 POSTURE and POSITION. Same as (V.U.I, i) 
 above, except that knee is not used. Operator keep- 
 ing forearm close against patient's sides. Patient re- 
 laxes region. 
 
124 VERTEBRA — UPPER DORSAE 
 
 A. ACTION, (a) Lift patient partly from 
 stool. 
 
 (b) Lower operator's forearms suddenly as if to 
 drop patient. 
 
 (cj Endeavor to straighten operator's arms 
 slightly, or at least catch patient before alighting on 
 stool. 
 
 B. ACTION, (a) Sway patient back and 
 forth to get relaxation. 
 
 (b) Apply sudden stress as above. 
 (V.U.I.) 2. THE LIFT, DROP AND CATCH 
 WITH OPERATOR BOWING BACKWARD. 
 USE. For a short operator. 
 
 POSTURE. Patient sitting on table. Operator 
 at back. Operator bows backward to lift patient. 
 
 PRINCIPLE. That of winding patient over onto 
 operator's chest, as a rope over a pulley. 
 
 POSITION. Hands same as (V.U.I, i) the sec- 
 ond preceding. 
 
 ACTION. Then drop and catch as in (V.U.I, i 
 Modified), just preceding. 
 
VERTEBRA — UPPER DORSAL 125 
 
 V. VERTEBRAL LESIONS. 
 U. UPPER DORSAL REGION. 
 
 D. DIRECT REMOVAL OF LESION. 
 
 (V.U.D.) 1. HEAD AND NECK LEVERAGE 
 WITH THUMB AT LESION. 
 
 POSTURE. Patient sitting on stool or chair. 
 Operator at back. 
 
 POSITION. Hand two at crown ; thumb one at 
 
 lesion. 
 
 ACTION, (a) Hand two prys head and neck 
 to one side, thumb one loosens individual vertebrae in 
 treating swerves, or 
 
 (b) exaggerate then change to opposite side to 
 pry lesion into normal position. 
 
 (V.U.D.) 1. Modifications: 
 
 A. Finger one may be reinforced by thumb inside 
 Of it, or 
 
 B. Finger one may oppose thumb in gripping 
 lesion, or 
 
 C. Hand two grip neck and thumb two reinforce 
 thumb one at lesion. 
 
 (V.U.D.) 2. HEAD FIXED WITH BOTH 
 THUMBS AT LESION. 
 
 POSTURE. Patient's head against wall, with 
 pillow to pad it. Patient sitting and operator at back 
 and to one side. 
 
 POSITION. Thumbs at either side of lesion. 
 ACTION. Head remains fixed as thumbs ma- 
 nipulate lesion as in (V.U.D.) i preceding. 
 
126 VERTEBRA— UPPER DORSAL 
 
 (V.U.D.) 3. NECK AND SHOULDER LEVER- 
 AGE WITH THUMB AT LESION. 
 
 USE. For interscapula region 
 
 POSTURE. Patient sitting. Operator in front 
 
 and to one side. 
 
 POSITION. Arm two, which is nearest patient, 
 passes back of neck, with hand two under, opposite 
 axilla from in front. 
 
 ACTION, (a) Bend neck and upper spine for- 
 ward and spring opposite side of thorax backward, 
 thus rotating spine. 
 
 (b) Hand one opposes at lesion and manipulates 
 as in (V.U.D. 1) preceding. 
 
 NOTE. Remember that HAND NO. 1 is always 
 the one at the lesion. All members of same side of 
 operator and patient ar e also No. 1. The other side is 
 No. 2 . 
 
 (V.U.D.) 4. FOLDED ARM LEVERAGE. 
 
 USE. Low as sixth dorsal or lower. 
 
 POSTURE. Patient sitting on stool. Operator 
 at back and at one side. Patient's arms folded above 
 head. 
 
 POSITION. Thumb of hand one at lesion. Hand 
 two reaches in front of patient and grasps arm two 
 about elbow. 
 
VERTEBRA — UPPER DORSAL I 27 
 
 ACTION. Hand two carries arms and head to 
 first exaggerate, second circle forward, and third op- 
 pose as hand one prys lesion to normal. 
 
 NOTE : In treating lower down hand one may 
 be reinforced by elbow resting against operator's 
 thigh. 
 
 1st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) '-:.; . 1 
 
 2 
 
 USE 3 
 
 1st POSTURE Patient 4 
 
 Operator 5 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 11 
 
 12 
 
 PRINCIPLE 15 
 
 DEGREE 18 
 
 CAUTION 20 
 
 NOTE 22 
 
VERTEBRA — UPPER DORSAL 128 
 
 ist letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE 3 
 
 ist POSTURE Patient 4 
 
 Operator 5 
 
 2d 6 
 
 ist POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 Consecutively. Simultaneously. 
 
 1 or, a 1 1 
 
 2 or, b 14 
 
 3 or, c 12 
 
 4 or, d 13 
 
 PRINCIPLE acts as a ... class lever 15 
 
 acts as a fulcrum with 16 
 
 as the power and as the weight 17 
 
 DEGREE • 18 
 
 19 
 
 CAUTION 20 
 
 21 
 
 NOTE a 
 
 23 
 
 24 
 
VERTEBRA — UPPER DORSAL 1 29 
 
 V. VERTEBRAL LESIONS. 
 U. UPPER DORSAL REGION. 
 
 E. EXTREME REMOVAL OF LESIONS. 
 (V.U.E.) 1. REINFORCED DOWNWARD PRES- 
 SURE AT SPINOUS PROCESS. 
 
 USE. If operator stands at side, this may be used 
 tor posterior conditions of entire spine, and most ribs. 
 
 POSTURE. Patient prone on table, with pillow 
 beneath chest, or patient may hang across table with 
 arms dangl'ng. Operator at head, on footstool. 
 
 POSITION. Operator's thumb or thenar emi- 
 nence at spinous process of lesion reinforced with 
 hand two. 
 
 ACTION. A. Patient inhales deeply, then ope- 
 rator gives sudden downward pressure during exhala- 
 tion, or 
 
 B. First give steady pressure to tire and relax, 
 second sudden pressure. 
 
 CAUTION. There is some danger of slipping 
 the wrong rib. 
 
 NOTE: It is always harder on patient, as well 
 as operator, to reduce lesion by main strength with 
 patient forced against an inanimate object. It is facili- 
 tated with the patient or articulation in motion. As 
 with patient sitting inclining forward, with elbows or 
 axilae suspended. 
 
130 VERTEBRA — UPPER DORSAL 
 
 (V.U.E.) 2. ARM AND TRUNK LEVERAGE 
 
 WITH REINFORCED ARM AT LESION (V). 
 
 (A Flying Wedge Treatment.) 
 
 FIRST POSTURE. Patient on low stool or 
 chair. Operator at back and to one side, facing pa- 
 tient. 
 
 POSITION. Thenar eminence of hand one at 
 lesion. Elbow one is reinforced by thigh one, which is 
 raised by foot one. Arm two reaches across shoulder 
 two or nearest ; hand two grasps elbow one or far- 
 therest. 
 
 SECOND POSTURE. Patient leans back at an- 
 gle of thirty degrees and relaxes. 
 
 ACTION. First. Hand one and its reinforce- 
 ments bring pressure on lesion as hand two carries 
 trunk back by forcing elbow one and shoulder two 
 backward with elbow pointing away from body. Give 
 steady pressure. 
 
 Second. Increase with sudden pressure on lesion 
 at finish, taking patient unawares. 
 
 (V.U.E.) 2. MODIFIED, OR SHOULDER AND 
 
 NECK LEVERAGE WITH REINFORCED 
 
 ARM AT LESION (V). 
 
 (A Flying Wedge Treatment.) 
 
 USE. For lateral curves, also for interscapular 
 region. 
 
VERTEBRA — UPPER DORSAL 
 
 POSTURE and POSITION. The same as 
 (V.U.E. 2), except that arm two is over shoulder one, 
 with arm two bearing against patient's neck. 
 
 ACTION. Hand one and its reinforcements force 
 lesion up, in and laterally as arm two rotates shoulder 
 one backward, forcing neck in opposition to pressure 
 at lesion. 
 
 (V.U.E.) 3. FOLDED ARM LEVERAGE SWING- 
 ING WITH OPERATOR'S WEIGHT 
 AIDING. (SWING.) 
 
 USE. Low as lumbar region, also applied to ribs. 
 Unusually easy for operator. 
 
 POSTURE. Patient sitting on stool inclining 
 forward at an angle of forty-five degrees, with arms 
 folded at level of face. Arms supported in swing 
 above elbows. Operator at side. 
 
 NOTE: Stool should be covered with plush, 
 corduroy or brussels, or be provided with knee. rests 
 to keep patient from sliding forward. 
 
 POSITION. Tkumb or thenar eminence of hand 
 
 one at lesion. Hand two reaches in front of patient 
 and swing to grasp elbow two or fartherest. 
 
 PRINCIPLE. Both operator's and patient's 
 
 weight count for energy expended. 
 
 ACTION. Hand one exaggerates, then prys le- 
 sion to the normal as hand two opposes. 
 
 DEGREE. Pressure may be increased without 
 discomfort if swing supports arms near or at axillae. 
 
132 VERTEBRA — UPPER DORSAL 
 
 (V.U.E.) 4 . CLASPED ARM LEVERAGE BOW- 
 ING SPINE WITH SWINGING FULCRUM 
 AND THUMB AT LESION. (SWING.) 
 
 USE. For anterior and lateral conditions in the 
 upper dorsal, cervical and inter-scapular regions, except 
 when neck is too supple. 
 
 NOTE : Swing replaces operator's forearms as 
 in (V.U.I.) 1, giving operator the added use of two 
 hands. 
 
 POSTURE. Patient sitting beneath swing on 
 corduroy-covered stool (to prevent sliding), or with 
 knees fixed against a support. Patient inclining body 
 forward at an agle of 60 degrees from floor. Swing is 
 carried forward to support patient's axillae. Patient's 
 arms clasped with hands gripping forearms near el- 
 bows and placed back of head, just below crown. 
 Operator at side, facing patient. 
 
 POSITION. Thumb of hand one at spinous pro- 
 cess, hand two grasps elbow one, or fartherest, as ope- 
 rator's forearm two rests on patient's clasped arms. 
 
 ACTION. First. Forearm two bears down on 
 patient's clasped arms, forcing head downward and for- 
 ward to bow spine posteriorly. 
 
 Second. Thumb of hand one forces lesion later- 
 ally as forearm two swings patient in opposition, thus 
 forcing lateral conditions back to normal. 
 

 VERTEBRA — UPPER DORSAL 1 33 
 
 For anterior conditions work spinous process back 
 and forth laterally as if loosening a nail as hand one 
 applies leverage in opposition. For mid-dorsal region 
 lower swing a few inches. 
 
 PRINCIPLE. The swing supports axillae as a 
 fulcrum and arm two applies pressure as the power of 
 a first-class lever raising the weight or lesion poster- 
 include all upper dorsal treatments. 
 
 NOTE : Treatments for the interscapular region 
 iorly. 
 
 1st letter the Structure, 26. for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE 3 
 
 POSTURE Patient 4 
 
 Operator 5 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION to 
 
 1 or, a 11 
 
 12 
 
 PRINCIPLE acts as a ... class lever 15 
 
 DEGREE 18 
 
 CAUTION 20 
 
 NOTE 22 
 
1 34 VERTEBRA — INTERSCAPULAR 
 
 i st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 . . -. 2 
 
 USE 3 
 
 1st POSTURE Patient . . . . 4 
 
 Operator 5 
 
 2d 6 
 
 1st POSITION Hand one 7 
 
 . . Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 Consecutively. Simultaneously. 
 
 1 or, a . n 
 
 2 or, b 14 
 
 3 or, c 12 
 
 4 or, d 13 
 
 PRINCIPLE acts as a ... class lever 15 
 
 acts as a fulcrum with .16 
 
 as the power and as the weight 17 
 
 DEGREE 18 
 
 • .19 
 
 CAUTION ! 20 
 
 21 
 
 NOTE 22 
 
 23 
 
 24 
 
VERTEBRA — INTERSCAPULAR 1 35 
 
 1st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE 3 
 
 1st POSTURE Patient 4 
 
 . . Operator 5 
 
 2d "., '.. 6 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 Consecutively. Simultaneously. 
 
 1 or, a 11 
 
 2 or, b 12 
 
 3 or, c 13 
 
 4 or, d 14 
 
 PRINCIPLE acts as a ... class lever 15 
 
 acts as a fulcrum with 16 
 
 as the power and as the weight 17 
 
 DEGREE 18 
 
 19 
 
 CAUTION 20 
 
 21 
 
 NOTE 22 
 
 23 
 
 24 
 
136 VERTEBRA — INTERSCAPULAR 
 
 V. VERTEBRAL LESIONS. 
 
 I. INTER-SCAPULAR REGION. 
 
 G. DIRECT REMOVAL OF LESION. 
 
 (V.I.G.) 1. Similar to (M.I.G. 1). Elbow and Shoulder 
 
 Leverage With Hand Reinforced. 
 
 POSTURE. Patient on side. 
 
 V. VERTEBRAL LESION. 
 
 I. INTER-SCAPULAR REGION. 
 
 D. DIRECT REMOVAL OF LESION. 
 
 (V.I.D.) 1. Similar to (M.I.D.) 1, or Arm Leverage 
 
 With Inverted Thumb at Lesion. 
 
 (V.I.D.) 2. NECK, ARM AND SHOULDER 
 
 LEVERAGE, PATIENT'S ARMS CLASPED. 
 
 (ILLUSTRATED.) 
 
 POSTURE. Patient sitting with arms clasped at 
 forehead. Operator at back. 
 
 USE. Lateral fifth cervical to sixth dorsal. 
 
 POSITION. Thumb one or thenar eminence at 
 lesion, hand two reaches across crown of head and 
 grasps elbow one, or fartherest elbow. 
 
 ACTION. Hand one brings pressure at lesion as 
 hand two opposes. 
 
 PRINCIPLE. Not rotating upper trunk, but 
 springing it at lesion. 
 
 NOTE. Patient should incline forward. This is 
 given easier with arm supported in swing at elbows. 
 
VERTEBRA — INTERSCAPULAR 13? 
 
 (V.I.D.) 3. RIGID HEAD AND NECK LEVER- 
 AGE, PATIENT'S HANDS CLASPED. 
 
 L T SE. Posterior conditions, second to sixth dor- 
 sal. 
 
 POSTURE. Patient sitting with hands clasped 
 at back of neck. Operator at back. 
 
 POSITION. Thumb one or thenar eminence at 
 lesion, hand two grasps elbows, binding head between 
 them. 
 
 ACTION. Hand one brings pressure at lesion as 
 hand two raises, lowers and circles elbows while oppos- 
 ing. 
 
 PRINCIPLE. Rocking upper trunk or springing 
 it at lesion. 
 
 1st letter the Structure, 26. for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE 3 
 
 POSTURE Patient 4 
 
 Operator 5 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 11 
 
 12 
 
 PRINCIPLE 15 
 
 DEGREE 18 
 
 CAUTION 20 
 
 NOTE 22 
 
I38 VERTEBRA — INTERSCAPULAR 
 
 V. VERTEBRAL LESIONS. 
 
 I. INTER-SCAPULAR REGION. 
 E. EXTREME TREATMENT. 
 
 NOTE: SOME ESPECIALLY EFFECTIVE 
 SWING TREATMENTS FOR THIS REGION ARE 
 (V. U. E.) 3-(V. U. E.) 4-(R. I. E.) 2. 
 
 (V.I.E.) 1. Similar to (R.I.E. 3) or Arm and Shoulder 
 Leverage with Reinforced Arm at Lesion. (V.) 
 POSTURE. Patient lying on side. Operator at 
 
 back. 
 
 NOTE : A flying wedge treatment. 
 (V.I.E.) 2. NECK, ARM AND SHOULDER 
 LEVERAGE, PATIENT'S HANDS CLASPED 
 AND REINFORCED ARM AT LESION. 
 
 NOTE : A flying wedge treatment. 
 
 L'SE. Very effective in lateral conditions. Also 
 applied lower or with patient's knees fixed for forcible 
 rotation of spine. 
 
 FIRST POSTURE. Patient sitting on low stool 
 •or chair, knees against wall, with hands clasped at back 
 ■of neck. Operator facing convex side of lesion. Ope- 
 rator grasps his own coat sleeve of hand two with same 
 hand. 
 
 POSITION. Hand two is forced between neck 
 and fartherest elbow of patient up beyond operator's 
 elbow. Hand one reinforced by elbow, knee and foot. 
 
 SECOND POSTURE. Operator backs to side of 
 patient. 
 
 ACTION. Hand one forces lesion laterally as 
 arm two opposes, forcing shoulder backward. 
 
VERTEBRA — DORSAL 1 39 
 
 V. VERTEBRAL LESIONS. 
 
 D. DORSAL, MIDDLE AND LOWER RE- 
 GIONS. 
 
 G. GENERAL TREATMENT. 
 
 (V.D.G.) i. SHOULDER LEVERAGE WITH 
 FINGERS AT LESION. Lying on side. 
 
 U"SE. Dorsal and lumbar regions for mild treat- 
 ment. 
 
 POSTURE. Patient on side. Operator in front. 
 
 POSITION. Finger tips of hand one grasp spi- 
 :nous processes. Hand two on shoulder. 
 
 PRINCIPLE. Springing the spine. 
 
 ACTION. Hand one springs vertebrae forward 
 and laterally, i. e., toward operator and upward. Hand 
 two opposes at shoulder. 
 
 NOTE: For lumbar region hand two on anterior 
 superior spine of ilium. 
 
 <V.D.G.) 2. SHOULDER LEVERAGE WITH 
 FINGERS AT LESION. Patient supine. 
 
 POSTURE. Patient supine. Operator at side. 
 
 POSITION. Hand one passing directly under to 
 -spinous process. Hand two on nearest shoulder. 
 
 PRINCIPLE and ACTION same as (V.D.G. i) 
 just preceding. 
 
 NOTE : For lumbar region hand two at anterior 
 -superior spine of ilium. 
 
I40 VERTEBRA — DORSAL 
 
 (V.D.G.) 2. MODIFIED. Reinforced. 
 
 USE. Very effective for bedfast patients. 
 
 NOTE : Patient's weight replaces hand two, and 
 hand two reinforces hand one. 
 
 (V.D.G.) 3. SHOULDER LEVERAGE WITH 
 THENAR EMINENCE AT LESION. LYING. 
 
 L T SE. For bedfast patients. Less effective than 
 (V.D.G. 3) MODIFIED, following. 
 
 POSTURE. Patient on side. Operator at back. 
 
 POSITION. Thenar eminence of hand one at 
 
 lesion ; operator's elbow reinforced by resting against 
 operator's hip. Hand two at shoulder or hip. 
 
 ACTION. Oppose pressure at lesion with hand 
 two. 
 
 PRINCIPLE. Rotation of spine with pressure 
 a£ lesion. 
 
 (V.D.G.) 3. MODIFIED. SITTING. 
 
 POSTURE. Patient sitting on table. Operator 
 standing at back, or patient sitting on stool or chair 
 and operator sitting on chair or bed. 
 
 POSITION. Thenar eminence or thumb one at 
 spinous process. Elbow one reinforced by hip one. 
 
 ACTION. Hand two opposes at opposite shoul- 
 der. 
 
VERTEBRA — DORSAL 141 
 
 (V.D.G.) 4. SHOULDER LEVERAGE 
 WITH THENAR EMINENCE AT LESION. 
 Prone. Similar to (R.D.G.) 4. Use entire spine for 
 rotations and posterior conditions. 
 
 POSTURE. Prone. Operator at opposite side 
 if rotated. 
 
 POSITION. Thenar eminence or thumb one at 
 
 spinous process, or in rotations on transverse pro- 
 cesses, most prominent. Hand two on shoulder one, 
 or the farthest. 
 
 ACTION. Hand one lifts shoulder from table as 
 hanil two opposes. 
 
 First. Steady pressure. 
 
 Second. Sudden pressure. 
 
 NOTE : For upper dorsal region operator moves 
 around toward head of table, grasping shoulder at 
 s.xilla. 
 
 For lower dorsal and lumbar region, hand one 
 changes to grasp anterior superior spine, and hand 
 two replaces hand one. 
 
 CAUTION : There is some danger of slipping 
 other ribs. Perhaps best given with pillow under 
 breast, especially with lady patients. 
 
142 VERTEBRA — DORSAL- . 
 
 (V.D.G.) 5. SHOULDER AND HIP LEVERAGE. 
 
 WITH FOREARMS. BOTH HANDS AT 
 LESION. (Illustrated.) 
 
 USE. To attract nutrition and correct lesions^ 
 Is best for operators with short, strong fingers. 
 
 POSTURE. Patient on side. Operator in front.. 
 
 POSITION. Forearm one against shoulder^ 
 Forearm two against hip. Finger tips of both hands, 
 at lesion. 
 
 ACTION. Fingers spring spine and forearms op- 
 pose. 
 
 PRINCIPLE. Two levers. 
 
 (V.D.G.) .5. MODIFIED. 
 
 POSTURE AND POSITION. Same. 
 
 ACTION. Arms manipulate hip and shoulder so 
 as to aid ringers approximate and separate lesion, like- 
 squeezing a sponge or playing an accordian. 
 
 V. VERTEBRAL LESIONS. 
 D. DORSAL REGION. 
 
 I. INDIRECT TREATMENT. 
 (V.D.I.) 1. Same as (V.U.I. 1 Modified) or the Lift,, 
 Drop and Catch. 
 
VERTEBRA — DORSAL 143 
 
 i st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) J 
 
 2 
 
 USE 3 
 
 POSTURE Patient 4 
 
 Operator 5 
 
 2d 6 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION I© 
 
 Consecutively. Simultaneously. 
 
 11 
 
 2 or, b 12 
 
 3 or, c 13 
 
 4 or, d 14 
 
 PRINCIPLE 15 
 
 acts as a fulcrum with 16 
 
 as the power and as the weight 17 
 
 DEGREE 18 
 
 19 
 
 CAUTION 20 
 
 2r 
 
 NOTE 22 
 
 23 
 
 24 
 
144 VERTEBRA — DORSAE 
 
 V. VERTEBRAL LESIONS. 
 D. DORSAL REGION. 
 
 D. DIRECT TREATMENT. 
 
 (V.D.D.) i. TRUNK LEVERAGE TO SPRING, 
 CIRCLE AND LIFT TO NORMAL. 
 
 (Illustrated.) 
 L^SE. Best for operator with short fingers. 
 
 POSTURE. Patient sitting on table or stool. 
 Operator in front. 
 
 POSITION. Hand one reaches around, gripping 
 vertebrae below lesion. Hand two supports shoulder 
 diagonally opposite. 
 
 ACTION. First. Hand two carries upper trunk 
 to side to break lesion, as hand one makes fixed point 
 below lesion. 
 
 Second. Circle body to front, as if to break loose 
 remaining sides of articulation, and 
 
 Third. Lifting and rotating trunk to set verte- 
 brae back to normal. 
 
 (V.D.D.) i. MODIFIED. REINFORCED 
 fame as (V.D.D. i), except: 
 
 POSITION. Hand two reinforces hand one at 
 spine, reaching around from opposite side. Operator's 
 head, chin and forearms replace hand two to aid move- 
 ment of trunk to break, circle, lift and rotate. 
 
VERTEBRA — DORSAL I 45 
 
 (V.D.D.) 2. TRUNK LEVERAGE TO SPRING, 
 
 CIRCLE, ROTATE AND FORCE TO 
 
 NORMAL. 
 
 USE. More effective than the two just preceding. 
 
 POSTURE. Patient sitting. Operator at back 
 and to one side, away from lesion. 
 
 POSITION. Thumb one or thenar eminence be- 
 low lesion. Hand two across patient's chest, grasp- 
 ing shoulder one or farthest. Elbow two grasps 
 .shoulder two. 
 
 ACTION. First. .Spring by drawing patient to 
 side at which operator stands. 
 
 Second. Circle trunk forward one quadrant. 
 
 Third. Circle trunk second quadrant while ro- 
 tating trunk 45 degrees to side. 
 
 Fourth. Apply direct pressure while pulling 
 trunk back to normal sitting posture. 
 
 (V.D.D.) 3. LOWER TRUNK AND LIMB TRAC- 
 TION WITH THENAR EMINENCE AT 
 
 LESION. (SWING.) 
 USE. For posterior conditions. 
 
 POSTURE. Patient standing one or two feet in 
 ifont of ceiling hooks with arms in swing. Operator 
 it back. 
 
 POSITION. Thenar eminence of hand one at 
 
 convexity. Hand two grasps shoulder two. Opera- 
 tor's arms straight. 
 
146 VERTEBRA — DORSAE 
 
 ACTION. First. Operator walks forward, keep- 
 ing arms straight while giving direct pressure on 
 lesion. 
 
 Second. With sudden jolts, spring spine at lesion. 
 
 DEGREE. The nearer vertical the straps or 
 ropes hang the less resistance will be noticed. 
 
 1st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) •••• 1 
 
 2 
 
 USE 3 
 
 1st POSTURE Patient 4 
 
 Operator 5 
 
 1st POSITION Hand one 7 
 
 ... .Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 11 
 
 12 
 
 PRINCIPLE 15 
 
 DEGREE i& 
 
 CAUTION 20 
 
 NOTE ..22 
 
VERTEBRA — DORSAL 147 
 
 V. VERTEBRAL LESIONS. 
 D. DORSAL REGION. 
 
 E. EXTREME REMOVAL OF LESIONS. 
 
 (V.D.E.) 1. ARM AND BILATERAL TRUNK 
 
 LEVERAGE WITH REINFORCED ARM 
 
 AT LESION. A FLYING WEDGE 
 
 TREATMENT. 
 
 FIRST POSTURE. Patient on low stool or 
 chair. Operator at back and to one side, facing pa- 
 tient. 
 
 POSITION. Thenar eminence of hand one at 
 at lesion. Elbow one is reinforced by thigh one, which 
 is raised by foot one. Arm two reaches across shoul- 
 der two, or nearest ; hand two grasps elbow one, or 
 farthest. Axilla two gripping shoulder two. 
 
 SECOND POSTURE. Patient leans back at an- 
 gle of sixty degrees and relaxes. Get good contact 
 with lesion. 
 
 ACTION. First. Hand one and its reinforce- 
 ments bring pressure on lesion as hand two carries 
 trunk back by forcing elbow one and shoulder two 
 backward with elbow pointing away from body. Give 
 
 steady pressure. 
 
 Second. Increase with sudden pressure on lesion 
 at finish, taking patient unawares. Either lifting heel 
 or swinging in knee. 
 
 DEGREE. May lift a medium-weight patient 
 from stool. 
 
I48 VERTEBRA DORSAL 
 
 <V.D.E.) 2. SHOULDER AXD LATERAL TRUNK 
 LEVERAGE WITH REINFORCED ARM AT 
 LESION. Same as (V.U.E. 2) Modified, or 
 
 Shoulder and Neck Leverage with Reinforced 
 Arm at Lesion, except : 
 
 ACTION. There is no lateral pressure on neck. 
 
 POSITION. Arm two is over shoulder, other- 
 wise similar to (V.D.E. 1) preceding. 
 
 USE. For lateral conditions almost entire length 
 of spine. 
 
 NOTE : Foct may engage chair leg. 
 
 1st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE 3 
 
 POSTURE Patient 4 
 
 - .- Operator 5 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 IT 
 
 -. 12 
 
 PRINCIPLE 15 
 
 DEGREE 18 
 
 CAUTION 20 
 
 NOTE 22 
 
VERTEBRA DORSAD 149. 
 
 (V.D.E.) 3. TRUNK LEVERAGE TO SPRING 
 AND CIRCLE WITH REINFORCED HAND 
 AT LESION. Similar to (V.D.D. 2), or TRUNK 
 LEVERAGE TO SPRING, CIRCLE, ROTATE 
 AND FORCE TO NORMAL, and in addition 
 
 Hand One is reinforced by Elbow, Knee and Foot. 
 
 (V.D.E.) 4. SHOULDER AND ARM LEVERAGE 
 WITH PATIENT'S W T EIGHT AND REIN- 
 FORCED ARM AT LESION. (V.) 
 
 USE. For medium or heavy patients this is the- 
 most extreme treatment. 
 
 FIRST POSTURE. Patient standing. Opera- 
 tor at back and to one side. 
 
 FIRST POSITION. Thenar eminence of hand 
 one at lesion, reinforced by elbow, knee and foot one. 
 
 SECOND POSTURE. Foot one supported on 
 stool 6 to 12 inches high, and, if needed, foot two on 
 stool 4 to 8 inches high. 
 
 SECOND POSITION. Hand two reaches across- 
 patient's chest and grasps elbow one, or farthest, and 
 arm two grasps side two of patient. 
 
 ACTION. First. Patient is tilted or bowed 
 backward and steady pressure brought on lesion. 
 
 Second. Sudden pressure is given unawares, or 
 at expiration. 
 
 DEGREE. May lift 160-pound patient from feet. 
 
I50 VERTEBRA — DORSAL 
 
 (V.D.E.) 5. CIRCLING AND BOWING SPINE 
 FOR ALTERNATE EXAGGERATION AND 
 PRESSURE FOR REDUCTION OF LESION. 
 
 (SWING.) 
 
 L^SE. For lateral swerves, slips or general free- 
 ing of spinal articulations. 
 
 POSTL^RE. Patient standing with arms in 
 swing at axilla. Operator standing at convex side of 
 lesion and diagonally back of patient. Operator's foot 
 one near patient and foot two diagonally backward one 
 step. 
 
 POSITION. Patient's hands clasped in front. 
 Operator's hand two grasps patient's clasped hands. 
 Thumb or thenar eminence of hand one at spinous 
 processes. 
 
 ACTION. First. With both hands start pa- 
 tient's body from you and continue around in a circle, 
 keeping patient's feet on floor, beneath ceiling hooks. 
 
 Second. Apply pressure at convexity of lateral 
 deviation of spine as patient swings from Operator. 
 
 Third. Continue circling body and moving from 
 vertebrae to vertebrae with pressure, 
 
 NOTE: Straps of swing should be crossed from 
 5 to 14 inches for a 10-foot ceiling to increase the in- 
 cline of shoulders and motion of spine as body travels 
 around circle. 
 
VERTEBRA — DORSAL 151 
 
 (V.D.E.) 5, MODIFIED. (SWING). The 
 same, except path of lesion is one-half the diameter 
 and lies forward and toward lesion side of ceiling 
 hooks. 
 
 USE. Fourth to tenth dorsal and typical ribs. 
 
 (V.D.E.) 6. ARM AND SHOULDER LEVERAGE 
 SWINGING TRUNK WITH OPERATOR'S 
 WEIGHT AT LESION. (SWING.) 
 
 USE. Posterior, lateral and rigid conditions. 
 
 POSTURE. Patient sitting, inclining forward at 
 30 degrees, with swing supporting axillae. Operator 
 at side. 
 
 POSITION. Thenar eminence of hand one at 
 lesion. Hand two reaches down in front of shoulder 
 one, or farthest, grasping elbow one. 
 
 ACTION. Hand one applies steady pressure. 
 Hand two opposes or lifts at elbow while swaying 
 trunk. Hand one applies sudden pressure, if needed. 
 
 NOTE: Most Dorsal, i. e., Middle and Lower, 
 Treatments are Applied to Lumbar Region. 
 
I 52 VERTEBRA DORSAL 
 
 ist letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE 3 
 
 ist POSTURE Patient ' 4 
 
 Operator 5 
 
 2d 6 
 
 ist POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTIOX 10 
 
 Consecutively. Simultaneously. 
 
 1 or. a 11 
 
 2 or. b 12 
 
 3 or, c 13 
 
 4 or. d 14 
 
 PRINCIPLE acts as a ... class lever 15 
 
 acts as a fulcrum with 16 
 
 as the power and as the weight 17 
 
 DEGREE 18 
 
 19 
 
 CAUTION 20 
 
 21 
 
 XOTE 22 
 
 23 
 
 24 
 
VERTEBRA — LUMBAR 1 53 
 
 V. VERTEBRAL LESIONS. 
 L. LUMBAR REGION. 
 
 G. GENERAL TREATMENT. 
 
 (V.L.G.) 1, 2 and 3. HIP LEVERAGE WITH 
 FINGERS AT LESION. 
 
 Same as (V.D.G. 1, 2 and 3), or Shoulder Lever- 
 age with Fingers or Thumb at Lesion, except : 
 
 POSITION. Hand two is at hip instead of 
 shoulder. 
 
 (V.L.G.) 4. SHOULDER LEVERAGE WITH 
 THUMB AT LESION. 
 
 POSTURE. Patient and operator sitting similar 
 to (M.D.D. 1) or Shoulder Leverage with Thumb at 
 Lesion. 
 
 V. VERTEBRAL LESIONS. 
 
 L. LUMBAR REGION. 
 
 I. INDIRECT TREATMENT. 
 
 (V.L.I.) 1. Same as (M.L.D. 1), or LONGITUDI- 
 NAL STRETCHING WITH TRUNK 
 LEVERAGE. 
 
 USE. For rigid or anterior conditions and mus- 
 cular contractions. 
 
 POSTURE. Patient on stool. 
 
 (V.L.I.) 2. Same as (M.L.I. 2), or LONGITUDI- 
 NAL STRETCHING WITH LIMB LEVER- 
 AGE. (FOR MALES.) 
 USE. Same as (V.L.L 1) just preceding. 
 
154- VERTEBRA LUMBAR 
 
 V. VERTEBRAL LESIONS. 
 L. LUMBAR REGION. 
 
 D. DIRECT REMOVAL OF LESION. 
 
 <V.L.D.) i. LOWER TRUNK AXD LIMB LEV- 
 ERAGE WITH LESION AT EDGE OF 
 TABLE. 
 
 USE. For lateral or posterior conditions. (See 
 ' action.) 
 
 POSTURE. Patient on back, sacrum beyond 
 table. Operator at foot, facing patient. 
 
 POSITION. Patient's knees over operator's 
 shoulders. Patient's feet crossed. Little ringer of 
 clenched fist on edge of table, supporting lesion. 
 
 FIRST ACTION. For Lateral first exaggerate, 
 
 -second circle, and third spring to normal. 
 
 SECOND ACTION. For Posterior carry knees 
 -in figure of eight with shoulder or raise and lower. 
 
 (V.L.D.) 2. FLEXED LIMB AND HIP LEVER- 
 AGE WITH REINFORCED FINGERS AT 
 LESION. 
 
 USE. For lateral or posterior conditions or rigid 
 spine. If lateral have convexity down. 
 
 POSTURE. Patient on table on side, with knees 
 and thighs flexed on abdomen. Operator in front. 
 -Patient's shins against operator. 
 
V E R T E B R A — EU M1A1 1 5 5 
 
 POSITION. Operator's ringers of hand one, re- 
 inforced by hand two and gripping spinous processes 
 from below. 
 
 ACTION. Lift and spring spine, carrying pa- 
 tient's limbs baofc and forth with aid of operator's 
 body. 
 
 (V.L.D.) 2. MODIFIED. OX BED OR COUCH. 
 
 POSTURE. The same, except operator faces 
 head, and patient's shins strike side of operator's leg 
 about knee. 
 
 POSITION. Hand one at lesion. Hand two 
 supports knees. 
 
 ACTION. Flexion and extension of operator's 
 knees carries patient's limbs as hand one manipulates 
 Lesion. 
 
 (V.L.D.) 3. SWINGING LIMB AND PELVIC 
 LEVERAGE WITH LATERAL PRESSURE 
 AT LESION. (SWING.) 
 
 USE. For lateral conditions or rigid spine high 
 as sixth dorsal vertebrae. 
 
 POSTURE. Patient prone, arms hanging over 
 each side of table. Lower limbs supported above pa- 
 tella in swing. Operator at side. 
 
 POSITION. Thumb one or thenar eminence at 
 lesion. Hand two grasps farther side of swing. 
 
 ACTION. Hand two draws patient's limbs to- 
 ward operator as hand one opposes or forces lesion to 
 normal position. 
 
I56 VERTEBRA — LUMBAR 
 
 (V.L.D.) 3. MODIFIED. (ASSISTANT.) 
 
 The same as (V.L.D.) 3 preceding, except opera- 
 tor or assistant carries patient's limb? on forearm. 
 The objection to the operator doing the lifting is that 
 it requires about nine-tenths of the operator's energy, 
 leaving only one-tenth to be expended at lesion. 
 
 (V.L.D.) 4. SWINGING LIMB AND PELVIC 
 
 LEVERAGE WITH OPERATOR'S WEIGHT 
 
 AT LESION. (SWING.) 
 
 USE. For posterior conditions of spine as high 
 as sixth dorsal vertebrae; including posterior sacrum. 
 
 Similar to (VX.D. 3) preceding, except: 
 
 POSTURE. Operator on stool, if needed, to 
 get directly over lesion. 
 
 POSITION. Thenar eminence of hand one di- 
 rectly over spinous process of lesion. 
 
 ACTION. First. Steady pressure at prominence 
 of lesion. 
 
 Second. Sudden pressure given unaware.-. 
 
 (V.L.D.) 5 . CRANK LEVERAGE OF LEGS WITH 
 THUMB OR FINGERS OPPOSING AT LE- 
 SION. (ILLUSTRATED.) 
 
 POSTURE. Patient on side on table, with knees 
 flexed at right angles or less. Operator in front. 
 
 PRINCIPLE. Shown in drawing: L. C Legs 
 act as crank. T. A. Thighs act as axle P. H. Pel- 
 vis acts as hub. S. S. Spine acts as flexible spoke of 
 wheel. 
 
VERTEBRA — LUMBAR I 57 
 
 POSITION. Thumb or fingers of hand one 
 §7*asp spinous processes. Hand two grasps ankles. 
 Patient's knees and legs extending beyond table and 
 brace against operator. 
 
 ACTION. First. Lift ankles to force or bow 
 spine downward and oppose or lift upward with 
 fingers at lesion. 
 
 Second. Lower ankles to bow spine upward and 
 oppose or press downward with thumb at lesion. 
 
 1st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) I 
 
 2 
 
 USE 3 
 
 POSTURE Patient 4 
 
 Operator 5 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 1 or, a 11 
 
 12 
 
 PRINCIPLE acts as a ... class lever 15 
 
 DEGREE ..18 
 
 CAUTION 20 
 
 NOTE 22 
 
I58 VERTEBRA LUMBAR 
 
 (KEY TO SYMBOL CONSTRUCTION) 
 1st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) -. 1 
 
 2 
 
 USE 3 
 
 *st POSTURE Patient 4 
 
 . , Operator % 
 
 2d 6 
 
 1st POSITION Hand one 7 
 
 Hand two & 
 
 2d 9 
 
 ACTION 1© 
 
 Consecutively. Simultaneously. 
 
 1 or, a ." if 
 
 2 or , b .- 12 
 
 3 or, c 13 
 
 4 • • or, d 14 
 
 PRINCIPLE acts as a ... class lever 15 
 
 acts as a fulcrum with 16 
 
 as the power and as the weight \J 
 
 DEGREE iS 
 
 •• 19 
 
 CAUTION 2® 
 
 21 
 
 NOTE 22 
 
 2J 
 
 24 
 
VERTEBRA — LUMBAR 159, 
 
 (KEY TO SYMBOL CONSTRUCTION) 
 1st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) ... : 1 
 
 2 
 
 USE & 
 
 1st POSTURE Patient -...._ 4. 
 
 Operator 3 
 
 2d 6te 
 
 1st POSITION Hand one 7- 
 
 Hand two &", 
 
 2d • 9* 
 
 ACTIOX 10* 
 
 Consecutively. Simultaneously. 
 
 1 or, a if 
 
 2 or, b 12* 
 
 3 or, c IX 
 
 4 or, d 14 .. 
 
 PRINCIPLE acts as a ... class lever 15; 
 
 acts as a fulcrum with 16* 
 
 as the power and as the weight 17-- 
 
 DEGREE 18:, 
 
 ic> 
 
 CAUTION 20 
 
 21 
 
 NOTE 22; 
 
 • 23. 
 
 2 4- 
 
l6o VERTEBRA LUMBAR 
 
 V. VERTEBRAL LESIONS. 
 L. LUMBAR REGION. 
 
 E. EXTREME TREATMENT. 
 
 <V.L.E.) i, 2, 3 and 4. Same as (V.D.E. 1, 2, 3 and 4), 
 all Flying Wedge Treatments. 
 
 <V.L.E.) 5. FLEXED LIMB AND LOWER 
 TRUNK LEVERAGE WITH REINFORCED 
 ARM AT LESION SUPPORTING PATIENT'S 
 WEIGHT. (V.) (A FLYING WEDGE 
 TREATMENT.) 
 
 USE. The most extreme treatment for posterior 
 conditions of lumbar region. 
 
 FIRST POSTURE. Patient on side on table. 
 Flips backed to edge. Trunk lying diagonally across, 
 with head to opposite side of table and flexed. Ope- 
 rator a?t back. Patient must relax. 
 
 POSITION. Thenar eminence of hand one at 
 lesion, reinforced by elbow, knee and foot. Arm two 
 grasps patient's knees. 
 
 FIRST ACTION. Hand two lifts knees to roll 
 patient on back. 
 
 SECOND POSTURE. Patient on back, so that 
 liand one and its reinforcements support lower trunk 
 and limbs of patient at prominence of lesion or spi- 
 nous process, which acts as a fulcrum. Patient re- 
 laxes. 
 
 SECOND ACTION. Hand two flexes and ex- 
 tends thighs so as to rock or teeter on lesion. 
 
VERTEBR A— I;UMB AR 1 6 
 
 THIRD ACTION. Extra or sudden pressure is 
 applied from below via hand one and its reinforce- 
 ments, or elbow, knee and foot. 
 
 NOTE : If patient's shoulders rise from table 
 then relaxation is incomplete and operator's work is 
 unnecessarily doubled. 
 
 (KEY TO SYMBOL CONSTRUCTION) 
 1st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 < ) 1 
 
 2 
 
 USE 3 
 
 POSTURE Patient 4 
 
 Operator . 5 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d . , 9 
 
 ACTION 10 
 
 11 
 
 '. .- 12 
 
 PRINCIPLE 15 
 
 DEGREE 18 
 
 CAUTION ". 20 
 
 NOTE 22 
 
VERTEBRA — SACRUM 
 
 V. VERTEBRAL LESIONS. 
 S. SACRUM. 
 
 I. INDIRECT REMOVAL OF LESIONS. 
 
 RULE. The sacrum is adjusted indirectly by 
 correcting the relative position of adjacent bones, i. e., 
 fifth lumbar and the innominates (see their treat- 
 ments) as well as by direct treatment. 
 
 (V.S.I.) i. KNEES FLEXED ON ABDOMEN, 
 SUPPORTING OPERATOR'S WEIGHT. 
 
 USE. To spring or bow lumbo-sacral articula- 
 tion posterior and supplement direct treatment of 
 lumbar region. 
 
 POSTURE. Patient on back, with thighs flexed 
 on abdomen. Operator on stool at side. 
 
 POSITION. Operator's chest on patient's shins, 
 and operator's hands grasp table ; or hand two on 
 shins, near knee, and hand one on sacrum. 
 
 PRINCIPLE. A two-armed lever. 
 
 ACTION. Press down on shins, throwing lum- 
 bar region posterior and apply rotary oscillation to 
 lever on table as a pivot. 
 
VERTEBRA — SACRUM 1 63 
 
 V. VERTEBRAL LESIONS. 
 S. SACRUM. 
 
 D. DIRECT REMOVAL OF LESION. 
 
 (V.S.D.) 1. CIRCLING FLEXED KNEES AND 
 SUPPORTING ABDOMEN AND LOWER 
 TRUNK WITH HAND AT LESION. SUPINE. 
 
 USE. Posterior fifth lumbar vetrebrae or sac- 
 rum. 
 
 POSTURE. Patient supine, with knees and 
 thighs flexed. Operator at side. 
 
 POSITION. Thenar eminence of hand one at 
 
 posterior portion of lesion, lying flat. 
 
 ACTION. Hand one presses upward as hand 
 two circles one or two knees, pulling toward operator 
 when flexed the most. 
 
 (V.S.D.) 1. MODIFIED. PATIENT ON SIDE- 
 POSTURE. Patient on side, facing operator. 
 Operator at side. 
 
 POSITION. Hands the same as (V.S.D. i) just 
 preceding. 
 
 ACTION. Hand one pulls as hand two circles 
 one or two knees from you, i. e., the top of the circle. 
 
 NOTE : See innominate treatment. Oftentimes 
 
 adjusting both innominates is equivalent to correcting 
 
 the sacrum, for example, two posterior innominates 
 
 equal one anterior sacrum. 
 
164 VHRTE3RA — SACRUM 
 
 V. VERTEBRAL LESIONS. 
 S. SACRUM. 
 
 E. EXTREME TREATMENT. 
 
 (V.S.E.) 1. SHOULDER AND TRUNK LEVER- 
 AGE, FORCING LESION AGAINST KNEE. 
 
 USE. For sacrum posterior above. 
 
 POSTURE. Patient sitting, knees at wall. Ope- 
 rator at back. 
 
 POSITION. Operator's padded knee {y^-inch. 
 felt) at prominence of lesion. Hands grasp patient's 
 shoulders from beneath. 
 
 ACTION. Pull as if loosening a post in the 
 ground, holding knee firm, i. e., pull and oscillate, cir- 
 cle or give figure of eight movement of shoulders, at 
 the same time carrying trunk well back, forcing lesion 
 against knee. 
 
 (V.S.E.) 2. DIRECT PRESSURE FROM OPERA- 
 TOR'S WEIGHT. 
 
 USE. Posterior sacrum. 
 
 POSTURE. Patient prone. Operator well over 
 patient. 
 
 POSITION. Thenar eminence with arm straight, 
 or padded knee or heel at lesion. 
 
 ACTION. Press slowly, then suddenly increase. 
 
 DEGREE. 100 to 200 pounds pressure for strong 
 subject. 
 
VERTEBRA — SACRUM 1 65 
 
 (V.S.E.) 2. MODIFIED. (SWING OR ASSIST- 
 ANT.) 
 
 ACTION. Thenar pressure, with knees carried 
 across table by assistant or swing. 
 
 (V.S.E.) 3. SIMILAR TO (V.U.E. 3), or Arm and 
 Trunk Leverage with Reinforced Arm at Lesion. 
 (V.). Except: 
 POSITION. Patient sits erect, and operator's 
 
 foot engages chair leg. 
 
 (V.S.E.) 4. (V.) Same as (V.L.E. 5). or Flexed Limb 
 and Lower Trunk Leverage with Reinforced Arm 
 at Lesion, Supporting Patient's. Weight. (V.) 
 
 1st letter the Structure, 2d for Region, and 3d Class. 
 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE 3 
 
 POSTURE Patient 4 
 
 Operator 5 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 11 
 
 12 
 
 PRINCIPLE 15 
 
 DEGREE 18 
 
 CAUTION 20 
 
 NOTE 22 
 
t66 YHRTBBRA— COCCYX 
 
 V. VERTEBRAL LESIONS. 
 C. COCCYX. 
 
 I. INDIRECT REMOVAL OF LESIONS. 
 (V.C.I.) i. EXTERNAL METHOD. 
 
 Same as (M.C.D. i), or Trunk Leverage with 
 Hand at External Coccygis. 
 
 USE. Harmless and preferred by many to 
 (V.C.D. i) or (V.C.E. i) following. 
 
 V. VERTEBRAL LESIONS. 
 C. COCCYX. 
 
 D. DIRECT REMOVAL OF LESION. 
 (V.C.D.) i. INTERNAL METHOD. 
 
 POSTURE. Patient on side, in Sim's position. 
 
 POSITION. Index ringer in rectum, reaching 
 scarcely to second segment of coccyx. 
 
 ACTION. Pull downward and spring gently to 
 normal position. 
 
 CAUTION : Avoid pressure on ganglion of im- 
 par, lying on second segment of coccyx. Second. 
 Treatment during last month of pregnancy, or, third, 
 too frequently if subject to hemorrhoids. 
 
 V. VERTEBRAL LESIONS. 
 C. COCCYX. 
 
 E. EXTREME METHOD. 
 
 (V.C.E.) i. COMBINED INTERNAL AND EX- 
 TERNAL METHODS. 
 POSTURE. Patient on side, in Sim's position. 
 
 POSITION. Finger one in rectum, thenar emi- 
 nence of hand two on evternal coccygius. See 
 (V.C.D. i) CAUTION just preceding. 
 
 ACTION. Finger one pulls and straightens as 
 kand one carries muscles up and back. 
 
ANTERIOR THORASIC MUSCLES 
 
 167 
 
 THE PECTORALIS MAJOR 
 
 Notice its origin and insertion. How its contraction would draw arm down- 
 ward and forward, and in extraordinary respiration with shoulder fixed it 
 would raise true ribs. Showing hew elevation of arm aids in anterior mus- 
 cular traction. 
 
1 68 
 
 ANTERIOR THORASIC MUSCLES 
 
 THE SERRATUS MAGNUS 
 (Sling Muscle) 
 
 Showing the value cf suspension at axillae to raise shoulder gird! 
 
 er girdle in gaming 
 
 anterior mu:cu!ar traction when reducing rib subluxations. Ei:her general or 
 
ANTERIOR THORASTC MUSCLES 169 
 
 PECTORALIS MINOR AND SERRATUS MAGNUS 
 
 , (Used in reducing r.b lesions) 
 
 Showing how raising of shoulder girdle, best obtained by suspension, would 
 cause anerior muscular tsaction. 
 
I70 CLAVICLE 
 
 CLAV. CLAVICAL 
 S. STERNAL END. 
 
 D. DIRECT REMOVAL OF LESION. 
 E. EXTREME. 
 
 (Clav.S.D.)i. THUMB FULCRUM AND CIRC- 
 LING ARM LEVERAGE (SITTING). 
 
 USE. For clavical depressed at sternum. 
 
 POSTURE. Patient sitting. Operator at back. 
 
 POSITION. Hsnd-one reaches over shoulder- 
 one beneath chin. Thumb grasping clavical from be- 
 neath. Hand-two grasps arm-two above elbow. 
 
 ACTION. Hand-two circles arm toward oper- 
 ator (top of circle) prying clavical over thumb-one 
 as a fulcrum. 
 
 NOTE. — Raising shoulder, girdle w r ill enable 
 thumb to grasp beneath clavical, if muscular tension 
 binds it down. 
 
 Lifting with thumb-one will lessen pain some- 
 what by keeping it off of first rib. 
 
 (CLAV. S.E.) 1. FINGER FULCRUM & CIRC- 
 LING ARM LEVERAGE (LYING). 
 
 USE. Less painful and more effective than the 
 preceding. 
 
 POSTURE. Patient lying, Operator at side, 
 iacing head. 
 
 POSITION. Three fingers of Hand-one grasp 
 nearest clavical from above. Hand-two grasps nearest 
 elbow. 
 
 ACTION. Hand-two lifts shoulder girdle and 
 circles arm toward head, as Hand-one lifts at clavicaL 
 
CLAYICLK 1 7 r 
 
 (CLAV.S.D.) 3. LATERAL TRACTION OF 
 
 SHOULDER GIRDLE WITH THENAR 
 
 EMINENCE AT LESION. 
 
 USE. For clavical prominent at sternal end. 
 
 POSTURE. Patient supine. Operator at side. 
 
 POSITION. Thenar eminence of Hand-one at 
 prominence of lesion. Hand-two grasps arm, holding 
 it out to side. 
 
 ACTION. Hand-two applies traction laterally, 
 endeavoring to separate shoulder girdle and clavical 
 from sternum, as Hand-one applies direct pressure at 
 prominence of lesion. 
 
 CLAV. THE CLAVICAL. 
 A. ACROMIAL END. 
 
 D. DIRECT TREATMENT. 
 
 (CLAV.A.D.) 1. ARM LEVERAGE WITH HAND 
 AT LESION. 
 
 USE. For slips, anterior or posterior. 
 
 NOTE. Compare with tip of corocoid process. 
 If too far posterior, the anterior fibres of deltoid may 
 catch on process during internal rotation and adduc- 
 tion. 
 
 POSTURE. Patient sitting or lying. 
 
 POSITION. Hand-one at sternal end of clav- 
 ical. Hand-two grasp arm near elbow. 
 
 ACTION. Hand-one aims to force clavical to nor- 
 mal, as hand two swings arm through normal move- 
 ments, as well as in opposition to pressure at lesion. 
 
172 FIRST AND SECOND RIBS 
 
 THE RIBS 
 
 R. THE RIBS. 
 
 U. THE UPPER DORSAL REGION. 
 D. DIRECT TREATMENT. 
 
 (R.U.D.) i. HEAD AND NECK LEVERAGE FOR 
 
 MUSCULAR TRACTION WITH FINGERS 
 
 AT HEAD OF RIB. (ILLUSTRATED). 
 
 USE. For first rib when displaced upward and 
 backward. 
 
 POSTURE. Patient sitting on table. Operator 
 at side away from lesion and back of patient. 
 
 POSITION. Hand-one reaches tinder arm one, 
 or nearest, and across patient's chest and over shoul- 
 der two grasping head or neck of first rib ; that is, 
 bringing pressure at a point one-half way between 
 vertical and horizontal and anterior and posterior as- 
 pects of neck and shoulder. Hand two- grasps head 
 above and toward lesion of crown. 
 
 ist. ACTION. Hand two carries head to op- 
 posite side to get muscular traction via scaleneii mus- 
 cles, as hand one holds down firmly at head of rib. 
 
 2nd. ACTION. Hand two circles head forward 
 and to opposite side (lesion side) to relax muscles 
 keeping muscular tension for the first 45 degrees or 
 8th of the circle. 
 
 3rd. ACTION. Hand one increases pressure at 
 head of rib to force it into position as hand two flexes 
 head to lesion side. 
 
 PRINCIPLE is that of muscular traction and di- 
 rect pressure at lesion. 
 
FIRST AND SECOND RIBS 1 73 
 
 (R.U.D.) 1. MODIFIED. 
 
 POSTURE. Patient lying on back. Operator at 
 side away from lesion. 
 
 POSITION and ACTION the same as (R.U.D.) 
 I just preceding, except that hand one does not reach 
 under patient's axilla. 
 
 (R.U.D.) 2. HEAD AND NECK LEVERAGE 
 FOR MUSCULAR TRACTION WITH THE- 
 NAR EMINENCE AND OPERATOR'S 
 WEIGHT AT LESION, 
 
 USE. For first rib when displaced upward and 
 backward. For second rib by using thumb instead of 
 thenar eminence of hand one. 
 
 POSTURE. Patient on low stool. Operator at 
 back standing on foot stool if necessary to raise oper- 
 ator six or eight inches. 
 
 POSITION. Thenar eminence of hand one or 
 thumb one on first rib near its head. Hand two on top 
 of head. 
 
 1st. ACTION. Hand two carries head to oppo- 
 site side for muscular traction as hand one holds down 
 firmly near head of rib. 
 
 2nd. ACTION. Hand two circles head forward 
 45 degrees and to opposite side (lesion side) to relax 
 muscles. 
 
 3rd. ACTION. Hand .one increases pressure 
 moving toward head of rib to force it into position 
 by direct pressure as hand two flexes head to lesion 
 side to relax muscles. 
 
 Note. Use extraordinary respiration with thumb 
 one at lesion in replacing second rib. 
 
174 FIRST AXD SECOND RIBS 
 
 (R.U.D.) 3. HEAD AND NECK LEVERAGE FOR 
 MUSCULAR TRACTION. 
 
 USE. For raising first and second ribs. 
 
 POSTURE. Patient sitting. Operator at back. 
 
 POSITION. Hand one at inferior border of rib- 
 Hand two at side of head toward lesion. 
 
 1st ACTIOX. Hand one lifts up on inferior 
 border, hand two forces head to opposite side. 
 
 2nd. ACTIOX. Hand two circles head one- 
 eighth of a circle backward or less. 
 
 1st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) * 
 
 2 
 
 USE 3 
 
 POSTURE Patient 4 
 
 Operator 5 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTIOX 10 
 
 11 
 
 12 
 
 PRINCIPLE 15 
 
 DEGREE 18 
 
 CAUTION 20 
 
 XOTE 22 
 
FIRST AND SECOND RIBS 175 
 
 R. THE RIBS. 
 
 I. INTER-SCAPULAR REGION. ANGLES. 
 E. EXTREME REMOVAL OF LESION. 
 
 (R.I.E.) i. REINFORCED SHOULDER LEVER- 
 
 AGE WITH OPERATOR'S KNEE AT 
 
 LESION— LYING. 
 
 USE. High as second or third rib. As an ex- 
 treme treatment for large or rigid patients. 
 
 POSTURE. Patient on side. Operator at 
 back. If patient is on ted or conch operator sits 
 at same level as patient. Operator's leg with knee 
 supporting lesion lies parallel with spine, its ankle 
 being supported on the other knee. 
 
 POSITION. Operator's hands clasped with fin- 
 gers interlocking grasp patient's upper elbow holding 
 it directly in front of patient. Operator's padded knee 
 (%-inch felt) at angle of rib. 
 
 ACTION. Hands pull on elbow, keeping arm 
 straight to force shoulder girdle backward, as knee 
 forces angle np or down as indicated by diagnosis. 
 
 CAUTION. Be positive in diagnosis in all di- 
 rect or extreme treatments, especially where pressure 
 is brought to bear with anything other than the 
 hands. 
 
 DEGREE. Robust patients have been given ioo 
 to 150 lbs. pressure without injury, but with benefit. 
 
176 INTERSCAPULAR RIBS — ANGLES 
 
 (R.I.E.) 2. CLASPED ARM AND SHOULDER 
 LEVERAGE FOR MUSCULAR TRAC- 
 TION WITH PRESSURE AT 
 ANGLES. (SWING). 
 
 Similar to vertebral and muscular treatment for 
 same region. 
 
 USE. Especially easy for vertebrae, muscles and 
 ribs as low as middle dorsal region. 
 
 POSTURE. Patient sitting- on cloth covered 
 stool or with knees braced to keep from sliding for- 
 ward and inclining forward at 45 degrees. Arms sup- 
 ported in swing between elbow and shoulder with 
 hands clasping forearms. Operator at side. 
 
 POSITION. Hand two reaches across crown or 
 back of patient's head and grasps elbow one or the 
 farth est. Thenar eminence or thumb of hand one 
 at lesion. 
 
 ACTION. Hand two swings the patient toward 
 operator as hand one brings pressure to bear at angle 
 of rib. 
 
 (R.I.E.) 3. ARM AND SHOULDER LEVERAGE 
 
 WITH REINFORCED ARM AT ANGLES. 
 
 (V) (A FLYING WEDGE TREATMENT). 
 
 USE. This is believed to be one of the most ef- 
 fective treatment for ribs whose angles lie in the inter- 
 scapular region. 
 
 POSTURE. Patient on side. Operator at back 
 facing head with foot one or farthest on low stool if 
 needed. 
 
 POSITION. Patient's elbow two, or the upper, 
 lies inside of elbow two of operator, and hand two 
 
INTERSCAPULAR RIBS— ANGLES 1 77 
 
 grasps wrist two of patient. Thenar eminence of hand 
 one at angle of rib with elbow one reinforced by knee 
 ^ne and foot one, and foot one on stool. 
 
 Note. Grasp patient firmly so that there will be 
 g"Ood contact, and no lost motion between operator 
 and lesion. 
 
 1st. ACTION. Arm two draws patient to 
 
 2nd. POSTURE. Or lying nearly supine with 
 •shoulder overhanging edge of table. 
 
 2nd. ACTION. Hand one applies pressure at 
 angle of rib from below upward. Hand one with its 
 reinforcements is also aided thus : The operator's foot 
 "is flexed to raise it and force leg and arm against the 
 lesion. This saves the operator's back and ribs pro- 
 vided trunk is kept straight. Or operator's knee is 
 :swung inward. 
 
 CAUTION. Do not allow patient's arm to be 
 <lrawn down parallel with side but keep it straight in 
 front so as to force shoulder directly in opposition to 
 pressure at lesion. 
 
 <R.I.£.) 3. MODIFIED. WITH ANTERIOR 
 MUSCULAR TRACTION. 
 
 The same as (R.I.E.) 3 just preceding except; 
 
 POSITION. Patient's upper arm is thrown 
 above head and held down by operator's head near 
 axilla. Hand two holds down shoulder one, or farth- 
 est. 
 
 CAUTION. Anterior dislocations of humerus 
 are possible in giving very extreme pressure. 
 
x 78 INTERSCAPULAR RIBS — ANGLES 
 
 (KEY TO SYMBOL CONSTRUCTION) 
 
 ist letter the Structure, 2d for Region, and 3d Class- 
 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2- 
 
 USE 3 
 
 ist POSTURE Patient 4. 
 
 Operator 5; 
 
 2d 6 
 
 ist POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9. 
 
 ACTION 10 
 
 Consecutively. Simultaneously. 
 
 1 or, a , 1 r 
 
 2 or, b 12 
 
 3 or, c 13 
 
 4 or, d 14 
 
 PRINCIPLE .acts as a ... class lever 15, 
 
 acts as a fulcrum with i6> 
 
 as the power and as the weight 17 
 
 DEGREE 18 
 
 19 
 
 CAUTION 20 
 
 ". 21 
 
 NOTE 22 
 
 23 
 
 • 24 
 
INTERSCAPULAR RIBS— ANGLES 1 79 
 
 (KEY TO SYMBOL CONSTRUCTION) 
 1st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) l 
 
 2 
 
 USE 3 
 
 1st POSTURE Patient 4 
 
 Operator . - 5 
 
 2d 6 
 
 1st POSITION Hand one 7 
 
 Hand two & 
 
 2d 9 
 
 ACTION ...-fc* 
 
 Consecutively. Simultaneously. 
 
 1 or, a if 
 
 2 or, c 12 
 
 3 or, d 1$ 
 
 4 or, b - 14 
 
 PRINCIPLE acts as a . . . class lever 15 
 
 acts as a fulcrum with 16 
 
 as the power and as the weight 17 
 
 DEGREE 18 
 
 *9 
 
 CAUTION 2© 
 
 21 
 
 NOTE 22 
 
 n 
 
 24 
 
ISO RIBS — TYPICAL 
 
 R. RI3 TREATMENT. 
 
 D. MID-DORSAL OR TYPICAL RIBS. 
 G. GENERAL TREATMENT. 
 
 (R.D.G.) i. ROCKING HAND AT ANGLES 
 
 WITH PATIENT'S WEIGHT AND CIRCLING 
 
 ARM LEVERAGE OPPOSING. 
 
 USE. As a mild treatment for bedfast patients, 
 may be given as a direct, or specific treatment. 
 
 POSTURE. Patient supine on table, bed or 
 <sotich. Operator at side. 
 
 POSITION. Fingers of hand one at angles of 
 Tibs, hands crossed with hand one beneath. Hand two 
 grasps patient's forearm. 
 
 ACTION. Hand one rocks on knuckles as a fui 
 cram or lifts ringer tips to force angles forward. Hand 
 two lifts and pulls nearest arm toward head of pa- 
 tient, and bears down in opposition to hand one. 
 
 PRINCIPLE is that of muscular traction by way 
 of the pectoral muscles and separation of articulations 
 at spine. 
 
 (R.D.G.) 2. ROCKING OR LIFTING, BOTH 
 
 HANDS AT ANGLES WITH PATIENT'S 
 
 WEIGHT OPPOSING. 
 
 POSTURE. Patient supine. Operator at side 
 facing head. 
 
 POSITION. Hands under patient from both 
 sides. Finger tips support angles of ribs. 
 
 ACTION. Rock or lift at angles. 
 
RIBS — TYPICAL I? I 
 
 (R.D.G.) 3. OPERATOR'S ARM LEVERAGE 
 
 WITH SHOULDER FULCRUM AND 
 
 PATIENT'S WEIGHT OPPOSING 
 
 USE. A mild treatment on table with little 
 strain on operator. Not easily adapted to bed. 
 
 POSTURE. Patient supine. Operator at head. 
 
 POSITION. Operators forearms over patient's 
 shoulders with hands supinated underneath patient, 
 finger tips supporting angles of ribs. 
 
 ACTION. Lift angles by prying over patient's 
 shoulders as a fulcrum together with lifting. 
 
 (R.D.G.) 4. ARM LEVERAGE FOR MUSCULAR 
 
 TRACTION WITH FINGERS AT ANGLES: 
 
 SITTING. 
 
 L T SE. For deepening a fiat or tubercular chest 
 by raising ribs that have too steep a slant or masses 
 of ribs that are dragged down or fallen. 
 
 POSTURE. Patient sitting on table or high 
 stool. Operator in front. 
 
 POSITION. Finger tips of hand one grasp an- 
 gles of ribs. Hand two grasps arm near shoulder. 
 
 ACTION. Hand one pulls angles of ribs away 
 from spine and forward. Hand two rotates patient's 
 arm upward and backward opposing hand one. 
 
 • (R.D.G.) 4. MODIFIED ARM LEVERAGE FOR 
 MUSCULAR TRACTION WITH FIN- 
 GERS AT ANGLES: LYING. 
 Posture. Patient on side. Operator in front. 
 POSITION and ACTION otherwise the same as 
 (R.D.G. 4) just preceding. 
 
tSz RIBS — TYPICAL 
 
 (R.D.G.) 5. ARM LEVERAGE WITH THUMB 
 OR THENAR EMINENCE AT ANGLES. 
 
 POSTURE. Patient sitting. Operator at back, 
 sitting or standing. 
 
 POSITION. Thumb or thenar eminence of hand 
 one at angles. Hand two at upper arm or shoulder. 
 
 ACTION. Hand one forces rib outward and for- 
 ward. Hand two rotates arm or shoulder or pulls 
 tliem in opposition to hand one. 
 
 (JR.D.G.) 6. ELBOW AND SHOULDER LEVER- 
 AGE WITH THENAR EMINENCE AT 
 ANGLES AND OPERATOR'S WEIGHT 
 AIDING. 
 
 USE. Easy on operator and effective as a gen- 
 eral, or specific treatment. 
 
 POSTURE. Patient prone. Operator at side 
 lacing foot of table. 
 
 1st. POSITION. Operator's hand two grasps 
 patient's elbow one, or farthest, and operator's 
 elbow two under patient's shoulder one. Hand one, 
 or thenar eminence at angle of rib. 
 
 1st. ACTION. Elbow two lifts patient's shoul- 
 ders to 
 
 2nd. POSITION. Inclining trunk toward oper- 
 ator. 
 
 2nd. ACTION. Hand-one presses downward 
 at angles with operator's weight aiding. Hand two 
 apposes or lifts at shoulder girdle. 
 
 PRINCIPLE. Anterior muscular traction by 
 way of shoulder girdle with separation of the spinal 
 articulation. 
 
RIBS — TYPICAL 183 
 
 <R.D.G.) 6. MODIFIED: FOR LOW TABLE. 
 The same as (R.D.G.) 6 just preceding, except: 
 
 POSITION. Operator's hand two grasps pa- 
 tient's shoulder or arm high up. Hand two at angles 
 -as above. 
 
 ACTION. Hand one brings pressure at angles. 
 Hand two opposes at shoulder. 
 
 PRINCIPLE. The same as (R.D.G.) 6 just pre- 
 ceding. 
 
 (R.D.G.) 7. ARM AND HIP LEVERAGE WITH 
 KNEE AT ANGLES AND PATIENT'S 
 WEIGHT AIDING. 
 
 L^SE. For patients not too supple. Easy on op- 
 erator. 
 
 1st. POSTURE. Patient on side. Operator at 
 back. 
 
 POSITION. Operator's elbow one or the one 
 nearest head of table lies inside the patient's upper 
 -elbow, or elbow two. Operator's hand one grasping 
 patients' hand two. Operator's hand two grasps crest 
 -of illium or anterior superior spine. Operator's knee 
 on table so that internal condyle brings pressure at 
 -angles of ribs as : 
 
 1st. ACTION. Hands rock patient backward 
 toward operator to 
 
 2nd. POSTURE. Patient's trunk inclined to 
 •about thirty degrees from side to side, so as to bow 
 trunk over knee as a fulcrum. 
 
 2nd. ACTION. Break patient across knee, and 
 slso raise knee by prying operator's leg over edge of 
 table as a fulcrum. 
 
1 84 RIBS — TYPICAL 
 
 (R.D.G.) 7. MODIFIED, OR ARM LEVERAGE 
 
 WITH KNEE AT ANGLES AND PATIENT'S 
 
 WEIGHT REINFORCED. 
 
 USE. For upper ribs, or inter scapular region; 
 also. 
 
 POSTURE. Patient supine. Operator at side*. 
 near head. 
 
 POSITION. Similar to (R.D.G. 7) just preced- 
 ing, except : Hand one changes to grasp arm two, or 
 upper arm. Hand two changes to farther shoulder. 
 
 ACTION. Hand two holds shoulder down, 
 Hand one uses arm and shoulder as leverage to bring 
 pressure of knee at angles of ribs as in (R.D.G. 7) 
 just preceding. 
 
 (R.D.G.) 8. LOWERING STERNAL END BY 
 FORCED EXHALATIONS WITH OPER- 
 ATOR'S WEIGHT AIDING. 
 
 USE. For barrel shaped, or asmatic chest, bulg- 
 
 olus. 
 
 ing cartilages or articulation of manubrium and gladi 
 
 POSTURE. Patient supine. Operator at head. 
 
 1st. POSITION. Patient's elbows pointing 
 toward operator. Operator's hands grasping patient's 
 
 elbows. 
 
 ACTION. 1st. Patient inhale as operator ap- 
 plies traction ; to exaggerate. 
 
 2nd. Patient exhales as operator throws elbows- 
 over chest, and presses patient's arms to force ribs. 
 down or take 
 
RIBS — TYPICAL I 85 
 
 2nd. POSITION. Operator loosens hold at el- 
 bows and presses ribs or protrusion with direct pres- 
 sure of hands during exhalation. 
 
 DEGREE. Operator may force the breath pretty 
 well out of patient so that they gasp to a reasonable 
 extent. Given not oftener than once in one or two 
 weeks. 
 
 Note. Bulging cartilages have been reduced 
 where it required weeks for soreness to disappear, but 
 chronic symptoms disappeared also. 
 
 1st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) '■-''■. 1 
 
 2 
 
 USE 3 
 
 1st POSTURE Patient 4 
 
 Operator 5 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 • 11 
 
 12 
 
 PRINCIPLE 15 
 
 DEGREE 18 
 
 CAUTION 20 
 
 NOTE '. 22 
 
1 86 RIBS — TYPICAL 
 
 (KEY TO SYMBOL CONSTRUCTION) 
 i st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE ,..'., 3 
 
 POSTURE Patient 4 
 
 Operator 5 
 
 2d 6 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d ; 9 
 
 ACTION 10 
 
 Consecutively. Simultaneously. 
 11 
 
 2 or, b 12 
 
 3 or > c • 13 
 
 4 . . or, d 14 
 
 PRINCIPLE 15 
 
 acts as a fulcrum with 16 
 
 as the power and as the weight Vj 
 
 DEGREE • 18 
 
 19 
 
 CAUTION 20 
 
 21 
 
 NOTE 22 
 
 23 
 
 24 
 
RIBS —TYPICAL 187 
 
 R. THE RIBS. 
 D. MID-DORSAL, OR TYPICAL RIBS. 
 I. INDIRECT TREATMENT. 
 
 (R.D.I.) 1. HIP AND SHOULDER LEVERAGE 
 FOR TRUNK ROTATION AND REPLACE- 
 MENT BY MUSCULAR TRACTION. 
 
 USE. For the typical and lower ribs, intercostal 
 muscles and quadratus lumborum. 
 
 POSTURE. Patient on side. Operator at side 
 facing patient. 
 
 POSITION. Hand one on crest of illium. Hand 
 two grasps patients' arm. 
 
 ACTION. 1st. Patient allows hip to rook back- 
 ward. 
 
 2nd. Operator applies traction at right angles to 
 ribs. 
 
 (R.D.I.) 1. MODIFIED: WINDLASS PRINCIPLE 
 
 POSTURE. Patient on side. Operator in front 
 with side to patient, facing foot. Patient's hip inclining 
 forward. 
 
 POSITION. Operator's forearm one lies back of 
 operator's waist or hip with palm outward, and with 
 hand one of the same hand, grasping patient's arm 
 above elbow. Operator's hand two on crest of illium. 
 Place operator's great trochanter or shaft of femur in 
 patient's axilla. ^ 
 
1 88 RIBS — TYPICAL 
 
 ACTION. Same as (R.D.I.) i just ' pre cediag* 
 except operator rotates his own body from head eE 
 table so as to wind patient's arm around, or separate 
 shoulder girdle from hips, as if on a windlass wMfc 
 opposing with hand two at illium. 
 
 Note. To make it less painful at axilla or pec- 
 toral muscle, get great trochanter well up into psr 
 tient's axilla and rotate and brace back from hips as 
 above. 
 
 ist letter the Structure, 26. for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 
 
 USE — 1 
 
 POSTURE Patient 4 
 
 Operator % 
 
 ist POSITION Hand one 7 
 
 Hand two « - S 
 
 2d « - $ 
 
 ACTION » 
 
 .-1:2 
 
 PRINCIPLE .-15 
 
 DEGREE tl 
 
 CAUTION "..--2* 
 
 NOTE -.zi 
 
RIBS — TYPICAL 1 89 
 
 R. THE RIBS. 
 
 D. MID-DORSAL, OR TYPICAL RIBS. 
 D. DIRECT REMOVAL OF LESION. 
 
 PLDJX) r. ARM AND SHOULDER LEVERAGE 
 WITH THUMB AT LESION. 
 
 POSTURE. Patient sitting. Operator in front 
 and to side away from lesion. 
 
 POSITION. Hand one passes back of body of 
 patient, thumb one reaching angles of ribs of opposite 
 side, Hand two grasps arm one, on lesion side. 
 
 ACTION. Hand two rotates arm backward 
 toward head as thumb one brings pressure on angles 
 forcing them away from spine both laterally and an- 
 teriorly. 
 
 (R.D.D.) 2. COMBINED ANGLE AND STERNAL 
 
 PRESSURE FOR ADJUSTMENT DURING 
 
 DEEP RESPIRATION. 
 
 USE. For raising or lowering either end of ribs. 
 As a specific treatment. 
 
 POSTURE. Patient on side. Operator at back, 
 43r prone with operator at side. 
 
 POSITION. Hand one at angle of rib, and hand 
 two at sternal end. 
 
 ACTION (A) If upper border is prominent and 
 anterior end up: 
 
 1st. Have patient inhale. 
 
 2nd. Exhale as pressure is applied carrying an- 
 terior end down and angle up. 
 
I 90 RIBS — TYPICAL 
 
 (B) If lower border is prominent and anterior 
 end down: 
 
 ist. Apply pressure upward at sternal end and 
 nward, or to war 
 or normal breathing 1 . 
 
 downward, or toward foot, at angle during inhalation 
 
 l &- 
 
 Note. Better results are sometimes gotten by 
 first exaggerating the lesion or throwing it still far- 
 ther from the normal position. 
 
 (R.D.D.) 2. MODIFIED: FOR SITTING POST- 
 URE. 
 
 POSTURE. Patient sitting on table or high 
 stool. Operator in front and to same side as lesion. 
 
 POSITION. Hand one at angle of ribs. Hand 
 two at anterior end. 
 
 ACTION. (A) When lower border is promi- 
 nent, and sternal end is lowered. 
 
 (a) Aim to swing or rotate patient's body back 
 and to opposite side from lesion, operator's chin and 
 head aiding, and (b) apply pressure while this side of 
 thorax is convex. 
 
 (B) When upper border is prominent, and ster- 
 nal end up: 
 
 (a) Swing body forward and to opposite side. 
 
 (b) Force to normal side during exhalation. 
 
RIBS — TYPICAL 191 
 
 (R.D.D.) 3. ARM LEVERAGE FOR LATERAL 
 
 PECTORAL TRACTION WITH DIRECT 
 
 PRESSURE AT LESION. 
 
 USE. For cartilages or sternal ends of ribs if 
 bulged. 
 
 POSTURE. Patient supine. Operator at side 
 facing head. 
 
 POSITION. Thenar eminence of hand one, or 
 
 the nearest, on lesion. Hand two grasps nearest arm. 
 above elbow as arm lies horizontal and directly away 
 from patient's body. 
 
 JTIOX. Hand one applies direct pressure at 
 protrusion, and hand two applies lateral traction. 
 
 PRINCIPLE is that of traction by way of the 
 pectoral muscles. 
 
 (R.D.D.) 4. SHOULDER LEVERAGE WITH 
 PRESSURE AT ANGLES AND ANTERIOR 
 MUSCULAR TRACTION WITH PA- 
 TIENT'S WEIGHT ADDING (SWING), 
 
 USE. As a general treatment preparatory to 
 specific work. For adjusting single slips or raising 
 groups of ribs either slipped, lapped' or drifted down- 
 ward enmasse from the third rib down. 
 
 POSTURE. Patient standing or kneeling on 
 pad with arms supported in swing at axillae. Operator 
 at back. Straps of swing crossed. 
 
 POSITION. Thenar eminence of hand one a 7 ., 
 angle or neck of rib. Hand two grasping shoulder 
 one, or opposite, from above. 
 
I92 RIBS — TYPICAL 
 
 PRINCIPLE. The crossed straps increase the 
 vertical traction on shoulder girdle, thus lifting the 
 anterior ends of ribs as a first-class lever, suspending 
 them by the pectorals, serratus magnus, intercostals, 
 etc. Pressure at neck or angle acts as a third-class 
 lever disengaging vertebral end or forces from lodg- 
 ment between transverse processes. 
 
 POSITION. Operator's thenar eminence of 
 hand one at angle of rib. Operator's elbow one may be 
 reinforced by operator's innominate. Hand two 
 grasps shoulder. 
 
 ACTION. Carry patient diagonally forward 
 toward lesion side with hand one. Retard or oppose 
 with hand two at shoulder. 
 
 NOTE. If swing is suspended from one hook 
 raise or shorten lesion side of swing. If swing is sup- 
 ported from two hooks straps may be spread or 
 crossed at different angles by separating hooks at 
 ceiling to get increased traction on lesion side or may 
 be shortened on lesion side as above mentioned. 
 
 DEGREE. Pressure may be varied according 
 to slack in swing at beginning of- treatment. The more 
 tense the straps the easier patient will swing from 
 floor. The treatment is more effective if swing is 
 low enough so that patient's feet drag across floor. 
 
 CAUTION. Don't allow patient to voluntarily 
 lift feet from floor. 
 
RIBS — TYPICAL I93 
 
 (R.D.D.) 5. STERNAL END LEVERAGE WITH 
 KNEE AT ANGLES AND ANTERIOR MUS- 
 CULAR TRACTION. 
 
 POSTURE. Patient sitting on stool. Operator 
 at back, sitting or standing. 
 
 POSITION. Hand one reaches around patient 
 grasping sternal end of rib. Padded knee (^g-inch 
 felt) at angle. Hand two grasps arm at or above 
 elbow. 
 
 ACTION. 1st. Patient inhales as operator 
 raises elbow above patient's head. 
 
 2nd. Patient exhales as operator applies pres- 
 sure at each end of rib, forcing them toward normal. 
 
 PRINCIPLE. Pressure at ends of the rib is ap- 
 plied on the see saw principle, one end being raised 
 and the other lowered with muscular traction aiding. 
 
iu4 
 
 RIBS — TYPICAL 
 
RCBS — TYPICAL 195 
 
 (R.D.D.) 6. .ANGLE PRESSURE WITH SHOUL- 
 DER LEVERAGE OPPOSING. 
 
 POSTURE. Patient on side. Operator in front. 
 
 POSITION. Thenar or hypothenar eminence 
 of hand one at shaft or angle of prominent rib. Hand 
 two grasps arm near shoulder girdle or elbow holding 
 it in front of patient and pointing directly forward 
 so that pressure will force shoulder backward. 
 
 ACTIOX. Hand one applies forcible pressure as 
 hand two opposes, or forces shoulder backward in op- 
 position. 
 
196 RIBS — TYPICAL 
 
 (KEY TO SYMBOL CONSTRUCTION) 
 1st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) • 1 
 
 2 
 
 USE 3 
 
 1st POSTURE Patient 4 
 
 Operator 5 
 
 2d 6 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTIOX 10 
 
 Consecutively. Simultaneously. 
 
 1 or, a 11 
 
 2 or, b 12 
 
 3 or - c x 3 
 
 4 or, d 14 
 
 PRINCIPLE acts as a ... class lever 15 
 
 . acts as a fulcrum with 16 
 
 as the power and as the weight 17 
 
 DEGREE 18 
 
 • 19 
 
 CAUTION 20 
 
 21 
 
 NOTE .22 
 
 23 
 
 24 
 
RI3S— TYPICAL 1 97 
 
 (KEY TO SYMBOL CONSTRUCTION) 
 ist letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE 3 
 
 ist POSTURE Patient 4 
 
 Operator 5 
 
 2d 6 
 
 ist POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 Consecutively. Simultaneously. 
 
 1 or, a 11 
 
 2 or, b 12 
 
 3 or, c 13 
 
 4 or, d 14 
 
 PRINCIPLE acts as a ... class lever 15 
 
 acts as a fulcrum with 16 
 
 as the power and as the weight 17 
 
 DEGREE 18 
 
 • 19 
 
 CAUTION .20 
 
 21 
 
 NOTE 22 
 
 2 3 
 
 24 
 
I9§ RIBS — TYPICAL 
 
 R. THE RIBS. 
 
 D. MID-DORSAL OR TYPICAL RIBS. 
 
 E. EXTREME REMOVAL OF LESION. 
 
 (R.D.E.) 1. BOTH SHOULDERS FOR UPPER 
 
 TRUNK LEVERAGE WITH KNEE AT 
 
 LESION. 
 
 USE. Only for very large or rigid patients. 
 
 . POSTURE. Patient sitting on stool. Operator 
 sitting on table at back. 
 
 . POSITION. Operator's knee padded (^-inch 
 felt) at angle of prominent rib or rib showing evidence 
 of lesion. Hand one on shoulder of same side. Hand 
 two on opposite shoulder. 
 
 ACTION. Hands pry patient backward with 
 lesion against knee as a fulcrum, forcing rib upward 
 or downward as indicated by diagnosis. 
 
 (R.D.E.) 2. SWINGING LIMB AND PELVIC 
 
 LEVERAGE WITH OPERATOR'S WEIGHT 
 
 AT ANGLES, FORCING ROTATION. 
 
 (SWING). 
 
 USE. From sixth rib down. 
 
 POSTURE. Patient on face, lower limbs in 
 swing, supported, above patella. Lesion side has knee 
 raised 5 to 8 inches higher than the other knee with 
 swing well up toward hip to keep that side of pelvis 
 from table. Operator at opposite side of table. 
 
 POSITION. Heel or thenar eminence of hand 
 one at angles of ribs. Hand two grasps farther limb 
 or swing just above it. 
 
RIBS — TYPICAL 1 99 
 
 ACTION. Hand one applies pressure as hand two 
 swings patient toward operator. 
 
 PRINCIPLE. Is that of lateral and longitudinal 
 traction. * . 
 
 <R.D.E.) 3. SHOULDER AND TRUNK LEVER- 
 AGE WITH REINFORCED ARM AT 
 ANGLES (A FLYING WEDGE 
 TREATMENT). 
 
 USE. For heavy or rigid patients if vertebral 
 end of rib is lowered. Used as high as* fifth or sixth 
 ribs. 
 
 POSTURE. Patient on stool with knees against 
 wall. Operator at back facing lesion side. 
 
 POSITION. Thenar eminence of hand one at 
 angle of rib reinforced by elbow, knee and foot. Foot 
 on low stool if necessary. Hand two grasps patient's 
 elbow one, or the farthest. Operator's axilla two 
 grasps shoulder one or shoulder two preferred. 
 
 ACTION. Hand two carries trunk backward 
 holding elbow so as to point forward from patient. 
 Hand one and its reinforcements apply pressure be- 
 tween angle and tubercle. 
 
 PRINCIPLE is that of putting the ligaments of 
 the articulations on the stretch and suddenly increase 
 pressure to spring rib back to normal. 
 
 <R.D.E.) 4. ARM AND SHOULDER LEVERAGE 
 WITH PRESSURE AT ANGLES AND MUS- 
 CULAR TRACTION WITH PATIENT'S 
 WEIGHT AIDING (SWING). 
 
2O0 RIBS — TYPICAL 
 
 USE. From third rib down, especially for pa- 
 tients taller than operator. Where extreme muscular 
 traction is desired. 
 
 Similar to (R.D.D. 4) the seventh preceding. 
 
 POSTURE. Patient kneeling on pad on floor. 
 Arms elapsed above head, and supported in swing at 
 cubital fossae. Operator at back, and away from 
 lesion side. 
 
 (R.D.E.) 4. MODIFIED: SUPINE (ASSISTANT). 
 
 Similar to (R. D. E.) 4 just preceding, except: 
 
 POSTURE. Patient supine ; assistant at head 
 applying traction on arm. Operator at side. 
 
 ACTION. Motion of body is limited, but pres- 
 sure at lesion is increased, that is in comparison to 
 (R.D.E. 4) just preceding. 
 
 (R.D.E.) 4. MODIFIED. ON SIDE (ASSIST- 
 ANT). 
 
 Similar to (R.D.E. 4) and (R.D.E. 4 modified), 
 just preceding, except : 
 
 POSTURE. Patient on side with lesion up; 
 assistant at head applying traction on arm. Operator 
 in front or back. 
 
 POSITION and ACTION the same. 
 
 NOTE. In the last two one of operator's hands 
 may apply pressure at angles, and the other at sternal 
 end. In direction indicated. 
 
RIBS — TYPICAL 20 1 
 
 (KEY TO SYMBOL CONSTRUCTION) 
 1 st letter the Structure, 26. for Region, and 3d Class. 
 SYMBOL, MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE 3 
 
 i-st POSTURE Patient 4 
 
 Operator 5 
 
 2d 6 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 Consecutively. Simultaneously. 
 
 1 or, a 11 
 
 2 or, b 12 
 
 3 or, c 13 
 
 4 or, d 14 
 
 PRINCIPLE acts as a ... class lever 15 
 
 acts as a fulcrum with 16 
 
 as the power and as the weight 17 
 
 DEGREE 18 
 
 :•-••• 19 
 
 CAUTION 20 
 
 21 
 
 NOTE 22 
 
 23 
 
 24 
 
202 ELEVENTH AND TWELFTH RIBS 
 
 R. THE RIBS. 
 
 L. THE LOWER OR FLOATING RIBS. 
 
 D. DIRECT TREATMENT. 
 (R.L.D.) i. ANTERIOR END AND CRANK 
 LEVERAGE WITH RESPIRATION. 
 
 POSTURE. Patient on side. Operator at side 
 of table in front or back. 
 
 POSITION. Fingers or thumb of hand one at 
 middle of rib or slightly toward spine. Hand two at 
 anterior end. 
 
 PRINCIPLE. Consider these ribs as shaped like 
 a new moon and moving as a bit brace, that is con- 
 sisting of a middle and two extremities which rotate 
 on their longitudinal axis. The head remains station- 
 ary as a rule ; the middle and anterior end being mov- 
 able are used as levers to rotate them to normal posi- 
 tion. 
 
 ACTION. Hand one carries rib upward or. 
 downward toward normal as hand two carries ante- 
 rior end in opposite direction during respiration. 
 (R.L.D.) 2. ANTERIOR END AND CRANK 
 
 LEVERAGE WITH MUSCULAR TRAC- 
 TION ABOVE LESION. 
 
 USE. To lower middle and raise tips of nth and 
 
 12th ribs. 
 
 POSTURE, patient on side. Operator m 
 trum. 
 
 POSITION. Index finger of hand one at sternal 
 
 end of rib and thumb at middle of upper border. Hand 
 two grasps arm of same side. 
 
 ACTION. Thumb and finger force rib to normal 
 as hand two draws arm upward or toward patient's 
 head. 
 
ELEVENTH AND TWELFTH RIBS 203 
 
 (R.L.D.) 3. DIRECT PRESSURE WITH MUS- 
 CULAR TRACTION BY WAY OF HIP 
 LEVERAGE. 
 
 USE. To raise nth and 12th ribs, or sometimes 
 given following muscular stretching of this region. 
 
 POSTURE. Patient on side. Operator at back 
 and toward foot. 
 
 POSITION. Carpal or metacarpal bones of 
 thumb one at middle of rib. Hand two at anterior 
 superior spine or crest of illium. 
 
 ACTION. Hand one forces rib up and at right 
 angles to their direction as hand two opposes at 
 illium. 
 
 1st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 (..-.:.) 1 
 
 2 
 
 USE ...3 
 
 POSTURE Patient 4 
 
 Operator 5 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 n 
 
 12 
 
 PRINCIPLE 15 
 
 DEGREE 18 
 
204 VISCERAL TREATMENT — CLASSIFIED 
 
 THE VISCERA 
 
 In the direct treatment of the viscera if we ad- 
 here to strictly Osteopathic principles, which we 
 should, we are to avoid gouging. and punching the 
 abdomen as Dr. Still puts it, but on the other hand 
 as he traces some diseases to the misplacement of vis- 
 cera and recommends their adjustment we may per- 
 haps resort to the following CLASSES OF TREAT- 
 MENT : 
 
 First for the REPLACEMENT OF ORGANS; 
 second, for the REMOVAL OF ABNORMAL AC- 
 CUMULATION OF THEIR CONTENTS, and 
 third the LIFTING OF NEW GROWTHS. 
 
 In replacing viscera and lifting new growths our 
 work is simply to combat the force of gravity or its 
 eftects, as a rule. For this reason we will find our 
 work limited to the lower two regions, or the pelvic 
 and abdominal cavities. Nature having protected the 
 other cavities from surgical and Osteopathic invasion 
 by the bony walls. Often the lifting of viscera or 
 tumors will only be necessary after the physiological 
 periods of congestion. Though in others it may be 
 after being on feet for some time, or after sudden 
 jolts, or jarring, or if patient is in a much weakened 
 condition. 
 
 The Emptying of Viscera may be indicated if there 
 is an abnormal density of the contents causing ob- 
 struction to the normal flow through the same. For 
 example; biliary calculi or channeled impaction. 
 
VISCERAL TREATMENT — CLASSIFIED 205 
 
 There may be conditions where emptying fluid con- 
 tents in the stomach are indicated as man might eas- 
 ily take something which nature never intended to 
 be there. 
 
 But " as to such organs as the liver and spleen 
 God has provided them with a rythm that a normal 
 nerve and blood supply will regulate. 
 
 (KEY TO SYMBOL CONSTRUCTION) 
 1 st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 (....) 1 
 
 ." 2 
 
 USE 3 
 
 POSTURE Patient 4 
 
 Operator 5 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 1 . or, a 11 
 
 12 
 
 PRINCIPLE acts as a ... class lever 15 
 
 DEGREE 18 
 
 CAUTION 20 
 
 NOTE 22 
 
206 GENU-PECTORAL POSTURE 
 
 The GENU-PECTORAL, OR KNEE CHEST 
 POSTURE is taken as follows: 
 
 Patient on table, bed or couch. 
 
 ist. Have patient get on knees. 
 
 2nd. Lower shoulder until they rest on tables 
 and far enough from knee so that thighs remain per- 
 pendicular. Or: 
 
 ist. Have patient lie on face, or prone. 
 
 2nd. Raise hips so that thighs will be perpendic- 
 ular. 
 
 Observe the Following Points: 
 
 i. Patient's hands must be underneath chest 
 with elbows far out to side. 
 
 2. Head turned to one side. The body will then 
 incline from hips to shoulders with the steepest slant 
 possible. 
 
 3. The body is then relaxed so as to sag and re- 
 lax the abdominal muscles. 
 
 4. Have slack in clothing over abdomen. 
 
 PRINCIPLE. The uterus hangs as a pendulum 
 normally when in this posture, unless held by ad- 
 hesions, bony prominences, new growths or impac- 
 tions. Other abdominal viscera tend to replace them- 
 selves with the aid of gravity. 
 
REPLACING CAECUM 207 
 
 R. REPLACING. 
 V. THE VISCERA. 
 
 Cae. THE CAECUM. 
 (R.V.Cae.) 
 
 POSTURE. Patient on back, knees flexed. 
 Operator at right of patient. 
 
 POSITION. Operator's fingers of both hands 
 meet at right angles, forming a kind of a hoe with 
 which to draw the caecum up and out of the pelvis 
 into the illiac fossae. 
 
 NOTE. Remember that as the colon descends 
 it glides into pelvis, like the drawing together of the 
 heels of a horseshoe. 
 
 ACTION. Force fingers well downward and aim 
 to rake or manipulate the caecum back to normal. 
 
 CAUTION. Beware of abscess formation or too 
 rough digging in with finger tips. Also see 
 (R.V.Tr.Col.) following, or Transverse Colon. 
 
 1st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE 3 
 
 POSTURE Patient 4 
 
 Operator 5 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 11 
 
 12 
 
 PRINCIPLE 15 
 
 DEGREE 18 
 
208 REPLACING VISCERA 
 
 R. REPLACING. 
 V. THE VISCERA. 
 Sig. THE SIGMOID. 
 
 (R.V.Sig.) (See R.V.Tr.Col.) 
 
 Treatment the same as (R.V.Cae.) just preceding, 
 except on opposite side. Also work sigmoid upward 
 toward right. 
 
 R.V.Tr.Col. 
 
 THE TRANSVERSE COLON. 
 
 POSTURE. The genu-pectoral, or knee chest. 
 
 POSITION. Operator stands at side, facing 
 feet, both hands at patient's abdomen, reaching 
 around patient from each side. Finger tips meet, and 
 index fingers, reinforced by the rest of the hand, aim 
 to rake or manipulate bowel into position. 
 
 ACTION. Operator endeavors to lift or force it 
 to normal position with the aid of gravity. 
 
 NOTE. The rest of colon may be lifted to nor- 
 mal by same treatment, or with only one hand at 
 caecum or sigmoid. In fact, this is the best way of 
 raising them or the bowel as a whole if patient is able 
 to take this posture. 
 
 R.V.Kid. KIDNEY. 
 
 POSTURE. Patient sits. Operator at side or 
 back. 
 
 POSITION. A floating kidney is perhaps best 
 palpitated in thin subjects by grasping back and front 
 with one hand in or below region where it is normally 
 found. 
 
REPLACING VISCERA 2O9 
 
 ACTION. A deep breath or a cough will aid you 
 to find it or perhaps cause it to slip through your 
 hands. 
 
 SECOND POSTURE. This same maneuver in 
 the genu-pectoral or knee chest posture may aid in 
 replacing, though absence of fat and strength of sup- 
 ports may fail to anchor it for some time. 
 
 NOTE : This replacement of organs is, of course, 
 secondary in a great majority of cases. The supports 
 must be strengthened by releasing the blood and nerve 
 force supplying the part. 
 
 1st letter the Structure, 26. for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE 3 
 
 POSTURE Patient 4 
 
 Operator 5 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 11 
 
 12 
 
 PRINCIPLE 15 
 
 DEGREE 18 
 
 CAUTION 20 
 
 NOTE 22 
 
2IO REPLACING VISCERA 
 
 R. REPLACING. 
 V. THE VISCERA. 
 
 U. RETRO-UTERUS IN RETRO-DIS- 
 PLACEMENTS. 
 
 R.V.U. Retro. 
 
 USE. For treatment externally without ex- 
 posure. 
 
 POSTURE. The genu-pectoral, or knee chest. 
 Operator at side, facing foot of table. 
 
 POSTURE. Hands or finger tips reach around 
 patient's body, meeting beneath, with index fingers re- 
 inforced by rest of hand reach well under crest of 
 pubis. 
 
 ACTION. First. Aim to carry uterus up out 
 of true pelvis. 
 
 ACTION. Second. Jar pelvis from side to side. 
 
 ACTION. Third. Repeat action one. 
 
 ACTION. Fourth. Then repeat action two. 
 
 CAUTION. Don't pound against it, but get 
 firmly against hips, so that there is no lost motion. 
 
 NOTE: A rubber tube inserted into vagina by 
 patient may aid without exposure by admitting air or 
 ballooning, or operator, by spreading buttox or in- 
 serting finger, may admit air. Inspiration followed 
 by deep expiration will aid. 
 
 Third. Lie on side at finish. 
 
 NOTE: In knee chest posture the uterus hangs 
 as a pendulum and the force of gravity aids. By lying 
 on the side after the knee chest posture, the intestines 
 seek the lowest level first and thus help support the 
 uterus. 
 
REPLACING VISCERA 211 
 
 (KEY TO SYMBOL CONSTRUCTION) 
 ist letter the Structure, 2d for Region, and 3d Class. 
 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE 3 
 
 ist POSTURE Patient . 4 
 
 Operator 5 
 
 2d 6 
 
 ist POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 Consecutively. Simultaneously. 
 
 1 or, a " 11 
 
 2 or, b 12 
 
 3 or, c 13 
 
 4 • • or, d i 4 
 
 PRINCIPLE acts as a ... class lever 15 
 
 acts as a fulcrum with 16 
 
 as the power and as the weight iy 
 
 DEGREE 18 
 
 •••• •••19 
 
 CAUTION 20 
 
 21 
 
 NOTE 22 
 
 23 
 
 - 24 
 
212 REPLACING VISCERA 
 
 R.V.Ova. REPLACING VISCERA, the OVARIES. 
 
 PRINCIPLE. Ovaries are replaced and con- 
 gestion and inflammation reduced via broad ligaments 
 and uterine replacements. 
 
 R. REPLACING. 
 V. THE VISCERA. 
 
 U.Ant. UTERUS in ANTERIOR DISPLACE- 
 MENTS. 
 
 R.V.U.Ant. i. ABDOMINAL MANIPULATION 
 WITH GRAVITY AIDING. 
 
 POSTURE. Patient on back. Hips raised on 
 thick pillows. Feet on low stool. Knees and thighs 
 ^exed. Operator facing feet. 
 
 ACTION. Hands aim to rake uterus from under 
 pubis. 
 
 NOTE: In most cases symptoms guide to diag- 
 nosis, and a great deal of examining and local treat- 
 ment may be dispensed with. 
 
REPLACING VISCERA 213 
 
 (R.V.U.) ANT. 2. REPLACING UTERUS IN 
 ANTEVERSION. 
 
 ABDOMINAL MANIPULATION AND PELVIC 
 
 JARRING WITH GRAVITY AIDING. 
 
 (SWING.) 
 
 FIRST POSTURE. Patient on back. 
 
 SECOND POSTURE. As patient raises hips 
 operator places a stool about 8 inches high underneath 
 them. 
 
 THIRD POSTURE. Hook patient's knees over 
 hooks of sv/ing, having them well up. 
 
 FOURTH POSTURE. Remove stool, leaving 
 patient's hips suspended. 
 
 FIFTH POSTURE. Slide patient toward swing 
 a little to flex knees and relax abdomen. Operator 
 facing foot of table. 
 
 FIRST POSITION. Finger tips meet, with 
 little fingers resting on abdomen aboye pubis. 
 
 ACTION. First. Rake uterus from pubis. Sec- 
 ond. Jar pelvis. Third. Repeat first action. Fourth. 
 Jar pelvis again. 
 
 SECOND POSITION (previous to action sec- 
 ond) is with operator's hands firmly against pelvis, 
 operator facing head. 
 
 NOTE: TO GET PATIENT LOWERED TO 
 TABLE: First. Put stool under hips. Second. 
 Take down knees. Third. Remove stool, or just the 
 reverse of suspending patient. 
 
 Burrows Gynecological Sling accomplishes about 
 the same result, except limbs are not flexed at knees. 
 
214 REPLACING VISCERA 
 
 (KEY TO SYMBOL CONSTRUCTION) 
 ist letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE 3 
 
 ist POSTURE Patient 4 
 
 Operator 5 
 
 2d 6 
 
 ist POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 Consecutively. Simultaneously. 
 
 1 or, a XI 
 
 2 or, c 12 
 
 3 or, d 13 
 
 4 or, b 14 
 
 PRINCIPLE acts as a ... class fever 15 
 
 acts as a fulcrum with 16 
 
 as the power and as the weight 17 
 
 DEGREE 18 
 
 ■ 19 
 
 CAUTION 20 
 
 21 
 
 NOTE 22 
 
 23 
 
 24 
 
EMPTYING VISCERA 215 
 
 E. EMPTYING. 
 
 V. THE VISCERA. 
 Kid. THE KIDNEY. 
 
 (E.V.Kid.) DIRECT PRESSURE FOR SEPARA- 
 TION AND DRAINING. 
 
 XOTE : As the kidneys are sometimes approxi- 
 mated in relation to the spinal column and each other 
 the upper portion of the ureters may become com- 
 pressed and the drainage interfered with. 
 
 POSTURE. Patient supine, with knees flexed. 
 Operator at side. 
 
 POSITION. Hand one over kidney, near me- 
 dian line. Hand two reinforces it. 
 
 ACTION. Aim to force each kidney backward 
 and away from median line. 
 
 PRINCIPLE. The spinal column acting as a 
 wedge between the pair of kidneys, or as an inclined 
 plane with each. 
 
 E.V. Stom. THE STOMACH. 
 
 USE. Masses of undigested or irritating con- 
 tents can often be broken up by direct manipulation 
 after drinking hot water. 
 
 E.V.Stom. 1. FLUID or SEMI-FLUID CONTENTS 
 MAY BE REMOVED AS FOLLOWS: 
 POSTURE. Patient on back, with knees flexed. 
 
 Operator at right side. 
 
 FIRST POSITION. Hand two, or left, under 
 
 opposite ribs at back or angles reaching over patient's 
 
 body. Hand one, or right, is forced under anterior 
 
 end of ribs and costal cartilages. 
 
2l6 EMPTYING VISCERA 
 
 ACTION, (a) Hand two lifts near angles to 
 raise anterior end of ribs ; this enables hand one to 
 slip farther beneath, using ulnar side of hand one as a 
 hoe. 
 
 SECOND POSITION. Reinforce with hand two. 
 
 ACTION. Draw toward pylorus with slow, deep 
 pressure. 
 
 Second. Lying on right side aids natural empty- 
 ing. 
 
 Third. Tickling facues with middle finger, palm 
 outward to produce vomiting. 
 
 E.V.Com. B. Duct. COMMON BILE DUCT. 
 
 POSTURE. Patient supine, with knees flexed. 
 Operator at side. 
 
 POSITION. Finger tips reinforced begin near 
 exit of duct, remembering that its course is that of a 
 reversed letter S, beginning at tip of ninth rib and 
 circling from one to one and a half inches below the 
 umbilicus and to the right. 
 
 ACTION. First. Beginning near exit, press 
 deeply and slowly toward exit one to three times. 
 
 Second. Then begin about one-half inch farther 
 up and repeat. 
 
 Third. Continue up to tip of ninth rib, following 
 the course of the duct. If enlarged it may sometimes 
 be felt ; if so, and tender, with symptoms of obstruc- 
 tion or gall stones, watch stools. 
 
 CAUTION. Beware of undue irritation. Per- 
 haps once in a week or ten days for a few treatments 
 will be enough with spinal and rib treatment. 
 
EMPTYING VISCERA 217 
 
 EMPTYING VISCERA. THE RECTUM. 
 
 E.V.Rec. 1. 
 
 POSTURE. Home Treatment. Patient leaning 
 far forward, so that shoulders nearly rest on knees 
 when at stool. 
 
 PRINCIPLE. This inhibits and relaxes the 
 sphincters if they are abnormally contractured and 
 often accomplishes what straining will not do. 
 
 E.V.Rec. 2. 
 
 USE. Aid to infants, especially if rectum is 
 dilated by hard or too large stools, or by too many or 
 too large injections. 
 
 POSTURE. Patient sitting inclined far forward. 
 
 ACTION. Direct pressure below coccyx, or deep 
 pressure through bladder. 
 
 E.V.U. UTERUS. 
 
 USE. Retained menses and mo-mbranes, etc., 
 may be result of displacements. 
 
 POSTURE. Knee chest, or genu-pectoral post- 
 ure. 
 
 POSITION. One or both hands above pubic 
 arch. 
 
 ACTION. Manipulation and jarring or other 
 methods of replacement may relieve the trouble. 
 
 (E.V.Col.) EMPTYING VISCERA. The COLON. 
 
 POSTURE. Patient supine, with knees flexed: 
 Operator at side. 
 
 POSITION 1 . Finger tips reinforced. Begin at 
 sigmoid if impaction is felt. 
 
218 EMPTYING VISCERA 
 
 ACTION. First. Aim to work in the direction 
 of peristalsis with deep, slow pressure. 
 
 Second. Finger tips reinforced beginning back an 
 inch or so after from one to three trials in one place. 
 
 PRINCIPLE. Same as manipulating common 
 bile duct just preceding. Follow back as far as there 
 are evidences of a tumor, but don't use it as an ordi- 
 nary method of moving the bowels. Find spinal 
 lesions. 
 
 NOTE: Watch the stools afterwards for small 
 lumps or balls, perhaps different in color. 
 
 DEGREE. Don't repeat every treatment if given 
 very strongly, as inflammation may be aggravated. 
 
 A high enema or oil enema may aid if retained during 
 manipulation, or to a less degree at other times. 
 
 Rather than give medicine for constipation, hot water, 
 raw egg or fruit early before breakfast, or cold water 
 drank regularly every morning, may be given. 
 Thompson (the authority on dietetics) says that near- 
 ly all cases of constipation can be cured by diet, leaf 
 vegetables being the best. Fruits are fine. Cream is 
 a natural laxative for infants. Oily foods, like ice 
 cream or olive oil, as salad dressing. 
 
 THE HIGH RECTAL ENEMA may be given 
 with the ordinary short tube if patient is given the 
 Trendlenburg posture as in (R. V. U. ante) 2. Using 
 the suspension hooks, a sling or swing. 
 
 Be* Osteopathic and keep far from the danger line 
 of drugs. 
 
EMPTYING VISCERA 2IQ 
 
 (KEY TO SYMBOL CONSTRUCTION) 
 ist letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL, MECHANICAL PRINCIPLE. 
 
 ( ) 
 
 USE 3 
 
 *st POSTURE Patient . . . ... 4 
 
 Operator 5 
 
 2d . 6 
 
 ist POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 Consecutively. Simultaneously. 
 
 1 or, a . . . ..11 
 
 2 or, b 12 
 
 3 or, c 13 
 
 4 or, d 14 
 
 PRINCIPLE acts as a ... class lever 15 
 
 acts as a fulcrum with 16 
 
 as the power and . as the weight ..... 17 
 
 DEGREE 18 
 
 • • 19 
 
 CAUTION 20 
 
 21 
 
 NOTE 22 
 
 23 
 24 
 
220 ORGANS OF SPECIAL SENSE 
 
 ORGANS O F SPECIAL SENSE 
 
 PALLIATIVE TREATMENTS. 
 THE EYE. 
 i. RELAXING TISSUES OF ORBIT. 
 
 POSTURE. Patient lying. Operator at head. 
 
 POSITION AXD ACTION. Outside of tip of 
 little finger works above and below and around eye- 
 ball from side to side with short strokes, about one- 
 half inch. < 
 
 2. STRETCHING LIDS. 
 
 POSITION. Thumb one on nose, well up ; thumb 
 two across to opposite of eye. beyond orbit on temple. 
 
 ACTION. Carry skin and muscles apart, thus 
 stretching lids across eyeball. 
 
 3. STIMULATE CILIARY GANGLION. 
 
 POSITION. Finger two of hand one on eyelid. 
 ACTION. Finger two of hand two taps finger 
 two of hand one lightly and rapidly. 
 
 4. GRANULATED LIDS. 
 
 POSTURE. Patient sitting or lying. 
 
 POSITION. Little finger or lead pencil on upper 
 
 eyelid. 
 
 ACTION. (1) Turn eyelid back over little 
 finger or lead pencil. 
 
 (2) Rub gently between fingers to break up 
 granules, using vaseline on fingers. 
 
ORGANS OP SPECIAL SENSE 22 1 
 
 5. STYS. 
 
 Pull hair out from center. 
 
 6. PTERYGIUM. 
 
 Finger nail glides like a skate across the cornea 
 capilaries feeding it, thus compressing or cutting off 
 the nutrition to the growth. 
 
 7. STIMULATE FIFTH NERVE. 
 
 By -pressure at various points of exit. (See illus- 
 trations in Gray's Anatomy.) 
 
 EAR. 
 TO REMOVE WAX. 
 
 (1 ) Try ear spoon, prying upward to loosen slug 
 deposited on floor of external auditory meatus. 
 
 CAUTION. Do not push the cylindrical or semi- 
 cylindrical slug of wax too hard against ear drum. 
 
 (2) Resort to ear syringe and warm water, or: 
 
 (3) Glycerine or warm sweet oil dropped in and 
 plugged with cotton at nights to soften. 
 
 (4) Or have patient form habit of pouring water 
 into the ears in the morning. 
 
 NOTE: If removing wax leaves the ears too 
 sensitive to sound have patient plug the ears with cot- 
 ton, removing it by degrees, taking a week or so. 
 
22 2 ORGANS OF SPECIAL SENSE 
 
 NOSE. ' 
 
 LOOSENING SECRETIONS. 
 
 POSITION. Tips of fingers and thumb two 
 
 compressing nostrils. 
 
 ACTION (i) Rotary oscillation over alae, or 
 circling to free secretion. 
 
 (2) Pressure high up on bridge with thumbs. 
 
 (3) Body weight on forehead. 
 
 (4) Breathing Exercise: 
 
 a. Inhale — Thumb on one nostril. 
 
 b. Puff — Thumbs and fingers on both 
 
 nostrils. 
 
 c. Exhale — Finger on other nostril. 
 
 Repeat — Inhale, Puff, Exhale, etc. 
 
 PRINCIPLE. The air pressure in purring affects 
 terminal branch of the fifth nerve to nasal cavity. 
 
 Babies' noses can be shaped, if too flat, by pinch- 
 ing bridge soon after birth. Very little pressure is 
 needed, however. 
 
ORGANS OF SPECIAL SENSE 223 
 
 TREATMENT OF TONSILS. 
 
 USE. (1) To induce vomiting, to empty stom- 
 ach, or, 
 
 (2) Dislodge fish bones or foreign bodies in the 
 oesophagus, or, 
 
 (3) In treating tonsillitis locally. 
 POSTURE. Patient sitting on stool or table. 
 POSITION. Insert middle finger after antiseptic 
 
 cleanliness, or have patient do so. Have palm open 
 outward on affected side. 
 
 ACTION. Glide over and around on tonsil, if 
 needed. 
 
 (KEY TO SYMBOL CONSTRUCTION) 
 
 1 st letter the Structure, 26. for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 
 
 use : .3 
 
 POSTURE Patient 4 
 
 Operator 5 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 ' 11 
 
 12 
 
 PRINCIPLE 15 
 
 DEGREE 18 
 
224 HUMERUS AT SHOULDER 
 
 THE UPPER LIMB. 
 
 See Rules i to 5 of The Lower Limb and the 
 tables accompanying them. The same principles ap- 
 ply here. They resemble the passive movements of 
 surgery and are a low grade of Osteopathy. 
 
 NOTE : THE SHOULDER JOINT is often un- 
 able to glide down in glenoid fossa enough to permit 
 raising of elbow above shoulder. 
 
 PRINCIPLE. Up to the level of the shoulder the 
 axis of rotation is at head of humerus. As the latissi- 
 mus dorsi and pectoralis major are tightened the axis 
 is changed to their insertion, and if elbow is carried 
 higher than shoulder there must be freedom of ad- 
 hesions and enough elasticity of ligaments to permit 
 head of humerus to duck down in glenoid cavity as it 
 r#cks against the long head of the biceps. 
 
 Capsular ligament has one inch of slack length- 
 wise normally if air pressure were removed. 
 
 Hum. HUMERUS. 
 S. AT SHOULDER. 
 
 G. GENERAL TREATMENT. 
 
 (Hum.S.G.) 1. 
 
 USE. 1.. For Thickened Ligaments and Ad- 
 hesions in or above shoulder joint for stretching and 
 by extreme pressure breaking loose. 
 
 POSTURE. Patient sitting on low seat. Opera- 
 tor at back. 
 
 POSITION. Hand one on humerus, near head. 
 . Hand two grasps arm above elbow. 
 
HUJfKMTS AT SHOULDKK 225 
 
 ACTION, (i) Hand one forces down with arm 
 held stiff and operator's weight assisting as hand two 
 lifts elbow beyond the height it easily rises. 
 
 (2) Elbow is carried back and forth six to twelve 
 inches as hand one continues pressure. 
 (Hum.S.G.) 2. 
 
 USE. For anterior or posterior ligaments and 
 adhesions. 
 
 POSTURE. Patient on back. Operator at side, 
 facing iiead. 
 
 POSITION. Hand one on humerus, near head. 
 Hand two at elbow. 
 
 ACTION. Hand one presses down and hand two 
 holds elbow or lifts slightly and carries it back and 
 forth. 
 
 NOTE: If it makes a sudden lunge don't get 
 scared. 
 
 If treatment was indicated and judiciously applied. 
 
 (Hum.S.G.) 3. ANTERIOR FIBERS of DELTOID 
 
 under coracoid process with slight ANTERIOR 
 
 DISLOCATIONS of HEAD of the HUMERUS. 
 
 POSTURE. Patient sitting. Operator at back. 
 
 POSITION. Hand two grasps arm above elbow. 
 Hand one on shoulder. 
 
 ACTION. (1) Hand two carries elbow back- 
 ward and upward to height of shoulder to stretch and 
 relax the fibers. 
 
 (2) Forward — To loosen. 
 
 {3) Up — To unhook 
 
 (4) Back — To normal. In other words, if it were 
 not for the angular movement described it would be 
 backward circumduction of arm. 
 
226 HUMERUS AT SHOULDER 
 
 (KEY TO SYMBOL CONSTRUCTION) 
 ist letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE 3 
 
 ist POSTURE Patient 4 
 
 Operator 5 
 
 2d 6 
 
 ist POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 Consecutively. Simultaneously. 
 
 1 or , a it 
 
 2 or, c 12 
 
 3 : or, d 13 
 
 4 or, b 14 
 
 PRINCIPLE acts as a . . . class lever 15 
 
 acts as a fulcrum with 16 
 
 as the power and as the weight 17 
 
 DEGREE 18 
 
 19 
 
 CAUTION 20 
 
 21 
 
 NOTE 22 
 
 : --^ 
 
 24 
 
HUMRRUS AT SHOULDER 227 
 
 (Hum.S.G.) 4. Stretching LONG HEAD OF BI- 
 CEPS. 
 
 •POSTURE. Patient on stool. Operator at back. 
 
 POSITION. Hand one on opposite shoulder. 
 Knee back of shoulder on side to be stretched. Hand 
 two grasps elbow of latter. 
 
 ACTION. Hand two and knee hold firmly as 
 hsind one pulls elbow backward and upward. 
 
 DISLOCATIONS OF SHOULDER. 
 
 (In Relative positions.) 
 
 4. SUPRA GLENOID. (Very rare.) Traction and 
 Elevation of elbow. ^ 
 
 (Upward.) 
 
 
 
 
 
 
 
 a 
 
 6 
 6 
 
 
 
 t* 
 
 
 
 
 
 
 
 
 
 -j 
 
 
 « 
 
 Q 
 
 Vg 
 
 
 < 
 
 O 
 
 a I 
 
 /"> 
 
 
 
 < 
 
 O O 
 
 
 
 •n 
 
 (— ( 
 
 & 
 
 O -, 
 
 s 
 
 > 
 
 O 
 
 < 
 
 c 
 
 < 
 
 O 
 
 g -g 
 
 < 
 
 -1 
 
 < 
 
 O ^ 
 
 "W 
 
 
 
 P£ 
 
 
 w 
 
 H 
 
 PQ 
 
 
 2 
 
 C/3 
 
 1 — < 
 
 CO 
 
 
 (Downward.) 
 
 
 
 re 
 
 
 cd 
 
 t>^ 
 
 
 « 
 
 5-h 
 
 
 N - x 
 
 > 
 
 /"" N 
 
 
 
 u 
 
 h4 
 
 
 .2 
 8 
 
 < 
 
 s 
 
 Q 
 
 O 
 
 & 
 
 £ 
 
 N«^ 
 
 
 
 U 
 
 Ph 
 
 
 < 
 
 CO 
 
 
 n 
 
 « 
 
 
 D 
 
 D 
 
 
 co 
 
 CO 
 
 <-*o 
 
 7. SUB GLENOID. (Uncommon.) 
 
 8. LUXIO ERECTA. (Very rare.) 
 
 9. SUB TRICEPETAL. (One case.) 
 
 See the Surgeries for diagnosis of limbs in detail. 
 
228 HUMERUS AT SHOULDER 
 
 Anterior Dislocations. (Most common.) The 
 tour principal classifications are in heavy type in il- 
 lustration above. 
 
 Ruptures of Capsular Ligament are most common 
 anteriorly. 
 
 The head of humerus also tends to escape slight- 
 ly downward and anteriorly in eight out of nine cases. 
 The ninth case being upward and usually requires the 
 fracture of the acromion process to make it possible. 
 
 RULE. In reducing a dislocation remember this 
 avenue of escape, using it to retrace the head of 
 humerus. 
 
 Surgeons consider shoulder dislocations as fre- 
 quent as all other dislocations combined. 
 
 Hum. THE HUMERUS. 
 S. AT THE SHOULDER. 
 
 D. DIRECT REDUCTION OF LESION. E. 
 
 EXTREME. 
 
 • 
 
 (Hum.S.D.) i. TRACTION WITH KNEE AS 
 FULCRUM. 
 
 USE. The three below are used .for all disloca- 
 tions of shoulder, especially in recent cases. 
 
 POSTURE. Patient on stool.;" Operator at back. 
 
 POSITION. Operator's knee in patient's axilla, 
 and foot on stool. 
 
 ACTION. Pull down on arm and release. 
 
 PRINCIPLE' of this and- the second and third fol- 
 lowing is that ligaments and muscles are stretched to 
 tire them. The part in the axilla acts as a wedge to 
 force head of humerus outward. Upon releasing it 
 springs back to normal. 
 
HUMERUS AT SHOULDER 229 
 
 (KEY TO SYMBOL CONSTRUCTION) 
 
 1st letter the Structure, 2d for Region, and 3d Class. 
 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) • 1 
 
 2 
 
 USE « 3 
 
 1st POSTURE Patient 4 
 
 Operator 5 
 
 2d 6 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 Consecutively. Simultaneously. 
 
 1 or, a 11 
 
 2 or, b 12 
 
 3 or, c 13 
 
 4 or, d 14 
 
 PRINCIPLE acts as a ... class lever. 15 
 
 acts as a fulcrum with 16 
 
 as the power and as the weight 17 
 
 DEGREE 18 
 
 ••• • •..: 19 
 
 CAUTION 20 
 
 21 
 
 NOTE ..;..... 22 
 
 .......:.. ................23 
 
 .:........ ,...24 
 
2 3°^ - L-Jl"*. HUMERUS AT SHOULDER 
 
 (Hum.S.E.) i. TRACTION with FOOT in AXILLA 
 as a FULCRUM. 
 
 POSTURE. Patient supine. Operator at side. 
 
 POSITION. Operator removes shoe and places 
 foot in axilla as hands grasp arm. 
 
 ACTION. Pull arm toward foot and release it. 
 
 PRINCIPLE is that of traction and a first-class 
 lever. 
 
 (Hum.S.E.) 2. TRACTION in SWING as a FUL- 
 CRUM. 
 
 POSTURE. Patient standing. Operator crouch- 
 ing at side. 
 
 POSITION. Patient's arm in loop or hook of 
 swing. 
 
 ACTION. Pull down and release it. 
 
 Hum. THE HUMERUS. 
 
 A. ANTERIOR LUXATION. 
 
 D. DIRECT REDUCTION OF LESION. E. 
 
 EXTREME. 
 
 (Hum.A.D.) i. HAND as FULCRUM with ARM 
 LEVERAGE. 
 
 POSTURE. Patient sitting. Operator at back. 
 
 NOTE: A general treating of joint may or may 
 not proceed. 
 
 POSITION. Hand one grasps arm one of pa- 
 tient, reaching under axilla and grasping humerus 
 near head, thumb pointing outward. Hand two grasps 
 elbow, crossing hand one. 
 
HUMERUS AT SHOULDER j 23 1 
 
 ACTION. (1) Hand two draws elbow back at 
 level of shoulder. 
 
 (2) Carry elbow forward, circling across chest 
 as hand one opposes or draws back on head of hu- 
 merus, as if to drag it back into glenoid fossa. 
 
 <Hum.A.E.) 1. HYPOTHENAR EMINENCE AS 
 FULCRUM WITH ARM LEVERAGE. 
 
 The same as B.R.Hum. 4, just preceding, only 
 with operator at side, facing head. 
 
 POSTURE. Patient on back, arms pointing 
 straight out from side. 
 
 POSITION. Hand one grasps humerus of pa- 
 tient near shoulder. Hand two grasps elbow. 
 
 ACTION. Relatively the same as the one just 
 preceding. 
 
 NOTE: If. head will not stay in socket try two 
 or three months' vacation for muscles to relax and 
 atrophied oneself to develop. 
 
 1st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 < > 
 
 USE 3 
 
 POSTURE Patient 4 
 
 Operator 5 
 
 1st POSITION Hand one 7 
 
 Hand two ; . . . . 8 
 
 2d 9 
 
 ACTION ,10 
 
 11 
 
 12 
 
 PRINCIPLE 15 
 
2^2 HUMERUS AT ELBOW 
 
 Ulna and Rad. ULNA AND RADIUS. 
 E. LUXATED AT ELBOW. 
 
 G. GENERAL TREATMENT. E. EXTREME. 
 
 (Ulna, and Rad.E.G.) i. RADIUS AND ULNA 
 BACKWARD, INTERNAL OR EXTERNAL, 
 OR ULNA BACKWARD. 
 
 POSTURE. Patient sitting. Operator at side. 
 
 POSITION. Operator's knee in cubital fossae.. 
 with elbow held at right angles. Hand one grasps pa- 
 tient's wrist as a lever. Hand two supports shoulder. 
 
 ACTION. Strong traction downward with knee. 
 
 (Rad.E.E.) i. WITH SWING OR ASSISTANT. 
 
 Same as No. i, just preceding, except patient's 
 shoulder is in a swing or sling made of a doubled 
 towel held by an assistant. 
 
 i st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE 3 
 
 POSTURE Patient 4 
 
 Operator 5 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d ' 9 
 
 ACTION 10 
 
 .11 
 
 12 
 
 PRINCIPLE 15 
 
 DEGREE .-..v::- • • • 18 
 
HUMERUS AT ELBOW 23^ 
 
 Rad. RADIUS. 
 
 E. LUXATED AT ELBOW. 
 
 P. POSTERIORLY. A. ANTERIORLY. 
 
 (Rad.E.P.) 1. 
 
 POSTURE. Patient sitting. Operator at side,, 
 away from lesion. 
 
 POSITION. Fingers of hand one grasp head of 
 radius posteriorly, palm upward. Hand two grasps 
 
 patient's wrist. 
 
 ACTION. Hand two circles forearm and extends 
 it at elbow, bringing direct pressure to force head of 
 radius forward. 
 
 (Rad.E.A.) 1. 
 
 (1) Hand is supinated. 
 
 (2) Apply traction. 
 
 (3) Direct pressure at lesion with normal move- 
 ments of arm, if necessary. 
 
 PRINCIPLE of dislocations in the forearm is 
 that the large end of bones are usually fixed if there 
 is a single dislocation, and the small end beside it does- 
 the slipping; i. e., the head of the radius and the distai 
 end of the ulna. 
 
234 HUMERUS AT ELBOW 
 
 Ulna, and Rad. ULNA AND RADIUS. 
 W. LUXAtED AT WRIST. 
 G. GENERAL TREATMENT. 
 (Ulna and Rad.W.G.) i. SIMPLE TRACTION. 
 
 NOTE : : Both ulna and radius may be forward, 
 backward and outward. 
 
 ACTION. Apply traction opposing at elbow. 
 
 POSITION. Elbow is held by operator's as- 
 sistant, or in swing or over edge of treating table. 
 Patient's hand is grasped, as if shaking hands, and 
 wrist is also grasped. , 
 
 Ulna and Rad. ULNA AND RADIUS. 
 W. LUXATED AT WRIST. 
 
 P. POSTERIORLY. 
 <Rad.W.P.) i. FINGER FULCRUM AND HAND 
 
 LEVERAGE WITH THENAR EMINENCE 
 
 AT LESION, 
 
 USE. Posterior radius or ulna often found in 
 "weeping sinews or ganglions of wrist, also apply to 
 anterior conditions and to carpal and metacarpal bones. 
 
 POSTURE. Patient sitting on stool. Palm down 
 ; on table. Operator at side. 
 
 POSITION. Hand two grasps affected hand, so 
 that index and middle fingers support carpus and rest 
 on table. 
 
 Thenar eminence of bawd one rests on radius, near 
 wrist; at back of arm. 
 
 ACTION. Hand one applies pressure downward 
 as hand two swings patientV hand laterally, wfaite 
 Singers of taR4 two He on Ubl^ supporting wrist. 
 
HUMERUS AT ELBOW 235 
 
 Ulna, and Rad. ULNA AND RADIUS. 
 
 W. LUXATED AT WRIST. 
 
 A. ANTERIORLY, 
 
 (Ulna and Rad. W. A.) i. Same principle as (Ulna and 
 Rad AV. P.) 1, just preceding, .except patient's palm is 
 supinated. 
 
 USE. For either one or both bones. 
 
 (KEY TO SYMBOL CONSTRUCTION) 
 1st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 ....." 2 
 
 use ....... v: 3 
 
 POSTURE Patient ............: 4 
 
 Operator 5 
 
 ist POSITION Hand one .:..'..... 7 
 
 Hand two 8 
 
 2d 9 
 
 action -::■•; 10 
 
 i or, a 11 
 
 12 
 
 PRINCIPLE 15 
 
 DEGREE ..v ; £ 18 
 
 CAUTION 29 
 
 note ........;.......... .;. .... :\ 2* 
 
236 HUMERUS AT WRIST 
 
 Car. CARPAL. 
 
 Os. OS MAGNUM (OR OTHER BONES). 
 P. POSTERIORLY. A. ANTERIOR. 
 
 (Car.Os.P.) 1. Same principle as (Ulna and Rad.W.P.) 
 1, the second preceding, as well as for (Phal.i P.) 1, 
 
 the third following. 
 
 Meta.Car. METACARPAL. 
 
 1. No. 1 (OR OTHER BONES). 
 P. POSTERIOR. A. ANTERIOR. 
 
 (Meta.Car.i P.) 1. Same principles are employed as 
 in the following for phalanges. 
 
 Phal. PHALANGES. 
 
 1. NO. 1 (OR OTHER BONES). 
 P. POSTERIOR. A. ANTERIOR. 
 
 (Phal. 1 P.) 1. 
 
 POSITION. Hand one grasps affected finger. 
 Hand two, or assistant, grasps wrist or arm. 
 
 ACTION. (A) Hand one applies traction. 
 Hand two opposes. 
 
 (B) Or exaggeration, then traction and direct 
 pressure. 
 
 (C) Or traction and rotary oscillation with direct 
 pressure. 
 
THE LOWER LIMB 
 
 237 
 
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 Ball of 
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 JOINTS 
 
 FLEXED; 
 
 Knee on 
 abdomen 
 
 ft: 
 
 c 
 < 
 
 s 
 
 Hip 
 
 and 
 
 ankle 
 
 POINT OF 
 PRESSURE; 
 
 Ankle 
 
 (Downward) 
 
 Knee 
 
 (Downward) 
 
 o 
 
 ^ o 
 
 pq fe 
 
 Knee or 
 patella 
 
 Knee or 
 patella 
 
 PATIENT'S 
 POvSTURE; 
 
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 •IN 
 
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 STRUCTURES 
 STRETCHED; 
 
 Quadracips extensor, 
 anterior ligaments, 
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 Posterior thigh and 
 buttock 
 
 o 
 
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THE LOWER LIMB 239 
 
 RULE 3> or RULE, of ABDUCTION AND ADDUC- 
 TION . 
 
 Abduct to stretch adductors, and adduct to 
 
 stretch abductors. 
 
 (M.Gt.Toe.I) 3. Great toe is abducted if angle is too 
 great, as in bunions. 
 
 (M.Thigh.Add.) 3. Adductors of thigh. 
 
 (a) Adductors of thigh- are stretched by spread- 
 ing feet, either with both feet on table and operator at 
 side, if very tense, or, 
 
 (b) With operator between feet, with one foot 
 of patient on table. 
 
 RULE 4, or RULE of ROTATION AND CIRCUM- 
 DUCTION. 
 
 Stretch external rotators by internal circumduc- 
 tion, and internal rotators and adductors by external 
 circumduction. 
 
 EXAMPLE: The THIGH. 
 (M.Ex.Rot.) 4. 
 (M.Int.Rot.) 4. 
 
 POSTURE. Patient supine. Operator at side. 
 
 POSITION. Hand one on knee. Hand two at 
 heel. 
 
 ACTION. Keep heel drawn in opposition to knee 
 
 as thigh is flexed upon abdomen and circumducted, 
 
 i. e., as knee is circled inward heel is thrown inward. 
 
240 
 
 THE LOWER LIMB 
 
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THE HIP JOINT 241 
 
 THE HIP 
 
 1. TO TEST FOR ANCHOLOSIS, or contractured 
 adductors : 
 
 Abduct leg and watch opposite anterior superior 
 spine to see if it follows down, as in moving a hammer 
 handle moves the head of the hammer. 
 
 2. HILDRETK'3 TEST FOR ANCHOLOSIS: 
 
 Grasp great trochanter and crest of illium on an- 
 terior superior spine and rotate limb to get motion. 
 
 3. TEST FOR ANCHOLOSIS. Dorsal position: 
 
 Patient on back. If knee is flexed force it to table 
 and watch if lumbar region becomes more concave. 
 
 REDUCTION. If head fails to find lodgment in 
 socket nature will aid during a rest from treatment ; 
 muscles will become strengthened and inflammation 
 subside. 
 
242 
 
 THE HIP JOINT 
 
 DISLOCATIONS OF HIP. 
 
 THE OLD AND MORE COMMON CLASSIFCATION. 
 
 (By far the most frequent) 
 
 DOR. ILLIUM 
 
 BACKWARD 
 
 and 
 
 UPWAR D 
 
 Toes In 
 SCIATIC 
 
 BACKWARD 
 
 Toes In 
 
 Dotted lines show 
 the vertical path of 
 the Great Tr ch- 
 anter: — L eg e x - 
 tended 
 
 PUBIC • 
 FOREWARD 
 and 
 UPWARD 
 
 GREAT TROCHANTER 
 
 The Primary One 
 
 OBTURATOR 
 
 FOREWARD 
 
 and 
 
 DOWNWARD 
 
 Toes In or Out 
 
 THE NEW CLASSIFICATION (Allis). 
 
 HIGH DORSAL 
 MID DORSAL 
 
 LOW DORSAL 
 
 (All toe in.) 
 
 Upper two toe out. ) 
 HIGH THYROID 
 
 MID THYROID 
 
 LOW THYROID 
 (Toe in or out.) 
 
 (See surgeries for diagnosis of limbs in detail.) 
 
THE HIP JOINT 243 
 
 (See McConnel and Teal also, for Eaughlin on the 
 
 hip.) 
 
 RULE. Head either lodges in an opening or the 
 bcdy weight forces it higher and in or around aceta- 
 bulum. 
 
 Distance up and back estimated by length of limb, 
 sitting or standing. 
 
 The axis of limb rotation extends from the great 
 trochanter to the heel when limb is straightened. 
 
 The head and neck of the femur and the toes 
 and foot of the patient, being at the extremities of this 
 line, are at right angles to each other. 
 
 It is obvious that when the head is carried posterior- 
 ly the toes will be carried inward; or when head is car- 
 ried anteriorly the toes are carried outward. 
 
 The exceptions being the obturator dislocation when 
 head is free to swing either way beneath pelvis. 
 
 Ruptured Y ligaments and relaxed condition of 
 other muscles and ligaments may* allow trochanter to fall 
 away from pelvis, and if head of femur has partly disap- 
 peared from tubercular conditions, it may glide anterior 
 or posterior, throwing toes either in or out. 
 
 NOTE. The sciatic dislocation is in reality poster- 
 ior and slightly upward in relation to the ascetabulum, 
 but is downward in relation to the obturator internus 
 muscle. It being the dividing line between the sciatic 
 and the dorsum of the illium dislocations. 
 
 Even the sciatic dislocation is above Nelation's line, 
 as it only rests on rim of sciatic notch. 
 
244 THE HIP JOINT 
 
 (KEY TO SYMBOL CONSTRUCTION) 
 1st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE 3 
 
 1st POSTURE Patient 4 
 
 Operator 5 
 
 2d 6 
 
 1st POSITION Hand one 7 
 
 . Hand two 8 
 
 2d . .... 9 
 
 ACTION .....10 
 
 Consecutively. Simultaneously. 
 
 1 or, a 11 
 
 2 or, b 12 
 
 3 or, c 13 
 
 4 . . . or, d 14 
 
 PRINCIPLE. . . . .acts as a ... class lever 15 
 
 . . _ acts as a fulcrum with 16 
 
 as the power and. as the weight 17 
 
 DEGREE 18 
 
 •••• •• •••- 19 
 
 CAUTION 20 
 
 ....... 21 
 
 NOTE 22 
 
 • ••• 23 
 
 •• • • • •• 24 
 
THE HIP JOINT 245 
 
 Fern. FEMUR. 
 BU. BACKWARD AND UPWARD. 
 
 D. DIRECT REDUCTION OF LESION. 
 
 (Fem.BU.D. ) 1. TROCHANTER FULCRUM 
 WITH LEG AND THIGH LEVERAGE. 
 
 (Leg short and toes point inward.) On dorsum 
 of illium. 
 
 NOTE : Traction and muscular relaxing may 
 
 preceed treatment. 
 
 POSTURE. Patient supine. Operator at side. 
 
 POSITION. First. Hand one on knee. Hand 
 two across instep, grasping heel. 
 
 ACTION. First. Flex knee at right angles. 
 
 ACTION. Second. Adduct diagonally up and 
 across to carry head forward and below acetabulum. 
 
 POSITION. Second. Change hand one to sup- 
 port great trochanter by doubling up the fist with 
 radial side up and chin or axilla to hook over knee. 
 
 PRINCIPLE. Hand one is fixed as. a fulcrum 
 and thigh as a lever, with pelvis as the weight, acting 
 as a claw hammer drawing a nail. 
 
 ACTION. Third. Abduct knee, swinging feet 
 outward and heel inward — to throw or draw head up 
 into acetabulum from below. 
 
246 THE HIP JOINT 
 
 (KEY TO SYMBOL CONSTRUCTION) 
 1st letter the Structure, 2d for Region, and 3d Class. 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 < ) 1 
 
 \ . . . 2 
 
 use ,.;..:. 3 
 
 1st POSTURE Patient . 4 
 
 Operator 5 
 
 2d 6 
 
 1st POSITION Hand one :' 7 
 
 Hand two 8 
 
 2d . . . . . 9 
 
 ACTION .- 10 
 
 Consecutively. Simultaneously. 
 
 1 or, a 11 
 
 2 . or, b 12 
 
 3 ■ •. or - c • x 3 
 
 4 . . or, d 14 
 
 PRINCIPLE. . . ..acts as a . . . class lever 15 
 
 acts as a fulcrum with 16 
 
 as the power and as the weight 17 
 
 . DEGREE 18 
 
 • • ■••' ...:..:..... 19 
 
 CAUTION 20 
 
 . :....... 21 
 
 NOTE 2* 
 
 V— •:•■•• .....23 
 
 --*....*..- • <♦*. • • ,f4 
 
THE HIP JOINT 247 
 
 Pern. FEMUR, HEAD OF. 
 
 B. BACKWARD AND DOWNWARD. 
 
 D. DIRECT REDUCTION. I. INDIRECT. 
 
 (Fern. B. D.) 1 Trochanter fulcrum with thigh 
 leverage and traction. 
 
 (Leg short and toes inward.) As patient lies, then 
 sits, leg shortens. 
 
 POSTURE. Patient supine. Operator at side. 
 
 POSITION. Hand one grasps great trochanter 
 and hand two knee. 
 
 ACTION. Hand two may apply traction in ad- 
 dition to previous treatment at fourth ACTION as 
 above described. 
 
 NOTE : Pelvis may be held down while reducing 
 a hip joint dislocation: 
 
 FIRST. By an assistant at opposite side reaching 
 across and grasping table so as to bear down on pelvis 
 with forearms. 
 
 SECOND. By hook of a swing with screw eye 
 in floor, or with screw eye in table and a board under- 
 neath to loop strap under; Board 6 ins. wide is hinged 
 to hang vertically from table at opposite side from lesion 
 so as to fold crosswise underneath table when not in use. 
 
 (Fem.BU.D.) 1 and (Fcm.BD.D.) 1 MODIFIED. The 
 two just preceding may be given sitting, with 
 same manipulation of leg, with the aid of a padded 
 concave block or sandbag under upper end qi 
 femn? as a fulcrum. 
 
248 THE HIP JOINT 
 
 (KEY TO SYMBOL CONSTRUCTION) 
 
 1st letter the Structure, 2d for Region, and 3d Class. 
 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 (.....) • • 1 
 
 2 
 
 USE 3 
 
 1st POSTURE Patient 4 
 
 Operator 5 
 
 2d 6 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 2d . 9 
 
 ACTION 10 
 
 Consecutively. Simultaneously. 
 
 1 or, a • IT 
 
 2 or, c I2 
 
 3 or, d x 3 
 
 4 or, b ..... 14 
 
 PRINCIPLE acts as a ... class lever 15 
 
 acts as a fulcrum with. . . 16 
 
 as the power and as the weight 17 
 
 DEGREE 18 
 
 ••• 19 
 
 CAUTION .20 
 
 21 
 
 NOTE 22 
 
 ...;............:,....... 23 
 
 24 
 
THE HIP JOINT 249 
 
 (Fem.BU.I.) 1. TRACTION WITH KNEE FUL- 
 CRUM AND LEG LEVERAGE. 
 
 NOTE: The stages and principles about corre- 
 sponding with supine posture. 
 
 POSTURE. Patient standing with hands on a 
 support to steady him, and, in addition, it is still better 
 if arms are supported in a swing at axilla. Operator 
 behind and to one side. 
 
 POSITION. Patient's thigh vertical, knees at 
 right angles. Operator's knee in popliteal space of 
 patient. Hand one supports ankle. 
 
 ACTION. FIRST. Operator applies his weight 
 — To drag head toward acetabulum. 
 
 SECOND. Swing ankle out— To let head slide 
 around beneath acetabulum. 
 
 THIRD. Swing ankle in — To throw head into 
 acetabulum. 
 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE 3 
 
 POSTURE Patient 4 
 
 Operator 5 
 
 1st POSITION Hand one 7 
 
 Hand two 8 
 
 ACTION 10 
 
 11 
 
 12 
 
2 SO THE HIP JOINT 
 
 Fern. FEMUR. 
 
 FU. FORWARD AND UPWARD. 
 I. INDIRECT REDUCTION. 
 
 (Fem.FU.I.) i. On crest of pubis. (Toe always out.) 
 
 As patient lies, then sits, leg lengthens. 
 
 FIRST POSTURE. Patient on side, lesion up. . 
 
 POSITION. Hand one on knee. Hand two on 
 hip. 
 
 SECOND POSTURE. Roll on face. 
 
 FIRST ACTION. Hyperextend thigh by hand 
 one lifting knee and hand two forcing hip to table. 
 
 SECOND. Assume first position and flex thigh 
 slightly, and 
 
 THIRD. Attempting to lift head over pubic 
 
 crest with the aid of assistant holding upper thigh in 
 
 a ^ sling, or having a swing as a fulcrum, using femur 
 
 as a lever to pry it over.. 
 i 
 
 Fern. FEMUR, 
 
 FD. FORWARD AND DOWNWARD. 
 
 I. INDIRECT REDUCTION. 
 
 (Tee in or out.) 
 
 (Patient lies, then sits, and leg lengthens.) 
 
 POSTURE. Patient supine. Operator at side. 
 
 POSITION. Hand one on knee. Hand two- 
 grasps feet. 
 
 ACTION, a. Flex knee and thigh on abdomen. 
 
 b. Carry knee diagonally upward and inward. 
 
 c. Continuing to make forcible internal circum- 
 duction. 
 
 d. Extension, 
 
TIBIA AND FIBULA 25! 
 
 Tib. and Fib. TIBIA AND FIBULA. 
 K. AT KNEE. 
 
 I. INDIRECT REDUCTION, 
 (Tib or Fib. K.I.) 1. 
 
 Same dislocations as ankle — -four direction of both 
 bones. In addition the fibula slips alone and usually 
 backward. 
 
 Strong traction restores both bones if slipping to- 
 gether, but, in addition, the fibula may need special 
 attention if a sprained ankle of shorty and especially 
 one of long, duration is present. 
 
 Fib. FIBULA. 
 
 K. AT THE KNEE. 
 
 D. DIRECT REDUCTION. E. EXTREME. 
 (Fib.K.D.) 1. 
 
 NOTE: The external popliteal nerve is often im- 
 pigned as it passes around the head of the fibula and 
 the various pains throughout the distribution of the 
 anterior tibial nerve can often be relieved here. 
 
 Diognostic tenderness found below head externally, 
 
 POSTURE. Patient supine or sitting. Operator 
 in front. 
 
 POSITION. Hand one grasps leg below knee 
 from opposite side, fingers of hand one grasping fibula. 
 Hand two holds ankle, flexing it slightly. 
 
 ACTION, a. Extend knee to a straight line, at 
 the same time gripping so as to draw head of fibula 
 forward. 
 
2 $2 TIBULA AND FIBULA 
 
 (Fib.K.E.) i. MODIFIED. Reinforced. 
 
 POSTURE. Patient sitting. Same as (Fib.K.D.) 
 i, just preceding, except: 
 
 POSITION. Hand two reinforces hand one, and 
 
 patient's stockinged foot rests against operator's knee. 
 
 ACTION. Force knee down to extend as opera- 
 tor's knee carries patient's foot, and hands grip to draw 
 fibula forward. 
 
 ([<EY TO SYMBOL CONSTRUCTION) 
 
 ist letter the Structure, 2d for Region, and 3d Class. 
 
 SYMBOL. MECHANICAL PRINCIPLE. 
 
 ( ) 1 
 
 2 
 
 USE 3 
 
 POSTURE Patient 4 
 
 Operator 5 
 
 1st POSITION Hand one. 7 
 
 Hand two 8 
 
 2d 9 
 
 ACTION 10 
 
 IT 
 
 12 
 
 PRINCIPLE! . . . .acts as a ... class lever 15 
 
 DEGREE 18 
 
 CAUTION 20 
 
 NOTE 22 
 
TABLE OF INNOMINATE TREATMENTS 
 
 INNOMINATE 
 DIRECTION 
 
 NATURE OF 
 TREATMENT 
 
 MECHANICAL 
 PRINCIPLE 
 
 POSTURE 
 Patient Operator 
 
 POSITION. 
 HAND ONE HAND TWO 
 
 ACTION 
 HAND ONE HAND TWO 
 
 (I. ANY I.) 1 
 
 Chance. 
 
 Supine 
 
 At Sacro-Illiac 
 Synchrondrosis 
 
 Grasps Heel 2 or 
 nearest 
 
 THIGH. — Flexion, abduction and external 
 circumduction. 
 
 (I.A.I.) 1 
 
 Flexed limb 
 ever Indirect 
 leverage 
 
 Knee and thigh 
 
 flexed 
 Side— Dr. Back- 
 
 at Posterior Sacrum 
 
 Grasps (upper) knee 
 2. Flexed against 
 body. 
 
 Incline patient backward and reinforce 
 Elbow 2 by Knee and Foot.— Pull & Force 
 
 
 
 
 
 
 
 POSTERIOR 
 
 
 
 
 
 
 (I.P.D.) 1 
 
 Wheel and lever 
 
 On side with el- 
 bow against Dr. 
 
 Post. Sup. Spine 
 
 Anterior Thigh. 
 
 Force suddenly Carrying limb back 
 as if trying to slide a large box. 
 
 (I.P.D.) 2 
 
 Wheel and lever 
 
 Side— Dr., back 
 
 Post. Sup. Spine 
 
 Grasping Knee. 
 
 Force suddenly Carrying limb back 
 
 (I.P.D.) 3 
 
 Wheel and lever 
 
 Prone. 
 
 Post. Sup. Spine 
 Post. Sup. Spine 
 
 Supporting Knee. 
 
 Grasping as in the 
 "flying wedge 
 treat's." 
 
 Downward pressure Lift and Adduct 
 
 (I.P.D.) 4 
 
 Trunk leverage 
 
 at wall 
 
 
 
 
 
 
 
 
 ANTERIOR 
 
 
 
 
 
 
 (I.A.D.) 1 
 
 Wheel and axle 
 
 Side— Dr., ba.k. 
 
 Ant. Sup. Spine. 
 
 Tuberosity, Ischium 
 
 
 (I.AJQ.) 2 
 
 Wheel and axle 
 (with exposure) 
 
 Side — Dr. front. 
 
 Supports thigh and 
 grasps tuberosity. 
 
 Ant. Sup. Spine. 
 
 Willi operator's elbows lar apart 
 Force— SUDDENLY Force 
 
 (LAD.) 3 
 
 Wheel and axle 
 (No exposure) 
 
 Thigh and knee 
 
 Hexed. 
 
 Supports ankle and 
 grasps tuberosity. 
 
 Ant. Sup. Spine. 
 
 Lift & pull— SUDDENLY Force 
 
 
 
 
 
 
 Pull— SUDDENLY Force 
 
 (I.A.D.) 4 
 
 Wheel and axle 
 momentum 
 (No exposure) 
 
 Side — Dr., front. 
 Side— Dr., back. 
 
 One suspension, 
 
 hook. 
 Supports knee. 
 
 Hands at Tuberosity 
 and Ant. Sup. 
 Spine. 
 
 Limb swinging and elbows far apart 
 Force— SUDDENLY (at end of stroke) 
 
 Force 
 
 This table is continued 
 
 ollowing page. See explanation following alsi 
 
TABLE OF INNOMINAT E TREATMENTS— Continued. 
 
 « 5 °S 
 
 MECHANICAL 
 PRINCIPLE 
 
 POSTURE 
 Patient Operator 
 
 POSITION. 
 HAND ONE ' HAND TWO 
 
 ACTION 
 HAND ONE HAND TWO 
 
 POSTERIOR 
 
 
 
 
 
 
 (I.P.E.) 1 
 
 Wheel and lever and 
 momentum 
 (No exposure) 
 
 Elbow against Dr. 
 Side— Dr., front. 
 
 One suspension hook 
 supports knee. 
 
 Hands at Ant. Thigh 
 and Post Sup. 
 Spine. 
 
 Limb swinging and elbows far apart 
 Force— SUDDENLY (at end of stroke) 
 
 Force 
 
 
 
 
 
 
 
 . ANTERIOR 
 
 
 
 
 
 
 (i.A.E.) 1 
 
 Wheel and axle and 
 momentum. 
 
 Side— Dr., back. 
 
 One suspension hook 
 supports knee. 
 
 Hands at Tuberosity 
 & Ant. Sup. Spine. 
 
 Limb swinging and elbows far apart 
 Force— SUDDENLY (at end of stroke) 
 
 Force 
 
 (I.A.E.) 2 
 
 Wheel and axle 
 (with exposure) 
 
 Sitting on stool. 
 Back at wall. 
 
 Hand 1 grasps tu-|Ant. Sup. Spine. 
 berosUy, reaching: 
 between thighs. 
 
 Pull— Suddenly Force 
 
 
 
 
 
 
 
 ANTERIOR 
 And UP. 
 
 
 
 
 
 
 (I.AU.D.) 1 
 
 Windlas. 
 (Drs. hips.) 
 
 Side — Face foot. 
 
 Crest of Illium. 
 
 L,ies back of Dr.'s 
 waist, palm out. 
 Grasp elbow. 
 
 Dr. Rotates body to wind arm around. 
 Force illium. (SEE (R.D.I.) 1) Pull arm. 
 
 
 
 
 
 
 
 
 
 
 
 (I.PU.I.) 1 
 
 Wheel and lever 
 
 Elbow against Dr. 
 Side — Dr., front. 
 
 Post, crest of Illium 
 
 Anterior Thigh. 
 
 As if trying to slide a large box 
 Force— SUDDENLY Force 
 
 
 
 
 
 
 When limb is suspended at knee; patient should keep knee stiff i„ i- , • i- u t i r j J3 ■ . 
 
 , to and fro, aim to take patient unawares as pressure fe^S^^ V * 1 ™ g y ***** ^ deVltallZC Hmb * W P J oint " After about ' 
 
 patient unawares as pressure is applied for 
 
OSTEOPATHIC A ND GYNECOLOGICA L_PCOTURES (APPROXIMATE) FOR TREATMENT DURING SUSPENSION 
 
 NOTE.— Cuts show the earlier forms or 
 Bigsby's suspension hooks, now much improved 
 and applied in all of (he ihree dozen .. 
 swing treatments here described. Other makes of 
 suspension devices accomplish a majority of the 
 treatments here mentioned. 
 
INDEX 255 
 
 INDEX TO WRITTEN TREATMENTS 
 
 TECH. 
 PAGE. 
 
2$6 INDEX 
 
 INDEX TO WRITTEN TREATMENTS 
 
 TECH. 
 PAGE. 
 
GENEKAL INDEX 257 
 
 VARIETIES OF INDEX EXPLAINED 
 
 THE KEY TO SYMBOLS (Page 1). 
 (For Indexing at Sight) 
 
 This should be committed to memory so as to be able to 
 assemble the pages of this book if the pages were scattered 
 and the numbers gone. Use the key like you would the 
 figures up to 474, each letter of symbol representing a figure, 
 and a symbol for each treatment. 
 
 THE SYMBOL INDEX (Page 6). 
 
 This is a condensed guide to the technique as well as to 
 the mechanical principles, or names of Osteopathic technique. 
 
 THE MECHANICAL PRINCIPLES OF OSTEOPATHIC 
 TECHNIQUE (Page 15) (Index of names). 
 
 These act as names to indicate the treatments. If not 
 sufficiently understood the page numbers following guide to 
 the technique in detail. 
 
 THE TECHNIQUE (Page 70) 
 
 This is practically indexed itself. As any symbol, traced 
 back to No. 1, has the explanation preceding it. 
 
 This brings us up to the GENERAL INDEX, making 
 the book an index system from beginning to end with every- 
 thing pigeon-holed where losing it is impossible. 
 
 (Numbers printed in bold face type refer to the Me- 
 chanical Principles of Osteopathic Technique, or names.) 
 
 GENERAL INDEX 
 
 A C 
 
 ACTION of technique ex- Caecum, replacing 207 
 
 P lained '. 34 . Carpus, 236 
 Ancholosis of hip, tests for, 
 
 241 CAUTION of technique ex- 
 Anterior neck, muscles. 14 plained, 34 
 
 Axis, see vertebra, cervical ™ rks com P a «d, 46- 
 
 examination of, 40, 41 
 B 
 
 spinous processes, 41 
 42 
 
 t . transverse processes, 
 Bold-tace type explained, use 46-51 
 
 of 34 Articular, 41-44 
 
 Bones (see their names) illustrated, 40-55 
 
258 
 
 GENERAL INDEX 
 
 lesion traced from muscu- 
 lar, 54 
 treatment of muscles, an- 
 terior, 14, 70-73 
 lateral, 14, 75-77 
 posterior, 14, 78-81 
 combined vertebral and 
 
 muscular, 15, 83-86 
 of vetebra, 20, 21, 105-119 
 Combined muscular and bone 
 
 treatment, 83-86 
 Clavicle, 28, 170, 171 
 Colon, replacing transverse, 
 208 
 emptying, 217, 218 
 Common bile duct, emptying, 
 216 
 
 Dislocations of humerus (dia- 
 gramatical), 227 
 of hip (diagramatical); 242 
 
 DEGREE in technique ex- 
 plained, 34 
 DIRECT treatment of mus- 
 cles explained, 36 
 Muscles, treatment of 
 cervical, 15, 70-81 
 interscapular, 17, 92 
 upper dorsal, 17, 89 
 dorsal, middle and low- 
 er, 18, 94, 95 
 sacral, 19, 103 
 coccygeal, 19, 104 
 Vertebra 
 
 cervical, 20, 111-114 
 upper dorsal, 22, 125- 
 
 126 
 interscapular, 23, 136, 
 
 137 
 dorsal, middle and low- 
 er, 24, 144, 145 
 lumbar, 26, 27, 154-156 
 sacrun, 27, 163 
 coccyx, 28, 166 
 Ribs 
 
 first and second, 29, 
 172-174 
 
 typical, 31, 189-193 
 eleventh and twelfth, 
 32, 202. 203 
 
 E 
 
 Ear, removing wax, 221 
 Emptying viscera, 215-217 
 
 indicated, 204 
 Eye, relaxing tissues of or 
 bit, .120 
 stretching lids, 220 
 stimulating ciliary gang- 
 lion, 220 
 granulated lids of, 220 
 stys, 221 
 plrygium, 221 
 EXTREME treatment ot 
 muscles explained, 36 
 Muscles, treatment of 
 cervical (see combin- 
 ed), 16, 83-86 
 interscapular, 18, 93 
 dorsal, middle and low- 
 er, 19, 97-98, 102 
 lumbar, 19, 101, 102 
 V ertebra 
 
 cervical, 21, 116-119 
 upper dorsal, 22, 129- 
 
 132 
 interscapular, 23, 138 
 dorsal, midde and low- 
 er, 25, 147-151 
 lumbar, 27, 160 
 sacrum, 28, 164-165 
 coccyx, 28, 166 
 Ribs 
 
 interscapular, 29, 175- 
 
 177 
 typical, 32, 196-198 
 
 Femur (see hip), 241-250 
 
 Fibula, at knee, 251, 252 
 at ankle, 253 
 
 Flying wedge treatments ex- 
 plained, 37, 38 
 
 FLYING WEDGE TREAT- 
 MENTS (M.D.E.) 3, 19, 98 
 
GENERAL INDEX 
 
 259 
 
 (V. U. E.) 2, 22, 130 
 (V. U. E.) 2 modified, 
 
 22, 130 
 (V. I. E.) 1, 23, 138 
 (V, L E.) 2, 23, 138 
 (V. I. E.) 2 modified, 
 
 23 
 (V. D. E.) 1, 25, 147 
 (V. D. E.) 2, 25, 148 
 (V. D. E.) 3, 25, 149 
 (V. D. E.)' 4, 25, 149 
 (V. L. E.) 1, 2, 3, 4. 27, 
 
 160 
 (V. L. E-) 5, 27, 160 
 (V. S. E.) 3, 28, 165 
 (V. S. E.) 4, 28, 165 
 (R. I. E.) 3, 29, 176 
 (R. I. E.) 3 mod. 29, 
 
 177 
 (R. D. E.) 3, 32, 197 
 (I. P. D.) 4, 255 
 
 GENERAL treatment of 
 muscles explained, 
 35, 70 
 Muscles, treatment of 
 cervical, 15, 70-81 
 upper dorsal, 17, 88 
 interscapular, 17, 91 
 dorsal, middle and low- 
 er, 18, 93, 94 
 Vertebra 
 
 cervical, 20, 105,' 106 
 upper dorsal, 21, 121 
 interscapular, 23, 136 
 dorsal, middle and low- 
 er, 24, 139-142 
 lumbar, 26, 153 
 Ribs 
 
 typical, 30, 180-184 
 Genu-Pectoral posture, 206 
 
 H 
 
 HAND ONE and HAND 
 TWO explained, 35 
 
 Hip, the hip, 241-250 
 ancholosis, tests for, 241 
 diagramatic classification of 
 
 dislocations, 242 
 diagnosis, 243, 244 
 Humerus, treatment of, 12, 
 224,231 
 
 INDIRECT treatment of 
 muscles explained, 36 
 Muscles, treatment of 
 cervical, 15, 70-81 
 lumbar, 19, 99 
 Vertebra 
 
 cervical, 20, 107-109 
 upper dorsal, 21, 123, 
 
 124 
 dorsal, middle and low- 
 er, 23, 142 
 lumbar, 26, 153 
 sacrum, 27, 162 
 coccyx, 28, 166 
 Ribs 
 
 typical, 31, 187 
 Innominates, examination of, 
 68, 69 
 effect on surrounding struc- 
 tures, 69 
 Innominate treatments, 255, 
 
 256 
 Infra hyoia muscles, 79 
 
 Jaring pelvis in replacing, 
 uterus, 206 
 
 Jotting in flying wedge treat- 
 ments, 37, 38 
 
 K 
 
 Key to symbols, 1, 2, 3 
 explained, 4, 5 
 exceptions, 2, 3 
 explained, 5 
 Knee chest treatment, 206 
 Kidney, replacing, 208, 209 
 
 emptying, 215 
 Knee (see tifia and fibula.) 
 
 Lateral muscles of neck, 15, 
 75, 76 
 
260 
 
 GENERAL INDEX 
 
 Lateral stretching of mus- 
 cles (see muscular treat- 
 ment), 15, 19 
 springing of spine, 86, 108, 
 138 
 Lower limb, 13, 14, 237-254 
 general treatment (see 
 rules 1-5), 13, 237-240 
 
 M 
 
 Mechanical aids, 39 
 
 principles, used in adjust- 
 ment, 39 
 of osteopathic technique, 
 15, S3 
 Meta carpal bones, 236 
 
 tarsal (also see mea car- 
 pal), 254 
 Muscuiar treatment, 15, 19 
 Muscies, see general, tins in- 
 dex 
 indirect, this index, 
 direct, this index 
 extreme, this index 
 symbol, index, 7, 8 
 mechanical princip'es of 
 
 technique, 17-19 
 technique, 70-104 
 
 Naming of treatment, 33 
 Nature or class of treatment 
 explained, 35, 36, 37, 204- 
 224 
 Neck (see cervical) 
 
 differential diagnosis by 
 motion, 42 
 by restricted motion, 
 42 
 examination of, 41 
 Osteopathic landmarks of, 
 
 42-43 
 muscular treatment, 15, 16, 
 
 70-81 
 combined treatment, 16, 83- 
 
 86 
 vertebral treatment, 20, 21, 
 105-119 
 
 Nose, shaping babies, 222 
 loosening secretions. 222- 
 
 Overies, replacing, 212 
 p 
 
 Phalanges, 236 ■ 
 Uoes), 254 
 
 Postures, lying, setting, kneel- 
 ing, standing, 56, 57 
 gynecological, 204, 211 
 
 POoTURE of technique ex- 
 plained, 33 
 
 Posterior muscles of neck, 15,. 
 70-73 
 springing of neck, 85 
 of dorsal spine, 123, 132 
 
 POSITION of technique ex- 
 plained, 34 
 
 PRINCIPLE of technique 
 explained, 34 
 
 Radius, 12, 232-235 
 Rectum, emptying, 217 
 Replacing viscera, indicated, 
 
 204, 207-213 
 Ribs, angles of, 58, 59, 60, 61, 
 64 
 anterior end, 60, 61, 65 
 at mid aullary line, 58 
 at mammary line, 58 
 axis of rib lesions, 61 
 costro-condral line of diag- 
 nostic tenderness, 58 
 examination of first ribs, 62 
 typical ribs, 64 
 11th and 12th, 65, 66 
 extraordinary means of lo- 
 cating rib lesions, 66 
 key to lesions of, 60, 61 
 normal elevation at various 
 
 lines, 58 
 Osteopathic landmark of, 
 
 . 11, 58, 66 
 prominent borders of, 60 
 slant of, 58, 59, 67 
 
GENERAL INDEX 
 
 2'6l 
 
 tracing from ribs to spine, 
 60 
 spine to ribs, 58 
 typical luxated, 60 
 treatment 
 
 set: general, this index 
 
 indirect, this index 
 
 direct, this index 
 
 extreme, this index 
 
 symbol index,. 8 
 
 mechanical principles of 
 
 technique, 29-32 
 technique, 172-203 
 Rules for palliative limb 
 treatment, 13, 237, 240 
 
 Sterno mastoid, stretching of, 
 
 15, 75, 80 
 Scaleni muscles, stretching 
 
 of, 15, 75, 76 
 Side One and Side Two ex- 
 plained, 35 
 Separations of vertebra (see 
 
 Spreads), 121 
 Spreads, veterbal, 121 
 Spine, examination of, 52 
 general contour, 52 ' 
 Osteopathic landmarks 
 
 compared, 45, 55 
 spinous processes, 44- 
 
 55 
 transverse processes, 
 
 46-50 
 articular processes, 44- 
 
 50 
 illustrated, 40-55 
 ossens lesions, 52 
 tracing from bony to mus- 
 cular lesions, 54 
 muscular to bony les- 
 ions, 56 
 to rib lesions, 58 
 Sigmoid flexture, replacing, 
 
 208 
 Symbols, use of, 33 
 Symbol, key, 1, 2, 3 
 explained, 4, 5, 33 
 exception to key, 2, 3 
 
 explained, 5 
 index, pages A, B, C, D or 
 6, 7, 8, 9 
 limbs, 12, 13, 14 
 Swing treatments (Fern. F. 
 
 U. I.), I* 250 
 (M. I. D.) 3, 17, 151 
 (M. D. D.) 3, 18, 95 
 (M. D. E.) 4, 19, 102 
 (M. L. E.) 4, 19, 103 
 (V. U. E.) 3, 22, 131 
 (V. U. E.) 4, 22, 132 
 (V. D. D.) 3, 25, 145 
 (V. D. E.) 5, 25, 150 
 (V, D. E.) 5 modified, 25, 
 
 150 
 (V. D. E.) 6, 25, 151 
 (V. L, D.) 3, 26, 155 
 (V. L. D.) 4, 27, 156 
 (R. U. D.) 2, 29, 173 
 (R. I. E.) 2, 29, 176 
 (R. D. D.) 4, 31, 191 
 (R. D. E.) 2, 32, 196 
 (R. D. E.) 4, 32, 198 
 (R. V. U. Ant.) 2, 213 
 for high rectal enema, 
 
 213, 218 
 (Hum. S. E.) 2, 230 
 (Rad. E. E.) 1, 232 
 (Ulna, and Rad. W. G.) 
 
 1, 234 
 (Fern. B. U. D.) 1, 245, 
 
 247 
 f^em. B. D.) 1, 247 
 (Fem. B. U. I.) 1, 249 
 (Fern. F. U. I.) 1, 250 
 (T. A. D.) 4, 255 
 (I. P. E.) 1, 256 
 (I. A. E.) 1, 256 
 Stomach, emptying, 215 
 
 Tarsus, 254 
 Tibia at knee, 251 
 
 ankle, 253 
 Technique explained, sub-di- 
 visions of, 33 
 Thyso hyoid muscle, 15, 79 
 Tonsils, 223 
 
262 GENERAL INDEX 
 
 Trapesius, stretching of, 15, V 
 
 n\ , *.t. \ Vertebra, examination 
 
 Tumors (see new growth,), trea tment of 
 
 jj see general, this index 
 
 TT1na 12 232 235 indirect, this index 
 
 Ulna, 12 232, 235 di hig index 
 
 Use of technique explained, extrerne, this index 
 
 TTi , . . see symbol, index, 7, 8 
 
 Uterus, replacing in retro- mechanical principles of 
 
 . v f S10n : 21 ° 9 : q technique of, 20-28 
 
 in anteversion, 212, 213 technique, 105-166 
 
 emptying, 217 H ' 
 
 ..', 
 
 8 D 174 
 
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